Author Affiliations

1. Department of Medicine, University of Chicago, Chicago, Illinois, United States

Address correspondence to:

Valerie G. Press, MD, MPH
Departments of Medicine and Pediatrics, University of Chicago
5841 South Maryland Avenue, MC 2007
Chicago, IL 60637
Phone: (773) 702-5170
Email: vpress@bsd.uchicago.edu

Abstract

Patients with chronic obstructive pulmonary disease (COPD) rely primarily on inhaled medications to control and treat symptoms. Although the medications delivered by inhaler devices are often quite efficacious when delivered to the lung, the real-world effectiveness of these inhaler devices often falls short. Barriers to effective inhaler use include inhaler misuse and cost-related nonadherence. Inhaler misuse can be reduced with appropriate education which leads to improved outcomes. Education can be provided in multiple settings by a wide array of clinicians and clinical team members including pharmacists, respiratory therapists, nurses, physicians, advanced practice nurses, physician assistants, and community health workers, among others. However, despite decades of research and existing effective strategies across settings and types of educators, overall not much progress has been made with respect to effective inhaler technique among populations of patients with COPD in nearly half a century. Similarly, cost-related nonadherence is a long-standing and critical barrier to effective control of COPD, with limited improvements, especially until very recently. This perspective reviews the current promising directions for inhaler-based therapies, ongoing challenges, and critical issues requiring urgent attention.

Citation

Citation: Press VG. Real-world use of inhaled COPD medications: the good, the bad, the ugly. Chronic Obstr Pulm Dis. 2024; 11(4): 331-340. doi: http://dx.doi.org/10.15326/jcopdf.2024.0546

Keywords

acute exacerbation of COPD, inhaler errors, rescue inhaler, inhaler education, adherence

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Click to read Real-World Use of Inhaled COPD Medications: the Good, the Bad, the Ugly

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Author Affiliations

1. Department of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, United States
2. Mindful Breathing Lab, Mayo Clinic, Rochester, Minnesota, United States

Address correspondence to:

Roberto Benzo, MD
Mindful Breathing Laboratory
Division of Pulmonary, Critical Care, and Sleep Medicine
200 First Street SW
Rochester, MN 55905
Phone: (507) 293-1989
Email: Benzo.Roberto@mayo.edu

Abstract

Introduction: Research evidence indicates that meaning in life (MIL) is a meaningful outcome in individuals living with chronic illness, but evidence is lacking for chronic obstructive pulmonary disease (COPD).

Objectives: We hypothesized that MIL is independently associated with clinically meaningful outcomes for patients with COPD.

Methods: We performed cross-sectional analysis from a large cohort with moderate–severe COPD that participated in a home pulmonary rehabilitation study. MIL was measured using the Meaning in Life Questionnaire (MLQ), with domains of Presence and Search. The study included 340 participants: mean age 69 years old (standard deviation [SD] 9.4), 55.3% female, forced expiratory volume in 1 second (FEV₁) 44.3% (SD 19.4), and a modified Medical Research Council (mMRC) dyspnea scale of 2.69 (SD 0.84).

Results: Patients with high MLQ Presence (versus low score) had meaningfully better scores (beyond the minimal clinically important difference) across all Chronic Respiratory Questionnaire (CRQ) domains: Dyspnea, Fatigue, Emotions, and Mastery (p≤0.02); self-management (p≤0.001); social support (p≤0.001); anxiety (p≤0.001); and depression (p≤0.01) scores. When adjusting for age, sex, FEV₁, mMRC, social support, and anxiety, MLQ Presence was independently associated with CRQ domains Fatigue, Emotions, and self-management (p≤0.01). MLQ Search was independently associated with CRQ Dyspnea, Fatigue, and Mastery (p<0.05).

Conclusions: In patients with COPD, the perception that life has meaning or the willingness to search for MIL is associated with the outcomes that patients consider most important. Our results are novel as MIL is a potentially modifiable outcome that could complement person-centered conversations during clinical visits, pulmonary rehabilitation, and health coaching.

Citation

Citation: Batzlaff C, Roy M, Hoult J, Benzo R. Meaning in life: a novel factor for promoting well-being in COPD. Chronic Obstr Pulm Dis. 2024; 11(4): 341-349. doi: http://dx.doi.org/10.15326/jcopdf.2023.0476

Keywords

pulmonary rehabilitation, health-related quality of life, care coordination, chronic airways obstruction, advocacy

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Author Affiliations

1. Division of Internal Medicine, Respiratory and Respiratory Critical Care Unit, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
2. Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand

Address correspondence to:

Siwasak Juthong, MD
Respiratory and Respiratory Critical Care Medicine Unit
Division of Internal Medicine
Faculty of Medicine
Prince of Songkla University
Hat Yai, Songkhla 90110, Thailand
Phone: +6674-451-474
Email: jsiwasakmd@gmail.com

Abstract

Background: The blood eosinophil count (BEC) is an effective biomarker for predicting inhaled corticosteroid responsiveness in patients with chronic obstructive pulmonary disease (COPD).

Methods: A 12-month prospective observational study was conducted in patients with COPD. BEC was measured at enrollment, and after 6 and 12 months. Patients were classified into 3 groups according to their baseline BEC: <100, 100–299, and ≥300 cells/µL. We aimed to describe the patterns of blood eosinophil stability in patients with stable COPD and compare the exacerbation rates and other clinical outcomes at 6 and 12 months.

Results: A total of 252 patients with COPD were included. The <100, 100–299, and ≥ 300 cells/μL groups consisted of 14.7%, 38.9%, and 46.4% of patients, respectively. BEC stability was highest (85%) in the ≥300 cells/μL group for both durations. The lowest stability was observed in the <100 cells/μL group at 57% and 46% after 6 and 12 months, respectively. The persistent ≥300 cells/μL group had a higher incidence of moderate-to-severe exacerbation (incidence rate ratio [IRR] 2.44, 95% confidence interval [CI]: 1.13–5.27, p value 0.023), as well as severe exacerbation (IRR 2.19, 95%CI: 1.39–3.45, p value 0.001). Other patient-reported outcomes did not differ significantly between groups.

Conclusions: Blood eosinophil levels had good stability in patients with COPD with a BEC ≥300 cells/µL and was associated with a high risk of exacerbation in the persistent ≥300 cells/μL group. The variability of BEC was higher in patients with COPD with a BEC <300 cells/µL.

Citation

Citation: Kaenmuang P, Navasakulpong A, Geater SL, Densrisereekul S, Juthong S. Blood eosinophil count stability and clinical outcomes in patients with chronic obstructive pulmonary disease in a high endemic area of parasitic infection: a prospective study. Chronic Obstr Pulm Dis. 2024; 11(4): 350-358. doi: http://dx.doi.org/10.15326/jcopdf.2023.0492

Keywords

chronic obstructive pulmonary disease, exacerbation, stability, blood eosinophil levels, variability

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Click to read Blood Eosinophil Count Stability and Clinical Outcomes in Patients With Chronic Obstructive Pulmonary Disease in a High Endemic Area of Parasitic Infection: A Prospective Study

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Author Affiliations

1. Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina, Charleston, South Carolina, United States
2. Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, Colorado, United States
3. BioPharmaceuticals Medical, AstraZeneca, Wilmington, Delaware, United States
4. Evidera, Bethesda, Maryland, United States
5. Evidera, Seattle, Washington, United States
6. Alexion, AstraZeneca Rare Disease, Wilmington, Delaware, United States

Address correspondence to:

Charlie Strange, MD
Division of Pulmonary and Critical Care Medicine
Medical University of South Carolina
Charleston, SC
Phone: (843) 792-3174
Email: strangec@musc.edu

Abstract

Background: Patient perception of medication onset of effect is important for adherence. Although the Onset of Effect Questionnaire (OEQ) has been validated in patients with asthma, it has not been evaluated in patients with chronic obstructive pulmonary disease (COPD). This study evaluated the COPD-OEQ in patients with COPD.

Methods: Two analyses (qualitative and quantitative) were conducted to assess the content validity and psychometric properties of the COPD-OEQ in participants with COPD. In the qualitative analysis, interviews assessed content validity by concept elicitation (CE) and cognitive interviewing (CI). CE included questions to understand the patient experience related to onset of medication effect. CI included completion of the COPD-OEQ and assessment of the COPD-OEQ items, response options, and instructions. During the 2-week quantitative analysis, 2 versions of the COPD-OEQ (Weekly and Daily) were administered to assess test-retest reliability, construct validity, and known-groups validity.

Results: The qualitative analysis demonstrated that 3 of the 5 COPD-OEQ items were relevant and understood as intended. Qualitative findings demonstrated inconsistent evidence that the COPD-OEQ Weekly and Daily were reliable and valid measures in participants with COPD. Test-retest reliability was observed for the COPD-OEQ Weekly and Daily; however, construct validity was weak and demonstrated inconsistent correlations among COPD-OEQ items. Overall, known-groups validity was not demonstrated.

Conclusion: The weak evidence from the quantitative analysis of the COPD-OEQ Weekly and Daily tools does not support use of the OEQ in general COPD. Although the OEQ produced inconsistent results, the content validity surrounding the perception of medication onset remained valid in patients with COPD.

Citation

Citation: Strange C, Make BJ, Trudo FJ, et al. Validation of the Onset of Effect Questionnaire in participants with chronic obstructive pulmonary disease. Chronic Obstr Pulm Dis. 2024; 11(4): 359-368. doi: http://dx.doi.org/10.15326/jcopdf.2023.0485

Keywords

chronic obstructive pulmonary disease, patient-reported outcome, Onset of Effect Questionnaire

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Click to read Validation of the Onset of Effect Questionnaire in Participants With Chronic Obstructive Pulmonary Disease

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Author Affiliations

1. Research and Development Service, VA Boston Healthcare System, Boston, Massachusetts, United States
2. Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Boston, Massachusetts, United States
3. The Pulmonary Center, Boston University School of Medicine, Boston, Massachusetts, United States
4. Pulmonary and Critical Care Medicine Section, VA Boston Healthcare System, Boston, Massachusetts, United States
5. Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States
6. Harvard Medical School, Boston, Massachusetts, United States

Address correspondence to:

Stephanie A. Robinson, PhD
200 Springs Rd. Bldg 70
Bedford, MA 01730
Phone: (781) 687-4776
Email: Stephanie.Robinson5@va.gov

Abstract

Background: The relationships between physical activity (PA) and exercise performance and systemic biomarkers in persons with chronic obstructive pulmonary disease (COPD) have not been well characterized. The impact of PA promotion on biomarkers reflecting myocardial stress, systemic inflammation, and muscle injury is unclear.

Methods: This secondary analysis used 3 previously published studies in persons with COPD (2 examined a PA intervention that promoted community-based walking for 3 months) to explore these relationships. PA (daily step counts) and exercise performance (6-minute walk test [6MWT]) were assessed. Serum N-terminal pro-β-type natriuretic peptide (NT-proBNP), the soluble receptor for advanced glycation end products (sRAGE), and muscle-type creatine kinase (CKMM) were assayed at baseline and 3 months. General linear models examined associations between PA/exercise performance and systemic biomarkers at baseline and the effect of the PA intervention on change in biomarkers.

Results: Participants included 366 U.S. Veterans: 98% male, mean age 70±8 years, and forced expiratory volume in 1 second percentage predicted 59±21%. Lower baseline NT-proBNP, but not sRAGE or CKMM, was associated with higher daily step count (-0.95pg/ml per 1000 steps/day, p=.060) and higher 6MWT distance (-0.80pg/ml per 100 meters, p=.001). Change in daily step count, but not 6MWT, was significantly greater in the intervention (789±1864) compared to the control group (-174±1448; p=.002). The PA intervention had no significant impact on change in the systemic biomarkers.

Interpretation: Exercise performance is associated with NT-proBNP in persons with COPD. A 3-month community-based walking intervention is not associated with myocardial stress or muscle injury as assessed by NT-proBNP and CKMM, respectively.

Clinical Trial Registration: NCT01772082 and NCT02099799

Citation

Citation: Berube MN, Robinson SA, Wan ES, Mongiardo MA, Finer EB, Moy ML. Physical activity and systemic biomarkers in persons with COPD: insights from a web-based pedometer-mediated intervention. Chronic Obstr Pulm Dis. 2024; 11(4): 369-381. doi: http://dx.doi.org/10.15326/jcopdf.2023.0472

Keywords

chronic obstructive pulmonary disease, exercise, pulmonary disease, walk test

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Click to read Physical Activity and Systemic Biomarkers in Persons With COPD: Insights from a Web-Based Pedometer-Mediated Intervention

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Author Affiliations

1. Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
2. Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
3. Division of Pulmonary Diseases and Critical Care Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
4. Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States

Address correspondence to:

Eman M. Metwally, MD, PhD, MSCR
2102 McGavran-Greenberg, CB #7435
University of North Carolina at Chapel Hill
Chapel Hill, NC 27599-7435
Phone: (919) 547-3531
Email: Eman_Metwally@med.unc.edu

Abstract

Rationale: Chronic obstructive pulmonary disease (COPD) is a common comorbidity among patients with lung cancer, and an important determinant of their outcomes, however, it is commonly underdiagnosed.

Objective: Our objective was to estimate the prevalence of COPD among a cohort of U.S. lung cancer patients, the timing of a COPD diagnosis relative to their lung cancer diagnosis, and the association between an earlier diagnosis of COPD and stage of lung cancer, with consideration of patient sociodemographic modifying factors.

Methods: We conducted an analysis of the Medicare-linked Surveillance, Epidemiology, and End Results database including patients aged 68+ years who were diagnosed with lung cancer between 2008 to 2017. Exposure: Prevalence of COPD was identified using claims and subclassified based on the timing of its diagnosis relative to the lung cancer diagnostic episode–“preexisting” if diagnosed > 3 months before lung cancer, and “concurrent” if diagnosed around the same time as the lung cancer (+/-3 months). Outcome: The stage of cancer at diagnosis (early versus late) was the outcome.

Results: Among 159,542 patients with lung cancer, 73.5% had COPD. Among those with COPD, 34.4% were diagnosed within 3 months of their lung cancer diagnosis and considered to have “concurrent COPD.” We observed a positive association between preexisting COPD diagnosis and early-stage lung cancer (prevalence ratio= 1.27; 95% confidence interval= 1.23–1.30), in adjusted models which were stronger for male, non-Hispanic Black, and Hispanic patients.

Conclusions: Seven out of 10 patients with lung cancer have COPD, however, many do not receive their COPD diagnosis until around the time of their lung cancer diagnosis. Among these patients, an early COPD diagnosis may improve early detection of lung cancer.

Citation

Citation: Metwally EM, Lund JL, Drummond MB, Peacock Hinton S, Poole C, Thompson CA. COPD with lung cancer among older United States adults: prevalence, diagnostic timeliness, and association with earlier stage tumors. Chronic Obstr Pulm Dis. 2024; 11(4): 382-395. doi: http://dx.doi.org/10.15326/jcopdf.2024.0489

Keywords

COPD, Medicare, epidemiology, lung cancer

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Click to read COPD With Lung Cancer Among Older United States Adults: Prevalence, Diagnostic Timeliness, and Association With Earlier Stage Tumors

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Author Affiliations

1. Pulmonary Section, Minneapolis VA Health Care System, Minneapolis, Minnesota, United States
2. Division of Pulmonary, Allergy, Critical Care, and Sleep, University of Minnesota, Minneapolis, Minnesota, United States
3. Division of Biostatistics and Health Data Science, University of Minnesota, Minneapolis, Minnesota, United States
4. Pulmonary and Critical Care, VA Puget Sound Health Care System, Seattle, Washington, United States
5. Tsinghua University, Beijing, China
6. Division of Health Services Research and Implementation, Kaiser Permanente Southern California, Pasadena, California, United States

Address correspondence to:

David MacDonald, MD, MS
Minneapolis VA Health Care System
Pulmonary, Critical Care, and Sleep (111N)
One Veterans Drive
Minneapolis, MN, 55417
Email: macdo147@umn.edu

Abstract

Rationale: Physical activity, lung function, and grip strength are associated with exacerbations, hospitalizations, and mortality in people with chronic obstructive pulmonary disease (COPD). We tested whether baseline inflammatory biomarkers were associated with longitudinal outcomes of these physiologic measurements.

Methods: The COPD Activity: Serotonin Transporter, Cytokines, and Depression (CASCADE) study was a prospective observational study of individuals with COPD. A total of 14 inflammatory biomarkers were measured at baseline. Participants were followed for 2 years. We analyzed associations between baseline biomarkers and forced expiratory volume in 1 second (FEV₁), physical activity, and grip strength.

We used a hierarchical hypothesis testing procedure to reduce type I error. We used Pearson correlations to test associations between baseline biomarkers and longitudinal changes in the outcomes of interest. We used Fisher’s linear discriminant analysis to test if linear combinations of baseline biomarkers predict rapid FEV₁ decline. Finally, we used linear mixed modeling to test associations between baseline biomarkers and outcomes of interest at baseline, year 1, and year 2; models were adjusted for age, smoking status, baseline biomarkers, and FEV₁.

Results: A total of 302 participants (age 67.5 ± 8.5 years, 19.5% female, 28.5% currently smoking) were included. Baseline biomarkers were not associated with longitudinal changes in grip strength, physical activity, or rapid FEV₁ decline. Higher interleukin-6 and C-reactive protein were associated with lower physical activity at baseline and these relationships persisted at year 1 and year 2.

Conclusion: Baseline inflammatory biomarkers did not predict changes in lung function or physical activity, but higher inflammatory biomarkers were associated with persistently low levels of physical activity.

Citation

Citation: MacDonald DM, Samorodnitsky S, Lock EF, et al. Biomarkers of inflammation and longitudinal evaluation of lung function, physical activity, and grip strength: a secondary analysis in the CASCADE study. Chronic Obstr Pulm Dis. 2024; 11(4): 396-405. doi: http://dx.doi.org/10.15326/jcopdf.2024.0500

Keywords

chronic obstructive pulmonary disease, biomarkers, exercise, inflammation, hand strength

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Click to read Biomarkers of Inflammation and Longitudinal Evaluation of Lung Function, Physical Activity, and Grip Strength: A Secondary Analysis in the CASCADE Study

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Author Affiliations

1. Division of Internal Medicine, University and Hospital of Fribourg, Fribourg, Switzerland
2. Division of Physiotherapy, Hospital of Fribourg, Fribourg, Switzerland
3. Division of Internal Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
4. Department of Pulmonary Medicine, Allergology and Clinical Immunology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland

Address correspondence to:

Gael Grandmaison, MD
Division of Internal Medicine
University and Hospital of Fribourg
2-6 Chemin des Pensionnats
1708 Fribourg, Switzerland
Phone: ++41 26 306 23 68
Email: gael.grandmaison@h-fr.ch

Abstract

Background: The suboptimal use of inhalers in the treatment of patients with chronic obstructive pulmonary disease (COPD) is probably a major but poorly documented problem in hospitalized patients. We aimed to describe the prevalence of misused inhalers among patients hospitalized with COPD in a department of general internal medicine.

Method: We conducted a monocentric cross-sectional study in consecutive patients with a diagnosis of COPD and hospitalized between August 2022 and April 2023 in the internal medicine division of Fribourg Hospital, Switzerland. Patients underwent an assessment of their inhaler technique and peak inspiratory flow (PIF) using the In-Check Dial G16^®. The primary outcome was the prevalence of misused inhalers, defined as an inhaler used with a critical error and/or insufficient PIF. Secondary outcomes included the prevalence of inhalers unsuitable to patients’ characteristics and of patients using at least one misused inhaler.

Results: The study included 96 patients and 160 inhalers were assessed at admission. Among these inhalers, 111 (69.4%; 95% confidence interval [CI] 61.6–76.4) were misused; 105 (65.6%; 95% CI 57.7–72.9) due to the presence of a critical error in the inhalation technique and 22 (13.8%; 95% CI 8.8–20.1) due to insufficient PIF. Concerning the secondary outcome, 27 inhalers (16.9%) were unsuitable, and 79 patients (82.3%) used at least one misused inhaler.

Conclusion: Among patients hospitalized with a diagnosis of COPD, two-thirds of inhalers were misused. Suboptimal use was mainly due to the presence of critical errors, but also to the presence of an insufficient PIF and unsuitable inhalers.

Citation

Citation: Grandmaison G, Grobéty T, Vaucher J, Hayoz D, Suter P. Prevalence of critical errors and insufficient peak inspiratory flow in patients hospitalized with COPD in a department of general internal medicine: a cross-sectional study. Chronic Obstr Pulm Dis. 2024; 11(4): 406-415. doi: http://dx.doi.org/10.15326/jcopdf.2024.0505

Keywords

chronic obstructive pulmonary disease, inhaler, peak inspiratory flow, hospital, critical error

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Click to read Prevalence of Critical Errors and Insufficient Peak Inspiratory Flow in Patients Hospitalized With COPD in a Department of General Internal Medicine: A Cross-Sectional Study

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Author Affiliations

1. Nephrology Department, Lishui Municipal Central Hospital, the Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, Zhejiang, China
2. Dental Department, The First Affiliated Hospital of Bengbu Medical University, Bengbu, Anhui, China
3. First Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
4. Rehabilitation Department, Lishui Municipal Central Hospital, the Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, Zhejiang, China

Address correspondence to:

Jiaqi Chen, MS
Lishui Municipal Central Hospital
The Fifth Affiliated Hospital of Wenzhou Medical University
Lishui, Zhejiang, 323000, China
Email: 463364681@qq.com
Hua Yang, MS
Lishui Municipal Central Hospital
The Fifth Affiliated Hospital of Wenzhou Medical University
Lishui, Zhejiang, 323000, China
Email: 17858763315@163.com

Abstract

Background: There is a global increase in the prevalence of osteoporosis and chronic obstructive pulmonary disease (COPD). Studies based on observation revealed a higher incidence of osteoporosis in patients with COPD. We looked into the genetic relationship between COPD and osteoporosis using the Mendelian randomization (MR) technique.

Methods: The inverse variance-weighted (IVW) method was the primary technique used in this MR investigation. The sensitivity was assessed using the simple median, weighted median, penalized weighted median, and MR Egger regression analysis.

Results: The IVW model demonstrated that genetically determined COPD is causally associated with an elevated risk of osteoporosis (odds ratio [OR] fixed-effect, 1.010; 95% confidence interval [CI], 1.001–1.019, P=0.021; OR random-effect, 1.010; 95% CI, 1.001–1.020, P=0.039). It was also found that this correlation held valid for the simple and weighted median, Penalized weighted, MR-Egger, and MR Egger (bootstrap) approaches. No heterogeneity was found in the IVW or MR-Egger analysis results (Q=131.374, P=0.061 and Q=128.895, P=0.069, respectively). Furthermore, no pleiotropic influence via genetic variations was revealed by MR-Egger regression (intercept, -0.0002; P=0.160). No one single nucleotide polymorphism was found to have a substantial impact on the relationship between COPD and osteoporosis by the leave-one-out sensitivity analysis.

Conclusion: Our MR analysis demonstrated a substantial positive impact of COPD on the risk of osteoporosis.

Citation

Citation: Dou Z, Chen X, Chen J, Yang H, Chen J. Chronic obstructive pulmonary disease and osteoporosis: a two-sample Mendelian randomization analysis. Chronic Obstr Pulm Dis. 2024; 11(4): 416-426. doi: http://dx.doi.org/10.15326/jcopdf.2024.0501

Keywords

chronic obstructive pulmonary disease, osteoporosis, Mendelian randomization, genetics

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Click to read Chronic Obstructive Pulmonary Disease and Osteoporosis: A Two-Sample Mendelian Randomization Analysis

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Author Affiliations

1. Division of Pulmonary and Critical Care Medicine, University of California Davis School of Medicine, Sacramento, California, United States
2. University of California Davis Health, Sacramento, California, United States
3. Department of Internal Medicine, University of California Davis School of Medicine, Sacramento, California, United States

Address correspondence to:

Reshma Gupta, MD, MSHPM
UC Davis Health and UC Davis School of Medicine
Department of Internal Medicine
4860 Y St.
Sacramento, CA 95817
Phone: (916) 734-2737
Email: regupta@ucdavis.edu

Abstract

As a result of climate change, wildfire frequency, duration, and severity are increasing in the United States. Exposure to wildfire-related air pollutants can lead to negative health outcomes, particularly among patients with preexisting respiratory diseases (e.g., asthma and chronic obstructive pulmonary disease) and those who are at higher risk for developing these conditions. Underserved communities are disproportionately affected for multiple reasons, including lack of financial and social resources, increased exposure to air pollutants at home and at work, and impaired access to health care. To best serve clinically high-risk and underserved populations, health systems must leverage community public health data, develop and mobilize a wildfire preparedness action plan to identify populations at high risk, and implement interventions to mitigate the consequences of poor air quality. University of California, Davis Health, located at the epicenter of the largest wildfires in California’s history, has developed the 5 pillar Wildfire Population Health Approach: (1) identify clinically at-risk and underserved patient populations using well-validated, condition-targeted registries; (2) assemble multidisciplinary care teams to understand the needs of these communities and patients; (3) create custom analytics and wildfire-risk stratification; (4) develop care pathways based on wildfire-risk tiers by disease, risk of exposure, and health care access; and (5) identify outcome measures tailored to interventions with a commitment to continuous, iterative improvement efforts. The Wildfire Population Health Approach provides an action plan for health systems and care teams to meet the needs of clinically at-risk and underserved patients affected by the increasing health threat posed by climate change-related wildfires.

Citation

Citation: Kuhn BT, Gupta R. Improving wildfire readiness among patients with chronic obstructive pulmonary disease and asthma: applying a population health approach to climate change. Chronic Obstr Pulm Dis. 2024; 11(4): 427-435. doi: http://dx.doi.org/10.15326/jcopdf.2024.0509

Keywords

chronic obstructive pulmonary disease, alpha-1 antitrypsin deficiency, air pollution, wildfires, climate change

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Click to read Improving Wildfire Readiness Among Patients With Chronic Obstructive Pulmonary Disease and Asthma: Applying a Population Health Approach to Climate Change

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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:

There is no correspondance information for this article.

Abstract

This article does not contain an abstract.

Citation

Citation: Erratum. Chronic Obstr Pulm Dis. 2024; 11(4): 436-436. doi: http://dx.doi.org/10.15326/jcopdf.2023.0422E

Keywords

There are no keywords for this article.

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Click to read Erratum

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