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Abstract
The PLATINO and PREPOCOL population-based studies documented the prevalence of chronic obstructive pulmonary disease (COPD) in several Latin American (Mexico City, Sao Paulo, Montevideo, Santiago and Caracas) and Colombian (Medellin, Bogota, Barranquilla, Bucaramanga and Cali) cities. COPD ranged between 6.2 and 19.6% in individuals ≥40 years of age, with substantial rates of underdiagnosis (up to 89%) but also overdiagnosis, mostly due to the lack of spirometric confirmation. The main risk factor was tobacco smoking, but male gender and age were also associated with COPD. COPD in never smokers represented about one third of the cases and was associated with previous history of tuberculosis or a diagnosis of asthma. COPD associated with biomass smoke exposure was a common clinical phenotype in Latin America, found as a risk factor in PREPOCOL and other observational studies in the region. Smoking has been decreasing in Latin America and efforts have been made to implement cleaner biomass stoves. Unfortunately, treatment of COPD in Latin America remains highly variable with low rates of smoking cessation counselling, low use of inhaled bronchodilators and influenza vaccination. A primary-care approach to COPD, particularly in the form of integrated programs is lacking but would be critical to improving rates of diagnosis and treatment of COPD.
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Heikkilä JM, Parkkamäki S, Salimäki J, Westermarck S, Pohjanoksa-Mäntylä M. Community pharmacists' knowledge of COPD, and practices and perceptions of medication counseling of COPD patients. Int J Chron Obstruct Pulmon Dis 2018; 13:2065-2074. [PMID: 30013334 PMCID: PMC6037276 DOI: 10.2147/copd.s159726] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background and purpose COPD is one of the leading causes of morbidity and mortality worldwide. Although medication counseling interventions by pharmacists have been found to support the management of COPD, little is known about pharmacists’ knowledge concerning COPD and regular practices and perceptions concerning medication counseling of COPD patients. The purpose of this study was to research these topics among Finnish community pharmacists. Materials and methods In January 2017, an electronic survey was e-mailed to Finnish community pharmacies (n=741) via the Association of the Finnish Pharmacies. One pharmacist from each pharmacy, preferably a specialist in asthma, was invited to answer the survey. Results Completed responses were received from 263 pharmacists (response rate =35%), of whom 196 pharmacists were specialists in asthma. Response rate among asthma pharmacists was 42%. Pharmacists were positive about their role in medication counseling and in support of the self-management of COPD patients. COPD-related knowledge was self-assessed as being good and was on a good level in respect of basic facts. However, almost half (46%) of the pharmacists did not know that COPD is considered a national public health issue, and ~50% of the pharmacists were not familiar with the current care guideline on COPD. Medication counseling was found to be more medicinal product-driven and less advisory concerning lifestyle changes such as smoking cessation and physical exercise. Conclusion Although the pharmacists’ knowledge of COPD was good on general topics, there were some gaps in their knowledge on the current care guideline and status of the disease. Pharmacists should more systematically individually target medication counseling according to patients’ needs. In addition, lifestyle treatments, including smoking cessation and physical exercise, should be part of the medication counseling.
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Affiliation(s)
- Juha Markus Heikkilä
- Faculty of Pharmacy, Division of Pharmacology and Pharmacotherapy, University of Helsinki, Helsinki, Finland, .,Hartola Pharmacy, Hartola, Finland,
| | | | | | | | - Marika Pohjanoksa-Mäntylä
- Faculty of Pharmacy, Division of Pharmacology and Pharmacotherapy, University of Helsinki, Helsinki, Finland,
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Lamprecht B, Soriano JB, Studnicka M, Kaiser B, Vanfleteren LE, Gnatiuc L, Burney P, Miravitlles M, García-Rio F, Akbari K, Ancochea J, Menezes AM, Perez-Padilla R, Montes de Oca M, Torres-Duque CA, Caballero A, González-García M, Buist S. Determinants of underdiagnosis of COPD in national and international surveys. Chest 2016; 148:971-985. [PMID: 25950276 DOI: 10.1378/chest.14-2535] [Citation(s) in RCA: 265] [Impact Index Per Article: 33.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND COPD ranks within the top three causes of mortality in the global burden of disease, yet it remains largely underdiagnosed. We assessed the underdiagnosis of COPD and its determinants in national and international surveys of general populations. METHODS We analyzed representative samples of adults aged ≥ 40 years randomly selected from well-defined administrative areas worldwide (44 sites from 27 countries). Postbronchodilator FEV1/FVC < lower limit of normal (LLN) was used to define chronic airflow limitation consistent with COPD. Undiagnosed COPD was considered when participants had postbronchodilator FEV1/FVC < LLN but were not given a diagnosis of COPD. RESULTS Among 30,874 participants with a mean age of 56 years, 55.8% were women, and 22.9% were current smokers. Population prevalence of (spirometrically defined) COPD ranged from 3.6% in Barranquilla, Colombia, to 19.0% in Cape Town, South Africa. Only 26.4% reported a previous lung function test, and only 5.0% reported a previous diagnosis of COPD, whereas 9.7% had a postbronchodilator FEV1/FVC < LLN. Overall, 81.4% of (spirometrically defined) COPD cases were undiagnosed, with the highest rate in Ile-Ife, Nigeria (98.3%) and the lowest rate in Lexington, Kentucky (50.0%). In multivariate analysis, a greater probability of underdiagnosis of COPD was associated with male sex, younger age, never and current smoking, lower education, no previous spirometry, and less severe airflow limitation. CONCLUSIONS Even with substantial heterogeneity in COPD prevalence, COPD underdiagnosis is universally high. Because effective management strategies are available for COPD, spirometry can help in the diagnosis of COPD at a stage when treatment will lead to better outcomes and improved quality of life.
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Affiliation(s)
- Bernd Lamprecht
- Department of Pulmonary Medicine, Kepler University Hospital, Linz, Austria; Faculty of Medicine, Johannes-Kepler-University, Linz, Austria.
| | - Joan B Soriano
- Instituto de Investigación, Hospital Universitario de la Princesa (IISP), Universidad Autónoma de Madrid, Catédra UAM-Linde, Madrid, Spain
| | - Michael Studnicka
- Department of Pulmonary Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Bernhard Kaiser
- Faculty of Medicine, Johannes-Kepler-University, Linz, Austria
| | - Lowie E Vanfleteren
- Department of Respiratory Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands; Program Development Centre, CIRO+, Centre of Expertise for Chronic Organ Failure, Horn, The Netherlands
| | - Louisa Gnatiuc
- Respiratory Epidemiology and Public Health, Imperial College, London, England
| | - Peter Burney
- Respiratory Epidemiology and Public Health, Imperial College, London, England
| | - Marc Miravitlles
- Servicio de Neumología, Hospital Universitari Vall d'Hebron, Ciber de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
| | | | - Kaveh Akbari
- Department of Radiology, General Hospital Linz (Akh Linz), Linz, Austria
| | - Julio Ancochea
- Servicio de Neumología, Hospital La Princesa, Universidad Autónoma de Madrid, Madrid, Spain
| | - Ana M Menezes
- Programa de Pós-Graduacão em Epidemiologia, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Rogelio Perez-Padilla
- Institute of Respiratory Diseases, Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico
| | - Maria Montes de Oca
- Servicio de Neumonología, Hospital Universitario de Caracas, Facultad de Medicina, Universidad Central de Venezuela, Caracas, Venezuela
| | - Carlos A Torres-Duque
- Departamento de Investigación, Fundación Neumológica Colombiana, Bogotá, Colombia; Asociación Colombiana de Neumología y Cirugía de Tórax, Bogotá, Colombia
| | - Andres Caballero
- Asociación Colombiana de Neumología y Cirugía de Tórax, Bogotá, Colombia; Clínica Reina Sofía, Bogotá, Colombia
| | | | - Sonia Buist
- Oregon Health & Science University, Portland, OR
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Pérez-Padilla R, Stelmach R, Soto-Quiroz M, Cruz AA. Fighting respiratory diseases: divided efforts lead to weakness. J Bras Pneumol 2015; 40:207-10. [PMID: 25029641 PMCID: PMC4109190 DOI: 10.1590/s1806-37132014000300001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
| | - Rafael Stelmach
- Heart Institute, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
| | | | - Alvaro Augusto Cruz
- Center of Excellence in Asthma, Federal University of Bahia, Salvador, Brazil
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Kainu A, Pallasaho P, Piirilä P, Lindqvist A, Sovijärvi A, Pietinalho A. Increase in prevalence of physician-diagnosed asthma in Helsinki during the Finnish Asthma Programme: improved recognition of asthma in primary care? A cross-sectional cohort study. PRIMARY CARE RESPIRATORY JOURNAL : JOURNAL OF THE GENERAL PRACTICE AIRWAYS GROUP 2013; 22:64-71. [PMID: 23299455 PMCID: PMC6442759 DOI: 10.4104/pcrj.2013.00002] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2012] [Revised: 11/18/2012] [Accepted: 11/30/2012] [Indexed: 11/18/2022]
Abstract
BACKGROUND The continuing rise in asthma prevalence has been questioned, with recent reports suggesting a plateau. AIMS To assess a 10-year trend in the age-adjusted prevalence of physician-diagnosed asthma, respiratory and allergic symptoms, and use of asthma medication in the adult population of Helsinki during the Finnish Asthma Programme from 1994 to 2004. METHODS Two cross-sectional postal surveys were conducted among random Finnish National Population Registry samples 10 years apart using the same protocol. A total of 6,062 subjects (75.9%) and 2,449 subjects (61.9%) participated in 1996 and 2006, respectively. RESULTS The prevalence of physician-diagnosed asthma increased from 6.5% in 1996 to 10.0% in 2006 (p<0.001). This was evident in both genders aged <60 years, but particularly in women aged <40 years, paralleling an increased use of asthma medication. Concurrently, the prevalence of allergic rhinoconjunctivitis increased from 37.2% to 44.4% (p<0.001). The prevalence of physician-diagnosed chronic obstructive pulmonary disease remained unchanged (3.7%), while current smoking abated. Subjects with a smoking history had more respiratory symptoms (p<0.001). Among subjects without physician-diagnosed asthma, those reporting allergic rhinoconjunctivitis had a higher prevalence of lower respiratory tract symptoms. CONCLUSIONS The prevalence of allergic rhinoconjunctivitis and physician-diagnosed asthma has increased in Helsinki during 10 years in adults, especially in women aged <40 years. Concomitantly, the use of asthma medication increased and subjects with physiciandiagnosed asthma were less symptomatic. The increase in the prevalence of physician-diagnosed asthma may partly be due to improved diagnostic recognition of asthma in primary care during the Finnish Asthma Programme, but the concurrent rise in allergic rhinoconjunctivitis may reflect a true rise in prevalence.
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Affiliation(s)
- Annette Kainu
- Division of Respiratory Medicine, Department of Medicine, Helsinki University Central Hospital, Peijas Hospital, Vantaa, Finland.
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Hukkinen M, Korhonen T, Heikkilä K, Kaprio J. Association between smoking behavior patterns and chronic obstructive pulmonary disease: a long-term follow-up study among Finnish adults. Ann Med 2012; 44:598-606. [PMID: 21612334 DOI: 10.3109/07853890.2011.580776] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Low-rate smoking patterns are common, but their pulmonary effects remain poorly known. The study hypothesis was that any level of daily smoking may cause chronic obstructive pulmonary disease (COPD). We investigated the association between longitudinal smoking patterns and COPD using logistic regressions and survival models adjusted for multiple covariates. Data from Finnish Twin Cohort surveys were used. Participants (n = 21,609) were grouped into categories describing 1981 smoking and change in smoking during 1975-1981. Light smoking was defined as < 5 cigarettes per day, moderate 5-19 cigarettes, and heavy ≥ 20 cigarettes per day. Finland's Social Insurance Institution provided data on inhaled anticholinergics purchases (1995-2008) and diagnoses entitling to special reimbursements (1981-2008). We defined COPD as regular anticholinergic use or special reimbursement eligibility for COPD, emphysema, or chronic bronchitis. COPD incidence was 2.5% (n = 528). Elevated disease risks were observed in former, moderate, and heavy smokers, in all who increased smoking, and in those who reduced from moderate to light smoking. Increased risk for anticholinergic use was found in former smokers, in constant light, moderate, and heavy smokers, and in increasers. Former, light, moderate, and heavy smoking in 1981 was associated with future development of disease. Our results demonstrate that all daily smoking patterns may impair pulmonary function.
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Affiliation(s)
- Maria Hukkinen
- Department of Public Health, Hjelt Institute, University of Helsinki, Helsinki, Finland.
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Kinnula VL, Vasankari T, Kontula E, Sovijarvi A, Saynajakangas O, Pietinalho A. The 10-year COPD Programme in Finland: effects on quality of diagnosis, smoking, prevalence, hospital admissions and mortality. PRIMARY CARE RESPIRATORY JOURNAL : JOURNAL OF THE GENERAL PRACTICE AIRWAYS GROUP 2011; 20:178-83. [PMID: 21431275 DOI: 10.4104/pcrj.2011.00024] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The Finnish National Programme for Chronic Bronchitis and Chronic Obstructive Pulmonary Disease (COPD) 1998-2007 was set up to reduce the prevalence of COPD, improve COPD diagnosis and care, reduce the number of moderate to severe cases of the disease, and reduce hospitalisations and treatment costs due to COPD. Over 900 events for 25,000 participating healthcare workers were arranged. The major strengths of this programme included multidisciplinary strategies and web-based guidelines in nearly all primary health care centres around the country. METHODS Data from national registries, epidemiological studies and questionnaires were used to measure whether the goals had been reached. RESULTS The prevalence of COPD remained unchanged. Smoking decreased in males from 30% to 26% (p<0.001) and in females from 20% to 17% (p<0.001). Significant improvements in the quality of spirometry were obtained. Hospitalisation decreased by 39.7% (p<0.001). COPD costs were 88% lower than had been anticipated from earlier investigations. No increase in COPD mortality was observed. CONCLUSIONS In combination with other efforts, the Finnish 10-year COPD Programme had significant positive consequences: no further increases in COPD prevalence, reduced smoking prevalence, improved quality of diagnosis, and reduction in COPD-related hospitalisations.
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Affiliation(s)
- Vuokko L Kinnula
- Department of Medicine, Division of Pulmonary Medicine, University of Helsinki, Helsinki, Finland.
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Laitinen T, Hodgson U, Kupiainen H, Tammilehto L, Haahtela T, Kilpeläinen M, Lindqvist A, Kinnula VL. Real-World Clinical Data Identifies Gender-related Profiles in Chronic Obstructive Pulmonary Disease. COPD 2009; 6:256-62. [DOI: 10.1080/15412550903051799] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Abstract
Chronic obstructive pulmonary disease (COPD) is a substantially underdiagnosed disorder, with the diagnosis typically missed or delayed until the condition is advanced. Spirometry is the most frequently used pulmonary function test and enables health professionals to make an objective measurement of airflow obstruction and assess the degree to which it is reversible. As a diagnostic test for COPD, spirometry is a reliable, simple, non-invasive, safe, and non-expensive procedure. Early diagnosis of COPD should provide support for smoking cessation initiatives and lead to reduction of the societal burden of the disease, but definitive confirmation of both proves elusive. Despite substantial effort and investment, implementation of quality spirometry is deficient because of several hurdles and limitations, described in this Review. All in all, spirometry is recognised as the essential test for diagnosis and monitoring of COPD.
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Affiliation(s)
- Joan B Soriano
- CIMERA (International Center for Advanced Respiratory Medicine), Recinte Hospital Joan March, Bunyola, Spain.
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Lampela P, Säynäjäkangas O, Jokelainen J, Keistinen T. Differences in COPD-related readmissions to primary and secondary care hospitals. Scand J Prim Health Care 2009; 27:80-4. [PMID: 19255931 PMCID: PMC3410466 DOI: 10.1080/02813430802673501] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2008] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVE To study differences in readmissions to primary and secondary care hospitals for exacerbations of chronic obstructive pulmonary disease (COPD). DESIGN A register-based study. SUBJECTS The data were gathered from the hospital admissions register of the Finnish National Research and Development Centre for Welfare and Health. The data included all acute periods of treatment received by COPD patients aged over 44 years in 1996-2004 who had a principal or subsidiary diagnosis of COPD (ICD 10: J41-J44), respiratory infection (ICD 10: J00-J39, J85-J86) or cardiac insufficiency (ICD 10: I50), followed by an emergency readmission. Treatment had to have taken place in either a primary care hospital or a specialized ward for respiratory diseases or internal medicine in a secondary care hospital. MAIN OUTCOME MEASURES The risk of readmission within a week of discharge, analysed by site of care. RESULTS The risk of readmission within seven days of discharge is 1.74-fold for a patient treated in primary care compared with a patient treated in secondary care. CONCLUSIONS COPD patients discharged from primary care hospitals have a greater risk of readmission, particularly within a week, than those discharged from secondary care. This risk may be attributed to differences in treatment procedures and arrangement of subsequent care. Thus, in the future, more attention should be paid to primary healthcare resources and staff training.
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