Digital Commons Network^™

Usp <800> Compliance: A Hazardous Drug Safe Handling Ppe Toolkit For Infusion Nurses, Cynthia Huff

Doctor of Nursing Practice (DNP) Projects

Problem: Safety concerns have existed for more than 40 years about how hazardous drug (HD) exposure contributes to long- and short-term adverse health outcomes for healthcare workers (HCWs). Careless handling may cause toxic residues to infiltrate hospital environments and patient care areas, and can even be traced to patients’ homes. New government regulations will require healthcare organizations to minimize exposure risks to HCWs by fully implementing the U.S. Pharmacopeia (USP) Convention Chapter 800: Hazardous Drugs: Handling in Healthcare Settings (USP, 2016) on December 1, 2019. According to Polovich and Olsen (2017), “The implementation of the USP <800> Standards will represent …

The Associations Of Out-Of-Home Placement With Penile-Vaginal Intercourse, Age Of Sexual Debut And Pregnancy Among Child Welfare Involved Youth: A Cross-Sectional Study Using The National Survey Of Child And Adolescent Well-Being (Nscaw) Ii, Gabriela S. Betancourt

Dissertations and Theses

Background: Studies of youth in out-of-home (OOH) care and adults with histories of OOH placements have found evidence of poorer sexual and reproductive health (SRH) compared with their counterparts in the general population, including inconsistent use of male condoms and contraceptives, higher prevalence of adolescent pregnancy, and history of unwanted sexual debut. However, within the population of youth involved in child welfare, the effects of OOH placement on SRH have been difficult to establish. The overall goals of the current study were to compare SRH indicators (ever having penile–vaginal intercourse; early age of sexual debut; reported pregnancy) among youth involved …

Non-Communicable Diseases Among Adolescents: Current Status, Determinants, Interventions And Policies, N Akseer, S Mehta, J Wigle, R Chera, Z J. Brickman, S Al-Gashm, B Sorichetti, A Vandermorris, D B. Hipgrave, N Schwalbe, Zulfiqar Ahmed Bhutta

Woman and Child Health

Background: Addressing non-communicable disease (NCDs) is a global priority in the Sustainable Development Goals, especially for adolescents. However, existing literature on NCD burden, risk factors and determinants, and effective interventions and policies for targeting these diseases in adolescents, is limited. This study develops an evidence-based conceptual framework, and highlights pathways between risk factors and interventions to NCD development during adolescence (ages 10-19 years) and continuing into adulthood. Additionally, the epidemiologic profile of key NCD risk factors and outcomes among adolescents and preventative NCD policies/laws/legislations are examined, and a multivariable analysis is conducted to explore the determinants of NCDs among adolescents …

Large-Scale Characterization Of Drug Responses Of Clinically Relevant Proteins In Cancer Cell Lines, Wei Zhao, Jun Li, Mei-Ju M Chen, Yikai Luo, Zhenlin Ju, Nicole K Nesser, Katie Johnson-Camacho, Christopher T Boniface, Yancey Lawrence, Nupur T Pande, Michael A Davies, Meenhard Herlyn, Taru Muranen, Ioannis K Zervantonakis, Erika Von Euw, Andre Schultz, Shwetha V Kumar, Anil Korkut, Paul T Spellman, Rehan Akbani, Dennis J Slamon, Joe W Gray, Joan S Brugge, Yiling Lu, Gordon B Mills, Han Liang

Faculty, Staff and Students Publications

Perturbation biology is a powerful approach to modeling quantitative cellular behaviors and understanding detailed disease mechanisms. However, large-scale protein response resources of cancer cell lines to perturbations are not available, resulting in a critical knowledge gap. Here we generated and compiled perturbed expression profiles of ∼210 clinically relevant proteins in >12,000 cancer cell line samples in response to ∼170 drug compounds using reverse-phase protein arrays. We show that integrating perturbed protein response signals provides mechanistic insights into drug resistance, increases the predictive power for drug sensitivity, and helps identify effective drug combinations. We build a systematic map of "protein-drug" connectivity …

Hepatitis C Virus Care Cascade In Persons Experiencing Homelessness In The United States In The Era Of Direct-Acting Antiviral Agents: A Scoping Review, Aubrey Del Rosario

Biomedical Sciences ETDs

Background: The Hepatitis C Virus (HCV) care cascade has been well characterized in the general United States population and other subpopulations. However, information is limited on care cascade outcomes in persons experiencing homelessness now that highly effective medications offer the potential for cure.

Objectives: The main objective of this study is to map the available evidence on HCV care cascade outcomes in homeless and marginally housed cohorts in the United States in the era of direct-acting antiviral agents. Primary and secondary outcomes of interest include linkage to care and sustained virologic response. Exploratory outcomes include other care cascade …

Improved Tolerability And Efficaciousness Of Miralax-Gatorade When Compared To Golytely In The Outpatient Setting, Bassem Farah

Clinical Research in Practice: The Journal of Team Hippocrates

A clinical decision report using Gu P, Lew D, Jung OS, et al. Comparing the Real-World Effectiveness of Competing Colonoscopy Preparations: Results of a Prospective Trial. Am J Gastroenterol. 2019;114(2):305-314. https://doi.org/10.14309/ajg.0000000000000057 for a patient reluctant to undergo colonoscopy screening due to concerns about GoLYTLEY's tolerability.

Social Determinants Of Discrimination And Access To Health Care Among Transgender Women In Oregon, Jonathan Garcia, Richard A. Crosby

Health, Behavior & Society Faculty Publications

Purpose: Transgender women in the United States experience health disparities and limited access to gender-affirming health services. This study describes the social determinants of health that shape access to health services for transgender women in Oregon, a state with a high tally of gender-affirming policies.

Methods: We conducted qualitative interviews with 25 transgender women between 18 and 39 years of age. Interviews explored the social, economic, cultural, and legal factors that shape access to health. A Qualtrics survey captured sociodemographic characteristics. We identified facilitators and barriers to accessing gender-affirming services using thematic analysis of qualitative data.

Results: Our participants perceived …

Valley Fever: Education For Primary Care Providers And Allied Health Care Professionals, Michelle Elizabeth Bergen

Doctor of Nursing Practice (DNP) Projects

Valley Fever: Educating Primary Care Providers and Allied Healthcare Professionals

Abstract

Problem: Coccidioidomycosis (cocci), informally Valley Fever (VF), infects the lungs with the fungal spore coccidioides. It is prevalent in areas where soil disturbance occurs. Currently, there are no related educational or standardized guidelines exist for primary care providers (PCPs) in California’s Central Valley, where VF is highly endemic (Centers for Disease Control and Prevention, 2018).

Context: A Doctor of Nursing Practice project educational program for PCPs and allied healthcare workers (AHWs) at the Adventist Health Central Valley Network (AHCVN) clinics. The project aimed to educate PCPs to …

Maternal Prenatal Cortisol Programs The Infant Hypothalamic–Pituitary–Adrenal Axis, Jessica L. Irwin, Amy L. Meyering, Gage Peterson, Laura M. Glynn, Curt A. Sandman, Laurel M. Hicks, Elysia Poggi Davis

Psychology Faculty Articles and Research

One of the key proposed agents of fetal programming is exposure to maternal glucocorticoids. Experimental animal studies provide evidence that prenatal exposure to elevated maternal glucocorticoids has consequences for hypothalamic–pituitary–adrenal (HPA) axis functioning in the offspring. There are very few direct tests of maternal glucocorticoids, such as cortisol, during human pregnancy and associations with infant cortisol reactivity. The current study examined the link between maternal prenatal cortisol trajectories and infant cortisol reactivity to the pain of inoculation in a sample of 152 mother-infant (47.4% girls) pairs. The results from the current study provide insight into fetal programming of the infant …

Knowledge, Attitudes And Practices Towards Covid-19 Among Pakistani Residents: Information Access And Low Literacy Vulnerabilities, Zafar Fatmi, Shafaq Mahmood, Waqas Hameed, Ibtisam Qazi, Muhammad Siddiqui, Anny Dhanwani, Sameen Siddiqi

Community Health Sciences

Background: Coronavirus disease (COVID-19) has accentuated the need for speedy access to information. Digital divide and socio-demographic disparity create an information hiatus and therefore unhealthy practices with regard to dealing with COVID-19, particularly in low- and middle-income countries.
Aims: We assessed knowledge, attitudes, practices and their determinants regarding COVID-19 in Pakistan during March-April 2020.
Methods: 905 adults ≥18 years (males and females) participated: 403 from a web-based survey; 365 from an urban survey; and 137 from a rural survey. Frequency of adequate knowledge, attitudes and practices for the three populations was determined based on available global guidelines. Multivariable logistic regression …

Global Burden Of Cardiovascular Diseases And Risk Factors, 1990-2019: Update From The Gbd 2019 Study, Gregory A. Roth, Veincent Christian F. Pepito, Gbd-Nhlbi-Jacc Global Burden Of Cardiovascular Diseases Writing Group, 608 Co-Authors

Ateneo School of Medicine and Public Health Publications

Cardiovascular diseases (CVDs), principally ischemic heart disease (IHD) and stroke, are the leading cause of global mortality and a major contributor to disability. This paper reviews the magnitude of total CVD burden, including 13 underlying causes of cardiovascular death and 9 related risk factors, using estimates from the Global Burden of Disease (GBD) Study 2019. GBD, an ongoing multinational collaboration to provide comparable and consistent estimates of population health over time, used all available population-level data sources on incidence, prevalence, case fatality, mortality, and health risks to produce estimates for 204 countries and territories from 1990 to 2019.

Prevalent cases …

High School Students As Citizen Scientists To Decrease Radon Exposure, Ellen J. Hahn, Craig Wilmhoff, Mary Kay Rayens, Nicholas B. Conley, Emily Morris, Angela Larck, Trista Allen, Susan M. Pinney

Nursing Faculty Publications

Residents in rural Kentucky (KY) and suburban Ohio (OH) expressed concerns about radon exposure and lung cancer. Although 85% of lung cancer cases are caused by tobacco smoke, radon exposure accounts for 10–15% of lung cancer cases. Academic and community members from the University of KY and the University of Cincinnati developed and pilot-tested a family-centered, youth-engaged home radon testing toolkit. The radon toolkit included radon information, and how to test, interpret, and report back findings. We educated youth as citizen scientists and their teachers in human subjects protection and home radon testing using the toolkit in the classroom. Youth …

Implementation Of The University Of Louisville Covid-19 Biorepository: Experiences From The Center Of Excellence In Infectious Diseases (Cerid), Dawn Balcom, Leslie A Wolf, Subathra Marimuthu, William Johnson, Danial Malik, Chet Dhakal, Pavani Nathala, Mohammed Abbas, Sahaj Hardeep Singh, Basel Haddad, Rafik Elbeblawy, Fnu Deepti, Ahmed Ali, Evelyn Exposito Gonzalez, Ruth Carrico

The University of Louisville Journal of Respiratory Infections

The limited availability of biological samples from patients testing positive for SARS-CoV-2 for future research was quickly identified at the onset of the COVID-19 pandemic. In response to this need, a COVID-19 biobank was initiated by the University of Louisville Division of Infectious Diseases, Center of Excellence for Research in Infectious Diseases (CERID). The COVID-19 biobank contains waste samples obtained from patients hospitalized with COVID-19 in any of the nine Louisville, Kentucky, area hospitals during the timeframe of April 13 to September 20, 2020. The COVID-19 biobank stores approximately 1,623 waste samples with 2,127 aliquots for distribution. All samples are …

Impact Of Endangered Animal Protection Rights, Policies, And Practices On Zoonotic Disease Spread, Daniella Fedak-Lengel

Honors Projects

Building on field research in Costa Rica and Belize, this honors project analyzes environmental and endangered animal protection policies, rights, and practices in Central America and the Caribbean, and assesses the impact of veterinary science and biological research and practice, particularly conservation biology, on animal welfare concerns. Informed by the recent surge in awareness regarding zoonoses and zoonotic disease transmission, prevention and control, resulting from the current global pandemic of SARS-CoV-2, the project assesses the need for new and innovative types of collaboration, particularly involving conservation biologists, environmental scientists, public health experts, law and policy makers, and global trade and …

Physicochemical Characterization And Genotoxicity Of The Broad Class Of Carbon Nanotubes And Nanofibers Used Or Produced In Us Facilities, Kelly Fraser, Vamsi Kodali, Naveena Yanamala, M. Eileen Birch, Lorenzo Cena, Gary Casuccio, Kristin Bunker, Traci L. Lersch, Douglas E. Evans, Aleksandr Stefaniak, Mary Ann Hammer, Michael L. Kashon, Theresa Boots, Tracy Eye, John Hubczak, Sherri A. Friend, Matthew Dahm, Mary K. Schubauer-Berigan, Katelyn Siegrist, David Lowry, Alison K. Bauer, Linda M. Sargent, Aaron Erdely

Public Health Sciences Faculty Publications

Background Carbon nanotubes and nanofibers (CNT/F) have known toxicity but simultaneous comparative studies of the broad material class, especially those with a larger diameter, with computational analyses linking toxicity to their fundamental material characteristics was lacking. It was unclear if all CNT/F confer similar toxicity, in particular, genotoxicity. Nine CNT/F (MW #1-7 and CNF #1-2), commonly found in exposure assessment studies of U.S. facilities, were evaluated with reported diameters ranging from 6 to 150 nm. All materials were extensively characterized to include distributions of physical dimensions and prevalence of bundled agglomerates. Human bronchial epithelial cells were exposed to the nine …

Effect Of Intrauterine Smoke Exposure On Microrna-15a Expression In Human Lung Development And Subsequent Asthma Risk., Sunita Sharma, Alvin T. Kho, Divya Chhabra, Kathleen Haley, Carrie A. Vyhlidal, R Gaedigk, J Steven Leeder, Kelan G. Tantisira, Benjamin Raby, Scott T. Weiss

Manuscripts, Articles, Book Chapters and Other Papers

Background: In utero smoke (IUS) exposure is associated with asthma susceptibility.

Objective: We sought to test the hypothesis that changes in miRNA expression by IUS exposure during human lung development is associated with asthma susceptibility.

Methods: Gene expression was profiled from 53 IUS unexposed and 51 IUS exposed human fetal lung tissues. We tested for the differential expression of miRNAs across post-conception age and by IUS using linear models with covariate adjustment. We tested the IUS-associated miRNAs for association with their gene expression targets using pair-wise inverse correlation. Using our mouse model, we investigated the persistence of the IUS-associated miRNA …

An Artificial Intelligence-Based, Personalized Smartphone App To Improve Childhood Immunization Coverage And Timelines Among Children In Pakistan: Protocol For A Randomized Controlled Trial, Abdul Momin Kazi, Saad Ahmed Qazi, Sadori Khawaja, Nazia Ahsan, Rao Moueed Ahmed, Muhammad Ayub Khan Mughal, Hussain Kalimuddin, Yasir Rauf, Mehreen Raza, Saima Jamal

Department of Paediatrics and Child Health

Background: The immunization uptake rates in Pakistan are much lower than desired. Major reasons include lack of awareness, parental forgetfulness regarding schedules, and misinformation regarding vaccines. In light of the COVID-19 pandemic and distancing measures, routine childhood immunization (RCI) coverage has been adversely affected, as caregivers avoid tertiary care hospitals or primary health centers. Innovative and cost-effective measures must be taken to understand and deal with the issue of low immunization rates. However, only a few smartphone-based interventions have been carried out in low- and middle-income countries (LMICs) to improve RCI.
Objective: The primary objectives of this study are to …

Aligning Food Environments With Institutional Values: A Mixed Methods Study Of Oregon Health Care Organizations, Elizaveta Walker

Dissertations and Theses

A major driver of the obesity epidemic is obesogenic food environments, characterized by nutrient-poor and energy-dense foods that saturate the collective physical, economic and sociocultural conditions that influence nutritional status. Food environments in organizations such as hospitals and public health agencies warrant special consideration given their health-focused mission. Improving food environments within health care settings has been highlighted by the Centers for Disease Control and Prevention (CDC) as one of seven key strategies to prevent obesity. However, most of the refereed literature examining healthy food environment policies (HFEPs) within hospitals focuses on the inpatient dietary environment, leaving a paucity of …

Lc-Ms/Ms Quantification Of Nevirapine And Its Metabolites In Hair For Assessing Long-Term Adherence, Haoran Yang, Liuxi Chu, Yan Wu, Wei Wang, Jin Yang, Quan Zhang, Shan Qiao Ph.D., Xiaoming Li Ph. D., Zhiyong Shen, Yuejiao Zhou, Shuaifeng Liu, Huihua Deng

Faculty Publications

The adherence assessment based on the combination of nevirapine (NVP) and its two metabolites (2-hydroxynevirapine and 3-hydroxynevirapine) would more comprehensively and accurately reflect long-term adherence than that of a single prototype. This study aimed to develop a specific, sensitive and selective method for simultaneous detection of the three compounds in hair and explore whether there was consistency among the three compounds in assessing long-term adherence. Furthermore, 75 HIV-positive patients who were taking the NVP drug were randomly recruited and divided into two groups (high-and low-adherence group). All participants self-reported their days of oral drug administration per month and provided their …

Smart Homes For Smart Health: Developing An Interactive System To Reduce In-Home Secondhand Smoke, Christie Kika, Janice Han, Vincent Berardi

Student Scholar Symposium Abstracts and Posters

Smoke from any source is potentially harmful because it contains fine particulate matter that is associated with acute and chronic conditions. Second-hand smoke (SHS) is particularly unsafe for children due to biological characteristics (higher breathing rates, immature lungs and underdeveloped immune systems) that make it difficult to filter toxins.To address this concern, we recently completed Project Fresh Air (PFA), an NIH-funded R01 intervention that installed air particle sensors in the households of tobacco smokers who lived with children. The purpose of our research is to investigate and develop efficient smart home devices that monitor SHS in various living spaces to …

Birth Interval And Childhood Undernutrition: Evidence From A Large Scale Survey In India, Holendro Singh Chungkham, Harihar Sahoo, Strong P. Marbaniang

ISI Best Publications

Background: The study of birth interval is important for maternal and child health. The long birth interval is favorable for maternal, child health, and nutritional outcomes. The present study is an attempt to explore the relationship between birth intervals and poor nutritional condition of children under five years of age in India. Methods: The unit of analysis is children under five years of age in India. The data come from the fourth round of Indian National Family Health Survey, 2015–2016. Bivariate and logistic regression model were used to explore the relationship between birth intervals and the poor nutritional status of …

How Museum Utilize Social Media On Communication, Jiake Han

School of Professional Studies

With the development of Internet, social media became more and more popular among people. Many industries realize the importance of social media in business. Traditionally, museum concentrates more on personal visual experience, which is hard to be replaced by online media. However, museums now also put more concentrate on social media platform because it expands the way of engagement. Especially, for Coronavirus, many organizations including museums have to close. Therefore, museums have to depend more on social media platforms to communicate with audiences. This research aims at finding how different kind of social media help museum communicate and engage with …

Respiratory Illness And Household Air Pollution: Problem Identification And Intervention, Hannah Flournoy

The Eleanor Mann School of Nursing Undergraduate Honors Theses

This study is an expanded literature review that identifies the key concepts of Household Air Pollution (HAP) and the relationship it has with respiratory illness. This study identifies twenty research studies that inspect HAP and respiratory symptoms across a number of communities that utilize biomass fuel as their primary fuel source. It seeks to identify the problems that come with HAP, such as childhood respiratory infection, COPD, and other respiratory illnesses. This review seeks to identify if people in low to middle income countries, who utilize biomass fuel sources, see and improved respiratory outcome from using modern cookstoves and other …

International Tourism As A Threat To Public Health In Thailand, Liam G. Lane

Binghamton University Undergraduate Journal

From its unique history, Thailand has embraced its independence and benefited from its cultural and natural beauty. Transitioning from an agricultural to industrial economy due to the emergence of a strong tourism industry, Thailand has experienced a period of intensive urbanization that has re-shaped Thai lifestyle. Materializing as regional and social disparities, these consequences of industrialization have seemingly divided Thai society, separating those who benefit from the tourism sector while marginalizing those who do not. Additionally, this transition has threatened public health statuses within Thailand, and considering the current tourism trends seen over the past 20 years there is a …

Characterizing The Unmet Hiv Prevention Needs And Hiv Risk Vulnerabilities Of Adolescent Girls And Young Women In Ethiopia, Carly A. Comins, Sheree Schwartz, Stefan Baral, Andargachew Mulu

HIV and AIDS

Although the disparity in HIV prevalence among young women and their male counterparts is not new, there is increasing recognition that addressing the unmet HIV prevention needs among AGYW is necessary to achieve epidemic control. In Ethiopia, data characterizing unmet HIV prevention needs and HIV risk vulnerabilities among AGYW, particularly out of school AGYW, have been limited. Armauer Hansen Research Institute and Johns Hopkins Bloomberg School of Public Health through Project SOAR conducted an integrated HIV biobehavioral survey (IBBS) focused on out-of-school adolescent girls and young women (AGYW) aged 15–24 years to assess AGYW HIV risk vulnerability. The purpose of …

Public Health State Of Emergency: Executive Order By The Governor Declaring A Public Health State Of Emergency, Rebecca Hu, Ellen Y. Min

Georgia State University Law Review

The Executive Order primarily functions to enumerate the Governor’s emergency powers during a Public Health State of Emergency. The Executive Order allows for the Governor to assist health and emergency management officials by deploying available resources for the mitigation and treatment of COVID-19 within Georgia.

The Link Between Heart Disease In Low Socioeconomic Communities In America, Khristopher Chea

Nursing | Senior Theses

As a future medical professional in the healthcare field, we continue to see patients admitted for cardiovascular issues. Cardiovascular diseases (CVDs) remain the leading cause of mortality among adults living in the U.S. despite advances in treatment throughout the past century. A number of risk factors such as hypertension, obesity, smoking, and physical inactivity contribute to the significant rise of cardiovascular disease. Research data suggests that there is correlation between cardiovascular disease, low socioeconomic status, and diet. According to the American Phycological Association socioeconomic status is measured by income, educational status, and occupation, and has been shown to be closely …

Multiomics Characterization Of Preterm Birth In Low- And Middle-Income Countries, Fyezah Jehan, Muhammad Imran Nisar, Muhammad Ilyas, Usma Mehmood, Aneeta Hotwani, Ambreen Nizar, Sajid Muhammad, Waqasuddin Khan, Javairia Khalid, Furqan Kabir

Department of Paediatrics and Child Health

Importance: Worldwide, preterm birth (PTB) is the single largest cause of deaths in the perinatal and neonatal period and is associated with increased morbidity in young children. The cause of PTB is multifactorial, and the development of generalizable biological models may enable early detection and guide therapeutic studies.
Objective: To investigate the ability of transcriptomics and proteomics profiling of plasma and metabolomics analysis of urine to identify early biological measurements associated with PTB.
Design, setting, and participants: This diagnostic/prognostic study analyzed plasma and urine samples collected from May 2014 to June 2017 from pregnant women in 5 biorepository cohorts in …

Improving Health Care Accessibility Among Geriatric Patients In Rural Communities, Capriana Calvachi

Honors Projects

The following literature review and analysis compiles information regarding ways to improve rural geriatric healthcare accessibility through the use of interprofessional care and outreach. I also wish to bring to light the various deficiencies often seen in this realm of care, and the reasons behind the inadequate rural physician retention rates. Using this background information, I compiled various collaborative approaches which seek to ease the strain faced by the healthcare system and its elderly patients.

Improving healthcare accessibility through the use of interprofessional care and outreach is an essential facet in geriatric medicine. By exploring the deficiencies of geriactric healthcare …

Characterization Of Age-Associated Copd Progression In The Copd Gene Cohort, Lauryn A. Winter

Dissertations and Theses (Open Access)

Chronic obstructive pulmonary disease (COPD) is a progressive and debilitating lung disease affecting primarily older adults. Incidence, morbidity and mortality from COPD are increasing worldwide. The purpose of this study was to determine the associations between age at baseline and markers of disease progression in COPD patients using data generated by the Genetic Epidemiology of COPD (COPD Gene) study. Participants with COPD were stratified by age (younger: age <65 years, elderly: age ≥ 65 years) and disease characteristics (lung function, exercise tolerance, exacerbation history, and comorbidity burden) at baseline and five-year follow up were compared between groups. Associations between age group and changes in these measures were also assessed. Disease characteristics differed significantly between elderly and younger COPD patients at both study visits. Elderly COPD patients had worse lung function and more comorbidities than younger COPD patients, while younger COPD patients reported more dyspnea and more frequent and severe exacerbations than elderly COPD patients. Following covariate adjustment, elderly participants were less likely than younger participants to develop new frequent exacerbations over the study period (relative risk ratio (95% confidence interval): 0.42 (0.20, 0.87)). There were no other significant associations between age group and markers of disease progression. These results suggest that although elderly COPD patients exhibit evidence of more severe lung function impairment than younger COPD patients, the rate of disease progression is similar between elderly and younger patients. However, further exploration is needed to understand the possible contribution of survivorship bias to this finding. Nevertheless, this study supports the importance of early detection and early intervention to slow disease progression and maximize both life expectancy and quality of life for COPD patients.