• Annual Meeting of the American Thoracic Society (ATS)
  • ATS stands for the American Thoracic Society. Actually, as the annual meeting in May demonstrated, this is really an international society rather than one just for Americans. Seventeen thousand (that's right, 17,000) pulmonary physicians, scientists and other members of the pulmonary community crowded into Seattle to attend 5 days of multiple, concurrent meetings. From 7 am until 9 pm you could attend a bewildering choice of formal meetings. Additional smaller, more specialized meetings also were scheduled to take advantage of this international gathering of some of the top people in their fields.
  • Why should you care about this? Because you need to be aware of the exciting new research, potential breakthroughs and (most importantly) the international focus now on COPD, its cause and its treatment. COPD is now an international epidemic. However, our attitude towards this disease, to quote Dr. Bart Celli, "has gone from nihilism to justified optimism". That is, the diagnosis of COPD no longer means a hopeless condition without any known treatment or chance of improvement. We are learning more and know that the prognosis is better than it used to be. COPD is now a preventable and treatable disease!
  • PREVENTION of COPD is the first step to be considered by the international community. WHO, the World Health Organization, after many years, has gotten America and Germany to join 130 countries trying to put warnings and restrictions on the sale of tobacco. While the US administration has finally signed up, this still needs the approval of a reluctant Congress! The tobacco lobby is very powerful. Some very harsh language was used at these meetings about the responsibility of the tobacco companies for worldwide health problems. By the year 2030, it is estimated that smoking will be the earth's largest, single cause of death, with COPD itself becoming the third leading cause of death! This will result in a worldwide catastrophe causing an estimated ten million (10,000,000) deaths a year, 70% of them in low/middle income countries. Cigarette consumption is down in the United States (with California leading the way) but the tobacco industry is getting bigger all the time! All of us should watch the votes of our representatives to see if they support the tobacco lobby. We also can join forces to stop support, and put limitations, on these companies. More on that subject later when we talk about the National Coalition of COPD.
  • EARLY RECOGNITION of COPD is now finally accepted as a necessity after years of pioneering efforts by Dr. Tom Petty and NHLEP, the organization he founded specifically for this purpose. There are 10 million to 13 million people in the United States with COPD, but many others are yet undiagnosed. It is speculated that there may be as many as 30 million in all! Why are there so many people around without proper help or diagnosis? Amazingly, many people who experience serious symptoms still regard themselves as quite normal and do not seek help. Another problem is that many family practice physicians are not familiar with spirometry. Did you know that the spirometer was invented before the blood pressure cuff? The truth of the matter is, you can't tell the extent of someone's COPD without spirometry any easier than you can tell what someone's blood pressure is without that blood pressure cuff. So, the push is on to educate medical students and interns, along with older Family Practice Physicians and Internists, in the need and interpretation of the spirometer. The earlier we can diagnose and treat COPD, the more we can limit its impact.
  • Pulmonary Rehabilitation is now considered the gold standard in the care of COPD. This was stated repeatedly as being obvious by physicians from various countries, yet never ceases to send a thrill of accomplishment through those of us who have long advocated this therapy. To give you a little history, back in 1990 after much debate the California Thoracic Society (CTS) issued a revolutionary Position Paper. Written by Drs. Richard Casaburi, Robert Chang, and Andy Ries it stated that pulmonary rehabilitation was the standard of care for the treatment of the pulmonary patient. Many pulmonary physicians at that time did not agree, but successful pulmonary rehabilitation programs in California convinced other influential physicians. They joined patients and coordinators of programs as advocates of this therapy. The position paper was not only accepted by CTS, but it triggered acceptance by other states and organizations. As additional research began to incontrovertibly prove the value of rehab, its use as a therapy spread until it is now internationally accepted. It is no longer considered a form of alternative health care. We now know that even patients with severe disease can benefit from rehab as much as those with mild disease. To again quote Dr. Celli, "If pulmonary rehab was a drug it would be a block buster! If a drug company was marketing it, everyone would get it!" What a thrill to have been part of this process and to see years of belief and effort bear fruit!
  • Now, along with the newly recognized importance of pulmonary rehab, lets not forget that acceptance includes the use of oxygen, when necessary, and the importance of exercise. (PERF Board members Drs Rich Casaburi, Tom Petty, and Brian Tiep were all early advocates and leaders in research in these fields, but more on that another time.) The results of many clinical trials were presented reaffirming this importance, including some studies that show that the more you are able to walk, the better your life expectancy and quality of life. Your FEV1 is no longer considered the only way to judge the impact of COPD on the individual. Another clinical trial showed that even in a normal subject the effects of a cold, as measured by decreased muscle strength, lasted as long as a month in non-COPD patients. Now do you understand why that last bout with a virus knocked the starch out of you? You CAN get better, so just give it time!
  • The average pharmacy cost in the United States per year for each COPD patient was reported as being $1,545.00 while in other countries it is $739.00. Is that because we are getting more and better medications here or is it because drug companies are charging us more? Lots of debate on that topic. There were also many lectures on new medications including Tiotropium (better known to many of you as Spiriva). And no, we can't tell you when it will be approved by the FDA and come on the US market. "Early next year" was the word, which is the same thing said last year at ATS.
  • Do you remember reading earlier remarks about COPD now being recognized as an international problem? Demonstrating this was a small meeting of the International COPD Coalition. Representatives of several organizations from the United States were invited to attend. Mary Burns represented PERF (as well as CSPR and CTS). 13 other countries, ranging from Australia to Russia, also were represented to discuss their common goals and problems, with Europeans estimating that 75% of those with COPD remain undiagnosed. Restriction of smoking is becoming more common. An amusing consequence of this, to us, is an upcoming ban on workplace smoking in the Netherlands will also include marijuana smoke. 800 Dutch "coffee shops", famous for selling cannabis, a.k.a. pot or marijuana, could see business go up in smoke. Coffee shop owners are aghast. Although cannabis is formally illegal in the Netherlands, its use and sale are tolerated under strict government conditions. Coffee shops, where customers can buy a small amount of cannabis without fear of arrest, are a major tourist draw. Smoking a joint in an Amsterdam coffee shop vies with canal boat tours and trips to the flower market for a place on many tourists' itineraries. Life is tough all over!
  • This session was a prelude to a larger meeting to be held this September in Vienna, Austria at the European Respiratory Society (ERS) meeting, which Mary is also planning to attend. We will keep you posted as news develops.
  • The sessions on SARS attracted a large audience at ATS. There had even been pre-convention rumors that ATS would be cancelled this year due to the outbreak. We have asked PERF Board member Dr. Brian Tiep for some information to pass on to all of you. Those of you who receive the newsletter on line will (by e-mailing subscribe@secondwind.org) have already received this information as part of our policy to keep you informed on important topics.
  • One of the hot topics at ATS was the results of NETT, The National Emphysema Treatment Trial. This trial determined the benefits of the best medical care (including pulmonary rehabilitation) plus lung volume reduction surgery as compared to the best medical care alone. The auditorium was filled to capacity for the 3-hour session. There is no way we can do a good job of presenting this information in the space left in this month's newsletter, but we promise to write it up in the next edition.