Change in individual chronic obstructive pulmonary disease assessment test item scores after short-term bronchodilator therapy and its impact on exacerbation in treatment-naïve patients with chronic obstructive pulmonary disease

Kim, Bo‐Guen; Shin, Sun Hye; Gil, Hyun-Il; Zo, Sungmin; Im, Yunjoo; Song, Ju Yeun; Lee, Chai Young; Kang, Danbee; Cho, Juhee; Park, Hye Yun

doi:10.1177/20406223221114235

Cited by 2 publications

(1 citation statement)

References 40 publications

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“…However, patients (with CAT score of < 10 or ≥ 10) who achieve CAT MCID improvement significantly had lower risk of subsequent COPD exacerbation event compared to those did not. In previous study, the group with improved CAT score (patients who exhibited a decrease of 2 points or more) had significantly fewer moderate-to-severe exacerbations than the those without improvement during the short-term (approximately 6 months) follow-up after bronchodilator therapy [ 21 ], which is similar with our result. Moreover, patients with stable or improved health status during 1 year follow-up had a lower likelihood of exacerbation also has been reported [ 22 ].…”

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confidence: 90%

The impact of the duration of the integrated disease management program on COPD-related outcomes

Lin

Wang

et al. 2023

Eur J Med Res

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Background The aim of this study is to assess the impact of the duration of the integrated disease management (IDM) program on COPD-related outcomes in real-world setting. Methods A retrospective cohort study among 3771 patients with COPD who had regularly completed 4 visits of IDM program within 1 year between April 1, 2017 and December 31, 2018. CAT score as the primary outcome used to investigate the association between IDM intervention duration and improvement in CAT score. Change in CAT score from baseline to each follow-up visit determined by using least-squares means (LSMeans) approach. The cut-off value of IDM duration for improving the CAT score was determined by the Youden index. Logistic regression was used to analyze the relationship between IDM intervention duration and MCID (the minimal clinically important difference) improvement in CAT score and the factor associated CAT improvement. Risks of COPD exacerbation events (COPD-related ED visit and COPD-related hospitalization) were estimated by using the cumulative incidence curve and Cox proportional hazards models. Result Among 3771 enrolled COPD patients, the majority of the study cohort were males (91.51%) and 42.7% of patients had CAT score of ≥ 10 at baseline. The mean of age was 71.47 years and the mean CAT at baseline were 10.49. The mean change from baseline in CAT score was − 0.87, − 1.19, − 1.23 and − 1.40 at 3-, 6-, 9- and 12 month follow-up (p < 0.0001 for all visits), respectively. Statistically significantly lower likelihood of achieving MCID improvement in CAT were observed at 3- and 6 month compared to 9 month (at 3 month: OR: 0.720, 95% CI 0.655–0.791; at 6 month: OR: 0.905, 95% CI 0.825–0.922). And only a modest increase likelihood of achieving MCID improvement in CAT at 12 month (OR: 1.097, 95% CI 1.001–1.201) compared with 9-month follow-up. In logistic regression on the entire cohort, CAT MCID improvement was most associated with baseline CAT scores ≥ 10, followed by frequent exacerbation in previous year (> 2 episodes/year), wheezing, and GOLD B or D at baseline. In baseline CAT ≥ 10 group, patients were more likely to achieve CAT MCID improvement and had greater decreases from baseline in CAT score observed at 3-, 6-, 9-, and 12 month compared with baseline CAT score < 10 group (all p < 0.0001). Moreover, in CAT ≥ 10 groups, patients who achieved CAT MCID improvement had lower risk of subsequent COPD exacerbation events (COPD-related ED visit: aHR: 1.196, 95% CI 0.985–1.453, p = 0.0713; COPD-related hospitalization: aHR: 1.529, 95% CI 1.215–1.924, p = 0.0003) when compared to those without. Conclusion This is the first real-world study indicating the association between COPD IDM intervention duration and COPD-related outcomes. From 3 to 12 month follow-up results showed that continued improvement over time in COPD-specific health status, particularly in patients with baseline CAT score of ≥ 10. Furthermore, a reduction of the risk of subsequent COPD exacerbations were observed in patients with CAT MCID improvement.

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Section: Discussionsupporting

confidence: 90%

The impact of the duration of the integrated disease management program on COPD-related outcomes

Lin

Wang

et al. 2023

Eur J Med Res

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Accelerated Lung Function Decline and Mucus–Microbe Evolution in Chronic Obstructive Pulmonary Disease

Meldrum,

Donaldson,

Narayana

et al. 2024

Am J Respir Crit Care Med

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Rationale Progressive lung function loss is recognized in chronic obstructive pulmonary disease (COPD); however, no study concurrently evaluates how accelerated lung function decline relates to mucus properties and the microbiome in COPD. Objectives Longitudinal assessment of mucus and microbiome changes accompanying accelerated lung function decline in patients COPD. Methods This was a prospective, longitudinal assessment of the London COPD cohort exhibiting the greatest FEV 1 decline ( n = 30; accelerated decline; 156 ml/yr FEV 1 loss) and with no FEV 1 decline ( n = 28; nondecline; 49 ml/yr FEV 1 gain) over time. Lung microbiomes from paired sputum (total 116 specimens) were assessed by shotgun metagenomics and corresponding mucus profiles evaluated for biochemical and biophysical properties. Measurements and Main Results Biochemical and biophysical mucus properties are significantly altered in the accelerated decline group. Unsupervised principal component analysis showed clear separation, with mucus biochemistry associated with accelerated decline, whereas biophysical mucus characteristics contributed to interindividual variability. When mucus and microbes are considered together, an accelerated decline mucus–microbiome association emerges, characterized by increased mucin (MUC5AC [mucin 5AC] and MUC5B [mucin 5B]) concentration and the presence of Achromobacter and Klebsiella . As COPD progresses, mucus–microbiome shifts occur, initially characterized by low mucin concentration and transition from viscous to elastic dominance accompanied by the commensals Veillonella , Gemella , Rothia , and Prevotella (Global Initiative for Chronic Obstructive Lung Disease [GOLD] A and B) before transition to increased mucus viscosity, mucins, and DNA concentration together with the emergence of pathogenic microorganisms including Haemophilus , Moraxella , and Pseudomonas (GOLD E). Conclusions Mucus–microbiome associations evolve over time with accelerated lung function decline, symptom progression, and exacerbations affording fresh therapeutic opportunities for early intervention.

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Change in individual chronic obstructive pulmonary disease assessment test item scores after short-term bronchodilator therapy and its impact on exacerbation in treatment-naïve patients with chronic obstructive pulmonary disease

Cited by 2 publications

References 40 publications

The impact of the duration of the integrated disease management program on COPD-related outcomes

The impact of the duration of the integrated disease management program on COPD-related outcomes

Accelerated Lung Function Decline and Mucus–Microbe Evolution in Chronic Obstructive Pulmonary Disease

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