Smoking Status, Body Mass Index, Health-Related Quality of Life, and Acceptance of Life With Illness in Stable Outpatients With COPD

BMI moderates the relationship between depression and chronic obstructive pulmonary disease: A cross‑sectional survey

BACKGROUND

Prior research has established a connection between depression and chronic obstructive pulmonary disease (COPD). However, the influence of age and BMI on this association remains unclear.

OBJECTIVES

We used the National Health and Nutrition Examination Survey (NHANES) database to explore the relationship between depression and COPD, and to investigate whether age and Body mass index (BMI) act as moderators in this relationship.

METHODS

We analyzed data from 10,940 participants in the NHANES database. Depression served as the independent variable. COPD status served as the outcome variable. We employed multivariable logistic regression to examine the relationship between depression and COPD.

RESULTS

Of the 10,940 respondents surveyed, about 3.9 % had COPD and 8.5 % had depression. The prevalence of depression in COPD patients was significantly greater than the prevalence of overall respondents (21.1 % VS.8.5 %). We found that the association between depression and COPD was mediated by BMI status. Controlling for other covariates, the association between depression and COPD increased significantly. For the underweight group, the impact of depression on the risk of COPD was lower compared to the normal BMI group.

CONCLUSION

This study confirms a significant association between depression and COPD, with BMI serving as a moderator. These findings enhance our understanding of the complex interplay between depression and COPD and underscore the importance of considering individual physical health characteristics in clinical assessments. The results have significant implications for clinical practice and public health policymaking.

BMI moderates the association between adverse childhood experiences and COPD

OBJECTIVES

Cigarette smoking and obesity are leading risk factors for chronic obstructive pulmonary disease (COPD). Although studies have established an association between adverse childhood experiences (ACEs) and COPD, few studies have examined whether this association is moderated by cigarette smoking or body mass index (BMI). This cross-sectional study examined the association between ACEs and COPD, and whether cigarette smoking or BMI moderates this association.

METHODS

Data for this study came from the 2019 Behavioral Risk Factor Surveillance System survey. An analytic sample of 75,700 adults aged 18-79 years (50.7% female) were analyzed using binary logistic regression. The outcome variable investigated was self-reported physician-diagnosed COPD, and the main explanatory variable was ACEs.

RESULTS

Of the 75,700 respondents examined, 8.1% had COPD. About one in three (33.6%) respondents had no ACEs, 23.1% had one ACE, and about one in five (20.2%) had four or more ACEs. In the multivariable binary logistic regression, we found that the association between ACEs and COPD differs by BMI status. Controlling for the effects of other factors, the association between ACEs and COPD is strongest for respondents who are obese (AOR = 1.41, 95% CI = 1.04-1.91).

CONCLUSIONS

The findings of this study demonstrate that ACEs are associated with COPD later in adulthood, and BMI moderated this association. The findings of this study add to the number of studies demonstrating the adverse impact of ACEs on chronic health outcomes among adults.

Adiposity increases weight-bearing exercise-induced dyspnea despite favoring resting lung hyperinflation in COPD

Objectives

Our aim was to study the associations between resting lung hyperinflation, weight-bearing exercise-induced dyspnea and adipose distribution in obese and normal-weight COPD patients.

Methods

We performed a comparison between 80 obese COPD patients (COPDOB) with 80 age- and FEV1 matched normal-weight COPD patients (COPDNW). Dyspnea was assessed by the mMRC scale and the Borg dyspnea score before and after a 6 min walk test. Further characterization included spirometry, body plethysmography and metronome paced tachypnea (MPT) to estimate dynamic hyperinflation. Body composition was assessed with bioelectrical impedance analysis. Associations between dyspnea scores and BMI and body composition groups were studied using logistic regression models.

Results

COPDOB patients had attenuated increases in TLC, FRC and RV compared to COPDNW patients ( p < 0.01). The groups had comparable 6 min walking distance and ΔFRC upon MPT ( p > 0.05). Compared to COPDNW, COPDOB patients reported more often a mMRC ≥ 2 (65 vs 46%; p = 0.02; OR 3.0, 95% CI 1.4–6.2, p < 0.01) and had higher ΔBorg upon 6MWT: 2.0 (SEM 0.20) vs. 1.4 (SEM 0.16), p = 0.01; OR for ΔBorg ≥ 2: 2.4, 95% CI 1.1–5.2, p = 0.03. Additional logistic regression analyses on the associations between body composition and dyspnea indicated that increased body fat percentage, fat mass index and waist-to-hip ratio were associated with higher ORs for mMRC ≥ 2 and ΔBorg upon 6MWT ≥ 2.

Conclusion

Despite its beneficial effect on resting lung hyperinflation, adiposity is associated with increased weight-bearing exercise-induced dyspnea in COPD.

Efficacy and Safety of Umeclidinium/Vilanterol in Current and Former Smokers with COPD: A Prespecified Analysis of The EMAX Trial

Introduction

Smoking may reduce the efficacy of inhaled corticosteroids (ICS) in patients with chronic obstructive pulmonary disease (COPD), but its impact on bronchodilator efficacy is unclear. This analysis of the EMAX trial explored efficacy and safety of dual- versus mono-bronchodilator therapy in current or former smokers with COPD.

Methods

The 24-week EMAX trial evaluated lung function, symptoms, health status, exacerbations, clinically important deterioration, and safety with umeclidinium/vilanterol, umeclidinium, and salmeterol in symptomatic patients at low exacerbation risk who were not receiving ICS. Current and former smoker subgroups were defined by smoking status at screening.

Results

The analysis included 1203 (50%) current smokers and 1221 (50%) former smokers. Both subgroups demonstrated greater improvements from baseline in trough FEV₁ at week 24 (primary endpoint) with umeclidinium/vilanterol versus umeclidinium (least squares [LS] mean difference, mL [95% CI]; current: 84 [50, 117]; former: 49 [18, 80]) and salmeterol (current: 165 [132, 198]; former: 117 [86, 148]) and larger reductions in rescue medication inhalations/day over 24 weeks versus umeclidinium (LS mean difference [95% CI]; current: − 0.42 [− 0.63, − 0.20]; former: − 0.25 − 0.44, − 0.05]) and salmeterol (current: − 0.28 [− 0.49, − 0.06]; former: − 0.29 [− 0.49, − 0.09]). Umeclidinium/vilanterol increased the odds (odds ratio [95% CI]) of clinically significant improvement at week 24 in Transition Dyspnea Index versus umeclidinium (current: 1.54 [1.16, 2.06]; former: 1.32 [0.99, 1.75]) and salmeterol (current: 1.37 (1.03, 1.82]; former: 1.60 [1.20, 2.13]) and Evaluating Respiratory Symptoms–COPD versus umeclidinium (current: 1.54 [1.13, 2.09]; former: 1.50 [1.11, 2.04]) and salmeterol (current: 1.53 [1.13, 2.08]; former: 1.53 [1.12, 2.08]). All treatments were well tolerated in both subgroups.

Conclusions

In current and former smokers, umeclidinium/vilanterol provided greater improvements in lung function and symptoms versus umeclidinium and salmeterol, supporting consideration of dual-bronchodilator therapy in symptomatic patients with COPD regardless of their smoking status.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12325-021-01855-y.

Patients with chronic obstructive pulmonary disease (COPD) often require daily medication to control their COPD. Many patients with COPD are smokers, and smoking is one of the most common causes of COPD. This means that it is important to find out whether COPD medications are effective in both smokers and nonsmokers. We analyzed data from a clinical trial (EMAX) that investigated the use of a combination of two bronchodilators, which are inhaled medications that help to open the airways. We compared umeclidinium/vilanterol, a dual-bronchodilator combination, with a single bronchodilator (either umeclidinium or salmeterol) over 6 months. We found that both current and former smokers who were treated with umeclidinium/vilanterol had larger improvements in lung function than those receiving umeclidinium or salmeterol. Current or former smokers who were treated with umeclidinium/vilanterol used their reliever inhaler less than those treated with umeclidinium or salmeterol. Patients treated with umeclidinium/vilanterol were generally less likely to experience disease worsening compared with umeclidinium or salmeterol if they were former smokers, or compared with salmeterol if they were current smokers. Our findings suggest that umeclidinium/vilanterol may be more effective than a single bronchodilator for daily treatment of patients with COPD who are current or former smokers. Physicians should consider prescribing a combination of two bronchodilators to patients who have symptoms, whether or not they currently smoke, as well as encouraging smoking cessation for all patients.

Long-term weight gain in obese COPD patients participating in a disease management program: a risk factor for reduced health-related quality of life

BACKGROUND

Little is known about how long-term weight gain affects the health perception of COPD patients.

OBJECTIVES

The aim is to evaluate the long-term association of BMI change and health-related quality of life (HRQoL) in obese COPD patients.

METHODS

Claims and survey data from a COPD disease management program were used to match two groups of COPD patients with BMI ≥ 30 who have differing weight trajectories over a 5-year timespan via propensity score and genetic matching. EQ-5D-5L, including visual analog scale (VAS) and COPD Assessment Test (CAT), were used as outcomes of interest. Sociodemographic and disease-based variables were matched.

RESULTS

Out of 1202 obese COPD patients, 126 with a weight increase of four or more BMI points were matched separately with 252 (propensity score matching) and 197 (genetic matching) control subjects who had relatively stable BMI. For the EQ-5D-5L, patients with BMI increase reported significantly worse health perception for VAS and all descriptive dimensions except pain/discomfort. For the CAT, especially the perception of ability to complete daily activities and overall energy results were significantly worse. VAS differences reach the range of minimal important differences. Stopping smoking and already being in obesity class II were the most influential risk factors for BMI increase.

CONCLUSION

Obese COPD patients who gain four or more BMI points over 5 years report significantly lower results in different dimensions of generic and disease-specific HRQoL than their peers with stable BMI. To improve real-world outcomes, tracking and preventing specific BMI trajectories could constitute a clinically relevant aspect of managing COPD patients.

Health-related quality of life of COPD patients aged over 40 years

BACKGROUND

Chronic obstructive pulmonary disease (COPD) is the fourth most frequent disease globally, and its worldwide prevalence is projected to increase in the following decades. Health-related quality of life (HRQOL) of COPD patients depends on multiple factors.

OBJECTIVE

The aim of this study was to identify the most important risk factors affecting HRQOL of COPD patients and to measure how specific clinical parameters can predict HRQOL.

METHODS

A questionnaire-based cross-sectional study combined with clinical data was conducted among patients diagnosed with COPD (n = 321, 52.6% females, mean age 66.4 ± 9.5) at the National Koranyi Institute for Pulmonology, Budapest in 2019-2020. The inclusion criteria were age ≥40 years and existing COPD. Multivariate linear regression analyses were conducted on three components of the COPD-specific Saint George's Respiratory Questionnaire (SGRQ-C) and on the physical (PCS) and mental component scales (MCS) of the 36-Item Short Form Health Survey (SF-36). Multiple linear regression analysis was performed to evaluate the effects of patient and disease characteristics on COPD Assessment Test (CAT) scores.

RESULTS

We found that frequent exacerbations, multiple comorbidities and tobacco smoking were associated with worse HRQOL. Engaging in more frequent physical activity and better 6-minute walking distance results were associated with better HRQOL.

CONCLUSIONS

Our results indicate that the complex therapy of COPD should focus not only on improving lung functions and preventing exacerbation, but also on treating comorbidities, encouraging increased physical activity, and supporting smoking cessation to assure better HRQOL for patients.