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Samuel Gurevich, MD1,2 Andrew Daya, MD2 Cristiana Da Silva, RRT, BS2 Christine Girard, MD2 Franck Rahaghi, MD2
Author Affiliations
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, United States
- Department of Pulmonary Medicine, Cleveland Clinic Florida, Weston, Florida, United States
Address correspondence to:
Samuel Gurevich, MD
Respiratory Center
Cleveland Clinic Florida Weston
Building A2950 Cleveland Clinic Blvd
Weston, FL 33331
Ph: (954) 659-5450
Fax: (954) 659-5451
Email: Gurevis@ccf.org
Abstract
Alpha-1 antitrypsin deficiency (AATD) is a common but highly underdiagnosed genetic disorder that may lead to chronic obstructive pulmonary disease (COPD), bronchiectasis, and liver disease. Early diagnosis is key to altering the course of disease as well as informing family members of potential risk. This randomized, prospective observational study compares the different testing modalities for AATD testing of at-risk patients initiated in the pulmonary function testing (PFT) laboratory. Providing a recommendation with a prescription for serologic testing, providing a finger-stick testing method (AlphaKit), and providing a buccal swab testing method (AlphaID) were compared to the community standard of referring the patient back to the PFT-ordering provider only. Results show that testing directly in the PFT laboratory has an odds ratio (OR) for completing testing of 35.14 (5.33 - 999.99), p-value of <0.0001, for buccal swab testing and an OR of 17.09 (2.58 - 729.99), p-value of 0.0002, for finger-stick testing compared to the community standard. Providing a prescription was no better than referral back to the PFT-ordering provider with an OR of 2.61(0.33 - 119.36), p-value of 0.6412. Resources needed to have testing performed by the Respiratory Therapy department were minimal with an average time of 1 to 5 minutes per patient tested. Causes of testing refusal were also identified. In conclusion, direct testing for AATD by respiratory therapists at the conclusion of PFT testing shows a significant improvement in rates of testing, especially with testing that utilizes buccal swab sample collection.
Citation
Citation: Gurevich S, Daya A, Da Silva C, Girard C, Rahaghi F. Improving screening for alpha-1 antitrypsin with direct testing in the pulmonary function testing laboratory. Chronic Obstr Pulm Dis. 2021; 8(2): 190-197. doi: http://dx.doi.org/10.15326/jcopdf.2020.0179
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Esther Pompe, MD, PhD1 Camille M. Moore, PhD2 Firdaus A.A. Mohamed Hoesein, MD, PhD3 Pim A. de Jong, MD, PhD3 Jean-Paul Charbonnier, PhD4 MeiLan K. Han, MD5 Steven M. Humphries, PhD6 Charles R. Hatt, PhD7 Craig J. Galbán, PhD8,9 Ed K. Silverman, MD, PhD10,11 James D. Crapo, MD12 George R. Washko, MD11 Elisabeth A. Regan, MD, PhD13 Barry Make, MD12 Matthew Strand, PhD2 Jan-Willem J. Lammers, MD, PhD1 Eva M. van Rikxoort, PhD4 David A. Lynch, MD6 on behalf of the COPDGene® investigators
Author Affiliations
- Imaging Department, University Medical Center Utrecht, Utrecht, the Netherlands
- Division of Biostatistics, Environment and Health, National Jewish Health, Denver, Colorado, United States
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
- Diagnostic Image Analysis Group, Radboud University Medical Center, Nijmegen, the Netherlands
- Division of Pulmonary and Critical Care, University of Michigan Health System, Ann Arbor, Michigan, United States
- Department of Radiology, National Jewish Health, Denver, Colorado, United States
- Imbio LLC, Minneapolis, Minnesota, United States
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, United States
- Center for Molecular Imaging, University of Michigan, Ann Arbor, Michigan, United States
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, National Jewish Health, Denver, Colorado, United States
- Division of Rheumatology, Department of Medicine, National Jewish Health, Denver, Colorado, United States
Address correspondence to:
Esther Pompe, MD
Imaging Department
University Medical Center
UtrechtPostbus 85500
3508 GA Utrecht
Postbox: E.03.511
E-mail: e.pompe@umcutrecht.nl
Phone: +31 88 75 50846
Abstract
Background: Little is known about factors associated with emphysema progression in cigarette smokers. We evaluated factors associated with change in emphysema and forced expiratory volume in 1 second (FEV1) in participants with and without chronic obstructive pulmonary disease (COPD).
Methods: This retrospective study included individuals participating in the COPD Genetic Epidemiology study who completed the 5-year follow-up, including inspiratory and expiratory computed tomography (CT) and spirometry. All paired CT scans were analyzed using micro-mapping, which classifies individual voxels as emphysema or functional small airway disease (fSAD). Presence and progression of emphysema and FEV1 were determined based on comparison to nonsmoker values. Logistic regression analyses were used to identify clinical parameters associated with disease progression.
Results: A total of 3088 participants were included with a mean ± SD age of 60.7±8.9 years, including 72 nonsmokers. In all Global initiative for chronic Obstructive Lung Disease (GOLD) stages, the presence of emphysema at baseline was associated with emphysema progression (odds ratio [OR]: GOLD 0: 4.32; preserved ratio-impaired spirometry [PRISm]; 5.73; GOLD 1: 5.16; GOLD 2: 5.69; GOLD 3/4: 5.55; all p ≤0.01). If there was no emphysema at baseline, the amount of fSAD at baseline was associated with emphysema progression (OR for 1% increase: GOLD 0: 1.06; PRISm: 1.20; GOLD 1: 1.7; GOLD 3/4: 1.08; all p ≤ 0.03).In 1735 participants without spirometric COPD, progression in emphysema occurred in 105 (6.1%) participants and only 21 (1.2%) had progression in both emphysema and FEV1.
Conclusions: The presence of emphysema is an important predictor of emphysema progression. In patients without emphysema, fSAD is associated with the development of emphysema. In participants without spirometric COPD, emphysema progression occurred independently of FEV1 decline.
Citation
Citation: Pompe E, Moore CM, Mohamed Hoesein FAA, et al for the COPDGene Investigators. Progression of emphysema and small airways disease in cigarette smokers. Chronic Obstr Pulm Dis. 2021; 8(2): 198-212. doi: http://dx.doi.org/10.15326/jcopdf.2020.0140
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Danielle M. Boyce, MPH1 Byron M. Thomashow, MD1,2 Jamie Sullivan, MPH1 Ruth Tal-Singer, PhD1
Author Affiliations
- COPD Foundation, Washington, DC, United States
- Columbia University Medical Center, New York, New York, United States
Abstract
Objectives: To investigate telemedicine adoption, emergency department avoidance, and related characteristics of patients with chronic obstructive pulmonary disease (COPD) with and without exacerbations since the coronavirus 2019 (COVID-19) pandemic began.
Methods: We conducted the second of a series of online surveys via SurveyMonkey.com of people with COPD between May 1, 2020 and May 31, 2020. Frequency, percentage, and Fisher’s exact test (2-sided) were calculated using SPSS version 26.
Results: More than half of respondents (157, 64%), indicated that they started using telemedicine in 2020. A total of 47% of respondents reported having had at least 1 exacerbation since January 1, 2020. Respondents who had at least 1 exacerbation in 2020 were more likely to start using telemedicine in 2020 than respondents who did not report any exacerbation in 2020 (75.7% versus 54.3%, p < 0.001). Respondents reporting a 2020 exacerbation indicated having a significantly higher avoidance of emergency health care since the pandemic began (27.8%) as compared to those who did not have an exacerbation in 2020 (10.1%), p < 0.001.
Conclusions: In response to social distancing and other COVID-19 precautions, people with COPD are avoiding traditional, in-person health care environments and turning to telemedicine to prevent and manage exacerbations. Further investigation is needed to identify best practices in and barriers to telemedicine in this population.
Citation
Citation: Boyce DM, Thomashow BM, Sullivan J, Tal-Singer R. New adopters of telemedicine during the coronavirus-19 pandemic in respondents to an online community survey: the case for access to remote management tools for individuals with chronic obstructive pulmonary disease. Chronic Obstr Pulm Dis. 2021; 8(2): 213-218. doi: http://dx.doi.org/10.15326/jcopdf.2020.0181
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Samuel L. Krachman, DO1 Maria Elena Vega, MD1 Daohai Yu, PhD2 Joseph Demidovich, DO1 Harsh Patel, MD1 Fredric Jaffe, DO1 Xavier Soler, MD3 Tahseen Shariff, RPSGT1 Gilbert E. D'Alonzo, DO1 Wissam Chatila, MD1 Sheila Weaver, DO1 Yasmin Daraz1* Sydney Cohen1* Gerard J. Criner, MD1
Author Affiliations
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania, United States
- Department of Clinical Sciences, Temple Clinical Research Institute, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania, United States
- Department of Pulmonary, Critical Care, and Sleep Medicine, University of California, San Diego, California, United States
*student
Address correspondence to:
Samuel L. Krachman, DO
Lewis Katz School of Medicine at Temple University
3401 North Broad St.
Philadelphia, PA 19140
Phone: (215) 707-4678
E-mail: samuel.krachman@tuhs.temple.edu
Abstract
Background: Factors responsible for poor sleep quality in patients with chronic obstructive pulmonary disease (COPD) includes the effects of medications. This study evaluates the effect of the inhaled triple therapy of budesonide-formoterol-tiotropium versus placebo-tiotropium on sleep quality in COPD patients.
Methods: Twenty-three patients (11 [48%] males; age 55 [51–60, 48-–5] years; body mass index [BMI] 25 [22–30, 18-40] kg/m2; forced expiratory volume in 1 second [FEV1]1.10 [0.80 –1.90, 0.60–2.80] L, 42 [31–62, 24–75] % predicted) were studied. Ten patients were randomized to budesonide-formoterol-tiotropium and 13 patients to placebo-tiotropium. At baseline and after 28 days, patients completed spirometry, polysomnography, an Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), COPD-specific St George’s Respiratory Questionnaire (SGRQ-C) and short form 36 (SF 36).
Results: After 28 days, there was a significant 29% increase in the bedtime FEV1 in the budesonide-formoterol-tiotropium group (from 0.75 [0.55–1.30, 0.50–2.40] L to 1.00 [0.75–1.55, 0.50–3.00] L, p=0.031), with no change in the placebo-tiotropium group (from 1.20 [0.80–1.50, 0.60–1.90] L to 1.15 [0.75–1.55, 0.50–1.80] L, p=0.91). No significant change was found post treatment in sleep efficiency or total sleep time in both the budesonide-formoterol-tiotropium group (from 78 [72-92, 62-98]% to 88 [77-92, 40-98]%, p=0.70 and 290 [268-358, 252-382] min to 342 [303-358, 157-372] min, p=0.77, respectively) and the placebo-tiotropium group (from 82 [75–88, 46–93]% to 84 [77–87, 62–94]%, p=0.96 and 320 [292–350, 180–378] min to 339 [303–349, 241–366] min, p=0.79, respectively). While there was no significant change in the arousal index in the budesonide-formoterol-tiotropium group (9 [5–16, 0–48] arousals/hour to 14 [9–17, 2-36] arousals/hour, p=0.43), a significant increase was seen in the placebo-tiotropium group (11 [4–13, 3-–2] arousals/hour to 17 [11–21, 2–33] arousals/hour, p=0.027). Similarly, there was no change in the ESS in the budesonide-formoterol-tiotropium group (6 [3–8, 0–11] to 6 [5–8, 0–1]), p=0.44), but a marginally significant increase in the placebo-tiotropium group (8 [5–12, 2–18] to 10 [713, 518], p=0.07), with a significant difference in the ESS 28 days post treatment between the 2 groups (6 [5-8, 0-11] versus 10 [7-13, 5-18], p=0.043). There was no significant change in nocturnal oxygenation, sleep architecture, PSQI, SGRQ-C, or SF 36 in both groups.
Conclusion: In patients with COPD, inhaled triple therapy with budesonide-formoterol-tiotropium as compared to placebo-tiotropium improves pulmonary function while preserving sleep quality and architecture.
Citation
Citation: Krachman SL, Vega ME, Yu D, et al. Effect of triple therapy with budesonide-formoterol-tiotropium versus placebo-tiotropium on sleep quality in patients with chronic obstructive pulmonary disease. Chronic Obstr Pulm Dis. 2021; 8(2): 219-229. doi: http://dx.doi.org/10.15326/jcopdf.2020.0178
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Fernando J. Martinez, MD, MS1 Byron Thomashow, MD2 Tamar Sapir, PhD3 Laura Simone, PhD3 Jeffrey Carter, PhD3 MeiLan Han, MD, MS4
Author Affiliations
- Weill Cornell Medicine, New York Presbyterian Hospital, New York, New York, United States
- Columbia University, New York Presbyterian Hospital, New York, New York, United States
- PRIME Education, LLC, Fort Lauderdale, Florida, United States
- University of Michigan Health System, Ann Arbor, Michigan, United States
Address correspondence to:
Fernando J. Martinez, MD, MS
1305 York Ave
Box 96, Room Y-1059
New York, NY 10021
Phone: 646.962.2748
Email: fjm2003@med.cornell.edu
Abstract
Introduction: Recommendations for chronic obstructive pulmonary disease (COPD) diagnosis and management requires symptom and exacerbation risk assessment. Adherence to these recommendations appears to be limited. We examined the impact of a COPD quality improvement (QI) program in the Southeastern United States.
Methods: From 2017 to 2018, nine pulmonary and 15 primary care physicians were included in our study and asked to identify 6 to 7 of their COPD patients using maintenance COPD medications with at least 2 office visits in the past year. A separate group of COPD patients (n=135 pulmonary and 165 primary care) from the same practices were evaluated. Physicians underwent focused, educational, peer-to-peer small group webinars. Data were collected from physicians and their patients using a systematic survey. Chart audits occurred at baseline and 6 months after the webinars.
Results: The majority of physicians (67%) saw ≥ 20 COPD patients/week. There were important discrepancies between the care clinicians thought they provided, and the care recalled by their patients. Clinicians felt that 33% of their patients experienced at least 2 exacerbations in the past year; 56% of their patients reported this frequency. There was discrepancy in the clinicians’ interpretations and the patients’ reasons for discontinuing their medications and in the use of referrals. Self-reported changes were noted by clinicians after educational webinars and improvements in patient care were noted in the year following intervention.
Conclusion: We identified notable discrepancies between the clinicians’ impression of care provided and the components actually recalled by their patients. We also identified improvements in processes of care and outcomes following an educational intervention based on the principles of audit and feedback.
Citation
Citation: Martinez FJ, Thomashow B, Sapir T, Simone L, Carter J, Han M. Does evaluation and management of COPD follow therapeutic strategy recommendations? Chronic Obstr Pulm Dis. 2021; 8(2): 230-242. doi: http://dx.doi.org/10.15326/jcopdf.2020.0175
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Vira Pravosud, MPH, MS1 David M. Mannino, MD1,2 Delia Prieto, MS2 Quan Zhang, PhD3 Radmila Choate, PhD, MPH1,2 Elisha Malanga, BS2 Timothy R. Aksamit, MD4
Author Affiliations
- College of Public Health, University of Kentucky, Lexington, Kentucky, United States
- COPD Foundation, Washington, DC, United States
- School of Public Health, Rutgers University, Piscataway, New Jersey, United States
- Pulmonary Disease and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, United States
Address correspondence to:
Vira Pravosud, MPH, MS
College of Public Health
Department of Epidemiology
University of Kentucky
111 Washington Avenue, Room 211C
Lexington, KY 40536
Email: vira.pravosud@uky.edu
Abstract
Purpose: Respiratory diseases caused by nontuberculous mycobacteria (NTM) have become a significant concern for patients and health care providers. We aimed to compare symptoms experienced during the 2 week period, at a single point in time, by patients with NTM lung disease (NTMLD) who were currently on any medication to treat their NTMLD versus those not on any therapies.
Methods: We analyzed responses to a “Burden of NTM Survey” developed by the COPD Foundation. The study population included 266 individuals with NTMLD. Using adjusted penalized logistic regression models, we determined associations between the self-reported symptoms and the use of any medication to treat NTMLD.
Results: Based on available data, most respondents were aged 50 and older (95.1%), of female gender (93.1%), and had been living with NTMLD for more than 5 years (55.7%). Many respondents reported symptoms that bother them very often or daily. After adjustment for age and gender, duration of living with NTMLD, and other respiratory illnesses, patients on medication had significantly larger odds of reporting difficulty in walking 500 meters without stopping, difficulty in interacting with others, fatigue or lack of energy, feelings of sadness or depression related to illness, and shortness of breath, wheezing or other difficulties.
Conclusion: In this study, patients currently on any medication to treat their NTMLD reported more symptoms associated with their NTMLD. Further investigations are needed to explore whether increased symptoms are related to differences in disease severity and/or medication effects.
Citation
Citation: Pravosud V, Mannino DM, Prieto D, et al. Symptom burden and medication use among patients with nontuberculous mycobacterial lung disease. Chronic Obstr Pulm Dis. 2021; 8(2): 243-254. doi: http://dx.doi.org/10.15326/jcopdf.2020.0184
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Robert M. Marron, MD1 Matthew Zheng, MD1 Gustavo Fernandez Romero, MD1 Huaqing Zhao, PhD2 Raj Patel, MD3 Ian Leopold, MD3 Ashanth Thomas, MD3 Taylor Standiford, MD3 Maruti Kumaran, MD3 Nicole Patlakh, BS1 Jeffrey Stewart, MD1 Gerard J. Criner, MD1 and the Temple University COVID-19 Research Group
Author Affiliations
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, United States
- Department of Clinical Sciences, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, United States
- Department of Radiology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, United States
Abstract
Background: Comorbid disease is a risk factor for severe coronavirus disease 2019 (COVID-19) infection. However, initial rates of chronic obstructive pulmonary disease (COPD) in case series were low and severity of COVID-19 in COPD patients was variable.
Methods: We performed a retrospective study of patients admitted with COVID-19 and evaluated outcomes in those with and without COPD and/or emphysema. Patients were identified as having COPD if they had a diagnosis in the medical record and a history of airflow-obstruction on spirometry, or a history of tobacco use and prescribed long-acting bronchodilator(s). Computed tomography scans were evaluated by radiologists. Propensity matching was performed for age, body mass index (BMI), and serologic data correlated with severity of COVID-19 disease (D-dimer, C-reactive protein, ferritin, fibrinogen, absolute lymphocyte count, lymphocyte percentage, and lactate dehydrogenase).
Results: Of 577 patients admitted with COVID-19, 103 had a diagnosis of COPD and/or emphysema. The COPD/emphysema cohort was older (67 versus 58, p<0.0001) than the other cohort and had a lower BMI. Among unmatched cohorts those with COPD/emphysema had higher rates of intensive care unit (ICU) admission (35% versus 24.9%, p=0.036) and maximal respiratory support requirements, with more frequent invasive mechanical ventilation (21.4% versus 11.8%), but no significant difference in mortality. After propensity-matching there was no difference in ICU admission, maximal respiratory support requirements, or mortality. Univariate and multivariate regression analyses yielded similar results.
Discussion: Our propensity-matched retrospective cohort study suggests that patients hospitalized with COVID-19 who have COPD and/or emphysema may not have worse outcomes than those without these comorbid conditions.
Citation
Citation: Marron RM, Zheng M, Romero GF, et al.Impact of chronic obstructive pulmonary disease and emphysema on outcomes of hospitalized patients with coronavirus 2019 pneumonia. Chronic Obstr Pulm Dis. 2021; 8(2): 255-268. doi: http://dx.doi.org/10.15326/jcopdf.2020.0200
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John G. Yonchuk, MS1 Divya Mohan MD, PhD2* Nathan K. LeBrasseur, MS, PhD3 Ashley R. George, PhD4* Sally Singh, PhD5 Ruth Tal-Singer, PhD6*
Author Affiliations
- Research and Development Technology, GlaxoSmithKline, Collegeville, Pennsylvania, United States
- Research and Development, GlaxoSmithKline, Collegeville, Pennsylvania, United States
- Department of Physical Medicine and Rehabilitation, Mayo Clinic Rochester, Minnesota, United States
- Bay Digital Consulting, Hertfordshire, United Kingdom
- Department of Respiratory Sciences, University of Leicester, Leicester Biomedical Research Centre, Respiratory, Leicester, United Kingdom
- COPD Foundation, Washington, DC, United States
* Employees of GlaxoSmithKline during the design and conduct of this work.
Address correspondence to:
John Yonchuk, MS
Phone: (610)348-2648
Email: john.g.yonchuk@gsk.com
Abstract
Background: Pulmonary rehabilitation (PR) is an important therapy for patients with chronic obstructive pulmonary disease (COPD), yet uptake remains low. Intervention strategies which recapitulate the benefits of PR are, therefore, needed and digital, home-based therapies present opportunity in this space. Digital therapies also potentially offer an opportunity to standardize PR in clinical trials for new COPD therapies.
Aims and Methods: We aimed to create a digital application (app), Respercise®, consisting of up to 4 strengthening exercises in conjunction with Therbands™ and a daily physical activity program with individualized step goals, and to test its feasibility in a clinical trial. App usability was surveyed qualitatively before development iterations and deployment in a 13-week interventional clinical trial. All participants who completed the study were invited for an exit interview and performed the 5-repetition sit-to-stand test amongst other measures.
Results: Feedback from clinical trial participants was positive; 97% of respondents liked the app. A total of 88% of participants reported that it was easy to fit the exercises into their daily routine, and there was over 90% adherence for entering daily step counts. Notably, on day 90 both females and males using Respercise alone demonstrated a 2.22- and 2.27-seconds improvement in time for 5-repetition sit-to-stand tests respectively, above the 1.7 second threshold that is considered clinically meaningful in COPD.
Conclusion: Respercise can be successfully deployed in clinical trials, offering the opportunity for standardization of exercise in clinical trials and, with further development, could have wider reach as a home-based intervention for individuals with COPD.
Citation
Citation: Yonchuk JG, Mohan D, LeBrasseur NK, George AR, Singh S, Tal-Singer R. Development of Respercise® a digital application for standardizing home exercise in COPD clinical trials. Chronic Obstr Pulm Dis. 2021; 8(2): 269-276. doi: http://dx.doi.org/10.15326/jcopdf.2020.0194
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Robert M. Burkes, MD, MSCR1 David J. Couper, PhD2 Igor Z. Barjaktarevic, MD, PhD3 Christopher B. Cooper, MD4 Wassim W. Labaki, MD5 Meilan K. Han, MD5 Prescott G. Woodruff MD, MPH6 Stephen C. Lazarus, MD6 Trisha M. Parekh, DO7 Robert Paine, III, MD8 Alejandro P. Comellas, MD9 Russell P. Bowler, MD, PhD10 Laura R. Loehr, MD, PhD11 Nirupama Putcha, MD, MHS12 Robert A. Wise, MD12 Todd T. Brown, MD, PhD13 M. Bradley Drummond, MD, MHS1
Author Affiliations
- Division of Pulmonary Diseases and Critical Care Medicine, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, United States
- Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, United States
- Division of Pulmonary, Critical Care, and Sleep Medicine, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California, United States
- Departments of Medicine and Physiology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California, United States
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan, United States
- Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, University of California-San Francisco, San Francisco, California, United States
- Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, University of Alabama-Birmingham, Birmingham, Alabama, United States
- Division of Pulmonary Medicine, University of Utah, Salt Lake City, Utah, United States
- Division of Pulmonary, Critical Care, and Occupational Medicine, University of Iowa, Iowa City, Iowa, United States
- Division of Pulmonary, Critical Care, and Sleep Medicine, National Jewish Hospital, Denver, Colorado, United States
- Division of General Medicine and Clinical Epidemiology, University of North Carolina, Chapel Hill, North Carolina, United States
- Division of Pulmonary and Critical Care, Johns Hopkins University, Baltimore, Maryland, United States
- Division of Endocrinology and Metabolism, Johns Hopkins University, Baltimore, Maryland, United States
Address correspondence to:
Robert M. Burkes, MD
231 Albert Sabin Way, ML 0564
Cincinnati, OH 45267
Phone: (724)730-3862
Email: burkesrt@ucmail.uc.edu
Abstract
Introduction: Age and vitamin D levels may affect symptom burden in chronic obstructive pulmonary disease (COPD). We used the Subpopulations and Intermediate Outcome Measures in COPD Study (SPIROMICS) to determine independent associations between vitamin D levels and COPD symptoms in different age strata.
Methods: Serum 25-hydroxy (OH)-vitamin D levels were modeled continuously and categorically (<20 ng/ml versus ≥20 ng/ml). Stratifying by age group (middle-age: 40-64 years old and older: >65 years old), multivariable modeling was performed to identify relationships between 25-OH-vitamin D levels and the COPD Assessment Test (CAT), the modified Medical Research Council score (mMRC), the St George’s Respiratory Questionnaire (SGRQ) total and subdomain scores, the Veterans’ Specific Activity Questionnaire, and the 6-minute walk test distance.
Results: In the middle-aged group, each 5 ng/ml higher 25-OH-vitamin D level was independently associated with more favorable CAT score (-0.35 [-0.67 to -0.03], P=0.03), total SGRQ (-0.91 [-1.65 to -0.17]; P=0.02), and the SGRQ subdomains (Symptoms:-1.07 [-1.96 to -0.18], P=0.02; Impact: -0.77 [-1.53 to -0.003], P=0.049; Activity: -1.07 [-1.96 to -0.18], P=0.02). These associations persisted after the addition of comorbidity score, reported vitamin D supplementation, outdoor time, or season of blood draw to models. No associations were observed between 25-OH-vitamin D levels and symptom scores in the older age group.
Discussion: When controlled for clinically relevant covariates, higher 25-OH-vitamin D levels are associated with more favorable respiratory-specific symptoms and quality-of-life assessments in middle-age but not older COPD individuals. Study of the role of vitamin D supplementation in the symptom burden of younger COPD patients is needed.
Citation
Citation: Burkes RM, Couper DJ, Barjaktarevic IZ, et al.Age-dependent associations between 25-hydroxy vitamin D levels and COPD symptoms: analysis of SPIROMICS. Chronic Obstr Pulm Dis. 2021; 8(2): 277-291. doi: http://dx.doi.org/10.15326/jcopdf.2020.0180
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