Author Affiliations

1. Denver, Colorado

Address correspondence to:

Ron Balkissoon, MD, MSc, DIH, FRCPC
balkissoonr@njhealth.org

Abstract

This article does not contain an abstract.

Citation

Citation: Balkissoon R. Journal club: the intersection of racial/ethnic disparities in coronavirus disease 2019 and COPD. J COPD F. 2021; 8(2): 292-302. doi: http://doi.org/10.15326/jcopdf.8.2.2021.0227

Keywords

COPD, COVID-19, coronavirus disease 2019, chronic obstructive pulmonary diseases, racial/ethnic disparities

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Click to read Journal Club: The Intersection of Racial/Ethnic Disparities in Coronavirus Disease 2019 and COPD

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Author Affiliations

1. Department of Medicine, Columbia University Irving Medical Center, New York, New York, United States
2. Department of Medicine, School of Medicine, University of Virginia, Charlottesville, Virginia, United States
3. Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, New York, New York, United States

Address correspondence to:

R. Graham Barr, MD, DrPH
Columbia University Irving Medical Center
Presbyterian Hospital 9 East 105
630 West 168th Street, New York, NY 10032
Email: rgb9@columbia.edu

Abstract

This article does not contain an abstract.

Citation

Citation: Kim JS, Barr RG. Letter to the editor: response by authors. J COPD F. 2021; 8(2): 188-189. doi: http://doi.org/10.15326/jcopdf.8.2.2021.0225

Keywords

There are no keywords for this article.

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Click to read Letter to the Editor: Response by Authors

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Author Affiliations

1. Division of Pulmonary Diseases and Critical Care Medicine, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, United States
2. Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, United States
3. Division of Pulmonary, Critical Care, and Sleep Medicine, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California, United States
4. Departments of Medicine and Physiology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California, United States
5. Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan, United States
6. Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, University of California-San Francisco, San Francisco, California, United States
7. Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, University of Alabama-Birmingham, Birmingham, Alabama, United States
8. Division of Pulmonary Medicine, University of Utah, Salt Lake City, Utah, United States
9. Division of Pulmonary, Critical Care, and Occupational Medicine, University of Iowa, Iowa City, Iowa, United States
10. Division of Pulmonary, Critical Care, and Sleep Medicine, National Jewish Hospital, Denver, Colorado, United States
11. Division of General Medicine and Clinical Epidemiology, University of North Carolina, Chapel Hill, North Carolina, United States
12. Division of Pulmonary and Critical Care, Johns Hopkins University, Baltimore, Maryland, United States
13. Division of Endocrinology and Metabolism, Johns Hopkins University, Baltimore, Maryland, United States

Address correspondence to:

Robert M. Burkes, MD
231 Albert Sabin Way, ML 0564
Cincinnati, OH 45267
Phone: (724)730-3862
Email: burkesrt@ucmail.uc.edu

Abstract

Introduction: Age and vitamin D levels may affect symptom burden in chronic obstructive pulmonary disease (COPD). We used the Subpopulations and Intermediate Outcome Measures in COPD Study (SPIROMICS) to determine independent associations between vitamin D levels and COPD symptoms in different age strata.

Methods: Serum 25-hydroxy (OH)-vitamin D levels were modeled continuously and categorically (<20 ng/ml versus ≥20 ng/ml). Stratifying by age group (middle-age: 40-64 years old and older: >65 years old), multivariable modeling was performed to identify relationships between 25-OH-vitamin D levels and the COPD Assessment Test (CAT), the modified Medical Research Council score (mMRC), the St George’s Respiratory Questionnaire (SGRQ) total and subdomain scores, the Veterans’ Specific Activity Questionnaire, and the 6-minute walk test distance.

Results: In the middle-aged group, each 5 ng/ml higher 25-OH-vitamin D level was independently associated with more favorable CAT score (-0.35 [-0.67 to -0.03], P=0.03), total SGRQ (-0.91 [-1.65 to -0.17]; P=0.02), and the SGRQ subdomains (Symptoms:-1.07 [-1.96 to -0.18], P=0.02; Impact: -0.77 [-1.53 to -0.003], P=0.049; Activity: -1.07 [-1.96 to -0.18], P=0.02). These associations persisted after the addition of comorbidity score, reported vitamin D supplementation, outdoor time, or season of blood draw to models. No associations were observed between 25-OH-vitamin D levels and symptom scores in the older age group.

Discussion: When controlled for clinically relevant covariates, higher 25-OH-vitamin D levels are associated with more favorable respiratory-specific symptoms and quality-of-life assessments in middle-age but not older COPD individuals. Study of the role of vitamin D supplementation in the symptom burden of younger COPD patients is needed.

Citation

Citation: Burkes RM, Couper DJ, Barjaktarevic IZ, et al.Age-dependent associations between 25-hydroxy vitamin D levels and COPD symptoms: analysis of SPIROMICS. J COPD F. 2021; 8(2): 277-291. doi: http://doi.org/10.15326/jcopdf.8.2.2020.0180

Keywords

COPD, COPD outcomes, vitamin D, COPD epidemiology, COPD symptoms

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Click to read Age-Dependent Associations Between 25-Hydroxy Vitamin D Levels and COPD Symptoms: Analysis of SPIROMICS

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Author Affiliations

1. Department Internal Medicine, Giannitsa Hospital, Giannitsa, Greece
2. Department of Respiratory Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
3. Department of Respiratory Medicine, G. Papanikolaou Hospital, Thessaloniki, Greece

Address correspondence to:

Afroditi K. Boutou, MD, MSc, PhD
Department of Respiratory Medicine
G. Papanikolaou Hospital
Exohi GR57010
Thessaloniki, Greece
Phone: +30 2313307248
E-mail: afboutou@yahoo.com

Abstract

This article does not contain an abstract.

Citation

Citation: Theodorakopoulou MP, Papakosta D, Kontakiotis T, Boutou AK. Omega-3 fatty acid supplementation for endothelial dysfunction in COPD: another fiasco? Or maybe not? J COPD F. 2021; 8(2): 185-187. doi: http://doi.org/10.15326/jcopdf.8.2.2021.0206

Keywords

COPD, fish-oil, endothelial dysfunction, flow-mediated dilatation, reactive hyperemia index

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Click to read Omega-3 Fatty Acid Supplementation for Endothelial Dysfunction in COPD: Another Fiasco? Or Maybe Not?

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Author Affiliations

1. Research and Development Technology, GlaxoSmithKline, Collegeville, Pennsylvania, United States
2. Research and Development, GlaxoSmithKline, Collegeville, Pennsylvania, United States
3. Department of Physical Medicine and Rehabilitation, Mayo Clinic Rochester, Minnesota, United States
4. Bay Digital Consulting, Hertfordshire, United Kingdom
5. Department of Respiratory Sciences, University of Leicester, Leicester Biomedical Research Centre, Respiratory, Leicester, United Kingdom
6. COPD Foundation, Washington, DC, United States

* Employees of GlaxoSmithKline during the design and conduct of this work.

Address correspondence to:

John Yonchuk, MS
Phone: (610)348-2648
Email: john.g.yonchuk@gsk.com

Abstract

Background: Pulmonary rehabilitation (PR) is an important therapy for patients with chronic obstructive pulmonary disease (COPD), yet uptake remains low. Intervention strategies which recapitulate the benefits of PR are, therefore, needed and digital, home-based therapies present opportunity in this space. Digital therapies also potentially offer an opportunity to standardize PR in clinical trials for new COPD therapies.

Aims and Methods: We aimed to create a digital application (app), Respercise^®, consisting of up to 4 strengthening exercises in conjunction with Therbands™ and a daily physical activity program with individualized step goals, and to test its feasibility in a clinical trial. App usability was surveyed qualitatively before development iterations and deployment in a 13-week interventional clinical trial. All participants who completed the study were invited for an exit interview and performed the 5-repetition sit-to-stand test amongst other measures.

Results: Feedback from clinical trial participants was positive; 97% of respondents liked the app. A total of 88% of participants reported that it was easy to fit the exercises into their daily routine, and there was over 90% adherence for entering daily step counts. Notably, on day 90 both females and males using Respercise alone demonstrated a 2.22- and 2.27-seconds improvement in time for 5-repetition sit-to-stand tests respectively, above the 1.7 second threshold that is considered clinically meaningful in COPD.

Conclusion: Respercise can be successfully deployed in clinical trials, offering the opportunity for standardization of exercise in clinical trials and, with further development, could have wider reach as a home-based intervention for individuals with COPD.

Citation

Citation: Yonchuk JG, Mohan D, LeBrasseur NK, George AR, Singh S, Tal-Singer R. Development of Respercise® a digital application for standardizing home exercise in COPD clinical trials. J COPD F. 2021; 8(2): 269-276. doi: http://doi.org/10.15326/jcopdf.8.2.2020.0194

Keywords

COPD, exercise, clinical trials, physical activity, digital applications, usability

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Click to read Development of Respercise® a Digital Application for Standardizing Home Exercise in COPD Clinical Trials

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Author Affiliations

1. Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, United States
2. Department of Clinical Sciences, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, United States
3. Department of Radiology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, United States

Address correspondence to:

Robert M. Marron, MD
Phone: (267) 838-2658
E-mail: robert.marron@tuhs.temple.edu

Abstract

Background: Comorbid disease is a risk factor for severe coronavirus disease 2019 (COVID-19) infection. However, initial rates of chronic obstructive pulmonary disease (COPD) in case series were low and severity of COVID-19 in COPD patients was variable.

Methods: We performed a retrospective study of patients admitted with COVID-19 and evaluated outcomes in those with and without COPD and/or emphysema. Patients were identified as having COPD if they had a diagnosis in the medical record and a history of airflow-obstruction on spirometry, or a history of tobacco use and prescribed long-acting bronchodilator(s). Computed tomography scans were evaluated by radiologists. Propensity matching was performed for age, body mass index (BMI), and serologic data correlated with severity of COVID-19 disease (D-dimer, C-reactive protein, ferritin, fibrinogen, absolute lymphocyte count, lymphocyte percentage, and lactate dehydrogenase).

Results: Of 577 patients admitted with COVID-19, 103 had a diagnosis of COPD and/or emphysema. The COPD/emphysema cohort was older (67 versus 58, p<0.0001) than the other cohort and had a lower BMI. Among unmatched cohorts those with COPD/emphysema had higher rates of intensive care unit (ICU) admission (35% versus 24.9%, p=0.036) and maximal respiratory support requirements, with more frequent invasive mechanical ventilation (21.4% versus 11.8%), but no significant difference in mortality. After propensity-matching there was no difference in ICU admission, maximal respiratory support requirements, or mortality. Univariate and multivariate regression analyses yielded similar results.

Discussion: Our propensity-matched retrospective cohort study suggests that patients hospitalized with COVID-19 who have COPD and/or emphysema may not have worse outcomes than those without these comorbid conditions.

Citation

Citation: Marron RM, Zheng M, Romero GF, et al.Impact of chronic obstructive pulmonary disease and emphysema on outcomes of hospitalized patients with coronavirus 2019 pneumonia. J COPD F. 2021; 8(2): 255-268. doi: http://doi.org/10.15326/jcopdf.8.2.2020.0200

Keywords

COPD, emphysema, chronic obstructive pulmonary disease, comorbidities, COVID-19, outcomes, coronavirus 2019

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Click to read Impact of Chronic Obstructive Pulmonary Disease and Emphysema on Outcomes of Hospitalized Patients with Coronavirus Disease 2019 Pneumonia

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Author Affiliations

1. College of Public Health, University of Kentucky, Lexington, Kentucky, United States
2. COPD Foundation, Washington, DC, United States
3. School of Public Health, Rutgers University, Piscataway, New Jersey, United States
4. Pulmonary Disease and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, United States

Address correspondence to:

Vira Pravosud, MPH, MS
College of Public Health
Department of Epidemiology
University of Kentucky
111 Washington Avenue, Room 211C
Lexington, KY 40536
Email: vira.pravosud@uky.edu

Abstract

Purpose: Respiratory diseases caused by nontuberculous mycobacteria (NTM) have become a significant concern for patients and health care providers. We aimed to compare symptoms experienced during the 2 week period, at a single point in time, by patients with NTM lung disease (NTMLD) who were currently on any medication to treat their NTMLD versus those not on any therapies.

Methods: We analyzed responses to a “Burden of NTM Survey” developed by the COPD Foundation. The study population included 266 individuals with NTMLD. Using adjusted penalized logistic regression models, we determined associations between the self-reported symptoms and the use of any medication to treat NTMLD.

Results: Based on available data, most respondents were aged 50 and older (95.1%), of female gender (93.1%), and had been living with NTMLD for more than 5 years (55.7%). Many respondents reported symptoms that bother them very often or daily. After adjustment for age and gender, duration of living with NTMLD, and other respiratory illnesses, patients on medication had significantly larger odds of reporting difficulty in walking 500 meters without stopping, difficulty in interacting with others, fatigue or lack of energy, feelings of sadness or depression related to illness, and shortness of breath, wheezing or other difficulties.

Conclusion: In this study, patients currently on any medication to treat their NTMLD reported more symptoms associated with their NTMLD. Further investigations are needed to explore whether increased symptoms are related to differences in disease severity and/or medication effects.

Citation

Citation: Pravosud V, Mannino DM, Prieto D, et al. Symptom burden and medication use among patients with nontuberculous mycobacterial lung disease. J COPD F. 2021; 8(2): 243-254. doi: http://doi.org/10.15326/jcopdf.8.2.2020.0184

Keywords

NTM, nontuberculous mycobacteria, nontuberculous mycobacterial lung disease, NTMLD, BronchandNTM360social, Burden of NTM Survey

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Click to read Symptom Burden and Medication Use Among Patients with Nontuberculous Mycobacterial Lung Disease

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Author Affiliations

1. Weill Cornell Medicine, New York Presbyterian Hospital, New York, New York, United States
2. Columbia University, New York Presbyterian Hospital, New York, New York, United States
3. PRIME Education, LLC, Fort Lauderdale, Florida, United States
4. University of Michigan Health System, Ann Arbor, Michigan, United States

Address correspondence to:

Fernando J. Martinez, MD, MS
1305 York Ave
Box 96, Room Y-1059
New York, NY 10021
Phone: 646.962.2748
Email: fjm2003@med.cornell.edu

Abstract

Introduction: Recommendations for chronic obstructive pulmonary disease (COPD) diagnosis and management requires symptom and exacerbation risk assessment. Adherence to these recommendations appears to be limited. We examined the impact of a COPD quality improvement (QI) program in the Southeastern United States.

Methods: From 2017 to 2018, nine pulmonary and 15 primary care physicians were included in our study and asked to identify 6 to 7 of their COPD patients using maintenance COPD medications with at least 2 office visits in the past year. A separate group of COPD patients (n=135 pulmonary and 165 primary care) from the same practices were evaluated. Physicians underwent focused, educational, peer-to-peer small group webinars. Data were collected from physicians and their patients using a systematic survey. Chart audits occurred at baseline and 6 months after the webinars.

Results: The majority of physicians (67%) saw ≥ 20 COPD patients/week. There were important discrepancies between the care clinicians thought they provided, and the care recalled by their patients. Clinicians felt that 33% of their patients experienced at least 2 exacerbations in the past year; 56% of their patients reported this frequency. There was discrepancy in the clinicians’ interpretations and the patients’ reasons for discontinuing their medications and in the use of referrals. Self-reported changes were noted by clinicians after educational webinars and improvements in patient care were noted in the year following intervention.

Conclusion: We identified notable discrepancies between the clinicians’ impression of care provided and the components actually recalled by their patients. We also identified improvements in processes of care and outcomes following an educational intervention based on the principles of audit and feedback.

Citation

Citation: Martinez FJ, Thomashow B, Sapir T, Simone L, Carter J, Han M. Does evaluation and management of COPD follow therapeutic strategy recommendations? J COPD F. 2021; 8(2): 230-242. doi: http://doi.org/10.15326/jcopdf.8.2.2020.0175

Keywords

COPD, adherence, evaluation, therapeutic strategy

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Click to read Does Evaluation and Management of COPD Follow Therapeutic Strategy Recommendations?

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