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Nathaniel Marchetti, DO1 Theresa Kaufman, DO1 Divay Chandra, MD2 Felix J. Herth, MD3 Pallav L. Shah, MD4 Dirk-Jan Slebos, MD5 Chandra Dass, MD1 Stephen Bicknell, MD6 Stefan H. Blaas, MD7 Michael Pfeifer, MD7 Franz Stanzell, MD8 Christian Witt, MD9 Gaetan Deslee, MD10 Wolfgang Gesierich, MD11 Martin Hetzel, MD12 Romain Kessler, MD13 Sylvie Leroy, MD14 Juergen Hetzel, MD15 Frank C. Sciurba, MD2 and Gerard J. Criner, MD1
Author Affiliations
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
- Thoraxklinik, University of Heidelberg, Heidelberg, Germany
- The National Institute for Health Research Respiratory Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust and Imperial College, London, United Kingdom
- University Medical Center Groningen, University of Groningen, The Netherlands
- Gartnaval General Hospital, Glasgow, Scotland
- Klinikum Donaustauf, Donaustauf, Germany
- Lungenklinik, Hemer, Germany
- Campus Charité Mitte, Berlin, Germany
- Service de Pneumologie Hôpital Maison Blanche, INSERM 903, Reims, France
- Asklepios-Fachkliniken, Muenchen-Gauting, Germany
- Krankenhaus von Roten Kreuz, Stuttgart, Germany
- CHU de Strasbourg – NHC, Strasbourg, France
- FHU OncoAge Côte d’Azur University, Nice, France
- Department of Internal Medicine II-Pneumology, University Hospital, Teubingen, Germany
Address correspondence to:
Nathaniel Marchetti, D.O.
Associate Professor of Medicine
Department of Thoracic Medicine and Surgery
Lewis Katz School of Medicine at Temple University
745 Parkinson Pavilion
3401 North Broad Street
Philadelphia, Pa 19140
Phone: 215-707-9929
Email: nathaniel.marchetti@tuhs.temple.edu
Abstract
Rationale: Bronchoscopic lung volume reduction utilizing shape-memory nitinol endobronchial coils (EBC) may be safer and more effective in severely hyperinflated homogeneous emphysema compared to medical therapy or lung volume reduction surgery (LVRS).
Methods: The effect of bilateral EBC in patients with homogeneous emphysema on spirometry, lung volumes and survival was compared to patients with homogeneous emphysema randomized in the National Emphysema Treatment Trial (NETT) to LVRS or medical therapy. NETT participants were selected to match EBC participants in age, baseline spirometry, and gender. Outcomes were compared from baseline, at 6 and 12 months.
Results: There were no significant baseline differences in gender in the EBC, NETT-LVRS or medical treatment patients. At baseline no differences existed between EBC and NETT-LVRS patients in forced expiratory volume in 1 second ( FEV1) or total lung capacity (TLC) %-predicted; residual volume (RV) and diffusing capacity of the lung for carbon monoxide (DLco) %-predicted were higher in the EBC group compared to NETT-LVRS (p < 0.001). Compared to the medical treatment group, EBC produced greater improvements in FEV1 and RV but not TLC at 6 months. FEV1 and RV in the EBC group remained significantly improved at 12-months compared to the medical treatment group. While all 3 therapies improved quality of life, survival at 12 months with EBC or medical therapy was greater than NETT-LVRS.
Conclusion: EBC may be a potential therapeutic option in patients with severe homogeneous emphysema and hyperinflation who are already receiving optimal medical treatment.
Citation
Citation: Marchetti N, Kaufman T, Chandra D, et al. Endobronchial coils versus lung volume reduction surgery or medical therapy for treatment of advanced homogenous emphysema. Chronic Obstr Pulm Dis. 2018; 5(2): 87-96. doi: http://dx.doi.org/10.15326/jcopdf.5.2.2017.0134
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Nathaniel T. Gaeckle, MD1 Brooke Heyman, MD2 Andrew J. Criner, BS1 Gerard J. Criner, MD1
Author Affiliations
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
- Department of Internal Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
Address correspondence to:
Nathaniel Gaeckle
Email: gaeckle@umn.edu
Phone: 612-805-8388
Abstract
Abstract:
Background: Poor dental health occurs in patients with chronic obstructive pulmonary disease (COPD); some evidence suggests that it may correlate with lower forced expiratory volume in 1 second (FEV1) and 6-minute walk distance, and an increased rate of exacerbations. However, there is no data that examines how dental health may impact the daily respiratory symptoms that COPD patients experience. We prospectively studied indices of dental health and hygiene in patients with COPD and determined their impact on daily respiratory symptoms.
Methods: A total of 20 individuals with COPD (median [interquartile range (IQR)] % FEV1 37 [29-43]) and 10 healthy control individuals with no lung disease were recruited. Dental questionnaires, spirometry, and a dental examination were administered on their initial visit. COPD participants were given an electronic COPD daily diary to document peak expiratory flow and the presence and magnitude of daily breathlessness, cough, sputum production, and wheeze.
Results: Compared to healthy controls, COPD participants had less teeth (median 16.5 versus 28, p=0.0001), a trend to a higher plaque index (median 2.2 versus 1.7, p=0.15), and worse oral health-related quality of life (median Oral Health Impact Profile score 12.0 versus 4.5, p=0.02). A greater number of teeth correlated with higher percentage of days with cough (r=0.48, p<0.05) and wheeze (r=0.47, p<0.05).
Conclusion: Individuals with severe COPD have poor oral hygiene and oral health-related quality of life. In the setting of poor dentition, a greater number of teeth correlates with more daily respiratory symptoms. More teeth may create a larger reservoir for inflammatory proteins and pathogenic bacteria to be aspirated into the airways.
Citation
Citation: Gaeckle NT, Heyman B, Criner AJ, Criner GJ. Markers of dental health correlate with daily respiratory symptoms in COPD. Chronic Obstr Pulm Dis. 2018; 5(2): 97-105. doi: http://dx.doi.org/10.15326/jcopdf.5.2.2017.0159
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James J. Tasch, DO1 Ann T. McLaughlan, DO1 Asad A. Nasir, MD1
Author Affiliations
- Graduate Medical Education, Arnot Ogden Medical Center, Elmira, New York
Address correspondence to:
James Tasch, DO
600 Roe Ave
Elmira, New York 14905
Phone: 607-737-4100
Email: james.tasch@steward.org
Abstract
Chronic obstructive pulmonary disease (COPD) currently affects more than 16 million Americans and it is estimated that roughly 100,000 Americans have undiagnosed, severe alpha-1 antitrypsin deficiency (AATD) (Chest. 2005;128[3]:1179-1186) (Chest. 2002;122[5]:1818-1829). Patients with AATD have an accelerated rate of decline of lung function caused by proteolytic enzymes. The morbidity associated with this inherited disorder is preventable due to the availability of augmentation therapy. Appropriate inpatient screening of patients with COPD for AATD is lacking and most screening is exclusively limited to outpatient pulmonary clinics. Between May 2016 and February 2017, genetic screening was completed on 54 individuals who were admitted with either a former diagnosis of COPD or active COPD exacerbation to Arnot Ogden Medical Center (AOMC) in Elmira, New York. The incorporation of inpatient genetic screening by resident physicians for AATD in COPD patients led to a high rate of screened and newly diagnosed AATD carriers with a variety of AATD genotypes. It is recommended that there should be an expansion of screening for AATD in hospitalized patients with COPD, regardless of age or smoking history.
Citation
Citation: Tasch JJ, McLaughlan AT, Nasir AA. A novel approach to screening for alpha-1 antitrypsin deficiency: inpatient testing at a teaching institution. Chronic Obstr Pulm Dis. 2018; 5(2): 106-110. doi: http://dx.doi.org/10.15326/jcopdf.5.2.2017.0170
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Nicola A. Hanania, MD, MS1 Sidney Braman, MD2 Sandra G. Adams, MD, MS3,4 Ruth Adewuya, MD5 Arzu Ari, PhD6 JoAnn Brooks, PhD7 Donald A. Mahler, MD8 Jill A. Ohar, MD9 Jay Peters, MD3 Shahin Sanjar, PhD10
Author Affiliations
- Section of Pulmonary and Critical Care Medicine, Baylor College of Medicine, Houston, Texas
- Icahn School of Medicine at Mount Sinai, New York, New York
- University of Texas Health Science Center, San Antonio
- South Texas Veterans Health Care System, San Antonio
- American College of Chest Physicians, Glenview, Illinois
- Texas State University, San Marcos
- Indiana University Health, Bloomington
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
- Wake Forest Health University Medical Center, Winston-Salem, North Carolina
- Sunovion Pharmaceuticals Inc., Marlborough, Massachusetts
Address correspondence to:
Nicola A. Hanania, MD, MS
Baylor College of Medicine
1504 Taub Loop
Houston, TX 77030
E-mail: hanania@bcm.edu
Phone: 713-873-3454
Abstract
Background: Inhaled medications form the foundation of pharmacologic treatment for chronic obstructive pulmonary disease (COPD).The Delivery Makes a Difference (DMaD) project was conducted to better understand health care provider (HCP) and patient perspectives about the role of inhalation delivery devices in COPD, and to examine the nature of educational efforts between HCPs and patients on proper device technique.
Methods: Data were derived from 2 original quantitative, web-based, descriptive, cross-sectional surveys distributed to HCPs who manage COPD (n=513) and patients with COPD (n=499) in the United States. Descriptive statistics were used to assess data across important demographic variables. Inferential statistics were used to assess differences in attitudinal, descriptive, and behavioral measures that were cross-tabulated with demographic data.
Results: When prescribing medication for newly diagnosed patients with stable or unstable COPD, only 37% of HCPs considered type of device to be highly important, with only 45% of HCPs assessing device technique in every newly diagnosed patient. Patients with COPD were also relatively unconcerned with proper device technique (64% never concerned), regardless of their COPD severity. Although patients did not identify education as a significant impediment to proper device use, they reported inconsistent educational experiences.
Conclusions: We found that HCPs and patients prioritize medication over device when selecting treatments, showing limited concerns about proper device use. These results highlight the need to coordinate professional education with patient-directed educational efforts to further promote proper device selection and use in COPD management.
Citation
Citation: Hanania NA, Braman S, Adams SG, et al. The role of inhalation delivery devices in COPD: Perspectives of patients and health care providers. Chronic Obstr Pulm Dis. 2018; 5(2): 111-123. doi: http://dx.doi.org/10.15326/jcopdf.5.2.2017.0168
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Chee H. Loh, MD1 Frank A. Genese, DO1 Kavya K. Kannan, MD2 Tina M. Lovings, BSRT, RRT-ACCS1 Stephen P. Peters MD, PhD1 Jill A. Ohar, MD1
Author Affiliations
- Department of Pulmonary and Critical Care, Wake Forest School of Medicine, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina
- Department of Internal Medicine, Wake Forest School of Medicine, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina
Abstract
Purpose: Objective documentation of airflow obstruction is often lacking inhospitalized patients treated for acute exacerbation of chronic obstructive pulmonary disease (AECOPD). The utility of spirometry performed in hospitalized patients to identify airflow obstruction, and thus a diagnosis of COPD, is unclear. Our aim was to compare inpatient spirometry, performed during an AECOPD, with outpatient spirometry.
Methods: A retrospective analysis of data from patients enrolled in an AECOPD care plan was performed. As part of the plan, patients underwent inpatient spirometry to establish a COPD diagnosis and outpatient clinic spirometry within 4 weeks of hospital discharge to confirm it. Data analyzed included forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), slow vital capacity (SVC) and FEV1/ vital capacity (VC). Obstruction was defined by FEV1/VC<0.70.
Results: A total of 159 patients (mean age 63.2 +/- 10.5 years) had corresponding in- and outpatient spirometry. The median days between inpatient and outpatient spirometry was 12 (interquartile range [IQR] 9-16). Inpatient spirometry had a sensitivity of 94%, specificity of 24%, positive predictive value of 83% and negative predictive value of 53% for predicting outpatient obstruction. The area under curve for using inpatient spirometry was 0.82. The mean difference between inpatient and outpatient FEV1 was 0.44 +/- 0.03 liters or 17.3 +/- 1.13 % predicted (p<0.0001) for FEV1.
Conclusions: Inpatient spirometry accurately predicts outpatient airflow obstruction, thus providing an opportunity to identify patients admitted with suspected AECOPD who have no prior spirometric documentation.
Citation
Citation: Loh CH, Genese FA, Kannan KK, Lovings TM, Peters SP, Ohar JA. Spirometry in hospitalized patients with acute exacerbation of COPD accurately predicts post discharge airflow obstruction. Chronic Obstr Pulm Dis. 2018; 5(2): 124-133. doi: http://dx.doi.org/10.15326/jcopdf.5.2.2017.0169
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Young Ju Suh, PhD1 Merry-Lynn N. McDonald, PhD2 George R. Washko, MD3 Brendan J. Carolan, MD4 Russell P. Bowler, MD, PhD4 David A. Lynch, MD4 Gregory L. Kinney, MPH, PhD5 Jessica M. Bon, MD6 Michael H. Cho, MD, MPH2 James D. Crapo, MD4 Elizabeth A. Regan, MD, PhD4,5 for the COPDGene Investigators
Author Affiliations
- Department of Biomedical Sciences, College of Medicine, Inha University, Incheon, Republic of Korea
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Medicine, National Jewish Health, Denver, Colorado
- School of Public Health, University of Colorado, Denver
- University of Pittsburgh, Pittsburgh, Pennsylvania
Address correspondence to:
Elizabeth A. Regan, MD
1400 Jackson St, K706
Denver, CO 80209
Email: ReganE@NJHealth.org
Phone: 303-398-1531
Fax: 303-270-2249
Abstract
Background: Adiponectin has been proposed as a biomarker of disease severity and progression in chronic obstructive pulmonary disease (COPD) and associated with spirometry-defined COPD and with computed tomography (CT)-measured emphysema. Increased adiponectin plays a role in other diseases including diabetes/metabolic syndrome, cardiovascular disease and osteoporosis. Previous studies of adiponectin and COPD have not assessed the relationship of adiponectin to airway disease in smokers and have not evaluated the effect of other comorbid diseases on the relationship of adiponectin and lung disease. We postulated that adiponectin levels would associate with both airway disease and emphysema in smokers with and without COPD, and further postulated that body composition and the comorbid diseases of osteoporosis, cardiovascular disease and diabetes might influence adiponectin levels.
Methods: Current and former smokers from the COPD Genetic Epidemiology study (COPDGene) (n= 424) were assigned to 4 groups based on CT lung characteristics and volumetric Bone Density (vBMD). Emphysema (% low attenuation area at -950) and airway disease (Wall area %) were used to assess smoking-related lung disease (SRLD). Group 1) Normal Lung with Normal vBMD; Group 2) Normal Lung and Osteoporosis; Group 3) SRLD with Normal vBMD; Group 4) SRLD with Osteoporosis. Cardiovascular disease (CVD), diabetes, C-reactive protein (CRP) and T-cadherin (soluble receptor for adiponectin) levels were defined for each group. Body composition was derived from chest CT. Multivariable regression assessed effects of emphysema, wall area %, bone density, comorbid diseases and other key factors on log adiponectin.
Results: Group 4, SRLD with Osteoporosis, had significantly higher adiponectin levels compared to other groups and the effect persisted in adjusted models. Systemic inflammation (by CRP) was associated with SRLD in Groups 3 and 4 but not with osteoporosis alone. In regression models, lower bone density and worse emphysema were associated with higher adiponectin. Airway disease was associated with higher adiponectin levels when T-cadherin was added to the model. Male gender, greater muscle and fat were associated with lower adiponectin.
Conclusions: Adiponectin is increased with both airway disease and emphysema in smokers. Bone density, and fat and muscle composition are all significant factors predicting adiponectin that should be considered when it is used as a biomarker of COPD. Increased adiponectin from chronic inflammation may play a role in the progression of bone loss in COPD and other lung diseases.
Citation
Citation: Suh YJ, McDonald M-LN, Washko GR, et al; for the COPDGene Investigators. Lung, fat and bone: increased adiponectin with the combination of smoking-related lung disease and osteoporosis. Chronic Obstr Pulm Dis. 2018; 5(2): 134-143. doi: http://dx.doi.org/10.15326/jcopdf.5.2.2016.0174
Keywords
COPD, emphysema, body composition, adiponectin, osteoporosis, airway disease, smoking-related lung disease, QCT, volumetric BMD, bone mineral density, T cadherin, CDH13, C-reactive protein, systemic inflammation, muscle area, pectoralis, subcutaneous fat area, visceral fa
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