Chronic Obstructive Pulmonary Diseases:Journal of the COPD Foundation

Volume 10, Issue 3 - 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 Bronchiectasis on COPD Severity and Alpha-1 Antitrypsin Deficiency as a Risk Factor in Individuals with a Heavy Smoking History

Manuel Izquierdo, DO; Chad R. Marion, DO, PhD; Frank Genese, DO; John D. Newell, MD; Wanda K. O'Neal, PhD; Xingnan Li, PhD; Gregory A. Hawkins, PhD; Igor Barjaktarevic, MD, PhD; R. Graham Barr, MD, PhD; Stephanie Christenson, MD; Christopher B. Cooper, MD, PhD; David Couper, PhD; Jeffrey Curtis, MD; Meilan K. Han, MD, MS; Nadia N. Hansel, MD, MPH; Richard E. Kanner, MD; Fernando J. Martinez, MD, MS; Robert Paine, III, MD; Vickram Tejwani, MD; Prescott G. Woodruff, MD, MPH; Joe G. Zein, MD, PhD; Eric A. Hoffman, PhD; Stephen P. Peters, MD, PhD; Deborah A. Meyers, PhD; Eugene R. Bleecker, MD; Victor E. Ortega, MD, PhD for the SubPopulations and InteRmediate Outcome Measures In COPD Study (SPIROMICS) investigators.

Bronchiectasis is common among patients with a heavy smoking history, but whether or not it can contribute to COPD severity in these patients is unknown. In this study, we used high-resolution CT scans, and genetic testing in patients with a heavy smoking history to identify possible risk factors for bronchiectasis and to determine the impact of bronchiectasis on COPD severity.

We found that having bronchiectasis was associated with more severe COPD in terms of lower lung function, higher symptoms, impaired quality of life, and a higher percentage of emphysema identified on CT scans. This study also showed that a genetic variant known to cause the genetic form of COPD, alpha-1 antitrypsin deficiency, is found often in patients with bronchiectasis. This finding supports current guideline recommendations to test for alpha-1antitrypsin deficiency in patients with a significant smoking history who have bronchiectasis.

Impact of Coronavirus Disease 2019 on Hospital Admissions, Health Status, and Behavioral Changes of Patients with COPD

Eva Pappe, MD; Ralf Hammerich, MD; Jacopo Saccomanno, MD; Thomas Sgarbossa, MD; Anne Pohrt, PhD; Bernd Schmidt, MD; Christian Grah, MD; Stephan Eisenmann, MD; Angelique Holland, MD; Stephan Eggeling, MD; Franz Stanzel, MD; Martin Witzenrath, MD; Ralf-Harto Hübner, MD

Patients with chronic obstructive lung disease (COPD) have an increased risk of getting severe coronavirus disease 2019 (COVID-19) which is why self-isolation was recommended. However, long periods of social isolation accompanied by limited access to health care services may have negatively affected patients with severe COPD.

In our study, we analyzed information from COPD patients at Charité-Universitätsmedizin Berlin from pre-pandemic years (2012 to 2019) to during the pandemic years (2020 and 2021). Using questionnaires, we asked COPD patients about changes in their health and behavior during the COVID-19 lockdown.

We found that COPD patients had fewer hospital stays and received fewer ventilation therapies during the COVID-19 pandemic. However, COPD mortality was slightly higher during the pandemic. In addition, COPD patients also reported changes in their behavior and increased COPD symptoms, the longer the lockdown lasted.

Our study shows that in the future, there will be a need for an increased focus on care and disease control for COPD patients to avert long time, serious collateral damage caused by the COVID-19 pandemic.

Understanding the Patient Experience of Home-Based Pulmonary Rehabilitation With Health Coaching for COPD: A Qualitative Interview Study

William R. Midthun, BA; Maria V. Benzo, MD; Jennifer L. Ridgeway, PhD; Roberto P. Benzo, MD, MS

A previous study evaluated a 12-week home-based pulmonary rehabilitation in individuals living with chronic obstructive pulmonary disease (COPD). This home rehabilitation program involved having participants interact with a computer tablet, which collected information about daily steps and the completion of a physical activity routine. It also collected participants’ descriptions of their symptoms of well-being, breathlessness, and fatigue. Participants spoke with a health coach on a weekly basis about the program and any goals they wanted to achieve.

In this current study, we interviewed participants who completed the home rehab program to learn about their experiences during their participation. We discovered that the participants’ motivation to improve their quality of life, the positive effects of health coaching, and the ability to do pulmonary rehabilitation from their own homes resulted in improvements in mood and symptom management. This research is important to help find the best environment and conditions that will allow patients to participate in pulmonary rehabilitation.

Impact of Marijuana Smoking on COPD Progression in a Cohort of Middle-Aged and Older Persons

Igor Barjaktarevic, MD, PhD; Christopher B. Cooper, MD; Tracie Shing, DrPH; Russell G. Buhr, MD, PhD; Eric A. Hoffman, PhD; Prescott G. Woodruff, MD, MPH; M. Bradley Drummond, MD, MHS; Richard E. Kanner, MD; MeiLan K. Han, MD, MS; Nadia N. Hansel, MD; Russell P. Bowler, MD, PhD; Gregory L. Kinney, MPH, PhD; Sean Jacobson, MS; Madeline A. Morris, MPH; Fernando J. Martinez, MD, MS; Jill Ohar, MD; David Couper, PhD; Donald P. Tashkin, MD

Much information has identified tobacco smoking as the major cause of chronic obstructive pulmonary disease (COPD), including emphysema and chronic bronchitis. In contrast, how marijuana smoking affects lung health has not been well-studied, particularly in middle-aged and older persons, who may likely have COPD. The very few studies that have been published in this age group have produced conflicting results.

The aim of our study was to examine the impact of marijuana smoking on the worsening, or development of, COPD, in persons with a history of heavy tobacco smoking who either had already developed or were at risk of developing COPD. We reviewed findings from the 930 current and former tobacco smokers participating in the Subpopulations and Intermediate Outcomes in COPD Study (SPIROMICS) who also admitted they had a history of current or former marijuana smoking. Our findings showed that having a history of marijuana smoking, even heavy marijuana smoking had no additional effect on an individual’s risk of developing COPD or having current COPD become worse when compared with individuals who have never smoked marijuana.

Clinical Use of an Exposure, Symptom, and Spirometry Algorithm to Stratify Smokers into COPD Risk Phenotypes: A Case-Finding Study Combined with Smoking Cessation Counseling

Abraham Bohadana MD; Ariel Rokach MD; Pascal Wild, PhD; Ofir Kotek MD; Chen-Chen Shuali MD; Hava Azulai MD; Gabriel Izbicki MD

Chronic obstructive pulmonary disease (COPD) is usually diagnosed by using the lung function test, spirometry to detect airflow obstruction. However, this will only detect advanced disease for which there is no cure.

In this case-finding study, we used a detailed set of rules or instructions, called a clinical algorithm to determine the risk or chance that individuals in a group of current smokers already had COPD. Individuals’ smoking history, their symptoms, and the results of their spirometry lung function tests were used to determine if they had no COPD, possibly had COPD, or probably had COPD. In addition, we also provided these smokers with information about stopping smoking and evaluated how effective this counseling was and if offering it after individuals were told about their possible or probable COPD made it more effective.

We found that smoking cessation advice given after spirometry results were shared was well accepted and resulted in a smoking cessation rate of 7.7%. In addition, we were able to determine the risk of developing COPD for individuals in a large group of smokers.

The Experiences of Individuals with a History of Acute Exacerbations of COPD and Their Thoughts on Death: Empirical Qualitative Research

Yasemin Ceyhan, PhD, RN

This study was conducted to reveal the experiences of individuals with a history of having flare-ups or acute exacerbations of COPD and their thoughts on death. The study was conducted between July and September 2022.

Interviews were conducted with 15 patients who had a recent exacerbation or flare-up. The patients were asked to describe any thoughts about death that the exacerbation event may have caused.

From the answers and comments given during the interview, we concluded that: the patients were able to recognize the symptoms of an acute exacerbation of COPD, the severity of the symptoms increased during the exacerbation, patients felt regret or anxiety about having another exacerbation, and all of these factors contributed to their fear of death.

These results show that it is crucial for health care providers to better understand the patient who has an exacerbation, to offer more accurate treatment and care options, and to follow up with the patient before and after an exacerbation.

Changes in Lung Volumes with Spirometric Disease Progression in COPD

Mehrdad Arjomandi, MD; Siyang Zeng, MS; Jianhong Chen, MS; Surya P. Bhatt, MD; Fereidoun Abtin, MD; Igor Barjaktarevic, MD, PhD; R. Graham Barr, MD, PhD; Eugene R. Bleecker, MD; Russell G. Buhr, MD, PhD; Gerard J. Criner, MD; Alejandro P. Comellas, MD; David J. Couper, PhD; Jeffrey L. Curtis, MD; Mark T. Dransfield, MD; Spyridon Fortis, MD; MeiLan K. Han, MD, MS; Nadia N. Hansel, MD, MPH; Eric A. Hoffman, PhD; John E. Hokanson, MPH, PhD; Robert J. Kaner, MD; Richard E. Kanner, MD; Jerry A. Krishnan, MD, PhD; Wassim W. Labaki, MD, MS; David A. Lynch, MD; Victor E. Ortega, MD, PhD; Stephen P. Peters, MD, PhD; Prescott G. Woodruff, MD, MPH; Christopher B. Cooper, MD; Russell P. Bowler, MD, PhD; Robert Paine III, MD, PhD; Stephen I. Rennard, MD; Donald P. Tashkin, MD; and the COPDGene and SPIROMICS Investigators

The amount of air trapping (or lung volume) in patients with COPD varies a lot and does not correlate very well with the severity of the disease as measured by spirometry. It is also not clear how important this air trapping is in patients who do not have airflow obstruction on spirometry. To better understand this, we studied the distribution and importance of lung volumes in 3 large cohorts of patients.

We found that the amount of air trapping from all 3 cohorts showed similar patterns of distribution and changes over time with worsening airflow obstruction. Baseline lung volumes at the pre-COPD stage could predict different prognoses.

The findings have important implications for the discovery of biomarkers and therapies. Lung volume measurements should be more routinely incorporated in the assessment of the people at risk for COPD and those with early disease.

Associations of Smoking, Cytomegalovirus Serostatus, and Natural Killer Cell Phenotypes in Smokers With and At Risk for COPD

Robert M. Burkes, MD, MSCR; Elijah Bailey, BS; Timothy Hwalek, MD; Andrew Osterburg, PhD; Laura Lach, MS; Ralph Panos, MD; Stephen N. Waggoner, PhD; Michael T. Borchers, PhD

In this study, we investigated how the presence of cytomegalovirus, a persistent viral infection common in humans, is associated with the development of types of natural killer cells that can cause inflammation (pro-inflammatory), in smokers with and without COPD. We focused on this as natural killer cells are understudied in COPD, can be targeted with new and emerging treatments, and may play a key role in the inflammatory process in COPD.

We discovered that pro-inflammatory natural killer cell types are more common in individuals who have a persistent cytomegalovirus infection. We also discovered that individuals who smoke heavily and have reduced lung function have a larger amount of these natural killer cell types. This study lays the foundation for future studies about natural killer cell activity in COPD patients, the role of cytomegalovirus in the development of COPD, and how natural killer cells may be a target for future COPD therapies.

Structured Evaluation and Management of Patients with COPD in an Accredited Program

Mandeep Singh, MD; En Shuo Hsu, BA; Efstathia Polychronopoulou, PhD; Gulshan Sharma, MD; Alexander G. Duarte, MD

Patients with COPD have complex needs and providing usual care may not allow patients to receive care based on the latest guidelines. This may result in patients not receiving therapies that help them control their symptoms.

Chronic disease management programs that focus on a specific disease can improve patient satisfaction, adherence to treatment, disease management, and cost control. The Joint Commission on Accreditation of Healthcare Organizations developed a process to allow health care centers to apply for and receive a special accreditation for providing disease-specific care that is based on the latest, proven care guidelines.

In this study, we compared the patient care provided at Joint Commission COPD disease-specific clinics to the care provided at primary care clinics. We compared the number of emergency department visits and hospital stays of the COPD patients being cared for in each type of clinic—disease-specific versus primary care.

We found that individuals treated at disease-specific clinics were more likely to receive pulmonary function testing, needed vaccines, smoking cessation counseling, and lung cancer screening—steps that are all considered to be the best approach to providing COPD care. Patients treated in the disease-specific clinics had fewer emergency department visits and hospital stays compared to the individuals receiving care at the primary care clinics.

Augmentation Therapy Modulates Systemic Inflammation in Individuals with Alpha-1 Antitrypsin Deficiency and Chronic Obstructive Pulmonary Disease

Jorge E. Lascano, MD; Leonard Riley, MD; Nazli Khodayari, PhD; Mark L. Brantly, MD

Individuals with alpha-1 antitrypsin deficiency (AATD) have a low level of the protein alpha-1 antitrypsin circulating through their bodies. The only therapy available is replacing the protein through an intravenous (IV) injection, called augmentation therapy. Individuals with AATD are likely to develop COPD and when they do, they have a higher level of the circulating C-reactive protein which is a marker of inflammation in the body. Our study’s objective was to show the benefit of augmentation therapy on systemic or whole-body inflammation in individuals with AATD.

In our study, we show that augmentation therapy helps patients with AATD and COPD not only by maintaining stable lung function but also by decreasing their systemic inflammation. That effect is more pronounced on individuals with a lower lung function.

Inhaled Corticosteroids and Risk of Cardiovascular Disease in Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta- Regression

Krishna Gadhvi*; Minnah Kandeil*; Dinushan Raveendran*; Jeewoo Choi*; Nia Davies, BSc; Sukanya Nanchahal, BSc; Oliva Wing, BSc; Jennifer Quint, PhD, MSc; Hannah Whittaker, PhD, MSc
*joint first authors

Inhaled corticosteroids are used to reduce symptoms in people with chronic obstructive pulmonary disease (COPD) and are associated with improved lung function and reduced flare-ups or exacerbations of COPD. Studies have suggested that patients with COPD taking inhaled corticosteroids may be less likely to develop cardiovascular (heart) disease compared with those who do not take inhaled corticosteroids. However, prior to our review, an up-to-date review of the literature had not been conducted.

Through our systematic review of the literature, a link between inhaled corticosteroids and a reduced risk of cardiovascular problems in COPD patients was found. Specifically, this link was seen in studies with longer periods of patient follow-up, in studies that compared inhaled corticosteroids with placebos or short-acting bronchodilator drugs, and in studies that did not exclude patients with a history of cardiovascular disease.

Overall, the results of our review suggest that subgroups of patients with COPD may benefit from inhaled corticosteroid use more than others in terms of reducing their risk of developing cardiovascular/heart disease. This includes those individuals who have been on inhaled corticosteroids for long periods of time.

Decreased Cardiac Autonomic Function is Associated with Higher Exacerbation Risk and Symptom Burden in Chronic Obstructive Pulmonary Disease

Sarath Raju, MD, MPH; Han Woo, PhD; Ashraf Fawzy, MD, MPH; Nirupama Putcha, MD, MHS; Aparna Balasubramanian, MD, MHS; Stephen C. Mathai; Ronald D. Berger, MD, PhD; Nadia N. Hansel, MD, MPH; Meredith C. McCormack, MD, MHS

Current ways of determining chronic obstructive pulmonary disease (COPD) severity, including lung function, do not fully predict disease acute events such as COPD flare-ups or exacerbations. However, heart rate variability holds promise as a marker of COPD severity and risk for exacerbations. Heart rate variability occurs when the amount of time between heartbeats fluctuates very slightly, adding or subtracting a fraction of a second between beats. It is a marker of resilience and the heart’s ability to respond to and recover from stressors.

This study utilized data from a clinical trial of 85 former smokers with COPD. The trial collected participants’ measurements of heart rate variability and information about the participants’ COPD symptoms, severity, quality of life, and exacerbations.

The study results demonstrated that impaired heart rate variability was associated with a greater risk for severe exacerbations requiring hospital care. Impaired heart rate variability was also associated with worse respiratory quality of life and greater risk for symptoms of chronic bronchitis. These results suggest that heart rate variability may be an important biomarker (a biologic sign or signal of an abnormal process or condition) of COPD-related health.