Journal of the COPD Foundation

Click to read Race and Gender Disparities are Evident in COPD Underdiagnoses Across all Severities of Measured Airflow Obstruction

A. James Mamary, MD¹ Jeffery I. Stewart, MD¹ Gregory L. Kinney, PhD² John E. Hokanson, PhD² Kartik Shenoy, MD¹ Mark T. Dransfield, MD³ Marilyn G. Foreman, MD, MS⁴ Gwendolyn B. Vance, RN¹ Gerard J. Criner, MD¹ for the COPDGene® Investigators

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Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine, Temple University Health System, Philadelphia, Pennsylvania
Department of Epidemiology, Colorado School of Public Health, Anschutz Medical Campus, University of Colorado, Aurora
Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama, Birmingham
Division of Pulmonary and Critical Care Medicine, Morehouse School of Medicine, Atlanta, Georgia

Address correspondence to:

A. James Mamary, MD
Temple Lung Center 745
Parkinson Pavilion 3401
North Broad Street Philadelphia Pa, 19140
Phone: 215-707-3332
Email: albert.mamary@tuhs.temple.edu

Abstract

The COPD Genetic Epidemiology (COPDGene®) study provides a rich cross-sectional dataset of patients with substantial tobacco smoke exposure, varied by race, gender, chronic obstructive pulmonary disease (COPD) diagnosis, and disease. We aimed to determine the influence of race, gender and Global initiative for chronic Obstructive Lung Disease (GOLD) stage on prevalence of prior COPD diagnosis at COPDGene® enrollment. Data from the complete phase 1 cohort of 10,192 participants were analyzed. Participants were non-Hispanic white and African-American, ≥45 years of age with a minimum of 10 pack years of cigarette smoking. Characterization upon enrollment included spirometry, demographics and history of COPD diagnosis determined by questionnaire. We evaluated the effects of race and gender on the likelihood of prior diagnosis of COPD and the interaction of race and GOLD stage, and gender and GOLD stage, as determined at study enrollment, on likelihood of prior diagnosis of COPD. We evaluated the 3-way interaction of race, gender and GOLD stage on prior diagnosis. African-Americans had higher odds of not having a prior COPD diagnosis at all GOLD stages of airflow obstruction versus non-Hispanic whites (p<0.0001). Women had higher odds of having a prior COPD diagnosis at all GOLD stages versus men (p<0.0001). Three-way interaction of race, gender and GOLD stage was not significant. African-Americans were less likely to have prior COPD regardless of the severity of airflow obstruction determined at study enrollment. Women were more likely to have a prior COPD diagnosis regardless of the severity of measured airflow obstruction. Race and gender are associated with significant disparities in COPD diagnosis.

Citation

Citation: Mamary AJ, Stewart JI, Kinney GL, et al for the COPDGene investigators. Race and gender disparities are evident in COPD underdiagnoses across all severities of measured airflow obstruction. J COPD F. 2018; 5(3): 177-184. doi: http://doi.org/10.15326/jcopdf.5.3.2017.0145

Keywords

spirometry, diagnosis, asthma, tobacco, epidemiology, smokers

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Stability of Frequency of Severe Chronic Obstructive Pulmonary Disease Exacerbations and Health Care Utilization in Clinical Populations

chronic obstructive pulmonary disease, COPD exacerbation, health care utilization, stability

Denitza P. Blagev, MD^1,2 Dave S. Collingridge, PhD^1,3 Susan Rea, PhD^3,4 Valerie G. Press, MD, MPH⁵ Matthew M. Churpek, MD, MPH, PhD⁵ Kyle Carey, MPH⁵ Richard A. Mularski, MD, MSHS, MCR^6,7 Siyang Zeng, MS^8,9 Mehrdad Arjomandi, MD^8,9

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Division of Pulmonary and Critical Care Medicine, Department of Medicine, Intermountain Medical Center, Murray, Utah
Division of Respiratory, Critical Care, and Sleep Medicine, Department of Medicine, University of Utah, Salt Lake City
Office of Research, Intermountain Healthcare, Salt Lake City, Utah
Homer Warner Center for Informatics Research, Murray, Utah
Section of General Internal Medicine, Department of Medicine, University of Chicago Medicine, Chicago, Illinois
Kaiser Permanente Center for Health Research – Northwest, Portland, Oregon
Division of Pulmonary and Critical Care Medicine, Oregon Health and Science University, Portland
Division of Pulmonary and Critical Care Medicine, San Francisco Veterans Affairs Medical Center, San Francisco, California
Division of Pulmonary, Critical Care Allergy, Immunology and Sleep Medicine, Department of Medicine, University of California, San Francisco

Address correspondence to:

Denitza P. Blagev, MD
Intermountain Medical Center
Heart Lung Building, 6^th Floor
5121 South Cottonwood Street
Murray, UT 84157
Email: denitza.blagev@imail.org
denitza.blagev@gmail.com
Phone: (801) 507 4695

Abstract

Rationale: Although chronic obstructive pulmonary disease (COPD) exacerbation frequency is stable in research cohorts, whether severe COPD exacerbation frequency can be used to identify patients at high risk for future severe COPD exacerbations and/or mortality is unknown.

Methods: Severe COPD exacerbation frequency stability was determined in 3 distinct clinical cohorts. A total of 17,450 patients with COPD in Intermountain Healthcare were categorized based on the number of severe COPD exacerbations per year. We determined whether exacerbation frequency was stable and whether it predicted mortality. These findings were validated in 83,134 patients from the U.S. Veterans Affairs (VA) nationwide health care system and 3326 patients from the University of Chicago Medicine health system.

Results: In the Intermountain Healthcare cohort, the majority (84%, 14,706 patients) had no exacerbations in 2009 and were likely to remain non-exacerbators with a significantly lower 6-year mortality compared with frequent exacerbators (2 or more exacerbations per year) (25% versus 57%, p<0.001). Similar findings were noted in the VA health system and the University of Chicago Medicine health system. Non-exacerbators were likely to remain non-exacerbators with the lowest overall mortality. In all cohorts, frequent exacerbator was not a stable phenotype until patients had at least 2 consecutive years of frequent exacerbations. COPD exacerbation frequency predicted any cause mortality.

Conclusions: In clinical datasets across different organizations, severe COPD exacerbation frequency was stable after at least 2 consecutive years of frequent exacerbations. Thus, severe COPD exacerbation frequency identifies patients across a health care system at high risk for future COPD-related health care utilization and overall mortality.

Citation

Citation: Blagev DP, Collingridge DS, Rea S, et al. Stability of frequency of severe chronic obstructive pulmonary disease exacerbations and health care utilization in clinical populations. J COPD F. 2018; 5(3): 208-220. doi: http://doi.org/10.15326/jcopdf.5.3.2017.0183

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Health-Related Quality of Life Improvements in Moderate to Very Severe Chronic Obstructive Pulmonary Disease Patients on Nebulized Glycopyrrolate: Evidence from the GOLDEN Studies

COPD, chronic obstructive pulmonary disease, health status, long-acting muscarinic antagonist, health-related quality of life, nebulizer, HRQoL

Gary T. Ferguson, MD¹ Edward M. Kerwin, MD²James F. Donohue, MD³Vaidyanathan Ganapathy, PhD⁴Robert L. Tosiello, MS⁴ Vamsi K. Bollu, PhD⁵ Krithika Rajagopalan, PhD⁴

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Pulmonary Research Institute of Southeast Michigan, Farmington Hills
Clinical Research Institute of Southern Oregon, PC, Medford
University of North Carolina School of Medicine, Chapel Hill
Sunovion Pharmaceuticals Inc., Marlborough, Massachusetts
Abilytic, Inc., Shrewsbury, Massachusetts

Address correspondence to:

Gary T. Ferguson, MD
Pulmonary Research Institute of Southeast Michigan
29255 West 10 Mile Road, Suite A
Farmington Hills, MI 48336
Tel: (248) 478-6561
Fax: (248) 478-6908
Email: garytferguson@msn.com

Abstract

Background: Symptoms of chronic obstructive pulmonary disease (COPD) may diminish patients’ health-related quality of life (HRQoL). We report effects of Longhala™ Magnair™ (glycopyrrolate) Inhalation Solution, a drug/device combination of the long-acting antimuscarinic glycopyrrolate administered using the eFlow® closed system (eFlow CS) nebulizer, on HRQoL from the Glycopyrrolate for Obstructive Lung Disease Via Electronic Nebulizer (GOLDEN) clinical studies.

Methods: Data consisted of a pooled analysis of 2 phase 3, 12-week efficacy studies (GOLDEN-3 and -4) of glycopyrrolate/eFlow CS (25 or 50 mcg twice daily [BID]) versus placebo, and a 48-week, open-label safety study (GOLDEN-5) of glycopyrrolate/eFlow CS 50 mcg BID versus tiotropium 18 mcg once daily in patients with moderate to very severe COPD. Change from baseline in HRQoL was measured via the St George’s Respiratory Questionnaire (SGRQ). Results are provided as mean changes in SGRQ Total score and as response analysis (≥4-point improvement [responder], no change, and ≥4-point worsening in Total score) using analysis of covariance or logistic regression, as applicable.

Results: A total of 1293 patients were evaluated from GOLDEN-3 and -4 and 1086 from GOLDEN-5. Glycopyrrolate/eFlow CS significantly improved SGRQ Total and component scores. The percentage of SGRQ responders in pooled GOLDEN-3/4 was 46.8% for glycopyrrolate/eFlow CS 25 mcg, 41.7% for glycopyrrolate/eFlow CS 50 mcg, and 34.5% for placebo. SGRQ Total and component score improvements were similar between glycopyrrolate/eFlow CS and tiotropium in GOLDEN-5.

Conclusions: The drug/device combination of glycopyrrolate/eFlow CS significantly improved HRQoL, as measured by the SGRQ, offering a potential maintenance treatment option in patients with moderate to very severe COPD.

ClinicalTrials.gov: NCT02347761, NCT02347774, NCT02276222

Citation

Citation: Ferguson GT, Kerwin EM, Donohue JF, et al. Health-related quality of life improvements in moderate to very severe chronic obstructive pulmonary disease patients on nebulized glycopyrrolate: evidence from the GOLDEN studies. J COPD F. 2018; 5(3): 193-207. doi: http://doi.org/10.15326/jcopdf.5.3.2017.0178

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The Effects of a Comprehensive Care Management Program on Readmission Rates After Acute Exacerbation of COPD at a Community-Based Academic Hospital

population health, rehospitalization prevention, risk factors for rehospitalization

Glenda Euceda, MD¹ Wing-Tai Kong, MD¹ Amber Kapoor, MPH² Patricia Dilauro, RN, RRT³ Rahila Ogunnaike, MD¹ John Chronakos, MD³

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Department of Internal Medicine, Danbury Hospital, Western Connecticut Health Network, Danbury
Department of Research & Innovation, Danbury Hospital, Western Connecticut Health Network, Danbury
Section of Pulmonary Medicine, Department of Internal Medicine, Danbury Hospital, Western Connecticut Health Network, Danbury

Address correspondence to:

John Chronakos, MD
33 Germantown Road
Danbury, CT 06810
E-mail: john.chronakos@gmail.com
Phone: (203)739-6805

Abstract

Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is one of the leading causes of hospitalization in the United States. Prior investigations suggest clinical and physiological parameters are important determinants for AECOPD readmissions. Strategies aimed at addressing these factors have not resulted in a major reduction of readmissions. We compared patients readmitted after an index AECOPD admission with non-readmitted patients. Patients’ age, gender, body mass index, comorbidities (obstructive sleep apnea, chronic hypercapnia, congestive heart failure, lung cancer, pulmonary arterial hypertension, pneumonia, interstitial lung disease, atrial fibrillation, musculoskeletal disorders, cognitive disorders, and anxiety disorders), substance abuse and smoking status were assessed. Some 272 patients were included: 20 patients were readmitted within 30 days of their index hospitalization; 252 patients were not readmitted within 30 days of their index admission. Readmitted patients were significantly more likely to have pneumonia than non-readmitted patients (30.0% versus 13.1%, p<0.05). No statistically significant difference was seen with respect to other clinical comorbidities. Patients readmitted within 30 days were significantly more likely than non-readmitted patients to have safety issues at home (80.0% versus. 39.3%, p<0.001), anxiety (60.0% versus 29.8%, p<0.01), and lack of transportation (35.0% versus 15.5%, p<0.05). Implementation of a comprehensive care management program (CCMP) was associated with a reduction in readmissions from 21.5% to 13.6% (p<0.01, 95% confidence interval [CI] 2.08-12.45). A CCMP can reduce readmissions through attention to social variables, optimization of in-hospital care, improved coordination of pre- and post-discharge, a system to better identify problems after discharge, and an office setup that accommodates same-day visits.

Citation

Citation: Euceda G, Kong W-T, Kapoor A^,Dilauro P, Ogunnaike R, Chronakos J. The effects of a comprehensive care management program on readmission rates after acute exacerbation of COPD at a community-based academic hospital. J COPD F. 2018; 5(3): 185-192. doi: http://doi.org/10.15326/jcopdf.5.3.2017.0177

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Internet Health Behaviors of Patients with Chronic Obstructive Pulmonary Disease and Assessment of Two Disease Websites

COPD, exacerbations, internet.chronic obstructive pulmonary disease, COPD websites, breathlessness

Donald A. Mahler, MD, FCCP^{1, 2} Frank Cerasoli, PhD³ Lindsay Della, PhD⁴ Mark Rudzinski, MBA⁵

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Emeritus Professor of Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
Valley Regional Hospital, Claremont, New Hampshire
Medical Dynamics, New York, New York
University of Louisville, Louisville, Kentucky
Rockpile Strategies LLC, LaGrange, Illinois

Address correspondence to:

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

Abstract

Background: Little is known about patients’ use of the internet to search for information about chronic obstructive pulmonary disease (COPD) and their perspectives on disease content on websites.

Objectives: Todetermine the interests and behavior of patients with COPD who search the internet for disease information and to assess their perspectives about 2 COPD educational websites.

Methods: Individuals with COPD who had registered for a consumer panel were invited electronically to participate in a survey which included general use of the internet, online health behaviors about COPD, and assessment of 2COPD educational websites.

Results: A total of 445 respondents completed the survey in 23 ± 12 minutes (72% response rate). A total of 95% reported that physicians were the primary source of information about COPD followed by internet searches about the disease (76%). The 3 major information priorities were “symptom control” (82%), “how COPD is affecting my body” (60%), and “treatments that might work better for me” (59%). Overall ratings (range, 1 – 10) were 7.4 ± 1.5 for the American Lung Association and 6.8 ±1.8 for the COPD Foundation websites. Ratings by respondents were higher for all 5 impression attributes and for 8 of 9 content attributes on the American Lung Association website compared with the COPD Foundation website.

Conclusions: This report describes, for the first time, information priorities of patients with COPD about their disease and their assessment of 2 educational websites. Our survey results can be used by health care professionals to recommend online resources to their patients.

Citation

Citation: Mahler DA, Cerasoli F, Della L, Rudzinski M. Internet health behaviors of patients with chronic obstructive pulmonary disease and assessment of two disease websites. J COPD F. 2018; 5(3): 158-166. doi: http://doi.org/10.15326/jcopdf.5.3.2017.0173

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Clinical Differences in COPD Patients with Variable Patterns of Hypoxemia

COPD, chronic obstructive pulmonary disease, long-term oxygen treatment, Long-term Oxygen Treatment Trial, LOTT

Erin R. Narewski, DO¹Amanda L. Blackford, ScM² Matthew R. Lammi, MD³ Anne L. Fuhlbrigge, MD, MPH⁴ Xavier Soler, MD, PhD⁵ Richard Albert, MD⁶ Gerard J. Criner, MD¹; for the Long-Term Oxygen Treatment Trial Research Group⁷

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Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
Division of Biostatistics and Bioinformatics, Bloomberg School of Health, Johns Hopkins University, Baltimore, Maryland
Division of Pulmonary and Critical Care Medicine, School of Medicine, Louisiana State University, New Orleans
Channing Laboratory, Brigham and Women’s Hospital and Division of Pulmonary and Critical Care Medicine, Harvard Medical School, Boston, Massachusetts
Division of Pulmonary and Critical Care Medicine, School of Medicine, University of California- San Diego
Division of Pulmonary and Critical Care Medicine, School of Medicine, University of Colorado, Denver
Members of the LOTT Research Group and their affiliations are listed in the Acknowledgements section of this article.

Address correspondence to:

Erin R. Narewski, DO
Department of Thoracic Medicine and Surgery
Lewis Katz School of Medicine
Temple University
3401 North Broad Street
Philadelphia, PA 19140
Erin.Narewski@tuhs.temple.edu

Abstract

Background: Chronic obstructive pulmonary disease (COPD) patients enrolled into the Long-term Oxygen Treatment Trial had hypoxemia at rest, hypoxemia on exertion, or hypoxemia both at rest and on exertion. We hypothesized that patients with different patterns of hypoxemia may have significant differences in clinical features.

Methods: All patients had COPD and oxygen saturation measured by pulse oximetry (blood oxygenation [SpO₂]) at rest and during the 6-minute walk test (6MWT). Hypoxemia at rest was defined as resting SpO₂between 89-93%. SpO₂ < 90% for at least 10 seconds and ³ 80% for at least 5 minutes during ambulation characterized hypoxemia on exertion. Severe exercise hypoxemia (< 80% for > 1 minute) was exclusionary.

Results: Of 738 patients studied, 133 (18.0%) had mild-moderate hypoxemia at rest only, 319 (43.2%) had hypoxemia on exertion only, and 286 (38.8%) had hypoxemia at both rest and exertion. Patients with hypoxemia at rest only were more likely to be current smokers, had higher body mass index (BMI) and a higher incidence of self-reported diabetes. Patients with hypoxemia on exertion only were more severely obstructed compared to the other groups. General and disease-specific quality of life scores were similarly impaired in all groups. Quality of well-being scores were more impaired in those with hypoxemia at rest only.

Conclusions: COPD patients with mild-moderate hypoxemia have distinct clinical characteristics based on the pattern of oxygen desaturation at rest and with exertion.

Citation

Citation: Narewski ER, Blackford AL, Lammi MR, et al; for the Long-term Oxygen Treatment Trial Research Group. Clinical differences in COPD patients with variable patterns of hypoxemia. J COPD F. 2018; 5(3): 167-176. doi: http://doi.org/10.15326/jcopdf.5.3.2017.0175

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Stem Cell Therapy for COPD: Where are we?

Posted in: Journal Club, Volume 5 | Issue 2

Ron Balkissoon, MD, MSc, DIH, FRCPC¹

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Denver, Colorado

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

Abstract

This article does not contain an abstract.

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Citation: Balkissoon R. Journal club. Stem cell therapy for COPD: where are we? J COPD F. 2018; 5(2): 148-153. doi: http://doi.org/10.15326/jcopdf.5.2.2018.0140

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Images in COPD Combined Pulmonary Fibrosis and Emphysema

Posted in: Images in COPD, Volume 5 | Issue 2

Mary Salvatore, MD¹ Kevin Kwon, BA¹ Robert M. Steiner, MD²

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Department of Radiology, Mount Sinai Medical Center, New York, New York
Columbia University Medical Center, New York, New York

Address correspondence to:

Mary Salvatore, MD
Department of Radiology
Mount Sinai Medical Center
1 Gustave L. Levy Place
New York, NY 10029
mary.salvatore@mountsinai.org

Abstract

This article does not contain an abstract.

Citation

Citation: Salvatore M, Kwon K, Steiner RM. Images in COPD: combined pulmonary fibrosis and emphysema. J COPD F. 2018; 5(2): 154-157. doi: http://doi.org/10.15326/jcopdf.5.2.2018.0137

Keywords

COPD, chronic obstructive pulmonary disease, combined pulmonary fibrosis and emphysema, CPFE, idiopathic pulmonary fibrosis, IPF

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The COPD Pipeline XXXVIII

Posted in: The COPD Pipeline, Volume 5 | Issue 2

Nicholas J. Gross, MD, PhD¹

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St. Francis Hospital and University Medical Research LLC

Address correspondence to:

Nicholas Gross, MD, PhD
Grossnicholas1@gmail.com

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This article does not contain an abstract.

Citation

Citation: Gross N. COPD pipeline XXXVII. J COPD F. 2018; 5(2): 144-147. doi: http://doi.org/10.15326/jcopdf.5.2.2018.0136

Keywords

INS1007, Pioneer, doxofylline, QVA, Gala treatment, Nemiralisib, CHI3L1, YKL-40

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Hope for Patients with Homogeneous Emphysema?

Posted in: Editorial, Volume 5 | Issue 2

Daniela Gompelmann, MD^1,2

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Pneumology and Critical Care Medicine, Thoraxklinik at University of Heidelberg, Heidelberg, Germany
Translational Lung Research Center Heidelberg, German Center for Lung Research, Heidelberg, Germany

Address correspondence to:

Daniela Gompelmann, MD
Phone: 004962213968087
Email: daniela.gompelmann@med.uni-heidelberg.de

Abstract

This article does not contain an abstract.

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Citation: Gompelmann D. Editorial: Hope for patients with homogeneous emphysema? J COPD F. 2018; 5(2): 84-86. doi: http://doi.org/10.15326/jcopdf.5.2.2018.0135

Keywords

COPD, chronic obstructive pulmonary disease, lung volume reduction surgery, endobronchial coils, homogeneous emphysema, LVRS

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Lung, Fat and Bone: Increased Adiponectin Associates with the Combination of Smoking-Related Lung Disease and Osteoporosis

Click to read Lung, Fat and Bone: Increased Adiponectin Associates with the Combination of Smoking-Related Lung Disease and Osteoporosis

Young Ju Suh, PhD¹ Merry-Lynn N. McDonald, PhD² George R. Washko, MD³ Brendan J. Carolan, MD⁴ Russell P. Bowler, MD, PhD⁴ David A. Lynch, MD⁴ Gregory L. Kinney, MPH, PhD⁵ Jessica M. Bon, MD⁶ Michael H. Cho, MD, MPH² James D. Crapo, MD⁴ Elizabeth A. Regan, MD, PhD^4,5 for the COPDGene Investigators

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Department of Biomedical Sciences, College of Medicine, Inha University, Incheon, Republic of Korea
Channing Division of Network Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
Department of Medicine, National Jewish Health, Denver, Colorado
School of Public Health, University of Colorado, Denver
University of Pittsburgh, Pittsburgh, Pennsylvania

Address correspondence to:

Elizabeth A. Regan, MD
1400 Jackson St, K706
Denver, CO 80209
Email: ReganE@NJHealth.org
Phone: 303-398-1531
Fax: 303-270-2249

Abstract

Background: Adiponectin has been proposed as a biomarker of disease severity and progression in chronic obstructive pulmonary disease (COPD) and associated with spirometry-defined COPD and with computed tomography (CT)-measured emphysema. Increased adiponectin plays a role in other diseases including diabetes/metabolic syndrome, cardiovascular disease and osteoporosis. Previous studies of adiponectin and COPD have not assessed the relationship of adiponectin to airway disease in smokers and have not evaluated the effect of other comorbid diseases on the relationship of adiponectin and lung disease. We postulated that adiponectin levels would associate with both airway disease and emphysema in smokers with and without COPD, and further postulated that body composition and the comorbid diseases of osteoporosis, cardiovascular disease and diabetes might influence adiponectin levels.

Methods: Current and former smokers from the COPD Genetic Epidemiology study (COPDGene) (n= 424) were assigned to 4 groups based on CT lung characteristics and volumetric Bone Density (vBMD). Emphysema (% low attenuation area at -950) and airway disease (Wall area %) were used to assess smoking-related lung disease (SRLD). Group 1) Normal Lung with Normal vBMD; Group 2) Normal Lung and Osteoporosis; Group 3) SRLD with Normal vBMD; Group 4) SRLD with Osteoporosis. Cardiovascular disease (CVD), diabetes, C-reactive protein (CRP) and T-cadherin (soluble receptor for adiponectin) levels were defined for each group. Body composition was derived from chest CT. Multivariable regression assessed effects of emphysema, wall area %, bone density, comorbid diseases and other key factors on log adiponectin.

Results: Group 4, SRLD with Osteoporosis, had significantly higher adiponectin levels compared to other groups and the effect persisted in adjusted models. Systemic inflammation (by CRP) was associated with SRLD in Groups 3 and 4 but not with osteoporosis alone. In regression models, lower bone density and worse emphysema were associated with higher adiponectin. Airway disease was associated with higher adiponectin levels when T-cadherin was added to the model. Male gender, greater muscle and fat were associated with lower adiponectin.

Conclusions: Adiponectin is increased with both airway disease and emphysema in smokers. Bone density, and fat and muscle composition are all significant factors predicting adiponectin that should be considered when it is used as a biomarker of COPD. Increased adiponectin from chronic inflammation may play a role in the progression of bone loss in COPD and other lung diseases.

Citation

Citation: Suh YJ, McDonald M-LN, Washko GR, et al; for the COPDGene Investigators. Lung, fat and bone: increased adiponectin with the combination of smoking-related lung disease and osteoporosis. J COPD F. 2018; 5(2): 134-143. doi: http://doi.org/10.15326/jcopdf.5.2.2016.0174

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COPD, emphysema, body composition, adiponectin, osteoporosis, airway disease, smoking-related lung disease, QCT, volumetric BMD, bone mineral density, T cadherin, CDH13, C-reactive protein, systemic inflammation, muscle area, pectoralis, subcutaneous fat area, visceral fa

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A Novel Approach to Screening for Alpha-1 Antitrypsin Deficiency: Inpatient Testing at a Teaching Institution

COPD, chronic obstructive pulmonary disease, alpha-1 antitrypsin deficiency, inpatient, AAT, genetic screening, resident physician, AAT carriers

James J. Tasch, DO¹ Ann T. McLaughlan, DO¹ Asad A. Nasir, MD¹

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Graduate Medical Education, Arnot Ogden Medical Center, Elmira, New York

Address correspondence to:

James Tasch, DO
600 Roe Ave
Elmira, New York 14905
Phone: 607-737-4100
Email: james.tasch@steward.org

Abstract

Chronic obstructive pulmonary disease (COPD) currently affects more than 16 million Americans and it is estimated that roughly 100,000 Americans have undiagnosed, severe alpha-1 antitrypsin deficiency (AATD) (Chest. 2005;128[3]:1179-1186) (Chest. 2002;122[5]:1818-1829). Patients with AATD have an accelerated rate of decline of lung function caused by proteolytic enzymes. The morbidity associated with this inherited disorder is preventable due to the availability of augmentation therapy. Appropriate inpatient screening of patients with COPD for AATD is lacking and most screening is exclusively limited to outpatient pulmonary clinics. Between May 2016 and February 2017, genetic screening was completed on 54 individuals who were admitted with either a former diagnosis of COPD or active COPD exacerbation to Arnot Ogden Medical Center (AOMC) in Elmira, New York. The incorporation of inpatient genetic screening by resident physicians for AATD in COPD patients led to a high rate of screened and newly diagnosed AATD carriers with a variety of AATD genotypes. It is recommended that there should be an expansion of screening for AATD in hospitalized patients with COPD, regardless of age or smoking history.

Citation

Citation: Tasch JJ, McLaughlan AT, Nasir AA. A novel approach to screening for alpha-1 antitrypsin deficiency: inpatient testing at a teaching institution. J COPD F. 2018; 5(2): 106-110. doi: http://doi.org/10.15326/jcopdf.5.2.2017.0170

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Spirometry in Hospitalized Patients with Acute Exacerbation of COPD Accurately Predicts Post Discharge Airflow Obstruction

COPD, chronic obstructive pulmonary disease, AECOPD, inpatient spirometry, COPD readmissions, acute exacerbations of COPD

Chee H. Loh, MD¹Frank A. Genese, DO¹Kavya K. Kannan, MD²Tina M. Lovings, BSRT, RRT-ACCS¹Stephen P. Peters MD, PhD¹Jill A. Ohar, MD¹

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Author Affiliations

Department of Pulmonary and Critical Care, Wake Forest School of Medicine, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina
Department of Internal Medicine, Wake Forest School of Medicine, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina

Address correspondence to:

Chee Hong Loh, MD
Email: seanchloh@gmail.com
Phone: (336)716-4328

Abstract

Purpose: Objective documentation of airflow obstruction is often lacking inhospitalized patients treated for acute exacerbation of chronic obstructive pulmonary disease (AECOPD). The utility of spirometry performed in hospitalized patients to identify airflow obstruction, and thus a diagnosis of COPD, is unclear. Our aim was to compare inpatient spirometry, performed during an AECOPD, with outpatient spirometry.

Methods: A retrospective analysis of data from patients enrolled in an AECOPD care plan was performed. As part of the plan, patients underwent inpatient spirometry to establish a COPD diagnosis and outpatient clinic spirometry within 4 weeks of hospital discharge to confirm it. Data analyzed included forced expiratory volume in 1 second (FEV₁), forced vital capacity (FVC), slow vital capacity (SVC) and FEV₁/ vital capacity (VC). Obstruction was defined by FEV₁/VC<0.70.

Results: A total of 159 patients (mean age 63.2 +/- 10.5 years) had corresponding in- and outpatient spirometry. The median days between inpatient and outpatient spirometry was 12 (interquartile range [IQR] 9-16). Inpatient spirometry had a sensitivity of 94%, specificity of 24%, positive predictive value of 83% and negative predictive value of 53% for predicting outpatient obstruction. The area under curve for using inpatient spirometry was 0.82. The mean difference between inpatient and outpatient FEV₁ was 0.44 +/- 0.03 liters or 17.3 +/- 1.13 % predicted (p<0.0001) for FEV₁.

Conclusions: Inpatient spirometry accurately predicts outpatient airflow obstruction, thus providing an opportunity to identify patients admitted with suspected AECOPD who have no prior spirometric documentation.

Citation

Citation: Loh CH, Genese FA, Kannan KK, Lovings TM, Peters SP, Ohar JA. Spirometry in hospitalized patients with acute exacerbation of COPD accurately predicts post discharge airflow obstruction. J COPD F. 2018; 5(2): 124-133. doi: http://doi.org/10.15326/jcopdf.5.2.2017.0169

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Endobronchial Coils Versus Lung Volume Reduction Surgery or Medical Therapy for Treatment of Advanced Homogenous Emphysema

emphysema, lung volume reduction, lung volume reduction coils

Nathaniel Marchetti, DO¹ Theresa Kaufman, DO¹ Divay Chandra, MD² Felix J. Herth, MD³ Pallav L. Shah, MD⁴ Dirk-Jan Slebos, MD⁵ Chandra Dass, MD¹ Stephen Bicknell, MD⁶ Stefan H. Blaas, MD⁷ Michael Pfeifer, MD⁷ Franz Stanzell, MD⁸ Christian Witt, MD⁹ Gaetan Deslee, MD¹⁰ Wolfgang Gesierich, MD¹¹ Martin Hetzel, MD¹² Romain Kessler, MD¹³ Sylvie Leroy, MD¹⁴ Juergen Hetzel, MD¹⁵ Frank C. Sciurba, MD² and Gerard J. Criner, MD¹

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Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
Thoraxklinik, University of Heidelberg, Heidelberg, Germany
The National Institute for Health Research Respiratory Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust and Imperial College, London, United Kingdom
University Medical Center Groningen, University of Groningen, The Netherlands
Gartnaval General Hospital, Glasgow, Scotland
Klinikum Donaustauf, Donaustauf, Germany
Lungenklinik, Hemer, Germany
Campus Charité Mitte, Berlin, Germany
Service de Pneumologie Hôpital Maison Blanche, INSERM 903, Reims, France
Asklepios-Fachkliniken, Muenchen-Gauting, Germany
Krankenhaus von Roten Kreuz, Stuttgart, Germany
CHU de Strasbourg – NHC, Strasbourg, France
FHU OncoAge Côte d’Azur University, Nice, France
Department of Internal Medicine II-Pneumology, University Hospital, Teubingen, Germany

Address correspondence to:

Nathaniel Marchetti, D.O.
Associate Professor of Medicine
Department of Thoracic Medicine and Surgery
Lewis Katz School of Medicine at Temple University
745 Parkinson Pavilion
3401 North Broad Street
Philadelphia, Pa 19140
Phone: 215-707-9929
Email: nathaniel.marchetti@tuhs.temple.edu

Abstract

Rationale: Bronchoscopic lung volume reduction utilizing shape-memory nitinol endobronchial coils (EBC) may be safer and more effective in severely hyperinflated homogeneous emphysema compared to medical therapy or lung volume reduction surgery (LVRS).

Methods: The effect of bilateral EBC in patients with homogeneous emphysema on spirometry, lung volumes and survival was compared to patients with homogeneous emphysema randomized in the National Emphysema Treatment Trial (NETT) to LVRS or medical therapy. NETT participants were selected to match EBC participants in age, baseline spirometry, and gender. Outcomes were compared from baseline, at 6 and 12 months.

Results: There were no significant baseline differences in gender in the EBC, NETT-LVRS or medical treatment patients. At baseline no differences existed between EBC and NETT-LVRS patients in forced expiratory volume in 1 second ( FEV₁) or total lung capacity (TLC) %-predicted; residual volume (RV) and diffusing capacity of the lung for carbon monoxide (DLco) %-predicted were higher in the EBC group compared to NETT-LVRS (p < 0.001). Compared to the medical treatment group, EBC produced greater improvements in FEV₁ and RV but not TLC at 6 months. FEV₁ and RV in the EBC group remained significantly improved at 12-months compared to the medical treatment group. While all 3 therapies improved quality of life, survival at 12 months with EBC or medical therapy was greater than NETT-LVRS.

Conclusion: EBC may be a potential therapeutic option in patients with severe homogeneous emphysema and hyperinflation who are already receiving optimal medical treatment.

Citation

Citation: Marchetti N, Kaufman T, Chandra D, et al. Endobronchial coils versus lung volume reduction surgery or medical therapy for treatment of advanced homogenous emphysema. J COPD F. 2018; 5(2): 87-96. doi: http://doi.org/10.15326/jcopdf.5.2.2017.0134

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Markers of Dental Health Correlate with Daily Respiratory Symptoms in COPD

COPD, chronic obstructive pulmonary disease, dental, plaque index, oral health, respiratory symptoms

Nathaniel T. Gaeckle, MD¹ Brooke Heyman, MD² Andrew J. Criner, BS¹ Gerard J. Criner, MD¹

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

Address correspondence to:

Nathaniel Gaeckle
Email: gaeckle@umn.edu
Phone: 612-805-8388

Abstract

Abstract:

Background: Poor dental health occurs in patients with chronic obstructive pulmonary disease (COPD); some evidence suggests that it may correlate with lower forced expiratory volume in 1 second (FEV₁) and 6-minute walk distance, and an increased rate of exacerbations. However, there is no data that examines how dental health may impact the daily respiratory symptoms that COPD patients experience. We prospectively studied indices of dental health and hygiene in patients with COPD and determined their impact on daily respiratory symptoms.

Methods: A total of 20 individuals with COPD (median [interquartile range (IQR)] % FEV₁ 37 [29-43]) and 10 healthy control individuals with no lung disease were recruited. Dental questionnaires, spirometry, and a dental examination were administered on their initial visit. COPD participants were given an electronic COPD daily diary to document peak expiratory flow and the presence and magnitude of daily breathlessness, cough, sputum production, and wheeze.

Results: Compared to healthy controls, COPD participants had less teeth (median 16.5 versus 28, p=0.0001), a trend to a higher plaque index (median 2.2 versus 1.7, p=0.15), and worse oral health-related quality of life (median Oral Health Impact Profile score 12.0 versus 4.5, p=0.02). A greater number of teeth correlated with higher percentage of days with cough (r=0.48, p<0.05) and wheeze (r=0.47, p<0.05).

Conclusion: Individuals with severe COPD have poor oral hygiene and oral health-related quality of life. In the setting of poor dentition, a greater number of teeth correlates with more daily respiratory symptoms. More teeth may create a larger reservoir for inflammatory proteins and pathogenic bacteria to be aspirated into the airways.

Citation

Citation: Gaeckle NT, Heyman B, Criner AJ, Criner GJ. Markers of dental health correlate with daily respiratory symptoms in COPD. J COPD F. 2018; 5(2): 97-105. doi: http://doi.org/10.15326/jcopdf.5.2.2017.0159

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The Role of Inhalation Delivery Devices in COPD: Perspectives of Patients and Health Care Providers

COPD, inhalation therapy, inhalation device

Nicola A. Hanania, MD, MS¹ Sidney Braman, MD² Sandra G. Adams, MD, MS^3,4 Ruth Adewuya, MD⁵ Arzu Ari, PhD⁶ JoAnn Brooks, PhD⁷ Donald A. Mahler, MD⁸ Jill A. Ohar, MD⁹ Jay Peters, MD³ Shahin Sanjar, PhD¹⁰

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Author Affiliations

Section of Pulmonary and Critical Care Medicine, Baylor College of Medicine, Houston, Texas
Icahn School of Medicine at Mount Sinai, New York, New York
University of Texas Health Science Center, San Antonio
South Texas Veterans Health Care System, San Antonio
American College of Chest Physicians, Glenview, Illinois
Texas State University, San Marcos
Indiana University Health, Bloomington
Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
Wake Forest Health University Medical Center, Winston-Salem, North Carolina
Sunovion Pharmaceuticals Inc., Marlborough, Massachusetts

Address correspondence to:

Nicola A. Hanania, MD, MS
Baylor College of Medicine
1504 Taub Loop
Houston, TX 77030
E-mail: hanania@bcm.edu
Phone: 713-873-3454

Abstract

Background: Inhaled medications form the foundation of pharmacologic treatment for chronic obstructive pulmonary disease (COPD).The Delivery Makes a Difference (DMaD) project was conducted to better understand health care provider (HCP) and patient perspectives about the role of inhalation delivery devices in COPD, and to examine the nature of educational efforts between HCPs and patients on proper device technique.

Methods: Data were derived from 2 original quantitative, web-based, descriptive, cross-sectional surveys distributed to HCPs who manage COPD (n=513) and patients with COPD (n=499) in the United States. Descriptive statistics were used to assess data across important demographic variables. Inferential statistics were used to assess differences in attitudinal, descriptive, and behavioral measures that were cross-tabulated with demographic data.

Results: When prescribing medication for newly diagnosed patients with stable or unstable COPD, only 37% of HCPs considered type of device to be highly important, with only 45% of HCPs assessing device technique in every newly diagnosed patient. Patients with COPD were also relatively unconcerned with proper device technique (64% never concerned), regardless of their COPD severity. Although patients did not identify education as a significant impediment to proper device use, they reported inconsistent educational experiences.

Conclusions: We found that HCPs and patients prioritize medication over device when selecting treatments, showing limited concerns about proper device use. These results highlight the need to coordinate professional education with patient-directed educational efforts to further promote proper device selection and use in COPD management.

Citation

Citation: Hanania NA, Braman S, Adams SG, et al. The role of inhalation delivery devices in COPD: Perspectives of patients and health care providers. J COPD F. 2018; 5(2): 111-123. doi: http://doi.org/10.15326/jcopdf.5.2.2017.0168

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New Treatment Options for COPD: How Do We Decide Phenotypes, Endotypes or Treatable Traits?

Posted in: Journal Club, Volume 5 | Issue 1

Ron Balkissoon, MD, MSc, DIH, FRCPC¹

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Denver, Colorado

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

Abstract

This article does not contain an abstract.

Citation

Citation: Balkissoon R. Journal club. New treatments options for COPD: How do we decide phenotypes, endotypes or treatable traits? J COPD F. 2018; 5(1): 72-80. doi: http://doi.org/10.15326/jcopdf.5.1.2018.0128

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There are no keywords for this article.

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Marijuana Lung

Posted in: Images in COPD, Volume 5 | Issue 1

Jay S. Leb, MD¹ Belinda D'Souza, MD¹ Robert M. Steiner, MD¹

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Columbia University Medical Center, New York, New York

Address correspondence to:

Jay S. Leb, MD
Department of Radiology
Columbia University Medical Center
630 West 168^th Street, MC-28
New York, NY 10032
jl4763@cumc.columbia.edu

Abstract

This article does not contain an abstract.

Citation

Citation: Leb JS, D’Souza B, Steiner RM. Images in COPD: Marijuana lung. J COPD F. 2018; 5(1): 81-83. doi: http://doi.org/10.15326/jcopdf.5.1.2017.0180

Keywords

COPD, computed tomography, emphysema, chronic obstructive pulmonary disease, marijuana, marijuana lung

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The COPD Pipeline XXXVII

Posted in: The COPD Pipeline, Volume 5 | Issue 1

Nicholas Gross, MD, PhD¹

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St Francis Hospital and University Medical Research, LLC

Address correspondence to:

Nicholas Gross, MD, PhD
grossnicholas1@gmail.com

Abstract

This article does not contain an abstract.

Citation

Citation: Gross N. The COPD pipeline XXXVII. J COPD F. 2018; 5(1): 66-71. doi: http://doi.org/10.15326/jcopdf.5.1.2017.0184

Keywords

COPD, chronic obstructive pulmonary disease, GSK2269557, Mepolizumab, Danirixin, INS1007, drug pipeline, CHF6333, AZD8871, ZephyrEZB

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Pneumonia Complicating COPD: Are Corticosteroids a Help or a Hindrance?

Posted in: Editorial, Volume 5 | Issue 1

Michael S. Niederman, MD^1,2

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Pulmonary and Critical Care Medicine, Weill Cornell Medical College, Cornell University, New York, New York
Division of Pulmonary and Critical Care Medicine, New York Presbyterian/Weill Cornell Medical Center, New York, New York

Address correspondence to:

Michael S. Niederman, MD
1305 York Avenue, 10th Floor,
New York, NY 10065
msn9004@med.cornell.edu

Abstract

This article does not contain an abstract.

Citation

Citation: Niederman MS. Pneumonia complicating COPD: Are corticosteroids a help or a hindrance? J COPD F. 2018; 5(1): 1-4. doi: http://doi.org/10.15326/jcopdf.5.1.2018.0162

Keywords

COPD, chronic obstructive pulmonary disease, pneumonia, corticosteroids

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Effectiveness of Umeclidinium-Vilanterol for Protocolized Management of Chronic Obstructive Pulmonary Disease Exacerbation in Hospitalized Patients: A Sequential Period Analysis

Click to read Effectiveness of Umeclidinium-Vilanterol for Protocolized Management of Chronic Obstructive Pulmonary Disease Exacerbation in Hospitalized Patients: A Sequential Period Analysis

Todd W. Chapin, PharmD, BCPS¹ Michael A. Mann, MPH² Gary L. Brown, RRT, FAARC³ Traci L. Leitheiser, BS, RRT, CTTS³ Becky Anderson, RRT³ David D. Leedahl, PharmD, BCPS-AQ ID, BCCCP¹

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Pharmacy Services, Sanford Health, Fargo, North Dakota
North Dakota State University College of Health Professions, Fargo
Respiratory Care Services, Sanford Health, Fargo, North Dakota

Address correspondence to:

David D. Leedahl, PharmD
801 Broadway N, Rt 0204
Fargo, ND 58122
Phone: (701) 417-2309
E-mail: david.leedahl@sanfordhealth.org

Abstract

Background: Bronchodilator therapy is a foundation of chronic obstructive pulmonary disease (COPD) exacerbation treatment. Although international guidelines recommend short-acting formulations given multiple times per day, long-acting formulations have not been adequately evaluated. The objective of our study was to determine the effectiveness of umeclidinium-vilanterol (UME/VIL), long-acting beta2-agonist/long-acting muscarinic antagonist (LABA/LAMA) as a once-daily alternative for treating COPD exacerbations in hospitalized patients.

Methods: In this retrospective sequential period analysis, we reviewed electronic medical records of patients hospitalized for COPD exacerbations before (September 1, 2015 to February 29, 2016) and after (April 1, 2016 to September 30, 2016) incorporation of UME/VIL into our standard COPD protocol. Before implementation, patients received a daily anticholinergic plus twice-daily long-acting beta2-agonist therapy (tiotropium plus formoterol, n=65). After implementation, UME/VIL replaced the previous regimen (n=58). No other changes were made to the COPD protocol. The primary outcome was 30-day hospital readmission rate. Hospital length of stay, 30-day mortality, and cost of care were analyzed as secondary outcomes.

Results: A trend toward increased 30-day readmission rates in the post-intervention group (24.1% versus 10.8%, p=0.049) was no longer statistically significant after adjustment for severity of illness (based on case-mix index) and complications or comorbidities based on diagnosis-related group codes (adjusted odds ratio: 2.499; 95% confidence interval: 0.916-7.380; p=0.074).

Conclusion: After adjustment for potential confounders,the implementation of a LABA/LAMA combination product was not statistically associated with an increased 30-day readmission rate but was associated with lower cost of care.

Citation

Citation: Chapin TW, Mann MA, Brown GL, Leitheiser TL, Anderson B, Leedahl DD. Effectiveness of umeclidinium-vilanterol for protocolized management of chronic obstructive pulmonary disease exacerbation in hospitalized patients: A sequential period analysis. J COPD F. 2018; 5(1): 38-45. doi: http://doi.org/10.15326/jcopdf.5.1.2017.0163

Keywords

COPD, chronic obstructive pulmonary disease, exacerbations, tiotropium, bronchodilator, length of stay, umeclidinium, vilanterol, formoterol, hospital readmission, treatment protocol, respiratory therapy

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Evaluation of Systemic Corticosteroids in Patients With an Acute Exacerbation of COPD and a Diagnosis of Pneumonia

Click to read Evaluation of Systemic Corticosteroids in Patients With an Acute Exacerbation of COPD and a Diagnosis of Pneumonia

Tyler Scholl, PharmD¹ Tyree H. Kiser, PharmD¹ Sheryl F. Vondracek, PharmD¹

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University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora

Address correspondence to:

Sheryl F. Vondracek, PharmD
University of Colorado
Skaggs School of Pharmacy and Pharmaceutical Sciences
12850 E. Montview Blvd. C238
Aurora, CO 80045
Phone: (303) 724 2638
Email: sheryl.vondracek@ucdenver.edu

Abstract

Background: Chronic obstructive pulmonary disease (COPD) and pneumonia are leading causes of morbidity and mortality and are frequently comorbid. Studies of systemic corticosteroids in pneumonia have shown conflicting outcomes, whereas studies in acute exacerbations of COPD (AECOPD) have shown significant benefits. No studies have evaluated systemic corticosteroids in patients with both an AECOPD and pneumonia.

Purpose: To evaluate the use of systemic corticosteroids in patients with both an AECOPD and pneumonia.

Patients and Methods: Patients with a diagnosis of both COPD or obstructive chronic bronchitis with exacerbation and pneumonia admitted to the University of Colorado Hospital between July 1, 2012 and May 20, 2016 were retrospectively evaluated. Patients who received systemic corticosteroids were compared to those that did not. The primary outcome was length of hospital stay (LOHS). Secondary outcomes were in-hospital treatment failure, a composite of intensive care unit (ICU) admission, ventilation, and escalation of steroid therapy, 30-day AECOPD or pneumonia readmission, and 30-day mortality.

Results: A total of 138 patients were included-- 89 in the steroid group and 49 in the non-steroid group. No significant differences in baseline characteristic were noted. No difference was seen in mean LOHS (4.7±3.2 versus 4.2±2.1 days, p=0.27), in-hospital treatment failure (7% versus 4%, p=0.72), 30-day readmission or 30-day mortality between the steroid and non-steroid groups, respectively. There was a difference in mean LOHS for patients with severe pneumonia between the steroid and non-steroid groups (6.0±4.0 versus 4.3±1.8; p=0.03).

Conclusions: This study suggests that systemic corticosteroids may not provide a clinical benefit to patients with an AECOPD and pneumonia.

Citation

Citation: Scholl T, Kiser TH, Vondracek SF.Evaluation of systemic corticosteroids in patients with an acute exacerbation of COPD and a diagnosis of pneumonia. J COPD F. 2018; 5(1): 57-65. doi: http://doi.org/10.15326/jcopdf.5.1.2017.0157

Keywords

COPD, pneumonia, exacerbation, corticosteroids, length of stay, hospitalized

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Marijuana Use Associations with Pulmonary Symptoms and Function in Tobacco Smokers Enrolled in the Subpopulations and Intermediate Outcome Measures in COPD Study (SPIROMICS)

Click to read Marijuana Use Associations with Pulmonary Symptoms and Function in Tobacco Smokers Enrolled in the Subpopulations and Intermediate Outcome Measures in COPD Study (SPIROMICS)

Madeline A. Morris, MPH¹ Sean R. Jacobson, MS¹ Gregory L. Kinney, PhD, MPH² Donald P. Tashkin, MD³ Prescott G. Woodruff, MD, MPH⁴ Eric A. Hoffman, PhD⁵ Richard E. Kanner, MD, MPH^6,7Christopher B. Cooper, MD³ M. Brad Drummond, MD, MHS⁸ R. Graham Barr, MD, DrPH, MPH⁹ Elizabeth C. Oelsner, MD⁹ Barry J. Make, MD¹ MeiLan K. Han, MD, MS¹⁰ Nadia N. Hansel, MD, MPH¹¹ Wanda K. O’Neal, PhD⁸ Russell P. Bowler, MD, PhD¹

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Author Affiliations

National Jewish Health, Denver, Colorado
Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora
Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine, University of California at Los Angeles
Division of Pulmonary, Critical Care, Sleep and Allergy, Department of Medicine and Cardiovascular Research Institute, University of California San Francisco, School of Medicine, San Francisco
Departments of Radiology, Medicine and Biomedical Engineering, University of Iowa, Iowa City
University of Utah Health Sciences Center, Salt Lake City
Department of Biostatics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora
Division of Pulmonary Diseases and Critical Care Medicine, University of North Carolina at Chapel Hill
Columbia University, Division of General Medicine, New York, New York
University Michigan Health System, Ann Arbor
Johns Hopkins University, Baltimore, Maryland

Address correspondence to:

Russell Bowler & Madeline A. Morris
Department of Medicine, Division of Pulmonary Medicine
National Jewish Health
Denver, Colorado
Telephone: (303)270-2014
Emails: bowler@njhealth.org mamorris8@gmail.com

Abstract

Background: Marijuana is often smoked via a filterless cigarette and contains similar chemical makeup as smoked tobacco. There are few publications describing usage patterns and respiratory risks in older adults or in those with chronic obstructive pulmonary disease (COPD).

Methods: A cross-sectional analysis of current and former tobacco smokers from the Subpopulations and Intermediate Outcome Measures in COPD Study (SPIROMICS) study assessed associations between marijuana use and pulmonary outcomes. Marijuana use was defined as never, former (use over 30 days ago), or current (use within 30 days). Respiratory health was assessed using quantitative high-resolution computed tomography (HRCT) scans, pulmonary function tests and questionnaire responses about respiratory symptoms.

Results: Of the total2304 participants, 1130 (49%) never, 982 (43%) former, and 192 (8%) current marijuana users were included. Neither current nor former marijuana use was associated with increased odds of wheeze (odds ratio [OR] 0.87, OR 0.97), cough (OR 1.22; OR 0.93) or chronic bronchitis (OR 0.87; OR 1.00) when compared to never users. Current and former marijuana users had lower quantitative emphysema (P=0.004, P=0.03), higher percent predicted forced expiratory volume in 1 second (FEV₁%) (P<0.001, P<0.001),and percent predicted forced vital capacity (FVC%) (p<0.001, P<0.001). Current marijuana users exhibited higher total tissue volume (P=0.003) while former users had higher air trapping (P<0.001) when compared to never marijuana users.

Conclusions: Marijuana use was found to have little to no association with poor pulmonary health in older current and former tobacco smokers after adjusting for covariates. Higher forced expiratory volume in 1 second (FEV₁) and forced vital capacity (FVC) was observed among current marijuana users. However, higher joint years was associated with more chronic bronchitis symptoms (e.g., wheeze), and this study cannot determine if long-term heavy marijuana smoking in the absence of tobacco smoking is associated with lung symptoms, airflow obstruction, or emphysema, particularly in those who have never smoked tobacco cigarettes.

Citation

Citation: Morris MA, Jacobson SR, Kinney GL, et al. Marijuana use associations with pulmonary symptoms and function in tobacco smokers enrolled in the Subpopulations and Intermediate Outcome Measures in COPD Study (SPIROMICS). J COPD F. 2018; 5(1): 46-56. doi: http://doi.org/10.15326/jcopdf.5.1.2017.0141

Keywords

emphysema, chronic obstructive pulmonary disease, Lung, smoking, marijuana, tobacco, epidemiology, pulmonary, cross-sectional, respiratory, forced expiratory volume, forced vital capacity, computed tomography scan

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The Short-term Impact of Symptom-defined COPD Exacerbation Recovery on Health Status and Lung Function

Click to read The Short-term Impact of Symptom-defined COPD Exacerbation Recovery on Health Status and Lung Function

Lindsey T. Murray, PhD¹ Nancy K. Leidy, PhD¹

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Evidera, Bethesda, Maryland

Address correspondence to:

Lindsey Murray, PhD
7101 Wisconsin Avenue
Suite 1400
Bethesda, MD 20814
Phone: 301-654-9729
email: lindsey.murray@evidera.com

Abstract

Background: This study examined the short-term effects of symptom-defined exacerbation recovery on health status and pulmonary function in moderate to severe chronic obstructive pulmonary disease (COPD) patients.

Methods: Secondary analyses of pooled data from two 12-week Phase II international, randomized controlled trials using the EXAcerbations of Chronic Pulmonary Disease Tool (EXACT) to identify symptom-defined exacerbations were conducted. Recovery was categorized as recovered, unrecovered (persistent worsening), or censored. Multiple regression analyses were used to test the effect of recovery status on change in the St George’s Respiratory Questionnaire (SGRQ) and forced expiratory volume in 1 second (FEV₁) from baseline to Week 12. Evaluating Respiratory Symptom scale (E-RS) scores were used to evaluate change in stable-state respiratory symptoms from baseline to Week 12.

Results: Of 1346 eligible patients, 414 (31%) experienced ≥1 symptom-defined exacerbation; 260 patients recovered from their events, 80 experienced an unrecovered event (persistent worsening), 74 patients had only censored events (excluded). Groups were similar at baseline, with the recovered group reporting significantly worse symptoms (p<0.01). Recovery group and baseline SGRQ were significant predictors of change in health status over 12 weeks (p=0.04; p<0.01); no effects were observed for lung function. Significant between-group differences in change in respiratory symptom severity from baseline to Week 12 were observed (p<0.01), with the persistent worsening group experiencing clinically meaningful deterioration in breathlessness and chest symptoms.

Conclusions: Results suggest some patients have difficulty recovering from symptom-defined exacerbations, leading to a deterioration in health status, dyspnea, and chest symptoms without short-term effects on lung function. Further study of symptom-defined exacerbation recovery and health outcomes is warranted.

Citation

Citation: Murray LT, Leidy NK. The short-term impact of symptom-defined COPD exacerbation recovery on health status and lung function. J COPD F. 2018; 5(1): 27-37. doi: http://doi.org/10.15326/jcopdf.5.1.2017.0166

Keywords

COPD, exacerbations, lung function, health status, patient-reported outcomes, EXACT, outcome measures

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Pattern and Adherence to Maintenance Medication Use in Medicare Beneficiaries with Chronic Obstructive Pulmonary Disease: 2008-2013

chronic obstructive pulmonary disease, inhaled corticosteroids, long-acting muscarinic antagonists, long-acting beta2-agonists, Medicare, medication adherence

Shawn P. E. Nishi, MD¹ Matthew Maslonka, MD² Wei Zhang, MS¹Yong-Fang Kuo, PhD³ Gulshan Sharma, MD, MPH^1,2

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Author Affiliations

Division of Pulmonary, Critical Care & Sleep Medicine, University of Texas Medical Branch, Galveston
Department of Internal Medicine, University of Texas Medical Branch, Galveston
Sealy Center on Aging, University of Texas Medical Branch, Galveston

Address correspondence to:

Shawn P.E. Nishi, MD
Division of Pulmonary, Critical Care & Sleep Medicine
University of Texas Medical Branch
301 University Blvd
Galveston, TX 77555-0561
Email: spnishi@utmb.edu
Telephone: (409)772-2436

Abstract

Background: Maintenance medications provide symptomatic relief, improve lung function and reduce the risk of exacerbations in patients with chronic obstructive pulmonary disease (COPD). Despite their proven benefits, limited information exists on maintenance medication use and adherence among users.

Objective: We examined the patterns and factors associated with the receipt of and adherence to maintenance medication in individuals with COPD.

Methods: A retrospective cross-sectional study of 5% of Medicare beneficiaries enrolled in Parts A, B and D with COPD who received maintenance medication from 2008 to 2013 was conducted. Maintenance medication includes: inhaled corticosteroids (ICSs), long-acting beta2- agonists (LABAs) and long-acting muscarinic antagonists (LAMAs) alone or in combination. We examined the proportion of beneficiaries with COPD who had at least one prescription filled for maintenance medication. Among users of maintenance medications, we also examined adherence, defined as proportion of days covered (PDC) ≥80% over the year from the first maintenance medication prescription fill date.

Results: Overall, maintenance medication (LAMAs, LABAs, ICSs and/or LABA/ICS) use increased from 67.8% in 2008 to 72.1% in 2013. The increase is related to increases in use of LABA/ICS, which rose from 41.1% in 2008 to 49.6% in 2013. Factors associated with receipt of maintenance medication include female gender, recent COPD hospitalization (odds ratio [OR] 1.63; 95% confidence interval [CI] 1.54-1.73), oxygen therapy (OR 1.74 95% CI, 1.68-1.81), dual eligibility status (OR 1.45; 95% CI 1.39-1.51), higher education level and evaluation by a pulmonary provider (OR 1.88; 95% CI 1.81-1.96). The overall adherence among maintenance medication users remained flat. The most important factor associated with adherence was dual eligibility status (OR, 1.67; 95% CI: 1.59-1.75).

Conclusions: Receipt of maintenance medications increased during the study period and was higher in those with dual eligibility. Overall, adherence to maintenance medications was suboptimal and remained unchanged.

Citation

Citation: Nishi SPE, Maslonka M, Zhang W, Kuo Y-F, Sharma G. Pattern and adherence to maintenance medication use in Medicare beneficiaries with chronic obstructive pulmonary disease: 2008-2013. J COPD F. 2018; 5(1): 16-26. doi: http://doi.org/10.15326/jcopdf.5.1.2017.0153

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