When the coronavirus pandemic restricted in-person services one year ago, pulmonary rehabilitation coordinators Mary Labiche and Zina White pioneered virtual pulmonary rehabilitation using VA Video Connect. Photo from March 31, 2021 VAntage Point blog.
BEDFORD, MA — The prevalence of chronic obstructive pulmonary disease among veterans is estimated to be between 8% and 19%—significantly higher than in the general population—due in large part to factors such as economic disadvantage and increased rates of smoking coupled with service-related and occupational exposures.
Additionally, among veterans, those with COPD tend to have higher rates of comorbidity and healthcare utilization compared to veterans without COPD.
Given the prevalence and significant burden of COPD within the VHA, substantial resources have been applied toward both clinical and research initiatives to improve outcomes for veterans with COPD. A new paper published in The International Journal of Chronic Obstructive Pulmonary Disease provided an overarching description of the recent research within VA related to physical, psychological and physiological health outcomes in veterans, as well as highlighting future directions to advance COPD research and clinical care in veterans with COPD.1
As the scope of the analysis was broad, the authors opted to conduct a narrative review, said Stephanie Robinson, PhD, an investigator with the VA Bedford Healthcare System and the paper’s lead author. “We reviewed the literature during the past 10 years or so to identify studies that focused on U.S. veterans with COPD.”
Research in the following areas was examined.
Physiological Outcomes and Interventions to Optimize Them in Veterans with COPD
The physiological and clinical outcomes that have been examined among veterans with COPD include lung function, hypoxemia and systemic effects associated with disease, such as alterations in body composition and bone mineral density. “These studies support current evidence-based guidelines, which include both pharmacological and non-pharmacological management of both stable COPD and acute exacerbations of COPD,” the authors wrote.
Longitudinal studies based within the VHA have resulted in an improved understanding of and delineation between healthy aging and disease processes such as COPD. Perhaps the most notable is the Normative Aging Study (NAS), which has followed more than 2,000 participants, first enrolled in 1963. “[T]he NAS represents a rich source of multidimensional information contributing to studies which have identified environmental (eg, smoking, air pollution) as well as genetic, epigenetic, and genomic risk factors that affect lung function and COPD susceptibility,” they wrote.
Physical Outcomes and Interventions to Improve Them in Veterans with COPD
Maximizing physical function is an overarching goal in the treatment of veterans with COPD, yet the clinical course of COPD can contribute to a vicious cycle of reduced function. Patients who experience dyspnea, tend to avoid physical activities that worsen dyspnea, causing further muscle deconditioning and reductions in exercise capacity. Pain, too, is a common symptom that can contribute to lower physical function.
There has been great interest within VHA to develop effective interventions to improve physical outcomes in veterans with COPD, according to the authors. The paper highlights several of these interventions and their impact on dyspnea, physical activity, exercise capacity, pain, and risk for acute COPD exacerbations.
Psychological Outcomes and Interventions to Optimize Them in Veterans with COPD
Depressive disorders are by far the most studied psychological disorder among veterans with COPD, the authors stated, adding that rates of depressive disorder have ranged from 38% to 86% based on the study sample. Rates of diagnosed anxiety disorders range from 23% to 61%. Yet only one-third of veterans receive any mental health treatment.
In cross-sectional studies of veterans, clinically significant depression symptoms were associated with low physical activity levels, worse self-reported functional impairment, greater dyspnea, and worse health-related quality of life (HRQoL).
The VHA has prioritized intervention development to improve psychological outcomes in veterans with COPD, the authors wrote. The paper describes several of those interventions and their impact on psychological outcomes.
A Wealth of Relevant Research
Robinson told U.S. Medicine that she was surprised to see how much relevant work was found by reviewers, even though they limited themselves to studies in U.S. veterans with COPD within the last decade or so.
“[T]here is a great deal of research and programs being conducted within the VA to improve the health of veterans with COPD,” Robinson said. “This research not only has implications for veterans, but for civilians with COPD as well, and truly has the potential to save lives.”
She said she hopes the review will serve as a synthesis of recent work conducted and point to specific gaps where future research is needed that may inspire future projects. “As detailed in our review, there is a vast amount of work targeted at improving these outcomes,” she said, “but future work that will integrate these lines of research and get these interventions into the hands of veterans who need them most is critical.”
- Bamonti PM, Robinson SA, Wan ES, Moy ML. Improving Physiological, Physical, and Psychological Health Outcomes: A Narrative Review in US Veterans with COPD. Int J Chron Obstruct Pulmon Dis. 2022 Jun 1;17:1269-1283. doi: 10.2147/COPD.S339323. PMID: 35677347; PMCID: PMC9167842.
