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Gerard J. Criner, MD1 Lii-Yoong H. Criner, RN, CRN1 Sheril A. George, BS, RRT1 Jiji K. Thomas, MBBS1 Michael R. Jacobs, PharmD1
Author Affiliations
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania, United States.
Address correspondence to:
Gerard J. Criner, MD
Department of Thoracic Medicine and Surgery
Lewis Katz School of Medicine
Temple University
745 Parkinson Pavilion
3401 North Broad Street
Philadelphia, PA 19140
Phone: (215) 707-8113
Email: gerard.criner@tuhs.temple.edu
Abstract
Rationale: High-flow nasal therapy (HFNT) has beneficial effects in patients hospitalized with acute hypoxemic respiratory failure. HFNT has not been extensively studied following hospitalization for an acute exacerbation of chronic obstructive pulmonary disease (AECOPD).
Objective: We explored the feasibility of conducting a multicentered trial to evaluate the use of HFNT to increase the time to next moderate/ severe exacerbation in patients recently hospitalized for a COPD exacerbation. In this pilot study we measured the hours of home daily HFNT use, maximally tolerated flow rates and temperature, and side effects for a period of 90 days.
Methods: Patients were enrolled in a 90-day, open-labeled pilot study of HFNT to determine the safety and feasibility of home use for daily outpatient COPD management. Patients ≥ 40 years of age with prior hospitalization within the past 12 weeks for an AECOPD were enrolled. COPD was the primary diagnosis in all patients.
Results: Thirty patients presented for HFNT titration. Two dropped out; 1 after receiving a lung transplant and the other was lost to follow-up. The remaining 28 patients completed 90 days of HFNT. None withdrew from HFNT due to intolerance. Use of HFNT averaged 6.8 (2.1) hours daily.
Conclusions: Daily home HFNT for up to 3 months is feasible in COPD patients following hospitalization for AECOPD. Improvements observed in disease-specific quality of life, respiratory symptoms, and 6-minute walk distance suggest the need for a prospective multicenter controlled clinical trial.
Citation
Citation: Criner GJ, Criner L-YH, George SA, Thomas JK, Jacobs MR. Feasibility of using daily home high-flow nasal therapy in COPD patients following a recent COPD hospitalization. Chronic Obstr Pulm Dis. 2022; 9(1): 4-14. doi: http://dx.doi.org/10.15326/jcopdf.2021.0236
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Sarah Gephine, PhD1,2 Didier Saey, PhD2 Jean-Marie Grosbois, MD3 François Maltais, MD2 Patrick Mucci, PhD1
Author Affiliations
- Université of Lille, Université de Artois, Université du Littoral Cote d’Opale, ULR 7369 - URePSSS - Unité de Recherche Pluridisciplinaire Sport Santé Société, Lille, France
- Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec, Canada
- FormAction Santé, Pérenchies, France
Address correspondence to:
Jean-Marie Grosbois
Zone d'Activité du Bois, Rue de Pietralunga
Pérenchies F-59840, France
Phone: +33 3 20 22 04 69
Email: jmgrosbois@formactionsante.com
Abstract
Daily life disability and vulnerability is often reported in patients with chronic obstructive pulmonary disease (COPD) and chronic respiratory failure. Although pulmonary rehabilitation is feasible in this population, its benefits on functional status and physical frailty is uncertain. This study aimed to evaluate the short- and medium-term effectiveness of a home-based pulmonary rehabilitation program in COPD patients with chronic respiratory failure. We also evaluate the impact of frailty status on the efficacy of the intervention.
Forty-seven participants underwent an 8-week home-based program. Functional capacity, physical frailty (Fried criteria), exercise tolerance, health-related quality of life, general fatigue, and anxiety and depressive symptoms were assessed at baseline (M0), and at 8 weeks (M2) and 8 months (M8) following study inclusion.
For the group as a whole, functional capacity, physical frailty, health-related quality of life, and fatigue scores were all improved at M2 and M8 (p<0.05), while exercise tolerance and depressive symptoms were only improved at M8 (p<0.01). However, when the group was divided according to frailty status, only the frail patients had improved health-related quality of life, general fatigue, and anxiety and depressive symptom scores after pulmonary rehabilitation (p<0.05).
In COPD patients with chronic respiratory failure, home-based pulmonary rehabilitation may be effective for improving functional capacity, physical frailty, and health-related quality of life at short- and medium-term. Physical frailty was not a barrier for benefiting from the intervention, and almost 80% of the patients who were frail prior to the program improved their frailty status after pulmonary rehabilitation.
Citation
Citation: Gephine S, Saey D, Grosbois J-M, Maltais F, Mucci P. Home-based pulmonary rehabilitation is effective in frail COPD patients with chronic respiratory failure. Chronic Obstr Pulm Dis. 2022; 9(1): 15-25. doi: http://dx.doi.org/10.15326/jcopdf.2021.0250
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Simon W. Lam, PharmD, MS1 Charlie Strange, MD2 Mark L. Brantly, MD3 James K. Stoller, MD, MS4
Author Affiliations
- Department of Pharmacy, Cleveland Clinic, Cleveland, Ohio, United States
- Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina, Charleston, South Carolina, United States
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida, Gainesville, Florida, United States
- Education and Respiratory Institute, Cleveland Clinic, Cleveland, Ohio, United States
Address correspondence to:
James K. Stoller, MD, MS
Education Institute
Cleveland Clinic
9500 Euclid Ave. NA 22
Cleveland, OH 44195
Phone:(216) 444-1960
Email:stollej@ccf.org
Abstract
Background: Alpha-1 antitrypsin deficiency (AATD) is under-recognized, prompting the need for enhanced detection strategies. The primary aim of this study is to determine the feasibility of using the electronic medical record (EMR) and linked electronic patient messages (EPM) to encourage AATD testing by patients with chronic obstructive pulmonary disease (COPD).
Methods: Study participants were eligible, untested adult patients who were prescribed an inhaled medication which is exclusively Food and Drug Administration-approved for treating COPD. Eligible patients received a message with basic information about AATD and availability of free, home-based AATD testing. Through a collaboration with the Alpha-1 Foundation’s Alpha-1 Coded Testing (ACT) study, patients referred to home-based testing through EPM were flagged. The effectiveness of the electronic message was evaluated by the proportion of patients who underwent testing, and the rate of detecting individuals with severe deficiency of AAT among those tested.
Results: A total of 12,369 patients on eligible inhalers were screened; 5430 patients met all criteria and received an EPM. During the study, 396 patients (7.3%) fully requested an ACT kit. Of these, 209 patients (52.8%) returned the test sample and received genotyping results; 65.5%, had a normal AAT genotype (PI*MM), 31.6% were heterozygotes for a deficient allele (PI*MS, PI*MZ and PI*M/Null rare), and 2.9% had severe deficiency of alpha-1 antitrypsin (PI*SZ, PI*ZZ, PI*S/Null rare).
Conclusion: While the response rate and test return rate were low, the rate of detecting individuals with AATD using this detection strategy exceeds that of many prior strategies. As such, while requiring independent validation in other populations, this detection strategy holds promise.
Citation
Citation: Lam SW, Strange C, Brantly ML, Stoller JK. A novel detection method to identify individuals with alpha-1 antitrypsin deficiency: linking prescription of COPD medications with the patient-facing electronic medical record. Chronic Obstr Pulm Dis. 2022; 9(1): 26-33. doi: http://dx.doi.org/10.15326/jcopdf.2021.0260
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C. Noelle Driver, MD, MS1 Paul J. Novotny, MS2 Roberto P. Benzo, MD, MS3
Author Affiliations
- Graduate School of Biomedical Sciences, School of Graduate Medical Education, Mayo Clinic, Rochester, Minnesota, United States
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, United States
- Mindful Breathing Laboratory, Department of Pulmonology and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, United States
Address correspondence to:
Roberto P. Benzo, MD
200 First St. S.W.
Rochester, MN 55905
Phone: 507-284-0561
Email:benzo.roberto@mayo.edu
Abstract
Introduction: There is a knowledge gap about how much physical activity is recommended to patients with chronic obstructive pulmonary disease (COPD). We asked, what is the average difference in sedentary time and physical activity associated with clinically meaningful differences in symptoms in a large, well-characterized cohort of patients with advanced COPD?
Study Design and Methods: We conducted a cross-sectional analysis of daily activity data in 292 patients with stable COPD. Activity measure coefficients from multivariable linear models were used to predict the average difference in activity between patients with twice the minimal clinically important difference in reported symptoms.
Results: Symptoms were assessed with the Chronic Respiratory Disease Questionnaire subdomains – dyspnea, fatigue, mastery, and emotions. Daily steps, minutes in light physical activity, and sedentary time were measured by triaxial accelerometers. Average sedentary time, light physical activity, and steps were 767.6 minutes, 177.7 minutes, and 2960 steps, respectively. Individuals with 1-point better dyspnea scores averaged 24.5 (8.4–40.5) minutes less sedentary time per day. Individuals with 1-point better dyspnea and fatigue scores averaged 21.5 (10.9–32.3) minutes or 12.5 (2.0–23.2) minutes more light physical activity per day, respectively. Individuals with 1-point better dyspnea, fatigue, mastery, and emotions scores averaged 762 (546–984), 579 (351–814), 418 (207–636), and 392 (157–634) more steps per day, respectively.
Conclusions: We provide guidance to clinicians counseling patients with severe COPD in activity-related goal setting on sedentary time, light physical activity, and steps associated with better symptoms.
Citation
Citation: Driver CN, Novotny PJ, Benzo RP. Differences in sedentary time, light physical activity, and steps associated with better COPD quality of life. Chronic Obstr Pulm Dis. 2022; 9(1): 34-44. doi: http://dx.doi.org/10.15326/jcopdf.2021.0230
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Jamie Sullivan, MPH1* Cara Pasquale, MPH1 Bill Clark, BS1 Elisha Malanga, BS1 Sergio Martinez1 David Mannino, MD1,2 Carl Stepnowsky, PhD3
Author Affiliations
- COPD Foundation, Miami, Florida, United States
- University of Kentucky, Lexington, Kentucky, United States
- University of California San Diego, La Jolla, California, United States
* Affiliation at the time the study was conducted.
Address correspondence to:
Carl Stepnowsky, PhD
3350 La Jolla Village Drive (111n-1)
San Diego, CA 92161
Phone: 858-642-1240
Email: cstepnowsky@health.ucsd.edu
Abstract
Introduction: Few studies have asked chronic obstructive pulmonary disease (COPD) -obstructive sleep apnea (OSA) overlap syndrome patients what outcomes of continuous positive airway pressure (CPAP) therapy are important to them, while also considering their self-reported CPAP adherence barriers and facilitators. This study conducted a series of focus groups to learn about those issues with the goal of applying these findings to the design of a larger Patient-Centered Outcomes Research Institute-funded scientific study, the O2VERLAP Study.
Methods: People previously diagnosed with both COPD and OSA, who were current or recent past users of the standard therapy for each condition (i.e., supplemental oxygen and CPAP, respectively), were included. Three qualitative focus groups were run using different communication modalities: (1) teleconference (audio only), (2) in-person, and (3) web-based.
Results: The focus groups included a total of 17 participants. The telephone and online focus groups resulted in more relevant and content-rich transcripts, while the in-person focus groups had far fewer excerpts able to be coded. Participants were most concerned about mask fit and comfort. Other key factors affecting CPAP use included nasal dryness and issues concerning insurance. The most important outcome to patients was daytime functioning.
Discussion: This work found that telephone and web-based qualitative focus groups resulted in greater topical discussions than in-person focus groups, likely due to the customary socializing that occurs in-person. The study identified: (1) CPAP use barriers and facilitators that helped guide intervention development for the larger study and, (2) daytime functioning as the most important outcome for patients.
Citation
Citation: Sullivan J, Pasquale C, Clark B, et al. Outcomes important to patients diagnosed with both COPD and sleep apnea: findings from the O2VERLAP study focus groups. Chronic Obstr Pulm Dis. 2022; 9(1): 45-54. doi: http://dx.doi.org/10.15326/jcopdf.2021.0268
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Thomas L. Keller, MD, MS1 Jennifer Wright, MD2 Lucas M. Donovan, MD, MS1,3 Laura J. Spece, MD, MS1,3 Kevin Duan, MD1 Nadiyah Sulayman, BA3 Alexandria Dominitz, BA3 J. Randall Curtis, MD, MPH1,4 David H. Au, MD, MS1,3 Laura C. Feemster, MD, MS1,3
Author Affiliations
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Seattle, Washington, United States
- Department of Medicine, University of Washington, Seattle, Washington, United States
- Health Services Research and Development Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Healthcare System, Seattle, Washington, United States
- Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington, United States
Address correspondence to:
Thomas Keller, MD, MS
Division of Pulmonary,
Critical Care, and Sleep Medicine
Department of Medicine
University of Washington
Campus Box 356522
Seattle, WA 98195-6522
Phone: 206-543-3166
Email: tlk33@uw.edu
Abstract
Rationale: Large gaps exist between guideline-recommended outpatient chronic obstructive pulmonary disease (COPD) care and clinical practice. Seeking to design effective interventions, we identified patient and primary care provider (PCP) characteristics associated with receiving evidence-based COPD care.
Methods: We performed an observational study of adults aged ≥ 40 years with clinically diagnosed COPD who received care at 2 University of Washington-affiliated primary care clinics between June 1, 2011, and June 1, 2013. Our primary outcome was the proportion of evidence-based outpatient COPD quality measures received through primary or pulmonary care. Among all patients, we assessed spirometry completion, respiratory symptom identification, smoking status ascertainment, oxygen saturation measurement, and guideline-concordant inhaled therapy prescription. We also determined confirmation of airflow obstruction, oxygen prescription, smoking cessation intervention, and pulmonary rehabilitation referral if eligible. We used multivariable mixed effects linear regression to estimate the association of patient and PCP characteristics with the primary outcome.
Results: Among 641 patients, 382 were male (59.6%) with mean age 63.6 (standard deviation [SD] 10.6) years. Most patients currently smoked (N=386, 60.2%). Patients saw 150 unique PCPs during 5.3 (SD 3.2) PCP visits, with 107 completing pulmonary referrals (16.7%). Patients received 67.5% (SD 18.4%) of eligible (median 7 [interquartile range 6–7]) evidence-based quality measures. After adjustment, pulmonary referral was associated with a higher receipt of outpatient quality measures (ß117.7%, 95% confidence interval: 12.6%, 22.7%). Patient demographics, comorbidities, and PCP identity/characteristics were not associated with outpatient care quality.
Conclusions: The quality of outpatient COPD care was suboptimal. Future studies should investigate if engaging pulmonologists in COPD management improves care quality.
Citation
Citation: Keller TL, Wright J, Donovan LM, et al. Association of patient and primary care provider factors with outpatient COPD care quality. Chronic Obstr Pulm Dis. 2022; 9(1): 55-67. doi: http://dx.doi.org/10.15326/jcopdf.2021.0232
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Byron Thomashow, MD1 Marjorie Stiegler, MD2,3 Gerard J. Criner, MD, FCCP4 Mark T. Dransfield, MD5 David M.G. Halpin, MD6 MeiLan K. Han, MD7 Peter Lange, MD8,9 Fernando J. Martinez, MD10 Dawn Midwinter, MSc11 Dave Singh, MD12 Maggie Tabberer, MSc11* Robert A. Wise, MD13 David A. Lipson, MD14,15 Paul Jones, MD11*
Author Affiliations
- Division of Pulmonary, Allergy, and Critical Care, Columbia University Medical Center, New York, New York, United States
- University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, United States
- GlaxoSmithKline, Research Triangle Park, North Carolina, United States
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, United States
- Lung Health Center, Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
- University of Exeter Medical School, College of Medicine and Health, University of Exeter, Exeter, United Kingdom
- Pulmonary and Critical Care, University of Michigan, Ann Arbor, Michigan, United States
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Medical Department, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
- Weill Cornell Medicine, New York, New York, United States
- GlaxoSmithKline, Brentford, Middlesex, United Kingdom
- Centre for Respiratory Medicine and Allergy, Institute of Inflammation and Repair, Manchester Academic Health Science Centre, University of Manchester, Manchester University NHS Foundation Trust, Manchester, United Kingdom
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
- GlaxoSmithKline, Collegeville, Pennsylvania, United States
- Pulmonary, Allergy, and Critical Care Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
*Affiliation at the time of the study.
Address correspondence to:
Byron Thomashow, MD
Division of Pulmonary, Allergy, and Critical Care
Columbia University Medical Center
161 Fort Washington Ave.
New York, NY 10032
Phone: (212) 305-5261
Email: bmt1@cumc.columbia.edu
Abstract
Background: In the InforMing the PAthway of COPD Treatment (IMPACT) trial, single-inhaler fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) reduced moderate/severe exacerbation rates versus FF/VI and UMEC/VI in patients with chronic obstructive pulmonary disease (COPD). This post hoc analysis tested the relationship between baseline health status, risk of future exacerbations, and efficacy outcomes.
Methods: IMPACT was a Phase 3, double-blind, 52-week trial in patients with symptomatic COPD (COPD Assessment Test [CAT] score ≥10) and ≥1 moderate/severe exacerbation in the prior year randomized 2:2:1 to FF/UMEC/VI 100/62.5/25mcg, FF/VI 100/25mcg, or UMEC/VI 62.5/25mcg. Annual rate of on-treatment moderate/severe exacerbations, lung function, and safety were analyzed by continuous baseline CAT score.
Results: Moderate/severe exacerbation rates increased with increasing baseline CAT scores in FF/UMEC/VI and UMEC/VI arms. There was a very small increase in on-treatment pneumonia rates at higher baseline CAT scores across all treatment arms. FF/UMEC/VI reduced moderate/severe exacerbation rates versus UMEC/VI (i.e., the inhaled corticosteroid effect) consistently across the range of CAT scores. The reduction with FF/UMEC/VI versus FF/VI (i.e., the long-acting muscarinic antagonist effect) was greatest at lower CAT scores and appeared lesser at higher CAT scores. Improvements in lung function were observed with FF/UMEC/VI versus FF/VI and UMEC/VI, regardless of baseline CAT score.
Conclusion: The CAT score was predictive of exacerbation risk. Worse baseline health status was associated with higher moderate/severe exacerbation and pneumonia rates. Irrespective of baseline CAT score, FF/UMEC/VI improved lung function, and reduced the annual moderate/severe exacerbation rates versus dual therapy. Results indicate an overall favorable benefit-risk profile of triple versus dual therapy, irrespective of CAT score.
Clinical Trial Registration:GSK (CTT116855/NCT02164513).
Citation
Citation: Thomashow B, Stiegler M, Criner GJ, et al. Higher COPD Assessment Test score associated with greater exacerbations risk: a post hoc analysis of the IMPACT trial. Chronic Obstr Pulm Dis. 2022; 9(1): 68-79. doi: http://dx.doi.org/10.15326/jcopdf.2021.0259
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Jill L. McCormick, MBA1 Taylar A. Clark, BA2 Christopher M. Shea, PhD3 Dean R. Hess, RRT, FAARC, PhD 4,5 Peter K. Lindenauer, MD, MSc2,6,7 Nicholas S. Hill, MD8 Crystal E. Allen, RN1 MaryJo S. Farmer, MD, PhD6,9 Ashley M. Hughes, PhD10 Jay S. Steingrub, MD6,9 Mihaela S. Stefan, MD, PhD2,6
Author Affiliations
- TechSpring, Baystate Health, Springfield, Massachusetts, United States
- Institute for Healthcare Delivery and Population Science, University of Massachusetts Chan Medical School – Baystate, Springfield, Massachusetts, United States
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, United States
- College of Professional Studies, Respiratory Care Leadership, Northeastern University, Boston Massachusetts, United States
- Department of Respiratory Care, Massachusetts General Hospital, Boston, Massachusetts, United States
- Department of Medicine, University of Massachusetts Chan Medical School - Baystate, Springfield, Massachusetts, United States
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, United States
- Division of Pulmonary and Critical Care Medicine, Tufts University School of Medicine, Boston, Massachusetts, United States
- Division of Pulmonary and Critical Care, Department of Medicine, University of Massachusetts Chan Medical School - Baystate, Springfield, Massachusetts, United States
- College of Applied Health Science at the University of Illinois at Chicago, Chicago, Illinois, United States
Address correspondence to:
Mihaela S. Stefan, MD, PhD
Associate Professor of Medicine, Hospitalist, and Clinician Investigator
Institute for Healthcare Delivery and Population Science
University of Massachusetts Chan Medical School- Baystate
Springfield, MA
Phone: (413) 794-0000
Email: Mihaela.Stefan@baystatehealth.org
Abstract
Background: This study brings a human-centered design (HCD) perspective to understanding the patient experience when using noninvasive ventilation (NIV) with the goal of creating better strategies to improve NIV comfort and tolerance.
Methods: Using an HCD motivational approach, we created a semi-structured interview to uncover the patients’ journey while being treated with NIV. We interviewed 16 patients with chronic obstructive pulmonary disease (COPD) treated with NIV while hospitalized. Patients’ experiences were captured in a stepwise narrative creating a journey map as a framework describing the overall experience and highlighting the key processes, tensions, and flows. We broke the journey into phases, steps, emotions, and themes to get a clear picture of the overall experience levers for patients.
Results: The following themes promoted NIV tolerance: trust in the providers, the favorable impression of the facility and staff, understanding why the mask was needed, how NIV works and how long it will be needed, immediate relief of the threatening suffocating sensation, familiarity with similar treatments, use of meditation and mindfulness, and the realization that treatment was useful. The following themes deterred NIV tolerance: physical and psychological discomfort with the mask, impaired control, feeling of loss of control, and being misinformed.
Conclusions: Understanding the reality of patients with COPD treated with NIV will help refine strategies that can improve their experience and tolerance with NIV. Future research should test ideas with the best potential and generate prototypes and design iterations to be tested with patients.
Citation
Citation: McCormick JL, Clark TA, Shea CM, et al. Exploring the patient experience with noninvasive ventilation: a human-centered design analysis to inform planning for better tolerance. Chronic Obstr Pulm Dis. 2022; 9(1): 80-94. doi: http://dx.doi.org/10.15326/jcopdf.2021.0274
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