Chronic Obstructive Pulmonary Diseases:Journal of the COPD Foundation

Volume 9, Issue 3 - 2022 | 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.

All summaries for the current issue are listed below in the order of publication, scroll down.

Short-Term Impact of the Frequency of COPD Exacerbations on Quality of Life

Erin R. Camac, DO; Natalie A. Stumpf, BA; Helen K. Voelker, BS; Gerard J. Criner, MD; for the COPD Clinical Research Network

Some individuals with COPD suffer from recurrent exacerbations or flare-ups of their disease. Our study of individuals with moderate-severe COPD, who were recruited to 2 large trials, reveals that the frequency of these exacerbations affects quality of life over a shorter period than previously demonstrated. In addition, not only do they feel worse, but they also miss out on the gains experienced by their peers as a result of COPD therapies. Individuals with moderate-severe COPD with frequent exacerbations experience heightened challenges, and more therapies are needed to improve their quality of life.

Differences of the Nasal Microbiome and Mycobiome by Clinical Characteristics of COPD Patients

Maura Alvarez Baumgartner, MD, MPH; Chengchen Li, MPH; Thomas M. Kuntz, PhD; Lina Nurhussien, MPH; Andrew J. Synn, MD; Wendy Y. Sun, BS; Jennifer E. Kang, BS; Peggy S. Lai, MD, MPH; Jeremy E. Wilkinson, PhD; Mary B. Rice, MD, MPH

A microbiome is a community of microorganisms—bacteria, fungi, and viruses—that live or co-exist as a group in different parts of the body—such as the lungs or nasal passage. The type of organisms making up the microbiome may change in response to different factors such as exercise, diet, exposure to disease, etc. Several studies have suggested that the lung microbiome may influence the risk of having chronic obstructive pulmonary disease (COPD) exacerbations or flare-ups. However, little is known about the relationship between the microbiome of the nasal passages—which are continuous with the lower airways of the lung—and clinical characteristics of COPD patients. To study this relationship, we sampled the nasal epithelial lining of 20 people with COPD and compared the bacterial and fungal microbiome of the nasal fluid with other characteristics, such as inhaler and oxygen treatment, COPD severity, level of eosinophils in the blood, and the season of sampling. We found that the make-up of the nasal microbiome differed across individuals and was explained, in part, by clinical characteristics of COPD. Use of different inhaled treatments, the level of eosinophils in the blood, and whether the individual was male or female affected the make-up of the bacterial microbiome. The fungal mycobiome was associated with blood eosinophil level and lower lung functioning. Our study indicates that the make-up of the nasal biome varies among COPD patients and may be partially explained by clinical characteristics.

Circulating 1,3-Beta-D-Glucan is Associated with Lung Function, Respiratory Symptoms, and Mediators of Matrix Degradation in Chronic Obstructive Pulmonary Disease

Matthew Gorgone, DO*; Deepti Singhvi, MD*; Seyed Mehdi Nouraie, MD; Malcolm Finkelman, PhD; Yonglong Zhang, PhD; Jiantao Pu, PhD; Divay Chandra, MD; Yingze Zhang, PhD; Georgios D. Kitsios, MD, PhD; Alison Morris, MD, MS; Frank C. Sciurba, MD; Jessica Bon, MD, MS
*Authors contributed equally

Only a fraction of individuals who smoke develop chronic obstructive pulmonary disease (COPD).This suggests that there are additional factors that contribute to the development of airflow obstruction. The movement of microbes (bacteria, fungi, algae, etc.) from the guts or lungs into the bloodstream might cause organ damage and/or worsen chronic disease. Studies have found that the circulating 1,3 beta-d-glucan (BDG)—which is a part of the cell wall of fungi—is associated with inflammation and poor clinical outcomes in several other chronic diseases. We sought to determine whether measured blood levels of BDG, in individuals with COPD, are associated with negative clinical outcomes/results. We found that individuals with COPD with high levels of BDG had greater airflow obstruction, respiratory symptoms, sputum production, and acute exacerbations or disease flare-ups.

Giving Voice to People – Experiences During Mild to Moderate Acute Exacerbations of COPD

Ana Machado, PT, MSc; Sara Almeida, GT, MSc, PhD; Chris Burtin, PT, MSc, PhD; Alda Marques, PT, MSc, PhD

People with COPD frequently suffer from acute exacerbations, i.e., an acute worsening or flare-up of their symptoms that requires additional treatment. These events have a negative impact on their health and disease progression and make them more at risk of having more exacerbations. The current management of exacerbations is, however, only partly effective. Enhancing our understanding of people’s experience of an exacerbation (needs, impact, perceptions) is, therefore, important to finding better treatment plans.

In this study, people with COPD were interviewed during the onset of an exacerbation that was being managed at home. We found that exacerbations have a huge negative impact on people’s lives, even when hospital admission is not required. People’s thoughts about pulmonary rehabilitation during the exacerbation showed the importance of raising awareness for this intervention. This study provides a foundation for developing person-centered interventions during acute exacerbations of COPD.

Machine Learning Prediction of Progression in Forced Expiratory Volume in 1 Second in the COPDGene® Study

Adel Boueiz, MD, MMSc*; Zhonghui Xu, MS* ;Yale Chang, PhD; Aria Masoomi, PhD; Andrew Gregory, BS; Sharon M. Lutz, PhD; Dandi Qiao, PhD; James D. Crapo, MD; Jennifer G. Dy, PhD; Edwin K. Silverman, MD, PhD; Peter J. Castaldi, MD; for the COPDGene Investigators

*These authors contributed equally

Personalized treatment of chronic obstructive pulmonary disease (COPD) requires the ability to accurately predict disease progression. However, existing models of disease progression in COPD are limited both in their ability to predict and to consider all factors that might play a role. We used a type of machine learning computer program or model that can learn, adapt, analyze, and draw conclusions from patterns within data or information. Specifically, we used a random forest model of machine learning that creates and then combines many small decision trees—each with its own prediction—that is combined into one forest that combines all the predictions for one larger, more accurate prediction.

We applied this machine learning program to clinical, demographic, and imaging information from a large group of current and former smokers. We showed that this machine learning approach increases the accuracy of predicting the progression of an individual’s spirometry results over a 5-year period. While future models can still be improved, the proposed random forest model could be helpful in identifying individuals for future studies who are most likely to experience rapid disease progression and benefit from therapeutic interventions.

Patterns and Predictors of Air Cleaner Adherence Among Adults with COPD

Wendy Lorizio, MD, MPH; Han Woo, PhD; Meredith C. McCormack, MD, MHS; Chen Liu, MHS; Nirupama Putcha, MD, MHS; Megan Wood, MS; Timothy Green, BS; Parisa Kaviany, MD; Daniel Belz, MD, MPH; Ashraf Fawzy, MD, MPH; Sara Carson, MD, MHS; Michelle N. Eakin, PhD, MA; Kirsten Koehler, PhD; Nadia N. Hansel, MD, MPH

Poor indoor air quality has been associated with worse chronic obstructive pulmonary disease (COPD) symptoms and effects of the disease. Studies have shown that in-home portable air cleaners reduce indoor pollutants and could improve respiratory health. However, the factors associated with consistently using an air cleaner –referred to as adherence—remains unknown. In this 6-month study of former smokers with COPD, participants were randomly assigned to receive either an active, working portable air cleaner or a sham or fake portable air cleaner. We explored whether characteristics of the individual, their COPD disease severity, and their home environment, including time in the study and season, could be associated with adherence or consistent use of the air cleaner. Information from 109 participants was assessed and 76% used at least 1 air cleaner 80% of the time. Higher annual household income and use of heat pump/electricity for heating were associated with higher adherence or consistent use. Adherence was highest during the first month in the study and lower during winter compared to other seasons. These findings suggest that cold weather season, use of gas for home heating, and lower annual income negatively impact adherence. Addressing factors associated with air cleaner adherence should be considered when designing future environmental studies.

Elastin Degradation and Lung Function Deterioration with Remote Secondhand Tobacco Smoke Exposure in Never-smokers

Jelena Mustra Rakic, PhD; Siyang Zeng, MS; Linnea Rohdin-Bibby, MS; Erin L. Van Blarigan, ScD; Xingjian Liu, PhD; Shuren Ma, PhD; John P. Kane MD, PhD; Rita F. Redberg, MD, MSc; Gerard M. Turino, MD; Eveline Oestreicher Stock, MD; Mehrdad Arjomandi, MD

Despite global efforts to regulate tobacco use, hundreds of millions of people worldwide continue to be exposed to secondhand tobacco smoke. The long-term health effects of exposure to secondhand tobacco smoke have not been well established and are important to study, particularly as the older generations who endured the highest burden of exposure are aging and becoming more prone to harms from such exposures. In this study, we show there is ongoing lung tissue damage associated with worse lung function long after past exposure to secondhand tobacco smoke in a group of individuals who never smoked tobacco directly. These findings suggest that exposure to secondhand tobacco smoke, even if many years in the past, could start a process of lung damage and lung function decline. These findings have important considerations for the treatment and care of aging populations with a history of environmental or occupational exposure to secondhand tobacco smoke.

Effect of Two Interventional Strategies on Improving Continuous Positive Airway Pressure Adherence in Existing COPD and Obstructive Sleep Apnea Patients: The O2VERLAP Study

Sergio Martinez; Jamie Sullivan, MPH; Cara Pasquale, MPH; Bill Clark, BS; Elisha Malanga, BS; Sean Deering; Lin Liu, PhD; Carl J. Stepnowsky, PhD

The O2VERLAP study was a research trial for patients with both chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) who were prescribed continuous positive airway pressure (CPAP) therapy. The study had 2 goals:

· Goal 1: Compare 2 different approaches to helping patients improve how consistently and often they use their CPAP (called adherence). The 2 different plans of support were—a web-based peer-coaching education and support program (proactive care) and education and support based on limited scheduled interactions and patient-initiated contacts (reactive care);

· Goal 2: Compare the effect the 2 different approaches—proactive and reactive—had on daytime functioning, sleep quality, and daytime symptoms—all patient-centered outcomes or results.

The study found no significant differences in change of CPAP adherence between the 2 groups and no differences in patient-centered results/outcomes. A possible explanation for these findings was that the study focused on existing CPAP users and these users’ CPAP adherence levels were higher than typical levels of CPAP use. This high level of CPAP adherence, in patients with both COPD and OSA in this study, is considered an unexpected and novel finding.

Predictors of High Sputum Eosinophils in COPD

Xiang Wen, MD;* Jieqi Peng, MD;* Youlan Zheng, MD;* Jiaxing Liu, MD; Heshen Tian, MD, PhD; Fan Wu, MD; Zihui Wang, MD; Huajing Yang, MD; Zhishan Deng, MD1 Shan Xiao, MD; Peiyu Huang, MD; Jianwu Xu, MD; Cuiqiong Dai, MD; Ningning Zhao, MD; Lifei Lu, MD; Jianwei Dai, PhD; Bing Li, PhD; Pixin Ran, MD, PhD; Yumin Zhou, MD, PhD

*Co-first authors; both authors contributed equally to the work

Eosinophils are white blood cells that are part of the immune system. However, having too many can contribute to the development of disease, including the development of chronic obstructive pulmonary disease (COPD). Recent studies have been focused on blood eosinophils, however, sputum eosinophils have been reported to more directly reflect whether eosinophilic airway inflammation exists and to what extent. Previous studies have shown that individuals with eosinophilic inflammation respond well to inhaled corticosteroid treatment.

Based on this, we conducted a study to explore what clinical factors predict high levels of sputum eosinophils. Our study found that high levels of blood eosinophil levels, severe respiratory symptoms, being a former smoker, and a family history of respiratory diseases may be predictors of high sputum eosinophils in COPD patients. High levels of sputum eosinophils were associated with lower lung function, more emphysema, and gas trapping

To our knowledge, this is the first study to investigate the factors of high sputum eosinophils in Chinese COPD patients. Our findings may assist clinicians in identifying patients with airway eosinophilic inflammation, so as to better guide the use of inhaled corticosteroids.

High Prevalence of Suboptimal Peak Inspiratory Flow in Hospitalized Patients With COPD: A Real-world Study

Donald A. Mahler, MD; Shaban Demirel, PhD; Ramon Hollander, MBA, RRT; Gokul Gopalan, MD, MPH; Asif Shaikh, MD; Cathy D. Mahle, PhD, MBA; Jessica Elder, PhD; Curtis Morrison, RRT

The main treatments for chronic obstructive pulmonary disease (COPD) include inhaled bronchodilators given by metered-dose inhalers, dry powder inhalers, soft mist inhalers, and nebulizers. Some patients with COPD have low peak inspiratory flow which may make it more difficult for them to fully inhale medications, particularly through dry powder inhalers. Peak inspiratory flow can be measured by pulmonary function testing.

We conducted a study to report how common a suboptimal/low peak inspiratory flow is in hospitalized COPD patients using 1 or more dry powder inhalers. Suboptimal/low peak inspiratory flow was found in 44.6% of patients in our single-site study. These results highlight the importance for health care professionals to select the most appropriate delivery system based on each patient’s abilities to inhale deeply.

Predicting COPD Progression in Current and Former Smokers Using a Joint Model for Forced Expiratory Volume in 1 Second and Forced Expiratory Volume in 1 Second to Forced Vital Capacity Ratio

Matthew Strand, PhD; Aastha Khatiwada, PhD; David Baraghoshi, MS; David Lynch, MB; Edwin K. Silverman, MD, PhD; Surya P. Bhatt, MD; Erin Austin, PhD; Elizabeth A. Regan, MD, PhD; Aladin M. Boriek, PhD; James D. Crapo, MD

Understanding factors or issues that can predict changes in lung function in adults with chronic obstructive pulmonary disease (COPD) or even individuals at risk for COPD may help doctors and patients better understand how to manage the disease and help target individuals for specific treatments.

In this article, we present a way of identifying factors to predict the amount of change in lung function that an individual, with certain characteristics, can expect to have over 5 or 10 years. What makes our proposed model unique is that it considers 2 lung function measures at the same time. One measure is used to identify airflow obstruction in the lung (classically used to define whether or not an individual has COPD), and the other measures the degree of airflow obstruction (classically used to measure severity of COPD). Patient characteristics that can predict lung function changes include their baseline or first lung function measures, their current smoking status (still smoking, quit smoking, quit smoking for many years, etc.), their body mass index, whether or not they have chronic bronchitis, and select computed tomography (CT) scan measures.

Chronic Obstructive Pulmonary Disease and Lung Cancer: A Review for Clinicians

Gerard J. Criner, MD; Alvar Agusti, MD; Hossein Borghaei, DO; Joseph Friedberg, MD; Fernando J. Martinez, MD; Curtis Miyamoto, MD; Claus F. Vogelmeier, MD; Bartolome R. Celli, MD

Chronic obstructive pulmonary disease (COPD) and lung cancer can both lead to debilitating disease and death. These diseases share some of the same risk factors and may occur at the same time in individuals at high risk of developing either disease.

Annual chest computed tomography (CT) scans are recommended for some individuals who may be at risk of developing lung cancer. If lesions that may be cancerous are found during this annual screening, a diagnosis of COPD will affect how the lung cancer is confirmed/diagnosed and how it is treated. This review discusses the link between lung cancer and COPD, the epidemiology (how often and why these diseases occur in certain groups of people) of the 2 diseases, as well as the benefits and problems with lung cancer screenings in patients with COPD and who should have these screenings. Finally, it reviews the important risk factors to consider in patients with COPD who must choose among the various options available for the treatment of lung cancer.