Chronic Obstructive Pulmonary Diseases:Journal of the COPD Foundation

Volume 3, Issue 1 - 2016

Chronic Obstructive Pulmonary Diseases: Journal of the COPD Foundation is an open access, peer-reviewed medical/scientific journal dedicated to publishing original research, reviews, and communications related to COPD. Articles are published online as quickly as possible following peer review and editorial acceptance and then aggregated into quarterly issues, and made available to the COPD medical/research community at no charge.

Editorial:

Long-Term Noninvasive Ventilation in COPD: Is High-Intensity NIV The Way To Go?

Marieke L. Duiverman, MD, PhD1 Peter J. Wijkstra, MD, PhD1

Author Affiliations

  1. Department of Pulmonary Diseases, University Medical Center Groningen, University of Groningen, the Netherlands

Address correspondence to:

M.L.Duiverman, MD, PhD
University Medical Center Groningen
P.O.Box 30.001
9700 RB Groningen
The Netherlands
Phone: +31503613200
E-mail: m.l.duiverman@umcg.nl

Abstract

This article does not contain an abstract.

Citation

Citation: Duiverman ML, Wijkstra PJ. Editorial. Long-term noninvasive ventilation in COPD: is high-intensity NIV the way to go? Chronic Obstr Pulm Dis (Miami). 2016; 3(1): 378-381. doi: http://dx.doi.org/10.15326/jcopdf.3.1.2015.0179

Keywords

There are no keywords for this article.

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Perspective:

MicroRNAs as Therapeutic Targets in Lung Disease: Prospects and Challenges

Tadashi Sato, MD, PhD1 Hario Baskoro, MD1 Stephen I. Rennard, MD2,3 Kuniaki Seyama, MD, PhD1 Kazuhisa Takahashi, MD, PhD1

Author Affiliations

  1. Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
  2. Pulmonary, Critical Care, Sleep and Allergy Medicine, Department of Internal Medicine, University of Nebraska Medical Center, Omaha
  3. Clinical Discovery Unit, AstraZeneca, Cambridge, United Kingdom

Address correspondence to:

Tadashi Sato, MD, PhD
Phone: 81-3-5802-1063
Fax: 81-3-5802-1617
E-mail: satotada@juntendo.ac.jp

Abstract

MicroRNAs (miRNAs) are small non-coding RNAs that regulate multiple target genes providing fine-tuned coordinated expression. Growing evidence suggests that miRNAs play important roles in lung development and the pathogenesis of lung disease and that they have great potential as novel therapeutic targets for the treatment of diseases such as lung cancer, asthma, pulmonary fibrosis, and chronic obstructive pulmonary disease (COPD). We have previously shown that miR-146a is a promising therapeutic target for controlling abnormal inflammatory response in COPD through a series of in vitro experiments in lung fibroblasts. However, further investigations in in vivo experimental models are needed to explore the role of miR-146a in the pathogenesis and therapy of COPD. Recently, miRNAs encapsulated in extracellular vesicles (EVs) have been recognized as modulators of intercellular communication. EVs, therefore, may also have therapeutic potential and show promise for use as biomarkers for various lung diseases. In addition to miRNAs, we briefly discuss a specific long non-coding RNA (lncRNA) that may contribute to the pathogenesis of COPD. The application of miRNA-based therapeutics faces several challenges related to mode of delivery, stability, and tissue specificity. However, recent advances in nanotechnology are expected to prove valuable for the development of miRNA-based therapeutics to treat lung disease.

Citation

Citation: Sato T, Baskoro H, Rennard SI, Seyama K, Takahashi K. MicroRNAs as therapeutic targets in lung disease: Prospects and challenges. Chronic Obstr Pulm Dis (Miami). 2016; 3(1): 382-388. doi: http://dx.doi.org/10.15326/jcopdf.3.1.2015.0160

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Original Research:

Effect of Megestrol Acetate and Testosterone on Body Composition and Hormonal Responses in COPD Cachexia

Richard Casaburi, PhD, MD1 Junko Nakata, MD1 Lawrence Bistrong, MD1 Edwardo Torres, MD1 Mehdi Rambod, MD1,2 Janos Porszasz, MD, PhD1

Author Affiliations

  1. Rehabilitation Clinical Trials Center, Los Angeles Biomedical Research Institute at Harbor-University of California, Los Angeles Medical Center, Torrance
  2. Division of Cardiology, University of Vermont College of Medicine, Burlington

Address correspondence to:

Richard Casaburi, PhD, MD
Rehabilitation Clinical Trials Center
Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center
1124 W Carson Street, Torrance, CA 90502
Tel: (310) 222-8200
Fax: (310) 222-8249
E-mail: casaburi@ucla.edu

Abstract

Background: Underweight chronic obstructive pulmonary disease (COPD) patients with involuntary weight loss have a poor prognosis; no effective therapy is currently available. We conducted the first clinical trial seeking to determine whether combination therapy with an appetite stimulant and an anabolic steroid would have beneficial effects on body composition for patients with COPD cachexia.

Methods: We conducted a 12–week pilot study in which 4 men and 5 women (age 64±10 y, forced expiratory volume in 1 second [FEV1] 31±9 %pred., body mass index [BMI] 18±3 kg/m2) with low-normal testosterone levels (average 532±45ng/dl in men and 12.4±5.3ng/dl in women) and weight loss ≥10 lbs over the previous year were treated with oral megestrol acetate 800mg/day plus weekly testosterone enanthate injections, initially 125 mg in men and 40 mg in women, with doses subsequently adjusted targeting circulating nadir testosterone levels of 850 and 300 ng/dl, respectively.

Results: On treatment, nadir testosterone level increases averaged 160±250 ng/dl (NS) in men and 322±49 (p<0.001) ng/dl in women. Body weight increased in all individuals, with average end-intervention weight gain of 3.1±2.2 kg (p<0.005). Two women and 2 men had COPD exacerbations and did not complete the 12-week study. In the 5 individuals who completed, dual energy x ray absorptiometry (DEXA) scans revealed an average 2.0±1.5 kg lean mass and 2.3±1.7 kg fat mass increase (each p<0.05). No adverse effects of treatment were detected.

Conclusions: Combination therapy reversed the trajectory of involuntary weight loss and increased lean mass in cachectic COPD patients. Though the interventions were apparently well tolerated, participant drop-out rate was high. Larger randomized placebo-controlled long-term studies with functional outcomes are needed.

Citation

Citation: Casaburi R, Nakata J, Bistrong L, Torres E, Rambod M, Porszasz J. Effect of megestrol acetate and testosterone on body composition and hormonal responses in COPD cachexia. Chronic Obstr Pulm Dis (Miami). 2016; 3(1): 389-397. doi: http://dx.doi.org/10.15326/jcopdf.3.1.2015.0128

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Daily Peak Expiratory Flow Rate and Disease Instability in Chronic Obstructive Pulmonary Disease

Jennifer Y. So, MD1 Alejandra C. Lastra, MD1 Huaqing Zhao, PhD1 Nathaniel Marchetti, DO1 Gerard J. Criner, MD1

Author Affiliations

  1. Division of Pulmonary and Critical Care Medicine, Temple University Hospital, Philadelphia, Pennsylvania

Address correspondence to:

Jennifer Y. So, MD
3401 N Broad St. 7th Floor
Philadelphia, PA, 19140-5189
phone:267-746-0516
Email:Jennso17@gmail.com

Abstract

Rationale: Chronic obstructive pulmonary disease, (COPD) is a major cause of morbidity and mortality in the United States. Peak expiratory flow rate (PEFR) monitoring could provide a daily objective measurement of lung function in COPD patients at home. We hypothesized that individuals with greater variability in daily PEFR would signal an unstable patient population with worse outcomes.

Methods: This was a retrospective analysis of prospectively collected data using an electronic diary to record daily PEFR and symptoms in severe and very severe COPD patients. Rates of PEFR change were used to characterize patients into stable and unstable groups determined by the distribution of slopes. Exacerbation-free days, time to first hospitalization, hospitalization rate, length of hospitalization, and all-cause mortality were assessed.

Results: A total of 104 severe and very severe COPD patients met entry criteria, and were observed for 37,702 patient-days. There were no significant differences in baseline symptoms, demographics, forced expiratory volume in 1 second (FEV1) or comorbidities between stable versus unstable groups. The unstable group had 34.7 less exacerbation-free days and significantly shorter 6 minute walk distances ( 6MWD) (227.1 versus 270.7 meters, p=0.031), shorter time to first hospitalization (163 versus 286 days, p=0.017), more frequent hospitalizations (2.6 versus 1.7 per year, p=0.032) and higher all-cause mortality (10.8 versus 5.1%, p= 0.04).

Conclusion: Patients with severe to very severe COPD with greater changes in PEFR have shorter 6MWD, reduced time to first hospitalization, more frequent hospitalizations, and higher all-cause mortality despite similar demographic, spirometric and comorbid parameters at baseline. Daily peak flow monitoring can be a useful tool in identifying COPD patients predisposed to worse outcomes.

Citation

Citation: So JY, Lastra AC, Zhao H, Marchetti N, Criner GJ. Daily peak expiratory flow rate and disease instability in chronic obstructive pulmonary disease. Chronic Obstr Pulm Dis (Miami). 2016; 3(1): 398-405. doi: http://dx.doi.org/10.15326/jcopdf.3.1.2015.0142

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Insight into Best Variables for COPD Case Identification: A Random Forests Analysis

Nancy K. Leidy, PhD1 Karen G. Malley, BA1 Anna W. Steenrod, MPH1 David M. Mannino, MD3 Barry J. Make, MD2 Russ P. Bowler, MD2 Byron M. Thomashow, MD4 R. G. Barr, MD4 Stephen I. Rennard, MD5 Julia F. Houfek, PhD5 Barbara P. Yawn, MD, MSc6 Meilan K. Han, MD, MS7 Catherine A. Meldrum, PhD7 Elizabeth D. Bacci, PhD1 John W. Walsh8 Fernando Martinez, MD, MS9; for the High-Risk-COPD Screening Study Group10

Author Affiliations

  1. Evidera, Bethesda, Maryland
  2. National Jewish Health, Denver, Colorado
  3. University of Kentucky, Lexington, Kentucky
  4. Columbia University, New York, New York
  5. University of Nebraska, Omaha, Nebraska
  6. Olmsted Medical Center, Rochester, Minnesota
  7. University of Michigan, Ann Arbor, Michigan
  8. COPD Foundation, Washington, DC
  9. Weill Cornell Medical Center, New York, New York
  10. High-Risk-COPD Screening Study Group: Rebecca Copeland, BS, University of Kentucky; Tim Dorius, MD, University of Nebraska Medical Center; David Hengerer, BA, Evidera; Karen Ishitani, RN, MSN, Olmsted Medical Center; Patricia Jellen, RN, MSN, New York Presbyterian Hospital; Katherine Kim, MPH, Evidera; Marge Kurland, RN, Olmsted Medical Center; James Melson, RN, BSN, University of Nebraska Medical Center; Randel Plant, BA, COPD Foundation; Christina Schnell, BA, CCRC, National Jewish Health; Jason Shiffermiller, MD, MPH, University of Nebraska Medical Center; Sonja Stringer, MPH, Evidera; Deb Sumnick, PBT, University of Nebraska; Kyle Textor, BA, Olmsted Medical Center; Jennifer Underwood, CCRC, National Jewish Health; Beth Whippo, RN-BC, MSN, New York Presbyterian Hospital

Address correspondence to:

Nancy Kline Leidy, PhD
Evidera
7101 Wisconsin Avenue, Suite 1400
Bethesda, Maryland 20814
Phone: 301-664-7272
Email: nancy.leidy@evidera.com

Abstract

Rationale: This study is part of a larger, multi-method project to develop a questionnaire for identifying undiagnosed cases of chronic obstructive pulmonary disease (COPD) in primary care settings, with specific interest in the detection of patients with moderate to severe airway obstruction or risk of exacerbation.

Objectives: To examine 3 existing datasets for insight into key features of COPD that could be useful in the identification of undiagnosed COPD.

Methods: Random forests analyses were applied to the following databases: COPD Foundation Peak Flow Study Cohort (N=5761), Burden of Obstructive Lung Disease (BOLD) Kentucky site (N=508), and COPDGene® (N=10,214). Four scenarios were examined to find the best, smallest sets of variables that distinguished cases and controls: (1) moderate to severe COPD (forced expiratory volume in 1 second [FEV1] <50% predicted) versus no COPD; (2) undiagnosed versus diagnosed COPD; (3) COPD with and without exacerbation history; and (4) clinically significant COPD (FEV1<60% predicted or history of acute exacerbation) versus all others.

Results: From 4 to 8 variables were able to differentiate cases from controls, with sensitivity ≥73 (range: 73–90) and specificity > 68 (range: 68–93). Across scenarios, the best models included age, smoking status or history, symptoms (cough, wheeze, phlegm), general or breathing-related activity limitation, episodes of acute bronchitis, and/or missed work days and non-work activities due to breathing or health.

Conclusions: Results provide insight into variables that should be considered during the development of candidate items for a new questionnaire to identify undiagnosed cases of clinically significant COPD.

Citation

Citation: Leidy NK, Malley KG, Steenrod AW, et al for the High Risk COPD Screening Group. Insight into best variables for COPD case identification: A random forests analysis. Chronic Obstr Pulm Dis (Miami). 2016; 3(1): 406-418. doi: http://dx.doi.org/10.15326/jcopdf.3.1.2015.0144

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Ambulatory Oxygen for Exercise-Induced Desaturation and Dyspnea in Chronic Obstructive Pulmonary Disease (COPD): Systematic Review and Meta-Analysis

Stanley I. Ejiofor, MRCP1 Susan Bayliss1 Abubacarr Gassamma1 Alice M. Turner, MRCP, PhD1,2

Author Affiliations

  1. University of Birmingham, Edgbaston Birmingham, United Kingdom
  2. Heart of England NHS Foundation Trust, Birmingham, United Kingdom

Address correspondence to:

Alice M. Turner
College of Medical and Dental Sciences
University of Birmingham
QEHB Research Labs
Mindelsohn Way
Birmingham, UK
B15 2WB
0121 371 3886.
Fax 0121 371 3887
Email: a.m.wood@bham.ac.uk

Abstract

Introduction: Ambulatory oxygen therapy is indicated in patients that use long term oxygen therapy (LTOT) and current guidelines suggest its use in patients who exhibit exertional desaturation if there is a demonstrable improvement in exercise capacity. Evidence for this is largely derived from single assessment studies which have shown clear benefit in this setting when oxygen versus air is used. The long term effects, however, of ambulatory oxygen therapy in this particular group of patients is controversial.

Methods: We conducted a systematic review of published literature from 1980 to June 2014 for trials in which ambulatory oxygen was compared to placebo in chronic obstructive pulmonary disease (COPD) patients not on LTOT. We also reviewed the effectiveness of devices delivering ambulatory oxygen. Outcome measures were focused towards exercise capacity, Borg scores and the ability of the delivery devices to maintain oxygen saturations on exercise.

Results: Twenty three studies (620 patients) were included in the review. Nine studies evaluated the clinical effectiveness of ambulatory oxygen and 14 studies evaluated the impact of the delivery devices. Ambulatory oxygen had no statistical effect on improving exercise capacity when assessed by the 6-minute walk test (6MWT) or the endurance shuttle walk test (ESWT);p=0.44 and p=0.29 respectively. End of test Borg scores showed no statistical improvement with ambulatory oxygen therapy during 6MWT (p=0.68). Oxygen conserving devices significantly improved oxygen saturations on exercise compared with continuous flow nasal cannulae (p=0.04).

Conclusion: Ambulatory oxygen therapy has limited long term benefit in improving functional exercise capacity or Borg dyspnea scores.

Citation

Citation: Ejiofor SI, Bayliss S, Gassamma B, Turner AM. Ambulatory oxygen for exercise-induced desaturation and dyspnea in chronic obstructive pulmonary disease (COPD): systematic review and meta-analysis. Chronic Obstr Pulm Dis (Miami). 2016; 3(1): 419-434. doi: http://dx.doi.org/10.15326/jcopdf.3.1.2015.0146

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Overall and Cardiovascular Safety of Aclidinium Bromide in Patients With COPD: A Pooled Analysis of Six Phase III, Placebo-Controlled, Randomized Studies

Kenneth R. Chapman, MD1 Ekkehard Beck, MD2 Daniel Alcaide, MSc3 Esther Garcia Gil, MD4

Author Affiliations

  1. Asthma & Airway Centre, University Health Network, Toronto Western Hospital, Toronto, Ontario, Canada
  2. Institut für Gesundheitsförderung GmbH, Rüdersdorf, Germany
  3. R&D Centre, Almirall S.A., Barcelona, Spain
  4. R&D Centre, AstraZeneca PLC, Barcelona, Spain

Address correspondence to:

Professor Kenneth R. Chapman
Director, Asthma & Airway Centre, University Health Network,
Toronto Western University
Room 7-451 East Wing, 399 Bathurst Street,
Toronto, Ontario M5T 2S8
Phone: 1-416-603-5499
Fax: 1-416-603-3456
Email: kchapman@ca.inter.net

Abstract

Background: Aclidinium bromide, an M3-receptor-selective, twice-daily (BID), long-acting muscarinic antagonist, is rapidly hydrolyzed in human plasma, resulting in low systemic exposure and urinary excretion. We evaluated the overall and cardiovascular (CV) safety of aclidinium in patients with moderate to severe chronic obstructive pulmonary disease (COPD) by pooling data from 6 randomized, double-blind, placebo-controlled, parallel-group studies of ≥1 month’s duration.Methods: Patients were current/former smokers aged ≥40 years with no history of clinically significant CV conditions. Treatment was administered (morning and evening) via GenuairTM/Pressair.®a Adverse events (AEs), major adverse CV events (MACE), cardiac and cerebrovascular AEs, and serious AEs (SAEs) were analyzed.

Results: The pooled population included 2781 patients (aclidinium: n=1529; placebo: n=1252). The incidence of AEs was similar with aclidinium (53.5%) and placebo (55.4%), as was the incidence of cardiac (aclidinium: 5.0%; placebo: 4.4%) and cerebrovascular (aclidinium: 0.4%; placebo: 0.5%) events. The incidence of MACE was low (AEs: 0.7%; SAEs: 0.5%) and comparable between groups. The incidence of cardiac and cerebrovascular events was similar for patients with CV risk factors with aclidinium and placebo (rate ratio [RR] [95 %confidence interval (CI)]=1.01[.074, 1.39]). In patients with mild to severe renal impairment, the incidence of cardiac events was similar between groups (RR [95% CI]=0.87 [0.56, 1.36]).

Conclusion: Aclidinium 400µg BID has a good safety profile and this pooled analysis found no evidence of increased CV or cerebrovascular risk compared with placebo in patients with moderate to severe COPD. Further studies are needed in high-risk patients.

Citation

Citation: Chapman KR, Beck E, Alcaide D, Garcia Gil E. Overall and cardiovascular safety of aclidinium bromide in patients with COPD: A pooled analysis of six phase III, placebo-controlled, randomized studies. Chronic Obstr Pulm Dis (Miami). 2016; 3(1): 435-445. doi: http://dx.doi.org/10.15326/jcopdf.3.1.2015.0148

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COPD9USA Session Summaries:

Interventional Options for COPD- LVRS, Bronchoscopic Therapies and the Future

Wilson Quezada, MD1 and Barry Make, MD2

Author Affiliations

  1. Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University Medical Center, New York, New York
  2. Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, Colorado

Address correspondence to:

Wilson Quezada, MD
Columbia University Medical Center
5141 Broadway, Rm 3-005
New York, Ny 10034
Email: wq16@cumc.columbia.edu

Abstract

This article serves as aCME available, enduring material summary of the following COPD9USA presentations:

  • “Lung Volume Reduction Surgery” Presenter: William A. Bulman, MD
  • “Bronchoscopic Approaches to Lung Volume Reduction” Presenter: Frank Sciurba, MD
  • “Stem Cell Therapies for Advanced Emphysema” Presenter: Edward P. Ingenito, MD, PhD
  • “Lung Transplantation for COPD” Presenter: Daniel Dilling, MD, FACP, FCCP

Citation

Citation: Quezada W, Make B. Interventional options for COPD-lung volume reduction surgery, bronchoscopic therapies and the future. Chronic Obstr Pulm Dis (Miami). 2016; 3(1): 446-453. doi: http://dx.doi.org/10.15326/jcopdf.3.1.2015.0171

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Pathophysiology of Emphysema and Implications

Monica Goldklang, MD1 and Robert Stockley, MD2

Author Affiliations

  1. Departments of Anesthesiology and Medicine, Columbia University Medical Center, New York, New York
  2. Department of Medicine, Queen Elizabeth Hospital, Birmingham, United Kingdom

Address correspondence to:

Monica Goldklang, MD
Columbia University Medical Center
630 West 168th Street, P&S 12-402
New York, NY 10032
Email: mpg2124@cumc.columbia.edu

Abstract

This article serves as a CME-available, enduring material summary of the following COPD9USA presentations:

  • “Overview of Lung Injury in COPD: Types and Key Questions” Presenter: Caroline Owen, MD, PhD
  • Emphysema as a Disease of Deficient Tissue Repair/Maintenance” Presenter: Rubin Tuder, MD

Citation

Citation: Goldklang M, Stockley R. Pathophysiology of emphysema and implications. Chronic Obstr Pulm Dis (Miami). 2016; 3(1): 454-458. doi: http://dx.doi.org/10.15326/jcopdf.3.1.2015.0175

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COPD Overlap Syndromes: Asthma and Beyond

Allison A. Lambert, MD, MHS1 and Mark T. Dransfield, MD2

Author Affiliations

  1. Department of Internal Medicine Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland
  2. Division of Pulmonary, Allergy and Critical Care and Lung Health Center, University of Alabama at Birmingham and the Birmingham Veterans Administration Medical Center, University of Alabama, Birmingham

Address correspondence to:

Allison Lambert, MD, MHS
1830 E. Monument Street
5th Floor
Division of Pulmonary and Critical Care Medicine
Baltimore, MD 21205
Email: alamber5@jhmi.edu

Abstract

This article serves as a CME-available, enduring material summary of the following COPD9USApresentations:

  • “COPD and Asthma” Presenter: Prescott Woodruff, MD, MPH
  • “COPD and Lung Cancer” Presenter: William Bulman, MD
  • “COPD and Bronchiectasis” Presenter: Jeremy Clain, MD
  • “COPD and Interstitial Lung Disease” Presenter GeorgeWashko, MD

Citation

Citation: Lambert AA, Dransfield MT. COPD overlap syndromes: Asthma and beyond. Chronic Obstr Pulm Dis (Miami). 2016; 3(1): 459-465. doi: http://dx.doi.org/10.15326/jcopdf.3.1.2015.0176

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The Human Microbiome in the Lung: Are Infections Contributing to Lung Health and Disease?

Khalilah Gates, MD1 Fernando Martinez, MD2

Author Affiliations

  1. Feinberg School of Medicine, Northwestern University, Chicago, Illinois
  2. Department of Medicine, Weill Cornell Medical College, Cornell University, New York, New York

Address correspondence to:

Khalilah Gates, MD
Northwestern University
240 E. Huron, McGaw M300
Chicago, IL 60611
Email: k-gates@northwestern.edu

Abstract

This article serves as a CME-available, enduring material summary of the following COPD9USA presentations:

  • “The Human Microbiome in the Lung: The Way Forward” Presenter: Gary B. Huffnagle, PhD
  • “COPD: Is it Just Bacteria?” Presenter: Alison Morris, MD, MS
  • "What We Have Learned From Other Disease States and How It Applies to COPD" Presenter: Fernando Martinez, MD, MS

Citation

Citation: Gates K, Martinez F. The human microbiome in the lung. Chronic Obstr Pulm Dis (Miami). 2016; 3(1): 466-472. doi: http://dx.doi.org/10.15326/jcopdf.3.1.2015.0174

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Back to the Future: Past, Present, and Future is COPD360

Michael W. Hess, BS, RRT, RCP1 and Barry Make, MD2

Author Affiliations

  1. Battle Creek Veterans Administration Medical Center, Battle Creek, Michigan
  2. National Jewish Health, Denver, Colorado

Address correspondence to:

Michael Hess, RRT
Email: mhessrrt@gmail.com

Abstract

The treatment and management of chronic obstructive pulmonary disease (COPD) have gone through significant changes over the past decade. This plenary session, part of the 2015 COPD9USA conference, examines how the diagnosis and management of COPD has become more individualized as new phenotypes have been identified. In addition, new diagnostic and management tools are evaluated and the importance of including the patient perspective when designing a treatment plan is discussed. Finally, the future integration of technology in research, clinical communication, and disease education is introduced, including how the COPD Foundation is encouraging and facilitating these efforts.

This article serves as a CME available enduring material summary of the following COPD9USA presentations:

  • “The Past and Present Evidence” presenter: Stephen Rennard, MD
  • “COPD: The Way Forward” presenter: Gerard Turino, MD
  • “E-Cigarettes—Hope, Hype or Danger?” presenter: Russell Bowler, MD, PhD
  • “Looking Forward” presenter Prescott Woodruff, MD
  • “The Future is Now: A Patient Perspective” presenter: Jim Nelson
  • “COPD360 & The Patient-Powered Research Network” presenter: John Walsh

Citation

Citation: Hess MW, Make B. Back to the future: past, present and future is COPD360. Chronic Obstr Pulm Dis (Miami). 2016; 3(1): 473-478. doi: http://dx.doi.org/10.15326/jcopdf.3.1.2015.0173

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Pulmonary Rehabilitation: Improvement with Movement

Anita Rajagopal, MD1 and Richard Casaburi, MD2

Author Affiliations

  1. Division of Pulmonary, Critical Care, and Sleep Medicine, University of Kentucky, Lexington, Kentucky
  2. Los Angeles Biomedical Research Institute at Harbor-University of California, Los Angeles Medical Center, Torrance

Address correspondence to:

Anita Rajagopal, MD
University of Kentucky
Division of Pulmonary, Critical Care and Sleep Medicine
740 S. Limestone, Ste. L-54
Lexington, KY 40536
Email: Anitaraj@gmail.com

Abstract

This article serves as a CME- available, enduring material summary of the following COPD9USA presentations:

  • “Lessons Learned from Pulmonary Education Program and On Track with COPD Ongoing Health Management.” Presenter: Scott Cerreta, BS, RRT
  • “Cultivating Memorial Funds for Pulmonary Rehabilitation” Presenter: Valerie McLeod, RRT
  • “Strategies for Success: Maintenance Program Best Practices” Presenter: David Vines, MHS, RRT
  • “Strategies for Success-Maximizing Participation and Completion Rates,” Presenter: Trina M. Limberg, BS, RRT

Citation

Citation:Rajagopal A, Casaburi R. Pulmonary rehabilitation: Improvement with movement. Chronic Obstr Pulm Dis (Miami). 2016; 3(1): 479-484. doi: http://dx.doi.org/10.15326/jcopdf.3.1.2015.0169

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Developing and Implementing Biomarkers and Novel Imaging in COPD

Surya P. Bhatt, MD1 and Meilan K. Han, MD2

Author Affiliations

  1. Division of Pulmonary, Allergy and Critical Care Medicine, and Lung Health Center, University of Alabama, Birmingham
  2. Division of Pulmonary and Critical Care, University of Michigan Hospital and Health Systems, Ann Arbor

Address correspondence to:

Surya P. Bhatt, MD
University of Alabama
Division of Pulmonary, Allergy & Critical Care Medicine
THT 422, 1720 2nd Ave South
Birmingham, AL 35294
Email: spbhatt@uab.edu

Abstract

This article serves as a CME available, enduring material summary of the following COPD9USA presentations:

“Computed Tomography and COPD” Presenter: George R. Washko, MD
“CT Imaging in Routine Clinical Practice: Are We Ready for Prime Time?” Presenter: Meilan K. Han, MD
“Beyond CT: What MRI can Tell Us about COPD” Presenter: R. Graham Barr, MD

Citation

Citation: Bhatt SP, Han MK. Developing and implementing biomarkers and novel imaging in COPD. Chronic Obstr Pulm Dis (Miami). 2016; 3(1): 485-490. doi: http://dx.doi.org/10.15326/jcopdf.3.1.2015.0170

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COPD Overdiagnosis, Underdiagnosis, and Treatment

Cristine E. Berry, MD, MHS1 and Barbara P. Yawn, MD, MSc2

CME Accreditation

Faculty Disclosure

On behalf of the COPD9USA Scientific Planning Committee Members and the COPD Foundation, we are pleased to provide you with an opportunity to receive continuing medical education credits. This online activity is an enduring material that has been derived from the COPD9USA conference, held in June 2015 in Chicago, Illinois.

The COPD Foundation is committed to improving the quality of life for individuals affected by COPD and COPD9USA reflected this commitment through interactive, practical and interprofessional educational opportunities. We realize that not everyone was able to attend the full conference, so we are pleased to be able to offer learners the opportunity to participate in this online activity. We hope that this activity will provide you with a snapshot of the exciting learning opportunities that were offered at the full conference.

COPD9USA was the second in a series of biennial conferences modeled after the successful COPD Conference Series held in Europe for the past 20 years. Founded by international experts, Professors Robert Stockley and Sue Hill, the COPD Conference Series has helped thousands of clinicians and researchers improve the care of their patients living with COPD worldwide. Unlike other COPD conferences that focus solely on the scientific and research aspects of COPD, the COPD Conference Series is designed to provide practical information for clinical management as well as the latest in clinical and basic research. The COPD Foundation is honored to serve as the host for the only COPD conference of this kind. We plan to host the COPDUSA conference every other year (odd calendar years). We are grateful to the world class faculty and all of the attendees who supported the conference. The need for focused COPD education for the entire healthcare provider team has never been greater.

We are looking forward to hosting COPD10USA in Chicago on July 28 and 29, 2017. As a registrant on the conference website, we will notify you with updates on the COPD9USA conference.

Thank you again for your interest in the COPD9USA conference and online activity and for your commitment to addressing the burden this devastating disease places on everyone in the U.S. and beyond. We look forward to your feedback on this activity and your participation in future conferences.

 

Sincerely,

COPD9USA Co-chairs:
Ravi Kalhan, M.D.
David Mannino, M.D.
Stephen Rennard, M.D.
Byron Thomashow, M.D.
John Walsh
Barbara Yawn, M.D

Click here to view Faculty Listing/Disclosure Information.

 

Accreditation

Joint Providership Statementplus

This activity has been planned and implemented in accordance with the Accreditation Requirements and Policies of the Accreditation Council for Continuing Medical Education through the joint providership of the University of Nebraska Medical Center, Center for Continuing Education and COPD Foundation.

Accreditation Statementplus

The University of Nebraska Medical Center, Center for Continuing Education is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Credit Designation Statementplus

The University of Nebraska Medical Center, Center for Continuing Education designates this enduring material for a maximum of .75 AMA PRA Category 1 CreditsTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

COPD9USA Supportersplus

We gratefully acknowledge the following for educational grant support of COPD9USA:

AstraZeneca
Boehringer Ingelheim
GRIFOLS

We gratefully acknowledge the following for support of COPD9USA:

Platinum:
Boehringer Ingelheim

Gold:
Will Rogers Foundation

Silver | Gordon Snyder Memorial Reception:
Alpha-1 Foundation

Bronze:
Phillips Healthcare
Sleep from Nair Foundation

 

About the Program

Program Goalplus

The COPD9USA program committee is committed to providing education that will encourage change in physician and healthcare provider behavior to improve patient care. The overall objective of COPD9USA is to provide an educational forum that stimulates government, clinical, research and patient communities to create a coordinated and comprehensive approach for advancing the implementation of research, clinical care, care delivery coordination and other public health interventions critical to improved outcomes in COPD. COPD9USA participants and faculty represent the entire spectrum of clinical care teams, academic researchers, hospital administrators and care coordinators, government and private policy makers, and patients and caregivers that are affected by the disease.

Educational Objectivesplus

The learning objectives for the COPD9USA conference were designed by the conference chairs. The enduring material will address the following objectives:

Learning Objectives

  1. Interpret the latest research in COPD including data related to treatment, diagnosis, pharmacological advances, new biomarkers and pulmonary rehabilitation.
  2. Recognize the influence of smoking, environment and microbiome on COPD and the extent of the COPD epidemic worldwide.
  3. Explain the diagnostic tools and treatment protocol for COPD.
    1. Diagnostic tools include screening questionnaires, peak flow, spirometry and CT scans
    2. Treatment protocol includes a review of the GOLD strategy, the Pocket Consultant Guide and the role of interventional options
  4. Explain COPD heterogeneity and phenotypes with emphasis on early-COPD, pre-COPD, mild-COPD, overlap syndrome and how this knowledge can translate into the delivery of phenotype-specific treatment options now and in the future.
  5. Discuss proactive versus reactive strategies in COPD care plans and the impact of payer policies and health care regulations on the delivery of care.
  6. Identify the co-morbidities associated with COPD and strategies for creating the individualized treatment plan.
  7. Describe exacerbation prevention and control methods to include recognizing when a hospitalization is required and self-management strategies for individuals with COPD.
  8. Identify best practices for addressing issues related to hospital readmissions and strategies for executing a team approach to care.
  9. Summarize the importance and differences between palliative care and end-of-life care for COPD.

Target Audienceplus

This CME activity is designed for primary care physicians, pulmonologists, nurses, nurse practitioners, physician assistants, respiratory therapists and other allied healthcare professionals. The program’s focus on care delivery is also designed to meet the needs of those responsible for quality improvement, care coordination and case management.

Release Datesplus

Date of Original Release: January 27, 2016
Expiration Date: January 27, 2017
Faculty Approval: January 17, 2016

Additional Information

Method of Participationplus

There are no fees for participating in and receiving credit for this activity.

  • Review the activity objectives and CME information.
  • Review the enduring material.
  • Click the link provided at the end of the activity, and complete the online post-test ( 75% accuracy) and evaluation instrument.
  • Print your certificate online.
  • The estimated time to complete each activity is .75 hours.

System Requirementsplus

There are no special technical requirements needed to view this CME activity.

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Disclaimersplus

There are no special technical requirements needed to view this CME activity.

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Contact Informationplus

If you have any questions about this activity, please contact Elisha Malanga at emalanga@copdfoundation.org
or
866-731-COPD (2673),
ext. 309.

Author Affiliations

  1. Department of Medicine, University of Arizona College of Medicine, Tucson
  2. Olmsted Medical Center, Rochester, Minnesota

Address correspondence to:

Cristine Berry, MD, MHS
1501 N. Campbell Avenue
P.O. Box 245030
Department of Medicine
College of Medicine
University of Arizona
Tucson, Arizona 85724
Email: cberry@deptofmed.arizona.edu

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Abstract

This article serves as a CME-available enduring material summary of the following COPD9USA presentations:

  • “Spirometry Isn’t for Screening – So What Is?” Presenter: David H. Au, MD, MS
  • “Diagnosis of COPD in a Primary Care Midwest Practice” Presenter: Barbara Yawn, MD, MSc
  • “What Happens in Primary Care Without Screening?” Presenter: Sandra G. Adams, MD, MS
  • “From Screening to Diagnosis to Management in a Busy Primary Care Practice”Presenter: Min Joo, MD
  • "Practical Considerations of How Phenotype and Genotype Can Affect Management Decisions” Presenter: Bartolome Celli, MD

Citation

Citation: Berry CE, Yawn BP. COPD overdiagnosis, underdiagnosis, and treatment. Chronic Obstr Pulm Dis (Miami). 2016; 3(1): 491-497. doi: http://dx.doi.org/10.15326/jcopdf.3.1.2015.0172

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COPD Pipeline:

The COPD Pipeline XXX

Nicholas Gross, MD, PhD1

Author Affiliations

  1. Stritch-Loyola School of Medicine, Maywood, Illinois

Address correspondence to:

Nicholas Gross, MD, PhD1
Grossnicholas1@gmail.com

Abstract

This article does not contain an abstract.

Citation

Citation: Gross N. COPD pipeline XXX. Chronic Obstr Pulm Dis (Miami). 2016; 3(1): 498-502. doi: http://dx.doi.org/10.15326/jcopdf.3.1.2015.0181

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Journal Club:

Journal Club

Ron Balkissoon, MD, MSc, DIH, FRCPC1

Author Affiliations

  1. Denver, Colorado

Address correspondence to:

Ron Balkissoon, MD, MSc, DIH, FRCPC
balkissoonr@njhealth.org

Abstract

This article does not contain an abstract.

Citation

Citation: Balkissoon R. The Journal Club. Chronic Obstr Pulm Dis (Miami). 2016; 3(1): Page #’s TBD. doi: http://dx.doi.org/10.15326/jcopdf.3.1.2016.0129 Chronic Obstr Pulm Dis (Miami). 2016; 3(1): 503-508. doi: http://dx.doi.org/10.15326/jcopdf.3.1.2016.0127

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