Focusing on Control in COPD Management

This activity is jointly provided by Global Education Group and Integritas Communications.

This activity is supported by an independent educational grant from AstraZeneca.

This event is not a part of the official AAFP FMX.

MEDICAL COMMUNICATIONS INQUIRIES info@integritasgrp.com integritasgrp.com

FACULTY

FACULTY

Barry J. Make, MD

Professor of Medicine Division of Pulmonary, Critical Care, and Sleep Medicine University of Colorado School of Medicine Co-Director, COPD Program Director, Pulmonary Rehabilitation and Respiratory Care Department of Medicine National Jewish Health Denver, Colorado

Dr. Barry Make is Co-Director of the COPD Program, Director, Pulmonary Rehabilitation and Respiratory Care, and Chair of the Faculty Appointment, Promotion, and Periodic Evaluation Committee at National Jewish Health. He is Professor of Medicine in the Division of Pulmonary Sciences, Critical Care, and Sleep Medicine at National Jewish Health and the University of Colorado School of Medicine. Dr. Make’s primary interest is clinical research on the management and outcomes of chronic obstructive pulmonary disease (COPD). Dr. Make also sees adult outpatients with COPD and related pulmonary disorders at National Jewish Health. Recognized as one of the Castle Connolly’s Top Doctors in the United States for the past 12 years, he received the Sreedhar Nair Lifetime Achievement Award from the American Thoracic Society. Dr. Make’s publications include over 275 articles, book chapters, and other materials. He has created audiovisual and educational materials for the professional community and patients and regularly lectures internationally on COPD. In addition to clinical research and clinical practice, Dr. Make is an active member of the professional community. He is a Fellow of the American College of Chest Physicians, the American College of Physicians, and the American Association of Cardiovascular and Pulmonary Rehabilitation. He is a member of the American Thoracic Society and the Colorado Trudeau Society. Dr. Make is currently an Investigator on several grants from the National Heart, Lung, and Blood Institute, the Department of Defense, and the American Lung Association for research on the Genetic Epidemiology of COPD, Beta-Blockers for the Prevention of Acute Exacerbations of COPD, Redefining Therapy in Early COPD, Losartan Effects on Emphysema Progression, Intervention Study in Overweight Patients with COPD, Chronic Refractory Cough Cohort Study, and Validating a Unique COPD Screening Tool in Primary Care. Dr. Make is Editor of Chronic Obstructive Pulmonary Diseases: Journal of the COPD Foundation.

Dr. Make received his Bachelor of Science (cum laude) from Pennsylvania State University in State College, Pennsylvania, and his medical degree from Jefferson Medical College in Philadelphia. He completed his internship at Thomas Jefferson University Hospital in Philadelphia and his residency in Internal Medicine at the University of Michigan Medical Center in Ann Arbor. Dr. Make completed fellowships in Pulmonary Medicine at the Medical Centers of Boston University in Massachusetts and of the University of West Virginia.

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FACULTY

Meredith C. McCormack, MD, MHS Associate Professor of Medicine Medical Director, Pulmonary Function Laboratory Pulmonary and Critical Care Medicine Johns Hopkins University Baltimore, Maryland

Dr. Meredith McCormack is an Associate Professor of Medicine in the Division of Pulmonary and Critical Care at the Johns Hopkins University School of Medicine and of Environmental Health Sciences at the Johns Hopkins Bloomberg School of Public Health, both in Baltimore, Maryland. With clinical expertise in COPD and asthma, as well as pulmonary physiology and pulmonary function testing, Dr. McCormack serves as the Medical Director of the Johns Hopkins University Pulmonary Function Laboratory and as the Vice Chair of the American Thoracic Society Committee for Proficiency Standards in Pulmonary Function Testing.

Dr. McCormack is a physician scientist with a research focus on the effect of environmental influences on underlying obstructive lung disease—specifically air pollution, diet, and obesity influences on COPD and asthma in children and adults. She has been funded by the National Institute of Environmental Health Sciences and the Environmental Protection Agency to conduct research on indoor pollution.

Dedicated to training the next generation of physician scientists, she serves as the Associate Program Director of the Johns Hopkins Pulmonary and Critical Care Fellowship program and plays an active role in mentoring fellows and junior faculty.

Dr. McCormack earned her medical degree from Jefferson Medical College of Thomas Jefferson University and completed her residency at Thomas Jefferson University Hospital and her fellowship in pulmonary and critical care medicine at Johns Hopkins. She earned her MHA from the Bloomberg School of Public Health.

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FACULTY

Barbara P. Yawn, MD, MSc, FAAFP Researcher Adjunct Professor Department of Family and Community Health University of Minnesota Rochester, Minnesota

Dr. Barbara Yawn is a family physician and researcher with experience in rural primary care and pragmatic research. Her research has resulted in over 400 peer-reviewed publications, several book chapters, and 3 edited books. She has served on the US Preventive Services Task Force and on 7 national and international guideline panels, and is the editor of Respiratory Medicine Case Reports and an associate editor for Respiratory Medicine in addition to serving on other editorial boards. Her main research foci include asthma, COPD, herpes zoster, and postpartum depression.

Dr. Yawn developed a research department in a large primary care–based medical group in Rochester and SE Minnesota, where she led studies funded by the National Institutes of Health, the Agency for HealthCare Quality and Research, the Centers for Disease Control and Prevention, and private foundations. She has worked with Dr. Make on several research grants and with Dr. McCormack in the Pulmonary Clinical Research Group funded by the Patient-Centered Outcomes Research Institute. Participating in educational work directed to primary care physicians and other clinicians, she is a frequent speaker at primary care continuing medical education conferences.

Dr. Yawn earned her medical degree from the University of Missouri at Columbia and completed a residency and master’s degree in family medicine and public health at the University of Minnesota in Minneapolis. She earned a second master’s degree in clinical research design and statistics at the University of Michigan in Ann Arbor.

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TARGET AUDIENCE This activity is intended for primary care physicians (PCPs) and clinicians specializing in respiratory disorders.

EDUCATIONAL OBJECTIVES PREAMBLE

After completing this activity, the participant should be better able to: • Individualize maintenance regimens for patients with COPD to minimize exacerbation risks • Longitudinally manage patients with COPD by monitoring symptom progression, assessing therapeutic response, and adjusting treatment as needed • Educate patients on the need for appropriate physical activity, techniques to avoid exacerbations, and treatment adherence

PROGRAM OVERVIEW Ongoing vigilant management of patients with COPD is essential to improving outcomes.

The importance of implementing focused therapy on preventing exacerbations cannot be overemphasized. Evidence-based education that addresses individualized maintenance regimens is needed to optimize COPD care over the long term. Patients who experience COPD exacerbations and hospitalizations are at increased risk of falling into a perpetual cycle of symptom progression, declining lung function, increasing disability, and accumulating fatigue. Clinicians should routinely employ symptom evaluations and well-defined follow-up plans for patients with COPD. Most will require treatment with medications—often combination regimens—which will likely intensify throughout the course of the disease. Patient preferences, results from routine symptom reassessments, exacerbation risks, and therapeutic adherence should all shape treatment decisions that are shared between the patient and the clinician. This program will focus on patient-clinician communication as a fundamental aspect of COPD care that better addresses patient preferences, exacerbation prevention, treatment goals, and longitudinal management, while overcoming barriers to treatment adherence.

PROGRAM AGENDA 6:30 pm

Welcome and Preactivity Survey

6:40 pm

CASE 1: Individualizing Maintenance Therapy for COPD

7:00 pm

Audience Question and Answer

7:05 pm

CASE 2: Escalating Therapy as COPD Progresses to Prevent Exacerbations

7:20 pm

Audience Question and Answer

7:25 pm

CASE 3: Managing Patients With a Significant Comorbidity Load

7:45 pm

Audience Question and Answer

7:50 pm

Concluding Comments and Postactivity Survey

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AMERICAN ACADEMY OF FAMILY PHYSICIANS CONTINUING EDUCATION

PREAMBLE

This live activity, Focusing on Control in COPD Management: A Case-Based Look at Exacerbation Prevention, with a beginning date of 09/25/2019, has been reviewed and is acceptable for up to 1.50 Prescribed credits by the American Academy of Family Physicians. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

PHYSICIAN ACCREDITATION STATEMENT This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of Global Education Group (Global) and Integritas Communications. Global is accredited by the ACCME to provide continuing medical education for physicians. *This CME/CE activity complies with all requirements of the federal Physician Payment Sunshine Act. If a reportable event is associated with this activity, the accredited provider managing the program will provide the appropriate physician data to the Open Payments database.

PHYSICIAN CREDIT DESIGNATION Global Education Group designates this live activity for a maximum of 1.5 AMA PRA Category 1 Creditsâ„¢. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

GLOBAL CONTACT INFORMATION For information about the accreditation of this program, please contact Global at 303-3951782 or cme@globaleducationgroup.com.

INSTRUCTIONS TO RECEIVE CREDIT In order to receive credit for this activity, the participant must submit a completed evaluation form at the conclusion of the program. You will be emailed a certificate within 4 weeks. If you do not receive your credit at that time, please contact cme@globaleduationgroup.com.

FEE INFORMATION & REFUND/ CANCELLATION POLICY There is no fee for this educational activity.

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PREAMBLE

DISCLOSURE OF CONFLICTS OF INTEREST Global requires instructors, planners, managers, and other individuals and their spouses/ life partners who are in a position to control the content of this activity to disclose any real or apparent conflict of interest they may have as related to the content of this activity. All identified conflicts of interest are thoroughly vetted by Global for fair balance, scientific objectivity of studies mentioned in the materials or used as the basis for content, and appropriateness of patient care recommendations.

The faculty reported the following financial relationships or relationships to products or devices they or their spouses/life partners have with commercial interests related to the content of this CME activity: Barry J. Make, MD Consultant/Independent Contractor: AstraZeneca plc, Boehringer Ingelheim International GmbH, Circassia AB, GlaxoSmithKline plc, Philips Respironics, Shire Plc, Spiration Inc., Sunovion Pharmaceuticals Inc., Theravance Biopharma US, Inc., Third Pole, Inc., Verona Pharma plc; Grant/Research Support: National Heart, Lung, and Blood Institute (NHLBI) Meredith C. McCormack, MD, MHS

Consultant/Independent Contractor: Celgene Corporation, GlaxoSmithKline plc, Talem Health, LLC; Other/Royalty: UpToDate, Inc. (royalties for authorship about pulmonary function testing that is not related to CME program content)

Barbara P. Yawn, MD, MSc, FAAFP

Consultant/Independent Contractor: AstraZeneca plc, Boehringer Ingelheim International GmbH, GlaxoSmithKline plc, Midmark Corporation, Novartis International AG; Grant/Research Support: Funding to my institution: AstraZeneca, Boehringer Ingelheim International GmbH, GlaxoSmithKline plc, Mylan N.V.

The planners and managers reported the following financial relationships or relationships to products or devices they or their spouses/life partners have with commercial interests related to the content of this CME activity: Lindsay Borvansky

Nothing to disclose

Andrea Funk

Nothing to disclose

Liddy Knight

Nothing to disclose

Ashley Cann

Nothing to disclose

Celeste Collazo, MD

Nothing to disclose

Rose O’Connor, PhD, CHCP

Nothing to disclose

Jim Kappler, PhD

Nothing to disclose

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DISCLOSURE OF UNLABELED USE This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the US Food and Drug Administration. Global and Integritas Communications do not recommend the use of any agent outside of the labeled indications.

PREAMBLE

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of any organization associated with this activity. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

DISCLAIMER Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management.

Any procedures, medications, or other courses of diagnosis or treatment discussed in this activity should not be used by clinicians without evaluation of patient conditions and possible contraindications on dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.

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CASE 1, PART 1

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GUIDELINES

»»Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease.

Global Initiative for Chronic Obstructive Lung Disease (GOLD), 2019 report. https://goldcopd.org/wp-content/uploads/2018/11/GOLD-2019-v1.7-FINAL-14Nov2018-WMS.pdf

»»Prevention of COPD exacerbations: a European Respiratory Society/ American Thoracic Society guideline.

Wedzicha JA, et al. Eur Respir J. 2017;50(3):1602265. https://www.thoracic.org/statements/resources/copd/prevention-copd-exacerbations.pdf

»»Management of COPD exacerbations: a European Respiratory Society/ American Thoracic Society guideline.

Papi A, et al. Eur Respir J. 2017;49(3):1600791. https://www.thoracic.org/statements/resources/copd/mgmt-of-COPD-exacerbations.pdf

CLINICAL PRACTICE TOOLS

»»The COPD Foundation Pocket Consultant Guide Mobile App

The COPD Pocket Guide, provided by the COPD Foundation, contains comprehensive management information as well as resource tools. It can be downloaded on any mobile device. https://www.copdfoundation.org/Learn-More/I-am-a-Healthcare-Provider/The-COPD-Pocket-ConsultantGuide.aspx

»»Modified Medical Research Council (mMRC) Dyspnea Scale

The mMRC scale, provided by MDCalc, allows for the baseline stratification of dyspnea in COPD, as well as other respiratory diseases, and can be downloaded on any mobile device. https://www.mdcalc.com/mmrc-modified-medical-research-council-dyspnea-scale

»»COPD Assessment Test (CAT)

The CAT, provided by the American Academy of Family Physicians, allows assessment of the global impact of COPD (cough, sputum, dyspnea, chest tightness) on patient health status. https://www.aafp.org/afp/2013/1115/afp20131115p655-fa.pdf

»»COPD Action Plan

The COPD Action Plan, provided by the American Lung Association, is a tool that facilitates the prevention, timely identification, and early and appropriate treatment of COPD exacerbations.

RESOURCE CENTER

http://action.lung.org/site/DocServer/ala-copd-management-plan.pdf

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SUGGESTED READING

»»Practical aspects of inhaler use in the management of chronic obstructive pulmonary disease in the primary care setting.

Yawn BP, et al. Int J Chron Obstruct Pulmon Dis. 2012;7:495-502. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3413176/pdf/copd-7-495.pdf

»»Management of patients during and after exacerbations of chronic obstructive pulmonary disease: the role of primary care physicians.

Yawn BP, Thomashow B. Int J Gen Med. 2011;4:665-676. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3177593/pdf/ijgm-4-665.pdf

»»Pulmonary rehabilitation following exacerbations of chronic obstructive pulmonary disease.

Puhan MA, et al. Cochrane Database Syst Rev. 2016;12:CD005305. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6463852/

»»An official American Thoracic Society/European Respiratory Society statement: key concepts and advances in pulmonary rehabilitation.

Spruit MA, et al. Am J Respir Crit Care Med. 2013;188(8):e13-e64. http://www.atsjournals.org/doi/abs/10.1164/rccm.201309-1634ST?url _ ver=Z39.88-2003&rfr _ id=ori%3Arid%3Acrossref.org&rfr _ dat=cr _ pub%3Dpubmed&#readcube-epdf

»»Reducing chronic obstructive pulmonary disease hospital readmissions.

An official American Thoracic Society workshop report.

Press VG, et al. Ann Am Thorac Soc. 2019;16(2):161-170. https://www.atsjournals.org/doi/full/10.1513/AnnalsATS.201811-755WS# _ i25

»»Triple versus dual inhaler therapy in moderate-to-severe COPD: a systematic review and meta-analysis of randomized controlled trials.

Zayed Y, et al. Clin Respir J. 2019;13(7):413-428. https://onlinelibrary.wiley.com/doi/epdf/10.1111/crj.13026

»»Once-daily single-inhaler triple versus dual therapy in patients with COPD. Lipson DA, et al. N Engl J Med. 2018; 378(18):1671-1680.

»»Triple therapy with budesonide/glycopyrrolate/formoterol fumarate with co-suspension delivery technology versus dual therapies in chronic obstructive pulmonary disease (KRONOS): a double-blind, parallelgroup, multicenter, phase 3 randomized controlled trial.

Ferguson GT, et al. Lancet Respir Med. 2018; 6(10):747-758. https://www.ncbi.nlm.nih.gov/pubmed/30232048

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RESOURCE CENTER

https://www.nejm.org/doi/10.1056/NEJMoa1713901?url _ ver=Z39.88-2003&rfr _ id=ori:rid:crossref. org&rfr _ dat=cr _ pub%3dwww.ncbi.nlm.nih.gov

PATIENT ADVOCACY ORGANIZATIONS AND RESOURCES »»American Lung Association

The American Lung Association is the leading organization working to save lives by improving lung health and preventing lung disease through education, advocacy, and research. http://www.lung.org/lung-disease/copd/living-with-copd/copd-management-tools.html

»»COPD Foundation

The COPD Foundation’s mission is to prevent and cure COPD and to improve the lives of all people affected by COPD. http://www.copdfoundation.org/What-is-COPD/Living-with-COPD/Newly-Diagnosed.aspx

»»Global Initiative for Chronic Obstructive Lung Disease (GOLD)

GOLD partners with health care professionals and public health officials to raise awareness of COPD and to improve prevention and treatment of this lung disease for patients around the world. http://goldcopd.org/patients-advocacy-groups/

»»National Jewish Health

National Jewish Health integrates the latest scientific discoveries with coordinated care for lung, heart, and immune diseases. Their Patient Education Program provides many free educational opportunities and support groups to assist patients and caregivers with managing illnesses and chronic conditions, such as COPD.

RESOURCE CENTER

https://www.nationaljewish.org/education-training/patient-education#education

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Please visit the CLINICAL RESOURCE CENTER for additional information and resources

ExchangeCME.com/COPDResources19

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