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Current Management Challenges in Chronic Obstructive Pulmonary Disease (COPD)

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A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Pulmonology".

Deadline for manuscript submissions: closed (31 December 2021) | Viewed by 35424

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Dr. Sabina Antonela Antoniu

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Guest Editor

University of Medicine and Pharmacy Grigore T Popa, Iași 700115, Romania
Interests: pulmonary diseases; palliative care; patient reported outcomes; inhaled therapies; rare diseases

Special Issue Information

Dear Colleagues,

Chronic obstructive pulmonary disease (COPD) is a prevalent respiratory disease mainly related to smoking exposure, for which the management guidelines have evolved over the last two decades based on the evidence coming from various clinical trials and answering various research questions. It is currently known that lung function impairment alone can no longer be considered as an appropriate marker of disease severity, and that there are various phenotypes of the disease which require an appropriate tailoring of the available therapeutic options, that the use of inhaled corticosteroids is increasingly restricted unlike asthma, and that disease morbidity (exacerbations number and severity) is one of the features used to guide the intensiveness of the management approach in individual patients.

However, despite this evidence, many therapeutic challenges still exist in COPD: end-stage disease can benefit from palliative care, but it is not known how early this should be; vaccination in elderly patients with COPD is still unclear in terms of effectiveness and the types of approaches; it is not known when and why inhaled corticosteroids doses should be reduced; and the appropriateness and effects of home-based rehabilitation programs are not also clear. Furthermore, in the ongoing COVID-19 era which is taking a heavy toll on all of us and indeed on COPD patients, the management of such patients is challenging and should be adjusted accordingly. All these challenges are addressed hopefully to the benefit of the healthcare community and of COPD patients by this issue of Medicina.

Dr. Sabina Antonela Antoniu
Guest Editor

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Keywords

chronic obstructive pulmonary disease
elderly
palliative care
health status
pulmonary rehabilitation
inhaled corticosteroids
exacerbations
immunization
vaccine
COVID-19

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Published Papers (10 papers)

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Research

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16 pages, 368 KiB

Open AccessArticle

What Are the Most Effective Factors in Determining Future Exacerbations, Morbidity Weight, and Mortality in Patients with COPD Attack?

by Çağla Koç and Füsun Şahin

Medicina 2022, 58(2), 163; https://doi.org/10.3390/medicina58020163 - 21 Jan 2022

Cited by 11 | Viewed by 3709

Abstract

Background and Objectives: This study aimed to investigate the important factors that affect COPD prognosis. Materials and Methods: We included 160 hospitalized patients with COPD exacerbation in the study. The hemoglobin (HB), hematocrit (HCT), leukocytes, red cell distribution width (RDW), mean platelet volume, platelet distribution width, plateletcrits, platelets, neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, eosinophils, uric acid, albumin, C-reactive protein (CRP), procalcitonin, arterial blood gases (PO2 and PCO2), pulmonary function test (FEV1 and FVC), echocardiography (ejection fraction-EF), Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage, Modified Medical Research Council (mMRC) and Borg scales, Charlson comorbidity index, body mass index (BMI), and the length of hospital stay were examined on the first day of hospitalization. Admission to the hospital with a new attack, hospitalization in the intensive care unit (ICU), and mortality during the six months after discharge were evaluated. Results: High CRP and procalcitonin levels were observed in the group with a long hospital stay. In the mortality group, the HB, HCT, BMI, and PO2 values were significantly lower than in the group without mortality, while the age and GOLD stage were higher. The age, Borg and mMRC scores, number of exacerbations experienced in the previous year, RDW, eosinophil count, and PCO2 were significantly higher in the ICU group than that without an ICU stay. The HCT and EF values were lower in the ICU group than that without an ICU stay. The FEV1 and FVC values were significantly lower in the follow-up attack group than those without a follow-up attack. The duration of COPD and the number of attacks that were experienced in the previous year were high. Conclusion: Scoring combining selected biomarkers and other factors is a strong determinant of the prognosis. Full article

(This article belongs to the Special Issue Current Management Challenges in Chronic Obstructive Pulmonary Disease (COPD))

14 pages, 1927 KiB

Open AccessArticle

Emphysema-Predominant COPD Had a Greater 5-Year Mortality and a Worse Annual Decline in Lung Function Than Airway Obstruction-Predominant COPD or Asthma at Initial Same Degree of Airflow Obstruction

by Chang-Wei Lin, Hung-Yu Huang, Fu-Tsai Chung, Chun-Yu Lo, Yu-Chen Huang, Ting-Wen Wang, Lan-Yan Yang, Yu-Bin Pan, Kian Fan Chung and Chun-Hua Wang

Medicina 2021, 57(11), 1261; https://doi.org/10.3390/medicina57111261 - 17 Nov 2021

Cited by 2 | Viewed by 2558

Abstract

Background and Objectives: We studied whether the extent of exertional oxygen desaturation and emphysema could cause greater mortality in COPD and asthma independent of airflow obstruction. Materials and Methods: We performed a 5-year longitudinal observational study in COPD and asthma patients who matched for airflow obstruction severity. All subjects performed a 6-min walk test (6MWT) and high-resolution computed tomography (HRCT) and followed spirometry and oxygen saturation (SpO₂) during the 6MWT every 3–6 months. Overall survival was recorded. Cumulative survival curves were performed according to the Kaplan–Meier method and compared with the log-rank test. Results: The COPD group had higher emphysema scores, higher Δinspiratory capacities (ICs) and lower SpO₂ during the 6MWT, which showed a greater yearly decline in FEV₁ (40.6 mL) and forced vital capacity (FVC) (28 mL) than the asthma group (FEV₁, 9.6 mL; FVC, 1.2 mL; p < 0.05). The emphysema-predominant COPD group had an accelerated annual decline in lung function and worse survival. The nadir SpO₂ ≤ 80% and a higher emphysema score were the strong risk factors for mortality in COPD patients. Conclusions: The greater structural changes with a higher emphysema score and greater desaturation during the 6MWT in COPD may contribute to worse yearly decline in FEV₁ and higher five-year mortality than in asthma patients with a similar airflow obstruction. The lowest SpO₂ ≤ 80% during the 6MWT and emphysema-predominant COPD were the strong independent factors for mortality in chronic obstructive airway disease patients. Full article

(This article belongs to the Special Issue Current Management Challenges in Chronic Obstructive Pulmonary Disease (COPD))

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12 pages, 768 KiB

Open AccessFeature PaperArticle

Blood Cadmium Levels and Oxygen Desaturation during the 6-Minute Walk Test in Patients with Chronic Obstructive Pulmonary Disease

by Li-Chung Chiu, Ping-Chih Hsu, Tzung-Hai Yen, Scott Chih-Hsi Kuo, Yueh-Fu Fang, Yu-Lun Lo, Shu-Min Lin, Cheng-Ta Yang and Chung-Shu Lee

Medicina 2021, 57(11), 1160; https://doi.org/10.3390/medicina57111160 - 25 Oct 2021

Cited by 2 | Viewed by 2132

Abstract

Background and Objectives: chronic obstructive pulmonary disease (COPD) is characterized by persistent airflow limitation and a history of exposure to noxious stimuli. Cigarette smoking is the most important causal factor for developing COPD. Cadmium, a minor metallic element, is one of the main inorganic components in tobacco smoke. Inhaled cadmium was associated with a decline in lung function, gas exchange impairment, and the development of obstructive lung disease. Patients with COPD who had oxygen desaturation during the 6-min walk test (6MWT) had a significantly worse prognosis than non-desaturation in COPD patients. Nonetheless, few studies have addressed the influence of blood cadmium levels on exercise-induced oxygen desaturation in COPD patients. Our objective was to assess the potential impact of blood cadmium levels on oxygen desaturation during the 6MWT among COPD patients. Materials and Methods: we performed a retrospective analysis of patients with COPD who were examined for blood cadmium levels in a tertiary care referral center in Taiwan, between March 2020 and May 2021. The 6-min walk test was performed. Normal control subjects who had no evidence of COPD were also enrolled. Results: a total of 73 COPD patients were analyzed and stratified into the high-blood cadmium group (13 patients) and low-blood cadmium group (60 patients). A total of 50 normal control subjects without a diagnosis of COPD were enrolled. The high-blood cadmium group had a significantly higher extent of desaturation than the low-blood cadmium group. The frequency of desaturation during 6MWT revealed a stepwise-increasing trend with an increase in blood cadmium levels. A multivariable logistic regression model revealed that blood cadmium levels were independently associated with desaturation during the 6MWT (odds ratio 12.849 [95% CI 1.168–141.329]; p = 0.037). Conclusions: our findings indicate that blood cadmium levels, within the normal range, were significantly associated with desaturation during 6MWT in patients with COPD. Full article

(This article belongs to the Special Issue Current Management Challenges in Chronic Obstructive Pulmonary Disease (COPD))

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11 pages, 319 KiB

Open AccessArticle

Assessment of Stress, Depressive and Anxiety Symptoms in Patients with COPD during In-Hospital Pulmonary Rehabilitation: An Observational Cohort Study

by Adam Wrzeciono, Oliver Czech, Katarzyna Buchta, Sabina Zabłotni, Edyta Gos, Łukasz Tłuczykont, Dagmara Górecka, Agnieszka Pastuła, Mateusz Adamczyk, Ewa Jach, Igor Świerkowski, Patryk Szary and Jan Szczegielniak

Medicina 2021, 57(3), 197; https://doi.org/10.3390/medicina57030197 - 25 Feb 2021

Cited by 8 | Viewed by 3698

Abstract

Background and Objectives: The relationship between physical health and mental health has been considered for years. A number of studies have shown a correlation between depressive states and the progress of somatic diseases. It seems that the proper cooperation of specialists may result in the improvement of the patient’s well-being and a positive effect on the course of the rehabilitation process. The aim of this study was to assess the symptoms of depression, anxiety, and stress in patients with chronic obstructive pulmonary disease (COPD) as well as the assessment of the relationship of psychological symptoms with sociodemographic factors and physical condition. Materials and Methods: The study enrolled 51 COPD patients who underwent a three-week pulmonary rehabilitation program. After admission to the rehabilitation department, the subjects were asked to complete the Hospital Anxiety and Depression Scale (HADS) questionnaire, the Perception of Stress Questionnaire (PSQ), and a sociodemographic questionnaire. Results: Anxiety states were diagnosed in 70% of respondents and depressive states were diagnosed in 54% of patients. Some of the respondents (14%) also showed a tendency to experience various grounded stresses. Additionally, there were correlations between the mental state and the results of fitness and respiratory tests. Conclusions: Patients with COPD are at risk for mental disorders, which may adversely affect their general health and significantly limit their physical and respiratory efficiencies. The development of widely available therapeutic solutions to reduce symptoms associated with depression, anxiety, and stress seems to be an important challenge for the management of patients with COPD. Full article

(This article belongs to the Special Issue Current Management Challenges in Chronic Obstructive Pulmonary Disease (COPD))

10 pages, 1164 KiB

Open AccessArticle

by I Re Heo, Ho Cheol Kim and Tae Hoon Kim

Medicina 2021, 57(1), 4; https://doi.org/10.3390/medicina57010004 - 23 Dec 2020

Cited by 15 | Viewed by 2589

Abstract

Background and Objectives: preserved ratio impaired spirometry (PRISm) is a common spirometric pattern that causes respiratory symptoms, systemic inflammation, and mortality. However, its impact on health-related quality of life (HRQOL) and its associated factors remain unclear. We aimed to identify these HRQOL-related factors and investigate the differences in HROOL between persons with PRISm and those with normal lung function. Materials and Methods: we reviewed the Korea National Health and Nutrition Examination Survey data from 2008 to 2013 to evaluate the HRQOL of persons with PRISm, as measured while using the Euro Quality of Life-5D (EQ-5D) and identify any influencing factors. PRISm was defined as pre-bronchodilator forced expiratory volume in 1 s (FEV₁) <80% predicted and FEV₁ to forced vital capacity (FVC) ratio (FEV₁/FVC) ≥0.7. Individuals with FEV₁ ≥80% predicted and FEV1/FVC ≥0.7 were considered as Controls. Results: of the 27,824 participants over the age of 40 years, 1875 had PRISm. The age- and sex-adjusted EQ-5D index was lower in the PRISm group than in the control group (PRISm, 0.930; control, 0.941; p = 0.005). The participants with PRISm showed a significantly higher prevalence of hypertension (p < 0.001), diabetes (p < 0.001), obesity (p < 0.001), low physical activity (p = 0.001), ever-smoker (p < 0.001), and low income (p = 0.034) than those in the control group. In participants with PRISm, lower EQ-5D index scores were independently associated with old age (p = 0.002), low income (p < 0.001), low education level (p < 0.001), and no economic activity (p < 0.001). Three out of five EQ-5D dimensions (mobility, self-care, and usual activity) indicated a higher proportion of dissatisfied participants in the PRISm group than the control group. Conclusions: the participants with PRISm were identified to have poor HRQOL when compared to those without PRISm. Old age and low socioeconomic status play important roles in HRQOL deterioration in patients with PRISm. By analyzing risk factors that are associated with poor HRQOL, early detection and intervention of PRISm can be done in order to preserve patients’ quality of life. Full article

(This article belongs to the Special Issue Current Management Challenges in Chronic Obstructive Pulmonary Disease (COPD))

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Review

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13 pages, 1266 KiB

Open AccessReview

Patient-Centered Discussion on End-of-Life Care for Patients with Advanced COPD

by Holly Mitzel, Dakota Brown, Morgan Thomas, Byrne Curl, Mackenzie Wild, Andrea Kelsch, Judge Muskrat, Abulquasem Hossain, Ken Ryan, Olawale Babalola, Madison Burgard and Masfique Mehedi

Medicina 2022, 58(2), 254; https://doi.org/10.3390/medicina58020254 - 8 Feb 2022

Cited by 3 | Viewed by 4132

Abstract

Exacerbations of chronic obstructive pulmonary disease (COPD) may lead to a rapid decline in health and subsequent death, an unfortunate tyranny of having COPD—an irreversible health condition of 16 million individuals in the USA totaling 60 million in the world. While COPD is the third largest leading cause of death, causing 3.23 million deaths worldwide in 2019 (according to the WHO), most patients with COPD do not receive adequate treatment at the end stages of life. Although death is inevitable, the trajectory towards end-of-life is less predictable in severe COPD. Thus, clinician-patient discussion for end-of-life and palliative care could bring a meaningful life-prospective to patients with advanced COPD. Here, we summarized the current understanding and treatment of COPD. This review also highlights the importance of patient-centered discussion and summarizes current status of managing patients with advanced COPD. Full article

(This article belongs to the Special Issue Current Management Challenges in Chronic Obstructive Pulmonary Disease (COPD))

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10 pages, 314 KiB

Open AccessReview

COPD in Firefighters: A Specific Event-Related Condition Rather than a Common Occupational Respiratory Disorder

by Armand-Gabriel Rajnoveanu, Ruxandra-Mioara Rajnoveanu, Nicoleta Stefania Motoc, Paraschiva Postolache, Gabriel Gusetu and Milena Adina Man

Medicina 2022, 58(2), 239; https://doi.org/10.3390/medicina58020239 - 5 Feb 2022

Cited by 7 | Viewed by 3078

Abstract

Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. Smoking remains the most important risk factor, but occupational exposures may play an essential role as well. Firefighters are among occupations regularly exposed to a variety of irritative inhalational products, and they may be expected to develop respiratory health problems because of such an occupational exposure. To better understand and characterize this relationship, we performed an extensive search of the scientific literature, and we identified two major research areas: firefighters exposed to wildland fire smoke and firefighters involved in the World Trade Centre disaster-related operations. Most of the studies did not report a significant increase in COPD diagnosis in firefighters. An accelerated rate of decline in lung function was seen, a short time after major exposure events. This is the reason for an increased rate of exacerbations observed in individuals already diagnosed with obstructive respiratory disorders. A limited number of studies not covering these specific circumstances of exposure were found. They reported long-term morbidity and mortality data, and the results are controversial. Major confounding factors for most of the studies were the “healthy worker effect” and the lack of useful data regarding smoking habits. Efforts should be made in the future to better characterize specific biomarkers for the progression of COPD; to establish exposure limits; and to implement preventive strategies like rotation of workers, smoking cessation programs, and long-term monitoring programs for respiratory disorders. Full article

(This article belongs to the Special Issue Current Management Challenges in Chronic Obstructive Pulmonary Disease (COPD))

14 pages, 354 KiB

Open AccessReview

Challenges in Diagnosing Occupational Chronic Obstructive Pulmonary Disease

by Cristiana Libu, Marina Ruxandra Otelea, Ioan Anton Arghir, Agripina Rascu, Sabina Antonela Antoniu and Oana Cristina Arghir

Medicina 2021, 57(9), 911; https://doi.org/10.3390/medicina57090911 - 30 Aug 2021

Cited by 4 | Viewed by 3471

Abstract

Occupational chronic obstructive pulmonary disease (oCOPD) represents 15–20% of the global burden of this disease. Even if industrial bronchitis has long been known, new occupational hazards continue to emerge and enlarge the number of people exposed to risk. This review discusses the challenges related to the early detection of oCOPD, in the context of new exposures and of limited usage of methods for an efficient disease occupational screening. It underlines that a better translation into clinical practice of the new methods for lung function impairment measurements, imaging techniques, or the use of serum or exhaled breath inflammation biomarkers could add significant value in the early detection of oCOPD. Such an approach would increase the chance to stop exposure at an earlier moment and to prevent or at least slow down the further deterioration of the lung function as a result of exposure to occupational (inhaled) hazards. Full article

(This article belongs to the Special Issue Current Management Challenges in Chronic Obstructive Pulmonary Disease (COPD))

13 pages, 324 KiB

Open AccessReview

The Role of Telemedicine in Extending and Enhancing Medical Management of the Patient with Chronic Obstructive Pulmonary Disease

by Claudio F. Donner, Richard ZuWallack and Linda Nici

Medicina 2021, 57(7), 726; https://doi.org/10.3390/medicina57070726 - 18 Jul 2021

Cited by 17 | Viewed by 5761

Abstract

Medical management of a chronic obstructive pulmonary disease (COPD) patient must incorporate a broadened and holistic approach to achieve optimal outcomes. This is best achieved with integrated care, which is based on the chronic care model of disease management, proactively addressing the patient’s unique medical, social, psychological, and cognitive needs along the trajectory of the disease. While conceptually appealing, integrated care requires not only a different approach to disease management, but considerably more health care resources. One potential way to reduce this burden of care is telemedicine: technology that allows for the bidirectional transfer of important clinical information between the patient and health care providers across distances. This not only makes medical services more accessible; it may also enhance the efficiency of delivery and quality of care. Telemedicine includes distinct, often overlapping interventions, including telecommunication (enhancing lines of communication), telemonitoring (symptom reporting or the transfer of physiological data to health care providers), physical activity monitoring and feedback to the patient and provider, remote decision support systems (identifying “red flags,” such as the onset of an exacerbation), tele-consultation (directing assessment and care from a distance), tele-education (through web-based educational or self-management platforms), tele-coaching, and tele-rehabilitation (providing educational material, exercise training, or even total pulmonary rehabilitation at a distance when standard, center-based rehabilitation is not feasible). While the above components of telemedicine are conceptually appealing, many have had inconsistent results in scientific trials. Interventions with more consistently favorable results include those potentially modifying physical activity, non-invasive ventilator management, and tele-rehabilitation. More inconsistent results in other telemedicine interventions do not necessarily mean they are ineffective; rather, more data on refining the techniques may be necessary. Until more outcome data are available clinicians should resist being caught up in novel technologies simply because they are new. Full article

(This article belongs to the Special Issue Current Management Challenges in Chronic Obstructive Pulmonary Disease (COPD))

10 pages, 277 KiB

Open AccessReview

Frailty, a Dimension of Impaired Functional Status in Advanced COPD: Utility and Clinical Applicability

by Sabina Antonela Antoniu, Lucian Vasile Boiculese and Virgiliu Prunoiu

Medicina 2021, 57(5), 474; https://doi.org/10.3390/medicina57050474 - 11 May 2021

Cited by 14 | Viewed by 2774

Abstract

Background and Objectives: In advanced chronic obstructive pulmonary disease (COPD), functional status is significantly impaired mainly as a result of disease related respiratory symptoms such as dyspnea or as a result of fatigue, which is the extra-respiratory symptom the most prevalent in this setting. “Physical” frailty, considered to be an aging phenotype, has defining traits that can also be considered when studying impaired functional status, but little is known about this relationship in advanced COPD. This review discusses the relevance of this type of frailty in advanced COPD and evaluates it utility and its clinical applicability as a potential outcome measure in palliative care for COPD. Materials and Methods: A conceptual review on the functional status as an outcome measure of mortality and morbidity in COPD, and an update on the definition and traits of frailty. Results: Data on the prognostic role of frailty in COPD are rather limited, but individual data on traits of frailty demonstrating their relationship with mortality and morbidity in advanced COPD are available and supportive. Conclusions: Frailty assessment in COPD patients is becoming a relevant issue not only for its potential prognostic value for increased morbidity or for mortality, but also for its potential role as a measure of functional status in palliative care for advanced COPD. Full article

(This article belongs to the Special Issue Current Management Challenges in Chronic Obstructive Pulmonary Disease (COPD))

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