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

This study aimed to evaluate the performance of machine learning models for predicting readmission of patients with chronic obstructive pulmonary disease (COPD) based on administrative data and chart review data. The study analyzed 4327 patient encounters from the University of Chicago Medicine to assess the risk of readmission within 90 days after an acute exacerbation of COPD. Two random forest prediction models were compared. One was derived from chart review data, while the other was derived using administrative data. The data were randomly partitioned into training and internal validation sets using a 70% to 30% split. The 2 models had comparable accuracy (administrative data area under the curve [AUC]=0.67, chart review AUC=0.64). These results suggest that despite its limitations in precisely identifying COPD admissions, administrative data may be useful for developing effective predictive tools and offer a less labor-intensive alternative to chart reviews.

Background: Individuals with chronic obstructive pulmonary disease (COPD) are disproportionately affected by social determinants of health that have been associated with worse respiratory outcomes. This study evaluates the association of perceived stress with respiratory outcomes and distinct biological mechanisms among former smokers with COPD.

Methods: Participants were assessed in an observational study at baseline, 3-months, and 6-months. Questionnaires assessed perceived stress (Perceived Stress Scale, [PSS]), respiratory symptoms, and incidence of COPD exacerbations. Generalized linear mixed models evaluated the association of PSS score with COPD outcomes and biomarkers of platelet activation (urine 11-dehydro-thromboxane B2 [11dTxB2]), oxidative stress (urine thiobarbituric acid reactive substances [TBARS], 8- hydroxydeoxyguanosine, and 8-isoprostane), and inflammation.

Results: Among 99 participants, the median PSS score was 13 (interquartile range 8-18) across all visits. Compared with low perceived stress (PSS 0-13), moderate (PSS 14-26) and high perceived stress (PSS 27-40) were associated with worse respiratory health status and respiratory-related quality of life, with point estimates for high perceived stress exceeding clinically important differences. Only high PSS was associated with increased moderate/severe exacerbations (odds ratio 4.15, 95% confidence interval [CI]: 1.28-13.47). Compared to low stress, high stress was associated with lower TBARS (β=-25.5%, 95%CI: -43.8- -1.2%) and higher 8-isoprostane (β=40.1%, 95%CI: 11.5-76.0%). Among individuals with mild-moderate COPD, compared to low stress, moderate (β=20.1%, 95%CI: 3.1-40.0%) and high (β=52.9%, 95%CI: 22.1-91.6%) stress were associated with higher 11dTxB2.

Conclusion: Among former smokers with COPD, higher perceived stress is associated with worse respiratory outcomes. Platelet activation and oxidative stress may be biological pathways through which perceived stress plays a role in COPD.

Background: Nontuberculous mycobacteria pulmonary disease (NTM-PD) is an emerging public health concern with increasing incidence and prevalence. Despite its chronic and progressive nature, there is a notable gap in research on the factors influencing hospital outcomes in this patient population.

Materials and methods: We conducted a retrospective cohort study using data from the National Inpatient Sample (NIS) to analyze hospitalizations of adult patients diagnosed with NTM-PD. We examined patient demographics, comorbidities, and hospital characteristics to identify predictors of hospital length of stay (LOS) and discharge disposition. Multivariate negative binomial regression and logistic regression models were employed to assess the impact of these variables.

Results: The study included 1167 hospitalized NTM-PD patients, with a mean age of 66.9 years. The overall mean LOS was 7.4 days, with an average hospital cost of $15,606. Discharge to a nursing home was associated with a 78% longer LOS (incidence rate ratio=1.78, p<0.0001). Key predictors of extended LOS included male gender, private insurance status, higher comorbidity burden, and increased number of procedures. Patients discharged to nursing homes were more likely to be older males with complex medical profiles. Interestingly, conditions such as malignancy and COPD, while linked to longer LOS, were associated with a decreased likelihood of discharge to a nursing home.

Conclusion: Our study highlights significant predictors of LOS and discharge outcomes in NTM-PD patients, emphasizing the need for personalized and proactive management. These findings underscore the importance of targeted interventions in the outpatient setting to reduce hospital admissions and improve patient outcomes.

Background: The objective of this study was to construct a prediction model to assess the onset of acute heart failure (AHF) in patients with chronic obstructive pulmonary disease (COPD) without a history of heart failure and to evaluate the predictive value of the nomogram.

Methods: This study involved 3730 patients with COPD and no history of heart failure. Clinical and laboratory data were collected from the Medical Information Mart for Intensive Care IV database. The patients were divided into a training set (2611 cases) and a validation set (1119 cases) in a 7:3 ratio. Least absolute shrinkage and selection operator (LASSO) regression was used to identify potential risk factors for AHF in patients with COPD. These factors were then subjected to multivariate logistic regression analysis to develop a prediction model for the risk of AHF. The model's differentiation, consistency, and clinical applicability were evaluated using receiver operating characteristic analysis, a calibration curve, and decision curve analysis (DCA), respectively.

Results: LASSO regression identified 10 potential predictors. The concordance index was 0.820. The areas under the curves for the training and validation sets were 0.8195 and 0.8035, respectively. The calibration curve demonstrated strong concordance between the nomogram's predictions and the actual outcomes. DCA confirmed the clinical applicability of the nomogram.

Conclusion: Our nomogram is a reliable and convenient tool for predicting acute heart failure in patients with COPD.

Background: Pseudomonas aeruginosa is an important pathogen in patients with chronic respiratory diseases. It can colonize the airways and could have prognostic value in bronchiectasis and cystic fibrosis. Its role in chronic obstructive pulmonary disease (COPD) is less well-defined.

Methods: A prospective study was conducted in Hong Kong to investigate the possible association between Pseudomonas aeruginosa colonization and acute exacerbation of COPD (AECOPD) risks.

Results: Among 327 Chinese patients with COPD, 33 (10.1%) of the patients had Pseudomonas aeruginosa colonization. Patients with or without Pseudomonas aeruginosa colonization had similar background characteristics. Patients with Pseudomonas aeruginosa colonization had increased risks of moderate to severe AECOPD, severe AECOPD, and pneumonia with an adjusted odds ratio (aOR) of 3.15 (95% CI 1.05-9.48, p=0.042), 2.59 (95% CI 1.01₋6.64, p=0.048), and 4.19 (95% CI 1.40₋12.54, p=0.011) respectively. Patients with Pseudomonas aeruginosa colonization also had increased annual frequency of moderate to severe AECOPDs, median 0 (0₋0.93) in the non-Pseudomonas aeruginosa colonization group and 1.35 (0₋3.39) in the Pseudomonas aeruginosa colonization group, with a p-value of 0.005 in multivariate linear regression.

Conclusion: Pseudomonas aeruginosa colonization is a potential independent risk factor for moderate to severe AECOPD and pneumonia among patients with COPD without coexisting bronchiectasis.

Background: Chronic bronchitis (CB), classically defined as having cough and sputum production for at least 3 months per year for 2 consecutive years, is frequently associated with chronic obstructive pulmonary disease (COPD).

Methods: This retrospective cohort study using the Optum^® de-identified electronic health record data set (Optum^® EHR) aimed to identify patients with CB, COPD, and both CB and COPD through the application of the classical definition of CB, and to compare the characteristics of these populations, and the timing of diagnosis as well as their health care resource utilization (HCRU). Scanning of the EHRs was performed electronically using a specially developed algorithm.

Results: Of 104,633,876 patients in the study period between January 2007 and September 2020, 628,545 patients had CB only (i.e., nonobstructive disease), 129,084 had COPD only (COPD cohort), and 77,749 had both COPD and CB (COPD-CB cohort). A total of 75.9% of patients (59,009 of 77,749) fulfilled the criteria for a CB diagnosis before their first diagnosis with COPD, compared with 24.1% who had COPD before being diagnosed with CB. HCRU over 5 years was highest in the COPD-CB cohort, whereas the COPD cohort and CB cohorts had similar HCRU over 5 years. The COPD-CB cohort had a greater percentage of common COPD comorbidities and exposure to more drug classes than the other cohorts.

Conclusions: These results highlight the importance of increased attention to CB. CB often precedes the diagnosis of COPD and subsequently leads to high HCRU. Interventions to better manage CB and prevent the progression of CB to COPD could improve morbidity in this population.

Objective: The severity of emphysema may be measured by lung density on computed tomography (CT) scanning, and in alpha-1 antitrypsin deficiency (AATD) this measure has been used as the primary outcome in trials of disease-modifying therapy, namely augmentation. However, the minimum clinically important difference (MCID) in lung density change is not known; this study aimed to derive and validate MCIDs for density values in AATD.

Methods: The distribution method and anchoring density against forced expiratory volume in 1 second (FEV₁) were used to derive mean and 95% confidence intervals for the MCID. Data from systematic reviews of CT density measurement and therapy for AATD obtained both absolute and annual changes in lung density. Using the range of potential MCID generated by these methods, a value was chosen for validation against mortality, lung function, and health status in the Birmingham, United Kingdom AATD cohort, using regression to adjust for confounders.

Results: Anchor and distribution methods generated a probable MCID of -1.87 g/L/year (range -1.53 to -2.20). The greatest differences between groups were found at the -2.2g/L/year with a greater FEV₁ decline in individuals with greater lung loss. Absolute lung density change had a probable MCID of -2.04g/L (range -1.83 to -2.30), and there was a difference in lung function (p<0.001) and mortality; where individuals whose absolute lung loss of more than -2.04g/L had a greater risk of death (p<0.05).

Interpretation: From initial evidence, we have shown absolute lung density change as a potential outcome for emphysema modifying therapies in AATD rather than annual density change, with an MCID of -2.04g/L.

Introduction: Chronic obstructive pulmonary disease (COPD) poses a substantial burden on individuals and the U.S. health care system. Up-to-date information describing individuals with COPD and their acute hospital-based health care utilization at the state level and by insurance type is lacking.

Methods: Individuals with COPD aged 40 and older were identified from large databases of Medicare fee-for-service, Medicaid, and commercial health insurance claims, and counts were extrapolated to the U.S. health insurance market. Demographics and outcome metrics were quantified between January 1 and December 31, 2021, and summarized by state and insurance type.

Results: Approximately 11.7 million insured individuals had COPD in 2021. The largest share were covered by Medicare (79.4%), followed by commercial insurance (11.3%) and Medicaid (9.3%). COPD prevalence varied among states, ranging from 44 (Utah) to 143 (West Virginia) per 1000 insured individuals. Nationwide, annual all-cause mortality for individuals with COPD covered by Medicare (11.5%) was more than double that of Medicaid (5.1%). There were 1.8 million COPD-related acute inpatient hospitalizations nationwide, with the largest share among individuals covered by Medicare (86.4%), followed by Medicaid (9.0%) and commercial insurance (4.6%). COPD-related hospitalization rates also varied among states, ranging from 97 (Idaho) to 200 (District of Columbia) per 1000 individuals with COPD. There were 1.4 million COPD-related emergency department/observation encounters not resulting in acute inpatient admissions nationwide.

Conclusion: There is substantial state and payer variation in COPD prevalence and burden. Understanding this variation provides valuable insights into populations with unmet needs that can inform public health strategies to address gaps.

Rationale: Nebulizers are an alternative to handheld devices for inhaled therapies in chronic obstructive pulmonary disease (COPD). Understanding nebulizer utilization patterns is essential to developing therapy guidelines.

Objectives: To describe characteristics of nebulizer users versus nonusers and factors associated with baseline nebulizer use and longitudinal uptake.

Methods: We analyzed SPIROMICS, a prospective cohort of 2,973 participants with or without tobacco use and/or COPD. We used cross-sectional multivariable logistic regression and interval-censored proportional hazard models to analyze factors associated with nebulizer use and uptake among tobacco-exposed participants with preserved spirometry (TEPS) and COPD from enrollment (Visit 1) through 4-7 years of follow-up (Visit 5).

Results: Nebulizer utilization was highest in advanced COPD, 49% of GOLD D participants at baseline. Nebulizer treatments were primarily as-needed short-acting bronchodilators. Baseline nebulizer use was associated with respiratory exacerbations in the prior year (one, OR 1.81, 95%CI [1.24,2.64]; two, OR 1.86, 95%CI [1.07,3.22]; three or more, OR 1.87, 95% CI [1.07,3.28]), lower FEV₁ (OR 2.81 per Liter decrease, 95% CI [2.09, 3.77]), CAT score > 10 (OR 1.89, 95% CI [1.17, 3.03]), 6MWD distance (OR 1.03 per 10 meter lower 6MWD, 95% CI [1.02,1.05]), and a history of asthma (OR 2.41, 95%CI [1.76,3.30]). Longitudinal uptake was similarly associated with exacerbations, lower FEV₁, CAT > 10, and asthma. Patterns were consistent between TEPS and COPD.

Conclusion: Nebulizers were predominantly used by participants with frequent exacerbations, high symptom burden and advanced COPD, and long-acting nebulized medications were underutilized. Randomized controlled trials are needed compare nebulizers with hand-held devices.

Background: Chronic obstructive pulmonary disease (COPD) may influence bleeding in atrial fibrillation (AF). We evaluated bleeding and all-cause death risks under warfarin versus direct oral anticoagulants (DOACs).

Methods: Besed on retrospective cohort from 12 centers of patients with AF on oral anticoagulation，we evaluated the associations of COPD and anticoagulant class with clinical outcomes using overlap-weighted logistic regression. Prespecified sensitivity and subgroup analyses were performed.

Results: COPD was associated with higher bleeding risk only among patients treated with warfarin (total bleeding: OR 2.53, 95% CI 1.00-6.45; RD 9.05%, 95% CI 0.15-22.50%; minor bleeding: aOR 3.00, 95% CI 1.09-8.24; RD 8.53%, 95% CI 0.56-21.53%).Among patients with AF and COPD, DOAC were associated with reduced risks of total bleeding (OR 0.08, 95% CI 0.01-0.50; RD -8.4%, 95% CI -22.0 to -5.3%) and minor bleeding (OR 0.01; RD -9.5%, 95% CI -23.1 to -4.5%) compared with warfarin. Subgroup analyses suggested that DOAC were associated with increased mortality at eGFR ≥60 mL/min/1.73 m² (OR 3.07, 95% CI 0.78-12.03; RD 9.9%) but lower mortality at eGFR <60 mL/min/1.73 m² (OR 0.20, 95% CI 0.05-0.78; RD -24.1%). FXa inhibitors were associated with higher major bleeding risk compared with dabigatran (OR 4.56, 95% CI 1.70-12.26; RD 10.2%, 95% CI 0.2-20.1%; with a number needed to harm (NNH) of 10.).

Conclusion: In AF with comorbid COPD, DOACs minimize bleeding versus warfarin and may confer survival benefit in renal impairment. Choice among DOACs should consider differential bleeding risk.