Individual trajectory-based care for COPD: getting closer, but not there yet

End-of-life care for people with chronic obstructive pulmonary disease: a scoping review protocol

BACKGROUND

Chronic obstructive pulmonary disease (COPD) is a progressive inflammatory disease that has a typical illness trajectory. Awareness of unique disease courses as well as providing end-of-life care (EOLC) for COPD patients is important as most patients experience varied degrees of suffering toward the end-of-life. The purpose of this scoping review is to map out key concepts, main sources, and types of evidence available in the area of research on EOLC with multiple interventions for people with COPD.

METHODS

This scoping review will be conducted following the latest Joanna Briggs Institute (JBI) guidelines. In addition, this review process will adhere to the preferred reporting items for systematic reviews and meta-analysis extension for scoping reviews (PRISMA-ScR). The initial simple search concepts will be set out as "chronic obstructive pulmonary disease" and "end-of-life care". Based on the eligibility criteria, Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, CINAHL Ultimate, Embase, and Google Scholar databases will be searched, and all quantitative and qualitative studies of the after-year publication of each electronic database will be included. This process of literature selection will be carried out independently by each researcher. The results will be summarised in a narrative synthesis approach and the gaps and potential biases of the evidence identified by comparing the adopted articles for EOLC with multiple interventions for people with COPD.

DISCUSSION

This scoping review will outline in detail the evidence and the gaps from primary studies that have been gathered from the qualitative and quantitative literature based on all eligibility criteria. Therefore, the results of this review will contribute to a new field of systematic reviews. Furthermore, providing an outline of an EOLC for COPD in this study may improve the practice of healthcare professionals in this area. Ethical approval and consent are not required as no human participants were involved in this study.

SYSTEMATIC REVIEW REGISTRATION

This research has been registered in the Open Science Framework (OSF) ( https://osf.io/upd4a ).

Risk Factors Associated with a First Exacerbation Among Patients with COPD Classified as GOLD A and B in Routine Clinical Practice in the UK

Purpose

Risk factors for exacerbations of chronic obstructive pulmonary disease (COPD) have been previously characterized for patients with more severe cases of COPD. It is unclear how the risk of first exacerbation may best be identified in patients with less severe disease. This study investigated risk factors for first exacerbation among English patients with COPD classified as Global Initiative for Chronic Obstructive Lung Disease (GOLD) group A or B.

Patients and Methods

A retrospective cohort study using data from the UK Clinical Practice Research Datalink (CPRD) AURUM linked to Hospital Episode Statistics. Patients with COPD aged ≥35 years and classified as GOLD group A or B (2020 criteria) from January 2013-December 2019 were eligible. Patients were required to have 24 months history in CPRD (baseline). Two cohorts were defined: cohort 1 included patients with no severe exacerbations during baseline; cohort 2 included patients with no moderate or severe exacerbations during baseline. Risk factors associated with severe, or combined moderate and severe exacerbation were examined for up to 5 years of follow-up.

Results

Overall, 194,948 patients were included in cohort 1 (mean age 66.2 years; 55.2% male), and 148,396 patients in cohort 2 (mean age 66.1 years; 56.6% male). Identified risk factors for exacerbation (and associated 1-year absolute risk of severe, or combined moderate and severe exacerbation, respectively) included: Medical Research Council dyspnea scale score (15.9%/28.4%); COPD Assessment Test score (9.6%/25.3%); GOLD grade of airflow limitation (forced expiratory volume in 1 second % predicted; 13.6%/27.5%); and lung cancer (8.1%/23.6%). After adjustment for risk factors, these factors remained independently associated with severe exacerbation at 1, 3, and 5 years of follow-up.

Conclusion

The identified risk factors may aid physicians in the early recognition of patients with COPD classified as GOLD group A or B at risk of first exacerbation.

Role of Short-Chain Fatty Acids Produced by Gut Microbiota in Innate Lung Immunity and Pathogenesis of the Heterogeneous Course of Chronic Obstructive Pulmonary Disease

Chronic obstructive pulmonary disease (COPD) is a widespread socially significant disease. The development of COPD involves the innate immune system. Interestingly, the regulation of the innate lung immune system is related to the gut microbiota. This connection is due to the production by gut microorganisms of short-chain fatty acids (SCFAs) such as acetate, propionate, and butyrate. Nutritional disturbances and changes in the structure of the intestinal microbiota lead to a decrease in SCFAs production and their effect on pulmonary immunity. The presence of a metabolic and immune axis linking the lungs and gut plays an important role in the pathogenesis of COPD. In addition, the nature of nutrition and SCFAs may participate in the development of the clinically heterogeneous course of COPD.