Global Initiative For Obstructive Lung Disease Research Articles

Lung Cancer Screening in People With COPD: The Pamplona-IELCAP Experience

IntroductionThe Global Initiative for Obstructive Lung Disease (GOLD) recommends lung cancer screening for patients with Chronic Obstructive Pulmonary Disease (COPD), but data is lacking regarding results of screening in this high-risk population. The main goal of the present work is to explore if lung cancer screening with Low Dose Chest Tomography (LDCT) in people with COPD, allows lung cancer (LC) diagnosis in early stages with survival compatible with curative state. MethodsThis is a post hoc exploratory analysis. Pamplona International Early Lung Cancer Action Program (P-IELCAP) participants with a GOLD defined obstructive pattern (post bronchodilator FEV1/FVC<0.70) were selected for analysis. The characteristics of those who developed LC and their survival are described. A Cox proportional analysis explored the factors associated with LC diagnosis. ResultsEight hundred and sixty-five patients (77% male, 93% in spirometric GOLD stage 1+2) were followed for 102±63 months. LC prevalence was 2.6% at baseline, with an annual LC diagnosis rate of 0.68%. Early-stage tumors predominated (74%) with a median survival (25–75th percentiles) of 139 (76–185) months. Cumulative tobacco exposure, FEV1%, and emphysema were the main predictors of an LC diagnosis. Eight (11%) patients with COPD had a second LC, most of them in early stage (92%), and 6 (8%) had recurrence. Median survival (25–75th percentiles) in these patients was 168 (108–191) months. ConclusionsLung cancer screening of selected high-risk participants with COPD allowed the LC diagnosis in early stages with survival compatible with curative state.

Airborne Particulate Matter Size and Chronic Obstructive Pulmonary Disease Exacerbations: A Prospective, Risk-Factor Analysis Comparing Global Initiative for Obstructive Lung Disease 3 and 4 Categories.

Current research primarily emphasizes the generalized correlations between airborne pollution and respiratory diseases, seldom considering the differential impacts of particular particulate matter sizes on chronic obstructive pulmonary disease (COPD) exacerbations in distinct Global Initiative for Obstructive Lung Disease (GOLD) categories. This study hypothesizes a critical association between particulate matter sizes (PM 1.0, PM 2.5, and PM 10) and exacerbation frequency in COPD patients categorized under GOLD 3 and GOLD 4, with a potential augmenting role played by proximity to main roads and industrial areas. This research aspires to offer a nuanced perspective on the exacerbation patterns in these groups, setting the stage for targeted intervention strategies. Utilizing a prospective design, this study followed 79 patients divided into GOLD 3 (n = 47) and GOLD 4 (n = 32) categories. The participants were monitored for ten days for daily activity levels, symptoms, living conditions, and airborne particulate matter concentrations, with spirometric evaluations employed to measure lung function. Statistical analyses were used to identify potential risk factors and significant associations. The analysis revealed substantial disparities in airborne particulate matter sizes between the two groups. The mean PM 1.0 concentration was notably higher in GOLD 4 patients (26 µg/m3) compared to GOLD 3 patients (18 µg/m3). Similarly, elevated PM 2.5 levels were observed in the GOLD 4 category (35 µg/m3) in contrast to the GOLD 3 category (24 µg/m3). A vital finding was the increased frequency of exacerbations in individuals residing within 200 m of main roads compared to those living further away (OR = 2.5, 95% CI: 1.5-4.1). Additionally, patients residing in homes smaller than 50 square meters demonstrated a greater frequency of exacerbations. Spirometry results corroborated the exacerbated condition in GOLD 4 patients, indicating a significant decline in lung function parameters compared to the GOLD 3 group. This study substantiates a significant association between airborne particulate matter sizes and exacerbation frequencies in COPD patients, particularly accentuating the increased risk in GOLD 4 patients. Our findings underscore the pivotal role of environmental factors, including the size of living areas and proximity to main roads, in influencing COPD exacerbations. These results suggest the need for personalized healthcare strategies and interventions, which account for environmental risk factors and the distinctions between GOLD 3 and GOLD 4 categories of COPD patients.

The burden of chronic obstructive pulmonary disease among hospitalised women in a developing country.

BACKGROUND: The course of chronic obstructive pulmonary disease (COPD) is different in men and women. There are limited data in Latin America regarding COPD exacerbations (ECOPD) in women. This study aims to determine the sociodemographic and clinical profile of ECOPD adjusted by gender.METHODS: Cross-sectional analytical study of all patients hospitalised due to an ECOPD in a tertiary university hospital in Colombia between 2015 and 2019. A group comparison analysis was performed between male and female groups.RESULTS: A total of 81 patients met the inclusion criteria (35.8% were women). The mean age was 71.49 years. Most of the patients were GOLD (Global Initiative for Obstructive Lung Disease) 3 and 4. A history of TB was present in 15% of our cohort. While the proportion of smokers was higher among men (OR 5.11; P = 0.013), exposure to wood smoke was significantly higher in women (OR 24; P < 0.001). Females were associated with a lower probability of having forced expiratory volume in 1 sec >0,87 L (OR 0.11; P = 0.013) and were associated with an increased probability of receiving inhaled corticosteroids during hospitalisation (OR 3.33; P = 0.023). No differences in terms of mortality or complications were found.CONCLUSION: Women with COPD are underrepresented in literature. This study was able to identify some factors related to female sex among patients hospitalised for severe ECOPD.

Circulating testosterone levels and health outcomes in chronic obstructive pulmonary disease: results from ECLIPSE and ERICA

The relationship of circulating testosterone levels with health outcomes in people with chronic obstructive pulmonary disease (COPD) is unknown.AimTo determine whether serum testosterone levels predict hospitalised acute exacerbations of COPD...

Assessment of artificial intelligence-aided chest computed tomography in diagnosis of chronic obstructive airway disease: an observational study

BackgroundThe Global Initiative for Obstructive Lung Disease (GOLD) staging approach is frequently used to classify the severity of COPD by using spirometry. Recent advancements in artificial intelligence applications enable the automatic identification of COPD severity by chest computer tomography (CT). The goal of this study is to define the role of artificial intelligence in determining the severity of COPD.Methods We used a non-contrast CT chest and a computer-aided detection system (Coreline Soft's AVIEW), which was conducted as a descriptive cross sectional study and involved 80 cases. For the diagnosis of parenchymal disease using density mask methods such as inspiratory low attenuation area-950% (%LAA-950 HUINS) and D-value (cluster-size analysis), the spirometry-based Tiffeneau index (TI; calculated as the ratio of forced expiratory volume in the first second (FEV1) to forced vital capacity was used to assess the severity of COPD.Results Based on the results of the spirometry, the patients were divided into four groups: mild (n = 23), moderate (n = 39), severe (n = 17), and very severe (n = 1). Insp. LAA-950 (%) in GOLD group 3 was substantially greater than in GOLD groups 2 and 1. Additionally, when compared to groups 2 and 1, the D-value in the GOLD 3 group was significantly higher.ConclusionsInspiratory LAA-950% and D-value were found to be significantly related to COPD severity as measured by dyspnea scale and spirometry. Inspiratory LAA-950% was effectively capable of distinguishing between patients with severe and moderate COPD.

COPD: what GPNs need to know from the latest GOLD update

Every year, the Global Initiative for Obstructive Lung Disease publishes its update on COPD. Beverley Bostock provides an overview of what the latest publication means for general practice nurses The latest guidance from the Global Initiative for Obstructive Lung Disease (GOLD) on chronic obstructive pulmonary disease (COPD) will have an impact on the management of patients in general practice. The definition of COPD has been updated as well as the recommended approach to diagnosis. Updated treatment recommendations act as an important reminder for primary care clinicians to implement interventions that are relevant in the community setting and to refer on for more specialised interventions in secondary care as appropriate. The replacement of the ABCD assessment tool with the ABE approach underlines the significant impact that exacerbations can have in the management of COPD, independent of the symptom burden. Updated sections on exacerbations remind clinicians of the importance of considering comorbid or new diagnoses as the cause of any symptoms.

Undiagnosed Asthma-COPD overlap among patients diagnosed as Asthma and COPD in a referral hospital, India

Patients who have features of both Asthma & COPD are now known as Asthma COPD overlap (ACO). Prevalence of ACO based on the Global Initiative for Asthma (GINA) and Global initiative for obstructive lung disease (GOLD) Syndromic Approach is scarce. In this cross-sectional observational study, we recruited physician-diagnosed–pAsthma, pCOPD & pACO by simple random sampling. Clinical features, spirometry, 6-min walk test, Serum Immunoglobulin E, % blood eosinophils and chest x-rays were reviewed. Syndromic approach was applied, and the diagnosis was reclassified accordingly.In all, 877 patients were included (Male = 445, Female = 432). Physician diagnosis for these were: pAsthma–713, pCOPD–157 and pACO–7. They were reclassified using the Syndromic approach as: sAsthma, sCOPD and sACO. The 713 pAsthmatics were reclassified as follows: sAsthma–684 (95.94%), sCOPD–12 (1.68%) and sACO–17 (2.38%). Of the 157 pCOPD patients, 91 (57.96%) were reclassified as sCOPD, 23 (14.6%) as sACO, and 17 (927.38%) as sAsthma. Of the 7 previously diagnosed pACO patients, only 1 (14.28%) was reclassified as sACO, 5 (71.42%) as sAsthma and 1 (14.28%) as sCOPD. sCOPD patients had more exacerbations (52.88% vs 46.34%, p = 0.479), critical care admissions (16.35% vs 7.32%, p = 0.157) and intubations (17.31% vs 9.76%, p = 0.255) compared to sACO patients, the latter had more events than sAsthma patients: exacerbations 46.34% vs 10.11% (p < 0.001), critical care admissions 7.32% vs 1.64% (p = 0.010) and intubations 9.76% vs 1.5% (p < 0.001).The syndromic approach helped us to identify ACO and also more appropriately classified COPD & Asthma. There was a significant difference between physician diagnosis and diagnosis using Syndromic Approach. It revealed considerable misclassification of several Asthmatic and ACO subjects, who could have been denied inhaled corticosteroids, as they were wrongly categorised as COPD by physician diagnosis.

Association Among Chronic Obstructive Pulmonary Disease Severity, Exacerbation Risk, and Anxiety and Depression Symptoms in the SPIROMICS Cohort.

Chronic obstructive pulmonary disease (COPD) is a common, progressive lung disease that often manifests with psychiatric symptoms. Despite this, patients with COPD are not routinely screened for anxiety and depression, which substantially contribute to COPD-related morbidity. To determine the relationship among COPD symptom severity, exacerbation risk, and clinically significant anxiety and depression symptoms in ever smokers with COPD. We used baseline data from the Subpopulations and Intermediate Outcome Measures In COPD Study (SPIROMICS) cohort to examine ever smokers with COPD across Global Initiative for Obstructive Lung Disease (GOLD) disease severity groups. Multivariable logistic regression models were used to calculate odds ratios for clinically significant anxiety and depression for each GOLD group, which was compared to the control group of ever smokers without COPD. Odds ratios were adjusted for subject demographics, medical comorbidities, and substance use covariates, and comparisons were completed using 2-tailed tests. Of the 2664 subjects studied, 784 (29.4%) had clinically significant anxiety, and 497 (18.7%) had clinically significant depression. In the multivariable analysis, high pulmonary symptom groups, groups B and D, had increased adjusted odds of clinically significant anxiety (group B: adjusted odds ratios [AOR] 1.28, P= 0.03; group D: AOR 1.95, P < 0.0001) and depression (group B: AOR 2.09, P < 0.0001; group D: AOR 3.04, P < 0.0001). GOLD group D, the group with high pulmonary symptoms and high COPD exacerbation risk, had thegreatest risk of both anxiety and depression among the GOLD groups. High COPDsymptom severity, even in the absence of elevated COPD exacerbation risk, is associated with clinically significant anxiety and depression. Our separate analyses of anxiety and depression symptoms in a large, multisite, national cohort are unique within the literature and have important treatment implications for COPD patients. Our findings alsohighlight the utility of screening patients with highCOPD symptom severity for anxiety and depression.

Study of Nocturnal Oxygen Desaturation in Chronic Obstructive Pulmonary Disease Patients

Background: Abnormal sleep architecture with decreased rapid eye movement sleep and arousals during the periods of nocturnal oxygen desaturation (NOD) are seen in patients with chronic obstructive pulmonary disease (COPD) with significant consequences. This study was done to evaluate the prevalence of NOD and other sleep-related disorders in COPD patients. Patients and Methods: This prospective cross-sectional study was conducted in the sleep laboratory of our tertiary center over 1 year. Fifty COPD patients were enrolled in this study. They were classified into mild COPD and moderate COPD, according to the Global Initiative for Obstructive Lung Disease (GOLD) classification. Complete history, physical examination, and relevant laboratory investigations were taken. All patients were subjected to overnight polysomnography. Results: Eight patients had mild COPD, whereas 42 patients had moderate COPD. Mean sleep efficiency was decreased with an average of 71.08% with a significant difference between mild and moderate COPD cases. Minimal SpO2, average SpO2, SpO2

Early use of non-invasive ventilation for acute exacerbations of chronic obstructive pulmonary diseaseon general respiratory wards

Background- Chronic Obstructive Pulmonary disease (COPD) as defined by Global Initiative for Obstructive Lung Disease (GOLD) is a common preventable and treatable disease, is characterized by persistent airflow limitation that is usually progressive and associated with an enhanced chronic inflammatory response in the airways and the lung to noxious particles or gases. Objectives-To evaluate outcome of NIV in terms ofTime for reversion of pH to normal, Duration of NIV, Hospital stay, Failure of NIV, Mortality and to compare the effect of noninvasive mechanical ventilation (NIV) in severelyacidotic (pH &lt; 7.25) with mildly acidotic (pH 7.25–7.35) patients with acute hypercapnic chronic obstructive lung disease (COPD) Methods-This is a prospective observational study of COPD patients with acute Type 2 respiratory failure initiated on NIV conducted in Christian Medical College, Vellore, Tamil Nadu. The study was conducted in the Department of Pulmonary Medicine, Christian Medical College, Vellore.Assuming the mean as 12h (SD=6h), the sample size is Hence it is decided to sample 25 mild acidosis and 25 severe acidosis cases for this study. In the present study, 53 patients were recruited from April 2017 to June 2018.

Cardiopulmonary Exercise Testing in Evaluation of Patients of Chronic Obstructive Pulmonary Disease

Objective assessment of severity in patients with chronic obstructive pulmonary disease (COPD) is mainly limited to pulmonary function testing performed at rest. But, accurate assessment of exercise capacity in patients with COPD may be possible with cardiopulmonary exercise testing (CPET). Forty-three patients with stable COPD were included and were divided into three groups based upon the spirometry data as per the Global Initiative for Obstructive Lung Disease (GOLD) guidelines as follows: Group A: mild COPD, Group B: moderately severe COPD and Group C: severe COPD. Symptom-limited CPET was performed using treadmill on incremental continuous ramp protocol in all of them. Five patients (11.6%) had mild COPD; 16 (37.2%) had moderately severe COPD and the remaining 22 (51.6%) patients had severe COPD. Anaerobic threshold was attained in all the 43 patients. The dominant symptom at peak exercise were dyspnoea (n = 19) and both dyspnoea and leg fatigue (n = 7). The other causes of exercise limitation included dyspnoea with significant oxygen desaturation (n = 6); and dyspnoea with severe oxygen desaturation (n = 2). Six patients complained only of leg fatigue at peak exercise. A significant correlation between forced expiratory volume in the first second (FEV1) percent predicted and the predicted maximum oxygen uptake (VO2 max % predicted) was observed in all the three groups (r = 0.39, p = 0.011) but with marked variability of peak VO2 for a given degree of airflow obstruction. Twenty-three (53.5%) patients with low anaerobic threshold (< 30%) were identified as potential group likely to benefit from exercise training for pulmonary rehabilitation. Cardiopulmonary exercise testing is useful to determine the causes of exercise limitation and to assess the maximal exercise capacity of patients with COPD.

Establishing Quality of Life in Southern Taiwan COPD Patients Using Long-Acting Bronchodilator.

BackgroundTo assess the health-related quality of life (HRQoL) of Taiwan patients with different stages of chronic obstructive pulmonary disease (COPD) and using different combination therapies and to explore the factors affecting HRQoL in these patients.MethodsThis cross-sectional study included outpatient participants aged 35 years old and older who were receiving long-acting bronchodilator treatment in one of two hospitals in Southern Taiwan. Participants were categorized according to their Global Initiative for Obstructive Lung Disease (GOLD) classification as either their COPD group, based on symptoms and exacerbation risk, or their COPD stage, based on spirometry results. Patients’ HRQoL was assessed using the St. George’s Respiratory Questionnaire score (SGRQ), World Health Organization Quality of Life Quality of Life-BREF (WHOQOL-BREF), and EQ-5D-5L. The total scores of the SGRQ, WHOQOL-BREF, EQ-5D utility index, and EQ-VAS were presented as mean ± standard deviation (SD) among different combination treatments. Univariate and multivariate analyses were used to explore the association of patients’ baseline characteristics and environmental factors with HRQoL.ResultsA total of 218 patients were enrolled in the study. The distribution of patients using GOLD group classification were as follows: 73.39% in group A, 20.19% group B, 1.83% group C and 4.59% group D. Triple therapy patients mostly showed a lower quality of life than other combination therapies, regardless of the GOLD classification system. However, only the SGRQ scores of GOLD groups A and B were significantly different when using different drug combinations (p-value = 0.0072 and 0.0430, respectively). The COPD assessment test (CAT) score, a questionnaire to assess impact of COPD on health status, was found to be associated with all the questionnaires.ConclusionThe HRQoL is impaired in patients with COPD, and it deteriorates with an increase of severity. The CAT was the strongest predictor of HRQoL.

Impact of Non-surgical Periodontal Therapy on Pulmonary functions, Periodontal Health and Salivary Matrix Metalloproteinase-8 of COPD Patients with Chronic Periodontitis: A Clinico-biochemical Study.

The aim of the study was to assess the impact of non-surgical periodontal therapy (NSPT) on periodontal clinical parameters, spirometric indices, and salivary MMP-8 levels in patients with chronic obstructive pulmonary disease (COPD) with concurrence of chronic periodontitis (CP) compared with systemically healthy CP. In this prospective clinico-biochemical study, a total of 75 patients belonging to various socioeconomic strata were randomly divided into cases, that is, COPD patients as per the Global Initiative for Obstructive Lung Disease (GOLD) criteria with concurrence of CP [at least ≥ 20 teeth with ≥ 2 tooth sites having pocket probing depth (PPD) or clinical attachment loss (CAL) ≥ 4mm and bleeding on probing (BOP)] and controls (systemically healthy CP). Both groups underwent NSPT and were evaluated for plaque index (PI), gingival index (GI), PPD, CAL, and BOP and spirometry (FEV1/forced vital capacity (FVC)) values at baseline, 3, 6, and 12 months and for salivary MMP-8 levels at baseline and 3 months. Statistical results showed that cases (COPD with CP; n = 37) were significantly older (mean age 56.16 ± 9.01 years), ex-smokers (48.6%) with male preponderance (78.4%), and belonged to the upper middle class (40.5%) as compared to controls (systemically healthy CP; n = 38). After NSPT, significant improvement in mean PI, GI, PPD, CAL, and BOP was observed in both groups at 3, 6, and 12 months with better results in controls. FEV1/FVC was significantly improved (P < .001) in cases with insignificant change in controls at 12 months. After 3 months, MMP-8 levels were significantly reduced in cases (P = .002) and controls (P < .001). The present study provided substantial evidence that COPD patients have poorer periodontal health as compared to systemically healthy counterparts. Further, these patients showed improvement in FEV1/FVC, however, with higher salivary MMP-8 levels despite NSPT at the end of the study, indicating a possible role of systemic inflammatory overburden of pulmonary disease.

Clinical and Prognostic Impact of Low Diffusing Capacity for Carbon Monoxide Values in Patients With Global Initiative for Obstructive Lung Disease I COPD

The Global Initiative for Obstructive Lung Disease (GOLD) does not promote diffusing capacity for carbon monoxide (Dlco) values in the evaluation of COPD. In GOLD spirometric stage I COPD patients, the clinical and prognostic impact of a low Dlco has not been explored. Could a Dlco threshold help define an increased risk of death and a different clinical presentation in these patients? GOLD stage I COPD patients (n= 360) were enrolled and followed over 109 ± 50months. Age, sex, pack-years' history, BMI, dyspnea, lung function measurements, exercise capacity, BODE index, and history of exacerbations were recorded. A cutoff value for Dlco was identified for all-cause mortality and the clinical and physiological characteristics of patients above and below the threshold compared. Cox regression analysis explored the predictive power of that cutoff value for all-cause mortality. A Dlco cutoff value of<60%predicted was associated with all-cause mortality (Dlco≥ 60%: 9%vsDlco< 60%: 23%, P= .01). At a same FEV1%predicted and Charlson score, patients with Dlco< 60%had lower BMI, more dyspnea, lower inspiratory capacity (IC)/total lung capacity (TLC) ratio, lower 6-min walk distance (6MWD), and higher BODE. Cox multiple regression analysis confirmed that after adjusting for age, sex, pack-years history, smoking status, and BMI, a Dlco< 60%is associated with all-cause mortality (hazard ratio [HR], 95% CI= 3.37, 1.35-8.39; P= .009) INTERPRETATION: In GOLD I COPD patients, a Dlco< 60%predicted is associated with increased risk of death and worse clinical presentation. What the cause(s) of this association are and whether they can be treated need to be determined.

Diagnostic Accuracy of a Two-Stage Sequential Screening Strategy Implemented by Community Health Workers (CHWs) to Identify Individuals with COPD in Rural India.

PurposeUndiagnosed Chronic Obstructive Pulmonary Disease (COPD) results in high morbidity, disability and mortality in India. Effective strategies for active COPD screening in community settings are needed to increase early identification, risk reduction and timely management. The objective of this study was to test the diagnostic accuracy of a sequential two-step screening strategy to detect COPD, implemented by community health workers (CHWs), among adults aged ≥40 years in a rural area of North India.Patients and MethodsTrained CHWs screened all consenting (n=3256) eligible adults in two villages using the Lung Function Questionnaire (LFQ) to assess their COPD risk and conducted pocket spirometry on 268 randomly selected (132 with high risk ie LFQ score ≤18 and 136 with low risk ie LFQ score >18) individuals. Subsequently, trained researchers conducted post-bronchodilator spirometry on these randomly selected individuals using a diagnostic quality spirometer and confirmed the COPD diagnosis according to the Global Initiative for Obstructive Lung Disease (GOLD) criteria (FEV1/FVC ratio <0.7).ResultsThis strategy of using LFQ followed by pocket spirometry was sensitive (78.6%) and specific (78.8%), with a positive predictive value of 66% and negative predictive value of 88%. It could accurately detect 67% of GOLD Stage 1, 78% of GOLD Stage 2, 82% of GOLD Stage 3 and 100% of GOLD Stage 4 individuals with airflow limitation.ConclusionCOPD can be accurately detected by trained CHWs using a simple sequential screening strategy. This can potentially contribute to accurate assessment of COPD and thus its effective management in low-resource settings.

The Impact of Fixed Triple Therapy with Beclometasone/Formoterol/Glycopyrronium on Health Status and Adherence in Chronic Obstructive Pulmonary Disease (COPD) in an Italian Context of Real Life: The TRITRIAL Study Protocol.

BackgroundThe fixed triple combination Beclometasone dipropionate/Formoterol fumarate/Glycopyrronium (BDP/FF/G, Trimbow®), an extrafine formulation in a unique pressurized metered dose inhaler, is indicated for the maintenance treatment in adult patients with moderate to severe COPD, not adequately treated by ICS/LABA or LABA/LAMA. Besides the evidence from three randomized controlled trials, the impact of fixed triple therapy has not been extensively evaluated in a real-world population of COPD patients. TRITRIAL (TRIple Therapy in Real life: Impact on Adherence and HeaLth status) is a non-interventional study to assess the effect of BDP/FF/G in a real world setting in Italy.DesignTRITRIAL is a 12-month, multicenter, cohort, prospective, longitudinal observational study. Two follow-up visits will be performed at 6 and 12 months, respectively. The study includes the collection of anamnestic clinical and functional data before the start of BDP/FF/G. The study is built for digital conduction, from signature of the informed consent on a dedicated web platform, to the collection of questionnaires and clinical data on the eCRF.PopulationA total of 800 patients with COPD ranging from Global Initiative for Obstructive Lung Disease (GOLD) stages 2 to 4, receiving therapy with BDP/FF/G according to the Summary of Product Characteristics and local clinical practice, will be recruited. All concomitant therapies will be permitted for the duration of the study.EvaluationsThe primary endpoint is the change of CAT score at 12 months versus baseline. Secondary endpoints are adherence, health-related quality of life, sleep quality, disease-related outcomes (lung function and COPD exacerbations), device usability, economic resources consumption, and safety.ConclusionTRITRIAL study is expected to give relevant information about effectiveness of BDP/FF/G fixed triple therapy in a real-life setting of patients with COPD, where adherence, usability of inhalers and patient’s preference of the device are crucial factors for the success of the therapy.

Health-related quality of life in patients with chronic obstructive pulmonary disease: A hospital-based study.

Background & objectives:Chronic obstructive pulmonary disease (COPD) adversely affects various functional and structural domains of the lungs, in addition to having an array of extra-pulmonary effects which affect overall well-being of a patient. This study was aimed at measuring the health-related quality of life (HRQOL) in COPD patients and relating the severity of disease and other factors with the degree of impairment of HRQOL.Methods:This cross-sectional study was conducted on 100 individuals with established COPD aged 45 yr or above. COPD severity was graded based on the Global Initiative for Obstructive Lung Disease (GOLD) staging system. Pulmonary function test was carried out as per the American Thoracic Society and European Respiratory Society task force standardised lung function testing guidelines. The quality of life was measured using the COPD-specific version of the St. George's Respiratory Questionnaire (SGRQ). The three component scores (activity, impact and symptoms) and the total score were compared across the various categories of age, gender and COPD grades. Using multivariable linear regression analysis, the relationship between COPD grades and various component scores, adjusting for age and gender, was determined.Results:The mean total SGRQ Classification score was found to be 48.5±17.1. There was a significant increase in the symptom, activity and impact component scores and the total scores of the participants with worsening of COPD grade. The activity, impact component scores and total score showed an increasing trend with age. However, the values of these three scores were lower in participants in the age group of 56-65 yr in comparison to those in the 45-55 yr age group. There was a significant increase in the symptom component score with increasing age across the study population. The difference in the various scores between males and females was not significant.Interpretation & conclusions:HRQOL is impaired in patients with COPD, and it deteriorates with increasing severity of the disease. The onset of COPD at a younger age has a much more significant deterioration of HRQOL, due to the early onset of symptoms and complications. These findings call for better early care and integration of pulmonary rehabilitation programmes into current health policies.

Symptom Burden and GOLD Classification in Medicare Advantage Patients with COPD Initiating Umeclidinium/Vilanterol or Fluticasone Propionate/Salmeterol Therapy.

BackgroundLong-acting muscarinic antagonist/long-acting β2-agonist (LAMA/LABA) provide greater improvements in lung function and symptoms than inhaled corticosteroid (ICS)/LABA in patients with chronic obstructive pulmonary disease (COPD). This study evaluated symptom burden and Global Initiative for Obstructive Lung Disease (GOLD) categorization among patients who recently initiated umeclidinium/vilanterol (UMEC/VI; LAMA/LABA) or fluticasone propionate/salmeterol (FP/SAL; ICS/LABA) single-inhaler dual therapy.MethodsCOPD-diagnosed Medicare Advantage enrollees aged ≥65 years were identified from the Optum Research Database (ORD). Eligible patients had ≥1 pharmacy claim for UMEC/VI or FP/SAL in the 6-month period before sample identification, with no evidence of triple therapy (ICS/LAMA/LABA), asthma, or lung cancer. Symptom burden was assessed via cross-sectional surveys using the COPD Assessment Test (CAT) and modified Medical Research Council (mMRC) dyspnea scale. Patients were classified into GOLD categories using patient-reported symptoms and claims-based exacerbation history. Treatment groups were balanced on potential confounders using inverse probability of treatment weighting (IPTW). CAT and mMRC scores were analyzed with generalized linear regression models using IPTW propensity scores.ResultsThe final analytic sample included 789 respondents (UMEC/VI: N=392; FP/SAL: N=397). Approximately 66% patients were classified as GOLD B when assessing symptoms with CAT and mMRC together, or CAT alone; more patients were classified as GOLD A (~40%) than GOLD B (~36%) using mMRC alone. Proportions of patients in each GOLD group were similar between treatment cohorts. Post-IPTW multivariable modeling showed similar symptom burden between treatment groups.ConclusionAfter controlling for baseline characteristics, symptom burden was similar between patients receiving UMEC/VI or FP/SAL. GOLD classification using mMRC produced more conservative results compared with CAT, potentially underestimating patient symptoms. Many patients receiving FP/SAL were classified as GOLD A or B, despite GOLD recommending non-ICS-containing therapy in these patients. These findings support the need for routine assessment of symptoms in patients with COPD.

Effect of Body Mass Index on Lung Function in Chinese Patients with Chronic Obstructive Pulmonary Disease: A Multicenter Cross-Sectional Study.

ObjectiveThe aim of this study was to explain “obesity paradox” in chronic obstructive pulmonary disease (COPD) by evaluating the effect of body mass index (BMI) on lung function in Chinese patients with COPD.MethodsA total of 1644 patients diagnosed with COPD were recruited from four Chinese tertiary hospitals and were divided into four groups including underweight, normal weight, overweight and obese according to BMI classification standard. The medical data of these patients were collected and used for the multiple linear regression analyses.ResultsAfter adjustment for age, sex, educational level, economic status, smoking status, alcohol consumption, duration of COPD history, events of acute exacerbation in previous year, hypertension, diabetes mellitus, cardiovascular disease, cerebrovascular disease and osteoporosis, BMI had a curvilinear correlation with the forced expiratory volume in the first second (FEV1) in patients with Global Initiative for Obstructive Lung Disease (GOLD) 1–2 grade (first-order coefficient β, 0.09; 95% CI, 0.03–0.16; second-order coefficient β, −0.002; 95% CI, −0.003–-0.001; P<0.01). However, BMI had a positive correlation with FEV1 in patients with GOLD 3–4 grade (β, 0.01; 95% CI, 0.008–0.017; P<0.01) when BMI was used as a quantitative variable. When BMI was used as a qualitative variable, only FEV1 in overweight group with GOLD 1–2 grade was significantly higher than that of normal weight group (P<0.01). Interestingly, both overweight and obese groups had higher FEV1 in GOLD 3–4 grade compared with normal weight group (β, 0.06; 95% CI, 0.02–0.11; β, 0.11; 95% CI, 0.04–0.18; P<0.01). The effect of BMI on predicted percentage of FEV1 (FEV1%) was similar to that of FEV1 in different GOLD grades.ConclusionObesity only had a protective effect on lung function in COPD patients with GOLD 3–4 grade rather than GOLD 1–2 grade.Trial RegistryClinicalTrials.gov, No.: NCT 03182309, URL: www.clinicaltrials.gov.

CROSS-SECTIONAL SURVEY TO ASSESS COPD MEDICATION USE BY UNITED STATES PHYSICIANS

SESSION TITLE: Obstructive Lung Disease Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Little information is available on the reasoning behind prescribing behaviors for specific COPD medications and classes by US primary care physicians (PCPs) and pulmonologists (Pulms). There is also a lack of information on how well these prescribers align with COPD treatment strategies, including those from the Global Initiative for Obstructive Lung Disease (GOLD) and the COPD Foundation. This study aimed to better understand COPD maintenance medication use by US physicians. METHODS: This was a retrospective analysis of Adelphi Respiratory Disease Specific Programme™ data, which surveyed physicians from July-December 2019. Physicians were presented with four COPD patient types and asked which treatment class they would use for each: 1) Maintenance-naïve, symptomatic COPD, significant exacerbation risk; 2) Maintenance-naïve, symptomatic COPD, recent exacerbation history; 3) Symptomatic COPD, no exacerbations in the past year, moderate dyspnea; 4) Symptomatic COPD, no exacerbations in the past year, severe dyspnea. The information was collected via completed questionnaires on disease management and case reports. All results were reported descriptively and no statistical testing was performed. RESULTS: There were 43 PCPs and 32 Pulms surveyed, covering a total of 800 COPD patients (408 PCP and 392 Pulms). Overall, PCPs used ICS/LABA at a higher rate than Pulms (50.4% vs 39.6%), as well as LAMA (33.2% vs 31.5%). LAMA/LABA (18.4% vs 13.5%) and ICS/LABA/LAMA (14.8% vs 7.9%) were used more by Pulms than PCPs. Patient 1, PCPs chose ICS/LABA (53.5%), LAMA (32.6%), and LAMA/LABA (18.6%); Pulms reported ICS/LABA/LAMA (37.5%), ICS/LABA (28.1%), and LAMA (15.6%) or LAMA/LABA (15.6%). Patient 2, PCPs chose ICS/LABA (55.8%), LABA/LAMA (44.2%), and LAMA (37.2%); Pulms reported LABA/LAMA (40.6%), ICS/LABA/LAMA (28.1%), and ICS/LABA (28.1%). Patient 3, PCPs chose ICS/LABA (39.5%), LAMA (30.2%), and LABA/LAMA (23.3%); Pulms chose ICS/LABA (37.5%), LABA/LAMA (34.4%), and LAMA (31.3%). Patient 4, PCPs chose ICS/LABA (55.8%), LAMA (30.2%), and ICS/LABA/LAMA (23.3%); Pulms chose LABA/LAMA (43.8%), ICS/LABA (28.1%), and LAMA (18.8%). Overall, 79.1% of PCPs and 71.9% of Pulms reported that they refer to clinical strategies when making treatment decisions. The majority reported adhering to GOLD strategies (PCPs 79.4%, Pulms 91.3%). CONCLUSIONS: This real-world data indicates that PCPs and Pulms utilize treatments for COPD at very different rates. Pulms were more likely to utilize dual bronchodilation than PCPs. PCPs were more likely to suggest ICS/LABA than Pulms. When presented with patient profiles, choices differed markedly between provider type. Most of the providers reported referring to clinical strategies. CLINICAL IMPLICATIONS: A better understanding of patient types that benefit from each treatment option could help to optimize patient care in COPD. DISCLOSURES: Employee relationship with GlaxoSmithKline Please note: >$100000 Added 03/03/2020 by Michael Bogart, source=Web Response, value=Salary No relevant relationships by Adam Haq, source=Web Response Employee relationship with GlaxoSmithKline Please note: >$100000 Added 04/30/2020 by David Mannino, source=Web Response, value=Salary No relevant relationships by James Siddall, source=Web Response No relevant relationships by Mark Small, source=Web Response