BBI Contributing Editor

SAN DIEGO Sunny San Diego played host to the Centennial meeting of the American Thoracic Society (ATS; New York) in May. The clinical highlights of the meeting included therapies and equipment for sleep apnea and asthma, and this year the ATS joined forces with the U.S. and Mexican governments to discuss tuberculosis (TB) control. ATS President-elect Peter Wagner, MD, welcomed officials from the two countries to discuss the control and elimination of TB. "TB is an international disease that doesn't recognize individual nations," Wagner said. "Our speakers will talk about managing it on both sides of the border."

According to Ken Castro, MD, director of the division of tuberculosis elimination at the Centers for Disease Control and Prevention (CDC; Atlanta), the U.S.-Mexico Binational TB Referral and Case Management Project is establishing a comprehensive binational TB referral and case management system between the nations. Castro noted, "Control personnel from both countries want to ensure that patients receive continuous care and complete the treatment regimens necessary to cure TB." Patients with active TB who move between Mexico and the U.S. and are seen at healthcare clinics in border cities will receive a Binational Health Card. Should patients choose to cross the border again, their physician will give ins-tructions on where to obtain healthcare to complete their treatment at the new destination. A toll-free number on the card helps patients find a health clinic if they are unsure of their destination upon departure.

Pablo Kuri-Morales, MD, general director of epidemiology at Mexico's Secretaria de Salud, expanded on Castro's message: "In the northern region of Mexico the rate of TB infection is much higher than in the rest of our country. This is mainly due to the high number of migrants in the area. As part of dealing with the poverty that exists in our country we are working hard and hope to have Mexico eventually free of TB."

Sleep apnea's stroke risks

Moderate-to-severe cases of the nighttime breathing problem known as obstructive sleep apnea (OAS) significantly increase the risk of suffering a stroke, according to Douglas Bradley, MD, professor of medicine and director of the Center for Sleep Medicine and Circadian Biology at the University of Toronto. He and his colleagues studied 1,475 people and found that those with moderate-to-severe sleep apnea at the beginning of the study were three to four times more likely to have a stroke than a comparable group of patients without sleep apnea during the next four years.

In obstructive sleep apnea, a person's airway narrows, or totally collapses, during sleep. As a result, the person stops breathing briefly multiple times throughout the night. The person's sleep interruption may cause excessive daytime sleepiness or high blood pressure. "The stroke risk we found for people with moderate to severe sleep apnea is quite significant double the risk of other well-known risk factors for stoke, such as hypertension or diabetes," Bradley said.

One possible reason for the increased stroke risk is that when a person stops breathing, the lack of oxygen kicks in the body's "fight or flight" response. Part of that reaction is to make the blood more clottable and blood clots in the brain can cause a stroke. "This study provides yet another reason why it is important to treat sleep apnea," Bradley said. "It also raises the question of whether people with sleep apnea should be put on aspirin therapy or given other anti-clotting drugs."

Virtual' asthma clinic online

Irvin Mayers, MD, of the University of Alberta (Edmonton, Alberta), took a look at the numbers and decided it was time to build a virtual asthma clinic. He said, "Despite progress in asthma, it remains the leading cause of physician visits, emergency admissions, hospitalizations and missed school days among children in Canada." An absence in this critical component of patient care remains in many practices.

Mayers and his associates created a web site that allows a certified asthma educator to communicate daily with patients, provide feedback and assist patients with asthma management as necessary. The team conducted a pilot study and reported their results to the ATS. Six pulmonologists participated in the pilot, enrolling 17 patients. The mean age was 37.8 and 58.8% of the patients were female. During the two-month study, the patients accessed the web site 200 times for a mean of 16.67 hits per patients. Mayers said, "The Internet is an appropriate medium for monitoring asthma patients. Patients log in frequently, complete data collection and continue participating in the program."

On the exhibit floor

Among the new products and services seen on the exhibit floor were interesting offerings from Restore Medical (St. Paul, Minnesota), ResMed (Poway, California) and Sleep MultiMedia (Scarsdale, New York).

In September 2004 the FDA approved the marketing of Restore's Pillar Procedure, the first FDA-cleared implantable treatment for obstructive sleep apnea. The Pillar Procedure is designed to restore or stiffen the palate, a contributor in nearly 80% of patients suffering from sleep and breathing disorders. The Pillar Device places three inserts into the patient's soft palate, causing the palate to stiffen. This helps to prevent or lessen blockages of the airway effectively treating sleep apnea. The inserts are less than 1" long and made from a woven soft polyester material that has been used for years in implantable medical products. The Pillar Procedure is conducted in a single, short, in-office setting using local anesthetic. It is completely reversible.

"The Pillar procedure offers an incredible advance for the treatment of OSA," said Restore Medical president and CEO Susan Critzer. "For the first time, physicians are able to provide patients with a one-time, minimally invasive, in-office procedure to effectively treat sleep apnea," she said.

The new S8 Escape from ResMed is the latest in the company's broad line of devices for continuous positive airway pressure (CPAP). The S8 Escape is a lightweight, compact flow generator. It is the first standard CPAP system with a "virtual" personal assistant that guides the patient through downloads and notifies him or her when it's time to call the provider, replace the mask or change the air filter. A new data card option enables the patient to easily deliver usage information to the clinician and receive prescribed pressure changes without a visit. Communication between physician and patient is greatly enhanced. ResMed is a manufacturer of products for the diagnosis and treatment of sleep-disordered breathing.

For those clinicians interested in setting up a sleep clinic, the SleepMultiMedia product is a comprehensive computerized textbook of sleep medicine with answers to most questions they might ask. Using text, sound, graphics, animation and video, this DVD-ROM- or CD-ROM-based multimedia software product contains chapters on polysomnography, the physiology of sleep, chronophysiology, neurophysiology, respiratory physiology, insomnia, obstructive sleep apnea syndrome, pediatrics, narcolepsy, parasomnias, women and sleep, restless legs syndrome, epilepsy and sleep, aging and sleep, hypersomnias, a full glossary of sleep terminology and extensive Medline references and abstracts.

A full procedure manual for running a sleep clinic is included, as are additional chapters on the Encyclopedia of Sleep and Sleep Disorders, 101 Questions about Sleep, the History of Sleep and Man, Case Histories, Sleep Center Procedure Manual and the Sleep Scoring Manual. The program's more than 1,500 pages are fully and extensively interactive with hypertext, comprehensive pull-down indexes, and full text search capabilities. Reference material and patient information forms are formatted for direct printing. The program is suitable for all levels of healthcare professionals, including students, nurses, internists, otolaryngologists, psychiatrists, neurologists, and sleep specialists and sleep researchers.

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