New "ROAD" program provides path to breathing easier

UC Davis takes steps to reduce hospital admissions for COPD

ROAD program patient and nurse
Marianne Gullingsrud helps pulmonary rehabilitation patients improve their breathing capacity and everyday lives.

Posted July 25, 2012

UC Davis Medical Center has launched a new program to reduce symptoms and hospital stays for people with chronic obstructive pulmonary disorder, or COPD -- a common cause of hospitalization and the third-leading cause of death in the U.S.

Through the Reversible Obstructive Airway Disease (ROAD) program, hospitalized COPD patients receive individualized treatment planning, one-on-one education, specialty-care referrals, pulmonary rehabilitation and day-time pager access to a registered respiratory care practitioner. The goal is to prevent acute exacerbations -- episodes when symptoms rapidly get worse, often leading to emergency department visits and hospitalization.

"Most hospitals do not provide integrated post-discharge care for COPD patients," said Samuel Louie, professor of pulmonary and critical care medicine and founder of the program. "As a result, readmissions are common, and mortality rates are as high as 24 percent for those in intensive care."

According to Louie, nearly one out of every five patients 40 years of age or older in U.S. hospitals has a diagnosis of COPD, with total annual health-care costs in the U.S. close to $50 billion.

"COPD may not be curable, but it is reversible," said Louie. "We brought together hospitalists, nurses, pharmacists, discharge planners and respiratory therapists in a united mission to improve outcomes for patients and reduce the costs of care at the same time."

So far, the ROAD program has enrolled more than 40 patients; just one has been readmitted to the hospital.

A national leader in treating lung diseases, Louie explained that people with COPD have chronic bronchitis that causes airway obstruction, emphysema that causes air to be trapped in the lungs or, more commonly, both. Most often caused by cigarette smoke, COPD leads to progressively labored breathing. It is typically diagnosed when the disease is moderate to severe, or when the volume of air that can be exhaled from the lungs in one second is less than 70 percent of what would be predicted.

"It's insidious," said Claudia Vukovich, a registered respiratory practitioner at UC Davis. "Patients don't notice at first that they are becoming more short of breath. And the disease may not be on the radars of those who quit smoking a while ago or who have only been exposed to second-hand smoke. It's usually when they are mapping the locations of benches in the mall so they know where they can sit and catch their breath that they seek help."

Often worried that they can't get enough air, COPD patients tend to prefer to be sedentary and avoid social activities.

"It's exactly the opposite of what they need," said Louie, noting that interaction with other patients in pulmonary rehabilitation is an important part of recovery.

ROAD program managers
ROAD case managers are all registered respiratory therapists who provide comprehensive care and support for COPD patients. In the back row (left to right) are Justin Griffiths, Brendy Avalos, Carrie Lipe, Julie Cortez, Claudia Vukovich and Anthony Yanes. In the front row are Rafael Antanesian, Carol Mason, Patricia Brown, Crystal Craddock and Michelle Young.

"We've seen remarkable improvements and much less need for hospitalization with targeted exercise therapy and a community of empathy and support," he added.

Vukovich trained a team of UC Davis respiratory care practitioners as COPD case managers using the successful approach she helped develop for the UC Davis Asthma Network (UCAN). The philosophy is simple: Help COPD patients regain their daily lives with personalized treatment plans combined with immediate access to experts when necessary. When hospitalization is required, the ROAD team can streamline admission.

"Too often, COPD patients do not get the treatment they need in a meaningful, respectful way," said Louie. "'Smoking-related' doesn't mean 'shouldn't be treated.' Every COPD patient and their families deserve the best possible quality of life."

For more information about ROAD or COPD treatment at UC Davis, call the ROAD program pager at 916-762-COPD and leave your call-back number.

UC Davis Medical Center is a comprehensive academic medical center where clinical practice, teaching and research converge to advance human health. Centers of excellence include the National Cancer Institute-designated UC Davis Comprehensive Cancer Center; the region's only level 1 pediatric and adult trauma centers; the UC Davis MIND Institute, devoted to finding treatments and cures for neurodevelopmental disorders; and the UC Davis Children's Hospital. The medical center serves a 33-county, 65,000-square-mile area that stretches north to the Oregon border and east to Nevada. It further extends its reach through the award-winning telemedicine program, which gives remote, medically underserved communities throughout California unprecedented access to specialty and subspecialty care. For more information, visit

Rehabilitation: More than just exercise

Marianne Gullingsrud and patientA key part of ROAD is pulmonary rehabilitation, which provides individualized education, targeted exercise therapies and a community of support for people with breathing conditions.

“The increased interaction with patients who have successfully achieved a better quality of life is priceless,” said Kimberly Hardin, a UC Davis professor of pulmonary medicine and director of pulmonary rehabilitation.

Hardin has brought the latest exercise technologies to the program as well as novel interventions using Nintendo Wii consoles, which were made possible by donations from pulmonary rehabilitation graduates.

“Since it's the kind of personalized exercise system that people can use at home, ‘Wiihab’ fits perfectly with our goal of helping people easily incorporate physical activity into their lives,” she said.

Marianne Gullingsrud, a respiratory care practitioner who helps patients reach their reconditioning goals, is currently training a UC Davis team for the regional Lung Games. Held in Concord, Calif., each fall, the games bring patients throughout Northern California together to compete with and encourage each other, while increasing general awareness of the benefits of pulmonary rehabilitation for people with chronic lung disease.

“Last year, we won six medals,” said Gullingsrud. “This year, we’ll bring back even more.”