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Women More Likely To Develop COPD
A total of 4,484 current and former smokers with COPD from the Genetic Epidemiology of COPD cohort were recently investigated using regression modeling to explore the association between gender, age, disease severity, and the contributing elements of the Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification who were observed across multiple age categories.
Compared to men with COPD, younger women with COPD had a greater likelihood of more severe dyspnea, airflow limitation, greater risk for exacerbations. These differences were less pronounced in older women with COPD. However, older women remained more likely to experience severe dyspnea and to manifest more severe COPD than older men, despite lower pack-years of smoking.
COPD has historically been viewed as a disease of men; however, prevalence and mortality have been increasing in women in recent decades. This has been attributed to increasing rates of smoking among women, and evidence suggests women may be more susceptible to the harmful effects of cigarette smoke and other known COPD risk factors. Gender differences have previously been observed in the clinical manifestations of COPD, with women reporting more severe dyspnea and a higher rate of exacerbations compared to men.
Women and younger patients with COPD tend to report higher levels of physical and psychological symptoms, and women also are over-represented amongst subjects with severe, early-onset COPD. In a study of 2,500 current and former smokers in Genetic Epidemiology of COPD (COPDGene) cohort, females showed an increased the risk of severe early-onset COPD by threefold. The predominance of women with early-onset COPD suggests that younger women may, in general, be more susceptible to severe manifestations of the disease, although more research is needed to clearly define age-by-gender interactions.
Research has begun to explore gender and age differences in the clinical features of COPD; however, no studies have taken a detailed approach to examine gender differences by age across GOLD grades and symptom groups.
The objective of the present study was to explore gender-by-age interactions and disease severity as defined by GOLD groupings and the three key contributing elements of the GOLD classification system (symptoms, exacerbation risk, and airflow limitation severity) using data from a large well-phenotyped COPD cohort.
This study suggests that women are more likely to be significantly burdened by the symptoms of COPD than men, and this effect appears most pronounced among younger women. Although prior results have highlighted important sex and gender differences in men and women with COPD, the modeling of age by gender interactions across the fifth through eighth decades of life is a point of novelty and highlights the clinical imperative to more effectively and thoroughly recognize and manage respiratory symptoms in women.
Study: Emphysema and Heart Failure a Deadly Combination
In a single-center study of smokers with heart failure, those who also had emphysema identified by CT were twice as likely to be re-hospitalized for heart failure in the following two years, and they demonstrated 70 percent greater odds of dying during that time frame than smokers without emphysema.
The researchers identified 225 inpatients who both smoked and had heart failure from January through March of 2014. The study population was 69 years old on average, 69 percent male and had an average left ventricular ejection fraction (LVEF) of 46 percent. Forty-six percent of those patients had emphysema upon CT. After adjusting for other risk factors, they were 2.11 times more likely to be re-admitted for heart failure over a 2.1-year follow-up and 70 percent more likely to die.
In addition to being more likely to wind up back in the hospital, emphysema patients also averaged longer stays (seven days versus five) and were likely to be re-admitted sooner—a median 162 days versus 327 days for people without emphysema.
“These data should serve as the basis for further study including considering whether therapy based on the presence of emphysema on CT can improve complex HF outcomes,” lead author Puja Kohli, MD, with Massachusetts General Hospital in Boston, and colleagues wrote in PLOS One.
“Our study findings add to that data and show an association between emphysema by CT and an increased cardiac afterload specifically among patients with HF,” they wrote. “The mechanism by which afterload is increased in patients with emphysema and HF is unclear; however, data suggest that increased transmural pressure because of thoracic pressure swings, extrinsic compression in the setting of hyperinflation, and systemic inflammation may all play a role.”
Kohli and colleagues noted that almost half of the patients in their study had emphysema, including 39 percent without known chronic obstructive pulmonary disorder.
“This under-recognized group of patients with both emphysema and heart failure may benefit from improved recognition and characterization of their co-morbid disease processes and optimization of therapies for their lung disease,” the authors wrote.
Click here to read the entire article on Cardiovascular Business.
Patients with COPD Prioritize Symptom Control Information Online
Patients with chronic obstructive pulmonary disease (COPD) still rely on their healthcare providers as the source of primary information about their disease, but about a third of these folks still bring information from the internet and the famous “Dr. Google” to appointments with them to discuss and prioritize information about symptom control, a recent online survey reported.
The research, conducted to understand how patients with COPD perceive web-based health information, was designed to determine behaviors of patients with COPD in use of the internet to learn about their disease; assess their perspectives regarding two educational websites (from the American Lung Association [ALA] and the COPD Foundation); and to see whether patient characteristics, such as older age, severity of breathlessness on the modified Medical Research Council (mMRC), and number of exacerbations in the past year, affected internet health behaviors and assessment of COPD educational websites.
Results from the online survey, completed by 445 respondents, found that physicians were the primary source of information, followed by COPD internet searches; COPD health searches focused on two areas -- specific information about COPD and treatments; patients prioritized disease information in order of “symptom control,” “how COPD affects my body,” and “treatments that might work for me”; attributes of the ALA website were rated mostly higher than the COPD Foundation website.
Ninety-five percent of the respondents said that they rely heavily on their physician as their primary source of information about COPD, but the authors noted that available time for discussions in the office may be limited. Similar to a 2013 Pew Research Center report that found that 72 percent of adult internet users in the United States sought online health information within the past year, 76 percent of these respondents indicated that they performed internet searches about COPD.
Patients rated content of both websites as “good” with mean overall ratings of approximately seven out of 10. Meaning that there is opportunity to improve online materials to achieve higher patients’ ratings. Assessments of specific features indicate that respondents provided higher ratings for all five impression attributes and for eight of nine content attributes on the ALA website compared with the COPD Foundation website. The identities of the websites were hidden during the survey.
Researchers hope that with improved knowledge about a chronic condition like COPD might help patients participate in collaborative self-management plans to improve outcomes. Individuals and organizations can use the findings to modify or enhance information about COPD on their websites. Healthcare providers could also use the survey to help recommend educational websites to patients, they said.
Multiple educational approaches are important to provide both interesting and informative content about COPD on the internet, the study said.
The study has several limitations: the respondents required internet access to participate, so findings may not be applicable to patients without a computer or digital literacy; the respondents were viewing sample static screenshots and not navigating live websites; and only two organizations were selected for review.
Click here to read the entire article on AJMC.
More than 40 Percent of Women with Asthma May Develop COPD
More than four in 10 women with asthma may eventually develop chronic obstructive pulmonary disease (COPD), according to a study conducted in Ontario, Canada, and published online in the Annals of the American Thoracic Society.
In “Asthma and COPD Overlap in Women: Incidence and Risk Factors,” Teresa To, PhD, and co-authors report that of the 4,051 women with asthma included in their study, 1,701 -- or 42 percent -- developed COPD. The woman of the study were followed for 14 years after being diagnosed with asthma, researchers examining risk factors for developing asthma and COPD overlap syndrome, known as ACOS. Those who developed ACOS experience increased exacerbations and hospitalizations and, thus, had a lower quality of life compared to those who have asthma or COPD alone.
The authors also reported that individual risk factors played a more significant role in the development of ACOS than exposure to fine particulate matter, a major air pollutant that because of its microscopic size penetrates deep into the lungs. Also, those women who had a more than five-pack-year smoking history, meaning they had smoked more than the equivalent of a pack of cigarettes a day for five years, were much more likely to develop ACOS than those who smoked fewer cigarettes or never smoked.
Smoking was not the only reason for the development of ACOS, however. Thirty-eight percent of the women who developed ACOS in the study had never smoked.
In addition to smoking, the study identified obesity, rural residence, lower education levels and unemployment as significant risk factors for ACOS. The authors speculated that these factors indicative of low socioeconomic status may result in suboptimal access to care, under-treatment of asthma and poor compliance to medications.
These factors can lead to more frequent attacks of asthma, which can lead to “airway remodeling” that increases the chances of developing ACOS.
“Previous studies have found an alarming rise in ACOS in women in recent years and that the mortality rate from ACOS was higher in women than men,” said Dr. To, a professor in the Graduate School of Public Health at the University of Toronto in Canada. “We urgently need to identify and quantify risk factors associated with ACOS in women to improve their health and save lives.”
The authors of the study said that are “encouraged by the fact that most of the risk factors identified” can be modified.
“The adverse impact of smoking and obesity on health may be even worse in those who are already living with asthma or COPD," said Dr. To. “Identifying modifiable risk factors in the progression from asthma to COPD is an essential first step in developing prevention strategies that lead to a healthy, active lifestyle.”
Black Lung Disease on the Rise
Black lung disease – known clinically as coal workers’ pneumoconiosis or CWP – that afflicts coal miners in Appalachia is on the rise, the National Institute for Occupational Safety and Health (NIOSH) reports.
According to NIOSH, the latest national estimate of 10 percent of coal miners with the disease is higher than the estimate last reported using data from 2012. That data showed that just 7 percent of coal miners who worked more than 25 years in underground mines had evidence of black lung.
In just six years, the number of black lung cases in coal miners is up by 3 percent, the organization says. “One in 10 underground coal miners who have worked in mines for at least 25 years were identified as having black lung,” NIOSH said. “Coal miners in central Appalachia (Kentucky, Virginia, and West Virginia) are disproportionately affected with as many as one in five having evidence of black lung – the highest level recorded in 25 years.”
The data is from the Coal Workers Health Surveillance Program (CWHSP). Established in 1970, the CWHSP offers health screening services to miners, including periodic chest X-rays, lung function testing, respiratory health assessment questionnaires and extended health surveillance to workers at surface coal mines.
NIOSH notes that by the late 1990s, the proportion of screened miners with black lung disease reached the lowest level on record.
Lower incidence outside Appalachia
NIOSH research also suggests that there has been a dramatic increase in progressive massive fibrosis (PMF), the most severe form of black lung disease. PMF had fallen to 0.08 percent among all miners examined by NIOSH in the CWHSP in the late 1990s. Miners outside central Appalachia excluded meant “the prevalence for the remainder of the United States was lower, but an increase since 2000 remains evident.”
Increases in the disease may be related to several recent developments, including the use of more sophisticated mining equipment that generates finer dust particles, which exacerbates the onset of disease when they reach the lungs.
Detection, control, screening
Black lung disease is preventable and that “recently enacted protections to prevent coal mine dust exposure and to identify CWP at its early stage remain essential to protect U.S. coal miners.”
Medical screenings should involve both detecting and controlling airborne coal dust. In addition, real-time dust samplers, which include personal dust monitors, have also been approved by the U.S. Mine Safety and Health Administration for use in underground mines.
COPD Sufferers Can Breathe Easier with New App
There’s an app for that – helping those living with COPD to breathe easier.
The app, Respirate, was created by two high school students in North Carolina and has gone on to win a national contest. The computer company Lenovo announced recently that Respirate is the online “Fan Favorite” as part of its 2018 Lenovo Scholar Network National Mobile App Development Competition.
The app’s most basic function is to help people who have chronic lung diseases improve their ability to breathe. Respirate operates by showing those with COPD how to perform various exercises to help them improve their lung function.
Respirate supplements pulmonary rehabilitation, a program of exercise and education for people who have COPD and other respiratory illnesses. In addition to showing people how to perform various exercises, the app includes to-do lists, reminders and motivational messages, and helps people calculate their body mass index (BMI) to determine how much body fat they have and how they can bring it down.
Possible upgrades include offering Respirate in more languages and seeing whether it can be offered on Apple devices.
Udai Virk and Jeffrey Li, juniors at Enloe High School in Raleigh, developed the app because they know people who have COPD, the third-leading cause of death in the country. “It was extremely mind blowing when we won,” said Virk, 16. “But when we sat down and thought about it afterward, we realized how spectacular our app could be.”
“We thought this was a huge thing,” Li said. “Let’s develop an app to help people manage this.”
The students are members of the Wake County magnet school’s health sciences academy.
Respirate was among six national winners announced in May, leading to the online “Fan Favorite” competition.
The app can be downloaded on the Google Play Store for use on Android devices.
Click here to read the full article on the Raleigh Herald Sun.
Study Evaluates Impact of Care Management Programs on COPD Readmission Rates
Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is one of the leading causes of hospitalization in the U.S. Due to the condition's significant financial and health burdens, healthcare organizations and government agencies throughout the nation are striving to reduce its frequency.
A recent study published in the American Journal of Managed Care analyzed both the clinical and psychosocial risk factors associated with readmissions for COPD exacerbations, with a focus on patients treated at Danbury Hospital, an academic community hospital which implemented a comprehensive care management program (CCMP) and chronic obstructive pulmonary disease (COPD) readmission reduction initiative. An exacerbation was defined as increased cough, sputum or dyspnea in a patient with COPD, as well as a change in sputum color.
“The Agency for Healthcare Research and Quality estimates that 1 out of every 5 patients over the age of 40 who have been hospitalized in the past decade carries a diagnosis of COPD,” noted the study. “Given its prevalence in hospitalized patients, COPD and its acute exacerbation pose a heavy financial burden in health care.”
Throughout the study, researchers collected data on patients with AECOPD, which included an assessment of their clinical comorbidities, such as pneumonia, cognitive disorders and smoking status. Patients' psychosocial risk factors, including anxiety, home safety, and access to transportation, were also analyzed. It was revealed that out of 272 patients, 20 were readmitted within 30 days of their index hospitalization.
Those who were readmitted had a higher rate of pneumonia at readmission and were more likely to have safety issues at home, anxiety and lack of transportation. There was no significant difference between those who were readmitted and those who were not in regard to their age, smoking status, gender or body mass index (BMI). Research also revealed that after one-year post implementation of the CCMP, the hospital's annual readmission rate decreased from 21.5 percent to 13.6 percent.
“From a community hospital that has successfully reduced readmissions for AECOPD after implementation of our CCMP, we speculate that a CCMP can reduce readmission rates with careful execution of a program that includes optimization of in-hospital care, better coordination of pre- and post-discharge care, attention to social variables, a system to better identify patient problems after discharge, and an office setup that can accommodate same day sick visits,” concluded the study.
Click Here to Access the Full Article in the American Journal of Managed Care
Antidepressant Use in People with COPD Linked to Increased Risk of Death and Hospitalization
A recent study published the European Respiratory Journal finds that individuals with chronic obstructive pulmonary disease (COPD) who take antidepressants have a 20 percent increased likelihood of death as well as a 15 percent increased risk of hospitalization due to related symptoms.
In fact, the study suggests that adults with COPD who are new users of serotonergic antidepressants have a higher likelihood of hospitalization, emergency room visits and respiratory condition-related mortality, as well as a higher rate of death overall when compared to non-users of the antidepressants.
"We were not surprised by these findings, as there are biological reasons why antidepressants could lead to respiratory issues," said Dr. Nicholas Vozoris, a scientist in the Li Ka Shing Knowledge Institute of St. Michael's Hospital and the lead author. "These drugs can cause sleepiness, vomiting and can negatively impact immune system cells. This increases the likelihood of infections, breathing issues, and other respiratory adverse events, especially in patients with COPD."
“COPD is a progressive lung disease that causes increasing breathlessness. It affects more than 10 percent of those aged 40 and older worldwide. Because of the nature of the disease, upwards of 70 percent of those with COPD also struggle with symptoms of low mood and anxiety,” said Dr. Vozoris.
Vozoris and his team leveraged health administrative databases from the Institute of Clinical Evaluative Sciences to analyze more than 28,000 individuals with COPD who recently began to use serotonergic antidepressants and were 66 years of age or older. The study revealed that these individuals had a significantly increased rate of both breathing-related and overall death.
"The study results should not cause alarm among those who use these medications, but rather increase caution among patients and physicians," Dr. Vozoris said. "I hope our study encourages increased awareness when prescribing these medications and monitoring for adverse side effects. Also, because there is this association, we as physicians should give thought to psychotherapy and pulmonary rehabilitation as non-drug related treatment."
Temple Researchers Find Success in Minimally Invasive Treatment for Emphysema
More than three million individuals in the U.S. have been diagnosed with emphysema, commonly associated with smoker's lung and long-term tobacco use. The condition is a related form of chronic obstructive pulmonary disease (COPD) and the severity of it has proven to be fatal.
Although treatments for emphysema exist, they often require intensive and risky lung volume reduction surgeries to help remove damaged tissue, which can lead to infections, respiratory failure and additional severe complications. In turn, researchers continue to search for less invasive treatment methods to enable patients to resume active lifestyles.
In a recent clinical trial, researchers at Temple University revealed the benefits of a new, minimally invasive emphysema endoscopic lung reduction therapy that utilizes a one-way valve to deflate damaged areas of the lungs. Over 190 patients with emphysema participated in the university's LIBERATE clinical trial and were implanted with the Zephyr Endobronchial Valve. The findings were presented at the ATS 2018 International Conference and published in the American Journal of Respiratory and Critical Care Medicine.
“The LIBERATE trial was designed to see whether Zephyr EBV was safe and effective over a relatively longer time frame, out to one year,” said Gerard Criner, chair and professor of thoracic medicine and surgery at the Lewis Katz School of Medicine, who served as principal investigator of the study.
The valve, which was implanted using a bronchoscope and flexible delivery catheter, prevents the hyperinflation caused by air that is trapped in damaged lung tissue. This approach, in turn, is intended to "mimic the mechanism of lung volume reduction surgery, shrinking the diseased regions and enabling more efficient functioning in healthier regions."
Researchers also discovered that the valve helped to reduce shortness of breath, improve lung function and enhance quality of life for at least one year after the implantation.
Traffic-related pollution linked to risk of asthma in children
Although physicians have long understood that the prevalence of smog and pollution can lead to asthma attacks, uncertainty has remained regarding the impact of long-term pollutant exposure on the development of the disease among children. Recent research, however, has shed light into this.
A study, published in the Journal of Allergy and Clinical Immunology, reveals that children who experience long-term exposure to traffic-related pollution, especially throughout early childhood, may have a significantly increased risk of developing pediatric asthma.
"Our previous research demonstrated that living close to a major roadway and lifetime exposure to air pollutants were associated with lower lung function in seven- to ten-year-old children," said corresponding author Mary B. Rice, MD, MPH. "We suspected that these exposures would also be associated with pediatric asthma."
Researchers analyzed data from more than 1,500 children who were born between 1999 and 2002, lived in the Boston-area and had mothers who were enrolled in a long-term study known as Project Viva. Researchers developed the study to examine the impact of behavioral and environmental factors, including exposure to pollution, on children's health.
During Project Viva, mothers provided medical, socio-economic and demographic information, which was later leveraged by Rice and her colleagues to determine the distance between each child's home address and the closest major roadway. Children's home addresses were also linked to both census and satellite-derived atmospheric data to determine each child's approximate daily exposure to fine particulate matter (PM). The children's daily exposure to soot was also examined. Upon analysis of the geographic data and Project Viva questionnaires, researchers discovered that living close to a major road was linked to childhood asthma.
"Children living less than 100 meters from a major road had nearly three times the odds of current asthma -- children who either experience asthma symptoms or use asthma medications daily -- by ages seven to 10, compared with children living more than 400 meters away from a major road," said Rice. "Even in the Boston area, where pollution levels are relatively low and within Environmental Protection Agency standards, traffic-related pollutants appear to increase the risk of asthma in childhood."
"Younger children spend a larger proportion of their time at home than school-aged children, and their airways are smaller and may be more likely to wheeze in response to pollution," said Rice. "This may explain why pollution exposure was most consistently linked to asthma in young children."
