Study aims to find ways to reduce COPD hospitalizations
When it comes to chronic obstructive pulmonary disease (COPD), certain Pennsylvania populations — including urban African Americans and rural residents — tend to develop more acute cases, which in turn can lead to longer and more frequent hospitalizations.
In an effort to understand what factors underpin this phenomenon and to reduce emergency room visits and excessive inpatient care, Gerard Criner, professor of medicine at the School of Medicine and director of pulmonary and critical care medicine at Temple University Hospital, is heading a Center for Excellence research consortium funded by a $4.7 million grant from the state Department of Health. Participants in the group include Lancaster General Hospital, Philadelphia Osteopathic Medicine, the University of Pittsburgh and the Western Pennsylvania Hospital. Geneticists at Harvard Medical School are also involved in determining if specific genotypes from these two disparate groups may influence the severity of the disease.
COPD, which includes chronic bronchitis, asthma and emphysema, is most often caused by smoking, and leaves sufferers winded, weak and too fatigued to pursue their regular activities. As the fourth-largest killer in the United States, in 2000 alone, COPD resulted in 1.5 million emergency room visits, 726,000 hospitalizations and 119,000 deaths. And, thanks to higher smoking rates in women over the past several decades, the rate of women dying from COPD has increased more than 150 percent since 1980.
“For most of these patients,” Criner said, “acute COPD can occur two or three times a year.” The condition, which Criner likened to a “heart attack of the lungs,” causes increased breathlessness, additional mucus production and blocked airways. It can be worsened by winter weather, pollution, infection and inflammations. “Exacerbations of COPD can have a morbid and costly dramatic impact,” he said.
The study, divided into two phases, is under way. The first phase has begun to evaluate urban and rural participants based on various factors, including demographics, ZIP codes, and gender to see which may influence the severity of the disease.
“So far, it’s too early to know if any of these factors play a part,” Criner said. “We've noted, for example, that people of African-American heritage tend to have a higher risk of severe COPD than Caucasians. But as yet, we don't know why.”
In the study's second phase, 40 COPD patients who have recently finished one- to three-month hospital stays have been supplied with personal digital assistants, on which they are asked to record the daily ups and downs of life with COPD. The goal is to see if personal monitoring can reduce the need for future hospitalization and cut down on exacerbations.
Participants, who are drawn from six separate sites, are asked to record changes in their medical condition, ranging from the color of their mucus to their body temperature. Patients in the study also have 24-hour access to pulmonary nurses and physicians via a 1-800 number. By keeping track of their day-to-day medical status and having unlimited and easily available advice at their fingertips, the program is designed to help patients “anticipate exacerbated conditions and to improve treatments of acute COPD,” Criner said.
“Panicked patients often end up in hospital emergency rooms, which can in turn, lead to hospital stays,” Criner said. “We want to see what effect charting symptoms has on prevalence and severity of COPD. The hope is that by collecting a daily diary and measuring the daily lung functions of the patients, we might be able to intervene day or night to prevent the need for admissions.”
Overall, the hope is that patients afflicted with reduced lung function will learn to understand the symptoms for exacerbation and to try to understand what makes it work.
“All the reasons that could account for a more severe incidence of COPD among rural residents and among African Americans could be addressed through education and early intervention,” Criner said.
- By Eryn Jelesiewicz