Chronic Obstructive Pulmonary Diseases-Journal of the Copd Foundation最新文献

{"title":"Impact of Pharmacist Inhaler Prescribing at Discharge for Chronic Obstructive Pulmonary Disease on Readmission Rates.","authors":"Ana-Maria Diaz, Lindsey M Smith, Amber N Peterson, Macie L Kent, Namitha J Vellian","doi":"10.15326/jcopdf.2024.0553","DOIUrl":"10.15326/jcopdf.2024.0553","url":null,"abstract":"<p><strong>Background: </strong>Acute exacerbation of chronic obstructive pulmonary disease (COPD) is one of the 6 conditions in the Hospital Readmissions Reduction Program for which institutions are penalized for high 30-day readmission rates. This institution's transitions of care (TOC) pharmacists have prescribing authority to optimize guideline-directed medical therapy (GDMT), defined as discharging on rescue plus triple therapy inhalers under an approved protocol. While several studies evaluate the impact of pharmacist-led interventions on COPD readmission rates, there is a lack of literature with respect to pharmacists prescribing inhalers under an approved protocol. This study aims to evaluate all-cause 30-day COPD readmission rates.</p><p><strong>Methods: </strong>This was an institutional review board-approved, single-center, retrospective evaluation conducted between May 2021 and August 2023. Patients were included if they met criteria under the Centers for Medicare and Medicaid Services Hospital Readmissions Reduction Program COPD model. Patients in the pre-implementation group received usual care, with postdischarge nurse follow-up while patients in the postimplementation group received TOC pharmacy services. The primary outcome was all-cause 30-day readmission rates. Secondary outcomes included readmission reason and proportion of patients discharged on GDMT.</p><p><strong>Results: </strong>A total of 279 patients were included, with 187 patients in the pre-implementation group and 92 patients in the postimplementation group. All-cause 30-day readmission rates in the pre- and postimplementation groups were 26% and 14%, respectively (<i>p</i>=0.02). The proportion of patients discharged on GDMT was 26% in the pre-implementation group and 100% in the postimplementation group (<i>p</i><0.001).</p><p><strong>Conclusion: </strong>Utilizing a TOC pharmacy service may be associated with a reduction in all-cause 30-day readmission rates for patients with COPD.</p>","PeriodicalId":51340,"journal":{"name":"Chronic Obstructive Pulmonary Diseases-Journal of the Copd Foundation","volume":" ","pages":"43-51"},"PeriodicalIF":2.3,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11925064/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142787541","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Iron Deficiency and All-Cause Hospitalization Risk in a Clinical Cohort of COPD.","authors":"Yukiko Kunitomo, Nirupama Putcha, Ashraf Fawzy, Sarath Raju, Meredith C McCormack, Robert A Wise, Nadia N Hansel, Aparna Balasubramanian","doi":"10.15326/jcopdf.2024.0550","DOIUrl":"10.15326/jcopdf.2024.0550","url":null,"abstract":"<p><strong>Background: </strong>The impact of iron deficiency on COPD morbidity independent of anemia status is unknown. Understanding the association between iron deficiency, anemia status, and risk of hospitalization in COPD may inform an approach to these comorbidities.</p><p><strong>Study design and methods: </strong>Adults ≥40 years from the Johns Hopkins COPD Precision Medicine Center of Excellence data repository with an outpatient iron profile and 1 year of subsequent follow-up time were included in the study. Baseline characteristics were compared across iron status, defined by transferrin saturation (TSAT), using <i>t</i>-tests and Chi-squared tests. The association between continuous TSAT and all-cause hospitalization over the 1-year follow-up period was assessed by logistic regression. Models were adjusted by covariates with an interaction term for anemia and stratified by sex.</p><p><strong>Results: </strong>There were 6532 individuals included with an average age of 65±12 years, 59% were female, and 56% White. Fifty-two percent of the cohort were iron deficient (TSAT≤20%), among whom 27% were non-anemic. Iron-deficient individuals had lower lung function and a higher prevalence of heart failure and diabetes. Iron deficiency was more prevalent among females (57%) compared to males (44%). In adjusted models, a decrease in TSAT by 10% was associated with 14.3% higher odds of all-cause hospitalization for females (95%CI:1.0-1.3), but not among males (OR:1.08, 95%CI:0.9-1.3). There was effect modification by anemia such that the association between TSAT and all-cause hospitalization was greater in non-anemic women (<i>p</i>-value interaction=0.08).</p><p><strong>Interpretation: </strong>Iron deficiency may be associated with adverse outcomes in the absence of anemia, with non-anemic women being a COPD sub-population particularly sensitive to iron deficiency.</p>","PeriodicalId":51340,"journal":{"name":"Chronic Obstructive Pulmonary Diseases-Journal of the Copd Foundation","volume":"12 1","pages":"72-81"},"PeriodicalIF":2.3,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11925066/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143069523","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving the Likelihood of Identifying Alpha-1 Antitrypsin Deficiency Among Patients With COPD: A Novel Predictive Model Using Real-World Data.","authors":"Daniel N Pfeffer, Rahul Dhakne, Omnya El Massad, Pulkit Sehgal, Thomas Ardiles, Michael O Calloway, M Chris Runken, Charlie Strange","doi":"10.15326/jcopdf.2023.0491","DOIUrl":"10.15326/jcopdf.2023.0491","url":null,"abstract":"<p><strong>Background: </strong>Despite guideline recommendations, most patients with chronic obstructive pulmonary disease (COPD) do not undergo alpha-1 antitrypsin deficiency (AATD) testing and approximately 90% of people with AATD in the United States remain undiagnosed. This study sought to develop a predictive model using real-world data to improve detection of AATD-positive patients in the general COPD population.</p><p><strong>Methods: </strong>A predictive model using extreme gradient boosting was developed using the EVERSANA database, including longitudinal, patient-level medical claims, prescription claims, AATD-specific testing data, and electronic health records (EHR). The model was trained and then validated to predict AATD-positive status. Patients were coded as AATD positive based on the presence of any of the following criteria: (1) ≥2 AATD diagnosis codes in claims; (2) an AATD diagnosis code in the EHR; (3) a positive laboratory test for AATD; or (4) use of AATD-related medication. Over 500 variables were used to train the predictive model and >20 models were run to optimize the predictive power.</p><p><strong>Results: </strong>A total of 13,585 AATD-positive patients and 7796 AATD-negative patients were included in the model. The inclusion of non-AATD laboratory test results was critical for defining cohorts and optimizing model prediction (e.g., respiratory comorbidities, and calcium, glucose, hemoglobin, and bilirubin levels). The final model yielded high predictive power, with an area under the receiver operating characteristic curve of 0.9.</p><p><strong>Conclusion: </strong>Predictive modeling using real-world data is a sound approach for assessing AATD risk and useful for identifying COPD patients who should be confirmed by genetic testing. External validation is warranted to further assess the generalizability of these results.</p>","PeriodicalId":51340,"journal":{"name":"Chronic Obstructive Pulmonary Diseases-Journal of the Copd Foundation","volume":" ","pages":"1-11"},"PeriodicalIF":2.3,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11925067/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142787568","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Characteristics of Patients With COPD and Comorbid Depression and Anxiety: Data From a National Multicenter Cohort Study.","authors":"Jing Gennie Wang, Sonali Bose, Janet T Holbrook, Lin Nan, Michelle N Eakin, Abebaw M Yohannes, Robert A Wise, Nicola A Hanania","doi":"10.15326/jcopdf.2024.0534","DOIUrl":"10.15326/jcopdf.2024.0534","url":null,"abstract":"<p><strong>Background: </strong>Most studies on mental health among individuals with chronic obstructive pulmonary disease (COPD) utilize screening questionnaires, which detect psychiatric <i>symptoms</i>, but cannot be used to <i>diagnose</i> depression/anxiety disorders. We utilized the Mini-International Neuropsychiatric Interview (MINI) to identify depression/anxiety disorders meeting the <i>Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition</i> diagnostic criteria and described associated disease burden in people with COPD.</p><p><strong>Methods: </strong>This is a cross-sectional, secondary analysis of a multicenter study designed to evaluate anxiety questionnaires in COPD patients. Research coordinators administered both the MINI and screening questionnaires to determine participants who met diagnostic criteria for depression/anxiety disorders and to capture symptom burden, respectively. Bivariate analyses were conducted to assess differences in COPD and patient-reported outcomes between those with and without depression/anxiety disorders.</p><p><strong>Results: </strong>Of 220 participants, 18 (8%) met the MINI criteria for depression and 17 (8%) for anxiety. Depression was associated with more breathlessness (modified Medical Research Council Dyspnea Scale 4 versus 3, <i>p</i>=0.045), higher COPD disease burden (COPD Assessment Test [CAT] 27 versus 17, <i>p</i><0.001), worse sleep quality (Pittsburgh Sleep Quality Index 11 versus 7, <i>p</i>=0.001) and health-related quality of life (5-Level EQ-5D 0.31 versus 0.59, <i>p</i><0.001). Anxiety was associated with lower CAT scores and worse health-related quality of life and function. Most with depression/anxiety disorders were not using antidepressants/anxiolytics, or receiving mental health counseling.</p><p><strong>Conclusion: </strong>Depression and anxiety disorders meeting diagnostic criteria are relatively common comorbidities that substantially impair quality of life and are undertreated, highlighting a need to prioritize mental health as an integral part of comprehensive COPD care.</p>","PeriodicalId":51340,"journal":{"name":"Chronic Obstructive Pulmonary Diseases-Journal of the Copd Foundation","volume":" ","pages":"33-42"},"PeriodicalIF":2.3,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11925073/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142787612","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Effect of Patient Sex on Treatment Outcomes in COPD: A Post Hoc Analysis of the IMPACT Trial.","authors":"Alejandra Hernández Alberola, Natalia Bartolomé Nogal, Almudena Blanco Miranda, David A Lipson, Lee Tombs, MeiLan K Han","doi":"10.15326/jcopdf.2024.0541","DOIUrl":"10.15326/jcopdf.2024.0541","url":null,"abstract":"<p><strong>Introduction: </strong>Lung physiology and chronic obstructive pulmonary disease (COPD) pathophysiology differ between sexes. This post hoc analysis investigated the InforMing the Pathway of COPD Treatment (IMPACT) trial outcomes by patient sex.</p><p><strong>Methods: </strong>IMPACT was a double-blind, 52-week trial. Patients ≥40 years with symptomatic COPD and a history of exacerbations were randomized 2:2:1 to fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) 100/62.5/25μg, FF/VI 100/25μg, or UMEC/VI 62.5/25μg. Annual rate and risk of moderate/severe exacerbations, change from baseline in trough forced expiratory volume in 1 second (FEV₁) and St George's Respiratory Questionnaire (SGRQ) score, and safety were assessed.</p><p><strong>Results: </strong>Of 10,355 patients, 66.3% were male. More females reported ≥2 moderate/severe prior exacerbations (58% versus 53%) at screening versus males. Additionally, females had worse mean (standard deviation) SGRQ scores (52.4[15.97] versus 49.8[17.24]) at baseline. FF/UMEC/VI improved annual exacerbation rate, lung function, and health status for both sexes versus dual therapy. The difference in trough FEV₁ across time points with FF/UMEC/VI versus FF/VI was 103mL-110mL in males and 70mL-84mL in females. On-treatment moderate/severe exacerbation rates remained higher for females (FF/UMEC/VI: 0.99; FF/VI: 1.19; UMEC/VI: 1.35) than males (0.87; 1.01; 1.14). Fewer exacerbations were experienced by females with eosinophil counts <150 cells/µL (0.81[0.68, 0.97], <i>p</i>=0.024) or <2 exacerbations in the past year (0.73[0.57, 0.94], <i>p</i>=0.013) with FF/UMEC/VI versus UMEC/VI.</p><p><strong>Conclusion: </strong>More females with COPD reported exacerbations in the prior year at screening, as well as during the study, versus males, across all treatments. FF/UMEC/VI improved exacerbation rates versus UMEC/VI in females with eosinophil counts <150 cells/µL or <2 exacerbations in the prior year, suggesting inhaled corticosteroids may play an important role in exacerbation reduction for females in this patient population. Clinical Trial Registration: GSK (CTT116855/NCT021645B).</p>","PeriodicalId":51340,"journal":{"name":"Chronic Obstructive Pulmonary Diseases-Journal of the Copd Foundation","volume":" ","pages":"591-603"},"PeriodicalIF":2.3,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142632351","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Childhood Cigarette Smoking and Risk of COPD in Older United States Adults: A Nationally Representative Replication Study.","authors":"Jenny E Ozga, James D Sargent, Alexander W Steinberg, Zhiqun Tang, Cassandra A Stanton, Laura M Paulin","doi":"10.15326/jcopdf.2024.0514","DOIUrl":"10.15326/jcopdf.2024.0514","url":null,"abstract":"<p><strong>Introduction: </strong>A recent study found that the prevalence of chronic obstructive pulmonary disease (COPD) is significantly higher among adults who began smoking cigarettes before (versus after) 15 years of age, independent of current smoking, cigarette pack years, and smoking duration. The current analysis went a step further to also account for secondhand smoke exposure, using data from U.S. adults aged 40+ years during Wave 5 (2018-2019) of the Population Assessment of Tobacco and Health Study.</p><p><strong>Methods: </strong>Adults who had ever smoked cigarettes were asked at what age they began smoking fairly regularly. Multivariable Poisson regression assessed the risk of self-reported COPD diagnosis due to childhood smoking (<15 years), adjusting for current smoking, cigarette pack years or smoking duration, secondhand smoke exposure, and sociodemographic covariates.</p><p><strong>Results: </strong>Overall, 13.4% reported that they had COPD. COPD prevalence was 7.5% for adults who never smoked compared to 29.0% and 21.1% for smoking onset at age <15 and 15+ years, respectively. Adults who initiated smoking at <15 (versus 15+) years had a higher prevalence of current smoking (45.9% versus 33.3%), longer smoking duration (mean 34.2 versus 27.3 years), greater cigarette pack years (mean 48.8 versus 30.8), and greater secondhand smoke exposure (<i>p</i>'s<0.05). In multivariable analysis, the relative risk for COPD for smoking onset <15 (versus 15+) years of age was 1.27 (95% confidence interval=1.06, 1.51).</p><p><strong>Conclusion: </strong>The increased risk of COPD due to childhood smoking was independent of cigarette pack years, smoking duration, secondhand smoke exposure, and current smoking. The findings give further evidence of increased COPD risk related to childhood smoking.</p>","PeriodicalId":51340,"journal":{"name":"Chronic Obstructive Pulmonary Diseases-Journal of the Copd Foundation","volume":" ","pages":"549-557"},"PeriodicalIF":2.3,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142480371","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identification of Severe Acute Exacerbations of Chronic Obstructive Pulmonary Disease Subgroups by Machine Learning Implementation in Electronic Health Records.","authors":"Huan Li, John Huston, Jana Zielonka, Shannon Kay, Maor Sauler, Jose Gomez","doi":"10.15326/jcopdf.2024.0556","DOIUrl":"10.15326/jcopdf.2024.0556","url":null,"abstract":"<p><strong>Rationale: </strong>Acute exacerbations of chronic obstructive pulmonary disease (AECOPDs) are heterogeneous. Machine learning (ML) has previously been used to dissect some of the heterogeneity in COPD. The widespread adoption of electronic health records (EHRs) has led to the rapid accumulation of large amounts of patient data as part of routine clinical care. However, it is unclear whether the implementation of ML in EHR-derived data has the potential to identify subgroups of AECOPD.</p><p><strong>Objectives: </strong>To determine whether ML implementation using EHR data from severe AECOPDs requiring hospitalization identifies relevant subgroups.</p><p><strong>Methods: </strong>This study used 2 retrospective cohorts of patients with AECOPDs (non-COVID-19 and COVID-19) treated at Yale-New Haven Hospital. <i>K</i>-means clustering was used to identify patient subgroups.</p><p><strong>Measurements and main results: </strong>We identified 3 subgroups in the non-COVID cohort (n=1736). Each subgroup had distinct clinical characteristics. The reference subgroup was the largest (n=904), followed by cardio-renal (n=548) and eosinophilic (n=284). The eosinophilic subgroup had milder severity of AECOPD, including a shorter hospital stay (<i>p</i><0.01). The cardio-renal subgroup had the highest mortality during (5%) and in the year after hospitalization (30%). Validation of the severe AECOPD classifier in the COVID-19 cohort recapitulated the characteristics seen in the non-COVID cohort. AECOPD subgroups in the COVID-19 cohort had different interleukin (IL)-1 beta, IL-2R, and IL-8 levels (false discovery rate ≤ 0.05). These specific leukocyte and cytokine profiles resulted in inflammatory differences between the AECOPD subgroups based on C-reactive protein levels.</p><p><strong>Conclusions: </strong>Incorporating ML with EHR data allows the identification of specific clinical and biological subgroups for severe AECOPD.</p>","PeriodicalId":51340,"journal":{"name":"Chronic Obstructive Pulmonary Diseases-Journal of the Copd Foundation","volume":" ","pages":"611-623"},"PeriodicalIF":2.3,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11703024/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142480372","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Interventions Following Escalations from a Continuous Respiratory Monitoring Service in Patients With Chronic Obstructive Pulmonary Disease.","authors":"Robert K Teresi, Ashley C Hendricks, Neema Moraveji, Richard K Murray, Michael Polsky, Diego J Maselli","doi":"10.15326/jcopdf.2023.0475","DOIUrl":"10.15326/jcopdf.2023.0475","url":null,"abstract":"<p><strong>Background: </strong>Continuous respiratory monitoring can support integrated care for chronic obstructive pulmonary disease (COPD) patients, by coupling them with remote clinical personnel who triage patients in coordination with their health care providers. When deploying such services, there remains uncertainty surrounding outcomes when at-risk patients are proactively identified and escalated for provider evaluation. This study presents findings from a service deployed in a real-world COPD cohort by analyzing the clinical interventions made during in-person and telehealth pulmonary outpatient visits following remote escalations.</p><p><strong>Methods: </strong>A single-center, retrospective, observational study of real-world COPD patients at a multisite pulmonary practice was conducted. Patients who were enrolled in a continuous respiratory monitoring service for at least one year and were seen by a provider within 7 days of an escalation by the service (N=168) were included. To evaluate the potential impact of these escalations on provider and patient burden, medical charts from outpatient visits were manually reviewed and grouped into 6 categories based on the clinical action(s) taken by the provider.</p><p><strong>Results: </strong>A total of 245 outpatient visits occurred from 168 patients within 7 days of escalation. Of the 245 visits, 206 (84.1%) resulted in clinical intervention and 163 (66.5%) resulted in treatment consistent with acute exacerbations of COPD. A total of 1.6% of the outpatient visits resulted in referral to the emergency department.</p><p><strong>Conclusion: </strong>Provider encounters occurring following the escalation of a patient from a continuous respiratory monitoring service consistently resulted in that provider administering a treatment to the escalated patient.</p>","PeriodicalId":51340,"journal":{"name":"Chronic Obstructive Pulmonary Diseases-Journal of the Copd Foundation","volume":" ","pages":"558-568"},"PeriodicalIF":2.3,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142367394","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Multimodal Intervention to Improve Guideline-Based Screening for Alpha-1 Antitrypsin Deficiency in a Community Health Setting.","authors":"Andrew A Wilson, Celia Bora, Catherine Silva, Julie L White, Natalie Sanfratello, Jaime Symowicz, Cristen Querey, Donna Gabriel","doi":"10.15326/jcopdf.2024.0540","DOIUrl":"10.15326/jcopdf.2024.0540","url":null,"abstract":"<p><strong>Rationale: </strong>Evidence-based guidelines recommend screening all individuals with chronic obstructive pulmonary disease (COPD) for the genetic disorder alpha-1 antitrypsin deficiency (AATD). However, it is estimated that only 5% of people with COPD have been tested for AATD, and a large fraction of the estimated 70,000 to 100,000 Americans with AATD have not yet been diagnosed. Low familiarity with AATD and limited knowledge about diagnostic tests and available treatments contribute to suboptimal screening rates.</p><p><strong>Objectives: </strong>Our objective was to address barriers to and improve rates of guideline-based AATD diagnostic testing among racially and ethnically diverse patients with COPD at a large community health center.</p><p><strong>Methods: </strong>A quality improvement initiative consisting of educational sessions and electronic health record (EHR) system interventions was implemented to improve the adoption of guideline-based screening for AATD in patients with COPD.</p><p><strong>Results: </strong>An analysis of EHR data demonstrated that among patients with a COPD diagnosis (n=1030), 22.2% (n=229) were screened for AATD in the 12 months following the start of the quality improvement initiative compared with 1.3% (n=13) of patients with a COPD diagnosis (n=972) seen in the 12 months prior to the start of the quality improvement initiative (<i>P</i><0.001).</p><p><strong>Conclusions: </strong>A quality improvement initiative consisting of educational sessions and EHR system modifications was successful in increasing clinicians' knowledge and diagnostic screening rates for AATD in patients with COPD at a large community health center.</p>","PeriodicalId":51340,"journal":{"name":"Chronic Obstructive Pulmonary Diseases-Journal of the Copd Foundation","volume":" ","pages":"582-590"},"PeriodicalIF":2.3,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142373487","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fall Risk and Medication Use Near End of Life Among Adults With Chronic Obstructive Pulmonary Disease.","authors":"Cara L McDermott, Laura C Feemster, Ruth A Engelberg, Laura J Spece, Lucas M Donovan, J Randall Curtis","doi":"10.15326/jcopdf.2024.0551","DOIUrl":"10.15326/jcopdf.2024.0551","url":null,"abstract":"<p><strong>Background: </strong>Falls are frequent among people with chronic obstructive pulmonary disease (COPD) and are associated with increased morbidity, mortality, and health care costs. Understanding modifiable medication factors that contribute to fall risk is an important step to developing fall prevention strategies for this highly susceptible group.</p><p><strong>Methods: </strong>This is a retrospective cohort study using electronic health record data from a single health system linked to Washington State death certificates of adults ages 40 or older who died between 2014-2018 with COPD. We identified demographics, comorbidities, fall-risk increasing drug (FRID) burden, and the occurrence of injurious falls within the 2 years prior to the date of death. We defined injurious falls using published algorithms of the International Classification of Diseases codes.</p><p><strong>Results: </strong>Of 8204 decedents with COPD, 2454 (30%) had an injurious fall in the 2 years before death, and FRID use was common among 65%. A higher percentage of patients with falls received prescriptions for anticonvulsants (35% versus 26%), antipsychotics (24% versus 13%), atypical antidepressants (28% versus 19%), and tricyclic antidepressants (10% versus 5%) versus those without a fall. In multivariable logistic regression, after adjusting for confounders, FRID burden was associated with greater odds of an injurious fall (odds ratio 1.07 [95% confidence interval 1.04-1.09]).</p><p><strong>Conclusion: </strong>Our findings highlight an opportunity for collaboration between pharmacists, pulmonologists, and patients to develop new processes to potentially deprescribe and optimize the use of FRIDs among patients with COPD to increase safety.</p>","PeriodicalId":51340,"journal":{"name":"Chronic Obstructive Pulmonary Diseases-Journal of the Copd Foundation","volume":" ","pages":"604-610"},"PeriodicalIF":2.3,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11703018/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142559385","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}