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Chronic Obstructive Pulmonary Disease: Updates in Lung Health

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A special issue of Healthcare (ISSN 2227-9032).

Deadline for manuscript submissions: closed (31 December 2018) | Viewed by 59812

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Prof. Dr. Andrew Harver

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Guest Editor

Department of Public Health Sciences, College of Health and Human Services, The University of North Carolina at Charlotte, 9201 University City Blvd., Charlotte, NC 28223-0001, USA
Interests: experimental psychology; respiratory physiology; pulmonary medicine

Assoc. Prof. Dr. Roy A. Pleasants II

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Guest Editor

Duke Clinical Research Institute and Durham VA Medical Center, Durham, NC, USA
Interests: asthma; COPD; epidemiology; infectious diseases; inhalational therapies; pharmacology

Special Issue Information

Dear Colleauges,

According to the Centers for Disease Control and Prevention, chronic obstructive pulmonary disease (COPD) is the third leading cause of death in the United States; the World Health Organization estimates that COPD caused 5% of all deaths globally in 2015. An estimated 16 million people are currently diagnosed with COPD in the United States—with many additional cases going undetected - placing substantial burden on individuals and their families, as well as health care systems at both local and national levels. The aim of this Special Issue is to address—through original research articles and brief reviews—developments in the prevention, diagnosis, and treatment of COPD as evidenced in recent national and international initiatives and guidelines. Additionally, we invite original research articles and brief reviews from colleagues that intersect with the overarching goals of Healthy People 2020 including: Attaining high-quality, longer lives free of preventable disease, disability, injury, and premature death; achieve health equity, eliminate disparities, and improve the health of all groups; create social and physical environments that promote good health for all; and promote quality of life, healthy development, and healthy behaviors across all life stages.

Prof. Dr. Andrew Harver
Assoc. Prof. Dr. Roy A. Pleasants II
Guest Editors

Manuscript Submission Information

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Healthcare is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2700 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

Asthma-chronic obstructive pulmonary disease overlap syndrome
Co-morbidities
COPD National Action Plan
Diagnosis, treatment, and management of COPD
Dyspnea
Evidence-based clinical practice
Global Initiative for Chronic Obstructive Lung Disease (GOLD)
Health disparities
Hospital Readmissions Reduction Program
Indoor and outdoor air pollution
International classification of functioning, disability, and health
Pulmonary rehabilitation
Quality of life
Tobacco cessation and prevention

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Published Papers (9 papers)

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Research

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7 pages, 429 KiB

Open AccessArticle

Desaturation during Six-Minute Walk Testing Predicts Major Morbidity Following Anatomic Lung Resection among Patients with COPD

by Christopher W. Towe, Katherine Wu, Alina Khil, Yaron Perry, Stephanie G. Worrell, Vanessa P. Ho and Philip A. Linden

Healthcare 2019, 7(1), 16; https://doi.org/10.3390/healthcare7010016 - 23 Jan 2019

Cited by 2 | Viewed by 4882

Abstract

Background: Pulmonary function testing (PFT) is commonly used to risk-stratify patients prior to lung resection. Guidelines recommend that patients with reduced lung function, due to chronic lung conditions such as Chronic Obstructive Pulmonary Disease (COPD), should receive additional physiologic testing to determine fitness for resection. We reviewed our experience with six-minute walk testing (SMWT) to determine the association of test results and post-operative complications. Methods: Consecutive adult patients undergoing segmentectomy, lobectomy, bilobectomy or pneumonectomy between 1 January, 2007 and 1 January, 2017 were identified in a prospectively maintained database. Patients with poor lung function, as defined by percent predicted forced expiratory volume in 1 s (FEV1) or diffusion capacity of carbon monoxide (DLCO) ≤60%, had results of SMWT extracted from their chart. Association of test result to post-operative events was performed. Results: 581 patients had anatomic lung resections with predicted post-operative FEV1 or DLCO values ≤60%, consistent with a diagnosis of COPD. Among them, 50 (8.6%) had preoperative SMWT performed. Patients who received SMWT were more likely to have a FEV1 or DLCO less than 40 percent predicted (24/50 (48.0%) vs 166/531 (31.3%), p = 0.016). Post-operatively, patients who had SMWT performed had higher rates of pneumonia, but similar rates of major morbidity. The post-exercise oxygen saturation and the amount of desaturation correlated with the occurrence of major morbidity. In multivariable regression, oxygen desaturation was an independent risk factor for the occurrence of major morbidity, and desaturation was an excellent predictor of major morbidity by receiver operating characteristic curves analsysis. Conclusions: Among patients with elevated risk, oxygen desaturation during SMWT was independently associated with the occurence of major morbidity in multivariable analysis, while pulmonary function testing was not. SMWT is an important tool for risk-stratification, and may be underutilized. Full article

(This article belongs to the Special Issue Chronic Obstructive Pulmonary Disease: Updates in Lung Health)

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14 pages, 923 KiB

Open AccessArticle

Use of a Cross-Sectional Survey in the Adult Population to Characterize Persons at High-Risk for Chronic Obstructive Pulmonary Disease

by Roy A. Pleasants, Khosrow Heidari, Jill Ohar, James F. Donohue, Njira Lugogo, Chelsea L. Richard, Sarojina Kanotra, David M. Mannino, Monica Kraft, Winston Liao and Charlie Strange

Healthcare 2019, 7(1), 12; https://doi.org/10.3390/healthcare7010012 - 18 Jan 2019

Cited by 4 | Viewed by 5759

Abstract

Rationale/Objective: The Behavioral Risk Factor Surveillance System (BRFSS) health survey has been used to describe the epidemiology of chronic obstructive pulmonary disease (COPD) in the US. Through addressing respiratory symptoms and tobacco use, it could also be used to characterize COPD risk. Methods: Four US states added questions to the 2015 BRFSS regarding productive cough, shortness of breath, dyspnea on exertion, and tobacco duration. We determined COPD risk categories: provider-diagnosed COPD as self-report, high-risk for COPD as ≥10 years tobacco smoking and at least one significant respiratory symptom, and low risk was neither diagnosed COPD nor high risk. Disease burden was defined by respiratory symptoms and health impairments. Data were analyzed using multiple logistic regression models with age as a covariate. Results: Among 35,722 adults ≥18 years, the overall prevalence of COPD and high-risk for COPD were 6.6% and 5.1%. Differences among COPD risk groups were evident based on gender, race, age, geography, tobacco use, health impairments, and respiratory symptoms. Risk for disease was seen early where 3.75% of 25–34 years-old met high-risk criteria. Longer tobacco duration was associated with an increased prevalence of COPD, particularly >20 years. Seventy-nine percent of persons ≥45 years-old with frequent shortness of breath (SOB) reported having or being at risk of COPD, reflecting disease burden. Conclusion: These data, representing nearly 18% of US adults, indicates those at high risk for COPD share many, but not all of the characteristics of persons diagnosed with the disease and demonstrates the value of the BRFSS as a tool to define lung health at a population level. Full article

(This article belongs to the Special Issue Chronic Obstructive Pulmonary Disease: Updates in Lung Health)

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14 pages, 2064 KiB

Open AccessArticle

Development of a Portable Dielectric Biosensor for Rapid Detection of Viscosity Variations and Its In Vitro Evaluations Using Saliva Samples of COPD Patients and Healthy Control

by Pouya Soltani Zarrin, Farabi Ibne Jamal, Niels Roeckendorf and Christian Wenger

Healthcare 2019, 7(1), 11; https://doi.org/10.3390/healthcare7010011 - 16 Jan 2019

Cited by 13 | Viewed by 6994

Abstract

Chronic Obstructive Pulmonary Disease (COPD) is a life-threatening lung disease affecting millions of people worldwide. Although the majority of patients with objective COPD go undiagnosed until the late stages of their disease, recent studies suggest that the regular screening of sputum viscosity could provide important information on the disease detection. Since the viscosity of sputum is mainly defined by its mucin–protein and water contents, dielectric biosensors can be used for detection of viscosity variations by screening changes in sputum’s contents. Therefore, the objective of this work was to develop a portable dielectric biosensor for rapid detection of viscosity changes and to evaluate its clinical performance in characterizing viscosity differences of saliva samples collected from COPD patients and Healthy Control (HC). For this purpose, a portable dielectric biosensor, capable of providing real-time measurements, was developed. The sensor performance for dielectric characterization of mediums with high water content, such as saliva, was evaluated using isopropanol–water mixtures. Subsequently, saliva samples, collected from COPD patients and HC, were investigated for clinical assessments. The radio frequency biosensor provided high repeatability of 1.1% throughout experiments. High repeatability, ease of cleaning, low-cost, and portability of the biosensor made it a suitable technology for point-of-care applications. Full article

(This article belongs to the Special Issue Chronic Obstructive Pulmonary Disease: Updates in Lung Health)

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7 pages, 420 KiB

Open AccessArticle

Impact of Previous Physical Activity Levels on Symptomatology, Functionality, and Strength during an Acute Exacerbation in COPD Patients

by Laura López-López, Irene Torres-Sánchez, Ramón Romero-Fernández, María Granados-Santiago, Janet Rodríguez-Torres and Marie Carmen Valenza

Healthcare 2018, 6(4), 139; https://doi.org/10.3390/healthcare6040139 - 29 Nov 2018

Cited by 7 | Viewed by 4514

Abstract

The main objective of this study is to determine the relationship between physical activity (PA) level prior to hospitalization and the pulmonary symptomatology, functionality, exercise capacity, and strength of acute exacerbated chronic obstructive pulmonary disease (COPD) patients. In this observational study, all data were taken during the patient’s first day in hospital. Patients were divided into two groups (a PA group, and a physical inactivity (PI) group), according to the PA level evaluated by the Baecke questionnaire. Cough status was evaluated by the Leicester Cough Questionnaire (LCQ), and dyspnea was assessed using the modified Medical Research Council dyspnea scale (mMRC). Functionality was measured by the Functional Independence Measure (FIM) and the London Chest Activity of Daily Living scale (LCADL). Exercise capacity was evaluated by the two-minute step-in-place (2MSP) test, and strength assessed by dynamometry. A total of 151 patients were included in this observational study. Patients in the PI group obtained worse results compared to the PA group, and significant differences (p < 0.05) were found in all of the variables. Those COPD patients who regularly perform PA have less dyspnea and cough, as well as better functionality, exercise capacity and strength during an exacerbation, without relationship to the severity of the pathology. Full article

(This article belongs to the Special Issue Chronic Obstructive Pulmonary Disease: Updates in Lung Health)

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8 pages, 203 KiB

Open AccessFeature PaperArticle

Impact of Quality Improvement on Care of Chronic Obstructive Pulmonary Disease Patients in an Internal Medicine Resident Clinic

by Robert M. Burkes, Takudzwa Mkorombindo, Udit Chaddha, Alok Bhatt, Karim El-Kersh, Rodrigo Cavallazzi and Nancy Kubiak

Healthcare 2018, 6(3), 88; https://doi.org/10.3390/healthcare6030088 - 25 Jul 2018

Cited by 8 | Viewed by 4655

Abstract

Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality. Guideline-discordant care of COPD is not uncommon. Further, there is a push to incorporate quality improvement (QI) training into internal medicine (IM) residency curricula. This study compared quality of care of COPD patients in an IM residents’ clinic and a pulmonary fellows’ clinic and, subsequently, the results of a quality improvement program in the residents’ clinic. Pre-intervention rates of quality measure adherence were compared between the IM teaching clinic (n = 451) and pulmonary fellows’ clinic (n = 177). Patient encounters in the residents’ teaching clinic after quality improvement intervention (n = 119) were reviewed and compared with pre-intervention data. Prior to intervention, fellows were significantly more likely to offer smoking cessation counseling (p = 0.024) and document spirometry showing airway obstruction (p < 0.001). Smoking cessation counseling, pneumococcal vaccination, and diagnosis of COPD by spirometry were targets for QI. A single-cycle, resident-led QI project was initiated. After, residents numerically improved in the utilization of spirometry (66.5% vs. 74.8%) and smoking cessation counseling (81.8% vs. 86.6%), and significantly improved rates of pneumococcal vaccination (p = 0.024). One cycle of resident-led QI significantly improved the rates of pneumococcal vaccination, with numerical improvement in other areas of COPD care. Full article

(This article belongs to the Special Issue Chronic Obstructive Pulmonary Disease: Updates in Lung Health)

Review

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8 pages, 654 KiB

Open AccessReview

COPD: The Annual Cost-Of-Illness during the Last Two Decades in Italy, and Its Mortality Predictivity Power

by Roberto W. Dal Negro

Healthcare 2019, 7(1), 35; https://doi.org/10.3390/healthcare7010035 - 1 Mar 2019

Cited by 12 | Viewed by 5771

Abstract

Chronic obstructive pulmonary disease (COPD) is a progressive pathological condition characterized by a huge epidemiological and socioeconomic impact worldwide. In Italy, the actual annual cost of COPD was assessed for the first time in 2002: the mean cost per patient per year was €1801 and ranged from €1500 to €3912, depending on COPD severity. In 2008, the mean annual cost per patient was €2723.7, ranging from €1830.6 in mild COPD up to €5451.7 in severe COPD. In 2015, it was €3291, which is 20.8% and 82.7% higher compared to the costs estimated in 2008 and 2002, respectively. In all these studies, the major cost component was direct costs, in particular hospitalization costs due to exacerbations, which corresponded to 59.9% of the total cost and 67.2% of direct costs, respectively. When the annual healthcare expenditure per patient is related to the length of survival by means of the PRO-BODE Index (PBI, which is the implementation of the well-known BODE Index with costs due to annual exacerbations and/or hospitalizations), the annual cost of care proved much more strictly and inversely proportional to patients’ survival at three years, with the highest regression coefficient (r = −0.58) of all the multidimensional indices presently available, including the BODE Index (r = −021). In Italy, even though tobacco smoking has progressively declined by up to 21% in the general population, the economic impact of COPD has shown relentless progression over the last two decades, confirming that the present national health system organization is still insufficient for facing the issue of chronic diseases, in particular COPD, effectively. The periodic assessment of costs is an effective instrument for care providers in predicting COPD mortality, and for decision makers for updating and planning their social, economic, and political strategies. Full article

(This article belongs to the Special Issue Chronic Obstructive Pulmonary Disease: Updates in Lung Health)

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11 pages, 232 KiB

Open AccessReview

The Role of Manual Therapy in Patients with COPD

by Stephanie Clarke, Prue E. Munro and Annemarie L. Lee

Healthcare 2019, 7(1), 21; https://doi.org/10.3390/healthcare7010021 - 1 Feb 2019

Cited by 14 | Viewed by 9495

Abstract

Chronic obstructive pulmonary disease (COPD) is a respiratory condition associated with altered chest wall mechanics and musculoskeletal changes. In this narrative review, we describe the underlying musculoskeletal abnormalities in COPD, the reasons for applying manual therapy techniques, their method of application and clinical effects. A variety of manual therapy techniques have been applied in individuals with COPD, including soft tissue therapy, spinal and joint manipulation and mobilisation, and diaphragmatic release techniques. These have been prescribed in isolation and in conjunction with other treatments, including exercise therapy. When applied in isolation, transient benefits in respiratory rate, heart rate and symptoms have been reported. Combined with exercise therapy, including within pulmonary rehabilitation, benefits and their corresponding clinical relevance have been mixed, the extent to which may be dependent on the type of technique applied. The current practical considerations of applying these techniques, including intense therapist–patient contact and the unclear effects in the long term, may limit the broad use of manual therapy in the COPD population. Further high quality research, with adequate sample sizes, that identifies the characteristic features of those with COPD who will most benefit, the optimal choice of treatment approach and the longevity of effects of manual therapy is required. Full article

(This article belongs to the Special Issue Chronic Obstructive Pulmonary Disease: Updates in Lung Health)

16 pages, 1043 KiB

Open AccessReview

Systematic Review of Pain in Clinical Practice Guidelines for Management of COPD: A Case for Including Chronic Pain?

by Hayley Lewthwaite, Georgia Williams, Katherine L. Baldock and Marie T. Williams

Healthcare 2019, 7(1), 15; https://doi.org/10.3390/healthcare7010015 - 22 Jan 2019

Cited by 21 | Viewed by 8212

Abstract

Chronic pain is highly prevalent and more common in people with chronic obstructive pulmonary disease (COPD) than people of similar age/sex in the general population. This systematic review aimed to describe how frequently and in which contexts pain is considered in the clinical practice guidelines (CPGs) for the broad management of COPD. Databases (Medline, Scopus, CiNAHL, EMbase, and clinical guideline) and websites were searched to identify current versions of COPD CPGs published in any language since 2006. Data on the frequency, context, and specific recommendations or strategies for the assessment or management of pain were extracted, collated, and reported descriptively. Of the 41 CPGs (English n = 20) reviewed, 16 (39%) did not mention pain. Within the remaining 25 CPGs, pain was mentioned 67 times (ranging from 1 to 10 mentions in a single CPG). The most frequent contexts for mentioning pain were as a potential side effect of specific pharmacotherapies (22 mentions in 13 CPGs), as part of differential diagnosis (14 mentions in 10 CPGs), and end of life or palliative care management (7 mentions in 6 CPGs). In people with COPD, chronic pain is common; adversely impacts quality of life, mood, breathlessness, and participation in activities of daily living; and warrants consideration within CPGs for COPD. Full article

(This article belongs to the Special Issue Chronic Obstructive Pulmonary Disease: Updates in Lung Health)

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9 pages, 527 KiB

Open AccessReview

Ward-Based Non-Invasive Ventilation in Acute Exacerbations of COPD: A Narrative Review of Current Practice and Outcomes in the UK

by Samuel P. Trethewey, Ross G. Edgar, Alice M. Turner and Rahul Mukherjee

Healthcare 2018, 6(4), 145; https://doi.org/10.3390/healthcare6040145 - 9 Dec 2018

Cited by 12 | Viewed by 8259

Abstract

Non-invasive ventilation (NIV) is frequently used as a treatment for acute hypercapnic respiratory failure (AHRF) in hospitalised patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). In the UK, many patients with AHRF secondary to AECOPD are treated with ward-based NIV, rather than being treated in critical care. NIV has been increasingly used as an alternative to invasive ventilation and as a ceiling of treatment in patients with a ‘do not intubate’ order. This narrative review describes the evidence base for ward-based NIV in the context of AECOPD and summarises current practice and clinical outcomes in the UK. Full article

(This article belongs to the Special Issue Chronic Obstructive Pulmonary Disease: Updates in Lung Health)

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