COPD Comorbidities Research Articles

MO083: Phenotypes of Patients With Combined Hypertension and COPD Depending on Renal Function

Abstract BACKGROUND AND AIMS Chronic kidney disease and hypertension are closely linked to cause and effect. Patients with COPD, in turn, have a 1.61 times higher risk of developing CKD than patients without COPD, after adjusting for clinical risk factors. Comorbidity of hypertension and COPD contributes to a greater decrease in renal function. The aim of this study was to identify the phenotypes of patients with a combined course of hypertension and COPD using cluster analysis. METHOD In a one-time study, 32 patients with hypertension and chronic obstructive pulmonary were examined. Patients of three groups underwent general clinical examination, collected complaints, tested on the questionnaires of mMRC and CAT, determined nutritional status by anthropometric study and bioimpedancemetry, conducted daily monitoring of blood pressure and ventilatory function, assessed the functional state of the kidneys by laboratory examination of blood. Statistical methods were used, including cluster analysis, using the "Statistics" program. RESULTS During the cluster analysis in patients with combined hypertension and chronic obstructive pulmonary disease, 5 large clusters of clinical and laboratory data of patients were identified. Cluster 1: male and female patients with COPD and hypertension, middle age 43 (1,2) years, smokers. The average duration of COPD is 10 years, hypertension is 20 years. Results for CAT-9, mMRC: 1, the number of exacerbations of COPD per year: 2. The average content of adipose tissue: 22.7% of muscle tissue: 36%, visceral fat: 9%. BMI: 29.5 kg/m2. FEV1: 49%, GFR: 68 ml/min. Cluster 2: male and female patients with COPD and hypertension, middle age 61 (1,3) years, smokers. The average duration of COPD is 27.5 years, and hypertension is 20 years. Results for CAT: 13.5, mMRC: 2.5, the number of exacerbations of COPD per year: 1. The average content of adipose tissue: 31.4% of muscle tissue: 30.4%, visceral fat: 17.5%. BMI: 31.3 kg/m2. FEV1: 44%, GFR: 63 mL/min. Cluster 3: male and female patients with COPD and hypertension, middle age 61 (1,3) years, smokers. The average duration of COPD is 13 years, and hypertension is 5 years. Results for CAT: 12.5, mMRC: 1.5, the number of exacerbations of COPD per year: 1. The average content of adipose tissue: 20.6% of muscle tissue: 34.3%, visceral fat: 7.0%. BMI: 23.9 kg/m2. FEV1: 32%, GFR: 58 ml/min. Cluster 4: male and female patients with COPD and hypertension, middle age 61 (1,3) years, smokers. The average duration of COPD is 10 years, and hypertension is 20 years. Results for CAT: 9.0, mMRC: 1, the number of exacerbations of COPD per year: 1. The average content of adipose tissue: 41.3% of muscle tissue: 28.6%, visceral fat: 11.0%. BMI: 35.0 kg/m2. FEV1: 80%, GFR: 81 mL/min. Cluster 5: male and female patients with COPD and hypertension, mean age 58.5 (1.2) years, smokers. The average duration of COPD is 27.5 years, and hypertension is 20 years. Results for CAT: 8.5, mMRC: 1.5, the number of exacerbations of COPD per year: 1.5. The average content of adipose tissue is 36.7% of muscle tissue: 30.5%, visceral fat: 13%. BMI: 30.1 kg/m2. FEV1: 61%, GFR: 77 mL/min. CONCLUSION Cluster analysis allows to identify five clusters of patients with combined hypertension and COPD, which can be combined into two phenotypes: with greater bronchial obstruction and lower GFR, and with less bronchial obstruction and greater GFR.

Association Between Serum Sodium and Long-Term Mortality in Critically Ill Patients with Comorbid Chronic Obstructive Pulmonary Disease: Analysis from the MIMIC-IV Database.

PurposeThe purpose of our study was to investigate the relationship between serum sodium levels and 1-year and 3-year mortality in critically ill patients with comorbid chronic obstructive pulmonary disease using real-world data.MethodsThe data of this study were collected from the Medical Information Mart for Intensive Care-IV (MIMIC-IV) database. First of all, we used the Kaplan–Meier curves and multivariable Cox regression analyses to measure the relationship between serum sodium levels and 1-year and 3-year mortality for critically ill patients with comorbid COPD. Next, a restricted cubic spline was used to analyze non-parametrically the relationship between mortality and serum sodium as a continuous variable. In addition, we also analyzed the mortality of different subgroups.ResultsA total of 5540 eligible subjects were extracted. Compared to normal serum sodium levels, adjusted multivariable Cox regression analysis confirmed that hyponatremia and hypernatremia were still significantly associated with 1-year mortality (HR = 1.551, 95% CI = 1.333~1.805, P<0.001; HR = 1.683, 95% CI = 1.317~2.151, P<0.001, respectively) and 3-year mortality (HR = 1.507, 95% CI = 1.302~1.744, P<0.001; HR = 1.612, 95% CI = 1.269~2.048, P<0.001, respectively). In patients with or without adjustment variables, there was an obvious U-shaped non-linear relationship between serum sodium levels and 1-year and 3-year mortality with a reference level of 139 mmol/L, which indicated that patients in both hyponatremia and hypernatremia had higher mortality than normal serum sodium levels.ConclusionThis study showed that both hyponatremia and hypernatremia were related to increased 1-year and 3-year mortality in critically ill patients with comorbid COPD, which provides a new reference for the control strategy of correcting serum sodium levels.

Interstitial lung abnormalities and interstitial lung diseases associated with cigarette smoking in a rural cohort undergoing surgical resection

BackgroundCigarette smoking is a risk factor for interstitial lung abnormalities (ILAs) and interstitial lung diseases (ILDs). Investigation defining the relationships between ILAs/ILDs and clinical, radiographic, and pathologic findings in smokers have been incomplete. Employing a cohort undergoing surgical resection for lung nodules/masses, we (1) define the prevalence of ILAs/ILDs, (2) delineate their clinical, radiographic and pathologic predictors, and (3) determine their associations with mortality.MethodsPatients undergoing resection of lung nodules/masses between 2017 and 2020 at a rural Appalachian, tertiary medical center were retrospectively investigated. Predictors for ILAs/ILDs and mortality were assessed using multivariate logistic regression analysis.ResultsIn the total study cohort of 352 patients, radiographic ILAs and ILDs were observed in 35.2% and 17.6%, respectively. Among ILA patterns, subpleural reticular changes (14.8%), non-emphysematous cysts, centrilobular (CL) ground glass opacities (GGOs) (8% each), and mixed CL-GGO and subpleural reticular changes (7.4%) were common. ILD patterns included combined pulmonary fibrosis emphysema (CPFE) (3.1%), respiratory bronchiolitis (RB)-ILD (3.1%), organizing pneumonitis (2.8%) and unclassifiable (4.8%). The group with radiographic ILAs/ILDs had a significantly higher proportion of ever smokers (49% vs. 39.9%), pack years of smoking (44.57 ± 36.21 vs. 34.96 ± 26.22), clinical comorbidities of COPD (35% vs. 26.5%) and mildly reduced diffusion capacity (% predicated 66.29 ± 20.55 vs. 71.84 ± 23). Radiographic centrilobular and paraseptal emphysema (40% vs. 22.2% and 17.6% vs. 9.6%, respectively) and isolated traction bronchiectasis (10.2% vs. 4.2%) were associated with ILAs/ILDs. Pathological variables of emphysema (34.9% vs. 18.5%), any fibrosis (15.9% vs. 4.6%), peribronchiolar metaplasia (PBM, 8% vs. 1.1%), RB (10.3% vs. 2.5%), and anthracosis (21.6% vs. 14.5%) were associated with ILAs/ILDs. Histologic emphysema showed positive correlations with any fibrosis, RB, anthracosis and ≥ 30 pack year of smoking. The group with ILAs/ILDs had significantly higher mortality (9.1% vs. 2.2%, OR 4.13, [95% CI of 1.84–9.25]).ConclusionsIn a rural cohort undergoing surgical resection, radiographic subclinical ILAs/ILDs patterns were highly prevalent and associated with ever smoking and intensity of smoking. The presence of radiographic ILA/ILD patterns and isolated honeycomb changes were associated with increased mortality. Subclinical ILAs/ILDs and histologic fibrosis correlated with clinical COPD as well as radiographic and pathologic emphysema emphasizing the co-existence of these pulmonary injuries in a heavily smoking population.

Prevalence and Predictors of Chronic Pain with Two-Year Follow-Up After Knee Arthroplasty

BackgroundPain relief is the most important issue in the long-term outcome of arthroplasty surgery, with nearly one-third of patients still suffered persistent pain and caused dissatisfaction after the surgery.MethodsA total of 713 patients underwent primary elective primary TKA and UKA were included consecutively between July 2018 and December 2019, using binary logistic method to analyze the data.ResultsThe prevalence of CPSP at rest and on movement at 2-year was 12.1% and 37.7% respectively after primary knee arthroplasty and CPSP at rest factors included: age above 80 (odds ratio [OR]= 6.72, 95% confidence interval [CI] 1.58 to 28.56), BMI above 30 (2.339, 1.02 to 5.383), and moderate to severe pain variables: preoperative pain, (1.95, 1.11 to 3.41); APSP on movement, 4.9 (2.31–10.6); and follow-up contralateral knee pain-at-rest scores (12.6, 5.5 to 28.5). Factors associated with presence of CPSP on movement included: no smoking (2.59, 1.07 to 6.26); and moderate to severe pain variables: preoperative pain, (1.57, 1.073 to 2.30); APSP at rest, (1.85, 1.13 to 3.02); APSP on movement, 6.11 (3.82 to 9.78); and follow-up contralateral knee pain-on-movement scores, 3.22 (2.08 to 5.00). Factors to occurrence of moderate to severe CPSP on movement include: presence of COPD (12.20, 2.19 to 67.98); and moderate to severe pain variables: preoperative pain (2.36, 1.32 to 4.23); APSP on movement (4.68, 1.95 to 11.25); and follow-up contralateral knee pain-on-movement scores (2.71, 1.66 to 4.42).ConclusionPrevention strategies should be targeted to different types of pain, and the comorbidity of COPD undergoing knee arthroplasty should receive early identification and attention.

Percutaneous fibrin injection for the successful closure of an iatrogenic bronchopleural fistula following percutaneous lung biopsy

Background: Bronchopleural fistula (BPF) following percutaneous lung mass biopsy is a very rare but challenging complication. We describe percutaneous fibrin injection as safe and successful in the treatment of BPF. Additionally, we present a thorough literature review of the reported treatment options of iatrogenic BPF. Summary: A 68-year-old man with a lung cancer, COPD, and multiple other comorbidities underwent an image-guided percutaneous biopsy of an enlarging right-upper lobe lung nodule that was complicated by a large iatrogenic right-sided pneumothorax requiring an image-guided placement of a drainage catheter. Four days after the catheter placement, he was diagnosed with a BPF after developing a continuous air leak, pneumomediastinum, and extensive subcutaneous emphysema. Because patient wished to avoid placement of a chest tube, endobronchial interventions, or any other invasive procedures for management of his BPF, he underwent an image-guided, percutaneous fistula closure by injection of fibrin sealant in the fistula tract. Conclusion: BPF represents a significant challenge requiring a multidisciplinary approach. Percutaneous fibrin injection in the fistula tract represents a less invasive option for patients who have small fistulae, are not operative candidates, or wish to avoid the morbidity of a major surgical interventions.

Clinical features of chronic obstructive pulmonary disease in the elderly

Analysis of randomized, retrospective and prospective clinical, case-control, and observational studies revealed the following main features of COPD in the elderly: (1) COPD is a complex and common condition in elderly patients, characterized by high rates of disturbing symptoms, significant risk of cognitive and functional decline, disease progression, frequent use of health care, extremely difficult treatment and increased mortality. (2) The elderly have an increased prevalence of COPD: in subjects aged 65 years and over, it represents 14,2% (from 11,0% to 18,0%), compared to 9,9% (from 8.2% to 11.8%) in those aged 40 and over. (3) Simultaneously with the 2-4 times higher prevalence of COPD, the elderly patients, especially those aged 75 years or older, also have a higher burden of the disease: frequency, severity and impact of symptoms significantly higher. higher, tolerance to effort and lower daily activities, higher incidence of severe acute exacerbations and higher prevalence of systemic comorbidities. (4) COPD acute exacerbations and comorbidities have poorer results in elderly patients, fact manifested by an increased rate and duration of the hospitalization, an increased rate of repeted hospitalizations and a higher mortality rate. (5) COPD is a multifaceted condition that involves more than just obstruction of the airflow. Systemic inflammation contributes to the development of systemic effects (loss and dysfunction of skeletal muscle, osteoporosis, anemia, cachexia, neurocognitive dysfunction). (6) Multidimensional assessment and multidisciplinary intervention, well recognized in the geriatric population, should be extended to patients with COPD

Host Factor Interaction Networks Identified by Integrative Bioinformatics Analysis Reveals Therapeutic Implications in COPD Patients With COVID-19.

Background: The COVID-19 pandemic poses an imminent threat to humanity, especially for those who have comorbidities. Evidence of COVID-19 and COPD comorbidities is accumulating. However, data revealing the molecular mechanism of COVID-19 and COPD comorbid diseases is limited. Methods: We got COVID-19/COPD -related genes from different databases by restricted screening conditions (top500), respectively, and then supplemented with COVID-19/COPD-associated genes (FDR<0.05, |LogFC|≥1) from clinical sample data sets. By taking the intersection, 42 co-morbid host factors for COVID-19 and COPD were finally obtained. On the basis of shared host factors, we conducted a series of bioinformatics analysis, including protein-protein interaction analysis, gene ontology and pathway enrichment analysis, transcription factor-gene interaction network analysis, gene-microRNA co-regulatory network analysis, tissue-specific enrichment analysis and candidate drug prediction. Results: We revealed the comorbidity mechanism of COVID-19 and COPD from the perspective of host factor interaction, obtained the top ten gene and 3 modules with different biological functions. Furthermore, we have obtained the signaling pathways and concluded that dexamethasone, estradiol, progesterone, and nitric oxide shows effective interventions. Conclusion: This study revealed host factor interaction networks for COVID-19 and COPD, which could confirm the potential drugs for treating the comorbidity, ultimately, enhancing the management of the respiratory disease.

Examination of clinical conditions and chest CT images of Covid-19 cases in Turkey; single center study.

In this study, we aim to study the clinical features and chest CT findings of the patients, COVID-19 diagnosis of which are verified. This retrospective study was conducted on RT-PCR (+) COVID-19 patients who were examined in our hospital's emergency department between March 11, 2020 and June 30, 2020. 326 patients were included in this retrospective study in total. Of the patients, 53.1% and 46.9% are males and females, respectively. The patients applied to the service with the symptoms of shortness of breath at the rate of 21.8% and cough at the rate of 20.6%. The study found that the most frequent abnormal CT finding is ground glass opacity at the rate of 26.7% and it is followed by atelectasis at the rate of 12.3%. Patients in the> 65 age group and patients with COPD comorbidities have significantly higher rates of admission to the intensive care unit. The most frequent findings in examination of pathological chest CT findings are ground glass opacity. The rate of length of intensive care unit stay and mortality is significantly higher in the patients above 65 years old compared to those below 65 years old.

Correlation between Measurement of Lung Diffusion Capacity Using Single Breath Methods (DLCO-SB) and COPD Group in Persahabatan Hospital Jakarta

Background: This was a preliminary study to measure DLCO-SB on COPD patients in Persahabatan Hospital to understand the prevalence of DLCO reduction among COPD patients.Methods: This was a cross sectional study of COPD patients who attended COPD-Asthma clinic in Persahabatan Hospital Jakarta. Spirometry and DLCO-SB were performed consecutively during May–July 2015. Comorbidities were also recorded.Results: Spirometry and DLCO-SB measurements were conducted on 65 COPD subjects of which 10.8% subjects were in COPD Group A, 29.2% Group B, 32.3% Group C and 27.7% Group D. The mean age was 64.15; mean FEV1% was 46.05%, mean DLCO measured was 19.42 ml/min/mmHg and the mean DLCO% was 72.00%. The proportion of DLCO decline among COPD patients was 56.92%. There were significant correlations between COPD group, GOLD COPD grade, FEV1, BMI and comorbidities with the DLCO value results. There were no significant correlation between DLCO value with sex, age, smoking history, Brinkmann Index, obstructive-restrictive criteria, comorbidities and length of COPD period. Conclusion: The proportion of DLCO decline among COPD patients was 56.92%. There were significant correlations between COPD group, GOLD COPD grade, FEV1, BMI and previous TB history with the results of DLCO.

Abstract 11806: CT Measure of Intraparenchymal Vascular Volume in Chronic Obstructive Pulmonary Disease Patients With and Without Pulmonary Hypertension

Purpose: Pulmonary hypertension, despite oxygen therapy, remains a major comorbidity of COPD. Pruning in the form of loss of small vessel fractional volume has been shown to be associated with right heart disease and poor outcomes in COPD. In this investigation we sought to investigate the relationship between this marker and the presence of precapillary pulmonary hypertension by hemodynamic measures. Methods: We conducted an automated search of patients at Brigham and Women’s Hospital with the diagnosis and PFTs consistent with COPD, CT pulmonary angiography and RHC timed within a year. Patients with other forms of lung disease, risk factors for group 1 PH, poor image quality, active lung infection or lung collapse were excluded. All data collection was approved by the IRB at Mass General Brigham (IRB #2018P000419).Using the Chest Imaging Platform ( www.chestimagingplatform.org ) we measured the total vascular volume (TBV), the small (vessels with a cross sectional area &lt;= 5 mm 2 , BV5) and large ( &gt; 5mm 2 , BVg5) for both the arteries and the veins; The small vessel fraction (BV5/TBV) a marker of pruning, and ratio of arterial to venous volumes were also calculated and analyzed using Wilcoxon Rank-sum and modeled using linear regression in R version 4.0.1 Results: Of the Total Cohort (N=44), 17 had precapillary PH (prePH), 12 had PH associated with elevated wedge pressures (pcPH) and the remaining 15 did not meet diagnostic criteria for PH. Patients with prePH had a lower arterial but not venous BV5/TBV (prePH: 0.39 vs noPH: 0.46, p = 0.04) and higher arterial to venous volume ratios for large vessels (1.95 vs 1.38 p = 0.008) compared to patients without PH. In a linear regression models, lower arterial but not venous small vessel fraction continued to be related to mean pulmonary artery pressures after adjustment for age and gender (p = 0.01). Conclusions: In this retrospective study of COPD patients with CT angiography and hemodynamic assessment, decreased small arterial vascular fraction derived from 3D reconstruction of the intraparenchymal vasculature was associated with increased mPAP and was higher in patients with precapillary PH compared to controls.

The negative health effects of having a combination of snoring and insomnia.

Insomnia and snoring are common sleep disorders. The aim was to investigate the association of having a combination of insomnia symptoms and snoring with comorbidity and daytime sleepiness. The study population comprised 25,901 participants (16-75 years, 54.4% women) from 4 Swedish cities, who answered a postal questionnaire that contained questions on snoring, insomnia symptoms (difficulties initiating and/or maintaining sleep and/or early morning awakening), smoking, educational level, and respiratory and nonrespiratory disorders. Snoring was reported by 4,221 (16.2%), while 9,872 (38.1%) reported ≥ 1 insomnia symptom. A total of 2,150 (8.3%) participants reported both insomnia symptoms and snoring. The association with hypertension (adjusted odds ratio [OR], 1.4; 95% confidence interval [CI], 1.2-1.6), chronic obstructive pulmonary disease (adjusted OR, 1.8; 95% CI, 1.3-2.4), asthma (adjusted OR, 1.9; 95% CI, 1.6-2.3), daytime sleepiness (adjusted OR, 7.9; 95% CI, 7.1-8.8), and the use of hypnotics (adjusted OR, 7.5; 95% CI, 6.1-9.1) was highest for the group with both insomnia symptoms and snoring. Participants with both snoring and insomnia run an increased risk of hypertension, chronic obstructive pulmonary disease, asthma, daytime sleepiness, and use of hypnotics. It is important to consider snoring in patients seeking medical assistance for insomnia and, vice versa, in patients with snoring inquiring about insomnia. Hägg SA, Ilieva E, Ljunggren M, etal. The negative health effects of having a combination of snoring and insomnia. J Clin Sleep Med. 2022;18(4):973-981.

Rhinosinusitis without nasal polyps is associated with poorer health-related quality of life in COPD

Rhinosinusitis without nasal polyps (RSsNP) is prevalent in COPD. Previous studies on its association with health-related quality of life (HRQoL) have limitations, and RSsNP is currently not recognized as a comorbidity. This study investigates HRQoL in COPD including a focus on RSsNP.Generic HRQoL was assessed with the Short Form-36 (SF-36v2) questionnaire and compared between 90 COPD and 93 control subjects and in subgroups with and without RSsNP. The association between RSsNP and COPD versus not and generic HRQoL was assessed by multivariable linear regression with adjustments for age, education, and body mass index (BMI). Disease-specific HRQoL was assessed by Sinonasal outcome test-22 (SNOT-22), St. Georges Respiratory Questionnaire (SGRQ), and COPD Assessment Test (CAT) and compared between COPD with and without RSsNP, and their association to RSsNP was assessed by multivariable linear regression with adjustments for age, BMI, and FEV1% predicted.RSsNP was associated with poorer disease-specific HRQoL, with higher SNOT-22 total score (14.67 points; 95% CI, 7.06–22.28; P < .001) and psychological subscale score (3.24 points; 95% CI, 0.37–6.11; P = .03), SGRQ symptom score (13.08 points; 95% CI, 2.73–23.4; P = .014), and CAT score (4.41 points; 95% CI, 1.15–7.66; P = .009).Generic HRQoL was poorer in COPD patients than in the control subjects. In addition to COPD, concomitant RSsNP was associated with poorer physical functioning, general health, vitality, and physical component summary.RSsNP in COPD is associated with poorer disease-specific HRQoL that is clinically relevant and, as it is amenable for treatment, should be recognized as a comorbidity of COPD.

Purposeful Incorporation of Patient Narratives in the Medical Record in the Netherlands.

Structuring patient and practice data into episodes formed the foundation of the earliest evidence base of family medicine. We aim to make patients' narratives part of the evidence base for family medicine by incorporating coded and structured information on the patient's reason to visit the family physician (FP) and adding the patient's personal and contextual characteristics to routine registration data. This documentation allows studies of relations between morbidity and elements of the patient story, providing more insight into the range of problems presented to primary care and in the patient-centeredness applied by FPs. The Dutch Practice-Based Research Network (PBRN), named FaMe-Net, is the world's oldest PBRN. Seven Dutch family practices provide regular primary care and participate in the PBRN. It contains all morbidity data of the approximately 40,000 listed patients (308,000 patient-years and 2.2 million encounters from 2005 until 2019). All information belonging to 1 health problem is ordered in 1 episode. Morbidity (diagnoses), reasons for encounter (RFE), and interventions are coded according to the International Classification of Primary Care (ICPC-2). Registration occurs within the electronic health record (EHR), specially designed to facilitate the extensive registration for the PBRN. Since 2016, the network expanded routine registration with the duration of symptoms and coded personal and contextual characteristics (eg, country of birth, level of education, family history, traumatic events) obtained through the self-reported 'context survey' of listed patients. These data are added to the EHR. Registered data are extracted from the EHR and processed for scientific research.We present data on the differences in RFEs of the most prominent symptoms of COVID-19 between 2019 and 2020; the relation between the diagnosis of pneumonia and presentation of the symptom 'cough,' and how personal determinants influence the chances of final diagnoses. Lastly, we show the relation of self-reported abuse with patient's contact frequency and psychosocial problems. Prompt introduction of registration rules brought insight into COVID-19-related symptoms early in the pandemic. In March 2020, symptoms related to COVID-19 were presented more often than in March 2019. Chronic conditions and prevention showed a collapsing contact frequency. Telephone, email, and video consultations increased from 31% to 53%.Episodes of pneumonia most frequently started with the RFE 'cough.' A combination of 'cough' and 'fever' as RFE increases the likelihood of pneumonia, as does cough in the presence of comorbid COPD among older men. The prevalence of pneumonia is higher among patients with low socioeconomic status. The Dutch PBRN FaMe-Net has started to add elements of patients' narratives and context to decades of morbidity registration, creating options for a scientific approach to primary care's core values. Assumptions of 'pre/post chances' of the final diagnosis, already existing implicitly in FPs minds, can be elaborated and quantified by investigating the associations between multiple registered variables, including parts of patients' 'stories.' This way, we aim to make visible what is intuitively already known by FPs.

Impact of prior smoking exposure and COPD comorbidity on treatment response to monoclonal antibodies in patients with severe asthma.

Patients suffering from severe asthma may benefit from an antibody treatment irrespective of their status as an ex-smoker https://bit.ly/3fYC8tC

Common comorbidities in COPD – providing patient-centred care

COPD management must incorporate looking for and treating several other conditions. By Anne Rodman

Dyspnoe und Komorbidität beim Lungenkarzinom: Warum die Anamnese so wichtig ist

Dyspnoea is a frequent and compromising symptom in patients with advanced and metastatic lung cancer. Exogenous as well as endogenous factors contribute to development of shortness of breath. Knowledge of these influences is essential for effective treatment of this important symptom. In our study, we evaluated the influence of cofactors and comorbidity on development of dyspnoea in lung cancer patients for the purpose of effective therapy of shortness of breath in this target group. In this prospective monocentric study, we registered severity of dyspnoea in advanced lung cancer patients using the modified Medical Research Council-Scale (mMRC-scale). Patients' history of COPD and cardiopulmonary comorbidity was recorded using a standardized questionnaire. Moreover, cofactors such as pain or cancer-induced mental stress were documented by visual rating scale. 25 (48,1 %) of 52 recruited lung cancer-patients reported moderate or severe dyspnoea. In logistic regression analysis history of COPD or cardiopulmonary comorbidity, severe pain, airway obstruction or pleural effusion were associated with severe dyspnoea (mMRC-scale ≥ 3). Furthermore, in our study cohort lower cancer level III UICC and absence of metastasis correlated with severe dyspnoea. Our findings confirm the relevance of dyspnoea in patients with advanced lung cancer. Probability of occurrence is influenced by comorbidity and cofactors. The knowledge of these factors contributes to better understanding of occurrence and treatment of dyspnoea.

COPD Comorbidity Profiles and 2-Year Trajectory of Acute and Postacute Care Use

Multiple morbidity is the norm in advanced COPD and contributes to high symptom burden and worse outcomes. Can distinct comorbidity profiles be identified and validated in a community-based sample of patients with COPD from a large integrated health care system using a standard, commonly used diagnostic code-based comorbidity index and downstream 2-year health care use data? In this retrospective cohort study, we used latent class analysis (LCA) to identify comorbidity profiles in a population-based sample of 91,453 patients with a COPD diagnosis between 2011 and 2015. We included specific comorbid conditions from the Charlson Comorbidity Index (CCI) and accounted for variation in underlying prevalence of different comorbidities across the three study sites. Sociodemographic, clinical, and health-care use data were obtained from electronic health records (EHRs). Multivariate logistic regression analysis was used to compare rates of acute and postacute care use by class. The mean age was 71 ± 11 years, 55%of patients were women, 23%of patients were people of color, and 80%of patients were former or current smokers. LCA identified four distinct comorbidity profiles with progressively higher CCI scores: low morbidity (61%; 1.9 ± 1.4), metabolic renal (21%; 4.7 ± 1.8), cardiovascular (12%; 4.6 ± 1.9), and multimorbidity (7%; 7.5 ± 1.7). In multivariate models, during 2 years of follow-up, a significant, nonoverlapping increase was found in the odds of having any all-cause acute (hospitalizations, observation stays, and ED visits) and postacute care use across the comorbidity profiles. Distinct comorbidity profiles can be identified in patients with COPD using standard EHR-based diagnostic codes, and these profiles are associated with subsequent acute and postacute care use. Population-based risk stratification schemes for end-to-end, comprehensive COPD management should consider integrating comorbidity profiles such as those found in this study.

Meta-Analysis the Association between Chronic Obstructive Pulmonary Disease Comorbidity and COVID-19 Mortality

disease that hit the world community at the end of 2019. The risk of death from COVID-19 is highly dependent on age and previous health conditions. COVID-19 severe and critical symptoms are more commonly found in older patients and patients who have chronic comor­bidities such as cardio­vascular disease, hyper­tension, diabetes, including COPD. This study aims to deter­mine the relationship between COPD and mortality of COVID-19 patients in hospitals. Subjects and Method: This a meta-analysis study using the PRISMA flowchart guidelines. The article search process was carried out between 2020-2021 using databases from PubMed, Google Scholar, Science Direct, BMJ Garuda, SINTA, and National Library. Based on the database, there were 9 articles that met the inclusion criteria. The analysis was carried out using RevMan 5.3 software. Results: A total of 9 articles reviewed in the meta-analysis showed that comorbid COPD had a statistically significant association with hos­pital mortality of COVID-19 patients (aOR = 1.51; 95% CI= 1.21 to 1.9; p &lt; 0.001). Conclusion: COPD comorbidities have an increased risk of dying of COVID-19 patients in hospital. Keywords: CPOD, COVID-19, death, meta-analysis Correspondence: Pamogsa Ratri Adha Daniyar. Masters Program in Public Health, Universitas Sebelas Maret. Jl. Ir. Sutami 36A, Surakarta 57126, Central Java. Email: pamogsadaniyar@gmail.com. Mobile: +62 852-9060-1552. Journal of Epidemiology and Public Health (2021), 06(02): 222-231 https://doi.org/10.26911/jepublichealth.2021.06.02.09

Self-reported exercise capacity among current smokers eligible for lung cancer screening: Distribution and association with key comorbidities

One concernas lung cancer screening (LCS) is implemented is that patients will be screened who are too ill to benefit. Poor exercise capacity (EC) predicts adverse outcomes following lung resection. ObjectiveDescribe the distribution of EC among smokers eligible for LCS and examine associations with comorbidities. MethodsCross-sectional analysis of baseline data from a randomized controlled trial of tobacco treatment in the context of LCS. Participants responded regarding limitations in moderate activities, ability to climb stairs, and frequency of dyspnea on a scale from never/almost never to all or most of the time. Responses were assigned a numeric score and summed to categorize exercise limitation. Associations between poor EC and key comorbidities were examined using adjusted logistic regression. Results660 participants completed a survey with the following characteristics: 64.4% male, 89.5% white, mean age 64.5. Overall EC categories were: good 39.0%, intermediate 41.6%, and poor 19.4%. Prevalence of poor EC was higher among patients with COPD (OR 4.62 95%CI 3.05–7.02), heart failure (OR 3.07 95%CI 1.62–5.82) and cardiovascular disease (OR 2.24, 95%CI 1.45–3.47), and was highest among patients with multimorbidity. Among patients with COPD and heart failure, 57% had poor and 0% had good EC. In adjusted logistic regression, only COPD and Charlson comorbidity index remained significantly associated with poor EC. ConclusionsMany patients eligible for LCS reported poor EC, with increased odds of poor EC among patients with comorbidities. More research is needed to determine how to best integrate EC and comorbidity into eligibility and shared decision-making conversations.

Severe COVID-19 among patients with asthma and COPD: a report from the Swedish National Airway Register.

Background:Patients with obstructive lung diseases may be at risk of hospitalization and/or death due to COVID-19.Aim:To estimate the frequency of severe COVID-19, and COVID-19-related mortality in a well-defined large population of patients with asthma and chronic inflammatory lung disease (COPD). Further to assess the frequency of asthma and COPD as registered comorbidities at discharge from hospital, and in death certificates.Methods:At the start of the pandemic, the Swedish National Airway Register (SNAR) included 271,404 patients with a physician diagnosis of asthma and/or COPD. In September 2020, after the first COVID-19 wave in Sweden, the database was linked with the National Patient Register (NPR), the Swedish Intensive Care Register and the Swedish Cause of Death Register, which all provide data about COVID-19 based on International Classification of Diseases (ICD-10) codes. Severe COVID-19 was defined as hospitalization and/or intensive care or death due to COVID-19.Results:Among patients in SNAR, 0.5% with asthma, and 1.2% with COPD were identified with severe COVID-19. Among patients < 18 years with asthma, only 0.02% were severely infected. Of hospitalized adults, 14% with asthma and 29% with COPD died. Further, of patients in SNAR, 56% with asthma and 81% with COPD were also registered in the NPR, while on death certificates the agreement was lower (asthma 24% and COPD 71%).Conclusion:The frequency of severe COVID-19 in asthma and COPD was relative low. Mortality for those hospitalized was double as high in COPD compared to asthma. Comorbid asthma and COPD were not always identified among patients with severe COVID-19.