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Fernando Diaz del Valle, MD1* Patricia B. Koff, RRT, MEd1* Sung-Joon Min, PhD2 Jonathan K. Zakrajsek, MS1 Linda Zittleman, MS3 Douglas H. Fernald, MA3 Andrea Nederveld, MD3 Donald E. Nease, MD3 Alexis R. Hunter, BS4 Eric J. Moody, PhD5 Kay Miller Temple, MD6 Jenny L. Niblock, ARNP, DNP7 Chrysanne Grund, BS7 Tamara K. Oser, MD3 K. Allen Greiner, MD7 R. William Vandivier, MD1
Author Affiliations
- Division of Pulmonary Sciences and Critical Care Medicine, Denver Anschutz Medical Campus, University of Colorado, Aurora, Colorado, United States
- Department of Medicine, Division of Healthcare Policy and Research, Denver Anschutz Medical Campus, University of Colorado, Aurora, Colorado, United States
- Department of Family Medicine, Denver Anschutz Medical Campus, University of Colorado, Aurora, Colorado, United States
- High Plains Research Council Community Advisory Council, Denver Anschutz Medical Campus, University of Colorado, Aurora, Colorado, United States
- Wyoming Institute for Disabilities, University of Wyoming, Laramie, Wyoming, United States
- Center for Rural Health, University of North Dakota School of Medicine and Health Sciences, Grand Forks, North Dakota, United States
- Department of Family Medicine and Community Health, University of Kansas Medical Center, Kansas City, Kansas, United States
*Contributed equally to the manuscript.
Address correspondence to:
R. William Vandivier, MD
Division of Pulmonary Sciences and Critical Care Medicine
University of Colorado Denver
12700 E 19th Ave, Campus Box C272
Aurora, CO 80045
Phone: (303)724-6068 E-mail: Bill.Vandivier@cuanschutz.edu
Abstract
Rationale: Rural chronic obstructive pulmonary disease (COPD) patients have worse outcomes and higher mortality compared with urban patients. Reasons for these disparities likely include challenges to delivery of care that have not been explored.
Objective: To determine challenges faced by rural primary care providers when caring for COPD patients.
Methods: Rural primary care providers in 7 primarily western states were asked about barriers they experienced when caring for COPD patients.
Results: A total of 71 rural primary care medical providers completed the survey, of which 51% were physicians and 49% were advanced practice providers (APPs). A total of 61% used Global Initiative for Chronic Obstructive Lung Disease or American Thoracic Society/European Respiratory Society guidelines as an assessment and treatment resource. The presence of multiple chronic conditions and patient failure to recognize and report symptoms were the greatest barriers to diagnose COPD. A total of 89% of providers used spirometry to diagnose COPD, but only 62% were satisfied with access to spirometry. Despite recommendations, 41% of providers never test for alpha-1 antitrypsin deficiency. A total of 87% were comfortable with their ability to assess symptoms, but only 11% used a guideline-recommended assessment tool. Although most providers were satisfied with their ability to treat symptoms and exacerbations, only 66% were content with their ability to prevent exacerbations. Fewer providers were happy with their access to pulmonologists (55%) or pulmonary rehabilitation (37%). Subgroup analyses revealed differences based on provider type (APP versus physician) and location (Colorado and Kansas versus other states), but not on population or practice size.
Conclusions: Rural providers face significant challenges when caring for COPD patients that should be targeted in future interventions to improve COPD outcomes.
Citation
Citation: Diaz del Valle F, Koff PB, Min SJ, et al.Challenges faced by rural primary care providers when caring for COPD patients in the western United States. Chronic Obstr Pulm Dis. 2021; 8(3): 336-349. doi: http://dx.doi.org/10.15326/jcopdf.2021.0215
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Oksana Bohn, MD1 Min Xi, MS2 Natalie K. Woodruff, BS2 Gary L. Hansen, PhD2,3 Charlene E. McEvoy, MD, MPH2,3 and the COPDGene® Investigators
Author Affiliations
- University of Minnesota, Minneapolis, Minnesota, United States
- HealthPartners Institute, Bloomington, Minnesota, United States
- RespirTech, a Philips company, St. Paul, Minnesota, United States
Address correspondence to:
Charlene McEvoy, MD, MPH
HealthPartners Institute
8170 33rd Avenue South, MS23301A
Bloomington, MN 55425
Email: Charlene.E.McEvoy@HealthPartners.com
Phone: (612) 845-6711
Abstract
Purpose: To assess whether the presence or absence of bronchiectasis has an impact on the patient-reported symptoms of chronic obstructive pulmonary disease (COPD) patients.
Methods: The study included participants from the COPD Genetic Epidemiology Study (COPDGene®) cohort with available high-resolution chest tomography reporting the presence or absence of bronchiectasis (BE+/BE-) and survey data reporting the presence or absence of chronic bronchitis symptoms (CB+/CB-). Patient symptoms based on the St George’s Respiratory Questionnaire (SGRQ) were then compared for the different groups.
Results: The study population included 7976 participants, mean age 60, Global initiative for chronic Obstructive Lung Disease (GOLD) stages 0 to 4, 18.8% BE+, and 19.5% CB+. The presence or absence of radiographic bronchiectasis was not associated with higher frequency of chronic bronchitis (GOLD 0 group odds ratio [OR] 1.01 [0.78,1.31], GOLD 1–2 group OR 1.19 [0.95, 1.50], GOLD 3–4 group OR 1.26 [0.99, 1.60]). Similarly, CB+ participants had higher SGRQ scores than CB- participants regardless of the presence of BE.
Conclusions: Across all GOLD stages, chronic bronchitis symptoms are associated with worse pulmonary symptoms and significant impairment in quality of life. For patients with chronic bronchitis, the presence or absence of bronchiectasis is not associated with a significant difference in SGRQ symptom scores. Symptoms of chronic bronchitis impose a heavy burden on patients and should be treated regardless of the presence or absence of underlying bronchiectasis.
Citation
Citation: Bohn O, Xi M, Woodruff NK, Hansen GL, McEvoy CE; COPDGene investigators. Chronic bronchitis in COPD patients creates worse symptom burden regardless of the presence of bronchiectasis in the COPDGene cohort. Chronic Obstr Pulm Dis. 2021; 8(3): 350-359. doi: http://dx.doi.org/10.15326/jcopdf.2021.0202
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Hunter G. Lindsay1 Frederick S. Wamboldt, MD1,2 Kristen E. Holm, PhD, MPH1,3 Barry J. Make, MD1 John Hokanson, MPH, PhD2 James D. Crapo, MD1 Elizabeth A. Regan, MD, PhD1,2 and the COPDGene® Investigators
Author Affiliations
- National Jewish Health, Denver Colorado, United States
- Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado, United States
- Department of Community and Behavioral Health, Colorado School of Public Health, Aurora, Colorado, United States
Address correspondence to:
Elizabeth A. Regan, MD, PhD
National Jewish Health
1400 Jackson St
Denver CO 80206
Phone: (303)398-1531
Email: Regane@njhealth.org
Abstract
Introduction: Smoking cessation counseling is a central part of the Medicare guidelines for lung cancer screening. With increasing age, many heavy smokers eventually stop smoking, however, factors influencing the decision to stop smoking are poorly understood. We postulated that declining health or physician-diagnosis of a medical condition may be associated with successful smoking cessation.
Methods: A total of 4448 current and former smokers in Phase 2 of the COPD Genetic Epidemiology (COPDGene®) study answered a question about reasons for stopping smoking. Participants were classified as successful quitters (n=3345), and unsuccessful quitters (n=1003). Reasons cited for quitting were grouped as: medical diagnoses, social factors, symptoms. Logistic modeling of factors associated with successful quitting were adjusted for age, gender, race, and education.
Results: The most common factors cited for a quit attempt by all respondents were medical diagnoses (48%), followed by social factors (47%), and respiratory symptoms (36%). Successful quitters were more likely to be older, male, and non-Hispanic White. An adjusted model found increased age, White race, education beyond high school, and male sex favored successful quitting while the cited medical diagnoses, social factors, and “other” reasons were associated with unsuccessful quitting. Fagerstrom Nicotine Dependence scores were ³ 5 in 54% of the unsuccessful group compared to 45% for successful quitters(p<0.0001) suggesting some increased nicotine dependence in the unsuccessful quitters.
Conclusions: Medical diagnosis was the most common factor cited for considering a quit attempt by both successful and unsuccessful quitters; however, successful quitting was influenced by demographic factors and potentially the severity of nicotine dependence.
Citation
Citation: Lindsay HG, Wamboldt FS, Holm KE, et al; and the COPDGene Investigators. Impact of a medical diagnosis on decision to stop smoking and successful smoking cessation. Chronic Obstr Pulm Dis. 2021; 8(3): 360-370. doi: http://dx.doi.org/10.15326/jcopdf.2020.0167
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Emily C. Sanders, MD1 Robert M. Burkes, MD, MSCR2 Jason R. Mock, MD, PhD3 Todd T. Brown, MD, PhD4 Robert A. Wise, MD5 Nadia N. Hansel, MD, MPH5 Mark C. Liu, MD5 M. Bradley Drummond, MD, MHS3
Author Affiliations
- Department of Internal Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Cincinnati, Cincinnati, Ohio, United States
- Division of Pulmonary Diseases and Critical Care Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
- Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University, Baltimore, Maryland, United States
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, United States
Address correspondence to:
M. Bradley Drummond, MD, MHS
Marsico Hall Room 7207, CB# 7248
125 Mason Farm Road
Chapel Hill, NC 27599
Phone: (919) 966-7054
brad_drummond@med.unc.edu
Abstract
Introduction: Cathelicidin is a vitamin D-regulated, antimicrobial peptide involved in the innate immune response of the airways. Reduced plasma cathelicidin concentrations are independently associated with worse pulmonary outcomes in current and former smokers. This study aimed to determine whether oral vitamin D supplementation in vitamin D-deficient current smokers increases plasma and bronchoalveolar lavage (BAL) cathelicidin levels.
Methods: Vitamin D-deficient (25-hydroxy vitamin D [25-OH vitamin D] <20 ng/ml) smokers (n=17) underwent collection of plasma and BAL for cathelicidin and 25-OH vitamin D measurements before and after 8 weeks of oral supplementation with 50,000 IU vitamin D3 weekly. Differences between baseline and 8-week levels of cathelicidin and 25-OH vitamin D in blood and BAL were assessed along with correlations between serum 25-OH vitamin D, plasma cathelicidin, and BAL cathelicidin.
Results: At baseline, there was no correlation between BAL and plasma cathelicidin. There was a significant increase in 25-OH vitamin D (median 17.0 to 43.3 ng/mL, p<0.001) after 8 weeks of vitamin D supplementation. There was no change in plasma cathelicidin (p=0.86), BAL cathelicidin (p=0.31), or BAL 25-OH vitamin D (p=0.89). There was no correlation between serum 25-OH vitamin D and either BAL or plasma cathelicidin post-supplementation.
Conclusion: Oral vitamin D supplementation, while increasing serum 25-OH vitamin D levels, does not increase plasma or BAL cathelicidin levels in vitamin D-deficient, active smokers. The lack of increased BAL cathelicidin may be explained by multiple factors related to dosing, smoking effects, or putative mechanisms of engagement. Future studies are needed to determine the effects of vitamin D supplementation on lung and blood functional activity.
Citation
Citation: Sanders EC, Burkes RM, Mock JR, et al. Bronchoalveolar lavage and plasma cathelicidin response to 25-hydroxy vitamin D supplementation: a pilot study. Chronic Obstr Pulm Dis. 2021; 8(3): 371-381. doi: http://dx.doi.org/10.15326/jcopdf.2021.0220
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Jorge Lascano, MD1 Jason Katz, BS*1Martin Cearras, MD2 Michael Campos, MD3
Author Affiliations
- Pulmonary and Critical Care Division, Department of Internal Medicine, UF Health-Shands Hospital, University of Florida, Gainesville, Florida, United States
- Advent Health Medical Group, Central Florida Division, Orlando, Florida, United States
- Pulmonary and Critical Care Division, Department of Internal Medicine, University of Miami Health Systems, Miami, Florida, United States
*medical student
Address correspondence to:
Jason B. Katz
MD-candidate
College of Medicine
University of Florida
Phone : (727)288-8356
Email : jasonbkatz@ufl.edu
Abstract
Purpose: Endothelial and platelet microparticles (eMPs and pMPs), markers of cellular activation, dysfunction, or apoptosis, have been associated with multiple cardiovascular conditions. Chronic obstructive pulmonary disease (COPD) is associated with cardiovascular comorbidities and platelet/endothelial dysfunction. We analyzed whether eMPs and pMPs are associated with COPD status and/or severity.
Patients and Methods: A total of 58 COPD patients and 19 controls were enrolled and followed for an average of 1.17 years. Characterization of COPD included lung function, Body mass index-airflow Obstruction-Dyspnea-Exercise (BODE) scores, health-related quality of life, exacerbations, comorbidities, and mortality. Plasma collection to measure eMPs and pMPs via flow cytometry was performed at enrollment as well as during acute exacerbation in 17 participants. We measured pMPs (CD31+, CD41+31+, CD 62P+), eMPs (ULEX lectin+, CD51+, CD54+, CD62E+), the apoptotic CD62E+/CD31+ ratio, and Annexin V MP.
Results: As a group, COPD participants had no difference in all MP levels studied compared with controls. No significant correlations with diffusion capacity for carbon monoxide, quality of life, and exacerbation status were found in all MPs studied. However, the eMP ULEX and the pMP CD 62P+ were higher among COPD Global initiative for chronic Obstructive Lung Disease (GOLD) stage 3 patients compared to controls. The CD62E+/CD31+ ratio was lower in controls and GOLD stage 1 COPD participants compared with GOLD stage 2/3 COPD participants, suggesting increased apoptosis. eMP ULEX lectin+ decreased during acute exacerbations and pMP41+31+ significantly increased as BODE score increased.
Conclusion: After adjusting for comorbidities, most eMPs and pMPs studied do not correlate significantly with COPD status or severity.
Citation
Citation: Lascano J, Katz J, Cearras M, Campos M.Association of systemic endothelial-derived and platelet-derived microparticles with clinical outcomes in chronic obstructive pulmonary disease. Chronic Obstr Pulm Dis. 2021; 8(3): 382-395. doi: http://dx.doi.org/10.15326/jcopdf.2021.0211
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Fortune O. Alabi, MD1 Hadaya A. Alkhateeb, BS1 Kayla M. DeBarros, BS1 Pierina S. Barletti Benel, BS1 Rachel L. Sanchez-Martez1 Mia L. Zeper, BS1 Reema A. Ismail1 Fred Umeh, MD1 Nelson Medina-Villanueva, MD1
Author Affiliations
- Florida Lung Asthma and Sleep Specialists, Kissimmee, Florida, United States
Address correspondence to:
Fortune O. Alabi, MD
3480 Polynesian Isles Blvd.
Kissimmee, FL 34746
Phone: 407-507-2615
Email: Falabi@floridalungdoctors.com
Abstract
Background: Chronic obstructive pulmonary disease (COPD) is a heterogeneous disease with differing clinical presentations, which range from an asymptomatic obstructive defect on spirometry to symptomatic normal spirometry. The current standard for diagnosis requires exposure history and the presence of an obstructive ventilatory defect (forced expiratory volume in 1 second [FEV1] to forced vital capacity [FVC] ratio < 70%) on spirometry. In this real-world study, we analyzed patients with physician-diagnosed COPD, described their characteristics, and evaluated the diagnostic sensitivity of Global initiative for chronic Obstructive Lung Disease (GOLD) criteria in this population.
Methods: We retrospectively analyzed the charts of 2115 patients for eligibility. A total of 1224 patients with physician-diagnosed COPD were selected for this study. The average age was 68.4±11.5 years, with 51% being female. Of the 1224 patients, 18% did not have a history of smoking, 73% had bronchodilator testing, and a significant response of ≥12% was noted in 23% of the COPD patients. Moreover, 43% of the patients met the GOLD criteria for the diagnosis of COPD, whereas the Global Lung Function Initiative (GLI) and lower limit of normal (LLN)criteria were only able to identify 26%.
Discussion: COPD-related mortality is continuing to rise, and it is currently ranked as the third leading cause of death, globally, after cardiovascular diseases and strokes. Despite this alarming statistic, COPD diagnosis is delayed in most cases and can remain undiagnosed, even in smokers. This is partly due to the restrictive GOLD diagnostic criteria, which requires the presence of FEV1/FVC ratio<70.
Conclusion: The recently proposed COPD Genetic Epidemiology (COPDGene®) 2019 definition for COPD will improve and enhance our ability to diagnose COPD earlier and more accurately.
Citation
Citation: Alabi FO, Alkhateeb HA, DeBarros KM, et al. The heterogeneity of COPD patients in a community-based practice and the inadequacy of the Global Initiative for Chronic Obstructive Lung Disease criteria: a real-world experience. Chronic Obstr Pulm Dis. 2021; 8(3): 396-407. doi: http://dx.doi.org/10.15326/jcopdf.2021.0229
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