COVID-19 & COPD Coordinating Care Webinar slides

12/3/20

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Allergy'&'Asthma'Network'NewsMore%information%at%allergyasthmanetwork.org

Meet%the%Allergy%&%Asthma%Network%Team%–Look%for%“About%Us”%&%“Meet%Our%Team”

Distinguishing%the%Difference:%%COVIDF19%vs.%Allergies%vs.%the%Flu%– Infographic in%our%COVIDF19%Information%Center

Webinar – Thursday,%December%10th – 4:00%PM%ETChronic%Rhinosinusitis:%Making%Treatment%Decisions

COVID&19)&)COPD:)Coordinating)Care

Dr.$Purvi ParikhDr.$Vickram Tejwani

Tonya$Winders

12/3/20

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Our$Speakers

Dr.$Vickram TejwaniPulmonary$and$Critical$Care$Fellow$Johns$$Hopkins$Pulmonary$Critical$Care Medicine

Dr.$Purvi ParikhClinical$Assistant$Professor$of$Medicine$NYU$Langone$School$of$Medicine &$Director,$Allergy$and$Asthma$Association,$Murray$Hill

National$Spokesperson,$$$$$$$$$$Allergy$&$Asthma$Network$

Tonya$WindersPresident$&$CEO,$Allergy$&$Asthma$Network

President,$Global$Allergy$&$Airways$Patient$Platform

Outline

! Current*State*of*COVID*– 19

! COPD*Overview*

! COPD*Care*During*COVID919

! Special*Considerations*for*COPD*Patients

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Poll$Question

!We’d%like%to%know%who%is%here%today.!Which%category%best%describes%you?

Current'State'of'COVID019

Tonya&Winders

12/3/20

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US#Data#Report#–CDC#

Cases#in#the#last#7#days

12/3/20

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In#the#News#– Two#Vaccines

Pfizer

Applied#to#FDA#for#emergency#use#authorization#of#

vaccine#– 11/27/20

Documents#online#–Hearing#set#for#December#10th

Moderna

Applied#to#FDA#for#emergency#use#authorization#of#

vaccine#– 11/30/20#

Trial#has#been#same#size#&#scope#as#for#

any#vaccine

What#does#emergency#authorization#mean?

Fastest#way#for#public#health#officials#to#get#

a#vaccine#to#the#public

Dramatically#shortened#drug#development#&#approval#process

Approved(

for(use(in(UK

VACCINE#READY#TO#SHIP#24#HOURS#AFTER#APPROVAL

McKinsey)&)Co.)Article)–

11/23

12/3/20

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In#the#News

! CDC#– COVID/19#likely#to#have#been#in#US#since#mid/December#2019#– earlier#than#originally#thought

! CDC#is#finalizing#recommendation#to#shorten#COVID/19#quarantine#times! 7#– 10#days#with#a#negative#test#to#exit#quarantine

! Coronavirus#spikes#expected#to#be#seen#due#to#holiday#travel! Dr.$Fauci:$

! Expect#even#larger#spikes#during#Christmas#season

! Children#should#be#in#school

In#the#News

! Testing#numbers#could#be#erratic#in#the#next#few#weeks:! Testing#sites#working#on#shortened#holiday#hours

! Many#people#traveling#– tests#required#to#return#home

! Need#to#look#at#the#picture#over#7#days! Dr.#Brix:##“If#you#traveled#over#Thanksgiving,#assume#you#were#exposed#&#became#infected.

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In#The#News

Journal#of#Allergy#and#Clinical#Immunology#–study• Of#the#subjects#positive#for#the#virus,#6.75#percent#had#asthma,#compared#to#9.62#percent#of#those#who#were#negative#for#COVIDJ19,#according#to#the#study#results.

• 3#explanations:• Asthma#is#associated#with#lower#ACE2#receptors#–mechanism#for#virus#to#infect#cells

• People#with#asthma#take#more#precautions• Inhaled#corticosteroids#may#reduce#risk#of#the#virus

COVID&19)Cases)in)US)by)Date)Reported

0

20000

40000

60000

80000

100000

120000

140000

160000

180000

February)28

March)6

March)13

March)20

March)27

April)3

April)10

April)17

April)24

May)1

May)8

May)15

May)22

May)29

June)1

June)8

June)15

June)22

June)29

July)6

July)13

July)20

July)27

August)3

August)10

August)17

August)24

August)31

Septem

ber)7

Septem

ber)14

Septem

ber)21

Sepember)28

October)5

October)12

October)19

October)26

Novemb

er)2

Novemb

er)9

Novemb

er)16

Novemb

er)23

Novemb

er)30

New)Cases)by)Day

Cases

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Poll$Question

! Public'health'guidance'in'my'area'is'requesting/requiring'stricter'social'distancing'&'wearing'of'masks.

COPD%Overview

Dr.$Purvi Parikh

12/3/20

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Chronic(Obstructive(Pulmonary(Disease(

EMPHYSEMA• Tiny(air(sacs(in(the(lungs(where(oxygen(transfers(into(the(bloodstream(are(damaged

• Air(may(also(become(trapped(in(the(lungs(and(hard(to(breathe(out

CHRONIC-BRONCHITIS• Bronchial(tubes(become(irritated(or(swollen

• Excess(mucus(and(coughing(can(last(up(to(three(months

• Bronchial(tubes(may(lose(their(cilia• Cilia(– tiny(hairs(that(move(mucus(so(it(can(be(coughed(out

Chronic(obstructive(pulmonary(disease,(or(COPD,(is(an(umbrella(term(used(to(describe(a(series(of(progressive(lung(diseases(characterized(by(difficulty(breathing.(The(two(primary(COPD(diseases(are:

384$Millionpeople%suffer%from%COPD%in%the%world%

3$Millionpeople%die%each%year%from%%COPD

COPD%is%currently%the%

3rdLeading%cause%

of%death%globally

COPD%is%now%prevalent%in%

low%resource%countries

COPD

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COPD%Annual%Costs

$32.1%Billion%in%2010Project%to%increase%to%%$49%Billion%in%2020

Early&Diagnosis&

Symptoms&include:! Shortness&of&breath! Repetitive&cough! Increased&phlegm&or&mucus&production

! Fatigue! More&frequent&chest&infections! Longer&to&recover&from&a&cold/chest&infection&

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Biggest'Risk'Factors'for'COPD

Smoking• Indoor,&,Outdoor,Pollution

• Occupational,Dusts,&Chemical

Although(30%(of(COPD(patients(never(

smoked!

COPD%Patients

COPD%most%often%occurs%in%people%more%than%40%years%of%age%who%smoke%or%have%done%so%earlier%in%life

• May%have%experienced%long@term%exposure%to%chemicals

COPD%typically%builds%up%over%time,%and%so%the%longer%someone%exposes%themselves%to%potential%lung%damage,%the%more%likely%it%is%that%they%might%develop%COPD• The%lungs%of%people%who%are%younger%may%recover%from%potential%irritants%faster%than%those%of%people%who%are%older

• Lung%damage%may%not%be%enough%to%cause%symptoms,%as%COPD%typically%takes%years%to%produce%noticeable%signs

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Definition(of(ACO

Asthma0COPD(overlap((ACO)(is(characterized(by(persistent(airflow(limitation(with(several(features(usually(associated(with(asthma(and(several(features(usually(associated(with(COPD

Asthma0COPD(overlap(is(identified(in(clinical(practice(by(the(features(that(it(shares(with(both(asthma(and(COPD

This(is(not(a(definition,(but(a(description(for(clinical(use,(as(Asthma0COPD(Overlap(includes(several(different(clinical(phenotypes(and(there(are(likely(to(be(several(different(underlying(mechanisms.

ACO

Asthma COPDACO

Symptoms/of/both/Asthma/&/COPD

Symptoms:

• Labored/breathing• Wheezing• Coughing,/with/or/without/mucus

• Tightness/in/the/chest

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It#Can#Be#a#Bit##Confusing#.#.#.#

Many#patients#with#symptoms#of#chronic#airways#disease#have#features#of#both#asthma#and#COPD#• This#has#been#called#AsthmaBCOPD#Overlap#(ACO)

AsthmaBCOPD#overlap#is#not#a#single#disease#

• Likely#that#a#range#of#different#underlying#mechanisms#and#origins#will#be#identified#

Patients#with#features#of#both#asthma#and#COPD#have#worse#outcomes#than#those#with#asthma#or#COPD#alone• Frequent#exacerbations#B Poor#quality#of#life#B More#rapid#decline#in#lung#function#B Higher#mortality#B Greater#health#care#utilization

How$does$COPD$affect$people’s$lives?

• Difficulty$with$physical$activities$like$walking$&$climbing$stairs• May$not$be$able$to$work• Hard$to$engage$in$social$activities$like$eating$out,$going$to$places$of$worship,$or$getting$together$with$friends$or$neighbors• Increased$confusion,$memory$loss,$depression,$or$other$mental$or$emotional$conditions• More$emergency$room$visits$or$overnight$hospital$stays

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Oxygen'Use

! People'with'severe'COPD'who'have'low'levels'of'oxygen'in'their'blood'may'be'treated'with'supplemental'oxygen'at'home

! Therapy'involves'breathing'in'oxygen'through'a'nasal'tube'or'mask'from'a'metal'tank'cylinder'or'oxygen'concentrator

! COPD'patients'should'check'with'their'oxygen'provider'to'be'sure'they'have'an'adequate'supply'during'COVIDB19

https://www.nih.gov/newsBevents/nihBresearchBmatters/longBtermBoxygenBcopd

Pulmonary*Rehabilitation

A*formal*program*to*help*build*fitness*and*help*patient*breathe

Exercise

Breathing*techniques

Nutrition

Relaxation

Emotional*&*group*support

Learning*about*medications

Strategies*for*living*better*with*COPD

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Pulmonary*Rehabilitation

Usually*an*outpatient*program

Might*work*with*an*interprofessional*team• Respiratory*Therapists• Dietitians• Social*Workers

Pulmonary*Rehabilitation*during*COVID819

! Most*Pulmonary*Rehab*Centers*have*temporarily*suspended*face8to8face*programs

! Virtual*Pulmonary*Rehab*via*telehealth,*phones,*video8conferencing! As*social*distancing*guidance*changes,*small*groups*can*meet! Most*important*issues*are*PATIENT*AND*STAFF*SAFETY,*to*avoid*contracting*and*further*spreading*COVID819*

! General*principles*of*infection*control*should*apply*until*there*is*an*effective*vaccine*that*is*widely*available*and*utilized.*Where*new*case*rates*are*high,*it*is*unlikely*that*center8based*rehabilitation*will*be*appropriate*for*people*with*chronic*respiratory*disease.

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COPD%Care%During%COVID/19

Dr.$Vickram Tejwani

COPD%Patients

! A%large%population%of%patients! COPD%is%progressive%5 it%gets%worse%as%time%goes%on

• Not%at%an%increased%risk%of%GETTING COVID519Good(news:

• Increased%risk%for%SEVERECOVID519Bad(news:

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COPD%&%COVID)19

• People%with%COPD%experience%shortness%of%breath%or%dyspnea

COPD

• People%with%COVID)19%experience%shortness%of%breath%or%dyspnea

COVID)19 • How%can%you%tell%the%difference?!?

???

COPD%&%COVID)19

COPD! Shortness-of-breath! Repetitive-cough! Increased%phlegm%or%mucus%production

! Fatigue

COVID:19! Shortness-of-breath! Repetitive-cough! Fever! Anorexia%(no%appetite)! Myalgias%(muscle%pain)! Gastrointestinal%symptoms

! Nausea! Diarrhea

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COVID&19)&)Comorbid)Conditions

You$are$increased$risk$of$severe$disease$if$you also$have$one$of$the$following:Cancer Liver)diseaseChronic)kidney)disease OverweightCOPD Pulmonary)fibrosisHeart)conditions)(heart)failure,coronary artery)disease,)cardiomyopathies)

Thalassemia)(a)blood)disorder)

Immunocompromised)state)(organ)translplant,)chemotherapy,)and)more)

Type)1)diabetes

Neurologic)conditions)(dementia)

COPD%&%COVID)19

• 98%%of%people%with%COPD%agree%they%want%to%be%as%healthy%as%the%can%be%to%fight%off%COVID>98%

• 83%%of%people%with%COPD%agree%that%COVID%has%been%a%wake)up%call%to%realize%their%disease%puts%them%at%risk.83%

• 54%%of%people%with%COPD%feel%more%depressed%about%having%COPD%and%its%impact%on%their%future.54%

https://us.gsk.com/en)us/behind)the)science/patients)consumers/breaking)barriers)for)better)copd)care/

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COPD%&%COVID)19%Care

! Inhalers! Bronchodilator%therapy%should%be%switched%from%nebulizer%to%an%inhaler%– either%metered)dose%inhaler%or%dry%powder%inhaler

! Should%use%a%spacer! Nebulizers

! Healthcare%workers%in%the%room%should%wear%personal%protective%equipment%(PPE)%appropriate%for%airborne%precautions

! Viral%particles%can%stay%airborne%for%1%– 3%hours

Management%of%patients%with%COPD%during%the%COVID)19%pandemicAmy Attaway, Umur Hatipoğlu

Cleveland%Clinic%Journal%of%Medicine Jul%2020, DOI: 10.3949/ccjm.87a.ccc007

COPD%&%COVID)19%Care

Significant%numbers%of%patients%will%treat%their%illness%at%home

Should%self)isolate%in%a%room

Ideally,%they%should%have%their%own%bathroom

If%nebulizer%is%needed,%it%should%be%used%in%a%room%with%the%doors%closedShould%remain%closed%for%several%hours%afterwards

Frequent%cleaning%&%disinfecting%of%surfaces%in%room

Medication%regimen%should%not%be%changed%without%discussion%with%doctor

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Emergency)COPD)&)COVID119)Care

If)COVID119)worsens,)pneumonia)can)develop

• Lung)inflammation)– fills)airway)sacs)with)fluid)– can)be)life1threatening

Acute)respiratory)distress)syndrome)(ARDS))can)also)develop

• May)need)to)be)placed)on)a)ventilator)to)get)enough)oxygen

If)you)have)COVID119)and)it)becomes)difficult)to)take)a)breath)1 be)prepared)to)call)911

What%Can%COPD%Patients%Do%to%Stay%Healthy?• Stay%at%home• Practice%the%3"W’s• Wash your%hands• Watch your%distance• Wear a%mask

• Avoid%sick%people• Clean%&%disinfect%surfaces• Reduce%your%stress,%enjoy%your%hobbies• Exercise,%eat%a%healthy%diet• Stay%connected%by%“virtual%means”

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Special(Considerations(for(COPD(Patients

Tonya&Winders

The$COPD$Charter

• Outlines$6$principles$of$quality$care$that$people$with$COPD$should$expect$to$receive,$wherever$they$live.

Global$Policy$Document

• To$mobilize$governments,$healthcare$providers,$policymakers,$lung$health$industry$partners$and$caregivers$to$address$the$unmet$need$and$burden$of$COPD

• Ultimately$working$together$to$deliver$meaningful$improvements$in$care,$now$and$in$the$future.$

• Aims$to$offer$a$consensus$on$global$standards$of$COPD$care.

Purpose$of$the$Charter

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Why$Do$We$Need$a$COPD$

Charter?

• Global$strategies$&$guidelines$exist,$but$there$are$vast$inconsistencies$in$the$way$people$with$COPD$are$managed,$having$a$devastating$impact$on$people$living$with$the$disease• COPD$does$not$receive$the$same$level$of$recognition$and$prioritization$globally• Healthcare$systems$and$providers$are$not$adequately$equipped$to$deliver$optimal$COPD$care$and$policy$reform$is$urgently$needed$to$drive$a$reduction$in$both$mortality$and$exacerbation$rates

Principles*of*Quality*Care*in*COPD

1• I*deserve*timely*access*for*the*diagnosis*and*assessment*of*my*COPD

2• I*deserve*to*understand*what*having*COPD*means*for*me*and*how*the*disease*may*progress

3• I*deserve*access*to*the*best*available*evidence>based,*personalized*treatment,*to*ensure*I*can*live*as*well*and*as*long*as*possible

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Principles*of*Quality*Care*in*COPD

4• I*deserve*an*urgent*review*of*my*current*management*plan*if*I*experience*an*‘exacerbation’,*to*prevent*further*exacerbations*and*disease*progression

5• I*deserve*access*to*specialist*care*when*needed*(whether*provided*in*hospital*or*in*the*community)*to*manage*my*COPD,*irrespective*of*where*I*live

6• I*deserve*to*live*with*COPD*freely*while*maximizing*quality*of*life*without*stigma*or*guilt

How$will$the$COPD$Charter$support$quality$care?

Drive$awareness$of$the$current$unmet$need$and$burden$in$COPD$and$highlight$to$governments,$healthcare$providers,$policymakers,$lung$health$industry$partners$and$caregivers$the$quality$care$that$people$with$COPD$should$expect$to$receive,$wherever$they$liveBy$sharing$the$COPD$Patient$Charter,$we$intend$to$engage$key$stakeholders$to$adopt$the$Patient$Charter$principles.$This$is$vital$if$we$are$to$address$the$unmet$need$and$burden$in$COPD$and$ultimately$work$together$to$deliver$meaningful$improvements$in$care,$both$now$and$in$the$future.

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COPD%Patients

COPD%Patients%have%the%right%to%quality%guidelines6based%healthcare%delivered%in%a%timely%and%collaborative%way.

Poll$Question

!In#my#geographical#area,#pulmonary#rehab#is#being#managed#on#telehealth.

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Questions?

Please&record&your&questions&in&the&Question&box&on&your&webinar&control&panel

We&will&address&as&many&questions&as&we&can

COVID&19)Vaccine)– Treatment,)Trust)&)Health)Inequities

Join%us%on%Tuesday,%December%15th for%the%18thwebinar%in%our%COVID>19%Webinar%Series%>

12/3/20

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COVID&19)&)COPD:)Coordinating)Care

Thank&you&for&listening!Get&guidelines5based&information&at&

allergyasthmanetwork.org