601
|
Giacomini M, DeJean D, Simeonov D, Smith A. Experiences of living and dying with COPD: a systematic review and synthesis of the qualitative empirical literature. ONTARIO HEALTH TECHNOLOGY ASSESSMENT SERIES 2012; 12:1-47. [PMID: 23074423 PMCID: PMC3384365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Objective of Analysis The objective of this analysis was to review empirical qualitative research on the experiences of patients with chronic obstructive pulmonary disease (COPD ), informal caregivers (“carers”), and health care providers—from the point of diagnosis, through daily living and exacerbation episodes, to the end of life. Clinical Need and Target Population Qualitative empirical studies (from social sciences, clinical, and related fields) can offer important information about how patients experience their condition. This exploration of the qualitative literature offers insights into patients’ perspectives on COPD, their needs, and how interventions might affect their experiences. The experiences of caregivers are also explored. Research Question What do patients with COPD, their informal caregivers (“carers”), and health care providers experience over the course of COPD? Research Methods Summary of Findings
Collapse
|
602
|
Erbas B, Ullah S, Hyndman RJ, Scollo M, Abramson M. Forecasts of COPD mortality in Australia: 2006-2025. BMC Med Res Methodol 2012; 12:17. [PMID: 22353210 PMCID: PMC3355029 DOI: 10.1186/1471-2288-12-17] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2011] [Accepted: 02/21/2012] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Chronic Obstructive Pulmonary Disease (COPD) is currently the fifth leading cause of death in Australia, and there are marked differences in mortality trends between men and women. In this study, we have sought to model and forecast age related changes in COPD mortality over time for men and women separately over the period 2006-2025. METHODS Annual COPD death rates in Australia from 1922 to 2005 for age groups (50-54, 55-59, 60-64, 65-69, 70-74, 75-79, 80-84, 85+) were used. Functional time series models of age-specific COPD mortality rates for men and women were used, and forecasts of mortality rates were modelled separately for men and women. RESULTS Functional time series models with four basis functions were fitted to each population separately. Twenty-year forecasts were computed, and indicated an overall decline. This decline may be slower for women than for men. By age, we expect similar rates of decline in men over time. In contrast, for women, forecasts for the age group 75-79 years suggest less of a decline over time compared to younger age groups. CONCLUSIONS By using a new method to predict age-specific trends in COPD mortality over time, this study provides important insights into at-risk age groups for men and women separately, which has implications for policy and program development.
Collapse
|
603
|
Wong CM, Peiris JSM, Yang L, Chan KP, Thach TQ, Lai HK, Lim WWL, Hedley AJ, He J, Chen P, Ou C, Deng A, Zhang X, Zhou D, Ma S, Chow A. Effect of influenza on cardiorespiratory and all-cause mortality in Hong Kong, Singapore and Guangzhou. Hong Kong Med J 2012; 18 Suppl 2:8-11. [PMID: 22311353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
1. Using a common modelling approach, mortality attributable to influenza was higher in the two subtropical cities Guangzhou and Hong Kong than in the tropical city Singapore. 2. The virus activity appeared more synchronised in subtropical cities, whereas seasonality of influenza tended to be less marked in the tropical city. 3. High temperature was associated with increased mortality after influenza infection in Hong Kong, whereas relative humidity was an effect modifier for influenza in Guangzhou. No effect modification was found for Singapore. 4. Seasonal and environmental factors probably play a more important role than socioeconomic factors in regulating seasonality and disease burden of influenza. Further studies are needed in identifying the mechanism behind the regulatory role of environmental factors.
Collapse
|
604
|
Gulbas G, Gunen H, In E, Kilic T. Long-term follow-up of chronic obstructive pulmonary disease patients on long-term oxygen treatment. Int J Clin Pract 2012; 66:152-7. [PMID: 22188416 DOI: 10.1111/j.1742-1241.2011.02833.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
AIMS Few studies exist on influence of long-term oxygen treatment (LTOT) on survival of chronic obstructive pulmonary disease (COPD) patients. This study was designed to determine whether LTOT improves survival or not in severely hypoxaemic COPD patients. MATERIALS COPD patients prescribed oxygen concentrator were consecutively included. Patients' baseline characteristics were noted. During follow-up, patients were divided into three groups according to LTOT utilisation: (i) non-utilisers, (ii) intermittent utilisers (< 15 h/day) and (iii) true utilisers (≥ 15 h/day). Patients' status (live or death) and, if died, the date of death were checked throughout the study. The factors which might influence mortality during 5-year period were analysed. RESULTS Two-hundred and twenty-eight patients completed the study. Of these patients, 55 were in Group 1, 112 were in Group 2 and 61 were in Group 3. Regarding the initial characteristics, there was not any significant difference between groups. Mean follow-up for whole group was 27.8 ± 18.5 months. Median survivals were similar between groups (19.5 ± 5.6, 32.5 ± 4.1 and 30.0 ± 5.7 months respectively) (p > 0.05). Compared with Group 1, survival was improved in Group 2 (p < 0.05) and there was a positive trend for Group 3 during first 2-year period. However, this improvement disappeared during further follow-up. Analysis of multiple factors which might influence mortality during 5-year period did not yield statistically significant parameter. DISCUSSION AND CONCLUSION We found that, regarding survival, any kind of LTOT proved to be beneficial over no LTOT only in the first 2 years of follow-up, and that there was not any difference between intermittent and true LTOT utilisation.
Collapse
|
605
|
Messer B, Griffiths J, Baudouin SV. The prognostic variables predictive of mortality in patients with an exacerbation of COPD admitted to the ICU: an integrative review. QJM 2012; 105:115-26. [PMID: 22071965 DOI: 10.1093/qjmed/hcr210] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION Chronic Obstructive Pulmonary Disease (COPD) frequently presents with an acute exacerbation (AECOPD). Debate exists as to whether these patients should be admitted to intensive care units (ICUs). An integrative review was performed to determine whether clinical variables available at the time of ICU admission are predictive of the intermediate-term mortality of patients with an AECOPD. METHODS An integrative review was structured to incorporate a five-stage review framework to facilitate data extraction, analysis and presentation. The quality of the studies contributing to the integrative review was assessed with a novel scoring system developed from previously published data and adapted to this setting. RESULTS The integrative review search strategy identified 28 studies assessing prognostic variables in this setting. Prognostic variables associated with intermediate-term mortality were low Glasgow Coma Scale (GCS) on admission to ICU, cardio-respiratory arrest prior to ICU admission, cardiac dysrhythmia prior to ICU admission, length of hospital stay prior to ICU admission and higher values of acute physiology scoring systems. Premorbid variables such as age, functional capacity, pulmonary function tests, prior hospital or ICU admissions, body mass index and long-term oxygen therapy were not found to be associated with intermediate-term mortality nor was the diagnosis attributed to the cause of the AECOPD. DISCUSSION Variables associated with intermediate-term mortality after AECOPD requiring ICU admission are those variables, which reflect underlying severity of acute illness. Premorbid and diagnostic data have not been shown to be predictive of outcome. A scoring system is proposed to assess studies of prognosis in AECOPD.
Collapse
|
606
|
Heinemann F, Budweiser S, Jörres RA, Arzt M, Rösch F, Kollert F, Pfeifer M. The role of non-invasive home mechanical ventilation in patients with chronic obstructive pulmonary disease requiring prolonged weaning. Respirology 2012; 16:1273-80. [PMID: 21883681 DOI: 10.1111/j.1440-1843.2011.02054.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVE Patients with COPD who require prolonged weaning from invasive mechanical ventilation show poor long-term survival. Whether non-invasive home mechanical ventilation (HMV) has a beneficial effect after prolonged weaning has not yet been clearly determined. METHODS Patients with COPD who required prolonged weaning and were admitted to a specialized weaning centre between January 2002 and February 2008 were enrolled in the study. Long-term survival and prognostic factors, including the role of non-invasive HMV, were evaluated. RESULTS Of 117 patients (87 men, 30 women; mean age 69.5±9.5 years) included in the study, weaning from invasive ventilation was achieved in 82 patients (70.1%). Successful weaning was associated with better survival 1 year after discharge from hospital (hazard ratio (HR) 2.24, 95% CI: 1.16-4.31; P=0.016). Among the 82 patients who were successfully weaned, non-invasive HMV was initiated in 39 (47.6%) due to persistent chronic ventilatory failure. Initiation of HMV was associated with a higher rate of survival to 1 year as compared with patients who did not receive ventilatory support (84.2% vs 54.3%; HR 3.68, 95% CI: 1.43-9.43; P=0.007). In addition, younger age and higher PaO₂, haemoglobin concentration and haematocrit at discharge were associated with better survival. In an adjusted multivariate analysis, initiation of non-invasive HMV after successful weaning remained an independent prognostic factor for survival to 1 year (HR 3.63, 95% CI: 1.23-10.75; P=0.019). CONCLUSIONS These findings suggest that based on the potential for improvement in long-term survival, non-invasive HMV should be considered in patients with severe COPD and persistent chronic hypercapnic respiratory failure after prolonged weaning.
Collapse
|
607
|
Chandra D, Stamm JA, Taylor B, Ramos RM, Satterwhite L, Krishnan JA, Mannino D, Sciurba FC, Holguín F. Outcomes of noninvasive ventilation for acute exacerbations of chronic obstructive pulmonary disease in the United States, 1998-2008. Am J Respir Crit Care Med 2012; 185:152-9. [PMID: 22016446 PMCID: PMC3297087 DOI: 10.1164/rccm.201106-1094oc] [Citation(s) in RCA: 240] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2011] [Accepted: 10/09/2011] [Indexed: 01/29/2023] Open
Abstract
RATIONALE The patterns and outcomes of noninvasive, positive-pressure ventilation (NIPPV) use in patients hospitalized for acute exacerbations of chronic obstructive pulmonary disease (COPD) nationwide are unknown. OBJECTIVES To determine the prevalence and trends of noninvasive ventilation for acute COPD. METHODS We used data from the Healthcare Cost and Utilization Project's Nationwide Inpatient Sample to assess the pattern and outcomes of NIPPV use for acute exacerbations of COPD from 1998 to 2008. MEASUREMENTS AND MAIN RESULTS An estimated 7,511,267 admissions for acute exacerbations occurred from 1998 to 2008. There was a 462% increase in NIPPV use (from 1.0 to 4.5% of all admissions) and a 42% decline in invasive mechanical ventilation (IMV) use (from 6.0 to 3.5% of all admissions) during these years. This was accompanied by an increase in the size of a small cohort of patients requiring transition from NIPPV to IMV. In-hospital mortality in this group appeared to be worsening over time. By 2008, these patients had a high mortality rate (29.3%), which represented 61% higher odds of death compared with patients directly placed on IMV (95% confidence interval, 24-109%) and 677% greater odds of death compared with patients treated with NIPPV alone (95% confidence interval, 475-948%). With the exception of patients transitioned from NIPPV to IMV, in-hospital outcomes were favorable and improved steadily year by year. CONCLUSIONS The use of NIPPV has increased significantly over time among patients hospitalized for acute exacerbations of COPD, whereas the need for intubation and in-hospital mortality has declined. However, the rising mortality rate in a small but expanding group of patients requiring invasive mechanical ventilation after treatment with noninvasive ventilation needs further investigation.
Collapse
|
608
|
Lindberg A, Larsson LG, Muellerova H, Rönmark E, Lundbäck B. Up-to-date on mortality in COPD - report from the OLIN COPD study. BMC Pulm Med 2012; 12:1. [PMID: 22230685 PMCID: PMC3276412 DOI: 10.1186/1471-2466-12-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2011] [Accepted: 01/09/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The poor recognition and related underdiagnosis of COPD contributes to an underestimation of mortality in subjects with COPD. Data derived from population studies can advance our understanding of the true burden of COPD. The objective of this report was to evaluate the impact of COPD on mortality and its predictors in a cohort of subjects with and without COPD recruited during the twenty first century. METHODS All subjects with COPD (n = 993) defined according to the GOLD spirometric criteria, FEV1/FVC < 0.70, and gender- and age-matched subjects without airway obstruction, non-COPD (n = 993), were identified in a clinical follow-up survey of the Obstructive Lung Disease in Northern Sweden (OLIN) Studies cohorts in 2002-2004. Mortality was observed until the end of year 2007. Baseline data from examination at recruitment were used in the risk factor analyses; age, smoking status, lung function (FEV1 % predicted) and reported heart disease. RESULTS The mortality was significantly higher among subjects with COPD, 10.9%, compared to subjects without COPD, 5.8% (p < 0.001). Mortality was associated with higher age, being a current smoker, male gender, and COPD. Replacing COPD with FEV1 % predicted in the multivariate model resulted in the decreasing level of FEV1 being a significant risk factor for death, while heart disease was not a significant risk factor for death in any of the models. CONCLUSIONS In this cohort COPD and decreased FEV1 were significant risk factors for death when adjusted for age, gender, smoking habits and reported heart disease.
Collapse
|
609
|
Reith S, Marx N. [Cardiac biomarkers in the critically ill]. Med Klin Intensivmed Notfmed 2012; 107:17-23. [PMID: 22349473 DOI: 10.1007/s00063-011-0028-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2011] [Accepted: 11/14/2011] [Indexed: 11/26/2022]
Abstract
Cardiac biomarkers in intensive care medicine are an excellent complement to existing clinical and diagnostic information in specific diseases. Due to their lack of specificity, the diagnostic properties of common cardiac biomarkers, such as natriuretic peptides and cardiac troponins, remain ambiguous, while their prognostic value has already been proven. In addition, there are several promising new biomarkers that might contribute to a "multimarker strategy" in the critically ill patient in the future, but further evaluation is still required.
Collapse
|
610
|
Bertoletti L, Mismetti P, Decousus H. Trends in cause-specific mortality in oxygen-dependent COPD: what about pulmonary embolism? Am J Respir Crit Care Med 2012; 184:1211-2; author reply 1212. [PMID: 22086992 DOI: 10.1164/ajrccm.184.10.1211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
611
|
Vanfleteren LEGW, Franssen FME, Uszko-Lencer NHMK, Spruit MA, Celis M, Gorgels AP, Wouters EFM. Frequency and relevance of ischemic electrocardiographic findings in patients with chronic obstructive pulmonary disease. Am J Cardiol 2011; 108:1669-74. [PMID: 22077976 DOI: 10.1016/j.amjcard.2011.07.027] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2011] [Revised: 07/10/2011] [Accepted: 07/10/2011] [Indexed: 11/30/2022]
Abstract
Cardiovascular disease is common in patients with chronic obstructive pulmonary disease (COPD) but often remains unrecognized. Ischemic electrocardiographic (ECG) changes are associated with a higher risk of dying from coronary heart disease but have never been systematically evaluated in COPD. Also, their relation to clinical outcome has not been studied. We aimed to determine the frequency of ischemic ECG changes and its relevance in relation to clinical outcome and predictors of impaired survival in patients with COPD. Clinical characteristics, pulmonary function, and co-morbidities were assessed in 536 patients with COPD during baseline assessment of a comprehensive pulmonary rehabilitation program. Moreover, electrocardiograms at rest were obtained in all patients. All electrocardiograms were scored independently by 2 cardiologists using the Minnesota scoring system. Major or minor Q or QS pattern, ST junction and segment depression, T-wave items, or left bundle branch block were considered ischemic ECG changes. One hundred thirteen patients (21%) had ischemic ECG changes. Moreover, 42 of 293 patients (14%) without self-reported cardiovascular co-morbidities had ischemic ECG changes. In addition, patients with ischemic ECG changes had higher dyspnea grades (Modified Medical Research Council (mMRC) 2.9 ± 1.1 vs 2.6 ± 1.1, p = 0.032), worse exercise performance (6-minute walking distance 387 ± 126 vs 425 ± 126 m, p = 0.004), more systemic inflammation (high-sensitivity C-reactive protein 11.2 ± 16.2 vs 7.9 ± 10.7 mmol/l, p = 0.01), higher scores on the Charlson Co-morbidity Index (1.8 ± 0.9 vs 1.5 ± 0.8 points), and higher scores BODE (5.3 ± 3.7 vs 4.5 ± 3.4 points, p = 0.033) and on ADO indexes (5.2 ± 1.7 vs 4.8 ± 1.7 points, p = 0.029) compared to patients without ischemic ECG changes, whereas forced expiratory volume in the first second was similar (40.8 ± 15.2% vs 42.6% ± 15.9%, p = 0.30). In conclusion, ischemic ECG changes are common in patients with COPD and associated with poor clinical outcome irrespective of forced expiratory volume in the first second. These results suggest an important role for cardiovascular disease in impaired survival in these patients.
Collapse
|
612
|
Rossi A, Zanardi E. E pluribus plurima: multidimensional indices and clinical phenotypes in COPD. Respir Res 2011; 12:152. [PMID: 22082092 PMCID: PMC3233517 DOI: 10.1186/1465-9921-12-152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2011] [Accepted: 11/14/2011] [Indexed: 11/22/2022] Open
|
613
|
Zanolin D, Ivanovic N, Panfil EM. [Ambulatory nursing for patients with chronic obstructive lung disease. Do specialized nursing personnel help in ambulatory care nursing programs?]. PFLEGE ZEITSCHRIFT 2011; 64:676-677. [PMID: 22097406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
|
614
|
|
615
|
Puhan MA, Gimeno-Santos E, Scharplatz M, Troosters T, Walters EH, Steurer J. Pulmonary rehabilitation following exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2011:CD005305. [PMID: 21975749 DOI: 10.1002/14651858.cd005305.pub3] [Citation(s) in RCA: 195] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Pulmonary rehabilitation has become a cornerstone in the management of patients with stable Chronic Obstructive Pulmonary Disease (COPD). Systematic reviews have shown large and important clinical effects of pulmonary rehabilitation in these patients. However, in unstable COPD patients who have recently suffered an exacerbation, the effects of pulmonary rehabilitation are less established. OBJECTIVES To assess the effects of pulmonary rehabilitation after COPD exacerbations on future hospital admissions (primary outcome) and other patient-important outcomes (mortality, health-related quality of life and exercise capacity). SEARCH STRATEGY Trials were identified from searches of CENTRAL, MEDLINE, EMBASE, PEDRO and the Cochrane Airways Group Register of Trials. Searches were current as of March 2010. SELECTION CRITERIA Randomized controlled trials comparing pulmonary rehabilitation of any duration after exacerbation of COPD with conventional care. Pulmonary rehabilitation programmes needed to include at least physical exercise. Control groups received conventional community care without rehabilitation. DATA COLLECTION AND ANALYSIS We calculated pooled odds ratios and weighted mean differences (MD) using random-effects models. We requested missing data from the authors of the primary studies. MAIN RESULTS We identified nine trials involving 432 patients. Pulmonary rehabilitation significantly reduced hospital admissions (pooled odds ratio 0.22 [95% CI 0.08 to 0.58], number needed to treat (NNT) 4 [95% CI 3 to 8], over 25 weeks) and mortality (OR 0.28; 95% CI 0.10 to 0.84), NNT 6 [95% CI 5 to 30] over 107 weeks). Effects of pulmonary rehabilitation on health-related quality of life were well above the minimal important difference when measured by the Chronic Respiratory Questionnaire (MD for dyspnea, fatigue, emotional function and mastery domains between 0.81 (fatigue; 95% CI 0.16 to 1.45) and 0.97 (dyspnea; 95% CI 0.35 to 1.58)) and the St. Georges Respiratory Questionnaire total score (MD -9.88; 95% CI -14.40 to -5.37); impacts domain (MD -13.94; 95% CI -20.37 to -7.51) and for activity limitation domain (MD -9.94; 95% CI -15.98 to -3.89)). The symptoms domain of the St. Georges Respiratory Questionnaire showed no significant improvement. Pulmonary rehabilitation significantly improved exercise capacity and the improvement was above the minimally important difference (six-minute walk test (MD 77.70 meters; 95% CI 12.21 to 143.20) and shuttle walk test (MD 64.35; 95% CI 41.28 to 87.43)). No adverse events were reported in three studies. AUTHORS' CONCLUSIONS Evidence from nine small studies of moderate methodological quality, suggests that pulmonary rehabilitation is a highly effective and safe intervention to reduce hospital admissions and mortality and to improve health-related quality of life in COPD patients who have recently suffered an exacerbation of COPD.
Collapse
|
616
|
George PM, Stone RA, Buckingham RJ, Pursey NA, Lowe D, Roberts CM. Changes in NHS organization of care and management of hospital admissions with COPD exacerbations between the national COPD audits of 2003 and 2008. QJM 2011; 104:859-66. [PMID: 21622541 DOI: 10.1093/qjmed/hcr083] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The 2003 UK Chronic Obstructive Pulmonary Disease (COPD) audit revealed wide variability between hospital units in care delivered. AIMS To assess whether processes of care, patient outcomes and organization of care have improved since 2003. DESIGN A UK national audit was performed in 2008 to survey the organization and delivery of clinical care provided to patients admitted to hospital with COPD. METHODS All UK acute hospital Trusts (units) were invited to participate. Each unit completed cross-sectional resource and organization questionnaires and a prospective clinical audit comprising up to 60 consecutively admitted cases of COPD exacerbation. Comparison between 2003 and 2008 includes aggregated statistics for units participating in both audit rounds. RESULTS A total of 192 units participated in both audit rounds (6197 admissions in 2003 and 8170 in 2008). In 2008, patients were older and of a poorer functional class. Overall mortality was unchanged but adjusting for age and performance status, inpatient mortality (P = 0.05) and 90-day mortality (P = 0.001) were both reduced in 2008. More patients were discharged under a respiratory specialist (P < 0.01), treated with non-invasive ventilation if acidotic (P < 0.001) and accepted onto early discharge schemes (P < 0.01) while median length of stay fell from 6 to 5 days (P < 0.001). Within these mean data, however, there remains considerable inter-unit variation in organization, resources and outcomes. CONCLUSION Overall improvements in resources and organization are accompanied by reduced mortality, shorter admissions and greater access to specialist services. There remains, however, considerable variation in the quality of secondary care provided between units.
Collapse
|
617
|
Miniati M, Monti S, Bottai M, Cocci F, Fornai E, Lubrano V. Prognostic value of C-reactive protein in chronic obstructive pulmonary disease. Intern Emerg Med 2011; 6:423-30. [PMID: 21249472 DOI: 10.1007/s11739-011-0520-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2010] [Accepted: 01/05/2011] [Indexed: 10/18/2022]
Abstract
To establish whether C-reactive protein (CRP) is an independent predictor of all-cause mortality and hospitalization in chronic obstructive pulmonary disease (COPD), we followed 200 patients with COPD and 201 age- and gender -matched controls for a median time of 4.2 years (range, 0.2-5.1 years). Airflow obstruction was rated moderate if forced expiratory volume in one second (FEV(1)) was 50-69% of the predicted value, or severe if FEV(1) was <50%. The CRP level was categorized as low (≤3 mg/L) or high (>3 mg/L). The hazard of death was estimated by a proportional hazard regression model, using controls with low CRP as the reference category. Fifty subjects died: 41 (21%) among the COPD and 9 (4%) among the controls (p < 0.0001). The hazard of death in moderate COPD was not significantly higher than in the reference category, independently of the CRP level. In severe COPD with a low CRP, the hazard of death is 3.4 times higher than in the reference category (p = 0.008); in severe COPD and a high CRP it is 9.6 times higher (p < 0.0001). The rate of hospitalization in COPD patients with a high CRP is 1.9 times higher than in those with a low CRP [95% confidence interval (CI), 1.2-3.2]. In severe COPD, it is 6.9 times higher than in moderate COPD (95% CI, 3.8-12.7). A high CRP level is a significant amplifier of the risk of death only in severe COPD. The degree of airflow obstruction is a strong independent predictor of COPD-related outcomes.
Collapse
|
618
|
Fragoso CAV, Concato J, McAvay G, Yaggi HK, Van Ness PH, Gill TM. Staging the severity of chronic obstructive pulmonary disease in older persons based on spirometric Z-scores. J Am Geriatr Soc 2011; 59:1847-54. [PMID: 22091498 PMCID: PMC3227010 DOI: 10.1111/j.1532-5415.2011.03596.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Among older persons, the use of spirometric Z-scores as calculated by the Lambda-Mu-Sigma (LMS) method has a strong scientific rationale for establishing a diagnosis of chronic obstructive pulmonary disease (COPD), but its clinical validity in staging COPD severity is not yet known. The current study has therefore evaluated the association between LMS-staged COPD and health outcomes, in two separate cohorts of older persons. DESIGN Longitudinal cohort study. SETTING The Cardiovascular Health Study (CHS, N = 3,248) and the Third National Health and Nutrition Examination Survey (NHANES-III, N = 1,354). PARTICIPANTS Community-living white participants aged 65 to 80. MEASUREMENTS Using spirometric data, COPD was staged as mild, moderate, or severe based on LMS-derived Z-scores. Clinical validity was then evaluated according to all-cause mortality, respiratory symptoms (chronic bronchitis, dyspnea, or wheezing), and moderate to severe dyspnea (available in CHS only). RESULTS In CHS, the LMS staging of COPD as mild, moderate, and severe was associated with mortality (adjusted HR (aHR) = 1.50, 95% confidence interval (CI) = 1.15-1.94; aHR = 1.31, 95% CI = 1.03-1.67; and aHR = 2.00, 95% CI = 1.70-2.36, respectively) and with respiratory symptoms (adjusted OR (aOR) = 1.69, 95% CI = 1.12-2.56; aOR = 1.87, 95% CI = 1.28-2.73; and aOR = 3.99, 95% CI = 2.91-5.48, respectively). Also in CHS, moderate and severe, but not mild, LMS-staged COPD was associated with moderate to severe dyspnea (aOR = 2.16, 95% CI = 1.24-3.75; aOR = 3.98, 95% CI = 2.77-5.74; and aOR = 0.84, 95% CI = 0.35-2.01, respectively). Similar associations were found for mortality and respiratory symptoms in NHANES-III, except mild severity was not associated with mortality (aHR = 0.93, 95% CI = 0.62-1.40). CONCLUSION In white older persons, the spirometric staging of COPD severity based on LMS-derived Z-scores was associated with several clinically relevant health outcomes. These results support the use of the LMS method for staging the severity of COPD in older populations.
Collapse
|
619
|
Irina S. [Blue bloater, pink puffer and other phenotypes of COPD]. PNEUMOLOGIA (BUCHAREST, ROMANIA) 2011; 60:196-197. [PMID: 22420167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
|
620
|
Minakata Y, Ichinose M. [Epidemiology of COPD in Japan]. NIHON RINSHO. JAPANESE JOURNAL OF CLINICAL MEDICINE 2011; 69:1721-1726. [PMID: 22073563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The prevalence of COPD in Japan is revealed to be 8.6 % which is almost the same as foreign countries. However, there are many undiagnosed COPD patients. More than half of undiagnosed COPD patients go regularly to medical institution with other diseases. Among the patients who are 40 or more and go clinics with non-respiratory diseases, the prevalence of COPD is 8.6 to 10.3 %. If they have smoking history or some respiratory symptoms, the prevalence of COPD is 22 %. In Japanese reports, atherosclerosis is detected in 73.8 % of COPD patients, and the prevalence of COPD is high in heart failure, ischemic heart failure and liver diseases. The effort to decrease the mortality of COPD in Japan is necessary.
Collapse
|
621
|
Kesten S, Celli B, Decramer M, Liu D, Tashkin D. Adverse health consequences in COPD patients with rapid decline in FEV1--evidence from the UPLIFT trial. Respir Res 2011; 12:129. [PMID: 21955733 PMCID: PMC3190346 DOI: 10.1186/1465-9921-12-129] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2011] [Accepted: 09/28/2011] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The rate of decline in forced expiratory volume in 1 second (FEV1) is representative of the natural history of COPD. Sparse information exists regarding the associations between the magnitude of annualised loss of FEV1 with other endpoints. METHODS Retrospective analysis of UPLIFT® trial (four-year, randomized, double-blind, placebo-controlled trial of tiotropium 18 μg daily in chronic obstructive pulmonary disease [COPD], n = 5993). Decline of FEV1 was analysed with random co-efficient regression. Patients were categorised according to quartiles based on the rate of decline (RoD) in post-bronchodilator FEV1. The St George's Respiratory Questionnaire (SGRQ) total score, exacerbations and mortality were assessed within each quartile. RESULTS Mean (standard error [SE]) post-bronchodilator FEV1 increased in the first quartile (Q1) by 37 (1) mL/year. The other quartiles showed annualised declines in FEV1 (mL/year) as follows: Q2 = 24 (1), Q3 = 59 (1) and Q4 = 125 (2). Age, gender, respiratory medication use at baseline and SGRQ did not distinguish groups. The patient subgroup with the largest RoD had less severe lung disease at baseline and contained a higher proportion of current smokers. The percentage of patients with ≥ 1 exacerbation showed a minimal difference from the lowest to the largest RoD, but exacerbation rates increased with increasing RoD. The highest proportion of patients with ≥ 1 hospitalised exacerbation was in Q4 (Q1 = 19.5% [tiotropium], 26% [control]; Q4 = 33.8% [tiotropium] and 33.1% [control]). Time to first exacerbation and hospitalised exacerbation was shorter with increasing RoD. Rate of decline in SGRQ increased in direct proportion to each quartile. The group with the largest RoD had the highest mortality. CONCLUSION Patients can be grouped into different RoD quartiles with the observation of different clinical outcomes indicating that specific (or more aggressive) approaches to management may be needed. TRIAL REGISTRATION ClinicalTrials.gov number, NCT00144339.
Collapse
|
622
|
Chen J, Schooling CM, Johnston JM, Hedley AJ, McGhee SM. How does socioeconomic development affect COPD mortality? An age-period-cohort analysis from a recently transitioned population in China. PLoS One 2011; 6:e24348. [PMID: 21935399 PMCID: PMC3174164 DOI: 10.1371/journal.pone.0024348] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2011] [Accepted: 08/05/2011] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a leading cause of death, particularly in developing countries. Little is known about the effects of economic development on COPD mortality, although economic development may potentially have positive and negative influences over the life course on COPD. We took advantage of a unique population whose rapid and recent economic development is marked by changes at clearly delineated and identifiable time points, and where few women smoke, to examine the effect of macro-level events on COPD mortality. METHODS We used Poisson regression to decompose sex-specific COPD mortality rates in Hong Kong from 1981 to 2005 into the effects of age, period and cohort. RESULTS COPD mortality declined strongly over generations for people born from the early to mid 20th century, which was particularly evident for the first generation to grow up in a more economically developed environment for both sexes. Population wide COPD mortality decreased when air quality improved and increased with increasing air pollution. COPD mortality increased with age, particularly after menopause among women. CONCLUSIONS Economic development may reduce vulnerability to COPD by reducing long-lasting insults to the respiratory system, such as infections, poor nutrition and indoor air pollution. However, some of these gains may be offset if economic development results in increasing air pollution or increasing smoking.
Collapse
|
623
|
Atsou K, Chouaid C, Hejblum G. Simulation-based estimates of effectiveness and cost-effectiveness of smoking cessation in patients with chronic obstructive pulmonary disease. PLoS One 2011; 6:e24870. [PMID: 21949774 PMCID: PMC3173494 DOI: 10.1371/journal.pone.0024870] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2011] [Accepted: 08/19/2011] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The medico-economic impact of smoking cessation considering a smoking patient with chronic obstructive pulmonary disease (COPD) is poorly documented. OBJECTIVE Here, considering a COPD smoking patient, the specific burden of continuous smoking was estimated, as well as the effectiveness and the cost-effectiveness of smoking cessation. METHODS A multi-state Markov model adopting society's perspective was developed. Simulated cohorts of English COPD patients who are active smokers (all severity stages combined or patients with the same initial severity stage) were compared to identical cohorts of patients who quit smoking at cohort initialization. Life expectancy, quality adjusted life-years (QALY), disease-related costs, and incremental cost-effectiveness ratio (ICER: £/QALY) were estimated, considering smoking cessation programs with various possible scenarios of success rates and costs. Sensitivity analyses included the variation of model key parameters. PRINCIPAL FINDINGS At the horizon of a smoking COPD patient's remaining lifetime, smoking cessation at cohort intitialization, relapses being allowed as observed in practice, would result in gains (mean) of 1.27 life-years and 0.68 QALY, and induce savings of -1824 £/patient in the disease-related costs. The corresponding ICER was -2686 £/QALY. Smoking cessation resulted in 0.72, 0.69, 0.64 and 0.42 QALY respectively gained per mild, moderate, severe, and very severe COPD patient, but was nevertheless cost-effective for mild to severe COPD patients in most scenarios, even when hypothesizing expensive smoking cessation intervention programmes associated with low success rates. Considering a ten-year time horizon, the burden of continuous smoking in English COPD patients was estimated to cost a total of 1657 M£ while 452516 QALY would be simultaneously lost. CONCLUSIONS The study results are a useful support for the setting of smoking cessation programmes specifically targeted to COPD patients.
Collapse
|
624
|
Martos R, Márton I. [Possible correlations between periodontitis and chronic obstructive pulmonary disease. Review of the literature]. FOGORVOSI SZEMLE 2011; 104:87-92. [PMID: 22039714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Chronic obstructive pulmonary disease (COPD) is a complex, multifactorial inflammatory disease of the airways and the pulmonary parenchyme, caused by infection, air pollution and particles. 4-7% of the adult population is involved. COPD is the 4th-6th common cause of death throughout the world. The main aetiological factor is smoking. Bacteria, such as bacteria from the oral cavity, could play a keyrole in the progression of the disease. Epidemiologic studies have noted a relationship between poor oral hygiene or periodontal bone loss and chronic obstructive pulmonary disease. The prevalence and mortality of the disease is increasing worldwide, the treatment is expensive, the efficiency of the present pharmacotherapy is poor, so the importance of prevention should be increasing. Patients with chronic obstructive pulmonary disease (COPD) are prone to frequent exacerbations which are a significant cause of morbidity and mortality. This review is a short summary of studies about the possible relationship between periodontitis and COPD.
Collapse
|
625
|
O'Farrell A, De La Harpe D, Johnson H, Bennett K. Trends in COPD mortality and in-patient admissions in men & women: evidence of convergence. IRISH MEDICAL JOURNAL 2011; 104:245-248. [PMID: 22125880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Chronic obstructive pulmonary disease (COPD) is one of the leading causes of mortality. Although more prevalent in men, it is anticipated that, due to the convergence in smoking rates, the prevalence rate in women will surpass that of men. There were 14,519 deaths attributable to COPD in the period 2000-2009. Although deaths decreased for both sexes, reduction in deaths was significantly higher among men (test for trend, p<0.01 for men vs. p=0.06 for women). Smoking rates decreased for both sexes from 1980-2009 with the percentage reduction in smoking significantly greater in men (11.5% vs. 7.0%, p<0.001). There has been a convergence in COPD deaths and COPD hospital in-patient discharges for men and women that mirrors the trend in the convergence of male and female smoking rates. This study provides evidence of the need for effective smoking cessation programmes that are targeted at women as well as men.
Collapse
|