Patients living with COPD have several accompanying medical conditions, called comorbidities. Clinicians and patients are increasingly advocating for holistic care (care that addresses the whole person, whole body) of patients with COPD and multiple comorbidities. The metabolic syndrome, in which individuals have high blood pressure, obesity, high cholesterol, and diabetes, is common among patients living with COPD.

This editorial highlights the following areas for future research related to COPD and the metabolic syndrome:

• understanding the impact of metabolic syndrome, particularly obesity, on the health of patients living with COPD, including their risk of COPD flare-ups or exacerbations and their quality of life
• testing types of patient care that focus on overall health rather than focusing only on COPD-specific measures such as COPD-related flare up and hospitalizations
• developing and testing new methods to foster collaboration among physicians who provide care to this population.

Dedicating resources to promote research in these areas will improve care for patients living with COPD and multiple comorbidities.

A recent study found that chronic obstructive pulmonary disease (COPD) is more common in adults who began smoking cigarettes before (versus after) 15 years of age, even when taking into consideration their current smoking status and lifetime amount of cigarette smoking. Our current study went a step further to determine whether childhood smoking is related to COPD when also accounting for second-hand smoke exposure. To do so, we analyzed a large dataset of adults aged 40 years and older to see if childhood cigarette smoking was related to a COPD diagnosis, while also taking into account individuals’ current smoking status, the total amount of smoking in their lifetime, their second-hand smoke exposure, and their characteristics like age, sex, and income.

We found that starting smoking before 15 years of age was related to more self-reported COPD diagnoses even when taking into account all of these other risk factors. This research shows that the developing lungs of children are particularly vulnerable to cigarette smoking. Our research findings support ongoing guidelines and efforts aimed at reducing childhood smoking.

Acute exacerbations or flare-ups of chronic obstructive pulmonary disease (COPD) are a leading cause of hospitalization and often lead to the COPD becoming worse. Getting treatment as early as possible for an exacerbation can reduce its severity and prevent hospitalization, however, patients often delay seeking care. Previous research showed that a continuous respiratory monitoring service was associated with reduced hospital admissions and emergency department visits, potentially by helping patients seek outpatient care (clinic or doctor visits) earlier.

This study examined this monitoring service by analyzing 245 outpatient visits that occurred after the monitoring system flagged that 168 patients appeared to be experiencing a worsening of their condition. In 84% of these visits, health care providers determined medical help was necessary, with two-thirds receiving treatment for an exacerbation. Fewer than 2% required an emergency department referral, suggesting that the monitoring service helped patients get outpatient care in a timely manner. These findings support the idea that continuous monitoring can assist in getting patients earlier treatment of exacerbations in an outpatient setting, potentially improving their outcomes.

Chronic obstructive pulmonary disease (COPD) is a progressive lung condition that makes it hard to breathe and causes symptoms like shortness of breath and respiratory muscle weakness. This study tested a new program called RESP-FIT, which is designed to strengthen respiratory muscles and improve symptoms. RESP-FIT combines 2 types of muscle training to target respiratory muscles and a mobile smartphone app to allow participants to track their training and how they feel each day.

Thirty adults with COPD participated in this study. Half completed the RESP-FIT training program, while the other half only tracked their symptoms using the smartphone app. Following 6 weeks of training, the group who completed RESP-FIT reported less shortness of breath, less anxiety, felt happier, and had stronger breathing muscles. However, they also reported feeling tired compared to those who did not do the program.

This research is important because it shows that the RESP-FIT training program could help people breathe better and feel better emotionally as they manage their COPD, but more work is needed to understand the fatigue from respiratory muscle strength training. We hope this study will lead to larger studies and better treatments for COPD in the future.

A quality improvement program for health care providers was carried out at a large community health center with the goal of improving the screening rates of patients with chronic obstructive pulmonary disease (COPD) for the condition alpha-1 antitrypsin deficiency (AATD). AATD is estimated to account for 1%-2% of all COPD cases in the United States and is a treatable and inherited condition. Despite existing guidelines recommending screening for all patients with COPD, screening rates remain low.

This program combined educational sessions and a plan that used the electronic health record (EHR) system to increase health care providers’ knowledge of AATD, remind them to screen patients with COPD, and improve their health center’s laboratory AATD testing processes. In the 12 months before the program started, 13 of the 972 patients with COPD (1.3%) seen at the health center were tested for AATD. In the 12 months after the program began, improvements in AATD screening rates were observed with 229 of the 1,030 patients with COPD (22.2%) being tested for AATD. The combination of educational sessions with an EHR system plan helped increase AATD screening rates of patients with COPD.

 

There are notable differences in the lung size and symptoms of chronic obstructive pulmonary disease (COPD) between males and females. This analysis of the IMPACT trial looks at the effect of different combinations of drugs on COPD exacerbations, and patients’ health status and lung function in males and females to determine if the sex of a patient affects clinical outcomes. Specifically, the effects of single-inhaler fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) were compared against the combinations of just UMEC/VI and FF/VI.

At the beginning of the study, females were slightly sicker and reported more COPD exacerbations compared to males. Females also had worse health status scores according to a questionnaire called the St George’s Respiratory Questionnaire. The FF/UMEC/VI combined treatment improved lung function and health status and reduced the risk of exacerbations in both sexes better than the combinations of just FF/VI or UMEC/VI. Still, the rate of exacerbations remained higher in females across all treatments. However, females with an eosinophil (a type of white blood cell) level of less than 150 cells taking FF/UMEC/VI experienced fewer exacerbations compared to those taking UMEC/VI. In addition, females who had less than 2 exacerbations in the past year and taking FF/UMEC/VI also experienced fewer exacerbations compared to those taking just UMEC/VI.

This research highlights the importance of personalized treatment approaches for both male and female patients with COPD.

Falls can cause serious injury and are common among people with chronic obstructive pulmonary disease (COPD). People with COPD often experience pain, anxiety, insomnia (difficulty sleeping), and shortness of breath. Medications, such as opioids and benzodiazepines, are used to treat these symptoms but can increase a person’s risk of falling. Understanding how and which medications may contribute to falls is important for developing ways to prevent falls among people with COPD.

In this study, we used electronic health records from the University of Washington Medicine that were linked to Washington state death certificates to examine medication use among people with COPD in the last 2 years of their lives. We analyzed the odds of falling among patients with COPD who used fall-risk−increasing drugs compared to those who did not. We found that the odds of falling increased with each fall-risk−increasing drug used. For example, a patient is more likely to fall if they are taking 2 fall-risk−increasing drugs versus one fall-risk−increasing drug. Plans to reduce fall-risk−increasing drug use that include patients, pharmacists, and pulmonologists may help prevent falls in people with COPD.

Patients with chronic obstructive pulmonary disease (COPD) often face serious health problems and high medical costs due to flare-ups or exacerbations of their condition. By using machine learning (a computer program or model that can learn, adapt, analyze, and draw conclusions from patterns within data) and information from electronic health records, we were able to better identify specific groups of patients who were hospitalized because of these flare-ups.

We analyzed data from routine medical care over a 5-year period to pinpoint these different groups and then confirmed our findings by studying patients hospitalized during the COVID-19 pandemic. We sorted patients into groups based on factors like their other health conditions, lab results, and the treatments they received while in the hospital.

One key finding was that a particularly severe group of patients had worse outcomes or results, including a higher risk of death during and after their hospital stay for a COPD flare-up.

This study shows how combining advanced data analysis with large amounts of health care information can help us identify which COPD patients are at higher risk of poor outcomes.

Alpha-1 antitrypsin (AAT) deficiency is a disease that can result from different kinds of genetic mutations of the SERPINA-1 gene, which can eventually lead to severe lung diseases such as emphysema at a very young age. “PiNull” mutations are a rare type of gene mutation that leads to a complete absence of AAT a protein that helps protect the lungs from inflammation and damage. It is even rarer to have 2 copies of these mutations (called homozygous).

Our case report details our discovery of a novel PiNull mutation named “Q0Bani-Yas” in a 35-year-old female who never smoked and had no significant environmental exposures. She was homozygous for this novel mutation, which led to a devastating, end-stage lung disease and she subsequently underwent lung transplantation.

Our case highlights the identification of an unusual but clinically relevant SERPINA-1 mutation and a story of devastating lung disease in a young, never-smoker. More importantly, this case exemplifies the need for a comprehensive and multispecialty approach to patients with AAT deficiency, including pulmonology, genetics, social work, ethics, interventional, and surgical services. This care coordination, including medication delivery, can also occur internationally to help manage advanced diseases caused by AAT deficiency.