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 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. 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 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. 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. 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 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. 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. 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. 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. 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. Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Shanghai, China

Address correspondence to:

Jing Zhang
Department of Pulmonary and Critical Care Medicine
Zhongshan Hospital, Shanghai Medical College, Fudan University
180 Fenglin Road
Shanghai, China
Phone: +86 134 7278 2754
Email: zhang.jing@zs-hospital.sh.cn

Abstract

Chronic obstructive pulmonary disease (COPD) is a paramount contributor to global morbidity and mortality. Over the past decade, the concept of the “gut-lung axis” has emerged, offering a lens through which to examine the intricate interplay between the host, microbiome, and respiratory diseases, including COPD. An expanding body of evidence underscores that the composition of both the gastrointestinal and respiratory microbiome deviates in COPD patients compared to healthy individuals, leading to distinct host immune responses and clinical manifestations.

The objective of this review is to provide a concise overview of the role both gut and respiratory microbiome play in the development of COPD.

This was accomplished by compiling current literature on the microbiome profile in stable and exacerbated cases of COPD, as well as exploring the biological mechanisms through a discussion of relevant experiments conducted on murine models.

Hallmark characteristics of the microbial profile in COPD encompass reduced Prevotella species in the respiratory microbiome, culminating in a loss of anti-inflammatory protection, and diminished Bacteroidetes in the gut microbiome, leading to a decrease in protective short-chain fatty acids.

The proliferation of Proteobacteria, particularly the Haemophilus species, Moraxellaspecies, and Pseudomonas species contribute to COPD pathologies via recognition of proinflammatory lipopolysaccharide via Toll-like receptors. As a consequence, deteriorated pulmonary function, enhanced severity, increased onset of exacerbations, and elevated mortality were observed.

Citation

Citation: Cheng Z, Zhang J. Exploring the role of gut-lung interactions in COPD pathogenesis: a comprehensive review on microbiota characteristics and inflammation modulation. J COPD F. 2024; 11(3): 311-325. doi: http://doi.org/10.15326/jcopdf.11.3.2023.0442

Keywords

COPD, inflammation, gut microbiota, gut-lung axis, lung microbiota

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Click to read Exploring the Role of Gut-Lung Interactions in COPD Pathogenesis: A Comprehensive Review on Microbiota Characteristics and Inflammation Modulation

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Author Affiliations

1. Department of Multidisciplinary Laboratory Medicine and Medical Biochemistry, Akershus University Hospital, Lørenskog, Norway
2. Institute for Clinical Medicine, University of Oslo, Oslo, Norway
3. Department of Pulmonary Medicine, Akershus University Hospital, Lørenskog, Norway
4. Department of Pulmonary Medicine, Østfold Hospital, Kalnes, Norway

Address correspondence to:

Gunnar Einvik, MD, PhD
Department of Pulmonary Medicine
Akershus University Hospital
1470 Lørenskog
Norway
Phone: +4741104542
Email: Gunnar.Einvik@medisin.uio.no

Abstract

Background: The prevalence of iron deficiency in patients with chronic obstructive pulmonary disease (COPD) varies in previous studies. We aimed to assess its prevalence according to 3 well-known criteria for iron deficiency, its associations with clinical characteristics of COPD, and mortality.

Methods: In a cohort study consisting of 84 COPD patients, of which 21 had chronic respiratory failure, and 59 were non-COPD controls, ferritin, transferrin saturation (TSat), and mortality across 6.5 years were assessed. Associations between clinical characteristics and iron deficiency were examined by logistic regression, while associations with mortality were assessed in mixed effects Cox regression analyses.

Results: The prevalence of iron deficiency in the study population was 10%–43% according to diagnostic criteria, and was consistently higher in individuals with COPD, peaking at 71% in participants with chronic respiratory failure. Ferritin < cutoff was significantly associated with forced expiratory volume in 1 second (FEV₁) (odds ratio [OR] 0.33 per liter increase), smoking (OR 3.2), and cardiovascular disease (OR 4.7). TSat < 20% was associated with body mass index (BMI) (OR 1.1 per kg/m² increase) and hemoglobin (OR 0.65 per g/dL increase). The combined criterion of low ferritin and TSat was only associated with FEV₁ (OR 0.39 per liter increase). Mortality was not significantly associated with iron deficiency (hazard ratio [HR] 1.2–1.8).

Conclusion: The prevalence of iron deficiency in the study population increased with increasing severity of COPD. Iron deficiency, defined by ferritin < cutoff, was associated with bronchial obstruction, current smoking, and cardiovascular disease, while TSat < 20% was associated with reduced levels of hemoglobin and increased BMI. Iron deficiency was not associated with increased mortality.

Citation

Citation: Hardang IM, Søyseth V, Kononova N, Hagve T-A, Einvik G. COPD: iron deficiency and clinical characteristics in patients with and without chronic respiratory failure. J COPD F. 2024; 11(3): 261-269. doi: http://doi.org/10.15326/jcopdf.11.3.2023.0477

Keywords

COPD, polycythemia, chronic respiratory failure, iron deficiency, anemia

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Click to read COPD: Iron Deficiency and Clinical Characteristics in Patients With and Without Chronic Respiratory Failure

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Author Affiliations

1. Department of Family and Community Health, University of Minnesota, Minneapolis, United States
2. DARTNet Institute, Aurora, Colorado, United States
3. Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, Connecticut, United States

Address correspondence to:

Barbara P Yawn, MD, MSc
1963 112^th Circle NE
Blaine, MN 55449
Phone: (507) 261-3096
Email: byawn47@gmail.com

Abstract

This article does not contain an abstract.

Citation

Citation: Yawn BP, Callen E, Gaona-Villarreal G, Shaikh A, Pace WD. Increased herpes zoster risk with inhaled corticosteroid use for those with chronic obstructive pulmonary disease. J COPD F. 2024; 11(3): 303-306. doi: http://doi.org/10.15326/jcopdf.11.3.2023.0478

Keywords

COPD, inhaled corticosteroids, herpes zoster, shingles

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Author Affiliations

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

Address correspondence to:

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

Abstract

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

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

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

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

Citation

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

Keywords

COPD, outcomes, health care access

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Author Affiliations

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

^aContributed equally

^bAffiliation at the time of the study

Address correspondence to:

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

Abstract

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

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

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

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

Citation

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

Keywords

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

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

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Author Affiliations

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

Address correspondence to:

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

Abstract

This article does not contain an abstract.

Citation

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

Keywords

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

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Author Affiliations

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

Address correspondence to:

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

Abstract

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

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

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

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

Citation

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

Keywords

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

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Author Affiliations

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

Address correspondence to:

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

Abstract

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

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

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

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

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

Citation

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

Keywords

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

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Author Affiliations

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

Address correspondence to:

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

Abstract

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

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

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

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

Citation

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

Keywords

COPD, epidemiology, prevention, cigarette, e-cigarette

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

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Author Affiliations

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

Address correspondence to:

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

Abstract

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

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

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

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

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

Citation

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

Keywords

COPD, lung function, CT-scan measurements, DOISNORE50

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

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Author Affiliations

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

Address correspondence to:

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

Abstract

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

Citation

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

Keywords

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

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

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Author Affiliations

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

Address correspondence to:

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

Abstract

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

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

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

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

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

Citation

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

Keywords

COPD, mortality, readmission, frailty, intensive care

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

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Author Affiliations

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

Address correspondence to:

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

Abstract

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

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

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

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

Citation

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

Keywords

COPD, exacerbations, smoking, never smokers, prognosis

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

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Author Affiliations

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

Address correspondence to:

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

Abstract

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

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

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

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

Citation

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

Keywords

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

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

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Author Affiliations

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

Address correspondence to:

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

Abstract

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

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

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

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

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

Citation

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

Keywords

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

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

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Author Affiliations

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

Address correspondence to:

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

Abstract

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

Citation

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

Keywords

COPD, emphysema, alpha-1 antitrypsin, protease

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

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Author Affiliations

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

Address correspondence to:

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

Abstract

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

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

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

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

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

Citation

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

Keywords

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

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

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Author Affiliations

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

Address correspondence to:

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

Abstract

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

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

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

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

Citation

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

Keywords

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

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

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Author Affiliations

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

Address correspondence to:

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

Abstract

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

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

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

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

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

Citation

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

Keywords

COPD, comorbidity, cardiovascular disease, health delivery

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

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Author Affiliations

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

Address correspondence to:

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

Abstract

Citation

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

Keywords

COPD, telemonitoring, home spirometry

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

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Author Affiliations

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

Address correspondence to:

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

Abstract

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

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

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

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

Citation

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

Keywords

COPD, smoking, cytomegalovirus, natural killer cell phenotypes

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

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Author Affiliations

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

Address correspondence to:

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

Abstract

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

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

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

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

Citation

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

Keywords

COPD, inhaled corticosteroids, cardiovascular disease

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

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Author Affiliations

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

Address correspondence to:

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

Abstract

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

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

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

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

Citation

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

Keywords

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

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

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Author Affiliations

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

Address correspondence to:

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

Abstract

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

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

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

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

Citation

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

Keywords

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

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

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Author Affiliations

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

Address correspondence to:

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

Abstract

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

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

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

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

Citation

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

Keywords

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

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

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Author Affiliations

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

Address correspondence to:

Mehrdad Arjomandi, MD
Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine
University of California, San Francisco
San Francisco Veterans Affairs Medical Center
Building 203, Room 3A-128, Mailstop 111-D
4150 Clement Street, San Francisco, CA 94121
Phone: (415) 221-4810 x24393
Email: mehrdad.arjomandi@ucsf.edu

Abstract

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

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

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

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

Citation

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

Keywords

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

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Author Affiliations

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

Address correspondence to:

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

Abstract

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

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

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

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

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

Citation

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

Keywords

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

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