COPD Insights: 6 Study Briefs for Primary Care

Optimal threshold to identify significant COPD risk. Results from the National Heart, Lung, and Blood Institute Pooled Cohorts Study published recently in JAMA support the use of forced expiratory volume in the first second to the forced vital capacity (FEV₁:FVC) <0.70 to identify persons at risk for clinically significant COPD. The 0.70 threshold provided discrimination of COPD-related hospitalization and mortality that was about the same as or more accurate than that of other fixed thresholds and the lower limit of normal and optimal discrimination in the subgroup analysis of ever smokers and in adjusted models.

Use of dry powder inhalers is less than ideal in ambulatory patients. In a recent study published in the Journal of the COPD Foundation, 1 in 5 stable, ambulatory patients with COPD who used dry powder inhalers had suboptimal peak inspiratory flow rate, as measured with an In-Check DIAL.® Factors associated with suboptimal use of a dry powder inhaler included women, shorter stature, and air trapping. The authors noted that spirometry allows for identification of patients with a decreased maximal forced inspiratory flow based on gender and height that can be used as a physiologic threshold value for future interventional studies.

Smoking cessation efforts may reduce COPD in nonsmokers. A CDC survey, published June 21 in MMWR, found that 6.2% of US adults reported having been told by a health care professional that they had COPD. The age-adjusted prevalence was 15.2%, 7.6%, and 2.8% among current smokers, former smokers, and never smokers, respectively. A relationship with state prevalence of COPD among adults who had never smoked suggested secondhand smoke exposure as a potential risk factor for COPD. Promotion of smoke-free environments was recommended to reduce COPD among persons who smoke-and those who do not.

Fitness trims COPD disease and death risk in middle-aged men. Higher levels of cardiorespiratory fitness (CRF) were associated with a lower long-term risk of COPD and death from COPD in healthy, middle-aged men. The study, appearing in the journal Thorax, found the estimated risk of incident COPD was 21% and 31% lower in study patients with normal and high CRF, respectively, than in those with low CRF, and the risk of death from COPD was 35% and 62% lower. There was a delay to incident COPD and death from COPD in the magnitude of 1.3 to 1.8 years in normal and high CRF compared with low CRF.

Electronic inhaler monitoring lowers high healthcare utilization. A study published in the Journal of Telemedicine and Telecare repors that, when used with a disease management program, electronic inhaler monitoring (EIM) may reduce healthcare utilization in patients with COPD and a history of high utilization. Study patients provided with electronic devices for monitoring controller and rescue inaler utilization were contacted when alerts were triggered indicating suboptimal adherence to controller inhalers or increased use of rescue inhalers. With EIM, there was a significant reduction in COPD-related healthcare utilization and a nonsignificant reduction in all-cause healthcare utilization.

Health literacy boosts COPD quality of life. In a recent issue of the Journal of Medical Internet Research, findings from a cross-sectional Web-based survey, showed health literacy was positively associated with generic health-related quality of life (HRQoL) in persons with COPD. Electronic health (eHealth) literacy was not. Both health literacy and eHealth literacy were positively associated with lung-specific HRQoL. Health literacy was positively associated with most lung-specific HRQoL indicators (eg, cough frequency, chest tightness); eHealth literacy was positively associated with 5 of 8 lung-specific HRQoL indicators. COPD knowledge was inversely associated with lung-specific HRQoL.