Chronic Obstructive Pulmonary Diseases:Journal of the COPD Foundation

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Validation of the Onset of Effect Questionnaire in Participants With Chronic Obstructive Pulmonary Disease

Posted in: Original Research, Volume 11 | Issue 4

Charlie Strange, MD1 Barry J. Make, MD2 Frank J. Trudo, MD, MBA3 Gale Harding, MA4 Danielle Rodriguez, PhD5 James M. Eudicone, MS, MBA3 Norbert Feigler, MD3 Hitesh N. Gandhi, MBBA, MHA, MAS6

Author Affiliations

  1. Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina, Charleston, South Carolina, United States
  2. Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, Colorado, United States
  3. BioPharmaceuticals Medical, AstraZeneca, Wilmington, Delaware, United States
  4. Evidera, Bethesda, Maryland, United States
  5. Evidera, Seattle, Washington, United States
  6. Alexion, AstraZeneca Rare Disease, Wilmington, Delaware, United States

Address correspondence to:

Charlie Strange, MD
Division of Pulmonary and Critical Care Medicine
Medical University of South Carolina
Charleston, SC
Phone: (843) 792-3174
Email: strangec@musc.edu

Abstract

Background: Patient perception of medication onset of effect is important for adherence. Although the Onset of Effect Questionnaire (OEQ) has been validated in patients with asthma, it has not been evaluated in patients with chronic obstructive pulmonary disease (COPD). This study evaluated the COPD-OEQ in patients with COPD.

Methods: Two analyses (qualitative and quantitative) were conducted to assess the content validity and psychometric properties of the COPD-OEQ in participants with COPD. In the qualitative analysis, interviews assessed content validity by concept elicitation (CE) and cognitive interviewing (CI). CE included questions to understand the patient experience related to onset of medication effect. CI included completion of the COPD-OEQ and assessment of the COPD-OEQ items, response options, and instructions. During the 2-week quantitative analysis, 2 versions of the COPD-OEQ (Weekly and Daily) were administered to assess test-retest reliability, construct validity, and known-groups validity.

Results: The qualitative analysis demonstrated that 3 of the 5 COPD-OEQ items were relevant and understood as intended. Qualitative findings demonstrated inconsistent evidence that the COPD-OEQ Weekly and Daily were reliable and valid measures in participants with COPD. Test-retest reliability was observed for the COPD-OEQ Weekly and Daily; however, construct validity was weak and demonstrated inconsistent correlations among COPD-OEQ items. Overall, known-groups validity was not demonstrated.

Conclusion: The weak evidence from the quantitative analysis of the COPD-OEQ Weekly and Daily tools does not support use of the OEQ in general COPD. Although the OEQ produced inconsistent results, the content validity surrounding the perception of medication onset remained valid in patients with COPD.

Citation

Citation: Strange C, Make BJ, Trudo FJ, et al. Validation of the Onset of Effect Questionnaire in participants with chronic obstructive pulmonary disease. J COPD F. 2024; 11(4): 359-368. doi: http://doi.org/10.15326/jcopdf.11.4.2023.0485

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Blood Eosinophil Count Stability and Clinical Outcomes in Patients With Chronic Obstructive Pulmonary Disease in a High Endemic Area of Parasitic Infection: A Prospective Study

Posted in: Original Research, Volume 11 | Issue 4

Punchalee Kaenmuang, MD1 Asma Navasakulpong, MD1 Sarayut Lucien Geater, MD1 Sirikorn Densrisereekul, MD2 Siwasak Juthong, MD1

Author Affiliations

  1. Division of Internal Medicine, Respiratory and Respiratory Critical Care Unit, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
  2. Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand

Address correspondence to:

Siwasak Juthong, MD
Respiratory and Respiratory Critical Care Medicine Unit
Division of Internal Medicine
Faculty of Medicine
Prince of Songkla University
Hat Yai, Songkhla 90110, Thailand
Phone: +6674-451-474
Email: jsiwasakmd@gmail.com

Abstract

Background: The blood eosinophil count (BEC) is an effective biomarker for predicting inhaled corticosteroid responsiveness in patients with chronic obstructive pulmonary disease (COPD).

Methods: A 12-month prospective observational study was conducted in patients with COPD. BEC was measured at enrollment, and after 6 and 12 months. Patients were classified into 3 groups according to their baseline BEC: <100, 100–299, and ≥300 cells/µL. We aimed to describe the patterns of blood eosinophil stability in patients with stable COPD and compare the exacerbation rates and other clinical outcomes at 6 and 12 months.

Results: A total of 252 patients with COPD were included. The <100, 100–299, and ≥ 300 cells/μL groups consisted of 14.7%, 38.9%, and 46.4% of patients, respectively. BEC stability was highest (85%) in the ≥300 cells/μL group for both durations. The lowest stability was observed in the <100 cells/μL group at 57% and 46% after 6 and 12 months, respectively. The persistent ≥300 cells/μL group had a higher incidence of moderate-to-severe exacerbation (incidence rate ratio [IRR] 2.44, 95% confidence interval [CI]: 1.13–5.27, p value 0.023), as well as severe exacerbation (IRR 2.19, 95%CI: 1.39–3.45, p value 0.001). Other patient-reported outcomes did not differ significantly between groups.

Conclusions: Blood eosinophil levels had good stability in patients with COPD with a BEC ≥300 cells/µL and was associated with a high risk of exacerbation in the persistent ≥300 cells/μL group. The variability of BEC was higher in patients with COPD with a BEC <300 cells/µL.

Citation

Citation: Kaenmuang P, Navasakulpong A, Geater SL, Densrisereekul S, Juthong S. Blood eosinophil count stability and clinical outcomes in patients with chronic obstructive pulmonary disease in a high endemic area of parasitic infection: a prospective study. J COPD F. 2024; 11(4): 350-358. doi: http://doi.org/10.15326/jcopdf.11.4.2023.0492

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

Posted in: Review, Volume 11 | Issue 3

Zi-Xuan Cheng1* Jing Zhang, MD1

Author Affiliations

  1. Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Shanghai, China
*PhD candidate

Address correspondence to:

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

Abstract

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

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

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

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

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

Citation

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

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Higher Plasma Omega-3 Levels are Associated With Improved Exacerbation Risk and Respiratory-Specific Quality of Life in COPD

Posted in: Original Research, Volume 11 | Issue 3

Tyus A. Kemper, BS1 Han Woo, PhD2 Daniel Belz, MD, MPH2 Ashraf Fawzy, MD, MPH2 Wendy Lorizio, MD, MPH2 Michelle N. Eakin, PhD, MA2 Nirupama Putcha, MD, MHS2 Meredith C. McCormack, MD, MHS2 Emily P. Brigham, MD, MHS3 Corrine Hanson, PhD4 Abigail L. Koch, MD5 Nadia N. Hansel, MD, MPH2,6

Author Affiliations

  1. Department of Health, Human Performance, and Recreation, Baylor University, Waco, Texas, United States
  2. Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States
  3. Division of Respiratory Medicine, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
  4. Medical Nutrition Education, College of Allied Health Professions, University of Nebraska Medical Center, Omaha, Nebraska, United States
  5. Section on Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Miami, Miami, Florida, United States
  6. Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States

Address correspondence to:

Nadia Hansel MD, MPH
Division of Pulmonary and Critical Care Medicine
Johns Hopkins University
5501 Hopkins Bayview Circle 4th Floor
Baltimore, MD, 21224
Email: nhansel1@jhmi.edu

Abstract

Background: Omega-3 polyunsaturated fatty acids (PUFAs) have been associated with systemic anti-inflammatory responses. Dietary intake of omega-3 PUFAs eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) has also been associated with lower chronic obstructive pulmonary disease (COPD) morbidity using self-report food frequency questionnaires.

Objective: The objective of this study was to investigate the relationship between measured PUFA intake using plasma EPA+DHA levels and COPD morbidity.

Methods: Former smokers with moderate-to-severe COPD living in low-income communities were enrolled in a 6-month prospective cohort study. Participants completed standardized questionnaires, spirometry, and plasma samples at 3-month intervals. Total plasma PUFAs were analyzed using gas chromatography/mass spectrometry for DHA and EPA concentrations. Linear or logistic mixed model regression was used to evaluate EPA+DHA’s and COPD morbidity’s association, accounting for demographics, lung function, pack years, comorbidities, and neighborhood poverty.

Results: A total of 133 plasma EPA+DHA samples from 57 participants were available. Participants exhibited average plasma EPA and DHA levels of 14.7±7.3µg/mL and 40.2±17.2µg/mL, respectively, across the 3 clinic visits. Each standard deviation increase in EPA+DHA levels was associated with 2.7 points lower St George’s Respiratory Questionnaire score (95% confidence interval [CI] -5.2, -0.2) and lower odds of moderate exacerbation (odds ratio 0.4; 95% CI 0.2, 0.9), but lacked significant association with the COPD Assessment Test score (95% CI -2.4, 0.8), modified Medical Research Council dyspnea scale (95% CI -02, 0.2), or severe exacerbations (95% CI 0.3, 1.4).

Conclusion: Plasma EPA+DHA levels are associated with better respiratory-specific quality of life and lower odds of moderate exacerbations in patients with moderate-to-severe COPD. Further research is warranted to investigate the efficacy of an omega-3 dietary intervention in the management of COPD morbidities.

Citation

Citation: Kemper TA, Woo H, Belz D, et al. Higher plasma omega-3 levels are associated with improved exacerbation risk and respiratory-specific quality of life in COPD. J COPD F. 2024; 11(3): 293-302. doi: http://doi.org/10.15326/jcopdf.11.3.2023.0468

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Recombinant Alpha-1 Antitrypsin–Fc Fusion Protein INBRX-101 in Adults With Alpha-1 Antitrypsin Deficiency: A Phase 1 Study

Posted in: Original Research, Volume 11 | Issue 3

Mark L. Brantly, MD1 Brooks T. Kuhn, MD, MAS2 Humam W. Farah, MD3 Ravi Mahadeva, MD, FRCP4 Alexandra Cole, MBChB, FRNZCGP, DHP5 Catherina L. Chang, MD, FRACP6 Cynthia D. Brown, MD7 Michael A. Campos, MD8 Jorge E. Lascano, MD1 Erin K. Babcock, BS9 Sharvari P. Bhagwat, PhD9 Teresa F. Boyea, PharmD9 Carson A. Veldstra, BS9 Vasily Andrianov, MD9 James L. Kalabus, PhD9 Brendan P. Eckelman, PhD9 Andrew G. Veale, FRACP10

Author Affiliations

  1. Department of Medicine, University of Florida College of Medicine, Gainesville, Florida, United States
  2. Department of Internal Medicine, University of California- Davis School of Medicine, Sacramento, California, United States
  3. Department of Internal Medicine, Pulmonary and Critical Care, Hannibal Clinic, Hannibal, Missouri, United States
  4. Department of Respiratory Medicine, University of Cambridge, Cambridge, United Kingdom
  5. Medical Department, Christchurch Clinical Studies Trust, Christchurch, New Zealand
  6. Department of Respiratory Medicine, Waikato Hospital, Hamilton, New Zealand
  7. Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, Indiana, United States
  8. Department of Medicine, University of Miami School of Medicine, Miami, Florida, United States
  9. Inhibrx, Inc., La Jolla, California, United States
  10. New Zealand Respiratory and Sleep Institute, Greenlane East, Auckland, New Zealand

Address correspondence to:

Mark L. Brantly, MD
Department of Medicine
University of Florida College of Medicine<
Gainesville, FL, United States
Phone: (352) 294-5117
Email: mbrantly@ufl.edu

Abstract

Background: Alpha-1 antitrypsin deficiency (AATD) is characterized by low alpha-1 antitrypsin (AAT) levels, predisposing individuals to lung disease. The standard of care, plasma-derived AAT (pdAAT), is delivered as weekly infusions to maintain serum AAT concentrations ≥11µM (≈50% of those in healthy individuals). INBRX-101, a recombinant human AAT-Fc fusion protein, was designed to have a longer half-life and achieve higher AAT levels than pdAAT.

Methods: In this phase 1 dose-escalation study (N=31), adults with AATD received 1 dose (part 1) or 3 doses (part 2) of 10 (part 1), 40, 80, or 120mg/kg INBRX-101 every 3 weeks (Q3W) via intravenous infusion. The primary endpoint was safety and tolerability. Secondary endpoints were pharmacokinetics (PK), pharmacodynamics (PD), and immunogenicity of INBRX-101.

Results: INBRX-101 was well tolerated. Most treatment-emergent adverse events were grade ≤2. In part 2 (n=18; each dose, n=6), dose-related increases in serum functional AAT (fAAT) were observed; mean fAAT levels remained above the 21µM target for up to 4 weeks after the final dose in the 120-mg/kg cohort. Antidrug antibodies had no meaningful impact on PK or PD. INBRX-101 was detected in pulmonary epithelial lining fluid (PELF) from all patients assessed (n=11), and PELF fAAT increased after dosing. PK/PD modeling projected steady-state serum fAAT ≥21µM at 120 mg/kg Q3W (average concentration ≈43µM; trough concentration ≈28µM) and Q4W (≈34µM; ≈21µM).

Conclusion: The favorable safety profile and ability to maintain serum fAAT levels >21µM with extended-interval dosing, support a phase 2 trial evaluating Q3W and Q4W dosing of INBRX-101.

Citation

Citation: Brantly ML, Kuhn BT, Farah HW, et al. Recombinant alpha-1 antitrypsin–fc fusion protein INBRX-101 in adults with alpha-1 antitrypsin deficiency: a phase 1 study. J COPD F. 2024; 11(3): 282-292. doi: http://doi.org/10.15326/jcopdf.11.3.2023.0469

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From Invisibility to Inclusion: A Call to Action to Address COPD Disparities in the Lesbian, Gay, Bisexual, Transgender, and Queer+ Community

Posted in: Journal Club, Volume 11 | Issue 3

Ninad T. Maniar, MD1,2 M. Bradley Drummond, MD, MHS3

Author Affiliations

  1. Department of Medicine, Department of Critical Care, MedStar Washington Hospital Center, Washington, District of Columbia, United States
  2. Department of Medicine, Georgetown University Medical Center, Washington, District of Columbia, United States
  3. Division of Pulmonary Diseases and Critical Care Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States

Address correspondence to:

Ninad T. Maniar, MD
110 Irving St. NW, 4B-42
Washington, DC, 20010
Phone: (202) 877-7259
Email: ninad.t.maniar@medstar.net

Abstract

COPD is a significant cause of morbidity and mortality both in the United States and worldwide. Lesbian, gay, bisexual, transgender, or queer + (LGBTQ+) individuals (the plus sign indicates inclusion of people who are questioning, intersex, asexual, or who hold other gender/sex/romantic identities not specifically identified) have a higher rate of tobacco smoking, predisposing them to an increased risk of developing COPD. Despite this risk, the burden of COPD in LGBTQ+ individuals is not known. Moreover, there is limited focus on efforts to identify and reduce disease risk in this population.

In this perspective, we present the results of a focused literature review of COPD in LGBTQ+ populations. We found only 8 studies that reported the prevalence of COPD in different subgroups of the LGBTQ+ population. All studies found an increased prevalence of COPD in the studied LGBTQ+ sub-groups compared to their heterosexual and/or cisgender counterparts.

We propose a 3-pronged call to action to improve the care of LGBTQ+ people with COPD. First, we must improve awareness and education about COPD in the LGBTQ+ community through the effective development and dissemination of educational resources to LGBTQ+ people and their health care providers. Second, we call for prevention and intervention efforts through targeted tobacco cessation initiatives and case-finding via screening spirometry among symptomatic LGBTQ+ smokers. Finally, well-designed cohort studies are required to better characterize the COPD burden among LGBTQ+ populations. With targeted approaches in these 3 areas, we can improve the health of this vulnerable population, historically marginalized by current COPD research efforts.

Citation

Citation: Maniar NT, Drummond MB. From invisibility to inclusion: a call to action to address COPD disparities in the lesbian, gay, bisexual, transgender, and queer+ community. J COPD F. 2024; 11(3): 326-330. doi: http://doi.org/10.15326/jcopdf.11.3.2024.0496

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The COPD Foundation on Its Twentieth Anniversary

Posted in: Perspectives, Volume 11 | Issue 3

Elisha Malanga, BS 1 Byron Thomashow, MD1,2 Jean Wright, MD1 Linda Walsh, BS1 Cathy Gray Carlomagno, BS1 Jamie Sullivan, MPH1 Stephanie Williams, RRT1 Bruce E. Miller, PhD1 Crystal Rothhaar, BS1 William Clark, BS1 Alan Hamilton, PhD1,3 Michael Hess, MPH1 Delia Prieto Oliver, MSEd1 Vincent Malanga, BS1 Peter Amari, BS1 James Crapo, MD1,4 David M. Mannino, MD1,5

Author Affiliations

  1. COPD Foundation, Miami, Florida, United States
  2. Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University, New York, NY
  3. Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
  4. Division of Pulmonary, Critical Care, and Sleep Medicine, National Jewish Health, Denver, Colorado, United States
  5. Department of Medicine, University of Kentucky College of Medicine, Lexington, Kentucky, United States

Address correspondence to:

David M. Mannino, MD
Department of Medicine
University of Kentucky College of Medicine
800 Rose Street
Lexington, KY 40536
Email:dmannino@copdfoundation.org

Abstract

This article does not contain an abstract.

Citation

Citation: Malanga E, Thomashow B, Wright J, et al. The COPD Foundation on its twentieth anniversary. J COPD F. 2024; 11(3): 247-260. doi: http://doi.org/10.15326/jcopdf.11.3.2024.0527

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

Posted in: Original Research, Volume 11 | Issue 3

Ingrid Marie Hardang, MD1,2 Vidar Søyseth, MD, PhD2,3 Natalia Kononova, MD2,4 Tor-Arne Hagve, MD, PhD1,2 Gunnar Einvik, MD, PhD2,3

Author Affiliations

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

Address correspondence to:

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

Abstract

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

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

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

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

Citation

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

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Sexual Orientation Health Disparities in Chronic Respiratory Disorders

Posted in: Short Communication, Volume 11 | Issue 3

Kevin P. Ferriter, MD1 Mike C. Parent, PhD, MBA2 Maggie Britton, PhD3

Author Affiliations

  1. Division of Pulmonary and Critical Care Medicine, Loyola University Chicago, Chicago, Illinois, United States
  2. Independent researcher, Chicago, Illinois, United States
  3. Division of Cancer Prevention and Population Sciences, Department of Health Disparities Research, MD Anderson, Houston, Texas, United States

Address correspondence to:

Kevin P. Ferriter, MD
Loyola University Chicago
Phone: (406) 465-4148
Email: kevin.ferriter@luhs.org

Abstract

Smoking, a leading cause of chronic respiratory disorders, is elevated among sexual minority (i.e., lesbian, gay, and bisexual) individuals. Elevations in smoking among sexual minority individuals may contribute to increased rates of chronic respiratory disorders among older sexual minority individuals. Data from 161,741 individuals (3.6% sexual minorities) aged 45 and older from the 2020 Behavioral Risk Factor Surveillance System were used to examine disparities in chronic respiratory disorders among older sexual minority individuals. Mediation was used to analyze a model with smoking mediating the relationship between sexual minority identity and self-reported chronic respiratory disorder. The results indicated that smoking mediated the relationship between sexual minority identity and self-reported chronic respiratory disorder. Smoking was 1.2 times more common, and the prevalence of chronic respiratory disorders was 1.2 times higher, among sexual minority individuals compared to heterosexual individuals. The present study indicates that smoking disparities observed among sexual minority individuals are linked to increased risk for chronic respiratory disorders, and also indicate that sexual minorities have an excess burden of chronic respiratory disorders.

Citation

Citation: Ferriter KP, Parent MC, Britton M. Sexual orientation health disparities in chronic respiratory disorders. J COPD F. 2024; 11(3): 307-310. doi: http://doi.org/10.15326/jcopdf.11.3.2023.0467

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Persons With Chronic Obstructive Pulmonary Disease and High Levels of Activation Improved Their Physical Activity Skills After an Educational Session

Posted in: Original Research, Volume 11 | Issue 3

María C. Fernández-Sánchez, MD1 Francisco J. Ruiz-López, MD, PhD2 José A. Ros-Lucas, MD, PhD2 Rubén Andújar-Espinosa, MD, PhD2 Juan Del Coso, PhD3 Teresa García-Pastor, PhD4

Author Affiliations

  1. Pneumology Unit, Internal Medicine Service, Rafael Mendez Hospital, Lorca, Spain
  2. Pneumonology Service, Arrixaca University Hospital, Murcia, Spain
  3. Centre for Sports Studies, Rey Juan Carlos University, Fuenlabrada, Spain
  4. Exercise Physiology Laboratory, Camilo José Cela University, Madrid, Spain

Address correspondence to:

Francisco José Ruiz-López
Pneumology Service
Arrixaca University Hospital
Ctra. Madrid-Cartagena s/n. El Palmar
Murcia, Spain 30120
Phone: +34653557861
Email: fjose.ruiz1@um.es

Abstract

Background: Daily physical activity is part of the self-management of patients with chronic obstructive pulmonary disease (COPD), and didactic information sessions may be insufficient for the provision of these skills. Prior activation can determine sensitivity to these sessions.

We evaluated whether the activation in patients with COPD, as measured by the Patient Activation Measure (PAM)-13 questionnaire, determined their responses to an educational group session on physical activity (PA), which were measured with actigraphy by the number of steps/day.

Methods: We conducted an uncontrolled clinical trial in an outpatient clinic with 75 patients with nonexacerbating COPD (forced expiratory volume in 1 second 30%–80%) who were selected consecutively. Patients were provided with an actigraph that they used for 15 days and completed the PAM-13 questionnaire. On the eighth day, they attended a group educational session where they were given PA information. We compared the changes in activity after the session by pooled PAM levels and the correlation between the change in the number of steps/day and the PAM-13 questionnaire.

Results: A total of 26 patients had activation levels of 1–2, while 49 patients had levels of 3–4. After the session, patients in Levels 1–2 decreased their number of steps (-596±42), while those in Levels 3–4 increased them (680±253, p<0.01). The level of activation was positively correlated with change in the number of steps/day (p<0.05).

Conclusion: COPD patients with greater activation showed greater improvements in daily PA after a group educational session.

Citation

Citation: Fernández-Sánchez MC, Ruiz-López FJ, Ros-Lucas JA, Andújar-Espinosa R, Del Coso J. García-Pastor T. Persons with chronic obstructive pulmonary disease and high levels of activation improved their physical activity skills after an educational session. J COPD F. 2024; 11(3): 270-281. doi: http://doi.org/10.15326/jcopdf.11.3.2023.0456

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Increased Herpes Zoster Risk With Inhaled Corticosteroid Use for Those With Chronic Obstructive Pulmonary Disease

Posted in: Short Communication, Volume 11 | Issue 3

Barbara P. Yawn, MD, MSc1 Elisabeth Callen, PhD, PStat2 Gabriela Gaona-Villarreal, MPH2 Asif Shaikh, MD, DrPH, MPH3 Wilson D. Pace, MD2

Author Affiliations

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

Address correspondence to:

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

Abstract

This article does not contain an abstract.

Citation

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

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Variations in COPD Health Care Access and Outcomes: A Rapid Review

Posted in: Review, Volume 11 | Issue 2

Julie A. Shatto, BSc1 Michael K. Stickland, PhD1,2,3 Lesley J. J. Soril, PhD2,4

Author Affiliations

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

Address correspondence to:

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

Abstract

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

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

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

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

Citation

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

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

Posted in: Original Research, Volume 11 | Issue 2

Paul Jones, MD, PhD1a Toru Soutome, BPharm2a,b Taizo Matsuki, PhD2a Masahiro Shinoda, MD, PhD3 Osamu Hataji, MD, PhD4 Motohiko Miura, MD, PhD5 Masaharu Kinoshita, MD6 Akira Mizoo, MD7 Kazunori Tobino, MD8 Takanobu Nishi, MSc2 Takeo Ishii, MD, PhD2b Yoko Shibata, MD, PhD9

Author Affiliations

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

aContributed equally

bAffiliation at the time of the study

Address correspondence to:

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

Abstract

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

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

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

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

Citation

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

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Diet and COPD: A Gut Feeling About Pathogenesis

Posted in: Editorial, Volume 11 | Issue 2

Laura R.C. Dowling, BBioMedS (Hons)1,2 Hayley A. Scott, PhD1,2

Author Affiliations

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

Address correspondence to:

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

Abstract

This article does not contain an abstract.

Citation

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

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

Posted in: Original Research, Volume 11 | Issue 2

Jun Jin, BS1 Yuemei Bian, BS2 Zhongyun Gu, BS3 Maoen Lin, BS1

Author Affiliations

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

Address correspondence to:

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

Abstract

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

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

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

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

Citation

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

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

Posted in: Original Research, Volume 11 | Issue 2

Patricia Alupo, MBChB, MMed1 Winceslaus Katagira, MBChB, MMed1 David Mukunya,MBChB, PhD2 Paul Okimat, MSc3 Vickram Tejwani, MD4 Alex Kayongo, PhD1 Joanitah Nalunjogi,MSc1 Nicole M. Robertson, MD5 Rupert Jones, MD, PhD1,6 John R. Hurst, PhD7 Bruce Kirenga, MBChB, MMed, PhD*1,2 Trishul Siddharthan, MD*8

Author Affiliations

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

Address correspondence to:

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

Abstract

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

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

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

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

Citation

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

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

Posted in: Original Research, Volume 11 | Issue 2

Roy A. Pleasants, PharmD,1,2 Ashley G. Henderson, MD3 Valentina Bayer, PhD4 Asif Shaikh, MD4 M. Bradley Drummond, MD, MS3

Author Affiliations

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

Address correspondence to:

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

Abstract

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

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

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

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

ClinicalTrials.gov identifier NCT04168775

Citation

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

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

Posted in: Original Research, Volume 11 | Issue 2

Abebaw M. Yohannes, PhD, MSc1,2 Anand S. Iyer, MD, MSPH2 Candice Clay, PhD3* Lauren Cochran, PharmD3 Xianyi Chen, MS3 David A. Lombardi, PhD3* Surya P. Bhatt, MD, MSPH2

Author Affiliations

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

Address correspondence to:

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

Abstract

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

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

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

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

Citation

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

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

Posted in: Original Research, Volume 11 | Issue 2

Lucas M. Donovan, MD, MS1,2 Thomas L. Keller, MD, MS2 Nancy H. Stewart, DO, MS3 Jennifer Wright, MD2 Laura J. Spece, MD, MS1,2 Kevin I. Duan, MD, MS2,4 Aristotle Leonhard, MD1,2 Brian N. Palen, MD1,2 Martha E. Billings, MD, MS1,2 David H. Au, MD, MS1,2 Laura C. Feemster, MD, MS1,2

Author Affiliations

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

Address correspondence to:

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

Abstract

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

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

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

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

Citation

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

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

Posted in: Original Research, Volume 11 | Issue 2

Tao Yu, MS1,2 Yunru Chen, MS3 Xiaoxia Ren, MD1,2 Ting Yang, MD1,2

Author Affiliations

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

Address correspondence to:

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

Abstract

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

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

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

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

Citation

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

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

Posted in: Original Research, Volume 11 | Issue 2

Mariah K. Jackson, MMN1 Yuni Choi, PhD2 Elliot Eisenberg, MD3 Corrine Hanson, PhD1 Ann Wang, MD3 Jing Gennie Wang, MD4 George R. Washko, MD5 Samuel Ash, MD6 Raul San Jose Estepar, PhD7 Gabrielle Liu, MD8 James M. Shikany, DrPH9 Lyn M. Steffen, PhD2 Robert Wharton, MD10 Ravi Kalhan, MD8 David R. Jacobs, Jr, PhD2 Sonali Bose, MD, MPH3

Author Affiliations

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

Address correspondence to:

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

Abstract

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

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

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

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

Citation

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

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

Posted in: Original Research, Volume 11 | Issue 2

Abdul H. Zaid, MBBS1 Suman B. Thapamagar, MBBS2 James D. Anholm, MD3 Laura Weaver-Carnahan, RN, RRT3 Lien Duong, PharmD3 Lennard Specht, MD3

Author Affiliations

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

Address correspondence to:

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

Abstract

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

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

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

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

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

Citation

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

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Safety and Reactogenicity of COVID-19 Vaccination in Severe Alpha-1 Antitrypsin Deficiency

Posted in: Original Research, Covid19, Volume 11 | Issue 1

Oliver J. McElvaney, MD, PhD1,2,3,4 Brian Cleary, MD1 Daniel D. Fraughen, MD1,2 Geraldine Kelly, MBA5 Oisin F. McElvaney, MD, PhD1 Mark P. Murphy, PhD1 Peter Branagan, MD1,2 Cedric Gunaratnam, MD1,2 Tomás P. Carroll, PhD1,5 Christopher H. Goss, MD, MSc3,4,6 Noel G. McElvaney, MD1,2

Author Affiliations

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

Address correspondence to:

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

Abstract

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

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

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

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

Citation

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

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

Posted in: Editorial, Volume 11 | Issue 1

Mark T. Dransfield, MD1,2

Author Affiliations

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

Address correspondence to:

Mark T. Dransfield, MD
mdransfield@uabmc.edu

Abstract

This article does not contain an abstract.

Citation

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

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

Posted in: Original Research, Volume 11 | Issue 1

Laura M. Paulin, MD, MHS1 Michael J. Halenar, MPH2 Kathryn C. Edwards, PhD2 Kristin Lauten, MA2 Kristie Taylor, PhD2 Mary Brunette, MD1 Susanne Tanski, MD, MPH1 Todd MacKenzie, PhD1 Cassandra A. Stanton, PhD2 Dorothy Hatsukami, PhD3 Andrew Hyland, PhD4 Martin C. Mahoney, MD, PhD4 Ray Niaura, PhD5 Dennis Trinidad, PhD, MPH6 Carlos Blanco, MD, PhD7 Wilson Compton, MD, MPE7 Lisa D. Gardner, PhD, MS8 Heather L. Kimmel, PhD7 K. Michael Cummings, PhD, MPH9 Dana Lauterstein, PhD8 Esther J. Roh, PhD, MS8 Daniela Marshall, PhD7,10 James D. Sargent, MD1

Author Affiliations

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

Address correspondence to:

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

Abstract

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

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

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

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

Citation

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

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Lung Structure and Risk of Sleep Apnea in SPIROMICS

Posted in: Original Research, Volume 11 | Issue 1

Abigail L. Koch, MD1 Tracie L. Shing, DrPH2 Andrew Namen, MD3 David Couper, PhD2 Benjamin Smith, MD, MSc4 R. Graham Barr, MD, PhD4 Surya Bhatt, MD, MSPH5 Nirupama Putcha, MD, MHS6 Aaron Baugh, MD7 Amit K. Saha, PhD, MS3 Michelle Zeidler, MD8 Alejandro Comellas, MD9 Christopher B. Cooper, MD8 Igor Barjaktarevic, MD, PhD8 Russell P. Bowler, MD, PhD10 MeiLan K. Han, MD, MS11 Victor Kim, MD12 Robert Paine, III, MD13 Richard E. Kanner, MD13 Jerry A. Krishnan, MD, PhD14 Fernando J. Martinez, MD, MS15 Prescott G. Woodruff, MD, MPH7 Nadia N. Hansel, MD6 Eric A. Hoffman, PhD9 Stephen P. Peters, MD, PhD3 Victor E. Ortega, MD, PhD16 for the SubPopulations and InteRmediate Outcome Measures in COPD Study (SPIROMICS) Investigators

Author Affiliations

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

Address correspondence to:

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

Abstract

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

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

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

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

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

Citation

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

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

Posted in: Short Communication, Volume 11 | Issue 1

MeiLan K. Han, MD1 Gerard J. Criner, MD2 David M.G. Halpin, MD3 Edward M. Kerwin, MD4 Lee Tombs, MSc5 David A. Lipson, MD6,7 Fernando J. Martinez, MD8 Robert A. Wise, MD9 Dave Singh, MD10

Author Affiliations

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

Address correspondence to:

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

Abstract

This article does not contain an abstract.

Citation

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

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Food Insecurity is Associated With COPD Morbidity and Perceived Stress

Posted in: Original Research, Volume 11 | Issue 1

Daniel C. Belz, MD, MPH1 Han Woo, PhD1 Mariah K. Jackson, RD2 Nirupama Putcha, MD, MHS1 Ashraf Fawzy, MD, MPH1 Wendy Lorizio, MD, MPH1 Meredith C. McCormack, MD, MHS1 Michelle N. Eakin, PhD, MA1 Corrine K. Hanson, PhD, RD2 Nadia N. Hansel, MD, MPH1

Author Affiliations

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

Address correspondence to:

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

Abstract

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

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

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

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

Citation

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

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

Posted in: Original Research, Volume 11 | Issue 1

Kevin I. Duan, MD, MS1,2 Lucas M. Donovan, MD, MS2,3 Laura J. Spece, MD, MS2,3 Edwin S. Wong, PhD2,3,4 Laura C. Feemster, MD, MS2,3 Alexander D. Bryant, MD, MS5 Robert Plumley3 Kristina Crothers, MD2,3 David H. Au, MD, MS2,3

Author Affiliations

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

Address correspondence to:

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

Abstract

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

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

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

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

Citation

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

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

Posted in: Review, Volume 11 | Issue 1

Fawaz A. Alwadani, MSc1,2 Kyrie Wheeler, BMBS, MSc3 Harriet Pittaway, MBBS4 Alice M. Turner, MBChB, PhD1

Author Affiliations

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

Address correspondence to:

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

Abstract

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

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

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

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

Citation

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

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

Posted in: Original Research, Volume 11 | Issue 1

Alex D. Federman, MD, MPH1 Rachel O’Conor, PhD2 Jeannys Nnemnbeng, MD, RRT3 Jyoti Ankam, MBBS, MPH1 Danielle McDermott, MS, CSCS4 Peter K. Lindenauer, MD, MSc5 Michael S. Wolf, PhD, MPH2 Juan P. Wisnivesky, MD, DrPH1,6

Author Affiliations

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

Address correspondence to:

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

Abstract

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

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

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

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

Citation

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

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

Posted in: Perspectives, Volume 11 | Issue 1

Nicole M. Robertson, MD, MPH1 Connor S. Centner, PhD2,3 Trishul Siddharthan, MD4

Author Affiliations

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

Address correspondence to:

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

Abstract

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

Citation

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

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

Posted in: Original Research, Volume 11 | Issue 1

Matthew T. Donnan, BSc, MBBS1,2 Shailesh Bihari, MBBS, FCICM, MD, PhD3,4 Ashwin Subramaniam, MBBS, MMED, FRACP, FCICM, PhD5-7 Eli J. Dabscheck, MBBS, MclinEpi, FRACP2,8 Brooke Riley, BBioMedSc, MBBS, FCICM1 David V. Pilcher, MBBS, MRCP1,7,9

Author Affiliations

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

Address correspondence to:

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

Abstract

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

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

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

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

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

Citation

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

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

Posted in: Original Research, Volume 11 | Issue 1

Anne O. Nielsen, MD, PhD1 Peter Lange, MD2 Ole Hilberg, MD3,4 Ingeborg Farver-Vestergaard, MSc3,4 Rikke Ibsen, MSc4 Anders Løkke, DrMed, MD3,4

Author Affiliations

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

Address correspondence to:

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

Abstract

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

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

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

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

Citation

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

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

Posted in: Short Communication, Volume 11 | Issue 1

Christopher Di Felice, MD1,2 Zachary B. Strumpf, MD1,3 Elizabeth A. Edmiston, PhD, RN, CCRN1,2 Christian F. Cuvillier Padilla, MD1,4 Leah C. Ellis-Jones, RN1 Joanne L. McKell, MD1,2 Mohammad A. Shatat, MD1,2 Sherrie D. Williams, MD1,2 Anna M. May, MD, MS1,2,3

Author Affiliations

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

Address correspondence to:

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

Abstract

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

Citation

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

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

Posted in: Short Communication, Volume 11 | Issue 1

R. Chad Wade, MD1,2,3,4 Sharon X. Ling, PhD†5 Erika S. Helgeson, PhD5 Helen Voelker, MS5 Wassim W. Labaki, MD, MS6 Daniel Meza, MD7 Oisin O’Corragain, MD8 Jennifer Y. So, MD9 Gerard J. Criner, MD8 MeiLan K. Han, MD, MS6 Ravi Kalhan, MD7 Robert M. Reed, MD9 Mark T. Dransfield, MD1,2,3,4 J. Michael Wells, MD, MSPH1,2,3,4

Author Affiliations

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

Address correspondence to:

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

Abstract

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

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

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

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

Citation

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

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

Posted in: Original Research, Volume 10 | Issue 4

Charlie Strange, MD1,2 Sheri Allison2 Jean McCathern2 Robert A. Sandhaus, MD, PhD2,3 Kristen E. Holm, PhD, MPH2,3

Author Affiliations

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

Address correspondence to:

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

Abstract

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

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

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

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

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

Citation

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

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Circulating Exosomes and Ambient Air Pollution Exposure in COPD

Posted in: Original Research, Volume 10 | Issue 4

Narjes Soleimanifar, PhD1 Sara Assadiasl, MD, PhD1 Effat Kalateh, MD2 Mohammad Sadegh Hassanvand, PhD3 Maryam Sadr, MS1 Hanieh Mojtahedi, MS1 Kazem Nadafi, PhD3 Mohammad Hossein Nicknam, MD, PhD1 Maryam Edalatifard, MD2

Author Affiliations

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

Address correspondence to:

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

Abstract

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

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

Methods: Peripheral blood samples were taken from 20 COPD patients without a smoking history or a family history of COPD, along with 20 nonsmoker healthy controls. The serum exosomes were counted by flow cytometry using a CD81 marker. The exposure to PM2.5 and PM10 was measured in daily, weekly, and monthly intervals based on the longitudinal measurements of the monitoring stations, and the correlation between exosome count and air pollutants was analyzed.

Results: The serum CD81+ exosome count in COPD patients was significantly elevated compared to the healthy controls and this was correlated with daily PM10 (P-value=0.02) and monthly PM2.5 (P-value=0.02) exposure. Although interferon-gamma levels of COPD patients were higher than healthy controls, there was no correlation between exosome count and cytokine level.

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

Citation

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

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

Posted in: Review, Volume 10 | Issue 4

Eric Sven Kroeber, MD1 Thomas Frese, MD1 Eva Johanna Kantelhardt, MD2 Benjarong Nanuppakrankijkun, MD1 Etienne Ngeh Ngeh, PhD3,4,5 Anne Schrimpf, PhD6 Mulugeta Tamire, PhD, MPH7 Susanne Unverzagt, PhD1

Author Affiliations

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

Address correspondence to:

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

Abstract

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

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

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

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

Citation

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

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

Posted in: Original Research, Volume 10 | Issue 4

Andrew J. Devine, BS*1 Noah J. Smith, BS*2 Rashika Joshi, MD1 Qiang Fan, PhD1 Michael T. Borchers, PhD1,3 Geremy C. Clair, PhD4 Joshua N. Adkins, PhD4 Brian M. Varisco, MD1,2,5,6

Author Affiliations

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

Address correspondence to:

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

Abstract

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

Citation

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

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

Posted in: Original Research, Covid19, Volume 10 | Issue 4

Margaret A. Hay, MD1 Kristen E. Holm, PhD2,3 Jean McCathern,2 Robert A. Sandhaus, MD, PhD2,3 Charlie Strange, MD1,2

Author Affiliations

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

Address correspondence to:

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

Abstract

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

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

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

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

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

Citation

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

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

Posted in: Original Research, Volume 10 | Issue 4

Meimei Xu, PhD1 Jiajia Wang, PhD2 Lianhui Shan, MS1 Xinying An, PhD1

Author Affiliations

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

Address correspondence to:

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

Abstract

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

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

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

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

Citation

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

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

Posted in: Short Communication, Volume 10 | Issue 4

Maria V. Benzo, MD1 Amelia Barwise, PhD1 Matthew M. Clark, PhD2 Kara Dupuy-McCauley, MD1 Madison Roy, MS1 Roberto P. Benzo, MD, MS1

Author Affiliations

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

Address correspondence to:

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

Abstract

This article does not contain an abstract.

Citation

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

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The 6th World Bronchiectasis and Nontuberculous Mycobacteria Conference Abstract Presentations

Posted in: Conference Report – Alpha-1 Foundation, Volume 10 | Issue 4

Timothy R. Aksamit, MD1 Elizabeth J. Emery, MPH, PMP2 Ashwin Basavaraj, MD2 Mark L. Metersky, MD3 Anne E. O'Donnell, MD4 Doreen J. Addrizzo-Harris, MD2

Author Affiliations

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

Address correspondence to:

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

Abstract

This article does not have an abstract.

Citation

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

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

Posted in: Original Research, Volume 10 | Issue 4

Jamuna K. Krishnan, MD, MBA, MS1 Sonal G. Mallya, MD2,3 Musarrat Nahid, MSc3 Aaron D. Baugh, MD4 MeiLan K. Han, MD, MS5 Kerri I. Aronson, MD, MS1 Parag Goyal MD, MS3,6 Laura C. Pinheiro, MPH, PhD3 Samprit Banerjee, PhD7 Fernando J. Martinez, MD, MS1 Monika M. Safford, MD3

Author Affiliations

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

Address correspondence to:

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

Abstract

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

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

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

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

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

Citation

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

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

Posted in: Original Research, Volume 10 | Issue 4

Junxiang Chen, PhD1 Zhonghui Xu, MS2 Li Sun, MS1 Ke Yu, MS1 Craig P. Hersh, MD, MPH2,3 Adel Boueiz, MD, MS2,3 John E. Hokanson, MPH, PhD4 Frank C. Sciurba, MD5 Edwin K. Silverman MD, PhD,2,3 Peter J. Castaldi, MD, MS2,6* Kayhan Batmanghelich, PhD1*

Author Affiliations

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

Address correspondence to:

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

Abstract

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

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

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

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

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

Citation

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

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

Posted in: Original Research, Volume 10 | Issue 4

Sandra E. Zaeh, MD, MS1 Meredith Case, MD, MBE2 David H. Au, MD, MS3,4 Michele DaSilva, MSEd, RRT, RRT-NPS5 Karen Deitemeyer 5 Julie DeLisa, MA6 Laura C. Feemster, MD, MS3,4 Lynn B. Gerald, PhD6,7 Jerry A. Krishnan, MD, PhD6,7 Jennifer Sculley, MDes7 Annette Woodruff, BS5 Michelle N. Eakin, PhD2

Author Affiliations

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

Address correspondence to:

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

Abstract

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

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

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

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

Citation

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

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

Posted in: Short Communication, Covid19, Volume 10 | Issue 4

Michael Rydberg, MD1 Pete Burkett, BBM2 Erica Johnson, PhD3 M. Bradley Drummond, MD, MHS4

Author Affiliations

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

Address correspondence to:

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

Abstract

This article does not contain an abstract.

Citation

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

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

Posted in: Short Communication, Volume 10 | Issue 3

Sarath Raju, MD, MPH1 Han Woo, PhD1 Ashraf Fawzy, MD, MPH1 Nirupama Putcha, MD, MHS1 Aparna Balasubramanian, MD, MHS1 Stephen C. Mathai1 Ronald D. Berger, MD, PhD1 Nadia N. Hansel, MD, MPH1,2 Meredith C. McCormack, MD, MHS1,2

Author Affiliations

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

Address correspondence to:

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

Abstract

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

Citation

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

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

Posted in: Original Research, Volume 10 | Issue 3

Robert M. Burkes, MD, MSCR1,2 Elijah Bailey, BS1 Timothy Hwalek, MD1 Andrew Osterburg, PhD1 Laura Lach, MS2 Ralph Panos, MD2 Stephen N. Waggoner, PhD3,4 Michael T. Borchers, PhD1,2

Author Affiliations

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

Address correspondence to:

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

Abstract

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

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

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

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

Citation

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

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