Chronic Obstructive Pulmonary Diseases:Journal of the COPD Foundation

Volume 8, Issue 3 - 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.

Chronic Obstructive Pulmonary Disease Outcomes at Veterans Affairs Versus Non-Veterans Affairs Hospitals

Stephanie L. LaBedz, MD; Jerry A. Krishnan, MD, PhD; Yu-Che Chung, MS; Peter K. Lindenauer MD, MSc; Laura J. Spece, MD, MS; Laura C. Feemster, MD; Ellen M. Stein, MS; Russell G. Buhr, MD, PhD; Sanjib Basu, PhD; Valentin Prieto-Centurion, MD, MS

The U.S. Centers for Medicare and Medicaid Services (CMS) and the Veterans Health Administration have both implemented policies intended to reduce readmissions in patients with COPD, but little is known about the relative performance of VA and non-VA hospitals on COPD readmissions and mortality in the ensuing years. Clinical trials of various interventions designed to reduce hospital readmissions in patients with COPD have demonstrated the potential to reduce readmissions but also to increase the risk of death. This study compared readmission and death rates at VA and non-VA hospitals using publicly available data from CMS Hospital Compare. We also measured the association between hospital-level readmission and death rates at VA and non-VA hospitals and across various hospital characteristics. From 2015 to 2018, VA hospitals had lower COPD readmission and death rates compared to non-VA hospitals. Readmission and death rates were not associated at VA hospitals. Among non-VA hospitals, higher readmission rates were associated with lower death rates. The inverse association between readmission and death rates at non-VA hospitals calls for re-examination of readmissions policies.

Patient-driven Research Agenda: What Needs to be Studied in Those Living with COPD During the Coronavirus Disease 2019 Pandemic?

Gretchen McCreary, MA; Danielle Boyce, MPH; Mary Ellen Houlihan; Jean Rommes, PhD; Carol Rubin, Med, MS; Karen Deitemeyer; William Clark, BS; Cara B. Pasquale, MPH; Richard A. Mularski, MD; Elisha Malanga, BS; Barbara P. Yawn, MD, MSc, MPH

The coronavirus disease 2019 (COVID-19) pandemic has caused stress, fear, and anxiety. Older adults and those with chronic conditions like COPD often protected themselves by staying away from friends, family and health care. The short- and long-term impact of this isolation on mental and physical health and well-being is not known. To find out what concerns the COPD community thought were the most important to study in these areas, we created a patient-driven research agenda to help researchers and funders decide what to study.

This brief report summarizes results from the COPD & Coping with COVID-19 Pandemic Survey, which was available to members of the COPD Patient-Powered Research Network. We hoped to understand their level of concern about topics including: Activities, Living Situations, Health care Use, COVID-19 data, and the “new Norm.” The top 25 ideas were then ranked by the COPD Foundation’s online community, COPD360social. The top issues for future research included: studying the effects of long-term stress and worry, how to regain trust in health information, and the impact of delaying or not getting medical care.

Understanding concerns and research questions that are important to people living with COPD is critical and should be considered by researchers and those guiding and funding research projects.

Global Attitudes of Health Care Providers About Aerosolized Airway Clearance Therapy in Bronchiectasis Patients During the Coronavirus Disease 2019 Pandemic

Pamela J. McShane, MD; Julie V. Philley, MD; Delia A. Prieto, MSEd; Timothy R. Aksamit, MD

Airway clearance therapy is an essential part of bronchiectasis management. Yet airway clearance involves procedures that aerosolizes or creates a fine mist of respiratory droplets, thereby potentially spreading infection through the air. This report describes the results of a survey that was sent to health care practitioners within bronchiectasis research registries in the United States, Europe, and Asia. The goal of the survey was to learn about attitudes that these providers have toward airway clearance therapy in the context of the coronavirus disease 2019 (COVID-19) pandemic and determine if procedures were in place to reduce virus transmission. The survey revealed universal concern among practitioners about the safety of airway clearance in the setting of a viral pandemic. The survey also revealed the lack of a unified approach, based on set procedures or protocols, for reducing the transmission of viruses during airway clearance therapy. The results of this survey provide motivation to create unified infection control protocols/procedures for airway clearance therapies. Hopefully these survey results incite further research to reduce infection transmission in this setting.

Polycythemia is Associated with Lower Incidence of Severe COPD Exacerbations in the SPIROMICS Study

Ashraf Fawzy, MD, MPH; Han Woo, PhD; Aparna Balasubramanian, MD, MHS; Igor Barjaktarevic, MD, PhD; R. Graham Barr, MD, DrPH; Russell P. Bowler, MD, PhD; Alejandro P. Comellas, MD; Christopher B. Cooper, MD, PhD; David Couper, PhD; Gerard J. Criner, MD; Mark T. Dransfield, MD; MeiLan K. Han, MD, MS; Eric A. Hoffman, PhD; Richard E Kanner, MD; Jerry A. Krishnan, MD, PhD; Fernando J. Martinez, MD, MS; Meredith McCormack, MD, MHS; Robert Paine III, MD; Stephen Peters, MD, PhD; Robert Wise, MD; Prescott G. Woodruff, MD, MPH; Nadia N. Hansel, MD, MPH; Nirupama Putcha, MD, MHS

Several studies have shown that individuals with COPD and anemia (low red blood cell count) have worse disease and more symptoms. However, less is known about the impact of elevated red blood cell count (polycythemia), which can occur due to living at high altitude, smoking, or having low blood oxygen levels. Older studies of individuals with COPD and polycythemia have shown mixed results ranging from lower death rate and fewer hospitalizations to no effect. However, these older studies included individuals with severe COPD or individuals who were prescribed oxygen. The current study investigates the impact of polycythemia in a contemporary and diverse group of individuals with COPD. Of the 1261 participants included in the study, 11.7% had polycythemia. After adjusting for several factors, individuals with polycythemia had a significantly lower risk for COPD flare-ups (exacerbations) and, despite having more severe disease and more emphysema, they did not have worse symptoms. These findings suggest a potential protective role of higher red blood cell count in individuals with COPD.

Impact of a Medical Diagnosis on Decision to Stop Smoking and Successful Smoking Cessation

Hunter G. Lindsay; Frederick S. Wamboldt, MD; Kristen E. Holm, PhD, MPH; Barry J. Make, MD; John Hokanson, MPH, PhD; James D. Crapo, MD; Elizabeth A. Regan, MD, PhD; and the COPDGene Investigators

We thought that smokers might be influenced to quit smoking if they developed a medical problem related to smoking. Current and former smokers were asked about reasons that influenced their decision to quit smoking. Potential reasons for quitting were grouped into: Medical Diagnoses, Social Factors, Symptoms, “No reason” and Other-unspecified. Medical reasons were commonly cited by both successful and unsuccessful quitters as a factor that influenced them to consider quitting. Smoking cessation is a complicated process that is impacted by many factors, including addiction to nicotine. For physicians, there is value in informing smokers of medical conditions such as COPD and heart disease when they are identified, in association with routine care and lung cancer screening. Symptoms such as shortness of breath were also important quitting factors and could be flagged for patients as smoking-related consequences in order to clarify the impact of smoking on health. Successful quitters in our study were older and had less chronic bronchitis and airway disease on chest CT scans, but more emphysema and worse lung function tests—spirometry--results. Quitting smoking appears to be associated with more smoking-related disease, but awareness of medical problems may be only one of the factors in the decision to stop.

Bronchoalveolar Lavage and Plasma Cathelicidin Response to 25-Hydroxy Vitamin D Supplementation: A Pilot Study

Emily C. Sanders, MD; Robert M. Burkes, MD, MSCR; Jason R. Mock, MD, PhD; Todd T. Brown, MD, PhD; Robert A. Wise, MD; Nadia N. Hansel, MD, MPH; Mark C. Liu, MD; M. Bradley Drummond, MD, MHS

Chronic obstructive pulmonary disease (COPD) is characterized by low lung function and recurrent breathing flare-ups. Previous studies have shown that low vitamin D levels are associated with worse breathing outcomes in COPD. Our group has been interested in a protein called cathelicidin. This protein is part of the immune system in the lungs, and may be controlled by vitamin D. This research study set out to understand if vitamin D treatment leads to changes in lung and blood cathelicidin levels. In this study, we enrolled 17 smokers (9 with COPD) with low blood vitamin D levels. We first collected samples from the lungs and blood to measure cathelicidin. We then treated all participants with a vitamin D pill once weekly for 8 weeks. After 8 weeks, we collected lung and blood samples again. We found that, although all participants increased their blood vitamin D levels, the blood and lung cathelicidin levels did not change when comparing before and after treatment with vitamin D. This research helps show that we can measure cathelicidin in the lung. Although there was not a difference after treatment in this study, some factors may have impacted the ability to see any difference. These study results will help inform the design of future studies examining vitamin D effects in the lungs.

Challenges Faced by Rural Primary Care Providers When Caring for COPD Patients in the Western United States

Fernando Diaz del Valle, MD;* Patricia B. Koff, RTT, Med;* Sung-Joon Min, PhD; Jonathan K. Zakrajsek, MS; Linda Zittleman, MS; Douglas H. Fernald, MA; Andrea Nederveld, MD; Donald E. Nease, MD; Alexis R. Hunter, BS; Eric J. Moody, PhD; Kay Miller Temple, MD; Jenny L. Niblock ARNP, DNP; Chrysanne Grund, BS; Tamara K. Oser, MD; K. Allen Greiner, MD; R. William Vandivier, MD
*contributed equally to the manuscript

COPD patients who live in rural areas have worse death rates, flare-ups (or exacerbations), and hospitalizations than COPD patients who live in urban areas. The reasons for these health differences are not clear but may be related to continued exposures to toxic materials in rural communities or unique issues that make it difficult to access medical care. These poor outcomes may also be due to obstacles that prevent health care providers from providing the best care, but these challenges have received much less attention. This study addressed this problem by surveying primary care providers in 7 primarily western states to ask about challenges they face when caring for COPD patients. The study identified bright spots in the increased, but not yet optimal, use of COPD guidelines to manage COPD, and the high use of lung function tests—spirometry—to diagnose COPD. But the study also found significant challenges to diagnosis, assessment, prevention, and access to other supportive health care services that were linked to specific types of health care providers and their practice location but was not related to the patient population served or the practice size. Rural providers face significant challenges when caring for COPD patients that can and should be targeted in future interventions to improve COPD outcomes.

Chronic Bronchitis in COPD Patients Creates Worse Symptom Burden Regardless of the Presence of Bronchiectasis in the COPDGene® Cohort

Oksana Bohn, MD; Min Xi, MS; Natalie K. Woodruff, BS; Gary L. Hansen, PhD; Charlene E. McEvoy, MD, MPH; and the COPDGene® Investigators

Past studies have examined the burden of symptoms for COPD patients with chronic bronchitis and/or bronchiectasis but did not clearly show which condition had the largest impact on quality of life. This study uses the COPD Genetic Epidemiology (COPDGene®) cohort to measure the self-reported symptom scores for patients with/without chronic bronchitis and with/without bronchiectasis, with particular attention given to those who may have had both conditions. We found that, regardless of the severity of COPD, chronic bronchitis symptoms are associated with worse pulmonary symptoms in general and a significant impairment in quality of life. Surprisingly, for patients with chronic bronchitis the presence of bronchiectasis did not result in higher symptom scores. This finding is important because it shows that the symptom burden for patients with and without bronchiectasis is not easily recognized. Chronic bronchitis symptoms for COPD impose a heavy burden on patients and treatment strategies should not depend upon the presence or absence of underlying bronchiectasis.

Association of Systemic Endothelial-Derived and Platelet-Derived Microparticles with Clinical Outcomes in Chronic Obstructive Pulmonary Disease

Jorge Lascano, MD; Jason Katz, BS; Martin Cearras, MD; Michael Campos, MD

Chronic obstructive pulmonary disease (COPD) is a very common lung disease worldwide. The majority of cases are due to inhaling harmful substances like cigarette smoke. Many patients with COPD also have damage to other organs besides the lungs, especially as the disease progresses. In order to prevent, diagnose, and treat COPD, we must understand how these multi-organ systems are affected. Our study looked at several tissues that are damaged as COPD progresses.

Microparticles are small vesicles released into the circulation when cells are in distress or dying. We studied microparticles from 2 sources: endothelial cells and platelets. Endothelial cells make up the arteries and veins of our body while platelets help prevent bleeding from these vessels. We were unable to find a comprehensive, clear association between endothelial or platelet-derived microparticles in COPD individuals, regardless of disease severity. Our main findings show that at early stages of the disease, there is significantly more damage to endothelium cells compared to later stages. On the contrary, we found increased platelet activation as the disease progresses.

The Heterogeneity of COPD Patients in a Community-Based Practice and the Inadequacy of the Global Initiative for Chronic Obstructive Lung Disease Criteria: A Real-World Experience

Fortune O. Alabi, MD; Hadaya A. Alkhateeb, BS; Kayla M. DeBarros, BS; Pierina S. Barletti Benel, BS; Rachel L. Sanchez-Martez; Mia L. Zeper, BS; Reema A. Ismail; Fred Umeh, MD; Nelson Medina-Villanueva, MD

Chronic obstructive pulmonary disease (COPD) is a disorder that affects the airways. It is currently ranked as the third leading cause of death globally, after cardiovascular diseases and strokes. Despite this, a COPD diagnosis is often delayed or can remain undiagnosed. This is partly due to restrictive diagnostic criteria/guidelines, including that of the Global initiative for chronic Obstructive Lung Disease (GOLD) and the Global Lung Function Initiative (GLI), which rely on abnormal breathing tests and tobacco smoking history. There is emerging data suggesting a more comprehensive approach should be used to diagnose COPD. In this study, we analyzed patients with physician-diagnosed COPD in a community-based practice, described their characteristics, and evaluated the sensitivity of GOLD and GLI criteria in this population.

Out of 1224 patients, 18% did not have a history of smoking and 43% of the patients met the GOLD criteria for the diagnosis of COPD. GLI criteria was only able to identify 26% of patients. A normal breathing test was noted in about 21% of patients. Among the 841 patients with computed tomography imaging of the chest, 51% showed evidence of emphysema (damaged air sacs in the lungs), and 21% of those had normal spirometry.

From our study, we conclude that COPD diagnostic criteria based on the GOLD criteria is too restrictive, and too many patients are left undiagnosed or receive a delayed diagnosis.