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Dietz de Loos DAE, Segboer CL, Gevorgyan A, Fokkens WJ. Disease-specific quality-of-life questionnaires in rhinitis and rhinosinusitis: review and evaluation. Curr Allergy Asthma Rep 2013; 13:162-70. [PMID: 23299562 DOI: 10.1007/s11882-012-0334-8] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Quality of life (QoL) measurements are the best approximation of the burden of disease for the patient. Patient-reported outcome measurements (PROMs) estimate health-related quality of life (HRQoL). PROMs can be generic or disease-specific. Generic PROMs allow comparisons between different diseases but can be relatively insensitive for measuring changes within a disease. Recommended QoL questionnaires in allergic rhinitis and rhinoconjunctivitis are the RQLQ (or adapted versions), in chronic rhinosinusitis, the SNOT-22 or RSOM-31, and in acute rhinosinusitis, the modified SNOT-16. PROMs can be used both for daily clinical work and for research. In daily practice, a quick evaluation of the questionnaire directly indicates how the patient is doing. It makes sure that symptoms important for the patient are not overlooked and, during the consultation, the physician can elaborate on specific aspects of the symptomatology. It is important, especially in research, to realize that disease-specific questionnaires are only validated for specific diseases and are not automatically valid for other diseases.
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Affiliation(s)
- Dirk A E Dietz de Loos
- Department of Otorhinolaryngology, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.
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Viggers H, Howden-Chapman P, Ingham T, Chapman R, Pene G, Davies C, Currie A, Pierse N, Wilson H, Zhang J, Baker M, Crane J. Warm homes for older people: aims and methods of a randomised community-based trial for people with COPD. BMC Public Health 2013; 13:176. [PMID: 23442368 PMCID: PMC3608967 DOI: 10.1186/1471-2458-13-176] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Accepted: 02/05/2013] [Indexed: 11/16/2022] Open
Abstract
Background Chronic Obstructive Pulmonary Disease (COPD) is of increasing importance with about one in four people estimated to be diagnosed with COPD during their lifetime. None of the existing medications for COPD has been shown to have much effect on the long-term decline in lung function and there have been few recent pharmacotherapeutic advances. Identifying preventive interventions that can reduce the frequency and severity of exacerbations could have important public health benefits. The Warm Homes for Elder New Zealanders study is a community-based trial, designed to test whether a NZ$500 electricity voucher paid into the electricity account of older people with COPD, with the expressed aim of enabling them to keep their homes warm, results in reduced exacerbations and hospitalisation rates. It will also examine whether these subsidies are cost-beneficial. Methods Participants had a clinician diagnosis of COPD and had either been hospitalised or taken steroids or antibiotics for COPD in the previous three years; their median age was 71 years. Participants were recruited from three communities between 2009 to early 2011. Where possible, participants’ houses were retrofitted with insulation. After baseline data were received, participants were randomised to either ‘early’ or ‘late’ intervention groups. The intervention was a voucher of $500 directly credited to the participants’ electricity company account. Early group participants received the voucher the first winter they were enrolled in the study, late participants during the second winter. Objective measures included spirometry and indoor temperatures and subjective measures included questions about participant health and wellbeing, heating, medication and visits to health professionals. Objective health care usage data included hospitalisation and primary care visits. Assessments of electricity use were obtained through electricity companies using unique customer numbers. Discussion This community trial has successfully enrolled 522 older people with COPD. Baseline data showed that, despite having a chronic respiratory illness, participants are frequently cold in their houses and economise on heating. Trial Registration The clinical trial registration is http://NCT01627418
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Affiliation(s)
- Helen Viggers
- He Kainga Oranga/Housing and Health Research Programme, University of Otago, PO Box 7343, Wellington, Wellington South, New Zealand.
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Feldman GJ. Improving the quality of life in patients with chronic obstructive pulmonary disease: focus on indacaterol. Int J Chron Obstruct Pulmon Dis 2013; 8:89-96. [PMID: 23431038 PMCID: PMC3575129 DOI: 10.2147/copd.s31209] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a common disease in the general population and it places a considerable burden on patients, with the disease negatively affecting quality of life. In practice, patients with COPD generally seek medical attention because of symptoms, particularly breathlessness, and the resulting physical limitations, which affect the health-related quality of life (HR-QOL) in patients. The defining feature of COPD is airflow limitation that causes air trapping and increased hyperinflation as the ventilation rate increases during physical effort. Hyperinflation causes or worsens breathlessness as breathing becomes inefficient, with the end result being an avoidance of physical exertion and a cycle of increasing dyspnea caused by inactivity and deconditioning, with deleterious effects on HR-QOL. Current published guidelines for COPD state that the goals of pharmacologic therapy should be to control symptoms, improve health status and exercise tolerance, and reduce the frequency of COPD exacerbations. Effective and sustained bronchodilation has emerged as a key strategy for improving dyspnea and ability to exercise. As there is no cure for COPD, a major goal of treatment and of research into new therapies is to improve HR-QOL in COPD patients.
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Affiliation(s)
- Gregory J Feldman
- S Carolina Pharmaceutical Research, Alliance Biomedical Group International, Spartanburg, SC 29303, USA.
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154
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Jehn M, Schindler C, Meyer A, Tamm M, Schmidt-Trucksäss A, Stolz D. Daily walking intensity as a predictor of quality of life in patients with chronic obstructive pulmonary disease. Med Sci Sports Exerc 2012; 44:1212-8. [PMID: 22293866 DOI: 10.1249/mss.0b013e318249d8d8] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE This study aimed to assess independent predictors of quality of life (QOL) in patients with chronic obstructive pulmonary disease, in particular, to evaluate the relationship between QOL and functional exercise capacity measured with an activity monitor. METHODS Functional exercise capacity was measured with an accelerometer-based walking intensity. QOL was assessed by Short Form-36 and Saint Georges Respiratory Questionnaire. Stepwise multivariate regression analyses were used to identify significant independent predictors of health-related QOL. RESULTS Daily walking intensity (fast walk) was the only significant independent predictor of the Short Form-36 domains "physical function" (P = 0.002) and "role physical" (P = 0.034). Age and depression were significant independent predictors of the domain "social functioning" (P = 0.035 and P = 0.002, respectively). Age and fast walk were significant independent predictors of the domain "mental health" (P = 0.006 and P = 0.017, respectively). Percent predicted forced expiratory volume in 1 s and fast walk were both significant independent predictors of the domains "general health" (P = 0.04 and P = 0.02, respectively) and "physical component score" (P = 0.038 and P = 0.017, respectively). In terms of the Saint Georges Respiratory Questionnaire, fast walk was a significant independent predictor of "activity score" (P = 0.001), "impact score" (P = 0.022), and "total score" (P = 0.01). CONCLUSIONS QOL is an important aspect to be integrated into long-term disease management and the assessment of daily walking intensity using accelerometry can provide additional information about the patient's functional status and well-being during a certain period.
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Affiliation(s)
- Melissa Jehn
- Department of Sports Medicine, Institute of Exercise and Health Sciences, University of Basel, Basel, Switzerland.
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156
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Cave AJ, Atkinson L, Tsiligianni IG, Kaplan AG. Assessment of COPD wellness tools for use in primary care: an IPCRG initiative. Int J Chron Obstruct Pulmon Dis 2012; 7:447-56. [PMID: 22927752 PMCID: PMC3422123 DOI: 10.2147/copd.s29868] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
COPD is considered a complex disease and global problem that is predicted to be the third most common cause of death by 2030. While managing this chronic condition, primary health care practitioners are faced with the ongoing challenge of achieving good quality of life and overall "wellness" for those affected. As such, a practical tool for monitoring quality of life in a clinical setting is required. However, due to the wide variety of general and disease-specific tools from which to choose, primary health care practitioners are given minimal guidance as to which tool may be most appropriate. To address these challenges, the International Primary Care Respiratory Group (IPCRG) proposed the creation of a user's guide for primary health care practitioners to assess "wellness" in COPD patients in an everyday clinical setting. This short report outlines the process by which the IPCRG Users' Guide to COPD "Wellness" Tools was developed. It also describes why this guide has the potential to be of great value in guiding primary health care practitioners to improve patient wellness.
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Affiliation(s)
- Andrew J Cave
- Department of Family Medicine, University of Alberta, Edmonton, Canada.
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Tsiligianni IG, van der Molen T, Moraitaki D, Lopez I, Kocks JWH, Karagiannis K, Siafakas N, Tzanakis N. Assessing health status in COPD. A head-to-head comparison between the COPD assessment test (CAT) and the clinical COPD questionnaire (CCQ). BMC Pulm Med 2012; 12:20. [PMID: 22607459 PMCID: PMC3431277 DOI: 10.1186/1471-2466-12-20] [Citation(s) in RCA: 114] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Accepted: 05/03/2012] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Health status provides valuable information, complementary to spirometry and improvement of health status has become an important treatment goal in COPD management. We compared the usefulness and validity of the COPD Assessment Test (CAT) and the Clinical COPD Questionnaire (CCQ), two simple questionnaires, in comparison with the St. George Respiratory Questionnaire (SGRQ). METHODS We administered the CAT, CCQ and SGRQ in patients with COPD stage I-IV during three visits. Spirometry, 6 MWT, MRC scale, BODE index, and patients perspectives on questionnaires were recorded in all visits. Standard Error of Measurement (SEM) was used to calculate the Minimal Clinical Important Difference (MCID) of all questionnaires. RESULTS We enrolled 90 COPD patients. Cronbach's alpha for both CAT and CCQ was high (0.86 and 0.89, respectively). Patients with severe COPD reported worse health status compared to milder subgroups. CAT and CCQ correlated significantly (rho =0.64, p < 0.01) and both with the SGRQ (rho = 0.65; CAT and rho = 0.77; CCQ, p < 0.01). Both questionnaires exhibited a weak correlation with lung function (rho = -0.35;CAT and rho = -0.41; CCQ, p < 0.01). Their reproducibility was high; CAT: ICC = 0.94 (CI 0.92-0.96), total CCQ ICC = 0.95 (0.92-0.96) and SGRQ = 0.97 (CI 0.95-0.98). The MCID calculated using the SEM method showed results similar to previous studies of 3.76 for the CAT, 0.41 for the CCQ and 4.84 for SGRQ. Patients suggested both CAT and CCQ as easier tools than SGRQ in terms of complexity and time considerations. More than half of patients preferred CCQ instead of CAT. CONCLUSIONS The CAT and CCQ have similar psychometric properties with a slight advantage for CCQ based mainly on patients' preference and are both valid and reliable questionnaires to assess health status in COPD patients.
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Affiliation(s)
- Ioanna G Tsiligianni
- Department of Thoracic Medicine, Medical School, University of Crete, Heraklion, Crete, P.O 71003, Greece
- Department of General Practice, University Medical Centre Groningen, Antonius Deusinglaan 1, P.O 9700 AD, Groningen, The Netherlands
- GRIAC research institute, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 1, P.O 9700 AD, Groningen, The Netherlands
| | - Thys van der Molen
- Department of General Practice, University Medical Centre Groningen, Antonius Deusinglaan 1, P.O 9700 AD, Groningen, The Netherlands
- GRIAC research institute, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 1, P.O 9700 AD, Groningen, The Netherlands
| | - Despoina Moraitaki
- Department of Thoracic Medicine, Medical School, University of Crete, Heraklion, Crete, P.O 71003, Greece
| | - Ilaine Lopez
- Department of General Practice, University Medical Centre Groningen, Antonius Deusinglaan 1, P.O 9700 AD, Groningen, The Netherlands
- GRIAC research institute, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 1, P.O 9700 AD, Groningen, The Netherlands
| | - Janwillem WH Kocks
- Department of General Practice, University Medical Centre Groningen, Antonius Deusinglaan 1, P.O 9700 AD, Groningen, The Netherlands
- GRIAC research institute, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 1, P.O 9700 AD, Groningen, The Netherlands
| | - Konstantinos Karagiannis
- Department of Thoracic Medicine, Medical School, University of Crete, Heraklion, Crete, P.O 71003, Greece
| | - Nikolaos Siafakas
- Department of Thoracic Medicine, Medical School, University of Crete, Heraklion, Crete, P.O 71003, Greece
| | - Nikolaos Tzanakis
- Department of Thoracic Medicine, Medical School, University of Crete, Heraklion, Crete, P.O 71003, Greece
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Ashworth AJ. Enhanced recovery from respiratory infection following treatment with a PDE-5 inhibitor: a single case study. PRIMARY CARE RESPIRATORY JOURNAL : JOURNAL OF THE GENERAL PRACTICE AIRWAYS GROUP 2012; 21:17. [PMID: 22382866 DOI: 10.4104/pcrj.2012.00016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Luoni C, Bisulli F, Canevini MP, De Sarro G, Fattore C, Galimberti CA, Gatti G, La Neve A, Muscas G, Specchio LM, Striano S, Perucca E. Determinants of health-related quality of life in pharmacoresistant epilepsy: results from a large multicenter study of consecutively enrolled patients using validated quantitative assessments. Epilepsia 2012; 52:2181-91. [PMID: 22136077 DOI: 10.1111/j.1528-1167.2011.03325.x] [Citation(s) in RCA: 193] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE To evaluate the relative contribution of demographic and epilepsy-related variables, depressive symptoms, and adverse effects (AEs) of antiepileptic drugs (AEDs) to health-related quality of life (HRQOL) in adults with pharmacoresistant epilepsy. METHODS Individuals with epilepsy whose seizures failed to respond to at least one AED were enrolled consecutively at 11 tertiary referral centers. HRQOL was assessed by the Quality of Life in Epilepsy Inventory-31 (QOLIE-31), AEs by the Adverse Event Profile (AEP), and depressive symptoms by the Beck Depression Inventory-II (BDI-II). Multivariate linear regression models were used to identify variables associated with QOLIE-31 total score and subscale scores. KEY FINDINGS Of 933 enrolled individuals aged 16 years or older, 809 (87%) were able to complete the self-assessment instruments and were included in the analysis. Overall, 61% of the variance in QOLIE-31 scores was explained by the final model. The strongest predictors of HRQOL were AEP total scores (β = -0.451, p < 0.001) and BDI-II scores (β = -0.398, p < 0.001). These factors were also the strongest predictors of scores in each of the seven QOLIE-31 subscales. Other predictors of HRQOL were age (β = -0.060, p = 0.008), lack of a driving license (β = -0.053, p = 0.018), pharmacoresistance grade, with higher HRQOL in individuals who had failed only one AED (β = 0.066, p = 0.004), and location of the enrolling center. Epilepsy-related variables (seizure frequency, occurrence of tonic-clonic seizures, age of epilepsy onset, disease duration) and number of AEDs had no significant predictive value on HRQOL. The AEP total score was the strongest negative predictor of HRQOL in the subgroup of 362 patients without depressive symptoms (BDI-II score <10), but even in this subgroup the BDI-II score was retained as a significant predictor. SIGNIFICANCE In individuals with pharmacoresistant epilepsy, AEs of medication and depressive symptoms are far more important determinants of HRQOL than seizures themselves. When seizure freedom cannot be achieved, addressing depressive comorbidity and reducing the burden of AED toxicity is likely to be far more beneficial than interventions aimed at reducing the frequency of seizures.
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Affiliation(s)
- Chiara Luoni
- Clinical Pharmacology Unit, University of Pavia, Pavia, Italy
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Dalal AA, Shah M, D'Souza AO, Chaudhari S, Crater G. Clinical and economic outcomes for patients initiating fluticasone propionate/salmeterol combination therapy (250/50 mcg) versus anticholinergics in a comorbid COPD/depression population. Int J Chron Obstruct Pulmon Dis 2012; 7:11-9. [PMID: 22315518 PMCID: PMC3273366 DOI: 10.2147/copd.s27846] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) is frequently associated with comorbid depression and anxiety. Managing COPD symptoms and exacerbations through use of appropriate and adequate pharmacotherapy in this population may result in better COPD-related outcomes. Methods This retrospective, observational study used administrative claims of patients aged 40 years and older with COPD and comorbid depression/anxiety identified from January 1, 2004 through June 30, 2008. Patients were assigned to fluticasone propionate/salmeterol 250/50 mcg combination (FSC) or anticholinergics (AC) based on their first (index) prescription. The risks of COPD exacerbations and healthcare utilization and costs were compared between cohorts during 1 year of follow-up. Results The adjusted risk of a COPD-related exacerbation during the 1-year follow-up period was 30% higher in the AC cohort (n = 2923) relative to the FSC cohort (n = 1078) (odds ratio [OR]: 1.30, 95% confidence interval [CI]: 1.08–1.56) after controlling for baseline differences in covariates. The risks of COPD-related hospitalizations and emergency department visits were 56% and 65% higher, respectively, in the AC cohort compared with the FSC cohort. The average number of COPD-related hospitalizations during the follow-up period was 46% higher for the AC cohort compared with the FSC cohort (incidence rate ratio [IRR]: 1.46, 95% CI: 1.01–2.09, P = 0.041). The savings from lower COPD-related medical costs ($692 vs $1042, P < 0.050) kept the COPD-related total costs during the follow-up period comparable to those in the AC cohort ($1659 vs $1677, P > 0.050) although the pharmacy costs were higher in the FSC cohort. Conclusions FSC compared with AC was associated with more favorable COPD-related outcomes and lower COPD-related utilization and medical costs among patients with COPD and comorbid anxiety/depression.
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