1
|
Zhang Q, Zhang H, Xu Q. Association of Chronic Obstructive Pulmonary Disease with Risk of Psychiatric Disorders: A Two-Sample Mendelian Randomization Study. Int J Chron Obstruct Pulmon Dis 2024; 19:343-351. [PMID: 38317665 PMCID: PMC10840522 DOI: 10.2147/copd.s442725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 01/14/2024] [Indexed: 02/07/2024] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) is a prevalent respiratory disorder often accompanied by comorbidities. Although the past few years have witnessed significant scientific progress, the potential relationship between COPD and mental illness remains a subject of debate. Materials and Methods We retrieved COPD data from the genome-wide association studies (GWAS) directory and data on mental illnesses, including Alzheimer's disease, schizophrenia, panic disorder, attention deficit hyperactivity disorder (ADHD), bipolar disorder, major depressive disorder, multiple disabilities, obsessive-compulsive disorder, post-traumatic stress disorder, and schizophrenia, from the Psychiatric Genomics Consortium. A two-sample Mendelian randomization (MR) approach was applied to explore the association between COPD and mental illnesses, with subgroup analyses based on smoking history. Results Our two-sample MR analysis revealed no causal link between overall COPD and the development of common psychiatric disorders. Subgroup analyses based on smoking history showed no causal association between never-smokers with COPD and the occurrence of psychiatric disorders. However, ever-smokers with COPD were associated with a significantly increased risk of ADHD (OR: 2.303, 95% CI: 1.558-3.403, P = 0.001) and a modestly reduced risk of Alzheimer's disease (OR: 0.994, 95% CI: 0.988-0.999, P = 0.034). Conclusion COPD patients with a history of smoking face a higher risk of developing ADHD but may experience a slight reduction in the risk of Alzheimer's disease. Conversely, there was no observed causal association between COPD and psychiatric disorders among patients who never smoked.
Collapse
Affiliation(s)
- Qinxia Zhang
- Department of Respiratory Medicine, The First People’s Hospital of Fuyang, Hangzhou, Zhejiang, 311400, People’s Republic of China
| | - Haifu Zhang
- Department of Medicine, The First People’s Hospital of Fuyang, Hangzhou, Zhejiang, 311400, People’s Republic of China
| | - Qinxing Xu
- Department of Respiratory Medicine, The First People’s Hospital of Fuyang, Hangzhou, Zhejiang, 311400, People’s Republic of China
| |
Collapse
|
2
|
Bardsley S, Criner GJ, Halpin DMG, Han MK, Hanania NA, Hill D, Lange P, Lipson DA, Martinez FJ, Midwinter D, Siler TM, Singh D, Wise RA, van Zyl-Smit RN, Berkman N. Single-inhaler triple therapy fluticasone furoate/umeclidinium/vilanterol versus dual therapy in current and former smokers with COPD: IMPACT trial post hoc analysis. Respir Med 2022; 205:107040. [PMID: 36470149 DOI: 10.1016/j.rmed.2022.107040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 11/07/2022] [Indexed: 11/13/2022]
Abstract
BACKGROUND Smoking is the major risk factor for chronic obstructive pulmonary disease (COPD). In IMPACT, single-inhaler fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) triple therapy significantly reduced moderate/severe exacerbation rates and improved lung function and health status versus FF/VI or UMEC/VI in COPD patients. This post hoc analysis investigated trial outcomes by smoking status. METHODS IMPACT was a double-blind, 52-week trial. Patients aged ≥40 years with symptomatic COPD and ≥1 moderate/severe exacerbation in the prior year were randomized 2:2:1 to FF/UMEC/VI 100/62.5/25 μg, FF/VI 100/25 μg, or UMEC/VI 62.5/25 μg. Endpoints assessed by smoking status at screening included rate and risk of moderate/severe exacerbations, change from baseline in trough forced expiratory volume in 1 s, and St George's Respiratory Questionnaire total score at Week 52. Safety was also assessed. RESULTS Of the 10,355 patients in the intent-to-treat population, 3,587 (35%) were current smokers. FF/UMEC/VI significantly reduced on-treatment moderate/severe exacerbation rates versus FF/VI and UMEC/VI in current (rate ratio 0.85 [95% confidence interval: 0.77-0.95]; P = 0.003 and 0.86 [0.76-0.98]; P = 0.021) and former smokers (0.85 [0.78-0.91]; P < 0.001 and 0.70 [0.64-0.77]; P < 0.001). FF/UMEC/VI significantly reduced time-to-first on-treatment moderate/severe exacerbation versus FF/VI and UMEC/VI in former smokers, and versus FF/VI in current smokers. Similar trends were seen for lung function and health status. Former smokers receiving inhaled corticosteroid-containing therapy had higher pneumonia incidence than current smokers. CONCLUSIONS FF/UMEC/VI improved clinical outcomes versus dual therapy regardless of smoking status. Benefits of FF/UMEC/VI versus UMEC/VI were greatest in former smokers, potentially due to relative corticosteroid resistance in current smokers. CLINICAL TRIAL REGISTRATION GSK (CTT116855/NCT02164513).
Collapse
Affiliation(s)
| | - Gerard J Criner
- Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - David M G Halpin
- University of Exeter Medical School, College of Medicine and Health, University of Exeter, Exeter, UK
| | - MeiLan K Han
- University of Michigan, Pulmonary & Critical Care, Ann Arbor, MI, USA
| | - Nicola A Hanania
- Section of Pulmonary and Critical Care Medicine, Baylor College of Medicine, Houston, TX, USA
| | - David Hill
- Waterbury Pulmonary Associates, Waterbury, CT, USA
| | - Peter Lange
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark; Medical Department, Pulmonary Section, Herlev-Gentofte Hospital, Herlev, Denmark
| | - David A Lipson
- GSK, Collegeville, PA, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Fernando J Martinez
- New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY, USA
| | | | | | - Dave Singh
- Centre for Respiratory Medicine and Allergy, Institute of Inflammation and Repair, Manchester Academic Health Science Centre, The University of Manchester, Manchester University NHS Foundation Hospital Trust, Manchester, UK
| | - Robert A Wise
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Richard N van Zyl-Smit
- Division of Pulmonology and UCT Lung Institute, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Neville Berkman
- Institute of Pulmonary Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
| |
Collapse
|
3
|
Impact of baseline clinical features on outcomes of nebulized glycopyrrolate therapy in COPD. NPJ Prim Care Respir Med 2021; 31:43. [PMID: 34620878 PMCID: PMC8497491 DOI: 10.1038/s41533-021-00255-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 09/16/2021] [Indexed: 02/08/2023] Open
Abstract
Inhaled bronchodilators are central for the treatment of chronic obstructive pulmonary disease (COPD), as they can provide symptom relief and reduce the frequency and severity of exacerbations while improving health status and exercise tolerance. In 2017, glycopyrrolate (GLY) delivered via the eFlow® closed system (CS) nebulizer (nebulized GLY; 25 µg twice daily), was approved by the US Food and Drug Administration for maintenance treatment of moderate-to-very-severe COPD. This approval was based largely on results from the replicate, placebo-controlled, Phase III clinical trials- GOLDEN 3 and 4. In this review, we summarize key findings from secondary analyses of the GOLDEN 3 and 4 studies, and provide a comprehensive overview that may assist both pulmonologists and primary-care providers in their treatment decisions. Comorbidities are common among patients with COPD in clinical practice and may impact bronchodilator efficacy. This review highlights outcomes among subpopulations of patients with comorbidities (e.g., anxiety/depression, cardiovascular disease), and their impact on the efficacy of nebulized GLY. In addition, the efficacy and safety of nebulized GLY across various demographics (e.g., age, gender) and baseline disease characteristics (e.g., disease severity, rescue medication use) are discussed. Real-world outcomes with nebulized GLY, including device satisfaction, healthcare resource utilization, and exacerbations, are also presented. These secondary analyses and real-world data complement the primary results with nebulized GLY from Phase III studies and support the need for the inclusion of patients representative of real-world clinical practice in RCTs. In addition, these data suggest that RCTs for COPD therapies should be complemented with real-world observational studies.
Collapse
|
4
|
Bjermer LH, Boucot IH, Vogelmeier CF, Maltais F, Jones PW, Tombs L, Compton C, Lipson DA, Kerwin EM. Efficacy and Safety of Umeclidinium/Vilanterol in Current and Former Smokers with COPD: A Prespecified Analysis of The EMAX Trial. Adv Ther 2021; 38:4815-4835. [PMID: 34347255 PMCID: PMC8408076 DOI: 10.1007/s12325-021-01855-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 07/06/2021] [Indexed: 12/25/2022]
Abstract
Introduction Smoking may reduce the efficacy of inhaled corticosteroids (ICS) in patients with chronic obstructive pulmonary disease (COPD), but its impact on bronchodilator efficacy is unclear. This analysis of the EMAX trial explored efficacy and safety of dual- versus mono-bronchodilator therapy in current or former smokers with COPD. Methods The 24-week EMAX trial evaluated lung function, symptoms, health status, exacerbations, clinically important deterioration, and safety with umeclidinium/vilanterol, umeclidinium, and salmeterol in symptomatic patients at low exacerbation risk who were not receiving ICS. Current and former smoker subgroups were defined by smoking status at screening. Results The analysis included 1203 (50%) current smokers and 1221 (50%) former smokers. Both subgroups demonstrated greater improvements from baseline in trough FEV1 at week 24 (primary endpoint) with umeclidinium/vilanterol versus umeclidinium (least squares [LS] mean difference, mL [95% CI]; current: 84 [50, 117]; former: 49 [18, 80]) and salmeterol (current: 165 [132, 198]; former: 117 [86, 148]) and larger reductions in rescue medication inhalations/day over 24 weeks versus umeclidinium (LS mean difference [95% CI]; current: − 0.42 [− 0.63, − 0.20]; former: − 0.25 − 0.44, − 0.05]) and salmeterol (current: − 0.28 [− 0.49, − 0.06]; former: − 0.29 [− 0.49, − 0.09]). Umeclidinium/vilanterol increased the odds (odds ratio [95% CI]) of clinically significant improvement at week 24 in Transition Dyspnea Index versus umeclidinium (current: 1.54 [1.16, 2.06]; former: 1.32 [0.99, 1.75]) and salmeterol (current: 1.37 (1.03, 1.82]; former: 1.60 [1.20, 2.13]) and Evaluating Respiratory Symptoms–COPD versus umeclidinium (current: 1.54 [1.13, 2.09]; former: 1.50 [1.11, 2.04]) and salmeterol (current: 1.53 [1.13, 2.08]; former: 1.53 [1.12, 2.08]). All treatments were well tolerated in both subgroups. Conclusions In current and former smokers, umeclidinium/vilanterol provided greater improvements in lung function and symptoms versus umeclidinium and salmeterol, supporting consideration of dual-bronchodilator therapy in symptomatic patients with COPD regardless of their smoking status. Supplementary Information The online version contains supplementary material available at 10.1007/s12325-021-01855-y. Patients with chronic obstructive pulmonary disease (COPD) often require daily medication to control their COPD. Many patients with COPD are smokers, and smoking is one of the most common causes of COPD. This means that it is important to find out whether COPD medications are effective in both smokers and nonsmokers. We analyzed data from a clinical trial (EMAX) that investigated the use of a combination of two bronchodilators, which are inhaled medications that help to open the airways. We compared umeclidinium/vilanterol, a dual-bronchodilator combination, with a single bronchodilator (either umeclidinium or salmeterol) over 6 months. We found that both current and former smokers who were treated with umeclidinium/vilanterol had larger improvements in lung function than those receiving umeclidinium or salmeterol. Current or former smokers who were treated with umeclidinium/vilanterol used their reliever inhaler less than those treated with umeclidinium or salmeterol. Patients treated with umeclidinium/vilanterol were generally less likely to experience disease worsening compared with umeclidinium or salmeterol if they were former smokers, or compared with salmeterol if they were current smokers. Our findings suggest that umeclidinium/vilanterol may be more effective than a single bronchodilator for daily treatment of patients with COPD who are current or former smokers. Physicians should consider prescribing a combination of two bronchodilators to patients who have symptoms, whether or not they currently smoke, as well as encouraging smoking cessation for all patients.
Collapse
|
5
|
Hanania NA, Yohannes AM, Ozol-Godfrey A, Tocco M, Goodin T, Sharma S, Sanjar S. Improvement in Lung Function and Patient-Reported Outcomes in Patients with COPD with Comorbid Anxiety and Depression Receiving Nebulized Glycopyrrolate in the GOLDEN 3 and 4 Studies. Int J Chron Obstruct Pulmon Dis 2021; 16:865-875. [PMID: 33833507 PMCID: PMC8020329 DOI: 10.2147/copd.s294053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 03/04/2021] [Indexed: 12/04/2022] Open
Abstract
Background Anxiety and depression (A/D) are common in patients with chronic obstructive pulmonary disease (COPD) and are often associated with lower adherence to treatment and worse patient-related outcomes. However, studies on the impact of comorbid A/D on responses to bronchodilators are limited. Methods This post hoc analysis of pooled data (N=861) from the GOLDEN 3 and 4 studies compared the efficacy and safety of nebulized glycopyrrolate (GLY) 25 µg in patients with moderate-to-very-severe COPD, grouped by self-reported A/D. Changes in forced expiratory volume in 1 second (FEV1) and health-related quality of life determined by St George’s Respiratory Questionnaire (SGRQ) scores in patients with or without comorbid A/D (A/D [+] or A/D [–]) were examined following 12 weeks of GLY 25 µg twice-daily (BID) or placebo treatment. Results A/D (+) patients were predominantly female, younger, included a higher proportion of current smokers, and had higher baseline SGRQ scores compared with the A/D (–) group. At 12 weeks, GLY resulted in placebo-adjusted improvements from baseline in FEV1 of 46.9 mL (p=0.19; not significant) and 106.7 mL (p<0.0001), in the A/D (+) and A/D (–) groups, respectively. Improvements were observed with GLY compared to placebo in SGRQ scores, regardless of baseline A/D status; the placebo-adjusted least squares mean change from baseline in SGRQ total scores was –3.16 (p>0.05) and –3.34 (p<0.001), for the A/D (+) and A/D (–) groups, respectively. Despite numerical improvements in SGRQ scores with GLY in the A/D (+) group, a higher response to placebo was observed. GLY was generally well tolerated throughout 12 weeks of treatment; incidence of adverse events was higher in the A/D (+) group compared with the A/D (–) group in both treatment arms. Conclusion GLY 25 µg BID resulted in numerical improvements in FEV1, SGRQ total scores and SGRQ responder rates in patients with moderate-to-very-severe COPD, regardless of A/D status at baseline; significant improvements were noted only in the A/D (+) group. The results emphasize the importance of considering underlying comorbidities including A/D when evaluating the efficacy of COPD treatments.
Collapse
Affiliation(s)
- Nicola A Hanania
- Section of Pulmonary, Critical Care and Sleep Medicine, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Abebaw M Yohannes
- Department of Physical Therapy, Azusa Pacific University, Azusa, CA, USA
| | | | | | | | | | | |
Collapse
|
6
|
Ahmadi A, Mazloom Z, Eftekhari MH, Masoompour SM, Fararouei M, Eskandari MH, Mehrabi S, Zare M, Sohrabi Z. Muscle mass and function are related to respiratory function in chronic obstructive pulmonary disease. Med J Islam Repub Iran 2021; 35:34. [PMID: 34211936 PMCID: PMC8236085 DOI: 10.47176/mjiri.35.34] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Indexed: 01/06/2023] Open
Abstract
Background: Chronic obstructive pulmonary disease (COPD), as an airway limitation condition, is accompanied by alteration of muscle mass and function. We aimed to determine the relationship between disease severity and body composition, muscle function, and nutritional status in COPD patients. Methods: This cross-sectional study was conducted on 129 COPD participants. Muscle strength, body composition, and calf circumference (CC) were measured using a hydraulic hand dynamometer, bioelectrical impedance analysis (BIA), and a tape measure, respectively. Furthermore, fat-free mass index (FFMI), body mass index (BMI) and muscle mass value were calculated by equations. Forced expiratory volume in one second (FEV1) was assessed as well. Nutritional status was also evaluated by subjective global assessment (SGA) questionnaire. SPSS software (version 21 ) was used, chi-square, fisher's exact test, univariate and multivariate linear regression models were used for statistical analysis. P-values less than 0.05 were considered significant. Results: Based on FEV1 classification, 52.7% of the patients had severe conditions. The reports indicated that the prevalence of low CC was 54.2%, low muscle mass 38.7%, low FFMI 34.8%, low right handgrip strength 61.2% and low left handgrip strength 64.3%. Furthermore, there was an increasing trend based on FEV1 in low CC (p=0.032), low muscle mass (p=0.005), low FFMI (p=0.002), low right handgrip strength (p=0.004) and low left handgrip strength (p=0.014). The results of univariate analysis showed muscle mass (p=0.036), total protein (p=0.043), FFM (p=0.047), FFMI (p=0.007), SGA (p=0.029), right handgrip strength (p=0.004) and left hand grip strength (p=0.023) were associated with FEV1. In addition, the results of multivariate analysis demonstrated low values of FFMI (p=0.005) and right handgrip strength (p=0.042) were the main detrimental factors for FEV1. The results of multivariate analysis were confirmed by stepwise model. Conclusion: Low values of muscle mass and function are prevalent among COPD patients. The present study revealed that low FFMI and handgrip strength were closely related to disease severity.
Collapse
Affiliation(s)
- Afsane Ahmadi
- Research Center for Health Sciences, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zohreh Mazloom
- Department of Clinical Nutrition, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Hassan Eftekhari
- Department of Clinical Nutrition, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sayed Masoom Masoompour
- Noncommunicable Disease Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Fararouei
- Department of Epidemiology, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Hadi Eskandari
- Department of Food Sciences and Technology, School of Agriculture, Shiraz University, Shiraz, Iran
| | - Samrad Mehrabi
- Department of Internal Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Morteza Zare
- Nutrition Research Center, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Sohrabi
- Department of Community Nutrition, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| |
Collapse
|
7
|
Whittaker HR, Pimenta JM, Jarvis D, Kiddle SJ, Quint JK. Characteristics Associated with Accelerated Lung Function Decline in a Primary Care Population with Chronic Obstructive Pulmonary Disease. Int J Chron Obstruct Pulmon Dis 2020; 15:3079-3091. [PMID: 33268984 PMCID: PMC7701160 DOI: 10.2147/copd.s278981] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 11/06/2020] [Indexed: 11/23/2022] Open
Abstract
Background Estimates for lung function decline in chronic obstructive pulmonary disease (COPD) have differed by study setting and have not been described in a UK primary care population. Purpose To describe rates of FEV1 and FVC decline in COPD and investigate characteristics associated with accelerated decline. Patients and Methods Current/ex-smoking COPD patients (35 years+) who had at least 2 FEV1 or FVC measurements ≥6 months apart were included using Clinical Practice Research Datalink. Patients were followed up for a maximum of 13 years. Accelerated rate of lung function decline was defined as the fastest quartile of decline using mixed linear regression, and association with baseline characteristics was investigated using logistic regression. Results A total of 72,683 and 50,649 COPD patients had at least 2 FEV1 or FVC measurements, respectively. Median rates of FEV1 and FVC changes or decline were -18.1mL/year (IQR: -31.6 to -6.0) and -22.7mL/year (IQR: -39.9 to -6.7), respectively. Older age, high socioeconomic status, being underweight, high mMRC dyspnoea and frequent AECOPD or severe AECOPD were associated with an accelerated rate of FEV1 and FVC decline. Current smoking, mild airflow obstruction and inhaled corticosteroid treatment were additionally associated with accelerated FEV1 decline whilst women, sputum production and severe airflow obstruction were associated with accelerated FVC decline. Conclusion Rate of FEV1 and FVC decline was similar and showed similar heterogeneity. Whilst FEV1 and FVC shared associations with baseline characteristics, a few differences highlighted the importance of both lung function measures in COPD progression. We identified important characteristics that should be monitored for disease progression.
Collapse
Affiliation(s)
- Hannah R Whittaker
- Respiratory Epidemiology, Occupational Medicine and Public Health, National Heart and Lung Institute, Imperial College London, London, UK
| | - Jeanne M Pimenta
- Epidemiology (Value Evidence and Outcomes), GlaxoSmithKline, R&D, Uxbridge, UK
| | - Deborah Jarvis
- Respiratory Epidemiology, Occupational Medicine and Public Health, National Heart and Lung Institute, Imperial College London, London, UK
| | - Steven J Kiddle
- MRC Biostatistics Unit, University of Cambridge, Cambridge, UK
| | - Jennifer K Quint
- Respiratory Epidemiology, Occupational Medicine and Public Health, National Heart and Lung Institute, Imperial College London, London, UK
| |
Collapse
|