Chronic obstructive pulmonary disease: getting it right. Does optimal management of chronic obstructive pulmonary disease alter disease progression and improve survival?

"Breathing New Life Into Chronic Obstructive Pulmonary Disease (COPD)" - Results From An Online Survey Of UK Patients

Background

There is a lack of data on the impact of COPD on individuals, their illness, behavior and attitude to the disease.

Method

500 UK patients with a primary care diagnosis of COPD responded to an online survey.

Results

61.2% of respondents were female and 85.8% were between 50 and 80 years old. Two-thirds (67.8%) of respondents did not smoke at the time of the survey. Almost half of those surveyed (46.2%, n=231) used three inhalers, and 31% (n=155) agreed or strongly agreed with the statement “I feel that my treatment is not adequately controlling my condition”, while 39.4% (n=197) disagreed or strongly disagreed. 48.8% (n=244) agreed their COPD was well managed. Over half the sample (56.8%, n=284) said they never forgot to use their inhaler as prescribed. Checks on inhaler use by doctors or nurses were reported as every six months/twice a year by 24.4% (n=122) and once a year by 38.8% (n=194). However, 17.2% (n=86) said their technique had never been checked, and at their last annual review, a third (33.2%, n=166) did not receive inhaler technique advice. Exacerbations were reported to affect an average of 7.4 days a year. They led to time in hospital, time off work and significantly affected quality of life. Patients reported that their COPD affected all aspects of their daily lives to a greater or lesser extent, with some living in fear of what the impact of the next flare-up could bring.

Conclusion

COPD impairs people’s ability to carry out daily tasks, leads to hospital admission, time off work and even unemployment. Respondents reported stress, worry and depression or low mood because of their COPD. This study highlights areas of concern for patients not being addressed by health care practitioners, including: pulmonary rehabilitation referral, better information giving and medicines optimization.

Symptom Burden of Chronic Lung Disease Compared with Lung Cancer at Time of Referral for Palliative Care Consultation

RATIONALE

A growing evidence base supports provision of palliative care services alongside life-prolonging care. Whereas palliative care processes have been implemented widely in the care of patients with lung cancer, the same is not true for patients with chronic, progressive lung disease.

OBJECTIVES

To compare the symptom burden of chronic lung disease with that of lung cancer at the time of initial palliative care consultation.

METHODS

Data were abstracted from the Carolinas Palliative Care Consortium's Quality Data Collection Tool, an electronic database used by seven academic and community palliative care practices in multiple states for quality improvement purposes. We analyzed data derived from first palliative care encounters collected during a 2-year period, including the primary diagnosis of chronic lung disease or lung cancer, unresolved symptoms, setting of initial palliative care encounter, Palliative Performance Scale status, and on that basis we estimated prognosis for survival. We compared key clinical variables between chronic lung disease and lung cancer using Kruskal-Wallis and χ(2) tests.

MEASUREMENTS AND MAIN RESULTS

We identified 152 patients with lung cancer and 86 patients with chronic lung disease. Of the total sample, 53% were women and 87% were white. Patients with chronic lung disease were more likely than those with lung cancer to have the initial palliative care encounter occur in the intensive care unit (17% vs. 6%; P = 0.005) and less likely as an outpatient (20% vs. 56%; P < 0.0001). Patients with chronic lung disease were also less likely to have a high Palliative Performance Scale status (14% vs. 30%; P = 0.009) but more likely to have an estimated prognosis for survival longer than 6 months (51% vs. 28%; P = 0.002). The most prevalent symptoms were dyspnea (55% vs. 42%) and pain (40% vs. 52%), neither of which differed between groups (P = 0.08).

CONCLUSIONS

Patients with chronic lung disease have symptom burdens similar to those of patients with lung cancer at the time of first palliative care encounter. Given the population burden of chronic lung disease and limitations in the palliative care workforce, attention should be focused on ensuring that pulmonologists are prepared to assess and manage the common palliative care needs of patients with chronic lung disease.

Free Urinary Desmosine and Isodesmosine as COPD Biomarkers: The Relevance of Confounding Factors

Background: Desmosine (DES) and isodesmosine (IDES) have been widely discussed as potential biomarkers of COPD. However, their clinical utility and validity remains unproven. Aim: This study aims to progress DES/IDES evaluation as a chronic obstructive pulmonary disease (COPD) biomarker by investigating its urinary excretion in a large sample cohort with respect to a) which factors influence DES/IDES levels in a population of healthy control individuals and COPD individuals; b) whether DES/IDES levels enable the differentiation between COPD individuals and healthy control individuals; c) whether DES/IDES can be used to differentiate between fast and slow decliners in lung function. Methods: Urinary DES and IDES were quantified in 365 individuals (147 healthy control individuals and 218 COPD individuals) from the Evaluation of COPD Longitudinally to Indentify Predictive Surrogate Endpoints (ECLIPSE) study (NCT00292552) by employing a validated liquid chromatography tandem mass spectrometry (LC-MS/MS) method. Results: Age, gender, body mass index (BMI) and smoking have a significant (p<0.05) influence on DES/IDES urinary excretion and need to be corrected for when investigating DES/IDES as a disease biomarker. Urinary DES/IDES allowed a statistically relevant differentiation (p<0.05) between stable COPD individuals and healthy control individuals, however, assay sensitivity and specificity were low (62% and 73%, respectively). Furthermore, urinary DES/IDES does not allow the differentiation of fast and slow decliners in lung function. Conclusions: The present results suggest that while urinary DES/IDES excretion is related to COPD, it is not a sensitive or specific biomarker for COPD diagnosis or prognosis.

The lung volume reduction coil for the treatment of emphysema: a new therapy in development

Lung volume reduction (LVR) coil treatment is a novel therapy for patients with severe emphysema. In this bilateral bronchoscopic treatment, approximately 10 LVR coils per lobe are delivered under fluoroscopic guidance in two sequential procedures. The LVR coil reduces lung volume by compressing the most destructed areas of the lung parenchyma and restores the lung elastic recoil. Both patients with upper- and lower-lobe predominant emphysema as well as a homogeneous emphysema distribution can be treated. LVR coil treatment results in an improvement of pulmonary function, exercise tolerance and quality of life. The LVR-coil treatment has been evaluated in several European clinical trials since 2008 and received CE mark approval in 2010. Currently, two large multicenter randomized controlled trials are underway in Europe and North America to assess the efficacy and safety of the LVR-coil treatment at 12 months compared with usual care. In this review, we share our experience with the LVR-coil treatment.