Guest: R. Stokes Peebles, Jr.

How confident are you in differentiating COPD from other chronic respiratory conditions? In this segment entitled The Lung in COPD: What's Left, hear Dr Stokes Peebles speak on improving diagnosis and symptom management in patients with COPD.

A 46-year-old woman who has had two admissions to the intensive care unit for asthma during the past year presents with a 4-day history of upper respiratory illness and a 6-hour history of shortness of breath and wheezing.

Guests: James F. Donohue, David Mannino

COPD is the sixth leading cause of death worldwide, and more alarming is the fact that mortality from this disease is predicted to rise. The impact of COPD may be underestimated, especially given that as many as half of all cases of COPD may be undiagnosed. Of the patients who are diagnosed with COPD, a significant percentage experience daily symptoms that affect their everyday lives. Early diagnosis and treatment are key to effective management of COPD.

In this promotional program, Improving Management of COPD, sponsored by AstraZeneca, the makers of SYMBICORT (budesonide/formoterol fumarate dihydrate) Inhalation Aerosol, Dr David Mannino and Dr James Donohue discuss improving diagnosis and effective management of COPD.

Program highlights:

• Discussing COPD as a treatable disease with airflow obstruction that is partially reversible and differentiating COPD from asthma and other diagnoses with similar symptoms and presentations
• Emphasizing the importance of spirometry in the diagnosis and assessment of COPD
• Reinforce the role that Symbicort can play in the management of COPD. 
  
  

Important Safety Information, including boxed WARNING

• For patients with COPD, the approved dosage of SYMBICORT is 160/4.5 mcg, 2 inhalations twice daily
• Lower respiratory tract infections, including pneumonia, have been reported following the inhaled administration of corticosteroids
  
  

  -In 2 placebo-controlled SYMBICORT COPD clinical studies, pneumonia did not occur with greater incidence in the SYMBICORT 160/4.5 group, compared with placebo, while the incidence of lung infections other than pneumonia (eg, bronchitis) was higher for SYMBICORT than placebo

• SYMBICORT is NOT a rescue medication and does NOT replace fast-acting inhalers to treat acute symptoms
• Long-term use of orally inhaled corticosteroids, such as budesonide, a component of SYMBICORT, may affect normal bone metabolism resulting in a loss of bone mineral density
• Glaucoma, increased intraocular pressure, and cataracts have been reported in patients following the long-term administration of inhaled corticosteroids, including budesonide, a component of SYMBICORT
• Patients who are receiving SYMBICORT should not use additional formoterol or other long-acting beta2-agonists for any reason
• Caution should be exercised when considering the coadministration of SYMBICORT with long-term ketoconazole and other known potent CYP3A4 inhibitors
• SYMBICORT should be administered with caution in patients being treated with MAO inhibitors or tricyclic antidepressants, or within 2 weeks of discontinuation of such agents
• Particular care is needed for patients being transferred from systemically active corticosteroids to inhaled corticosteroids
• Excessive beta-adrenergic stimulation has been associated with central nervous system and cardiovascular effects. SYMBICORT, like all products containing sympathomimetic amines, should be used with caution in patients with cardiovascular disorders, especially coronary insufficiency, cardiac arrhythmias, and hypertension
• The most common adverse events ≥3% reported in COPD clinical trials included nasopharyngitis, oral candidiasis, bronchitis, sinusitis, and upper respiratory tract infection
• WARNING: Long-acting beta2-adrenergic agonists may increase the risk of asthma-related death. Therefore, when treating patients with asthma, SYMBICORT should only be used for patients with asthma not adequately controlled on other asthma-controller medications (eg, low- to medium-dose inhaled corticosteroids) or whose disease severity clearly warrants initiation of treatment with 2 maintenance therapies. Data from a large placebo-controlled US study that compared the safety of another long-acting beta2-adrenergic agonist (salmeterol) or placebo added to usual asthma therapy showed an increase in asthma-related deaths in patients receiving salmeterol. This finding with salmeterol may apply to formoterol (a long-acting beta2-adrenergic agonist), one of the active ingredients in SYMBICORT (see WARNINGS in full Prescribing Information)
   

Indications

• SYMBICORT 160/4.5 is indicated for the maintenance treatment of airflow obstruction in patients with chronic obstructive pulmonary disease (COPD), including chronic bronchitis and emphysema
• SYMBICORT is NOT indicated for the relief of acute bronchospasm and should not be initiated in patients during rapidly deteriorating or potentially life-threatening episodes of COPD

Please see full Prescribing Information, including boxed WARNING, also available at www.SymbicortTouchPoints.com

Sponsored by

300823 05/10

Guest: Allan T. Luskin

****THIS ACTIVITY HAS EXPIRED******

Asthma affects more than 22 million people in the United States. The number of deaths due to asthma has declined in recent years; however, hospitalization rates have remained relatively stable over the last decade, and the burden of avoidable hospitalizations remains substantial. This program will focus on the use of practice guidelines in patient management, including individualizing therapy and methods to improve patient self-management, adherence, and ultimately, treatment effectiveness.

This Review article is from the issue dated July 15, 2010. Pulmonary embolism should be suspected in all patients who present with new or worsening dyspnea, chest pain, or sustained hypotension without a clear alternative cause. This review focuses on the optimal diagnostic strategy and management, according to the clinical presentation.

This Case Study of the Massachusetts General Hospital is from the issue dated May 27, 2010. A 48-year-old man was seen in the orthopedic clinic of this hospital because of cough, pain in the left shoulder, and a radiographically lucent lesion in the scapula.

Guest: Sidney Braman

Chronic obstructive pulmonary disease, or COPD, is often diagnosed in late stages, as it is a slowly progressing condition. How can physicians diagnose patients with this deadly disease in its earlier stages, to increase the success of reversing some of its symptoms? Dr. Sidney Braman, professor of medicine at the Warren Alpert Medical School of Brown University, describes who is affected by COPD, and how physicians can best treat these patients. Dr. Todd Mahr hosts.

Guest: Bob Baltera

In the United States, almost 50,000 new cases of pulmonary fibrosis — a disease that causes progressive scarring of the lung tissue — are diagnosed annually, including among some first responders to Ground Zero in New York. There are no treatment options, but early research has begun in hopes of one day treating this deadly disease, as Bob Baltera, chief executive officer of Amira Pharmaceuticals explains to host Bruce Japsen. Amira Pharmaceuticals is a San Diego-based company focused on the discovery and early development of compounds to treat inflammatory disease.

This article is from the issue dated May 13, 2010. In this article, the investigators examined a subgroup of children whose mothers had participated in a trial of prenatal vitamin A supplementation that was performed in an area of Nepal where traditionally there is suboptimal nutrition. The lung function of children whose mothers had received vitamin A supplementation during pregnancy was 2 to 3% better than that of children whose mothers had received placebo.

Guest: Harold S. Nelson

The incidence of asthma has doubled in the past two decades, though the cause of this rise is difficult to pinpoint. While the hygiene hypothesis has, for years, served as one possible explanation, newer studies show a possible link between asthma and vitamin levels or exposure to certain chemicals or medications. How might this knowledge help us prevent the development of asthma, and what research still needs to be performed to determine the key factors here, and put an end to the increasing incidence of asthma? Dr. Harold Nelson, professor of medicine at the University of Colorado School of Medicine and National Jewish Health hospital in Denver, lays out the evidence for these potential risk factors, from the child's date of birth, to acetaminophen use, to vitamin D levels, to exposure to cleaning sprays and other household chemicals. Dr. Jennifer Shu hosts.

Guests: Jill A. Ohar, Charlie Strange

Because both asthma and COPD share some common characteristics, differentiating between the two diseases in clinical practice can be a challenge. Despite their similarities, there are critical differences between asthma and COPD that influence diagnosis, management, and prognosis. Appropriate management of asthma and COPD can only be achieved when clinicians acknowledge those similarities and differences.

In this program, Asthma or COPD?: Knowing the Differences, Choosing the Treatments, sponsored by AstraZeneca, Dr Jill Ohar and Dr Charlie Strange highlight the similarities and differences between asthma and COPD and discuss the impact on appropriate management for both diseases.

Program highlights

• Comparing and contrasting asthma and COPD, including characteristics of airflow obstruction
  
• Discussing appropriate optimal management of both diseases, including the role of spirometry and pharmacologic and nonpharmacologic treatment
• Understanding the role of ICS/LABA combination therapy as maintenance treatment of both asthma and COPD
  
  

Sponsored by

292382   12/09

This Case Record of the Massachusetts General Hospital is from the issue dated April 22, 2010. An 89-year-old man had experienced progressive dyspnea for 6 months, worsening over the past 3 days. He had a history of exposure to asbestos and had smoked cigarettes for many years.

This article is from the issue dated April 15, 2010. A 67-year-old man presents with progressive dyspnea. He has smoked cigarettes since he was 15 years of age. Worsening breathlessness forced him to retire as a laborer. His physical examination is notable for distant breath sounds on auscultation, with a prolonged expiratory phase.

Also, the Images in Clinical Medicine feature is described.

Guest: Daniel Sterman

Interventional pulmonology offers patients with airway disorders a variety of innovative procedures, including endobronchial stenting, laser bronchoscopy and endobronchial brachytherapy. Dr. Daniel Sterman, associate professor of medicine and director of the interventional pulmonology program at Penn Medicine, talks about the state of the art in interventional pulmonology for treating patients with lung cancer, airway obstructions and other conditions. What specific challenges and risks are there with these types of procedures? Join host Dr. Lee Freedman to learn more.

Produced in Cooperation with

Guest: Evelyn Hermes-DeSantis

Pregnancy in patients with pulmonary arterial hypertension (PAH) is linked to several risks. Women of childbearing age are often encouraged to avoid pregnancy. But when pregnancy does occur, how can clinicians balance improvement of outcomes with considerations for the maternal and fetal health? Joining Dr. Charles Turck to discuss these issues and more is Dr. Evelyn Hermes-DeSantis, director of the Drug Information Service at Robert Wood Johnson University Hospital in New Brunswick, New Jersey, and clinical associate professor at the Ernest Mario School of Pharmacy at Rutgers, the State University of New Jersey.

FDA is recommending new safety measures to improve the safe use of long acting beta agonists (LABAs).

CL5814

Guest: Andrew Haas

Until recently, bronchoscopy has involved using cameras with CT guidance to determine abnormalities along the airway and lymph nodes. How is ultrasound now being used for bronchoscopic needle biopsies? What are other novel therapeutic applications for endobronchial ultrasound-guided transbronchial needle aspiration? Dr. Andrew Haas, assistant professor of medicine in the pulmonary, allergy and critical care division at the University of Pennsylvania Medical Center, discusses the diagnostic and therapeutic uses of ultrasound-guided bronchoscopy. Dr. Lee Freedman hosts.

Tune in for highlights and latest research presented at the American Association for Respiratory Care's 55th International Respiratory Congress. This meeting took place in San Antonio, Texas, December 5th through 8th. Findings included the effect of specialized rapid response teams on serious complications like cardiac arrest and respiratory failure, the ability of neonates to ventilate on Neurally Adjusted Ventilatory Assist, or NAVA, and research on the improved prevention of ventilator-associated pneumonia.

Guest: Jesse Joad

Long-acting, single-agent beta agonists should be used in tandem with a corticosteroid for the treatment of asthma. Despite a black box warning from the Food and Drug Administration (FDA) to this effect, evidence suggests nearly half of our patients do not take these medications together, which appears to result in more severe asthma attacks and an increased mortality risk. In theory, longer-acting beta agonists (LABAs) should help with compliance, but if these single-agent drugs aren't taken as recommended, is there a role for them in the treatment of asthma? Dr. Jesse Joad, professor of pediatrics at the University of California, Davis School of Medicine and a former member of the FDA's Pulmonary and Allergy Drug Advisory Committee, talks with host Dr. Jennifer Shu about the pharmacologic and logistical differences between LABAs taken as monotherapy and LABAs taken in combination with a steroid. Dr. Joad will also provide her insights on the best ways to communicate with your patients on these important issues.

Guest: Frank Leone

Smoking-related morbidities and health complications are well-established. Even with social trends impinging on the freedom to smoke in convenient locations, many of our patients still can't kick the habit. Host Dr. Lee Freedman learns more about effective pharmacologic and non-pharmacologic ‘quit smoking' remedies from Dr. Frank Leone, associate professor of medicine and director of the Comprehensive Smoking Treatment Program at the University of Pennsylvania School of Medicine.

Guest: Frank Leone

The morbidities and health complications from smoking are certainly well established. But even with social trends increasingly making the life of a smoker more difficult, many of our patients still can’t kick the habit. Joining your host Dr. Lee Freedman, to discuss smoking cessation therapies is Dr. Frank Leone, pulmonologist and director of Comprehensive Smoking Treatment Programs at the University of Pennsylvania. Dr. Leone covers the origins of the habit, nicotine addiction, and how to best approach patients with both pharmacologic and non-pharmacologic treatments.

Guest: Raymond P. Onders

Dr. Raymond Onders, director of Minimally Invasive Surgery at University Hospitals Case Medical Center in Cleveland, Ohio, describes the development of the Diaphragm Pacing System that electrically stimulates breathing.  Hear how this life-saving technology has helped spinal cord patients, and is being tested for use with ALS patients and in the critical care setting to replace ventilators.  Hosted by Dr. Bruce Bloom.

Guest: Raymond P. Onders

A diaphragm pacing system electronically stimulates breathing in patients with amyotrophic lateral sclerosis (ALS). Not only can this device prolong the lives of ALS patients, it can greatly enhance the quality of their lives. Dr. Raymond Onders, associate professor of surgery and medicine at Case Western Reserve University School of Medicine, and director of minimally invasive surgery at University Hospitals Case Medical Center in Cleveland, tells host Dr. Bruce Bloom about a novel diaphragm pacing system that is making international inroads in the treatment of ALS.

Guest: Gwen Huitt

Dr. Huitt discusses the range of atypical mycobacterial infections encountered in practice.  She emphasizes the settings in which these infections present, how a diagnosis can be made and how they should be treated and followed.

Guest: Gwen Huitt

First and foremost, what is hot tub lung? Not surprisingly, it typically affects patients who spend time in and around pools, hot tubs and other aquatic environments. But several additional issues of this condition require answers, including diagnosis and treatment patterns. Further, how do we gauge the prognosis for patients who suffer hot tub lung? Dr. Gwenn Huitt, a mycobacterial infection specialist from the National Jewish Medical and Research Center, probes these questions and more with host Dr. Lee Freedman.

Guests: Gokhan Mutlu, Scott Budinger

Does the air we breath cause cardiovascular disease? Join Dr. Larry Kaskel discuss the results of a study by Dr Gokhan Mutlu and Dr. Scott Budinger about pollution particles triggering blood clots.

Guest: Fernando Martinez

Dr. Martinez discusses the collaboration of different medical discplines that takes place at the Arizona Respiratory Center and how their innovative approach is leading to new understanding of major respiratory illnesses and how they should be managed.

Guest: Fernando Martinez

Dr. Martinez discusses the formulation of the new guidelines on the diagnosis and management of asthma. He then emphasizes the changes in clinical practice that will result from the implementation of these guidelines.

Guest: Fernando Martinez

Dr. Martinez describes this multicentered network of facilities that is working together to take a fresh look at the etiology, diagnosis and treatment of asthma in children.

Guest: Geoffrey Kurland

Join Dr. Geoffrey Kurland as he describes how he treats his pediatric patients differently because of his own battle with Hairy Cell Leukemia.

Guest: Jeffrey Kline

Dr. Larry Kaskel is joined by Dr. Jeffrey Kline, developer of the PERC decision rule. He will discuss how PERC can decrease unnecessary, expensive testing being performed on healthy persons primarily in response to physicians’ fear of medical malpractice.

Guest: Steven Brown

In this segment, Dr. Brown examines the process of pulmonary rehabilitation. In addition he defines criteria a physician should use to evaluate if a patient should undergo pulmonary rehabilitation.

Guest: Steven Brown

In this segment, Dr. Brown examines the diagnostic fundamentals of COPD and the most accurate methodologies used to diagnose this pulmonary disease.

Guest: Steven Brown

Dr. Brown discusses the single most important intervention for patients showing warning signs and/or developing manifestations of pulmonary disease: quitting smoking.

Guest: Steven Brown

In this segment, Dr. Brown talks about current COPD treatments and their effectiveness.

Guest: J. Douglas Hudson

Dr. Hudson discusses the common sleep disorders that can be confirmed using sleep studies.

Guest: John Hansen-Flaschen

Dr. Hansen-Flaschen discusses chronic infections of the lungs and treatment options.