The second of four Clinical Year in Review sessions was held on Monday, May 16, and featured reviews of some of the most important and impactful papers published over the past year in COPD, asthma, health disparities, and sleep medicine.
Brian Daniel Hobbs, MD, MSci, of Brigham and Women’s Hospital, opened the session with a review of recent literature exploring the clinical implications of the latest advances in COPD diagnosis and management, including a recently published article that looked at COVID-19 risk in COPD.
“I think we have all been struggling to know the actual risk for our COPD patients for having severe outcomes with COVID-19,” Dr. Hobbs said.
He cited a recently published population-based study of data on more than 8.3 million adults from approximately 1,200 general practices in the United Kingdom.
“They captured 14,500 COVID hospitalizations and about 6,000 deaths, and indeed it appears that COPD is associated with a higher risk of death from COVID-19, and the risk is similar to that confirmed by idiopathic pulmonary fibrosis,” he said. “What’s also interesting is asthma, even when subdivided into active asthma and severe asthma, did not portend a higher risk of death in the study.”
Florence Schleich, MD, PhD, of the University of Liège in Belgium, followed with a presentation reviewing current research related to asthma, including a recent study exploring the association between childhood trajectories of body mass index and asthma.
“Anthropometric data on 620 infants from the Melbourne Atopy Cohort Study were collected up to 18 times in the first 24 months of the study,” Dr. Schleich said. “BMI trajectories were developed by using trajectory modeling.”
Compared with those children with the “average” trajectory, she said the children belonging to the “early-low and catch-up” and “persistently high” BMI trajectories were at higher risk of asthma at the age of 18 years.
“High BMI may induce a restrictive pattern leading to respiratory symptoms such as dyspnea, and in asthma, this contributes to poor asthma control,” Dr. Schleich said. “The results of this study are in line with previous studies showing that obese patients with early onset of asthma have increased type-2 inflammation.”
Next, Isaretta L. Riley, MD, MPH, Duke University School of Medicine, reviewed recent literature looking at the impact of health disparities in pulmonary, critical care, and sleep medicine, including a study examining structural racism as a root cause of asthma and atopic disease disparities.
“The authors in this study highlight the role of several structural racism variables on asthma and atopic disease, including but not limited to, the role of residential segregation, social and economic position, environmental justice variables, interpersonal racism and discrimination, and mass incarceration on outcomes,” Dr. Riley said. “Proximal pathways of structural racism include physical factors such as environmental hazards, built environment, housing quality, and occupational exposure. Social environment factors such as wealth gap, financial strain, neighborhood violence, and adverse childhood experiences are also examples of proximal structural racism pathways.”
The authors also hypothesize biological pathways that can explain the association between structural racism and asthma outcomes.
“Upstream and proximal structural racism pathways affect the innate and adaptive immune response and the stress response to ultimately affect asthma outcomes and contribute to health disparities,” Dr. Riley said.
In the final presentation of the session, Andrey Zinchuk, MD, MHS, BS, Yale University School of Medicine, reviewed some of the latest clinical developments in sleep medicine, including a study that looked at the association between insomnia and depression in older adults.
“We know that older adults with insomnia are at a high risk of depression, affecting outcomes in many chronic respiratory conditions,” Dr. Zinchuk said. “We don’t know, however, if successfully treating insomnia in this population can reduce the risk of developing depression.”
He cited the findings from a recent parallel-group, assessor-blinded randomized, controlled trial of 291 adults 60 years or older with insomnia; 156 individuals were randomized to two months of cognitive behavioral therapy for insomnia in group sessions. The remainder received sleep education therapy.
“The findings from this study suggest that CBTi therapy for insomnia in an older adult is possible and efficacious; however, other interventions are needed,” Dr. Zinchuk said. “Only 26 percent in the CBTi group remained insomnia free at three years, compared to 19 percent in the control arm. Because depression increases the risk of exacerbations of respiratory disorders, heart failure, cognitive decline, and dementia alike, identifying insomnia as a potential therapeutic target is clinically relevant.”