How to "cure" a chronic, incurable disease - A potential giant step in saving the lives of many thousands of Americans, and potentially millions worldwide, who are afflicted with COPD, the third leading cause of death in the U.S. The financial effect of COPD in the United States alone is well over $50 billion per year. It is estimated that some 30 million Americans have COPD, which of course means that at least that... more »
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 »
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 »
What can be done in primary care settings to increase appropriate provider assessment of the need for oxygen and prescription of LTOT?
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 »
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?
COPD is a major health problem leading to 140,000 deaths in the United States. Treatments are supportive, but there is a compelling need for treatments that modify the progression of the disease and that prevent exacerbations. There needs to be a research infrastructure that unites basic, translational, and clinical researchers to develop new approaches. Although this challenge had been met in the past with the now... 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?
Specific biomarkers to monitor COPD disease activity are needed.
What barriers and facilitators modify the effectiveness of smoking cessation programs in patients with COPD?
What measures other than PFT data can be used to predict risk of 1) COPD exacerbations (e.g., hospitalization, urgent care visit, or ED visit for COPD exacerbation) or 2) relapse (e.g., re-hospitalization, urgent care visit, or ED visit) following hospital discharge after treatment of COPD exacerbations?
Is there a role for statins and/or ACE-inhibitor medications in patients with more mild COPD who do not present with acute exacerbations?
What are the biological, environmental, social and economic determinants of health in rural areas related to COPD and other lung disease.
What is the comparative effectiveness of prescribing continuous LTOT in COPD that targets fixed oxygen flow rates vs. oxygen saturation on patient-reported outcomes (symptom frequency, activities of daily living, quality of life, sleep quality, exacerbations)?