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

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 Distinguishing%the%Difference:%%COVIDF19%vs.%Allergies%vs.%the%Flu% – Infographic in%our%COVIDF19%Information%Center Meet%the%Allergy%&%Asthma%Network%Team%– Look%for%“About%Us”%&%“Meet%Our%Team” COVID&19)&)COPD:)Coordinating)Care Dr.$Purvi Parikh Dr.$Vickram Tejwani Tonya$Winders 1

12/3/20 Our$Speakers Dr.$Vickram Tejwani Dr.$Purvi Parikh Tonya$Winders Pulmonary$and$Critical$Care$Fellow$ Clinical$Assistant$Professor$of$ President$&$CEO,$Allergy$&$Asthma$ Medicine$NYU$Langone$School$of$ Network Johns$$Hopkins$Pulmonary$Critical$ Medicine &$Director,$Allergy$and$ Care Medicine President,$Global$Allergy$&$ Asthma$Association,$Murray$Hill Airways$Patient$Platform National$Spokesperson,$$$$$$$$$$ Allergy$&$Asthma$Network$ Outline ! Current*State*of*COVID*– 19 ! COPD*Overview* ! COPD*Care*During*COVID919 ! Special*Considerations*for*COPD* Patients 2

12/3/20 Poll$Question ! We’d%like%to%know%who%is%here%today. ! Which%category%best%describes%you? Current'State'of'COVID019 Tonya&Winders 3

12/3/20 Cases#in#the#last#7#days US#Data#Report#– CDC# 4

12/3/20 In#the#News#– Two#Vaccines Approved( for(use(in( What#does#emergency# Pfizer Moderna UK authorization#mean? Applied#to#FDA#for# Applied#to#FDA#for# Fastest#way#for#public# emergency#use# emergency#use# health#officials#to#get# authorization#of# authorization#of# a#vaccine#to#the# vaccine#– 11/27/20 vaccine#– 11/30/20# public Dramatically# Documents#online#– Trial#has#been#same# shortened#drug# Hearing#set#for# size#&#scope#as#for# development#&# December#10 th any#vaccine approval#process VACCINE#READY#TO#SHIP#24#HOURS#AFTER#APPROVAL McKinsey)&) Co.)Article)– 11/23 5

12/3/20 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. 6

12/3/20 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 New)Cases)by)Day 180000 160000 140000 120000 100000 80000 60000 40000 20000 0 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)1 3 July)2 0 July)2 7 August)3 September)7 September)14 September)21 October)5 October)12 October)19 October)26 November)2 November)9 November)16 November)23 November)30 July)6 August)10 August)17 August)24 August)31 Sepember)28 Cases 7

12/3/20 Poll$Question ! Public'health'guidance'in'my'area'is' requesting/requiring'stricter'social' distancing'&'wearing'of'masks. COPD%Overview Dr.$Purvi Parikh 8

12/3/20 Chronic(Obstructive(Pulmonary(Disease( 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: EMPHYSEMA CHRONIC-BRONCHITIS • Tiny(air(sacs(in(the(lungs(where( • Bronchial(tubes(become(irritated(or( oxygen(transfers(into(the( swollen bloodstream(are(damaged • Excess(mucus(and(coughing(can( • Air(may(also(become(trapped(in( last(up(to(three(months the(lungs(and(hard(to(breathe( • Bronchial(tubes(may(lose(their(cilia out • Cilia(– tiny(hairs(that(move(mucus(so( it(can(be(coughed(out COPD 3$Million COPD%is%now% COPD%is% 384$Million currently%the% prevalent%in% people%die% people%suffer% 3 rd low% each%year% from%COPD%in% resource% the%world% Leading%cause% from%%COPD countries of%death% globally 9

12/3/20 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& 10

12/3/20 Smoking • Indoor,&,Outdoor, Biggest'Risk'Factors'for' Pollution • Occupational,Dusts, COPD &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 11

12/3/20 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 Symptoms/of/both/Asthma/ &/COPD ACO Asthma COPD Symptoms: • Labored/breathing • Wheezing • Coughing,/with/or/without/ mucus • Tightness/in/the/chest 12

12/3/20 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,$depression,$ or$other$mental$or$emotional$conditions • More$emergency$room$visits$or$overnight$ hospital$stays 13

12/3/20 Oxygen'Use ! People'with'severe'COPD'who'have'low'levels'of' oxygen'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' oxygen'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* Exercise to*help*build* Breathing*techniques fitness*and*help* patient*breathe Nutrition Relaxation Emotional*&*group*support Learning*about*medications Strategies*for*living*better*with*COPD 14

12/3/20 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. 15

12/3/20 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% Good(news: GETTING COVID519 • Increased%risk%for% SEVERE Bad(news: COVID519 16