Chronic Obstructive Pulmonary Diseases:Journal of the COPD Foundation

Volume 11, Issue 1 - 2024 | 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.

Safety and Reactogenicity of Coronavirus Disease 2019 Vaccination in Severe Alpha-1 Antitrypsin Deficiency

Oliver J. McElvaney, MD, PhD; Brian Cleary, MD; Daniel D. Fraughen, MD; Geraldine Kelly, MBA; Oisin F. McElvaney, MD, PhD; Mark P. Murphy, PhD; Peter Branagan, MD; Cedric Gunaratnam, MD; Tomás P. Carroll, PhD; Christopher H. Goss, MD, MSc; Noel G. McElvaney, MD

Although the COVID-19 vaccination is recommended for patients with severe alpha-1 antitrypsin deficiency (AATD), there is limited information regarding vaccine safety in this population. In our study, we investigated the side effects associated with 2 COVID-19 vaccines: the initial adenoviral vector ChAdOx1 nCoV-19 (AstraZeneca) COVID vaccine series, as well as the monovalent and bivalent BNT162b2 (Pfizer/BioNTech) mRNA-based booster vaccines. We also examined the safety of giving a COVID-19 booster vaccine and the flu vaccine on the same day and whether this was tolerable or bearable for patients.

We found that individuals with severe AATD did not have an increased number of adverse events or side effects compared to persons with non-AATD COPD and/or patients without lung disease. Most adverse events or side effects experienced across all 3 groups were mild and improved or disappeared without treatment. Within the AATD group, young females were at the highest risk for adverse events or side effects. However, having emphysema or significant liver disease did not increase the risk of adverse events or side effects. Receiving the COVID-19 mRNA booster and the annual flu vaccine on the same day also did not result in increased adverse events compared to receiving the vaccines one week apart. These results provide reassurance regarding the use of these vaccines, and other similar vaccines, in patients with AATD moving forward.

Feasibility Trial of a Comprehensive, Highly Patient-Centered COPD Self-Management Support Program

Alex D. Federman, MD, MPH; Rachel O’Conor, PhD; Jeannys Nnemnbeng, MD, RRT; Jyoti Ankam, MBBS, MPH; Danielle McDermott, MS, CSCS; Peter K. Lindenauer, MD, MSc; Michael S. Wolf, PhD, MPH; Juan P. Wisnivesky, MD, DrPH

People with chronic obstructive pulmonary disease (COPD) must manage a variety of self-care tasks to achieve the best control of their illness, yet they face many obstacles to mastering or even regularly completing self-care tasks.

We developed the Supporting self-Management Behaviors in older Adults (SAMBA)-COPD program to help patients better manage their COPD. SAMBA-COPD involves community health workers screening patients for and addressing barriers to self-care, guiding patients through home-based pulmonary rehabilitation, and connecting them with a pharmacist to learn when and how to use antibiotics and steroids for COPD exacerbations. We conducted a clinical trial to test the feasibility of SAMBA-COPD. We compared it with another, standard COPD education control program. Most patients completed the activities provided through the study and 92% of patients reported that the program was very or extremely helpful. Individuals who completed the SAMBA program in the study had better scores on their COPD Assessment Test, and longer 6-minute walk test distances, and did better at consistently taking their medications. Our study suggests the SAMBA-COPD intervention is feasible though more testing is needed.

Lung Structure and Risk of Sleep Apnea in SPIROMICS

Abigail L. Koch, MD; Tracie L. Shing, DrPH; Andrew Namen, MD; David Couper, PhD; Benjamin Smith, MD, MSc; R. Graham Barr, MD, PhD; Surya Bhatt, MD, MSPH; Nirupama Putcha, MD, MHS; Aaron Baugh, MD; Amit K. Saha, PhD, MS; Michelle Zeidler, MD; Alejandro Comellas, MD; Christopher B. Cooper, MD; Igor Barjaktarevic, MD, PhD8 Russell P. Bowler, MD, PhD; MeiLan K. Han, MD, MS; Victor Kim, MD; Robert Paine, III, MD; Richard E. Kanner, MD; Jerry A. Krishnan, MD, PhD; Fernando J. Martinez, MD, MS; Prescott G. Woodruff, MD, MPH; Nadia N. Hansel, MD; Eric A. Hoffman, PhD; Stephen P. Peters, MD, PhD; Victor E. Ortega, MD, PhD; for the SubPopulations and InteRmediate Outcome Measures in COPD Study (SPIROMICS) Investigators

SPIROMICS is a large study looking at current and former smokers and chronic obstructive pulmonary disease (COPD) and conducted at several locations in the United States. People with COPD may also have sleep apnea and the combination can be linked to worse quality of life and an increased need to seek medical care. We know that severity of this lung disease is associated with abnormal lung function and measurements on a computed tomography (CT) scan, but we did not know if lung function or CT scan measurements are associated with the risk of having sleep apnea.

We used 2 sleep apnea risk questionnaires, the Berlin Sleep Questionnaire, and the DOISNORE50. These 2 questionnaires were used to determine if either is linked to changes in lung function and CT scan measurements since each has different criteria to identify individuals at high risk of having sleep apnea. We found that among the people with decreased lung function and abnormal CT scan measurements, there was an increased likelihood of being at high risk for sleep apnea on both questionnaires with minor variations between the two.

These results can be used to begin an earlier formal sleep study in those at risk which will allow for the sleep apnea to be treated before the patient experiences a decline in quality of life or an increase in doctor visits.

Inhaler Formulary Change in COPD and the Association with Exacerbations, Health Care Utilization, and Costs

Kevin I. Duan, MD, MS; Lucas M. Donovan, MD, MS; Laura J. Spece, MD, MS; Edwin S. Wong, PhD; Laura C. Feemster, MD, MS; Alexander D. Bryant, MD, MS; Robert Plumley; Kristina Crothers, MD; David H. Au, MD, MS

Drug formularies are the lists of medications managed by health systems and insurance companies that affect what inhalers are available to patients with COPD. Sometimes, the inhalers on a formulary can change, and patients need to switch inhalers for nonmedical reasons. Previously, there was limited research on whether formulary changes that resulted in inhaler switches could affect COPD disease control.

In our study, we analyzed records from the U.S. Department of Veterans Affairs (VA) to see what occurred to patient outcomes or results after an inhaler was removed from the VA formulary. We found that the removal of formoterol (a long-acting inhaler used in COPD) from the VA formulary was not associated with worsening COPD control, more health care appointments, or higher health care costs.

Food Insecurity is Associated With COPD Morbidity and Perceived Stress

Daniel C. Belz, MD, MPH; Han Woo, PhD; Mariah K. Jackson, RD; Nirupama Putcha, MD, MHS; Ashraf Fawzy, MD, MPH; Wendy Lorizio, MD, MPH; Meredith C. McCormack, MD, MHS; Michelle N. Eakin, PhD, MA; Corrine K. Hanson, PhD, RD; Nadia N. Hansel, MD, MPH

Socioeconomic status is a person or group’s standing in society based on their education, where they live, their occupation, their financial situation, and their access to resources. Studies have shown that socioeconomic status can have a significant effect on health. This can be because people have a hard time affording medications or attending appointments, but we still do not understand all the ways that socioeconomic status affects health. One way socioeconomic status could impact health is through food insecurity – the lack of consistent access to enough food. The goal of this study was to understand how food insecurity may influence the health of individuals with chronic obstructive pulmonary disease (COPD).

We used questionnaires to ask about participants’ lack of access to food during the study. We also used questionnaires to understand these individuals’ respiratory symptoms, quality of life, psychological stress, and COPD flares or exacerbations. We found that when people are experiencing food insecurity, they also have worse COPD symptoms. This was true even when we considered other measures of socioeconomic status such as education level and household income. This study suggests that addressing food insecurity could improve the health of individuals with COPD. A future study will provide healthy food to patients with COPD to see if this improves their symptoms.

COPD and Smoking Status – It Does Matter: Characteristics and Prognosis of COPD According to Smoking Status

Anne O. Nielsen, MD, PhD; Peter Lange, MD; Ole Hilberg, MD; Ingeborg Farver-Vestergaard, MSc; Rikke Ibsen, MSc; Anders Løkke, DrMed, MD

It is well known that tobacco smoking is the main risk factor for developing chronic obstructive lung disease (COPD). However, patients with no smoking history can develop COPD as well. In this study, we have evaluated differences in symptoms, risk of hospitalization, and risk of death from COPD among current smokers, former smokers, and never smokers diagnosed with COPD.

We found that current smokers have more severe disease in terms of breathlessness and cough compared to both former smokers and never smokers. Furthermore, current smokers with COPD have a higher risk of being hospitalized for their COPD and death compared to never smokers with COPD. These findings highlight the need for campaigns to prevent smoking and may help primary care physicians as well as other health care professionals to motivate patients with COPD to stop smoking.

Relationship Between Tobacco Product Use and Health-Related Quality of Life Among Individuals With COPD in Waves 1–5 (2013–2019) of the Population Assessment of Tobacco and Health Study

Laura M. Paulin, MD, MHS; Michael J. Halenar, MPH; Kathryn C. Edwards, PhD; Kristin Lauten, MA; Kristie Taylor, PhD; Mary Brunette, MD; Susanne Tanski, MD, MPH; Todd MacKenzie, PhD; Cassandra A. Stanton, PhD; Dorothy Hatsukami, PhD; Andrew Hyland, PhD; Martin C. Mahoney, MD, PhD; Ray Niaura, PhD; Dennis Trinidad, PhD, MPH; Carlos Blanco, MD, PhD; Wilson Compton, MD, MPE; Lisa D. Gardner, PhD, MS; Heather L. Kimmel, PhD; K. Michael Cummings, PhD, MPH; Dana Lauterstein, PhD; Esther J. Roh, PhD, MS; Daniela Marshall, PhD; James D. Sargent, MD

Cigarette smoking is the most common cause of COPD in the United States. Once COPD develops, continued exposure to cigarette smoke is associated with worse outcomes or results. Less is known about the impact of noncigarette tobacco product use, including e-cigarettes, in individuals with COPD.

We examined the association between tobacco product use and health-related quality of life as measured by the PROMIS Global-10 questionnaire. We did this in adults 40 years old and older who participated in the COPD in the Population Assessment of Tobacco and Health (PATH) Study. Among 1670 adults with COPD, using both e-cigarettes and cigarettes in the past 30 days was associated with worse health-related quality of life compared to either adults who only smoked cigarettes or individuals who had stopped smoking cigarettes for 5 years or longer. Never smoking and stopping smoking for 5 years or longer were the only categories associated with a higher health-related quality of life when compared to exclusive cigarette smoking.

This study supports the known harms of continued cigarette smoking among individuals with existing COPD and supports the known benefits of stopping smoking (smoking cessation). Future studies that examine the impact of a longer period of exclusive e-cigarette use and using both e-cigarettes and cigarette smoking would be helpful in further understanding how these products impact quality of life.

The Long-Term Impact of Frailty After an Intensive Care Unit Admission Due to Chronic Obstructive Pulmonary Disease

Matthew T. Donnan, BSc, MBBS; Shailesh Bihari, MBBS, FCICM, MD, PhD; Ashwin Subramaniam, MBBS, MMED, FRACP, FCICM, PhD; Eli J. Dabscheck, MBBS, MclinEpi, FRACP; Brooke Riley, BBioMedSc, MBBS, FCICM; David V. Pilcher, MBBS, MRCP

Frailty or physical weakness is common, especially in older individuals, and affects physical and cognitive (reasoning, thinking) health. People with frailty are vulnerable and less able to cope with illness. Frailty is now recognized as an important aspect of COPD, but the impact it has on the after-effects of a COPD exacerbation or “flare-up” is less well understood.

In our study, we analyzed long-term information from patients in Australia and New Zealand who were admitted to an intensive care unit with an exacerbation of COPD. Our findings showed that frailty was very common (54.1%), that patients with frailty were twice as likely to die within 1 year following an exacerbation of COPD, and that by 4 years, only 23.7% of patients with frailty had survived. This study will help doctors and COPD patients and their families when discussing a likely prognosis and may help in decision-making regarding appropriate treatments.

Improving Referral Patterns for Bronchoscopic Lung Volume Reduction: A Quality Improvement Initiative

Christopher Di Felice, MD; Zachary B. Strumpf, MD; Elizabeth A. Edmiston, PhD, RN, CCRN; Christian F. Cuvillier Padilla, MD; Leah C. Ellis-Jones, RN; Joanne L. McKell, MD; Mohammad A. Shatat, MD; Sherrie D. Williams, MD; Anna M. May, MD, MS

Bronchoscopic lung volume reduction is a minimally invasive procedure for patients with severe emphysema who remain breathless despite the best medical therapy. Multiple studies have shown that bronchoscopic lung volume reduction results in improvements in lung function, exercise endurance, and quality of life. While this procedure is widely available in the United States, there is limited information available about how to improve awareness and referrals for it.

This quality improvement study sought to improve the process of getting this procedure recommended for patients who qualify for it at a Veterans Affairs medical center. The initiative included education for health care providers and comments in the lung function testing report of those patients who may be eligible for the procedure. This strategy resulted in a significant increase in the number of patients referred for BLVR evaluation, many of whom were eligible for the procedure. The findings of this study support the creation of a process—specific to each hospital/institution—that assists physicians in identifying patients eligible for bronchoscopic lung volume reduction.

Associations Between Coronary Artery Calcium Score and Exacerbation Risk in BLOCK-COPD

R. Chad Wade, MD; Sharon X. Ling, PhD; Erika S. Helgeson, PhD; Helen Voelker, MS; Wassim W. Labaki, MD, MS; Daniel Meza, MD; Oisin O’Corragain, MD; Jennifer Y. So, MD; Gerard J. Criner, MD8 MeiLan K. Han, MD, MS; Ravi Kalhan, MD; Robert M. Reed, MD; Mark T. Dransfield, MD; J. Michael Wells, MD, MSPH

In 2019, the previously published Beta-Blockers for the Prevention of Acute Exacerbations of Chronic Obstructive Pulmonary Disease (BLOCK-COPD) study evaluated whether a medicine typically used in heart disease could be used in COPD treatment. That study failed to show that the medication provided a benefit for COPD patients and resulted in some concern for harm in the group receiving the study medication (metoprolol). The reasons for the 2019 finding were unclear. Our current study evaluates whether plaques in the arteries supplying the heart, identified by computed tomography (CT) scan, could explain some of the findings seen in the BLOCK-COPD trial.

Our study measured plaques in each of the 4 major arteries of the heart using a CT scan and evaluated if having more plaque put patients at greater risk for flares of their COPD. We also investigated whether patients with plaque in the arteries who were treated with metoprolol had a different response than those treated with the placebo.

We found that plaque, in one of the arteries supplying a specific region of the heart, was correlated with a higher risk of flares in COPD. We did not find any links between plaque in the coronary arteries and COPD control in patients treated with metoprolol.

Any Decrease in Lung Function is Associated with Worse Clinical Outcomes: Post Hoc Analysis of the IMPACT Interventional Trial

MeiLan K. Han, MD; Gerard J. Criner, MD; David M.G. Halpin, MD; Edward M. Kerwin, MD; Lee Tombs, MSc; David A. Lipson, MD; Fernando J. Martinez, MD; Robert A. Wise, MD; Dave Singh, MD

A key measure to track chronic obstructive pulmonary disease (COPD) worsening is how fast patients can blow air out of their lungs. The amount of air blown out in 1 second (forced expiratory volume in 1 second [FEV1]) helps doctors to understand how well the lung is functioning. A decrease in FEV1 (meaning worse lung function) is linked with poorer outcomes or results for patients.

We used data from the Informing the Pathway of COPD Treatment (IMPACT) clinical trial to study the connection between changes in FEV1 and outcomes for patients 1 year after receiving the drugs fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI), FF/VI, or UMEC/VI. The monitored outcomes included worsening of symptoms (exacerbations) that required additional treatment, a hospital visit, or resulted in death, and quality of life measures.

We showed that patients who had any decrease in lung function throughout the study (regardless of the extent of change) had more exacerbations and less improvements in their quality of life than patients who had no decrease in lung function. Importantly, patients taking FF/UMEC/VI were at a much lower risk of a decrease in lung function than those taking FF/VI or UMEC/VI. Together these data show that FF/UMEC/VI may help prevent lung function decline and improve patient outcomes.

Integrating Artificial Intelligence in the Diagnosis of COPD Globally: A Way Forward

Nicole M. Robertson, MD, MPH; Connor S. Centner, PhD; Trishul Siddharthan, MD

Artificial intelligence (AI) technology could potentially improve the detection and outcomes of lung diseases such as chronic obstructive pulmonary disease (COPD) worldwide by improving early diagnosis, watching for worsening disease, and starting treatment.

In our perspective/opinion article, we discuss how AI technology can help with diagnosing and monitoring COPD. This can be done by including AI reviews of medical imaging (X-rays, CT scans), patient histories, blood work, and lung function tests in a doctor’s evaluation of patients. This may be useful across the globe including in countries with less medical resources.

Pulmonary Rehabilitation for Chronic Obstructive Pulmonary Disease Patients With Underlying Alpha-1 Antitrypsin Deficiency: A Systematic Review and Practical Recommendations

Fawaz A. Alwadani, MSc; Kyrie Wheeler, BMBS, MSc; Harriet Pittaway, MBBS; Alice M. Turner, MBChB, PhD

Alpha-1 antitrypsin deficiency (AATD) is a genetic condition that can lead to lung problems like COPD earlier in life. Those with this genetic condition often discover they have COPD at a younger age, and their COPD may be different than that of individuals with usual COPD.

We conducted research to determine if the well-known benefits of an exercise program called pulmonary rehabilitation for usual COPD patients are also seen in those with AATD. Also, we aimed to gather all available information and results related to exercise interventions specifically for the AATD patient group.

We found that AATD patients benefit from pulmonary rehabilitation, improving their exercise capacity and well-being. However, their muscles may respond differently to exercise than other usual COPD patients. More research is needed, to understand how best to guide and support AATD patients, especially since they often learn of their lung issues earlier in life.