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Choate R, Holm KE, Sandhaus RA, Mannino DM, Strange C. Long-Term SGRQ Stability in a Cohort of Individuals with Alpha-1 Antitrypsin Deficiency-Associated Lung Disease. Int J Chron Obstruct Pulmon Dis 2024; 19:889-900. [PMID: 38617018 PMCID: PMC11016265 DOI: 10.2147/copd.s443183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 03/25/2024] [Indexed: 04/16/2024] Open
Abstract
Background Health-related quality of life (HRQoL) assessments such as St. George's Respiratory Questionnaire (SGRQ) are often used as outcome measures to evaluate patient-perceived changes in health status among individuals with lung disease. Several factors have been linked to deterioration in SGRQ, including symptoms (dyspnea, wheezing) and exercise intolerance. Whether these findings apply to individuals with alpha-1 antitrypsin deficiency (AATD) remains incompletely studied. This longitudinal study examines the trajectory of SGRQ scores in a cohort of United States individuals with AATD-associated lung disease and defines factors associated with longitudinal change. Methods Individuals with AATD-associated lung disease enrolled in AlphaNet, a disease management program, who had ≥3 SGRQ measurements collected between 2009 and 2019, and baseline data for clinically important variables were included in these analyses. Data collected after lung transplants were excluded. Mixed-effects model analyses were used to evaluate the changes in SGRQ total and subscale scores over time and by modified Medical Research Council (mMRC) Scale, use of oxygen, age, sex, productive cough, and exacerbation frequency at baseline. Sensitivity analyses were conducted to examine the potential effect of survivor bias. Results Participants (n=2456, mean age 57.1±9.9 years, 47% female) had a mean SGRQ total score of 44.7±18.9 at baseline, 48% used oxygen regularly, and 55% had ≥2 exacerbations per year. The median length of follow-up was 6 (IQR 3-9) years. The SGRQ total score and subscales remained stable throughout the observation period. Age, mMRC categories, presence or absence of productive cough, frequency of exacerbations, and use of oxygen at baseline were significantly associated with the rate of change of SGRQ total (p<0.0001). Conclusion We observed long-term stability in HRQoL and an association between the rate of change in SGRQ and baseline mMRC, exacerbation frequency, productive cough, and use of oxygen in this cohort of individuals with AATD-associated lung disease.
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Affiliation(s)
- Radmila Choate
- University of Kentucky College of Public Health, Lexington, Kentucky, USA
| | - Kristen E Holm
- Department of Medicine, National Jewish Health, Denver, Colorado, USA
- Alphanet, Inc., Coral Gables, Florida, USA
| | - Robert A Sandhaus
- Department of Medicine, National Jewish Health, Denver, Colorado, USA
- Alphanet, Inc., Coral Gables, Florida, USA
| | - David M Mannino
- University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Charlie Strange
- Alphanet, Inc., Coral Gables, Florida, USA
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
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Choate R, Holm KE, Sandhaus RA, Mannino DM, Strange C. Characteristics associated with SF-36 in alpha-1 antitrypsin deficiency-associated COPD: a cross-sectional analysis. BMC Pulm Med 2024; 24:138. [PMID: 38500152 PMCID: PMC10949668 DOI: 10.1186/s12890-024-02953-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 03/05/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND Generic measures of health-related quality of life (HRQoL), such as the 36-Item Short Form Survey (SF-36), are widely used in assessing chronic conditions. These tools have an advantage over disease-specific instruments, as they allow comparisons across different health conditions and with the general population. In alpha-1 antitrypsin deficiency (AATD)-associated chronic obstructive pulmonary disease (COPD), HRQoL research remains scarce. This cross-sectional study evaluates the factors associated with HRQoL in a cohort of patients with AATD-associated COPD. METHODS Our study included participants of AlphaNet (2008-2019), a health management organization for people with AATD in the US who are prescribed augmentation therapy. Norm-based SF-36 scores for the mental and physical component summary scores (MCS and PCS, mean of 50 ± 10 in the general US population) and 8 individual scales were evaluated. Individuals with lung disease and data available on ≥1 measurement on any SF-36 scale and clinically relevant characteristics such as modified Medical Research Council (mMRC) scale, exacerbation frequency, productive cough, and use of oxygen were included in these analyses. Generalized linear regression models were fit to examine the association of baseline characteristics with MCS and PCS scores. Age, sex, regular use of oxygen, exacerbation frequency, mMRC, and productive cough were included in these models. RESULTS Participants (n=4398, mean age 57.6 [SD=10.6] years, 45.4% female) had a mean MCS score of 51.2 ± 10.8 and PCS of 36.3 ± 9.8. The average mMRC score was 2.4 ± 1.3, and 56.4% had 2 or more exacerbations per year. Overall, the physical component of SF-36 was more severely impacted compared to the mental component. In multivariable regression analyses, PCS scores were significantly associated with exacerbation frequency, mMRC, regular use of oxygen, and productive cough; MCS was associated with age, sex, exacerbation frequency, mMRC, and productive cough. CONCLUSIONS These findings demonstrate that patient-perceived physical health is significantly impaired in this cohort of people with AATD-associated COPD compared to mental health. Longitudinal studies are needed to evaluate the change in physical and mental health status over time in this population.
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Affiliation(s)
- Radmila Choate
- University of Kentucky College of Public Health, Lexington, Kentucky, United States.
| | - Kristen E Holm
- Department of Medicine, National Jewish Health, Denver, Colorado, United States
- AlphaNet, Inc, Coral Gables, Florida, United States
| | - Robert A Sandhaus
- Department of Medicine, National Jewish Health, Denver, Colorado, United States
- AlphaNet, Inc, Coral Gables, Florida, United States
| | - David M Mannino
- University of Kentucky College of Medicine, Lexington, Kentucky, United States
| | - Charlie Strange
- AlphaNet, Inc, Coral Gables, Florida, United States
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Medical University of South Carolina, Charleston, South Carolina, United States
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Ellis P, Bailey E, Choate R, Holm KE, Sandhaus RA, Turner AM, Newnham M. Prevalence of Cardiovascular Disease and Rate of Major Adverse Cardiovascular Events in Severe Alpha-1 Antitrypsin Deficiency COPD. Int J Chron Obstruct Pulmon Dis 2024; 19:149-159. [PMID: 38249829 PMCID: PMC10800105 DOI: 10.2147/copd.s419846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 12/05/2023] [Indexed: 01/23/2024] Open
Abstract
Aim Alpha-1 antitrypsin deficiency is an autosomal co-dominant condition that predisposes individuals to early-onset emphysema. As with COPD, AATD-COPD is associated with pulmonary exacerbations, which impacts on overall mortality and quality of life. Though there is evidence that COPD is associated with a higher prevalence of cardiovascular disease and major adverse cardiovascular events (MACE), it is unclear if this is true for patients with AATD-COPD. Methods Prevalence of cardiovascular disease was determined in two separate severe AATD cohorts: AlphaNet, USA and the Birmingham AATD registry, UK. All patients had preexisting lung disease. Cardiovascular disease was defined as presence of any of the following: heart failure, ischaemic heart disease, atrial fibrillation, stroke, and myocardial infarction. A Cox proportional hazards model was used to assess the impact of prior cardiovascular disease and frequent exacerbator phenotype on risk of future MACE. Results Out of 3493 patients with severe AATD, 14.7% had prior cardiovascular disease, including stroke (2.3%), myocardial infarction (2.2%), and heart failure (2.5%). Frequent exacerbators were more likely to have preexisting cardiovascular disease compared with those with one or no exacerbations in the preceding year (63% vs 44.8%, p = 0.001). There was increased risk of future MACE in frequent exacerbators (HR 1.85, 95% CI 1.24 to 2.75), former and current smokers (HR 1.80, 95% CI 1.07 to 3.02, p = 0.026, and HR 4.04, 95% CI 1.44 to 11.32, p = 0.008, respectively), and those with prior cardiovascular disease (HR 3.81, 95% CI 2.60 to 5.58, p < 0.001). Conclusion In severe AATD-COPD, MACE are associated with an increased exacerbation frequency, previous cardiovascular disease, and a history of smoking.
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Affiliation(s)
- Paul Ellis
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Emily Bailey
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Radmila Choate
- University of Kentucky College of Public Health, Lexington, KY, USA
| | - Kristen E Holm
- Division of Neurology and Behavioural Health, National Jewish Health, Denver, CO, USA
- AlphaNet, Kissimmee, FL, USA
| | - Robert A Sandhaus
- AlphaNet, Kissimmee, FL, USA
- Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, CO, USA
| | - Alice M Turner
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Michael Newnham
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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Choate R, Holm KE, Sandhaus RA, Mannino DM, Strange C. Health-related Quality of Life in Alpha-1 Antitrypsin Deficiency-associated Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med 2023; 208:1132-1134. [PMID: 37581489 DOI: 10.1164/rccm.202304-0697le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 08/14/2023] [Indexed: 08/16/2023] Open
Affiliation(s)
| | - Kristen E Holm
- Department of Medicine, National Jewish Health, Denver, Colorado
- AlphaNet, Inc., Coral Gables, Florida; and
| | - Robert A Sandhaus
- Department of Medicine, National Jewish Health, Denver, Colorado
- AlphaNet, Inc., Coral Gables, Florida; and
| | - David M Mannino
- College of Medicine, University of Kentucky, Lexington, Kentucky
| | - Charlie Strange
- AlphaNet, Inc., Coral Gables, Florida; and
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Medical University of South Carolina, Charleston, South Carolina
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Prieto-Centurion V, Holm KE, Casaburi R, Porszasz J, Basu S, Bracken NE, Gallardo R, Gonzalez V, Illendula SD, Sandhaus RA, Sullivan JL, Walsh LJ, Gerald LB, Krishnan JA. A Hybrid Effectiveness/Implementation Clinical Trial of Adherence to Long-Term Oxygen Therapy for Chronic Obstructive Pulmonary Disease. Ann Am Thorac Soc 2023; 20:1561-1570. [PMID: 37683098 PMCID: PMC10632931 DOI: 10.1513/annalsats.202302-104oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 09/07/2023] [Indexed: 09/10/2023] Open
Abstract
Rationale: Interventions to promote adherence to long-term oxygen therapy (LTOT) in chronic obstructive pulmonary disease (COPD) are needed. Objectives: To examine the real-world effectiveness of phone-based peer coaching on LTOT adherence and other outcomes in a pragmatic trial of patients with COPD. Methods: In a hybrid effectiveness/implementation pragmatic trial, patients were randomized to receive phone-based proactive coaching (educational materials, five phone-based peer coaching sessions over 60 d), reactive coaching (educational materials, peer coaching when requested), or usual care. Study staff members collected baseline and outcome data via phone at 30, 60, and 90 days after randomization. Adherence to LTOT over 60 days, the primary effectiveness outcome, was defined as mean LTOT use ⩾17.7 h/d. LTOT use was calculated using information about home oxygen equipment use in worksheets completed by study participants. Comparisons of adherence to LTOT between each coaching group and the usual care group using multivariable logistic regression models were prespecified as the primary analyses. Secondary effectiveness outcomes included Patient Reported Outcome Management Information System measures for physical, emotional, and social health. We assessed early implementation domains in the reach, adoption, and implementation framework. Results: In 444 participants, the proportions who were adherent to LTOT at 60 days were 74% in usual care, 84% in reactive coaching, and 70% in proactive coaching groups. Although reach, adoption by stakeholder partners, and intervention fidelity were acceptable, complete LTOT adherence data were available in only 73% of participants. Reactive coaching (adjusted odds ratio, 1.77; 97.5% confidence interval, 0.80-3.90) and proactive coaching (adjusted odds ratio, 0.70; 97.5% confidence interval, 0.34-1.46) did not improve adherence to LTOT compared with usual care. However, proactive coaching significantly reduced depressive symptoms and sleep disturbance compared with usual care and reduced depressive symptoms compared with reactive coaching. Unexpectedly, LTOT adherence was significantly lower in the proactive compared with the reactive coaching group. Conclusions: The results were inconclusive about whether a phone-based peer coaching strategy changed LTOT adherence compared with usual care. Further studies are needed to confirm the potential benefits of proactive peer coaching on secondary effectiveness outcomes and differences in LTOT adherence between proactive and reactive peer coaching. Clinical trial registered with ClinicalTrials.gov (NCT02098369).
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Affiliation(s)
| | - Kristen E. Holm
- Department of Medicine, National Jewish Health, Denver, Colorado
- Department of Community and Behavioral Health, Colorado School of Public Health, Aurora, Colorado
| | - Richard Casaburi
- Lindquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California
| | - Janos Porszasz
- Lindquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California
| | | | - Nina E. Bracken
- Breathe Chicago Center, Division of Pulmonary, Critical Care, Sleep and Allergy
- Office of Population Health Sciences, Office of the Vice Chancellor for Health Affairs, University of Illinois Chicago, Chicago, Illinois
| | - Richard Gallardo
- Alzheimer’s Therapeutic Research Institute, San Diego, California
| | - Vanessa Gonzalez
- School of Public Health, and
- American Academy of Sleep Medicine Foundation, Darien, Illinois; and
| | - Sai D. Illendula
- Breathe Chicago Center, Division of Pulmonary, Critical Care, Sleep and Allergy
- Office of Population Health Sciences, Office of the Vice Chancellor for Health Affairs, University of Illinois Chicago, Chicago, Illinois
| | | | | | | | - Lynn B. Gerald
- Breathe Chicago Center, Division of Pulmonary, Critical Care, Sleep and Allergy
- Office of Population Health Sciences, Office of the Vice Chancellor for Health Affairs, University of Illinois Chicago, Chicago, Illinois
| | - Jerry A. Krishnan
- Breathe Chicago Center, Division of Pulmonary, Critical Care, Sleep and Allergy
- Office of Population Health Sciences, Office of the Vice Chancellor for Health Affairs, University of Illinois Chicago, Chicago, Illinois
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Strange C, Allison S, McCathern J, Sandhaus RA, Holm KE. Augmentation Therapy for Alpha-1 Antitrypsin Deficiency: Patient Experiences With Self-Infusion, Home Providers, and Clinics. Chronic Obstr Pulm Dis 2023; 10:392-399. [PMID: 37549313 DOI: 10.15326/jcopdf.2023.0430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
Background Currently approved therapies for individuals with alpha-1 antitrypsin deficiency (AATD) are intravenously infused products. The burdens and demographics of infusion practices in the United States are not well-characterized. Research Question What is the prevalence of different infusion practices in the United States? Study Design and Methods AlphaNet disease management participants completed a survey that captured current and past infusion practices. Data regarding the reasons for choosing their current infusion practice, problems with past infusion practices, resources required, and support services utilized were collected from February 8, 2022 through July 1, 2022. Results Among 5266 individuals, infusions happened at home by health care providers (60.2%), at infusion clinics (30.6%), and by self-infusion (8.1%). Self-infusion prevalence increased with time on therapy and was more prevalent in younger individuals (61.2 ± 10.5 years) compared to users of other infusion practices (64.1 ± 11.0 years), (p<0.001). The perceived benefits of self-infusion included: (1) freedom and flexibility (77.9%), (2) ability to travel (44.5%), (3) avoidance of infusion clinics (41.8%), (4) time-savings (35.9%), (5) less absence from work (26.6%), (6) less exposure to infections (22.1%), and (7) less cost (16.4%). Self-infusion was done through permanent intravenous catheters in 41.2% and peripheral intravenous catheters in 58.3%. Self-infusers were more satisfied (93.1% "very satisfied") than other groups. Among individuals currently infusing with home nurses or in clinics, 21.4% would consider self-infusing in the future. Interpretation Self-infusion of alpha-1 antitrypsin is feasible and associated with high satisfaction scores. Recommendations for catheter care, infusion support, and cost management are informed by survey results.
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Affiliation(s)
- Charlie Strange
- Medical University of South Carolina, Charleston, South Carolina, United States
- AlphaNet, Inc., Coral Gables, Florida, United States
| | - Sheri Allison
- AlphaNet, Inc., Coral Gables, Florida, United States
| | | | - Robert A Sandhaus
- AlphaNet, Inc., Coral Gables, Florida, United States
- National Jewish Health, Denver, Colorado, United States
| | - Kristen E Holm
- AlphaNet, Inc., Coral Gables, Florida, United States
- National Jewish Health, Denver, Colorado, United States
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Hay MA, Holm KE, McCathern J, Sandhaus RA, Strange C. Impact of Coronavirus Disease 2019 and Vaccination Attitudes on Alpha-1 Antitrypsin Deficiency. Chronic Obstr Pulm Dis 2023; 10:335-342. [PMID: 37363861 DOI: 10.15326/jcopdf.2023.0406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
Background Individuals with alpha-1 antitrypsin deficiency (AATD)-associated chronic obstructive pulmonary disease (COPD) may be at increased risk of coronavirus disease 2019 (COVID-19) pneumonia since COPD is associated with an increased risk of severe COVID-19 infection. Research Question We hypothesized that the AlphaNet disease management program would lower COVID-19 burdens. We evaluated the prevalence of COVID-19 infection, severe COVID-19, interruptions in augmentation therapy, and intention to vaccinate. Study Design and Methods Data regarding COVID-19 were collected monthly from March 2020 through February 2022. Responses from 8019 individuals were analyzed to evaluate the prevalence and severity of COVID-19 infections, interruptions in AATD care, and the likelihood of vaccination. Results By the end of 2020, 4% of patients reported a positive COVID-19 test. Of those, 35.3% were hospitalized, with 8.6% admitted to the intensive care unit (ICU). By February 2022, the prevalence of COVID-19 infections had increased to 18.6%, with hospitalization rates of 22.1% and ICU admissions at 4.7%. Attitudes about COVID-19 vaccination assessed in December 2020 before the vaccine was widely available suggested 10.3% of patients would definitely not get the vaccine. Notably, 38.2% of those subsequently self-reported receipt of a COVID-19 vaccine. Interpretation The prevalence of COVID-19 infections in patients with AATD was lower than the prevalence in the general U.S. population during 2020, although with a higher hospitalization rate. This health-managed population has a high vaccination intent. Those with an initially low vaccination intent changed their minds over time. We interpret these results as showing that most AlphaNet individuals with AATD had success at navigating the COVID-19 pandemic with lower case rates than the general U.S. population.
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Affiliation(s)
- Margaret A Hay
- Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina, Charleston, South Carolina, United States
| | - Kristen E Holm
- AlphaNet, Inc., Coral Gables, Florida, United States
- Department of Medicine, National Jewish Health, Denver, Colorado, United States
| | | | - Robert A Sandhaus
- AlphaNet, Inc., Coral Gables, Florida, United States
- Department of Medicine, National Jewish Health, Denver, Colorado, United States
| | - Charlie Strange
- Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina, Charleston, South Carolina, United States
- AlphaNet, Inc., Coral Gables, Florida, United States
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Edinger JD, Wamboldt FS, Johnson RL, Simmons B, Tsai S, Morin CM, Holm KE. Adherence to behavioral recommendations of cognitive behavioral therapy for insomnia predicts medication use after a structured medication taper. J Clin Sleep Med 2023; 19:1495-1503. [PMID: 37086054 PMCID: PMC10394369 DOI: 10.5664/jcsm.10616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 03/31/2023] [Accepted: 03/31/2023] [Indexed: 04/23/2023]
Abstract
STUDY OBJECTIVES Cognitive behavioral therapy for insomnia (CBTI) has been paired with supervised medication tapering to help hypnotic-dependent individuals discontinue their hypnotics. This study examined the hypothesis that higher participant adherence to behavioral recommendations of CBTI will predict lower odds of using sleep medications 3 months after completion of a combined CBTI/sleep medication tapering protocol. METHODS Fifty-eight individuals who used sedative hypnotics completed four CBTI sessions followed by sleep medication tapering. Logistic regression was used to examine the association of stability of time in bed and stability of rise time (measured as the within-person standard deviation) at completion of CBTI with two outcomes at 3-month follow-up: use of sedative hypnotics and use of any medication/substance for sleep. RESULTS Participants with more stability in their rise time after CBTI than at baseline (ie, a decrease in their within-person standard deviation) had 69.5% lower odds of using sedative hypnotics at follow-up (odds ratio = 0.305, 95% confidence interval = 0.095-0.979, P = .046) than individuals who had no change or a decrease in the stability of their rise time. Results were similar for time in bed: participants with more stability in their time in bed after CBTI than at baseline had 83.2% lower odds of using sedative hypnotics (odds ratio = 0.168, 95% confidence interval = 0.049-0.580, P = .005). Increase in stability of rise time and stability of time in bed was also associated with reduced odds of using any medication/substance for sleep at follow-up. CONCLUSIONS Participants who implement behavioral recommendations of CBTI appear to have more success with discontinuing use of sleep medications. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov; Name: The Role of Tapering Pace and Selected Traits on Hypnotic Discontinuation; URL: https://clinicaltrials.gov/ct2/show/NCT02831894; Identifier: NCT02831894. CITATION Edinger JD, Wamboldt FS, Johnson RL, et al. Adherence to behavioral recommendations of cognitive behavioral therapy for insomnia predicts medication use after a structured medication taper. J Clin Sleep Med. 2023;19(8):1495-1503.
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Affiliation(s)
- Jack D. Edinger
- National Jewish Health, Denver, Colorado
- Duke University Medical Center, Durham, North Carolina
| | | | | | | | | | | | - Kristen E. Holm
- National Jewish Health, Denver, Colorado
- Colorado School of Public Health, Denver, Colorado
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9
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Ellis PR, Holm KE, Choate R, Mannino DM, Stockley RA, Sandhaus RA, Turner AM. Quality of Life and Mortality Outcomes for Augmentation Naïve and Augmented Patients with Severe Alpha-1 Antitrypsin Deficiency. Chronic Obstr Pulm Dis 2023; 10:139-147. [PMID: 36749925 PMCID: PMC10392875 DOI: 10.15326/jcopdf.2022.0339] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background Intravenous alpha-1 antitrypsin (AAT) augmentation therapy is the only specific treatment available for alpha-1 antitrypsin deficiency (AATD) related lung disease. It is widely used worldwide but remains unavailable to patients with AATD in the United Kingdom (UK). While randomized trials of augmentation therapy have demonstrated biochemical efficacy and lung tissue preservation using CT densitometry, these studies were not adequately powered to demonstrate effectiveness in well-accepted clinical endpoints such as quality of life (QOL) or survival. We used large prospectively followed AATD patient populations in the US and UK to explore these important clinical endpoints. Methods Inclusion criteria: adults with severe AATD and associated lung disease. Treatment group: US AATD patients receiving augmentation therapy for lung disease. Control Group: Augmentation therapy naïve AATD patients. Multivariable regression and survival analyses were used to asses QOL and mortality outcomes respectively. Results Mean annual deterioration of SGRQ total score was 1.43 points greater/year in the control group compared to those receiving augmentation therapy (95% CI 0.47 to 2.39, p =0.003) At 7 years, median survival was 82.7% (95% CI 75.3 to 90.7) for the control group versus 87.8% (95% CI 82.8 to 93.2) in the augmentation group, p = 0.66. There was significant heterogeneity between cohorts. Conclusions Comparison of two highly characterized AATD cohorts was not able to reliably determine if AAT augmentation therapy improves QOL or mortality in patients with severe AATD related lung disease. Alternative surrogate biomarkers of disease progression, such as CT lung density, may be a more pragmatic option.
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Affiliation(s)
- Paul R Ellis
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Kristen E Holm
- Division of Neurology and Behavioral Health, National Jewish Health, Denver, Colorado, United States.,AlphaNet, Kissimmee, Florida, United States
| | - Radmila Choate
- University of Kentucky College of Public Health, Lexington, Kentucky, United States
| | - David M Mannino
- University of Kentucky College of Public Health, Lexington, Kentucky, United States
| | - Robert A Stockley
- Lung Investigation Unit, Queen Eilizabeth Hospital Birmingham, University Hospitals Birmingham, National Health Service Foundation Trust, Birmingham, United Kingdom
| | - Robert A Sandhaus
- AlphaNet, Kissimmee, Florida, United States.,Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, Colorado, United States
| | - Alice M Turner
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
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10
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Adviento BA, Regan EA, Make BJ, Han MK, Foreman MG, Iyer AS, Bhatt SP, Kim V, Bon J, Soler X, Kinney GL, Hanania NA, Lowe KE, Holm KE, Yohannes AM, Shinozaki G, Hoth KF, Fiedorowicz JG. Clinical Markers Associated With Risk of Suicide or Drug Overdose Among Individuals With Smoking Exposure: A Longitudinal Follow-up Study of the COPDGene Cohort. Chest 2023; 163:292-302. [PMID: 36167120 PMCID: PMC10083129 DOI: 10.1016/j.chest.2022.09.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 08/11/2022] [Accepted: 09/03/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Studies have shown that COPD and smoking are associated with increased suicide risk. To date, there are no prospective studies examining suicide risk among individuals with smoking exposure along a spectrum of pulmonary diseases ranging from normal spirometry to severe COPD. RESEARCH QUESTION Which clinical variables predict death by suicide or overdose of indeterminate intent in a large cohort of individuals with smoking exposure within the Genetic Epidemiology of COPD (COPDGene) study? STUDY DESIGN AND METHODS We studied data from 9,930 participants involved in COPDGene, a multisite, prospective cohort study of individuals with smoking exposure. Primary cause of adjudicated deaths was identified by using death certificates, family reports, and medical records. Time to death by suicide/overdose was examined as the primary outcome in Cox regression models including age, sex, race, BMI, pack-years, current smoking status, airflow limitation (FEV1 % predicted), dyspnea (modified Medical Research Council scale score ≥ 2), 6-min walk distance, supplemental oxygen use, and severe exacerbations in the prior year with time-varying covariates and other causes of death as a competing risk. RESULTS The cohort was 47% female and 33% Black (67% White); they had a mean ± SD age of 59.6 ± 9.0 years and a mean FEV1 % predicted of 76.1 ± 25.5. Sixty-three individuals died by suicide/overdose. Factors associated with risk of suicide/overdose were current smoking (hazard ratio [HR], 6.44; 95% CI, 2.64-15.67), use of sedative/hypnotics (HR, 2.33; 95% CI, 1.24-4.38), and dyspnea (HR, 2.23; 95% CI, 1.34-3.70). Lower risk was associated with older age (per-decade HR, 0.45; 95% CI, 0.31-0.67), higher BMI (HR, 0.95; 95% CI, 0.91-0.99), and African-American race (HR, 0.41; 95% CI, 0.23-0.74). Severity of airflow limitation (FEV % predicted) was not associated with suicide risk. INTERPRETATION In this well-characterized cohort of individuals with smoking exposure with and without COPD, risk factors for suicide/overdose were identified that emphasize the subjective experience of illness over objective assessments of lung function.
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Affiliation(s)
- Brigid A Adviento
- Department of Psychiatry, University of Iowa, Iowa City, IA; Department of Internal Medicine, University of Iowa, Iowa City, IA
| | - Elizabeth A Regan
- Division of Rheumatology, Department of Medicine, National Jewish Health, Denver, CO
| | - Barry J Make
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, National Jewish Health, Denver, CO; Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, CO
| | - MeiLan K Han
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - Marilyn G Foreman
- Pulmonary and Critical Care Medicine Division, Morehouse School of Medicine, Atlanta, GA
| | - Anand S Iyer
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, The University of Alabama at Birmingham, Birmingham, AL
| | - Surya P Bhatt
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, The University of Alabama at Birmingham, Birmingham, AL
| | - Victor Kim
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - Jessica Bon
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA; VA Pittsburgh Healthcare System, Pittsburgh, PA
| | - Xavier Soler
- Department of Pulmonary, Critical Care and Sleep Medicine, University of California San Diego, San Diego, CA
| | - Gregory L Kinney
- Department of Epidemiology, Colorado School of Public Health, University of Colorado, Aurora, CO
| | - Nicola A Hanania
- Section of Pulmonary and Critical Care Medicine, Baylor College of Medicine, Houston, TX
| | - Katherine E Lowe
- Case Western Reserve University School of Medicine, Cleveland, OH
| | - Kristen E Holm
- Division of Neurology and Behavioral Health, National Jewish Health, Denver, CO; Department of Community and Behavioral Health, Colorado School of Public Health, University of Colorado, Aurora, CO
| | | | - Gen Shinozaki
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA
| | - Karin F Hoth
- Department of Psychiatry, University of Iowa, Iowa City, IA; Iowa Neuroscience Institute, University of Iowa, Iowa City, IA.
| | - Jess G Fiedorowicz
- Ottawa Hospital, Ottawa Hospital Research Institute, and University of Ottawa, Ottawa, Ontario, Canada
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11
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Choate R, Sandhaus RA, Holm KE, Mannino DM, Strange C. Patient-Reported Pulmonary Symptoms, Exacerbations, and Management in a Cohort of Patients With Alpha-1 Antitrypsin Deficiency. Chronic Obstr Pulm Dis 2022; 9:549-561. [PMID: 36103189 PMCID: PMC9718576 DOI: 10.15326/jcopdf.2022.0317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Rationale Identifying pulmonary exacerbations in patients with alpha-1 antitrypsin deficiency (AATD) is critical as they are associated with disease progression and poor health-related quality of life. Not all changes in usual respiratory symptoms will be identified as exacerbations by patients with AATD. Methods Data collected via regular monthly telephone calls during the first year of the AlphaNet Step Forward Study were analyzed. AlphaNet subscribers were asked about changes in their usual respiratory symptoms, whether they considered changes in symptoms to be pulmonary exacerbations, and their management. Participants who reported changes in their usual respiratory symptoms throughout the year were included in the study. Per-patient and per-event analyses were performed. Results Participants (n=316, age 58±10 years, 53% female) reported 797 events of changes in their usual respiratory symptoms in 1 year. Almost half (48%) of these symptom events were identified as pulmonary exacerbations by the study participants. The average number of symptoms was higher in events recognized by participants as exacerbations than those not identified as exacerbations (3.3±1.5 versus 1.8±1.1, respectively). A greater proportion of the exacerbation events were managed by taking antibiotics or corticosteroids or both (81%, 53%, and 41% of the events, respectively). With exacerbations, participants mainly spoke to the pulmonary specialist (39%) or went to the doctor's office (37%). Symptom events not recognized as exacerbations were mostly self-treated (56%). Conclusions Changes in usual pulmonary symptoms are not universally recognized as exacerbations. Patients' perspectives in recognizing changes in pulmonary symptoms as exacerbation events are critical.
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Affiliation(s)
- Radmila Choate
- College of Public Health, University of Kentucky, Lexington, Kentucky, United States
| | - Robert A. Sandhaus
- Department of Medicine, National Jewish Health, Denver, Colorado, United States,AlphaNet, Inc., Coral Gables, Florida, United States
| | - Kristen E. Holm
- Department of Medicine, National Jewish Health, Denver, Colorado, United States,AlphaNet, Inc., Coral Gables, Florida, United States
| | - David M. Mannino
- College of Medicine, University of Kentucky, Lexington, Kentucky, United States
| | - Charlie Strange
- AlphaNet, Inc., Coral Gables, Florida, United States,Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Medical University of South Carolina, Charleston, South Carolina, United States
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12
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Bathgate CJ, Kilbourn KM, Murphy NH, Wamboldt FS, Holm KE. Pilot RCT of a telehealth intervention to reduce symptoms of depression and anxiety in adults with cystic fibrosis. J Cyst Fibros 2021; 21:332-338. [PMID: 34366282 DOI: 10.1016/j.jcf.2021.07.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 07/15/2021] [Accepted: 07/24/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Adults with cystic fibrosis (awCF) have higher levels of depression and anxiety than community samples. The Coping and Learning to Manage Stress with CF (CALM) intervention was developed for awCF reporting elevated symptoms of depression or anxiety. METHODS In this pilot study, awCF were randomly assigned to either six telehealth sessions (CALM; n = 15) or treatment-as-usual (TAU; n = 16). Primary outcomes were depression and anxiety. Secondary outcomes were coping self-efficacy and health-related quality of life (HrQOL). Tertiary outcomes were feasibility, acceptability, and satisfaction. Assessments were completed at baseline, post-intervention, and 3-month follow-up. Group differences were examined via independent samples t-tests. Effect size (ES) was calculated via Cohen's d to provide a measure of the magnitude of the treatment effect. RESULTS At post-intervention, the CALM group had a lower mean score than the TAU group for depression (medium ES) and anxiety (large ES). The CALM group had higher (i.e., better) mean scores than the TAU group for coping (large ES) and HrQOL domains of Social Functioning (large ES) and Vitality (large ES). Most treatment gains were not sustained at 3-month follow-up. CALM was feasible, requiring <12 min. for setup and scheduling, and allowed seamless participation when hospitalized. Mean scores for acceptability and satisfaction indicated that most participants either agreed or strongly agreed that CALM was acceptable and satisfactory. CONCLUSIONS CALM shows promise as an intervention to reduce symptoms of depression and anxiety and improve coping and HrQOL. Next steps are to add a booster session and examine CALM via a multi-site RCT.
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Affiliation(s)
- Christina J Bathgate
- Department of Medicine, National Jewish Health, 1400 Jackson St., M107D, Denver, CO 80206, USA.
| | - Kristin M Kilbourn
- Department of Psychology, University of Colorado Denver, 1200 Larimer St, Denver, CO 80204, USA
| | - Nora H Murphy
- Department of Medicine, National Jewish Health, 1400 Jackson St., M107D, Denver, CO 80206, USA
| | - Frederick S Wamboldt
- Department of Medicine, National Jewish Health, 1400 Jackson St., M107D, Denver, CO 80206, USA
| | - Kristen E Holm
- Department of Medicine, National Jewish Health, 1400 Jackson St., M107D, Denver, CO 80206, USA
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13
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Brunette AM, Warner K, Holm KE, Meschede K, Wamboldt FS, Kozora E, Moser DJ, Make BJ, Crapo JD, Moreau KL, Weinberger HD, Bowler R, Hoth KF. Daily Activities: The Impact of COPD and Cognitive Dysfunction. Arch Clin Neuropsychol 2021; 36:acaa090 767 779-767. [PMID: 33103191 PMCID: PMC8500183 DOI: 10.1093/arclin/acaa090] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2020] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Chronic obstructive pulmonary disease (COPD) is characterized by airflow limitation; however, pulmonary function does not fully account for patients' functional difficulties. The primary aim of the study was to determine the association between several domains of cognition and daily activity among those with COPD. METHOD Eighty-nine former smokers completed a neuropsychological battery including measures across multiple domains of cognition, pulmonary function measures, and daily activity questionnaires. Using a cross-sectional design, we compared daily activity between former smokers with and without COPD using two measures (St. George's Respiratory Questionnaire [SGRQ] Activity Subscale and Lawton Instrumental Activities of Daily Living [IADL] Scale) and examined the association between cognition and daily activity among those with COPD. RESULTS As expected, former smokers with COPD reported more difficulty than those without COPD on both activity measures (SGRQ Activity Subscale p < .001; Lawton IADL Scale p = .040). Among former smokers with COPD, poorer delayed recall was associated with more difficulty with daily activities (SGRQ Activity Subscale) (p = .038) while adjusting for severity of airflow limitation, exercise tolerance, oxygen use, dyspnea, and symptoms of anxiety and depression. CONCLUSION The findings suggest that cognition is associated with daily activity in patients with COPD. Future research should examine whether cognitive interventions may help to maximize patients' engagement in daily activities.
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Affiliation(s)
- Amanda M Brunette
- University of Iowa, Department of Psychological and Brain Sciences, Iowa City, IA 52242, USA
| | - Kelsey Warner
- University of Iowa Carver College of Medicine, Department of Psychiatry, Iowa City, IA 52242, USA
- Hennepin Healthcare, Department of Speech-Language Pathology, Minneapolis, MN 55404, USA
| | - Kristen E Holm
- National Jewish Health, Department of Medicine, Denver, CO 80206, USA
- Colorado School of Public Health, Department of Community and Behavioral Health, Aurora, CO 80045, USA
| | - Kimberly Meschede
- National Jewish Health, Department of Medicine, Denver, CO 80206, USA
| | - Frederick S Wamboldt
- National Jewish Health, Department of Medicine, Denver, CO 80206, USA
- University of Colorado School of Medicine at the Anschutz Medical Campus, Department of Psychiatry, Aurora, CO 80045, USA
| | - Elizabeth Kozora
- National Jewish Health, Department of Medicine, Denver, CO 80206, USA
- University of Colorado School of Medicine at the Anschutz Medical Campus, Department of Psychiatry, Aurora, CO 80045, USA
| | - David J Moser
- University of Iowa Carver College of Medicine, Department of Psychiatry, Iowa City, IA 52242, USA
| | - Barry J Make
- National Jewish Health, Department of Medicine, Denver, CO 80206, USA
- University of Colorado School of Medicine at the Anschutz Medical Campus, Department of Medicine, Aurora, CO 80045, USA
| | - James D Crapo
- National Jewish Health, Department of Medicine, Denver, CO 80206, USA
- University of Colorado School of Medicine at the Anschutz Medical Campus, Department of Medicine, Aurora, CO 80045, USA
| | - Kerrie L Moreau
- University of Colorado School of Medicine at the Anschutz Medical Campus, Department of Medicine, Aurora, CO 80045, USA
- Denver Veterans Administration Medical Center, Geriatric Research Education and Clinical Center, Denver, CO 80220 USA
| | - Howard D Weinberger
- National Jewish Health, Department of Medicine, Denver, CO 80206, USA
- University of Colorado School of Medicine at the Anschutz Medical Campus, Department of Medicine, Aurora, CO 80045, USA
| | - Russell Bowler
- National Jewish Health, Department of Medicine, Denver, CO 80206, USA
- University of Colorado School of Medicine at the Anschutz Medical Campus, Department of Medicine, Aurora, CO 80045, USA
| | - Karin F Hoth
- University of Iowa Carver College of Medicine, Department of Psychiatry, Iowa City, IA 52242, USA
- National Jewish Health, Department of Medicine, Denver, CO 80206, USA
- University of Iowa, Iowa Neuroscience Institute, Iowa City, IA 52242, USA
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14
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Lindsay HG, Wamboldt FS, Holm KE, Make BJ, Hokanson J, Crapo JD, Regan EA. Impact of a Medical Diagnosis on Decision to Stop Smoking and Successful Smoking Cessation. Chronic Obstr Pulm Dis 2021; 8:360-370. [PMID: 34010545 DOI: 10.15326/jcopdf.2020.0167] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Introduction Smoking cessation counseling is a central part of the Medicare guidelines for lung cancer screening. With increasing age, many heavy smokers eventually stop smoking, however, factors influencing the decision to stop smoking are poorly understood. We postulated that declining health or physician-diagnosis of a medical condition may be associated with successful smoking cessation. Methods A total of 4448 current and former smokers in Phase 2 of the COPD Genetic Epidemiology (COPDGene®) study answered a question about reasons for stopping smoking. Participants were classified as successful quitters (n=3345), and unsuccessful quitters (n=1003). Reasons cited for quitting were grouped as: medical diagnoses, social factors, symptoms. Logistic modeling of factors associated with successful quitting were adjusted for age, gender, race, and education. Results The most common factors cited for a quit attempt by all respondents were medical diagnoses (48%), followed by social factors (47%), and respiratory symptoms (36%). Successful quitters were more likely to be older, male, and non-Hispanic White. An adjusted model found increased age, White race, education beyond high school, and male sex favored successful quitting while the cited medical diagnoses, social factors, and "other" reasons were associated with unsuccessful quitting. Fagerstrom Nicotine Dependence scores were ³ 5 in 54% of the unsuccessful group compared to 45% for successful quitters(p<0.0001) suggesting some increased nicotine dependence in the unsuccessful quitters. Conclusions Medical diagnosis was the most common factor cited for considering a quit attempt by both successful and unsuccessful quitters; however, successful quitting was influenced by demographic factors and potentially the severity of nicotine dependence.
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Affiliation(s)
| | - Frederick S Wamboldt
- National Jewish Health, Denver Colorado, United States.,Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado, United States
| | - Kristen E Holm
- National Jewish Health, Denver Colorado, United States.,Department of Community and Behavioral Health, Colorado School of Public Health, Aurora Colorado, United States
| | - Barry J Make
- National Jewish Health, Denver Colorado, United States
| | - John Hokanson
- Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado, United States
| | - James D Crapo
- National Jewish Health, Denver Colorado, United States
| | - Elizabeth A Regan
- National Jewish Health, Denver Colorado, United States.,Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado, United States
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15
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Hoth KF, Moreau KL, Weinberger HD, Holm KE, Meschede K, Crapo JD, Make BJ, Moser DJ, Kozora E, Bowler RP, Pierce GL, Ten Eyck P, Wamboldt FS. Carotid Artery Stiffness is Associated With Cognitive Performance in Former Smokers With and Without Chronic Obstructive Pulmonary Disease. J Am Heart Assoc 2020; 9:e014862. [PMID: 32338117 PMCID: PMC7428572 DOI: 10.1161/jaha.119.014862] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Heavy smokers perform worse on neuropsychological assessment than age‐matched peers. However, traditional pulmonary measures of airflow limitation and hypoxemia explain only a modest amount of variance in cognition. The current objective was to determine whether carotid artery stiffness is associated with cognition in former smokers beyond the effects of amount of smoking and pulmonary function. Methods and Results Eighty‐four former smokers including individuals across a spectrum of airflow limitation severity were included: 30 without chronic obstructive pulmonary disease (Global Initiative for Chronic Obstructive Lung Disease [GOLD] 0 with normal spirometry and lung computed tomography), 31 with mild‐moderate chronic obstructive pulmonary disease (GOLD 1–2), and 23 with severe‐very severe chronic obstructive pulmonary disease (GOLD 3–4). Participants completed questionnaires, spirometry, carotid ultrasonography, and neuropsychological testing. Multiple linear regression was used to determine whether carotid artery stiffness is associated with neuropsychological performance in 4 cognitive domains after adjusting for age, sex, pack‐years of smoking, estimated premorbid intellectual functioning, and airflow limitation. Higher carotid artery β‐stiffness index was associated with reduced executive functioning‐processing speed in the fully adjusted model (β=−0.49, SE=0.14; P=0.001). Lower premorbid intellectual function, male sex, and presence of airflow limitation (GOLD 1 or 2 and GOLD 3 or 4) were also associated with worse executive functioning‐processing speed. β‐Stiffness index was not significantly associated with performance in other cognitive domains. Conclusions Carotid artery stiffness is associated with worse performance on executive functioning‐processing speed in former smokers beyond the effects of aging, amount of past smoking, severity of airflow limitation, and hypoxemia. Future research should examine whether carotid stiffness can be used to identify former smokers at risk for subsequent cognitive impairment.
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Affiliation(s)
- Karin F Hoth
- Psychiatry University of Iowa Iowa City IA.,Iowa Neuroscience Institute University of Iowa Iowa City IA.,Medicine National Jewish Health Denver CO
| | - Kerrie L Moreau
- Medicine University of Colorado Anschutz Medical Campus Aurora CO
| | - Howard D Weinberger
- Medicine National Jewish Health Denver CO.,Medicine University of Colorado Anschutz Medical Campus Aurora CO
| | - Kristen E Holm
- Medicine National Jewish Health Denver CO.,Community and Behavioral Health University of Colorado School of Public Health Aurora CO
| | | | - James D Crapo
- Medicine National Jewish Health Denver CO.,Medicine University of Colorado Anschutz Medical Campus Aurora CO
| | - Barry J Make
- Medicine National Jewish Health Denver CO.,Medicine University of Colorado Anschutz Medical Campus Aurora CO
| | | | - Elizabeth Kozora
- Medicine National Jewish Health Denver CO.,Psychiatry University of Colorado Anschutz Medical Campus Aurora CO
| | - Russell P Bowler
- Medicine National Jewish Health Denver CO.,Medicine University of Colorado Anschutz Medical Campus Aurora CO
| | - Gary L Pierce
- Health and Human Physiology University of Iowa Iowa City IA.,Abboud Cardiovascular Research Center University of Iowa Iowa City IA.,Environmental Health Sciences Research Center University of Iowa Iowa City IA
| | - Patrick Ten Eyck
- Institute for Clinical and Translational Science University of Iowa Iowa City IA
| | - Frederick S Wamboldt
- Medicine National Jewish Health Denver CO.,Psychiatry University of Colorado Anschutz Medical Campus Aurora CO
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16
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Choate R, Mannino DM, Holm KE, Beiko T, Boyd B, Sandhaus RA. Home-Based Multicomponent Intervention Increases Exercise Activity and Improves Body Mass Index: Results of a 5-Year Randomized Trial Among Individuals with Alpha-1 Antitrypsin Deficiency-Associated Lung Disease. Chronic Obstr Pulm Dis 2020; 8. [PMID: 33135406 DOI: 10.15326/jcopdf.8.1.2020.0183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background The Step Forward Study (SFS) was designed to increase exercise activity and improve body mass index (BMI) among individuals with alpha-1 antitrypsin deficiency (AATD)-associated lung disease. Methods The SFS is a randomized trial of an intensive distance intervention that was delivered via a series of mailings and teleconferences versus no additional intervention. All participants (n=500) were also enrolled in a disease management program designed for individuals with AATD-associated lung disease who have been prescribed augmentation therapy. The primary outcome was self-reported number of exercise minutes per week. The secondary outcome was BMI. Linear mixed model analyses were used to assess the difference in average weekly exercise minutes between the intervention arms over time. T-tests, signed rank and Wilcoxon rank-sum tests were used to evaluate changes in BMI between the intervention arms and within each BMI category. Results The study included 429 individuals with evaluable primary outcome data.There was a significant effect of intervention on exercise minutes over time (p=0.018). Participants in the intervention group reported an average of 167.14 minutes (standard deviation [SD]=10.68) of weekly exercise and those in the standard care group reported 148.31 minutes (SD=10.96). There was a significant difference in BMI change between the intervention (mean BMI decrease 0.74, SD=2.16) and the standard care group (mean BMI decrease 0.27, SD=1.63); p=0.0122. Conclusion Individuals who were randomly assigned to the intervention group reported more exercise activity and improvements in BMI over the course of this multicomponent intervention compared to individuals assigned to standard care.
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Affiliation(s)
- Radmila Choate
- College of Public Health, University of Kentucky, Lexington, Kentucky, United States
| | - David M Mannino
- College of Public Health, University of Kentucky, Lexington, Kentucky, United States.,College of Medicine, University of Kentucky, Lexington, Kentucky, United States
| | - Kristen E Holm
- Department of Medicine, National Jewish Health, Denver, Colorado, United States.,AlphaNet, Inc., Coral Gables, Florida, United States
| | - Tatsiana Beiko
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Medical University of South Carolina, Charleston, South Carolina, United States
| | - Bonnie Boyd
- AlphaNet, Inc., Coral Gables, Florida, United States
| | - Robert A Sandhaus
- Department of Medicine, National Jewish Health, Denver, Colorado, United States.,AlphaNet, Inc., Coral Gables, Florida, United States
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17
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Croghan A, Brunette A, Holm KE, Kozora E, Moser DJ, Wamboldt FS, Meschede K, Make BJ, Crapo JD, Weinberger HD, Moreau KL, Bowler RP, Hoth KF. Reduced Attention in Former Smokers with and without COPD. Int J Behav Med 2019; 26:600-607. [PMID: 31732904 PMCID: PMC7269072 DOI: 10.1007/s12529-019-09826-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Attention difficulties are often reported by patients with chronic obstructive pulmonary disease (COPD); however, limited research exists using objective tests designed specifically to measure attention in this population. This study aimed to (1) identify specific attention deficits in COPD and (2) determine which demographic/clinical characteristics are associated with reduced attention. METHODS Eighty-four former smokers (53 COPD, 31 no COPD) completed questionnaires, pulmonary function testing, and the Conner's Continuous Performance Test II (CPT-II). Participants with and without COPD were compared on CPT-II measures of inattention, impulsivity, and vigilance. CPT-II measures that differed significantly between the two groups were further examined using hierarchical regression modeling. Demographic/clinical characteristics were entered into models with attention as the dependent variable. RESULTS Participants with COPD performed worse than those without COPD on CPT measures of inattention and impulsivity (i.e., detectability [discrimination of target from non-target stimuli], perseverations [reaction time under 100 ms], omissions [target stimuli response failures], and commissions [responses to non-target stimuli]). More severe COPD (measured by greater airflow limitation) was associated with poorer ability to detect targets vs. foils and perseverative responding after adjusting for age and other covariates in the model. CONCLUSION Former smokers with COPD experience problems with attention that go beyond slowed processing speed, including aspects of inattention and impulsivity. Clinicians should be aware that greater airflow limitation and older age are associated with attention difficulties, as this may impact functioning.
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Affiliation(s)
- Anna Croghan
- Department of Psychology, University of North Dakota, Grand Forks, ND, USA
- Department of Psychiatry, University of Iowa Carver College of Medicine, 200 Hawkins Dr., W278GH, Iowa City, IA, 52242, USA
| | - Amanda Brunette
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA, USA
| | - Kristen E Holm
- National Jewish Health, Department of Medicine, Denver, CO, USA
- Colorado School of Public Health, Department of Community and Behavioral Health, Aurora, CO, USA
| | - Elizabeth Kozora
- National Jewish Health, Department of Medicine, Denver, CO, USA
- Department of Psychiatry, University of Colorado School of Medicine at the Anschutz Medical Campus, Aurora, CO, USA
| | - David J Moser
- Department of Psychiatry, University of Iowa Carver College of Medicine, 200 Hawkins Dr., W278GH, Iowa City, IA, 52242, USA
| | - Frederick S Wamboldt
- National Jewish Health, Department of Medicine, Denver, CO, USA
- Department of Psychiatry, University of Colorado School of Medicine at the Anschutz Medical Campus, Aurora, CO, USA
| | | | - Barry J Make
- National Jewish Health, Department of Medicine, Denver, CO, USA
- University of Colorado School of Medicine at the Anschutz Medical Campus, Aurora, CO, USA
| | - James D Crapo
- National Jewish Health, Department of Medicine, Denver, CO, USA
- University of Colorado School of Medicine at the Anschutz Medical Campus, Aurora, CO, USA
| | - Howard D Weinberger
- National Jewish Health, Department of Medicine, Denver, CO, USA
- University of Colorado School of Medicine at the Anschutz Medical Campus, Aurora, CO, USA
| | - Kerrie L Moreau
- University of Colorado School of Medicine at the Anschutz Medical Campus, Aurora, CO, USA
- VA Eastern Colorado Geriatric Research, Education, and Clinical Center Aurora, Denver, CO, USA
| | - Russell P Bowler
- National Jewish Health, Department of Medicine, Denver, CO, USA
- University of Colorado School of Medicine at the Anschutz Medical Campus, Aurora, CO, USA
| | - Karin F Hoth
- Department of Psychiatry, University of Iowa Carver College of Medicine, 200 Hawkins Dr., W278GH, Iowa City, IA, 52242, USA.
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18
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Iyer AS, Holm KE, Bhatt SP, Kim V, Kinney GL, Wamboldt FS, Jacobs MR, Regan EA, Armstrong HF, Lowe KE, Martinez CH, Dransfield MT, Foreman MG, Shinozaki G, Hanania NA, Wise RA, Make BJ, Hoth KF. Symptoms of anxiety and depression and use of anxiolytic-hypnotics and antidepressants in current and former smokers with and without COPD - A cross sectional analysis of the COPDGene cohort. J Psychosom Res 2019; 118:18-26. [PMID: 30782350 PMCID: PMC6383809 DOI: 10.1016/j.jpsychores.2019.01.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 01/03/2019] [Accepted: 01/04/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To compare the frequency of anxiety/depressive symptoms and use of anxiolytic-hypnotics/antidepressants in smokers with and without COPD and to identify characteristics associated with having unmedicated symptoms. METHODS Cross-sectional analysis of ambulatory, current/former smokers ≥10 pack years enrolled in the COPDGene study. We measured anxiety/depressive symptoms using the Hospital Anxiety and Depression Scale (subscales ≥8), recorded anxiolytic-hypnotic/antidepressant use, and defined unmedicated symptoms as elevated anxiety/depressive symptoms and not on medications. Regression analysis identified characteristics associated with having unmedicated symptoms. KEY RESULTS Of 5331 current/former smokers (45% with and 55% without COPD), 1332 (25.0%) had anxiety/depressive symptoms. Anxiety symptoms were similar in frequency in smokers with and without COPD (19.7% overall), while depressive symptoms were most frequent in severe-very severe COPD at 20.7% (13.1% overall). In the entire cohort, 1135 (21.2%) were on medications. Anxiolytic-hypnotic use was highest in severe-very severe COPD (range 7.6%-12.0%), while antidepressant use showed no significant variation in smokers with and without COPD (range 14.7%-17.1%). Overall, 881 (66% of those with symptoms) had unmedicated symptoms, which was associated with African American race (adjusted OR 2.95, 95% CI 2.25-3.87), male gender (adjusted OR 1.93, 95% CI 1.57-2.36), no health insurance (adjusted OR 2.38, 95% CI 1.30-4.35), severe-very severe COPD (adjusted OR 1.48, 95% CI 1.04-2.11), and higher respiratory symptoms/exacerbation history (adjusted OR 2.21, 95% CI 1.62-3.02). CONCLUSIONS Significant unmet mental health care needs exist in current and former smokers with and without COPD. One in five have unmedicated symptoms, identified by key demographic and clinical characteristics. PRIMARY FUNDING SOURCE National Institutes of Health and The COPD Foundation.
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Affiliation(s)
- Anand S Iyer
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA; Lung Health Center, University of Alabama at Birmingham, Birmingham, AL, USA; Health Services, Outcomes, and Effectiveness Research Training Program, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Kristen E Holm
- Department of Medicine, National Jewish Health, Denver, CO, USA; Department of Community and Behavioral Health, Colorado School of Public Health, Aurora, CO, USA
| | - Surya P Bhatt
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA; Lung Health Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Victor Kim
- Department of Thoracic Medicine and Surgery, Temple University School of Medicine Philadelphia, PA, USA
| | - Gregory L Kinney
- Department of Epidemiology, Colorado School of Public Health, University of Colorado, Aurora, CO, USA
| | - Frederick S Wamboldt
- Department of Medicine, National Jewish Health, Denver, CO, USA; Department of Psychiatry, University of Colorado School of Medicine at the Anschutz Medical Campus, Aurora, CO, USA
| | - Michael R Jacobs
- Department of Thoracic Medicine and Surgery, Temple University School of Medicine Philadelphia, PA, USA
| | - Elizabeth A Regan
- Department of Medicine, National Jewish Health, Denver, CO, USA; Department of Epidemiology, Colorado School of Public Health, University of Colorado, Aurora, CO, USA
| | - Hilary F Armstrong
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Katherine E Lowe
- Department of Epidemiology, Colorado School of Public Health, University of Colorado, Aurora, CO, USA
| | - Carlos H Martinez
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Mark T Dransfield
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA; Lung Health Center, University of Alabama at Birmingham, Birmingham, AL, USA; Veterans Affairs Medical Center, Birmingham, AL, USA
| | - Marilyn G Foreman
- Division of Pulmonary and Critical Care Medicine, Morehouse School of Medicine, Atlanta, GA, USA
| | - Gen Shinozaki
- Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City, IA, USA; Iowa Neuroscience Institute, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Nicola A Hanania
- Division of Pulmonary/Critical Care Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Robert A Wise
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Barry J Make
- Department of Medicine, National Jewish Health, Denver, CO, USA
| | - Karin F Hoth
- Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City, IA, USA; Iowa Neuroscience Institute, Carver College of Medicine, University of Iowa, Iowa City, IA, USA; Department of Pulmonary, Critical Care, and Sleep Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA, USA.
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Choate R, Mannino DM, Holm KE, Sandhaus RA. Comparing Patients with ZZ Versus SZ Alpha-1 Antitrypsin Deficiency: Findings from AlphaNet's Disease Management Program. Chronic Obstr Pulm Dis 2018; 6:29-39. [PMID: 30775422 DOI: 10.15326/jcopdf.6.1.2018.0134] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background: The aim of this study was to examine differences in demographic, health, and behavioral characteristics in individuals with ZZ and SZ genotypes of alpha-1 antitrypsin deficiency (AATD) within AlphaNet's Disease Management and Prevention Program (ADMAPP). Methods: Self-reported data from 3535 patients with AATD, including 3031 (85.7%) patients with ZZ, ZNull, and NullNull genotypes (referred to here as ZZ), and 504 (14.3%) with the SZ genotype were analyzed using t-tests, ANOVAs, and Chi-squared tests. Results: The average age of the cohort was 56.3±10.6 years. The majority of respondents were male (51.2%), white (98.2%) and married (65.2%). SZs reported having more frequent exacerbations (p<0.001) and hospitalizations (p=0.012) than ZZs. A higher proportion of SZs than ZZs had been diagnosed with high blood pressure, diabetes, congestive heart failure, and other comorbid conditions. SZs were more likely than ZZs to report "poor" health (p=0.005). Over a third (38.4%) of SZs do not exercise compared to 27.1% of ZZs (p<0.001). A greater proportion of SZs compared to ZZs view themselves as being overweight (p<0.001) or "out of shape" (p=0.001). A higher proportion of SZs than ZZs reported any history of smoking and current smoking (p<0.001). Conclusions: In patients with AATD and lung disease participating in a disease management program, a higher proportion of SZs than ZZs report exacerbations, comorbidities, and overall poor health, as well as unhealthy behaviors such as lack of exercise and current smoking. Future work should consider the extent to which genotype-specific health promotion interventions would be useful.
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Affiliation(s)
- Radmila Choate
- Department of Preventive Medicine and Environmental Health, University of Kentucky College of Public Health, Lexington
| | - David M Mannino
- Department of Preventive Medicine and Environmental Health, University of Kentucky College of Public Health, Lexington
| | - Kristen E Holm
- Division of Medical, Behavioral, and Community Health, National Jewish Health; Department of Community and Behavioral Health, University of Colorado Denver School of Public Health, Denver
| | - Robert A Sandhaus
- Division of Pulmonary Sciences and Critical Care Medicine, National Jewish Health, University of Colorado Denver School of Medicine, Denver
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Lowe KE, Make BJ, Crapo JD, Kinney GL, Hokanson JE, Kim V, Iyer AS, Bhatt SP, Hoth KF, Holm KE, Wise R, DeMeo D, Foreman MG, Stone TJ, Regan EA. Association of low income with pulmonary disease progression in smokers with and without chronic obstructive pulmonary disease. ERJ Open Res 2018; 4:00069-2018. [PMID: 30443555 PMCID: PMC6230816 DOI: 10.1183/23120541.00069-2018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 09/11/2018] [Indexed: 11/09/2022] Open
Abstract
Low socioeconomic status has been associated with chronic obstructive pulmonary disease (COPD) but little is known about its impact on disease progression. We assessed the association of income to symptoms, pulmonary disease severity and progression in smokers with and without COPD. The COPDGene cohort of 4826 smokers who reported annual income in phase 2 was analysed. Those who reported annual income <USD 15 000 per year were “low-income” and the remainder “higher income”. Baseline demographics, symptoms, computed tomography (CT) imaging, and 5-year change in spirometry and CT metrics were characterised by group. The low income group was younger (55.7 versus 61.7, p<0.0001), had more current smokers (73% versus 36%, p<0.0001), higher rates of severe exacerbations (13% versus 7%, p<0.0001), more chronic bronchitis (22% versus 14%, p<0.0001), reduced access to preventative care and lower quality of life, but less emphysema (4.7% versus 6.2%, p<0.0001). After 5 years the low-income group had more smoking-related disease progression, without significant change in exacerbations or symptoms, than higher-income subjects. Low income was an independent predictor of decreasing forced expiratory volume in 1 s (FEV1) (p=0.001) and increased airway disease (p=0.007) after adjusting for baseline FEV1, age, sex, race, exposures and current smoking. Income disparity beyond the effects of race and current smoking is an important factor for disease progression. Worldwide, poverty and its consequences: associated respiratory exposures, limited healthcare access, and inadequate education about smoking risks, may exacerbate chronic lung disease. Income is a factor in predicting pulmonary disease progression in smokers with and without COPD; those with lower income experience faster progression and worse symptomshttp://ow.ly/1SSe30lU1cX
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Affiliation(s)
| | - Barry J Make
- Dept of Medicine, National Jewish Health, Denver, CO, USA
| | - James D Crapo
- Dept of Medicine, National Jewish Health, Denver, CO, USA
| | - Gregory L Kinney
- Dept of Epidemiology, Colorado School of Public Health, Aurora, CO, USA
| | - John E Hokanson
- Dept of Epidemiology, Colorado School of Public Health, Aurora, CO, USA
| | - Victor Kim
- Dept of Thoracic Medicine and Surgery, Temple University, Philadelphia, PA, USA
| | - Anand S Iyer
- Dept of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Surya P Bhatt
- Dept of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Karin F Hoth
- Dept of Psychiatry, University of Iowa, Iowa City, IA, USA
| | - Kristen E Holm
- Dept of Medicine, National Jewish Health, Denver, CO, USA
| | - Robert Wise
- Dept of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Dawn DeMeo
- Dept of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | | | | | - Elizabeth A Regan
- Dept of Medicine, National Jewish Health, Denver, CO, USA.,Dept of Epidemiology, Colorado School of Public Health, Aurora, CO, USA
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Sieluk J, Levy J, Sandhaus RA, Silverman H, Holm KE, Mullins CD. Costs of Medical Care Among Augmentation Therapy Users and Non-Users with Alpha-1 Antitrypsin Deficiency in the United States. Chronic Obstr Pulm Dis 2018; 6:6-16. [PMID: 30775420 DOI: 10.15326/jcopdf.6.1.2017.0187] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background: This study is the first to utilize a large claims database to estimate medical costs of patients with alpha-1 antitrypsin deficiency (AATD) in the United States. Methods: Adult AATD patients were identified from the OptumLabs™ Data Warehouse. Insurer and patient out-of-pocket costs were categorized into the following cost buckets, stratified by augmentation therapy use: physician visits (PV), emergency department visits (ED), inpatient stays (IP), augmentation therapy (AUG), other prescription drug costs (RX), and other costs (OTH). Costs were weighted and adjusted to 2017 U.S. dollars using the medical care component of the consumer price index. Results: The study cohort consisted of9117 AATD patients followed for 53,872 person years observed between 1993 and 2015. The annual costs among AATD patients totaled $127,537 among augmentation therapy users and $15,874 among non-users. The major drivers of annual costs to the insurer among the 7975 patients not on augmentation therapy were: PV: $5352 (37.7%) and IP: $4506 (31.8%). Among the 1142 augmentation users, major annual cost drivers to the insurer were PV: $15,064 (12.3%) and AUG: $82,002 (66.7%). Annual patient out-of-pocket costs were $4601 (AUG: $2084 [45.3%]; RX: $940 [20.4%]) and $1689 (PV: $727 [43.0%]; RX: $589 [34.9%]) among augmentation therapy users and non-users, respectively. Averaged across the entire cohort, the average annual costs per AATD patient were $22,975, paid by insurers ($21,100) and patients ($1875). Conclusions: Annual medical costs among patients with AATD are $127,537 and $15,874 among augmentation therapy users and non-users, respectively, with 75.3% of the cost difference attributable to AUG.
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Affiliation(s)
- Jan Sieluk
- Pharmaceutical Health Services Research Department, School of Pharmacy, University of Maryland, Baltimore.,OptumLabs, Cambridge, Massachusetts
| | - Joseph Levy
- Pharmaceutical Health Services Research Department, School of Pharmacy, University of Maryland, Baltimore
| | - Robert A Sandhaus
- Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, Colorado
| | | | - Kristen E Holm
- Division of Medical, Behavioral, and Community Health, National Jewish Health, Denver, Colorado
| | - C Daniel Mullins
- Pharmaceutical Health Services Research Department, School of Pharmacy, University of Maryland, Baltimore
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Brunette AM, Holm KE, Wamboldt FS, Kozora E, Moser DJ, Make BJ, Crapo JD, Meschede K, Weinberger HD, Moreau KL, Bowler RP, Hoth KF. Subjective cognitive complaints and neuropsychological performance in former smokers with and without chronic obstructive pulmonary disease. J Clin Exp Neuropsychol 2018; 40:411-422. [PMID: 28766459 PMCID: PMC5953430 DOI: 10.1080/13803395.2017.1356912] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE This study examined the association of perceived cognitive difficulties with objective cognitive performance in former smokers. We hypothesized that greater perceived cognitive difficulties would be associated with poorer performance on objective executive and memory tasks. METHOD Participants were 95 former smokers recruited from the COPDGene study. They completed questionnaires (including the Cognitive Difficulties Scale [CDS] and the Hospital Anxiety and Depression Scale [HADS]), neuropsychological assessment, and pulmonary function testing. Pearson correlations and t-tests were conducted to examine the bivariate association of the CDS (total score and subscales for attention/concentration, praxis, delayed recall, orientation for persons, temporal orientation, and prospective memory) with each domain of objective cognitive functioning (memory recall, executive functioning/processing speed, visuospatial processing, and language). Simultaneous multiple linear regression was used to further examine all statistically significant bivariate associations. The following covariates were included in all regression models: age, sex, pack-years, premorbid functioning (WRAT-IV Reading), HADS total score, and chronic obstructive pulmonary disease (COPD) status (yes/no based on GOLD criteria). RESULTS In regression models, greater perceived cognitive difficulties overall (using CDS total score) were associated with poorer performance on executive functioning/processing speed tasks (b = -0.07, SE = 0.03, p = .037). Greater perceived cognitive difficulties on the CDS praxis subscale were associated with poorer performance on executive functioning/processing speed tasks (b = -3.65, SE = 1.25, p = .005), memory recall tasks (b = -4.60, SE = 1.75, p = .010), and language tasks (b = -3.89, SE = 1.39, p = .006). CONCLUSIONS Clinicians should be aware that cognitive complaints may be indicative of problems with the executive functioning/processing speed and memory of former smokers with and without COPD.
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Affiliation(s)
- Amanda M Brunette
- a Department of Psychological and Brain Sciences , University of Iowa , Iowa City , IA , USA
| | - Kristen E Holm
- b Department of Medicine , National Jewish Health , Denver , CO , USA
- c Department of Community and Behavioral Health , Colorado School of Public Health , Aurora , CO , USA
| | - Frederick S Wamboldt
- b Department of Medicine , National Jewish Health , Denver , CO , USA
- d Department of Psychiatry , University of Colorado School of Medicine at the Anschutz Medical Campus , Aurora , CO , USA
| | - Elizabeth Kozora
- b Department of Medicine , National Jewish Health , Denver , CO , USA
- d Department of Psychiatry , University of Colorado School of Medicine at the Anschutz Medical Campus , Aurora , CO , USA
| | - David J Moser
- e Department of Psychiatry , University of Iowa Carver College of Medicine , Iowa City , IA , USA
| | - Barry J Make
- b Department of Medicine , National Jewish Health , Denver , CO , USA
- f Department of Medicine , University of Colorado School of Medicine at the Anschutz Medical Campus , Aurora , CO , USA
| | - James D Crapo
- b Department of Medicine , National Jewish Health , Denver , CO , USA
- f Department of Medicine , University of Colorado School of Medicine at the Anschutz Medical Campus , Aurora , CO , USA
| | - Kimberly Meschede
- b Department of Medicine , National Jewish Health , Denver , CO , USA
| | - Howard D Weinberger
- b Department of Medicine , National Jewish Health , Denver , CO , USA
- f Department of Medicine , University of Colorado School of Medicine at the Anschutz Medical Campus , Aurora , CO , USA
| | - Kerrie L Moreau
- f Department of Medicine , University of Colorado School of Medicine at the Anschutz Medical Campus , Aurora , CO , USA
- g Geriatric Research Education and Clinical Center , Denver Veterans Administration Medical Center , Denver , CO , USA
| | - Russell P Bowler
- b Department of Medicine , National Jewish Health , Denver , CO , USA
- f Department of Medicine , University of Colorado School of Medicine at the Anschutz Medical Campus , Aurora , CO , USA
| | - Karin F Hoth
- b Department of Medicine , National Jewish Health , Denver , CO , USA
- e Department of Psychiatry , University of Iowa Carver College of Medicine , Iowa City , IA , USA
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23
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Holm KE, Casaburi R, Cerreta S, Gussin HA, Husbands J, Porszasz J, Prieto-Centurion V, Sandhaus RA, Sullivan JL, Walsh LJ, Krishnan JA. Patient Involvement in the Design of a Patient-Centered Clinical Trial to Promote Adherence to Supplemental Oxygen Therapy in COPD. Patient 2017; 9:271-9. [PMID: 26521057 DOI: 10.1007/s40271-015-0150-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Patients are increasingly viewed as key stakeholders who can contribute in meaningful ways to clinical research and are emphasized in research funded by the Patient-Centered Outcomes Research Institute (PCORI). We are not aware of other peer-reviewed publications that report methods and outcomes of patient engagement to refine study design for a PCORI-sponsored clinical effectiveness trial. OBJECTIVE The aim of this report was to describe the process and outcomes of involving patients in the design of a clinical trial to promote adherence to supplemental oxygen therapy among patients with chronic obstructive pulmonary disease. METHODS In-person focus groups and individual discussions via telephone and email were used to elicit feedback to refine the intervention and clarify outcomes of highest importance to patients. RESULTS A total of 25 patients and five caregivers provided feedback. Their feedback has informed decisions regarding the length of intervention sessions (20 min and in some cases longer was acceptable), the importance of including caregivers, and discussion topics (e.g., social discomfort about using oxygen in public, identifying personally relevant reasons to use oxygen, pulmonary rehabilitation). Multiple outcomes were rated as highly important to patients (physical function, fatigue, sleep, anxiety, depression, and ability to participate in social roles and activities), and the outcome that was ranked as most important varied by individual. Therefore, multiple patient-reported outcomes will be used as endpoints for the clinical trial. CONCLUSIONS Patient involvement led to refinements of the intervention and clinical trial endpoints to better address the expressed needs and concerns of patients and caregivers.
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Affiliation(s)
- Kristen E Holm
- Department of Medicine, National Jewish Health, Denver, CO, USA. .,Department of Community and Behavioral Health, Colorado School of Public Health, Aurora, CO, USA.
| | - Richard Casaburi
- Rehabilitation Clinical Trials Center, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, USA
| | | | - Hélène A Gussin
- Population Health Sciences Program, University of Illinois Hospital and Health Sciences System, Chicago, IL, USA
| | | | - Janos Porszasz
- Rehabilitation Clinical Trials Center, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, USA
| | | | - Robert A Sandhaus
- Department of Medicine, National Jewish Health, Denver, CO, USA.,AlphaNet, Miami, FL, USA.,Alpha-1 Foundation, Miami, FL, USA
| | | | | | - Jerry A Krishnan
- Population Health Sciences Program, University of Illinois Hospital and Health Sciences System, Chicago, IL, USA.,Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA
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Holm KE, Patterson JM, Gurney JG. Parental Involvement and Family-Centered Care in the Diagnostic and Treatment Phases of Childhood Cancer: Results from a Qualitative Study. J Pediatr Oncol Nurs 2016; 20:301-13. [PMID: 14738162 DOI: 10.1177/1043454203254984] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Few research studies have addressed the ways parents participate in their childs medical care, particularly in relation to the cancer experience. The purpose of this study was to explore parents descriptions of their participation in medical care for their children with cancer. For this study, seven focus groups were conducted with 45 parents of 26 children who had completed cancer treatment at least one year prior, and who were still alive. Data were coded using thematic analysis procedures. It was found that parents emphasized their role as advocates during the diagnosis and treatment phases, by informing themselves about their childrens medical conditions, making medical care decisions, limiting the actions of medical professionals, and affirming and supporting medical professionals. These results emphasize the need to employ a family-centered approach in cancer care medical settings, by fostering and supporting the active inclusion of parents in their child’s treatment and management.
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Affiliation(s)
- Kristen E Holm
- Department of Family Social Science, University of Minnesota, St. Paul, USA
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Fenster BE, Holm KE, Weinberger HD, Moreau KL, Meschede K, Crapo JD, Make BJ, Bowler R, Wamboldt FS, Hoth KF. Right ventricular diastolic function and exercise capacity in COPD. Respir Med 2015; 109:1287-92. [PMID: 26371994 DOI: 10.1016/j.rmed.2015.09.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 09/02/2015] [Accepted: 09/02/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Decreased exercise capacity in chronic obstructive pulmonary disease (COPD) is incompletely explained by pulmonary pathologic and physiologic abnormalities. We evaluated the extent to which right ventricular diastolic function (RVDF) is associated with exercise capacity in COPD. METHODS Fifty-one patients with COPD were evaluated by echocardiography, spirometry, and the 6 min walk test (6MWT). RVDF was assessed using 4 echocardiographic parameters: 1) the ratio of tricuspid valve (TV) early (E) and late (A) inflow velocities (TV E/A) 2) TV early tissue Doppler velocity (TV e') 3) TV deceleration time (DT) and 4) the ratio of TV E and e' velocities (TV E/e'). Multiple linear regression was used to examine the extent to which these parameters were associated with 6MWT distance. All models adjusted for age, sex, post-bronchodilator FEV1/FVC, resting heart rate, and use of supplemental O2 during 6MWT. A regression model was calculated for each of the 4 markers of RVDF. RESULTS Forty-seven percent of the sample had GOLD stage III or IV COPD. All 51 subjects had preserved left ventricular ejection fraction (LVEF, mean = 71.7%, SD = 7.8%). A higher TV E/A ratio was associated with increased 6MWT distance (p = 0.001). TV e', TV DT and TV E/e' did not have a statistically significant association with 6MWT distance in regression models. CONCLUSIONS In a cohort with moderate to severe COPD and normal LVEF, TV E/A was associated with 6MWT distance after adjusting for relevant demographic and medical covariates. RV diastolic dysfunction may independently contribute to exercise intolerance in COPD.
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Affiliation(s)
- Brett E Fenster
- National Jewish Health, Division of Cardiology, Denver, CO, United States.
| | - Kristen E Holm
- National Jewish Health, Division of Pulmonary, Critical Care and Sleep Medicine, Denver, CO, United States
| | | | - Kerrie L Moreau
- University of Colorado School of Medicine at the Anschutz Medical Campus, Department of Medicine, Aurora, CO, United States
| | - Kimberly Meschede
- National Jewish Health, Division of Pulmonary, Critical Care and Sleep Medicine, Denver, CO, United States
| | - James D Crapo
- National Jewish Health, Division of Pulmonary, Critical Care and Sleep Medicine, Denver, CO, United States
| | - Barry J Make
- National Jewish Health, Division of Pulmonary, Critical Care and Sleep Medicine, Denver, CO, United States
| | - Russell Bowler
- National Jewish Health, Division of Pulmonary, Critical Care and Sleep Medicine, Denver, CO, United States
| | - Frederick S Wamboldt
- University of Colorado School of Medicine at the Anschutz Medical Campus, Department of Psychiatry, Aurora, CO, United States
| | - Karin F Hoth
- University of Iowa Carver College of Medicine, Department of Psychiatry, Iowa City, IA, United States
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Hoth KF, Wamboldt FS, Ford DW, Sandhaus RA, Strange C, Bekelman DB, Holm KE. The social environment and illness uncertainty in chronic obstructive pulmonary disease. Int J Behav Med 2015; 22:223-32. [PMID: 25008041 DOI: 10.1007/s12529-014-9423-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE Illness uncertainty is associated with worse outcomes in patients with chronic health conditions. Research on social factors associated with uncertainty has focused on the beneficial role of social support. The goal of this study was to develop a more nuanced understanding of the social factors that are associated with uncertainty. METHODS Four hundred sixty-two individuals with alpha-1 antitrypsin deficiency (AATD)-associated chronic obstructive pulmonary disease (COPD) completed a mailed questionnaire. Measures of the social environment included general family functioning, perceived criticism from family members, whether the participant had family members with AATD or COPD, and participation in support groups. Uncertainty was measured using the Mishel Uncertainty in Illness Scale including subscales for ambiguity (uncertainty about physical cues and symptoms) and complexity (uncertainty about treatment and the medical system). Hierarchical regression was used to identify social correlates of ambiguity and complexity while adjusting for demographic and medical characteristics and psychological distress. RESULTS Perceived criticism was associated with more complexity (b = 0.21, SE = 0.09, p = 0.015) and ambiguity (b = 0.40, SE = 0.12, p = 0.001). Having a family member with AATD or COPD was associated with more ambiguity (b = 3.28, SE = 1.00, p = 0.001). Participation in support groups was associated with less ambiguity. Individuals who attended three or more support groups in the prior year reported less ambiguity than individuals who had not attended any (b = -3.31, SE = 1.29, p = 0.010). CONCLUSIONS The social environment is complex and encompasses more than social support. Multiple aspects of the social environment are associated with uncertainty, including perceived criticism, having a family member with a similar illness, and participation in support groups.
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Affiliation(s)
- Karin F Hoth
- Department of Psychiatry, University of Iowa Carver College of Medicine, 200 Hawkins Drive, W278GH, Iowa City, IA, 52242, USA,
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Holm KE, Borson S, Sandhaus RA, Ford DW, Strange C, Bowler RP, Make BJ, Wamboldt FS. Differences in adjustment between individuals with alpha-1 antitrypsin deficiency (AATD)-associated COPD and non-AATD COPD. COPD 2013; 10:226-34. [PMID: 23547634 DOI: 10.3109/15412555.2012.719049] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Smokers who have severe alpha-1 antitrypsin deficiency (AATD) are at risk for developing COPD earlier in life than smokers without AATD, and are likely to experience challenges adjusting to their illness because they are in a highly productive life stage when they are diagnosed with COPD. This study examined whether individuals with AATD-associated COPD differ from individuals with non-AATD COPD with regard to depression, anxiety, dyspnea, and health-related quality of life (HRQL). Cross-sectional data were collected via self-report questionnaires completed by 480 individuals with non-AATD COPD and 578 individuals with AATD-associated COPD under protocols with IRB approval. Multiple linear regression models were used to test whether individuals with non-AATD COPD differed from individuals with AATD-associated COPD with regard to depression, anxiety, dyspnea, and HRQL. All models adjusted for demographic and health characteristics. Individuals with AATD-associated COPD did not report more symptoms of depression or anxiety; however, they did report more dyspnea (B = 0.31, 95% CI = 0.16 to 0.47, p < 0.001) and impairment in HRQL (B = 4.75, 95% CI = 2.10 to 7.41, p < 0.001) than other individuals with COPD. Individuals with AATD-associated COPD were more likely to be a member of a couple (rather than single) and had a higher level of education when compared to individuals with non-AATD COPD. Resources available to persons with AATD-associated COPD, such as being in a serious relationship and having higher education, may offset the effect of age when considering symptoms of depression and anxiety in patients with COPD.
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Affiliation(s)
- Kristen E Holm
- Department of Medicine, National Jewish Health, Denver, CO 80206, USA.
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Hoth KF, Wamboldt FS, Strand M, Ford DW, Sandhaus RA, Strange C, Bekelman DB, Holm KE. Prospective impact of illness uncertainty on outcomes in chronic lung disease. Health Psychol 2013; 32:1170-4. [PMID: 23772888 DOI: 10.1037/a0032721] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To determine which aspect of illness uncertainty (i.e., ambiguity or complexity) has a stronger association with psychological and clinical outcomes over a 2-year period among individuals with a genetic subtype of chronic obstructive pulmonary disease (COPD). Ambiguity reflects uncertainty about physical cues and symptoms, and complexity reflects uncertainty about treatment and the medical system. METHOD Four-hundred and 7 individuals with alpha-1 antitrypsin deficiency-associated COPD completed questionnaires at baseline, 1- and 2-year follow-up. Uncertainty was measured using the Mishel Uncertainty in Illness Scale. Outcomes were measured using the Hospital Anxiety and Depression Scale, St. George's Respiratory Questionnaire, and MMRC Dyspnea Scale. Ambiguity and complexity were examined as predictors of depressive symptoms, anxiety, quality of life, and breathlessness using linear mixed models adjusting for demographic and health characteristics. RESULTS Ambiguity was associated with more depressive symptoms (b = 0.09, SE = 0.02, p < .001) and anxiety (b = 0.13, SE = 0.02, p < .001), worse quality of life (b = 0.57, SE = 0.10, p < .001), and more breathlessness (b = 0.02, SE = 0.006, p < .001). Complexity did not have an independent effect on any outcome. Interactions between ambiguity and time since diagnosis were not statistically significant. CONCLUSIONS Ambiguity was prospectively associated with worse mood, quality of life, and breathlessness. Thus, ambiguity should be targeted in psychosocial interventions. Time since diagnosis did not affect the association between ambiguity and outcomes, suggesting that the impact of ambiguity is equally strong throughout the course of COPD.
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Holm KE, Wamboldt FS, Ford DW, Sandhaus RA, Strand MJ, Strange C, Hoth KF. The prospective association of perceived criticism with dyspnea in chronic lung disease. J Psychosom Res 2013; 74:450-3. [PMID: 23597335 PMCID: PMC3631318 DOI: 10.1016/j.jpsychores.2013.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2012] [Revised: 02/01/2013] [Accepted: 02/03/2013] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Perceived criticism from family members influences mental health. The link between perceived criticism and physical health has not been thoroughly investigated. The objective of this study was to examine the association of perceived criticism with dyspnea in chronic obstructive pulmonary disease (COPD). METHODS 401 individuals with alpha-1 antitrypsin deficiency-associated COPD completed questionnaires at baseline, 1- and 2-year follow-up. Perceived criticism at baseline was examined as a predictor of dyspnea at all three time points using a linear mixed model that adjusted for demographic and health characteristics. RESULTS There was an interaction between perceived criticism and psychological distress (p=0.038). Perceived criticism was associated with dyspnea only among individuals with elevated psychological distress (b=0.32, SE=0.13, p=0.018). CONCLUSION Further research is needed to replicate these findings and determine the extent to which they apply to other common subjective physical symptoms such as pain.
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Affiliation(s)
- Kristen E. Holm
- National Jewish Health, Department of Medicine, Denver, CO, United States,Colorado School of Public Health, Department of Community and Behavioral Health, Aurora, CO, United States
| | - Frederick S. Wamboldt
- National Jewish Health, Department of Medicine, Denver, CO, United States,University of Colorado School of Medicine at the Anschutz Medical Campus, Department of Psychiatry, Aurora, CO, United States
| | - Dee W. Ford
- Medical University of South Carolina, Division of Pulmonary and Critical Care Medicine, Charleston, SC, United States
| | - Robert A. Sandhaus
- National Jewish Health, Department of Medicine, Denver, CO, United States,Clinical Director, Alpha-1 Foundation, Miami, FL, United States
| | - Matthew J. Strand
- National Jewish Health, Division of Biostatistics and Bioinformatics, Denver, CO, United States,Colorado School of Public Health, Department of Biostatistics, Aurora, CO, United States
| | - Charlie Strange
- Medical University of South Carolina, Division of Pulmonary and Critical Care Medicine, Charleston, SC, United States
| | - Karin F. Hoth
- National Jewish Health, Department of Medicine, Denver, CO, United States,University of Colorado School of Medicine at the Anschutz Medical Campus, Department of Psychiatry, Aurora, CO, United States,University of Colorado School of Medicine at the Anschutz Medical Campus, Department of Neurology, Aurora, CO, United States
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Hoth KF, Ford DW, Sandhaus RA, Strange C, Wamboldt FS, Holm KE. Alcohol use predicts ER visits in individuals with alpha-1 antitrypsin deficiency (AATD) associated COPD. COPD 2012; 9:417-25. [PMID: 22651849 DOI: 10.3109/15412555.2012.684414] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Excessive alcohol use in COPD has been associated with increased mortality; however, little is known about alcohol use in AATD-associated COPD. A total of 538 individuals with AATD-associated COPD completed questionnaires at baseline and 330 also completed 2 years of follow-up questionnaires. Demographic and health information was collected, including information about alcohol use, ER visits for COPD, and hospitalizations for COPD. Problem alcohol use was characterized using the CAGE screening questionnaire and recent alcohol consumption. Demographic and clinical characteristics associated with problem drinking were identified using logistic regression. Problem drinking at baseline was examined as a predictor of ER visits and hospital admissions for COPD in the subsequent two years using logistic regression adjusting for demographic variables and baseline health status. 14% of the sample reported a history of problem drinking per the CAGE and 8% reported problem drinking in the past week. Problem drinking was associated with higher education and greater lifetime tobacco exposure. Recent alcohol consumption was a significant predictor of having an ER visit for COPD in the subsequent two years. Compared to individuals who reported problem drinking in the past week, individuals with no consumption (OR = 0.32, 95% CI = 0.10 to 0.97, p = .043) and individuals with low-to-moderate consumption (OR = 0.25, 95% CI = 0.08 to 0.77, p = .016) had significantly lower odds of an ER visit. Neither measure of problem drinking predicted hospital admission. Screening for recent excessive alcohol use in this population may identify individuals at risk for use of costly emergency health services.
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Affiliation(s)
- Karin F Hoth
- National Jewish Health, Department of Medicine, Denver, CO, United States.
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Plaufcan MR, Wamboldt FS, Holm KE. Behavioral and characterological self-blame in chronic obstructive pulmonary disease. J Psychosom Res 2012; 72:78-83. [PMID: 22200527 PMCID: PMC3246615 DOI: 10.1016/j.jpsychores.2011.10.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2010] [Revised: 10/06/2011] [Accepted: 10/14/2011] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To assess behavioral and characterological self-blame, identify demographic and relational correlates of self-blame, and determine the association of self-blame with psychological and clinical outcomes of chronic obstructive pulmonary disease (COPD). METHODS Data were collected via self-report questionnaires completed by 398 individuals with COPD who had at least a 10 pack-year history of smoking. Behavioral and characterological self-blame were measured, and multiple regression was used to identify correlates of both types of self-blame. Multiple regression was also used to determine the association of self-blame with outcomes of COPD. RESULTS More than one-third of participants endorsed the maximum possible score on the measure of behavioral self-blame. The perception that family members blamed the individual for having COPD (p=.001), tobacco exposure (p=.005), and general family functioning (p=.002) were associated with behavioral self-blame. Current smoking status (p=.001) and perception of blame from family (p<.001) were associated with characterological self-blame. While behavioral self-blame was associated with fewer symptoms of depression (p=.02), characterological self-blame was associated with more symptoms of depression (p=.02). CONCLUSIONS Individuals with COPD tend to blame themselves for smoking and other behaviors that may have led to their COPD. Smoking-related variables and the perception that family members blamed the individual for having COPD were associated with self-blame. Findings support the importance of distinguishing between behavioral and characterological self-blame in COPD, as behavioral self-blame had a negative association with depression and characterological self-blame had a positive association with depression.
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Affiliation(s)
| | - Frederick S. Wamboldt
- Department of Medicine, National Jewish Health,Department of Psychiatry, University of Colorado Denver
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Holm KE, LaChance HR, Bowler RP, Make BJ, Wamboldt FS. Family factors are associated with psychological distress and smoking status in chronic obstructive pulmonary disease. Gen Hosp Psychiatry 2010; 32:492-8. [PMID: 20851269 PMCID: PMC2943490 DOI: 10.1016/j.genhosppsych.2010.06.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2010] [Revised: 06/24/2010] [Accepted: 06/29/2010] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective of this study was to test three hypotheses in a sample of individuals with chronic obstructive pulmonary disease (COPD): (1) unsupportive family relationships are associated with psychological distress, (2) psychological distress is associated with smoking status and (3) unsupportive family relationships are indirectly associated with smoking status via psychological distress. METHOD Cross-sectional data were collected via self-report questionnaires completed by 455 individuals with COPD who had at least a 10-pack-year smoking history. The hypotheses were tested with structural equation modeling. RESULTS All three hypotheses were supported. Unsupportive family relationships were associated with psychological distress (β=.67, P<.001), psychological distress was associated with smoking status (β=.40, P<.001), and unsupportive family relationships were indirectly associated with smoking status via psychological distress (β=.27, P<.001). CONCLUSION Results of this study suggest that family relationships are an important factor to include in future longitudinal research that attempts to elucidate social and psychological influences on smoking behavior.
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Affiliation(s)
| | - Heather R. LaChance
- Department of Medicine, National Jewish Health,Department of Psychiatry, University of Colorado Denver
| | - Russell P. Bowler
- Department of Medicine, National Jewish Health,Department of Medicine, University of Colorado Denver
| | - Barry J. Make
- Department of Medicine, National Jewish Health,Department of Medicine, University of Colorado Denver
| | - Frederick S. Wamboldt
- Department of Medicine, National Jewish Health,Department of Psychiatry, University of Colorado Denver
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Holm KE, Bowler RP, Make BJ, Wamboldt FS. Family Relationship Quality is Associated with Psychological Distress, Dyspnea, and Quality of Life in COPD. COPD 2009; 6:359-68. [DOI: 10.1080/15412550903143919] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Rueter MA, Holm KE, McGeorge CR, Conger RD. Adolescent suicidal ideation subgroups and their association with suicidal plans and attempts in young adulthood. Suicide Life Threat Behav 2008; 38:564-75. [PMID: 19014308 DOI: 10.1521/suli.2008.38.5.564] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Suicidal ideation during adolescence is quite common. Longitudinal ideation patterns may predict adolescents at greatest risk of progressing to more serious suicidal behaviors. We enumerated suicidal ideation trajectory subgroups and estimated subgroup association with later suicidal plans and attempts using data collected across a 13-year period from 552 Caucasian adolescents. Three subgroups were found: non-ideators (no ideation), decreasers (ideation decreased), and increasers (ideation persisted or increased). Probability of planning a suicide was greatest among increasers (females: .54, males: 51, p < .01). Probability of attempting suicide was greatest among male decreasers (.36, p < .01) and female increasers (.25, p < .01).
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Holm KE, Co D, Patterson JM, Rueter MA, Wamboldt F. The Impact of Uncertainty Associated with a Child's Chronic Health Condition on Parents' Health. Fam Syst Health 2008; 26:282-295. [PMID: 20490375 PMCID: PMC2873603 DOI: 10.1037/a0012912] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
We investigated whether uncertainty about the impact of children's chronic health conditions on their daily lives leads to changes in mothers' and fathers' mental and physical health. Three waves of data were collected over three years from parents of 228 children with chronic health conditions. Parents reported their level of uncertainty about how the child's health condition affected the child's daily life, as well as measures of their own mental and physical health at each wave of data collection. Results of structural equation models indicate that, among mothers, more illness-related uncertainty was associated with a subsequent increase in psychological symptoms relative to other mothers in the study. Psychological symptoms, in turn, were associated with a subsequent increase in physical symptoms among mothers. Uncertainty did not affect fathers' health. Illness-related uncertainty may be a risk factor for psychological and physical symptoms in mothers of children with chronic health conditions. As such, interventions that address uncertainty related to the child's chronic health condition may improve psychological and physical well-being of mothers of children with chronic health conditions.
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Rueter MA, Holm KE, Burzette R, Kim KJ, Conger RD. Mental health of rural young adults: prevalence of psychiatric disorders, comorbidity, and service utilization. Community Ment Health J 2007; 43:229-49. [PMID: 17345147 DOI: 10.1007/s10597-007-9082-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2005] [Accepted: 01/02/2007] [Indexed: 10/23/2022]
Abstract
Few studies estimate rural psychiatric disorder rates. No study has reported either DSM-III-R or DSM IV disorder prevalence and mental health service use among US rural young adults. This paper reports psychiatric disorder prevalence, comorbidity, service utilization, and disorder correlates in a community sample of 536 young adults, aged 19 to 23 years, living in the rural Midwestern US. More than 60% of the sample met criteria for a lifetime disorder. Substance use disorders were most prevalent. Results indicate that young adults living in the rural Midwest demonstrate substantial rates of psychiatric disorder that are comparable to other population groups.
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Affiliation(s)
- Martha A Rueter
- Department of Family Social Science, University of Minnesota, 290 McNeal Hall, 1985 Buford Hall, St. Paul, MN 55108, USA.
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Patterson JM, Holm KE, Gurney JG. The impact of childhood cancer on the family: a qualitative analysis of strains, resources, and coping behaviors. Psychooncology 2004; 13:390-407. [PMID: 15188446 DOI: 10.1002/pon.761] [Citation(s) in RCA: 187] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Clinical research has led to tremendous improvements in treatment efficacy for most childhood cancers; overall 5-year survival is now greater than 75%. Long-term consequences of cure (i.e. adverse medical and psychosocial effects) have only recently begun to emerge as a primary focus of clinical research, including studies of health-related quality of life among survivors. Usually lacking in such efforts, however, is consideration of the impact of the cancer experience on the family, and the influence that the family's response to cancer has on quality of life in the child. From this qualitative analysis of seven focus groups with 45 parents of children a year or more out of cancer treatment, we report those aspects of a child's cancer diagnosis, treatment, and recovery that parents perceived as particularly difficult for their family, and the resources and coping behaviors parents perceived as helpful to their family in dealing with and managing the cancer experience. Using the Family Adjustment and Adaptation Response theoretical model to organize the data, the domains of strains and resources were delineated into themes and sub-themes related to the cancer, child, family, health-care system, and community. Within a third domain, coping, sub-themes were identified within the themes of appraisal-focused, problem-focused, and emotion-focused coping behaviors. Integration of this information should serve to improve future studies of health-related quality of life among children who survive cancer.
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Affiliation(s)
- Joän M Patterson
- Division of Epidemiology, University of Minnesota, Minneapolis 55455, USA
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Abstract
Self-help literature is pervasive and influential in the United States. A critical analysis of self-help books would help therapists to determine their utility for the therapeutic process and assist them in making reading recommendations to clients. In this study, a content analysis was conducted of the top 11 relationship self-help books on the New York Times Bestseller List over a period of 10 years (1988-1998) to determine the degree to which these books support a feminist approach to therapy. This study yielded three major findings. First, the number of feminist books, the number of nonfeminist books, and those falling in the middle across four components of feminist family therapy are about equal. However, the second major finding was that the top-selling books are more likely to be nonfeminist than feminist. The third finding is that most best-selling self-help books appear to have become less compatible with a feminist approach to relationships over time. This analysis encourages therapists to think critically about these best-selling books; it will also allow therapists to consider this methodology as a model for critically analyzing other books that they recommend to clients or use in their own professional development.
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Affiliation(s)
- T S Zimmerman
- Marriage and Family Therapy Master's Program, Colorado State University, Fort Collins, CO 80523-1570, USA
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Starrels ME, Holm KE. Adolescents' Plans for Family Formation: Is Parental Socialization Important? J Marriage and Family 2000; 62:416-429. [PMID: 0 DOI: 10.1111/j.1741-3737.2000.00416.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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