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Tyler McGrady, MPH1 David M. Mannino, MD1 Elisha Malanga2 Byron M. Thomashow, MD3 John Walsh2 Robert A. Sandhaus, MD, PhD4 James K. Stoller, MD, MS5
Author Affiliations
- Department of Preventive Medicine and Environmental Health, University of Kentucky College of Public Health, Lexington
- COPD Foundation, Washington, D.C.
- Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Medical Center, New York, New York
- Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, Colorado
- Respiratory and Education Institutes, Cleveland Clinic, Cleveland, Ohio
Address correspondence to:
David M. Mannino, MD
University of Kentucky College of Public Health
111 Washington Avenue
Lexington, KY 40536
Phone 1 859 218 2099
Fax 1 859 257 9862
E-mail: dmannino@uky.edu
Abstract
Objectives: This study compared characteristics of chronic obstructive pulmonary disease (COPD) among patients with and without alpha-1 antitrypsin deficiency (A1AD).
Methods: Data from WebMD’s Lung Disease Health Check was analyzed for participants who self-reported a COPD diagnosis (N=177,865) and whether or not they had an A1AD diagnosis (based on a positive response to the question “Do you have alpha-1 antitrypsin deficiency?”). We used regression modeling to determine the relation between A1AD status and demographic characteristics, symptoms, lung function, quality of life, comorbidities, and smoking habits.
Results: Out of 177,865 participants who reported a COPD diagnosis, 1,619 (0.92%) also reported an A1AD diagnosis. When compared to the total COPD population, those with A1AD were less likely to be female (odds ratio [OR]=0.68, 95% confidence interval [CI] 0.61, 0.75) or current smokers (OR 0.72, 95% CI 0.62, 0.83), and more likely to know their lung function value (OR=3.44, 95% CI 3.07, 3.87). With regard to symptoms, those with A1AD were less likely to report wheezing (OR=0.82, 95% CI 0.75, 0.91) and chronic cough (OR=0.81, 95% CI 0.73, 0.89) and more likely to report tightness in the chest (OR= 1.19, 95% CI 1.08, 1.32). Overall, A1AD participants had a lower quality of life with a higher proportion reporting severe impairment in work life (OR=1.55, 95% CI 1.39, 1.7), home life (OR=1.40, 95% CI 1.26, 1.56), and personal relationships (OR=1.48, 95% CI 1.32, 1.65).
Conclusions: COPD patients with A1AD report significantly worse quality of life relative to the non-A1AD COPD population.
Citation
Citation: McGrady T, Mannino DM, Malanga E, et al. Characteristics of chronic obstructive pulmonary disease (COPD) patients reporting alpha-1 antitrypsin deficiency in the WebMD lung health check database.
Chronic Obstr Pulm Dis (Miami). 2015; 2(2): 141-151. doi: http://dx.doi.org/10.15326/jcopdf.2.2.2014.0160
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Dionne C.W. Braeken, MSc1,2 Frits M.E. Franssen, MD, PhD1,2 Hartwig Schütte, MD, PhD3,7 Mathias W. Pletz, MD, PhD4,7 Robert Bals, MD, PhD5,7 Peter Martus, PhD6 Gernot G.U. Rohde, MD, PhD2,7 on behalf of the CAPNETZ Study Group
Author Affiliations
- Department of Research and Education, CIRO+, Centre of Expertise for Chronic Organ Failure, Horn, the Netherlands
- Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands
- Department of Internal Medicine/Infectious Diseases and Respiratory Medicine, Charité-Universitätsmedizin Berlin, Germany
- Gastroenterology, Hepatology and Infectious Diseases, Jena University Hospital, Germany
- Internal Medicine V – Pneumology, Medical Centre of the Saarland University, Homburg, Germany
- Clinical Epidemiology and Applied Biostatistics, UKT Tübingen, Germany
- CAPNETZ STIFTUNG, Hannover, Germany
Address correspondence to:
Dionne Braeken, MSc
Department of Respiratory Medicine
Maastricht University Medical Centre (MUMC+)
PO Box 5800, 6202 AZ
Maastricht, the Netherlands
dionnebraeken@ciro-horn.nl
+31 (0)43 387 5047
Abstract
Background:Mortality of community acquired pneumonia (CAP) remains high despite significant research efforts. Knowledge about comorbidities including chronic obstructive pulmonary disease (COPD) might help to improve management and ultimately, survival. The impact of COPD on CAP severity and mortality remains a point of discussion.
Objectives:Assess the prevalence and clinical characteristics of COPD in the observational German Competence Network for CAP, CAPNETZ, and to study the impact of COPD on CAP severity and mortality.
Methods:1307 consecutive patients with CAP (57.0% males, age 59.0±18.5), classified as CAP-only (n=1043; 78.0%) and CAP-COPD (n=264; 20.2%) were followed up for 180 days. Associations between CAP, COPD and mortality were evaluated by univariate/multivariate and Kaplan-Meier survival analyses.
Results:CAP-COPD patients were older, more often males, current/former smokers, with higher confusion-urea-respiratory rate-blood pressure, (CURB) scores. Length of hospital stay, urea, glucose and leucocytes plasma levels, and arterial carbon dioxide tension (PaCO2) were significantly increased in CAP-COPD. Thirty, 90- and 180-day mortality rates were significantly increased in CAP-COPD (p=0.046, odds ratio [OR]=2.48, 95% confidence interval [CI] 1.015-6.037; p=0.003, OR=2.80, 95%CI 1.430-5.468; p=0.001, OR=2.57, 95%CI 1.462-4.498; respectively). Intensive care unit (ICU)-admission and age, but not COPD, were identified as independent predictors of short- and long-term mortality.
Conclusion:Severity as well as mortality was significantly higher in COPD patients with CAP. To improve CAP management with the aim to decrease its still-too-high mortality, underlying comorbidities, particularly COPD, need to be assessed.
Citation
Citation: Braeken DCW, Franssen FME, Schutte H, et al on behalf of the CAPNETZ Study Group. Increased severity and mortality of CAP in COPD: Results from the German Competence Network, CAPNETZ. Chronic Obstr Pulm Dis (Miami). 2015; 2(2): 131-140. doi: http://dx.doi.org/10.15326/jcopdf.2.2.2014.0149
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Bartolome R. Celli, MD1 Marc Decramer, MD2 Guus M. Asijee, PhD3 Katrin Kupas, PhD4 Donald P. Tashkin, MD5
Author Affiliations
- Pulmonary Division, Brigham and Women’s Hospital, Boston, Massachusetts
- Respiratory Division, University of Leuven, Leuven, Belgium
- Boehringer-Ingelheim Pharma GmbH & Co KG, TA Respiratory Diseases, Ingelheim, Germany
- Independent statistical consultant, Frankfurt, Germany
- Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine University of California, Los Angeles
Address correspondence to:
Professor Bartolome R. Celli, MD
Pulmonary Division, Brigham and Women's Hospital
75 Francis Street, PBB Clinics 3
Boston, MA 02115
(617) 732-7420
E-mail: bcelli@partners.org
Abstract
Background: A history of past exacerbations is a predictor of future events for patients with chronic obstructive pulmonary disease (COPD). Very little is known about the effect of pharmacologic therapies on patients with frequent or infrequent exacerbations.
Methods: We conducted a post-hoc analysis of the Understanding Potential Long-term Impacts on Function with Tiotropium (UPLIFT®) trial database. Patients were classified as having a low risk of exacerbations if they experienced ≤1 exacerbation and no COPD-related hospitalization(s) in the year preceding trial entry or as high risk of exacerbations if they had ≥2 exacerbations (courses of oral steroids/antibiotics) or ≥1 COPD-related hospitalization(s) in the year preceding the trial.
Results: In patients at low risk or high risk for exacerbations, compared to placebo, tiotropium significantly reduced: 1) the time to first COPD exacerbation (hazard ratio [HR]: 0.81; 95% confidence interval [CI]: 0.74, 0.88; p <0.0001; HR: 0.89; 95% CI: 0.81, 0.97; p=0.0066, respectively); 2) the number of COPD exacerbations (rate ratio [RR]: 0.79; 95% CI: 0.72, 0.86; p<0.0001; RR: 0.88; 95% CI: 0.81; 0.95; p=0.0009). Furthermore, upon treatment with tiotropium, the proportion of patients transitioning from the low- to the high-risk exacerbations group was statistically lower compared to placebo (RR: 0.78; 95% CI: 0.67, 0.92; p=0.0030)
Conclusions: This analysis shows that tiotropium reduces the risk of subsequent exacerbation and also prolongs time to first exacerbation, in both the high- and low-risk exacerbator subgroups. It also decreases the proportion of patients who shift from the low- to the high-risk exacerbations group compared to placebo.
Citation
Citation: Celli BR, Decramer M, Asijee GM, Kupas K, Tashkin DP. Effects of tiotropium on exacerbations in patients with COPD with low or high risk of exacerbations: A post-hoc analysis from the 4-year UPLIFT® trial.
Chronic Obstr Pulm Dis (Miami). 2015; 2(2): 122-130. doi: http://dx.doi.org/10.15326/jcopdf.2.2.2014.0155
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MeiLan K. Han, MD, MS1 Anna W. Steenrod, MPH2 Elizabeth D. Bacci, PhD2 Nancy K. Leidy, PhD2 David M. Mannino, MD3 Byron M. Thomashow, MD4 R. G. Barr, MD4 Barry J. Make, MD5 Russ P. Bowler, MD5 Stephen I. Rennard, MD6 Julia F. Houfek, PhD6 Barbara P. Yawn, MD, MSc7 Catherine A. Meldrum, PhD1 John W. Walsh8 Fernando J. Martinez, MD, MS9
for the High-Risk-COPD Screening Study Group10
Author Affiliations
- University of Michigan, Ann Arbor
- Evidera, Bethesda, Maryland
- University of Kentucky, Lexington
- Columbia University, New York, New York
- National Jewish Health, Denver, Colorado
- University of Nebraska, Omaha
- Olmsted Medical Center, Rochester, Minnesota
- COPD Foundation, Washington, DC
- Weill Cornell Medical Center, New York, New York
- High-Risk-COPD Screening Study Group: Rebecca Copeland, BS, University of Kentucky; Tim Dorius, MD, University of Nebraska Medical Center; David Hengerer, BA, Evidera; Patricia Jellen, RN, MSN, New York Presbyterian Hospital; Katherine Kim, MPH, Evidera; Marge Kurland, RN, Olmsted Medical Center; Karen Malley, BA, Evidera; Lindsey Murray, MPH, Evidera; Jason Shiffermiller, MD, MPH, University of Nebraska Medical Center; Christina Schnell, BA, CCRC, National Jewish Health; Sonja Stringer, MPH, Evidera; Deb Sumnick, PBT, University of Nebraska; Randel Plant, COPD Foundation; Jennifer Underwood, CCRP, National Jewish Health; Beth Whippo, MSN, RN, New York Presbyterian Hospital
Address correspondence to:
MeiLan K. Han, MD, MS
University of Michigan
Telephone: 734-936-5201
Email: mrking@umich.edu
Abstract
Objective: Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality, yet research suggests this disease is greatly underdiagnosed. This literature review sought to summarize the most common and significant variables associated with case-finding or missed cases of COPD to inform more effective and efficient detection of high-risk COPD patients in primary care.
Methods: PubMed and EMBASE were searched for articles describing case-finding and epidemiologic research to detect or characterize new cases of COPD. International studies in primary and non-primary care settings, published in English from 2002–2014, were eligible for inclusion. Studies related to risk factors for development of COPD were excluded.
Results: Of the 33 studies identified and reviewed, 21 were case-finding or screening and 12 were epidemiological, including cross-sectional, longitudinal, and retrospective designs. A range of variables were identified within and across studies. Variables common to both screening and epidemiological studies included age, smoking status, and respiratory symptoms. Seven significant predictors from epidemiologic studies did not appear in screening tools. No studies targeted discovery of higher risk patients such as those with reduced lung function or risks for exacerbations.
Conclusion: Variables used to identify new cases of COPD or differentiate COPD cases and non-cases are wide-ranging, (from sociodemographic to self-reported health or health history variables), providing insight into important factors for case identification. Further research is underway to develop and test the best, smallest variable set that can be used as a screening tool to identify people with undiagnosed, high-risk COPD in primary care.
Citation
Citation: Han MK, Steenrod AW, Bacci ED, et al for the High-Risk-COPD Screening Study Group. Identifying patients with undiagnosed COPD in primary care settings: Insight from screening tools and epidemiologic studies.
Chronic Obstr Pulm Dis (Miami). 2015; 2(2): 103-121. doi: http://dx.doi.org/10.15326/jcopdf.2.2.2014.0152
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James E. Hansen, MD,1 Janos Porszasz, MD, PhD1 Richard Casaburi, PhD, MD1 William W. Stringer, MD1
Author Affiliations
- Respiratory and Critical Care Division, Department of Medicine, Los Angeles Biomedical Research Institute-Harbor, University of California -Los Angeles Medical Center,Torrance, California; University of California-Los Angeles David Geffen School of Medicine, Los Angeles
Abstract
Background: Spirometric values of 5880 never-smoking black, Latin, and white men and women in the Third National Health and Nutrition Examination Survey (NHANES-3) reference population were reviewed. Good published equations for forced expiratory volume in 1 second (FEV1) over forced expiratory volume in 6 seconds (FEV6) and FEV1over forced vital capacity (FVC) often significantly mis-identified the lower limit of normal (LLN) targets in both younger and older adults. To improve detection of smaller airways disease in adults, we wished to redefine the LLN for these ratios and develop new ones for forced expiratory volume in 3 seconds (FEV3)/FEV6 and FEV3/FVC.
Methods: In each of 6 ethnic/gender, never-smoking NHANES-3 groups, arranged sequentially by age from 20.0 to 79.9 years, the values of FEV1/FEV6, FEV1/FVC, FEV3/FEV6, and FEV3/FVC were placed in groups of 40 so that the actual lowest second (5%) ratios could be identified. The slopes and intercepts of the resulting 24 linear equations through these lowest 5% ratios were then each adjusted by multiple iterations to best identify equations which actually identified the lowest 5% in both younger and older adults.
Results: In all never-smokers, the new equations were closer to the 5% LLN targets than were those of Hankinson for FEV1/FEV6 and FEV1/FVC and Quanjer for FEV1/FVC. In 3508 NHANES-3 current smokers, the FEV3/FEV6 and FEV3/FVC identified significantly more values below LLN than the FEV1/FEV6 and FEV1/FVC.
Conclusion: New simple linear iterative equations for FEV1/FEV6, FEV1/FVC, FEV3/FEV6, and FEV3/FVC to identify LLN are offered. None require exponents or logarithms. The latter 2 detected more abnormalities in current-smokers and likely better identify small airways disease in adults.
Citation
Citation: Hansen JE, Porszasz J, Casaburi R, Stringer WW. Re-Defining lower limit of normal for FEV1/FEV6, FEV1/FVC, FEV3/FEV6 and FEV3/FVC to improve detection of airway obstruction.
Chronic Obstr Pulm Dis (Miami). 2015; 2(2): 94-102. doi: http://dx.doi.org/10.15326/jcopdf.2.2.2014.0144
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