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

Chronic obstructive pulmonary disease (COPD) among individuals living in rural areas is associated with worse health outcomes. New strategies are needed to study interventions and deliver proven therapies to people with COPD in rural areas. This statement from the COPD Foundation Medical and Scientific Advisory Committee highlights specific challenges in capturing the key characteristics of rural residents and identifies approaches to improve research for COPD in rural areas. Specifically, geographic isolation, access to specialist care, lack of broadband access, and complex tobacco and exposure histories are drivers of COPD health disparities in rural populations that are not captured by conventional definitions of rurality. To improve the design of research studies among people with COPD living in rural settings, certain actions are identified. These include the inclusion of specific covariates such as distance and travel time to health care services and multidimensional assessment tools for societal and individual health determinants in data collection; deploying qualitative and mixed-methods research designs to assess cultural differences driving health care access and health behaviors; decentralized carousel recruitment models in study design; and operationalizing research partnerships to improve support for primary care providers engaged in research. These approaches will permit robust assessment of the complex matrices driving disparate health outcomes among people with COPD in rural areas.

Background: Cathepsins, a family of lysosomal proteolytic enzymes, have been implicated in the pathogenesis of various complex diseases, including chronic obstructive pulmonary disease (COPD). However, the causal relationship between cathepsins and COPD remains unclear.

Methods: This study employed Mendelian randomization (MR) to investigate the potential causal effects of cathepsin levels on COPD risk. This MR analysis utilized genetic data from individuals of European ancestry in the INTERVAL study and FinnGen consortium. Specifically, summary-level genetic data for 9 cathepsins (B, E, F, G, H, O, L2, S, and Z) were obtained from the INTERVAL study, while COPD summary statistics were sourced from the FinnGen consortium. We conducted comprehensive MR analyses, including univariable MR, reverse MR, multivariable MR (MVMR), and MR least absolute shrinkage and selection operator, to assess causal relationships between cathepsin levels and COPD risk.

Results: Univariable MR analysis revealed no significant causal relationships (forward or reverse) between the 9 cathepsins and COPD risk. However, MVMR analysis identified cathepsins O and S as having direct causal effects on COPD. For cathepsins O and S, odds ratio was estimated as 1.130 (p=0.022, 95% confidence interval [CI] = 1.018-1.255) and 1.068 (p=0.025, 95% CI = 1.008-1.132), respectively. Furthermore, these 2 cathepsins were independent risk factors for COPD after adjusting for smoking.

Conclusions: To our knowledge, this is the first MR study to systematically evaluate the causal role of cathepsins in COPD. Further research, particularly clinical trials, is warranted to validate these associations and explore the therapeutic potential of targeting cathepsins in COPD management.

Rationale: Chronic lung diseases, including chronic obstructive pulmonary disease (COPD) and bronchiectasis (BE), may differ by sex in symptom onset, diagnostic delays, and disease burden. This study examined health care experiences and symptom burden among individuals with self-reported COPD, BE, or nontuberculous mycobacteria (NTM).

Methods: This cross-sectional study analyzed data from an online survey of U.S. and international participants with self-reported COPD, BE, or NTM, recruited via COPD Foundation social media. The questionnaire, developed with input from COPD Foundation leadership, physician-researchers, and patient stakeholders, assessed health care experiences, disease burden, and symptoms. A subset of women answered menopause-related questions. Descriptive statistics were compared by sex and disease group: COPD (with/without BE or NTM) and BE (with/without NTM). T-tests assessed continuous variables; Chi-square or Fisher's exact tests analyzed categorical variables.

Results: Among 632 respondents (mean age 70±9 years, 74% women), 68% reported COPD and 32% BE. Women with COPD were younger (p=0.048) and sought care sooner after symptom onset (p<0.010) than men. More women with COPD did not have their diagnosis explained by a health care provider (p=0.038) and reported diagnosis-related anxiety, depression, or fear (p=0.007). Among participants with BE, men were more likely to receive a confirmed diagnosis sooner (p=0.038) and during hospitalization (p=0.024). Disease management burden, pulmonologist visit frequency, Chronic Airways Assessment Test scores, numbers of comorbidities, and financial burden were similar across groups. Over 75% of women were postmenopausal, and one-third reported worsened pulmonary symptoms postmenopause.

Conclusions: Differences in diagnostic delays and symptom burden highlight the need for further research into health care disparities to improve pulmonary care and outcomes.

Purpose: Chronic obstructive pulmonary disease (COPD) remains a challenging condition to manage due to its variability in clinical presentation and progression. While disease control is a well-defined concept in asthma, its relevance in COPD is less clear. This study aimed to evaluate the clinical utility of a COPD control framework, developed in Spain, in Portuguese outpatients by analyzing exacerbation rates among controlled and uncontrolled patients.

Methods: This prospective, observational study enrolled 133 COPD outpatients, evaluated at baseline (V0), 6 months (V1), and one year (V2). Patients were classified as controlled or uncontrolled based on criteria assessing clinical stability and disease impact, incorporating dyspnea severity, rescue medication use, physical activity, sputum color, and recent exacerbation history. Patients classified as controlled and uncontrolled were compared regarding the occurrence of an exacerbation (hospitalization, emergency visit, or ambulatory exacerbation) during follow-up.

Results: At baseline, 33.1% of patients were classified as controlled. This proportion increased to 46.2% at V1 but decreased to 31.6% at V2. Notably, only 12% remained consistently controlled throughout follow-up. There was a consistent trend of higher exacerbation rates among those previously uncontrolled. Only the difference in emergency visits at 12 months reached statistical significance (27.1% versus 7.8% in controlled patients, p=0.023).

Conclusion: This study provides the first independent validation of COPD control criteria in a Portuguese cohort. Although the control framework proved feasible for clinical application, its predictive value for exacerbations was low in this severe-disease cohort. Future research should expand on these findings in diverse populations to optimize COPD management strategies.

Chronic obstructive pulmonary disease (COPD) is a global health challenge. Increasing numbers of patients with COPD are prescribed multiple medications (both for COPD and non-COPD disorders). This increases the risk of polypharmacy in these patients which can be linked with patient harm. However, the definition of polypharmacy is varied across literature (ranging from use of ≥3 to ≥20 medications). This review aims to report the prevalence of polypharmacy, report the varying definitions of polypharmacy, and report medication related harms amongst patients with COPD. We identified 28 studies reporting polypharmacy rates in COPD populations. A total of 13 studies (46.3%) defined polypharmacy as the use of ≥5 medications; however, the remaining studies had different definitions of polypharmacy. The available studies include multiple different countries and settings (primary care, secondary care, and community-based surveys). Polypharmacy and hyper polypharmacy (use of ≥10 medications) rates varied from 3.9% to 81.4% and 6.6% to 74.6% respectively. Polypharmacy in patients with COPD is common but poorly understood due to difficulty in comparing previous literature with differences in methodologies, patient populations, and definitions of polypharmacy. The multimorbid COPD population is likely at higher risk to the effects of polypharmacy through poor adherence, adverse drug reactions, and drug-drug interactions. Clinicians should be mindful of the patient's age, comorbidities, and drug-drug interactions while prescribing medications in the COPD clinic.

Objectives: A critical step in designing clinical trials to evaluate treatment efficacy in chronic obstructive pulmonary disease (COPD) is selecting fit-for-purpose outcome measures that reflect health concepts meaningful to people living with COPD. The purpose of this review was to summarize and synthesize qualitative literature addressing how patients with COPD describe aspects of their disease, to inform health concept selection and outcome measure selection.

Methods: A literature review and metasynthesis of qualitative research published from 2013 to 2023 was performed. Studies meeting criteria underwent critical appraisal and data extraction. Studies were summarized and synthesized with constant comparative analysis to review author interpretations and direct patient quotes.

Results: Nineteen studies addressing the patient experience of COPD met screening criteria for full review and data synthesis. In total, 507 patients (range: 8-64 individuals per study) across 11 countries participated in these studies via interviews (63.2%), focus groups (15.8%), or online forums (5.3%). Prominent COPD symptoms included breathlessness, cough, mucus, wheezing, chest discomfort, difficulty sleeping, tiredness, and weakness. Patients described significant impacts on physical activity, emphasizing difficulties with activities of daily living. The symptoms experienced and the persistent limitation on physical activity had severe consequences on social and role functioning and psychological and emotional health.

Conclusion: This qualitative metasynthesis summarizes evidence about symptoms experienced by patients with COPD and the impact of these symptoms on daily life. The synthesis provides an empirical foundation for the development of a standardized set of patient-inspired health concepts to be considered when selecting outcome measures for COPD clinical trials.

Background and objectives: Chronic obstructive pulmonary disease (COPD) and asthma account for a significant health care burden within the United States. The asthma-COPD overlap (ACO) phenotype has been associated with increased exacerbation frequency and health care utilization compared to either disease alone. However, hospital-based outcomes of these diagnoses have not been described in the literature.

Methods: Hospitalization data were extracted from the Healthcare Cost and Utilization Project Nationwide Readmissions Database (HCUP-NRD 2012-2015). Using International Classification of Diseases, Ninth Revision, Clinical Modification codes, we classified patients as having asthma, COPD, or ACO. We used analytic sample weights to compute national estimates, and weighted regression analyses to evaluate hospitalization outcomes.

Results: Of 2,522,013 patients reviewed, 1,732,946 (68.7%) had COPD, 668,867 (26.5%) had asthma, and 120,200 (4.8%) had ACO. Patients with ACO were younger than those with COPD (63 versus 69 years old, p< 0.05), with a higher rate of respiratory failure and an increased hospital length of stay. Index admission mortality was higher in patients with COPD (adjusted odds ratios [OR] [95%]: 2.10 [1.84; 2.40]) and asthma (adjusted OR [95%]: 1.59 [1.38; 1.83]) as compared to those with ACO. However, the all-cause readmission rate was higher in the COPD group (15.7%) but not in the asthma group (10.7%) as compared to the ACO group (11.5%).

Conclusion: While ACO was associated with higher rates of baseline comorbidities, increased length of stay, and higher health care cost during index admission, this did not translate into higher in-hospital mortality, complication rates, or risk for asthma-related readmission mortality when compared to asthma or COPD alone, highlighting the complexity of the ACO disease burden.

This review addresses the multifaceted challenges and opportunities in managing chronic obstructive pulmonary disease (COPD), from both the patient and health care professional (HCP) perspectives. Coauthored by a patient organization advocate, a pulmonologist, and a nurse practitioner, this article synthesizes insights gained through collaborative discussions and a comprehensive literature review. It highlights the critical importance of early diagnosis of COPD, emphasizing that delayed diagnosis can lead to significant underdiagnosis and mismanagement of the disease. Lung function declines more rapidly in the early stages of COPD. Therefore, delayed or underdiagnosed COPD results in a lost opportunity to improve or maintain lung function, prevent exacerbations, and enhance the quality of life. The typical patient journey is also outlined in this article, underscoring the necessity of encouraging patients to actively engage in their care. Patients and HCPs collectively call for improvements in COPD management, emphasizing the importance of maintenance therapy; a deeper understanding of COPD exacerbations, focusing on their prevention; and fostering a partnership between patients and their HCPs in care management. The role of HCPs is crucial in promoting the self-management and awareness of COPD among patients. By integrating patient perspectives into clinical practice, health care systems can better address the complex needs of patients with COPD and ultimately enhance their health outcomes.

Background: Variable hospital care for chronic obstructive pulmonary disease (COPD) and underutilization of pulmonary rehabilitation (PR) may contribute to poor outcomes. Clinical pathways can optimize care by providing real-time decision support based on evidence and expert consensus. An inpatient COPD pathway was implemented in May 2021.

Objective: The objective was to evaluate the impact of the COPD pathway on length of stay (LOS), discharge disposition, resource use, PR referrals, and readmissions.

Study design and methods: A 2-part COPD pathway embedded into the electronic health record was built by multidisciplinary providers across a large academic medical center. Providers could place orders and document notes directly from the pathway. We identified all COPD hospitalizations one year after pathway implementation using International Classification of Diseases, Tenth Revision, Clinical Modification codes according to methods used by the Centers for Medicare & Medicaid Services.

Results: A total of 766 patients contributed to 971 hospitalizations. The pathway was opened in 142 (14.6%) hospitalizations. No significant differences in demographics, insurance, or smoking status were noted between pathway versus nonpathway patients. Bivariate analyses demonstrated lower LOS (5.4 days versus 7.1 days, p=0.001) and total costs ($5756 versus $8781, p< 0.001) with pathway use, but no significant difference between 30-day readmissions (16% versus 22%, p=0.12). In multivariable analysis, pathway use was associated with greater PR referrals (odds ratio [OR] 5.76, 95% confidence interval [CI] 2.47-13.45, p<0.001) and discharges to home (OR 1.96, 95% CI 1.13-3.39, p=0.016).

Conclusion: Despite low utilization, pathway use was associated with more PR referrals and discharges to home with a trend toward lower LOS, resource use, and decreased readmissions.