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

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.

Background: Metabolic dysfunction-associated fatty liver disease (MAFLD) affects approximately 38.7% of individuals globally and potentially leads to cirrhosis and hepatocellular carcinoma. This study aims to investigate the prevalence, characteristics, and impact of MAFLD on the frequency of exacerbations in chronic obstructive pulmonary disease (COPD) patients in Vietnam.

Methods: This cross-sectional descriptive study involved stable COPD patients, and using FibroScan to detect fatty liver while applying the 2020 Asian Pacific Association for the Study of the Liver criteria for a MAFLD diagnosis.

Results: Of the 168 COPD patients, 48.8% were diagnosed with MAFLD. Patients with MAFLD had significantly worse lung function, with a lower forced expiratory volume in 1 second (57.2% versus 67.0%, p=0.002) and forced vital capacity (80.8% versus 88.1%, p=0.009), compared to those without MAFLD. The frequency of exacerbations was higher in the MAFLD group, with 46.3% experiencing ≥2 exacerbations in the previous year, compared to 30.2% in the non-MAFLD group (p=0.032). Elevated controlled attenuation parameter (CAP) scores (>289dB/m) were strongly associated with frequent exacerbations in the previous year (odds ratio [OR] 5.64, p=0.001). MAFLD was also identified as an independent factor increasing the risk of exacerbation (OR 3.64, p=0.014).

Conclusion: Nearly half of the COPD patients were diagnosed with MAFLD. MAFLD is associated with worse lung function and an increased frequency of exacerbations in the past year. Elevated CAP scores were found to be a significant risk factor for frequent exacerbations in the past year. MAFLD is an independent risk factor for exacerbations in COPD patients.

Background: Chronic obstructive pulmonary disease (COPD) is characterized by progressive airway inflammation and compromised immune defense, often worsened by reduced secretory immunoglobulin A (sIgA) levels. This decline in sIgA is linked to diminished polymeric immunoglobulin receptor (pIgR) activity, which impairs mucosal immunity. MicroRNA-144 (miR-144), a microRNA implicated in inflammation, may contribute to pIgR suppression, though this pathway in COPD remains poorly understood.

Methods: Human bronchial epithelial cells were exposed to cigarette smoke extract (CSE) to mimic COPD conditions, and were subsequently divided into control and CSE-treated groups. miR-144 was either inhibited or overexpressed in these cells via transient transfection. Expression levels of miR-144, transforming growth factor beta-induced factor homeobox 1 (TGIF-1), transforming growth factor beta (TGF-β), and pIgR were analyzed using quantitative real-time polymerase chain reaction and Western blot. Additionally, a TGF-β inhibitor was applied to assess TGF-β's role in miR-144-mediated regulation of pIgR.

Results: CSE treatment significantly upregulated miR-144 and TGIF-1 while reducing TGF-β and pIgR expression. miR-144 inhibition restored TGF-β and pIgR levels, while miR-144 overexpression reduced them further, indicating miR-144's direct influence on this regulatory pathway. TGF-β inhibition enhanced the reduction of pIgR under miR-144 overexpression, underscoring TGF-β's key role in pIgR regulation.

Conclusion: miR-144 mediates immune suppression in COPD by downregulating pIgR through the TGF-β pathway, suggesting that miR-144 could serve as a therapeutic target to restore airway immune function and mitigate disease progression in COPD.

Rationale: Alpha-1 antitrypsin deficiency (AATD) is the most common genetic cause of chronic obstructive pulmonary disease (COPD), but considerable phenotypic variability exists among affected individuals who share disease-causing variants. Therefore, a multicenter longitudinal cohort study of 270 adult participants with PiZZ AATD will be established with a goal of examining how computed tomography (CT) imaging and serum and airway biomarkers can be used to explain differences in phenotypic manifestations and outcomes.

Methods: Study visits at enrollment, 18 months, and 36 months will obtain spirometry, patient-reported outcomes, and biosampling from blood, nasal mucosa, and sputum. Chest CT image acquisition will be utilized for whole lung and lobar estimations of emphysema based on lung density and to test novel measurements of airway remodeling and lung tissue mechanics. Dried blood spot cards will be collected if the participant experiences an acute exacerbation of COPD during the study. Genetic analysis will be performed with complete SERPINA1 sequencing, and peripheral blood mononuclear cells will be isolated to generate a repository of inducible pluripotent stem cells.

Results: The cohort will be deeply characterized, including imaging, physiology, and symptomatology, cross-sectionally and longitudinally over a 3-year follow-up period. A validation cohort from Ireland will independently enroll patients with identical procedures.

Conclusion: This is the first cohort of AATD to incorporate such detailed metrics of disease, including quantitative emphysema measures, with the overarching goal of improving the understanding of disease heterogeneity in AATD and identifying factors associated with disease severity and progression.

The prevalence of chronic obstructive pulmonary disease (COPD) is higher in people with schizophrenia than in the general population, even after adjusting for smoking, but schizophrenia has not generally been considered in discussions of COPD multimorbidity. People with schizophrenia die prematurely, and COPD is an important but neglected cause of this mortality. People with schizophrenia have a higher prevalence of ever smoking tobacco than the general population. The link between COPD and schizophrenia may be partially explained by higher rates of smoking, but may also be syndemic, with shared genetic, socioeconomic, and environmental risk factors, and common pathophysiological mechanisms. People with a mental illness tend to receive medical care intermittently. There is often a lack of continuity of care, and primary and preventive services are infrequently used. Physical symptoms may be viewed as "psychosomatic," leading to underdiagnosis. People with schizophrenia are less likely to receive adequate general medical care, including investigation and treatment, in line with guidelines. Antipsychotic drugs are associated with adverse effects that may be problematic in people with COPD. The management and outcomes for people with schizophrenia and COPD could be improved by reducing stigma, developing integrated services, undertaking physical health checks that include asking about respiratory symptoms and arranging spirometry when indicated, care coordination that includes addressing physical health issues, vaccination, support with smoking cessation, exercise, and pulmonary rehabilitation.

Background: Chronic obstructive pulmonary disease (COPD) affects millions of people and is associated with significant morbidity and mortality. Patients experience a high symptom burden with impacts on quality of life, which have not been well quantified.

Methods: Phreesia's PatientInsightsquantitative survey was offered in January 2025 to patients with COPD during their check-in process for health care provider (HCP) visits. The survey comprised 28 questions. Survey question categories included COPD symptom experience and impact, and the treatment journey of patients with COPD. The survey also sought to identify potential communication gaps between patients and HCPs that might hinder effective COPD management.

Results: Of 1615 patients surveyed, most (59%) were female, and the majority identified as White (82%). A total of 39% of patients had experienced COPD for over 7 years at the time the survey was conducted, and 25% reported experiencing symptoms all 30 days in a typical month. A large proportion (64%) said that COPD had a moderate-to-great impact on their daily lives. Only 45% of patients had detailed discussions about their COPD with their HCPs. Among patients who had not tried/were currently not on any maintenance medications (n=339), the leading reasons included that their COPD was not severe enough, and that their HCP had not recommended it. Among patients who had tried maintenance medications, the majority (77%) indicated that they would be willing to try another therapy.

Conclusions: Improvements in patient-HCP communication are needed to achieve more effective, timely COPD management.