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Your Guide To Abnormal Lab Values For Chronic Obstructive Pulmonary Disease (COPD)
COPD requires regular monitoring through tests like spirometry to assess the condition's severity and aid in an individualized treatment plan.
COPD is a progressive lung condition that makes breathing challenging. By regularly monitoring lab values, doctors can help assess the disease's progression and prescribe the most appropriate treatment.
The most important test to assess the degree of COPD is spirometry. Spirometry is often used to follow the course and response to treatment of COPD
Here's what to know about spirometry, other potential lab tests that may be used, and how to know when the results are abnormal. It's best to discuss the results with your doctor.
Regular spirometry tests are typically the most integral to assessing shifts in the progression of COPD. Your spirometry test results will tell you two things:
Your doctor will have available the data available to predict the normal values for someone of your age, height, race, and sex. Your doctor may reference these guidelines to determine the severity of the COPD.
An FEV1/FVC ratio of less than 70% may also indicate COPD. People with very severe COPD may have values as low as the 30% range.
In blood tests, people with a high neutrophil-to-lymphocyte ratio (NLR) or eosinophil-to-basophil ratio (EBR) often have greater severity of COPD. These test results reveal the underlying inflammation that's a hallmark of the condition but are not definitive.
Though COPD is a chronic condition, regular monitoring via labwork can slow the disease's progression and help doctors develop the most effective treatment plan.
Regular spirometry tests, in particular, can help assess the severity of the condition. A combination of lifestyle changes, pulmonary rehab, and treatments like bronchodilators and corticosteroids can help COPD patients live as fully and well as possible.
First-Ever Biologic Approved For COPD
The FDA approved dupilumab (Dupixent) as the first biologic treatment for adults with chronic obstructive pulmonary disease (COPD), Sanofi and Regeneron announced on Friday.
An injectable interleukin (IL)-4 and IL-13 pathway inhibitor, dupilumab is indicated as an add-on maintenance treatment for inadequately controlled COPD with an eosinophilic phenotype.
Primary support for the approval came from two phase III trials -- BOREAS and NOTUS -- involving more than 900 COPD patients on maximal inhaled therapy (typically triple therapy) and with blood eosinophil evidence of type 2 inflammation. Both studies met their primary endpoint, with dupilumab as a subcutaneous injection every 2 weeks reducing the annualized rate of moderate or severe COPD exacerbations versus placebo over a year.
In BOREAS, add-on treatment with dupilumab led to a 30% reduction in annual exacerbations (0.78 vs 1.10, respectively; rate ratio [RR] 0.70, 95% CI 0.58-0.86, P<0.001). And in NOTUS, dupilumab maintenance yielded a 34% reduction (0.86 vs 1.30; RR 0.66, 95% CI 0.54-0.82, P<0.001).
Trial data also showed improvements in quality of life and lung function, with numerically greater improvements in post-bronchodilator forced expiratory volume in 1 second (FEV1) and a significant improvement in pre-bronchodilator FEV1.
COPD causes progressive declines in lung function and consistently ranks in the top five leading causes of death in the U.S., where an estimated 300,000 adults with COPD have inadequately controlled disease and an eosinophilic phenotype.
"People living with inadequately controlled COPD have long awaited new medicines to help manage the daily suffering they experience from breathlessness, coughing, wheezing, exhaustion, and unpredictable hospitalization," Jean Wright, MD, CEO of the COPD Foundation, said in a statement. "These patients often struggle with everyday activities many people take for granted such as taking a walk or running errands outside the home. We welcome the approval of this new therapeutic option to offer patients a new way to help gain better control of their disease."
The most common adverse events with dupilumab in BOREAS and NOTUS (>2%, and occurring more frequently than with placebo) included viral infection, headache, nasopharyngitis, back pain, diarrhea, arthralgia, urinary tract infection, injection site reactions, rhinitis, eosinophilia, toothache, and gastritis. Of note, cholecystitis was reported in more patients on dupilumab than placebo recipients (0.6% vs 0.1%).
Beyond COPD, dupilumab is also approved for atopic dermatitis, asthma, eosinophilic esophagitis, chronic rhinosinusitis, and prurigo nodularis.
Ian Ingram is Managing Editor at MedPage Today and helps cover oncology for the site.
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Symptom Clusters Offer Insight Into COPD Clinical Complexity
Photo Credit: Sinenkiy
A recent study found that the respiratory and non-respiratory symptom burden in patients with COPD is high when compared with patients without COPD.
The respiratory and nonrespiratory symptom burden in patients with chronic obstructive pulmonary disease (COPD) is high when compared with patients without COPD, according to a study published in EJR Open Research.
"The most prevalent symptoms in patients with COPD were dyspnea (68%), fatigue (68%), and muscle weakness (53%), while non-COPD participants mainly complained about insomnia (16%) and daytime or night-time micturition (14%)," wrote Sarah Houben-Wilke, PhD, and colleagues.
The study included 538 patients with COPD from primary, secondary, and tertiary care settings and 116 patients without COPD from primary care practices. Participants rated the severity of 20 physical and psychological symptoms using a visual analog scale (VAS).
Both groups were comparable in gender and age. Male patients comprised 58% of the COPD group and 55% of the non-COPD group, and average ages were 64 ±9 years for the COPD group and 63 ±6 years for the non-COPD group.
The study found that forced expiratory volume in 1 second was lower in the COPD group (57 ±23% predicted vs 111 ±17% predicted). Additionally, VAS scores were higher in patients with COPD for most symptoms, except for pain, dizziness, and micturition during the day and night. Predominant symptoms in the COPD group were dyspnea, fatigue, and muscle weakness.
"Muscle weakness as the third most important symptom might be explained by the high prevalence of fatigue. Indeed, participants described the sensation of fatigue as persistent, overwhelming tiredness, severe lack of energy, and physical weakness that worsens over time," the researchers wrote. "Furthermore, multiple physical and psychological factors seem to be associated with fatigue, but little is known about the underlying determinants of fatigue in patients with COPD."
Cluster analysis of patients with COPD identified three patterns of symptom severity reflecting the least (cluster 1), medium (cluster 2), and highest (cluster 3) symptom burden. In all three clusters, dyspnea and fatigue were most common.
"Health status and care dependency differed between all clusters, while functional mobility, exacerbation history, and lung function differed between cluster 1 and the other two clusters," researchers reported. "Identifying clusters of patients with shared symptom experiences will help us to understand the impact of the disease and define integrated, multidimensional treatment strategies."
Cluster 3 included more female patients, which aligns with studies that show higher symptom burden and lower QOL in women compared with men with COPD.
"Further research should focus on appropriate approaches to achieve adequate treatment strategies in women with COPD," researchers wrote.
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