Respiratory Institute

Cleveland, OH, United States

Respiratory Institute

Cleveland, OH, United States
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Sidney Braman, MD, Professor in the Pulmonary, Critical Care and Sleep Medicine Division of the Icahn School of Medicine at Mount Sinai – National Jewish Health Respiratory Institute and lead author of the study will present a poster presentation titled "Respiratory Failure that Develops During Hospitalization: A Comparison of Medical vs. Surgical Patients" (Abstract #A1895) from 11:15 am – 1:00 pm on Sunday, May 21 in a session on Critical Care: Outcomes in Respiratory Failure. James P. Lamberti, MD, Professor of Medicine at Virginia Commonwealth University Inova Campus and Medical Director of Respiratory Care Services at Inova Fairfax Hospital, will present a poster presentation titled "Medicare Patients Who Develop Respiratory Failure During Hospitalization Have Higher Mortality Compared to Medicare Patients Admitted with Respiratory Failure" (Abstract #A1893) from 11:15 am – 1:00 pm on Sunday, May 21 during the same session. "Respiratory compromise is a significant cause of morbidity and mortality, and we believe that the data scheduled for presentation at ATS 2017 provide an important foundation on which to expand our understanding of this serious condition and help develop effective intervention strategies that may improve patient care and outcomes," said Phillip Porte, Executive Director of RCI. About Respiratory Compromise Respiratory compromise, which includes respiratory distress, insufficiency, failure and arrest, can occur across numerous clinical scenarios. For example, respiratory compromise may appear post-operatively or may be drug-induced by the delivery of a sedative, opioid, or analgesic to patients who were not properly assessed or properly monitored. According to the U.S. Department of Health & Human Services, Agency for Healthcare Research and Quality, respiratory compromise is the third most rapidly increasing hospital inpatient cost in the United States, with $7.8 billion spent on respiratory compromise in U.S. hospitals in 2007. Respiratory compromise increases patient mortality rates by over 30 percent and hospital and ICU stays by almost 50 percent. RCI defines respiratory compromise as a state in which there is a high likelihood of decompensation into respiratory insufficiency, respiratory failure or death that could be prevented or mitigated through specific interventions (enhanced monitoring and/or therapies). About Respiratory Compromise Institute The Respiratory Compromise Institute brings together a broad-based coalition of organizations, companies, and individuals dedicated to reducing—and eventually eliminating—preventable adverse events and deaths due to respiratory compromise. iii Kelley SD, SA, Agarwal S, Parikh N, Erslon M, Morris P. Respiratory insufficiency, arrest and failure among medical patients on the general care floor. Crit Care Med. 2012;40(12):764. iv NAMDRC, National Association for Medical Direction of Respiratory Care. Reducing respiratory compromise and depression. PR Web. Available at http://www.prweb.com/pdfdownload/12615503.pdf. To view the original version on PR Newswire, visit:http://www.prnewswire.com/news-releases/respiratory-compromise-institute-to-present-data-at-ats-2017-highlighting-high-incidence-of-respiratory-compromise-among-hospitalized-medicare-patients-300458857.html


The studies are the first retrospective analyses of mortality associated with respiratory failure based on Medicare administrative claims data for inpatient admissions to short-term acute care hospitals. The study was conducted for the time period between January 1, 2012 and December 31, 2014. Based on a review of the Medicare database of hospital admissions, an annual estimate of at least 111,020 Medicare beneficiaries suffer from respiratory compromise. The first study (Abstract #A1895) evaluated medical records for patients who developed respiratory failure after hospitalization for medical (n =16,653) or surgical (n =13,895) inpatient stays. The average age for the medical and surgical groups was 73.2 and 72.4 years of age, respectively. In-hospital mortality was greater for medical compared with surgical patients (32.7% vs. 25.1%, p < 0.0001). Mortality during the 30 days post-discharge was also greater for medical compared with surgical patients (15.3% vs. 9.8%, p < 0.0001). In both medical and surgical groups, hospital mortality was considerably worse when acute kidney failure occurred during the hospitalization (p <0.0001). While both groups had a high rate of intubation, medical patients had more non-invasive mechanical ventilation compared with surgical patients (33% vs. 14%, p < 0.001). The majority of patients in both groups showed evidence of a prior hospitalization within the year previous to the index admission used in this analysis. Medical patients were more likely to have been in a skilled nursing facility (26% vs. 16%, p < 0.001). "While these data verify that respiratory compromise is a significant safety issue in the hospital setting, particularly among this elderly population, we know that it can be identified in most cases and by doing so, acute respiratory failure may be prevented," said Sidney Braman, MD, Professor in the Pulmonary, Critical Care and Sleep Medicine Division of the Icahn School of Medicine at Mount Sinai – National Jewish Health Respiratory Institute and lead author of the study. "The results support the need for improved monitoring and intervention strategies to reduce the risk of respiratory compromise and improve outcomes." The other study (Abstract #A1893) compared Medicare patients who had hospital-acquired respiratory compromise (HARC) (n=16,653, average age 73.2 years) with patients who had respiratory failure diagnosed at the time of hospital admission (n = 18,503, average age = 70.8 years). In-hospital mortality was 32.7% in patients with HARC versus 27.8% in those patients with respiratory failure diagnosed at time of hospital admission (p < 0.0001). Mortality at 30 days post hospital discharge was also significantly different (HARC: 15.3% and respiratory failure at time of hospital admission: 12.9%, p = 0.0001). Patients with HARC had high rates of concomitant diseases (chronic heart failure (45%), hypertension (38%), atrial fibrillation (35%), acute kidney failure (36%), pneumonia (31%) and septicemia (26%). "This analysis shows that Medicare patients who are recognized as having respiratory failure after hospitalization have significantly higher mortality than patients diagnosed as having respiratory failure at time of hospital admission," said James P. Lamberti, MD, Professor of Medicine at Virginia Commonwealth University Inova Campus and Medical Director of Respiratory Care Services at Inova Fairfax Hospital. "The fact that 48% of patients who develop HARC either die in the hospital or within 30 days of hospital discharge demonstrates the urgent need for further study of HARC. Since this study utilized Medicare administrative claims data, a prospective observation study is required to understand the time course and progression of respiratory compromise after hospital admission. Better clinical data will hopefully allow development of strategies for early identification and intervention in the continuum of respiratory compromise to respiratory failure within the hospital. Further study will also identify the role of palliative care in this group of patients with a very high risk of death." Phillip Porte, Executive Director of RCI, commented: "Collectively, the study results suggest the urgent need for further study of hospital acquired respiratory compromise, with a focus on early identification and preventative strategies to reduce respiratory compromise. While data on respiratory compromise are limited, these two studies help establish a foundation of the incidence among elderly patients in the hospital setting and provide a compelling call to action to improve our understanding to prevent and manage respiratory compromise to mitigate progression to more debilitating forms of respiratory dysfunction." Respiratory compromise, which includes respiratory distress, insufficiency, failure and arrest, can occur across numerous clinical scenarios. For example, respiratory compromise may appear post-operatively or may be drug-induced by the delivery of a sedative, opioid, or analgesic to patients who were not properly assessed or properly monitored. According to the U.S. Department of Health & Human Services, Agency for Healthcare Research and Quality, respiratory compromise is the third most rapidly increasing hospital inpatient cost in the United States, with $7.8 billion spent on respiratory compromise in U.S. hospitals in 2007. Respiratory compromise increases patient mortality rates by over 30 percent and hospital and ICU stays by almost 50 percent. RCI defines respiratory compromise as a state in which there is a high likelihood of decompensation into respiratory insufficiency, respiratory failure or death that could be prevented or mitigated through specific interventions (enhanced monitoring and/or therapies). The Respiratory Compromise Institute brings together a broad-based coalition of organizations, companies, and individuals dedicated to reducing—and eventually eliminating—preventable adverse events and deaths due to respiratory compromise. To view the original version on PR Newswire, visit:http://www.prnewswire.com/news-releases/respiratory-compromise-institute-presents-data-underscoring-respiratory-compromise-as-a-leading-cause-of-mortality-in-hospitalized-medicare-patients-300460784.html


News Article | May 24, 2017
Site: www.eurekalert.org

ATS 2017, WASHINGTON, DC -- In a new study presented at the 2017 American Thoracic Society International Conference, adult asthma patients treated with bronchial thermoplasty (BT) had fewer severe exacerbations and were able to reduce their ER visits and hospitalizations in the two years following treatment. Approved by the FDA in 2010, BT is a new device-based therapy that uses a series of three radio-frequency treatments to open the airways of adults with severe, persistent asthma whose symptoms are not adequately controlled by inhaled corticosteroids or long-acting beta-agonists. To date, more than 6,800 patients in 33 countries have been treated with BT. The "Post-FDA Approval Clinical Trial Evaluating BT in Severe Persistent Asthma" (PAS2 study), which involves hundreds of patients at dozens of research centers, looks at the long-term effects and safety of BT. "The results of the PAS2 study suggest that after a single series of BT procedures, patients experience long-term improvement in their asthma control," said lead author Geoffrey Chupp, MD, from Yale School of Medicine. "These results indicate that BT works across the spectrum of severe asthma patients. We believe BT should be more widely considered as a treatment option in patients with poorly controlled severe asthma." Two-hundred eighty four patients were enrolled in the study at 27 centers in the U.S. and Canada. Two-hundred seventy-nine study subjects had at least one BT procedure, and 271 had all three procedures. In the 12 months prior to the first BT procedure, 78 percent of subjects had at least one severe exacerbation, 16 percent required hospitalization and 29 percent had ER visits. In the first year follow up, 50.6 percent had severe exacerbations; 45.4 percent had exacerbations in the second year follow up. Asthma-related hospitalizations and ER visits also saw significant, continuing reductions: 14.4 percent and 12.7 percent of subjects had hospitalizations, respectively, in the first and second year, and 18.3 percent and 13.5 percent made ER visits in the first and second year post-treatment. "On average, patients also reduced their inhaled corticosteroid dose and a significant number were able to discontinue maintenance oral corticosteroids," said Dr. Chupp. "BT offers an alternative approach for patients who are inadequately controlled with medications designed to improve the control of their asthma." Authors: G. Chupp1, J. Kline2, S.B. Khatri3, C. McEvoy4, G.A. Silvestri5, A. Shifren6, S. Bansal7, M. McClelland8, M. Dransfield9, R. Olivenstein10, E. Lawson11, M. Simoff12, M.M. Wahidi13, C.R. Lamb14, S. Ferguson15, A. Haas16, K. Hogarth17, R. Tejedor18, J. Toth19, A. Majid20, S. Rafeq21, J.M. Fitzgerald22, K. Enfield23, G.M. Grubb24, E. McMullen24, M. Laviolette25; 1Yale University - New Haven, CT/US, 2University of Iowa Hospitals and Clinics - Iowa City, IA/US, 3Cleveland Clinic Respiratory Institute - Cleveland, OH/US, 4Regions Hospital - St. Paul, MN/US, 5Medical University of South Carolina - Charleston, SC/US, 6Washington University School of Medicine - St. Louis, MO/US, 7Dubois Regional Medical Center - DuBois, PA/US, 8Spectrum Health Hospitals - Grand Rapids, MI/US, 9University of Alabama - Birmingham, AL/US, 10Montreal Chest Institute, McGill University - Montreal, QC/CA, 11Surrey Memorial Hospital - Surrey, BC/CA, 12Henry Ford Hospital - Detroit, MI/US, 13Duke University Medical Center - Durham, NC/US, 14Lahey Hospital and Medical Center - Burlington, MA/US, 15University of Wisconsin Madison - Madison, WI/US, 16University of Pennsylvania - Philadelphia, PA/US, 17University of Chicago - Chicago, IL/US, 18LSU Health Science Center - New Orleans, LA/US, 19Penn State University - Hershey, PA/US, 20Beth Israel Deaconess Medical Center - Boston, MA/US, 21St. Elizabeth's Medical Center, Tufts Medical School - Boston, MA/US, 22University of British Columbia - Vancouver, BC/CA, 23University of Virginia Health System - Charlottesville, VA/US, 24Boston Scientific - Marlborough, MA/US, 25Laval University - Québec, QC/CA Rationale: Bronchial thermoplasty (BT) is a non-pharmacologic, device-based treatment for subjects ?18 years with severe persistent asthma not well controlled with inhaled corticosteroids (ICS) and long-acting beta-agonists (LABA). The "Post-FDA Approval Clinical Trial Evaluating BT in Severe Persistent Asthma" (PAS2 study) collects real-world data on subjects undergoing BT treatment with the Alair BT System. We report for the first time baseline and follow-up results for the primary and secondary endpoints to 2 years. Methods: The PAS2 study is a prospective, open-label, observational, multi-center trial at US and Canadian centers. Subjects 18-65 years taking ICS ?1000μg/day (beclomethasone or equivalent) and LABA ?80μg/day (salmeterol or equivalent) were enrolled. Additional inclusion criteria were: pre-bronchodilator FEV1 ?60% predicted, non-smoker for ?1 year ( Results: Two-hundred eighty-four subjects were enrolled at 27 centers; 279 subjects had at least 1 of 3 BT procedures; 271 subjects had all 3 BT procedures. Subjects had mean age 45.7 years with 64.5% female and mean BMI 32.2kg/m2. Mean ICS dose was 2269μg/day, LABA dose was 74μg/day, and SABA dose was 2.35μg/day at baseline. Baseline mean AQLQ was 4.03 with a mean of 25.2 years since asthma diagnosis. In the 12 months prior to first BT procedure, 78% of subjects had at least one severe exacerbation (mean 1.6/subject), 16% had hospitalizations, and 29% had ER visits. In the first and second year of follow-up, 50.6% and 45.4% of subjects had severe exacerbations, respectively. Similarly, 14.4% and 12.7% of subjects had hospitalizations in the first and second year of follow-up, and 18.3% and 13.5% of subjects had ER visits in the first and second year of follow-up. Conclusion: The PAS2 study shows that compared to the year prior to BT treatment, in the 2 years after BT treatment study subjects experienced improved asthma control with respect to severe exacerbations, hospitalizations and ER visits. Short-Acting Beta Agonists (SABA) used per day for asthma symptoms (μg/day) How long has the subject been diagnosed with asthma (years) Session: A7043 Novel Therapeutic Targets in Obstructive Lung Disease Abstract Presentation Time: Wednesday, May 24, 2017, 9:15-9:30 a.m. ET Location: Marquis Ballroom 6 (Level M2), Marriott Marquis Washington


Neil Schachter, MD, Pulmonologist and Medical Director at the Mount Sinai – National Jewish Health Respiratory Institute, and affiliated with Mount Sinai Hospital, has been named a 2017 Top Doctor in New York City, New York. Top Doctor Awards is dedicated to selecting and honoring those healthcare practitioners who have demonstrated clinical excellence while delivering the highest standards of patient care. Dr. Neil Schachter is a vastly experienced pulmonologist and critical care physician, having been in practice for more than 48 years. His career in medicine started in 1968, when he graduated from New York University School of Medicine. A residency followed at New York’s Bellevue Hospital, and after serving as a pulmonologist and Lieutenant Commander in the United States Navy, Dr. Schachter undertook advanced training in chest medicine at the Yale University School of Medicine. Dr. Schachter is renowned across New York and beyond as an expert pulmonary medicine physician, and he is also a specialist in pediatrics, sleep medicine and critical care medicine. He diagnoses and treats a wide range of conditions for patients of all ages, including asthma, bronchitis, emphysema and obstructive lung disease. Dr. Schachter has written many medical papers, and is the author of the acclaimed book ‘Life And Breath’. Alongside his practice he has served for more than three decades as Professor of Pulmonary, Critical Care and Sleep Medicine at the Icahn School of Medicine at Mount Sinai. His expertise, allied to his wealth of experience, makes Dr. Neil Schachter a very deserving winner of a 2017 Top Doctor Award. Top Doctor Awards specializes in recognizing and commemorating the achievements of today’s most influential and respected doctors in medicine. Our selection process considers education, research contributions, patient reviews, and other quality measures to identify top doctors.


Alkhouri N.,Cleveland Clinic | Fiocchi C.,Digestive Disease Institute | Fiocchi C.,Cleveland Clinic Lerner Research Institute | Dweik R.,Respiratory Institute | And 2 more authors.
Alimentary Pharmacology and Therapeutics | Year: 2015

Background There is an urgent need for cheap, reproducible, easy to perform and specific biomarkers for diagnosis, differentiation and stratification of inflammatory bowel disease (IBD) patients. Technical advances allow for the determination of volatile organic compounds in the human breath to differentiate between health and disease. Aim Review and discuss medical literature on volatile organic compounds in exhaled human breath in GI disorders, focusing on diagnosis and differentiation of IBD. Methods A systematic search in PubMed, Ovid Medline and Scopus was completed using appropriate keywords. In addition, a bibliography search of each article was performed. Results Mean breath pentane, ethane, propane, 1-octene, 3-methylhexane, 1-decene and NO levels were elevated (P < 0.05 to P < 10-7) and mean breath 1-nonene, (E)-2-nonene, hydrogen sulphide and methane were decreased in IBD compared to healthy controls (P = 0.003 to P < 0.001). A combined panel of 3 volatile organic compounds (octene, (E)-2-nonene and decene) showed the best discrimination between paediatric IBD and controls (AUC 0.96). Breath condensate cytokines were higher in IBD compared to healthy individuals (P < 0.008). Breath pentane, ethane, propane, isoprene and NO levels correlated with disease activity in IBD patients. Breath condensate interleukin-1β showed an inverse relation with clinical disease activity. Conclusions Breath analysis in IBD is a promising approach that is not yet ready for routine clinical use, but data from other gastrointestinal diseases suggest the feasibility for use of this technology in clinical practice. Well-designed future trials, incorporating the latest breath detection techniques, need to determine the exact breath metabolome pattern linked to diagnosis and phenotype of IBD. © 2014 John Wiley & Sons Ltd.


Kaw R.,Cleveland Clinic | Bhateja P.,Respiratory Institute | Mar H.P.,Medicine Institute Center for Value Based Care Research | Hernandez A.V.,Cleveland Clinic Lerner Research Institute | And 3 more authors.
Chest | Year: 2016

BACKGROUND: Among patients with OSA, a higher number of medical morbidities are known to be associated with those who have obesity hypoventilation syndrome (OHS) compared with OSA alone. OHS can pose a higher risk of postoperative complications after elective noncardiac surgery (NCS) and often is unrecognized at the time of surgery. The objective of this study was to retrospectively identify patients with OHS and compare their postoperative outcomes with those of patients with OSA alone. METHODS: Patients meeting criteria for OHS were identified within a large cohort with OSA who underwent elective NCS at a major tertiary care center. We identified postoperative outcomes associated with OSA and OHS as well as the clinical determinants of OHS (BMI, apnea-hypopnea index [AHI]). Multivariable logistic and linear regression models were used for dichotomous and continuous outcomes, respectively. RESULTS: Patients with hypercapnia from definite or possible OHS and overlap syndrome are more likely to experience postoperative respiratory failure (OR, 10.9; 95% CI, 3.7-32.3; P .0001), postoperative heart failure (OR, 5.4; 95% CI, 1.9-15.7; P = .002), prolonged intubation (OR, 3.1; 95% CI, 0.6-15.3; P = .2), postoperative ICU transfer (OR, 10.9; 95% CI, 3.7-32.3; P .0001), and longer ICU (b-coefficient, 0.86; SE, 0.32; P = .009) and hospital (b-coefficient, 2.94; SE, 0.87; P = .0008) lengths of stay compared with patients with OSA. Among the clinical determinants of OHS, neither BMI nor AHI showed associations with any postoperative outcomes in univariable or multivariable regression. CONCLUSIONS: Better emphasis is needed on preoperative recognition of hypercapnia among patients with OSA or overlap syndrome undergoing elective NCS. Copyright © 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.


Bukstein D.,Respiratory Institute | Luskin A.T.,Respiratory Institute | Farrar J.R.,Life science Press
Allergy and Asthma Proceedings | Year: 2011

Medical advances have allowed many patients with chronic diseases to lead relatively normal lives, but disparity between patient perceptions of "normal" and therapeutically defined disease control contributes to lowered adherence to treatment. This disconnect is greatest in diseases such as allergic rhinitis (AR) in which patients experience varying symptom severity over time - from asymptomatic periods to episodes of severe illness. This study was designed to evaluate the concept of adherence as applied to patients with AR. We reviewed the published literature. Adherence (or nonadherence) is an active process involving decision making on the part of the patient. Poor adherence with therapy can be the major barrier to achieving disease control, and the "on again, off again" approach to AR treatment embraced purposely by some patients may contribute to symptom lability, disease exacerbations, and higher costs. Evidence from surveys suggests that although specific educational interventions can temporarily improve adherence, in the long term most patients eventually revert to their former behavior. The available data suggest a need to reappraise how we address adherence with therapy in patients with chronic diseases with variable symptoms such as AR. The question is not just whether patient behavior can conform to recommended treatment plans, but whether it should. Experience suggests that successful strategies will be brief, easy to use, and capable of being tailored to individual patients in diverse clinical settings. Increased flexibility with medications is a corollary, particularly when patients are relatively asymptomatic (i.e., considered in control). Copyright © 2011, OceanSide Publications, Inc.


Tonelli A.R.,Respiratory Institute | Zein J.,Respiratory Institute | Ioannidis J.P.A.,Stanford University
Cardiovascular Therapeutics | Year: 2013

Objective: We studied the entire agenda of randomized clinical trials in pulmonary hypertension (PH) using sociological methods. We explored the geometry of the PH network to interpret the evidence on multiple competing treatments for the same indication. Design: We searched MEDLINE, Embase and Cochrane Library Databases for published studies. We queried clinicaltrials.gov and WHO International Clinical Trials Registry platform for non-published studies. Results: We found 75 randomized trials (41 published [n = 4136 participants] and 34 registered unpublished [planned n = 3470 participants]). Of the published randomized studies, all used placebo as the comparator arm except for two nonindustry-sponsored comparisons between phosphodiestearase-5 (PDE-5) inhibitors and endothelin receptor antagonists (ERA), and one study comparing two different regimens of treprostinil. Similarly, only five unpublished/ongoing trials used an active PH treatment as comparator (PDE-5 inhibitors versus ERA (n = 3), different doses of sildenafil (n = 1) and two formulations of epoprostenol (n = 1). Of the 75 trials, 47 were sponsored by the manufacturer of the tested active product(s), and only two trials were sponsored by two companies comparing their products. Conclusions: The relative merits of different treatment options are not directly known, as there are very few head-to-head comparisons. A limited number of ongoing studies are using active FDA-approved PH-treatments for comparison. This lack of information can be overcome by carefully designing comparative effectiveness trials. © 2013 John Wiley & Sons Ltd.


Mohanka M.,Respiratory Institute | Khemasuwan D.,Respiratory Institute | Stoller J.K.,Respiratory Institute
Expert Opinion on Biological Therapy | Year: 2012

Introduction: Alpha-1 antitrypsin deficiency (AATD) is a relatively common, but under-recognized condition which manifests commonly with liver cirrhosis and emphysema. Specific therapy for lung-affected individuals with AATD is augmentation therapy, which consists of intravenous infusion of purified human plasma-derived alpha-1 antitrypsin (AAT). Augmentation therapy was first approved by the United States Food and Drug Administration (FDA) in 1987 for emphysema associated with severe AATD and today, six augmentation therapy preparations, all of which derive from pooled human plasma, have received FDA approval. Areas covered: This paper reviews augmentation therapy for AATD, including the various available commercial preparations, their processing and biochemical differences, evidence regarding biochemical and clinical efficacy, patterns of clinical use, adverse effect profiles, cost-effectiveness and potential uses in conditions other than emphysema associated with AATD. Novel and emerging strategies for treating AATD are briefly discussed next, including alternative dosing and administration strategies, recombinant preparations, small molecule inhibitors of neutrophil elastase and of AAT polymerization, autophagy-enhancing drugs and gene therapy approaches. Expert opinion: We conclude with a discussion of our approach to managing patients with AATD and use of augmentation therapy. © 2012 Informa UK, Ltd.

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