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American Association for Respiratory Care, Dec. 6-9, 2010

The 56th American Association for Respiratory Care International Respiratory Congress

The 56th American Association for Respiratory Care International Respiratory Congress was held Dec. 6 to 9 in Las Vegas and attracted approximately 6,000 participants. The conference highlighted recent advances in respiratory care, with presentations focusing on understanding the underlying mechanisms of sleep apnea, detection of chronic obstructive pulmonary disease (COPD), and the clinical and economic impact of readmissions associated with COPD. The conference featured over 250 sessions on current respiratory care topics and over 300 original research projects.

During one presentation, Antonio Stigall, R.R.T., of the Space Coast Sleep Disorders Center in Melbourne, Fla., reviewed the types and management of sleep-disordered breathing. He noted that, while the prevalence of obstructive sleep apnea appears to be high, only a limited number of patients obtain a diagnosis and are treated.

According to Stigall, an estimated 20 million Americans are suspected of having obstructive sleep apnea, and 80 to 90 percent of them are undiagnosed and untreated.

"Diagnosis and treatment is important because, over time, untreated obstructive sleep apnea can be associated with hypertension, heart failure, coronary artery disease, stroke, type II diabetes, anxiety, and depression," Stigall said.

Continuous positive airway pressure (CPAP) is considered the standard of care for obstructive sleep apnea; however, some hindrances prevent compliance and widespread adoption.

"Improper mask fit is a potential obstacle for decreasing compliance with therapy. Many times, if the mask interface doesn't fit correctly or leaks, the experience is uncomfortable for the patient and they may not use CPAP on a sustained and regular basis. Unfortunately, many managed care plans carry only a limited variety of interfaces and may not cover devices utilized to treat central apnea and/or complex sleep apnea," Stigall added. "Follow-up with a sleep specialist within 31 to 90 days after initiation of CPAP is ideal. During that time, the sleep specialist can assess the efficacy of CPAP and determine if changes need to be made in mask fit, pressure, heated humidity, or modality. If the patient's insurance plan does not cover a certain mask or mode, the practicing clinician can request approval based on medical necessity."

According to Stigall, depending on the severity of the patient's condition, other treatment options include weight loss, positional therapy, the use of a dental appliance, or surgery.

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During another presentation, Steve Nelson, R.R.T., a registered respiratory therapist practicing in Irving, Texas, discussed a collaboration that involved pulmonary function testing using a mobile spirometry unit (MSU) across the United States at public events since 2006. The MSU provided testing and information to more than 35,000 individuals, with over 250 respiratory therapists participating.

"In an effort with the COPD foundation and National Heart, Blood, and Lung Institute, we evaluated the effectiveness of a step-wise approach to diagnosing COPD. We used a six-question interview related to risk factors for COPD and performed peak flow measurement. If a patient had a low peak flow, they went on to perform spirometry," Nelson said. "We evaluated this approach across the United States at fairs and events, target-rich environments of older people and likely smokers, and we assessed 5,300 individuals over a 15-month period. We found 3,600 individuals who required peak flow measurement, and, from that, we had 119 that required spirometry and 99 diagnosed with severe COPD."

Overall, Nelson concluded that peak flow measurement can be used to find individuals at risk for COPD. They can then be referred to a pulmonary function lab for spirometry instead of using spirometry up front.

"Primary care offices have been doing peak flow measurements for years to monitor asthma. They should now consider using the same simple tool to find people at risk for COPD," Nelson added.

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Douglas S. Laher, R.R.T., a registered respiratory therapist based in Cleveland, discussed the clinical and economic impact of unplanned hospital readmission of patients with COPD, focusing on the role of the respiratory therapist to reduce hospital readmissions.

"Hospital readmissions have become rampant, with almost 18 percent of patients readmitted for the same diagnosis, which means that nearly one in five patients return to the hospital following discharge. The cost to the federal government is roughly five billion dollars in spending that could have been potentially avoided. In addition, it is estimated that 75 percent of those readmissions could be avoided with adequate care, education, and discharge planning, which means that hospitals have untapped opportunities to reduce uncompensated costs," Laher said.

According to Laher, the respiratory therapist can play a significant role in reducing these costs because 30 percent of current readmissions come from seven diagnoses, the top three of which are congestive heart failure, COPD, and pneumonia.

"Hospitals really need to invest in improving the discharge process by focusing on the education of patients prior to discharge, which is one of the biggest opportunities for the respiratory therapist to prevent readmissions," Laher said.

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