Chronic Obstructive Pulmonary Diseases:Journal of the COPD Foundation

Volume 11, Issue 3 - 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.

The COPD Foundation on Its Twentieth Anniversary

Elisha Malanga, BS; Byron Thomashow, MD; Jean Wright, MD; Linda Walsh, BS; Cathy Gray Carlomagno, BS; Jamie Sullivan, MPH; Stephanie Williams, RRT; Bruce E. Miller, PhD; Crystal Rothhaar, BS; William Clark, BS; Alan Hamilton, PhD; Michael Hess, MPH; Delia Prieto Oliver, MSEd; Vincent Malanga, BS; Peter Amari, BS; James Crapo, MD; David M. Mannino, MD

In 2024, the COPD Foundation (COPDF), a 501(c)(3) nonprofit organization, is celebrating 20 years of existence. Founded in 2004 by John W. Walsh, a patient advocate, along with global COPD opinion leaders, the COPDF has a mission to help millions of people live longer and healthier lives by advancing research, advocacy, and awareness to stop COPD, bronchiectasis, and nontuberculous mycobacterial (NTM) lung disease.

Embracing innovation, the COPDF aims to engage, educate, and empower the community through a unique approach that includes patients, caregivers, health care professionals, researchers, academic institutions, government agencies, patient advocacy groups, and industry leaders. This perspective article highlights the COPDF’s efforts over the past 20 years and outlines past, present, and future strategies to improve the lives of patients.

COPD: Iron Deficiency and Clinical Characteristics in Patients With and Without Chronic Respiratory Failure

Ingrid Marie Hardang, MD; Vidar Søyseth, MD, PhD; Natalia Kononova, MD; Tor-Arne Hagve, MD, PhD; Gunnar Einvik, MD, PhD

Iron deficiency—not having enough iron in your body—can make symptoms of chronic obstructive pulmonary disease (COPD) worse and possibly influence the risk of death. As there is no agreement on which definitions to use to diagnose iron deficiency in patients with COPD, it is important to compare several commonly used definitions.

In our study, 84 participants with COPD and 59 without COPD, had blood samples taken to test for iron deficiency. We looked at how the frequency of iron deficiency varied according to several blood test−based definitions of iron deficiency and whether certain symptoms were related to these definitions. At the end of the study (on average more than 4 years after the first testing), the number of deaths among participants was registered, and statistical analyses were performed to determine whether there was an association between iron deficiency and mortality or risk of death.

Even though the frequency of iron deficiency varied according to the different definitions, it was lowest in participants without COPD and highest in participants with the most severe respiratory failure. No association between iron deficiency and mortality in participants with COPD was found.

Persons With Chronic Obstructive Pulmonary Disease and High Levels of Activation Improved Their Physical Activity Skills After an Educational Session

María C. Fernández-Sánchez, MD; Francisco J. Ruiz-López,MD, PhD; José A. Ros-Lucas, MD, PhD; Rubén Andújar-Espinosa, MD, PhD; Juan Del Coso, PhD; Teresa García-Pastor, PhD

Daily physical activity is essential for chronic obstructive pulmonary disease (COPD) patients and is part of their self-management. However, rehabilitation programs, along with educational sessions, are not always enough to encourage these skills in some patients.

We designed a study to evaluate the physical activity level of patients after they attended an educational session aimed at reducing inactive or sedentary behavior. Prior to the session, we determined patients´ activation or motivation/ involvement levels using a Patient Activation Measure-13 questionnaire. The most activated patient would be one who is involved in self-management, works closely with health care professionals, and shows interest in maintaining their health. To measure patients' physical activity, we provided them with a motion sensor a week before and after the educational session.

We discovered that the most activated patients were those who had greater activity after the educational session. This response was not affected by the severity of their illness or

mood. Therefore, despite the limitations in our study, it appears that if a patient with COPD is highly activated, they are responsive to an educational session on physical activity. In this way, we can select which patients to bring to these sessions and which ones require a different approach to improve their physical activity.

Recombinant Alpha-1 Antitrypsin–Fc Fusion Protein INBRX-101 in Adults With Alpha-1 Antitrypsin Deficiency: A Phase 1 Study

Mark L. Brantly, MD; Brooks T. Kuhn, MD, MAS; Humam W. Farah, MD; Ravi Mahadeva, MD, FRCP; Alexandra Cole; Catherina L. Chang; Cynthia D. Brown, MD; Michael A. Campos, MD;Jorge E. Lascano, MD; Erin K. Babcock, BS; Sharvari P. Bhagwat, PhD; Teresa F. Boyea, PharmD; Carson A. Veldstra, BS; Vasily Andrianov, MD; James L. Kalabus, PhD; Brendan P. Eckelman, PhD; Andrew G. Veale, FRACP

Alpha-1 antitrypsin (AAT) is a protein that helps protect the lungs from inflammation and damage. Inherited AAT deficiency (AATD) results in lower AAT blood levels that may lead to lung damage. The only approved therapy for AATD lung disease comes from human plasma (pdAAT). AATD individuals receive intravenous or IV infusions of pdAAT to increase their AAT levels. However, as pdAAT is short-lived, patients must be treated every week, adding to their burden. Additionally, their AAT levels are still much lower than levels in people without AATD. Research suggests that higher levels of AAT in the blood are more beneficial.

In this study, 31 adults with AATD received IV infusions of INBRX-101, a version of AAT made in the laboratory, every 3 weeks. INBRX-101 is expected to stay in the blood longer than pdAAT. This study looked at how safe INBRX-101 is for people with AATD.

Treatment with INBRX-101 was well tolerated. For the entire 3 weeks after receiving INBRX-101, blood levels of active AAT stayed within the range seen in people without AATD. Additionally, INBRX-101 was found in the lungs, showing that it can reach the site where AAT activity is especially needed. Based on these results, a larger trial comparing INBRX-101 with pdAAT is underway.

Higher Plasma Omega-3 Levels are Associated with Improved Exacerbation Risk and Respiratory-Specific Quality of Life in COPD

Tyus A. Kemper, BS; Han Woo, PhD; Daniel Belz, MD, MPH; Ashraf Fawzy, MD, MPH; Wendy Lorizio, MD, MPH; Michelle N. Eakin, PhD, MA; Nirupama Putcha, MD, MHS; Meredith C. McCormack, MD, MHS; Emily P. Brigham, MD, MHS; Corrine Hanson, PhD; Abigail L. Koch, MD; Nadia N. Hansel, MD, MPH

Chronic obstructive pulmonary disease (COPD) makes it difficult for individuals to breathe and is caused by smoking or exposure to harmful airborne pollutants. In our prospective cohort study, we explored how omega-3 fatty acids may influence the health of former smokers with COPD.

We aimed to see if there was a link between the amount of omega-3 in a patient’s blood and the severity of their COPD. We found that people with higher levels of omega-3 in their blood seemed to have better lung health, even after controlling for many related risk factors, such as an individual’s socioeconomic status (a person’s standing in society based on their education, where they live, their occupation, their financial situation, and their access to resources) and comorbidity (having additional health concerns or diseases). Specifically, they experienced fewer flare-ups of their condition and reported a better quality of life related to their lung health.

This finding is significant because it suggests that what we eat, specifically including foods rich in omega-3 like some fish, may support improvement in the health of people with COPD. Our research adds to the growing evidence that diet plays a crucial role in managing lung health, particularly for those with conditions like COPD. It opens up the possibility that, in the future, dietary changes could become a part of how we manage COPD, alongside medication and other treatments.

Increased Herpes Zoster Risk With Inhaled Corticosteroid Use for Those With Chronic Obstructive Pulmonary Disease

Barbara P. Yawn, MD, MSc; Elisabeth Callen, PhD, PStat; Gabriela Gaona-Villarreal, MPH; Asif Shaikh, MD, DrPH, MPH; Wilson D. Pace, MD

Shingles or herpes zoster is a painful rash that occurs primarily in older adults with a higher risk for individuals with chronic diseases like COPD and individuals taking certain medications like steroids.

We looked at the risk of shingles among individuals with COPD who had been using inhaled corticosteriods for less than 3 months and compared this to the risk of shingles among individuals using inhaled corticosteroids for 2 years or longer.

We found that longer inhaled corticosteroid use increased the risk of shingles 2.5 times and that about 100 people with COPD would need to be treated with longer-term inhaled corticosteroids to have one additional case of shingles over 4 years.

Inhaled corticosteroids should be used in people with frequent or severe COPD exacerbations or lung flare-ups. An effective vaccine (recommended by the Centers for Disease Control and Prevention) is available to help prevent shingles. For those without exacerbations, the vaccine is also recommended but it may also be possible to limit inhaled corticosteroid use.

Sexual Orientation Health Disparities in Chronic Respiratory Disorders

Kevin P. Ferriter, MD; Mike C. Parent, PhD, MBA; Maggie Britton, PhD

Smoking is a leading cause of chronic respiratory disorders, and smoking is high among sexual minority (i.e., lesbian, gay, and bisexual) individuals. We aimed to better understand the link between smoking, which often starts in adolescence, and chronic respiratory disorders, which typically occur in adulthood, among sexual minority individuals.

We used data from 161,741 individuals (3.6% were sexual minorities) aged 45 and older, from a national data set. Smoking was 1.2 times more common among sexual minority individuals compared to heterosexual individuals, and the prevalence—or frequency of occurrence—of chronic respiratory disorders was 1.2 times higher among sexual minority individuals compared to heterosexual individuals. The link between sexual minority status and chronic respiratory disorders from smoking was supported by the data.

Our findings highlight that the high rates of smoking that are observed among sexual minority individuals, starting in adolescence, are linked with increased risk for chronic respiratory disorders among sexual minorities in adulthood.

Exploring the Role of Gut-Lung Interactions in COPD Pathogenesis: A Comprehensive Review on Microbiota Characteristics and Inflammation Modulation

Zi-Xuan Cheng* Jing Zhang, MD
*PhD candidate

Chronic obstructive pulmonary disease (COPD) significantly impacts global health, and the gut-lung axis idea is important for understanding its development. The gut-lung axis is the idea that there is a connection between the gastrointestinal (stomach, esophagus, intestines) microbiome—the collection of all the bacteria, fungi, and viruses that live in our stomach/intestines—and our lungs.

Studies have shown that COPD patients have unique microbiomes, which can lead to unique symptoms. In this review, we summarize the role both the gastrointestinal and the respiratory microbiome play in the development of COPD.

We found that individuals with COPD often have reduced amounts of the bacteria Prevotella spp in their lungs and lower amounts of Bacteroidetes in their stomach. These reduced amounts can lead to reduced anti-inflammatory effects and a reduction in protective short-chain fatty acids. Individuals with COPD may also have an increased amount of Proteobacteria, which can cause their COPD to become worse.

Further research is needed to better understand the specific effects of different bacteria, viruses, and fungi and use this knowledge to create treatments.

From Invisibility to Inclusion: A Call to Action to Address COPD Disparities in the Lesbian, Gay, Bisexual, Transgender, and Queer+ Community

Ninad T. Maniar, MD; M. Bradley Drummond, MD, MHS

COPD is known to affect demographic groups differently. Lesbian, gay, bisexual, transgender, queer, and other sexual and gender minorities (LGBTQ+) have an increased exposure to tobacco and thus, may be at a higher risk for COPD. This perspective piece reviews the literature describing COPD prevalence—or frequency of occurrence—in members of the LGBTQ+ community. The prevalence of COPD is higher in LGBTQ+ people than in their studied counterparts.

From these findings, we propose a call to action to improve the health of LGBTQ+ people with COPD by increasing education among the community about COPD and the harms of tobacco smoke, boosting COPD prevention and treatment efforts, and finally, focusing research to cover the gaps in the existing literature on COPD in LGBTQ+ people.