“Prevention is worth a pound of cure”

NGP. The AARC has a number of goals it aimed to achieve in 2007 – what was the inspiration behind these goals, how important are they to the AARC and how far have you got in achieving them?

TK. 2007 has been a successful year. Our goals come from our president and currently Toni Rodriguez holds the office. Toni has an extremely high level of energy and vision for the AARC. She stated in her acceptance speech that we are on the threshold of great things and she has been able to translate that energy to our volunteers who are making a difference. Another individual who has made a significant and enduring contribution to our profession is Sam Giordano, the Chief Executive Officer of the AARC. Sam has shepherded the organization since 1981 and has consistently provided the leadership that has brought this organization to its current stable and viable status today. And as we are a non-profit organization, we rely on a strong volunteer base, which we have, and through their efforts we are making a difference.

Two areas where we are seeing great strides are in broadening our issues to our elected and governmental officials. We have been able to draft language and gain sponsorship for a Medicare Part B initiative for respiratory care outside of the acute care hospital. We have also been granted recognition of respiratory therapists in the Public Health Service who now can be granted officer status. These are only two of many initiatives that are making a difference for our patients and professional respiratory therapists. In April 2007, the AARC celebrated its 60th birthday. As we recognize our longevity and successes we also realize that there is much to do.

NGP. The AARC encourages and promotes professional excellence, advances the science and practice of respiratory care, and serves as an advocate for patients and their families, the public, the profession and the respiratory therapist. How do you go about accomplishing this?

TK. The AARC certainly has this as their mission. This is a multi-pronged effort. We promote science in a variety of ways. We publish Respiratory Care, the science journal of the American Association for Respiratory Care. We also host two journal conferences annually, of which the proceedings are published in the journal. At our annual meeting, the International Respiratory Congress we also allow clinicians from around the world to present their scientific papers. Many great ideas are shared and ultimately improvement in patient care is the result.

We certainly advocate for our patients. That really is why we are here. We instill this throughout our operations. This is realized in many ways. One is through the ongoing education that we provide our members. Ultimately this trickles down to the level of care we provide. An example is our recent co-operative grant with the Environmental Protection Agency (EPA) the expectation of which was to teach respiratory therapists about common asthma triggers and then how to remove them from patients’ homes. After a multi-center study was completed we found that by having respiratory therapists teach patients about the asthma triggers in their home they are likely to make changes that are sustained over time. We continue to work with the EPA on this through an expanded partnership in 2008.

NGP. How do you educate the American public about respiratory care?

TK. We have a mission to educate patients as well. This can be seen at our website, yourlunghealth.org. Here we provide free information that is vetted by recognized professionals in pulmonary care. Included is an Ask Dr. Tom column where Thomas Petty MD (a world renowned pulmonologist and pioneer in pulmonary medicine) answers patients respiratory related questions posed by patients on the website. We also offer an electronic magazine called Asthma and Allergy Health. We also promote community initiatives. Because COPD is the fourth leading cause of death in the United States we have teamed up with the COPD Foundation and the NHLBI to work with the public. Our current project is the Mobile Spirometry Unit. It is through this project that we travel to community heath events across the country to educate and perform spirometry tests for the public. We are especially eager to screen people over the age of 40 with a history of smoking. They are prime targets for COPD. We started in February 2007 and we have been to more than 25 cities and screened over 8000 people. We are excited about this and expect to see this program grow in 2008.

NGP. In your opinion, what respiratory conditions should we be focusing on?

TK. There is so much for us to focus on. If we keep our eye on the needs of the patients we will never fail. Sometimes it seems like they are left out of the equation when it comes to providing the best care. We cannot lose sight of this at all. I think that the two conditions that we must focus on the most are that of COPD and asthma. Both are chronic lung diseases that are treatable and with COPD even preventable with better smoking education and treatable with early diagnosis.

NGP. What are the main challenges of respiratory care in the US?

TK. The challenges are many. We have to have better coverage for patients who need optimal respiratory care. We need to make sure that preventive care as well as post acute care receives the attention it deserves. Therefore pulmonary rehabilitation and home care are two areas that must be adequately reimbursed. It is a struggle for many of our patients to manage if there is not funding. These are two areas the AARC is striving to positively impact.

NGP. Have there been any exciting developments in respiratory research at the AARC? What have you been focusing on?

TK. There are so many developments today. The care of patients is changing. Many of these changes are realized in newer modes and types of mechanical ventilators. In addition to this our ability to liberate patients from the ventilator faster has improved. I remember even 10 years ago managing open-heart patients on the ventilator for days. Now because of therapist driven protocols the benchmark is three to four hours of post-op ventilation. This makes a huge difference in post-op length of stay. We have seen major changes in ventilatory management of premature babies. Again the prognosis is much better because of a better understanding of the interface of machine and patient as well as the infusion of better pharmacotherapy.

Another area is home care. Patients who are on oxygen can now be very mobile. In past years they were homebound because of dependence on heavy and clumsy metal cylinders or electrical devices. Now there are portable oxygen concentrators that generate their own electricity and are lightweight. This has made a huge impact on oxygen-dependant patients.

There has been other research that illustrates that protocol-driven therapy in asthma care can reduce length of stay in the hospital and even reduce admission from the emergency department when a respiratory therapist is part of the process.

As an organization we promote all of this. In all three of my examples there were respiratory therapists who were part of the research that made it happen.

NGP. What are your predictions for the future regarding respiratory health? What would you like to see happen in the future?

TK. I feel strongly that the best promotion of respiratory health is being proactive. We need to teach the public about the dangers of smoking. We also must continue our role as patient educators. In other words once a diagnosis is made we need to teach our patients optimal self-management. As we look to the future we will see in the next 10 years that COPD will move from the fourth to the third leading cause of death. Why? The baby-boomers. This group will swell the ranks of patients with chronic lung diseases and we need to be ready to mange this. We will need more respiratory therapists as well. This is a profession that we are actively touting to middle and high school level students as a viable and rewarding health care profession, which will be in demand for years to come.

NGP. What are your predictions for the healthcare industry more generally?

TK. The healthcare industry must be ready for a major influx of pulmonary patients with COPD being the most prominent. We will also need sustainable healthcare coverage for all who need it. Those two examples are obvious. There is the unknown as well. We need to be prepared for a mass casualty event or epidemic. September 11, 2001 opened our eyes to the fact we were not prepared.

We also need to get our elected officials better tuned into the healthcare needs of the nation. Again this must be proactive and not reactive. Prevention is worth a pound of cure. That is what we need to have in our mindset.

About Tom Kallstrom

Tom Kallstrom is Chief Operating Officer for the American Association for Respiratory Care (AARC), and is also a registered respiratory therapist. Entering the profession at the University of Minnesota Hospitals, Kallstrom has spent the bulk of his experience with the University Hospitals of Cleveland’s Rainbow Babies and Children’s Hospital. Before arriving at the AARC, Kallstrom was at Cleveland Clinic Health Care System’s Fairview Hospital in Cleveland. He has moved up through the ranks from bedside caregiver to manager to administrative director.

• In 1998, approximately 107,000 Americans died of COPD
  
• COPD's prevalence and death rate are rising. In 2020, COPD is projected to become the third leading cause of death in the United States
  
• COPD has a higher mortality rate than asthma (5,438 deaths from asthma in 1998 versus 107,000 deaths from COPD in 1998)
  
• The highest increase in mortality has been in white women, as observed between 1960 and 1998
  
• An estimated 30 million Americans have COPD. However, only 16 million adult Americans have been diagnosed with disease
  
• In 2000, the annual cost to the nation for COPD was estimated to be approximately $30.4 billion. Health care expenditures accounted for $14.7 billion, and indirect costs (decreased income due to loss of work or premature death) were $15.7 billion

Source: www.aarc.org