Author Affiliations

1. Division of Pulmonary Medicine, Department of Medicine, University of Alberta, Alberta, Canada
2. Medicine Strategic Clinical Network, Respiratory Health Section, Alberta Health Services, Alberta, Canada
3. G.F. MacDonald Centre for Lung Health, Covenant Health, Alberta, Canada
4. Division of General Internal Medicine, Department of Medicine, University of Alberta, Alberta, Canada

Address correspondence to:

Lesley Soril, PhD
Medicine Strategic Clinical Network, Alberta Health Services
Seventh Street Plaza, 2nd Floor
10030 107 Street
Edmonton, AB T5J 3E4
Phone: 1-587-689-4033
Email: Lesley.Soril@albertahealthservices.ca

Abstract

Background: Health inequities among individuals with chronic obstructive pulmonary disease (COPD) are often associated with differential access to health care and health outcomes. A greater understanding of the literature concerning such variation is necessary to determine where gaps or inequities exist along the continuum of COPD care.

Methods: A rapid review of the published and grey literature reporting variations in health care access and/or health outcomes for individuals with COPD was completed. Variation was defined as differential patterns in access indicators or outcome measures within sociodemographic categories, including age, ethnicity, geography, race, sex, and socioeconomic status. Emergent themes were identified from the included literature and synthesized narratively.

Results: Thirty-five articles were included for final review; the majority were retrospective cohort studies. Twenty-five studies assessed variation in access to health care. Key indicators included: access to spirometry testing, medication adherence, participation in pulmonary rehabilitation, and contact with general practitioners and/or respiratory specialists. Twenty-one studies assessed variation in health outcomes in COPD and key metrics included: hospital-based resource utilization (length of stay and admissions/readmissions), COPD exacerbations, and mortality. Patients who live in rural environments and those of lower socioeconomic status had both poorer access to care and outcomes at the system and patient level. Other sociodemographic variables, including ethnicity, race, age, and sex were associated with variation in health care access and outcomes, although these findings were less consistent.

Conclusions: The results of this rapid review suggest that substantial variation in access and outcomes exists for individuals with COPD, highlighting opportunities for targeted interventions and policies.

Citation

Citation: Shatto JA, Stickland MK, Soril LJJ. Variations in COPD health care access and outcomes: a rapid review. J COPD F. 2024; 11(2): 229-246. doi: http://doi.org/10.15326/jcopdf.11.2.2023.0441

Keywords

COPD, outcomes, health care access

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Author Affiliations

1. GSK, Brentford, Middlesex, United Kingdom
2. Japan Medical & Development, GSK K.K, Tokyo, Japan
3. Department of Respiratory Medicine, Tokyo Shinagawa Hospital, Tokyo, Japan
4. Respiratory Center, Matsusaka Municipal Hospital, Matsusaka, Mie, Japan
5. Department of Respiratory Medicine, Tohoku Rosai Hospital, Miyagi, Japan
6. Department of Respiratory Medicine, Nagata Hospital, Fukuoka, Japan
7. Department of Pulmonary Medicine, Japan Community Healthcare Organization Tokyo Shinjuku Medical Center, Tokyo, Japan
8. Department of Respiratory Medicine, Iizuka Hospital, Fukuoka, Japan
9. Department of Pulmonary Medicine, Fukushima Medical University, Fukushima, Japan

^aContributed equally

^bAffiliation at the time of the study

Address correspondence to:

Paul Jones, MD, PhD
GSK
980 Great West Road
Brentford, Middlesex
TW8 9GS, United Kingdom
Phone: +44 (771) 340-1434
Email: paul.8.jones@gsk.com

Abstract

Background: A previous longitudinal study of chronic obstructive pulmonary disease (COPD) Assessment Test (CAT) score changes suggested patients fall into 3 patterns: stable, improving, and worsening. This study assessed the evolution of CAT scores over time and its relationship to exacerbations.

Methods: In total, 84 participants used a telemedicine platform to complete CAT weekly for 52 weeks. Completion rates, annualized change in CAT scores, and learning effects were measured, as well as CAT changes of >4 units during look-back periods of 4 and 8 weeks. In a subgroup of participants with at least a 25% completion rate (adherent group, n=68 [81%]), the relationship between change in CAT score and exacerbations at any time during the study was examined post hoc.

Results: Linear regression showed that 50%, 22%, and 28% of the adherent subgroup had CAT scores indicating worsening, stable, and improving health status, respectively. In the adherent subgroup, 70% (n=7/10) of participants who had an exacerbation during the study had worsening CAT scores, versus 47% (n=27/58) without an exacerbation. The hazard ratio association between CAT score increase and moderate exacerbation was 1.13 (95% confidence interval: 1.03–1.24). Most participants experienced at least one CAT score change of >4 units, and 7% showed an initial learning effect with a median of 2 weeks.

Conclusions: Measuring trends in CAT scores may allow future studies to group patients into 3 defined categories of change over time and quantify CAT change trajectories to assess treatment response and potentially predict medium-term outcomes within individual patients.

Citation

Citation: Jones P, Soutome T, Matsuki T, et al. Health status progression measured using weekly telemonitoring of COPD Assessment Test scores over 1 year and its association with COPD exacerbations. J COPD F. 2024; 11(2): 144-154. doi: http://doi.org/10.15326/jcopdf.11.2.2023.0415

Keywords

COPD, exacerbations, telemonitoring, patient-reported outcome, CAT score

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Click to read Health Status Progression Measured Using Weekly Telemonitoring of COPD Assessment Test Scores Over 1 Year and Its Association With COPD Exacerbations

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Author Affiliations

1. School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, Australia
2. Immune Health Research Program, Hunter Medical Research Institute, New Lambton Heights, Australia

Address correspondence to:

Hayley A. Scott, PhD
Immune Health Research Program
Hunter Medical Research Institute
Lot 1 Kookaburra Circuit
New Lambton Heights NSW Australia 2305
Email: Hayley.Scott@newcastle.edu.au

Abstract

This article does not contain an abstract.

Citation

Citation: Dowling LRC, Scott HA. Diet and COPD: a gut feeling about pathogenesis. J COPD F. 2024; 11(2): 133-135. doi: http://doi.org/10.15326/jcopdf.11.2.2024.0508

Keywords

COPD, plant-based diet, gut microbiota, A Priori Diet Quality Score

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Click to read Diet and COPD: A Gut Feeling About Pathogenesis

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Author Affiliations

1. Department of Respiratory Medicine, Hangzhou Ninth People’s Hospital, Hangzhou City, Zhejiang Province, China
2. Clinical Nutrition Department, Hangzhou Ninth People’s Hospital, Hangzhou City, Zhejiang Province, China
3. General Surgery, Hangzhou Ninth People’s Hospital, Hangzhou City, Zhejiang Province, China

Address correspondence to:

Maoen Lin, BS
Department of Respiratory Medicine
Hangzhou Ninth People’s Hospital
No. 98, Yilong Road, Yipong Street
Qiantang District, Hangzhou City
Zhejiang Province
311225, China
Phone: 8613868387799
Email: maoenlinlin@163.com

Abstract

Objective: This study aimed to investigate dietary fiber (DF) intake with the prevalence of chronic obstructive pulmonary disease (COPD) in the middle-aged and elderly population through analysis of the National Health and Nutrition Examination Survey (NHANES) data.

Methods: The study utilized data from 3 cycles of the NHANES database (2007–2012). The exposure variable was DF intake, and the outcome variable was COPD prevalence. Weighted logistic regression was utilized to construct relationship models between the 2 variables. Confounding factors were adjusted, and subgroup analysis was to explore the association of DF intake with COPD. Restricted cubic spline (RCS) analysis investigated the nonlinear relationship between DF intake and COPD. Finally, mediation analysis was performed to determine whether the influence of DF intake on COPD prevalence is mediated through the alteration of white blood cell (WBC) counts.

Results: This study included a total of 7301 eligible participants aged >40 years. The results of the study indicated that an increase in DF intake significantly reduced the prevalence of COPD (odds ratio: 0.98, 95% confidence interval: 0.96–0.99, p<0.001), and DF intake was correlated with lung function indicators (e.g., forced expiratory volume in 1 second). Stratified analysis revealed that an increased DF intake significantly reduced the risk of COPD in male individuals, middle-aged individuals (aged 40–59 years), those with a body mass index ≤30 kg/m², individuals with a history of smoking, and alcohol consumers (p<0.05). Through RCS analysis exploring the nonlinear association between DF intake and COPD prevalence, the critical threshold for the impact of DF intake on COPD prevalence was 15.10 gm. When DF intake was ≥15.10 g/d, it effectively reduced the prevalence of COPD. Mediation analysis results indicated that the WBC count partially mediated the association between DF intake and COPD, with a mediation proportion of 9.89% (p=0.006).

Conclusions: Increased DF intake was linked to decreased prevalence of COPD, particularly in men and middle-aged people. WBC counts may be an important pathway linking DF intake and COPD.

Citation

Citation: Jin J, Bian Y, Gu Z, Lin M. Association between dietary fiber intake and prevalence of chronic obstructive pulmonary disease in a middle-aged and elderly population: a study based on the National Health and Nutrition Examination Survey database. J COPD F. 2024; 11(2): 216-228. doi: http://doi.org/10.15326/jcopdf.11.2.2023.0457

Keywords

chronic obstructive pulmonary disease, NHANES, dietary fiber intake, logistic regression, white blood cell counts

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Click to read Association Between Dietary Fiber Intake and Prevalence of Chronic Obstructive Pulmonary Disease in a Middle-Aged and Elderly Population: A Study Based on the National Health and Nutrition Examination Survey Database

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Author Affiliations

1. Makerere University Lung Institute, Kampala, Uganda
2. Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
3. Soroti District Local Government, Soroti, Uganda
4. Respiratory Institute, Cleveland Clinic, Cleveland, Ohio, United States
5. Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
6. Faculty of Health, University of Plymouth, Plymouth, United Kingdom
7. Respiratory, University College London, London, United Kingdom
8. Division of Pulmonary, Critical Care and Sleep Medicine, University of Miami, Miami, Florida, United States

Address correspondence to:

Patricia Alupo, MBChB, MMed
Makerere University Lung Institute
Phone: +256701124540
Email: alupopat@gmail.com

Abstract

Background: The neutrophil-to-lymphocyte ratio (NLR) is an inexpensive biomarker that potentially predicts acute exacerbations of chronic obstructive pulmonary disease (AECOPDs). We evaluated the association of baseline NLR and respiratory hospitalization risk within one year among chronic obstructive pulmonary disease (COPD) patients in Uganda, a low- and middle-income country.

Methods: A total of 312 COPD patients were followed for one year. Clinical characteristics and exacerbation rates were collected. Poisson regression with robust variance estimators was used to measure the association between NLR and hospital admissions due to COPD exacerbations. Receiver-operator characteristic (ROC) curves and the area under the curve were used to assess the ability of NLR to predict AECOPDs.

Results: The median (Q 1, Q 3) age was 64 years (53, 71). Females comprised 50.96% (n=159) of the cohort, and 71.2% (n=222) of participants had moderate or severe COPD. A total of 9.9% (n=31) of participants experienced a COPD exacerbation during the period of follow-up. At baseline, the median (Q 1, Q 3) NLR ratio among participants who experienced an exacerbation was 1.46 (0.92, 2.33) compared to 1.03 (0.72,1.42) among those who did not experience one during the follow-up period (p=0.002). Using Youden and Liu’s methods, the optimal NLR cutoff for predicting COPD exacerbation was 1.17. This cutoff resulted in a ROC curve area of 0.64 (95% confidence interval: 0.56, 0.73).

Conclusions: The NLR could be used as a risk predictor, in low- and middle-income countries, for hospital admissions due to COPD exacerbations. A cutoff of 1.17 was an independent predictor of hospitalization due to acute exacerbations of COPD within one year.

Citation

Citation: Alupo P, Katagira W, Mukunya D, et al. The neutrophil-to-lymphocyte ratio as a predictor of acute exacerbations among patients with COPD in Uganda. J COPD F. 2024; 11(2): 187-195. doi: http://doi.org/10.15326/jcopdf.11.2.2023.0443

Keywords

COPD, biomarkers, exacerbations, acute exacerbations of COPD, neutrophil-to-lymphocyte ratio

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Click to read The Neutrophil-to-Lymphocyte Ratio as a Predictor of Acute Exacerbations Among Patients With COPD in Uganda

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Author Affiliations

1. Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
2. Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan, United States
3. Division of Pulmonary Diseases and Critical Care Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
4. Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, Connecticut, United States

Address correspondence to:

Roy A. Pleasants, PharmD
University of North Carolina at Chapel Hill
Chapel Hill, NC
Phone: (919) 843-9938
Email: pleas005@email.unc.edu

Abstract

Background: We examined the effect of physical position on peak inspiratory flow (PIF) in patients with chronic obstructive pulmonary disease (COPD) using dry-powder inhalers (DPIs) with low‑medium internal resistance (R2) and/or high internal resistance (R5).

Methods: This prospective study in stable, ambulatory patients with spirometry-confirmed COPD evaluated the effect of 3 physical positions on maximal PIF achieved. Participants had PIFs of 30–90L/min (R5) or 60–90L/min (R2 DPIs) using the In-Check™ DIAL. PIF was measured in triplicate randomly in 3 positions that patients might be in while using their inhaler (standing, sitting, and semi-upright [supine position with the head of the bed at 45°, neck flexed forward]) against prescribed DPI resistance (R2/R5/both). Correlations between PIF and percentage decline in PIF between positions and differences in participant characteristics with >10% versus ≤10% PIF decline standing to semi-upright were calculated.

Results: A total of 76 participants (mean age, 65.2 years) had positional measurements; 59% reported seated DPI use at home. The mean (standard deviation) PIF standing, sitting, and semi-upright was 80.7 (13.4), 77.8 (14.3), and 74.0 (14.5) L/min, respectively, for R2 and 51.1 (9.52), 48.6 (9.84), and 45.8 (7.69) L/min, respectively, for R5 DPIs. PIF semi-upright was significantly lower than sitting and standing (R2; P < 0.0001) and standing (R5; P= 0.002). Approximately half of the participants had >10% decline in PIF from standing to semi-upright. Patient characteristics exceeding the 0.10 absolute standardized difference threshold with the decline in PIF for both the R2 and R5 DPIs were waist-to-hip ratio, modified Medical Research Council dyspnea score, and postbronchodilator percentage predicted forced vital capacity and PIF by spirometry.

Conclusions: PIF was significantly affected by physical position regardless of DPI resistance. PIF was highest when standing and lowest when semi-upright. We recommend that patients with COPD stand while using an R2 or R5 DPI. Where unfeasible, the position should be sitting rather than semi-upright.

ClinicalTrials.gov identifier NCT04168775

Citation

Citation: Pleasants RA, Henderson AG, Bayer V, Shaikh A, Drummond MD. Effect of physical position on peak inspiratory flow in stable COPD: an observational study. J COPD F. 2024; 11(2): 174-186. doi: http://doi.org/10.15326/jcopdf.11.2.2023.0460

Keywords

peak inspiratory flow rate, inhalation technique, chronic airways obstruction, dry-powder inhalers

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Click to read Effect of Physical Position on Peak Inspiratory Flow in Stable COPD: An Observational Study

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Author Affiliations

1. Department of Physical Therapy, School of Health Professions, University of Alabama at Birmingham, Birmingham, Alabama, United States
2. Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, and Lung Health Center, University of Alabama at Birmingham, Birmingham, Alabama, United States
3. Theravance Biopharma U.S., Inc., South San Francisco, California, United States

Address correspondence to:

Abebaw M. Yohannes, PhD, MSc
Department of Physical Therapy/School of Health Professions
Division of Pulmonary, Allergy and Critical Care Medicine &
Lung Health Center
University of Alabama at Birmingham
Birmingham, AL
Phone: (205) 934-3566
Email: amyohann@uab.edu

Abstract

Background: Revefenacin, a once-daily, nebulized, long-acting muscarinic antagonist approved in the United States for the maintenance of chronic obstructive pulmonary disease (COPD), significantly improves lung function and quality of life versus placebo in patients with moderate-to-very severe COPD. Comorbid anxiety and/or depression may alter patients’ symptom perception and response to bronchodilators. The impact of revefenacin in patients with COPD with comorbid anxiety and/or depression has not been previously investigated.

Methods: This post hoc subgroup analysis examined data from two 12-week, randomized, phase 3 trials in patients with moderate-to-very severe COPD with the following self-reported subgroups: anxiety only (A), depression only (D), anxiety and depression (+A/+D), and neither anxiety nor depression (−A/−D). We assessed change from baseline in trough forced expiratory volume in 1 second (FEV₁) at Day 85 and health status by the St George’s Respiratory Questionnaire (SGRQ) and COPD Assessment Test (CAT).

Results: Of 812 patients, 90 (11%), 110 (14%), 141 (17%), and 471 (58%) had A, D, +A/+D, and −A/−D respectively. In revefenacin versus placebo, trough FEV₁ significantly improved from baseline at Day 85 across all subgroups as well as the SGRQ and CAT scores in patients with A, +A/+D, and −A/−D. Revefenacin was well tolerated regardless of A/D status, with a minimal incidence of treatment-emergent antimuscarinic adverse events across subgroups.

Conclusions: In this analysis, revefenacin versus placebo significantly improved health outcomes in patients with moderate-to-very severe COPD with A, +A/+D, and −A/−D, but not in patients with D. The safety profile of revefenacin was not affected by comorbid anxiety/depression status.

Citation

Citation: Yohannes AM, Iyer AS, Clay C, et al. Post hoc analysis of lung function improvement and patient-reported outcomes with revefenacin in adults with moderate-to-very severe COPD and comorbid anxiety or depression. J COPD F. 2024; 11(2): 196-205. doi: http://doi.org/10.15326/jcopdf.11.2.2023.0465

Keywords

quality of life, lung function, patient-reported outcomes, depression, anxiety

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Click to read Post Hoc Analysis of Lung Function Improvement and Patient-Reported Outcomes With Revefenacin in Adults With Moderate-to-Very Severe COPD and Comorbid Anxiety or Depression

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Author Affiliations

1. Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, Washington, United States
2. Department of Medicine, University of Washington, Seattle, Washington, United States
3. Department of Internal Medicine, University of Kansas, Kansas City, Kansas, United States
4. Division of Respiratory Medicine, University of British Columbia, Vancouver, Canada

Address correspondence to:

Lucas M. Donovan, MD, MS
HSR&D Center of Innovation for Veteran-Centered and Value-Driven Care
VA Puget Sound Health Care System
Division of Pulmonary, Critical Care and Sleep Medicine
1660 South Columbian Way
Seattle, WA 98108
Email: ldonovan@uw.edu

Abstract

Study Objectives: Observational studies link untreated obstructive sleep apnea (OSA) with adverse outcomes in chronic obstructive pulmonary disease (COPD). The first step in addressing OSA is a clinical assessment. However, given competing demands and a lack of high-quality evidence, it is unclear how often such assessments occur. We explored the documentation of OSA assessment among patients with COPD in primary care, and the patient and provider characteristics associated with these assessments.

Methods: We conducted a cross-sectional study of patients with clinically diagnosed COPD at 2 primary care practices. We abstracted charts to determine whether providers assessed OSA, defined as documentation of symptoms, treatment, or a referral to sleep medicine. We performed multivariable mixed-effects logistic regression to assess the associations of patient and provider characteristics with OSA assessment.

Results: Among 641 patients with clinically diagnosed COPD, 146 (23%) had OSA assessed over a 1-year period. Positive associations with OSA assessment included body mass index ≥ 30 (odds ratio [OR] 3.5, 95% confidence interval [CI] 1.8–7.0), pulmonary subspecialist visits (OR 3.9, 95%CI 2.4–6.3), and a prior sleep study demonstrating OSA documented within the electronic medical record (OR 18.0, 95%CI 9.0–35.8). Notably, patients identifying as Black were less likely to have OSA assessed than those identifying as White (OR 0.5, 95%CI 0.2–0.9).

Conclusions: Providers document an assessment of OSA among a quarter of patients with COPD. Our findings highlight the importance of future work to rigorously test the impact of assessment on important health outcomes. Our findings also reinforce that additional strategies are needed to improve the equitable delivery of care.

Citation

Citation: Donovan LM, Keller TL, Stewart NH, et al. Assessment of obstructive sleep apnea among patients with chronic obstructive pulmonary disease in primary care. J COPD F. 2024; 11(2): 136-143. doi: http://doi.org/10.15326/jcopdf.11.2.2023.0438

Keywords

chronic obstructive pulmonary disease, primary care, obstructive sleep apnea

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Click to read Assessment of Obstructive Sleep Apnea Among Patients With Chronic Obstructive Pulmonary Disease in Primary Care

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Author Affiliations

1. National Center for Respiratory Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
2. Peking Union Medical College, Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
3. Centre for Evidence-based Chinese Medicine, School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China

Address correspondence to:

Xiaoxia Ren, MD
Department of Pulmonary and Critical Care Medicine
Center of Respiratory Medicine
China-Japan Friendship Hospital
No 2, East Yinghua Road
Chaoyang District
Beijing 100029, China
Email: xiaoxiaren2011@163.com

Abstract

Introduction/Objective: Respiratory microbiome studies have fostered our understanding of the various phenotypes and endotypes of heterogeneous chronic obstructive pulmonary disease (COPD). This study aimed to identify microbiome-driven clusters that reflect the clinical features and dominant microbiota of COPD.

Methods: This cross-sectional study included 32 patients with stable COPD between December 2019 and December 2020 from the outpatient clinic of the China-Japan Friendship Hospital. Sputum samples were tested for 16S rRNA. Patients were classified according to the species level using an unsupervised clustering method to compare the inflammatory phenotypes of 2 clusters and analyze the correlation between the main bacteria and clinical indicators in each cluster. Patients were further divided into 2 clusters according to microorganisms.

Results: Neutrophils in cluster 1 were significantly increased compared with cluster 2. Cluster 1 was predominantly Bacteroides, while cluster 2 was dominated by Prevotella and Fusobacterium at the genus level. Fusobacterium was negatively correlated with the COPD Assessment Test (CAT) score, and Bacteroides were positively correlated with the number of acute exacerbations of COPD.

Conclusion: This study found that differential flora was negatively associated with CAT scores and the number of acute exacerbations of COPD. This microbiome-driven, unbiased clustering method for COPD can help identify new endotype-related COPD phenotypes.

Citation

Citation: Yu T, Chen Y, Ren X, Yang T. Respiratory microbiome profiles associated with distinct inflammatory phenotype and clinical indexes in chronic obstructive pulmonary disease. J COPD F. 2024; 11(2): 155-163. doi: http://doi.org/10.15326/jcopdf.11.2.2023.0445

Keywords

chronic obstructive pulmonary disease, cluster analysis, microbiome

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Click to read Respiratory Microbiome Profiles Associated With Distinct Inflammatory Phenotype and Clinical Indexes in Chronic Obstructive Pulmonary Disease

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Author Affiliations

1. Division of Medical Nutrition Education, University of Nebraska Medical Center, Omaha, Nebraska, United States
2. Division of Epidemiology and Community Health, University of Minnesota Twin Cities, Minneapolis, Minnesota, United States
3. Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, United States
4. Division of Pulmonary Critical Care and Sleep Medicine, Department of Internal Medicine, the Ohio State University Wexner Medical Center, Columbus, Ohio, United States
5. Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States
6. Critical Care, South Shore Hospital, Weymouth, Massachusetts, United States
7. Department of Radiology, Brigham and Women’s Hospital, Boston, Massachusetts, United States
8. Division of Pulmonary and Critical Care Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States
9. Division of Preventive Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
10. Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, United States

Address correspondence to:

Mariah K. Jackson, MMN
Division of Medical Nutrition Education
University of Nebraska Medical Center
Omaha, Nebraska
Phone: (402) 836-9892
Email: mariah.jackson@unmc.edu

Abstract

Background: Chronic obstructive pulmonary disease (COPD) is a significant public health concern and intercepting the development of emphysema is vital for COPD prevention. Smokers are a high-risk population for emphysema with limited prevention strategies. We aimed to determine if adherence to a nutritionally rich, plant-centered diet among young ever-smokers is associated with reduced risk of future radiographic emphysema.

Methods: We studied participants from the Coronary Artery Risk Development in Young Adults (CARDIA) Lung Prospective Cohort Study who were 18–30 years old at enrollment and followed for 30 years. We analyzed 1706 adults who reported current or former smoking by year 20. Repeated measures of diet history were used to calculate A Priori Diet Quality Scores (APDQSs), and categorized into quintiles, with higher quintiles representing higher nutritionally rich plant-centered food intake. Emphysema was assessed at year 25 (n=1351) by computed tomography (CT). Critical covariates were selected, acknowledging potential residual confounding.

Results: Emphysema was observed in 13.0% of the cohort, with a mean age of 50.4 ± 3.5 years. The prevalence of emphysema was 4.5% in the highest APDQS quintile (nutritionally rich), compared with 25.4% in the lowest quintile. After adjustment for multiple covariates, including smoking, greater adherence to a plant-centered diet was inversely associated with emphysema (highest versus lowest quintile odds ratio: 0.44, 95% CI 0.19-0.99, p_trend=0.008).

Conclusion: Longitudinal adherence to a nutritionally rich, plant-centered diet was associated with a decreased risk of emphysema development in middle adulthood, warranting further examination of diet as a strategy for emphysema prevention in a high-risk smoking population.

Citation

Citation: Jackson MK, Choi Y, Eisenberg E, et al. A plant-centered diet is inversely associated with radiographic emphysema: findings from the CARDIA Lung Study. J COPD F. 2024; 11(2): 164-173. doi: http://doi.org/10.15326/jcopdf.11.2.2023.0437

Keywords

emphysema, dietary intake, plant-centered diet, smoking; life course

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Click to read A Plant-Centered Diet is Inversely Associated With Radiographic Emphysema: Findings from the CARDIA Lung Study

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Author Affiliations

1. Pulmonary and Critical Care, Loma Linda University Medical Center, Loma Linda, California, United States
2. Pulmonary and Critical Care, Riverside University Health System, Moreno Valley, California, United States
3. Pulmonary and Critical Care, VA Loma Linda Healthcare System, Loma Linda, California, United States

Address correspondence to:

Abdul H. Zaid, MBBS
11234 Anderson Street
MC 1503A
Loma Linda, California 92354
Phone: (909) 558-4911 x44911
Email: docahz@gmail.com

Abstract

Background: Dyspnea is frequently a debilitating symptom of chronic obstructive pulmonary disease (COPD). Cannabinoid receptor agonists have the potential to alter dyspnea in these patients.

Objective: Our objective was to determine if dronabinol, a pure cannabinoid, improves dyspnea and exercise tolerance in COPD.

Methods: In this double-blind randomized, crossover pilot study, COPD patients received up to 20mg of oral dronabinol or placebo daily for 6 weeks with an intervening washout period. Dyspnea and fatigue were assessed using the Borg scale at rest and after an incremental shuttle walk. Functional status, mood, and depression were measured using the St George’s Respiratory Questionnaire (SGRQ), the Pulmonary Functional Status and Dyspnea Questionnaire (PFSDQ), and the Geriatric Depression Scale (GDS).

Results: A total of 11 participants (with mean forced expiratory volume in 1 second 50.8 ± 24.8%) completed the study with no improvement in dyspnea at rest or postexercise taking dronabinol versus placebo (Borg scale 0.27, 95% confidence interval [CI] -0.59 to 1.14 versus 0.23 points, 95% CI -0.71 to 1.07 at rest and 0.82, 95% CI -0.59 to 2.22 versus 0.36 points, 95% CI 0.13 to 2.78 post exercise; p=0.94 and p=0.69 respectively). Dronabinol compared with placebo showed no significant change in PFSDQ dyspnea scores (0.64, 95% CI -3.92 to 5.20 versus 5.0, 95% CI -6.29 to 16.29; p=0.43) or shuttle walk distances (20.7m, 95% CI -21.5 to 62.8 versus 13.7m, 95% CI -24.8 to 52.2; p=0.69). There were no significant differences in fatigue at rest and postexercise, SGRQ scores, or GDS scores.

Conclusions: In this pilot study, dronabinol did not significantly improve dyspnea or exercise capacity compared with placebo.

Citation

Citation: Zaid AH, Thapamagar SB, Anholm JD, et al. Effects of dronabinol on dyspnea and quality of life in patients with COPD. J COPD F. 2024; 11(2): 206-215. doi: http://doi.org/10.15326/jcopdf.11.2.2023.0401

Keywords

COPD, quality of life, dyspnea, exercise tolerance, cannabinoids

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Click to read Effects of Dronabinol on Dyspnea and Quality of Life in Patients With COPD

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Author Affiliations

1. Department of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
2. National Centre for Alpha-1 Antitrypsin Deficiency, Beaumont Hospital, Dublin, Ireland
3. Seattle Children’s Research Institute, Seattle, Washington, United States
4. Department of Medicine, University of Washington, Seattle, Washington, United States
5. Alpha-1 Foundation of Ireland, Dublin, Ireland
6. Department of Pediatrics, University of Washington, Seattle, Washington, United States

Address correspondence to:

Oliver J. McElvaney, MD, PhD
Department of Medicine
Royal College of Surgeons in Ireland
Dublin, Ireland
Phone: +353 18093763
Email: olivermcelvaney@rcsi.ie

Abstract

Background: Patients with alpha-1 antitrypsin deficiency (AATD) exhibit dysregulated inflammatory responses and a predilection for autoimmunity. While the adverse event (AE) profiles of COVID-19 vaccines in several chronic inflammatory conditions are now available, safety and tolerability data for patients with severe AATD have yet to be described. The feasibility of coadministering vaccines against COVID-19 and influenza in this population is similarly unclear.

Methods: We conducted a prospective study of 170 patients with Pi*ZZ genotype AATD receiving their initial vaccination series with ChAdOx1 nCoV-19 (AstraZeneca). Patients were monitored clinically for AEs over the week that followed their first and second doses. In parallel, we conducted the same assessments in patients with Pi*MM genotype chronic obstructive pulmonary disease (COPD) (n=160) and Pi*MM individuals without lung disease (n=150). The Pi*ZZ cohort was subsequently followed through 2 consecutive mRNA-based booster vaccines (monovalent and bivalent BNT162b2, Pfizer/BioNTech). To assess the safety of combined vaccination against COVID-19 and influenza, the quadrivalent influenza vaccine was administered to participants attending for their second COVID-19 booster vaccination, either on the same day or following a 1-week interval.

Results: Pi*ZZ AATD participants did not display increased AEs compared to Pi*MM COPD or Pi*MM non-lung disease controls. Although unexpected and serious vaccine-associated AEs did occur, the majority of AEs experienced across the 3 groups were mild and self-limiting. The AATD demographic at highest risk for AEs (especially systemic and prolonged AEs) was young females. No increase in AE risk was observed in patients with established emphysema, sonographic evidence of liver disease, or in those receiving intravenous augmentation therapy. AE incidence declined sharply following the initial vaccine series. Same-day coadministration of the COVID-19 mRNA bivalent booster vaccine and the annual influenza vaccine did not result in increased AEs compared to sequential vaccines 1 week apart.

Conclusions: Despite their pro-inflammatory state, patients with severe AATD are not at increased risk of AEs or serious AEs compared to patients with nonhereditary COPD and patients without lung disease. Same-day coadministration of COVID-19 booster vaccines with the annual influenza vaccine is feasible, safe, and well-tolerated in this population.

Citation

Citation: McElvaney OJ, Cleary B, Fraughen DD, et al. Safety and reactogenicity of COVID-19 vaccination in severe alpha-1 antitrypsin deficiency. J COPD F. 2024; 11(1): 3-12. doi: http://doi.org/10.15326/jcopdf.11.1.2023.0432

Keywords

alpha-1 antitrypsin deficiency, safety, COVID-19, influenza, vaccine

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Author Affiliations

1. Editor in Chief, Chronic Obstructive Pulmonary Diseases: Journal of the COPD Foundation, Miami, Florida, United States
2. Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States

Address correspondence to:

Mark T. Dransfield, MD
mdransfield@uabmc.edu

Abstract

This article does not contain an abstract.

Citation

Citation: Dransfield MT. Editorial—2014–2024: Celebrating 10 years of nonprofit, open-access publishing focused on COPD, bronchiectasis, and nontuberculous mycobacteria research. J COPD F. 2024; 11(1): 1-2. doi: http://doi.org/10.15326/jcopdf.11.1.2024.0497

Keywords

editorial, Journal of the COPD Foundation; 10th anniversary

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Click to read Editorial–2014–2024: Celebrating 10 Years of Nonprofit, Open-Access Publishing Focused on COPD, Bronchiectasis, and Nontuberculous Mycobacteria Research

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Author Affiliations

1. Geisel School of Medicine at Dartmouth, The C. Everett Koop Institute at Dartmouth, Hanover, New Hampshire, United States
2. Behavioral Health and Health Policy Practice, Westat, Rockville, Maryland, United States
3. Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, Minnesota, United States
4. Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York, United States
5. School of Global Public Health, New York University, New York, New York, United States
6. University of California at San Diego, La Jolla, California, United States
7. National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland, United States
8. Center for Tobacco Products, Food and Drug Administration, Silver Spring, Maryland, United States
9. Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, United States
10. Axle Informatics, Rockville, Maryland, United States

Address correspondence to:

Laura M. Paulin, MD
Phone: (603) 650-5533
Email: Laura.m.paulin@hitchcock.org

Abstract

Introduction: We examined the association between tobacco product use and health-related quality of life (HRQoL) among individuals with chronic obstructive pulmonary disease (COPD) in Waves 1–5 of the Population Assessment of Tobacco and Health (PATH) Study.

Methods: Adults ≥40 years with an ever COPD diagnosis were included in cross-sectional (Wave 5) and longitudinal (Waves 1 to 5) analyses. Tobacco use included 13 mutually exclusive categories of past 30-day (P30D) single use and polyuse with P30D exclusive cigarette use and ≥5-year cigarette cessation as reference groups. Multivariable linear regression and generalized estimating equations (GEE) were used to examine the association between tobacco use and HRQoL as measured by the Patient-Reported Outcomes Measurement Information System (PROMIS) Global-10 questionnaire.

Results: Of 1670 adults, 79.4% ever used cigarettes; mean (standard error [SE]) pack years was 30.9 (1.1). In cross-sectional analysis, P30D exclusive cigarette use, and e-cigarette/cigarette dual use were associated with worse HRQoL compared to ≥5-year cigarette cessation. Compared to P30D exclusive cigarette use, never tobacco use and ≥5-year cigarette cessation were associated with better HRQoL, while e-cigarette/cigarette dual use had worse HRQoL. Longitudinally (n=686), e-cigarette/cigarette dual use was associated with worsening HRQoL compared to both reference groups. Only never tobacco use was associated with higher HRQoL over time compared to P30D exclusive cigarette use.

Conclusions: E-cigarette/cigarette dual use was associated with worse HRQoL compared to ≥5-year cigarette cessation and exclusive cigarette use. Never use and ≥5-year cigarette cessation were the only categories associated with higher HRQoL compared to exclusive cigarette use. Findings highlight the importance of complete smoking cessation for individuals with COPD.

Citation

Citation: Paulin LM, Halenar MJ, Edwards KC, et al. Relationship between tobacco product use and health-related quality of life among individuals with COPD in waves 1–5 (2013–2019) of the Population Assessment of Tobacco and Health Study. J COPD F. 2024; 11(1): 68-82. doi: http://doi.org/10.15326/jcopdf.11.1.2023.0422

Keywords

COPD, epidemiology, prevention, cigarette, e-cigarette

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Click to read Relationship Between Tobacco Product Use and Health-Related Quality of Life Among Individuals With COPD in Waves 1–5 (2013–2019) of the Population Assessment of Tobacco and Health Study

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Author Affiliations

1. Leonard M. Miller School of Medicine, University of Miami, Miami, Florida, United States
2. Collaborative Studies Coordinating Center, Department of Biostatistics, Gilling’s School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States
3. Section on Pulmonary, Critical Care, Allergy and Immunological Diseases, Wake Forest School of Medicine, Wake Forest, North Carolina, United States
4. Department of Medicine, Columbia University Medical Center, New York, New York, United States
5. Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
6. Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, United States
7. Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California, San Francisco, California, United States
8. Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, United States
9. Departments of Radiology, Medicine, and Bioengineering, University of Iowa, Iowa City, Iowa, United States
10. Division of Pulmonary, Critical Care, and Sleep Medicine, National Jewish Health, Denver, Colorado, United States
11. Division of Pulmonary and Critical Care Medicine, School of Medicine, University of Michigan, Ann Arbor, Michigan, United States
12. Division of Pulmonary and Critical Care Medicine, Department of Medicine, Temple University School of Medicine, Philadelphia, Pennsylvania, United States
13. Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, Utah, United States
14. Division of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois at Chicago, Chicago, Illinois, United States
15. Division of Pulmonary and Critical Care Medicine, Weill Cornell Medical College, New York, New York, United States
16. Department of Internal Medicine, Division of Respiratory Diseases, Center for Individualized Medicine, Mayo Clinic, Scottsdale, Arizona, United States

Address correspondence to:

Abigail L. Koch, MD
University of Miami
1951 NW 7^th Ave 2^nd Floor
Miami, FL 33136
Phone: (813)465-2644
Email:Abigail.koch@miami.edu

Abstract

Rationale: The SubPopulations and InteRmediate Outcome Measures in COPD Study (SPIROMICS) is a prospective cohort study that enrolled 2981 participants with the goal of identifying new chronic obstructive pulmonary disease (COPD) subgroups and intermediate markers of disease progression. Individuals with COPD and obstructive sleep apnea (OSA) experience impaired quality of life and more frequent exacerbations. COPD severity also associates with computed tomography scan-based emphysema and alterations in airway dimensions.

Objectives: The objective was to determine whether the combination of lung function and structure influences the risk of OSA among current and former smokers.

Methods: Using 2 OSA risk scores, the Berlin Sleep Questionnaire (BSQ), and the DOISNORE50 (Diseases, Observed apnea, Insomnia, Snoring, Neck circumference > 18 inches, Obesity with body mass index [BMI] > 32, R = are you male, Excessive daytime sleepiness, 50 = age ≥ 50) (DIS), 1767 current and former smokers were evaluated for an association of lung structure and function with OSA risk.

Measurements and Main Results: The study cohort's mean age was 63 years, BMI was 28 kg/m², and forced expiratory volume in 1 second (FEV₁) was 74.8% predicted. The majority were male (55%), White (77%), former smokers (59%), and had COPD (63%). A high-risk OSA score was reported in 36% and 61% using DIS and BSQ respectively. There was a 9% increased odds of a high-risk DIS score (odds ratio [OR]=1.09, 95% confidence interval [CI]:1.03–1.14) and nominally increased odds of a high-risk BSQ score for every 10% decrease in FEV₁ %predicted (OR=1.04, 95%CI: 0.998–1.09). Lung function-OSA risk associations persisted after additionally adjusting for lung structure measurements (%emphysema, %air trapping, parametric response mapping for functional small airways disease, , mean segmental wall area, tracheal %wall area, dysanapsis) for DIS (OR=1.12, 95%CI:1.03–1.22) and BSQ (OR=1.09, 95%CI:1.01–1.18).

Conclusions: Lower lung function independently associates with having high risk for OSA in current and former smokers. Lung structural elements, especially dysanapsis, functional small airways disease, and tracheal %wall area strengthened the effects on OSA risk.

Citation

Citation: Koch AL, Shing TL, Namen A, et al. Lung structure and risk of sleep apnea in SPIROMICS. J COPD F. 2024; 11(1): 26-36. doi: http://doi.org/10.15326/jcopdf.11.1.2023.0411

Keywords

COPD, lung function, CT-scan measurements, DOISNORE50

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Click to read Lung Structure and Risk of Sleep Apnea in SPIROMICS

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Author Affiliations

1. Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan, United States
2. Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, United States
3. University of Exeter Medical School, College of Medicine and Health, University of Exeter, Exeter, United Kingdom
4. Clinical Research Institute and Altitude Clinical Consulting, Medford, Oregon, United States
5. Precise Approach Ltd, London, United Kingdom
6. GSK, Collegeville, Pennsylvania, United States
7. Pulmonary, Allergy, and Critical Care Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
8. Division of Pulmonology and Critical Care Medicine, Weill Cornell Medicine, New York, New York, United States
9. Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
10. Centre for Respiratory Medicine and Allergy, Institute of Inflammation and Repair, Manchester Academic Health Science Centre, University of Manchester, Manchester University National Health Service Foundation Trust, Manchester, United Kingdom

Address correspondence to:

MeiLan K. Han, MD
Division of Pulmonary and Critical Care Medicine
University of Michigan
1500 E. Medical Center Drive
Ann Arbor, MI 48109
Phone: (734) 615-9772
Email: mrking@umich.edu

Abstract

This article does not contain an abstract.

Citation

Citation: Han MK, Criner GJ, Halpin DMG, et al. Any decrease in lung function is associated with worse clinical outcomes: post hoc analysis of the IMPACT interventional trial. J COPD F. 2024; 11(1): 106-113. doi: http://doi.org/10.15326/jcopdf.11.1.2023.0391

Keywords

chronic obstructive pulmonary disease, exacerbations, forced expiratory volume in 1 second, health status, triple therapy

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Click to read Any Decrease in Lung Function is Associated With Worse Clinical Outcomes: Post Hoc Analysis of the IMPACT Interventional Trial

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Author Affiliations

1. Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, United States
2. Medical Nutrition Program, College of Allied Health Professions, University of Nebraska, Omaha, Nebraska, United States

Address correspondence to:

Daniel C. Belz, MD, MPH
5501 Hopkins Bayview Circle
Baltimore MD, 21224
Phone: (410) 550-5405
Email: dbelz2@jhmi.edu

Abstract

Background: Low socioeconomic status (SES) has been associated with worse clinical outcomes in chronic obstructive pulmonary disease (COPD). Food insecurity is more common among individuals with low SES and has been associated with poor outcomes in other chronic illnesses, but its impact on COPD has not been studied.

Methods: Former smokers with spirometry-confirmed COPD were recruited from low-income areas of Baltimore, Maryland, and followed for 9 months as part of a cohort study of diet and indoor air pollution. Food insecurity and respiratory outcomes, including COPD exacerbations and patient-reported outcomes, were assessed at regular intervals. The association between food insecurity and COPD outcomes was analyzed using generalized linear mixed models. Additional analyses examined the association of COPD morbidity with subdomains of food insecurity and the association of food insecurity with psychological well-being measures.

Results: Ninety-nine participants had available data on food insecurity and COPD outcomes. A total of 26.3% of participants were food insecure at 1 or more times during the study. After adjusting for individual SES, neighborhood poverty, and low healthy food access, food insecurity was associated with a higher incidence rate of moderate and severe exacerbations and worse dyspnea, COPD health status, and respiratory-specific quality of life. Subdomains of food insecurity were independently associated with worse patient-reported outcomes. Food insecurity was additionally associated with higher perceived stress.

Discussion: Among former smokers with COPD, food insecurity was associated with a higher incidence of exacerbations, worse patient-reported outcomes, and higher perceived stress. Subdomains of food insecurity were independently associated with worse patient-reported outcomes.

Citation

Citation: Belz DC, Woo H, Jackson MK, et al. Food insecurity is associated with COPD morbidity and perceived stress. J COPD F. 2024; 11(1): 47-55. doi: http://doi.org/10.15326/jcopdf.11.1.2023.0440

Keywords

chronic obstructive pulmonary disease, social determinants of health, food insecurity

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Click to read Food Insecurity is Associated With COPD Morbidity and Perceived Stress

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Author Affiliations

1. Division of Respiratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
2. Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, Washington, United States
3. Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, Washington, United States
4. Department of Health Systems and Population Health, University of Washington, Seattle, Washington, United States
5. Kaiser Permanente Washington, Seattle, Washington, United States

Address correspondence to:

Kevin Duan, MD, MS
Centre for Lung Health at Gordon and Leslie Diamond Health Care Centre
2775 Laurel Street, 7th Floor
Vancouver, British Columbia
Canada, V5Z 1M9
Email: kevin.duan@ubc.ca
Phone: (604) 875-4122

Abstract

Rationale: Prescription formularies specify which medications are available to patients. Formularies change frequently, potentially forcing patients to switch medications for nonclinical indications (nonmedical switching). Nonmedical switching is known to impact disease control and adherence. The consequences of nonmedical switching have not been rigorously studied in COPD.

Methods: We conducted a cohort study of Veterans with COPD on inhaler therapy in January 2016 when formoterol was removed from the Department of Veterans Affairs (VA) national formulary. A 2-point difference-in-differences analysis using multivariable negative binomial and generalized linear models was performed to estimate the association of the formulary change with patient outcomes in the 6 months before and after the change. Our primary outcome was the number of COPD exacerbations in 6 months, with secondary outcomes of total health care encounters and encounter-related costs in 6 months.

Results: We identified 10,606 Veterans who met our inclusion criteria, of which 409 (3.9%) experienced nonmedical switching off formoterol. We did not identify a change in COPD exacerbations (-0.04 exacerbations; 95% confidence interval [CI] -0.12, 0.03) associated with the formulary change. In secondary outcome analysis, we did not observe a change in the number of health care encounters (-0.12 visits; 95% CI -1.00, 0.77) or encounter-related costs ($369; 95% CI -$1141, $1878).

Conclusions: Among COPD patients on single inhaler therapy, nonmedical inhaler switches due to formulary discontinuation of formoterol were not associated with changes in COPD exacerbations, encounters, or encounter-related costs. Additional research is needed to confirm our findings in more severe disease and other settings.

Citation

Citation: Duan KI, Donovan LM, Spece LJ, et al. Inhaler formulary change in COPD and the association with exacerbations, health care utilization, and costs. J COPD F. 2024; 11(1): 37-46. doi: http://doi.org/10.15326/jcopdf.11.1.2023.0425

Keywords

health care utilization, pulmonary disease, chronic obstructive, health care costs

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Click to read Inhaler Formulary Change in COPD and the Association with Exacerbations, Health Care Utilization, and Costs

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Author Affiliations

1. Institute for Applied Health Research, University of Birmingham, Birmingham, United Kingdom
2. Department of Physical Therapy, Jazan University, Jazan, Saudi Arabia
3. Heartlands Hospital, Birmingham, United Kingdom
4. Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom

Address correspondence to:

Alice M. Turner, MBChB, PhD
Institute for Applied Health Research
University of Birmingham
Birmingham, United Kingdom B15 2TT
Phone: +44 (0)7825683519
Email: a.m.turner@bham.ac.uk

Abstract

Background: Alpha-1 antitrypsin deficiency (AATD) is an often-overlooked genetic condition that makes individuals susceptible to early onset of chronic obstructive pulmonary disease (COPD). The established benefits of exercise-based pulmonary rehabilitation (PR) for usual COPD patients are unclear for those with underlying AATD, especially given potentially differing muscle adaptations to exercise. This review seeks to compare PR outcomes between AATD and usual COPD patients and to consolidate current knowledge on exercise intervention outcomes for the AATD population.

Methods: A thorough search of 4 databases (Ovid, Medline, CINAHL, CENTRAL) was conducted based on 3 search concepts: (1) alpha-1 antitrypsin deficiency, (2) pulmonary rehabilitation OR exercise, and (3) muscle morphology. A dual review process and quality assessment were independently implemented throughout all stages of the review.

Results: Four studies highlighted modest exercise capacity and quality of life in AATD patients undergoing PR. However, one study reported unique muscle and mitochondrial responses compared to usual COPD patients. Additionally, a moderate exercise session did not alter pro-inflammatory cytokine levels in AATD patients, despite higher levels of tumor necrosis factor-α levels in muscle biopsies compared to usual COPD patients.

Conclusions: The current literature base insufficiently addresses the efficacy of PR on AATD, with indications that exercise adaptation may deviate from that of usual COPD patients. Further research is needed to optimize PR, particularly in identifying the most suitable exercise intensity, and delivery setting, and addressing specific educational needs for individuals with AATD.

Citation

Citation: Alwadani FA, Wheeler K, Pittaway H, Turner AM. Pulmonary rehabilitation for chronic obstructive pulmonary disease patients with underlying alpha-1 antitrypsin deficiency: a systematic review and practical recommendations. J COPD F. 2024; 11(1): 121-132. doi: http://doi.org/10.15326/jcopdf.11.1.2023.0434

Keywords

chronic obstructive pulmonary disease, alpha-1 antitrypsin deficiency, pulmonary rehabilitation, AATD, exercise therapy

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Click to read Pulmonary Rehabilitation for Chronic Obstructive Pulmonary Disease Patients With Underlying Alpha-1 Antitrypsin Deficiency: A Systematic Review and Practical Recommendations

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Author Affiliations

1. Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, United States
2. Department of Medicine, Feinberg School of Medicine, Northwestern University, New York, New York, United States
3. Graduate School of Biomedical Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, United States
4. Baystate Medical Center, Springfield, Massachusetts, United States
5. Department of Healthcare Delivery and Population Sciences, Chan Medical School-Baystate, University of Massachusetts, Springfield, Massachusetts, United States
6. Division of Pulmonary and Critical Care Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, United States

Address correspondence to:

Alex D. Federman, MD, MPH
Division of General Internal Medicine
Icahn School of Medicine at Mount Sinai
17 East 102^nd Street
Box 1087
New York, NY 10029
Phone: (212) 824-7565
Email: alex.federman@mssm.edu

Abstract

Purpose: To test the feasibility of a novel self-management support intervention for people with chronic obstructive pulmonary disease (COPD).

Methods: We conducted a feasibility randomized controlled trial involving patients ≥40 years with severe or very severe COPD in New York, New York (n=59). Community health workers screened patients and addressed barriers to COPD self-management. Patients were also offered home-based pulmonary rehabilitation (HBPR) and an antibiotic and steroid rescue pack. Control patients received general COPD education. Clinical outcomes for intervention and control were compared by difference-in-differences (DiD) at baseline and 6 months. The study was not powered for statistically significant differences for any measure. Feasibility measures were collected at 6 months.

Results: There were high rates of completion of intervention activities, including 75% of patients undergoing evaluation for and participating in HBPR. Most (92%) intervention patients said the program was very or extremely helpful and 96% said they would participate again. Clinical outcomes generally favored the intervention: COPD assessment test, DiD -1.1 (95% confidence interval [CI] -5.9 to 3.6); 6-minute walk test distance, DiD 7.4 meters (95% CI -45.1 to 59.8); self-reported hospitalizations, DiD -9.8% (95% CI -42.3% to 22.8%); medication adherence, DiD 7.7% (-29.6%, 45.0%), and Physical Activity Adult Questionnaire, DiD 86 (95% CI -283 to 455). Intervention patients reported more emergency department visits, DiD 10.6% (95% CI 17.7% to 38.8%).

Conclusion: A highly patient-centered, self-management support intervention for people with COPD was well received by patients and associated with potential improvements in clinical and self-management outcomes. A fully powered study of the intervention is warranted.

Citation

Citation: Federman AD, O’Conor R, Nnemnbeng J, et al. Feasibility trial of a comprehensive, highly patient-centered COPD self-management support program. J COPD F. 2024; 11(1): 13-25. doi: http://doi.org/10.15326/jcopdf.11.1.2023.0419

Keywords

clinical trials, pulmonary rehabilitation, patient-centered, medication adherence

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Click to read Feasibility Trial of a Comprehensive, Highly Patient-Centered COPD Self-Management Support Program

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Author Affiliations

1. Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
2. University of Louisville School of Medicine, Louisville, Kentucky, United States
3. Department of Bioengineering, School of Engineering, University of Louisville, Louisville, Kentucky, United States
4. Division of Pulmonary, Critical Care, and Sleep Medicine, University of Miami, Miami, Florida, United States

Address correspondence to:

Trishul Siddharthan, MD
1951 NW 7^th St.
Suite 2308
Miami, FL 33136
Email: tsiddhar@miami.edu
Phone: (305) 243-6387

Abstract

The advancement of artificial intelligence (AI) capabilities has paved the way for a new frontier in medicine, which has the capability to reduce the burden of COPD globally. AI may reduce health care-associated expenses while potentially increasing diagnostic specificity, improving access to early COPD diagnosis, and monitoring COPD progression and subsequent disease management. We evaluated how AI can be integrated into COPD diagnosing globally and leveraged in resource-constrained settings.AI has been explored in diagnosing and phenotyping COPD through auscultation, pulmonary function testing, and imaging. Clinician collaboration with AI has increased the performance of COPD diagnosing and highlights the important role of clinical decision-making in AI integration. Likewise, AI analysis of computer tomography (CT) imaging in large population-based cohorts has increased diagnostic ability, severity classification, and prediction of outcomes related to COPD. Moreover, a multimodality approach with CT imaging, demographic data, and spirometry has been shown to improve machine learning predictions of the progression to COPD compared to each modality alone. Prior research has primarily been conducted in high-income country settings, which may lack generalization to a global population. AI is a World Health Organization priority with the potential to reduce health care barriers in low- and middle-income countries. We recommend a collaboration between clinicians and an AI-supported multimodal approach to COPD diagnosis as a step towards achieving this goal. We believe the interplay of CT imaging, spirometry, biomarkers, and sputum analysis may provide unique insights across settings that could provide a basis for clinical decision-making that includes early intervention for those diagnosed with COPD.

Citation

Citation: Robertson NM, Centner CS, Siddharthan T. Integrating artificial intelligence in the diagnosis of COPD globally: a way forward. J COPD F. 2024; 11(1): 114-120. doi: http://doi.org/10.15326/jcopdf.11.1.2023.0449

Keywords

COPD, machine learning, artificial intelligence, prediction, computer tomography

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Click to read Integrating Artificial Intelligence in the Diagnosis of COPD Globally: A Way Forward

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Author Affiliations

1. Department of Intensive Care, The Alfred Hospital, Melbourne, Australia
2. Department of Respiratory Medicine, The Alfred Hospital, Melbourne, Australia
3. College of Medicine and Public Health, Flinders University, South Australia
4. Department of Intensive and Critical Care, Finders Medical Centre, Adelaide, Australia
5. Intensive Care Unit, Peninsula Health, Melbourne, Australia
6. Peninsula Clinical School, Monash University, Frankston, Victoria, Australia
7. Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
8. Central Clinical School, Monash University, The Alfred Hospital, Melbourne, Australia
9. The Australian and New Zealand Intensive Care Society, Centre for Outcome and Resources Evaluation, Melbourne, Victoria, Australia

Address correspondence to:

Professor Shailesh Bihari
Department of Intensive Care Unit
Flinders Medical Centre,
Bedford Park, Australia, 5042<
Email: biharishailesh@gmail.com
Email: biha002@flinders.edu.au

Abstract

Rationale: Frailty is an increasingly recognized aspect of chronic obstructive pulmonary disease (COPD). The impact of frailty on long-term survival after admission to an intensive care unit (ICU) due to an exacerbation of COPD has not been described.

Objective: The objective was to quantify the impact of frailty on time to death up to 4 years after admission to the ICU in Australia and New Zealand for an exacerbation of COPD.

Methods: We performed a multicenter retrospective cohort study of adult patients admitted to 179 ICUs with a primary diagnosis of an exacerbation of COPD using the Australian and New Zealand Intensive Care Society Adult Patient Database from January 1, 2018, through December 31, 2020, in New Zealand, and March 31, 2022, in Australia. Frailty was measured using the clinical frailty scale (CFS). The primary outcome was survival up to 4 years after ICU admission. The secondary outcome was readmission to the ICU due to an exacerbation of COPD.

Measurements and Main Results: We examined 7126 patients of which 3859 (54.1%) were frail (CFS scores of 5–8). Mortality in not-frail individuals versus frail individuals at 1 and 4 years was 19.8% versus 40.4%, and 56.8% versus 77.3% respectively (both p<0.001). Frailty was independently associated with a shorter time to death (adjusted hazard ratio 1.66; 95% confidence interval 1.54–1.80).There was no difference in the proportion of survivors with or without frailty who were readmitted to the ICU during a subsequent hospitalization.

Conclusion: Frailty was independently associated with poorer long-term survival in patients admitted to the ICU with an exacerbation of COPD.

Citation

Citation: Donnan MT, Bihari S, Subramaniam A, Dabscheck EJ, Riley B, Pilcher DV. The long-term impact of frailty after an intensive care unit admission due to chronic obstructive pulmonary disease. J COPD F. 2024; 11(1): 83-94. doi: http://doi.org/10.15326/jcopdf.11.1.2023.0453

Keywords

COPD, mortality, readmission, frailty, intensive care

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Click to read The Long-Term Impact of Frailty After an Intensive Care Unit Admission Due to Chronic Obstructive Pulmonary Disease

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Author Affiliations

1. Department of Pulmonary Medicine, North Zealand Hospital Hillerød, Copenhagen, Denmark
2. Department of Pulmonary Medicine, Herlev/Gentofte Hospital, Copenhagen, Denmark
3. Department of Medicine, Hospital Little Belt, Vejle, Denmark
4. Department of Regional Health Research, University of Southern Denmark, Odense, Denmark

Address correspondence to:

Anders Løkke, DrMed, MD
Department of Medicine
Hospital Little Belt
Vejle, Denmark
Email: aloekke@gmail.com
Phone: 0045 28894197

Abstract

Background: Chronic obstructive pulmonary disease is a chronic, often progressive disease, which in most patients is caused by tobacco smoking. Our study focuses on differences in COPD-related outcomes between never smokers, former smokers, and current smokers.

Methods: A nationwide, population-based cohort study utilizing Danish health registries. Clinical and socioeconomic variables including smoking status, comorbidities, and dyspnea were obtained. Poisson and Cox Regression were used to calculate the impact of these clinical parameters on the risk of moderate and severe exacerbations and mortality during 12 months of follow-up.

Results: A total of 49,826 patients ≥40 years of age, with a hospital diagnosis of COPD in 2008–2017, were identified (mean age 69.2 years, 52% females). A total of 2127 (4%) were never smokers, 29,854 (60%) were former smokers and 17,845 (36%) current smokers. Compared to former and current smokers, never smokers reported a lower modified Medical Research Council score and had a milder COPD stage according to the Global Initiative for Chronic Obstructive Lung Disease classification. During follow-up, never smokers had a significantly lower risk of severe exacerbations (hazard ratio 0.87, 95% confidence interval [CI] 0.78–0.97) and a lower rate of death (mortality ratio 0.75, 95% CI 0.70–0.81) compared to patients with a smoking history.

Discussion: Our nationwide study showed that COPD in never smokers is characterized by a lower level of dyspnea, milder lung function impairment, and a lower risk of exacerbations and death. At the same time, we found active smokers to have the highest risk. These findings highlight the need for campaigns to prevent smoking and may help general practitioners as well as other health care professionals to motivate patients with COPD to stop smoking.

Citation

Citation: Nielsen AO, Lange P, Hilberg O, Farver-Vestergaard I, Ibsen R, Løkke A. COPD and smoking status – it does matter: characteristics and prognosis of COPD according to smoking status. J COPD F. 2024; 11(1): 56-67. doi: http://doi.org/10.15326/jcopdf.11.1.2023.0433

Keywords

COPD, exacerbations, smoking, never smokers, prognosis

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Click to read COPD and Smoking Status – It Does Matter: Characteristics and Prognosis of COPD According to Smoking Status

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Author Affiliations

1. Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, United States
2. Case Western Reserve University School of Medicine, Cleveland, Ohio, United States
3. University Hospitals Cleveland Medical Center, Cleveland, Ohio, United States
4. Cleveland Clinic Foundation, Cleveland, Ohio, United States

Address correspondence to:

Christopher Di Felice, MD
Department of Pulmonary and Critical Care Medicine
Louis Stokes Cleveland Department of Veterans Affairs Medical Center
Cleveland, OH 44106
Phone: (216)791-3800 ext. 66270
Email: Christopher.DiFelice@va.gov

Abstract

Bronchoscopic lung volume reduction (BLVR) is a minimally invasive treatment option for patients with severe emphysema and hyperinflation refractory to optimal medical care. This therapy is effective in improving functional status and quality of life, underscoring the importance of identifying potential procedure candidates. To our knowledge, scalable strategies to improve the referral of advanced lung disease patients are lacking. This quality improvement project aimed to increase identification and referral for BLVR in a large Veterans Affairs academic medical center. We show implementing case identification within a pulmonary function testing report, in conjunction with provider education, increased referral rates for BLVR. Because of the ubiquity of lung function testing, other advanced lung disease programs may consider adopting this strategy to improve patients’ access to timely clinical evaluation and therapy.

Citation

Citation: Di Felice C, Strumpf ZB, Edmiston EA, et al. Improving referral patterns for bronchoscopic lung volume reduction: a quality improvement initiative. J COPD F. 2024; 11(1): 95-100. doi: http://doi.org/10.15326/jcopdf.11.1.2023.0397

Keywords

bronchoscopic lung volume reduction, quality of care, pulmonary function testing

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Click to read Improving Referral Patterns for Bronchoscopic Lung Volume Reduction: A Quality Improvement Initiative

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Author Affiliations

1. Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
2. Lung Health Center, University of Alabama at Birmingham, Birmingham, Alabama, United States
3. Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
4. Acute Care Service, Birmingham VA Medical Center, Birmingham, Alabama, United States
5. Division of Biostatistics, University of Minnesota, Minneapolis, Minnesota, United States
6. Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan, United States
7. Division of Pulmonary and Critical Care Medicine, Northwestern University, Chicago, Illinois, United States
8. Department of Thoracic Medicine and Surgery, Temple University, Philadelphia, Pennsylvania, United States
9. Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, Maryland, United States

Address correspondence to:

R. Chad Wade, MD
Division of Pulmonary, Allergy, and Critical Care Medicine
University of Alabama at Birmingham
Phone: (205) 934-5555
Email: rcwade@uabmc.edu

Abstract

Introduction: In 2019, the Beta-Blockers for the Prevention of Acute Exacerbations of Chronic Obstructive Pulmonary Disease study (BLOCK-COPD) evaluated the effect of metoprolol on exacerbation risk and mortality in a COPD population without indications for beta-blocker use. We hypothesized that an imaging metric of coronary artery disease (CAD), the coronary artery calcium (CAC) score, would predict exacerbation risk and identify a differential response to metoprolol treatment.

Methods: The study population includes participants in the BLOCK-COPD study from multiple study sites. Participants underwent clinically indicated thoracic computed tomography (CT) scans ± 12 months from enrollment. The Weston scoring system quantified CAC. Adjusted Cox proportional hazards models evaluated for associations between CAC and time to exacerbation.

Results: Data is included for 109 participants. The mean CAC score was 5.1±3.7, and 92 participants (84%) had CAC scores greater than 0. Over a median (interquartile range) follow-up time of 350 (280 to 352) days, there were 61 mild exacerbations and 19 severe/very severe exacerbations. No associations were found between exacerbations of any severity and CAC>0 or total CAC. Associations were observed between total CAC and CAC>0 in the left circumflex (LCx) and time to exacerbation of any severity (adjusted hazard ratio [aHR]=1.39, confidence interval [CI]: 1.08–1.79, p=0.01) and (aHR=1.96, 95% CI: 1.04–3.70, p= 0.04), respectively.

Conclusion: CAD is a prevalent comorbidity in COPD accounting for significant mortality. Our study confirms the high prevalence of CAD using the CAC score; however, we did not discover an association between CAC and exacerbation risk. We did find novel associations between CAC in the LCx and exacerbation risk which warrant further investigation in larger cohorts.

Citation

Citation: Wade RC, Ling SX, Helgeson ES, et al. Associations between coronary artery calcium score and exacerbation risk in BLOCK-COPD. J COPD F. 2024; 11(1): 101-105. doi: http://doi.org/10.15326/jcopdf.11.1.2023.0423

Keywords

COPD, acute exacerbations, coronary artery calcium, beta-blockers

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Click to read Associations Between Coronary Artery Calcium Score and Exacerbation Risk in BLOCK-COPD

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Author Affiliations

1. Medical University of South Carolina, Charleston, South Carolina, United States
2. AlphaNet, Inc., Coral Gables, Florida, United States
3. National Jewish Health, Denver, Colorado, United States

Address correspondence to:

Charlie Strange, MD
MSC630
Medical University of South Carolina
Charleston, SC 29425
Email: strangec@musc.edu

Abstract

Background: Currently approved therapies for individuals with alpha-1 antitrypsin deficiency (AATD) are intravenously infused products. The burdens and demographics of infusion practices in the United States are not well-characterized.

Research Question: What is the prevalence of different infusion practices in the United States?

Study Design and Methods: AlphaNet disease management participants completed a survey that captured current and past infusion practices. Data regarding the reasons for choosing their current infusion practice, problems with past infusion practices, resources required, and support services utilized were collected from February 8, 2022 through July 1, 2022.

Results: Among 5266 individuals, infusions happened at home by health care providers (60.2%), at infusion clinics (30.6%), and by self-infusion (8.1%). Self-infusion prevalence increased with time on therapy and was more prevalent in younger individuals (61.2 ± 10.5 years) compared to users of other infusion practices (64.1 ± 11.0 years), (p<0.001). The perceived benefits of self-infusion included: (1) freedom and flexibility (77.9%), (2) ability to travel (44.5%), (3) avoidance of infusion clinics (41.8%), (4) time-savings (35.9%), (5) less absence from work (26.6%), (6) less exposure to infections (22.1%), and (7) less cost (16.4%). Self-infusion was done through permanent intravenous catheters in 41.2% and peripheral intravenous catheters in 58.3%. Self-infusers were more satisfied (93.1% “very satisfied”) than other groups. Among individuals currently infusing with home nurses or in clinics, 21.4% would consider self-infusing in the future.

Interpretation: Self-infusion of alpha-1 antitrypsin is feasible and associated with high satisfaction scores. Recommendations for catheter care, infusion support, and cost management are informed by survey results.

Citation

Citation: Strange C, Allison S, McCathern J, Sandhaus RA, Holm KE. Augmentation therapy for alpha-1 antitrypsin deficiency: patient experiences with self-infusion, home providers, and clinics. J COPD F. 2023; 10(4): 392-399. doi: http://doi.org/10.15326/jcopdf.10.4.2023.0430

Keywords

COPD, alpha-1 antitrypsin deficiency, AATD, antitrypsin, self-infusion

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Click to read Augmentation Therapy for Alpha-1 Antitrypsin Deficiency: Patient Experiences With Self-Infusion, Home Providers, and Clinics

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Author Affiliations

1. Molecular Immunology Research Center, Tehran University of Medical Sciences, Tehran, Iran
2. Thoracic Research Center, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
3. Center for Air Pollution Research, Institute for Environmental Research, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran

Address correspondence to:

Maryam Edalatifard, MD
Thoracic Research Center
Imam Khomeini Hospital
Tehran University of Medical Sciences
Tehran, Iran
Email: m-edalatifard@tums.ac.ir

Abstract

Background: Chronic obstructive pulmonary disease (COPD) is characterized by progressive obstruction of airways due to chronic inflammation. Both genetic and environmental components are risk factors for COPD. The most common cause of COPD is smoking. However, evidence suggests that 17% to 38% of COPD patients are nonsmokers, so other factors like air pollution may also play a role.

Objective: The relationship between serum exosomes and exposure to particulate matter (PM) <2.5 and 10 micrometers (µm) in the residing environment of COPD patients and healthy groups was investigated. The correlation between inflammatory cytokine levels with exosome count was also studied.

Methods: Peripheral blood samples were taken from 20 COPD patients without a smoking history or a family history of COPD, along with 20 nonsmoker healthy controls. The serum exosomes were counted by flow cytometry using a CD81 marker. The exposure to PM_2.5 and PM₁₀ was measured in daily, weekly, and monthly intervals based on the longitudinal measurements of the monitoring stations, and the correlation between exosome count and air pollutants was analyzed.

Results: The serum CD81+ exosome count in COPD patients was significantly elevated compared to the healthy controls and this was correlated with daily PM₁₀ (P-value=0.02) and monthly PM_2.5 (P-value=0.02) exposure. Although interferon-gamma levels of COPD patients were higher than healthy controls, there was no correlation between exosome count and cytokine level.

Conclusion: Considering the significant relationship between air pollutants and the count of serum exosomes demonstrated in the present study, air pollution might be a considerable risk factor in the progression of airway inflammation.

Citation

Citation: Soleimanifar N, Assadiasl S, Kalateh E, et al. Circulating exosomes and ambient air pollution exposure in COPD. J COPD F. 2023; 10(4): 412-421. doi: http://doi.org/10.15326/jcopdf.10.4.2023.0400

Keywords

chronic obstructive pulmonary disease, inflammation, particulate matter, exosomes, ambient air pollution

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Click to read Circulating Exosomes and Ambient Air Pollution Exposure in COPD

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Author Affiliations

1. Institute of General Practice and Family Medicine, Interdisciplinary Center for Health Sciences, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
2. Institute of Medical Epidemiology, Biostatistics and Informatics, Interdisciplinary Center for Health Sciences, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
3. Department of Physiotherapy, Regional Hospital Bamenda, North-West Region, Bamenda, Cameroon
4. Research Organization for Health Education and Rehabilitation-Cameroon, Bamenda, Cameroon
5. African Regional Community, Guidelines International Network, Bamenda, Cameroon
6. Faculty of Medicine, Department of General Practice, University of Leipzig, Leipzig, Germany
7. School of Public Health, Preventive Medicine, Addis Ababa University, Addis Ababa, Ethiopia

Address correspondence to:

Eric Sven Kroeber, MS
Institute of General Practice and Family Medicine
Center for Health Sciences
Martin-Luther-University-Halle-Wittenberg
Magdeburger Str. 8, 06112
Halle (Salle), Germany
Email: eric.kroeber@posteo.de

Abstract

Background: The rising burden of chronic obstructive pulmonary disease (COPD) in African countries is attributed to the growing and aging of the populations, lifestyles, and environmental changes. This systematic review aims to map the available evidence on COPD interventions in Africa.

Methods: We performed a systematic search in 6 databases (including local African databases) and registries with updates through January 2022. We included randomized controlled trials (RCTs) that included patients diagnosed with COPD and were conducted in Africa, studying outcomes on acute respiratory episodes and rates, physical and functional abilities, and adverse events. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The study quality was assessed using the Cochrane risk of bias tool. We primarily summarized the results in narrative form.

Results: Out of 1594 identified publications, we included 18 studies with a total of 1504 participants, conducted in Egypt, South Africa, and Tunisia. Eight studies investigated interventions for patients in stable phases treated in outpatient settings, and 10 included patients with acute COPD exacerbations treated in emergency or intensive care settings. The interventions mainly included ventilatory support and pharmacological and rehabilitative interventions. Reported treatment effects were heterogeneous, ranging from no beneficial effects to clinically relevant benefits.

Conclusions: The included studies were conducted in countries with high infrastructural development and half of them were set in intensive care units. Despite the paucity of RCTs on COPD management, research activities have been increasing over the last several years.

Citation

Citation: Kroeber ES, Frese T, Kantelhardt EJ, et al. Randomized controlled trials on chronic obstructive pulmonary disease in Africa: a systematic review. J COPD F. 2023; 10(4): 422-436. doi: http://doi.org/10.15326/jcopdf.10.4.2023.0387

Keywords

systematic review, non-communicable diseases, chronic lung diseases, pulmonology, randomized controlled trials

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Click to read Randomized Controlled Trials on Chronic Obstructive Pulmonary Disease in Africa: A Systematic Review

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Author Affiliations

1. Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
2. University of Cincinnati School of Medicine, Cincinnati, Ohio, United States
3. Division of Pulmonary and Critical Care Medicine, University of Cincinnati, Cincinnati, Ohio, United States
4. Pacific Northwest National Laboratory, Richland, Washington, United States
5. Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
6. Arkansas Children's Research Institute, Little Rock, Arkansas, United States

Address correspondence to:

Brian Varisco, MD
Arkansas Children's Research Institute
13 Children's Way
Little Rock, AR 72202
Phone: (501) 364-7373
Email: BVarisco@uams.edu

Abstract

Chymotrypsin-like elastase 1 (CELA1) is a serine protease that is neutralized by alpha-1antitrypsin (AAT) and prevents emphysema in a murine antisense oligonucleotide model of AAT-deficient emphysema. Mice with genetic ablation of AAT do not have emphysema at baseline but develop emphysema with injury and aging. We tested the role of the CELA1 gene in emphysema development in this genetic model of AAT-deficiency following tracheal lipopolysaccharide (LPS), 10 months of cigarette smoke exposure, aging, and a low-dose tracheal porcine pancreatic elastase (LD-PPE) model we developed. In this last model, we performed proteomic analysis to understand differences in lung protein composition. We were unable to show that AAT-deficient mice developed more emphysema than wild type with escalating doses of LPS. In the LD-PPE model, AAT-deficient mice developed significant and progressive emphysema from which Cela1^-/- & AAT-deficient mice were protected. Cela1^-/-& AAT-deficient lungs had more matrix-associated proteins than AAT-deficientlungs but also had more leukocyte-associated proteases. With cigarette smoke exposure, Cela1^-/- &AAT-deficient mice had more emphysema than AAT-deficient mice but had less myeloperoxidase activity. Cela1^-/-&AAT-deficient mice had less age-related airspace simplification than AAT-deficient and were comparable to wild type. While CELA1 promotes inflammation-independent emphysema progression and its absence preserves the lung matrix in multiple models of AAT-deficient emphysema, for unclear reasons Cela1 deficiency is associated with increased emphysema with cigarette smoke. While anti-CELA1 therapies could potentially be used to prevent emphysema progression in AAT deficiency after smoking cessation, an understanding of why and how cigarette smoke exacerbates emphysema in Cela1 deficiency and whether AAT replacement therapy mitigates this effect is needed first.

Citation

Citation: Devine AJ, Smith NJ, Joshi R, et al. Chymotrypsin-like elastase-1 mediates progressive emphysema in alpha-1 antitrypsin deficiency. J COPD F. 2023; 10(4): 380-391. doi: http://doi.org/10.15326/jcopdf.10.4.2023.0416

Keywords

COPD, emphysema, alpha-1 antitrypsin, protease

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Click to read Chymotrypsin-like Elastase-1 Mediates Progressive Emphysema in Alpha-1 Antitrypsin Deficiency

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Author Affiliations

1. Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina, Charleston, South Carolina, United States
2. AlphaNet, Inc., Coral Gables, Florida, United States
3. Department of Medicine, National Jewish Health, Denver, Colorado, United States

Address correspondence to:

Charlie Strange, MD
MSC630
Medical University of South Carolina
Charleston, SC, 29425
Phone: (843) 792-3174
Email: strangec@musc.edu

Abstract

Background: Individuals with alpha-1 antitrypsin deficiency (AATD)-associated chronic obstructive pulmonary disease (COPD) may be at increased risk of coronavirus disease 2019 (COVID-19) pneumonia since COPD is associated with an increased risk of severe COVID-19 infection.

Research Question: We hypothesized that the AlphaNet disease management program would lower COVID-19 burdens. We evaluated the prevalence of COVID-19 infection, severe COVID-19, interruptions in augmentation therapy, and intention to vaccinate.

Study Design and Methods: Data regarding COVID-19 were collected monthly from March 2020 through February 2022. Responses from 8019 individuals were analyzed to evaluate the prevalence and severity of COVID-19 infections, interruptions in AATD care, and the likelihood of vaccination.

Results: By the end of 2020, 4% of patients reported a positive COVID-19 test. Of those, 35.3% were hospitalized, with 8.6% admitted to the intensive care unit (ICU). By February 2022, the prevalence of COVID-19 infections had increased to 18.6%, with hospitalization rates of 22.1% and ICU admissions at 4.7%. Attitudes about COVID-19 vaccination assessed in December 2020 before the vaccine was widely available suggested 10.3% of patients would definitely not get the vaccine. Notably, 38.2% of those subsequently self-reported receipt of a COVID-19 vaccine.

Interpretation: The prevalence of COVID-19 infections in patients with AATD was lower than the prevalence in the general U.S. population during 2020, although with a higher hospitalization rate. This health-managed population has a high vaccination intent. Those with an initially low vaccination intent changed their minds over time. We interpret these results as showing that most AlphaNet individuals with AATD had success at navigating the COVID-19 pandemic with lower case rates than the general U.S. population.

Citation

Citation: Hay M, Holm KE, McCathern J, Sandhaus RA, Strange C. Impact of coronavirus disease 2019 and vaccination attitudes on alpha-1 antitrypsin deficiency. J COPD F. 2023; 10(4): 335-342. doi: http://doi.org/10.15326/jcopdf.10.4.2023.0406

Keywords

COPD, alpha-1 antitrypsin deficiency, AATD, COVID-19, antitrypsin

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Click to read Impact of Coronavirus Disease 2019 and Vaccination Attitudes on Alpha-1 Antitrypsin Deficiency

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Author Affiliations

1. Institute of Medical Information, Chinese Academy of Medical Sciences, Beijing, China
2. Department of Occupational and Environmental Health, School of Public Health, Capital Medical University, Beijing, China

Address correspondence to:

Meimei Xu, PhD
Email: xumeimei2005@163.com
Tel.:+86 10 52328713
Xinying An, PhD
Email: an.xinying@imicams.ac.cn
Tel.: +86 10 52328710

Abstract

Background: Despite studies investigating the publication rates and factors influencing publication outcomes of clinical trials in some disease fields, there is a notable lack of research focusing on chronic obstructive pulmonary disease (COPD) clinical trials. This study aims to explore the characteristics of COPD-related clinical trials and identify factors associated with publication status and publication time.

Methods: A systematic search was conducted on the World Health Organization International Clinical Trials Registry Platform on April 28, 2022, to identify completed interventional clinical trials related to COPD. Various trial features were analyzed, and factors influencing publication status and time were examined.

Results: A total of 2577 completed interventional clinical trials focusing on COPD were identified. A total of 42.76% of trials enrolled ≤50 participants. The majority of trials were randomized (81.72%), blind (57.39%), parallel-assignment (59.14%), single-center (51.30%), multi-arm (83.86%), nonindustry funded (52.00%), and conducted for therapeutic purposes (73.11%). The 2-year cumulative publication rate was found to be 27.9%. The median time of study duration, dissemination lag, and publication lag were 17.27, 21.07, and 24.70 months, respectively. Multivariate analysis revealed that sample size, blind design, and study phase significantly influenced the likelihood of publication, while intervention model, primary purpose, study phase, funder, and study duration were significant factors affecting publication time.

Conclusion: The findings highlight the inadequacy of large multi-center interventional clinical trials for COPD and indicate a low 2-year cumulative publication rate. Strengthening collaboration among investigators and adopting scientifically robust designs for larger phase 3 clinical trials are crucial to advancing COPD research and enhancing publication outcomes.

Citation

Citation: Xu M, Wang J, Shan L, An X. The current landscape of COPD-related clinical trials registered on the World Health Organization's International Clinical Trials Registry Platform: a comprehensive analysis of study characteristics and publication status. J COPD F. 2023; 10(4): 400-411. doi: http://doi.org/10.15326/jcopdf.10.4.2023.0417

Keywords

COPD, clinical trials, publication rate, publication status, publication time

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Click to read The Current Landscape of COPD-Related Clinical Trials Registered on the World Health Organization’s International Clinical Trials Registry Platform: A Comprehensive Analysis of Study Characteristics and Publication Status

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Author Affiliations

1. Mindful Breathing Laboratory, Division of Pulmonary, Critical Care, and Sleep Medicine, Mayo Clinic, Rochester, Minnesota, United States
2. Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, United States

Address correspondence to:

Roberto Benzo, MD, MS
Mindful Breathing Laboratory
Mayo Clinic
200 First St. SW
Rochester, MN 55902
Email: benzo.roberto@mayo.edu

Abstract

Citation

Citation: Benzo MV, Barwise A, Clark MM, Dupuy-McCauley K, Roy M, Benzo RP. Improving dyspnea by targeting weight loss in patients with chronic obstructive lung disease and severe obesity through health coaching and remote monitoring. J COPD F. 2023; 10(4): 444-449. doi: http://doi.org/10.15326/jcopdf.10.4.2023.0404

Keywords

quality of life, dyspnea, obesity

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Click to read Improving Dyspnea by Targeting Weight Loss in Patients With Chronic Obstructive Lung Disease and Severe Obesity Through Health Coaching and Remote Monitoring

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Author Affiliations

1. Mayo Clinic, Rochester, Minnesota, United States
2. New York University Grossman School of Medicine, New York, New York, United States
3. University of Connecticut School of Medicine, Farmington, Connecticut, United States
4. Georgetown University Hospital, Washington, District of Columbia, United States

Address correspondence to:

Timothy R. Aksamit, MD
Pulmonary Disease and Critical Care Medicine
Mayo Clinic
Rochester, Minnesota
Email: aksamit.timothy@mayo.edu

Abstract

Citation

Citation: Aksamit TR, Emery EJ, Basavaraj A, Metersky ML, O'Donnell AE, Addrizzo-Harris DJ. The 6th World Bronchiectasis and Nontuberculous Mycobacteria Conference abstract presentations. J COPD F. 2023; 10(4): 450-516. doi: http://doi.org/10.15326/jcopdf.10.4.2023.0464

Keywords

bronchiectasis, nontuberculous mycobacteria, 6th World Bronchiectasis and NTM Conference

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Click to read The 6th World Bronchiectasis and Nontuberculous Mycobacteria Conference Abstract Presentations

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Author Affiliations

1. Division of Pulmonary and Critical Care Medicine, Weill Cornell Medicine, New York, New York, United States
2. Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States
3. Division of General Internal Medicine, Weill Cornell Medicine, New York, New York, United States
4. Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, University of California San Francisco, San Francisco, California, United States
5. Division of Pulmonary and Critical Care Medicine, University of Michigan Health System, Ann Arbor, Michigan, United States
6. Division of Cardiology, Weill Cornell Medicine, New York, New York, United States
7. Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, United States

Address correspondence to:

Jamuna K. Krishnan, MD
Division of Pulmonary and Critical Care Medicine
Weill Cornell Medicine
1305 York Avenue Y-1047, Box 96
Phone: (646) 962-2333
Email: jkk9002@med.cornell.edu

Abstract

Rationale: Cardiovascular disease (CVD) affects the prognosis of patients with chronic obstructive pulmonary disease (COPD). Black women with COPD have a disproportionate risk of CVD-related mortality, yet disparities in CVD prevention in COPD are unknown.

Objectives: We aimed to identify race-sex differences in the receipt of statin treatment for CVD prevention, and whether these differences were explained by factors influencing health care utilization in the REasons for Geographic And Racial Differences in Stroke (REGARDS) COPD study sub-cohort.

Methods: We conducted a cross-sectional analysis among REGARDS Medicare beneficiaries with COPD. Our primary outcome was the presence of statin on in-home pill bottle review among individuals with an indication. Prevalence ratios (PR) for statin treatment among race-sex groups compared to White men were estimated using Poisson regression with robust variance. We then adjusted for covariates previously shown to impact health care utilization.

Results: Of the 2032 members within the COPD sub-cohort with sufficient data, 1435 participants (19% Black women, 14% Black men, 28% White women, and 39% White men) had a statin indication. All race-sex groups were less likely to receive statins than White men in unadjusted models. After adjusting for covariates that influence health care utilization, Black women (PR 0.76, 95% confidence interval [CI] 0.67 to 0.86) and White women (PR 0.84 95% CI 0.76 to 0.91) remained less likely to be treated compared to White men.

Conclusion: All race-sex groups were less likely to receive statin treatment in the REGARDS COPD sub-cohort compared to White men. This difference persisted in women after controlling for individual health care utilization factors, suggesting structural interventions are needed.

Citation

Citation: Krishnan JK, Mallya SG, Nahid M, et al. Disparities in guideline-concordant statin treatment in individuals with COPD. J COPD F. 2023; 10(4): 369-379. doi: http://doi.org/10.15326/jcopdf.10.4.2023.0395

Keywords

COPD, comorbidity, cardiovascular disease, health delivery

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Click to read Disparities in Guideline-Concordant Statin Treatment in Individuals With Chronic Obstructive Pulmonary Disease

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Author Affiliations

1. Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
2. Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States
3. Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States
4. Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
5. Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
6. Division of General Internal Medicine and Primary Care, Brigham and Women’s Hospital, Boston, Massachusetts, United States

Address correspondence to:

Junxiang Chen, PhD
Department of Biomedical Informatics
University of Pittsburgh
5607 Baum Blvd
Pittsburgh, PA 15206
Phone: (412) 624-5100
Email: juc91@pitt.edu

Abstract

Rationale: Chronic obstructive pulmonary disease (COPD) is characterized by pathologic changes in the airways, lung parenchyma, and persistent inflammation, but the links between lung structural changes and blood transcriptome patterns have not been fully described.

Objectives: The objective of this study was to identify novel relationships between lung structural changes measured by chest computed tomography (CT) and blood transcriptome patterns measured by blood RNA sequencing (RNA-seq).

Methods: CT scan images and blood RNA-seq gene expression from 1223 participants in the COPD Genetic Epidemiology (COPDGene^®) study were jointly analyzed using deep learning to identify shared aspects of inflammation and lung structural changes that we labeled image-expression axes (IEAs). We related IEAs to COPD-related measurements and prospective health outcomes through regression and Cox proportional hazards models and tested them for biological pathway enrichment.

Results: We identified 2 distinct IEAs: IEA_emph which captures an emphysema-predominant process with a strong positive correlation to CT emphysema and a negative correlation to forced expiratory volume in 1 second and body mass index (BMI); and IEA_airway which captures an airway-predominant process with a positive correlation to BMI and airway wall thickness and a negative correlation to emphysema. Pathway enrichment analysis identified 29 and 13 pathways significantly associated with IEA_emph and IEA_airway, respectively (adjusted p<0.001).

Conclusions: Integration of CT scans and blood RNA-seq data identified 2 IEAs that capture distinct inflammatory processes associated with emphysema and airway-predominant COPD.

Citation

Citation: Chen J, Xu Z, Sun L, et al. Deep learning integration of chest computed tomography and gene expression identifies novel aspects of COPD. J COPD F. 2023; 10(4): 355-368. doi: http://doi.org/10.15326/jcopdf.10.4.2023.0399

Keywords

emphysema, genomics, machine learning

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Click to read Deep Learning Integration of Chest Computed Tomography Imaging and Gene Expression Identifies Novel Aspects of COPD

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Author Affiliations

1. Division of Pulmonary, Critical Care, and Sleep Medicine, Yale University School of Medicine, New Haven, Connecticut, United States
2. Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, United States
3. Veterans Affairs Puget Sound Health Services Research and Development, Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, Washington, United States
4. Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, Washington, United States
5. Patient Advisory Board, American Lung Association, Chicago, Illinois, United States
6. Division of Pulmonary, Critical Care, Sleep, and Allergy, Department of Medicine, University of Illinois Chicago, Chicago, Illinois, United States
7. Office of Population Health Sciences, University of Illinois-Chicago, Chicago, Illinois, United States

Address correspondence to:

Sandra E. Zaeh, MD, MS
Division of Pulmonary, Critical Care, and Sleep Medicine
Yale University School of Medicine
333 Cedar Street
New Haven, CT 06510
Phone: (908) 938-0982
E-mail: sandra.zaeh@yale.edu

Abstract

Purpose: While home oxygen therapy increases survival in patients with chronic obstructive pulmonary disease (COPD) who have severe resting hypoxemia, recent evidence suggests that there is no survival benefit of home oxygen for patients with COPD who have isolated exertional desaturation. We aimed to understand clinician practice patterns surrounding the prescription of home oxygen for patients with COPD.

Methods: We conducted semi-structured qualitative interviews via videoconference with 15 physicians and 3 nurse practitioners who provide care for patients with COPD. Clinicians were recruited through the American Lung Association Airways Clinical Research Centers. Interview guides were created with the assistance of patient investigators and included questions regarding clinician practices surrounding the prescription of oxygen for patients with COPD and the use of clinical guidelines. Interviews were recorded, transcribed, and coded for themes.

Results: Of the 18 clinician interviewees, one-third were women, with most participants (n=11) being < 50 years old. Results of the semi-structured interviews suggested research evidence, clinical experience, and patient preferences contributed to clinician decision-making. Most clinicians described a shared decision-making process for prescribing home oxygen for patients, including discussion of risks and benefits, and developing an understanding of patient values and preferences. Clinicians did not use a structured tool to conduct these conversations.

Conclusion: Clinicians consider a number of patient and clinical factors when prescribing home oxygen therapy, often using a shared decision-making process. Tools to support shared decision-making about the use of home oxygen are needed.

Citation

Citation: Zaeh SE, Case M, Au DH, et al. Clinical practices surrounding the prescription of home oxygen in patients with COPD and desaturation. J COPD F. 2023; 10(4): 343-354. doi: http://doi.org/10.15326/jcopdf.10.4.2023.0402

Keywords

obstructive lung disease, patient preferences, qualitative research, shared decision-making

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Click to read Clinical Practices Surrounding the Prescription of Home Oxygen in Patients With COPD and Desaturation

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Author Affiliations

1. Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
2. Monitored Therapeutics, Inc., Dublin, Ohio, United States
3. Midmark Corporation, Versailles, Ohio, United States
4. Division of Pulmonary Diseases and Critical Care Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States

Address correspondence to:

M. Bradley Drummond, MD, MHS
University of North Carolina at Chapel Hill
Marsico Hall Room 7207, CB#7248
Chapel Hill, NC 27599
Phone: (919) 966-7054
Email: brad_drummond@med.unc.edu

Abstract

Citation

Citation: Rydberg M, Burkett P, Johnson E, Drummond MB. Home telemonitoring program in individuals with COPD during the coronavirus disease 2019 pandemic: a pilot study. J COPD F. 2023; 10(4): 437-443. doi: http://doi.org/10.15326/jcopdf.10.4.2023.0431

Keywords

COPD, telemonitoring, home spirometry

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Click to read Home Telemonitoring Program in Individuals With COPD During the Coronavirus Disease 2019 Pandemic: A Pilot Study

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Author Affiliations

1. Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States
2. Department of Environmental Health Sciences and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland

Address correspondence to:

Sarath Raju MD, MPH
Division of Pulmonary and Critical Care Medicine
Johns Hopkins University
5501 Hopkins Bayview Circle 4^th Floor
Baltimore, MD, 21224
Phone: (410) 550-2511
Email: sraju3@jhmi.edu

Abstract

Current measures of chronic obstructive pulmonary disease (COPD) severity, including lung function, do not fully explain symptom burden, and there is a need to identify predictors of exacerbation risk and morbidity. Autonomic dysfunction may be implicated in both cardiovascular and respiratory morbidity in COPD and convey risk for exacerbations. Heart rate variability (HRV) is a marker of cardiac autonomic function that is predictive of cardiovascular health and has promise as a non-invasive COPD biomarker. The CLEAN AIR Heart study provided an opportunity to investigate the association between HRV and COPD morbidity among former smokers with moderate-severe COPD. Eighty-five participants, contributing 305 HRV measurements, underwent repeated clinical assessments over 4 study periods that included a 24-Holter monitoring assessment of HRV. HRV measures of interest were standard deviation of normal-to-normal intervals, (SDNN) (overall HRV) and root-mean-square of successive differences (RMSSD) (parasympathetic function). Exacerbation risk was assessed using negative binomial models, and mixed-effects models analyzed associations between HRV and symptoms. Decreases in SDNN (incidence rate ratio [IRR]1.40; 95% confidence interval [CI] 1.13 to1.74) and RMSSD (IRR 1.60; 95% CI 1.07 to 2.37) were associated with severe exacerbation risk. Decreases in SDNN were associated with higher St George’s Respiratory Questionnaire scores, COPD Assessment Test scores, and chronic bronchitis symptoms. Findings demonstrate that HRV is associated with COPD symptom burden and exacerbation risk. HRV may represent an important biomarker with the potential to identify high-risk COPD populations.

Citation

Citation: Raju S, Woo H, Fawzy A, et al. Decreased cardiac autonomic function is associated with higher exacerbation risk and symptom burden in chronic obstructive pulmonary disease. J COPD F. 2023; 10(3): 328-334. doi: http://doi.org/10.15326/jcopdf.10.3.2023.0410

Keywords

comorbidity, exacerbations, COPD morbidity

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Click to read Decreased Cardiac Autonomic Function is Associated with Higher Exacerbation Risk and Symptom Burden in Chronic Obstructive Pulmonary Disease

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Author Affiliations

1. Division of Pulmonary, Critical Care and Sleep Medicine, College of Medicine, University of Cincinnati, Cincinnati, Ohio, United States
2. Department of Veterans Affairs, Cincinnati VA Hospital, Cincinnati, Ohio, United States
3. Center for Autoimmune Genomics and Etiology, Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
4. Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio, United States

Address correspondence to:

Robert M. Burkes, MD, MSCR
Division of Pulmonary, Critical Care and Sleep Medicine
Department of Internal Medicine
University of Cincinnati College of Medicine
P.O. Box 45267-0564
Cincinnati, Ohio 45267
Email: burkesrt@ucmail.uc.edu
Phone: (513)558-7296

Abstract

Introduction: Chronic obstructive disease (COPD) risk factors, smoking, and chronic infection (cytomegalovirus [CMV]) may mold natural killer (NK) cell populations. What is not known is the magnitude of the effect CMV seropositivity imparts on populations of smokers with and at risk for COPD. We investigate the independent influence of CMV seropositivity on NK cell populations and differential effects when stratifying by COPD and degree of smoking history.

Methods: Descriptive statistics determine the relationship between cytotoxic NK cell populations and demographic and clinical variables. Multivariable linear regression and predictive modeling were performed to determine associations between positive CMV serology and proportions of CD57+ and natural killer group 2C (NKG2C)+ NK cells. We dichotomized our analysis by those with a heavy smoking history and COPD and described the effect size of CMV seropositivity on NK cell populations.

Results: When controlled for age, race, sex, pack-years smoked, body mass index, and lung function, CMV+ serostatus was independently associated with a higher proportion of CD57+, NKG2C+, and NKG2C+CD57+ NK cells. CMV+ serostatus was the sole predictor of larger NKG2C+ and CD57+NKG2C+ populations. Associations are more pronounced in those with COPD and heavy smokers.

Conclusion: Among Veterans who are current and former smokers, CMV+ serostatus was independently associated with larger CD57+ and NKG2C+ populations, with a larger effect in heavy smokers and those with COPD, and was the sole predictor for increased expression of NKG2C+ and CD57+NKG2C+ populations. These findings may be broadened to include the assessment of longitudinal NK cell population change, accrued inflammatory potential, and further identification of pro-inflammatory NK cell population clusters.

Citation

Citation: Burkes RM, Bailey E, Hwalek T, et al. Associations of smoking, cytomegalovirus serostatus, and natural killer cell phenotypes in smokers with and at risk for COPD. J COPD F. 2023; 10(3): 286-296. doi: http://doi.org/10.15326/jcopdf.10.3.2022.0382

Keywords

COPD, smoking, cytomegalovirus, natural killer cell phenotypes

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Click to read Associations of Smoking, Cytomegalovirus Serostatus, and Natural Killer Cell Phenotypes in Smokers With and At Risk for COPD

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Author Affiliations

1. Faculty of Medicine, Imperial College London, London, United Kingdom
2. School of Public Health and the National Heart and Lung Institute, Imperial College London, London, United Kingdom

Address correspondence to:

Hannah Whittaker, PhD, MSc
Floor 9
Sir Michael Uren Building
86 Wood Lane W12 0BZ
London, United Kingdom
Email: h.whittaker@imperial.ac.uk

Abstract

Background: Previous studies have reported mixed associations between inhaled corticosteroids (ICSs) and cardiovascular disease (CVD) in people with chronic obstructive pulmonary disease (COPD). Using updated literature, we investigated the association between ICS-containing medications and CVD in COPD patients, stratified by study-related factors.

Methods: We searched MEDLINE and EMBASE for studies that reported effect estimates for the association between ICS-containing medications and the risk of CVD in COPD patients. CVD outcomes specifically included heart failure, myocardial infarction, and stroke-related events. We conducted a random-effects meta-analysis and a meta-regression to identify effect-modifying study-related factors.

Results: Fifteen studies met inclusion criteria and investigated the association between ICS-containing medications and the risk of CVD. Pooled results from our meta-analysis showed a significant association between ICS-containing medication and reduced risk of CVD (hazard ratio 0.87, 95% confidence intervals 0.78 to 0.97). Study follow-up time, non-ICS comparator, and exclusion of patients with previous CVD modified the association between ICS use and risk of CVD.

Conclusions: Overall, we found an association between ICS-containing medications and reduced risk of CVD in COPD patients. Results from the meta-regression suggest that subgroups of COPD patients may benefit from ICS use more than others and further work is needed to determine this.

Citation

Citation: Gadhvi K, Kandeil M, Raveendran D, et al. Inhaled corticosteroids and risk of cardiovascular disease in chronic obstructive pulmonary disease: a systematic review and meta-regression. J COPD F. 2023; 10(3): 317-327. doi: http://doi.org/10.15326/jcopdf.10.3.2022.0386

Keywords

COPD, inhaled corticosteroids, cardiovascular disease

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Click to read Inhaled Corticosteroids and Risk of Cardiovascular Disease in Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Regression

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Author Affiliations

1. Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas, United States
2. Office of Biostatistics, University of Texas Medical Branch, Galveston, Texas, United States

Address correspondence to:

Alexander Duarte, MD
Division of Pulmonary, Critical Care, and Sleep Medicine
University of Texas Medical Branch
301 University Blvd.
Galveston, TX 77555
Phone: (409) 772-2436
Email: aduarte@utmb.edu

Abstract

Background: Chronic obstructive pulmonary disease (COPD) is an ambulatory care-sensitive condition.

Methods: We compared the impact of care received by patients with COPD at Joint Commission-accredited, disease-specific clinics and primary care clinics at an academic health care systemfrom April 2014 to March 2018. Patients with COPD ≥ 40 years old with ≥ 2 outpatient visits 30 days apart were identified. Baseline demographics, disease-specific performance measures, and health care utilization were compared between groups. Propensity matching was conducted and time to the first emergency department (ED) visit and hospitalization was performed using Cox regression analysis.

Results: Of 4646 unique patients with COPD, 1114 were treated at disease-specific clinics and 3532 at primary care clinics. The entire group was predominantly female (58.8 %), non-Hispanic White (74.2 %) with a mean age of 65.4 ± 11.4 years consisting of current (47.6 %) or former smokers (38.4 %). In the disease-specific group, performance measures were performed more frequently, and lower rates of ED visits (hazard ratio [HR]=0.31, 95% confidence interval [CI] 0.18–0.54) and hospitalizations (HR 0.41, 95% CI 0.21–0.79) noted in comparison to the primary care group.

Conclusion: In this observational study, the implementation of achronic disease management program through accredited disease-specific clinics for patients with COPD was associated with reduced all-cause ED visits and hospitalizations.

Citation

Citation: Singh M, Hsu ES, Polychronopoulou E, Sharma G, Duarte AG. Structured evaluation and management of patients with COPD in an accredited program. J COPD F. 2023; 10(3): 297-307. doi: http://doi.org/10.15326/jcopdf.10.3.2022.0366

Keywords

COPD, health care utilization, chronic disease management, emergency department use, Joint Commission

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Click to read Structured Evaluation and Management of Patients with COPD in an Accredited Program

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Author Affiliations

1. Mindful Breathing Laboratory, Division of Pulmonary, Critical Care and Sleep Medicine, Mayo Clinic, Rochester, Minnesota, United States
2. Division of Health Care Delivery Research, Mayo Clinic, Rochester, Minnesota, United States
3. Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, United States

Address correspondence to:

Roberto Benzo, MD, MS
Mindful Breathing Laboratory
Mayo Clinic
200 First St SW
Rochester, MN 55902
Email: benzo.roberto@mayo.edu

Abstract

Background: We recently reported on a randomized trial of home-based pulmonary rehabilitation (PR) for chronic obstructive pulmonary disease (COPD) that showed improvement in all domains of quality of life, accelerometry-measured physical activity, and self-management. In this current study, we used a theoretical framework to help us gain an in-depth understanding of how patients experience complex, multi-component programs to help uncover factors related to behavior change and to inform program scale-up in other populations.

Study Design and Methods: The parent trial was conducted with COPD patients receiving care at an academic medical center and a community health system in the upper Midwest. The 12-week PR intervention included 3 daily video-guided exercises, activity monitors, and weekly telephonic health coaching. Trial participants were eligible to participate in an individual phone interview about their experience if they completed the intervention within the prior 12 months.. Analysis of verbatim transcripts followed an inductive thematic approach followed by deductive categorization and interpretation using a theoretical model: the Capability, Opportunity, Motivation–Behavior (COM-B) model developed for linking intervention functions to aspects of behavioral change.

Results: Among 32 eligible program participants,32 were approached, and 15 completed interviews between October 19, 2021, and January 13, 2022. The COM-B model and recommendations for program improvement were observed in the primary findings.

Discussion: Participants’ feedback highlighted how the health coaching bolstered skills and confidence among individuals with the poorest function at program enrollment and how improved physical function and mood led to motivation. It also highlighted the roles of technology and telephonic support in a home-based program. Suggestions for improvement included providing exercise variations.

Citation

Citation: Midthun WR, Benzo MV, Ridgeway JL, Benzo RP. Understanding the patient experience of home-based pulmonary rehabilitation with health coaching for COPD: a qualitative interview study. J COPD F. 2023; 10(3): 224-233. doi: http://doi.org/10.15326/jcopdf.10.3.2022.0384

Keywords

COPD, pulmonary rehabilitation, motivational interviewing, health coaching, home-based

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Click to read Understanding the Patient Experience of Home-Based Pulmonary Rehabilitation with Health Coaching for COPD: A Qualitative Interview Study

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Author Affiliations

1. University of Florida, Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, Gainesville, Florida, United States
2. Department of Internal Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, Kansas City Veterans Affairs Medical Center, Kansas City, Missouri, United States

Address correspondence to:

Jorge Lascano, MD
1600 SW Archer Road PO Box 100225
Gainesville, Florida 32610
Phone: (352) 273-8740
Email: Jorge.lascano@medicine.ufl.edu

Abstract

Background: Alpha-1 antitrypsin (AAT) deficiency is a genetic disorder that leads to chronic obstructive pulmonary disease (COPD) and lower circulating levels of AAT, which is a protease inhibitor with potent anti-inflammatory effects. In order to better understand the presence of systemic inflammation in AAT-deficient individuals with COPD, we investigatedthe plasma levels of C-reactive protein (CRP).

Methods: AAT-deficient individuals and a matched cohort with a normal AAT genotype were recruited from the Alpha-1 Foundation DNA and Tissue Bank. AAT genotypes were determined by a combination of a Taqman-based assay. AAT and CRP levels were determined by nephelometry. Comparisons were determined by unpaired t-test and standard Pearson’s correlation.

Results: Our study included 40 control participants and 742 AAT-deficient participants, of which 498 received augmentation therapy. In the AAT-deficient participants, the plasma AAT was 20.2±11.6µM and 4.5±1.3µM (P<0.0001) with and without augmentation therapy, respectively, and the CRP was 0.32±0.53mg/dL and 0.69±1.97mg/dL (P=0.0169), respectively. There was a negative correlation between the percentage predicted of forced expiratory volume in 1 second and CRP in the group not receiving augmentation therapy (r=−0.2528, P<0.05), and there was no correlation in participants receiving augmentation therapy.

Conclusion: Compared to healthy individuals, AAT-deficient individuals with COPD have higher levels of circulating CRP, suggesting increased systemic inflammation. However, AAT-deficient individuals receiving augmentation therapy had lower plasma CRP levels compared to those who are not.

Citation

Citation: Lascano J, Riley L, Khodayari N, Brantly M. Augmentation therapy modulates systemic inflammation in individuals with alpha-1 antitrypsin deficiency and chronic obstructive pulmonary disease. J COPD F. 2023; 10(3): 308-316. doi: http://doi.org/10.15326/jcopdf.10.3.2023.0407

Keywords

COPD, alpha-1 antitrypsin deficiency, augmentation therapy, C-reactive protein

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Click to read Augmentation Therapy Modulates Systemic Inflammation in Individuals with Alpha-1 Antitrypsin Deficiency and Chronic Obstructive Pulmonary Disease

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Author Affiliations

1. San Francisco Veterans Affairs Healthcare System, San Francisco, California, United States
2. Department of Medicine, University of California, San Francisco, California, United States
3. Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, Washington, United States
4. University of Alabama at Birmingham, Birmingham, Alabama, United States
5. Department of Medicine, University of California, Los Angeles, California, United States
6. Columbia-Presbyterian Medical Center, New York, New York, United States
7. University of Arizona, College of Medicine, Tucson, Arizona, United States
8. Temple University, Philadelphia, Pennsylvania, United States
9. University of Iowa, Iowa City, Iowa, United States
10. University of North Carolina, Chapel Hill, North Carolina, United States
11. Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, United States
12. Medical Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, United States
13. Department of Medicine, Johns Hopkins University, Baltimore, United States
14. Department of Epidemiology, School of Public Health, University of Colorado, United States
15. Weill Cornell Medical Center, New York, New York, United States
16. University of Utah, Salt Lake City, Utah, United States
17. University of Illinois at Chicago, Chicago, Illinois, United States
18. Department of Radiology, National Jewish Health Systems, Denver, Colorado, United States
19. Mayo Clinic, Scottsdale, Arizona, United States
20. Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
21. Department of Medicine, National Jewish Health Systems, Denver, Colorado, United States
22. University of Nebraska Medical Center, Omaha, Nebraska, United States

Address correspondence to:

Mehrdad Arjomandi, MD
Division of Pulmonary, Critical Care, Allergy, and Sleep 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: Abnormal lung volumes representing air trapping identify the subset of smokers with preserved spirometry who develop spirometric chronic obstructive pulmonary disease (COPD) and adverse outcomes. However, how lung volumes evolve in early COPD as airflow obstruction develops remains unclear.

Methods: To establish how lung volumes change with the development of spirometric COPD, we examined lung volumes from the pulmonary function data (seated posture) available in the U.S. Department of Veterans Affairs electronic health records (n=71,356) and lung volumes measured by computed tomography (supine posture) available from the COPD Genetic Epidemiology (COPDGene^®) study (n=7969) and the SubPopulations and InterMediate Outcome Measures In COPD Study (SPIROMICS) (n=2552) cohorts, and studied their cross-sectional distributions and longitudinal changes across the airflow obstruction spectrum. Patients with preserved ratio-impaired spirometry (PRISm) were excluded from this analysis.

Results: Lung volumes from all 3 cohorts showed similar patterns of distributions and longitudinal changes with worsening airflow obstruction. The distributions for total lung capacity (TLC), vital capacity (VC), and inspiratory capacity (IC) and their patterns of change were nonlinear and included different phases. When stratified by airflow obstruction using Global initiative for chronic Obstructive Lung Disease (GOLD) stages, patients with GOLD 1 (mild) COPD had larger lung volumes (TLC, VC, IC) compared to patients with GOLD 0 (smokers with preserved spirometry) or GOLD 2 (moderate) disease. In longitudinal follow-up of baseline GOLD 0 patients who progressed to spirometric COPD, those with an initially higher TLC and VC developed mild obstruction (GOLD 1) while those with initially lower TLC and VC developed moderate obstruction (GOLD 2).

Conclusions: In COPD, TLC, and VC have biphasic distributions, change in nonlinear fashions as obstruction worsens, and could differentiate those GOLD 0 patients at risk for more rapid spirometric disease progression.

Citation

Citation: Arjomandi M, Zeng S, Chen J, et al; COPD and SPIROMICS investigators. Changes in lung volumes with spirometric disease progression in COPD. J COPD F. 2023; 10(3): 270-285. doi: http://doi.org/10.15326/jcopdf.10.3.2022.0363

Keywords

COPD, computed tomography, air trapping, lung volumes, early disease

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Click to read Changes in Lung Volumes with Spirometric Disease Progression in COPD

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Author Affiliations

1. Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, United States
2. Collaborative Studies Coordinating Center, Department of Biostatistics, Gilling’s School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States
3. Center for the Study of Healthcare Innovation, Implementation, and Policy, Health Services Research and Development, Greater Los Angeles Veterans Affairs Healthcare System, Los Angeles, California, United States
4. Departments of Radiology, Medicine and Bioengineering, University of Iowa, Iowa City, Iowa, United States
5. Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California, San Francisco, California, United States
6. Division of Pulmonary Diseases and Critical Care Medicine, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina, United States
7. Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, Utah, United States
8. Division of Pulmonary and Critical Care Medicine, School of Medicine, University of Michigan, Ann Arbor, Michigan, United States
9. Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, United States
10. Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, Colorado, United States
11. Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
12. College of Nursing and Health Sciences, University of Vermont, Burlington, Vermont, United States
13. Division of Pulmonary and Critical Care Medicine, Weill Cornell Medical College, New York, New York, United States
14. Division of Pulmonary, Critical Care, Allergy and Immunology, School of Medicine, Wake Forest University, Wake Forest, North Carolina, United States

Address correspondence to:

Donald P. Tashkin, MD
Division of Pulmonary and Critical Care Medicine
David Geffen School of Medicine
University of California at Los Angeles
10833 Le Conte Ave.
Los Angeles, CA 90095 USA
Phone: (310) 825-3163
E-mail: dtashkin@mednet.ucla.edu

Abstract

Background: Limited data are available regarding marijuana smoking’s impact on the development or progression of chronic obstructive pulmonary disease (COPD) in middle-aged or older adults with a variable history of tobacco cigarette smoking.

Methods: We divided ever-tobacco smoking participants in the SubPopulations and InteRmediate Outcomes In COPD Study (SPIROMICS) into 3 groups based on self-reported marijuana use: current, former, or never marijuana smokers (CMSs, FMSs or NMSs, respectively). Longitudinal data were analyzed in participants with ≥2 visits over a period of ≥52 weeks.

Measurements: We compared CMSs, FMSs, and NMSs, and those with varying amounts of lifetime marijuana use. Mixed effects linear regression models were used to analyze changes in spirometry, symptoms, health status, and radiographic metrics; zero-inflated negative binomial models were used for exacerbation rates. All models were adjusted for age, sex, race, baseline tobacco smoking amount, and forced expiratory volume in 1 second (FEV₁) %predicted.

Results: Most participants were followed for ≥4 years. Annual rates of change in FEV₁, incident COPD, respiratory symptoms, health status, radiographic extent of emphysema or air trapping, and total or severe exacerbations were not different between CMSs or FMSs versus NMSs or between those with any lifetime amount of marijuana use versus NMSs.

Conclusions: Among SPIROMICS participants with or without COPD, neither former nor current marijuana smoking of any lifetime amount was associated with evidence of COPD progression or its development. Because of our study’s limitations, these findings underscore the need for further studies to better understand longer-term effects of marijuana smoking in COPD.

Citation

Citation: Barjaktarevic I, Cooper CB, Shing T, et al. Impact of marijuana smoking on COPD progression in a cohort of middle-aged and older persons. J COPD F. 2023; 10(3): 234-247. doi: http://doi.org/10.15326/jcopdf.10.3.2022.0378

Keywords

COPD, exacerbations, spirometry, marijuana, high-resolution CT

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Click to read Impact of Marijuana Smoking on COPD Progression in a Cohort of Middle-Aged and Older Persons

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Author Affiliations

1. Section on Pulmonary, Critical Care, Allergy and Immunological Diseases, Wake Forest School of Medicine, Wake Forest, North Carolina, United States
2. Department of Pulmonary Disease, Rochester General Hospital, Rochester, New York, United States
3. Departments of Radiology, Medicine, and Biomedical Engineering, University of Iowa, Iowa City, Iowa, United States
4. Marisco Lung Institute, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
5. Department of Medicine, University of Arizona, Tucson, Arizona, United States
6. Center for Precision Medicine, Department of Biochemistry, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
7. Department of Medicine, David Geffen School of Medicine, Los Angeles, California, United States
8. Columbia University Medical Center, New York City, New York, United States
9. Division of Pulmonary and Critical Care Medicine, Department of Medicine, Cardiovascular Research Institute, University of California, San Francisco, California, United States
10. Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States
11. VA Ann Arbor Healthcare System, Ann Arbor, Michigan, United States
12. Division of Pulmonary and Critical Care Medicine, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, United States
13. School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States
14. Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, Department of Medicine, University of Utah Health Sciences Center, Salt Lake City, Utah, United States
15. Division of Pulmonary and Critical Care Medicine, Department of Medicine, Weill Cornell Medical College of Cornell University, New York City, New York, United States
16. Respiratory Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, United States
17. Department of Internal Medicine, Division of Respiratory Diseases, Center for Individualized Medicine, Mayo Clinic, Scottsdale, Arizona, United States

Address correspondence to:

Victor E. Ortega, MD, PhD
Division of Respiratory Diseases
Department of Internal Medicine
Center for Individualized Medicine
Mayo Clinic
13400 E. Shea Boulevard
Scottsdale, Arizona
Email: Ortega.Victor@mayo.edu
Phone: (480) 301-9432

Abstract

Rationale: Bronchiectasis is common among those with heavy smoking histories, but risk factors for bronchiectasis, including alpha-1 antitrypsin deficiency, and its implications for COPD severity are uncharacterized in such individuals.

Objectives: To characterize the impact of bronchiectasis on COPD and explore alpha-1antitrypsin as a risk factor for bronchiectasis.

Methods: SubPopulations and InteRmediate Outcome Measures In COPD Study (SPIROMICS) participants (N=914; ages 40–80 years; ≥20-pack-year smoking) had high-resolution computed tomography (CT) scans interpreted visually for bronchiectasis, based on airway dilation without fibrosis or cicatrization. We performed regression-based models of bronchiectasis with clinical outcomes and quantitative CT measures. We deeply sequenced the gene encoding -alpha-1 antitrypsin, SERPINA1, in 835 participants to test for rare variants, focusing on the PiZ genotype (Glu³⁶⁶Lys, rs28929474).

Measurements and Main Results: We identified bronchiectasis in 365 (40%) participants, more frequently in women (45% versus 36%, p=0.0045), older participants (mean age=66[standard deviation (SD)=8.3] versus 64[SD=9.1] years, p=0.0083), and those with lower lung function (forced expiratory volume in 1 second [FEV₁ ] percentage predicted=66%[SD=27] versus 77%[SD=25], p<0.0001; FEV₁ to forced vital capacity [FVC] ratio=0.54[0.17] versus 0.63[SD=0.16], p<0.0001). Participants with bronchiectasis had greater emphysema (%voxels ≤-950 Hounsfield units, 11%[SD=12] versus 6.3%[SD=9], p<0.0001) and parametric response mapping functional small airways disease (26[SD=15] versus 19[SD=15], p<0.0001). Bronchiectasis was more frequent in the combined PiZZ and PiMZ genotype groups compared to those without PiZ, PiS, or other rare pathogenic variants (N=21 of 40 [52%] versus N=283 of 707[40%], odds ratio [OR]=1.97; 95% confidence interval [CI]=1.002, 3.90, p=0.049), an association attributed to White individuals (OR=1.98; 95%CI = 0.9956, 3.9; p=0.051).

Conclusions: Bronchiectasis was common in those with heavy smoking histories and was associated with detrimental clinical and radiographic outcomes. Our findings support alpha-1antitrypsin guideline recommendations to screen for alpha-1 antitrypsin deficiency in an appropriate bronchiectasis subgroup with a significant smoking history.

Citation

Citation: Izquierdo M, Marion CR, Genese F, et al; for the SubPopulations and InteRmediate Outcome Measures In COPD Study (SPIROMICS) investigators. Impact of bronchiectasis on COPD severity and alpha-1 antitrypsin deficiency as a risk factor in individuals with a heavy smoking history. J COPD F. 2023; 10(3): 199-210. doi: http://doi.org/10.15326/jcopdf.10.3.2023.0388

Keywords

COPD, lung function, bronchiectasis, alpha-1 antitrypsin

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Author Affiliations

1. Respiratory Research Unit, Pulmonary Institute, Department of Medicine, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
2. PW Statistical Consulting, Laxou, France
3. Hadassah School of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel

Address correspondence to:

Abraham B. Bohadana, MD
Pulmonary Institute
Shaare Zedek Medical Center
12 Bayit Street
91031
Jerusalem, Israel
Email: abohadana@szmc.org.il
Phone: 972-2-6555111

Abstract

Background: Chronic obstructive pulmonary disease (COPD) case-finding aims to detect airflow obstruction in symptomatic smokers and ex-smokers. We used a clinical algorithm including smoking, symptoms, and spirometry to classify smokers into COPD risk phenotypes. In addition, we evaluated the acceptability and effectiveness of including smoking cessation advice in the case-finding intervention.

Methods: Smoking, symptoms, and spirometry abnormalities (airflow obstruction: forced expiratory volume in 1 second [FEV₁] to forced vital capacity [FVC] <0.7 or preserved-ratio spirometry (FEV₁<80% of predicted value and FEV₁/FVC ratio ≥ 0.7)[ were assessed in a group of 864 smokers aged ≥ 30 years. The combination of these parameters allowed the identification of 4 phenotypes: Phenotype A (no symptoms, normal spirometry; reference), Phenotype B (symptoms; normal spirometry; possible COPD), Phenotype C (no symptoms; abnormal spirometry; possible COPD), and Phenotype D (symptoms; abnormal spirometry; probable COPD). We assessed phenotype differences in clinical variables and modeled the trend from phenotype A to phenotype D. Smoking cessation advice based on spirometry was provided. Follow-up was done by telephone 3 months later.

Results: Using smokers without symptoms or abnormal spirometry (phenotype A; n=212 ]24.5%[) as a reference, smokers were classified into possible COPD (phenotype B;n=332 ]38.4%[; and C: n=81 ]9.4%[) and probable COPD (phenotype D: n=239 ]27.2%[). The trend from baseline phenotype A to probable COPD phenotype D was significant for the number of cigarettes/day and the number of years of smoking (p=0.0001). At follow-up, 58 (7.7%) of the respondents (n=749) reported that they had quit smoking.

Conclusions: Our clinical algorithm allowed us to classify smokers into COPD phenotypes whose manifestations were associated with smoking intensity and to significantly increase the number of smokers screened for COPD. Smoking cessation advice was well accepted, resulting in a low but clinically significant quit rate.

Citation

Citation: Bohadana A, Rokach A, Wild P, et al. Clinical use of an exposure, symptom, and spirometry algorithm to stratify smokers into COPD risk phenotypes: a case-finding study combined with smoking cessation counseling. J COPD F. 2023; 10(3): 248-258. doi: http://doi.org/10.15326/jcopdf.10.3.2022.0368

Keywords

PRISm, COPDGene®, smoking cessation, COPD phenotypes, screening spirometry

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Click to read Clinical Use of an Exposure, Symptom, and Spirometry Algorithm to Stratify Smokers into COPD Risk Phenotypes: A Case-Finding Study Combined with Smoking Cessation Counseling

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Author Affiliations

1. Department of Internal Medicine-Nursing, Faculty of Health Sciences, Kirsehir Ahi Evran University, Kirsehir, Turkey

Address correspondence to:

Yasemin Ceyhan, PhD, RN 3^rd Floor
Bagbasi Campus Faculty of Health Sciences
Kirşehir, Turkey
Phone:+90 546 459 80 65
E-mail: yasemin-ceyhan@hotmail.com

Abstract

Background: The most important problem of chronic obstructive pulmonary disease (COPD) patients is acute exacerbation. Researching this experience and examining its relationship with death is extremely important in patient care.

Methods: This study was conducted to reveal the experiences of individuals with a history of acute exacerbations of chronic obstructive pulmonary disease (AECOPDs) and their thoughts on death by qualitative empirical research. The study was conducted in a pulmonology clinic between July and September 2022. In-depth face-to-face interviews were conducted with patients in their rooms using a semi-structured form created specifically for the study and used as a data collection tool. With patient consent, interviews were recorded and documented. During the data analysis phase, the Colaizzi method was used. The study was presented in accordance with the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist for qualitative research.

Results: The study was completed with 15 patients. A total of 13 of the patients were male and the mean age was 65 years. Patient statements were coded after the interviews and collected under 11 sub-themes. These sub-themes were categorized under the following main themes: recognizing AECOPDs, AECOPD instant experiences, post-AECOPD, and thoughts on death.

Conclusion: Patients were able to recognize the symptoms of an AECOPD, that the severity of the symptoms increased during the exacerbation, that they felt regret or anxiety about re-exacerbation, and that all of these factors contributed to their fear of death.

Citation

Citation: Ceyhan Y. The experiences of individuals with a history of acute exacerbations of COPD and their thoughts on death: empirical qualitative research. J COPD F. 2023; 10(3): 259-269. doi: http://doi.org/10.15326/jcopdf.10.3.2023.0389

Keywords

COPD, acute exacerbations, death, nurse

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Click to read The Experiences of Individuals with a History of Acute Exacerbations of COPD and Their Thoughts on Death: Empirical Qualitative Research

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Author Affiliations

1. Department of Infectious Diseases and Respiratory Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
2. Administrative Office for Clinical Quality and Risk Management, Charité-Universitätsmedizin Berlin, Berlin, Germany
3. Institute of Biometry and Clinical Epidemiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
4. Department of Respiratory Medicine, DRK Kliniken Berlin Mitte, Berlin, Germany
5. Department of Internal Medicine and Respiratory Medicine, Clinic Havelhöhe Berlin, Berlin, Germany
6. Department of Internal Medicine I, Pulmonary Medicine, University Hospital Halle (Saale), Germany
7. Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-University Marburg, Marburg, Germany
8. Department of Thoracic Surgery, Vivantes Netzwerk für Gesundheit, Klinikum Neukölln, Berlin, Germany
9. Lungenklinik Hemer, Hemer, Germany

Address correspondence to:

Eva Pappe, MD
Charitéplatz 1
10117
Berlin, Germany
Phone: 0049 30 450 653078
E-mail: eva.pappe@charite.de

Abstract

Introduction: Patients with chronic obstructive pulmonary disease (COPD) have an increased risk of acquiring severe coronavirus disease 2019 (COVID-19), which is why self-isolation was recommended. However, long periods of social isolation, accompanied by limited access to health care systems, might influence the outcome of patients with severe COPD negatively.

Methods: Data from COPD and pneumonia patients at Charité-Universitätsmedizin Berlin and the volume of endoscopic lung volume reduction (ELVR) surgeries from the German Lung Emphysema Registry (Lungenemphysem Register e.V.) were analyzed from pre-pandemic (2012 to 2019) to the pandemic period (2020 and 2021). In addition, 52 patients with COPD Global initiative for chronic Obstructive Lung Disease (GOLD) stage 4 status included in the lung emphysema registry received questionnaires during lockdowns from June 2020 to April 2021.

Results: Admissions and ventilation therapies administered to COPD patients significantly decreased during the COVID-19 pandemic. Likewise, there was a reduction in ELVR treatments and follow-ups registered in German emphysema centers. Mortality was slightly higher among patients hospitalized with COPD during the pandemic. Increasing proportions of COPD patients with GOLD stage 3 and GOLD stage 4 status reported behavioral changes and subjective feelings of increasing COPD symptoms the longer the lockdown lasted. However, COPD symptom questionnaires revealed stable COPD symptoms over the pandemic time period.

Summary: This study reveals reduced COPD admissions and elective treatment procedures of COPD patients during the pandemic, but a slight increase in mortality among patients hospitalized with COPD, irrespective of COVID-19. Correspondingly, patients with severe COPD reported subjective deterioration of their health status, probably caused by their very strict compliance with lockdown measures.

Citation

Citation: Pappe E, Hammerich R, Saccomanno J, et al. Impact of coronavirus disease 2019 on hospital admissions, health status, and behavioral changes of patients with COPD. J COPD F. 2023; 10(3): 211-223. doi: http://doi.org/10.15326/jcopdf.10.3.2022.0383

Keywords

COPD, COVID-19, endoscopic lung volume reduction, lockdown measures

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Author Affiliations

1. Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
2. Harvard College, Harvard University, Cambridge, Massachusetts, United States
3. Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States
4. Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States

*Affiliation at the time of study

Address correspondence to:

Mary B. Rice, MD, MPH
Phone: (617) 667-5864
Email: mrice1@bidmc.harvard.edu

Abstract

Rationale: Although physical activity is strongly encouraged for patients with chronic obstructive pulmonary disease (COPD), it is unknown if physical activity affects daily exposure to air pollution, or whether it attenuates or exacerbates the effects of pollution on the airways among adults with COPD.

Methods: Thirty former smokers with moderate-to-severe COPD in Boston were followed for 4 non-consecutive months in different seasons. We assessed daily lung function (forced expiratory volume in 1 second [FEV₁] and forced vital capacity [FVC]), prior-day personal pollutant exposure measured by portable air quality monitors (fine particulate matter [PM_2.5] nitrogen oxide [NO₂], and ozone [O₃]), and daily step count. We constructed multi-level linear mixed-effects models with random intercepts for person and person-observation month, adjusting for demographic/seasonal covariates to test if step count was associated with daily pollution exposure, and if associations between prior-day pollution and lung function differed based on prior-day step count. Where effect modification was found, we performed stratified analyses by tertile of step count.

Results: Higher daily step count was associated with higher same-day personal exposure to PM_2.5, and O₃ but not NO₂. Each interquartile range (IQR) increment in step count was associated with 0.97 µg/m³ (95%CI: 0.30, 1.64) higher exposure to PM_2.5 and 0.15 parts per billion (95% CI: -0.05, 0.35) higher exposure to O₃ in adjusted models. We observed an interaction between prior-day NO₂ and step count on FEV₁ and FVC (P_interaction<0.05) in which the negative associations between NO₂ and lung function were reduced or absent at higher levels of daily activity. For example, FEV₁ was 28.5 mL (95%CI: -41.0, -15.9) lower per IQR of NO₂ in the lowest tertile of step count, but there was no association in the highest tertile of step count (-1.6mL, 95% CI: -18.4, 15.2).

Conclusions: Higher physical activity was associated with modestly higher daily exposure to PM_2.5 and O₃ and may attenuate the association between NO₂ exposure and lung function.

Citation

Citation: Chen K, Aglan M, Purcell A, et al. Physical activity, air pollution exposure, and lung function interactions among adults with COPD. J COPD F. 2023; 10(2): 170-177. doi: http://doi.org/10.15326/jcopdf.10.2.2022.0385

Keywords

COPD, FEV₁, physical activity, particulate matter, FVC, ambient pollution

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Click to read Physical Activity, Air Pollution Exposure, and Lung Function Interactions Among Adults with COPD

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