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For many nurses working in primary care, chronic obstructive pulmonary disease (COPD) is a familiar condition. From carrying out annual reviews to supporting people living with the symptoms of cough, phlegm, breathlessness and managing their effect on day-to-day living, most community nurses will have some experience of supporting people living with COPD. Increasingly, though, community nurses are having to consider comorbidities as part of the review, as for many people living with COPD, this will be just one of the long-term conditions they have already been diagnosed with or of which they will be at risk. In this article, the relationship between COPD and other long-term conditions will be highlighted, along with recommendatio how to identify and manage comorbidities in order to holistically optimise outcomes.ns about [ABSTRACT FROM AUTHOR]

Background: No short patient-reported outcome (PRO) instruments assess overall health status across different obstructive lung diseases. Thus, the wording of the introduction to the Chronic Obstructive Pulmonary Disease (COPD) Assessment Test (CAT) was modified to permit use in asthma and/or COPD. This tool is called the Chronic Airways Assessment Test (CAAT). Methods: The psychometric properties of the CAAT were evaluated using baseline data from the NOVELTY study (NCT02760329) in patients with physician-assigned asthma, asthma + COPD or COPD. Analyses included exploratory/confirmatory factor analyses, differential item functioning and analysis of construct validity. Responses to the CAAT and CAT were compared in patients with asthma + COPD and those with COPD. Results: CAAT items were internally consistent (Cronbach's alpha: > 0.7) within each diagnostic group (n = 510). Models for structural and measurement invariance were strong. Tests of differential item functioning showed small differences between asthma and COPD in individual items, but these were not consistent in direction and had minimal overall impact on the total score. The CAAT and CAT were highly consistent when assessed in all NOVELTY patients who completed both (N = 277, Pearson's correlation coefficient: 0.90). Like the CAT itself, CAAT scores correlated moderately (0.4–0.7) to strongly (> 0.7) with other PRO measures and weakly (< 0.4) with spirometry measures. Conclusions: CAAT scores appear to reflect the same health impairment across asthma and COPD, making the CAAT an appropriate PRO instrument for patients with asthma and/or COPD. Its brevity makes it suitable for use in clinical studies and routine clinical practice. Trial registration: NCT02760329. Plain language summary: Chronic Airways Assessment Test: a questionnaire adapted to assess overall health in asthma and/or COPD What is it about? Asthma and chronic obstructive pulmonary disease (COPD) can have a significant effect on a person's health and wellbeing. For people with these conditions, most of the health questionnaires available for use in patient care are designed for one specific diagnosis – either asthma (e.g. Asthma Control Test) or COPD (e.g. COPD Assessment Test [CAT]). A small number of questionnaires are available for use in both asthma and COPD, but these either take too long to complete, or do not focus on the overall health of patients. Since the symptoms in asthma and COPD overlap, a health questionnaire is needed for use in both asthma and COPD that can be completed during a routine visit to a doctor. This questionnaire could also help with research into the impact of lung diseases in people who have an unclear diagnosis. The CAT was changed so that people with asthma or COPD (or both) could use the same test. We named this new version the Chronic Airways Assessment Test (CAAT). Our goal was to determine whether CAAT scores meant the same level of health in people with asthma, COPD, or both conditions. The CAAT has eight questions, each scored 0 to 5, and takes only a few minutes to complete. The first three questions ask about the person's symptoms, including how often they cough and whether they have chest mucus or chest tightness. The remaining five questions ask how the person's asthma or COPD (or both) affects their daily life. These questions ask about shortness of breath, difficulties doing activities at home, confidence in leaving their home, whether they sleep soundly and how much energy they have. We found that the CAAT performed similarly in people with asthma or COPD (or both). This indicates that the CAAT score means a similar thing for someone with asthma, COPD or both conditions. Why is it important? The CAAT is a quick and simple way for patients to share with their doctor how bad their symptoms are and how much they affect their daily life. The development of the CAAT means that only one questionnaire is needed to measure the effect of a person's symptoms on their current level of health, whether they have asthma, COPD, or both. This will allow doctors to improve the level of care patients receive. [ABSTRACT FROM AUTHOR]

Objective: The majority of hospitalized patients with asthma or chronic obstructive pulmonary disease (COPD) misuse their inhalers. In a published program, "Nebs no More after 24," the authors found their program to be effective at reducing unnecessary nebulized treatments, increasing patient education, and decreasing costs. The objective of this study was to develop financial models, both internal to our hospital and more generalizable externally, of the cost impact of transitioning adults hospitalized with asthma or COPD to metered dose inhalers (MDIs) after 24 h of scheduled nebulized medications ("nebs"), when appropriate, to help hospitals make cost-efficient decisions for inhaled medications. Methods: "Internal" and "external" cost models were developed using number of patients, medication costs, and labor costs for nebulized medications and education for inhalers. Cost-savings were calculated by subtracting costs of nebulized-only cases from costs of nebulizer-plus-MDI cases. Estimates for staffing costs were obtained from the United States Bureau of Labor Statistics. Results: Cost-savings were estimated at $12,136 or $20,783 in the internal model and $8,927 or $14,283 in the external model when 50% or 80% of patients transitioned from nebs to MDIs, respectively. The marginal cost saving for every additional five new patients (∼1% of n = 552) transitioning to MDIs was estimated at $187.50. Models representing transitions from all-nebulized to nebulizer-plus-MDI respiratory medications resulted in cost savings, largely from the reduction of labor cost of nebulizer administration with nebs-only treatment. Therefore, transitioning from nebs to MDIs can lead to cost savings and could allow greater opportunities for inhaler education. [ABSTRACT FROM AUTHOR]

Background: Though, smoking is the leading cause of chronic obstructive pulmonary disease worldwide, the household air pollution due to use of solid biomass fuel is considered as a major risk factor for the development of obstructive lung disease. The aim of the study was to assess the effect of solid biomass fuel exposure on lung functions in non-smoking female population. Methods: A hospital based, descriptive cross sectional study was carried out among 140 non-smoking female patients aged 40 or more and who had been exposed to solid biomass fuel. These patients underwent spirometry to assess their lung function and were classified as obstructive, restrictive or mixed. Modified medical research council (mMRC) dyspnoea scale for symptom assessment, 6-minute walk test (6 MWT) to determine the exercise capacity and Cumulative exposure index to assess the duration of exposure were also done. Results: All 140 (100%) patients having abnormal lung function, 4 (2.86%) had restrictive pattern, 5 (3.57%) had mixed pattern and 131 (93.57%) had obstructive pattern. Of 131 patients having obstructive pattern, 11 had mild obstruction, 49 had moderate obstruction, 39 had severe obstruction and 32 had very severe obstruction. Most commonly used biomass fuel was wood (43.57%). All the patients had shortness of breath, whereas cough was present in only 35.71% cases. 77 (55%) patients presented with a dyspnoea of mMRC grade 3 and above. Conclusion: Cumulative exposure index for solid biomass fuel is directly proportional to the severity of lung impairment as well as the symptom severity. [ABSTRACT FROM AUTHOR]

Chronic obstructive pulmonary disease, COPD, exacerbations of chronic obstructive pulmonary disease, global initiative for chronic obstructive lung disease, forced spirometry, risk factors Expert Interview COPD Keywords: Keywords: Chronic obstructive pulmonary disease; COPD; exacerbations of chronic obstructive pulmonary disease; forced spirometry; global initiative for chronic obstructive lung disease; risk factors EN Chronic obstructive pulmonary disease COPD exacerbations of chronic obstructive pulmonary disease forced spirometry global initiative for chronic obstructive lung disease risk factors The definition of chronic obstructive pulmonary disease (COPD) hasrecently been reformulated better to encompass the heterogeneousnature of this lung condition.1 The new definition is broader, includesrisk factors other than smoking, and aims to improve the diagnosis,management and clinical trials of a disorder with high morbidity andmortality rates.1 In this expert interview, MeiLan K Han and Alvar Agustí discuss the GlobalInitiative for Chronic Obstructive Lung Disease (GOLD) 2023 executivereport, which proposes a new definition for COPD and covers the latestupdates in its diagnosis, management, and prevention.2 Q. Could you please give us a brief overview ofthe definition of chronic obstructive pulmonarydisease proposed by the Global Initiative forChronic Obstructive Lung Disease (GOLD) 2023report? For instance, a recentepidemiological study on the prevalence of COPD in patients 40 years orolder among the general population of Spain found that almost 80% ofindividuals with COPD were not diagnosed and, therefore, not treated.6There are potential explanations for this situation. Approximately one-third of patients with COPD worldwideare not smokers; therefore, there have to be other causative factorsbesides smoking.4 This is not to say that smoking is not important; it isan extremely important risk factor for COPD. [Extracted from the article]

First- and second-hand exposure to smoke or air pollutants is the primary cause of chronic obstructive pulmonary disease (COPD) pathogenesis, where genetic and age-related factors predispose the subject to the initiation and progression of obstructive lung disease. Briefly, airway inflammation, specifically bronchitis, initiates the lung disease, leading to difficulty in breathing (dyspnea) and coughing as initial symptoms, followed by air trapping and inhibition of the flow of air into the lungs due to damage to the alveoli (emphysema). In addition, mucus obstruction and impaired lung clearance mechanisms lead to recurring acute exacerbations causing progressive decline in lung function, eventually requiring lung transplant and other lifesaving interventions to prevent mortality. It is noteworthy that COPD is much more common in the population than currently diagnosed, as only 16 million adult Americans were reported to be diagnosed with COPD as of 2018, although an additional 14 million American adults were estimated to be suffering from COPD but undiagnosed by the current standard of care (SOC) diagnostic, namely the spirometry-based pulmonary function test (PFT). Thus, the main issue driving the adverse disease outcome and significant mortality for COPD is lack of timely diagnosis in the early stages of the disease. The current treatment regime for COPD emphysema is most effective when implemented early, on COPD onset, where alleviating symptoms and exacerbations with timely intervention(s) can prevent steep lung function decline(s) and disease progression to severe emphysema. Therefore, the key to efficiently combatting COPD relies on early detection. Thus, it is important to detect early regional pulmonary function and structural changes to monitor modest disease progression for implementing timely interventions and effectively eliminating emphysema progression. Currently, COPD diagnosis involves using techniques such as COPD screening questionnaires, PFT, arterial blood gas analysis, and/or lung imaging, but these modalities are limited in their capability for early diagnosis and real-time disease monitoring of regional lung function changes. Hence, promising emerging techniques, such as X-ray phase contrast, photoacoustic tomography, ultrasound computed tomography, electrical impedance tomography, the forced oscillation technique, and the impulse oscillometry system powered by robust artificial intelligence and machine learning analysis capability are emerging as novel solutions for early detection and real time monitoring of COPD progression for timely intervention. We discuss here the scope, risks, and limitations of current SOC and emerging COPD diagnostics, with perspective on novel diagnostics providing real time regional lung function monitoring, and predicting exacerbation and/or disease onset for prognosis-based timely intervention(s) to limit COPD–emphysema progression. [ABSTRACT FROM AUTHOR]