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Angela Wang, MD, CTS President
 This edition of CTS Inspirations features two different approaches to improving COPD/asthma care. As most of us know, COPD is the third leading cause of death in the United States. (1) The disease places enormous burdens not just on individual patients and their families, but also on healthcare resources. (2,3) Each of the model programs highlighted below utilizes existing resources to create something new. These days, we hear a lot about creative freedom. As if creativity can only flourish in situations where there are no constraints. Innovation and "disruption" have become almost synonymous terms in many people's minds. But sometimes, ingenuity demands that you work with what you have. Creativity can mean taking advantage of limited options and coming up with a different way of putting the existing pieces together to create a better paradigm.
1. http://www.cdc.gov/nchs/data/nvsr/nvsr61/nvsr61_04.pdf
2. http://www.cdc.gov/nchs/data/series/sr_13/sr13_168.pdf
3. http://www.lung.org/assets/documents/EXESUM.pdf
Vipul V. Jain, MD, MS, Associate Clinical Professor of Medicine, UCSF Fresno, Medical Director, Chronic Lung Disease Program, Division of Pulmonary and Critical Care Medicine
 Critical need exists for strategies to prevent recurrent severe exacerbations of asthma and COPD; driving recent investigation on integrated programs for advanced obstructive lung disease. Dr. Jain and colleagues study of a pulmonologist-led Chronic Lung Disease Program developed at UCSF-Fresno was recently published in Respiratory Medicine. The study outlines key elements and predictors of success of the program.
The program included clinical evaluation, onsite PFT, health education, and self-management action plan along with close scheduled and on-demand follow-up. Patients with ≥2 asthma or COPD exacerbations requiring ER visit or hospitalization within the prior year were enrolled, and followed for respiratory ER visits and hospitalizations over a year.
The sample (n = 104) had a significant decrease in respiratory ER visits and rehospitalizations. Reduction of healthcare utilization was strongly associated with GERD and sinusitis therapy, and was independent of pulmonary rehabilitation. Direct variable cost analyses estimated annual savings at $1.17 million. Multivariate logistic regression analysis revealed lack of spirometry utilization as an independent risk factor for severe exacerbations. Although costs of developing such a program may seem significant, cost analyses suggests cost-effectiveness; with an overall out-of-pocket savings of over a million dollars per year.
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Stephanie Tsao NP and George Su MD
The Healthy San Francisco (HSF) Asthma/COPD Program, based at San Francisco General Hospital (SFGH), aims to develop innovative ways to improve the quality of asthma/COPD care delivered to vulnerable populations served by the SF safety net system.
In an effort to increase patient access to COPD self-management education and support, in 2010, we launched Better Breathing, a four-session course for patients living with COPD and their caregivers. Taught by a multidisciplinary team of COPD experts, including NPs, RNs, RTs and nutritionists, Better Breathing utilizes a curriculum that provides the education and skills training needed to help patients follow a COPD Action Plan. This curriculum covers disease education, correct use of inhalers, breathing techniques, healthy lifestyle habits and how to improve communication with the healthcare team. It has also served as a training resource for healthcare providers seeking to improve their own skills in caring for patients with COPD.
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CTS
CTS Fall Symposium
Idiopathic Pulmonary Fibrosis and Pulmonary Hypertension: Advances in Diagnosis & Management
October 3, 2015
Cedars-Sinai Medical Center
A course for all who provide care for patients with lung disease, including (adult and pediatric) pulmonologists, critical care physicians, cardiologists, rheumatologists, trainees, nurse practitioners, nurses, physician assistants and respiratory therapists.
Multidisciplinary Luncheon and Meet the Professors Roundtable Discussions
Make the most of this educational activity by participating in lively and thought-provoking panel presentations, Q&A and roundtable lunch discussions with the course faculty. They will discuss pearls in outpatient management and common challenges faced in their field of expertise.
Early bird registration opens June 15
Click here for agenda and faculty list
Los Angeles Times
Dozens of Southern California facilities, including oil refineries, aerospace plants and metal factories, will face new requirements to reduce toxic emissions or notify their neighbors of the health risks from their operations under rules approved June 5 by air quality officials. The move by the South Coast Air Quality Management District governing board follows new guidelines from state environmental officials that estimate the cancer risk from toxic air contaminants is nearly three times what experts previously thought.
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By Chelsea Adams
 New research shows a rare but often fatal complication among lung transplant patients is likely caused by bacteria normally found in the urinary tract. Dr. Ankit Bharat, a thoracic surgeon and surgical director at the Northwestern University Feinberg School of Medicine in Chicago, found elevated levels of ammonia in a 44-year-old double lung transplant patient a week after transplant surgery. Reasons for the patient's hyperammonemia weren't clear.
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Reuters
The California Senate recently voted to raise the legal smoking age in the most populous U.S. state to 21 from 18, in a move that could make California one of the states with the highest smoking age. The measure was approved by the Senate 26-8 and must now be approved by the state Assembly.
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The Medical News
A Canadian study published in the June issue of the journal CHEST found weight loss reduced asthma severity as measured by airway hyperresponsiveness in obese adults. The incidence of asthma is 1.47 times higher in obese people than nonobese people, and a three-unit increase in body mass index is associated with a 35 percent increase in the risk of asthma. The study supports the active treatment of comorbid obesity in individuals with asthma.
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MedPage Today
Obstructive sleep apnea may increase the risks of death, heart disease, stroke and kidney disease, as well as hasten kidney function decline, according to a study of more than 3 million U.S. veterans. Compared with OSA-negative patients, untreated OSA was associated with an 86 percent higher mortality risk, and treated OSA was associated with a 35 percent higher mortality risk, researchers wrote in the journal Thorax.
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Medical News Today
It is estimated that more than 158,000 people in the U.S. will die from lung cancer this year, emphasizing the need for earlier detection of the disease, leading to better treatment outcomes. Now, researchers have discovered a biomarker that could lead to a highly accurate blood test for early detection of nonsmall cell lung cancer — the most common form of the disease. The discovery was published in the journal Oncotarget.
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The Medical News
Idiopathic pulmonary fibrosis is a chronic lung disease for which as yet no causal therapy exists. It is, however, known that the lung interstitium — the connective tissue between the air sacs in the lower part of the lung — is affected. There scar tissue consisting mainly of collagen accumulates, thus reducing lung elasticity and gradually impairing lung function. Patients with IPF have an extremely poor prognosis; on average they survive only two or three years after the diagnosis has been made.
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Medical Daily
Lung cancer is one of the most aggressive forms of cancer, and it's also one of the leading causes of cancer death in the world. It's especially difficult to defeat because even after chemotherapy and initial remission, it often comes back. But researchers hope they've found a new approach that will change that. A new study out of the Weizmann Institute of Science explains how researchers developed a treatment involving three avenues that has the potential to prevent the recurrence of lung cancer.
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