Medicine and Health Sciences Commons^™

Letter To Editor Regarding The Ocean Study, Barbara P. Yawn, Barry Make, David M. Mannino, Fernando J. Martinez, Meilan K. Han

Preventive Medicine and Environmental Health Faculty Publications

No abstract provided.

Gold In Practice: Chronic Obstructive Pulmonary Disease Treatment And Management In The Primary Care Setting, Barbara P. Yawn, Matthew L. Mintz, Dennis E. Doherty

Internal Medicine Faculty Publications

Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality. Early detection and appropriate treatment and management of COPD can lower morbidity and perhaps mortality. Clinicians in the primary care setting provide the majority of COPD care and are pivotal in the diagnosis and management of COPD. In this review, we provide an overview of the Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2020 report, with a focus on the management of COPD in the primary care setting. We discuss the pathophysiology of COPD; describe COPD risk factors, signs, and symptoms that may facilitate earlier diagnosis …

The Effect Of Provider Education On Copd Screening Rates In The Primary Care Setting, Kelli Craig

DNP Projects

BACKGROUND: Chronic Obstructive Pulmonary Disease is one of the leading causes of morbidity and mortality in the United States. With early detection, COPD is a treatable disease, highlighting the need for an effective screening measure. The COPD Population Screener Questionnaire (COPD-PS) is a valid, accurate questionnaire that can identify individuals likely to have COPD.

PURPOSE: The purpose of this study was to evaluate the impact of a provider-based educational intervention on the knowledge, attitudes, self-efficacy and screening rates of COPD using the COPD-PS screening tool among primary care providers.

METHODS: This study was a single-center, pre/post implementation study to evaluate …

Can Capture Be Used To Identify Undiagnosed Patients With Mild-To-Moderate Copd Likely To Benefit From Treatment?, Nancy K. Leidy, Fernando J. Martinez, Karen G. Malley, David M. Mannino, Meilan K. Han, Elizabeth D. Bacci, Randall W. Brown, Julia F. Houfek, Wassim W. Labaki, Barry J. Make, Catherine A. Meldrum, Wilson Quezada, Stephen Rennard, Byron Thomashow, Barbara P. Yawn

Preventive Medicine and Environmental Health Faculty Publications

Background: COPD Assessment in Primary Care To Identify Undiagnosed Respiratory Disease and Exacerbation Risk (CAPTURE™) uses five questions and peak expiratory flow (PEF) thresholds (males ≤350 L/min; females ≤250 L/min) to identify patients with a forced expiratory volume in 1 second (FEV₁)/forced vital capacity (FVC)11 60%–80% predicted) who may also benefit from diagnosis and treatment.

Methods: Data from the CAPTURE development study were used to test its sensitivity (SN) and specificity (SP) differentiating mild-to-moderate COPD (n=73) from no COPD (n=87). SN and SP for differentiating all COPD cases (mild to severe; n=259) from those without COPD (n=87) were …

Retrospective Analysis To Describe Associations Between Tumor Necrosis Factor Alpha Inhibitors And Copd-Related Hospitalizations, Neil A. Accortt, James B. Chung, Machaon Bonafede, Brendan L. Limone, David M. Mannino

Preventive Medicine and Environmental Health Faculty Publications

Background: Limited information exists on the impact of tumor necrosis factor inhibition on COPD exacerbations. This retrospective study characterized this impact among COPD patients with underlying autoimmune conditions, exposed to tumor necrosis factor inhibitors (TNFi) and/or non-biologic disease-modifying antirheumatic drugs (DMARDs).
Patients and methods: Adult COPD patients with ≥1 diagnosis for rheumatoid arthritis (RA), psoriasis (PsO), psoriatic arthritis (PsA), or ankylosing spondylitis (AS) before or within 6 months following the index COPD diagnosis were identified from the Truven Health MarketScan^® databases. Patients were required to have a second claim for RA, PsO, PsA, AS, or DMARD use (biologic or …

Defining And Targeting Health Disparities In Chronic Obstructive Pulmonary Disease, Roy A. Pleasants, Isaretta L. Riley, David M. Mannino

Preventive Medicine and Environmental Health Faculty Publications

The global burden of chronic obstructive pulmonary disease (COPD) continues to grow in part due to better outcomes in other major diseases and in part because a substantial portion of the worldwide population continues to be exposed to inhalant toxins. However, a disproportionate burden of COPD occurs in people of low socioeconomic status (SES) due to differences in health behaviors, sociopolitical factors, and social and structural environmental exposures. Tobacco use, occupations with exposure to inhalant toxins, and indoor biomass fuel (BF) exposure are more common in low SES populations. Not only does SES affect the risk of developing COPD and …

Impact Of Lung Function On Exacerbations, Health Care Utilization, And Costs Among Patients With Copd, Xuehua Ke, Jessica Marvel, Tzy-Chyi Yu, Debra Wertz, Caroline Geremakis, Liya Wang, Judith J. Stephenson, David M. Mannino

Preventive Medicine and Environmental Health Faculty Publications

Objective: To evaluate the impact of lung function, measured as forced expiratory volume in 1 second (FEV₁) % predicted, on health care resource utilization and costs among patients with COPD in a real-world US managed-care population.

Methods: This observational retrospective cohort study utilized administrative claim data augmented with medical record data. The study population consisted of patients with one or more medical claims for pre- and postbronchodilator spirometry during the intake period (July 1, 2012 to June 30, 2013). The index date was the date of the earliest medical claim for pre- and postbronchodilator spirometry. Spirometry results were …

Development Of The Chronic Obstructive Pulmonary Disease Morning Symptom Diary (Copd-Msd), Gary Globe, Brooke Currie, Nancy Kline Leidy, Paul Jones, David M. Mannino, Fernando Martinez, Paul Klekotka, Sean O'Quinn, Niklas Karlsson, Ingela Wiklund

Preventive Medicine and Environmental Health Faculty Publications

Background: The morning tends to be the most difficult time of day for many patients with chronic obstructive pulmonary disease (COPD) when symptoms can limit one’s ability to perform even simple activities. Morning symptoms have been linked to higher levels of work absenteeism, thereby increasing the already substantial economic burden associated with COPD. A validated patient-reported outcome (PRO) instrument designed to capture morning symptoms will allow for a more comprehensive approach to the evaluation of treatment benefit in COPD clinical trials.

Methods: A qualitative interview study was conducted among a sample of symptomatic adults with COPD. Concept elicitation interviews ( …

Development Of A Spirometry T-Score In The General Population, Sei Won Lee, Hyun Kuk Kim, Seunghee Baek, Ji-Ye Jung, Young Sam Kim, Jae Seung Lee, Sang-Do Lee, David M. Mannino, Yeon-Mok Oh

Preventive Medicine and Environmental Health Faculty Publications

Background and objective: Spirometry values may be expressed as T-scores in standard deviation units relative to a reference in a young, normal population as an analogy to the T-score for bone mineral density. This study was performed to develop the spirometry T-score.

Methods: T-scores were calculated from lambda-mu-sigma-derived Z-scores using a young, normal age reference. Three outcomes of all-cause death, respiratory death, and COPD death were evaluated in 9,101 US subjects followed for 10 years; an outcome of COPD-related health care utilization (COPD utilization) was evaluated in 1,894 Korean subjects followed for 4 years.

Results: The …

Baseline Of Copd Management In A Norton Healthcare Primary Care Clinic, Angela Goldring

DNP Projects

Background: Chronic obstructive pulmonary disease (COPD) is a leading cause of death in the United States (U.S), with rates in Kentucky among the highest in the nation. Quality care in the primary care setting is key to optimizing the health outcomes of those with COPD.

Purpose: The objective of this study was to establish a baseline of COPD patient care in a primary care clinic. The specific aims of this study were to: 1) describe the demographic and health-related characteristics of patients with COPD who have a primary care provider (PCP) at one Norton Healthcare primary care clinic; 2) …

Copd Surveillance-United States, 1999-2011, Earl S. Ford, Janet B. Croft, David M. Mannino, Anne G. Wheaton, Xingyou Zhang, Wayne H. Giles

David M. Mannino

This report updates surveillance results for COPD in the United States. For 1999 to 2011, data from national data systems for adults aged ≥ 25 years were analyzed. In 2011, 6.5% of adults (approximately 13.7 million) reported having been diagnosed with COPD. From 1999 to 2011, the overall age-adjusted prevalence of having been diagnosed with COPD declined (P = .019). In 2010, there were 10.3 million (494.8 per 10,000) physician office visits, 1.5 million (72.0 per 10,000) ED visits, and 699,000 (32.2 per 10,000) hospital discharges for COPD. From 1999 to 2010, no significant overall trends were noted for physician …

Elevated Cardiovascular Risk Among Adults With Obstructive And Restrictive Airway Functioning In The United States: A Cross-Sectional Study Of The National Health And Nutrition Examination Survey From 2007 - 2010, Earl S. Ford, Ann G. Wheaton, David M. Mannino, Latitia Presley-Cantrell, Chaoyang Li, Janet B. Croft

David M. Mannino

Background

Reasons for the excess risk for cardiovascular disease among people with chronic obstructive pulmonary disease remain unclear. Our objective was to examine the cardiovascular risk profile for adults with obstructive and restrictive impairments of lung functioning in a representative sample of adults from the United States.

Methods

We used data from adults aged 20–79 years who participated in the National Health and Nutrition Examination Survey from 2007 to 2010 and had a pulmonary function test. The severity of obstructive impairment was defined by adapting the Global Initiative for Chronic Obstructive Lung Disease criteria.

Results

Among 7249 participants, 80.9% had …

Occupational Chronic Obstructive Pulmonary Disease: An Update, Enrique Diaz-Guzman, David M. Mannino, Shambhu Aryal

David M. Mannino

Chronic obstructive pulmonary disease represents a major cause of morbidity and mortality in industrialized and nonindustrialized countries. Although tobacco use remains the main factor associated with development of the disease, occupational risk factors represent an important and preventable cause. The most common occupationally related factors include exposure to organic dusts, metallic fumes, and a variety of other mineral gases and/or vapors. This article summarizes the literature on the subject and provides an update of the most recent advances in the field.

Epidemiology Of Comorbidities In Chronic Obstructive Pulmonary Disease: Clusters, Phenotypes And Outcomes, Shambhu Aryal, Enrique Diaz-Guzman, David M. Mannino

David M. Mannino

COPD is a complex multisystem disease often accompanied by multiple co-morbidities that contribute to symptoms, exacerbations, hospital admissions and mortality. Individual comorbidities can be grouped into clusters of common human pathology: inflammation/immune response (e.g., ischemic heart disease, metabolic syndrome), thrombosis/hemorrhage (e.g., cerebrovascular diseases, pulmonary embolism), fibrosis/cell proliferation (e.g., lung cancer and other malignancies) and apoptosis/necrosis (e.g., osteoporosis, skeletal muscle dysfunction). While the prevalence of the co-morbidities has been described in a number of observational studies, there is considerable variability in results; moreover characterization of cluster of co-morbidities with the most clinical significance in terms of morbidity and mortality is still …

Blood Fibrinogen As A Biomarker Of Chronic Obstructive Pulmonary Disease, Annelyse Duvoix, Jenny Dickens, Imran Haq, David M. Mannino, Bruce Miller, Ruth Tal-Singer, David A. Lomas

David M. Mannino

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a multicomponent condition that is characterised by airflow obstruction that is not fully reversible and is a major global cause of morbidity and mortality. The most widely used marker of disease severity and progression is FEV(1). However, FEV(1) correlates poorly with both symptoms and other measures of disease progression and thus there is an urgent need for other biological markers to better characterise individuals with COPD. Fibrinogen is an acute phase plasma protein that has emerged as a promising biomarker in COPD. Here we review the current clinical evidence linking fibrinogen with COPD …

Fibrinogen, Copd And Mortality In A Nationally Representative U.S. Cohort, David M. Mannino, Deepa Valvi, Hana Mullerova, Ruth Tal-Singer

David M. Mannino

BACKGROUND:

Fibrinogen is a marker of systemic inflammation and may represent an important biomarker for the progression of chronic obstructive pulmonary disease (COPD).

METHODS:

We used baseline data from the Third National Health and Nutrition Examination Survey (NHANES III) and follow-up mortality data to determine the relation between fibrinogen levels and COPD and to examine how fibrinogen levels at baseline affected long-term outcomes. Elevated fibrinogen was defined as the upper 10% of the fibrinogen level distribution.

RESULTS:

Our study sample included 8,507 subjects, including 245 with Stage 3 or 4 COPD and 826 with Stage 2 COPD. Then, 3,290 of …

Fibrinogen, Chronic Obstructive Pulmonary Disease (Copd) And Outcomes In Two United States Cohorts, Deepa Valvi, David M. Mannino, Hana Mullerova, Ruth Tal-Singer

David M. Mannino

Background

Fibrinogen is a marker of systemic inflammation and may be important in the pathogenesis and progression of chronic obstructive pulmonary disease (COPD).

Methods

We used baseline data from Atherosclerosis Risk in Communities and Cardiovascular Health Studies to determine the relation between fibrinogen levels and COPD and to examine how fibrinogen levels at baseline affected outcomes of death, development of COPD, lung function decline, and COPD-hospitalizations.

Results

Our study sample included 20,192 subjects, of whom 2995 died during the follow-up period. The mean fibrinogen level was 307.6 mg/dL and 10% of the sample had levels >393.0 mg/dL. Subjects with Stage …

Pre- And Post-Bronchodilator Lung Function As Predictors Of Mortality In The Lung Health Study, David M. Mannino, Enrique Diaz-Guzman, Sonia Buist

David M. Mannino

Background

Chronic obstructive pulmonary disease (COPD) is supposed to be classified on the basis of post-bronchodilator lung function. Most longitudinal studies of COPD, though, do not have post-bronchodilator lung function available. We used pre-and post bronchodilator lung function data from the Lung Health Study to determine whether these measures differ in their ability to predict mortality.

Methods

We limited our analysis to subjects who were of black or white race, on whom we had complete data, and who participated at either the 1 year or the 5 year follow-up visit. We classified subjects based on their baseline lung function, according …

Copd In Never Smokers: Results From The Population-Based Burden Of Obstructive Lung Disease Study, Bernd Lamprecht, Mary Ann Mcburnie, William M. Vollmer, Gunnar Gudmundsson, Tobias Welte, Ewa Nizankowska-Mogilnicka, Michael Studnicka, Eric Bateman, Josep M. Anto, Peter Burney, David M. Mannino, Sonia A. Buist

David M. Mannino

Background: Never smokers comprise a substantial proportion of patients with COPD. Their characteristics and possible risk factors in this population are not yet well defined.

Methods: We analyzed data from 14 countries that participated in the international, population-based Burden of Obstructive Lung Disease (BOLD) study. Participants were aged ≥ 40 years and completed postbronchodilator spirometry testing plus questionnaires about respiratory symptoms, health status, and exposure to COPD risk factors. A diagnosis of COPD was based on the postbronchodilator FEV1/FVC ratio, according to current GOLD (Global Initiative for Obstructive Lung Disease) guidelines. In addition to this, the lower limit of normal …

Update On The Management Of Chronic Obstructive Pulmonary Disease, Andrea K. Maas, David M. Mannino

David M. Mannino

Chronic obstructive pulmonary disease is a highly prevalent, underdiagnosed, and undertreated chronic lung disease. Early and appropriate treatment may help modify the course of the disease with respect to exacerbation timing and frequency, quality of life, and mortality. Steady progress continues to be made in understanding the disease pathogenesis and treatment modalities, and there is some evidence that outcomes are improving.

Searching For Copd: Are Questionnaires The Answer?, David M. Mannino

David M. Mannino

Comment on

COPD screening in general practice using a telephone questionnaire. [COPD. 2010]

Get full access at http://informahealthcare.com/doi/abs/10.3109/15412555.2010.512510

Development Of The Lung Function Questionnaire (Lfq) To Identify Airflow Obstruction, Barbara P. Yawn, Douglas W. Mapel, David M. Mannino, Fernando J. Martinez, James F. Donohue, Nicola A. Hanania, Mark Kosinski, Regina Rendas-Baum, Matthew Mintz, Steven Samuels, Anand A. Dalal

David M. Mannino

Objective:

To describe the item-selection and item-reduction for the Lung Function Questionnaire (LFQ), being developed to help clinicians identify patients appropriate for diagnostic evaluation for chronic obstructive pulmonary disease (COPD) using spirometry.

Methods:

Item selection and reduction were based on information from 387 ≥40-year-old respondents to the third National Health and Nutrition Examination Survey who had self-reported chronic bronchitis. Item reduction involved stepwise logistic regression. The accuracy of the final subset of items for identifying individuals with airflow obstruction (forced expiratory volume in one second/forced vital capacity <0.70) versus those without it was assessed with receiver operating characteristic analysis. Content and face validity were assessed using focus groups of primary care physicians (n = 16) and interviews with COPD patients (n = 16).

Results:

The model with all five items (age; smoking history; the presence of …

Prevalence Of Copd Among Symptomatic Patients In A Primary Care Setting, Barbara Yawn, David M. Mannino, Thomas Littlejohn, Gary Ruoff, Amanda Emmett, Ibrahim Raphiou, Glenn Crater

David M. Mannino

Objective: Spirometry is recognized as the gold standard assessment for the diagnosis of COPD. However, spirometry continues to be underused, perpetuating the underdiagnosis of COPD. The aim of this study was to evaluate the prevalence of COPD in a primary care setting in patients with a smoking history and self-reported chronic bronchitis symptoms.

Research design and methods: This was a multi-center, cross-sectional study. The primary assessment was the percentage of patients with airway obstruction (post-bronchodilator FEV1/FVC ratio ≤ 0.70) compared to those without obstruction (post-bronchodilator FEV1/FVC ratio > 0.70).

Results: Airflow obstruction consistent with COPD was confirmed in 26% of patients …

Life Expectancy And Years Of Life Lost In Chronic Obstructive Pulmonary Disease: Findings From The Nhanes Iii Follow-Up Study, Robert M. Shavelle, David R. Paculdo, Scott J. Kush, David M. Mannino, David J. Strauss

David M. Mannino

Rationale

Previous studies have demonstrated that chronic obstructive pulmonary disease (COPD) causes increased mortality in the general population. But life expectancy and the years of life lost have not been reported.

Objectives

To quantify mortality, examine how it varies with age, sex, and other risk factors, and determine how life expectancy is affected.

Methods

We constructed mortality models using the Third National Health and Nutrition Examination Survey, adjusting for age, sex, race, and major medical conditions. We used these to compute life expectancy and the years of life lost.

Measurements and main results

Pulmonary function testing classified patients as having …

Obstructive Lung Disease Models: What Is Valid, Jill M. Ferdinands, David M. Mannino

David M. Mannino

Use of disease simulation models has led to scrutiny of model methods and demand for evidence that models credibly simulate health outcomes. We sought to describe recent obstructive lung disease simulation models and their validation. Medline and EMBASE were used to identify obstructive lung disease simulation models published from January 2000 to June 2006. Publications were reviewed to assess model attributes and four types of validation: first-order (verification/debugging), second-order (comparison with studies used in model development), third-order (comparison with studies not used in model development), and predictive validity. Six asthma and seven chronic obstructive pulmonary disease models were identified. Seven …

The Epidemiology And Economics Of Chronic Obstructive Pulmonary Disease, David M. Mannino, S. Braman

David M. Mannino

Chronic obstructive pulmonary disease (COPD) is a preventable and treatable disease responsible for a large human and economic burden around the world. Cigarette smoking is the main risk factor for COPD in the developed world, although other important risk factors include occupational exposures, air pollution, airway hyperresponsiveness, asthma, and genetic predisposition. In most of the world, COPD prevalence and mortality continue to rise in response to increases in smoking, particularly by women and adolescents. COPD is also an important cause of disability, and is linked to comorbid diseases, such as depression and cardiovascular disease, which adds to the large economic …

Changing The Burden Of Copd Mortality, David M. Mannino, Victor A. Kiri

David M. Mannino

COPD is a major cause of mortality and morbidity worldwide with an estimated 2.75 million deaths in 2000 (fourth leading cause of death). In addition to the considerable morbidity and mortality associated with COPD, this disease incurs significant healthcare and societal costs. Current COPD guidelines acknowledge that the following can improve COPD mortality: smoking cessation; long-term oxygen therapy; and lung volume reduction surgery in small subsets of COPD patients. To date, no randomized controlled trials have demonstrated an effect of pharmacological treatment on mortality, although several observational studies suggest that both long-acting bronchodilators and inhaled corticosteroids may provide a survival …

Cardiorespiratory Hospitalizations Associated With Smoke Exposure During The 1997, Southeast Asian Forest Fires, Joshua A. Mott, David M. Mannino, Clinton J. Alverson, Andrew Kiyu, Jamilah Hashim, Tzesan Lee, Kenneth Falter, Stephen C. Redd

David M. Mannino

We investigated the cardiorespiratory health effects of smoke exposure from the 1997 Southeast Asian Forest Fires among persons who were hospitalized in the region of Kuching, Malaysia. We selected admissions to seven hospitals in the Kuching region from a database of all hospital admissions in the state of Sarawak during January 1, 1995 and December 31, 1998. For several cardiorespiratory disease classifications we used Holt-Winters time-series analyses to determine whether the total number of monthly hospitalizations during the forest fire period (August 1 to October 31, 1997), or post-fire period (November 1, 1997 to December 31, 1997) exceeded forecasted estimates …

Sex Differences In Copd And Lung Cancer Mortality Trends—United States, 1968–1999, Neely Kazerouni, C. J. Alverson, Stephen C. Redd, Joshua A. Mott, David M. Mannino

David M. Mannino

Purpose: Cigarette smoking by U.S. women in the 1940s and 1950s caused large increases in smoking-related lung disease among women. To determine the magnitude of these increases, we compared the mortality trends for males and females in the United States for chronic obstructive pulmonary disease (COPD) and lung cancer for 1968-1999.

Methods: We used the national mortality data files compiled by the National Center for Health Statistics of the CDC and U.S. census data to calculate age-adjusted (2000) death rates for COPD, lung cancer, and all causes.

Results: COPD death rate for females increased by 382% from 1968 through 1999, …

Copd In The Never-Smoker, David M. Mannino, Kathryn Marie Mcgonigle

David M. Mannino

Objectives 1. Identify never-smokers as an important subset of the COPD population. 2. Discuss the relationship between asthma and COPD. 3. Understand the genetic components of COPD. 4. Identify occupational risk factors for COPD. 5. Discuss prevention methods for COPD in the never-smoker.