Spirometry May Be Key to Early COPD Detection
A recent paper released by the National Lung Health Education Program (NLHEP) reveals that spirometry could be the key to early detection of chronic obstructive pulmonary disease (COPD) in smokers. According to recent National Heart, Lung, and Blood Institute statistics, there are an estimated 15 million Americans with undiagnosed COPD. NLHEP chairman Thomas L. Petty, MD, says that spirometry can quickly detect COPD in its early stages. He adds that abnormal spirometry readings can also be indicative of heart disease, cancer, and stroke—the three most common causes of death in the United States.

On the basis of a large survey of health of Americans, Petty and his colleagues estimate that more than one fourth of American smokers aged 45 and over with any respiratory symptoms are developing COPD as evidenced by airway obstruction on spirometry testing. They also found that approximately 10% of men and 14% of women who smoke but have no respiratory symptoms do have abnormal spirometry readings.

NLHEP’s principal recommendation is that primary care providers perform spirometry tests in their offices for all smoking patients aged 45 and over. Anyone with shortness of breath, chronic cough, excess mucus, or wheezing should also be tested. Considerable attention should then be given to smokers with airway obstruction detected by the spirometry test and every effort should be made to help them stop smoking. “COPD that has developed in a susceptible smoker is usually diagnosed after more than two-thirds of lung function has been permanently lost,” Petty says. “By that time the patient complains of shortness of breath during even moderate activity.”

NLHEP has also provided specifications for a new type of spirometer for detecting COPD in smokers, which is designed to be less expensive, faster, and easier to use than current models used for asthma. The accuracy of these new office spirometers will be validated by clinical trials in primary care settings before they are offered for sale later this year. In the meantime, doctors can use current models of diagnostic quality spirometers to detect COPD in their smoking patients and intervene before the disease progresses to the point of becoming disabling. www.nlhep.org.

Proper Reevaluation of Continuous Oxygen Therapy Could Save Millions
A recent study revealed that improper reevaluation of patients—primarily smokers over 45—with chronic obstruction pulmonary disease (COPD) on continuous oxygen therapy (COT) unnecessarily may be costing Americans $153 million per year. This is because either patients are not reevaluated in a timely manner or the reevaluation is not performed accurately.

The study considered 57 COPD patients who were prescribed home oxygen therapy; of the 55 who returned to the clinic, only 19 were appropriately reevaluated according to the guidelines established by the Third Oxygen Consensus Conference. The conference recommended that patients receiving COT be reevaluated 1 to 3 months after continuous oxygen therapy is initiated when the patient is medically unstable. The Medicare system currently allows a full year to pass before reevaluation. Of those 19, 11 (58%) were discontinued from COT. Researchers say that up to 60% of the remaining patients could have potentially been discontinued from COT if they had been given appropriate reevaluations.

The study report indicates that close to 800,000 patients receive long-term oxygen therapy in the United States yearly, at a cost of $1.8 billion. Recent Medicare statistics reveal that in 1992, more than 168,000 beneficiaries were new home oxygen users. On the basis of the study’s findings, approximately 32,000 of those COPD patients remained unnecessarily on COT during that year. Proper reevaluation of such patients could have saved anywhere from $106 to $153 million. The researchers suggest that Medicare restrict the initial prescription of COT to 3 months in a first step to save money.

The study also found that the rate of appropriate reevaluation was significantly higher among pulmonary physicians than among primary care physicians. This suggests that referring patients using COT to a pulmonary specialist is the best course of action to ensure proper reevaluation of their conditions. www.aart.org.

RT Magazine EAB Member Retires Julien Roy, RRT, a member of RT’s Editorial Advisory Board, has retired from his position at Halifax Medical Center, Daytona Beach, Fla, as of April 28, 2000. He was sent to the Cleveland Clinic for a second evaluation on his declining heart function. His ejection fraction is still very low—20%. Extensive damage to the left side, which now is affecting his right side with enlargement and high pressures, suggests that a heart transplant will be performed in the near future. He is also waiting to have a dual ventricular pacer implanted. Roy will be doing some work with pulmonary disease management to keep himself occupied and will stay involved with the American Association for Respiratory Care and the American Association of Cardiovascular and Pulmonary Rehabilitation, nationally and at the state level. VSRC Holds Annual Fall Symposium The Virginia Society of Respiratory Care (VSRC) will hold its annual fall educational seminar at the Four Points Sheraton Hotel in Blacksburg, Va, on October 25-27. The first day will include a workshop discussing the vision and values of the RCP, and personality profiling in hiring and promoting RCPs. The day will end with VSRC’s 11th Annual Golf Tournament at the Blacksburg Country Club. The days that follow will include other key topics such as home ventilation, pulse oximetry, sleep apnea, and nutrition for COPD. There will be a competitive volleyball tournament on the last day of the seminar. Exhibitors will be displaying their respiratory products and services in the hall on Thursday and Friday. For more information, contact Cam McLaughlin at (540) 633-4277 or Carolyn Phillips at (540) 889-3108.

NETT Yields Valuable Information Regarding Emphysema Patients at ATS
The National Emphysema Treatment Trial (NETT), designed to evaluate the benefits and risks of lung volume reduction surgery in patients with emphysema, is already yielding valuable information on the natural history, pathophysiology, and treatment of severe emphysema. Some of this information was made available at the American Thoracic Society (ATS) 96th International Conference that was held in Toronto on May 5-10.

“NETT has already characterized and followed in detail the largest group of severe emphysema patients ever, and we have only begun to mine the information in the baseline data that could impact the lives of emphysema patients,” comments Alfred P. Fishman, MD, chairman of the NETT Steering Committee.

Participants enrolled in NETT are characterized as to the type and distribution of emphysema, exercise ability, quality of life, and associated heart effects, among other variables. NETT also examines how these characteristics change with 6 to 10 weeks of medical treatment given to all participants before being randomly assigned to receive either surgery with medical treatment or medical treatment alone.

Important findings on several characteristics of emphysema patients are reflected in the following key abstracts that were presented at the ATS conference:

• Predictors of Improved Health-Related Quality of Life (QOL) Following Pulmonary Rehabilitation in the NETT. Reilly J, Moy M, Kaplan R, Diaz P, Benditt J, Criner G, Lee S, Boston. Findings: Patients with the poorest QOL at baseline experienced the most significant improvements in QOL with rehabilitation.

• Pulmonary Rehabilitation Improves Exercise Capacity and Dyspnea in the NETT. Make B, Tolliver R, Christensen P, Karla S, MacIntyre N, Ries A. National Jewish Medical & Research Center, Denver. Findings: Of the first 490 trial participants with severe emphysema, pulmonary rehabilitation resulted in improved exercise capacity, improved functional capacity, and decreased shortness of breath.

• Measurement of Health-Related QOL in the NETT. Kaplan RM, Reilly J, Mohsenifar Z. La Jolla, Calif. Findings: Preliminary evidence suggests significant improvements in QOL following the rehabilitation phase of NETT.

• Correlates of Resting Energy O2 Consumption (RO2) in Severe Emphysema. Marzouk K, Cohen R, Levine M, Berkoski P, O’Donnell CP, Polotsky VY, Scharf SM. New Hyde Park, NY, Baltimore. Findings: Examining the relationships between resting energy needs and body mass and lung function indicated resting energy use in emphysema patients was more than double that of normal patients. This was probably due to the necessity to overcome abnormal lung function.

• Similar Patient Outcomes After Rehabilitation at a NETT Clinical Center and its Satellite Rehabilitation Programs. Meldrum MK, Martinez FJ, Jain A, Strawderman R, Christensen PJ. Ann Arbor, Mich. Findings: Preliminary results indicate that standardized pulmonary rehabilitation can be delivered by a clinical center and trained satellite programs with similar patient outcomes.

The trial, funded and overseen by the National Heart, Lung, and Blood Institute along with Medicare, is taking place at 19 primary research sites and more than 300 satellite sites across the country. Information on NETT is available at (800) 314-2597; www.nettstudy.org; www.emphysemastudy.org. Additional information regarding these abstracts is available on the ATS Web site, www.thoracic.org.