Inhalers are used to deliver medications often taken by patients with chronic lung disease to control their symptoms. These inhaler devices can be difficult to use and are often quite expensive. Further, the clinicians who take care of patients with lung disease often do not realize how tricky it is for individuals to use the inhalers well enough to get the medication into their lungs.

There are some recent promising advances, particularly related to price caps and changes to clinical guidelines that help clinicians know how to provide the best care to patients. However, there are ongoing challenges. Education on how to use inhalers is often not done at all or not done well. Different types of education have better or worse outcomes. Therefore, highlighting effective ways to teach inhaler use in guidelines would be helpful for clinicians. There are also numerous types of inhalers. Patients do not always get to choose the type that works best for them due to costs or other limitations. This can decrease individuals' ability to use inhalers, especially if their insurance changes them from one type of inhaler to another.

Ultimately, better inhaler education is needed, and inhalers need to be more affordable.

In this study, we investigated how meaning in life is associated with quality of life in people with moderate to severe COPD. We used the “Meaning in Life” questionnaire. This measures the presence of meaning in life (the subjective sense that life is meaningful) and the search for meaning in life (the drive, motivation, and intensity one has toward finding meaning in life).

Participants with a higher presence of meaning in life (compared to those with low presence) had less shortness of breath, fatigue, anxiety, and depression. They managed behaviors, thoughts, and emotions productively. They also had increased their social support. Participants with a higher search for meaning in life (compared to those with a low search) reported feeling less short of breath and less fatigue. They also felt a greater sense of control over their health.

Our results suggest that having a high presence or search for meaning in life is associated with a better quality of life. Promoting meaning in life during health care conversations may improve outcomes in people living with COPD.

Blood eosinophils are a type of white blood cell that helps the body fight disease. The blood eosinophil count measures the number of eosinophils in the blood. It is also an effective test for predicting how well patients with chronic obstructive pulmonary disease (COPD) are responding to treatments such as inhaled corticosteroids. However, it is unclear how reliable blood eosinophil count measurements are because of the interference by other factors. This is especially true in regions known to have high rates of parasitic infections.

To explore the stability of the blood eosinophil count test, participants were put into 3 groups according to their initial blood eosinophil count measurement Blood eosinophil count measurements were monitored at 6 and 12 months.

We found that blood eosinophil count stability was highest (85%) in the group of individuals with ≥300 cells. In contrast, the lowest stability was observed in the <100 cells group. Notably, the ≥ 300 cells group experienced a higher rate of exacerbations or flare-ups than other groups.

This study showed the good stability of blood eosinophil counts in patients with COPD who have ≥300 cells.

Patients’ views or opinions about how effective their medicine is will affect how consistently they take the medicine, as prescribed. A survey tool called the Onset of Effect Questionnaire has previously been used and studied with asthma patients, but never studied with COPD patients.

Using lung function tests and interviews, we found that most patients were satisfied that their COPD medications were working and could feel them working right away. Therefore, the questionnaire content was accurate and useful or validated. However, there was a weak link between these patient opinions and how effective their bronchodilator medicine was. Neither the forced expiratory volume in 1 second lung function test ) nor the peak expiratory flow test matched well with the Onset of Effect Questionnaire results.

In a group of COPD patients with mild to severe disease, the Onset of Effect Questionnaire results demonstrate that patients respond to bronchodilators and inhaled corticosteroid medications in many different ways. These findings show the need to further study patient perceptions or opinions in COPD management.

In people with chronic obstructive pulmonary disease (COPD), the relationship between physical activity, exercise performance, and blood health markers (substances in the blood that can be linked to specific conditions or diseases) is not well understood, nor is the effect of promoting physical activity. We analyzed data from 3 studies, 2 of which tested a 3-month walking program. Physical activity (daily steps) and exercise performance (6-minute walk distance) were measured, along with specific blood markers at the start and after 3 months.

The study included 366 Veterans, mostly male, averaging 70 years old. We found that lower levels of a marker of heart stress (NT-proBNP) were associated with higher daily step counts and better exercise performance. However, markers of inflammation (sRAGE) and muscle damage (CKMM) did not show similar patterns. Participants in the walking program increased their daily steps significantly more than those not in the program. Despite this increase in physical activity, there were no significant changes in the blood markers.

In summary, better exercise performance is linked to lower levels of heart stress markers found in the blood of people with COPD. However, a 3-month walking program does not impact the level of blood markers of heart stress, inflammation, or muscle damage.

Chronic obstructive pulmonary disease (COPD) is a common condition among patients with lung cancer. COPD is frequently underdiagnosed in the general population, but little is known about how often it is underdiagnosed among patients with lung cancer and how this relates to the stage of lung cancer they have at diagnosis.

To address these questions, we analyzed Medicare insurance claims linked to a cancer registry for more than 159,500 patients diagnosed with lung cancer between 2008 and 2017. We classified patients with lung cancer based on whether they had a COPD diagnosis, and if so, when their COPD was first documented in the Medicare claims.

We observed that 7 out of 10 patients with lung cancer also had COPD and that one-third of them did not receive their COPD diagnosis until their lung cancer diagnosis. Patients who received their COPD diagnosis at least 3 months before their lung cancer diagnosis had a 30% higher chance of an earlier-stage lung cancer diagnosis compared to those who had undiagnosed COPD till their lung cancer diagnosis.

Our findings highlight the importance of a timely COPD diagnosis to achieve earlier detection of lung cancer and better patient outcomes, especially among racial minorities.

Individuals with chronic obstructive pulmonary disease (COPD) have high levels of inflammation measured in their blood. Compared to individuals without COPD, on average, they also have decreased physical activity, strength, and lung function. Inflammation may affect physical activity, strength, and lung function in individuals with COPD, but prior studies have been undecided about this.

In this study, we used data from 302 participants in the COPD Activity: Serotonin Transporter, Cytokines, and Depression (CASCADE) study to test whether higher levels of 14 different blood biomarkers of inflammation predicted changes in physical activity, grip strength, and lung function over 2 years of follow-up.

Individuals with higher measures of inflammation (C-reactive protein and interleukin-6) on their first visit/blood test, had lower activity at that visit and over 2 years of follow-up. However, higher levels of inflammation were not associated with changes in physical activity, strength, or lung function.

These findings do not support targeting inflammation to improve physical activity, strength, or lung function. Some links between inflammation and physical activity may be due to instances where lower physical activity leads to more inflammation.

Treatment of COPD relies mainly on inhaled therapy. This requires the best use of inhalers to ensure effective delivery of medicines. Improper use of inhalers is associated with poorer disease control and more frequent hospital admissions. This misuse may be due to how patients use their inhalers or patients’ inability to generate enough breath strength to use the inhaler effectively. However, how often patients hospitalized with COPD misuse their inhaler is not well known.

We studied the percentage of inhalers misused by patients hospitalized with COPD in a general internal medicine department of Fribourg, Switzerland, between August 2022 and April 2023. A misused inhaler was defined as an inhaler used with an error that may have reduced the dose of medication reaching the lungs and/or used with insufficient breath strength.

We found that 69% of inhalers were misused; 66% due to an incorrect technique and 14% due to insufficient breath strength. We also found that 82% of patients misused at least one inhaler.

These results highlight that inhaler misuse is a major problem among hospitalized patients with COPD. During hospitalization, inhalers and how patients use them must be assessed to ensure that patients benefit from their prescribed treatments.

Multiple studies indicate that COPD can cause an individual to have an increased chance of developing osteoporosis—a condition in which the bones become weak and brittle.

This study conducted a Mendelian randomization which means we used genetic variants (different forms of the same gene) to make a judgment about the relationship between a risk factor (in this case COPD) and an outcome or result (in this case osteoporosis) using observational data/information. Specifically, we explored the genetic relationship between COPD and osteoporosis.

Our study showed there is a relationship between genetically-predicted COPD and an increased risk of osteoporosis. The higher likelihood of osteoporosis occurring in patients with COPD means that COPD patients should be monitored regularly for bone-related tests to prevent osteoporosis. Also, additional research is needed to identify strategies to prevent osteoporosis in individuals with COPD.

With climate change, wildfires are becoming more common, and the smoke from wildfires can be damaging to health, particularly among people with breathing disorders. The University of California, Davis Health (UCDH) is located in an area that experiences many wildfires, and in response, they have developed a plan to improve the health of people in their community, especially people at high risk of health problems because of wildfire smoke.

The UCDH Wildfire Population Health Approach has 5 parts: (1) identify people at risk of wildfire smoke-related health problems, (2) bring together teams from different medical areas to best help patients, (3) create ways to measure wildfire risk, (4) develop care plans that can be adjusted for individual patient groups, and (5) commit to learning and adjusting the plan as needed.

Climate change and wildfires threaten the lives and health of communities, especially people at high risk for health problems. The plan proposed in this article provides specific suggestions to help improve patient health in response to the dangers from wildfires and wildfire smoke.