Opioids, PTSD, Smartphone App Highlight COPD News

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This week is Respiratory Care Week, an annual event conducted by the American Association for Respiratory Care and respiratory care professionals around the country that recognizes the respiratory care profession and promotes awareness of lung health issues and practices. Here we review 3 new studies on chronic obstructive pulmonary disease (COPD).

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High New Opioid Use in Older Adults Raises Safety Concerns

• New opioid use is high, and may even be excessive, among older adults who have COPD, according to a retrospective population-based cohort study.

• More than two-thirds of 107,109 community-dwellers and more than half of 16,207 long-term care residents with COPD received an incident opioid drug during a 10-year period.

• Long-term care residents received multiple opioid dispensings (8.8%), dispensings for more than 30 days’ duration (up to 19.8%), second dispensings (35% to 43%), and early refills (24.2%).

• Incident opioid dispensing occurred during COPD exacerbations in 6.9% of long-term care residents and 18.1% of long-term care residents who had frequent exacerbations.

• The same patterns of incident opioid use occurred among community-dwellers but with relatively lower frequencies.

• The researchers concluded that the degree and pattern of new opioid use raises potential safety concerns in these populations.

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Severe Stress on COPD Affects Perception of Symptom Burden

• Post-traumatic stress disorder (PTSD) is as an important comorbidity that affects COPD management, according to a new structured review.

• Several studies have demonstrated an impact of comorbid anxiety and depression on COPD-related outcomes.

• These researchers conducted a structured review of 19 articles on the co-occurrence of COPD and PTSD and the impact of PTSD on COPD-related outcomes.

• Studies that used more robust COPD measures, such as a physician exam, generally did not find a relationship between PTSD and COPD.

• Among studies that examined the impact of PTSD on COPD-related outcomes, there was more consistent evidence that PTSD affects the perception of respiratory symptom burden and management.

• The researchers think more studies are needed to determine whether COPD and PTSD are likely to be comorbid and to elucidate the mechanisms connecting PTSD and COPD-related outcomes.

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Smartphone App for Daily COPD Symptoms: Adherence and Quick Responses

• A smartphone/tablet-based telemedicine disease management program facilitates early detection and treatment of COPD exacerbation symptoms, according to a new study.

• Researchers provided 30 patients with a smartphone application for daily COPD symptom reporting.

• The patients reported daily symptoms over 10 months using a smartphone application or by logging in to a restricted-access Web site through a home computer.

• Patient adherence to the reporting system exceeded 90% for more than half of the participants.

• In more than 50% of worsening COPD symptom reports, a nurse responded in less than 6 hours with patient-specific treatment recommendations.

• The researchers noted that the timely response was substantially better than typical to start steroids, antibiotics, or both after the onset of symptoms.

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Take-away Messages:

• New opioid use may be excessively high in older, respiratory-vulnerable patients with COPD.

• Evidence is weak to support the co-occurrence of COPD and PTSD, but much stronger evidence implicates PTSD as an important comorbidity that affects COPD management.

• A smartphone application leads to high compliance of daily symptom reporting and to timely responses to reports of COPD symptom worsening.