Chronic Obstructive Pulmonary Diseases:Journal of the COPD Foundation

Volume 12, Issue 3 - 2025

Chronic Obstructive Pulmonary Diseases: Journal of the COPD Foundation is an open access, peer-reviewed medical/scientific journal dedicated to publishing original research, reviews, and communications related to COPD. Following peer review and editorial acceptance, manuscripts are published online as quickly as possible as Articles in Press.  These accepted manuscripts are then aggregated into journal issues 6 times per year (January, March, May, July, September, and November) and made available to the COPD medical/research community at no charge, without a required subscription fee. The Journal is indexed by PubMed, PubMed Central, Scopus and Web of Science.

Editorial:

The Chronic Airways Assessment Test (CAAT™): Evolution From the COPD Assessment Test (CAT™)

Ruth Tal-Singer, PhD1 James D. Chalmers, MD2 Paul W. Jones, MD3 Helen K. Reddel, MBBS, PhD4 Toru Oga, MD5 Claus F. Vogelmeier, MD6 Janelle Yorke, RN, PhD7 Bruce E. Miller, PhD8 for the CAAT Governance Board

Author Affiliations

  1. Global Allergy and Airways Patient Platform, Vienna, Austria
  2. Division of Respiratory Medicine and Gastroenterology, University of Dundee, Dundee, United Kingdom
  3. Institute for Infection and Immunity, City St Georges, University of London, London, United Kingdom
  4. Woolcock Institute of Medical Research, Macquarie University; Macquarie Medical School, Macquarie University; and The University of Sydney, Sydney, Australia.
  5. Department of Respiratory Medicine, Kawasaki Medical School, Kurashiki, Okayama, Japan.
  6. Department of Medicine, Pulmonary and Critical Care Medicine, University of Marburg, German Center for Lung Research, Marburg, Germany
  7. School of Nursing, Hong Kong Polytechnic University, Hong Kong, Special Administrative Region of China
  8. COPD Foundation, Miami, Florida, United States

Address correspondence to:

Ruth Tal-Singer, PhD
Global Allergy and Airways Patient Platform
Vienna, Austria
Email: rtalsinger@gaapp.org

Abstract

This article does not contain an abstract.

Citation

Citation: Tal-Singer R, Chalmers JD, Jones PW, et al; CAAT Governance Board. The Chronic Airways Assessment Test (CAAT™): Evolution from the COPD Assessment Test (CAT™). Chronic Obstr Pulm Dis. 2025; 12(3): 203-206. doi: http://dx.doi.org/10.15326/jcopdf.2025.0614

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Letter to the Editor:

Clinical Implications of Pseudomonas Aeruginosa Colonization in Chronic Obstructive Pulmonary Disease Patients: Is There Enough Evidence?

Aikaterini Gakidi, MD1 Nicholas S. Hopkinson, MD, PhD2 Michael I. Polkey, MD, PhD2 Afroditi K. Boutou, MD, MSc, PhD1

Author Affiliations

  1. Department of Respiratory Medicine, Hippokratio Hospital, Thessaloniki, Greece
  2. National Institute for Health and Care Research Respiratory Biomedical Research Unit, Royal Brompton and Harefield National Health Service Foundation Trust and Imperial College, London, United Kingdom

Address correspondence to:

Afroditi K. Boutou
Department of Respiratory Medicine
Hippokratio Hospital
Thessaloniki, Greece
Email: afboutou@yahoo.com

Abstract

This article does not contain an abstract.

Citation

Citation: Gakidi A, Hopkinson NS, Polkey MI, Boutou AK. Clinical implications of Pseudomonas aeruginosa colonization in chronic obstructive pulmonary disease patients: is there enough evidence? Chronic Obstr Pulm Dis. 2025; 12(3): 207-209. doi: http://dx.doi.org/10.15326/jcopdf.2025.0627

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Response by Authors:

Letter to the Editor: Response by Authors

Wang Chun Kwok, MBBS1 Terence Chi Chun Tam, MBBS1 Chi Hung Chau, MBBS2 Fai Man Lam, MBBS2 James Chung Man Ho, MD1

Author Affiliations

  1. Division of Respiratory Medicine, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, China
  2. Tuberculosis and Chest Unit, Grantham Hospital, Aberdeen, Hong Kong Special Administrative Region, China

Address correspondence to:

Wang Chun Kwok, MBBS
Department of Medicine
Queen Mary Hospital
The University of Hong Kong
102 Pok Fu Lam Road
Hong Kong
Phone: 22553111
Email: kwokwch@hku.hk

Abstract

This article does not contain an abstract.

Citation

Citation: Kwok WC, Tam TCC, Chau CH, Lam FM, Ho JCM. Letter to the editor: response by authors. Chronic Obstr Pulm Dis. 2025; 12(3): 210-211. doi: http://dx.doi.org/10.15326/jcopdf.2025.0634

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Erratum:

Erratum

Wang Chun Kwok, MBBS1 Terence Chi Chun Tam, MBBS1 Chi Hung Chau, MBBS2 Fai Man Lam, MBBS2 James Chung Man Ho, MD1

Author Affiliations

  1. Division of Respiratory Medicine, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, China
  2. Tuberculosis and Chest Unit, Grantham Hospital, Aberdeen, Hong Kong Special Administrative Region, China

Address correspondence to:

There is no correspondance information for this article.

Abstract

This article does not contain an abstract.

Citation

Citation: Erratum. Chronic Obstr Pulm Dis. 2025; 12(3): 212-212. doi: http://dx.doi.org/10.15326/jcopdf.2024.0582E

Keywords

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Original Research:

Psychobiologic Correlates of Stress in Individuals With COPD

Trisha M. Parekh, DO, MSPH1 Rekha Ramachandran, MS2 Young-il Kim, PhD2 Zahra Haider3 Darlene Bhavnani, PhD, MPH4 J. Michael Wells, MD, MSPH5,6,7 Elizabeth Matsui, MD4 Mark T. Dransfield, MD5,6,7

Author Affiliations

  1. Division of Pulmonary and Critical Care, University of Texas at Austin, Austin, Texas, United States
  2. Department of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
  3. Undergraduate Program, University of Texas at Austin, Austin, Texas, United States
  4. Department of Population Health, University of Texas at Austin, Austin, Texas, United States
  5. Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
  6. Lung Health Center, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
  7. Section for Pulmonary and Critical Care Medicine, Birmingham VA Healthcare System, Birmingham, Alabama, United States

Address correspondence to:

Trisha M. Parekh, DO, MSPH
University of Texas at Austin Dell Medical School
Division of Pulmonary and Critical Care
1601 Trinity Street Building A
Austin, TX 78712
Email: trisha.parekh@austin.utexas.edu

Abstract

Background: Psychological stress is elevated in individuals with chronic medical conditions, including those with chronic obstructive pulmonary disease (COPD). Nail cortisol may have utility as a marker for testing the biologic effects of stress reduction interventions. The aim of this pilot study is to explore the use of nail cortisol as a marker of chronic psychological stress in individuals with COPD.

Methods: Pearson’s correlation was used to test if nail cortisol was correlated with perceived stress, serum cortisol, or inflammatory biomarkers. A multivariable linear regression model was used to evaluate the association between perceived stress and nail cortisol. Stepwise logistic regression modeling was used to determine associations of psychobiologic measures of stress with demographic, clinical, and psychological variables.

Results: A total of 50 participants were included in the study. The mean (standard deviation [SD]) perceived stress score was 12 (+/-6) and mean (SD) nail cortisol level was 0.05 (+/-0.09) nmol/g. Nail cortisol was not correlated with perceived stress, serum cortisol, or inflammatory markers. There was no association between nail cortisol and perceived stress after controlling for confounders. Suboptimal health status and grit score were associated with perceived stress. Higher levels of serum fibrinogen were associated with higher levels of serum cortisol. Experiencing 3 or more negative lifetime events was associated with a decrease in nail cortisol.

Conclusions: We found no correlation between nail cortisol and levels of perceived stress, serum cortisol, or inflammatory biomarkers and there were no similar associations of variables across psychobiologic measures of stress.

Citation

Citation: Parekh TM, Ramachandran R, Kim Y, et al. Psychobiologic correlates of stress in individuals with COPD. Chronic Obstr Pulm Dis. 2025; 12(3): 213-222. doi: http://dx.doi.org/10.15326/jcopdf.2024.0578

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Pragmatic Evaluation of an Improvement Program for People Living With Modifiable High-Risk COPD Versus Usual Care: Protocol for the Cluster Randomized PREVAIL Trial

Katherine Hickman, MBBS1,2,3 Yasir Tarabichi, MD, MSCR4 Andrew P. Dickens, MSc, PhD5 Rachel Pullen, MBChB5 Margee Kerr, PhD5,6 Amy Couper, BSc5,6 Alexander Evans, MSc6 James Gatenby, MD6 Luis Alves, MD7,8Cono Ariti, MSc5 Mona Bafadhel, MBChB, MRCP, PhD9 Victoria Carter, BSc6 James Chalmers, MBChB, PhD10 Rongchang Chen, MD11 Graham Devereux, MBChB, PhD, FRCP12 M. Bradley Drummond, MD, MHS13 J. Martin Gibson, MD, FRCP14,15,16 David M. G. Halpin, MD, DPhil17 MeiLan K. Han, MD, MS18 Nicola A. Hanania, MD, MS19 John R. Hurst, PhD20 Alan Kaplan, MD5,21,22 Konstantinos Kostikas, MD, PhD, FERS5,23 Barry Make, MD24 Douglas Mapel, MD, MPH25 Jonathan Marshall, BSc, PhD26 Fernando Martinez, MD, MS27 Catherine Meldrum, PhD, RN28 Marije van Melle, PhD5,29 Marc Miravitlles, MD30 Tamsin Morris, BSc31 Hana Mullerova, PhD26 Ruth Murray, PhD6 Shigeo Muro, MD, PhD 32 Clementine Nordon, MD, PhD26 Jill Ohar, MD33 Wilson Pace, MD, FAAFP34,35 Michael Pollack, MSc36 Jennifer K. Quint, FRCP37 Anita Sharma, FRACGP, MBBS38 Dave Singh, MD39 Mukesh Singh, MBBS40,41,42 Frank Trudo, MD, MBA36 Dennis Williams, PharmD43,44 Tom Wilkinson, MA Cantab, MBBS, PhD, FRCP, FERS45,46,47 Tonya Winders, MBA48 David Price, MA, MBBC, FRCGP5,6,49

Author Affiliations

  1. National Respiratory Audit Programme, Care Quality Improvement Department, Royal College of Physicians, London, England, United Kingdom
  2. Low Moor Medical Practice, Bradford, England, United Kingdom
  3. West Yorkshire Integrated Care Board, Primary Care Respiratory Society, Wakefield, United Kingdom
  4. Center for Clinical Informatics Research and Education, MetroHealth, Cleveland, Ohio, United States
  5. Observational and Pragmatic Research Institute, Singapore, Singapore
  6. Optimum Patient Care, Cambridge, United Kingdom
  7. Epidemiology Research Unit, Institute of Public Health, University of Porto, Porto, Portugal
  8. Laboratory for Integrative and Translational Research in Population Health, Porto, Portugal
  9. Life Sciences and Medicine, King’s Centre for Lung Health, School of Immunology and Microbial Science, King’s College London, London, United Kingdom
  10. Scottish Centre for Respiratory Research, University of Dundee, Ninewells Hospital and Medical School, Dundee, United Kingdom
  11. Key Laboratory of Respiratory Disease of Shenzhen, Shenzhen Institute of Respiratory Disease, Shenzhen People's Hospital; Second Affiliated Hospital of Jinan University, First Affiliated Hospital of South University of Science and Technology of China, China
  12. Respiratory Medicine, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
  13. Division of Pulmonary Diseases and Critical Care Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
  14. Department of Diabetes and Endocrinology, Salford Royal Hospital, Salford, United Kingdom
  15. NorthWest EHealth Ltd., Manchester, United Kingdom
  16. Diabetes and Metabolic Medicine, University of Manchester, Manchester, United Kingdom
  17. College of Medicine and Health, University of Exeter Medical School, Exeter, United Kingdom
  18. Division of Pulmonary and Critical Care, University of Michigan Health, Ann Arbor, Michigan, United States
  19. Airways Clinical Research Center, Section of Pulmonary and Critical Care Medicine, Baylor College of Medicine, Waco, Texas, United States
  20. University College London Respiratory, University College London, London, United Kingdom
  21. Airways Group of Canada, Stouffville, Ontario, Canada
  22. Department of Commuity and Family Medicine, University of Toronto, Toronto, Canada
  23. Respiratory Medicine Department, University of Ioannina, Ioannina, Greece
  24. Department of Medicine, National Jewish Health, Denver, Colorado, United States
  25. College of Pharmacy, University of New Mexico Albuquerque, New Mexico, United States
  26. BioPharmaceuticals Medical, AstraZeneca, Cambridge, United Kingdom
  27. Department of Medicine, University of Massachusetts Chan Medical School/UMassMemorial Health, Worcester, Massachusetts, United States
  28. Pulmonary and Critical Care Medicine Division, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Michigan, United States
  29. Connecting Medical Dots BV, Utrecht, the Netherlands
  30. Pneumology Department, Vall d’Hebron University Hospital, Vall d’Hebron Research Institute, Vall d’Hebron Barcelona Hospital Campus, CIBER of Respiratory Diseases, Barcelona, Spain
  31. Medical and Scientific Affairs, AstraZeneca, London, United Kingdom
  32. Department of Respiratory Medicine, Nara Medical University, Nara, Japan
  33. Section on Pulmonary, Critical Care, Allergy and Immunology, Wake Forest University, Winston-Salem, North Carolina, United States
  34. DARTNet Institute, Aurora, Colorado, United States
  35. Department of Family Medicine, Ashutz Medical Campus, University of Colorado, Aurura, Colorado, United States
  36. Global Patient Safety, BioPharmaceuticals, AstraZeneca, Wilmington, Delaware, United States
  37. School of Public Health, Imperial College London, London, United Kingdom
  38. Platinum Medical Centre, Chermside, Queensland, Australia
  39. Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester University NHS Foundation Trust, Manchester, United Kingdom
  40. General Practice, Horse Fair Practice Group, Rugeley, Staffordshire, United Kingdom
  41. Keele University Medical School, Staffordshire, United Kingdom
  42. Medical School Teaching Practice, Rugeley, Staffordshire, United Kingdom
  43. Allergy and Asthma Network, Vienna, Virginia, United States
  44. Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, North Carolina, United States
  45. Mymhealth Limited, London, United Kingdom
  46. National Institute for Health and Care Research, Southampton Biomedical Research Centre, University of Southampton, Southampton, United Kingdom
  47. Faculty of Medicine, University of Southampton, Southampton, United Kingdom
  48. Global Allergy & Airways Patient Platform, Vienna, Austria
  49. Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom

Address correspondence to:

David Price
Observational and Pragmatic Research Institute
22 Sin Ming Lane, #06-76
Midview City, Singapore 573969
Phone: +65 3105 1489
Email: dprice@opri.sg

Abstract

Background: The burden of chronic obstructive pulmonary disease (COPD) is well established, but opportunities for earlier diagnosis and improved management are still missed. Compared to the general COPD population, patients with a history of exacerbations and suboptimal treatment (“modifiable high-risk”) are at greater risk of future exacerbations and adverse health outcomes. To date there is no systematic approach for identifying and treating this patient group.

Methods: Two cluster randomized controlled trials (CRTs) in the United Kingdom and United States will assess the impact of a primary care-based quality improvement program (COllaboratioN on QUality improvement initiative for achieving Excellence in STandards of COPD care [CONQUEST]), compared to routine care. In each trial, 126 primary care clusters will be randomized 1:1 to intervention or control arms. Three groups of modifiable high-risk patients will be identified using electronic medical records: undiagnosed with potential COPD, newly diagnosed COPD, and already diagnosed COPD. Eligible patients will be aged ≥40 years, have experienced ≥2 moderate/≥1 severe exacerbation(s) in the prior 24 months, including ≥1 in the last 12 months, and not be prescribed inhaled triple therapy. Patients in the undiagnosed group will also be required to have a positive smoking history. Primary trial outcomes will be the annual rate of exacerbations and the annual rate of major adverse cardiac or respiratory events, comparing the quality improvement program against routine care.

Discussion: These will be the first CRTs assessing such a comprehensive primary care-based COPD quality improvement program. Intention-to-treat analysis of trial outcomes after 24 months will inform its effectiveness in targeting the identification, assessment, treatment, and follow-up of patients with modifiable high-risk COPD.

Trial registration: UK trial: ISRCTN15819828; US trial: NCT05306743

Citation

Hickman K, Tarabichi Y, Dickens AP, et al. Pragmatic evaluation of an improvement program for people living with modifiable high-risk COPD versus usual care: protocol for the cluster randomized PREVAIL trial. Chronic Obstr Pulm Dis. 2025; 12(3): 223-239. doi: http://dx.doi.org/10.15326/jcopdf.2024.0564

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Inhalation Innovation: Optimizing COPD Care Through Clinical Pharmacist Integration in a Rehabilitation Hospital's Multidisciplinary Team – A Quality Improvement Study

Annelies I.M. Walravens, MPharm1* Emma Walravens, MPharm1,2* Stephanie C.M. Wuyts, MPharm2,3 Sander Boudewyn, MPharm4 Kayleigh Spriet, MPharm4 Kristel De Paepe, MD4 Eline Tommelein, MPharm, PhD5

Author Affiliations

  1. Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
  2. Pharmacy Department, Universitair Ziekenhuis Brussel, Brussels, Belgium
  3. Research Center for Digital Medicine, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
  4. Queen Elisabeth Institute, Oostduinkerke, Belgium
  5. Department of Pharmaceutical and Pharmacological Sciences, Experimental Pharmacology, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
*These authors contributed equally to this work.

Address correspondence to:

Emma Walravens
Laarbeeklaan 103
1090 Brussels, Belgium
Phone: +32 470 25 36 20
Email: emma.walravens@vub.be

Abstract

Background: Inhalation therapy is the cornerstone of chronic obstructive pulmonary disease (COPD) management. However, errors frequently occur since every type of inhalation device has different characteristics, complicating their use. The clinical pharmacist is an expert on these devices and can be involved in the care and education of inhaler use in patients with COPD.

Objective: The feasibility of a pharmaceutical care protocol specifically for patients with COPD in a rehabilitation hospital was assessed in a quality improvement study (mixed-methods).

Method: First, the clinical pharmacist had 6 contact moments with hospitalized patients between January and April 2022, which contained appropriateness evaluations and educational moments that were focused on inhalation techniques. Subsequently, a focus group discussion with all involved health care professionals (HCPs) took place to evaluate the preliminary results of the protocol’s implementation.

Results: A total of 19 patients entered the study with the protocol resulting in a decrease of critical device errors (38.5% at baseline, to 7.7% at discharge). The HCPs concluded that it was feasible to implement the protocol given certain adjustments. A multidisciplinary collaboration between pharmacists and nurses is necessary to permit the practical implementation, as well as an individualization of the protocol based on the patient’s needs. In patient follow-up, transmural care is essential including the HCPs in primary care, and the outpatient clinic.

Conclusion: The evaluation of the protocol by the involved HCPs emphasizes the importance of a clinical pharmacist in the care of patients with COPD as part of the multidisciplinary team, not only in the community or in an acute hospital setting, but also in a rehabilitation hospital.

Citation

Citation: Walravens A, Walravens E, Wuyts S, et al. Inhalation innovation: optimizing COPD care through clinical pharmacist integration in a rehabilitation hospital's multidisciplinary team – a quality improvement study. Chronic Obstr Pulm Dis. 2025; 12(3): 240-249. doi: http://dx.doi.org/10.15326/jcopdf.2024.0569

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Use of a Digital Inhaler to Assess COPD Disease Variability and Identify Impending Acute COPD Exacerbations: A Pilot Study

M. Bradley Drummond, MD, MHS1 Caleb C. Hemphill, MS1 Tanisha Hill, PhD, MPH2 Amanda Boe, PhD2 Daisy Yu, PhD2 Jill A. Ohar, MD3

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. Teva Branded Pharmaceutical Products Research and Development, Inc., Parsippany, New Jersey, United States
  3. Section of Pulmonary, Critical Care, Allergy, and Immunology, School of Medicine, Wake Forest University, Winston-Salem, North Carolina, 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

Rationale: Studies have shown that digital inhalers, using remote monitoring data, can improve medication adherence and clinical outcomes, such as prediction of impending asthma exacerbations. There is limited research on the clinical utility of physiologic inhalation parameters and inhaler medication use data captured by a digital inhaler to identify impending acute exacerbations of chronic obstructive pulmonary disease (AECOPDs).

Objectives: The objective was to determine variation in digital inhaler-measured physiologic and inhaler use metrics in ambulatory chronic obstructive pulmonary disease (COPD) patients in advance of an AECOPD.

Methods: This phase 4, open-label, 3-month pilot study was conducted at 2 U.S. centers. Participants used the ProAir Digihaler for primary rescue medication during the study. Participants were contacted monthly for COPD disease assessments. Inhaler metric variations leading up to an AECOPD were evaluated.

Results: The ProAir Digihaler measured key inhalation metrics (mean [standard deviation]) including peak inspiratory flow (PIF) (67.6 [20.3]L/min), inhalation volume (1.40 [0.60]L), and recorded inhaler use from 9649 inhalations among 40 participants. Statistically significant reductions were observed in inhalation volume (1.4L versus 1.1L), inhalation duration (1875msec versus 1492.1msec), and time to peak (500msec versus 376.3msec) (p<0.02 for all comparisons) during the 14 days preceding an AECOPD. There were no significant changes observed in PIF (67.2 versus 63.3, p=0.1) and number of inhalations per day (2.7 versus 3.7, p=0.2).

Conclusions: Physiologic data captured by a digital inhaler may serve as a valuable remote patient monitoring tool to help support the identification of early or impending AECOPDs among ambulatory COPD patients and monitor COPD disease variability.

Citation

Citation: Drummond MB, Hemphill CC, Hill T, Boe A, Yu D, Ohar JA. Use of a digital inhaler to assess COPD disease variability and identify impending acute COPD exacerbations: a pilot study. Chronic Obstr Pulm Dis. 2025; 12(3): 250-259. doi: http://dx.doi.org/10.15326/jcopdf.2024.0555

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