The numbers are staggering. Statistics show that millions of Americans are affected by chronic obstructive pulmonary disease (COPD) the fourth leading
by Denise H. McClinton

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

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

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

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

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

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

“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

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

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.”