Chronic Obstructive Pulmonary Diseases:Journal of the COPD Foundation

Volume 10, Issue 1 - 2023

Chronic Obstructive Pulmonary Diseases: Journal of the COPD Foundation is an open access, peer-reviewed medical/scientific journal dedicated to publishing original research, reviews, and communications related to COPD. Articles are published online as quickly as possible following peer review and editorial acceptance and then aggregated into quarterly issues, and made available to the COPD medical/research community at no charge. The Journal is indexed by PubMed, PubMed Central, Scopus and Web of Science.

Original Research:

Association of Hoover’s Sign with Maximal Expiratory-to-Inspiratory Pressure Ratio in Patients with COPD

Thomas G. Maloney, DO1* Zachary S. Anderson, DO1 Ashley B. Vincent, DO1 Adam L. Magiera, DO1 Philip C. Slocum, DO2

Author Affiliations

  1. Freeman Health System, Joplin, Missouri, United States
  2. Freeman Lung Institute, Freeman Health System, Joplin, Missouri, United States

* Current Affiliation: Department of Internal Medicine, University of Iowa Health Care, Iowa City, Iowa, United
States

Address correspondence to:

Thomas G. Maloney, DO
Internal Medicine
University of Iowa Health Care
200 Hawkins Dr – SE636 GH
Iowa City, IA 52242
Email: maloneytg@gmail.com

Abstract

Purpose: In chronic obstructive pulmonary disease (COPD) some patients develop paradoxical inspiratory rib motion, which is termed Hoover’s sign. Our objective was to determine whether Hoover’s sign is associated with a difference in the maximal expiratory pressure (MEP), the maximal inspiratory pressure (MIP), the MEP/MIP ratio, and other features on pulmonary function tests (PFTs).

Methods: This observational prospective single-center cohort study enrolled patients with an established diagnosis of COPD with Global initiative for chronic Obstructive Lung Disease (GOLD) stage 3 (severe) and 4 (very severe) based on PFTs. Respiratory pressure measurements were also collected. Patients were examined for the presence or absence of Hoover’s sign on physical examination by 2 internal medicine resident physicians trained in examining for Hoover’s sign by a pulmonologist.

Results: A total of 71 patients were examined for the presence of Hoover’s sign. Hoover’s sign was present in 49.3% of patients. Observer agreement (k statistic) was 0.8 for Hoover’s sign. Median MEP/MIP was significantly greater in patients with Hoover’s sign than those without Hoover’s sign (1.88 versus 1.16, p<0.001). Patients with Hoover’s sign also had a significantly lower MIP (39.0 versus 58.0, p<0.001) and higher residual volume (RV) to total lung capacity (TLC) ratio indicating a higher degree of air trapping (65 versus 59.5, p<0.014).

Conclusion: The presence of Hoover’s sign in patients with COPD is associated with a higher MEP/MIP ratio. This suggests respiratory pressure measurements can predict diaphragm dysfunction in patients with GOLD stage 3 and 4 COPD. Patients with Hoover’s sign were also found to have a lower MIP and more air trapping.

Citation

Citation: Maloney TG, Anderson ZS, Vincent AB, Magiera AL, Slocum PC. Association of Hoover’s sign with maximal expiratory-to-inspiratory pressure ratio in patients with COPD. Chronic Obstr Pulm Dis. 2023; 10(1): 1-6. doi: http://dx.doi.org/10.15326/jcopdf.2022.0341

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Novel SERPINA1 Alleles Identified Through a Large Alpha-1 Antitrypsin Deficiency Screening Program and Review of Known Variants

Gayle S. Wiesemann, BS1 Regina A. Oshins, BS2 Tammy O. Flagg, MB, MT2 Mark L. Brantly, MD2

Author Affiliations

  1. University of Florida College of Medicine, Gainesville, Florida, United States
  2. Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Florida, Gainesville, Florida, United States

Address correspondence to:

Mark L. Brantly, MD
1600 SW Archer Rd, Rm M331
Gainesville, FL, 32610
Phone: (352) 294-5116
Email: mbrantly@ufl.edu

Abstract

The SERPINA1 gene encodes the serine protease inhibitor alpha-1 antitrypsin (AAT) and is located on chromosome 14q31-32.3 in a cluster of homologous genes likely formed by exon duplication. AAT has a variety of anti-inflammatory properties. Its clinical relevance is best illustrated by the genetic disease alpha-1 antitrypsin deficiency (AATD) which is associated with an increased risk for chronic obstructive pulmonary disease (COPD) and cirrhosis. While 2 single nucleotide polymorphisms (SNPs) , S and Z, are responsible for more than 95% of all individuals with AATD, there are a number of rare variants associated with deficiency and dysfunction, as well as those associated with normal levels and function. Our laboratory has identified a number of novel AAT alleles that we report in this manuscript. We screened more than 500,000 individuals for AATD alleles through our testing program over the past 20 years. The characterization of these alleles was accomplished by DNA sequencing, measurement of AAT plasma levels and isoelectric focusing at pH 4-5. We report 22 novel AAT alleles discovered through our screening programs, such as Zlittle rock and QOchillicothe, and review the current literature of known AAT genetic variants.

Citation

Citation: Wiesemann GS, Oshins RA, Flagg TO, Brantly ML. Novel SERPINA1 alleles identified through a large alpha-1 antitrypsin deficiency screening program and review of known variants. Chronic Obstr Pulm Dis. 2023; 10(1): 7-21. doi: http://dx.doi.org/10.15326/jcopdf.2022.0321

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Urine and Plasma Markers of Platelet Activation and Respiratory Symptoms in COPD

Ashraf Fawzy, MD, MPH1 Nirupama Putcha, MD, MHS1 Sarath Raju, MD, MPH1 Han Woo, PhD1 Cheng Ting Lin, MD2 Robert H. Brown, MD, MPH2,3 Marlene S. Williams, MD4 Nauder Faraday, MD, MPH3 Meredith C. McCormack, MD, MHS1 Nadia N. Hansel, MD, MPH1

Author Affiliations

  1. Division of Pulmonary and Critical Care, Johns Hopkins University, Baltimore, Maryland, United States
  2. Department of Radiology, Johns Hopkins University, Baltimore, Maryland, United States
  3. Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, United States
  4. Division of Cardiology, Johns Hopkins University, Baltimore, Maryland, United States

Address correspondence to:

Ashraf Fawzy, MD, MPH
5501 Hopkins Bayview Circle
Baltimore MD, 21224
Phone: (410) 550-6305
Email: afawzy1@jhmi.edu

Abstract

Introduction: Antiplatelet therapy has been associated with fewer exacerbations and reduced respiratory symptoms in chronic obstructive pulmonary disease (COPD). Whether platelet activation is associated with respiratory symptoms in COPD is unknown.

Methods: Former smokers with spirometry-confirmed COPD had urine 11-dehydro-thromboxane B2 (11dTxB2), plasma soluble CD40L (sCD40L), and soluble P-selectin (sP-selectin) repeatedly measured during a 6- to 9-month study period. Multivariate mixed-effects models adjusted for demographics, clinical characteristics, and medication use evaluated the association of each biomarker with respiratory symptoms, health status, and quality of life.

Results: Among 169 participants (average age 66.5±8.2 years, 51.5% female, 47.5±31 pack years, forced expiratory volume in 1 second percent predicted 53.8±17.1), a 100% increase in 11dTxB2 was associated with worse respiratory symptoms reflected by higher scores on the COPD Assessment Test (β 0.77, 95% confidence interval [CI]: 0.11–1.4) and Ease of Cough and Sputum Clearance Questionnaire β 0.77, 95%CI: 0.38–1.2, worse health status (Clinical COPD Questionnaire β 0.13, 95%CI: 0.03-0.23) and worse quality of life (St George’s Respiratory Questionnaire β 1.9, 95%CI: 0.39-3.4). No statistically significant associations were observed for sCD40L or sP-selectin. There was no consistent statistically significant effect modification of the relationship between urine 11dTxB2 and respiratory outcomes by history of cardiovascular disease, subclinical coronary artery disease, antiplatelet therapy, or COPD severity.

Conclusions: In stable moderate-severe COPD, elevated urinary11dTxB2, a metabolite of the platelet activation product thromboxane A2, was associated with worse respiratory symptoms, health status, and quality of life.

Citation

Citation: Fawzy A, Putcha N, Raju S, et al. Urine and plasma markers of platelet activation and respiratory symptoms in COPD. Chronic Obstr Pulm Dis. 2023; 10(1): 22-32. doi: http://dx.doi.org/10.15326/jcopdf.2022.0326

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Mortality Risk and Serious Cardiopulmonary Events in Moderate-to-Severe COPD: Post Hoc Analysis of the IMPACT Trial

J. Michael Wells, MD1 Gerard J. Criner, MD2 David M.G. Halpin, MD3 MeiLan K. Han, MD4 Renu Jain, PhD5 Peter Lange, MD6,7 David A. Lipson, MD8,9 Fernando J. Martinez, MD10 Dawn Midwinter, MSc11 Dave Singh, MD12 Robert A. Wise, MD13

Author Affiliations

  1. Division of Pulmonary, Allergy, and Critical Care Medicine, Lung Health Center, University of Alabama at Birmingham, Birmingham, Alabama, United States
  2. Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, United States
  3. University of Exeter Medical School, University of Exeter, Exeter, United Kingdom
  4. Pulmonary and Critical Care, University of Michigan, Ann Arbor, Michigan, United States
  5. GSK, Research Triangle Park, North Carolina, United States
  6. Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
  7. Pulmonary Section, Medical Department, Herlev-Gentofte Hospital, Herlev, Denmark
  8. GSK, Collegeville, Pennsylvania, United States
  9. Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
  10. New York-Presbyterian Weill Cornell Medical Center, New York, New York, United States
  11. GSK, Brentford, United Kingdom
  12. Centre for Respiratory Medicine and Allergy, Institute of Inflammation and Repair, Manchester Academic Health Science Centre, The University of Manchester, Manchester University NHS Foundation Hospital Trust, Manchester, United Kingdom
  13. Johns Hopkins University School of Medicine, Baltimore, Maryland, United States

Address correspondence to:

J. Michael Wells, MD
Division of Pulmonary, Allergy, and Critical Care Medicine
Lung Health Center
University of Alabama at Birmingham
Birmingham, AL
Phone: (205) 934-6047
Email: jmwells@uabmc.edu

Abstract

Background: In the InforMing the Pathway of COPD Treatment (IMPACT) trial, single-inhaler fluticasone furoate (FF) /umeclidinium (UMEC) /vilanterol (VI) significantly reduced severe exacerbation rates and all-cause mortality (ACM) risk versus UMEC/VI among patients with chronic obstructive pulmonary disease (COPD). This post hoc analysis aimed to define the risk of ACM during and following a moderate/severe exacerbation, and further determine the benefit-risk profile of FF/UMEC/VI versus FF/VI and UMEC/VI using a cardiopulmonary composite adverse event (AE) endpoint.

Methods: The 52-week, double-blind IMPACT trial randomized patients with symptomatic COPD and ≥1 exacerbation in the prior year 2:2:1 to once-daily FF/UMEC/VI 100/62.5/25mcg, FF/VI 100/25mcg, or UMEC/VI 62.5/25mcg. Post hoc endpoints included the risk of ACM during, 1–90 and 91–365 days post moderate or severe exacerbation and time-to-first cardiopulmonary composite event.

Results: Of the 10,355 patients included, 5034 (49%) experienced moderate/severe exacerbations. Risk of ACM was significantly increased during a severe exacerbation event compared with baseline (hazard ratio [HR]: 41.22 [95% confidence interval (CI) 26.49–64.15]; p<0.001) but not significantly different at 1–90 days post-severe exacerbation (HR: 2.13 [95% CI: 0.86–5.29]; p=0.102). Moderate exacerbations did not significantly increase the risk of ACM during or after an exacerbation. Cardiopulmonary composite events occurred in 647 (16%), 636 (15%), and 356 (17%) patients receiving FF/UMEC/VI, FF/VI, and UMEC/VI, respectively; FF/UMEC/VI significantly reduced cardiopulmonary composite event risk versus UMEC/VI by 16.5% (95% CI: 5.0–26.7; p=0.006).

Conclusion: Results confirm a substantial mortality risk during severe exacerbations, and an underlying CV risk. FF/UMEC/VI significantly reduced the risk of a composite cardiopulmonary AE versus UMEC/VI.

Clinical Trial Registration: GSK (CTT116855/NCT02164513).

Citation

Citation: Wells JM, Criner GJ, Halpin DMG, et al. Mortality risk and serious cardiopulmonary events in moderate-to-severe COPD: post hoc analysis of the IMPACT trial. Chronic Obstr Pulm Dis. 2023; 10(1): 33-45. doi: http://dx.doi.org/10.15326/jcopdf.2022.0332

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Primary Care Provider Experience With Proactive E-Consults to Improve COPD Outcomes and Access to Specialty Care

Laura J. Spece, MD, MS1,2,3* William G. Weppner, MD, MPH3,4* Bryan J. Weiner, PhD5,6 Margaret Collins, PhD1 Rosemary Adamson, MB, BS2 Douglas B. Berger, MD, MLitt2,3 Karin M. Nelson, MD, MSHS1,2,3 Jennifer McDowell, BS1 Eric Epler, BS1 Paula G. Carvalho, MD3,4 Deborah M. Woo, PharmD2 Lucas M. Donovan, MD, MS1,2,3 Laura C. Feemster, MD, MS1,2,3 David H. Au, MD, MS1,2,3 George Sayre, PsyD1,5

Author Affiliations

  1. Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, Washington, United States
  2. VA Puget Sound Health Care System, Seattle, Washington, United States
  3. Department of Medicine, University of Washington, Seattle, Washington, United States
  4. Boise VA Medical Center, Boise, Idaho, United States
  5. Department of Health Services, University of Washington, Seattle, Washington, United States
  6. Department of Global Health, University of Washington, Seattle, Washington, United States

*Co-first authors, listed alphabetically

Address correspondence to:

Laura J. Spece, MD, MS
HSR&D MS 152
1660 S. Columbian Way
Seattle, WA 98108
Phone: (206) 277-6779
Email: spece@uw.edu

Abstract

Background: Often patients with chronic obstructive pulmonary disease (COPD) receive poor quality care with limited access to pulmonologists. We tested a novel intervention, INtegrating Care After Exacerbation of COPD (InCasE), that improved patient outcomes after hospitalization for COPD. InCasE used population-based identification of patients for proactive e-consultation by pulmonologists, and tailored recommendations with pre-populated orders timed to follow-up with primary care providers (PCPs). Although adoption by PCPs was high, we do not know how PCPs experienced the intervention.

Objective: Our objective was to assess PCPs’ experience with proactive pulmonary e-consults after hospitalization for COPD.

Methods: We conducted a convergent mixed methods study among study PCPs at 2 medical centers and 10 outpatient clinics. PCPs underwent semi-structured interviews and surveys. We performed descriptive analyses on quantitative data and inductive and deductive coding based on prespecified themes of acceptability, appropriateness, and feasibility for qualitative data.

Key Results: We conducted 10 interviews and 37 PCPs completed surveys. PCPs perceived InCasE to be acceptable and feasible. Facilitators included the proactive consult approach to patient identification and order entry. PCPs also noted the intervention was respectful and collegial. PCPs had concerns regarding appropriateness related to an unclear role in communicating recommendations to patients. PCPs also noted a potential decrease in autonomy if overused.

Conclusion: This evaluation indicates that a proactive e-consult intervention can be deployed to collaboratively manage the health of populations with COPD in a way that is acceptable, appropriate, and feasible for primary care. Lessons learned from this study suggest the intervention may be transferable to other settings and specialties.

Citation

Citation: Spece LJ, Weppner WG, Weiner BJ, et al. Primary care provider experience with proactive e-consults to improve COPD outcomes and access to specialty care. Chronic Obstr Pulm Dis. 2023; 10(1): 46-54. doi: http://dx.doi.org/10.15326/jcopdf.2022.0357

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A Model to Predict Residual Volume from Forced Spirometry Measurements in Chronic Obstructive Pulmonary Disease

John W. Evankovich, MD1 S.M. Nouraie, MD1 Frank C. Sciurba, MD1

Author Affiliations

  1. Division of Pulmonary Allergy and Critical Care Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States

Address correspondence to:

Frank C. Sciurba, MD
The University of Pittsburgh
3471 Fifth Avenue
Suite 1211, Kaufmann Bldg.
Pittsburgh, PA 15213
Phone: (412) 648-6494
Email : sciurbafc@upmc.edu

Abstract

Background: Lung hyperinflation with elevated residual volume (RV) is associated with poor prognosis in adults with chronic obstructive pulmonary disease (COPD) and is a critical criterion for lung volume reduction selection. Here, we proposed that patterns within spirometric measures could represent the degree of hyperinflation.

Methods: Fractional polynomial multivariate regression was used to develop a prediction model based on age, biological sex, forced expiratory volume in 1 second (FEV1), and forced vital capacity (FVC) to estimate plethysmography measured RV in patients in the Pittsburgh Specialized Center for Clinically Oriented Research (SCCOR) cohort (n=450). Receiver operating characteristic area under the curve (ROC-AUC) and optimal cut-points from the model were identified. The model was validated in a separate cohort (n=793).

Results: The best fit model: RV %est=[FVC %predicted] x 3.46-[FEV1/FVC] x 179.80- [FVC % (sqrt)] x 79.53-[age] x 0.98- [sex] x 10.88 + 737.06, where [sex], m=1. R2 of observed versus %predicted RV was 0.71. The optimal cut-point to predict an RV % >175% was 161. At this cut-point, ROC-AUC was 0.95, with a sensitivity 0.95, specificity 0.86, positive predictive value (PPV) of 97%, negative predictive value (NPV) of 76%, positive likelihood ratio (LR) of 6.6, and negative LR of 0.06. In a validation cohort of COPD patients (n=793), the model performed similarly, with a sensitivity of 0.82, specificity of 0.83, PPV of 85%, NPV of 79%, positive LR of 4.7, and negative LR of 0.21.

Conclusions: In patients with COPD, a model using only spirometry, age, and biological sex can estimate elevated RV. This tool could facilitate the identification of candidates for lung volume reduction procedures and can be integrated into existing epidemiologic databases to investigate the clinical impact of hyperinflation.

Citation

Citation: Evankovich JW, Nouraie SM, Sciurba FC. A model to predict residual volume from forced spirometry measurements in chronic obstructive pulmonary disease. Chronic Obstr Pulm Dis. 2023; 10(1): 55-63. doi: http://dx.doi.org/10.15326/jcopdf.2022.0354

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Persistent Steroid Exposure Before Coronavirus Disease 2019 Diagnosis and Risk of Hospitalization in Patients With Chronic Obstructive Pulmonary Disease

Laura C. Myers, MD, MPH1,2 Richard K. Murray, MD3 Bonnie M.K. Donato, PhD4 Vincent X. Liu, MD, MSc1,2 Patricia Kipnis, PhD1,2 Asif Shaikh, MD, DrPH5 Jessica Franchino-Elder, PhD, MPH4

Author Affiliations

  1. The Permanente Medical Group, Kaiser Permanente Northern California, Oakland, California, United States
  2. Division of Research, Kaiser Permanente Northern California, Oakland, California, United States
  3. Spire Health, San Francisco, California, United States
  4. Health Economics and Outcomes Research, Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, Connecticut, United States
  5. Clinical Development and Medical Affairs, Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, Connecticut, United States

Address correspondence to:

Laura C. Myers, MD, MPH
Division of Research
Kaiser Permanente Northern California
2000 Broadway
Oakland, California 94612
Email: laura.c.myers@kp.org
Phone: (925) 433-3491

Abstract

Background: It is unclear whether persistent inhaled steroid exposure in chronic obstructive pulmonary disease (COPD) patients before coronavirus disease 2019 (COVID-19) is associated with hospitalization risk.

Objective: Our objective was to examine the association between persistent steroid exposure and COVID-19–related hospitalization risk in COPD patients.

Study Design and Methods: This retrospective cohort study used electronic health records from the Kaiser Permanente Northern California health care system (February 2, 2020, to September 30, 2020) for patients aged ≥40 years with COPD and a positive polymerase chain reaction test result for COVID-19. Primary exposure was persistent oral and/or inhaled steroid exposure defined as ≥6 months of prescriptions filled in the year before the COVID-19 diagnosis. Multivariable logistic regression was performed for the primary outcome of COVID-19–related hospitalization or death/hospice referral. Steroid exposure in the month before a COVID-19 diagnosis was a covariate.

Results: Of >4.3 million adults, 697 had COVID-19 and COPD, of whom 270 (38.7%) had COVID-19–related hospitalizations. Overall, 538 (77.2%) were neither exposed to steroids in the month before COVID-19 diagnosis nor persistently exposed; 53 (7.6%) were exposed in the month before but not persistently; 23 (3.3%) were exposed persistently but not in the month before; and 83 (11.9%) were exposed both persistently and in the month before. Adjusting for all confounders including steroid use in the month before, the odds ratio for hospitalization was 0.77 (95% confidence interval 0.41–1.46) for patients persistently exposed to steroids before a COVID-19 diagnosis.

Interpretation: No association was observed between persistent steroid exposure and the risk of COVID-19–related hospitalization in COPD patients.

Citation

Citation: Myers LC, Murray RK, Donato BMK, et al. Persistent steroid exposure before coronavirus disease 2019 diagnosis and risk of hospitalization in patients with chronic obstructive pulmonary disease. Chronic Obstr Pulm Dis. 2023; 10(1): 64-76. doi: http://dx.doi.org/10.15326/jcopdf.2022.0351

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The Influence of Provider Connectedness on Continuity of Care and Hospital Readmissions in Patients With COPD: A Claims Data-Based Social Network Study

Johanna Forstner, MSc1 Jan Koetsenruijter, PhD1 Christine Arnold, MSc1 Gunter Laux, PhD1 Michel Wensing, PhD1

Author Affiliations

  1. Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany

Address correspondence to:

Johanna Forstner, MSc
Department of General Practice and Health Services Research
University Hospital Heidelberg
Im Neuenheimer Feld 130.3
69120 Heidelberg, Germany
Phone: 0049 6221 5635559
Email: jmforstner@gmail.com

Abstract

Background: Hospital readmission rates are very high in patients with chronic obstructive pulmonary disease (COPD). Continuity of care (CoC) with general practitioners (GPs) and ambulatory specialists can impact readmission rates. This study aimed to identify shared patient networks of ambulatory care physicians and to examine the effect of provider connectedness on CoC and hospital readmissions.

Methods: A retrospective observational study was conducted in claims data from the years 2016 to 2018 in patients with COPD (aged 40 years or older; hospital stay in 2017). Linkages between GPs, pneumologists, and cardiologists were determined on the basis of shared patients. Multilevel regression models were used to analyze the impact of provider connectedness, operationalized by several social network characteristics, on continuity of care (sequential continuity [SECON] index) and hospital readmission rates.

Results: A total of 7294 patients linked to 3673 GPs were available for analysis. Closeness centrality (β=- 0.029) and the external-internal (EI)-index (β =0.037) impacted on the SECON index. The EI-index (odds ratio [OR]=1.25) and degree centrality (OR=1.257) impacted 30-day readmission. Network density (OR=0.811) and the SECON index (OR=1.121) affected the likelihood of a 90-day readmission. None of the predictors had a significant impact on 180-day and 365-day readmissions.

Conclusions: Ambulatory care providers’ connectedness showed some effects on hospital readmissions and CoC in patients with COPD up to 90 days after hospital discharge, but the additional predictive power is limited.

Citation

Citation: Forstner J, Koetsenruijter J, Arnold C, Laux G, Wensing M. The influence of provider connectedness on continuity of care and hospital readmissions in patients with COPD: a claims data-based social network study. Chronic Obstr Pulm Dis. 2023; 10(1): 77-88. doi: http://dx.doi.org/10.15326/jcopdf.2022.0359

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Physical Activity and Symptom Burden in COPD: The Canadian Obstructive Lung Disease Study

Loes Oostrik, MSc1 Jean Bourbeau, MD, MSc2,3,4 Dany Doiron, PhD2,3 Bryan Ross, MD, MSc4 Pei Zhi-Li, MSc2,3 Shawn D. Aaron, MD5 Kenneth R. Chapman, MD, MSc 6 Paul Hernandez, MDCM 7 François Maltais, MD8 Darcy D. Marciniuk, MD 9 Denis O’Donnell, MD10 Wan C. Tan, MD 11 Don D. Sin, MD, MPH11 Brandie Walker, MD, PhD 12 Tania Janaudis-Ferreira, PhD, MSc2,3,13

Author Affiliations

  1. Physical Therapy Sciences, Program in Clinical Health Sciences, University Medical Center Utrecht, Utrecht University, Netherlands
  2. Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
  3. Respiratory Epidemiology and Clinical Research Unit, Research Institute, McGill University Health Center, Montreal, Quebec, Canada
  4. Montreal Chest Institute, McGill University Health Centre, Montreal, Quebec, Canada
  5. Ottawa Hospital Research Institute, Ottawa University, Ottawa, Canada
  6. Toronto General Hospital Research Institute, University of Toronto, Toronto, Canada
  7. Division of Respirology, Faculty of Medicine, Dalhousie University, Halifax, Canada
  8. Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Quebec, Canada
  9. Respiratory Research Centre, University of Saskatchewan, Saskatoon, Canada
  10. Division of Respiratory and Critical Care Medicine, Queen's University, Kingston, Canada
  11. Centre for Heart Lung Innovation, University of British Columbia, St Paul's Hospital, Vancouver, Canada
  12. Department of Medicine, University of Calgary, Alberta, Canada
  13. School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada

Address correspondence to:

Tania Janaudis-Ferreira, PhD
McGill University
3630 Promenade Sir-William Osler
Montreal, QC, CAN H3G1Y5
Email: tania.janaudis-ferreira@mcgill.ca

Abstract

Background: The relationship between symptom burden and physical activity (PA) in chronic obstructive pulmonary disease (COPD) remains poorly understood with limited data on undiagnosed individuals and those with mild to moderate disease.

Objective: The primary objective was to evaluate the relationship between symptom burden and moderate-to-vigorous intensity PA (MVPA) in individuals from a random population-based sampling mirroring the population at large.

Methods: Baseline participants of the Canadian Cohort Obstructive Lung Disease (n=1558) were selected for this cross-sectional sub-study. Participants with mild COPD (n=406) and moderate COPD (n=331), healthy individuals (n=347), and those at risk of developing COPD (n=474) were included. The Community Healthy Activities Model Program for Seniors (CHAMPS) questionnaire was used to estimate MVPA in terms of energy expenditure. High symptom burden was classified using the COPD Assessment Test ([CAT] ≥10).

Results: Significant associations were demonstrated between high symptom burden and lower MVPA levels in the overall COPD sample (β=-717.09; 95% confidence interval [CI]=-1079.78, -354.40; p<0.001) and in the moderate COPD subgroup (β=-694.1; 95% CI=-1206.54, -181.66; p=0.006). A total of 72% of the participants with COPD were previously undiagnosed. The undiagnosed participants had significantly higher MVPA than those with physician diagnosed COPD (β=-592.41 95% CI=-953.11, -231.71; p=0.001).

Conclusion: MVPA was found to be inversely related to symptom burden in a large general population sample that included newly diagnosed individuals, most with mild to moderate COPD. Assessment of symptom burden may help identify patients with lower MVPA, especially for moderate COPD and for relatively inactive individuals with mild COPD.

Citation

Citation: Oostrik L, Bourbeau J, Doiron D, et al. Physical activity and symptom burden in COPD: the Canadian Obstructive Lung Disease study. Chronic Obstr Pulm Dis. 2023; 10(1): 89-101. doi: http://dx.doi.org/10.15326/jcopdf.2022.0349

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Ambient Air Pollution Exposure and Sleep Quality in COPD

Mudiaga O. Sowho, MD, MPH1 Abigail L. Koch, MD2 Nirupama Putcha, MD, MHS1 Han Woo, PhD1 Amanda Gassett, MS3 Laura M. Paulin, MD, MHS4 Kirsten Koehler, PhD5 R. Graham Barr, MD6 Alejandro P. Comellas, MD7 Christopher B. Cooper, MD, PhD8 Igor Barjaktarevic, MD8 Michelle R. Zeidler, MD8 Martha E. Billings, MD, MS3 Russell P. Bowler, MD, MPH9 MeiLan K. Han, MD, MS10 Victor Kim, MD11 Robert Paine III, MD12 Trisha M. Parekh, DO, MSPH13 Jerry A. Krishnan, MD, PhD14 Stephen P. Peters, MD, PhD15 Prescott G. Woodruff, MD, MPH16 Aaron M. Baugh, MD16 Joel D. Kaufman, MD, MPH3 David Couper, PhD17 Nadia N. Hansel, MD, MPH1

Author Affiliations

  1. Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, United States
  2. Leonard M. Miller School of Medicine, University of Miami, Miami, Florida, United States
  3. Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, Washington, United States
  4. Department of Medicine, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, United States
  5. Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States
  6. Department of Medicine, Columbia University Medical Center, New York, New York, United States
  7. Division of Pulmonary, Critical Care, and Occupational Medicine, College of Medicine, University of Iowa, Iowa City, Iowa, United States
  8. Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California Los Angeles, Los Angeles, California, United States
  9. Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, Colorado, United States
  10. Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan, United States
  11. Division of Pulmonary and Critical Care Medicine, Department of Medicine, Temple University School of Medicine, Philadelphia, Pennsylvania, United States
  12. Division of Respiratory, Critical Care and Occupational Medicine, University of Utah, Salt Lake City, Utah, United States
  13. Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
  14. Division of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois at Chicago, Chicago, Illinois, United States
  15. Section on Pulmonary, Critical Care, Allergy and Immunologic Diseases, Wake Forest University, Winston-Salem, North Carolina, United States
  16. Division of Pulmonary, Critical Care and Sleep Medicine, University of California San Francisco, San Francisco, California, United States
  17. Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States

Address correspondence to:

Mudiaga Sowho, MD, MPH
5501 Hopkins Bayview Circle, JHAAC
Baltimore, MD
Email: msowho1@jhmi.edu
Phone: (410) 550-6264

Abstract

Rationale: Ambient air pollution exposure is associated with respiratory morbidity among individuals with chronic obstructive pulmonary disease (COPD), particularly among those with concomitant obesity. Although people with COPD report high incidence of poor sleep quality, no studies have evaluated the association between air pollution exposure, obesity, and sleep disturbances in COPD.

Methods: We analyzed data collected from current and former smokers with COPD enrolled in the Subpopulations and Intermediate Outcome Measures in COPD -Air Pollution ancillary study (SPIROMICS AIR). Socio-demographics and anthropometric measurements were collected, and 1-year mean historical ambient particulate matter (PM2.5) and ozone concentrations at participants’ residences were estimated by cohort-specific spatiotemporal modeling. Sleep quality was assessed with the Pittsburgh Sleep Quality Index (PSQI), and regression models were constructed to determine the association of 1-year PM2.5 (1Yr-PM2.5) and 1-year ozone (1Yr-ozone) with the PSQI score, and whether obesity modified the association.

Results: In 1308 participants (age: 65.8±7.8 years, 42% women), results of regression analyses suggest that each 10µg/m3 increase in 1Yr-PM2.5 was associated with a 2.1-point increase in PSQI (P=0.03). Obesity modified the association between 1Yr-PM2.5 and PSQI (P=0.03). In obese and overweight participants, a 10µg/m3 increase in 1Yr-PM2.5 was associated with a higher PSQI (4.0 points, P<0.01, and 3.4 points, P<0.01, respectively); but no association in lean-normal weight participants (P=0.51). There was no association between 1 Yr-ozone and PSQI.

Conclusion: Overweight and obese individuals with COPD appear to be susceptible to the effects of ambient PM2.5 on sleep quality. In COPD, weight and ambient PM2.5 may be modifiable risk factors to improve sleep quality.

Citation

Citation: Sowho MO, Koch AL, Putcha N, et al. Ambient air pollution exposure and sleep quality in COPD. Chronic Obstr Pulm Dis. 2023; 10(1): 102-111. doi: http://dx.doi.org/10.15326/jcopdf.2022.0350

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Associations Between Muscle Weakness and Clinical Outcomes in Current and Former Smokers

Richard H. Zou, MD1 S. Mehdi Nouraie, MD, PhD1 Harry B. Rossiter, PhD2 Merry-Lynn McDonald, PhD, MS3 Dawn L. DeMeo, MD, MPH4 Stefanie Mason, MD4 George R. Washko, MD4 Punam K. Saha, PhD5 Barry J. Make, MD6 Richard Casaburi, PhD, MD2 Elizabeth A. Regan, MD, PhD6 Jessica Bon, MD, MS1,7 for the COPDGene Investigators

Author Affiliations

  1. Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
  2. The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California, United States
  3. Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
  4. Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States
  5. Department of Radiology, University of Iowa, Iowa City, Iowa, United States
  6. Department of Medicine, National Jewish Health, Denver, Colorado, United States
  7. Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, United States

Address correspondence to:

Jessica Bon, MD, MS
UPMC Montefiore Hospital, NW628
3459 Fifth Avenue
Pittsburgh, PA 15213
Email: bonjm@upmc.edu

Abstract

Introduction: Smokers with chronic obstructive pulmonary disease (COPD) are at increased risk of muscle weakness. There are limited data describing weakness in smokers with normal spirometry and preserved ratio-impaired spirometry (PRISm), 2 subgroups at risk of respiratory symptom burden and activity limitations. In this study, we evaluated the associations of 2 weakness measures, sit-to-stand (STS) and handgrip strength (HGS), with clinical outcomes in smokers with COPD, normal spirometry, and PRISm.

Methods: We evaluated 1972 current and former smokers from the COPD Genetic Epidemiology (COPDGene®) cohort with STS and HGS measurements at their 10-year study visit. Multivariable regression modeling was used to assess associations between weakness measures and the 6-minute walk distance (6MWD) test, the St George’s Respiratory Questionnaire (SGRQ), the Short-Form-36 (SF-36), severe exacerbations, and prospective mortality, reported as standardized coefficients (β), odds ratios (ORs), or hazard ratios (HRs).

Results: Compared with HGS, STS was more strongly associated with the 6MWD (β=0.45, p<0.001 versus. β=0.25, p<0.001), SGRQ (β=-0.24, p<0.001 versus β=-0.18, p<0.001), SF-36 Physical Functioning (β=0.36, p<0.001 versus β=0.25, p<0.001), severe exacerbations (OR 0.95, p=0.04 versus OR 0.97, p=0.01), and prospective mortality (HR 0.83, p=0.001 versus HR 0.94, p=0.03). Correlations remained after stratification by spirometric subgroups. Compared with males, females had larger magnitude effect sizes between STS and clinical outcomes.

Conclusions: STS and HGS are easy to perform weakness measures that provide important information about functional performance, health-related quality of life, severe exacerbations, and survival in smokers, regardless of spirometric subgroup. This iterates the importance of screening current and former smokers for weakness in the outpatient setting.

Citation

Citation: Zou RH, Nouraie M, Rossiter HB, et al. Associations between muscle weakness and clinical outcomes in current and former smokers. Chronic Obstr Pulm Dis. 2023; 10(1): 112-121. doi: http://dx.doi.org/10.15326/jcopdf.2022.0365

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Brief Report:

Common Respiratory Pathogens Other Than Haemophilus in Small Airways Are Associated With Neutrophilic Inflammation and Poor Health Status in Stable COPD Patients

Nawaf M. Alotaibi, MD, MSc1,2 Sheena Tam, BSc1 Stephan F. van Eeden, MD1 Tawimas Shaipanich, MD3,4 Stephen Lam, MD3,4 Janice M. Leung, MD1,3 Don D. Sin, MD, MPH1,3

Author Affiliations

  1. Centre for Heart Lung Innovation, James Hogg Research Centre, St. Paul’s Hospital, Vancouver, British Columbia, Canada
  2. Division of Pulmonary Medicine, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
  3. Division of Respiratory Medicine, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
  4. British Columbia Cancer Agency, Vancouver, British Columbia, Canada

Address correspondence to:

Don D. Sin, MD, MPH
St. Paul’s Hospital, Room 8446
Vancouver, BC, V6Z 1Y6, Canada
Phone: (604) 806-8346
Email: Don.Sin@hli.ubc.ca

Abstract

This article does not contain an abstract.

Citation

Citation: Alotaibi NM, Tam S, van Eeden SF, et al. Common respiratory pathogens other than haemophilus in small airways are associated with neutrophilic inflammation and poor health status in stable COPD patients. Chronic Obstr Pulm Dis. 2023; 10(1): 122-126. doi: http://dx.doi.org/10.15326/jcopdf.2022.0338

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