Chronic Obstructive Pulmonary Diseases:Journal of the COPD Foundation

Volume 10, Issue 2 - 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:

Impact of Coronavirus Disease 2019-Related Infection Prevention and Control Measures on the Occurrence of COPD Exacerbations During Inpatient Pulmonary Rehabilitation

Kiki Waeijen-Smit, MSc1,2 Sarah Houben-Wilke, PhD1 Rein Posthuma, MD1,2 Fenne de Jong, BSc1 Daisy J. A. Janssen, PhD, MD1,3 Nicole P. H. van Loon, MD1,4 Bita Hajian, PhD, MD1,2 Sami O. Simons, PhD, MD2 Martijn A. Spruit, PhD1,2 Frits M. E. Franssen, PhD, MD1,2

Author Affiliations

  1. Department of Research and Development, Ciro, Horn, the Netherlands
  2. Department of Respiratory Medicine, School of Nutrition and Translational Research in Metabolism, Faculty of Health Medicine and Life Sciences, Maastricht University Medical Centre, Maastricht, the Netherlands
  3. Department of Health Services Research, Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
  4. Department of Internal Medicine, Maastricht University Medical Center, Maastricht, the Netherlands

Address correspondence to:

Kiki Waeijen-Smit, MSc
Ciro
Department of Research and Development
P.O. Box 4009
6080 AA Haelen, the Netherlands
Email: KikiSmit@ciro-horn.nl
Phone: 31 (0) 475 587 602

Abstract

Rationale: A significant reduction in hospitalizations for acute exacerbations of COPD (AECOPDs) has been reported during the coronavirus disease 2019 (COVID-19) pandemic. It remains unclear whether this reduction is the result of health care avoidance by patients, or of infection prevention and control (IPC) measures.

Objectives: Our objective was to explore the impact of COVID-19–related IPC measures on the occurrence of AECOPD in a real-life inpatient pulmonary rehabilitation (PR) setting, thereby ruling out potential effects of health care avoidance.

Methods: Patients with COPD admitted for 8 weeks of inpatient PR at Ciro (Horn, the Netherlands) between October 2020 and March 2021, the first winter with full COVID-19–related IPC measures,were compared to patients admitted during the same period in previous years (2017–2018, 2018–2019, and 2019–2020). Electronic medical records were retrospectively screened for the occurrence of moderate to severe AECOPDs, drop-out, and mortality.

Results: A total of 501 patients with COPD (median age 66.6 [interquartile range (IQR) 60.3–71.9] years, 43.1% male, forced expiratory volume in 1 second [FEV1] 35.9 [26.8–50.6] % predicted) were analyzed. During 2020–2021, 22 patients (31.0%) experienced ≥1 AECOPD compared to 43 patients (33.6%) in 2019–2020, 55 patients (36.9%) in 2018–2019, and 83 patients (54.2%) in 2017–2018. This represents a 25.4% reduction in 2020–2021 compared to the average of the previous 3 periods, p=0.077. No differences in AECOPD severity, drop-out, or mortality were observed.

Conclusions: COVID-19–related IPC measures did not significantly reduce the AECOPD rate during inpatient PR in a single-center setting. The current findings suggest that avoidance of health care may be an important factor in the observed reduction of AECOPD-related hospitalizations during the pandemic and that the value of the strict COVID-19-related IPC measures for the prevention of AECOPDs warrants further research.

Citation

Citation: Waeijen-Smit K, Houben-Wilke S, Posthuma R, et al. Impact of coronavirus disease 2019-related infection prevention and control measures on the occurrence of COPD exacerbations during inpatient pulmonary rehabilitation. Chronic Obstr Pulm Dis. 2023; 10(2): 127-138. doi: http://dx.doi.org/10.15326/jcopdf.2022.0345

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Quality of Life and Mortality Outcomes for Augmentation Naïve and Augmented Patients with Severe Alpha-1 Antitrypsin Deficiency

Paul R. Ellis, MBChB, PhD1 Kristen E. Holm, PhD, MPH2,3 Radmila Choate, PhD, MPH4 David M. Mannino, MD4 Robert A. Stockley, MD, DSc5 Robert A. Sandhaus, MD3,6 Alice M. Turner, MBChB, PhD1

Author Affiliations

  1. Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
  2. Division of Neurology and Behavioral Health, National Jewish Health, Denver, Colorado, United States
  3. AlphaNet, Kissimmee, Florida, United States
  4. University of Kentucky College of Public Health, Lexington, Kentucky, United States
  5. Lung Investigation Unit, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham, National Health Service Foundation Trust, Birmingham, United Kingdom
  6. Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, Colorado, United States

Address correspondence to:

Paul Ellis, MBChB, PhD
Phone: +44 7794751625
Email: p.ellis@bham.ac.uk

Abstract

Background: Intravenous alpha-1 antitrypsin (AAT) augmentation therapy is the only specific treatment available for alpha-1 antitrypsin deficiency (AATD)-related lung disease. It is widely used worldwide but remains unavailable to patients with AATD in the United Kingdom. While randomized trials of augmentation therapy have demonstrated biochemical efficacy and lung tissue preservation using computed tomography (CT) densitometry, these studies were not adequately powered to demonstrate effectiveness in well-accepted clinical endpoints such as quality of life (QOL) or survival. We used large, prospectively followed AATD patient populations in the United States and United Kingdom to explore these important clinical endpoints.

Methods: Our inclusion criterion was adults with severe AATD and associated lung disease. The treatment group was U.S. AATD patients receiving augmentation therapy for lung disease. The control group was augmentation therapy naïve AATD patients. Multivariable regression and survival analyses were used to assess QOL and mortality outcomes respectively.

Results: Mean annual deterioration of the St George’s Respiratory Questionnaire total score was 1.43 points greater/year in the control group compared to those receiving augmentation therapy (95% confidence interval [CI] 0.47 to 2.39, p =0.003). At 7 years, median survival was 82.7% (95% CI 75.3 to 90.7) for the control group versus 87.8% (95% CI 82.8 to 93.2) in the augmentation group, p=0.66. There was significant heterogeneity between cohorts.

Conclusion: A comparison of 2 highly characterized AATD cohorts was not able to reliably determine if AAT augmentation therapy improves QOL or mortality in patients with severe AATD-related lung disease. Alternative surrogate biomarkers of disease progression, such as CT lung density, may be a more pragmatic option.

Citation

Citation: Ellis PR, Holm KE, Choate R, et al. Quality of life and mortality outcomes for augmentation naïve and augmented patients with severe alpha-1 antitrypsin deficiency. Chronic Obstr Pulm Dis. 2023; 10(2): 139-147. doi: http://dx.doi.org/10.15326/jcopdf.2022.0339

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Development of a Communication Instrument to Address Sexuality in COPD: COSY

Claudia Steurer-Stey, MD1,2 Kaba Dalla Lana, BSc1 Alexandra Strassmann, PhD, MAS, MS1 Stefanie Gonin-Spahni, DrPhil3 Michelle Borgmann, MSc3 Ursina Brun del Re, DrPhil4 Sebastian Haas, MD5 Eliane Sarasin, MD6 Andrea Burri, PhD7 Anja Frei, DrPhil1 Milo A. Puhan, MD, PhD1

Author Affiliations

  1. Epidemiology, Biostatistics, and Prevention Institute, University of Zurich, Zurich, Switzerland
  2. MediX Group Practice, Zurich, Switzerland
  3. Health Psychology and Behavioural Medicine, University of Bern, Bern, Switzerland
  4. Zurich Institute for Clinical Sexology and Sexual Therapy, Zurich, Switzerland
  5. Clinic for Psychiatry, Psychotherapy, and Psychosomatics, Hohenegg, Meilen, Switzerland
  6. Gynaecologic Psychosomatic and Sexual Medicine, University Hospital, Zurich, Switzerland
  7. Institute for Sex Counseling and Sexual Sciences, Zurich, Switzerland

Address correspondence to:

Claudia Steurer-Stey, MD
University of Zurich
Epidemiology, Biostatistics and Prevention Institute
Hirschengraben 84
CH-8001 Zurich, Switzerland
Phone: +41 44 634 43 60
Email: Claudia.steurer-stey@uzh.ch

Abstract

Introduction: Sexuality, an important aspect of quality of life, is often overlooked in COPD. Our aim was to develop an instrument that facilitates communication and counseling on sexuality in persons living with chronic obstructive pulmonary disease (COPD).

Methods: We searched for publications on sexuality in COPD focusing on communication about sexuality and tools to support such communication. We also performed a survey asking 25 patients and 36 health care professionals (HCPs) about their attitudes, experiences, barriers, and facilitators when talking about sexuality. We set up a project expert team of HCPs and 3 persons with COPD. In a half-day workshop, the team discussed the results of the literature review and the survey as a basis for the contents, the “when and how” to address communication about sexuality, and the design of the communication instrument.

Results: The survey showed that although patients and HCPs wanted to talk about sexuality, it rarely happened due to communication barriers, lack of self-confidence, and misconceptions on both sides. In review rounds of the expert team, feedback on the drafts was collected and integrated into the final version of the communication instrument: COmmunication about SexualitY in COPD (COSY). The COSY instrument resulted in 4 tools: a communication leaflet, an application guide, a pictorial representation of the spectrum of intimacy for HCPs, and a comprehensible, picturized information booklet for patients.

Conclusions: Addressing sexuality in persons living with COPD should not be neglected. The COSY instrument could help to start and shape communication and consultations about sexuality and a more holistic consideration of quality of life.

Citation

Citation: Steurer-Stey C, Dalla Lana K, Strassmann A, et al. Development of a communication instrument to address sexuality in COPD: COSY. Chronic Obstr Pulm Dis. 2023; 10(2): 148-158. doi: http://dx.doi.org/10.15326/jcopdf.2022.0355

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Airway and Systemic Prostaglandin E2 Association with COPD Symptoms and Macrophage Phenotype

Vickram Tejwani, MD1,2 Andres F. Villabona-Rueda, MD2 Pratik Khare, MS3 Cissy Zhang, BS4 Anne Le, MD3,4,5 Nirupama Putcha, MD, MHS2 Franco D’Alessio, MD2 Neil E. Alexis, PhD6 Nadia N. Hansel, MD, MPH2 Ashraf Fawzy, MD, MPH2

Author Affiliations

  1. Respiratory Institute, Cleveland Clinic, Cleveland, Ohio, United States
  2. Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, United States
  3. Department of Chemical and Biomolecular Engineering, Johns Hopkins University, Baltimore, Maryland, United States
  4. Department of Pathology, Johns Hopkins University, Baltimore, Maryland, United States
  5. Department of Oncology, Johns Hopkins University, Baltimore, Maryland, United States
  6. Center for Environmental Medicine, Asthma, and Lung Biology, Division of Allergy and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, 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

Background: Polymorphisms and products of the cyclooxygenase (COX) pathway have been associated with the development of chronic obstructive pulmonary disease (COPD) and adverse outcomes. COX-produced prostaglandin E2 (PGE-2) may play a role in the inflammation observed in COPD, potentially through deleterious airway macrophage polarization. A better understanding of the role of PGE-2 in COPD morbidity may inform trials for therapeutics targeting the COX pathway or PGE-2.

Methods: Urine and induced sputum were collected from former smokers with moderate-severe COPD. The major urinary metabolite of PGE-2 (PGE-M) was measured, and ELISA was performed on sputum supernatant for PGE-2 airway measurement. Airway macrophages underwent flow cytometry phenotyping (surface CD64, CD80, CD163, CD206, and intracellular IL-1β, TGF-β1). Health information was obtained the same day as the biologic sample collection. Exacerbations were collected at baseline and then monthly telephone calls.

Results: Among 30 former smokers with COPD (mean±SD age 66.4±8.88 years and forced expiratory volume in 1 second [FEV1] 62.4±8.37 percent predicted), a 1 pg/mL increase in sputum PGE-2 was associated with higher odds of experiencing at least one exacerbation in the prior 12 months (odds ratio 3.3; 95% confidence interval: 1.3 to15.0), worse respiratory symptoms and health status. PGE-M was not associated with exacerbations or symptoms. Neither airway PGE-2 nor urinary PGE-M was uniformly associated with an M1 or M2 polarization.

Conclusions: Elevated levels of sputum PGE-2, rather than systemic PGE-2, is associated with increased respiratory symptoms and history of exacerbation among individuals with COPD. Additional studies focused on mechanism of action are warranted.

Citation

Citation: Tejwani V, Villabona-Rueda AF, Khare P, et al. Airway and systemic prostaglandin E2 association with COPD symptoms and macrophage phenotype. Chronic Obstr Pulm Dis. 2023; 10(2): 159-169. doi: http://dx.doi.org/10.15326/jcopdf.2022.0375

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Physical Activity, Air Pollution Exposure, and Lung Function Interactions Among Adults with COPD

Kelly Chen, MS1* Mostafa Aglan, MD1* Alexandra Purcell2 Lina Nurhussien, MPH1* Petros Koutrakis, PhD3 Brent A. Coull, PhD4 Andrew Synn, MD1 Mary B. Rice, MD, MPH1

Author Affiliations

  1. Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
  2. Harvard College, Harvard University, Cambridge, Massachusetts, United States
  3. Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States
  4. Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States

*Affiliation at the time of study

Address correspondence to:

Mary B. Rice, MD, MPH
Phone: (617) 667-5864
Email: mrice1@bidmc.harvard.edu

Abstract

Rationale: Although physical activity is strongly encouraged for patients with chronic obstructive pulmonary disease (COPD), it is unknown if physical activity affects daily exposure to air pollution, or whether it attenuates or exacerbates the effects of pollution on the airways among adults with COPD.

Methods: Thirty former smokers with moderate-to-severe COPD in Boston were followed for 4 non-consecutive months in different seasons. We assessed daily lung function (forced expiratory volume in 1 second [FEV1] and forced vital capacity [FVC]), prior-day personal pollutant exposure measured by portable air quality monitors (fine particulate matter [PM2.5] nitrogen oxide [NO2], and ozone [O3]), and daily step count. We constructed multi-level linear mixed-effects models with random intercepts for person and person-observation month, adjusting for demographic/seasonal covariates to test if step count was associated with daily pollution exposure, and if associations between prior-day pollution and lung function differed based on prior-day step count. Where effect modification was found, we performed stratified analyses by tertile of step count.

Results: Higher daily step count was associated with higher same-day personal exposure to PM2.5, and O3 but not NO2. Each interquartile range (IQR) increment in step count was associated with 0.97 µg/m3 (95%CI: 0.30, 1.64) higher exposure to PM2.5 and 0.15 parts per billion (95% CI: -0.05, 0.35) higher exposure to O3 in adjusted models. We observed an interaction between prior-day NO2 and step count on FEV1 and FVC (Pinteraction<0.05) in which the negative associations between NO2 and lung function were reduced or absent at higher levels of daily activity. For example, FEV1 was 28.5 mL (95%CI: -41.0, -15.9) lower per IQR of NO2 in the lowest tertile of step count, but there was no association in the highest tertile of step count (-1.6mL, 95% CI: -18.4, 15.2).

Conclusions: Higher physical activity was associated with modestly higher daily exposure to PM2.5 and O3 and may attenuate the association between NO2 exposure and lung function.

Citation

Citation: Chen K, Aglan M, Purcell A, et al. Physical activity, air pollution exposure, and lung function interactions among adults with COPD. Chronic Obstr Pulm Dis. 2023; 10(2): 170-177. doi: http://dx.doi.org/10.15326/jcopdf.2022.0385

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Factors Associated with Attrition in a Longitudinal Cohort of Older Adults in the Community

Noah Katsuno, BA1 Pei Z. Li, PhD2 Jean Bourbeau, MD2 Shawn Aaron, MD3 Francois Maltais, MD4 Paul Hernandez, MD5 Kenneth R. Chapman, MD6 Brandie Walker, MD7 Darcy D. Marciniuk, MD8 Denis D. ODonnell, MD9 Don D. Sin, MD1 James C. Hogg, MD1 Michael Cheng, MBBS1 Jeremy Road, MD10 Wan C. Tan, MD1 on behalf of the CanCOLD Collaborative Research Group*

Author Affiliations

  1. University of British Columbia, Centre for Heart Lung Innovation, St Paul’s Hospital, Vancouver, British Columbia, Canada
  2. Research Institute, McGill University Health Centre, McGill University, Montreal, Quebec Canada
  3. Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
  4. Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Quebec City, Quebec, Canada
  5. Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
  6. University of Toronto, Toronto, Ontario, Canada
  7. Department of Medicine, University of Calgary, Calgary, Alberta, Canada
  8. Respiratory Research Centre, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
  9. Queen’s University, Kingston, Ontario, Canada
  10. Department of Medicine, University of British Columbia and Vancouver General Hospital, Vancouver, British Columbia, Canada

*Listed in Acknowledgements section

Address correspondence to:

Wan C. Tan, MD
University of British Columbia
Centre for Heart Lung Innovation
St Paul’s Hospital, Rm166
081 Burrard Street, Vancouver, B.C., V6Z 1Y6, Canada
Phone:1-(604)682-2344 ext. 62749
Email: wan.tan@hli.ubc.ca

Abstract

Introduction: Retaining participants in longitudinal studies increases their power. We undertook this study in a population-based longitudinal cohort of adults with COPD to determine the factors associated with increased cohort attrition.

Methods: In the longitudinal population-based Canadian Cohort of Obstructive Lung Disease (CanCOLD) study, 1561 adults > 40 years old were randomly recruited from 9 urban sites. Participants completed in-person visits at 18-month intervals and also were followed up every 3 months over the phone or by email. The cohort retention for the study and the reasons for attrition were analyzed. Hazard ratios and robust standard errors were calculated using Cox regression methods to explore the associations between participants who remained in the study and those who did not.

Results: The median follow-up (years) of the study is 9.0 years. The overall mean retention was 77%. Reasons for attrition (23%) were: dropout by participant (39%), loss of contact (27%), investigator-initiated withdrawal (15%), deaths (9%), serious disease (9%), and relocation (2%). Factors independently associated with attrition were lower educational attainment, higher pack-year tobacco consumption, diagnosed cardiovascular disease, and a higher Hospital Anxiety and Depression Scale score: adjusted hazard ratios (95% confidence interval) were 1.43(1.11, 1.85); 1.01(1.00, 1.01); 1.44(1.13, 1.83); 1.06(1.02, 1.10) respectively.

Conclusion: Identification and awareness of risk factors for attrition could direct targeted retention strategies in longitudinal studies. Moreover, the identification of patient characteristics associated with study dropout could address any potential bias introduced by differential dropouts.

Citation

Citation: Katsuno N, Li PZ, Bourbeau J, et al. Factors associated with attrition in a longitudinal cohort of older adults in the community. Chronic Obstr Pulm Dis. 2023; 10(2): 178-189. doi: http://dx.doi.org/10.15326/jcopdf.2022.0380

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The Association Between Systemic Arterial Hypertension and Chronic Obstructive Pulmonary Disease. Results from the U.S. National Health and Nutrition Examination Survey 1999-2018: A Cross-sectional Study

Xiaopeng Liang, MD1 Oscar Hou In Chou, MSc1 Bernard MY Cheung, PhD1,2,3

Author Affiliations

  1. Division of Clinical Pharmacology and Therapeutics, Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Hong Kong, China
  2. State Key Laboratory of Pharmaceutical Biotechnology, The University of Hong Kong, Pokfulam, Hong Kong, China
  3. Institute of Cardiovascular Science and Medicine, The University of Hong Kong, Pokfulam, Hong Kong, China

Address correspondence to:

Bernard M.Y. Cheung, PhD
Department of Medicine
School of Clinical Medicine
Queen Mary Hospital
102 Pokfulam Road
Hong Kong
Email: mycheung@hku.hk
Phone: +852 22554347
Fax: +852 28186474

Abstract

Background: Systemic arterial hypertension (HTN) is one of the common comorbidities among patients with chronic obstructive pulmonary disease (COPD). This study aimed to investigate the association between HTN and COPD.

Methods: A total of 46,804 eligible non-pregnant participants aged ≥ 20 years examined in the Mobile Examination Center of the National Health and Nutrition Examination Survey (NHANES) 1999–2018 were included in this cross-sectional study. Participants with invalid data on covariates, HTN, and COPD were excluded. The association between HTN and COPD was studied using logistic regression upon adjusting the potential covariates.

Results: Among the participants, 46.1% (95% confidence interval [CI], 45.3–46.9) had HTN, and 6.8% (95% CI, 6.4–7.2) had self-reported COPD. COPD was associated with HTN (OR [odds ratio]=1.18, 95% CI [1.05–1.31], P<0.01) after adjusting for demographics, socioeconomic factors, smoking, diabetes, body mass index, and medication use, including inhaled corticosteroids and methylxanthines. The association between HTN and COPD was significant among adults younger than 60 years (P<0.01). Stratified by smoking status, there was a significant association between HTN and COPD in current heavy smokers (1.25, 95% CI [1.01–1.58]; P=0.04).

Conclusions: In this nationwide survey, COPD was associated with HTN. The association was more robust among adults younger than 60 years and current heavy smokers. Future prospective studies are needed to examine the relationship between HTN and COPD.

Citation

Citation: Liang X, Chou OHI, Cheung BMY. The association between systemic arterial hypertension and chronic obstructive pulmonary disease. Results from the U.S. National Health and Nutrition Examination Survey 1999-2018: a cross-sectional study. Chronic Obstr Pulm Dis. 2023; 10(2): 190-198. doi: http://dx.doi.org/10.15326/jcopdf.2022.0306

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