5 Qs on COPD Mortality and Quality of Life

Chronic obstructive pulmonary disease (COPD) is the 4th leading cause of death worldwide, projected to move up to 3rd by next year, according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD).¹ COPD is also a major cause of chronic morbidity that leads to disability and reduced health-related quality of life (HRQoL).

Several recent studies have addressed key aspects of COPD patient care, mortality, and HRQoL. Take this brief test to find out what you know about the latest findings.

Question 1. In a recent Spanish study, patients in which of the following COPD phenotypes had the poorest disease-specific HRQoL?

A. Non-exacerbator
B. Exacerbator with emphysema
C. Exacerbator with chronic bronchitis
D. Asthma-COPD overlap syndrome

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Answer: C. Exacerbator with chronic bronchitis. HRQoL was significantly poorer in this phenotype than in the others. The patients also recorded the worst score in all COPD Assessment Test items and St George’s Respiratory Questionnaire for COPD components. The authors suggested these patients may warrant a different treatment approach that focuses on exacerbation and chronic bronchitis components.²

Question 2. The Greek UNLOCK* study showed overuse of which of the following treatments for patients with COPD who were classified into GOLD 2018 A–D disease severity groups?

A. Oxygen therapy
B. Inhaled corticosteroids (ICS)
C. Single bronchodilation
D. Dual bronchodilation

*UNLOCK, Uncovering and Noting Long-term Outcomes in COPD and asthma to enhance Knowledge

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Answer: B. ICS. The UNLOCK study found that COPD patients who were classified into the A-D disease severity groups overused ICS, with the majority of patients using them for symptom management. Physicians prescribed combinations of bronchodilator with ICS vs single or dual bronchodilation as a first choice, independent of the GOLD group. Dyspnea and cough were the main symptoms. Close to 90% of the patients reported having a poor health status.³

Question 3. In a recent meta-analysis, long-term statin treatment for patients with COPD was effective in reducing which of the following?

A. Mortality risk
B. Pulmonary hypertension
C. Erythrocyte sedimentation rate
D. A, B, and C
E. A and B

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Answer: E. A and B. Statins reduced C-reactive protein (CRP) levels and pulmonary hypertension as well as the risk of all-cause mortality, heart disease-related mortality, and COPD acute exacerbations in patients with COPD. Fluvastatin, atorvastatin, and rosuvastatin were more effective vs other statins in reducing CRP levels; fluvastatin and atorvastatin were more effective in reducing pulmonary hypertension.⁴

Question 4. In a prospective study, what effect did influenza vaccination have on influenza-related hospitalization among patients with COPD?

A. Significant reduction
B. Modest reduction
C. No effect
D. Slight increase

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Answer: A. Significant reduction. There was a 38% reduction in influenza-related hospitalizations in vaccinated vs unvaccinated patients with COPD. Influenza-positive patients experienced higher crude mortality and critical illness vs influenza-negative patients. Initiatives to increase vaccination uptake and early use of antiviral agents were recommended for this population.⁵

Question 5. In a prospective analysis, how did all-cause mortality in patients with atrial fibrillation (AF) who had COPD compare with those who did not have COPD?

A. Slightly lower
B. Roughly the same
C. Close to 2-fold higher
D. Just over 3-fold higher

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Answer: C. Close to 2-fold higher. The incidence of adverse events was higher in patients who had both AF and COPD vs patients with only AF. Rates of all-cause mortality and hemorrhagic events were significantly increased in patients who had COPD, although comorbid COPD was not associated with differences in cardiovascular death or stroke rate.⁶

References:

1. GOLD. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease (2019 report). https://goldcopd.org/wp-content/uploads/2018/11/GOLD-2019-v1.7-FINAL-14Nov2018-WMS.pdf. Accessed March 8, 2019.

2. Chai CS, Liam CK, Pang YK, et al. Clinical phenotypes of COPD and health-related quality of life: a cross-sectional study. Int J Chron Obstruct Pulmon Dis. 2019;14:565-573. 

3. Tsiligianni I, Kampouraki M, Ierodiakonou D, Poulorinakis I, Papadokostakis P. COPD patients’ characteristics, usual care, and adherence to guidelines: the Greek UNLOCK study. Int J Chron Obstruct Pulmon Dis. 2019;14:547-556.

4. Lu Y, Chang R, Yao J, et al. Effectiveness of long-term using statins in COPD - a network meta-analysis. Respir Res. 2019;20:17.

5. Mulpuru S, Li L, Ye L, et al. Effectiveness of influenza vaccination on hospitalizations and risk factors for severe outcomes in hospitalized patients with COPD. Chest. 2019;155:69-78.

6. Rodríguez-Mañero M, López-Pardo E, Cordero A, et al. A prospective study of the clinical outcomes and prognosis associated with comorbid COPD in the atrial fibrillation population. Int J Chron Obstruct Pulmon Dis. 2019;14:371-380.