By Kathey Leibold, RRT
MD Buyline Clinical Analyst
“Patients Take Center Stage” was the headline on the program at the recent American Association for Respiratory Care Congress in Indianapolis, and the theme of patient-centered care was reflected in sessions, lectures, and presentations over the four-day event.
With the introduction of the National Institutes of Health Chronic Obstructive Pulmonary Disease (COPD) National Action Plan earlier this year, there is an emphasis on the disease and on its patient-centered management.
The plan’s goals are to:
• Promote awareness and understanding of COPD;
• Improve prevention, diagnosis, treatment, and management of COPD;
• Increase collection, analysis, and sharing of data to track progress and drive change;
• Increase COPD research;
• Translate national policy, educational, and program recommendations into research and public health care actions.
Claire Wineland, a 20-year-old cystic fibrosis patient and advocate for those with chronic lung disease, delivered the keynote address. She spoke about how she works to inspire and empower patients to live fully every day. While advancements in science are important, she said, “How can the current health care system shift the focus to the patient?” She added that she wanted to be thought of as more than just a patient. As someone with a chronic disease, Claire noted that she seeks ongoing support to live the best life possible. She stressed that health care professionals should not fight against a disease, but rather fight for an improved life.
Grace Anne Dorney Koppel, current president of the COPD Foundation, addressed AARC attendees, patients, and caregivers at the third annual Respiratory Patient Advocacy Summit. The wife of broadcast journalist Ted Koppel, she was diagnosed with COPD in 2001.
Sharman Lamka, president and co-founder of The FACES (Family and Caregiver Education & Support) Foundation, presented awards to respiratory therapists working in chronic lung disease care. The FACES Foundation promotes professional excellence in the education and care of patients with pulmonary illnesses. The foundation honors the memory of Ms. Lamka’s husband, Philip C. Lamka, and his struggle with ILD, Interstitial Lung Disease.
Meilan Han, M.D., of the University of Michigan, presented “Challenges of COPD Care” at the fifth annual Thomas L. Petty Memorial Lecture. COPD is the third-leading cause of death and the fourth-leading cause of disability in the United States. Dr. Han shared that 16 million Americans are diagnosed with chronic lung disease, and the numbers are growing. “Over 50 percent of those suffering with pulmonary disease remain undiagnosed,” she noted. “COPD patients are younger, and more are women. The new face of COPD is a woman under the age of 65.”
Dr. Han added that challenges to care include low socioeconomic status, limited access to both acute and rehabilitative care, limited access to pharmaceutical therapies, and limited smoking cessation assistance. There are also barriers to the diagnosis of COPD. This disease is both underdiagnosed and misdiagnosed, with limited spirometry availability at the primary care level, and limited expertise for interpretation.How does this effect health care systems? Dr. Han answered that one million Americans with COPD are admitted to hospitals annually and 20 percent are readmitted within a month of discharge. As a result, COPD is now on Medicare’s radar. The NIH projects that costs for care of the COPD patient will reach $49 billion by 2020. Dr. Han reports that there is no continuum of care, citing poor coordination both inside and outside the hospital setting. Patients are discharged with limited education and support. She noted the need to increase funding for COPD research and to improve access to care.
Brian Walsh, current AARC president, shared with attendees that COPD must be addressed with accurate diagnosis, proper inpatient treatment, ongoing support, and long-term management. He stated that this should be important to hospitals across the country as it results in decreased admissions, improved outcomes, and a greater focus on patient care.
Walsh stressed the importance of early screening and diagnosis of COPD and predicted that the future of COPD care management is with telemedicine. He reminded attendees of three pending Congressional bills related to telemedicine: H.R. 2550, the Medicare Telehealth Parity Act; H.R. 2291, the Helping Expand Access to Rural Telemedicine (HEART) Act; and H.R. 766, Telehealth in Public Housing.
Vendors at this year’s AARC exhibit reflected support of the COPD patient with diagnostic and therapeutic systems for the inpatient as well as innovative products for home care therapies. Vyaire Health’s broad product line includes a range of complete pulmonary functions systems, portable spirometers for clinics and physician offices, units for pulmonary rehabilitation, handheld units for home care applications, and screening devices for smoking cessation programs.
MGC Diagnostics also offers a portfolio of products — from sophisticated pulmonary function systems to a portable, complete spirometry system. Both companies provide advanced software solutions to improve collection, review, and management of patient data.
Monaghan Medical showcased products for peak flow meters, airway clearance, and drug delivery. The Aerobika device offers OPEP (oscillating positive pressure expiratory pressure) to assist in airway clearance for those with chronic lung disease. The AeroEclipse product is a breath-actuated nebulizer for patients who require medication delivery. D R Burton Healthcare demonstrated the new iPEP® device, which combines both incentive spirometry and PEP (positive expiratory pressure).MIR, Vitalograph and ndd Medical Technologies showed their spirometer product lines for screening, diagnosis, and monitoring of patients with lung disease.
Airway clearance products, such as the CoughAssist T70 from Philips Healthcare, support the chronic patient. Philips demonstrated the InnoSpire nebulizer and the InnoSpire GO portable handheld unit, which is currently pending FDA approval.
Philips Healthcare and ResMed showcased their broad range of non-invasive ventilation (NIV) products. Breas Medical demonstrated its Z1 CPAP and Z1 Auto CPAP micro units. Recent studies have reported reduced acute exacerbations and decreased hospital admissions for COPD patients who use NIV.
High Frequency Chest Wall Oscillation (HFCWO) solutions include Hill-Rom’s popular Vest Airway Clearance System and the new portable Monarch unit, SmartVest’s Airway Clearance System, RespirTech’s inCourage system, and the AffloVest system. All of these devices support chronic care needs.
With a focus on the reduction of hospital readmissions and improved patient outcomes, hospitals will be looking at their programs associated with care of patients with chronic lung disease. Facilities will seek products and solutions to support this underserved patient population.
About the author: Kathey Leibold joined MD Buyline in 2002 with over 24 years of experience in respiratory care for the neonatal, pediatric, cardiac and neurocritical care units, with rotations through PACU and the emergency department. She worked at Methodist Hospital in Lubbock, Texas, for five years as a respiratory therapist with an emphasis in critical care before moving to Medical City Dallas Hospital. Throughout her career, she has also enjoyed the role of preceptor, providing clinical support to new employees and students.
In addition to the respiratory, pulmonary, and neurodiagnostic product categories, Leibold is responsible for infant care, pulse oximetry, capnography, tissue oximetry and transcutaneous monitoring products at MD Buyline.
Leibold received her degree in respiratory care from South Plains College. She is credentialed through the National Board for Respiratory Care as a registered respiratory therapist, and is licensed by the Texas Medical Board as a respiratory care practitioner. She is a member of the American Association of Respiratory Care.