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Vaezi A, Mirsaeidi M. Proposing the potential of utilizing the CAT score for early detection of COPD in asymptomatic patients, shifting towards a patient-centered approach: A review. Medicine (Baltimore) 2024; 103:e37715. [PMID: 38608107 PMCID: PMC11018188 DOI: 10.1097/md.0000000000037715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 03/04/2024] [Indexed: 04/14/2024] Open
Abstract
Chronic obstructive pulmonary disease (COPD) constitutes a significant public health challenge, with delayed diagnosis and underdiagnosis being pervasive issues. The United States Preventive Service Task Force recommends restricting COPD screening to symptomatic smokers, a focus that has exhibited limitations, leading to delayed diagnoses, and imposing a substantial burden on patients, their families, and the healthcare system. This paper explores an alternative approach, highlighting the potential utility of the COPD assessment test (CAT) score as a prescreening tool. A CAT score of 10 or higher could serve as an appropriate threshold for further diagnostic procedures, given its robust correlation with pulmonary function test parameters and is valuable capacity to quantify patients' symptoms. The utilization of CAT as a prescreening tool in primary care signifies a transition towards a more patient-centered and comprehensive approach to COPD diagnosis and care.
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Affiliation(s)
- Atefeh Vaezi
- Division of Pulmonary, Critical Care, and Sleep Medicine, College of Medicine-Jacksonville, University of Florida, Jacksonville, FL
| | - Mehdi Mirsaeidi
- Division of Pulmonary, Critical Care, and Sleep Medicine, College of Medicine, University of Florida, Jacksonville, FL
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2
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Jenkins AR, Groenen MTJ, Vaes AW, Janssen DJA, Wouters EFM, Franssen FME, Spruit MA. Baseline dependent minimally important differences for clinical outcomes of pulmonary rehabilitation in people with COPD. Pulmonology 2024; 30:24-33. [PMID: 37455240 DOI: 10.1016/j.pulmoe.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 06/12/2023] [Accepted: 06/13/2023] [Indexed: 07/18/2023] Open
Abstract
INTRODUCTION Minimally important differences (MIDs) for common outcomes of pulmonary rehabilitation are well documented for people with chronic obstructive pulmonary disease (COPD). It is not known whether MIDs differ based on COPD disease characteristics. This study aimed to estimate MIDs for clinical outcomes of pulmonary rehabilitation dependent upon baseline characteristics. METHODS A database containing 2791 people with COPD was split into derivation (n=2245; age 66±9 years; 50% males; FEV1 47±20% predicted) and comparator (n=546; age 66±9 years; 47% males; FEV1 46±21% predicted) cohorts. MIDs were estimated using 0.5 x SD (symmetrically distributed) or 0.5 x IQR (non-symmetrically distributed) for: 6-minute walk test (6MWT), constant work rate test (CWRT), COPD assessment test (CAT), St. George's respiratory questionnaire (SGRQ), hospital anxiety and depression scale (HADS), and fat-free mass index (FFMI). MIDs were estimated based on baseline outcome scores, lung function, modified medical research council (mMRC) grade and FFMI. RESULTS MID estimates were comparable to previously reported values. MIDs for SGRQ domains (Symptom=8.7 points, Activity=7.1 points, Impact=8.1 points) and FFMI were produced (0.36kg/m2). There was greater variation of change in 6MWT, SGRQ-activity, SGRQ-impact, HADS and FFMI on which the MIDs were determined when categorising for baseline values (all, p<0.05). Greater variation of change in 6MWT on which the MIDs were determined was evident with COPD disease severity grouping (p<0.05). The magnitude of change in 6MWT, CAT, CWRT, SGRQ-activity, and FFMI with baseline mMRC score categorisation resulted in greater variation on which the MIDs were determined (all, p<0.05). Baseline stratification for FFMI resulted in greater variation of change in CWRT (p<0.001) and HADS-depression (p = 0.043) on which MIDs were determined. DISCUSSION Findings suggest that baseline presentation should be considered for people with COPD when assessing the efficacy of pulmonary rehabilitation. However, clinical significance of the variation underpinning MIDs is yet to be determined.
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Affiliation(s)
- A R Jenkins
- Clinical Exercise and Respiratory Physiology Laboratory, Dept of Kinesiology and Physical Education, Faculty of Education, McGill University, Montreal, QC, Canada.
| | - M T J Groenen
- Department of Research and Development, Ciro, Horn, the Netherlands
| | - A W Vaes
- Department of Research and Development, Ciro, Horn, the Netherlands
| | - D J A Janssen
- Department of Research and Development, Ciro, Horn, the Netherlands; Department of Health Services Research, Care and Public Health Research Institute, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - E F M Wouters
- Department of Research and Development, Ciro, Horn, the Netherlands; Department of Respiratory Medicine, Maastricht University Medical Centre, NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - F M E Franssen
- Department of Research and Development, Ciro, Horn, the Netherlands; Department of Respiratory Medicine, Maastricht University Medical Centre, NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - M A Spruit
- Department of Research and Development, Ciro, Horn, the Netherlands; Department of Respiratory Medicine, Maastricht University Medical Centre, NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
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Quadflieg K, Machado A, de Lima FF, Dederen A, Daenen M, Ruttens D, Thomeer M, Spruit MA, Burtin C. Physical status, symptoms and health-related quality of life during a severe exacerbation of COPD: Recovery and discriminative capacity for future events. Respir Med 2023; 220:107437. [PMID: 37918543 DOI: 10.1016/j.rmed.2023.107437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 10/20/2023] [Accepted: 10/22/2023] [Indexed: 11/04/2023]
Abstract
OBJECTIVE Severe acute exacerbations of chronic obstructive pulmonary disease (AECOPD) can have a negative impact on functional capacity, symptoms and health-related quality of life (HRQOL). This study aimed to i) investigate the recovery of muscle strength, functional capacity, symptoms, and HRQOL in patients after a severe AECOPD; ii) compare with matched patients with stable COPD (SCOPD); and iii) assess whether these assessments at hospital discharge could discriminate patients' risk for future events. METHODS This observational study assessed patients with AECOPD during hospital discharge (T1) and one month after discharge (T2). Patients with SCOPD were assessed once. Quadriceps force, handgrip strength, short physical performance battery (SPPB), 6-min walk distance (6 MWD), COPD assessment test (CAT), London chest activity of daily living (LCADL), modified medical research council, checklist individual strength-fatigue, patient health questionnaire, and physical activity (Actigraph) were measured. Exacerbation-related readmission and mortality within six months and 1-year were collected. RESULTS Forty-four patients with AECOPD were matched with 44 patients with SCOPD. At T2, a significant improvement was found for the SPPB total score, 6 MWD, CAT score, and LCADL score. Compared to patients with SCOPD, a worse LCADL score was found at T2 in patients with AECOPD. Patients with AECOPD that were readmitted or died had a worse SPPB classification and five-repetition sit-to-stand test at T1. CONCLUSION Patients after severe AECOPD improved in functional capacity and HRQOL one month after hospital discharge, but ADL performance was still worse compared to SCOPD. Patients who were readmitted or died had significantly worse scores on functional tests at hospital discharge.
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Affiliation(s)
- Kirsten Quadflieg
- REVAL - Rehabilitation Research Center, BIOMED - Biomedical Research Institute, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
| | - Ana Machado
- REVAL - Rehabilitation Research Center, BIOMED - Biomedical Research Institute, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium; Respiratory Research and Rehabilitation Laboratory (Lab 3R), School of Health Sciences (ESSUA), Institute of Biomedicine (iBiMED), Department of Medical Sciences, University of Aveiro, Aveiro, Portugal
| | - Fabiano Francisco de Lima
- REVAL - Rehabilitation Research Center, BIOMED - Biomedical Research Institute, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium; Department of Physical Therapy, SãoPaulo State University (UNESP), Presidente Prudente, Brazil
| | - Anand Dederen
- Department Lung Diseases, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Marc Daenen
- Department Lung Diseases, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - David Ruttens
- Department Lung Diseases, Ziekenhuis Oost-Limburg, Genk, Belgium; Faculty of Medicine and Life Sciences, Hasselt University, Genk, Belgium
| | - Michiel Thomeer
- Department Lung Diseases, Ziekenhuis Oost-Limburg, Genk, Belgium; Faculty of Medicine and Life Sciences, Hasselt University, Genk, Belgium
| | - Martijn A Spruit
- CIRO, Center of Expertise for Chronic Organ Failure, Department of Research and Education, Horn, the Netherlands; Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Chris Burtin
- REVAL - Rehabilitation Research Center, BIOMED - Biomedical Research Institute, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium.
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Kirui BK, Santosa A, Vanfleteren LE, Li H, Franzén S, Stridsman C, Nyberg F. Pre- and post-vaccination characteristics and risk factors for COVID-19 outcomes in a Swedish population-based cohort of COPD patients. ERJ Open Res 2023; 9:00711-2022. [PMID: 37377661 PMCID: PMC10291311 DOI: 10.1183/23120541.00711-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 05/09/2023] [Indexed: 06/29/2023] Open
Abstract
Rationale Evidence on risk factors for Coronavirus disease 2019 (COVID-19) outcomes among patients with COPD in relation to COVID-19 vaccination remains limited. The objectives of the present study were to characterise determinants of COVID-19 infection, hospitalisation, intensive care unit (ICU) admission and death in COPD patients in their unvaccinated state compared to when vaccinated. Methods We included all COPD patients in the Swedish National Airway Register (SNAR). Events of COVID-19 infection (test and/or healthcare encounter), hospitalisation, ICU admission and death were identified from 1 January 2020 to 30 November 2021. Using adjusted Cox regression, associations between baseline sociodemographics, comorbidities, treatments, clinical measurements and COVID-19 outcomes, during unvaccinated and vaccinated follow-up time, were analysed. Results The population-based COPD cohort included 87 472 patients, among whom 6771 (7.7%) COVID-19 infections, 2897 (3.3%) hospitalisations, 233 (0.3%) ICU admissions and 882 (1.0%) COVID-19 deaths occurred. During unvaccinated follow-up, risk of COVID-19 hospitalisation and death increased with age, male sex, lower education, non-married status and being foreign-born. Comorbidities increased risk of several outcomes, e.g. respiratory failure for infection and hospitalisation (adjusted hazard ratios (HR) 1.78, 95% CI 1.58-2.02 and 2.51, 2.16-2.91, respectively), obesity for ICU admission (3.52, 2.29-5.40) and cardiovascular disease for mortality (2.80, 2.16-3.64). Inhaled COPD therapy was associated with infection, hospitalisation and death. COPD severity was also associated with COVID-19, especially hospitalisation and death. Although the risk factor panorama was similar, COVID-19 vaccination attenuated HRs for some risk factors. Conclusion This study provides population-based evidence on predictive risk factors for COVID-19 outcomes and highlights the positive implications of COVID-19 vaccination for COPD patients.
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Affiliation(s)
- Brian K. Kirui
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ailiana Santosa
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lowie E.G.W. Vanfleteren
- COPD Center, Department of Respiratory Medicine and Allergology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Huiqi Li
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Stefan Franzén
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- National Diabetes Register, Centre of Registers Västra Götaland, Gothenburg, Sweden
| | - Caroline Stridsman
- Department of Public Health and Clinical Medicine, Division of Medicine/The OLIN-unit, Umeå University, Umeå, Sweden
| | - Fredrik Nyberg
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Souto-Miranda S, Rocha V, Mendes MA, Simão P, Martins V, Spruit MA, Marques A. The presence of extra-pulmonary treatable traits increases the likelihood of responding to pulmonary rehabilitation. Respir Med 2023; 206:107086. [PMID: 36516547 DOI: 10.1016/j.rmed.2022.107086] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 11/10/2022] [Accepted: 12/05/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Studies suggest that people with chronic obstructive pulmonary disease (COPD) who are worse at baseline respond better to pulmonary rehabilitation (PR). Identifying treatable traits (TTs) may help to distinguish responders from non-responders. We explored the impact of PR on extra-pulmonary traits of people with COPD and whether the presence of TT influences the type of response to PR. METHODS A comprehensive assessment of 9 TT including symptoms (dyspnoea, fatigue, anxiety and depression), functional capacity, deconditioning, balance, impact of the disease and health-related quality of life was conducted before and after a 12-week community-based PR programme. Pre-post differences between people with or without each TT at baseline were compared with independent samples t-tests or Mann-Whitney U tests. Proportion of responders between groups were explored with chi-square tests and odds ratio. RESULTS 102 people with COPD were included (70 [65; 75] years old, 78% male, FEV1 47 [36; 60] %predicted). They had a median of 3 (out of 9) TTs per person and each patient responded on average to 5 (out of 9) outcomes of PR. People with TT were more responsive than those without them in all outcomes (p < 0.05) except for the 1-min sit-to-stand test. The presence of TT increased 4 to 20 times the likelihood of being a good responder. CONCLUSIONS Identification of baseline extra-pulmonary TT in people with COPD showed the potential to inform on PR responsiveness and might therefore be an important strategy for patient prioritization, treatment personalisation (i.e., activation of the most suitable components) and optimisation.
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Affiliation(s)
- Sara Souto-Miranda
- Respiratory Research and Rehabilitation Laboratory (Lab3R), School of Health Sciences (ESSUA), University of Aveiro, Aveiro, Portugal; Institute of Biomedicine (iBiMED), University of Aveiro, Aveiro, Portugal; Department of Medical Sciences (DCM), University of Aveiro, Aveiro, Portugal; Department of Respiratory Medicine, Maastricht University Medical Centre, NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands.
| | - Vânia Rocha
- Respiratory Research and Rehabilitation Laboratory (Lab3R), School of Health Sciences (ESSUA), University of Aveiro, Aveiro, Portugal; Institute of Biomedicine (iBiMED), University of Aveiro, Aveiro, Portugal.
| | - Maria Aurora Mendes
- Respiratory Research and Rehabilitation Laboratory (Lab3R), School of Health Sciences (ESSUA), University of Aveiro, Aveiro, Portugal; Pulmonology Department, Centro Hospitalar do Baixo Vouga (CHBV) E.P.E, Aveiro, Portugal
| | - Paula Simão
- Unidade Local de Saúde de Matosinhos, Matosinhos, Porto, Portugal.
| | - Vitória Martins
- Pulmonology Department, Hospital Distrital da Figueira da Foz, Figueira da Foz, Portugal.
| | - Martijn A Spruit
- Department of Respiratory Medicine, Maastricht University Medical Centre, NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands; Department of Research and Development, Ciro, Horn, the Netherlands
| | - Alda Marques
- Respiratory Research and Rehabilitation Laboratory (Lab3R), School of Health Sciences (ESSUA), University of Aveiro, Aveiro, Portugal; Institute of Biomedicine (iBiMED), University of Aveiro, Aveiro, Portugal.
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Kahnert K, Fischer C, Alter P, Trudzinski F, Welte T, Behr J, Herth F, Kauczor HU, Bals R, Watz H, Rabe K, Söhler S, Kokot I, Vogelmeier C, Jörres R. [What have we learned from the German COPD cohort COSYCONET and where do we go from here?]. Pneumologie 2022; 77:81-93. [PMID: 36526266 PMCID: PMC9931494 DOI: 10.1055/a-1966-0848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
COSYCONET 1 is the only German COPD cohort which is large enough to be internationally comparable. The recruitment, which started in 2010 and ended in December 2013, comprised 2741 patients with the diagnosis of COPD who were subsequently investigated in regular follow-up visits. All visits included a comprehensive functional and clinical characterisation. On the basis of this detailed data set, it was possible to address a large number of clinical questions. These questions ranged from the prescription of medication, the detailed analysis of comorbidities, in particular cardiovascular disease, and biomarker assessment to radiological and health-economic aspects. Currently, more than 60 publications of COSYCONET data are internationally available. The present overview provides a description of all the results that were obtained, focussing on the relationship between different clinical and functional aspects as well as their potential practical consequences. In addition, information on the follow-up study COSYCONET 2 is given.
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Affiliation(s)
- Kathrin Kahnert
- 27192Medizinische Klinik und Poliklinik V, Klinikum der Universitat München LMU, Comprehensive Pneumology Center, Member of the German Center for Lung Research (DZL), München, Deutschland,Korrespondenzadresse PD Dr. med. Kathrin Kahnert Klinikum der Universität München LMU, Medizinische Klinik VZiemssenstr. 180336 MünchenDeutschland
| | - Carolina Fischer
- 27192Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Institut und Poliklinik für Arbeits-, Sozial- und Umweltmedizin, Ludwig-Maximilians-Universität München, München, Deutschland
| | - Peter Alter
- 9377Klinik für Pneumologie, Philipps-Universitat Marburg, Member of the German Center for Lung Research (DZL), Marburg, Deutschland
| | - Franziska Trudzinski
- 14996Thoraxklinik-Heidelberg gGmbH, Translational Lung
Research Centre Heidelberg (TLRC), Member of the German Center for Lung
Research, Heidelberg, Deutschland
| | - Tobias Welte
- 9177Klinik für Pneumologie, Medizinische Hochschule Hannover, Member of the German Center of Lung Research (DZL), Hannover, Deutschland
| | - Jürgen Behr
- 27192Medizinische Klinik und Poliklinik V, Klinikum der Universitat München LMU, Comprehensive Pneumology Center, Member of the German Center for Lung Research (DZL), München, Deutschland
| | - Felix Herth
- 14996Thoraxklinik-Heidelberg gGmbH, Translational Lung
Research Centre Heidelberg (TLRC), Member of the German Center for Lung
Research, Heidelberg, Deutschland
| | - Hans-Ulrich Kauczor
- 27178Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Heidelberg, Translational Lung Research Centre Heidelberg (TLRC), Member of the German Center for Lung Research, Heidelberg, Deutschland
| | - Robert Bals
- 39072Innere Medizin V – Pulmonologie, Allergologie, Beatmungs-und Umweltmedizin, Universitätsklinikum des Saarlandes, Associated member of the Germen Center of Lung Research (DZL), Homburg, Deutschland,9377Helmholtz Institute for Pharmaceutical Research Saarland (HIPS), Helmholtz Centre for Infection Research (HZI), Saarland University Campus, Saarbrücken, Deutschland
| | - Henrik Watz
- 9213Pulmonary Research Institute, LungenClinic Grosshansdorf, Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Grosshansdorf, Deutschland
| | - Klaus Rabe
- 9213Pulmonary Research Institute, LungenClinic Grosshansdorf, Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Grosshansdorf, Deutschland,98594Medizinische Fakultät, Christian-Albrechts Universität zu Kiel, Kiel, Deutschland
| | - Sandra Söhler
- 9377Klinik für Pneumologie, Philipps-Universitat Marburg, Member of the German Center for Lung Research (DZL), Marburg, Deutschland
| | - Inge Kokot
- 9377Klinik für Pneumologie, Philipps-Universitat Marburg, Member of the German Center for Lung Research (DZL), Marburg, Deutschland
| | - Claus Vogelmeier
- 9377Klinik für Pneumologie, Philipps-Universitat Marburg, Member of the German Center for Lung Research (DZL), Marburg, Deutschland
| | - Rudolf Jörres
- 27192Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Institut und Poliklinik für Arbeits-, Sozial- und Umweltmedizin, Ludwig-Maximilians-Universität München, München, Deutschland
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Farver-Vestergaard I, Rubio-Rask S, Timm S, Christiansen CF, Hilberg O, Løkke A. Disease-Specific Anxiety in Chronic Obstructive Pulmonary Disease: Translation and Initial Validation of a Questionnaire. Front Psychol 2022; 13:907939. [PMID: 35865679 PMCID: PMC9294537 DOI: 10.3389/fpsyg.2022.907939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 06/20/2022] [Indexed: 11/13/2022] Open
Abstract
Background Commonly applied measures of symptoms of anxiety are not sensitive to disease-specific anxiety in patients with chronic obstructive pulmonary disease (COPD). There is a need for validated instruments measuring COPD-specific anxiety. Therefore, we translated the COPD-Anxiety Questionnaire (CAF) into Danish (CAF-R-DK) and performed an initial validation of the psychometric properties in a sample of patients with COPD. Materials and Methods Translation procedures followed the World Health Organization guidelines. Participants with COPD completed questionnaires measuring COPD-specific anxiety (CAF-R-DK), general psychological distress (Hospital Anxiety and Depression Scale) as well as variables related to COPD (COPD Assessment Test; modified Medical Research Council dyspnea scale), quality of life (the 12-item Short Form survey, SF12), and socio-demography. Results A total of 260 patients with COPD (mean age: 65.0, 69% female) completed questionnaires. The Danish version of CAF-R-DK demonstrated acceptable Cronbach’s α values that were comparable with those of the original CAF. As expected, the CAF-R-DK showed positive correlations with convergent constructs (CAT; HADS) and negative correlations with discriminant constructs (SF-12). However, the results for specific subdomains of the CAF-R-DK indicated inconsistency in the underlying concept of disease-specific anxiety, which was also suggested based on the subsequent confirmatory and exploratory factor analyzes. Conclusion The CAF could serve as an important supplement to generic psychological distress screening of patients with COPD in somatic health care settings, and the questionnaire is now available in Danish. Translation into other languages is needed with the purpose of obtaining data for further testing the psychometric properties of the questionnaire.
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Affiliation(s)
| | | | - Signe Timm
- Research Unit, Lillebaelt Hospital, Kolding, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | | | - Ole Hilberg
- Department of Medicine, Lillebaelt Hospital, Vejle, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Anders Løkke
- Department of Medicine, Lillebaelt Hospital, Vejle, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
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Souto-Miranda S, van ‘t Hul AJ, Vaes AW, Antons JC, Djamin RS, Janssen DJA, Franssen FME, Marques A, Spruit MA. Differences in Pulmonary and Extra-Pulmonary Traits between Women and Men with Chronic Obstructive Pulmonary Disease. J Clin Med 2022; 11:jcm11133680. [PMID: 35806965 PMCID: PMC9267757 DOI: 10.3390/jcm11133680] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 06/11/2022] [Accepted: 06/23/2022] [Indexed: 02/04/2023] Open
Abstract
Background: Evidence suggests sex-related differences in chronic obstructive pulmonary disease (COPD). Whether these differences are reflected in the prevalence of treatable traits remains unknown. Methods: Two samples of patients referred to secondary (n = 530) or tertiary care (n = 2012) were analyzed. Men and women were matched for age, forced expiratory volume in 1 s and body mass index. Sex-related differences were tested using t-tests, Mann-Whitney U, or chi-square tests. Results: Frequent exacerbations (30.5 vs. 19.7%), high cardiovascular risk (88.1 vs. 66.2%) and activity-related severe dyspnea (50.9 vs. 34.8%) were more prevalent in women in secondary care (p < 0.05). Severe hyperinflation (43.0 vs. 25.4%), limited diffusing capacity (79.6 vs. 70.1%), impaired mobility (44.0 vs. 28.7%), frequent exacerbations (66.8 vs. 57.4%), frequent hospitalizations (47.5 vs. 41.6%), severe activity-related dyspnea (89.1 vs. 85.0%), symptoms of anxiety (56.3 vs. 42.0%) and depression (50.3 vs. 44.8%), and poor health status (79.9 vs. 71.0%) were more prevalent in women in tertiary care (p < 0.05). Severe inspiratory muscle weakness (14.6 vs. 8.2%) and impaired exercise capacity (69.1 vs. 59.6%) were more prevalent among men (p < 0.05) in tertiary care. Conclusions: Sex-related differences were found, with most traits more prevalent and severe among women. Care providers should be aware of these differences to adjust treatment.
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Affiliation(s)
- Sara Souto-Miranda
- Department of Research and Development, Ciro, 6085 NM Horn, The Netherlands; (A.W.V.); (D.J.A.J.); (F.M.E.F.); (M.A.S.)
- Respiratory Research and Rehabilitation Laboratory (Lab3R) and Institute of Biomedicine (iBiMED), University of Aveiro, 3810-193 Aveiro, Portugal;
- Department of Respiratory Medicine, Maastricht University Medical Centre, NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht University, 6229 ER Maastricht, The Netherlands
- Correspondence:
| | - Alex J. van ‘t Hul
- Department of Respiratory Diseases, Radboud Institute for Health Sciences, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (A.J.v.‘t.H.); (J.C.A.)
| | - Anouk W. Vaes
- Department of Research and Development, Ciro, 6085 NM Horn, The Netherlands; (A.W.V.); (D.J.A.J.); (F.M.E.F.); (M.A.S.)
| | - Jeanine C. Antons
- Department of Respiratory Diseases, Radboud Institute for Health Sciences, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (A.J.v.‘t.H.); (J.C.A.)
| | - Remco S. Djamin
- Department of Respiratory Diseases, Amphia Hospital, 4818 CK Breda, The Netherlands;
| | - Daisy J. A. Janssen
- Department of Research and Development, Ciro, 6085 NM Horn, The Netherlands; (A.W.V.); (D.J.A.J.); (F.M.E.F.); (M.A.S.)
- Department of Health Services Research, Care and Public Health Research Institute, Faculty of Health Medicine and Life Sciences, Maastricht University, 6226 NB Maastricht, The Netherlands
| | - Frits M. E. Franssen
- Department of Research and Development, Ciro, 6085 NM Horn, The Netherlands; (A.W.V.); (D.J.A.J.); (F.M.E.F.); (M.A.S.)
- Department of Respiratory Medicine, Maastricht University Medical Centre, NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht University, 6229 ER Maastricht, The Netherlands
| | - Alda Marques
- Respiratory Research and Rehabilitation Laboratory (Lab3R) and Institute of Biomedicine (iBiMED), University of Aveiro, 3810-193 Aveiro, Portugal;
| | - Martijn A. Spruit
- Department of Research and Development, Ciro, 6085 NM Horn, The Netherlands; (A.W.V.); (D.J.A.J.); (F.M.E.F.); (M.A.S.)
- Department of Respiratory Medicine, Maastricht University Medical Centre, NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht University, 6229 ER Maastricht, The Netherlands
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9
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Stoffels AA, Meys R, van Hees HW, Franssen FM, van den Borst B, van ’t Hul AJ, Klijn PH, Vaes AW, De Brandt J, Burtin C, Spruit MA. Isokinetic testing of quadriceps function in COPD: feasibility, responsiveness, and minimal important differences in patients undergoing pulmonary rehabilitation. Braz J Phys Ther 2022; 26:100451. [PMID: 36288671 PMCID: PMC9593178 DOI: 10.1016/j.bjpt.2022.100451] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 09/09/2022] [Accepted: 10/03/2022] [Indexed: 11/26/2022] Open
Abstract
Evaluation of isokinetic quadriceps testing in COPD is needed to assess its efficacy. Isokinetic testing was performed incorrectly in a quarter of patients with COPD. Quadriceps peak torque and total work improved following pulmonary rehabilitation. Minimal important differences for peak torque and total work were determined.
Background Isokinetic testing of peripheral muscle function is valid and reliable in patients with chronic obstructive pulmonary disease (COPD). Objective To evaluate whether and to what extent isokinetic testing of quadriceps function meets pre-defined test criteria in patients with COPD; to determine the response to pulmonary rehabilitation (PR), and to calculate minimal important differences (MIDs) of isokinetic quadriceps function. Methods Retrospective analysis of 2033 patients with COPD (age: 65±9 years, body mass index: 26±6 kg/m2, FEV1: 49±22% predicted) who followed a comprehensive PR program. Pre and post PR isokinetic quadriceps function was assessed with 30 maximal extension-flexion contractions at an angular speed of 90°/s on a computerized dynamometer. The chosen anchors were 6-min walk test and COPD assessment test. Results Pre PR, 27% of the patients performed the isokinetic test incorrectly. In male and female patients with a correct pre and post PR isokinetic test, peak torque (Δ=10±13 Nm or 9% and Δ=7±9 Nm or 10%, respectively) and total work (Δ=263±270 J or 14% and Δ=198±190 J or 15%, respectively) improved significantly. There was no change in work fatigue index following PR. Using distribution-based calculations, MID estimates for peak torque and total work ranged between 6–7 Nm and 97–135 J in males and between 4–5 Nm and 62–99 J in females. Conclusions Based on the current test criteria, three in four patients with COPD performed the isokinetic quadriceps test correctly during baseline PR assessment. Furthermore, peak torque and total work, but not work fatigue index, were responsive to PR and sex-specific MIDs were established.
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Affiliation(s)
- Anouk A.F. Stoffels
- Department of Pulmonary Diseases, Radboud University Medical Center, Nijmegen, the Netherlands,Department of Research and Development, Ciro, Horn, the Netherlands,Nutrim School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands,Corresponding author at: Department of Pulmonary Diseases, Radboud University Medical Center, 6500 HB Nijmegen, the Netherlands
| | - Roy Meys
- Department of Research and Development, Ciro, Horn, the Netherlands,Nutrim School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands,Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands
| | | | - Frits M.E. Franssen
- Department of Research and Development, Ciro, Horn, the Netherlands,Nutrim School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands,Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands
| | - Bram van den Borst
- Department of Pulmonary Diseases, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Alex J. van ’t Hul
- Department of Pulmonary Diseases, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Peter H. Klijn
- Department of Pulmonology, Merem Pulmonary Rehabilitation Centre, Hilversum, the Netherlands,Department of Pulmonary Medicine, Amsterdam UMC, Amsterdam, the Netherlands
| | - Anouk W. Vaes
- Department of Research and Development, Ciro, Horn, the Netherlands
| | - Jana De Brandt
- REVAL–Rehabilitation Research Center, BIOMED–Biomedical Research Institute, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
| | - Chris Burtin
- REVAL–Rehabilitation Research Center, BIOMED–Biomedical Research Institute, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
| | - Martijn A. Spruit
- Department of Research and Development, Ciro, Horn, the Netherlands,Nutrim School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands,Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands
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10
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Stöber A, Lutter JI, Schwarzkopf L, Kirsch F, Schramm A, Vogelmeier CF, Leidl R. Impact of Lung Function and Exacerbations on Health-Related Quality of Life in COPD Patients Within One Year: Real-World Analysis Based on Claims Data. Int J Chron Obstruct Pulmon Dis 2021; 16:2637-2651. [PMID: 34588773 PMCID: PMC8473986 DOI: 10.2147/copd.s313711] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 08/04/2021] [Indexed: 01/05/2023] Open
Abstract
PURPOSE Real-world evidence on the impact of forced expiratory volume in one second (FEV1) and exacerbations on health-related quality of life (HRQoL) in patients with chronic obstructive pulmonary disease (COPD) is sparse especially with regard to GOLD ABCD groups. This study investigates how changes in FEV1 and exacerbations affect generic and disease-specific HRQoL in COPD patients over one year. METHODS Using German claims data and survey data, we classified 3016 COPD patients and analyzed their health status by GOLD groups AB and CD. HRQoL was measured with the disease-specific COPD assessment test (CAT) and the visual analog scale (VAS) from the generic Euro-Qol 5D-5L. We applied change score models to assess associations between changes in FEV1 (≥100 mL decrease/no change/≥100 mL increase) or the development of severe exacerbations with change in HRQoL. RESULTS FEV1 decrease was associated with a significant but not minimal important difference (MID) deterioration in disease-specific HRQoL (mean change [95% CI]: CAT +0.74 [0.15 to 1.33]), while no significant change was observed in the generic VAS. Experiencing at least one severe exacerbation also had a significant impact on CAT deterioration (+1.58 [0.52 to 2.64]), but again not on VAS. Here, GOLD groups AB showed not only a statistically but also a clinically relevant MID deterioration in CAT (+2.1 [0.88 to 3.32]). These particular patient groups were further characterized by a higher probability of being male, having a higher mMRC and Charlson index, and a lower probability of having higher FEV1 or BMI values. CONCLUSION FEV1 decline and the occurrence of ≥1 severe exacerbation are significantly associated with overall deterioration in disease-specific HRQoL. Preventing severe exacerbations particularly in patients without previous severe exacerbations (ABCD groups A and B) may help to stabilize the key patient-reported outcome HRQoL.
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Affiliation(s)
- Alisa Stöber
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Neuherberg, Germany
- Institute for Medical Information Processing, Biometry, and Epidemiology (IBE), Ludwig-Maximilians-University Munich (LMU), Munich, Germany
| | - Johanna I Lutter
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Neuherberg, Germany
- Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Larissa Schwarzkopf
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Neuherberg, Germany
- Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
- Institute fuer Therapieforschung (IFT), Working Group Therapy and Health Services Research, Munich, Germany
| | - Florian Kirsch
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Neuherberg, Germany
| | - Anja Schramm
- AOK Bayern, Service Center of Health Care Management, Regensburg, Germany
| | - Claus F Vogelmeier
- Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-University Marburg, Member of the German Center for Lung Research (DZL), Marburg, Germany
| | - Reiner Leidl
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Neuherberg, Germany
- Munich Center of Health Sciences (MC-Health), Institute for Health Economics and Management, Ludwig-Maximilians-University Munich (LMU), Munich, Germany
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11
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Stridsman C, Vanfleteren LEGW, Konradsen JR, Axelsson Fisk S, Pedroletti C, Sjöö Y, Syk J, Sterner T, Lindberg A, Tunsäter A, Nyberg F, Ekberg-Jansson A, Karlsson Sundbaum J. Predictors of severe COVID-19 in a registry-based Swedish cohort of patients with COPD. Eur Respir J 2021; 58:13993003.01920-2021. [PMID: 34413151 PMCID: PMC8581651 DOI: 10.1183/13993003.01920-2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 08/04/2021] [Indexed: 11/07/2022]
Abstract
It is unclear if patients with COPD are at increased risk of becoming infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) [1, 2]. However, after contracting SARS-CoV-2, patients with COPD are at high risk of severe coronavirus disease 2019 (COVID-19), a condition associated with morbidity and mortality [3, 4]. Although studies have described COVID-19 cohorts and investigated COPD as a risk factor, studies investigating patients with COPD in relation to risks of COVID-19 remain rare. Approved by the Swedish Ethical Review Authority (2020-02777), the current study was based on the Swedish National Airway Register (SNAR), which includes a large, well-characterised cohort of patients with COPD [5]. In the cohort, patients who have been hospitalised or died from COVID-19 were identified, which afforded a unique opportunity to study predictors of severe COVID-19 in COPD. Older age, male sex, low educational level, symptom burden, degree of obstruction, underweight, obesity, comorbidity and prior COPD inpatient or secondary care predict severe COVID-19 in patients with COPDhttps://bit.ly/2VHZIEm
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Affiliation(s)
- Caroline Stridsman
- Dept of Public Health and Clinical Medicine, Division of Medicine/The OLIN-unit, Umeå University, Umeå, Sweden
| | - Lowie E G W Vanfleteren
- COPD Center, Dept of Respiratory Medicine and Allergology, Sahlgrenska University Hospital, Gothenburg, Sweden.,Dept of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jon R Konradsen
- Dept of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Sten Axelsson Fisk
- Dept of Clinical Sciences Lund, Obstetrics and Gynaecology, Lund University and Ystad Hospital, Lund, Sweden
| | | | - Yvonne Sjöö
- The Swedish National Airway Register, Gothenburg, Sweden
| | - Jörgen Syk
- Dept of Women's and Children's Health, Uppsala University, Uppsala, Sweden.,Academic Primary Health Care Centre, Stockholm, Sweden.,Dept of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Therese Sterner
- Dept of Occupational and Environmental Dermatology, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Anne Lindberg
- Dept of Public Health and Clinical Medicine, Division of Medicine/The OLIN-unit, Umeå University, Umeå, Sweden
| | - Alf Tunsäter
- Dept of Respiratory Medicine and Allergology, Skåne University Hospital, Lund University, Lund, Sweden
| | - Fredrik Nyberg
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ann Ekberg-Jansson
- Dept of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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12
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Torres DDFM, Nascimento ACSD, Destro SF, Cardoso AP, Mello FCDQ. Applicability of the chronic obstructive pulmonary disease assessment test as a measure of health status in patients with sequelae of pulmonary tuberculosis. J Bras Pneumol 2021; 47:e20210170. [PMID: 34406228 PMCID: PMC8352765 DOI: 10.36416/1806-3756/e20210170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Diego de Faria Magalhães Torres
- . Serviço de Fisioterapia, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro (RJ), Brasil
| | | | - Sara Ferreira Destro
- . Programa de Graduação em Medicina, Faculdade Estácio de Sá, Rio de Janeiro (RJ), Brasil
| | - Alexandre Pinto Cardoso
- . Instituto de Doenças do Tórax, Universidade Federal do Rio de Janeiro, Rio de Janeiro (RJ), Brasil
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13
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Stoffels AAF, De Brandt J, Meys R, van Hees HWH, Vaes AW, Klijn P, Burtin C, Franssen FME, van den Borst B, Sillen MJH, Janssen DJA, Spruit MA. Short Physical Performance Battery: Response to pulmonary rehabilitation and minimal important difference estimates in patients with chronic obstructive pulmonary disease. Arch Phys Med Rehabil 2021; 102:2377-2384.e5. [PMID: 34175275 DOI: 10.1016/j.apmr.2021.05.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 04/21/2021] [Accepted: 05/18/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To determine the response to a pulmonary rehabilitation (PR) program and minimal important differences (MIDs) for the Short Physical Performance Battery (SPPB) subtests and SPPB summary score in patients with Chronic Obstructive Pulmonary Disease (COPD). DESIGN Retrospective analysis using distribution- and anchor-based methods. SETTING PR center in the Netherlands including a comprehensive 8-week inpatient and 14-week outpatient program of 40 sessions. PARTICIPANTS 632 patients with COPD (age: 65±8 years, 50% male, FEV1: 43 (27-47) % predicted) INTERVENTION: Not applicable. MAIN OUTCOME MEASURE Baseline and post PR results of the SPPB, consisting of three balance standing tests, 4-meter gait speed (4MGS) test and 5-repetition sit-to-stand (5STS) test. The chosen anchors were 6-minute walk test and COPD Assessment Test. Patients were stratified according to their SPPB summary scores into a low-performance, moderate-performance or high-performance group. RESULTS 5STS (∆= -1.14 (-4.20- -0.93) seconds) and SPPB summary score (∆= 1 (0-2) points) improved after PR in patients with COPD. In patients with low-performance at baseline, balance tandem and 4MGS significantly increased as well. Based on distribution-based calculations, the MID estimates range between 2.19-6.33 seconds for 5STS and 0.83-0.96 points for SPPB summary score. CONCLUSIONS The 5STS and SPPB summary score are both responsive to PR in patients with COPD. The balance tandem test and 4MGS are only responsive to PR in patients with COPD with a low-performance at baseline. Based on distribution-based calculations, a MID estimate of 1 point for the SPPB summary score is recommended in patients with COPD. Future research is needed to confirm MID estimates for SPPB in different centres.
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Affiliation(s)
- Anouk A F Stoffels
- Department of Pulmonary Diseases, Dekkerswald Radboud university medical centre, Radboud Institute for Health Sciences, Nijmegen, the Netherlands; Department of Research and Development, CIRO, Horn, the Netherlands; Department of Respiratory Medicine, Maastricht university medical centre (MUMC+), NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht, The Netherlands.
| | - Jana De Brandt
- REVAL - Rehabilitation Research Center, BIOMED - Biomedical Research Institute, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
| | - Roy Meys
- Department of Research and Development, CIRO, Horn, the Netherlands; Department of Respiratory Medicine, Maastricht university medical centre (MUMC+), NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht, The Netherlands
| | - Hieronymus W H van Hees
- Department of Pulmonary Diseases, Dekkerswald Radboud university medical centre, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
| | - Anouk W Vaes
- Department of Research and Development, CIRO, Horn, the Netherlands
| | - Peter Klijn
- Department of Pulmonology, Merem pulmonary rehabilitation centre, Hilversum, the Netherlands; Department of Pulmonary, Amsterdam university medical centre, Amsterdam, the Netherlands
| | - Chris Burtin
- REVAL - Rehabilitation Research Center, BIOMED - Biomedical Research Institute, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
| | - Frits M E Franssen
- Department of Research and Development, CIRO, Horn, the Netherlands; Department of Respiratory Medicine, Maastricht university medical centre (MUMC+), NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht, The Netherlands
| | - Bram van den Borst
- Department of Pulmonary Diseases, Dekkerswald Radboud university medical centre, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
| | | | - Daisy J A Janssen
- Department of Research and Development, CIRO, Horn, the Netherlands; Department of Health Services Research, Care and Public Health Research Institute, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Martijn A Spruit
- Department of Research and Development, CIRO, Horn, the Netherlands; Department of Respiratory Medicine, Maastricht university medical centre (MUMC+), NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht, The Netherlands; REVAL - Rehabilitation Research Center, BIOMED - Biomedical Research Institute, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
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14
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Abstract
A loss of physical functioning (i.e., a low physical capacity and/or a low physical activity) is a common feature in patients with chronic obstructive pulmonary disease (COPD). To date, the primary care physiotherapy and specialized pulmonary rehabilitation are clearly underused, and limited to patients with a moderate to very severe degree of airflow limitation (GOLD stage 2 or higher). However, improved referral rates are a necessity to lower the burden for patients with COPD and for society. Therefore, a multidisciplinary group of healthcare professionals and scientists proposes a new model for referral of patients with COPD to the right type of exercise-based care, irrespective of the degree of airflow limitation. Indeed, disease instability (recent hospitalization, yes/no), the burden of disease (no/low, mild/moderate or high), physical capacity (low or preserved) and physical activity (low or preserved) need to be used to allocate patients to one of the six distinct patient profiles. Patients with profile 1 or 2 will not be referred for physiotherapy; patients with profiles 3-5 will be referred for primary care physiotherapy; and patients with profile 6 will be referred for screening for specialized pulmonary rehabilitation. The proposed Dutch model has the intention to get the right patient with COPD allocated to the right type of exercise-based care and at the right moment.
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15
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Gulart AA, Martins ACB, Tressoldi C, Cani KC, de Araujo CLP, Lago PD, Mayer AF. Baseline Characteristics of Subjects with Chronic Obstructive Pulmonary Disease Associated to the Improvement in Activities of Daily Living after Exercise Training. COPD 2021; 18:45-52. [PMID: 33427517 DOI: 10.1080/15412555.2020.1868421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This study aimed to identify baseline variables predicting improvement in ADLs following an exercise training program in subjects with COPD. Sixty-seven patients with COPD underwent assessment of spirometry, modified Medical Research Council scale, COPD Assesment Test (CAT), Six Minute Walk Test (6MWT), London Chest Activity of Daily Living (LCADL) scale and Glittre-ADL test (TGlittre). After 24 sessions, they were reassessed for limitation in ADLs (LCADL and TGlittre). The main outcome was the achieving of minimal important difference (MID) of TGlittre, LCADL and both (ADLs). The cut-off points to discriminate the subjects who achieved the MID of TGlittre, LCADL and ADLs were established using the ROC curve. A cut-off point of 3.7 min in baseline TGlittre was able to discriminate subjects who achieved the MID of TGlittre (AUC = 0.77). Subjects with baseline TGlittre ≥3.7 min were 6.92 (95%CI 2.2-20.9) times more likely to achieve the MID of TGlittre post-exercise training. A cut-off point of 32% in LCADL was able to discriminate subjects who achieved the MID of LCADL (AUC = 0.81) and in ADLs (AUC = 0.78). Subjects with baseline LCADL ≥32% were 12.3 (95% CI 2.50 - 60.7) times more likely to achieve the MID of LCADL. In conclusion, the baseline variables that best predict the improvement of individuals after exercise training are TGlittre and LCADL, showing that subjects with significant functional impairment are more likely to clinically significantly improve their ADLs.
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Affiliation(s)
- Aline A Gulart
- Núcleo de Assistência, Ensino e Pesquisa em Reabilitação Pulmonar (NuReab), Universidade do Estado de Santa Catarina (UDESC), Florianópolis, Brazil.,Programa de Pós Graduação em Ciências do Movimento Humano, Centro de Ciências da Saúde e do Esporte (CEFID), Universidade do Estado de Santa Catarina (UDESC), Florianópolis, Brazil
| | - Ana C B Martins
- Núcleo de Assistência, Ensino e Pesquisa em Reabilitação Pulmonar (NuReab), Universidade do Estado de Santa Catarina (UDESC), Florianópolis, Brazil
| | - Caroline Tressoldi
- Núcleo de Assistência, Ensino e Pesquisa em Reabilitação Pulmonar (NuReab), Universidade do Estado de Santa Catarina (UDESC), Florianópolis, Brazil
| | - Katerine C Cani
- Núcleo de Assistência, Ensino e Pesquisa em Reabilitação Pulmonar (NuReab), Universidade do Estado de Santa Catarina (UDESC), Florianópolis, Brazil
| | - Cintia L P de Araujo
- Grupo de Pesquisa em Interação Cardiopulmonar (GPIC), Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil.,Programa de Pós Graduação em Ciências da Saúde, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Pedro Dal Lago
- Grupo de Pesquisa em Interação Cardiopulmonar (GPIC), Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil.,Programa de Pós Graduação em Ciências da Saúde, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Anamaria F Mayer
- Núcleo de Assistência, Ensino e Pesquisa em Reabilitação Pulmonar (NuReab), Universidade do Estado de Santa Catarina (UDESC), Florianópolis, Brazil.,Programa de Pós Graduação em Ciências do Movimento Humano, Centro de Ciências da Saúde e do Esporte (CEFID), Universidade do Estado de Santa Catarina (UDESC), Florianópolis, Brazil.,Programa de Pós Graduação em Fisioterapia, Centro de Ciências da Saúde e do Esporte (CEFID), Universidade do Estado de Santa Catarina (UDESC), Florianópolis, Brazil
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16
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Meys R, Delbressine JM, Goërtz YM, Vaes AW, Machado FV, Van Herck M, Burtin C, Posthuma R, Spaetgens B, Franssen FM, Spies Y, Vijlbrief H, van’t Hul AJ, Janssen DJ, Spruit MA, Houben-Wilke S. Generic and Respiratory-Specific Quality of Life in Non-Hospitalized Patients with COVID-19. J Clin Med 2020; 9:jcm9123993. [PMID: 33317214 PMCID: PMC7764406 DOI: 10.3390/jcm9123993] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 12/04/2020] [Accepted: 12/07/2020] [Indexed: 12/12/2022] Open
Abstract
The impact of coronavirus disease 2019 (COVID-19) on quality of life appears to be highly underestimated, especially in patients who have not been admitted to the hospital. Therefore, our aim was to assess respiratory-specific quality of life in addition to generic quality of life in former patients with confirmed/suspected COVID-19 who have never been admitted to the hospital. Members of an online Belgian social support group for patients with confirmed/suspected COVID-19 with persistent complaints, completed an online survey. The five-level EQ-5D (EQ-5D-5L) and the Clinical COPD Questionnaire (CCQ) were used to assess generic and respiratory-specific quality of life, respectively. Data of 210 non-hospitalized patients (88% women, 45 ± 11 years, 79 ± 17 days after symptom onset) were included in the analyses. Mean EQ-5D index and visual analogue scale (EQ-VAS) score was 0.62 ± 0.19 and 50.71 ± 18.87, respectively, with 40% of the patients demonstrating an EQ-5D index that was below the fifth percentile of normative values, indicating poor generic quality of life. The mean CCQ score was 2.01 ± 0.98 points, while 123 respondents (59%) had a total score ≥1.9 points, indicating poor respiratory-specific quality of life. The correlation between EQ-5D index score/EQ-VAS score and CCQ total score was moderate (r = -0.524 and r = -0.374; both p < 0.001). In conclusion, both generic and respiratory-specific quality of life are affected in non-hospitalized patients with COVID-19, approximately three months after the onset of symptoms. The combined use of the EQ-5D and the CCQ could identify the broad impact of COVID-19 on quality of life.
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Affiliation(s)
- Roy Meys
- Department of Research and Development, Ciro, 6085 NM Horn, The Netherlands; (J.M.D.); (Y.M.J.G.); (A.W.V.); (F.V.C.M.); (M.V.H.); (R.P.); (F.M.E.F.); (D.J.A.J.); (M.A.S.); (S.H.-W.)
- Nutrim School of Nutrition and Translational Research in Metabolism, 6229 HX Maastricht, The Netherlands
- Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), 6229 HX Maastricht, The Netherlands
- Correspondence: ; Tel.: +31-(0)475-587-602
| | - Jeannet M. Delbressine
- Department of Research and Development, Ciro, 6085 NM Horn, The Netherlands; (J.M.D.); (Y.M.J.G.); (A.W.V.); (F.V.C.M.); (M.V.H.); (R.P.); (F.M.E.F.); (D.J.A.J.); (M.A.S.); (S.H.-W.)
| | - Yvonne M.J. Goërtz
- Department of Research and Development, Ciro, 6085 NM Horn, The Netherlands; (J.M.D.); (Y.M.J.G.); (A.W.V.); (F.V.C.M.); (M.V.H.); (R.P.); (F.M.E.F.); (D.J.A.J.); (M.A.S.); (S.H.-W.)
- Nutrim School of Nutrition and Translational Research in Metabolism, 6229 HX Maastricht, The Netherlands
- Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), 6229 HX Maastricht, The Netherlands
| | - Anouk W. Vaes
- Department of Research and Development, Ciro, 6085 NM Horn, The Netherlands; (J.M.D.); (Y.M.J.G.); (A.W.V.); (F.V.C.M.); (M.V.H.); (R.P.); (F.M.E.F.); (D.J.A.J.); (M.A.S.); (S.H.-W.)
| | - Felipe V.C. Machado
- Department of Research and Development, Ciro, 6085 NM Horn, The Netherlands; (J.M.D.); (Y.M.J.G.); (A.W.V.); (F.V.C.M.); (M.V.H.); (R.P.); (F.M.E.F.); (D.J.A.J.); (M.A.S.); (S.H.-W.)
- Nutrim School of Nutrition and Translational Research in Metabolism, 6229 HX Maastricht, The Netherlands
- Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), 6229 HX Maastricht, The Netherlands
| | - Maarten Van Herck
- Department of Research and Development, Ciro, 6085 NM Horn, The Netherlands; (J.M.D.); (Y.M.J.G.); (A.W.V.); (F.V.C.M.); (M.V.H.); (R.P.); (F.M.E.F.); (D.J.A.J.); (M.A.S.); (S.H.-W.)
- REVAL–Rehabilitation Research Center, BIOMED–Biomedical Research Institute, Faculty of Rehabilitation Sciences, Hasselt University, 3500 Diepenbeek, Belgium;
| | - Chris Burtin
- REVAL–Rehabilitation Research Center, BIOMED–Biomedical Research Institute, Faculty of Rehabilitation Sciences, Hasselt University, 3500 Diepenbeek, Belgium;
| | - Rein Posthuma
- Department of Research and Development, Ciro, 6085 NM Horn, The Netherlands; (J.M.D.); (Y.M.J.G.); (A.W.V.); (F.V.C.M.); (M.V.H.); (R.P.); (F.M.E.F.); (D.J.A.J.); (M.A.S.); (S.H.-W.)
- Nutrim School of Nutrition and Translational Research in Metabolism, 6229 HX Maastricht, The Netherlands
- Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), 6229 HX Maastricht, The Netherlands
| | - Bart Spaetgens
- Department of Internal Medicine, Maastricht University Medical Centre (MUMC+), 6202 AZ Maastricht, The Netherlands;
| | - Frits M.E. Franssen
- Department of Research and Development, Ciro, 6085 NM Horn, The Netherlands; (J.M.D.); (Y.M.J.G.); (A.W.V.); (F.V.C.M.); (M.V.H.); (R.P.); (F.M.E.F.); (D.J.A.J.); (M.A.S.); (S.H.-W.)
- Nutrim School of Nutrition and Translational Research in Metabolism, 6229 HX Maastricht, The Netherlands
- Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), 6229 HX Maastricht, The Netherlands
| | - Yvonne Spies
- Lung Foundation Netherlands, 3818 LE Amersfoort, The Netherlands; (Y.S.); (H.V.)
| | - Herman Vijlbrief
- Lung Foundation Netherlands, 3818 LE Amersfoort, The Netherlands; (Y.S.); (H.V.)
| | - Alex J. van’t Hul
- Department of Pulmonary Diseases, Radboud Institute for Health Sciences, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands;
| | - Daisy J.A. Janssen
- Department of Research and Development, Ciro, 6085 NM Horn, The Netherlands; (J.M.D.); (Y.M.J.G.); (A.W.V.); (F.V.C.M.); (M.V.H.); (R.P.); (F.M.E.F.); (D.J.A.J.); (M.A.S.); (S.H.-W.)
- Department of Health Services Research, Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, 6229 ER Maastricht, The Netherlands
| | - Martijn A. Spruit
- Department of Research and Development, Ciro, 6085 NM Horn, The Netherlands; (J.M.D.); (Y.M.J.G.); (A.W.V.); (F.V.C.M.); (M.V.H.); (R.P.); (F.M.E.F.); (D.J.A.J.); (M.A.S.); (S.H.-W.)
- Nutrim School of Nutrition and Translational Research in Metabolism, 6229 HX Maastricht, The Netherlands
- Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), 6229 HX Maastricht, The Netherlands
| | - Sarah Houben-Wilke
- Department of Research and Development, Ciro, 6085 NM Horn, The Netherlands; (J.M.D.); (Y.M.J.G.); (A.W.V.); (F.V.C.M.); (M.V.H.); (R.P.); (F.M.E.F.); (D.J.A.J.); (M.A.S.); (S.H.-W.)
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17
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Vogelmeier CF, Kerwin EM, Bjermer LH, Tombs L, Jones PW, Boucot IH, Naya IP, Lipson DA, Compton C, Barnes N, Maltais F. Impact of baseline COPD symptom severity on the benefit from dual versus mono-bronchodilators: an analysis of the EMAX randomised controlled trial. Ther Adv Respir Dis 2020; 14:1753466620968500. [PMID: 33167780 PMCID: PMC7659027 DOI: 10.1177/1753466620968500] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Rationale: Symptom relief is a key treatment goal in patients with chronic obstructive pulmonary disease (COPD). However, there are limited data available on the response to bronchodilator therapy in patients at low risk of exacerbations with different levels of symptom severity. This study compared treatment responses in patients with a range of symptom severities as indicated by baseline COPD assessment test (CAT) scores. Methods: The 24-week EMAX trial evaluated the benefits of umeclidinium/vilanterol versus umeclidinium or salmeterol in symptomatic patients at low exacerbation risk who were not receiving inhaled corticosteroids. This analysis assessed lung function, symptoms, health status, and short-term deterioration outcomes in subgroups defined by a baseline CAT score [<20 (post hoc) and ⩾20 (pre-specified)]. Outcomes were also assessed using post hoc fractional polynomial modelling with continuous transformations of baseline CAT score covariates. Results: Of the intent-to-treat population (n = 2425), 56% and 44% had baseline CAT scores of <20 and ⩾20, respectively. Umeclidinium/vilanterol demonstrated favourable improvements compared with umeclidinium and salmeterol for the majority of outcomes irrespective of the baseline CAT score, with the greatest improvements generally observed in patients with CAT scores <20. Fractional polynomial analyses revealed consistent improvements in lung function, symptoms and reduction in rescue medication use with umeclidinium/vilanterol versus umeclidinium and salmeterol across a range of CAT scores, with the largest benefits seen in patients with CAT scores of approximately 10–21. Conclusions: Patients with symptomatic COPD benefit similarly from dual bronchodilator treatment with umeclidinium/vilanterol. Fractional polynomial analyses demonstrated the greatest treatment differences favouring dual therapy in patients with a CAT score <20, although benefits were seen up to scores of 30. This suggests that dual bronchodilation may be considered as initial therapy for patients across a broad range of symptom severities, not only those with severe symptoms (CAT ⩾20). Trial registration: NCT03034915, 2016-002513-22 (EudraCT number). The reviews of this paper are available via the supplemental material section.
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Affiliation(s)
- Claus F Vogelmeier
- Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Centre Giessen and Marburg, Philipps-Universität Marburg, Germany.,Member of the German Centre for Lung Research (DZL), Baldingerstraße, Marburg 35043, Germany
| | - Edward M Kerwin
- Clinical Research Institute of Southern Oregon, Medford, OR, USA
| | - Leif H Bjermer
- Respiratory Medicine and Allergology, Lund University, Lund, Sweden
| | - Lee Tombs
- Precise Approach Ltd, Contingent Worker on Assignment at GSK, Stockley Park West, Uxbridge, Middlesex, UK
| | | | | | - Ian P Naya
- GSK, Brentford, Middlesex, UK.,RAMAX Ltd., Bramhall, Cheshire, UK
| | - David A Lipson
- Respiratory Clinical Sciences, GSK, Collegeville, PA, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | | | - François Maltais
- Centre de Pneumologie, Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec, Québec, Canada
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18
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Stridsman C, Konradsen JR, Vanfleteren L, Pedroletti C, Binnmyr J, Edfelt P, Fjällman Schärberg K, Sjöö Y, Nyberg F, Lindberg A, Tunsäter A, Ekberg-Jansson A. The Swedish National Airway Register (SNAR): development, design and utility to date. Eur Clin Respir J 2020; 7:1833412. [PMID: 33224453 PMCID: PMC7594834 DOI: 10.1080/20018525.2020.1833412] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background The Swedish National Airway Register (SNAR) was initiated in 2013 to ensure and improve the quality of care for patients with asthma and COPD. Aim To describe the development and design of SNAR, and to study the 2019 data to evaluate its potential utility related to improvement of quality of care. Methods SNAR includes data from patients with asthma (both children and adults) and COPD from primary, secondary and tertiary care, and also, for COPD inpatient care. Data on diagnostic investigations (e.g. spirometry, blood sample, skin prick test), symptom-scores, comorbidities and prescribed treatments are registered. The registrations are entered manually by healthcare professionals, or directly transferred from electronic medical records to a web-based platform. Results In 2019, 1000 clinics participated and data were directly transferred by about 88% of them. The register included data on 205,833 patients with asthma and 80,372 with COPD (of these, 5% had both diagnoses). Registrations of new patients and follow-up visits from primary and secondary/tertiary care in 2019 were completed for 75,707 patients with asthma (11,818 children <12 yr, 6545 adolescents 12–17 yr, and 57,344 adults >17 yr) and 38,117 with COPD. Depending on age and disease group, 43–77% had performed spirometry, 36–65% Asthma Control Test, and 60% COPD Assessment Test. The prevalence of current smoking was about 2% in adolescents, 10% in adults with asthma, and 34% in COPD. For these, smoking cessation support was offered to 27%, 38% and 51%, respectively. Overall, limited data were available on investigation of allergy, 6-min walk test, patient education and written treatment plans. Regarding asthma, sex-differences in disease management were evident. Conclusion SNAR has cumulatively registered data from over 270,000 individuals, and the register is important for patients, caregivers, authorities, politicians and researchers to evaluate the effect of treatment and to ensure high and equal quality of care nationwide.
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Affiliation(s)
- C Stridsman
- Department of Public Health and Clinical Medicine, Division of Medicine, the OLIN-unit, Umeå University, Umeå, Sweden
| | - J R Konradsen
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - L Vanfleteren
- COPD Center, Department of Respiratory Medicine and Allergology, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - C Pedroletti
- Department of Woman and Child Health, Uppsala University, Uppsala, Sweden.,Södertälje General Hospital, Sweden
| | - J Binnmyr
- The Swedish Asthma- and Allergy Association, Stockholm, Sweden.,The Swedish Asthma- and Allergy Research Foundation, Stockholm, Sweden
| | - P Edfelt
- The Swedish Heart and Lung Association, Stockholm, Sweden
| | | | - Y Sjöö
- The Swedish National Airway Register, Gothenburg, Sweden
| | - F Nyberg
- School of Public Health and Community, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - A Lindberg
- Department of Public Health and Clinical Medicine, Division of Medicine, the OLIN-unit, Umeå University, Umeå, Sweden
| | - A Tunsäter
- Department of Respiratory Medicine and Allergology, Skåne University Hospital, Lund University, Lund, Sweden
| | - A Ekberg-Jansson
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
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19
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Hanada M, Ishimatsu Y, Sakamoto N, Nagura H, Oikawa M, Morimoto Y, Sato S, Mukae H, Kozu R. Corticosteroids are associated with reduced skeletal muscle function in interstitial lung disease patients with mild dyspnea. Respir Med 2020; 174:106184. [PMID: 33086134 DOI: 10.1016/j.rmed.2020.106184] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 09/29/2020] [Accepted: 09/30/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Interstitial lung diseases (ILDs) patients receiving steroid treatment tend to be immobilized by dyspnea and muscle weakness as the disease progresses. We therefore expected that steroid treatment for ILDs would have a greater effect on muscle function under severe dyspnea. To test this hypothesis, we evaluated whether the effect of corticosteroid treatment on peripheral muscle force and exercise capacity varied according to patients' dyspnea severity. METHODS In this retrospective cross-sectional study of 87 ILD patients enrolled between 2008 and 2017, quadriceps force (QF), handgrip force (HF), and 6-min walk distance (6 MWD) were compared between a low (grades 0-2) and a high (grades 3-4) modified-Medical Research Council (mMRC) dyspnea scale score group. RESULTS In patients with lower levels of dyspnea, corticosteroid treatments were associated with lower QF and HF (20.0 vs. 30.0 kgf, p = 0.01; 22.5 vs. 28.4 kgf, p = 0.03, respectively) values; however, no significant differences were observed between the corticosteroid and control subgroups in the high mMRC group (QF: 18.5 vs. 17.3 kgf, p = 0.64; HF: 21.0 vs. 17.1 kgf, p = 0.24, respectively). Analysis of covariance indicated that both corticosteroid treatment and mMRC dyspnea scale interacted with QF, HF, and 6 MWD. The effects of the corticosteroid treatment varied according to the level of dyspnea (interaction β = 7.52, p = 0.034; interaction β = 8.78, p = 0.048; interaction β = 131.08, p < 0.001). CONCLUSIONS Muscle weakness and exercise capacity in ILD patients in the low mMRC group were associated with corticosteroid treatment.
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Affiliation(s)
- Masatoshi Hanada
- Cardiorespiratory Division, Department of Rehabilitation Medicine, Nagasaki University Hospital, Nagasaki, Japan; Department of Cardiopulmonary Rehabilitation Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Yuji Ishimatsu
- Department of Nursing, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
| | - Noriho Sakamoto
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Hiroki Nagura
- Cardiorespiratory Division, Department of Rehabilitation Medicine, Nagasaki University Hospital, Nagasaki, Japan; Department of Cardiopulmonary Rehabilitation Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Masato Oikawa
- Cardiorespiratory Division, Department of Rehabilitation Medicine, Nagasaki University Hospital, Nagasaki, Japan; Department of Cardiopulmonary Rehabilitation Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Yosuke Morimoto
- Department of Physical Therapy, Faculty of Rehabilitation, Kobe Gakuin University, Hyogo, Japan
| | - Shuntaro Sato
- Clinical Research Center, Nagasaki University Hospital, Nagasaki, Japan
| | - Hiroshi Mukae
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Ryo Kozu
- Cardiorespiratory Division, Department of Rehabilitation Medicine, Nagasaki University Hospital, Nagasaki, Japan; Department of Cardiopulmonary Rehabilitation Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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20
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Koolen EH, van den Borst B, de Man M, Antons JC, Robberts B, Dekhuijzen PNR, Vercoulen JH, van den Heuvel M, Spruit MA, van der Wees PJ, van 't Hul AJ. The clinical effectiveness of the COPDnet integrated care model. Respir Med 2020; 172:106152. [PMID: 32956973 DOI: 10.1016/j.rmed.2020.106152] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 08/14/2020] [Accepted: 09/09/2020] [Indexed: 12/28/2022]
Abstract
RATIONALE Integrated care models have the potential to improve outcomes for patients with COPD. We therefore designed the COPDnet integrated care model and implemented it in two hospitals and affiliated primary care regions in the Netherlands. The COPDnet model consists of a comprehensive diagnostic trajectory ran in secondary care followed by a non-pharmacological intervention program of both monodisciplinary and multidisciplinary components. OBJECTIVE To assess the clinical effectiveness of the COPDnet integrated care model on health status change in patients with COPD. METHODS A total of 402 patients with COPD were offered care according to the COPDnet model. At baseline and between 7- and 9-months later health status was measured with the Clinical COPD Questionnaire (CCQ). Primary analysis was carried out for the sample at large. In addition, subgroup analyses were performed after stratification for the type of non-pharmacological intervention where patients had been referred to. RESULTS The CCQ total score improved statistically significantly from 1.94 ± 1.04 to 1.73 ± 0.96 (P < 0.01) in the 154 patients with valid follow-up measurements. Subgroup analyses revealed significant improvements in the patients receiving pulmonary rehabilitation only. No change in health status was found in patients receiving pharmacotherapy only, carried out self-treatment or who participated in mono-disciplinary primary care offered by allied healthcare professionals. CONCLUSIONS An improved health status was found in patients with COPD who received care according to the COPDnet integrated care model. Subgroups participating in an interdisciplinary pulmonary rehabilitation program predominantly accounted for this effect.
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Affiliation(s)
- E H Koolen
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Respiratory Diseases, 6525 GA, Nijmegen, the Netherlands
| | - B van den Borst
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Respiratory Diseases, 6525 GA, Nijmegen, the Netherlands
| | - M de Man
- Bernhoven, Department of Pulmonary Diseases, 5406 PT, Uden, the Netherlands
| | - J C Antons
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Respiratory Diseases, 6525 GA, Nijmegen, the Netherlands
| | - B Robberts
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Respiratory Diseases, 6525 GA, Nijmegen, the Netherlands
| | - P N R Dekhuijzen
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Respiratory Diseases, 6525 GA, Nijmegen, the Netherlands
| | - J H Vercoulen
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Medical Psychology, 6525 GA, Nijmegen, the Netherlands
| | - M van den Heuvel
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Respiratory Diseases, 6525 GA, Nijmegen, the Netherlands
| | - M A Spruit
- Department of Respiratory Medicine, Maastricht University Medical Centre, NUTRIM School of Nutrition and Translational Research in Metabolism, 6229 HX, Maastricht, the Netherlands; Department of Research and Development, CIRO+, 6085 NM, Horn, the Netherlands; REVAL-Rehabilitation Research Center, BIOMED-Biomedical Research Institute, Faculty of Rehabilitation Sciences, Hasselt University, 3590 BE, Diepenbeek, Belgium
| | - P J van der Wees
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Department of Rehabilitation, 6525 GA, Nijmegen, the Netherlands
| | - A J van 't Hul
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Respiratory Diseases, 6525 GA, Nijmegen, the Netherlands.
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21
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Moya-Álvarez V, Quevedo-Marín JL, Ji Z, Navarro-Jiménez C, Jiménez-García R, López-de-Andrés A, Pérez-Trullén A, de Miguel-Díez J. Variation in Assignment of the COPD Patients into a GOLD Group According to Symptoms Severity. Int J Chron Obstruct Pulmon Dis 2020; 15:1987-1995. [PMID: 32848383 PMCID: PMC7430767 DOI: 10.2147/copd.s253445] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 07/02/2020] [Indexed: 11/23/2022] Open
Abstract
Introduction The Global Organization of Lung Disease (GOLD) classifies patients with chronic obstructive pulmonary disease (COPD) taking into account the symptoms. The modified Medical Research Council's dyspnea scale (mMRC) and the COPD assessment test (CAT) are used to assess these symptoms. In this study, we analyze the concordance of GOLD classification using mMRC and CAT. Patients and Methods This is an observational study of a cohort of 169 patients with COPD, who were classified following the GOLD 2017 recommendations, using both mMRC and CAT. A concordance analysis was applied, and a ROC curve was generated to identify the CAT score that best concorded with the mMRC scale. Results The concordance for the GOLD groups classified by CAT and mMRC was moderate (kappa 0.492). For mMRC score of 1 and 2, a CAT score of ≥9 and ≥16 showed the maximum value of the Youden index, respectively. By reclassifying the patients with the new cut-off points obtained, the best concordance was obtained between the cut-off point for CAT of 16 and for mMRC of 2, followed by CAT of 9 and mMRC of 1. Conclusion Because of the deficient concordance between CAT and mMRC, we propose the use of new cut-off points in future updates of the GOLD strategy.
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Affiliation(s)
| | | | - Zichen Ji
- Pulmonology Service, Gregorio Marañón University General Hospital, Madrid28007, Spain
| | | | - Rodrigo Jiménez-García
- Public Health and Maternal and Child Health Department, Faculty of Medicine, Complutense University of Madrid, Madrid28040, Spain
| | - Ana López-de-Andrés
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Madrid28922, Spain
| | - Alfonso Pérez-Trullén
- Pulmonology Service, Lozano Blesa University Clinical Hospital, Zaragoza50009, Spain
| | - Javier de Miguel-Díez
- Pulmonology Service, Gregorio Marañón University General Hospital, Madrid28007, Spain
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22
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Stoffels AAF, De Brandt J, Meys R, van Hees HWH, Vaes AW, Klijn P, Burtin C, Franssen FME, van den Borst B, Sillen MJH, Wouters EFM, Janssen DJA, Spruit MA. Phenotypic Characteristics of Patients With Chronic Obstructive Pulmonary Disease After Stratification for the Short Physical Performance Battery Summary Score. Arch Phys Med Rehabil 2020; 101:1887-1897. [PMID: 32497598 DOI: 10.1016/j.apmr.2020.05.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 05/08/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To assess the phenotypic characteristics of patients with chronic obstructive pulmonary disease (COPD) after stratification for Short Physical Performance Battery (SPPB) summary scores and to determine phenotypic characteristics of the SPPB summary score at the start of pulmonary rehabilitation (PR). DESIGN Retrospective, cross-sectional. SETTING Baseline assessment for PR program. PARTICIPANTS Patients with COPD (n=900; age 65±8y, 52% male, forced expiratory volume in the first second of expiration, 43% [interquartile range, 31%-62%] predicted). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Patients were stratified according to their SPPB summary scores into low-performance (LP), moderate-performance (MP), or high-performance (HP) groups. Furthermore, lung function, arterial blood gases, body composition, physical capacity, lower limb muscle strength and endurance, and symptoms of anxiety and depression were assessed. RESULTS Generally, physical capacity and muscle function were lower and scores for symptoms of anxiety and depression were higher in LP patients than MP and HP patients (all values, P<.01). However, 25% of HP patients with COPD scored high on symptoms of anxiety and/or depression (≥10 points), and HP patients still had on average an impaired physical capacity (median, 6-minute walk test [6MWT] distance of 69% predicted). Furthermore, age and 6MWT distance (m) were the only independent predictors in a multivariate regression model, explaining 29% of the variance in SPPB summary score. CONCLUSIONS In COPD, LP patients have the worst physical and emotional functioning. However, HP patients can still exhibit physical and emotional impairments. Because the explained variance in SPPB summary score is low, SPPB should not be considered as a test to discriminate between patients with COPD with a low or preserved physical capacity and emotional status.
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Affiliation(s)
- Anouk A F Stoffels
- Department of Pulmonary Diseases, Dekkerswald Radboudumc, Nijmegen, the Netherlands; Department of Research and Development, CIRO, Horn, the Netherlands.
| | - Jana De Brandt
- Reval Rehabilitation Research, Biomedical Research Institute, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
| | - Roy Meys
- Department of Research and Development, CIRO, Horn, the Netherlands
| | | | - Anouk W Vaes
- Department of Research and Development, CIRO, Horn, the Netherlands
| | - Peter Klijn
- Department of Pulmonology, Merem Pulmonary Rehabilitation Centre, Hilversum, the Netherlands; Department of Pulmonology, Amsterdam University Medical Centre, Amsterdam, the Netherlands
| | - Chris Burtin
- Reval Rehabilitation Research, Biomedical Research Institute, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
| | - Frits M E Franssen
- Department of Research and Development, CIRO, Horn, the Netherlands; Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, the Netherlands
| | - Bram van den Borst
- Department of Pulmonary Diseases, Dekkerswald Radboudumc, Nijmegen, the Netherlands
| | | | | | - Daisy J A Janssen
- Department of Research and Development, CIRO, Horn, the Netherlands; Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Martijn A Spruit
- Department of Research and Development, CIRO, Horn, the Netherlands; Reval Rehabilitation Research, Biomedical Research Institute, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium; Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, the Netherlands
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23
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Graf J, Jörres RA, Lucke T, Nowak D, Vogelmeier CF, Ficker JH. Medical Treatment of COPD. DEUTSCHES ARZTEBLATT INTERNATIONAL 2019; 155:599-605. [PMID: 30282573 DOI: 10.3238/arztebl.2018.0599] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 01/19/2018] [Accepted: 05/03/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is common around the world and carries a high morbidity and mortality. Symptom- and risk-oriented drug treatment is recommended, both in Germany and in other countries. It is not yet known to what extent the treatment that is actually delivered in Germany corresponds to the current recommendations in the guidelines. METHODS As recommended by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) in 2017, 2281 patients of the national COPD cohort COSYCONET (COPD and Systemic Consequences-Comorbidities Network) were classified into Gold classes A-D on the basis of disease-specific manifestations and the frequency of exacerbations. Moreover, the regular use of medications was documented and categorized according to active substance groups. For all groups, the documented treatment that was actually given was compared to the recommended treatment. RESULTS 67.6% of the patients received a combination of a long-acting anticholinergic drug (LAMA) and a long-acting beta-mimetic drug (LABA), while 65.8% received inhaled corticosteroids (ICS), 11.7% theophylline, and 12.6% oral corticosteroids (OCS). Despite recommendations to the contrary, 66% of the patients in Groups A and B (low exacerbation rates) were treated with ICS; some of these patients carried an additional diagnosis of bronchial asthma. There was evidence of undertreatment mainly in groups C and D (high exacerbation rate), because many of the patients in these groups were not treated with LAMA or LAMA/LABA as recommended. CONCLUSION The observed deviations from the recommended treatment, some of which were substantial, might lead to suboptimal treatment outcomes as well as to avoidable side effects of medication.
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Affiliation(s)
- Jana Graf
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Comprehensive Pneumology Center Munich, German Center for Lung Research (DZL), Munich, Germany; Department of Medicine, Pulmonary, Critical Care and Sleep Medicine, University Hospitals of Gießen and Marburg, Marburg site, German Center for Lung Research (DZL); Department of Respiratory Medicine, Allergology and Sleep Medicine, General Hospital Nürnberg, Paracelsus Medical University, Nürnberg, Germany
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24
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Spruit MA, Wouters EF. Organizational aspects of pulmonary rehabilitation in chronic respiratory diseases. Respirology 2019; 24:838-843. [PMID: 30810256 PMCID: PMC6849848 DOI: 10.1111/resp.13512] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 02/05/2019] [Accepted: 02/07/2019] [Indexed: 12/20/2022]
Abstract
Adult patients with chronic respiratory diseases may suffer from multiple physical (pulmonary and extra-pulmonary), emotional and social features which necessitate a comprehensive, interdisciplinary rehabilitation programme. To date, pulmonary rehabilitation programmes show a lot of variation in setting, content, frequency and duration. Future projects should strive for a standard set of assessment measures to identify patients eligible for pulmonary rehabilitation, taking disease complexity into consideration, which should result in referral to an appropriate rehabilitation setting. Local circumstances may complicate this crucial endeavour.
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Affiliation(s)
- Martijn A. Spruit
- Department of Research and EducationCIRO, Centre of Expertise for Chronic Organ FailureHornThe Netherlands
- Department of Respiratory MedicineMaastricht University Medical Center (MUMC+)MaastrichtThe Netherlands
- NUTRIM School of Nutrition and Translational Research in MetabolismMaastrichtThe Netherlands
- REVAL Rehabilitation Research Center, BIOMED Biomedical Research Institute, Faculty of Rehabilitation SciencesHasselt UniversityDiepenbeekBelgium
| | - Emiel F.M. Wouters
- Department of Research and EducationCIRO, Centre of Expertise for Chronic Organ FailureHornThe Netherlands
- Department of Respiratory MedicineMaastricht University Medical Center (MUMC+)MaastrichtThe Netherlands
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Miravitlles M, Koblizek V, Esquinas C, Milenkovic B, Barczyk A, Tkacova R, Somfay A, Zykov K, Tudoric N, Kostov K, Zbozinkova Z, Svoboda M, Sorli J, Krams A, Valipour A. Determinants of CAT (COPD Assessment Test) scores in a population of patients with COPD in central and Eastern Europe: The POPE study. Respir Med 2019; 150:141-148. [PMID: 30961941 DOI: 10.1016/j.rmed.2019.03.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 03/15/2019] [Accepted: 03/17/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND The COPD Assessment Test (CAT) has been proposed to help guide therapy in chronic obstructive pulmonary disease (COPD). It is important to understand the distribution of scores in different COPD populations and their determinants. METHODS The POPE study is an international, observational cross-sectional study of COPD subjects in 11 Central and Eastern European countries aimed at characterizing COPD phenotypes. Here we report the analysis of CAT scores with the objective of identifying their determinants, evaluating symptom load and investigating the distribution of scores among the participating countries. Additionally, we investigated the discrepancies between the CAT and modified Medical Research Council (mMRC) scores when used to classify patients according to the GOLD strategy. RESULTS The study included 3452 patients (69.2% men, mean forced expiratory volume in 1 s (FEV1% predicted) 52.5%). The mean CAT score was 17.5 (SD = 7.8), ranging from 15.1 in Hungary to 21.2 in Bulgaria. Multiple linear regression analysis showed six variables significantly associated with CAT scores: depression, number of previous exacerbations, 6-min walking distance, FEV1(%), mMRC and country and explained 47.2% of the variance of CAT. According to either CAT or mMRC, up to 23.9% patients would be classified in different GOLD groups. CONCLUSIONS The CAT score may be predicted by factors related to COPD severity, depression and exercise capacity, with significant differences in the distribution of CAT scores in different countries. According to our results CAT >10 is not equivalent to mMRC >2 for assessing symptom burden. TRIAL REGISTRATION ClinicalTrials.gov, identifier NCT02119494.
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Affiliation(s)
- Marc Miravitlles
- Pneumology Department, Hospital Universitari Vall d'Hebron/Vall d'Hebron Research Institute (VHIR), CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain.
| | - Vladimir Koblizek
- Department of Pneumology, University Hospital Hradec Králové, Charles University, Faculty of Medicine in Hradec Králové, Czech Republic
| | - Cristina Esquinas
- Pneumology Department, Hospital Universitari Vall d'Hebron/Vall d'Hebron Research Institute (VHIR), CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
| | - Branislava Milenkovic
- Clinic for Pulmonary Diseases, Faculty of Medicine, Clinical Center of Serbia, Belgrade, Serbia
| | - Adam Barczyk
- Department of Pneumology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Ruzena Tkacova
- Department of Respiratory Medicine and Tuberculosis, Faculty of Medicine, P.J. Safarik University, Kosice, Slovakia
| | - Attila Somfay
- Department of Pulmonology, University of Szeged, Deszk, Hungary
| | - Kirill Zykov
- Pulmonology Scientific Research Institute under FMBA of Russia, Moscow State University of Medicine and Dentistry Named after A.I.Evdokimov, Russia
| | - Neven Tudoric
- School of Medicine Zagreb, University Hospital Dubrava, Zagreb, Croatia
| | - Kosta Kostov
- Clinic of Pulmonary Diseases, Military Medical Academy, Sofia, Bulgaria
| | - Zuzana Zbozinkova
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Michal Svoboda
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Jurij Sorli
- Pulmonary Department, Topolsica Hospital, Topolsica, Slovenia
| | - Alvils Krams
- Faculty of Medicine, University of Latvia, Riga, Latvia; Riga East University Hospital, Latvia
| | - Arschang Valipour
- Department of Respiratory and Critical Care Medicine, Ludwig-Boltzmann-Institute for COPD and Respiratory Epidemiology, Otto-Wagner-Spital, Wien, Austria
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26
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Koolen EH, van Hees HW, van Lummel RC, Dekhuijzen R, Djamin RS, Spruit MA, van 't Hul AJ. "Can do" versus "do do": A Novel Concept to Better Understand Physical Functioning in Patients with Chronic Obstructive Pulmonary Disease. J Clin Med 2019; 8:E340. [PMID: 30862102 PMCID: PMC6463143 DOI: 10.3390/jcm8030340] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 03/01/2019] [Accepted: 03/04/2019] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Physical capacity (PC) and physical activity (PA) represent associated but separate domains of physical function. It remains unknown whether this framework may support a better understanding of the impaired physical function in patients with chronic obstructive pulmonary disease (COPD). The current study had two aims: (1) to determine the distribution of patients with COPD over the PC-PA quadrants, and (2) to explore whether differences exist in clinical characteristics between these quadrants. METHODS In this retrospective study, PC was measured using the six-minute walk distance (6MWD), and PA was assessed with an accelerometer. Moreover, patients' clinical characteristics were obtained. Patients were divided into the following quadrants: (I) low PC (6MWD <70% predicted), low PA, using a step-defined inactivity index (<5000 steps/day, "can't do, don't do" quadrant); (II) preserved PC, low PA ("can do, don't do" quadrant); (III) low PC, preserved PA ("can't do, do do" quadrant); and (IV) preserved PC, preserved PA ("can do, do do" quadrant). RESULTS The distribution of the 662 COPD patients over the quadrants was as follows: "can't do, don't do": 34%; "can do, don't do": 14%; "can't do, do do": 21%; and "can do, do do": 31%. Statistically significant differences between quadrants were found for all clinical characteristics, except for educational levels. CONCLUSIONS This study proves the applicability of the PC-PA quadrant concept in COPD. This concept serves as a pragmatic clinical tool, that may be useful in the understanding of the impaired physical functioning in COPD patients and therefore, may improve the selection of appropriate interventions to improve physical function.
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Affiliation(s)
- Eleonore H Koolen
- Department of Pulmonary Diseases, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands.
| | - Hieronymus W van Hees
- Department of Pulmonary Diseases, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands.
| | | | - Richard Dekhuijzen
- Department of Pulmonary Diseases, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands.
| | - Remco S Djamin
- Department of Pulmonary Diseases, Amphia Hospital, 4819 EV Breda, The Netherlands.
| | - Martijn A Spruit
- Department of Research and Education, CIRO+, Center of Expertise for Chronic Organ Failure, 6085 NM Horn, The Netherlands.
- Department of Respiratory Medicine, Maastricht University Medical Centre, NUTRIM School of Nutrition and Translational Research in Metabolism, 6229 HX Maastricht, The Netherlands.
- REVAL-Rehabilitation Research Center, BIOMED-Biomedical Research Institute, Faculty of Rehabilitation Sciences, Hasselt University, 3590 BE Diepenbeek, Belgium.
| | - Alex J van 't Hul
- Department of Pulmonary Diseases, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands.
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27
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von Siemens SM, Jörres RA, Behr J, Alter P, Lutter J, Lucke T, Söhler S, Welte T, Watz H, Vogelmeier CF, Trudzinski F, Rief W, Herbig B, Kahnert K. Effect of COPD severity and comorbidities on the result of the PHQ-9 tool for the diagnosis of depression: results from the COSYCONET cohort study. Respir Res 2019; 20:30. [PMID: 30744630 PMCID: PMC6371561 DOI: 10.1186/s12931-019-0997-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 02/04/2019] [Indexed: 01/01/2023] Open
Abstract
The diagnosis of depression, a frequent comorbidity of chronic obstructive pulmonary disease (COPD), is often supported by questionnaires, such as the Patient Health Questionnaire 9 (PHQ-9). It is unknown to which extent its single questions are affected by the clinical characteristics of COPD patients. We addressed this question in 2255 GOLD grade 1–4 patients from the COSYCONET (COPD and Systemic Consequences - Comorbidities Network) COPD cohort. The dependence on COPD severity was assessed using symptoms, exacerbation risk (GOLD A-D; modified Medical Research Council dyspnoea scale (mMRC)), and frequent comorbidities as predictors of PHQ-9 results, while including age, gender, body mass index (BMI) and smoking habits as covariates. Symptoms and exacerbation risk were associated with depression in an additive manner, with mean elevations in the PHQ-9 sum score by 2.75 and 1.44 points, respectively. Asthma, sleep apnoea, gastrointestinal disorders, osteoporosis and arthritis were linked to increases by 0.8 to 1.3 points. Overall, the COPD characteristics contributed to the mean PHQ-9 score by increases from 4.5 or 5.2 to 6.3 points, respectively, when either taking GOLD A as reference or the absence of comorbidities. This finding was independent of the diagnosis of mental disorder or the intake of antidepressants. The presence of COPD led to an increase in the proportion of scores indicating depression from 12 to 22%. Single item analysis revealed homogenous effects regarding GOLD groups, but heterogeneous effects regarding GOLD grades. These findings indicate specific effects of COPD severity on the PHQ-9 depression score, especially symptoms and exacerbation risk, explaining the high prevalence of depression in COPD. Alternative explanations like an overlap of COPD severity and PHQ-9 items are discussed. Of note, we also found COPD treatment effects on depression scores.
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Affiliation(s)
- Sarah Marietta von Siemens
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Comprehensive Pneumology Center Munich (CPC-M), Ludwig-Maximilians-Universität München, Ziemssenstr. 1, 80336, Munich, Germany
| | - Rudolf A Jörres
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Comprehensive Pneumology Center Munich (CPC-M), Ludwig-Maximilians-Universität München, Ziemssenstr. 1, 80336, Munich, Germany
| | - Jürgen Behr
- Department of Internal Medicine V, University of Munich (LMU), Ziemssenstr. 1, 80336, Munich, Germany
| | - Peter Alter
- Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-University Marburg, Germany, Member of the German Center for Lung Research (DZL), Baldingerstrasse, 35043, Marburg, Germany
| | - Johanna Lutter
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München GmbH - German Research Center for Environmental Health, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research, Ingolstädter Landstr. 1, 85764, Munich, Germany
| | - Tanja Lucke
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Comprehensive Pneumology Center Munich (CPC-M), Ludwig-Maximilians-Universität München, Ziemssenstr. 1, 80336, Munich, Germany
| | - Sandra Söhler
- ASCONET Study Coordination Office, University of Marburg, Baldingerstraße, 35043, Marburg, Germany
| | - Tobias Welte
- Department of Pneumology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Henrik Watz
- Pulmonary Research Institute at LungenClinic Grosshansdorf, Airway Research Center North, Member of the German Center for Lung Research, Woehrendamm 80, 22927, Grosshansdorf, Germany
| | - Claus F Vogelmeier
- Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-University Marburg, Germany, Member of the German Center for Lung Research (DZL), Baldingerstrasse, 35043, Marburg, Germany
| | - Franziska Trudzinski
- Department of Internal Medicine V - Pulmonology, Allergology, Respiratory Intensive Care Medicine, Saarland University Hospital, Kirrberger Straße 1, 66424, Homburg, Germany
| | - Winfried Rief
- Department of Clinical Psychology and Psychotherapy, Philipps-University Marburg, Germany, Gutenbergstraße 18, 35032, Marburg, Germany
| | - Britta Herbig
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Comprehensive Pneumology Center Munich (CPC-M), Ludwig-Maximilians-Universität München, Ziemssenstr. 1, 80336, Munich, Germany
| | - Kathrin Kahnert
- Department of Internal Medicine V, University of Munich (LMU), Ziemssenstr. 1, 80336, Munich, Germany.
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28
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Königsdorfer N, Jörres RA, Söhler S, Welte T, Behr J, Ficker JH, Bals R, Watz H, Lutter JI, Lucke T, Biertz F, Alter P, Vogelmeier CF, Kahnert K. Adherence To Respiratory And Nonrespiratory Medication In Patients With COPD: Results Of The German COSYCONET Cohort. Patient Prefer Adherence 2019; 13:1711-1721. [PMID: 31631986 PMCID: PMC6791408 DOI: 10.2147/ppa.s223438] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 09/13/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Adherence to COPD medication is often considered to be lower than in other chronic diseases. In view of the frequent comorbidities of COPD, the economic impact of nonadherence and the potential for adverse effects, a direct comparison between the adherence to respiratory and nonrespiratory medication in the same patients seems of particular interest. OBJECTIVES We aimed to investigate the intake of respiratory and nonrespiratory medication in the same patients with COPD and frequent comorbidities. METHOD Within the COPD cohort COSYCONET, we contacted 1042 patients, mailing them a list with all medication regarding all their diseases, asking for regular, irregular and non-intake. RESULTS Valid responses were obtained in 707 patients covering a wide spectrum of drugs. Intake of LABA, LAMA or ICS was regular in 91.9% of patients, even higher for cardiovascular and antidiabetes medication but lower for hyperlipidemia and depression/anxiety medication. Regular intake of respiratory medication did not depend on GOLD groups A-D or grades 1-4, was highest in patients with concomitant cardiovascular disorders and was lowest for concomitant asthma. It was slightly larger for LAMA and LABA administered via combined compared to single inhalers, and lower when similar compounds were prescribed twice. Most differences did not reach statistical significance owing to the overall high adherence. CONCLUSION Our results indicate a high adherence to respiratory medication in participants of a COPD cohort, especially in those with cardiovascular comorbidities. Compared to the lower adherence reported in the literature for COPD patients, our observations still suggest some room for improvement, possibly through disease management programs.
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Affiliation(s)
- Norbert Königsdorfer
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Comprehensive Pneumology Center Munich (CPC-M), Ludwig-Maximilians-Universität München, Munich80336, Germany
| | - Rudolf A Jörres
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Comprehensive Pneumology Center Munich (CPC-M), Ludwig-Maximilians-Universität München, Munich80336, Germany
| | - Sandra Söhler
- ASCONET Study Coordination Office, University of Marburg, Marburg35043, Germany
| | - Tobias Welte
- Department of Pneumology, Hannover Medical School, Hannover30625, Germany
| | - Jürgen Behr
- Department of Internal Medicine V, University of Munich, Comprehensive Pneumology Center, Member of the German Center for Lung Research, Munich80336, Germany
| | - Joachim H Ficker
- Department of Respiratory Medicine, Allergology and Sleep Medicine, General Hospital Nuernberg, Paracelsus Medical University, Nuernberg, Germany
| | - Robert Bals
- Department of Internal Medicine V, Pneumology, Allergology, Respiratory Intensive Care Medicine, Saarland University Hospital, Homburg66424, Germany
| | - Henrik Watz
- Pulmonary Research Institute at LungenClinic Grosshansdorf, Airway Research Center North, Member of the German Center for Lung Research, Grosshansdorf22927, Germany
| | - Johanna I Lutter
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München GmbH – German Research Center for Environmental Health, Comprehensive Pneumology Center Munich (CPC-M), Munich85764, Germany
| | - Tanja Lucke
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Comprehensive Pneumology Center Munich (CPC-M), Ludwig-Maximilians-Universität München, Munich80336, Germany
| | - Frank Biertz
- Institute for Biostatistics, Hannover Medical School, Hannover30625, Germany
| | - Peter Alter
- Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-University Marburg, Marburg35043, Germany
| | - Claus F Vogelmeier
- Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-University Marburg, Marburg35043, Germany
| | - Kathrin Kahnert
- Department of Internal Medicine V, University of Munich, Comprehensive Pneumology Center, Member of the German Center for Lung Research, Munich80336, Germany
- Correspondence: Kathrin Kahnert Department of Internal Medicine V, University of Munich, Comprehensive Pneumology Center, Member of the German Center for Lung Research, Ziemssenstr. 1, Munich80336, GermanyTel +49 89 4400 2590 Email
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Houben-Wilke S, Janssen DJA, Franssen FME, Vanfleteren LEGW, Wouters EFM, Spruit MA. Contribution of individual COPD assessment test (CAT) items to CAT total score and effects of pulmonary rehabilitation on CAT scores. Health Qual Life Outcomes 2018; 16:205. [PMID: 30376861 PMCID: PMC6208036 DOI: 10.1186/s12955-018-1034-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 10/17/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The COPD Assessment Test (CAT) contains eight items (cough, phlegm, chest tightness, breathlessness, limited activities, confidence leaving home, sleeplessness and energy). The current study aimed 1) to better understand the impact of the respiratory and non-respiratory CAT item scores on the CAT total score; and 2) to determine the impact of pulmonary rehabilitation (PR) on CAT items and CAT total score. METHODS CAT total score of ≥10 or ≥ 18 points was used to classify patients as highly symptomatic, a decrease of 2 points was considered as clinically relevant improvement. 'Cough', 'phlegm', 'chest tightness', 'breathlessness' were defined as respiratory items; ≥3 points on each item was defined as highly symptomatic. RESULTS In total, 497 clinically stable patients (55% male, age 64.0 (57.5-71.0) years, FEV1 46.0 (32.0-63.0)% predicted, CAT total score 22.0 (17.5-26.0) points) were included. 95% had CAT score ≥ 10 points and 75% ≥18 points. Respectively, 45% and 54% of subjects scored high on 3 or 4 of the respiratory CAT items. Following PR, 220 patients (57.7%) reported an improved health status as assessed by CAT total score (- 3.0 (- 7.0-1.0) points). Change in CAT item scores ranged from 0.0 (- 1.0-0.0) to - 1.0 (- 2.0-0.0) points) with best improvements in 'energy' (- 1.0 (- 2.0-0.0)points). CONCLUSIONS A substantial number of patients classified as highly symptomatic did not report a high level of respiratory symptoms, indicating that non-respiratory symptoms impact on disease classification and treatment algorithm. The impact of PR on CAT item scores varied by individual item. TRIAL REGISTRATION Netherlands National Trial Register ( NTR3416 ). Registered 2 May 2012.
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Affiliation(s)
- Sarah Houben-Wilke
- Department of Research and Education, CIRO, Hornerheide 1, Horn, 6085 NM The Netherlands
| | - Daisy J. A. Janssen
- Department of Research and Education, CIRO, Hornerheide 1, Horn, 6085 NM The Netherlands
- Centre of Expertise for Palliative Care, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Frits M. E. Franssen
- Department of Research and Education, CIRO, Hornerheide 1, Horn, 6085 NM The Netherlands
- Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Lowie E. G. W. Vanfleteren
- Department of Research and Education, CIRO, Hornerheide 1, Horn, 6085 NM The Netherlands
- COPD center, Sahlgrenska University Hospital and Institute of Medicine, Gothenburg University, Gothenburg, Sweden
| | - Emiel F. M. Wouters
- Department of Research and Education, CIRO, Hornerheide 1, Horn, 6085 NM The Netherlands
- Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Martijn A. Spruit
- Department of Research and Education, CIRO, Hornerheide 1, Horn, 6085 NM The Netherlands
- Department of Respiratory Medicine, Maastricht University Medical Center, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands
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30
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Polastri M, Ambrosino N, Vitacca M, Nava S, Clini EM. Assessment of Symptoms in Patients with COPD: Strengths and Limitations of Clinical Scores. CURRENT PULMONOLOGY REPORTS 2018. [DOI: 10.1007/s13665-018-0217-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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31
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Soriano JB, Hahsler M, Soriano C, Martinez C, de-Torres JP, Marín JM, de Lucas P, Cosio BG, Fuster A, Casanova C. Temporal transitions in COPD severity stages within the GOLD 2017 classification system. Respir Med 2018; 142:81-85. [DOI: 10.1016/j.rmed.2018.07.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 07/30/2018] [Accepted: 07/31/2018] [Indexed: 10/28/2022]
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32
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Franssen FME, Smid DE, Deeg DJH, Huisman M, Poppelaars J, Wouters EFM, Spruit MA. The physical, mental, and social impact of COPD in a population-based sample: results from the Longitudinal Aging Study Amsterdam. NPJ Prim Care Respir Med 2018; 28:30. [PMID: 30097575 PMCID: PMC6086825 DOI: 10.1038/s41533-018-0097-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 07/10/2018] [Accepted: 07/19/2018] [Indexed: 12/31/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is associated with substantial health impact that may already become apparent in early disease. This study aims to examine the features of subjects with COPD in a Dutch population-based sample and compare their physical status, mental status, and social status to non-COPD subjects. This study made use of Longitudinal Aging Study Amsterdam (LASA) data. Demographics, clinical characteristics, self-reported diseases, post-bronchodilator spirometry, physical, mental, and social status were assessed. A number of 810 subjects (50.5% male, mean age 60.5 ± 2.9 years) were included. Subjects with COPD (n = 68, mean FEV1 67.6 [IQR 60.4–80.4] %.) had a slower walking speed than non-COPD subjects, p = 0.033. When compared to non-COPD subjects, COPD subjects gave a lower rating on their health (physical subscale of SF-12: 15 [IQR 16.0–19.0] vs. 18 [IQR 11.0–17.0] points) and life (EQ5D VAS: 75 [IQR 70.0–90.0] vs. 80 points [IQR 65.0–85.5]) surveys. COPD subjects also had a more impaired disease-specific health status (CAT: 9.5 ± 5.9 vs. 6.7 ± 5.2, respectively), were less likely to have a partner (69% vs. 84%, respectively) and received emotional support less often (24% vs. 36%, respectively) compared to non-COPD subjects (All comparisons p < 0.001). In a population-based sample, subjects with COPD had a reduced physical performance, a more impaired disease-specific health status and were more socially deprived compared to non-COPD subjects. These impairments need to be taken into consideration when setting up a management program for patients with mild COPD. Patients with early-stage chronic lung disease need holistic support to limit the physical, mental and social impacts of the condition. There is more to chronic obstructive pulmonary disease (COPD) than persistent airflow limitation; systemic effects, including loss of muscle strength and higher risk of heart conditions, mental health and social problems can manifest from the early stages. Frits Franssen at CIRO, the Netherlands, and co-workers interviewed 810 participants aged 55–65 from the Longitudinal Aging Study Amsterdam to investigate the physical, mental and social status of COPD sufferers and compare them with healthy controls. Those with COPD were more likely to walk slower, tire easily and perceive themselves as having poor overall health. Socially, COPD patients were less likely to have long-term partners and felt the need for more emotional support than their healthy peers.
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Affiliation(s)
- Frits M E Franssen
- Department of Research & Education, CIRO, Horn, The Netherlands. .,NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands. .,Department of Respiratory Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands.
| | - Dionne E Smid
- Department of Research & Education, CIRO, Horn, The Netherlands
| | - Dorly J H Deeg
- Department of Epidemiology & Biostatistics, EMGO+Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Martijn Huisman
- Department of Epidemiology & Biostatistics, EMGO+Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.,Department of Sociology, VU University, Amsterdam, The Netherlands
| | - Jan Poppelaars
- Department of Epidemiology & Biostatistics, EMGO+Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.,Department of Sociology, VU University, Amsterdam, The Netherlands
| | - Emiel F M Wouters
- Department of Research & Education, CIRO, Horn, The Netherlands.,Department of Respiratory Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Martijn A Spruit
- Department of Research & Education, CIRO, Horn, The Netherlands.,NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands.,REVAL - Rehabilitation Research Center, BIOMED - Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
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33
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Houben-Wilke S, Augustin IM, Vercoulen JH, van Ranst D, Bij de Vaate E, Wempe JB, Spruit MA, Wouters EFM, Franssen FME. COPD stands for complex obstructive pulmonary disease. Eur Respir Rev 2018; 27:27/148/180027. [PMID: 29875138 DOI: 10.1183/16000617.0027-2018] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 04/16/2018] [Indexed: 02/03/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD) has extensively been reported as a complex disease affecting patients' health beyond the lungs with a variety of intra- and extrapulmonary components and considerable variability between individuals. This review discusses the assessment of this complexity and underlines the importance of transdisciplinary management programmes addressing the physical, emotional and social health of the individual patient.COPD management is challenging and requires advanced, sophisticated strategies meeting the patient's individual needs. Due to the heterogeneity and complexity of the disease leading to non-linear and consequently poorly predictable treatment responses, multidimensional patient profiling is crucial to identify the right COPD patient for the right treatment. Current methods are often restricted to general, well-known and commonly used assessments neglecting potentially relevant (interactions between) individual, unique "traits" to finally ensure personalised treatment. Dynamic, personalised and holistic approaches are needed to tackle this multifaceted disease and to ensure personalised medicine and value-based healthcare.
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Affiliation(s)
| | | | - Jan H Vercoulen
- Radboud University Medical Center, Nijmegen, The Netherlands
| | | | | | - Johan B Wempe
- University Medical Center Groningen, Groningen, The Netherlands
| | - Martijn A Spruit
- CIRO+, Horn, The Netherlands.,Dept of Respiratory Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Emiel F M Wouters
- CIRO+, Horn, The Netherlands.,Dept of Respiratory Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Frits M E Franssen
- CIRO+, Horn, The Netherlands.,Dept of Respiratory Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
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Lopez-Campos JL, Centanni S. Current Approaches for Phenotyping as a Target for Precision Medicine in COPD Management. COPD 2018; 15:108-117. [PMID: 29558165 DOI: 10.1080/15412555.2018.1443064] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The study of airway diseases continues to present several challenges for modern medicine. The different disease presentations with variables and overlapping features may result in a real challenge for the clinician. In this context, the concept of precision medicine has started to emerge in order to give answers to some of these challenges from a diagnostic and therapeutic point of view. The main reasons to target for precision medicine in chronic obstructive pulmonary disease (COPD) include that there is variability in the clinical presentation, there is no correlation between the different clinical variables at the patient level, there are a number of relevant clinical variables associated with outcomes, we do have specific therapies for specific patient types, and that there is variability in the clinical response to different therapies. To bring precision medicine into clinical practice several approaches have been used, including the use of independent variables to identify subjects, the use of multidimensional indexes, the so-called clinical phenotypes, and the approximation by the so-called treatable traits. All these approaches have their strengths and weaknesses which are reviewed in the present document. Although there is no universally accepted proposal, the available initiatives provide us with a framework on which to start working and move toward precision medicine in COPD, with the ultimate goal of bringing the best possible medicine to each patient in particular.
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Affiliation(s)
- Jose Luis Lopez-Campos
- a Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Universidad de Sevilla , Seville , Spain.,b Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III , Madrid , Spain
| | - Stefano Centanni
- c Respiratory Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, Department of Health Sciences , Università degli Studi di Milano , Milan , Italy
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35
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Soriano JB. Brighter than GOLD. THE LANCET RESPIRATORY MEDICINE 2018; 6:165-166. [DOI: 10.1016/s2213-2600(18)30001-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Accepted: 12/14/2017] [Indexed: 01/21/2023]
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