Respiratory Care Currents

 Published: October 30, 2023

By: Debbie Bunch


These COPD Patients Often Don’t Receive Guideline-Concordant Therapy After a Hospitalization

A large study based on data from the U.S. Veterans Health Administration has found that people living in rural areas who are hospitalized with COPD are less likely to receive inhaler therapy in accordance with evidence based guidelines than others.

The same was true for those who had to drive long distances to get to a lung specialty center and those who had fragmented care, defined as primary care and prescriptions from the VA but hospitalization outside of the VA.

The trial involved an analysis of data on 33,785 people with a mean age of 70.5 years who were hospitalized with COPD between 2017 and 2020. The vast majority of the patients were men, and 36.7% lived in a rural area; 64.2% had to drive at least half an hour to get to the nearest VA pulmonary specialty care center and 28.9% were classified as having fragmented care. Specific findings showed —

  • 6% of the patients were on guideline-discordant inhaler regimens three months after the exacerbation.
  • The most common regimen not in line with guidelines was LABA plus inhaled corticosteroids (23.3%), followed by short-acting inhalers (13.2%), and LAMA alone (9.6%).
  • People with fragmented care had a 56% greater chance of being prescribed non-guideline therapy.
  • Patients living in rural areas were 18% more likely to be on guideline-discordant regimens than those in urban areas.
  • Patients who had to drive between 30 minutes to an hour to get to a specialty center were 9% more likely to be on guideline-discordant therapy than those who could reach a center in 30 minutes or less. Those who had to drive more than 90 minutes were 38% more likely.
  • The link between non-guideline treatment and fragmented care or living in a rural area was strongest among Black/African American patients, although Black patients overall were 19% less likely than white patients overall to be on non-guideline treatment.
  • Women were 14% more likely to be on non-guideline treatment overall.

The investigators call for the development of innovative programs aimed at improving the delivery of guideline-concordant COPD care, particularly in high-risk COPD patients experiencing fragmented care and geographic barriers.

The study was published by The Lancet Regional Health — Americas. Read More

iNO May Benefit Patients with COVID-19 Pneumonia

Studies have shown that inhaled nitric oxide (iNO) can boost blood oxygen levels in patients with acute lung injury. Now researchers taking part in a multicenter trial have shown that iNO can also benefit the lungs of people with COVID-19 pneumonia.

Their finding comes from a study involving 193 adults with COVID-19 and respiratory failure at four U.S. hospitals and one hospital in Sweden. All were on mechanical ventilation. The patients were randomized to receive either high-dose iNO (up to 80 parts per million) for 48 hours or usual care.

Results showed —

  • Patients who received iNO experienced improved oxygenation and had fewer risks of long-term sensory and motor neurologic symptoms, such as weakness or pain in the extremities, compared with patients receiving usual care.
  • iNO patients also had lower levels of SARS-CoV-2 in their blood and sputum, suggesting that nitric oxide has anti-viral activity.
  • iNO was well tolerated and was not associated with any serious adverse events.
  • Mechanical ventilation duration and mortality rates at 28 and 90 days did not differ significantly between the two groups.

“In addition to the well-documented effects on oxygenation, these findings suggest new and promising advantages of utilizing high-concentration inhaled nitric oxide as an antimicrobial agent,” said co-senior author Lorenzo Berra, MD, medical director of respiratory care at the Massachusetts General Hospital and the Reginald Jenney Associate Professor of Anesthesia at Harvard Medical School.

He believes more study is warranted to look at both the anti-microbial and clinical properties of high-dose iNO in adults with acute hypoxemic respiratory failure. Read More

COVID-19 Isn’t the Only Virus That Can Run Long

Much has been said and written about long COVID and the effects it has on people for months or even years after they recover from the acute phase of the virus.

According to British researchers publishing in The Lancet’s EClinicalMedicine, COVID-19 isn’t the only virus that can linger long after the initial illness ends. In a study conducted among 10,171 adults in the U.K. who were taking part in the COVIDENCE UK study, people can experience lasting symptoms after acute respiratory infections that test negative for COVID-19 too.

“Our findings may chime with the experience of people who have struggled with prolonged symptoms after having a respiratory infection despite testing negative for COVID-19 on a nose or throat swab,” said study author Professor Adrian Martineau. “Ongoing research into the long-term effects of COVID-19 and other acute respiratory infections is important because it can help us to get to the root of why some people experience more prolonged symptoms than others.”

The researchers believe this research could ultimately help scientists identify the best treatment and plan of care for people whose symptoms persist after a respiratory infection, whether COVID-19 or another respiratory virus is to blame. Read More

Email with questions or comments, we’d love to hear from you.

Debbie Bunch

Debbie Bunch is an AARC contributor who writes feature articles, news stories, and other content for Newsroom, the AARC website, and associated emailed newsletters. In her spare time, she enjoys reading, traveling, photography, and spending time with her children and grandchildren. Connect with Debbie by email or on AARConnect or LinkedIn.

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