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Heraganahally SS, Howarth T, Sorger L, Ben Saad H. Sex differences in pulmonary function parameters among Indigenous Australians with and without chronic airway disease. PLoS One 2022; 17:e0263744. [PMID: 35134094 PMCID: PMC8824342 DOI: 10.1371/journal.pone.0263744] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 01/25/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Studies assessing normative values and sex differences in pulmonary function test parameters (PFTPs) among Indigenous populations are sparse. METHODS PFTPs were compared between male and female Indigenous Australian adults with and without chest radiologically proven chronic airway diseases (CADs). RESULTS 485 adults (56% were female) with no significant difference in age, body mass index or smoking status between sexes were included. Females displayed a higher prevalence of radiology without CADs compared to males (66 vs. 52%, respectively). Among patients without CADs, after adjustment for age, stature and smoking, males displayed significantly higher absolute values of Forced Vital Capacity (FVC) (mean difference, 0.41L (0.21,0.62), p<0.001) and Forced Expiratory Volume in one second (FEV1) (mean difference 0.27L (0.07,0.47), p<0.001), with no significant difference in FEV1/FVC ratio (mean difference -0.02 (-0.06, 0.02), p = 0.174). Male and female patients with radiologically proven CADs demonstrated lower FEV1/FVC values. However, compared to females, males showed significantly greater reductions in pre- [-0.53 (-0.74, -0.32) vs. -0.29 (-0.42, -0.16), p = 0.045] and post- [-0.51 (-0.72, -0.3) vs. -0.27 (-0.39, -0.14), p = 0.049] bronchodilator FEV1. CONCLUSIONS There are significant sex differences in the PFTPs among Indigenous Australians. Recognising these differences may be of value in the accurate diagnosis, management, monitoring and prognostication of CADs in this population.
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Affiliation(s)
- Subash S. Heraganahally
- Department of Respiratory and Sleep Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia
- Flinders University - College of Medicine and Public Health, Adelaide, South Australia, Australia
- Darwin Respiratory and Sleep Health, Darwin Private Hospital, Darwin, Northern Territory, Australia
| | - Timothy Howarth
- Darwin Respiratory and Sleep Health, Darwin Private Hospital, Darwin, Northern Territory, Australia
- College of Health and Human Sciences, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Lisa Sorger
- Department of Medical Imaging, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Helmi Ben Saad
- Faculty of Medicine of Sousse, Laboratory of Physiology, University of Sousse, Sousse, Tunisia
- Farhat HACHED Hospital, Research Laboratory “Heart Failure, LR12SP09”, University of Sousse, Sousse, Tunisia
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2
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Abstract
There are many differences between men and women in risk factor vulnerability and impact, symptom development, presentation, clinical manifestations, and outcomes of chronic obstructive pulmonary disease (COPD). These differences have been inadequately explored, which is of particular concern in view of the delay in diagnosis and treatment that occurs for both men and women, and the need to use all therapies in a targeted and tailored way for best clinical gain and least harm. Women are generally underrepresented in randomized trials, as are non-tobacco-related phenotypes of COPD. We must garner the information available to better describe optimal treatment approaches.
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Affiliation(s)
- Christine Jenkins
- Respiratory Group, The George Institute for Global Health, Sydney, Level 5, 1 King Street, Newtown, New South Wales 2042 Australia; UNSW Medicine and Health, UNSW Sydney, NSW, Australia; Concord Clinical School, University of Sydney, NSW, Australia.
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3
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Roldán A, Forte A, Monteagudo P, Cordellat A, Monferrer-Marín J, Blasco-Lafarga C. Determinants of dynamic inspiratory muscle strength in healthy trained elderly. Postgrad Med 2021; 133:807-816. [PMID: 34148484 DOI: 10.1080/00325481.2021.1945761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND The S-Index assessed by means of electronic devices is a measure of Inspiratory Muscle Strength (IMS) that highly correlates with the maximal inspiratory pressure (MIP). The variables involved when using regression models for the prediction of IMS/MIP depend on both the sample characteristics and the device or protocol used. In light of the scarce information on the influence of physical activity (PA) on IMS in healthy older adults (OA), together with the incorporation of new assessment devices, the objectives of this research are: 1) to determine which factors influence the IMS in a group of trained OA, using a portable electronic device; and 2) to propose a regression model to improve its assessment and training. METHODS One hundred and fifty-nine individuals were assessed for body composition, lung capacity, IMS, and PA. A total of 92 individuals (72.73 ± 4.99 years) were considered for the final sample. RESULTS Using age, sex, and weight as control variables, forced expiratory volume in the first second (FEV1) is the variable which is most likely to be included in the model (80%), without physical fitness appearing to be decisive. In the absence of spirometric variables, cardiorespiratory fitness (6MWT) takes on this role in a predictive model (16%). CONCLUSIONS This is the first study proposing IMS predictive formulas considering spirometry and/or physical fitness results for a Spanish, healthy, and trained OAs population. A predictive formula including also the spirometric variables (mainly the FEV1) might better predict the inspiratory muscle strength. In addition, physical and respiratory functions confirm to be different, so it is necessary for the inspiratory muscles to be trained in a specific way.
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Affiliation(s)
- A Roldán
- Sports Performance and Physical Fitness Research Group (UIRFIDE), Physical Education and Sports Department, University of Valencia, Valencia, Spain
| | - A Forte
- Statistics and Operations Research Department, University of Valencia, Valencia, Spain
| | - P Monteagudo
- Sports Performance and Physical Fitness Research Group (UIRFIDE), Physical Education and Sports Department, University of Valencia, Valencia, Spain.,Education and Specific Didactics Department, Jaime I University, Castellón, Spain
| | - A Cordellat
- Sports Performance and Physical Fitness Research Group (UIRFIDE), Physical Education and Sports Department, University of Valencia, Valencia, Spain
| | - J Monferrer-Marín
- Sports Performance and Physical Fitness Research Group (UIRFIDE), Physical Education and Sports Department, University of Valencia, Valencia, Spain
| | - C Blasco-Lafarga
- Sports Performance and Physical Fitness Research Group (UIRFIDE), Physical Education and Sports Department, University of Valencia, Valencia, Spain
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4
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Buttery SC, Zysman M, Vikjord SAA, Hopkinson NS, Jenkins C, Vanfleteren LEGW. Contemporary perspectives in COPD: Patient burden, the role of gender and trajectories of multimorbidity. Respirology 2021; 26:419-441. [PMID: 33751727 DOI: 10.1111/resp.14032] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 02/21/2021] [Indexed: 12/13/2022]
Abstract
An individual's experience of COPD is determined by many factors in addition to the pathological features of chronic bronchitis and emphysema and the symptoms that derive directly from them. Multimorbidity is the norm rather than the exception, so most people with COPD are living with a range of other medical problems which can decrease overall quality of life. COPD is caused by the inhalation of noxious particles or gases, in particular tobacco smoke, but also by early life disadvantage impairing lung development and by occupations where inhaled exposures are common (e.g. industrial, farming and cleaning work). Wealthy people are therefore relatively protected from developing COPD and people who do develop the condition may have reduced resources to cope. COPD is also no longer a condition that predominantly affects men. The prevalence of COPD among women has equalled that of men since 2008 in many high-income countries, due to increased exposure to tobacco, and in low-income countries due to biomass fuels. COPD is one of the leading causes of death in women in the USA, and death rates attributed to COPD in women in some countries are predicted to overtake those of men in the next decade. Many factors contribute to this phenomenon, but in addition to socioeconomic and occupational factors, there is increasing evidence of a higher susceptibility of females to smoking and pollutants. Quality of life is also more significantly impaired in women. Although most medications (bronchodilators and inhaled corticosteroids) used to treat COPD demonstrate similar trends for exacerbation prevention and lung function improvement in men and women, this is an understudied area and clinical trials frequently have a preponderance of males. A better understanding of gender-based predictors of efficacy of all therapeutic interventions is crucial for comprehensive patient care. There is an urgent need to recognize the increasing burden of COPD in women and to facilitate global improvements in disease prevention and management in this specific population. Many individuals with COPD follow a trajectory of both lung function decline and also multimorbidity. Unfavourable lung function trajectories throughout life have implications for later development of other chronic diseases. An enhanced understanding of the temporal associations underlying the development of coexisting diseases is a crucial first step in unravelling potential common disease pathways. Lessons can be learned from exploring disease trajectories of other NCD as well as multimorbidity development. Further research will be essential to explain how early life risk factors commonly influence trajectories of COPD and other diseases, how different diseases develop in relation to each other in a temporal way and how this ultimately leads to different multimorbidity patterns in COPD. This review integrates new knowledge and ideas pertaining to three broad themes (i) the overall burden of disease in COPD, (ii) an unappreciated high burden in women and (iii) the contrast of COPD trajectories and different multimorbidity patterns with trajectories of other NCD. The underlying pathology of COPD is largely irreversible, but many factors noted in the review are potentially amenable to intervention. Health and social care systems need to ensure that effective treatment is accessible to all people with the condition. Preventive strategies and treatments that alter the course of disease are crucial, particularly for patients with COPD as one of many problems.
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Affiliation(s)
- Sara C Buttery
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Maéva Zysman
- Centre de Recherche cardio-thoracique de Bordeaux, Univ-Bordeaux, Pessac, France.,Service des Maladies Respiratoires, CHU Bordeaux, Pessac, France
| | - Sigrid A A Vikjord
- Department of Medicine and Rehabilitation, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway.,HUNT Research Centre, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Levanger, Norway
| | | | - Christine Jenkins
- Respiratory Group, The George Institute for Global Health, Sydney, NSW, Australia
| | - Lowie E G W Vanfleteren
- COPD Center, Department of Respiratory Medicine and Allergology, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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5
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Baha A, Kokturk N. Physician's attitude against COPD guidelines and the choice of first-line treatment for COPD. Respir Med 2020; 176:106273. [PMID: 33271467 DOI: 10.1016/j.rmed.2020.106273] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 10/30/2020] [Accepted: 11/26/2020] [Indexed: 10/22/2022]
Abstract
AIM Our aim was to evaluate changes in attitudes of pulmonologists in Turkey towards COPD guidelines and their choice of first-line treatments for COPD patients. MATERIAL-METHOD 333 physicians who completed the questionnaire were included in this cross-sectional questionnaire study. The questionnaire contained demographic data, professional information, extent of guideline use, rationales behind using or not using a guideline. The data was compared with the same survey conducted previously in 2011 and was analyzed by appropriate statistical methods. RESULTS 80 physicians were resident pulmonologists (24%), 250 physicians were specialists (75.1%). 298 (89.5%) physicians reported that they follow at least one guideline for selection of the appropriate treatment in COPD. The current application of guidelines when compared with the first survey in 2011, was found to be decreased, 91.2% and 89.5%, respectively (p = 0.07). 46.8% (n = 156) of participants thought that guidelines provided the physicians more legal protection (p < 0.001). The number of physicians who didn't follow the guidelines due to workload increased over this period of time (36.8% in 2011, 85.3% in 2018, p < 0.001). The number of physicians using inhaler steroid combinations as their first choice of treatment was found to be similar with the previous survey (p = 0.909). CONCLUSION According to the results of previous questionnaire, the application of COPD guidelines has decreased. The number of pulmonologists who declared they have no time for following or applying guidelines has profoundly increased since 2011. Despite the warnings of these guidelines, the use of inhaler steroid combination as a first treatment option in COPD is still common.
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Affiliation(s)
- Ayse Baha
- Near East University Faculty of Medicine, Department of Pulmonary Medicine, Mersin-10, Turkey.
| | - Nurdan Kokturk
- Gazi University Faculty of Medicine, Department of Pulmonary Medicine, Ankara, Turkey
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6
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Gazourian L, Thedinger WB, Regis SM, Pagura EJ, Price LL, Gawlik M, Stefanescu CF, Lamb C, Rieger-Christ KM, Singh H, Casasola M, Walker AR, Rupal A, Patel AS, Come CE, Sanayei AM, Long WP, Rizzo GS, McKee AB, Washko GR, San Jose Estepar R, Wald C, McKee BJ, Thomson CC, Liesching TN. Qualitative emphysema and risk of COPD hospitalization in a multicenter CT lung cancer screening cohort study. Respir Med 2020; 176:106245. [PMID: 33253972 DOI: 10.1016/j.rmed.2020.106245] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 11/15/2020] [Accepted: 11/17/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND In the United States, 9 to 10 million Americans are estimated to be eligible for computed tomographic lung cancer screening (CTLS). Those meeting criteria for CTLS are at high-risk for numerous cardio-pulmonary co-morbidities. The objective of this study was to determine the association between qualitative emphysema identified on screening CTs and risk for hospital admission. STUDY DESIGN AND METHODS We conducted a retrospective multicenter study from two CTLS cohorts: Lahey Hospital and Medical Center (LHMC) CTLS program, Burlington, MA and Mount Auburn Hospital (MAH) CTLS program, Cambridge, MA. CTLS exams were qualitatively scored by radiologists at time of screening for presence of emphysema. Multivariable Cox regression models were used to evaluate the association between CT qualitative emphysema and all-cause, COPD-related, and pneumonia-related hospital admission. RESULTS We included 4673 participants from the LHMC cohort and 915 from the MAH cohort. 57% and 51.9% of the LHMC and MAH cohorts had presence of CT emphysema, respectively. In the LHMC cohort, the presence of emphysema was associated with all-cause hospital admission (HR 1.15, CI 1.07-1.23; p < 0.001) and COPD-related admission (HR 1.64; 95% CI 1.14-2.36; p = 0.007), but not with pneumonia-related admission (HR 1.52; 95% CI 1.27-1.83; p < 0.001). In the MAH cohort, the presence of emphysema was only associated with COPD-related admission (HR 2.05; 95% CI 1.07-3.95; p = 0.031). CONCLUSION Qualitative CT assessment of emphysema is associated with COPD-related hospital admission in a CTLS population. Identification of emphysema on CLTS exams may provide an opportunity for prevention and early intervention to reduce admission risk.
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Affiliation(s)
- Lee Gazourian
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Lahey Hospital & Medical Center, Burlington, MA, 01805, USA.
| | | | - Shawn M Regis
- Department of Radiation Oncology, Lahey Hospital & Medical Center, Burlington, MA, 01805, USA
| | - Elizabeth J Pagura
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Lahey Hospital & Medical Center, Burlington, MA, 01805, USA
| | - Lori Lyn Price
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, 02111, USA; Tufts Clinical and Translational Science Institute, Tufts University, Boston, MA, 02111, USA
| | - Melissa Gawlik
- Quality and Safety, Lahey Hospital & Medical Center, Burlington, MA, 01805, USA
| | | | - Carla Lamb
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Lahey Hospital & Medical Center, Burlington, MA, 01805, USA
| | | | - Harpreet Singh
- Department of Medicine, Mount Auburn Hospital, Cambridge, MA, 02138, USA
| | - Marcel Casasola
- Department of Medicine, Mount Auburn Hospital, Cambridge, MA, 02138, USA
| | - Alexander R Walker
- Department of Medicine, Mount Auburn Hospital, Cambridge, MA, 02138, USA
| | - Arashdeep Rupal
- Department of Medicine, Mount Auburn Hospital, Cambridge, MA, 02138, USA
| | - Avignat S Patel
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Lahey Hospital & Medical Center, Burlington, MA, 01805, USA
| | - Carolyn E Come
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Lahey Hospital & Medical Center, Burlington, MA, 01805, USA
| | - Ava M Sanayei
- Tufts University School of Medicine, Boston, MA, 02111, USA
| | - William P Long
- Tufts University School of Medicine, Boston, MA, 02111, USA
| | - Giulia S Rizzo
- Department of General Surgery, UMass Memorial Medical Center, Worcester, MA, 01655, USA
| | - Andrea B McKee
- Department of Radiation Oncology, Lahey Hospital & Medical Center, Burlington, MA, 01805, USA
| | - George R Washko
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA, 02115, USA; Applied Chest Imaging Laboratories, Brigham and Women's Hospital, Boston, MA, 02115, USA
| | - Raul San Jose Estepar
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA, 02115, USA; Department of Radiology, Brigham and Women's Hospital Boston, MA, 02115, USA
| | - Christoph Wald
- Department of Radiology, Lahey Hospital & Medical Center, Burlington, MA, 01805, USA
| | - Brady J McKee
- Department of Radiology, Lahey Hospital & Medical Center, Burlington, MA, 01805, USA
| | - Carey C Thomson
- Department of Medicine, Mount Auburn Hospital, Cambridge, MA, 02138, USA; Harvard Medical School, Boston, MA, 02115, USA; Division of Pulmonary and Critical Care Medicine, Mount Auburn Hospital, Cambridge, MA, 02138, USA
| | - Timothy N Liesching
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Lahey Hospital & Medical Center, Burlington, MA, 01805, USA
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7
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Groeneveld JM, Ballering AV, van Boven K, Akkermans RP, Olde Hartman TC, Uijen AA. Sex differences in incidence of respiratory symptoms and management by general practitioners. Fam Pract 2020; 37:631-636. [PMID: 32473018 PMCID: PMC7571773 DOI: 10.1093/fampra/cmaa040] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Differences between women and men play an important role in lung physiology and epidemiology of respiratory diseases, but also in the health care processes. OBJECTIVE To analyse sex differences in patients encountering their general practitioner (GP) with respiratory symptoms with regard to incidence, GP's management and final diagnoses. METHODS Retrospective cohort study, using data of the Dutch Practice Based Research Network. All patients who encountered their GP from 01-07-2013 until 30-06-2018 with a new episode of care starting with a reason for encounter in the respiratory category (R) of the ICPC-2 classification were included (n = 16 773). Multi-level logistic regression was used to analyse influence of patients' sex on management of GPs with adjustment for possible confounders. RESULTS We found a significant higher incidence of respiratory symptoms in women than in men: 230/1000 patient years [95% confidence interval (CI) 227-232] and 186/1000 patient years (95% CI 183-189), respectively. When presenting with cough, GPs are more likely to perform physical examination [odds ratio (OR) 1.22; 95% CI 1.11-1.35] and diagnostic radiology (OR 1.25; 95% CI 1.08-1.44), but less likely to prescribe medication (OR 0.88; 95% CI 0.82-0.95) in men. When visiting the GP with dyspnoea, men more often undergo diagnostic imaging (OR 1.32; 95% CI 1.05-1.66) and are more often referred to a specialist (OR 1.35; 95% CI 1.13-1.62). CONCLUSIONS Women encounter their GP more frequently with respiratory symptoms than men and GPs perform more diagnostic investigations in men. We suggest more research in general practice focussing on sex differences and possible confounders.
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Affiliation(s)
- Johanna M Groeneveld
- Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Aranka V Ballering
- Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University of Groningen, University Medical Center of Groningen, Groningen, The Netherlands
| | - Kees van Boven
- Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Reinier P Akkermans
- Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Tim C Olde Hartman
- Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Annemarie A Uijen
- Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands
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8
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Isgrò V, Sultana J, Fontana A, Ientile V, Alecci U, Scoglio R, Magliozzo F, Scondotto S, Caramori G, Cazzola M, Trifirò G. Gender differences in COPD management in a Sicilian general practice setting: a cohort study evaluating the impact of educational interventions. ERJ Open Res 2020; 6:00279-2020. [PMID: 32832528 PMCID: PMC7430144 DOI: 10.1183/23120541.00279-2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 05/21/2020] [Indexed: 01/30/2023] Open
Abstract
Aim The aim of this study was to measure gender differences among COPD patients' quality of care (QOC) before and after two educational interventions in Southern Italy. Methods In this prospective cohort study, COPD patients were identified from primary care electronic medical records (EMRs). Twelve process indicators concerning diagnosis, preventative measures and therapeutic processes were developed as a measure of QOC. Educational interventions consisted of clinical seminars and audits on COPD QOC at baseline, and at 12 and 24 months. QOC indicators were stratified by gender: odds ratios (ORs) (males as reference group) of having a good QOC indicator were calculated at baseline, 12 and 24 months, with 95% confidence intervals (CIs) using hierarchical generalised linear models. Results Of 46 326 people registered in the EMRs, 1463 COPD patients (3.1%) were identified, of which 37% were women. QOC indicators reflecting best practice 24 months after the educational programme were generally not different to baseline, often favouring men. On the other hand, the composite global QOC indicator suggested that while a good overall QOC at baseline was significantly higher in men than women (OR: 0.74; 95% CI: 0.57–0.96), it became nonsignificant at 24 months (OR: 0.96; 95% CI: 0.72–1.29). Conclusions Specific QOC indicators among COPD patients often favoured men. However, several gender disparities seen at baseline disappeared at 24 months, suggesting that even general educational interventions which do not target gender can improve the gender disparity in QOC. This observational study shows that quality of care (QOC) is better among male COPD patients in primary care. Planned educational interventions over 24 months abolished gender difference in global QOC, although not in all QOC items.https://bit.ly/3cfwPST
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Affiliation(s)
- Valentina Isgrò
- Dept of Biomedical Sciences, Dentistry and Functional and Morphologic Imaging, University of Messina, Messina, Italy.,These authors contributed equally
| | - Janet Sultana
- Dept of Biomedical Sciences, Dentistry and Functional and Morphologic Imaging, University of Messina, Messina, Italy.,These authors contributed equally
| | - Andrea Fontana
- Unit of Biostatistics, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Valentina Ientile
- Dept of Biomedical Sciences, Dentistry and Functional and Morphologic Imaging, University of Messina, Messina, Italy
| | - Umberto Alecci
- Italian Society of General Practice (SIMG), Florence, Italy
| | | | | | | | - Gaetano Caramori
- Dept of Biomedical Sciences, Dentistry and Functional and Morphologic Imaging, University of Messina, Messina, Italy
| | - Mario Cazzola
- Dept of Experimental Medicine, Tor Vergata University, Rome, Italy
| | - Gianluca Trifirò
- Dept of Biomedical Sciences, Dentistry and Functional and Morphologic Imaging, University of Messina, Messina, Italy.,Unit of Clinical Pharmacology, G. Martino Academic Hospital, Messina, Italy
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9
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Lakshmanan S, Jankowich M, Wu WC, Blackshear C, Abbasi S, Choudhary G. Gender Differences in Risk Factors Associated With Pulmonary Artery Systolic Pressure, Heart Failure, and Mortality in Blacks: Jackson Heart Study. J Am Heart Assoc 2020; 9:e013034. [PMID: 31902323 PMCID: PMC6988159 DOI: 10.1161/jaha.119.013034] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background Pulmonary hypertension is prevalent in black individuals, especially women. Elevated pulmonary artery systolic pressure (PASP) is associated with significant morbidity and mortality. Methods and Results We developed linear and proportional hazards models to examine potential gender‐related differences in risk factors for elevated PASP (estimated by transthoracic echocardiography) and PASP‐associated clinical outcomes (incident heart failure admissions and mortality) in JHS (Jackson Heart Study) participants. JHS is a prospective observational cohort study of heart disease in blacks from the Jackson, Mississippi, metropolitan area. The study cohort included participants with measurable transtricuspid gradients (n=3286) at the time of first/baseline examination, 2000–2004. The median age (interquartile range) of patients at baseline was 57.8 years (18.6 years) with 67.5% being women. The median PASP at baseline was higher in women (men: 26 mm Hg [interquartile range 8], women: 27 mm Hg [interquartile range 9]. In multivariate linear regression analyses with PASP, significant gender interactions were noted for age, chronic lung disease, pulse pressure, and obstructive spirometry. In exploratory analyses stratified by gender, body mass index, and obstructive and restrictive spirometry patterns were associated with PASP in women, and chronic lung disease was associated with PASP in men. Age and pulse pressure had stronger associations with PASP in women compared with men. There was a significant interaction between gender and PASP for heart failure admissions but not mortality. Conclusions Specific cardiopulmonary risk factors are associated with elevated PASP in women and men. Women with elevated PASP have a higher risk of incident heart failure admissions. Future research is needed to understand associated gender‐specific mechanisms that can help identify targeted prevention and management strategies for patients with elevated PASP.
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Affiliation(s)
- Suvasini Lakshmanan
- Division of Cardiology Providence VA Medical Center Providence RI.,Alpert Medical School of Brown University Providence RI
| | - Matthew Jankowich
- Alpert Medical School of Brown University Providence RI.,Division of Pulmonary, Critical Care and Sleep Medicine Providence VA Medical Center Providence RI
| | - Wen-Chih Wu
- Division of Cardiology Providence VA Medical Center Providence RI.,Alpert Medical School of Brown University Providence RI
| | - Chad Blackshear
- Department of Data Science University of Mississippi Jackson MS
| | - Siddique Abbasi
- Division of Cardiology Providence VA Medical Center Providence RI.,Alpert Medical School of Brown University Providence RI
| | - Gaurav Choudhary
- Division of Cardiology Providence VA Medical Center Providence RI.,Alpert Medical School of Brown University Providence RI
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10
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Stolz D, Kostikas K, Loefroth E, Fogel R, Gutzwiller FS, Conti V, Cao H, Clemens A. Differences in COPD Exacerbation Risk Between Women and Men: Analysis From the UK Clinical Practice Research Datalink Data. Chest 2019; 156:674-684. [PMID: 31103696 DOI: 10.1016/j.chest.2019.04.107] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 04/23/2019] [Accepted: 04/29/2019] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Historically, COPD has been considered to affect mostly older men with a history of smoking; however, in recent times, its prevalence and mortality rates have steadily increased among women. OBJECTIVES The goal of this study was to systematically assess differences in COPD expression between women and men in UK primary care clinics who were newly diagnosed with COPD. METHODS This retrospective cohort study compared women and men with an incident diagnosis of COPD by using electronic medical records data from the Clinical Practice Research Datalink and linked Hospital Episode Statistics data. The overall study period was between January 1, 2006, and February 28, 2016; patients with an incident diagnosis of COPD between January 1, 2010, and February 28, 2015, were analyzed. RESULTS A cohort of 22,429 patients were identified as incident patients and included in the study; 48% of patients with COPD were women. The risk of first moderate or severe exacerbation was 17% greater in women than in men (hazard ratio, 1.17; 95% CI, 1.12-1.23), with a median time to first exacerbation of 504 days for women and 637 days for men. These differences were more prominent in the younger age group (≥ 40 years to < 65 years), as well as in Global Initiative for Chronic Obstructive Lung Disease 2016 groups B, C, and D and in individuals with moderate to severe airflow obstruction. The annual rate of moderate or severe exacerbations was higher in women compared with men in the first, second, and third year of follow-up. CONCLUSIONS These results highlight the unmet need for appropriate identification and management of women with COPD in clinical practice.
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Affiliation(s)
- Daiana Stolz
- Clinic of Respiratory Medicine and Pulmonary Cell Research, University Hospital, Basel, Switzerland
| | - Konstantinos Kostikas
- Clinic of Respiratory Medicine and Pulmonary Cell Research, University Hospital, Basel, Switzerland; Respiratory Medicine Department, University of Ioannina Medical School, Ioannina, Greece.
| | | | - Robert Fogel
- Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | | | | | - Hui Cao
- Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | - Andreas Clemens
- Novartis Pharma AG, Basel, Switzerland; Heart Center Freiburg University, Cardiology and Angiology I, Faculty of Medicine, Freiburg, Germany
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11
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Åberg J, Hasselgren M, Montgomery S, Lisspers K, Ställberg B, Janson C, Sundh J. Sex-related differences in management of Swedish patients with a clinical diagnosis of chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis 2019; 14:961-969. [PMID: 31123398 PMCID: PMC6511243 DOI: 10.2147/copd.s193311] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Accepted: 02/25/2019] [Indexed: 01/15/2023] Open
Abstract
Purpose: Women with chronic obstructive pulmonary disease (COPD) have more symptoms, more exacerbations, lower health status scores, and more comorbidity. However, it is unclear whether management of COPD differs by sex. The aim of the study was to investigate differences by sex in the care of patients with COPD. Patients and methods: The population included 1329 primary and secondary care patients with a doctor´s diagnosis of COPD in central Sweden. Data were obtained from patient questionnaires and included patient characteristics and data on achieved COPD care. Analyses included cross-tabulations, chi-squared test and multiple logistic regression using several measures in COPD management as dependent variables, female sex as independent variable, and with adjustment for age groups, previous exacerbations, COPD Assessment Test, level of dyspnea assessed by the modified Medical Research Council scale, comorbid conditions, self-rated moderate/severe disease, level of education and body mass index. Results: Women were more likely to receive triple therapy (OR 1.86 (95% CI 1.38–2.51)), to have any maintenance treatment (OR 1.82 (95% CI 1.31–2.55)), to be on sick leave (OR 2.16 (95% CI 1.19–3.93)), to have received smoking cessation support (OR 1.80 (95% CI 1.18–2.75)) and to have had pneumococcal vaccination (OR 1.82 (95% CI 1.37–2.43)), all independently of age, severity of disease or other potential confounders. Conclusion: Management of COPD differs by sex, with women being more actively managed than men. It is unclear whether this is due to patient- or care-related factors.
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Affiliation(s)
- Joakim Åberg
- School of Medical Sciences, Örebro University, Örebro 70185, Sweden
| | | | - Scott Montgomery
- Clinical Epidemiology and Biostatistics, Örebro University, Örebro 70182, Sweden.,Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Epidemiology and Public Health, University College, London, UK
| | - Karin Lisspers
- Department of Public Health and Caring Sciences, Family Medicine and Preventive medicine, Uppsala University, Uppsala 75122, Sweden
| | - Björn Ställberg
- Department of Public Health and Caring Sciences, Family Medicine and Preventive medicine, Uppsala University, Uppsala 75122, Sweden
| | - Christer Janson
- Department of Medical Sciences, Respiratory, Allergy & Sleep Research, Uppsala University, Uppsala 75105, Sweden
| | - Josefin Sundh
- Department of Respiratory Medicine, School of Medical Sciences, Örebro University, Örebro 70185, Sweden
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12
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Terry DR, Nguyen H, Kim JA, Islam MR. Factors contributing to COPD hospitalisations from 2010 to 2015: Variation among rural and metropolitan Australians. CLINICAL RESPIRATORY JOURNAL 2019; 13:306-313. [PMID: 30816003 DOI: 10.1111/crj.13012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 01/21/2019] [Accepted: 02/24/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Rural and remote populations experience the greatest burden of chronic obstructive pulmonary disease (COPD), the fifth leading cause of death in Australia. Currently there is a need to prioritise health services to improve health outcomes among those at higher risk of COPD. OBJECTIVES To investigate the differences in COPD hospitalisation between rural and urban populations and determine predictive factors contributing to COPD hospitalisation. METHODS Statewide hospitalisation data from 2010 to 2015 were obtained through the Victorian Admitted Episodes Dataset and other key data sets. The rates of hospitalisation were analysed using hierarchical multiple regression to examine the association between COPD hospitalisations and a number of predictor variables. RESULTS The highest COPD incidence occurred in metropolitan males aged 85 years of age and older (35.092 hospitalisations per 1000 population). Among metropolitan residents, smoking, population density and household income had a significant association with COPD hospitalisations for both sexes. Among rural males, smoking rates, household income and rural land use (farming) were significant predictors of COPD hospitalisations. There was an overall stability in statewide COPD hospitalisation over the 5 years to 2015, P = 0.420. CONCLUSION This investigation highlights many rural and regional areas have much lower COPD hospitalisation rates than metropolitan areas. Between males and females, there are heterogenetic factors that contribute to the significant variation associated with COPD hospitalisation in metropolitan and rural areas, such as rural land use among rural males. This indicates that risk factor assessments, beyond smoking alone, need to be individualised and prioritised in practice to optimise care.
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Affiliation(s)
- Daniel R Terry
- School of Nursing and Healthcare Professions, Federation University Australia, Ballarat, Victoria, Australia
| | - Hoang Nguyen
- Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, Tasmania, Australia
| | - Jeong-Ah Kim
- School of Nursing and Healthcare Professions, Federation University Australia, Ballarat, Victoria, Australia
| | - Md Rafiqul Islam
- Department of Rural Health, The University of Melbourne, Shepparton, Victoria, Australia.,Goulburn Valley Health, Shepparton, Victoria, Australia.,School of Health and Social Development, Deakin University, Burwood, Victoria, Australia
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13
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Fisk M, McMillan V, Brown J, Holzhauer-Barrie J, Khan MS, Baxter N, Roberts CM. Inaccurate diagnosis of COPD: the Welsh National COPD Audit. Br J Gen Pract 2019; 69:e1-e7. [PMID: 30559109 PMCID: PMC6301368 DOI: 10.3399/bjgp18x700385] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Accepted: 08/20/2018] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND The diagnosis of chronic obstructive pulmonary disease (COPD) is confirmed with spirometry demonstrating persistent airflow obstruction. AIM To evaluate the clinical characteristics and management of patients in primary care on COPD registers with spirometry incompatible with COPD. DESIGN AND SETTING A primary care audit of Welsh COPD Read-Coded patient data from the Quality and Outcomes Framework (QOF) COPD register in Wales. METHOD Patients on the QOF COPD register with incompatible spirometry (post-bronchodilator forced expiratory lung volume in 1 second/forced vital capacity [FEV1/FVC] ratio ≥0.70) were compared with those with compatible spirometry (FEV1/FVC <0.70). RESULTS This audit included 63% of Welsh practices contributing 48 105 patients. Only 19% (n = 8957) of patients were post-bronchodilator FEV1/FVC Read-Coded and were included in this study. Of these, 75% (n = 6702) had compatible spirometry and 25% (n = 2255) did not. Patients with incompatible spirometry were more likely female (P = 0.009), never-smokers (P<0.001), had higher body mass index (P<0.001), and better mean FEV1 (P<0.001). Medical Research Council (MRC) breathlessness scores, exacerbation frequency, and asthma co-diagnosis were similar between groups. Patients in both groups were just as likely to receive inhaled corticosteroid (ICS) and long-acting beta-agonists (LABAs), but patients with incompatible spirometry were less likely to receive long-acting muscarinic antagonists (LAMAs) (P<0.001) or LABA/ICS (P = 0.002) combinations. CONCLUSION Patients on the COPD QOF register with spirometry incompatible with COPD are symptomatic and managed using significant resources. If quality of care and effective resource use are to be improved, focus must be given to correct diagnosis in this group.
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Affiliation(s)
- Marie Fisk
- Experimental Medicine and Immunotherapeutics (EMIT) Department, University of Cambridge, Cambridge
| | | | - James Brown
- Royal Free London NHS Foundation Trust and UCL Respiratory, Division of Medicine, University College London, London
| | | | | | - Noel Baxter
- National COPD Audit Programme Primary Care Workstream, Royal College of Physicians, London
| | - C Michael Roberts
- National COPD Audit Programme; associate director, Clinical Effectiveness and Evaluation Unit, Care Quality Improvement Department, Royal College of Physicians, London
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14
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Kopitovic I, Bokan A, Andrijevic I, Ilic M, Marinkovic S, Milicic D, Vukoja M. Frequency of COPD in health care workers who smoke. J Bras Pneumol 2017; 43:351-356. [PMID: 29160380 PMCID: PMC5790652 DOI: 10.1590/s1806-37562017000000028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 04/14/2017] [Indexed: 11/28/2022] Open
Abstract
Objective: COPD is one of the major causes of morbidity and mortality worldwide. Health care providers should counsel their smoking patients with COPD to quit smoking as the first treatment step. However, in countries with high prevalences of smoking, health care workers may also be smokers. The aim of this study was to determine the frequency and severity of COPD in health care workers who smoke. Methods: This was a cross-sectional study. All health care workers who smoke, from nine health care centers in Serbia, were invited to participate in the study and perform spirometry. The diagnosis of COPD was based on a post-bronchodilator FEV1/FVC ratio of < 0.70. All patients completed the COPD Assessment Test and the Fagerström Test for Nicotine Dependence. Results: The study involved 305 subjects, and 47 (15.4%) were male. The mean age of the participants was 49.0 ± 6.5 years. Spirometry revealed obstructive ventilatory defect in 33 subjects (10.8%); restrictive ventilatory defect, in 5 (1.6%); and small airway disease, in 96 (31.5%). A diagnosis of COPD was made in 29 patients (9.5%), 25 (86.2%) of whom were newly diagnosed. On the basis of the Global Initiative for COPD guidelines, most COPD patients belonged to groups A or B (n = 14; 48.2%, for both); 1 belonged to group D (3.6%); and none, to group C. Very high nicotine dependence was more common in those with COPD than in those without it (20.7% vs. 5.4%, p = 0.01). Conclusions: In this sample of health care workers, the frequency of COPD was comparable with that in the general population. The presence of COPD in health care workers who smoke was associated with higher nicotine dependence.
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Affiliation(s)
- Ivan Kopitovic
- . Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Republic of Serbia.,. Medical Faculty Novi Sad, University of Novi Sad, Novi Sad, Republic of Serbia
| | - Aleksandar Bokan
- . Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Republic of Serbia.,. Medical Faculty Novi Sad, University of Novi Sad, Novi Sad, Republic of Serbia
| | - Ilija Andrijevic
- . Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Republic of Serbia.,. Medical Faculty Novi Sad, University of Novi Sad, Novi Sad, Republic of Serbia
| | - Miroslav Ilic
- . Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Republic of Serbia.,. Medical Faculty Novi Sad, University of Novi Sad, Novi Sad, Republic of Serbia
| | - Sanja Marinkovic
- . General Hospital Sremska Mitrovica, Sremska Mitrovica, Republic of Serbia
| | - Dragana Milicic
- . Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Republic of Serbia.,. Medical Faculty Novi Sad, University of Novi Sad, Novi Sad, Republic of Serbia
| | - Marija Vukoja
- . Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Republic of Serbia.,. Medical Faculty Novi Sad, University of Novi Sad, Novi Sad, Republic of Serbia
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