Chronic Obstructive Pulmonary Diseases:Journal of the COPD Foundation

Volume 10, Issue 2 - 2023 | Plain Language Summaries

Short summaries, in non-technical, simple language of articles published in the most recent issue of Chronic Obstructive Pulmonary Diseases: Journal of the COPD Foundation are provided here. Links to the full, published research article are provided with each summary. The Journal is indexed by PubMed, PubMed Central, Scopus and Web of Science.

All summaries for the current issue are listed below in the order of publication, scroll down.

Impact of Coronavirus Disease 2019-Related Infection Prevention and Control Measures on the Occurrence of COPD Exacerbations During Inpatient Pulmonary Rehabilitation

Kiki Waeijen-Smit, MSc; Sarah Houben-Wilke, PhD; Rein Posthuma, MD; Fenne de Jong, BSc; Daisy J. A. Janssen, PhD, MD; Nicole P. H. van Loon, MD; Bita Hajian, PhD, MD; Sami O. Simons, PhD, MD; Martijn A. Spruit, PhD; Frits M. E. Franssen, PhD, MD


During the coronavirus disease 2019 (COVID-19) pandemic, a global reduction in hospitalizations for exacerbations of COPD was observed. It is unknown whether this reduction was driven by patients avoiding health care services or rather by COVID-19-related infection prevention and control measures. The current study explored the number of exacerbations of patients with COPD who were admitted for 8 weeks of inpatient pulmonary rehabilitation during the COVID-19 pandemic (2020–2021) and also during previous years (2017–2020). This was done to attempt to rule out health care avoidance as a reason for the reduced number of exacerbations.

A total of 501 patients with COPD were analyzed. During the COVID-19 pandemic, a non-significant 25.4% reduction in exacerbations was observed as compared to pre-pandemic years. These findings suggest that avoidance of health care may be an important factor in the observed reduction of exacerbations during the pandemic.

Quality of Life and Mortality Outcomes for Augmentation Naïve and Augmented Patients with Severe Alpha-1 Antitrypsin Deficiency

Paul R. Ellis, MBChB, PhD; Kristen E. Holm, PhD, MPH; Radmila Choate, PhD, MPH; David M. Mannino, MD; Robert A. Stockley, MD, DSc; Robert A. Sandhaus, MD; Alice M. Turner, MBChB, PhD


Alpha-1 antitrypsin deficiency (AATD) is a genetic condition that causes individuals to have a low level of the alpha-1 antitrypsin (AAT) protein in their blood which leads to the development of early-onset lung damage. Augmentation therapy involves getting regular injections of AAT to restore the blood levels of AAT. This treatment is widely available in the United States and parts of Europe but not yet in the United Kingdom. Though augmentation therapy has been shown to slow the rate of progression of lung damage, it has not been proven that it improves quality of life or prolongs the life of patients with AATD. This is difficult to establish with randomized control trials as AATD is rare and AATD-related lung disease progresses slowly.

This study compared differences in quality of life and survival between 2 large AATD groups: one receiving augmentation therapy and one receiving usual COPD care. The results showed some improvement in the rate of decline of quality of life in patients receiving augmentation therapy. However, differences in data collection methods and health care systems between the groups meant that a definitive conclusion could not be made. The length of survival in both groups was similar.

Development of a Communication Instrument to Address Sexuality in COPD: COSY

Claudia Steurer-Stey, MD; Kaba Dalla Lana, BSc; Alexandra Strassmann, PhD, MAS, MS; Stefanie Gonin-Spahni, DrPhil; Michelle Borgmann, MSc; Ursina Brun del Re, DrPhil; Sebastian Haas, MD; Eliane Sarasin, MD; Andrea Burri, PhD; Anja Frei, DrPhil; Milo A. Puhan, MD, PhD


COPD can have an impact on intimacy and sexual health. The symptoms of shortness of breath, fatigue, decreased physical performance, and associated anxiety can reduce interest in or the ability to engage in sexual activity.

Our research shows that intimacy and sexuality, as aspects of holistic well-being, are not discussed with people affected by COPD. Misconceptions exist including that sexual fulfillment is not an important issue for elderly sick people. However, we found that 1 out of 2 individuals with COPD wanted to talk about sexual issues, but they don't start these conversations because they don't know how. The same was reported by caregivers.

We developed "the COSY-door opener" that can help health care professionals communicate and counsel about sexual issues. For people with COPD, we created an information booklet using pictures of the range of intimacy along with 6 helpful tips. The booklet supports communication with care providers and partners and provides encouragement on how intimacy and sexual activity can be enjoyed by individuals with COPD.

Airway and Systemic Prostaglandin E2 Association with COPD Symptoms and Macrophage Phenotype

Vickram Tejwani, MD; Andres F. Villabona-Rueda, MD; Pratik Khare, MS; Cissy Zhang, BS; Anne Le, MD; Nirupama Putcha, MD, MHS; Franco D’Alessio, MD; Neil E. Alexis, PhD; Nadia N. Hansel, MD, MPH; Ashraf Fawzy, MD, MPH


The overall goal of this study is to understand the role a protein called prostaglandin E2 (PGE2) has in the severity of COPD and if it affects a cell called a macrophage. We measured the amount of the PGE2 protein in the airways and the whole body of individuals with COPD. We also determined the type of macrophages found in the airways of these individuals.

Several questionnaires were used to determine these individuals’ respiratory symptoms, health status, quality of life, and COPD flares or exacerbations. This information was used to determine the severity of COPD in individuals. We found that individuals with COPD and higher levels of PGE2 in their airways had worse respiratory symptoms and health status and were more likely to have a flare. However, there was no link between these COPD outcomes and the level of PGE2 in the whole body.

This study suggests that individuals with COPD with uncontrolled symptoms have higher levels of the protein PGE2 in their airways but not their whole body. Further research is needed to better understand this relationship since it remains unclear whether higher PGE2 levels are causing or just responding to increased airway inflammation. This may help identify future treatments for COPD.

Physical Activity, Air Pollution Exposure, and Lung Function Interactions Among Adults with COPD

Kelly Chen, MS; Mostafa Aglan, MD; Alexandra Purcell; Lina Nurhussien, MPH; Petros Koutrakis, PhD; Brent A. Coull, PhD; Andrew Synn, MD; Mary B. Rice, MD, MPH


In previous studies involving a group of 30 adult former smokers with COPD, higher exposure to nitrogen dioxide (NO2) pollution was associated with poorer lung function. This current study evaluated if daily physical activity, measured in terms of step count, reduced or intensified the effects of air pollution on the groups’ lung function.

We found that physical activity was associated with a small increase in daily personal exposure to ozone and fine particulate matter, but not to NO2. Given the health benefits of physical activity in COPD, our study suggests that COPD patients should not give up routine physical activity in order to avoid pollution exposure that is at a typical daily exposure level (i.e., levels within current acceptable Environmental Protection Agency [EPA] standards).

Factors Associated with Attrition in a Longitudinal Cohort of Older Adults in the Community

Noah Katsuno, BA; Pei Z. Li, PhD; Jean Bourbeau, MD; Shawn Aaron, MD; Francois Maltais, MD; Paul Hernandez, MD; Kenneth R. Chapman, MD; Brandie Walker, MD; Darcy D. Marciniuk, MD; Denis D. ODonnell, MD; Don D. Sin, MD; James C. Hogg, MD; Michael Cheng, MBBS; Jeremy Road, MD; Wan C. Tan, MD on behalf of the CanCOLD Collaborative Research Group


In this study, 1561 men and women, ages 40 years and older from the general population, were followed for 9 years. Participants were seen in person every 18 months and with follow-up every 3 months over the phone or by email. We tracked the number of participants who remained in the study and those who did not and noted the reasons for their leaving.

Over 80% of the individuals remained during the study with 77% in the last year, a high rate in comparison with previous studies. We found that individuals who had fewer years of education, who smoked cigarettes heavily, who had doctor-diagnosed heart disease, hypertension, or stroke, and who had higher levels of anxiety and depression were the most likely not to remain in the study.

Since good scientific studies are those in which the majority of participants remain in the study, the results of this study are important for raising awareness of the factors that result in individuals quitting a study. These results can also help develop strategies, for individuals with unique life circumstances, on how to cope with the demands of the study and remain in it.

The Association Between Systemic Arterial Hypertension and Chronic Obstructive Pulmonary Disease. Results from the U.S. National Health and Nutrition Examination Survey 1999-2018: A Cross-sectional Study

Xiaopeng Liang, MD; Oscar Hou In Chou, MSc; Bernard MY Cheung, PhD


Systemic arterial hypertension, or high blood pressure, is a common additional illness or comorbidity for individuals with COPD. This study used data from the nationwide U.S. National Health and Nutrition Examination Survey (1999-2018). We examined the association between hypertension (high blood pressure) and COPD.

A total of 46,804 eligible non-pregnant participants aged ≥ 20 years were included in this study. Our results demonstrated a significant association between hypertension and COPD, especially among adults aged less than 60 years and current heavy smokers.

Notably, our study did not restrict the sample to severe COPD patients or men but examined the general population. These findings suggest the need to manage both hypertension and COPD to help reduce the burden of this comorbidity.