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Buttery SC, Lewis A, Alzetani A, Bolton CE, Curtis KJ, Dodd JW, Habib AM, Hussain A, Havelock T, Jordan S, Kallis C, Kemp SV, Kirk A, Lawson RA, Mahadeva R, Munavvar M, Naidu B, Rathinam S, Shackcloth M, Shah PL, Tenconi S, Hopkinson NS. Survival following lung volume reduction procedures: results from the UK Lung Volume Reduction (UKLVR) registry. BMJ Open Respir Res 2024; 11:e002092. [PMID: 38423954 PMCID: PMC10910650 DOI: 10.1136/bmjresp-2023-002092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 01/26/2024] [Indexed: 03/02/2024] Open
Abstract
INTRODUCTION Lung volume reduction surgery (LVRS) and endobronchial valve (EBV) placement can produce substantial benefits in appropriately selected people with emphysema. The UK Lung Volume Reduction (UKLVR) registry is a national multicentre observational study set up to support quality standards and assess outcomes from LVR procedures at specialist centres across the UK. METHODS Data were analysed for all patients undergoing an LVR procedure (LVRS/EBV) who were recruited into the study at participating centres between January 2017 and June 2022, including; disease severity and risk assessment, compliance with guidelines for selection, procedural complications and survival to February 2023. RESULTS Data on 541 patients from 14 participating centres were analysed. Baseline disease severity was similar in patients who had surgery n=244 (44.9%), or EBV placement n=219 (40.9%), for example, forced expiratory volume in 1 s (FEV1) 32.1 (12.1)% vs 31.2 (11.6)%. 89% of cases had discussion at a multidisciplinary meeting recorded. Median (IQR) length of stay postprocedure for LVRS and EBVs was 12 (13) vs 4 (4) days(p=0.01). Increasing age, male gender and lower FEV1%predicted were associated with mortality risk, but survival did not differ between the two procedures, with 50 (10.8%) deaths during follow-up in the LVRS group vs 45 (9.7%) following EBVs (adjusted HR 1.10 (95% CI 0.72 to 1.67) p=0.661) CONCLUSION: Based on data entered in the UKLVR registry, LVRS and EBV procedures for emphysema are being performed in people with similar disease severity and long-term survival is similar in both groups.
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Affiliation(s)
- S C Buttery
- National Heart and Lung Institute, Imperial College, London, UK
- Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - A Lewis
- Department of Health Sciences, Brunel University London, Uxbridge, UK
| | - A Alzetani
- University Hospital Southampton, Southampton, UK
| | - C E Bolton
- NIHR Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, UK
- Nottingham University Hospitals Trust, City Hospital Campus, Nottingham, UK
| | - K J Curtis
- University Hospitals Bristol and Weston, Bristol, UK
| | - J W Dodd
- Academic Respiratory Unit, University of Bristol, Bristol, UK
- North Bristol Lung Centre, North Bristol NHS Trust, Bristol, UK
| | - A M Habib
- New Cross Hospital, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
| | - A Hussain
- Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - T Havelock
- University Hospital Southampton, Southampton, UK
| | - S Jordan
- Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - C Kallis
- National Heart and Lung Institute, Imperial College, London, UK
| | - S V Kemp
- National Heart and Lung Institute, Imperial College, London, UK
- Nottingham University Hospitals Trust, City Hospital Campus, Nottingham, UK
| | - A Kirk
- Department of Thoracic Surgery, West of Scotland Regional Heart and Lung Centre, Golden Jubilee National Hospital, West Dunbartonshire, Scotland, UK
| | - R A Lawson
- Northern General Hospital, Sheffield, UK
| | | | - M Munavvar
- Lancashire Teaching Hospitals NHS Trust, Preston, UK
| | - B Naidu
- Heartlands Hospital, Birmingham Teaching Hospitals, Birmingham, UK
| | - S Rathinam
- Thoracic Surgery, Glenfield Hospital, Leicester, UK
| | - M Shackcloth
- Liverpool Heart and Chest Hospital, Liverpool, UK
| | - P L Shah
- National Heart and Lung Institute, Imperial College, London, UK
- Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - S Tenconi
- Northern General Hospital, Sheffield, UK
| | - N S Hopkinson
- National Heart and Lung Institute, Imperial College, London, UK
- Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK
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Murrieta-Álvarez I, A Fernández-Gutiérrez J, A Pérez C, León-Peña AA, Reyes-Cisneros ÓA, Benítez-Salazar JM, Sánchez-Bonilla D, Olivares-Gazca JC, Fernández-Lara D, Pérez-Padilla R, Ruiz-Delgado GJ, Ruiz-Argüelles GJ. Impaired lung function in multiple sclerosis: a single-center observational study in 371 persons. Neurol Sci 2023; 44:4429-4439. [PMID: 37410269 DOI: 10.1007/s10072-023-06914-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 06/15/2023] [Indexed: 07/07/2023]
Abstract
INTRODUCTION Abnormal lung function in people with multiple sclerosis (PwMS) could be considered as the result of muscle weakness or MS-specific structural central nervous system (CNS) abnormalities as a precipitant factor for the worsening of motor impairment or cognitive symptoms. METHODS This is a cross-sectional observational study in PwMS. Forced spirometry was conducted, and normative metrics of forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), and the relation FEV1/FVC were calculated. Qualitative and quantitative brain magnetic resonance imaging (MRI) examinations were carried out. RESULTS A total of 371 PwMS were included in the study. Of those, 196 (53%) had RRMS, 92 (25%) SPMS, and 83 (22%) PPMS. Low FVC and FEV1 was present in 16 (8%), 16 (19%), and 23 (25%) of the patients in the RRMS, PPMS, and SPMS, respectively. PwMS with T2-FLAIR lesions involving the corpus callosum (CC) had a significantly higher frequency of abnormally low FVC and FEV1 (OR 3.62; 95% CI 1.33-9.83; p = 0.012) than patients without lesions in that region. This association remained significant in the RRMS group (OR 10.1; 95% CI 1.3-67.8; p 0.031) when the model excluded PPMS and SPMS. According to our study, for every increase of 1 z score of FVC, we observed an increase of 0.25 cm3 of hippocampal volume (β 0.25; 95% CI 0.03-0.47; p 0.023) and 0.43 cm3 of left hippocampus volume (β 0.43; 95% CI 0.16-0.71; p 0.002). CONCLUSIONS We observed an incremental prevalence of abnormally low pulmonary function tests that parallels a sequence from more early relapsing courses to long-standing progressive courses (RRMS to PPMS or SPMS).
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Affiliation(s)
- Iván Murrieta-Álvarez
- Clínica Ruiz, Centro de Hematología y Medicina Interna, Puebla, México
- Universidad Popular Autónoma del Estado de Puebla, Puebla, México
- Baylor College of Medicine, Houston, TX, USA
| | - José A Fernández-Gutiérrez
- Clínica Ruiz, Centro de Hematología y Medicina Interna, Puebla, México
- Universidad Popular Autónoma del Estado de Puebla, Puebla, México
| | | | | | - Óscar A Reyes-Cisneros
- Clínica Ruiz, Centro de Hematología y Medicina Interna, Puebla, México
- Universidad Anáhuac Puebla, Tlaxcalancingo, México
| | - José M Benítez-Salazar
- Universidad Popular Autónoma del Estado de Puebla, Puebla, México
- Houston Methodist Hospital, Houston, TX, USA
| | - Daniela Sánchez-Bonilla
- Clínica Ruiz, Centro de Hematología y Medicina Interna, Puebla, México
- Universidad Popular Autónoma del Estado de Puebla, Puebla, México
| | | | | | | | - Guillermo J Ruiz-Delgado
- Clínica Ruiz, Centro de Hematología y Medicina Interna, Puebla, México
- Universidad Popular Autónoma del Estado de Puebla, Puebla, México
- Laboratorios Ruiz SYNLAB, Puebla, México
| | - Guillermo J Ruiz-Argüelles
- Clínica Ruiz, Centro de Hematología y Medicina Interna, Puebla, México.
- Universidad Popular Autónoma del Estado de Puebla, Puebla, México.
- Laboratorios Ruiz SYNLAB, Puebla, México.
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Zysman M, Mahay G, Guibert N, Barnig C, Leroy S, Guilleminault L. Impact of pharmacological and non-pharmacological interventions on mortality in chronic obstructive pulmonary disease (COPD) patients. Respir Med Res 2023; 84:101035. [PMID: 37651981 DOI: 10.1016/j.resmer.2023.101035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 06/15/2023] [Accepted: 06/16/2023] [Indexed: 09/02/2023]
Abstract
PURPOSE This review aimed to summarise evidence about the impact of pharmacological and non-pharmacological interventions on survival in COPD patients. METHODS We performed a narrative literature review on the effect of pharmacological and non-pharmacological interventions on survival in COPD patients. RESULTS Inhaled therapies are central to reduce symptoms in COPD. In particular, inhaled steroids seem to have the greatest effect on mortality. Despite the anti-inflammatory effects attributed to statins, their benefit in COPD has been shown only in cases of combined cardiovascular diseases. The use of beta-blockers in COPD has not been associated with increased COPD-related mortality and a beneficial effect on all-cause mortality has even been shown in COPD patients with cardiovascular diseases. Influenza and pneumococcal vaccination reduced the occurrence of exacerbations and mortality due to COPD. In addition, long-term oxygen therapy (LTOT) (≥15h/day) in COPD patients with severe hypoxemia had a positive effect on survival. Regarding non-pharmacological interventions, it has been demonstrated that smoking cessation, treatment compliance and nutritional supplementation for underweight patients also have a positive effect on survival. Non-invasive ventilation results were dependent on patient PaCO2 levels. In patients with advanced COPD, further prospective studies are needed to know the effect of bronchoscopic lung volume reduction and lung transplant on COPD survival. Regarding lung transplant, a survival benefit in patients with a pre-transplant BODE score of ≥7 has been shown in retrospective studies. CONCLUSION Most of the studies did not evaluate survival as the main criteria and further long-term studies on the global management of COPD are required.
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Affiliation(s)
- Maeva Zysman
- Service de Pneumologie, CHU Haut-Lévèque, Bordeaux, France; Univ. Bordeaux, Centre de Recherche cardio-thoracique, INSERM U1045, CIC 1401, Pessac, France
| | - Guillaume Mahay
- Service de Pneumologie, Oncologie thoracique et soins intensifs respiratoires, CHU Rouen, Rouen, France
| | - Nicolas Guibert
- Pôle des voies respiratoires, CHU de Toulouse, Toulouse, France
| | - Cindy Barnig
- INSERM, EFS BFC, LabEx LipSTIC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, Univ. Bourgogne Franche-Comté, Besançon, France; Service de Pneumologie, Oncologie thoracique et allergologie respiratoire, CHRU Besançon, Besançon, France
| | - Sylvie Leroy
- Université Côte d'Azur, Centre Hospitalier Universitaire de Nice, CNRS UMR 7275 - FHU OncoAge, Service de Pneumologie Oncologie Thoracique et Soins Intensifs Respiratoires, CHU de Nice, Hôpital Pasteur, Nice, France
| | - Laurent Guilleminault
- Pôle des voies respiratoires, CHU de Toulouse, Toulouse, France; Institut Toulousain des Maladies Infectieuses et Inflammatoires (Infinity) INSERM UMR1291 - CNRS UMR5051 - Université Toulouse III, CRISALIS F-CRIN, Toulouse, France.
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Engelen MPKJ, Kirschner SK, Coyle KS, Argyelan D, Neal G, Dasarathy S, Deutz NEP. Sex related differences in muscle health and metabolism in chronic obstructive pulmonary disease. Clin Nutr 2023; 42:1737-1746. [PMID: 37542951 DOI: 10.1016/j.clnu.2023.06.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 06/05/2023] [Accepted: 06/28/2023] [Indexed: 08/07/2023]
Abstract
BACKGROUND & AIMS Sex differences in muscle function and mass, dyspnea, and clinical outcomes have been observed in patients with Chronic Obstructive Pulmonary Disease (COPD) despite a similar level of airflow obstruction. Protein and amino acid metabolism is altered in COPD, however, it remains unclear whether a difference in metabolic signature exists between males and females with COPD that may explain the observed differences in muscle health and clinical outcomes. METHODS In 234 moderate to severe COPD patients (males/females: 113/121) and 182 healthy controls (males/females: 77/105), we assessed, besides presence of comorbidities and clinical features, muscle function by handgrip and leg dynamometry, and body composition by dual-energy x-ray absorptiometry. In the postabsorptive state, a mixture of 18 stable isotopes of amino acids was administered by pulse and arterialized blood was sampled for 2 h. Amino acid concentrations and enrichments were analyzed by LC-MS/MS to calculate whole body (net) protein breakdown (WBnetPB) and whole body production (WBP) rates (μmol/hour) of the amino acids playing a known role in muscle health. Statistics was done by ANCOVA to examine the effects of sex, COPD, and sex-by-COPD interaction with as covariates age and lean mass. Significance was set as p < 0.05. RESULTS Lung function was comparable between males and females with COPD. Being a female and presence of COPD were independently associated with lower appendicular lean mass, muscle strength, and WBnetPB (p < 0.05). Being a male was associated with higher visceral adipose tissue, C-reactive protein (CRP) (p < 0.05), and higher prevalence of heart failure and obstructive sleep apnea. Sex-by-COPD interactions were found indicating lower fat mass (p = 0.0005) and WBPs of phenylalanine (measure of whole body protein turnover) and essential amino acids (p < 0.05), particularly in COPD females. Higher visceral adipose tissue (p = 0.025), CRP (p < 0.0001), and WBP of tau-methylhistidine (p = 0.010) (reflecting enhanced myofibrillar protein breakdown) were observed in COPD males. CONCLUSIONS Presence of sex specific changes in protein and amino acid metabolism and cardiometabolic health in COPD need to be considered when designing treatment regimens to restore muscle health in males and females with COPD. CLINICAL TRIAL REGISTRY www. CLINICALTRIALS gov, NCT01787682, NCT01624792, NCT02157844, NCT02065141, NCT02770092, NCT02780219, NCT03327181, NCT03796455, NCT01173354, NCT01154400.
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Affiliation(s)
- Mariëlle P K J Engelen
- Center for Translational Research in Aging & Longevity, Department of Kinesiology and Sport Management, Texas A&M University, College Station, TX, USA; Primary Care & Rural Medicine, Texas A&M University, College Station, TX, USA.
| | - Sarah K Kirschner
- Center for Translational Research in Aging & Longevity, Department of Kinesiology and Sport Management, Texas A&M University, College Station, TX, USA
| | - Kimberly S Coyle
- Center for Translational Research in Aging & Longevity, Department of Kinesiology and Sport Management, Texas A&M University, College Station, TX, USA
| | - David Argyelan
- Center for Translational Research in Aging & Longevity, Department of Kinesiology and Sport Management, Texas A&M University, College Station, TX, USA
| | - Gabriel Neal
- Primary Care & Rural Medicine, Texas A&M University, College Station, TX, USA
| | - Srinivasan Dasarathy
- Department of Gastroenterology and Hepatology, Lerner Research Institute Cleveland Clinic, Cleveland, OH, USA; Department of Inflammation and Immunity, Lerner Research Institute Cleveland Clinic, Cleveland, OH, USA
| | - Nicolaas E P Deutz
- Center for Translational Research in Aging & Longevity, Department of Kinesiology and Sport Management, Texas A&M University, College Station, TX, USA; Primary Care & Rural Medicine, Texas A&M University, College Station, TX, USA
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Osundolire S, Goldberg RJ, Lapane KL. Anxiety and Depression Among US Nursing Home Residents with Chronic Obstructive Pulmonary Disease. Int J Chron Obstruct Pulmon Dis 2023; 18:1867-1882. [PMID: 37662488 PMCID: PMC10473093 DOI: 10.2147/copd.s417449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 08/11/2023] [Indexed: 09/05/2023] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) is highly prevalent among nursing home residents; however, few studies have focused on the psychological impact of this clinically significant condition on nursing home residents. Objective We examine the prevalence of, and factors associated with, anxiety and depression in nursing home residents with COPD. Methods Using the US 2018 Minimum Dataset (MDS), we conducted a cross-sectional study among 239,615 residents aged ≥50 years old in US Medicare/Medicaid certified nursing homes with COPD. Anxiety and depression were diagnosed based on clinical diagnoses, physical examination findings, and treatment orders. Multivariable adjusted Poisson models with a generalized estimating equations approach account for the clustering among residents within nursing homes. Results The average age of the study population was 79 years (SD: 10.6), 62.0% were women, and 43.7% had five or more comorbid conditions. In this population, 37.2% had anxiety, 57.6% had depression, and 27.5% had both mental health conditions. Women, current tobacco users, persons 50-64 years old, those who reported having moderate or severe pain, and nursing home residents with multimorbidity were more likely to have anxiety or depression than respective comparison groups. Conclusion Anxiety and depression are common among US nursing home residents with COPD. Women, medically complex patients, and those who report having moderate-to-severe pain appear to be more likely to have anxiety and depression. Clinical teams should be aware of these findings when managing nursing home residents with COPD and use various nonpharmacological and medical interventions for the effective management of anxiety and depression. Longitudinal studies evaluating how anxiety and depression affect the management of COPD and related outcomes, and how best to improve the quality of life of nursing home residents with COPD, are warranted.
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Affiliation(s)
- Seun Osundolire
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, 01605, USA
| | - Robert J Goldberg
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, 01605, USA
| | - Kate L Lapane
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, 01605, USA
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Siraj RA, Alrajeh A, Aldabayan YS, Aldhahir AM, Alqahtani JS, Alghamdi SM, Alqarni AA, Banakher BO, Algarni SS, Alhotye M, Khormi SK, Alghamdi HS, Alotaibi FF, Alahmari MA. Attitudes, confidence, barriers and current practice of managing depression in patients with COPD in Saudi Arabia: a national cross-sectional survey. BMJ Open 2023; 13:e069670. [PMID: 37156583 PMCID: PMC10173993 DOI: 10.1136/bmjopen-2022-069670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 04/27/2023] [Indexed: 05/10/2023] Open
Abstract
OBJECTIVE To investigate physicians' perceptions and current practices of identifying and managing depression in patients with chronic obstructive pulmonary disease (COPD). DESIGN A cross-sectional online survey was employed between March and September 2022. SETTINGS Saudi Arabia. PARTICIPANTS 1015 physicians, including general practitioners and family, internal and pulmonary medicine specialists. PRIMARY OUTCOME MEASURES Physicians' perceptions, confidence, practices and barriers to recognising and managing depression in patients with COPD. RESULTS A total of 1015 physicians completed to the online survey. Only 31% of study participants received adequate training for managing depression. While 60% of physicians reported that depression interferes with self-management and worsens COPD symptoms, less than 50% viewed the importance of regular screening for depression. Only 414 (41%) physicians aim to identify depression. Of whom, 29% use depression screening tools, and 38% feel confident in discussing patients' feelings. Having adequate training to manage depression (OR: 2.89; 95% CI: 2.02 to 3.81; p<0.001) and more years of experience (OR: 1.25; 95% CI: 1.08 to 1.45; p=0.002) were associated with the intention to detect depression in COPD patients. The most common barriers linked to recognising depression are poor training (54%), absence of standard procedures (54%) and limited knowledge about depression (53%). CONCLUSION The prevalence of identifying and confidently managing depression in patients with COPD is suboptimal, owing to poor training, the absence of a standardised protocol and inadequate knowledge. Psychiatric training should be supported in addition to adopting a systematic approach to detect depression in clinical practice.
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Affiliation(s)
- Rayan A Siraj
- Department of Respiratory Care, College of Applied Medical Sciences, King Faisal University, Al-Ahasa, Saudi Arabia
| | - Ahmed Alrajeh
- Department of Respiratory Care, College of Applied Medical Sciences, King Faisal University, Al-Ahasa, Saudi Arabia
| | - Yousef S Aldabayan
- Department of Respiratory Care, College of Applied Medical Sciences, King Faisal University, Al-Ahasa, Saudi Arabia
| | | | - Jaber S Alqahtani
- Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam, Saudi Arabia
| | - Saeed M Alghamdi
- Department of Clinical Technology, Respiratory Care Program, Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Abdullah A Alqarni
- Department of Respiratory Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Bashaer O Banakher
- Department of Respiratory Therapy, Maternity and Children's Specialized Hospital, Jeddah, Saudi Arabia
| | - Saleh S Algarni
- Department of Respiratory Therapy, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Munyra Alhotye
- Department of Respiratory Therapy, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Shahad K Khormi
- Department of Respiratory Therapy, King Abdul Aziz Specialist Hospital, Taif, Saudi Arabia
| | - Hussam S Alghamdi
- Family Medicine, King Fahd Military Medical Complex, Dhahran, Saudi Arabia
| | - Faisal F Alotaibi
- Public Security, Medical Service, Ministry of Interior, Dhahran, Saudi Arabia
| | - Mushabbab A Alahmari
- Department of Respiratory Therapy, College of Applied Medical Sciences, University of Bisha, Bisha, Saudi Arabia
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Volpato E, Farver-Vestergaard I, Brighton LJ, Peters J, Verkleij M, Hutchinson A, Heijmans M, von Leupoldt A. Nonpharmacological management of psychological distress in people with COPD. Eur Respir Rev 2023; 32:32/167/220170. [PMID: 36948501 PMCID: PMC10032611 DOI: 10.1183/16000617.0170-2022] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 12/31/2022] [Indexed: 03/24/2023] Open
Abstract
Psychological distress is prevalent in people with COPD and relates to a worse course of disease. It often remains unrecognised and untreated, intensifying the burden on patients, carers and healthcare systems. Nonpharmacological management strategies have been suggested as important elements to manage psychological distress in COPD. Therefore, this review presents instruments for detecting psychological distress in COPD and provides an overview of available nonpharmacological management strategies together with available scientific evidence for their presumed benefits in COPD. Several instruments are available for detecting psychological distress in COPD, including simple questions, questionnaires and clinical diagnostic interviews, but their implementation in clinical practice is limited and heterogeneous. Moreover, various nonpharmacological management options are available for COPD, ranging from specific cognitive behavioural therapy (CBT) to multi-component pulmonary rehabilitation (PR) programmes. These interventions vary substantially in their specific content, intensity and duration across studies. Similarly, available evidence regarding their efficacy varies significantly, with the strongest evidence currently for CBT or PR. Further randomised controlled trials are needed with larger, culturally diverse samples and long-term follow-ups. Moreover, effective nonpharmacological interventions should be implemented more in the clinical routine. Respective barriers for patients, caregivers, clinicians, healthcare systems and research need to be overcome.
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Affiliation(s)
- Eleonora Volpato
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
- IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
- Shared first authorship
| | | | - Lisa Jane Brighton
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Jeannette Peters
- Department of Pulmonary Diseases, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Marieke Verkleij
- Department of Paediatric Psychology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | - Monique Heijmans
- Netherlands Institute for Health Services Research (Nivel), Utrecht, The Netherlands
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Grosbois JM, Détrée A, Pierache A, Bautin N, Pérez T, Wallaert B, Chenivesse C, Le Rouzic O. Impact of Cardiovascular and Metabolic Comorbidities on Long-term Outcomes of Home-based Pulmonary Rehabilitation in COPD. Int J Chron Obstruct Pulmon Dis 2023; 18:155-167. [PMID: 36860514 PMCID: PMC9969866 DOI: 10.2147/copd.s381744] [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: 07/11/2022] [Accepted: 10/31/2022] [Indexed: 02/24/2023] Open
Abstract
Background Cardiovascular and metabolic comorbidities in chronic obstructive pulmonary disease (COPD) are associated with higher symptoms burden. Few center-based studies have evaluated the impact of these comorbidities on short-term pulmonary rehabilitation outcomes with contrasting results. Research Question This study aimed to determine whether cardiovascular diseases and metabolic comorbidities impacted long-term outcomes of a home-based PR program in COPD patients. Study Design and methods Data of 419 consecutive COPD patients addressed to our pulmonary rehabilitation program between January 2010 and June 2016 were retrospectively analyzed. Our program consisted of once-weekly supervised home sessions, including therapeutic education and self-management support, with unsupervised retraining exercises and physical activities the other days for 8 weeks. Exercise capacity (6-min stepper test [6MST]), quality of life (visual simplified respiratory questionnaire), and anxiety and depression (hospital anxiety and depression scale) were assessed respectively, before (M0) and at the end (M2) of the pulmonary rehabilitation program, and at 6 (M8) and 12 months (M14) after its achievement. Results Patients (mean age 64.1±11.2 years, 67% males, mean forced expiratory volume in one second (FEV1) 39.2±17.0% predicted) were classified as having cardiovascular comorbidities (n=195), only metabolic disorders (n=122) or none of these comorbidities (n=102). After adjustment, all outcomes appeared similar between groups at baseline and improved after pulmonary rehabilitation with a greater effect at M14 for patients with only metabolic disorders on anxiety and depression score (-5.0±0.7 vs -2.9±0.8 and -2.6±0.6, p=0.021). Quality of life and exercise capacity improvements were not significantly different between the three groups at M2 and M14. Conclusion Cardiovascular and metabolic comorbidities do not preclude COPD patients from obtaining clinically meaningful improvements in exercise capacity, quality of life and anxiety-depression up to 1 year after a home-based pulmonary rehabilitation.
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Affiliation(s)
| | - Axelle Détrée
- Groupe Hospitalier Loos Haubourdin, Réhabilitation Respiratoire, Loos, F-59120, France
| | - Adeline Pierache
- Université de Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, Lille, F-59000, France,CHU Lille, Department of Biostatistics, Lille, F-59000, France
| | - Nathalie Bautin
- Université de Lille, CHU Lille, CNRS, Inserm, Institut Pasteur de Lille, U1019 - UMR 9017 - CIIL - Center for Infection and Immunity of Lille, Lille, F-59000, France,CHU Lille, Pneumologie et Immuno-Allergologie, Centre de référence constitutif pour les maladies pulmonaires rares, Lille, F-59000, France
| | - Thierry Pérez
- Université de Lille, CHU Lille, CNRS, Inserm, Institut Pasteur de Lille, U1019 - UMR 9017 - CIIL - Center for Infection and Immunity of Lille, Lille, F-59000, France,CHU Lille, Pneumologie et Immuno-Allergologie, Centre de référence constitutif pour les maladies pulmonaires rares, Lille, F-59000, France
| | - Benoit Wallaert
- Université de Lille, CHU Lille, CNRS, Inserm, Institut Pasteur de Lille, U1019 - UMR 9017 - CIIL - Center for Infection and Immunity of Lille, Lille, F-59000, France,CHU Lille, Pneumologie et Immuno-Allergologie, Centre de référence constitutif pour les maladies pulmonaires rares, Lille, F-59000, France
| | - Cécile Chenivesse
- Université de Lille, CHU Lille, CNRS, Inserm, Institut Pasteur de Lille, U1019 - UMR 9017 - CIIL - Center for Infection and Immunity of Lille, Lille, F-59000, France,CHU Lille, Pneumologie et Immuno-Allergologie, Centre de référence constitutif pour les maladies pulmonaires rares, Lille, F-59000, France
| | - Olivier Le Rouzic
- Université de Lille, CHU Lille, CNRS, Inserm, Institut Pasteur de Lille, U1019 - UMR 9017 - CIIL - Center for Infection and Immunity of Lille, Lille, F-59000, France,CHU Lille, Pneumologie et Immuno-Allergologie, Centre de référence constitutif pour les maladies pulmonaires rares, Lille, F-59000, France,Correspondence: Olivier Le Rouzic, Pneumologie et Immuno-Allergologie, Institut Cœur Poumon, 1 boulevard Jules Leclercq, CHU de Lille, Lille, 59037, France, Tel +33 3 20 44 59 48, Fax +33 3 20 44 57 68, Email
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9
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Giezeman M, Sundh J, Athlin Å, Lisspers K, Ställberg B, Janson C, Montgomery S, Kisiel MA, Nager A, Sandelowsky H, Hasselgren M. Comorbid Heart Disease in Patients with COPD is Associated with Increased Hospitalization and Mortality - A 15-Year Follow-Up. Int J Chron Obstruct Pulmon Dis 2023; 18:11-21. [PMID: 36644219 PMCID: PMC9838124 DOI: 10.2147/copd.s378979] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 10/05/2022] [Indexed: 01/10/2023] Open
Abstract
Purpose The aim of this study was to examine the association of comorbid heart disease, defined as chronic heart failure or ischemic heart disease, on all-cause and cause-specific hospitalization and mortality in patients with COPD over a period of nearly 15 years. Materials and Methods The cohort study included patients with COPD from primary and secondary care in 2005 with data from questionnaires and medical record reviews. The Swedish Board of Health and Welfare provided hospitalization and mortality data from 2005 through 2019. Cox regression analyses, adjusted for sex, age, educational level, smoking status, BMI, exacerbations, dyspnea score and comorbid diabetes or hypertension, assessed the association of comorbid heart disease with all-cause and cause-specific time to first hospitalization and death. Linear regression analyses, adjusted for the same variables, assessed this association with hospitalization days per year for those patients that had been hospitalized. Results Of the 1071 patients, 262 (25%) had heart disease at baseline. Cox regression analysis showed a higher risk of hospitalization for patients with heart disease for all-cause (HR (95% CI) 1.55; 1.32-1.82), cardiovascular (2.14; 1.70-2.70) and other causes (1.27; 1.06-1.52). Patients with heart disease also had an increased risk of all-cause (1.77; 1.48-2.12), cardiovascular (3.40; 2.41-4.78) and other (1.50; 1.09-2.06) mortality. Heart disease was significantly associated with more hospitalization days per year of all-cause (regression coefficient 0.37; 95% CI 0.15-0.59), cardiovascular (0.57; 0.27-0.86) and other (0.37; 0.12-0.62) causes. No significant associations were found between heart disease and respiratory causes of hospitalization and death. Conclusion Comorbid heart disease in patients with COPD is associated with an increased risk for all-cause hospitalization and mortality, mainly due to an increase of hospitalization and death of cardiovascular and other causes, but not because of respiratory disease. This finding advocates the need of a strong clinical focus on primary and secondary prevention of cardiovascular disease in patients with COPD.
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Affiliation(s)
- Maaike Giezeman
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden,Centre for Clinical Research and Education, Karlstad, Sweden,Correspondence: Maaike Giezeman, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden, Email
| | - Josefin Sundh
- Department of Respiratory Medicine, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Åsa Athlin
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Karin Lisspers
- Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden
| | - Björn Ställberg
- Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden
| | - Christer Janson
- Department of Medical Sciences, Respiratory, Allergy & Sleep Research, Uppsala University, Uppsala, Sweden
| | - Scott Montgomery
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden,Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden,Department of Epidemiology and Public Health, University College London, London, UK
| | - Marta A Kisiel
- Department of Medical Sciences, Occupational and Environmental Medicine, Uppsala University, Uppsala, Sweden
| | - Anna Nager
- Division of Family Medicine and Primary Care, Inst NVS, Karolinska Institutet, Stockholm, Sweden
| | - Hanna Sandelowsky
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden,Division of Family Medicine and Primary Care, Inst NVS, Karolinska Institutet, Stockholm, Sweden,Academic Primary Health Care Centre, Region Stockholm, Sweden
| | - Mikael Hasselgren
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden,Centre for Clinical Research and Education, Karlstad, Sweden
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10
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YAĞCI İ, PERİNCEK G. Relationship between Functional Status and Type D Personality and Psychiatric Symptoms of Patients with Chronic Obstructive Pulmonary Disease (COPD). PSIKIYATRIDE GUNCEL YAKLASIMLAR - CURRENT APPROACHES IN PSYCHIATRY 2022. [DOI: 10.18863/pgy.1090854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Emotional difficulties, adjustment difficulties, anxiety disorder, paranoid reactions and depression are among the common psychiatric disorders in patients with Chronic Obstructive Pulmonary Disease (COPD). Type D personality is characterized by social inhibition and negative affectivity. Individuals with Type D personality have difficulty in coping with chronic diseases. The aim of our study was to determine type D personality and psychiatric symptoms in patients with COPD. A patient group was formed with 44 people hospitalized with COPD in the Chest Diseases service and a control group was formed with 44 healthy people. A sociodemographic data form, the Beck Depression Inventory, State and Trait Anxiety Inventory, Somatosensory Amplification Scale, Type D Personality Scale, and BODE (Body mass index, Obstruction, Dyspnea, Exercise capacity) index, were used to. According to the results of our study, state and trait anxiety, depression and D-type personality, exaggeration of bodily sensations scale scores were statistically significantly higher in the patient group compared to the control group. Moreover, a high score on the somatosensory amplification scale and having a type D personality were correlated with the BODE index score. These results suggest that it is important for patients with COPD to be examined by a psychiatrist..
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11
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Whittaker H, Van Ganse E, Dalon F, Nolin M, Marrant-Micallef C, Pison C, Ryan DP, Deslee G, Quint JK, Belhassen M. Differences in severe exacerbations rates and healthcare utilisation in COPD populations in the UK and France. BMJ Open Respir Res 2022; 9:9/1/e001150. [PMID: 35944943 PMCID: PMC9367183 DOI: 10.1136/bmjresp-2021-001150] [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: 11/15/2021] [Accepted: 07/31/2022] [Indexed: 11/15/2022] Open
Abstract
Introduction Chronic obstructive pulmonary disease (COPD) is a leading cause of mortality in Europe; however, it is important to understand how clinical practice patterns differ between countries and how this might relate to disease outcomes, to identify ways of improving local disease management. We aimed to describe and compare the management of patients with COPD in the UK and France between 2008 and 2017. Methods We used data from the Clinical Practice Research Datalink GOLD and Hospital Episode Statistics in the UK and the Echantillon Généraliste des Bénéficiaire in France to identify patients with COPD each year between 2008 and 2017. We compared patient characteristics, all-cause mortality and COPD exacerbations each year between 2008 and 2017 for patients in the UK and France separately. Health care utilisation and COPD exacerbations in 2017 were compared between France and the UK using t-tests and χ2 tests. Results Patients with COPD were similar in gender and comorbidities in both countries. Incidence of COPD exacerbations remained stable in the UK and France between 2007 and 2017. In 2017, the proportion of all-cause and COPD-related hospitalisations was greater in the UK than in France (43.9% vs 32.8% and 8.3% vs 4.9%, respectively; p<0.001) as was the proportion of patients visiting accident and emergency (A&E) (39.8% vs 16.2%, respectively; p<0.001). In addition, the mean length of stay in hospital for COPD-related causes was shorter in the UK than in France (6.2 days (SD 8.4) vs 10.5 days (SD 9.1), respectively; p<0.001). Discussion Overall, UK patients were more likely to go to A&E, be hospitalised for COPD-related causes and stay in hospital for fewer days after being admitted for COPD-related reasons compared with patients in France, illustrating a difference in health-seeking behaviours and access to healthcare.
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Affiliation(s)
- Hannah Whittaker
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Eric Van Ganse
- PELyon, Pharmaco Epidemiologie Lyon, Lyon, France.,Respiratory Medicine, Hospital Croix-Rousse, Lyon, France
| | | | - Maeva Nolin
- PELyon, Pharmaco Epidemiologie Lyon, Lyon, France
| | | | - Christophe Pison
- Clinique de Pneumologie, Centre Hospitalier Universitaire de Grenoble, Service de Pneumologie, Grenoble, France
| | - Dermot P Ryan
- Allergy and Respiratory Research Group, Centre for Population Health Sciences: GP Section, University of Edinburgh, Edinburgh, UK
| | - Gaetan Deslee
- Department of Respiratory Medicine, INSERM UMRS 903, University Hospital of Reims, Reims, France
| | - Jennifer K Quint
- National Heart and Lung Institute, Imperial College London, London, UK
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12
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Nikolovski A, Gamgoum L, Deol A, Quilichini S, Kazemir E, Rhodenizer J, Oliveira A, Brooks D, Alsubheen S. Psychometric properties of the hospital anxiety and depression scale (HADS) in individuals with chronic obstructive pulmonary disease (COPD): A systematic review protocol (Preprint). JMIR Res Protoc 2022; 11:e37854. [PMID: 36136379 PMCID: PMC9539646 DOI: 10.2196/37854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 07/13/2022] [Accepted: 07/30/2022] [Indexed: 11/13/2022] Open
Abstract
Background In individuals with chronic obstructive pulmonary disease (COPD), anxiety and depression contribute to increased mortality and exacerbations, decreased physical functioning, and deteriorated health-related quality of life. The Hospital Anxiety and Depression Scale (HADS) is a patient-reported tool developed to measure symptoms of anxiety and depression in clinical settings. The HADS has been frequently used with individuals with COPD; however, its measurement properties lack critical appraisal in this population. Objective This review aims to summarize and critically appraise the validity, reliability, and responsiveness of the HADS in individuals with COPD. Methods Five electronic databases (MEDLINE, Embase, Scopus, PsychINFO, and Web of Science) will be systematically searched. Articles will be included if they assessed the measurement properties of the HADS in COPD; were published in a peer-reviewed journal; and were written in English. The COSMIN (Consensus-based Standards for the Selection of Health Measurement Instruments) guidelines will be used to assess the methodological quality and level of evidence in the selected studies. Results To date, 12 articles met the inclusion criteria and will be included in the systematic review. The results of the psychometric properties of HADS will be qualitatively summarized and compared against the criteria for good measurement properties. The overall quality of evidence will be graded using the modified Grading of Recommendations, Assessment, Development and Evaluation approach. We expect to complete the systematic review by December 2022. Conclusions This systematic review will be the first to evaluate the psychometric properties of the HADS in individuals with COPD. Given the negative impact of anxiety and depression on physical functioning and health-related quality of life, this systematic review provides an opportunity to use the HADS as a validated measurement tool for the assessment and treatment of anxiety and depression in individuals with COPD. Trial Registration PROSPERO CRD42022302064; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=302064 International Registered Report Identifier (IRRID) PRR1-10.2196/37854
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Affiliation(s)
| | - Lara Gamgoum
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Arshpreet Deol
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Shea Quilichini
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Ethan Kazemir
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | | | - Ana Oliveira
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
- West Park Healthcare Centre, Toronto, ON, Canada
- Lab 3R Respiratory Research and Rehabilitation Laboratory, School of Health Sciences, University of Aveiro, Aveiro, Portugal
| | - Dina Brooks
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
- West Park Healthcare Centre, Toronto, ON, Canada
- Department of Physical Therapy and Rehabilitation Science, University of Toronto, Toronto, ON, Canada
| | - Sanaa Alsubheen
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
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13
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Siraj R, McKeever T, Gibson J, Bolton C. Incidence of depression and antidepressant prescription in patients with COPD: A large UK population-based cohort study. Respir Med 2022; 196:106804. [DOI: 10.1016/j.rmed.2022.106804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 03/04/2022] [Accepted: 03/06/2022] [Indexed: 10/18/2022]
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14
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Le TT, Qato DM, Magder L, Bjarnadóttir M, Zafari Z, Simoni-Wastila L. Prevalence and Newly Diagnosed Rates of Multimorbidity in Older Medicare Beneficiaries with COPD. COPD 2021; 18:541-548. [PMID: 34468243 DOI: 10.1080/15412555.2021.1968815] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Few studies have quantified the multimorbidity burden in older adults with chronic obstructive pulmonary disease (COPD) using large and generalizable data. Such evidence is essential to inform evidence-based research, clinical care, and resource allocation. This retrospective cohort study used a nationally representative sample of Medicare beneficiaries aged 65 years or older with COPD and 1:1 matched (on age, sex, and race) non-COPD beneficiaries to: (1) quantify the prevalence of multimorbidity at COPD onset and one-year later; (2) quantify the rates [per 100 person-years (PY)] of newly diagnosed multimorbidity during in the year prior to and in the year following COPD onset; and (3) compare multimorbidity prevalence in beneficiaries with and without COPD. Among 739,118 eligible beneficiaries with and without COPD, the average number of multimorbidity was 10.0 (SD = 4.7) and 1.0 (SD = 3.3), respectively. The most prevalent multimorbidity at COPD onset and at one-year after, respectively, were hypertension (70.8% and 80.2%), hyperlipidemia (52.2% and 64.8%), anemia (42.1% and 52.0%), arthritis (39.8% and 47.7%), and congestive heart failure (CHF) (31.3% and 38.8%). Conditions with the highest newly diagnosed rates before and following COPD onset, respectively, included hypertension (39.8 and 32.3 per 100 PY), hyperlipidemia (22.8 and 27.6), anemia (17.8 and 20.3), CHF (16.2 and 13.2), and arthritis (12.9 and 13.2). COPD was significantly associated with increased odds of all measured conditions relative to non-COPD controls. This study updates existing literature with more current, generalizable findings of the substantial multimorbidity burden in medically complex older adults with COPD-necessary to inform patient-centered, multidimensional care.Supplemental data for this article is available online at https://doi.org/10.1080/15412555.2021.1968815 .
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Affiliation(s)
- Tham T Le
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD, USA.,Peter Lamy Center for Drug Therapeutic and Aging, University of Maryland, College Park, MD, USA
| | - Danya M Qato
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD, USA.,Peter Lamy Center for Drug Therapeutic and Aging, University of Maryland, College Park, MD, USA.,Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Larry Magder
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Margrét Bjarnadóttir
- Department of Decision, Operation, and Information Technologies, University of Maryland, College Park, MD, USA
| | - Zafar Zafari
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD, USA
| | - Linda Simoni-Wastila
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD, USA.,Peter Lamy Center for Drug Therapeutic and Aging, University of Maryland, College Park, MD, USA
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15
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Kim Y, Kim YJ, Cho WK. Effect of multiple comorbidities on mortality in chronic obstructive pulmonary disease among Korean population: a nationwide cohort study. BMC Pulm Med 2021; 21:56. [PMID: 33573635 PMCID: PMC7879613 DOI: 10.1186/s12890-021-01424-7] [Citation(s) in RCA: 1] [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] [Received: 10/18/2020] [Accepted: 01/27/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The effects of comorbidities on chronic obstructive pulmonary disease (COPD) have been usually studied individually in the past. In this study, we aimed to investigate the comorbidities associated with mortality, the effect of multimorbidity on mortality and other factors associated with mortality among Korean COPD population. METHODS The Korean National Health Insurance Service-National Sample Cohort version 2.0, collected between 2002 and 2015, was used. Among COPD patients [entire cohort (EC), N = 12,779], 44% of the participants underwent additional health examination, and they were analysed separately [health-screening cohort (HSC), N = 5624]. Fifteen comorbidities previously reported as risk factors for mortality were studied using Cox proportional hazards regression models. RESULTS Total mortality rates were 38.6 per 1000 person-years (95% CI 37.32-40.01) and 27.4 per 1000 person-years (95% CI 25.68-29.22) in EC and HSC, respectively. The most common causes of death were disease progression, lung cancer, and pneumonia. Only some of the comorbidities had a direct impact on mortality. Multimorbidity, assessed by the number of comorbid diseases, was an independent risk factor of all-cause mortality in both cohorts and was a risk factor of respiratory mortality only in HSC. The Kaplan-Meier analysis showed significant differences in survival trajectories according to the number of comorbidities in all-cause mortality but not in respiratory mortality. Low BMI, old age and male sex were independent risk factors for both mortalities in both cohorts. CONCLUSIONS The number of comorbidities might be an independent risk factor of COPD mortality. Multimorbidity contributes to all-cause mortality in COPD, but the effect of multimorbidity is less evident on respiratory mortality.
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Affiliation(s)
- Youngmee Kim
- Red Cross College of Nursing, Chung-Ang University, Seoul, Korea
| | - Ye-Jee Kim
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Won-Kyung Cho
- International Healthcare Center, Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea.
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16
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Zucchi JW, Franco EAT, Schreck T, Castro e Silva MH, Migliorini SRDS, Garcia T, Mota GAF, de Morais BEB, Machado LHS, Batista ANR, de Paiva SAR, de Godoy I, Tanni SE. Different Clusters in Patients with Chronic Obstructive Pulmonary Disease (COPD): A Two-Center Study in Brazil. Int J Chron Obstruct Pulmon Dis 2020; 15:2847-2856. [PMID: 33192058 PMCID: PMC7654519 DOI: 10.2147/copd.s268332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 09/06/2020] [Indexed: 11/23/2022] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) has a functional definition. However, differences in clinical characteristics and systemic manifestations make COPD a heterogeneous disease and some manifestations have been associated with different risks of acute exacerbations, hospitalizations, and death. Objective Therefore, the objective of the study was to evaluate possible clinical clusters in COPD at two study centers in Brazil and identify the associated exacerbation and mortality rate during 1 year of follow-up. Methods We included patients with COPD and all underwent an evaluation composed of the Charlson Index, body mass index (BMI), current pharmacological treatment, smoking history (packs-year), history of exacerbations/hospitalizations in the last year, spirometry, six-minute walking test (6MWT), quality of life questionnaires, dyspnea, and hospital anxiety and depression scale. Blood samples were also collected for measurements of C-reactive protein (CRP), blood gases, laboratory analysis, and blood count. For the construction of the clusters, 13 continuous variables of clinical importance were considered: hematocrit, CRP, triglycerides, low density lipoprotein, absolute number of peripheral eosinophils, age, pulse oximetry, BMI, forced expiratory volume in the first second, dyspnea, 6MWD, total score of the Saint George Respiratory Questionnaire and packs-year of smoking. We used the Ward and K-means methods and determined the best silhouette value to identify similarities of individuals within the cluster (cohesion) in relation to the other clusters (separation). The number of clusters was determined by the heterogeneity values of the cluster, which in this case was determined as four clusters. Results We evaluated 301 COPD patients and identified four different groups of COPD patients. The first cluster (203 patients) was characterized by fewer symptoms and lower functional severity of the disease, the second cluster by higher values of peripheral eosinophils, the third cluster by more systemic inflammation and the fourth cluster by greater obstructive severity and worse gas exchange. Cluster 2 had an average of 959±3 peripheral eosinophils, cluster 3 had a higher prevalence of nutritional depletion (46.1%), and cluster 4 had a higher BODE index. Regarding the associated comorbidities, we found that only obstructive sleep apnea syndrome and pulmonary thromboembolism were more prevalent in cluster 4. Almost 50% of all patients presented an exacerbation during 1 year of follow-up. However, it was higher in cluster 4, with 65% of all patients having at least one exacerbation. The mortality rate was statistically higher in cluster 4, with 26.9%, vs 9.6% in cluster 1. Conclusion We could identify four clinical different clusters in these COPD populations, that were related to different clinical manifestations, comorbidities, exacerbation, and mortality rate. We also identified a specific cluster with higher values of peripheral eosinophils.
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Affiliation(s)
- José William Zucchi
- Pulmonology Division of Botucatu Medical School, São Paulo State University (UNESP), Botucatu, Brazil
| | | | - Thomas Schreck
- Ostbayerische Technische Hochschule Regensburg (OTH Regensburg), Faculty of Business Studies, Regensburg, German
| | | | | | - Thaís Garcia
- Pulmonology Division of Botucatu Medical School, São Paulo State University (UNESP), Botucatu, Brazil
| | | | | | | | | | | | - Irma de Godoy
- Pulmonology Division of Botucatu Medical School, São Paulo State University (UNESP), Botucatu, Brazil
| | - Suzana Erico Tanni
- Pulmonology Division of Botucatu Medical School, São Paulo State University (UNESP), Botucatu, Brazil
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17
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Molto A, Gossec L, Poiraudeau S, Claudepierre P, Soubrier M, Fayet F, Wendling D, Gaudin P, Dernis E, Guis S, Pouplin S, Ruyssen A, Chales G, Mariette X, Beauvais C, Combe B, Flipo RM, Richette P, Chary-Valckenaere I, Saraux A, Sibilia J, Schaeverbeke T, Dougados M. Evaluation of the impact of a nurse-led program of systematic screening of comorbidities in patients with axial spondyloarthritis: The results of the COMEDSPA prospective, controlled, one year randomized trial. Semin Arthritis Rheum 2020; 50:701-708. [PMID: 32521324 DOI: 10.1016/j.semarthrit.2020.05.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 04/29/2020] [Accepted: 05/04/2020] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To evaluate the impact of a nurse-led program of systematic screening for the management (detection/prevention) of comorbidities. METHODS Prospective, randomized, controlled, open, 12-month trial (NCT02374749). PARTICIPANTS consecutive patients with axial Spondyloarthritis (axSpA) (according to the rheumatologist) THE PROGRAM: A nurse collected data on comorbidities during a specific outpatient visit. In the event of non-agreement with recommendations, the patient was informed and a specific recommendation was given to the patient (orally and in a with a detailed written report). Patients were seen after one year in a nurse-led visit. TREATMENT ALLOCATION: random allocation (i.e. either this program or an educational program not presented here and considered here as the control group). MAIN OUTCOME change after one year of a weighted comorbidity management score (0 to 100 where 0= optimal management). RESULTS 502 patients were included (252 and 250 in the active and control groups, respectively): age: 47±12 years, male gender: 63%, disease duration: 14±11y. After one year, no differences were observed in a weighted comorbidity management score. However, the number of patients in agreement with recommendations was significantly higher in the active group for vaccinations (flu vaccination: 28.6% vs. 9.9%, p<0.01; pneumococcal vaccination:40.0% vs. 21.1%,p=0.04), for cancer screening (skin cancer screening: 36.3% vs. 17.2%, p=0.04) and for osteoporosis (bone densitometry performed: 22.6% vs. 8.7%, p<0.01; Vitamin D supplementation initiation: 51.9% vs. 9.4%, p<0.01). CONCLUSIONS AND RELEVANCE This study suggests the short-term benefit of a single-visit nurse-led program for systematic screening of comorbidities for its management in agreement with recommendations, even in this young population of patients with axSpA.
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Affiliation(s)
- Anna Molto
- Rheumatology Department, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Paris, France; Université de Paris, INSERM U-1153, CRESS, Paris, France.
| | - Laure Gossec
- Sorbonne Université, IPLESP, INSERM, Paris France; Pitié Salpêtrière hospital, APHP, Rheumatology department, Paris, France
| | - Serge Poiraudeau
- Rehabilitation and Physical Medicine Department, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Pascal Claudepierre
- Rheumatology Department, Henri Mondor Hospital, Assistance Publique Hôpitaux de Paris, and Université Paris Est Créteil, EA, 7379 - EpidermE, F-94010, Créteil, France
| | - Martin Soubrier
- Rheumatology Department, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Françoise Fayet
- Rheumatology Department, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Daniel Wendling
- Rheumatology Department, CHRU de BESANCON, University Teaching Hospital, and Université Bourgogne Franche-Comté, EA4266 (EPILAB), Besançon, France
| | | | | | | | | | - Adeline Ruyssen
- Centre de Rhumatologie, Hôpital Purpan, Toulouse, et Faculté de Médecine, Université Toulouse III, Paul Sabatier University, Toulouse, France
| | - Gerard Chales
- Medecine Faculty, Department of Rheumatology, South Hospital, Rennes 1 University, Rennes, France
| | - Xavier Mariette
- Rheumatology Department, APHP, Bicêtre Hospital, Le Kremlin-Bicetre, France
| | | | - Bernard Combe
- Rheumatology department, CHU Montpellier, Montpellier University, Montpellier, France
| | - René-Marc Flipo
- Rheumatology Department, CHU Roger Salengro Hospital, University of Lille, Lille, France
| | - Pascal Richette
- Université Paris Diderot, UFR médicale, Paris, France; APHP Hôpital Lariboisiére, Fédération de Rhumatologie, Paris, France
| | | | - Alain Saraux
- Rheumatology Unit, UMR1227 (Lymphocytes B et Autoimmunité), Université de Brest, Inserm, CHU Brest, LabEx IGO, Brest, France
| | - Jean Sibilia
- Department of Rheumatology, Hautepierre CHU, Fédération de médecine translationnelle, UMR INSERM 1109, Strasbourg, France
| | | | - Maxime Dougados
- Rheumatology Department, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Paris, France; Université de Paris, INSERM U-1153, CRESS, Paris, France
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18
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Rebordosa C, Houben E, Laugesen K, Bothner U, Montonen J, Aguado J, Overbeek JA, Ehrenstein V, Asmar J, Wallace L, Gilsenan AW. No Evidence of Off-label Use of Olodaterol and Indacaterol in Denmark, France, and the Netherlands: A Drug Utilization Study. Sci Rep 2020; 10:586. [PMID: 31953521 PMCID: PMC6968970 DOI: 10.1038/s41598-019-57397-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 12/23/2019] [Indexed: 12/19/2022] Open
Abstract
To characterize the use of olodaterol and indacaterol in clinical practice and to quantify the off-label use in asthma. Drug utilization study of new users of olodaterol or indacaterol between 2014 and 2017 in the PHARMO Database Network in the Netherlands, the Danish population registers, and the IMS Real-World Evidence Longitudinal Patient Database panels in France. On-label use was defined as use among adults with a recorded diagnosis of COPD. Off-label use was defined as use among adults with a recorded diagnosis of asthma without a recorded diagnosis of COPD or as use among patients aged ≤18 years. Potential off-label use was defined as no recorded diagnosis of either COPD or asthma. The study included 4,158 new users of olodaterol and 9,966 new users of indacaterol. Prevalence of off-label use ranged from 3.5% for both drugs to 12.4% for olodaterol and 11.9% for indacaterol. Prevalence of on-label use ranged from 47.8% to 77.7% for olodaterol and from 28.7% to 70.1% for indacaterol. The remaining new users of olodaterol and indacaterol were classified as potential off-label users, with prevalence ranging from 17.3% to 48.6% for olodaterol and from 20.5% to 66.6% for indacaterol. This study provides no evidence of a major concern in Europe for olodaterol or indacaterol for off-label use in asthma or for pediatric use.
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Affiliation(s)
- Cristina Rebordosa
- RTI Health Solutions, Av. Diagonal 605, 9-1, 08028, Barcelona, Spain.
- Research Triangle Park, NC, North Carolina, USA.
| | - Eline Houben
- PHARMO Institute for Drug Outcomes Research, Van Deventerlaan 30-40 3528 AE, Utrecht, Netherlands
| | - Kristina Laugesen
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, 8200, Aarhus N, Denmark
| | - Ulrich Bothner
- Boehringer Ingelheim International GmbH, Binger Str. 173, 55216, Ingelheim am Rhein, Germany
| | - Jukka Montonen
- Boehringer Ingelheim International GmbH, Binger Str. 173, 55216, Ingelheim am Rhein, Germany
| | - Jaume Aguado
- RTI Health Solutions, Av. Diagonal 605, 9-1, 08028, Barcelona, Spain
- Research Triangle Park, NC, North Carolina, USA
| | | | - Vera Ehrenstein
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, 8200, Aarhus N, Denmark
| | - Joelle Asmar
- IQVIA, RWI, Tour D2, 17 Bis Place des Reflets, TSA 64567, 92099, La Défense Cedex, France
| | - Laura Wallace
- Boehringer Ingelheim International GmbH, 900 Ridgebury Road, Ridgefield, CT, 06877, USA
| | - Alicia W Gilsenan
- RTI Health Solutions, Av. Diagonal 605, 9-1, 08028, Barcelona, Spain
- Research Triangle Park, NC, North Carolina, USA
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19
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Dalon F, Devouassoux G, Belhassen M, Nachbaur G, Correia Da Silva C, Sail L, Jacoud F, Chouaid C, Van Ganse E. Impact of Therapy Persistence on Exacerbations and Resource Use in Patients Who Initiated COPD Therapy. Int J Chron Obstruct Pulmon Dis 2019; 14:2905-2915. [PMID: 31908439 PMCID: PMC6927267 DOI: 10.2147/copd.s222762] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 12/02/2019] [Indexed: 12/15/2022] Open
Abstract
Purpose This study assessed therapy persistence in patients with chronic obstructive pulmonary disease (COPD) in France, and the impact of non-persistence on exacerbations and described COPD-related healthcare resource use (HRU). Methods Patients aged ≥45 years who received ≥1 dispensed bronchodilator per quarter over three consecutive quarters between 2007 and 2014 and initiated specific COPD therapy were selected from the Echantillon Généraliste des Bénéficiaires (EGB) database. Persistence, defined as the absence of dispensing gaps of >90 days, was measured at 12 months. Exacerbations were compared between persistent and non-persistent patients during follow-up after patient matching and adjustment for confounding factors. COPD-related HRU during follow-up was described. Results Among 4020 patients with COPD, 2164 initiated a specific therapy. Of these, 54.4% stopped treatment within 12 months. Persistence with all COPD therapy regimens was low, particularly for inhaled corticosteroid (ICS; 25.6%) and ICS/twice-daily long-acting beta-agonist (39.4%) regimens. Among 721 persistent patients who were matched with 721 non-persistent patients, there was no difference in the number of moderate or severe exacerbations at 12 months. However, medical procedures (for instance, pulmonary function testing and chest X-rays) were more frequently observed among persistent patients than among non-persistent patients, suggesting worse disease severity. Conclusion Patients receiving specific treatment(s) for COPD demonstrated low persistence for all examined therapy regimens, with no clear impact of persistence status on the frequency of exacerbations at 12 months.
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Affiliation(s)
| | - Gilles Devouassoux
- Pulmonary Department, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France.,EA 7426, PI3, Inflammation & Immunité de L'épithélium Respiratoire, Université Claude-Bernard-Lyon1, Lyon, France
| | - Manon Belhassen
- PELyon, PharmacoEpidemiology, Lyon, France.,EA 7425 HESPER Health Services and Performance Research, Université Claude-Bernard-Lyon1, Lyon, France
| | - Gaëlle Nachbaur
- GlaxoSmithKline France, Pharmaco Epidemiology and Health Economics and Outcomes Research, Rueil-Malmaison, France
| | - Camille Correia Da Silva
- GlaxoSmithKline France, Pharmaco Epidemiology and Health Economics and Outcomes Research, Rueil-Malmaison, France
| | - Lynda Sail
- GlaxoSmithKline France, Pharmaco Epidemiology and Health Economics and Outcomes Research, Rueil-Malmaison, France
| | | | | | - Eric Van Ganse
- PELyon, PharmacoEpidemiology, Lyon, France.,Pulmonary Department, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France.,EA 7425 HESPER Health Services and Performance Research, Université Claude-Bernard-Lyon1, Lyon, France
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20
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Sawalha S, Hedman L, Backman H, Stenfors N, Rönmark E, Lundbäck B, Lindberg A. The impact of comorbidities on mortality among men and women with COPD: report from the OLIN COPD study. Ther Adv Respir Dis 2019; 13:1753466619860058. [PMID: 31291820 PMCID: PMC6624914 DOI: 10.1177/1753466619860058] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Comorbidities probably contribute to the increased mortality observed among subjects with chronic obstructive pulmonary disease (COPD), but sex differences in the prognostic impact of comorbidities have rarely been evaluated in population-based studies. The aim of this study was to evaluate the impact of common comorbidities, cardiovascular disease (CVD), diabetes mellitus (DM), and anxiety/depression (A/D), on mortality among men and women with and without airway obstruction in a population-based study. METHODS All subjects with airway obstruction [forced expiratory volume in 1 second (FEV1)/(forced) vital capacity ((F)VC) <0.70, n = 993] were, together with age- and sex-matched referents, identified after examinations of population-based cohorts in 2002-2004. Spirometric groups: normal lung function (NLF) and COPD (post-bronchodilator FEV1/(F)VC <0.70) and additionally, LLN-COPD (FEV1/(F)VC <lower limit of normal). Mortality data was collected until December 2015. RESULTS In COPD, the prevalence of CVD and DM was higher in men, whereas the prevalence of A/D was higher in women. The cumulative mortality was significantly higher in COPD than NLF, and higher in men than women in both groups. Among women with COPD, CVD and A/D but not DM increased the risk of death independent of age, body mass index, smoking habits, and disease severity, whereas among men DM and A/D but not CVD increased the risk for death. When the LLN criterion was applied, the pattern was similar. CONCLUSION There were sex-dependent differences regarding the impact of comorbidities on prognosis in COPD. Even though the prevalence of CVD was higher in men, the impact of CVD on mortality was higher in women, and despite higher prevalence of A/D in women, the impact on mortality was similar in both sexes. The reviews of this paper are available via the supplemental material section.
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Affiliation(s)
- Sami Sawalha
- Department of Public Health and Clinical Medicine, Division of Medicine, Umeå University, Umeå, Sweden.,Division of Respiratory Medicine, Sunderby Hospital, 971 80 Luleå, Sweden
| | - Linnea Hedman
- Department of Public Health and Clinical Medicine, The OLIN unit, Section of Sustainable Health, Umeå University, Umeå, Sweden.,Department of Health Science, Division of Nursing, Luleå University of Technology, Luleå, Sweden
| | - Helena Backman
- Department of Public Health and Clinical Medicine, The OLIN unit, Section of Sustainable Health, Umeå University, Umeå, Sweden
| | - Nikolai Stenfors
- Department of Public Health and Clinical Medicine, Division of Medicine, Umeå University. Umeå, Sweden
| | - Eva Rönmark
- Department of Public Health and Clinical Medicine, The OLIN unit, Section of Sustainable Health, Umeå University, Umeå, Sweden
| | - Bo Lundbäck
- Krefting Research center, Institution of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Anne Lindberg
- Department of Public Health and Clinical Medicine, Division of Medicine, Umeå University. Umeå, Sweden
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21
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Park SC, Kim DW, Park EC, Shin CS, Rhee CK, Kang YA, Kim YS. Mortality of patients with chronic obstructive pulmonary disease: a nationwide populationbased cohort study. Korean J Intern Med 2019; 34:1272-1278. [PMID: 31610634 PMCID: PMC6823577 DOI: 10.3904/kjim.2017.428] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 05/04/2018] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND/AIMS Chronic obstructive pulmonary disease (COPD) is a major cause of mortality in the world. There are no population-based studies on longterm mortality in COPD patients in Korea. METHODS Using the large, population-based, National Health Insurance Service- National Sample Cohort (NHIS-NSC), we identified COPD patients using the International Classification of Disease-Tenth Revision (ICD-10) and prescription details in the NHIS-NSC during 2003 to 2013. We analyzed the survival curves of COPD patients by sex, age, and cause of death. RESULTS A total of 14,127 individuals older than 40 years were diagnosed with COPD. There were a total of 3,695 deaths (26.2%) in COPD patients during the study period. The 5-year mortality of COPD patients was 25.4% (29.9% in males and 19.1% in females). The mortality rate increased rapidly with age. The most common cause of death in COPD was chronic lower respiratory disease. CONCLUSION This study described long-term mortality in COPD patients in Korea. Higher mortality was observed in males, and it was closely related to age.
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Affiliation(s)
- Seon Cheol Park
- Division of Pulmonology, Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Korea
- Department of Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Dong Wook Kim
- Department of Policy Research Affairs, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Eun Cheol Park
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Cheung Soo Shin
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Chin Kook Rhee
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Young Ae Kang
- Division of Pulmonology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Young Sam Kim
- Division of Pulmonology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- Correspondence to Young Sam Kim, M.D. Division of Pulmonology, Department of Internal Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea Tel: +82-2-2228-1971, Fax: +82-2-393-6884, E-mail:
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22
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Gothe H, Rajsic S, Vukicevic D, Schoenfelder T, Jahn B, Geiger-Gritsch S, Brixner D, Popper N, Endel G, Siebert U. Algorithms to identify COPD in health systems with and without access to ICD coding: a systematic review. BMC Health Serv Res 2019; 19:737. [PMID: 31640678 PMCID: PMC6805625 DOI: 10.1186/s12913-019-4574-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 09/30/2019] [Indexed: 02/03/2023] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) causes significant morbidity and mortality worldwide. Estimation of incidence, prevalence and disease burden through routine insurance data is challenging because of under-diagnosis and under-treatment, particularly for early stage disease in health care systems where outpatient International Classification of Diseases (ICD) diagnoses are not collected. This poses the question of which criteria are commonly applied to identify COPD patients in claims datasets in the absence of ICD diagnoses, and which information can be used as a substitute. The aim of this systematic review is to summarize previously reported methodological approaches for the identification of COPD patients through routine data and to compile potential criteria for the identification of COPD patients if ICD codes are not available. Methods A systematic literature review was performed in Medline via PubMed and Google Scholar from January 2000 through October 2018, followed by a manual review of the included studies by at least two independent raters. Study characteristics and all identifying criteria used in the studies were systematically extracted from the publications, categorized, and compiled in evidence tables. Results In total, the systematic search yielded 151 publications. After title and abstract screening, 38 publications were included into the systematic assessment. In these studies, the most frequently used (22/38) criteria set to identify COPD patients included ICD codes, hospitalization, and ambulatory visits. Only four out of 38 studies used methods other than ICD coding. In a significant proportion of studies, the age range of the target population (33/38) and hospitalization (30/38) were provided. Ambulatory data were included in 24, physician claims in 22, and pharmaceutical data in 18 studies. Only five studies used spirometry, two used surgery and one used oxygen therapy. Conclusions A variety of different criteria is used for the identification of COPD from routine data. The most promising criteria set in data environments where ambulatory diagnosis codes are lacking is the consideration of additional illness-related information with special attention to pharmacotherapy data. Further health services research should focus on the application of more systematic internal and/or external validation approaches.
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Affiliation(s)
- Holger Gothe
- Department of Public Health, Health Services Research and Health Technology Assessment, Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Eduard Wallnoefer Zentrum 1, A-6060, Hall i.T., Austria. .,Medical Faculty "Carl Gustav Carus", Technical University Dresden, Loescherstrasse 18, D-01307, Dresden, Germany.
| | - Sasa Rajsic
- Department of Public Health, Health Services Research and Health Technology Assessment, Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Eduard Wallnoefer Zentrum 1, A-6060, Hall i.T., Austria
| | - Djurdja Vukicevic
- Department of Public Health, Health Services Research and Health Technology Assessment, Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Eduard Wallnoefer Zentrum 1, A-6060, Hall i.T., Austria
| | - Tonio Schoenfelder
- Medical Faculty "Carl Gustav Carus", Technical University Dresden, Loescherstrasse 18, D-01307, Dresden, Germany
| | - Beate Jahn
- Department of Public Health, Health Services Research and Health Technology Assessment, Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Eduard Wallnoefer Zentrum 1, A-6060, Hall i.T., Austria
| | - Sabine Geiger-Gritsch
- Department of Public Health, Health Services Research and Health Technology Assessment, Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Eduard Wallnoefer Zentrum 1, A-6060, Hall i.T., Austria
| | - Diana Brixner
- University of Utah, School of Medicine, Salt Lake City, UT, 84132, USA
| | - Niki Popper
- Department of Public Health, Health Services Research and Health Technology Assessment, Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Eduard Wallnoefer Zentrum 1, A-6060, Hall i.T., Austria.,, dwh Gmbh, Neustiftgasse 57-59, A-1070, Vienna, Austria.,TU Wien, Research Unit of Information and Software Engineering, Vienna, Austria
| | - Gottfried Endel
- Evidence-Based Medicine and Health Technology Assessment, Main Association of Austrian Social Insurance Institutions, Kundmanngasse 21, A-1031, Vienna, Austria
| | - Uwe Siebert
- Department of Public Health, Health Services Research and Health Technology Assessment, Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Eduard Wallnoefer Zentrum 1, A-6060, Hall i.T., Austria.,Division of Health Technology Assessment and Bioinformatics, ONCOTYROL - Center for Personalized Cancer Medicine, Innsbruck, Austria.,Center for Health Decision Science, Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, 718 Huntington Ave, Boston, MA, 02115, USA.,Institute for Technology Assessment and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 101 Merrimac St, Boston, MA, 02114, USA
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23
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Impact of Disease-Specific Fears on Pulmonary Rehabilitation Trajectories in Patients with COPD. J Clin Med 2019; 8:jcm8091460. [PMID: 31540306 PMCID: PMC6780973 DOI: 10.3390/jcm8091460] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 09/10/2019] [Accepted: 09/10/2019] [Indexed: 01/23/2023] Open
Abstract
Disease-specific fears predict health status in chronic obstructive pulmonary disease (COPD), but their role in pulmonary rehabilitation (PR) remains poorly understood and especially longer-term evaluations are lacking. We therefore investigated changes in disease-specific fears over the course of PR and six months after PR, and investigated associations with PR outcomes (COPD assessment test (CAT) and St. Georges respiratory questionnaire (SGRQ)) in a subset of patients with COPD (n = 146) undergoing a 3-week inpatient PR program as part of the STAR study (Clinicaltrials.gov, ID: NCT02966561). Disease-specific fears as measured with the COPD anxiety questionnaire improved after PR. For fear of dyspnea, fear of physical activity and fear of disease progression, improvements remained significant at six-month follow-up. Patients with higher disease-specific fears at baseline showed elevated symptom burden (CAT and SGRQ Symptom scores), which persisted after PR and at follow-up. Elevated disease-specific fears also resulted in reduced improvements in Quality of Life (SGRQ activity and impact scales) after PR and at follow-up. Finally, improvement in disease-specific fears was associated with improvement in symptom burden and quality of life. Adjustment for potential confounding variables (sex, smoking status, age, lung function, and depressive symptoms) resulted in comparable effects. These findings show the role of disease-specific fears in patients with COPD during PR and highlight the need to target disease-specific fears to further improve the effects of PR.
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24
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Spilling CA, Bajaj MPK, Burrage DR, Ruickbie S, Thai NJ, Baker EH, Jones PW, Barrick TR, Dodd JW. Contributions of cardiovascular risk and smoking to chronic obstructive pulmonary disease (COPD)-related changes in brain structure and function. Int J Chron Obstruct Pulmon Dis 2019; 14:1855-1866. [PMID: 31686798 PMCID: PMC6709516 DOI: 10.2147/copd.s213607] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 07/10/2019] [Indexed: 12/12/2022] Open
Abstract
Background Brain damage and cardiovascular disease are extra-pulmonary manifestations of chronic obstructive pulmonary disease (COPD). Cardiovascular risk factors and smoking are contributors to neurodegeneration. This study investigates whether there is a specific, COPD-related deterioration in brain structure and function independent of cardiovascular risk factors and smoking. Materials and methods Neuroimaging and clinical markers of brain structure (micro- and macro-) and function (cognitive function and mood) were compared between 27 stable COPD patients (age: 63.0±9.1 years, 59.3% male, forced expiratory volume in 1 second [FEV1]: 58.1±18.0% pred.) and 23 non-COPD controls with >10 pack years smoking (age: 66.6±7.5 years, 52.2% male, FEV1: 100.6±19.1% pred.). Clinical relationships and group interactions with brain structure were also tested. All statistical analyses included correction for cardiovascular risk factors, smoking, and aortic stiffness. Results COPD patients had significantly worse cognitive function (p=0.011), lower mood (p=0.046), and greater gray matter atrophy (p=0.020). In COPD patients, lower mood was associated with markers of white matter (WM) microstructural damage (p<0.001), and lower lung function (FEV1/forced vital capacity and FEV1) with markers of both WM macro (p=0.047) and microstructural damage (p=0.028). Conclusion COPD is associated with both structural (gray matter atrophy) and functional (worse cognitive function and mood) brain changes that cannot be explained by measures of cardiovascular risk, aortic stiffness, or smoking history alone. These results have important implications to guide the development of new interventions to prevent or delay progression of neuropsychiatric comorbidities in COPD. Relationships found between mood and microstructural abnormalities suggest that in COPD, anxiety, and depression may occur secondary to WM damage. This could be used to better understand disabling symptoms such as breathlessness, improve health status, and reduce hospital admissions.
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Affiliation(s)
- Catherine A Spilling
- Institute for Molecular and Clinical Sciences, St George’s University of London, LondonSW17 ORE, UK
| | - Mohani-Preet K Bajaj
- Institute for Molecular and Clinical Sciences, St George’s University of London, LondonSW17 ORE, UK
| | - Daniel R Burrage
- Institute for Infection and Immunity, St George’s University of London, LondonSW17 ORE, UK
| | - Sachelle Ruickbie
- Institute for Infection and Immunity, St George’s University of London, LondonSW17 ORE, UK
| | - N Jade Thai
- Clinical Research and Imaging Centre, University of Bristol, BristolBS2 8DX, UK
| | - Emma H Baker
- Institute for Infection and Immunity, St George’s University of London, LondonSW17 ORE, UK
| | - Paul W Jones
- Institute for Infection and Immunity, St George’s University of London, LondonSW17 ORE, UK
| | - Thomas R Barrick
- Institute for Molecular and Clinical Sciences, St George’s University of London, LondonSW17 ORE, UK
| | - James W Dodd
- Academic Respiratory Unit, University of Bristol, BristolBS10 5NB, UK
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25
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Garvey C, Criner GJ. Impact of Comorbidities on the Treatment of Chronic Obstructive Pulmonary Disease. Am J Med 2018; 131:23-29. [PMID: 29777661 DOI: 10.1016/j.amjmed.2018.05.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 05/04/2018] [Indexed: 01/03/2023]
Abstract
Chronic obstructive pulmonary disease (COPD) frequently exists alongside other chronic diseases. Comorbidities can have a significant influence on the course of COPD, affecting disease-related symptoms and increasing morbidity and mortality in patients. Studies indicate that management of comorbid COPD can be improved by engaging in a multidisciplinary team-based approach. A collaborative effort from different disease specialists and health care professionals, together with disease self-management and management programs, could improve the outcomes of patients with comorbid COPD.
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Affiliation(s)
- Chris Garvey
- Sleep Disorders and Pulmonary Rehabilitation, University of California, San Francisco.
| | - Gerard J Criner
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pa
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26
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Sleep Disturbance in Smokers with Preserved Pulmonary Function and with Chronic Obstructive Pulmonary Disease. Ann Am Thorac Soc 2018; 14:1836-1843. [PMID: 28825846 DOI: 10.1513/annalsats.201706-453oc] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
RATIONALE Sleep disturbance frequently affects patients with chronic obstructive pulmonary disease (COPD), and is associated with reduced quality of life and poorer outcomes. Data indicate that smokers with preserved pulmonary function have clinical symptoms similar to those meeting spirometric criteria for COPD, but little is known about the driving factors for sleep disturbance in this population of emerging interest. OBJECTIVES To compare the magnitude and correlates of sleep disturbance between smokers with preserved pulmonary function and those with airflow obstruction. METHODS Using cross-sectional data from the COPD Outcomes-Based Network for Clinical Effectiveness and Research Translation multicenter registry, we identified participants clinically identified as having COPD with a smoking history of at least 20 pack-years and either preserved pulmonary function or airflow obstruction. We quantified sleep disturbance by T-score measured in the sleep disturbance domain of the Patient-Reported Outcomes Information System questionnaire, and defined a minimum important difference as a T-score difference of two points. We performed univariate and multivariable linear regression to evaluate correlates within each group. RESULTS We identified 100 smokers with preserved pulmonary function and 476 with airflow obstruction. The sleep disturbance T-score was 4.1 points greater among individuals with preserved pulmonary function (95% confidence interval [CI], 2.0-6.3). In adjusted analyses, depression symptom T-score was associated with sleep disturbance in both groups (airflow obstruction: β, 0.61 points; 95% CI, 0.27-0.94; preserved pulmonary function: β, 0.25 points; 95% CI, 0.12-0.38). Of note, lower percent predicted FEV1 was associated with greater sleep disturbance among those with preserved pulmonary function (β, -0.19 points; 95% CI, -0.31 to -0.07), whereas higher FEV1 was associated with greater sleep disturbance among individuals with airflow obstruction (β, 0.06 points; 95% CI, 0.01-0.10). CONCLUSIONS Among smokers with clinically identified COPD, the severity of sleep disturbance is greater among those with preserved pulmonary function compared with those with airflow obstruction. Nonrespiratory symptoms, such as depression, were associated with sleep disturbance in both groups, whereas the relationship of sleep disturbance with FEV1 differed.
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27
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Yohannes AM. Serotonergic antidepressants in COPD: beneficial or harmful? Eur Respir J 2018; 52:52/1/1801095. [PMID: 30054351 DOI: 10.1183/13993003.01095-2018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 06/20/2018] [Indexed: 11/05/2022]
Affiliation(s)
- Abebaw Mengistu Yohannes
- School of Behavioral and Applied Sciences, Dept of Physical Therapy, Azusa Pacific University, Azusa, CA, USA
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Park Y, Jung JY, Kim YS, Chung KS, Song JH, Kim SY, Kim EY, Kang YA, Park MS, Chang J, Leem AY. Relationship between depression and lung function in the general population in Korea: a retrospective cross-sectional study. Int J Chron Obstruct Pulmon Dis 2018; 13:2207-2213. [PMID: 30140153 PMCID: PMC6054762 DOI: 10.2147/copd.s169025] [Citation(s) in RCA: 13] [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 Lung function and depression are closely related to many chronic lung diseases. However, few studies have evaluated this association in the general population. In this study, we evaluated the relationship between lung function and depression in the general population in Korea. Participants and methods Data from the Ansung–Ansan cohort, a community-based cohort in Korea, were used to analyze the relationships between depression and lung function parameters. A total of 3,321 men and women aged 40–69 years were enrolled. Spirometry data included the forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), and the FEV1/FVC ratio. Depression was defined as a score of ≥16 by the Beck Depression Inventory (BDI). A propensity score analysis was conducted with the aim of reducing the bias of the retrospective study. Results The overall prevalence of depression in the study population was 13.1% (434/3,321 participants). Depression was significantly more prevalent in women than in men (P<0.001) and in never smokers than in ever smokers (P<0.001). The group with depression was older (P<0.001) and had a lower average body mass index (BMI) (P=0.015) than the group without depression. The FEV1 (P<0.001), FVC (P<0.001), and FEV1/FVC ratio (P=0.022) were significantly lower in the group with depression than in the group without depression. After adjusting for age, sex, BMI, and smoking status, the mean FEV1 was lower in the group with a high BDI score than in the group with a low BDI score (P=0.044). Using multiple linear regression analysis and adjusting for covariates, no statistically significant relationship between lung function and the BDI score was found. However, the BDI score and FEV1 were inversely related in subjects older than 50 years (P=0.023). Conclusion Depression is associated with decreased lung function in the general population, especially in adults older than 50 years.
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Affiliation(s)
- Youngmok Park
- Division of Pulmonology, Department of Internal Medicine, Institute of Chest Disease, Severance Hospital, Yonsei University College of Medicine, Seodaemun-gu, Seoul, South Korea,
| | - Ji Ye Jung
- Division of Pulmonology, Department of Internal Medicine, Institute of Chest Disease, Severance Hospital, Yonsei University College of Medicine, Seodaemun-gu, Seoul, South Korea,
| | - Young Sam Kim
- Division of Pulmonology, Department of Internal Medicine, Institute of Chest Disease, Severance Hospital, Yonsei University College of Medicine, Seodaemun-gu, Seoul, South Korea,
| | - Kyung Soo Chung
- Division of Pulmonology, Department of Internal Medicine, Institute of Chest Disease, Severance Hospital, Yonsei University College of Medicine, Seodaemun-gu, Seoul, South Korea,
| | - Joo Han Song
- Division of Pulmonology, Department of Internal Medicine, Institute of Chest Disease, Severance Hospital, Yonsei University College of Medicine, Seodaemun-gu, Seoul, South Korea,
| | - Song Yee Kim
- Division of Pulmonology, Department of Internal Medicine, Institute of Chest Disease, Severance Hospital, Yonsei University College of Medicine, Seodaemun-gu, Seoul, South Korea,
| | - Eun Young Kim
- Division of Pulmonology, Department of Internal Medicine, Institute of Chest Disease, Severance Hospital, Yonsei University College of Medicine, Seodaemun-gu, Seoul, South Korea,
| | - Young Ae Kang
- Division of Pulmonology, Department of Internal Medicine, Institute of Chest Disease, Severance Hospital, Yonsei University College of Medicine, Seodaemun-gu, Seoul, South Korea,
| | - Moo Suk Park
- Division of Pulmonology, Department of Internal Medicine, Institute of Chest Disease, Severance Hospital, Yonsei University College of Medicine, Seodaemun-gu, Seoul, South Korea,
| | - Joon Chang
- Division of Pulmonology, Department of Internal Medicine, Institute of Chest Disease, Severance Hospital, Yonsei University College of Medicine, Seodaemun-gu, Seoul, South Korea,
| | - Ah Young Leem
- Division of Pulmonology, Department of Internal Medicine, Institute of Chest Disease, Severance Hospital, Yonsei University College of Medicine, Seodaemun-gu, Seoul, South Korea,
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Miravitlles M, Roche N, Cardoso J, Halpin D, Aisanov Z, Kankaanranta H, Kobližek V, Śliwiński P, Bjermer L, Tamm M, Blasi F, Vogelmeier CF. Chronic obstructive pulmonary disease guidelines in Europe: a look into the future. Respir Res 2018; 19:11. [PMID: 29347928 PMCID: PMC5774162 DOI: 10.1186/s12931-018-0715-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 01/05/2018] [Indexed: 02/07/2023] Open
Abstract
Clinical practice guidelines are ubiquitous and are developed to provide recommendations for the management of many diseases, including chronic obstructive pulmonary disease. The development of these guidelines is burdensome, demanding a significant investment of time and money. In Europe, the majority of countries develop their own national guidelines, despite the potential for overlap or duplication of effort. A concerted effort and consolidation of resources between countries may alleviate the resource-intensity of maintaining individual national guidelines. Despite significant resource investment into the development and maintenance of clinical practice guidelines, their implementation is suboptimal. Effective strategies of guideline dissemination must be given more consideration, to ensure adequate implementation and improved patient care management in the future.
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Affiliation(s)
- Marc Miravitlles
- Pneumology Department, University Hospital Vall d'Hebron, Ciber de Enfermedades Respiratorias (CIBERES), Barcelona, Spain.
| | - Nicolas Roche
- Service de Pneumologie et Soins Intensifs Respiratoires, Hôpital Cochin (AP-HP), University Paris Descartes (EA2511), Paris, France
| | - João Cardoso
- Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, Universidade Nova de Lisboa, Lisbon, Portugal
| | | | - Zaurbek Aisanov
- Pulmonology Department, Pulmonology Research Institute, Russian National Medical University, Moscow, Russia
| | - Hannu Kankaanranta
- Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland.,Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - Vladimir Kobližek
- Department of Pneumology, University Hospital Hradec Kralove, Faculty of Medicine in Hradec Kralove, Charles University in Prague, Hradec Kralove, Czech Republic
| | - Paweł Śliwiński
- 2nd Department of Respiratory Medicine, Institute of Tuberculosis and Lung Diseases, Warsaw, Poland
| | - Leif Bjermer
- Department of Respiratory Medicine & Allergology, Skåne University Hospital, Lund, Sweden
| | - Michael Tamm
- Clinic of Pulmonary Medicine and Respiratory Cell Research, University Hospital, Basel, Switzerland
| | - Francesco Blasi
- Department of Pathophysiology and Transplantation, University of Milan, and Department of Internal Medicine, Respiratory Unit and Adult Cystic Fibrosis Center, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Claus F Vogelmeier
- Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-University Marburg, Member of the German Center for Lung Research (DZL), Marburg, Germany
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Rose L, Istanboulian L, Carriere L, Thomas A, Lee HB, Rezaie S, Shafai R, Fraser I. Program of Integrated Care for Patients with Chronic Obstructive Pulmonary Disease and Multiple Comorbidities (PIC COPD+): a randomised controlled trial. Eur Respir J 2018; 51:51/1/1701567. [DOI: 10.1183/13993003.01567-2017] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 10/08/2017] [Indexed: 11/05/2022]
Abstract
We sought to evaluate the effectiveness of a multi-component, case manager-led exacerbation prevention/management model for reducing emergency department visits. Secondary outcomes included hospitalisation, mortality, health-related quality of life, chronic obstructive pulmonary disease (COPD) severity, COPD self-efficacy, anxiety and depression.Two-centre randomised controlled trial recruiting patients with ≥2 prognostically important COPD-associated comorbidities. We compared our multi-component intervention including individualised care/action plans and telephone consults (12-weekly then 9-monthly) with usual care (both groups). We used zero-inflated Poisson models to examine emergency department visits and hospitalisation; Cox proportional hazard model for mortality.We randomised 470 participants (236 intervention, 234 control). There were no differences in number of emergency department visits or hospital admissions between groups. We detected difference in emergency department visit risk, for those that visited the emergency department, favouring the intervention (RR 0.74, 95% CI 0.63–0.86). Similarly, risk of hospital admission was lower in the intervention group for those requiring hospital admission (RR 0.69, 95% CI 0.54–0.88). Fewer intervention patients died (21 versus 36) (HR 0.56, 95% CI 0.32–0.95). No differences were detected in other secondary outcomes.Our multi-component, case manager-led exacerbation prevention/management model resulted in no difference in emergency department visits, hospital admissions and other secondary outcomes. Estimated risk of death (intervention) was nearly half that of the control.
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31
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Mago R, Fagiolini A, Weiller E, Weiss C. Healthcare professionals' perceptions on the emotional impact of having an inadequate response to antidepressant medications: survey and prospective patient audit. Ann Gen Psychiatry 2018; 17:20. [PMID: 29780430 PMCID: PMC5948926 DOI: 10.1186/s12991-018-0189-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 05/03/2018] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Despite the availability of effective antidepressants, about half of patients with major depressive disorder (MDD) display an inadequate response to their initial treatment. A large patient survey recently reported that 29.8% of MDD patients experiencing an inadequate treatment response felt frustrated about their medication and 19.2% were frustrated with their healthcare provider. This survey and chart audit evaluated healthcare professionals' (HCP) views on the emotional impact of having an inadequate response to antidepressant medication. METHODS HCPs who frequently treat patients with MDD completed a survey and chart audit of their MDD patients currently experiencing an inadequate response to antidepressant treatment. RESULTS 287 HCPs completed 1336 chart audits. HCPs reported that 38% of their patients were trusting/accepting of their MDD medications and 41% of their patients trusted/felt confident with their healthcare provision. Conversely, HCPs reported that 11% of their patients were frustrated with their medication and 5% with their healthcare benefits. HCPs cited impact on daily life (53%) and treatment issues (lack of efficacy and side effects; 50%) as the main drivers for their patients' feelings of frustration. When HCPs recognized patients' feelings of frustration, the top concerns of the HCPs were worsening of symptoms (43%) and non-compliance (41%). CONCLUSIONS This survey and chart audit highlights the emotional burden associated with inadequate responses to MDD treatment in addition to persistent symptoms. Differences between the views of the HCPs and patients are highlighted and suggest that HCPs may underestimate the full impact that having to try numerous medications has on their patients.
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Affiliation(s)
- Rajnish Mago
- Simple and Practical Mental Health, Philadelphia, PA USA.,210 W Rittenhouse Square Suite 404, Philadelphia, PA 19103 USA
| | | | | | - Catherine Weiss
- Otsuka Pharmaceutical Development & Commercialization, Inc, Princeton, NJ USA
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Guillien A, Laurent L, Soumagne T, Puyraveau M, Laplante JJ, Andujar P, Annesi-Maesano I, Roche N, Degano B, Dalphin JC. Anxiety and depression among dairy farmers: the impact of COPD. Int J Chron Obstruct Pulmon Dis 2017; 13:1-9. [PMID: 29296078 PMCID: PMC5741076 DOI: 10.2147/copd.s143883] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) and farming are two conditions that have been associated with an increased risk of anxiety and depression. Dairy farming is an independent risk factor for COPD. Objective To test the hypotheses that the prevalence of anxiety and/or depression is higher in dairy farmers with COPD than in farmers without COPD, and higher in dairy farmers with COPD than in non-farmers with COPD. Methods Anxiety and depression were evaluated using the Hospital Anxiety and Depression Scale in 100 dairy farmers with COPD (DF-COPD), 98 dairy farmers without COPD (DF-controls), 85 non-farming patients with COPD (NF-COPD) and 89 non-farming subjects without COPD (NF-controls), all identified by screening in the Franche-Comté region of France. Anxiety and depression were considered present when the Hospital Anxiety and Depression Scale score was ≥8. COPD was defined by a post-bronchodilator forced expiratory volume in 1 second/forced vital capacity ratio <0.7. Results The crude prevalence of anxiety did not differ between the four groups, ranging from 36% in NF-controls to 47% in NF-COPD (p=0.15 between groups). Similarly, the prevalence of depression did not differ significantly between the four groups (p=0.16 between groups). In dairy farmers (n=198), the only factors associated with anxiety were quality of life and current smoking. Depression in dairy farmers was associated with airflow limitation (lower forced expiratory volume in 1 second and COPD grade 2 or more) as well as with some COPD-related features (dyspnea severity, current smoking, and poorer quality of life). In non-farmers, both anxiety and depression were associated with airflow limitation and COPD-related features. Conclusion In our population, the prevalence of anxiety and/or depression was similar in dairy farmers with and without COPD and in non-farmers with COPD. Nevertheless, the degree of airway obstruction and some COPD-related features were associated with depression among dairy farmers, whereas these factors were not associated with anxiety.
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Affiliation(s)
- Alicia Guillien
- Research Unit EA 3920, Franche-Comté University, Besançon, France
| | - Lucie Laurent
- Department of Clinical Physiology, University Hospital, Besançon, France
| | - Thibaud Soumagne
- Department of Respiratory Diseases, University Hospital, Besançon, France
| | - Marc Puyraveau
- Clinical Methodology Center, University Hospital, Besançon, France
| | | | - Pascal Andujar
- University of Medical Sciences, Paris-est Créteil University, Créteil, France
| | - Isabella Annesi-Maesano
- Epidemiology of Allergic and Respiratory Diseases Department (EPAR), Saint-Antoine Medical School, Paris, France
| | - Nicolas Roche
- Respiratory and Intensive Care Medicine, Cochin Hospital (AP-HP), University Paris Descartes, Paris, France.,Research Unit EA 2511, University Paris Descartes, Paris, France
| | - Bruno Degano
- Research Unit EA 3920, Franche-Comté University, Besançon, France
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Kurashima K, Takaku Y, Ohta C, Takayanagi N, Yanagisawa T, Kanauchi T, Takahashi O. Smoking history and emphysema in asthma-COPD overlap. Int J Chron Obstruct Pulmon Dis 2017; 12:3523-3532. [PMID: 29263658 PMCID: PMC5724421 DOI: 10.2147/copd.s149382] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Emphysema is a distinct feature for classifying COPD, and smoking history (≥10 pack-years) is one of several newly proposed criteria for asthma-COPD overlap (ACO). We studied whether or not a smoking history (≥10 pack-years) and emphysema are useful markers for classifying ACO and differentiating it from asthma with chronic airflow obstruction (CAO). Methods We retrospectively studied the mortalities and frequencies of exacerbation in 256 consecutive patients with ACO (161 with emphysema and 95 without emphysema) who had ≥10 pack-years smoking history, 64 asthma patients with CAO but less of a smoking history (<10 pack-years) and 537 consecutive patients with COPD (452 with emphysema and 85 without emphysema) from 2000 to 2016. In the patients with emergent admission, the causes were classified into COPD exacerbation, asthma attack, and others. Results No asthma patients with CAO had emphysema according to computed tomography findings. The prognoses were significantly better in patients with asthma and CAO than in those with ACO and COPD and better in those with ACO than in those with COPD. In both ACO and COPD patients, the prognoses were better in patients without emphysema than in those with it (P=0.027 and P=0.023, respectively). The frequencies of emergent admission were higher in COPD patients than in ACO patients, and higher in patients with emphysema than in patients without emphysema. ACO/emphysema (+) patients experienced more frequent admission due to COPD exacerbation (P<0.001), while ACO/emphysema (-) patients experienced more frequent admission due to asthma attack (P=0.014). Conclusion A smoking history (≥10 pack-years) was found to be a useful marker for differentiating ACO and asthma with CAO, and emphysema was a useful marker for classifying ACO. These markers are useful for predicting the overall survival and frequency of exacerbation.
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Affiliation(s)
| | | | | | | | | | - Tetsu Kanauchi
- Department of Radiology, Saitama Cardiovascular and Respiratory Center, Kumagaya
| | - Osamu Takahashi
- Center for Clinical Epidemiology, St Luke's International Hospital, Tokyo, Japan
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34
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Smokers Always Pay Twice. Ann Am Thorac Soc 2017; 14:1770-1771. [DOI: 10.1513/annalsats.201709-732ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Sun L, Chen Y, Wu R, Lu M, Yao W. Changes in definition lead to changes in the clinical characteristics across COPD categories according to GOLD 2017: a national cross-sectional survey in China. Int J Chron Obstruct Pulmon Dis 2017; 12:3095-3102. [PMID: 29118578 PMCID: PMC5659231 DOI: 10.2147/copd.s142801] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose To investigate how the changes of definition in assessment of Global Initiative for Chronic Obstructive Lung Disease (GOLD) stratification 2017 lead to changes of chronic obstructive pulmonary disease (COPD) patient clinical characteristics across categories in China. Patients and methods COPD patients from 11 medical centers in China were stratified into old and new groups A–D twice according to the GOLD 2011 and 2017 comprehensive assessment. Demography and clinical characteristics were compared between old and new groups A–D. Results In 1,532 COPD patients, the distribution from group A to D was 330 (21.5%), 132 (8.6%), 411 (26.8%), 659 (43.0%) and 557 (36.4%), 405 (26.4%), 184 (12.0%), 386 (25.2%), respectively according to GOLD 2011 and 2017. 46.7% (500/1,070) patients in high-risk groups were regrouped to low-risk groups. Compared to the old groups A and B, the new groups A and B had a higher proportion of males, lower body mass index, higher modified Medical Research Council (mMRC) grade, poor pulmonary function, more patients with chronic bronchitis, and fewer patients with coronary heart disease and hypertension disease. Compared to the old groups C and D, the new groups C and D had older patients, fewer men, better pulmonary functions, frequent acute exacerbations in the previous year, and more patients with chronic bronchitis, coronary heart disease, or diabetes mellitus. The new group D had more patients with stroke than the old group D. Conclusion In China, GOLD 2017 shifted the overall COPD comprehensive assessments distribution to more low-risk groups. The new high-risk groups had more characteristics associated with high risk of acute exacerbation and mortality. Some of the changes in demography and clinical characteristics of the new low-risk groups were associated with high risk of acute exacerbation and/or mortality.
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Affiliation(s)
- Lina Sun
- Department of Pulmonary and Critical Care Medicine, Peking University Third Hospital, Beijing, China
| | - Yahong Chen
- Department of Pulmonary and Critical Care Medicine, Peking University Third Hospital, Beijing, China
| | - Rui Wu
- Department of Pulmonary and Critical Care Medicine, Peking University Third Hospital, Beijing, China
| | - Ming Lu
- Department of Pulmonary and Critical Care Medicine, Peking University Third Hospital, Beijing, China
| | - Wanzhen Yao
- Department of Pulmonary and Critical Care Medicine, Peking University Third Hospital, Beijing, China
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Roos AB, Stampfli MR. Targeting Interleukin-17 signalling in cigarette smoke-induced lung disease: Mechanistic concepts and therapeutic opportunities. Pharmacol Ther 2017; 178:123-131. [PMID: 28438639 DOI: 10.1016/j.pharmthera.2017.04.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
It is widely accepted that compromised lung function in chronic obstructive pulmonary disease (COPD) is, at least in part, a consequence of persistent airway inflammation caused by particles and noxious gases present in cigarette smoke and indoor air pollution from burning biomass fuel. Currently, the World Health Organization estimates that 80 million people have moderate or severe COPD worldwide. While there is a global need for effective medical treatment, current therapeutic interventions have shown limited success in preventing disease pathology and progression. This is, in large part, due to the complexity and heterogeneity of COPD, and an incomplete understanding of the molecular mechanisms governing inflammatory processes in individual patients. This review discusses recent discoveries related to the pro-inflammatory cytokine interleukin (IL)-17A, and its potential role in the pathogenesis of COPD. We propose that an intervention strategy targeting IL-17 signalling offers an exciting opportunity to mitigate inflammatory processes, and prevent the progression of tissue pathologies associated with COPD.
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Affiliation(s)
- Abraham B Roos
- Respiratory, Inflammation and Autoimmunity, Innovative Medicines, AstraZeneca R&D, Mölndal, Sweden and
| | - Martin R Stampfli
- Department of Pathology and Molecular Medicine, McMaster Immunology Research Centre, McMaster University, Hamilton, ON, Canada; Department of Medicine, Firestone Institute of Respiratory Health at St. Joseph's Health Care, McMaster University, Hamilton, ON, Canada.
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Schivo M, Albertson TE, Haczku A, Kenyon NJ, Zeki AA, Kuhn BT, Louie S, Avdalovic MV. Paradigms in chronic obstructive pulmonary disease: phenotypes, immunobiology, and therapy with a focus on vascular disease. J Investig Med 2017; 65:953-963. [PMID: 28258130 DOI: 10.1136/jim-2016-000358] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2017] [Indexed: 12/21/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is a complex and heterogeneous syndrome that represents a major global health burden. COPD phenotypes have recently emerged based on large cohort studies addressing the need to better characterize the syndrome. Though comprehensive phenotyping is still at an early stage, factors such as ethnicity and radiographic, serum, and exhaled breath biomarkers have shown promise. COPD is also an immunological disease where innate and adaptive immune responses to the environment and tobacco smoke are altered. The frequent overlap between COPD and other systemic diseases, such as cardiovascular disease, has influenced COPD therapy, and treatments for both conditions may lead to improved patient outcomes. Here, we discuss current paradigms that center on improving the definition of COPD, understanding the immunological overlap between COPD and vascular inflammation, and the treatment of COPD-with a focus on comorbid cardiovascular disease.
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Affiliation(s)
- Michael Schivo
- Department of Internal Medicine, University of California Davis School of Medicine, Sacramento, California, USA.,Center for Comparative Respiratory Biology and Medicine, Genome and Biomedical Sciences Facility, University of California Davis, Davis, California, USA
| | - Timothy E Albertson
- Department of Internal Medicine, University of California Davis School of Medicine, Sacramento, California, USA.,Department of Medicine, Veterans Administration Northern California Healthcare System, Mather, California, USA
| | - Angela Haczku
- Department of Internal Medicine, University of California Davis School of Medicine, Sacramento, California, USA.,Center for Comparative Respiratory Biology and Medicine, Genome and Biomedical Sciences Facility, University of California Davis, Davis, California, USA
| | - Nicholas J Kenyon
- Department of Internal Medicine, University of California Davis School of Medicine, Sacramento, California, USA.,Center for Comparative Respiratory Biology and Medicine, Genome and Biomedical Sciences Facility, University of California Davis, Davis, California, USA
| | - Amir A Zeki
- Department of Internal Medicine, University of California Davis School of Medicine, Sacramento, California, USA.,Center for Comparative Respiratory Biology and Medicine, Genome and Biomedical Sciences Facility, University of California Davis, Davis, California, USA
| | - Brooks T Kuhn
- Department of Internal Medicine, University of California Davis School of Medicine, Sacramento, California, USA
| | - Samuel Louie
- Department of Internal Medicine, University of California Davis School of Medicine, Sacramento, California, USA.,Center for Comparative Respiratory Biology and Medicine, Genome and Biomedical Sciences Facility, University of California Davis, Davis, California, USA
| | - Mark V Avdalovic
- Department of Internal Medicine, University of California Davis School of Medicine, Sacramento, California, USA.,Department of Medicine, Veterans Administration Northern California Healthcare System, Mather, California, USA
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Abstract
INTRODUCTION Treatment of patients suffering from major depression could be highly challenging for psychiatrists. Intractability as well as relapse is commonly seen among these patients, leading to functional impairment and poor quality of life. The present review discusses some of the novel investigational drugs that are under pre-clinical or clinical phases in the treatment of major depression. Areas covered: Molecules belonging to different classes such as triple reuptake inhibitors, opioid receptors, ionotropic and metabotropic glutamate receptors, and neurotrophin in the treatment of major depression are covered in this article. Expert opinion: Although the historical discovery of earlier antidepressant molecules (iproniazid and imipramine) is through serendipitous discovery, the present research focuses on discovering novel molecules based on our current pathophysiological knowledge of the disease condition. The fast-acting antidepressant property of N-methyl-d-aspartate (NMDA) receptor molecules, including ketamine is an exciting area of research. Other drug molecules such as amitifadine (triple reuptake inhibitor), ALKS-5461 (kappa receptor antagonist and mu opioidergic receptor agonist), rapastinel (NMDA glutamatergic receptor modulator) are under Phase-III clinical trials and could be approved in the near future for the treatment of major depression.
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Affiliation(s)
- Ashish Dhir
- a Department of Neurology, School of Medicine , University of California Davis , Sacramento , CA , USA
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