Barry Make, MD

Navigating care for patients with chronic obstructive pulmonary disease can be a course fraught with obstacles. COPD researchers and clinicians will get guidance from experts at three morning sessions during ATS 2011.

The first, B2 “A Large, Multicenter Cross-Sectional Clinical, Radiographic and Genomic Characterization Study in COPD: Lessons from COPDGene,” will take place from 8:15 to 10:45 a.m. Monday in the Four Seasons Ballroom 1-2 (lower level) of the Colorado Convention Center.

COPDGene is an observational study, funded by the National Heart, Lung, and Blood Institute, designed to identify genetic factors associated with COPD.

“The reason previous attempts to do this have been unsuccessful is because COPD is not a single disease,” said Barry Make, MD, co-chair of the symposium. COPDGene has enrolled 10,000 subjects, smokers with and without mild to severe COPD.

COPDGene is working to characterize the disease process—including assessing emphysema, gas trapping and airway wall thickening—by using high-resolution CT chest scans to phenotype COPD. Then subtypes of COPD based on the phenotypes will be used in a comprehensive genome-wide study to identify COPD susceptibility genes.

Dr. Make, professor in the division of pulmonary sciences and critical care medicine at National Jewish Health and the University of Colorado in Denver, promised a rich mix of information from the ongoing study, including:

 
As for the “lessons” stated in the course’s title, Dr. Make said that attendees would learn how to design a study to ensure enrollment targets are met, improve management of patients using CT scans and recognize the influence of race and gender on clinical outcomes to better target therapy.

James Crapo, MD, also of National Jewish Health and the University of Colorado, and Gerard J. Criner, MD, of Temple University in Philadelphia, will co-chair the session.

This session and the International Conference are supported by educational grants from AstraZeneca, LP, Boehringer Ingelheim Pharmaceuticals, Inc. and Forest Laboratories, Inc. The grants have no influence on the content, quality and scientific integrity of this CME activity, which is developed by the American Thoracic Society. All CME sessions are free of the control of commercial interests.

Debating the Future
From 8:15 to 10:45 a.m. on Tuesday, session C7 “Charting the Future of Pulmonary Rehabilitation: Cutting-Edge Debates” will focus on four issues that could shape the future of pulmonary rehabilitation, said Richard Casaburi, MD, PhD, symposium co-chair. The symposium will take place in the Centennial Ballroom A-B-C on the third level of the Hyatt Regency Denver.

Experts will debate the pros and cons of:

Richard Casaburi, MD, PhD

“Pulmonary rehabilitation is at a crucial crossroads,” said Dr. Casaburi, who is professor of medicine at Harbor-UCLA Medical Center’s Los Angeles Biomedical Research Institute. While the scientific basis of the discipline has grown, access to what has become the standard of care for those debilitated by lung disease is poor in many regions.

“For pulmonary rehabilitation to move forward, a number of choices will have to be made,” he said. “Because of a gap in professional practice and differences in practices among centers, many patients entering pulmonary rehabilitation will not gain optimal benefit.”

According to Dr. Casaburi, addressing the differences will involve taking a hard look the issues and asking questions such as: Is establishment of university-based training programs a major priority? What are the implications of studies supporting home-based pulmonary rehabilitation on the viability of in-center programs? Should the six-minute walk be supplanted by more complex testing that better assesses physiologic capabilities? Should we focus on modifications aimed at improving COPD symptoms and quality of life or should our focus be on disease modification?

Co-chairing the symposium will be Christine Garvey, FNP, MSN, MPA, of Seton Medical Center in Daly City, Calif.

Sande Okelo, MD

Confronting Non-Adherence
On Wednesday from 8 to 10:45 a.m., session D12 “Understanding and Identifying Non-Adherence to Better Treat Asthma, COPD and Obstructive Sleep Apnea” will give attendees an opportunity to get up-to-date information on how patient non-adherence impacts a variety of conditions commonly encountered by pulmonologists, said Sande Okelo, MD, symposium co-chair.

“There has been a growing appreciation among clinicians and researchers that patients do not always follow recommended therapies,” said Dr. Okelo, who is assistant professor of pediatric pulmonology at Johns Hopkins University in Baltimore. Attendees will gain insights into improving patient care by learning about various strategies to assess and address patient adherence problems.

Many consequences of non-adherence, such as lack of improvement in control of asthma, are witnessed regularly by clinicians and researchers, Dr. Okelo said of the session, which will take place in room 102-104-106 (street level) of the Colorado Convention Center.

“But the consequences aren’t always framed within the context of adherence vs. non-adherence. For example, a patient with asthma may be viewed as having ‘severe’ asthma, but in actuality may instead be poorly adherent to less potent and cheaper medication regimens that, if taken appropriately, would control his/her asthma,” he said.

Topics covered in the symposium include:

“I hope that attendees will develop an appreciation of how common non-adherence is, to understand the risks of not assessing patient adherence, to appreciate the importance of routinely evaluating patient adherence and to realize that there are practical and feasible strategies that can be used to improve patient adherence,” said Dr. Okelo.

Kristie Ross, MD, of University Hospitals Rainbow Babies and Children’s Hospital in Cleveland, and Amy Jordan, PhD, of the University of Melbourne, Australia, will co-chair the symposium with Dr. Okelo.