1
|
Izquierdo JL, Oeste CL, Hernández Medrano I. Artificial Intelligence in Pneumology: Diagnostic and Prognostic Utilities. Arch Bronconeumol 2023; 59:67-68. [PMID: 35908985 DOI: 10.1016/j.arbres.2022.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 07/08/2022] [Indexed: 02/07/2023]
Affiliation(s)
- José Luis Izquierdo
- Department of Medicine and Medical Specialties, Universidad de Alcalá, Madrid, Spain; Servicio de Neumología, Hospital Universitario de Guadalajara, Spain.
| | | | | |
Collapse
|
2
|
de Oliveira JCM, de Carvalho Aguiar I, de Oliveira Beloto ACN, Santos IR, Filho FSSL, Sampaio LMM, Donner CF, Oliveira LVFD. Clinical significance in COPD patients followed in a real practice. Multidiscip Respir Med 2013; 8:43. [PMID: 23806051 PMCID: PMC3706245 DOI: 10.1186/2049-6958-8-43] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Accepted: 03/29/2013] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is an important public health issue in many countries which is estimated to become the fifth cause of disability and the third cause of mortality in the world within 2020.The objective of this study was to identify the clinical characteristics in the real clinical practice of a sample of patients with COPD followed in a pulmonology clinic. METHODS The initial sample contained 207 subjects with respiratory claims that searched for specialized treatment and initiated regular monitoring between 2004 and 2009 in a private clinic localized in Cascavel, in the state of Parana, Brazil. Demographic data (weight, height, body mass index - BMI), history of comorbidities, use of respiratory and non respiratory drugs were also registered. RESULTS The main cause related to the development of COPD was current or prior smoking (92.0%); the most frequently reported symptom was dyspnea (95.0%), followed by cough (86.1%), wheezing (69.4%) and sputum production (40.0%). During the follow up, 51 patients developed the need for oxygen therapy (28.3%). In 96 patients, there were periods of acute exacerbation, resulting in 37 hospitalizations. In addition to COPD, a significant number of comorbidities were identified, being cardiovascular disease and neurological disorders the most prevalent ones. CONCLUSIONS Based on the data collected, we could outline the profile of patients with COPD, showing characteristics of an elderly population, with multiple comorbidities, suggesting a health related quality of life lower than expected.
Collapse
Affiliation(s)
- Júlio César Mendes de Oliveira
- Institute of the Lung, Cascavel, PR, Brazil
- Rehabilitation Sciences Master and Doctoral Degree Program - Nove de Julho University, UNINOVE, Sao Paulo, SP, Brazil
| | - Isabella de Carvalho Aguiar
- Rehabilitation Sciences Master and Doctoral Degree Program - Nove de Julho University, UNINOVE, Sao Paulo, SP, Brazil
| | - Ana Carolina Negrinho de Oliveira Beloto
- Institute of the Lung, Cascavel, PR, Brazil
- Rehabilitation Sciences Master and Doctoral Degree Program - Nove de Julho University, UNINOVE, Sao Paulo, SP, Brazil
| | - Israel Reis Santos
- Rehabilitation Sciences Master and Doctoral Degree Program - Nove de Julho University, UNINOVE, Sao Paulo, SP, Brazil
| | | | - Luciana M Malosa Sampaio
- Rehabilitation Sciences Master and Doctoral Degree Program - Nove de Julho University, UNINOVE, Sao Paulo, SP, Brazil
| | - Claudio F Donner
- Mondo Medico, Multidisciplinary and Rehabilitation Outpatient Clinic, Borgomanero, No, Italy
| | | |
Collapse
|
3
|
Comorbidity of major depressive episode and chronic physical conditions in Spain, a country with low prevalence of depression. Gen Hosp Psychiatry 2012; 34:510-7. [PMID: 22727261 DOI: 10.1016/j.genhosppsych.2012.05.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2011] [Revised: 05/11/2012] [Accepted: 05/15/2012] [Indexed: 11/24/2022]
Abstract
OBJECTIVES The objectives were to describe the comorbidity between 12-month major depressive episode (MDE) and chronic physical condition (CPC) in Spain, a Latin country with relatively low prevalence of depression. METHODS The European Study of Epidemiology of Mental Disorders (ESEMeD)-Spain is a cross-sectional, general-population, household survey representative of the Spanish noninstitutionalized adult population (N=5473). The Composite International Diagnostic Interview was used for assessing mental disorders. CPCs were assessed among a subsample (N=2121) with a standardized checklist. Logistic regression analysis was performed. ESEMeD-Spain is part of the World Health Organization World Mental Health Surveys. RESULTS Among those with CPC, the prevalence of MDE was 5.9%, and the odds ratio (OR) of comorbid MDE was 2.2 compared with those without CPC. The strongest association with MDE was for respiratory disorders (OR up to 7.8). Having an MDE increased notably the odds of disability among those with a CPC (ORs ranged from 3.6 to 23.0). The likelihood of receiving treatment for the MDE was similar irrespective of having or not comorbid CPC. CONCLUSIONS Results show intense associations among MDE and CPC. Compared to other developed countries, higher likehoods of comorbidity and more severe impacts on disability are found in specific comorbid conditions. These findings highlight the need to improve the treatment of MDE in those with a CPC in Spain.
Collapse
|
4
|
Miravitlles M, Andreu I, Romero Y, Sitjar S, Altés A, Anton E. Difficulties in differential diagnosis of COPD and asthma in primary care. Br J Gen Pract 2012; 62:e68-75. [PMID: 22520766 PMCID: PMC3268496 DOI: 10.3399/bjgp12x625111] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2011] [Revised: 11/01/2011] [Accepted: 11/15/2011] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) and asthma treatment must be based on appropriate diagnosis. However, patients receiving inhaled therapy in primary care may not be accurately diagnosed according to current guidelines. AIM To analyse the characteristics of patients treated with inhaled medication, the concordance of tools for differential diagnosis, and the adequacy of prescription of inhaled corticosteroids (ICs) in primary care. DESIGN AND SETTING Cross-sectional, multicentre, non-interventional study conducted in 10 primary care centres in Barcelona, Spain. METHOD Patients with chronic respiratory disease, aged >40 years were treated with ICs. They provided sociodemographic and clinical information and performed forced spirometry with a bronchodilator test (BDT). The diagnostic accuracy of asthma and COPD diagnoses were tested using two differential diagnosis questionnaires. RESULTS A total of 328 patients were initially classified as having COPD (64.8%), asthma (15.4%), or indeterminate (19.8%) by their GPs. After spirometry, 40% of patients had moderate-severe airflow obstruction according to the GOLD classification; mean reversibility of forced expiratory volume in 1 second (FEV1) was 8.4%; 18.6% had a positive BDT; and 39.8% had post-bronchodilator FEV1/forced vital capacity >0.7. Concordance of the differential diagnosis tools was moderate (clinical diagnosis versus spirometry and between the two questionnaires), low (clinical diagnosis versus questionnaires), and very low (spirometry versus differential diagnosis). Of the patients diagnosed with COPD, 71.4% were treated with ICs, and 12% of those classified as having asthma were not receiving ICs. CONCLUSION Most patients can be classified as having COPD or asthma by primary care physicians. The use of the two questionnaires did not provide a better differential diagnostic compared with symptoms and spirometry with a BDT. Misdiagnosis may lead to inadequate treatment.
Collapse
Affiliation(s)
- Marc Miravitlles
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Ciber de Enfermedades Respiratorias (CIBERES), Hospital Clinic, Barcelona, Spain.
| | | | | | | | | | | |
Collapse
|
5
|
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.
Collapse
Affiliation(s)
- Javier de Miguel-Díez
- Pneumology Department, Hospital General Universitario Gregorio Marañón, Doctor Esquerdo, 46, 28007, Madrid, Spain.
| | | | | | | | | | | | | | | |
Collapse
|
6
|
Miravitlles M, Brosa M, Velasco M, Crespo C, Gobartt E, Diaz S, González-Rojas N. An economic analysis of pharmacological treatment of COPD in Spain. Respir Med 2009; 103:714-21. [PMID: 19168340 DOI: 10.1016/j.rmed.2008.11.019] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2008] [Revised: 11/16/2008] [Accepted: 11/27/2008] [Indexed: 11/27/2022]
|
7
|
Miravitlles M, Murio C, Tirado-Conde G, Levy G, Muellerova H, Soriano JB, Ramirez-Venegas A, Ko FWS, Canelos-Estrella B, Giugno E, Bergna M, Chérrez I, Anzueto A. Geographic differences in clinical characteristics and management of COPD: the EPOCA study. Int J Chron Obstruct Pulmon Dis 2009; 3:803-14. [PMID: 19281096 PMCID: PMC2650616 DOI: 10.2147/copd.s4257] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
AIMS Data on differences in clinical characteristics and management of COPD in different countries and settings are limited. We aimed to characterize the profile of patients with COPD in a number of countries and their treatment in order to evaluate adherence to recommendations of international guidelines. METHOD This was an observational, international, cross-sectional study on patients with physician-diagnosed COPD. Demographic and clinical characteristics, risk factors, and treatment were collected by their physician via an internet web-based questionnaire developed for the study. RESULTS A total of 77 investigators from 17 countries provided data on 833 patients. The countries with the highest number of patients included were: Argentina (128), Ecuador (134), Spain (162), and Hong Kong (153). Overall, 79.3% were men and 81% former smokers, with a mean FEV1 = 42.7%, ranging from 34.3% in Hong Kong to 58.8% in Ecuador. Patients reported a mean of 1.6 exacerbations the previous year, with this frequency being significantly and negatively correlated with FEV1 (%) (r = -0.256; p < 0.0001). Treatment with short-acting bronchodilators and theophyllines was more frequent in Ecuador and Hong Kong compared with Spain and Argentina, and in patients belonging to lower socioeconomic levels (p < 0.0001 for all comparisons). Inadequacy of treatment with inhaled corticosteroids and theophyllines was high, with significant differences among countries. CONCLUSIONS Differences in the clinical characteristics and management of COPD were significant across countries. Adherence to international guidelines appears to be low. Efforts should be made to disseminate and adapt guidelines to the socioeconomic reality of different settings.
Collapse
Affiliation(s)
- Marc Miravitlles
- Servei de Pneumologia, Institut Clínic del Tòrax, Hospital Clínic, Barcelona, Spain.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
8
|
|
9
|
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]
|
10
|
Fernández Liz E, Luque Mellado FJ. [A systematic review of therapy coordination between primary and specialist care]. Aten Primaria 2007; 39:15-21. [PMID: 17286919 PMCID: PMC7713405 DOI: 10.1157/13098274] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2006] [Accepted: 05/08/2006] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES To evaluate existing information on questions of therapy coordination between primary and hospital care and to identify activities with positive results that could be adapted at the local level. DESIGN Systematic review. DATA SOURCES MEDLINE, SIETES, and Cochrane systematic review databases were searched for articles published between January 1990 and August 2005. SELECTION OF STUDIES Those conducted in countries with a National Health Service. Thirty-six studies were included: a) observational studies on drug prescription for patients moving between primary and specialist care (18 studies); b) studies of the views of health professionals: review and consensus articles and editorials (7 articles); qualitative studies (4 articles); c) intervention studies (7 studies). Four-hundred and thirty-one studies were excluded. RESULTS The most common problems were: lack of information for patient follow-up, disagreement in drug selection, increases in costs due to hospital stays and difficulties in assuming clinical responsibilities. The solution put forward was that a unified policy of common medicines and budgets is essential. Little information was available on the studies that posed or evaluated interventions to improve therapy coordination. Conditions with the most information available were heart failure, diabetes mellitus, asthma, high blood pressure, and anticoagulant treatment. CONCLUSIONS The creation of pharmacotherapy committees, involving professionals belonging to both primary and specialist care, was proposed. These committees would adapt for local use protocols and clinical practice guidelines, in line with the prescription quality standards of primary care.
Collapse
Affiliation(s)
- Eladio Fernández Liz
- Servei d'Atenció Primària Muntanya de Barcelona, Institut Català de la Salut, Barcelona, Spain.
| | | |
Collapse
|
11
|
de Granda-Orive JI, Martínez-Albiach JM. Smoking Cessation in Patients With Chronic Obstructive Pulmonary Disease. ACTA ACUST UNITED AC 2005; 41:625-33. [PMID: 16324602 DOI: 10.1016/s1579-2129(06)60297-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- J I de Granda-Orive
- Servicio de Neumología, Hospital Militar Central de la Defensa Gómez Ulla, Madrid, Spain.
| | | |
Collapse
|