|
Jenny E. Ozga, PhD1 James D. Sargent, MD2 Alexander W. Steinberg, MD3 Zhiqun Tang, PhD1 Cassandra A. Stanton, PhD1 Laura M. Paulin, MD, MHS3
Author Affiliations
- Behavioral Health and Health Policy, Westat, Rockville, Maryland, United States
- Departments of Pediatrics and Biomedical Data Sciences, Geisel School of Medicine, Hanover, New Hampshire, United States
- Section of Pulmonary and Critical Care, Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, United States
Address correspondence to:
Laura M. Paulin, MD, MHS
Dartmouth-Hitchcock Medical Center
Section of Pulmonary and Critical Care
One Medical Center Drive Suite 5C
Lebanon, NH 03756
Phone: (603) 650-5533
Email: Laura.M.Paulin@Hitchcock.org
Abstract
Introduction: A recent study found that the prevalence of chronic obstructive pulmonary disease (COPD) is significantly higher among adults who began smoking cigarettes before (versus after) 15 years of age, independent of current smoking, cigarette pack years, and smoking duration. The current analysis went a step further to also account for secondhand smoke exposure, using data from U.S. adults aged 40+ years during Wave 5 (2018–2019) of the Population Assessment of Tobacco and Health Study.
Methods: Adults who had ever smoked cigarettes were asked at what age they began smoking fairly regularly. Multivariable Poisson regression assessed the risk of self-reported COPD diagnosis due to childhood smoking (<15 years), adjusting for current smoking, cigarette pack years or smoking duration, secondhand smoke exposure, and sociodemographic covariates.
Results: Overall, 13.4% reported that they had COPD. COPD prevalence was 7.5% for adults who never smoked compared to 29.0% and 21.1% for smoking onset at age <15 and 15+ years, respectively. Adults who initiated smoking at <15 (versus 15+) years had a higher prevalence of current smoking (45.9% versus 33.3%), longer smoking duration (mean 34.2 versus 27.3 years), greater cigarette pack years (mean 48.8 versus 30.8), and greater secondhand smoke exposure (p’s<0.05). In multivariable analysis, the relative risk for COPD for smoking onset <15 (versus 15+) years of age was 1.27 (95% confidence interval=1.06, 1.51).
Conclusions: The increased risk of COPD due to childhood smoking was independent of cigarette pack years, smoking duration, secondhand smoke exposure, and current smoking. The findings give further evidence of increased COPD risk related to childhood smoking.
Citation
Citation: Ozga JE, Sargent JD, Steinberg AW, Tang Z, Stanton CA, Paulin LM. Childhood cigarette smoking and risk of COPD in older U.S. adults: a nationally representative replication study. Chronic Obstr Pulm Dis. 2024; 11(6): 549-557. doi: http://dx.doi.org/10.15326/jcopdf.2024.0514
|
Robert K. Teresi, BA1 Ashley C. Hendricks, BS1 Neema Moraveji, PhD1 Richard K. Murray, MD1 Michael Polsky, MD2 Diego J. Maselli, MD3
Author Affiliations
- Research Department, Spire Health, San Francisco, California, United States
- Pulmonary Associates of Richmond, Richmond, Virginia, United States
- Division of Pulmonary Diseases and Critical Care Medicine,Department of Medicine, University of Texas Health, San Antonio, Texas, United States
Address correspondence to:
Neema Moraveji, PhD
Spire Health
San Francisco, California
Phone: (415) 533-2385
Email: neema@spirehealth.com
Abstract
Background: Continuous respiratory monitoring can support integrated care for chronic obstructive pulmonary disease (COPD) patients, by coupling them with remote clinical personnel who triage patients in coordination with their health care providers. When deploying such services, there remains uncertainty surrounding outcomes when at-risk patients are proactively identified and escalated for provider evaluation. This study presents findings from a service deployed in a real-world COPD cohort by analyzing the clinical interventions made during in-person and telehealth pulmonary outpatient visits following remote escalations.
Methods: A single-center, retrospective, observational study of real-world COPD patients at a multisite pulmonary practice was conducted. Patients who were enrolled in a continuous respiratory monitoring service for at least one year and were seen by a provider within 7 days of an escalation by the service (N=168) were included. To evaluate the potential impact of these escalations on provider and patient burden, medical charts from outpatient visits were manually reviewed and grouped into 6 categories based on the clinical action(s) taken by the provider.
Results: A total of 245 outpatient visits occurred from 168 patients within 7 days of escalation. Of the 245 visits, 206 (84.1%) resulted in clinical intervention and 163 (66.5%) resulted in treatment consistent with acute exacerbations of COPD. A total of 1.6% of the outpatient visits resulted in referral to the emergency department.
Conclusions: Provider encounters occurring following the escalation of a patient from a continuous respiratory monitoring service consistently resulted in that provider administering a treatment to the escalated patient.
Citation
Citation: Teresi RK, Hendricks AC, Moraveji N, Murray RK, Polsky M, Maselli DJ. Clinical interventions following escalations from a continuous respiratory monitoring service in patients with chronic obstructive pulmonary disease. Chronic Obstr Pulm Dis. 2024; 11(6): 558-568. doi: http://dx.doi.org/10.15326/jcopdf.2023.0475
|
Sarah N. Miller, PhD, RN1 Martina Mueller, PhD1 Michelle Nichols, PhD, RN1 Ronald J. Teufel, II, MD2 Diana M. Layne, PhD, RN1 Charlie Strange, MD2 Mohan Madisetti, MSc1 MaryChris Pittman, BA1 Teresa J. Kelechi, PhD, RN1 Paul W. Davenport, PhD3
Author Affiliations
- College of Nursing, Medical University of South Carolina, Charleston, South Carolina, United States
- College of Medicine, Medical University of South Carolina, Charleston, South Carolina, United States
- Department of Physiological Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida, United States
Address correspondence to:
Sarah N. Miller, PhD, RN
College of Nursing
Medical University of South Carolina
99 Jonathan Lucas St.
Charleston, SC 29425
Email: millesar@musc.edu
Abstract
Background: Chronic obstructive pulmonary disease (COPD) is a progressive respiratory disease associated with respiratory muscle weakness and activity-limiting symptoms such as dyspnea. Respiratory muscle strength training (RMST) is an empirically validated therapy to increase respiratory muscle strength. The theoretically-informed, technology-enhanced RESPiratory FITness (RESP-FIT) intervention for COPD is a 6-week combined inspiratory and expiratory muscle strength training program with symptom measurement in real time via ecological momentary assessment (EMA).
Objectives: In addition to hypothesis-generating purposes, the purpose of this randomized control pilot study was to explore whether observed effects (on symptoms, patient-reported outcomes, and respiratory muscle strength) support carrying out a future large-scale trial of RESP-FIT.
Methods: A total of 30 adults with COPD were randomized to intervention (n=15) or control groups, with the intervention group undergoing 6 weeks of mHealth-enhanced RMST. Daily symptom data were collected in real time over the 6-week intervention period using EMA.
Results: Compared to the control group, participants in the intervention group reported decreased dyspnea and anxiety, increased happiness, and improved respiratory muscle strength. However, reports of fatigue and sleep disturbance increased in the intervention group compared to the control group.
Conclusion: Results support the hypothesis that the 6-week RESP-FIT program will improve respiratory muscle strength, emotional state (anxiety and happiness), and breathlessness in COPD but may contribute to fatigue, at least in the short term. Future work is needed to determine the efficacy of RESP-FIT, determine mechanisms of action on dyspnea and fatigue, and conduct within-participant comparisons of EMA data to explore individual or environmental fluctuations in COPD symptoms.
Citation
Citation: Miller SN, Mueller M, Nichols M, et al. RESP-FIT: a technology-enhanced combined inspiratory and expiratory muscle strength training intervention for adults with COPD. Chronic Obstr Pulm Dis. 2024; 11(6): 569-581. doi: http://dx.doi.org/10.15326/jcopdf.2024.0523
|
Andrew A. Wilson, MD1 Celia Bora, DNP2 Catherine Silva, MD2 Julie L. White, MS, CHCP1 Natalie Sanfratello, MPH, CHCP1 Jaime Symowicz, PhD3 Cristen Querey, MS3 Donna Gabriel, PhD, MS3
Author Affiliations
- Chobanian & Avedisian School of Medicine, Boston University, Boston, Massachusetts, United States
- East Boston Neighborhood Health Center, Boston, Massachusetts, United States
- Med-IQ, Baltimore, Maryland, United States
Address correspondence to:
Andrew A. Wilson, MD
670 Albany St, 2nd Floor, CReM
Boston, MA 02118
Phone: (617) 358-0736
Email: awilson@bu.edu
Abstract
Rationale: Evidence-based guidelines recommend screening all individuals with chronic obstructive pulmonary disease (COPD) for the genetic disorder alpha-1 antitrypsin deficiency (AATD). However, it is estimated that only 5% of people with COPD have been tested for AATD, and a large fraction of the estimated 70,000 to 100,000 Americans with AATD have not yet been diagnosed. Low familiarity with AATD and limited knowledge about diagnostic tests and available treatments contribute to suboptimal screening rates.
Objectives: Our objective was to address barriers to and improve rates of guideline-based AATD diagnostic testing among racially and ethnically diverse patients with COPD at a large community health center.
Methods: A quality improvement initiative consisting of educational sessions and electronic health record (EHR) system interventions was implemented to improve the adoption of guideline-based screening for AATD in patients with COPD.
Results: An analysis of EHR data demonstrated that among patients with a COPD diagnosis (n=1030), 22.2% (n=229) were screened for AATD in the 12 months following the start of the quality improvement initiative compared with 1.3% (n=13) of patients with a COPD diagnosis (n=972) seen in the 12 months prior to the start of the quality improvement initiative (P<0.001).
Conclusions: A quality improvement initiative consisting of educational sessions and EHR system modifications was successful in increasing clinicians’ knowledge and diagnostic screening rates for AATD in patients with COPD at a large community health center.
Citation
Citation: Wilson AA, Bora C, Silva C, et al. A multimodal intervention to improve guideline-based screening for alpha-1 antitrypsin deficiency in a community health setting. Chronic Obstr Pulm Dis. 2024; 11(6): 582-590. doi: http://dx.doi.org/10.15326/jcopdf.2024.0540
|
Alejandra Hernández Alberola, MD1 Natalia Bartolomé Nogal, MSc1 Almudena Blanco Miranda, PhD1 David A. Lipson, MD2,3 Lee Tombs, MSc4 MeiLan K. Han, MD5
Author Affiliations
- GSK, Madrid, Spain
- Respiratory Immunology Research Unit, GSK, Collegeville, Pennsylvania, United States
- Pulmonary, Allergy, and Critical Care Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
- Precise Approach Ltd, London, United Kingdom
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan, United States
Address correspondence to:
MeiLan K. Han, MD
Division of Pulmonary and Critical Care Medicine
University of Michigan
1500 E. Medical Center Drive
Ann Arbor, Michigan, 48109
Phone: (734) 615-9772
Email: mrking@umich.edu
Abstract
Introduction: Lung physiology and chronic obstructive pulmonary disease (COPD) pathophysiology differ between sexes. This post hoc analysis investigated the InforMing the Pathway of COPD Treatment (IMPACT) trial outcomes by patient sex.
Methods: IMPACT was a double-blind, 52-week trial. Patients ≥40 years with symptomatic COPD and a history of exacerbations were randomized 2:2:1 to fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) 100/62.5/25μg, FF/VI 100/25μg, or UMEC/VI 62.5/25μg. Annual rate and risk of moderate/severe exacerbations, change from baseline in trough forced expiratory volume in 1 second (FEV1) and St George's Respiratory Questionnaire (SGRQ) score, and safety were assessed.
Results: Of 10,355 patients, 66.3% were male. More females reported ≥2 moderate/severe prior exacerbations (58% versus 53%) at screening versus males. Additionally, females had worse mean (standard deviation) SGRQ scores (52.4[15.97] versus 49.8[17.24]) at baseline. FF/UMEC/VI improved annual exacerbation rate, lung function, and health status for both sexes versus dual therapy. The difference in trough FEV1 across time points with FF/UMEC/VI versus FF/VI was 103mL–110mL in males and 70mL–84mL in females. On-treatment moderate/severe exacerbation rates remained higher for females (FF/UMEC/VI: 0.99; FF/VI: 1.19; UMEC/VI: 1.35) than males (0.87; 1.01; 1.14). Fewer exacerbations were experienced by females with eosinophil counts <150 cells/µL (0.81[0.68, 0.97], p=0.024) or <2 exacerbations in the past year (0.73[0.57, 0.94], p=0.013) with FF/UMEC/VI versus UMEC/VI.
Conclusions: More females with COPD reported exacerbations in the prior year at screening, as well as during the study, versus males, across all treatments. FF/UMEC/VI improved exacerbation rates versus UMEC/VI in females with eosinophil counts <150 cells/µL or <2 exacerbations in the prior year, suggesting inhaled corticosteroids may play an important role in exacerbation reduction for females in this patient population.
Clinical Trial Registration: GSK (CTT116855/NCT021645B)
Citation
Citation: Alberola AH, Nogal NB, Miranda AB, Lipson DA, Tombs L, Han MK. The effect of patient sex on treatment outcomes in COPD: a post hoc analysis of the IMPACT trial. Chronic Obstr Pulm Dis. 2024; 11(6): 591-603. doi: http://dx.doi.org/10.15326/jcopdf.2024.0541
|
Cara L. McDermott, PharmD, PhD1,2 Laura C. Feemster, MD, MS3,4 Ruth A. Engelberg, PhD3 Laura J. Spece, MD, MS3,4 Lucas M. Donovan, MD, MS3,4 J. Randall Curtis, MD, MPH3†
Author Affiliations
- Division of Geriatrics and Palliative Care, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, United States
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, United States
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, Washington, United States
- Health Systems Research, Department of Veterans Affairs Puget Sound Health Care System, Seattle, Washington, United States
†deceased
Address correspondence to:
Cara L. McDermott, PharmD, PhD
Box 3003, DUMC
Division of Geriatrics and Palliative Care
Durham, NC 27710
Phone: (919) 660-8386
Email: cara.mcdermott@duke.edu
Abstract
Background: Falls are frequent among people with chronic obstructive pulmonary disease (COPD) and are associated with increased morbidity, mortality, and health care costs. Understanding modifiable medication factors that contribute to fall risk is an important step to developing fall prevention strategies for this highly susceptible group.
Methods: This is a retrospective cohort study using electronic health record data from a single health system linked to Washington State death certificates of adults ages 40 or older who died between 2014–2018 with COPD. We identified demographics, comorbidities, fall-risk increasing drug (FRID) burden, and the occurrence of injurious falls within the 2 years prior to the date of death. We defined injurious falls using published algorithms of the International Classification of Diseases codes.
Results: Of 8204 decedents with COPD, 2454 (30%) had an injurious fall in the 2 years before death, and FRID use was common among 65%. A higher percentage of patients with falls received prescriptions for anticonvulsants (35% versus 26%), antipsychotics (24% versus 13%), atypical antidepressants (28% versus 19%), and tricyclic antidepressants (10% versus 5%) versus those without a fall. In multivariable logistic regression, after adjusting for confounders, FRID burden was associated with greater odds of an injurious fall (odds ratio 1.07 [95% confidence interval 1.04–1.09]).
Conclusion: Our findings highlight an opportunity for collaboration between pharmacists, pulmonologists, and patients to develop new processes to potentially deprescribe and optimize the use of FRIDs among patients with COPD to increase safety.
Citation
Citation: McDermott CL, Feemster LC, Engelberg RA, Spece LJ, Donovan LM, Curtis JR. Fall risk and medication use near end of life among adults with chronic obstructive pulmonary disease. Chronic Obstr Pulm Dis. 2024; 11(6): 604-610. doi: http://dx.doi.org/10.15326/jcopdf.2024.0551
|
Huan Li, MS1 John Huston, MD1 Jana Zielonka, MD1 Shannon Kay, MD, MS1 Maor Sauler, MD1 Jose Gomez, MD, MS1,2
Author Affiliations
- Pulmonary, Critical Care and Sleep Medicine Section, Yale University, New Haven, Connecticut, United States
- Center for Precision Pulmonary Medicine, Yale University, New Haven, Connecticut, United States
Address correspondence to:
Jose Gomez, MD
Yale University
300 Cedar Street (S419 TAC)
New Haven, CT 06520-8057
Phone: (203) 785-4163
Email: jose.gomez-villalobos@yale.edu
Abstract
Rationale: Acute exacerbations of chronic obstructive pulmonary disease (AECOPDs) are heterogeneous. Machine learning (ML) has previously been used to dissect some of the heterogeneity in COPD. The widespread adoption of electronic health records (EHRs) has led to the rapid accumulation of large amounts of patient data as part of routine clinical care. However, it is unclear whether the implementation of ML in EHR-derived data has the potential to identify subgroups of AECOPD.
Objectives: To determine whether ML implementation using EHR data from severe AECOPDs requiring hospitalization identifies relevant subgroups.
Methods: This study used 2 retrospective cohorts of patients with AECOPDs (non-COVID-19 and COVID-19) treated at Yale-New Haven Hospital. K-means clustering was used to identify patient subgroups.
Measurements and Main Results: We identified 3 subgroups in the non-COVID cohort (n=1736). Each subgroup had distinct clinical characteristics. The reference subgroup was the largest (n=904), followed by cardio-renal (n=548) and eosinophilic (n=284). The eosinophilic subgroup had milder severity of AECOPD, including a shorter hospital stay (p<0.01). The cardio-renal subgroup had the highest mortality during (5%) and in the year after hospitalization (30%). Validation of the severe AECOPD classifier in the COVID-19 cohort recapitulated the characteristics seen in the non-COVID cohort. AECOPD subgroups in the COVID-19 cohort had different interleukin (IL)-1 beta, IL-2R, and IL-8 levels (false discovery rate ≤ 0.05). These specific leukocyte and cytokine profiles resulted in inflammatory differences between the AECOPD subgroups based on C-reactive protein levels.
Conclusions: Incorporating ML with EHR data allows the identification of specific clinical and biological subgroups for severe AECOPD.
Citation
Citation: Li H, Huston J, Zielonka J, Kay S, Sauler M, Gomez J. Identification of severe acute exacerbations of chronic obstructive pulmonary disease subgroups by machine learning implementation in electronic health records. Chronic Obstr Pulm Dis. 2024; 11(6): 611-623. doi: http://dx.doi.org/10.15326/jcopdf.2024.0556
|
|