Testing for Inhaled Insulin

Diabetics now have a new option thanks to the breakthrough new medication AFREZZA®, an inhaled insulin now available by prescription. 

The labeling for AFREZZA®, mandates spirometry testing (specifically FEV1) to rule out chronic lung disease prior to initiating therapy, six months after initiation and every year thereafter1. 

MD Spiro offers a number of spirometer options and the expertise to easily integrate spirometry into your practice. From the non-reimbursable, PulmoLife at $195 to the full featured MicroLab at $2,295, Micro Direct has a spirometer designed to meet your needs. 
American Thoracic Society (ATS) Coding Recommendations

To aid in the coding for spirometry testing, the ATS has determined the appropriate ICD-9 codes and CPT codes. The following table lists examples of how to record these diagnosis and billing codes:

Spirometry prior to initiation of therapy  94010*  V72.85 + code for underlying condition (diabetes) as additional diagnosis Spirometry after first 6 months of therapy  94010*  V58.83 + V58.67 + code for underlying condition (diabetes) as additional diagnosis  Annual spirometry testing 94010*  V58.83 + V58.67 + code for underlying condition (diabetes) as additional diagnosis 

* It may also be appropriate to append this code with the “-32” modifier indicating that the test is “mandated” by the FDA as part of the labeling restrictions for inhaled insulin.2

For additional information, call us today at 800-588-3381.

a All Current Procedural Terminology (CPT) 5-digit number codes, descriptions, number modifiers, instructions, guidelines and other material are Copyright © 2014 American Medical Association. All rights reserved. 
1. This information is not a substitute for medical advice and does not provide a complete summary of AFREZZA® or any inhaled insulin product or address all considerations in making treatment decisions regarding their use. Always refer to the complete product information provided by the manufacturer. 
2. Modifier minute: modifier 32. American Academy of Professional Coders website. Accessed December 22, 2014. 

AFREZZA® is a registered trademark owned by MannKind Corporation. 
Micro Direct, Inc./MD Spiro is not sponsored by nor has any affiliation with Sanofi, US, Inc., MannKind or the AFREZZA® trademark.
Read more..

Time is Right for E-Cig Regulation

Reducing the risks of e-cigarettes to smokers, encouraging the smoking-cessation potential, and restricting access by nonsmokers offer a regulatory trifecta that can be implemented immediately, according to a former FDA official.

The "roadmap" to effective regulation hinges on implementation of the pending FDA deeming rule, which is expected to go into effect later this year. Regulation could begin almost immediately without the need for additional research, Eric Lindblom, JD, of Georgetown University Law Center in Washington, argues in the March issue of Food and Drug Law Journal.

"The minute [the deeming rule] comes out, the FDA has a terrific opportunity to immediately start regulating e-cigarettes," Lindblom, former director of the policy office at the FDA's Center for Tobacco Control, told MedPage Today.

"Right now, it's sort of like the Wild West, as has been often said about e-cigarette regulation in the U.S.," he added. "There really isn't any right now.

"Some in the industry think that any regulation at all is bad, but I think some thoughtful regulation could get rid of the bad actors and minimize the risks and potential harms and actual harms from e-cigarette use. At the same time, they can realize their potential to help people quit or as a less harmful alternative for smokers. Let's let them do that, but let's do it in a careful, regulated way that doesn't cause any unnecessary harms."

By itself, the deeming rule will not reduce the potential harms or maximize potential benefits, he added. Implementation of the rule will extend the FDA's regulatory reach to a wide range of tobacco products, including e-cigarettes and hookah or water-pipe tobacco. Whether the agency chooses to exercise its regulatory authority without additional studies remains to be seen.

The debate over e-cigarette regulation has gained momentum as the popularity and sales of the the various devices and products have taken off. In his article, Lindblom notes that public health officials remain divided over the form that regulation should take.

Supporters of a "soft approach" want to ensure that regulation does not become an obstacle to e-cigarettes' potential to help smokers quit or switch to potentially less harmful alternatives to conventional cigarettes. The "hard approach" camp emphasizes that nicotine -- in any form -- remains addictive and poses substantial harms as compared with no smoking. They also have expressed concern that smokers may use...

Read more..
Smoking Cessation is Important for YOUR Heart’s Health

The link between smoking and cancer is well known, but there’s another major killer associated with smoking that often goes unnoticed – heart disease.

“Smoking not only causes cancer. Smoking is also a significant contributor to heart disease, the top cause of death for men and women in the U.S.,” said Paul Fitzpatrick, manager of the Defense Health Agency’s (DHA) “Quit Tobacco” program.

DHA wants to spread awareness about how smoking and tobacco use contributes to heart disease. DHA is also promoting heart-healthy lifestyles and tobacco cessation through TRICARE, the health plan for service members and their families, and through the Quit Tobacco website.

Approximately 600,000 people die of heart disease each year in the U.S. – about one in every four deaths, according to the Centers for Disease Control and Prevention. Of these, 107,000 men and women die of heart disease related to smoking and smoke-less tobacco products, deaths that are largely preventable. On average, smokers die 13-14 years earlier than non-smokers.

Here’s how smoking causes heart disease, according to the American Heart Association:

•    Reduces the amount of oxygen your heart gets
•    Raises your blood pressure
•    Speeds up your heart rate
•    Makes clots more likely, which can lead to heart attack or stroke
•    Decreases exercise tolerance
•    Causes inflammation of blood vessels including those in your heart

Heart disease has become the number one cause of smoking-related deaths in women. Wow.

“This finding is important to men, too, because most of us have women in our lives as wives, mothers, daughters and sisters. Everyone wants their loved ones to live longer,” Fitzpatrick said.

Women who smoke and use oral contraceptives are even more vulnerable. Smoking greatly increases their risk of coronary artery disease and stroke, compared to non-smoking women who use oral contraceptives, according to the AHA.

Quitting smoking before the age of 40 reduces the risk of dying from smoking-related disease by about 90 percent, according to CDC research. However, it’s never too late to quit. If you become one of the millions of people who quit tobacco successfully each year, you can feel benefits almost immediately and will be on your way to a longer, healthier life.

What better way to celebrate the month of love by getting your patients in a smoking cessation program at your practice.  This could be the year YOU...

Read more..
Draft guideline to improve asthma diagnosis

The draft guideline – NICE’s first on asthma – reinforces recommendations made in the 2014 BTS/SIGN asthma guideline, which also supports spirometry as the preferred initial test to assess the presence and severity of airflow obstruction.

A number of methods and assessments are available to determine the likelihood of asthma. These include measures of airflow obstruction, such as spirometry and peak flow, and measures of reversibility with bronchodilators, with both types of measure being widely used in current clinical practice.

This latest guideline aims to determine the most clinical and cost effective way to effectively diagnose people with asthma and determine the most effective monitoring strategy to ensure optimum asthma control.

The guideline stresses that to achieve an accurate diagnosis clinical tests should be used as well as checking for signs and symptoms. The process which the healthcare professional should follow in the initial assessment, and the tests to use, are presented in simple flow charts.

The draft guideline recommends spirometry as the first-line investigation for asthma in adults older than 16 and children aged 5–16 years. Healthcare professionals should regard a forced expiratory volume in 1 s/forced vital capacity (FEV1/FVC) ratio of less than 70% as a positive test for obstructive airway disease.

Further breath tests should be carried out depending on the results from spirometry and the patient’s age.  For adults and young people over 5 years, healthcare professionals may need to check for levels of nitric oxide, a gas which is found in larger volumes in people with asthma, using the fractional exhaled nitric oxide (FeNO) test, and carry out a bronchodilator reversibility (BDR) test. The treatment of under-5s should be based on professional judgment and observation until the child is old enough to take clinical tests.

Around 1 in 10 of adults with asthma develops the condition because they are exposed to certain substances, such as chemicals or dust, in their workplace. The draft guideline also recommends that healthcare professionals should ask employed people how their symptoms are affected by work to check if they may have occupational asthma.
Professor Mark Baker, director of clinical practice at NICE said: “Asthma is a long-term incurable condition that affects millions of people of all ages. If left untreated asthma attacks can be life threatening.

However, with appropriate treatment...

Read more..
Take Action to Fight Against Lung Disease

Join the American Lung Association in its effort to eliminate tobacco-caused death and disease! By taking action to prevent and reduce tobacco use in your state, you are standing with the American Lung Association to advance the fight against lung disease. As part of the American Lung Association Action Network, you can also take action to reduce other lung diseases and support our efforts to make indoor and outdoor air safe to breathe. Thank you for taking action!

State Alerts
Help the American Lung Association implement its road map to eliminate tobacco-caused death and disease in the U.S. Elected officials must take action to pass the tobacco control policies called for in State of Tobacco Control 2015 to reduce smoking rates to 10 percent by 2024 and protect everyone from secondhand smoke. Choose a specific state alert you would like to take action on at the American Lung Association Tobacco Control by clicking here.

In this New Year it is truly time for you to get serious with your practice and your patients to stomp out smoking. What better way to do so then to implement a solid Smoking Cessation program.  Hold your patient’s hands, encourage them, and test them to ensure they are taking their health seriously.  Join us in supporting the American Lung Association and our efforts to help others to stop smoking once and for all. 

Our Smoking Cessation products can help support you in this New Year!


Read more..
Asthma, COPD Linked With More Inflammatory Bowel Disease

In this New Year, it is important for us to be educated about new studies that have come out in reference to airway management, asthma, COPD, and more.  A higher incidence of inflammatory bowel disease (IBD) has been found in persons with airway diseases, such as asthma and COPD, in a study published online ahead of print in European Respiratory Journal.

Lead author Paul Brassard, MD, and fellow investigators determined that the incidence of Crohn disease was 27% higher in persons with asthma and 55% higher in persons with COPD, and that incidence of ulcerative colitis was 30% higher in persons with COPD.

These percentages were determined in comparison with the general population of Québec, which the investigators noted is the province with the second-highest incidence of Crohn disease in Canada and a prevalence of asthma and COPD that is above the Canadian average.

"Although a link has previously been suggested, this is the first study to find significantly increased rates of IBD incidence in people with asthma and COPD," said Brassard in a statement from the European Lung Foundation. "If we can confirm a link between the two conditions it will help diagnose and treat people sooner, reducing their symptoms and improving their quality of life."

The researchers noted in their study that when patients with airway disease develop digestive symptoms, clinicians need to be aware of the possible occurrence of new cases of IBD, even in older age groups and regardless of smoking status.

Brassard's group identified 136,178 persons with asthma and 143,904 persons with COPD in the administrative health databases of Québec. Among those with asthma, there was an average incidence of 23.1 cases of Crohn disease and 8.8 cases of ulcerative colitis per 100,000 person-years.

Among persons with COPD, there were 26.2 cases of Crohn disease and 17 cases of ulcerative colitis per 100,000 person-years. The incidence of both Crohn disease and ulcerative colitis in elderly patients with COPD was significantly higher than in the general population.

Women with asthma were more likely than men to develop Crohn disease, and men with COPD were more likely than women to develop ulcerative colitis.

The researchers pointed out that immunologic dysfunctions triggered by environmental factors are a common element in the pathogenesis of both IBD and airway diseases such as asthma and COPD, and that pulmonary involvement is one of the extraintestinal...

Read more..
FIRS Mobilizes Members to Raise Awareness on COPD and Smoking Cessation

The Forum of International Respiratory Societies (FIRS) is continuing to mobilize its members to raise awareness of COPD and help prevent the risk factors that cause it.

210 million people have COPD worldwide, causing the death of at least 2.9 million people each year. It is the sixth major cause of death and disability in low- and middle-income countries and is projected to be the third most common cause of death by 2020.

World COPD Day, which is observed in November each year, was an opportunity to highlight the impact of COPD to governments, politicians, funding agencies, clinicians, public health personnel, and also the general public—but it can’t stop there.

FIRS is dedicated to raising awareness of the disease.  The alliance hopes to highlight some of the key risk factors, diagnosis, and essential management components of the disease.

Risk Factors for COPD
Risk factors for COPD other than smoking tobacco are being increasingly recognized. These include environmental exposures, such as occupational exposures to dusts and fumes, and indoor biomass fuel burning in many developing countries.

Epidemiological studies indicate that the most common risk factors for COPD are age, smoking, indoor exposure to coal and workplace exposure to dust.

Spirometry is Essential for COPD diagnosis
One possible explanation of the inaccurate diagnostic labelling of COPD is the underutilization of spirometry for COPD diagnosis. Only 20% of individuals surveyed in a population-based study had undergone spirometry sometime in their life. Spirometry training programs, as well as the availability of spirometers in the primary care setting, are still scarce—and that is where MD Spiro comes into play.

Treatment and Prevention of COPD
Patients should have access to comprehensive treatment including education for patients and family, smoking cessation programs, medication, pulmonary rehabilitation, and oxygen therapy as prescribed.

Prevention of smoking and exposure to pollutants, such as coal and dust, are the interventions most likely to succeed against COPD worldwide.

ATS President Tom Ferkol, MD said: "COPD is a global killer. It is a major cause of death and disability in low- and middle-income countries and is projected to be the third-leading cause of death by 2020. We have joined together with other members of the Forum to highlight the impact of COPD to the public and policymakers. Understanding the risk factors for COPD, raising...

Read more..
November Is COPD Awareness Month: The Third Leading Cause of Death in the U.S.

Try to imagine what it might feel like to take every breath through a straw. For many people with lung diseases like chronic obstructive pulmonary disease or COPD, they don't have to imagine because that's what breathing can feel like on many days, especially days when air pollution levels are high. With COPD it often becomes more and more difficult for people to breathe over time because the air sacs that carry air from the nose and mouth to the lungs become less elastic.

November is COPD Awareness Month and Wednesday, Nov. 19, was World COPD Day. If there's one thing that the American Lung Association of the Northeast wants the public to know as we shine the spotlight on this disease this month is that COPD can be treated.

When diagnosed early and properly managed, both COPD's progression and its severity can be minimized. That's why it is so important to be aware of the signs and symptoms of this disease so that if you notice symptoms in yourself or a loved one, you know to make an appointment to see your doctor right away.

Are your lungs trying to tell you something?

The most common symptoms of COPD include constant coughing, shortness of breath while performing everyday activities, excess sputum production, feeling unable to breathe or take a deep breath, and wheezing. COPD most often occurs in people age 40 and over who have a history of smoking, have had long-term exposure to lung irritants or have a rare genetic condition called alpha-1 antitrypsin (AAT) deficiency.

COPD is the third leading cause of death in the United States, claiming more than 120,000 American lives each year. More than 12 million people have been diagnosed, but another 12 million people are likely to have COPD and don't know it.

Particularly alarming is the rise of COPD in Women. Last year, the American Lung Association reissued its report Taking Her Breath Away, which found that the number of deaths among women from COPD has increased four-fold over the past three decades. Since 2000, more women than men in this country have died of this disease.

As we observe COPD Awareness Month, please spread the word to your loved ones that if they have trouble breathing they should see their doctor. Never assume that trouble breathing is a normal part of aging; it is not. Get yourself checked out. COPD is diagnosed using a simple test called spirometry. Spirometry is a noninvasive test that checks the amount of air you can blow out of your lungs and how fast you...

Read more..