Many pharma companies are developing inhaled antibiotics for patients with bronchiectasis, recognizing the increasing market (over 110,000 patients in the US). These drugs cost thousands of dollars per year and will be heavily marketed and heavily used, as there are limited options for these patients. It is unknown if rotating oral antibiotics (cost is a fraction of the inhaled ABx) would yield similar results. A Cochrane... more »
Goal 3: Advance Translational Research
Can novel therapeutics including cell-based therapy be tested in patients with severe acute lung injury (P/F <200) and shock (need for vasopressors) since these are the patients with the highest mortality (> 30%) based on NHLBI ARDS Network data?
Can novel extracorporeal devices that remove carbon dioxide be tested to limit or avoid positive pressure ventilation in patients with acute respiratory failure from COPD?
Will adaptive trial design improve clinical research for acute lung injury?
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
a. Enhance our understanding of the behavioral issues that lead to smoking addiction
b. Explore effective behavioral and pharmacological and non-pharmacological mechanisms to reverse smoking addiction
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 »
Subjects with both COPD and asthma are typically excluded from clinical trials, but they represent an important segment of the chronic airflow obstruction population. Defining this combination diagnosis is difficult, but requiring a significant smoking history (e.g. 10 pack years), chronic airflow obstruction (GOLD stage 2 or greater after bronchodilator), age > 45, and childhood onset of asthma could identify the relevant... more »
Implementation of checklist to improve outcomes of COPD patients with acute exacerbations
• Does implementation of a checklist designed to improve the care of patients with COPD exacerbations result in greater adherence to guideline recommendations?
• Does implementation of a checklist designed to improve the care of patients with COPD exacerbations results in improved patient outcomes?
Integrated healthcare strategies during transitions in COPD care
• What is cost effectiveness of multi-component COPD programs?
• Will early admission to a Pulmonary Rehabilitation program following a hospitalization for COPD reduce the likelihood of readmission within the following year?
• What is the most effective time to implement the transition from hospitalization following a COPD exacerbation admission?
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 »
Considering the fact that Blacks bear a disproportionate degree of asthma morbidity and mortality, should treatment recommendations be different for Blacks vs. Caucasians?
Study patient-provider communication of asthma self-management requirements to see where gaps in communication may contribute to suboptimal self-management decisions. Examine patients’ decision-making in the home management of asymptomatic and acute. Compare different approaches to the delivery of asthma self-management education and best practices for supporting the patient as they gain competency in this area.
Systematically examine the contribution of unconventional beliefs and negative attitudes to inadequate clinical outcomes for asthma.
Budesonide/fomoterol controller/reliever therapy ('smart' therapy) in large US studies - adults