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Start Over Author "Surya P. Bhatt" Journal annals of the american thoracic society
23 results on '"Surya P. Bhatt"'

3. Lung Function and the Risk of Exacerbation in the β-Blockers for the Prevention of Acute Exacerbations of Chronic Obstructive Pulmonary Disease Trial

Author

Trisha M. Parekh, Erika S. Helgeson, John Connett, Helen Voelker, Sharon X. Ling, Stephen C. Lazarus, Surya P. Bhatt, David M. MacDonald, Takudzwa Mkorombindo, Ken M. Kunisaki, Spyridon Fortis, David Kaminsky, and Mark T. Dransfield

Subjects
Pulmonary and Respiratory Medicine, Pulmonary Disease, Chronic Obstructive, Forced Expiratory Volume, Vital Capacity, Humans, Lung, Bronchodilator Agents, Metoprolol
Published
2023

4. Pooled Cohort Probability Score for Subclinical Airflow Obstruction

Author

Surya P. Bhatt, Pallavi P. Balte, Joseph E. Schwartz, Byron C. Jaeger, Patricia A. Cassano, Paulo H. Chaves, David Couper, David R. Jacobs, Ravi Kalhan, Robert Kaplan, Donald Lloyd-Jones, Anne B. Newman, George O’Connor, Jason L. Sanders, Benjamin M. Smith, Yifei Sun, Jason G. Umans, Wendy B. White, Sachin Yende, and Elizabeth C. Oelsner

Subjects
Adult, Male, Pulmonary and Respiratory Medicine, Pulmonary Disease, Chronic Obstructive, Risk Factors, Spirometry, Forced Expiratory Volume, Vital Capacity, Humans, Female, Middle Aged, Nutrition Surveys, Lung
Published
2022

5. Parameter D: New Measure of Airflow Obstruction

Author

Surya P Bhatt, Arie Nakhmani, Nithin M Thimmegowda, Venkata Sthanam, Carla G Wilson, Nirav R Bhakta, Young-il Kim, and Sandeep Bodduluri

Subjects
Pulmonary and Respiratory Medicine
Published
2023

6. Comparative Impact of Depressive Symptoms and FEV1% on Chronic Obstructive Pulmonary Disease

Author

Jacqueline O’Toole, Han Woo, Nirupama Putcha, Christopher B. Cooper, Prescott Woodruff, Richard E. Kanner, Robert Paine, Russell P. Bowler, Alejandro Comellas, Karin F. Hoth, Jerry A. Krishnan, Meilan Han, Mark Dransfield, Anand S. Iyer, David Couper, Stephen P. Peters, Gerard Criner, Victor Kim, R. Graham Barr, Fernando J. Martinez, Nadia N. Hansel, Michelle N. Eakin, Neil E. Alexis, Wayne H. Anderson, Mehrdad Arjomandi, Igor Barjaktarevic, Lori A. Bateman, Surya P. Bhatt, Eugene R. Bleecker, Richard C. Boucher, Stephanie A. Christenson, Alejandro P. Comellas, David J. Couper, Gerard J. Criner, Ronald G. Crystal, Jeffrey L. Curtis, Claire M. Doerschuk, Mark T. Dransfield, Brad Drummond, Christine M. Freeman, Craig Galban, MeiLan K. Han, Annette T. Hastie, Eric A. Hoffman, Yvonne Huang, Robert J. Kaner, Eric C. Kleerup, Lisa M. LaVange, Stephen C. Lazarus, Deborah A. Meyers, Wendy C. Moore, John D. Newell, Laura Paulin, Cheryl Pirozzi, Elizabeth C. Oelsner, Wanda K. O’Neal, Victor E. Ortega, Sanjeev Raman, Stephen I. Rennard, Donald P. Tashkin, J Michael Wells, Robert A. Wise, and Prescott G. Woodruff

Subjects
Pulmonary and Respiratory Medicine, medicine.medical_specialty, COPD, business.industry, Internal medicine, medicine, Pulmonary disease, medicine.disease, business, Depressive symptoms, Depression (differential diagnoses), respiratory tract diseases
Abstract

Rationale: Individuals with Chronic Obstructive Pulmonary Disease (COPD) have a high prevalence of depression, which is associated with increased COPD hospitalizations and readmissions. Objectives:...

Published
2022

7. Clinically Significant and Comorbid Anxiety and Depression Symptoms Predict Severe Respiratory Exacerbations in Smokers: A Post Hoc Analysis of the COPDGene and SPIROMICS Cohorts

Author

Anand S. Iyer, Trisha M. Parekh, Jacqueline O’Toole, Surya P. Bhatt, Michelle N. Eakin, Jerry A. Krishnan, Abebaw M. Yohannes, Prescott G. Woodruff, Christopher B. Cooper, Richard E. Kanner, Nicola A. Hanania, Mark T. Dransfield, Elizabeth A. Regan, Karin F. Hoth, Victor Kim, James D. Crapo, Edwin K. Silverman, Barry J. Make, Terri Beaty, Ferdouse Begum, Peter J. Castaldi, Michael Cho, Dawn L. DeMeo, Adel R. Boueiz, Marilyn G. Foreman, Eitan Halper-Stromberg, Lystra P. Hayden, Craig P. Hersh, Jacqueline Hetmanski, Brian D. Hobbs, John E. Hokanson, Nan Laird, Christoph Lange, Sharon M. Lutz, Merry-Lynn McDonald, Margaret M. Parker, Dmitry Prokopenko, Dandi Qiao, Phuwanat Sakornsakolpat, Emily S. Wan, Sungho Won, Juan Pablo Centeno, Jean-Paul Charbonnier, Harvey O. Coxson, Craig J. Galban, MeiLan K. Han, Eric A. Hoffman, Stephen Huries, Francine L. Jacobson, Philip F. Judy, Ella A. Kazerooni, Alex Kluiber, David A. Lynch, Pietro Nardelli, John D. Newell, Aleena Notary, Andrea Oh, James C. Ross, Raul San José Estépar, Joyce Schroeder, Jered Sieren, Berend C. Stoel, Juerg Tschirren, Edwin Van Beek, Bram van Ginneken, Eva van Rikxoort, Gonzalo Vegas Sanchez-Ferrero, Lucas Veitel, George R. Washko, Carla G. Wilson, Robert Jensen, Douglas Everett, Jim Crooks, Katherine Pratte, Matt Strand, Gregory Kinney, Kendra A. Young, Jessica Bon, Alejandro A. Diaz, Barry Make, Susan Murray, Elizabeth Regan, Xavier Soler, Russell P. Bowler, Katerina Kechris, Farnoush Banaei-Kashani, Jeffrey L. Curtis, Perry G. Pernicano, Nicola Hanania, Mustafa Atik, Aladin Boriek, Kalpatha Guntupalli, Elizabeth Guy, Amit Parulekar, Craig Hersh, George Washko, R. Graham Barr, John Austin, Belinda D’Souza, Byron Thomashow, Neil MacIntyre, H. Page McAdams, Robert Wise, Robert Brown, Nadia N. Hansel, Karen Horton, Allison Lambert, Los Angeles, Richard Casaburi, Alessandra Adami, Matthew Budoff, Hans Fischer, Janos Porszasz, Harry Rossiter, William Stringer, Amir Sharafkhaneh, Charlie Lan, Christine Wendt, Brian Bell, Ken M. Kunisaki, Russell Bowler, Richard Rosiello, David Pace, Gerard Criner, David Ciccolella, Francis Cordova, Chandra Dass, Gilbert D’Alonzo, Parag Desai, Michael Jacobs, Steven Kelsen, A. James Mamary, Nathaniel Marchetti, Aditi Satti, Kartik Shenoy, Robert M. Steiner, Alex Swift, Irene Swift, Maria Elena Vega-Sanchez, Mark Dransfield, William Bailey, Anand Iyer, Hrudaya Nath, J. Michael Wells, Douglas Conrad, Andrew Yen, Alejandro P. Comellas, John Newell, Brad Thompson, Ella Kazerooni, Wassim Labaki, Craig Galban, Dharshan Vummidi, Joanne Billings, Abbie Begnaud, Tadashi Allen, Frank Sciurba, Divay Chandra, Carl Fuhrman, Joel Weissfeld, Antonio Anzueto, Sandra Adams, Diego Maselli-Caceres, Mario E. Ruiz, and Harjinder Singh

Subjects
Pulmonary and Respiratory Medicine, medicine.medical_specialty, Comorbid anxiety, business.industry, Internal medicine, Post-hoc analysis, Medicine, Respiratory system, business, Depressive symptoms
Published
2022

8. Video Telehealth Pulmonary Rehabilitation for Chronic Obstructive Pulmonary Disease Is Associated with Clinical Improvement Similar to Center-based Pulmonary Rehabilitation

Author

Inmaculada Aban, Surya P. Bhatt, Gary Cutter, Daniel Baugh, Jason Hitchcock, Young-il Kim, and Mark T. Dransfield

Subjects
Pulmonary and Respiratory Medicine, medicine.medical_specialty, COPD, Exercise Tolerance, business.industry, medicine.medical_treatment, Telehealth, medicine.disease, Telemedicine, Pulmonary Disease, Chronic Obstructive, Physical therapy, Medicine, Humans, Center (algebra and category theory), Pulmonary rehabilitation, Letters, business
Published
2023

9. Access to Pulmonary Rehabilitation Among Medicare Beneficiaries with COPD

Author

Gargya, Malla, Sandeep, Bodduluri, Vivek, Sthanam, Gulshan, Sharma, and Surya P, Bhatt

Abstract

Pulmonary rehabilitation (PR) remains substantially underutilized as a treatment modality for chronic obstructive pulmonary disease (COPD). A major barrier to the uptake of PR is the poor availability of and access to PR.To quantify patients' access to PR centers in the United States.Using the 100% Medicare population with coverage for the year 2018, four geodesic distance-based buffers of 10-, 15-, 25- and 50-mile radii around the geographic centroid of each zip code with at least one beneficiary with COPD were created. Street addresses of PR centers across the continental US were geocoded. We calculated the distance between the residential zip code centroid and the closest PR center. The proportion of individuals with least one PR center available within the four distance buffers were calculated overall as well as in metropolitan, micropolitan, small-town, and rural areas.Of 62,930,784 Medicare beneficiaries, 10,376,949 (16.5%) had COPD. There were 1,696 PR centers across the United States, with one PR center for every 6,030 individuals with COPD. Mean distance to the nearest PR center was 12.4 (SD16.6) miles. Overall, the proportion of individuals with COPD who had a PR center available within 10-, 15-, 25-, and 50-mile radii was 61.5%, 73.2%, 86.6%, and 97.1%, respectively. Proportions for rural areas were 11.3%, 24.3%, 53.4%, and 88.6%, respectively. Compared to those living in metropolitan areas, those living in rural areas were 95% less likely to have a PR center within 10 miles of their residence (odds ratio 0.048, 95% CI 0.039 to 0.057).In a nationally representative sample of Medicare beneficiaries, we found that two-fifths of adults with COPD overall, and eight out of nine of those in rural areas, have poor access to PR.

Published
2022

10. Defining Resilience to Smoking-related Lung Disease: A Modified Delphi Approach from SPIROMICS

Author

Anita L. Oh, Richard A. Mularski, Igor Barjaktarevic, R. Graham Barr, Russell P. Bowler, Alejandro P. Comellas, Christopher B. Cooper, Gerard J. Criner, MeiLan K. Han, Nadia N. Hansel, Eric A. Hoffman, Richard E. Kanner, Jerry A. Krishnan, Robert Paine, Trisha M. Parekh, Stephen P. Peters, Stephanie A. Christenson, Prescott G. Woodruff, Wayne H. Anderson, Mehrdad Arjomandi, Nirav Bhakta, Surya P. Bhatt, Russell Buhr, Jeffrey L. Curtis, M. Bradley Drummond, Victor Kim, Wassim Labaki, Allison Lambert, Stephen C. Lazarus, Alex Mackay, Wendy Moore, Sarah L. O'Beirne, Laura Paulin, Benjamin M. Smith, Donald P. Tashkin, and James Michael Wells

Subjects
Pulmonary and Respiratory Medicine, Spirometry, medicine.medical_specialty, media_common.quotation_subject, Modified delphi, Pulmonary disease, Pulmonary Disease, Chronic Obstructive, 03 medical and health sciences, 0302 clinical medicine, Forced Expiratory Volume, medicine, Humans, 030212 general & internal medicine, Intensive care medicine, Lung, media_common, COPD, medicine.diagnostic_test, business.industry, Smoking, Editorials, medicine.disease, respiratory tract diseases, 030228 respiratory system, Lung disease, Psychological resilience, Consensus development, business
Abstract

Rationale: Diagnosis of chronic obstructive pulmonary disease (COPD) relies on abnormal spirometry. However, spirometry may underestimate the effects of smoking, missing smokers with respiratory di...

Published
2021

12. Acute Exacerbations Are Associated with Progression of Emphysema

Author

Surya P. Bhatt, Sandeep Bodduluri, Mark T. Dransfield, Joseph M. Reinhardt, James D. Crapo, Edwin K. Silverman, Stephen Humphries, David A. Lynch, and Matthew J. Strand

Subjects
Pulmonary and Respiratory Medicine, Emphysema, Pulmonary Disease, Chronic Obstructive, Pulmonary Emphysema, Disease Progression, Humans
Published
2022

13. Clinically Significant and Comorbid Anxiety and Depression Symptoms Predict Severe Respiratory Exacerbations in Smokers: A

Author

Anand S, Iyer, Trisha M, Parekh, Jacqueline, O'Toole, Surya P, Bhatt, Michelle N, Eakin, Jerry A, Krishnan, Abebaw M, Yohannes, Prescott G, Woodruff, Christopher B, Cooper, Richard E, Kanner, Nicola A, Hanania, Mark T, Dransfield, Elizabeth A, Regan, Karin F, Hoth, Victor, Kim, and Harjinder, Singh

Subjects
Pulmonary Disease, Chronic Obstructive, Smokers, Depression, Humans, Letters, Anxiety, Anxiety Disorders
Published
2021

14. Both Duration and Pack-Years of Tobacco Smoking Should Be Used for Clinical Practice and Research

Author

Roy A. Pleasants, M. Patricia Rivera, Surya P. Bhatt, and Stephen L. Tilley

Subjects
Pulmonary and Respiratory Medicine, medicine.medical_specialty, Biomedical Research, Lung Neoplasms, business.industry, MEDLINE, Pulmonary disease, Consumer Behavior, Viewpoints, Clinical Practice, Pulmonary Disease, Chronic Obstructive, Emergency medicine, Tobacco Smoking, Humans, Medicine, Duration (project management), business, Lung
Published
2020

15. Acquired Cystic Fibrosis Transmembrane Conductance Regulator Dysfunction and Radiographic Bronchiectasis in Current and Former Smokers: A Cross-Sectional Study

Author

J. Michael Wells, Melis Atalar Aksit, Garry R. Cutting, S. Vamsee Raju, Karen S. Raraigh, Steven M. Rowe, Lawrence Rasmussen, Surya P. Bhatt, P. Hrudaya Nath, Mark T. Dransfield, Krittika Teerapuncharoen, and George M. Solomon

Subjects
Male, Pulmonary and Respiratory Medicine, medicine.medical_specialty, Cystic Fibrosis, Cross-sectional study, Radiography, Cystic Fibrosis Transmembrane Conductance Regulator, Gastroenterology, Pulmonary Disease, Chronic Obstructive, Internal medicine, Humans, Medicine, Letters, Aged, Bronchiectasis, biology, business.industry, Smoking, Middle Aged, Former Smoker, medicine.disease, Cystic fibrosis transmembrane conductance regulator, Cross-Sectional Studies, biology.protein, Female, Tomography, X-Ray Computed, business
Published
2019

16. Effect of Zephyr Endobronchial Valves on Dyspnea, Activity Levels, and Quality of Life at One Year. Results from a Randomized Clinical Trial

Author

Mark T. Dransfield, Justin L. Garner, Surya P. Bhatt, Dirk-Jan Slebos, Karin Klooster, Frank C. Sciurba, Pallav L. Shah, Nathaniel T. Marchetti, Richard D. Sue, Shawn Wright, Hiram Rivas-Perez, Tanya A. Wiese, Momen M. Wahidi, Hugo Goulart de Oliveira, Brian Armstrong, Sri Radhakrishnan, Narinder S. Shargill, Gerard J. Criner, Lewis Katz, Francis Cordova, Parag Desai, Nathaniel Marchetti, Victor Kim, Kartik Shenoy, John Travaline, Jiji Thomas, Lii-Yoong H. Criner, Richard Sue, Aaron Thornburg, Terry Thomas, Mark Dransfield, Surya Bhatt, James Michael Wells, Necole Seabron-Harris, Umair Gauhar, Crissie Despirito, Frank Sciurba, Jessica Bon Field, Divay Chandra, Joseph Leader, Roy Semaan, Christina Ledezma, Pallav Shah, Samuel Kemp, Justin Garner, Arafa Aboelhassan, Karthi Srikanthan, Eric Tenda, Anita Abraham, Cai Sim, Momen Wahidi, Kamran Mahmood, Scott Shofer, Kathleen Coles, Guilherme Augusto Oliveira, Betina Machado, Igor Benedetto, Fabio Svartman, Amarilio de Macedo Neto, Leonardo Schreiner, Taiane Vieira, Brian Morrissey, Ken Yoneda, Tina Tham, Daniel Tompkins, Paulo F. Guerreiro Cardoso, Rodrigo Athanazio, Felipe Nominando, Samia Rached, Luciana Cassimiro, Steven Hays, Eric Seeley, Pavan Shrestha, Gabriela R. Dincheva, Adnan Majid, Daniel Alape-Moya, Mihir Parikh, Alichia Paton, Alexis Agnew, Nicholas Pastis, Charlie Strange, Tatsiana Beiko, Danielle Woodford, Mary Blanton, Lisa Kopas, Timothy Connolly, Jose Fernando Santacruz, Bhavin Shah, Mark Vollenweider, Luis Herrera, Rumi Khan, Kristine Sernulka, P. Michael McFadden, Richard Barbers, Michelle Hernandez, Michael Machuzak, Francisco Almeida, Joseph Cicenia, Thomas Gildea, Atul Mehta, Sonali Sethi, Yvonne Meli, David Hsia, Richard Casaburi, William Stringer, Leticia Diaz, Arthur Sung, Meghan Ramsey, Ryan Van Wert, Karen Morris, Nabil Jarad, Tim Batchelor, Iara Sequeiros, Katy Tucker, Malgorzata Kornaszweska, Hazem Fallouh, Ramsey Sabit, Hatam Naase, Joseph George, Azin Salimian, Helen Dyer, Stephen Hazelrigg, Kristal Adams, Karen Bade, Ganesh Krishna, Bryan S. Benn, Michelle Canfield, Sharmila Vetri Villalan, Travis Stewart, Dirk-Ja n Slebos, Nick H. T. ten Hacken, Jorine Hartman, Sonja Augustijn, and Groningen Research Institute for Asthma and COPD (GRIAC)

Subjects
Male, Exacerbation, medicine.medical_treatment, EMPHYSEMA, Bronchoscopic lung volume reduction, law.invention, 0302 clinical medicine, Randomized controlled trial, Quality of life, law, Forced Expiratory Volume, Surveys and Questionnaires, interventional bronchoscopy, Medicine, PREDICTS MORTALITY, 030212 general & internal medicine, LUNG-VOLUME-REDUCTION, Pneumonectomy, Zephyr Valve, Lung function, Original Research, Rehabilitation, Exercise Tolerance, Patient-centered outcomes, Prostheses and Implants, respiratory system, Middle Aged, Treatment Outcome, Pulmonary Emphysema, patient-reported outcomes, Anesthesia, Female, Pulmonary and Respiratory Medicine, REHABILITATION, Adult, Bronchi, Severe copd, OBSTRUCTIVE PULMONARY-DISEASE, CAPACITY, chronic obstructive pulmonary disease, 03 medical and health sciences, severe emphysema, SEVERE COPD, Bronchoscopy, PATIENT-CENTERED OUTCOMES, Humans, Aged, business.industry, respiratory tract diseases, PHYSICAL-ACTIVITY, 030228 respiratory system, EXACERBATION, Quality of Life, business, Adult Pulmonary
Abstract

Rationale: Bronchoscopic lung volume reduction with Zephyr Valves improves lung function, exercise tolerance, and quality of life of patients with hyperinflated emphysema and little to no collateral ventilation. Objectives: Post hoc analysis of patient-reported outcomes (PROs), including multidimensional measures of dyspnea, activity, and quality of life, in the LIBERATE (Lung Function Improvement after Bronchoscopic Lung Volume Reduction with Pulmonx Endobronchial Valves used in Treatment of Emphysema) study are reported. Methods: A total of 190 patients with severe heterogeneous emphysema and little to no collateral ventilation in the target lobe were randomized 2:1 to the Zephyr Valve or standard of care. Changes in PROs at 12 months in the two groups were compared: dyspnea with the Transitional Dyspnea Index (TDI), focal score; the Chronic Obstructive Pulmonary Disease Assessment Test (CAT; breathlessness on hill/stairs); Borg; the EXAcerbations of Chronic pulmonary disease Tool–PRO, dyspnea domain; activity with the TDI, magnitude of task/effort/functional impairment, CAT (limited activities), and the St. George’s Respiratory Questionnaire (SGRQ), activity domain; and psychosocial status with the SGRQ, impacts domain, and CAT (confidence and energy). Results: At 12 months, patients using the Zephyr Valve achieved statistically significant and clinically meaningful improvements in the SGRQ; CAT; and the TDI, focal score, compared with standard of care. Improvements in the SGRQ were driven by the impacts and activity domains (P

Published
2020

17. Recent Advances in Computed Tomography Imaging in Chronic Obstructive Pulmonary Disease

Author

John D. Newell, Eric A. Hoffman, Surya P. Bhatt, Sandeep Bodduluri, and Joseph M. Reinhardt

Subjects
Pulmonary and Respiratory Medicine, Spirometry, medicine.medical_specialty, Focused Review, Radiography, Pulmonary disease, Computed tomography, Disease, 030218 nuclear medicine & medical imaging, Pulmonary Disease, Chronic Obstructive, 03 medical and health sciences, 0302 clinical medicine, medicine, Humans, Lung, COPD, medicine.diagnostic_test, business.industry, Disease progression, Gold standard (test), medicine.disease, respiratory tract diseases, 030228 respiratory system, Disease Progression, Radiology, Tomography, X-Ray Computed, business
Abstract

Lung imaging is increasingly being used to diagnose, quantify, and phenotype chronic obstructive pulmonary disease (COPD). Although spirometry is the gold standard for the diagnosis of COPD and for severity staging, the role of computed tomography (CT) imaging has expanded in both clinical practice and research. COPD is a heterogeneous disease with considerable variability in clinical features, radiographic disease, progression, and outcomes. Recent studies have examined the utility of CT imaging in enhancing diagnostic certainty, improving phenotyping, predicting disease progression and prognostication, selecting patients for intervention, and also in furthering our understanding of the complex pathophysiology of this disease. Multiple CT metrics show promise for use as imaging biomarkers in COPD.

Published
2018

18. It’s Time to Rehabilitate Pulmonary Rehabilitation

Author

Surya P. Bhatt

Subjects
Pulmonary and Respiratory Medicine, medicine.medical_specialty, business.industry, medicine.medical_treatment, Physical therapy, medicine, Pulmonary rehabilitation, business
Published
2019

19. Results of a Medicare Bundled Payments for Care Improvement Initiative for Chronic Obstructive Pulmonary Disease Readmissions

Author

Mark T. Dransfield, Anand S Iyer, J Greg Sanders, Lauren Leach, Trisha M. Parekh, Cindy C Blackburn, deNay Kirkpatrick, J. Michael Wells, Jessica K. Nichols, Surya P. Bhatt, and Erica M. Anderson

Subjects
Male, Pulmonary and Respiratory Medicine, medicine.medical_specialty, Time Factors, Exacerbation, Pulmonary disease, Medicare, Patient Readmission, Centers for Medicare and Medicaid Services, U.S, Pulmonary Disease, Chronic Obstructive, 03 medical and health sciences, 0302 clinical medicine, Ambulatory care, Humans, Medicine, Prospective Studies, 030212 general & internal medicine, Intensive care medicine, Aged, Proportional Hazards Models, Aged, 80 and over, COPD, business.industry, Bundled payments, Middle Aged, Readmission rate, medicine.disease, Quality Improvement, United States, 030228 respiratory system, Alabama, Female, business, Index hospitalization, Medicaid
Abstract

Approximately 20% of Medicare beneficiaries hospitalized for acute exacerbations of chronic obstructive pulmonary disease (COPD) are readmitted within 30 days of discharge. In addition to implementing penalties for excess readmissions, the U.S. Centers for Medicare and Medicaid Services has developed Bundled Payments for Care Improvement (BPCI) initiatives to improve outcomes and control costs.To evaluate whether a comprehensive COPD multidisciplinary intervention focusing on inpatient, transitional, and outpatient care as part of our institution's BPCI participation would reduce 30-day all-cause readmission rates for COPD exacerbations and reduce overall costs.We performed a pre-postintervention study comparing all-cause readmissions and costs after index hospitalization for Medicare-only patients with acute exacerbation of COPD. The primary outcome was the difference in 30-day all-cause readmission rate compared with historical control subjects; secondary outcomes included the 90-day all-cause readmission rate and also health care costs compared with BPCI target prices.Seventy-eight consecutive Medicare patients were prospectively enrolled in the BPCI intervention in 2014 and compared with 109 patients in the historical group from 2012. Patients in BPCI were more likely to receive regular follow-up phone calls, pneumococcal and influenza vaccines, home health care, durable medical equipment, and pulmonary rehabilitation, and to attend pulmonary clinic. There was no difference in all-cause readmission rates at 30 days (BPCI, 12 events [15.4%] vs. non-BPCI, 19 events [17.4%]; P = 0.711), and 90 days (21 [26.9%] vs. 37 [33.9%]; P = 0.306). Compared with BPCI target prices, we incurred 4.3% lower 90-day costs before accounting for significant investment from the health system.A Medicare BPCI intervention did not reduce 30-day all-cause readmission rates or overall costs after hospitalization for acute exacerbation of COPD. Although additional studies enrolling larger numbers of patients at multiple centers may demonstrate the efficacy of our BPCI initiative for COPD readmissions, this is unlikely to be cost effective at any single center.

Published
2017

20. Imaging Small Airway Disease: Probabilities and Possibilities

Author

Surya P. Bhatt

Subjects
Pulmonary and Respiratory Medicine, Emphysema, medicine.medical_specialty, business.industry, Pulmonary emphysema, MEDLINE, Pulmonary disease, Pulmonary Disease, Chronic Obstructive, Text mining, Airway disease, Pulmonary Emphysema, medicine, Humans, Radiology, business, Tomography, Probability
Published
2019

21. Combined Forced Expiratory Volume in 1 Second and Forced Vital Capacity Bronchodilator Response, Exacerbations, and Mortality in Chronic Obstructive Pulmonary Disease

Author

Spyridon Fortis, Alejandro Comellas, Barry J. Make, Craig P. Hersh, Sandeep Bodduluri, Dimitris Georgopoulos, Victor Kim, Gerard J. Criner, Mark T. Dransfield, Surya P. Bhatt, James D. Crapo, Edwin K. Silverman, Elizabeth A. Regan, Terri Beaty, Ferdouse Begum, Robert Busch, Peter J. Castaldi, Michael Cho, Dawn L. DeMeo, Adel R. Boueiz, Marilyn G. Foreman, Eitan Halper-Stromberg, Nadia N. Hansel, Megan E. Hardin, Lystra P. Hayden, Jacqueline Hetmanski, Brian D. Hobbs, John E. Hokanson, Nan Laird, Christoph Lange, Sharon M. Lutz, Merry-Lynn McDonald, Margaret M. Parker, Dandi Qiao, Stephanie Santorico, Emily S. Wan, Sungho Won, Mustafa Al Qaisi, Harvey O. Coxson, Teresa Gray, MeiLan K. Han, Eric A. Hoffman, Stephen Humphries, Francine L. Jacobson, Philip F. Judy, Ella A. Kazerooni, Alex Kluiber, David A. Lynch, John D. Newell, James C. Ross, Raul San Jose Estepar, Joyce Schroeder, Jered Sieren, Douglas Stinson, Berend C. Stoel, Juerg Tschirren, Edwin Van Beek, Bram van Ginneken, Eva van Rikxoort, George Washko, Carla G. Wilson, Robert Jensen, Douglas Everett, Jim Crooks, Camille Moore, Matt Strand, John Hughes, Gregory Kinney, Katherine Pratte, Kendra A. Young, Jeffrey L. Curtis, Carlos H. Martinez, Perry G. Pernicano, Nicola Hanania, Philip Alapat, Mustafa Atik, Venkata Bandi, Aladin Boriek, Kalpatha Guntupalli, Elizabeth Guy, Arun Nachiappan, Amit Parulekar, Craig Hersh, R. Graham Barr, John Austin, Belinda D’Souza, Gregory D.N. Pearson, Anna Rozenshtein, Byron Thomashow, Neil MacIntyre, H. Page McAdams, Lacey Washington, Charlene McEvoy, Joseph Tashjian, Robert Wise, Robert Brown, Karen Horton, Allison Lambert, Nirupama Putcha, Richard Casaburi, Alessandra Adami, Matthew Budoff, Hans Fischer, Janos Porszasz, Harry Rossiter, William Stringer, Amir Sharafkhaneh, Charlie Lan, Christine Wendt, Brian Bell, Eugene Berkowitz, Gloria Westney, Russell Bowler, Richard Rosiello, David Pace, Gerard Criner, David Ciccolella, Francis Cordova, Chandra Dass, Gilbert D’Alonzo, Parag Desai, Michael Jacobs, Steven Kelsen, A. James Mamary, Nathaniel Marchetti, Aditi Satti, Kartik Shenoy, Robert M. Steiner, Alex Swift, Irene Swift, Maria Elena Vega-Sanchez, Mark Dransfield, William Bailey, Surya Bhatt, Anand Iyer, Hrudaya Nath, J. Michael Wells, Joe Ramsdell, Paul Friedman, Xavier Soler, Andrew Yen, Alejandro P. Comellas, John Newell, Brad Thompson, Ella Kazerooni, Joanne Billings, Abbie Begnaud, Tadashi Allen, Frank Sciurba, Jessica Bon, Divay Chandra, Carl Fuhrman, Joel Weissfeld, Antonio Anzueto, Sandra Adams, Diego Maselli-Caceres, and Mario E. Ruiz

Subjects
Pulmonary and Respiratory Medicine, Spirometry, Male, Vital capacity, medicine.medical_specialty, medicine.drug_class, Vital Capacity, Pulmonary disease, Risk Assessment, Severity of Illness Index, Cohort Studies, 03 medical and health sciences, Pulmonary Disease, Chronic Obstructive, 0302 clinical medicine, Internal medicine, Bronchodilator, Forced Expiratory Volume, medicine, Humans, 030212 general & internal medicine, Respiratory system, Asthma, Aged, Proportional Hazards Models, Retrospective Studies, Original Research, medicine.diagnostic_test, business.industry, Middle Aged, medicine.disease, Survival Analysis, respiratory tract diseases, Bronchodilator Agents, Respiratory Function Tests, Logistic Models, Treatment Outcome, 030228 respiratory system, Volume (thermodynamics), Multivariate Analysis, Cardiology, Disease Progression, Female, business, Tomography, X-Ray Computed
Abstract

Rationale: The American Thoracic Society (ATS)/European Respiratory Society defines a positive bronchodilator response (BDR) by a composite of BDR in either forced expiratory volume in 1 second (FEV(1)) and/or forced vital capacity (FVC) greater than or equal to 12% and 200 ml (ATS-BDR). We hypothesized that ATS-BDR components would be differentially associated with important chronic obstructive pulmonary disease (COPD) outcomes. Objectives: To examine whether ATS-BDR components are differentially associated with clinical, functional, and radiographic features in COPD. Methods: We included subjects with COPD enrolled in the COPDGene study. In the main analysis, we excluded subjects with self-reported asthma. We categorized BDR into the following: 1) No-BDR, no BDR in either FEV(1) or FVC; 2) FEV(1)-BDR, BDR in FEV(1) but no BDR in FVC; 3) FVC-BDR, BDR in FVC but no BDR in FEV(1); and 4) Combined-BDR, BDR in both FEV(1) and FVC. We constructed multivariable logistic, linear, zero-inflated negative binomial, and Cox hazards models to examine the association of BDR categories with symptoms, computed tomography findings, change in FEV(1) over time, respiratory exacerbations, and mortality. We also created models using the ATS BDR definition (ATS-BDR) as the main independent variable. Results: Of 3,340 COPD subjects included in the analysis, 1,083 (32.43%) had ATS-BDR, 182 (5.45%) had FEV(1)-BDR, 522 (15.63%) had FVC-BDR, and 379 (11.34%) had Combined-BDR. All BDR categories were associated with FEV(1) decline compared with No-BDR. Compared with No-BDR, both ATS-BDR and Combined-BDR were associated with higher functional residual capacity %predicted, greater internal perimeter of 10 mm, and greater 6-minute-walk distance. In contrast to ATS-BDR, Combined-BDR was independently associated with less emphysema (adjusted beta regression coefficient, −1.67; 95% confidence interval [CI], −2.68 to −0.65; P = 0.001), more frequent respiratory exacerbations (incidence rate ratio, 1.25; 95% CI, 1.03–1.50; P = 0.02) and severe exacerbations (incidence rate ratio, 1.34; 95% CI, 1.05–1.71; P = 0.02), and lower mortality (adjusted hazards ratio, 0.76; 95% CI, 0.58–0.99; P = 0.046). Sensitivity analysis that included subjects with self-reported history of asthma showed similar findings. Conclusions: BDR in both FEV(1) and FVC indicates a COPD phenotype with asthma-like characteristics, and provides clinically more meaningful information than current definitions of BDR.

Published
2019

22. Depression Is Associated with Readmission for Acute Exacerbation of Chronic Obstructive Pulmonary Disease

Author

deNay Kirkpatrick, Jennifer Trevor, Jeffrey J. Garner, John C. Williams, J. Michael Wells, Neha M. Patel, Anand S Iyer, Mark T. Dransfield, and Surya P. Bhatt

Subjects
Counseling, Male, Pulmonary and Respiratory Medicine, Acute exacerbation of chronic obstructive pulmonary disease, medicine.medical_specialty, Exacerbation, Comorbidity, Disease, Patient Readmission, Cohort Studies, Pulmonary Disease, Chronic Obstructive, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Humans, Medicine, 030212 general & internal medicine, Depression (differential diagnoses), Original Research, Aged, Retrospective Studies, Depressive Disorder, COPD, Depression, business.industry, Medical record, Smoking, Middle Aged, medicine.disease, United States, Hospitalization, Logistic Models, 030228 respiratory system, Multivariate Analysis, Emergency medicine, Disease Progression, Physical therapy, Anxiety, Female, Smoking Cessation, medicine.symptom, business, Medicaid
Abstract

Hospitalization for acute exacerbation of chronic obstructive pulmonary disease (COPD) is associated with significant morbidity and health care costs, and hospitals in the United States are now penalized by the Centers for Medicare and Medicaid Services for excessive readmissions. Identifying patients at risk of readmission is important, but modifiable risk factors have not been clearly established, and the potential contributing role of psychological disease has not been examined adequately. We hypothesized that depression and anxiety would increase the risk of both short- and long-term readmissions for acute exacerbation of COPD.To characterize the associations between depression and anxiety and COPD readmission risk.We examined the medical records for all patients with a primary diagnosis of acute exacerbation of COPD by International Classification of Diseases, Ninth Revision codes admitted to the University of Alabama at Birmingham Hospital between November 2010 and October 2012. Those who did not meet the standardized study criteria for acute exacerbation of COPD and those with other respiratory illnesses as the primary diagnosis were excluded. Comorbidities were recorded on the basis of physician documentation of the diagnosis and/or the use of medications in the electronic medical record. Multivariable regression analyses identified factors associated with readmission for acute exacerbation of COPD at 1 year and within 30 and 90 days.Four hundred twenty-two patients were included, with 132 readmitted in 1 year. Mean age was 64.8 ± 11.7 years, and mean percent predicted FEV1 was 48.1 ± 18.7%. On univariate analysis, readmitted patients had lower percent predicted FEV1 (44.9 ± 17.3% vs. 50.2 ± 19.4%; P = 0.05) and a higher frequency of depression (47.7% vs. 23.4%; P 0.001). On multivariable analysis, 1-year readmission was independently associated with depression (adjusted odds ratio [OR], 2.67; 95% confidence interval [CI], 1.59-4.47) and in-hospital tobacco cessation counseling (adjusted OR, 0.34; 95% CI, 0.18-0.66). Depression also predicted readmission at 30 days (adjusted OR, 3.83; 95% CI, 1.84-7.96) and 90 days (adjusted OR, 2.47; 95% CI, 1.34-4.55).Depression is an independent risk factor for both short- and long-term readmissions for acute exacerbation of COPD and may represent a modifiable risk factor. In-hospital tobacco cessation counseling was also associated with reduced 1-year readmission.

Published
2016

23. Pneumothorax Risk Factors in Smokers with and without Chronic Obstructive Pulmonary Disease

Author

Edwin J. R. van Beek, Hiroto Hatabu, Eugene Berkowitz, Brian D. Hobbs, Sharon Kuong, Craig P. Hersh, George R. Washko, H. Page McAdams, Amir Sharafkhaneh, John Armstrong, Nadia N. Hansel, Joel L. Weissfeld, Raúl San José Estépar, Quentin Anderson, Peter J. Castaldi, Neil R. MacIntyre, Carlos Farinas, Kalpalatha K. Guntupalli, Carlos S. Restrepo, David A. Katz, Robert A. Wise, Jessica Bon, David A. Lynch, Russell P. Bowler, Richard Rosiello, Joe W. Ramsdell, Nathaniel Marchetti, Chandra Dass, Carlos Orozco, Gloria Westney, Rachna Madan, Dennis E. Niewoehner, Satinder Singh, Robert H. Brown, Amy L Mumbower, Charlene McEvoy, Christine H. Wendt, Valerie Hale, Beatrice Trotman-Dickenson, Steven Meller, John D. Newell, Robert M. Steiner, Hasan Al-Azzawi, MeiLan K. Han, Danielle Hooper, Debra S. Dyer, Michael E. DeBakey, Mario E. Ruiz, Collin Bray, Anne Marie Marciel, R. Graham Barr, Linda Fahr, Philip Alapat, Venkata Bandi, Paul J. Friedman, Jeffrey L. Curtis, Hans Fischer, Victor Kim, Antara Mallampalli, Fernando J. Martinez, Ella A. Kazerooni, Carl R. Fuhrman, Francine L. Jacobson, Audrey Caine, L. Alexander Frigini, Susan Pinero, Suzanne Roland, Elizabeth Guy, Alejandro Cornellas, Nicola A. Hanania, A. James Mamary, Karen M. Horton, Mark T. Dransfield, Andetta R. Hunsaker, Gregory B. Diette, C.P. Hersh, Marc Willis, Christian W. Cox, Roham Darvishi, Peter Clarke, Marilyn G. Foreman, Hirani Kamal, Aditi Satti, Byron Thomashow, Joseph Bradley, Barry J. Make, Lacey Washington, Ariel Kruger, Jonathan H. Chung, Antonio Anzueto, Michael Wells, Charles Trinh, John H. M. Austin, Joseph H. Tashjian, Richard Casaburi, Timothy Bresnahan, Arun Nachiappan, Libby Cone, Marilyn Foreman, Dawn L. DeMeo, Sandra G. Adams, Ritu R. Gill, Edwin K. Silverman, Michael J. Lane, Jose Freytes, Frank C. Sciurba, Mustafa A. Atik, Gerard J. Criner, William C. Bailey, Hrudaya Nath, Kathryn L. Rice, Janos Porszasz, Matthew J. Budoff, Belinda D’Souza, Joyce D. Schroeder, Tadashi Allen, and Surya P. Bhatt

Subjects
Male, Pulmonary and Respiratory Medicine, Chronic Obstructive, medicine.medical_specialty, Local histogram, pneumothorax, Chronic Obstructive Pulmonary Disease, Clinical Trials and Supportive Activities, Chest ct, Pulmonary disease, Computed tomography, White People, Pulmonary Disease, Pulmonary Disease, Chronic Obstructive, Sex Factors, Clinical Research, Risk Factors, Internal medicine, Tobacco, medicine, Humans, Tomography, Lung, Original Research, Emphysema, COPD, COPDGene Investigators, Tobacco Smoke and Health, medicine.diagnostic_test, business.industry, Smoking, Pneumothorax, Odds ratio, Middle Aged, respiratory system, medicine.disease, United States, Confidence interval, X-Ray Computed, respiratory tract diseases, Surgery, Pulmonary Emphysema, Respiratory, Female, Tomography, X-Ray Computed, business
Abstract

RationaleThe demographic, physiological, and computed tomography (CT) features associated with pneumothorax in smokers with and without chronic obstructive pulmonary disease (COPD) are not clearly defined.ObjectivesWe evaluated the hypothesis that pneumothorax in smokers is associated with male sex, tall and thin stature, airflow obstruction, and increased total and subpleural emphysema.MethodsThe study included smokers with and without COPD from the COPDGene Study, with quantitative chest CT analysis. Pleural-based emphysema was assessed on the basis of local histogram measures of emphysema. Pneumothorax history was defined by subject self-report.Measurements and main resultsPneumothorax was reported in 286 (3.2%) of 9,062 participants. In all participants, risk of prior pneumothorax was significantly higher in men (odds ratio [OR], 1.55; 95% confidence interval [CI], 1.08-2.22) and non-Hispanic white subjects (OR, 1.90; 95% CI, 1.34-2.69). Risk of prior pneumothorax was associated with increased percent CT emphysema in all participants and participants with COPD (OR, 1.04 for each 1% increase in emphysema; 95% CI, 1.03-1.06). Increased pleural-based emphysema was independently associated with risk of past pneumothorax in all participants (OR, 1.05 for each 1% increase; 95% CI, 1.01-1.10). In smokers with normal spirometry, risk of past pneumothorax was associated with non-Hispanic white race and lifetime smoking intensity (OR, 1.20 for every 10 pack-years; 95% CI, 1.09-1.33).ConclusionsAmong smokers, pneumothorax is associated with male sex, non-Hispanic white race, and increased percentage of total and subpleural CT emphysema. Pneumothorax was not independently associated with height or lung function, even in participants with COPD. Clinical trial registered with www.clinicaltrials.gov (NCT00608764).

Published
2014

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