Chronic Obstructive Pulmonary Disease (COPD)

Even if the whole country quit smoking today, the epidemic of chronic obstructive pulmonary disease (COPD) would continue for decades. The continuing surge of new cases of COPD is inevitable because of damage already done to smokers' lungs. The single most important intervention to avoid worsening of COPD and its symptoms is to stop smoking. While there is still no cure—the day-to-day quality of life of each individual patient can be vastly improved through medical treatment and exercise. Also, special steps can help patients avoid acute exacerbations, which are to COPD what myocardial infarctions are to coronary artery disease. All patients with COPD, even those with difficult-to-treat disease, can be helped.

Because COPD is so common and deadly—now the fourth leading cause of death in the U.S.1—the Temple Lung Center has built a major clinical and research program devoted to patients with advanced COPD. Today, primary care physicians and community pulmonologists can manage most COPD patients using guideline-based care with bronchodilators and anti-inflammatories and oxygen supplementation. But as dyspnea grows worse and exacerbations become more frequent, the management strategies often must reach into the grey areas that are not specified in the treatment guidelines in order to give patients relief. This beyond-the-algorithm care is where the Temple team excels.

Temple is one of the largest COPD treatment centers in the country

The Temple Lung Center now operates one of the nation’s largest pulmonary referral and research networks for seriously ill patients with COPD. Many of the individuals seen here have already progressed to severe treatment-refractory disease. Others present with repeated exacerbations, concomitant diseases, or personal issues that complicate care. Recent data show that we now manage care for over 2000 COPD patients every year and Temple University Hospital admits more COPD patients than any other single hospital in Pennsylvania2. Over the past five years, we have handled more cases of complicated bronchitis and asthma than any other hospital in Pennsylvania2. Seeing so many patients at all stages of disease gives our staff the expertise needed to offer outstanding patient care and, especially when leveraged with our transplant/surgery programs and our many research programs, to produce clinical outcomes that consistently exceed expectations.

Based on our years of hands-on experience in assisting the most difficult-to-treat patients, we have found that even the most challenging referral can benefit from expanded pulmonary function testing and other special evaluations. This precise diagnosis and staging is followed by appropriately tailored treatments, closely supervised pulmonary rehabilitation (including education, exercise to improve endurance, breathing exercises, and nutrition counseling) and, when necessary, support with oxygen supplementation, surgery, transplantation, or alternative interventions.

LVRS and other special procedures

Building on the university’s long history of surgical expertise and innovation, Temple pulmonary specialists conducted the first randomized trial of Lung Volume Reduction Surgery (LVRS) to treat patients with extremely severe emphysema3. In this operation, upper lobes of the damaged lung are resected, reducing the overall size of the thorax and thereby improving the patient’s respiratory mechanics and ability to breathe efficiently. As a major participant in the largest-ever trial of LVRS (the National Emphysema Treatment Trial, or NETT)4, Temple ranked 4th in the nation in overall enrollment. In the three years following Medicare approval for LVRS in January 2004 we evaluated over 600 patients and performed over 125 surgeries.

Based on excellent outcomes (eg, early postoperative extubation and ambulation rates, low intra- and postoperative complication rates) and well-defined processes of care, Temple’s program recently became only the second in the nation to receive a Certificate of Distinction for safety and quality of care in LVRS from the Joint Commission. This Certificate of Distinction reflects our high volumes of patients, our adherence to up-to-date standards, and our documented clinical outcomes. It means that you can refer patients who are LVRS candidates to the Temple Lung Center with an extra assurance of safety, quality clinical care, and reimbursement eligibility.

The LVRS option has evolved from 10 years ago when Temple published its landmark study of this complex procedure. Since that time, the National Emphysema Treatment Trial has identified the most appropriate patient/disease subtypes and pulmonologists recognize that many patients either do not want or are not eligible for the surgery. That’s why Temple is also now leading the clinical testing of less-invasive procedures to deflate or selectively collapse a diseased portion of the lung (e.g., procedures involving placement of an endobronchial valve or instillation of a hydrogel-proteoglycan sclerosing compound). In fact, we are currently involved in over a dozen COPD clinical trials and we continue to work hard with every patient to maximize outcomes with existing therapies such as pulmonary rehabilitation, oxygen supplementation, and standard medications.  


Research that benefits COPD patients

The best COPD treatments for patients with an advanced stage of the illness may be a novel therapy or an aggressive application of a traditional therapy. With one of the most active and innovative pulmonary research programs in the country, the Temple Lung Center is not only exploring the root causes of COPD and other diseases, it is also leading national efforts to find safer and more effective therapies for patients suffering from advanced stages of these pulmonary illnesses.

Research currently underway at Temple involves the prevention of COPD exacerbations; evaluation of the safety and efficacy of various corticosteroids and bronchodilators; determining the genetic causes of COPD; and investigation of novel antiinflammatories (eg, anti-leukotrienes), antibiotics (eg, chronic macrolide therapy), and vaccines (eg, pneumococcal vaccines). The Lung Center also recently won a major NIH grant to coordinate 10 Mid-Atlantic hospitals in a 6-year study of supplemental home oxygen in patients with moderate COPD (the Long-Term Oxygen Treatment Trial, or LOTT). This Medicare-sponsored trial will help answer the long-standing question: Does oxygen help those with less-than-severe COPD? Please contact us for information on any of our ongoing COPD clinical trials and for specifics on patient eligibility criteria.



Temple is Asking:
Do genes influence who gets severe emphysema and who doesn’t?

 

Temple researchers are well-known for their early investigations into one of the few known genetic causes of emphysema (alpha-1 antitrypsin deficiency)6. This exploration into the genetic determinants of lung disease has continued with ongoing collaborations between Lung Center clinicians and basic scientists around the world who are using new genomic and proteomic tools to identify inherited risk factors. Temple is currently participating in the largest study of COPD ever undertaken—an NIH-funded study aimed at determining the genetic and other underlying causes of COPD (COPDGeneTM).


To refer a patient for COPD treatment, call 1-800-TEMPLE-MED (1-800-836-7536).


References

1. Mannino DM. Chest 2002;121:121S-126S.

2. Pennsylvania Health Care Cost Containment Council: 2006 Hospital Performance Report, 2007.

3. Criner GJ et al. Am J Respir Crit Care Med 1999;160:2018-2027.

4. Fishman A et al. N Engl J Med 2003;348:2059-2073.

5. Reilly J et al. Chest 2007;131:1108-1113.

6. Kueppers F Am J Hum Genet 1976;28:370-377.

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