Course Introduction

Knowing that we practice in a cost-sensitive environment, we at Correctional Medicine Institute
(CMI) still choose to present continuing medical education based on best practices, delivered
by experts in each disease state. This four-credit CME program, Managing Asthma and COPD
in Correctional Medicine, addresses two of the most rapidly rising medical challenges facing
correctional medicine, both of which are constantly reinforced by the influx of new inmates. Linda
Susan Cox, MD, principal faculty for the asthma course, is well known throughout the medical
community as an expert in allergy and immunology. A practicing physician, she is also Assistant
Clinical Professor of Medicine at Nova Southeastern University of College of Osteopathic Medicine
in Ft. Lauderdale, Florida. The faculty for the COPD course, Antonio Anzueto, MD, is equally well
known. Dr. Anzueto is Professor of Medicine at the University of Texas Health Science Center, Chief of its Pulmonary Disease Section and Director of the Pulmonary Function Laboratory.

According to expert sources, the prevalence of asthma in prisons is 8.5%, compared to 7.5% in the
general population. It is the third-most preventable cause of hospitalization and its successful
management can greatly reduce the financial impact of the disease, which is in excess of $14
billion annually in the USA.

Chronic Obstructive Pulmonary Disease (COPD) is the umbrella classification for two
underlying diseases, emphysema and chronic bronchitis. Right now the disease is the fourth
leading cause of death in the United States and is expected to move up to number three by 2020.
Generally diagnosed in persons over the age of 60, as the prison population ages the incidence of
COPD increases.

To prevent, manage and treat asthma and COPD in the correctional setting, the most important
thing we can do for our patients is to minimize smoking. Approximately 80-90% of COPD
sufferers are now, or have been smokers. While great strides have been made in meeting the
NCCHC goal of making all correctional facilities completely smoke-free, a 2007 survey of 51 of
the 52 US Department of Corrections facilities showed that about 60% have completely banned
tobacco on prison grounds, and another 27% have a ban on indoor tobacco use. The study also
showed that when the bans are accompanied by long-term smoking cessation programs the
quitting success rate rises dramatically. Therefore, this course encourages the use of smoking
cessation programs and creation of support groups where possible. We also recommend review of
the NCCHC Clinical Guideline for Health Care in Correctional Settings: Asthma, available on-line
at www.ncchc.org/resources/clinicalguides/Adult_Asthma.pdf, as part of this CME effort.

We hope you will find this information useful, and that you will share this education with your
colleagues and members of your staff.

Keith Ivens, MD,
President, Correctional Medicine Institute