Motivating Conversations About COPD: What Patients Prefer

Living with a chronic condition like chronic obstructive pulmonary disease (COPD) can be challenging. Early diagnosis and timely clinical conversations are crucial for managing this condition effectively. A recent study delved into understanding what motivates patients to initiate conversations about COPD with their healthcare providers, revealing valuable insights into message features that can encourage these vital discussions.

In a quest to identify effective message features, researchers conducted a discrete choice experiment involving 928 participants, primarily non-Hispanic white adults with some college experience. Their goal was to determine which messages would inspire them to talk to a clinician about COPD. Key findings were:

1. COPD Susceptibility Matters (25.53% preference): Messages focusing on COPD susceptibility, such as signs and symptoms, were the most influential in motivating patients to discuss COPD, highlighting the importance of raising awareness about the early warning signs of the disease.

2. Message Source Counts (19.32% preference): Patients placed a significant emphasis on the source of the message. Those from medical authorities including clinicians and COPD organizations were highly preferred, demonstrating that trust in the messenger plays a vital role in encouraging dialogue.

3. Supportive Call-to-Action (14.12% preference): Participants responded positively to messages that supported their autonomy in decision-making regarding COPD screening. Empowering patients to take control of their health decisions is essential.

4. Emotional Frame (13.24% preference): Messages that conveyed hope for living a healthy life with COPD and boosted self-efficacy in seeking screening garnered attention, showing that emotions can be powerful motivators in healthcare discussions.

5. Efficacy Matters (8.65% preference): While less influential than other factors, messages that conveyed efficacy in getting screened still played a role. Patients need to believe that taking action will make a difference.

6. Preference for Susceptibility Over Risk Behaviors: Interestingly, patients favored messages about COPD signs and symptoms over those related to risk behaviors like smoking and environmental exposures. This suggests that emphasizing early detection and symptom awareness might be more effective.

7. Variation in Message Preferences: The study also revealed that message preferences varied based on age, gender, race, ethnicity, education level, and smoking status. Tailoring messages to specific patient demographics could enhance their effectiveness.

These findings offer valuable guidance for healthcare professionals and organizations in promoting COPD awareness and early diagnosis. By crafting messages that focus on susceptibility, come from credible sources, empower patients, and evoke hope, clinicians can encourage more patients to discuss COPD during their appointments.

COPD is a challenging condition, but initiating clinical conversations about it is a crucial step toward effective management. Understanding what motivates patients to discuss COPD is vital. This study's findings shed light on the message features that can inspire these conversations, ultimately improving the early detection and management of COPD.

By tailoring messages to patient preferences, healthcare providers can play a pivotal role in reducing the burden of this disease, particularly among at-risk populations.

Read the full study in PEC Innovations.

Research Uncovers Why Viral Infections are Worse for People with COPD

New research has identified the cells responsible for exacerbating viral infections in people with chronic obstructive pulmonary disease (COPD) – tissue-resident natural killer (trNK) cells that are abnormally active in people with COPD. When exposed to viral infections in COPD-affected lungs, these trNK cells respond too aggressively and, as a result, fail to produce the necessary cytokine, or signaling protein, to fight the infection.

The findings, discovered by researchers from the Hunter Medical Research Institute and the University of Newcastle in collaboration with Grace Cooper from University of Southampton, were published in the American Journal of Respiratory and Critical Care Medicine.

In the study, mice were exposed to cigarette smoke for 12 weeks to induce COPD-like lung disease, after which their lung trNK cell phenotypes and function were analyzed. That analysis showed that when the natural killer (NK) cells were exposed to viral infections, they became overactive and ultimately stopped working. This overly aggressive immune response meant the NK cells could not produce the necessary signaling protein, or cytokine, and could not fight the infection. 

“Collectively,” researchers concluded, “these results demonstrate that trNK cell function is altered in cigarette smoke-induced disease and suggests that smoke exposure may aberrantly prime trNK cell responsiveness to viral infection. This may contribute to excess inflammation during viral exacerbations of COPD.”

Read the original article in Medical Xpress.

Emphysema is More Common in Cannabis Smokers

According to the Centers for Disease Control and Prevention (CDC), marijuana is used by more than 48 million people, making it the most used federally illegal drug in the U.S. It affects the part of the brain responsible for memory, learning, attention, decision-making, coordination, emotion, and reaction time and has been linked to increased risk of psychosis or schizophrenia in some users.

If those facts aren’t sobering enough, new research has also linked it to higher rates of chronic obstructive pulmonary disease (COPD).

According to a study in Radiology, COPD is more common in cannabis smokers than cigarette smokers, likely because it enters the lungs unfiltered. The study involved chest CT scans of 56 marijuana smokers, 33 tobacco-only smokers and 57 nonsmokers. It found higher rates of emphysema among the marijuana smokers (42 out of 56) than nonsmokers (three out of 57) but not tobacco-only smokers (22 out of 33). 

The scans also found higher rates of bronchial thickening – inflammation of the lining of the bronchial tubes – among cannabis smokers, as well as bronchiectasis (widened, damaged airways) and mucoid impaction. The study also found that paraseptal emphysema was the predominant subtype in marijuana smokers. The rarest form of emphysema, paraseptal emphysema damages tiny ducts that connect air sacs in the lungs, usually affecting the upper part of the lung with fluid-filled sacs called bullae forming on the surface.

The study’s findings align with other research that associates marijuana smoking with large airway inflammation, increased airway resistance, and lung hyperinflation, and more prevalent symptoms of chronic bronchitis. Another study found that frequent marijuana smokers had more outpatient medical visits for respiratory problems than those who do not smoke.

To read the full study, visit Radiology.

Study: COPD-related Anxiety is Misunderstood and Under-Addressed

Anxiety related to chronic obstructive pulmonary diseases (COPD) is triggered initially by specific events in the illness trajectory and thereafter maintained by COPD-related internal, external, and behavioral factors. That is according to new research designed to improve identification and management of COPD-related anxiety, a prevalent but often unidentified issue that is not typically managed adequately.

Researchers in Denmark synthesized the findings of 41 qualitative studies of patients’ experiences of COPD-related anxiety. They identified four themes related to the disorder – initial events, internal maintaining factors, external maintaining factors, and behavioral maintaining factors – and used them to create a conceptual model of COPD-related anxiety from the patient perspective. 

“According to the model, specific initial events can trigger COPD-related anxiety, i.e., realizing the diagnosis and/or prognosis, experiencing exacerbation/symptom progression for the first time, and loss of function and/or abilities due to COPD,” they wrote, noting that despite multiple studies exploring the psychological effect of other illnesses including cancer, the same cannot be said for COPD. “One possible explanation for this lack of focus might be related to the consideration that smokers should expect to be ill from smoking, which is a widespread understanding of COPD, despite also being the case for certain cancers and cardiovascular disease. Another explanation may be the relatively slow progression of the disease, often resulting in several visits to the doctor with symptoms and declining lung function before the diagnosis is confirmed by the physician and disclosed to the patient.”

Results of the study, published in the June 2023 issue of International Journal of Chronic Obstructive Pulmonary Disease, suggest that, once triggered, COPD-related anxiety was maintained and potentially worsened over time by internal, external, and behavioral maintaining factors. For example, the review showed that patients were troubled by thoughts of death and the process of dying. They further expressed that, even shortly after being diagnosed with COPD and understanding the prognosis, death became a near reality, which affected their internal processes. 

“In spite of being aware of patient needs, many health-care providers feel inadequately prepared for discussing end-of-life issues and might therefore tend to avoid bringing up the subject. Moreover, appropriate timing of these conversations can be challenging, due to the unpredictability of the general illness trajectory in COPD compared to cancer.”

The study also suggests that patients suppress information about mental health, believing that their healthcare providers and caregivers could not understand or comprehend their situation. As such, they refrained from requesting help with their anxiety and initiated avoidance and social distancing which worsened symptoms. 

“With the purpose of strengthening the identification of COPD-related anxiety in the future, there are a number of potential barriers among health-care providers that need to be overcome, such as not recognizing the scale of the problem, not considering anxiety as part of the remit, and lack of knowledge about or access to appropriate interventions. Both health-care providers and patients can benefit from implementing systematic, psychological screening processes, because it can potentially increase confidence in assessing and managing psychological symptoms,” the researchers wrote.

Additional insights from Dr. Nair:  The need to breathe is so fundamental that if one chronically has trouble doing it, it will predispose them to anxiety. Anxiety also causes one to hyperventilate, which actually leads the body to emphasize the main defect in COPD – impairment to getting the breath out of your lungs. The “obstruction” in COPD is getting air out (exhalation) rather than in (inhalation). It takes longer to empty your lungs than it does to fill them, so the more times you breathe in the less time you have to breathe out. Thus, anxiety is an important symptom for a doctor to address when treating a person with COPD in a comprehensive manner.

Read the full study in International Journal of Chronic Obstructive Pulmonary Disease