Southern Regional Meeting 2017, New Orleans, LA, February 11-13 ...

UHS Chenango Memorial Expands Pulmonology Services

NORWICH – Respiratory disorders such chronic obstructive pulmonary disease and asthma impact many lives in Chenango County. According to a nurse practitioner who specializes in such illnesses, there are a number of factors that contribute to the prevalence of these long-term lung diseases.

"Smoking and tobacco use certainly plays a role, as does environmental exposure," explained Mary Rivera, ANP. "From exposure to mold and mildew to jobs in the building and manufacturing trades, there are many contributing factors that can place someone at risk of developing a respiratory disorder or worsen an existing condition."

Often lung disease is an underlying condition that is either undiagnosed or unmanaged, Rivera said.

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Recognizing the unmet need, UHS Chenango Memorial sought to expand pulmonology services. They recruited Rivera, who has practiced with UHS in acute and critical care roles for close to 25 years.

"We are thrilled to welcome Mary to our team at UHS Cardiology in Norwich. She is an experienced Nurse Practitioner with a longstanding affiliation with UHS and CMH. Her expertise in critical care and pulmonology is something our community desperately needs," said Chris Kisacky, Vice President of Service Coordination and Development at UHS Chenango Memorial Hospital.

PHC Pulmonology Gains National Recognition For COPD And Pneumonia Treatment

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Piedmont HealthCare announced that PHC Pulmonology has been recognized in America's Top 100 Hospitals for Pulmonary Care for COPD and pneumonia at Iredell Memorial Hospital through Healthgrades.

The PHC Pulmonary Medicine, Critical Care Medicine and Sleep Medicine office is comprised of four physicians: Dr. Ahmed Elnaggar, Dr. Jose Perez, Dr. Enrique Ordaz and Dr. Vishal Patel. When asked about their recent award, Perez stated, "This recognition is a big deal for a small hospital compared to a lot of the other institutions on the list and their available resources. I know that we can do even better and there are still opportunities to explore and improve."

Healthgrades awards tell you which hospitals deliver superior quality care. Healthgrades evaluates hospital performance using objective quality measures including clinical outcomes and patient safety, as well as patient experience, the organization's website reads.

To book at appointment with Piedmont HealthCare Pulmonology, call 704-838-8240.

The office has two locations. Statesville: 208 Old Mocksville Road, and Mooresville: 170 Medical Park Road, Floor 2.

In COPD And Pulmonary Hypertension, Potential Care Gaps Warrant Further Research

Posters presented at the 2023 American Thoracic Society International Conference called for improvements in care for chronic obstructive pulmonary disease (COPD) and pulmonary hypertension.

A series of posters presented at the 2023 American Thoracic Society International Conference focused on advancing care for patients with chronic obstructive pulmonary disease (COPD) and pulmonary hypertension (PH), with studies highlighting areas with room for improvement when it comes to caring for patients with pulmonary conditions.

Focusing on the Patient Experience

Patients with COPD experience declines in quality of life due to clinical symptoms, but also psychological distress from the stigma associated with the condition, according to one abstract.1

The study aimed to validate the COPD-related Stigma Scale (COPDSS), a 24-item survey designed to measure COPD-related stigma and its effect on patients. "A validated scale for measuring COPD-related stigma is critical to understanding COPD-related stigma effects and their magnitude," the authors wrote.

The cross-sectional study evaluated the factor structure of the scale and its reliability, validity, and sensitivity in 271 patients with COPD who completed the COPDSS online. The scale showed adequate to high internal consistency reliabilities, as measured by Cronbach's α, and confirmatory factor analysis indicated that one higher order (COPD stigma) with 4 subscales (social stigma, felt stigma, anticipated stigma around oxygen, and smoking-related stigma) fit the data well.

Considering there has been limited research on stigma and COPD, consistent measurement of such factors could fill a knowledge gap and allow for more personalized care, and the COPDSS may hold potential as a measure of COPD-related stigma. Most of the population was female and Caucasian, and research in diverse populations may be needed, the authors noted.

Another poster explored the association of supplemental oxygen use and symptoms, health status, and mood in patients with PH.2

Supplemental oxygen is often used as a supportive therapy for PH, as it reduces pulmonary vascular resistance and can ease symptoms. However, the symptom profile and health status in those who use supplemental oxygen is not well researched, according to the authors.

In the study, which was a secondary analysis of a cross-sectional study of 176 adults with PH, participants were stratified into 2 cohorts: oxygen use (n = 115) and no reported oxygen use (n = 61).

All participants completed surveys related to physical and mental health status. These included the Sociodemographics, Pulmonary Arterial Hypertension Symptom Scale (PAHSS) to gauge symptom severity, the Pulmonary Arterial Hypertension Symptom Interference Scale (PAHSIS) for the degree to which symptoms interfere with life, the Medical Outcomes Study Short Form (SF)-36 to determine health status, and the Profile of Moods State (POMS) to gauge patient mood.

Patients using oxygen were significantly older and showed higher PAHSS and PAHSIS scores. They also showed worse SF-36 and POMS scores compared with patients who reported no oxygen use. Overall, those using supplemental oxygen reported more significant symptom severity and interference with daily life compared with patients who were not using oxygen.

A notable limitation was a lack of data on how participants used their supplemental oxygen, which varies from patient to patient. The patient population was also 86% female and mostly non-Hispanic White, potentially limiting its generalizability.

"Future research will help determine who may benefit from supplemental oxygen and the effect on symptoms, health status, and function," the authors wrote.

Addressing Potential Care Gaps in Respiratory Conditions

One poster examined the incidence of obstructive sleep apnea (OSA) in patients with severe and very severe COPD to determine the effect screening for OSA may have in this population.3

COPD and OSA occurring simultaneously is known as overlap syndrome, and these patients experience more severe oxygen desaturations during sleep vs those with either COPD or OSA alone. When treated with continuous positive airway pressure (CPAP), they have a lower mortality risk compared with patients who are not treated, so identifying patients with overlap syndrome who may benefit from CPAP is important.

Patients with COPD and no prior diagnosis of OSA were screened with an at-home cardiorespiratory monitor, and the researchers found that patients had a high rate of OSA and/or nocturnal oxygen desaturation. Of 67 participants with COPD, 38 (57%) were shown to have symptomatic OSA and/or nocturnal desaturation. These findings suggest that screening for OSA should be standard for patients with severe or very severe COPD, the authors concluded.

Another area where unmet care needs are present is the treatment of women with advanced COPD, according to the final poster presented during the session.4

COPD is a condition that carries a significant symptom burden, and women report an increased number of exacerbations, higher symptom burden, and lower quality of life than men with the condition. As COPD progresses, palliative care (PC) is recommended to improve quality of life, the authors noted.

"The Global Initiative for Chronic Obstructive Lung Disease recommends early integration of PC and throughout continuum of care as disease progresses to improve QOL," the authors wrote. "Thus, the primary objective of this study is to explore the unmet care needs, identify barriers to care, and knowledge of PC services of women with advanced COPD."

Participants in the study (n = 30) completed questionnaires related to quality of life, COPD symptoms, and PC, if applicable. Preliminary results found that women with advanced COPD reported unique care barriers to accessing resources, such as medications or oxygen. Another commonly reported theme was stigmatism, as well as emotions such as anger and embarrassment due to the stigma around COPD. None of the participants were receiving PC, and most had never heard of it.

The findings suggest there are unmet care needs among women with advanced COPD and that further research into barriers to care is needed. PC may be underutilized, and emotional support resources are lacking.

Overall, presenters emphasized the need for more research on the patient experience and possible care gaps to optimize the treatment of patients with COPD, PH, and other lung conditions.

References

1. Woo S, Reich JC, Pond RS. Validity and reliability of the Chronic Obstructive Pulmonary Disease-Related Stigma Scale using confirmatory factor analysis. Poster presented at: American Thoracic Society International Conference; May 20-24, 2023; Washington, DC. Accessed May 22, 2023. Https://cattendee.Abstractsonline.Com/meeting/10703/Presentation/9124

2. Matura L, Proana M, Iroegbu. The association of oxygen use and symptoms, health status and mood in pulmonary hypertension. Poster presented at: American Thoracic Society International Conference; May 20-24, 2023; Washington, DC. Accessed May 22, 2023. Https://cattendee.Abstractsonline.Com/meeting/10703/Presentation/9126

3. Hilberg O, Gantzhorn EK, Jensen HI, Loekke A, Hansen KK. The effect of screening for obstructive sleep apnea in severe and very severe COPD - an exploratory clinical study. Poster presented at: American Thoracic Society International Conference; May 20-24, 2023; Washington, DC. Accessed May 22, 2023. Https://cattendee.Abstractsonline.Com/meeting/10703/Presentation/9123

4. Madiraca J, Lindell KO, Phillips S, Coyne P, Miller S. Exploring the unmet care needs of women with advanced chronic obstructive lung disease (COPD). Poster presented at: American Thoracic Society International Conference; May 20-24, 2023; Washington, DC. Accessed May 22, 2023. Https://cattendee.Abstractsonline.Com/meeting/10703/Presentation/12309

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