Research

Study aims to reduce COPD hospitalizations

A research consortium led by the School of Medicine’s Gerard Criner has entered phase 2 of its investigation into why certain Pennsylvania populations — including urban African Americans and rural residents — tend to develop more severe chronic obstructive pulmonary disease (COPD).

During the first phase of the research, urban and rural participants were evaluated based on various factors, including demographics, ZIP codes and gender to see which influence the severity of the disease.

“So far, it’s too early to know if any of these factors play a part,” Criner reported. “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 recording 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 of the illness.
Participants, who are drawn from six separate sites, are being 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 continued. “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. 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.”

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, due to higher smoking rates in women over the past several decades, the death rate from COPD has increased for women more than 150 percent since 1980.

“For most of these patients,” said Criner, “acute COPD can occur two or three times a year.”

The condition, which Criner likens 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 noted.

Participants in the research consortium 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 might influence the severity of the disease.

- By Eryn Jelesiewicz