Chronic Obstructive Pulmonary Diseases:Journal of the COPD Foundation

Volume 10, Issue 4 - 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 and Vaccination Attitudes on Alpha-1 Antitrypsin Deficiency

Margaret A. Hay, MD; Kristen E. Holm, PhD; Jean McCathern; Robert A. Sandhaus, MD, PhD; Charlie Strange, MD

The coronavirus disease 2019 (COVID-19) pandemic was a unique challenge for individuals with alpha-1 antitrypsin deficiency associated with chronic obstructive pulmonary disease (COPD). Not only were they at higher risk for severe illness, but it also impacted their ability to receive regular augmentation therapy—the only approved therapy for alpha-1 antitrypsin deficiency.

In this study, we followed members of AlphaNet (a disease management program) on their journey through the pandemic with monthly surveys from March 2020 to February 2022. We tracked COVID-19 infections and how severe they were, interruptions in receiving augmentation therapy, and individuals’ attitudes toward COVID-19 vaccination.

We learned that while the rate of acquiring COVID-19 was lower than the general U.S. population, AlphaNet members did have higher hospitalization and intensive care unit admission rates. Most AlphaNet members intended to and did receive the COVID-19 vaccine. Those unvaccinated were more likely to be hospitalized or admitted to the intensive care unit. Many of those initially expressing a low likelihood of getting vaccinated, changed their minds over time, highlighting how vaccine hesitancy changes based on perceived risk. Interruptions in augmentation therapy were most commonly due to concerns it might increase the risk of acquiring COVID-19, but supply chain issues became a larger reason later in the pandemic. These results highlight the importance of vaccination and strategies to reduce future vaccine hesitancy.

Clinical Practices Surrounding the Prescription of Home Oxygen in Patients With COPD and Desaturation

Sandra E. Zaeh, MD, MS; Meredith Case, MD, MBE; David H. Au, MD, MS; Michele DaSilva, MSEd, RRT, RRT-NPS; Karen Deitemeyer; Julie DeLisa, MA; Laura C. Feemster, MD, MS; Lynn B. Gerald, PhD; Jerry A. Krishnan, MD, PhD; Jennifer Sculley, MDes; Annette Woodruff, BS; Michelle N. Eakin, PhD

Chronic obstructive pulmonary disease (COPD) affects more than 16 million Americans and is a leading cause of death. Patients with COPD who have severely low oxygen saturations (the amount of oxygen circulating in the blood) at rest are frequently prescribed oxygen therapy as it can help these individuals live longer. Oxygen therapy is also often prescribed for patients who only have low oxygen saturations with exertion or exercise despite the benefits for these patients being less clear. Recently published research showed no benefit in clinical outcomes with oxygen use for this group of patients.

Through our research, we performed interviews with clinicians to better understand how they decide to prescribe home oxygen for patients with COPD. Through analysis of our data, we found that the factors that influence a clinician’s decision to prescribe oxygen include assessment of research evidence, past clinical experience, and patient preferences regarding the use of oxygen. Most clinicians described having a shared decision-making conversation with patients regarding the decision to use home oxygen and included a variety of information in the conversation. We suggest that the creation of a shared decision-making tool might help facilitate discussions between clinicians and patients about home oxygen use.

Deep Learning Integration of Chest Computed Tomography Imaging and Gene Expression Identifies Novel Aspects of COPD

Junxiang Chen, PhD; Zhonghui Xu, MS; Li Sun, MS; Ke Yu, MS; Craig P. Hersh, MD, MPH; Adel Boueiz, MD, MS; John E. Hokanson, MPH, PhD; Frank C. Sciurba, MD; Edwin K. Silverman MD, PhD; Peter J. Castaldi, MD, MS; Kayhan Batmanghelich, PhD

Chronic obstructive pulmonary disease, or COPD, is a common illness that affects the lungs, causing breathing problems, inflammation, and lung damage. However, we do not know exactly how changes in the lungs are related to this inflammation, so we set out to investigate this. We analyzed lung scans and blood samples from 1,223 people. We used deep learning to find patterns and links between the lung scans and inflammation signals in the blood. (Deep learning is a type of computer learning that works with many layers of artificial neural networks or algorithms modeled to work like the human brain—to learn from large amounts of data.) From this, we found 2 main patterns that we call image-expression axes (IEAs). The first pattern, called IEAemph, is linked to the condition called emphysema, where the air sacs in the lungs get damaged and enlarged. This pattern was also associated with lower lung function and lower body weight. The second pattern, called IEAairway, relates to changes in the airways, the tubes that air travels through in the lungs. This pattern was linked to higher body weight and thicker airway walls.

Our research shows that there are 2 distinct processes happening in COPD—one relating to emphysema, and the other to changes in the airways. This could help us to develop more targeted treatments for different types of COPD in the future.

Disparities in Guideline-Concordant Statin Treatment in Individuals With Chronic Obstructive Pulmonary Disease

Jamuna K. Krishnan, MD, MBA, MS; Sonal G. Mallya, MD; Musarrat Nahid, MSc; Aaron D. Baugh, MD; MeiLan K. Han, MD, MS; Kerri I. Aronson, MD, MS; Parag Goyal MD, MS; Laura C. Pinheiro, MPH, PhD; Samprit Banerjee, PhD; Fernando J. Martinez, MD, MS; Monika M. Safford, MD

Cardiovascular disease is a leading cause of death for people with COPD. People with COPD are at high risk of negative health consequences related to cardiovascular disease. Black women with COPD have a significantly higher risk of dying from cardiovascular disease compared to White women. Some therapies or medicines can help prevent cardiovascular disease or lower the risk of dying from it. However, the differences in receiving these therapies, between groups of individuals, remain unknown. Identifying differences in who receives preventative therapies and how they receive them is the first step toward developing interventions to address this issue.

A medicine called statins is a recommended treatment to prevent cardiovascular disease. In this study, we sought to determine whether there were differences by race and sex in the receipt of statin treatment (according to guideline recommendations) in a patient population with COPD. Our results found that women, especially Black women, are less likely to be treated with statins compared to White men. These differences persist even when accounting for factors that could influence the ability to receive these preventative therapies. Factors such as education level or where individuals live. These findings suggest that an intervention that includes the entire health care system is needed to improve cardiovascular disease prevention among patients with COPD to address health equity or fairness in preventative care.

Chymotrypsin-like Elastase-1 Mediates Progressive Emphysema in Alpha-1 Antitrypsin Deficiency

Andrew J. Devine, BS; Noah J. Smith, BS; Rashika Joshi, MD; Qiang Fan, PhD; Michael T. Borchers, PhD; Geremy C. Clair, PhD; Joshua N. Adkins, PhD; Brian M. Varisco, MD

The lungs exchange oxygen and carbon dioxide between the atmosphere and the body via small sac-like structures called alveoli. Emphysema occurs when the walls between these structures are destroyed. This impairs the exchange of oxygen and carbon dioxide in the lungs. Usually, emphysema occurs in people who have smoked for many years, but some people have a defect in a gene that produces an important protein called alpha-1 antitrypsin. This mutation affects their ability to adequately produce the alpha-1 protein and puts them at risk of developing earlier onset, more severe emphysema.

We previously demonstrated that the mutated gene interacts with a protein called chymotrypsin-like elastase 1. In this study, we used mouse models of emphysema to show that chymotrypsin-like elastase 1 is important in the progressive destruction of alveolar walls and that the lungs of mice without the chymotrypsin-like elastase 1 gene have more of the protein present in those alveolar walls. This study may suggest that in addition to replacing the missing alpha-1 antitrypsin protein in patients with the genetic mutation, there might be an added benefit of inhibiting chymotrypsin-like elastase 1 in these patients.

Augmentation Therapy for Alpha-1 Antitrypsin Deficiency: Patient Experiences With Self-Infusion, Home Providers, and Clinics

Charlie Strange, MD; Sheri Allison; Jean McCathern; Robert A. Sandhaus, MD, PhD; Kristen E. Holm, PhD, MPH

Currently approved therapies for alpha-1 antitrypsin deficiency are given by an intravenous (IV) infusion of purified protein, usually weekly. Although the infusions are generally well tolerated, some individuals use nursing services at infusion centers or in their homes to obtain IV access, mix and infuse the drug, ensure the process is sterile, and be on standby for side effects. Others have chosen to self-infuse—give themselves the infusion—without the use of paid nursing services.

This report is a United States survey of individuals in the AlphaNet disease management program receiving intravenous augmentation therapy. Among the 5,266 individuals surveyed, 60.2% reported receiving infusions in the home from a health care provider, 30.6% received infusions at clinics, and 8.1% reported self-infusing. Self-infusion prevalence increased with time on therapy and was more prevalent in younger individuals. Among those individuals who responded as self-infusing, 41.2% completed it by using permanent intravenous catheters and 58.3% reported using peripheral intravenous catheters. Among individuals currently infusing with home nurses or in clinics, 21.4% said they would consider self-infusions in the future. Self-infusion of alpha-1 antitrypsin is feasible and associated with high satisfaction scores. These survey results will be useful when recommendations for catheter care, infusion support, and cost management are considered and updated.

The Current Landscape of COPD-Related Clinical Trials Registered on the World Health Organization’s International Clinical Trials Registry Platform: A Comprehensive Analysis of Study Characteristics and Publication Status

Meimei Xu, PhD; Jiajia Wang, PhD; Lianhui Shan, MS; Xinying An, PhD

During this research, we examined clinical trials related to chronic obstructive pulmonary disease (COPD) to understand if and when the trials’ results were published, and what factors influenced the trial being published in a medical journal.

We found 2577 completed trials focusing on COPD. Interestingly, only 27.9% of these trials were published within 2 years of completion, indicating a low publication rate. We also found that trials with larger sample sizes, blind designs (meaning the participants did not know if they were receiving the actual treatment being studied or just a placebo), and certain study phases were more likely to be published. Additionally, factors like the intervention model (the plan for how participants in the trial would receive the trial’s drug or therapy), the primary purpose, the study phase of the trial, the funding source, and the study duration influenced the time it took for trials to be published.

This research was essential because it sheds light on the publication status of COPD trials and the factors that affect their publication. By understanding these findings, researchers and stakeholders can work together to improve the design and reporting of COPD trials, leading to better treatment options and management for people with COPD in the future.

Circulating Exosomes and Ambient Air Pollution Exposure in COPD

Narjes Soleimanifar, PhD; Sara Assadiasl, MD, PhD; Effat Kalateh, MD; Mohammad Sadegh Hassanvand, PhD; Maryam Sadr, MS; Hanieh Mojtahedi, MS; Kazem Nadafi, PhD; Mohammad Hossein Nicknam, MD, PhD; Maryam Edalatifard, MD

Chronic obstructive pulmonary disease (COPD) is a lung disease caused by smoking and exposure to pollutants. Exosomes are small particles released by lung cells when they are stressed or damaged. These particles contain various substances that affect their function. In lung diseases, the elevated level of exosomes in the blood is suggestive of ongoing lung inflammation and injury.

This study aimed to understand the relationship between serum exosomes, exposure to pollutants, and markers of inflammation in COPD patients and healthy individuals. The participants' exposure to air pollutants was monitored at daily, weekly, and monthly intervals. The results showed that COPD patients had more exosomes in their blood compared to healthy people. Furthermore, serum exosome levels were significantly associated with exposure to air pollutants. Of note, there was no significant correlation between exosome levels and measures of inflammation in the blood. This suggests that exosomes may play a role in COPD development through mechanisms unrelated to inflammation.

Randomized Controlled Trials on Chronic Obstructive Pulmonary Disease in Africa: A Systematic Review

Eric Sven Kroeber, MD; Thomas Frese, MD; Eva Johanna Kantelhardt, MD; Benjarong Nanuppakrankijkun, MD; Etienne Ngeh Ngeh, PhD; Anne Schrimpf, PhD; Mulugeta Tamire, PhD, MPH; Susanne Unverzagt, PhD

Chronic obstructive pulmonary disease (COPD) is a lung disease that makes it hard to breathe. It is becoming a bigger problem in African countries due to factors like population aging, lifestyle changes, and environmental issues.

This review aimed to gather evidence on COPD interventions studied in Africa. We searched databases and registries, including African ones, through January 2022 for eligible studies. We aimed to describe the benefits of COPD interventions on the number and severity of respiratory episodes and improvements in physical abilities. Furthermore, we summarized unwanted events that cause harm to the patients.

This review summarizes results from 18 relevant studies involving 1504 patients from Egypt, South Africa, and Tunisia. Eight studies focused on stable COPD patients in outpatient settings. Ten studied patients with severe, sudden onset exacerbations and treatment in emergency or intensive care. All studies reported the benefits and harms of ventilatory support, medications, and rehabilitation. Treatment effects varied across the studies highlighting the need for further research in COPD management in Africa. The studies took place in countries with comparably good infrastructure. Although there is limited evidence for COPD management, research activities in this area have been on the rise in recent years.

Home Telemonitoring Program in Individuals With COPD During the Coronavirus Disease 2019 Pandemic: A Pilot Study

Michael Rydberg, MD; Pete Burkett, BBM; Erica Johnson, PhD; M. Bradley Drummond, MD, MHS

The coronavirus disease 2019 (COVID-19) pandemic accelerated the need for telemedicine resources for many patients. Little is known about the ease, usefulness, and impact of using remote patient monitoring tools with individuals with chronic obstructive pulmonary disease (COPD).

In this pilot study, we provided 12 COPD patients with a novel in-home telemonitoring system consisting of a home spirometer, a Bluetooth®-enabled home pulse oximeter, and a computer-tablet-based system with avatar-assisted technology for collecting information (An avatar is an electronic image of a human assistant). Participants were asked to complete daily assessments. The goal of the study was to determine if and how often patients used the 3 devices over 12 weeks. We also measured whether using the devices would change patients’ COPD Assessment Test (CAT) questionnaire scores. We found that 50% of participants used all the devices as planned more than 50% of the time. A total of 57% of participants had a ≥2-point improvement in their CAT score at the end of the 12 weeks. Nearly three-quarters of participants reported that using the spirometer made them feel secure. The same proportion reported that the tablet was useful in managing their COPD symptoms.

This study shows that a telehealth plan that uses several different types of interaction is feasible for use with COPD patients and may be associated with improvements in COPD symptoms.

Improving Dyspnea by Targeting Weight Loss in Patients With Chronic Obstructive Lung Disease and Severe Obesity Through Health Coaching and Remote Monitoring

Maria V. Benzo, MD; Amelia Barwise, PhD; Matthew M. Clark, PhD; Kara Dupuy-McCauley, MD; Madison Roy, MS; Roberto P. Benzo, MD, MS

Breathlessness is the most common symptom of chronic obstructive lung disease. Patients with this condition and severe obesity have more breathlessness, worse quality of life, more frequent exacerbations (or flare-ups of the disease), and more health care visits than nonobese individuals. Weight loss may reduce an individual’s feelings of breathlessness.

This study consisted of a 12-week program that included using the Weight Watchers program to log food eaten, taking routine weight measurements with a Bluetooth scale, and counting daily steps through a fitness tracker. The program also included weekly health coaching to discuss progress and to create goals for a lifestyle change.

We found that individuals with severe obesity and chronic obstructive lung disease who completed this program had significant improvements in breathlessness and weight loss. Patients voiced enthusiasm for the program, particularly the health coaching that increased their motivation and accountability, and for the friendliness of the technology used. Patients recommended a longer program to support a sustained change, closer follow-up support from the health care providers after the program, and more individualized education on nutrition, emotional management, and exercise plans. Overall, this program may represent a feasible and possibly effective approach to reducing breathlessness in patients with severe obesity and chronic obstructive lung disease.