Pneumonia Day: Today is the day to act!

This past November 12, we celebrated “Pneumonia Day,” named for a disease that has little connotation in the real world, because of the perception that we need only a short course of antibiotics to get better. Such is the origin of the term “walking pneumonia,” which emphasizes that we can still walk even while sick with pneumonia.

However, we recently experienced the most important moment of awareness related to this condition, when one of the U.S. presidential candidates became sick with that disease known as “pneumonia.”

Suddenly, the media devoted great interest to explore this condition, as if it were a new outbreak or a rare disease that could potentially kill someone. Even the health-care providers seem to believe that “pneumonia” is not a big deal, ignoring the fact that it is the most common infectious cause of death overall, and that it not only affects children but also the elderly and patients with poor immune systems.

One out of nine patients who are admitted to the hospital for pneumonia may die during the hospitalization, and one out of four patients who get admitted to an ICU may not survive the event.

However, it also highlights that pneumonia is more than just an acute disease, compromising the brain, heart, and kidneys. In the long run, even after surviving the hospitalization for pneumonia, it can kill and cause other well-known complications leading to death, such as myocardial infarction, arrhythmias, heart failure, and sudden cardiac death.

Please, stop for one moment and ask yourself about your role in preventing pneumonia and pneumonia-related deaths in your communities. The Chest Infections NetWork is here to help you advocate for the common goal of solving this problem.

Marcos I. Restrepo, MD, MSc, FCCP

Steering Committee Member

Delivery makes a difference: Providing inhaled medication to your patients

One might ask why CHEST (American College of Chest Physicians) and Sunovion developed a steering committee of experts in the field of obstructive lung disease to evaluate the knowledge, attitudes, beliefs, and practices of physicians and other health-care professionals related to inhalational medicines and devices. While inhalers are approved by the FDA Center for Drug Evaluation Research (CEDER) as drug and device combination, the process assesses reproducibility and shelf‐life but does not address the real‐world situation that each of us face with individual patients. How often do clinicians consider the characteristics of each delivery system, as well as the medication being delivered? One might be surprised at the answer.

Patients are frequently prescribed several types of devices with different instructions for optimal use. For example, dry powder inhalers often require high flow rates (30-90 L/min) to deaggregate powder pellets into particles less than 5 mcm, while metereddose inhalers require a slow inspiratory flow (less than 30 L/min). Patients who use both types of devices often confuse which inspiratory flow rate to use with which devices, despite proper education and training. This does not even take into consideration the variable number of steps required by various inhalational devices (which can be as few as 3 steps to as many as 12 steps). Additionally, studies demonstrate that peak inspiratory flow rates, inspiratory volumes, and drug deposition in the lungs may be influenced by gender, height, and weight; as well as by the degree of pulmonary reserve and hyperinflation.

Are there data to suggest that these questions impact the care of patients with severe asthma or COPD? I eagerly await the results of the survey.

Jay I. Peters, MD, FCCP

Steering Committee Member

A California victory for tobacco control

Californians approved Proposition 56, “Cigarette Tax to Fund Healthcare, Tobacco Use Prevention, Research, and Law Enforcement.” This measure increases the excise tax on all forms of tobacco by $2.00. For the first time, it applies to electronic products that vaporize nicotine that were previously only subject to sales tax. This is in addition to federal excise taxes ($1.01) and state and local sales taxes ($0.50 to $0.60). (https://ballotpedia.org/California_Proposition_56,_Tobacco _Tax_Increase_(2016)

When Prop 56 goes into effect April 1, 2017, the average price of a package of cigarettes will increase to at least $7.89. Based on data from the Surgeon General’s report on “Preventing Tobacco Use Among Youth and Young Adults,” this tax increase should equate with a fall in smoking rates by about 12%. Youth and young adults are particularly susceptible to price increases, which helps prevent smoking initiation or continuation.

Tobacco-related health-care costs Californians $3.5 billion dollars annually (Official Voter Information Guide, 2016). Funds raised by Prop 56 will be used by state and local health programs such as Medi-Cal to defray the costs of smoking prevention pro

grams, smoking cessation, and treatment of tobacco-related illnesses (California Tobacco Control Program).

Prop 56 expands on tougher laws implemented in 2016 that expanded the workplace prohibition of smoking, increased fees for tobacco retailers and wholesalers, broadened the definition of smoking to include e-cigarettes, and increased the minimum age to purchase tobacco to 21 years old. Combined, these measures are expected to result in a further decline in tobacco usage in California.

Alan Roth, RRT, MS, FCCP

Steering Committee Member

NETWORKS: Pneumonia Day, evaluating inhalers, tobacco taxes Chest Infections Clinical Pulmonary Medicine Interprofessional Team