Author Affiliations

1. Division of Respiratory Medicine, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, China
2. Tuberculosis and Chest Unit, Grantham Hospital, Aberdeen, Hong Kong Special Administrative Region, China

Address correspondence to:

There is no correspondance information for this article.

Abstract

Background:Pseudomonas aeruginosa is an important pathogen in patients with chronic respiratory diseases. It can colonize the airways and could have prognostic value in bronchiectasis and cystic fibrosis. Its role in chronic obstructive pulmonary disease (COPD) is less well-defined.

Methods: A prospective study was conducted in Hong Kong to investigate the possible association between Pseudomonas aeruginosa colonization and acute exacerbation of COPD (AECOPD) risks.

Results: Among 327 Chinese patients with COPD, 33 (10.1%) of the patients had Pseudomonas aeruginosa colonization. Patients with or without Pseudomonas aeruginosa colonization had similar background characteristics. Patients with Pseudomonas aeruginosa colonization had increased risks of moderate to severe AECOPD, severe AECOPD, and pneumonia with an adjusted odds ratio (aOR) of 3.15 (95% CI 1.05−9.48, p=0.042), 2.59 (95% CI 1.01₋6.64, p=0.048), and 4.19 (95% CI 1.40₋12.54, p=0.011) respectively. Patients with Pseudomonas aeruginosa colonization also had increased annual frequency of moderate to severe AECOPDs, median 0 (0₋0.93) in the non-Pseudomonas aeruginosa colonization group and 1.35 (0₋3.39) in the Pseudomonas aeruginosa colonization group, with a p-value of 0.005 in multivariate linear regression.

Conclusion: Pseudomonas aeruginosa colonization is a potential independent risk factor for moderate to severe AECOPD and pneumonia among patients with COPD without coexisting bronchiectasis.

Citation

Citation: Erratum. J COPD F. 2025; 12(3): 1-1. doi: http://doi.org/10.15326/jcopdf.12.3.2024.0582E

Keywords

There are no keywords for this article.

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Author Affiliations

1. Division of Pulmonary and Critical Care Medicine, Joan and Sanford I. Weill Department of Medicine, Weill Cornell Medical College, New York, New York, United States
2. Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, United States
3. Novartis Pharma AG, Basel, Switzerland
4. Novartis Institutes for BioMedical Research Inc, Cambridge, Massachusetts, United States
5. Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, United States

Address correspondence to:

Fernando J. Martinez, MD
Division of Pulmonary and Critical Care Medicine
Joan and Sanford I.
Weill Department of Medicine
Weill Cornell Medical College New York, New York
Phone:(646) 962-2333
Email: fjm2003@med.cornell.edu

Abstract

Background: Chronic bronchitis (CB), classically defined as having cough and sputum production for at least 3 months per year for 2 consecutive years, is frequently associated with chronic obstructive pulmonary disease (COPD).

Methods: This retrospective cohort study using the Optum^® de-identified electronic health record data set (Optum^® EHR) aimed to identify patients with CB, COPD, and both CB and COPD through the application of the classical definition of CB, and to compare the characteristics of these populations, and the timing of diagnosis as well as their health care resource utilization (HCRU). Scanning of the EHRs was performed electronically using a specially developed algorithm.

Results: Of 104,633,876 patients in the study period between January 2007 and September 2020, 628,545 patients had CB only (i.e., nonobstructive disease), 129,084 had COPD only (COPD cohort), and 77,749 had both COPD and CB (COPD-CB cohort). A total of 75.9% of patients (59,009 of 77,749) fulfilled the criteria for a CB diagnosis before their first diagnosis with COPD, compared with 24.1% who had COPD before being diagnosed with CB. HCRU over 5 years was highest in the COPD-CB cohort, whereas the COPD cohort and CB cohorts had similar HCRU over 5 years. The COPD-CB cohort had a greater percentage of common COPD comorbidities and exposure to more drug classes than the other cohorts.

Conclusions: These results highlight the importance of increased attention to CB. CB often precedes the diagnosis of COPD and subsequently leads to high HCRU. Interventions to better manage CB and prevent the progression of CB to COPD could improve morbidity in this population.

Citation

Citation: Krishnan JK, Criner GJ, Lashari BH, et al. Disease onset and burden in patients with chronic bronchitis and COPD: a real-world evidence study. J COPD F. 2025; 12(2): 127-136. doi: http://doi.org/10.15326/jcopdf.12.2.2024.0565

Keywords

chronic bronchitis, electronic health records, real-world evidence

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Author Affiliations

1. Milliman, Inc., New York, New York, United States
2. US Medical Respiratory, BioPharmaceuticals, AstraZeneca, Wilmington, Delaware, United Staes
3. US Medical Evidence, BioPharmaceuticals, AstraZeneca, Wilmington, Delaware, United States
4. COPD Foundation, Miami, Florida, United States

Address correspondence to:

Winston Fopalan, MD, MPH
Miliman, Inc.
New York, NY
Email: winston.fopalan@milliman.com
Phone: (646) 473-3230

Abstract

Introduction: Chronic obstructive pulmonary disease (COPD) poses a substantial burden on individuals and the U.S. health care system. Up-to-date information describing individuals with COPD and their acute hospital-based health care utilization at the state level and by insurance type is lacking.

Methods: Individuals with COPD aged 40 and older were identified from large databases of Medicare fee-for-service, Medicaid, and commercial health insurance claims, and counts were extrapolated to the U.S. health insurance market. Demographics and outcome metrics were quantified between January 1 and December 31, 2021, and summarized by state and insurance type.

Results: Approximately 11.7 million insured individuals had COPD in 2021. The largest share were covered by Medicare (79.4%), followed by commercial insurance (11.3%) and Medicaid (9.3%). COPD prevalence varied among states, ranging from 44 (Utah) to 143 (West Virginia) per 1000 insured individuals. Nationwide, annual all-cause mortality for individuals with COPD covered by Medicare (11.5%) was more than double that of Medicaid (5.1%). There were 1.8 million COPD-related acute inpatient hospitalizations nationwide, with the largest share among individuals covered by Medicare (86.4%), followed by Medicaid (9.0%) and commercial insurance (4.6%). COPD-related hospitalization rates also varied among states, ranging from 97 (Idaho) to 200 (District of Columbia) per 1000 individuals with COPD. There were 1.4 million COPD-related emergency department/observation encounters not resulting in acute inpatient admissions nationwide.

Conclusions: There is substantial state and payer variation in COPD prevalence and burden. Understanding this variation provides valuable insights into populations with unmet needs that can inform public health strategies to address gaps.

Citation

Citation: Bazell C, Alston M, Feigler N, et al. Variation in prevalence and burden of chronic obstructive pulmonary disease by state and insurance type in the United States. J COPD F. 2025; 12(2): 158-174. doi: http://doi.org/10.15326/jcopdf.12.2.2024.0560

Keywords

COPD, hospitalizations, prevalence, demographics, health insurance

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Author Affiliations

1. Division of Pulmonary and Critical Care, Johns Hopkins University, Baltimore, Maryland, United States
2. Division of Cardiology, Johns Hopkins University, Baltimore, Maryland, United States

Address correspondence to:

Obiageli Offor, MD, MPH
Division of Pulmonary and Critical Care
Johns Hopkins University
Baltimore, Maryland
Email: ooffor1@jhmi.edu

Abstract

Background: Individuals with chronic obstructive pulmonary disease (COPD) are disproportionately affected by social determinants of health that have been associated with worse respiratory outcomes. This study evaluates the association of perceived stress with respiratory outcomes and distinct biological mechanisms among former smokers with COPD.

Methods: Participants were assessed in an observational study at baseline, 3-months, and 6-months. Questionnaires assessed perceived stress (Perceived Stress Scale, [PSS]), respiratory symptoms, and incidence of COPD exacerbations. Generalized linear mixed models evaluated the association of PSS score with COPD outcomes and biomarkers of platelet activation (urine 11-dehydro-thromboxane B2 [11dTxB2]), oxidative stress (urine thiobarbituric acid reactive substances [TBARS], 8- hydroxydeoxyguanosine, and 8-isoprostane), and inflammation.

Results: Among 99 participants, the median PSS score was 13 (interquartile range 8–18) across all visits. Compared with low perceived stress (PSS 0–13), moderate (PSS 14–26) and high perceived stress (PSS 27–40) were associated with worse respiratory health status and respiratory-related quality of life, with point estimates for high perceived stress exceeding clinically important differences. Only high PSS was associated with increased moderate/severe exacerbations (odds ratio 4.15, 95% confidence interval [CI]: 1.28–13.47). Compared to low stress, high stress was associated with lower TBARS (β=-25.5%, 95%CI: -43.8– -1.2%) and higher 8-isoprostane (β=40.1%, 95%CI: 11.5–76.0%). Among individuals with mild-moderate COPD, compared to low stress, moderate (β=20.1%, 95%CI: 3.1–40.0%) and high (β=52.9%, 95%CI: 22.1–91.6%) stress were associated with higher 11dTxB2.

Conclusions: Among former smokers with COPD, higher perceived stress is associated with worse respiratory outcomes. Platelet activation and oxidative stress may be biological pathways through which perceived stress plays a role in COPD.

Citation

Citation: Offor O, Eakin MN, Woo H, et al. Perceived stress is associated with health outcomes, platelet activation, and oxidative stress in COPD. J COPD F. 2025; 12(2): 98-108. doi: http://doi.org/10.15326/jcopdf.12.2.2024.0561

Keywords

COPD, oxidative stress, outcomes, platelet activation, perceived stress

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Author Affiliations

1. Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California, United States
2. Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine, University of California, Los Angeles, California, United States
3. Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Health Systems Research, Greater Los Angeles VA Healthcare System, Los Angeles, California, United States
4. Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, California, United States

Address correspondence to:

Kristin Schwab Jensen, MD
David Geffen School of Medicine
University of California, Los Angeles
10833 LeConte Avenue
52-257 Center for Health Sciences
Los Angeles, CA 90095
Phone: (310) 825-5316
Email: Ksjensen@mednet.ucla.edu

Abstract

Virtual pulmonary rehabilitation (PR) is a proven yet underutilized intervention in chronic obstructive pulmonary disease (COPD) patients. However, neither the safety nor the effectiveness of virtual PR is established for patients with advanced disease and higher disease severity, particularly those requiring supplemental oxygen. We performed a retrospective review of 167 patients to evaluate the feasibility, safety, and effectiveness of virtual PR in oxygen-dependent versus nonoxygen-dependent COPD patients. Our primary outcome, attendance, was high (88% of sessions were attended by both groups). Adverse events occurred in only 2 (1%) participants, one in each group. Both groups showed significant postintervention improvements in dyspnea and depression scores (COPD Assessment Test [CAT], modified Medical Research Council [mMRC], Patient Health Questionnaire-9 [PHQ-9]) and functional exercise capacity (1-minute sit-to-stand [1MSTS]), with the improvements approaching or exceeding the established minimal clinically important difference values. When comparing the oxygen-dependent and nonoxygen groups, there were no significant differences in the degree of improvement for CAT, PHQ-9, and 1MSTS. For mMRC, those on oxygen did improve by 0.3 less than those not on oxygen (P=0.052). These findings suggest virtual PR is safe and effective for COPD patients requiring oxygen. To our knowledge, this is the first study to compare outcomes of virtual PR in patients on and off oxygen. Future research should explore patient-specific factors that can further individualize care.

Citation

Citation: Filizola H, Kumar A, Buhr RG, Schwab Jensen K. Outcomes of virtual pulmonary rehabilitation in oxygen-dependent COPD patients. J COPD F. 2025; 12(2): 184-189. doi: http://doi.org/10.15326/jcopdf.12.2.2024.0572

Keywords

pulmonary rehabilitation, oxygen therapy, telehealth, COPD epidemiology, long-term oxygen therapy ambulatory

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Click to read Outcomes of Virtual Pulmonary Rehabilitation in Oxygen-Dependent COPD Patients

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Author Affiliations

1. Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Gulou District, Nanjing, China
2. Department of Respiratory and Critical Care Medicine, Jinling Hospital, School of Medicine, Nanjing University, Gulou District, Nanjing, China

Address correspondence to:

Dong Wang, PhD
Department of Cardiology
Zhongda Hospital
School of Medicine
Southeast University
Gulou District
Nanjing, China
Phone: +86 18851651351
Email:wangdong_seu@163.com

Abstract

Background: The objective of this study was to construct a prediction model to assess the onset of acute heart failure (AHF) in patients with chronic obstructive pulmonary disease (COPD) without a history of heart failure and to evaluate the predictive value of the nomogram.

Methods: This study involved 3730 patients with COPD and no history of heart failure. Clinical and laboratory data were collected from the Medical Information Mart for Intensive Care IV database. The patients were divided into a training set (2611 cases) and a validation set (1119 cases) in a 7:3 ratio. Least absolute shrinkage and selection operator (LASSO) regression was used to identify potential risk factors for AHF in patients with COPD. These factors were then subjected to multivariate logistic regression analysis to develop a prediction model for the risk of AHF. The model’s differentiation, consistency, and clinical applicability were evaluated using receiver operating characteristic analysis, a calibration curve, and decision curve analysis (DCA), respectively.

Results: LASSO regression identified 10 potential predictors. The concordance index was 0.820. The areas under the curves for the training and validation sets were 0.8195 and 0.8035, respectively. The calibration curve demonstrated strong concordance between the nomogram's predictions and the actual outcomes. DCA confirmed the clinical applicability of the nomogram.

Conclusion: Our nomogram is a reliable and convenient tool for predicting acute heart failure in patients with COPD.

Citation

Citation: Wu Z, Zhan S, Wang D, Tang C. A novel nomogram for predicting the risk of acute heart failure in intensive care unit patients with COPD. J COPD F. 2025; 12(2): 117-126. doi: http://doi.org/10.15326/jcopdf.12.2.2024.0562

Keywords

COPD, nomogram, Medical Information Mart for Intensive Care, acute heart failure

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Click to read A Novel Nomogram for Predicting the Risk of Acute Heart Failure in Intensive Care Unit Patients With COPD

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Author Affiliations

1. School of Health Sciences, University of Birmingham, Birmingham, United Kingdom
2. University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
3. Sandwell and West Birmingham NHS Foundation Trust, West Bromwich, West Midlands, United Kingdom
4. University Hospitals of Derby and Burton NHS Foundation Trust, Derby, United Kingdom

Address correspondence to:

Paul Ellis, MBChB, MRCP, PhD
School of Health Sciences
University of Birmingham
Birmingham, UK, B15 2TT
Email: p.ellis@bham.ac.uk

Abstract

Background: The severity of emphysema may be measured by lung density on computed tomography (CT) scanning, and in alpha-1 antitrypsin deficiency (AATD) this measure has been used as the primary outcome in trials of disease-modifying therapy, namely augmentation. However, the minimum clinically important difference (MCID) in lung density change is not known; this study aimed to derive and validate MCIDs for density values in AATD.

Methods: The distribution method and anchoring density against forced expiratory volume in 1 second (FEV₁) were used to derive mean and 95% confidence intervals for the MCID. Data from systematic reviews of CT density measurement and therapy for AATD obtained both absolute and annual changes in lung density. Using the range of potential MCID generated by these methods, a value was chosen for validation against mortality, lung function, and health status in the Birmingham, United Kingdom AATD cohort, using regression to adjust for confounders.

Results: Anchor and distribution methods generated a probable MCID of -1.87 g/L/year (range -1.53 to -2.20). The greatest differences between groups were found at the -2.2g/L/year with a greater FEV₁ decline in individuals with greater lung loss. Absolute lung density change had a probable MCID of -2.04g/L (range -1.83 to -2.30), and there was a difference in lung function (p<0.001) and mortality; where individuals whose absolute lung loss of more than -2.04g/L had a greater risk of death (p<0.05).

Interpretation: From initial evidence, we have shown absolute lung density change as a potential outcome for emphysema modifying therapies in AATD rather than annual density change, with an MCID of -2.04g/L.

Citation

Citation: Ho ESY, Ellis PR, Kavanagh D, Subramanian D, Stockley RA, Turner AM. Proposal and validation of the minimum clinically important difference in emphysema progression. J COPD F. 2025; 12(2): 109-116. doi: http://doi.org/10.15326/jcopdf.12.2.2024.0511

Keywords

emphysema, alpha-1 antitrypsin deficiency, lung density, minimum clinically important difference

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Author Affiliations

1. Division of Pulmonary, Allergy and Critical Care, Jane and Leonard Korman Respiratory Institute, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, United States

Address correspondence to:

Saqib H. Baig, MD, MS
Division of Pulmonary, Allergy and Critical Care
Jane and Leonard Korman Respiratory Institute
Sidney Kimmel Medical College
Thomas Jefferson University
834 Walnut Street, Suite 650
Philadelphia, PA 19107
Phone: (215) 955-9161
Email: Saqib.baig@jefferson.edu

Abstract

Background: Nontuberculous mycobacteria pulmonary disease (NTM-PD) is an emerging public health concern with increasing incidence and prevalence. Despite its chronic and progressive nature, there is a notable gap in research on the factors influencing hospital outcomes in this patient population.

Materials and Methods: We conducted a retrospective cohort study using data from the National Inpatient Sample (NIS) to analyze hospitalizations of adult patients diagnosed with NTM-PD. We examined patient demographics, comorbidities, and hospital characteristics to identify predictors of hospital length of stay (LOS) and discharge disposition. Multivariate negative binomial regression and logistic regression models were employed to assess the impact of these variables.

Results: The study included 1167 hospitalized NTM-PD patients, with a mean age of 66.9 years. The overall mean LOS was 7.4 days, with an average hospital cost of $15,606. Discharge to a nursing home was associated with a 78% longer LOS (incidence rate ratio=1.78, p<0.0001). Key predictors of extended LOS included male gender, private insurance status, higher comorbidity burden, and increased number of procedures. Patients discharged to nursing homes were more likely to be older males with complex medical profiles. Interestingly, conditions such as malignancy and COPD, while linked to longer LOS, were associated with a decreased likelihood of discharge to a nursing home.

Conclusion: Our study highlights significant predictors of LOS and discharge outcomes in NTM-PD patients, emphasizing the need for personalized and proactive management. These findings underscore the importance of targeted interventions in the outpatient setting to reduce hospital admissions and improve patient outcomes.

Citation

Citation: Baig SH, Sirapu S, Johnson J. Hospitalized nontuberculous mycobacterial pulmonary disease patients and their outcomes in the United States: a retrospective study using national inpatient sample data. J COPD F. 2025; 12(2): 146-157. doi: http://doi.org/10.15326/jcopdf.12.2.2024.0568

Keywords

comorbidities, health care utilization, nontuberculous mycobacteria lung disease, hospital length of stay, discharge disposition

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Click to read Hospitalized Nontuberculous Mycobacterial Pulmonary Disease Patients and Their Outcomes in the United States: A Retrospective Study Using National Inpatient Sample Data

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Author Affiliations

1. Pritzker School of Medicine, University of Chicago, Chicago, Illinois, United States
2. Internal Medicine Residency Program, University of Wisconsin, Madison, Wisconsin, United States
3. Section of Emergency Medicine, Department of Medicine, University of Chicago, Chicago, Illinois, United States
4. Emergency Medicine Residency, Denver Health, Denver, Colorado, United States
5. Section of Otolaryngology, Department of Surgery, University of Chicago, Chicago, Illinois, United States
6. Section of General Internal Medicine, Department of Medicine, University of Chicago, Chicago, Illinois, United States
7. Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Rush University, Chicago, Illinois United States
8. Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, University of Wisconsin-Madison, Madison, Wisconsin, United States
9. Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, Wisconsin, United States

Address correspondence to:

Valerie Press, MD, MPH
University of Chicago
Departments of Medicine and Pediatrics
5841 South Maryland Avenue, MC 2007
Chicago, IL 60637
vpress@bsd.uchicago.edu
Phone: (773) 702-5170

Abstract

This study aimed to evaluate the performance of machine learning models for predicting readmission of patients with chronic obstructive pulmonary disease (COPD) based on administrative data and chart review data. The study analyzed 4327 patient encounters from the University of Chicago Medicine to assess the risk of readmission within 90 days after an acute exacerbation of COPD. Two random forest prediction models were compared. One was derived from chart review data, while the other was derived using administrative data. The data were randomly partitioned into training and internal validation sets using a 70% to 30% split. The 2 models had comparable accuracy (administrative data area under the curve [AUC]=0.67, chart review AUC=0.64). These results suggest that despite its limitations in precisely identifying COPD admissions, administrative data may be useful for developing effective predictive tools and offer a less labor-intensive alternative to chart reviews.

Citation

Citation: Chokkara S, Hermsen MG, Bonomo M, et al. Comparison of chart review and administrative data in developing predictive models for readmissions in chronic obstructive pulmonary disease.

Keywords

COPD, readmissions, machine learning, prediction

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Click to read Comparison of Chart Review and Administrative Data in Developing Predictive Models for Readmissions in Chronic Obstructive Pulmonary Disease

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Author Affiliations

1. School of Public Health, Imperial College London, London, United Kingdom
2. University College London, Medical School-Royal Free Campus, London, United Kingdom

Address correspondence to:

Elizabeth Moore, MSc
School of Public Health
Imperial College London
Sir Michael Uren Hub
86 Wood Lane
London, England W12 0BZ
Email: liz.moore@imperial.ac.uk
Phone: 020 7594 8821

Abstract

Objective: Acute exacerbations of COPD(AECOPD) can have severe impacts on patients with the disease and a heavy burden on health care resources. Electronic health records (EHRs) are a valuable resource for identifying cases of AECOPD and research. Studies have attempted to validate case definitions of AECOPD and this review aims to summarize validated AECOPD definitions in EHRs and to provide guidance on the best algorithms to use to ensure accurate cohorts of AECOPD cases are available for researchers using EHRs.

Methods: MEDLINE and Embase were searched and studies that met the inclusion criteria were reviewed by ≥2 reviewers. Data extracted included the algorithms used to identify AECOPD, the reference standards used to compare against the algorithm, and measures of validity. The risk of bias was assessed using QUADAS-2 adapted for this review.

Results: Out of 2784 studies found by the search strategy, 12 met the inclusion criteria. The clinical terminology used to build algorithms to detect AECOPD included codes from the International Classification of Diseases (ICD) Ninth Revision, Clinical Modification and Tenth Revision (ICD-9-CM and ICD-10), along with the Read codes from United Kingdom general practices. AECOPD can be identified within EHRs using validated definitions, however, the validity of AECOPD definitions varies considerably depending on the algorithm used and the settings to which they are applied.

Conclusion: Although there are validated definitions that can be used to identify AECOPD, there is no clear consensus on which provides the highest validity or the most sensitive and specific definition to use.

Citation

Citation: Moore E, Stone P, Alizadeh A et al. Validation of acute exacerbation of chronic obstructive pulmonary disease recording in electronic health records: a systematic review. J COPD F. 2025; 12(2): 190-202. doi: http://doi.org/10.15326/jcopdf.12.2.2024.0577

Keywords

COPD, acute exacerbation of COPD, AECOPD, electronic health records

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Click to read Validation of Acute Exacerbation of Chronic Obstructive Pulmonary Disease Recording in Electronic Health Records: A Systematic Review

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Author Affiliations

1. Division of Respiratory Medicine, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, China
2. Tuberculosis and Chest Unit, Grantham Hospital, Aberdeen, Hong Kong Special Administrative Region, China

Address correspondence to:

James Chung-man Ho, MD
4/F Professorial Block
Department of Medicine Queen Mary Hospital
102 Pokfulam Rd.
Hong Kong SAR, China
Email: jhocm@hku.hk

Abstract

Background:Pseudomonas aeruginosa is an important pathogen in patients with chronic respiratory diseases. It can colonize the airways and could have prognostic value in bronchiectasis and cystic fibrosis. Its role in chronic obstructive pulmonary disease (COPD) is less well-defined.

Methods: A prospective study was conducted in Hong Kong to investigate the possible association between Pseudomonas aeruginosa colonization and acute exacerbation of COPD (AECOPD) risks.

Results: Among 327 Chinese patients with COPD, 33 (10.1%) of the patients had Pseudomonas aeruginosa colonization. Patients with or without Pseudomonas aeruginosa colonization had similar background characteristics. Patients with Pseudomonas aeruginosa colonization had increased risks of moderate to severe AECOPD, severe AECOPD, and pneumonia with an adjusted odds ratio (aOR) of 3.15 (95% CI 1.05−9.48, p=0.042), 2.59 (95% CI 1.01₋6.64, p=0.048), and 4.19 (95% CI 1.40₋12.54, p=0.011) respectively. Patients with Pseudomonas aeruginosa colonization also had increased annual frequency of moderate to severe AECOPDs, median 0 (0₋0.93) in the non-Pseudomonas aeruginosa colonization group and 1.35 (0₋3.39) in the Pseudomonas aeruginosa colonization group, with a p-value of 0.005 in multivariate linear regression.

Conclusion: Pseudomonas aeruginosa colonization is a potential independent risk factor for moderate to severe AECOPD and pneumonia among patients with COPD without coexisting bronchiectasis.

Citation

Citation: Kwok WC, Tam TCC, Chau CH, Lam FM, Ho JCM. Clinical implications of pseudomonas aeruginosa colonization in chronic obstructive pulmonary disease patients. J COPD F. 2025; 12(2): 137-145. doi: http://doi.org/10.15326/jcopdf.12.2.2024.0582

Keywords

COPD, pneumonia, COPD exacerbation, Pseudomonas aeruginosa

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Click to read Clinical Implications of Pseudomonas Aeruginosa Colonization in Chronic Obstructive Pulmonary Disease Patients

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Author Affiliations

1. Baylor College of Medicine, Harris Health Ben Taub Hospital, Houston, Texas, United States
2. Harvard Medical School, Boston, Massachusetts, United States

Address correspondence to:

Bartolomé R. Celli, MD
Harvard Medical School
31 River Glen Rd
Wellesley, MA 02481
Phone: (617) 678-0177
Email: bcelli@copdnet.org

Abstract

Chronic obstructive pulmonary disease (COPD) is a highly prevalent inflammatory lung condition characterized by chronic respiratory symptoms and airflow obstruction that often leads to diminished quality of life. Nonpharmacologic management for patients with COPD involves smoking cessation and healthy lifestyle changes. Pharmacologic treatments include inhaled bronchodilators with or without the use of inhaled corticosteroids, which can be administered through inhalation or nebulization. In addition, oral medications including macrolide antibiotics and phosphodiesterase (PDE) 4 inhibitors can help reduce exacerbation risk. However, many of these medications provide suboptimal disease control, owing to limited efficacy, increased risk of adverse events with long-term use, or difficulty in administration technique. PDE3 plays an important role in maintaining smooth muscle function, and PDE4 plays a crucial role in the inflammatory response in airway smooth muscle. Direct molecular inhibition of PDE3 or PDE4 has been shown to provide benefit in COPD. Dual PDE3 and PDE4 inhibition may, therefore, have synergistic anti-inflammatory and bronchodilator effects. These results have been observed in clinical trials of nebulized ensifentrine, a novel, dual-action PDE3 and PDE4 inhibitor that is the first in its class to be approved by the U.S. Food and Drug Administration for maintenance treatment of COPD in adult patients. In this review, we explore the pathophysiologic mechanisms of COPD, describe current paradigms and methods of drug delivery for the treatment of the disease, and illustrate how dual inhibition of PDE3 and PDE4 may provide additional benefit to current standard-of-care regimens.

Citation

Citation: Hanania NA, Celli BR. Phosphodiesterase inhibition as a therapeutic strategy for chronic obstructive pulmonary disease: where we have been and what lies ahead. J COPD F. 2025; 12(1): 82-92. doi: http://doi.org/10.15326/jcopdf.12.1.2024.0559

Keywords

COPD, quality of life, phosphodiesterase, PDE4 inhibitors, standard of care

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Click to read Phosphodiesterase Inhibition as a Therapeutic Strategy for Chronic Obstructive Pulmonary Disease: Where We Have Been and What Lies Ahead

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Author Affiliations

1. Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, The Ohio State University, Columbus, Ohio, United States
2. Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, United States
3. Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
4. Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States
5. Department of Physical Therapy, School of Health Professions, University of Alabama at Birmingham, Birmingham, Alabama, United States
6. Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
7. Section of Pulmonary and Critical Care Medicine, Baylor College of Medicine, Houston, Texas, United States

Address correspondence to:

Jing Gennie Wang, MD
241 W. 11^th Ave
Suite 5000, 5065B
Columbus, OH 43201
Phone: (646) 617-3656
Email: jing.wang2@osumc.edu

Abstract

Background: Most studies on mental health among individuals with chronic obstructive pulmonary disease (COPD) utilize screening questionnaires, which detect psychiatric symptoms, but cannot be used to diagnose depression/anxiety disorders. We utilized the Mini-International Neuropsychiatric Interview (MINI) to identify depression/anxiety disorders meeting the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition diagnostic criteria and described associated disease burden in people with COPD.

Methods: This is a cross-sectional, secondary analysis of a multicenter study designed to evaluate anxiety questionnaires in COPD patients. Research coordinators administered both the MINI and screening questionnaires to determine participants who met diagnostic criteria for depression/anxiety disorders and to capture symptom burden, respectively. Bivariate analyses were conducted to assess differences in COPD and patient-reported outcomes between those with and without depression/anxiety disorders.

Results: Of 220 participants, 18 (8%) met the MINI criteria for depression and 17 (8%) for anxiety. Depression was associated with more breathlessness (modified Medical Research Council Dyspnea Scale 4 versus 3, p=0.045), higher COPD disease burden (COPD Assessment Test [CAT] 27 versus 17, p<0.001), worse sleep quality (Pittsburgh Sleep Quality Index 11 versus 7, p=0.001) and health-related quality of life (5-Level EQ-5D 0.31 versus 0.59, p<0.001). Anxiety was associated with lower CAT scores and worse health-related quality of life and function. Most with depression/anxiety disorders were not using antidepressants/anxiolytics, or receiving mental health counseling.

Conclusion: Depression and anxiety disorders meeting diagnostic criteria are relatively common comorbidities that substantially impair quality of life and are undertreated, highlighting a need to prioritize mental health as an integral part of comprehensive COPD care.

Citation

Citation: Wang JG, Bose S, Holbrook JT, et al. Clinical characteristics of patients with COPD and comorbid depression and anxiety: data from a national multicenter cohort study. J COPD F. 2025; 12(1): 33-42. doi: http://doi.org/10.15326/jcopdf.12.1.2024.0534

Keywords

chronic obstructive pulmonary disease, depression, anxiety

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Click to read Clinical Characteristics of Patients With COPD and Comorbid Depression and Anxiety: Data From a National Multicenter Cohort Study

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Author Affiliations

1. Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States

Address correspondence to:

Aparna Balasubramanian, MD, MHS
1830 East Monument Street, Floor 5
Division of Pulmonary and Critical Care Medicine
Johns Hopkins University School of Medicine
Baltimore, Maryland 21205
Email: abalasu2@jhmi.edu

Abstract

Background: The impact of iron deficiency on COPD morbidity independent of anemia status is unknown. Understanding the association between iron deficiency, anemia status, and risk of hospitalization in COPD may inform an approach to these comorbidities.

Study Design and Methods: Adults ≥40 years from the Johns Hopkins COPD Precision Medicine Center of Excellence data repository with an outpatient iron profile and 1 year of subsequent follow-up time were included in the study. Baseline characteristics were compared across iron status, defined by transferrin saturation (TSAT), using t-tests and Chi-squared tests. The association between continuous TSAT and all-cause hospitalization over the 1-year follow-up period was assessed by logistic regression. Models were adjusted by covariates with an interaction term for anemia and stratified by sex.

Results: There were 6532 individuals included with an average age of 65±12 years, 59% were female, and 56% White. Fifty-two percent of the cohort were iron deficient (TSAT≤20%), among whom 27% were non-anemic. Iron-deficient individuals had lower lung function and a higher prevalence of heart failure and diabetes. Iron deficiency was more prevalent among females (57%) compared to males (44%). In adjusted models, a decrease in TSAT by 10% was associated with 14.3% higher odds of all-cause hospitalization for females (95%CI:1.0−1.3), but not among males (OR:1.08, 95%CI:0.9−1.3). There was effect modification by anemia such that the association between TSAT and all-cause hospitalization was greater in non-anemic women (p-value interaction=0.08).

Interpretation: Iron deficiency may be associated with adverse outcomes in the absence of anemia, with non-anemic women being a COPD sub-population particularly sensitive to iron deficiency.

Citation

Citation: Kunitomo Y, Putcha N, Fawzy A, et al. Iron deficiency and all-cause hospitalization risk in a clinical cohort of COPD. J COPD F. 2025; 12(1): 72-81. doi: http://doi.org/10.15326/jcopdf.12.1.2024.0550

Keywords

COPD, comorbidity, epidemiology, sex, iron deficiency

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Click to read Iron Deficiency and All-Cause Hospitalization Risk in a Clinical Cohort of COPD

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Author Affiliations

1. Heritage College of Osteopathic Medicine, Ohio University, Athens, Ohio, United States
2. College of Medicine, University of Cincinnati, Cincinnati, Ohio, United States
3. Critical Care Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, United States
4. Northern Kentucky University, Highland Heights, Kentucky, United States
5. University of Arkansas at Little Rock, Little Rock, Arkansas, United States
6. University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
7. Arkansas Children’s Research Institute, Little Rock, Arkansas, United States

Address correspondence to:

Brian M. Varisco, MD
Arkansas Children’s Research Institute
13 Children’s Way
Little Rock, Arkansas, USA 72202
Phone: (501) 364-7512
Email: bvarisco@uams.edu

Abstract

Background: Alpha-1 antitrypsin (AAT) deficiency is the most common genetic cause of emphysema. Chymotrypsin-like elastase 1 (CELA1) is a serine protease neutralized by AAT and is important in emphysema progression. Cela1-deficiency is protective in murine models of AAT-deficient emphysema. KF4 anti-CELA1 antibody prevented emphysema in porcine pancreatic elastase (PPE) and cigarette smoke models in wild-type mice.

Methods: We evaluated potential toxicities of KF4 and its ability to prevent emphysema in AAT deficiency. We found Cela1 protein expression in mouse lungs, pancreas, small intestine, spleen, and bone marrow. In toxicity studies, mice treated with KF4 25mg/kg weekly for 4 weeks showed an elevation in blood urea nitrogen and slower weight gain compared to lower doses or equivalent dose immunoglobin G (IgG). By histologic grading of tissue injury of the lung, kidney, liver, and heart, there was some evidence of liver injury with KF4 25mg/kg, but in all tissues, injury was less than in control mice subjected to cecal ligation and puncture. In efficacy studies, KF4 doses as low as 0.5mg/kg reduced the lung elastase activity of AAT^-/- mice treated with 0.2 units of PPE.

Results: In this injury model, AAT^-/- mice treated with KF4 1mg/kg weekly, human purified AAT 60mg/kg weekly, and combined KF4 and AAT treatment had less emphysema than mice treated with IgG 1mg/kg weekly. However, the efficacy of KF4, AAT, or KF4 and AAT was similar.

Conclusion: While KF4 might be an alternative to AAT replacement, combined KF4 and AAT replacement does not confer additional benefit.

Citation

Citation: Devine AJ, Smith NJ, Joshi R, et al. KF4 anti-chymotrypsin-like elastase 1 antibody and purified alpha-1 antitrypsin have similar but not additive efficacy in preventing emphysema in murine alpha-1 antitrypsin deficiency. J COPD F. 2025; 12(1): 12-22. doi: http://doi.org/10.15326/jcopdf.12.1.2024.0535

Keywords

COPD, emphysema, alpha-1 antitrypsin, protease, elastase

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Click to read KF4 Anti-Chymotrypsin-like Elastase 1 Antibody and Purified Alpha-1 Antitrypsin Have Similar but Not Additive Efficacy in Preventing Emphysema in Murine Alpha-1 Antitrypsin Deficiency

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Author Affiliations

1. Data and Analytics, EVERSANA, Milwaukee, Wisconsin, United States
2. Data and Analytics, EVERSANA, Pune, India
3. Medical Affairs, Grifols Shared Services North America, Durham, North Carolina, United States
4. Global Health Economics and Outcomes Research/Real-World Evidence, Grifols Shared Services North America, Durham, North Carolina, United States
5. Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Medical University of South Carolina, Charleston, South Carolina, United States
6. AlphaNet, Coral Gables, Florida, United States

Address correspondence to:

M. Chris Runken, PharmD
Grifols, Shared Services North America
79 T.W. Alexander Drive
Durham, NC 27709
Phone: (919) 316-6343
Email: chris.runken@grifols.com

Abstract

Background: Despite guideline recommendations, most patients with chronic obstructive pulmonary disease (COPD) do not undergo alpha-1 antitrypsin deficiency (AATD) testing and approximately 90% of people with AATD in the United States remain undiagnosed. This study sought to develop a predictive model using real-world data to improve detection of AATD-positive patients in the general COPD population.

Methods: A predictive model using extreme gradient boosting was developed using the EVERSANA database, including longitudinal, patient-level medical claims, prescription claims, AATD-specific testing data, and electronic health records (EHR). The model was trained and then validated to predict AATD-positive status. Patients were coded as AATD positive based on the presence of any of the following criteria: (1) ≥2 AATD diagnosis codes in claims; (2) an AATD diagnosis code in the EHR; (3) a positive laboratory test for AATD; or (4) use of AATD-related medication. Over 500 variables were used to train the predictive model and >20 models were run to optimize the predictive power.

Results: A total of 13,585 AATD-positive patients and 7796 AATD-negative patients were included in the model. The inclusion of non-AATD laboratory test results was critical for defining cohorts and optimizing model prediction (e.g., respiratory comorbidities, and calcium, glucose, hemoglobin, and bilirubin levels). The final model yielded high predictive power, with an area under the receiver operating characteristic curve of 0.9.

Conclusions: Predictive modeling using real-world data is a sound approach for assessing AATD risk and useful for identifying COPD patients who should be confirmed by genetic testing. External validation is warranted to further assess the generalizability of these results.

Citation

Citation: Pfeffer DN, Dhakne R, El Massad O, et al. Improving the likelihood of identifying alpha-1 antitrypsin deficiency among patients with COPD: a novel predictive model using real-world data. J COPD F. 2025; 12(1): 1-11. doi: http://doi.org/10.15326/jcopdf.12.1.2023.0491

Keywords

alpha-1 antitrypsin deficiency, detection, electronic health records, predictive model, testing

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Click to read Improving the Likelihood of Identifying Alpha-1 Antitrypsin Deficiency Among Patients With COPD: A Novel Predictive Model Using Real-World Data

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Author Affiliations

1. Department of Laboratory Medicine, Affiliated Wuxi Fifth Hospital of Jiangnan University, Wuxi, China
2. Respiratory and Critical Care Medicine, the Second People’s Hospital of Banan District, Chongqing, China
3. Department of Respiratory Medicine, the Second Affiliated Hospital, Chongqing Medical University, Chongqing, China

Address correspondence to:

Chengfeng Fu, MM
Respiratory and Critical Care Medicine
Second People’s Hospital of Banan District
Chongqing, China
Phone: +86 15086717989
Email: chengfengfu@stu.cqmu.edu.cn

Abstract

Objective: Chronic obstructive pulmonary disease (COPD) is closely associated with arthritis. This study aims to evaluate the correlation between COPD and mortality among participants with arthritis.

Methods: The study included 11,298 participants from the National Health and Nutrition Examination Survey (NHANES) 1999–2018, who self-reported having arthritis. Cox proportional hazard models were used to assess the association between COPD and mortality among participants with arthritis. Kaplan-Meier survival curves were plotted to compare survival probabilities between groups. Subgroup and sensitivity analyses were conducted to assess the robustness of the results.

Results: During an average follow-up of 8.8 years, 3061 all-cause deaths were observed, including 1024 related to cardiovascular disease (CVD). After weighted multivariable adjustment, COPD was found to be significantly associated with both all-cause and CVD mortality among these arthritis participants. The hazard ratio (HR) for all-cause mortality among arthritis patients with COPD was 1.41 (95% confidence interval [CI]: 1.25–1.60, p < 0.001), and the HR for CVD mortality was 1.29 (95% CI: 1.08–1.53, p < 0.001). Kaplan-Meier survival curves attributed higher rates of both all-cause and CVD mortality among participants with COPD compared to those without (log-rank test, p < 0.001). Additionally, COPD increased the risk of both chronic lower respiratory disease (CLRD) mortality (HR 5.46, 95% CI: 3.48–8.56, p < 0.001) and non-CLRD mortality (HR 1.24, 95% CI: 1.07–1.44, p=0.004).

Conclusion: In the American population, arthritis patients with COPD have higher risks of all-cause and CVD mortality compared to those without COPD.

Citation

Citation: Zhang Y, Chen G, Huang A, Hu Y, Fu C. Association between chronic obstructive pulmonary disease and mortality in participants with arthritis: data from the National Health and Nutrition Examination Survey 1999–2018. J COPD F. 2025; 12(1): 61-71. doi: http://doi.org/10.15326/jcopdf.12.1.2024.0573

Keywords

COPD, all-cause mortality, NHANES, arthritis, cardiovascular mortality

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Click to read Association Between Chronic Obstructive Pulmonary Disease and Mortality in Participants with Arthritis: Data from the National Health and Nutrition Examination Survey 1999–2018

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Author Affiliations

1. Department of Medicine, Queen Mary Hospital, University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, China
2. Department of Statistics, College of Arts and Sciences, University of South Carolina, Columbia, South Carolina, United States

Address correspondence to:

Terence Chi Chun Tam, MBBS
4/F, Professorial Block
Department of Medicine
The University of Hong Kong, Queen Mary Hospital
102 Pokfulam Road
Pokfulam, Hong Kong, China
Email: cctam@hotmail.com

Abstract

Background: Triple therapy with inhaled corticosteroids and dual bronchodilator therapy is recommended for chronic obstructive pulmonary disease (COPD) patients who have exacerbations and eosinophilia. It can be administered by single inhaler triple therapy (SITT) or by multiple inhaler triple therapy (MITT). There is a lack of evidence of the benefits of SITT over MITT in the Chinese population, especially on switching from existing MITT to SITT.

Methods: A total of 70 Chinese patients with COPD were recruited in this open-label, double-arm clinical trial to investigate the number of critical inhaler errors, the modified Medical Research Council (mMRC) dyspnea scale, the Medication Adherence Report Scale for Asthma (MARS-A) score, and a satisfaction score upon switching from MITT to SITT.

Results: The mean number of critical inhaler errors was 0.4±1.0 in the SITT group and 1.1±1.8 in the MITT group( p=0.038) at the first visit; and 0.2±0.6 in the SITT group and 0.8±1.1 in the MITT group (p=0.007) at the second visit. The mean change in MARS-A from baseline to first visit was +3.76±7.48 in the SITT group and -1.27±7.76 in the MITT group (p-value 0.008). A total of 22 (59.5%) and 8 (24.2%) of the patients in the SITT and the MITT group respectively, had an increase in MARS-A score from baseline to first visit, with an adjusted odds ratio of 6.23 (95% confidence interval=1.63–23.77, p=0.007), favoring SITT. There was no significant difference in the change in the mMRC dyspnea scale and the satisfaction score between the 2 groups.

Conclusion: Switching from MITT to SITT in Chinese COPD patients may have the benefits of having fewer critical inhaler errors and a higher MARS-A score.

Citation

Citation: Kwok WC, Ma TF, Tsui CK, Ho JCM, Tam TCC. Prospective randomized study on switching triple inhaler therapy in COPD from multiple inhaler devices to a single inhaler device in a Chinese population. J COPD F. 2025; 12(1): 52-60. doi: http://doi.org/10.15326/jcopdf.12.1.2024.0519

Keywords

COPD, triple therapy, single inhaler triple therapy, multiple inhaler triple therapy

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Click to read Prospective Randomized Study on Switching Triple Inhaler Therapy in COPD from Multiple Inhaler Devices to a Single Inhaler Device in a Chinese Population

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Author Affiliations

1. Applied Chest Imaging Laboratory, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States
2. Department of Respiratory Medicine, Saitama Medical University, Saitama, Japan
3. Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States
4. Boston University School of Medicine, Boston, Massachusetts, United States
5. Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, United States
6. Department of Genetics, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, United States
7. Department of Epidemiology, University of Alabama at Birmingham School of Public Health, Birmingham, Alabama, United States
8. Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States
9. Department of Critical Care Medicine, South Shore Hospital, South Weymouth, Massachusetts, United States
10. Tufts University School of Medicine, Boston, Massachusetts, United States

Address correspondence to:

Toru Shirahata, MD
Dept. of Respiratory Medicine
Saitama Medical University
38 Morohongo, Moroyama-machi, Iruma-gun
Saitama, 350-0495, Japan
Email: t_shira@saitama-med.ac.jp

Abstract

Background: Cigarette smoke contributes to skeletal muscle wasting. While exercise and nutritional therapies are effective in improving skeletal muscle quantity and quality, the effect of medications on longitudinal muscle loss is unclear. We investigated whether long-term use of common medications affects longitudinal skeletal muscle changes in current and former smokers.

Methods: Using quantitative computed tomography imaging, we measured the 5-year changes in pectoralis muscle area (delta-PMA) and pectoralis muscle density (delta-PMD) of 4191 participants in the COPD Genetic Epidemiology (COPDGene^®) study. We tested whether specific medications were associated with delta-PMA and/or delta-PMD using regression analyses. Propensity score matching (PSM) analysis was performed to determine the effect of the medications on longitudinal changes on delta-PMA.

Results: Over the study period, the median delta-PMA for the entire population showed a decrease of 2.23cm² (interquartile range: -6.52, 1.54). Regression analyses demonstrated statin use was associated with less loss of PMA, whereas, aspirin use was associated with a greater loss of PMA. Specifically, in the PSM-adjusted analysis, statin use was associated with attenuated loss of PMA (median; -1.5 versus -2.5cm², p=0.017), while aspirin use was associated with increased loss of PMA (median; -2.5 versus -1.9cm², p=0.040).

Conclusions: In current and former smokers, statin use was associated with reduced pectoralis muscle wasting, while aspirin use was associated with increased muscle loss. Additional research is needed to verify these findings. (Clinicaltrials.gov identifier NCT00608764)

Citation

Citation: Shirahata T, Enzer NA, Castro V, et al. Effect of common medications on longitudinal pectoralis muscle area in smokers. J COPD F. 2025; 12(1): 23-32. doi: http://doi.org/10.15326/jcopdf.12.1.2024.0557

Keywords

aspirin, smoker, pectoralis muscle deterioration, statin

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Click to read Effect of Common Medications on Longitudinal Pectoralis Muscle Area in Smokers

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Author Affiliations

1. Respiratory Research@Alfred, Monash University, Melbourne, Victoria, Australia
2. Institute for Breathing and Sleep, Melbourne, Victoria, Australia
3. Department of Physiotherapy, Alfred Health, Melbourne, Victoria, Australia
4. Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
5. Lung Foundation Australia, Brisbane, Queensland, Australia

Address correspondence to:

Narelle S. Cox, PhD
Respiratory Research@Alfred
Monash University
Level 6, The Alfred Centre
99 Commercial Rd
Melbourne, Victoria, 3004, Australia
Email: Narelle.Cox@monash.edu

Abstract

This article does not contain an abstract.

Citation

Citation: May AK, Holland AE, Alison JA, Herrmann K, Cox NS. Telerehabilitation services remain increased post-COVID-19 in Australia. J COPD F. 2025; 12(1): 93-97. doi: http://doi.org/10.15326/jcopdf.12.1.2024.0575

Keywords

pulmonary rehabilitation, telehealth, telerehabilitation, chronic respiratory disease, service delivery

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Click to read Telerehabilitation Services Remain Increased Post-COVID-19 in Australia

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Author Affiliations

1. Lakeland Regional Health, Lakeland, Florida, United States

Address correspondence to:

Ana-Maria Diaz, PharmD
Lakeland Regional Health
1324 Lakeland Hills Blvd
Lakeland, Florida 33805
Phone: (813) 401-0064
Email: Ana-Maria.Diaz@myLRH.org

Abstract

Background: Acute exacerbation of chronic obstructive pulmonary disease (COPD) is one of the 6 conditions in the Hospital Readmissions Reduction Program for which institutions are penalized for high 30-day readmission rates. This institution’s transitions of care (TOC) pharmacists have prescribing authority to optimize guideline-directed medical therapy (GDMT), defined as discharging on rescue plus triple therapy inhalers under an approved protocol. While several studies evaluate the impact of pharmacist-led interventions on COPD readmission rates, there is a lack of literature with respect to pharmacists prescribing inhalers under an approved protocol. This study aims to evaluate all-cause 30-day COPD readmission rates.

Methods: This was an institutional review board-approved, single-center, retrospective evaluation conducted between May 2021 and August 2023. Patients were included if they met criteria under the Centers for Medicare and Medicaid Services Hospital Readmissions Reduction Program COPD model. Patients in the pre-implementation group received usual care, with postdischarge nurse follow-up while patients in the postimplementation group received TOC pharmacy services. The primary outcome was all-cause 30-day readmission rates. Secondary outcomes included readmission reason and proportion of patients discharged on GDMT.

Results: A total of 279 patients were included, with 187 patients in the pre-implementation group and 92 patients in the postimplementation group. All-cause 30-day readmission rates in the pre- and postimplementation groups were 26% and 14%, respectively (p=0.02). The proportion of patients discharged on GDMT was 26% in the pre-implementation group and 100% in the postimplementation group (p<0.001).

Conclusion: Utilizing a TOC pharmacy service may be associated with a reduction in all-cause 30-day readmission rates for patients with COPD.

Citation

Citation: Diaz AM, Smith LM, Peterson AN, Kent ML, Vellian NJ. Impact of pharmacist inhaler prescribing at discharge for chronic obstructive pulmonary disease on readmission rates. J COPD F. 2025; 12(1): 43-51. doi: http://doi.org/10.15326/jcopdf.12.1.2024.0553

Keywords

chronic obstructive pulmonary disease, hospital pharmacist, intervention, readmission rate, transitions of care

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Click to read Impact of Pharmacist Inhaler Prescribing at Discharge for Chronic Obstructive Pulmonary Disease on Readmission Rates

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Author Affiliations

1. Division of Pulmonary and Critical Care, Department of Medicine, Weill Cornell Medicine, New York, New York, United States
2. Section of Pulmonary, Critical Care, Allergy, and Immunologic Diseases, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, United States

Address correspondence to:

Jamuna Krishnan, MD, MBA
Division of Pulmonary and Critical Care
Department of Medicine
Weill Cornell Medicine
New York, NY
Phone: (646) 962-2333
Email: jkk9002@med.cornell.edu

Abstract

This article does not contain an abstract.

Citation

Citation: Krishnan JK, Bon J. COPD and metabolic syndrome: unanswered questions and opportunities for innovation. J COPD F. 2024; 11(6): 544-548. doi: http://doi.org/10.15326/jcopdf.11.6.2024.0576

Keywords

COPD, comorbidities, metabolic syndrome

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Click to read COPD and Metabolic Syndrome: Unanswered Questions and Opportunities for Innovation

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Author Affiliations

1. Division of Pulmonary and Critical Care Medicine, University of California, Los Angeles, California, United States
2. Department of Medicine, University of California, Los Angeles, California, United States
3. Human Genetics, University of California, Los Angeles, California, United States
4. Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
5. Division of Pulmonary and Critical Care Medicine, University of Florida, Gainesville, Florida, United States

Address correspondence to:

Igor Barjaktarevic, MD, PhD
Division of Pulmonary and Critical Care Medicine
University of California
Los Angeles, California
Email: ibarjaktarevic@mednet.ucla.edu

Abstract

Alpha-1 antitrypsin (AAT) deficiency is an autosomal codominant disorder caused by SERPINA1 gene mutations. PI*Z and PI*S mutations commonly underlie this deficiency, but rarer homozygous PI*Null (Q0) mutations may result in a complete loss of AAT. Such rare mutations lead to severe AAT deficiency and early onset of lung disease. We present a case of a 35-year-old female never-smoker born to consanguineous parents who developed severe panlobular emphysema and end-stage respiratory insufficiency requiring lung transplantation. Subsequent genetic testing identified her as homozygous for a novel c.82del mutation—here named Q0_Bani-Yas based on the region of the primary carrier's origin—which resulted in undetectable levels of the AAT protein.

Citation

Citation: Barjaktarevic IZ, Hong AW, Hoover A, et al. Alpha-1 antitrypsin deficiency in a young never smoker with novel Pi*Null homozygous mutation: a case report. J COPD F. 2024; 11(6): 624-629. doi: http://doi.org/10.15326/jcopdf.11.6.2024.0518

Keywords

alpha-1 antitrypsin deficiency, Pi*null, mutation, SERPINA1

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Click to read Alpha-1 Antitrypsin Deficiency in a Young Never Smoker With Novel Pi*Null Homozygous Mutation: a Case Report

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Author Affiliations

1. Pulmonary, Critical Care and Sleep Medicine Section, Yale University, New Haven, Connecticut, United States
2. Center for Precision Pulmonary Medicine, Yale University, New Haven, Connecticut, United States

Address correspondence to:

Jose Gomez, MD
Yale University
300 Cedar Street (S419 TAC)
New Haven, CT 06520-8057
Phone: (203) 785-4163
Email: jose.gomez-villalobos@yale.edu

Abstract

Rationale: Acute exacerbations of chronic obstructive pulmonary disease (AECOPDs) are heterogeneous. Machine learning (ML) has previously been used to dissect some of the heterogeneity in COPD. The widespread adoption of electronic health records (EHRs) has led to the rapid accumulation of large amounts of patient data as part of routine clinical care. However, it is unclear whether the implementation of ML in EHR-derived data has the potential to identify subgroups of AECOPD.

Objectives: To determine whether ML implementation using EHR data from severe AECOPDs requiring hospitalization identifies relevant subgroups.

Methods: This study used 2 retrospective cohorts of patients with AECOPDs (non-COVID-19 and COVID-19) treated at Yale-New Haven Hospital. K-means clustering was used to identify patient subgroups.

Measurements and Main Results: We identified 3 subgroups in the non-COVID cohort (n=1736). Each subgroup had distinct clinical characteristics. The reference subgroup was the largest (n=904), followed by cardio-renal (n=548) and eosinophilic (n=284). The eosinophilic subgroup had milder severity of AECOPD, including a shorter hospital stay (p<0.01). The cardio-renal subgroup had the highest mortality during (5%) and in the year after hospitalization (30%). Validation of the severe AECOPD classifier in the COVID-19 cohort recapitulated the characteristics seen in the non-COVID cohort. AECOPD subgroups in the COVID-19 cohort had different interleukin (IL)-1 beta, IL-2R, and IL-8 levels (false discovery rate ≤ 0.05). These specific leukocyte and cytokine profiles resulted in inflammatory differences between the AECOPD subgroups based on C-reactive protein levels.

Conclusions: Incorporating ML with EHR data allows the identification of specific clinical and biological subgroups for severe AECOPD.

Citation

Citation: Li H, Huston J, Zielonka J, Kay S, Sauler M, Gomez J. Identification of severe acute exacerbations of chronic obstructive pulmonary disease subgroups by machine learning implementation in electronic health records. J COPD F. 2024; 11(6): 611-623. doi: http://doi.org/10.15326/jcopdf.11.6.2024.0556

Keywords

acute exacerbations of COPD, machine learning, electronic health records, clusters

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Click to read Identification of Severe Acute Exacerbations of Chronic Obstructive Pulmonary Disease Subgroups by Machine Learning Implementation in Electronic Health Records

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Author Affiliations

1. Division of Geriatrics and Palliative Care, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, United States
2. Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, United States
3. Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, Washington, United States
4. Health Systems Research, Department of Veterans Affairs Puget Sound Health Care System, Seattle, Washington, United States

Address correspondence to:

Cara L. McDermott, PharmD, PhD
Box 3003, DUMC
Division of Geriatrics and Palliative Care
Durham, NC 27710
Phone: (919) 660-8386
Email: cara.mcdermott@duke.edu

Abstract

Background: Falls are frequent among people with chronic obstructive pulmonary disease (COPD) and are associated with increased morbidity, mortality, and health care costs. Understanding modifiable medication factors that contribute to fall risk is an important step to developing fall prevention strategies for this highly susceptible group.

Methods: This is a retrospective cohort study using electronic health record data from a single health system linked to Washington State death certificates of adults ages 40 or older who died between 2014–2018 with COPD. We identified demographics, comorbidities, fall-risk increasing drug (FRID) burden, and the occurrence of injurious falls within the 2 years prior to the date of death. We defined injurious falls using published algorithms of the International Classification of Diseases codes.

Results: Of 8204 decedents with COPD, 2454 (30%) had an injurious fall in the 2 years before death, and FRID use was common among 65%. A higher percentage of patients with falls received prescriptions for anticonvulsants (35% versus 26%), antipsychotics (24% versus 13%), atypical antidepressants (28% versus 19%), and tricyclic antidepressants (10% versus 5%) versus those without a fall. In multivariable logistic regression, after adjusting for confounders, FRID burden was associated with greater odds of an injurious fall (odds ratio 1.07 [95% confidence interval 1.04–1.09]).

Conclusion: Our findings highlight an opportunity for collaboration between pharmacists, pulmonologists, and patients to develop new processes to potentially deprescribe and optimize the use of FRIDs among patients with COPD to increase safety.

Citation

Citation: McDermott CL, Feemster LC, Engelberg RA, Spece LJ, Donovan LM, Curtis JR. Fall risk and medication use near end of life among adults with chronic obstructive pulmonary disease. J COPD F. 2024; 11(6): 604-610. doi: http://doi.org/10.15326/jcopdf.11.6.2024.0551

Keywords

COPD, medication, falls, end of life, care delivery

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Click to read Fall Risk and Medication Use Near End of Life Among Adults With Chronic Obstructive Pulmonary Disease

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Author Affiliations

1. GSK, Madrid, Spain
2. Respiratory Immunology Research Unit, GSK, Collegeville, Pennsylvania, United States
3. Pulmonary, Allergy, and Critical Care Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
4. Precise Approach Ltd, London, United Kingdom
5. Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan, United States

Address correspondence to:

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

Abstract

Introduction: Lung physiology and chronic obstructive pulmonary disease (COPD) pathophysiology differ between sexes. This post hoc analysis investigated the InforMing the Pathway of COPD Treatment (IMPACT) trial outcomes by patient sex.

Methods: IMPACT was a double-blind, 52-week trial. Patients ≥40 years with symptomatic COPD and a history of exacerbations were randomized 2:2:1 to fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) 100/62.5/25μg, FF/VI 100/25μg, or UMEC/VI 62.5/25μg. Annual rate and risk of moderate/severe exacerbations, change from baseline in trough forced expiratory volume in 1 second (FEV₁) and St George's Respiratory Questionnaire (SGRQ) score, and safety were assessed.

Results: Of 10,355 patients, 66.3% were male. More females reported ≥2 moderate/severe prior exacerbations (58% versus 53%) at screening versus males. Additionally, females had worse mean (standard deviation) SGRQ scores (52.4[15.97] versus 49.8[17.24]) at baseline. FF/UMEC/VI improved annual exacerbation rate, lung function, and health status for both sexes versus dual therapy. The difference in trough FEV₁ across time points with FF/UMEC/VI versus FF/VI was 103mL–110mL in males and 70mL–84mL in females. On-treatment moderate/severe exacerbation rates remained higher for females (FF/UMEC/VI: 0.99; FF/VI: 1.19; UMEC/VI: 1.35) than males (0.87; 1.01; 1.14). Fewer exacerbations were experienced by females with eosinophil counts <150 cells/µL (0.81[0.68, 0.97], p=0.024) or <2 exacerbations in the past year (0.73[0.57, 0.94], p=0.013) with FF/UMEC/VI versus UMEC/VI.

Conclusions: More females with COPD reported exacerbations in the prior year at screening, as well as during the study, versus males, across all treatments. FF/UMEC/VI improved exacerbation rates versus UMEC/VI in females with eosinophil counts <150 cells/µL or <2 exacerbations in the prior year, suggesting inhaled corticosteroids may play an important role in exacerbation reduction for females in this patient population.

Clinical Trial Registration: GSK (CTT116855/NCT021645B)

Citation

Citation: Alberola AH, Nogal NB, Miranda AB, Lipson DA, Tombs L, Han MK. The effect of patient sex on treatment outcomes in COPD: a post hoc analysis of the IMPACT trial. J COPD F. 2024; 11(6): 591-603. doi: http://doi.org/10.15326/jcopdf.11.6.2024.0541

Keywords

COPD, triple therapy, dual therapy, FF/UMEC/VI, patient traits

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Click to read The Effect of Patient Sex on Treatment Outcomes in COPD: A Post Hoc Analysis of the IMPACT Trial

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Author Affiliations

1. Chobanian & Avedisian School of Medicine, Boston University, Boston, Massachusetts, United States
2. East Boston Neighborhood Health Center, Boston, Massachusetts, United States
3. Med-IQ, Baltimore, Maryland, United States

Address correspondence to:

Andrew A. Wilson, MD
670 Albany St, 2^nd Floor, CReM
Boston, MA 02118
Phone: (617) 358-0736
Email: awilson@bu.edu

Abstract

Rationale: Evidence-based guidelines recommend screening all individuals with chronic obstructive pulmonary disease (COPD) for the genetic disorder alpha-1 antitrypsin deficiency (AATD). However, it is estimated that only 5% of people with COPD have been tested for AATD, and a large fraction of the estimated 70,000 to 100,000 Americans with AATD have not yet been diagnosed. Low familiarity with AATD and limited knowledge about diagnostic tests and available treatments contribute to suboptimal screening rates.

Objectives: Our objective was to address barriers to and improve rates of guideline-based AATD diagnostic testing among racially and ethnically diverse patients with COPD at a large community health center.

Methods: A quality improvement initiative consisting of educational sessions and electronic health record (EHR) system interventions was implemented to improve the adoption of guideline-based screening for AATD in patients with COPD.

Results: An analysis of EHR data demonstrated that among patients with a COPD diagnosis (n=1030), 22.2% (n=229) were screened for AATD in the 12 months following the start of the quality improvement initiative compared with 1.3% (n=13) of patients with a COPD diagnosis (n=972) seen in the 12 months prior to the start of the quality improvement initiative (P<0.001).

Conclusions: A quality improvement initiative consisting of educational sessions and EHR system modifications was successful in increasing clinicians’ knowledge and diagnostic screening rates for AATD in patients with COPD at a large community health center.

Citation

Citation: Wilson AA, Bora C, Silva C, et al. A multimodal intervention to improve guideline-based screening for alpha-1 antitrypsin deficiency in a community health setting. J COPD F. 2024; 11(6): 582-590. doi: http://doi.org/10.15326/jcopdf.11.6.2024.0540

Keywords

chronic obstructive pulmonary disease, alpha-1 antitrypsin deficiency, screening, alpha-1 antitrypsin, quality improvement initiative

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Click to read A Multimodal Intervention to Improve Guideline-Based Screening for Alpha-1 Antitrypsin Deficiency in a Community Health Setting

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Author Affiliations

1. College of Nursing, Medical University of South Carolina, Charleston, South Carolina, United States
2. College of Medicine, Medical University of South Carolina, Charleston, South Carolina, United States
3. Department of Physiological Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida, United States

Address correspondence to:

Sarah N. Miller, PhD, RN
College of Nursing
Medical University of South Carolina
99 Jonathan Lucas St.
Charleston, SC 29425
Email: millesar@musc.edu

Abstract

Background: Chronic obstructive pulmonary disease (COPD) is a progressive respiratory disease associated with respiratory muscle weakness and activity-limiting symptoms such as dyspnea. Respiratory muscle strength training (RMST) is an empirically validated therapy to increase respiratory muscle strength. The theoretically-informed, technology-enhanced RESPiratory FITness (RESP-FIT) intervention for COPD is a 6-week combined inspiratory and expiratory muscle strength training program with symptom measurement in real time via ecological momentary assessment (EMA).

Objectives: In addition to hypothesis-generating purposes, the purpose of this randomized control pilot study was to explore whether observed effects (on symptoms, patient-reported outcomes, and respiratory muscle strength) support carrying out a future large-scale trial of RESP-FIT.

Methods: A total of 30 adults with COPD were randomized to intervention (n=15) or control groups, with the intervention group undergoing 6 weeks of mHealth-enhanced RMST. Daily symptom data were collected in real time over the 6-week intervention period using EMA.

Results: Compared to the control group, participants in the intervention group reported decreased dyspnea and anxiety, increased happiness, and improved respiratory muscle strength. However, reports of fatigue and sleep disturbance increased in the intervention group compared to the control group.

Conclusion: Results support the hypothesis that the 6-week RESP-FIT program will improve respiratory muscle strength, emotional state (anxiety and happiness), and breathlessness in COPD but may contribute to fatigue, at least in the short term. Future work is needed to determine the efficacy of RESP-FIT, determine mechanisms of action on dyspnea and fatigue, and conduct within-participant comparisons of EMA data to explore individual or environmental fluctuations in COPD symptoms.

Citation

Citation: Miller SN, Mueller M, Nichols M, et al. RESP-FIT: a technology-enhanced combined inspiratory and expiratory muscle strength training intervention for adults with COPD. J COPD F. 2024; 11(6): 569-581. doi: http://doi.org/10.15326/jcopdf.11.6.2024.0523

Keywords

COPD, dyspnea, respiratory muscle strength training, mHealth

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Click to read RESP-FIT: A Technology-Enhanced Combined Inspiratory and Expiratory Muscle Strength Training Intervention for Adults With COPD

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Author Affiliations

1. Research Department, Spire Health, San Francisco, California, United States
2. Pulmonary Associates of Richmond, Richmond, Virginia, United States
3. Division of Pulmonary Diseases and Critical Care Medicine,Department of Medicine, University of Texas Health, San Antonio, Texas, United States

Address correspondence to:

Neema Moraveji, PhD
Spire Health
San Francisco, California
Phone: (415) 533-2385
Email: neema@spirehealth.com

Abstract

Background: Continuous respiratory monitoring can support integrated care for chronic obstructive pulmonary disease (COPD) patients, by coupling them with remote clinical personnel who triage patients in coordination with their health care providers. When deploying such services, there remains uncertainty surrounding outcomes when at-risk patients are proactively identified and escalated for provider evaluation. This study presents findings from a service deployed in a real-world COPD cohort by analyzing the clinical interventions made during in-person and telehealth pulmonary outpatient visits following remote escalations.

Methods: A single-center, retrospective, observational study of real-world COPD patients at a multisite pulmonary practice was conducted. Patients who were enrolled in a continuous respiratory monitoring service for at least one year and were seen by a provider within 7 days of an escalation by the service (N=168) were included. To evaluate the potential impact of these escalations on provider and patient burden, medical charts from outpatient visits were manually reviewed and grouped into 6 categories based on the clinical action(s) taken by the provider.

Results: A total of 245 outpatient visits occurred from 168 patients within 7 days of escalation. Of the 245 visits, 206 (84.1%) resulted in clinical intervention and 163 (66.5%) resulted in treatment consistent with acute exacerbations of COPD. A total of 1.6% of the outpatient visits resulted in referral to the emergency department.

Conclusions: Provider encounters occurring following the escalation of a patient from a continuous respiratory monitoring service consistently resulted in that provider administering a treatment to the escalated patient.

Citation

Citation: Teresi RK, Hendricks AC, Moraveji N, Murray RK, Polsky M, Maselli DJ. Clinical interventions following escalations from a continuous respiratory monitoring service in patients with chronic obstructive pulmonary disease. J COPD F. 2024; 11(6): 558-568. doi: http://doi.org/10.15326/jcopdf.11.6.2023.0475

Keywords

chronic obstructive pulmonary disease, continuous respiratory monitoring, remote physiologic monitoring, burden, physiology

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Click to read Clinical Interventions Following Escalations from a Continuous Respiratory Monitoring Service in Patients With Chronic Obstructive Pulmonary Disease

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Author Affiliations

1. Behavioral Health and Health Policy, Westat, Rockville, Maryland, United States
2. Departments of Pediatrics and Biomedical Data Sciences, Geisel School of Medicine, Hanover, New Hampshire, United States
3. Section of Pulmonary and Critical Care, Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, United States

Address correspondence to:

Laura M. Paulin, MD, MHS
Dartmouth-Hitchcock Medical Center
Section of Pulmonary and Critical Care
One Medical Center Drive Suite 5C
Lebanon, NH 03756
Phone: (603) 650-5533
Email: Laura.M.Paulin@Hitchcock.org

Abstract

Introduction: A recent study found that the prevalence of chronic obstructive pulmonary disease (COPD) is significantly higher among adults who began smoking cigarettes before (versus after) 15 years of age, independent of current smoking, cigarette pack years, and smoking duration. The current analysis went a step further to also account for secondhand smoke exposure, using data from U.S. adults aged 40+ years during Wave 5 (2018–2019) of the Population Assessment of Tobacco and Health Study.

Methods: Adults who had ever smoked cigarettes were asked at what age they began smoking fairly regularly. Multivariable Poisson regression assessed the risk of self-reported COPD diagnosis due to childhood smoking (<15 years), adjusting for current smoking, cigarette pack years or smoking duration, secondhand smoke exposure, and sociodemographic covariates.

Results: Overall, 13.4% reported that they had COPD. COPD prevalence was 7.5% for adults who never smoked compared to 29.0% and 21.1% for smoking onset at age <15 and 15+ years, respectively. Adults who initiated smoking at <15 (versus 15+) years had a higher prevalence of current smoking (45.9% versus 33.3%), longer smoking duration (mean 34.2 versus 27.3 years), greater cigarette pack years (mean 48.8 versus 30.8), and greater secondhand smoke exposure (p’s<0.05). In multivariable analysis, the relative risk for COPD for smoking onset <15 (versus 15+) years of age was 1.27 (95% confidence interval=1.06, 1.51).

Conclusions: The increased risk of COPD due to childhood smoking was independent of cigarette pack years, smoking duration, secondhand smoke exposure, and current smoking. The findings give further evidence of increased COPD risk related to childhood smoking.

Citation

Citation: Ozga JE, Sargent JD, Steinberg AW, Tang Z, Stanton CA, Paulin LM. Childhood cigarette smoking and risk of COPD in older U.S. adults: a nationally representative replication study. J COPD F. 2024; 11(6): 549-557. doi: http://doi.org/10.15326/jcopdf.11.6.2024.0514

Keywords

chronic obstructive pulmonary disease, cigarette smoking, adolescent, youth, age of initiation

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Click to read Childhood Cigarette Smoking and Risk of COPD in Older U.S. Adults: A Nationally Representative Replication Study

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Author Affiliations

1. Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, United States
2. Medical Service, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, United States
3. Graduate Program in Immunology, University of Michigan, Ann Arbor, Michigan, United States
4. Collaborative Studies Coordinating Center, Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
5. Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan, United States
6. Research Service, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, United States
7. Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, United States
8. Division of Pulmonary, Critical Care, Sleep and Allergy, Department of Medicine, University of California San Francisco, San Francisco, California, United States
9. Division of Allergy, Immunology, and Infectious Disease, Department of Pediatrics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
10. Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
11. Weill Cornell Medicine, New York-Presbyterian Hospital, New York City, New York, United States
12. Division of Pulmonary, Critical Care and Sleep Medicine, University of California Los Angeles, Los Angeles, California, United States
13. Department of Radiology, University of Iowa, Iowa City, Iowa, United States
14. Department of Medicine and Department of Epidemiology, Columbia University Medical Center, New York City, New York, United States
15. Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Scottsdale, Arizona, United States
16. Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, Colorado, United States
17. Department of Medicine, University of Iowa, Iowa City, Iowa, United States
18. Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
19. Division of Pulmonary, Critical Care, Sleep and Allergy, University of Illinois at Chicago, Chicago, Illinois, United States
20. Department of Medicine, Johns Hopkins University, Baltimore, Maryland, United States
21. Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, United States
22. Section of Pulmonary, Critical Care, Allergy and Immunologic Diseases, Wake Forest University, Winston-Salem, North Carolina, United States
23. Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, University of Utah Health Sciences Center, Salt Lake City, Utah, United States
24. National Heart and Lung Institute, Imperial College, London, United Kingdom

Address correspondence to:

Jeffrey L. Curtis, MD
Pulmonary and Critical Care Medicine Section (506/111G)
VA Ann Arbor Healthcare System
2215 Fuller Road
Ann Arbor, MI 48105
Phone: (734) 925-5568
Email: jlcurtis@umich.edu

Abstract

Background: The biological mechanisms leading some tobacco-exposed individuals to develop early-stage chronic obstructive pulmonary disease (COPD) are poorly understood. This knowledge gap hampers development of disease-modifying agents for this prevalent condition.

Objectives: Accordingly, with National Heart, Lung and Blood Institute support, we initiated the SubPopulations and InteRmediate Outcome Measures In COPD Study (SPIROMICS) Study of Early COPD Progression (SOURCE), a multicenter observational cohort study of younger individuals with a history of cigarette smoking and thus at-risk for, or with, early-stage COPD. Our overall objectives are to identify those who will develop COPD earlier in life, characterize them thoroughly, and by contrasting them to those not developing COPD, define mechanisms of disease progression.

Methods/Discussion: SOURCE utilizes the established SPIROMICS clinical network. Its goal is to enroll n=649 participants, ages 30–55 years, all races/ethnicities, with ≥10 pack-years cigarette smoking, in either Global initiative for chronic Obstructive Lung Disease (GOLD) groups 0–2 or with preserved ratio-impaired spirometry; and an additional n=40 never-smoker controls. Participants undergo baseline and 3-year follow-up visits, each including high-resolution computed tomography, respiratory oscillometry and spirometry (pre- and postbronchodilator administration), exhaled breath condensate (baseline only), and extensive biospecimen collection, including sputum induction. Symptoms, interim health care utilization, and exacerbations are captured every 6 months via follow-up phone calls. An embedded bronchoscopy substudy involving n=100 participants (including all never-smokers) will allow collection of lower airway samples for genetic, epigenetic, genomic, immunological, microbiome, mucin analyses, and basal cell culture.

Conclusion: SOURCE should provide novel insights into the natural history of lung disease in younger individuals with a smoking history, and its biological basis.

Citation

Citation: Curtis JL, Bateman LA, Murray S, et al. Design of the SPIROMICS study of early COPD progression: SOURCE study. J COPD F. 2024; 11(5): 444-459. doi: http://doi.org/10.15326/jcopdf.11.5.2023.0490

Keywords

health-related quality of life, preserved ratio-impaired spirometry, smoking-related lung disease, SPIROMICS, imaging phenotypes

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Click to read Design of the SPIROMICS Study of Early COPD Progression: SOURCE Study

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Author Affiliations

1. Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, United States
2. Division of Pulmonary, Critical Care, and Sleep Medicine, Ohio State University, Columbus, Ohio, United States
3. Division of Pulmonary and Critical Care Medicine, Washington University in St. Louis, St. Louis, Missouri, United States
4. Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland, United States

Address correspondence to:

Robert A. Wise, MD
Division of Pulmonary and Critical Care Medicine
Johns Hopkins University
5501 Hopkins Bayview Circle
Baltimore, MD 21224
Email: rwise@jhmi.edu

Abstract

Background: Social distancing early in the COVID-19 pandemic helped mitigate viral spread and protect vulnerable populations. Broad availability of vaccines allowed social re-integration, but effects on mental health, social determinants of health, and attitudes among individuals with chronic obstructive pulmonary disease (COPD), who are high risk for adverse outcomes following COVID-19 infection, are unknown.

Methods: Participants in the Losartan Effects on Emphysema Progression trial were recruited into an ancillary study from May to November 2020. Study coordinators administered telephone questionnaires to evaluate respiratory symptoms (COPD Assessment Test [CAT]), anxiety (Generalized Anxiety Disorder-7 [GAD-7]) and depressive (Patient Health Questionnaire [PHQ-8]) symptoms, social isolation, instrumental support, and attitudes and actions related to the COVID-19 pandemic. Generalized estimating equation models evaluated changes in patient-reported scores from the period before vaccine availability (prevaccine, May to December 2020) to the postvaccine period (May 2021 to September 2022).

Results: Of 157 enrolled participants, 138 were interviewed during both periods. Compared with the prevaccine period, severe respiratory symptoms (CAT>20) were higher in the postvaccine period (odds ratio [OR] 1.36, 95% confidence interval [CI] 95%: 1.00–1.85), as were moderate anxiety symptoms (GAD-7≥10; OR 1.65, 95%CI: 1.11–2.46) and moderate depressive symptoms (PHQ-8≥10; OR 1.77, 95%CI: 1.22–2.55). Social isolation improved, though not significantly, and instrumental support was unchanged. In the postvaccine period compliance with COVID-19 mitigation strategies remained high and governmental health care entities were viewed as trustworthy by fewer respondents.

Conclusions: Despite a trend towards less social isolation following broad availability of COVID-19 vaccines, individuals with COPD reported worse symptoms, and greater anxiety and depressive symptoms compared to the prevaccine period.

Citation

Citation: Fawzy A, Wang JG, Krings JG, et al. Impact of COVID-19 vaccine rollout on mental health, social determinants of health, and attitudes among individuals with COPD. J COPD F. 2024; 11(5): 496-506. doi: http://doi.org/10.15326/jcopdf.11.5.2024.0537

Keywords

depression, COVID-19, anxiety, vaccination, social isolation

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Click to read Impact of COVID-19 Vaccine Rollout on Mental Health, Social Determinants of Health, and Attitudes Among Individuals With COPD

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Author Affiliations

1. Desert Oasis Healthcare, Palm Springs, California, United States
2. ResMed Science Center, San Diego, California, United States

Address correspondence to:

Leanne Kaye, PhD, MPH, RD
ResMed Science Center
San Diego, CA
Phone: 1 (800) 424-0737
Email: leanne.kaye@resmed.com

Abstract

Introduction: Chronic obstructive pulmonary disease (COPD) is a progressive lung disease that adds a significant economic burden to the health care system in the United States. Digital platforms integrated into clinical workflows have demonstrated success in improving patient outcomes in COPD, but few studies have explored the impact of an integrated digital and clinical approach on drivers of direct health care costs (COPD-related prescriptions, emergency department [ED] visits, and hospitalizations) in a real-world setting.

Methods: We conducted a 6-month retrospective matched control analysis to assess the impact of a digital quality improvement (QI) program delivered by clinical pharmacists on health care resource utilization among people living with COPD.

Results: Compared to matched controls at 6 months, participants in the digital QI program had a 66.7% relative reduction in COPD-related ED visits and hospitalizations (0.04±0.19 versus 0.12±0.44, p=0.044), as well as a 47% reduction in all-cause ED visits and hospitalizations (0.25±0.63 versus 0.47±1.09, p=0.059). Participants in the digital QI program also had higher rates of COPD-related prescription fills for antibiotics (0.43±0.93 versus 0.35±0.74, p=0.881) and oral corticosteroids (0.56±1.02 versus 0.36±0.91, p=0.045), as well as a greater number of COPD-related nonacute urgent care visits compared to matched controls (0.3±0.63 versus 0.14±0.44, p=0.027).

Conclusion: Digital health platforms integrated into a virtual clinical pharmacist workflow can help reduce costly COPD-related ED visits and hospitalizations, and shift utilization to less acute care. Care models integrating digital platforms may also offer a scalable approach to managing COPD and should be explored in different clinical settings.

Citation

Citation: Brazeal T, Kaye L, Vuong V, Le J, Peris Z, Barrett MA. Reducing health care resource utilization in COPD: a retrospective matched control analysis of a digital quality improvement program. J COPD F. 2024; 11(5): 515-523. doi: http://doi.org/10.15326/jcopdf.11.5.2024.0532

Keywords

COPD, health care resource utilization, digital health, clinical pharmacist

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Click to read Reducing Health Care Resource Utilization in COPD: A Retrospective Matched Control Analysis of a Digital Quality Improvement Program

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Author Affiliations

1. Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, Washington, United States
2. Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Washington, Seattle, Washington, United States
3. Department of Medicine, University of Washington, Seattle, Washington, United States
4. Department of Medicine, Henry Ford Macomb Hospital, Macomb Township, Michigan, United States
5. Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of California-San Francisco, San Francisco, California, United States

Address correspondence to:

Sophia Hayes, MD
University of Washington
Division of Pulmonary, Critical Care, and Sleep Medicine
1959 Northeast Pacific Street, Box 356522
Seattle, WA 98195
shayes4@uw.edu

Abstract

This article does not contain an abstract.

Citation

Citation: Hayes SA, Bhatia-Lin AL, Campbell J, Baugh A. A syndemic model: COPD, multimorbidity, and poverty. J COPD F. 2024; 11(5): 437-443. doi: http://doi.org/10.15326/jcopdf.11.5.2024.0558

Keywords

COPD, multimorbidity, poverty, syndemic

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Click to read A Syndemic Model: COPD, Multimorbidity, and Poverty

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Author Affiliations

1. Pulmonary, Allergy, Critical Care, and Sleep Medicine, University of Minnesota, Minneapolis, Minnesota, United States
2. Pulmonary, Allergy, Critical Care, and Sleep Medicine, Minneapolis VA Health Care System, Minneapolis, Minnesota, United States
3. Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota, United States

Address correspondence to:

Arianne K. Baldomero, MD, MS
Pulmonary, Allergy, Critical Care, and Sleep Medicine
Minneapolis VA Health Care System
1 Veterans Drive (Mail Stop: 111N)
Minneapolis, MN, 55417
Phone: (612) 629-7316
Email: baldo004@umn.edu

Abstract

Individuals living in rural areas in the United States experienced disparities in COVID-19 incidence and mortality rates, and people with chronic obstructive pulmonary disease (COPD) are at high risk of poor outcomes. We sought to determine whether veterans with COPD living in rural areas experienced different perceptions and practices of COVID-19 mitigation strategies, access to care, and health disparities during the COVID-19 pandemic, compared to their urban-living counterparts. We performed a one-time survey of veterans with COPD, collecting COVID-19−related information including individual perceptions and practice of mitigation strategies, COVID-19 vaccination status, access to care, and respiratory symptoms stratified by rural-urban status. A total of 100 participants completed the survey with 47 living in rural areas and 53 living in urban areas. There were no significant differences in perceptions and practices related to COVID-19 mitigation strategies (including vaccination), access to care, or respiratory and mental health outcomes. This lack of disparity between rural and urban veterans with COPD might be explained by the strength of the Veterans Health Administration in telemedicine or by an increased uptake of mitigation practices in people with chronic respiratory illness.

Citation

Citation: Robichaux C, Zanotto A, Wendt CH, Michalik M, Gravely A, Baldomero AK. Rural versus urban health disparities in the COVID-19 era among veterans with COPD. J COPD F. 2024; 11(5): 538-543. doi: http://doi.org/10.15326/jcopdf.11.5.2024.0521

Keywords

COPD, COVID-19, veterans, rural health, disparities

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Click to read Rural Versus Urban Health Disparities in the COVID-19 Era Among Veterans With COPD

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Author Affiliations

1. Department of Respiratory and Critical Care Medicine, Jinhua Guangfu Oncology Hospital, Jinhua, Zhejiang, China
2. Department of Respiratory and Critical Care Medicine, the First People’s Hospital of Yongkang, Yongkang, Zhejiang, China

Address correspondence to:

Fuan Yu, MD
Department of Respiratory and Critical Care Medicine
The First People’s Hospital of Yongkang
599 Jinshan West Road
Yongkang City, Jinhua City
Zhejiang Province, China
Email: 13506591475@163.com

Abstract

Objective: The objective of this review is to synthesize current evidence of the association between body mass index (BMI) categories and the risk of exacerbation in patients with chronic obstructive pulmonary disease (COPD).

Methods: A systematic search was conducted across 3 electronic databases: PubMed, Embase, and Scopus. Eligible studies must have reported on the association between BMI (either as continuous or categorical) and risk of COPD exacerbation, as defined according to recognized clinical criteria. Observational studies (cohort, case-control, cross-sectional) were eligible for inclusion. The Newcastle Ottawa Scale (NOS) was used to evaluate the methodological quality. Combined effect sizes were reported as relative risk (RR) and corresponding 95% confidence intervals (CI).

Results: A total of 11 studies were included. Of them, 4 studies were prospective, 4 were retrospective cohorts in design, 2 were cross-sectional studies, and one study was a secondary data analysis from a randomized trial. Compared to patients with a normal BMI, underweight patients had an increased risk of COPD exacerbation (RR 1.90, 95% CI: 1.03, 3.48; N=7, I²=94.2%). Overweight and obese BMI status was associated with a similar risk of exacerbation.

Conclusion: Our findings report that underweight, but not overweight or obese patients, have an increased risk of COPD exacerbation, compared to individuals with a normal BMI. This differential association emphasizes the need for nuanced investigations into the underlying mechanisms of the impact of BMI on the course of COPD. Further research is needed to inform personalized interventions and improve COPD management strategies.

Citation

Citation: Wang M, Ni X, Yu F. Impact of body mass index on the risk of exacerbation in patients with COPD: a systematic review and meta-analysis. J COPD F. 2024; 11(5): 524-533. doi: http://doi.org/10.15326/jcopdf.11.5.2024.0507

Keywords

COPD, exacerbation, BMI, underweight, overweight

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Click to read Impact of Body Mass Index on the Risk of Exacerbation in Patients With COPD: A Systematic Review and Meta-Analysis

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Author Affiliations

1. Division of Pulmonary and Critical Care Medicine, Joan and Sanford I. Weill Department of Medicine, Weill Cornell Medicine, New York City, New York, United States
2. Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, United States
3. Novartis Pharmaceuticals UK Ltd, London, United Kingdom
4. Novartis Institutes for BioMedical Research, Inc, Cambridge, Massachusetts, United States
5. Novartis Pharma AG, Basel, Switzerland

Address correspondence to:

Jamuna K. Krishnan, MD, MBA, MSc
Division of Pulmonary and Critical Care Medicine
Joan and Sanford I. Weill Department of Medicine
Weill Cornell Medicine
New York, New York
Phone: (646) 962-2333
Email: jkk9002@med.cornell.edu

Fernando J. Martinez, MD
Division of Pulmonary and Critical Care Medicine
Joan and Sanford I. Weill Department of Medicine
Weill Cornell Medicine
New York, New York
Phone: (646) 962-2333
Email: fjm2003@med.cornell.edu

Abstract

Background: Patients with chronic obstructive pulmonary disease (COPD) often develop other morbidities, suggesting a systemic component to this disease. This retrospective noninterventional cohort study investigated relationships between multimorbidities in COPD and their impact on COPD exacerbations and COPD-related health care resource utilization (HCRU) using real-world evidence from Optum’s de-identified Clinformatics® Data Mart Database.

Methods: Demographic and clinical characteristics were assessed. Overall comorbidity burden and proportion of individuals with gastroesophageal reflux disease (GERD), diabetes, or osteoporosis/osteopenia were compared in age-matched COPD versus non-COPD cohorts using descriptive statistics. COPD exacerbations and COPD-related HCRU (hospitalizations and emergency department visits) were compared between age-matched cohorts of COPD patients with and without specific common morbidities (GERD, diabetes, and osteoporosis/osteopenia). Additional weight-matching was performed for matched cohorts of COPD patients with and without diabetes, and with and without osteoporosis/osteopenia. The follow-up period was 5 years.

Results: Age-matched cohorts with and without COPD each comprised 158,106 patients. Morbidities were more common in the COPD cohort than the cohort without COPD (GERD: 44.9% versus 27.8%; diabetes: 40.8% versus 31.1%; osteoporosis/osteopenia: 18.8% versus 14.1%, respectively). Compared with matched cohorts with COPD only, cohorts of COPD patients with either GERD, diabetes, or osteoporosis/osteopenia experienced increased risk of severe exacerbations (odds ratio [OR]=1.819, OR=1.119, and OR=1.373, respectively), moderate exacerbations (OR=1.699, OR=1.102, and OR=1.322, respectively), or any exacerbations (OR=1.848, OR=1.099, and OR=1.384, respectively, p<0.001 for all comparisons) and increased risk of COPD-related HCRU (emergency department visits: OR=1.983, OR=1.098, and OR=1.343, respectively; hospitalization visits: OR=2.222, OR=1.26, and OR=1.368, respectively; p<0.001 for all comparisons).

Conclusions: These real-world data confirm that GERD, diabetes, and osteoporosis are common morbidities in patients with COPD and, moreover, that they affect frequency of exacerbation and HCRU. Determining and addressing the mechanisms behind the systemic effects of COPD may be beneficial for COPD patients and may also help reduce COPD exacerbations.

Citation

Citation: Krishnan JK, Martinez FJ, Altman P, et al. Multimorbidities in COPD are associated with increased exacerbations and health care resource utilization in real-world patients from a U.S. database. J COPD F. 2024; 11(5): 472-481. doi: http://doi.org/10.15326/jcopdf.11.5.2024.0515

Keywords

COPD, diabetes, osteoporosis, multimorbidities, GERD

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Click to read Multimorbidities in COPD are Associated With Increased Exacerbations and Health Care Resource Utilization in Real-World Patients from a U.S. Database

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Author Affiliations

1. Pulmonary, Critical Care Department, Guthrie Clinic, Robert Packer Hospital, Sayre, Pennsylvania, United States

Address correspondence to:

Jonathan Burgei, DO
Robert Packer Hospital Pulmonary office
1 Guthrie Sq
Sayre, PA 18840
Phone: (570) 887-2847
Email: Jonathan.burgei@guthrie.org

Abstract

This article does not contain an abstract.

Citation

Citation: Burgei JW, Alsheimer K, Lantry JF, Swalih M, Hehn BT. Retrospective review of pneumothorax rates in a rural, micropolitan area after bronchoscopic lung volume reduction. J COPD F. 2024; 11(5): 534-537. doi: http://doi.org/10.15326/jcopdf.11.5.2024.0502

Keywords

COPD, bronchoscopy, interventional pulmonology, valves

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Click to read Retrospective Review of Pneumothorax Rates in a Rural, Micropolitan Area After Bronchoscopic Lung Volume Reduction

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Author Affiliations

1. Department of Respiratory and Critical Care, The Affiliated People's Hospital of Ningbo University, Yinzhou People’s Hospital, Ningbo, China

Address correspondence to:

Huaying Wang, MD
Department of Respiratory and Critical Care
The Affiliated People's Hospital of Ningbo University
Yinzhou People’s Hospital
No. 251 Baizhang East Road
Ningbo 315040, China
Phone: 86-13967810430
Email: yingmeire@163.com

Abstract

Background: The interactions between fibroblasts and bronchial epithelial cells play important roles in the development of chronic obstructive pulmonary disease (COPD). Interleukin (IL)-17A triggers the activation of fibroblasts and the secretion of inflammatory mediators, which promotes epithelial-mesenchymal transition (EMT) in bronchial epithelial cells. Fibroblasts secrete C-X-C motif chemokine ligand 12 (CXCL12), which specifically binds to its receptor, C-X-C motif chemokine receptor 4 (CXCR4) to mediate inflammatory responses. This study aims to investigate IL-17A- and CXCL12-induced airway remodeling.

Methods: Primary lung fibroblasts were isolated from human and murine lung tissue for the in vitro experiments, and a mouse model of cigarette smoke (CS)-induced COPD was established for the in vivo experiments. The results were analyzed using a one-way analysis of variance and Tukey’s test or Bonferroni’s test for the post-hoc test. A p-value < 0.05 was considered statistically significant.

Results: Through in vitro experiments, we found that IL-17A-activated primary lung fibroblasts secreted CXCL12 and stimulated EMT in bronchial epithelial cells. However, these effects could be blocked by neutralizing IL-17A or CXCL12. In vivo, an anti-IL-17A antibody or a CXCR4 antagonist could reverse the degree of EMT in the lungs of the COPD mouse model. The IL-17A-induced EMT and increased CXCL12 expression occurred via extracellular signal-regulated kinase (ERK)/phosphorylated-ERK pathways.

Conclusions: This study showed that exposure of mice to CS and IL-17A stimulation upregulated CXCL12 expression and induced EMT by activating the ERK signaling pathway. These data offer a novel perspective regarding the molecular mechanism of CXCL12/CXCR4 signaling in IL-17A-induced EMT related to airway remodeling.

Citation

Citation: Chen X, Chen L, Chen G, et al. Interleukin-17A promotes airway remodeling in chronic obstructive pulmonary disease by activating C-X-C motif chemokine ligand 12 secreted by lung fibroblasts. J COPD F. 2024; 11(5): 482-495. doi: http://doi.org/10.15326/jcopdf.11.5.2024.0495

Keywords

chronic obstructive pulmonary disease, chemokine CXCL12, epithelial–mesenchymal transition, fibroblasts, interleukin-17A

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Click to read Interleukin-17A Promotes Airway Remodeling in Chronic Obstructive Pulmonary Disease by Activating C-X-C Motif Chemokine Ligand 12 Secreted by Lung Fibroblasts

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Author Affiliations

1. School of Pharmacy, North Sichuan Medical College, Nanchong, China
2. Department of Tuberculosis, Chengdu Public Health Clinical Medical Center, Chengdu, China
3. Department of Pulmonary and Critical Care Medicine, The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, China
4. Department of Pulmonary and Critical Care Medicine, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
5. Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Jinan University, Guangzhou, China
6. Department of Pulmonary and Critical Care Medicine, University of Chinese Academy of Sciences Shenzhen Hospital, Shenzhen, China
7. Department of Pulmonary and Critical Care Medicine, The Fifth People's Hospital of Sichuan Province, Chengdu, China

Address correspondence to:

Tao Wang, MD
Department of Pulmonary and Critical Care Medicine
University of Chinese Academy of Sciences Shenzhen Hospital
Shenzhen, China
Email: 4941291@qq.com

XinQi Yuan, BS
Department of Respiratory and Critical Care Medicine
The Fifth People's Hospital of Sichuan Province
Chengdu, China
Email: 178503908@qq.com

Abstract

Background: This present work focused on predicting prognostic outcomes of inpatients developing acute exacerbation of chronic obstructive pulmonary disease (AECOPD), and enhancing patient monitoring and treatment by using objective clinical indicators.

Methods: The present retrospective study enrolled 322 AECOPD patients. Registry data downloaded based on the chronic obstructive pulmonary disease (COPD) Pay-for-Performance Program database from January 2012 to December 2018 were used to check whether the enrolled patients were eligible. Our primary and secondary outcomes were intensive care unit (ICU) admission and in-hospital mortality, respectively. The best feature subset was chosen by recursive feature elimination. Moreover, 7 machine learning (ML) models were trained for forecasting ICU admission among AECOPD patients, and the model with the most excellent performance was used.

Results: According to our findings, a random forest (RF) model showed superb discrimination performance, and the values of area under the receiver operating characteristic curve were 0.973 and 0.828 in training and test cohorts, separately. Additionally, according to decision curve analysis, the net benefit of the RF model was higher when differentiating patients with a high risk of ICU admission at a <0.55 threshold probability. Moreover, the ML-based prediction model was also constructed to predict in-hospital mortality, and it showed excellent calibration and discrimination capacities.

Conclusions: The ML model was highly accurate in assessing the ICU admission and in-hospital mortality risk for AECOPD cases. Maintenance of model interpretability helped effectively provide accurate and lucid risk prediction of different individuals.

Citation

Citation: Jia Q, Chen Y, Zen Q, et al. Development and validation of machine learning-based models for prediction of intensive care unit admission and in-hospital mortality in patients with acute exacerbations of chronic obstructive pulmonary disease. J COPD F. 2024; 11(5): 460-471. doi: http://doi.org/10.15326/jcopdf.11.5.2023.0446

Keywords

machine learning, acute exacerbations of chronic obstructive pulmona, ICU admission, in-hospital mortality, risk assessment

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Click to read Development and Validation of Machine Learning-Based Models for Prediction of Intensive Care Unit Admission and In-Hospital Mortality in Patients With Acute Exacerbations of Chronic Obstructive Pulmonary Disease

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Author Affiliations

1. University of Birmingham, Institute of Applied Health Research, Birmingham, United Kingdom
2. University Hospitals Birmingham, Edgbaston, United Kingdom

Address correspondence to:

Joshua De Soyza, BMBS
University of Birmingham
Institute of Applied Health Research
Birmingham, UK
Phone: 01213713885
Email: joshdesoyza@gmail.com,
j.desoyza@bham.ac.uk

Abstract

Introduction: Bronchiectasis occurs in patients with alpha-1 antitrypsin deficiency (AATD), but it is unknown whether an association exists independently of chronic obstructive pulmonary disease (COPD). We assessed whether bronchiectasis was associated with COPD in our cohort, and whether it has clinical significance for lung function decline, exacerbation rate, or symptoms.

Study Design and Methods: PiZZ, PiSZ, and PiMZ patients from the Birmingham AATD Research Database were studied. Demographics were recorded, along with the outcomes of symptoms, forced expiratory volume in 1 second (FEV₁), transfer factor of carbon monoxide (TLCO), carbon monoxide transfer coefficient (KCO), and annualized exacerbation rate. Lung function decline was calculated for those with ≥3 measurements. Multivariate regression analyses were conducted to assess for associations of bronchiectasis with each outcome. A further binomial logistic regression model assessed for predictors of bronchiectasis diagnosis, including COPD. Those with alternative bronchiectasis causes were excluded from statistical models.

Results: A total of 1290 patients were eligible. PiZZ patients with bronchiectasis were older at presentation (54 versus 49 years, p<0.001), less likely to have smoked (65% versus 76.1%, p=0.001), and had higher modified Medical Research Council scores (mMRC) (mMRC 2 versus 0 odds ratio [OR] 1.97, 95% constant interval [CI] 1.20–3.25, p=0.008; mMRC 3 versus 0 OR 2.58 95% CI 1.59–4.19, p<0.001; mMRC 4 versus 0 OR 2.2 95% CI 1.23–3.92; p=0.008) than those without. The OR of bronchiectasis diagnosis was not associated with COPD diagnosis in any phenotype. Bronchiectasis was associated with lower serum alpha-1 antitrypsin levels in PiZZ patients (p=0.012). Bronchiectasis was not associated with a difference in FEV₁ percentage predicted (pp)/year decline, KCO pp/year, TLCO pp/year decline, or exacerbation rate in multivariate analysis.

Conclusions: Bronchiectasis exists in a significant minority of AATD patients independently of COPD and is associated with more severe shortness of breath. Appropriate treatment of bronchiectasis in AATD is essential.

Citation

Citation: De Soyza J, Ellis P, Newnham M, Rickard L, Turner AM. Bronchiectasis occurs independently of chronic obstructive pulmonary disease in alpha-1 antitrypsin deficiency. J COPD F. 2024; 11(5): 507-514. doi: http://doi.org/10.15326/jcopdf.11.5.2024.0526

Keywords

COPD, alpha-1 antitrypsin deficiency, bronchiectasis

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Click to read Bronchiectasis Occurs Independently of Chronic Obstructive Pulmonary Disease in Alpha-1 Antitrypsin Deficiency

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Author Affiliations

1. Division of Internal Medicine, University and Hospital of Fribourg, Fribourg, Switzerland
2. Division of Physiotherapy, Hospital of Fribourg, Fribourg, Switzerland
3. Division of Internal Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
4. Department of Pulmonary Medicine, Allergology and Clinical Immunology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland

Address correspondence to:

Gael Grandmaison, MD
Division of Internal Medicine
University and Hospital of Fribourg
2-6 Chemin des Pensionnats
1708 Fribourg, Switzerland
Phone: ++41 26 306 23 68
Email: gael.grandmaison@h-fr.ch

Abstract

Background: The suboptimal use of inhalers in the treatment of patients with chronic obstructive pulmonary disease (COPD) is probably a major but poorly documented problem in hospitalized patients. We aimed to describe the prevalence of misused inhalers among patients hospitalized with COPD in a department of general internal medicine.

Method: We conducted a monocentric cross-sectional study in consecutive patients with a diagnosis of COPD and hospitalized between August 2022 and April 2023 in the internal medicine division of Fribourg Hospital, Switzerland. Patients underwent an assessment of their inhaler technique and peak inspiratory flow (PIF) using the In-Check Dial G16^®. The primary outcome was the prevalence of misused inhalers, defined as an inhaler used with a critical error and/or insufficient PIF. Secondary outcomes included the prevalence of inhalers unsuitable to patients’ characteristics and of patients using at least one misused inhaler.

Results: The study included 96 patients and 160 inhalers were assessed at admission. Among these inhalers, 111 (69.4%; 95% confidence interval [CI] 61.6–76.4) were misused; 105 (65.6%; 95% CI 57.7–72.9) due to the presence of a critical error in the inhalation technique and 22 (13.8%; 95% CI 8.8–20.1) due to insufficient PIF. Concerning the secondary outcome, 27 inhalers (16.9%) were unsuitable, and 79 patients (82.3%) used at least one misused inhaler.

Conclusion: Among patients hospitalized with a diagnosis of COPD, two-thirds of inhalers were misused. Suboptimal use was mainly due to the presence of critical errors, but also to the presence of an insufficient PIF and unsuitable inhalers.

Citation

Citation: Grandmaison G, Grobéty T, Vaucher J, Hayoz D, Suter P. Prevalence of critical errors and insufficient peak inspiratory flow in patients hospitalized with COPD in a department of general internal medicine: a cross-sectional study. J COPD F. 2024; 11(4): 406-415. doi: http://doi.org/10.15326/jcopdf.11.4.2024.0505

Keywords

chronic obstructive pulmonary disease, inhaler, peak inspiratory flow, hospital, critical error

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Click to read Prevalence of Critical Errors and Insufficient Peak Inspiratory Flow in Patients Hospitalized With COPD in a Department of General Internal Medicine: A Cross-Sectional Study

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Author Affiliations

1. Nephrology Department, Lishui Municipal Central Hospital, the Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, Zhejiang, China
2. Dental Department, The First Affiliated Hospital of Bengbu Medical University, Bengbu, Anhui, China
3. First Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
4. Rehabilitation Department, Lishui Municipal Central Hospital, the Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, Zhejiang, China

Address correspondence to:

Jiaqi Chen, MS
Lishui Municipal Central Hospital
The Fifth Affiliated Hospital of Wenzhou Medical University
Lishui, Zhejiang, 323000, China
Email: 463364681@qq.com
Hua Yang, MS
Lishui Municipal Central Hospital
The Fifth Affiliated Hospital of Wenzhou Medical University
Lishui, Zhejiang, 323000, China
Email: 17858763315@163.com

Abstract

Background: There is a global increase in the prevalence of osteoporosis and chronic obstructive pulmonary disease (COPD). Studies based on observation revealed a higher incidence of osteoporosis in patients with COPD. We looked into the genetic relationship between COPD and osteoporosis using the Mendelian randomization (MR) technique.

Methods: The inverse variance-weighted (IVW) method was the primary technique used in this MR investigation. The sensitivity was assessed using the simple median, weighted median, penalized weighted median, and MR Egger regression analysis.

Results: The IVW model demonstrated that genetically determined COPD is causally associated with an elevated risk of osteoporosis (odds ratio [OR] fixed-effect, 1.010; 95% confidence interval [CI], 1.001–1.019, P=0.021; OR random-effect, 1.010; 95% CI, 1.001–1.020, P=0.039). It was also found that this correlation held valid for the simple and weighted median, Penalized weighted, MR-Egger, and MR Egger (bootstrap) approaches. No heterogeneity was found in the IVW or MR-Egger analysis results (Q=131.374, P=0.061 and Q=128.895, P=0.069, respectively). Furthermore, no pleiotropic influence via genetic variations was revealed by MR-Egger regression (intercept, -0.0002; P=0.160). No one single nucleotide polymorphism was found to have a substantial impact on the relationship between COPD and osteoporosis by the leave-one-out sensitivity analysis.

Conclusion: Our MR analysis demonstrated a substantial positive impact of COPD on the risk of osteoporosis.

Citation

Citation: Dou Z, Chen X, Chen J, Yang H, Chen J. Chronic obstructive pulmonary disease and osteoporosis: a two-sample Mendelian randomization analysis. J COPD F. 2024; 11(4): 416-426. doi: http://doi.org/10.15326/jcopdf.11.4.2024.0501

Keywords

chronic obstructive pulmonary disease, osteoporosis, Mendelian randomization, genetics

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Click to read Chronic Obstructive Pulmonary Disease and Osteoporosis: A Two-Sample Mendelian Randomization Analysis

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Author Affiliations

1. Pulmonary Section, Minneapolis VA Health Care System, Minneapolis, Minnesota, United States
2. Division of Pulmonary, Allergy, Critical Care, and Sleep, University of Minnesota, Minneapolis, Minnesota, United States
3. Division of Biostatistics and Health Data Science, University of Minnesota, Minneapolis, Minnesota, United States
4. Pulmonary and Critical Care, VA Puget Sound Health Care System, Seattle, Washington, United States
5. Tsinghua University, Beijing, China
6. Division of Health Services Research and Implementation, Kaiser Permanente Southern California, Pasadena, California, United States

Address correspondence to:

David MacDonald, MD, MS
Minneapolis VA Health Care System
Pulmonary, Critical Care, and Sleep (111N)
One Veterans Drive
Minneapolis, MN, 55417
Email: macdo147@umn.edu

Abstract

Rationale: Physical activity, lung function, and grip strength are associated with exacerbations, hospitalizations, and mortality in people with chronic obstructive pulmonary disease (COPD). We tested whether baseline inflammatory biomarkers were associated with longitudinal outcomes of these physiologic measurements.

Methods: The COPD Activity: Serotonin Transporter, Cytokines, and Depression (CASCADE) study was a prospective observational study of individuals with COPD. A total of 14 inflammatory biomarkers were measured at baseline. Participants were followed for 2 years. We analyzed associations between baseline biomarkers and forced expiratory volume in 1 second (FEV₁), physical activity, and grip strength.

We used a hierarchical hypothesis testing procedure to reduce type I error. We used Pearson correlations to test associations between baseline biomarkers and longitudinal changes in the outcomes of interest. We used Fisher’s linear discriminant analysis to test if linear combinations of baseline biomarkers predict rapid FEV₁ decline. Finally, we used linear mixed modeling to test associations between baseline biomarkers and outcomes of interest at baseline, year 1, and year 2; models were adjusted for age, smoking status, baseline biomarkers, and FEV₁.

Results: A total of 302 participants (age 67.5 ± 8.5 years, 19.5% female, 28.5% currently smoking) were included. Baseline biomarkers were not associated with longitudinal changes in grip strength, physical activity, or rapid FEV₁ decline. Higher interleukin-6 and C-reactive protein were associated with lower physical activity at baseline and these relationships persisted at year 1 and year 2.

Conclusion: Baseline inflammatory biomarkers did not predict changes in lung function or physical activity, but higher inflammatory biomarkers were associated with persistently low levels of physical activity.

Citation

Citation: MacDonald DM, Samorodnitsky S, Lock EF, et al. Biomarkers of inflammation and longitudinal evaluation of lung function, physical activity, and grip strength: a secondary analysis in the CASCADE study. J COPD F. 2024; 11(4): 396-405. doi: http://doi.org/10.15326/jcopdf.11.4.2024.0500

Keywords

chronic obstructive pulmonary disease, biomarkers, exercise, inflammation, hand strength

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Click to read Biomarkers of Inflammation and Longitudinal Evaluation of Lung Function, Physical Activity, and Grip Strength: A Secondary Analysis in the CASCADE Study

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Author Affiliations

1. Department of Medicine, University of Chicago, Chicago, Illinois, United States

Address correspondence to:

Valerie G. Press, MD, MPH
Departments of Medicine and Pediatrics, University of Chicago
5841 South Maryland Avenue, MC 2007
Chicago, IL 60637
Phone: (773) 702-5170
Email: vpress@bsd.uchicago.edu

Abstract

Patients with chronic obstructive pulmonary disease (COPD) rely primarily on inhaled medications to control and treat symptoms. Although the medications delivered by inhaler devices are often quite efficacious when delivered to the lung, the real-world effectiveness of these inhaler devices often falls short. Barriers to effective inhaler use include inhaler misuse and cost-related nonadherence. Inhaler misuse can be reduced with appropriate education which leads to improved outcomes. Education can be provided in multiple settings by a wide array of clinicians and clinical team members including pharmacists, respiratory therapists, nurses, physicians, advanced practice nurses, physician assistants, and community health workers, among others. However, despite decades of research and existing effective strategies across settings and types of educators, overall not much progress has been made with respect to effective inhaler technique among populations of patients with COPD in nearly half a century. Similarly, cost-related nonadherence is a long-standing and critical barrier to effective control of COPD, with limited improvements, especially until very recently. This perspective reviews the current promising directions for inhaler-based therapies, ongoing challenges, and critical issues requiring urgent attention.

Citation

Citation: Press VG. Real-world use of inhaled COPD medications: the good, the bad, the ugly. J COPD F. 2024; 11(4): 331-340. doi: http://doi.org/10.15326/jcopdf.11.4.2024.0546

Keywords

acute exacerbation of COPD, inhaler errors, rescue inhaler, inhaler education, adherence

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Click to read Real-World Use of Inhaled COPD Medications: the Good, the Bad, the Ugly

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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:

There is no correspondance information for this article.

Abstract

This article does not contain an abstract.

Citation

Citation: Erratum. J COPD F. 2024; 11(4): 436-436. doi: http://doi.org/10.15326/jcopdf.11.4.2023.0422E

Keywords

There are no keywords for this article.

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Click to read Erratum

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Author Affiliations

1. Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
2. Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
3. Division of Pulmonary Diseases and Critical Care Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
4. Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States

Address correspondence to:

Eman M. Metwally, MD, PhD, MSCR
2102 McGavran-Greenberg, CB #7435
University of North Carolina at Chapel Hill
Chapel Hill, NC 27599-7435
Phone: (919) 547-3531
Email: Eman_Metwally@med.unc.edu

Abstract

Rationale: Chronic obstructive pulmonary disease (COPD) is a common comorbidity among patients with lung cancer, and an important determinant of their outcomes, however, it is commonly underdiagnosed.

Objective: Our objective was to estimate the prevalence of COPD among a cohort of U.S. lung cancer patients, the timing of a COPD diagnosis relative to their lung cancer diagnosis, and the association between an earlier diagnosis of COPD and stage of lung cancer, with consideration of patient sociodemographic modifying factors.

Methods: We conducted an analysis of the Medicare-linked Surveillance, Epidemiology, and End Results database including patients aged 68+ years who were diagnosed with lung cancer between 2008 to 2017. Exposure: Prevalence of COPD was identified using claims and subclassified based on the timing of its diagnosis relative to the lung cancer diagnostic episode–“preexisting” if diagnosed > 3 months before lung cancer, and “concurrent” if diagnosed around the same time as the lung cancer (+/-3 months). Outcome: The stage of cancer at diagnosis (early versus late) was the outcome.

Results: Among 159,542 patients with lung cancer, 73.5% had COPD. Among those with COPD, 34.4% were diagnosed within 3 months of their lung cancer diagnosis and considered to have “concurrent COPD.” We observed a positive association between preexisting COPD diagnosis and early-stage lung cancer (prevalence ratio= 1.27; 95% confidence interval= 1.23–1.30), in adjusted models which were stronger for male, non-Hispanic Black, and Hispanic patients.

Conclusions: Seven out of 10 patients with lung cancer have COPD, however, many do not receive their COPD diagnosis until around the time of their lung cancer diagnosis. Among these patients, an early COPD diagnosis may improve early detection of lung cancer.

Citation

Citation: Metwally EM, Lund JL, Drummond MB, Peacock Hinton S, Poole C, Thompson CA. COPD with lung cancer among older United States adults: prevalence, diagnostic timeliness, and association with earlier stage tumors. J COPD F. 2024; 11(4): 382-395. doi: http://doi.org/10.15326/jcopdf.11.4.2024.0489

Keywords

COPD, Medicare, epidemiology, lung cancer

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Click to read COPD With Lung Cancer Among Older United States Adults: Prevalence, Diagnostic Timeliness, and Association With Earlier Stage Tumors

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Author Affiliations

1. Research and Development Service, VA Boston Healthcare System, Boston, Massachusetts, United States
2. Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Boston, Massachusetts, United States
3. The Pulmonary Center, Boston University School of Medicine, Boston, Massachusetts, United States
4. Pulmonary and Critical Care Medicine Section, VA Boston Healthcare System, Boston, Massachusetts, United States
5. Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States
6. Harvard Medical School, Boston, Massachusetts, United States

Address correspondence to:

Stephanie A. Robinson, PhD
200 Springs Rd. Bldg 70
Bedford, MA 01730
Phone: (781) 687-4776
Email: Stephanie.Robinson5@va.gov

Abstract

Background: The relationships between physical activity (PA) and exercise performance and systemic biomarkers in persons with chronic obstructive pulmonary disease (COPD) have not been well characterized. The impact of PA promotion on biomarkers reflecting myocardial stress, systemic inflammation, and muscle injury is unclear.

Methods: This secondary analysis used 3 previously published studies in persons with COPD (2 examined a PA intervention that promoted community-based walking for 3 months) to explore these relationships. PA (daily step counts) and exercise performance (6-minute walk test [6MWT]) were assessed. Serum N-terminal pro-β-type natriuretic peptide (NT-proBNP), the soluble receptor for advanced glycation end products (sRAGE), and muscle-type creatine kinase (CKMM) were assayed at baseline and 3 months. General linear models examined associations between PA/exercise performance and systemic biomarkers at baseline and the effect of the PA intervention on change in biomarkers.

Results: Participants included 366 U.S. Veterans: 98% male, mean age 70±8 years, and forced expiratory volume in 1 second percentage predicted 59±21%. Lower baseline NT-proBNP, but not sRAGE or CKMM, was associated with higher daily step count (-0.95pg/ml per 1000 steps/day, p=.060) and higher 6MWT distance (-0.80pg/ml per 100 meters, p=.001). Change in daily step count, but not 6MWT, was significantly greater in the intervention (789±1864) compared to the control group (-174±1448; p=.002). The PA intervention had no significant impact on change in the systemic biomarkers.

Interpretation: Exercise performance is associated with NT-proBNP in persons with COPD. A 3-month community-based walking intervention is not associated with myocardial stress or muscle injury as assessed by NT-proBNP and CKMM, respectively.

Clinical Trial Registration: NCT01772082 and NCT02099799

Citation

Citation: Berube MN, Robinson SA, Wan ES, Mongiardo MA, Finer EB, Moy ML. Physical activity and systemic biomarkers in persons with COPD: insights from a web-based pedometer-mediated intervention. J COPD F. 2024; 11(4): 369-381. doi: http://doi.org/10.15326/jcopdf.11.4.2023.0472

Keywords

chronic obstructive pulmonary disease, exercise, pulmonary disease, walk test

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Click to read Physical Activity and Systemic Biomarkers in Persons With COPD: Insights from a Web-Based Pedometer-Mediated Intervention

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Author Affiliations

1. Department of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, United States
2. Mindful Breathing Lab, Mayo Clinic, Rochester, Minnesota, United States

Address correspondence to:

Roberto Benzo, MD
Mindful Breathing Laboratory
Division of Pulmonary, Critical Care, and Sleep Medicine
200 First Street SW
Rochester, MN 55905
Phone: (507) 293-1989
Email: Benzo.Roberto@mayo.edu

Abstract

Introduction: Research evidence indicates that meaning in life (MIL) is a meaningful outcome in individuals living with chronic illness, but evidence is lacking for chronic obstructive pulmonary disease (COPD).

Objectives: We hypothesized that MIL is independently associated with clinically meaningful outcomes for patients with COPD.

Methods: We performed cross-sectional analysis from a large cohort with moderate–severe COPD that participated in a home pulmonary rehabilitation study. MIL was measured using the Meaning in Life Questionnaire (MLQ), with domains of Presence and Search. The study included 340 participants: mean age 69 years old (standard deviation [SD] 9.4), 55.3% female, forced expiratory volume in 1 second (FEV₁) 44.3% (SD 19.4), and a modified Medical Research Council (mMRC) dyspnea scale of 2.69 (SD 0.84).

Results: Patients with high MLQ Presence (versus low score) had meaningfully better scores (beyond the minimal clinically important difference) across all Chronic Respiratory Questionnaire (CRQ) domains: Dyspnea, Fatigue, Emotions, and Mastery (p≤0.02); self-management (p≤0.001); social support (p≤0.001); anxiety (p≤0.001); and depression (p≤0.01) scores. When adjusting for age, sex, FEV₁, mMRC, social support, and anxiety, MLQ Presence was independently associated with CRQ domains Fatigue, Emotions, and self-management (p≤0.01). MLQ Search was independently associated with CRQ Dyspnea, Fatigue, and Mastery (p<0.05).

Conclusions: In patients with COPD, the perception that life has meaning or the willingness to search for MIL is associated with the outcomes that patients consider most important. Our results are novel as MIL is a potentially modifiable outcome that could complement person-centered conversations during clinical visits, pulmonary rehabilitation, and health coaching.

Citation

Citation: Batzlaff C, Roy M, Hoult J, Benzo R. Meaning in life: a novel factor for promoting well-being in COPD. J COPD F. 2024; 11(4): 341-349. doi: http://doi.org/10.15326/jcopdf.11.4.2023.0476

Keywords

pulmonary rehabilitation, health-related quality of life, care coordination, chronic airways obstruction, advocacy

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Author Affiliations

1. Division of Pulmonary and Critical Care Medicine, University of California Davis School of Medicine, Sacramento, California, United States
2. University of California Davis Health, Sacramento, California, United States
3. Department of Internal Medicine, University of California Davis School of Medicine, Sacramento, California, United States

Address correspondence to:

Reshma Gupta, MD, MSHPM
UC Davis Health and UC Davis School of Medicine
Department of Internal Medicine
4860 Y St.
Sacramento, CA 95817
Phone: (916) 734-2737
Email: regupta@ucdavis.edu

Abstract

As a result of climate change, wildfire frequency, duration, and severity are increasing in the United States. Exposure to wildfire-related air pollutants can lead to negative health outcomes, particularly among patients with preexisting respiratory diseases (e.g., asthma and chronic obstructive pulmonary disease) and those who are at higher risk for developing these conditions. Underserved communities are disproportionately affected for multiple reasons, including lack of financial and social resources, increased exposure to air pollutants at home and at work, and impaired access to health care. To best serve clinically high-risk and underserved populations, health systems must leverage community public health data, develop and mobilize a wildfire preparedness action plan to identify populations at high risk, and implement interventions to mitigate the consequences of poor air quality. University of California, Davis Health, located at the epicenter of the largest wildfires in California’s history, has developed the 5 pillar Wildfire Population Health Approach: (1) identify clinically at-risk and underserved patient populations using well-validated, condition-targeted registries; (2) assemble multidisciplinary care teams to understand the needs of these communities and patients; (3) create custom analytics and wildfire-risk stratification; (4) develop care pathways based on wildfire-risk tiers by disease, risk of exposure, and health care access; and (5) identify outcome measures tailored to interventions with a commitment to continuous, iterative improvement efforts. The Wildfire Population Health Approach provides an action plan for health systems and care teams to meet the needs of clinically at-risk and underserved patients affected by the increasing health threat posed by climate change-related wildfires.

Citation

Citation: Kuhn BT, Gupta R. Improving wildfire readiness among patients with chronic obstructive pulmonary disease and asthma: applying a population health approach to climate change. J COPD F. 2024; 11(4): 427-435. doi: http://doi.org/10.15326/jcopdf.11.4.2024.0509

Keywords

chronic obstructive pulmonary disease, alpha-1 antitrypsin deficiency, air pollution, wildfires, climate change

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