Management Of COPD Research Articles

Do we really target the receptors? Deposition and co-deposition of ICS-LABA fixed combination drugs

Fixed dose combinations of aerosolized bronchodilators and steroids are routinely used in current asthma and COPD management. As spatial distribution of their receptors within the human airways is different, it is a challenging task to deliver the right drug component to the right receptor. The aim of this work was to apply numerical methods to analyse the airway deposition distribution of two inhalation corticosteroid (ICS) – long-acting beta-agonist (LABA) combination drugs in comparison with the distribution of the corresponding receptors. Our results revealed that different combination drugs exhibit different co-deposition patterns depending on the aerodynamic properties of their components. While ICS and LABA components of Symbicort® Turbuhaler® had similar deposition efficiencies in the same airway generation throughout the whole respiratory tract, the steroid component of Relvar® Ellipta® had up to 25% higher deposition than its bronchodilator component in the large bronchi and up to 40% lower deposition in the deeper airways. Present results highlight the need for extensive research to elucidate whether each drug component should deposit according to its receptor distribution or similar deposition distribution patterns of the components should be attained to benefit from the synergistic effects documented in the open literature. Once this aspect clarified, the next step will be to tailor the aerodynamic properties of each component of combination drugs to yield the desired deposition distribution in the lungs.

Evaluation of a Digital COPD Education Program for Healthcare Professionals in Long-Term Care - A Mixed Methods Study.

BackgroundLack of routines and competence among healthcare professionals have been reported as barriers to COPD management in long-term care. Online education could be used as a strategy to make COPD education more accessible.PurposeThe aim of this study was to evaluate a digital COPD education program for healthcare professionals in long-term care regarding feasibility, knowledge and working procedures.MethodsA randomized controlled feasibility trial with a convergent mixed methods design was conducted. Two municipalities in Sweden were randomized to intervention (n=20) or control (n=17). The intervention was a digital COPD education program accessible for three months. Data was collected through questionnaires on COPD-specific knowledge, conceptual knowledge, feasibility and usage of the COPD Web platform. Repeated individual interviews using a semi-structured interview guide was also performed. Quantitative and qualitative findings were merged using a mixed methods design.ResultsThe digital COPD education program appears feasible based on the expressed satisfaction of the healthcare workers and their reports that it supported them in their work. Across questionnaires, objective COPD-specific knowledge increased by 14 to 16 percentage points in the intervention group compared to 0 to 6 percentage points in the control group (p=0.001). The objective increase in COPD-specific knowledge was also captured in the interviews, where a perceived increase in knowledge led to increased security and focus on COPD management. Few changes in working procedures were expressed, but participants felt that attention was raised regarding COPD and the importance of preventive healthcare services. In addition, increased knowledge of healthcare services provided by other involved professions was emphasized, leading to discussions with other professions in relation to COPD management.ConclusionA digital COPD education program is feasible and can increase the COPD-specific knowledge of healthcare professionals in long-term care, leading to increased focus on COPD-related issues. More comprehensive measures, including organizational changes, might be needed to change working procedures.

Evaluating the Feasibility and Pretesting the Impact of an Educational and Telemonitoring Program for COPD Patients in Lebanon.

PurposeThe objective of this study was to investigate the feasibility and pretest the effectiveness of an educational and telemonitoring program in a sample of Lebanese COPD patients to inform the design of a randomized study.Patients and MethodsThis study recruited a convenient sample of 15 patients from the pulmonology departments of four hospitals. Validated questionnaires were adapted to meet the context of this study in terms of adequacy, acceptability, adoption, fidelity, and cost. The impact of this program on quality of life and anxiety was measured by the COPD Assessment Test (CAT), the COPD Clinical Questionnaire (CCQ), and the Hospital Anxiety and Depression Scale (HADS). All measurements were performed before and after the intervention.ResultsAll 15 participants who agreed to participate in this intervention found the program adequate and acceptable for addressing COPD-related issues. Regarding adoption, all participants declared having no difficulty explaining to others the content of the education sessions and that they would suggest this program to other COPD patients. In terms of effectiveness, six patients had improving in quality of life scores, and five patients had lower anxiety and depression scores compared to baseline measures. A knowledge assessment was done at the end of each session, showing an increase in knowledge for all participants. Skills were also assessed at the end of the program. Participants made no errors that had an impact on their health. Regarding the cost, it was difficult to evaluate the relative cost of this intervention given the economic situation in the country.ConclusionThis study is the first to evaluate the application of telehealth to optimize COPD management in Lebanon. The approach proposed gave insights into the different obstacles and facilitating factors for implementing such a project to allow a large-scale work on the adaptation of the COPD patient to his disease in Lebanon.

Study to Find Out the Efficacy of 6 Minute Walk Test in Assessing Response to Medical Intervention in Chronic Obstructive Pulmonary Disease Patients

Background: The aim was to find out the correlation of 6 minute walk test (6MWT) with spirometry values, in patients who are on treatment for chronic obstructive pulmonary disease, also to study the efficacy of the 6 MWT in assessing response to medical intervention in patients suffering from COPD. This was undertaken with an objective to study whether 6 MWT can be recommended for a primary care setting in resource-constrained countries in effective management of COPD
 Methods: We included 50 patients with stable COPD attending the outpatient department in the stipulated study period and diagnosis of COPD was established by clinical symptoms and spirometric data of ratio of FEV 1 and forced vital capacity (FVC) ? 0.7. 
 Results: The 6 minute walk distance (6MWD) of the patients was assessed once the health status of the patients has been stabilized. This was done under strict monitoring, just before discharge of the patient from the hospital. Participants aged less than 60 years had a 6MWD of 342.13±19.36 m while those aged above 60 years clocked 286.36±20.13 m.
 Conclusions: 6MWT can be a useful replacement of spirometry in assessment of severity of COPD.
 Key words: Chronic obstructive pulmonary disease, six-minute walk test, spirometric indices, severity

An Integrated, Multimodal, Digital Health Solution for Chronic Obstructive Pulmonary Disease: Prospective Observational Pilot Study.

BackgroundChronic obstructive pulmonary disease (COPD) affects millions of Americans and has a high economic impact partially due to frequent emergency room visits and hospitalizations. Advances in digital health have made it possible to collect data remotely from multiple devices to assist in managing chronic diseases such as COPD.ObjectiveIn this pilot study, we evaluated the ability of patients with COPD to use the Wellinks mHealth platform to collect information from multiple modalities important to the management of COPD. We also assessed patient satisfaction and engagement with the platform.MethodsA single-site, observational, prospective pilot study (N=19) was conducted using the Wellinks platform in adults with COPD. All patients were aged over 30 years at screening, owned an iPhone, and were currently undergoing a treatment regimen that included nebulized therapy. Enrolled patients received a study kit consisting of the Flyp nebulizer, Smart One spirometer, the Nonin pulse oximeter, plus the Wellinks mHealth app, and training for all devices. For 8 weeks, participants were to enter daily symptoms and medication use manually; spirometry, nebulizer, and pulse oximeter data were automatically recorded. Data were sent to the attending physician in a monthly report. Patient satisfaction was measured via a 5-point scale and the Net Promoter Score (NPS) captured in interviews at the end of the observation period.ResultsAverage age of the patients was 79.6 (range 65-95) years. Participants (10 female; 9 male) had an average FEV1% (forced expiratory volume in 1 second as % of predicted for the patient) of 56.2% of predicted (range 23%-113%) and FEV1/forced vital capacity of 65%. COPD severity, as assessed by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification, was mild in 2 patients, moderate in 6, and severe/very severe in 11; 9 patients were on home oxygen. During this 8-week study, average use of the spirometer was 2.5 times/week, and the pulse oximeter 4.2 times/week. Medication use was manually documented 9.0 times/week, nebulizer use 1.9 times/week, and symptoms recorded 1.2 times/week on average. The correlation coefficients of home to office measurements for peak flow and FEV1 were high (r=0.94 and 0.96, respectively). Patients found the app valuable (13/16, 81%) and easy to use (15/16, 94%). The NPS was 59.ConclusionsThis study demonstrates that our cohort of patients with COPD engaged with the Wellinks mHealth platform avidly and consistently over the 8-week period, and that patient satisfaction was high, as indicated by the satisfaction survey and the NPS of 59. In this small, selected sample, patients were both willing to use the technology and capable of doing so successfully regardless of disease severity, age, or gender. The Wellinks mHealth platform was considered useful and valuable by patients, and can assist clinicians in improved, timely decision making for better COPD management.

A single inhaler triple therapy fluticasone furoate/umeclidinium/vilanterol for the treatment of COPD

ABSTRACT Introduction Single inhaler triple therapy (SITT) with an inhaled corticosteroid, a long-acting β2-agonist, and a long-acting muscarinic antagonist is an effective and attractive therapeutic option codified in the recommendations of guidelines and treatment strategies for the management of COPD. Areas covered The preclinical and clinical development in COPD of fluticasone furoate (FF)/umeclidinium (UMEC)/vilanterol (VI) SITT and its use in the real world. Expert opinion Findings from phase III/IV trials and the use of FF/UMEC/VI in the real-world setting support the view that it may be a useful, safe, and cost-effective option for the maintenance treatment of COPD, especially when dealing with patients who are not adequately controlled with dual ICS/LABA or LAMA/LABA therapy. Only direct head-to-head comparisons will be able to establish whether FF/UMEC/VI may be preferable to the other SITTs approved for COPD due to its pharmacokinetic and pharmacodynamic characteristics and especially the fact that it is the only one that can be taken once-daily. In addition, there is a need for further studies, especially in the real world, to optimize the positioning of FF/UMEC/VI in the treatment of COPD, also considering the availability of FF/VI and UMEC/VI and the need for better differentiation between the three treatments.

Efficacy and safety of modified Bushen Yiqi formulas (MBYF) as an add-on to formoterol and budesonide in the management of COPD: study protocol for a multicentre, double-blind, placebo-controlled, parallel-group, randomized clinical trial: FB-MBYF Trial

BackgroundInhaled glucocorticoid corticosteroid (ICS), long-acting β2-adrenoceptor agonist (LABA), and other drugs have limited therapeutic effects on COPD with significant individual differences. Traditional Chinese medicine (TCM)-modified Bushen Yiqi formula (MBYF) demonstrates advantages in COPD management in China. This study aims to evaluate the efficacy and safety of MBYF as an add-on to budesonide/formoterol in COPD patients and confirm the related genes affecting the therapeutic effect in the treatment of COPD.MethodsIn this multicentre, randomised, double-blind, placebo-controlled, parallel-group study, eligible patients with COPD will randomly receive a 360-day placebo or MBYF as an adjuvant to budesonide/formoterol in a 1:1 ratio and be followed up with every 2 months. The primary outcomes will be the frequency, times, and severity of acute exacerbation of COPD (AECOPD), COPD assessment test (CAT) score, and pulmonary function tests (PFTs). The secondary outcomes will include the modified Medical Research Council (mMRC) dyspnoea scale, 6-min walking test (6MWT), BODE index, quantitative scores of syndromes classified in TCM, inflammation indices, and hypothalamic-pituitary-adrenaline (HPA) axis function. We will also test the genotype to determine the relationship between drugs and efficacy. All the data will be recorded in case report forms (CRFs) and analysed by SPSS V.20.0.DiscussionA randomized clinical trial design to evaluate the efficacy and safety of MBYF in COPD is described. The results will provide evidence for the combination therapy of modern medicine and TCM medicine, and individual therapy for COPD.Trial registration.Trial registrationID: ChiCTR1900026124, Prospective registration.

Beyond the Lung: Geriatric Conditions Afflict Community-Dwelling Older Adults With Self-Reported Chronic Obstructive Pulmonary Disease.

RationaleChronic obstructive pulmonary disease (COPD) predominantly affects older adults. However, the co-morbid occurrence of geriatric conditions has been understudied.ObjectiveCharacterize the prevalence of geriatric conditions among community-dwelling U.S. older adults with self-reported COPD.MethodsWe conducted a nationally representative, cross-sectional study of 3,005 U.S. community-dwelling older adults (ages 57–85 years) from the National Social Life, Health, and Aging Project (NSHAP). We evaluated the prevalence of select geriatric conditions (multimorbidity, functional disability, impaired physical function, low physical activity, modified frailty assessment, falls, polypharmacy, and urinary incontinence) and psychosocial measures (frequency of socializing, sexual activity in the last year, loneliness, cognitive impairment, and depressive symptoms) among individuals with self-reported COPD as compared to those without. Using multivariate logistic and linear regressions, we investigated the relationships between COPD and these geriatric physical and psychosocial conditions.Main ResultsSelf-reported COPD prevalence was 10.7%, similar to previous epidemiological studies. Individuals with COPD had more multimorbidity [modified Charlson score 2.6 (SD 1.9) vs. 1.6 (SD 1.6)], more functional disability (58.1 vs. 29.6%; adjusted OR 3.1, 95% CI 2.3, 4.3), falls in the last year (28.4 vs. 20.8%; adjusted OR 1.4, 95% CI 1.01, 2.0), impaired physical function (75.8 vs. 56.6%; adjusted OR 2.1, 95% CI 1.1, 3.7), more frequently reported extreme low physical activity (18.7 vs. 8.1%; adjusted OR 2.3, 95% CI 1.5, 3.5) and higher frailty prevalence (16.0 vs. 2.7%; adjusted OR 6.3, 95% CI 3.0,13.0) than those without COPD. They experienced more severe polypharmacy (≥10 medications, 37.5 vs. 16.1%; adjusted OR 2.9, 95% CI 2.0, 4.2). They more frequently reported extreme social disengagement and were lonelier, but the association with social measures was eliminated when relationship status was accounted for, as those with COPD were less frequently partnered. They more frequently endorsed depressive symptoms (32.0 vs. 18.9%, adjusted OR 1.9, 95% CI 1.4, 2.7). There was no noted difference in cognitive impairment between the two populations.ConclusionsGeriatric conditions are common among community-dwelling older adults with self-reported COPD. A “beyond the lung” approach to COPD care should center on active management of geriatric conditions, potentially leading to improved COPD management, and quality of life.

An Investigation of the Factors Affecting Compliance when Using Home Non-invasive Ventilation Therapy

Abstract: Home non-invasive ventilation has become a well-established form of therapy over the last few decades. Many conditions benefit from home NIV, for instance, patients with motor neurone disease (MND) and chest wall deformities that lead to respiratory complications. Home NIV has been shown to increase survival and improve quality of life in many chest wall diseases and MND. There is also substantial evidence to indicate that NIV can palliate symptoms of Obesity Hypoventilation Syndrome (OHS). Also, Home NIV is a valuable tool in the management of patients with severe COPD and has been shown to reduce mortality and morbidity in patients with chronic respiratory failure. However, the usefulness of home NIV varies according to compliance. This review investigates the factors affecting compliance with home NIV. Compliance remains to be an incredibly complex matter. Yet, due to the importance of compliance and its effect on outcomes, investigating influencing variables is a priority.

Prioritising primary care respiratory research needs: results from the 2020 International Primary Care Respiratory Group (IPCRG) global e-Delphi exercise

Respiratory diseases remain a significant cause of global morbidity and mortality and primary care plays a central role in their prevention, diagnosis and management. An e-Delphi process was employed to identify and prioritise the current respiratory research needs of primary care health professionals worldwide. One hundred and twelve community-based physicians, nurses and other healthcare professionals from 27 high-, middle- and low-income countries suggested 608 initial research questions, reduced after evidence review by 27 academic experts to 176 questions covering diagnosis, management, monitoring, self-management and prognosis of asthma, COPD and other respiratory conditions (including infections, lung cancer, tobacco control, sleep apnoea). Forty-nine questions reached 80% consensus for importance. Cross-cutting themes identified were: a need for more effective training of primary care clinicians; evidence and guidelines specifically relevant to primary care, adaption for local and low-resource settings; empowerment of patients to improve self-management; and the role of the multidisciplinary healthcare team.

Chronic Obstructive Pulmonary Disease: A View on Comorbidity Phenotypes. A literature review

This review’s purpose is to summarize the current state of knowledge on the systemic implication of chronic pulmonary obstructive disease Background: The ‘systemic repercussions’ of COPD are of great importance. These include accidental weight loss, skeletal muscle dysfunction, and a higher risk of cardiovascular disease, osteoporosis, and depression. Frequently affecting the patient’s health and prognosis, these extrapulmonary COPD characteristics demand thorough screening and proper management to give the most effective medical care. Methods: We conducted a search of papers describing COPD as a systematic disease on the MEDLINE database. Discussion: Local and systemic inflammation, oxidative stress, and changes in the neuro-humoral states are some of the likely candidate pathways by which these extrapulmonary complications of COPD are affected, even though the mechanisms for the association of COPD with systemic disorders have not been fully clarified. The processes and mechanisms behind the extrapulmonary symptoms of COPD will likely become more transparent with further research. Conclusion: COPD management should be based on a clear understanding of COPD-related comorbidities and their impact on COPD itself.

Feasibility of Using Daily Home High-Flow Nasal Therapy in COPD Patients Following a Recent COPD Hospitalization.

High-flow nasal therapy (HFNT) has beneficial effects in patients hospitalized with acute hypoxemic respiratory failure. HFNT has not been extensively studied following hospitalization for an acute exacerbation of chronic obstructive pulmonary disease (AECOPD). We explored the feasibility of conducting a multicentered trial to evaluate the use of HFNT to increase the time to next moderate/ severe exacerbation in patients recently hospitalized for a COPD exacerbation. In this pilot study we measured the hours of home daily HFNT use, maximally tolerated flow rates and temperature, and side effects for a period of 90 days. Patients were enrolled in a 90-day, open-labeled pilot study of HFNT to determine the safety and feasibility of home use for daily outpatient COPD management. Patients ≥ 40 years of age with prior hospitalization within the past 12 weeks for an AECOPD were enrolled. COPD was the primary diagnosis in all patients. Thirty patients presented for HFNT titration. Two dropped out; 1 after receiving a lung transplant and the other was lost to follow-up. The remaining 28 patients completed 90 days of HFNT. None withdrew from HFNT due to intolerance. Use of HFNT averaged 6.8 (2.1) hours daily. Daily home HFNT for up to 3 months is feasible in COPD patients following hospitalization for AECOPD. Improvements observed in disease-specific quality of life, respiratory symptoms, and 6-minute walk distance suggest the need for a prospective multicenter controlled clinical trial.

Knowledge of Traditional Indian Medicinal Plants for the Management of COPD

Knowledge of Traditional Indian Medicinal Plants for the Management of COPD

Feasibility of a Novel Real-Time Provider Teaching Intervention in Acute Exacerbation of Chronic Obstructive Pulmonary Disease.

BackgroundIt is not known whether an intervention using real-time provider teaching in acute exacerbation of chronic obstructive pulmonary disease (AECOPD) improves provider knowledge and/or patient outcomes.ObjectiveTo pilot the combination of a novel, real-time provider teaching intervention delivered by subspecialists to Internal Medicine trainees with a traditional patient education and medication reconciliation (PEMR) intervention and to assess the impact of these interventions on provider knowledge regarding COPD and patient care.MethodsThis was a single-center, nonrandomized, quality-improvement study. Patients admitted with AECOPD were prospectively identified between June 19 and November 20, 2019. Patients with asthma, lung cancer, or interstitial lung disease were excluded. The primary care team received a novel intervention featuring in-person, real-time teaching, covering Global Initiative on Chronic Obstructive Lung Disease COPD groups and management, including pulmonary rehabilitation referral. Providers completed a knowledge assessment before and after their real-time teaching session. Provider knowledge scores before and after teaching were compared using McNemar’s test. Patients received a traditional PEMR intervention from a nurse practitioner and/or clinical pharmacist. A retrospective chart review was conducted for 50 historical control patients admitted with AECOPD to obtain preintervention rates of discharge on long-acting bronchodilators and referral to pulmonary rehabilitation. The proportions of patients discharged on long-acting bronchodilators and referred to pulmonary rehabilitation in the intervention group were compared with the preintervention historical control patients using chi-square testing.ResultsSeventy-one providers caring for patients with AECOPD received real-time teaching. Postintervention, there was significant improvement in knowledge scores pertaining to Global Initiative on Chronic Obstructive Lung Disease groups and exacerbation risk (81% correct vs. 43% on pretest; P < 0.001) and guideline-directed treatment (83% correct vs. 28% on pretest; P < 0.001). Out of 44 eligible patients, 75% (n = 33 patients) received the PEMR intervention. Ninety percent of patients (n = 40 patients) were discharged on any long-acting inhaler, similar to the group of preintervention control subjects. Pulmonary rehabilitation referrals were made for 50% of patients (n = 22 patients) compared with 6% of preintervention control subjects (n = 3 patients; P < 0.001).ConclusionIn this single-center quality-improvement study, the combination of a novel, real-time provider teaching intervention and a traditional PEMR intervention improved provider knowledge and was associated with increased referrals to pulmonary rehabilitation.

Integrated Disease Management for Chronic Obstructive Pulmonary Disease in Primary Care, from the Controlled Trial to Clinical Program: A Cohort Study.

PurposeIntegrated disease management (IDM) for COPD in primary care has been primarily investigated under clinical trial conditions. We previously published a randomized controlled trial (RCT) where the IDM intervention improved quality of life (QoL) and exacerbation-related outcomes. In this study, we assess the same IDM intervention in a real-world evaluation and identify patient characteristics associated with improved outcomes.MethodsThis historical cohort study included patients enrolled for 12 (±3 months) in the Best Care COPD IDM program. The main outcome was a ≥3 point improvement in COPD assessment test (CAT). Secondary outcomes were COPD exacerbations requiring antibiotics and/or prednisone, unscheduled physician visits, emergency department visits and hospitalizations.ResultsData for 571 patients (all patients) were included, 158 met the reference RCT eligibility (RCT matched). Improved QoL was observed in 43% (95% CI:38.9,47.2) of all patients, 47% (95% CI:39.5,55.6) of RCT matched vs 92% (95% CI:79.2,95.1) in the reference RCT intervention arm (n=72). Reductions (12 months IDM vs prior year) were observed in the proportion of patients experiencing exacerbation-related events (all patients): antibiotics/prednisone (−9.0%,95% CI:-13.9,-3.9); unscheduled physician (−33.1%,95% CI:-38.2,-27.9); emergency department (−9.6%,95% CI:-13.5,-5); and hospitalizations (−6.8%,95% CI:-10.0,-3.7). For the RCT matched group all reductions were comparable to the reference RCT intervention arm. The strongest predictors of improved QoL were baseline CAT, CAT≥20 vs CAT<10 (OR 15.6,95% CI:7.91,30.83), GOLD group B (OR 6.4,95% CI:3.42,11.85) and D (OR 5.64,95% CI:2.80,11.37) vs GOLD group A. Patients with prior antibiotic/prednisone use, FEV1 <30% predicted and GOLD group D were less likely to have no urgent health service utilization (OR 0.5,95% CI:0.30,0.68), (OR 0.2,95% CI:0.07,0.78) and (OR 0.3,95% CI:0.14,0.51), respectively.ConclusionBest Care COPD improved QoL and reduced exacerbation-related outcomes in a manner directionally similar to the RCT from which it emanated. Baseline QoL, exacerbation history, and GOLD category were identified as possible predictors of IDM impact and will inform future program development and resource allocation.

Feasibility of RESP-FIT: Technology-Enhanced Self-Management Intervention for Adults with COPD.

IntroductionChronic obstructive pulmonary disease (COPD) is associated with substantial functional morbidity, including activity-limiting symptoms such as dyspnea and fatigue. Self-management interventions aid in symptomatic management of COPD and have been shown to produce positive outcomes on quality of life (QOL) and reduce hospital admissions.PurposeThe purpose of this randomized controlled longitudinal pilot study was to assess feasibility of the combined Respiratory Fitness (RESP-FIT) + Smartphone Airway Management System (SAMS) program, a 6-week, self-management, technology-enhanced respiratory muscle strength training (RMST) mHealth intervention.Patients and MethodsFeasibility was assessed by evaluating recruitment, retention, acceptability, adherence, and safety data. Data were collected from 30 participants (15 in intervention group, 15 in control) at 3 time points (baseline, 6 weeks, and 14 weeks). The intervention group was requested to perform RMST at regular intervals during the week (5 breaths, 5 times a day, 5 days a week). Bluetooth enabled tracking was used to track training sessions. Data were analyzed using descriptive statistics.ResultsRecruitment was staggered for device usage and was completed in 57 weeks, with near 90% retention from baseline to end-of-intervention. Mobile application rating scale scores and interview data indicated moderate satisfaction. Participants completed 14,388 actions in the app. The most commonly used features were recording of daily symptoms via ecological momentary assessment (EMA) and tracking RMST if assigned to training sessions. Training days were successfully captured using EMA, but Bluetooth enabled training tracking was found to be not feasible. Overall, participants reported satisfaction with the RESP-FIT + SAMS mHealth intervention and found it acceptable.ConclusionRESP-FIT is feasible and enables real-time COPD symptom assessment in the home environment, but additional work is needed to integrate Bluetooth technology into the platform. Ongoing investigations focus on the accuracy of symptom perception, self-efficacy, and momentary factors that impact adherence behaviors.

P7‐66: Clinical inertia in the management of COPD: A review of the literature

P7‐66: Clinical inertia in the management of COPD: A review of the literature

Overcoming Therapeutic Inertia to Reduce the Risk of COPD Exacerbations: Four Action Points for Healthcare Professionals.

BackgroundTherapeutic inertia, defined as failure to escalate or initiate adequate therapy when treatment goals are not met, contributes to poor management of COPD exacerbations.MethodsA multidisciplinary panel of five expert clinicians actively managing COPD and representative of UK practice developed action points to reduce exacerbation risk, based on evidence, clinical expertise, and experience. The action points are applicable despite changing circumstances (eg, virtual clinics). The panel agreed areas where further evidence is needed.ResultsThe four action points were (1) an experienced HCP, such as a GP or member of the multi-professional COPD team should review patients within one month of every exacerbation that requires oral steroids, antibiotics, or hospitalization to address modifiable risk factors, optimize non-pharmacological measures, and evaluate pharmacological therapy. (2) Presenting to hospital with an exacerbation defines an important window of opportunity to reduce the risk of further exacerbations. Follow-up by a GP, or member of the multi-professional specialist COPD team within one month of discharge with a full management review and appropriate escalation of pharmacological treatment is essential. (3) Healthcare professionals (HCPs) in all healthcare settings should be able to recognize COPD exacerbations, refer as appropriate and document the episode accurately in medical records across service boundaries. HCPs should support patients to recognize and report exacerbations. (4) HCPs should intervene proactively based on risk assessments, disease activity and any treatable traits at or as soon as possible after diagnosis and annually thereafter. Delivering these action points needs coordinated action with policymakers, funders, and service providers.ConclusionThese action points should be a fundamental part of clinical practice to determine if a change in management is necessary to reduce the risk of exacerbations. Policymakers should use these action points to develop systems and initiatives that reduce the risk of further exacerbations.

Relevance of Symptom Variability for Control and Management of COPD

Relevance of Symptom Variability for Control and Management of COPD

USING CAT SCORES AND RESPIRATORY INFECTION HISTORY TO UNCOVER THERAPUTIC GAPS IN CARE FOR COPD PATIENTS WITH PERSISTANT AIRWAY CLEARENCE NEEDS

TOPIC: Respiratory Care TYPE: Original Investigations PURPOSE: By analyizing gross score and individual question scores within CAT, as well as changes in scores, better targeted COPD interventions an be identified. METHODS: General: 9,091 home based COPD patients were managed over the course of their disease from January 2018 to May 2021 using a goal based, assessment driven COPD Software [Nexus, Encore Healthcare, Livingston TN], administered by a respiratory therapist via in home or telemed visits. The patients accessed the program as part of a prescription for Non Invasive Ventilation from their HME provider. The program deploys objective & subjective assessments to populate an individualized plan of care with a risk/acuity based schedule of visits and goals. The 9,091 patients have received over 278,000 assessments and analytics from the database have processed over 10 million datapoints.Detailed: Patient symptoms were measured using the COPD Assessemnt Test (CAT) at initial visit and regular intervals. The test entails 8 questions with answers scaled from 0-5, (5 = most severe impact). The questions were grouped into 3 domains: airway clearance symptoms (Cough, Phelgm, Chest tightness), activitiy (Walking, Activities, Going out), and pre-hypercapnea (sleep, energy). The Software sorted total scores over 20, or specifc symptom answers >=4, and the patients received focused discussion & education from the RT on each visit. The patient scores were also indexed to history of Respiratory Infections, Hospitalizations for COPD, GOLD Staging and Grouping. RESULTS: Of the 1905 (42%) patients with a reported history of respiratory infections and multiple CAT assessments, 16% scored a 4 or 5 symptom impairment on any of the 3 airway clearance questions. Screening COPD patients for both history of respiratory infection and CAT airway clearance issues revealed that 16% of the patients with a history of infections also had significant airway clearances issues as evidenced by the CAT assessment. CONCLUSIONS: Home based COPD management programs led by respiratory therapists using a protocol based software with plan of care goals, can alert physicians and assist patients in targeting specific therapies to improve symptom management. By combining respiratory infection history with specific CAT questions relating to airway clearance, patients can be identified for more targeted therapies. CLINICAL IMPLICATIONS: Understanding prior hospitalizations, current risk factors, and selecting HME providers with post discharge and home based care management programs can support physician and patient outcomes. This demonstrates the opportunity for greater collaboration between physicians, discharge programs and Home Medical Equipment providers to significantly improve COPD management. DISCLOSURES: Owner/Founder relationship with Encore Healthcare, LLC Please note: 1/1/2016 - 4/30/2021 Added 04/29/2021 by Zach Gantt, source=Web Response, value=Salary No relevant relationships by Frederic Seifer, source=Web Response