Author Affiliations

1. Division of Clinical Pharmacology and Therapeutics, Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Hong Kong, China
2. State Key Laboratory of Pharmaceutical Biotechnology, The University of Hong Kong, Pokfulam, Hong Kong, China
3. Institute of Cardiovascular Science and Medicine, The University of Hong Kong, Pokfulam, Hong Kong, China

Address correspondence to:

Bernard M.Y. Cheung, PhD
Department of Medicine
School of Clinical Medicine
Queen Mary Hospital
102 Pokfulam Road
Hong Kong
Email: mycheung@hku.hk
Phone: +852 22554347
Fax: +852 28186474

Abstract

Background: Systemic arterial hypertension (HTN) is one of the common comorbidities among patients with chronic obstructive pulmonary disease (COPD). This study aimed to investigate the association between HTN and COPD.

Methods: A total of 46,804 eligible non-pregnant participants aged ≥ 20 years examined in the Mobile Examination Center of the National Health and Nutrition Examination Survey (NHANES) 1999–2018 were included in this cross-sectional study. Participants with invalid data on covariates, HTN, and COPD were excluded. The association between HTN and COPD was studied using logistic regression upon adjusting the potential covariates.

Results: Among the participants, 46.1% (95% confidence interval [CI], 45.3–46.9) had HTN, and 6.8% (95% CI, 6.4–7.2) had self-reported COPD. COPD was associated with HTN (OR [odds ratio]=1.18, 95% CI [1.05–1.31], P<0.01) after adjusting for demographics, socioeconomic factors, smoking, diabetes, body mass index, and medication use, including inhaled corticosteroids and methylxanthines. The association between HTN and COPD was significant among adults younger than 60 years (P<0.01). Stratified by smoking status, there was a significant association between HTN and COPD in current heavy smokers (1.25, 95% CI [1.01–1.58]; P=0.04).

Conclusions: In this nationwide survey, COPD was associated with HTN. The association was more robust among adults younger than 60 years and current heavy smokers. Future prospective studies are needed to examine the relationship between HTN and COPD.

Citation

Citation: Liang X, Chou OHI, Cheung BMY. The association between systemic arterial hypertension and chronic obstructive pulmonary disease. Results from the U.S. National Health and Nutrition Examination Survey 1999-2018: a cross-sectional study. J COPD F. 2023; 10(2): 190-198. doi: http://doi.org/10.15326/jcopdf.10.2.2022.0306

Keywords

COPD, smoking, systemic arterial hypertension, hypertension, NHANES

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Author Affiliations

1. Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
2. Division of Neurology and Behavioral Health, National Jewish Health, Denver, Colorado, United States
3. AlphaNet, Kissimmee, Florida, United States
4. University of Kentucky College of Public Health, Lexington, Kentucky, United States
5. Lung Investigation Unit, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham, National Health Service Foundation Trust, Birmingham, United Kingdom
6. Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, Colorado, United States

Address correspondence to:

Paul Ellis, MBChB, PhD
Phone: +44 7794751625
Email: p.ellis@bham.ac.uk

Abstract

Background: Intravenous alpha-1 antitrypsin (AAT) augmentation therapy is the only specific treatment available for alpha-1 antitrypsin deficiency (AATD)-related lung disease. It is widely used worldwide but remains unavailable to patients with AATD in the United Kingdom. While randomized trials of augmentation therapy have demonstrated biochemical efficacy and lung tissue preservation using computed tomography (CT) densitometry, these studies were not adequately powered to demonstrate effectiveness in well-accepted clinical endpoints such as quality of life (QOL) or survival. We used large, prospectively followed AATD patient populations in the United States and United Kingdom to explore these important clinical endpoints.

Methods: Our inclusion criterion was adults with severe AATD and associated lung disease. The treatment group was U.S. AATD patients receiving augmentation therapy for lung disease. The control group was augmentation therapy naïve AATD patients. Multivariable regression and survival analyses were used to assess QOL and mortality outcomes respectively.

Results: Mean annual deterioration of the St George’s Respiratory Questionnaire total score was 1.43 points greater/year in the control group compared to those receiving augmentation therapy (95% confidence interval [CI] 0.47 to 2.39, p =0.003). At 7 years, median survival was 82.7% (95% CI 75.3 to 90.7) for the control group versus 87.8% (95% CI 82.8 to 93.2) in the augmentation group, p=0.66. There was significant heterogeneity between cohorts.

Conclusion: A comparison of 2 highly characterized AATD cohorts was not able to reliably determine if AAT augmentation therapy improves QOL or mortality in patients with severe AATD-related lung disease. Alternative surrogate biomarkers of disease progression, such as CT lung density, may be a more pragmatic option.

Citation

Citation: Ellis PR, Holm KE, Choate R, et al. Quality of life and mortality outcomes for augmentation naïve and augmented patients with severe alpha-1 antitrypsin deficiency. J COPD F. 2023; 10(2): 139-147. doi: http://doi.org/10.15326/jcopdf.10.2.2022.0339

Keywords

emphysema, alpha-1 antitrypsin deficiency, AAT augmentation therapy

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Author Affiliations

1. Epidemiology, Biostatistics, and Prevention Institute, University of Zurich, Zurich, Switzerland
2. MediX Group Practice, Zurich, Switzerland
3. Health Psychology and Behavioural Medicine, University of Bern, Bern, Switzerland
4. Zurich Institute for Clinical Sexology and Sexual Therapy, Zurich, Switzerland
5. Clinic for Psychiatry, Psychotherapy, and Psychosomatics, Hohenegg, Meilen, Switzerland
6. Gynaecologic Psychosomatic and Sexual Medicine, University Hospital, Zurich, Switzerland
7. Institute for Sex Counseling and Sexual Sciences, Zurich, Switzerland

Address correspondence to:

Claudia Steurer-Stey, MD
University of Zurich
Epidemiology, Biostatistics and Prevention Institute
Hirschengraben 84
CH-8001 Zurich, Switzerland
Phone: +41 44 634 43 60
Email: Claudia.steurer-stey@uzh.ch

Abstract

Introduction: Sexuality, an important aspect of quality of life, is often overlooked in COPD. Our aim was to develop an instrument that facilitates communication and counseling on sexuality in persons living with chronic obstructive pulmonary disease (COPD).

Methods: We searched for publications on sexuality in COPD focusing on communication about sexuality and tools to support such communication. We also performed a survey asking 25 patients and 36 health care professionals (HCPs) about their attitudes, experiences, barriers, and facilitators when talking about sexuality. We set up a project expert team of HCPs and 3 persons with COPD. In a half-day workshop, the team discussed the results of the literature review and the survey as a basis for the contents, the “when and how” to address communication about sexuality, and the design of the communication instrument.

Results: The survey showed that although patients and HCPs wanted to talk about sexuality, it rarely happened due to communication barriers, lack of self-confidence, and misconceptions on both sides. In review rounds of the expert team, feedback on the drafts was collected and integrated into the final version of the communication instrument: COmmunication about SexualitY in COPD (COSY). The COSY instrument resulted in 4 tools: a communication leaflet, an application guide, a pictorial representation of the spectrum of intimacy for HCPs, and a comprehensible, picturized information booklet for patients.

Conclusions: Addressing sexuality in persons living with COPD should not be neglected. The COSY instrument could help to start and shape communication and consultations about sexuality and a more holistic consideration of quality of life.

Citation

Citation: Steurer-Stey C, Dalla Lana K, Strassmann A, et al. Development of a communication instrument to address sexuality in COPD: COSY. J COPD F. 2023; 10(2): 148-158. doi: http://doi.org/10.15326/jcopdf.10.2.2022.0355

Keywords

COPD, patient-centered, communication, sexuality, intimacy, instrument

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Author Affiliations

1. Respiratory Institute, Cleveland Clinic, Cleveland, Ohio, United States
2. Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, United States
3. Department of Chemical and Biomolecular Engineering, Johns Hopkins University, Baltimore, Maryland, United States
4. Department of Pathology, Johns Hopkins University, Baltimore, Maryland, United States
5. Department of Oncology, Johns Hopkins University, Baltimore, Maryland, United States
6. Center for Environmental Medicine, Asthma, and Lung Biology, Division of Allergy and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States

Address correspondence to:

Ashraf Fawzy, MD, MPH
5501 Hopkins Bayview Circle
Baltimore MD, 21224
Phone: (410)550-6305
Email: afawzy1@jhmi.edu

Abstract

Background: Polymorphisms and products of the cyclooxygenase (COX) pathway have been associated with the development of chronic obstructive pulmonary disease (COPD) and adverse outcomes. COX-produced prostaglandin E2 (PGE-2) may play a role in the inflammation observed in COPD, potentially through deleterious airway macrophage polarization. A better understanding of the role of PGE-2 in COPD morbidity may inform trials for therapeutics targeting the COX pathway or PGE-2.

Methods: Urine and induced sputum were collected from former smokers with moderate-severe COPD. The major urinary metabolite of PGE-2 (PGE-M) was measured, and ELISA was performed on sputum supernatant for PGE-2 airway measurement. Airway macrophages underwent flow cytometry phenotyping (surface CD64, CD80, CD163, CD206, and intracellular IL-1β, TGF-β1). Health information was obtained the same day as the biologic sample collection. Exacerbations were collected at baseline and then monthly telephone calls.

Results: Among 30 former smokers with COPD (mean±SD age 66.4±8.88 years and forced expiratory volume in 1 second [FEV₁] 62.4±8.37 percent predicted), a 1 pg/mL increase in sputum PGE-2 was associated with higher odds of experiencing at least one exacerbation in the prior 12 months (odds ratio 3.3; 95% confidence interval: 1.3 to15.0), worse respiratory symptoms and health status. PGE-M was not associated with exacerbations or symptoms. Neither airway PGE-2 nor urinary PGE-M was uniformly associated with an M1 or M2 polarization.

Conclusions: Elevated levels of sputum PGE-2, rather than systemic PGE-2, is associated with increased respiratory symptoms and history of exacerbation among individuals with COPD. Additional studies focused on mechanism of action are warranted.

Citation

Citation: Tejwani V, Villabona-Rueda AF, Khare P, et al. Airway and systemic prostaglandin E2 association with COPD symptoms and macrophage phenotype. J COPD F. 2023; 10(2): 159-169. doi: http://doi.org/10.15326/jcopdf.10.2.2022.0375

Keywords

COPD, macrophage, prostaglandin

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Click to read Airway and Systemic Prostaglandin E2 Association with COPD Symptoms and Macrophage Phenotype

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Author Affiliations

1. University of British Columbia, Centre for Heart Lung Innovation, St Paul’s Hospital, Vancouver, British Columbia, Canada
2. Research Institute, McGill University Health Centre, McGill University, Montreal, Quebec Canada
3. Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
4. Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Quebec City, Quebec, Canada
5. Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
6. University of Toronto, Toronto, Ontario, Canada
7. Department of Medicine, University of Calgary, Calgary, Alberta, Canada
8. Respiratory Research Centre, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
9. Queen’s University, Kingston, Ontario, Canada
10. Department of Medicine, University of British Columbia and Vancouver General Hospital, Vancouver, British Columbia, Canada

*Listed in Acknowledgements section

Address correspondence to:

Wan C. Tan, MD
University of British Columbia
Centre for Heart Lung Innovation
St Paul’s Hospital, Rm166
081 Burrard Street, Vancouver, B.C., V6Z 1Y6, Canada
Phone:1-(604)682-2344 ext. 62749
Email: wan.tan@hli.ubc.ca

Abstract

Introduction: Retaining participants in longitudinal studies increases their power. We undertook this study in a population-based longitudinal cohort of adults with COPD to determine the factors associated with increased cohort attrition.

Methods: In the longitudinal population-based Canadian Cohort of Obstructive Lung Disease (CanCOLD) study, 1561 adults > 40 years old were randomly recruited from 9 urban sites. Participants completed in-person visits at 18-month intervals and also were followed up every 3 months over the phone or by email. The cohort retention for the study and the reasons for attrition were analyzed. Hazard ratios and robust standard errors were calculated using Cox regression methods to explore the associations between participants who remained in the study and those who did not.

Results: The median follow-up (years) of the study is 9.0 years. The overall mean retention was 77%. Reasons for attrition (23%) were: dropout by participant (39%), loss of contact (27%), investigator-initiated withdrawal (15%), deaths (9%), serious disease (9%), and relocation (2%). Factors independently associated with attrition were lower educational attainment, higher pack-year tobacco consumption, diagnosed cardiovascular disease, and a higher Hospital Anxiety and Depression Scale score: adjusted hazard ratios (95% confidence interval) were 1.43(1.11, 1.85); 1.01(1.00, 1.01); 1.44(1.13, 1.83); 1.06(1.02, 1.10) respectively.

Conclusion: Identification and awareness of risk factors for attrition could direct targeted retention strategies in longitudinal studies. Moreover, the identification of patient characteristics associated with study dropout could address any potential bias introduced by differential dropouts.

Citation

Citation: Katsuno N, Li PZ, Bourbeau J, et al. Factors associated with attrition in a longitudinal cohort of older adults in the community. J COPD F. 2023; 10(2): 178-189. doi: http://doi.org/10.15326/jcopdf.10.2.2022.0380

Keywords

population-based longitudinal cohort, predictor of attrition, retention strategies

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Click to read Factors Associated with Attrition in a Longitudinal Cohort of Older Adults in the Community

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Author Affiliations

1. Department of Research and Development, Ciro, Horn, the Netherlands
2. Department of Respiratory Medicine, School of Nutrition and Translational Research in Metabolism, Faculty of Health Medicine and Life Sciences, Maastricht University Medical Centre, Maastricht, the Netherlands
3. Department of Health Services Research, Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
4. Department of Internal Medicine, Maastricht University Medical Center, Maastricht, the Netherlands

Address correspondence to:

Kiki Waeijen-Smit, MSc
Ciro
Department of Research and Development
P.O. Box 4009
6080 AA Haelen, the Netherlands
Email: KikiSmit@ciro-horn.nl
Phone: 31 (0) 475 587 602

Abstract

Rationale: A significant reduction in hospitalizations for acute exacerbations of COPD (AECOPDs) has been reported during the coronavirus disease 2019 (COVID-19) pandemic. It remains unclear whether this reduction is the result of health care avoidance by patients, or of infection prevention and control (IPC) measures.

Objectives: Our objective was to explore the impact of COVID-19–related IPC measures on the occurrence of AECOPD in a real-life inpatient pulmonary rehabilitation (PR) setting, thereby ruling out potential effects of health care avoidance.

Methods: Patients with COPD admitted for 8 weeks of inpatient PR at Ciro (Horn, the Netherlands) between October 2020 and March 2021, the first winter with full COVID-19–related IPC measures,were compared to patients admitted during the same period in previous years (2017–2018, 2018–2019, and 2019–2020). Electronic medical records were retrospectively screened for the occurrence of moderate to severe AECOPDs, drop-out, and mortality.

Results: A total of 501 patients with COPD (median age 66.6 [interquartile range (IQR) 60.3–71.9] years, 43.1% male, forced expiratory volume in 1 second [FEV₁] 35.9 [26.8–50.6] % predicted) were analyzed. During 2020–2021, 22 patients (31.0%) experienced ≥1 AECOPD compared to 43 patients (33.6%) in 2019–2020, 55 patients (36.9%) in 2018–2019, and 83 patients (54.2%) in 2017–2018. This represents a 25.4% reduction in 2020–2021 compared to the average of the previous 3 periods, p=0.077. No differences in AECOPD severity, drop-out, or mortality were observed.

Conclusions: COVID-19–related IPC measures did not significantly reduce the AECOPD rate during inpatient PR in a single-center setting. The current findings suggest that avoidance of health care may be an important factor in the observed reduction of AECOPD-related hospitalizations during the pandemic and that the value of the strict COVID-19-related IPC measures for the prevention of AECOPDs warrants further research.

Citation

Citation: Waeijen-Smit K, Houben-Wilke S, Posthuma R, et al. Impact of coronavirus disease 2019-related infection prevention and control measures on the occurrence of COPD exacerbations during inpatient pulmonary rehabilitation. J COPD F. 2023; 10(2): 127-138. doi: http://doi.org/10.15326/jcopdf.10.2.2022.0345

Keywords

pulmonary rehabilitation, COVID-19, COPD exacerbations, infection prevention, control measures

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Click to read Impact of Coronavirus Disease 2019-Related Infection Prevention and Control Measures on the Occurrence of COPD Exacerbations During Inpatient Pulmonary Rehabilitation

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Author Affiliations

1. Physical Therapy Sciences, Program in Clinical Health Sciences, University Medical Center Utrecht, Utrecht University, Netherlands
2. Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
3. Respiratory Epidemiology and Clinical Research Unit, Research Institute, McGill University Health Center, Montreal, Quebec, Canada
4. Montreal Chest Institute, McGill University Health Centre, Montreal, Quebec, Canada
5. Ottawa Hospital Research Institute, Ottawa University, Ottawa, Canada
6. Toronto General Hospital Research Institute, University of Toronto, Toronto, Canada
7. Division of Respirology, Faculty of Medicine, Dalhousie University, Halifax, Canada
8. Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Quebec, Canada
9. Respiratory Research Centre, University of Saskatchewan, Saskatoon, Canada
10. Division of Respiratory and Critical Care Medicine, Queen's University, Kingston, Canada
11. Centre for Heart Lung Innovation, University of British Columbia, St Paul's Hospital, Vancouver, Canada
12. Department of Medicine, University of Calgary, Alberta, Canada
13. School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada

Address correspondence to:

Tania Janaudis-Ferreira, PhD
McGill University
3630 Promenade Sir-William Osler
Montreal, QC, CAN H3G1Y5
Email: tania.janaudis-ferreira@mcgill.ca

Abstract

Background: The relationship between symptom burden and physical activity (PA) in chronic obstructive pulmonary disease (COPD) remains poorly understood with limited data on undiagnosed individuals and those with mild to moderate disease.

Objective: The primary objective was to evaluate the relationship between symptom burden and moderate-to-vigorous intensity PA (MVPA) in individuals from a random population-based sampling mirroring the population at large.

Methods: Baseline participants of the Canadian Cohort Obstructive Lung Disease (n=1558) were selected for this cross-sectional sub-study. Participants with mild COPD (n=406) and moderate COPD (n=331), healthy individuals (n=347), and those at risk of developing COPD (n=474) were included. The Community Healthy Activities Model Program for Seniors (CHAMPS) questionnaire was used to estimate MVPA in terms of energy expenditure. High symptom burden was classified using the COPD Assessment Test ([CAT] ≥10).

Results: Significant associations were demonstrated between high symptom burden and lower MVPA levels in the overall COPD sample (β=-717.09; 95% confidence interval [CI]=-1079.78, -354.40; p<0.001) and in the moderate COPD subgroup (β=-694.1; 95% CI=-1206.54, -181.66; p=0.006). A total of 72% of the participants with COPD were previously undiagnosed. The undiagnosed participants had significantly higher MVPA than those with physician diagnosed COPD (β=-592.41 95% CI=-953.11, -231.71; p=0.001).

Conclusion: MVPA was found to be inversely related to symptom burden in a large general population sample that included newly diagnosed individuals, most with mild to moderate COPD. Assessment of symptom burden may help identify patients with lower MVPA, especially for moderate COPD and for relatively inactive individuals with mild COPD.

Citation

Citation: Oostrik L, Bourbeau J, Doiron D, et al. Physical activity and symptom burden in COPD: the Canadian Obstructive Lung Disease study. J COPD F. 2023; 10(1): 89-101. doi: http://doi.org/10.15326/jcopdf.10.1.2022.0349

Keywords

COPD, symptom burden, physical activity, undiagnosed, CanCOLD

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Click to read Physical Activity and Symptom Burden in COPD: The Canadian Obstructive Lung Disease Study

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Author Affiliations

1. Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
2. The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California, United States
3. Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
4. Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States
5. Department of Radiology, University of Iowa, Iowa City, Iowa, United States
6. Department of Medicine, National Jewish Health, Denver, Colorado, United States
7. Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, United States

Address correspondence to:

Jessica Bon, MD, MS
UPMC Montefiore Hospital, NW628
3459 Fifth Avenue
Pittsburgh, PA 15213
Email: bonjm@upmc.edu

Abstract

Introduction: Smokers with chronic obstructive pulmonary disease (COPD) are at increased risk of muscle weakness. There are limited data describing weakness in smokers with normal spirometry and preserved ratio-impaired spirometry (PRISm), 2 subgroups at risk of respiratory symptom burden and activity limitations. In this study, we evaluated the associations of 2 weakness measures, sit-to-stand (STS) and handgrip strength (HGS), with clinical outcomes in smokers with COPD, normal spirometry, and PRISm.

Methods: We evaluated 1972 current and former smokers from the COPD Genetic Epidemiology (COPDGene^®) cohort with STS and HGS measurements at their 10-year study visit. Multivariable regression modeling was used to assess associations between weakness measures and the 6-minute walk distance (6MWD) test, the St George’s Respiratory Questionnaire (SGRQ), the Short-Form-36 (SF-36), severe exacerbations, and prospective mortality, reported as standardized coefficients (β), odds ratios (ORs), or hazard ratios (HRs).

Results: Compared with HGS, STS was more strongly associated with the 6MWD (β=0.45, p<0.001 versus. β=0.25, p<0.001), SGRQ (β=-0.24, p<0.001 versus β=-0.18, p<0.001), SF-36 Physical Functioning (β=0.36, p<0.001 versus β=0.25, p<0.001), severe exacerbations (OR 0.95, p=0.04 versus OR 0.97, p=0.01), and prospective mortality (HR 0.83, p=0.001 versus HR 0.94, p=0.03). Correlations remained after stratification by spirometric subgroups. Compared with males, females had larger magnitude effect sizes between STS and clinical outcomes.

Conclusions: STS and HGS are easy to perform weakness measures that provide important information about functional performance, health-related quality of life, severe exacerbations, and survival in smokers, regardless of spirometric subgroup. This iterates the importance of screening current and former smokers for weakness in the outpatient setting.

Citation

Citation: Zou RH, Nouraie M, Rossiter HB, et al. Associations between muscle weakness and clinical outcomes in current and former smokers. J COPD F. 2023; 10(1): 112-121. doi: http://doi.org/10.15326/jcopdf.10.1.2022.0365

Keywords

chronic obstructive pulmonary disease, COPD outcomes, cigarette smoking, COPDGene, musculoskeletal comorbidities

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Click to read Associations Between Muscle Weakness and Clinical Outcomes in Current and Former Smokers

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Author Affiliations

1. Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, United States
2. Leonard M. Miller School of Medicine, University of Miami, Miami, Florida, United States
3. Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, Washington, United States
4. Department of Medicine, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, United States
5. Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States
6. Department of Medicine, Columbia University Medical Center, New York, New York, United States
7. Division of Pulmonary, Critical Care, and Occupational Medicine, College of Medicine, University of Iowa, Iowa City, Iowa, United States
8. Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California Los Angeles, Los Angeles, California, United States
9. Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, Colorado, United States
10. Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan, United States
11. Division of Pulmonary and Critical Care Medicine, Department of Medicine, Temple University School of Medicine, Philadelphia, Pennsylvania, United States
12. Division of Respiratory, Critical Care and Occupational Medicine, University of Utah, Salt Lake City, Utah, United States
13. Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
14. Division of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois at Chicago, Chicago, Illinois, United States
15. Section on Pulmonary, Critical Care, Allergy and Immunologic Diseases, Wake Forest University, Winston-Salem, North Carolina, United States
16. Division of Pulmonary, Critical Care and Sleep Medicine, University of California San Francisco, San Francisco, California, United States
17. Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States

Address correspondence to:

Mudiaga Sowho, MD, MPH
5501 Hopkins Bayview Circle, JHAAC
Baltimore, MD
Email: msowho1@jhmi.edu
Phone: (410) 550-6264

Abstract

Rationale: Ambient air pollution exposure is associated with respiratory morbidity among individuals with chronic obstructive pulmonary disease (COPD), particularly among those with concomitant obesity. Although people with COPD report high incidence of poor sleep quality, no studies have evaluated the association between air pollution exposure, obesity, and sleep disturbances in COPD.

Methods: We analyzed data collected from current and former smokers with COPD enrolled in the Subpopulations and Intermediate Outcome Measures in COPD -Air Pollution ancillary study (SPIROMICS AIR). Socio-demographics and anthropometric measurements were collected, and 1-year mean historical ambient particulate matter (PM_2.5) and ozone concentrations at participants’ residences were estimated by cohort-specific spatiotemporal modeling. Sleep quality was assessed with the Pittsburgh Sleep Quality Index (PSQI), and regression models were constructed to determine the association of 1-year PM_2.5 (1Yr-PM_2.5) and 1-year ozone (1Yr-ozone) with the PSQI score, and whether obesity modified the association.

Results: In 1308 participants (age: 65.8±7.8 years, 42% women), results of regression analyses suggest that each 10µg/m³ increase in 1Yr-PM_2.5 was associated with a 2.1-point increase in PSQI (P=0.03). Obesity modified the association between 1Yr-PM_2.5 and PSQI (P=0.03). In obese and overweight participants, a 10µg/m³ increase in 1Yr-PM_2.5 was associated with a higher PSQI (4.0 points, P<0.01, and 3.4 points, P<0.01, respectively); but no association in lean-normal weight participants (P=0.51). There was no association between 1 Yr-ozone and PSQI.

Conclusion: Overweight and obese individuals with COPD appear to be susceptible to the effects of ambient PM_2.5 on sleep quality. In COPD, weight and ambient PM_2.5 may be modifiable risk factors to improve sleep quality.

Citation

Citation: Sowho MO, Koch AL, Putcha N, et al. Ambient air pollution exposure and sleep quality in COPD. J COPD F. 2023; 10(1): 102-111. doi: http://doi.org/10.15326/jcopdf.10.1.2022.0350

Keywords

COPD, air pollution, sleep quality, obesity

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Author Affiliations

1. Division of Pulmonary Allergy and Critical Care Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States

Address correspondence to:

Frank C. Sciurba, MD
The University of Pittsburgh
3471 Fifth Avenue
Suite 1211, Kaufmann Bldg.
Pittsburgh, PA 15213
Phone: (412) 648-6494
Email : sciurbafc@upmc.edu

Abstract

Background: Lung hyperinflation with elevated residual volume (RV) is associated with poor prognosis in adults with chronic obstructive pulmonary disease (COPD) and is a critical criterion for lung volume reduction selection. Here, we proposed that patterns within spirometric measures could represent the degree of hyperinflation.

Methods: Fractional polynomial multivariate regression was used to develop a prediction model based on age, biological sex, forced expiratory volume in 1 second (FEV₁), and forced vital capacity (FVC) to estimate plethysmography measured RV in patients in the Pittsburgh Specialized Center for Clinically Oriented Research (SCCOR) cohort (n=450). Receiver operating characteristic area under the curve (ROC-AUC) and optimal cut-points from the model were identified. The model was validated in a separate cohort (n=793).

Results: The best fit model: RV %est=[FVC %predicted] x 3.46-[FEV₁/FVC] x 179.80- [FVC % (sqrt)] x 79.53-[age] x 0.98- [sex] x 10.88 + 737.06, where [sex], m=1. R² of observed versus %predicted RV was 0.71. The optimal cut-point to predict an RV % >175% was 161. At this cut-point, ROC-AUC was 0.95, with a sensitivity 0.95, specificity 0.86, positive predictive value (PPV) of 97%, negative predictive value (NPV) of 76%, positive likelihood ratio (LR) of 6.6, and negative LR of 0.06. In a validation cohort of COPD patients (n=793), the model performed similarly, with a sensitivity of 0.82, specificity of 0.83, PPV of 85%, NPV of 79%, positive LR of 4.7, and negative LR of 0.21.

Conclusions: In patients with COPD, a model using only spirometry, age, and biological sex can estimate elevated RV. This tool could facilitate the identification of candidates for lung volume reduction procedures and can be integrated into existing epidemiologic databases to investigate the clinical impact of hyperinflation.

Citation

Citation: Evankovich JW, Nouraie SM, Sciurba FC. A model to predict residual volume from forced spirometry measurements in chronic obstructive pulmonary disease. J COPD F. 2023; 10(1): 55-63. doi: http://doi.org/10.15326/jcopdf.10.1.2022.0354

Keywords

emphysema, lung volume reduction, hyperinflation, lung volume, bronchoscopy

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Click to read A Model to Predict Residual Volume from Forced Spirometry Measurements in Chronic Obstructive Pulmonary Disease

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Author Affiliations

1. Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany

Address correspondence to:

Johanna Forstner, MSc
Department of General Practice and Health Services Research
University Hospital Heidelberg
Im Neuenheimer Feld 130.3
69120 Heidelberg, Germany
Phone: 0049 6221 5635559
Email: jmforstner@gmail.com

Abstract

Background: Hospital readmission rates are very high in patients with chronic obstructive pulmonary disease (COPD). Continuity of care (CoC) with general practitioners (GPs) and ambulatory specialists can impact readmission rates. This study aimed to identify shared patient networks of ambulatory care physicians and to examine the effect of provider connectedness on CoC and hospital readmissions.

Methods: A retrospective observational study was conducted in claims data from the years 2016 to 2018 in patients with COPD (aged 40 years or older; hospital stay in 2017). Linkages between GPs, pneumologists, and cardiologists were determined on the basis of shared patients. Multilevel regression models were used to analyze the impact of provider connectedness, operationalized by several social network characteristics, on continuity of care (sequential continuity [SECON] index) and hospital readmission rates.

Results: A total of 7294 patients linked to 3673 GPs were available for analysis. Closeness centrality (β=- 0.029) and the external-internal (EI)-index (β =0.037) impacted on the SECON index. The EI-index (odds ratio [OR]=1.25) and degree centrality (OR=1.257) impacted 30-day readmission. Network density (OR=0.811) and the SECON index (OR=1.121) affected the likelihood of a 90-day readmission. None of the predictors had a significant impact on 180-day and 365-day readmissions.

Conclusions: Ambulatory care providers’ connectedness showed some effects on hospital readmissions and CoC in patients with COPD up to 90 days after hospital discharge, but the additional predictive power is limited.

Citation

Citation: Forstner J, Koetsenruijter J, Arnold C, Laux G, Wensing M. The influence of provider connectedness on continuity of care and hospital readmissions in patients with COPD: a claims data-based social network study. J COPD F. 2023; 10(1): 77-88. doi: http://doi.org/10.15326/jcopdf.10.1.2022.0359

Keywords

COPD, administrative claims, readmissions, continuity of care, social networks

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Click to read The Influence of Provider Connectedness on Continuity of Care and Hospital Readmissions in Patients With COPD: A Claims Data-Based Social Network Study

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Author Affiliations

1. The Permanente Medical Group, Kaiser Permanente Northern California, Oakland, California, United States
2. Division of Research, Kaiser Permanente Northern California, Oakland, California, United States
3. Spire Health, San Francisco, California, United States
4. Health Economics and Outcomes Research, Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, Connecticut, United States
5. Clinical Development and Medical Affairs, Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, Connecticut, United States

Address correspondence to:

Laura C. Myers, MD, MPH
Division of Research
Kaiser Permanente Northern California
2000 Broadway
Oakland, California 94612
Email: laura.c.myers@kp.org
Phone: (925) 433-3491

Abstract

Background: It is unclear whether persistent inhaled steroid exposure in chronic obstructive pulmonary disease (COPD) patients before coronavirus disease 2019 (COVID-19) is associated with hospitalization risk.

Objective: Our objective was to examine the association between persistent steroid exposure and COVID-19–related hospitalization risk in COPD patients.

Study Design and Methods: This retrospective cohort study used electronic health records from the Kaiser Permanente Northern California health care system (February 2, 2020, to September 30, 2020) for patients aged ≥40 years with COPD and a positive polymerase chain reaction test result for COVID-19. Primary exposure was persistent oral and/or inhaled steroid exposure defined as ≥6 months of prescriptions filled in the year before the COVID-19 diagnosis. Multivariable logistic regression was performed for the primary outcome of COVID-19–related hospitalization or death/hospice referral. Steroid exposure in the month before a COVID-19 diagnosis was a covariate.

Results: Of >4.3 million adults, 697 had COVID-19 and COPD, of whom 270 (38.7%) had COVID-19–related hospitalizations. Overall, 538 (77.2%) were neither exposed to steroids in the month before COVID-19 diagnosis nor persistently exposed; 53 (7.6%) were exposed in the month before but not persistently; 23 (3.3%) were exposed persistently but not in the month before; and 83 (11.9%) were exposed both persistently and in the month before. Adjusting for all confounders including steroid use in the month before, the odds ratio for hospitalization was 0.77 (95% confidence interval 0.41–1.46) for patients persistently exposed to steroids before a COVID-19 diagnosis.

Interpretation: No association was observed between persistent steroid exposure and the risk of COVID-19–related hospitalization in COPD patients.

Citation

Citation: Myers LC, Murray RK, Donato BMK, et al. Persistent steroid exposure before coronavirus disease 2019 diagnosis and risk of hospitalization in patients with chronic obstructive pulmonary disease. J COPD F. 2023; 10(1): 64-76. doi: http://doi.org/10.15326/jcopdf.10.1.2022.0351

Keywords

COPD, chronic obstructive pulmonary disease, COVID-19, coronavirus disease 2019, steroids

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Click to read Persistent Steroid Exposure Before Coronavirus Disease 2019 Diagnosis and Risk of Hospitalization in Patients With Chronic Obstructive Pulmonary Disease

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Author Affiliations

1. Division of Pulmonary, Allergy, and Critical Care Medicine, Lung Health Center, University of Alabama at Birmingham, Birmingham, Alabama, United States
2. Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, United States
3. University of Exeter Medical School, University of Exeter, Exeter, United Kingdom
4. Pulmonary and Critical Care, University of Michigan, Ann Arbor, Michigan, United States
5. GSK, Research Triangle Park, North Carolina, United States
6. Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
7. Pulmonary Section, Medical Department, Herlev-Gentofte Hospital, Herlev, Denmark
8. GSK, Collegeville, Pennsylvania, United States
9. Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
10. New York-Presbyterian Weill Cornell Medical Center, New York, New York, United States
11. GSK, Brentford, United Kingdom
12. Centre for Respiratory Medicine and Allergy, Institute of Inflammation and Repair, Manchester Academic Health Science Centre, The University of Manchester, Manchester University NHS Foundation Hospital Trust, Manchester, United Kingdom
13. Johns Hopkins University School of Medicine, Baltimore, Maryland, United States

Address correspondence to:

J. Michael Wells, MD
Division of Pulmonary, Allergy, and Critical Care Medicine
Lung Health Center
University of Alabama at Birmingham
Birmingham, AL
Phone: (205) 934-6047
Email: jmwells@uabmc.edu

Abstract

Background: In the InforMing the Pathway of COPD Treatment (IMPACT) trial, single-inhaler fluticasone furoate (FF) /umeclidinium (UMEC) /vilanterol (VI) significantly reduced severe exacerbation rates and all-cause mortality (ACM) risk versus UMEC/VI among patients with chronic obstructive pulmonary disease (COPD). This post hoc analysis aimed to define the risk of ACM during and following a moderate/severe exacerbation, and further determine the benefit-risk profile of FF/UMEC/VI versus FF/VI and UMEC/VI using a cardiopulmonary composite adverse event (AE) endpoint.

Methods: The 52-week, double-blind IMPACT trial randomized patients with symptomatic COPD and ≥1 exacerbation in the prior year 2:2:1 to once-daily FF/UMEC/VI 100/62.5/25mcg, FF/VI 100/25mcg, or UMEC/VI 62.5/25mcg. Post hoc endpoints included the risk of ACM during, 1–90 and 91–365 days post moderate or severe exacerbation and time-to-first cardiopulmonary composite event.

Results: Of the 10,355 patients included, 5034 (49%) experienced moderate/severe exacerbations. Risk of ACM was significantly increased during a severe exacerbation event compared with baseline (hazard ratio [HR]: 41.22 [95% confidence interval (CI) 26.49–64.15]; p<0.001) but not significantly different at 1–90 days post-severe exacerbation (HR: 2.13 [95% CI: 0.86–5.29]; p=0.102). Moderate exacerbations did not significantly increase the risk of ACM during or after an exacerbation. Cardiopulmonary composite events occurred in 647 (16%), 636 (15%), and 356 (17%) patients receiving FF/UMEC/VI, FF/VI, and UMEC/VI, respectively; FF/UMEC/VI significantly reduced cardiopulmonary composite event risk versus UMEC/VI by 16.5% (95% CI: 5.0–26.7; p=0.006).

Conclusion: Results confirm a substantial mortality risk during severe exacerbations, and an underlying CV risk. FF/UMEC/VI significantly reduced the risk of a composite cardiopulmonary AE versus UMEC/VI.

Clinical Trial Registration: GSK (CTT116855/NCT02164513).

Citation

Citation: Wells JM, Criner GJ, Halpin DMG, et al. Mortality risk and serious cardiopulmonary events in moderate-to-severe COPD: post hoc analysis of the IMPACT trial. J COPD F. 2023; 10(1): 33-45. doi: http://doi.org/10.15326/jcopdf.10.1.2022.0332

Keywords

pneumonia, respiratory therapy, pulmonary disease, chronic obstructive, cardiovascular diseases

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Click to read Mortality Risk and Serious Cardiopulmonary Events in Moderate-to-Severe COPD: Post Hoc Analysis of the IMPACT Trial

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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. VA Puget Sound Health Care System, Seattle, Washington, United States
3. Department of Medicine, University of Washington, Seattle, Washington, United States
4. Boise VA Medical Center, Boise, Idaho, United States
5. Department of Health Services, University of Washington, Seattle, Washington, United States
6. Department of Global Health, University of Washington, Seattle, Washington, United States

^*Co-first authors, listed alphabetically

Address correspondence to:

Laura J. Spece, MD, MS
HSR&D MS 152
1660 S. Columbian Way
Seattle, WA 98108
Phone: (206) 277-6779
Email: spece@uw.edu

Abstract

Background: Often patients with chronic obstructive pulmonary disease (COPD) receive poor quality care with limited access to pulmonologists. We tested a novel intervention, INtegrating Care After Exacerbation of COPD (InCasE), that improved patient outcomes after hospitalization for COPD. InCasE used population-based identification of patients for proactive e-consultation by pulmonologists, and tailored recommendations with pre-populated orders timed to follow-up with primary care providers (PCPs). Although adoption by PCPs was high, we do not know how PCPs experienced the intervention.

Objective: Our objective was to assess PCPs’ experience with proactive pulmonary e-consults after hospitalization for COPD.

Methods: We conducted a convergent mixed methods study among study PCPs at 2 medical centers and 10 outpatient clinics. PCPs underwent semi-structured interviews and surveys. We performed descriptive analyses on quantitative data and inductive and deductive coding based on prespecified themes of acceptability, appropriateness, and feasibility for qualitative data.

Key Results: We conducted 10 interviews and 37 PCPs completed surveys. PCPs perceived InCasE to be acceptable and feasible. Facilitators included the proactive consult approach to patient identification and order entry. PCPs also noted the intervention was respectful and collegial. PCPs had concerns regarding appropriateness related to an unclear role in communicating recommendations to patients. PCPs also noted a potential decrease in autonomy if overused.

Conclusion: This evaluation indicates that a proactive e-consult intervention can be deployed to collaboratively manage the health of populations with COPD in a way that is acceptable, appropriate, and feasible for primary care. Lessons learned from this study suggest the intervention may be transferable to other settings and specialties.

Citation

Citation: Spece LJ, Weppner WG, Weiner BJ, et al. Primary care provider experience with proactive e-consults to improve COPD outcomes and access to specialty care. J COPD F. 2023; 10(1): 46-54. doi: http://doi.org/10.15326/jcopdf.10.1.2022.0357

Keywords

COPD, primary care, e-consult

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Click to read Primary Care Provider Experience With Proactive E-Consults to Improve COPD Outcomes and Access to Specialty Care

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Author Affiliations

1. University of Florida College of Medicine, Gainesville, Florida, United States
2. Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Florida, Gainesville, Florida, United States

Address correspondence to:

Mark L. Brantly, MD
1600 SW Archer Rd, Rm M331
Gainesville, FL, 32610
Phone: (352) 294-5116
Email: mbrantly@ufl.edu

Abstract

The SERPINA1 gene encodes the serine protease inhibitor alpha-1 antitrypsin (AAT) and is located on chromosome 14q31-32.3 in a cluster of homologous genes likely formed by exon duplication. AAT has a variety of anti-inflammatory properties. Its clinical relevance is best illustrated by the genetic disease alpha-1 antitrypsin deficiency (AATD) which is associated with an increased risk for chronic obstructive pulmonary disease (COPD) and cirrhosis. While 2 single nucleotide polymorphisms (SNPs) , S and Z, are responsible for more than 95% of all individuals with AATD, there are a number of rare variants associated with deficiency and dysfunction, as well as those associated with normal levels and function. Our laboratory has identified a number of novel AAT alleles that we report in this manuscript. We screened more than 500,000 individuals for AATD alleles through our testing program over the past 20 years. The characterization of these alleles was accomplished by DNA sequencing, measurement of AAT plasma levels and isoelectric focusing at pH 4-5. We report 22 novel AAT alleles discovered through our screening programs, such as Z_{little rock} and QO_chillicothe, and review the current literature of known AAT genetic variants.

Citation

Citation: Wiesemann GS, Oshins RA, Flagg TO, Brantly ML. Novel SERPINA1 alleles identified through a large alpha-1 antitrypsin deficiency screening program and review of known variants. J COPD F. 2023; 10(1): 7-21. doi: http://doi.org/10.15326/jcopdf.10.1.2022.0321

Keywords

COPD, alpha-1 antitrypsin, genomics, novel alleles, allele characterization, PolyPhen-2

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Click to read Novel SERPINA1 Alleles Identified Through a Large Alpha-1 Antitrypsin Deficiency Screening Program and Review of Known Variants

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Author Affiliations

1. Division of Pulmonary and Critical Care, Johns Hopkins University, Baltimore, Maryland, United States
2. Department of Radiology, Johns Hopkins University, Baltimore, Maryland, United States
3. Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, United States
4. Division of Cardiology, Johns Hopkins University, Baltimore, Maryland, United States

Address correspondence to:

Ashraf Fawzy, MD, MPH
5501 Hopkins Bayview Circle
Baltimore MD, 21224
Phone: (410) 550-6305
Email: afawzy1@jhmi.edu

Abstract

Introduction: Antiplatelet therapy has been associated with fewer exacerbations and reduced respiratory symptoms in chronic obstructive pulmonary disease (COPD). Whether platelet activation is associated with respiratory symptoms in COPD is unknown.

Methods: Former smokers with spirometry-confirmed COPD had urine 11-dehydro-thromboxane B2 (11dTxB2), plasma soluble CD40L (sCD40L), and soluble P-selectin (sP-selectin) repeatedly measured during a 6- to 9-month study period. Multivariate mixed-effects models adjusted for demographics, clinical characteristics, and medication use evaluated the association of each biomarker with respiratory symptoms, health status, and quality of life.

Results: Among 169 participants (average age 66.5±8.2 years, 51.5% female, 47.5±31 pack years, forced expiratory volume in 1 second percent predicted 53.8±17.1), a 100% increase in 11dTxB2 was associated with worse respiratory symptoms reflected by higher scores on the COPD Assessment Test (β 0.77, 95% confidence interval [CI]: 0.11–1.4) and Ease of Cough and Sputum Clearance Questionnaire β 0.77, 95%CI: 0.38–1.2, worse health status (Clinical COPD Questionnaire β 0.13, 95%CI: 0.03-0.23) and worse quality of life (St George’s Respiratory Questionnaire β 1.9, 95%CI: 0.39-3.4). No statistically significant associations were observed for sCD40L or sP-selectin. There was no consistent statistically significant effect modification of the relationship between urine 11dTxB2 and respiratory outcomes by history of cardiovascular disease, subclinical coronary artery disease, antiplatelet therapy, or COPD severity.

Conclusions: In stable moderate-severe COPD, elevated urinary11dTxB2, a metabolite of the platelet activation product thromboxane A2, was associated with worse respiratory symptoms, health status, and quality of life.

Citation

Citation: Fawzy A, Putcha N, Raju S, et al. Urine and plasma markers of platelet activation and respiratory symptoms in COPD. J COPD F. 2023; 10(1): 22-32. doi: http://doi.org/10.15326/jcopdf.10.1.2022.0326

Keywords

chronic obstructive pulmonary disease, biomarkers, aspirin, platelet activation

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Click to read Urine and Plasma Markers of Platelet Activation and Respiratory Symptoms in COPD

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Author Affiliations

1. Freeman Health System, Joplin, Missouri, United States
2. Freeman Lung Institute, Freeman Health System, Joplin, Missouri, United States

* Current Affiliation: Department of Internal Medicine, University of Iowa Health Care, Iowa City, Iowa, United
States

Address correspondence to:

Thomas G. Maloney, DO
Internal Medicine
University of Iowa Health Care
200 Hawkins Dr – SE636 GH
Iowa City, IA 52242
Email: maloneytg@gmail.com

Abstract

Purpose: In chronic obstructive pulmonary disease (COPD) some patients develop paradoxical inspiratory rib motion, which is termed Hoover’s sign. Our objective was to determine whether Hoover’s sign is associated with a difference in the maximal expiratory pressure (MEP), the maximal inspiratory pressure (MIP), the MEP/MIP ratio, and other features on pulmonary function tests (PFTs).

Methods: This observational prospective single-center cohort study enrolled patients with an established diagnosis of COPD with Global initiative for chronic Obstructive Lung Disease (GOLD) stage 3 (severe) and 4 (very severe) based on PFTs. Respiratory pressure measurements were also collected. Patients were examined for the presence or absence of Hoover’s sign on physical examination by 2 internal medicine resident physicians trained in examining for Hoover’s sign by a pulmonologist.

Results: A total of 71 patients were examined for the presence of Hoover’s sign. Hoover’s sign was present in 49.3% of patients. Observer agreement (k statistic) was 0.8 for Hoover’s sign. Median MEP/MIP was significantly greater in patients with Hoover’s sign than those without Hoover’s sign (1.88 versus 1.16, p<0.001). Patients with Hoover’s sign also had a significantly lower MIP (39.0 versus 58.0, p<0.001) and higher residual volume (RV) to total lung capacity (TLC) ratio indicating a higher degree of air trapping (65 versus 59.5, p<0.014).

Conclusion: The presence of Hoover’s sign in patients with COPD is associated with a higher MEP/MIP ratio. This suggests respiratory pressure measurements can predict diaphragm dysfunction in patients with GOLD stage 3 and 4 COPD. Patients with Hoover’s sign were also found to have a lower MIP and more air trapping.

Citation

Citation: Maloney TG, Anderson ZS, Vincent AB, Magiera AL, Slocum PC. Association of Hoover’s sign with maximal expiratory-to-inspiratory pressure ratio in patients with COPD. J COPD F. 2023; 10(1): 1-6. doi: http://doi.org/10.15326/jcopdf.10.1.2022.0341

Keywords

chronic obstructive pulmonary disease, diaphragm dysfunction, Hoover’s sign, maximal expiratory pressure to maximal inspiratory

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Click to read Association of Hoover’s Sign with Maximal Expiratory-to-Inspiratory Pressure Ratio in Patients with COPD

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Author Affiliations

1. Centre for Heart Lung Innovation, James Hogg Research Centre, St. Paul’s Hospital, Vancouver, British Columbia, Canada
2. Division of Pulmonary Medicine, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
3. Division of Respiratory Medicine, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
4. British Columbia Cancer Agency, Vancouver, British Columbia, Canada

Address correspondence to:

Don D. Sin, MD, MPH
St. Paul’s Hospital, Room 8446
Vancouver, BC, V6Z 1Y6, Canada
Phone: (604) 806-8346
Email: Don.Sin@hli.ubc.ca

Abstract

This article does not contain an abstract.

Citation

Citation: Alotaibi NM, Tam S, van Eeden SF, et al. Common respiratory pathogens other than haemophilus in small airways are associated with neutrophilic inflammation and poor health status in stable COPD patients. J COPD F. 2023; 10(1): 122-126. doi: http://doi.org/10.15326/jcopdf.10.1.2022.0338

Keywords

COPD, BAL, colonization, pathogens, neutrophilic inflammation

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Click to read Common Respiratory Pathogens Other Than Haemophilus in Small Airways Are Associated With Neutrophilic Inflammation and Poor Health Status in Stable COPD Patients

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Author Affiliations

1. Department of Family and Community Health, University of Minnesota, Minneapolis, Minnesota, United States
2. COPD Foundation, Miami, Florida, United States
3. American Academy of Family Physicians National Research Network, Leawood, Kansas, United States
4. Department of Family Medicine, University of Colorado, Aurora, Colorado, United States
5. Division of Pharmacotherapy and Experimental Therapeutics, Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, North Carolina, United States

Address correspondence to:

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

Abstract

Objectives: The objective of this study was to assess health care professionals’ (HCPs) knowledge of an increased herpes zoster (HZ) risk and burden for patients with chronic obstructive pulmonary disease (COPD), HCPs’ familiarity with the Advisory Committee on Immunization Practices’ (ACIP) HZ vaccine recommendations, and the HCPs’ current adult vaccine practices. Another objective was to evaluate the impact of a short educational video on knowledge and future vaccine intent.

Participants and Methods: An online survey of family physicians (FPs), pulmonologists, nurse practitioners (NPs), and physician assistants (PAs) querying demographics, awareness of ACIP HZ vaccine recommendations, and HZ burdens and risks in patients with COPD and their current recommendations for HZ, influenza, and pneumococcal vaccines was conducted. For those not strongly recommending HZ vaccines concordant with ACIP recommendations, a 5-minute educational video was presented, and post video questions assessed future intended HZ vaccine recommendations.

Results: Among 1020 HCP responders, awareness and ACIP concordant HZ vaccine recommendations ranged from 59.0% to 95.2% across HCPs. Lowest recommendation rates were consistently reported by pulmonologists for the 2-dose HZ vaccine beginning at age 50; for the 2-dose vaccine use in those with prior 1-dose HZ vaccinations, and for those with prior HZ. Among all HCPs, HZ vaccine recommendations were lower than for pneumococcal and influenza vaccines. After viewing the educational video, reported vaccine recommendation intent increased significantly in all groups of HCPs, as did awareness of increased HZ risk among patients with COPD.

Conclusions: Significant educational opportunities exist for HCPs related to HZ and its vaccine prevention among patients with COPD which may be responsive to brief, targeted interventions.

Citation

Citation: Yawn BP, Loskutova NY, Merrill DD, et al. Health care professionals’ herpes zoster awareness and vaccine recommendations for patients with COPD. J COPD F. 2022; 9(4): 562-575. doi: http://doi.org/10.15326/jcopdf.9.4.2022.0322

Keywords

COPD, vaccination, herpes zoster, educational intervention, preventive medicine

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Click to read Health Care Professionals’ Herpes Zoster Awareness and Vaccine Recommendations for Patients with COPD

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Author Affiliations

1. Evidera, Bethesda, Maryland, United States
2. Novartis Pharma AG, Basel, Switzerland

Address correspondence to:

Nancy Kline Leidy, PhD
Evidera
7101 Wisconsin Avenue, Suite 1400
Bethesda, MD 20814
Email: Nancy.Leidy@evidera.com
Phone: (301) 654-9729

Abstract

Accurately interpreting scores on patient-reported outcome (PRO) measures is essential to understanding and communicating treatment benefit. Over the years, terminology and methods for developing recommendations for PRO score interpretation in clinical trials have evolved, leading to some confusion in the field. The phrase “minimal clinically important difference (MCID)” has been simplified to “minimal important difference (MID)” and use of responder thresholds to interpret statistically significant treatment effects has increased. Anchor-based derivation methods continue to be the standard, with specific variations preferred by regulatory authorities for drug development programs. In the midst of these changes, the Evaluating Respiratory Symptoms™ in COPD (E-RS:COPD) was developed and qualified for use as an endpoint in chronic obstructive pulmonary disease (COPD) drug development programs. This paper summarizes the evolution of terminology and method preferences for the development of recommendations for interpreting scores from PRO measures used in clinical trials, and how these changes are reflected in the E-RS:COPD recommendations. The intent is to add clarity to discussions around PRO endpoints and facilitate use of the E-RS:COPD as a key efficacy endpoint in clinical trials of COPD.

Citation

Citation: Leidy NK, Bushnell DM, Thach C, Hache C, Gutzwiller FS. Interpreting Evaluating Respiratory Symptoms™ in COPD diary scores in clinical trials: terminology, methods, and recommendations. J COPD F. 2022; 9(4): 576-590. doi: http://doi.org/10.15326/jcopdf.9.4.2022.0307

Keywords

patient-reported outcome measure, Evaluating Respiratory Symptoms™ in Chronic Obstru, symptomatic relief, interpretation recommendations for PRO measures, PROs and clinical trials

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Click to read Interpreting Evaluating Respiratory Symptoms™ in COPD Diary Scores in Clinical Trials: Terminology, Methods, and Recommendations

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Author Affiliations

1. Rehabilitation Clinical Trials Center, Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California, United States
2. COPD Foundation, Miami, Florida, United States
3. Respiratory Diagnostic and Evaluation Services and Respiratory Medicine, West Park Healthcare Centre, Toronto, Canada
4. ISGlobal, Barcelona, Spain
5. Universitat Pompeu Fabra, Barcelona, Spain
6. Consorcio de Investigación Biomédica en Red Epidemiología y Salud Pública, Madrid, Spain
7. Biopharmaceuticals, Respiratory and Immunology, AstraZeneca, Gothenburg Sweden
8. Department of Medicine and Rehabilitation Science, University of Toronto, Toronto, Canada
9. Evidera, Bethesda, Maryland, United States
10. Université Laval, Quebec, Canada
11. Respiratory Investigation Unit, Department of Medicine, Queen's University and Kingston Health Sciences Centre, Kingston, Ontario, Canada
12. Hospital General Universitario Gregorio Marañón Universidad, Madrid, Spain
13. Complutense de Madrid-Medical School, Madrid, Spain
14. Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska, United States
15. Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
16. Department of Research and Development, Ciro, Horn and Department of Respiratory Medicine, Maastricht University Medical Centre, Maastricht, Netherlands
17. Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
18. Department of Sports Medicine, University of Tübingen, Tübingen, Germany
19. Department of Respiratory Diseases, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands

Address correspondence to:

Richard Casaburi, PhD, MD
Rehabilitation Clinical Trials Center
The Lundquist Institute at Harbor UCLA Medical Center
CDCRC Building
1124 W. Carson St.
Torrance, CA 90502
Email: casaburi@ucla.edu
Phone: (310) 222-8200

Abstract

Introduction: The COPD Biomarkers Qualification Consortium (CBQC) was formed under COPD Foundation management, with the goal of qualifying biomarkers and clinical outcome assessments through established regulatory processes for chronic obstructive pulmonary disease (COPD). Within CBQC, a working group evaluated opportunities for qualification of an exercise endurance measure. In a recent publication (Chronic Obstr Pulm Dis. 2022; 9[2]:252-265), we described a conceptual framework establishing exercise endurance’s direct relationship to an individual with COPD’s experience of physical functioning in daily life, and that increase in exercise endurance is a patient-centered, meaningful treatment benefit. We further proposed endurance time during constant work rate cycle ergometery (CWRCE) as a useful efficacy endpoint in clinical therapeutic intervention trials. In this current publication, we describe the process of assembling an integrated database of endurance time responses to interventions in COPD.

Methods: We sought participant-level data from published studies incorporating CWRCE as an outcome measure. A literature search screened 2993 publications and identified 553 studies for assessment. Two interventions had sufficient data across studies to warrant data extraction: bronchodilators and rehabilitative exercise training. Investigators were contacted and requested to provide participant-by-participant data from their published studies.

Results: The final dataset included data from 8 bronchodilator studies (2166) participants and 15 exercise training studies (3488 participants). The database includes 71 variables per participant, comprising demographic, pulmonary function, and detailed physiologic response data. This paper provides a detailed description of the analysis population, while analysis supporting the validation/qualification process and addressing other scientific questions will be described in subsequent publications.

Citation

Citation: Casaburi R, Merrill D, Dolmage T, et al. Endurance time during constant work rate cycle ergometry in COPD: development of an integrated database from interventional studies. J COPD F. 2022; 9(4): 520-537. doi: http://doi.org/10.15326/jcopdf.9.4.2022.0331

Keywords

bronchodilator, exercise endurance, clinical outcome assessment, exercise training, patient-centric

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Click to read Endurance Time During Constant Work Rate Cycle Ergometry in COPD: Development of an Integrated Database From Interventional Studies

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Author Affiliations

1. College of Public Health, University of Kentucky, Lexington, Kentucky, United States
2. Department of Medicine, National Jewish Health, Denver, Colorado, United States
3. AlphaNet, Inc., Coral Gables, Florida, United States
4. College of Medicine, University of Kentucky, Lexington, Kentucky, United States
5. Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Medical University of South
   Carolina, Charleston, South Carolina, United States

Address correspondence to:

Radmila Choate, PhD, MPH
College of Public Health
University of Kentucky
Lexington, KY
Phone: (859)218-2237
E-mail: radmila.choate@uky.edu

Abstract

Rationale: Identifying pulmonary exacerbations in patients with alpha-1 antitrypsin deficiency (AATD) is critical as they are associated with disease progression and poor health-related quality of life. Not all changes in usual respiratory symptoms will be identified as exacerbations by patients with AATD.

Methods: Data collected via regular monthly telephone calls during the first year of the AlphaNet Step Forward Study were analyzed. AlphaNet subscribers were asked about changes in their usual respiratory symptoms, whether they considered changes in symptoms to be pulmonary exacerbations, and their management. Participants who reported changes in their usual respiratory symptoms throughout the year were included in the study. Per-patient and per-event analyses were performed.

Results: Participants (n=316, age 58±10 years, 53% female) reported 797 events of changes in their usual respiratory symptoms in 1 year. Almost half (48%) of these symptom events were identified as pulmonary exacerbations by the study participants. The average number of symptoms was higher in events recognized by participants as exacerbations than those not identified as exacerbations (3.3±1.5 versus 1.8±1.1, respectively). A greater proportion of the exacerbation events were managed by taking antibiotics or corticosteroids or both (81%, 53%, and 41% of the events, respectively). With exacerbations, participants mainly spoke to the pulmonary specialist (39%) or went to the doctor's office (37%). Symptom events not recognized as exacerbations were mostly self-treated (56%).

Conclusions: Changes in usual pulmonary symptoms are not universally recognized as exacerbations. Patients' perspectives in recognizing changes in pulmonary symptoms as exacerbation events are critical.

Citation

Citation: Choate R, Sandhaus RA, Holm KE, Mannino DM, Strange C. Patient-reported pulmonary symptoms, exacerbations, and management in a cohort of patients with alpha-1 antitrypsin deficiency. J COPD F. 2022; 9(4): 549-561. doi: http://doi.org/10.15326/jcopdf.9.4.2022.0317

Keywords

COPD, exacerbations, alpha-1 antitrypsin deficiency, pulmonary symptoms

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Click to read Patient-Reported Pulmonary Symptoms, Exacerbations, and Management in a Cohort of Patients With Alpha-1 Antitrypsin Deficiency

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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, New York, United States
2. Division of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois at Chicago, Chicago, Illinois, United States
3. Center for Clinical Trials and Evidence Synthesis, Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States
4. Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, United States
5. Pulmonary and Critical Care Medicine, University of Vermont, Burlington, Vermont, United States
6. Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
7. Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri, United States

Address correspondence to:

Janet T. Holbrook, PhD
415 N. Washington Street
Baltimore, MD 21231
Phone: 443-287-5791
Email: janet.holbrook@jhu.edu

Abstract

Background: Patients with chronic obstructive pulmonary disease (COPD) are at higher risk for severe coronavirus disease 2019 (COVID-19). From the pandemic’s onset there has been concern regarding effects on health and well-being of high-risk patients.

Methods: This was an ancillary study to the Losartan Effects on Emphysema Progression (LEEP) Trial and was designed to collect descriptive information longitudinally about the health and wellbeing of COPD patients who were enrolled in a clinical trial. Participants were interviewed by telephone about their health status every 2 weeks and their mental health, knowledge, and behaviors every 8 weeks from June 2020 to April 2021. There were no pre-specified hypotheses.

Results: We enrolled 157 of the 220 participants from the parent LEEP trial. Their median age was 69 years, 55% were male, and 82% were White; median forced expiratory volume in 1 second (FEV₁)% predicted was 48%. Nine confirmed COVID-19 infections were reported, 2 resulting in hospitalization. Rates of elevated anxiety or depressive symptoms were 8% and 19% respectively in June 2020 and remained relatively stable during follow-up. By April 2021, 85% of participants said they were “very likely” to receive a vaccine; 91% were vaccinated (≥1 dose) by the end of December 2021.

Conclusion: Our select cohort of moderate to severe COPD patients who were well integrated into a health care network coped well with the COVID-19 pandemic. Few participants were diagnosed with COVID-19, levels of depression and anxiety were stable, most adopted accepted risk reduction behaviors, and did not become socially isolated; most were vaccinated by the end of 2021.

Citation

Citation: Zhang WZ, LaBedz SL, Holbrook JT, et al; the American Lung Association Airways Clinical Research Centers. Impact of the coronavirus disease 2019 pandemic on physical and mental health of patients with COPD: results from a longitudinal cohort study conducted in the United States (2020-2021). J COPD F. 2022; 9(4): 510-519. doi: http://doi.org/10.15326/jcopdf.9.4.2022.0287

Keywords

COPD, depression, COVID-19, anxiety, vaccination, vaccine hesitancy

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Click to read Impact of the Coronavirus Disease 2019 Pandemic on Physical and Mental Health of Patients With COPD: Results From a Longitudinal Cohort Study Conducted in the United States (2020-2021)

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Author Affiliations

1. Pulmonary, Allergy, Critical Care, and Sleep Medicine, Minneapolis VA Health Care System, Minneapolis, Minnesota, United States
2. Pulmonary, Allergy, Critical Care, and Sleep Medicine, University of Minnesota, Minneapolis, Minnesota, United States
3. Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota, United States
4. Pulmonary, Critical Care, and Occupational Medicine, University of Iowa Hospital and Clinics, Iowa City, Iowa, United States
5. Center for Access and Delivery Research and Evaluation, Iowa City VA Health Care System, Iowa City, Iowa, United States

Address correspondence to:

Arianne K. Baldomero, MD, MS
Assistant Professor of Medicine
Minneapolis VA Health Care System
Pulmonary, Critical Care, and Sleep (111N)
One Veterans Drive, Minneapolis, MN, 55417
Email: baldo004@umn.edu

Abstract

Rationale: Many patients with suspected chronic obstructive pulmonary disease (COPD) do not undergo spirometry to confirm the diagnosis. Underutilization is often attributed to barriers to accessing spirometry.

Objective: Our objective wasto identify factors associated with spirometry underutilization for patients who are less likely to face access barriers related to travel, insurance, and availability of spirometry.

Methods: A retrospective analysis was conducted of patients enrolled in the Veterans Health Administration and living in urban areas with a new diagnosis of COPD between 2012 to 2015, reducing out-of-pocket cost and travel barriers, respectively. We included only patients whose primary care clinic was located in an academically affiliated tertiary level facility with spirometry available. We used logistic regression to estimate associations between patient characteristics and receipt of spirometry within 2 years before or after COPD diagnosis.

Results: Of 24,300 patients, 59.7% had spirometry. Compared to patients <55 years, patients 75–84 years had an adjusted odds ratio (aOR) of undergoing spirometry of 0.80 (95% confidence interval [CI]:0.72–0.90), while patients ≥85 years had an aOR of 0.47 (95%CI: 0.40–0.54). Compared to patients with a Charlson Comorbidity Index (CCI) ≥3, patients with a CCI of 0 had an aOR of 0.60 (95%CI:0.54–0.67). Patients who had not seen a pulmonary specialist had lower odds of receiving spirometry (aOR 0.38 [95%CI:0.35–0.41]).

Conclusion: Spirometry underutilization persists among patients who are less likely to have access barriers related to travel, insurance, and availability of spirometry. Spirometry underutilization is associated with older age, not having received pulmonary care, and having fewer comorbidities. COPD care quality initiatives will need to address these factors.

Citation

Citation: Baldomero AK, Kunisaki KM, Bangerter A, et al. Beyond access: factors associated with spirometry underutilization among patients with a diagnosis of COPD in urban tertiary care centers. J COPD F. 2022; 9(4): 538-548. doi: http://doi.org/10.15326/jcopdf.9.4.2022.0303

Keywords

chronic obstructive pulmonary disease, spirometry, pulmonary disease, health care services, Veterans Affairs

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Click to read Beyond Access: Factors Associated With Spirometry Underutilization Among Patients With a Diagnosis of COPD in Urban Tertiary Care Centers

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Author Affiliations

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

Address correspondence to:

Abraham B. Bohadana, MD
Pulmonary Institute, Shaare Zedek Medical Center
12 Bayit Street
Jerusalem, Israel
Phone: (972) (0) 58-437-8069
Fax: (972) 02 6555686
Email: abraham.bohadana@gmail.com

Abstract

Background: Although smoking is the leading cause of chronic obstructive pulmonary disease (COPD), many patients with COPD smoke, highlighting the need for effective smoking cessation interventions in this population. This study examined the efficacy and safety of varenicline in increasing smoking cessation rates through "gradual" versus "abrupt" cessation in COPD patients with low motivation to quit smoking.

Methods: A randomized, open label, 30-week, controlled trial (ClinicalTrials.gov identifier: NCT02894957) was conducted between January 2019 and October 2020 at a center in Israel. Smokers with COPD, poorly motivated to quit, were randomized to 6 weeks of varenicline for smoking reduction and a target quit day (TQD) at the end of week 6 (gradual cessation group) or ad libitum smoking for 5 weeks, 1 week of varenicline, and a TQD at the end of week 6 (abrupt cessation group). After the pre-quit phase, both groups received 12-week regular varenicline treatment and 12-week follow-up. Primary outcome was biochemically-validated continuous abstinence for weeks 6–30. Secondary outcomes were: (1) biochemically-confirmed7-day point prevalence abstinence for weeks 4–30, (2) efficient smoking reduction (≥50% in number of cigarettes/day) in the pre-quit phase; and (3) number of cigarettes/day, motivation to quit, and changes in respiratory symptoms and spirometry from baseline through week 30.

Results: A drug recall issued by the study sponsor stopped the study after 70/242 (28.9%) patients had been enrolled. The gradual cessation group (n=29) had significantly higher continuous abstinence rates from TQD through week 30 versus the abrupt cessation group (n=41): 20.7% versus 4.9% (odds ratio [OR]=5.09; 95% confidence interval [CI] 0.89-29.17; p=0.048) and higher 7-day point prevalence abstinence levels at all time points but week 18 (p=0.027 at week 6, 0.056 at week 7, and 0.096 at week 9). Motivation to quit increased (p=0.002) and the number of cigarettes/day decreased (p=0.002) over time in both groups. Respiratory symptoms, but not spirometry, improved in both groups at week 30. Treatment was safe and well tolerated.

Conclusions: In poorly motivated smokers with COPD, using varenicline for a 6-week gradual smoking cessation before TQD, compared with abrupt cessation, significantly increased quit rates up to 6 months. Results were not affected by the smaller-than-expected sample size. Further studies are needed to confirm these data.

Citation

Citation: Bohadana A, Rokach A, Wild P, et al. Varenicline for gradual versus abrupt smoking cessation in poorly motivated smokers with COPD: a prematurely terminated randomized controlled trial. J COPD F. 2022; 9(4): 486-499. doi: http://doi.org/10.15326/jcopdf.9.4.2022.0305

Keywords

COPD, chronic obstructive pulmonary disease, smoking, cigarette smoking, cessation, varenicline

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Click to read Varenicline for Gradual Versus Abrupt Smoking Cessation in Poorly Motivated Smokers With COPD: A Prematurely Terminated Randomized Controlled Trial

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Author Affiliations

1. Department of Internal Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, United States
2. Dartmouth College, Hanover, New Hampshire, United States
3. Department of Pulmonary and Critical Care, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, United States

Address correspondence to:

Jacob S. Warner, DO
Department of Internal Medicine
Dartmouth-Hitchcock Medical Center
1 Medical Center Drive
Lebanon, NH, 03756
Phone: (805) 674-1168
Email: Jacob.s.warner@outlook.com

Abstract

Purpose: Individuals in rural areas of the United States have a greater risk of chronic obstructive pulmonary disease (COPD) and have worse COPD outcomes. New Hampshire (NH) is split between non-rural and rural counties.

Methods: We examined differences in COPD exacerbation rates ([encounters per county/county population of 35 years of age and older] × 100), length of stay (LOS), and total charges by rurality, determined by the 2013 National Center for Health Statistics rural-urban classification. Linear regression analysis determined the association of rural status on COPD outcomes, adjusting for age, gender, insurance status, and county-level smoking prevalence.

Findings: A total of 15,916 encounters were analyzed, of which 5805 were inpatient and 10,111 were from the emergency department, 7058 (44%) were male, and the mean age was 65.6. A total of 31% were from large, fringe metro counties, 25.9% were from medium metro counties, 37.6% were from micropolitan counties, and 5.5% were from non-core counties. In multivariable regression, rural counties had higher COPD exacerbation rates compared to urban counties (non-core beta=0.18, [confidence interval (CI) 0.16, 0.20]; micropolitan beta=0.02, CI [0.01, 0.03]); medium metro counties (beta=-0.07, Cl [-0.09, -0.06]) had lower rates of COPD exacerbations (P < 0.001 for all). Compared to urban counties, encounters from rural counties had lower total charges (medium metro beta=-1695 [-2410, -980]; micropolitan beta=-2701 [-3315, -2088]; non-core beta=-4453 [-5646, -3260], all p<0.001). LOS did not differ by rurality.

Conclusions: Accounting for poverty and other sociodemographic factors, the rates of COPD exacerbation encounters were higher in rural versus non-rural NH counties. Additionally, non-rural areas carried higher total charges, potentially due to more resource availability. These results support the need for future interventions to improve outcomes in rural COPD patients.

Citation

Citation: Warner JS, Bryan JM, Paulin LM. The effect of rurality and poverty on COPD outcomes in New Hampshire: an analysis of statewide hospital discharge data. J COPD F. 2022; 9(4): 500-509. doi: http://doi.org/10.15326/jcopdf.9.4.2022.0299

Keywords

COPD, delivery of health care, social epidemiology

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Click to read The Effect of Rurality and Poverty on COPD Outcomes in New Hampshire: An Analysis of Statewide Hospital Discharge Data

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Author Affiliations

1. Institut Universitaire de Cardiologie et de Pneumologie de Québec, Canada
2. Département de Médecine et Faculté de Médecine, Montréal, Canada
3. Centre Hospitalier Universitaire de Québec, Site IUCPQ, Université Laval, Québec, Canada

Address correspondence to:

François Maltais, MD
Centre de Pneumologie
Institut Universitaire de Cardiologie et de Pneumologie de Québec
2725, Chemin Ste-Foy
Québec, Canada, G1V 4G5
Phone: (418) 656-4747
Email: francois.maltais@med.ulaval.ca

Abstract

This article does not contain an abstract.

Citation

Citation: Pelletier E, Desmeules P, Lacasse Y, et al. Antibody response to severe acute respiratory syndrome coronavirus-2 vaccination in COPD: a cohort study. J COPD F. 2022; 9(4): 591-595. doi: http://doi.org/10.15326/jcopdf.9.4.2022.0315

Keywords

COPD, COVID-19, coronavirus disease 2019, vaccination, antibodies

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Click to read Antibody Response to Severe Acute Respiratory Syndrome Coronavirus-2 Vaccination in COPD: A Cohort Study

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Author Affiliations

1. Denver, Colorado, United States
2. Lung Health Center, Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Alabama, Birmingham, Alabama, United States

Address correspondence to:

Ron Balkissoon, MD, MSc
Email: balkissoonr@njhealth.org

Abstract

This article does not contain an abstract.

Citation

Citation: Balkissoon R, Mkorombindo T. Journal club: impaired ventilatory efficiency and exercise intolerance in former/current smokers with dyspnea disproportionate to their lung function: pathophysiological insights gained through cardiopulmonary exercise testing. J COPD F. 2022; 9(3): 477-485. doi: http://doi.org/10.15326/jcopdf.9.3.2022.0344

Keywords

COPD, exercise intolerance, impaired ventilatory efficiency, cardiopulmonary exercise testing

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Click to read Journal Club: Impaired Ventilatory Efficiency and Exercise Intolerance in Former/Current Smokers With Dyspnea Disproportionate to Their Lung Function: Pathophysiological Insights Gained Through Cardiopulmonary Exercise Testing

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Author Affiliations

1. National Center for Respiratory Medicine, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
2. Guangzhou Medical University , Guangzhou Institutes of Biomedicine and Health Joint School of Life Sciences, Guangzhou Medical University, Guangzhou, China.
3. Guangzhou Laboratory, Bio-Island, Guangzhou, China.

Address correspondence to:

Yumin Zhou, MD, PhD
Email: zhouyumin410@126.com
and
Pixin Ran, MD, PhD
Email: pxran@gzhmu.edu.cn
National Center for Respiratory Medicine
State Key Laboratory of Respiratory Disease
National Clinical Research Center for Respiratory Disease
Guangzhou Institute of Respiratory Health
The First Affiliated Hospital of Guangzhou Medical University
151 Yanjiang Road, Guangzhou, China.

Abstract

Background: Eosinophils are involved in the development of chronic obstructive pulmonary disease (COPD) and inhaled corticosteroid responsiveness. We evaluated clinical predictors of high sputum eosinophil levels in a COPD cohort in China.

Methods: We conducted an observational, prospective, population-based, cross-sectional study. Participants were tested for COPD and underwent spirometry, computed tomography scans, and a blood test. Participants also produced induced sputum and responded to an information-gathering questionnaire. High sputum eosinophils were defined as ≥3.0%. Multivariate logistic regression was used to identify predictors of high sputum eosinophil levels.

Results: We recruited 895 patients with complete and quality control data. The median percentage of sputum eosinophil abundance was 2.00% (interquartile range: 0.75–5.00) and the prevalence of COPD with high sputum eosinophils was 38.0%. Covariance analysis indicated that the high sputum eosinophil group had lower lung function, more severe emphysema, and air trapping. Multivariate logistic regression indicated that high blood eosinophil levels, severe respiratory symptoms, being a former smoker, and a family history of respiratory diseases were associated with high sputum eosinophil levels.

Conclusion: High blood eosinophil levels, severe respiratory symptoms, being a former smoker, and a family history of respiratory diseases may be predictors of high sputum eosinophil levels in Chinese COPD patients. High sputum eosinophils were associated with lower lung function, more emphysema, and gas trapping.

Citation

Citation: Wen X, Pen J, Zheng Y, et al. Predictors of high sputum eosinophils in chronic obstructive pulmonary disease. J COPD F. 2022; 9(3): 413-426. doi: http://doi.org/10.15326/jcopdf.9.3.2022.0310

Keywords

COPD, chronic obstructive pulmonary disease, high sputum eosinophils

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Click to read Predictors of High Sputum Eosinophils in COPD

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Author Affiliations

1. Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, United States
2. Valley Regional Hospital, Claremont, New Hampshire, United States
3. Legacy Research Institute, Portland, Oregon, United States
4. Legacy Salmon Creek Medical Center, Vancouver, Washington, Unites States
5. Boehringer Ingelheim Pharmaceuticals, Incorporated, Ridgefield, Connecticut, United States

Address correspondence to:

Donald A. Mahler, MD
Valley Regional Hospital
243 Elm Street
Claremont, NH 03743, USA
Phone: (603) 277-0383
Email: mahlerdonald@gmail.com

Abstract

For optimal drug delivery, dry powder inhalers (DPIs) depend on the patient’s peak inspiratory flow (PIF) and the internal resistance of the device to create turbulent energy and disaggregate the powder. A suboptimal PIF may lead to ineffective drug inhalation into the lungs. Our objective was to report the prevalence of suboptimal PIF in patients with COPD hospitalized for any reason using 1 or more DPIs. In this real-world, observational, single‑site, retrospective study, PIF was measured for each DPI using the In-Check™ DIAL set to match the resistance of the DPI used by each patient. PIFs <60 and <30L/min were considered suboptimal for low to medium-high- and high-resistance DPIs, respectively. At initial hospitalization, the prevalence of suboptimal PIF was 44.6% in 829 patients (mean age, 71.7 years; 56.8% female); 21.2% were measured during admission for a COPD exacerbation. Suboptimal PIF percentages were 61.0% (38.1±9.5L/min [mean±standard deviation (SD)]) across low to medium-high-resistance DPIs and 17.2% (20.7±4.2L/min) for high-resistance DPIs. Overall, 190/829 patients had 1 or more 30-day all-cause readmission with 253 corresponding PIF measurements. For readmissions, suboptimal PIFs were observed in 49.5% (94/190) of patients. Suboptimal PIF percentages were 65.4% (38.4±9.2L/min) for low to medium-high-resistance DPIs and 19.8% (22.4±3.3L/min) for high-resistance DPIs. As the overall prevalence of suboptimal PIFs in hospitalized patients with COPD varied according to the specific internal resistance of the DPI, these findings may have clinical implications for inhaler selection.

Citation

Citation: Mahler DA, Demirel S, Hollander R, et al. High prevalence of suboptimal peak inspiratory flow in hospitalized patients with COPD: a real-world study. J COPD F. 2022; 9(3): 427-438. doi: http://doi.org/10.15326/jcopdf.9.3.2022.0291

Keywords

chronic obstructive pulmonary disease, dry powder inhaler, peak inspiratory flow

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Click to read High Prevalence of Suboptimal Peak Inspiratory Flow in Hospitalized Patients With COPD: A Real-world Study

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Author Affiliations

1. Division of Biostatistics, National Jewish Health, Denver, Colorado, United States
2. Department of Radiology, National Jewish Health, Denver, Colorado, United States
3. Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical Center, Boston, Massachusetts, United States
4. Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
5. Department of Mathematical and Statistical Sciences, University of Colorado Denver, Denver, Colorado, United States
6. Department of Medicine, National Jewish Health, Denver, Colorado, United States
7. Department of Medicine, Baylor College of Medicine, Houston, Texas, United States

Address correspondence to:

Matthew Strand, PhD
National Jewish Health
Phone: (303) 398-1862
Email: strandm@njhealth.org

Abstract

Understanding baseline characteristics that can predict the progression of lung disease such as chronic obstructive pulmonary disease (COPD) for current or former smokers may allow for therapeutic intervention, particularly for individuals at high risk of rapid disease progression or transition from non-COPD to COPD. Classic diagnostic criteria for COPD and disease severity such as the Global Initiative for Chronic Obstructive Lung Disease document are based on forced expiratory volume in 1 second (FEV₁) and FEV₁ to forced vital capacity (FVC) ratio. Modeling changes in these outcomes jointly is beneficial given that they are correlated, and they are both required for specific disease classifications. Here, linear mixed models were used to model changes in FEV₁ and FEV₁/FVC jointly for 5- and 10-year intervals, using important baseline predictors to better understand the factors that affect disease progression. Participants with predicted loss of FEV₁ and/or FEV₁/FVC of at least 5% tended to have more emphysema, higher functional residual capacity, higher airway wall thickness as measured by Pi10, lower FVC to total lung capacity ratio and a lower body mass index at baseline, all relative to overall cohort averages. The model developed can be used to predict progression for any potential COPD individual, based on demographic, symptom, computed tomography, and comorbidity variables.

Citation

Citation: Strand M, Khatiwada A, Baraghoshi D, et al. Predicting COPD progression in current and former smokers using a joint model for forced expiratory volume in 1 second and forced expiratory volume in 1 second to forced vital capacity ratio. J COPD F. 2022; 9(3): 439-453. doi: http://doi.org/10.15326/jcopdf.9.3.2022.0281

Keywords

spirometry, GOLD, COPDGene, PRISm, preserved ratio-impaired spirometry, linear mixed model

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Click to read Predicting COPD Progression in Current and Former Smokers Using a Joint Model for Forced Expiratory Volume in 1 Second and Forced Expiratory Volume in 1 Second to Forced Vital Capacity Ratio

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Author Affiliations

1. Center for Tobacco Control Research and Education, University of California, San Francisco, California, United States
2. Cardiovascular Research Institute, University of California, San Francisco, California, United States
3. Medical Service, San Francisco Veterans Affairs Medical Center; San Francisco; California, United States
4. Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, Washington, United States
5. Flight Attendant Medical Research Institute, Bland Lane Center of Excellence on Secondhand Smoke, University of California, San Francisco, California, United States
6. Department of Epidemiology and Biostatistics, University of California, San Francisco, California, United States
7. Department of Medicine, Mount Sinai-St. Luke's-Roosevelt Hospital, New York, New York, United States
8. Division of Cardiology, University of California, San Francisco, California, United States
9. Division of Pulmonary, Critical Care, Allergy and Immunology, and Sleep Medicine, University of California, San Francisco, California, United States
10. Division of Occupational and Environmental Medicine; University of California, San Francisco, California, United States

Address correspondence to:

Mehrdad Arjomandi, MD
Department of 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: Prolonged past exposure to secondhand tobacco smoke (SHS) in never-smokers is associated with abnormal lung function and reduced diffusing capacity suggestive of an associated lung tissue injury and damage. The mechanisms by which past SHS exposure may contribute to lung tissue damage are unknown. Elastin is a major constituent of extracellular matrix in lung parenchyma.

Objective: To determine whether past exposure to SHS is associated with ongoing lung tissue damage as indicated by elevated elastin degradation products that are linked to lung function.

Methods: We measured the plasma levels of elastin degradation markers (EDM) from 193 never-smoking flight attendants with a history of remote SHS exposure in aircraft cabins and 103 nonsmoking flight attendants or sea-level control participants without such history of cabin SHS exposure and examined those levels versus their lung function with adjustment for covariates. The cabin SHS exposure was estimated based on airline employment history and years of the smoking ban enactment.

Results: The median [interquartile range] plasma EDM level for all participants was 0.30 [0.24–0.36] ng/mL with a total range of 0.16–0.65 ng/mL. Plasma EDM levels were elevated in those with a history of exposure to cabin SHS compared to those not exposed (0.33±0.08 versus 0.26±0.06 ng/mL; age- and sex-adjusted P<0.001). In those with a history of cabin SHS exposure, higher EDM levels were associated with a lower diffusing capacity (parameter estimate [PE] 95% [confidence interval(CI)]=4.2 [0.4–8.0] %predicted decrease per 0.1 ng/mL increase in EDM; P=0.030). Furthermore, EDM levels were inversely associated with forced expiratory volume in 1 second (FEV₁), FEV₁ to forced vital capacity (FVC) ratio , and forced expiratory flow rate between 25% and 75% ( FEF_25%-75%) (PE [95%CI]=5.8 [2.1–9.4], 4.0 [2.2–5.7], and 12.5 [5.8–19.2] %predicted decrease per 0.1 ng/mL increase in EDM, respectively; P<0.001). Plasma EDM mediated a substantial fraction of the association of SHS with FEV₁, FVC, and FEF_25%-75% (P<0.05).

Conclusions: Long after past exposure to SHS, there is ongoing elastin degradation beyond what is expected from the aging process, which likely contributes to lower lung function and a reduced pulmonary capillary bed as seen in chronic obstructive pulmonary disease (COPD).

Citation

Citation: MustraRakic J, Zeng S, Rohdin-Bibby L, et al. Elastin degradation and lung function deterioration with remote secondhand tobacco smoke exposure in never-smokers. J COPD F. 2022; 9(3): 377-393. doi: http://doi.org/10.15326/jcopdf.9.3.2022.0289

Keywords

biomarkers, desmosine/isodesmosine, flight attendants, lung damage, secondhand tobacco smoke exposure

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Click to read Elastin Degradation and Lung Function Deterioration with Remote Secondhand Tobacco Smoke Exposure in Never-smokers

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Author Affiliations

1. Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, United States
2. Cátedra Salud Respiratoria, University of Barcelona; Respiratory Institute, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Centro de Investigacion Biomedica en Red Enfermedades Respiratorias, Barcelona, Spain
3. Department of Medical Oncology, Fox Chase Cancer Center at Temple University, Philadelphia, Pennsylvania, United States
4. Cornell University School of Medicine, New York, New York, United States
5. Department of Radiation Oncology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, United States
6. Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Centre Giessen and Marburg, Philipps-University Marburg, German Centre for Lung Research, Marburg, Germany
7. Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States.
8. Harvard Medical School, Boston, Massachusetts, United States

Address correspondence to:

Gerard J. Criner, MD
Department of Thoracic Medicine and Surgery
Lewis Katz School of Medicine
Temple University
745 Parkinson Pavilion
3401 North Broad Street
Philadelphia, PA 19140
Email: Gerard.Criner@tuhs.temple.edu
Phone: (215)707-7979

Abstract

Chronic obstructive pulmonary disease (COPD) and lung cancer are common global causes of morbidity and mortality. Because both diseases share several predisposing risks, the 2 diseases may occur concurrently in susceptible individuals. The diagnosis of COPD has important implications for the diagnostic approach and treatment options if lesions concerning for lung cancer are identified during screening. Importantly, the presence of COPD has significant implications on prognosis and management of patients with lung cancer. In this monograph, we review the mechanistic linkage between lung cancer and COPD, the impact of lung cancer screening on patients at risk, and the implications of the presence of COPD on the approach to the diagnosis and treatment of lung cancer. This manuscript succinctly reviews the epidemiology and common pathogenetic factors for the concurrence of COPD and lung cancer. Importantly for the clinician, it summarizes the indications, benefits, and complications of lung cancer screening in patients with COPD, and the assessment of risk factors for patients with COPD undergoing consideration of various treatment options for lung cancer.

Citation

Citation: Criner GJ, Agusti A, Borghaei H, et al. Chronic obstructive pulmonary disease and lung cancer: a review for clinicians. J COPD F. 2022; 9(3): 454-476. doi: http://doi.org/10.15326/jcopdf.9.3.2022.0296

Keywords

COPD, chronic obstructive pulmonary disease, lung cancer

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Author Affiliations

1. Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States.
2. Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States.
3. Division of Pulmonary and Sleep Medicine, Children’s National Health System, School of Medicine and Health Sciences, George Washington University, Washington, DC, United States.

Address correspondence to:

Wendy Lorizio, MD, MPH
Division of Pulmonary and Critical Care Medicine
Johns Hopkins University
Asthma and Allergy Center
5501 Hopkins Bayview Cir
Baltimore, MD 21224
Office: (410) 550-2449
Email: wlorizi1@jhmi.edu

Abstract

Rationale: Poor indoor air quality has been associated with worse chronic obstructive pulmonary disease (COPD) morbidity. In-home portable air cleaners reduce indoor pollutants and could improve respiratory health. Factors associated with air cleaner adherence among adults with COPD remains unknown.

Methods: In a 6-month trial of former smokers with COPD, participants (n=116) received active or sham portable air cleaners. Air cleaner adherence was measured by electronic monitors. Potential baseline predictors of adherence included individual factors (demographics, socioeconomic status, smoking history, psychological well-being), COPD disease severity, and housing characteristics. Time and season were also considered. Stepwise logistic regression and longitudinal fixed effect analysis were performed to assess independent predictors of adherence.

Results: A total of 109 participants had an objective measure of adherence, and 76.1% used at least 1 air cleaner 80% of the time (defined a priori as adherent). Higher annual household income ≥$35,000 (odds ratio [OR]=4.4, 95% confidence interval [CI], 1.1–18.0) and use of heat pump/electricity (versus gas) for heating (OR=6.1, 95%CI, 1.7–22.4) were associated with higher odds of adherence. Further, poor quality of life (St George’s Respiratory Questionnaire, per 10-point increase) and prior year exacerbations were associated with lower odds of adherence (OR=0.65, 95%CI, 0.4–1.0) and (OR=0.26, 95%CI, 0.1–0.9), respectively. Adherence was highest during the first month and lower during winter compared to other seasons.

Conclusion: These findings suggest that cold weather season, use of gas for home heating, and lower annual income negatively impact adherence. Poor quality of life and worse disease control may also decrease adherence. Addressing factors associated with air cleaner adherence should be considered when designing future environmental studies.

Citation

Citation: Lorizio W, Woo H, McCormack MC, et al. Patterns and predictors of air cleaner adherence among adults with COPD. J COPD F. 2022; 9(3): 366-376. doi: http://doi.org/10.15326/jcopdf.9.3.2022.0309

Keywords

COPD, predictors, adherence, air cleaners, HEPA filters

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Author Affiliations

1. Channing Division of Network Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States
2. Pulmonary and Critical Care Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States
3. Department of Electrical and Computer Engineering, Northeastern University, Boston, Massachusetts, United States
4. Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, Massachusetts, United States
5. Division of Pulmonary Medicine, Department of Medicine, National Jewish Health, Denver, Colorado, United States
6. Division of General Medicine and Primary Care, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States

Address correspondence to:

Adel Boueiz, MD, MMSc
Channing Division of Network Medicine
Brigham and Women’s Hospital
181 Longwood Avenue
Boston, MA 02115
Phone: (617) 525-2111
Email: adel.boueiz@channing.harvard.edu

Abstract

Background: The heterogeneous nature of chronic obstructive pulmonary disease (COPD) complicates the identification of the predictors of disease progression. We aimed to improve the prediction of disease progression in COPD by using machine learning and incorporating a rich dataset of phenotypic features.

Methods: We included 4496 smokers with available data from their enrollment and 5-year follow-up visits in the COPD Genetic Epidemiology (COPDGene^®) study. We constructed linear regression (LR) and supervised random forest models to predict 5-year progression in forced expiratory in 1 second (FEV₁) from 46 baseline features. Using cross-validation, we randomly partitioned participants into training and testing samples. We also validated the results in the COPDGene 10-year follow-up visit.

Results: Predicting the change in FEV₁ over time is more challenging than simply predicting the future absolute FEV₁ level. For random forest, R-squared was 0.15 and the area under the receiver operator characteristic (ROC) curves for the prediction of participants in the top quartile of observed progression was 0.71 (testing) and respectively, 0.10 and 0.70 (validation). Random forest provided slightly better performance than LR. The accuracy was best for Global initiative for chronic Obstructive Lung Disease (GOLD) grades 1–2 participants, and it was harder to achieve accurate prediction in advanced stages of the disease. Predictive variables differed in their relative importance as well as for the predictions by GOLD.

Conclusion: Random forest, along with deep phenotyping, predicts FEV₁ progression with reasonable accuracy. There is significant room for improvement in future models. This prediction model facilitates the identification of smokers at increased risk for rapid disease progression. Such findings may be useful in the selection of patient populations for targeted clinical trials.

Citation

Citation: Boueiz A, Xu Z, Chang Y, et al. Machine learning prediction of progression in forced expiratory volume in 1 second in the CODPGene® study. J COPD F. 2022; 9(3): 349-365. doi: http://doi.org/10.15326/jcopdf.9.3.2021.0275

Keywords

COPD, disease progression, 5-year changes in FEV1, prediction, random forest machine learning

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Click to read Machine Learning Prediction of Progression in Forced Expiratory Volume in 1 Second in the COPDGene® Study

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Author Affiliations

1. COPD Foundation, Washington, DC, United States
2. University of California San Diego, La Jolla, California, United States

Address correspondence to:

Carl Stepnowsky, PhD
3350 La Jolla Village Drive (111n-1)
San Diego, CA 92161
Phone: 858-642-1240
Email: cstepnowsky@health.ucsd.edu

Abstract

Background: Obstructive sleep apnea (OSA) is a sleep disorder prevalent in >10% of individuals diagnosed with chronic obstructive pulmonary disease (COPD). Continuous positive airway pressure (CPAP) is the first-line therapy for OSA, but many do not use it enough during sleep to effectively manage OSA. The O₂VERLAP study compared proactive care (PC)—structured web-based peer-coaching education and support intervention versus reactive care (RC)—education and support based on limited scheduled interactions and patient-initiated contacts.

Methods: Participants were primarily recruited from patient communities (COPD, OSA, and the National Patient-Centered Outcomes Research Network [PCORnet]) through electronic methods. Inclusion criteria: ≥40 years old, diagnosis of both COPD and OSA, and currently using CPAP. Participants were then randomly assigned to either the PC or RC group, with outcomes assessed at baseline and 6 and 12 weeks. The primary study outcome was CPAP adherence (hours of use/night) and secondary outcomes were daytime functioning, sleep quality, and daytime sleepiness. Changes in outcomes over time were examined using random effects models.

Results: The study enrolled 332 participants of which 294 were randomized. While groups differed significantly in CPAP adherence at baseline (PC: 6.1±3.1, RC: 7.3±2.4 hours/night; P<0.001), there were no significant differences in change of primary and secondary outcomes at either 6 or 12 weeks.

Conclusions: In this group of patients with both COPD and OSA on CPAP therapy, no difference was found between the provision of PC and RC. The study did find unexpectedly high baseline CPAP adherence levels, which suggests that any improvement from the intervention would have been very small and difficult to detect.

Citation

Citation: Martinez S, Sullivan J, Pasquale C, et al. Effect of two interventional strategies on improving continuous positive airway pressure adherence in existing COPD and obstructive sleep apnea patients: the O₂VERLAP study. J COPD F. 2022; 9(3): 394-412. doi: http://doi.org/10.15326/jcopdf.9.3.2022.0293

Keywords

chronic obstructive pulmonary disease, obstructive sleep apnea, O2VERLAP, CPAP, reactive care, proactive care

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Click to read Effect of Two Interventional Strategies on Improving Continuous Positive Airway Pressure Adherence in Existing COPD and Obstructive Sleep Apnea Patients: The O2VERLAP Study

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Author Affiliations

1. Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
2. Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States
3. Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States

Address correspondence to:

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

Abstract

Rationale: While studies suggest that the lung microbiome may influence risk of chronic obstructive pulmonary disease (COPD) exacerbations, little is known about the relationship between the nasal biome and clinical characteristics of COPD patients.

Methods: We sampled the nasal lining fluid by nasosorption of both nares of 20 people with moderate-to-severe COPD. All 40 samples, plus 4 negative controls, underwent DNA extraction, and 16SV4 ribosomal RNA (rRNA) (bacterial) and ribosomal internal transcribed spacer 2 (ITS2) (fungal) sequencing. We measured the proportion of variance (R²) in beta diversity explained by clinical factors, including age, sex, body mass index (BMI), COPD treatment, disease severity (forced expiratory volume in 1 second [FEV₁], symptom/exacerbation frequency), peripheral eosinophil level (≥150 versus <150 cells/µL) and season of sampling, with the PERMANOVA test on the Bray-Curtis dissimilarities, accounting for within-person correlation of samples. We assessed the relative abundance of microbial features in the nasal community and their associations with clinical characteristics using the Microbiome Multivariable Association with Linear Models (MaAsLin2) package.

Results: The most abundant nasal fluid bacterial taxa were Corynebacterium, Staphylococcus, Streptococcus, Moraxella, and Dolosigranulum, and fungal taxa were Malassezia, Candida, Malasseziales, Cladosporium and Aspergillus. Bacterial microbiome composition was associated with short-acting muscarinic antagonist use (R² 11.8%, p=0.002), sex (R² 8.3%, p=0.044), nasal steroid use (R² 7.7%, p=0.064), and higher eosinophil level (R² 7.6%, p=0.084). Mycobiome composition was associated with higher eosinophil level (R² 14.4%, p=0.004) and low FEV₁ (R² 7.5%, p=0.071). No specific bacterium or fungus differed significantly in relative abundance by clinical characteristics in the multivariate per-feature analysis.

Conclusion: The taxonomical composition of the nasal biome is heterogeneous in COPD patients and may be explained in part by clinical characteristics.

Citation

Citation: Alvarez Baumgartner M, Li C, Kuntz T, et al. Differences of the nasal microbiome and mycobiome by clinical characteristics of COPD patients. J COPD F. 2022; 9(3): 309-324. doi: http://doi.org/10.15326/jcopdf.9.3.2021.0267

Keywords

chronic obstructive pulmonary disease, microbiome, clinical characteristics, mycobiome, upper airways

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Author Affiliations

1. Institute of Biomedicine, University of Aveiro, Aveiro, Portugal
2. Department of Medical Sciences, University of Aveiro, Aveiro, Portugal
3. Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
4. Biomedical Research Institute, Hasselt University, Diepenbeek, Belgium
5. Respiratory Research and Rehabilitation Laboratory, School of Health Sciences, University of Aveiro, Aveiro, Portugal

Address correspondence to:

Alda Marques, PT, MSc, PhD
Respiratory Research and Rehabilitation Laboratory
School of Health Sciences and Institute of Biomedicine
University of Aveiro, Agras do Crasto
Campus Universitário de Santiago
Edifício 30, 3810-193
Aveiro, Portugal
Email: amarques@ua.pt
Phone: 00 +351 234372462

Abstract

Background: Acute exacerbations of chronic obstructive pulmonary disease (AECOPDs) have a negative impact on health status and disease progression, but their clinical presentation is heterogenous. A comprehensive understanding of individuals’ experiences during an AECOPD is needed to develop person-centered interventions, such as pulmonary rehabilitation (PR). This study aimed to explore people’s experiences during mild to moderate AECOPDs, and their thoughts on PR during this period.

Methods: Short, semi-structured interviews were conducted with people with mild to moderate AECOPDs treated on an outpatient basis within 48 hours of the diagnosis. Interviews were audio recorded, transcribed, and analyzed by deductive thematic analysis using the Web Qualitative Data Analysis software.

Results: Eleven people with AECOPDs (9 male, 67±10 years, forced expiratory volume in 1 second 41±16%predicted) participated. Four themes and 17 subthemes were identified: impact of an AECOPD (symptoms, physiological changes, limitations in activities of daily living, social constraints, psychological and emotional challenges, family disturbances); dealing with an AECOPD, ([not] depending on others, planning and compensation strategies); main needs during an AECOPD (breathe better, feel less tired, get rid of sputum, be able to walk); and (un)certainty about PR (lack of knowledge, getting better, exercises, design and timing, trust in health professionals).

Conclusion: AECOPDs, even when not requiring hospital admission, have a huge negative impact on people’s lives. Individuals’ thoughts about PR reflect the need to raise awareness for this intervention during AECOPDs. This study provides a foundation for the development of meaningful person-centered interventions during AECOPDs.

Citation

Citation: Machado A, Almeida S, Burtin C, Marques A. Giving voice to people – experiences during mild to moderate acute exacerbations ofCOPD. J COPD F. 2022; 9(3): 336-348. doi: http://doi.org/10.15326/jcopdf.9.3.2022.0283

Keywords

COPD, exacerbations, pulmonary rehabilitation, qualitative research, person-centered

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Author Affiliations

1. Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
2. Associates of Cape Cod Incorporated, East Falmouth, Massachusetts, United States
3. Department of Radiology, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
4. Center for Medicine and the Microbiome, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
5. Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, United States

^*Authors contributed equally

Address correspondence to:

Jessica Bon, MD, MS
Phone: (412) 692-2210
Email: Bonjm@upmc.edu

Abstract

Introduction: Factors beyond cigarette smoke likely contribute to chronic obstructive pulmonary disease (COPD) pathogenesis. Prior studies demonstrate fungal colonization of the respiratory tract and increased epithelial barrier permeability in COPD. We sought to determine whether 1,3-beta-d-glucan (BDG), a polysaccharide component of the fungal cell wall, is detectable in the plasma of individuals with COPD and associates with clinical outcomes and matrix degradation proteins.

Methods: BDG was measured in the plasma of current and former smokers with COPD. High BDG was defined as a value greater than the 95^th percentile of BDG in smokers without airflow obstruction. Pulmonary function, emphysema, and symptoms were compared between COPD participants with high versus low BDG. The relationship between plasma BDG, matrix metalloproteinases (MMP) 1, 7, and 9, and tissue inhibitor of matrix metalloproteinases (TIMP) 1, 2, and 4 was assessed adjusting for age, sex, and smoking status.

Results: COPD participants with high BDG plasma levels (19.8%) had lower forced expiratory volume in 1 second to forced vital capacity ratios (median 31.9 versus 39.3, p=0.025), higher St George’s Respiratory Questionnaire symptom scores (median 63.6 versus 57.4, p=0.016), and greater prevalence of sputum production (69.4% versus 52.0%) and exacerbations (69.4% versus 48%) compared to COPD participants with low BDG. BDG levels directly correlated with MMP1 (r=0.27, p<0.001) and TIMP1 (r=0.16, p=0.022) in unadjusted and adjusted analyses.

Conclusions: Elevated plasma BDG levels correlate with worse lung function, greater respiratory morbidity, and circulating markers of matrix degradation in COPD. These findings suggest that targeting dysbiosis or enhancing epithelial barrier integrity may have disease-modifying effects in COPD.

Citation

Citation: Gorgone M, Singhvi D, Nouraie SM, et al. Circulating 1,3-beta-d-glucan is associated with lung function, respiratory symptoms, and mediators of matrix degradation in chronic obstructive pulmonary disease. J COPD F. 2022; 9(3): 325-335. doi: http://doi.org/10.15326/jcopdf.9.3.2022.0290

Keywords

chronic obstructive pulmonary disease, microbial translocation

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Click to read Circulating 1,3-Beta-D-Glucan is Associated with Lung Function, Respiratory Symptoms, and Mediators of Matrix Degradation in Chronic Obstructive Pulmonary Disease

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Author Affiliations

1. College of Medicine, the University of Kentucky, Lexington, Kentucky, United States
2. Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania, United States
3. University of Minnesota, Minneapolis, Minnesota, United States

Address correspondence to:

Erin R. Camac, DO, FCCP
College of Medicine,
The University of Kentucky
The Kentucky Clinic
740 Limestone
Second Floor, Wing C, Room 211
Lexington, KY 40536
Phone: (814) 571-0195
Email: erin.camac.do@gmail.com

Abstract

Background: Chronic obstructive pulmonary disease (COPD) patients in the Simvastatin for the Prevention of Exacerbations in Moderate-to-Severe COPD (STATCOPE) and Azithromycin for Prevention of Exacerbations of COPD (MACRO) trials provide an opportunity to prospectively study the short-term effect of acute exacerbations of COPD (AECOPDs).

Research Question: We hypothesized that those patients with frequent exacerbations (≥2 AECOPDs per patient year) would experience greater short-term decline in quality of life as measured by the St George’s Respiratory Questionnaire (SGRQ).

Study Design and Methods: A total of 1934 COPD patients were randomized in STATCOPE or MACRO. Patients who were randomized to azithromycin in MACRO or were followed less than 180 days were excluded. A total of 1219 patients were included. Patients were divided into 2 groups: infrequent exacerbators (< 2 exacerbations per patient year), and frequent exacerbators (≥2 exacerbations per year.) Data were collected at baseline, measured over time, and compared between groups.

Results: Of the patients studied, 871 were in the infrequent exacerbators group. A total of 348 were in the frequent exacerbators group. Frequent exacerbators used more respiratory medications, were more likely to have used oxygen, steroids, or antibiotics in the 12 months preceding study entry, had more obstruction on spirometry, and had more severe symptoms as measured by SGRQ at baseline. Over at least 180 days, symptom scores worsened in frequent exacerbators and improved in infrequent exacerbators.

Interpretation: Patients with frequent exacerbations of COPD experienced a short-term slight worsening of severely impaired SGRQ symptoms scores, while patients with infrequent exacerbations experienced improvement while on COPD therapies.

Citation

Citation: Camac ER, Stumpf NA, Voelker HK, Criner GJ; COPD Clinical Research Network. Short-term impact of the frequency of COPD exacerbations on quality of life. J COPD F. 2022; 9(3): 298-308. doi: http://doi.org/10.15326/jcopdf.9.3.2021.0280

Keywords

COPD, exacerbations, quality of life

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Click to read Short-Term Impact of the Frequency of COPD Exacerbations on Quality of Life

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Author Affiliations

1. Lung Health Center, Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Alabama, Birmingham, Alabama, United States
2. Denver, Colorado

Address correspondence to:

Takudzwa Mkorombindo, MD
Email: tmkorombindo@uabmc.edu

Abstract

This article does not contain an abstract.

Citation

Citation: Mkorombindo T, Balkissoon R. Journal club:biologics and potential for immune modulation in chronic obstructive lung disease. J COPD F. 2022; 9(2): 285-297. doi: http://doi.org/10.15326/jcopdf.9.2.2022.0318

Keywords

COPD, biologics, immune modulation

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Click to read Journal Club: Biologics and Potential for Immune Modulation in Chronic Obstructive Lung Disease

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Author Affiliations

1. Department of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
2. Beaumont Hospital, Dublin, Ireland
3. Alpha-1 Foundation of Ireland, Dublin, Ireland

Address correspondence to:

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

Abstract

Patients with severe alpha-1 antitrypsin deficiency (AATD) are at increased risk for the development of chronic obstructive pulmonary disease (COPD), particularly if they smoke. This, coupled with their predilection for dysregulated inflammation and autoimmunity, makes affected individuals priority candidates for vaccination against coronavirus disease 2019 (COVID-19). To promote vaccine uptake effectively, an understanding of the factors motivating people to proceed with vaccination is essential. The attitudes of patients with AATD towards COVID-19 vaccination have yet to be described.

We prospectively studied 170 Pi*ZZ genotype AATD patients, 150 patients with nonhereditary (Pi*MM genotype) COPD and 140 Pi*MM genotype individuals without lung disease receiving first-dose vaccination with ChAdOx1 nCoV-19 (AstraZeneca). Patient attitudes towards vaccination and motivations for getting vaccinated were assessed at the time of the vaccine being offered. Following completion of the 2-dose vaccine series, Pi*ZZ patients were then re-assessed regarding their attitudes towards booster vaccination.

The most common primary motivation for accepting vaccination in Pi*ZZ participants ≥50 years old was a fear of illness or death from COVID-19. In contrast, Pi*ZZ patients <50 years most often cited a desire to socialize. The motivation pattern of younger Pi*ZZ AATD patients was similar to that of non-deficient individuals of comparable age, whereas older Pi*ZZ individuals were more closely aligned with Pi*MM COPD and differed from age-matched controls without lung disease. When considering booster vaccination, Pi*ZZ patients were increasingly motivated by a desire to reacquire social freedoms. A desire to reduce the risk of transmission was not a prominent consideration in any of the groups studied. The most commonly cited reason for booster hesitancy was a lack of incentive, given that no additional social freedoms were available to triple-vaccinated individuals compared to those who were double-vaccinated at the time.

Taken together, these data may inform policymakers attempting to promote vaccine uptake among patients with AATD.

Citation

Citation: McElvaney OJ, Cleary B, Fraughen DD, et al. Attitudes towards vaccination for coronavirus disease 2019 in patients with severe alpha-1 antitrypsin deficiency. J COPD F. 2022; 9(2): 266-273. doi: http://doi.org/10.15326/jcopdf.9.2.2022.0288

Keywords

alpha-1 antitrypsin deficiency, COVID-19 vaccination

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Click to read Attitudes Towards Vaccination for Coronavirus Disease 2019 in Patients with Severe Alpha-1 Antitrypsin Deficiency

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Author Affiliations

1. Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, University of Utah, Salt Lake City, Utah, United States
2. Department of Biostatistics, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
3. Division of Pulmonary and Critical Care, Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, United States
4. Department of Physiology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, United States
5. Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine, Temple University Hospital, Philadelphia, Pennsylvania, United States
6. Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
7. Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan, United States
8. Department of Medicine, University of California San Francisco, San Francisco, California, United States
9. Division of Internal Medicine, Wake Forest School of Medicine, Winston Salem, North Carolina, United States
10. Division of Internal Medicine, Wake Forest University Health Sciences, Winston-Salem, North Carolina, United States
11. Division of Physiologic Imaging, Department of Radiology, University of Iowa Carver College of Medicine, Iowa City, Iowa, United States
12. Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Health Services Research and Development, Greater Los Angeles Veterans Affairs Healthcare System, Los Angeles, California, United States
13. Division of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah, United States
14. Division of Pulmonary and Critical Care, Weill Cornell Medicine, New York, New York, United States
15. Department of Internal Medicine, Columbia University, New York, New York, United States
16. Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
17. Division of Pulmonary, Critical Care and Occupational Medicine, Department of Internal Medicine, University of Iowa, Iowa City, Iowa, United States
18. Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska, United States
19. San Francisco Veterans Affairs Healthcare System, San Francisco, California, United States

Address correspondence to:

Robert Paine III, MD
26 N 1900 E
Salt Lake City, UT 84132
Email: Robert.paine@hsc.utah.edu
Phone: 801-597-6821

Abstract

Background: Forced expiratory volume in 1 second (FEV₁) is central to the diagnosis of chronic obstructive pulmonary disease (COPD) but is imprecise in classifying disease burden. We examined the potential of the maximal mid-expiratory flow rate (forced expiratory flow rate between 25% and 75% [FEF_25%-75%]) as an additional tool for characterizing pathophysiology in COPD.

Objective: To determine whether FEF_25%-75% helps predict clinical and radiographic abnormalities in COPD.

Study Design and Methods: The SubPopulations and InteRediate Outcome Measures In COPD Study (SPIROMICS) enrolled a prospective cohort of 2978 nonsmokers and ever-smokers, with and without COPD, to identify phenotypes and intermediate markers of disease progression. We used baseline data from 2771 ever-smokers from the SPIROMICS cohort to identify associations between percent predicted FEF_25%-75% (%predFEF_25%-75%) and both clinical markers and computed tomography (CT) findings of smoking-related lung disease.

Results: Lower %predFEF_25-75% was associated with more severe disease, manifested radiographically by increased functional small airways disease, emphysema (most notably with homogeneous distribution), CT-measured residual volume, total lung capacity (TLC), and airway wall thickness, and clinically by increased symptoms, decreased 6-minute walk distance, and increased bronchodilator responsiveness (BDR). A lower %predFEF_25-75% remained significantly associated with increased emphysema, functional small airways disease, TLC, and BDR after adjustment for FEV₁ or forced vital capacity (FVC).

Interpretation: The %predFEF_25-75% provides additional information about disease manifestation beyond FEV₁. These associations may reflect loss of elastic recoil and air trapping from emphysema and intrinsic small airways disease. Thus, %predFEF_25-75% helps link the anatomic pathology and deranged physiology of COPD.

Citation

Citation: Ronish BE, Couper DJ, Barjaktarevic IZ, et al. Forced expiratory flow at 25%-75% links COPD physiology to emphysema and disease severity in the SPIROMICS cohort. J COPD F. 2022; 9(2): 111-121. doi: http://doi.org/10.15326/jcopdf.9.2.2021.0241

Keywords

spirometry, emphysema, pulmonary physiology, FEF_25-75%, mid-flow rate, functional small airways disease

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Click to read Forced Expiratory Flow at 25%-75% Links COPD Physiology to Emphysema and Disease Severity in the SPIROMICS Cohort

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Author Affiliations

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

Address correspondence to:

Roberto Benzo, MD, MSc
Email: benzo.roberto@mayo.edu

Abstract

Background: Self-management abilities are a recognized ingredient for living well with chronic obstructive pulmonary disease (COPD), improving all outcomes. Fostering self-management requires a personalized program and patient engagement to make lifestyle decisions.

While some self-management practices are proven effective, like the prompt use of a plan for COPD exacerbations, there is a guideline-recognized gap on specific self-management behaviors that can impact particular COPD symptoms and allow for tailored self-management programs. We aimed to investigate the association of well-defined self-management behaviors with the most common COPD symptoms in a large cohort of patients with COPD.

Methods: We analyzed baseline data of stable COPD patients who participated in 3 National Institutes of Health-funded studies. Symptoms were defined by the 4 domains of the Chronic Respiratory Questionnaire: dyspnea-fatigue-emotions-mastery. The self-management behaviors were the individual items of the Self-Management Ability Scale-30. Lasso regression models were built to explore the association of behaviors with symptoms, adjusting for lung function and age.

Results: We analyzed 512 stable COPD patients, 54% female, age mean (standard deviation [SD]) 69.6 (9.9) years and forced expiratory volume in 1 second percent predicted (FEV₁%) 42.2 (19.0).Dyspnea was associated with exercising and self-efficacy for self-care. Emotion was associated with good relationships, self-efficacy for self-care, positivity, and participating in agreeable activities. Fatigue was associated with self-efficacy for self-care, doing exercise, and participating in agreeable activities. Mastery was associated with self-efficacy for self-care, positivity, exercising, and participating in agreeable activities.

Discussion: Our findings provide specific self-management behaviors associated with common COPD symptoms that may inform self-management programs. Positive thinking represents a novel self-management approach to COPD emotions and mastery.

Citation

Citation: Benzo MV, Novotny P, Benzo RP. Adding granularity of COPD self-management to impact quality of life. J COPD F. 2022; 9(2): 277-284. doi: http://doi.org/10.15326/jcopdf.9.2.2021.0277

Keywords

COPD, pulmonary rehabilitation, self-management, health-related quality of life, health coaching

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Click to read Adding Granularity of COPD Self-Management to Impact Quality of Life

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Author Affiliations

1. Pulmonary and Critical Care Medicine, Weill Cornell Medicine, New York, New York, United States
2. Department of Medicine, Weill Cornell Medicine, New York, New York, United States
3. Division of Biostatistics, Department of Population Health Sciences, Weill Cornell Medical College, New York, New York, United States
4. Evidera, Bethesda, Maryland, United States
5. Division of Pulmonary and Critical Care Medicine, University of Michigan Health System, Ann Arbor, Michigan, United States
6. Department of Medicine, National Jewish Medical and Research Center, Denver, Colorado, United States
7. Pulmonary and Critical Care, University of California San Francisco, San Francisco, California, United States
8. University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
9. Pulmonary and Critical Care Medicine, Temple University Hospital, Philadelphia, Pennsylvania, United States
10. Medical Service, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, United States
11. Pulmonary, Allergy and Critical Care, University of Alabama at Birmingham, Birmingham, Alabama, United States
12. Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore Maryland, United States
13. Division of Pulmonary and Critical Care Medicine, Department of Veterans Affairs Medical Center, University of Utah, Salt Lake City, Utah, United States
14. Section on Pulmonary, Critical Care, Allergy and Immunological Diseases, Wake Forest School of Medicine Medical Center, Winston-Salem, North Carolina, United States
15. National Heart and Lung Institute, Imperial College London, United Kingdom

Address correspondence to:

Jamuna K. Krishnan, MD
Division of Pulmonary and Critical Care Medicine
Weill Cornell Medicine
1305 York Avenue, Y-1047, Box 96
New York, NY 10021
Phone: 646-962-2333
Email: jkk9002@med.cornell.edu

Abstract

Rationale: It has been suggested that patients with chronic obstructive pulmonary disease (COPD) experience considerable daily respiratory symptom fluctuation. A standardized measure is needed to quantify and understand the implications of day-to-day symptom variability.

Objectives: To compare standard deviation with other statistical measures of symptom variability and identify characteristics of individuals with higher symptom variability.

Methods: Individuals in the SubPopulations and InteRmediate Outcome Measures In COPD Study (SPIROMICS) Exacerbations sub-study completed an Evaluating Respiratory Symptoms in COPD (E-RS) daily questionnaire. We calculated within-subject standard deviation (WS-SD) for each patient at week 0 and correlated this with measurements obtained 4 weeks later using Pearson’s r and Bland Altman plots. Median WS-SD value dichotomized participants into higher versus lower variability groups. Association between WS-SD and exacerbation risk during 4 follow-up weeks was explored.

Measurements and Main Results: Diary completion rates were sufficient in 140 (68%) of 205 sub-study participants. Reproducibility (r) of the WS-SD metric from baseline to week 4 was 0.32. Higher variability participants had higher St George’s Respiratory Questionnaire (SGRQ) scores (47.3 ± 20.3 versus 39.6 ± 21.5, p=.04) than lower variability participants. Exploratory analyses found no relationship between symptom variability and health care resource utilization-defined exacerbations.

Conclusions: WS-SD of the E-RS can be used as a measure of symptom variability in studies of patients with COPD. Patients with higher variability have worse health-related quality of life. WS-SD should be further validated as a measure to understand the implications of symptom variability.

Citation

Citation: Krishnan JK, Ancy KM, Oromendia C, et al. Characterizing COPD symptom variability in the stable state utilizing the Evaluating Respiratory Symptoms in COPD instrument. J COPD F. 2022; 9(2): 195-208. doi: http://doi.org/10.15326/jcopdf.9.2.2021.0263

Keywords

chronic obstructive pulmonary disease, exacerbations, patient-reported outcomes, EXACT, symptom variation

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Click to read Characterizing COPD Symptom Variability in the Stable State Utilizing the Evaluating Respiratory Symptoms in COPD Instrument

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Author Affiliations

1. Division of Medicine, Akershus University Hospital, Lørenskog, Norway
2. Institute of Clinical Medicine, University of Oslo, Oslo, Norway
3. Department of Medical Research, Bærum Hospital, Vestre Viken Hospital Trust, Gjettum, Norway
4. Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
5. Division for Research and Innovation, Akershus University Hospital, Lørenskog, Norway

Address correspondence to:

Gunnar Einvik, MD, PhD
Department of Pulmonary Medicine
Division of Medicine
Akershus University Hospital, Pb 1000
1470 Lørenskog, Norway
E-mail: gunnar.einvik@medisin.uio.no
Phone +47 41104542

Abstract

Background: Chronic obstructive pulmonary disease (COPD) is often misdiagnosed. We aimed to estimate the prevalence of misdiagnosed COPD in middle-aged Norwegians, and to assess potentially treatable clinical traits in over- and undiagnosed individuals.

Methods and Findings: The Akershus Cardiac Examination (ACE) 1950 Study is a population-based study of the 1950 birth cohort of Akershus county including 3706 participants aged 62-65 years at baseline. COPD was defined as a forced expiratory volume in 1 second (FEV₁) to forced vital capacity (FVC) ratio < lower limit of normal (LLN). Misdiagnosed COPD was defined according to self-reported COPD.

A total of 259 (7.1%) participants had spirometry confirmed COPD. Of these, only 72 (28%) reported having COPD, thus 187 (72%) were undiagnosed. A total of 92 (2.5%) of the 164 particpants who reported having COPD had an FEV₁/FVC ratio ≥ LLN and were overdiagnosed. They had lower lung function, and more respiratory symptoms, self-reported asthma, eosinophils, and sleep apnea than other non-COPD participants . The main predictor of being overdiagnosed was overweight. Spirometry in participants reporting wheezing or cough and current smokers or participants with ≥20 tobacco pack-year history would have identified 85% of the undiagnosed cases.

Conclusion: Both over- and underdiagnosis of COPD is frequent. Undiagnosed individuals have better lung function and less symptoms, but similar prevalence of comorbidities and systemic inflammation. Overdiagnosed individuals have treatable traits including asthma, eosinophilic inflammation, and sleep apnea. The main predictor of being overdiagnosed was being overweight.

Citation

Citation: Caspersen NF, Soyseth V, Lyngbakken MN, et al. Treatable traits in misdiagnosed chronic obstructive pulmonary disease: data from the Akershus Cardiac Examination 1950 study. J COPD F. 2022; 9(2): 165-180. doi: http://doi.org/10.15326/jcopdf.9.2.2021.0265

Keywords

chronic obstructive pulmonary disease; misdiagnosi, treatable traits

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Click to read Treatable Traits in Misdiagnosed Chronic Obstructive Pulmonary Disease: Data from the Akershus Cardiac Examination 1950 Study

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Author Affiliations

1. Department of Respiratory Disease, AORN Sant’Anna e San Sebastiano, Caserta, Italy
2. Department of Pulmonary and Critical Care, Lenox Hill Hospital, New York, New York, United States
3. Intensive Care Unit, Hospital Morales Meseguer, Murcia, Spain

Address correspondence to:

Domenica Di Costanzo, MD
Department of Respiratory Disease
AORN Sant’Anna e San Sebastiano
Caserta, Italy
Via Ferdinando Palasciano, 81100 Caserta CE
Telephone: +390823232630
Email: domenica.dicostanzo@libero.it

Abstract

This article does not contain an abstract.

Citation

Citation: Di Costanzo D, Meredith S, Mina B, Esquinas AM. Insights about human-centered design analysis as a tool to improve patients’ tolerance with non-invasive ventilation. J COPD F. 2022; 9(2): 274-276. doi: http://doi.org/10.15326/jcopdf.9.2.2022.0295

Keywords

COPD, noninvasive ventilation, patient experience, human-centered design, qualitative analysis

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Click to read Insights About the Human-Centered Design Analysis as a Tool to Improving Patients’ Tolerance with Non-Invasive Ventilation

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Author Affiliations

1. Pulmonary Section, Minneapolis VA Health Care System, Minneapolis, Minnesota, United States
2. Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, University of Minnesota, Minneapolis, Minnesota, United States
3. Lung Health Center, University of Alabama at Birmingham, Birmingham, Alabama, United States
4. Division of Biostatistics, University of Minnesota, Minneapolis, Minnesota, United States
5. Cardiology Section, Minneapolis VA Health Care System, Minneapolis, Minnesota, United States
6. Lundquist Institute for Biomedical Innovation at Harbor–UCLA Medical Center, Torrance, California, United States
7. State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China

† deceased

Address correspondence to:

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

Abstract

Introduction: Autonomic dysfunction is common in chronic obstructive pulmonary disease (COPD), and worse autonomic function may be a marker of risk for acute exacerbations of COPD (AECOPD). Heart rate variability (HRV) is a measure of autonomic function. Our objective was to test whether lower (worse) HRV is a risk factor for AECOPD.

Methods: We measured standard deviation of normal RR intervals (SDNN) and root mean square of successive RR interval differences (RMSSD) on 10-second electrocardiograms (ECGs) performed at screening and day 42 in participants in the Beta Blockers for the Prevention of Acute Exacerbations of COPD trial ( BLOCK-COPD), a placebo-controlled trial of metoprolol for prevention of AECOPD. We used Cox-proportional hazards models to test if these HRV measures were associated with risk of any AECOPD, and separately, hospitalized AECOPD. We tested associations using baseline HRV measures and incorporating HRV measures from day 42 as a time-varying covariate. We also tested for interactions with metoprolol assignment.

Results: Of 532 trial participants, 529 (forced expiratory volume in 1 second [FEV₁ ]41 ± 16.3 % predicted) were included in this analysis. We did not find a significant association between HRV measures and risk of AECOPD when all participants were analyzed together. There was a significant interaction between RMSSD and assignment to metoprolol on time to first hospitalized AECOPD; in the placebo group greater RMSSD was associated with a lower risk of hospitalized AECOPD (adjusted hazard ratio0.71, 95% confidence interval: 0.52 to 0.96, per 10 ms increase) but there was no association in the metoprolol group.

Conclusions: Autonomic dysfunction as measured by HRV may be a risk factor for AECOPD. Future studies should analyze longer HRV recordings and their performance in broader samples of people with COPD, including those on beta-blockers.

Citation

Citation: MacDonald DM, Mkorombindo T, Ling SX, et al. Heart rate variability on 10-second electrocardiogram and risk of acute exacerbation of COPD: a secondary analysis of the BLOCK COPD trial. J COPD F. 2022; 9(2): 226-236. doi: http://doi.org/10.15326/jcopdf.9.2.2021.0264

Keywords

acute exacerbation of COPD, heart rate variability, BLOCK-COPD, electrocardiogram, autonomic nervous system

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Click to read Heart Rate Variability on 10-Second Electrocardiogram and Risk of Acute Exacerbation of COPD: A Secondary Analysis of the BLOCK COPD Trial

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Author Affiliations

1. Section of General Internal Medicine, Department of Medicine, University of Chicago, Chicago, Illinois, United States
2. Vizient, Inc., Irving, Texas, United States

Address correspondence to:

Valerie Press, MD, MPH
University of Chicago
5841 S Maryland, MC 2007
Chicago, IL 60637
Phone: (773)702-5170
Email: vpress@bsd.uchicago.edu

Abstract

Background: Chronic obstructive pulmonary disease (COPD) is the third-leading cause of early readmissions. The Centers for Medicare and Medicaid instituted a financial penalty for excessive COPD readmissions galvanizing hospitals to implement effective strategies to reduce readmissions. We evaluated a 6-month COPD Chronic Care Management Collaborative to support hospitals to reduce preventable COPD-related revisits.

Methods: Sites were recruited among nearly 300 Vizient, Inc., members. The Collaborative used performance improvement initiatives to assist with implementation of effective strategies. Participants submitted performance data for 2 outcome measures: emergency department (ED) and hospital revisits.

Results: Forty-seven members enrolled (Part I+II: n=33; Part I: n=3; Part II: n=11) of which 23 submitted data (n=23/47). The majority (n=19/23, 83%) reduced rates of COPD-related ED and/or hospital revisits. Among all 23 sites, the change in ED visits went from 11.05% to 10.87%; among 7 sites with reductions in ED visits, the reduction was 12.7% to 9%. Among all 23 sites, there were not reductions in hospital readmissions (18.53% to 18.64%); among 7 sites with reductions, the readmission rate went from 20.1% to 15.6%. The mean reach across 17 hospitals reporting reach for their most successful measure at baseline was 35.2% (SD=26.7%) and for the other 6, reporting reach at follow-up was 73.8%% (SD=18.3%); of note, only 3 sites submitted both baseline and follow-up data.

Conclusions: The Collaborative successfully supported the majority of sites in reducing COPD-related ED and/or hospital revisits using subject matter experts and coaching strategies to support hospitals' implementation of COPD quality improvement interventions.

Citation

Citation: Press VG, Randall K, Hanser A. Evaluation of COPD chronic care management collaborative to reduce emergency department and hospital revisits across U.S. hospitals. J COPD F. 2022; 9(2): 209-225. doi: http://doi.org/10.15326/jcopdf.9.2.2021.0273

Keywords

COPD, readmissions, hospital readmission reduction program, quality improvement

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Click to read Evaluation of COPD Chronic Care Management Collaborative to Reduce Emergency Department and Hospital Revisits Across U.S. Hospitals

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Author Affiliations

1. Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
2. Birmingham Medical School, University of Birmingham, Birmingham, United Kingdom
3. University Hospitals Coventry and Warwickshire, Coventry, United Kingdom
4. Health Economics Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
5. University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom

Address correspondence to:

Janine Dretzke, MSc
Institute of Applied Health Research
University of Birmingham, B15 2TT
Birmingham, United Kingdom
Phone: +44 (121) 4147850
Email: j.dretzke@bham.ac.uk

Abstract

Background: Uncertainty remains around the benefit of home non-invasive ventilation (NIV) for stable chronic obstructive pulmonary disease (COPD) patients and those with a recent exacerbation (post-hospital). The aim of this systematic review was to: (1) update the evidence base with studies published in any language, including Chinese language studies not indexed in standard medical databases, and (2) explore the impact of additional studies on the evidence base.

Methods: Standard systematic review methodology was used for identifying and appraising studies. Randomized controlled trials (RCTs) and non-randomized studies reporting mortality, hospitalizations, exacerbations, quality of life, adverse events, or adherence were included. Random effects meta-analysis was undertaken for mortality and hospitalizations, with studies sub-grouped by population and study design. Sensitivity analysis was performed to explore the effect of including studies from Western and non-Western countries.

Results: A total of 103 studies were included, substantially more than in previous reviews. There was no significant effect on mortality for the stable population. There was a benefit from NIV for the post-hospital population based on non-randomized studies, or RCTs from non-Western countries. There was a small but significant reduction in hospital admissions (1–2/year) with NIV across all sub-groups, and a variable reduction in duration of stay with greater reductions in studies from China.

Conclusions: The evidence base on home NIV is considerably larger than previously presented. While NIV may reduce hospital admissions and improve quality of life, there is still little evidence of a reduction in mortality, regardless of country. Individual participant data analysis may clarify which patients would benefit most from NIV.

Citation

Citation: Dretzke J, Wang J, Yao M, et al. Home non-invasive ventilation in COPD: a global systematic review. J COPD F. 2022; 9(2): 237-251. doi: http://doi.org/10.15326/jcopdf.9.2.2021.0242

Keywords

COPD, meta-analysis, systematic review, home non-invasive ventilation

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Click to read Home Non-Invasive Ventilation in COPD: A Global Systematic Review

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