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Clinical Practices Surrounding the Prescription of Home Oxygen in Patients With COPD and Desaturation. 慢性阻塞性肺病和去饱和度患者家庭氧气处方的临床实践。
IF 2.4 4区 医学 Q2 Medicine Pub Date : 2023-10-26 DOI: 10.15326/jcopdf.2023.0402
Sandra E Zaeh, Meredith Case, David H Au, Michele DaSilva, Karen Deitemeyer, Julie DeLisa, Laura C Feemster, Lynn B Gerald, Jerry A Krishnan, Jennifer Sculley, Annette Woodruff, Michelle N Eakin

Purpose: While home oxygen therapy increases survival in patients with chronic obstructive pulmonary disease (COPD) who have severe resting hypoxemia, recent evidence suggests that there is no survival benefit of home oxygen for patients with COPD who have isolated exertional desaturation. We aimed to understand clinician practice patterns surrounding the prescription of home oxygen for patients with COPD.

Methods: We conducted semi-structured qualitative interviews via videoconference with 15 physicians and 3 nurse practitioners who provide care for patients with COPD. Clinicians were recruited through the American Lung Association Airways Clinical Research Centers. Interview guides were created with the assistance of patient investigators and included questions regarding clinician practices surrounding the prescription of oxygen for patients with COPD and the use of clinical guidelines. Interviews were recorded, transcribed, and coded for themes.

Results: Of the 18 clinician interviewees, one-third were women, with most participants (n=11) being < 50 years old. Results of the semi-structured interviews suggested research evidence, clinical experience, and patient preferences contributed to clinician decision-making. Most clinicians described a shared decision-making process for prescribing home oxygen for patients, including discussion of risks and benefits, and developing an understanding of patient values and preferences. Clinicians did not use a structured tool to conduct these conversations.

Conclusions: Clinicians consider a number of patient and clinical factors when prescribing home oxygen therapy, often using a shared decision-making process. Tools to support shared decision-making about the use of home oxygen are needed.

目的:虽然家庭氧气治疗提高了患有严重静息低氧血症的慢性阻塞性肺病(COPD)患者的生存率,但最近的证据表明,对于患有孤立性运动性去饱和的COPD患者,家庭氧气没有生存益处。我们旨在了解临床医生为COPD患者开具家庭氧气处方的实践模式。方法:我们通过视频会议对15名为COPD患者提供护理的医生和3名执业护士进行了半结构化的定性访谈。临床医生是通过美国肺脏协会航空公司临床研究中心招募的。访谈指南是在患者调查人员的协助下创建的,其中包括有关COPD患者氧气处方和临床指南使用的临床医生实践问题。访谈被记录、转录并按主题编码。结果:在18名临床医生受访者中,三分之一是女性,大多数参与者(n=11)年龄在50岁以下。半结构化访谈的结果表明,研究证据、临床经验和患者偏好有助于临床医生的决策。大多数临床医生描述了为患者开具家庭氧气处方的共同决策过程,包括对风险和益处的讨论,以及对患者价值观和偏好的理解。临床医生没有使用结构化的工具来进行这些对话。结论:临床医生在开家庭氧气治疗处方时考虑了许多患者和临床因素,通常使用共同的决策过程。需要支持关于家庭氧气使用的共同决策的工具。
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引用次数: 0
Chymotrypsin-like Elastase-1 Mediates Progressive Emphysema in Alpha-1 Antitrypsin Deficiency. Chymopry蛋白酶样弹性蛋白酶-1介导α-1抗胰蛋白酶缺乏症的进行性肺气肿。
IF 2.4 4区 医学 Q2 Medicine Pub Date : 2023-10-26 DOI: 10.15326/jcopdf.2023.0416
Andrew J Devine, Noah J Smith, Rashika Joshi, Qiang Fan, Michael T Borchers, Geremy C Clair, Joshua N Adkins, Brian M Varisco

Chymotrypsin-like elastase 1 (CELA1) is a serine protease that is neutralized by alpha-1antitrypsin (AAT) and prevents emphysema in a murine antisense oligonucleotide model of AAT-deficient emphysema. Mice with genetic ablation of AAT do not have emphysema at baseline but develop emphysema with injury and aging. We tested the role of the CELA1 gene in emphysema development in this genetic model of AAT-deficiency following tracheal lipopolysaccharide (LPS), 10 months of cigarette smoke exposure, aging, and a low-dose tracheal porcine pancreatic elastase (LD-PPE) model we developed. In this last model, we performed proteomic analysis to understand differences in lung protein composition. We were unable to show that AAT-deficient mice developed more emphysema than wild type with escalating doses of LPS. In the LD-PPE model, AAT-deficient mice developed significant and progressive emphysema from which Cela1-/- & AAT-deficient mice were protected. Cela1-/-& AAT-deficient lungs had more matrix-associated proteins than AAT-deficientlungs but also had more leukocyte-associated proteases. With cigarette smoke exposure, Cela1-/- &AAT-deficient mice had more emphysema than AAT-deficient mice but had less myeloperoxidase activity. Cela1-/-&AAT-deficient mice had less age-related airspace simplification than AAT-deficient and were comparable to wild type. While CELA1 promotes inflammation-independent emphysema progression and its absence preserves the lung matrix in multiple models of AAT-deficient emphysema, for unclear reasons Cela1 deficiency is associated with increased emphysema with cigarette smoke. While anti-CELA1 therapies could potentially be used to prevent emphysema progression in AAT deficiency after smoking cessation, an understanding of why and how cigarette smoke exacerbates emphysema in Cela1 deficiency and whether AAT replacement therapy mitigates this effect is needed first.

糜蛋白酶样弹性蛋白酶1(CELA1)是一种丝氨酸蛋白酶,被α-1抗胰蛋白酶(AAT)中和,并在AAT缺陷型肺气肿的小鼠反义寡核苷酸模型中预防肺气肿。AAT基因消融的小鼠在基线时没有肺气肿,但随着损伤和衰老而发展为肺气肿。我们在气管脂多糖(LPS)、香烟烟雾暴露10个月、衰老和我们开发的低剂量气管猪胰腺弹性蛋白酶(LD-PPE)模型后AAT缺乏的遗传模型中测试了CELA1基因在肺气肿发展中的作用。在最后一个模型中,我们进行了蛋白质组学分析,以了解肺部蛋白质组成的差异。随着LPS剂量的增加,我们无法证明AAT缺陷小鼠比野生型小鼠患上更多的肺气肿。在LD-PPE模型中,AAT缺陷小鼠发展为严重的进行性肺气肿,Cela1-/-和AAT缺陷的小鼠受到保护。与AAT缺乏的肺相比,Cela1-/-&AAT缺乏肺具有更多的基质相关蛋白,但也具有更多的白细胞相关蛋白酶。在香烟烟雾暴露下,Cela1-/-&AAT缺陷小鼠比AAT缺陷的小鼠有更多的肺气肿,但髓过氧化物酶活性较低。Cela1-/-&AAT缺陷小鼠的年龄相关性空域简化程度低于AAT缺陷,与野生型相当。虽然在多种AAT缺乏型肺气肿模型中,CELA1促进炎症非依赖性肺气肿的发展,并且其缺失保留了肺基质,但由于不清楚的原因,CELA1缺乏与吸烟引起的肺气肿增加有关。虽然抗CELA1疗法可能用于预防戒烟后AAT缺乏症的肺气肿进展,但首先需要了解吸烟为什么以及如何加剧CELA1缺乏症的气肿,以及AAT替代疗法是否能减轻这种影响。
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引用次数: 0
WITHDRAWN: Role of Oxidative Stress and Genetic Polymorphism of Matrix Metalloproteinase-2 and Tissue Inhibitor of Metalloproteinase-2 in COPD. 撤回:氧化应激与基质金属蛋白酶-2和组织金属蛋白酶-2抑制剂基因多态性在慢性阻塞性肺病中的作用
IF 2.4 4区 医学 Q2 Medicine Pub Date : 2023-08-03 DOI: 10.15326/jcopdf.2022.0370
Poonam Sangwan, Huma Quasimi, Jai Gopal Sharma, Mohammad Anwar Habib, Mohammad Iqbal Alam

Article in press withdrawn by publisher.

出版商撤销了正在出版的文章。
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引用次数: 0
Augmentation Therapy Modulates Systemic Inflammation in Individuals with Alpha-1 Antitrypsin Deficiency and Chronic Obstructive Pulmonary Disease. 增强治疗调节α -1抗胰蛋白酶缺乏和慢性阻塞性肺疾病个体的全身性炎症
IF 2.4 4区 医学 Q2 Medicine Pub Date : 2023-07-26 DOI: 10.15326/jcopdf.2023.0407
J Lascano, L Riley, N Khodayari, M Brantly

Background: Alpha-1 antitrypsin (AAT) deficiency is a genetic disorder that leads to chronic obstructive pulmonary disease (COPD) and lower circulating levels of AAT, which is a protease inhibitor with potent anti-inflammatory effects. In order to better understand the presence of systemic inflammation in AAT-deficient individuals with COPD, we investigatedthe plasma levels of C-reactive protein (CRP).

Methods: AAT-deficient individuals and a matched cohort with a normal AAT genotype were recruited from the Alpha-1 Foundation DNA and Tissue Bank. AAT genotypes were determined by a combination of a Taqman-based assay. AAT and CRP levels were determined by nephelometry. Comparisons were determined by unpaired t-test and standard Pearson's correlation.

Results: Our study included 40 control participants and 742 AAT-deficient participants, of which 498 received augmentation therapy. In the AAT-deficient participants, the plasma AAT was 20.2±11.6µM and 4.5±1.3µM (P<0.0001) with and without augmentation therapy, respectively, and the CRP was 0.32±0.53mg/dL and 0.69±1.97mg/dL (P=0.0169), respectively. There was a negative correlation between the percentage predicted of forced expiratory volume in 1 second and CRP in the group not receiving augmentation therapy (r=-0.2528, P<0.05), and there was no correlation in participants receiving augmentation therapy.

Conclusion: Compared to healthy individuals, AAT-deficient individuals with COPD have higher levels of circulating CRP, suggesting increased systemic inflammation. However, AAT-deficient individuals receiving augmentation therapy had lower plasma CRP levels compared to those who are not.

背景:α -1抗胰蛋白酶(AAT)缺乏是一种遗传性疾病,可导致慢性阻塞性肺疾病(COPD)和AAT循环水平降低,AAT是一种具有强抗炎作用的蛋白酶抑制剂。为了更好地了解缺乏aat的COPD患者是否存在全身性炎症,我们研究了血浆c反应蛋白(CRP)水平。方法:从Alpha-1基金会DNA和组织库中招募AAT缺陷个体和AAT基因型正常的匹配队列。AAT基因型由Taqman-based assay联合测定。浊度法测定AAT和CRP水平。比较采用非配对t检验和标准Pearson相关。结果:我们的研究包括40名对照参与者和742名aat缺陷参与者,其中498名接受了增强治疗。在AAT缺乏的参与者中,血浆AAT分别为20.2±11.6µM和4.5±1.3µM (PP=0.0169)。未接受强化治疗组1秒用力呼气量预测百分比与CRP呈负相关(r=-0.2528, p)。结论:与健康个体相比,aat缺乏的COPD患者循环CRP水平较高,提示全身炎症增加。然而,接受强化治疗的aat缺陷个体的血浆CRP水平低于未接受强化治疗的个体。
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引用次数: 0
Understanding the Patient Experience of Home-Based Pulmonary Rehabilitation with Health Coaching for COPD: A Qualitative Interview Study. 了解慢性阻塞性肺病患者在家庭肺康复治疗和健康指导中的体验:一项定性访谈研究。
IF 2.3 4区 医学 Q2 RESPIRATORY SYSTEM Pub Date : 2023-07-26 DOI: 10.15326/jcopdf.2022.0384
William R Midthun, Maria V Benzo, Jennifer L Ridgeway, Roberto P Benzo

Background: We recently reported on a randomized trial of home-based pulmonary rehabilitation (PR) for chronic obstructive pulmonary disease (COPD) that showed improvement in all domains of quality of life, accelerometry-measured physical activity, and self-management. In this current study, we used a theoretical framework to help us gain an in-depth understanding of how patients experience complex, multi-component programs to help uncover factors related to behavior change and to inform program scale-up in other populations.

Study design and methods: The parent trial was conducted with COPD patients receiving care at an academic medical center and a community health system in the upper Midwest. The 12-week PR intervention included 3 daily video-guided exercises, activity monitors, and weekly telephonic health coaching. Trial participants were eligible to participate in an individual phone interview about their experience if they completed the intervention within the prior 12 months.. Analysis of verbatim transcripts followed an inductive thematic approach followed by deductive categorization and interpretation using a theoretical model: the Capability, Opportunity, Motivation-Behavior (COM-B) model developed for linking intervention functions to aspects of behavioral change.

Results: Among 32 eligible program participants,32 were approached, and 15 completed interviews between October 19, 2021, and January 13, 2022. The COM-B model and recommendations for program improvement were observed in the primary findings.

Discussion: Participants' feedback highlighted how the health coaching bolstered skills and confidence among individuals with the poorest function at program enrollment and how improved physical function and mood led to motivation. It also highlighted the roles of technology and telephonic support in a home-based program. Suggestions for improvement included providing exercise variations.

背景:我们最近报告了一项针对慢性阻塞性肺病(COPD)的家庭肺康复(PR)随机试验,结果显示患者在生活质量、加速度计测量的体力活动和自我管理等所有方面都有所改善。在目前的这项研究中,我们使用了一个理论框架来帮助我们深入了解患者是如何体验复杂的多成分项目的,以帮助发现与行为改变相关的因素,并为在其他人群中推广项目提供参考:母体试验的对象是在中西部偏上地区的一家学术医疗中心和一家社区医疗系统接受治疗的慢性阻塞性肺病患者。为期 12 周的 PR 干预包括每天 3 次视频指导练习、活动监测器和每周一次的电话健康指导。如果试验参与者在之前的 12 个月内完成了干预,则有资格参加关于其经历的个人电话访谈。对逐字记录誊本的分析采用归纳式主题方法,然后使用一个理论模型进行演绎分类和解释:能力、机会、动机-行为(COM-B)模型,该模型旨在将干预功能与行为改变的各个方面联系起来:2021 年 10 月 19 日至 2022 年 1 月 13 日期间,在 32 名符合条件的计划参与者中,有 32 人接受了访谈,15 人完成了访谈。在主要调查结果中观察到了 COM-B 模型和计划改进建议:参与者的反馈意见强调了健康指导如何增强了计划注册时功能最差的个人的技能和信心,以及身体功能和情绪的改善如何激发了他们的积极性。他们还强调了技术和电话支持在以家庭为基础的计划中的作用。改进建议包括提供不同的锻炼方式。
{"title":"Understanding the Patient Experience of Home-Based Pulmonary Rehabilitation with Health Coaching for COPD: A Qualitative Interview Study.","authors":"William R Midthun, Maria V Benzo, Jennifer L Ridgeway, Roberto P Benzo","doi":"10.15326/jcopdf.2022.0384","DOIUrl":"10.15326/jcopdf.2022.0384","url":null,"abstract":"<p><strong>Background: </strong>We recently reported on a randomized trial of home-based pulmonary rehabilitation (PR) for chronic obstructive pulmonary disease (COPD) that showed improvement in all domains of quality of life, accelerometry-measured physical activity, and self-management. In this current study, we used a theoretical framework to help us gain an in-depth understanding of how patients experience complex, multi-component programs to help uncover factors related to behavior change and to inform program scale-up in other populations.</p><p><strong>Study design and methods: </strong>The parent trial was conducted with COPD patients receiving care at an academic medical center and a community health system in the upper Midwest. The 12-week PR intervention included 3 daily video-guided exercises, activity monitors, and weekly telephonic health coaching. Trial participants were eligible to participate in an individual phone interview about their experience if they completed the intervention within the prior 12 months.. Analysis of verbatim transcripts followed an inductive thematic approach followed by deductive categorization and interpretation using a theoretical model: the Capability, Opportunity, Motivation-Behavior (COM-B) model developed for linking intervention functions to aspects of behavioral change.</p><p><strong>Results: </strong>Among 32 eligible program participants,32 were approached, and 15 completed interviews between October 19, 2021, and January 13, 2022. The COM-B model and recommendations for program improvement were observed in the primary findings.</p><p><strong>Discussion: </strong>Participants' feedback highlighted how the health coaching bolstered skills and confidence among individuals with the poorest function at program enrollment and how improved physical function and mood led to motivation. It also highlighted the roles of technology and telephonic support in a home-based program. Suggestions for improvement included providing exercise variations.</p>","PeriodicalId":51340,"journal":{"name":"Chronic Obstructive Pulmonary Diseases-Journal of the Copd Foundation","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2023-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10484487/pdf/JCOPDF-10-224.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10536735","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Impact of Coronavirus Disease 2019 on Hospital Admissions, Health Status, and Behavioral Changes of Patients with COPD. 2019冠状病毒病对慢性阻塞性肺病患者入院、健康状况和行为改变的影响
IF 2.4 4区 医学 Q2 Medicine Pub Date : 2023-07-26 DOI: 10.15326/jcopdf.2022.0383
Eva Pappe, Ralf Hammerich, Jacopo Saccomanno, Thomas Sgarbossa, Anne Pohrt, Bernd Schmidt, Christian Grah, Stephan Eisenmann, Angelique Holland, Stephan Eggeling, Franz Stanzel, Martin Witzenrath, Ralf-Harto Hübner

Introduction: Patients with chronic obstructive pulmonary disease (COPD) have an increased risk of acquiring severe coronavirus disease 2019 (COVID-19), which is why self-isolation was recommended. However, long periods of social isolation, accompanied by limited access to health care systems, might influence the outcome of patients with severe COPD negatively.

Methods: Data from COPD and pneumonia patients at Charité-Universitätsmedizin Berlin and the volume of endoscopic lung volume reduction (ELVR) surgeries from the German Lung Emphysema Registry (Lungenemphysem Register e.V.) were analyzed from pre-pandemic (2012 to 2019) to the pandemic period (2020 and 2021). In addition, 52 patients with COPD Global initiative for chronic Obstructive Lung Disease (GOLD) stage 4 status included in the lung emphysema registry received questionnaires during lockdowns from June 2020 to April 2021.

Results: Admissions and ventilation therapies administered to COPD patients significantly decreased during the COVID-19 pandemic. Likewise, there was a reduction in ELVR treatments and follow-ups registered in German emphysema centers. Mortality was slightly higher among patients hospitalized with COPD during the pandemic. Increasing proportions of COPD patients with GOLD stage 3 and GOLD stage 4 status reported behavioral changes and subjective feelings of increasing COPD symptoms the longer the lockdown lasted. However, COPD symptom questionnaires revealed stable COPD symptoms over the pandemic time period.

Summary: This study reveals reduced COPD admissions and elective treatment procedures of COPD patients during the pandemic, but a slight increase in mortality among patients hospitalized with COPD, irrespective of COVID-19. Correspondingly, patients with severe COPD reported subjective deterioration of their health status, probably caused by their very strict compliance with lockdown measures.

慢性阻塞性肺疾病(COPD)患者感染2019年严重冠状病毒病(COVID-19)的风险增加,这就是建议自我隔离的原因。然而,长期的社会隔离,加上获得卫生保健系统的机会有限,可能会对严重慢性阻塞性肺病患者的预后产生负面影响。方法:分析Charité-Universitätsmedizin Berlin的COPD和肺炎患者的数据,以及德国肺气肿登记处(Lungenemphysem Register e.v.)的内镜下肺减容(ELVR)手术量,从大流行前(2012年至2019年)到大流行期间(2020年和2021年)。此外,在2020年6月至2021年4月的封锁期间,纳入肺气肿登记处的52名COPD全球慢性阻塞性肺疾病倡议(GOLD) 4期状态患者接受了问卷调查。结果:在COVID-19大流行期间,COPD患者的入院率和通气治疗显著减少。同样,在德国肺气肿中心登记的ELVR治疗和随访也有所减少。大流行期间因慢性阻塞性肺病住院的患者死亡率略高。GOLD 3期和GOLD 4期COPD患者报告的行为改变和主观感觉COPD症状随着封锁时间的延长而增加。然而,COPD症状调查问卷显示,在大流行期间,COPD症状稳定。摘要:本研究显示,在大流行期间,COPD住院患者的死亡率和选择性治疗程序有所减少,但与COVID-19无关,COPD住院患者的死亡率略有增加。相应地,严重慢性阻塞性肺病患者报告其健康状况主观恶化,这可能是由于他们非常严格地遵守封锁措施造成的。
{"title":"Impact of Coronavirus Disease 2019 on Hospital Admissions, Health Status, and Behavioral Changes of Patients with COPD.","authors":"Eva Pappe,&nbsp;Ralf Hammerich,&nbsp;Jacopo Saccomanno,&nbsp;Thomas Sgarbossa,&nbsp;Anne Pohrt,&nbsp;Bernd Schmidt,&nbsp;Christian Grah,&nbsp;Stephan Eisenmann,&nbsp;Angelique Holland,&nbsp;Stephan Eggeling,&nbsp;Franz Stanzel,&nbsp;Martin Witzenrath,&nbsp;Ralf-Harto Hübner","doi":"10.15326/jcopdf.2022.0383","DOIUrl":"https://doi.org/10.15326/jcopdf.2022.0383","url":null,"abstract":"<p><strong>Introduction: </strong>Patients with chronic obstructive pulmonary disease (COPD) have an increased risk of acquiring severe coronavirus disease 2019 (COVID-19), which is why self-isolation was recommended. However, long periods of social isolation, accompanied by limited access to health care systems, might influence the outcome of patients with severe COPD negatively.</p><p><strong>Methods: </strong>Data from COPD and pneumonia patients at Charité-Universitätsmedizin Berlin and the volume of endoscopic lung volume reduction (ELVR) surgeries from the German Lung Emphysema Registry (<i>Lungenemphysem Register e.V</i>.) were analyzed from pre-pandemic (2012 to 2019) to the pandemic period (2020 and 2021). In addition, 52 patients with COPD Global initiative for chronic Obstructive Lung Disease (GOLD) stage 4 status included in the lung emphysema registry received questionnaires during lockdowns from June 2020 to April 2021.</p><p><strong>Results: </strong>Admissions and ventilation therapies administered to COPD patients significantly decreased during the COVID-19 pandemic. Likewise, there was a reduction in ELVR treatments and follow-ups registered in German emphysema centers. Mortality was slightly higher among patients hospitalized with COPD during the pandemic. Increasing proportions of COPD patients with GOLD stage 3 and GOLD stage 4 status reported behavioral changes and subjective feelings of increasing COPD symptoms the longer the lockdown lasted. However, COPD symptom questionnaires revealed stable COPD symptoms over the pandemic time period.</p><p><strong>Summary: </strong>This study reveals reduced COPD admissions and elective treatment procedures of COPD patients during the pandemic, but a slight increase in mortality among patients hospitalized with COPD, irrespective of COVID-19. Correspondingly, patients with severe COPD reported subjective deterioration of their health status, probably caused by their very strict compliance with lockdown measures.</p>","PeriodicalId":51340,"journal":{"name":"Chronic Obstructive Pulmonary Diseases-Journal of the Copd Foundation","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2023-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10484494/pdf/JCOPDF-10-211.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10536734","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Changes in Lung Volumes with Spirometric Disease Progression in COPD. 慢性阻塞性肺疾病患者肺容积随肺活量疾病进展的变化。
IF 2.3 4区 医学 Q2 RESPIRATORY SYSTEM Pub Date : 2023-07-26 DOI: 10.15326/jcopdf.2022.0363
Mehrdad Arjomandi, Siyang Zeng, Jianhong Chen, Surya P Bhatt, Fereidoun Abtin, Igor Barjaktarevic, R Graham Barr, Eugene R Bleecker, Russell G Buhr, Gerard J Criner, Alejandro P Comellas, David J Couper, Jeffrey L Curtis, Mark T Dransfield, Spyridon Fortis, MeiLan K Han, Nadia N Hansel, Eric A Hoffman, John E Hokanson, Robert J Kaner, Richard E Kanner, Jerry A Krishnan, Wassim W Labaki, David A Lynch, Victor E Ortega, Stephen P Peters, Prescott G Woodruff, Christopher B Cooper, Russell P Bowler, Robert Paine, Stephen I Rennard, Donald P Tashkin

Background: Abnormal lung volumes representing air trapping identify the subset of smokers with preserved spirometry who develop spirometric chronic obstructive pulmonary disease (COPD) and adverse outcomes. However, how lung volumes evolve in early COPD as airflow obstruction develops remains unclear.

Methods: To establish how lung volumes change with the development of spirometric COPD, we examined lung volumes from the pulmonary function data (seated posture) available in the U.S. Department of Veterans Affairs electronic health records (n=71,356) and lung volumes measured by computed tomography (supine posture) available from the COPD Genetic Epidemiology (COPDGene®) study (n=7969) and the SubPopulations and InterMediate Outcome Measures In COPD Study (SPIROMICS) (n=2552) cohorts, and studied their cross-sectional distributions and longitudinal changes across the airflow obstruction spectrum. Patients with preserved ratio-impaired spirometry (PRISm) were excluded from this analysis.

Results: Lung volumes from all 3 cohorts showed similar patterns of distributions and longitudinal changes with worsening airflow obstruction. The distributions for total lung capacity (TLC), vital capacity (VC), and inspiratory capacity (IC) and their patterns of change were nonlinear and included different phases. When stratified by airflow obstruction using Global initiative for chronic Obstructive Lung Disease (GOLD) stages, patients with GOLD 1 (mild) COPD had larger lung volumes (TLC, VC, IC) compared to patients with GOLD 0 (smokers with preserved spirometry) or GOLD 2 (moderate) disease. In longitudinal follow-up of baseline GOLD 0 patients who progressed to spirometric COPD, those with an initially higher TLC and VC developed mild obstruction (GOLD 1) while those with an initially lower TLC and VC developed moderate obstruction (GOLD 2).

Conclusions: In COPD, TLC, and VC have biphasic distributions, change in nonlinear fashions as obstruction worsens, and could differentiate those GOLD 0 patients at risk for more rapid spirometric disease progression.

背景:在肺活量正常的吸烟者中,有一部分会发展为慢性阻塞性肺疾病(COPD)并出现不良后果。然而,早期慢性阻塞性肺病患者的肺活量是如何随着气流阻塞的发展而变化的仍不清楚:为了确定肺容积是如何随着肺活量慢性阻塞性肺病的发展而变化的,我们研究了美国退伍军人事务部电子健康数据(坐姿)中的肺容积。方法:我们研究了美国退伍军人事务部电子健康记录中的肺功能数据(坐姿)(n=71356)和慢性阻塞性肺病遗传流行病学(COPDGene®)研究(n=7969)及慢性阻塞性肺病亚人群和中期结果测量研究(SPIROMICS)(n=2552)队列中的肺容量,并研究了它们在气流阻塞范围内的横截面分布和纵向变化。本分析不包括肺活量比值受损(PRISm)的患者:结果:随着气流阻塞的恶化,所有 3 个队列的肺活量都呈现出相似的分布模式和纵向变化。总肺活量(TLC)、肺活量(VC)和吸气量(IC)的分布及其变化规律是非线性的,并包括不同的阶段。根据全球慢性阻塞性肺病倡议(GOLD)分期对气流阻塞进行分层时,GOLD 1(轻度)慢性阻塞性肺病患者的肺活量(TLC、VC、IC)比 GOLD 0(肺活量保留的吸烟者)或 GOLD 2(中度)患者大。在对发展为肺活量慢性阻塞性肺疾病的基线 GOLD 0 患者的纵向随访中,最初 TLC 和 VC 较高的患者发展为轻度阻塞(GOLD 1),而最初 TLC 和 VC 较低的患者发展为中度阻塞(GOLD 2):结论:在慢性阻塞性肺病患者中,TLC 和 VC 呈双相分布,随着阻塞的恶化而发生非线性变化,可以区分出肺活量疾病进展较快的 GOLD 0 患者。
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引用次数: 0
Structured Evaluation and Management of Patients with COPD in an Accredited Program. 慢性阻塞性肺病患者在认可项目中的结构化评估和管理。
IF 2.4 4区 医学 Q2 Medicine Pub Date : 2023-07-26 DOI: 10.15326/jcopdf.2022.0366
Mandeep Singh, En Shuo Hsu, Efstathia Polychronopoulou, Gulshan Sharma, Alexander G Duarte

Background: Chronic obstructive pulmonary disease (COPD) is an ambulatory care-sensitive condition.

Methods: We compared the impact of care received by patients with COPD at Joint Commission-accredited, disease-specific clinics and primary care clinics at an academic health care systemfrom April 2014 to March 2018. Patients with COPD ≥ 40 years old with ≥ 2 outpatient visits 30 days apart were identified. Baseline demographics, disease-specific performance measures, and health care utilization were compared between groups. Propensity matching was conducted and time to the first emergency department (ED) visit and hospitalization was performed using Cox regression analysis.

Results: Of 4646 unique patients with COPD, 1114 were treated at disease-specific clinics and 3532 at primary care clinics. The entire group was predominantly female (58.8 %), non-Hispanic White (74.2 %) with a mean age of 65.4 ± 11.4 years consisting of current (47.6 %) or former smokers (38.4 %). In the disease-specific group, performance measures were performed more frequently, and lower rates of ED visits (hazard ratio [HR]=0.31, 95% confidence interval [CI] 0.18-0.54) and hospitalizations (HR 0.41, 95% CI 0.21-0.79) noted in comparison to the primary care group.

Conclusions: In this observational study, the implementation of achronic disease management program through accredited disease-specific clinics for patients with COPD was associated with reduced all-cause ED visits and hospitalizations.

背景:慢性阻塞性肺疾病(COPD)是一种对门诊护理敏感的疾病。方法:我们比较了2014年4月至2018年3月在学术卫生保健系统的联合委员会认可的疾病特异性诊所和初级保健诊所接受COPD患者护理的影响。COPD患者年龄≥40岁,间隔30天门诊次数≥2次。比较各组之间的基线人口统计、疾病特异性表现指标和医疗保健利用情况。进行倾向匹配,并使用Cox回归分析进行首次急诊科(ED)就诊时间和住院时间。结果:4646例COPD患者中,1114例在疾病特异性诊所接受治疗,3532例在初级保健诊所接受治疗。整个组主要为女性(58.8%),非西班牙裔白人(74.2%),平均年龄为65.4±11.4岁,包括当前吸烟者(47.6%)或曾经吸烟者(38.4%)。与初级保健组相比,在特定疾病组中,绩效测量更频繁,ED就诊率(风险比[HR]=0.31, 95%可信区间[CI] 0.18-0.54)和住院率(HR 0.41, 95% CI 0.21-0.79)更低。结论:在这项观察性研究中,通过认可的疾病特异性诊所对COPD患者实施慢性疾病管理计划与减少全因ED就诊和住院有关。
{"title":"Structured Evaluation and Management of Patients with COPD in an Accredited Program.","authors":"Mandeep Singh,&nbsp;En Shuo Hsu,&nbsp;Efstathia Polychronopoulou,&nbsp;Gulshan Sharma,&nbsp;Alexander G Duarte","doi":"10.15326/jcopdf.2022.0366","DOIUrl":"https://doi.org/10.15326/jcopdf.2022.0366","url":null,"abstract":"<p><strong>Background: </strong>Chronic obstructive pulmonary disease (COPD) is an ambulatory care-sensitive condition.</p><p><strong>Methods: </strong>We compared the impact of care received by patients with COPD at Joint Commission-accredited, disease-specific clinics and primary care clinics at an academic health care systemfrom April 2014 to March 2018. Patients with COPD ≥ 40 years old with ≥ 2 outpatient visits 30 days apart were identified. Baseline demographics, disease-specific performance measures, and health care utilization were compared between groups. Propensity matching was conducted and time to the first emergency department (ED) visit and hospitalization was performed using Cox regression analysis.</p><p><strong>Results: </strong>Of 4646 unique patients with COPD, 1114 were treated at disease-specific clinics and 3532 at primary care clinics. The entire group was predominantly female (58.8 %), non-Hispanic White (74.2 %) with a mean age of 65.4 ± 11.4 years consisting of current (47.6 %) or former smokers (38.4 %). In the disease-specific group, performance measures were performed more frequently, and lower rates of ED visits (hazard ratio [HR]=0.31, 95% confidence interval [CI] 0.18-0.54) and hospitalizations (HR 0.41, 95% CI 0.21-0.79) noted in comparison to the primary care group.</p><p><strong>Conclusions: </strong>In this observational study, the implementation of achronic disease management program through accredited disease-specific clinics for patients with COPD was associated with reduced all-cause ED visits and hospitalizations.</p>","PeriodicalId":51340,"journal":{"name":"Chronic Obstructive Pulmonary Diseases-Journal of the Copd Foundation","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2023-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10484492/pdf/JCOPDF-10-297.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10175641","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Clinical Use of an Exposure, Symptom, and Spirometry Algorithm to Stratify Smokers into COPD Risk Phenotypes: A Case Finding Study Combined with Smoking Cessation Counseling. 临床应用暴露、症状和肺活量测定法将吸烟者分为COPD风险表型:一项结合戒烟咨询的病例发现研究
IF 2.4 4区 医学 Q2 Medicine Pub Date : 2023-07-26 DOI: 10.15326/jcopdf.2022.0368
Abraham Bohadana, Ariel Rokach, Pascal Wild, Ofir Kotek, Chen-Chen Shuali, Hava Azulai, Gabriel Izbicki

Background: Chronic obstructive pulmonary disease (COPD) case-finding aims to detect airflow obstruction in symptomatic smokers and ex-smokers. We used a clinical algorithm including smoking, symptoms, and spirometry to classify smokers into COPD risk phenotypes. In addition, we evaluated the acceptability and effectiveness of including smoking cessation advice in the case-finding intervention.

Methods: Smoking, symptoms, and spirometry abnormalities (airflow obstruction: forced expiratory volume in 1 second [FEV1] to forced vital capacity [FVC] <0.7 or preserved-ratio spirometry (FEV1<80% of predicted value and FEV1/FVC ratio ≥ 0.7)] were assessed in a group of 864 smokers aged ≥ 30 years. The combination of these parameters allowed the identification of 4 phenotypes: Phenotype A (no symptoms, normal spirometry; reference), Phenotype B (symptoms; normal spirometry; possible COPD), Phenotype C (no symptoms; abnormal spirometry; possible COPD), and Phenotype D (symptoms; abnormal spirometry; probable COPD). We assessed phenotype differences in clinical variables and modeled the trend from phenotype A to phenotype D. Smoking cessation advice based on spirometry was provided. Follow-up was done by telephone 3 months later.

Results: Using smokers without symptoms or abnormal spirometry (phenotype A; n=212 [24.5%]) as a reference, smokers were classified into possible COPD (phenotype B;n=332 [38.4%]; and C: n=81 [9.4%]) and probable COPD (phenotype D: n=239 [27.2%]). The trend from baseline phenotype A to probable COPD phenotype D was significant for the number of cigarettes/day and the number of years of smoking (p=0.0001). At follow-up, 58 (7.7%) of the respondents (n=749) reported that they had quit smoking.

Conclusions: Our clinical algorithm allowed us to classify smokers into COPD phenotypes whose manifestations were associated with smoking intensity and to significantly increase the number of smokers screened for COPD. Smoking cessation advice was well accepted, resulting in a low but clinically significant quit rate.

背景:慢性阻塞性肺疾病(COPD)病例调查旨在发现有症状的吸烟者和戒烟者的气流阻塞。我们使用包括吸烟、症状和肺活量测定在内的临床算法将吸烟者分为COPD风险表型。此外,我们评估了在病例发现干预中纳入戒烟建议的可接受性和有效性。方法:对864名年龄≥30岁的吸烟者进行吸烟、症状和肺活量测量异常(气流阻塞:1秒用力呼气量[FEV1]与用力肺活量[FVC] 11/FVC比值≥0.7)的评估。这些参数的组合允许鉴定4种表型:表型A(无症状,肺活量正常;B型(症状;正常的肺量测定法;可能为COPD),表型C型(无症状;不正常的肺量测定法;可能的COPD)和表型D(症状;不正常的肺量测定法;可能的COPD)。我们评估了临床变量的表现型差异,并建立了从表现型A到表现型d的趋势模型。3个月后电话随访。结果:使用无症状或肺量异常的吸烟者(表现型A;n=212[24.5%])作为参考,将吸烟者分为可能的COPD(表型B;n=332 [38.4%];C型:n=81[9.4%])和可能的COPD (D型:n=239[27.2%])。从基线表现型A到可能的COPD表现型D的趋势在每天吸烟数量和吸烟年数方面具有显著性(p=0.0001)。在随访中,58名(7.7%)受访者(n=749)报告他们已经戒烟。结论:我们的临床算法使我们能够将吸烟者分为COPD表型,其表现与吸烟强度相关,并显着增加了筛查COPD的吸烟者数量。戒烟建议被广泛接受,导致低但临床意义重大的戒烟率。
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引用次数: 0
The Experiences of Individuals with a History of Acute Exacerbations of COPD and Their Thoughts on Death: Empirical Qualitative Research. 有慢性阻塞性肺病急性加重病史者的经历及其对死亡的思考:实证定性研究。
IF 2.4 4区 医学 Q2 Medicine Pub Date : 2023-07-26 DOI: 10.15326/jcopdf.2023.0389
Yasemin Ceyhan

Background: The most important problem of chronic obstructive pulmonary disease (COPD) patients is acute exacerbation. Researching this experience and examining its relationship with death is extremely important in patient care.

Methods: This study was conducted to reveal the experiences of individuals with a history of acute exacerbations of chronic obstructive pulmonary disease (AECOPDs) and their thoughts on death by qualitative empirical research. The study was conducted in a pulmonology clinic between July and September 2022. In-depth face-to-face interviews were conducted with patients in their rooms using a semi-structured form created specifically for the study and used as a data collection tool. With patient consent, interviews were recorded and documented. During the data analysis phase, the Colaizzi method was used. The study was presented in accordance with the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist for qualitative research.

Results: The study was completed with 15 patients. A total of 13 of the patients were male and the mean age was 65 years. Patient statements were coded after the interviews and collected under 11 sub-themes. These sub-themes were categorized under the following main themes: recognizing AECOPDs, AECOPD instant experiences, post-AECOPD, and thoughts on death.

Conclusion: Patients were able to recognize the symptoms of an AECOPD, that the severity of the symptoms increased during the exacerbation, that they felt regret or anxiety about re-exacerbation, and that all of these factors contributed to their fear of death.

背景:慢性阻塞性肺病(COPD)患者最重要的问题是急性加重。研究这种经历及其与死亡的关系对患者护理极为重要:本研究旨在通过定性实证研究,揭示有慢性阻塞性肺疾病急性加重(AECOPDs)病史的患者的经历及其对死亡的看法。研究于 2022 年 7 月至 9 月期间在一家肺科诊所进行。研究人员在病房内与患者进行了面对面的深入访谈,访谈中使用了专为本研究制作的半结构化表格作为数据收集工具。在征得患者同意后,对访谈进行了录音和记录。在数据分析阶段,采用了科莱兹方法。研究报告是根据定性研究报告综合标准(COREQ)的检查表撰写的:共有 15 名患者完成了研究。其中 13 名患者为男性,平均年龄为 65 岁。访谈结束后,对患者的陈述进行了编码,并按照 11 个子主题进行了收集。这些次主题被归类为以下主要主题:认识 AECOPD、AECOPD 即时体验、AECOPD 后和对死亡的思考:结论:患者能够识别 AECOPD 的症状,症状的严重程度在病情恶化期间有所增加,他们对病情再次恶化感到遗憾或焦虑,所有这些因素都导致了他们对死亡的恐惧。
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引用次数: 0
期刊
Chronic Obstructive Pulmonary Diseases-Journal of the Copd Foundation
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