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Lucas M. Donovan, MD, MS1,2 Thomas L. Keller, MD, MS2 Nancy H. Stewart, DO, MS3 Jennifer Wright, MD2 Laura J. Spece, MD, MS1,2 Kevin I. Duan, MD, MS2,4 Aristotle Leonhard, MD1,2 Brian N. Palen, MD1,2 Martha E. Billings, MD, MS1,2 David H. Au, MD, MS1,2 Laura C. Feemster, MD, MS1,2
Author Affiliations
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, Washington, United States
- Department of Medicine, University of Washington, Seattle, Washington, United States
- Department of Internal Medicine, University of Kansas, Kansas City, Kansas, United States
- Division of Respiratory Medicine, University of British Columbia, Vancouver, Canada
Address correspondence to:
Lucas M. Donovan, MD, MS
HSR&D Center of Innovation for Veteran-Centered and Value-Driven Care
VA Puget Sound Health Care System
Division of Pulmonary, Critical Care and Sleep Medicine
1660 South Columbian Way
Seattle, WA 98108
Email: ldonovan@uw.edu
Abstract
Study Objectives: Observational studies link untreated obstructive sleep apnea (OSA) with adverse outcomes in chronic obstructive pulmonary disease (COPD). The first step in addressing OSA is a clinical assessment. However, given competing demands and a lack of high-quality evidence, it is unclear how often such assessments occur. We explored the documentation of OSA assessment among patients with COPD in primary care, and the patient and provider characteristics associated with these assessments.
Methods: We conducted a cross-sectional study of patients with clinically diagnosed COPD at 2 primary care practices. We abstracted charts to determine whether providers assessed OSA, defined as documentation of symptoms, treatment, or a referral to sleep medicine. We performed multivariable mixed-effects logistic regression to assess the associations of patient and provider characteristics with OSA assessment.
Results: Among 641 patients with clinically diagnosed COPD, 146 (23%) had OSA assessed over a 1-year period. Positive associations with OSA assessment included body mass index ≥ 30 (odds ratio [OR] 3.5, 95% confidence interval [CI] 1.8–7.0), pulmonary subspecialist visits (OR 3.9, 95%CI 2.4–6.3), and a prior sleep study demonstrating OSA documented within the electronic medical record (OR 18.0, 95%CI 9.0–35.8). Notably, patients identifying as Black were less likely to have OSA assessed than those identifying as White (OR 0.5, 95%CI 0.2–0.9).
Conclusions: Providers document an assessment of OSA among a quarter of patients with COPD. Our findings highlight the importance of future work to rigorously test the impact of assessment on important health outcomes. Our findings also reinforce that additional strategies are needed to improve the equitable delivery of care.
Citation
Citation: Donovan LM, Keller TL, Stewart NH, et al. Assessment of obstructive sleep apnea among patients with chronic obstructive pulmonary disease in primary care. Chronic Obstr Pulm Dis. 2024; 11(2): 136-143. doi: http://dx.doi.org/10.15326/jcopdf.2023.0438
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Paul Jones, MD, PhD1a Toru Soutome, BPharm2a,b Taizo Matsuki, PhD2a Masahiro Shinoda, MD, PhD3 Osamu Hataji, MD, PhD4 Motohiko Miura, MD, PhD5 Masaharu Kinoshita, MD6 Akira Mizoo, MD7 Kazunori Tobino, MD8 Takanobu Nishi, MSc2 Takeo Ishii, MD, PhD2b Yoko Shibata, MD, PhD9
Author Affiliations
- GSK, Brentford, Middlesex, United Kingdom
- Japan Medical & Development, GSK K.K, Tokyo, Japan
- Department of Respiratory Medicine, Tokyo Shinagawa Hospital, Tokyo, Japan
- Respiratory Center, Matsusaka Municipal Hospital, Matsusaka, Mie, Japan
- Department of Respiratory Medicine, Tohoku Rosai Hospital, Miyagi, Japan
- Department of Respiratory Medicine, Nagata Hospital, Fukuoka, Japan
- Department of Pulmonary Medicine, Japan Community Healthcare Organization Tokyo Shinjuku Medical Center, Tokyo, Japan
- Department of Respiratory Medicine, Iizuka Hospital, Fukuoka, Japan
- Department of Pulmonary Medicine, Fukushima Medical University, Fukushima, Japan
aContributed equally
bAffiliation at the time of the study
Address correspondence to:
Paul Jones, MD, PhD
GSK
980 Great West Road
Brentford, Middlesex
TW8 9GS, United Kingdom
Phone: +44 (771) 340-1434
Email: paul.8.jones@gsk.com
Abstract
Background: A previous longitudinal study of chronic obstructive pulmonary disease (COPD) Assessment Test (CAT) score changes suggested patients fall into 3 patterns: stable, improving, and worsening. This study assessed the evolution of CAT scores over time and its relationship to exacerbations.
Methods: In total, 84 participants used a telemedicine platform to complete CAT weekly for 52 weeks. Completion rates, annualized change in CAT scores, and learning effects were measured, as well as CAT changes of >4 units during look-back periods of 4 and 8 weeks. In a subgroup of participants with at least a 25% completion rate (adherent group, n=68 [81%]), the relationship between change in CAT score and exacerbations at any time during the study was examined post hoc.
Results: Linear regression showed that 50%, 22%, and 28% of the adherent subgroup had CAT scores indicating worsening, stable, and improving health status, respectively. In the adherent subgroup, 70% (n=7/10) of participants who had an exacerbation during the study had worsening CAT scores, versus 47% (n=27/58) without an exacerbation. The hazard ratio association between CAT score increase and moderate exacerbation was 1.13 (95% confidence interval: 1.03–1.24). Most participants experienced at least one CAT score change of >4 units, and 7% showed an initial learning effect with a median of 2 weeks.
Conclusions: Measuring trends in CAT scores may allow future studies to group patients into 3 defined categories of change over time and quantify CAT change trajectories to assess treatment response and potentially predict medium-term outcomes within individual patients.
Citation
Citation: Jones P, Soutome T, Matsuki T, et al. Health status progression measured using weekly telemonitoring of COPD Assessment Test scores over 1 year and its association with COPD exacerbations. Chronic Obstr Pulm Dis. 2024; 11(2): 144-154. doi: http://dx.doi.org/10.15326/jcopdf.2023.0415
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Tao Yu, MS1,2 Yunru Chen, MS3 Xiaoxia Ren, MD1,2 Ting Yang, MD1,2
Author Affiliations
- National Center for Respiratory Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
- Peking Union Medical College, Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
- Centre for Evidence-based Chinese Medicine, School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
Address correspondence to:
Xiaoxia Ren, MD
Department of Pulmonary and Critical Care Medicine
Center of Respiratory Medicine
China-Japan Friendship Hospital
No 2, East Yinghua Road
Chaoyang District
Beijing 100029, China
Email: xiaoxiaren2011@163.com
Abstract
Introduction/Objective: Respiratory microbiome studies have fostered our understanding of the various phenotypes and endotypes of heterogeneous chronic obstructive pulmonary disease (COPD). This study aimed to identify microbiome-driven clusters that reflect the clinical features and dominant microbiota of COPD.
Methods: This cross-sectional study included 32 patients with stable COPD between December 2019 and December 2020 from the outpatient clinic of the China-Japan Friendship Hospital. Sputum samples were tested for 16S rRNA. Patients were classified according to the species level using an unsupervised clustering method to compare the inflammatory phenotypes of 2 clusters and analyze the correlation between the main bacteria and clinical indicators in each cluster. Patients were further divided into 2 clusters according to microorganisms.
Results: Neutrophils in cluster 1 were significantly increased compared with cluster 2. Cluster 1 was predominantly Bacteroides, while cluster 2 was dominated by Prevotella and Fusobacterium at the genus level. Fusobacterium was negatively correlated with the COPD Assessment Test (CAT) score, and Bacteroides were positively correlated with the number of acute exacerbations of COPD.
Conclusion: This study found that differential flora was negatively associated with CAT scores and the number of acute exacerbations of COPD. This microbiome-driven, unbiased clustering method for COPD can help identify new endotype-related COPD phenotypes.
Citation
Citation: Yu T, Chen Y, Ren X, Yang T. Respiratory microbiome profiles associated with distinct inflammatory phenotype and clinical indexes in chronic obstructive pulmonary disease. Chronic Obstr Pulm Dis. 2024; 11(2): 155-163. doi: http://dx.doi.org/10.15326/jcopdf.2023.0445
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Mariah K. Jackson, MMN1 Yuni Choi, PhD2 Elliot Eisenberg, MD3 Corrine Hanson, PhD1 Ann Wang, MD3 Jing Gennie Wang, MD4 George R. Washko, MD5 Samuel Ash, MD6 Raul San Jose Estepar, PhD7 Gabrielle Liu, MD8 James M. Shikany, DrPH9 Lyn M. Steffen, PhD2 Robert Wharton, MD10 Ravi Kalhan, MD8 David R. Jacobs, Jr, PhD2 Sonali Bose, MD, MPH3
Author Affiliations
- Division of Medical Nutrition Education, University of Nebraska Medical Center, Omaha, Nebraska, United States
- Division of Epidemiology and Community Health, University of Minnesota Twin Cities, Minneapolis, Minnesota, United States
- Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, United States
- Division of Pulmonary Critical Care and Sleep Medicine, Department of Internal Medicine, the Ohio State University Wexner Medical Center, Columbus, Ohio, United States
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States
- Critical Care, South Shore Hospital, Weymouth, Massachusetts, United States
- Department of Radiology, Brigham and Women’s Hospital, Boston, Massachusetts, United States
- Division of Pulmonary and Critical Care Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States
- Division of Preventive Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, United States
Address correspondence to:
Mariah K. Jackson, MMN
Division of Medical Nutrition Education
University of Nebraska Medical Center
Omaha, Nebraska
Phone: (402) 836-9892
Email: mariah.jackson@unmc.edu
Abstract
Background: Chronic obstructive pulmonary disease (COPD) is a significant public health concern and intercepting the development of emphysema is vital for COPD prevention. Smokers are a high-risk population for emphysema with limited prevention strategies. We aimed to determine if adherence to a nutritionally rich, plant-centered diet among young ever-smokers is associated with reduced risk of future radiographic emphysema.
Methods: We studied participants from the Coronary Artery Risk Development in Young Adults (CARDIA) Lung Prospective Cohort Study who were 18–30 years old at enrollment and followed for 30 years. We analyzed 1706 adults who reported current or former smoking by year 20. Repeated measures of diet history were used to calculate A Priori Diet Quality Scores (APDQSs), and categorized into quintiles, with higher quintiles representing higher nutritionally rich plant-centered food intake. Emphysema was assessed at year 25 (n=1351) by computed tomography (CT). Critical covariates were selected, acknowledging potential residual confounding.
Results: Emphysema was observed in 13.0% of the cohort, with a mean age of 50.4 ± 3.5 years. The prevalence of emphysema was 4.5% in the highest APDQS quintile (nutritionally rich), compared with 25.4% in the lowest quintile. After adjustment for multiple covariates, including smoking, greater adherence to a plant-centered diet was inversely associated with emphysema (highest versus lowest quintile odds ratio: 0.44, 95% CI 0.19-0.99, ptrend=0.008).
Conclusion: Longitudinal adherence to a nutritionally rich, plant-centered diet was associated with a decreased risk of emphysema development in middle adulthood, warranting further examination of diet as a strategy for emphysema prevention in a high-risk smoking population.
Citation
Citation: Jackson MK, Choi Y, Eisenberg E, et al. A plant-centered diet is inversely associated with radiographic emphysema: findings from the CARDIA Lung Study. Chronic Obstr Pulm Dis. 2024; 11(2): 164-173. doi: http://dx.doi.org/10.15326/jcopdf.2023.0437
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Roy A. Pleasants, PharmD,1,2 Ashley G. Henderson, MD3 Valentina Bayer, PhD4 Asif Shaikh, MD4 M. Bradley Drummond, MD, MS3
Author Affiliations
- Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan, United States
- Division of Pulmonary Diseases and Critical Care Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
- Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, Connecticut, United States
Address correspondence to:
Roy A. Pleasants, PharmD
University of North Carolina at Chapel Hill
Chapel Hill, NC
Phone: (919) 843-9938
Email: pleas005@email.unc.edu
Abstract
Background: We examined the effect of physical position on peak inspiratory flow (PIF) in patients with chronic obstructive pulmonary disease (COPD) using dry-powder inhalers (DPIs) with low‑medium internal resistance (R2) and/or high internal resistance (R5).
Methods: This prospective study in stable, ambulatory patients with spirometry-confirmed COPD evaluated the effect of 3 physical positions on maximal PIF achieved. Participants had PIFs of 30–90L/min (R5) or 60–90L/min (R2 DPIs) using the In-Check™ DIAL. PIF was measured in triplicate randomly in 3 positions that patients might be in while using their inhaler (standing, sitting, and semi-upright [supine position with the head of the bed at 45°, neck flexed forward]) against prescribed DPI resistance (R2/R5/both). Correlations between PIF and percentage decline in PIF between positions and differences in participant characteristics with >10% versus ≤10% PIF decline standing to semi-upright were calculated.
Results: A total of 76 participants (mean age, 65.2 years) had positional measurements; 59% reported seated DPI use at home. The mean (standard deviation) PIF standing, sitting, and semi-upright was 80.7 (13.4), 77.8 (14.3), and 74.0 (14.5) L/min, respectively, for R2 and 51.1 (9.52), 48.6 (9.84), and 45.8 (7.69) L/min, respectively, for R5 DPIs. PIF semi-upright was significantly lower than sitting and standing (R2; P < 0.0001) and standing (R5; P= 0.002). Approximately half of the participants had >10% decline in PIF from standing to semi-upright. Patient characteristics exceeding the 0.10 absolute standardized difference threshold with the decline in PIF for both the R2 and R5 DPIs were waist-to-hip ratio, modified Medical Research Council dyspnea score, and postbronchodilator percentage predicted forced vital capacity and PIF by spirometry.
Conclusions: PIF was significantly affected by physical position regardless of DPI resistance. PIF was highest when standing and lowest when semi-upright. We recommend that patients with COPD stand while using an R2 or R5 DPI. Where unfeasible, the position should be sitting rather than semi-upright.
ClinicalTrials.gov identifier NCT04168775
Citation
Citation: Pleasants RA, Henderson AG, Bayer V, Shaikh A, Drummond MD. Effect of physical position on peak inspiratory flow in stable COPD: an observational study. Chronic Obstr Pulm Dis. 2024; 11(2): 174-186. doi: http://dx.doi.org/10.15326/jcopdf.2023.0460
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Patricia Alupo, MBChB, MMed1 Winceslaus Katagira, MBChB, MMed1 David Mukunya,MBChB, PhD2 Paul Okimat, MSc3 Vickram Tejwani, MD4 Alex Kayongo, PhD1 Joanitah Nalunjogi,MSc1 Nicole M. Robertson, MD5 Rupert Jones, MD, PhD1,6 John R. Hurst, PhD7 Bruce Kirenga, MBChB, MMed, PhD*1,2 Trishul Siddharthan, MD*8
Author Affiliations
- Makerere University Lung Institute, Kampala, Uganda
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
- Soroti District Local Government, Soroti, Uganda
- Respiratory Institute, Cleveland Clinic, Cleveland, Ohio, United States
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
- Faculty of Health, University of Plymouth, Plymouth, United Kingdom
- Respiratory, University College London, London, United Kingdom
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Miami, Miami, Florida, United States
*Joint senior authorship
Address correspondence to:
Patricia Alupo, MBChB, MMed
Makerere University Lung Institute
Phone: +256701124540
Email: alupopat@gmail.com
Abstract
Background: The neutrophil-to-lymphocyte ratio (NLR) is an inexpensive biomarker that potentially predicts acute exacerbations of chronic obstructive pulmonary disease (AECOPDs). We evaluated the association of baseline NLR and respiratory hospitalization risk within one year among chronic obstructive pulmonary disease (COPD) patients in Uganda, a low- and middle-income country.
Methods: A total of 312 COPD patients were followed for one year. Clinical characteristics and exacerbation rates were collected. Poisson regression with robust variance estimators was used to measure the association between NLR and hospital admissions due to COPD exacerbations. Receiver-operator characteristic (ROC) curves and the area under the curve were used to assess the ability of NLR to predict AECOPDs.
Results: The median (Q 1, Q 3) age was 64 years (53, 71). Females comprised 50.96% (n=159) of the cohort, and 71.2% (n=222) of participants had moderate or severe COPD. A total of 9.9% (n=31) of participants experienced a COPD exacerbation during the period of follow-up. At baseline, the median (Q 1, Q 3) NLR ratio among participants who experienced an exacerbation was 1.46 (0.92, 2.33) compared to 1.03 (0.72,1.42) among those who did not experience one during the follow-up period (p=0.002). Using Youden and Liu’s methods, the optimal NLR cutoff for predicting COPD exacerbation was 1.17. This cutoff resulted in a ROC curve area of 0.64 (95% confidence interval: 0.56, 0.73).
Conclusions: The NLR could be used as a risk predictor, in low- and middle-income countries, for hospital admissions due to COPD exacerbations. A cutoff of 1.17 was an independent predictor of hospitalization due to acute exacerbations of COPD within one year.
Citation
Citation: Alupo P, Katagira W, Mukunya D, et al. The neutrophil-to-lymphocyte ratio as a predictor of acute exacerbations among patients with COPD in Uganda. Chronic Obstr Pulm Dis. 2024; 11(2): 187-195. doi: http://dx.doi.org/10.15326/jcopdf.2023.0443
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Abebaw M. Yohannes, PhD, MSc1,2 Anand S. Iyer, MD, MSPH2 Candice Clay, PhD3* Lauren Cochran, PharmD3 Xianyi Chen, MS3 David A. Lombardi, PhD3* Surya P. Bhatt, MD, MSPH2
Author Affiliations
- Department of Physical Therapy, School of Health Professions, University of Alabama at Birmingham, Birmingham, Alabama, United States
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, and Lung Health Center, University of Alabama at Birmingham, Birmingham, Alabama, United States
- Theravance Biopharma U.S., Inc., South San Francisco, California, United States
*At the time this study was conducted.
Address correspondence to:
Abebaw M. Yohannes, PhD, MSc
Department of Physical Therapy/School of Health Professions
Division of Pulmonary, Allergy and Critical Care Medicine &
Lung Health Center
University of Alabama at Birmingham
Birmingham, AL
Phone: (205) 934-3566
Email: amyohann@uab.edu
Abstract
Background: Revefenacin, a once-daily, nebulized, long-acting muscarinic antagonist approved in the United States for the maintenance of chronic obstructive pulmonary disease (COPD), significantly improves lung function and quality of life versus placebo in patients with moderate-to-very severe COPD. Comorbid anxiety and/or depression may alter patients’ symptom perception and response to bronchodilators. The impact of revefenacin in patients with COPD with comorbid anxiety and/or depression has not been previously investigated.
Methods: This post hoc subgroup analysis examined data from two 12-week, randomized, phase 3 trials in patients with moderate-to-very severe COPD with the following self-reported subgroups: anxiety only (A), depression only (D), anxiety and depression (+A/+D), and neither anxiety nor depression (−A/−D). We assessed change from baseline in trough forced expiratory volume in 1 second (FEV1) at Day 85 and health status by the St George’s Respiratory Questionnaire (SGRQ) and COPD Assessment Test (CAT).
Results: Of 812 patients, 90 (11%), 110 (14%), 141 (17%), and 471 (58%) had A, D, +A/+D, and −A/−D respectively. In revefenacin versus placebo, trough FEV1 significantly improved from baseline at Day 85 across all subgroups as well as the SGRQ and CAT scores in patients with A, +A/+D, and −A/−D. Revefenacin was well tolerated regardless of A/D status, with a minimal incidence of treatment-emergent antimuscarinic adverse events across subgroups.
Conclusions: In this analysis, revefenacin versus placebo significantly improved health outcomes in patients with moderate-to-very severe COPD with A, +A/+D, and −A/−D, but not in patients with D. The safety profile of revefenacin was not affected by comorbid anxiety/depression status.
Citation
Citation: Yohannes AM, Iyer AS, Clay C, et al. Post hoc analysis of lung function improvement and patient-reported outcomes with revefenacin in adults with moderate-to-very severe COPD and comorbid anxiety or depression. Chronic Obstr Pulm Dis. 2024; 11(2): 196-205. doi: http://dx.doi.org/10.15326/jcopdf.2023.0465
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Abdul H. Zaid, MBBS1 Suman B. Thapamagar, MBBS2 James D. Anholm, MD3 Laura Weaver-Carnahan, RN, RRT3 Lien Duong, PharmD3 Lennard Specht, MD3
Author Affiliations
- Pulmonary and Critical Care, Loma Linda University Medical Center, Loma Linda, California, United States
- Pulmonary and Critical Care, Riverside University Health System, Moreno Valley, California, United States
- Pulmonary and Critical Care, VA Loma Linda Healthcare System, Loma Linda, California, United States
Address correspondence to:
Abdul H. Zaid, MBBS
11234 Anderson Street
MC 1503A
Loma Linda, California 92354
Phone: (909) 558-4911 x44911
Email: docahz@gmail.com
Abstract
Background: Dyspnea is frequently a debilitating symptom of chronic obstructive pulmonary disease (COPD). Cannabinoid receptor agonists have the potential to alter dyspnea in these patients.
Objective: Our objective was to determine if dronabinol, a pure cannabinoid, improves dyspnea and exercise tolerance in COPD.
Methods: In this double-blind randomized, crossover pilot study, COPD patients received up to 20mg of oral dronabinol or placebo daily for 6 weeks with an intervening washout period. Dyspnea and fatigue were assessed using the Borg scale at rest and after an incremental shuttle walk. Functional status, mood, and depression were measured using the St George’s Respiratory Questionnaire (SGRQ), the Pulmonary Functional Status and Dyspnea Questionnaire (PFSDQ), and the Geriatric Depression Scale (GDS).
Results: A total of 11 participants (with mean forced expiratory volume in 1 second 50.8 ± 24.8%) completed the study with no improvement in dyspnea at rest or postexercise taking dronabinol versus placebo (Borg scale 0.27, 95% confidence interval [CI] -0.59 to 1.14 versus 0.23 points, 95% CI -0.71 to 1.07 at rest and 0.82, 95% CI -0.59 to 2.22 versus 0.36 points, 95% CI 0.13 to 2.78 post exercise; p=0.94 and p=0.69 respectively). Dronabinol compared with placebo showed no significant change in PFSDQ dyspnea scores (0.64, 95% CI -3.92 to 5.20 versus 5.0, 95% CI -6.29 to 16.29; p=0.43) or shuttle walk distances (20.7m, 95% CI -21.5 to 62.8 versus 13.7m, 95% CI -24.8 to 52.2; p=0.69). There were no significant differences in fatigue at rest and postexercise, SGRQ scores, or GDS scores.
Conclusions: In this pilot study, dronabinol did not significantly improve dyspnea or exercise capacity compared with placebo.
Citation
Citation: Zaid AH, Thapamagar SB, Anholm JD, et al. Effects of dronabinol on dyspnea and quality of life in patients with COPD. Chronic Obstr Pulm Dis. 2024; 11(2): 206-215. doi: http://dx.doi.org/10.15326/jcopdf.2023.0401
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Jun Jin, BS1 Yuemei Bian, BS2 Zhongyun Gu, BS3 Maoen Lin, BS1
Author Affiliations
- Department of Respiratory Medicine, Hangzhou Ninth People’s Hospital, Hangzhou City, Zhejiang Province, China
- Clinical Nutrition Department, Hangzhou Ninth People’s Hospital, Hangzhou City, Zhejiang Province, China
- General Surgery, Hangzhou Ninth People’s Hospital, Hangzhou City, Zhejiang Province, China
Address correspondence to:
Maoen Lin, BS
Department of Respiratory Medicine
Hangzhou Ninth People’s Hospital
No. 98, Yilong Road, Yipong Street
Qiantang District, Hangzhou City
Zhejiang Province
311225, China
Phone: 8613868387799
Email: maoenlinlin@163.com
Abstract
Objective: This study aimed to investigate dietary fiber (DF) intake with the prevalence of chronic obstructive pulmonary disease (COPD) in the middle-aged and elderly population through analysis of the National Health and Nutrition Examination Survey (NHANES) data.
Methods: The study utilized data from 3 cycles of the NHANES database (2007–2012). The exposure variable was DF intake, and the outcome variable was COPD prevalence. Weighted logistic regression was utilized to construct relationship models between the 2 variables. Confounding factors were adjusted, and subgroup analysis was to explore the association of DF intake with COPD. Restricted cubic spline (RCS) analysis investigated the nonlinear relationship between DF intake and COPD. Finally, mediation analysis was performed to determine whether the influence of DF intake on COPD prevalence is mediated through the alteration of white blood cell (WBC) counts.
Results: This study included a total of 7301 eligible participants aged >40 years. The results of the study indicated that an increase in DF intake significantly reduced the prevalence of COPD (odds ratio: 0.98, 95% confidence interval: 0.96–0.99, p<0.001), and DF intake was correlated with lung function indicators (e.g., forced expiratory volume in 1 second). Stratified analysis revealed that an increased DF intake significantly reduced the risk of COPD in male individuals, middle-aged individuals (aged 40–59 years), those with a body mass index ≤30 kg/m2, individuals with a history of smoking, and alcohol consumers (p<0.05). Through RCS analysis exploring the nonlinear association between DF intake and COPD prevalence, the critical threshold for the impact of DF intake on COPD prevalence was 15.10 gm. When DF intake was ≥15.10 g/d, it effectively reduced the prevalence of COPD. Mediation analysis results indicated that the WBC count partially mediated the association between DF intake and COPD, with a mediation proportion of 9.89% (p=0.006).
Conclusions: Increased DF intake was linked to decreased prevalence of COPD, particularly in men and middle-aged people. WBC counts may be an important pathway linking DF intake and COPD.
Citation
Citation: Jin J, Bian Y, Gu Z, Lin M. Association between dietary fiber intake and prevalence of chronic obstructive pulmonary disease in a middle-aged and elderly population: a study based on the National Health and Nutrition Examination Survey database. Chronic Obstr Pulm Dis. 2024; 11(2): 216-228. doi: http://dx.doi.org/10.15326/jcopdf.2023.0457
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