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Álvarez-Dobaño JM, Rodríguez-García C, Atienza G, Toubes ME, Rodríguez-Núñez N, Zamarrón C, Novo-Platas JÁ, Soto-Feijóo R, Landín E, Carreiras-Cuiña M, Martínez-Martínez HJ, Carbajales MC, Otero B, Valdés L. Analysis of the quality of e-Consultations in chronic obstructive pulmonary disease. Respir Med 2024; 222:107514. [PMID: 38171405 DOI: 10.1016/j.rmed.2023.107514] [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: 11/13/2023] [Revised: 12/22/2023] [Accepted: 12/25/2023] [Indexed: 01/05/2024]
Abstract
INTRODUCTION The quality of e-Consultations in the COPD is unknown. The objectives of this study were (i) to evaluate the quality of referrals; (ii) to define the characteristics of patients referred from Primary Care (PC) to the Unit of Pulmonology; and (iii) to describe differences between accepted and rejected patients. METHODS A retrospective, observational study of e-Consultations requested by PC for suspected COPD throughout 2022. To quantify the quality of the e-Consultations, an arbitrary scale of 12 variables (score 0-10) was created. RESULTS In total, 384 e-Consultations were reviewed, of which 167 (43.5 %) resulted in a face-to-face visit, and 217 (56.5 %) were rejected. No differences were observed between the two types of patients, except for confirmations of diagnostic suspicion of COPD [significantly higher in accepted patients (p = 0.042)]; physical examination data of rejected patients (more data provided; p = 0.015); and lung function (significantly better in rejected patients). The mean quality of referrals was acceptable (5.6 ± 2.1 score): 121 (31.3 %) had insufficient quality; 118 (30.5 %) acceptable; 75 (19.4 %) good, and 30 (7.8 %) excellent. Quality was low in half of the variables analyzed (6/12); acceptable in 3, and good in another 3. The capacity of resolution of referrals was good (one e-Consultation) in 199 requests (66.1 %); deficient (two e-Consultations) in 72 (23.9 %), and poor (≥3 e-Consultations) in 30 (10 %). Overdiagnosis was 40.2 % (86/214 e-Consultations). The risk could be classified in 247 patients (64.3 %; 135 low-risk; 90 high-risk). CONCLUSIONS When adequate information is provided, e-Consultations help identify different levels of severity. However, the quality and capacity of resolution of referrals were suboptimal, with a high percentage of overdiagnoses.
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Affiliation(s)
- José M Álvarez-Dobaño
- Servicio de Neumología, Hospital Clínico-Universitario de Santiago, Santiago de Compostela, Spain; Grupo Interdisciplinar de Investigación en Neumología, Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Spain.
| | - Carlota Rodríguez-García
- Servicio de Neumología, Hospital Clínico-Universitario de Santiago, Santiago de Compostela, Spain; Grupo Interdisciplinar de Investigación en Neumología, Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Spain.
| | - Gerardo Atienza
- Unidad de Calidad y Seguridad Del Paciente, Subdirección de Calidad, Gerencia Área Sanitaria de Santiago de Compostela y Barbanza, Spain.
| | - María E Toubes
- Servicio de Neumología, Hospital Clínico-Universitario de Santiago, Santiago de Compostela, Spain.
| | - Nuria Rodríguez-Núñez
- Servicio de Neumología, Hospital Clínico-Universitario de Santiago, Santiago de Compostela, Spain.
| | - Carlos Zamarrón
- Servicio de Neumología, Hospital Clínico-Universitario de Santiago, Santiago de Compostela, Spain.
| | - José Ángel Novo-Platas
- Servicio de Control y Gestión, Gerencia Área Sanitaria de Santiago de Compostela y Barbanza, Spain.
| | - Roi Soto-Feijóo
- Servicio de Neumología, Hospital Clínico-Universitario de Santiago, Santiago de Compostela, Spain.
| | - Elisa Landín
- Servicio de Neumología, Hospital Clínico-Universitario de Santiago, Santiago de Compostela, Spain.
| | - María Carreiras-Cuiña
- Servicio de Neumología, Hospital Clínico-Universitario de Santiago, Santiago de Compostela, Spain.
| | | | | | | | - Luis Valdés
- Servicio de Neumología, Hospital Clínico-Universitario de Santiago, Santiago de Compostela, Spain; Grupo Interdisciplinar de Investigación en Neumología, Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Spain; Departamento de Medicina, Facultad de Medicina, Universidad de Santiago de Compostela, Spain.
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Yang X, Yao M, Yin D, Zhang N, Li J, Jiang Y, Fu R, Qian Y. Comparative Study on Chronic Obstructive Pulmonary Disease Screening Tools in Primary Healthcare Institutions in Beijing, China. Int J Chron Obstruct Pulmon Dis 2023; 18:1773-1781. [PMID: 37608835 PMCID: PMC10441650 DOI: 10.2147/copd.s419550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 08/08/2023] [Indexed: 08/24/2023] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) has a high incidence rate in China, but the diagnosis rate remains insufficient. This study aimed to explore and compare COPD screening tools for primary healthcare institutions in China. Purpose Exploring COPD Screening Tools and Their Combined Use for Primary Healthcare Institutions in China. Patients and Methods From September 2022 to March 2023, a screening for COPD was conducted among residents aged 35 years and above in primary healthcare institutions in Beijing, China. The screening involved the use of the CAPTURE scale, COPD-SQ scale, and peak expiratory flow rate test. Any positive results from these screening tests were followed by further pulmonary function testing to confirm the diagnosis. Sensitivity, specificity, positive predictive value, negative predictive value, and receiver operating characteristic (ROC) curves were calculated for each screening tool alone and in combination. Results A total of 986 individuals completed the screening tests. The positive rates for the CAPTURE scale, COPD-SQ scale, and peak flow meter screening were 41.78%, 29.11%, and 52.03%, respectively. Of the participants, 166 (24.09%) underwent pulmonary function tests, with an average age of 61.69±13.68 years. The peak flow meter screening showed the highest sensitivity (83.78%) when used alone, while the COPD-SQ scale exhibited the best specificity (59.69%), positive predictive value (31.58%), and negative predictive value (58.56%). Significant differences (P<0.05) were observed between any two of the three screening tools. Among the combinations, the peak flow meter screening + COPD-SQ scale showed the highest accuracy, with a Youden index of 0.277 and an AUC of 0.638. Conclusion There is variation in the accuracy of existing screening tools for COPD when used alone. For primary healthcare institutions, the optimal COPD screening tool is the combination of peak flow meter screening and the COPD-SQ questionnaire. If limited by screening equipment conditions, the COPD-SQ questionnaire can be used alone for screening.
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Affiliation(s)
- Xu Yang
- Department of General Practice, Donghuashi Community Health Service Center, Beijing, People’s Republic of China
| | - Mi Yao
- Department of General Practice, Peking University Health Science Center, Beijing, People’s Republic of China
| | - Delu Yin
- Department of Health Development, Capital Institute of Pediatrics, Beijing, People’s Republic of China
| | - Na Zhang
- Department of General Practice, Donghuashi Community Health Service Center, Beijing, People’s Republic of China
| | - Jing Li
- Department of General Practice, Donghuashi Community Health Service Center, Beijing, People’s Republic of China
| | - Yan Jiang
- Department of General Practice, Donghuashi Community Health Service Center, Beijing, People’s Republic of China
| | - Rundong Fu
- Department of General Practice, Donghuashi Community Health Service Center, Beijing, People’s Republic of China
| | - Yi Qian
- Department of General Practice, Donghuashi Community Health Service Center, Beijing, People’s Republic of China
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Cherian M, Magner KMA, Whitmore GA, Vandemheen KL, FitzGerald JM, Bergeron C, Boulet LP, Cote A, Field SK, Penz E, McIvor RA, Lemière C, Gupta S, Mayers I, Bhutani M, Hernandez P, Lougheed MD, Licskai CJ, Azher T, Ainslie M, Ezer N, Mulpuru S, Aaron SD. Patient and physician factors associated with symptomatic undiagnosed asthma or COPD. Eur Respir J 2023; 61:13993003.01721-2022. [PMID: 36328359 DOI: 10.1183/13993003.01721-2022] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 10/05/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND It remains unclear why some symptomatic individuals with asthma or COPD remain undiagnosed. Here, we compare patient and physician characteristics between symptomatic individuals with obstructive lung disease (OLD) who are undiagnosed and individuals with physician-diagnosed OLD. METHODS Using random-digit dialling and population-based case finding, we recruited 451 participants with symptomatic undiagnosed OLD and 205 symptomatic control participants with physician-diagnosed OLD. Data on symptoms, quality of life and healthcare utilisation were analysed. We surveyed family physicians of participants in both groups to elucidate differences in physician practices that could contribute to undiagnosed OLD. RESULTS Participants with undiagnosed OLD had lower mean pre-bronchodilator forced expiratory volume in 1 s percentage predicted compared with those who were diagnosed (75.2% versus 80.8%; OR 0.975, 95% CI 0.963-0.987). They reported greater psychosocial impacts due to symptoms and worse energy and fatigue than those with diagnosed OLD. Undiagnosed OLD was more common in participants whose family physicians were practising for >15 years and in those whose physicians reported that they were likely to prescribe respiratory medications without doing spirometry. Undiagnosed OLD was more common among participants who had never undergone spirometry (OR 10.83, 95% CI 6.18-18.98) or who were never referred to a specialist (OR 5.92, 95% CI 3.58-9.77). Undiagnosed OLD was less common among participants who had required emergency department care (OR 0.44, 95% CI 0.20-0.97). CONCLUSIONS Individuals with symptomatic undiagnosed OLD have worse pre-bronchodilator lung function and present with greater psychosocial impacts on quality of life compared with their diagnosed counterparts. They were less likely to have received appropriate investigations and specialist referral for their respiratory symptoms.
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Affiliation(s)
- Mathew Cherian
- The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Kate M A Magner
- The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - G A Whitmore
- Desautels Faculty of Management, McGill University, Montreal, QC, Canada
| | | | - J Mark FitzGerald
- Department of Medicine, The University of British Columbia, Vancouver, BC, Canada.,Deceased
| | - Celine Bergeron
- Department of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | | | - Andreanne Cote
- Centre de Recherche, Hôpital Laval, Université Laval, Quebec City, QC, Canada
| | - Stephen K Field
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Erika Penz
- Department of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - R Andrew McIvor
- Firestone Institute for Respiratory Health, McMaster University, Hamilton, ON, Canada
| | - Catherine Lemière
- Department of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Samir Gupta
- Department of Medicine and Li Ka Shing Knowledge Institute of St Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Irvin Mayers
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Mohit Bhutani
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Paul Hernandez
- Department of Medicine, Dalhousie University, Halifax, NS, Canada
| | - M Diane Lougheed
- Department of Medicine, Queen's University, Kingston, ON, Canada
| | | | - Tanweer Azher
- Department of Medicine, Memorial University, St John's, NL, Canada
| | - Martha Ainslie
- Department of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Nicole Ezer
- Department of Medicine, McGill University, Montreal, QC, Canada
| | - Sunita Mulpuru
- The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Shawn D Aaron
- The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
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Shrestha P, Pant S. Obstructive Lung Disease among Patients Performing Spirometry in a Tertiary Care Centre: A Descriptive Cross-sectional Study. JNMA J Nepal Med Assoc 2022; 60:777-780. [PMID: 36705140 PMCID: PMC9794931 DOI: 10.31729/jnma.7455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 08/22/2022] [Indexed: 01/31/2023] Open
Abstract
INTRODUCTION Obstructive lung disease is a leading cause of morbidity and mortality worldwide which causes economic and social burdens. Spirometry is a standard test for screening and evaluating patients with symptoms of chronic respiratory diseases and is the investigation of choice for identifying airflow obstruction. Chronic obstructive lung disease prevalence, mortality, and morbidity vary across different countries. The study aimed to find out the prevalence of obstructive lung disease among the patients performing spirometry in a tertiary care centre. METHODS A descriptive cross-sectional study was conducted in the pulmonary function test clinic of the Department of Internal Medicine of a tertiary care hospital between 1 October 2021 and 31 March 2022 from hospital records. Ethical approval was taken from the Institutional Review Committee (Reference number: 200320203). Convenience sampling was done. Point estimate and 95% Confidence Interval were calculated. RESULTS Among 401 patients, obstructive lung disease was present in 173 (43.14%) (38.29-47.99, 95% Confidence Interval). The mean age was 55.78±18.54 years. The most common symptom for referral was dyspnea seen in 151 (87.30%). CONCLUSIONS The prevalence of obstructive lung disease in our study was higher compared to other studies from the similar setting. Spirometry should be used more frequently for diagnosis and to stratify patients for appropriate treatment.
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Affiliation(s)
- Prinsa Shrestha
- Kathmandu Medical College and Teaching Hospital, Sinamangal, Kathmandu, Nepal,Correspondence: Dr Prinsa Shrestha, Kathmandu Medical College and Teaching Hospital, Sinamangal, Kathmandu, Nepal. , Phone: +977-9843534852
| | - Subash Pant
- Department of Internal Medicine, Kathmandu Medical College and Teaching Hospital, Sinamangal, Kathmandu, Nepal
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Baha A, Kokturk N. Physician's attitude against COPD guidelines and the choice of first-line treatment for COPD. Respir Med 2020; 176:106273. [PMID: 33271467 DOI: 10.1016/j.rmed.2020.106273] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 10/30/2020] [Accepted: 11/26/2020] [Indexed: 10/22/2022]
Abstract
AIM Our aim was to evaluate changes in attitudes of pulmonologists in Turkey towards COPD guidelines and their choice of first-line treatments for COPD patients. MATERIAL-METHOD 333 physicians who completed the questionnaire were included in this cross-sectional questionnaire study. The questionnaire contained demographic data, professional information, extent of guideline use, rationales behind using or not using a guideline. The data was compared with the same survey conducted previously in 2011 and was analyzed by appropriate statistical methods. RESULTS 80 physicians were resident pulmonologists (24%), 250 physicians were specialists (75.1%). 298 (89.5%) physicians reported that they follow at least one guideline for selection of the appropriate treatment in COPD. The current application of guidelines when compared with the first survey in 2011, was found to be decreased, 91.2% and 89.5%, respectively (p = 0.07). 46.8% (n = 156) of participants thought that guidelines provided the physicians more legal protection (p < 0.001). The number of physicians who didn't follow the guidelines due to workload increased over this period of time (36.8% in 2011, 85.3% in 2018, p < 0.001). The number of physicians using inhaler steroid combinations as their first choice of treatment was found to be similar with the previous survey (p = 0.909). CONCLUSION According to the results of previous questionnaire, the application of COPD guidelines has decreased. The number of pulmonologists who declared they have no time for following or applying guidelines has profoundly increased since 2011. Despite the warnings of these guidelines, the use of inhaler steroid combination as a first treatment option in COPD is still common.
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Affiliation(s)
- Ayse Baha
- Near East University Faculty of Medicine, Department of Pulmonary Medicine, Mersin-10, Turkey.
| | - Nurdan Kokturk
- Gazi University Faculty of Medicine, Department of Pulmonary Medicine, Ankara, Turkey
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Kraskovsky V, Schneider J, Mador MJ, Provost KA. Longer Duration of Palliative Care in Patients With COPD Is Associated With Death Outside the Hospital. J Palliat Care 2019; 37:125-133. [PMID: 31262230 DOI: 10.1177/0825859719851486] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Patients with advanced chronic obstructive pulmonary disease (COPD) have a significant symptom burden despite maximal medical therapy, yet few are referred for concomitant palliative care. OBJECTIVE To evaluate the utilization and impact of palliative care on the location of death and to identify clinical variables associated with palliative care contact. DESIGN Retrospective chart review from 2010 to 2016 at the VA Western New York Healthcare System using ICD-9/10 diagnosis of COPD. Palliative care contact was identified by Z51.5 or stop code 353. RESULTS Only 0.5% to 2% of living patients received palliative care, increasing abruptly at death (6%). Lower diffusion capacity for carbon monoxide (DLCO) (greater emphysema) was associated with palliative care contact, independent of comorbid disease burden or age. Initial outpatient contact was associated with a longer duration of palliative care (P = .003) and death in a home-like setting. Outpatient palliative care was associated with more severe airflow obstruction (forced expiratory volume in 1 second, percent predicted [FEV1%]), whereas greater disease exacerbation frequency was associated with inpatient contact. COPD patients not referred to palliative care had a greater comorbid disease burden, similar FEV1%, fewer disease exacerbations, and a greater DLCO. CONCLUSION Few patients with COPD received palliative care, similar to national trends. Initial outpatient palliative contact had the longest duration of care and death in the preferred home environment. The extent of emphysema (DLCO reduction) and more frequent disease exacerbations identified in patients were more likely to receive palliative care. Our study begins to define the benefits of palliative care in advanced COPD and confirms underutilization in the years before death, where a prolonged impact on the quality of life may be realized.
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Affiliation(s)
- Valeri Kraskovsky
- 1 Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Jaclyn Schneider
- 2 Department of Geriatrics and Palliative Medicine, Veterans Health Administration, VA Western New York Healthcare System at Buffalo, Buffalo, NY, USA.,3 Division of Geriatrics and Palliative Medicine, Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - M Jeffery Mador
- 4 Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Veterans Health Administration, VA Western New York Healthcare System at Buffalo, Buffalo, NY, USA.,5 Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Karin A Provost
- 4 Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Veterans Health Administration, VA Western New York Healthcare System at Buffalo, Buffalo, NY, USA.,5 Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
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Burkes RM, Mkorombindo T, Chaddha U, Bhatt A, El-Kersh K, Cavallazzi R, Kubiak N. Impact of Quality Improvement on Care of Chronic Obstructive Pulmonary Disease Patients in an Internal Medicine Resident Clinic. Healthcare (Basel) 2018; 6:E88. [PMID: 30044381 PMCID: PMC6165540 DOI: 10.3390/healthcare6030088] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 07/14/2018] [Accepted: 07/23/2018] [Indexed: 12/04/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality. Guideline-discordant care of COPD is not uncommon. Further, there is a push to incorporate quality improvement (QI) training into internal medicine (IM) residency curricula. This study compared quality of care of COPD patients in an IM residents' clinic and a pulmonary fellows' clinic and, subsequently, the results of a quality improvement program in the residents' clinic. Pre-intervention rates of quality measure adherence were compared between the IM teaching clinic (n = 451) and pulmonary fellows' clinic (n = 177). Patient encounters in the residents' teaching clinic after quality improvement intervention (n = 119) were reviewed and compared with pre-intervention data. Prior to intervention, fellows were significantly more likely to offer smoking cessation counseling (p = 0.024) and document spirometry showing airway obstruction (p < 0.001). Smoking cessation counseling, pneumococcal vaccination, and diagnosis of COPD by spirometry were targets for QI. A single-cycle, resident-led QI project was initiated. After, residents numerically improved in the utilization of spirometry (66.5% vs. 74.8%) and smoking cessation counseling (81.8% vs. 86.6%), and significantly improved rates of pneumococcal vaccination (p = 0.024). One cycle of resident-led QI significantly improved the rates of pneumococcal vaccination, with numerical improvement in other areas of COPD care.
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Affiliation(s)
- Robert M Burkes
- Department of Internal Medicine, University of Louisville, 550 S. Jackson Street, ACB 3rd Floor, Louisville, KY 40202, USA.
| | - Takudzwa Mkorombindo
- Department of Internal Medicine, University of Louisville, 550 S. Jackson Street, ACB 3rd Floor, Louisville, KY 40202, USA.
| | - Udit Chaddha
- Department of Internal Medicine, University of Louisville, 550 S. Jackson Street, ACB 3rd Floor, Louisville, KY 40202, USA.
| | - Alok Bhatt
- Department of Internal Medicine, University of Louisville, 550 S. Jackson Street, ACB 3rd Floor, Louisville, KY 40202, USA.
| | - Karim El-Kersh
- Division of Pulmonary, Critical Care, and Sleep Medicine Disorders, Department of Internal Medicine, University of Louisville, 550 S. Jackson Street, Pulmonary, Critical Care and Sleep Disorders Medicine Offices, ACB 3rd Floor, Louisville, KY 40202, USA.
| | - Rodrigo Cavallazzi
- Division of Pulmonary, Critical Care, and Sleep Medicine Disorders, Department of Internal Medicine, University of Louisville, 550 S. Jackson Street, Pulmonary, Critical Care and Sleep Disorders Medicine Offices, ACB 3rd Floor, Louisville, KY 40202, USA.
| | - Nancy Kubiak
- Department of General Internal Medicine, University of Louisville, Palliative Care, and Medical Education, 550 S. Jackson Street, General Internal Medicine and Palliative Care Offices, ACB 3rd Floor, Louisville, KY 40202, USA.
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Liang J, Abramson MJ, Zwar N, Russell G, Holland AE, Bonevski B, Mahal A, van Hecke B, Phillips K, Eustace P, Paul E, Petrie K, Wilson S, George J. Interdisciplinary model of care (RADICALS) for early detection and management of chronic obstructive pulmonary disease (COPD) in Australian primary care: study protocol for a cluster randomised controlled trial. BMJ Open 2017; 7:e016985. [PMID: 28928190 PMCID: PMC5623556 DOI: 10.1136/bmjopen-2017-016985] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 06/30/2017] [Accepted: 07/05/2017] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION Up to half of all smokers develop clinically significant chronic obstructive pulmonary disease (COPD). Gaps exist in the implementation and uptake of evidence-based guidelines for managing COPD in primary care. We describe the methodology of a cluster randomised controlled trial (cRCT) evaluating the efficacy and cost-effectiveness of an interdisciplinary model of care aimed at reducing the burden of smoking and COPD in Australian primary care settings. METHODS AND ANALYSIS A cRCT is being undertaken to evaluate an interdisciplinary model of care (RADICALS - Review of Airway Dysfunction and Interdisciplinary Community-based care of Adult Long-term Smokers). General practice clinics across Melbourne, Australia, are identified and randomised to the intervention group (RADICALS) or usual care. Patients who are current or ex-smokers, of at least 10 pack years, including those with an existing diagnosis of COPD, are being recruited to identify 280 participants with a spirometry-confirmed diagnosis of COPD. Handheld lung function devices are being used to facilitate case-finding. RADICALS includes individualised smoking cessation support, home-based pulmonary rehabilitation and home medicines review. Patients at control group sites receive usual care and Quitline referral, as appropriate. Follow-ups occur at 6 and 12 months from baseline to assess changes in quality of life, abstinence rates, health resource utilisation, symptom severity and lung function. The primary outcome is change in St George's Respiratory Questionnaire score of patients with COPD at 6 months from baseline. ETHICS AND DISSEMINATION This project has been approved by the Monash University Human Research Ethics Committee and La Trobe University Human Ethics Committee (CF14/1018 - 2014000433). Results of the study will be disseminated in peer-reviewed journals and research conferences. If the intervention is successful, the RADICALS programme could potentially be integrated into general practices across Australia and sustained over time. TRIAL REGISTRATION NUMBER ACTRN12614001155684; Pre-results.
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Affiliation(s)
- Jenifer Liang
- Centre for Medicine Use and Safety, Monash University, Parkville, Victoria, Australia
| | - Michael J Abramson
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Nicholas Zwar
- School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
- School of Medicine, University of Wollongong, Keiraville, New South Wales, Australia
| | - Grant Russell
- Southern Academic Primary Care Research Unit, Department of General Practice, Monash University, Notting Hill, Victoria, Australia
| | - Anne E Holland
- Discipline of Physiotherapy, La Trobe University, Bundoora, Victoria, Australia
- Department of Physiotherapy, Alfred Health, Prahran, Victoria, Australia
- Institute for Breathing and Sleep, Austin Hospital, Heidelberg, Victoria, Australia
| | - Billie Bonevski
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Ajay Mahal
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- The Nossal Institute for Global Health, University of Melbourne, Carlton, Victoria, Australia
| | - Benjamin van Hecke
- Boehringer Ingelheim (BI) Pty Ltd, North Ryde, New South Wales, Australia
| | | | - Paula Eustace
- Eastern Melbourne PHN (EMPHN), Box Hill, Victoria, Australia
| | - Eldho Paul
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Clinical Haematology Department, Alfred Hospital, Melbourne, Victoria, Australia
| | - Kate Petrie
- Centre for Medicine Use and Safety, Monash University, Parkville, Victoria, Australia
| | - Sally Wilson
- Centre for Medicine Use and Safety, Monash University, Parkville, Victoria, Australia
| | - Johnson George
- Centre for Medicine Use and Safety, Monash University, Parkville, Victoria, Australia
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Gershon A, Mecredy G, Croxford R, To T, Stanbrook MB, Aaron SD. Outcomes of patients with chronic obstructive pulmonary disease diagnosed with or without pulmonary function testing. CMAJ 2017; 189:E530-E538. [PMID: 28396329 PMCID: PMC5386846 DOI: 10.1503/cmaj.151420] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 09/14/2016] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND A small number of people with chronic obstructive pulmonary disease (COPD) receive pulmonary function testing around the time of diagnosis. Because omitting testing increases misdiagnosis, we sought to determine whether health outcomes differed between patients whose COPD was diagnosed with or without pulmonary function testing. METHODS We conducted a longitudinal population study of patients with physician-diagnosed COPD from 2005 to 2012 using health administrative data from Ontario, Canada. We assessed whether having pulmonary function testing around the time of diagnosis was associated with the composite outcome of admission to hospital for COPD or all-cause death, using adjusted survival analysis. RESULTS Chronic obstructive pulmonary disease was diagnosed in 68 898 patients during the study period; 41.2% of patients received peridiagnostic pulmonary function testing. In adjusted analysis, patients who underwent testing were less likely to die or be admitted to hospital for COPD (adjusted hazard ratio [HR] 0.91, 95% confidence interval [CI] 0.89-0.94) and were more likely to be prescribed an inhaled long-acting bronchodilator than patients who did not undergo testing. Subgroup analysis suggested that the association of testing and outcomes was confined to patients with COPD diagnosed in the ambulatory care setting (adjusted HR 0.80, 95% CI 0.76-0.84). INTERPRETATION Confirmation of a COPD diagnosis using pulmonary function testing is associated with a decreased risk of death and admission to hospital for COPD. In ambulatory patients, this effect may be from increased use of appropriate COPD medications. The findings of this study validate current guideline recommendations that encourage pulmonary function testing for diagnosis in all patients with suspected COPD.
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Affiliation(s)
- Andrea Gershon
- Institute for Clinical Evaluative Sciences (Gershon, Mecredy, Croxford, To, Stanbrook); Sunnybrook Health Sciences Centre (Gershon); Institute of Health Policy, Management and Evaluation (Gershon, Stanbrook) and Dalla Lana School of Public Health (To), University of Toronto; The Hospital for Sick Children (To); University Health Network (Stanbrook), Toronto, Ont.; Ottawa Hospital Research Institute (Aaron), University of Ottawa, Ottawa, Ont.
| | - Graham Mecredy
- Institute for Clinical Evaluative Sciences (Gershon, Mecredy, Croxford, To, Stanbrook); Sunnybrook Health Sciences Centre (Gershon); Institute of Health Policy, Management and Evaluation (Gershon, Stanbrook) and Dalla Lana School of Public Health (To), University of Toronto; The Hospital for Sick Children (To); University Health Network (Stanbrook), Toronto, Ont.; Ottawa Hospital Research Institute (Aaron), University of Ottawa, Ottawa, Ont
| | - Ruth Croxford
- Institute for Clinical Evaluative Sciences (Gershon, Mecredy, Croxford, To, Stanbrook); Sunnybrook Health Sciences Centre (Gershon); Institute of Health Policy, Management and Evaluation (Gershon, Stanbrook) and Dalla Lana School of Public Health (To), University of Toronto; The Hospital for Sick Children (To); University Health Network (Stanbrook), Toronto, Ont.; Ottawa Hospital Research Institute (Aaron), University of Ottawa, Ottawa, Ont
| | - Teresa To
- Institute for Clinical Evaluative Sciences (Gershon, Mecredy, Croxford, To, Stanbrook); Sunnybrook Health Sciences Centre (Gershon); Institute of Health Policy, Management and Evaluation (Gershon, Stanbrook) and Dalla Lana School of Public Health (To), University of Toronto; The Hospital for Sick Children (To); University Health Network (Stanbrook), Toronto, Ont.; Ottawa Hospital Research Institute (Aaron), University of Ottawa, Ottawa, Ont
| | - Matthew B Stanbrook
- Institute for Clinical Evaluative Sciences (Gershon, Mecredy, Croxford, To, Stanbrook); Sunnybrook Health Sciences Centre (Gershon); Institute of Health Policy, Management and Evaluation (Gershon, Stanbrook) and Dalla Lana School of Public Health (To), University of Toronto; The Hospital for Sick Children (To); University Health Network (Stanbrook), Toronto, Ont.; Ottawa Hospital Research Institute (Aaron), University of Ottawa, Ottawa, Ont
| | - Shawn D Aaron
- Institute for Clinical Evaluative Sciences (Gershon, Mecredy, Croxford, To, Stanbrook); Sunnybrook Health Sciences Centre (Gershon); Institute of Health Policy, Management and Evaluation (Gershon, Stanbrook) and Dalla Lana School of Public Health (To), University of Toronto; The Hospital for Sick Children (To); University Health Network (Stanbrook), Toronto, Ont.; Ottawa Hospital Research Institute (Aaron), University of Ottawa, Ottawa, Ont
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10
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Fernández-Villar A, López-Campos JL, Represas Represas C, Marín Barrera L, Leiro Fernández V, López Ramírez C, Casamor R. Factors associated with inadequate diagnosis of COPD: On-Sint cohort analysis. Int J Chron Obstruct Pulmon Dis 2015; 10:961-7. [PMID: 26028969 PMCID: PMC4441359 DOI: 10.2147/copd.s79547] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The purpose of this study was to evaluate the frequency of inadequate diagnosis and factors predictive of this in patients with chronic obstructive pulmonary disease (COPD) participating in the On-Sint study. METHODS The On-Sint cohort was recruited for a multicenter observational study in which 356 physicians (71.6% from primary care) included adult patients who had been diagnosed with COPD. Patients' clinical and functional information since diagnosis and details for the recruiting physicians were collected from patient files and at the inclusion visit. We performed a multivariate analysis to evaluate the influence of these variables on diagnostic inadequacy (absence of postbronchodilator forced expiratory volume in one second/forced vital capacity [FEV1/FVC] <0.70 or, if this value was missing, prebronchodilator FEV1/FVC <0.70). RESULTS In total, 1,214 patients were included in the study. The patients had a mean age of 66.4±9.7 years and 78.8% were male. In total, 51.3% of patients did not have an obstructive spirometry performed, and 21.4% had a normal or non-obstructive spirometry pattern. Patient-related factors associated with inadequate diagnosis were: years since diagnosis (odds ratio [OR] 1.03, 95% confidence interval [CI] 1.01-1.05), number of exacerbations in the previous year (OR 1.01, 95% CI 1.01-1.02), comorbidities (OR 1.05, 95% CI 1.01-1.015), and obesity (OR 1.06, 95% CI 1.02-1.10 per kg/m(2) of body mass index), while a longer smoking history (OR 0.98, 95% CI 0.97-0.99 for each pack/year) and short-acting or long-acting bronchodilator therapy (OR 0.61, 95% CI 0.44-0.76 and OR 0.46, 95% CI 0.27-0.76, respectively) were inversely related. With regard to physician-related variables, being followed up by primary care physicians (OR 3.0, 95% CI 2.11-4.34) and in rural centers (OR 1.63, 95% CI 1.12-2.38) were positively associated with an inadequate diagnosis, while having regular follow-ups in the most severe cases (OR 0.66, 95% CI 0.46-0.93) and use of quality of life questionnaires (OR 0.55, 95% CI 0.40-0.76) were negatively associated. CONCLUSION Diagnosis of COPD was inadequate in half of the patients from the On-Sint cohort. There were multiple factors, both patient-related and physician-related, associated with this misdiagnosis.
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Affiliation(s)
- Alberto Fernández-Villar
- Department of Pneumology, Complexo Hospitalario de Vigo, Instituto de Investigación Biomédica de Vigo, Vigo, Spain
| | - José Luis López-Campos
- Medical-Surgical Unit of Respiratory Diseases, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/Universidad de Sevilla, Seville, Spain ; Centro de Investigación Biomédica en Red de Respiratorio, Instituto de Salud Carlos III, Madrid, Spain
| | - Cristina Represas Represas
- Department of Pneumology, Complexo Hospitalario de Vigo, Instituto de Investigación Biomédica de Vigo, Vigo, Spain
| | - Lucía Marín Barrera
- Centro de Investigación Biomédica en Red de Respiratorio, Instituto de Salud Carlos III, Madrid, Spain
| | - Virginia Leiro Fernández
- Department of Pneumology, Complexo Hospitalario de Vigo, Instituto de Investigación Biomédica de Vigo, Vigo, Spain
| | - Cecilia López Ramírez
- Centro de Investigación Biomédica en Red de Respiratorio, Instituto de Salud Carlos III, Madrid, Spain
| | - Ricard Casamor
- Medical Department, Novartis Farmacéutica, Barcelona, Spain
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11
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Moreira GL, Gazzotti MR, Manzano BM, Nascimento O, Perez-Padilla R, Menezes AMB, Jardim JR. Incidence of chronic obstructive pulmonary disease based on three spirometric diagnostic criteria in Sao Paulo, Brazil: a nine-year follow-up since the PLATINO prevalence study. SAO PAULO MED J 2015; 133:245-51. [PMID: 26176929 PMCID: PMC10876369 DOI: 10.1590/1516-3180.2015.9620902] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 09/10/2014] [Accepted: 02/09/2015] [Indexed: 11/22/2022] Open
Abstract
CONTEXT AND OBJECTIVE Chronic obstructive pulmonary disease (COPD) is a respiratory disease of high prevalence and socioeconomic impact worldwide. It affects approximately 16% of the population of São Paulo. The incidence of COPD is still unknown in Brazil. The aim of this study was to estimate new cases of COPD in a population-based sample in São Paulo, Brazil, using three different spirometric diagnostic criteria, and to assess the concordance between these criteria. DESIGN AND SETTING Prospective cohort study, in the city of São Paulo, Brazil. METHODS A questionnaire was applied and anthropometry and pre and post-bronchodilator spirometry were performed on the same subjects as in the initial PLATINO study (2003) in São Paulo. Data from this follow-up study were added to the original database of the initial phase. Incident COPD cases refer to subjects who developed the disease in accordance with each spirometric criterion during the nine-year follow-up period. The Statistical Package for the Social Sciences, version 17.0 (SPSS Inc., Chicago, IL, USA) was used in the analysis and the significance level was set at P < 0.05. RESULTS 613 subjects participated in the follow-up. New COPD cases ranged in frequency from 1.4% to 4.0%, depending on the diagnostic criterion used. The concordance between the criteria ranged from 35% to 60%. CONCLUSION The incidence of COPD after a nine-year follow-up was high, but varied according to the spirometric criterion used. The agreement between the criteria for identifying new cases of the disease ranged from 35% to 60%.
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Affiliation(s)
- Graciane Laender Moreira
- PhD. Physiotherapist, Department of Translational Medicine, Universidade Federal de São Paulo (Unifesp), São Paulo, Brazil.
| | | | - Beatriz Martins Manzano
- PhD. Physiotherapist, Department of Translational Medicine, Universidade Federal de São Paulo (Unifesp), São Paulo, Brazil.
| | - Oliver Nascimento
- MD, PhD. Pulmonology Sector, Universidade Federal de São Paulo (Unifesp), São Paulo, Brazil.
| | - Rogelio Perez-Padilla
- MD. Adjunct Professor, National Institute of Respiratory Diseases, Mexico City, Mexico.
| | - Ana Maria Baptista Menezes
- MD, PhD. Adjunct Professor, Department of Internal Medicine, School of Medicine, Universidade Federal de Pelotas (UFPel), Pelotas, Rio Grande do Sul, Brazil.
| | - José Roberto Jardim
- MD, PhD. Adjunct Professor, Universidade Federal de São Paulo (Unifesp), São Paulo, Brazil.
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12
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Collins BF, Ramenofsky D, Au DH, Ma J, Uman JE, Feemster LC. The association of weight with the detection of airflow obstruction and inhaled treatment among patients with a clinical diagnosis of COPD. Chest 2014; 146:1513-1520. [PMID: 24763942 PMCID: PMC4251614 DOI: 10.1378/chest.13-2759] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Accepted: 04/01/2014] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Most patients with a clinical diagnosis of COPD have not had spirometry to confirm airflow obstruction (AFO). Overweight and obese patients report more dyspnea than normal weight patients, which may be falsely attributed to AFO. We sought to determine whether overweight and obese patients who received a clinical diagnosis of COPD were more likely to receive a misdiagnosis (ie, lack of AFO on spirometry) and be subsequently treated with inhaled medications. METHODS The cohort comprised US veterans with COPD (International Classification of Diseases, 9th Revision, code; inhaled medication use; or both) and spirometry measurements from one of three Pacific Northwest Veterans Administration Medical Centers. The measured exposures were overweight and obesity (defined by BMI categories). Outcomes were (1) AFO on spirometry and (2) escalation or deescalation of inhaled therapies from 3 months before spirometry to 9 to 12 months after spirometry. We used multivariable logistic regression with calculation of adjusted proportions for all analyses. RESULTS Fifty-two percent of 5,493 veterans who had received a clinical diagnosis of COPD had AFO. The adjusted proportion of patients with AFO decreased as BMI increased (P < .01 for trend). Among patients without AFO, those who were overweight and obese were less likely to remain off medications or to have therapy deescalated (adjusted proportions: normal weight, 0.69 [95% CI, 0.64-0.73]; overweight, 0.62 [95% CI, 0.58-0.65; P = .014]; obese, 0.60 [95% CI, 0.57-0.63; P = .001]). CONCLUSIONS Overweight and obese patients are more likely to be given a misdiagnosis of COPD and not have their inhaled medications deescalated after spirometry demonstrated no AFO. Providers may be missing potential opportunities to recognize and treat other causes of dyspnea in these patients.
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Affiliation(s)
- Bridget F Collins
- Health Services Research and Development, Department of Veterans Affairs, Seattle, WA.
| | - David Ramenofsky
- Division of Pulmonary and Critical Care, Department of Medicine, University of Washington, Seattle, WA
| | - David H Au
- Health Services Research and Development, Department of Veterans Affairs, Seattle, WA
| | - Jun Ma
- Department of Health Services Research, Palo Alto Medical Foundation Research Institute, and Stanford Prevention Research Center, Stanford University School of Medicine, Palo Alto, CA
| | - Jane E Uman
- Health Services Research and Development, Department of Veterans Affairs, Seattle, WA
| | - Laura C Feemster
- Health Services Research and Development, Department of Veterans Affairs, Seattle, WA
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13
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Gershon AS, Hwee J, Croxford R, Aaron SD, To T. Patient and Physician Factors Associated With Pulmonary Function Testing for COPD. Chest 2014; 145:272-281. [DOI: 10.1378/chest.13-0790] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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14
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Frantz S, Nihlén U, Dencker M, Engström G, Löfdahl C, Wollmer P. Impulse oscillometry may be of value in detecting early manifestations of COPD. Respir Med 2012; 106:1116-23. [DOI: 10.1016/j.rmed.2012.04.010] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2011] [Revised: 04/26/2012] [Accepted: 04/30/2012] [Indexed: 10/28/2022]
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15
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Abstract
Spirometry is the gold standard for making the diagnosis of COPD. It should be performed in every case of suspected COPD. Other pulmonary functions, such as lung volumes, can give insight into physiologic consequences of COPD, such as hyperinflation. Pulmonary function testing can also aid in assessing the severity of disease and in managing the disease after diagnosis is made.
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Affiliation(s)
- Kristina L Bailey
- Pulmonary, Critical Care, Sleep and Allergy Division, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE 68198-5910, USA.
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16
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Cooke CE, Sidel M, Belletti DA, Fuhlbrigge AL. Review: Clinical Inertia in the Management of Chronic Obstructive Pulmonary Disease. COPD 2012; 9:73-80. [DOI: 10.3109/15412555.2011.631957] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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17
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Tsujimura S, Nakamura H, Sato I, Tsuduki K, Shirahata T, Yoshida S, Chubachi S, Miyazaki M, Aoki H, Nakamura M, Takahashi S, Nakajima T, Minematsu N, Tateno H, Asano K. Evaluation of a new fiber-grating vision sensor for assessing pulmonary functions in healthy and COPD subjects. Physiol Meas 2011; 32:1701-13. [PMID: 21941027 DOI: 10.1088/0967-3334/32/10/015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Spirometry is practically the only tool to evaluate pulmonary functions. Other automatic systems comparable to spirometry are expected. A fiber-grating (FG) vision sensor is a non-contact respiratory monitoring system to detect changes in volumes by measuring the movement of laser spots on the body surface. We examined the contributions of the FG sensor to evaluating pulmonary functions. The FG sensor showed a linear correlation with spirometry in tidal volumes (TV) obtained from five controls (R = 0.98, P < 0.0001). We also showed agreement of TV between the two devices using Bland-Altman analysis. TV measured by the FG sensor were reproducible and applicable to distinct subjects. To detect airway obstruction, we performed forced expiration in controls (n = 16) and chronic obstructive pulmonary disease (COPD) patients (n = 18) with the FG sensor and spirometry. Forced expiratory volume in 1 s (FEV(1)) and FEV(1)/forced vital capacity in COPD patients were lower than those in controls by the FG sensor. In addition, prolonged expiration in natural breathing by the FG sensor was related to airflow limitation by spirometry. The FG sensor was helpful to measure volume changes and to evaluate pulmonary functions in controls and patients with COPD. Its upcoming clinical applications are promising for simplicity and feasibility.
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Affiliation(s)
- S Tsujimura
- Division of Pulmonary Medicine, Keio University, 35 Shinanomachi Shinjuku-ku, Tokyo, Japan
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18
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Price DB, Yawn BP, Jones RCM. Improving the differential diagnosis of chronic obstructive pulmonary disease in primary care. Mayo Clin Proc 2010; 85:1122-9. [PMID: 21123639 PMCID: PMC2996146 DOI: 10.4065/mcp.2010.0389] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) and asthma represent a substantial portion of primary care practice. In adults, differentiating asthma from COPD can be difficult but is important because of the marked differences in treatment, disease progression, and outcomes between the 2 conditions. Currently, clinical COPD is often misdiagnosed or undiagnosed until late in the disease. Earlier diagnosis could markedly reduce morbidity and improve quality of life. Establishing a diagnosis of COPD requires spirometry testing, interpreted in the context of the patient's symptoms, smoking status, age, and comorbidities. Additional tests and tools may be helpful in the differential diagnosis, including questionnaires specifically developed to discriminate between COPD and asthma and, in special cases, imaging studies. Follow-up and monitoring of asthma and COPD are always necessary and provide additional benefit in patients in whom only continued care and reassessment can confirm the final diagnosis, such as younger individuals with fixed airway obstruction, smokers with asthma, and patients with both disorders. Key areas for improvement include enhanced case identification, improved quality and interpretation of findings on spirometry, and increased use of tools such as differential diagnosis questionnaires and algorithms to guide the diagnostic and monitoring process. To achieve optimal outcomes, the primary care team should make every effort to establish a firm diagnosis. For this review, we conducted a PubMed search with no time limits using the Medical Subject Headings chronic obstructive pulmonary disease or COPD and asthma, in association with the following search terms: diagnosis, differential diagnosis, mixed or comorbid disease, diagnostic techniques, spirometry, questionnaires, and primary care.
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Affiliation(s)
- David B Price
- Center of Academic Primary Care, University of Aberdeen, Foresterhill Health Center, Westburn Road, Aberdeen AB25 2AY, Scotland.
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