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Chronic Obstructive Pulmonary Disease Resources
Chronic obstructive pulmonary disease (COPD) is a term used to describe two respiratory illnesses-chronic bronchitis and/or emphysema. More than 16 million Americans have this disease, which primarily results from smoking tobacco. It is considered the fourth leading cause of death in the United States and is projected to rise to number three in 2020. In 2000, the annual cost to the nation for COPD was estimated to be approximately $30.4 billion. Symptoms of the disease are not noticeable for several years and usually do not surface until a person is in his/her 40s. Early signs of the disease include a chronic cough and increased mucus production.
COPD and asthma have similar characteristics, including coughing and wheezing, but they are two distinct conditions in terms of disease onset and frequency of symptoms. COPD often is misdiagnosed, and the person is treated as having asthma. A survey of 75 primary care physicians revealed they prescribe similar medications for COPD and asthma, even though appropriate treatments differ.
According to the National Lung Health Education Program, symptoms of COPD are related to airway obstruction resulting in the lungs' inability to use oxygen effectively and remove carbon dioxide. Physicians can diagnosis COPD with the assistance of a spirometer, which also can be used to monitor the progression of COPD.
The main objectives in treating COPD include slowing the decline in lung functioning; relieving symptoms, such as shortness of breath and cough; improving daily lung function; decreasing exacerbations; and improving the quality of life. There have been several guidelines published for the treatment of COPD, including the recommendation of beginning treatment with aerosol bronchodilators. Antibiotics are useful in treating exacerbations caused by bacterial infections. There currently are no medications available to cure the disease or reverse the loss of lung function caused by smoking.
Want more information on COPD and other respiratory issues? Log on to http://www.aarc.org/patient_education/. Scroll down the page to Respiratory Health Tips. Located under this section are several links that will provide you with information regarding COPD, cystic fibrosis, sleep apnea, dealing with allergies, and much more. The site also has 12 intelligence quotient (IQ) tests to test your knowledge of respiratory health issues. After taking each test, the user can submit his/her response and receive a score. Along with each answer is the rationale of why the statement was true or false.
Source: American Association for Respiratory Care (AARC), Irving, Texas.
Alternative Hospital-at-Home Care for Elderly Proven Feasible
In a report recently released in the Annals of Internal Medicine, the results of a study conducted concluded that the hospital-at-home care model is feasible, safe, and efficacious for certain older patients with selected acute medical illnesses who require acute hospital-level care. The objective of the 22-month study was to assess the clinical feasibility and efficacy of providing acute hospital-level care in a patient's home in a hospital-at-home setting.
The participants included 455 community-dwelling elderly patients (65 years and older) who required admission to an acute care hospital for community-acquired pneumonia, exacerbation of chronic heart failure, exacerbation of COPD, or cellulitis. The inpatient acute care settings included three Medicare-managed health systems at two sites and a Veterans Administration medical center. Treatment of these patients was provided in a hospital-at-home model of care that substituted treatment that would normally have been provided in an acute care hospital.
The pilot study's targeted outcome was to evaluate the safety, clinical and functional outcomes, patient and caregiver satisfaction, and the cost of providing acute hospital level care at home in lieu of an inpatient stay in an acute care facility.
During two consecutive 11-month phases, patients were initially identified the morning after admission to acute care and followed throughout their inpatient stay in the observation phase. The second phase consisted of the intervention phase, in which patients were identified in the emergency room and offered the option of receiving their care in a hospital-at-home, rather than being admitted to the facility.
Those consenting to the at-home care signed an informed consent, and they were transported home by an ambulance. Evaluation by a physician was done before transporting home or shortly after arriving at home. A hospital-at-home nurse met the ambulance at the patient's home, and one-on-one nursing supervision was provided for an initial period of at least 8 to 24 hours, depending upon the need. Intermittent nursing care was provided at least daily after direct nursing care was no longer required. Daily home visits were conducted by the hospital-at-home physician, and such physicians were available on a 24-hour basis for emergent visits. Durable medical equipment, oxygen therapy, skilled therapies, and pharmacy support were provided by a Medicare-certified home health agency. Other support services were provided by independent contractors as necessary. Illness-specific, hospital-at-home care maps, clinical outcome evaluations, and specific discharge criteria were developed and provided a pathway for care. The hospital-at-home physician followed up the patient until the patient was stable and discharged, and then care reverted to the primary care physician.
In two of the three sites, 69% of the patients chose hospital-at-home care, and 29% chose care at home at the other facility. The hospital-at-home care was less procedurally oriented than an inpatient stay but met quality standards of care similar to those of acute care. A shorter length of stay was demonstrated in the hospital-at-home, with 3.2 days versus 4.9 days, and there was evidence of fewer complications in the hospital-at-home model.
The authors acknowledge the need for continued research in this area, and results conclude hospital-at-home care is feasible. Reprints of this article are available from Bruce Leff, MD, Johns Hopkins Bayview Medical Center, The Johns Hopkins Care Center, John R. Burton Pavilion, 5505 Hopkins Bayview Circle, Baltimore, MD 21224; e-mail: [email protected]; http://www.hospitalathome.org.
REFERENCE
1.Leff, B., Burton L., Mader S., Naughton, B., Burl, J., Inouye, S., et al. (2005). Hospital at home: Feasibility and outcomes of a program to provide hospital-level care at home for acutely ill older patients. Annals of Internal Medicine, 143, 798-808.
Resource Tip
Looking for a great resource for your falls prevention program? The National Council on The Aging has an excellent site for resources on preventing falls along with other great resources. Log on to http://www.healthyagingprograms.com/content.asp?sectionid=69 to access a copy of their inaugural issue. The site provides an extensive collection of resources, including tool kits, research, and examples of model programs, Web sites, and much more.
The second issue of Falls Free E-Newsletter reports news from the American Geriatrics Society regarding a collaborative effort to update the current Guideline for the Prevention of Falls in Older Persons. According to the report, the updated version is scheduled for publication in the May 2006 issue of the Journal of the American Geriatrics Society and will be available on the American Geriatrics Web site at http://www.americangeriatrics.org/.
Included with the update is a recommendation that physical therapy be included in treatment, in order to help address balance, gait, mobility, and safety deficits.
Access a four-page listing of recommended resources and Web sites focusing on fall prevention at http://www.healthyagingprograms.com/content.asp?sectionid=98. This list contains links to Safe Steps Program Materials, including an instructional video, educational wall poster, and activities that help track medications, exercise, and assess overall home safety. A director's guide that includes a home modification checklist and a medication tracker also is available.
The Falls Free E-Newsletter includes information and a link to a Clinical Reference Card on Medications that Contribute to Falls. This reference card was created by the American Society of Consulting Pharmacists and lists more than 130 medications commonly used in the geriatric settings.
The Falls Free Coalition is a group of national organizations and state coalitions working to reduce the growing number of falls and fall-related injuries among older adults. The newsletter is produced by the National Council on The Aging's Center for Healthy Aging and with support from the Archstone Foundation and Home Safety Council. Upcoming newsletters will be posted on the Center's Web site (http://www.healthyagingprograms.org).
FDA Issues Public Health Advisory
The Food and Drug Administration (FDA) has requested manufacturers of Advair Diskus, Foradil Aerolizer, and Serevent Diskus to update their product labels with new warnings to alert the public. These products contain medicines belonging to the long-acting beta 2-adreneric agonists (LABA). According to the FDA, these products may increase the chance of severe asthma episodes and death when those episodes occur. In one asthma medicine study, an increased number of people taking a LABA in addition to their usual asthma care died of their asthma compared with people taking a placebo in addition to their usual asthma care, although the number of asthma deaths in the study was small. Bronchodilator medications help to relax the muscles around the airways in the lungs. Wheezing happens when the muscles around the airways tighten.
The FDA issued the following recommendations regarding the use of these bronchodilators in asthma treatment:
* LABAs should not be the first medicine used to treat asthma. LABAs should be added to the asthma treatment plan only when other medications do not control asthma, including the use of low- or medium-dose corticosteroids.
* Don't stop using your LABA or other asthma medicines until you have discussed with your healthcare provider whether or not to continue treatment.
* Don't use your LABA to treat wheezing that is getting worse. Call your healthcare professional immediately if wheezing worsens while using a LABA.
* LABAs do not relieve sudden wheezing. Always have a short-acting bronchodilator medicine with you to treat sudden wheezing.
The new warnings are about LABA use for asthma. Information is not available regarding similar concerns when LABA is used for exercise-induced wheezing or COPD.
This information is available at http://www.fda.gov/cder/drug/advisory/LABA.htm.
You can subscribe to MedWatch and receive information on drugs and other medical products by logging onto MedWatch at http://www.fda.gov/medwatch.
The FDA is responsible for ensuring that foods are safe, wholesome, and correctly labeled. It also oversees medicines, medical devices (from bandages to artificial hearts), blood products, vaccines, cosmetics, veterinary drugs, animal feed, and electronic products that emit radiation (such as microwave ovens and video monitors), ensuring that these products are safe and effective.
Accreditation News
The Accreditation Commission for Health Care, Inc. (ACHC) announced that the Centers for Medicare and Medicaid (CMS) has approved ACHC for recognition as a national accreditation program for home health agencies seeking to participate in the Medicare or Medicaid programs. The date of this final notice is effective February 24, 2006 through February 24, 2009. Section 1865 (b) (1) of the Social Security Act states that if a provider entity demonstrates through accreditation by an approved national accreditation organization that all applicable Medicare conditions are met or exceeded, CMS would "deem" those provider entities as having met the requirements. Details of the review of the ACHC application are available on the Federal Register: February 24, 2006 (Volume 71, Number 37).
ACHC will be applying for additional recognition of its hospice program in the spring and similar recognition for its home medical equipment program later in the year. Tom Cesar, President of ACHC, commented, "This is our 20th year of service, what a great way to begin celebrating our anniversary." Sources: [email protected]; http://www.achc.org
What Is a Respiratory Therapist?
Americans with breathing problems include people with chronic lung problems, such as asthma, bronchitis, and emphysema. In addition, people who have experienced heart attacks, accident victims, premature infants, those with cystic fibrosis, lung cancer, and AIDS can also have breathing disorders. A respiratory therapist under the direction of a physician can work with patients to provide respiratory care. There are approximately 100,000 respiratory therapists in the United States, according to the American Association of Respiratory Care (AARC). The respiratory therapist is a vital part of the healthcare team and of the more than 7,000 hospitals in the country, approximately 5,700 have separate respiratory care departments. Many therapists are now working in skilled nursing facilities, home health agencies, and medical equipment supply companies. There is also a growing awareness of the importance of respiratory therapy in hospice. The need for respiratory care professionals is expected to grow in the future because of the increase in the elderly population.
Activities of the respiratory therapist include measuring the capacity of a patient's lungs to determine if there is impaired functioning, performing stress tests and other studies of the cardiopulmonary system, and obtaining and analyzing sputum and breath specimens. Treatment offered by the respiratory therapist includes, but is not limited to, monitoring and managing therapy that will help a patient recover lung function and monitoring equipment and patient responses to therapy.
Education and training in respiratory therapy consists of two levels: the certified respiratory therapist and the registered respiratory therapist. A 2-year associate's degree or 4-year baccalaureate degree is required. After graduation, they are eligible to take a national voluntary examination and, upon passing, can obtain the credential Certified Respiratory Therapist (CRT). More than 400 community colleges and universities nationwide offer respiratory care programs.
As of November 2005, Medicare confirmed respiratory therapy as a hospice benefit. The AARC questioned the Centers for Medicare and Medicaid (CMS) if respiratory therapy, when part of a hospice patient's plan of care, is a Medicare-covered hospice service? The response from CMS stated, "Respiratory therapy would be a covered hospice service if the hospice decides its patient requires the service. Provision of the service would be paid for out of the hospice daily rate made to the hospice" (http://www.aarc.org/headlines/rt_hospice.cfm).
Available for download and printing, on the AARC Web site are clinical practice guidelines for respiratory therapy protocols. To locate these guidelines, log on to their Web site listed below and scroll down the left hand side of the screen and click on "Resources" and then "Clinical Practice Guidelines."
If you want to learn more about the importance of respiratory therapy, log on to their site at http://www.aarc.org or contact them at American Association for Respiratory Care at 11030 Ables Lane, Dallas, TX 75229-4593.