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Researchers Study Diagnostic Error in Asthma, COPD

Researchers at the University of Illinois at Chicago have been awarded a $1.5 million grant from the Agency for Healthcare Research and Quality to study the impact of diagnostic error on outcomes for pulmonary patients and the use of lung-function testing in primary care.

More than 30 million adults in the U.S. have been diagnosed with asthma or chronic obstructive pulmonary disease, which includes emphysema and chronic bronchitis, and many receive daily treatment. However, studies suggest 30 to 50 percent of these patients may have an incorrect diagnosis.

Spirometry is the nationally and internationally recommended test for diagnosing asthma and COPD and who better to partner on spirometry with then MD Spiro.

"Despite the clinical guidelines supporting the use of spirometry to identify asthma and COPD, many patients do not receive the test prior to receiving a diagnosis," says Dr. Min Joo, principal investigator on the grant and associate professor of medicine in the UIC College of Medicine.

Spirometry tests lung function by measuring how much and how fast a patient can move air out of the lungs. The patients take a big breath and exhales as hard and long as possible into a machine.

Joo says that without a spirometry test, patients are at risk for worse sickness and even death, as well as unnecessary medical costs that disproportionately affect African Americans and underserved minority populations.

"A shocking number of patients are misdiagnosed and face a two-fold danger," she said.

"First, they are taking medication for a condition they may not have, creating unnecessary exposure to the side effects and complications of those medications, such as pneumonia from using inhaled corticosteroids. Second, their real conditions are left unidentified and untreated. This may be particularly true for minority and underserved populations who are known to have multi-morbidities and therefore have a number of potential causes for shortness of breath and other breathing-related issues," Joo said.

One study found that up to 65 percent of COPD patients seen in a federally qualified health center turned out not to have COPD when spirometry was later performed.

"In the past, attempts to increase the use of spirometry in a primary care setting have had limited long term success, and a new approach is needed to reduce diagnostic error and better understand its impact on patient safety and outcomes," Joo said. "Our study will test an approach...

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Be a Hero.  Help Your Patients Quit Today.

Introducing the New Freedom From Smoking® Plus from the American Lung Association

About 70 percent of smokers say they want to quit and 40 percent will make a quit attempt this year.

In order to continually provide the most comprehensive and effective smoking cessation program in the country, the American Lung Association unveiled its newest addition to the Freedom From Smoking® program: an interactive, online quit-smoking experience for the 19.4 million tobacco users who make a quit attempt every year.

Coupled with the Freedom program and our smoking cessation product the SmokeCheck Breath CO Monitor, you can help empower your patients to “Be a Hero” for themselves and their family.  

Freedom From Smoking® Plus will help smokers quit for good through a new highly engaging platform that includes activities, videos, quizzes and more. Over the course of nine sessions, users create a personalized quit plan, learn about medications to help them quit, get through the rough patches and transition to a smoke-free lifestyle.  In addition, individuals using the program can lean on the support network of the American Lung Association that includes:

  • An online support community with other quitters who understand how hard it can be to quit and can help motivate each other to stay smoke-free.
  • Certified tobacco cessation counselors at the Lung HelpLine that are available through 1-800-LUNGUSA any time a quitter has a question or needs extra support during the quitting process.

See FreedomFromSmoking.org in action on your desktop, tablet or smartphone and share this new tool with friends and loved ones that want to quit smoking.

For over 35 years, our Freedom From Smoking® program has helped hundreds of thousands of people break their addiction to tobacco through our group clinic and through our self-help guide. Thanks to our efforts and those of our partner organizations, there are now more former smokers than current smokers in the United States. With the addition of Freedom From Smoking® Plus, the American Lung Association is poised to help even more people be smoke-free for good.  

To celebrate the successes of people that have found smoke-free freedom, we are sharing personal stories from former smokers. Through the EACH Breath blog, ten individuals will share how they were able to break their addiction to tobacco and encourage smokers to give quitting a try.

You can follow their stories on Facebook and Twitter with...

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Decline in Smoking is Reducing COPD Deaths

Fewer Americans are dying from chronic obstructive pulmonary disease (COPD), but not black women and the middle-aged, a new government report shows.

Between 2000 and 2014, there was a 12 percent overall drop in deaths from the progressive lung disease, according to the U.S. Centers for Disease Control and Prevention. 

Report co-author Hanyu Ni said the figures aren't unexpected, noting that "the declines in the COPD-related mortality are consistent with declines in the prevalence of current smoking for men and women in the United States."

But, Ni added, the study only quantified death rate trends, and didn't look at the reasons behind those trends. Ni is an associate director for science with the CDC's division of vital statistics at the U.S. National Center for Health Statistics.

Dr. David Mannino, who's with the University of Kentucky's College of Public Health, agreed that the study "results are not surprising." He, too, cited the nationwide decline in smoking, the No. 1 cause of COPD.

"Smoking is the biggest factor driving COPD deaths in the U.S.," said Mannino, a professor of medicine in the division of pulmonary, critical care and sleep medicine.

Chronic obstructive pulmonary disease is a progressive disease of the airways that makes it difficult to breathe. COPD includes emphysema and chronic bronchitis. It's the third-biggest killer in the United States, and most people with COPD are current or past smokers, according to the U.S. National Heart, Lung, and Blood Institute.
For the study, Ni's team reviewed data collected by the National Vital Statistics System between 2000 and 2014.

The report painted a mixed picture of risk.

For example, while men saw their COPD fatality rate drop by nearly 23 percent, women saw their rate fall by just 4 percent.

Age also played a role. Men between the ages of 65 and 84 saw their death rate drop by nearly 30 percent, while those 85 and older saw their rate dip by 23 percent. But for men between 45 and 64, the death rate rose by nearly 13 percent.

Similarly, women between 65 and 84 saw their death rate drop by 16 percent. But those between 45 and 64 saw a rise of 24 percent, while the death rate among those 85 and older increased more than 6 percent.

When the numbers were broken down by race, white women saw little change during the study period, while black women saw their death rate rise by 4 percent. Conversely, white men experienced a drop of 21 percent, while black men saw...

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Children With Food Allergies Predisposed to Asthma and Rhinitis

Children with a history of food allergy have a high risk of developing asthma and allergic rhinitis during childhood as well. The risk increases with the number of food allergies a child might have, say researchers from The Children's Hospital of Philadelphia (CHOP) in a new study recently published in BMC Pediatrics.

"Eczema, asthma and allergic rhinitis are among the most common childhood medical conditions in the U.S.," said lead researcher David A. Hill, MD, PhD, an allergy and immunology fellow with an interest in food allergy. "Disease rates for these conditions seem to be changing, prompting a need for more information and surveillance." Compared with previous reports, this study found higher rates of asthma and lower rates of eczema, a skin inflammation.

In Philadelphia, asthma rates are among the highest in the nation, affecting one in five children. In this study, the researchers found an asthma prevalence rate of 21.8 percent.

The study is a retrospective analysis of the electronic health records of more than one million urban and suburban children in the CHOP Care Network from 2001 to 2015. The researchers divided the records into two cohorts: a closed-birth cohort of 29,662 children, followed continuously for their first five years of life, and a cross-sectional cohort of 333,200 children and adolescents, followed for at least 12 months. The patients were 48 percent white and 40 percent black.

While prior studies have suggested patients with food allergies are at increased risk of developing asthma, those analyses were small and limited. This study is the largest to date to examine the characteristics of healthcare provider-diagnosed eczema, asthma, allergic rhinitis and food allergy in a pediatric primary care population.
In the closed-birth cohort, the incidence of at least one food allergy between birth and age five was 8 percent, with the peak age of diagnosis between 12 and 17 months of age. The overall prevalence of at least one food allergy for the large cross-sectional cohort was 6.7 percent, in line with previously published rates. However, allergies to specific foods diverged from previous patterns. Allergies to peanut, milk, shellfish and soy were proportionately higher in the study population, while wheat allergy was proportionately rarer, and sesame allergy was higher than previously appreciated.

The researchers said that further studies should examine whether the food allergy patterns they found are comparable...

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National Asthma and Lung Groups Collaborate to Empower Patients and Raise Awareness About Disease Severity

The Allergy & Asthma Network recently partnered with the CHEST Foundation for a joint campaign to empower patients with persistent, difficult-to-control asthma.

The campaign hopes to increase patients’ understanding of their condition through special education programs. It also aims to ensure that patients, families, caregivers, and healthcare providers are aware of the latest asthma treatment options, the importance of a specialist referral, and highlight the role of the healthcare team and loved ones in the care of an asthma patient.

“The CHEST Foundation has long been dedicated to supporting and educating those affected by asthma and asthma-related conditions,” John Howington, president of the CHEST Foundation, said in a press release. “We are proud to be working with the Network to help patients nationwide start living their lives in a healthier, more enjoyable way due to decreased asthma interference.”

The CHEST Foundation disseminates patient education material and programs, clinical research grants, and community service efforts. Since its inception in 1996, the foundation has awarded more than $10 million in research funding for lung health.

The Allergy & Asthma Network specializes in sharing family-friendly, medically accurate information through its magazine, Allergy & Asthma Today. For more than 30 years, the Allergy & Asthma Network has been leading efforts to halt asthma suffering, and realizes the severity of misunderstood asthma symptoms.

“Despite many advances in healthcare, 10 Americans die every day from asthma and asthma-related complications,” said Tonya Winders, president and CEO of the Allergy & Asthma Network.

“These deaths can be prevented with continued education of both patients and providers – a sentiment that the CHEST Foundation shares with our organization. This campaign is a joint effort to raise the understanding of asthma across the country, especially in urban areas where the illness is most severe.”

The new collaborative initiative will work to raise awareness about asthma by tailoring the organizations’ efforts toward patients, caregivers, schools, parents, clinicians, and everyone involved in the lives of those living with severe asthma. The initiative will focus on helping individuals feel more empowered by a better understanding of their condition, and gaining access to updated research and resources to more effectively manage their condition.

The asthma awareness...

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COPD Patients Underuse Pulmonary Rehab, Study Shows

New research conducted by The University of Texas Medical Branch at Galveston suggests that pulmonary rehabilitation (PR) therapy among older adults with chronic obstructive pulmonary disease (COPD) is underutilized – despite the health benefits and cost effectiveness of the therapy.

The study recently published in the Journal of Cardiopulmonary Rehabilitation and Prevention, is the first to describe the PR trends among COPD patients.

COPD is associated with disabling dyspnea (difficulty breathing), skeletal muscle dysfunction, significant rise in occurrence, and a common cause of death.

Current guidelines recommend PR to improve dyspnea, functional capacity, and quality of life. PR is designed to relieve symptoms and flares of COPD, and also to teach patients how to manage the disease.

Patients who receive PR show a reduction in shortness of breath, increased exercise ability, improved health-related quality of life, and less need to seek healthcare help.

“The majority of the economic burden of caring for COPD stems from hospitalization for sudden COPD flare-ups,” said Dr. Shawn Nishi, an assistant professor at UT’s Internal Medicine Division of Pulmonary, Critical Care and Sleep Medicine, in a press release. “PR is known to reduce COPD-related emergency room visits, hospitalizations and unscheduled doctor visits. PR provides an overall cost-effective management for a health care system.”

In the study, researchers analyzed PR trends and patterns among approximately 33,000 COPD patients with Medicare insurance between 2003 and 2012.

The team observed a modest increase in patients using PR; from 2.6% in 2003 to 3.7% in 2012; but overall rates of PR use remains low.

Results revealed that patients with COPD who were more likely to get PR were younger, non-Hispanic white, higher in socioeconomic status, with multiple health issues, and patients with multiple evaluations by a pulmonary doctor.

The largest PR increases during the study time, were among male patients older than 75 years, people from Black ethnic backgrounds, patients with higher socioeconomic status, and among those with other health issues.

“Starting in 2015, the Centers for Medicare and Medicaid Services added COPD to the list of conditions subject to penalties for readmissions to the hospital within 30 days after release,” said Nishi. “As the health care system shifts from volume- to value-based reimbursement from CMS, it is prudent for health...

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FDA Extends Authority to e-Cigarettes: Implications for Smoking Cessation?

On August 8, a final rule from the US Food and Drug Administration (FDA) goes into effect that tobacco control experts say could dramatically change the status of e-cigarettes in this country. The rule extends the agency’s regulatory authority to all tobacco products, including e-cigarettes, and requires manufacturers to report product ingredients and undergo the agency’s premarket review to receive marketing authorization.

The move is intended to “improve public health and protect future generations from the risks of tobacco use,” the FDA said in a statement. Tobacco-control experts lauded the FDA for restricting e-cigarette use in adolescents: the rule makes it illegal for the products to be sold in person or online to people younger than 18 years. Use of e-cigarettes has skyrocketed among adolescents, and there’s some early evidence that it may lead to cigarette smoking in this demographic. 

Yet some experts have expressed misgivings about unintended consequences of tight regulations that could potentially block cigarette smoking cessation efforts by adult e-cigarette users.

The concerns bring to light the health conundrum presented by e-cigarettes: do these devices deliver a recreational drug or a medicine? If they can do both, which some experts argue is likely the reality, how do health agencies and health care professionals balance the risks with the benefits?

POPULARITY GROWS
According to the first estimates from a nationally representative household interview survey, more than 12% of US adults have tried an e-cigarette, while less than 4% are current users. Since they entered the US market in 2007, e-cigarettes, which typically contain nicotine in varying dosages, have become increasingly popular among cigarette smokers trying to quit or reduce their harm.

“Survey after survey shows [that] when you ask people who have tried e-cigarettes what [they tried] for, one big chunk says to quit smoking and another big chunk says to reduce smoking,” said Jonathan Foulds, PhD, professor of public health sciences and psychiatry at Penn State College of Medicine’s Cancer Institute.

There aren’t robust data yet on how many people in the United States are switching from cigarettes to e-cigarettes to help them quit. However, in the United Kingdom, where e-cigarettes are already a widely accepted quit-smoking tool, there’s a clear preference for the devices over traditional nicotine replacement therapy (NRT).

The trend...

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Coal Dust Kills 23,000 Per Year in EU: Report

The report blamed coal plant pollution for nearly 12,000 new cases of chronic bronchitis and more than half-a-million asthma attacks in children in the EU in 2013

HIGHLIGHTS

  1. There are a total of 280 coal-fired plants in the European Union
  2. Coal accounted for 18% of EU's greenhouse gas emissions in 2014
  3. Poland, Germany, Romania, Bulgaria and UK among the worst offenders

Paris, France: Lung-penetrating dust from coal-fired power plants in the European Union claims some 23,000 lives a year and racks up tens of billions of euros in health costs, an NGO report said Tuesday.

Even as the bloc shifts towards renewable sources like wind and Sun energy, coal still accounted for 18 per cent of the EU's greenhouse gas emissions in 2014 and a quarter of its electricity mix in 2015, said the analysis.

Emissions from 257 power plants for which data was available "were associated with 22,900 premature deaths in 2013," said the report entitled "Europe's dark cloud: How coal-burning countries make their neighbors sick".

There are a total of 280 coal-fired plants.

The study was compiled by researchers from four green energy lobby groups: the Health and Environment Alliance, the WWF, Climate Action Network Europe and Sandbag.

In addition to deaths, the report blamed coal plant pollution for nearly 12,000 new cases of chronic bronchitis and more than half-a-million asthma attacks in children in the EU in 2013.

The medical treatment required, as well as reduced productivity caused by absence from work, amassed "substantial costs" of 32.4 billion to 62.3 billion euros ($36 billion to $70 billion), said the report.

About 83 percent of deaths, some 19,000 in total, were blamed on inhalation of fine particulate matter, air-borne particles so small -- under 2.5 micrometers in diameter -- that they can enter deep into the lungs and bloodstream.

Hearth Disease, Cancer

"Most common causes of death connected to particulate matter exposure are strokes, heart disease, chronic lung disease or lung cancer," said the report.

It warned the particles "are transported hundreds of kilometers and across national borders, impacting the health of people both within the country of production and further afield."

The report listed the EU's worst offenders, attributing 4,690 premature deaths to coal power stations in Poland, 2,490 to Germany, 1,660 to Romania, 1,390 to Bulgaria and 1,350 to Britain.

The five countries most affected by pollution...

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