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Effect Analysis of Lung Rehabilitation Training in 5A Nursing Mode for Elderly Patients with COPD Based on X-Ray. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:1963426. [PMID: 35734776 PMCID: PMC9208961 DOI: 10.1155/2022/1963426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 05/20/2022] [Accepted: 05/23/2022] [Indexed: 11/30/2022]
Abstract
This study was aimed at evaluating the application effect of pulmonary rehabilitation training under 5A nursing mode based on X-ray in elderly patients with chronic obstructive pulmonary disease (COPD). Then, 84 elderly patients with chronic obstructive emphysema were selected as the research subjects. COPD knowledge level questionnaire, caregiver self-efficacy scale (CSES), COPD assessment test (CAT), and 6-minute walking experiment (6MWD) were adopted, and the clinical application effect of pulmonary rehabilitation training and conventional nursing under 5A nursing mode was comprehensively compared. The results show that after two and four months of intervention, the average score of COPD knowledge level questionnaire in the test group was 27.43 points and 30.08 points, respectively, higher than that in the control group (P < 0.05). After two and four months of intervention, the number of patients with good compliance in the test group was remarkably improved, and the severity of airflow restriction in the test group was slower than that in the control group. In short, pulmonary rehabilitation training under 5A nursing mode based on X-ray can effectively improve the disease knowledge level, self-efficacy, and pulmonary rehabilitation training compliance of elderly COPD patients, which played an important role in improving the quality of life of patients and alleviating the degree of dyspnea of patients.
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Liu SJ, Ren Z, Wang L, Wei GX, Zou L. Mind⁻Body (Baduanjin) Exercise Prescription for Chronic Obstructive Pulmonary Disease: A Systematic Review with Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E1830. [PMID: 30149535 PMCID: PMC6165467 DOI: 10.3390/ijerph15091830] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 08/13/2018] [Accepted: 08/20/2018] [Indexed: 12/18/2022]
Abstract
Baduanjin exercise is a traditional Chinese health Qigong routine created by an ancient physician for health promotion. Its mild-to-moderate exercise intensity is suitable for individuals with medical conditions. Recently, a large number of trials have been conducted to investigate the effects of Baduanjin exercise in patients with chronic obstructive pulmonary disease (COPD). It remains to be determined whether Baduanjin exercise prescription is beneficial for the management of COPD patients. Thus, we conducted a systematic review to objectively evaluate the existing literature on this topic. We searched six databases (PubMed, Web of Science, Cochrane Library, Scopus, China National Knowledge Infrastructure, and Wanfang) from inception until early May 2018. The adapted Physical Therapy Evidence Database (PEDro) scale was used for study quality assessment of all randomized controlled trials (RCTs). Based on 95% confidence interval (CI), the pooled effect size (Hedge's g) of exercise capability (6-Minute Walking Test, 6-MWT), lung function parameters (forced expiratory volume in one second, FEV₁; forced volume vital capacity, FVC; FEV₁/FVC ratio), and quality of life were calculated based on the random-effects model. Twenty RCTs (n = 1975 COPD patients) were included in this review, with sum scores of the adapted PEDro scale between 5 and 9. Study results of the meta-analysis indicate that Baduanjin is effective in improving exercise capability (Hedge's g = 0.69, CI 0.44 to 0.94, p < 0.001, I² = 66%), FEV₁ (Hedge's g = 0.47, CI 0.22 to 0.73, p < 0.001, I² = 68.01%), FEV₁% (Hedge's g = 0.38, CI 0.21 to 0.56, p < 0.001, I² = 54.74%), FVC (Hedge's g = 0.39, CI 0.22 to 0.56, p < 0.001, I² = 14.57%), FEV₁/FVC (Hedge's g = 0.5, CI 0.33 to 0.68, p < 0.001, I² = 53.49%), and the quality of life of COPD patients (Hedge's g = -0.45, CI -0.77 to -0.12, p < 0.05, I² = 77.02%), as compared to control groups. Baduanjin exercise as an adjunctive treatment may potentially improve exercise capability and pulmonary function of COPD patients as well as quality of life. Baduanjin exercise could be tentatively prescribed for COPD in combination with the conventional rehabilitation program to quicken the process of recovery. To confirm the positive effects of Baduanjin exercise for COPD patients, future researchers need to consider our suggestions mentioned in this article.
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Affiliation(s)
- Shi-Jie Liu
- Department of Physical Education, Wuhan University of Technology, Wuhan 430070, China.
| | - Zhanbing Ren
- Department of Physical Education, Shenzhen University, Shenzhen 518060, China.
| | - Lin Wang
- Department of Physical Education, Wuhan University of Technology, Wuhan 430070, China.
| | - Gao-Xia Wei
- Key Laboratory of Behavioral Science, Institute of Psychology, Chinese Academy of Sciences, Beijing 100101, China.
| | - Liye Zou
- Department of Sports Science and Physical Education, The Chinese University of Hong Kong, Shatin, Hong Kong, China.
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Villar-Álvarez F, Moreno-Zabaleta R, Mira-Solves JJ, Calvo-Corbella E, Díaz-Lobato S, González-Torralba F, Hernando-Sanz A, Núñez-Palomo S, Salgado-Aranda S, Simón-Rodríguez B, Vaquero-Lozano P, Navarro-Soler IM. Do not do in COPD: consensus statement on overuse. Int J Chron Obstruct Pulmon Dis 2018; 13:451-463. [PMID: 29440883 PMCID: PMC5799849 DOI: 10.2147/copd.s151939] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background To identify practices that do not add value, cause harm, or subject patients with chronic obstructive pulmonary disease (COPD) to a level of risk that outweighs possible benefits (overuse). Methods A qualitative approach was applied. First, a multidisciplinary group of healthcare professionals used the Metaplan technique to draft and rank a list of overused procedures as well as self-care practices in patients with stable and exacerbated COPD. Second, in successive consensus-building rounds, description files were created for each "do not do" (DND) recommendation, consisting of a definition, description, quality of supporting evidence for the recommendation, and the indicator used to measure the degree of overuse. The consensus group comprised 6 pulmonologists, 2 general practitioners, 1 nurse, and 1 physiotherapist. Results In total, 16 DND recommendations were made for patients with COPD: 6 for stable COPD, 6 for exacerbated COPD, and 4 concerning self-care. Conclusion Overuse poses a risk for patients and jeopardizes care quality. These 16 DND recommendations for COPD will lower care risks and improve disease management, facilitate communication between physicians and patients, and bolster patient ability to provide self-care.
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Affiliation(s)
| | - Raúl Moreno-Zabaleta
- Pulmonology, Inpatient and Noninvasive Mechanical Ventilation, Hospital Universitario Infanta Sofía, Madrid
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Caballero Vázquez A, Romero Ortiz AD, González de Vega San Román JM, Del Moral RG, Alcázar Navarrete B. [Epidemiological Evolution of Lung Cancer in the South of Spain from 1990 to 2010]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2018; 21:32-36. [PMID: 29357970 PMCID: PMC5972351 DOI: 10.3779/j.issn.1009-3419.2018.01.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background Changes in lung cancer has been characterized by the increase of cases among women and the increase in adenocarcinomas among other histological subtypes. Methods Descriptive analysis of cases diagnosed with lung cancer in Hospital Virgen de las Nieves (Spain) from 1990 to 2010, based on five variables (age, sex, smoking, histology and pathological anatomy). The study establishes associations between these variables and compares the results with the literature. Results 2, 026 patients were diagnosed with lung cancer in this period; 1, 838 were males (90.7%) and 188 women (9.3%); 1, 892 patients (93.4%) were smokers or ex-smokers and 134 (6.6%) had never smoked; the most frequent non-small cell histology types were squamous cell carcinoma and adenocarcinoma and it was the most frequent neoplasia in women and were associated with a lower tobacco consumption. Conclusion The large majority of lung cancer cases is associated with a history of smoking tobacco and there are histopathological differences according to gender and cumulative tobacco smoke load.
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Valeiro B, Hernández C, Barberán-Garcia A, Rodríguez DA, Aibar J, Llop L, Vilaró J. Viabilidad de la evaluación domiciliaria del estado funcional de pacientes con enfermedad pulmonar obstructiva crónica en fase de recuperación de una exacerbación. Arch Bronconeumol 2016; 52:256-61. [DOI: 10.1016/j.arbres.2015.10.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 09/21/2015] [Accepted: 10/18/2015] [Indexed: 11/30/2022]
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Treatment patterns in COPD patients newly diagnosed in primary care. A population-based study. Respir Med 2015; 111:47-53. [PMID: 26758585 DOI: 10.1016/j.rmed.2015.12.004] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 10/31/2015] [Accepted: 12/15/2015] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Treatment for COPD is tailored based on clinical characteristics and severity. However, prescription patterns in COPD patients newly diagnosed in primary care may differ from guideline recommendations. METHOD We performed an epidemiological study with data obtained from the Information System for the Development in Research in Primary Care (SIDIAP), a population database that contains information of 5.8 million inhabitants (80% of the population of Catalonia). Patients newly diagnosed with COPD from 2007 to 2012 were identified and information about the initial treatment patterns was collected. The initial treatment was also described by phenotype and severity. RESULTS During the study period 41,492 patients were newly diagnosed with COPD. Patients were classified as non exacerbators (28,552 patients, 69%), asthma-COPD overlap syndrome (ACOS) (2152 patients, 5.2%) and frequent exacerbators (10,888 patients, 27.6%). Among the patients in whom FEV1 was available, 13.9% were GOLD stage 1, 55.2% stage 2, 26% stage 3 and 4.8% stage 4. Globally, the most frequently prescribed treatment patterns were short-acting bronchodilators (SABD) in monotherapy (17.7%), long-acting β-2 agonists (LABA) + inhaled corticosteroids (ICS) (17.3%) and triple therapy (12.2%). The frequency of patients treated with a SABD increased from 15.9% to 19.5% during the study period, while the number of untreated patients decreased from 24.4% to 15.1%. Up to 45.2% of patients were initially treated with ICS, which were frequently prescribed in the ACOS (69.2%) and in the exacerbator phenotype patients (52.4%) while ICS use has decreased from 43.8% in 2007 to 35.8% in 2012 in non exacerbator patients. Up to 13.6% and 14.8% of GOLD 4 patients received no treatment or only SABD after diagnosis. CONCLUSIONS Initial treatment patterns in newly diagnosed COPD patients often do no comply with guidelines. The use of ICS is excessive but has decreased mainly in non exacerbator patients. Many COPD patients still remain untreated after diagnosis, although this has decreased. Some GOLD 4 patients are still receiving SABD or no treatment at all after diagnosis.
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Balcells E, Gimeno-Santos E, de Batlle J, Ramon MA, Rodríguez E, Benet M, Farrero E, Ferrer A, Guerra S, Ferrer J, Sauleda J, Barberà JA, Agustí À, Rodriguez-Roisin R, Gea J, Antó JM, Garcia-Aymerich J. Characterisation and prognosis of undiagnosed chronic obstructive pulmonary disease patients at their first hospitalisation. BMC Pulm Med 2015; 15:4. [PMID: 25595204 PMCID: PMC4360934 DOI: 10.1186/1471-2466-15-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2015] [Accepted: 01/08/2015] [Indexed: 11/22/2022] Open
Abstract
Background Under-diagnosis of COPD is an important unmet medical need. We investigated the characteristics and prognosis of hospitalised patients with undiagnosed COPD. Methods The PAC-COPD cohort included 342 COPD patients hospitalised for the first time for an exacerbation of COPD (2004–2006). Patients were extensively characterised using sociodemographic, clinical and functional variables, and the cohort was followed-up through 2008. We defined “undiagnosed COPD” by the absence of any self-reported respiratory disease and regular use of any pharmacological respiratory treatment. Results Undiagnosed COPD was present in 34% of patients. They were younger (mean age 66 vs. 68 years, p = 0.03), reported fewer symptoms (mMRC dyspnoea score, 2.1 vs. 2.6, p < 0.01), and had a better health status (SGRQ total score, 29 vs. 40, p < 0.01), milder airflow limitation (FEV1% ref., 59% vs. 49%, p < 0.01), and fewer comorbidities (two or more, 40% vs. 56%, p < 0.01) when compared with patients with an established COPD diagnosis. Three months after hospital discharge, 16% of the undiagnosed COPD patients had stopped smoking (vs. 5%, p = 0.019). During follow-up, annual hospitalisation rates were lower in undiagnosed COPD patients (0.14 vs. 0.25, p < 0.01); however, this difference disappeared after adjustment for severity. Mortality was similar in both groups. Conclusions Undiagnosed COPD patients have less severe disease and lower risk of re-hospitalisation when compared with hospitalised patients with known COPD. Electronic supplementary material The online version of this article (doi:10.1186/1471-2466-15-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Judith Garcia-Aymerich
- Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Doctor Aiguader 88, 08003 Barcelona, Spain.
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de la Matta-Martín M. [Objections to the proposed indication for preoperative thoracic radiography in surgical patients]. ACTA ACUST UNITED AC 2014; 61:528-9. [PMID: 24388788 DOI: 10.1016/j.redar.2013.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Revised: 09/30/2013] [Accepted: 10/29/2013] [Indexed: 12/01/2022]
Affiliation(s)
- M de la Matta-Martín
- Unidad de Gestión Clínica Bloque Quirúrgico, Hospital General, Hospital Universitario Virgen del Rocío, Sevilla, España.
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Güell MR, Cejudo P, Rodríguez-Trigo G, Gàldiz JB, Casolive V, Regueiro M, Soler-Cataluña JJ. Standards for Quality Care in Respiratory Rehabilitation in Patients With Chronic Pulmonary Disease. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/j.arbr.2012.08.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Standards for quality care in respiratory rehabilitation in patients with chronic pulmonary disease. Quality Healthcare Committee. Spanish Society of Pneumology and Thoracic Surgery (SEPAR). Arch Bronconeumol 2012; 48:396-404. [PMID: 22835266 DOI: 10.1016/j.arbres.2012.05.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Revised: 05/21/2012] [Accepted: 05/27/2012] [Indexed: 11/21/2022]
Abstract
Respiratory rehabilitation (RR) has been shown to be effective with a high level of evidence in terms of improving symptoms, exertion capacity and health-related quality of life (HRQL) in patients with COPD and in some patients with diseases other than COPD. According to international guidelines, RR is basically indicated in all patients with chronic respiratory symptoms, and the type of program offered depends on the symptoms themselves. As requested by the Spanish Society of Pneumology and Thoracic Surgery (SEPAR), we have created this document with the aim to unify the criteria for quality care in RR. The document is organized into sections: indications for RR, evaluation of candidates, program components, characteristics of RR programs and the role of the administration in the implementation of RR. In each section, we have distinguished 5 large disease groups: COPD, chronic respiratory diseases other than COPD with limiting dyspnea, hypersecretory diseases, neuromuscular diseases with respiratory symptoms and patients who are candidates for thoracic surgery for lung resection.
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The Excessive Use of Inhaled Corticosteroids in Chronic Obstructive Pulmonary Disease. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/j.arbr.2012.03.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Izquierdo Alonso JL, Rodríguez Glez-Moro JM. The excessive use of inhaled corticosteroids in chronic obstructive pulmonary disease. Arch Bronconeumol 2012; 48:207-12. [PMID: 22385832 DOI: 10.1016/j.arbres.2012.01.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2011] [Accepted: 01/08/2012] [Indexed: 01/04/2023]
Abstract
Despite the fact that the recommendations of the main clinical guidelines have restricted the indications for inhaled corticosteroids in chronic obstructive pulmonary disease (COPD), currently more than 80% of patients are receiving this treatment in Spain, mostly with high doses. A detailed review of the literature does not justify the use of these high doses, a position that agrees with the recommendations of the FDA. A re-evaluation of their safety, the consistency of the data on their efficacy showing similar results with moderate doses and a better patient selection require the use of this treatment in COPD patients to be reconsidered.
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de Miguel-Díez J, Carrasco-Garrido P, Rejas-Gutierrez J, Martín-Centeno A, Gobartt-Vázquez E, Hernandez-Barrera V, Gil de MA, Jimenez-Garcia R. Inappropriate overuse of inhaled corticosteroids for COPD patients: impact on health costs and health status. Lung 2011; 189:199-206. [PMID: 21499887 DOI: 10.1007/s00408-011-9289-0] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2010] [Accepted: 03/18/2011] [Indexed: 11/29/2022]
Abstract
The aim of this study was to evaluate the relationship between inappropriate overuse of inhaled corticosteroids and self-reported health status and the annual cost of patients with stable chronic obstructive pulmonary disease (COPD) recruited in the primary-care setting. An observational, crossover, descriptive study was conducted. Patients with stable COPD and aged ≥40 years, evaluated in primary care, were included. Data collected were demographic variables, clinical characteristics, self-reported health status (SF-12), the severity of the illness, treatment, and health-care resource utilization in the past year. The patients were recruited during a period of 3 months (from January 1 to March 31, 2003). Use was considered inappropriate when corticosteroids were prescribed by physicians for patients not meeting criteria for its use as recommended in guidelines. A total of 10,711 patients [75.6% males; mean age = 67.1 (SD = 9.66) years] were evaluated. Disease severity was mild in 35.5% of the cases, moderate in 53.4%, and severe in 11.2%. Among them, 3,697 (34.5%) subjects were prescribed inhaled corticosteroids or drug combinations containing such therapies, with a rate of inappropriate use of 18.2%. Physical health status was significantly lower among patients showing inappropriate corticosteroids use: 37.35 (SD = 9.53) vs. 40.7 (SD = 9.80) (p < 0.05). The annual cost per patient of COPD management was significantly higher in the group with inappropriate inhaled corticosteroids use: <euro>1,590 (SD = 1,834) vs. <euro>1,157 (SD = 1,536) (p < 0.05). Factors statistically associated with inappropriate use of corticosteroids were educational attainment [OR: 2.77 (95% CI: 1.36-5.63) for nonuniversity training], a history of heart disease [OR: 1.42 (95% CI: 1.02-1.97)], depression [OR: 1.47 (95% CI: 1.05-2.05)], any allergy [OR 1.69 (95% CI: 1.13-2.54)], and physical health status [OR 0.97 (95% CI: 0.96-0.98)]. Lack of adherence to the recommended criteria for using inhaled corticosteroids therapy in the management of COPD patients was associated with lower self-reported health status and higher costs. Factors statistically associated with inappropriate use of corticosteroids were educational attainment, a history of heart disease, depression, any allergy, and physical health status.
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Affiliation(s)
- Javier de Miguel-Díez
- Pneumology Department, Hospital General Universitario Gregorio Marañón, Doctor Esquerdo, 46, 28007, Madrid, Spain.
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Lacoma A, Prat C, Andreo F, Lores L, Ruiz-Manzano J, Ausina V, Domínguez J. Value of procalcitonin, C-reactive protein, and neopterin in exacerbations of chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis 2011; 6:157-69. [PMID: 21468168 PMCID: PMC3064422 DOI: 10.2147/copd.s16070] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2011] [Indexed: 01/31/2023] Open
Abstract
Objective: The identification of biological markers in order to assess different aspects of COPD is an area of growing interest. The objective of this study was to investigate whether levels of procalcitonin (PCT), C-reactive protein (CRP), and neopterin in COPD patients could be useful in identifying the etiological origin of the exacerbation and assessing its prognosis. Methods: We included 318 consecutive COPD patients: 46 in a stable phase, 217 undergoing an exacerbation, and 55 with pneumonia. A serum sample was collected from each patient at the time of being included in the study. A second sample was also collected 1 month later from 23 patients in the exacerbation group. We compared the characteristics, biomarker levels, microbiological findings, and prognosis in each patient group. PCT and CRP were measured using an immunofluorescence assay. Neopterin levels were measured using a competitive immunoassay. Results: PCT and CRP showed significant differences among the three patient groups, being higher in patients with pneumonia, followed by patients with exacerbation (P < 0.0001). For the 23 patients with paired samples, PCT and CRP levels decreased 1 month after the exacerbation episode, while neopterin increased. Neopterin showed significantly lower levels in exacerbations with isolation of pathogenic bacteria, but no differences were found for PCT and CRP. No significant differences were found when comparing biomarker levels according to the Gram result: PCT (P = 0.191), CRP (P = 0.080), and neopterin (P = 0.109). However, median values of PCT and CRP were high for Streptococcus pneumoniae, Staphylococcus aureus, and enterobacteria. All biomarkers were higher in patients who died within 1 month after the sample collection than in patients who died later on. Conclusions: According to our results, biomarker levels vary depending on the clinical status. However, the identification of the etiology of infectious exacerbation by means of circulating biomarkers is encouraging, but its main disadvantage is the absence of a microbiological gold standard, to definitively demonstrate their value. High biomarker levels during an exacerbation episode correlate with the short-term prognosis, and therefore their measurement can be useful for COPD management.
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Affiliation(s)
- Alicia Lacoma
- Servei de Microbiologia, Hospital Universitari Germans Trias i Pujol, Fundació Institut d'Investigació en Ciències de Salut Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain
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Barnestein-Fonseca P, Leiva-Fernández J, Vidal-España F, García-Ruiz A, Prados-Torres D, Leiva-Fernández F. Is it possible to diagnose the therapeutic adherence of patients with COPD in clinical practice? A cohort study. BMC Pulm Med 2011; 11:6. [PMID: 21261951 PMCID: PMC3033862 DOI: 10.1186/1471-2466-11-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2010] [Accepted: 01/24/2011] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Therapeutic adherence of patients with chronic obstructive pulmonary disease (COPD) is poor. It is therefore necessary to determine the magnitude of non-adherence to develop strategies to correct this behaviour. The purpose of this study was to analyse the diagnostic validity of indirect adherence methods. METHODS SAMPLE 195 COPD patients undergoing scheduled inhaled treatment attending 5 Primary Care Centres of Malaga, Spain. VARIABLES Sociodemographic profile, illness data, spirometry, quality of life (St. George Respiratory Questionnaire: SGRQ), and inhaled medication counting (count of dose/pill or electronic monitoring) were collected. The patient's knowledge of COPD (Batalla test:BT),their attitude towards treatment (Morisky-Green test: MGT) and their self-reported therapeutic adherence (Haynes-Sackett test: HST) were used as methods of evaluating adherence. The follow-up consisted four visits over one year (the recruitment visit: V0; and after 1 month:V1; 6 months:V2; and 1 year:V3). RESULTS The mean age was 69.59 (95% CI, 68.29-70.89) years old and 93.8% were male. Other findings included: 85.4% had a low educational level, 23.6% were smokers, 71.5% mild-moderate COPD stage with a FEV1 = 56.86 (SD = 18.85); exacerbations per year = 1.41(95% CI, 1-1.8). The total SGRQ score was 44.96 (95% CI, 42.46-47.46), showing a mild self-perceived impairment in health. The prevalence of adherence (dose/pill count) was 68.1% (95% CI, 60.9-75.3) at V1, 80% (95% CI, 73-87) at V2 and 84% (95% CI, 77.9) at V3. The MGT showed a specificity of 67.34% at V1, 76.19% at V2 and 69.62% at V3. The sensitivity was 53.33% at V1, 66.66% at V2 and 33.33% at V3.The BT showed a specificity of 55.1% at V1, 70.23% at V2 and 67.09% at V3. The sensitivity was 68.88% at V1, 71.43% at V2 and 46.66% at V3. Considering both tests together, the specificity was 86.73% at V1, 94.04% at V2 and 92.49% at V3 and the sensitivity was 37.77% at V1, 47.62% at V2 and 13.3% at V3. CONCLUSIONS The prevalence of treatment adherence changes over time. Indirect methods (dose/pill count and self-reported) can be useful to detect non-adherence in COPD patients. The combination of MGT and BT is the best approach to test self-reported adherence.
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Canals-Borrajo G, Martínez-Andión B, Cigüenza-Fuster ML, Esteva M, San Martín MAL, Roman M, Góngora M. Spirometry for detection of undiagnosed chronic obstructive pulmonary disease in primary care. Eur J Gen Pract 2010; 16:215-21. [PMID: 20849314 DOI: 10.3109/13814788.2010.518233] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The aim of this study was to assess the utility of family physicians' office spirometry, to detect previously undiagnosed chronic obstructive pulmonary disease (COPD) in individuals who smoke. Furthermore, agreement between doctors with more or less experience in performing spirometry was assessed. METHODS Cross-sectional study. Smokers aged 40-69 years who attended a family practice centre were invited to participate. Variables considered were tobacco pack-years, time of tobacco use, smoking cessation, COPD symptoms, Medical Research Council Dyspnoea Scale values, pre- and post-bronchodilator spirometry data, and acceptability of spirometry curves. RESULTS 212 subjects underwent spirometry, and 179 yielded acceptable spirometry curves. Of these, 173 subjects underwent reversibility testing, of whom 39 (22.5%, 95% CI: 16.2-29.1%) were diagnosed as COPD. Of these, 48.7% were classified as COPD Stage I and 41.0% as Stage II following GOLD criteria. Age, gender, pack-years and cough were related to airflow obstruction levels. Symptom number was not related to presence of airflow obstruction. More than 80% of spirometry curves were acceptable. Agreement on curve acceptability between junior doctors and a family physician trainer was very good, but moderate between junior doctors and a pulmonologist. CONCLUSIONS Forced spirometry data from smokers attending general practice doctors can be used to identify a significant number of previously undiagnosed COPD cases.
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Affiliation(s)
- Gema Canals-Borrajo
- Emergencies Service. Hospital Son Llàtzer. Balearic Institute of Health (Ibsalut), Palma de Mallorca 07198, Spain
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Murio C, Soler X, Pérez M, Calero G, Ruiz-Manzano J. Acute exacerbation of chronic obstructive pulmonary disease in primary care setting in Spain: the EPOCAP study. Ther Adv Respir Dis 2010; 4:215-23. [PMID: 20624789 DOI: 10.1177/1753465810374611] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The present study was designed to describe the clinical profile of acute exacerbations of chronic obstructive pulmonary disease (COPD) and the treatment prescribed by primary care physicians (PCPs) in Spain. METHOD An observational, multicenter and cross-sectional study was performed in patients diagnosed with acute exacerbation of COPD and treated by PCPs. Patients diagnosed with asthma, cystic fibrosis, significant bronchiectasis or pneumonia were not included in the study. RESULTS A total of 329 general physicians recruited 1088 evaluable patients across the country. Mean age was 66.5+/-10.2 years; male : female ratio was 3 : 1. Spirometry was performed in 28.3% of the patients. The number of acute exacerbations in the last year was 3.3+/-2.5; 88.7% had increased expectoration, 87.5% increased dyspnea, 64.4% increased sputum purulence, and 43.5% fever. A total of 6.1% (n = 59) of patients were hospitalized due to exacerbation. The most frequently prescribed medications were antibiotics (84.5%, n = 919), mucolytic agents (72.5%, n = 789), inhaled corticosteroids (ICs) (71.3%, n = 776), and short-acting beta-adrenergic drugs (67.8%, n = 738). Oral corticosteroids were prescribed to 436 patients (40.1%). CONCLUSIONS The clinical profile of acute exacerbations of COPD treated in a primary care setting in Spain was characterized by shortness of breath and increased sputum production. Patients were managed by PCP mainly in outpatient clinics with antibiotics, mucolytic agents, inhaled corticosteroids, oral corticosteroids and short-acting beta-adrenergic agents. The percentage of patients with confirmed diagnosis of COPD by pulmonary function tests was very low.
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Affiliation(s)
- Cristina Murio
- Hospital General de Catalunya, Unidad de Neumologia, Barcelona, Spain
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García Robredo B, Calleja Hernández MA, Luque Vega MI, Ubago Pérez R, Faus Dáder MJ. [Compliance of prescriptions for chronic obstructive pulmonary disease patients given upon hospital discharge]. FARMACIA HOSPITALARIA 2010; 34:188-93. [PMID: 20537931 DOI: 10.1016/j.farma.2010.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2009] [Revised: 01/12/2010] [Accepted: 01/12/2010] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Measure the degree of compliance of prescriptions given to Chronic Obstructive Pulmonary Disorder (COPD) patients upon hospital discharge by comparing them to international recommendations. Identify factors that influence the degree of compliance. Evaluate the effect of that degree of compliance on the number of COPD exacerbations. METHOD Retrospective observational study. We selected all episodes identified as COPD in a tertiary hospital during 2006. By consulting the clinical history database, we accessed the hospital discharge report and calculated the treatment's degree of proximity to the recommendations issued in the Global Initiative for Chronic Obstructive Lung Disease (GOLD). For each episode, we calculated the number of exacerbations in the six following months. Descriptive, bivariate statistical analysis. RESULTS We obtained 365 episodes. The mean degree of compliance was 82% (SD=15.9). The patient's age and the severity of the disease did not influence the degree of compliance. We observed an inverse correlation between the hospital stay and the degree of compliance (p=0.026). Discharge reports issued by the Pneumonology Department had a significantly higher degree of compliance (p<0.001). No statistically significant relationship was found between the degree of compliance and the number of exacerbations. CONCLUSIONS The degree of compliance is high according to the GOLD recommendations. The Pneumology Department had the highest degree of compliance, and a higher degree of compliance was related to a shorter hospital stay. The treatment compliance had no effect on the number of exacerbations of the disease.
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Affiliation(s)
- B García Robredo
- Servicio de Farmacia, Hospital Universitario Virgen de las Nieves, Granada, España.
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Gea J, Orozco-Levi M, Gallart L. [Increased inspiratory oxygen fractions (FIO2) using a conventional drug delivery nebuliser]. Arch Bronconeumol 2010; 46:230-7. [PMID: 20378234 DOI: 10.1016/j.arbres.2010.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2009] [Revised: 01/27/2010] [Accepted: 02/05/2010] [Indexed: 11/26/2022]
Abstract
UNLABELLED Nebulised drugs are very useful in COPD exacerbations. The most frequently used propellant is compressed air, which is commonly administered together with nasal oxygen in those patients with respiratory failure. The purpose of this approach is to avoid the risks inherent in breathing high inspiratory oxygen fractions (FIO(2)). AIM To analyze the actual FIO(2) obtained with such a common method under experimental conditions. METHODS Volunteers breathed using different patterns (quiet breathing, panting and deep breathing), through either the nose or the mouth, with oxygen flows of 0 vs. 4l/min. Then, they repeated quiet breathing and panting patterns, with nebulization of saline propelled by compressed air (8l/min) and oxygen flows of 0, 2, 4, 6 and 8l/min. The F(I)O(2) was simultaneously determined both in retronasal (RN) and retropharyngeal (RF) areas. RESULTS During breathing without simultaneous nebulization and oxygen flow of 4l/min, FIO(2) reached mean values of 0.42-0.71 (RN) and 0.29-0.38 (RF) for the three ventilatory patterns analyzed. With nebulisations during quiet breathing, mean FIO(2) values were 0.39 (RN) and 0.27 (RF) for 2l/min O(2) flow, 0.47 (RN), 0.34 (RF) for 4l/min, 0.58 (RN), 0.38 (RF) for 6l/min, and 0.68 (RN) and 0.50 (RF) for 8l/min. Similar results were obtained with the panting pattern. CONCLUSION The FIO(2) obtained using the conventional nebulization system (propulsion with compressed air and simultaneous nasal oxygen therapy) are relatively high, and therefore, might involve risks for COPD patients during exacerbations.
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Affiliation(s)
- Joaquim Gea
- Servicio de Neumología, Hospital del Mar, Instituto Municipal de Investigación Médica (IMIM), Universitat Pompeu Fabra, Barcelona, España.
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de Miguel-Díez J, Carrasco-Garrido P, Rejas-Gutierrez J, Martín-Centeno A, Gobartt-Vázquez E, Hernandez-Barrera V, de Miguel AG, Jimenez-Garcia R. The influence of heart disease on characteristics, quality of life, use of health resources, and costs of COPD in primary care settings. BMC Cardiovasc Disord 2010; 10:8. [PMID: 20167091 PMCID: PMC2832777 DOI: 10.1186/1471-2261-10-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2009] [Accepted: 02/18/2010] [Indexed: 11/13/2022] Open
Abstract
Background To evaluate the influence of heart disease on clinical characteristics, quality of life, use of health resources, and costs of patients with COPD followed at primary care settings under common clinical practice conditions. Methods Epidemiologic, observational, and descriptive study (EPIDEPOC study). Patients ≥ 40 years of age with stable COPD attending primary care settings were included. Demographic, clinical characteristics, quality of life (SF-12), seriousness of the disease, and treatment data were collected. Results were compared between patients with or without associated heart disease. Results A total of 9,390 patients with COPD were examined of whom 1,770 (18.8%) had heart disease and 78% were males. When comparing both patient groups, significant differences were found in the socio-demographic characteristics, health profile, comorbidities, and severity of the airway obstruction, which was greater in patients with heart disease. Differences were also found in both components of quality of life, physical and mental, with lower scores among those patients with heart disease. Higher frequency of primary care and pneumologist visits, emergency-room visits and number of hospital admissions were observed among patients with heart diseases. The annual total cost per patient was significantly higher in patients with heart disease; 2,937 ± 2,957 vs. 1,749 ± 2,120, p < 0.05. Variables that were showed to be independently associated to COPD in subjects with hearth conditions were age, being inactive, ex-smokers, moderate physical exercise, body mass index, concomitant blood hypertension, diabetes, anxiety, the SF-12 physical and mental components and per patient per year total cost. Conclusion Patients with COPD plus heart disease had greater disease severity and worse quality of life, used more healthcare resources and were associated with greater costs compared to COPD patients without known hearth disease.
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Affiliation(s)
- Javier de Miguel-Díez
- Department of Pneumology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
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21
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Soler N, Ballester E, Martín A, Gobartt E, Miravitlles M, Torres A. Changes in management of chronic obstructive pulmonary disease (COPD) in primary care: EMMEPOC study. Respir Med 2010; 104:67-75. [DOI: 10.1016/j.rmed.2009.08.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2009] [Revised: 07/31/2009] [Accepted: 08/06/2009] [Indexed: 11/17/2022]
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Valero C, Monteagudo M, Llagostera M, Bayona X, Granollers S, Acedo M, Ferro JJ, Rodríguez-Latre L, Almeda J, Muñoz L. Evaluation of a combined strategy directed towards health-care professionals and patients with chronic obstructive pulmonary disease (COPD): information and health education feedback for improving clinical monitoring and quality-of-life. BMC Public Health 2009; 9:442. [PMID: 20128887 PMCID: PMC2799410 DOI: 10.1186/1471-2458-9-442] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2009] [Accepted: 12/01/2009] [Indexed: 11/30/2022] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) is a health problem that is becoming increasingly attended-to in Primary Care (PC). However, there is a scarcity of health-care programs and studies exploring the implementation of Clinical Practice Guidelines (CPG). The principal objective of the present study is to evaluate the effectiveness of a combined strategy directed towards health-care professionals and patients to improve the grade of clinical control and the quality-of-life (QoL) of the patients via a feedback on their state-of-health. A training plan for the health-care professionals is based on CPG and health education. Method/Design Multi-centred, before-after, quasi experimental, prospective study involving an intervention group and a control group of individuals followed-up for 12 months. The patients receive attention from urban and semi-urban Primary Care Centres (PCC) within the administrative area of the Costa de Ponent (near Barcelona). All the pacients corresponding to the PCC of one sub-area were assigned to the intervention group and patients from the rest of sub-areas to the group control. The intervention includes providing data to the health-care professionals (clinician/nurse) derived from a clinical history and an interview. A course of training focused on aspects of CPG, motivational interview and health education (tobacco, inhalers, diet, physical exercise, physiotherapy). The sample random includes a total of 801 patients (≥ 40 years of age), recorded as having COPD, receiving attention in the PCC or at home, who have had at least one clinical visit, and who provided written informed consent to participation in the study. Data collected include socio-demographic characteristics, drug treatment, exacerbations and hospital admissions, evaluation of inhaler use, tobacco consumption and life-style and health-care resources consumed. The main endpoints are dyspnoea, according to the modified scale of the Medical Research Council (MRC) and the QoL, evaluated with the St George's Respiratory Questionnaire (SGRQ). The variables are obtained at the start and the end of the intervention. Information from follow-up visits focuses on the changes in life-style activities of the patient. Discussion This study is conducted with the objective of generating evidence that shows that implementation of awareness programs directed towards health-care professionals as well as patients in the context of PC can produce an increase in the QoL and a decrease in the disease exacerbation, compared to standard clinical practice. Trial Registration Clinical Trials.gov Identifier: NCT00922545;
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Affiliation(s)
- Carles Valero
- Unit Methodology, Assessment and Quality, SAP Dreta, Catalan Health Institute, 08025 Barcelona, Spain.
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XRCC1 Arg194Trp polymorphism and risk of chronic obstructive pulmonary disease. ACTA ACUST UNITED AC 2009; 29:551-6. [DOI: 10.1007/s11596-009-0505-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2008] [Indexed: 01/02/2023]
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Jimenez-Garcia R, de Miguel-Díez J, Rejas-Gutierrez J, Martín-Centeno A, Gobartt-Vázquez E, Hernandez-Barrera V, Gil de Miguel A, Carrasco-Garrido P. Health, treatment and health care resources consumption profile among Spanish adults with diabetes and chronic obstructive pulmonary disease. Prim Care Diabetes 2009; 3:141-148. [PMID: 19632167 DOI: 10.1016/j.pcd.2009.06.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2008] [Revised: 05/31/2009] [Accepted: 06/16/2009] [Indexed: 10/20/2022]
Abstract
AIMS To describe the health, treatment and health care resources consumption profile among Spanish adults with diabetes and chronic obstructive pulmonary disease (COPD), and compare it with that of non-diabetic COPD patients. PATIENTS AND METHODS An observational and descriptive epidemiological study (EPIDEPOC study). The study included patients with stable COPD and aged > or =40 years, evaluated in primary care. Data were collected relating to sociodemographic variables, health profile, quality of life (SF-12), treatment and health care resources consumption. The results corresponding to diabetic and non-diabetic patients were compared. RESULTS A total of 10,711 patients (75.6% males) with COPD were evaluated. The prevalence of diabetes was 16.9%. The diabetic patients were significantly older, with a larger percentage of women, and a lesser educational level compared with the non-diabetic patients. In addition, the diabetics were more sedentary, smoked less, and presented a higher percentage of obesity (33.6% versus 19.7%) than the non-diabetic patients. The severity of airways obstruction was greater among the diabetics than in the non-diabetic patients (54.57+/-13.37% versus 57.92+/-13.39%, respectively, p<0.05). As to co-morbidity, the diabetics showed a greater frequency of arterial hypertension, hypercholesterolemia, heart disease, depression and anxiety. Both the physical and the mental component as measured by the SF-12 yielded significantly poorer results among the diabetics. On the other hand, the diabetic subjects showed a higher consumption of drugs for COPD. In addition, they consumed significantly more health care (and thus economical) resources than the non-diabetic patients. The results of the multivariate logistic regression analysis showed that the variables that were independently associated to COPD among diabetic patients were: higher age, higher BMI, concomitant chronic heart disease, use of inhaled corticoids, SF-12 mental component, SF-12 physical component and total cost of COPD. CONCLUSIONS The presence of diabetes in patients with COPD shows in the bivariate analysis a more severe lung disease, greater co-morbidity, poorer quality of life, and a greater consumption of resources, as well as a less favorable course in the previous year. However, the multivariate logistic regression shows that the variables that are independently associated to COPD among diabetic patients are higher age, higher BMI, concomitant chronic heart disease, use of inhaled corticoids, physical and mental component of quality of life questionnaire and total cost of COPD.
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Affiliation(s)
- Rodrigo Jimenez-Garcia
- Unidad de Docencia e Investigación en Medicina Preventiva y Salud Pública, Facultad de Ciencias de la Salud, Avda. de Atenas s/n, 28922 Alcorcón, Madrid, Spain
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Rodríguez-González Moro JM, Izquierdo JL, Antón E, de Lucas P, Martín A. Health-related quality of life in outpatient women with COPD in daily practice: the MUVICE Spanish study. Respir Med 2009; 103:1303-12. [PMID: 19406631 DOI: 10.1016/j.rmed.2009.04.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2009] [Revised: 03/24/2009] [Accepted: 04/01/2009] [Indexed: 01/01/2023]
Abstract
AIMS A cross-sectional multicenter study was designed to assess health-related quality of life (HRQL) in women with chronic obstructive pulmonary disease (COPD) who were attended in the outpatient setting in actual conditions of the daily practice. METHODS A total of 1786 women with COPD (mean age of 66.5 years) and 1661 pairs of men and women matched by age and COPD severity participated in a cross-sectional study. HRQL was measured with the Short Form 12 Health Survey Questionnaire (SF-12). RESULTS The mean PCS-12 and MCS-12 scores were 36.5+/-10.3 and 44.1+/-11.8, respectively. General health and physical functioning domains were those with the lowest scores, whereas role emotional and social functioning were those with the highest scores. The percentage of women with low HRQL increased according to age, whereas the percentage of women with high or normal HRQL decreased significantly. In relation to COPD severity, more women rated HRQL as low in the physical component than in the mental component. HRQL correlated significantly with FEV(1) in both PCS-12 and MCS-12 scales. As expected, an inverse significant correlation between HRQL and degree of dyspnea in the PCS-12 and the MCS-12 scales was observed. Women had also a significantly worse HRQL than men in all physical and mental domains. CONCLUSIONS In outpatient women with COPD, HRQL was impaired especially the physical component of the SF-12. For the same age and severity of COPD, women showed significantly lower scores in all physical and mental domains of the SF-12 than men.
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de Miguel Diez J, Carrasco Garrido P, García Carballo M, Gil de Miguel A, Rejas Gutierrez J, Bellón Cano JM, Hernández Barrera V, Jimenez García R. Determinants and predictors of the cost of COPD in primary care: a Spanish perspective. Int J Chron Obstruct Pulmon Dis 2009; 3:701-12. [PMID: 19281084 PMCID: PMC2650614 DOI: 10.2147/copd.s2427] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objectives 1) To estimate the annual cost of patients with stable chronic obstructive pulmonary disease (COPD) followed in primary care in Spain; 2) To analyze the possible cost predictor variables. Patients and methods A multicenter, epidemiological, observational, descriptive study. Sociodemographic data, severity of disease, associated comorbidity, treatment followed by patients, quality of life (SF-12 questionnaire), health care resource utilization in the previous 12 months and duration of working disability due to COPD were collected. Results A total of 10,711 patients (75.6% men; 24.4% women) with a mean age of 67.1 ± 9.66 years were evaluated. The mean forced expiratory volume in one second (FEV1) value was 57.4 ± 13.4%. The total cost per patient per year was €1,922.60 ± 2,306.44. The largest component of this cost was hospitalization (€788.72 ± 1,766.65), followed by cost of drugs (€492.87 ± 412.15) and visits to emergency rooms (€134.32 ± 195.44). Linear regression analysis found associated heart disease, FEV1, physical component of quality of life, number of medical visits (primary care physician, pneumologist and emergency room), hospital admissions (frequency and duration of stay) and duration of working disability to be significant predictors of the total annual cost. Conclusions The total annual cost of a COPD patient followed in primary care in Spain was considered high in this study. The presence of associated heart disease, severity of airflow obstruction, physical component of quality of life, health care resource utilization and duration of work disability were found to be predictor of cost.
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Martín A, Rodríguez-González Moro JM, Izquierdo JL, Gobartt E, de Lucas P. Health-related quality of life in outpatients with COPD in daily practice: the VICE Spanish Study. Int J Chron Obstruct Pulmon Dis 2009; 3:683-92. [PMID: 19283915 PMCID: PMC2650615 DOI: 10.2147/copd.s4791] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The objective of this study was to measure health-related quality of life (HRQL) in outpatients with chronic obstructive pulmonary disease (COPD) and to assess differences in HRQL according to age, gender, and severity of COPD. METHODS A total of 9405 patients (79% men, mean age 68 years) participated in a cross-sectional study. HRQL was measured with the Short Form 12 Health Survey Questionnaire (SF-12). Severity of COPD was graded into three levels according to forced expiratory volume in one second value. RESULTS COPD severity was mild in 33.8% of cases, moderate in 49.3% and severe in 16.8%. The mean physical component summary (PCS-12) and mental component summary (MCS-12) scores were 36.8 +/- 10.4 and 47.2 +/- 11.2, respectively. General health and physical functioning domains were those with the lowest scores. The mean MCS-12 scores were significantly higher in men (47.9 +/- 10.9) than in women (44.1 +/- 11.8) (P < 0.001). Patients older than 60 years rated HRQL worse than patients aged 40-59 years. There were statistically significant differences according to severity of disease in the mean scores of all domains of the PCS-12 and MCS-12 scales. CONCLUSIONS The present findings show the influence of female gender, older age and moderate-to-severe of airflow limitation on HRQL in outpatients with COPD attended in daily practice.
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Bolíbar I, Plaza V, Llauger M, Amado E, Antón PA, Espinosa A, Domínguez L, Fraga M, Freixas M, de la Fuente JA, Liguerre I, Medrano C, Peiro M, Pou M, Sanchis J, Solanes I, Valero C, Valverde P. Assessment of a primary and tertiary care integrated management model for chronic obstructive pulmonary disease. BMC Public Health 2009; 9:68. [PMID: 19239679 PMCID: PMC2661072 DOI: 10.1186/1471-2458-9-68] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2008] [Accepted: 02/24/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The diagnosis and treatment of patients with chronic obstructive pulmonary disease (COPD) in Spain continues to present challenges, and problems are exacerbated when there is a lack of coordinated follow-up between levels of care. This paper sets out the protocol for assessing the impact of an integrated management model for the care of patients with COPD. The new model will be evaluated in terms of 1) improvement in the rational utilization of health-care services and 2) benefits reflected in improved health status and quality of life for patients. METHODS/DESIGN A quasi-experimental study of the effectiveness of a COPD management model called COPD PROCESS. The patients in the study cohorts will be residents of neighborhoods served by two referral hospitals in Barcelona, Spain. One area comprises the intervention group (n = 32,248 patients) and the other the control group (n = 32,114 patients). The study will include pre- and post-intervention assessment 18 months after the program goes into effect. Analyses will be on two datasets: clinical and administrative data available for all patients, and clinical assessment information for a cohort of 440 patients sampled randomly from the intervention and control areas. The main endpoints will be the hospitalization rates in the two health-care areas and quality-of-life measures in the two cohorts. DISCUSSION The COPD PROCESS model foresees the integrated multidisciplinary management of interventions at different levels of the health-care system through coordinated routine clinical practice. It will put into practice diagnostic and treatment procedures that are based on current evidence, multidisciplinary consensus, and efficient use of available resources. Care pathways in this model are defined in terms of patient characteristics, level of disease severity and the presence or absence of exacerbation. The protocol covers the full range of care from primary prevention to treatment of complex cases.
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Affiliation(s)
- Ignasi Bolíbar
- Department of Clinical Epidemiology and Public Health, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, CIBER Epidemiology and Public Health (CIBERESP), Barcelona, Spain
| | - Vicente Plaza
- Department of Respiratory Medicine, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Spain
| | | | - Ester Amado
- Àmbit Barcelona. Catalan Health Institute, Barcelona, Spain
| | - Pedro A Antón
- Department of Respiratory Medicine, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Spain
| | - Ana Espinosa
- Department of Clinical Epidemiology and Public Health, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, CIBER Epidemiology and Public Health (CIBERESP), Barcelona, Spain
| | - Leandra Domínguez
- EAP Encants, CAP Maragall, Catalan Health Institute, Barcelona, Spain
| | - Mar Fraga
- EAP Xafarinas. Catalan Health Institute, Barcelona, Spain
| | | | | | - Iskra Liguerre
- CAP Sant Andreu, Catalan Health Institute, Barcelona, Spain
| | | | - Meritxell Peiro
- Department of Respiratory Medicine, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Spain
| | - Mariantònia Pou
- EAP Encants, CAP Maragall, Catalan Health Institute, Barcelona, Spain
| | - Joaquin Sanchis
- Department of Respiratory Medicine, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Spain
| | - Ingrid Solanes
- Department of Respiratory Medicine, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Spain
| | - Carles Valero
- SAP Dreta, Catalan Health Institute, Barcelona, Spain
| | - Pepi Valverde
- EAP Gaudí (CAP Sagrada Familia), Consorci Sanitari Integral, Barcelona, Spain
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COPD case finding by spirometry in high-risk customers of urban community pharmacies: a pilot study. Respir Med 2009; 103:839-45. [PMID: 19200706 DOI: 10.1016/j.rmed.2008.12.022] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2008] [Revised: 12/18/2008] [Accepted: 12/27/2008] [Indexed: 11/20/2022]
Abstract
BACKGROUND COPD case finding is currently recommended at primary and tertiary care levels only. AIM To evaluate the feasibility of a community pharmacy program for COPD case finding in high-risk customers by means of spirometry. METHODS Pilot cross-sectional descriptive study in 13 urban community pharmacies in Barcelona, Spain, from April to May 2007. Customers >40 years old with respiratory symptoms and/or a history of smoking were invited to participate in the study during pharmacists' routine work shifts. High-risk customers were identified by means of a 5-item COPD screening questionnaire based on criteria of the Global Initiative for Chronic Obstructive Lung Disease, and were invited to perform spirometry accordingly. Those with an FEV(1)/FVC ratio less than 0.70 were referred to the hospital for a repeat spirometry. RESULTS Of the 161 pharmacy customers studied, 100 (62%) scored 3 or more items in the COPD screening questionnaire, and after spirometry, 21 (24%) had an FEV(1)/FVC ratio<0.7. When these subjects with airflow limitation were offered referral to a hospital respiratory function laboratory for further assessments, 11 (52%) attended the appointment. Over 70% of spirometries were rated as being of acceptable quality. No significant differences were observed in lung function parameters between the pharmacy and hospital measurements. CONCLUSIONS COPD case finding by spirometry in high-risk customers of urban community pharmacies is feasible. Similarly to primary care practitioners, pharmacists have access to high-risk, middle-aged subjects who have never been tested for COPD. Pharmacists can help with early detection of COPD if they are correctly trained.
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Carrasco-Garrido P, de Miguel-Díez J, Rejas-Gutierrez J, Martín-Centeno A, Gobartt-Vázquez E, Hernandez-Barrera V, de Miguel AG, Jimenez-Garcia R. Characteristics of chronic obstructive pulmonary disease in Spain from a gender perspective. BMC Pulm Med 2009; 9:2. [PMID: 19121205 PMCID: PMC2633274 DOI: 10.1186/1471-2466-9-2] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2008] [Accepted: 01/02/2009] [Indexed: 11/10/2022] Open
Abstract
Background The objective of this study was to analyze the clinical and management characteristics of chronic obstructive pulmonary disease (COPD) in men and women, to determine possible gender-associated differences between the two groups of patients. Methods An observational and descriptive epidemiological study (EPIDEPOC study). The study included patients with stable COPD and aged ≥ 40 years, evaluated in primary care. Data were collected relating to sociodemographic variables, clinical characteristics, quality of life (SF-12), severity of disease and treatment. The results obtained in men and women were compared. Results A total of 10,711 patients (75.6% males and 24.4% females) were evaluated. Significant differences were found between males and females in relation to the following parameters: age (67.4 ± 9.2 years in men vs 66.1 ± 10.8 in women, p < 0.05), smoking (91.9% of the men were smokers or ex-smokers vs 30% of the women), comorbidity (the frequency of hypertension, diabetes, anxiety and depression was greater in women, while ischemic heart disease was more common in men), mental component of quality of life (49.4 ± 10.3 in men vs 44.6 ± 11.9 in women, p < 0.05) and severity of disease (56.5 ± 13.3% in men vs 60.7 ± 3.2 in women, p < 0.05). As regards treatment, the percentage use of long-acting b2-adrenergic agonists, anticholinergic agents, theophyllines and mucolytic agents was significant greater in men. The total annual cost of COPD was greater in males than in females (1989.20 ± 2364.47 € vs 1724.53 ± 2106.90, p < 0.05). Conclusion The women with COPD evaluated in this study were younger, smoked less and have more comorbidity, a poorer quality of life, and lesser disease severity than men with COPD. However, they generated a lesser total annual cost of COPD than men.
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Capdevila JA, Gavagnach M, Martínez S, Torres A. [Critical evaluation of clinical practice guidelines]. Med Clin (Barc) 2008; 130:376-9. [PMID: 18381030 DOI: 10.1157/13117462] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Josep Anton Capdevila
- Comisión de Medicina y Especialidades Relacionadas, Consell Català d'Especialistes en Ciències de la Salut, Institut d'Estudis de la Salut, Departament de Salut, Generalitat de Catalunya.
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López Varela MV, Muiño A, Pérez Padilla R, Jardim JR, Tálamo C, Montes de Oca M, Valdivia G, Pertuzé J, Halbert R, Menezes AM. [Treatment of chronic obstructive pulmonary disease in 5 Latin American cities: the PLATINO study]. Arch Bronconeumol 2008; 44:58-64. [PMID: 18361870 DOI: 10.1016/s1579-2129(08)60016-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE PLATINO project is a population-based study designed to determine the prevalence of chronic obstructive pulmonary disease (COPD) in São Paulo, Brazil; Mexico City, Mexico; Montevideo, Uruguay; Santiago de Chile, Chile; and Caracas, Venezuela. The objective of this portion of PLATINO was to describe preventive and pharmacological treatment of COPD patients and factors associated with such treatment. PATIENTS AND METHODS Eligible subjects completed a questionnaire and underwent postbronchodilator spirometry. RESULTS Of the total of 5529 individuals who answered items referring to treatment, 758 had COPD (ratio of postbronchodilator forced expiratory volume in 1 second to forced vital capacity of <0.7), and 86 of them had been previously diagnosed by a physician. Among all COPD patients, only half of smokers or former smokers had been advised to quit and 24.7% had received some type of respiratory medication. Only 13.5% had used inhaled corticosteroids, and those were the patients with the most severe disease. In the group of patients who had a previous medical diagnosis of COPD, 69% of the smokers or former smokers had been advised to quit by a physician and 75.6% had received respiratory medication in the preceding year: 43% reported having used inhaled medication and 36% had used bronchodilators. Rates of vaccination against influenza and the use of mucolytic drugs and inhalers varied from one health care facility to another. All drug prescriptions were based on previous spirometry. CONCLUSIONS Spirometry emerged not only as a diagnostic tool, but also as a factor associated with treatment, against a background of uneven use of available health care resources in these 5 Latin American cities.
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Medinas-Amorós M, Alorda C, Renom F, Rubí M, Centeno J, Ferrer V, Gorriz T, Mas-Tous C, Ramis F. Quality of life in patients with chronic obstructive pulmonary disease: the predictive validity of the BODE index. Chron Respir Dis 2008; 5:7-11. [PMID: 18303096 DOI: 10.1177/1479972307082329] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is currently the fourth cause of mortality and morbility in the developed world. Patients with COPD experience a progressive deterioration of health-related quality of life (HRQOL). A new model of severity classification, the body mass index, bronchial obstruction, dyspnoea, exercise (BODE) index, has recently been proposed. OBJECTIVE To evaluate the relationship between HRQOL and the BODE index, and the predictive ability of BODE on HRQOL measurements. METHODS Two HRQOL questionnaires were administered, namely the Nottingham Health Profile (NHP) and St George's Respiratory Questionnaire (SGRQ), in a sample of 67 patients with severe COPD. RESULTS Pearsonś correlation coefficient analysis shows a positive correlation between the BODE index and the total scores of the specific (P < 0.001), and general HRQOL (P < 0.001); the analysis shows a significant correlation between the BODE index and the subscales of symptoms, activity and impact of SGRQ (P < 0.001) and the subscales energy and physical mobility of the NHP (P < 0.001). The regression analysis shows that the BODE index is a significant predictor of HRQOL, explaining 46,1% of the total score of the SGRQ (P < 0.001) and 14.8% of the total score of the NHP (P < 0.001). CONCLUSIONS The BODE index is good at predicting the worsening of HRQOL in patients with severe COPD.
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Affiliation(s)
- M Medinas-Amorós
- Department of Psychology, Joan March Hospital, Bunyola, Baleares, Spain.
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Villar Álvarez F, de Miguel Díez J, Luis Álvarez-Sala J. EPOC y acontecimientos cardiovasculares. Arch Bronconeumol 2008. [DOI: 10.1157/13116603] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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López Varela MV, Muiño A, Pérez Padilla R, Roberto Jardim J, Tálamo C, Montes de Oca M, Valdivia G, Pertuzé J, Halbert R, María Menezes A. Tratamiento de la EPOC en 5 ciudades de América Latina: estudio PLATINO. Arch Bronconeumol 2008. [DOI: 10.1157/13115743] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Izquierdo Alonso J, Rodríguez González-Moro J, de Lucas Ramos P, Martín Centeno A, Gobartt Vázquez E. ¿Ha cambiado el manejo de la EPOC en España? Resultados de un estudio multicéntrico comunitario (VICE). Rev Clin Esp 2008; 208:18-25. [DOI: 10.1157/13115003] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Güell Rous MR, Luis Díez Betoret J, Sanchis Aldás J. Rehabilitación respiratoria y fisioterapia respiratoria. Un buen momento para su impulso. Arch Bronconeumol 2008. [DOI: 10.1157/13114663] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Rous MRG, Betoret JLD, Aldás JS. Pulmonary Rehabilitation and Respiratory Physiotherapy: Time to Push Ahead. ACTA ACUST UNITED AC 2008. [DOI: 10.1016/s1579-2129(08)60011-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Sicras-Mainar A, Velasco-Velasco S, Llopart-López JR, Navarro-Artieda R, de Haro-Martí L. [Calculation of morbidity, use of resources and costs of patients treated with tiotropium bromide for COPD in a Spanish population]. Aten Primaria 2007; 39:547-55. [PMID: 17949628 PMCID: PMC7659490 DOI: 10.1157/13110735] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2007] [Accepted: 03/28/2007] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE To determine the co-morbidity and economic impact of treatment with tiotropium bromide (TB) for COPD, in a population cared for by Spanish primary care teams (PCTs) and specialist physicians, in the context of routine clinical practice. DESIGN Retrospective multi-centre study. SETTING Four PCTs and 2 urban hospitals. PARTICIPANTS Patients with COPD receiving regular treatment with TB, during 2004. MAIN MEASUREMENTS Age and sex, episodes of co-morbidity, clinical parameters, resource use, and pharmacological groups. The costs model was established by differentiating semi-fixed from variable costs (pharmacy, tests, referrals) in the PCTs, as well as the visits, emergencies and hospital admissions occurring in the hospitals. A logistical regression analysis was made to correct the model. The costs were contrasted by analysis of covariance (ANCOVA), with the estimation of marginal means (Bonferroni adjustment). RESULTS Of 900 patients with COPD, 14.3% (n=129) received treatment with TB (95% CI, 12.0%-16.6%). The mean episodes/patient/year was 2.1 (1.4) versus 1.8 (1.3) (NS), seriousness/severity 41.3% versus 26.3% (P =.001), defined daily dose (DDD) 5928.5 (9624.1) versus 6187.7 (12471.3) (NS) and number visits/patient/year 15.1 (9.4) versus 17.3(11.9) (P=.044). After adjustments for age and sex, TB use was associated with Diabetes Mellitus (OR=1.6; 95% CI, 1.0-2.5; P=.034) and severity of patients' illness (OR=1.8; 95% CI, 1.2-2.8; P=.004). Quantification of unit cost/year was 2793.16 (3166.30) euros (3359.27 [3423.25] euros versus 2703.09 [3113.75] euros; P=.001). The adjusted patient cost/year was 2831.23 euros (SE, 217.32) with TB versus 2786.86 euros (SE, 88.53) without TB (NS). CONCLUSIONS TB is associated, as therapy complementing routine treatment, with the presence of Diabetes, and with the severity of the disease. The costs of COPD entail high resource consumption. The prescription of TB does not imply greater overall cost of the disease.
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Affiliation(s)
- Antoni Sicras-Mainar
- Dirección de Planificación, Badalona Serveis Assistencials, Badalona. Barcelona, España.
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Alvarez-Gutiérrez FJ, Miravitlles M, Calle M, Gobartt E, López F, Martín A. [Impact of chronic obstructive pulmonary disease on activities of daily living: results of the EIME multicenter study]. Arch Bronconeumol 2007; 43:64-72. [PMID: 17288894 DOI: 10.1016/s1579-2129(07)60026-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to determine the impact of chronic obstructive pulmonary disease (COPD) on activities of daily living in a large group of patients in Spain who responded to a specific questionnaire. A second aim was to explore the practical utility of the questionnaire and determine which variables could be used to identify "fragile" patients or patients in greater need of attention. To do this, we examined the relationship between questionnaire results and clinical variables, lung function measurements, socioeconomic status, and validated quality of life questionnaires. METHODS We conducted an observational, descriptive, multicenter, cross-sectional study in which 227 respiratory specialists from all over Spain collected data from 1057 patients with COPD. Each patient was given a specific questionnaire containing 7 items that measured the extent to which COPD affected different aspects of their lives. The patients rated each item on a scale of 0 to 2, depending on the level of impact. Total possible scores, thus, ranged from 0 to 14, and patients with a score of 9 or higher were classified as fragile. We then explored the relationship between questionnaire results and clinical variables, socioeconomic status, spirometric values, and quality of life as measured by the St George's Respiratory Questionnaire (SGRQ). RESULTS We studied 1057 patients (95.2% male) with a mean (SD) age of 67 (9) years and a mean predicted forced expiratory volume in 1 second (FEV1) of 41.8% (13.3%). The mean questionnaire score was 6.3 (3.1). The activities that were affected most were sport and leisure, habitual physical activity, and sex life (major impact reported by 52.5%, 30.3%, and 20.2% of patients, respectively). We found a correlation between questionnaire scores and known disease severity markers such as SGRQ scores, dyspnea, number of exacerbations, and FEV1 in liters. Patients included in the fragile category were older and had a lower socioeconomic status. CONCLUSIONS COPD impact questionnaire scores correlated well with SGRQ scores and the usual clinical variables and lung function measurements for evaluating disease severity (dyspnea, FEV1, and exacerbations). The questionnaire could, therefore, be a useful tool for identifying fragile patients who, in addition to having poorer clinical status and lung function measurements, have a lower socioeconomic status.
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Orive JIDG, Esteban JJ. [The Archivos archive, 2006: an overview of research published in Archivos de Bronconeumología]. Arch Bronconeumol 2007; 43:399-410. [PMID: 17663893 DOI: 10.1016/s1579-2129(07)60092-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
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Polverino E, Gómez FP, Manrique H, Soler N, Roca J, Barberà JA, Rodríguez-Roisin R. Gas exchange response to short-acting beta2-agonists in chronic obstructive pulmonary disease severe exacerbations. Am J Respir Crit Care Med 2007; 176:350-5. [PMID: 17431221 DOI: 10.1164/rccm.200612-1864oc] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
RATIONALE Short-acting beta(2)-agonists are one of the mainstays of bronchodilator strategy for exacerbations of chronic obstructive pulmonary disease (COPD). The assessment of pulmonary gas exchange after salbutamol in COPD severe exacerbations remains unknown. OBJECTIVES We investigated whether the effects of nebulized salbutamol during COPD severe exacerbations are associated with further deterioration of pulmonary gas exchange. METHODS We examined patients with severe COPD when hospitalized for exacerbation (n = 9), and while in stable convalescence. MEASUREMENTS AND MAIN RESULTS We assessed spirometry, arterial blood gases, systemic hemodynamics, and V/Q relationships 30 and 90 minutes after administration of 5.0 mg salbutamol. At exacerbation, compared with baseline, 30 minutes after salbutamol administration, cardiac output (Q) increased (from 6.5 +/- [SEM] 0.4 to 7.3 +/- 0.5 L . min(-1)) (p < 0.03) alone, without inducing changes in gas exchange indices. When in convalescence, compared with baseline, 30 minutes after salbutamol, there was an increase in Q (from 5.7 +/- 0.5 to 7.0 +/- 0.6 L . min(-1)) and Vo(2) (from 211 +/- 12 to 232 +/- 11 ml . min(-1)) (p < 0.002 each), whereas Pa(O(2)) decreased (from 71 +/- 4 to 63 +/- 3 mm Hg) and alveolar-arterial Po(2) difference increased due to increased perfusion of low-V/Q-ratio regions (from 4.5 +/- 2.6 to 9.6 +/- 4.1% of Q) (p < 0.05); Sa(O(2)) (93 +/- 2%) and Pa(CO(2)) (43 +/- 2 mm Hg) remained unchanged. This deleterious gas exchange response persisted at 90 minutes. CONCLUSIONS At exacerbation, salbutamol does not aggravate pulmonary gas exchange abnormalities. When in convalescence, however, baseline lung function improvement was associated with a detrimental gas exchange response to salbutamol, resulting in further V/Q imbalance and small decreases in Pa(O(2)) compounded by small increases in Q and Vo(2).
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Affiliation(s)
- Eva Polverino
- Servei de Pneumologia (Institut del Tòrax), Hospital Clínic, Institut d'Investigacions Biomédiques August Pi i Sunyer, CIBER Enfermedades Respiratorias, Universitat de Barcelona, Barcelona, Spain
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Álvarez-Gutiérrez FJ, Miravitlles M, Calle M, Gobartt E, López F, Martín A. Impacto de la EPOC en la vida diaria de los pacientes. Resultados del estudio multicéntrico EIME. Arch Bronconeumol 2007. [DOI: 10.1157/13098416] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Torres Martí A, Quintano Jiménez J, Martínez Ortiz de Zárate M, Rodríguez Pascual C, Prieto Prieto J, Zalacaín Jorge R. Tratamiento antimicrobiano de la enfermedad pulmonar obstructiva crónica en el anciano. Semergen 2007. [DOI: 10.1016/s1138-3593(07)73852-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abreu González J, Hernández García C, Abreu González P, Martín García C, Jiménez A. [Effect of intravenous magnesium sulfate on chronic obstructive pulmonary disease exacerbations requiring hospitalization: a randomized placebo-controlled trial]. Arch Bronconeumol 2007; 42:384-7. [PMID: 16948990 DOI: 10.1016/s1579-2129(06)60551-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Magnesium sulfate has been shown to have a bronchodilating effect in asthma, but this effect has not been clearly established in the context of chronic obstructive pulmonary disease (COPD). For this reason we investigated the possible bronchodilating effect of magnesium sulfate in COPD exacerbations. PATIENTS AND METHODS We studied 24 patients with exacerbated COPD who required admission to our hospital's pneumology department. All patients underwent baseline spirometry and were subsequently randomized to groups in a double-blind crossover design. Patients received 1.5 g of magnesium sulfate or placebo in an intravenous solution for 20 minutes. Those who received magnesium sulfate the first day were given placebo the second day, and vice versa. Spirometry was performed 15, 30, and 45 minutes after administration of magnesium sulfate or placebo. Finally, 400 microg of salbutamol were administered using a spacer and a final spirometry was performed 15 minutes later. All patients also received treatment with corticosteroids, intravenous antibiotics, oxygen, and regularly-scheduled bronchodilator therapy (salbutamol and ipratropium bromide every 6 hours). RESULTS When we compared absolute increase in milliliters and percentage increase in forced expiratory volume in 1 second (FEV1) obtained with magnesium sulfate application to the increases obtained with placebo after 15, 30, and 45 minutes, no significant differences were found. When we compared absolute and percentage increases in FEV1 after administering salbutamol, we found significantly greater increases after magnesium sulfate administration. The mean (SD) absolute increase in FEV1 was 0.18 [corrected] (0.42) L after magnesium sulfate administration and 0.081 [0.01] L after placebo (P=.004). The percentage increase in FEV1 was 17.11% (3.7%) after magnesium sulfate and 7.06% (1.8%) after placebo (P=.008). CONCLUSIONS Intravenous administration of magnesium sulfate has no bronchodilating effect in patients with COPD exacerbations. It does, however, enhance the bronchodilating effect of inhaled ss2-agonists.
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Affiliation(s)
- Juan Abreu González
- Servicio de Neumología, Hospital Universitario de Canarias, La Laguna, Santa Cruz de Tenerife, España.
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Hueto J, Cebollero P, Pascal I, Cascante JA, Eguía VM, Teruel F, Carpintero M. [Spirometry in primary care in Navarre, Spain]. Arch Bronconeumol 2007; 42:326-31. [PMID: 16945262 DOI: 10.1016/s1579-2129(06)60541-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To analyze the use and quality of spirometry in primary care settings in Navarre, Spain. PATIENTS AND METHODS A questionnaire was completed simultaneously by professionals responsible for spirometry in all of the primary health care centers in Navarre. Data were collected on availability, model of spirometer, frequency of use, calibration, methods, personnel responsible for testing, and training of personnel. Then, baseline spirometry without a bronchodilator test was performed in 171 patients in their primary health care center and then the test was repeated on the same day in a hospital pneumology department. Spirometry was supervised by 2 pneumologists who jointly assessed the acceptability of the flow-volume curves. The quality of spirometry was assessed according to the recommendations of the American Thoracic Society and the interpretation of spirometry results according to the criteria of the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR). RESULTS A total of 90.9% of primary health care centers in Navarre have a spirometer, although 22% of those spirometers have never been used. Only 2 centers performed between 10 and 20 spirometry tests per week and none performed more than 20. In 96% of primary health care centers the spirometers were not regularly calibrated. The professionals who performed spirometry were not dedicated for that task in 51.2% of cases, and the mean period of supervised training was 10 hours. When comparisons were made between the mean values obtained in the primary care centers and the pneumology department, statistically significant differences were detected for forced vital capacity (P < .0001) and forced expiratory volume in the first second (P = .0002). Significant differences were also found between the flow-volume curves performed in the 2 different care settings for the initial and end portions of the curve as well as for the slope. The criteria for reproducibility recommended by the American Thoracic Society were not met in 76% of cases for forced vital capacity and 39.7% of cases for forced expiratory volume in the first second. Incorrect functional diagnosis occurred in 39.7% of spirometry tests and there was a tendency in the primary care settings to falsely diagnose patterns as restrictive and to inadequately classify the severity of obstruction. CONCLUSIONS Despite the fact that spirometers are available in the majority of primary health care centers in Navarre, we found a marked underuse of these devices and little compliance with recommendations for the use of spirometry. Furthermore, the quality of the measurements performed in this care setting was very low.
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Affiliation(s)
- Javier Hueto
- Sección de Neumología. Hospital Virgen del Camino. Pamplona. Navarra. España.
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Izquierdo-Alonso JL, de Miguel-Díez J. Economic impact of pulmonary drugs on direct costs of stable chronic obstructive pulmonary disease. COPD 2006; 1:215-23. [PMID: 17136989 DOI: 10.1081/copd-120039809] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
QUESTION OF THE STUDY To assess the impact of prescribing pulmonary drugs according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines on direct costs in stable chronic obstructive pulmonary disease (COPD). PATIENTS AND METHODS A total of 560 ambulatory COPD patients completed a specific questionnaire that included data regarding drug therapy. Severity was graded according to the British Thoracic Society (BTS) criteria and appropriateness of pharmacological treatment according to GOLD guidelines. RESULTS Annual direct costs were 1,657 EUR in stage I, 2,425 EUR in stage II, and 3,303 EUR in stage III. The mean direct costs was 2,061 EUR (38% corresponded to drug therapy). Medication accounted for 43%, 37.6%, and 28.4% of total direct costs for stage I, II, and III, respectively. Inhaled steroids and long-acting beta2-agonists accounted for 78%, 76%, and 75% of total drugs costs in stages I, II, and III, respectively. Drug therapy which was not in accordance with guidelines accounted for 78.7% and 54% of total drug costs in stages I and II, respectively. Most patients with severe disease were treated adequately. ANSWER TO THE QUESTION: Pharmacologic treatment has a great impact on direct medical costs in stable COPD. According to GOLD guidelines, patients with mild or moderate COPD are frequently treated with nonrecommended drugs.
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