Pulmonary Prognosis

The numbers are staggering. Statistics show that millions of Americans are affected by chronic obstructive pulmonary disease (COPD) — the fourth leading cause of death and disability in the United States.

“Over 16 million Americans have been diagnosed with COPD, yet epidemiological studies show that another 16 million or more remain undiagnosed,” says Gretchen Lawrence, BA, RRT, FAARC, of the National Lung Health Education Program. The disease, which causes lung damage, is characterized by breathing difficulties due to emphysema and/or chronic bronchitis.

Unfortunately, the numbers are expected to increase.

“Naturally, everyone is keeping an eye on the aging baby boomer generation; even if the prevalence of the disease remains unchanged, diagnosis will have to grow proportionally with the population,” says Carla Laureano, marketing manager for CHAD Therapeutics. “Taken with advances in disease management and care, early diagnosis and better awareness of the disease, we can expect a significant rise in COPD patients being treated by the health care community. Most experts agree that by 2020, COPD will be the third leading cause of death in the world.”

“One reason there has been an increase in COPD diagnosis is that physicians are a lot more aware of it now,” says Bob Fary, vice president of sales for Inogen. “Patients are also being identified earlier on in the disease process.”

According to Joe Priest, president and CEO of AirSep Corp., “There is a greater understanding today by more and more physicians that identifying COPD earlier in the disease state leads to certainly better outcomes, and also it prevents the terrible deterioration that occurs when you catch somebody at the end stage of COPD.”

Patient interest in better quality of life may also be a factor in increasing diagnoses. “People used to have symptoms such as being short of breath and having a nasty cough, and they just thought they were getting old,” says Scott Wilkinson, Invacare Corp.’s group product manager for oxygen therapy. “Today, there is more awareness that prompts people to think that they are not just getting old but that there is something wrong.”

Right Treatment, Right Time

The goal of COPD treatment, regardless of the patient’s progression — mild to severe — is to return the patient to the highest functioning level possible to improve and maintain quality of life, explains Lawrence.

“This means that it is important to develop a comprehensive treatment plan, including getting the patient on the optimal combination of medications, monitoring and supporting progress, preventing exacerbations and treating them early.”

Although COPD is a progressive, and eventually terminal, disease, the earlier it is identified and treated, the more successful the outcome. “The idea is that you hopefully catch somebody in an early enough stage [to] stop the downward spiral of the disease and stabilize him so that his quality of life is better than it would otherwise be,” says Priest.

“The days when a patient would be discharged from the hospital on oxygen and go home to be tethered to a concentrator for the rest of his life are long gone,” says CHAD’s Laureano. “Not only is the medical and home care community seeking to treat the source and symptoms of diseases but we are also seeking to address the lifestyle changes that come along with the diagnosis of COPD.”

One way this is being accomplished is by using oxygen earlier in the disease process. “Now, because these patients are being identified earlier on, they can receive this treatment earlier while it is appropriate,” says Fary. Often, he explains, earlier-stage patients will use oxygen only at night to relieve strain off their heart and other organs. “You never want to provide people with oxygen if they do not need it, but if they have the need for it — even if only part of the day — it is the single best treatment for COPD,” he states.

Wilkinson explains there are really two components to treatment: oxygen therapy and regular activity. “Oxygen therapy by itself is not enough; being mobile is just as important as being on oxygen if you have COPD,” he says.

Lifestyle Solutions

In the past, changes in oxygen technology have been heavily related to provider needs, according to Laureano. However, patient preferences have begun affecting product design as well.

“As the face of the COPD patient population changes, with each successive generation becoming more technology-savvy, there will be an increasing demand for lifestyle solutions [with tools that allow people] to continue their hobbies, spend time with their families and travel,” she explains. “As patients become more involved in their disease management, they will demand that manufacturers push the technology envelope.”

The most notable push in the oxygen market is the production of smaller, more portable systems. At Medtrade in October, Airsep previewed its small FreeStyle portable concentrator, which, scheduled to be released in 2005, weighs less than 5 pounds.

This type of product yields benefits both for the patient and the provider, says Priest. When providers can help patients become more proficient using the equipment, more compliant and have a better understanding of their therapy, then it is better for the patient, the payer and the provider.

“What the provider is really providing,” he says, “is the therapy and the service in the home to help the patient utilize the equipment and educate them properly on their treatment — it’s not just the delivery of the oxygen.”

At Invacare, says Wilkinson, the impetus behind design changes stems from offering products that benefit both patients and providers, such as the company’s HomeFill oxygen system. “We certainly have our research efforts into oxygen therapy devices that make it easier for patients to be mobile — to get out of their houses so they can enjoy their life and they can extend their life,” he explains. “All of our development goes into what patients want, which are smaller portables, lighter portables and less conspicuous portables to try and drive them to be more active.”

Patient mobility and provider satisfaction are key components in design that result in true solutions for both, says Laureano. “For example, oxygen therapy and conservation hasn’t changed much over the last 15 years,” she says, but adds that CHAD’s Sage device is a good example of “how manufacturers are moving from products that merely meet basic physiological needs to [those] that offer true lifestyle solutions.”

According to Randy Krotz, director of communications for Tyco Healthcare, “the impact on patient care and quality of life is very significant” for patients using small portable systems such as Puritan Bennett’s Helios. “Individuals can leave their home easily and play golf, go shopping, visit friends and so forth. They do not have to dramatically change their lifestyle. In addition, psychologically, individuals are not as depressed about being on oxygen because they can do with portable liquid oxygen systems what they did before going on oxygen. Plus, studies have shown that those who are homebound on oxygen tend to be much more depressed since they have lost their ‘freedom.’”

Fary emphasizes that with new portable systems such as the Inogen One, “there will be advantages therapeutically because a patient is much more likely to use a system like that as prescribed [the way] the doctor would like them to.”

Such new technology can also have a positive impact on a provider’s overall respiratory program. “Instead of sending a driver out every week or every other week, a provider can send a clinician out periodically to work on a disease management program with the patient to reinforce their education of the disease and encourage them to be compliant with their prescriptions and so on,” Fary says.

Other products also are impacting provider profitability and patient compliance. Sunrise Medical has a conserving device that will allow a home care provider to download usage information of ambulatory oxygen in ways that generally aren’t available, says Rem Siekmann, global product manager, oxygen product line, for the company’s Respiratory Products Division.

“This device is being used in National Institutes of Health-funded studies and is not generally commercially available, but if there was a demand for this kind of information on the part of health care providers, it can be created,” he says.

The good news is that while oxygen reimbursement will be cut as mandated by the Medicare Modernization Act, manufacturers are moving forward by creating products that will enable patients to remain healthier longer — and providers to remain profitable.

“There is an opportunity for HME providers to try to find a greater role for themselves rather than just to acquiesce to the lower reimbursement and provide less service,” says Siekmann. “There’s no question that oxygen is still a mainstay of the HME business, and it is really a manufacturer’s responsibility to try to help those providers to do a better job.”

Experts Interviewed

Philip Corsello, MD, medical director, disease management program and associate professor of medicine, National Jewish Medical and Research Center, Denver; Bob Fary, vice president of sales, Inogen Corp., Santa Barbara, Calif.; Carla Laureano, marketing manager, CHAD Therapeutics, Chatsworth, Calif.; Randy Krotz, director of communications, Tyco Healthcare, Mansfield, Mass.; Gretchen Lawrence, BA, RRT, FAARC, National Lung Health Education Program, Dallas; Joe Priest, president and CEO, AirSep Corp., Buffalo, N.Y.; Rem Siekmann, global product manager, oxygen product line, Sunrise Medical’s Respiratory Products Division, Longmont, Colo.; and Scott Wilkinson, group product manager for oxygen therapy, Invacare Corp., Elyria, Ohio.

Getting Out of the Driver’s Seat

Home medical equipment providers have a great opportunity to increase respiratory business by dedicating resources to their COPD patients and creating programs that establish their role in the care of these patients. New products are enabling providers to concentrate on educational programs rather than deliveries, and experts say this is the right move to make.

“The smart HME provider would find a way of making sure that the patient is properly oxygenated by doing some saturation level testing with patients,” says Rem Siekmann, global product manager, oxygen product line, for Sunrise Medical’s Respiratory Products Division. “Then, they can recommend a more appropriate mode of therapy to the clinician, because many times all a patient will get is the least expensive thing rather than the most appropriate modality.”

There are many ways of delivering oxygen, each with different strengths, he points out. The savvy home care provider can become a partner in the process of care, offering real value to clinicians.

Scott Wilkinson, Invacare Corp.’s group product manager for oxygen therapy, says HME providers can play a strong role in patient education. “The HME provider is going to be the one who ultimately sets up the patient on the equipment they are going to use. They train them how to use the equipment and they stress the benefits of what the equipment can bring to their lifestyle and their overall health,” he says. “Providers are also ultimately going to be the ones who drive compliance of product usage.”

Many people diagnosed with COPD don’t know what to expect, offering providers a primary role in the process, says Carla Laureano, marketing manager for CHAD Therapeutics. “The provider has a unique opportunity, because of his varied experience, to be able to offer insight and counseling in what can be a very frightening situation. Someone facing oxygen therapy for the first time may regard it as an end to their current lifestyle, and the provider can go far in helping to alleviate their concerns by presenting information on their therapy and equipment options,” she explains.

Bob Fary, vice president of sales for Inogen, says HME providers who want to offer a substantial clinical program should note that such a program is two-fold. “First of all, it should entail a good educational program for the patient that allows them to understand their condition,” he says. “But it should also include clinical follow-ups in which respiratory therapists are speaking with these patients, ensuring they are compliant with their prescriptions or their respiratory medications, their oxygen use and rehab. It is very important that these patients are active and remain active, so they do not end up homebound.”

Siekmann also points out that the provider can emphasize that patients can feel better when the prescribed therapy is used appropriately. This might entail using another product or a new way of using their existing product.“Most patients feel that if they’re getting supplemental oxygen they either do not have a right to feel better than they are feeling or that it is not possible to feel better,” he says. “Many times they just feel fortunate to be getting some help.”