UTHSCT pulmonologist receives $3.25 million NIH grant to help COPD patients do pulmonary rehabilitation at home

Wednesday, September 9, 2009

Patients with chronic obstructive pulmonary disease, or COPD, struggle for each breath.

They may not be able to walk across a room without gasping or wheezing.

As they avoid physical activity, they lose more lung capacity, making breathing even more difficult.

So they do less and less physical activity and their lung capacity dwindles even more.

Pulmonary rehabilitation – in which COPD patients learn how to manage their own illness and engage in regular physical activity such as walking – can break this negative cycle and significantly benefit people with COPD.

Yet less than 2 percent of COPD patients use pulmonary rehabilitation services.

David Coultas, MD, a pulmonary specialist at The University of Texas Health Science Center at Tyler, wants to change that.

He recently received a five-year, $3.25 million grant from the National Institutes of Health to determine if showing people with COPD how to participate in pulmonary rehabilitation in their own home will improve their health and quality of life.

Pulmonary rehabilitation usually requires coming to a center several days a week for eight to 12 weeks. Funding for these programs has been unstable, and not all medical centers offer them, Dr. Coultas said.

Many patients with COPD are 70 years of age or older or live in rural areas a distance from pulmonary rehabilitation centers, making it difficult for them to participate.

“We have designed a process of pulmonary rehabilitation that will be feasible for patients to do – a self-management program for people with COPD – so they can better understand the illness and what they can do for themselves,” said Dr. Coultas, who is board certified in internal medicine and pulmonary disease.

The 18-month study will enroll 300 patients with COPD who live in Tyler and surrounding counties, he said. Family medicine and primary care physicians will recommend patients for the study.

Participants will be randomly assigned to two groups. One group will receive basic information about how to manage their COPD.

The other group will receive that, plus one face-to-face meeting with a health educator, a workbook that explains how to do pulmonary rehabilitation at home, and telephone support from a health educator.

“We want them to make it part of their everyday life. We’re giving them the tools to manage their illness on their own,” said Dr. Coultas, UTHSCT’s vice president for clinical affairs.

Before the study begins, participants will be given an initial test that measures their quality of life and how far they can walk. At the end of the study, their quality of life and walking distance will be measured again, to see if they have changed for the better.

“I expect to see an improvement in the patients’ quality of life, that they have less difficulty breathing with exertion, and that they are able to do more,” he said.

“I also anticipate that they will have fewer flare-ups of their COPD, with a corresponding decrease in their use of health care resources. I expect the study to show people have a better quality of life with a reduction in their health care costs,” Dr. Coultas added.

“Ultimately, if this is effective, this same approach could be applied to many people with chronic diseases, such as diabetes and heart failure,” he said.

The study is a collaboration with John Sloan, Ph.D., an associate professor in the Department of Health and Kinesiology at The University of Texas at Tyler; Karan Singh, Ph.D., University of North Texas Health Science Center – Fort Worth; and Jay Ashmore, Ph.D., a health behavior psychologist in Plano.

For 60 years, The University of Texas Health Science Center at Tyler has provided excellent patient care and cutting-edge treatments, specializing in pulmonary disease, cancer, heart disease, primary care, and the disciplines that support them. With an operating budget of more than $125 million and biomedical research funding that exceeds $10 million annually, UTHSCT has a major economic impact on East Texas. Its two medical residency programs – in family medicine and occupational medicine – provide doctors for many communities in East Texas and beyond.

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