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Erin R. Camac, DO1 Natalie A. Stumpf, BA2 Helen K. Voelker, BS3 Gerard J. Criner, MD2; for the COPD Clinical Research Network
Author Affiliations
- College of Medicine, the University of Kentucky, Lexington, Kentucky, United States
- Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania, United States
- University of Minnesota, Minneapolis, Minnesota, United States
Address correspondence to:
Erin R. Camac, DO, FCCP
College of Medicine,
The University of Kentucky
The Kentucky Clinic
740 Limestone
Second Floor, Wing C, Room 211
Lexington, KY 40536
Phone: (814) 571-0195
Email: erin.camac.do@gmail.com
Abstract
Background: Chronic obstructive pulmonary disease (COPD) patients in the Simvastatin for the Prevention of Exacerbations in Moderate-to-Severe COPD (STATCOPE) and Azithromycin for Prevention of Exacerbations of COPD (MACRO) trials provide an opportunity to prospectively study the short-term effect of acute exacerbations of COPD (AECOPDs).
Research Question: We hypothesized that those patients with frequent exacerbations (≥2 AECOPDs per patient year) would experience greater short-term decline in quality of life as measured by the St George’s Respiratory Questionnaire (SGRQ).
Study Design and Methods: A total of 1934 COPD patients were randomized in STATCOPE or MACRO. Patients who were randomized to azithromycin in MACRO or were followed less than 180 days were excluded. A total of 1219 patients were included. Patients were divided into 2 groups: infrequent exacerbators (< 2 exacerbations per patient year), and frequent exacerbators (≥2 exacerbations per year.) Data were collected at baseline, measured over time, and compared between groups.
Results: Of the patients studied, 871 were in the infrequent exacerbators group. A total of 348 were in the frequent exacerbators group. Frequent exacerbators used more respiratory medications, were more likely to have used oxygen, steroids, or antibiotics in the 12 months preceding study entry, had more obstruction on spirometry, and had more severe symptoms as measured by SGRQ at baseline. Over at least 180 days, symptom scores worsened in frequent exacerbators and improved in infrequent exacerbators.
Interpretation: Patients with frequent exacerbations of COPD experienced a short-term slight worsening of severely impaired SGRQ symptoms scores, while patients with infrequent exacerbations experienced improvement while on COPD therapies.
Citation
Citation: Camac ER, Stumpf NA, Voelker HK, Criner GJ; COPD Clinical Research Network. Short-term impact of the frequency of COPD exacerbations on quality of life. Chronic Obstr Pulm Dis. 2022; 9(3): 298-308. doi: http://dx.doi.org/10.15326/jcopdf.2021.0280
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Maura Alvarez Baumgartner, MD, MPH 1 Chengchen Li, MPH2 Thomas M. Kuntz, PhD2 Lina Nurhussien, MPH1 Andrew J. Synn, MD1 Wendy Y. Sun, BS1 Jennifer E. Kang, BS 1 Peggy S. Lai, MD, MPH3 Jeremy E. Wilkinson, PhD 2 Mary B. Rice, MD, MPH1
Author Affiliations
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States
Abstract
Rationale: While studies suggest that the lung microbiome may influence risk of chronic obstructive pulmonary disease (COPD) exacerbations, little is known about the relationship between the nasal biome and clinical characteristics of COPD patients.
Methods: We sampled the nasal lining fluid by nasosorption of both nares of 20 people with moderate-to-severe COPD. All 40 samples, plus 4 negative controls, underwent DNA extraction, and 16SV4 ribosomal RNA (rRNA) (bacterial) and ribosomal internal transcribed spacer 2 (ITS2) (fungal) sequencing. We measured the proportion of variance (R2) in beta diversity explained by clinical factors, including age, sex, body mass index (BMI), COPD treatment, disease severity (forced expiratory volume in 1 second [FEV1], symptom/exacerbation frequency), peripheral eosinophil level (≥150 versus <150 cells/µL) and season of sampling, with the PERMANOVA test on the Bray-Curtis dissimilarities, accounting for within-person correlation of samples. We assessed the relative abundance of microbial features in the nasal community and their associations with clinical characteristics using the Microbiome Multivariable Association with Linear Models (MaAsLin2) package.
Results: The most abundant nasal fluid bacterial taxa were Corynebacterium, Staphylococcus, Streptococcus, Moraxella, and Dolosigranulum, and fungal taxa were Malassezia, Candida, Malasseziales, Cladosporium and Aspergillus. Bacterial microbiome composition was associated with short-acting muscarinic antagonist use (R2 11.8%, p=0.002), sex (R2 8.3%, p=0.044), nasal steroid use (R2 7.7%, p=0.064), and higher eosinophil level (R2 7.6%, p=0.084). Mycobiome composition was associated with higher eosinophil level (R2 14.4%, p=0.004) and low FEV1 (R2 7.5%, p=0.071). No specific bacterium or fungus differed significantly in relative abundance by clinical characteristics in the multivariate per-feature analysis.
Conclusion: The taxonomical composition of the nasal biome is heterogeneous in COPD patients and may be explained in part by clinical characteristics.
Citation
Citation: Alvarez Baumgartner M, Li C, Kuntz T, et al. Differences of the nasal microbiome and mycobiome by clinical characteristics of COPD patients. Chronic Obstr Pulm Dis. 2022; 9(3): 309-324. doi: http://dx.doi.org/10.15326/jcopdf.2021.0267
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Matthew Gorgone, DO1* Deepti Singhvi, MD1* Seyed Mehdi Nouraie, MD1 Malcolm Finkelman, PhD2 Yonglong Zhang, PhD2 Jiantao Pu, PhD3 Divay Chandra, MD1 Yingze Zhang, PhD1 Georgios D. Kitsios, MD, PhD1,4 Alison Morris, MD, MS1,4 Frank C. Sciurba, MD1 Jessica Bon, MD, MS1,5
Author Affiliations
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
- Associates of Cape Cod Incorporated, East Falmouth, Massachusetts, United States
- Department of Radiology, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
- Center for Medicine and the Microbiome, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
- Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, United States
*Authors contributed equally
Address correspondence to:
Jessica Bon, MD, MS
Phone: (412) 692-2210
Email: Bonjm@upmc.edu
Abstract
Introduction: Factors beyond cigarette smoke likely contribute to chronic obstructive pulmonary disease (COPD) pathogenesis. Prior studies demonstrate fungal colonization of the respiratory tract and increased epithelial barrier permeability in COPD. We sought to determine whether 1,3-beta-d-glucan (BDG), a polysaccharide component of the fungal cell wall, is detectable in the plasma of individuals with COPD and associates with clinical outcomes and matrix degradation proteins.
Methods: BDG was measured in the plasma of current and former smokers with COPD. High BDG was defined as a value greater than the 95th percentile of BDG in smokers without airflow obstruction. Pulmonary function, emphysema, and symptoms were compared between COPD participants with high versus low BDG. The relationship between plasma BDG, matrix metalloproteinases (MMP) 1, 7, and 9, and tissue inhibitor of matrix metalloproteinases (TIMP) 1, 2, and 4 was assessed adjusting for age, sex, and smoking status.
Results: COPD participants with high BDG plasma levels (19.8%) had lower forced expiratory volume in 1 second to forced vital capacity ratios (median 31.9 versus 39.3, p=0.025), higher St George’s Respiratory Questionnaire symptom scores (median 63.6 versus 57.4, p=0.016), and greater prevalence of sputum production (69.4% versus 52.0%) and exacerbations (69.4% versus 48%) compared to COPD participants with low BDG. BDG levels directly correlated with MMP1 (r=0.27, p<0.001) and TIMP1 (r=0.16, p=0.022) in unadjusted and adjusted analyses.
Conclusions: Elevated plasma BDG levels correlate with worse lung function, greater respiratory morbidity, and circulating markers of matrix degradation in COPD. These findings suggest that targeting dysbiosis or enhancing epithelial barrier integrity may have disease-modifying effects in COPD.
Citation
Citation: Gorgone M, Singhvi D, Nouraie SM, et al. Circulating 1,3-beta-d-glucan is associated with lung function, respiratory symptoms, and mediators of matrix degradation in chronic obstructive pulmonary disease. Chronic Obstr Pulm Dis. 2022; 9(3): 325-335. doi: http://dx.doi.org/10.15326/jcopdf.2022.0290
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Ana Machado, PT, MSc1,2,3,4 Sara Almeida, GT, MSc, PhD1,5 Chris Burtin, PT, MSc, PhD3,4 Alda Marques, PT, MSc, PhD1,5
Author Affiliations
- Institute of Biomedicine, University of Aveiro, Aveiro, Portugal
- Department of Medical Sciences, University of Aveiro, Aveiro, Portugal
- Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
- Biomedical Research Institute, Hasselt University, Diepenbeek, Belgium
- Respiratory Research and Rehabilitation Laboratory, School of Health Sciences, University of Aveiro, Aveiro, Portugal
Address correspondence to:
Alda Marques, PT, MSc, PhD
Respiratory Research and Rehabilitation Laboratory
School of Health Sciences and Institute of Biomedicine
University of Aveiro, Agras do Crasto
Campus Universitário de Santiago
Edifício 30, 3810-193
Aveiro, Portugal
Email: amarques@ua.pt
Phone: 00 +351 234372462
Abstract
Background: Acute exacerbations of chronic obstructive pulmonary disease (AECOPDs) have a negative impact on health status and disease progression, but their clinical presentation is heterogenous. A comprehensive understanding of individuals’ experiences during an AECOPD is needed to develop person-centered interventions, such as pulmonary rehabilitation (PR). This study aimed to explore people’s experiences during mild to moderate AECOPDs, and their thoughts on PR during this period.
Methods: Short, semi-structured interviews were conducted with people with mild to moderate AECOPDs treated on an outpatient basis within 48 hours of the diagnosis. Interviews were audio recorded, transcribed, and analyzed by deductive thematic analysis using the Web Qualitative Data Analysis software.
Results: Eleven people with AECOPDs (9 male, 67±10 years, forced expiratory volume in 1 second 41±16%predicted) participated. Four themes and 17 subthemes were identified: impact of an AECOPD (symptoms, physiological changes, limitations in activities of daily living, social constraints, psychological and emotional challenges, family disturbances); dealing with an AECOPD, ([not] depending on others, planning and compensation strategies); main needs during an AECOPD (breathe better, feel less tired, get rid of sputum, be able to walk); and (un)certainty about PR (lack of knowledge, getting better, exercises, design and timing, trust in health professionals).
Conclusion: AECOPDs, even when not requiring hospital admission, have a huge negative impact on people’s lives. Individuals’ thoughts about PR reflect the need to raise awareness for this intervention during AECOPDs. This study provides a foundation for the development of meaningful person-centered interventions during AECOPDs.
Citation
Citation: Machado A, Almeida S, Burtin C, Marques A. Giving voice to people – experiences during mild to moderate acute exacerbations ofCOPD. Chronic Obstr Pulm Dis. 2022; 9(3): 336-348. doi: http://dx.doi.org/10.15326/jcopdf.2022.0283
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Adel Boueiz, MD, MMSc1,2* Zhonghui Xu, MS1* Yale Chang, PhD3 Aria Masoomi, PhD3 Andrew Gregory, BS1 Sharon M. Lutz, PhD4 Dandi Qiao, PhD1 James D. Crapo, MD5 Jennifer G. Dy, PhD3 Edwin K. Silverman, MD, PhD1,2 Peter J. Castaldi, PhD1,6 for the COPDGene Investigators
Author Affiliations
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States
- Pulmonary and Critical Care Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States
- Department of Electrical and Computer Engineering, Northeastern University, Boston, Massachusetts, United States
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, Massachusetts, United States
- Division of Pulmonary Medicine, Department of Medicine, National Jewish Health, Denver, Colorado, United States
- Division of General Medicine and Primary Care, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States
*These authors contributed equally
Address correspondence to:
Adel Boueiz, MD, MMSc
Channing Division of Network Medicine
Brigham and Women’s Hospital
181 Longwood Avenue
Boston, MA 02115
Phone: (617) 525-2111
Email: adel.boueiz@channing.harvard.edu
Abstract
Background: The heterogeneous nature of chronic obstructive pulmonary disease (COPD) complicates the identification of the predictors of disease progression. We aimed to improve the prediction of disease progression in COPD by using machine learning and incorporating a rich dataset of phenotypic features.
Methods: We included 4496 smokers with available data from their enrollment and 5-year follow-up visits in the COPD Genetic Epidemiology (COPDGene®) study. We constructed linear regression (LR) and supervised random forest models to predict 5-year progression in forced expiratory in 1 second (FEV1) from 46 baseline features. Using cross-validation, we randomly partitioned participants into training and testing samples. We also validated the results in the COPDGene 10-year follow-up visit.
Results: Predicting the change in FEV1 over time is more challenging than simply predicting the future absolute FEV1 level. For random forest, R-squared was 0.15 and the area under the receiver operator characteristic (ROC) curves for the prediction of participants in the top quartile of observed progression was 0.71 (testing) and respectively, 0.10 and 0.70 (validation). Random forest provided slightly better performance than LR. The accuracy was best for Global initiative for chronic Obstructive Lung Disease (GOLD) grades 1–2 participants, and it was harder to achieve accurate prediction in advanced stages of the disease. Predictive variables differed in their relative importance as well as for the predictions by GOLD.
Conclusion: Random forest, along with deep phenotyping, predicts FEV1 progression with reasonable accuracy. There is significant room for improvement in future models. This prediction model facilitates the identification of smokers at increased risk for rapid disease progression. Such findings may be useful in the selection of patient populations for targeted clinical trials.
Citation
Citation: Boueiz A, Xu Z, Chang Y, et al. Machine learning prediction of progression in forced expiratory volume in 1 second in the CODPGene® study. Chronic Obstr Pulm Dis. 2022; 9(3): 349-365. doi: http://dx.doi.org/10.15326/jcopdf.2021.0275
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Wendy Lorizio, MD, MPH1 Han Woo, PhD1 Meredith C. McCormack, MD, MHS1 Chen Liu, MHS1 Nirupama Putcha, MD, MHS1 Megan Wood, MS2 Timothy Green, BS2 Parisa Kaviany, MD3 Daniel Belz, MD, MPH1 Ashraf Fawzy, MD, MPH1 Sara Carson, MD, MHS1 Michelle N. Eakin, PhD, MA1 Kirsten Koehler, PhD2 Nadia N. Hansel, MD, MPH1,2
Author Affiliations
- Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States.
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States.
- Division of Pulmonary and Sleep Medicine, Children’s National Health System, School of Medicine and Health Sciences, George Washington University, Washington, DC, United States.
Address correspondence to:
Wendy Lorizio, MD, MPH
Division of Pulmonary and Critical Care Medicine
Johns Hopkins University
Asthma and Allergy Center
5501 Hopkins Bayview Cir
Baltimore, MD 21224
Office: (410) 550-2449
Email: wlorizi1@jhmi.edu
Abstract
Rationale: Poor indoor air quality has been associated with worse chronic obstructive pulmonary disease (COPD) morbidity. In-home portable air cleaners reduce indoor pollutants and could improve respiratory health. Factors associated with air cleaner adherence among adults with COPD remains unknown.
Methods: In a 6-month trial of former smokers with COPD, participants (n=116) received active or sham portable air cleaners. Air cleaner adherence was measured by electronic monitors. Potential baseline predictors of adherence included individual factors (demographics, socioeconomic status, smoking history, psychological well-being), COPD disease severity, and housing characteristics. Time and season were also considered. Stepwise logistic regression and longitudinal fixed effect analysis were performed to assess independent predictors of adherence.
Results: A total of 109 participants had an objective measure of adherence, and 76.1% used at least 1 air cleaner 80% of the time (defined a priori as adherent). Higher annual household income ≥$35,000 (odds ratio [OR]=4.4, 95% confidence interval [CI], 1.1–18.0) and use of heat pump/electricity (versus gas) for heating (OR=6.1, 95%CI, 1.7–22.4) were associated with higher odds of adherence. Further, poor quality of life (St George’s Respiratory Questionnaire, per 10-point increase) and prior year exacerbations were associated with lower odds of adherence (OR=0.65, 95%CI, 0.4–1.0) and (OR=0.26, 95%CI, 0.1–0.9), respectively. Adherence was highest during the first month and lower during winter compared to other seasons.
Conclusion: These findings suggest that cold weather season, use of gas for home heating, and lower annual income negatively impact adherence. Poor quality of life and worse disease control may also decrease adherence. Addressing factors associated with air cleaner adherence should be considered when designing future environmental studies.
Citation
Citation: Lorizio W, Woo H, McCormack MC, et al. Patterns and predictors of air cleaner adherence among adults with COPD. Chronic Obstr Pulm Dis. 2022; 9(3): 366-376. doi: http://dx.doi.org/10.15326/jcopdf.2022.0309
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Jelena Mustra Rakic, PhD*,1,2 Siyang Zeng, MS*,3,4 Linnea Rohdin-Bibby, MS5 Erin L. Van Blarigan, ScD6 Xingjian Liu, PhD7 Shuren Ma, PhD7 John P. Kane MD, PhD2 Rita F. Redberg, MD, MSc5,8 Gerard M. Turino, MD7 Eveline Oestreicher Stock, MD**,2,5,8 Mehrdad Arjomandi, MD**,1,3,9,10
Author Affiliations
- Center for Tobacco Control Research and Education, University of California, San Francisco, California, United States
- Cardiovascular Research Institute, University of California, San Francisco, California, United States
- Medical Service, San Francisco Veterans Affairs Medical Center; San Francisco; California, United States
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, Washington, United States
- Flight Attendant Medical Research Institute, Bland Lane Center of Excellence on Secondhand Smoke, University of California, San Francisco, California, United States
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, United States
- Department of Medicine, Mount Sinai-St. Luke's-Roosevelt Hospital, New York, New York, United States
- Division of Cardiology, University of California, San Francisco, California, United States
- Division of Pulmonary, Critical Care, Allergy and Immunology, and Sleep Medicine, University of California, San Francisco, California, United States
- Division of Occupational and Environmental Medicine; University of California, San Francisco, California, United States
*These authors contributed equally to this work.
**Co-senior authors
Address correspondence to:
Mehrdad Arjomandi, MD
Department of Medicine
University of California, San Francisco
San Francisco Veterans Affairs Medical Center
Building 203, Room 3A-128, Mailstop 111-D
4150 Clement Street, San Francisco, CA 94121
Phone: (415) 221-4810 x24393
Email: mehrdad.arjomandi@ucsf.edu
Abstract
Background: Prolonged past exposure to secondhand tobacco smoke (SHS) in never-smokers is associated with abnormal lung function and reduced diffusing capacity suggestive of an associated lung tissue injury and damage. The mechanisms by which past SHS exposure may contribute to lung tissue damage are unknown. Elastin is a major constituent of extracellular matrix in lung parenchyma.
Objective: To determine whether past exposure to SHS is associated with ongoing lung tissue damage as indicated by elevated elastin degradation products that are linked to lung function.
Methods: We measured the plasma levels of elastin degradation markers (EDM) from 193 never-smoking flight attendants with a history of remote SHS exposure in aircraft cabins and 103 nonsmoking flight attendants or sea-level control participants without such history of cabin SHS exposure and examined those levels versus their lung function with adjustment for covariates. The cabin SHS exposure was estimated based on airline employment history and years of the smoking ban enactment.
Results: The median [interquartile range] plasma EDM level for all participants was 0.30 [0.24–0.36] ng/mL with a total range of 0.16–0.65 ng/mL. Plasma EDM levels were elevated in those with a history of exposure to cabin SHS compared to those not exposed (0.33±0.08 versus 0.26±0.06 ng/mL; age- and sex-adjusted P<0.001). In those with a history of cabin SHS exposure, higher EDM levels were associated with a lower diffusing capacity (parameter estimate [PE] 95% [confidence interval(CI)]=4.2 [0.4–8.0] %predicted decrease per 0.1 ng/mL increase in EDM; P=0.030). Furthermore, EDM levels were inversely associated with forced expiratory volume in 1 second (FEV1), FEV1 to forced vital capacity (FVC) ratio , and forced expiratory flow rate between 25% and 75% ( FEF25%-75%) (PE [95%CI]=5.8 [2.1–9.4], 4.0 [2.2–5.7], and 12.5 [5.8–19.2] %predicted decrease per 0.1 ng/mL increase in EDM, respectively; P<0.001). Plasma EDM mediated a substantial fraction of the association of SHS with FEV1, FVC, and FEF25%-75% (P<0.05).
Conclusions: Long after past exposure to SHS, there is ongoing elastin degradation beyond what is expected from the aging process, which likely contributes to lower lung function and a reduced pulmonary capillary bed as seen in chronic obstructive pulmonary disease (COPD).
Citation
Citation: MustraRakic J, Zeng S, Rohdin-Bibby L, et al. Elastin degradation and lung function deterioration with remote secondhand tobacco smoke exposure in never-smokers. Chronic Obstr Pulm Dis. 2022; 9(3): 377-393. doi: http://dx.doi.org/10.15326/jcopdf.2022.0289
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Sergio Martinez1 Jamie Sullivan, MPH1* Cara Pasquale, MPH1 Bill Clark, BS1 Elisha Malanga, BS1 Sean Deering2* Lin Liu, PhD2 Carl J. Stepnowsky, PhD2
Author Affiliations
- COPD Foundation, Washington, DC, United States
- University of California San Diego, La Jolla, California, United States
*Affiliation at the time of study
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
Background: Obstructive sleep apnea (OSA) is a sleep disorder prevalent in >10% of individuals diagnosed with chronic obstructive pulmonary disease (COPD). Continuous positive airway pressure (CPAP) is the first-line therapy for OSA, but many do not use it enough during sleep to effectively manage OSA. The O2VERLAP study compared proactive care (PC)—structured web-based peer-coaching education and support intervention versus reactive care (RC)—education and support based on limited scheduled interactions and patient-initiated contacts.
Methods: Participants were primarily recruited from patient communities (COPD, OSA, and the National Patient-Centered Outcomes Research Network [PCORnet]) through electronic methods. Inclusion criteria: ≥40 years old, diagnosis of both COPD and OSA, and currently using CPAP. Participants were then randomly assigned to either the PC or RC group, with outcomes assessed at baseline and 6 and 12 weeks. The primary study outcome was CPAP adherence (hours of use/night) and secondary outcomes were daytime functioning, sleep quality, and daytime sleepiness. Changes in outcomes over time were examined using random effects models.
Results: The study enrolled 332 participants of which 294 were randomized. While groups differed significantly in CPAP adherence at baseline (PC: 6.1±3.1, RC: 7.3±2.4 hours/night; P<0.001), there were no significant differences in change of primary and secondary outcomes at either 6 or 12 weeks.
Conclusions: In this group of patients with both COPD and OSA on CPAP therapy, no difference was found between the provision of PC and RC. The study did find unexpectedly high baseline CPAP adherence levels, which suggests that any improvement from the intervention would have been very small and difficult to detect.
Citation
Citation: Martinez S, Sullivan J, Pasquale C, et al. Effect of two interventional strategies on improving continuous positive airway pressure adherence in existing COPD and obstructive sleep apnea patients: the O2VERLAP study. Chronic Obstr Pulm Dis. 2022; 9(3): 394-412. doi: http://dx.doi.org/10.15326/jcopdf.2022.0293
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Xiang Wen, MD1* Jieqi Peng, MD1* Youlan Zheng, MD1* Jiaxing Liu, MD1 Heshen Tian, MD, PhD1 Fan Wu, MD1 Zihui Wang, MD1 Huajing Yang, MD1 Zhishan Deng, MD1 Shan Xiao, MD1 Peiyu Huang, MD1 Jianwu Xu, MD1 Cuiqiong Dai, MD1 Ningning Zhao, MD1 Lifei Lu, MD1 Jianwei Dai, PhD2 Bing Li, PhD2 Pixin Ran, MD, PhD1,3 Yumin Zhou, MD, PhD1,3
Author Affiliations
- National Center for Respiratory Medicine, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
- Guangzhou Medical University , Guangzhou Institutes of Biomedicine and Health Joint School of Life Sciences, Guangzhou Medical University, Guangzhou, China.
- Guangzhou Laboratory, Bio-Island, Guangzhou, China.
* Co-first authors, both authors contributed equally to the work
Address correspondence to:
Yumin Zhou, MD, PhD
Email: zhouyumin410@126.com
and
Pixin Ran, MD, PhD
Email: pxran@gzhmu.edu.cn
National Center for Respiratory Medicine
State Key Laboratory of Respiratory Disease
National Clinical Research Center for Respiratory Disease
Guangzhou Institute of Respiratory Health
The First Affiliated Hospital of Guangzhou Medical University
151 Yanjiang Road, Guangzhou, China.
Abstract
Background: Eosinophils are involved in the development of chronic obstructive pulmonary disease (COPD) and inhaled corticosteroid responsiveness. We evaluated clinical predictors of high sputum eosinophil levels in a COPD cohort in China.
Methods: We conducted an observational, prospective, population-based, cross-sectional study. Participants were tested for COPD and underwent spirometry, computed tomography scans, and a blood test. Participants also produced induced sputum and responded to an information-gathering questionnaire. High sputum eosinophils were defined as ≥3.0%. Multivariate logistic regression was used to identify predictors of high sputum eosinophil levels.
Results: We recruited 895 patients with complete and quality control data. The median percentage of sputum eosinophil abundance was 2.00% (interquartile range: 0.75–5.00) and the prevalence of COPD with high sputum eosinophils was 38.0%. Covariance analysis indicated that the high sputum eosinophil group had lower lung function, more severe emphysema, and air trapping. Multivariate logistic regression indicated that high blood eosinophil levels, severe respiratory symptoms, being a former smoker, and a family history of respiratory diseases were associated with high sputum eosinophil levels.
Conclusion: High blood eosinophil levels, severe respiratory symptoms, being a former smoker, and a family history of respiratory diseases may be predictors of high sputum eosinophil levels in Chinese COPD patients. High sputum eosinophils were associated with lower lung function, more emphysema, and gas trapping.
Citation
Citation: Wen X, Pen J, Zheng Y, et al. Predictors of high sputum eosinophils in chronic obstructive pulmonary disease. Chronic Obstr Pulm Dis. 2022; 9(3): 413-426. doi: http://dx.doi.org/10.15326/jcopdf.2022.0310
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Donald A. Mahler, MD1,2 Shaban Demirel, PhD3 Ramon Hollander, MBA, RRT4 Gokul Gopalan, MD, MPH5 Asif Shaikh, MD5 Cathy D. Mahle, PhD, MBA5 Jessica Elder, PhD5 Curtis Morrison, RRT4
Author Affiliations
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, United States
- Valley Regional Hospital, Claremont, New Hampshire, United States
- Legacy Research Institute, Portland, Oregon, United States
- Legacy Salmon Creek Medical Center, Vancouver, Washington, Unites States
- Boehringer Ingelheim Pharmaceuticals, Incorporated, Ridgefield, Connecticut, United States
Address correspondence to:
Donald A. Mahler, MD
Valley Regional Hospital
243 Elm Street
Claremont, NH 03743, USA
Phone: (603) 277-0383
Email: mahlerdonald@gmail.com
Abstract
For optimal drug delivery, dry powder inhalers (DPIs) depend on the patient’s peak inspiratory flow (PIF) and the internal resistance of the device to create turbulent energy and disaggregate the powder. A suboptimal PIF may lead to ineffective drug inhalation into the lungs. Our objective was to report the prevalence of suboptimal PIF in patients with COPD hospitalized for any reason using 1 or more DPIs. In this real-world, observational, single‑site, retrospective study, PIF was measured for each DPI using the In-Check™ DIAL set to match the resistance of the DPI used by each patient. PIFs <60 and <30L/min were considered suboptimal for low to medium-high- and high-resistance DPIs, respectively. At initial hospitalization, the prevalence of suboptimal PIF was 44.6% in 829 patients (mean age, 71.7 years; 56.8% female); 21.2% were measured during admission for a COPD exacerbation. Suboptimal PIF percentages were 61.0% (38.1±9.5L/min [mean±standard deviation (SD)]) across low to medium-high-resistance DPIs and 17.2% (20.7±4.2L/min) for high-resistance DPIs. Overall, 190/829 patients had 1 or more 30-day all-cause readmission with 253 corresponding PIF measurements. For readmissions, suboptimal PIFs were observed in 49.5% (94/190) of patients. Suboptimal PIF percentages were 65.4% (38.4±9.2L/min) for low to medium-high-resistance DPIs and 19.8% (22.4±3.3L/min) for high-resistance DPIs. As the overall prevalence of suboptimal PIFs in hospitalized patients with COPD varied according to the specific internal resistance of the DPI, these findings may have clinical implications for inhaler selection.
Citation
Citation: Mahler DA, Demirel S, Hollander R, et al. High prevalence of suboptimal peak inspiratory flow in hospitalized patients with COPD: a real-world study. Chronic Obstr Pulm Dis. 2022; 9(3): 427-438. doi: http://dx.doi.org/10.15326/jcopdf.2022.0291
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Matthew Strand, PhD1 Aastha Khatiwada, PhD1 David Baraghoshi, MS1 David Lynch, MB2 Edwin K. Silverman, MD, PhD3 Surya P. Bhatt, MD4 Erin Austin, PhD5 Elizabeth A. Regan, MD, PhD6 Aladin M. Boriek, PhD7 James D. Crapo, MD6
Author Affiliations
- Division of Biostatistics, National Jewish Health, Denver, Colorado, United States
- Department of Radiology, National Jewish Health, Denver, Colorado, United States
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical Center, Boston, Massachusetts, United States
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
- Department of Mathematical and Statistical Sciences, University of Colorado Denver, Denver, Colorado, United States
- Department of Medicine, National Jewish Health, Denver, Colorado, United States
- Department of Medicine, Baylor College of Medicine, Houston, Texas, United States
Address correspondence to:
Matthew Strand, PhD
National Jewish Health
Phone: (303) 398-1862
Email: strandm@njhealth.org
Abstract
Understanding baseline characteristics that can predict the progression of lung disease such as chronic obstructive pulmonary disease (COPD) for current or former smokers may allow for therapeutic intervention, particularly for individuals at high risk of rapid disease progression or transition from non-COPD to COPD. Classic diagnostic criteria for COPD and disease severity such as the Global Initiative for Chronic Obstructive Lung Disease document are based on forced expiratory volume in 1 second (FEV1) and FEV1 to forced vital capacity (FVC) ratio. Modeling changes in these outcomes jointly is beneficial given that they are correlated, and they are both required for specific disease classifications. Here, linear mixed models were used to model changes in FEV1 and FEV1/FVC jointly for 5- and 10-year intervals, using important baseline predictors to better understand the factors that affect disease progression. Participants with predicted loss of FEV1 and/or FEV1/FVC of at least 5% tended to have more emphysema, higher functional residual capacity, higher airway wall thickness as measured by Pi10, lower FVC to total lung capacity ratio and a lower body mass index at baseline, all relative to overall cohort averages. The model developed can be used to predict progression for any potential COPD individual, based on demographic, symptom, computed tomography, and comorbidity variables.
Citation
Citation: Strand M, Khatiwada A, Baraghoshi D, et al. Predicting COPD progression in current and former smokers using a joint model for forced expiratory volume in 1 second and forced expiratory volume in 1 second to forced vital capacity ratio. Chronic Obstr Pulm Dis. 2022; 9(3): 439-453. doi: http://dx.doi.org/10.15326/jcopdf.2022.0281
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