What is the most effective way to phenotype (classify) patients with respiratory failure requiring mechanical ventilation?
Goal 2: Reduce Human Disease
Ventilating patients in the operating room constitutes the largest number of patients exposed to mechanical ventilation in this country and world wide [many millions of patients]. Postoperative pulmonary problems may, in part, due to the mechanical ventilation received in the OR. Yet, this cohort has never been systematically studied in terms of the effect of specific ventilatory patterns on postoperative outcomes. Data... more »
How can we increase physical activity in our COPD patients?
Does a collaborative self management plan for COPD reduce or increase mortality risk? (based on two conflicting VA studies)
Tiotropium is widely used for COPD, but patients report highly variable responses to this medication. A clinical trial of severe COPD subjects could address both short-term (bronchodilator effect) and intermediate-term (COPD exacerbations) outcomes of this heterogeneous response by examining radiologic (chest CT), clinical (Six Minute Walk, Spirometry), and pharmacogenetic (GWAS) influences on this heterogeneous response.... more »
Alpha-1 antitrypsin augmentation therapy is widely used for PI ZZ subjects, but randomized clinical trials of AAT augmentation therapy have not been adequately powered to assess the efficacy of this treatment. A clinical trial using COPD exacerbation frequency as the primary outcome, rather than decline in lung function, in PI ZZ subjects with moderate-to-severe COPD could provide definitive evidence for the utility of... more »
Although severely alpha-1 antitrypsin deficiency (PI ZZ) individuals are rare, PI MZ subjects comprise approximately 3% of the US population. Mounting evidence suggests that PI MZ is a significant risk factor for COPD. A clinical trial of COPD exacerbation frequency using AAT augmentation therapy in PI MZ subjects with moderate-to-severe COPD could provide a rationale for AAT augmentation therapy (or small molecule neutrophil... more »
1. What is the comparative effectiveness of different approaches to implementing use of spirometry in primary care to confirm the diagnosis of COPD (e.g., increased reimbursements, use of EMRs and other tools) 2. What is the comparative effectiveness of using symptoms vs. spirometry in increasing patient and adherence to COPD treatment guidelines? 3. What is the comparative effectiveness of using a fixed FEV1/FVC ratio... more »
Management of COPD in the presence of comorbidity • Does a protocol-based screening for commonly occurring comorbid conditions in patients with COPD (eg. CAD, CHF, depression, sleep apnea) improve management and outcomes for patients with COPD? • How should providers coordinate management strategies and treatment goals in patients with COPD and other co-existing chronic diseases? • What is the comparative effectiveness... more »
Further development and clinical usefulness of COPD phenotypes
a. Linking phenotypes to clinically meaningful outcomes
b. Establishing treatment algorithms for different phenotypes
Incorporate important co-morbidities of COPD into treatment guidelines. This becomes crucially important with cardiovascular disease (CVD) which shares risk factors and pathogenesis
Disease modifying COPD therapy
a. Should we be starting therapy earlier in the course of disease?
b. Is there a survival benefit of oxygen therapy for exercise-induced hypoxemia?
a. Better tools for early recognition
b. More research in self-management and communications technology to assist patients
Define the pathobiology of the disorder (COPD)
a. Mechanisms of lung injury
b. Mechanisms of lung repair
c. Balance of lung and systemic pathobiologic manifestations and mechanisms
COPD hospitalizations a. Define the pathobiological changes that lead to severe exacerbations that cause hospitalizations b. Define novel clinical and biological phenotypic characterizations of hospitalized patients who fail treatment that results in death or early readmission c. Explore new or understudied therapies for treatment of acute COPD hospitalizations: antioxidant, non-steroidal anti-inflammatory (STATIN or... more »