Henrik Watz’s research while affiliated with Itzehoe Hospital and other places

Importance Previous exacerbations of chronic obstructive pulmonary disease (ECOPD) are associated with future events. For more than a decade, patients at high risk have been defined as individuals with a history of 2 or more moderate ECOPD, 1 or more severe ECOPD, or both within 12 months, and treatments have been allocated accordingly, but these cutoffs lack validation. Objectives To validate ECOPD history categories by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) and explore alternative cutoffs to estimate moderate and severe ECOPD and all-cause mortality in COPD. Design, Setting, and Participants This cohort study analyzed data from patients with COPD in the German COPD and Systemic Consequences-Comorbidities Network (COSYCONET) study. Patients were recruited from September 2010 to December 2013. Analyses were conducted in September 2023 to August 2024. Main Outcomes and Measures Risk of moderate and severe (ie, with hospitalization) ECOPD and all-cause mortality over a 4.5-year follow-up period were assessed using binomial logistic regressions and area under the receiver operating characteristic curves (AUROCs) with 95% CIs. Results Among 2291 patients with COPD GOLD categories 1 to 4 (mean [SD] age, 65 [8] years; 1396 male [60.9%]), the mean (SD) estimated forced expiratory volume in the first second of expiration was 52.5% (18.6%). ECOPD history categories by GOLD had an AUROC of 0.63 (95% CI, 0.60-0.65) and 0.62 (95% CI, 0.58-0.66) to estimate moderate and severe ECOPD, respectively. A single previous moderate ECOPD within 12 months more accurately estimated future moderate and severe ECOPD (AUROC, 0.66; 95% CI, 0.64-0.69), and in line with GOLD, 1 previous severe ECOPD within 12 months estimated moderate and severe ECOPD (AUROC, 0.63; 95% CI, 0.60-0.67). The 4-year mortality rate was 219 patients (9.6%). Patients with 3 or more previous moderate ECOPD (odds ratio, 2.18; 95% CI, 1.27-3.72) or 1 or more previous severe ECOPD (odds ratio, 1.57; 95% CI, 1.29-1.91) within 12 months were more likely to die compared with patients without prior ECOPD. Conclusions and Relevance This study’s findings suggest a limited estimative performance of ECOPD history categories by GOLD. Novel cutoffs were suggested, categorizing patients as without exacerbations or with high-risk exacerbations based on a history of 1 or more moderate ECOPD, 1 or more severe ECOPD, or both within 12 months.

Background The COPD Assessment Test (CAT) comprises eight questions. We evaluated the information that each of the questions and the total score contributed to outcomes and characteristics of chronic obstructive lung disease (COPD), including their dependence on smoking status. Methods Patients with COPD of the COSYCONET cohort with Global Initiative for Chronic Obstructive Lung Disease (GOLD) grades 1–4 and the former grade 0 were included. The evaluated outcomes included mortality, exacerbation risk, the comorbidities asthma, cardiac disease (coronary artery disease/heart failure), osteoporosis, and emphysema, for which a reduction in carbon monoxide transfer coefficient (KCO) <55% predicted was considered as marker. Analyses were performed by Cox proportional hazard or logistic multiple regression analyses separately for smokers and nonsmokers. Results In total, 2509 patients had complete data, among them 1884 nonsmokers (ex or never; 38.4% female; mean age±SD 66.1±8.5 years) and 625 current smokers (45.1% female, 61.6±7.9 years). The pattern of responses to the single questions of the CAT differed between outcome variables, as well as between smokers and nonsmokers, but in most cases the total score was superior to the single items. The CAT total score was associated with mortality (p<0.05) only in nonsmokers, while for exacerbation frequency/severity, it was of about equal importance in smokers and nonsmokers. Regarding KCO, the total score was indicative (p<0.05) only in nonsmokers. Particularly in smokers, single items could show opposite signs of their coefficients which therefore largely cancelled in the total score. Conclusion Our results show in detail for which outcomes single items are informative in nonsmokers and current smokers with COPD, overall being more informative in nonsmokers. Only regarding exacerbation risk, the predictive value was similar in both groups. These results might be helpful to extract as much as possible information from a COPD questionnaire that is often part of routine assessment. Trial Registration NCT01245933.

Background Earlier diagnosis and treatment of chronic obstructive pulmonary disease (COPD), particularly preventing exacerbations, are key to slowing disease progression and reducing mortality. This study focused on the identification of patients in Germany with unstable COPD due to suboptimal treatments. Methods The IQVIA™ LRx database, capturing 80% of Statutory Health Insurance prescriptions was used to identify patients with COPD using a machine learning (ML) model. Patients with unstable COPD were identified through high prescriptions of oral corticosteroid (OCS) and/or rescue inhalers during the period from April 2022 to March 2023. Results The ML model identified around 2.6 million treated patients with COPD, with 77% precision. The mean age was 71 years, 48% were female and 86% were aged ≥60 years. About 14% patients (n=363k) exhibited unstable COPD due to high OCS prescriptions, while 10% patients (n=256k) had high rescue inhaler prescriptions. Among those with high OCS and high rescue inhaler prescriptions, respectively, 43% and 38% were on dual therapy, 17% and 21% were on single inhaler triple therapy, 14% and 16% were on multiple inhaler triple therapy, 11% and 9% were on monotherapy and 15% and 17% had no maintenance therapy. Conclusions A substantial portion of unstable COPD patients were either on suboptimal maintenance therapy (monotherapy or inhaled corticosteroid-based dual therapy) or not receiving any maintenance therapy. The study highlights a substantial need in Germany for improved maintenance therapy, which could reduce disease burden, improve disease stability and reduce reliance on OCS and rescue therapies, thereby minimising side effects.

Background In patients with chronic diseases, including those with chronic obstructive pulmonary disease (COPD), knowledge on the disease and its self-management is considered as relevant for improving disease control and long-term outcome. We studied to which extent components of knowledge depended on potential predictors, such as participation in educational programs and disease severity. For example, the perception of exacerbations or GOLD grade might modulate the content and reliability of COPD understanding. Methods Data from the German COSYCONET 2 COPD cohort was used, and 13 questions addressing knowledge and self-management were analyzed. Results Overall, 310 patients with the diagnosis of COPD of GOLD grades 1/2/3/4 as well as the former grade 0 were included (39.7% female, median age 66.0 years). The answers to 3 questions (knowledge of term exacerbation, pursed lip breathing technique, criteria for contacting a doctor) were improved (p < 0.05 each) when patients had had moderate-to-severe exacerbations, and to one question (breathing exercise) when having COPD grade 3/4 versus 0/1/2. The other 9 responses did not depend on disease severity, but most of the knowledge was improved when having participated in an educational COPD program. This was particularly true for knowledge that also depended on exacerbations, or if the treating physician was a pulmonary specialist. In some responses, the proportion of correct answers was significantly reduced in males compared to females. The dependence on education level, existence of a treatment plan, self-reported level of risk aversion and low depression score was weak and heterogeneous. Conclusion These findings suggest that part of the disease-related knowledge in patients with COPD was reinforced by the experience of exacerbations, especially knowledge regarding criteria on contacting a physician. These observations might help in focusing education on those parts of knowledge that are considered as important by patients based on their own experience.

Background: There is increasing interest in the use of home-based monitoring in people with chronic lung diseases to improve access to care, support patient self-management, and facilitate the collection of information for clinical care and research. However, integration of home-based monitoring into clinical and research settings requires careful consideration of test performance and other attributes. There is no published guidance from professional respiratory societies to advance the science of home-based monitoring for chronic lung disease. Methods: An international multidisciplinary panel of 32 clinicians, researchers, patients, and caregivers developed a multidimensional framework for the evaluation of home-based monitoring in chronic lung disease developed through consensus using a modified Delphi survey. We also present an example of how the framework could be used to evaluate home-based monitoring using spirometry and pulse oximetry in adults with asthma, bronchiectasis/cystic fibrosis (CF), chronic obstructive pulmonary disease (COPD), and interstitial lung disease (ILD). Results: The PANACEA framework includes seven domains (test Performance, disease mANAgement, Cost, patient Experience, clinician Experience, researcher Experience, and Access) to assess the degree to which home-based monitoring assessments meet the conditions for clinical and research use in chronic lung disease. Knowledge gaps and recommendations for future research of home spirometry and pulse oximetry in asthma, bronchiectasis/CF, COPD, and ILD were identified. Conclusion: The development of the PANACEA framework allows standardized evaluation of home-based monitoring in chronic lung diseases to support clinical application and future research.

Background: Chronic obstructive pulmonary disease (COPD) is commonly associated with ageing, with the prevalence and severity increasing by age. Smoking-induced premature ageing is thought to contribute to COPD, particularly lung emphysema. This study aimed to explore the relationship between lung function impairment and skin texture, as a marker of biological or premature ageing, in COPD patients. Methods: A subcohort from the COSYCONET COPD-study was analyzed, where skin-relief replicas of the eye’s outer corner and mid-lower inner arm were collected, along with semi-quantitative facial photographs. We examined the correlation between skin parameters and lung function, particularly the diffusing capacity (TLCO) as an indicator of emphysema. Results: Among 46 COPD patients (69 ± 8 years, 52% female), skin texture from the inner forearm, but not from the eye corner, was significantly associated with TLCO% predicted, with a higher skin roughness correlating with a lower TLCO (p = 0.015). This relationship persisted after adjusting for age, BMI, sex, pack years, and smoking status. No significant associations were found with facial photographs. Conclusions: These findings suggest that systemic ageing, reflected in inner arm skin texture, is linked to lung emphysema. Skin ageing markers may be valuable in future interventional studies involving anti-ageing treatments.