Chronic Obstructive Pulmonary Diseases:Journal of the COPD Foundation

Articles in Press

Final Chronic Obstructive Pulmonary Diseases: Journal of the COPD Foundation (JCOPDF) manuscripts are published and available in our Articles in Press section as soon as possible following editorial acceptance. These articles have completed both a rigorous peer review process and a thorough copyediting/editorial acceptance phase. Quarterly, these articles will be compiled into formal issues along with editorials, correspondence and additional themed reviews and features. To receive notifications of the posting of new Articles in Press AND the posting of new JCOPDF issues, sign up for a free subscription here.

Alpha-1 Antitrypsin Deficiency: A Predisposing Factor for the Development of Pulmonary Langerhans Cell Histiocytosis

Paul R. Ellis, MBChB, MRCP1 Edward J. Campbell, MD2 Alice M. Turner, MBChB, MRCP, PhD, PGCE (Med)1 Robert A. Stockley, MD, DSc3

Author Affiliations

  1. Institute for Applied Health Research, University of Birmingham, Birmingham, United Kingdom
  2. HerediLab Inc., Salt Lake City, Utah
  3. University Birmingham NHS Foundation Trust, Birmingham, United Kingdom

Address correspondence to:

Paul R. Ellis, MBChB, MRCP
Institute for Applied Health Research
University of Birmingham
B15 2TT
Birmingham, United Kingdom
Email: p.ellis@bham.ac.uk
Phone: 44+121 371 3886

Abstract


Citation

Citation: Ellis PR, Campbell EJ, Turner AM, Stockley RA. Alpha-1 antitrypsin deficiency: a predisposing factor for the development of pulmonary Langerhans cell histiocytosis? Chronic Obstr Pulm Dis. 2019; 6(3): 206-209. doi: http://dx.doi.org/10.15326/jcopdf.6.3.2019.0129

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A Retrospective Claims Analysis of Dual Bronchodilator Fixed-Dose Combination Versus Bronchodilator Monotherapy in Patients with Chronic Obstructive Pulmonary Disease

Charlie Strange, MD1 Valery Walker, MS2 Junliang Tong, PhD2 Jonathan Kurlander, MS2 Maureen Carlyle, MPH2 Lauren A. Millette, PhD3 Eric Wittbrodt, PharmD, MPH3

Author Affiliations

  1. Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina, Charleston
  2. Optum, Inc., Eden Prairie, Minnesota
  3. AstraZeneca, Wilmington, Delaware

Address correspondence to:

Valery Walker
Optum, Inc.
11000 Optum Circle
Eden Prairie, MN 55344
Email: Valery.walker@optum.com

Abstract

Introduction: Patients with chronic obstructive pulmonary disease (COPD) increasingly receive combination bronchodilator therapies. Real world evidence for the benefits of combination therapy compared to monotherapy is lacking.

Methods: COPD patients aged ≥ 40 years initiating monotherapy (MT) with either a long-acting muscarinic antagonist (LAMA) or long-acting beta2-agonist (LABA) or dual therapy (DT) with a LAMA/LABA fixed dose combination (FDC) between January 1, 2016 and December 31, 2016 were identified from a large U.S. administrative claims database. Patients diagnosed with cystic fibrosis, idiopathic pulmonary fibrosis, or asthma were excluded. Cohorts were propensity score matched 1:1 using baseline measures (e.g., exacerbations, hospitalizations) as proxies for COPD severity to create balanced cohorts.

Results: Following propensity score matching (PSM), 1286 patients remained in each cohort for analysis. Patients were followed for approximately 1 year. Patients in the DT versus MT cohort had lower rates of exacerbations leading to hospitalization (incidence rate ratio 0.7886; p=0.019), lower mean COPD-related pharmacy costs per patient per month (PPPM) ($300 versus $379, respectively; p<0.001) and total costs PPPM ($990 versus $1203, respectively; p=0.003). This occurred despite lower mean COPD-related pharmacy fills PPPM in the DT versus MT cohorts (1.41 versus 1.51, respectively; p=0.038). Patients in the DT cohort had lower rates of switching (p<0.001) and augmentation (p<0.001), and higher rates of non-persistence (p<0.001) versus the MT cohort. Rates of discontinuation were similar.

Conclusions: Patients in the DT cohort had lower rates of exacerbations leading to hospitalization, lower COPD-related pharmacy and total costs PPPM, and lower rates of switching and augmentation compared to patients in the MT cohort.

Citation

Citation: Strange C, Walker V, Tong J, et al. A retrospective claims analysis of dual bronchodilator fixed-dose combination versus bronchodilator monotherapy in patients with chronic obstructive pulmonary disease. Chronic Obstr Pulm Dis. 2019; 6(3): 221-232. doi: http://dx.doi.org/10.15326/jcopdf.6.3.2018.0160

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Spirometry Measurement of Peak Inspiratory Flow Identifies Suboptimal Use of Dry Powder Inhalers in Ambulatory Patients with COPD

Alexander G. Duarte, MD1 Leon Tung, MD1 Wei Zhang, MS1 En Shuo Hsu, MA2 Yong-Fang Kuo, PhD2,3 Gulshan Sharma, MD, MPH1,3

Author Affiliations

  1. Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, University of Texas Medical Branch, Galveston
  2. Office of Biostatistics, University of Texas Medical Branch, Galveston
  3. Sealy Center of Aging, University of Texas Medical Branch, Galveston

Address correspondence to:

Alexander G. Duarte, MD
Division of Pulmonary, Critical Care and Sleep Medicine
University of Texas Medical Branch
301 University Blvd., 5.140 John Sealy Annex
Galveston, Texas 77555-0561
Email: aduarte@utmb.edu

Abstract

Objectives: Determine the prevalence of suboptimal peak inspiratory flow rate (PIFR) and associated patient characteristics and compare PIFR measurements obtained with spirometry and In-Check DIAL® device in ambulatory patients with COPD.

Methods: Patients underwent PIFR measurement with In-Check DIAL® device and pulmonary function testing with calibrated equipment. Group characteristics and lung function were compared for patients with suboptimal (≤ 60 L/min) and optimal (> 60 L/min) PIFR. Receiver operating curve analysis determined the best maximal forced inspiratory flow (FIF max) value in identifying optimal PIFR by gender and height.

Results: From July 1, 2016 to January 31, 2018, a total of 303 patients with chronic obstructive pulmonary disease (COPD) had PIFR and pulmonary function measurements. Group mean age was 65.5 ± 11.3 years with equal gender distribution. Suboptimal PIFR was observed in 61 (20.1%) patients. A significant correlation was observed between PIFR and FIF max, inspiratory capacity and residual volume (RV) to total lung capacity (TLC) ratio.

In the suboptimal PIFR group, mean FIF max measured by spirometry was significantly less compared with the optimal PIFR group; 178.5 ± 56.9 L/min and 263.4 ± 89.9 L/min, respectively (p<0.0001). Receiver operator curve analysis of FIF max to identify an optimal PIFR yielded an area under the curve of 0.79. Males < 65 inches had a suboptimal PIFR in 16.7 % of the male cohort, while females < 65 inches had a suboptimal PIFR in 27.4 % of the women.

Conclusions: Suboptimal PIFR was present in 1 in 5 stable patients with COPD and was more frequent in short statured females. Spirometry determined FIF max was associated with PIFR based on gender and height.

Citation

Citation: Duarte AD, Tung L, Zhang W, Hsu ES, Kuo Y-F, Sharma G. Spirometry measurement of peak inspiratory flow identifies suboptimal use of dry powder inhalers in ambulatory patients with COPD. Chronic Obstr Pulm Dis. 2019; 6(3): 246-255. doi: http://dx.doi.org/10.15326/jcopdf.6.3.2018.0163

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Identifying Smoking-Related Disease on Lung Cancer Screening CT Scans: Increasing the Value

Elizabeth A. Regan, MD1,2 Katherine E. Lowe, MSc 1,2 Barry J. Make, MD1 David A. Lynch, MD1 Gregory L. Kinney, PhD2 Matthew J. Budoff, MD3 Song Shou Mao, PhD3 Debra Dyer, MD1 Jeffrey L. Curtis, MD4,6 Russell P. Bowler, MD1 MeiLan K. Han, MD4 Terri H. Beaty, PhD5 John E. Hokanson, PhD2 Elizabeth Kern, MD1 Stephen Humphries, PhD1 Douglas Curran-Everett, PhD1 Edwin J.R. van Beek, MD7 Edwin K. Silverman, MD8 James D. Crapo, MD1 James H. Finigan, MD1 and the COPDGene® Investigators

Author Affiliations

  1. Division of Pulmonary Medicine National Jewish Health, Denver, Colorado
  2. School of Public Health, University of Colorado, Denver
  3. Division of Cardiology, Harbor-University of California-Los Angeles Medical Center, Los Angeles
  4. Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor
  5. Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
  6. Pulmonary and Critical Care Medicine, Ann Arbor Healthcare System, Ann Arbor, Michigan
  7. Edinburgh Imaging, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, Scottland
  8. Channing Division of Network Medicine, Brigham Women’s Hospital, Boston, Massachusetts

Address correspondence to:

Elizabeth A. Regan, MD, PhD
National Jewish Health
1400 Jackson St, K706
Denver, CO 80206
ReganE@NJHealth.org
Phone: 303-398-1531

Abstract

Background: Lung cancer screening (LCS) via chest computed tomography (CT) scans can save lives by identifying early-stage tumors. However, most smokers die of comorbid smoking-related diseases. LCS scans contain information about smoking-related conditions that is not currently systematically assessed. Identifying these common comorbid diseases on CT could increase the value of screening with minimal impact on LCS programs. We determined the prevalence of 3 comorbid diseases from LCS eligible scans and quantified related adverse outcomes.

Methods: We studied COPD Genetic Epidemiology study (COPDGene®) participants (n=4078) who met criteria for LCS screening at enrollment (age > 55 years, and < 80 years, > 30 pack years smoking, current smoker or former smoker within 15 years of smoking cessation). CT scans were assessed for coronary artery calcification (CAC), emphysema, and vertebral bone density. We tracked the following clinically significant events: myocardial infarctions (MIs), strokes, pneumonia, respiratory exacerbations, and hip and vertebral fractures.

Results: Overall, 77% of eligible CT scans had one or more of these diagnoses identified. CAC (> 100 mg) was identified in 51% of scans, emphysema in 44%, and osteoporosis in 54%. Adverse events related to the underlying smoking-related diseases were common, with 50% of participants reporting at least one. New diagnoses of cardiovascular disease, emphysema and osteoporosis were made in 25%, 7% and 46%, of participants respectively. New diagnosis of disease was associated with significantly more adverse events than in participants who did not have CT diagnoses for both osteoporosis and cardiovascular risk.

Conclusions: Expanded analysis of LCS CT scans identified individuals with evidence of previously undiagnosed cardiovascular disease, emphysema or osteoporosis that corresponded with adverse events. LCS CT scans can potentially facilitate diagnoses of these smoking-related diseases and provide an opportunity for treatment or prevention.

Citation

Citation: Regan EA, Lowe KE, Make BJ, et al and the COPDGene investigators. Identifying smoking-related disease on lung cancer screening CT scans: increasing the value. Chronic Obstr Pulm Dis. 2019; 6(3): 233-245. doi: http://dx.doi.org/10.15326/jcopdf.6.3.2018.0142

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Introducing the New COPD Pocket Consultant Guide App: Can A Digital Approach Improve Care? A Statement of the COPD Foundation

Byron Thomashow, MD1 James D. Crapo, MD2 M. Bradley Drummond, MD3 MeiLan K. Han, MD4 Ravi Kalhan, MD5 Elisha Malanga, BS6 Vinny Malanga, BS, MCP6 David M. Mannino, MD7 Stephen Rennard, MD8 Frank C. Sciurba, MD9 Kristen S. Willard, MS6 Robert Wise, MD10 Barbara Yawn, MD6

Author Affiliations

  1. Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University, New York
  2. Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, Colorado
  3. Division of Pulmonary Diseases and Critical Medicine, Department of Medicine, University of North Carolina, Chapel Hill
  4. Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan Health System, Ann Arbor
  5. Asthma and COPD Program, Northwestern University Feinberg School of Medicine, Chicago, Illinois
  6. COPD Foundation, Washington, D.C.
  7. GlaxoSmithKline, Philadelphia, Pennsylvania and Department of Preventative Medicine and Environmental Health University of Kentucky, College of Public Health, Lexington
  8. Early Clinical Development, IMED Biotech Unit, AstraZeneca, Cambridge, United Kingdom and Department of Medicine, University of Nebraska Medical Center, Omaha
  9. Division of Pulmonary Allergy and Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
  10. Pulmonary and Critical Care, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland

Address correspondence to:

Byron Thomashow, MD
Email: bmt1@cumc.columbia.edu
Phone: (212)305-5261

Abstract

The COPD Foundation has tried to address gaps in chronic obstructive pulmonary disease (COPD) care by providing COPD Pocket Consultant Guide cards to U.S. health care providers. Since launching the card in 2007, there have been numerous updates and more than 800,000 of these cards have been distributed at no charge to health care professionals. The most recent versions have concentrated on presenting an algorithm for COPD management based on 7 severity domains: spirometry, symptoms, exacerbations, oxygen requirements, the presence of chronic bronchitis or emphysema and comorbidities. To increase the usability and reach of this tool, the COPD Pocket Consultant Guide is now available as an app for iOS and Android. This updated version of the app includes new COPD and asthma/COPD overlap flow charts; an interactive therapy chart that takes into account modified Medical Research Council (mMRC), COPD Assessment Test (CAT), and spirometry scores; anxiety and depression screeners; up-to-date medication charts in both brand and generic formats; a checklist to aid in determining when a patient should be referred to a pulmonologist and more. Potential use of the COPD Pocket Consultant Guide app in clinical care is discussed.

Citation

Citation: Thomashow B, Crapo JD, Drummond MB, et al. Introducing the new COPD Pocket Consultant Guide app: can a digital approach improve care? A statement of the COPD Foundation. Chronic Obstr Pulm Dis. 2019; 6(3): 210-220. doi: http://dx.doi.org/10.15326/jcopdf.6.3.2018.0167

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