Chronic Obstructive Pulmonary Diseases:Journal of the COPD Foundation

Volume 9, Issue 4 - 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.

Varenicline for Gradual Versus Abrupt Smoking Cessation in Poorly Motivated Smokers With COPD: A Prematurely Terminated Randomized Controlled Trial

Abraham Bohadana, MD; Ariel Rokach, MD; Pascal Wild, PhD; Bela Peker; Yossi-Freier Dror, PhD; Polina Babai; Nissim Arish, MD; Gabriel Izbicki, MD

Abruptly quitting smoking or smoking cessation can be difficult to achieve for patients with chronic obstructive pulmonary disease (COPD). This study examined the effectiveness and safety of the drug varenicline, in increasing smoking cessation rates through gradual versus abrupt cessation plans in COPD patients with low motivation to quit smoking.

Smokers with COPD with little motivation to quit were randomly placed in 1 of 2 groups. The gradual cessation group received 6 weeks of varenicline for smoking reduction and a target quit day at the end of week 6. The abrupt cessation group smoked as much as desired for 5 weeks, followed by 1 week of varenicline and had a target quit date at the end of week 6. Thereafter, both groups received varenicline treatment for 12 weeks and a 12-week, non-treatment follow-up (total duration: 30 weeks).

Despite a drug recall issued by the study sponsor, which terminated the study after only 70 of the 240 planned patients had enrolled, the gradual cessation group had significantly better continuous non-smoking rates than the abrupt cessation group . In addition, motivation to quit increased and the number of cigarettes smoked per day decreased in both groups. Respiratory symptoms, but not respiratory function, improved at the end of the study in the 2 groups.

The Effect of Rurality and Poverty on COPD Outcomes in New Hampshire: An Analysis of Statewide Hospital Discharge Data

Jacob S. Warner, DO; Jane M. Bryan; Laura M. Paulin, MD, MHS

Individuals living in rural areas of the United States have worse chronic obstructive lung disease (COPD) outcomes. Using hospital data for the state of New Hampshire, our study compared the differences between more rural counties and urban counties for the rate of COPD exacerbations, the overall length of stay for patients hospitalized with COPD, and the amount of money charged per visit. Our research showed that there were significantly higher COPD exacerbation rates in the rural counties but no difference in the length of stay. Additionally, urban counties had greater charges applied to each exacerbation visit.

This research is important since it shows that in a smaller geographical area such as the state of New Hampshire, rurality is still an independent risk factor for increased COPD exacerbations. Furthermore, our research shows that COPD exacerbations treated at more urban hospitals generally have larger charges. This helps identify areas for further work in reducing COPD exacerbations and areas with potential resource overuse.

Impact of the Coronavirus Disease 2019 Pandemic on Physical and Mental Health of Patients With COPD: Results From a Longitudinal Cohort Study Conducted in the United States (2020-2021)

William Z. Zhang, MD; Stephanie L. LaBedz, MD; Janet T. Holbrook, PhD; Andrew Gangemi, MD; Ramasubramanian Baalachandran, MBBS; Michelle N. Eakin, PhD, MD; Robert A. Wise, MD; Kaharu Sumino, MD, MPH; for the American Lung Association Airways Clinical Research Centers.

Patients with chronic obstructive pulmonary disease (COPD) are at increased risk for adverse outcomes from coronavirus disease 2019 (COVID-19). There is concern that heightened awareness of these risks, along with social restrictions during the COVID-19 pandemic, could have negatively affected the mental and physical health of COPD patients. To determine the pandemic’s impact on this vulnerable population, a cohort of COPD patients enrolled in the Losartan Effects on Emphysema Progression clinical trial were surveyed about their physical and mental health, knowledge and beliefs about COVID-19, and their risk reduction behaviors from June 2020 to April 2021.

Of the 157 enrolled participants, 9 were diagnosed with COVID-19, resulting in 2 hospitalizations. Rates of hospitalization for COPD exacerbations or “flare-ups” were reduced during the study compared to pre-pandemic rates. Levels of moderate to severe anxiety and depression remained low throughout the study, and participants reported strong social support. Participants were well informed about COVID-19 symptoms and how it is spread, and most engaged in behaviors that would reduce their risk of getting the disease. Willingness to receive a COVID-19 vaccine varied throughout the study, but most participants reported receiving at least one vaccine dose by December 2021.

Overall, results indicate a group of clinical trial participants with COPD were successful in coping with the risks and restrictions associated with the COVID-19 pandemic.

Endurance Time During Constant Work Rate Cycle Ergometry in COPD: Development of an Integrated Database From Interventional Studies

Richard Casaburi, PhD, MD; Debora Merrill, MBA; Thomas E. Dolmage, MSc; Judith Garcia-Aymerich, MD, PhD; Malin Fageras, PhD; Roger Goldstein, MD; Gale Harding, MS; Nancy Kline Leidy, PhD; François Maltais, MD; Denis O’Donnell, MD; Janos Porszasz, MD, PhD; Luis Puente-Maestu, PhD, MD; Stephen Rennard, MD; Frank Sciurba, MD; Martijn A. Spruit, PhD, PT; Ruth Tal-Singer, PhD; Kay Tetzlaff, MD; Alex van ’t Hul, PhD; Ren Yu, MA; Alan Hamilton, PhD

Performing activities of daily living is difficult for people living with chronic obstructive pulmonary disease (COPD). We wanted to establish an exercise test that reflects the ability of patients to perform activities of daily living, for use in research studies. We have shown that the ability to continue activities for a longer duration is important to patients, and that this can be measured by the time a patient is able to exercise on a stationary bicycle (exercise time).

As a first step in determining the usefulness of this measure, we combined data from a large number of published studies that included stationary bicycle exercise tests. These studies evaluated exercise responses to either inhaled bronchodilators or exercise training. The resulting database is presented in detail and includes participant characteristics, exercise times, lung function, physiologic responses (such as heart rate and breathing rate), and symptoms (such as shortness of breath).

This unique database provides a review of exercise time during cycling to determine whether it is valid for use in research studies.

Beyond Access: Factors Associated With Spirometry Underutilization Among Patients With a Diagnosis of COPD in Urban Tertiary Care Centers

Arianne K. Baldomero, MD, MS; Ken M. Kunisaki, MD, MS; Ann Bangerter, BS; David B. Nelson, PhD; Chris H. Wendt, MD; Spyridon Fortis, MD; Hildi Hagedorn, PhD; R. Adams Dudley, MD, MBA

Spirometry is a lung function test that is recommended to confirm a diagnosis of chronic obstructive pulmonary disease (COPD). However, only about a third of patients with a diagnosis of COPD have spirometry and this can lead to possible incorrect diagnoses. Other studies have shown that patients without spirometry often lack health insurance and/or their local clinics do not have spirometry testing, but we wanted to look more deeply into other reasons patients are missing spirometry.

Among patients who live in urban cities (and therefore, should have shorter travel) and who receive care in highly specialized Veterans Affairs medical centers (and therefore, should not have insurance or testing barriers), we found that 60% of patients with a diagnosis of COPD received spirometry. In this group who did not have the well-recognized barriers to spirometry testing, patients less likely to receive spirometry included those who were older, had not seen a lung specialist, and had fewer underlying medical conditions.

These factors should be considered in programs to improve spirometry use, reduce COPD misdiagnosis, and improve COPD care.

Patient-Reported Pulmonary Symptoms, Exacerbations, and Management in a Cohort of Patients With Alpha-1 Antitrypsin Deficiency

Radmila Choate, PhD, MPH; Robert A. Sandhaus, MD, PhD; Kristen E. Holm, PhD, MPH; David M. Mannino, MD; Charlie Strange, MD

Individuals with alpha-1 antitrypsin deficiency (AATD)—a genetic condition that increases an individual’s risk of developing emphysema—often experience exacerbations or “flare-ups” of their respiratory symptoms. These events often require a change or increase in regular medications, unplanned doctor visits, or hospitalizations. In this study, we described the perspectives of people with AATD in recognizing changes in their usual respiratory symptoms as exacerbations.

Our study participants were in AlphaNet, a health management organization for people with AATD in the United States. Every month, they were asked about changes in their usual respiratory symptoms, changes in disease management, and whether they considered these events an exacerbation. The most common symptoms were increased shortness of breath, cough, and sputum amount. Participants reported almost half of the events, in which they experienced worsening of respiratory symptoms, as exacerbations. During events that were perceived as exacerbations, they reported being sick for approximately 12 days, often being seen by a physician, and receiving treatment with antibiotics and/or corticosteroids.

This study highlights the importance of patients’ perspectives in recognizing changes in respiratory symptoms as exacerbations.

Health Care Professionals’ Herpes Zoster Awareness and Vaccine Recommendations for Patients with COPD

Barbara P. Yawn, MD, MSc, MSPH; Natalia Y. Loskutova, MD, PhD; Debora D. Merrill, MBA; Sergio Martinez; Elisabeth Callen, PhD; Janice Cotton, MA; Jennifer K. Carroll, MD, MPH; Dennis Williams, PharmD

Shingles affects people with COPD at higher rates than others their age, making it important for their health care teams to recommend shingles vaccination. The ShiPPS study was an online survey of family physicians, pulmonologists, nurse practitioners, and physician assistants. Survey questions asked about: (1) awareness of increased shingles risk and problems in COPD, (2) current U.S shingles vaccination recommendations, and (3) how often and how strongly these health care professionals recommend shingles vaccination. Those not strongly recommending vaccination in people affected by COPD watched a short educational video about shingles and its prevention. After viewing the video, additional questions asked about future plans to recommend shingles vaccination.

Overall, the 1,020 health care professionals reported varying levels of belief that shingles causes enough health risk to recommend vaccination. Pulmonologists reported the lowest level, 25% less than all other groups. Pulmonologists were also the least likely to recommend shingles vaccination according to U.S. guidelines. Watching the video resulted in an increase in plans among all groups for shingles vaccination recommendations. The study highlighted practice improvement opportunities and suggested even a short, 5-minute educational video can result in significant improvement in clinicians’ vaccination intent among people affected by COPD.

Interpreting Evaluating Respiratory Symptoms™ in COPD Diary Scores in Clinical Trials: Terminology, Methods, and Recommendations

Nancy Kline Leidy, PhD; Donald M. Bushnell, MA; Chau Thach, PhD; Carolina Hache, PhD; Florian S. Gutzwiller, MD, MPH

This paper describes the terminology and methods scientists use to develop recommendations for interpreting scores on patient-reported outcome (PRO) measures, with specific reference to the Evaluating Respiratory Symptoms in COPD (E-RS: COPD) diary. PRO measures are standardized questionnaires that provide summary scores representing how patients are experiencing their health condition. These questionnaires can ask people to rate their symptoms, psychological state, quality of life, or other aspects of health. In clinical trials, scores from PRO questionnaires can help scientists and regulators determine the extent to which a given treatment is effective. To do this, scientists compare scores across treatment groups to see if they differ. They also count and compare the number of patients in each group who experienced a meaningful treatment benefit, based on change in scores exceeding a predefined threshold. Thresholds for a meaningful change are specific to each PRO questionnaire, developed through a careful, multi-method scientific process. The information summarized in this paper suggests the recommendations for interpreting E-RS: COPD scores are sound and can be used to design and interpret clinical trials testing the effect of treatment on respiratory symptoms in people with COPD.

Antibody Response to Severe Acute Respiratory Syndrome Coronavirus-2 Vaccination in COPD: A Cohort Study

Éliane Pelletier, MD; Philippe Desmeules, PhD; Yves Lacasse, MD, MSc; Sophie Tanguay, BSc; Julie Milot, MD, PhD; Mathieu C. Morissette, PhD; François Maltais, MD

Vaccination against coronavirus disease 2019 (COVID-19) is the most effective preventive measure to protect against the development of this infectious disease, particularly its severe form. There are, however, certain persons who do not develop protective antibodies following COVID vaccination and in whom this vaccination is less effective. People living with chronic lung disease such as COPD are at risk of complications if they get sick from COVID-19. The focus of our work was to learn if vaccination against COVID-19 is effective in people with COPD. We found that people with COPD tolerate the vaccination against COVID-19 well. The vast majority of them develop protective antibodies against the virus, similarly to people without lung disease. Our findings are very reassuring about the effectiveness of COVID-19 vaccination in people with COPD.