Individuals who experience difficulties getting medicines because of the cost of the drug, often have trouble taking the drug exactly and as often as their doctor prescribed. This is called cost-related nonadherence. This can badly affect conditions like chronic obstructive pulmonary disease (COPD), which requires chronic long-term management.

We performed a review of the information available from the COPD Genetic Epidemiology (COPDGene^®) study participants. We identified individuals with COPD who had also completed the social and economic questionnaires of the study. We found that of the eligible 2521 participants, 408 (16.2%) experienced cost-related nonadherence. In other words, they did not take their medicines as prescribed by their doctors. Individuals who experienced cost-related nonadherence also experienced a faster decline in their lung function (the ability of their lungs to work). They also experienced more frequent flare-ups of their disease, or exacerbations.

Government policies that focus on the cost of inhalers, such as the Inflation Reduction Act, may improve medication adherence and ultimately, COPD outcomes or results.

People with chronic obstructive pulmonary disease (COPD) can often have muscle wasting—a thinning and loss of muscle tissue. One of the reasons for this is thought to be the spread of inflammation--the body’s response to harmful toxins or irritants—which can cause redness, pain, swelling, and damage to healthy tissue. Inflammation in individuals with COPD can occur not only in the lungs but throughout the body.

We measured the arm and leg muscles of people with COPD and created an arm muscle index and leg muscle index to pull together all the measurements and summarize them. We then looked at whether these measurements are related to daily activity levels and an individual’s ability to exercise.

Our results showed that greater leg muscle size can be associated with a better ability to move. Also, we found that arm muscle size was not related in any way to the ability to exercise.

These results suggest that maintaining and training strong leg muscles is very important for helping people with COPD to remain active. Also, the leg muscle index we developed may be useful for showing the effects of rehabilitation. In the future, we plan to use this index in actual rehabilitation settings to continue our research into how increased leg muscle size improves the ability to move.

The RELIANCE study was created to help answer a question important to many people living with COPD and chronic bronchitis: If symptoms continue despite inhaler therapy, is azithromycin or roflumilast the better next step to prevent serious flare-ups known as exacerbations? Both medicines have been shown separately to reduce COPD exacerbations, but they have never been compared directly in a clinical trial.

RELIANCE is a national study in the United States that enrolled people with COPD who had recently been hospitalized and were already receiving standard inhaled treatments. Participants were randomly assigned to receive long-term azithromycin or roflumilast and then followed over time to see whether they were hospitalized again or died. The study has completed enrollment and follow-up visits are on-going. To make the study easier and more accessible, people could join the study from traditional medical centers or community clinics, give permission to participate in person or remotely, and complete follow-up visits online or by phone.

By designing the study around the needs of patients, caregivers, and clinicians, we hoped to produce results that reflect real-world care. What we learn from RELIANCE may guide treatment choices, improve patient–clinician decision-making, and help reduce hospitalizations for people living with COPD.

Lung cancer is frequent in people with chronic obstructive pulmonary disease (COPD). For cancer that is only in the lungs (localized or early lung cancer), surgery is the best treatment option, but it is not always possible because people with COPD may not have lungs strong enough to tolerate surgery.

In our study, we reported on the 2009–2019 experience of treating localized lung cancer in individuals with COPD in a specialized care hospital in Canada. Of the 1307 persons included in the study, 918 underwent surgery. Those who did not have surgery had standard radiation treatment or stereotactic radiotherapy, a form of highly precise radiation treatment. Some patients did not receive any active cancer treatment, because they were too ill or preferred to not be treated for the cancer.

Individuals 75 years or older or who had reduced lung capacity (the amount of air one is able to breathe in) did not receive the surgery. The most effective treatment was surgery although stereotactic radiation therapy was a reasonable option when surgery was not possible.

This study may help doctors, patients, and families know what the best treatment decision is when COPD patients have lung cancer.

Individuals living with chronic obstructive pulmonary disease (COPD) may go to the emergency department or be hospitalized for a worsening of their COPD symptoms. The neighborhood that people live in may influence how often these events occur. In this study, we examined how rates (how often it occurred) of emergency department visits, hospitalizations, and 30-day readmissions (being readmitted to the hospital within 30 days of the first hospital stay) for COPD flare-ups or exacerbations differed across neighborhoods in Travis County, Texas for 5 years (2016-2020). We also looked at whether specific neighborhood characteristics or features were related to these visits and hospitalizations.

We found that rates of emergency department visits and hospitalizations for COPD showed clear geographic patterns (patterns related to where the individuals lived) across neighborhoods, with some areas experiencing higher rates than others. However, readmission rates showed little geographic patterning. We also found that several neighborhood characteristics were associated with higher rates of emergency visits and hospitalizations, but not with readmission rates.

Our findings suggest that neighborhood conditions may play an important role in the use of fast, short-term medical care for COPD, particularly emergency department visits and hospitalizations.

Patients with chronic obstructive pulmonary disease (COPD) have flare-ups or exacerbations during which breathing symptoms worsen. Many patients do not seek medical care or receive treatment during exacerbations. Prior research showed that COPD exacerbations have a bad effect on patients’ quality of life (their happiness, comfort, well-being) immediately after exacerbations. We wanted to know how untreated COPD exacerbations affected patients’ long-term quality of life.

Our study included over 400 patients with COPD. We tracked their exacerbations by calling them twice a month, for a year, and asking about worsening breathing symptoms. We also noted both untreated and treated exacerbations. We used a questionnaire to measure patients’ quality of life at the beginning and end of the study.

We found that patients who had either treated or untreated exacerbations had worse quality of life at the end of one year compared to those who had no exacerbations. Our findings show that COPD exacerbations have an impact on long-term quality of life, including untreated exacerbations where patients did not seek medical care.

This study highlights the importance of working to prevent exacerbations from happening in the first place. It also suggests that treatment of exacerbations may help ease the effect on a person’s long-term quality of life.

Many people have low levels of vitamin D in their blood, and in our study, we wanted to understand if this affects chronic obstructive pulmonary disease, (COPD).

To find out, we looked at health data from over 300,000 adults in the U.K. Biobank, a large ongoing study. We looked at their vitamin D levels at the start of the study. Some individuals in the study already had COPD, so we checked if low vitamin D was more common in them. For those without COPD, we a looked at about 15 years of the individuals’ information to see who developed the disease and how they were doing

We learned that people with low vitamin D were more likely to have COPD already or faced a much higher risk of developing it later—nearly double in some cases. They also had higher rates of death from COPD. This link was stronger in men, current smokers, those not taking vitamin D supplements, and people with depression.

In the future, these findings could guide ways to prevent COPD or slow its progress, such as checking vitamin D levels in at-risk people and considering taking vitamin D supplements to improve lung health and survival.

Patients with chronic obstructive pulmonary disease (COPD) commonly do not use their inhaler medications as prescribed, leading to poor patient outcomes. We conducted phone interviews with diverse patients with COPD to learn about the things that make it easier or harder for them to use inhaler medications. Interview questions were guided by a process called the Capability, Opportunity, and Motivation model of Behavior (COM-B).

Just over half of study participants reported using their COPD medications as prescribed, although many admitted to sometimes missing doses. Common reasons for missing doses included not being able to afford the inhaler, forgetfulness, and not having the inhaler with them. Through our interviews, we learned that participants overcame these difficulties by asking for cheaper inhalers, using reminders or routines, and keeping inhalers in specific locations. Nearly half of participants reported using their inhalers differently than prescribed. Several described using their inhaler with the wrong schedule or using the inhaler incorrectly and were unaware of their inhaler misuse. Others used their inhalers differently than prescribed because they felt inhalers were not always necessary, missing doses carried little risk, and having COPD did not fit in with their self-image or caused them emotional distress.

Future efforts to improve medication use in patients with COPD should include education and address specific difficulties and reasons for not taking medicines as prescribed.