listen.

That’s the difference in having the attorneys at Cloud Willis & Ellis represent your medical practice in managing your accounts receivables. We provide the complete services of an agency and a law firm or anywhere in between — you choose. We will collaborate with you to design a collection strategy that helps limit unpaid invoices and medical bills. Then we will implement that strategy in our office, and help you implement the strategy in yours. We have the experience and know-how in medical collections to make it better for you.

be many in someone living with COPD. When it comes to treatment, clinicians must engage their patients in tobacco cessation counseling from the beginning, refer to accredited pulmonary rehabilitation across COPD stages and ages, and keep patients up to date on vaccinations. Other updates include new letter groupings (from GOLD Groups A, B, C, and D to Groups A, B, and E), and treatment recommendations that emphasize starting with combined long-acting bronchodilator inhalers (long acting muscarinic +/- long acting beta-agonist) for those with a high symptom burden and not using an inhaled corticosteroid initially. When symptoms or exacerbations get worse (i.e. GOLD Group E), then we recommend adding an inhaled corticosteroid for those with a high serum eosinophil count (>300 cells/µL) and generally try to minimize how long someone stays on this due to important side effects. If patients continue to experience high symptom bur- den or exacerbations, clinicians can add oral anti-inflammatory agents such as roflumilast or azithromycin for select people. Finally, supplemental oxygen therapy should be started for those with severe hypoxemia and stopped when no longer meeting criteria. For those who meet criteria (e.g. hyperinflation), clinicians should consider referring patients to a center that performs bronchoscopic or surgical lung volume reduction. For those still getting worse despite maximum therapies, a “treatable traits” approach can be considered. In this model, clinicians reframe someone as person with “end-stage COPD” to a person with COPD and set of traits each with unique treatment approaches, e.g. refractory breathlessness, emotional symptoms, frequent exacerbations, hyperinflation, or chronic respiratory failure. Utilizing this approach can help clinicians proactively implement interprofessional strategies to help these patients which include referral to specialists in geriatrics and palliative care, nutritional support, psychosocial counseling, and others.

The future of COPD will focus on identifying distinct disease subtypes and personalized treatment strategies. The Lung Health Center at the UAB is at the forefront of investigating novel pharmaceutical, device, and behavioral interventions to change the trajectory of COPD. Actively enrolling studies in-

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