COVID&19)&)COPD:)Coordinating)Care Dr.$Purvi Parikh - - PDF document

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COVID&19)&)COPD:)Coordinating)Care Dr.$Purvi Parikh - - PDF document

Feb 24, 2024 418 likes •687 views

12/3/20 Allergy'&'Asthma'Network'News More%information%at%allergyasthmanetwork.org Webinar Thursday,%December%10 th 4:00%PM%ET Chronic%Rhinosinusitis:%Making%Treatment%Decisions

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12/3/20 1

Allergy'&'Asthma'Network'News

More%information%at%allergyasthmanetwork.org

Meet%the%Allergy%&%Asthma%Network%Team%– Look%for%“About%Us”%&%“Meet%Our%Team” Distinguishing%the%Difference:%%COVIDF19%vs.%Allergies%vs.%the%Flu% – Infographic in%our%COVIDF19%Information%Center Webinar – Thursday,%December%10th – 4:00%PM%ET Chronic%Rhinosinusitis:%Making%Treatment%Decisions

COVID&19)&)COPD:)Coordinating)Care

Dr.$Purvi Parikh Dr.$Vickram Tejwani Tonya$Winders

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12/3/20 2

Our$Speakers

Dr.$Vickram Tejwani

Pulmonary$and$Critical$Care$Fellow$ Johns$$Hopkins$Pulmonary$Critical$ Care Medicine

Dr.$Purvi Parikh

Clinical$Assistant$Professor$of$ Medicine$NYU$Langone$School$of$ Medicine &$Director,$Allergy$and$ Asthma$Association,$Murray$Hill National$Spokesperson,$$$$$$$$$$ Allergy$&$Asthma$Network$

Tonya$Winders

President$&$CEO,$Allergy$&$Asthma$ Network President,$Global$Allergy$&$ Airways$Patient$Platform

Outline

! Current*State*of*COVID*– 19 ! COPD*Overview* ! COPD*Care*During*COVID919 ! Special*Considerations*for*COPD* Patients

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Poll$Question

!We’d%like%to%know%who%is%here%today. !Which%category%best%describes%you? Current'State'of'COVID019

Tonya&Winders

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US#Data#Report#– CDC#

Cases#in#the#last#7#days

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In#the#News#– Two#Vaccines Pfizer

Applied#to#FDA#for# emergency#use# authorization#of# vaccine#– 11/27/20 Documents#online#– Hearing#set#for# December#10th

Moderna

Applied#to#FDA#for# emergency#use# authorization#of# vaccine#– 11/30/20# Trial#has#been#same# size#&#scope#as#for# any#vaccine

What#does#emergency# authorization#mean?

Fastest#way#for#public# health#officials#to#get# a#vaccine#to#the# public Dramatically# shortened#drug# development#&# approval#process

Approved( for(use(in( UK VACCINE#READY#TO#SHIP#24#HOURS#AFTER#APPROVAL

McKinsey)&) Co.)Article)– 11/23

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In#the#News

! CDC#– COVID/19#likely#to#have#been#in#US#since# mid/December#2019#– earlier#than#originally# thought ! CDC#is#finalizing#recommendation#to#shorten# COVID/19#quarantine#times ! 7#– 10#days#with#a#negative#test#to#exit# quarantine ! Coronavirus#spikes#expected#to#be#seen#due#to# holiday#travel ! Dr.$Fauci:$ ! Expect#even#larger#spikes#during# Christmas#season ! Children#should#be#in#school

In#the#News

! Testing#numbers#could#be#erratic#in#the#next#few# weeks: ! Testing#sites#working#on#shortened#holiday# hours ! Many#people#traveling#– tests#required#to# return#home ! Need#to#look#at#the#picture#over#7#days ! Dr.#Brix:##“If#you#traveled#over#Thanksgiving,# assume#you#were#exposed#&#became#infected.

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In#The#News

Journal#of#Allergy#and#Clinical#Immunology#– study

  • Of#the#subjects#positive#for#the#virus,#6.75#percent#had#

asthma,#compared#to#9.62#percent#of#those#who#were# negative#for#COVIDJ19,#according#to#the#study#results.

  • 3#explanations:
  • Asthma#is#associated#with#lower#ACE2#receptors#–

mechanism#for#virus#to#infect#cells

  • People#with#asthma#take#more#precautions
  • Inhaled#corticosteroids#may#reduce#risk#of#the#virus

COVID&19)Cases)in)US)by)Date)Reported

20000 40000 60000 80000 100000 120000 140000 160000 180000 February)28 March)6 March)13 March)20 March)27 April)3 April)10 April)17 April)24 May)1 May)8 May)15 May)22 May)29 June)1 June)8 June)15 June)22 June)29 July)6 July)1 3 July)2 0 July)2 7 August)3 August)10 August)17 August)24 August)31 September)7 September)14 September)21 Sepember)28 October)5 October)12 October)19 October)26 November)2 November)9 November)16 November)23 November)30

New)Cases)by)Day

Cases

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Poll$Question

! Public'health'guidance'in'my'area'is' requesting/requiring'stricter'social' distancing'&'wearing'of'masks. COPD%Overview

Dr.$Purvi Parikh

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Chronic(Obstructive(Pulmonary(Disease(

EMPHYSEMA

  • Tiny(air(sacs(in(the(lungs(where(
  • xygen(transfers(into(the(

bloodstream(are(damaged

  • Air(may(also(become(trapped(in(

the(lungs(and(hard(to(breathe(

  • ut

CHRONIC-BRONCHITIS

  • Bronchial(tubes(become(irritated(or(

swollen

  • Excess(mucus(and(coughing(can(

last(up(to(three(months

  • Bronchial(tubes(may(lose(their(cilia
  • Cilia(– tiny(hairs(that(move(mucus(so(

it(can(be(coughed(out Chronic(obstructive(pulmonary(disease,(or(COPD,(is(an(umbrella(term(used(to(describe(a( series(of(progressive(lung(diseases(characterized(by(difficulty(breathing.( The(two(primary(COPD(diseases(are:

384$Million

people%suffer% from%COPD%in% the%world%

3$Million people%die% each%year% from%%COPD

COPD%is% currently%the%

3rd

Leading%cause%

  • f%death%

globally

COPD%is%now% prevalent%in% low% resource% countries

COPD

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COPD%Annual% Costs

$32.1%Billion%in%2010 Project%to%increase%to%% $49%Billion%in%2020

Early&Diagnosis&

Symptoms&include:

! Shortness&of&breath ! Repetitive&cough ! Increased&phlegm&or&mucus& production ! Fatigue ! More&frequent&chest&infections ! Longer&to&recover&from&a& cold/chest&infection&

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Biggest'Risk'Factors'for' COPD

Smoking

  • Indoor,&,Outdoor,

Pollution

  • Occupational,Dusts,

&Chemical

Although(30%(of( COPD(patients(never( smoked!

COPD%Patients

COPD%most%often%occurs%in%people%more%than%40%years%of%age%who% smoke%or%have%done%so%earlier%in%life

  • May%have%experienced%long@term%exposure%to%chemicals

COPD%typically%builds%up%over%time,%and%so%the%longer%someone%exposes% themselves%to%potential%lung%damage,%the%more%likely%it%is%that%they% might%develop%COPD

  • The%lungs%of%people%who%are%younger%may%recover%from%potential%irritants%faster%than%

those%of%people%who%are%older

  • Lung%damage%may%not%be%enough%to%cause%symptoms,%as%COPD%typically%takes%years%to%

produce%noticeable%signs

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Definition(of(ACO

Asthma0COPD(overlap((ACO)(is(characterized(by(persistent(airflow( limitation(with(several(features(usually(associated(with(asthma(and( several(features(usually(associated(with(COPD Asthma0COPD(overlap(is(identified(in(clinical(practice(by(the(features(that( it(shares(with(both(asthma(and(COPD This(is(not(a(definition,(but(a(description(for(clinical(use,(as(Asthma0COPD( Overlap(includes(several(different(clinical(phenotypes(and(there(are(likely( to(be(several(different(underlying(mechanisms.

ACO

Asthma COPD

ACO

Symptoms/of/both/Asthma/ &/COPD Symptoms:

  • Labored/breathing
  • Wheezing
  • Coughing,/with/or/without/

mucus

  • Tightness/in/the/chest
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It#Can#Be#a#Bit##Confusing#.#.#.#

Many#patients#with#symptoms#of#chronic#airways#disease#have#features#of# both#asthma#and#COPD#

  • This#has#been#called#AsthmaBCOPD#Overlap#(ACO)

AsthmaBCOPD#overlap#is#not#a#single#disease#

  • Likely#that#a#range#of#different#underlying#mechanisms#and#origins#will#be#identified#

Patients#with#features#of#both#asthma#and#COPD#have#worse#outcomes# than#those#with#asthma#or#COPD#alone

  • Frequent#exacerbations#B Poor#quality#of#life#B More#rapid#decline#in#lung#function#B Higher#

mortality#B Greater#health#care#utilization

How$does$COPD$affect$people’s$lives?

  • Difficulty$with$physical$activities$like$walking$&$

climbing$stairs

  • May$not$be$able$to$work
  • Hard$to$engage$in$social$activities$like$eating$out,$

going$to$places$of$worship,$or$getting$together$ with$friends$or$neighbors

  • Increased$confusion,$memory$loss,$depression,$
  • r$other$mental$or$emotional$conditions
  • More$emergency$room$visits$or$overnight$

hospital$stays

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Oxygen'Use

! People'with'severe'COPD'who'have'low'levels'of'

  • xygen'in'their'blood'may'be'treated'with'

supplemental'oxygen'at'home ! Therapy'involves'breathing'in'oxygen'through'a' nasal'tube'or'mask'from'a'metal'tank'cylinder'or'

  • xygen'concentrator

! COPD'patients'should'check'with'their'oxygen' provider'to'be'sure'they'have'an'adequate' supply'during'COVIDB19

https://www.nih.gov/newsBevents/nihBresearchBmatters/longBtermBoxygenBcopd

Pulmonary*Rehabilitation

A*formal*program* to*help*build* fitness*and*help* patient*breathe Exercise Breathing*techniques Nutrition Relaxation Emotional*&*group*support Learning*about*medications Strategies*for*living*better*with*COPD

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Pulmonary*Rehabilitation Usually*an*outpatient*program Might*work*with*an*interprofessional*team

  • Respiratory*Therapists
  • Dietitians
  • Social*Workers

Pulmonary*Rehabilitation*during*COVID819

! Most*Pulmonary*Rehab*Centers*have*temporarily*suspended*face8to8face* programs ! Virtual*Pulmonary*Rehab*via*telehealth,*phones,*video8conferencing ! As*social*distancing*guidance*changes,*small*groups*can*meet ! Most*important*issues*are*PATIENT*AND*STAFF*SAFETY,*to*avoid* contracting*and*further*spreading*COVID819* ! General*principles*of*infection*control*should*apply*until*there*is*an* effective*vaccine*that*is*widely*available*and*utilized.*Where*new*case* rates*are*high,*it*is*unlikely*that*center8based*rehabilitation*will*be* appropriate*for*people*with*chronic*respiratory*disease.

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COPD%Care%During%COVID/19

Dr.$Vickram Tejwani

COPD%Patients

! A%large%population%of%patients ! COPD%is%progressive%5 it%gets%worse%as% time%goes%on

  • Not%at%an%increased%risk%of%

GETTING COVID519

Good(news:

  • Increased%risk%for%SEVERE

COVID519

Bad(news:

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COPD%&%COVID)19

  • People%with%COPD%

experience% shortness%of%breath%

  • r%dyspnea

COPD

  • People%with%COVID)

19%experience% shortness%of%breath%

  • r%dyspnea

COVID)19

  • How%can%you%tell%the%

difference?!?

???

COPD%&%COVID)19

COPD

! Shortness-of-breath ! Repetitive-cough ! Increased%phlegm%or%mucus% production ! Fatigue

COVID:19

! Shortness-of-breath ! Repetitive-cough ! Fever ! Anorexia%(no%appetite) ! Myalgias%(muscle%pain) ! Gastrointestinal%symptoms

! Nausea ! Diarrhea

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COVID&19)&)Comorbid)Conditions

You$are$increased$risk$of$severe$disease$if$you also$have$one$of$the$following: Cancer Liver)disease Chronic)kidney)disease Overweight COPD Pulmonary)fibrosis Heart)conditions)(heart)failure,coronary artery) disease,)cardiomyopathies) Thalassemia)(a)blood)disorder) Immunocompromised)state)(organ)translplant,) chemotherapy,)and)more) Type)1)diabetes Neurologic)conditions)(dementia)

COPD%&%COVID)19

  • 98%%of%people%with%COPD%agree%they%want%to%be%as%

healthy%as%the%can%be%to%fight%off%COVID>

98%

  • 83%%of%people%with%COPD%agree%that%COVID%has%been%a%

wake)up%call%to%realize%their%disease%puts%them%at%risk.

83%

  • 54%%of%people%with%COPD%feel%more%depressed%about%

having%COPD%and%its%impact%on%their%future.

54%

https://us.gsk.com/en)us/behind)the)science/patients)consumers/breaking)barriers)for)better)copd)care/

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COPD%&%COVID)19%Care

! Inhalers ! Bronchodilator%therapy%should%be%switched%from%nebulizer%to%an% inhaler%– either%metered)dose%inhaler%or%dry%powder%inhaler ! Should%use%a%spacer ! Nebulizers ! Healthcare%workers%in%the%room%should%wear%personal%protective% equipment%(PPE)%appropriate%for%airborne%precautions ! Viral%particles%can%stay%airborne%for%1%– 3%hours

Management%of%patients%with%COPD%during%the%COVID)19%pandemic Amy Attaway, Umur Hatipoğlu Cleveland%Clinic%Journal%of%Medicine Jul%2020, DOI: 10.3949/ccjm.87a.ccc007

COPD%&%COVID)19%Care

Significant% numbers%of% patients%will% treat%their% illness%at% home

Should%self)isolate%in%a%room Ideally,%they%should%have%their%own%bathroom If%nebulizer%is%needed,%it%should%be%used%in%a%room%with% the%doors%closed Should%remain%closed%for%several%hours%afterwards Frequent%cleaning%&%disinfecting%of%surfaces%in%room Medication%regimen%should%not%be%changed%without% discussion%with%doctor

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Emergency)COPD)&)COVID119)Care

If)COVID119)worsens,)pneumonia)can)develop

  • Lung)inflammation)– fills)airway)sacs)with)fluid)– can)be)life1threatening

Acute)respiratory)distress)syndrome)(ARDS))can)also)develop

  • May)need)to)be)placed)on)a)ventilator)to)get)enough)oxygen

If)you)have)COVID119)and)it)becomes)difficult)to)take)a)breath) 1 be)prepared)to)call)911

What%Can%COPD%Patients%Do%to%Stay% Healthy?

  • Stay%at%home
  • Practice%the%3"W’s
  • Wash your%hands
  • Watch your%distance
  • Wear a%mask
  • Avoid%sick%people
  • Clean%&%disinfect%surfaces
  • Reduce%your%stress,%enjoy%your%hobbies
  • Exercise,%eat%a%healthy%diet
  • Stay%connected%by%“virtual%means”
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Special(Considerations(for(COPD(Patients

Tonya&Winders

The$COPD$Charter

  • Outlines$6$principles$of$quality$care$that$people$with$

COPD$should$expect$to$receive,$wherever$they$live.

Global$Policy$ Document

  • To$mobilize$governments,$healthcare$providers,$

policymakers,$lung$health$industry$partners$and$ caregivers$to$address$the$unmet$need$and$burden$of$ COPD

  • Ultimately$working$together$to$deliver$meaningful$

improvements$in$care,$now$and$in$the$future.$

  • Aims$to$offer$a$consensus$on$global$standards$of$COPD$

care.

Purpose$of$the$ Charter

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Why$Do$We$ Need$a$ COPD$ Charter?

  • Global$strategies$&$guidelines$exist,$but$

there$are$vast$inconsistencies$in$the$way$ people$with$COPD$are$managed,$having$a$ devastating$impact$on$people$living$with$ the$disease

  • COPD$does$not$receive$the$same$level$of$

recognition$and$prioritization$globally

  • Healthcare$systems$and$providers$are$not$

adequately$equipped$to$deliver$optimal$ COPD$care$and$policy$reform$is$urgently$ needed$to$drive$a$reduction$in$both$ mortality$and$exacerbation$rates

Principles*of*Quality*Care*in*COPD

1

  • I*deserve*timely*access*for*the*diagnosis*and*assessment*of*my*

COPD

2

  • I*deserve*to*understand*what*having*COPD*means*for*me*and*how*

the*disease*may*progress

3

  • I*deserve*access*to*the*best*available*evidence>based,*personalized*

treatment,*to*ensure*I*can*live*as*well*and*as*long*as*possible

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Principles*of*Quality*Care*in*COPD

4

  • I*deserve*an*urgent*review*of*my*current*management*plan*if*I*experience*an*

‘exacerbation’,*to*prevent*further*exacerbations*and*disease*progression

5

  • I*deserve*access*to*specialist*care*when*needed*(whether*provided*in*hospital*
  • r*in*the*community)*to*manage*my*COPD,*irrespective*of*where*I*live

6

  • I*deserve*to*live*with*COPD*freely*while*maximizing*quality*of*life*without*

stigma*or*guilt

How$will$the$COPD$Charter$ support$quality$care?

Drive$awareness$of$the$current$unmet$need$ and$burden$in$COPD$and$highlight$to$ governments,$healthcare$providers,$ policymakers,$lung$health$industry$partners$ and$caregivers$the$quality$care$that$people$ with$COPD$should$expect$to$receive,$ wherever$they$live By$sharing$the$COPD$Patient$Charter,$we$ intend$to$engage$key$stakeholders$to$adopt$ the$Patient$Charter$principles.$This$is$vital$if$ we$are$to$address$the$unmet$need$and$ burden$in$COPD$and$ultimately$work$ together$to$deliver$meaningful$ improvements$in$care,$both$now$and$in$the$ future.

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COPD%Patients COPD%Patients%have% the%right%to%quality% guidelines6based% healthcare%delivered%in% a%timely%and% collaborative%way.

Poll$Question

!In#my#geographical#area,#pulmonary#rehab# is#being#managed#on#telehealth.

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Questions?

Please&record&your&questions&in&the&Question&box&on&your& webinar&control&panel We&will&address&as&many&questions&as&we&can

COVID&19)Vaccine)– Treatment,)Trust)&) Health)Inequities

Join%us%on%Tuesday,%December%15th for%the%18th webinar%in%our%COVID>19%Webinar%Series%>

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COVID&19)&)COPD:)Coordinating)Care

Thank&you&for&listening! Get&guidelines5based&information&at& allergyasthmanetwork.org