What can be done in primary care settings to increase appropriate provider assessment of the need for oxygen and prescription of LTOT?
1. Does pulmonary rehabilitation (PR) reduce mortality risk? 2. Does PR in the post-hospitalization period reduce subsequent health care utilization? 3. Can the principles of PR be applied more broadly across the disease spectrum to reduce morbidity, mortality, and health care expenditures in patients with COPD? 4. Does early PR following hospitalization for acute exacerbation reduce mortality and readmission rates... more »
Early detection and treatment of COPD
a. Best tests to detect
b. Impact of early treatment
c. Impact of early treatment on disease progression
There are two broad issues that any future clinical trials in COPD need to seriously consider, that of the challenges of timely and efficient subject recruitment and the need to increase the participation of low to middle income countries that experience a disproportionate burden of COPD in evidence generation. My specific suggestions are as follows: 1) Address the optimal medical management of multiple physical and psychological... more »
There should be a study for prevention of Airflow Obstruction Progression. Rationale: All diseases have a prodrome followed by an early face of disease progression. Complex medical chronic diseases can only be slowed through the addition of several interventions all of which contribute to a final improvement of prognosis (witness CV diseases). Definition of “Early Disease”: Would be aimed at patients with airflow obstruction... more »
What is the impact of an organized, comprehensive, COPD patient education program, on medication delivery effectiveness, care plan adherence, appropriate use of LTOT and Pulmonary Rehabilitation? Metrics could include incidence and severity of exacerbations, and health care resource consumption.
Does palliative care and/or hospice care as practiced across communities improve end-of-life care for COPD – specifically, does it reduce the burden of symptoms, improve HRQoL and satisfaction, reduce utilization in last 6 months of life (i.e. hospital visits, cost, invasive ventilation use, etc), improve the end-of-life experience, and increase the concordance of place of death to expressed patient preferences?
What is the comparative effectiveness and cost effectiveness of counseling plus nicotine replacement vs. counseling plus bupropion vs. counseling plus varenicline on smoking cessation rates, patient-reported outcomes (symptom frequency, activities of daily living, quality of life, sleep quality, exacerbations), and COPD and non-COPD morbidity/mortality?
Challenge the unspoken of high cost, high risk and unclear benefits of current COPD care a. PRCT of lung transplantation vs. optimized medical care b. Noninvasive ventilation for treatment of chronic severe respiratory failure c. Chronic combined vs. de-escalation of chronic bronchodilator therapy to as needed for GOLD stages III-IV d. Self management programs in COPD e. Telemedicine in outpatient management of severe... more »
Chronic obstructive pulmonary disease (COPD) affects over 12-24 million individuals in the U.S. where it is responsible for ~ 800,000 hospitalizations per year, and recently became America’s 3rd leading cause of death. The lag between clinical practice and treatment options described by efficacy studies to improve the quality of life, functional status, and survival in patients with COPD make it ideal for efforts in patient-centered... more »
Many lung diseases (IPF, COPD) are characterized by marked heterogeneity at the tissue level. Unfortunately, most of the tools we currently employ to understand lung disease are unable to elucidate the mechanisms that result in regional heterogeneity. Clinical studies and animal models, while invaluable, generally assume that all lung tissue is similarly affected based on the presence or absence of diagnostic criteria... more »
How do we generalize our educational efforts such that multiple co-morbidities and their self-care can be addressed?
What barriers and facilitators modify the effectiveness of smoking cessation programs in patients with COPD?
How can we create precision diagnostics for COPD in practice settings that will help inform the transition from screening to better diagnosis and treatment strategies and that will help identify patients or communities at highest risk for unrecognized or over diagnosed COPD.