Author Affiliations

1. Division of Pulmonary and Critical Care Medicine, Mass General Brigham, Harvard Medical School, Boston, Massachusetts, United States
2. Early Respiratory and Immunology Clinical Development, BioPharmaceuticals R&D, AstraZeneca, Boston, Massachusetts, United States
3. Translational Science and Experimental Medicine, Research and Early Development, Respiratory and Immunology, BioPharmaceuticals R&D, AstraZeneca, Cambridge, United Kingdom
4. Lovelace Scientific Resources, Albuquerque, New Mexico, United States
5. Lovelace Biomedical Research Institute, Albuquerque, New Mexico, United States
6. Dynamic Omics, Centre for Genomics Research, Discovery Sciences, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, Maryland, United States
7. Translational Science and Experimental Medicine, Research and Early Development, Respiratory and Immunology, AstraZeneca, Gothenburg, Sweden
8. Faculty of Medicine, University of Southampton, Southampton, United Kingdom
9. Late Respiratory and Immunology Clinical Development, BioPharmaceuticals R&D, AstraZeneca, Cambridge, United Kingdom
10. Late Respiratory and Immunology Clinical Development, BioPharmaceuticals R&D, AstraZeneca, Durham, North Carolina, United States

Address correspondence to:

Yohannes Tesfaigzi, PhD
Mass General Hospital
Division of Pulmonary and Critical Care Medicine
Harvard Medical School
Boston, MA, United States
Phone: (617) 525-3480
Email: ytesfaigzi@bwh.harvard.edu

Abstract

Background: Pulmonary function tests may predict future outcomes; however, they are not often performed in middle-aged individuals at risk for future airway obstruction. We examined whether smokers with low lung function (LLF) have an increased risk of developing health problems and mortality over time.

Methods: Current and ever smokers (n=830) from the Lovelace Cohort aged 40–60 years without baseline airway obstruction and with at least 2 spirometry measurements over 18 months were included. Participants were divided into high lung function (HLF) and LLF function tertiles based on forced expiratory volume in 1 second percentage predicted (FEV₁%pred). Lung function, health status, and comorbidities were compared at baseline and over 17 years; mortality at 17 years was also assessed. From these participants, 61 HLF (baseline FEV1%pred >99%) and 26 LLF (baseline FEV1%pred <88%) were examined at 17 years follow-up using logistic regression.

Results: Baseline demographic and clinical characteristics were generally similar between the LLF and HLF tertiles, except for age, sex, body mass index, and lung function. In the overall cohort (LLF, n=277; HLF, n=277), survival of the HLF versus LLF cohort showed a hazard ratio of 0.49 (p=0.02). At the 17-year follow-up, LLF was associated with increased prevalence of wheeze, cardiovascular diseases, chronic lung diseases, diabetes, and worse health status.

Conclusions: Smokers with LLF without airflow obstruction exhibited reduced survival and an increased risk for development of chronic morbidities. Thus, spirometry may be used to identify at-risk individuals, allowing for early preventative interventions that can improve long-term health outcomes. Take home message: Among ever smokers without airflow obstruction, LLF is associated with increased mortality and poor health status. Spirometry may identify at-risk patients, enabling early emphasis on interventions with the potential to improve long-term health outcomes.

Citation

Citation: Tesfaigzi Y, Brown MN, Liu C, et al. Low lung function in middle-aged smokers impacts health status, morbidities, and mortality: an observational analysis of the Lovelace smokers cohort. Chronic Obstr Pulm Dis. 2025; 12(5): 357-367. doi: http://dx.doi.org/10.15326/jcopdf.2025.0605

Keywords

comorbidity, mortality, lung function, health status, middle-aged smokers

Full Text

Click to read Low Lung Function in Middle-Aged Smokers Impacts Health Status, Morbidities, and Mortality: An Observational Analysis of the Lovelace Smokers Cohort

PDF Download

PDF Version (1316KB)

Author Affiliations

1. Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, United States
2. Amgen Discovery Research, Thousand Oaks, California, United States
3. Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, United States
4. Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California, United States
5. Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California, United States
6. Department of Physiology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, United States

Address correspondence to:

Igor Barjaktarevic, MD, PhD
Division of Pulmonary and Critical Care
Department of Medicine
David Geffen School of Medicine
University of California Los Angeles
10833 Le Conte Avenue, 37-131 CHS
Los Angeles, CA 90095
Email: ibarjaktarevic@mednet.ucla.edu

Abstract

Background: Chronic obstructive pulmonary disease (COPD) phenotyping is an approach for developing tailored therapies. The eosinophilic phenotype is associated with exacerbation risk and response to specific treatments. This study evaluates the relationship between sputum and blood eosinophilia, hypothesizing that sputum eosinophil percentage (SpE%) better reflects disease severity and exacerbation risk than blood eosinophil counts (BEC).

Methods: This was a single-center, prospective observational cohort with 107 participants aged 40–80 with clinically diagnosed COPD. Participants completed spirometry, a 6-minute walk test, and questionnaires, and blood and sputum samples were provided at baseline and 3 months. BEC and SpE% were measured via routine complete blood counts and flow cytometric analyses (fluorescence-activated cell sorting [FACS]). Eosinophilic phenotype thresholds were defined as BEC≥300 cells/μL and SpE%≥2%, and associations with clinical characteristics and outcomes were investigated.

Results: Adequate sputum specimens were obtained less frequently than blood (60.7% versus 98%). SpE% showed poor repeatability (interclass coefficient 0.36) and poor correlation with FACS (Spearman’s 𝜌=0.008, p=0.58). Conversely, BEC showed higher repeatability (𝜌=0.67, p<0.01) and better correlation with FACS (𝜌=0.74, p<0.01). More participants were classified as eosinophilic COPD by sputum (33.3%) than by blood (19.6%). BEC values were poorly correlated with SpE% (𝜌=0.13, P=0.39), and sputum and blood-based diagnostic criteria showed poor agreement (64.5%, Cohen’s 𝜅 0.10). High SpE%, but not high BEC, was associated with lower forced expiratory volume in 1 second percentage predicted.

Conclusions: In stable COPD patients, BEC and SpE% did not correlate well, and blood- and sputum-based diagnostic criteria identified different individuals. Defining eosinophilic COPD requires a better understanding of the bio-compartment sampled, testing methods, and cut-off values used.

Citation

Citation: LeMaster WB, Ingersoll SA, Phee H, et al. Diagnosing type 2 inflammation in COPD: comparison of blood and sputum eosinophil assessment in the University of California, Los Angeles COPD phenotyping study. Chronic Obstr Pulm Dis. 2025; 12(5): 368-379. doi: http://dx.doi.org/10.15326/jcopdf.2024.0599

Keywords

COPD, biomarkers, phenotypes, eosinophils, sputum, blood

Full Text

Click to read Diagnosing Type 2 Inflammation in COPD: Comparison of Blood and Sputum Eosinophil Assessment in the University of California, Los Angeles COPD Phenotyping Study

PDF Download

PDF Version (1017KB)

Author Affiliations

1. Intensive Care Unit, The First Hospital of Jilin University, Changchun, Jilin, China
2. Department of Neurology, The First Hospital of Jilin University, Changchun, Jilin, China
3. Division of Clinical Research, The First Hospital of Jilin University, Changchun, Jilin, China

Address correspondence to:

Suyan Tian, PhD
Division of Clinical Research
The First Hospital of Jilin University
Changchun, Jilin, China
Email: wmxt@jlu.edu.cn

Abstract

Background: Cathepsins, a family of lysosomal proteolytic enzymes, have been implicated in the pathogenesis of various complex diseases, including chronic obstructive pulmonary disease (COPD). However, the causal relationship between cathepsins and COPD remains unclear.

Methods: This study employed Mendelian randomization (MR) to investigate the potential causal effects of cathepsin levels on COPD risk. This MR analysis utilized genetic data from individuals of European ancestry in the INTERVAL study and FinnGen consortium. Specifically, summary-level genetic data for 9 cathepsins (B, E, F, G, H, O, L2, S, and Z) were obtained from the INTERVAL study, while COPD summary statistics were sourced from the FinnGen consortium. We conducted comprehensive MR analyses, including univariable MR, reverse MR, multivariable MR (MVMR), and MR least absolute shrinkage and selection operator, to assess causal relationships between cathepsin levels and COPD risk.

Results: Univariable MR analysis revealed no significant causal relationships (forward or reverse) between the 9 cathepsins and COPD risk. However, MVMR analysis identified cathepsins O and S as having direct causal effects on COPD. For cathepsins O and S, odds ratio was estimated as 1.130 (p=0.022, 95% confidence interval [CI] = 1.018–1.255) and 1.068 (p=0.025, 95% CI = 1.008–1.132), respectively. Furthermore, these 2 cathepsins were independent risk factors for COPD after adjusting for smoking.

Conclusion: To our knowledge, this is the first MR study to systematically evaluate the causal role of cathepsins in COPD. Further research, particularly clinical trials, is warranted to validate these associations and explore the therapeutic potential of targeting cathepsins in COPD management.

Citation

Citation: Duan C, Zhang A, Tian S. Genetic evidence for causal relationships between circulating cathepsin levels and chronic obstructive pulmonary disease: a Mendelian randomization study. Chronic Obstr Pulm Dis. 2025; 12(5): 380-389. doi: http://dx.doi.org/10.15326/jcopdf.2025.0626

Keywords

chronic obstructive pulmonary disease, Mendelian randomization, causal inference, cathepsin

Full Text

Click to read Genetic Evidence for Causal Relationships Between Circulating Cathepsin Levels and Chronic Obstructive Pulmonary Disease: A Mendelian Randomization Study

PDF Download

PDF Version (825KB)

Author Affiliations

1. Pulmonology Department, Unidade Local de Saúde de Santo António, Porto, Portugal
2. Institute of Biomedical Sciences Abel Salazar, School of Medicine and Biomedical Sciences, University of Porto, Porto, Portugal
3. Interdisciplinary Centre of Marine and Environmental Research, University of Porto, Porto, Portugal

Address correspondence to:

Beatriz Ferraz, MD
Largo do Prof. Abel Salazar
4099-001 Porto
Portugal
Phone: +351 91 717 44 95
Email: beatrizferraz26@gmail.com

Abstract

Purpose: Chronic obstructive pulmonary disease (COPD) remains a challenging condition to manage due to its variability in clinical presentation and progression. While disease control is a well-defined concept in asthma, its relevance in COPD is less clear. This study aimed to evaluate the clinical utility of a COPD control framework, developed in Spain, in Portuguese outpatients by analyzing exacerbation rates among controlled and uncontrolled patients.

Methods: This prospective, observational study enrolled 133 COPD outpatients, evaluated at baseline (V0), 6 months (V1), and one year (V2). Patients were classified as controlled or uncontrolled based on criteria assessing clinical stability and disease impact, incorporating dyspnea severity, rescue medication use, physical activity, sputum color, and recent exacerbation history. Patients classified as controlled and uncontrolled were compared regarding the occurrence of an exacerbation (hospitalization, emergency visit, or ambulatory exacerbation) during follow-up.

Results: At baseline, 33.1% of patients were classified as controlled. This proportion increased to 46.2% at V1 but decreased to 31.6% at V2. Notably, only 12% remained consistently controlled throughout follow-up. There was a consistent trend of higher exacerbation rates among those previously uncontrolled. Only the difference in emergency visits at 12 months reached statistical significance (27.1% versus 7.8% in controlled patients, p=0.023).

Conclusion: This study provides the first independent validation of COPD control criteria in a Portuguese cohort. Although the control framework proved feasible for clinical application, its predictive value for exacerbations was low in this severe-disease cohort. Future research should expand on these findings in diverse populations to optimize COPD management strategies.

Citation

Citation: Ferraz BD, Cardoso MF, Rodrigues C, et al. Exploring clinical control of COPD: insights from a Portuguese outpatient population. Chronic Obstr Pulm Dis. 2025; 12(5): 390-398. doi: http://dx.doi.org/10.15326/jcopdf.2025.0628

Keywords

chronic airways obstruction, dyspnea, acute exacerbations, COPD management, Exacerbation of COPD Tool

Full Text

Click to read Exploring Clinical Control of COPD: Insights From a Portuguese Outpatient Population

PDF Download

PDF Version (680KB)

Author Affiliations

1. Department of Epidemiology and Environmental Health, College of Public Health, University of Kentucky, Lexington, Kentucky, United States
2. Pulmonary Disease and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, United States
3. COPD Foundation, Miami, Florida, United States
4. Channing Division of Network Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States

Address correspondence to:

Radmila Choate, PhD, MPH
111 Washington Avenue, Ste 215B
University of Kentucky College of Public Health
Department of Epidemiology and Environmental Health
Lexington, KY 40536
Phone: (859) 218-2237
Email: radmila.choate@uky.edu

Abstract

Rationale: Chronic lung diseases, including chronic obstructive pulmonary disease (COPD) and bronchiectasis (BE), may differ by sex in symptom onset, diagnostic delays, and disease burden. This study examined health care experiences and symptom burden among individuals with self-reported COPD, BE, or nontuberculous mycobacteria (NTM).

Methods: This cross-sectional study analyzed data from an online survey of U.S. and international participants with self-reported COPD, BE, or NTM, recruited via COPD Foundation social media. The questionnaire, developed with input from COPD Foundation leadership, physician-researchers, and patient stakeholders, assessed health care experiences, disease burden, and symptoms. A subset of women answered menopause-related questions. Descriptive statistics were compared by sex and disease group: COPD (with/without BE or NTM) and BE (with/without NTM). T-tests assessed continuous variables; Chi-square or Fisher’s exact tests analyzed categorical variables.

Results: Among 632 respondents (mean age 70±9 years, 74% women), 68% reported COPD and 32% BE. Women with COPD were younger (p=0.048) and sought care sooner after symptom onset (p<0.010) than men. More women with COPD did not have their diagnosis explained by a health care provider (p=0.038) and reported diagnosis-related anxiety, depression, or fear (p=0.007). Among participants with BE, men were more likely to receive a confirmed diagnosis sooner (p=0.038) and during hospitalization (p=0.024). Disease management burden, pulmonologist visit frequency, Chronic Airways Assessment Test scores, numbers of comorbidities, and financial burden were similar across groups. Over 75% of women were postmenopausal, and one-third reported worsened pulmonary symptoms postmenopause.

Conclusions: Differences in diagnostic delays and symptom burden highlight the need for further research into health care disparities to improve pulmonary care and outcomes.

Citation

Citation: Choate R, Aksamit TR, Torrence J, et al. Navigating COPD and bronchiectasis: a COPD Foundation survey of differences in patient-perceived health care experiences by sex. Chronic Obstr Pulm Dis. 2025; 12(5): 399-410. doi: http://dx.doi.org/10.15326/jcopdf.2025.0620

Keywords

COPD, bronchiectasis, sex, self-perceived experiences

Full Text

Click to read Navigating COPD and Bronchiectasis: A COPD Foundation Survey of Differences in Patient-Perceived Health Care Experiences by Sex

PDF Download

PDF Version (687KB)

Author Affiliations

1. Lahey Hospital and Medical Center, UMass Chan Medical School-Lahey, Burlington, Massachusetts, United States
2. Tufts University School of Medicine, Boston, Massachusetts, United States
3. Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States

Address correspondence to:

Victor Pinto-Plata, MD
Department of Pulmonary and Critical Care Medicine
Lahey Hospital and Medical Center
41 Mall Road
Burlington, MA 01805
Phone: (781)744-8482
Email: Victor.M.Pinto-Plata@lahey.org

Abstract

Background: Chronic obstructive pulmonary disease (COPD) remains underdiagnosed and undertreated. Because screening asymptomatic individuals for COPD is not recommended, several case-finding tools have been explored. The COPD Assessment in Primary Care to Identify Undiagnosed Respiratory Disease and Exacerbation Risk (CAPTURE) questionnaire and peak expiratory flow (PEF) rate (CAPTURE tool) have been tested in the primary care setting, with disappointing results. We hypothesized that these tools could yield better results in a computed tomography lung screening (CTLS) program, where individuals have a history of cigarette smoking and higher prevalence of COPD.

Methods: We recruited 67 patients referred to a CTLS program at a single institution. Participants completed the CAPTURE and COPD Assessment Test (CAT) questionnaires. Spirometric testing was completed with a portable device and low-dose chest computed tomography (CT) was performed according to a standard protocol.

Results: The group’s mean age was 66 ±7 years, 43% were male, with a 37 pack-year smoking history. Eighteen (27%) had COPD (forced expiratory volume in 1 second of 60 ±22% predicted) and a higher CAT score (12 [interquartile range (IQR) 6–15]) compared to the nonobstructed group (CAT=7 [IQR 3–10]), p<0.02. Combining the CAPTURE questionnaire with PEF generated the best COPD diagnostic criteria (sensitivity=0.82, specificity=0.73, area under the receiver operating curve [AUROC]=0.784), followed by combining the CAPTURE questionnaire and emphysema presence (sensitivity=0.73, specificity=0.71, AUROC=0.779). The CAPTURE questionnaire alone had a sensitivity=0.766, specificity=0.616, and AUROC=0.669.

Conclusions: The CAPTURE tool is an effective method to find COPD cases in lung cancer screenings. A CT diagnosis of emphysema can substitute peak flow in this population.

Citation

Citation: Spetrini R, Pikman P, Kang V, et al. Prospective COPD case finding in a lung cancer screening program: a pilot study. Chronic Obstr Pulm Dis. 2025; 12(5): 411-418. doi: http://dx.doi.org/10.15326/jcopdf.2025.0636

Keywords

COPD, COPD Assessment Test, lung cancer screenings, underdiagnosis, case identification

Full Text

Click to read Prospective COPD Case Finding in a Lung Cancer Screening Program: A Pilot Study

PDF Download

PDF Version (380KB)

Author Affiliations

1. Division of Pulmonary Diseases and Critical Care Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
2. COPD Foundation, Miami, Florida, United States
3. Section on Pulmonary, Critical Care, Allergy and Immunologic Diseases, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, United States
4. Department of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
5. Department of Pulmonary and Critical Care Medicine, Geisinger Medical Center, Danville, Pennsylvania, United States
6. Division of Pulmonary, Allergy and Critical Care, University of Alabama at Birmingham, Birmingham, Alabama, United States
7. Section for Pulmonary and Critical Care Medicine, Birmingham VA Medical Center, Birmingham, Alabama, United States

Address correspondence to:

M. Bradley Drummond, MD, MHS
Division of Pulmonary Diseases and Critical Care Medicine
University of North Carolina at Chapel Hill
Chapel Hill, North Carolina
Phone: (919) 966-7054
Email: brad_drummond@med.unc.edu

Abstract

Chronic obstructive pulmonary disease (COPD) among individuals living in rural areas is associated with worse health outcomes. New strategies are needed to study interventions and deliver proven therapies to people with COPD in rural areas. This statement from the COPD Foundation Medical and Scientific Advisory Committee highlights specific challenges in capturing the key characteristics of rural residents and identifies approaches to improve research for COPD in rural areas. Specifically, geographic isolation, access to specialist care, lack of broadband access, and complex tobacco and exposure histories are drivers of COPD health disparities in rural populations that are not captured by conventional definitions of rurality. To improve the design of research studies among people with COPD living in rural settings, certain actions are identified. These include the inclusion of specific covariates such as distance and travel time to health care services and multidimensional assessment tools for societal and individual health determinants in data collection; deploying qualitative and mixed-methods research designs to assess cultural differences driving health care access and health behaviors; decentralized carousel recruitment models in study design; and operationalizing research partnerships to improve support for primary care providers engaged in research. These approaches will permit robust assessment of the complex matrices driving disparate health outcomes among people with COPD in rural areas.

Citation

Citation: Thornton ME, Mannino DM, Ohar JA, et al. Improving research for COPD in rural areas: a statement from the COPD Foundation Medical and Scientific Advisory Committee. Chronic Obstr Pulm Dis. 2025; 12(5): 419-425. doi: http://dx.doi.org/10.15326/jcopdf.2025.0618

Keywords

pulmonary disease, research priorities, chronic obstructive, rural health

Full Text

Click to read Improving Research for COPD in Rural Areas: A Statement from the COPD Foundation Medical and Scientific Advisory Committee

PDF Download

PDF Version (614KB)

Author Affiliations

1. PPD Evidera Patient-Centered Research, Thermo Fisher Scientific, London, United Kingdom
2. Patient-Centered Research, COPD Foundation, Miami, Florida, United States
3. Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada

Address correspondence to:

Ashley Duenas, MSc
PPD Evidera Patient-Centered Research
Thermo Fisher Scientific
The Ark, 201 Talgarth Rd, Hammersmith W6 8BJ
United Kingdom
Phone: +44-20-8576-5052
Email: ashley.duenas@thermofisher.com

Abstract

Objectives: A critical step in designing clinical trials to evaluate treatment efficacy in chronic obstructive pulmonary disease (COPD) is selecting fit-for-purpose outcome measures that reflect health concepts meaningful to people living with COPD. The purpose of this review was to summarize and synthesize qualitative literature addressing how patients with COPD describe aspects of their disease, to inform health concept selection and outcome measure selection.

Methods: A literature review and metasynthesis of qualitative research published from 2013 to 2023 was performed. Studies meeting criteria underwent critical appraisal and data extraction. Studies were summarized and synthesized with constant comparative analysis to review author interpretations and direct patient quotes.

Results: Nineteen studies addressing the patient experience of COPD met screening criteria for full review and data synthesis. In total, 507 patients (range: 8–64 individuals per study) across 11 countries participated in these studies via interviews (63.2%), focus groups (15.8%), or online forums (5.3%). Prominent COPD symptoms included breathlessness, cough, mucus, wheezing, chest discomfort, difficulty sleeping, tiredness, and weakness. Patients described significant impacts on physical activity, emphasizing difficulties with activities of daily living. The symptoms experienced and the persistent limitation on physical activity had severe consequences on social and role functioning and psychological and emotional health.

Conclusions: This qualitative metasynthesis summarizes evidence about symptoms experienced by patients with COPD and the impact of these symptoms on daily life. The synthesis provides an empirical foundation for the development of a standardized set of patient-inspired health concepts to be considered when selecting outcome measures for COPD clinical trials.

Citation

Citation: Duenas A, Kornalska K, Hamilton A. A metasynthesis of qualitative literature to inform the selection of meaningful and measurable health concepts for clinical trials in COPD. Chronic Obstr Pulm Dis. 2025; 12(5): 426-439. doi: http://dx.doi.org/10.15326/jcopdf.2025.0633

Keywords

COPD, qualitative research, patient experience, health concepts, health outcomes

Full Text

Click to read A Metasynthesis of Qualitative Literature to Inform the Selection of Meaningful and Measurable Health Concepts for Clinical Trials in COPD-related

PDF Download

PDF Version (1018KB)

Author Affiliations

1. Department of Respiratory Medicine, Freeman Hospital, The Newcastle Upon Tyne Hospitals Teaching Foundation Trust, Newcastle, United Kingdom
2. School of Medicine, Newcastle University, Newcastle Upon Tyne, United Kingdom
3. Faculty of Medical Sciences, School of Biomedical, Nutritional, and Sport Sciences, Newcastle University, Newcastle Upon Tyne, United Kingdom
4. School of Pharmacy, Newcastle University, Newcastle Upon Tyne, United Kingdom
5. Faculty of Medical Sciences, Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, United Kingdom

Address correspondence to:

Henil Upadhyay, MBBS
The Newcastle Upon Tyne Hospitals NHS Foundation Trust
Newcastle, United Kingdom
Email: h.upadhyay@nhs.net

Abstract

Chronic obstructive pulmonary disease (COPD) is a global health challenge. Increasing numbers of patients with COPD are prescribed multiple medications (both for COPD and non-COPD disorders). This increases the risk of polypharmacy in these patients which can be linked with patient harm. However, the definition of polypharmacy is varied across literature (ranging from use of ≥3 to ≥20 medications).

This review aims to report the prevalence of polypharmacy, report the varying definitions of polypharmacy, and report medication related harms amongst patients with COPD.

We identified 28 studies reporting polypharmacy rates in COPD populations. A total of 13 studies (46.3%) defined polypharmacy as the use of ≥5 medications; however, the remaining studies had different definitions of polypharmacy. The available studies include multiple different countries and settings (primary care, secondary care, and community-based surveys). Polypharmacy and hyper polypharmacy (use of ≥10 medications) rates varied from 3.9% to 81.4% and 6.6% to 74.6% respectively.

Polypharmacy in patients with COPD is common but poorly understood due to difficulty in comparing previous literature with differences in methodologies, patient populations, and definitions of polypharmacy. The multimorbid COPD population is likely at higher risk to the effects of polypharmacy through poor adherence, adverse drug reactions, and drug-drug interactions. Clinicians should be mindful of the patient’s age, comorbidities, and drug-drug interactions while prescribing medications in the COPD clinic.

Citation

Citation: Upadhyay H, Akter F, Koumides A, Husband A, DeSoyza A. Polypharmacy in patients with COPD: a scoping review. Chronic Obstr Pulm Dis. 2025; 12(5): 440-449. doi: http://dx.doi.org/10.15326/jcopdf.2025.0630

Keywords

COPD, medication, multimorbidity, chronic airways obstruction

Full Text

Click to read Polypharmacy in Patients With COPD: A Scoping Review

PDF Download

PDF Version (532KB)

Author Affiliations

1. Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, United States

Address correspondence to:

Stephen T. Russell, MD
Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine
Department of Medicine
Emory University School of Medicine
615 Michael Street
Suite 205
Atlanta, GA 30322
Email: struss2@emory.edu

Abstract

This article does not contain an abstract.

Citation

Citation: Russell ST, Lama VN, Kempker JA. Bronchodilator response in COPD: definitions, reference equations, and race. Chronic Obstr Pulm Dis. 2025; 12(5): 450-454. doi: http://dx.doi.org/10.15326/jcopdf.2025.0611

Keywords

COPD, spirometry, bronchodilator response, reference equations

Full Text

Click to read Bronchodilator Response in COPD: Definitions, Reference Equations, and Race

PDF Download

PDF Version (385KB)