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Servadio M, Rosa AC, Addis A, Kirchmayer U, Cozzi I, Michelozzi P, Cipelli R, Heiman F, Davoli M, Belleudi V. Investigating socioeconomic disparities in lung cancer diagnosis, treatment and mortality: an Italian cohort study. BMC Public Health 2024; 24:1543. [PMID: 38849792 PMCID: PMC11161996 DOI: 10.1186/s12889-024-19041-4] [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: 01/10/2024] [Accepted: 06/03/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND Lung cancer is one of the most lethal cancers worldwide and patient clinical outcomes seem influenced by their socioeconomic position (SEP). Since little has been investigated on this topic in the Italian context, our aim was to investigate the role of SEP in the care pathway of lung cancer patients in terms of diagnosis, treatment and mortality. METHODS This observational retrospective cohort study included patients discharged in the Lazio Region with a lung cancer diagnosis between 2014 and 2017. In the main analysis, educational level was used as SEP measure. Multivariate models, adjusted for demographic and clinical variables, were applied to evaluate the association between SEP and study outcomes, stratified for metastatic (M) and non-metastatic (NM) cancer. We defined a diagnosis as 'delayed' when patients received their initial cancer diagnosis after an emergency department admission. Access to advanced lung cancer treatments (high-cost, novel and innovative treatments) and mortality were investigated within the 24-month period post-diagnosis. Moreover, two additional indicators of SEP were examined in the sensitivity analysis: one focusing on area deprivation and the other on income-based exemption. RESULTS A total of 13,251 patients were identified (37.3% with metastasis). The majority were males (> 60%) and over half were older than 70 years. The distribution of SEP levels among patients was as follow: 31% low, 29% medium-low, 32% medium-high and 7% high. As SEP increased, the risks of receiving a delayed diagnosis ((high vs low: M: OR = 0.29 (0.23-0.38), NM: OR = 0.20 (0.16-0.25)) and of mortality ((high vs low M: OR = 0.77 (0.68-0.88) and NM: 0.61 (0.54-0.69)) decreased. Access to advanced lung cancer treatments increased in accordance with SEP only in the M cohort (high vs low: M: OR = 1.57 (1.18-2.09)). The primary findings were corroborated by sensitivity analysis. CONCLUSIONS Our study highlighted the need of public health preventive and educational programs in Italy, a country where the care pathway of lung cancer patients, especially in terms of diagnosis and mortality, appears to be negatively affected by SEP level.
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Affiliation(s)
- Michela Servadio
- Department of Epidemiology, Regional Health Service Lazio, Rome, Italy
| | - Alessandro C Rosa
- Department of Epidemiology, Regional Health Service Lazio, Rome, Italy.
| | - Antonio Addis
- Department of Epidemiology, Regional Health Service Lazio, Rome, Italy
| | - Ursula Kirchmayer
- Department of Epidemiology, Regional Health Service Lazio, Rome, Italy
| | - Ilaria Cozzi
- Department of Epidemiology, Regional Health Service Lazio, Rome, Italy
| | - Paola Michelozzi
- Department of Epidemiology, Regional Health Service Lazio, Rome, Italy
| | | | | | - Marina Davoli
- Department of Epidemiology, Regional Health Service Lazio, Rome, Italy
| | - Valeria Belleudi
- Department of Epidemiology, Regional Health Service Lazio, Rome, Italy
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Vieira RJ, Leemann L, Briggs A, Pereira AM, Savouré M, Kuna P, Morais-Almeida M, Bewick M, Azevedo LF, Louis R, Klimek L, Bahbah F, Samolinski B, Anto JM, Zuberbier T, Fonseca JA, Bousquet J, Sousa-Pinto B. Poor Rhinitis and Asthma Control Is Associated With Decreased Health-Related Quality of Life and Utilities: A MASK-air Study. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:1530-1538.e6. [PMID: 38561141 DOI: 10.1016/j.jaip.2024.03.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 02/15/2024] [Accepted: 03/21/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Allergic rhinitis (AR) and asthma may affect health-related quality of life. However, national estimates on the quality of life of patients with AR or asthma are lacking. OBJECTIVE To provide estimates for utility scores and EuroQoL five-dimension (EQ-5D) visual analog scale (VAS) for patients with AR or asthma. METHODS We conducted a cross-sectional study using direct patient data from the MASK-air app on European MASK-air users with self-reported AR or asthma. We used a multi-attribute instrument (EQ-5D) to measure quality of life (as utility scores and EQ-5D VAS values). Mean scores were calculated per country and disease control level using multilevel regression models with poststratification, accounting for age and sex biases. RESULTS We assessed data from 7905 MASK-air users reporting a total of up to 82,737 days. For AR, utilities ranged from 0.86 to 0.99 for good control versus 0.72 to 0.85 for poor control; EQ-5D VAS levels ranged from 78.9 to 87.9 for good control versus 55.3 to 64.2 for poor control. For asthma, utilities ranged from 0.84 to 0.97 for good control versus 0.73 to 0.87 for poor control; EQ-5D VAS levels ranged from 68.4 to 81.5 for good control versus 51.4 to 64.2 for poor control. Poor disease control was associated with a mean loss of 0.14 utilities for both AR and asthma. For the same control levels, AR and asthma were associated with similar utilities and EQ-5D VAS levels. However, lower values were observed for asthma plus AR compared with AR alone. CONCLUSIONS Poor AR or asthma control are associated with reduced quality of life. The estimates obtained from mobile health data may provide valuable insights for health technology assessment studies.
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Affiliation(s)
- Rafael José Vieira
- Department of Community Medicine, Information, and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal; Centre for Health Technology and Services Research, Health Research Network (CINTESIS@RISE), Faculty of Medicine, University of Porto, Porto, Portugal
| | - Lucas Leemann
- Department of Political Science, University of Zurich, Zurich, Switzerland
| | - Andrew Briggs
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Ana Margarida Pereira
- Department of Community Medicine, Information, and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal; Centre for Health Technology and Services Research, Health Research Network (CINTESIS@RISE), Faculty of Medicine, University of Porto, Porto, Portugal
| | - Marine Savouré
- Inserm, Equipe d'Epidémiologie Respiratoire Intégrative, CESP, Villejuif, France; Université Paris-Saclay, Université de Versailles Saint-Quentin-en-Yvelines, Université Paris-Sud, Villejuif, France
| | - Piotr Kuna
- Division of Internal Medicine, Asthma, and Allergy, Barlicki University Hospital, Medical University of Lodz, Lodz, Poland
| | | | - Michael Bewick
- University of Central Lancashire Medical School, Preston, United Kingdom
| | - Luís Filipe Azevedo
- Department of Community Medicine, Information, and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal; Centre for Health Technology and Services Research, Health Research Network (CINTESIS@RISE), Faculty of Medicine, University of Porto, Porto, Portugal
| | - Renaud Louis
- Department of Pulmonary Medicine, CHU Liège, Liège, Belgium; GIGA I3 Research Group, University of Liège, Liège, Belgium
| | - Ludger Klimek
- Department of Otolaryngology, Head and Neck Surgery, Universitätsmedizin Mainz, Mainz, Germany; Center for Rhinology and Allergology, Wiesbaden, Germany
| | | | - Boleslaw Samolinski
- Department of Prevention of Environmental Hazards, Allergology and Immunology, Medical University of Warsaw, Warsaw, Poland
| | - Josep M Anto
- ISGlobal, Barcelona Institute for Global Health, Barcelona, Spain; Universitat Pompeu Fabra, Barcelona, Spain; CIBER Epidemiología y Salud Pública, Barcelona, Spain
| | - Torsten Zuberbier
- Institute of Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology, Allergology and Immunology, Berlin, Germany
| | - João A Fonseca
- Department of Community Medicine, Information, and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal; Centre for Health Technology and Services Research, Health Research Network (CINTESIS@RISE), Faculty of Medicine, University of Porto, Porto, Portugal
| | - Jean Bousquet
- Institute of Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology, Allergology and Immunology, Berlin, Germany; MASK-air SAS, Montpellier, France.
| | - Bernardo Sousa-Pinto
- Department of Community Medicine, Information, and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal; Centre for Health Technology and Services Research, Health Research Network (CINTESIS@RISE), Faculty of Medicine, University of Porto, Porto, Portugal
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Andreozzi P, Gussoni G, Sesti G, Montano N, Pietrangelo A. Impact of electronic cigarettes (e-cigs) and heat-not-burn/heated tobacco products (HnB/HTP) on asthma and chronic obstructive pulmonary disease: a viewpoint of the Italian Society of Internal Medicine. Intern Emerg Med 2024:10.1007/s11739-024-03648-x. [PMID: 38806787 DOI: 10.1007/s11739-024-03648-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Accepted: 05/14/2024] [Indexed: 05/30/2024]
Abstract
The association of cigarette smoking with several severe and very severe diseases (oncological, cardiovascular, respiratory) which have dramatic epidemiological, medical, and financial impact, is a well-known public threat. Asthma and chronic obstructive pulmonary disease (COPD) are highly prevalent diseases in Italy, posing significant public health challenges. Tobacco smoking, a primary risk factor for COPD and a common asthma trigger, remains a critical preventable public health issue. While universally acknowledged that quitting smoking drastically reduces the risk of smoking-related health issues, a significant portion of smokers and patients find quitting challenging or undesirable, hence a need for new ways to deal with it. A worth considering alternative might be the switch to electronic cigarettes (e-cig), and heat-not-burn/heated tobacco products (HnB/HTP). Emerging evidence suggests potential benefits in asthma and COPD management when transitioning from traditional smoking to e-cigs or HnB devices. However, the effectiveness of these products in facilitating smoking cessation is still debated, alongside concerns about their role in promoting smoking initiation among non-smokers. Internists are among the physicians who most frequently assist patients with smoking-related diseases, and in this perspective they cannot avoid paying attention to the progressive diffusion of smoking products alternative to the traditional cigarette, and to the controversies with respect to their use. In this context, the Italian Society of Internal Medicine, also recognizing a growing need for clarity for healthcare providers, has undertaken a comprehensive analysis of existing literature to offer an informed perspective on the health impact of e-cigs and HnB/HTP on asthma and COPD.
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Affiliation(s)
- Paola Andreozzi
- Predictive Medicine Unit, Department of Internal Medicine, Endocrine-Metabolic Sciences and Infectious Diseases, Azienda Ospedaliero Universitaria Policlinico Umberto I, Rome, Italy
| | | | - Giorgio Sesti
- Department of Clinical and Molecular Medicine, University of Rome-Sapienza, 00189, Rome, Italy
| | - Nicola Montano
- Department of Clinical Community Sciences, University of Milan, 20122, Milan, Italy
| | - Antonello Pietrangelo
- Internal Medicine Unit, Department of Medical and Surgical Sciences, University Hospital of Modena, Modena, Italy.
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Calabria S, Ronconi G, Dondi L, Dondi L, Dell'Anno I, Nordon C, Rhodes K, Rogliani P, Dentali F, Martini N, Maggioni AP. Cardiovascular events after exacerbations of chronic obstructive pulmonary disease: Results from the EXAcerbations of COPD and their OutcomeS in CardioVascular diseases study in Italy. Eur J Intern Med 2024:S0953-6205(24)00181-X. [PMID: 38729787 DOI: 10.1016/j.ejim.2024.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 04/16/2024] [Accepted: 04/27/2024] [Indexed: 05/12/2024]
Abstract
INTRODUCTION Exacerbations of chronic obstructive pulmonary disease (COPD) can increase the risk of severe cardiovascular events. OBJECTIVE Assess the crude incidence rates (IR) of cardiovascular events and the impact of exacerbations on the risk of cardiovascular events within different time periods following an exacerbation. METHODS COPD patients aged ≥45 years between 01/01/2015 and 12/31/2018 were identified from the Fondazione Ricerca e Salute administrative database. IRs of severe non-fatal and fatal cardiovascular events were obtained for post-exacerbation time periods (1-7, 8-14, 15-30, 31-180, 181-365 days). Time-dependent Cox proportional hazard models compared cardiovascular risks between periods with and without exacerbations. RESULTS Of 216,864 COPD patients, >55 % were male, mean age was 74 years, frequent comorbidities were cardiovascular, metabolic and psychiatric. During an average 34-month follow-up, 69,620 (32 %) patients had ≥1 exacerbation and 46,214 (21 %) experienced ≥1 cardiovascular event. During follow-up, 55,470 patients died; 4,661 were in-hospital cardiovascular-related deaths. Among 10,269 patients experiencing cardiovascular events within 365 days post-exacerbation, the IR was 15.8 per 100 person-years (95 %CI 15.5-16.1). Estimated hazard ratios (HR) for the cardiovascular event risk associated with periods post-exacerbation were highest within 7 days (HR: 34.3, 95 %CI: 33.1-35.6), especially for heart failure (HR 50.6; 95 %CI 48.6-52.7) and remained elevated throughout 365 days (HR 1.1, 95 %CI 1.02-1.13). CONCLUSIONS COPD patients in Italy are at high risk of severe cardiovascular events following exacerbations, suggesting the need to prevent exacerbations and possible subsequent cardiovascular events through early interventions and treatment optimization.
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Affiliation(s)
- Silvia Calabria
- Fondazione Ricerca e Salute (ReS) - Research and Health Foundation, Rome, Italy
| | - Giulia Ronconi
- Fondazione Ricerca e Salute (ReS) - Research and Health Foundation, Rome, Italy
| | - Letizia Dondi
- Fondazione Ricerca e Salute (ReS) - Research and Health Foundation, Rome, Italy
| | - Leonardo Dondi
- Fondazione Ricerca e Salute (ReS) - Research and Health Foundation, Rome, Italy
| | - Irene Dell'Anno
- Fondazione Ricerca e Salute (ReS) - Research and Health Foundation, Rome, Italy.
| | | | - Kirsty Rhodes
- BioPharmaceuticals Medical, AstraZeneca, Cambridge, UK
| | - Paola Rogliani
- Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Francesco Dentali
- Department of Internal Medicine, ASST dei Sette Laghi, Varese, Italy
| | - Nello Martini
- Fondazione Ricerca e Salute (ReS) - Research and Health Foundation, Rome, Italy
| | - Aldo Pietro Maggioni
- Fondazione Ricerca e Salute (ReS) - Research and Health Foundation, Rome, Italy; ANMCO Research Center Heart Care Foundation, Firenze, Italy
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Lapi F, Marconi E, Rossi A, Cricelli C. The burden of recurrent respiratory tract infections in adult population: a population-based study in primary care. Fam Pract 2024; 41:76-85. [PMID: 38460149 DOI: 10.1093/fampra/cmae009] [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] [Indexed: 03/11/2024] Open
Abstract
BACKGROUND Viral infections are the main original cause of recurrent respiratory tract infections (RRTIs), but their complications and recurrences are due to bacteria as well. While some operational definitions and epidemiology of RRTIs are reported in paediatrics, no similar definitions have been proposed for adults. AIM To assess the epidemiology and characteristics of RRTIs in the adult population. DESIGN AND SETTING Cohort study in the primary care setting. METHODS Using the Health Search Database, we selected a cohort of patients aged 18 years or older between 2002 and 2022. Yearly, we counted upper and lower respiratory tract infections (RTIs) per patient. We investigated 2 cut-offs defining RRTIs, nominally 3+ RRTIs/patient/year or greater than the mean value of RTIs/patient/year. The associations between these two event definitions and the correlates defining the patients' vulnerability were assessed by estimating a logistic regression model. RESULTS Over the study years, the mean number of RTIs/patient/year ranged from 0.07-0.16 or 1.10-1.13 events, when the denominator was formed by the overall population or those diagnosed with RTIs, respectively. When the analysis was focussed on 2022, we obtained 0.2% (1.3% among those with RTIs) or 13% (11.3% among those with RTIs) cases of RRTIs, using a cut-off of 3+ or >=0.16 events (mean value/patient), respectively. Consistent associations were found for these two operational definitions and the investigated clinical correlates. CONCLUSION We provided evidence on the epidemiology and concurrent/predisposing factors of RRTIs in adults. These data should support health authorities and general practitioners for the application of the most appropriate preventive and/or treatment strategies.
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Affiliation(s)
- Francesco Lapi
- Health Search, Italian College of General Practitioners and Primary Care, Florence, Italy
| | - Ettore Marconi
- Health Search, Italian College of General Practitioners and Primary Care, Florence, Italy
| | - Alessandro Rossi
- Italian College of General Practitioners and Primary Care, Florence, Italy
| | - Claudio Cricelli
- Italian College of General Practitioners and Primary Care, Florence, Italy
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Calzetta L, Di Daniele N, Chetta A, Vitale M, Gholamalishahi S, Cazzola M, Rogliani P. The Impact of Thermal Water in Asthma and COPD: A Systematic Review According to the PRISMA Statement. J Clin Med 2024; 13:1071. [PMID: 38398384 PMCID: PMC10889407 DOI: 10.3390/jcm13041071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 02/02/2024] [Accepted: 02/08/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Asthma and chronic obstructive pulmonary disease (COPD) are global health challenges leading to substantial morbidity and mortality. While existing guidelines emphasize evidence-based treatments, the potential therapeutic role of thermal water (TW) inhalation remains under-investigated. METHODS This systematic review followed PRISMA-P guidelines and sought to evaluate the impact of TW in asthma and COPD. A thorough literature search, performed up to May 2023, encompassed in vitro, in vivo, randomized controlled trial (RCT), non-RCT, and observational studies. RESULTS The review included 12 studies reporting different findings. In vitro studies suggested TW could enhance antioxidant capacity and cell proliferation. In a murine model of non-atopic asthma, TW inhalation reduced airway hyperresponsiveness and inflammation. RCTs in COPD patients indicated mixed effects, including improved quality of life, reduced airway oxidant stress, and enhanced exercise tolerance. Asthma patients exposed to water aerosols exhibited improved lung function and reduced airway inflammation. Non-RCTs showed improved lung function and antioxidant activity after TW therapy. Additionally, observational studies reported enhanced lung function and reduced airway inflammation. CONCLUSION The current evidence suggests potential benefits of TW therapy in asthma and COPD. However, limited high-quality RCTs and concerns regarding occupational TW exposure necessitate further investigation. While TW therapy offers a non-invasive treatment, its therapeutic potential still needs definitive demonstration. Future research should therefore prioritize well-designed RCTs to thoroughly establish the efficacy and safety of TW as a potential therapeutic intervention for asthma and COPD.
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Affiliation(s)
- Luigino Calzetta
- Respiratory Disease and Lung Function Unit, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy;
| | - Nicola Di Daniele
- Department of Systems Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy;
- Fondazione Leonardo per le Scienze Mediche Onlus, Policlinico Abano, 35031 Abano Terme, Italy
| | - Alfredo Chetta
- Respiratory Disease and Lung Function Unit, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy;
- Cardio-Thoracic and Vascular Department, University Hospital of Parma, 43126 Parma, Italy
| | - Marco Vitale
- Faculty of Medicine, Vita-Salute University-San Raffaele, 20132 Milan, Italy;
- Italian Foundation for Research in Balneology (FoRST), 00198 Rome, Italy
| | - Shima Gholamalishahi
- Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy; (S.G.); (M.C.); (P.R.)
| | - Mario Cazzola
- Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy; (S.G.); (M.C.); (P.R.)
| | - Paola Rogliani
- Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy; (S.G.); (M.C.); (P.R.)
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Tan EH, Robinson DE, Jödicke AM, Mosseveld M, Bødkergaard K, Reyes C, Moayyeri A, Voss A, Marconi E, Lapi F, Reinold J, Verhamme KMC, Pedersen L, Braitmaier M, de Wilde M, Ruiz MF, Aragón M, Bosco-Levy P, Lassalle R, Prieto-Alhambra D, Sanchez-Santos MT. Drug utilization analysis of osteoporosis medications in seven European electronic health databases. Osteoporos Int 2023; 34:1771-1781. [PMID: 37436441 PMCID: PMC10511353 DOI: 10.1007/s00198-023-06837-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 06/19/2023] [Indexed: 07/13/2023]
Abstract
We studied the characteristics of patients prescribed osteoporosis medication and patterns of use in European databases. Patients were mostly female, older, had hypertension. There was suboptimal persistence particularly for oral medications. Our findings would be useful to healthcare providers to focus their resources on improving persistence to specific osteoporosis treatments. PURPOSE To characterise the patients prescribed osteoporosis therapy and describe the drug utilization patterns. METHODS We investigated the treatment patterns of bisphosphonates, denosumab, teriparatide, and selective estrogen receptor modulators (SERMs) in seven European databases in the United Kingdom, Italy, the Netherlands, Denmark, Spain, and Germany. In this cohort study, we included adults aged ≥ 18 years, with ≥ 1 year of registration in the respective databases, who were new users of the osteoporosis medications. The study period was between 01 January 2018 to 31 January 2022. RESULTS Overall, patients were most commonly initiated on alendronate. Persistence decreased over time across all medications and databases, ranging from 52-73% at 6 months to 29-53% at 12 months for alendronate. For other oral bisphosphonates, the proportion of persistent users was 50-66% at 6 months and decreased to 30-44% at 12 months. For SERMs, the proportion of persistent users at 6 months was 40-73% and decreased to 25-59% at 12 months. For parenteral treatment groups, the proportions of persistence with denosumab were 50-85% (6 month), 30-63% (12 month) and with teriparatide 40-75% (6 month) decreasing to 21-54% (12 month). Switching occurred most frequently in the alendronate group (2.8-5.8%) and in the teriparatide group (7.1-14%). Switching typically occurred in the first 6 months and decreased over time. Patients in the alendronate group most often switched to other oral or intravenous bisphosphonates and denosumab. CONCLUSION Our results show suboptimal persistence to medications that varied across different databases and treatment switching was relatively rare.
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Affiliation(s)
- Eng Hooi Tan
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, OX3 7LD, UK
| | - Danielle E Robinson
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, OX3 7LD, UK
| | - Annika M Jödicke
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, OX3 7LD, UK
| | - Mees Mosseveld
- Department of Medical Informatics, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Katrine Bødkergaard
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Carlen Reyes
- Fundació Institut Universitari Per a La Recerca a L'Atenció Primària de Salut Jordi Gol I Gurina (IDIAPJGol), Barcelona, Spain
| | | | - Annemarie Voss
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Ettore Marconi
- Health Search, Italian College of General Practitioners and Primary Care, Florence, Italy
| | - Francesco Lapi
- Health Search, Italian College of General Practitioners and Primary Care, Florence, Italy
| | - Jonas Reinold
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Katia M C Verhamme
- Department of Medical Informatics, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Lars Pedersen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Malte Braitmaier
- Department of Biometry and Data Management, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Marcel de Wilde
- Department of Medical Informatics, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Marc Far Ruiz
- Fundació Institut Universitari Per a La Recerca a L'Atenció Primària de Salut Jordi Gol I Gurina (IDIAPJGol), Barcelona, Spain
| | - María Aragón
- Fundació Institut Universitari Per a La Recerca a L'Atenció Primària de Salut Jordi Gol I Gurina (IDIAPJGol), Barcelona, Spain
| | - Pauline Bosco-Levy
- Univ. Bordeaux, INSERM CIC-P1401, Bordeaux PharmacoEpi, Bordeaux, France
| | - Regis Lassalle
- Univ. Bordeaux, INSERM CIC-P1401, Bordeaux PharmacoEpi, Bordeaux, France
| | - Daniel Prieto-Alhambra
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, OX3 7LD, UK.
- Department of Medical Informatics, Erasmus University Medical Centre, Rotterdam, The Netherlands.
| | - Maria T Sanchez-Santos
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, OX3 7LD, UK
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Hendrychova T, Svoboda M, Maly J, Vlcek J, Zimcikova E, Dvorak T, Zatloukal J, Volakova E, Plutinsky M, Brat K, Popelkova P, Kopecky M, Novotna B, Koblizek V. Self-Reported Overall Adherence and Correct Inhalation Technique Discordance in Chronic Obstructive Pulmonary Disease Population. Front Pharmacol 2022; 13:860270. [PMID: 36034870 PMCID: PMC9411979 DOI: 10.3389/fphar.2022.860270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 06/02/2022] [Indexed: 11/18/2022] Open
Abstract
Background: Adherence to inhaled medication constitutes a major problem in patients with chronic obstructive pulmonary disease (COPD) globally. However, large studies evaluating adherence in its entirety and capturing a large variety of potentially associated factors are still lacking. Objective: To study both elementary types of adherence to chronic inhaled COPD medication in “real-life” COPD patients and to assess relationships with a wide-ranging spectrum of clinical parameters. Methods: Data from the Czech Multicentre Research Database (CMRD) of COPD, an observational prospective study, were used. Overall adherence (OA) was evaluated with Morisky Medication Adherence Scale (©MMAS-4) and adherence to an application technique (A-ApplT) with the Five Steps Assessment. Mann–Whitney U test, Spearman’s correlation, and logistic regression were used to explore relationships between variables. Results: Data of 546 participants (69.6% of all patients from the CMRD) were analyzed. Two-thirds self-reported optimal OA, but only less than one-third demonstrated A-ApplT without any error. OA did not correlate with A-ApplT. Next, better OA was associated with higher education, a higher number of inhalers, a lower rate of exacerbations, poorer lung function, higher degree of upper respiratory tract symptoms (SNOT-22), absence of depressive symptoms, ex-smoking status, regular mouthwash after inhaled corticosteroids (ICS), and flu vaccination. By contrast, better A-ApplT was associated with a lower number of inhalers, better lung function, and regular mouthwash after ICS. Independent predictors of nonoptimal OA included lower degree of education, absence of flu vaccination, anemia, depression, and peptic ulcer history, whereas independent predictors of lower A-ApplT were lower education, absence of regular mouthwash after ICS, and higher COPD Assessment Test score. Conclusions: Parameters associated with OA and A-ApplT differ, and those associated with both adherence domains are sometimes associated inversely. Based on this finding, we understand these as two separate constructs with an overlap.
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Affiliation(s)
- Tereza Hendrychova
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Kralove, Charles University, Hradec Kralove, Czechia
| | - Michal Svoboda
- Institute of Biostatistics and Analyses, Ltd. Spin-off Company of the Masaryk University, Brno, Czechia
| | - Josef Maly
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Kralove, Charles University, Hradec Kralove, Czechia
| | - Jiri Vlcek
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Kralove, Charles University, Hradec Kralove, Czechia
| | - Eva Zimcikova
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Kralove, Charles University, Hradec Kralove, Czechia
| | - Tomas Dvorak
- Pulmonary Department, Klaudian Hospital, Mlada Boleslav, Czechia
| | - Jaromir Zatloukal
- Department of Respiratory Diseases and Tuberculosis, University Hospital Olomouc, Olomouc, Czechia
- Faculty of Medicine, Palacky University Olomouc, Olomouc, Czechia
| | - Eva Volakova
- Department of Respiratory Diseases and Tuberculosis, University Hospital Olomouc, Olomouc, Czechia
- Faculty of Medicine, Palacky University Olomouc, Olomouc, Czechia
| | - Marek Plutinsky
- Department of Respiratory Diseases, University Hospital Brno, Brno, Czechia
- Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Kristian Brat
- Department of Respiratory Diseases, University Hospital Brno, Brno, Czechia
- Faculty of Medicine, Masaryk University, Brno, Czechia
- International Clinical Research Center, St. Anne´s University Hospital, Brno, Czechia
| | - Patrice Popelkova
- Department of Pulmonary Diseases and Tuberculosis, University Hospital Ostrava, Ostrava, Czechia
- Faculty of Medicine in Ostrava, Ostrava, Czechia
| | - Michal Kopecky
- Department of Pneumology, University Hospital Hradec Kralove, Hradec Kralove, Czechia
- Faculty of Medicine in Hradec Kralove, Charles University, Hradec Kralove, Czechia
| | - Barbora Novotna
- Department of Pneumology, Bulovka Hospital, Prague, Czechia
- 3rd Faculty of Medicine, Charles University, Prague, Czechia
| | - Vladimir Koblizek
- Department of Pneumology, University Hospital Hradec Kralove, Hradec Kralove, Czechia
- Faculty of Medicine in Hradec Kralove, Charles University, Hradec Kralove, Czechia
- *Correspondence: Vladimir Koblizek,
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9
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Baan EJ, de Roos EW, Engelkes M, de Ridder M, Pedersen L, Berencsi K, Prieto-Alhambra D, Lapi F, Van Dyke MK, Rijnbeek P, Brusselle GG, Verhamme KMC. Characterization of Asthma by Age of Onset: A Multi-Database Cohort Study. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:1825-1834.e8. [PMID: 35398554 DOI: 10.1016/j.jaip.2022.03.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 03/14/2022] [Accepted: 03/15/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Asthma can occur at any age but the differences in patient characteristics between childhood-, adult-, and late-onset asthma are not well understood. OBJECTIVE To investigate differences in patients' characteristics by age at asthma onset. METHODS From 5 European electronic databases, we created a cohort encompassing adult patients with doctor-diagnosed asthma in 2008 to 2013. Patients were categorized based on their age at asthma onset: childhood-onset (age at onset < 18 y), adult-onset (age at onset 18-40 y), and late-onset asthma (age at onset ≥ 40 y). Comorbidities were assessed at study entry. For each characteristic and comorbidity, odds ratios and age- and sex-adjusted odds ratios (ORadj) comparing asthma-onset categories were estimated per database and combined in a meta-analysis using a random effect model. RESULTS In total, 586,436 adult asthma patients were included, 81,691 had childhood-onset, 218,184 adult-onset, and 286,561 late-onset asthma. Overall, 7.3% had severe asthma. Subjects with adult-onset compared with childhood-asthma had higher risks for overweight/obesity (ORadj 1.4; 95% CI 1.1-1.8) and lower risks for atopic disorders (ORadj 0.8; 95% CI 0.7-0.95). Patients with late-onset compared with adult-onset asthma had higher risks for nasal polyposis (ORadj 1.8; 95% CI 1.2-2.6), overweight/obesity (ORadj 1.3; 95% CI 1.2-1.4), gastroesophageal reflux disease (ORadj 1.4; 95% CI 1.2-1.7), and diabetes (ORadj 2.3; 95% CI 1.8-2.9). A significant association between late-onset asthma and uncontrolled asthma was observed (ORadj 2.8; 95% CI 1.7-4.5). CONCLUSIONS This international study demonstrates clear differences in comorbidities between childhood-, adult-, and late-onset asthma phenotypes in adults. Furthermore, patients with late-onset asthma had more frequent uncontrolled asthma.
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Affiliation(s)
- Esmé J Baan
- Department of Medical Informatics, Erasmus MC-University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Emmely W de Roos
- Department of Epidemiology, Erasmus MC-University Medical Center Rotterdam, Rotterdam, The Netherlands; Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - Marjolein Engelkes
- Department of Medical Informatics, Erasmus MC-University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Maria de Ridder
- Department of Medical Informatics, Erasmus MC-University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Lars Pedersen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Klara Berencsi
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark; Musculoskeletal Pharmaco- and Device Epidemiology, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
| | - Dani Prieto-Alhambra
- Department of Medical Informatics, Erasmus MC-University Medical Center Rotterdam, Rotterdam, The Netherlands; GREMPAL Research Group, Idiap Jordi Gol Primary Care Research Institute, CIBERFES ISCIII, Universitat Autonoma de Barcelona, Barcelona, Spain; Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Francesco Lapi
- Health Search, Italian College of General Practitioners and Primary Care, Florence, Italy
| | - Melissa K Van Dyke
- Epidemiology, Value Evidence and Outcomes, Global R&D, GSK, Collegeville, Pennsylvania, USA
| | - Peter Rijnbeek
- Department of Medical Informatics, Erasmus MC-University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Guy G Brusselle
- Department of Epidemiology, Erasmus MC-University Medical Center Rotterdam, Rotterdam, The Netherlands; Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium; Department of Respiratory Medicine, Erasmus MC-University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Katia M C Verhamme
- Department of Medical Informatics, Erasmus MC-University Medical Center Rotterdam, Rotterdam, The Netherlands; Department of Bioanalysis, Ghent University, Ghent, Belgium.
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10
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Tun MH, Borg B, Godfrey M, Hadley-Miller N, Chan ED. Respiratory manifestations of Marfan syndrome: a narrative review. J Thorac Dis 2021; 13:6012-6025. [PMID: 34795948 PMCID: PMC8575822 DOI: 10.21037/jtd-21-1064] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 09/03/2021] [Indexed: 12/11/2022]
Abstract
Objective The prevalence of Marfan syndrome (MFS) is estimated to be 1 in 10,000 to 15,000 individuals, but the phenotype of MFS may not be apparent and hence its diagnosis may not be considered by clinicians. Furthermore, the effects of MFS on the lungs and breathing are underrecognized despite the high morbidity that can occur. The objective of this Narrative Review is to delineate the molecular consequences of a defective fibrillin-1 protein and the skeletal and lung abnormalities in MFS that may contribute to respiratory compromise. It is important for clinicians to be cognizant of these MFS-associated respiratory conditions, and a contemporaneous review is needed. Background MFS is an autosomal dominant, connective tissue disorder caused by mutations in the FIBRILLIN-1 (FBN1) gene, resulting in abnormal elastic fibers as well as increased tissue availability of transforming growth factor-beta (TGFβ), both of which lead to the protean clinical abnormalities. While these clinical characteristics are most often recognized in the cardiovascular, skeletal, and ocular systems, MFS may also cause significant impairment on the lungs and breathing. Methods We searched PubMed for the key words of “Marfan syndrome,” “pectus excavatum,” and “scoliosis” with that of “lung disease,” “breathing”, or “respiratory disease.” The bibliographies of identified articles were further searched for relevant articles not previously identified. Each relevant article was reviewed by one or more of the authors and a narrative review was composed. Conclusions Though the classic manifestations of MFS are cardiovascular, skeletal, and ocular, FBN1 gene mutation can induce a variety of effects on the respiratory system, inducing substantial morbidity and potentially increased mortality. These respiratory effects may include chest wall and spinal deformities, emphysema, pneumothorax, sleep apnea, and potentially increased incidence of asthma, bronchiectasis, and interstitial lung disease. Further research into approaches to prevent respiratory complications is needed, but improved recognition of the respiratory complications of MFS is necessary before this research is likely to occur.
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Affiliation(s)
- Mon Hnin Tun
- Department of Pediatrics, University of Alberta, Edmonton, Canada
| | - Bryan Borg
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.,Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO, USA
| | - Maurice Godfrey
- Munroe Meyer Institute, University of Nebraska Medical Center, Omaha, NE, USA
| | - Nancy Hadley-Miller
- Department of Orthopedics, University of Colorado Anschutz Medical Campus, Children's Hospital Colorado, Aurora, CO, USA
| | - Edward D Chan
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.,Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO, USA.,Department of Academic Affairs, National Jewish Health, Denver, CO, USA
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11
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Calzetta L, Ritondo BL, Matera MG, Chetta A, Rogliani P. Medium-dose ICS-containing FDCs reduce all-cause mortality in COPD patients: an in-depth analysis of dual and triple therapies. Expert Rev Respir Med 2021; 16:357-365. [PMID: 34196591 DOI: 10.1080/17476348.2021.1951237] [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] [Indexed: 10/21/2022]
Abstract
OBJECTIVES The recent publication of additional data retrieval for patients missing week 52 vital status in the original analyses of the ETHOS study provides the urgent need of updating previous network meta-analyses (NMA) to produce stronger evidence on mortality in patients receiving dual and triple FDCs according with the level of ICS dose. METHODS A NMA was performed to compare the effect of ICS/LABA/LAMA, ICS/LABA, and LABA/LAMA FDCs administered via the same inhaler device in COPD patients. The number need to treat (NNT) was also calculated. RESULTS When considering on-treatment all-cause of death (analyzed patients: 18,864), MD ICS/LABA/LAMA and MD ICS/LABA FDCs significantly reduced the risk of mortality vs. LABA/LAMA FDC (RR 0.59 95%CrI 0.35-0.97 and 0.61 95%CrI 0.38-0.99 respectively, P < 0.05); NNT ranged between 123 and 129. MD ICS/LABA/LAMA FDC also significantly reduced the risk of adjudicated cardiovascular mortality vs. LABA/LAMA FDC (RR 0.44 95%CI 0.19-0.97, P < 0.05). Low-dose (LD) ICS/LABA FDC did not significantly modulate mortality. CONCLUSION MD ICS/LABA/LAMA and MD ICS/LABA FDCs were effective in reducing on-treatment all-cause of death, with MD ICS/LABA/LAMA FDC being effective also against adjudicated cardiovascular mortality. The protection against mortality was related with the level of ICS dose in the FDCs.
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Affiliation(s)
- Luigino Calzetta
- Department of Medicine and Surgery, Respiratory Disease and Lung Function Unit, University of Parma, Parma, Italy
| | - Beatrice Ludovica Ritondo
- Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Maria Gabriella Matera
- Department of Experimental Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Alfredo Chetta
- Department of Medicine and Surgery, Respiratory Disease and Lung Function Unit, University of Parma, Parma, Italy
| | - Paola Rogliani
- Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy
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12
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The Burden of Short-Acting β 2-Agonist Use in Asthma: Is There an Italian Case? An Update from SABINA Program. Adv Ther 2021; 38:3816-3830. [PMID: 34043208 PMCID: PMC8280008 DOI: 10.1007/s12325-021-01772-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 05/01/2021] [Indexed: 12/26/2022]
Abstract
Introduction Preliminary results from the SABINA (SABA use INAsthma) program showed lower overuse of short-acting β2-agonist (SABA) in Italy compared to other European countries. The aim of the present study was to ascertain whether SABINA’s results might have been affected by the Italian National Health System and pharmaceutical market dynamics, by examining patients’ characteristics in relation to SABA prescription/purchase habits. Methods Multiple approaches were used: (1) a retrospective study using the General Practitioners’ (GPs) Italian IQVIA Longitudinal Patient Database (LPD) to assess SABA overuse (more than two canisters/year) and its association with exacerbation risk; (2) a survey conducted across 200 Italian pharmacies to calculate the proportions of SABA purchases without a prescription; (3) a cross-sectional study on the specialists’ IQVIA Patient Analyzer database to understand the SABA prescription habits of specialists. Results Among SABA users identified through IQVIA LPD, the proportion of patients having more than two SABA canisters/year was 32%. Overall, patients prescribed more than two SABA canisters/year by GPs had 30% higher risk of exacerbations than patients with a maximum of two SABA canisters/year. The joint evaluation of IQVIA LPD and survey’s findings revealed that IQVIA LPD tracks three out of four SABA canisters dispensed. The survey showed that, on average, SABA users purchased four canisters/year. Patients prescribed SABA by specialists were more frequently men, younger, thinner, and had higher spirometry values. Conclusion SABA overuse is common in Italy, with a share of consumption not regulated by medical prescriptions. Because SABA overuse increases exacerbation risk, changes to national guidelines should be encouraged to ensure implementation of global recommendations. Supplementary Information The online version contains supplementary material available at 10.1007/s12325-021-01772-0.
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13
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Maniscalco M, Ambrosino P, Fuschillo S, Stufano S, Sanduzzi A, Matera MG, Cazzola M. Bronchodilator reversibility testing in post-COVID-19 patients undergoing pulmonary rehabilitation. Respir Med 2021; 182:106401. [PMID: 33873099 PMCID: PMC8041746 DOI: 10.1016/j.rmed.2021.106401] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 04/05/2021] [Accepted: 04/08/2021] [Indexed: 11/18/2022]
Abstract
Background The usefulness of bronchodilators in coronavirus diseases 2019 (COVID-19) survivors is still uncertain, especially for patients with a concomitant obstructive lung disease. We aimed at verifying the level of bronchodilator reversibility in COVID-19 patients undergoing multidisciplinary pulmonary rehabilitation after the acute phase. Methods We enrolled 105 consecutive patients referring to the Pulmonary Rehabilitation Unit of Istituti Clinici Scientifici Maugeri Spa SB, IRCCS of Telese Terme, Benevento, Italy after being discharged from the COVID-19 acute care ward and after recovering from acute COVID-19 pneumonia. All subjects performed a spirometry before and after inhalation of salbutamol 400 μg to determine the bronchodilation response within 48 h of admission to the unit. Results All patients had suffered from a moderate to severe COVID-19, classified 3 or 4 according to the WHO classification, Seventeen patients had concomitant obstructive lung disease (14 suffering from COPD and 3 from asthma). FEV1 after salbutamol improved on average by 41.7 mL in the entire examined sample, by 29.4 mL in subjects without concomitant obstructive lung diseases, by 59.3 mL in COPD patients and by 320.0 mL in asthma patients. Mean FVC after salbutamol improved by 65.7 mL in the entire examined sample, by 52.5 mL in subjects without concomitant obstructive lung diseases, by 120.0 mL in COPD patients, and by 200.0 mL in asthma patients. Conclusions This study suggests that a treatment with bronchodilators must always be taken into consideration in post-COVID-19 patients because it can induce a functional improvement that, even if small, can facilitate the breathing of these patients.
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Affiliation(s)
| | | | | | - Silvia Stufano
- Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - Alessandro Sanduzzi
- Section of Respiratory Diseases, Department of Clinical Medicine and Surgery, Monaldi Hospital, University of Naples Federico II, Naples, Italy
| | - Maria Gabriella Matera
- Unit of Pharmacology, Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Mario Cazzola
- Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy.
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14
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Matera MG, Ora J, Calzetta L, Rogliani P, Cazzola M. Sex differences in COPD management. Expert Rev Clin Pharmacol 2021; 14:323-332. [PMID: 33560876 DOI: 10.1080/17512433.2021.1888713] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Introduction: A growing body of evidence indicates that prevalence of chronic obstructive pulmonary disease (COPD) has been increasing more rapidly among women compared to men, but the available data on the differences between the sexes in the responses to the various COPD therapies are still scarce.Areas covered: The aim of this narrative review is to provide an overview of current knowledge on sex differences in COPD management.Expert opinion: There is no solid evidence of sex differences in response to usual COPD treatments but there are sex-related differences in management of patients with a clinical diagnosis of COPD. It is difficult to explain the reason for these differences, but most likely they are due to local prescribing habits, rather than solid scientific reasons. However, there are also signals of different sex-related responses, the qualification and quantification of which is difficult with the information currently available. These signals should lead to the inclusion of more women in clinical trials, but also to the design of prospective clinical studies to assess the possible differences linked to sex in COPD treatment responses, whose identification is an important step toward the definition of personalized COPD therapy.
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Affiliation(s)
- Maria Gabriella Matera
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Josuel Ora
- Respiratory Diseases Unit, "Tor Vergata" University Hospital, Rome, Italy
| | - Luigino Calzetta
- Unit of Respiratory Disease and Lung Function Dept. Medicine and Surgery, University of Parma, ParmaItaly
| | - Paola Rogliani
- Respiratory Diseases Unit, "Tor Vergata" University Hospital, Rome, Italy.,Department of Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Mario Cazzola
- Department of Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy
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15
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Lombardi C, Roca E, Bigni B, Cottini M, Passalacqua G. Clinical course and outcomes of patients with asthma hospitalized for severe acute respiratory syndrome coronavirus 2 pneumonia: A single-center, retrospective study. Ann Allergy Asthma Immunol 2020; 125:707-709. [PMID: 32745609 PMCID: PMC7395222 DOI: 10.1016/j.anai.2020.07.029] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 07/02/2020] [Accepted: 07/27/2020] [Indexed: 01/22/2023]
Affiliation(s)
- Carlo Lombardi
- Asthma Center and COVID Unit, Departmental Unit of Allergology, Immunology, and Pneumology, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy; COVID Unit, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy.
| | - Elena Roca
- COVID Unit, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Barbara Bigni
- COVID Unit, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | | | - Giovanni Passalacqua
- Allergy and Respiratory Diseases Clinic Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Martino, University Of Genoa, Genoa, Italy
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16
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Engelkes M, Baan EJ, de Ridder MAJ, Svensson E, Prieto-Alhambra D, Lapi F, Giaquinto C, Picelli G, Boudiaf N, Albers F, Evitt LA, Cockle S, Bradford E, Van Dyke MK, Suruki R, Rijnbeek P, Sturkenboom MCJM, Janssens HM, Verhamme KMC. Incidence, risk factors and re-exacerbation rate of severe asthma exacerbations in a multinational, multidatabase pediatric cohort study. Pediatr Allergy Immunol 2020; 31:496-505. [PMID: 32115766 PMCID: PMC7496431 DOI: 10.1111/pai.13237] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 02/04/2020] [Accepted: 02/06/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND There are sparse real-world data on severe asthma exacerbations (SAE) in children. This multinational cohort study assessed the incidence of and risk factors for SAE and the incidence of asthma-related rehospitalization in children with asthma. METHODS Asthma patients 5-17 years old with ≥1 year of follow-up were identified in six European electronic databases from the Netherlands, Italy, the UK, Denmark and Spain in 2008-2013. Asthma was defined as ≥1 asthma-specific disease code within 3 months of prescriptions/dispensing of asthma medication. Severe asthma was defined as high-dosed inhaled corticosteroids plus a second controller. SAE was defined by systemic corticosteroids, emergency department visit and/or hospitalization all for reason of asthma. Risk factors for SAE were estimated by Poisson regression analyses. RESULTS The cohort consisted of 212 060 paediatric asthma patients contributing to 678 625 patient-years (PY). SAE rates ranged between 17 and 198/1000 PY and were higher in severe asthma and highest in severe asthma patients with a history of exacerbations. Prior SAE (incidence rate ratio 3-45) and younger age increased the SAE risk in all countries, whereas obesity, atopy and GERD were a risk factor in some but not all countries. Rehospitalization rates were up to 79% within 1 year. CONCLUSIONS In a real-world setting, SAE rates were highest in children with severe asthma with a history of exacerbations. Many severe asthma patients were rehospitalized within 1 year. Asthma management focusing on prevention of SAE is important to reduce the burden of asthma.
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Affiliation(s)
| | - Esme J Baan
- Medical Informatics, ErasmusMC, Rotterdam, The Netherlands
| | | | | | - Daniel Prieto-Alhambra
- Jordi Gol Primary Care Research Institute, Universitat Autonoma de Barcelona, Barcelona, Spain.,Centre for Statistics in Medicine, NDORMS, University of Oxford, Oxford, UK
| | | | | | | | - Nada Boudiaf
- Research and Development, GlaxoSmithKline, Middlesex, UK
| | - Frank Albers
- Research and Development, GlaxoSmithKline, Research Triangle Park, NC, USA
| | - Lee A Evitt
- Research and Development, GlaxoSmithKline, Brentford, UK
| | - Sarah Cockle
- Research and Development, GlaxoSmithKline, Brentford, UK
| | - Eric Bradford
- Research and Development, GlaxoSmithKline, Brentford, UK
| | | | | | - Peter Rijnbeek
- Medical Informatics, ErasmusMC, Rotterdam, The Netherlands
| | | | - Hettie M Janssens
- Pediatrics div Respiratory Medicine and Allergology, ErasmusMC- /Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Katia M C Verhamme
- Medical Informatics, ErasmusMC, Rotterdam, The Netherlands.,Department of Infection Control & Epidemiology, OLV Hospital, Aalst, Belgium
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17
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Maniscalco M, Martucci M, Fuschillo S, de Felice A, D'Anna SE, Cazzola M. A case scenario study on adherence to COPD GOLD recommendations by general practitioners in a rural area of southern Italy: The "progetto PADRE". Respir Med 2020; 170:105985. [PMID: 32843161 DOI: 10.1016/j.rmed.2020.105985] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 04/07/2020] [Accepted: 04/19/2020] [Indexed: 01/19/2023]
Abstract
The aim of the present study was to evaluate in a sample of 200 patients diagnosed with COPD and selected from the physician database of 15 general practices from Valle Telesina (Benevento, Italy) if the diagnostic-therapeutic algorithm adopted by GPs operating in a non-urban district in Southern Italy adhered to GOLD 2018 recommendations for COPD. Each patient underwent a specialist visit by an experienced chest physician that collected anamnesis, assessed mMRC and CAT scores, and performed a spirometry. In case of diagnostic doubt, a second visit was performed at the Pulmonary Rehabilitation Unit of the Istituti Clinici Scientifici Maugeri IRCCS in Telese Terme where other diagnostic tests were performed. Our results showed that GPs participating in the study often diagnosed and empirically treated COPD without a confirmative spirometry or even despite a spirometry that was not diagnostic of obstructive lung disease. Furthermore, real-life implementation of GOLD strategy, as regards patients' ABCD categorization, was poor and many patients belonging to groups A and B (39% and 48%, respectively) were over-treated and 19% of those belonging to group D were under-treated. The discrepancy between guidelines and daily clinical practice present also in this study supports the opinion of many that those who develop guidelines for the management of COPD must seriously try to understand if and why the guidelines might not reflect real life and therefore how it could be improved.
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Affiliation(s)
- Mauro Maniscalco
- Pulmonary Rehabilitation Unit, ICS Maugeri SpA, IRCCS, Telese Terme (Benevento), Italy
| | - Michele Martucci
- Pulmonary Rehabilitation Unit, ICS Maugeri SpA, IRCCS, Telese Terme (Benevento), Italy
| | - Salvatore Fuschillo
- Pulmonary Rehabilitation Unit, ICS Maugeri SpA, IRCCS, Telese Terme (Benevento), Italy
| | - Alberto de Felice
- Pulmonary Rehabilitation Unit, ICS Maugeri SpA, IRCCS, Telese Terme (Benevento), Italy
| | | | - Mario Cazzola
- Respiratory Medicine Unit, Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy.
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18
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Berencsi K, Sami A, Ali MS, Marinier K, Deltour N, Perez-Gutthann S, Pedersen L, Rijnbeek P, Van der Lei J, Lapi F, Simonetti M, Reyes C, Sturkenboom MCJM, Prieto-Alhambra D. Impact of risk minimisation measures on the use of strontium ranelate in Europe: a multi-national cohort study in 5 EU countries by the EU-ADR Alliance. Osteoporos Int 2020; 31:721-755. [PMID: 31696274 DOI: 10.1007/s00198-019-05181-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 09/26/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION In May 2013 and March 2014, the European Medicines Agency (EMA) issued two decisions restricting the use of strontium ranelate (SR). These risk minimisation measures (RMM) introduced new contraindications and limited the indications of SR therapy. The EMA required an assessment of the impact of RMMs on the use of SR in Europe. Methods design: multi-national, multi-database cohort Setting: electronic medical record databases based on hospital (Denmark) and primary care provenance (Italy, Spain, the Netherlands, UK). PARTICIPANTS the database source populations were included for population-based analyses, and SR users for patient-level analyses. INTERVENTION New RMMs included contraindications (ischaemic heart disease, peripheral arterial disease, cerebrovascular disease, uncontrolled hypertension) and restricted SR indication to severe osteoporosis with initiation by experienced physician and not as first line anti-osteoporosis therapy. METHODS Prevalence and incidence rates of SR use in the population; prevalence of contraindications and restricted indications in SR users, plus 1-year therapy persistence. Drug use measures were calculated in three periods for comparison: reference (2004 to May 2013), transition (June 2013 to March 2014) and assessment (from April 2014 to end 2016). RESULTS The study population included 143 million person-years(PY) of follow-up and 76,141 incident episodes of SR treatment. Average monthly prevalence rates of SR use dropped by 86.4% from 62.6/10,000 PY (95 CI 62.4-62.9) in the reference to 8.5 (8.5-8.6) in the assessment period. Similarly, the incidence rate of SR use fell by 97.3% from 7.4/10,000 PY (7.4-7.4) to 0.2 (0.2-0.2) between the reference and assessment period. The prevalence of any contraindication decreased, whilst the prevalence of restricted indications increased in these periods. One-year persistence decreased in the assessment compared with reference period. CONCLUSIONS Our study demonstrates a substantial impact of the regulatory action to restrict use of SR in Europe: SR utilisation overall decreased strongly. The proportion of patients fulfilling the restricted indications, without contraindications, increased after the proposed RMMs.
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Affiliation(s)
- K Berencsi
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
- Pharmaco- and Device Epidemiology, Centre for Statistics in Medicine, NDORMS, University of Oxford, Oxford, UK
| | - A Sami
- Pharmaco- and Device Epidemiology, Centre for Statistics in Medicine, NDORMS, University of Oxford, Oxford, UK
| | - M S Ali
- Pharmaco- and Device Epidemiology, Centre for Statistics in Medicine, NDORMS, University of Oxford, Oxford, UK
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - K Marinier
- Department of Pharmacoepidemiology, Servier, Suresnes, France
| | - N Deltour
- Department of Pharmacoepidemiology, Servier, Suresnes, France
| | | | - L Pedersen
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
| | - P Rijnbeek
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - J Van der Lei
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - F Lapi
- Health Search, Italian College of General Practitioners and Primary Care, Florence, Italy
| | - M Simonetti
- Health Search, Italian College of General Practitioners and Primary Care, Florence, Italy
| | - C Reyes
- GREMPAL Research Group, Idiap Jordi Gol Primary Care Research Institute and CIBERFes, Universitat Autonoma de Barcelona and Instituto de Salud Carlos III, Barcelona, Spain
| | | | - D Prieto-Alhambra
- Pharmaco- and Device Epidemiology, Centre for Statistics in Medicine, NDORMS, University of Oxford, Oxford, UK.
- GREMPAL Research Group, Idiap Jordi Gol Primary Care Research Institute and CIBERFes, Universitat Autonoma de Barcelona and Instituto de Salud Carlos III, Barcelona, Spain.
- Botnar Research Centre, Windmill Road, Oxford, OX37LD, UK.
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19
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Engelkes M, de Ridder MA, Svensson E, Berencsi K, Prieto-Alhambra D, Lapi F, Giaquinto C, Picelli G, Boudiaf N, Albers FC, Cockle SM, Bradford ES, Suruki RY, Brusselle GG, Rijnbeek PR, Sturkenboom MC, Verhamme KM. Multinational cohort study of mortality in patients with asthma and severe asthma. Respir Med 2020; 165:105919. [PMID: 32174450 DOI: 10.1016/j.rmed.2020.105919] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Revised: 02/24/2020] [Accepted: 02/26/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND Data on the risk of death following an asthma exacerbation are scarce. With this multinational cohort study, we assessed all-cause mortality rates, mortality rates following an exacerbation, and patient characteristics associated with all-cause mortality in asthma. METHODS Asthma patients aged ≥18 years and with ≥1 year of follow-up were identified in 5 European electronic databases from the Netherlands, Italy, UK, Denmark and Spain during the study period January 1, 2008-December 31, 2013. Patients with asthma-COPD overlap were excluded. Severe asthma was defined as use of high dose ICS + use of a second controller. Severe asthma exacerbations were defined as emergency department visits, hospitalizations or systemic corticosteroid use, all for reason of asthma. RESULTS The cohort consisted of 586,436 asthma patients of which 42,611 patients (7.3%) had severe asthma. The age and sex standardized all-cause mortality rates ranged between databases from 5.2 to 9.5/1000 person-years (PY) in asthma, and between 11.3 and 14.8/1000 PY in severe asthma. The all-cause mortality rate in the first week following a severe asthma exacerbation ranged between 14.1 and 59.9/1000 PY. Mortality rates remained high in the first month following a severe asthma exacerbation and decreased thereafter. Higher age, male gender, comorbidity, smoking, and previous severe asthma exacerbations were associated with mortality. CONCLUSION All-cause mortality following a severe exacerbation is high, especially in the first month following the event. Smoking cessation, comorbidity-management and asthma-treatment focusing on the prevention of exacerbations might reduce associated mortality.
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Affiliation(s)
| | | | | | | | - Daniel Prieto-Alhambra
- GREMPAL Research Group, Idiap Jordi Gol Primary Care Research Institute, Universitat Autonoma de Barcelona, Barcelona, Spain; Musculoskeletal Pharmaco and Device Epidemiology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, UK
| | | | | | | | - Nada Boudiaf
- Research and Development, GlaxoSmithKline, Middlesex, UK
| | - Frank C Albers
- Global Respiratory Franchise, GlaxoSmithKline, Research Triangle Park, NC, United States
| | - Sarah M Cockle
- Research and Development, GlaxoSmithKline, Brentford, UK
| | - Eric S Bradford
- Research and Development, GlaxoSmithKline, Research Triangle Park, NC, United States
| | | | - Guy Go Brusselle
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium; Departments of Epidemiology and Respiratory Medicine, ErasmusMC, Rotterdam, the Netherlands
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20
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Open triple therapy for chronic obstructive pulmonary disease: Patterns of prescription, exacerbations and healthcare costs from a large Italian claims database. Pulm Pharmacol Ther 2020; 61:101904. [PMID: 32092473 DOI: 10.1016/j.pupt.2020.101904] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 02/20/2020] [Accepted: 02/20/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND The combination of two long acting bronchodilators with an inhaled corticosteroid, known as Triple Therapy (TT), is a usual clinical practice for patients affected by chronic obstructive pulmonary disease (COPD). This analysis aimed to identify subjects with COPD treated with extemporaneous combination of ICS/LABA and LAMA (namely open TT) and to describe the pharmacological strategy, the spirometry use, the exacerbations occurrence and the costs, in the perspective of the Italian National Health System (NHS). METHODS Through record linkage of administrative data (ReS database) of about 12 million inhabitants in 2014, a cohort of patients aged ≥45, without asthma and treated with open TT (index date) was selected. Specific drugs, oxygen supply and exacerbations were described in one year before the index date, while spirometry tests over two years before the index date. All these resources utilization, the persistence to the open TT, and integrated costs of the above healthcare services were analysed for 1-year follow-up. RESULTS In 2014, 10,352 patients (mean age 74 ± 9; males 66.0%) with COPD and treated with open TT were identified (prevalence 160.6 per 100,000 inhabitants aged ≥45). During the previous year, the 44.0% of this cohort was already treated with open TT, 7.0% did not received any drugs for obstructive airway diseases, 11.1% needed home oxygen therapy, and 28.7% experienced at least an exacerbation. In the follow-up year, the 37.5% of the cohort was found persistent to the open TT, 17.0% needed oxygen therapy, and the 30.9% underwent an exacerbation. Spirometry was performed on 45.7% of patients in the two previous years, while on 33.3% in the subsequent year. In the follow-up, on average, every patient of the cohort costed to the NHS €5,295: 48.2% for hospitalizations, 41.2% for drugs and 10.6% for outpatient services. CONCLUSIONS This large observational study based on claims data reliably identified subjects with COPD treated with open TT and their burden on the NHS. Moreover, it could describe the real clinical management of the open TT, before the marketing of the fixed one. These findings are useful for health policymakers in order to promote the appropriate utilization of both currently marketed and future therapies.
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21
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Heffler E, Carpagnano GE, Favero E, Guida G, Maniscalco M, Motta A, Paoletti G, Rolla G, Baraldi E, Pezzella V, Piacentini G, Nardini S. Fractional Exhaled Nitric Oxide (FENO) in the management of asthma: a position paper of the Italian Respiratory Society (SIP/IRS) and Italian Society of Allergy, Asthma and Clinical Immunology (SIAAIC). Multidiscip Respir Med 2020; 15:36. [PMID: 32269772 PMCID: PMC7137762 DOI: 10.4081/mrm.2020.36] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 02/05/2020] [Indexed: 02/08/2023] Open
Abstract
Asthma prevalence in Italy is on the rise and is estimated to be over 6% of the general population. The diagnosis of asthma can be challenging and elusive, especially in children and the last two decades has brought evidences that asthma is not a single disease but consists of various phenotypes. Symptoms can be underestimated by the patient or underreported to the clinician and physical signs can be scanty. Usual objective measures, like spirometry, are necessary but sometimes not significant. Despite proper treatment, asthma can be a very severe condition (even leading to death), however new drugs have recently become available which can be very effective in its control. Since asthma is currently thought to be caused by inflammation, a direct measure of the latter can be of paramount importance. For this purpose, the measurement of Fractional Exhaled Nitric Oxide (FENO) has been used since the early years of the current century as a non-invasive, easy-to-assess tool useful for diagnosing and managing asthma. This SIP-IRS/SIAAIC Position Paper is a narrative review which summarizes the evidence behind the usefulness of FENO in the diagnosis, management and phenotypization of asthma.
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Affiliation(s)
- Enrico Heffler
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center IRCCS, Rozzano (MI).,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI)
| | - Giovanna Elisiana Carpagnano
- Department of Medical and Surgical Sciences, University of Foggia; Section of Respiratory Diseases, Hospital d'Avanzo, Foggia
| | - Elisabetta Favero
- Department of Medicine-DIMED, Immunological and Respiratory Rare Disease, Allergologic Clinic Ca' Foncello Hospital, Treviso
| | - Giuseppe Guida
- Allergy and Pneumology Unit, A.O. S. Croce e Carle, Cuneo
| | - Mauro Maniscalco
- Respiratory Rehabilitation Unit, ICS Maugeri, Institute of Telese Terme IRCCS
| | - Andrea Motta
- Institute of Biomolecular Chemistry, National Research Council, Pozzuoli (NA)
| | - Giovanni Paoletti
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center IRCCS, Rozzano (MI).,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI)
| | - Giovanni Rolla
- Allergy and Clinical Immunology, University of Turin and A.O. Mauriziano, Turin
| | - Eugenio Baraldi
- Department of Woman's and Child's Health, University Hospital of Padua
| | - Vincenza Pezzella
- Department of Woman, Child and of General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples
| | - Giorgio Piacentini
- Paediatric Section, Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona
| | - Stefano Nardini
- Italian Respiratory Society-Società Italiana di Pneumologia, Milan, Italy
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22
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Germini F, Veronese G, Marcucci M, Coen D, Ardemagni D, Montano N, Fabbri A. Validation of the BAP-65 score for prediction of in-hospital death or use of mechanical ventilation in patients presenting to the emergency department with an acute exacerbation of COPD: a retrospective multi-center study from the Italian Society of Emergency Medicine (SIMEU). Eur J Intern Med 2019; 61:62-68. [PMID: 30391167 DOI: 10.1016/j.ejim.2018.10.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Revised: 10/07/2018] [Accepted: 10/24/2018] [Indexed: 11/24/2022]
Abstract
Exacerbations of chronic obstructive pulmonary disease (COPDE) frequently require hospitalizations, may necessitate of invasive mechanical ventilation (IMV), and are associated with a remarkable in-hospital mortality. The BAP-65 score is a risk assessment model (RAM) based on simple variables, that has been proposed for the prediction of these adverse outcomes in patients with COPDE. If showed to be accurate, the BAP-65 RAM might be used to guide the patients management, in terms of destination and treatment. We conducted a retrospective, multicentre, chart-review study, on patients attending the ED for a COPDE during 2014. The aim of the study was the validation of the BAP-65 RAM for the prediction of in-hospital death or use of IMV (composite primary outcome). We assessed the discrimination and the prognostic performance of the BAP-65 RAM. We enrolled 2908 patients from 20 centres across Italy. The mean (standard deviation) age was 76 (11) years, and 38% of patients were female. The composite outcome occurred in 5.3% of patients. The AUROC of BAP-65 for the composite outcome was 0.64 (95%CI 0.59-0.68). The sensitivity of BAP-65 score ≥ 4 to predict in-hospital mortality was 44% (95% CI 34%-55%), the specificity was 84% (95% CI 82%-85%), the positive predictive value was 9% (95% CI 6%-12%), and the negative predictive value was 98% (95% CI 97%-98%). CONCLUSIONS: In patients attending Italian EDs with a COPDE, we found that the BAP-65 score did not have sufficient accuracy to stratify patients upon their risk of severe in-hospital outcomes.
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Affiliation(s)
- Federico Germini
- Department of Health Research Methods, Evidence, and Impact (formerly Clinical Epidemiology and Biostatistics), McMaster University, Hamilton, ON, Canada; Department of Health Sciences, Università degli Studi di Milano, Milan, Italy; Emergency Department, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy.
| | - Giacomo Veronese
- Department of Emergency Medicine, Grande Ospedale Metropolitano Niguarda Ca' Granda, Università di Milano-Bicocca, Milan, Italy
| | - Maura Marcucci
- Department of Health Research Methods, Evidence, and Impact (formerly Clinical Epidemiology and Biostatistics), McMaster University, Hamilton, ON, Canada
| | - Daniele Coen
- Department of Emergency Medicine, Grande Ospedale Metropolitano Niguarda Ca' Granda, Università di Milano-Bicocca, Milan, Italy
| | - Deborah Ardemagni
- Geriatric Unit, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Nicola Montano
- Emergency Department, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Andrea Fabbri
- Department of Emergency Medicine, Ospedale Morgagni-Pierantoni, Forlì, Italy
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23
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Ho T, Cusack RP, Chaudhary N, Satia I, Kurmi OP. Under- and over-diagnosis of COPD: a global perspective. Breathe (Sheff) 2019; 15:24-35. [PMID: 30838057 PMCID: PMC6395975 DOI: 10.1183/20734735.0346-2018] [Citation(s) in RCA: 94] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Globally, chronic obstructive pulmonary disease (COPD) is the fourth major cause of mortality and morbidity and projected to rise to third within a decade as our efforts to prevent, identify, diagnose and treat patients at a global population level have been insufficient. The European Respiratory Society and American Thoracic Society, along with the Global Initiative for Chronic Obstructive Lung Disease (GOLD) strategy document, have highlighted key pathological risk factors and suggested clinical treatment strategies in order to reduce the mortality and morbidity associated with COPD. This review focuses solely on issues related to the under- and over-diagnosis of COPD across the main geographical regions of the world and highlights some of the associated risk factors. Prevalence of COPD obtained mainly from epidemiological studies varies greatly depending on the clinical and spirometric criteria used to diagnose COPD, i.e. forced expiratory volume in 1 s to forced vital capacity ratio <0.7 or 5% below the lower limit of normal, and this subsequently affects the rates of under- and over-diagnosis. Although under-utilisation of spirometry is the major reason, additional factors such as exposure to airborne pollutants, educational level, age of patients and language barriers have been widely identified as other potential risk factors. Co-existent diseases, such as asthma, bronchiectasis, heart failure and previously treated tuberculosis, are reported to be the other determinants of under- and over-diagnosis of COPD. COPD is a major cause of morbidity and mortality, but misdiagnosis of COPD is a huge problem worldwide. Its main causes are under-utilisation of spirometry and lack of uniformity in diagnosis criteria, particularly in resource poor settings.http://ow.ly/KfP330nonkh
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Affiliation(s)
- Terence Ho
- Firestone Institute of Respiratory Health, Division of Respirology, Dept of Medicine, McMaster University, Hamilton, ON, Canada.,All authors contributed equally
| | - Ruth P Cusack
- Division of Respirology, Dept of Medicine, McMaster University, Hamilton, ON, Canada.,All authors contributed equally
| | - Nagendra Chaudhary
- Dept of Paediatrics, Universal College of Medical Sciences, Bhairahawa, Nepal.,All authors contributed equally
| | - Imran Satia
- Division of Respirology, Dept of Medicine, McMaster University, Hamilton, ON, Canada.,All authors contributed equally
| | - Om P Kurmi
- Population Health Research Institute, Division of Respirology, Dept of Medicine, McMaster University, Hamilton, ON, Canada.,All authors contributed equally
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24
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Matera MG, Rinaldi B, Page C, Rogliani P, Cazzola M. Pharmacokinetic considerations concerning the use of bronchodilators in the treatment of chronic obstructive pulmonary disease. Expert Opin Drug Metab Toxicol 2018; 14:1101-1111. [DOI: 10.1080/17425255.2018.1530215] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Maria Gabriella Matera
- Department of Experimental Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Barbara Rinaldi
- Department of Experimental Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Clive Page
- Sackler Institute of Pulmonary Pharmacology, King’s College London, London, UK
| | - Paola Rogliani
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | - Mario Cazzola
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
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25
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Gatti V, Banfi P, Centanni S, D'Antonio S, Giustini S, Piraino A, Zibellini M, Marini MG. Enlightening chronic obstructive pulmonary disease through patients' and caregivers' narratives. Int J Chron Obstruct Pulmon Dis 2018; 13:3095-3105. [PMID: 30323580 PMCID: PMC6178274 DOI: 10.2147/copd.s172214] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Purpose The primary aim of this research was to raise awareness for COPD through real narratives of patients, caregivers, and pulmonologists. The second objective includes providing clinicians new means of caring for and treating patients with COPD. Methods Using narrative medicine, testimonies from patients, their caregivers, and clinicians were collected through an online questionnaire enriched by a narrative plot. Narrations were analyzed throughout descriptive statistics and an elaboration of recurring words and expressions. Results Throughout the project, 350 narratives were collected from 235 patients, 55 caregivers, and 60 physicians. Though a generally neutral reaction had been observed upon diagnosis, COPD had been found to have a high impact on the patients’ and caregivers’ lives. Metaphors utilized by patients and caregivers were suggestive of fear and panic unlike those utilized by clinicians who usually had a more technical approach. Smoking was a significant concern for not only patients and caregivers but also clinicians. Conclusion Physicians are therefore challenged to find new ways of communicating COPD to raise awareness on this pathology and encourage corrective habits. An important social objective should be the implementation of a health system that is able to optimize patients’ and caregivers’ lives.
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Affiliation(s)
| | - Paolo Banfi
- Fondazione Don Carlo Gnocchi IRCCS, Milan, Italy
| | - Stefano Centanni
- Respiratory Unit, ASST San Paolo e San Carlo, Department of Health Sciences, University of Milan, Milan, Italy
| | | | - Saffi Giustini
- Italian General Practitioners' Association "SIMG", Florence, Local Health Unit of Montale, Pistoia, Italy
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26
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Germini F, Veronese G, Marcucci M, Coen D, Ardemagni D, Montano N, Fabbri A. COPD exacerbations in the emergency department: Epidemiology and related costs. A retrospective cohort multicentre study from the Italian Society of Emergency Medicine (SIMEU). Eur J Intern Med 2018; 51:74-79. [PMID: 29371059 DOI: 10.1016/j.ejim.2018.01.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 12/31/2017] [Accepted: 01/04/2018] [Indexed: 10/18/2022]
Abstract
UNLABELLED Acute exacerbations of chronic obstructive pulmonary disease (AECOPDs) frequently cause patients with COPD to access the emergency department and have a negative impact on the course of the disease. The objectives of our study were: 1) describing the socio-demographic and clinical characteristics, and the clinical management, of patients with AECOPD, when they present to the emergency department; and 2) estimating the costs related to the management of these patients. We conducted a retrospective cohort study in Italy, collecting data on 4396 patients, from 34 centres. Patients had a mean (SD) age of 76,6 (10.6) years, and 61.2% of them where males. >70% of the patients had a moderate to very high comorbidity burden, and heart failure was present in 26.4% of the cohort. The 64.6% of patients were admitted to hospital wards, with a mean (SD) length of stay of 10.8 (9.8) days. The estimated cost per patient was 2617 €. CONCLUSIONS Patients attending the ED for an AECOPD are old and present important comorbidities. The rate of admission is high, and costs are remarkable.
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Affiliation(s)
- Federico Germini
- Department of Health Research Methods, Evidence, and Impact (formerly Clinical Epidemiology and Biostatistics), McMaster University, Hamilton, ON, Canada,; Department of Health Sciences, Università degli Studi di Milano, Milan, Italy; Emergency Department, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy.
| | - Giacomo Veronese
- Department of Emergency Medicine, Grande Ospedale Metropolitano Niguarda Ca' Granda, Università di Milano-Bicocca, Milan, Italy
| | - Maura Marcucci
- Department of Health Research Methods, Evidence, and Impact (formerly Clinical Epidemiology and Biostatistics), McMaster University, Hamilton, ON, Canada
| | - Daniele Coen
- Department of Emergency Medicine, Grande Ospedale Metropolitano Niguarda Ca' Granda, Università di Milano-Bicocca, Milan, Italy
| | - Deborah Ardemagni
- Geriatric Unit, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Nicola Montano
- Emergency Department, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Andrea Fabbri
- Department of Emergency Medicine, Ospedale Morgagni-Pierantoni, Forlì, Italy
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27
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Ferrara R, Ientile V, Piccinni C, Pasqua A, Pecchioli S, Fontana A, Alecci U, Scoglio R, Magliozzo F, Torrisi SE, Vancheri C, Vitulo P, Fantaci G, Ferrajolo C, Cazzola M, Cricelli C, Caputi AP, Trifirò G. Improvement in the management of chronic obstructive pulmonary disease following a clinical educational program: results from a prospective cohort study in the Sicilian general practice setting. NPJ Prim Care Respir Med 2018; 28:10. [PMID: 29572448 PMCID: PMC5865126 DOI: 10.1038/s41533-018-0077-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 02/07/2018] [Accepted: 02/16/2018] [Indexed: 11/09/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory disorder of the lungs associated with progressive disability. Although general practitioners (GPs) should play an important role in the COPD management, critical issues have been documented in the primary care setting. The aim of this study was to evaluate the effectiveness of an educational program for the improvement of the COPD management in a Sicilian general practice setting. The effectiveness of the program, was evaluated by comparing 15 quality-of-care indicators developed from data extracted by 33 GPs, at baseline vs. 12 and 24 months, and compared with data from a national primary care database (HSD). Moreover, data on COPD-related and all-cause hospitalizations over time of COPD patients, was measured. Overall, 1,465 patients (3.2%) had a registered diagnosis of COPD at baseline vs. 1,395 (3.0%) and 1,388 (3.0%) over time (vs. 3.0% in HSD). COPD patients with one spirometry registered increased from 59.7% at baseline to 73.0% after 2 years (vs. 64.8% in HSD). Instead, some quality of care indicators where not modified such as proportion of COPD patients treated with ICS in monotherapy that was almost stable during the study period: 9.6% (baseline) vs. 9.9% (after 2 years), vs. 7.7% in HSD. COPD-related and all-cause hospitalizations of patients affected by COPD decreased during the two observation years (from 6.9% vs. 4.0%; from 23.0% vs. 18.9%, respectively). Our study showed that educational program involving specialists, clinical pharmacologists and GPs based on training events and clinical audit may contribute to partly improve both diagnostic and therapeutic management of COPD in primary care setting, despite this effect may vary across GPs and indicators of COPD quality of care.
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Affiliation(s)
- Rosarita Ferrara
- Unit of Clinical Pharmacology, Academic Hospital G. Martino, Messina, Italy
| | - Valentina Ientile
- Unit of Clinical Pharmacology, Academic Hospital G. Martino, Messina, Italy
| | - Carlo Piccinni
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Alessandro Pasqua
- Health Search, Italian College of General Practitioners and Primary Care, Florence, Italy
| | - Serena Pecchioli
- Health Search, Italian College of General Practitioners and Primary Care, Florence, Italy
| | - Andrea Fontana
- Unit of Biostatistics, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | - Umberto Alecci
- Italian Society of General Practice (SIMG), Catania, Italy
| | | | | | - Sebastiano Emanuele Torrisi
- Regional Referral Center for Rare Lung Diseases, University - Hospital "G. Rodolico", Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Carlo Vancheri
- Regional Referral Center for Rare Lung Diseases, University - Hospital "G. Rodolico", Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Patrizio Vitulo
- Pulmonology Unit, Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS - ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), Palermo, Italy
| | - Giovanna Fantaci
- Epidemiologic Observatory - Sicilian Regional Department of Health, Palermo, Italy
| | - Carmen Ferrajolo
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Napoli, Italy
| | - Mario Cazzola
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | | | | | - Gianluca Trifirò
- Unit of Clinical Pharmacology, Academic Hospital G. Martino, Messina, Italy.
- Department of Biomedical Sciences, Dentistry and Functional and Morphologic Imaging, University of Messina, Messina, Italy.
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Zhang N, Cheng S, Ambroggio L, Florin TA, Macaluso M. Accounting for misclassification bias of binary outcomes due to underscreening: a sensitivity analysis. BMC Med Res Methodol 2017; 17:168. [PMID: 29233110 PMCID: PMC5727965 DOI: 10.1186/s12874-017-0447-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 11/27/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Diagnostic tests are performed in a subset of the population who are at higher risk, resulting in undiagnosed cases among those who do not receive the test. This poses a challenge for estimating the prevalence of the disease in the study population, and also for studying the risk factors for the disease. METHODS We formulate this problem as a missing data problem because the disease status is unknown for those who do not receive the test. We propose a Bayesian selection model which models the joint distribution of the disease outcome and whether testing was received. The sensitivity analysis allows us to assess how the association of the risk factors with the disease outcome as well as the disease prevalence change with the sensitivity parameter. RESULTS We illustrated our model using a retrospective cohort study of children with asthma exacerbation that were evaluated for pneumonia in the emergency department. Our model found that female gender, having fever during ED or at triage, and having severe hypoxia are significantly associated with having radiographic pneumonia. In addition, simulation studies demonstrate that the Bayesian selection model works well even under circumstances when both the disease prevalence and the screening proportion is low. CONCLUSION The Bayesian selection model is a viable tool to consider for estimating the disease prevalence and in studying risk factors of the disease, when only a subset of the target population receive the test.
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Affiliation(s)
- Nanhua Zhang
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 5041, Cincinnati, OH, 45229, USA. .,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Si Cheng
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 5041, Cincinnati, OH, 45229, USA
| | - Lilliam Ambroggio
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 5041, Cincinnati, OH, 45229, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Todd A Florin
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Maurizio Macaluso
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 5041, Cincinnati, OH, 45229, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Contoli M, Corsico AG, Santus P, Di Marco F, Braido F, Rogliani P, Calzetta L, Scichilone N. Use of ICS in COPD: From Blockbuster Medicine to Precision Medicine. COPD 2017; 14:641-647. [PMID: 29116901 DOI: 10.1080/15412555.2017.1385056] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is a major cause of mortality worldwide, whose burden is expected to increase in the next decades, because of numerous risk factors, including the aging of the population. COPD is both preventable and treatable by an effective management including risk factor reduction, prevention, assessment, and treatment of acute exacerbations and co-morbidities. The available agents approved for COPD treatment are long-acting or ultra-long-acting β2-agonists (LABAs) and long-acting muscarinic antagonists (LAMAs) bronchodilators, as well as inhaled corticosteroids (ICS) in combination with LABAs. ICS use has been restricted only to selected COPD patients by the most recent documents, mainly based on the risk of exacerbations. However, several observational studies showed a high rate of prescription of ICS in COPD, irrespective of clinical recommendations, questioning the efficacy of these compounds in unselected patients with COPD and leading to possible increase risk of side effects related to ICS use. After examining the low levels of adherence in primary care and in the clinical settings to national and international recommendations for the treatment of COPD in different countries, the most common drivers of the prevailing use of ICS are critically reviewed here by examining their pros and cons, aimed at identifying evidence-based drivers for a proper selection of patients who may benefit from the proper use of ICS.
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Affiliation(s)
- Marco Contoli
- a Section of Respiratory Internal and Cardio-Respiratory Diseases, Department of Medical Sciences , University of Ferrara , Ferrara , Italy
| | - Angelo G Corsico
- b Division of Respiratory Diseases, Foundation IRCCS Policlinico San Matteo, Department of Internal Medicine and Therapeutics , University of Pavia , Pavia , Italy
| | - Pierachille Santus
- c Department of Biomedical and Clinical Sciences (DIBIC) , University of Milan , Milan , Italy.,d Division of Respiratory Diseases , "Luigi Sacco" University Hospital , Milan , Italy.,e ASST Fatebenefratelli-Sacco , Milan , Italy
| | - Fabiano Di Marco
- f Respiratory Unit, ASST Santi Paolo e Carlo, Ospedale San Paolo , Milan , Italy.,g Department of Health Science , Università degli Studi di Milano , Milan , Italy
| | - Fulvio Braido
- h Respiratory and Allergy Department , University of Genoa, Ospedale Policlinico San Martino , Genoa , Italy
| | - Paola Rogliani
- i Department of Systems Medicine , University of Rome Tor Vergata , Rome , Italy
| | - Luigi Calzetta
- i Department of Systems Medicine , University of Rome Tor Vergata , Rome , Italy
| | - Nicola Scichilone
- j Department of Biomedicine and DIBIMIS , University of Palermo , Palermo , Italy
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Metabolic syndrome and Chronic Obstructive Pulmonary Disease (COPD): The interplay among smoking, insulin resistance and vitamin D. PLoS One 2017; 12:e0186708. [PMID: 29065130 PMCID: PMC5655494 DOI: 10.1371/journal.pone.0186708] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 10/05/2017] [Indexed: 02/06/2023] Open
Abstract
Background A close relationship between Metabolic Syndrome (MetS) and Chronic Obstructive Pulmonary Disease (COPD) has been described, but the exact nature of this link remains unclear. Current epidemiological data refer exclusively to the MetS prevalence among patients with COPD and data about the prevalence of COPD in MetS patients are still unavailable. Aim of the study To analyse and compare risk factors, clinical and metabolic characteristics, as well as the main respiratory function parameters, among patients affected by MetS, COPD or both diseases. Patients We recruited 59 outpatients with MetS and 76 outpatients with COPD. After medical history collection, physical examination, blood sampling for routine analysis, spirometric evaluation, they were subdivided into MetS (n = 46), MetS+COPD (n = 60), COPD (n = 29). Results A MetS diagnosis was assigned to 62% of COPD patients recruited in the COPD Outpatients Clinic of the Pneumology Department, while the COPD prevalence in MetS patients enrolled in the Internal Medicine Metabolic Disorders Outpatients Clinic was 22%. More than 60% of subjects enrolled in each Department were unaware that they suffered from an additional disease. MetS+COPD patients exhibited significantly higher C-peptide levels. We also found a positive relation between C-peptide and pack-years in all subjects and a negative correlation between C-peptide and vitamin D only in current smokers. Finally, a negative association emerged between smoking and vitamin D. Conclusions We have estimated, for the first time, the COPD prevalence in MetS and suggest a potential role of smoking in inducing insulin resistance. Moreover, a direct effect of smoking on vitamin D levels is proposed as a novel mechanism, which may account for both insulin resistance and COPD development.
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Biffi A, Comoretto R, Arfè A, Scotti L, Merlino L, Vaghi A, Pesci A, de Marco R, Corrao G. Can healthcare utilization data reliably capture cases of chronic respiratory diseases? a cross-sectional investigation in Italy. BMC Pulm Med 2017; 17:20. [PMID: 28103865 PMCID: PMC5248488 DOI: 10.1186/s12890-016-0362-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2016] [Accepted: 12/29/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Healthcare utilization data are increasingly used for chronic disease surveillance. Nevertheless, no standard criteria for estimating prevalence of high-impact diseases, such as chronic obstructive pulmonary disease (COPD) and asthma, are available. In this study an algorithm for recognizing COPD/asthma cases from HCU data is developed and implemented in the HCU databases of the Italian Lombardy Region (about 10 million residents). The impact of diagnostic misclassification for reliably estimating prevalence was also assessed. METHODS Disease-specificdrug codes, hospital discharges together with co-payment exemptions when available, and a combination of them according with patient's age, were used to create the proposed algorithm. Identified cases were considered for prevalence estimation. An external validation study was also performed in order to evaluate systematic uncertainty of prevalence estimates. RESULTS Raw prevalence of COPD and asthma in 2010 was 3.6 and 3.3% respectively. According to external validation, sensitivity values were 53% for COPD and 39% for asthma. Adjusted prevalence estimates were respectively 6.8 and 8.5% for COPD (among person aged 40 years or older) and asthma (among person aged 40 years or younger). CONCLUSIONS COPD and asthma prevalence may be estimated from HCU data, albeit with high systematic uncertainty. Validation is recommended in this setting.
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Affiliation(s)
- A Biffi
- Laboratory of Healthcare Research and Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Via Bicocca degli Arcimboldi, 8, Edificio U7, 20126 Milan, Italy
| | - R Comoretto
- Laboratory of Healthcare Research and Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Via Bicocca degli Arcimboldi, 8, Edificio U7, 20126 Milan, Italy
| | - A Arfè
- Laboratory of Healthcare Research and Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Via Bicocca degli Arcimboldi, 8, Edificio U7, 20126 Milan, Italy
- Department of Decision Sciences, Bocconi University, Milan, Italy
| | - L Scotti
- Laboratory of Healthcare Research and Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Via Bicocca degli Arcimboldi, 8, Edificio U7, 20126 Milan, Italy
| | - L Merlino
- Operative Unit of Territorial Health Services, Region Lombardia, Milan, Italy
| | - A Vaghi
- Division of Pneumology, “Guido Salvini” Hospital, Garbagnate Milanese, Italy
| | - A Pesci
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- Division of Pneumology, “San Gerardo” Hospital, Monza, Italy
| | - R de Marco
- Unit of Epidemiology and Medical Statistics, University of Verona, Verona, Italy
| | - G Corrao
- Laboratory of Healthcare Research and Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Via Bicocca degli Arcimboldi, 8, Edificio U7, 20126 Milan, Italy
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Rogliani P, Ora J, Puxeddu E, Cazzola M. Airflow obstruction: is it asthma or is it COPD? Int J Chron Obstruct Pulmon Dis 2016; 11:3007-3013. [PMID: 27942210 PMCID: PMC5137932 DOI: 10.2147/copd.s54927] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Despite the availability of guideline recommendations, diagnostic confusion between COPD and asthma appears common, and often it is very difficult to decide whether the obstruction is caused by asthma or COPD in a patient with airway obstruction. However, there are well-defined features that help in differentiating asthma from COPD in the presence of fixed airflow obstruction. Nonetheless, the presentations of asthma and COPD can converge and mimic each other, making it difficult to give these patients a diagnosis of either condition. The association of asthma and COPD in the same patient has been designated mixed asthma–COPD phenotype or overlap syndrome. However, since the absence of a clear definition and the inclusion of patients with different characteristics under this umbrella term, it may not facilitate treatment decisions, especially in the absence of clinical trials addressing this heterogeneous population. We are realizing that neither asthma nor COPD are single diseases, but rather syndromes consisting of several endotypes and phenotypes, consequently comprising a spectrum of diseases that must be recognized and adequately treated with targeted therapy. Therefore, we must treat patients by personalizing therapy on the basis of those treatable traits present in each subject.
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Affiliation(s)
- Paola Rogliani
- Department of Systems Medicine, Tor Vergata University of Rome, Rome, Italy
| | - Josuel Ora
- Department of Systems Medicine, Tor Vergata University of Rome, Rome, Italy
| | - Ermanno Puxeddu
- Department of Systems Medicine, Tor Vergata University of Rome, Rome, Italy
| | - Mario Cazzola
- Department of Systems Medicine, Tor Vergata University of Rome, Rome, Italy
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Prevalence, Costs and Consequences of “Manovra AIFA” for ICS-LABA Treatment in Patients with Asthma or COPD: A Real-Practice Analysis. GLOBAL & REGIONAL HEALTH TECHNOLOGY ASSESSMENT 2016. [DOI: 10.5301/grhta.5000235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Visentin E, Nieri D, Vagaggini B, Peruzzi E, Paggiaro P. An observation of prescription behaviors and adherence to guidelines in patients with COPD: real world data from October 2012 to September 2014. Curr Med Res Opin 2016; 32:1493-502. [PMID: 27215310 DOI: 10.1080/03007995.2016.1182900] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
INTRODUCTION GOLD guideline recommendations are currently the "gold standard" for the treatment of COPD patients. OBJECTIVES The objective of this analysis was to evaluate compliance with GOLD guidelines in managing COPD patients' treatment by general practitioners (GPs) and pulmonologists. Since inhaled corticosteroid (ICS) use is defined as inappropriate in mild and moderate COPD patients, special attention was paid to ICS therapy use in these classes. METHODS The study was based on the Italian GP database IMS Health Longitudinal Patient Database (IMS Health LPD) and on the Patient Analyzer specialist IMS Health database. The observed cohort included all patients with a diagnosis of COPD, aged 40 years or more, with at least one ATC R03 class prescription, visited by GPs and pulmonologists during four timeframes: October 2012 - March 2013 (cohort 1), April 2013 - September 2013 (cohort 2), October 2013 - March 2014 (cohort 3); April 2014 - September 2014 (cohort 4). Patients were classified into disease severity groups following 2008 GOLD guidelines, based on FEV1 value. RESULTS Cohorts were quite similar in size (about two thousand patients per cohort). Pulmonologists visited more severe patients than GPs. About 50% of GPs' mild and moderate patients received treatments containing inhaled corticosteroids. Pulmonologists were more adherent to guidelines, with smaller percentages of mild patients treated with therapies containing ICS (ranging from 19.0% to 30.1%). An improvement in adherence was observed during the four time periods, with a decrease in the use of therapies containing ICS in mild and moderate patients. In absolute terms, it emerged that GPs more often prescribe ICS improperly to patients in the mild and moderate severity classes than pulmonologists. CONCLUSION Real world data indicate that adherence to GOLD guidelines is only partially met by GPs in their general practice and shows higher prescription appropriateness by pulmonologists.
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Affiliation(s)
- Elena Visentin
- a IMS Health Information Solutions Italy srl , Milan , Italy
| | - Dario Nieri
- b Cardio-Thoracic and Vascular Department , University of Pisa , Pisa , Italy
| | - Barbara Vagaggini
- b Cardio-Thoracic and Vascular Department , University of Pisa , Pisa , Italy
| | | | - Pierluigi Paggiaro
- b Cardio-Thoracic and Vascular Department , University of Pisa , Pisa , Italy
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Cazzola M, Rogliani P. Do we really need asthma-chronic obstructive pulmonary disease overlap syndrome? J Allergy Clin Immunol 2016; 138:977-983. [PMID: 27372569 DOI: 10.1016/j.jaci.2016.04.028] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 03/29/2016] [Accepted: 04/01/2016] [Indexed: 12/23/2022]
Abstract
The association of asthma and chronic obstructive pulmonary disease (COPD) in the same patient, which is designated as mixed asthma-COPD phenotype or overlap syndrome (ACOS), remains a controversial issue. This is primarily because many conflicting aspects in the definition of ACOS remain, and it is extremely difficult to summarize the distinctive features of this syndrome. Furthermore, we are realizing that asthma, COPD, and ACOS are not single diseases but rather syndromes consisting of several endotypes and phenotypes and, consequently, comprising a spectrum of diseases. The umbrella term ACOS blurs the lines between asthma and COPD and allows an approach that simplifies therapy. However, this approach contradicts the modern concept according to which we must move toward more targeted and personalized therapies to treat patients with these diseases. Therefore we argue that the term ACOS must be abandoned and ultimately replaced when new phenotypes and underlying endotypes are identified and a new taxonomy of airway diseases is generated.
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Affiliation(s)
- Mario Cazzola
- University of Rome Tor Vergata, Department of Systems Medicine, Respiratory Medicine, Rome, Italy.
| | - Paola Rogliani
- University of Rome Tor Vergata, Department of Systems Medicine, Respiratory Medicine, Rome, Italy
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Vieira R, Fonseca JA, Lopes F, Freitas A. Trends in hospital admissions for obstructive lung disease from 2000 to 2010 in Portugal. Respir Med 2016; 116:63-9. [PMID: 27296823 DOI: 10.1016/j.rmed.2016.05.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 05/13/2016] [Accepted: 05/17/2016] [Indexed: 11/28/2022]
Abstract
The burden of hospitalisations for obstructive lung diseases (OLD) has not been sufficiently studied. We aimed to characterise the hospitalisations for OLD from 2000 to 2010 in all Portuguese public hospitals. We analysed hospital discharges with a diagnosis of OLD regarding the patients' gender, age, residence and comorbidities. Of the 120 399 hospital admissions with a principal diagnosis of OLD, COPD (ICD-9-CM 491.x, 492.x, 496) was responsible for 81%. The change in patients discharged with OLD as a principal diagnosis was only 1% from 2000 to 2010 and did not change for COPD. Hospital admissions and deaths for COPD and other OLD increased with age and were more common in men than women. In-hospital mortality for COPD decreased 34.1% from 2000 to 2010, while the median length of stay was fairly constant at 8 days. Respiratory failure, insufficiency and/or arrest, and pneumonia, are the principal diagnoses often associated with COPD. When both pneumonia and COPD were diagnosed there was an increasing trend to classify pneumonia as the principal diagnosis (64.4%-72.9%), a sign that may lead to underestimation of COPD hospitalisations. In summary, a considerable decrease in in-hospital COPD mortality was observed while hospital admissions and the length of stay did not change substantially. These results suggest that better healthcare or other factors may be counteracting the expected increase of the burden of COPD.
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Affiliation(s)
- Rafael Vieira
- Department of Health Information and Decision Sciences (CIDES), Faculty of Medicine, University of Porto, Rua Dr. Plácido da Costa, 4200-450 Porto, Portugal.
| | - João Almeida Fonseca
- Department of Health Information and Decision Sciences (CIDES), Faculty of Medicine, University of Porto, Rua Dr. Plácido da Costa, 4200-450 Porto, Portugal; Center for Health Technology and Services Research (CINTESIS), University of Porto, Rua Dr. Plácido da Costa, 4200-450 Porto, Portugal
| | - Fernando Lopes
- Department of Health Information and Decision Sciences (CIDES), Faculty of Medicine, University of Porto, Rua Dr. Plácido da Costa, 4200-450 Porto, Portugal; Center for Health Technology and Services Research (CINTESIS), University of Porto, Rua Dr. Plácido da Costa, 4200-450 Porto, Portugal
| | - Alberto Freitas
- Department of Health Information and Decision Sciences (CIDES), Faculty of Medicine, University of Porto, Rua Dr. Plácido da Costa, 4200-450 Porto, Portugal; Center for Health Technology and Services Research (CINTESIS), University of Porto, Rua Dr. Plácido da Costa, 4200-450 Porto, Portugal
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Sommariva S, Finch AP, Jommi C. The assessment of new drugs for asthma and COPD: a Delphi study examining the perspectives of Italian payers and clinicians. Multidiscip Respir Med 2016; 11:4. [PMID: 26823977 PMCID: PMC4730839 DOI: 10.1186/s40248-016-0038-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 01/05/2016] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Asthma and chronic obstructive pulmonary disease (COPD) are disorders of the lungs characterized by airflow obstruction, inflammation and tissue remodeling. Management of patients with these diseases is complex and the improvement of diagnostic-therapeutic strategies represents a critical challenge for the healthcare system. In this context, investigating the criteria and information needed for an appropriate and effective evaluation of incoming treatment options is crucial to ensure that clinicians and policy-makers are provided with the best available evidence to make decisions aimed at improving patient outcomes. Therefore, the objective of this study was to investigate the degree of agreement among Health Technology Assessment (HTA) experts on issues crucial to the evaluation of new drugs for asthma and COPD and to appropriately manage the clinical pathway for patients. METHOD This research was conducted using an e-Delphi technique organized in three subsequent rounds and involving a panel of ten experts (six regional and local payers and four clinicians). Panelists were asked to comment in written form on a set of statements, explaining qualitatively the extent to which they agreed or disagreed with the assertions. Statements were subsequently modified and resubmitted for assessment. RESULTS Panelists expressed their opinions during each round and, after round III, a consensus document was finalized. The degree of consensus was high among experts and concerned five main topics: (a) the need to address current unmet needs of patients with asthma or COPD, (b) the importance of further studies and real-life information in the evaluation of treatments, (c) existing evidence and evidence needed to assess drugs, (d) critical issues in obtaining a positive evaluation from regional and local authorities for new treatments to be included in regional formularies and to have an important place in therapeutic categories, and (e) the major obstacles to the appropriate administration of drugs and management of patients. CONCLUSION The final document highlights that no proof of difference among drugs exists, that evidence on final endpoints (and particularly on mortality) should be strengthened and that actions regarding risk factors, appropriate diagnosis, patient staging and adherence to therapy are particularly important for a better clinical management.
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Affiliation(s)
- Silvia Sommariva
- Centre for Research on Health and Social Care Management, Bocconi University, Milan, Italy
- Università Bocconi - CERGAS, Via Roentgen, 1, 20136 Milano, Italy
| | - Aureliano P. Finch
- Centre for Research on Health and Social Care Management, Bocconi University, Milan, Italy
| | - Claudio Jommi
- Centre for Research on Health and Social Care Management, Bocconi University, Milan, Italy
- Department of Pharmaceutical Sciences, Università del Piemonte Orientale A. Avogadro, Novara, Italy
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Treatment patterns in COPD patients newly diagnosed in primary care. A population-based study. Respir Med 2015; 111:47-53. [PMID: 26758585 DOI: 10.1016/j.rmed.2015.12.004] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 10/31/2015] [Accepted: 12/15/2015] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Treatment for COPD is tailored based on clinical characteristics and severity. However, prescription patterns in COPD patients newly diagnosed in primary care may differ from guideline recommendations. METHOD We performed an epidemiological study with data obtained from the Information System for the Development in Research in Primary Care (SIDIAP), a population database that contains information of 5.8 million inhabitants (80% of the population of Catalonia). Patients newly diagnosed with COPD from 2007 to 2012 were identified and information about the initial treatment patterns was collected. The initial treatment was also described by phenotype and severity. RESULTS During the study period 41,492 patients were newly diagnosed with COPD. Patients were classified as non exacerbators (28,552 patients, 69%), asthma-COPD overlap syndrome (ACOS) (2152 patients, 5.2%) and frequent exacerbators (10,888 patients, 27.6%). Among the patients in whom FEV1 was available, 13.9% were GOLD stage 1, 55.2% stage 2, 26% stage 3 and 4.8% stage 4. Globally, the most frequently prescribed treatment patterns were short-acting bronchodilators (SABD) in monotherapy (17.7%), long-acting β-2 agonists (LABA) + inhaled corticosteroids (ICS) (17.3%) and triple therapy (12.2%). The frequency of patients treated with a SABD increased from 15.9% to 19.5% during the study period, while the number of untreated patients decreased from 24.4% to 15.1%. Up to 45.2% of patients were initially treated with ICS, which were frequently prescribed in the ACOS (69.2%) and in the exacerbator phenotype patients (52.4%) while ICS use has decreased from 43.8% in 2007 to 35.8% in 2012 in non exacerbator patients. Up to 13.6% and 14.8% of GOLD 4 patients received no treatment or only SABD after diagnosis. CONCLUSIONS Initial treatment patterns in newly diagnosed COPD patients often do no comply with guidelines. The use of ICS is excessive but has decreased mainly in non exacerbator patients. Many COPD patients still remain untreated after diagnosis, although this has decreased. Some GOLD 4 patients are still receiving SABD or no treatment at all after diagnosis.
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Pesce G, Locatelli F, Cerveri I, Bugiani M, Pirina P, Johannessen A, Accordini S, Zanolin ME, Verlato G, de Marco R. Seventy Years of Asthma in Italy: Age, Period and Cohort Effects on Incidence and Remission of Self-Reported Asthma from 1940 to 2010. PLoS One 2015; 10:e0138570. [PMID: 26439263 PMCID: PMC4595078 DOI: 10.1371/journal.pone.0138570] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 09/01/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND It is well known that asthma prevalence has been increasing all over the world in the last decades. However, few data are available on temporal trends of incidence and remission of asthma. OBJECTIVE To evaluate the rates of asthma incidence and remission in Italy from 1940 to 2010. METHODS The subjects were randomly sampled from the general Italian population between 1991 and 2010 in the three population-based multicentre studies: ECRHS, ISAYA, and GEIRD. Individual information on the history of asthma (age at onset, age at the last attack, use of drugs for asthma control, co-presence of hay-fever) was collected on 35,495 subjects aged 20-84 and born between 1925-1989. Temporal changes in rates of asthma incidence and remission in relation to age, birth cohort and calendar period (APC) were modelled using Poisson regression and APC models. RESULTS The average yearly rate of asthma incidence was 2.6/1000 (3,297 new cases among 1,263,885 person-years). The incidence rates have been linearly increasing, with a percentage increase of +3.9% (95%CI: 3.1-4.5), from 1940 up to the year 1995, when the rates begun to level off. The stabilization of asthma incidence was mainly due to a decrease in the rates of atopic asthma after 1995, while non-atopic asthma has continued to increase. The overall rate of remission was 43.2/1000person-years, and it did not vary significantly across generations, but was associated with atopy, age at asthma onset and duration of the disease. CONCLUSIONS After 50 years of a continuous upward trend, the rates of asthma incidence underwent a substantial stabilization in the late 90s. Despite remarkable improvements in the treatment of asthma, the rate of remission did not change significantly in the last seventy years. Some caveats are required in interpreting our results, given that our estimates are based on self-reported events that could be affected by the recall bias.
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Affiliation(s)
- Giancarlo Pesce
- Unit of Epidemiology & Medical Statistics, Dept. of Public Health & Community Medicine, University of Verona, Verona, Italy
| | - Francesca Locatelli
- Unit of Epidemiology & Medical Statistics, Dept. of Public Health & Community Medicine, University of Verona, Verona, Italy
| | - Isa Cerveri
- Unit of Respiratory Diseases, IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | | | - Pietro Pirina
- Institute for Respiratory Diseases, University of Sassari, Sassari, Italy
| | - Ane Johannessen
- Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway
| | - Simone Accordini
- Unit of Epidemiology & Medical Statistics, Dept. of Public Health & Community Medicine, University of Verona, Verona, Italy
| | - Maria Elisabetta Zanolin
- Unit of Epidemiology & Medical Statistics, Dept. of Public Health & Community Medicine, University of Verona, Verona, Italy
| | - Giuseppe Verlato
- Unit of Epidemiology & Medical Statistics, Dept. of Public Health & Community Medicine, University of Verona, Verona, Italy
| | - Roberto de Marco
- Unit of Epidemiology & Medical Statistics, Dept. of Public Health & Community Medicine, University of Verona, Verona, Italy
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Artyukhov IP, Arshukova IL, Dobretsova EA, Dugina TA, Shulmin AV, Demko IV. Epidemiology of chronic obstructive pulmonary disease: a population-based study in Krasnoyarsk region, Russia. Int J Chron Obstruct Pulmon Dis 2015; 10:1781-6. [PMID: 26366070 PMCID: PMC4562723 DOI: 10.2147/copd.s79601] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Krasnoyarsk region is a territory with the widespread risk factors for chronic obstructive pulmonary disease (COPD) such as tobacco smoke, air pollution, and occupational exposure. An assessment of COPD prevalence based on medical diagnosis statistics underestimates the true COPD prevalence. This study aims to evaluate how medical examinations may increase the accuracy of estimates of COPD prevalence. METHODS True COPD prevalence was estimated as a number of patients with the established disease diagnosis supplemented by the additional disease cases detected during medical examinations per 1,000 inhabitants of the region. Official medical statistics data and the data collected from the Global Alliance against Chronic Respiratory Diseases program 2011 among 15,000 inhabitants of the region aged 18 years and older were analyzed. RESULTS This study revealed the COPD cases without official medical diagnosis. The true prevalence of COPD is estimated to be two times higher than the prevalence estimates based on medical diagnosis statistics. CONCLUSION Undiagnosed and untreated cases of COPD result in severe COPD forms as well as addition of severe comorbidities. Because of this, there is an increase in the index of potential years of life lost. Conducting special medical examinations may increase the number of COPD cases detected at the early stages of the disease. This, in turn, may reduce the overall burden of the disease for the population of the region.
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Affiliation(s)
- Ivan P Artyukhov
- Department of Health Care Management, Krasnoyarsk State Medical University, Krasnoyarsk, Russia
| | - Irina L Arshukova
- Department of Public Health and Health Care, Krasnoyarsk State Medical University, Krasnoyarsk, Russia
| | - Elena A Dobretsova
- Department of Public Health and Health Care, Krasnoyarsk State Medical University, Krasnoyarsk, Russia
| | - Tatyana A Dugina
- Department of Public Health and Health Care, Krasnoyarsk State Medical University, Krasnoyarsk, Russia
| | - Andrey V Shulmin
- Department of Public Health and Health Care, Krasnoyarsk State Medical University, Krasnoyarsk, Russia
| | - Irina V Demko
- Department of Internal Diseases, Krasnoyarsk State Medical University, Krasnoyarsk, Russia
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Cazzola M, Calzetta L, Matera MG, Muscoli S, Rogliani P, Romeo F. Chronic obstructive pulmonary disease and coronary disease: COPDCoRi, a simple and effective algorithm for predicting the risk of coronary artery disease in COPD patients. Respir Med 2015; 109:1019-25. [PMID: 26111914 DOI: 10.1016/j.rmed.2015.05.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 04/07/2015] [Accepted: 05/24/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is often associated with cardiovascular artery disease (CAD), representing a potential and independent risk factor for cardiovascular morbidity. Therefore, the aim of this study was to identify an algorithm for predicting the risk of CAD in COPD patients. METHODS We analyzed data of patients afferent to the Cardiology ward and the Respiratory Diseases outpatient clinic of Tor Vergata University (2010-2012, 1596 records). The study population was clustered as training population (COPD patients undergoing coronary arteriography), control population (non-COPD patients undergoing coronary arteriography), test population (COPD patients whose records reported information on the coronary status). The predicting model was built via causal relationship between variables, stepwise binary logistic regression and Hosmer-Lemeshow analysis. The algorithm was validated via split-sample validation method and receiver operating characteristics (ROC) curve analysis. The diagnostic accuracy was assessed. RESULTS In training population the variables gender (men/women OR: 1.7, 95%CI: 1.237-2.5, P < 0.05), dyslipidemia (OR: 1.8, 95%CI: 1.2-2.5, P < 0.01) and smoking habit (OR: 1.5, 95%CI: 1.2-1.9, P < 0.001) were significantly associated with CAD in COPD patients, whereas in control population also age and diabetes were correlated. The stepwise binary logistic regressions permitted to build a well fitting predictive model for training population but not for control population. The predictive algorithm shown a diagnostic accuracy of 81.5% (95%CI: 77.78-84.71) and an AUC of 0.81 (95%CI: 0.78-0.85) for the validation set. CONCLUSIONS The proposed algorithm is effective for predicting the risk of CAD in COPD patients via a rapid, inexpensive and non-invasive approach.
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Affiliation(s)
- Mario Cazzola
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy.
| | - Luigino Calzetta
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | | | - Saverio Muscoli
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Paola Rogliani
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Francesco Romeo
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
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COPD prevalence in a north-eastern Italian general population. Respir Med 2015; 109:1040-7. [PMID: 26052037 DOI: 10.1016/j.rmed.2015.05.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Revised: 05/04/2015] [Accepted: 05/06/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND COPD prevalence estimates vary mostly depending on different study methodologies. We evaluated the prevalence and clinical features of COPD, as defined by GOLD and ERS/ATS recommendations in a representative sample of Northern Italy general population. METHODS A randomized cross-sectional study was performed. The study participants completed a questionnaire covering: key indicators for considering a diagnosis of COPD, self-reported physician diagnoses of respiratory disease, pharmacological treatment for respiratory disease, indirect costs, occupational and environmental exposures. They also underwent spirometry and physician assessment. RESULTS We evaluated 1236 subjects. Daily respiratory symptoms were experienced by 26.7%. Of this group, only 30.7% had previously performed a spirometry. The overall COPD prevalence was: 11.7% according to GOLD criterion; 9.1% according to LLN criterion; 6.8% according to self-reported physician diagnosis. Of note, 48,8% of subjects with a reported diagnosis of COPD had never undergone a spirometry before the study. CONCLUSIONS Our study provides an estimation of COPD prevalence in a representative sample of Northern Italy general population relying on both clinical symptoms and spirometry outcomes, and describes the different prevalence rates depending on the adopted diagnostic criterion. Spirometry underuse may account for under-diagnosis and misdiagnosis of COPD. It may result in a major impact on quality of life as well as in economic burden.
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Carlone S, Balbi B, Bezzi M, Brunori M, Calabro S, Foschino Barbaro MP, Micheletto C, Privitera S, Torchio R, Schino P, Vianello A. Health and social impacts of COPD and the problem of under-diagnosis. Multidiscip Respir Med 2014; 9:63. [PMID: 25699180 PMCID: PMC4334408 DOI: 10.1186/2049-6958-9-63] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 11/27/2014] [Indexed: 11/10/2022] Open
Abstract
This article deals with the prevalence and the possible reasons of COPD underestimation in the population and gives suggestions on how to overcome the obstacles and make the correct diagnosis in order to provide the patients with the appropriate therapy. COPD is diagnosed in later or very advanced stages. In Italy the rate of COPD under-diagnosis ranges between 25 and 50% and, as a consequence, the patient does not consult his doctor until the symptoms have worsened, mainly due to exacerbations. A missed diagnosis influences the timing of therapeutic intervention, thus contributing to the evolution into more severe stages of the illness. An incisive intervention to limit under-diagnosis cannot act only in remittance (passive diagnosis), but must be the promoter for a series of preventive actions: primary, secondary and rehabilitative. To reduce under-diagnosis, some actions need to be taken, such as screening programs for smokers subjects, use of questionnaires aimed to qualify and monitor the disease severity, spirometry, early diagnosis. There is a consensus regarding diagnoses based on screening of at-risk subjects and symptoms, rather than screening of the general population. In practice, all individuals over 40 years of age with risk factors should make a spirometry test. Screening actions on a national scale can be the following: compilation of questionnaires in waiting rooms of doctor’s offices or performing simple maneuvers to evaluate the expiratory force at pharmacies. It is now widely recognized that COPD is a complex syndrome with several pulmonary and extrapulmonary components; as a result, the airway obstruction as assessed by FEV1 by itself does not adequately describe the complexity of the disease and FEV1 cannot be used alone for the optimal diagnosis, assessment, and management of the disease. The identification and subsequent grouping of key elements of the COPD syndrome into clinically meaningful and useful subgroups (phenotypes) can guide therapy more effectively. In conclusion, we firmly believe that an early and correct diagnosis can influence positively the progress of the disease (lowering the lung function impairment), decrease the risk of exacerbations, relieve symptoms and increase the patients’ quality of life leading also to a decrease in costs associated to the exacerbations and hospitalization of the patient.
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Affiliation(s)
- Stefano Carlone
- Pulmonary Department, San Giovanni-Addolorata General Hospital, Rome, Italy
| | - Bruno Balbi
- Pulmonary Rehabilitation Department, IRCCS Fondazione Salvatore Maugeri, Veruno (NO), Italy
| | - Michela Bezzi
- Endoscopy and Laser Therapy, Respiratory Unit, Hospital of Brescia, Brescia, Italy
| | - Marco Brunori
- Respiratory Pathophysiology and Rehabilitation Unit, Policlinico Umberto I, Rome, Italy
| | - Stefano Calabro
- Respiratory Unit, San Bassano Hospital, Bassano del Grappa, Vicenza Italy
| | | | | | - Salvatore Privitera
- Centre for Prevention and Monitoring Respiratory Failure, ASP, Catania, Italy
| | - Roberto Torchio
- Respiratory Function and Sleep Laboratory, AOU S. Luigi, Orbassano (TO), Italy
| | - Pietro Schino
- Physiopatology Respiratory Unit, General Hospital F. Miulli, Acquaviva delle Fonti (BA), Italy
| | - Andrea Vianello
- Respiratory Pathophysiology Division, University-City Hospital of Padova, Padova, Italy
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Blasi F, Raddi F, Miravitlles M. Interactive Monitoring Service and COPD: Is it Possible to Reduce Nonadherence? COPD 2014; 12:227-32. [PMID: 25093542 DOI: 10.3109/15412555.2014.933796] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) represents one of the main causes of death worldwide. It affects hundreds of millions of people and is likely to spread further in the coming years. Despite the chronic nature of the disease and the proven efficacy of current therapies, treatment nonadherence is unfortunately common and too often related to treatment failure, disease exacerbations, hospitalizations, and high healthcare costs. At present, studies aimed to assess and improve patients' adherence in chronic respiratory diseases--and especially in COPD--are limited, but a review of the few data available makes it clear that there is a need for an innovative approach that leverages health technology to encourage patients to adhere to prescribed chronic treatments.
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Affiliation(s)
- Francesco Blasi
- 1Department of Pathophysiology and Transplantation, Università degli Studi di Milano, IRCCS Fondazione Ca' Granda, Ospedale Maggiore Policlinico , Milano , Italy
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Andreou G, Vlachos F, Makanikas K. Effects of chronic obstructive pulmonary disease and obstructive sleep apnea on cognitive functions: evidence for a common nature. SLEEP DISORDERS 2014; 2014:768210. [PMID: 24649370 PMCID: PMC3932644 DOI: 10.1155/2014/768210] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2013] [Revised: 10/09/2013] [Accepted: 10/31/2013] [Indexed: 12/16/2022]
Abstract
Patients with chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea syndrome (OSAS) show similar neurocognitive impairments. Effects are more apparent in severe cases, whereas in moderate and mild cases the effects are equivocal. The exact mechanism that causes cognitive dysfunctions in both diseases is still unknown and only suggestions have been made for each disease separately. The primary objective of this review is to present COPD and OSAS impact on cognitive functions. Secondly, it aims to examine the potential mechanisms by which COPD and OSAS can be linked and provide evidence for a common nature that affects cognitive functions in both diseases. Patients with COPD and OSAS compared to normal distribution show significant deficits in the cognitive abilities of attention, psychomotor speed, memory and learning, visuospatial and constructional abilities, executive skills, and language. The severity of these deficits in OSAS seems to correlate with the physiological events such as sleep defragmentation, apnea/hypopnea index, and hypoxemia, whereas cognitive impairments in COPD are associated with hypoventilation, hypoxemia, and hypercapnia. These factors as well as vascocerebral diseases and changes in systemic hemodynamic seem to act in an intermingling and synergistic way on the cause of cognitive dysfunctions in both diseases. However, low blood oxygen pressure seems to be the dominant factor that contributes to the presence of cognitive deficits in both COPD and OSAS.
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Affiliation(s)
- Georgia Andreou
- Department of Special Education, University of Thessaly, Argonafton & Filellinon, 38221 Volos, Greece
| | - Filippos Vlachos
- Department of Special Education, University of Thessaly, Argonafton & Filellinon, 38221 Volos, Greece
| | - Konstantinos Makanikas
- Department of Special Education, University of Thessaly, Argonafton & Filellinon, 38221 Volos, Greece
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Bellocchia M, Masoero M, Ciuffreda A, Croce S, Vaudano A, Torchio R, Boita M, Bucca C. Predictors of cardiovascular disease in asthma and chronic obstructive pulmonary disease. Multidiscip Respir Med 2013; 8:58. [PMID: 24004921 PMCID: PMC3844573 DOI: 10.1186/2049-6958-8-58] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Accepted: 07/29/2013] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Cardiovascular disease (CVD) is a common comorbidity in patients with chronic airway obstruction, and is associated with systemic inflammation and airway obstruction. The aim of this study was to evaluate the predictors of CVD in two different conditions causing chronic airway obstruction, asthma and COPD. METHODS Lung function tests, clinical and echocardiographic data were assessed in 229 consecutive patients, 100 with asthma and 129 with COPD. CVD was classified into: pressure overload (PO) and volume overload (VO). Sub-analysis of patients with ischemic heart disease (IHD) and pulmonary hypertension (PH) was also performed. RESULTS CVD was found in 185 patients (81%: 51% COPD and 30% asthmatics) and consisted of PO in 42% and of VO in 38% patients. COPD patients, as compared to asthmatics, had older age, more severe airway obstruction, higher prevalence of males, of smokers, and of CVD (91% vs 68%), either PO (46% vs 38%) or VO (45% vs 30%). CVD was associated with older age and more severe airway obstruction both in asthma and COPD. In the overall patients the predictive factors of CVD were age, COPD, and male sex; those of PO were COPD, BMI, VC, FEV1 and MEF50 and those of VO were age, VC and MEF50. In asthma, the predictors of CVD were VC, FEV1, FEV1 /VC%, and PaO2, those of PO were VC, FEV1 and FEV1 /VC%, while for VO there was no predictor. In COPD the predictors of CVD were age, GOLD class and sex, those of VO age, VC and MEF50, and that of PO was BMI. Sub-analysis showed that IHD was predicted by COPD, age, BMI and FEV1, while PH (found only in 25 COPD patients), was predicted by VO (present in 80% of the patients) and FEV1. In subjects aged 65 years or more the prevalence of CVD, PO and VO was similar in asthmatic and COPD patients, but COPD patients had higher prevalence of males, smokers, IHD, PH, lower FEV1 and higher CRP. CONCLUSIONS The results of this study indicate that cardiovascular diseases are frequent in patients with chronic obstructive disorders, particularly in COPD patients. The strongest predictors of CVD are age and airway obstruction. COPD patients have higher prevalence of ischemic heart disease and pulmonary hypertension. In the elderly the prevalence of PO and VO in asthma and COPD patients is similar.
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Affiliation(s)
- Michela Bellocchia
- Department of Medical Sciences, University of Turin, Via Genova 3, 10126 Turin, Italy
| | - Monica Masoero
- Department of Medical Sciences, University of Turin, Via Genova 3, 10126 Turin, Italy
| | - Antonio Ciuffreda
- Department of Medical Sciences, University of Turin, Via Genova 3, 10126 Turin, Italy
| | - Silvia Croce
- Department of Medical Sciences, University of Turin, Via Genova 3, 10126 Turin, Italy
| | - Arianna Vaudano
- Department of Medical Sciences, University of Turin, Via Genova 3, 10126 Turin, Italy
| | - Roberto Torchio
- Cardiorespiratory Pathophysiology Department, AOU S, Luigi, Gonzole Region 10, 10043 Orbassano, Turin, Italy
| | - Monica Boita
- Department of Medical Sciences, University of Turin, Via Genova 3, 10126 Turin, Italy
| | - Caterina Bucca
- Department of Medical Sciences, University of Turin, Via Genova 3, 10126 Turin, Italy
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Cazzola M, Calzetta L, Lauro D, Bettoncelli G, Cricelli C, Di Daniele N, Rogliani P. Asthma and COPD in an Italian adult population: role of BMI considering the smoking habit. Respir Med 2013; 107:1417-22. [PMID: 23702090 DOI: 10.1016/j.rmed.2013.04.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Revised: 04/14/2013] [Accepted: 04/23/2013] [Indexed: 12/28/2022]
Abstract
Smoking and body mass index (BMI) are well-documented risk factors that contribute substantially to chronic obstructive pulmonary disease (COPD) and asthma. However, the relations among smoking, obesity, and COPD or asthma remain to be clarified. We conducted a population-based cross-sectional epidemiologic study to explore the association between BMI and COPD or asthma among non-smokers, smokers and ex-smokers using information obtained from the Health Search database (HSD) owned by the Italian College of General Practitioners (SIMG), which stores information on about 1.5% of the total Italian population served by general practitioners (GPs). Our study confirms the importance of smoking status in patients with COPD, but not in those with asthma. Moreover, it demonstrates that the increase in BMI is frequently associated with the diagnosis of COPD or asthma, suggesting that the probability of suffering from COPD or asthma increases with the increase in body weight regardless of the smoking status. The association between an increase in BMI appears to be greater in women than in men. Our data also show that underweight is significantly associated with COPD, but only in men, while being underweight apparently protects from the possibility of suffering from asthma.
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Affiliation(s)
- Mario Cazzola
- Department of System Medicine, University of Rome Tor Vergata, Rome, Italy.
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de Marco R, Pesce G, Marcon A, Accordini S, Antonicelli L, Bugiani M, Casali L, Ferrari M, Nicolini G, Panico MG, Pirina P, Zanolin ME, Cerveri I, Verlato G. The coexistence of asthma and chronic obstructive pulmonary disease (COPD): prevalence and risk factors in young, middle-aged and elderly people from the general population. PLoS One 2013; 8:e62985. [PMID: 23675448 PMCID: PMC3651288 DOI: 10.1371/journal.pone.0062985] [Citation(s) in RCA: 232] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Accepted: 03/26/2013] [Indexed: 11/21/2022] Open
Abstract
Background The joint distribution of asthma and chronic obstructive pulmonary disease (COPD) has not been well described. This study aims at determining the prevalence of self-reported physician diagnoses of asthma, COPD and of the asthma-COPD overlap syndrome and to assess whether these conditions share a common set of risk factors. Methods A screening questionnaire on respiratory symptoms, diagnoses and risk factors was administered by mail or phone to random samples of the general Italian population aged 20–44 (n = 5163) 45–64 (n = 2167) and 65–84 (n = 1030) in the frame of the multicentre Gene Environment Interactions in Respiratory Diseases (GEIRD) study. Results A physician diagnosis of asthma or COPD (emphysema/chronic bronchitis/COPD) was reported by 13% and 21% of subjects aged <65 and 65–84 years respectively. Aging was associated with a marked decrease in the prevalence of diagnosed asthma (from 8.2% to 1.6%) and with a marked increase in the prevalence of diagnosed COPD (from 3.3% to 13.3%). The prevalence of the overlap of asthma and COPD was 1.6% (1.3%–2.0%), 2.1% (1.5%–2.8%) and 4.5% (3.2%–5.9%) in the 20–44, 45–64 and 65–84 age groups. Subjects with both asthma and COPD diagnoses were more likely to have respiratory symptoms, physical impairment, and to report hospital admissions compared to asthma or COPD alone (p<0.01). Age, sex, education and smoking showed different and sometimes opposite associations with the three conditions. Conclusion Asthma and COPD are common in the general population, and they coexist in a substantial proportion of subjects. The asthma-COPD overlap syndrome represents an important clinical phenotype that deserves more medical attention and further research.
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Affiliation(s)
- Roberto de Marco
- Unit of Epidemiology and Medical Statistics, University of Verona, Verona, Italy.
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Maio S, Baldacci S, Simoni M, Angino A, Martini F, Cerrai S, Sarno G, Pala A, Bresciani M, Paggiaro P, Viegi G. Impact of asthma and comorbid allergic rhinitis on quality of life and control in patients of Italian general practitioners. J Asthma 2012; 49:854-61. [PMID: 22957769 DOI: 10.3109/02770903.2012.716471] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Asthma is a disease with elevated prevalence within the general population. Although general practitioners (GPs) are among the first health-care professionals to whom patients refer for their symptoms, there are few evaluations of this disease based on data provided by the GPs. The aim of this observational study is to assess the impact of asthma and comorbid allergic rhinitis on individual/social burden, quality of life, and disease control in asthmatic patients of Italian GPs. METHODS Throughout Italy, 107 GPs enrolled 995 patients diagnosed with asthma and using anti-asthmatic drug prescriptions, or with asthma-like symptoms during the previous 12 months. Data were collected through questionnaires filled out by GPs and patients. RESULTS Of the 995 asthmatic patients, 60.6% had concomitant allergic rhinitis (R+A), 39.4% had asthma alone. The latter, compared to those with R+A, showed significantly lower prevalence of intermittent asthma (37.5% vs. 55.6%) and higher prevalence of mild, moderate, and severe persistent asthma (28.4% vs. 23.2%, 28.7% vs. 18.8%, and 5.4% vs 2.4%, respectively). Individual/social burden due to asthma was frequent and increased with disease severity: 87.5% of severe persistent asthma patients reported at least one medical consultation in the last 12 months, 37.5% emergency department visits, 26.7% hospitalization, and 62.5% limitations in daily activities. Control and quality of life were inversely associated with disease severity and were worse in patients with R+A than in those with asthma alone. CONCLUSIONS This study showed the negative impact of high severity levels and comorbid allergic rhinitis on quality of life of asthmatic patients and on individual/social burden due to asthma in an Italian GPs setting.
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Affiliation(s)
- Sara Maio
- Pulmonary Environmental Epidemiology Unit, CNR Institute of Clinical Physiology, Pisa, Italy.
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Cazzola M, Calzetta L, Bettoncelli G, Cricelli C, Romeo F, Matera MG, Rogliani P. Cardiovascular disease in asthma and COPD: a population-based retrospective cross-sectional study. Respir Med 2012; 106:249-56. [PMID: 21856140 DOI: 10.1016/j.rmed.2011.07.021] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2011] [Revised: 07/21/2011] [Accepted: 07/27/2011] [Indexed: 11/24/2022]
Abstract
We conducted a large population-based retrospective cross-sectional study for determining the extent of clinically recognized chronic obstructive pulmonary disease (COPD) and asthma, and the prevalence of associated cardiovascular diseases (CVDs), using information obtained from the Health Search Database (HSD) owned by the Italian College of General Practitioners (SIMG). Our study provides further evidence that patients with the diagnosis of COPD are at increased association with the diagnosis of most CVDs. It also documents that age clusters between 35 and 54 years are those at highest association of simultaneous presence of the diagnosis of CVD and that of COPD, with a progressive significant reduction in older age clusters. Moreover, it shows that the diagnosis of asthma is modestly associated with the diagnosis of different CV morbidities.
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Affiliation(s)
- Mario Cazzola
- Department of Internal Medicine, University of Rome Tor Vergata, Rome, Italy.
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