Epidemiology of advanced lung disease in the United States

The effects of inspiratory muscle training based on the perceptions of patients with advanced lung disease: a qualitative study

BACKGROUND

Advanced lung disease is a chronic non-neoplastic disease that compromises activities of daily living. Treatment includes pulmonary rehabilitation and inspiratory muscle training. Studies have shown the effectiveness of inspiratory muscle training in lung disease patients, but literature is scarce on the patients' perceptions about this topic.

OBJECTIVE

To explore the perceptions of patients with advanced lung disease about inspiratory muscle training.

METHODS

Qualitative study. Interviews were conducted using a semi-structured questionnaire regarding topics on the participation of patients in inspiratory muscle training and on daily activities performed before and after training. Interviews were transcribed and analyzed according to thematic content analysis.

RESULTS

Ten patients (eight women and 2 men, ranging in age from 27 to 89 years) with inspiratory muscle weakness (maximal inspiratory pressure=44±13.9cmH₂O) were included. Five patients were diagnosed with Chronic Obstructive Pulmonary Disease, two with bronchiectasis and three with pulmonary fibrosis. All patients completed at least 80% of the total training sessions. The reports were grouped into four thematic categories: (1) impact of inspiratory muscle training on breathlessness (e.g., "I wasn't feeling as tired as I previously felt."); (2) change in daily activities (e.g., "I needed to go to the supermarket, I felt less tired doing it."); (3) improved mobility (e.g., "I could not stand for long periods […] walking, for example […] Now I stand more, I have more capability."); and (4) increased communication (e.g., "More power, right? Even in speaking […] When I could, I felt my voice coming out better.").

CONCLUSION

There were improvements in breathlessness, daily activities, mobility, and communication, which positively affected the psychological and social aspects of the patients.

Experimental progressive emphysema in BALB/cJ mice as a model for chronic alveolar destruction in humans

Emphysema, one of the major components of chronic obstructive pulmonary disease (COPD), is characterized by the progressive and irreversible loss of alveolar lung tissue. Even though >80% of COPD cases are associated with cigarette smoking, only a relatively small proportion of smokers develop emphysema, suggesting a potential role for genetic factors in determining individual susceptibility to emphysema. Although strain-dependent effects have been shown in animal models of emphysema, the molecular basis underlying this intrinsic susceptibility is not fully understood. In this present study, we investigated emphysema development using the elastase-induced experimental emphysema model in two commonly used mouse strains, C57BL/6J and BALB/cJ. The results demonstrate that mice with different genetic backgrounds show disparate susceptibility to the development of emphysema. BALB/cJ mice were found to be much more sensitive than C57BL/6J to elastase injury in both a dose-dependent and time-dependent manner, as measured by significantly higher mortality, greater body weight loss, greater decline in lung function, and a greater loss of alveolar tissue. The more susceptible BALB/cJ strain also showed the persistence of inflammatory cells in the lung, especially macrophages and lymphocytes. A comparative gene expression analysis following elastase-induced injury showed BALB/cJ mice had elevated levels of il17A mRNA and a number of classically (M1) and alternatively (M2) activated macrophage genes, whereas the C57BL/6J mice demonstrated augmented levels of interferon-γ. These findings suggest a possible role for these cellular and molecular mediators in modulating the severity of emphysema and highlight the possibility that they might contribute to the heterogeneity observed in clinical emphysema outcomes.

Adherence to current guidelines for chronic obstructive pulmonary disease (COPD) among patients treated with combination of long-acting bronchodilators or inhaled corticosteroids

Background

To estimate the potential cost savings by following the current Global Initiative for Chronic Obstructive Lung Disease (GOLD) guideline recommendations in patients being treated for chronic obstructive pulmonary disease (COPD) with the combination of long-acting β₂-agonist (LABA), long-acting muscarinic antagonist (LAMA) or inhaled corticosteroids (ICS).

Methods

The Geisinger Health System (GHS) database was utilized to identify subjects between January 1, 2004 to March 12, 2007. The index date was based on the first prescription of a LAMA plus LABA, LAMA plus LABA/ICS, or LABA plus ICS. Patients were included in the study if they: had a COPD diagnosis; had data representative of treatment 12 months prior to and 12 months post index date; were 40 years of age or over; had no prior diagnosis for asthma; and had pulmonary function test (PFT) data. We examined the baseline characteristics of these patients along with their healthcare resource utilization. Based on PFT data within 30 days of the index date, a subgroup was classified as adhering or non-adhering to GOLD guidelines.

Results

A total of 364 subjects could be classified as adhering or non-adherent to current GOLD guidelines based on their PFT results. The adherent subgroup received COPD medications consistent with current GOLD guidelines. Of the LAMA plus LABA cohort, 25 patients adhered and 39 patients were non-adherent to current GOLD guidelines. In the cohort of LABA plus ICS, 74 patients were adherent and 180 patients non-adherent to current GOLD guidelines. In the cohort of LAMA plus LABA/ICS, 21 patients were adherent and 25 patients non-adherent to current GOLD guidelines. GOLD adherence was associated with mean total cost of all services savings of $5,889 for LAMA plus LABA, $3,330 for LABA + ICS, and $10,217 for LAMA plus LABA/ICS cohorts.

Conclusion

Staging of COPD with a PFT and adherence to current GOLD guidelines was associated with lower costs in subjects with moderate to severe COPD. Appropriate use of LAMA plus LABA, LABA plus ICS, and LAMA plus LABA/ICS has economic as well as clinical benefits for patients and payers.

Berlin's medical students' smoking habits, knowledge about smoking and attitudes toward smoking cessation counseling

BACKGROUND

Diseases associated with smoking are a foremost cause of premature death in the world, both in developed and developing countries. Eliminating smoking can do more to improve health and prolong life than any other measure in the field of preventive medicine. Today's medical students will play a prominent role in future efforts to prevent and control tobacco use.

METHODS

A cross-sectional, self-administered, anonymous survey of fifth-year medical students in Berlin, Germany was conducted in November 2007. The study explored the prevalence of smoking among medical students. We assessed their current knowledge regarding tobacco dependence and the effectiveness of smoking cessation methods. Students' perceived competence to counsel smokers and promote smoking cessation treatments was also explored. Analyses were based on responses from 258 students (86.6% response rate).

RESULTS

One quarter of the medical students surveyed were current smokers. The smoking rate was 22.1% among women, 32.4% among men. Students underestimated smoking-related mortality and the negative effect of smoking on longevity. A considerable number of subjects erroneously assumed that nicotine causes coronary artery disease. Students' overall knowledge of the effectiveness of smoking cessation methods was inadequate. Only one third of the students indicated that they felt qualified to counsel patients about tobacco dependence.

CONCLUSIONS

This study reveals serious deficiencies in knowledge and counseling skills among medical students in our sample. The curriculum of every medical school should include a tobacco module. Thus, by providing comprehensive training in nicotine dependence interventions to medical students, smokers will have access to the professional expertise they need to quit smoking.

Chronic Obstructive Pulmonary Disease hospitalization rates in Massachusetts: a trend analysis

BACKGROUND

Chronic Obstructive Pulmonary Disease (COPD) causes a huge economic burden and >80% of COPD cases are attributable to smoking. Massachusetts introduced a comprehensive Tobacco Control Program (MTCP) in January 1993. A trend analysis of COPD hospitalization rates might indirectly reflect the potential impact of such comprehensive tobacco control programs.

METHODS

Age-adjusted COPD hospitalization rates/100,000 was abstracted from the Massachusetts Community Health Information Profile Database between 1989 and 2005. Joinpoint Regression Analyses program was employed to estimate annual percent changes (APC) in COPD rates by age, sex and race.

RESULTS

In 1989, 265/100,000 age-adjusted COPD hospitalization rates were reported that increased to 423/100,000 in 1993, and then declined to 329/100,000 in 2005. A significant annual decline of 5.6 percentage points was observed in overall COPD rates from 1993 onwards. A similar temporal pattern, with an age-gradient and a slower annual decline in female COPD rates relative to male COPD rates, was observed. COPD rates in both Blacks and Whites were similar to the general overall pattern. Such consistent annual declines in COPD hospitalization rates from 1993 onwards in Massachusetts also closely correspond to the introduction of the MTCP in January 1993.

CONCLUSION

The findings indirectly suggest that smoking cessation should remain the cornerstone strategy for the prevention and control of COPD burden. However, additional studies across different population settings are essential for a definitive conclusion with regard to the immediate impact of a comprehensive tobacco control program on COPD hospitalization rates showing possible gender susceptibility.

Changes in radiographic abnormalities in organ donors: Associations with lung transplantation

BACKGROUND

Only 20% of organ donors are considered suitable for lung transplantation. No extensive study exists that has evaluated changes in thoracic radiographic abnormalities in organ donors. The purpose of this study was to determine the impact of radiographic abnormalities on successful transplantation.

METHODS

In a retrospective survey of 110 organ donors, chest radiographs (N = 417) taken during the initial 24 hours after admission and just before organ harvest were evaluated for 9 radiographic criteria, radiographic diagnoses and clinical characteristics and their association with lung transplantation.

RESULTS

Initial lung densities were present in 37% of lungs; there were bilateral infiltrates in 25% of cases. During evaluation (69.7 +/- 60 hours), 38% of right lungs and 28% of left lungs improved radiographically. Up to 51% of lungs with initial infiltrates resolved completely. Worsening of lung infiltrates was more common in the non-transplant group (p = 0.02); however, improvement in densities was not associated with transplantation (p = 0.6). Multivariate analysis determined that moderate and severe lung densities (OR 7.68, p = 0.01; OR 10.8, p = 0.004) and bilateral infiltrates (OR 4.79, p = 0.02) were independent predictors of rejection for transplantation. With densities removed from the model, the number of abnormal diagnoses on the final films was an independent predictor of rejection for transplantation (OR 3.23, p = 0.003).

CONCLUSIONS

More than 33% of proposed organ donors initially have lung infiltrates, with >33% showing improvement or resolution, but this improvement does not impact on procurement. Multiple abnormal radiographic diagnoses also contribute to transplant rejection.

Sex Differences in COPD and Lung Cancer Mortality Trends—United States, 1968–1999

PURPOSE

Cigarette smoking by U.S. women in the 1940s and 1950s caused large increases in smoking-related lung disease among women. To determine the magnitude of these increases, we compared the mortality trends for males and females in the United States for chronic obstructive pulmonary disease (COPD) and lung cancer for 1968-1999.

METHODS

We used the national mortality data files compiled by the National Center for Health Statistics of the CDC and U.S. census data to calculate age-adjusted (2000) death rates for COPD, lung cancer, and all causes.

RESULTS

COPD death rate for females increased by 382% from 1968 through 1999, whereas for males it increased by 27% during the same period. As a result, the COPD death rate for U.S. females is approaching that for males. The lung cancer death rate for females increased by 266% from 1968 to 1999, whereas for males, it increased by 15%.

CONCLUSIONS

Physicians, women, and groups interested in women's health issues need to be aware of these trends and target prevention strategies toward females.

Doenças respiratórias como causa de internações hospitalares de pacientes do Sistema Único de Saúde num serviço terciário de clínica médica na região nordeste do Rio Grande do Sul

Objetivo: Levantamento epidemiológico das internações hospitalares por doenças respiratórias no Serviço de Clínica Médica do Hospital Geral de Caxias do Sul no Estado do Rio Grande do Sul, região sul do Brasil. Pacientes e métodos: Estudo retrospectivo realizado no Hospital Universitário entre novembro de 1998 e novembro de 1999. Os dados de: a) causa primária da internação; b) doenças associadas; c) variação sazonal; d) duração da internação; e) mortalidade foram obtidos do arquivo médico informatizado do SCM-HG. Resultados: De 1.200 internações no SCM-HG, 228 (19%) apresentaram como causa primária enfermidade respiratória. As causas mais freqüentes de admissão hospitalar foram DPOC -- 94 pacientes (41,3%), pneumonias -- 68 (29,8 %) e asma brônquica -- 22 (9,6%). Cinqüenta (21,9%) indivíduos apresentaram comorbidades: insuficiência cardíaca -- 18 (7,7%), hipertensão arterial sistêmica -- 15 (6,4%) e diabetes melito -- 10 (4,4%). As pneumonias tiveram maior prevalência no período compreendido entre setembro e novembro, a asma brônquica entre outubro e novembro e a DPOC entre maio a novembro. O tempo médio de internação foi de 10,4 ± 10 dias. A mortalidade da amostra, de 26 (11,4%) pacientes. Conclusões: 1) Doenças respiratórias foram responsáveis por aproximadamente 1/5 das internações no SCM-HG. 2) Portadores de DPOC representam a maior parcela dos pacientes. 3) A duração média de internação dos com doença respiratória foi maior do que o restante dos pacientes do hospital (10,4 dias versus 7,7 dias, respectivamente). 4) DPOC, pneumonias e asma brônquica apresentaram a variação sazonal esperada.

Worldwide epidemiology of chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) continues to cause a heavy health and economic burden around the world. Recent studies have added evidence to the etiologic role of known and suspected risk factors for lung function decline and COPD, including smoking, occupational exposures, air pollution, airway hyperresponsiveness, and certain genetic variations. Among most populations, COPD prevalence and mortality are still increasing and will likely continue to rise in response to increases in smoking, particularly by women and adolescents. Resources aimed at smoking cessation and prevention and the early detection of COPD will be of the most benefit in our continuing efforts against this important cause of morbidity and mortality.