Motivating Conversations About COPD: What Patients Prefer

Living with a chronic condition like chronic obstructive pulmonary disease (COPD) can be challenging. Early diagnosis and timely clinical conversations are crucial for managing this condition effectively. A recent study delved into understanding what motivates patients to initiate conversations about COPD with their healthcare providers, revealing valuable insights into message features that can encourage these vital discussions.

In a quest to identify effective message features, researchers conducted a discrete choice experiment involving 928 participants, primarily non-Hispanic white adults with some college experience. Their goal was to determine which messages would inspire them to talk to a clinician about COPD. Key findings were:

1. COPD Susceptibility Matters (25.53% preference): Messages focusing on COPD susceptibility, such as signs and symptoms, were the most influential in motivating patients to discuss COPD, highlighting the importance of raising awareness about the early warning signs of the disease.

2. Message Source Counts (19.32% preference): Patients placed a significant emphasis on the source of the message. Those from medical authorities including clinicians and COPD organizations were highly preferred, demonstrating that trust in the messenger plays a vital role in encouraging dialogue.

3. Supportive Call-to-Action (14.12% preference): Participants responded positively to messages that supported their autonomy in decision-making regarding COPD screening. Empowering patients to take control of their health decisions is essential.

4. Emotional Frame (13.24% preference): Messages that conveyed hope for living a healthy life with COPD and boosted self-efficacy in seeking screening garnered attention, showing that emotions can be powerful motivators in healthcare discussions.

5. Efficacy Matters (8.65% preference): While less influential than other factors, messages that conveyed efficacy in getting screened still played a role. Patients need to believe that taking action will make a difference.

6. Preference for Susceptibility Over Risk Behaviors: Interestingly, patients favored messages about COPD signs and symptoms over those related to risk behaviors like smoking and environmental exposures. This suggests that emphasizing early detection and symptom awareness might be more effective.

7. Variation in Message Preferences: The study also revealed that message preferences varied based on age, gender, race, ethnicity, education level, and smoking status. Tailoring messages to specific patient demographics could enhance their effectiveness.

These findings offer valuable guidance for healthcare professionals and organizations in promoting COPD awareness and early diagnosis. By crafting messages that focus on susceptibility, come from credible sources, empower patients, and evoke hope, clinicians can encourage more patients to discuss COPD during their appointments.

COPD is a challenging condition, but initiating clinical conversations about it is a crucial step toward effective management. Understanding what motivates patients to discuss COPD is vital. This study's findings shed light on the message features that can inspire these conversations, ultimately improving the early detection and management of COPD.

By tailoring messages to patient preferences, healthcare providers can play a pivotal role in reducing the burden of this disease, particularly among at-risk populations.

Read the full study in PEC Innovations.

Research Uncovers Why Viral Infections are Worse for People with COPD

New research has identified the cells responsible for exacerbating viral infections in people with chronic obstructive pulmonary disease (COPD) – tissue-resident natural killer (trNK) cells that are abnormally active in people with COPD. When exposed to viral infections in COPD-affected lungs, these trNK cells respond too aggressively and, as a result, fail to produce the necessary cytokine, or signaling protein, to fight the infection.

The findings, discovered by researchers from the Hunter Medical Research Institute and the University of Newcastle in collaboration with Grace Cooper from University of Southampton, were published in the American Journal of Respiratory and Critical Care Medicine.

In the study, mice were exposed to cigarette smoke for 12 weeks to induce COPD-like lung disease, after which their lung trNK cell phenotypes and function were analyzed. That analysis showed that when the natural killer (NK) cells were exposed to viral infections, they became overactive and ultimately stopped working. This overly aggressive immune response meant the NK cells could not produce the necessary signaling protein, or cytokine, and could not fight the infection. 

“Collectively,” researchers concluded, “these results demonstrate that trNK cell function is altered in cigarette smoke-induced disease and suggests that smoke exposure may aberrantly prime trNK cell responsiveness to viral infection. This may contribute to excess inflammation during viral exacerbations of COPD.”

Read the original article in Medical Xpress.

Emphysema is More Common in Cannabis Smokers

According to the Centers for Disease Control and Prevention (CDC), marijuana is used by more than 48 million people, making it the most used federally illegal drug in the U.S. It affects the part of the brain responsible for memory, learning, attention, decision-making, coordination, emotion, and reaction time and has been linked to increased risk of psychosis or schizophrenia in some users.

If those facts aren’t sobering enough, new research has also linked it to higher rates of chronic obstructive pulmonary disease (COPD).

According to a study in Radiology, COPD is more common in cannabis smokers than cigarette smokers, likely because it enters the lungs unfiltered. The study involved chest CT scans of 56 marijuana smokers, 33 tobacco-only smokers and 57 nonsmokers. It found higher rates of emphysema among the marijuana smokers (42 out of 56) than nonsmokers (three out of 57) but not tobacco-only smokers (22 out of 33). 

The scans also found higher rates of bronchial thickening – inflammation of the lining of the bronchial tubes – among cannabis smokers, as well as bronchiectasis (widened, damaged airways) and mucoid impaction. The study also found that paraseptal emphysema was the predominant subtype in marijuana smokers. The rarest form of emphysema, paraseptal emphysema damages tiny ducts that connect air sacs in the lungs, usually affecting the upper part of the lung with fluid-filled sacs called bullae forming on the surface.

The study’s findings align with other research that associates marijuana smoking with large airway inflammation, increased airway resistance, and lung hyperinflation, and more prevalent symptoms of chronic bronchitis. Another study found that frequent marijuana smokers had more outpatient medical visits for respiratory problems than those who do not smoke.

To read the full study, visit Radiology.

Study: COPD-related Anxiety is Misunderstood and Under-Addressed

Anxiety related to chronic obstructive pulmonary diseases (COPD) is triggered initially by specific events in the illness trajectory and thereafter maintained by COPD-related internal, external, and behavioral factors. That is according to new research designed to improve identification and management of COPD-related anxiety, a prevalent but often unidentified issue that is not typically managed adequately.

Researchers in Denmark synthesized the findings of 41 qualitative studies of patients’ experiences of COPD-related anxiety. They identified four themes related to the disorder – initial events, internal maintaining factors, external maintaining factors, and behavioral maintaining factors – and used them to create a conceptual model of COPD-related anxiety from the patient perspective. 

“According to the model, specific initial events can trigger COPD-related anxiety, i.e., realizing the diagnosis and/or prognosis, experiencing exacerbation/symptom progression for the first time, and loss of function and/or abilities due to COPD,” they wrote, noting that despite multiple studies exploring the psychological effect of other illnesses including cancer, the same cannot be said for COPD. “One possible explanation for this lack of focus might be related to the consideration that smokers should expect to be ill from smoking, which is a widespread understanding of COPD, despite also being the case for certain cancers and cardiovascular disease. Another explanation may be the relatively slow progression of the disease, often resulting in several visits to the doctor with symptoms and declining lung function before the diagnosis is confirmed by the physician and disclosed to the patient.”

Results of the study, published in the June 2023 issue of International Journal of Chronic Obstructive Pulmonary Disease, suggest that, once triggered, COPD-related anxiety was maintained and potentially worsened over time by internal, external, and behavioral maintaining factors. For example, the review showed that patients were troubled by thoughts of death and the process of dying. They further expressed that, even shortly after being diagnosed with COPD and understanding the prognosis, death became a near reality, which affected their internal processes. 

“In spite of being aware of patient needs, many health-care providers feel inadequately prepared for discussing end-of-life issues and might therefore tend to avoid bringing up the subject. Moreover, appropriate timing of these conversations can be challenging, due to the unpredictability of the general illness trajectory in COPD compared to cancer.”

The study also suggests that patients suppress information about mental health, believing that their healthcare providers and caregivers could not understand or comprehend their situation. As such, they refrained from requesting help with their anxiety and initiated avoidance and social distancing which worsened symptoms. 

“With the purpose of strengthening the identification of COPD-related anxiety in the future, there are a number of potential barriers among health-care providers that need to be overcome, such as not recognizing the scale of the problem, not considering anxiety as part of the remit, and lack of knowledge about or access to appropriate interventions. Both health-care providers and patients can benefit from implementing systematic, psychological screening processes, because it can potentially increase confidence in assessing and managing psychological symptoms,” the researchers wrote.

Additional insights from Dr. Nair:  The need to breathe is so fundamental that if one chronically has trouble doing it, it will predispose them to anxiety. Anxiety also causes one to hyperventilate, which actually leads the body to emphasize the main defect in COPD – impairment to getting the breath out of your lungs. The “obstruction” in COPD is getting air out (exhalation) rather than in (inhalation). It takes longer to empty your lungs than it does to fill them, so the more times you breathe in the less time you have to breathe out. Thus, anxiety is an important symptom for a doctor to address when treating a person with COPD in a comprehensive manner.

Read the full study in International Journal of Chronic Obstructive Pulmonary Disease

Hitting the Road Safely

Summer is here, bringing with it thoughts of vacations and quick getaways. But for people with chronic obstructive pulmonary disease (COPD), getting where they need or want to be – whether it’s for appointments, errands, a trip across country, or just getting out of the house for the day – can be stressful.

There are ways to safely get from here to there, including having a plan, checking the weather, avoiding secondhand smoke, and being prepared with any supplies he or she may need while on the road. Following are suggestions to make leaving home safer and less challenging from the COPD Caregiver’s Toolkit, published by the National Heart, Lung, and Blood Institute (NHLBI), part of the National Institutes of Health (NIH).

Have a Plan

Knowing what to do in advance makes leaving the house easier for everyone. Allow enough preparation time, and check with the person with COPD about their energy levels and level of ambition so you both have a clear understanding of the goals and ambition level for the outing. This will also help you both be mentally prepared for what needs to come next.

Check the Weather

Check the forecast and pay close attention to any predicted weather changes (e.g., intense humidity or cold) that might trigger a COPD flare-up. Pack the right weather protection and consider whether the car should be started in advance to get it warmed up or cooled down before getting in.

Avoid Secondhand Smoke

Not only is secondhand smoke an irritant, but it can change how the lungs and airways work. Thus, it’s important to avoid public smoking areas or anywhere that runs the risk of exposure.

Be Prepared

Ensure you have all necessary supplies, including any medications, oxygen supplies, etc., and make sure you have emergency phone numbers and contacts. If air travel is involved, contact the airline in advance to verify that the oxygen delivery device you plan to take is approved for use on the airplane.

If You’re Staying Behind

If someone else is taking the person with COPD to their appointment, establish a plan for them to use when making transportation arrangements. Make sure whoever is providing transportation understands any special needs and/or limitations. Many areas also offer senior or medical transportation services or check to see if any available public transportation is ADA-compliant.

Traveling with Oxygen

Preparation is particularly critical when traveling with oxygen. Answer these questions before leaving the house or during trip planning:

1. Do we have enough oxygen to travel with?
2. Do we have all the oxygen supplies we need?
3. Have we reviewed tank safety for traveling?
4. If flying, have we assessed what is needed for in-flight oxygen and oxygen at our destination?

NHLBI also shares the following outdoor safety checklist in its COPD Caregiver’s Toolkit:

• Sign up for air quality alerts from airnow.gov.
• Get outdoor allergen levels from your local news or weather websites.
• When outdoor air quality is poor or allergen levels are high, keep windows and doors closed and use air conditioning whenever possible.
• Avoid outdoor activities, especially during peak poor outdoor air quality hours from 1:00-4:00 pm.
• If you live in an area where wildfires are common, talk to your healthcare provider about ways to protect the person you care for against wildfire smoke.

More travel safety information can be found in NHLBI’s COPD Caregiver’s Toolkit, available here.

Sepsis Multiplies In-Hospital Mortality Risk In COPD

Although slightly fewer than 1% of hospitalizations for chronic obstructive pulmonary disease (COPD) are complicated by sepsis, this complication increases the risk for in-hospital mortality fivefold, investigators who studied a representative national sample found. 

Among nearly 7 million hospitalizations in which the primary diagnosis was COPD, about 65,000 (0.93%) patients experienced sepsis as a complication. In all, 31% of COPD patients with sepsis were discharged from the hospital to another care facility, and 19% died in the hospital.

COPD has been associated with increased risk for sepsis because of the use of corticosteroids, underlying comorbidities and, potentially, impaired barrier function, the authors note.

Researchers identified 6,940,615 hospitalizations where the primary diagnosis was COPD; in 64,748 of those cases, sepsis was a complication. As noted, the in-hospital death rate was 19% for patients with COPD and sepsis and the rate of discharge to other facilities was 31%. Investigators saw that the adjusted odds for in-hospital mortality remained stable over time, and discharge to facilities increased significantly.

Predictors of in-hospital mortality among patients with sepsis included increasing age, white ethnicity, treatment in the Northeast region, disseminated intravascular coagulation, pneumococcal infection, congestive heart failure, and renal failure.

A COPD specialist who was not involved in the study told Medscape Medical News that sepsis is an uncommon but severe complication for patients with COPD and those with other severe illnesses.

Additional insight from Dr. Nair: There are levels that infection can affect people, from simple infection to sepsis to septic shock. For instance, if you had a respiratory infection with only lung symptoms such as cough and phlegm (such as a COPD exacerbation), that would be a simple infection. If infection starts to affect other areas of the body distant to the infection site, then the infection has progressed to sepsis.

Symptoms include change of mental status (agitated or drowsy), shivering, both fever and low temperature, rapid breathing, high heart rate, and low urine volume. When one then goes on to have consistently low blood pressure and ongoing organ dysfunction, that is septic shock.

Many people with COPD are at the baseline more fragile physically, making it harder to ward off and stand up to infections. They are often older than 65 and can have some degree of immune compromise. All these factors make fighting off serious infection more difficult for patients with COPD compared with the average population – which is not a true surprise. This is one reason being in the best shape possible is so important when it comes to fighting infection. If you can’t do this on your own, then pulmonary rehabilitation is a good way to start.

To read the full report, visit Medscape.

Research Pinpoints Role of Biomarker In COPD

A report suggests that people with chronic obstructive pulmonary disease (COPD) and asthma have a protein in their lungs that leaks a small molecule into their bloodstream which restricts their breathing instead of relaxing their airways.

Published in the American Journal of Respiratory Cell and Molecular Biology, the report says this discovery may help clinicians diagnose and determine the severity of chronic lung diseases and make current treatments more effective. A protein in the cell membranes of the lungs can leak cyclic adenosine monophosphate (cAMP), causing the airways to become constricted.

These cells control constriction of the airways in asthma. By losing cAMP, the cells are more apt to constrict and worsen asthma, researchers said. They defined cAMP in the bloodstream as a biomarker by analyzing blood samples from a well-defined cohort of asthma patients. They determined that cAMP blood levels are higher in asthma patients. 

The knowledge gained from this research allows for better diagnostics of the illness and forms the basis for new therapeutics that will plug the leak of cAMP into the protein.

Additional insights from Dr. Nair:  There is a certain “back to the future element” to cAMP and lung disease. Theophylline was used for asthma and COPD many years ago, but it fell out of favor due to side effects that would occur (high pulse, nausea, vomiting, insomnia, irritability) if it was not maintained at a certain level or therapeutic window. That level got thrown off easily by drug interactions, sometimes with common medications such as antibiotics and common conditions such as liver disease. At very high levels, cardiac rhythm abnormalities and seizures could occur. Also, it was not as effective as regular treatment. It is very rarely used anymore, except for people who have been on it a long time. 

There has been a search for a “cleaner version” of Theophylline. The closest we have come to is a medication called Daliresp (Roflumalast). It is more of an add on medication – sometimes it helps and sometimes it doesn’t. It is also limited by GI side effects.

To read more about the study, please visit AJMC.

COPD + OSA = OS

Obstructive sleep apnea (OSA) occurs when the breathing stops and starts repeatedly throughout the night. Chronic obstructive pulmonary disease (COPD) is a group of lung conditions that make breathing difficult by blocking airflow in the lungs. When the two conditions occur together – which they do about 13% of the time – it results in a condition called overlap syndrome (OS).

OS can be a cause for concern, as the combination of symptoms from COPD and OSA may make it hard for the body to get enough oxygen. Too, compared to people with COPD or OSA alone, someone with OS is more likely to experience:

• Nocturnal oxygen desaturation (NOD) – when blood oxygen levels decrease during sleep
• Hypercapnia – too much carbon dioxide in the blood
• Hypoxia – not enough oxygen in the blood

Lack of oxygen in the blood leads to oxidative stress. This then causes the release of “messengers” that cause an inflammatory response in cells and blood vessels called systemic inflammatory mediators, which can lead to the hardening of the arteries and a type of coronary artery disease called endothelial dysfunction. As a result, people with OS have a higher risk of developing high blood pressure and heart failure.

In terms of treating OS, the most effective option is noninvasive positive airway pressure (PAP) using a continuous PAP (CPAP) machine during sleep. A mask is worn over the mouth and nose to introduce pressured air into the lungs as a person sleeps by splinting open the collapsed upper airways. Lifestyle changes such as quitting smoking, maintaining a moderate body weight and pulmonary rehabilitation and a structured exercise program can also be beneficial for those with OS.

Other potential options, which may not be suitable for everyone with OS, include supplemental oxygen at night and use of bronchodilators and corticosteroids.

Additional comment from Dr. Nair: It is well known that there is an association between COPD and sleep apnea, although this can sometimes be missed because people with COPD do not have the body type commonly associated with sleep apnea (classically thought of as overweight). If you have any symptoms of sleep apnea, mention it to your doctor. In addition to quality-of-life issues, sleep apnea can magnify some of COPD’s bad effects, such as low oxygen and pulmonary hypertension. 

To read the complete article, visit Medical News Today. 

New Treatment Helps COPD, Emphysema Patients

A new procedure approved by the Food and Drug Administration (FDA) is helping certain patients diagnosed with chronic obstructive pulmonary disorder (COPD) and emphysema to breathe better. The procedure, endobronchial valves (EBV), involves placing valves in a patient’s lungs that can be moved or removed if needed. The results, so far, have been promising.

Some patients who’ve undergone it are moving forward with more breath, better endurance and have even been able to perform light work that they haven’t in years, in some cases. For example, one patient suffering with COPD since 1998 couldn’t catch her breath when moving about her house. Since undergoing the mostly painless procedure she has been able to resume yard work – something she hadn’t been able to do in years.

A good alternative to more invasive surgery options, which often involve removing portions of the patient’s lung and are painful, EBV is currently available to certain emphysema patients, who must pass heart, blood, and breathing tests to qualify.

Additional insight from Dr. Nair: “EBV therapy, as described here, may be on the verge of wider use. It is always good to add a new weapon to treat COPD and once again refute the notion emphysema is not reversible. EBV therapy is lung volume reduction therapy but does not require a full-blown surgery like true LVRS does. This therapy may seem ingenious, but it is not going to be successful in everyone. EBV therapy may be on the verge of wider use. It is always good to add a new weapon to treat COPD and once again refute the notion Emphysema “is not reversible.”

To read the complete article, click here.