Chronic obstructive pulmonary disease (COPD) is a leading cause of death in Canada. Many people have sudden flare‑ups, or exacerbations, leading to emergency care and hospital admissions. Recent Canadian guidelines recommend, for people with more symptoms and/or frequent or serious exacerbations, a single inhaler that combines 3 medicines called single‑inhaler triple‑therapy. Many patients who should be on this treatment currently are not. We asked what could happen if more eligible patients used single-inhaler triple-therapy.

We built a statistical model that followed people in Canada with COPD over 10 years. We compared current care plans to the best guideline-recommended single-inhaler triple-therapy use.

In the right patients, the appropriate use of single-inhaler triple-therapy compared to current care avoided approximately 2.8 million exacerbations treated in clinics and 159,000 exacerbations needing hospital care over 10 years. Deaths in this group could fall by about one‑fifth, and the health system could save about $3.9 billion Canadian dollars because of the fewer exacerbations.

Putting the 2023 Canadian COPD guidance into practice could help patients live longer, avoid emergency visits and hospital stays, and lower health care costs. Real‑world results will depend on how widely single-inhaler triple-therapy is used and whether medicines are taken as prescribed, but these findings support earlier, guideline‑based treatment.

Doctors often use pulmonary function tests to understand an individual’s lung health. They usually focus on the amount of air a person can breathe out or exhale in 1 second. This is called the forced expiratory volume in 1 second or FEV₁ measurement. However, FEV₁ may fail to find early changes in the small airways of the lungs. The forced expiratory volume in 3 seconds (FEV₃) to forced expiratory volume in 6 second (FEV₆) ratio is a unique lung function measure that identifies early airflow concerns.

In this study, the lower limit of normal for FEV₃/FEV₆ was measured using individuals’ sex, age and ethnicity. The lower limit of normal is a measurement of lung function that 95% of healthy people (with similar characteristics as the individual taking the test) would have. So, an individual’s lung function is considered not normal if it falls in the bottom 5% of results for their group. We found that participants with an FEV₃/FEV₆ ratio less than the lower limit of normal had increased risks of congestive heart failure, asthma, chronic bronchitis, emphysema, and respiratory symptoms. We revealed for the first time that both a reduced FEV₃/FEV₆ ratio and an excessive FEV₃/FEV₆ ratio were associated with an increased risk of death.

These findings suggest that the measurement of the FEV₃/FEV₆ ratio may serve as an early warning sign offering doctors a more complete tool for determining an individual’s possible health risks.

Smoke from wildfires is an increasing problem for patients with chronic obstructive pulmonary disease (COPD), since wildfires are becoming more frequent, and smoke can cause flare-ups in breathing symptoms. There are known strategies or steps to take to reduce problems at an individual level. However, gaps remain about how patients may or may not change their day-to-day behavior. To understand these gaps, we interviewed patients with COPD who lived close to historically large wildfires.

We interviewed these patients about their relationship with and understanding of wildfire smoke, how they protect their health from smoke, and their experience with prescribed burns—a controlled, planned fire set by fire experts to help control the land or a larger fire. Three major themes emerged: (1) patients tended to get wildfire and air quality information from internet and smartphone apps, not from their doctor, clinic, or hospital. However, patients said they would be open to receiving information from their doctors; (2) not all patients were aware they could reduce the effect the fire and smoke has on them, but education and supplying masks and air cleaners could improve this awareness; and (3) patients prefer real-time alerts sent to their phones from trusted sources, such as their doctor, clinic, or hospital to change their behavior during periods of poor air quality.

These findings can help us design successful patient-centered plans that protect patients’ health from the harms of wildfire smoke.

Individuals with chronic obstructive pulmonary disease (COPD) often face high medical costs. These costs can come from unexpected emergency department visits or hospital stays for serious flare-ups known as exacerbations. For long-term management of their disease, many people with COPD rely on inhaled medications that are often expensive. COPD makes it harder for some people to work and it may reduce their income. Taken together, these challenges make people with COPD vulnerable to financial toxicity, a term that describes the financial burden of medical care and the stress it can cause.

We conducted interviews with 30 diverse individuals living with COPD to better understand their experiences with financial toxicity. Participants described many sources of financial burden, including out-of-pocket costs for inhalers, and the emotional effect these expenses had on their lives. To lower their costs, individuals reported using their inhalers differently from how the inhaler was prescribed by their doctor or skipping medical care. Others addressed medical expenses by cutting back on everyday spending or changing major financial planning decisions such as dipping into retirement savings or moving to cheaper housing.

This study suggests that financial toxicity is common among people with COPD and may impact how they manage their health, finances, and emotional well-being. These findings may help guide future research and efforts to reduce the financial burden and improve support for people with COPD.

Alpha-1 antitrypsin deficiency (AATD) is a condition which is passed down through families and carries an increased risk of lung and liver disease. However, certain types of AATD are not known to cause bad outcomes. This is partly related to the low rates of testing done for AATD.

We evaluated testing patterns within a health care system and determined the importance of detecting rare types of AATD. We observed that testing rates were improved through the use of an order set within the electronic medical record that included testing all new patients with liver disease for AATD. We looked at all patients who tested positive for AATD, regardless of whether it was the type traditionally known to cause disease or not.

We found a group of AATD patients who had worse health concerns including lower lung function, more inflammation, greater health care usage (more hospital stays including being admitted to the intensive care unit), and increased death compared to other types of AATD. Many of these patients would not have been identified using our typical method to test these patients, which supports the need to further study if current AATD screening guidelines identify all groups at risk for bad health results.

Chronic obstructive pulmonary disease (COPD) is a serious lung condition caused largely by smoking. People with this disease often have low oxygen levels in their blood, but we do not fully understand all the reasons why. One possible cause is changes in the small blood vessels in the lungs — but this has not been well studied yet.

In this study we looked at data from nearly 9,000 current and former smokers. Each person had a detailed chest scan, breathing tests, and oxygen level measurements. Using automated software, we measured the volume of very small blood vessels in the lungs.

We found that individuals with a larger volume in the small lung blood vessels had lower blood oxygen levels and were more likely to need extra oxygen support. This was true even after considering how serious the lung disease was and other health-related factors.

Understanding that small lung blood vessel changes can help cause low oxygen levels — independent of airway damage — gives researchers a new angle to explore. Future work could focus on finding these vessel changes earlier and developing treatments that target this specific part of smoking-related lung disease.

People with chronic lung diseases like chronic obstructive pulmonary disease (COPD), asthma, and cystic fibrosis tend to have low vitamin D levels, and these low levels are linked to worse health results. This has led to many studies looking at taking vitamin D supplements (pills taken by mouth) as a treatment for lung diseases.

Despite years of clinical trials and reviews, taking vitamin D supplements does not appear to meaningfully improve lung function, reduce flare-ups or exacerbations, or improve quality of life in people with these diseases. Although oral supplements can raise vitamin D in the blood, this is not reflected in the lung.

Experimental studies of vitamin D supplements, as used with cell and animal models, have shown that vitamin D can protect against inhaled insults (dust, pollution) and pathogens (germs, viruses, bacteria), without raising vitamin D levels in the blood.

No clinical trials have tested inhaled vitamin D in humans with chronic lung disease. Targeted lung supplementation of vitamin D (by inhaling vitamin D) may provide a better option for treating chronic lung disease and should be further studied.

Many patients with chronic obstructive pulmonary disease (COPD) suffer from draining, limiting, constant symptoms. Our study measured changes in patient COPD symptoms following a COPD program led by pharmacists

This program, titled COPD Coordinated Access to Reduce Exacerbations (COPD CARE), uses clinical pharmacists as part of the patient’s primary care team to deliver the best COPD practices. Pharmacists review patient COPD symptoms and inhaler techniques, ask about smoking, prescribe COPD medications, and provide referrals as needed.

Veterans’ COPD symptoms improved from their first to their second pharmacist-led visit. These findings suggest that clinical pharmacists are well positioned to improve patient COPD symptoms within primary care teams.