Chronic Obstructive Pulmonary Diseases:Journal of the COPD Foundation

Volume 8, Issue 2 - 2021 | 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.

Improving Screening for Alpha-1 Antitrypsin Deficiency with Direct Testing in the Pulmonary Function Testing Laboratory

Samuel Gurevich, MD; Andrew Daya, MD; Cristiana Da Silva, RRT, BS; Christine Girard, MD; Franck Rahaghi, MD

Alpha-1 antitrypsin deficiency is a common but highly underdiagnosed genetic disorder that can significantly affect the liver and the lungs—causing COPD. Newer types of testing include a mouth swab and a finger-stick and can be easily performed in high-risk patients.

During this study, we offered testing for alpha-1 antitrypsin deficiency to patients whose lung function test—spirometry—suggested they had COPD. The respiratory therapist performed either the mouth swab or the finger-stick test depending on which test they were randomly assigned to receive. These 2 tests were compared to the option of offering patients a prescription for the blood test or a referral back to the physician who ordered the spirometry testing. Referring patients back to their physician for possible alpha-1 testing is the current community standard.

The results show a significant increase in the rate of testing when at-risk patients were offered testing by the respiratory therapist, especially with the mouth swab test (35 times more than compared to just sending patients back to their doctor). This testing was easily included in the workflow of the pulmonary function laboratory, and well received by respiratory therapists and patients alike.

Expanded testing of at-risk patients will find more individuals with alpha-1 antitrypsin deficiency. These patients can then be offered treatment earlier and more completely, thereby improving their outcomes.

Progression of Emphysema and Small Airways Disease in Cigarette Smokers

Esther Pompe, MD, PhD; Camille M. Moore, PhD; Firdaus A.A. Mohamed Hoesein, MD, PhD; Pim A. de Jong, MD, PhD; Jean-Paul Charbonnier, PhD; MeiLan K. Han, MD; Steven M. Humphries, PhD; Charles R. Hatt, PhD; Craig J. Galbán, PhD; Ed K. Silverman, MD, PhD; James D. Crapo, MD; George R. Washko, MD; Elisabeth A. Regan, MD, PhD; Barry Make, MD; Matthew Strand, PhD; Jan-Willem J. Lammers, MD, PhD; Eva M. van Rikxoort, PhD; David A. Lynch, MD; on behalf of the COPDGene investigators

Chronic obstructive pulmonary disease (COPD) is a disease that affects the airways and is often the result of cigarette smoking. The disease course of COPD is difficult to predict and differs between patients. We have not been able to predict in which patients the disease will progress into more severe COPD and in which patients the disease remains stable for many years. Therefore, knowledge is needed to identify those patients that are at risk for disease progression.

In this study, we evaluated factors associated with COPD progression in participants from the COPDGene study. We evaluated disease progression over 5 years and compared computed tomography (CT) results. We found that in all patients, the presence of airway destruction, i.e., emphysema, is associated with disease progression. Also, small airway disease as a sign of inflammation, detected on CT, played an important role in disease progression when there was no emphysema present. We found this in participants with mild COPD and even in smokers without COPD. This means that detection of early signs of this disease could prevent it from worsening by early intervention and treatment.

New Adopters of Telemedicine During the Coronavirus-19 Pandemic in Respondents to an Online Community Survey: The Case for Access to Remote Management Tools for Individuals with Chronic Obstructive Pulmonary Disease

Danielle M. Boyce, MPH; Byron M. Thomashow, MD; Jamie Sullivan, MPH; Ruth Tal-Singer, PhD

At the beginning of the COVID-19 pandemic, we started conducting surveys of the COPD community to determine its needs and how to best serve them. We found that more than half (157 people) of the respondents who answered the second survey in May 2020 started using telemedicine (phone, e-mail, or internet-based visits with their health care providers) in 2020. Nearly half of the respondents had at least 1 flare-up or sudden worsening of their COPD—an exacerbation—since January 1, 2020. The people who had at least 1 exacerbation in 2020 were more likely to start using telemedicine in 2020 compared to those who did not have any exacerbations in 2020. In addition, respondents who had an exacerbation in 2020 were more likely to avoid the emergency department for health care since the pandemic began than those who did not have an exacerbation in 2020. This tells us that some of the most severely ill individuals in the COPD community are worried about the risks associated with in-person health care and are using telemedicine more than ever before. We hope to use this information to advocate for better access to telemedicine care for people with COPD in the future.

Plain Language Summary Effect of Triple Therapy with Budesonide-Formoterol-Tiotropium Versus Placebo-Tiotropium on Sleep Quality in Patients with Chronic Obstructive Pulmonary Disease

Samuel L. Krachman, DO; Maria Elena Vega, MD; Daohai Yu, PhD; Joseph Demidovich, DO; Harsh Patel, MD; Fredric Jaffe, DO; Xavier Soler, MD; Tahseen Shariff, RPSGT; Gilbert E. D'Alonzo, DO; Wissam Chatila, MD; Sheila Weaver, DO; Yasmin Daraz; Sydney Cohen; Gerard J. Criner, MD

Patients with chronic obstructive pulmonary disease (COPD) often sleep poorly. This poor sleep quality may be caused by low blood oxygen levels while asleep and an increase in the work of breathing during the night with an overinflated, mechanically disadvantaged chest. In addition, many of the medications used by patients with COPD, including inhaled medications, may cause disrupted sleep.

We enrolled 10 COPD patients in an inhaled triple therapy (budesonide-formoterol-tiotropium) group and 13 in a placebo-tiotropium group to determine if either treatment had an effect on sleep quality. Sleep quality was measured with overnight sleep studies and with standardized patient questionnaires. At the end of 28 days, the triple therapy group had a significant improvement in their bedtime lung function while there was no change noted in the placebo-tiotropium group. As to sleep quality, there were no changes noted in the triple therapy group, however, there was an increase in the number of arousals during the night and an increase in daytime sleepiness noted in the placebo-tiotropium group. In both groups there was no change noted in nighttime blood oxygen levels or in overall quality of life.

Our study shows that in patients with COPD, the use of inhaled triple therapy as compared to placebo-tiotropium improves lung function while preserving sleep quality.

Does Evaluation and Management of COPD Follow Therapeutic Strategy Recommendations?

Fernando J. Martinez, MD, MS; Byron Thomashow, MD; Tamar Sapir, PhD; Laura Simone, PhD; Jeffrey Carter, PhD; MeiLan Han, MD, MS

Chronic obstructive pulmonary disease (COPD) diagnosis and management requires reviewing symptoms and the risk of acute flares-up of the disease. It has been difficult to know if such an approach is taking place in physician practices.

As part of a COPD quality improvement program in the Southeastern United States, 9 pulmonary and 15 primary care physicians were asked to identify 6 to 7 of their COPD patients for surveying and interviewing. In addition, a separate group of COPD patients from the same physicians were also selected. Physicians underwent focused, educational, peer-to-peer training. Information was collected from physicians and their patients.

The study revealed that there was significant difference between the care physicians thought they provided, and the care recalled by their patients. Physicians felt that a third of their patients experienced at least 2 flare-ups of lung disease in the past year while more than half of their patients reported this frequency. Similarly, there was discrepancy in the clinicians’ interpretations and the patients’ reasons for discontinuing their medications and in the use of specialty care referral. Physicians reported changes they made after the educational webinars which led to improvements in patient care in the year following intervention.

The information learned through this program will provide an opportunity to improve the care for COPD patients in the future.

Symptom Burden and Medication Use Among Patients with Nontuberculous Mycobacterial Lung Disease

Vira Pravosud, MPH, MS; David M. Mannino, MD; Delia Prieto, MS; Quan Zhang, PhD; Radmila Choate, PhD, MPH; Elisha Malanga, BS; Timothy R. Aksamit, MD

Health care providers are concerned about the increasing number of people living with lung infections that occur because of nontuberculous mycobacteria (NTM). Our study aimed to better understand how much, and in what way, a patient may be affected by NTM lung infection or disease. We were interested in comparing disease symptoms in patients with or without the concurrent use of medication to treat NTM lung infections. Identified through responses to a “Burden of NTM Survey” (developed by the COPD Foundation), our study included 266 individuals with a self-reported history of NTM lung infection or disease. After accounting for patients’ age, gender, duration of NTM lung infection(s), and having other lung diseases, more patients on medication to treat NTM lung infections, compared to those not on medication, were often troubled by shortness of breath, wheezing or other breathing difficulties; lack of energy; depression; difficulty in walking 500 meters without stopping, and in interacting with others.

While describing disease impacts that matter most to patients, our study provides helpful insights for the development of a practical tool (a composite symptom score) that health care professionals can use to evaluate the burden of NTM lung disease among patients.

Impact of Chronic Obstructive Pulmonary Disease and Emphysema on Outcomes of Hospitalized Patients with COVID-19 Pneumonia

Robert M. Marron, MD; Matthew Zheng, MD; Gustavo Fernandez Romero, MD; Huaqing Zhao, PhD; Raj Patel, MD; Ian Leopold, MD; Ashanth Thomas, MD; Taylor Standiford, MD; Maruti Kumaran, MD; Nicole Patlakh, BS; Jeffrey Stewart, MD; Gerard J. Criner, MD; and the Temple University COVID-19 Research Group

During the early stages of the COVID-19 pandemic it became clear that certain conditions put patients at an increased risk of more severe COVID-19 disease and worse outcomes. There were varied reports of the severity of outcomes for patients with chronic obstructive pulmonary disease (COPD) suffering from COVID-19 reported in initial studies during the pandemic.

Using 2 types of statistical analysis we sought to determine if patients with COPD and/or emphysema had worse COVD-19 outcomes than those without these conditions. We took into account differences in the populations with and without COPD and/or emphysema as well as factoring in other variables that were associated with worse COVID-19 outcomes.

Our results showed that patients with COPD and/or emphysema do not necessarily have worse outcomes when hospitalized with COVID-19. As COPD is a common, chronic disease and is the fourth-leading cause of death in the United States, further research into the prevention, management, and outcomes of COVID-19 in patients suffering from this disease should continue.