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Chen KY, Kuo HY, Lee KY, Feng PH, Wu SM, Chuang HC, Chen TT, Sun WL, Tseng CH, Liu WT, Cheng WH, Majumdar A, Stettler M, Tsai CY, Ho SC. Associations of the distance-saturation product and low-attenuation area percentage in pulmonary computed tomography with acute exacerbation in patients with chronic obstructive pulmonary disease. Front Med (Lausanne) 2023; 9:1047420. [PMID: 36687440 PMCID: PMC9846059 DOI: 10.3389/fmed.2022.1047420] [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: 09/18/2022] [Accepted: 12/14/2022] [Indexed: 01/05/2023] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) has high global health concerns, and previous research proposed various indicators to predict mortality, such as the distance-saturation product (DSP), derived from the 6-min walk test (6MWT), and the low-attenuation area percentage (LAA%) in pulmonary computed tomographic images. However, the feasibility of using these indicators to evaluate the stability of COPD still remains to be investigated. Associations of the DSP and LAA% with other COPD-related clinical parameters are also unknown. This study, thus, aimed to explore these associations. Methods This retrospective study enrolled 111 patients with COPD from northern Taiwan. Individuals' data we collected included results of a pulmonary function test (PFT), 6MWT, life quality survey [i.e., the modified Medical Research Council (mMRC) scale and COPD assessment test (CAT)], history of acute exacerbation of COPD (AECOPD), and LAA%. Next, the DSP was derived by the distance walked and the lowest oxygen saturation recorded during the 6MWT. In addition, the DSP and clinical phenotype grouping based on clinically significant outcomes by previous study approaches were employed for further investigation (i.e., DSP of 290 m%, LAA% of 20%, and AECOPD frequency of ≥1). Mean comparisons and linear and logistic regression models were utilized to explore associations among the assessed variables. Results The low-DSP group (<290 m%) had significantly higher values for the mMRC, CAT, AECOPD frequency, and LAA% at different lung volume scales (total, right, and left), whereas it had lower values of the PFT and 6MWT parameters compared to the high-DSP group. Significant associations (with high odds ratios) were observed of the mMRC, CAT, AECOPD frequency, and PFT with low- and high-DSP groupings. Next, the risk of having AECOPD was associated with the mMRC, CAT, DSP, and LAA% (for the total, right, and left lungs). Conclusion A lower value of the DSP was related to a greater worsening of symptoms, more-frequent exacerbations, poorer pulmonary function, and more-severe emphysema (higher LAA%). These readily determined parameters, including the DSP and LAA%, can serve as indicators for assessing the COPD clinical course and may can serve as a guide to corresponding treatments.
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Affiliation(s)
- Kuan-Yuan Chen
- Division of Pulmonary Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan,Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, New Taipei City, Taiwan
| | - Hsiao-Yun Kuo
- School of Respiratory Therapy, College of Medicine, Taipei Medical University, New Taipei City, Taiwan
| | - Kang-Yun Lee
- Division of Pulmonary Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan,Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, New Taipei City, Taiwan,Division of Pulmonary Medicine, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, New Taipei City, Taiwan
| | - Po-Hao Feng
- Division of Pulmonary Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan,Division of Pulmonary Medicine, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, New Taipei City, Taiwan
| | - Sheng-Ming Wu
- Division of Pulmonary Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan,Division of Pulmonary Medicine, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, New Taipei City, Taiwan
| | - Hsiao-Chi Chuang
- Division of Pulmonary Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan,School of Respiratory Therapy, College of Medicine, Taipei Medical University, New Taipei City, Taiwan,Division of Pulmonary Medicine, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, New Taipei City, Taiwan
| | - Tzu-Tao Chen
- Division of Pulmonary Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan,Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, New Taipei City, Taiwan,Division of Pulmonary Medicine, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, New Taipei City, Taiwan
| | - Wei-Lun Sun
- Division of Pulmonary Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Chien-Hua Tseng
- Division of Pulmonary Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan,Division of Pulmonary Medicine, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, New Taipei City, Taiwan,Division of Critical Care Medicine, Department of Emergency and Critical Care Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Wen-Te Liu
- Sleep Center, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan,Department of Medical Research, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan,Research Center of Artificial Intelligence in Medicine, Taipei Medical University, New Taipei City, Taiwan
| | - Wun-Hao Cheng
- School of Respiratory Therapy, College of Medicine, Taipei Medical University, New Taipei City, Taiwan
| | - Arnab Majumdar
- Department of Civil and Environmental Engineering, Imperial College London, London, United Kingdom
| | - Marc Stettler
- Department of Civil and Environmental Engineering, Imperial College London, London, United Kingdom
| | - Cheng-Yu Tsai
- Sleep Center, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan,Department of Civil and Environmental Engineering, Imperial College London, London, United Kingdom,Cheng-Yu Tsai,
| | - Shu-Chuan Ho
- Division of Pulmonary Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan,School of Respiratory Therapy, College of Medicine, Taipei Medical University, New Taipei City, Taiwan,*Correspondence: Shu-Chuan Ho,
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2
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Zaigham S, Tanash H, Nilsson PM, Muhammad IF. Triglyceride-Glucose Index is a Risk Marker of Incident COPD Events in Women. Int J Chron Obstruct Pulmon Dis 2022; 17:1393-1401. [PMID: 35746923 PMCID: PMC9212790 DOI: 10.2147/copd.s360793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 04/30/2022] [Indexed: 12/02/2022] Open
Abstract
Purpose The triglyceride-glucose index (TyG index) is a marker of insulin resistance and metabolic dysfunction and has the advantage of being universally available. Although recent evidence suggests the TyG index has relevance to respiratory health, there have been no prospective studies assessing its value as a biomarker for chronic lung diseases. We aim to assess the TyG index as a potential risk marker for future incident COPD events in the general population. Patients and Methods Baseline TyG index was assessed in 28,282 middle-aged men and women without previous history of chronic obstructive pulmonary disease (COPD) from the Malmö Preventive Project (men between 1974 and 1982 and women between 1982 and 1992). All subjects were followed up prospectively, and Cox proportional hazards regression was used to assess incident COPD events according to quartiles of TyG index. Results After an average of 31 years of follow-up, TyG index was a strong predictor of future COPD events even after adjusting for potential confounders (Q4 (highest TyG index) HR (95% CI): 1.21 (1.09–1.35) vs Q1 (reference), p-trend <0.001). After stratifying by sex, the results remained statistically significant in women only (Q4 vs Q1 HR 1.72 (1.41–2.09)). Additionally, the risk remained significant in a cohort of life-long never smokers (Q4 vs Q1 HR 1.47 (1.08–2.01)). Conclusion A raised TyG index is a novel risk marker of future incident COPD events in women. Insulin resistance as reflected by the TyG index can precede the development of obstructive lung disease and as such may be an easily measurable and useful predictor of COPD in women.
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Affiliation(s)
- Suneela Zaigham
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Hanan Tanash
- Department of Respiratory Medicine, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Peter M Nilsson
- Department of Clinical Sciences, Lund University, Malmö, Sweden.,Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden
| | - Iram F Muhammad
- Department of Clinical Sciences, Lund University, Malmö, Sweden
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3
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Shin SH, Kim DK, Kim SH, Shin TR, Jung KS, Yoo KH, Hwang KE, Park HY, Jo YS. Lack of Association between Inhaled Corticosteroid Use and the Risk of Future Exacerbation in Patients with GOLD Group A Chronic Obstructive Pulmonary Disease. J Pers Med 2022; 12:jpm12060916. [PMID: 35743701 PMCID: PMC9224662 DOI: 10.3390/jpm12060916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 05/07/2022] [Accepted: 05/30/2022] [Indexed: 11/16/2022] Open
Abstract
Background: As most clinical trials have been performed in more symptomatic and higher-risk patients, evidence regarding treatment in patients with Global Initiative for Chronic Obstructive Lung Disease (GOLD) group A chronic obstructive pulmonary disease (COPD) is limited. We assessed the distribution of inhaler treatment and sought to investigate the association between inhaled corticosteroid (ICS) use and future exacerbation in GOLD group A COPD patients. Methods: Patients with GOLD group A COPD who received maintenance inhalers were identified from a multicentre, prospective cohort in South Korea. Patients were categorized as group A when they had fewer symptoms and did not experience severe exacerbation in the previous year. Development of moderate or severe exacerbation during the 1-year follow-up was analysed according to baseline inhaler treatment. Results: In 286 patients with GOLD group A COPD, mono-bronchodilator (37.8%), dual-bronchodilator (29.0%), triple therapy (17.5%), and ICS/long-acting beta-2 agonist (15.4%) were used. Compared to patients without ICS-containing inhalers (N = 191), those using ICS (N = 95) were more dyspnoeic, and more likely to have asthma history, lower lung function, and bronchodilator response. During the 1-year follow-up, moderate or severe exacerbations occurred in 66 of 286 (23.1%) patients. In the multivariable logistic regression analysis, ICS-containing inhaler use was not associated with the development of exacerbation, even in the subgroup with a high probability of asthma–COPD overlap. Conclusion: Although about one-third of patients with GOLD group A COPD were using ICS-containing inhalers, use of ICS was not associated with a reduction in the future development of exacerbation.
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Affiliation(s)
- Sun Hye Shin
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea;
| | - Deog Kyeom Kim
- Department of Internal Medicine, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul 07061, Korea;
| | - Sang-Heon Kim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul 04763, Korea;
| | - Tae Rim Shin
- Lung Research Institute, Hallym University College of Medicine, Chuncheon 24252, Korea; (T.R.S.); (K.-S.J.)
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Seoul 07441, Korea
| | - Ki-Suck Jung
- Lung Research Institute, Hallym University College of Medicine, Chuncheon 24252, Korea; (T.R.S.); (K.-S.J.)
- Department of Pulmonary, Allergy and Critical Care Medicine, Hallym University Sacred Heart Hospital, Anyang 14068, Korea
| | - Kwang Ha Yoo
- Division of Pulmonary and Allergy, Department of Internal Medicine, Konkuk University School of Medicine, Seoul 05030, Korea;
| | - Ki-Eun Hwang
- Department of Internal Medicine, Wonkwang University School of Medicine, Iksan 54538, Korea;
| | - Hye Yun Park
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea;
- Correspondence: (H.Y.P.); (Y.S.J.); Tel.: +82-2-3410-3429 (H.Y.P.); +82-2-2258-6067 (Y.S.J.); Fax: +82-2-599-3589 (Y.S.J.)
| | - Yong Suk Jo
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul 06591, Korea
- Correspondence: (H.Y.P.); (Y.S.J.); Tel.: +82-2-3410-3429 (H.Y.P.); +82-2-2258-6067 (Y.S.J.); Fax: +82-2-599-3589 (Y.S.J.)
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4
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Oca MMD, Varela MVL, Menezes AMB, Wehrmeister FC, Ramirez L, Miravitlles M. Respiratory symptoms (COPD Assessment Test and modified Medical Research Council dyspnea scores) and GOLD-ABCD COPD classification: the LASSYC study. J Bras Pneumol 2021; 47:e20210156. [PMID: 34787288 DOI: 10.36416/1806-3756/e20210156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 07/28/2021] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To assess the frequency and severity of 24-hour respiratory symptoms according to COPD GOLD-ABCD classification (2017-version), the distribution of the patients with COPD into GOLD categories using mMRC (≥2) or CAT (≥10) scores, and agreement between these cut-off points. METHODS In this cross-sectional study (LASSYC study), 24-hour day respiratory symptoms were assessed by the Evaluating Respiratory Symptoms in COPD (E-RS) questionnaire, Nighttime Symptoms of COPD Instrument (NiSCI), Early Morning Symptoms of COPD Instrument (EMSCI), CAT and mMRC scores. RESULTS Among the 734 patients with COPD, 61% were male, age 69.6±8.7 years, FEV1% post-BD 49.1±17.5%, mMRC 1.8±1.0 and CAT 15.3±.8.1. By mMRC 33.7% were group-A, 29.2% group-B, 10.2% group-C and 26.9% group-D. By CAT 22.3% were group-A, 41% group-B, 4.8% group-C and 31.9% group-D. Using the mMRC the severity of E-RS, NiSCI and EMSCI scores increased from group A to D. Using the CAT, the groups B and D had the higher scores. Agreement between mMRC and CAT was 89.5% (Kappa statistics=75.7%). For mMRC score of 2, CAT score of ≥11 showed the maximum Youden's index (1.34). For mMRC score of 1, CAT score of ≥9 and ≥10 showed the maximum Youden's index (1.48). CONCLUSION GOLD COPD classification by CAT seems to better discriminate 24-hour symptoms. Results do not support the equivalent use of CAT≥10 and mMRC≥2 for assessing symptoms.
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Affiliation(s)
| | | | - Ana Maria B Menezes
- Post-Graduate Program in Epidemiology, Federal University of Pelotas, Pelotas (RS) Brasil
| | - Fernando C Wehrmeister
- Post-Graduate Program in Epidemiology, Federal University of Pelotas, Pelotas (RS) Brasil
| | | | - Marc Miravitlles
- Department of Pneumology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute, CIBER de Enfermedades Respiratorias, Barcelona, Spain
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5
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ODABAŞ ÖK, DOĞAN D, YILMAZ TE, ÖZKARA A. Evaluation of Adaptation to Guidelines on the Management of Chronic Obstructive Pulmonary Diseases in Family Medicine. KONURALP TIP DERGISI 2021. [DOI: 10.18521/ktd.905234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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6
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Harb HS, Ibrahim Laz N, Rabea H, Abdelrahim MEA. Determinants of incorrect inhaler technique in chronic obstructive pulmonary disease patients. Int J Clin Pract 2021; 75:e14073. [PMID: 33559260 DOI: 10.1111/ijcp.14073] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 02/03/2021] [Indexed: 11/27/2022] Open
Abstract
AIMS There is a lack of an overview of determinants of incorrect inhaler technique among chronic obstructive pulmonary diseases (COPD) subjects. The aim of this study was to determine the prevalence and possible determinants of incorrect inhaler technique in COPD subjects with common inhalers. METHODS A cross over study was conducted in 180 COPD subjects. Baseline assessment of inhaler technique was evaluated in 10 placebo inhalers including: [pressurised metered dose inhaler (pMDI), Aerolizer, Handihaler, Turbohaler, Discus, Breezhaler, Ellipta, Easyhaler, Diskhaler and Respimat] without receiving any instructions. Subjects were then crossed over to other inhalers in random order. Inhaler technique was assessed. The proper technique of inhalers was demonstrated and the number of counselling attempts needed to achieve a correct technique was recorded. Patient past-experience, demographics/clinical variables were recorded. RESULTS Incorrect inhaler techniques were highly prevalent among COPD subjects, ranging from 80% of participants demonstrated incorrect use, a minimum of 1 error, with Ellipta, to 100% with Respimat/Diskhaler (P < .001). Past-experience (OR = 14.639 at P < .001) and inhaler-type (OR = 10.397 at P < .001, 4.267 at P =. 007, 2.664 at P =. 057, 8.666 at P =. 001, 10.250 at P < .001, 0.613 at P =. 212 and 0.265 at P< .001 for pMDI, Aerolizer, Handihaler, Turbohaler, Discus, Breezhaler and Ellipta, respectively) were the strongest determinants of incorrect technique followed by gender (OR = 0.310 at P < .001), age category (OR = 0.307 at P < .001) and GOLD group (OR = 2.289 at P =. 005). CONCLUSION Incorrect inhaler techniques are highly prevalent among COPD subjects. Lack of past-experience, certain inhaler types, female gender, older age and lower GOLD group are the most significant determinants of incorrect technique.
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Affiliation(s)
- Hadeer S Harb
- Department of Clinical Pharmacy, Faculty of Pharmacy, Beni-Suef University, Beni-Suef, Egypt
| | - Nabila Ibrahim Laz
- Department of Chest Diseases, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
| | - Hoda Rabea
- Department of Clinical Pharmacy, Faculty of Pharmacy, Beni-Suef University, Beni-Suef, Egypt
| | - Mohamed E A Abdelrahim
- Department of Clinical Pharmacy, Faculty of Pharmacy, Beni-Suef University, Beni-Suef, Egypt
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7
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Meshe OF, Bungay H, Claydon LS. Participants' experiences of the benefits, barriers and facilitators of attending a community-based exercise programme for people with chronic obstructive pulmonary disease. HEALTH & SOCIAL CARE IN THE COMMUNITY 2020; 28:969-978. [PMID: 31833614 PMCID: PMC7187230 DOI: 10.1111/hsc.12929] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 11/20/2019] [Accepted: 11/28/2019] [Indexed: 05/08/2023]
Abstract
Community-based exercise programmes (CEPs) are aimed at sustaining benefits of pulmonary rehabilitation (PR) in people with chronic obstructive pulmonary disease (COPD). The aim of this study was to understand participants' experiences of the benefits, barriers and facilitators of adherence to a CEP. A descriptive qualitative design was applied, employing in-depth semi-structured interviews with a convenience sample of 12 participants with COPD attending a CEP in the East of England. Interviews were audio-recorded, transcribed and analysed using thematic analysis. Four main themes were identified: perceived benefits, enablers and barriers, perception of safety and recommendations for programme improvement. Participants experienced physical, social and psychological benefits. Regular attendance is important to avoid deterioration in perceived benefits. CEPs may therefore provide a cost-effective approach to improving and sustaining initial benefits of PR. Enablers included ease of access, perceived benefits and convenient programme components, being a retiree, social support and seasons. Identified barriers to attendance were poor physical health, family commitments and transport difficulties. The findings clearly suggest that a CEP supervised by an exercise instructor motivates participants to attend and exercise regularly. Increasing adherence to an exercise programme will prevent deterioration in perceived health, in addition to the physical, psychological and social benefits to the individual.
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Affiliation(s)
- Oluwasomi F. Meshe
- Faculty of Health, Education, Medicine and Social CareAnglia Ruskin UniversityChelmsfordEssexUK
| | - Hilary Bungay
- Faculty of Health, Education, Medicine and Social CareAnglia Ruskin UniversityCambridgeEssexUK
| | - Leica S. Claydon
- Faculty of Health, Education, Medicine and Social CareAnglia Ruskin UniversityChelmsfordEssexUK
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8
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Lewthwaite H, Koch EM, Ekström M, Hamilton A, Bourbeau J, Maltais F, Borel B, Jensen D. Predicting the rate of oxygen consumption during the 3-minute constant-rate stair stepping and shuttle tests in people with chronic obstructive pulmonary disease. J Thorac Dis 2020; 12:2489-2498. [PMID: 32642156 PMCID: PMC7330369 DOI: 10.21037/jtd.2020.03.13] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background The 3-minute constant-rate stair stepping (3-min CRSST) and constant-speed shuttle tests (3-min CSST) were developed to assess breathlessness in response to a standardized exercise stimulus. Estimating the rate of oxygen consumption (V’O2) during these tests would assist clinicians to relate the stepping/shuttle speeds that elicit breathlessness to daily physical activities with a similar metabolic demand. This study: (I) developed equations to estimate the V’O2 of these tests in people with chronic obstructive pulmonary disease (COPD); and (II) compared the newly developed and American College of Sports Medicine (ACSM) metabolic equations for estimating the V’O2 of these tests. Methods This study was a retrospective analysis of people with COPD who completed a 3-min CRSST (n=98) or 3-min CSST (n=69). Multivariate linear regression estimated predictors (alpha <0.05) of V’O2 to construct COPD-specific metabolic equations. The mean squared error (MSE) of the COPD-specific and ACSM equations was calculated and compared. Bland-Altman analyses evaluated level of agreement between measured and predicted V’O2 using each equation; limits of agreement (LoA) and patterns of bias were compared. Results Stepping rate/shuttle speed and body mass were identified as significant predictors of V’O2. The MSE of the COPD-specific equations was 0.05 L·min−1 for both tests. Mean difference between measured and predicted V’O2 was 0.00 L·min−1 (95% LoA −0.46, 0.46) and 0.00 L·min−1 (95% LoA −0.44, 0.44) for the 3-min CRSST and 3-min CSST, respectively. For the ACSM metabolic equations, the MSE was 0.10 L·min−1 and 0.18 L·min−1 for the 3-min CRSST and 3-min CSST, respectively. The ACSM metabolic equations underestimated V’O2 of the 3-min CRSST by −0.18 L·min−1 (95% LoA −0.68, 0.32), and overestimated V’O2 of the 3-min CSST by 0.35 L·min−1 (95% LoA −0.14, 0.84). Conclusions This study presents metabolic equations to predict V’O2 of the 3-min CRSST and 3-min CSST for people with COPD that are more accurate than the ACSM metabolic equations.
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Affiliation(s)
- Hayley Lewthwaite
- Clinical Exercise and Respiratory Physiology Laboratory, Department of Kinesiology and Physical Education, Faculty of Education, McGill University, Montréal, Canada.,Innovation, Implementation and Clinical Translation in Health (IIMPACT), School of Health Sciences, University of South Australia, Adelaide, Australia
| | - Emily M Koch
- Clinical Exercise and Respiratory Physiology Laboratory, Department of Kinesiology and Physical Education, Faculty of Education, McGill University, Montréal, Canada
| | - Magnus Ekström
- Department of Clinical Sciences, Division of Respiratory Medicine and Allergology, Lund University, Lund, Sweden
| | - Alan Hamilton
- Boehringer Ingelheim Canada, Burlington, Ontario, Canada
| | - Jean Bourbeau
- Research Institute of the McGill University Health Centre, Translational Research in Respiratory Diseases Program, Montréal, Canada.,Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, McGill University Health Centre, Montréal, Canada.,Division of Respiratory Medicine, Faculty of Medicine, McGill University, Montréal, Canada
| | - François Maltais
- Centre de recherche, Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec City, Canada
| | - Benoit Borel
- Laboratoire Handicap, Activité, Vieillissement, Autonomie, Environnement, Faculté des Sciences et Techniques, Université de Limoges, Limoges, France
| | - Dennis Jensen
- Clinical Exercise and Respiratory Physiology Laboratory, Department of Kinesiology and Physical Education, Faculty of Education, McGill University, Montréal, Canada.,Research Institute of the McGill University Health Centre, Translational Research in Respiratory Diseases Program, Montréal, Canada.,Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, McGill University Health Centre, Montréal, Canada.,Division of Respiratory Medicine, Faculty of Medicine, McGill University, Montréal, Canada.,Research Centre for Physical Activity and Health, Faculty of Education, McGill University, Montréal, Canada
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9
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Zhou M, Chen C, Peng J, Luo CH, Feng DY, Yang H, Xie X, Zhou Y. Fast Prediction of Deterioration and Death Risk in Patients With Acute Exacerbation of Chronic Obstructive Pulmonary Disease Using Vital Signs and Admission History: Retrospective Cohort Study. JMIR Med Inform 2019; 7:e13085. [PMID: 31638595 PMCID: PMC6913742 DOI: 10.2196/13085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 06/22/2019] [Accepted: 08/19/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) has 2 courses with different options for medical treatment: the acute exacerbation phase and the stable phase. Stable patients can use the Global Initiative for Chronic Obstructive Lung Disease (GOLD) to guide treatment strategies. However, GOLD could not classify and guide the treatment of acute exacerbation as acute exacerbation of COPD (AECOPD) is a complex process. OBJECTIVE This paper aimed to propose a fast severity assessment and risk prediction approach in order to strengthen monitoring and medical interventions in advance. METHODS The proposed method uses a classification and regression tree (CART) and had been validated using the AECOPD inpatient's medical history and first measured vital signs at admission that can be collected within minutes. We identified 552 inpatients with AECOPD from February 2011 to June 2018 retrospectively and used the classifier to predict the outcome and prognosis of this hospitalization. RESULTS The overall accuracy of the proposed CART classifier was 76.2% (83/109 participants) with 95% CI 0.67-0.84. The precision, recall, and F-measure for the mild AECOPD were 76% (50/65 participants), 82% (50/61 participants), and 0.79, respectively, and those with severe AECOPD were 75% (33/44 participants), 68% (33/48 participants), and 0.72, respectively. CONCLUSIONS This fast prediction CART classifier for early exacerbation detection could trigger the initiation of timely treatment, thereby potentially reducing exacerbation severity and recovery time and improving the patients' health.
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Affiliation(s)
- Mi Zhou
- Surgical Intensive Care Unit, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Chuan Chen
- School of Data and Computer Science, Sun Yat-sen University, Guangzhou, China
| | - Junfeng Peng
- School of Data and Computer Science, Sun Yat-sen University, Guangzhou, China
| | - Ching-Hsing Luo
- School of Data and Computer Science, Sun Yat-sen University, Guangzhou, China
| | - Ding Yun Feng
- Department of Respiratory and Critical Care Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Hailing Yang
- Department of Respiratory and Critical Care Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xiaohua Xie
- School of Data and Computer Science, Sun Yat-sen University, Guangzhou, China
| | - Yuqi Zhou
- Department of Respiratory and Critical Care Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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Gaveikaite V, Grundstrom C, Winter S, Chouvarda I, Maglaveras N, Priori R. A systematic map and in-depth review of European telehealth interventions efficacy for chronic obstructive pulmonary disease. Respir Med 2019; 158:78-88. [PMID: 31614305 DOI: 10.1016/j.rmed.2019.09.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 09/06/2019] [Accepted: 09/08/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Evidence to support the implementation of telehealth (TH) interventions in the management of chronic obstructive pulmonary disease (COPD) varies throughout Europe. Despite more than ten years of TH research in COPD management, it is still not possible to define which TH interventions are beneficial to which patient group. Therefore, informing policymakers on TH implementation is complicated. We aimed to examine the provision and efficacy of TH for COPD management to guide future decision-making. METHODS A mapping study of twelve systematic reviews of TH interventions for COPD management was conducted. This was followed by an in-depth review of fourteen clinical trials performed in Europe extracted from the systematic reviews. Efficacy outcomes for COPD management were synthesized. RESULTS The mapping study revealed that systematic reviews with a meta-analysis often report positive clinical outcomes. Despite this, we identified a lack of pragmatic trial design affecting the synthesis of reported outcomes. The in-depth review visualized outcomes for three TH categories, which revealed a plethora of heterogeneous outcomes. Suggestions for reporting within these three outcomes are synthesized as targets for future empirical research reporting. CONCLUSION The present study indicates the need for more standardized and updated systematic reviews. Policymakers should advocate for improved TH trial designs, focusing on the entire intervention's adoption process evaluation. One of the policymakers' priorities should be the harmonization of the outcome sets, which would be considered suitable for deciding about subsequent reimbursement. We propose possible outcome sets in three TH categories which could be used for discussion with stakeholders.
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Affiliation(s)
- Violeta Gaveikaite
- Laboratory of Computing, Medical Informatics and Biomedical Imaging Technologies, Aristotle University of Thessaloniki, Thessaloniki, 54636, Greece; Department of Chronic Disease Management, Philips Research, High Tech Campus 34, Eindhoven, 5656AE, the Netherlands.
| | - Casandra Grundstrom
- M3S, Department of Information Processing Science, University of Oulu, Pentti Kaiteran katu 1, Oulu, FI-90014, Finland.
| | - Stefan Winter
- Department of Chronic Disease Management, Philips Research, Pauwelsstraße 17, Aachen, 52074, Germany.
| | - Ioanna Chouvarda
- Laboratory of Computing, Medical Informatics and Biomedical Imaging Technologies, Aristotle University of Thessaloniki, Thessaloniki, 54636, Greece.
| | - Nicos Maglaveras
- Laboratory of Computing, Medical Informatics and Biomedical Imaging Technologies, Aristotle University of Thessaloniki, Thessaloniki, 54636, Greece; Department of IEMS in McCormick School of Engineering, Northwestern University, 2145 Sheridan Road Tech C210, Evanston, IL, 60208, USA.
| | - Rita Priori
- Department of Smart Interfaces and Modules, Philips Research, High Tech Campus 34, Eindhoven, 5656AE, the Netherlands.
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11
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Vestbo J, Vogelmeier CF, Small M, Siddall J, Fogel R, Kostikas K. Inhaled corticosteroid use by exacerbations and eosinophils: a real-world COPD population. Int J Chron Obstruct Pulmon Dis 2019; 14:853-861. [PMID: 31114183 PMCID: PMC6489586 DOI: 10.2147/copd.s189585] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 03/15/2019] [Indexed: 11/23/2022] Open
Abstract
Background: Blood eosinophils may predict response to inhaled corticosteroids (ICS) in chronic obstructive pulmonary disease (COPD) where ICS is recommended in patients at high risk of exacerbations. The proportion of patients who may benefit the most from ICS-based therapy was quantified in a real-world population. Materials and methods: European data from the Adelphi Real World Respiratory Disease Specific Programme™ 2017 survey were collected from consecutive COPD patients by participating physicians. Overall, 1,528 patients were assessable for Global Initiative for COPD (GOLD) 2017 status and were included in the analysis. Results: More GOLD D patients had elevated eosinophil counts compared with GOLD B. The proportions of GOLD D patients with a history of ≥2 exacerbations and eosinophil counts of ≥150, ≥300, and ≥400 cells/µL were 81.2%, 39.4%, and 24.6%, respectively. In total, 10.6% of the patients had ≥300 eosinophils/µL and a history of ≥2 exacerbations. ICS-based therapy was received by 41.5% of GOLD B and 68.0% of GOLD D patients. Conclusion: There was no apparent relation between ICS use and eosinophil blood count. There are differences in the distributions of patients with frequent exacerbations and/or high blood eosinophil counts and the use of ICS in COPD. These data may provide information for the implementation of future treatment recommendations.
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Affiliation(s)
- Jørgen Vestbo
- Division of Infection, Immunity & Respiratory Medicine, University of Manchester, Manchester, UK
| | - Claus F Vogelmeier
- Department for Pulmonary Medicine, Philipps-University of Marburg, Marburg, Germany
| | - Mark Small
- Respiratory Research, Adelphi Real World, Bollington, UK
| | - James Siddall
- Respiratory Research, Adelphi Real World, Bollington, UK
| | - Robert Fogel
- Global Medical Affairs, Novartis Pharma AG, Basel, Switzerland
| | - Konstantinos Kostikas
- Global Medical Affairs, Novartis Pharma AG, Basel, Switzerland.,Respiratory Medicine Department, University of Ionnina Medical School, Ionnina, Greece
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12
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Xiong XF, Fan LL, Wu HX, Zhu M, Cheng DY. Effects of Tiotropium Combined with Theophylline on Stable COPD Patients of Group B, D and its Impact on Small Airway Function: A Randomized Controlled Trial. Adv Ther 2018; 35:2201-2213. [PMID: 30415298 PMCID: PMC6267715 DOI: 10.1007/s12325-018-0831-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Tiotropium bromide has been widely used in clinical practice, while theophylline is another treatment option for chronic obstructive pulmonary disease (COPD). However, only a few relevant studies have investigated the long-term outcomes and efficacy of both in patients with COPD. We evaluated the effects of tiotropium and low-dose theophylline on stable COPD patients of groups B and D. METHODS Eligible participants (n = 170) were randomized and received either tiotropium 18 µg once daily with theophylline 100 mg twice daily (Group I) or tiotropium 18 µg once daily (Group II) for 6 months. COPD assessment test (CAT), modified Medical Research Council (mMRC) dyspnea scores and pulmonary function tests were measured before randomization and during the treatment. RESULTS After 6 months of treatment, the CAT scores in both groups decreased significantly (11.41 ± 3.56 and 11.08 ± 3.05, p < 0.0001). The changes of CAT (p = 0.028) and mMRC scores (p = 0.049) between the two groups differed after 1 month of treatment. In Group I, forced expiratory flow after 25% of the FVC% predicted (MEF25% pred) was significantly improved after 3 months (4.84 ± 8.73%, p < 0.0001) and 6 months (6.21 ± 8.65%, p < 0.0001). There was a significant difference in small airway function tests (MEF50% pred, MEF25% pred, and MMEF% pred) between the two groups after 6 month of treatment (p = 0.003, p < 0.0001, and p = 0.021, respectively). CONCLUSIONS Tiotropium combined with low-dose theophylline significantly improved the symptoms and general health of patients with stable COPD of groups B and D after 6 months of follow-up. Additionally, this therapy also improved the indicators of small airway function. TRIAL REGISTRATION Chinese Clinical Trial Registry (Registry ID: ChiCTR1800019027).
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Affiliation(s)
- Xiao-Feng Xiong
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Li-Li Fan
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Hong-Xia Wu
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Min Zhu
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - De-Yun Cheng
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China.
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13
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Lowe KE, Make BJ, Crapo JD, Kinney GL, Hokanson JE, Kim V, Iyer AS, Bhatt SP, Hoth KF, Holm KE, Wise R, DeMeo D, Foreman MG, Stone TJ, Regan EA. Association of low income with pulmonary disease progression in smokers with and without chronic obstructive pulmonary disease. ERJ Open Res 2018; 4:00069-2018. [PMID: 30443555 PMCID: PMC6230816 DOI: 10.1183/23120541.00069-2018] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 09/11/2018] [Indexed: 11/09/2022] Open
Abstract
Low socioeconomic status has been associated with chronic obstructive pulmonary disease (COPD) but little is known about its impact on disease progression. We assessed the association of income to symptoms, pulmonary disease severity and progression in smokers with and without COPD. The COPDGene cohort of 4826 smokers who reported annual income in phase 2 was analysed. Those who reported annual income <USD 15 000 per year were “low-income” and the remainder “higher income”. Baseline demographics, symptoms, computed tomography (CT) imaging, and 5-year change in spirometry and CT metrics were characterised by group. The low income group was younger (55.7 versus 61.7, p<0.0001), had more current smokers (73% versus 36%, p<0.0001), higher rates of severe exacerbations (13% versus 7%, p<0.0001), more chronic bronchitis (22% versus 14%, p<0.0001), reduced access to preventative care and lower quality of life, but less emphysema (4.7% versus 6.2%, p<0.0001). After 5 years the low-income group had more smoking-related disease progression, without significant change in exacerbations or symptoms, than higher-income subjects. Low income was an independent predictor of decreasing forced expiratory volume in 1 s (FEV1) (p=0.001) and increased airway disease (p=0.007) after adjusting for baseline FEV1, age, sex, race, exposures and current smoking. Income disparity beyond the effects of race and current smoking is an important factor for disease progression. Worldwide, poverty and its consequences: associated respiratory exposures, limited healthcare access, and inadequate education about smoking risks, may exacerbate chronic lung disease. Income is a factor in predicting pulmonary disease progression in smokers with and without COPD; those with lower income experience faster progression and worse symptomshttp://ow.ly/1SSe30lU1cX
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Affiliation(s)
| | - Barry J Make
- Dept of Medicine, National Jewish Health, Denver, CO, USA
| | - James D Crapo
- Dept of Medicine, National Jewish Health, Denver, CO, USA
| | - Gregory L Kinney
- Dept of Epidemiology, Colorado School of Public Health, Aurora, CO, USA
| | - John E Hokanson
- Dept of Epidemiology, Colorado School of Public Health, Aurora, CO, USA
| | - Victor Kim
- Dept of Thoracic Medicine and Surgery, Temple University, Philadelphia, PA, USA
| | - Anand S Iyer
- Dept of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Surya P Bhatt
- Dept of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Karin F Hoth
- Dept of Psychiatry, University of Iowa, Iowa City, IA, USA
| | - Kristen E Holm
- Dept of Medicine, National Jewish Health, Denver, CO, USA
| | - Robert Wise
- Dept of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Dawn DeMeo
- Dept of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | | | | | - Elizabeth A Regan
- Dept of Medicine, National Jewish Health, Denver, CO, USA.,Dept of Epidemiology, Colorado School of Public Health, Aurora, CO, USA
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14
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Hu YH, Liang ZY, Xu LM, Xu WH, Liao H, Li R, Wang K, Xu Y, Ou CQ, Chen X. Comparison of the clinical characteristics and comprehensive assessments of the 2011 and 2017 GOLD classifications for patients with COPD in China. Int J Chron Obstruct Pulmon Dis 2018; 13:3011-3019. [PMID: 30319249 PMCID: PMC6167996 DOI: 10.2147/copd.s174668] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective Compared with the 2011 Global Initiative for Chronic Obstructive Lung Disease (GOLD), there have been significant changes in the 2017 GOLD classification. The purpose of this study was to analyze the changes in clinical characteristics of the new A-B-C-D system and to explore its role in comprehensive assessment of COPD. Subjects and methods A total of 631 stable COPD patients were included in a cross-sectional survey. Data collected included baseline data and pulmonary function testing results, respiratory muscle strength, symptoms and quality of life, exercise capacity, nutritional status, and anxiety and depression as a comprehensive assessment. Based on the 2011 GOLD and 2017 GOLD classifications, patients were divided into Groups A1–D1 and Groups A2–D2, respectively. Results In the 2011 GOLD, 64 subjects in Group C1 were reclassified into Group A2 (41.6%), while 77 subjects in Group D1 were reclassified into Group B2 (27.1%). The old and new grading systems were somewhat consistent (Cohen’s kappa=0.6963, P<0.001). Lung function was lower, while the body mass index, airflow obstruction, dyspnea, and exercise capacity index (BODE index) was higher in Group A2 than in Group A1 (P<0.001). In Group B2, lung function, 6-minute walking distance (6MWD), and respiratory muscle strength were significantly lower than in Group B1 (P<0.001), while the BODE index (P<0.001) was higher. In comprehensive assessment, subjects in Groups B2 and D2 had significantly lower lung function, 6MWD, respiratory muscle strength, quality of life, higher symptom scores, and BODE index than subjects in Group A2 (P<0.001). The differences between Group A2 and C2 were small. Conclusion Compared with the 2011 GOLD, the 2017 GOLD reclassified more patients into Groups A and B, those with significantly worse lung function and higher BODE index. In the comprehensive assessment of the new classification, Groups B and D may have greater disease severity. However, the effectiveness of the new grading system in predicting patient prognosis, and its guidance on the use of drugs, remains to be explored in future studies.
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Affiliation(s)
- Yu-He Hu
- Department of Respiratory Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China,
| | - Zhen-Yu Liang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Li-Mei Xu
- Department of Respiratory Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China,
| | - Wen-Hui Xu
- Department of Respiratory Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China,
| | - Hao Liao
- Department of Respiratory Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China,
| | - Rui Li
- Department of Respiratory Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China,
| | - Kai Wang
- Department of Respiratory Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China,
| | - Ying Xu
- Department of Respiratory Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China,
| | - Chun-Quan Ou
- State Key Laboratory of Organ Failure Research, Department of Biostatistics, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou, China,
| | - Xin Chen
- Department of Respiratory Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China,
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15
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Smid DE, Franssen FME, Gonik M, Miravitlles M, Casanova C, Cosio BG, de Lucas-Ramos P, Marin JM, Martinez C, Mir I, Soriano JB, de Torres JP, Agusti A, Atalay NB, Billington J, Boutou AK, Brighenti-Zogg S, Chaplin E, Coster S, Dodd JW, Dürr S, Fernandez-Villar A, Groenen MTJ, Guimarães M, Hejduk K, Higgins V, Hopkinson NS, Horita N, Houben-Wilke S, Janssen DJA, Jehn M, Joerres R, Karch A, Kelly JL, Kim YI, Kimura H, Koblizek V, Kocks JH, Kon SSC, Kwon N, Ladeira I, Lee SD, Leuppi JD, Locantore N, Lopez-Campos JL, D-C Man W, Maricic L, Mendoza L, Miedinger D, Mihaltan F, Minami S, van der Molen T, Murrells TJ, Nakken N, Nishijima Y, Norman IJ, Novotna B, O'Donnell DE, Ogata Y, Pereira ED, Piercy J, Price D, Pothirat C, Raghavan N, Ringbaek T, Sajkov D, Sigari N, Singh S, Small M, da Silva GF, Tanner RJ, Tsiligianni IG, Tulek B, Tzanakis N, Vanfleteren LEGW, Watz H, Webb KA, Wouters EFM, Xie GG, Yoshikawa M, Spruit MA. Redefining Cut-Points for High Symptom Burden of the Global Initiative for Chronic Obstructive Lung Disease Classification in 18,577 Patients With Chronic Obstructive Pulmonary Disease. J Am Med Dir Assoc 2018; 18:1097.e11-1097.e24. [PMID: 29169740 DOI: 10.1016/j.jamda.2017.09.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 09/07/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Patients with chronic obstructive pulmonary disease (COPD) can be classified into groups A/C or B/D based on symptom intensity. Different threshold values for symptom questionnaires can result in misclassification and, in turn, different treatment recommendations. The primary aim was to find the best fitting cut-points for Global initiative for chronic Obstructive Lung Disease (GOLD) symptom measures, with an modified Medical Research Council dyspnea grade of 2 or higher as point of reference. METHODS After a computerized search, data from 41 cohorts and whose authors agreed to provide data were pooled. COPD studies were eligible for analyses if they included, at least age, sex, postbronchodilator spirometry, modified Medical Research Council, and COPD Assessment Test (CAT) total scores. MAIN OUTCOMES Receiver operating characteristic curves and the Youden index were used to determine the best calibration threshold for CAT, COPD Clinical Questionnaire, and St. Georges Respiratory Questionnaire total scores. Following, GOLD A/B/C/D frequencies were calculated based on current cut-points and the newly derived cut-points. FINDINGS A total of 18,577 patients with COPD [72.0% male; mean age: 66.3 years (standard deviation 9.6)] were analyzed. Most patients had a moderate or severe degree of airflow limitation (GOLD spirometric grade 1, 10.9%; grade 2, 46.6%; grade 3, 32.4%; and grade 4, 10.3%). The best calibration threshold for CAT total score was 18 points, for COPD Clinical Questionnaire total score 1.9 points, and for St. Georges Respiratory Questionnaire total score 46.0 points. CONCLUSIONS The application of these new cut-points would reclassify about one-third of the patients with COPD and, thus, would impact on individual disease management. Further validation in prospective studies of these new values are needed.
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Affiliation(s)
- Dionne E Smid
- Department of Research and Education, CIRO, Horn, The Netherlands.
| | - Frits M E Franssen
- Department of Research and Education, CIRO, Horn, The Netherlands; Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | | | - Marc Miravitlles
- Pneumology Department, Hospital Universitari Vall d'Hebron, CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
| | - Ciro Casanova
- Pulmonary Department and Research Unit, Hospital Universitario NS La Candelaria, Santa Cruz de Tenerife, Spain
| | - Borja G Cosio
- Department of Respiratory Medicine, Hospital Son Espases-IdISPa-CIBERES, Islas Baleares, Spain
| | - Pilar de Lucas-Ramos
- Hospital General Universitario Gregorio Marañon, Pulmonary Department, Madrid, Spain
| | - Jose M Marin
- Hospital Universitario Miguel Servet, IISAragon, CIBER Enfermedades Respiratorias, Zaragoza, Spain
| | - Cristina Martinez
- Pneumology Service Instituto Nacional de Silicosis-Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Isabel Mir
- Hospital General Universitario Gregorio Marañón, Madrid, Pulmonary Department, Madrid, Spain
| | - Joan B Soriano
- Instituto de Investigación Hospital Universitario de la Princesa, IISP, Universidad Autónoma de Madrid, Madrid, Spain
| | - Juan P de Torres
- Pulmonary Department, Clinica Universidad de Navarra, Pamplona, Spain
| | - Alvar Agusti
- Respiratory Institute, Hospital Clinic, University of Barcelona and CIBERES, Spain
| | - Nart B Atalay
- Department of Psychology, TOBB University of Economics and Technology, Ankara, Turkey
| | - Julia Billington
- Central Surgery, Surbiton Health Centre, Surbiton, Surrey, United Kingdom
| | - Afroditi K Boutou
- Intensive Care Unit, G Gennimats, General Hospital, Thessaloniki, Greece; Respiratory Failure Unit, Aristotle University of Thessaloniki, Greece
| | | | - Emma Chaplin
- Center for Exercise and Rehabilitation Science, NIHR Leicester Respiratory Biomedical Research Unit, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Samantha Coster
- King's College London, Florence Nightingale Faculty of Nursing and Midwifery, London, United Kingdom
| | - James W Dodd
- Academic Respiratory Unit University of Bristol, North Bristol Lung Centre, Southmead Hospital Bristol, United Kingdom
| | - Selina Dürr
- University Clinic of Medicine, Cantonal Hospital Baselland, Liestal, Switzerland
| | - Alberto Fernandez-Villar
- Servicio de Neumología, Instituto de Investigación Biomédica de Vigo, IBIV, Complexo Hospitalario de Vigo, Vigo, Pontevedra, España
| | | | - Miguel Guimarães
- Pulmonology Department of Centro Hospitalar Vila Nova de Gaia/Espinho, EPE, Portugal
| | - Karel Hejduk
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | | | - Nicholas S Hopkinson
- NIHR Respiratory Biomedical Research Unit at Royal Brompton and Harefield NHS Foundation Trust, Imperial College London, London, United Kingdom
| | - Nobuyuki Horita
- Department of Pulmonology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | | | | | - Melissa Jehn
- Arbeitsbereich Ambulante Pneumologie, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Rudolf Joerres
- Institute and Output Clinic for Occupational and Environmental Medicine, Munich, Germany
| | - Annika Karch
- Institute for Biostatistics, Hannover Medical School, Hannover, Germany
| | - Julia L Kelly
- Academic Unit of Sleep and Ventilation, National Heart and Lung Institute, Imperial College London, NIHR Respiratory Disease Biomedical Research Unit at the Royal Brompton, United Kingdom; Harefield NHS Foundation Trust and Imperial College, London, United Kingdom
| | - Yu-Il Kim
- Division of Pulmonology, Department of Internal Medicine, Chonnam National University Hospital, Donggu, Gwangju, South Korea
| | - Hiroshi Kimura
- Second Department of Internal Medicine, Nara Medical University, Nara, Japan
| | - Vladimir Koblizek
- Department of Pneumology, Faculty of Medicine in Hradec Kralove, Charles University in Prague and University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - Janwillem H Kocks
- Department of Primary Care, Groningen Research Institute for Asthma and COPD, GRIAC, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Samantha S C Kon
- The Hillingdon Hospital NHS Foundation Trust, United Kingdom; NIHR Respiratory Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust and Imperial College, United Kingdom
| | - Namhee Kwon
- Respiratory Franchise Medical, GlaxoSmithKline (GSK), London, United Kingdom
| | - Inês Ladeira
- Pulmonology Department of Centro Hospitalar Vila Nova de Gaia/Espinho, EPE, Portugal
| | - Sang-Do Lee
- Department of Pulmonary and Critical Care Medicine, Clinical Research Center for Chronic Obstructive Airway Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Joerg D Leuppi
- University Clinic of Medicine, Cantonal Hospital Baselland, Liestal, Switzerland
| | | | - José L Lopez-Campos
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla, IBiS, Hospital Universitario Virgen del Rocio, Universidad de Sevilla, Sevilla, Spain; CIBER de Enfermedades Respiratorias, CIBERES, Instituto de Salud Carlos III, Madrid, Spain
| | - William D-C Man
- NIHR Respiratory Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust and Imperial College, United Kingdom
| | - Lana Maricic
- University Hospital Osijek; Department of Internal Medicine; Faculty of Medicine, University J.J Strossmayer Osijek, Osijek, Croatia
| | - Laura Mendoza
- Hospital Clínico Universidad de Chile, Región Metropolitana, Chile
| | - David Miedinger
- University Clinic of Medicine, Cantonal Hospital Baselland, Liestal, Switzerland
| | | | - Seigo Minami
- Department of Respiratory Medicine, Osaka Police Hospital, Osaka, Japan
| | - Thys van der Molen
- Department of Primary Care, Groningen Research Institute for Asthma and COPD, GRIAC, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Trevor J Murrells
- King's College London, Florence Nightingale Faculty of Nursing and Midwifery, London, United Kingdom
| | - Nienke Nakken
- Department of Research and Education, CIRO, Horn, The Netherlands
| | - Yu Nishijima
- Department of Respiratory Medicine, Osaka Police Hospital, Osaka, Japan; Department of Respiratory Medicine, Allergy and Rheumatic Diseases, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Ian J Norman
- King's College London, Florence Nightingale Faculty of Nursing and Midwifery, London, United Kingdom
| | - Barbora Novotna
- Department of Pneumology, Faculty of Medicine in Hradec Kralove, Charles University in Prague and University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - Denis E O'Donnell
- Department of Medicine, Queen's University and Kingston General Hospital, Kingston, ON, Canada
| | - Yoshitaka Ogata
- Department of Respiratory Medicine, Osaka Police Hospital, Osaka, Japan
| | | | | | - David Price
- Observational and Pragmatic Research Institute, Singapore; University of Aberdeen, Aberdeen, United Kingdom
| | - Chaicharn Pothirat
- Division of Pulmonary, Critical Care and Allergy, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Natya Raghavan
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Thomas Ringbaek
- Department of Respiratory Medicine, Hvidovre Hospital, University of Copenhagen, Denmark
| | - Dimitar Sajkov
- Australian Respiratory and Sleep Medicine Institute, Flinders Medical Center, Adelaide, Australia
| | - Naseh Sigari
- Internal Medicine Department, Medical Faculty, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Sally Singh
- Center for Exercise and Rehabilitation Science, NIHR Leicester Respiratory Biomedical Research Unit, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Mark Small
- Adelphi Real World, Bollington, United Kingdom
| | | | - Rebecca J Tanner
- NIHR Respiratory Biomedical Research Unit at Royal Brompton and Harefield NHS Foundation Trust, Imperial College London, London, United Kingdom
| | - Ioanna G Tsiligianni
- Department of Primary Care, Groningen Research Institute for Asthma and COPD, GRIAC, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands; Agia Barbara Health Care Center, Heraklion Crete, Greece
| | - Baykal Tulek
- Department of Chest Diseases, Faculty of Medicine, Selcuk University, Konya, Turkey
| | - Nikolaos Tzanakis
- Department of Thoracic Medicine, University Hospital of Heraklion, Medical School, University of Crete, Crete, Greece
| | - Lowie E G W Vanfleteren
- Department of Research and Education, CIRO, Horn, The Netherlands; Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Henrik Watz
- Pulmonary Research Institute at Lung Clinic Grosshansdorf, German Center for Lung Research, Grosshansdorf, Germany
| | - Katherine A Webb
- Department of Medicine, Queen's University and Kingston General Hospital, Kingston, ON, Canada
| | - Emiel F M Wouters
- Department of Research and Education, CIRO, Horn, The Netherlands; Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Guogang G Xie
- Department of Respiratory Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, China
| | - Masanori Yoshikawa
- Second Department of Internal Medicine, Nara Medical University, Nara, Japan
| | - Martijn A Spruit
- Department of Research and Education, CIRO, Horn, The Netherlands; REVAL, Rehabilitation Research Center, BIOMED, Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium; Department of Respiratory Medicine, Maastricht University Medical Centre, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands
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Zheng Y, Xu Z, He Y, Liao H. Severity assessment of chronic obstructive pulmonary disease based on hesitant fuzzy linguistic COPRAS method. Appl Soft Comput 2018. [DOI: 10.1016/j.asoc.2018.04.035] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Bikov A, Horváth A, Tomisa G, Bártfai L, Bártfai Z. Changes in the Burden of Comorbidities in Patients with COPD and Asthma-COPD Overlap According to the GOLD 2017 Recommendations. Lung 2018; 196:591-599. [PMID: 30008015 DOI: 10.1007/s00408-018-0141-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 07/09/2018] [Indexed: 01/19/2023]
Abstract
PURPOSE Comorbidities associated with chronic obstructive pulmonary disease (COPD) affect quality of life and increase mortality. Asthma-COPD overlap (ACO) may express a different profile of comorbidities compared to COPD alone. It is unclear how recent changes in GOLD recommendations affect the profile of comorbidities in COPD and ACO. METHODS Eight hundred and thirty-four patients with COPD were recruited from 67 Hungarian secondary care outpatient clinics, 469 of them had ACO. Comorbidities were defined by respiratory specialists based on medical history, patient report, and medications. COPD grades were defined according to the old 2016 and the new 2017 GOLD document. Comorbidities were compared along COPD ABCD groups determined by the old and new GOLD. RESULTS 66 and 72% of the COPD patients in groups C and D (GOLD 2016) were recategorized to groups A and B (GOLD 2017), respectively. There was no difference in the prevalence of disorders along the 2016 GOLD categories except for osteoporosis in ACO (p = 0.01). When the patients were categorized according to the 2017 GOLD criteria, the prevalence of osteoporosis (p = 0.01) was different among the four groups in all COPD patients. Subgroup analysis of non-ACO COPD patients revealed inter-group differences for cardiac arrhythmia (p < 0.01). No alteration was seen in the prevalence of coronary artery disease, hypertension, diabetes, or the total number of comorbidities. CONCLUSION A significant number of patients are recategorized according to the GOLD 2017 criteria. This change only marginally affects the profile of comorbidities; still this needs to be considered when assessing the patients in daily practice.
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Affiliation(s)
- András Bikov
- Department of Pulmonology, Semmelweis University, 1/C, Diós árok, Budapest, 1125, Hungary.
| | - Alpár Horváth
- Chiesi Hungary Ltd., Dunavirág u. 2, Budapest, 1138, Hungary
- Department of Pulmonology, University of Debrecen, Nagyerdei körút 98, Debrecen, 4012, Hungary
| | - Gábor Tomisa
- Chiesi Hungary Ltd., Dunavirág u. 2, Budapest, 1138, Hungary
- Department of Pulmonology, University of Debrecen, Nagyerdei körút 98, Debrecen, 4012, Hungary
| | - Liza Bártfai
- Sopron Health Centre, Gyori u. 15, Sopron, 9400, Hungary
| | - Zoltán Bártfai
- Pereszteg-Pinnye General Practitioner Praxis, Petofi Sandor u. 29, Pereszteg, 9484, Hungary
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Jo YS, Park S, Kim DK, Yoo CG, Lee CH. The cutoff point of clinical chronic obstructive pulmonary disease questionnaire for more symptomatic patients. BMC Pulm Med 2018; 18:38. [PMID: 29482616 PMCID: PMC5828492 DOI: 10.1186/s12890-018-0601-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 02/15/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND An adequate threshold for the Clinical Chronic Obstructive Pulmonary Disease (COPD) Questionnaire (CCQ) defining more symptomatic COPD patients has not been determined. We aimed to determine the efficacy of the CCQ and the appropriate CCQ threshold for more symptomatic COPD patients. METHODS COPD patients aged > 40 years who smoked/had smoked ≥10 packs/year were prospectively enrolled over 1 year from three South Korean hospitals (n = 126). Correlations between the CCQ and St. George's Respiratory Questionnaire (SGRQ), COPD Assessment Test (CAT), the modified Medical Round Council (mMRC) scale, lung function, and exercise capacity were evaluated. "More symptomatic patients" were those with an SGRQ score ≥ 25. Area under the receiver operating curve and classification and regression tree analyses were performed to determine the CCQ threshold equivalent to an SGRQ score ≥ 25. RESULTS The CCQ significantly correlated with the SGRQ, CAT, and mMRC scale (r = 0.76, 0.69, and 0.53, respectively). A CCQ cutoff of 1.4 predicted an SGRQ score of 25 better than others. A CCQ score of 1.4 was a significant determinant of an SGRQ score ≥ 25 even after adjusting for potential confounders. CONCLUSIONS The CCQ was correlated with other symptom indicators, lung function, and exercise capacity. A CCQ cutoff of 1.4 agreed better than CCQ cutoff of 1.0, suggested by guideline, and this cutoff value may identify more symptomatic COPD patients well. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02527486 . Date of registration: December 19, 2014, retrospectively registered.
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Affiliation(s)
- Yong Suk Jo
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-Ro Jongno-Gu, Seoul, 03080 Republic of Korea
| | - Sangshin Park
- Center for International Health Research, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI 02903 USA
- Department of Pediatrics, The Warren Alpert Medical School of Brown University, Providence, RI 02903 USA
| | - Deog Kyeom Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Chul-Gyu Yoo
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-Ro Jongno-Gu, Seoul, 03080 Republic of Korea
| | - Chang-Hoon Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-Ro Jongno-Gu, Seoul, 03080 Republic of Korea
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Arkhipov V, Arkhipova D, Miravitlles M, Lazarev A, Stukalina E. Characteristics of COPD patients according to GOLD classification and clinical phenotypes in the Russian Federation: the SUPPORT trial. Int J Chron Obstruct Pulmon Dis 2017; 12:3255-3262. [PMID: 29138554 PMCID: PMC5680946 DOI: 10.2147/copd.s142997] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Background The high prevalence of COPD in the Russian Federation has been demonstrated in several epidemiological studies. However, there are still no data on the clinical characteristics of these patients according to Global Initiative for Chronic Obstructive Lung Disease (GOLD) groups and phenotypes, which could provide additional understanding of the burden of COPD, routine clinical practice, and ways to improve the treatment of patients with COPD in Russia. Patients and methods SUPPORT was an observational multicenter study designed to obtain data about the distribution of patients with previously diagnosed COPD according to the severity of bronchial obstruction, symptom severity, risk of exacerbation, COPD phenotypes, and treatment of COPD. We included patients with a previous diagnosis of COPD who visited one of 33 primary-care centers for any reason in 23 cities in Russia. Results Among the 1,505 patients with a previous diagnosis of COPD who attended the primary-care centers and were screened for the study, 1,111 had a spirometry-confirmed diagnosis and were included in the analysis. Up to 53% of the patients had severe or very severe COPD (GOLD stages III–IV), and 74.3% belonged to the GOLD D group. The majority of patients were frequent exacerbators (exacerbators with chronic bronchitis [37.3%], exacerbators without chronic bronchitis [14%]), while 35.8% were nonexacerbators and 12.9% had asthma–COPD overlap. Among the GOLD D group patients, >20% were treated with only short-acting bronchodilators. Conclusion COPD is still misdiagnosed in primary care in Russia. COPD patients in primary care are usually GOLD D with frequent exacerbations and are often treated with only short-acting bronchodilators.
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Affiliation(s)
- Vladimir Arkhipov
- Clinical Pharmacology and Therapy Department, Russian Medical Academy of Postgraduate Education, Moscow, Russian Federation
| | - Daria Arkhipova
- Clinic Pharmacology and Propaedeutic Internal Diseases Department, First Moscow State Medical University, Moscow, Russian Federation
| | - Marc Miravitlles
- Pneumology Department, Hospital Universitari Vall d'Hebron, Ciber de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
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20
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van Buul AR, Kasteleyn MJ, Chavannes NH, Taube C. The association between objectively measured physical activity and morning symptoms in COPD. Int J Chron Obstruct Pulmon Dis 2017; 12:2831-2840. [PMID: 29042764 PMCID: PMC5633288 DOI: 10.2147/copd.s143387] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
PURPOSE The morning is the most bothersome period for COPD patients. Morning symptom severities in different Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages are not well studied. Furthermore, factors that are associated with morning symptoms, especially the associations with objectively measured physical activity, are also not well described. MATERIALS AND METHODS The aim of this cross-sectional observational study was to assess morning symptom severity in GOLD A, B, C and D patients, according to the definitions of the GOLD 2015 statement. Morning symptoms were assessed with the PRO-Morning COPD Symptoms Questionnaire. Differences in morning symptom severity between different COPD stages were assessed with a one-way analysis of variance followed by post hoc analyses. The association between dyspnea severity (assessed with the modified Medical Research Council scale), health status, airflow limitation, lung hyperinflation, anxiety and depression, inflammatory parameters, exacerbations, objectively measured physical activity parameters retrieved from accelerometry and morning symptom severity was evaluated using linear regression analysis. RESULTS Eighty patients were included (aged 65.6±8.7 years, forced expiratory volume in 1 second [FEV1] % predicted 55.1±16.9). Mean (±SD) morning symptom score was 19.7 (±11.7). Morning symptom severity was significantly different between COPD stages: mean (±SD) score in GOLD A was 9.7 (±7.2), in GOLD B 19.8 (±10.7), in GOLD C 8.6 (±9.3) and in GOLD D 23.8 (±11.2) (p<0.001). Lower health status, more symptoms, increased anxiety and depression, less physical activity (all p<0.001) and lower FEV1 (p=0.03) were associated with an increased morning symptom severity. CONCLUSION Patients with overall more symptomatic COPD have significant higher morning symptom scores. Morning symptom severity was associated with important clinical outcomes: lower health status, more symptoms, increased anxiety and depression, fewer steps a day, less time in moderate and vigorous physical activity with bouts of at least 10 minutes and lower FEV1. The data suggest that morning symptoms should be carefully assessed in addition to assessment by general COPD-specific questionnaires, especially in those with more symptomatic COPD. More research is needed on potential therapies to improve morning symptoms; this study shows potential targets for intervention.
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Affiliation(s)
| | - Marise J Kasteleyn
- Department of Pulmonology.,Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
| | - Niels H Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
| | - Christian Taube
- Department of Pulmonology.,Department of Pulmonary Medicine, West German Lung Center, Essen University Hospital, Ruhrlandklinik, University Duisburg-Essen, Essen, Germany
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Roversi S, Corbetta L, Clini E. GOLD 2017 recommendations for COPD patients: toward a more personalized approach. ACTA ACUST UNITED AC 2017. [DOI: 10.1186/s40749-017-0024-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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22
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Tudoric N, Koblizek V, Miravitlles M, Valipour A, Milenkovic B, Barczyk A, Somfay A, Zykov K, Kostov K, Zbozinkova Z, Svoboda M, Sorli J, Krams A, Tkacova R. GOLD 2017 on the way to a phenotypic approach? Analysis from the Phenotypes of COPD in Central and Eastern Europe (POPE) Cohort. Eur Respir J 2017; 49:49/4/1602518. [PMID: 28446560 DOI: 10.1183/13993003.02518-2016] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 01/18/2017] [Indexed: 11/05/2022]
Affiliation(s)
- Neven Tudoric
- School of Medicine Zagreb, University Hospital Dubrava, Zagreb, Croatia
| | - Vladimir Koblizek
- Department of Pneumology, University Hospital Hradec Kralove, Faculty of Medicine in Hradec Kralove, Charles University in Prague, Hradec Kralove, Czech Republic
| | - Marc Miravitlles
- Pneumology Department, Hospital Universitari Vall d'Hebron, CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
| | - Arschang Valipour
- Department of Respiratory and Critical Care Medicine, Ludwig-Boltzmann-Institute for COPD and Respiratory Epidemiology, Otto-Wagner-Spital, Wien, Austria
| | - Branislava Milenkovic
- Clinic for Pulmonary Diseases, Clinical Centre of Serbia, Faculty of Medicine, Belgrade, Serbia
| | - Adam Barczyk
- Department of Pneumology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Attila Somfay
- Department of Pulmonology, University of Szeged, Deszk, Hungary
| | - Kirill Zykov
- Laboratory of Pulmonology, Moscow State University of Medicine and Dentistry named after A.I. Evdokimov, Moscow, Russian Federation
| | - Kosta Kostov
- Clinic of Pulmonary Diseases, Military Medical Academy, Sofia, Bulgaria
| | - Zuzana Zbozinkova
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Michal Svoboda
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Jurij Sorli
- Pulmonary Department, Topolsica Hospital, Topolsica, Slovenia
| | - Alvils Krams
- Faculty of Medicine, University of Latvia, Riga, Latvia
| | - Ruzena Tkacova
- Department of Respiratory Medicine and Tuberculosis, Faculty of Medicine, P.J. Safarik University, Kosice, Slovakia
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Westerik JAM, Metting EI, van Boven JFM, Tiersma W, Kocks JWH, Schermer TR. Associations between chronic comorbidity and exacerbation risk in primary care patients with COPD. Respir Res 2017; 18:31. [PMID: 28166777 PMCID: PMC5294875 DOI: 10.1186/s12931-017-0512-2] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Accepted: 01/18/2017] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND COPD often coexists with chronic conditions that may influence disease prognosis. We investigated associations between chronic (co)morbidities and exacerbations in primary care COPD patients. METHOD Retrospective cohort study based on 2012-2013 electronic health records from 179 Dutch general practices. Comorbidities from patients with physician-diagnosed COPD were categorized according to International Classification of Primary Care (ICPC) codes. Chi-squared tests, uni- and multivariable logistic, and Cox regression analyses were used to study associations with exacerbations, defined as oral corticosteroid prescriptions. RESULTS Fourteen thousand six hundred three patients with COPD could be studied (mean age 67 (SD 12) years, 53% male) for two years. At baseline 12,826 (88%) suffered from ≥1 comorbidities, 3263 (22%) from ≥5. The most prevalent comorbidities were hypertension (35%), coronary heart disease (19%), and osteoarthritis (18%). Several comorbidities showed statistically significant associations with frequent (i.e., ≥2/year) exacerbations: heart failure (odds ratio [OR], 95% confidence interval: 1.72; 1.38-2.14), blindness & low vision (OR 1.46; 1.21-1.75), pulmonary cancer (OR 1.85; 1.28-2.67), depression 1.48; 1.14-1.91), prostate disorders (OR 1.50; 1.13-1.98), asthma (OR 1.36; 1.11-1.70), osteoporosis (OR 1.41; 1.11-1.80), diabetes (OR 0.80; 0.66-0.97), dyspepsia (OR 1.25; 1.03-1.50), and peripheral vascular disease (OR 1.20; 1.00-1.45). From all comorbidity categories, having another chronic respiratory disease beside COPD showed the highest risk for developing a new exacerbation (Cox hazard ratio 1.26; 1.17-1.36). CONCLUSION Chronic comorbidities are highly prevalent in primary care COPD patients. Several chronic comorbidities were associated with having frequent exacerbations and increased exacerbation risk.
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Affiliation(s)
- Janine A M Westerik
- Department of Primary and Community Care, Radboud University Medical Center, 117-ELG, Geert Grooteplein Noord 21, Nijmegen, 6525 EZ, The Netherlands
| | - Esther I Metting
- Department of General Practice, Groningen Research Institute for Asthma and COPD (GRIAC), University Medical Center Groningen, University of Groningen, HPC FA21, Antonius Deusinglaan 1, Groningen, 9713 AV, The Netherlands
| | - Job F M van Boven
- Department of General Practice, Groningen Research Institute for Asthma and COPD (GRIAC), University Medical Center Groningen, University of Groningen, HPC FA21, Antonius Deusinglaan 1, Groningen, 9713 AV, The Netherlands
| | - Waling Tiersma
- Department of Primary and Community Care, Radboud University Medical Center, 117-ELG, Geert Grooteplein Noord 21, Nijmegen, 6525 EZ, The Netherlands
| | - Janwillem W H Kocks
- Department of General Practice, Groningen Research Institute for Asthma and COPD (GRIAC), University Medical Center Groningen, University of Groningen, HPC FA21, Antonius Deusinglaan 1, Groningen, 9713 AV, The Netherlands
| | - Tjard R Schermer
- Department of Primary and Community Care, Radboud University Medical Center, 117-ELG, Geert Grooteplein Noord 21, Nijmegen, 6525 EZ, The Netherlands.
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Safka KA, Wald J, Wang H, McIvor L, McIvor A. GOLD Stage and Treatment in COPD: A 500 Patient Point Prevalence Study. CHRONIC OBSTRUCTIVE PULMONARY DISEASES-JOURNAL OF THE COPD FOUNDATION 2016; 4:45-55. [PMID: 28848910 DOI: 10.15326/jcopdf.4.1.2016.0126] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background and Objective: The Global initiative for chronic Obstructive Lung Disease (GOLD) guidelines recommend using a combination of spirometry, symptoms and exacerbation history to classify patients into 4 categories (A, B, C, D) to guide treatment decisions along with a stepwise increase in therapy. Our objectives were to identify the GOLD stage of patients in respiratory outpatient clinics and assess how treatment compares to guideline recommendations. Methods: This was a point prevalence study using a convenience sample of 500 patients with chronic obstructive pulmonary disease (COPD) from a single tertiary care outpatient respiratory clinic. Results: Patients' GOLD classification was determined based on symptoms (modified Medical Research Council [mMRC] dyspnea scale, COPD Assessment Test [CAT]), spirometry and self-reported exacerbation history. A total of 8.2% of patients were in the GOLD group A, 28.3% in group B, 4.2% in group C and 59.2% in group D. Conclusions: In this 500 patient point prevalence study we report a low proportion of patients in GOLD group C and a high level of inhaled corticosteroids (ICS)/ long-acting beta2-agonist (LABA) and triple therapy use throughout all GOLD categories. Clinical Implications: The GOLD guidelines have attempted to provide direction to practitioners by grouping patients into 4 groups based on symptoms and exacerbations however, the low prevalence of GOLD group C may indicate that not all of these groupings are clinically relevant. Future research is needed to better identify clinically relevant phenotypes that predict benefit from ICS and methods to promote guideline concordant management in COPD.
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Affiliation(s)
- Katherine A Safka
- Firestone Institute for Respiratory Health, McMaster University, Hamilton, Ontario, Canada
| | - Joshua Wald
- Firestone Institute for Respiratory Health, McMaster University, Hamilton, Ontario, Canada
| | - Hongyu Wang
- Firestone Institute for Respiratory Health, McMaster University, Hamilton, Ontario, Canada
| | - Luke McIvor
- Firestone Institute for Respiratory Health, McMaster University, Hamilton, Ontario, Canada
| | - Andrew McIvor
- Firestone Institute for Respiratory Health, McMaster University, Hamilton, Ontario, Canada
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Corlateanu A, Covantev S, Mathioudakis AG, Botnaru V, Siafakas N. Prevalence and burden of comorbidities in Chronic Obstructive Pulmonary Disease. Respir Investig 2016; 54:387-396. [PMID: 27886849 DOI: 10.1016/j.resinv.2016.07.001] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 07/01/2016] [Indexed: 02/08/2023]
Abstract
The classical definition of Chronic Obstructive Pulmonary Disease (COPD) as a lung condition characterized by irreversible airway obstruction is outdated. The systemic involvement in patients with COPD, as well as the interactions between COPD and its comorbidities, justify the description of chronic systemic inflammatory syndrome. The pathogenesis of COPD is closely linked with aging, as well as with cardiovascular, endocrine, musculoskeletal, renal, and gastrointestinal pathologies, decreasing the quality of life of patients with COPD and, furthermore, complicating the management of the disease. The most frequently described comorbidities include skeletal muscle wasting, cachexia (loss of fat-free mass), lung cancer (small cell or non-small cell), pulmonary hypertension, ischemic heart disease, hyperlipidemia, congestive heart failure, normocytic anemia, diabetes, metabolic syndrome, osteoporosis, obstructive sleep apnea, depression, and arthritis. These complex interactions are based on chronic low-grade systemic inflammation, chronic hypoxia, and multiple common predisposing factors, and are currently under intense research. This review article is an overview of the comorbidities of COPD, as well as their interaction and influence on mutual disease progression, prognosis, and quality of life.
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Affiliation(s)
- Alexandru Corlateanu
- Department of Respiratory Medicine, State University of Medicine and Pharmacy "Nicolae Testemitanu", Stefan cel Mare Street 165, 2004 Chisinau, Republic of Moldova.
| | - Serghei Covantev
- Department of Respiratory Medicine, State University of Medicine and Pharmacy "Nicolae Testemitanu", Stefan cel Mare Street 165, 2004 Chisinau, Republic of Moldova.
| | - Alexander G Mathioudakis
- Chest Centre, Aintree University Hospitals NHS Foundation Trust, Langmoor Lane, Liverpool, Merseyside L9 7AL, United Kingdom.
| | - Victor Botnaru
- Department of Respiratory Medicine, State University of Medicine and Pharmacy "Nicolae Testemitanu", Stefan cel Mare Street 165, 2004 Chisinau, Republic of Moldova.
| | - Nikolaos Siafakas
- University General Hospital, Department of Thoracic Medicine, Stavrakia, 71110 Heraklion, Crete, Greece.
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Topp M, Vestbo J, Mortensen EL. Psychometric Properties of the COPD-Specific Beliefs About Medicine Questionnaire in an Outpatient Population: A Rasch-Analysis. CHRONIC OBSTRUCTIVE PULMONARY DISEASES (MIAMI, FLA.) 2016; 3:748-757. [PMID: 28848900 PMCID: PMC5556958 DOI: 10.15326/jcopdf.3.4.2016.0134] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/15/2016] [Indexed: 11/21/2022]
Abstract
Background: Understanding non-adherence in patients with chronic obstructive pulmonary disease (COPD) remains challenging. The necessity and the concerns scales of the Beliefs about Medicines Questionnaire (BMQ) are known to correlate with adherence behavior in several chronic diseases including asthma but less is known about COPD. In the present study a COPD-specific BMQ (BMQ-COPD) was translated and administered to Danish COPD outpatients. Our aim was to derive high-quality measures of the 2 dimensions included in the BMQ-COPD. Methods: A total of 168 patients with COPD were included from a Danish respiratory outpatient clinic. The Rasch model was used to evaluate psychometric characteristics of the BMQ-COPD and to obtain necessity and concerns scales fulfilling criteria of unidimensionality and overall fit, and with all items showing individual item fit with no local dependencies, and no differential item functioning. Further, we explored the association with disease-related variables and subsequent adherence behavior. Results: Shortened versions of the original necessity and concerns scales fitted the Rasch model and were at least as good as the original scales as predictors of adherence, although only the necessity scale was significantly associated with adherence. Conclusion: In a Danish COPD setting high-quality measures of necessity and concerns could be derived from the BMQ-COPD. The excluded items appear to reflect other dimensions.
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Affiliation(s)
- Marie Topp
- Department of Respiratory Medicine, Hvidovre Hospital, Denmark
| | - Jørgen Vestbo
- Respiratory and Allergy Research Group, Manchester Academic Health Science Centre, University Hospital South Manchester, NHS Foundation Trust, Manchester, United Kingdom
| | - Erik Lykke Mortensen
- Department of Public Health and Center for Healthy Aging, University of Copenhagen, Denmark
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Rimland JM, Abraha I, Luchetta ML, Cozzolino F, Orso M, Cherubini A, Dell'Aquila G, Chiatti C, Ambrosio G, Montedori A. Validation of chronic obstructive pulmonary disease (COPD) diagnoses in healthcare databases: a systematic review protocol. BMJ Open 2016; 6:e011777. [PMID: 27251687 PMCID: PMC4893853 DOI: 10.1136/bmjopen-2016-011777] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
INTRODUCTION Healthcare databases are useful sources to investigate the epidemiology of chronic obstructive pulmonary disease (COPD), to assess longitudinal outcomes in patients with COPD, and to develop disease management strategies. However, in order to constitute a reliable source for research, healthcare databases need to be validated. The aim of this protocol is to perform the first systematic review of studies reporting the validation of codes related to COPD diagnoses in healthcare databases. METHODS AND ANALYSIS MEDLINE, EMBASE, Web of Science and the Cochrane Library databases will be searched using appropriate search strategies. Studies that evaluated the validity of COPD codes (such as the International Classification of Diseases 9th Revision and 10th Revision system; the Real codes system or the International Classification of Primary Care) in healthcare databases will be included. Inclusion criteria will be: (1) the presence of a reference standard case definition for COPD; (2) the presence of at least one test measure (eg, sensitivity, positive predictive values, etc); and (3) the use of a healthcare database (including administrative claims databases, electronic healthcare databases or COPD registries) as a data source. Pairs of reviewers will independently abstract data using standardised forms and will assess quality using a checklist based on the Standards for Reporting of Diagnostic accuracy (STARD) criteria. This systematic review protocol has been produced in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol (PRISMA-P) 2015 statement. ETHICS AND DISSEMINATION Ethics approval is not required. Results of this study will be submitted to a peer-reviewed journal for publication. The results from this systematic review will be used for outcome research on COPD and will serve as a guide to identify appropriate case definitions of COPD, and reference standards, for researchers involved in validating healthcare databases. TRIAL REGISTRATION NUMBER CRD42015029204.
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Affiliation(s)
- Joseph M Rimland
- Geriatrics and Geriatric Emergency Care, Italian National Research Center on Aging, Ancona, Italy
| | - Iosief Abraha
- Health Planning Service, Regional Health Authority of Umbria, Perugia, Italy
| | | | - Francesco Cozzolino
- Health Planning Service, Regional Health Authority of Umbria, Perugia, Italy
| | - Massimiliano Orso
- Health Planning Service, Regional Health Authority of Umbria, Perugia, Italy
| | - Antonio Cherubini
- Geriatrics and Geriatric Emergency Care, Italian National Research Center on Aging, Ancona, Italy
| | - Giuseppina Dell'Aquila
- Geriatrics and Geriatric Emergency Care, Italian National Research Center on Aging, Ancona, Italy
| | - Carlos Chiatti
- Scientific Directorate, Italian National Research Center on Aging, Ancona, Italy
| | - Giuseppe Ambrosio
- Department of Cardiology, University of Perugia School of Medicine, Perugia, Italy
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Kim YJ, Lim B, Kyung SY, Park JW, Jeong SH. Comorbidity and Inflammatory Markers May Contribute to Predict Mortality of High-Risk Patients With Chronic Obstructive Pulmonary Disease Exacerbation. J Clin Med Res 2016; 8:531-6. [PMID: 27298662 PMCID: PMC4894023 DOI: 10.14740/jocmr2594w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2016] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Acute exacerbation of chronic obstructive pulmonary disease (COPD) causes not only an accelerated disease progression, but also an increased mortality rate. The purpose of this study was to analyze the factors associated with clinical features, comorbidities and mortality in patients at high risk for acute COPD exacerbation who had been hospitalized at least once in a year. METHODS The study enrolled 606 patients who had been diagnosed with and were being treated for COPD at university affiliated hospital. Among them, there were 61 patients at high risk for acute exacerbation of COPD who had been hospitalized at least once in a year. A retrospective analysis was conducted to examine the factors affecting mortality. The analysis divided the patients into non-survivor and survivor groups, and reviewed their medical records for clinical aspects, comorbidities, pulmonary function tests and blood tests. RESULTS In the high-risk group, the number of comorbidities at diagnosis (P = 0.020) and the Charlson comorbidity index value (P = 0.018) were higher in the non-survivor group than in the survivor group. During hospitalization, the non-survivor group had a significantly higher neutrophil (%) and a significantly lower lymphocyte (%) in complete blood count. Under stable conditions, the high-sensitivity C-reactive protein (hsCRP) concentration in blood plasma and neutrophil (%) were significantly higher (P = 0.025 and P = 0.036), while the lymphocyte (%) was significantly lower (P = 0.005) in the non-survivor group. A pulmonary function test revealed no statistically significant differences between the two groups. CONCLUSION The number of comorbidities, neutrophil (%), lymphocyte (%) in complete blood cell (CBC) and hsCRP in blood plasma concentration among the groups at high risk for COPD exacerbation are associated with increased mortality.
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Affiliation(s)
- Yu Jin Kim
- Division of Pulmonology and Allergy, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea; These authors contributed equally to this work
| | - Byeongwoo Lim
- Division of Pulmonology and Allergy, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea; These authors contributed equally to this work
| | - Sun Young Kyung
- Division of Pulmonology and Allergy, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Jeong-Woong Park
- Division of Pulmonology and Allergy, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Sung Hwan Jeong
- Division of Pulmonology and Allergy, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
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Han MK, Martinez CH, Au DH, Bourbeau J, Boyd CM, Branson R, Criner GJ, Kalhan R, Kallstrom TJ, King A, Krishnan JA, Lareau SC, Lee TA, Lindell K, Mannino DM, Martinez FJ, Meldrum C, Press VG, Thomashow B, Tycon L, Sullivan JL, Walsh J, Wilson KC, Wright J, Yawn B, Zueger PM, Bhatt SP, Dransfield MT. Meeting the challenge of COPD care delivery in the USA: a multiprovider perspective. THE LANCET RESPIRATORY MEDICINE 2016; 4:473-526. [PMID: 27185520 DOI: 10.1016/s2213-2600(16)00094-1] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 03/01/2016] [Accepted: 03/01/2016] [Indexed: 12/21/2022]
Abstract
The burden of chronic obstructive pulmonary disease (COPD) in the USA continues to grow. Although progress has been made in the the development of diagnostics, therapeutics, and care guidelines, whether patients' quality of life is improved will ultimately depend on the actual implementation of care and an individual patient's access to that care. In this Commission, we summarise expert opinion from key stakeholders-patients, caregivers, and medical professionals, as well as representatives from health systems, insurance companies, and industry-to understand barriers to care delivery and propose potential solutions. Health care in the USA is delivered through a patchwork of provider networks, with a wide variation in access to care depending on a patient's insurance, geographical location, and socioeconomic status. Furthermore, Medicare's complicated coverage and reimbursement structure pose unique challenges for patients with chronic respiratory disease who might need access to several types of services. Throughout this Commission, recurring themes include poor guideline implementation among health-care providers and poor patient access to key treatments such as affordable maintenance drugs and pulmonary rehabilitation. Although much attention has recently been focused on the reduction of hospital readmissions for COPD exacerbations, health systems in the USA struggle to meet these goals, and methods to reduce readmissions have not been proven. There are no easy solutions, but engaging patients and innovative thinkers in the development of solutions is crucial. Financial incentives might be important in raising engagement of providers and health systems. Lowering co-pays for maintenance drugs could result in improved adherence and, ultimately, decreased overall health-care spending. Given the substantial geographical diversity, health systems will need to find their own solutions to improve care coordination and integration, until better data for interventions that are universally effective become available.
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Affiliation(s)
- MeiLan K Han
- Division of Pulmonary and Critical Care, University of Michigan Health System, Ann Arbor, MI, USA.
| | - Carlos H Martinez
- Division of Pulmonary and Critical Care, University of Michigan Health System, Ann Arbor, MI, USA
| | - David H Au
- Center of Innovation for Veteran-Centered and Value-Driven Care, and VA Puget Sound Health Care System, US Department of Veteran Affairs, Seattle, WA, USA; Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle, WA, USA
| | - Jean Bourbeau
- McGill University Health Centre, McGill University, Montreal, QC, Canada
| | - Cynthia M Boyd
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Richard Branson
- Department of Surgery, University of Cincinnati, Cincinnati, OH, USA
| | - Gerard J Criner
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Ravi Kalhan
- Asthma and COPD Program, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | | | - Jerry A Krishnan
- University of Illinois Hospital & Health Sciences System, University of Illinois, Chicago, IL, USA
| | - Suzanne C Lareau
- University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
| | - Todd A Lee
- Department of Pharmacy Systems, Outcomes and Policy, University of Illinois, Chicago, IL, USA
| | | | - David M Mannino
- Department of Preventive Medicine and Environmental Health, University of Kentucky, Lexington, KY, USA
| | - Fernando J Martinez
- Department of Internal Medicine, Weill Cornell School of Medicine, New York, NY, USA
| | - Catherine Meldrum
- Division of Pulmonary and Critical Care, University of Michigan Health System, Ann Arbor, MI, USA
| | - Valerie G Press
- Section of Hospital Medicine, University of Chicago Medicine, Chicago, IL, USA
| | - Byron Thomashow
- Division of Pulmonary, Critical Care and Sleep Medicine, Columbia University Medical Center, New York, NY, USA
| | - Laura Tycon
- Palliative and Supportive Institute, Pittsburgh, PA, USA
| | | | | | - Kevin C Wilson
- Boston University School of Medicine, Boston, MA, USA; American Thoracic Society, New York, NY, USA
| | - Jean Wright
- Carolinas HealthCare System, Charlotte, NC, USA
| | - Barbara Yawn
- Family and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Patrick M Zueger
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois, Chicago, IL, USA
| | - Surya P Bhatt
- Division of Pulmonary, Allergy and Critical Care Medicine, and UAB Lung Health Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Mark T Dransfield
- Division of Pulmonary, Allergy and Critical Care Medicine, and UAB Lung Health Center, University of Alabama at Birmingham, Birmingham, AL, USA; Birmingham VA Medical Center, Birmingham, AL, USA
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Karloh M, Fleig Mayer A, Maurici R, Pizzichini MMM, Jones PW, Pizzichini E. The COPD Assessment Test: What Do We Know So Far?: A Systematic Review and Meta-Analysis About Clinical Outcomes Prediction and Classification of Patients Into GOLD Stages. Chest 2016; 149:413-425. [PMID: 26513112 DOI: 10.1378/chest.15-1752] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 09/09/2015] [Accepted: 10/01/2015] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND The COPD Assessment Test (CAT) was developed as a simple instrument to assess health status in patients with COPD. This study aimed to systematically review the determinants of the CAT score, its ability to predict clinical outcomes, and the agreement between CAT (≥ 10) and the modified Medical Research Council scale (mMRC ≥ 2) to categorize patients into the new Global Initiative for Chronic Obstructive Lung Disease classification system. METHODS From January 1, 2009, to June 30, 2015, databases were searched for studies using CAT in adults with COPD and in general populations aiming to detect COPD. Two investigators independently screened, selected, and extracted data by using a standardized form. Where appropriate, the results were combined in a random effects meta-analysis. RESULTS Of 453 studies, 17 were included, and eight were used in the meta-analysis. The models to predict the CAT score were able to explain < 50% of its variance. CAT scores can indicate risk of exacerbation, depression, acute deterioration in health status, and mortality. All studies found a different proportion of patients in each Global Initiative for Chronic Obstructive Lung Disease category using CAT ≥ 10 or mMRC ≥ 2. On average, the distribution was 13% different according to the instrument used. The κ agreement between CAT and mMRC ranged from 0.13 to 0.77. CONCLUSIONS CAT may be used as a complementary tool in a patient's clinical assessment to predict COPD exacerbation, health status deterioration, depression, and mortality. The interpretation of this meta-analysis does not support the use of the recommended cutoff points of ≥10 for CAT and ≥2 for mMRC as equivalents for the purpose of assessing patient symptoms.
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Affiliation(s)
- Manuela Karloh
- Asthma and Airway Inflammation Research Center-NUPAIVA and Post Graduate Program in Medical Sciences, Federal University of Santa Catarina, Florianópolis, Brazil; Center of Assistance, Education and Research in Pulmonary Rehabilitation, Santa Catarina State University, Florianópolis, Brazil
| | - Anamaria Fleig Mayer
- Center of Assistance, Education and Research in Pulmonary Rehabilitation, Santa Catarina State University, Florianópolis, Brazil
| | - Rosemeri Maurici
- Asthma and Airway Inflammation Research Center-NUPAIVA and Post Graduate Program in Medical Sciences, Federal University of Santa Catarina, Florianópolis, Brazil
| | - Marcia M M Pizzichini
- Asthma and Airway Inflammation Research Center-NUPAIVA and Post Graduate Program in Medical Sciences, Federal University of Santa Catarina, Florianópolis, Brazil
| | - Paul W Jones
- Division of Clinical Science, St. George's University of London, London, UK
| | - Emilio Pizzichini
- Asthma and Airway Inflammation Research Center-NUPAIVA and Post Graduate Program in Medical Sciences, Federal University of Santa Catarina, Florianópolis, Brazil.
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Six-minute-walk distance and accelerometry predict outcomes in chronic obstructive pulmonary disease independent of Global Initiative for Chronic Obstructive Lung Disease 2011 Group. Ann Am Thorac Soc 2015; 12:349-56. [PMID: 25568929 DOI: 10.1513/annalsats.201408-365oc] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
RATIONALE The 2011 combined Global Initiative for Chronic Obstructive Lung Disease (GOLD) assessment incorporates symptoms, exacerbation history, and spirometry in discriminating risk of exacerbations in patients with chronic obstructive pulmonary disease (COPD). Six-minute-walk distance (6MWD) and accelerometry also have been used to assess disease severity in COPD. The association between these measures and the risks of hospitalization and mortality in the context of GOLD 2011 is unknown. OBJECTIVES To describe changes in exercise tolerance and physical activity over time in patients with COPD and to test the hypothesis that lower baseline 6MWD or accelerometry step count is associated with increased risk of COPD-related hospitalization or all-cause mortality, independent of GOLD 2011 group. METHODS Physical function and medical outcomes were prospectively assessed in 326 patients with moderate to severe COPD in INSPIRE-II, a randomized controlled trial of a coping skills training intervention. Cox models were used to determine if GOLD 2011 group, 6MWD, or accelerometry steps were associated with risk of COPD-related hospitalization or all-cause mortality. MEASUREMENTS AND MAIN RESULTS Physical function declined over time in GOLD group D but remained stable in groups A, B, and C. GOLD classification was associated with time to death or first COPD-related hospitalization. Baseline 6MWD was more strongly associated with time to death or first COPD-related hospitalization (hazard ratio, 0.50 [95% confidence interval, 0.34, 0.73] per 150 m, P=0.0003) than GOLD 2011 classification. A similar relationship was observed for accelerometry steps (hazard ratio, 0.80 [95% confidence interval, 0.70, 0.92] per 1,000 steps, P=0.002). CONCLUSIONS Exercise tolerance and daily physical activity are important predictors of hospitalization and mortality in COPD, independent of GOLD 2011 classification. Physical function may represent a modifiable risk factor that warrants increased attention as a target for interventions to improve clinically meaningful outcomes in COPD.
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Gunen H, Yilmaz M, Aktas O, Ergun P, Ortakoylu MG, Demir A, Cetinkaya P, Gurgun A, Otlu M, Cilli A, Yilmaz U, Kokturk N, Candemir I, Yakar HI, Ar I, Konya A. Categorization of COPD patients in Turkey via GOLD 2013 strategy document: ALPHABET study. Int J Chron Obstruct Pulmon Dis 2015; 10:2485-94. [PMID: 26622176 PMCID: PMC4654531 DOI: 10.2147/copd.s87464] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Objective To determine distribution of COPD assessment categories and physicians’ adherence to Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2013 strategy in Turkish COPD patients. Methods A total of 1,610 COPD patients (mean [standard deviation] age: 62.6 [9.9] years, 85.7% were males) were included in this multicenter, non-interventional, cross-sectional study. Patients were categorized via GOLD 2013 strategy document. Consistency between reported and re-classified GOLD categories, and measures used for symptom evaluation and exacerbation was analyzed. Results Overall, 41.1% of patients were assigned to GOLD A, while 13.2% were assigned to GOLD C categories. Long-acting beta-2 agonist + long-acting muscarinic antagonist + inhaled corticosteroid regimen was the most common treatment (62.0%). Over-treatment was noted in >70% of GOLD A, B, and C patients. A high consistency between measures of symptom evaluation (Kappa coefficient =0.993, P<0.0001) and a low-moderate consistency between exacerbation risk measures (Kappa coefficient =0.237, P<0.0001) were noted. Conclusion Our findings revealed GOLD A as the most prevalent category in Turkish cohort of COPD patients. Group assignment was altered depending on the chosen measure for symptom and risk assessment. Physician non-adherence to treatment recommendations in GOLD 2013 document leading to over-treatment in patients assigned to GOLD A, B, and C categories was also detected.
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Affiliation(s)
- Hakan Gunen
- Department of Chest Diseases, Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Yilmaz
- Department of Chest Diseases, Safranbolu State Hospital, Karabuk, Turkey
| | - Oguz Aktas
- Department of Chest Diseases, Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Pinar Ergun
- Department of Chest Diseases, Ataturk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, Turkey
| | - Mediha Gonenc Ortakoylu
- Department of Chest Diseases, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Atike Demir
- Department of Chest Diseases, Dr Suat Seren Chest Diseases and Thoracic Surgery Training and Research Hospital, Izmir, Turkey
| | - Pelin Cetinkaya
- Department of Chest Diseases, Cukurova Dr Askim Tufekci State Hospital, Adana, Turkey
| | - Alev Gurgun
- Department of Chest Diseases, Ege University Faculty of Medicine, Izmir, Turkey
| | - Muge Otlu
- Department of Chest Diseases, Bingol State Hospital, Bingol, Turkey
| | - Aykut Cilli
- Department of Chest Diseases, Akdeniz University, Faculty of Medicine, Antalya, Turkey
| | - Ufuk Yilmaz
- Department of Chest Diseases, Dr Suat Seren Chest Diseases and Thoracic Surgery Training and Research Hospital, Izmir, Turkey
| | - Nurdan Kokturk
- Department of Chest Diseases, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Ipek Candemir
- Department of Chest Diseases, Ataturk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, Turkey
| | - Halil Ibrahim Yakar
- Department of Chest Diseases, Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Idilhan Ar
- Medical Department, Novartis Pharmaceuticals, Istanbul, Turkey
| | - Aylin Konya
- Medical Department, Novartis Pharmaceuticals, Istanbul, Turkey
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Mapel DW, Dalal AA, Johnson PT, Becker LK, Hunter AG. Application of the new GOLD COPD staging system to a US primary care cohort, with comparison to physician and patient impressions of severity. Int J Chron Obstruct Pulmon Dis 2015; 10:1477-86. [PMID: 26251587 PMCID: PMC4524525 DOI: 10.2147/copd.s78827] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background In 2011, the traditional Global Initiative for Chronic Obstructive Lung Disease (GOLD) COPD spirometry-based severity classification system was revised to also include exacerbation history and COPD Assessment Test (CAT) and modified Medical Research Council Dyspnea Scale (mMRC) scores. This study examined how COPD patients treated in primary care are reclassified by the new GOLD system compared to the traditional system, and each system’s level of agreement with patient’s or physician’s severity assessments. Methods In this US multicenter cross-sectional study, COPD patients were recruited by 83 primary care practitioners (PCPs) to complete spirometry testing and a survey. Patients were classified by the traditional spirometry-based system (stages 1–4) and under the new system (grades A, B, C, D) using spirometry, exacerbation history, mMRC, and/or CAT results. Concordance between physician and patient-reported severity, spirometry stage, and ABCD grade based on either mMRC or CAT scores was examined. Results Data from 445 patients with spirometry-confirmed COPD were used. As compared to the traditional system, the GOLD mMRC system reclassifies 47% of patients, and GOLD CAT system reclassifies 41%, but the distributions are very different. The GOLD mMRC system resulted in relatively equal distributions by ABCD grade (33%, 22%, 19%, 26%, respectively), but the GOLD CAT system put most into either B or D groups (9%, 45%, 4%, and 42%). The addition of exacerbation history reclassified only 19 additional patients. Agreement between PCPs’ severity rating or their patients’ self-assessment and the new ABCD grade was very poor (κ=0.17 or less). Conclusion As compared to the traditional system, the GOLD 2011 multidimensional system reclassified nearly half of patients, but how they were reclassified varied greatly by whether the mMRC or CAT questionnaire was chosen. Either way, the new system had little correlation with the PCPs or their patients’ impressions about the COPD severity.
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Affiliation(s)
- Douglas W Mapel
- Epidemiology and Health Outcomes Research, Lovelace Clinic Foundation, Albuquerque, NM, USA
| | - Anand A Dalal
- US Health Outcomes and Medical Policy, GlaxoSmithKline, Research Triangle Park, NC, USA
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Affiliation(s)
- Paul W Jones
- Institute for Infection and Immunity, St George's, University of London, London, UK
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Suzuki T, Tada Y, Kawata N, Ikari J, Kasahara Y, Sakurai Y, Iesato K, Nishimura R, West J, Tatsumi K. Influence of pulmonary emphysema on COPD assessment test-oriented categorization in GOLD document. Int J Chron Obstruct Pulmon Dis 2015; 10:1199-205. [PMID: 26150711 PMCID: PMC4480590 DOI: 10.2147/copd.s82910] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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 The COPD assessment test (CAT) score is a key component of the multifactorial assessment of COPD in the Global initiative for chronic Obstructive Lung Disease (GOLD) guidelines of 2014. Nevertheless, little is known regarding the differences among COPD categories in terms of clinical parameters such as pulmonary function or radiological findings. Thus, our aims in this study were to evaluate the associations between CAT scores and pulmonary clinical parameters, and to investigate factors that could discriminate between a "less symptomatic group" (categories A and C) and a "more symptomatic group" (categories B and D) among stable COPD patients. METHODS We enrolled 200 outpatients at Chiba University Hospital. Study subjects were assessed by CAT, pulmonary function testing, and multidetector computed tomography (MDCT). We assessed possible correlations between these indices. RESULTS CAT scores were negatively correlated with percentage of the forced expiratory volume in 1 second predicted value (FEV1 %predicted) and percentage of the diffusing capacity for carbon monoxide per liter of lung volume predicted value (DLCO/VA [%predicted]) results and positively correlated with low attenuation volume percentage (LAV%) and residual volume to total lung capacity ratios (RV/TLC). In the "more symptomatic group" (category B or D), the mean DLCO/VA (%predicted) was significantly lower and the mean LAV% and RV/TLC was significantly higher than those in the "less symptomatic group" (category A or C), respectively. Interestingly, those in category B had higher mean LAV% compared to those in category C. CONCLUSION CAT scores were significantly correlated with pulmonary function parameters and emphysematous changes on MDCT. The new GOLD classification system would be a step toward a phenotypic approach, especially taking into account the degree of emphysema and hyperinflation.
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Affiliation(s)
- Toshio Suzuki
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yuji Tada
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Naoko Kawata
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Jun Ikari
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yasunori Kasahara
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yoriko Sakurai
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Ken Iesato
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Rintaro Nishimura
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - James West
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Koichiro Tatsumi
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
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Raluy-Callado M, Lambrelli D, MacLachlan S, Khalid JM. Epidemiology, severity, and treatment of chronic obstructive pulmonary disease in the United Kingdom by GOLD 2013. Int J Chron Obstruct Pulmon Dis 2015; 10:925-37. [PMID: 25999708 PMCID: PMC4437524 DOI: 10.2147/copd.s82064] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Objectives In 2013, the Global Initiative for Chronic Obstructive Lung Disease (GOLD) updated the management strategy on COPD based on severity using a combined assessment of symptoms, degree of airflow limitation, and number of exacerbations. This study quantified prevalence and incidence of COPD in the United Kingdom and estimated disease severity by GOLD 2013 categories A/B (low risk) and C/D (high risk). Methods The Clinical Practice Research Datalink was used to identify COPD patients ≥40 years. Patient characteristics were described, and prevalence was calculated on December 31, 2013. Five-year incidence (2009–2013) was estimated, with rates standardized using 2011 UK population age and sex. To classify patients by GOLD categories, spirometry results, the modified British Medical Research Council grade, and history of exacerbations were used. Results The prevalent cohort comprised 49,286 patients with COPD with mean age 70 years; 51.0% were male. Overall prevalence was 33.3 per 1,000 persons (95% confidence interval [CI]: 33.1–33.6); 66.4% were classified as GOLD A/B and 33.6% as C/D. The standardized prevalence of GOLD A/B was 21.9 per 1,000 persons (95% CI: 21.7–22.1) and of C/D was 11.1 (95% CI: 10.9–11.2). A total of 27,224 newly diagnosed COPD patients were identified with mean age 67 years at diagnosis; 53.0% were male. Incidence was 2.2 per 1,000 person-years (95% CI: 2.2–2.3); 68.7% were classified in categories A/B and 31.3% in C/D, of which 17.2% did not receive COPD maintenance medication. Conclusion A third of COPD patients in the UK are considered high risk (GOLD 2013 categories C/D), and a third of patients are diagnosed for the first time at these severe stages. Given the progressive nature of the disease, results suggest that closer attention to respiratory symptoms for early detection, diagnosis, and appropriate treatment of COPD in the UK is warranted.
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Eze IC, Hemkens LG, Bucher HC, Hoffmann B, Schindler C, Künzli N, Schikowski T, Probst-Hensch NM. Association between ambient air pollution and diabetes mellitus in Europe and North America: systematic review and meta-analysis. ENVIRONMENTAL HEALTH PERSPECTIVES 2015; 123:381-9. [PMID: 25625876 PMCID: PMC4421762 DOI: 10.1289/ehp.1307823] [Citation(s) in RCA: 383] [Impact Index Per Article: 42.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Accepted: 01/26/2015] [Indexed: 05/17/2023]
Abstract
BACKGROUND Air pollution is hypothesized to be a risk factor for diabetes. Epidemiological evidence is inconsistent and has not been systematically evaluated. OBJECTIVES We systematically reviewed epidemiological evidence on the association between air pollution and diabetes, and synthesized results of studies on type 2 diabetes mellitus (T2DM). METHODS We systematically searched electronic literature databases (last search, 29 April 2014) for studies reporting the association between air pollution (particle concentration or traffic exposure) and diabetes (type 1, type 2, or gestational). We systematically evaluated risk of bias and role of potential confounders in all studies. We synthesized reported associations with T2DM in meta-analyses using random-effects models and conducted various sensitivity analyses. RESULTS We included 13 studies (8 on T2DM, 2 on type 1, 3 on gestational diabetes), all conducted in Europe or North America. Five studies were longitudinal, 5 cross-sectional, 2 case-control, and 1 ecologic. Risk of bias, air pollution assessment, and confounder control varied across studies. Dose-response effects were not reported. Meta-analyses of 3 studies on PM2.5 (particulate matter ≤ 2.5 μm in diameter) and 4 studies on NO2 (nitrogen dioxide) showed increased risk of T2DM by 8-10% per 10-μg/m3 increase in exposure [PM2.5: 1.10 (95% CI: 1.02, 1.18); NO2: 1.08 (95% CI: 1.00, 1.17)]. Associations were stronger in females. Sensitivity analyses showed similar results. CONCLUSION Existing evidence indicates a positive association of air pollution and T2DM risk, albeit there is high risk of bias. High-quality studies assessing dose-response effects are needed. Research should be expanded to developing countries where outdoor and indoor air pollution are high.
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Affiliation(s)
- Ikenna C Eze
- Swiss Tropical and Public Health Institute, Basel, Switzerland
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Gläser S, Krüger S, Merkel M, Bramlage P, Herth FJF. Chronic obstructive pulmonary disease and diabetes mellitus: a systematic review of the literature. Respiration 2015; 89:253-64. [PMID: 25677307 DOI: 10.1159/000369863] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Accepted: 11/10/2014] [Indexed: 01/08/2023] Open
Abstract
The objective of this systematic review was to discuss our current understanding of the complex relationship between chronic obstructive pulmonary disease (COPD) and type-2 diabetes mellitus (T2DM). We performed a systematic search of the literature related to both COPD and diabetes using PubMed. Relevant data connecting both diseases were compiled and discussed. Recent evidence suggests that diabetes can worsen the progression and prognosis of COPD; this may result from the direct effects of hyperglycemia on lung physiology, inflammation or susceptibility to bacterial infection. Conversely, it has also been suggested that COPD increases the risk of developing T2DM as a consequence of inflammatory processes and/or therapeutic side effects related to the use of high-dose corticosteroids. In conclusion, although there is evidence to support a connection between COPD and diabetes, additional research is needed to better understand these relationships and their possible implications.
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Affiliation(s)
- Sven Gläser
- Department of Internal Medicine B - Cardiology, Intensive Care, Pulmonary Medicine and Infectious Diseases and Scientific Division of Pneumological Research and Pneumological Epidemiology, University of Greifswald, Greifswald, Germany
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Herth FJ, Bramlage P, Müller-Wieland D. Current Perspectives on the Contribution of Inhaled Corticosteroids to an Increased Risk for Diabetes Onset and Progression in Patients with Chronic Obstructive Pulmonary Disease. Respiration 2015; 89:66-75. [DOI: 10.1159/000368371] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Accepted: 09/08/2014] [Indexed: 11/19/2022] Open
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Wilke S, Smid DE, Spruit MA, Janssen DJA, Muris JWM, van der Molen T, van den Akker M, Jones PW, Wouters EFM, Franssen FME. The 2014 Updated GOLD Strategy: A Comparison of the Various Scenarios. CHRONIC OBSTRUCTIVE PULMONARY DISEASES-JOURNAL OF THE COPD FOUNDATION 2014; 1:212-220. [PMID: 28848823 DOI: 10.15326/jcopdf.1.2.2014.0135] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background: The 2014 updated Global initiative for chronic Obstructive Lung Disease (GOLD) strategy added the St. George's Respiratory Questionnaire (SGRQ) as the fourth possible symptoms measure. The impact of the suggested tools for symptoms of COPD and the different definitions of future risk on the frequency distribution and clinical characteristics of the GOLD groups remain unknown. Methods: Demographic and clinical characteristics were assessed in 542 patients with COPD (57.7% male, age 64.6 [9.0] years, FEV1 54.7 [22.3]% predicted). Health status was assessed by the COPD-specific SGRQ and symptoms of anxiety and depression by the Hospital Anxiety and Depression Scale, anxiety (HADS-A) and depression (HADS-D) subscale. Cohen's Kappa was used to assess agreement between groups. Results: Level of agreement in frequency distribution using the modified Medical Research Council dyspnea (mMRC) scale ≥2, COPD Assessment Test (CAT) ≥10, Clinical COPD Questionnaire (CCQ) ≥1 and SGRQ ≥25 was moderate to very good. Best agreement was reached between CCQ and SGRQ (К = 0.838 or 0.851, p<0.001). Patients classified in mMRC GOLD A reported higher SGRQ scores, higher HADS-A and HADS-D scores compared to patients classified in CAT GOLD A or SGRQ GOLD A. Outcomes were comparable between the risk assessment groups. Conclusions: Choice of the symptom measure impacts GOLD groups more than choice of the exacerbation risk assessment. Health care professionals should be aware that patients are heterogeneous in terms of health status and symptoms of anxiety and depression based on the symptom measure used.
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Affiliation(s)
- Sarah Wilke
- Joint first author.,Department of Research and Education, CIRO+, Centre of Expertise for Chronic Organ Failure, Horn, the Netherlands
| | - Dionne E Smid
- Joint first author.,Department of Research and Education, CIRO+, Centre of Expertise for Chronic Organ Failure, Horn, the Netherlands
| | - Martijn A Spruit
- Department of Research and Education, CIRO+, Centre of Expertise for Chronic Organ Failure, Horn, the Netherlands
| | - Daisy J A Janssen
- Department of Research and Education, CIRO+, Centre of Expertise for Chronic Organ Failure, Horn, the Netherlands.,Centre of Expertise for Palliative Care, Maastricht University Medical Centre, the Netherlands
| | - Jean W M Muris
- Caphri School of Public Health and Primary Care, Department of Family Medicine, Maastricht University, the Netherlands
| | - Thys van der Molen
- Department of General Practice, University of Groningen, University Medical Centre Groningen, the Netherlands
| | - Marjan van den Akker
- Caphri School of Public Health and Primary Care, Department of Family Medicine, Maastricht University, the Netherlands.,Department of General Practice, KU Leuven, Leuven, Belgium
| | - Paul W Jones
- Division of Clinical Science, St. George's University of London, United Kingdom
| | - Emiel F M Wouters
- Department of Research and Education, CIRO+, Centre of Expertise for Chronic Organ Failure, Horn, the Netherlands.,Department of Respiratory Medicine, Maastricht University Medical Centre, the Netherlands
| | - Frits M E Franssen
- Department of Research and Education, CIRO+, Centre of Expertise for Chronic Organ Failure, Horn, the Netherlands
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Price DB, Baker CL, Zou KH, Higgins VS, Bailey JT, Pike JS. Real-world characterization and differentiation of the Global Initiative for Chronic Obstructive Lung Disease strategy classification. Int J Chron Obstruct Pulmon Dis 2014; 9:551-61. [PMID: 24920893 PMCID: PMC4043424 DOI: 10.2147/copd.s62104] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [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 This study aimed to characterize and differentiate the Global Initiative for Chronic Obstructive Lung Disease (GOLD) strategy 2011 cut points through the modified Medical Research Council dyspnea scale (mMRC) and chronic obstructive pulmonary disease (COPD) assessment test (CAT). METHODS Analysis of COPD patient data from the 2012 Adelphi Respiratory Disease Specific Program was conducted in Europe and US. Matched data from physicians and patients included CAT and mMRC scores. Receiver operating characteristic curves and kappa analysis determined a cut point for CAT and mMRC alignment and thus defined patient movement ("movers") within GOLD groups A-D, depending on the tool used. Logistic regression analysis, with a number of physician- and patient-reported covariates, characterized those movers. RESULTS Comparing GOLD-defined high-symptom patients using mMRC and CAT cut points (≥2 and ≥10, respectively), there were 890 (53.65%) movers; 887 of them (99.66%) moved from less symptomatic GOLD groups A and C (using mMRC) to more symptomatic groups B and D (using CAT). For receiver operating characteristic (area under the curve: 0.82, P<0.001) and kappa (maximized: 0.45) recommended CAT cut points of ≥24 and ≥26, movers reduced to 429 and 403 patients, respectively. Logistic regression analysis showed variables significantly associated with movers were related to impact on normal life, age, cough, and sleep (all P<0.05). Within movers, direction of movement was significantly associated with the same variables (all P<0.05). CONCLUSION Use of current mMRC or CAT cut points leads to inconsistencies for COPD assessment classification. It is recommended that cut points are aligned and both tools administered simultaneously for optimal patient care and to allow for closer management of movers. Our research may suggest an opportunity to investigate a combined score approach to patient management based on the worst result of mMRC and CAT. The reduced number of remaining movers may then identify patients who have greater impact of disease and may require a more personalized treatment plan.
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Affiliation(s)
- David B Price
- University of Aberdeen, Division of Applied Health Sciences, Aberdeen, UK
| | - Christine L Baker
- Pfizer Inc, Outcomes and Evidence, Global Health and Value, New York, USA
| | - Kelly H Zou
- Pfizer Inc, Statistical Center for Outcomes, Real-World and Aggregate Data, Global Innovative Pharma Business, New York, USA
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Tan WC, Bourbeau J, Hernandez P, Chapman KR, Cowie R, FitzGerald JM, Marciniuk DD, Maltais F, Buist AS, O'Donnell DE, Sin DD, Aaron SD. Exacerbation-like respiratory symptoms in individuals without chronic obstructive pulmonary disease: results from a population-based study. Thorax 2014; 69:709-17. [PMID: 24706040 PMCID: PMC4112491 DOI: 10.1136/thoraxjnl-2013-205048] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
RATIONALE Exacerbations of COPD are defined clinically by worsening of chronic respiratory symptoms. Chronic respiratory symptoms are common in the general population. There are no data on the frequency of exacerbation-like events in individuals without spirometric evidence of COPD. AIMS To determine the occurrence of 'exacerbation-like' events in individuals without airflow limitation, their associated risk factors, healthcare utilisation and social impacts. METHOD We analysed the cross-sectional data from 5176 people aged 40 years and older who participated in a multisite, population-based study on lung health. The study cohort was stratified into spirometrically defined COPD (post-bronchodilator FEV1/FVC < 0.7) and non-COPD (post bronchodilator FEV1/FVC ≥ 0.7 and without self-reported doctor diagnosis of airway diseases) subgroups and then into those with and without respiratory 'exacerbation-like' events in the past year. RESULTS Individuals without COPD had half the frequency of 'exacerbation-like' events compared with those with COPD. In the non-COPD group, the independent associations with 'exacerbations' included female gender, presence of wheezing, the use of respiratory medications and self-perceived poor health. In the non-COPD group, those with exacerbations were more likely than those without exacerbations to have poorer health-related quality of life (12-item Short-Form Health Survey), miss social activities (58.5% vs 18.8%), miss work for income (41.5% vs 17.3%) and miss housework (55.6% vs 16.5%), p<0.01 to <0.0001. CONCLUSIONS Events similar to exacerbations of COPD can occur in individuals without COPD or asthma and are associated with significant health and socioeconomic outcomes. They increase the respiratory burden in the community and may contribute to the false-positive diagnosis of asthma or COPD.
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Affiliation(s)
- W C Tan
- UBC James Hogg Research Center, Providence Heart + Lung Institute, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - J Bourbeau
- Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, McGill University, Montréal, Quebec, Canada
| | - P Hernandez
- Respirology Division, Department of Medicine, QEII Health Sciences Centre, Dalhousie University, Halifax, Nova Scotia, Canada
| | - K R Chapman
- Asthma & Airway Centre, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - R Cowie
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - J M FitzGerald
- University of British Columbia, Institute for Heart and Lung Health, Vancouver, British Columbia, Canada
| | - D D Marciniuk
- Division of Respirology, Critical Care and Sleep Medicine, and Airway research Group, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - F Maltais
- Centre de Pneumologie, Institute Universitaire de Cardiologie et de Pneumologie de Québec, Quebec, Canada
| | - A S Buist
- Oregon Health and Science University, Portland, Oregon, USA
| | - D E O'Donnell
- Division of Respiratory & Critical Care Medicine, Queen's University, Kingston, Ontario, Canada
| | - D D Sin
- UBC James Hogg Research Center, Providence Heart + Lung Institute, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - S D Aaron
- Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
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Soriano JB, Román-Rodríguez M. A golden goal in 2010, and another GOLD in 2014 in primary care, or vice versa. PRIMARY CARE RESPIRATORY JOURNAL : JOURNAL OF THE GENERAL PRACTICE AIRWAYS GROUP 2014; 23:5-6. [PMID: 24615414 PMCID: PMC6442285 DOI: 10.4104/pcrj.2014.00018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 02/13/2014] [Indexed: 11/08/2022]
Affiliation(s)
- Joan B Soriano
- Medical Epidemiologist, FISIB-IdlSPA Hospital Universitari Son Espases, Palma de Mallorca, Spain
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Miyazaki M, Nakamura H, Chubachi S, Sasaki M, Haraguchi M, Yoshida S, Tsuduki K, Shirahata T, Takahashi S, Minematsu N, Koh H, Nakamura M, Sakamaki F, Terashima T, Sayama K, Jones PW, Asano K, Betsuyaku T. Analysis of comorbid factors that increase the COPD assessment test scores. Respir Res 2014; 15:13. [PMID: 24502760 PMCID: PMC3922022 DOI: 10.1186/1465-9921-15-13] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Accepted: 02/03/2014] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The chronic obstructive pulmonary disease (COPD) Assessment Test (CAT) is a concise health status measure for COPD. COPD patients have a variety of comorbidities, but little is known about their impact on quality of life. This study was designed to investigate comorbid factors that may contribute to high CAT scores. METHODS An observational study at Keio University and affiliated hospitals enrolled 336 COPD patients and 67 non-COPD subjects. Health status was assessed by the CAT, the St. Georges Respiratory Questionnaire (SGRQ), and all components of the Medical Outcomes Study Short-Form 36-Item (SF-36) version 2, which is a generic measure of health. Comorbidities were identified based on patients' reports, physicians' records, and questionnaires, including the Frequency Scale for the Symptoms of Gastro-esophageal reflux disease (GERD) and the Hospital Anxiety and Depression Scale. Dual X-ray absorptiometry measurements of bone mineral density were performed. RESULTS The CAT showed moderate-good correlations with the SGRQ and all components of the SF-36. The presence of GERD, depression, arrhythmia, and anxiety was significantly associated with a high CAT score in the COPD patients. CONCLUSIONS Symptomatic COPD patients have a high prevalence of comorbidities. A high CAT score should alert the clinician to a higher likelihood of certain comorbidities such as GERD and depression, because these diseases may co-exist unrecognized. TRIAL REGISTRATION Clinical trial registered with UMIN (UMIN000003470).
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Affiliation(s)
- Masaki Miyazaki
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Hidetoshi Nakamura
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
- Department of Respiratory Medicine, Saitama Medical University, Saitama, Japan
| | - Shotaro Chubachi
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Mamoru Sasaki
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Mizuha Haraguchi
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Shuichi Yoshida
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Keishi Tsuduki
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Toru Shirahata
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Saeko Takahashi
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Naoto Minematsu
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | | | | | | | - Takeshi Terashima
- Department of Respiratory Medicine, Tokyo Dental College, Chiba, Japan
| | - Koichi Sayama
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Paul W Jones
- Division of Clinical Science, St. George’s University of London, London, UK
| | - Koichiro Asano
- Division of Pulmonary Medicine, Department of Medicine, Tokai University School of Medicine, Kanagawa, Japan
| | - Tomoko Betsuyaku
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
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