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Brian Carlin, MD1 Gary T. Ferguson, MD2 Ayca Ozol-Godfrey, PhD3 Thomas Goodin, PhD3 Shahin Sanjar, PhD3
Author Affiliations
- Sleep Medicine and Lung Health Consultants, LLC, Pittsburgh, Pennsylvania
- Pulmonary Research Institute of Southeast Michigan, Farmington Hills, Michigan
- Sunovion Pharmaceuticals, Inc., Marlborough, Massachusetts
Address correspondence to:
Brian Carlin, MD
Sleep Medicine and Lung Health Consultants
P.O. Box 174
Ingomar, PA 15127 USA
Phone: +1 (412) 351-6545
E-mail: bwcmd@yahoo.com
Abstract
Background: Concurrent chronic obstructive pulmonary disease (COPD) and metabolic syndrome (MetS) represent an important clinical phenotype with overlapping symptomology. The effect of MetS in COPD patients was assessed following treatment with nebulized glycopyrrolate (GLY; administered via eFlow® Closed System Nebulizer).
Methods: Posthoc analyses were performed on pooled lung function, patient-reported outcome (PRO) and safety data by MetS status from patients treated with placebo, GLY 25 and 50 mcg twice daily in two 12-week studies (GOLDEN 3 and 4; N=1293). Patients with MetS were characterized as having ≥ 3 of hypertension, hyperlipidemia, diabetes, body mass index (BMI) > 30 kg/m2 risk factors. The results are presented for the Food and Drug Administration-approved GLY 25 mcg dose.
Results: A total of25% of patients met MetS criteria.At baseline, the MetS subgroup had higher BMIs, more ex-smokers, greater incidences of cardiovascular risk factors, and MetS-specific risk factors were 2–14 times higher than non-MetS. At 12 weeks, GLY produced significant, clinically important improvements (MetS: 0.121 L; non-MetS: 0.083 L) in trough forced expiratory volume in 1 second. In the non-MetS group, significant improvements occurred in the St George’s Respiratory Questionnaire (MetS: –2.28, p=0.157; non-MetS: –3.71) and Evaluating Respiratory Symptoms in COPD tool (MetS: 0.42, p=0.574; non-MetS: –1.61) total scores. Incidence of adverse events was similar with GLY versus placebo regardless of MetS status.
Conclusions: GLY was well-tolerated and significantly improved lung function regardless of MetS status, while significant PRO improvements occurred in non-MetS patients. These results highlight the importance of comorbidities on bronchodilator responses and patient symptoms in COPD patients.
Citation
Citation: Carlin B, Ferguson GT, Ozol-Godfrey A, Goodin T, Sanjar S. The effect of metabolic syndrome status on lung function and patient-reported outcomes in patients with COPD receiving nebulized glycopyrrolate. Chronic Obstr Pulm Dis. 2020; 7(4): 315-326. doi: http://dx.doi.org/10.15326/jcopdf.7.4.2020.0145
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Karen F. Hyden, PhD, MSN/Ed, RN1 Heather L. Coats, PhD, MSN, RN1 Paula M. Meek, PhD, RN2
Author Affiliations
- College of Nursing, University of Colorado Anschutz Medical Campus, Aurora
- College of Nursing, University of Utah, Salt Lake City
Abstract
Background: Home-based palliative care (HBPC) is an important aspect of care for patients with moderate to advanced stages of chronic obstructive pulmonary disease (COPD) and their caregivers. HBPC provides symptom management, advanced care planning and goals of care conversations in the home, with the goal of maximizing quality of life and minimizing health care utilization. There is a gap in the knowledge of how the patients with COPD and their caregivers experience HBPC. The overall purpose of this study is to describe which aspects of HBPC were the most meaningful to patients with COPD, and their caregivers.
Methods: Through a descriptive design with narrative analysis methodology, we interviewed COPD patients and their caregivers to investigate their experience of HBPC received in the 30 days post hospitalization for a COPD exacerbation. A thematic analysis was conducted and the patient and caregiver interviews were analyzed in dyad using thematic analysis.
Results: A total of 10 dyads were interviewed. Patients and their caregivers perceived 3 times as many facilitators as barriers of receiving home-based palliative care in the 30 days post hospitalization for a COPD exacerbation. The outcomes of this study provide information that describes the aspects of HBPC that patients and their caregivers found most meaningful.
Conclusion: An understanding of the most meaningful aspects of HBPC from the perspectives of the patients with COPD and their caregivers can be used to inform the development of the best model for HBPC for this patient population.
Citation
Citation: Hyden KF, Coats HL, Meek PM. Home-based palliative care: perspectives of chronic obstructive pulmonary disease patients and their caregivers. Chronic Obstr Pulm Dis. 2020; 7(4): 327-335. doi: http://dx.doi.org/10.15326/jcopdf.7.4.2020.0144
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Anne M. Mathews, MD1 Nicholas G. Wysham, MD2 Jichun Xie, PhD1 Xiaodi Qin, PhD1 Coral X. Giovacchini, MD1 Magnus Ekström, MD3 Neil R. MacIntyre, MD1
Author Affiliations
- Duke University Medical Center, Durham North Carolina
- Department of Pulmonary and Critical Care, the Vancouver Clinic and School of Medicine, Washington State University, Vancouver
- Department of Clinical Sciences, Division of Respiratory Medicine and Allergology, Lund University, Lund, Sweden
Address correspondence to:
Neil MacIntyre, MD
Box 3911, Room 1120
Duke University Medical Center
Erwin Road
Durham, NC 27710
Email: neil.macintyre@duke.edu
Abstract
Rationale: Hypercapnia develops in one third of patients with advanced chronic obstructive pulmonary disease (COPD) and is associated with increased morbidity and mortality. Multiple factors in COPD are thought to contribute to the development of hypercapnia including increased carbon dioxide (CO2) production, increased dead space ventilation, and the complex interactions of deranged respiratory system mechanics, inspiratory muscle overload and the ventilatory control center in the brainstem. However, these factors have not previously been systematically analyzed in a large, well-characterized population of severe COPD patients.
Methods: This is a secondary analysis of the clinical, physiologic and imaging data from the National Emphysema Treatment Trial (NETT). All patients with complete baseline data for the key predictor variables were included. An inclusive list of 32 potential predictor variables were selected a priori based on consensus of the investigators and literature review. Stepwise variable selection yielded 10 statistically significant associations in multivariate regression.
Results: A total of 1419 patients with severe COPD were included in the analysis; mean age 66.4 years (standard deviation 6.3), 38% females, and 422 (29.7%) had baseline hypercapnia. Key variables associated with hypercapnia were low resting partial pressure of oxygen in blood, low minute ventilation (Ve), high volume of exhaled carbon dioxide, low forced expiratory volume in 1 second, high residual volume, lower % emphysema on chest computed tomography, use of oxygen, low ventilatory reserve (high Ve/maximal voluntary ventilation), and not being at high altitude. Low diffusing capacity for carbon monoxide showed a positive association with hypercapnia in univariate analysis but a negative correlation in multivariate analysis. Measures of dyspnea and quality of life did not associate with degree of hypercapnia in multivariable analysis.
Conclusions: Hypercapnia in a well-characterized cohort with severe COPD and emphysema is chiefly related to poor lung mechanics, high CO2 production, and a reduced ventilatory capability. Hypercapnia is less impacted by gas exchange abnormalities or the presence of emphysema.
Citation
Citation: Matthews AM, Wysham NG, Xie J, et al. Hypercapnia in advanced chronic obstructive pulmonary disease: a secondary analysis of the National Emphysema Treatment Trial. Chronic Obstr Pulm Dis. 2020; 7(4): 336-345. doi: http://dx.doi.org/10.15326/jcopdf.7.4.2020.0176
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Matthew Strand, PhD1 Erin Austin, PhD2 Matthew Moll, MD3 Katherine A. Pratte, MSPH, PhD1 Elizabeth A. Regan, MD, PhD1 Lystra P. Hayden, MD, MMSc3 Surya P. Bhatt, MD4 Aladin M. Boriek, PhD5 Richard Casaburi, PhD, MD6 Edwin K. Silverman, MD, PhD3 Spyridon Fortis, MD7 Ingo Ruczinski, PhD8 Harald Koegler, MD9 Harry B. Rossiter, PhD6 10 Mariaelena Occhipinti, MD, PhD11* Nicola A. Hanania, MD, MS5 Hirut T. Gebrekristos, PhD12 David A. Lynch, MB1 Ken M. Kunisaki, MD13 Kendra A. Young, MSPH, PhD14 Jessica C. Sieren, PhD7 Margaret Ragland, MD, MS14 John E. Hokanson, MPH, PhD14 Sharon M. Lutz, PhD15 Barry J. Make, MD1 Gregory L. Kinney, MPH, PhD14 Michael H. Cho, MD, MPH3 Massimo Pistolesi, MD11 Dawn L. DeMeo, MD, MPH3 15 Frank C. Sciurba, MD16 Alejandro P. Comellas, MD7 Alejandro A. Diaz, MD3 Igor Barjaktarevic, MD, PhD17 Russell P. Bowler, MD, PhD1 Richard E. Kanner, MD18 Stephen P. Peters, MD, PhD19 Victor E. Ortega, MD, PhD19 Mark T. Dransfield, MD4 James D. Crapo, MD1
Author Affiliations
- National Jewish Health, Denver, Colorado
- University of Colorado at Denver
- Brigham and Women’s Hospital, Boston, Massachusetts
- University of Alabama at Birmingham
- Baylor College of Medicine, Houston, Texas
- The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California
- University of Iowa, Iowa City
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
- Boehringer-Ingelheim, Ingelheim, Germany
- University of Leeds, Leeds, United Kingdom
- University of Florence, Florence, Italy
- Morehouse School of Medicine, Atlanta, Georgia
- Minneapolis Veterans Administration Health Care System, Minnesota
- University of Colorado Anschutz Medical Campus, Aurora
- Harvard Medical School, Harvard University, Boston, Massachusetts
- University of Pittsburgh, Pittsburgh, Pennsylvania
- David Geffen School of Medicine, University of California-Los Angeles, Los Angeles
- School of Medicine, University of Utah, Salt Lake City
- Wake Forest School of Medicine, Wake Forest University, Winston-Salem, North Carolina
* Dr. Occhipinti is now at the Imaging Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland
Abstract
Background: Risk factor identification is a proven strategy in advancing treatments and preventive therapy for many chronic conditions. Quantifying the impact of those risk factors on health outcomes can consolidate and focus efforts on individuals with specific high-risk profiles. Using multiple risk factors and longitudinal outcomes in 2 independent cohorts, we developed and validated a risk score model to predict mortality in current and former cigarette smokers.
Methods: We obtained extensive data on current and former smokers from the COPD Genetic Epidemiology (COPDGene®) study at enrollment. Based on physician input and model goodness-of-fit measures, a subset of variables was selected to fit final Weibull survival models separately for men and women. Coefficients and predictors were translated into a point system, allowing for easy computation of mortality risk scores and probabilities. We then used the SubPopulations and InteRmediate Outcome Measures In COPD Study (SPIROMICS) cohort for external validation of our model.
Results: Of 9867 COPDGene participants with standard baseline data, 17.6% died over 10 years of follow-up, and 9074 of these participants had the full set of baseline predictors (standard plus 6-minute walk distance and computed tomography variables) available for full model fits. The average age of participants in the cohort was 60 for both men and women, and the average predicted 10-year mortality risk was 18% for women and 25% for men. Model time-integrated area under the receiver operating characteristic curve statistics demonstrated good predictive model accuracy (0.797 average), validated in the external cohort (0.756 average). Risk of mortality was impacted most by 6-minute walk distance, forced expiratory volume in 1 second and age, for both men and women.
Conclusions: Current and former smokers exhibited a wide range of mortality risk over a 10- year period. Our models can identify higher risk individuals who can be targeted for interventions to reduce risk of mortality, for participants with or without chronic obstructive pulmonary disease (COPD) using current Global initiative for chronic Obstructive Lung Disease (GOLD) criteria.
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Aloknath A. Pandya, MD1* Lii-Yoong Helga Criner, RN, CCRN1 JiJi Thomas, MBBS1 Michael Jacobs, PharmD1 Gerard J. Criner, MD1
Author Affiliations
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
*Dr. Pandya is now with Pulmonary Associates of Drexel Hill, Drexel Hill, Pennsylvania
Address correspondence to:
Aloknath Pandya, MD
Phone:(267) 858-2669
Email: apandya1@gmail.com
Abstract
Background: The effect of high-flow nasal therapy (HFNT) in individuals with an exacerbation of chronic obstructive pulmonary disease (COPD) and hypercapnia is not well studied. We assessed patient tolerance and impact of air-gas therapy delivered by humidified HFNT (20-35 L/min) on gas exchange in hypercapnic COPD patients during hospitalization for COPD exacerbation. We hypothesized that HFNT use would be safe and well tolerated in individuals hospitalized for COPD exacerbation regardless of the degree of hypercapnia.
Methods: Patients hospitalized for a COPD exacerbation were included if they were hypercapnic (arterial partial pressure of carbon dioxide [PaCO2] > 45 mmHg), ≥ 10 pack-year history, and agreed to treatment with HFNT, along with daily arterial blood gas (ABG) samples and bedside spirometry. They were placed on a HFNT system following admission for at least 3 days with an air-gas blend to maintain a flow rate between 20-35 L/min and fraction of inspired oxygen (FiO2) titrated to keep oxygen saturation (SaO2) values > 90%. Patient tolerance of HFNT and evidence of clinical deterioration as defined by worsening hypoxia or hypercapnia was the primary endpoint.
Results: Ten consecutive patients participated in the study. The patients had frequent prior exacerbations, were hypercapnic, dyspneic, and gas trapped. Participants received an air-gas flow rate (median [interquartile range (IQR)] 25 (IQR 20-30) L/min and FiO2 of 30 (IQR 30-30) %. There was no increase in PaCO2 levels (p = 0.26) or dyspnea (Borg scale, p= 0.52) while using HFNT. No patient discontinued HFNT, had further decompensation, required non-invasive ventilation or intubation during the study period.
Conclusion: In a pilot study, patients experiencing a severe COPD exacerbation were able to tolerate continuous HFNT safely regardless of degree of hypercapnia.
Citation
Citation: Pandya AA, Criner LH, Thomas J, Jacobs M, Criner GJ. Tolerability and safety of high-flow nasal therapy in patients hospitalized with an exacerbation of COPD. Chronic Obstr Pulm Dis. 2020; 7(4): 362-369. doi: http://dx.doi.org/10.15326/jcopdf.7.4.2020.0137
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Robert M. Burkes, MD1 Agathe S. Ceppe, MS2 David J. Couper, PhD3 Alejandro P. Comellas, MD4 J. Michael Wells, MD5 Stephen P. Peters, MD, PhD6 Gerard J. Criner, MD7 Richard E. Kanner, MD8 Robert Paine III, MD8 Stephanie A. Christenson, MD9 Christopher B. Cooper, MD10 Igor Z. Barjaktarevic, MD10 Jerry A. Krishnan, MD, PhD11 Wassim W. Labaki, MD12 MeiLan K. Han, MD12 Jeffrey L. Curtis, MD12,13 Nadia N. Hansel, MD14 Robert A. Wise, MD14 M. Bradley Drummond, MD, MHS1,2 for the SPIROMICS collaborators*
Author Affiliations
- Division of Pulmonary Diseases and Critical Care Medicine, University of North Carolina, Chapel Hill
- Marsico Lung Institute, University of North Carolina, Chapel Hill
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill
- Division of Pulmonary, Critical Care, and Occupational Medicine, Carver College of Medicine, University of Iowa, Iowa City
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama, Birmingham
- Section of Pulmonary, Critical Care, Allergy, and Immunologic Disease, Wake Forest University, Winston-Salem, North Carolina
- Division of Thoracic Medicine and Surgery, Temple University, Philadelphia, Pennsylvania
- Division of Respiratory, Critical Care and Occupational Pulmonary Medicine, Department of Internal Medicine, School of Medicine, University of Utah, Salt Lake City
- Division of Pulmonary Critical Care, Allergy, and Sleep Medicine, University of California, San Francisco
- Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine, University of California, Los Angeles
- Division of Pulmonary, Critical Care, Sleep, and Allergy Medicine, University of Illinois, Chicago
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor
- Medicine Service, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University Baltimore, Maryland
*A complete list of SPIROMICS collaborators is provided in the Acknowledgements section.
Address correspondence to:
Robert M. Burkes, MD
130 Mason Farm Rd, CB#7020
Chapel Hill, NC 27599
Phone: 919-966-2533
E-mail: burkesrt@ucmail.uc.edu
Abstract
Rationale: The antimicrobial peptide cathelicidin, also known in humans as LL-37, is a defensin secreted by immune and airway epithelial cells. Deficiencies in this peptide may contribute to adverse pulmonary outcomes in chronic obstructive pulmonary disease (COPD).
Objectives: Using clinical and biological samples from the SubPopulations and InteRmediate Outcome Measures In COPD Study (SPIROMICS), we assessed the associations of plasma cathelicidin levels with cross-sectional and longitudinal COPD outcomes.
Methods: A total of 1609 SPIROMICS participants with COPD and available plasma samples were analyzed. Cathelicidin was modeled dichotomously (lowest quartile [< 50 ng/ml] versus highest 75% [≥ 50 ng/ml]) and continuously per 10 ng/ml. Fixed-effect multilevel regression analyses were used to assess associations between cathelicidin and cross-sectional as well as longitudinal lung function. The associations between cathelicidin and participant-reported retrospective and prospective COPD exacerbations were assessed via logistic regression.
Measurements and Main Results: Cathelicidin < 50 ng/ml (N=383) was associated with female sex, black race, and lower body mass index (BMI).At baseline,cathelicidin < 50 ng/ml was independently associated with 3.55% lower % predicted forced expiratory volume in 1 second (FEV1)(95% confidence interval [CI] -6.22% to -0.88% predicted; p=0.01), while every 10 ng/ml lower cathelicidin was independently associated with 0.65% lower % predicted FEV1 (95% CI -1.01% to -0.28% predicted; p < 0.001). No independent associations with longitudinal lung function decline or participant-reported COPD exacerbations were observed.
Conclusions: Reduced cathelicidin is associated with lower lung function at baseline. Plasma cathelicidin may potentially identify COPD patients at increased risk for more severe lung disease.
Citation
Citation: Burkes RM, Ceppe AS, Couper DJ, et al. Plasma cathelicidin is independently associated with reduced lung function in COPD: analysis of the Subpopulations and Intermediate Outcome Measures In COPD Study Cohort. Chronic Obstr Pulm Dis. 2020; 7(4): 370-381. doi: http://dx.doi.org/10.15326/jcopdf.7.4.2020.0142
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MeiLan K. Han, MD, MS1 Wen Ye, PhD2 Dong-Yun Kim, PhD3 Prescott Woodruff, MD, MS4 for the Pulmonary Trials Cooperative Investigators
Author Affiliations
- Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor
- School of Public Health, University of Michigan, Ann Arbor
- National Institutes of Health, Bethesda, Maryland
- Division of Pulmonary and Critical Care, University of California, San Francisco
Address correspondence to:
MeiLan K. Han, MD, MS
Phone: (734) 936-5201
Email: mrking@umich.edu
Abstract
Redefining Therapy in Early COPD (RETHINC) is a 12-week multicenter, randomized, double-blind, placebo-controlled, parallel-group study to assess the efficacy and safety of indacaterol/glycopyrrolate 27.5/15.6 mcg inhaled twice daily in symptomatic current and former smokers with respiratory symptoms as defined by COPD Assessment Test (CAT) score ≥ 10 despite preserved spirometry defined by post-bronchodilator forced expiratory volume in 1 second (FEV1) to forced vital capacity (FVC) ratio ≥ 0.70. Recruitment began in July 2017 with the goal of enrolling 580 participants. The baseline examination includes spirometry (with slow and forced maneuvers) and symptom questionnaires. A follow-up phone call at 4 weeks assesses symptoms and safety. The second and final visit at week 12 includes spirometry before and after study drug (hourly over 3 hours) and follow-up symptom questionnaires. The primary endpoint is the proportion of individuals who experience a 4-unit improvement in St George’s Respiratory Questionnaire (SGRQ) score at 12 weeks without treatment failure, defined as an increase in lower respiratory symptoms necessitating treatment with active, long-acting inhaled bronchodilators, corticosteroids or antibiotics. Key secondary endpoints include the proportion of individuals with a 2-unit improvement in the CAT score; 1-unit improvement in the Baseline Dyspnea Index (BDI) and Transition Dyspnea Index (TDI), both a 4-unit improvement in SGRQ and a 1-unit improvement in BDI/TDI; and mean change in SGRQ, CAT and BDI/TDI. Other secondary endpoints include area under the curve 0-3 hours for FEV1 after study drug, change from baseline in trough inspiratory capacity, forced expiratory flow 25%-75% of FVC (FEF25-75) iso-volume FEF25-75 and mean change in symptoms and rescue medication use based on daily diary. We anticipate results to be available in 2021. This paper describes the RETHINC study and explains the rationale behind it.
Citation
Citation: Han MK, Ye W, Kim DY, Woodruff P; Pulmonary Trials Cooperative investigators. Design of the redefining therapy in early COPD study. Chronic Obstr Pulm Dis. 2020; 7(4): 382-389. doi: http://dx.doi.org/10.15326/jcopdf.7.4.2020.0157
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Katherine A. Despotes, MD1 Radmila Choate, PhD, MPH2,3 Doreen Addrizzo-Harris, MD4 Timothy R. Aksamit, MD5 Alan Barker, MD6 Ashwin Basavaraj, MD4 Charles L. Daley, MD7 Edward Eden, MD8 Angela DiMango, MD9 Kevin Fennelly, MD10 Julie Philley, MD11 Margaret M. Johnson, MD12 Pamela J. McShane, MD13 Mark L. Metersky, MD14 Anne E. O’Donnell, MD15 Kenneth N. Olivier, MD, MPH10 Matthias A. Salathe, MD16 Andreas Schmid, MD16 Byron Thomashow, MD9 Gregory Tino, MD17 Kevin L. Winthrop, MD, MPH6,18 Michael R. Knowles, MD1 Mary Leigh Anne Daniels, MD, MPH1 Peadar G. Noone, MD1
Author Affiliations
- Department of Medicine, University of North Carolina at Chapel Hill
- Research, COPD Foundation, Washington, DC
- College of Public Health, University of Kentucky, Lexington
- School of Medicine, New York University, New York, New York
- Pulmonary Disease and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota
- Department of Pulmonary and Critical Care, School of Medicine, Oregon Health and Science University, Portland
- Division of Mycobacterial and Respiratory Infections, National Jewish Health, Denver, Colorado
- Icahn School of Medicine, Mt. Sinai West and Mt. Sinai St Luke’s Hospitals, Mt. Sinai, New York
- Center for Chest Disease, Columbia College of Physicians and Surgeons, New York, New York
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
- University of Texas at Tyler
- Center for Chest Disease, Mayo Clinic Florida, Jacksonville
- Department of Medicine, University of Chicago, Chicago, Illinois
- Division of Pulmonary and Critical Care Medicine, School of Medicine, University of Connecticut, Farmington
- Georgetown University Medical Center, Washington, DC
- University of Kansas Medical Center, Kansas City
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Department of Infectious Disease, School of Medicine, Oregon Health and Science University School of Medicine, Portland
Abstract
Background: Increasing numbers of patients are being diagnosed with bronchiectasis, yet much remains to be elucidated about this heterogeneous patient population. We sought to determine the relationship between nutrition and health outcomes in non-cystic fibrosis (non-CF) bronchiectasis, using data from the U.S. Bronchiectasis Nontuberculous Mycobacterial Research Registry (U.S. BRR).
Methods: This was a retrospective, observational, longitudinal study using 5-year follow-up data from the BRR. Bronchiectasis was confirmed on computed tomography (CT). We stratified patients into nutrition categories using body mass index (BMI), and correlated BMI to markers of disease severity.
Results: Overall, n = 496 patients (mean age 64.6 ± 13 years; 83.3% female) were included. At baseline 12.3% (n = 61) were underweight (BMI < 18.5kg/m2), 63.9% (n = 317) had normal weight (BMI ≥ 18.5kg/m2 and <25.0kg/m2), 17.3% (n = 86) were overweight (BMI ≥ 25.0kg/m2 and < 30.0kg/m2), and 6.5% (n= 32) were obese (BMI ≥ 30kg/m2). Men were overrepresented in the overweight and obese groups (25.6% and 43.8% respectively, p < 0.0001). Underweight patients had lower lung function (forced expiratory volume in 1 second [FEV1] % predicted) than the other weight groups (64.5 ± 22, versus 73.5 ± 21, 68.5 ± 20, and 76.5 ± 21 in normal, overweight, and obese groups respectively, p = 0.02). No significant differences were noted between BMI groups for other markers of disease severity at baseline, including exacerbation frequency or hospitalization rates. No significant differences were noted in BMI distribution between patients with and without Pseudomonas, non-tuberculous mycobacteria, or by cause of bronchiectasis. The majority of patients demonstrated stable BMI over 5 years.
Conclusions: Although underweight patients with bronchiectasis have lower lung function, lower BMI does not appear to relate to other markers of disease severity in this patient population.
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Wendy Y. Sun, BA1 Chunyi Zhang, MPH1 Andrew J. Synn, MD1 Lina Nurhussien, MPH1 Brent A. Coull, PhD2 Mary B. Rice, MD, MPH1
Author Affiliations
- Division of Pulmonary, Sleep and Critical Care Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Department of Biostatistics, Department of Environmental Health, T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
Address correspondence to:
Mary B. Rice, MD, MPH
Division of Pulmonary, Critical Care, and Sleep Medicine
Beth Israel Deaconess Medical Center
330 Brookline Ave KSB23
Boston, MA 02215
Phone: (617) 667-5864
Email: mrice1@bidmc.harvard.edu
Abstract
Despite clinical guidelines for chronic obstructive pulmonary disease (COPD) patients to self-treat worsening respiratory symptoms with supplemental inhaler/nebulizer use, few studies have investigated if symptom changes are associated with differences in oxygenation, lung function, or self-treatment. A total of 26 former smokers (mean age 72.7 ±7.5 years; 57.7% female) with COPD (≥ Global Initiative for Chronic Obstructive Lung Disease Stage 2) were followed for up to 4 months, during which they recorded daily oxygenation, lung function, and inhaler/nebulizer use. Differences in these health measures were assessed in association with self-reported worsening symptoms and COPD exacerbations, as defined by validated questionnaire. We collected 2451 observations with spirometry and questionnaire data and identified 253 symptom days (10.3%) and 47 (1.92%) exacerbation days. In linear mixed effects models adjusted for age, sex, race, height, weight, and season, each respiratory symptom reported worse than baseline was associated with a 0.19 percentage point (95% CI -0.31 to -0.07) lower daily oxygen saturation (p=0.002). On major symptom days (defined as worse-than-baseline dyspnea, sputum purulence or sputum amount), oxygen saturation was 0.56 percentage points lower (95% CI -0.89 to -0.23, p=0.001) than days without increased major symptoms. We found no association of symptom days or exacerbations with forced expiratory volume in 1 second. There were 8 reports of increased inhaler/nebulizer use from baseline on symptom days (1.5% of 253). In this moderate-to-severe COPD population, worsening respiratory symptoms were common and associated with lower oxygenation. However, participants did not self-treat symptoms with increased inhaler/nebulizer use, which may suggest poor perceived clinical benefit from short-acting bronchodilators and a potential target for patient education.
Citation
Citation: Sun WY, Zhang C, Synn AJ, Nurhussien L, Coull BA, Rice MB. Change in inhaler use, lung function and oxygenation in association with symptoms in COPD. Chronic Obstr Pulm Dis. 2020; 7(4): 404-412. doi: http://dx.doi.org/10.15326/jcopdf.7.4.2020.0138
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