Author Affiliations

1. COPD Foundation, Washington, DC
2. Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland

Address correspondence to:

Michelle N. Eakin, PhD
Johns Hopkins University
5501 Hopkins Bayview Circle Room 4b.74
Baltimore, MD 21224
Email: Meakin1@jhmi.edu

Abstract

This article does not contain an abstract.

Citation

Citation: Latham S, Sullivan J, Williams S, Eakin MN. Maintaining emotional well-being during the COVID-19 pandemic: a resource for your patients. J COPD F. 2020; 7(2): 76-78. doi: http://doi.org/10.15326/jcopdf.7.2.2020.0150

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There are no keywords for this article.

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Click to read Maintaining Emotional Well-Being During the COVID-19 Pandemic: A Resource for Your Patients

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Author Affiliations

1. COPD Foundation, Washington, D.C.
2. Editor in Chief, Chronic Obstructive Pulmonary Diseases: Journal of the COPD Foundation, COPD Foundation, Washington, DC
3. Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, Colorado

Address correspondence to:

Ruth Tal-Singer, PhD
Chief Scientific Strategy Officer
COPD Foundation
Email: rtalsinger@copdfoundation.org

Abstract

This article does not contain an abstract.

Citation

Citation: Tal-Singer R, Crapo JD. COPD at the time of COVID-19: a COPD Foundation perspective. J COPD F. 2020; 7(2): 73-75. doi: http://doi.org/10.15326/jcopdf.7.2.2020.0149

Keywords

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

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Click to read COPD at the Time of COVID-19: A COPD Foundation Perspective

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Author Affiliations

1. Division of Cardiothoracic Radiology, Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
2. Division of Pulmonology, Department of Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania

Address correspondence to:

Baskaran Sundaram, MD
Division of Cardiothoracic Radiology
Department of Radiology
Thomas Jefferson University Hospital Philadelphia, Pennsylvania
Email: baskaran.sundaram@jefferson.edu
Telephone: (215) 955-4214
Fax: (215) 955-549

Abstract

This article does not contain an abstract.

Citation

Citation: Leung SS, Lee P, Most JE, Sundaram B. Images in COPD: idiopathic emphysema in a never smoker. J COPD F. 2020; 7(2): 130-133. doi: http://doi.org/10.15326/jcopdf.7.2.2020.0148

Keywords

emphysema, idiopathic

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Click to read Images in COPD: Idiopathic Emphysema in a Never Smoker

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Author Affiliations

1. Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York City, New York
2. Respiratory Institute-Mount Sinai Beth Israel Medical Center-National Jewish, New York City, New York
3. Barry Commoner Center for Health and the Environment, Queens College, City University of New York, Queens
4. Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque
5. Program in Sleep Medicine, University of New Mexico Health Sciences Center, Albuquerque
6. Department of Electrical and Computer Engineering, University of New Mexico School of Engineering, Albuquerque

Address correspondence to:

Albert Miller, MD
Telephone: 718-670-4192
Email: almillermd@gmail.com

Abstract

This article does not contain an abstract.

Citation

Citation: Miller A, Brown LK. Comments on “COPDGene 2019: redefining the diagnosis of chronic obstructive pulmonary disease.” J COPD F. 2020; 7(2): 79-81. doi: http://doi.org/10.15326/jcopdf.7.2.2020.0134

Keywords

COPD, obstructive lung disease, CT emphysema

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Click to read Comments on “COPDGene 2019: Redefining the Diagnosis of Chronic Obstructive Pulmonary Disease”

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Author Affiliations

1. Clinical Research Institute of Southern Oregon, Medford
2. American Health Research, Charlotte, North Carolina
3. GlaxoSmithKline plc., Research Triangle Park, Durham, North Carolina
4. GlaxoSmithKline plc., Uxbridge, United Kingdom
5. Respiratory Medical Franchise, GlaxoSmithKline plc., Brentford, United Kingdom

Address correspondence to:

Edward M. Kerwin, MD
Clinical Research Institute of Southern Oregon
3860 Crater Lake Ave
Medford, OR 97504
Phone: (541) 858-1003
Email: ekerwin@criresearch.com

Abstract

Background: Inhaler errors among patients with chronic obstructive pulmonary disease (COPD) can reduce treatment efficacy.

Methods: This randomized, open-label, crossover study evaluated correct use of ELLIPTA versus DISKUS plus HandiHaler. Participants with COPD attended at least 3 study visits (Day 1 [Visit 1], Day 28 [Visit 2], and Day 56 [Visit 3]). Inhalers contained placebo; usual maintenance medication was continued. Participants were randomized to an inhaler sequence (ELLIPTA then DISKUS plus HandiHaler, or the reverse) and preference questionnaire at Visit 1. Participants read the instructions for use in the approved prescribing information for their inhaler(s) and correct use was assessed at Visit 1 (verbal guidance provided if required). Correct use was reassessed at Visit 2, and with the next inhaler(s) at Visit 3. Primary endpoint was the proportion of participants demonstrating correct use (0 errors) with the assigned inhaler(s) after 28 days.

Results: A greater proportion of study participants (n = 217) correctly used ELLIPTA (96%) versus DISKUS plus HandiHaler (87%) after 28 days. The odds of demonstrating correct use with ELLIPTA were 6.88 times that of DISKUS plus HandiHaler (p < 0.001). Overall, > 99% of participants made 0 critical errors (errors leading to no or significantly reduced medication inhaled) with ELLIPTA versus 89% with DISKUS plus HandiHaler after 28 days. ELLIPTA was the patient-preferred option versus DISKUS plus HandiHaler or no preference (p < 0.001).

Conclusions: Delivery of COPD maintenance therapy via ELLIPTA demonstrates higher correct use rates and lower critical error rates compared with DISKUS plus HandiHaler.

Citation

Citation: Kerwin EM, Spangenthal S, Zvarich M, et al. ELLIPTA versus DISKUS plus HANDIHALER in COPD: a randomized, open-label, crossover study in a clinical trial setting. J COPD F. 2020; 7(2): 118-129. doi: http://doi.org/10.15326/jcopdf.7.2.2019.0153

Keywords

COPD, ELLIPTA, DISKUS, HandiHaler, correct use, patient preference

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Click to read ELLIPTA Versus DISKUS plus HandiHaler in COPD: A Randomized, Open-Label, Crossover Study in a Clinical Trial Setting

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Author Affiliations

1. Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, University of Alabama at Birmingham
2. Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham
3. Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham
4. Department of Psychology, University of Alabama at Birmingham
5. Lung Health Center, University of Alabama at Birmingham
6. Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham
7. Birmingham VA Medical Center, Birmingham, Alabama

Address correspondence to:

Trisha Parekh, DO
1900 University Blvd, THT 422-433
Birmingham, AL 35294
Phone: (205) 934-5555
Email: trishaparekh@uabmc.edu

Abstract

Introduction: Low-income chronic obstructive pulmonary disease (COPD) individuals are known to have higher rates of COPD-related hospitalizations and readmissions. Levels of psychological stress are also higher in low-income populations and may be associated with acute care use. We sought to: (1) determine the association between stress and acute care use in COPD, (2) evaluate the social determinants of health (SDH) in low and high stress individuals, and (3) determine the association between low income and high stress with acute care use.

Materials and Methods: Using results from a survey-based study of individuals with COPD at the University of Alabama (UAB), we used multivariable regression modeling to evaluate the association of high stress with acute care use (COPD-related emergency department [ED] visits or hospitalizations). We then compared SDH between low and high stress groups and evaluated the association of low income + high stress with acute care use in a secondary model.

Results: We included 126 individuals in our study. The high stress group was more likely to be < 65 years old and female. No differences in race, smoking, years of smoking, body mass index, dyspnea, or lung function (forced expiratory volume in 1 second [FEV₁]%) by stress group were observed. The high stress group had a 2.5-fold increased adjusted odds of acute care use (adjusted odds ratio [AOR]95% confidence interval [CI], 2.51, 1.06–5.98) compared to the low stress group, while the low-income + high stress group had a 4-fold increased adjusted odds of acute care use (AOR, 95% CI, 4.38, 1.25–15-45) compared to high-income + low-stress group.

Conclusions: Acute care use and stress are associated in COPD. These associations are more pronounced in the low-income + high stress population who disproportionately contribute to health care utilization and frequently lack the resources needed to cope with stress.

Citation

Citation: Parekh TM, Cherrington AL, Bhatia S, et al. The association of low income and high stress with acute care use in COPD patients. J COPD F. 2020; 7(2): 107-117. doi: http://doi.org/10.15326/jcopdf.7.2.2019.0165

Keywords

COPD, health care utilization, psychological stress, social determinants of health

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Author Affiliations

1. Midwest Chest Consultants, PC, St Charles, Missouri
2. Theravance Biopharma US, Inc., South San Francisco, California

Address correspondence to:

Glenn D. Crater, MD
Phone: (650) 808-4078
Email: gcrater@theravance.com

Abstract

Although no nebulized, dual mechanism, long-acting bronchodilator is currently marketed, with the approval of once-daily long-acting muscarinic antagonist (LAMA) revefenacinefenacin, it is theoretically possible to deliver a LAMA and long-acting beta2-agonist via standard jet nebulizer. The primary and secondary objectives of our study were to characterize the safety profile of revefenacin administered sequentially before or in combination with formoterol, via standard jet nebulizer in patients with moderate to very severe chronic obstructive pulmonary disease (COPD). In this randomized, double-blind, 42-day trial (NCT03573817), patients received revenacin 175 µg (n=63) or placebo (n=59), followed by formoterol 20 µg in the morning and formoterol alone in the evening formoterol 21 days via standard jet nebulizer (sequential administration). For another 21 days, revefenacin/placebo and formoterol, were administered as mixed solutions via single nebulization in the morning (combined administration), and formoterol alone in the evening. The adverse events’ (AEs) incidence was higher in the placebo + formoterol arms (11%–12%) than in the revefenacin + formoterol arms (5%–8%). The most common AEs were worsening/exacerbation of COPD, cough, and dizziness. There were no serious AEs or deaths reported in any arm. The least squares mean in trough forced expiratory volume in 1 second (FEV₁) versus baseline was higher in the revefenacin + formoterol arms (116–157 mL) than in the placebo + formoterol arms (35–53 mL). Revefenacin had a safety profile similar to formoterol alone when delivered sequentially or combined. Trough FEV₁ was similar when revefenacin was delivered sequentially or combined with formoterol, with revefenacin providing an additional 81–104 mL improvements over formoterol alone.

Citation

Citation: Siler TM, Moran EJ, Barnes CN, Crater GD. Safety and efficacy of revefenacin and formoterol in sequence and combination via a standard jet nebulizer in patients with chronic obstructive pulmonary disease: a phase 3b, randomized, 42-day study. J COPD F. 2020; 7(2): 99-106. doi: http://doi.org/10.15326/jcopdf.7.2.2019.0154

Keywords

COPD, chronic obstructive pulmonary disease, Revefenacin, safety, combined administration, dual administration, phase 3 randomized controlled trial, sequential administration, standard jet nebulizer

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Click to read Safety and Efficacy of Revefenacin and Formoterol in Sequence and Combination via a Standard Jet Nebulizer in Patients with Chronic Obstructive Pulmonary Disease: A Phase 3b, Randomized, 42-Day Study

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Author Affiliations

1. Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
2. Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
3. Division of Rheumatology, National Jewish Health, Denver, Colorado
4. Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora
5. PRecisiOn Medicine Translational Research (PROMoTeR) Center, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care, Boston, Massachusetts
6. Harvard Medical School, Boston, Massachusetts
7. Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, Colorado

Address correspondence to:

Dawn L. DeMeo, MD, MPH
Harvard Medical School
Brigham and Women’s Hospital
Phone: (617) 525-0866
Email: dawn.demeo@channing.harvard.edu

Abstract

Background: Apparent increased female susceptibility to chronic obstructive pulmonary disease (COPD) suggests sex hormones modulate disease pathogenesis. Little is known about associations between multiparity and lung function in smokers.

Research Question: We hypothesized that multiparity is associated with lung function and measures of emphysema and airway disease.

Study Design and Methods: Utilizing female participants from the 5-year follow up of the COPD Genetic Epidemiology (COPDGene^®) study we performed multivariable linear regressions to assess the effect of multiparity and number of pregnancies on forced expiratory volume in 1 second (FEV₁) percentage of predicted (% predicted), FEV₁/forced vital capacity (FVC), percent emphysema on computed tomography (CT) scans, and Pi10, a measure of airway thickening. We sampled never smokers and those with lower smoking exposure from the National Health and Nutrition Examination Survey (NHANES) 2011-2012 dataset.

Results: We included 1820 participants from COPDGene^® and 418 participants from NHANES (321 never smokers, 97 ever smokers). In COPDGene^®, multiparity (beta coefficient [β] = -3.8, 95% confidence interval [CI]: [-6.5, -1.1], p = 0.005) and higher number of pregnancies were associated with lower FEV₁ % predicted. Multiparity was not associated with percent emphysema or Pi10. In individuals with no or mild obstruction, multiparity was associated with lower FEV₁ % predicted. There was an interaction with multiparity and age on FEV₁ % predicted (p = 0.025). In NHANES, there was no association between multiparity and FEV₁ % predicted in never smokers or the lower smoking exposure group.

Interpretation: Multiparity was associated with lower FEV₁ % predicted in current and former smokers in COPDGene^® study participants. These preliminary results emphasize the importance of smoking abstinence in women of child-bearing age.

Citation

Citation: Moll M, Regan EA, Hokanson JE, et al. The association of multiparity with lung function and chronic obstructive pulmonary disease-related phenotypes. J COPD F. 2020; 7(2): 86-98. doi: http://doi.org/10.15326/jcopdf.7.2.2019.0166

Keywords

COPD, chronic obstructive pulmonary disease, phenotypes, multiparity, pregnancy, female, hormones

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Click to read The Association of Multiparity with Lung Function and Chronic Obstructive Pulmonary Disease-Related Phenotypes

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Author Affiliations

1. Denver, Colorado

Address correspondence to:

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

Abstract

This article does not contain an abstract.

Citation

Citation: Balkissoon R. Journal club-COPD2020 update. Global Initiative for Chronic Obstructive Lung Disease 2020 report and the Journal of the COPD Foundation special edition, moving to a new definition for COPD: “COPDGene2019”. J COPD F. 2020; 7(1): 64-72. doi: http://doi.org/10.15326/jcopdf.7.1.2020.0133

Keywords

COPD, chronic obstructive pulmonary disease, Global initiative for chronic Obstructive Lung Dis, GOLD, COPD Genetic Epidemiology, COPDGene

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Click to read Journal Club—COPD2020 Update. Global Initiative for Chronic Obstructive Lung Disease 2020 Report and the Journal of the COPD Foundation Special Edition, Moving to a New Definition for COPD: “COPDGene® 2019”

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Author Affiliations

1. Lewis Katz School of Medicine, Temple University and Temple University Hospital, Philadelphia, Pennsylvania
2. Columbia University Medical Center, New York, New York

Address correspondence to:

Clinton A. Veselis, MD
Department of Radiology
Temple University Hospital
3401 N. Broad St
Philadelphia, PA 19140
Phone: 267-858-8044
Email: Clinton.Veselis@tuhs.temple.edu

Abstract

This article does not contain an abstract.

Citation

Citation: Veselis CA, Steiner RM, Dass C. Bronchoscopic lung volume reduction using endobronchial valves: imaging appearance. J COPD F. 2020; 7(1): 60-63. doi: http://doi.org/10.15326/jcopdf.7.1.2019.0180

Keywords

emphysema, CT, endobronchial valves, bronchoscopic lung volume reduction, high resolution computed tomography

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Click to read Bronchoscopic Lung Volume Reduction Using Endobronchial Valves: Imaging Appearance

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Author Affiliations

1. Strategic Consulting, AESARA, Inc., Chapel Hill, North Carolina
2. Department of Pharmaceutical Outcomes and Policy, University of North Carolina, Chapel Hill
3. Health Economics and Outcomes Research, Optum Inc., Eden Prairie, Minnesota

Address correspondence to:

Richard H. Stanford, PharmD, MS
Strategic Consulting
AESARA, Inc.
Chapel Hill, NC
Email: richard@aesara.com
Phone: (919) 602-0283

Abstract

Background: Population-based risk assessments are needed to identify individuals who may benefit from chronic obstructive pulmonary disease (COPD) management programs for preventing exacerbations. This study compared the validated COPD treatment ratio (CTR) versus other COPD exacerbation predictors: prior exacerbation and rescue and maintenance medication use.

Methods: A retrospective observational study using medical and pharmacy claims data among Medicare Advantage with Part D beneficiaries with COPD (January 2011–August 2016). Unadjusted and adjusted logistic regression models tested the predictive performance (C-statistic) of potential exacerbation predictors for future severe exacerbations.

Results: The unadjusted association between exacerbation predictors and severe exacerbation was examined in 60,776 patients: baseline severe exacerbation had the highest C-statistic (0.668), then number of rescue units dispensed (0.651), CTR (0.619), and number of controller units dispensed (0.562). During the at-risk period, baseline CTR was inversely associated with severe exacerbation (odds ratio, <1.0); other predictors were positively associated with a severe exacerbation (odds ratio, >1.0). Adjusting for age, geographic region, chronic oxygen, and nebulizer use, the severe exacerbation odds were 0.90 (95% confidence interval [CI], 0.89–0.91) lower per 0.10 change in CTR (C-statistic, 0.710). The C-statistic was 0.734 when baseline exacerbation was added to the model.

Conclusions: The CTR is an effective tool for identifying patients diagnosed with COPD who are at increased risk of severe exacerbation. Although CTR does not predict future exacerbation as well as prior severe exacerbation history, it has the advantage of being applicable in predicting future exacerbations in patients without an exacerbation history, or in databases limited to pharmacy claims only. In addition, the significant reduction in risk has been observed with incremental increases in the ratio: the ratio can be monitored to assess COPD health improvements over time.

Citation

Citation: Stanford RH, Korrer S, Brekke L, Reinsch T, Bengston LGS. Validation and assessment of the COPD treatment ratio as a predictor of severe exacerbations. J COPD F. 2020; 7(1): 38-48. doi: http://doi.org/10.15326/jcopdf.7.1.2019.0132

Keywords

COPD, chronic obstructive pulmonary disease, COPD exacerbation, COPD treatment ratio, CTR, maintenance medication, rescue inhaler

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Click to read Validation and Assessment of the COPD Treatment Ratio as a Predictor of Severe Exacerbations

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Author Affiliations

1. Research, COPD Foundation, Inc., Washington, DC
2. University of Kentucky College of Public Health, Lexington
3. Tulane University School of Medicine, New Orleans, Louisiana
4. University of Illinois at Chicago
5. Kaiser Permanente Center for Health Research, Portland, Oregon

Address correspondence to:

Radmila Choate, PhD, MPH
University of Kentucky College of Public Health
111 Washington Avenue, Room 215B
Lexington, KY 40536
Phone: 859-218-2237
Email: Radmila.choate@uky.edu

Abstract

Rationale: Cough and phlegm are common symptoms of chronic obstructive pulmonary disease (COPD) and may significantly affect quality of life. This study assessed the burden of cough and phlegm on clinical outcomes and quality of life among people with a self-reported physician diagnosis of COPD.

Methods: Patient-reported data from the COPD Foundation’s Patient-Powered Research Network (COPD PPRN) were utilized. Cough and phlegm severity and frequency were assessed by responses to questions on the COPD Assessment Test (CAT) and categorized into none/low, moderate and severe. Quality of life domains were evaluated using the Patient-Reported Outcome Measurement Information System (PROMIS-29). Associations between cough and phlegm levels and PROMIS-29 domains were examined using multivariate analysis of variance (MANOVA).

Results: The 5286 participants were average age 64.4 years (SD=11.4), 87.9% white, 60.4% female, 51.2% married, and 42.2% with caregivers. Approximately three-fourths of the participants had moderate or severe cough or phlegm levels. Respondents with moderate and high cough or phlegm had significantly worse dyspnea (p<0.0001), more exacerbations in the previous one year (p<0.0001), worse physical and social functioning, and more symptoms of anxiety and depression on PROMIS-29 compared to those with no/low cough and phlegm.

Conclusions: In this group of people with COPD, higher levels of cough and phlegm are associated with worse clinical and quality of life outcomes.

Citation

Citation: Choate R, Pasquale CB, Parada NA, Prieto-Centurion V, Mularski RA, Yawn BP. The burden of cough and phlegm in people with COPD: a COPD Patient-Powered Research Network study. J COPD F. 2020; 7(1): 49-59. doi: http://doi.org/10.15326/jcopdf.7.1.2019.0146

Keywords

chronic obstructive pulmonary disease, patient-reported outcomes, symptom burden, COPD, cough, phlegm, PROMIS-29

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Click to read The Burden of Cough and Phlegm in People With COPD: A COPD Patient-Powered Research Network Study

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Author Affiliations

1. U.S. Value Evidence and Outcomes, GlaxoSmithKline plc., Research Triangle Park, North Carolina
2. Value Evidence and Outcomes, GlaxoSmithKline plc., Uxbridge, United Kingdom
3. Optum, Eden Prairie, Minnesota

Address correspondence to:

Maggie Tabberer, MSc
Value Evidence and Outcomes
GlaxoSmithKline
R&D Stockley Park
Uxbridge, UB11 1BT, United Kingdom
Email: margaret.x.tabberer@gsk.com
Tel: +44 208 990 2041

Abstract

Rationale: Uptake of the COPD Assessment Test (CAT^TM) is not yet widespread in patients with chronic obstructive pulmonary disease (COPD) within U.S. primary care and its alignment with other assessments has not been evaluated in U.S. clinical practice.

Objectives: To assess the alignment of the CAT with other standard measures of COPD severity and its usability in a U.S. primary care population.

Methods: This was a multicenter, prospective, observational, longitudinal study of patients with COPD and their primary care physicians. Patients with spirometry-confirmed airflow restriction completed a daily electronic diary (eDiary) over 12 weeks; surveys were also administered at baseline and at 6- and 12-week follow-up.

Measurements and Main Results: In the study population (n=178), statistically significant differences (P<0.05) were found across 4 CAT impact score groups where at all time points patients in the Low Impact CAT score group had superior lung function and physical/mental health status than patients in the Medium, High, and Very High Impact groups. Numerical, though lesser, differences were also found across these latter 3 groups. Furthermore, the average total EXAcerbations of COPD Tool (EXACT®) score was significantly worse in patients in the highest CAT score group over the first 7 days.

Conclusions: COPD severity; respiratory symptoms; frequency, severity, and duration of pulmonary exacerbations; and overall physical and mental health status are linked concurrently and prospectively to CAT impact score categories. The stratification of patients according to CAT impact scores, and application of clinical and functional health status information to these categories, enhances the usability of the CAT in practice settings for COPD management.

Citation

Citation: Stanford RH, Tabberer M, Kosinski MA, et al. Assessment of the COPD Assessment Test within U.S. primary care. J COPD F. 2020; 7(1): 26-37. doi: http://doi.org/10.15326/jcopdf.7.1.2019.0135

Keywords

chronic obstructive pulmonary disease, COPD Assessment Test, EXACT, primary health care, communication, EXacerbations of COPD Tool

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Click to read Assessment of the COPD Assessment Test Within U.S. Primary Care

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Author Affiliations

1. Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
2. Arasila Biotech, San Diego, California
3. Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland

Address correspondence to:

Craig P. Hersh, MD, MPH
Channing Division of Network Medicine
Brigham and Women’s Hospital
181 Longwood Ave
Boston, MA 02115
Phone: 617-525-0729
Email: craig.hersh@channing.harvard.edu

Abstract

Asthma-COPD overlap (ACO) is a common clinical syndrome, yet there is no single objective definition. We hypothesized that immunoglobulin E (IgE) measurements could be used to refine the definition of ACO. In baseline plasma samples from 2870 participants in the COPD Genetic Epidemiology (COPDGene^®) study, we measured total IgE levels and specific IgE levels to 6 common allergens. Compared to usual chronic obstructive pulmonary disease (COPD), participants with ACO (based on self-report of asthma) had higher total IgE levels (median 67.0 versus 42.2 IU/ml) and more frequently had at least one positive specific IgE (43.5% versus 24.5%). We previously used a strict definition of ACO in participants with COPD, based on self-report of a doctor’s diagnosis of asthma before age 40. This strict ACO definition was refined by the presence of atopy, determined by total IgE > 100 IU/ml or at least one positive specific IgE, as was the broader definition of ACO based on self-reported asthma history. Participants with all 3 ACO definitions were younger (mean age 60.0–61.3 years), were more commonly African American (36.8%–44.2%), had a higher exacerbation frequency (1.0–1.2 in the past year), and had more airway wall thickening on quantitative analysis of chest computed tomography (CT) scans. Among participants with ACO, 37%–46% did not have atopy; these individuals had more emphysema on chest CT scan. Based on associations with exacerbations and CT airway disease, IgE did not clearly improve the clinical definition of ACO. However, IgE measurements could be used to subdivide individuals with atopic and non-atopic ACO, who might have different biologic mechanisms and potential treatments.

Citation

Citation: Hersh CP, Zacharia S, Prakash R, et al and the COPDGene Investigators. Immunoglobulin E as a biomarker for the overlap of atopic asthma and chronic obstructive pulmonary disease. J COPD F. 2020; 7(1): 1-12. doi: http://doi.org/10.15326/jcopdf.7.1.2019.0138

Keywords

chronic obstructive pulmonary disease, asthma, atopy, chest CT scan, immunoglobulin E

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Click to read Immunoglobulin E as a Biomarker for the Overlap of Atopic Asthma and Chronic Obstructive Pulmonary Disease

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Author Affiliations

1. Medical Innovation, Value Evidence and Outcomes, GlaxoSmithKline, Collegeville, Pennsylvania
2. Epidemiology, Value Evidence and Outcomes, GlaxoSmithKline, Middlesex, United Kingdom
3. Quantitative Sciences and Statistics, GlaxoSmithKline, Collegeville, Pennsylvania
4. Quantitative Sciences and Statistics, GlaxoSmithKline, Stevenage, United Kingdom
5. National Institute for Health Research, Nottingham Biomedical Research Centre, Respiratory Theme and Department of Respiratory Medicine, University of Nottingham, School of Medicine, City Hospital, Nottingham University Hospitals National Health Service Trust Campus, Nottingham, United Kingdom
6. Department of Cardiology, Wales Heart Research Institute, Cardiff University, Cardiff, United Kingdom
7. Medical Research Council Centre for Inflammation Research, University of Edinburgh, Edinburgh, United Kingdom
8. University of Cambridge, Division of Experimental Medicine and Immunotherapeutics, Addenbrooke’s Hospital, Cambridge, United Kingdom
9. National Institute for Health Research, Respiratory Biomedical Research Unit, Royal Brompton & Harefield National Health Service Foundation Trust and Imperial College, London, United Kingdom

*These authors contributed equally to this manuscript as joint first authors.
**These authors contributed equally to this manuscript as joint last authors.

Address correspondence to:

Victoria S. Benson, PhD
Phone: 020 89903306
Email: victoria.x.tribble@gsk.com

Abstract

Objective: To identify phenotypic factors associated with the Short Physical Performance Battery (SPPB) and its individual sub-tests: standing balance, 4‑meter gait speed (4mGS) and 5-repetition sit-to-stand (5STS).

Methods: The Evaluation of the Role of Inflammation in non-pulmonary disease manifestations in Chronic Airways disease (ERICA) study recruited adult participants with stable chronic obstructive pulmonary disease (COPD). Proportional odds models identified factors associated with the SPPB, and a principal component analysis (PCA) evaluated how much SPPB variance was explainable by each of its 3 sub-tests.

Results: Of 729 enrolled participants, 717 (60% male, mean age 67 years) had full SPPB data. Overall, 76% of patients had some evidence of functional limitations (SPPB total score < 12). Scores < 4 were observed in 71%, 31%, and 22% of participants for the 5STS, 4mGS, and balance sub-tests, respectively. A longer 6-minute walk test and greater quadriceps maximal voluntary contraction decreased the odds of being in a lower score category for SPPB total score and for all 3 sub-tests. Aging, self-reported hypertension and higher dyspnea increased the odds, and being married decreased the odds of being in a lower category for total score. All sub-tests contributed equally to total score.

Conclusion: Each of the 3 sub-tests contributed independent information to the SPPB, demonstrating their usefulness for assessing COPD when considered together rather than individually. The 5STS sub-test had the greatest variation in scores and may thus have the best discriminatory power for clinical COPD studies of lower limb performance where only one SPPB test is feasible.

Citation

Citation: Mohan D, Benson VS, Allinder M, et al. Short physical performance battery: what does each sub-test measure in patients with chronic obstructive pulmonary disease? J COPD F. 2020; 7(1): 13-25. doi: http://doi.org/10.15326/jcopdf.7.1.2019.0144

Keywords

COPD, chronic obstructive pulmonary disease, cross-sectional study, Short Physical Performance Battery test, 4-meter gait speed, 5-repetition sit-to-stand

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Click to read Short Physical Performance Battery: What Does Each Sub-Test Measure in Patients with Chronic Obstructive Pulmonary Disease?

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Author Affiliations

1. National Heart and Lung Institute, Imperial College, London, United Kingdom
2. Division of Infection, Immunity & Respiratory Medicine, University of Manchester, United Kingdom
3. Pulmonary and Rehabilitation Research Group, University Hospital Aintree, Liverpool, United Kingdom

Address correspondence to:

Peter J. Barnes, FRS
email: p.j.barnes@imperial.ac.uk

Abstract

This article does not contain an abstract.

Citation

Citation: Barnes PJ, Vestbo J, Calverley PM. The pressing need to redefine "COPD". J COPD F. 2019; 6(5): 380-383. doi: http://doi.org/10.15326/jcopdf.6.5.2019.0173

Keywords

COPD, chronic obstructive pulmonary disease, diagnosis, COPDGene, PRISm, preserved ratio-impaired spirometry, Genetic Epidemiology of COPD

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Click to read The Pressing Need to Redefine COPD

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Author Affiliations

1. Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, National Jewish Health, University of Colorado School of Medicine, Denver

Address correspondence to:

Barry J. Make, MD
email: MakeB@njhealth.org

Abstract

This article does not contain an abstract.

Citation

Citation: Make BJ. COPD: a new diagnostic paradigm. J COPD F. 2019; 6(5): 438-443. doi: http://doi.org/10.15326/jcopdf.6.5.2019.0172

Keywords

COPD, chronic obstructive pulmonary disease, COPD Genetic Epidemiology, COPDGene, PRISm, preserved ratio-impaired spirometry, COPD diagnosis

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Click to read COPD: A New Diagnostic Paradigm

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Author Affiliations

1. Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora
2. Department of Medicine, National Jewish Health, Denver, Colorado
3. Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor
4. Department of Biostatistics and Informatics, University of Colorado Anschutz Medical Campus, Aurora
5. Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
6. Division of Biostatistics and Bioinformatics, Office of Academic Affairs, National Jewish Health, Denver, Colorado
7. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore Maryland
8. VA Boston Healthcare System, Boston, Massachusetts
9. Department of Radiology, National Jewish Health, Denver, Colorado

Address correspondence to:

Kendra A. Young, MSPH, PhD
Department of Epidemiology
Colorado School of Public Health
University of Colorado Anschutz Medical Campus
13001 East 17th Avenue
Room W3142, Campus Box B-119
Aurora, CO 80045
Phone: 303-724-4441
Email: Kendra.Young@UCDenver.edu

Abstract

Background: Previous attempts to explore the heterogeneity of chronic obstructive pulmonary disease (COPD) clustered individual patients using clinical, demographic, and disease features. We developed continuous multidimensional disease axes based on radiographic and spirometric variables that split into an airway-predominant axis and an emphysema-predominant axis.

Methods: The COPD Genetic Epidemiology study (COPDGene^®) is a cohort of current and former smokers, > 45 years, with at least 10 pack years of smoking history. Spirometry measures, blood pressure and body mass were directly measured. Mortality was assessed through continuing longitudinal follow-up and cause of death was adjudicated. Among 8157 COPDGene^® participants with complete spirometry and computed tomography (CT) measures, the top 2 deciles of the airway-predominant and emphysema-predominant axes previously identified were used to categorize individuals into 3 groups having the highest risk for mortality using Cox proportional hazard ratios. These groups were also assessed for causal mortality. Biomarkers of COPD (fibrinogen, soluble receptor for advanced glycation end products [sRAGE], C-reactive protein [CRP], clara cell secretory protein [CC16], surfactant-D [SP-D]) were compared by group.

Findings: High-risk subtype classification was defined for 2638 COPDGene^® participants who were in the highest 2 deciles of either the airway-predominant and/or emphysema-predominant axis (32% of the cohort). These high-risk participants fell into 3 groups: airway-predominant disease only (APD-only), emphysema-predominant disease only (EPD-only) and combined APD-EPD. There was 26% mortality for the APD-only group, 21% mortality for the EPD-only group, and 54% mortality for the combined APD-EPD group. The APD-only group (n=1007) was younger, had a lower forced expiratory volume in 1 second (FEV₁) percent (%) predicted and a strong association with the preserved ratio-impaired spirometry (PRISm) quadrant. The EPD-only group (n=1006) showed a relatively higher FEV₁ % predicted and included largely GOLD stage 0, 1 and 2 partipants. Individuals in each of the 3 high-risk groups were at greater risk for respiratory mortality, while those in the APD-only group were additionally at greater risk for cardiovascular mortality. Biomarker analysis demonstrated a significant association of the APD-only group with CRP, and sRAGE demonstrated greatest significance with both the EPD-only and the combined APD-EPD groups.

Interpretation: Among current and former smokers, individuals in the highest 2 deciles for mortality risk on the airway-predominant axis and the emphysema-predominant axis have unique associations to spirometric patterns, different imaging characteristics, biomarkers and causal mortality.

Citation

Citation: Young KA, Regan EA, Han MK, et al and the COPDGene Investigators. Subtypes of COPD have unique distributions and differential risk of mortality. J COPD F. 2019; 6(5): 400-413. doi: http://doi.org/10.15326/jcopdf.6.5.2019.0150

Keywords

COPD, chronic obstructive pulmonary disease, biomarkers, mortality, COPD Genetic Epidemiology, COPDGene, PRISm, preserved ratio-impaired spirometry, subtypes, airway-predominant disease, emphysema-predominant disease

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Click to read Subtypes of COPD Have Unique Distributions and Differential Risk of Mortality

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Author Affiliations

1. COPD Foundation, Washington, DC

Address correspondence to:

Byron Thomashow, MD
Chief Medical Officer
COPD Foundation
Email: bmt1@cumc.columbia.edu

Abstract

This article does not contain an abstract.

Citation

Citation: COPD Foundation Board of Directors. Time to redefine? A statement of the COPD Foundation. J COPD F. 2019; 6(5): 430-432. doi: http://doi.org/10.15326/jcopdf.6.5.2019.0168

Keywords

COPD, chronic obstructive pulmonary disease, COPD Genetic Epidemiology, COPDGene, COPD diagnosis

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Click to read Time to Redefine? A Statement of the COPD Foundation

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Author Affiliations

1. Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora
2. Division of Biostatistics and Bioinformatics, Office of Academic Affairs, National Jewish Health, Denver, Colorado
3. Department of Pulmonary Sciences and Critical Care Medicine, University of Colorado School of Medicine, Aurora
4. Department of Mathematical and Statistical Sciences, University of Colorado at Denver
5. Department of Medicine, National Jewish Health, Denver, Colorado
6. Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, Massachusetts

Address correspondence to:

Kendra A. Young, MSPH, PhD
Department of Epidemiology
Colorado School of Public Health
University of Colorado Anschutz Medical Campus
13001 East 17th Avenue
Room W3142, Campus Box B-119
Aurora, CO 80045
Phone: 303-724-4441
Email: Kendra.Young@cuanschutz.edu

Abstract

Rationale: We classified individuals into pulmonary disease subtypes based on 2 underlying pathophysiologic disease axes (airway-predominant and emphysema-predominant) and their increased mortality risk. Our next objective was to determine whether some subcomponents of these subtypes are additionally associated with unique patterns of Global initiative for chronic Obstructive Lung Disease (GOLD) spirometry stage progression.

Methods: After accounting for intra-individual measurement variability in spirometry measures between baseline (Phase 1) and the 5-year follow up (Phase 2) of the COPD Genetic Epidemiology (COPDGene^®) study, 4615 individuals had complete data that would characterize patterns of disease progression over 5 years (2033 non-Hispanic whites; 827 African Americans; 48% female). Individuals could express increased risk for mortality on one or both of the primary subtype axes (airway-predominant or emphysema-predominant) and thus they were further classified into 6 groups: high-risk airway-predominant disease only (APD-only), moderate-risk airway-predominant disease only (MR-APD-only), high-risk emphysema-predominant disease only (EPD-only), combined high-risk airway- and emphysema-predominant disease (combined APD-EPD), combined moderate-risk airway- and emphysema-predominant disease (combined MR-APD-EPD), and no high-risk pulmonary subtype. Outcomes were dichotomized for GOLD spirometry stage progression from Phase 1 to Phase 2. Logistic regression of the progression outcomes on the pulmonary subtypes were adjusted for age, sex, race, and change in smoking status.

Results: The MR-APD-only group was associated with conversion from GOLD 0 to preserved ratio-impaired spirometry (PRISm) status (odds ratio [OR] 11.3, 95% confidence interval [CI] 5.7–22.1) and GOLD 0 to GOLD 2–4 (OR 6.0, 95% CI 2.0–18.0). The EPD-only group was associated with conversion from GOLD 0 to GOLD 1 (OR 2.4, 95% CI 1.2–4.6), and GOLD 1 to GOLD 2–4 (OR 2.6, 95% CI 1.0–6.9). Conversion between PRISm and GOLD 2–4 (31%–38%) occurred in both the APD-only and the MR-APD-only groups.

Conclusion: Differential conversion occurs from GOLD 0 to PRISm and GOLD 0 to GOLD 1 based on groups expressing airway-predominant disease or emphysema-predominant disease independently or in combination. Airway-predominant and emphysema-predominant subtypes are highly important in determining patterns of early disease progression.

Citation

Citation: Young KA, Strand MJ, Ragland MF, et al for the COPDGene^® Investigators. Pulmonary subtypes exhibit differential Global Initiative for Chronic Obstructive Lung Disease spirometry stage progression: the COPDGene^® study. J COPD F. 2019; 6(5): 414-429. doi: http://doi.org/10.15326/jcopdf.6.5.2019.0155

Keywords

COPD, chronic obstructive pulmonary disease, spirometry, COPD Genetic Epidemiology study, COPDGene®, subtypes, progression, airway-predominant, emphysema-predominant

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Click to read Pulmonary Subtypes Exhibit Differential Global Initiative for Chronic Obstructive Lung Disease Spirometry Stage Progression: The COPDGene^® Study

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Author Affiliations

1. Dorney-Koppel Foundation, Potomac, Maryland

Address correspondence to:

Grace Anne Dorney Koppel, MA, JD
Email: gacdk@dornkop.com

Abstract

This article does not contain an abstract.

Citation

Citation: Dorney Koppel GA. Letter to the editor: a patient perspective. J COPD F. 2019; 6(5): 433-435. doi: http://doi.org/10.15326/jcopdf.6.5.2019.0170

Keywords

COPD, chronic obstructive pulmonary disease, COPD Genetic Epidemiology, COPD diagnosis, COPDGene®, patient perspective

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Click to read Letter to the Editor: A Patient Perspective

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Author Affiliations

1. Department of Family and Community Health, University of Minnesota School of Medicine, Minneapolis
2. COPD Foundation, Washington, DC
3. Group Practice Forum, Los Angeles, California

Address correspondence to:

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

Abstract

This article does not contain an abstract.

Citation

Citation: Yawn BJ, Fromer L. Letter to the editor: a primary care perspective. J COPD F. 2019; 6(5): 436-437. doi: http://doi.org/10.15326/jcopdf.6.5.2019.0169

Keywords

COPD, chronic obstructive pulmonary disease, primary care, COPD Genetic Epidemiology, COPDGene, COPD diagnosis

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Click to read Letter to the Editor: A Primary Care Perspective

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Author Affiliations

1. Cleveland Clinic Lerner College of Medicine of Case Western Reserve School of Medicine, Cleveland, Ohio
2. National Jewish Health, Denver, Colorado
3. University of Texas Health, San Antonio
4. University of Colorado at Denver
5. Columbia University, New York, New York
6. Johns Hopkins University, Baltimore, Maryland
7. University of Pittsburgh, Pittsburgh, Pennsylvania
8. Brigham and Women's Hospital, Boston, Massachusetts
9. University of Alabama at Birmingham
10. University of Arizona Health Sciences, Tucson
11. VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
12. Baylor College of Medicine, Houston, Texas
13. Los Angeles Biomedical Research Institute at Harbor- University of California Los Angeles Medical Center, Torrance
14. Thirona, Nijmegen, The Netherlands
15. University of Iowa, Iowa City
16. University of California at San Diego
17. COPD Foundation, Washington, DC
18. Temple University, Philadelphia, Pennsylvania
19. Ann Arbor VA Medical Center, Ann Arbor, Michigan
20. Northeastern University, Boston, Massachusetts
21. Novartis Institute for Biomedical Research, Cambridge, Massachusetts
22. Morehouse School of Medicine, Atlanta, Georgia
23. Hôpital Foch, Suresnes, France
24. University of Michigan, Ann Arbor
25. Boehringer Ingelheim, Biberach an der Riss, Germany
26. University of British Columbia, Vancouver, Canada
27. University of Colorado Anschutz Medical Campus, Aurora
28. University of California-San Diego, La Jolla
29. Kangwon National University, Chuncheon, Korea
30. Boehringer-Ingelheim, Ingelheim, Germany
31. Harvard Medical School, Boston, Massachusetts
32. Duke University Health, Durham, North Carolina
33. Weill-Cornell Medicine, New York, New York
34. Minnesota Health Partners, St. Paul
35. AstraZeneca, Denver, Colorado
36. University of Washington, Seattle
37. VIDA Diagnostics, Inc, Coralville, Iowa
38. University of Florence, Florence, Italy
39. AstraZeneca, Cambridge, United Kingdom
40. University of Nebraska Medical Center, Omaha
41. Reliant Medical Group, Worcester, Massachusetts
42. University of Leeds, Leeds, United Kingdom
43. GlaxoSmithKline, Research Triangle Park, North Carolina
44. GlaxoSmithKline, Collegeville, Pennsylvania
45. COPD Foundation, Miami, Florida
46. VA Boston Healthcare System, Jamaica Plain, Massachusetts
47. Minneapolis VA, Minneapolis, Minnesota

† deceased

Address correspondence to:

James D. Crapo, MD
1400 Jackson St, K701
Denver, CO 80209
303-398-1657
Email: CrapoJ@NJHealth.org

Abstract

Background: Chronic obstructive pulmonary disease (COPD) remains a major cause of morbidity and mortality. Present-day diagnostic criteria are largely based solely on spirometric criteria. Accumulating evidence has identified a substantial number of individuals without spirometric evidence of COPD who suffer from respiratory symptoms and/or increased morbidity and mortality. There is a clear need for an expanded definition of COPD that is linked to physiologic, structural (computed tomography [CT]) and clinical evidence of disease. Using data from the COPD Genetic Epidemiology study (COPDGene^®), we hypothesized that an integrated approach that includes environmental exposure, clinical symptoms, chest CT imaging and spirometry better defines disease and captures the likelihood of progression of respiratory obstruction and mortality.

Methods: Four key disease characteristics – environmental exposure (cigarette smoking), clinical symptoms (dyspnea and/or chronic bronchitis), chest CT imaging abnormalities (emphysema, gas trapping and/or airway wall thickening), and abnormal spirometry – were evaluated in a group of 8784 current and former smokers who were participants in COPDGene^® Phase 1. Using these 4 disease characteristics, 8 categories of participants were identified and evaluated for odds of spirometric disease progression (FEV₁ > 350 ml loss over 5 years), and the hazard ratio for all-cause mortality was examined.

Results: Using smokers without symptoms, CT imaging abnormalities or airflow obstruction as the reference population, individuals were classified as Possible COPD, Probable COPD and Definite COPD. Current Global initiative for obstructive Lung Disease (GOLD) criteria would diagnose 4062 (46%) of the 8784 study participants with COPD. The proposed COPDGene^® 2019 diagnostic criteria would add an additional 3144 participants. Under the new criteria, 82% of the 8784 study participants would be diagnosed with Possible, Probable or Definite COPD. These COPD groups showed increased risk of disease progression and mortality. Mortality increased in patients as the number of their COPD characteristics increased, with a maximum hazard ratio for all cause-mortality of 5.18 (95% confidence interval [CI]: 4.15–6.48) in those with all 4 disease characteristics.

Conclusions: A substantial portion of smokers with respiratory symptoms and imaging abnormalities do not manifest spirometric obstruction as defined by population normals. These individuals are at significant risk of death and spirometric disease progression. We propose to redefine the diagnosis of COPD through an integrated approach using environmental exposure, clinical symptoms, CT imaging and spirometric criteria. These expanded criteria offer the potential to stimulate both current and future interventions that could slow or halt disease progression in patients before disability or irreversible lung structural changes develop.

Citation

Citation: Lowe KE, Regan EA, Anzueto A, et al. COPDGene 2019: redefining the diagnosis of chronic obstructive pulmonary disease. J COPD F. 2019; 6(5): 384-399. doi: http://doi.org/10.15326/jcopdf.6.5.2019.0149

Keywords

COPD, chronic obstructive pulmonary disease, spirometry, Global initiative for chronic Obstructive Lung Dis, GOLD, COPDGene, PRISm, COPD Genetic Epidemiology study, preserved ratio-impaired spirometry, COPD diagnosis

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Click to read COPDGene® 2019: Redefining the Diagnosis of Chronic Obstructive Pulmonary Disease

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Author Affiliations

1. Airway Biology and Disease Branch, Division of Lung Diseases, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland

Address correspondence to:

Thomas L. Croxton, PhD, MD
Email: croxtont@nhlbi.nih.gov

Abstract

This article does not contain an abstract.

Citation

Citation: Croxton TL. Fifty years of the Division of Lung Diseases: a program officer perspective.

Keywords

There are no keywords for this article.

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Click to read Fifty Years of the Division of Lung Diseases: A Program Officer Perspective

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Author Affiliations

1. Denver, Colorado

Address correspondence to:

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

Abstract

This article does not contain an abstract.

Citation

Citation: Balkissoon R.Journal club—COPD exacerbations and gastroesophageal reflux disease: why proton pump inhibitor therapy is not enough.

Keywords

COPD, chronic obstructive pulmonary disease, exacerbations, gastroesophageal reflux disease, proton pump inhibitor therapy

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Click to read Journal Club-- COPD Exacerbations and Gastroesophageal Reflux Disease: Why Proton Pump Inhibitor Therapy is Not Enough

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Author Affiliations

1. Johns Hopkins University School of Medicine, Baltimore, Maryland
2. University of Illinois College of Medicine, Chicago

Address correspondence to:

Robert A. Wise, MD
Johns Hopkins University School of Medicine
5501 Hopkins Bayview Circle
Baltimore, MD 21224
Phone: 410-550-0545
Email: rwise@jhmi.edu

Abstract

The National Institutes of Health (NIH)-National Heart, Lung, and Blood Institute’s (NHLBI) Division of Lung Diseases is celebrating its 50^th anniversary. On this occasion, we are reviewing the major landmark clinical trials that were initiated by the NHLBI’s Division of Lung Disease and that have had substantial impact on our understanding of chronic obstructive pulmonary disease (COPD) and how it is best treated. Although some of these trials did not show hypothesized treatment benefits for COPD, they have enabled clinicians to provide care for individuals with COPD relying on the most rigorous evidence. The 5 trials that are reviewed here are: the Intermittent Positive Pressure Breathing Trial, the Nocturnal Oxygen Treatment Trial, the Lung Health Study, the National Emphysema Treatment Trial, and the Long-term Oxygen Treatment Trial. These clinical trials have not only set the standards for COPD care but have served as models for the state-of-the-art conduct of clinical research in COPD.

Citation

Citation: Wise RA, Krishnan JA. Celebration of the 50-year anniversary of the National Heart, Lung, and Blood Institute Division of Lung Diseases: a half-century of landmark clinical trials.

Keywords

COPD, chronic obstructive pulmonary disease, clinical trials, lung volume reduction surgery, oxygen therapy, smoking cessation, positive pressure breathing

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Click to read Celebration of the 50-Year Anniversary of the National Heart, Lung, and Blood Institute Division of Lung Diseases: A Half-Century of Landmark Clinical Trials

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Author Affiliations

1. University of Illinois at Chicago
2. Los Angeles Biomedical Research Institute at Harbor-University of California-Los Angeles Medical Center, Torrance
3. Portland VA Medical Center, Portland, Oregon
4. Johns Hopkins University, Baltimore, Maryland
5. Institute for Healthcare Delivery Design, University of Illinois Hospital and Health Sciences System, Chicago

Address correspondence to:

Valentin Prieto-Centurion, MD, MS
University of Illinois at Chicago
1220 S. Wood St, MC 619
Chicago, IL 60608
Phone: (312) 413-1960
Email: vprieto@uic.edu

Abstract

Background: Low physical activity in patients with chronic obstructive pulmonary disease (COPD) is associated with increased morbidity and mortality. To inform the design of a home-based physical activity promotion program for patients with COPD recently discharged from a minority-serving hospital, we conducted a cohort study to evaluate objectively measured daily physical activity and patient-reported outcomes.

Methods: This was a 12-week prospective cohort study of patients with a physician diagnosis of COPD recently hospitalized (≤ 12 weeks) for respiratory symptoms. Daily physical activity was recorded using wrist-based and “clip-on” pedometers, and analyzed as mean daily step counts averaged over 7 days.

Results: Twenty-two patients were enrolled a median (interquartile range, [IQR]) of 14 (7 to 29) days after hospital discharge. The median daily step count (IQR) in the first week after enrollment (week 1) was 3710 (1565 to 5129) steps. The median within-person change in daily step count (IQR) from week 1 to week 12 was 314 (-30 to 858) steps (p=0.28). Within-person correlation of week-to-week daily step counts was high (r ≥ 0.75). Time from hospital discharge to enrollment was not correlated with mean daily step counts on week 1 (r= -0.13) and only weakly correlated with change in mean daily step counts from week 1 to week 12 (r=0.37).

Conclusions: Daily physical activity was variable in this cohort of recently hospitalized patients with COPD, but with little within-person change over a 12-week period. These observations highlight the need for flexible physical activity promotion programs addressing the needs of a heterogeneous patient population.

Citation

Citation: Prieto-Centurion V, Casaburi R, Coultas DB, et al. Daily physical activity in patients with COPD after hospital discharge in a minority population.

Keywords

COPD, physical activity, post-hospital discharge

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Click to read Daily Physical Activity in Patients With COPD After Hospital Discharge in a Minority Population

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Author Affiliations

1. Editor in Chief, Chronic Obstructive Pulmonary Diseases: Journal of the COPD Foundation
2. National Jewish Health, Denver, Colorado

Address correspondence to:

James D. Crapo, MD
Email: crapoj@njhealth.org

Abstract

This article does not contain an abstract.

Citation

Citation: Crapo JD. Editorial: fifty years of the Division of Lung Diseases and the evolution of pulmonary research and medicine.

Keywords

COPD, chronic obstructive pulmonary disease, NHLBI, National Heart Lung and Blood Institute, Division of Lung Diseases, DLD, pulmonary research, pulmonary training, history of pulmonary research

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Click to read Fifty Years of the Division of Lung Diseases and the Evolution of Pulmonary Research and Medicine

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Author Affiliations

1. Section of Pulmonary, Critical Care, Allergy, and Immunological Diseases, Wake Forest University School of Medicine, Winston-Salem, North Carolina
2. Division of Pulmonary Diseases and Critical Care, Department of Medicine, University of North Carolina, Chapel Hill
3. Internal Medicine & Pulmonology, Charlotte Lung & Health Center, Charlotte, North Carolina

Address correspondence to:

Jill Ohar, MD
Email: johar@wakehealth.edu
Phone: 336-406-6733

Abstract

Chronic obstructive pulmonary disease is the third leading cause of death and disease burden worldwide. It includes a spectrum of diseases including chronic bronchitis which is characterized by overproduction, hypersecretion and decreased elimination of mucus. Chronic bronchitis has numerous clinical consequences, including predisposition to lower respiratory tract infections, accelerated decline in lung function, increased exacerbation rate and decreased health-related quality of life.

Although the inflammatory mechanisms responsible for mucus cell metaplasia in chronic obstructive pulmonary disease and stable chronic bronchitis are poorly understood, the main goals of therapy are to decrease mucus hypersecretion by controlling inflammation and to increase mucus clearance. Non-pharmacological measures include smoking cessation and chest physiotherapy. Pharmacological interventions include expectorants and mucolytics together with long-acting beta2-adrenergic receptor agonists, anticholinergics, glucocorticoids, phosphodiesterase-4 inhibitors, antioxidants, and antibiotics.

Guaifenesin is an expectorant that is thought to increase hydration and decrease viscosity of mucus leading to improved clearance of accumulated secretions from the upper and lower airway. Although guaifenesin has a Food and Drug Administration Over-the-Counter (OFC) Monograph indication to "help loosen phlegm (mucus) and thin bronchial secretions in patients with stable chronic bronchitis," there is limited published evidence of either mechanism of action or clinical efficacy in this disease state. Here we review the pathophysiology and consequences of chronic mucus hypersecretion and examine the evidence for the use of guaifenesin in patients with stable chronic bronchitis.

Citation

Citation: Ohar JA, Donohue JF, Spangenthal S. The role of guaifenesin in the management of chronic mucus hypersecretion associated with stable chronic bronchitis: a comprehensive review.

Keywords

COPD, chronic bronchitis, chronic obstructive pulmonary disease, stable chronic bronchitis, chronic mucus hypersecretion, guaifenesin, expectorants

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Click to read The Role of Guaifenesin in the Management of Chronic Mucus Hypersecretion Associated with Stable Chronic Bronchitis: A Comprehensive Review

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Author Affiliations

1. Department of Preventive Medicine and Environmental Health, University of Kentucky College of Public Health, Lexington

Address correspondence to:

David M. Mannino, MD
Department of Preventive Medicine and Environmental Health
University of Kentucky
College of Public Health
111 Washington Avenue Lexington, KY 40536
Phone: 859 797 2579
E-mail: dmannino@uky.edu

Abstract

Our understanding of the epidemiology of chronic obstructive pulmonary disease (COPD), including such metrics as incidence, prevalence, risk factors, outcome, and comorbidities has increased greatly over the past 50 years. Much of this increase is attributable to National Heart Blood and Lung Institute (NHLBI)-sponsored studies. This paper will review 13 of these key studies and their contribution to our understanding of COPD in the last half century.

Citation

Citation: Mannino DM. Fifty years of progress in the epidemiology of chronic obstructive pulmonary disease: a review of National Heart, Lung, and Blood Institute-sponsored studies.

Keywords

epidemiology, NHLBI, National Heart Lung and Blood Institute, Division of Lung Diseases

Full Text

Click to read Fifty Years of Progress in the Epidemiology of Chronic Obstructive Pulmonary Disease: A Review of National Heart, Lung, and Blood Institute-Sponsored Studies

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Author Affiliations

1. Geisel School of Medicine at Dartmouth, Hanover, New Hampshire and Respiratory Services, Valley Regional Hospital, Claremont, New Hampshire
2. Wake Forest University Medical Center, Winston-Salem, North Carolina
3. Theravance Biopharma US, Inc., South San Francisco, California

Address correspondence to:

Glenn Crater, MD
Phone: 650-808-4078
Email: gcrater@theravance.com

Abstract

Background: Patients with chronic obstructive pulmonary disease (COPD) and suboptimal peak inspiratory flow rate (sPIFR) may not benefit optimally from dry powder inhalers (DPI) because of inadequate inspiratory flow. Nebulized bronchodilators may provide a better alternative. We compared bronchodilation with the long-acting muscarinic antagonist (LAMA) revefenacin for nebulization versus the DPI LAMA tiotropium, in patients with COPD and sPIFR (< 60 L/min against the resistance of Diskus^®).

Methods: This was a randomized, double-blind, double-dummy, 28-day Phase 3b study in patients with COPD enrolled based on sPIFR. The primary endpoint was trough forced expiratory volume in 1 second (FEV₁) on Day 29 for revefenacin for nebulization versus tiotropium HandiHaler^® DPI.

Results: We enrolled 206 patients with mean (standard deviation) age, 65 (8) years; percent predicted FEV₁, 37 (16)%; PIFR, 45 (12) L/min. In the intent-to-treat (ITT) population, revefenacin improved trough FEV₁ from baseline; however, the difference versus tiotropium was not significant (least squares [LS] mean difference [standard error], 17.0 [22.4] mL, P=0.4461). In a prespecified analysis of patients with FEV₁ < 50% predicted, revefenacin produced an LS mean difference (95% confidence interval [CI]), 49.1 (6.3—91.9) mL in trough FEV₁ and 103.5 (7.7—199.3) mL in forced vital capacity versus tiotropium. Revefenacin produced >100 mL increase in FEV₁ in 41.6% versus 34.4% of patients with tiotropium in ITT and 41.4% versus 25.7% of patients in FEV₁ < 50% predicted populations.

Conclusions: Revefenacin did not produce significant improvements in FEV₁ versus tiotropium in the ITT population, but increased trough FEV₁ in patients with FEV₁ < 50% predicted and sPIFR.

Clinical Trial Registration (www.Clinicaltrials.gov): Study 0149 (NCT03095456)

Citation

Citation: Mahler DA, Ohar JA, Barnes CN, Moran EJ, Pendyala S, Crater GD. Nebulizedversus dry powder long-acting muscarinic antagonist bronchodilators in patients with COPD and suboptimal peak inspiratory flow rate.

Keywords

tiotropium, long-acting muscarinic antagonist, peak inspiratory flow rate, dry powder inhalers, nebulizers

Full Text

Click to read Nebulized Versus Dry Powder Long-Acting Muscarinic Antagonist Bronchodilators in Patients With COPD and Suboptimal Peak Inspiratory Flow Rate

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Author Affiliations

1. Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
2. Clinical Research Institute of Southern Oregon, Medford, Oregon
3. Evidera, Bethesda, Maryland
4. Sunovion Pharmaceuticals Inc., Marlborough, Massachusetts

Address correspondence to:

Carole Dembek
Sunovion Pharmaceuticals Inc.
84 Waterford Drive
Marlborough, MA 01752
Phone: +1 508-357-7704
Email: carole.dembek@sunovion.com

Abstract

Background: Chronic cough, dyspnea, and excessive sputum production, the characteristic symptoms of chronic obstructive pulmonary disease (COPD), can negatively affect patients’ health-related quality of life (HRQoL). The fixed-dose combination of a long-acting beta2-adrenergic agonist and a long-acting muscarinic antagonist (LABA/LAMA) have been shown to improve HRQoL and COPD symptoms as measured by the St George’s Respiratory Questionnaire (SGRQ) and the Transition Dyspnea Index (TDI) total scores. However, the impact of a LABA/LAMA on the individual components of HRQoL and dyspnea with daily activities is unknown.

Methods: Secondary analysis of pooled data from 2 replicate, phase 3, 12-week, randomized, placebo, and active-controlled trials of twice-daily indacaterol/glycopyrrolate (IND/GLY) were analyzed. Change from baseline in HRQoL and dyspnea was measured by SGRQ and TDI, respectively. Total and component scores were evaluated using linear mixed models. Logistic regression was used to analyze the proportion of patients achieving minimum clinically important difference. Study outcomes were further explored in patient subgroups.

Results: A total of 2038 patients from FLIGHT1/FLIGHT2 studies were evaluated. IND/GLY significantly improved SGRQ component scores (symptoms [–7.3], activity [–3.6], and impacts [–5.0]); all P < 0.001 compared with placebo. IND/GLY also significantly improved symptoms scores compared with IND and GLY (–3.5 and –3.7, respectively; both P < 0.001). Patients treated with IND/GLY also had significant improvements in TDI component scores compared with placebo: functional impairment (0.48), magnitude of task (0.61), and magnitude of effort (0.54); all P < 0.001. All component scores were significantly higher for IND/GLY compared with IND and GLY (P ≤ 0.002 for all).

Conclusions: Twice-daily IND/GLY significantly improved total scores as well as components of HRQoL and dyspnea in patients with COPD. These data demonstrate multiple clinical benefits of LABA/LAMA maintenance therapy in the COPD population.

ClinicalTrials.gov: NCT 01727141 and NCT 01712516

Citation

Citation: Mahler DA, Kerwin E, Murray L, Dembek C. The impact of twice-daily indacaterol/glycopyrrolate on the components of health-related quality of life and dyspnea in patients with moderate-to-severe chronic obstructive pulmonary disease.

Keywords

chronic obstructive pulmonary disease, Transition Dyspnea Index, St George’s Respiratory Questionnaire, health-related quality of life, indacaterol/glycopyrrolate

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Click to read The Impact of Twice-Daily Indacaterol/Glycopyrrolate on the Components of Health-Related Quality of Life and Dyspnea in Patients with Moderate-to-Severe Chronic Obstructive Pulmonary Disease

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Author Affiliations

1. Advance Health Solutions, New York, New York
2. School of Professional Studies, Columbia University, New York, New York
3. Harvard Medical School and Chronic Obstructive Pulmonary Disease Center, Brigham and Women’s Hospital, Boston, Massachusetts
4. Department of Family Medicine and Public Health, Division of Health Policy, University of California San Diego, La Jolla
5. Sunovion Pharmaceuticals Inc., Marlborough, Massachusetts

Address correspondence to:

Maryam Navaie, DrPH, MBA
Advance Health Solutions, LLC
5 Penn Plaza, 23rd Floor
New York, NY 10001
Phone : (212) 835-1510
E-mail: mnavaie@advancehealthsolutions.com

Abstract

Background: Long-acting beta2-agonists (LABAs), with or without inhaled corticosteroids (ICSs), delivered by handheld inhalers or nebulizers are recommended as maintenance therapy in chronic obstructive pulmonary disease (COPD). This study evaluated exacerbations, health resource utilization (HRU), and costs among Medicare beneficiaries with COPD on handheld ICS+LABA who switched to nebulized arformoterol (ARF) or continued ICS+LABA following a respiratory event.

Methods: Using Medicare claims, we identified beneficiaries with COPD (international classification of disease, 9th revision, clinical modification [ICD-9-CM] 490-492.xx, 494.xx, 496.xx) between 2010-2014 who had ≥ 1 year of continuous enrollment in Parts A, B, and D; ≥ 2 COPD-related outpatient visits ≥ 30 days apart or ≥ 1 hospitalization(s); ICS+LABA use 90-days before ARF initiation; and a respiratory event (COPD-related hospitalization or emergency department [ED] visit < 30 days before ARF initiation). Using propensity scores, 423 beneficiaries who switched to ARF were matched to 423 beneficiaries who continued on handheld ICS+LABA (controls). Difference-in-difference regression models examined outcomes at 180-days follow-up.

Results: Beneficiaries who switched to ARF had 1.5 fewer exacerbations (p=0.015) but no difference in hospitalizations and ED visits compared to controls. Durable medical equipment (DME) costs were higher among ARF users than controls ($1590), yet total health care costs were similar due to cost offsets by ARF in pharmacy (-$794), inpatient (-$524), and outpatient care (-$65). ARF accounted for 55% ($886.63) of DME costs, with the remaining costs attributed to oxygen therapy ($428.10) and nebulized corticosteroids ($590.85).

Conclusions: Switching from handheld ICS+LABA to nebulized ARF resulted in fewer COPD exacerbations among Medicare beneficiaries. Nebulized LABAs may improve outcomes in selected patients with COPD.

Citation

Citation: Navaie M, Celli BR, Xu Z, Cho-Reyes S, Dembek C, Gilmer TP. Exacerbations, health resource utilization, and costs among Medicare beneficiaries with chronic obstructive pulmonary disease treated with nebulized arformoterol following a respiratory event.

Keywords

chronic obstructive pulmonary disease, exacerbations, hospitalization, long-acting beta2-agonists, Medicare, nebulized therapy, arformoterol, health resource utilization, costs, durable medical equipment

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Click to read Exacerbations, Health Resource Utilization, and Costs Among Medicare Beneficiaries with Chronic Obstructive Pulmonary Disease Treated with Nebulized Arformoterol Following a Respiratory Event

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Author Affiliations

1. Denver, Colorado

Address correspondence to:

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

Abstract

This article does not contain an abstract.

Citation

Citation: Balkissoon R.Journal club—electronic cigarettes and vaping as a harm reduction alternative: really? J COPD F. 2019; 6(3): 281-291. doi: http://doi.org/10.15326/jcopdf.6.3.2019.0143

Keywords

COPD, chronic obstructive pulmonary disease, vaping, electronic cigarettes, e-cigarettes, nicotine addiction, JUULing

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Click to read Journal Club—Electronic Cigarettes and Vaping as a Harm Reduction Alternative: Really?

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Author Affiliations

1. Division of Behavioral Health, Department of Pediatrics, National Jewish Health, Denver, Colorado

Address correspondence to:

Bruce G. Bender, PhD
National Jewish Health
1400 Jackson Street
Denver, CO 80206
Ph: 303-398-1697
E-mail: benderb@njhealth.org

Abstract

This article does not contain an abstract.

Citation

Citation: Bender B. Editorial--How important are inhaler technique errors? J COPD F. 2019; 6(3): 203-205. doi: http://doi.org/10.15326/jcopdf.6.3.2019.0142

Keywords

COPD, chronic obstructive pulmonary disease, asthma, inhaler errors, metered-dose inhalers, MDIs

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Click to read Editorial--How Important Are Inhaler Technique Errors?

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Author Affiliations

1. Advance Health Solutions, LLC, New York, New York
2. Harvard Medical School, Boston, Massachusetts and Chronic Obstructive Pulmonary Disease Center, Brigham and Women’s Hospital, Boston, Massachusetts
3. Global Health Economics and Outcomes Research, Sunovion Pharmaceuticals, Inc., Marlborough, Massachusetts
4. Columbia University, School of Professional Studies, New York, New York

Address correspondence to:

Maryam Navaie, DrPH, MBA
Chief Global Strategy Officer
Advance Health Solutions, LLC
5 Penn Plaza, 23rd Floor
New York, NY 10001
Phone: (212) 835-1510
E-mail: mnavaie@advancehealthsolutions.com

Abstract

Background: Metered dose inhalers (MDIs) are commonly prescribed for inhalation therapy, but correct use is critical to promoting effective medication delivery. This systematic literature review and meta-analysis evaluates the overall and step-by-step prevalence of errors among adults with obstructive lung diseases in the United States who used MDIs.

Methods: Electronic and manual searches conducted between 1979-2018 using PubMed, EMBASE, PsycINFO, Cochrane, and Google identified 10 articles that met the following inclusion criteria: (a) English language, (b) U.S. adults diagnosed with chronic obstructive pulmonary disease, and (c) MDI use error rates. Meta-analytic techniques using random-effects models were applied to calculate effect sizes, weighted proportions, and 95% confidence intervals (CIs). Heterogeneity was assessed by the I² statistic.

Results: Aggregate findings revealed that 86.7% of patients (n=390, 95% CI 77.5-96.0) made at least 1 inhalation technique error, and 76.9% (n=885, 95% CI 65.8-87.9) incorrectly performed ≥ 20% of device use steps. The most prevalent step-by-step errors across the studies (n=1105) were failure to: (a) exhale fully and away from the inhaler before inhalation (65.5% [95% CI 52.0, 78.9]); (b) hold breath for 5-10 seconds (41.9% [95% CI 29.8, 53.9]); (c) inhale slowly and deeply (39.4% [95% CI 26.2, 52.5]); (d) exhale after inhalation (35.9% [95% CI 17.0, 54.8]); and (e) shake the inhaler before use (34.2% [95% CI 30.6, 37.7]).

Conclusions: Across the studies used in this meta-analysis more than three-fourths of U.S. adults with obstructive lung diseases used MDIs incorrectly. Our findings suggest the need for ongoing patient education and consideration of alternative devices to mitigate errors.

Citation

Citation: Cho-Reyes S, Celli BR, Dembek C, Yeh K, Navaie M. Inhalation technique errors with metered-dose inhalers among patients with obstructive lung diseases: a systematic review and meta-analysis of U.S. studies. J COPD F. 2019; 6(3): 267-280. doi: http://doi.org/10.15326/jcopdf.6.3.2018.0168

Keywords

COPD, chronic obstructive pulmonary disease, asthma, systematic literature review, meta-analysis, inhaler errors, nebulizers, inhalation technique, handheld inhalers, metered-dose inhaler errors, MDI errors, inhaler education

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Click to read Inhalation Technique Errors with Metered-Dose Inhalers Among Patients with Obstructive Lung Diseases: A Systematic Review and Meta-Analysis of U.S. Studies

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Author Affiliations

1. Los Angeles Biomedical Research Institute, Harbor-University of California, Los Angeles Medical Center, Torrance
2. Division of Pulmonary, Allergy, and Critical Care Medicine and Lung Health Center, University of Alabama, Birmingham
3. Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland
4. Department of Medicine, National Jewish Health, Denver, Colorado

Address correspondence to:

William W. Stringer, MD
Los Angeles Biomedical Research Institute,
Harbor-UCLA Medical Center
1124 West Carson Street
CDCRC Rm # 213
Torrance, CA 90502
Email: stringer@ucla.edu

Abstract

COPD Genetic Epidemiology Study (COPDGene^®) manuscripts have provided important insights into chronic obstructive pulmonary disease (COPD) pathophysiology and outcomes, including a better understanding of COPD phenotypes relating computed tomography (CT) anatomic data to spirometric and patient-reported outcomes. Spirometry significantly underdiagnoses smoking-induced lung disease, and there is a marked improvement in sensitivity and specificity with CT scanning. This review also highlights the COPDGene^® exploration of specific spirometry phenotypes (e.g.,PRISm), contributors to spirometric decline, composite physiologic measures, asthma-COPD overlap (ACO) syndrome, consequences of bronchodilator responsiveness, newer methods to assess small airway dysfunction, and spirometric correlates of comorbid diseases such as obesity and diabetes.

Citation

Citation: Stringer WW, Porszasz J, Bhatt SP, McCormack MC, Make BJ, Casaburi R. Physiologic insights from the COPD Genetic Epidemiology study. J COPD F. 2019; 6(3): 256-266. doi: http://doi.org/10.15326/jcopdf.6.3.2019.0128

Keywords

COPD, chronic obstructive pulmonary disease, COPD Genetic Epidemiology, COPDGene, PRISm, asthma-COPD overlap, Preserved Ratio Impaired Spirometry

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Click to read Physiologic Insights from the COPD Genetic Epidemiology Study

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Author Affiliations

1. Institute for Applied Health Research, University of Birmingham, Birmingham, United Kingdom
2. HerediLab Inc., Salt Lake City, Utah
3. University Birmingham NHS Foundation Trust, Birmingham, United Kingdom

Address correspondence to:

Paul R. Ellis, MBChB, MRCP
Institute for Applied Health Research
University of Birmingham
B15 2TT
Birmingham, United Kingdom
Email: p.ellis@bham.ac.uk
Phone: 44+121 371 3886

Abstract

This article does not contain an abstract.

Citation

Citation: Ellis PR, Campbell EJ, Turner AM, Stockley RA. Alpha-1 antitrypsin deficiency: a predisposing factor for the development of pulmonary Langerhans cell histiocytosis? J COPD F. 2019; 6(3): 206-209. doi: http://doi.org/10.15326/jcopdf.6.3.2019.0129

Keywords

inflammation, alpha-1 antitrypsin deficiency, pulmonary Langerhans cell histiocytosis

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Click to read Alpha-1 Antitrypsin Deficiency: A Predisposing Factor for the Development of Pulmonary Langerhans Cell Histiocytosis

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Author Affiliations

1. Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina, Charleston
2. Optum, Inc., Eden Prairie, Minnesota
3. AstraZeneca, Wilmington, Delaware

Address correspondence to:

Valery Walker
Optum, Inc.
11000 Optum Circle
Eden Prairie, MN 55344
Email: Valery.walker@optum.com

Abstract

Introduction: Patients with chronic obstructive pulmonary disease (COPD) increasingly receive combination bronchodilator therapies. Real world evidence for the benefits of combination therapy compared to monotherapy is lacking.

Methods: COPD patients aged ≥ 40 years initiating monotherapy (MT) with either a long-acting muscarinic antagonist (LAMA) or long-acting beta2-agonist (LABA) or dual therapy (DT) with a LAMA/LABA fixed dose combination (FDC) between January 1, 2016 and December 31, 2016 were identified from a large U.S. administrative claims database. Patients diagnosed with cystic fibrosis, idiopathic pulmonary fibrosis, or asthma were excluded. Cohorts were propensity score matched 1:1 using baseline measures (e.g., exacerbations, hospitalizations) as proxies for COPD severity to create balanced cohorts.

Results: Following propensity score matching (PSM), 1286 patients remained in each cohort for analysis. Patients were followed for approximately 1 year. Patients in the DT versus MT cohort had lower rates of exacerbations leading to hospitalization (incidence rate ratio 0.7886; p=0.019), lower mean COPD-related pharmacy costs per patient per month (PPPM) ($300 versus $379, respectively; p<0.001) and total costs PPPM ($990 versus $1203, respectively; p=0.003). This occurred despite lower mean COPD-related pharmacy fills PPPM in the DT versus MT cohorts (1.41 versus 1.51, respectively; p=0.038). Patients in the DT cohort had lower rates of switching (p<0.001) and augmentation (p<0.001), and higher rates of non-persistence (p<0.001) versus the MT cohort. Rates of discontinuation were similar.

Conclusions: Patients in the DT cohort had lower rates of exacerbations leading to hospitalization, lower COPD-related pharmacy and total costs PPPM, and lower rates of switching and augmentation compared to patients in the MT cohort.

Citation

Citation: Strange C, Walker V, Tong J, et al. A retrospective claims analysis of dual bronchodilator fixed-dose combination versus bronchodilator monotherapy in patients with chronic obstructive pulmonary disease. J COPD F. 2019; 6(3): 221-232. doi: http://doi.org/10.15326/jcopdf.6.3.2018.0160

Keywords

COPD, chronic obstructive pulmonary disease, long-acting muscarinic antagonist, LABA, long-acting beta2-agonist, LAMA, fixed-dose combination, LAMA/LABA, administrative claims, retrospective analysis

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Click to read A Retrospective Claims Analysis of Dual Bronchodilator Fixed-Dose Combination Versus Bronchodilator Monotherapy in Patients with Chronic Obstructive Pulmonary Disease

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Author Affiliations

1. Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, University of Texas Medical Branch, Galveston
2. Office of Biostatistics, University of Texas Medical Branch, Galveston
3. Sealy Center of Aging, University of Texas Medical Branch, Galveston

Address correspondence to:

Alexander G. Duarte, MD
Division of Pulmonary, Critical Care and Sleep Medicine
University of Texas Medical Branch
301 University Blvd., 5.140 John Sealy Annex
Galveston, Texas 77555-0561
Email: aduarte@utmb.edu

Abstract

Objectives: Determine the prevalence of suboptimal peak inspiratory flow rate (PIFR) and associated patient characteristics and compare PIFR measurements obtained with spirometry and In-Check DIAL^® device in ambulatory patients with COPD.

Methods: Patients underwent PIFR measurement with In-Check DIAL^® device and pulmonary function testing with calibrated equipment. Group characteristics and lung function were compared for patients with suboptimal (≤ 60 L/min) and optimal (> 60 L/min) PIFR. Receiver operating curve analysis determined the best maximal forced inspiratory flow (FIF max) value in identifying optimal PIFR by gender and height.

Results: From July 1, 2016 to January 31, 2018, a total of 303 patients with chronic obstructive pulmonary disease (COPD) had PIFR and pulmonary function measurements. Group mean age was 65.5 ± 11.3 years with equal gender distribution. Suboptimal PIFR was observed in 61 (20.1%) patients. A significant correlation was observed between PIFR and FIF max, inspiratory capacity and residual volume (RV) to total lung capacity (TLC) ratio.

In the suboptimal PIFR group, mean FIF max measured by spirometry was significantly less compared with the optimal PIFR group; 178.5 ± 56.9 L/min and 263.4 ± 89.9 L/min, respectively (p<0.0001). Receiver operator curve analysis of FIF max to identify an optimal PIFR yielded an area under the curve of 0.79. Males < 65 inches had a suboptimal PIFR in 16.7 % of the male cohort, while females < 65 inches had a suboptimal PIFR in 27.4 % of the women.

Conclusions: Suboptimal PIFR was present in 1 in 5 stable patients with COPD and was more frequent in short statured females. Spirometry determined FIF max was associated with PIFR based on gender and height.

Citation

Citation: Duarte AD, Tung L, Zhang W, Hsu ES, Kuo Y-F, Sharma G. Spirometry measurement of peak inspiratory flow identifies suboptimal use of dry powder inhalers in ambulatory patients with COPD. J COPD F. 2019; 6(3): 246-255. doi: http://doi.org/10.15326/jcopdf.6.3.2018.0163

Keywords

COPD, chronic obstructive pulmonary disease, peak inspiratory flow rate, inhalation therapy, dry powder inhaler, pulmonary function test

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Click to read Spirometry Measurement of Peak Inspiratory Flow Identifies Suboptimal Use of Dry Powder Inhalers in Ambulatory Patients with COPD

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Author Affiliations

1. Division of Pulmonary Medicine National Jewish Health, Denver, Colorado
2. School of Public Health, University of Colorado, Denver
3. Division of Cardiology, Harbor-University of California-Los Angeles Medical Center, Los Angeles
4. Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor
5. Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
6. Pulmonary and Critical Care Medicine, Ann Arbor Healthcare System, Ann Arbor, Michigan
7. Edinburgh Imaging, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, Scottland
8. Channing Division of Network Medicine, Brigham Women’s Hospital, Boston, Massachusetts

Address correspondence to:

Elizabeth A. Regan, MD, PhD
National Jewish Health
1400 Jackson St, K706
Denver, CO 80206
ReganE@NJHealth.org
Phone: 303-398-1531

Abstract

Background: Lung cancer screening (LCS) via chest computed tomography (CT) scans can save lives by identifying early-stage tumors. However, most smokers die of comorbid smoking-related diseases. LCS scans contain information about smoking-related conditions that is not currently systematically assessed. Identifying these common comorbid diseases on CT could increase the value of screening with minimal impact on LCS programs. We determined the prevalence of 3 comorbid diseases from LCS eligible scans and quantified related adverse outcomes.

Methods: We studied COPD Genetic Epidemiology study (COPDGene^®) participants (n=4078) who met criteria for LCS screening at enrollment (age > 55 years, and < 80 years, > 30 pack years smoking, current smoker or former smoker within 15 years of smoking cessation). CT scans were assessed for coronary artery calcification (CAC), emphysema, and vertebral bone density. We tracked the following clinically significant events: myocardial infarctions (MIs), strokes, pneumonia, respiratory exacerbations, and hip and vertebral fractures.

Results: Overall, 77% of eligible CT scans had one or more of these diagnoses identified. CAC (> 100 mg) was identified in 51% of scans, emphysema in 44%, and osteoporosis in 54%. Adverse events related to the underlying smoking-related diseases were common, with 50% of participants reporting at least one. New diagnoses of cardiovascular disease, emphysema and osteoporosis were made in 25%, 7% and 46%, of participants respectively. New diagnosis of disease was associated with significantly more adverse events than in participants who did not have CT diagnoses for both osteoporosis and cardiovascular risk.

Conclusions: Expanded analysis of LCS CT scans identified individuals with evidence of previously undiagnosed cardiovascular disease, emphysema or osteoporosis that corresponded with adverse events. LCS CT scans can potentially facilitate diagnoses of these smoking-related diseases and provide an opportunity for treatment or prevention.

Citation

Citation: Regan EA, Lowe KE, Make BJ, et al and the COPDGene investigators. Identifying smoking-related disease on lung cancer screening CT scans: increasing the value. J COPD F. 2019; 6(3): 233-245. doi: http://doi.org/10.15326/jcopdf.6.3.2018.0142

Keywords

COPD, chronic obstructive pulmonary disease, comorbidities, lung cancer screenings, smoking-related disease

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Click to read Identifying Smoking-Related Disease on Lung Cancer Screening CT Scans: Increasing the Value

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Author Affiliations

1. Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University, New York
2. Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, Colorado
3. Division of Pulmonary Diseases and Critical Medicine, Department of Medicine, University of North Carolina, Chapel Hill
4. Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan Health System, Ann Arbor
5. Asthma and COPD Program, Northwestern University Feinberg School of Medicine, Chicago, Illinois
6. COPD Foundation, Washington, D.C.
7. GlaxoSmithKline, Philadelphia, Pennsylvania and Department of Preventative Medicine and Environmental Health University of Kentucky, College of Public Health, Lexington
8. Early Clinical Development, IMED Biotech Unit, AstraZeneca, Cambridge, United Kingdom and Department of Medicine, University of Nebraska Medical Center, Omaha
9. Division of Pulmonary Allergy and Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
10. Pulmonary and Critical Care, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland

Address correspondence to:

Byron Thomashow, MD
Email: bmt1@cumc.columbia.edu
Phone: (212)305-5261

Abstract

The COPD Foundation has tried to address gaps in chronic obstructive pulmonary disease (COPD) care by providing COPD Pocket Consultant Guide cards to U.S. health care providers. Since launching the card in 2007, there have been numerous updates and more than 800,000 of these cards have been distributed at no charge to health care professionals. The most recent versions have concentrated on presenting an algorithm for COPD management based on 7 severity domains: spirometry, symptoms, exacerbations, oxygen requirements, the presence of chronic bronchitis or emphysema and comorbidities. To increase the usability and reach of this tool, the COPD Pocket Consultant Guide is now available as an app for iOS and Android. This updated version of the app includes new COPD and asthma/COPD overlap flow charts; an interactive therapy chart that takes into account modified Medical Research Council (mMRC), COPD Assessment Test (CAT), and spirometry scores; anxiety and depression screeners; up-to-date medication charts in both brand and generic formats; a checklist to aid in determining when a patient should be referred to a pulmonologist and more. Potential use of the COPD Pocket Consultant Guide app in clinical care is discussed.

Citation

Citation: Thomashow B, Crapo JD, Drummond MB, et al. Introducing the new COPD Pocket Consultant Guide app: can a digital approach improve care? A statement of the COPD Foundation. J COPD F. 2019; 6(3): 210-220. doi: http://doi.org/10.15326/jcopdf.6.3.2018.0167

Keywords

COPD, chronic obstructive pulmonary disease, exacerbations, acute exacerbation of COPD, AECOPD, depression, Pocket Consultant Guide, app, management, maintenance, medication, anxiety

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Click to read Introducing the New COPD Pocket Consultant Guide App: Can A Digital Approach Improve Care? A Statement of the COPD Foundation

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Author Affiliations

1. Denver, Colorado

Address correspondence to:

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

Abstract

This article does not contain an abstract.

Citation

Citation: Balkissoon R. .Journal club - bronchiectasis/COPD overlap: syndrome versus treatable trait? J COPD F. 2019; 6(2): 193-199. doi: http://doi.org/10.15326/jcopdf.6.2.2019.0134

Keywords

COPD, chronic obstructive pulmonary disease, bronchiectasis, overlap syndrome

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Click to read Journal Club - Bronchiectasis/COPD Overlap: Syndrome Versus Treatable Trait?

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Author Affiliations

1. Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania

Address correspondence to:

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

Abstract

This article does not contain an abstract.

Citation

Citation: Marron RM, Vega Sanchez ME. Images in COPD: asthma-COPD overlap syndrome. J COPD F. 2019; 6(2): 200-202. doi: http://doi.org/10.15326/jcopdf.6.2.2018.0169

Keywords

COPD, chronic obstructive pulmonary disease, asthma-COPD overlap syndrome, ACOS, high-resolution computed tomography, CT densitometry

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Click to read Asthma-COPD Overlap Syndrome

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Author Affiliations

1. Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Medical University of South Carolina, Charleston

Address correspondence to:

Charlie Strange, MD
Division of Pulmonary, Critical Care, Allergy and Sleep Medicine
Medical University of South Carolina
MSC630, 96 Jonathan Lucas St
Charleston, SC, 29425
Email:strangec@musc.edu
Phone: 843-792-3174

Abstract

This article does not contain an abstract.

Citation

Citation: Strange C. Rare disease registries: steps forward. J COPD F. 2019; 6(2): 126-128. doi: http://doi.org/10.15326/jcopdf.6.2.2019.0133

Keywords

alpha-1 antitrypsin deficiency, bronchiectasis, registry, ciliary, immunodeficiency

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Click to read Rare Disease Registries: Steps Forward

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Author Affiliations

1. Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania

Address correspondence to:

Yaniv Dotan, MD, PhD
Department of Thoracic Medicine and Surgery
Temple University Hospital
3401 N Broad Street
Philadelphia, PA 19140
Email: Yaniv.dotan@sluhn.org
Phone:(484)795-6446

Abstract

This article does not contain an abstract.

Citation

Citation: Dotan Y, So JY, Kim V. Chronic bronchitis: where are we now? J COPD F. 2019; 6(2): 178-192. doi: http://doi.org/10.15326/jcopdf.6.2.2018.0151

Keywords

COPD, chronic bronchitis, chronic obstructive pulmonary disease, cigarette smoking

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Click to read Chronic Bronchitis: Where Are We Now?

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Author Affiliations

1. Pulmonary Research Institute of Southeast Michigan, Farmington Hills
2. South Carolina Pharmaceutical Research, Spartanburg
3. Sherman Clinical Research, Sherman, Texas
4. Theravance Biopharma US, Inc., South San Francisco, California

Address correspondence to:

Gary T. Ferguson, MD
Suite A
29255 West 10 Mile Road
Farmington Hills, MI 48336
Email: garytferguson@msn.com
Phone: (248) 478-6561

Abstract

Background: Revefenacin, a novel, lung-selective, long-acting muscarinic antagonist, has been developed for nebulized therapy for chronic obstructive pulmonary disease (COPD). We present the results of replicate Phase III efficacy and safety studies of revefenacin in patients with moderate to very severe COPD.

Methods: In 2 double-blind, parallel-group studies, (Study 0126 and Study 0127), patients ≥ 40 years old were randomized to revefenacin 88 μg, revefenacin 175 μg or placebo administered once daily by standard jet nebulizer for 12 weeks. The primary endpoint was 24-hour trough forced expiratory volume in 1 second (FEV₁) on day 85. Secondary efficacy endpoints included overall treatment effect (OTE) on trough FEV₁ and peak FEV₁ (0-2 hours after first dose). Safety assessments included treatment-emergent adverse events.

Results: At day 85, revefenacin 88 µg and 175 µg improved trough FEV₁ versus placebo in Study 0126 (by 79 mL [p=0.0003] and 146 mL [p<0.0001]) and Study 0127 (by 160 mL and 147 mL; both p<0.0001). Compared with placebo, pooled data of revefenacin 88 µg and 175 µg increased OTE trough FEV₁ by 115 mL and 142 mL (both p<0.001) and increased peak FEV₁ by 127 mL and 129 mL (both p<0.0001). Revefenacin 175 µg demonstrated greater improvements in FEV₁ in concomitant long-acting beta2-agonist patients and in more severe patients than revefenacin 88 µg. Adverse events were minor.

Conclusions: Revefenacin, administered once daily for 12 weeks to patients with moderate to very severe COPD, demonstrated clinically significant improvements in trough FEV₁ and OTE FEV₁. Revefenacin was generally well tolerated with no major safety concerns.

Citation

Citation: Ferguson GT, Feldman G, Pudi KK, et al. Improvements in lung function with nebulized revefenacin in the treatment of patients with moderate to very severe COPD: results from two replicate phase III clinical trials. J COPD F. 2019; 6(2): 154-165. doi: http://doi.org/10.15326/jcopdf.6.2.2018.0152

Keywords

COPD, chronic obstructive pulmonary disease, forced expiratory volume in 1 second, FEV₁, Revefenacin, nebulized therapy, Phase III randomized controlled trial

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Click to read Improvements in Lung Function with Nebulized Revefenacin in the Treatment of Patients with Moderate to Very Severe COPD: Results from Two Replicate Phase III Clinical Trials

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Author Affiliations

1. Icahn School of Medicine Mt Sinai, New York, New York
2. University of Kentucky College of Public Health, Lexington
3. Oregon Health Sciences University Hospital, Portland
4. New York University School of Medicine, New York
5. Pulmonary Disease and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota
6. Division of Mycobacterial and Respiratory Infections, National Jewish Health, Denver, Colorado
7. University of North Carolina at Chapel Hill
8. Columbia College of Physicians and Surgeons, Center for Chest Disease, New York, New York
9. National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland
10. University of Texas at Tyler
11. Mayo Clinic Florida, Pulmonary and Critical Care, Jacksonville
12. Division of Pulmonary and Critical Care Medicine, University of Connecticut School of Medicine, Farmington
13. Georgetown University Medical Center, Washington, DC
14. University of Kansas Medical School, Kansas City
15. University of Miami Miller School of Medicine, Miami, Florida
16. University of Pennsylvania Perelman School of Medicine, Philadelphia
17. Department of Infectious Disease, Oregon Health and Science University School of Medicine, Portland

Address correspondence to:

Edward Eden, MBBS
Division of Pulmonary, Critical Care and Sleep Medicine
Mt Sinai West, Room # 3A-55
1000 10^th Avenue
New York, NY 10019
Phone: 212-523-7341
Email: edward.eden@mountsinai.org

Abstract

Objective: This study compares and contrasts the clinical features of non-cystic fibrosis bronchiectasis with 3 uncommon disorders known to be associated with bronchiectasis but with distinctly different underlying defined pathophysiologic derangements, namely severe alpha-1 antitrypsin deficiency (AATD), common variable immunodeficiency (CVI) and primary ciliary dyskinesia (PCD).

Methods: The Bronchiectasis Research Registry provides a central database for studying patients with non-cystic fibrosis bronchiectasis. This report consists of information from 13 U.S. sites pertaining to the 3 study diagnoses. Patients with AATD (SZ and ZZ phenotypes only), CVI (patients with IgG≤500), PCD (history of physician diagnosed Kartagener’s syndrome or PCD), and patients with confirmed absence of the above 3 diagnoses (idiopathic control group) were included in the study. Descriptive statistics were computed for the main demographic and clinical characteristics of the sample stratified by group. Values between the groups were compared using Kruskal-Wallis test, and Chi-squared/ Fisher’s exact tests respectively. The significance level was set at 0.05. Software SAS 9.4 was used to perform the statistical analyses.

Results: Of the 2170 participants in the database enrolled as of January 2017, 615 respondents had sufficient data and were included in the analyses. Patients with PCD (n=79, mean age 41.9 years [standard deviation (SD)=14.5]) were significantly younger than patients with AATD (n=58, mean age 66.9 [SD=10.7]), CVI (n=18, mean age 66.7 years [SD=10.5]) or the idiopathic group (n=460, mean age 64.2 [SD=15.9]), p<.0001. Compared to other groups, those with PCD had lower pulmonary function (forced expiratory volume in 1 second [FEV₁] forced vital capacity [FVC] and FEV1/FVC ratio) (p<0.01), and a greater proportion of them reported having exacerbations and/or hospitalizations in the past 2 years (p<0.01). Overall, Pseudomonas aeruginosa and Staphylococcus aureus were the organisms most commonly isolated from sputum. Mycobacterial infection was most commonly reported in those with AATD.

Conclusions: This report from the U.S. Bronchiectasis Research Registry compares and contrasts differences in the clinical features of patients suffering from 3 rare conditions, with different underlying causes, to those without. The group with PCD had more symptoms, greater morbidity, lower lung function and more commonly were infected by Pseudomonas aeruginosa. A greater percentage of those with AATD reported mycobacterial lung involvement.

Citation

Citation: Eden E, Choate R, Barker A, et al. The clinical features of bronchiectasis associated with alpha-1 antitrypsin deficiency, common variable immunodeficiency and primary ciliary dyskinesia--results from the U.S. Bronchiectasis Research Registry. J COPD F. 2019; 6(2): 145-153. doi: http://doi.org/10.15326/jcopdf.6.2.2018.0156

Keywords

alpha-1 antitrypsin deficiency, bronchiectasis, Bronchiectasis Research Registry, common variable immunodeficiency, primary ciliary dyskinesia

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Click to read The Clinical Features of Bronchiectasis Associated with Alpha-1 Antitrypsin Deficiency, Common Variable Immunodeficiency and Primary Ciliary Dyskinesia--Results from the U.S. Bronchiectasis Research Registry

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Author Affiliations

1. CIRO, Center of Expertise for Chronic Organ Failure, Horn, The Netherlands
2. Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
3. Centre of Expertise for Palliative Care, Maastricht University Medical Center, Maastricht, The Netherlands
4. COPD Center, Sahlgrenska University Hospital and Institute of Medicine, Gothenburg University, Gothenburg, Sweden

Address correspondence to:

Dr. Sarah Houben-Wilke
Hornerheide 1
6085 NM Horn
The Netherlands
Email: sarahwilke@ciro-horn.nl
Phone: +31 (0)475 587 602

Abstract

Beyond respiratory impairment, patients with chronic obstructive pulmonary disease (COPD) often suffer from comorbidities which are associated with worse health status, higher health care costs and worse prognosis. Reported prevalences of comorbidities largely differ between studies which might be explained by different assessment methods (objective assessment, self-reported assessment, or assessment by medical records), heterogeneous study populations, inappropriate control groups, incomparable methodologies, etc. This narrative review demonstrates and further evaluates the variability in prevalence of several comorbidities in patients with COPD and control individuals and discusses several shortcomings and pitfalls which need to be considered when interpreting comorbidity data. Like in other chronic organ diseases, the accurate diagnosis and integrated management of comorbidities is a key for outcome in COPD. This review highlights that there is a need to move from the starting point of an established index disease towards the concept of the development of multimorbidity in the elderly including COPD as an important and highly prevalent pulmonary component.

Citation

Citation: Houben-Wilke S, Triest FJJ, Franssen FME, Janssen DJA, Wouters EFM, Vanfleteren LEGW. Revealing methodological challenges in chronic obstructive pulmonary disease studies assessing comorbidities: a narrative review. J COPD F. 2019; 6(2): 166-177. doi: http://doi.org/10.15326/jcopdf.6.2.2018.0145

Keywords

COPD, chronic obstructive pulmonary disease, comorbidity, multimorbidity, methodology, bias, control group

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Click to read Revealing Methodological Challenges in Chronic Obstructive Pulmonary Disease Studies Assessing Comorbidities: A Narrative Review

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Author Affiliations

1. Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
2. Institute for Health Care Delivery Science at Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York

Address correspondence to:

Sidney Braman, MD
Division of Pulmonary, Critical Care & Sleep Medicine
Icahan School of Medicine at Mount Sinai
5th Floor, Rm 5-20
Annenberg Bldg
1468 Madison Avenue
New York, NY 10029
Email: sidney.braman@mssm.edu

Abstract

We evaluated whether visiting a primary care provider (PCP) or medical subspecialist within 10 days of discharge reduces 30-day readmissions following hospitalization for acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Data were retrospectively collected from electronic health records for AECOPD-related hospitalizations at an urban, academic medical center for patients 40 years of age or older between June 2011 and June 2016. Primary outcome was probability of all-cause 30-day readmission. Follow-up was defined as visiting a PCP or any medical subspecialist within 10 days of discharge. Generalized linear mixed models were used to examine the association between hospital readmissions and a visit to a PCP or medical subspecialist. Of the 2653 hospital discharges, 17.6% (n=468) had a 30-day readmission. Follow-up did not affect 30-day readmission risk (adjusted odds ratio 1.14; 95% confidence interval 0.89, 1.47). Prompt follow-up is not associated with a reduced risk of 30-day readmission following AECOPD, highlighting the need for a comprehensive approach to chronic obstructive pulmonary disease (COPD).

Citation

Citation: Budde J, Agarwal P, Mazumdar M, Braman SS. Follow-up soon after discharge may not reduce COPD readmissions. J COPD F. 2019; 6(2): 129-131. doi: http://doi.org/10.15326/jcopdf.6.2.2018.0149

Keywords

COPD, chronic obstructive pulmonary disease, hospital readmissions, acute exacerbation of COPD, AECOPD, physician follow-up, health care delivery

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Click to read Follow-up Soon After Discharge May Not Reduce COPD Readmissions

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