Chronic Obstructive Pulmonary Diseases:Journal of the COPD Foundation

Volume 11, Issue 2 - 2024

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.

Editorial:

Editorial–2014–2024: Celebrating 10 Years of Nonprofit, Open-Access Publishing Focused on COPD, Bronchiectasis, and Nontuberculous Mycobacteria Research

Mark T. Dransfield, MD1,2

Author Affiliations

  1. Editor in Chief, Chronic Obstructive Pulmonary Diseases: Journal of the COPD Foundation, Miami, Florida, United States
  2. Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States

Address correspondence to:

Mark T. Dransfield, MD
mdransfield@uabmc.edu

Abstract

This article does not contain an abstract.

Citation

Citation: Dransfield MT. Editorial—2014–2024: Celebrating 10 years of nonprofit, open-access publishing focused on COPD, bronchiectasis, and nontuberculous mycobacteria research. Chronic Obstr Pulm Dis. 2024; 11(1): 1-2. doi: http://dx.doi.org/10.15326/jcopdf.2024.0497

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Original Research:

Safety and Reactogenicity of COVID-19 Vaccination in Severe Alpha-1 Antitrypsin Deficiency

Oliver J. McElvaney, MD, PhD1,2,3,4 Brian Cleary, MD1 Daniel D. Fraughen, MD1,2 Geraldine Kelly, MBA5 Oisin F. McElvaney, MD, PhD1 Mark P. Murphy, PhD1 Peter Branagan, MD1,2 Cedric Gunaratnam, MD1,2 Tomás P. Carroll, PhD1,5 Christopher H. Goss, MD, MSc3,4,6 Noel G. McElvaney, MD1,2

Author Affiliations

  1. Department of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
  2. National Centre for Alpha-1 Antitrypsin Deficiency, Beaumont Hospital, Dublin, Ireland
  3. Seattle Children’s Research Institute, Seattle, Washington, United States
  4. Department of Medicine, University of Washington, Seattle, Washington, United States
  5. Alpha-1 Foundation of Ireland, Dublin, Ireland
  6. Department of Pediatrics, University of Washington, Seattle, Washington, United States

Address correspondence to:

Oliver J. McElvaney, MD, PhD
Department of Medicine
Royal College of Surgeons in Ireland
Dublin, Ireland
Phone: +353 18093763
Email: olivermcelvaney@rcsi.ie

Abstract

Background: Patients with alpha-1 antitrypsin deficiency (AATD) exhibit dysregulated inflammatory responses and a predilection for autoimmunity. While the adverse event (AE) profiles of COVID-19 vaccines in several chronic inflammatory conditions are now available, safety and tolerability data for patients with severe AATD have yet to be described. The feasibility of coadministering vaccines against COVID-19 and influenza in this population is similarly unclear.

Methods: We conducted a prospective study of 170 patients with Pi*ZZ genotype AATD receiving their initial vaccination series with ChAdOx1 nCoV-19 (AstraZeneca). Patients were monitored clinically for AEs over the week that followed their first and second doses. In parallel, we conducted the same assessments in patients with Pi*MM genotype chronic obstructive pulmonary disease (COPD) (n=160) and Pi*MM individuals without lung disease (n=150). The Pi*ZZ cohort was subsequently followed through 2 consecutive mRNA-based booster vaccines (monovalent and bivalent BNT162b2, Pfizer/BioNTech). To assess the safety of combined vaccination against COVID-19 and influenza, the quadrivalent influenza vaccine was administered to participants attending for their second COVID-19 booster vaccination, either on the same day or following a 1-week interval.

Results: Pi*ZZ AATD participants did not display increased AEs compared to Pi*MM COPD or Pi*MM non-lung disease controls. Although unexpected and serious vaccine-associated AEs did occur, the majority of AEs experienced across the 3 groups were mild and self-limiting. The AATD demographic at highest risk for AEs (especially systemic and prolonged AEs) was young females. No increase in AE risk was observed in patients with established emphysema, sonographic evidence of liver disease, or in those receiving intravenous augmentation therapy. AE incidence declined sharply following the initial vaccine series. Same-day coadministration of the COVID-19 mRNA bivalent booster vaccine and the annual influenza vaccine did not result in increased AEs compared to sequential vaccines 1 week apart.

Conclusions: Despite their pro-inflammatory state, patients with severe AATD are not at increased risk of AEs or serious AEs compared to patients with nonhereditary COPD and patients without lung disease. Same-day coadministration of COVID-19 booster vaccines with the annual influenza vaccine is feasible, safe, and well-tolerated in this population.

Citation

Citation: McElvaney OJ, Cleary B, Fraughen DD, et al. Safety and reactogenicity of COVID-19 vaccination in severe alpha-1 antitrypsin deficiency. Chronic Obstr Pulm Dis. 2024; 11(1): 3-12. doi: http://dx.doi.org/10.15326/jcopdf.2023.0432

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Feasibility Trial of a Comprehensive, Highly Patient-Centered COPD Self-Management Support Program

Alex D. Federman, MD, MPH1 Rachel O’Conor, PhD2 Jeannys Nnemnbeng, MD, RRT3 Jyoti Ankam, MBBS, MPH1 Danielle McDermott, MS, CSCS4 Peter K. Lindenauer, MD, MSc5 Michael S. Wolf, PhD, MPH2 Juan P. Wisnivesky, MD, DrPH1,6

Author Affiliations

  1. Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, United States
  2. Department of Medicine, Feinberg School of Medicine, Northwestern University, New York, New York, United States
  3. Graduate School of Biomedical Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, United States
  4. Baystate Medical Center, Springfield, Massachusetts, United States
  5. Department of Healthcare Delivery and Population Sciences, Chan Medical School-Baystate, University of Massachusetts, Springfield, Massachusetts, United States
  6. Division of Pulmonary and Critical Care Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, United States

Address correspondence to:

Alex D. Federman, MD, MPH
Division of General Internal Medicine
Icahn School of Medicine at Mount Sinai
17 East 102nd Street
Box 1087
New York, NY 10029
Phone: (212) 824-7565
Email: alex.federman@mssm.edu

Abstract

Purpose: To test the feasibility of a novel self-management support intervention for people with chronic obstructive pulmonary disease (COPD).

Methods: We conducted a feasibility randomized controlled trial involving patients ≥40 years with severe or very severe COPD in New York, New York (n=59). Community health workers screened patients and addressed barriers to COPD self-management. Patients were also offered home-based pulmonary rehabilitation (HBPR) and an antibiotic and steroid rescue pack. Control patients received general COPD education. Clinical outcomes for intervention and control were compared by difference-in-differences (DiD) at baseline and 6 months. The study was not powered for statistically significant differences for any measure. Feasibility measures were collected at 6 months.

Results: There were high rates of completion of intervention activities, including 75% of patients undergoing evaluation for and participating in HBPR. Most (92%) intervention patients said the program was very or extremely helpful and 96% said they would participate again. Clinical outcomes generally favored the intervention: COPD assessment test, DiD -1.1 (95% confidence interval [CI] -5.9 to 3.6); 6-minute walk test distance, DiD 7.4 meters (95% CI -45.1 to 59.8); self-reported hospitalizations, DiD -9.8% (95% CI -42.3% to 22.8%); medication adherence, DiD 7.7% (-29.6%, 45.0%), and Physical Activity Adult Questionnaire, DiD 86 (95% CI -283 to 455). Intervention patients reported more emergency department visits, DiD 10.6% (95% CI 17.7% to 38.8%).

Conclusion: A highly patient-centered, self-management support intervention for people with COPD was well received by patients and associated with potential improvements in clinical and self-management outcomes. A fully powered study of the intervention is warranted.

Citation

Citation: Federman AD, O’Conor R, Nnemnbeng J, et al. Feasibility trial of a comprehensive, highly patient-centered COPD self-management support program. Chronic Obstr Pulm Dis. 2024; 11(1): 13-25. doi: http://dx.doi.org/10.15326/jcopdf.2023.0419

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Lung Structure and Risk of Sleep Apnea in SPIROMICS

Abigail L. Koch, MD1 Tracie L. Shing, DrPH2 Andrew Namen, MD3 David Couper, PhD2 Benjamin Smith, MD, MSc4 R. Graham Barr, MD, PhD4 Surya Bhatt, MD, MSPH5 Nirupama Putcha, MD, MHS6 Aaron Baugh, MD7 Amit K. Saha, PhD, MS3 Michelle Zeidler, MD8 Alejandro Comellas, MD9 Christopher B. Cooper, MD8 Igor Barjaktarevic, MD, PhD8 Russell P. Bowler, MD, PhD10 MeiLan K. Han, MD, MS11 Victor Kim, MD12 Robert Paine, III, MD13 Richard E. Kanner, MD13 Jerry A. Krishnan, MD, PhD14 Fernando J. Martinez, MD, MS15 Prescott G. Woodruff, MD, MPH7 Nadia N. Hansel, MD6 Eric A. Hoffman, PhD9 Stephen P. Peters, MD, PhD3 Victor E. Ortega, MD, PhD16 for the SubPopulations and InteRmediate Outcome Measures in COPD Study (SPIROMICS) Investigators

Author Affiliations

  1. Leonard M. Miller School of Medicine, University of Miami, Miami, Florida, United States
  2. Collaborative Studies Coordinating Center, Department of Biostatistics, Gilling’s School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States
  3. Section on Pulmonary, Critical Care, Allergy and Immunological Diseases, Wake Forest School of Medicine, Wake Forest, North Carolina, United States
  4. Department of Medicine, Columbia University Medical Center, New York, New York, United States
  5. Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
  6. Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, United States
  7. Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California, San Francisco, California, United States
  8. Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, United States
  9. Departments of Radiology, Medicine, and Bioengineering, University of Iowa, Iowa City, Iowa, United States
  10. Division of Pulmonary, Critical Care, and Sleep Medicine, National Jewish Health, Denver, Colorado, United States
  11. Division of Pulmonary and Critical Care Medicine, School of Medicine, University of Michigan, Ann Arbor, Michigan, United States
  12. Division of Pulmonary and Critical Care Medicine, Department of Medicine, Temple University School of Medicine, Philadelphia, Pennsylvania, United States
  13. Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, Utah, United States
  14. Division of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois at Chicago, Chicago, Illinois, United States
  15. Division of Pulmonary and Critical Care Medicine, Weill Cornell Medical College, New York, New York, United States
  16. Department of Internal Medicine, Division of Respiratory Diseases, Center for Individualized Medicine, Mayo Clinic, Scottsdale, Arizona, United States

Address correspondence to:

Abigail L. Koch, MD
University of Miami
1951 NW 7th Ave 2nd Floor
Miami, FL 33136
Phone: (813)465-2644
Email:Abigail.koch@miami.edu

Abstract

Rationale: The SubPopulations and InteRmediate Outcome Measures in COPD Study (SPIROMICS) is a prospective cohort study that enrolled 2981 participants with the goal of identifying new chronic obstructive pulmonary disease (COPD) subgroups and intermediate markers of disease progression. Individuals with COPD and obstructive sleep apnea (OSA) experience impaired quality of life and more frequent exacerbations. COPD severity also associates with computed tomography scan-based emphysema and alterations in airway dimensions.

Objectives: The objective was to determine whether the combination of lung function and structure influences the risk of OSA among current and former smokers.

Methods: Using 2 OSA risk scores, the Berlin Sleep Questionnaire (BSQ), and the DOISNORE50 (Diseases, Observed apnea, Insomnia, Snoring, Neck circumference > 18 inches, Obesity with body mass index [BMI] > 32, R = are you male, Excessive daytime sleepiness, 50 = age ≥ 50) (DIS), 1767 current and former smokers were evaluated for an association of lung structure and function with OSA risk.

Measurements and Main Results: The study cohort's mean age was 63 years, BMI was 28 kg/m2, and forced expiratory volume in 1 second (FEV1) was 74.8% predicted. The majority were male (55%), White (77%), former smokers (59%), and had COPD (63%). A high-risk OSA score was reported in 36% and 61% using DIS and BSQ respectively. There was a 9% increased odds of a high-risk DIS score (odds ratio [OR]=1.09, 95% confidence interval [CI]:1.03–1.14) and nominally increased odds of a high-risk BSQ score for every 10% decrease in FEV1 %predicted (OR=1.04, 95%CI: 0.998–1.09). Lung function-OSA risk associations persisted after additionally adjusting for lung structure measurements (%emphysema, %air trapping, parametric response mapping for functional small airways disease, , mean segmental wall area, tracheal %wall area, dysanapsis) for DIS (OR=1.12, 95%CI:1.03–1.22) and BSQ (OR=1.09, 95%CI:1.01–1.18).

Conclusions: Lower lung function independently associates with having high risk for OSA in current and former smokers. Lung structural elements, especially dysanapsis, functional small airways disease, and tracheal %wall area strengthened the effects on OSA risk.

Citation

Citation: Koch AL, Shing TL, Namen A, et al. Lung structure and risk of sleep apnea in SPIROMICS. Chronic Obstr Pulm Dis. 2024; 11(1): 26-36. doi: http://dx.doi.org/10.15326/jcopdf.2023.0411

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Inhaler Formulary Change in COPD and the Association with Exacerbations, Health Care Utilization, and Costs

Kevin I. Duan, MD, MS1,2 Lucas M. Donovan, MD, MS2,3 Laura J. Spece, MD, MS2,3 Edwin S. Wong, PhD2,3,4 Laura C. Feemster, MD, MS2,3 Alexander D. Bryant, MD, MS5 Robert Plumley3 Kristina Crothers, MD2,3 David H. Au, MD, MS2,3

Author Affiliations

  1. Division of Respiratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
  2. Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, Washington, United States
  3. Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, Washington, United States
  4. Department of Health Systems and Population Health, University of Washington, Seattle, Washington, United States
  5. Kaiser Permanente Washington, Seattle, Washington, United States

Address correspondence to:

Kevin Duan, MD, MS
Centre for Lung Health at Gordon and Leslie Diamond Health Care Centre
2775 Laurel Street, 7th Floor
Vancouver, British Columbia
Canada, V5Z 1M9
Email: kevin.duan@ubc.ca
Phone: (604) 875-4122

Abstract

Rationale: Prescription formularies specify which medications are available to patients. Formularies change frequently, potentially forcing patients to switch medications for nonclinical indications (nonmedical switching). Nonmedical switching is known to impact disease control and adherence. The consequences of nonmedical switching have not been rigorously studied in COPD.

Methods: We conducted a cohort study of Veterans with COPD on inhaler therapy in January 2016 when formoterol was removed from the Department of Veterans Affairs (VA) national formulary. A 2-point difference-in-differences analysis using multivariable negative binomial and generalized linear models was performed to estimate the association of the formulary change with patient outcomes in the 6 months before and after the change. Our primary outcome was the number of COPD exacerbations in 6 months, with secondary outcomes of total health care encounters and encounter-related costs in 6 months.

Results: We identified 10,606 Veterans who met our inclusion criteria, of which 409 (3.9%) experienced nonmedical switching off formoterol. We did not identify a change in COPD exacerbations (-0.04 exacerbations; 95% confidence interval [CI] -0.12, 0.03) associated with the formulary change. In secondary outcome analysis, we did not observe a change in the number of health care encounters (-0.12 visits; 95% CI -1.00, 0.77) or encounter-related costs ($369; 95% CI -$1141, $1878).

Conclusions: Among COPD patients on single inhaler therapy, nonmedical inhaler switches due to formulary discontinuation of formoterol were not associated with changes in COPD exacerbations, encounters, or encounter-related costs. Additional research is needed to confirm our findings in more severe disease and other settings.

Citation

Citation: Duan KI, Donovan LM, Spece LJ, et al. Inhaler formulary change in COPD and the association with exacerbations, health care utilization, and costs. Chronic Obstr Pulm Dis. 2024; 11(1): 37-46. doi: http://dx.doi.org/10.15326/jcopdf.2023.0425

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Food Insecurity is Associated With COPD Morbidity and Perceived Stress

Daniel C. Belz, MD, MPH1 Han Woo, PhD1 Mariah K. Jackson, RD2 Nirupama Putcha, MD, MHS1 Ashraf Fawzy, MD, MPH1 Wendy Lorizio, MD, MPH1 Meredith C. McCormack, MD, MHS1 Michelle N. Eakin, PhD, MA1 Corrine K. Hanson, PhD, RD2 Nadia N. Hansel, MD, MPH1

Author Affiliations

  1. Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, United States
  2. Medical Nutrition Program, College of Allied Health Professions, University of Nebraska, Omaha, Nebraska, United States

Address correspondence to:

Daniel C. Belz, MD, MPH
5501 Hopkins Bayview Circle
Baltimore MD, 21224
Phone: (410) 550-5405
Email: dbelz2@jhmi.edu

Abstract

Background: Low socioeconomic status (SES) has been associated with worse clinical outcomes in chronic obstructive pulmonary disease (COPD). Food insecurity is more common among individuals with low SES and has been associated with poor outcomes in other chronic illnesses, but its impact on COPD has not been studied.

Methods: Former smokers with spirometry-confirmed COPD were recruited from low-income areas of Baltimore, Maryland, and followed for 9 months as part of a cohort study of diet and indoor air pollution. Food insecurity and respiratory outcomes, including COPD exacerbations and patient-reported outcomes, were assessed at regular intervals. The association between food insecurity and COPD outcomes was analyzed using generalized linear mixed models. Additional analyses examined the association of COPD morbidity with subdomains of food insecurity and the association of food insecurity with psychological well-being measures.

Results: Ninety-nine participants had available data on food insecurity and COPD outcomes. A total of 26.3% of participants were food insecure at 1 or more times during the study. After adjusting for individual SES, neighborhood poverty, and low healthy food access, food insecurity was associated with a higher incidence rate of moderate and severe exacerbations and worse dyspnea, COPD health status, and respiratory-specific quality of life. Subdomains of food insecurity were independently associated with worse patient-reported outcomes. Food insecurity was additionally associated with higher perceived stress.

Discussion: Among former smokers with COPD, food insecurity was associated with a higher incidence of exacerbations, worse patient-reported outcomes, and higher perceived stress. Subdomains of food insecurity were independently associated with worse patient-reported outcomes.

Citation

Citation: Belz DC, Woo H, Jackson MK, et al. Food insecurity is associated with COPD morbidity and perceived stress. Chronic Obstr Pulm Dis. 2024; 11(1): 47-55. doi: http://dx.doi.org/10.15326/jcopdf.2023.0440

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COPD and Smoking Status – It Does Matter: Characteristics and Prognosis of COPD According to Smoking Status

Anne O. Nielsen, MD, PhD1 Peter Lange, MD2 Ole Hilberg, MD3,4 Ingeborg Farver-Vestergaard, MSc3,4 Rikke Ibsen, MSc4 Anders Løkke, DrMed, MD3,4

Author Affiliations

  1. Department of Pulmonary Medicine, North Zealand Hospital Hillerød, Copenhagen, Denmark
  2. Department of Pulmonary Medicine, Herlev/Gentofte Hospital, Copenhagen, Denmark
  3. Department of Medicine, Hospital Little Belt, Vejle, Denmark
  4. Department of Regional Health Research, University of Southern Denmark, Odense, Denmark

Address correspondence to:

Anders Løkke, DrMed, MD
Department of Medicine
Hospital Little Belt
Vejle, Denmark
Email: aloekke@gmail.com
Phone: 0045 28894197

Abstract

Background: Chronic obstructive pulmonary disease is a chronic, often progressive disease, which in most patients is caused by tobacco smoking. Our study focuses on differences in COPD-related outcomes between never smokers, former smokers, and current smokers.

Methods: A nationwide, population-based cohort study utilizing Danish health registries. Clinical and socioeconomic variables including smoking status, comorbidities, and dyspnea were obtained. Poisson and Cox Regression were used to calculate the impact of these clinical parameters on the risk of moderate and severe exacerbations and mortality during 12 months of follow-up.

Results: A total of 49,826 patients ≥40 years of age, with a hospital diagnosis of COPD in 2008–2017, were identified (mean age 69.2 years, 52% females). A total of 2127 (4%) were never smokers, 29,854 (60%) were former smokers and 17,845 (36%) current smokers. Compared to former and current smokers, never smokers reported a lower modified Medical Research Council score and had a milder COPD stage according to the Global Initiative for Chronic Obstructive Lung Disease classification. During follow-up, never smokers had a significantly lower risk of severe exacerbations (hazard ratio 0.87, 95% confidence interval [CI] 0.78–0.97) and a lower rate of death (mortality ratio 0.75, 95% CI 0.70–0.81) compared to patients with a smoking history.

Discussion: Our nationwide study showed that COPD in never smokers is characterized by a lower level of dyspnea, milder lung function impairment, and a lower risk of exacerbations and death. At the same time, we found active smokers to have the highest risk. These findings highlight the need for campaigns to prevent smoking and may help general practitioners as well as other health care professionals to motivate patients with COPD to stop smoking.

Citation

Citation: Nielsen AO, Lange P, Hilberg O, Farver-Vestergaard I, Ibsen R, Løkke A. COPD and smoking status – it does matter: characteristics and prognosis of COPD according to smoking status. Chronic Obstr Pulm Dis. 2024; 11(1): 56-67. doi: http://dx.doi.org/10.15326/jcopdf.2023.0433

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Relationship Between Tobacco Product Use and Health-Related Quality of Life Among Individuals With COPD in Waves 1–5 (2013–2019) of the Population Assessment of Tobacco and Health Study

Laura M. Paulin, MD, MHS1 Michael J. Halenar, MPH2 Kathryn C. Edwards, PhD2 Kristin Lauten, MA2 Kristie Taylor, PhD2 Mary Brunette, MD1 Susanne Tanski, MD, MPH1 Todd MacKenzie, PhD1 Cassandra A. Stanton, PhD2 Dorothy Hatsukami, PhD3 Andrew Hyland, PhD4 Martin C. Mahoney, MD, PhD4 Ray Niaura, PhD5 Dennis Trinidad, PhD, MPH6 Carlos Blanco, MD, PhD7 Wilson Compton, MD, MPE7 Lisa D. Gardner, PhD, MS8 Heather L. Kimmel, PhD7 K. Michael Cummings, PhD, MPH9 Dana Lauterstein, PhD8 Esther J. Roh, PhD, MS8 Daniela Marshall, PhD7,10 James D. Sargent, MD1

Author Affiliations

  1. Geisel School of Medicine at Dartmouth, The C. Everett Koop Institute at Dartmouth, Hanover, New Hampshire, United States
  2. Behavioral Health and Health Policy Practice, Westat, Rockville, Maryland, United States
  3. Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, Minnesota, United States
  4. Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York, United States
  5. School of Global Public Health, New York University, New York, New York, United States
  6. University of California at San Diego, La Jolla, California, United States
  7. National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland, United States
  8. Center for Tobacco Products, Food and Drug Administration, Silver Spring, Maryland, United States
  9. Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, United States
  10. Axle Informatics, Rockville, Maryland, United States

Address correspondence to:

Laura M. Paulin, MD
Phone: (603) 650-5533
Email: Laura.m.paulin@hitchcock.org

Abstract

Introduction: We examined the association between tobacco product use and health-related quality of life (HRQoL) among individuals with chronic obstructive pulmonary disease (COPD) in Waves 1–5 of the Population Assessment of Tobacco and Health (PATH) Study.

Methods: Adults ≥40 years with an ever COPD diagnosis were included in cross-sectional (Wave 5) and longitudinal (Waves 1 to 5) analyses. Tobacco use included 13 mutually exclusive categories of past 30-day (P30D) single use and polyuse with P30D exclusive cigarette use and ≥5-year cigarette cessation as reference groups. Multivariable linear regression and generalized estimating equations (GEE) were used to examine the association between tobacco use and HRQoL as measured by the Patient-Reported Outcomes Measurement Information System (PROMIS) Global-10 questionnaire.

Results: Of 1670 adults, 79.4% ever used cigarettes; mean (standard error [SE]) pack years was 30.9 (1.1). In cross-sectional analysis, P30D exclusive cigarette use, and e-cigarette/cigarette dual use were associated with worse HRQoL compared to ≥5-year cigarette cessation. Compared to P30D exclusive cigarette use, never tobacco use and ≥5-year cigarette cessation were associated with better HRQoL, while e-cigarette/cigarette dual use had worse HRQoL. Longitudinally (n=686), e-cigarette/cigarette dual use was associated with worsening HRQoL compared to both reference groups. Only never tobacco use was associated with higher HRQoL over time compared to P30D exclusive cigarette use.

Conclusions: E-cigarette/cigarette dual use was associated with worse HRQoL compared to ≥5-year cigarette cessation and exclusive cigarette use. Never use and ≥5-year cigarette cessation were the only categories associated with higher HRQoL compared to exclusive cigarette use. Findings highlight the importance of complete smoking cessation for individuals with COPD.

Citation

Citation: Paulin LM, Halenar MJ, Edwards KC, et al. Relationship between tobacco product use and health-related quality of life among individuals with COPD in waves 1–5 (2013–2019) of the Population Assessment of Tobacco and Health Study. Chronic Obstr Pulm Dis. 2024; 11(1): 68-82. doi: http://dx.doi.org/10.15326/jcopdf.2023.0422

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The Long-Term Impact of Frailty After an Intensive Care Unit Admission Due to Chronic Obstructive Pulmonary Disease

Matthew T. Donnan, BSc, MBBS1,2 Shailesh Bihari, MBBS, FCICM, MD, PhD3,4 Ashwin Subramaniam, MBBS, MMED, FRACP, FCICM, PhD5-7 Eli J. Dabscheck, MBBS, MclinEpi, FRACP2,8 Brooke Riley, BBioMedSc, MBBS, FCICM1 David V. Pilcher, MBBS, MRCP1,7,9

Author Affiliations

  1. Department of Intensive Care, The Alfred Hospital, Melbourne, Australia
  2. Department of Respiratory Medicine, The Alfred Hospital, Melbourne, Australia
  3. College of Medicine and Public Health, Flinders University, South Australia
  4. Department of Intensive and Critical Care, Finders Medical Centre, Adelaide, Australia
  5. Intensive Care Unit, Peninsula Health, Melbourne, Australia
  6. Peninsula Clinical School, Monash University, Frankston, Victoria, Australia
  7. Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
  8. Central Clinical School, Monash University, The Alfred Hospital, Melbourne, Australia
  9. The Australian and New Zealand Intensive Care Society, Centre for Outcome and Resources Evaluation, Melbourne, Victoria, Australia

Address correspondence to:

Professor Shailesh Bihari
Department of Intensive Care Unit
Flinders Medical Centre,
Bedford Park, Australia, 5042<
Email: biharishailesh@gmail.com
Email: biha002@flinders.edu.au

Abstract

Rationale: Frailty is an increasingly recognized aspect of chronic obstructive pulmonary disease (COPD). The impact of frailty on long-term survival after admission to an intensive care unit (ICU) due to an exacerbation of COPD has not been described.

Objective: The objective was to quantify the impact of frailty on time to death up to 4 years after admission to the ICU in Australia and New Zealand for an exacerbation of COPD.

Methods: We performed a multicenter retrospective cohort study of adult patients admitted to 179 ICUs with a primary diagnosis of an exacerbation of COPD using the Australian and New Zealand Intensive Care Society Adult Patient Database from January 1, 2018, through December 31, 2020, in New Zealand, and March 31, 2022, in Australia. Frailty was measured using the clinical frailty scale (CFS). The primary outcome was survival up to 4 years after ICU admission. The secondary outcome was readmission to the ICU due to an exacerbation of COPD.

Measurements and Main Results: We examined 7126 patients of which 3859 (54.1%) were frail (CFS scores of 5–8). Mortality in not-frail individuals versus frail individuals at 1 and 4 years was 19.8% versus 40.4%, and 56.8% versus 77.3% respectively (both p<0.001). Frailty was independently associated with a shorter time to death (adjusted hazard ratio 1.66; 95% confidence interval 1.54–1.80).There was no difference in the proportion of survivors with or without frailty who were readmitted to the ICU during a subsequent hospitalization.

Conclusion: Frailty was independently associated with poorer long-term survival in patients admitted to the ICU with an exacerbation of COPD.

Citation

Citation: Donnan MT, Bihari S, Subramaniam A, Dabscheck EJ, Riley B, Pilcher DV. The long-term impact of frailty after an intensive care unit admission due to chronic obstructive pulmonary disease. Chronic Obstr Pulm Dis. 2024; 11(1): 83-94. doi: http://dx.doi.org/10.15326/jcopdf.2023.0453

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Brief Reports:

Improving Referral Patterns for Bronchoscopic Lung Volume Reduction: A Quality Improvement Initiative

Christopher Di Felice, MD1,2 Zachary B. Strumpf, MD1,3 Elizabeth A. Edmiston, PhD, RN, CCRN1,2 Christian F. Cuvillier Padilla, MD1,4 Leah C. Ellis-Jones, RN1 Joanne L. McKell, MD1,2 Mohammad A. Shatat, MD1,2 Sherrie D. Williams, MD1,2 Anna M. May, MD, MS1,2,3

Author Affiliations

  1. Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, United States
  2. Case Western Reserve University School of Medicine, Cleveland, Ohio, United States
  3. University Hospitals Cleveland Medical Center, Cleveland, Ohio, United States
  4. Cleveland Clinic Foundation, Cleveland, Ohio, United States

Address correspondence to:

Christopher Di Felice, MD
Department of Pulmonary and Critical Care Medicine
Louis Stokes Cleveland Department of Veterans Affairs Medical Center
Cleveland, OH 44106
Phone: (216)791-3800 ext. 66270
Email: Christopher.DiFelice@va.gov

Abstract

Bronchoscopic lung volume reduction (BLVR) is a minimally invasive treatment option for patients with severe emphysema and hyperinflation refractory to optimal medical care. This therapy is effective in improving functional status and quality of life, underscoring the importance of identifying potential procedure candidates. To our knowledge, scalable strategies to improve the referral of advanced lung disease patients are lacking. This quality improvement project aimed to increase identification and referral for BLVR in a large Veterans Affairs academic medical center. We show implementing case identification within a pulmonary function testing report, in conjunction with provider education, increased referral rates for BLVR. Because of the ubiquity of lung function testing, other advanced lung disease programs may consider adopting this strategy to improve patients’ access to timely clinical evaluation and therapy.

Citation

Citation: Di Felice C, Strumpf ZB, Edmiston EA, et al. Improving referral patterns for bronchoscopic lung volume reduction: a quality improvement initiative. Chronic Obstr Pulm Dis. 2024; 11(1): 95-100. doi: http://dx.doi.org/10.15326/jcopdf.2023.0397

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Associations Between Coronary Artery Calcium Score and Exacerbation Risk in BLOCK-COPD

R. Chad Wade, MD1,2,3,4 Sharon X. Ling, PhD†5 Erika S. Helgeson, PhD5 Helen Voelker, MS5 Wassim W. Labaki, MD, MS6 Daniel Meza, MD7 Oisin O’Corragain, MD8 Jennifer Y. So, MD9 Gerard J. Criner, MD8 MeiLan K. Han, MD, MS6 Ravi Kalhan, MD7 Robert M. Reed, MD9 Mark T. Dransfield, MD1,2,3,4 J. Michael Wells, MD, MSPH1,2,3,4

Author Affiliations

  1. Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
  2. Lung Health Center, University of Alabama at Birmingham, Birmingham, Alabama, United States
  3. Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
  4. Acute Care Service, Birmingham VA Medical Center, Birmingham, Alabama, United States
  5. Division of Biostatistics, University of Minnesota, Minneapolis, Minnesota, United States
  6. Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan, United States
  7. Division of Pulmonary and Critical Care Medicine, Northwestern University, Chicago, Illinois, United States
  8. Department of Thoracic Medicine and Surgery, Temple University, Philadelphia, Pennsylvania, United States
  9. Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, Maryland, United States
†Deceased

Address correspondence to:

R. Chad Wade, MD
Division of Pulmonary, Allergy, and Critical Care Medicine
University of Alabama at Birmingham
Phone: (205) 934-5555
Email: rcwade@uabmc.edu

Abstract

Introduction: In 2019, the Beta-Blockers for the Prevention of Acute Exacerbations of Chronic Obstructive Pulmonary Disease study (BLOCK-COPD) evaluated the effect of metoprolol on exacerbation risk and mortality in a COPD population without indications for beta-blocker use. We hypothesized that an imaging metric of coronary artery disease (CAD), the coronary artery calcium (CAC) score, would predict exacerbation risk and identify a differential response to metoprolol treatment.

Methods: The study population includes participants in the BLOCK-COPD study from multiple study sites. Participants underwent clinically indicated thoracic computed tomography (CT) scans ± 12 months from enrollment. The Weston scoring system quantified CAC. Adjusted Cox proportional hazards models evaluated for associations between CAC and time to exacerbation.

Results: Data is included for 109 participants. The mean CAC score was 5.1±3.7, and 92 participants (84%) had CAC scores greater than 0. Over a median (interquartile range) follow-up time of 350 (280 to 352) days, there were 61 mild exacerbations and 19 severe/very severe exacerbations. No associations were found between exacerbations of any severity and CAC>0 or total CAC. Associations were observed between total CAC and CAC>0 in the left circumflex (LCx) and time to exacerbation of any severity (adjusted hazard ratio [aHR]=1.39, confidence interval [CI]: 1.08–1.79, p=0.01) and (aHR=1.96, 95% CI: 1.04–3.70, p= 0.04), respectively.

Conclusion: CAD is a prevalent comorbidity in COPD accounting for significant mortality. Our study confirms the high prevalence of CAD using the CAC score; however, we did not discover an association between CAC and exacerbation risk. We did find novel associations between CAC in the LCx and exacerbation risk which warrant further investigation in larger cohorts.

Citation

Citation: Wade RC, Ling SX, Helgeson ES, et al. Associations between coronary artery calcium score and exacerbation risk in BLOCK-COPD. Chronic Obstr Pulm Dis. 2024; 11(1): 101-105. doi: http://dx.doi.org/10.15326/jcopdf.2023.0423

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Any Decrease in Lung Function is Associated With Worse Clinical Outcomes: Post Hoc Analysis of the IMPACT Interventional Trial

MeiLan K. Han, MD1 Gerard J. Criner, MD2 David M.G. Halpin, MD3 Edward M. Kerwin, MD4 Lee Tombs, MSc5 David A. Lipson, MD6,7 Fernando J. Martinez, MD8 Robert A. Wise, MD9 Dave Singh, MD10

Author Affiliations

  1. Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan, United States
  2. Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, United States
  3. University of Exeter Medical School, College of Medicine and Health, University of Exeter, Exeter, United Kingdom
  4. Clinical Research Institute and Altitude Clinical Consulting, Medford, Oregon, United States
  5. Precise Approach Ltd, London, United Kingdom
  6. GSK, Collegeville, Pennsylvania, United States
  7. Pulmonary, Allergy, and Critical Care Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
  8. Division of Pulmonology and Critical Care Medicine, Weill Cornell Medicine, New York, New York, United States
  9. Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
  10. Centre for Respiratory Medicine and Allergy, Institute of Inflammation and Repair, Manchester Academic Health Science Centre, University of Manchester, Manchester University National Health Service Foundation Trust, Manchester, United Kingdom

Address correspondence to:

MeiLan K. Han, MD
Division of Pulmonary and Critical Care Medicine
University of Michigan
1500 E. Medical Center Drive
Ann Arbor, MI 48109
Phone: (734) 615-9772
Email: mrking@umich.edu

Abstract

This article does not contain an abstract.

Citation

Citation: Han MK, Criner GJ, Halpin DMG, et al. Any decrease in lung function is associated with worse clinical outcomes: post hoc analysis of the IMPACT interventional trial. Chronic Obstr Pulm Dis. 2024; 11(1): 106-113. doi: http://dx.doi.org/10.15326/jcopdf.2023.0391

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Perspective:

Integrating Artificial Intelligence in the Diagnosis of COPD Globally: A Way Forward

Nicole M. Robertson, MD, MPH1 Connor S. Centner, PhD2,3 Trishul Siddharthan, MD4

Author Affiliations

  1. Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
  2. University of Louisville School of Medicine, Louisville, Kentucky, United States
  3. Department of Bioengineering, School of Engineering, University of Louisville, Louisville, Kentucky, United States
  4. Division of Pulmonary, Critical Care, and Sleep Medicine, University of Miami, Miami, Florida, United States

Address correspondence to:

Trishul Siddharthan, MD
1951 NW 7th St.
Suite 2308
Miami, FL 33136
Email: tsiddhar@miami.edu
Phone: (305) 243-6387

Abstract

The advancement of artificial intelligence (AI) capabilities has paved the way for a new frontier in medicine, which has the capability to reduce the burden of COPD globally. AI may reduce health care-associated expenses while potentially increasing diagnostic specificity, improving access to early COPD diagnosis, and monitoring COPD progression and subsequent disease management. We evaluated how AI can be integrated into COPD diagnosing globally and leveraged in resource-constrained settings.AI has been explored in diagnosing and phenotyping COPD through auscultation, pulmonary function testing, and imaging. Clinician collaboration with AI has increased the performance of COPD diagnosing and highlights the important role of clinical decision-making in AI integration. Likewise, AI analysis of computer tomography (CT) imaging in large population-based cohorts has increased diagnostic ability, severity classification, and prediction of outcomes related to COPD. Moreover, a multimodality approach with CT imaging, demographic data, and spirometry has been shown to improve machine learning predictions of the progression to COPD compared to each modality alone. Prior research has primarily been conducted in high-income country settings, which may lack generalization to a global population. AI is a World Health Organization priority with the potential to reduce health care barriers in low- and middle-income countries. We recommend a collaboration between clinicians and an AI-supported multimodal approach to COPD diagnosis as a step towards achieving this goal. We believe the interplay of CT imaging, spirometry, biomarkers, and sputum analysis may provide unique insights across settings that could provide a basis for clinical decision-making that includes early intervention for those diagnosed with COPD.

Citation

Citation: Robertson NM, Centner CS, Siddharthan T. Integrating artificial intelligence in the diagnosis of COPD globally: a way forward. Chronic Obstr Pulm Dis. 2024; 11(1): 114-120. doi: http://dx.doi.org/10.15326/jcopdf.2023.0449

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Review:

Pulmonary Rehabilitation for Chronic Obstructive Pulmonary Disease Patients With Underlying Alpha-1 Antitrypsin Deficiency: A Systematic Review and Practical Recommendations

Fawaz A. Alwadani, MSc1,2 Kyrie Wheeler, BMBS, MSc3 Harriet Pittaway, MBBS4 Alice M. Turner, MBChB, PhD1

Author Affiliations

  1. Institute for Applied Health Research, University of Birmingham, Birmingham, United Kingdom
  2. Department of Physical Therapy, Jazan University, Jazan, Saudi Arabia
  3. Heartlands Hospital, Birmingham, United Kingdom
  4. Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom

Address correspondence to:

Alice M. Turner, MBChB, PhD
Institute for Applied Health Research
University of Birmingham
Birmingham, United Kingdom B15 2TT
Phone: +44 (0)7825683519
Email: a.m.turner@bham.ac.uk

Abstract

Background: Alpha-1 antitrypsin deficiency (AATD) is an often-overlooked genetic condition that makes individuals susceptible to early onset of chronic obstructive pulmonary disease (COPD). The established benefits of exercise-based pulmonary rehabilitation (PR) for usual COPD patients are unclear for those with underlying AATD, especially given potentially differing muscle adaptations to exercise. This review seeks to compare PR outcomes between AATD and usual COPD patients and to consolidate current knowledge on exercise intervention outcomes for the AATD population.

Methods: A thorough search of 4 databases (Ovid, Medline, CINAHL, CENTRAL) was conducted based on 3 search concepts: (1) alpha-1 antitrypsin deficiency, (2) pulmonary rehabilitation OR exercise, and (3) muscle morphology. A dual review process and quality assessment were independently implemented throughout all stages of the review.

Results: Four studies highlighted modest exercise capacity and quality of life in AATD patients undergoing PR. However, one study reported unique muscle and mitochondrial responses compared to usual COPD patients. Additionally, a moderate exercise session did not alter pro-inflammatory cytokine levels in AATD patients, despite higher levels of tumor necrosis factor-α levels in muscle biopsies compared to usual COPD patients.

Conclusions: The current literature base insufficiently addresses the efficacy of PR on AATD, with indications that exercise adaptation may deviate from that of usual COPD patients. Further research is needed to optimize PR, particularly in identifying the most suitable exercise intensity, and delivery setting, and addressing specific educational needs for individuals with AATD.

Citation

Citation: Alwadani FA, Wheeler K, Pittaway H, Turner AM. Pulmonary rehabilitation for chronic obstructive pulmonary disease patients with underlying alpha-1 antitrypsin deficiency: a systematic review and practical recommendations. Chronic Obstr Pulm Dis. 2024; 11(1): 121-132. doi: http://dx.doi.org/10.15326/jcopdf.2023.0434

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