Gender and COPD in patients attending a pulmonary clinic

Biological sex differences in the perception of CO2-induced air hunger

INTRODUCTION

Biological sex may mediate 'dyspnoea' during submaximal exercise, but whether it mediates air hunger (AH), a highly unpleasant form of dyspnoea, remains unclear.

METHOD

Forty healthy adults (twenty females) completed 6-min of quiet breathing (rest) followed by a hyperoxic CO2 rebreathing task to evoke AH. AH intensity (AH-I) and unpleasantness (AH-U) were measured every 30-s. The Multidimensional Dyspnoea Profile (MDP) was administered after CO2 rebreathing.

RESULTS

Compared to males, AH-I and AH-U thresholds occurred at lower PETCO2 in females (AH-I: 44.15 ± 2.81 vs 48.90 ± 4.47 mmHg, P < 0.001; AH-U: 43.86 ± 2.57 vs 47.59 ± 2.75 mmHg, P < 0.001) and after a smaller increase in PETCO2 above resting PETCO2 (AH-I: 7.04 ± 2.63 vs 10.08 ± 5.28 mmHg, P = 0.027; AH-U: 6.75 ± 2.22 vs 8.77 ± 2.99 mmHg, P = 0.020). AH-I and AH-U were higher in females than males at standardised absolute V̇E of 25, 30 and 35 L/min (P < 0.05). AH-U, but not AH-I, remained higher (main effect of sex, P = 0.026) in females than males at standardised relative V̇E of 20, 25, and 30 % MVV. More females (n = 9) than males (n= 4) terminated CO2 rebreathing due to maximal AH perception (P = 0.001). Compared to males, females reported greater intensities of 'mental effort/concentration' (7 ± 3 vs 4 ± 3), 'tight/constricted lungs' (6 ± 3 vs 2 ± 2), and 'breathing work/effort' (6 ± 2 vs 4 ± 3) (all P < 0.05) on the MDP.

CONCLUSION

Our findings suggest that sex differences exist in the perception of AH, which are not entirely accounted for by sex differences in ventilatory capacity.

Gender-stratified analyses of symptoms associated with life-threatening events in patients calling out-of-hours primary care for shortness of breath

BACKGROUND

Women and men seem to perceive shortness of breath (SOB) differently. However, it is unknown whether symptom presentation varies between genders during a life-threatening event (LTE).

AIM

To assess whether symptoms associated with an LTE vary between women and men with SOB calling out-of-hours primary care (OHS-PC).

METHODS

Cross-sectional study including data from patients contacting two large Dutch OHS-PC centres for SOB between 1 September 2020 and 31 August 2021. We compared symptoms mentioned during triage conversations between patients with and without LTEs (amongst others, acute coronary syndrome, pulmonary embolism, acute heart failure and severe pneumonia), stratified by gender.

RESULTS

We included 1,861 adults contacting OHS-PC for SOB (mean age 53.3 years, 55.3% women). The risk of an LTE was lower in women than in men (15.0% vs. 18.7%, RR 0.80; 95% CI 0.65-0.98). Patients with LTEs were older, more often had someone else calling for them, a history of cardiovascular disease, cardiovascular medication use and inability to speak full sentences compared to those without LTEs. Differences between women and men were only apparent for calling at night (women: 24.0% vs. 15.2%, p = 0.006, versus men: 18.7% vs. 22.5%, p = 0.300; p-value interaction term: 0.009) and participation of general practitioners during telephone triage (women: 49.4% vs. 49.5%, p = 0.975, versus men: 56.1% vs. 43.0%, p = 0.003; p-value interaction term: 0.033).

CONCLUSIONS

Among patients contacting OHS-PC with SOB, about 1 in 6 had an LTE, more often men than women. We found no strong evidence of symptom differences between gender groups predictive of LTEs.

TRIAL REGISTRATION

The Netherlands Trial Register, number: NL9682, registration date: 20-08-2021.

Associations of comorbid heart disease and depression/anxiety with multidimensional breathlessness in COPD - A cross-sectional study

BACKGROUND

Comorbid conditions and breathlessness are associated with poor outcomes in chronic obstructive pulmonary disease (COPD). We evaluated the associations of comorbid heart disease and depression/anxiety with breathlessness in daily life among people with COPD.

METHODS

Cross-sectional analysis from the PRAXIS cohort in central Sweden. Data on patient characteristics and the modified Medical Research Council (mMRC) and Dyspnea-12 breathlessness instruments (D-12) were obtained from questionnaires in 2022. Lung function data were collected from record review. Outcome variables were clinically significant breathlessness defined as mMRC≥2 and D-12 total (>2.7), physical (>1.4) and affective (>1.2) scores above published minimal clinical important differences. Associations of heart disease and depression/anxiety with each outcome were analyzed using multivariable Poisson regression adjusted for relevant confounders.

RESULTS

In 522 included patients, mMRC ≥2 was present in 59 % and increased D-12 total, physical and affective domain scores in 69 %, 74 %, and 50 %, respectively. Heart disease was independently associated with mMRC (relative risk ratio [95 % confidence interval] 1.34 [1.17-1.53]), D12 physical domain (1.12[1.02-1.24]) and D-12 affective domain (1.20[1.02-1.42]). Depression/anxiety was independently associated with increased D-12 affective domain (1.25[1.04-1.49]). In addition, previous exacerbations and GOLD stage 3-4 were associated with mMRC and D-12, respectively.

CONCLUSION

In COPD, comorbid heart disease is associated with both activity-related breathlessness and with physical and affective domains of breathlessness while depression/anxiety is associated with the affective domain of breathlessness. As the influence of different dimensions of breathlessness may differ according to comorbidity the D-12 instrument adds more information when assessing breathlessness in patients with COPD.

The relationship between fatigue levels and psychosocial adjustment in elderly individuals with chronic obstructive pulmonary disease: A descriptive study

BACKGROUND

Chronic Obstructive Pulmonary Disease (COPD) is associated with physical limitations and significant social, psychological, and behavioral challenges. This study investigates the relationship between fatigue levels and psychosocial adjustment in COPD patients, considering their sociodemographic characteristics.

METHODS

A descriptive study was conducted with 160 COPD patients hospitalized in the Pulmonology Department of a university hospital. Data were collected via face-to-face interviews using a patient information form, the COPD and Asthma Fatigue Scale (CAFS), and the Psychosocial Adjustment to Illness Scale-Self-Report (PAIS-SR). Statistical analyses included Independent Sample t-test, One-Way ANOVA, Mann-Whitney U test, Kruskal-Wallis test, and Spearman correlation analysis, with significance set at p < 0.05.

RESULTS

The mean age of participants was 68.70 ± 9.41 years; 71.9% were male, and 67.9% had COPD for over six years. Most participants (74.4%) reported limitations in daily living activities due to the disease, and 91.9% reported having social support. Mean scores were 58.03 ± 15.80 on the CAFS and 64.19 ± 6.41 on the PAIS-SR. Significant differences were observed in fatigue and psychosocial adjustment scores based on gender, social support, and disease impact on daily activities (p < 0.05). A weak positive correlation was found between fatigue levels and psychosocial adjustment (p < 0.05).

CONCLUSIONS

COPD patients experience moderate-to-high fatigue levels and challenges in psychosocial adjustment, with fatigue negatively influencing adjustment. Interventions should focus on enhancing coping strategies, addressing psychosocial needs, and leveraging social support systems to improve patient outcomes.

Predictors of Discharge With Supplemental Oxygen After Lobectomy for Lung Cancer

BACKGROUND

Before lung cancer resection, patients inquire about dyspnea and the potential need for supplemental oxygen. The objective of this study was to identify predictors of discharge with supplemental oxygen for patients undergoing lobectomy for lung cancer.

METHODS

Using The Society of Thoracic Surgeons General Thoracic Surgery Database, study investigators conducted a retrospective cohort study of patients who underwent lobectomy for lung cancer from July 2018 to December 2021. Multivariable logistic regression was used to determine the adjusted association of pulmonary function with discharge on supplemental oxygen and identify independent predictors of discharge with supplemental oxygen. Pulmonary function was modeled as the minimum of either predicted postoperative forced expiratory volume in 1 second or predicted postoperative diffusing capacity of lung for carbon monoxide.

RESULTS

Overall, 2100 (8.4%) patients who underwent lobectomy were discharged with supplemental oxygen. Those patients with a minimum of either predicted postoperative forced expiratory volume in 1 second or predicted postoperative diffusing capacity of lung for carbon monoxide ≤60% had a progressively increased risk of discharge with supplemental oxygen than patients with minimum function >60%. The 2 strongest predictors of discharge with supplemental oxygen were increasing body mass index (25-29 kg/m2: adjusted odds ratio [aOR], 1.38; 95% CI, 1.21-1.57; 30-39 kg/m2: aOR, 2.14; 95% CI, 1.88-2.45; ≥40 kg/m2: aOR, 3.51; 95% CI, 2.79-4.39; reference, 18.5-24 kg/m2) and former (aOR, 2.04; 95% CI, 1.67-2.52) or current (aOR, 2.61; 95% CI, 2.10-3.26) smoking status (reference, never smoker).

CONCLUSIONS

Of those patients who underwent lobectomy for lung cancer, 8.4% were discharged with supplemental oxygen. The study identified preoperative independent predictors of discharge with supplemental oxygen that may be useful during shared decision-making discussions of treatment options for lung cancer and setting expectations with patients.

Prediction of spirometry outcome in Croatian patients with chronic obstructive pulmonary disease

The current study offers an extensive examination of the influence of 29 diverse parameters on spirometry measurement variables in a cohort of 534 patients with chronic obstructive pulmonary disease (COPD) from five different centers in Croatia. The study elucidates both the magnitude and direction of the effect exerted by the 29 predictors on forced vital capacity (FVC), forced expiratory volume in one second (FEV1), the ratio FEV1/FVC, and predicted forced expiratory flow at 50% of FVC. Additionally, the development of prediction models for these parameters has been undertaken using several statistical methods. The study identifies fat-free mass index, 6-minute walk distance, predicted diffusing capacity of the lung for carbon monoxide, arterial partial pressure of oxygen, and both arterial and tissue hemoglobin oxygen saturation percentage as robust positive predictors for all four spirometry parameters. Body mass index is recognized as a weak positive predictor for FEV1 and FEV1/FVC, commonly observed in COPD patients. As expected, smoking years is identified as a strong negative predictor for all four spirometry parameters, while age and illness duration exhibit strong predictive negative associations. Furthermore, modified medical research council, arterial partial pressure carbon dioxide, St George's respiratory questionnaire, COPD assessment test, depression anxiety stress scales, and nutritional risk screening are identified as weak negative predictors. Charlson comorbidity index, phase angle, and number of comorbidities do not exhibit a significant impact on spirometry variables. Ultimately, the performed factorial analysis categorized the 29 parameters into five groups, which were identified as relating to lung function, health status, nutritional status, age, and smoking. Multiple regression analysis, including four newly derived parameters based on the results of factorial analysis, identified nutritional status as a positive predictor for spirometry readings, while smoking, poor health status, and age were identified as negative predictors in successive order.

Reprint of: Smoking and pulmonary health in women: A narrative review and behavioral health perspective

OBJECTIVE

Cigarette smoking prevalence has declined slower among women than men, and smoking-related pulmonary disease (PD) has risen among women. Given these trends, there is a critical need to understand and mitigate PD risk among women who smoke. The purpose of this narrative review and commentary is to highlight important evidence from the literature on smoking and PD among women.

METHODS

This review focuses broadly on examining cigarette smoking and PD among women within six topic areas: (1) demographic characteristics and prevalence of smoking, (2) smoking behavior, (3) lung cancer, (4) obstructive PD, (5) diagnostic and treatment disparities, and (6) gaps in the literature and potential directions for future research and treatment.

RESULTS

Growing evidence indicates that compared to men, women are at increased risk for developing smoking-related PD and poorer PD outcomes. Gender disparities in smoking-related PD may be largely accounted for by genetic differences and sex hormones contributing to PD pathogenesis and presentation, smoking behavior, nicotine dependence, and pathogen/carcinogen clearance. Moreover, gender disparities in smoking-related PD may be exacerbated by important social determinants (e.g., women with less formal education and those from minoritized groups may be at especially high risk for poor PD outcomes due to higher rates of smoking).

CONCLUSION

Rising rates of smoking-related PD among women risk widening diagnostic and treatment disparities. Ongoing research is needed to explore potentially complex relationships between sex, gender, and smoking-related PD processes and outcomes, and to improve smoking-cessation and PD treatment for women.

Smoking and pulmonary health in women: A narrative review and behavioral health perspective

OBJECTIVE

Cigarette smoking prevalence has declined slower among women than men, and smoking-related pulmonary disease (PD) has risen among women. Given these trends, there is a critical need to understand and mitigate PD risk among women who smoke. The purpose of this narrative review and commentary is to highlight important evidence from the literature on smoking and PD among women.

METHODS

This review focuses broadly on examining cigarette smoking and PD among women within six topic areas: (1) demographic characteristics and prevalence of smoking, (2) smoking behavior, (3) lung cancer, (4) obstructive PD, (5) diagnostic and treatment disparities, and (6) gaps in the literature and potential directions for future research and treatment.

RESULTS

Growing evidence indicates that compared to men, women are at increased risk for developing smoking-related PD and poorer PD outcomes. Gender disparities in smoking-related PD may be largely accounted for by genetic differences and sex hormones contributing to PD pathogenesis and presentation, smoking behavior, nicotine dependence, and pathogen/carcinogen clearance. Moreover, gender disparities in smoking-related PD may be exacerbated by important social determinants (e.g., women with less formal education and those from minoritized groups may be at especially high risk for poor PD outcomes due to higher rates of smoking).

CONCLUSION

Rising rates of smoking-related PD among women risk widening diagnostic and treatment disparities. Ongoing research is needed to explore potentially complex relationships between sex, gender, and smoking-related PD processes and outcomes, and to improve smoking-cessation and PD treatment for women.

Sex-differences in COPD: from biological mechanisms to therapeutic considerations

Chronic obstructive pulmonary disease (COPD) is a heterogeneous respiratory condition characterized by symptoms of dyspnea, cough, and sputum production. We review sex-differences in disease mechanisms, structure-function-symptom relationships, responses to therapies, and clinical outcomes in COPD with a specific focus on dyspnea. Females with COPD experience greater dyspnea and higher morbidity compared to males. Imaging studies using chest computed tomography scans have demonstrated that females with COPD tend to have smaller airways than males as well as a lower burden of emphysema. Sex-differences in lung and airway structure lead to critical respiratory mechanical constraints during exercise at a lower absolute ventilation in females compared to males, which is largely explained by sex differences in maximum ventilatory capacity. Females experience similar benefit with respect to inhaled COPD therapies, pulmonary rehabilitation, and smoking cessation compared to males. Ongoing re-assessment of potential sex-differences in COPD may offer insights into the evolution of patterns of care and clinical outcomes in COPD patients over time.

Reduced tidal volume-inflection point and elevated operating lung volumes during exercise in females with well-controlled asthma

INTRODUCTION

Individuals with asthma breathe at higher operating lung volumes during exercise compared with healthy individuals, which contributes to increased exertional dyspnoea. In health, females are more likely to develop exertional dyspnoea than males at a given workload or ventilation, and therefore, it is possible that females with asthma may develop disproportional dyspnoea on exertion. The purpose of this study was to compare operating lung volume and dyspnoea responses during exercise in females with and without asthma.

METHODS

Sixteen female controls and 16 females with asthma were recruited for the study along with 16 male controls and 16 males with asthma as a comparison group. Asthma was confirmed using American Thoracic Society criteria. Participants completed a cycle ergometry cardiopulmonary exercise test to volitional exhaustion. Inspiratory capacity manoeuvres were performed to estimate inspiratory reserve volume (IRV) and dyspnoea was evaluated using the Modified Borg Scale.

RESULTS

Females with asthma exhibited elevated dyspnoea during submaximal exercise compared with female controls (p<0.05). Females with asthma obtained a similar IRV and dyspnoea at peak exercise compared with healthy females despite lower ventilatory demand, suggesting mechanical constraint to tidal volume (VT) expansion. VT-inflection point was observed at significantly lower ventilation and V̇O2 in females with asthma compared with female controls. Forced expired volume in 1 s was significantly associated with VT-inflection point in females with asthma (R2=0.401; p<0.01) but not female controls (R2=0.002; p=0.88).

CONCLUSION

These results suggest that females with asthma are more prone to experience exertional dyspnoea, secondary to dynamic mechanical constraints during submaximal exercise when compared with females without asthma.

The Molecular Blueprint for Chronic Obstructive Pulmonary Disease (COPD): A New Paradigm for Diagnosis and Therapeutics

The global prevalence of chronic obstructive pulmonary disease (COPD) has increased over the last decade and has emerged as the third leading cause of death worldwide. It is characterized by emphysema with prolonged airflow limitation. COPD patients are more susceptible to COVID-19 and increase the disease severity about four times. The most used drugs to treat it show numerous side effects, including immune suppression and infection. This review discusses a narrative opinion and critical review of COPD. We present different aspects of the disease, from cellular and inflammatory responses to cigarette smoking in COPD and signaling pathways. In addition, we highlighted various risk factors for developing COPD apart from smoking, like occupational exposure, pollutants, genetic factors, gender, etc. After the recent elucidation of the underlying inflammatory signaling pathways in COPD, new molecular targeted drug candidates for COPD are signal-transmitting substances. We further summarize recent developments in biomarker discovery for COPD and its implications for disease diagnosis. In addition, we discuss novel drug targets for COPD that could be explored for drug development and subsequent clinical management of cardiovascular disease and COVID-19, commonly associated with COPD. Our extensive analysis of COPD cause, etiology, diagnosis, and therapeutic will provide a better understanding of the disease and the development of effective therapeutic options. In-depth knowledge of the underlying mechanism will offer deeper insights into identifying novel molecular targets for developing potent therapeutics and biomarkers of disease diagnosis.

Identifying the Relationship Between Economic Prosperity and Quality of Life in Chronic Obstructive Pulmonary Disease Patients

Background Chronic obstructive pulmonary disease (COPD) places a significant economic burden on national healthcare systems, and the economic effects of diseases have long been known. The study aimed to evaluate the association of parental family financial wealth with current economic prosperity and the combined effect of both on health-related quality of life (HRQOL) in a sample of patients with COPD. The moderating effect of birth order is further investigated. Methods The results of the study are based on a purposive sample of 105 COPD patients at the Larisa University Hospital pulmonology clinic (94 males and 11 females), with an average age of 68.9 (SD = 9.2). The data collection was carried out in the spring and summer of 2020. Participants completed the 36-item Short Form Survey (SF-36) and a sociodemographic questionnaire with self-reported parental and current wealth items. A mediation model with the moderation of the indirect effect of parental wealth on current wealth and the direct effect of parental wealth on HRQOL was applied to test the research hypotheses among the variables studied. Results Parental wealth was found to affect current wealth significantly, and both were involved considerably in HRQOL. Birth order had a significant moderating effect on the relationship between parental wealth and HRQOL. Among parental families with lower financial status, patients who grew up as third or later children had significantly lower HRQOL than the first or second children of these families. Neither age nor COPD duration was related to current wealth or HRQOL. Conclusions An intergenerational transmission of poverty was found in our sample. In addition, a birth order effect can provide further insight into the harsher environment that the later children of a low-income family are exposed to and the long-term implications for their HRQOL.

IMplementing Predictive Analytics towards efficient COPD Treatments (IMPACT): protocol for a stepped-wedge cluster randomized impact study

INTRODUCTION

Personalized disease management informed by quantitative risk prediction has the potential to improve patient care and outcomes. The integration of risk prediction into clinical workflow should be informed by the experiences and preferences of stakeholders, and the impact of such integration should be evaluated in prospective comparative studies. The objectives of the IMplementing Predictive Analytics towards efficient chronic obstructive pulmonary disease (COPD) treatments (IMPACT) study are to integrate an exacerbation risk prediction tool into routine care and to determine its impact on prescription appropriateness (primary outcome), medication adherence, quality of life, exacerbation rates, and sex and gender disparities in COPD care (secondary outcomes).

METHODS

IMPACT will be conducted in two phases. Phase 1 will include the systematic and user-centered development of two decision support tools: (1) a decision tool for pulmonologists called the ACCEPT decision intervention (ADI), which combines risk prediction from the previously developed Acute COPD Exacerbation Prediction Tool with treatment algorithms recommended by the Canadian Thoracic Society's COPD pharmacotherapy guidelines, and (2) an information pamphlet for COPD patients (patient tool), tailored to their prescribed medication, clinical needs, and lung function. In phase 2, we will conduct a stepped-wedge cluster randomized controlled trial in two outpatient respiratory clinics to evaluate the impact of the decision support tools on quality of care and patient outcomes. Clusters will be practicing pulmonologists (n ≥ 24), who will progressively switch to the intervention over 18 months. At the end of the study, a qualitative process evaluation will be carried out to determine the barriers and enablers of uptake of the tools.

DISCUSSION

The IMPACT study coincides with a planned harmonization of electronic health record systems across tertiary care centers in British Columbia, Canada. The harmonization of these systems combined with IMPACT's implementation-oriented design and partnership with stakeholders will facilitate integration of the tools into routine care, if the results of the proposed study reveal positive association with improvement in the process and outcomes of clinical care. The process evaluation at the end of the trial will inform subsequent design iterations before largescale implementation.

TRIAL REGISTRATION

NCT05309356.

Differences of Clinical Characteristics and Drug Prescriptions between Men and Women with COPD in China

BACKGROUND

Sex differences in symptoms exist in patients with COPD. Our aim is to measure the differences between men and women with COPD, focusing on risk factors, symptoms, quality of life and drug prescriptions.

METHODS

In this cross-sectional observational study, patients with COPD were collected in China; demographic characteristics, smoking history, occupational exposure, biomass exposure, lung function, dyspnea, quality of life, and prescriptions for inhaled medications were collected. The nearest neighbor algorithm was used to match female and male patients (ratio 2:1) on age, body mass index, and lung function.

RESULTS

Compared with 1462 men, the 731 women generally had lower educational levels and were married less (both p < 0.001). A total of 576 (90.0%) women did not smoke cigarettes. More men were exposed to occupational dust (539 (36.9%) vs. 84 (11.5%), p = 0.013), while more women were exposed to biomass smoke (330 (45.1%) vs. 392 (26.8%), p = 0.004). Except for phlegm and chest tightness, women had more complaints than men for cough, breathlessness, activities, confidence, sleep and energy (p < 0.05). In addition, more women were prescribed triple therapy than men (236 (36.3%) vs. 388 (31.0%), p = 0.020).

CONCLUSIONS

There are obvious discrepancies in the quality of life and use of inhaled medications between male and female patients with COPD.

Gender-specific differences in COPD symptoms and their impact for the diagnosis of cardiac comorbidities

BACKGROUND

In chronic obstructive pulmonary disease (COPD), gender-specific differences in the prevalence of symptoms and comorbidity are known.

RESEARCH QUESTION

We studied whether the relationship between these characteristics depended on gender and carried diagnostic information regarding cardiac comorbidities.

STUDY DESIGN AND METHODS

The analysis was based on 2046 patients (GOLD grades 1-4, 795 women; 38.8%) from the COSYCONET COPD cohort. Assessments comprised the determination of clinical history, comorbidities, lung function, COPD Assessment Test (CAT) and modified Medical Research Council dyspnea scale (mMRC). Using multivariate regression analyses, gender-specific differences in the relationship between symptoms, single CAT items, comorbidities and functional alterations were determined. To reveal the relationship to cardiac disease (myocardial infarction, or heart failure, or coronary artery disease) logistic regression analysis was performed separately in men and women.

RESULTS

Most functional parameters and comorbidities, as well as CAT items 1 (cough), 2 (phlegm) and 5 (activities), differed significantly (p < 0.05) between men and women. Beyond this, the relationship between functional parameters and comorbidities versus symptoms showed gender-specific differences, especially for single CAT items. In men, item 8 (energy), mMRC, smoking status, BMI, age and spirometric lung function was related to cardiac disease, while in women primarily age was predictive.

INTERPRETATION

Gender-specific differences in COPD not only comprised differences in symptoms, comorbidities and functional alterations, but also differences in their mutual relationships. This was reflected in different determinants linked to cardiac disease, thereby indicating that simple diagnostic information might be used differently in men and women.

CLINICAL TRIAL REGISTRATION

The cohort study is registered on ClinicalTrials.gov with identifier NCT01245933 and on GermanCTR.de with identifier DRKS00000284, date of registration November 23, 2010. Further information can be obtained on the website http://www.asconet.net .

The Impact of Depression and Exercise Self-Efficacy on Benefits of Pulmonary Rehabilitation in Veterans with COPD

Pulmonary rehabilitation (PR) improves health-related quality of life (HRQoL) and exercise capacity. Little is known about the impact of depression symptoms and exercise self-efficacy on improvements in these key PR outcomes. This study examined the impact of baseline depression status and change in depression symptoms (Beck Depression Inventory-II [BDI-II] score) over the course of PR on change in HRQoL assessed by the Chronic Respiratory Disease Questionnaire-Self Reported (CRQ-SR) and exercise capacity as measured by the 6-Minute Walk Test (6MWT). We also examined whether baseline exercise self-efficacy moderated the association between baseline depression symptoms and change in these key PR outcomes. We studied 112 US veterans (aged 70.38 ± 8.49 years) with chronic obstructive pulmonary disease (COPD) who completed PR consisting of twice-weekly 2-hour classes for 18 sessions. Depressed (BDI-II >13) and nondepressed (BDI-II ≤13) patients at baseline demonstrated comparable and significant improvement in CRQ-SR total score, subscales, and 6MWT. Greater reduction in depression over the course of treatment was significantly associated with greater improvement in CRQ-SR total score and the following subscales: fatigue, mastery, and emotional function. Change in depression did not predict change in 6MWT distance. Baseline exercise self-efficacy moderated the association between baseline depression symptoms and change in CRQ-SR fatigue. Specifically, when baseline exercise self-efficacy was <30.4, greater baseline depression was associated with less improvement in CRQ-SR fatigue. When baseline self-efficacy was >152.0, greater baseline depression was associated with greater improvement in CRQ-SR fatigue. PR programs should address mood and confidence to exercise given their impact on key PR outcomes.

Sex-specific characteristics for the coexistence of asthma and COPD in the Canadian population: a cross-sectional analysis of CLSA data

Objective: The coexistence of asthma and COPD (asthma + COPD) is a condition found among patients who present with clinical features of both asthma and COPD. Epidemiological evidence points to an increasingly disproportionate burden of asthma + COPD and COPD in females. The objective of this cross-sectional study is to identify female and male-specific epidemiological and clinical characteristics associated with asthma + COPD.Methods: Baseline data from the comprehensive cohort of Canadian Longitudinal Study on Aging (CLSA) were used in this cross-sectional study which included 30,097 subjects between the ages of 45- and 85-years Participants were categorized into four mutually exclusive groups: asthma + COPD, COPD-only, asthma-only and neither asthma nor COPD.Results: The prevalence was significantly greater in females than males for asthma + COPD (2.71% vs. 1.41%; p < 0.001), COPD-only (3.22% vs. 2.87%; p < 0.001) and asthma-only (13.31% vs. 10.11%; p < 0.001). The association between smoking and asthma + COPD was modified by age in females. Osteoporosis and underactive thyroid disease were significantly more prevalent in females than in males in asthma + COPD, COPD-only and asthma-only groups. In asthma + COPD group, a greater proportion of respiratory symptoms associated with asthma was observed in females whereas a greater proportion of respiratory symptoms associated with COPD was observed in males. Severity of airway obstruction determined by spirometry measurements was greater in males than females.Conclusions: In the Canadian adult population, several epidemiological and clinical characteristics in asthma + COPD varied between females and males. The findings in this study will help healthcare professional in the recognition and management of coexisting asthma and COPD in females and males.

Chronic moderate hypercapnia suppresses ventilatory responses to acute CO&lt;sub&gt;2&lt;/sub&gt; challenges

Chronic hypercapnia (CH) is a hallmark of chronic lung disease, and CH increases the risk for acute-on-chronic exacerbations leading to greater hypoxemia/hypercapnia and poor health outcomes. However, the role of hypercapnia per se (duration and severity) in determining an individual's ability to tolerate further hypercapnic exacerbations is unknown. Our primary objective herein was to test the hypothesis that mild-to-moderate CH (arterial [Formula: see text] ∼50-70 mmHg) increases susceptibility to pathophysiological responses to severe acute CO₂ challenges. Three groups (GR) of adult female goats were studied during 14 days of exposure to room air (<i>GR 1</i>; control) or 6% inspired CO₂ (<i>GR 2</i>; mild CH), or 7 days of 6% inspired CO₂ followed by 7 days of 8% inspired CO₂ (<i>GR 3</i>; moderate CH). Consistent with previous reports, there were no changes in physiological parameters in <i>GR 1</i> (RA control), but mild CH (<i>GR 2</i>) increased steady-state ventilation and transiently suppressed CO₂/[H⁺] chemosensitivity. Further increasing InCO₂ from 6% to 8% (<i>GR 3</i>) transiently increased ventilation and arterial [H⁺]. Similar to mild CH, moderate CH increased ventilation to levels greater than predicted. However, in contrast to mild CH, acute ventilatory chemosensitivity was suppressed throughout the duration of moderate CH, and the arterial - mixed expired CO₂ gradient became negative. These data suggest that moderate CH limits physiological responses to acute severe exacerbations and provide evidence of recruitment of extrapulmonary systems (i.e., gastric CO₂ elimination) during times of moderate-severe hypercapnia.<b>NEW &amp; NOTEWORTHY</b> Moderate levels of chronic hypercapnia (CH; ∼70 mmHg) in healthy adult female goats elicited similar steady-state physiological adaptations compared with mild CH (∼55 mmHg). However, unlike mild CH, moderate CH chronically suppressed acute CO₂/[H⁺] chemosensitivity and reversed the arterial to mixed expired CO₂ gradient. These findings suggest that moderate CH suppresses vital mechanisms of ventilatory control and recruits additional physiological systems (i.e., gastric CO₂ release) to help buffer excess CO₂.

Smoke-Free Policies and 30-Day Mortality Rates for Chronic Obstructive Pulmonary Disease

BACKGROUND

Smoke-free policies have been shown to impact 30-day readmission rates due to chronic obstructive pulmonary disease (COPD) among adults aged ≥65 years. However, little is known about the association between smokefree policies and 30-day mortality rates for COPD. Therefore, we investigated the association between comprehensive smoke-free policies and 30-day mortality rates for COPD.

METHODS

We used a cross-sectional study design and retrospectively examined risk-adjusted 30-day mortality rates for COPD across US hospitals in 1171 counties. Data were sourced from Centers for Medicare and Medicaid Services (CMS) Hospital Value-Based Purchasing (HVBP) Program, American Hospital Association (AHA) Annual Surveys, US Census Bureau Current Population Survey, and US Tobacco Control Laws Database from the American Nonsmokers' Rights Foundation (ANRF). Data were averaged at the county level for years 2015-2018. Hierarchical Poisson models adjusted for differences in hospital characteristics and accounted for the clustering of hospitals within a county were used.

RESULTS

Our findings show a consistent association between stronger smoke-free policies and a reduction in COPD mortality. When evaluating smoke-free policy, county characteristics, and hospital characteristics individually, we found that counties with full coverage or partial coverage had a reduced incidence rate of COPD mortality compared to no coverage counties. After adjusting for the county and hospital characteristics, counties with full coverage of smoke-free policies had a reduced rate of 30-day COPD mortality (adjusted incidence rate ratio [IRR]: 0.87, 95% CI: 0.79, 0.96) compared to counties with no policy coverage.

CONCLUSION

Comprehensive smoke-free policies are associated with a reduction in 30-day mortality following hospital admission for COPD. Partial smoke-free legislation is an insufficient preventative measure. These findings have strong implications for hospital policy-makers, suggesting that policy interventions to reduce COPD-related 30-day mortality should include implementing smoke-free policies and public health policy-makers to incentivize comprehensive smokefree policies.

Differences in Pulmonary and Extra-Pulmonary Traits between Women and Men with Chronic Obstructive Pulmonary Disease

Background: Evidence suggests sex-related differences in chronic obstructive pulmonary disease (COPD). Whether these differences are reflected in the prevalence of treatable traits remains unknown. Methods: Two samples of patients referred to secondary (n = 530) or tertiary care (n = 2012) were analyzed. Men and women were matched for age, forced expiratory volume in 1 s and body mass index. Sex-related differences were tested using t-tests, Mann-Whitney U, or chi-square tests. Results: Frequent exacerbations (30.5 vs. 19.7%), high cardiovascular risk (88.1 vs. 66.2%) and activity-related severe dyspnea (50.9 vs. 34.8%) were more prevalent in women in secondary care (p < 0.05). Severe hyperinflation (43.0 vs. 25.4%), limited diffusing capacity (79.6 vs. 70.1%), impaired mobility (44.0 vs. 28.7%), frequent exacerbations (66.8 vs. 57.4%), frequent hospitalizations (47.5 vs. 41.6%), severe activity-related dyspnea (89.1 vs. 85.0%), symptoms of anxiety (56.3 vs. 42.0%) and depression (50.3 vs. 44.8%), and poor health status (79.9 vs. 71.0%) were more prevalent in women in tertiary care (p < 0.05). Severe inspiratory muscle weakness (14.6 vs. 8.2%) and impaired exercise capacity (69.1 vs. 59.6%) were more prevalent among men (p < 0.05) in tertiary care. Conclusions: Sex-related differences were found, with most traits more prevalent and severe among women. Care providers should be aware of these differences to adjust treatment.

Sex Differences in the International Primary Care Airways Group Questionnaire for Screening of Chronic Obstructive Pulmonary Disease: A Retrospective, Cross-Sectional Study

Background and Objective

Methods

Results

Conclusion

Age and Sex Differences in Balance Outcomes among Individuals with Chronic Obstructive Pulmonary Disease (COPD) at Risk of Falls

No previous research has examined age and sex differences in balance outcomes in individuals with chronic obstructive pulmonary disease (COPD) at risk of falls. A secondary analysis of baseline data from an ongoing trial of fall prevention in COPD was conducted. Age and sex differences were analyzed for the Berg Balance scale (BBS), Balance Evaluation System Test (BEST test) and Activities-specific Balance Confidence Scale (ABC). Overall, 223 individuals with COPD were included. Females had higher balance impairments than males [BBS: mean (SD) = 47 (8) vs. 49 (6) points; BEST test: 73 (16) vs. 80 (16) points], and a lower confidence to perform functional activities [ABC = 66 (21) vs. 77 (19)]. Compared to a younger age (50-65 years) group, age >65 years was moderately associated with poor balance control [BBS (r = - 0.37), BEST test (r = - 0.33)] and weakly with the ABC scale (r = - 0.13). After controlling for the effect of balance risk factors, age, baseline dyspnea index (BDI), and the 6-min walk test (6-MWT) explained 38% of the variability in the BBS; age, sex, BDI, and 6-MWT explained 40% of the variability in the BEST test; And BDI and the 6-MWT explained 44% of the variability in the ABC scale. This study highlights age and sex differences in balance outcomes among individuals with COPD at risk of falls. Recognition of these differences has implications for pulmonary rehabilitation and fall prevention in COPD, particularly among females and older adults.

A Trend Analysis of Chronic Obstructive Pulmonary Disease Mortality in the United States by Race and Sex

Rationale: Chronic respiratory diseases, among which chronic obstructive pulmonary disease (COPD) remains the largest contributor, are the fourth leading cause of death in the United States. Updated mortality trends provide insight for targeted interventions. Objectives: To provide detailed insights into COPD mortality trends. Methods: This study used death certificate data collected from the U.S. Centers for Disease Control WONDER (Wide-Ranging Online Data for Epidemiology Research) system between 2004 and 2018 among Americans 40 years of age and older. We used Joinpoint regression analysis to capture trends in annual age-adjusted COPD mortality rates and of the number of deaths caused by influenza or pneumococcal disease with COPD. To place mortality trends into perspective, we examined influenza and pneumococcal vaccination rates within the same time frame using population survey data. Results: Overall, mortality from COPD decreased, with an annual percentage change (APC) of -0.6% (95% confidence interval [CI], -0.9% to -0.3%) between 2004, at 72.9 deaths per population of 100,000, and 2018, at 67.4 deaths per population of 100,000. COPD mortality in men exceeded that in women; however, mortality in men continued to decline, with an APC of -1.2% (95% CI, -1.5% to -0.9%), unlike mortality in women, whose death rates were overall unchanged. Further stratifying sex by race, we found that African American women were the only sociodemographic group to have had an increase in COPD mortality, with an APC of 1.3% (95% CI, 0.9% to 1.6%). The number of deaths caused by influenza with COPD had increased over time, with an observed APC of 19.58% (95% CI, 6.9% to 33.8%) between 2004 and 2018. Increased influenza mortality paralleled trends of decreased influenza vaccination rates, wherein between 2011 and 2018, there was an APC of -5.1% (95% CI, -8.2% to -2.0%). This trend was also present for those with COPD; 451.4 per 1,000 respondents in 2011 were vaccinated against influenza compared with 352.1 per 1,000 respondents in 2018, resulting in an APC of -1.8% (95% CI, -3.3% to -0.2%). Pneumococcal vaccination rates between 2011 and 2018 remained unchanged; meanwhile, deaths caused by pneumococcal disease with COPD decreased, with an APC of -10.1% (95% CI, -16.6% to -3.1%). Conclusions: COPD mortality has decreased among Americans overall; however, there remain important sociodemographic groups that have not secured the same deceleration in death rates.

Differences Between Men and Women with Chronic Obstructive Pulmonary Disease

There are many differences between men and women in risk factor vulnerability and impact, symptom development, presentation, clinical manifestations, and outcomes of chronic obstructive pulmonary disease (COPD). These differences have been inadequately explored, which is of particular concern in view of the delay in diagnosis and treatment that occurs for both men and women, and the need to use all therapies in a targeted and tailored way for best clinical gain and least harm. Women are generally underrepresented in randomized trials, as are non-tobacco-related phenotypes of COPD. We must garner the information available to better describe optimal treatment approaches.

Patterns of medical care utilization according to environmental factors in asthma and chronic obstructive pulmonary disease patients

BACKGROUND/AIMS

Weather and air pollution are associated with the exacerbation of respiratory diseases. We investigated patterns of medical care use according to meteorological factors and air pollution in patients with asthma or chronic obstructive pulmonary disease (COPD).

METHODS

We analyzed the medical care utilization patterns of patients with asthma or COPD registered in the Korea Health Insurance Review and Assessment database for the period 2007 to 2013. The patterns were divided into hospitalization and emergency department (ED) use.

RESULTS

The medical care use of patients with asthma or COPD increased when the mean temperature and relative humidity were lower, and the temperature difference and atmospheric pressure were greater. Medical care use increased with the concentrations of particulate matter and ozone. Among age groups, sensitivity to pollutants was greatest in patients aged ≥ 65 years. The effect of being elderly was greater for asthma than for COPD, with a higher hospitalization rate. ED utilization affected by environmental factors was significantly greater for females and hospitalization was significantly more common for males.

CONCLUSION

Meteorological factors and air pollutants were shown to contribute to increased medical care utilization by patients with asthma and COPD, particularly elderly patients. The overall effect was greater for COPD, but the effect in elderly patients was greater for asthma. In addition, the patterns of change in medical care use due to environmental factors differed according to sex.

Testosterone deficiency promotes the development of pulmonary emphysema in orchiectomized mice exposed to elastase

Testosterone deficiency is commonly observed in male patients with chronic obstructive pulmonary disease (COPD), which is characterized by chronic inflammation of the airways and pulmonary emphysema. Although clinical trials have indicated that testosterone replacement therapy can improve respiratory function in patients with COPD, the role of testosterone in the pathogenesis of COPD remains unclear. The aim of this study was to explore the effect of testosterone deficiency on the development of pulmonary emphysema in orchiectomized (ORX) mice exposed to porcine pancreatic elastase (PPE). ORX mice developed more severe emphysematous changes 21 d after PPE inhalation than non-ORX mice. Testosterone propionate supplementation significantly reduced PPE-induced emphysematous changes in ORX mice. PPE exposure also increased the number of neutrophils and T cells in bronchoalveolar lavage fluid (BALF) of mice that had undergone ORX and sham surgery. T cell counts were significantly higher in the BALF of ORX mice than of sham mice. Testosterone supplementation reduced the infiltration of T cells into BALF and alleviated emphysematous changes in the lungs of ORX mice. Our findings suggest that testosterone, a male-specific hormone, may suppress the development of pulmonary emphysema through the regulation of T cell-mediated immunity.

The Perception of Physicians on Gender-Specific Differences in the Diagnosis of COPD: Results from a Questionnaire-Based Survey

Objective

To evaluate the perception of physicians on gender-specific differences in the diagnosis of chronic obstructive pulmonary disease (COPD) using a qualitative and anonymous questionnaire-based survey.

Methods

The survey was conducted amongst respiratory physicians attending a standalone educational conference (29-30 September 2017) using the SpotMe® App. The 20-item standardized closed questionnaire had pre-coded responses to questions on physician's profile, and perception of COPD diagnosis and existing comorbidities between genders. All the responses were recorded anonymously.

Results

Of 368 physicians who downloaded the SpotMe® App and had access to the survey, 132 (35.9%) completed the survey. Respondents were predominantly hospital-based (57.3%), aged 30-49 years (54.2%), male (56.5%), and from large cities (59.5%). 68.7% of physicians perceived the prevalence of COPD to be higher in men; over 50% of physicians perceived that women were more prone to the effects of smoking. More than 60% of physicians agreed that women experience more severe symptoms (anxiety and depression) and have reduced quality of life than men. Over 50% of physicians agreed that misdiagnosis/underdiagnosis of COPD in women was an important factor for gender-differences.

Conclusion

Results from this survey indicate that the understanding of COPD burden in women varies among healthcare professionals.

Factors affecting the severity of fatigue in male patients with chronic obstructive pulmonary disease

BACKGROUND AND OBJECTIVES

Fatigue, the second most common symptom after dyspnea in patients with chronic obstructive pulmonary disease, impairs functional capacity and quality of life. This study aims to predict the factors that affect fatigue severity and investigate the effects of fatigue in patients with chronic obstructive pulmonary disease.

METHODS

Data were collected to assess demographic and clinical characteristics, cigarette consumption, fatigue severity (Fatigue Severity Scale), dyspnea severity (Medical Research Council Dyspnea Scale), level of physical activity (International Physical Activity Questionnaire-Short Form), and health-related quality of life (36-Item Short Form Health Survey).

RESULTS

A total of 64 male chronic obstructive pulmonary disease patients were evaluated (mean age 61.1±4.7 years, mean Fatigue Severity Scale score 39.8±14.4). The result of the linear regression model was significant and explained 84% of the variance in fatigue severity (Adjusted R-squared=0.84, F=29.48, df=60, p<.001). It showed that the Medical Research Council Dyspnea Scale score (β=.40), cigarette consumption (β=.35), and physical activity level (β=-.37) were significantly correlated with the severity of fatigue (p<.001 for all) and that they independently contributed to the prediction of severity of fatigue.

CONCLUSION

Dyspnea, cigarette consumption, and physical activity level affect fatigue severity. Additionally, physical activity level, pulmonary function, and health-related quality of life were also associated with fatigue. These findings support the assertion that it is important to measure fatigue and the factors that affect its severity.

Effect of Triple Therapy with Budesonide-Formoterol-Tiotropium Versus Placebo-Tiotropium on Sleep Quality in Patients with Chronic Obstructive Pulmonary Disease

Background

Factors responsible for poor sleep quality in patients with chronic obstructive pulmonary disease (COPD) includes the effects of medications. This study evaluates the effect of the inhaled triple therapy of budesonide-formoterol-tiotropium versus placebo-tiotropium on sleep quality in COPD patients.

Methods

Twenty-three patients (11 [48%] males; age 55 [51-60, 48--5] years; body mass index [BMI] 25 [22-30, 18-40] kg/m²; forced expiratory volume in 1 second [FEV₁]1.10 [0.80 -1.90, 0.60-2.80] L, 42 [31-62, 24-75] % predicted) were studied. Ten patients were randomized to budesonide-formoterol-tiotropium and 13 patients to placebo-tiotropium. At baseline and after 28 days, patients completed spirometry, polysomnography, an Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), COPD-specific St George's Respiratory Questionnaire (SGRQ-C) and short form 36 (SF 36).

Results

After 28 days, there was a significant 29% increase in the bedtime FEV₁ in the budesonide-formoterol-tiotropium group (from 0.75 [0.55-1.30, 0.50-2.40] L to 1.00 [0.75-1.55, 0.50-3.00] L, p=0.031), with no change in the placebo-tiotropium group (from 1.20 [0.80-1.50, 0.60-1.90] L to 1.15 [0.75-1.55, 0.50-1.80] L, p=0.91). No significant change was found post treatment in sleep efficiency or total sleep time in both the budesonide-formoterol-tiotropium group (from 78 [72-92, 62-98]% to 88 [77-92, 40-98]%, p=0.70 and 290 [268-358, 252-382] min to 342 [303-358, 157-372] min, p=0.77, respectively) and the placebo-tiotropium group (from 82 [75-88, 46-93]% to 84 [77-87, 62-94]%, p=0.96 and 320 [292-350, 180-378] min to 339 [303-349, 241-366] min, p=0.79, respectively). While there was no significant change in the arousal index in the budesonide-formoterol-tiotropium group (9 [5-16, 0-48] arousals/hour to 14 [9-17, 2-36] arousals/hour, p=0.43), a significant increase was seen in the placebo-tiotropium group (11 [4-13, 3--2] arousals/hour to 17 [11-21, 2-33] arousals/hour, p=0.027). Similarly, there was no change in the ESS in the budesonide-formoterol-tiotropium group (6 [3-8, 0-11] to 6 [5-8, 0-1]), p=0.44), but a marginally significant increase in the placebo-tiotropium group (8 [5-12, 2-18] to 10 [7-13, 5-18], p=0.07), with a significant difference in the ESS 28 days post treatment between the 2 groups (6 [5-8, 0-11] versus 10 [7-13, 5-18], p=0.043). There was no significant change in nocturnal oxygenation, sleep architecture, PSQI, SGRQ-C, or SF 36 in both groups.

Conclusion

In patients with COPD, inhaled triple therapy with budesonide-formoterol-tiotropium as compared to placebo-tiotropium improves pulmonary function while preserving sleep quality and architecture.

Factors affecting the severity of fatigue in male patients with chronic obstructive pulmonary disease

BACKGROUND AND OBJECTIVES

Fatigue, the second most common symptom after dyspnea in patients with chronic obstructive pulmonary disease, impairs functional capacity and quality of life. This study aims to predict the factors that affect fatigue severity and investigate the effects of fatigue in patients with chronic obstructive pulmonary disease.

METHODS

Data were collected to assess demographic and clinical characteristics, cigarette consumption, fatigue severity (Fatigue Severity Scale), dyspnea severity (Medical Research Council Dyspnea Scale), level of physical activity (International Physical Activity Questionnaire Short-Form), and health-related quality of life (36-Item Short Form Health Survey).

RESULTS

A total of 64 male COPD patients were evaluated (mean age 61.1 ± 4.7 years, mean FSS score 39.8 ± 14.4). The result of the linear regression model was significant and explained 84% of the variance in fatigue severity (Adjusted R-squared = 0.84, F = 29.48, df = 60, p < .001). It showed that the MRC score (β = .40), cigarette consumption (β = .35), and physical activity level (β = -.37) were significantly correlated with the severity of fatigue (p < .001 for all) and that they independently contributed to the prediction of severity of fatigue.

CONCLUSION

Dyspnea, cigarette consumption, and physical activity level affect fatigue severity. Additionally, physical activity level, pulmonary function, and HRQOL were also associated with fatigue. These findings support the assertion that it is important to measure fatigue and the factors that affect its severity.

Gender does not impact the short- or long-term outcomes of home-based pulmonary rehabilitation in patients with COPD

Pulmonary rehabilitation, whether performed at home or in a specialised centre, is effective in the management of COPD. As gender-related differences in COPD were previously reported, we aimed to evaluate the impact of gender on pulmonary rehabilitation outcomes in the short, medium and long term.

In this retrospective observational study of 170 women and 310 men with COPD, we compared the outcomes of an 8-week home-based pulmonary rehabilitation programme including an individualised plan of retraining exercises, physical activities, therapeutic education, and psychosocial and self-management support. Exercise tolerance, anxiety, depression, and quality of life (QOL) were assessed using the 6-min stepper test (6MST), Hospital Anxiety and Depression Scale (HADS) and Visual Simplified Respiratory Questionnaire (VSRQ), respectively. Assessments were carried out before, immediately after the pulmonary rehabilitation programme (T2) and at 8 (T8) and 14 months (T14).

At baseline, women were younger (mean 62.1 versus 65.3 years), more often nonsmokers (24.7% versus 7.7%) and had a higher body mass index (28 versus 26.4 kg·m⁻²). They more often lived alone (50.6% versus 24.5%) and experienced social deprivation (66.7% versus 56.4%). They had significantly lower exercise tolerance (−34 strokes, 6MST) and higher anxiety and depression (+3.2 HADS total score), but there were no between gender differences in QOL (VSRQ). Both groups showed similar improvements in all outcome measures at T2, T8 and T14 with a tendency for men to lose QOL profits over time.

Despite some differences in baseline characteristics, women and men with COPD had similar short-, medium- and long-term benefits of a home-based pulmonary rehabilitation programme.

Despite some differences in baseline characteristics, women and men with COPD had similar short-, medium- and long-term benefits of a home-based pulmonary rehabilitation programmehttps://bit.ly/2XfFakK

Sex differences between women and men with COPD: A new analysis of the 3CIA study

BACKGROUND

There is partial evidence that COPD is expressed differently in women than in men, namely on symptoms, pulmonary function, exacerbations, comorbidities or prognosis. There is a need to improve the characterization of COPD in females.

METHODS

We obtained and pooled data of 17 139 patients from 22 COPD cohorts and analysed the clinical differences by sex, establishing the relationship between these characteristics in women and the prognosis and severity of the disease. Comparisons were established with standard statistics and survival analysis, including crude and multivariate Cox-regression analysis.

RESULTS

Overall, 5355 (31.2%) women were compared with men with COPD. Women were younger, had lower pack-years, greater FEV₁%, lower BMI and a greater number of exacerbations (all p < 0.05). On symptoms, women reported more dyspnea, equal cough but less expectoration (p < 0.001). There were no differences in the BODE index score in women (2.4) versus men (2.4) (p = 0.5), but the distribution of all BODE components was highly variable by sex within different thresholds of BODE. On prognosis, 5-year survival was higher in COPD females (86.9%) than in males (76.3%), p < 0.001, in all patients and within each of the specific comorbidities that we assessed. The crude and adjusted RR and 95% C.I. for death in males was 1.82 (1.69-1.96) and 1.73 (1.50-2.00), respectively.

CONCLUSIONS

COPD in women has some characteristic traits expressed differently than compared to men, mainly with more dyspnea and COPD exacerbations and less phlegm, among others, although long-term survival appears better in female COPD patients.

Incorporating Comprehensive Assessment Parameters to Better Characterize and Plan Rehabilitation for Persons with Chronic Obstructive Pulmonary Disease

OBJECTIVES

The current management of chronic obstructive pulmonary disease (COPD) largely ignores its heterogeneous pulmonary and extrapulmonary manifestations in the individual patient. This study aimed to identify clusters of patients with COPD based on a thorough traits assessment.

DESIGN

An observational, prospective, single-center study.

SETTING AND PARTICIPANTS

Patients with COPD referred by chest physicians for a comprehensive pulmonary rehabilitation program to CIRO (Horn, the Netherlands) were eligible to participate. CIRO is a specialized pulmonary rehabilitation center in the southern part of the Netherlands for patients with complex underlying respiratory diseases.

METHODS

Clinically stable patients with COPD underwent a comprehensive assessment, including pulmonary traits (airflow limitation, static hyperinflation, gas transfer, respiratory pressures, and arterial blood gases), extrapulmonary functional traits, and health status (quadriceps muscle strength, physical functioning, body composition, comorbidities, symptoms perception, and social and emotional functioning). Clusters were generated using the SOM-Ward Cluster algorithm, a hybrid algorithm that applies the classical hierarchical method of Ward on top of the self-organizing map topology.

RESULTS

Based on the abovementioned attributes of 518 patients with mild to very severe COPD (44% women, age 64.1 ± 9.1 years, forced expiratory volume in the first second 48.6% ± 20.0% of predicted), 7 clusters were identified. Clusters had unique patterns differing in demographics, pulmonary, extrapulmonary functional, and behavioral traits and/or health status.

CONCLUSION AND IMPLICATIONS

The tremendous heterogeneity in pulmonary, extrapulmonary functional and behavioral traits, and health status in patients with COPD supports the need for an individual comprehensive assessment and a goal-directed personalized management strategy.

Immediate postoperative high-sensitivity troponin T concentrations and long-term patient-reported health-related quality of life: A prospective cohort study

BACKGROUND

Myocardial injury after noncardiac surgery is associated with mortality and major adverse postoperative cardiovascular events. The effect of postoperative troponin concentrations on patient-reported health-related quality of life (HRQoL) is unknown.

OBJECTIVE

The study examined the association between immediate postoperative troponin concentrations and self-reported HRQoL 1 year after surgery.

DESIGN

Prospective cohort study.

SETTING

Single-centre tertiary care hospital in the Netherlands between July 2012 and 2015.

PATIENTS

Patients aged at least 60 years undergoing moderate and major noncardiac surgery.

INTERVENTION

None.

MAIN OUTCOME MEASURES

HRQoL total score was assessed with the EuroQol five-dimensional questionnaire. Tobit regression analysis was used to determine the association between postoperative troponin concentrations and 1-year HRQoL. Peak high-sensitivity troponin T values were divided into four categories: less than 14, 14 to 49, 50 to 149 and at least 150 ng l.

RESULTS

A total of 3085 patients with troponin measurements were included. 2634 (85.4%) patients were alive at 1-year follow-up of whom 1297 (49.2%) returned a completed questionnaire. The median score for HRQoL was 0.82 (0.85, 0.81, 0.77 and 0.71 per increasing troponin category). Multivariable analysis revealed betas of -0.06 [95% confidence interval (CI) -0.09 to -0.02], -0.11 (95% CI -0.18 to -0.04) and -0.18 (95% CI -0.29 to -0.07) for troponin levels of 14 to 49, 50 to 149 and at least 150 ng l when compared with values less than 14 ng l. Other independent predictors for lower HRQoL were chronic obstructive pulmonary disease, female sex, peripheral arterial disease and increasing age.

CONCLUSION

Higher levels of postoperative troponin measured immediately after surgery were independently associated with lower self-reported HRQoL total score at 1-year follow-up.

Exploring characteristics of COPD patients with clinical improvement after integrated disease management or usual care: post-hoc analysis of the RECODE study

BACKGROUND

The cluster randomized controlled trial on (cost-)effectiveness of integrated chronic obstructive pulmonary disease (COPD) management in primary care (RECODE) showed that integrated disease management (IDM) in primary care had no effect on quality of life (QOL) in COPD patients compared with usual care (guideline-supported non-programmatic care). It is possible that only a subset of COPD patients in primary care benefit from IDM. We therefore examined which patients benefit from IDM, and whether patient characteristics predict clinical improvement over time.

METHOD

Post-hoc analyses of the RECODE trial among 1086 COPD patients. Logistic regression analyses were performed with baseline characteristics as predictors to examine determinants of improvement in QOL, defined as a minimal decline in Clinical COPD Questionnaire (CCQ) of 0.4 points after 12 and 24 months of IDM. We also performed moderation analyses to examine whether predictors of clinical improvement differed between IDM and usual care.

RESULTS

Regardless of treatment type, more severe dyspnea (MRC) was the most important predictor of clinically improved QOL at 12 and 24 months, suggesting that these patients have most room for improvement. Clinical improvement with IDM was associated with female gender (12-months) and being younger (24-months), and improvement with usual care was associated with having a depression (24-months).

CONCLUSIONS

More severe dyspnea is a key predictor of improved QOL in COPD patients over time. More research is needed to replicate patient characteristics associated with clinical improvement with IDM, such that IDM programs can be offered to patients that benefit the most, and can potentially be adjusted to meet the needs of other patient groups as well.

TRIAL REGISTRATION

Netherlands Trial Register, NTR2268. Registered 31 March 2010.

Effect of Gender on Lung Function and Patient-Reported Outcomes in Patients with COPD Receiving Nebulized Glycopyrrolate

Purpose

The clinical manifestation of COPD can differ by gender, with women experiencing worse lung function and health-related quality of life than men. Additionally, women tend to report more symptoms given the same disease severity. Accordingly, the impact of gender on efficacy and safety in patients with moderate-to-very-severe COPD was examined following 12 weeks of nebulized glycopyrrolate (GLY) 25 µg twice daily (BID) or placebo.

Patients and Methods

GLY and placebo pooled data from the replicate 12-week GOLDEN 3 and 4 studies (n=861) were grouped by gender. Endpoints reported were change from baseline in trough forced expiratory volume in 1 second (FEV1), St George's Respiratory Questionnaire (SGRQ) and EXAcerbations of COPD Tool-Respiratory Symptoms (EXACT-RS) total scores. Safety was evaluated by reviewing the incidence of adverse events (AEs) and serious AEs.

Results

Men (placebo: 54.7%; GLY: 56.1%) were generally older with a greater proportion of high cardiovascular risk and use of background long-acting β2-agonists or inhaled corticosteroids. GLY treatment resulted in significant, clinically important improvements in trough FEV1, regardless of gender. Patients treated with GLY reported significant improvements in SGRQ total score, irrespective of gender; however, the improvement was numerically higher in women. Although EXACT-RS improved in both genders, only women experienced a significant improvement. Overall, GLY was well tolerated with a numerically lower incidence of AEs in men than women.

Conclusion

Treatment with nebulized GLY resulted in lung function, SGRQ total score, and EXACT-RS total score improvements regardless of gender. However, only EXACT-RS showed significantly greater improvements in women compared with men. Treatment with GLY was generally well tolerated across genders. These data support the efficacy and safety of GLY 25 µg BID in patients with moderate-to-very-severe COPD, independent of gender. Gender similarities in airflow improvement and differences in symptom-reporting augment the evidence supporting the consideration of individualized treatment plans for COPD patients.

Chronic Cough and Phlegm in Subjects Undergoing Comprehensive Health Examination in Japan - Survey of Chronic Obstructive Pulmonary Disease Patients Epidemiology in Japan (SCOPE-J)

Purpose

The purpose of this study was to estimate the prevalence of subjects with chronic cough and phlegm and describe their characteristics including the presence or absence of airflow limitation among the general population in Japan.

Subjects and Methods

This was an observational cross-sectional survey targeting multiple regions of Japan. Subjects aged 40 years or above who were undergoing comprehensive health examination were recruited. The existence of chronic cough and phlegm, airflow limitation, and treatment for respiratory diseases were examined. Chronic cough and phlegm were defined as having both symptoms for at least 3 months of the year and for at least 2 consecutive years, or as receiving any treatment for chronic bronchitis at the time of recruitment. Airflow limitation was defined as forced expiratory volume in 1 s/forced vital capacity (FEV1/FVC) less than 0.7.

Results

In a total of 22,293 subjects, 380 subjects (1.7%) had chronic cough and phlegm. Among these 380 subjects, 21.8% received treatment for a respiratory disease, and 11.6% had airflow limitation. Compared to subjects without both chronic cough and phlegm but with airflow limitation, subjects with chronic cough and phlegm without airflow limitation were younger, more likely to be current smokers (39.6%), and had higher total scores on a chronic obstructive pulmonary disease (COPD) assessment test (CAT). Scores of CAT questions 1-4 (cough, phlegm, chest tightness, breathlessness, respectively) were higher in subjects with chronic cough and phlegm regardless of airflow limitation.

Conclusion

This study demonstrated that subjects identified to have chronic cough and phlegm in comprehensive health examination settings were symptomatic, while most of them did not receive any treatment for respiratory diseases and did not have airflow limitation. Screening subjects for chronic cough and phlegm in a comprehensive health examination followed by a detailed examination of screened subjects could be an effective approach for better management of chronic cough and phlegm. Smoking cessation should be included in the management, in consideration that around 40% of subjects with chronic cough and phlegm were current smokers.

Characteristics of Chronic Obstructive Pulmonary Disease Patients with Pulmonary Hypertension Assessed by Echocardiography in a Three-Year Observational Cohort Study

Background

Pulmonary hypertension (PH) is a major comorbidity of chronic obstructive pulmonary disease (COPD). However, the association of PH detected by echocardiography and COPD-related outcome in longitudinal follow-up has not been elucidated. In this study, we aimed to investigate the relationship between clinical characteristics of COPD patients with PH detected by echocardiography and various outcome parameters such as COPD exacerbation and health status over a three-year observation period.

Methods

In this observational study, we analyzed patients with COPD who underwent chest computed tomography and echocardiography at baseline (n = 183).

Results

The prevalence of PH was 21.9% (40 patients). The median estimated systolic pulmonary artery pressure in patients with PH was 38.8 mmHg. COPD patients with PH were older, had a lower body mass index, scored worse in the COPD Assessment Test and St. George's Respiratory Questionnaire, and exhibited a lower diffusing capacity of the lung for carbon monoxide in comparison to patients without PH. In computed tomography images, the percentages of low-attenuation areas (LAA%) and interstitial abnormalities were higher in COPD patients with PH than in those without PH. Higher values for LAA% (LAA ≥ 30%) and interstitial abnormalities independently increased the risk of PH. The ratio of main pulmonary diameter to aortic artery diameter was significantly correlated with estimated systolic pulmonary artery pressure. In the follow-up analysis, the frequency of exacerbations in three years was significantly higher in patients with PH compared to patients without PH.

Conclusion

In this study, we identified the clinical characteristics of COPD patients with PH detected by echocardiography. The presence of PH assessed by echocardiography was related to future COPD exacerbations and closely related to radiographical emphysema.

Activities of Daily Living and Life-Space Mobility in Older Adults with Chronic Obstructive Pulmonary Disease

Purpose

The aim of this study was to investigate whether limitation during the performance of activities of daily living (ADL) was associated with life-space mobility in older people with chronic obstructive pulmonary disease (COPD), and to generate a regression model for life-space mobility score.

Patients and Methods

This cross-sectional study with a convenience sample included older people (aged ≥60 years old) with COPD. We assessed participants’ lung function (spirometry), life-space mobility (University of Alabama at Birmingham Study of Aging Life-Space Assessment questionnaire), severity of dyspnea (Modified Dyspnea Index) and limitation during the performance of ADL (London Chest Activity of Daily Living). We used Pearson’s correlation to investigate the associations between the measures, and multiple linear regression to detect which of the measures influenced life-space mobility. Statistical significance was set at 5%.

Results

Fifty participants completed all the assessments (29 females [58%]; mean ± SD age of 67 ± 6 years old, FEV₁ 47 ± 29% of predicted, and body mass index 22.5 ± 11.6 kg/m²). Their mean scores for life-space mobility and for limitation during the performance of ADL were 49.7 ± 27.2 and 16.46 ± 9.74, respectively. We found a strong inverse correlation between limitation during the performance of ADL and life-space mobility (r = −0.57, p = <0.01) as well as between severity of dyspnea and life-space mobility (r= 0.86, p= <0.01). Both sex and limitation during the performance of ADL were considered as independent factors associated to life-space mobility (R²= 0.56).

Conclusion

In this study, limitations during the performance of ADL and dyspnea had a strong correlation with life-space mobility in older adults with COPD. Also, alongside sex, the limitation during the performance of ADL is an independent factor associated with life-space mobility in a regression model.

Chronic obstructive pulmonary disease (COPD) in Spain and the different aspects of its social impact: a multidisciplinary opinion document

Chronic obstructive pulmonary disease (COPD) is one of the most prevalent diseases in the World, and one of the most important causes of mortality and morbidity. In adults 40 years and older, it affects more than 10% of the population and has enormous personal, family and social burden. Tobacco smoking is its main cause, but not the only one, and there is probably a genetic predisposition that increases the risk in some patients. The paradigm of this disease is changing in Spain, with an increase of women that has occurred in recent years. Many of the physio pathological mechanisms of this condition are well known, but the psychological alterations to which it leads, the impact of COPD on relatives and caregivers, the limitation of daily life observed in these patients, and the economic and societal burden that they represent for the health system, are not so well-known. A major problem is the high under-diagnosis, mainly due to difficulties for obtaining, in a systematic way, spirometries in hospitals and health-care centers. For this reason, the Fundación de Ciencias de la Salud and the Spanish National Network Center for Research in Respiratory Diseases (CIBERES) have brought together experts in COPD, patients and their organizations, clinical psychologists, experts in health economics, nurses and journalists to obtain their opinion about COPD in Spain. They also discussed the scientific bibliometrics on COPD that is being carried out from the CIBERES and speculated on the future of this condition. The format of the meeting consisted in the discussion of a series of questions that were addressed by different speakers and discussed until a consensus conclusion was reached.

Gender differences among Swedish COPD patients: results from the ARCTIC, a real-world retrospective cohort study

The present study aimed to generate real-world evidence regarding gender differences among chronic obstructive pulmonary disease (COPD) patients, especially as regards the diagnosis and outcomes in order to identify areas for improvement and management and optimize the associated healthcare resource allocation. ARCTIC is a large, real-world, retrospective cohort study conducted in Swedish COPD patients and a matched reference population from 52 primary care centers in 2000–2014. The incidence of COPD, prevalence of asthma and other comorbidities, risk of exacerbations, mortality rate, COPD drug prescriptions, and healthcare resource utilization were analyzed. In total, 17,479 patients with COPD were included in the study. During the study period, COPD was more frequent among women (53.8%) and women with COPD experienced more exacerbations vs. men (6.66 vs. 4.66). However, the overall mortality rate was higher in men compared with women (45% vs. 38%), but no difference for mortality due to COPD was seen between genders over the study period. Women seemed to have a greater susceptibility to asthma, fractures, osteoporosis, rheumatoid arthritis, rhinitis, depression, and anxiety, but appeared less likely to have diabetes, kidney diseases, and cardiovascular diseases. Furthermore, women had a greater risk of COPD-related hospitalization and were likely to receive a significantly higher number of COPD drug prescriptions compared with men. These results support the need to reduce disease burden among women with COPD and highlight the role of healthcare professionals in primary care who should consider all these parameters in order to properly diagnose and treat women with COPD.

Personalized medicine for patients with COPD: where are we?

Chronic airflow limitation is the common denominator of patients with chronic obstructive pulmonary disease (COPD). However, it is not possible to predict morbidity and mortality of individual patients based on the degree of lung function impairment, nor does the degree of airflow limitation allow guidance regarding therapies. Over the last decades, understanding of the factors contributing to the heterogeneity of disease trajectories, clinical presentation, and response to existing therapies has greatly advanced. Indeed, diagnostic assessment and treatment algorithms for COPD have become more personalized. In addition to the pulmonary abnormalities and inhaler therapies, extra-pulmonary features and comorbidities have been studied and are considered essential components of comprehensive disease management, including lifestyle interventions. Despite these advances, predicting and/or modifying the course of the disease remains currently impossible, and selection of patients with a beneficial response to specific interventions is unsatisfactory. Consequently, non-response to pharmacologic and non-pharmacologic treatments is common, and many patients have refractory symptoms. Thus, there is an ongoing urgency for a more targeted and holistic management of the disease, incorporating the basic principles of P4 medicine (predictive, preventive, personalized, and participatory). This review describes the current status and unmet needs regarding personalized medicine for patients with COPD. Also, it proposes a systems medicine approach, integrating genetic, environmental, (micro)biological, and clinical factors in experimental and computational models in order to decipher the multilevel complexity of COPD. Ultimately, the acquired insights will enable the development of clinical decision support systems and advance personalized medicine for patients with COPD.

Differences in COPD Exacerbation Risk Between Women and Men: Analysis From the UK Clinical Practice Research Datalink Data

BACKGROUND

Historically, COPD has been considered to affect mostly older men with a history of smoking; however, in recent times, its prevalence and mortality rates have steadily increased among women.

OBJECTIVES

The goal of this study was to systematically assess differences in COPD expression between women and men in UK primary care clinics who were newly diagnosed with COPD.

METHODS

This retrospective cohort study compared women and men with an incident diagnosis of COPD by using electronic medical records data from the Clinical Practice Research Datalink and linked Hospital Episode Statistics data. The overall study period was between January 1, 2006, and February 28, 2016; patients with an incident diagnosis of COPD between January 1, 2010, and February 28, 2015, were analyzed.

RESULTS

A cohort of 22,429 patients were identified as incident patients and included in the study; 48% of patients with COPD were women. The risk of first moderate or severe exacerbation was 17% greater in women than in men (hazard ratio, 1.17; 95% CI, 1.12-1.23), with a median time to first exacerbation of 504 days for women and 637 days for men. These differences were more prominent in the younger age group (≥ 40 years to < 65 years), as well as in Global Initiative for Chronic Obstructive Lung Disease 2016 groups B, C, and D and in individuals with moderate to severe airflow obstruction. The annual rate of moderate or severe exacerbations was higher in women compared with men in the first, second, and third year of follow-up.

CONCLUSIONS

These results highlight the unmet need for appropriate identification and management of women with COPD in clinical practice.

Functional Status of Patients with COPD Assessed by London Chest Activity of Daily Living Scale: Gender Association and Validity of a Cutoff Point

PURPOSE

Whether the difference in the impact of chronic obstructive pulmonary disease (COPD) on the functional status of men and women stems from clinical distinctions or to the measuring instrument used is unclear. Like most instruments for assessing functional limitation in COPD, the interpretation of the results of the London Chest Activity of Daily Living (LCADL) scale is limited because a lack of a valid cutoff point to this scale. For that, this study sought to compare the functional status between men and women with COPD; and propose a cutoff point for LCADL capable of discriminating the prognosis of these individuals.

METHODS

A sample of 138 subjects with moderate-severe COPD was evaluated by the LCADL. The percentage of the individual maximum score was used to obtain a cutoff point capable of discriminating patients with the worse prognosis according to the BODE Index. The cutoff point was also tested in an independent sample (n = 70).

RESULTS

Regarding the total score, domestic and leisure domains of the LCADL, men had better scores than women (P ≤ 0.01). The cutoff point found was 37% (area under the curve = 0.70, 95% confidence interval = 0.60-0.80, sensitivity = 0.55 and specificity = 0.74). Individuals who scored ≥ 37% had a worse prognosis and level of physical activities of daily living than those who scored below (P ≤ 0.02).

CONCLUSION

When evaluated by the LCADL, men and women with COPD present difference in the functional status. The established cutoff point (37%) adequately discriminates individuals regarding the prognosis, contributing to improve the interpretation capacity of the LCADL.

Women and COPD: do we need more evidence?

The increasingly female face of chronic obstructive pulmonary disease (COPD) prevalence among women has equalled that of men since 2008, due in part to increased tobacco use among women worldwide and exposure to biomass fuels. This finding is supported by a number of characteristics. There is evidence of susceptibility to smoking and other airborne contaminants, along with epidemiological and phenotypic manifestations. COPD has thus become the leading cause of death in women in the USA. The clinical presentation is characterised by increasingly pronounced dyspnoea with a marked tendency towards anxiety and depression, undernutrition, nonsmall cell lung cancer (especially adenocarcinoma) and osteoporosis. Quality of life is also more significantly impacted. The theories advanced to explain these differences involve the role played by oestrogens, impaired gas exchange in the lungs and smoking habits. While these differences require appropriate therapeutic responses (smoking cessation, pulmonary rehabilitation, long-term oxygen therapy), barriers to the treatment of women with COPD include greater under-diagnosis than in men, fewer spirometry tests and medical consultations. Faced with this serious public health problem, we need to update and adapt our knowledge to the epidemiological changes.

The face of COPD is increasingly female. We need more evidence and a change in how the disease is managed. http://ow.ly/zueL30mWqlS

Gender Differences in Chronic Obstructive Pulmonary Disease Using the Lung Information Needs Questionnaire

Aim: To investigate gender-related information needs in patients with chronic obstructive pulmonary disease (COPD) using the Lung Information Needs Questionnaire (LINQ). Design: Cross-sectional, prospective cohort study. Methods: Patients with COPD receiving standardized self-management education including information regarding disease knowledge, medications, avoidance of exacerbation, smoking cessation, exercise, and nutrition were included. Gender differences were assessed by pulmonary function tests, 6-minute walking test, modified Medical Research Council dyspnea scale, Mini-Mental State Examination, St. George's Respiratory Questionnaire, and LINQ. Results: A total of 122 patients were enrolled. Females displayed significantly higher information needs for total LINQ score (p < .001), avoidance of exacerbation (p < .03), and nutrition (p < .006). Significant correlations were seen between total LINQ score and gender (p = .001), forced expiratory volume in 1 second, % predicted (p = .003), and Mini-Mental State Examination (p = .002) for male patients. In females, modified Medical Research Council dyspnea scale was correlated with the total LINQ score (p = .04).

Assessing hostility in patients with chronic obstructive pulmonary disease (COPD)

COPD is a disease that can adversely affect patients' psychology. The purpose of this study is to investigate whether COPD patients feel increased hostility, and if hostility is associated with socio-economic factors. A cross-sectional study was conducted in 203 COPD patients in primary health care services in Greece, using the hostility and direction of hostility questionnaire HDHQ. Patient demographics, smoking habits, body mass index (BMI) and disease grade were also recorded. The results showed significant differences between males and females, with women exhibiting higher hostility (p = 0.004). Age correlates negatively with hostility, with younger patients showing higher values. Patients who continue to smoke (p = 0.005), and those in a very poor financial situation, have a much higher level of hostility. Regarding family status, married patients show the least hostility. In patients with very severe COPD and those with low education (p = 0.035) there is a high level of self-criticism. In conclusion, patients with COPD, still smokers, single, low-income and low-educated, especially female patients, have a higher risk of developing hostility. These findings suggest a need for further research in order to clarify the complexity of the different risk factors.

Impact of cataract on health-related quality of life in a longitudinal Japanese chronic obstructive pulmonary cohort

Cigarette smoking increases the risk of developing both cataract and chronic obstructive pulmonary disease (COPD). The prevalence of cataract and the clinical characteristics of COPD patients with cataract were retrospectively investigated in a 2-year observational COPD cohort. We analyzed 395 patients with complete data on ophthalmologic evaluation (319 subjects with COPD and 76 subjects at risk of COPD). There was no difference in the prevalence of cataract between COPD patients and those at risk (47.0% vs. 42.1%, p = 0.44). Age ≥ 75 years, low body mass index, and hypertension were independently associated with cataract as a comorbidity in COPD. The incidence of exacerbation within 2 years was significantly higher in COPD patients with cataract than those without cataract (36.6% vs. 18.3%, p = 0.0019). COPD patients with cataract exhibited significantly higher COPD assessment test score compared to those without cataract (13.7 ± 8.9 vs. 11.5 ± 7.2, p = 0.0240). Overall St George's Respiratory Questionnaire score and each component were significantly worse in COPD patients with cataract compared to those without cataract. COPD patients with cataract exhibited poor health-related quality of life and frequent exacerbations. The association between cataract and exacerbations of COPD deserves further attention.