International Journal of Chronic Obstructive Pulmonary Disease最新文献

Objective: Fewer than 3% of adults with Chronic Obstructive Pulmonary Disease (COPD) attend in-person, center-based pulmonary rehabilitation (PR) despite demonstrated health benefits and reduction in mortality. This study evaluated the feasibility and usability of a novel home-based, virtual PR (V-PR) intervention compared to center-based PR (C-PR). The virtual PR intervention was supported by remote therapeutic monitoring (V-PR+RTM; Blue Marble Platform, Blue Marble Health, Altadena, CA). Additionally, we collected data on the 6-Minute Walk Test to explore the efficacy of the V-PR compared to C-PR.

Patients and methods: Adults with stable COPD referred for PR were recruited. The participants self-selected C-PR or V-PR and were provided a 6-8-week personalized exercise and COPD self-management educational program. In addition, weekly phone contacts with the V-PR group were made. Feasibility was measured using qualitative analysis of adherence, reasons for withdrawal, and self-reported barriers to using the software at home. Usability was measured with the System Usability Scale (SUS). Efficacy was evaluated with the 6 minute Walk Test (6MWT) and various functional performance and patient-centered health-related quality of life (HRQoL) questionnaires.

Results: Forty-eight participants were enrolled, and 40 (83.3%) completed the intervention, n=17 in the C-PR group and n=23 in the V-PR group. Four participants from each group withdrew due to reasons related to health issues (appendicitis, thrush, COVID, back pain) or the health status of their spouse, no-shows, and time constraints. Adherence to the exercise dose (3x/week) and educational offerings were >80% in both groups. Participants in the V-PR group scored the software as having high usability. In both groups, 6MWT distance improved significantly, as did scores on the CAT and SGRQ. No adverse events were reported in either group.

Conclusion: A software-enabled virtual PR program with remote therapeutic monitoring is feasible, usable, and effective. It could offer an alternative model that increases PR uptake for those unable or unwilling to attend in-person, center-based PR.

Background: It is unclear whether patients with Global Initiative for Chronic Obstructive Lung Disease stage 1 (mild) chronic obstructive pulmonary disease (COPD) have a higher risk of all-cause mortality than participants with normal spirometry results.

Methods: We used the data from the National Health and Nutrition Examination Survey (NHANES) III and 2007-2012, which included participants aged 20-79 years, to investigate whether patients with mild COPD (whole population and subgroups) have a higher risk of all-cause mortality than participants with normal spirometry. Mild COPD was defined as prebronchodilator forced expiratory volume in 1 second /forced vital capacity <0.70 and FEV₁ ≥80% of the predicted value. All-cause mortality risk is the total risk of death from all causes over a given period of time. We performed subgroup analyses by sex, age, smoking status, race, body mass index, and level of education. We also performed sensitivity analyses using the lower limit of normal to define COPD.

Results: 1,760 patients (64.5% male; median aged 59 years) with mild COPD and 19,969 participants with normal spirometry (46.9% male; median aged 43 years) were followed up (median 308 months). Patients with mild COPD had a higher all-cause mortality risk than participants with normal spirometry (adjusted: Hazard Ratios 1.13, 95% Confidence Intervals 1.04-1.23; P = 0.005). The results remained robust in the sensitivity analyses. The subgroup analyses results for male sex, age ≥50 years, and current smokers were consistent with the main analysis.

Conclusion: Patients with mild COPD had a higher all-cause mortality risk than those with normal spirometry, especially males, those aged ≥50 years, and current smokers. These results suggest the need for appropriate management of different subgroups with mild COPD.

Purpose: In Switzerland, while the quality of acute inpatient care for patients with AECOPD is high, a lack of post-acute care interventions has been identified. To correct this shortfall, an integrated care program for patients with AECOPD was initiated at University Hospital Zurich. The study's aim was to compare defined post-acute care intervention implementation rates before and after the new program's implementation.

Methods: A retrospective medical chart review was performed regarding patients hospitalized due to AECOPD between July 2019 and March 2023. The control group (CG) had received usual care, while the intervention group (IG) received the newly implemented program. Implementation rates were compared with Pearson's chi-squared-test or Fisher's exact test.

Results: Charts of 107 participants (IG: 55, CG: 52) were evaluated. Implementation rates increased significantly in the IG for exacerbation management, dyspnea management, recommendation for rehabilitation, smoking cessation advice, evaluation of inhalation technique and recommendation of vaccination (p < 0.05) but not for physical activity, post-discharge medical follow-up or nutrition.

Conclusion: This study provides promising evidence that the introduction of a hospital-initiated integrated care program can significantly increase the implementation rate of post-acute care interventions in patients hospitalized due to AECOPD.

Background: Observational studies have underscored a robust association between frailty and chronic obstructive pulmonary disease (COPD), yet the causality remains equivocal.

Methods: This study employed bidirectional two-sample Mendelian randomization (MR) analysis. Univariable MR investigated the causal relationship between frailty and COPD. Genetic correlation was assessed using linkage disequilibrium score (LDSC) regression. Multivariable MR and mediation analysis explored the influence of various confounders and their mediating effects. The primary analytic approach was inverse variance weighted (IVW).

Results: LDSC analysis revealed moderate genetic correlations between frailty and Global Biobank Meta-Analysis Initiative (GBMI) COPD (r_g = 0.643, P = 6.66×10^-62) as well as FinnGen COPD (r_g = 0.457, P = 8.20×10^-28). IVW analysis demonstrated that frailty was associated with increased risk of COPD in both the GBMI cohort (95% CI, 1.475 to 2.158; P = 2.40×10^-9) and the FinnGen database (1.411 to 2.434; 9.02×10^-6). Concurrently, COPD was identified as a susceptibility factor for frailty (P < 0.05). These consistent findings persisted after adjustment for potential confounders in MVMR. Additionally, mediation analysis revealed that walking pace mediated 19.11% and 15.40% of the impact of frailty on COPD risk, and 17.58% and 23.26% of the effect of COPD on frailty risk in the GBMI and FinnGen cohorts, respectively.

Conclusion: This study has strengthened the current evidence affirming a reciprocal causal relationship between frailty and COPD, highlighting walking pace as a pivotal mediator.

Purpose: This study aims to construct a contemporaneous symptom network of inpatients with Exacerbation of Chronic Obstructive Pulmonary Disease (ECOPD) based on the symptom cluster, identify core and bridge symptoms, and patient subgroups with different symptom clusters based on individual differences in the intensity of patient symptom experiences.

Patients and methods: This study used convenience sampling to collect demographic, symptom, auxiliary examination, and prognosis information of 208 inpatients with ECOPD from April 2022 to October 2023. The data underwent exploratory factor analysis (EFA), symptom network analysis, latent class analysis (LCA), Spearman correlation analysis, Wilcoxon signed-rank test, single-factor regression and multiple-factor stepwise regression.

Results: In hospitalized patients with ECOPD, symptom network analysis revealed that loss of appetite was the core symptom, while chest distress was the bridge symptom. Through LCA analysis, two symptom subgroups were identified: a high-symptom group (53.8%) and a low-symptom group (46.2%). This suggests that there is significant heterogeneity in symptom experience among ECOPD individuals. Patients in the high-symptom group had a higher probability of experiencing symptom clusters related to nutrition-sleep.

Conclusion: The combination of symptom network analysis and LCA comprehensively captures the symptom/symptom cluster characteristics and accounts for the heterogeneity of ECOPD patients from both individual and group perspectives. This study identifies core symptoms, bridge symptoms, and symptom subgroups, offering valuable insights for precision symptom management in ECOPD.

Background: This study aims to investigate the association between vitamin D levels and the risk of severe acute exacerbations of chronic obstructive pulmonary disease (AECOPD).

Methods: We conducted a prospective observational study with 636 COPD patients admitted for exacerbations between January 2021 and December 2022. Patients were categorized based on serum 25-hydroxyvitamin D levels: severe deficiency (<10 ng/mL), deficiency (10-20 ng/mL), insufficiency (20-30 ng/mL), or sufficiency (>30 ng/mL). Severe exacerbation was defined when the patient visits an emergency room or is hospitalized due to COPD exacerbation. Multivariate Cox regression was used to evaluate the risk associated with vitamin D deficiency.

Results: Over an 18-month follow-up, 178 (28.0%) patients experienced at least one severe exacerbation. The severe deficiency group had the highest exacerbation rate (40.6%), followed by deficiency (27.8%), insufficiency (22.5%), and sufficiency (18.1%) groups (P<0.01). Multivariate Cox regression analysis showed that severe vitamin D deficiency was significantly associated with an increased risk of severe exacerbations (HR=2.74, 95% CI: 1.55-4.84; P<0.01) compared to vitamin D sufficiency.

Conclusion: Severe vitamin D deficiency is a significant predictor of severe COPD exacerbations, highlighting the importance of routine vitamin D assessment and supplementation in COPD management.

Purpose: The C-reactive protein (CRP)-albumin-lymphocyte (CALLY) index is a newly developed biomarker that combines measurements of CRP, serum albumin, and lymphocyte count. This index provides a thorough assessment of a patient's inflammation level, nutritional condition, and immunological function. The objective of this study is to examine the correlation between the CALLY index and all-cause mortality in COPD patients.

Methods: We calculated the CALLY index using data from the National Health and Nutrition Examination Survey (NHANES) for the 2007-2008 and 2009-2010 cycles, extracted from the participants' peripheral blood samples. The study utilized Kaplan-Meier curves, restricted cubic spline (RCS) curves, and Cox regression analysis to evaluate the relationship between the CALLY index and the risk of all-cause mortality in COPD patients. To assess the predictive accuracy of the CALLY index, we calculated the area under the receiver operating characteristic (ROC) curve (AUC).

Results: The study included 1,048 participants and found a significant negative correlation between the CALLY index and all-cause mortality in patients with COPD. The CALLY index was a major predictor of survival in COPD patients [fully adjusted model: in the 3rd quartile, HR = 1.61, 95% CI: 1.02-2.52, p = 0.039; in the 2nd quartile, HR = 2.11, 95% CI: 1.22-3.65, p = 0.008; in the 1st quartile, HR = 3.12, 95% CI: 2.00-4.85, p < 0.001]. The RCS curves demonstrated a non-linear association between the CALLY index and all-cause mortality in COPD patients. The areas under the curve (AUC) in predicting 5- and 10-year all-cause mortality were 0.693 and 0.656.

Conclusion: The CALLY index has a strong relationship with all-cause mortality in patients with COPD in the US and could serve as a prognostic biomarker for these patients.

Purpose: Oral corticosteroids (OCS) are recommended for the treatment of exacerbations in people with COPD; however, high cumulative lifetime doses (≥1000mg prednisolone-equivalent) are associated with adverse health effects. This issue is well defined in asthma but is less well understood in COPD. The aim of this study was to examine cumulative OCS dispensed to people with COPD over 12 months.

Patients and methods: This was a secondary analysis of data from two randomised controlled trials involving people with COPD followed up for 12 months following pulmonary rehabilitation. Clinical and administrative (respiratory-related hospital admissions and emergency presentations, dispensed OCS and COPD maintenance medications) data were examined to determine cumulative OCS dose relative to the 1000mg threshold and the relationship with clinical features.

Results: Of 232 participants (126 females, age mean 68 ± SD 9 years, FEV₁ 53 ± 22% predicted), 48% (n = 112) were dispensed OCS at least once over 12 months. Sixty-two participants (26%) were dispensed ≥1000mg. Participants with a high cumulative dose were more likely to have had a respiratory admission (OR 4.1, 95% CI 2.3 to 8.7) and greater breathlessness (modified Medical Research Council scale ≥2, OR 2.5, 95% CI 1.3 to 5.0); no relationship with disease severity or maintenance medications was demonstrated.

Conclusion: One in four people with COPD were dispensed unsafe lifetime cumulative OCS doses over a period of only 12 months. Further work is needed to determine the magnitude of this issue in COPD and strategies to address exposure to high doses of OCS.

Background: Chronic obstructive pulmonary disease (COPD) affects breathing, speech production, and coughing. We evaluated a machine learning analysis of speech for classifying the disease severity of COPD.

Methods: In this single centre study, non-consecutive COPD patients were prospectively recruited for comparing their speech characteristics during and after an acute COPD exacerbation. We extracted a set of spectral, prosodic, and temporal variability features, which were used as input to a support vector machine (SVM). Our baseline for predicting patient state was an SVM model using self-reported BORG and COPD Assessment Test (CAT) scores.

Results: In 50 COPD patients (52% males, 22% GOLD II, 44% GOLD III, 32% GOLD IV, all patients group E), speech analysis was superior in distinguishing during and after exacerbation status compared to BORG and CAT scores alone by achieving 84% accuracy in prediction. CAT scores correlated with reading rhythm, and BORG scales with stability in articulation. Pulmonary function testing (PFT) correlated with speech pause rate and speech rhythm variability.

Conclusion: Speech analysis may be a viable technology for classifying COPD status, opening up new opportunities for remote disease monitoring.

Introduction: Hyponatraemia has been suggested to be associated with morbidity and mortality among various medical disorders. Evidence on the association between stable-state hyponatraemia and prognosis in patients with chronic obstructive pulmonary disease (COPD) is lacking.

Methods: All COPD patients followed up in a regional hospital in year 2015 were included, with their clinical outcomes reviewed in the subsequent eight years. Association between stable-state hyponatraemia and mortality was evaluated. Stable-state hyponatraemia is defined as baseline serum sodium levels, at least 90 days away from the last AECOPD <135 mmol/L.

Results: There were 271 COPD patients included. Hyponatraemia was associated with shorter overall survival with adjusted hazard ratio (aHR) 1.74 (95% CI = 1.07-2.65, p = 0.026). The median overall survival was 3.05 years (95% CI = 2.65-3.46) for patients in the hyponatraemia group, in contrast to 3.35 years (95% CI = 2.86-3.83) for those without hyponatraemia. The highest baseline serum sodium levels were significantly negatively associated with annual acute exacerbation of COPD (AECOPD) and annual hospitalized AECOPD frequency in the follow-up period, with Pearson correlation coefficient of -0.16 (p = 0.011) and - 0.14 (p = 0.027), respectively.

Conclusion: Stable-state hyponatraemia was associated with increased mortality and probably AECOPD frequency among patients with COPD.