Chronic Obstructive Pulmonary Diseases-Journal of the Copd Foundation最新文献

Background: Nocturnal symptoms and sleep disturbances are increasingly recognized as clinically important in chronic obstructive pulmonary disease (COPD) but remain understudied in low- and middle-income countries. Objective: To assess sleep quality and determine its association with respiratory symptoms in Vietnamese outpatient COPD patients.

Methods: We conducted a cross-sectional study on 289 consecutive patients (≥ 40 years old) with a confirmed COPD diagnosis who were being monitored at the COPD management unit of Bach Mai Hospital, Hanoi (February-May 2025). Demographic and clinical data (mMR dyspnea, CAT score, FEV₁ after bronchodilator use, comorbidities, number of hospitalizations in the previous year) were collected through structured interviews and medical record reviews. Sleep was assessed using the Pittsburgh Sleep Quality Index (PSQI).

Results: The mean PSQI total score was 9.2 ± 3.7; 85.8% of participants met the threshold for poor sleep. 65.4% of patients had mMRC ≥ 2, 88.9% had CAT ≥ 10, and 88.9% of patients had an acute hospitalization in the past year. High CAT score, mMRC, long disease duration, and FEV1 below 50% were risk factors for impaired sleep quality as measured by PSQI.

Conclusions: Poor sleep quality is highly prevalent among Vietnamese outpatient COPD patients and is closely associated with respiratory symptom burden and disease severity. These findings underscore the importance of routine sleep quality assessment in COPD management and suggest that optimizing symptom control may contribute to improved sleep and overall patient outcomes.

Background: Individuals with chronic obstructive lung disease (COPD) rely on inhaler-based medications to treat and control symptoms. Most patients do not use correct technique. Teach-to-goal (TTG) inhaler education programs have been found to improve inhaler technique. There is limited understanding as to whether TTG inhaler education is effective when delivered over the phone.

Research question: What was the effect of a phone-based TTG inhaler technique education program among Medicare Advantage beneficiaries with COPD?

Study design and methods: Beneficiaries with a diagnosis of COPD within the prior two years, who had filled at least one maintenance inhaler at least once in the prior year, had a VBID plan, and received the inhaler education component of the COPD intervention program were evaluated. Inhaler technique was measured by validated checklists; patients self-reported technique.

Results: Of 1876 patients analyzed, n=13 used more than one inhaler. At the initial assessment, 39.4% of participants were using their inhalers incorrectly. By the end of the first education session, the percentage of participants that were using their inhaler incorrectly decreased to 6.9%.

Interpretation: A phone-based TTG inhaler education program offered by a large national health plan demonstrated improvements in inhaler technique across different inhaler devices and sub-populations. The multiple-session approach was likely critical for longer-term retention of correct technique, though further study is needed to confirm this. Some sub-group populations are also at greater risk for baseline inhaler misuse and/or post-training inhaler misuse indicating a need for further evaluation of how to tailor inhaler education by individuals' needs.

Rationale: Rationale: Chronic obstructive pulmonary disease (COPD) is a leading cause of hospitalization and death, particularly among patients with chronic bronchitis and frequent exacerbations. Results of placebo-controlled clinical trials indicate that treatment escalation with either long-term oral roflumilast or azithromycin can reduce COPD exacerbations. However, head-to-head comparative data from clinical trials are lacking, so the relative harms and benefits of these treatments are unclear.

Objective: The RofLumilast or Azithromycin to preveNt COPD Exacerbations (RELIANCE) study is an investigator-initiated, multicenter, randomized, pragmatic clinical trial embedded in clinical practice to evaluate the effectiveness of treatment escalation with long-term azithromycin versus roflumilast in patients with COPD and chronic bronchitis.

Methods/design: We solicited preferences from patients, clinicians, and other stakeholders during the design and implementation phases of the study, including feedback that informed modifications related to the COVID-19 pandemic. Eligibility criteria did not require assessments outside of clinical practice, with exclusions principally for safety. The composite endpoint of first all-cause hospitalization or death served as the primary outcome. Enrollment was initially through university-affiliated clinical centers but was subsequently expanded to recruit patients in community-based practices who might not otherwise participate in research. We employed human-centered design principles to improve the usability of study activities from the perspective of participants, study staff, and treating clinicians.

Final design: The final study design offered the option for patients with COPD and chronic bronchitis at high-risk of hospitalization or death to be remotely consented, prescribed a medication according to the randomized treatment allocation, and complete virtual follow-up study visits in a decentralized clinical trial.

Objectives: The objective of this study was to examine the relationships and usefulness of physical activity, physical performance, and physical function in patients with chronic obstructive pulmonary disease (COPD), focusing on 2 newly proposed skeletal muscle indices: the upper limb skeletal muscle mass index (USMI) and lower limb skeletal muscle mass index (LSMI).

Methods: A total of 80 stable patients with COPD who participated in outpatient pulmonary rehabilitation at Osaka Fukujuji Hospital were enrolled. The primary measurements were the USMI, LSMI, and skeletal muscle index (SMI). The explanatory measurements included physical activity, incremental shuttle walking distance (ISWD), quadriceps strength, handgrip strength, the Nagasaki University Respiratory Activities of Daily Living Questionnaire, and pulmonary function. Pearson’s correlation coefficient and stepwise multiple regression analysis were used for the statistical analyses.

Results: USMI showed no significant correlations with physical activity parameters or ISWD. In contrast, LSMI was significantly correlated with weekly exercise volume (r=0.42, p<0.01), daily exercise volume (r=0.42, p<0.01), time spent in activities ≥3 metabolic equivalents of task (r=0.40, p<0.01), and ISWD (r=0.46, p<0.01). Multiple regression analysis identified ISWD as an independent factor for USMI, LSMI, and SMI.

Conclusions: This study demonstrated that LSMI, similar to SMI, was associated with physical activity and exercise capacity in patients with COPD. These findings highlight the importance of evaluating, maintaining, and strengthening lower limb skeletal muscle mass and suggest that LSMI may serve as a useful clinical evaluation index.

Introduction: High rates of medication nonadherence contribute to poor outcomes in chronic obstructive pulmonary disease (COPD), but the mechanisms driving nonadherence remain poorly understood.

Methods: We conducted qualitative semistructured interviews to evaluate barriers and facilitators of inhaler adherence. The Capability, Opportunity, and Motivation model of Behavior informed the semistructured interview guide and analysis.

Results: Short-term lapses in inhaler use commonly resulted from inhaler unaffordability, not possessing the inhaler, forgetfulness, and geographical or logistical issues accessing health care services. Participants overcame these barriers by requesting more affordable inhalers, keeping inhalers in strategic locations, routinizing inhaler use, utilizing reminders or cues, having extra inhalers, and leaning on social support. Nearly half of participants reported using their inhalers differently than prescribed because of insufficient knowledge, skills, or complex motivational barriers. Participants who reported using an incorrect dosage schedule or poor inhaler technique were unaware of their inhaler misuse. Although participants collectively saw some benefit to using inhalers, many were intentionally nonadherent due to conflicting motivational factors. Common motivational barriers to adherence included beliefs that inhalers were not always necessary, nonadherence carried little risk, their self-identity conflicted with having COPD, and emotional distress related to numerous medications. There were strong interactions between reinforcement and other motivational factors that created feedback loops which strengthened or weakened adherence.

Conclusions: Barriers to medication adherence were common and varied by individual. Knowledge and skills barriers are well-suited for interventions that utilize instruction or enablement, whereas motivational barriers could be addressed through reinforcement or interventions tailored at the individual level.

Background: Lung resection is the preferred treatment option for lung cancer. Patients with chronic obstructive pulmonary disease (COPD) may be denied surgery due to lung function impairment or other comorbidities.

Objective: We aimed to describe the predictors of lung resection and long-term survival in patients with COPD with early-stage nonsmall cell lung cancer (NSCLC).

Study design and methods: This is a retrospective cohort study of patients with COPD who were treated for resectable NSCLC between 2009 and 2019 in a tertiary care hospital. The decision to operate or not followed a thorough clinical evaluation. Survival status was obtained from a provincial registry. A multivariable logistic regression analysis was used to determine predictors of surgery. A propensity score technique was used to control for confounding by indication. Hazard ratios for survival were estimated from a Cox regression model, adjusted for measured baseline confounders and propensity score as covariates.

Results: A total of 1307 patients with COPD were included, including 918 who underwent surgery. Of those, 147 (38%) did not have surgery and were treated with stereotactic body radiotherapy, 86 (22%) were treated with conventional radiotherapy, and 156 (40%) did not receive any active treatment. Predictors of surgery included age, forced expiratory volume in 1 second, adenocarcinoma versus squamous cell carcinoma, and stage 2A versus stage 1A. Propensity score-adjusted survival was significantly reduced with nonsurgical versus surgical approaches.

Interpretation: Lung resection was associated with better survival in patients with COPD and resectable lung cancer compared to nonsurgical approaches.

Rationale: The variation of chronic obstructive pulmonary disease (COPD) population-level exacerbation rates at fine spatial scales is unclear but is important for understanding the potential role of neighborhood-level factors in risk for COPD exacerbations. We aim to describe the spatial distribution of emergency department (ED) visits, hospitalizations, and readmissions for acute exacerbations of COPD (AECOPDs) across census tracts in Travis County, Texas, and understand the neighborhood characteristics that may contribute to census tract-level morbidity.

Methods: We used the Texas Health Care Information Collection data set and the U.S. Census Bureau’s 2019 American Community Survey to calculate census tract-specific population-based incidence rates (PBIRs) and readmission rates from January 2016 through December 2020. Conditional autoregressive models were used to map estimated PBIRs of acute care use outcomes across census tracts. We then examined associations of neighborhood characteristics with census tract-level rates of acute care use.

Results: Census tract-level incidence rates of COPD-related ED visits and hospital admissions exhibited spatial patterning across Travis County. In contrast, there was less spatial patterning of census tract-level readmission rates across census tracts. Several census tract demographic, socioeconomic, and built environment characteristics were associated with census tract-level COPD-related ED visit and hospitalization rates, but not with COPD readmission rates.

Conclusion: There is a spatial pattern of ED visit and hospitalization PBIRs for AECOPDs within Travis County and several associations with neighborhood characteristics. Readmission rates did not exhibit clear spatial patterning across census tracts and did not have similar associations with neighborhood characteristics.

Objective: Untreated chronic obstructive pulmonary disease (COPD) exacerbations are associated with short-term changes in lung function and decreased health-related quality of life (HRQoL). This study aims to examine the association between untreated exacerbations and long-term HRQoL, as well as differences in characteristics between treated and untreated exacerbations.

Methods: A secondary analysis was performed using data from a prospective observational cohort study of participants with COPD. Participants’ HRQoL was measured using the Chronic Respiratory Questionnaire (CRQ) at baseline and at 12 months. Exacerbations were ascertained with phone calls every 2 weeks, with detailed information regarding exacerbations obtained by research staff. Exacerbations were considered treated if participants took prednisone or antibiotics. Mixed models were used to analyze differences in treated and untreated exacerbation characteristics. Linear and logistic regression models were used to examine the association between the number of treated and untreated exacerbations and a change in CRQ at 12 months.

Results: Among 410 participants, 355 experienced 1097 exacerbations during the 12-month study period, of which 460 (42%) were treated. Treated exacerbations were more severe and lasted longer (25.5 versus 19.9 days, p<0.001) compared to untreated exacerbations. Each additional untreated exacerbation experienced was associated with a significant worsening of long-term HRQoL scores compared to those without exacerbations: CRQ dyspnea (adjusted b= -0.10; 95% confidence interval -0.18 to -0.03), CRQ fatigue (b= -0.07; -0.14 to -0.01), and CRQ emotional function (b= -0.08; -0.14 to -0.02).

Conclusion: Untreated COPD exacerbations occurred frequently and were associated with worse long-term HRQoL, despite being shorter and less severe than treated exacerbations.

Background: Chronic obstructive pulmonary disease (COPD) is a progressive disease with a high prevalence and cost burden on the health care system. Overall, adherence to prescribed therapies is low and associated with worse outcomes.

Objective: Cost-related nonadherence (CRN) is a type of nonadherence that could be addressed through policy. We evaluated the long-term association of CRN on COPD outcomes in a well-profiled cohort.

Methods: We identified 2521 participants with baseline COPD who answered the social and economic questionnaire in the COPD Genetic Epidemiology study cohort. Of these, 408 participants endorsed experiencing CRN. Multivariable regression models were utilized to assess the association of experiencing CRN and COPD outcomes including functional status, health status, and progression of disease.

Results: Experiencing CRN is associated with worse functional status by the 6-minute walk distance, symptom burden by the COPD Assessment Test score, and health status by the St George’s Respiratory Questionnaire. Longitudinal analysis revealed an association of CRN with faster lung function decline and an increased risk of COPD exacerbations.

Conclusion: Policy changes to address out-of-pocket medication costs may improve COPD outcomes and potentially lead to long-term cost savings.