1
|
A scoring system to detect fixed airflow limitation in smokers from simple easy-to-use parameters. Sci Rep 2018; 8:13329. [PMID: 30190580 PMCID: PMC6127215 DOI: 10.1038/s41598-018-31198-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 08/08/2018] [Indexed: 11/08/2022] Open
Abstract
No validated screening method currently exists for Chronic Obstructive Pulmonary Disease (COPD) in smokers. Therefore, we constructed a predictive model with simple parameters that can be applied for COPD screening to detect fixed airflow limitation. This observational cross-sectional study included a random sample of 222 smokers with no previous diagnosis of COPD undertaken in a Spanish region in 2014-2016. The main variable was fixed airflow limitation by spirometry. The secondary variables (COPD factors) were: age, gender, smoking (pack-years and Fagerström test), body mass index, educational level, respiratory symptoms and exacerbations. A points system was developed to predict fixed airflow limitation based on secondary variables. The model was validated internally through bootstrapping, determining discrimination and calibration. The system was then integrated into a mobile application for Android. Fifty-seven patients (25.7%) presented fixed airflow limitation. The points system included as predictors: age, pack-years, Fagerström test and presence of respiratory symptoms. Internal validation of the system was very satisfactory, both in discrimination and calibration. In conclusion, a points system has been constructed to predict fixed airflow limitation in smokers with no previous COPD. This system can be integrated as a screening tool, though it should be externally validated in other geographical regions.
Collapse
|
2
|
Carlone S, Balbi B, Bezzi M, Brunori M, Calabro S, Foschino Barbaro MP, Micheletto C, Privitera S, Torchio R, Schino P, Vianello A. Health and social impacts of COPD and the problem of under-diagnosis. Multidiscip Respir Med 2014; 9:63. [PMID: 25699180 PMCID: PMC4334408 DOI: 10.1186/2049-6958-9-63] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 11/27/2014] [Indexed: 11/10/2022] Open
Abstract
This article deals with the prevalence and the possible reasons of COPD underestimation in the population and gives suggestions on how to overcome the obstacles and make the correct diagnosis in order to provide the patients with the appropriate therapy. COPD is diagnosed in later or very advanced stages. In Italy the rate of COPD under-diagnosis ranges between 25 and 50% and, as a consequence, the patient does not consult his doctor until the symptoms have worsened, mainly due to exacerbations. A missed diagnosis influences the timing of therapeutic intervention, thus contributing to the evolution into more severe stages of the illness. An incisive intervention to limit under-diagnosis cannot act only in remittance (passive diagnosis), but must be the promoter for a series of preventive actions: primary, secondary and rehabilitative. To reduce under-diagnosis, some actions need to be taken, such as screening programs for smokers subjects, use of questionnaires aimed to qualify and monitor the disease severity, spirometry, early diagnosis. There is a consensus regarding diagnoses based on screening of at-risk subjects and symptoms, rather than screening of the general population. In practice, all individuals over 40 years of age with risk factors should make a spirometry test. Screening actions on a national scale can be the following: compilation of questionnaires in waiting rooms of doctor’s offices or performing simple maneuvers to evaluate the expiratory force at pharmacies. It is now widely recognized that COPD is a complex syndrome with several pulmonary and extrapulmonary components; as a result, the airway obstruction as assessed by FEV1 by itself does not adequately describe the complexity of the disease and FEV1 cannot be used alone for the optimal diagnosis, assessment, and management of the disease. The identification and subsequent grouping of key elements of the COPD syndrome into clinically meaningful and useful subgroups (phenotypes) can guide therapy more effectively. In conclusion, we firmly believe that an early and correct diagnosis can influence positively the progress of the disease (lowering the lung function impairment), decrease the risk of exacerbations, relieve symptoms and increase the patients’ quality of life leading also to a decrease in costs associated to the exacerbations and hospitalization of the patient.
Collapse
Affiliation(s)
- Stefano Carlone
- Pulmonary Department, San Giovanni-Addolorata General Hospital, Rome, Italy
| | - Bruno Balbi
- Pulmonary Rehabilitation Department, IRCCS Fondazione Salvatore Maugeri, Veruno (NO), Italy
| | - Michela Bezzi
- Endoscopy and Laser Therapy, Respiratory Unit, Hospital of Brescia, Brescia, Italy
| | - Marco Brunori
- Respiratory Pathophysiology and Rehabilitation Unit, Policlinico Umberto I, Rome, Italy
| | - Stefano Calabro
- Respiratory Unit, San Bassano Hospital, Bassano del Grappa, Vicenza Italy
| | | | | | - Salvatore Privitera
- Centre for Prevention and Monitoring Respiratory Failure, ASP, Catania, Italy
| | - Roberto Torchio
- Respiratory Function and Sleep Laboratory, AOU S. Luigi, Orbassano (TO), Italy
| | - Pietro Schino
- Physiopatology Respiratory Unit, General Hospital F. Miulli, Acquaviva delle Fonti (BA), Italy
| | - Andrea Vianello
- Respiratory Pathophysiology Division, University-City Hospital of Padova, Padova, Italy
| |
Collapse
|
3
|
Llauger MA, Rosas A, Burgos F, Torrente E, Tresserras R, Escarrabill J. [Accesibility and use of spirometry in primary care centers in Catalonia]. Aten Primaria 2014; 46:298-306. [PMID: 24768654 PMCID: PMC6983645 DOI: 10.1016/j.aprim.2013.12.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Revised: 12/01/2013] [Accepted: 12/05/2013] [Indexed: 11/05/2022] Open
Abstract
Objetivo Conocer la accesibilidad y la utilización de la espirometría forzada (EF) en los dispositivos públicos de atención primaria en Cataluña. Diseño Estudio transversal mediante encuesta. Participantes Trescientos sesenta y seis equipos de atención primaria (EAP) de Cataluña. Tercer trimestre de 2010. Mediciones Encuesta con información relativa a los espirómetros, la formación, la interpretación y el control de calidad, y el grado de prioridad que la calidad de la espirometría tenía para el equipo. Se analizaron: media de EF/100 habitantes/año; índice de EF/mes/EAP; índice de EF/mes/10.000 habitantes. Resultados principales Porcentaje de respuesta: 75%. El 97,5% de los EAP dispone de espirómetro y realiza una media de 2,01 espirometrías/100 habitantes (34,68 espirometrías/EAP/mes). El 83% dispone de profesionales formados y más del 50% de los centros realizan formación reglada, pero no se dispone de información sobre la calidad de la misma. En el 70% se hace algún tipo de calibración. La interpretación la realiza el médico de familia en el 87,3% de los casos. En el 68% de los casos no se lleva a cabo ningún tipo de control de calidad de la exploración. En dos tercios de los casos se introducen manualmente los datos en la historia clínica informatiza. Más del 50% se atribuye una prioridad alta para las estrategias de mejora de la calidad de la EF. Conclusiones A pesar de la accesibilidad a la EF deben realizarse esfuerzos para estandarizar la formación, incrementar el número de exploraciones y promover el control de calidad sistemático.
Collapse
Affiliation(s)
- M Antònia Llauger
- EAP Encants, SAP Muntanya-Dreta de Barcelona, ICS, Barcelona, España; Pla Director de les Malalties de l'Aparell Respiratori (PDMAR), Departament de Salut de Catalunya, Barcelona, España.
| | - Alba Rosas
- Pla Director de les Malalties de l'Aparell Respiratori (PDMAR), Departament de Salut de Catalunya, Barcelona, España; Subdirecció de Planificació Sanitària, Direcció General de Planificació i Recerca en Salut, Departament de Salut, Generalitat de Catalunya, Barcelona, España
| | - Felip Burgos
- Centre Diagnòstic Respiratori, Institut del Tòrax, Hospital Clínic, IDIBAPS, Barcelona, España; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Palma de Mallorca, España
| | - Elena Torrente
- Pla Director de les Malalties de l'Aparell Respiratori (PDMAR), Departament de Salut de Catalunya, Barcelona, España; Red de servicios de Salud Orientados a Enfermedades Crónicas (REDISECC), Madrid, España; Agència d'Informació, Avaluació i Qualitat en Salut (AIAQS), Barcelona, España
| | - Ricard Tresserras
- Pla Director de les Malalties de l'Aparell Respiratori (PDMAR), Departament de Salut de Catalunya, Barcelona, España; Subdirecció de Planificació Sanitària, Direcció General de Planificació i Recerca en Salut, Departament de Salut, Generalitat de Catalunya, Barcelona, España; Observatori de Teràpies Respiratòries (OBsTRD), FORES, Vic (Barcelona), España
| | - Joan Escarrabill
- Pla Director de les Malalties de l'Aparell Respiratori (PDMAR), Departament de Salut de Catalunya, Barcelona, España; Red de servicios de Salud Orientados a Enfermedades Crónicas (REDISECC), Madrid, España; Observatori de Teràpies Respiratòries (OBsTRD), FORES, Vic (Barcelona), España; Programa d'Atenció a la Cronicitat, Hospital Clínic i Barcelona Esquerra, Barcelona, España
| | | |
Collapse
|
4
|
Lyngsø AM, Gottlieb V, Backer V, Nybo B, Østergaard MS, Jørgensen HL, Frølich A. Early Detection of COPD in Primary Care: The Copenhagen COPD Screening Project. COPD 2013; 10:208-15. [DOI: 10.3109/15412555.2012.714426] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
5
|
Clotet J, Real J, Lorente I, Fuentes A, Paredes E, Ciria C. Espirometría como método de cribado y de intervención antitabaco en fumadores de alto riesgo en atención primaria. Aten Primaria 2012; 44:328-34. [DOI: 10.1016/j.aprim.2011.05.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2011] [Revised: 05/12/2011] [Accepted: 05/24/2011] [Indexed: 11/25/2022] Open
|
6
|
Gil-Guillén V, Orozco-Beltrán D, Carratala Munuera CV, Plaza-Sirvent C, Lorca-Amorrich P, López-Pineda A, Vela-Troncoso MP, Soler JJ, Yarza-Cañellas M, Fernández A, Rosado-Bretón L, Olivares-Bautista C, Muñoz-Fernández A. FUMEPOC: early detection of chronic obstructive pulmonary disease in smokers. BMC Public Health 2011; 11:413. [PMID: 21627787 PMCID: PMC3120686 DOI: 10.1186/1471-2458-11-413] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2011] [Accepted: 05/31/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Currently is not feasible using conventional spirometry as a screening method in Primary Care especially among smoking population to detect chronic obstructive pulmonary disease in early stages. Therefore, the FUMEPOC study protocol intends to analyze the validity and reliability of Vitalograph COPD-6 spirometer as simpler tool to aid screening and diagnosis of this disease in early stages in primary care surgery. METHODS / DESIGN STUDY DESIGN An observational, descriptive study of diagnostic tests, undertaken in Primary Care and Pneumology Outpatient Care Centre at San Juan Hospital and Elda Hospital. All smokers attending the primary care surgery and consent to participate in the study will undergo a test with Vitalograph COPD-6 spirometer. Subsequently, a conventional spirometry will be performed in the hospital and the results will be compared with those of the Vitalograph COPD-6 test. DISCUSSION It is difficult to use the spirometry as screening for early diagnose test in real conditions of primary care clinical practice. The use of a simpler tool, Vitalograph COPD-6 spirometer, can help in the early diagnose and therefore, it could improve the clinical management of the disease.
Collapse
Affiliation(s)
- Vicente Gil-Guillén
- Departamento Medicina Clínica, Universidad Miguel Hernández de Elche (Campus de San Juan), 03550 San Juan de Alicante, Alicante, Spain
| | - Domingo Orozco-Beltrán
- Unidad Investigación, Hospital Universitario San Juan de Alicante, Carretera Nacional 332 Alicante-Valencia s/n, 03550, Sant Joan d'Alacant (Alicante), Spain
| | - Concepcion V Carratala Munuera
- Departamento Medicina Clínica, Universidad Miguel Hernández de Elche, Carretera Nacional 332 Alicante-Valencia s/n, 03550, Sant Joan d'Alacant (Alicante), Spain
| | - Carlos Plaza-Sirvent
- Unidad Investigación, Hospital Universitario San Juan de Alicante, Carretera Nacional 332 Alicante-Valencia s/n, 03550, Sant Joan d'Alacant (Alicante), Spain
| | - Patricia Lorca-Amorrich
- Unidad Investigación, Hospital Universitario San Juan de Alicante, Carretera Nacional 332 Alicante-Valencia s/n, 03550, Sant Joan d'Alacant (Alicante), Spain
| | - Adriana López-Pineda
- Unidad Investigación, Hospital Universitario San Juan de Alicante, Carretera Nacional 332 Alicante-Valencia s/n, 03550, Sant Joan d'Alacant (Alicante), Spain
| | - María P Vela-Troncoso
- Departamento de Medicina Interna, Hospital General de Elda (Alicante), Ctra. Sax-Elda, s/n, 03600, Elda, Spain
| | - Juan J Soler
- Servicio de Neumología, Hospital de Requena, Casablanca, S/N, 46340, Requena, Spain
| | - Manuel Yarza-Cañellas
- Agencia Valenciana de Salud, Conselleria de Sanidad, Micer Mascó no 31, 46010, Valencia, Spain
| | - Antonio Fernández
- Unidad Investigación, Hospital Universitario San Juan de Alicante, Carretera Nacional 332 Alicante-Valencia s/n, 03550, Sant Joan d'Alacant (Alicante), Spain
| | - Luis Rosado-Bretón
- Agencia Valenciana de Salud, Conselleria de Sanidad, Micer Mascó no 31, 46010, Valencia, Spain
| | | | | | | |
Collapse
|
7
|
Lee PN, Fry JS. Systematic review of the evidence relating FEV1 decline to giving up smoking. BMC Med 2010; 8:84. [PMID: 21156048 PMCID: PMC3017006 DOI: 10.1186/1741-7015-8-84] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2010] [Accepted: 12/14/2010] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND The rate of forced expiratory volume in 1 second (FEV1) decline ("beta") is a marker of chronic obstructive pulmonary disease risk. The reduction in beta after quitting smoking is an upper limit for the reduction achievable from switching to novel nicotine delivery products. We review available evidence to estimate this reduction and quantify the relationship of smoking to beta. METHODS Studies were identified, in healthy individuals or patients with respiratory disease, that provided data on beta over at least 2 years of follow-up, separately for those who gave up smoking and other smoking groups. Publications to June 2010 were considered. Independent beta estimates were derived for four main smoking groups: never smokers, ex-smokers (before baseline), quitters (during follow-up) and continuing smokers. Unweighted and inverse variance-weighted regression analyses compared betas in the smoking groups, and in continuing smokers by amount smoked, and estimated whether beta or beta differences between smoking groups varied by age, sex and other factors. RESULTS Forty-seven studies had relevant data, 28 for both sexes and 19 for males. Sixteen studies started before 1970. Mean follow-up was 11 years. On the basis of weighted analysis of 303 betas for the four smoking groups, never smokers had a beta 10.8 mL/yr (95% confidence interval (CI), 8.9 to 12.8) less than continuing smokers. Betas for ex-smokers were 12.4 mL/yr (95% CI, 10.1 to 14.7) less than for continuing smokers, and for quitters, 8.5 mL/yr (95% CI, 5.6 to 11.4) less. These betas were similar to that for never smokers. In continuing smokers, beta increased 0.33 mL/yr per cigarette/day. Beta differences between continuing smokers and those who gave up were greater in patients with respiratory disease or with reduced baseline lung function, but were not clearly related to age or sex. CONCLUSION The available data have numerous limitations, but clearly show that continuing smokers have a beta that is dose-related and over 10 mL/yr greater than in never smokers, ex-smokers or quitters. The greater decline in those with respiratory disease or reduced lung function is consistent with some smokers having a more rapid rate of FEV1 decline. These results help in designing studies comparing continuing smokers of conventional cigarettes and switchers to novel products.
Collapse
Affiliation(s)
- Peter N Lee
- PN Lee Statistics and Computing Ltd, Surrey, UK.
| | | |
Collapse
|
8
|
Lyngsø AM, Backer V, Gottlieb V, Nybo B, Østergaard MS, Frølich A. Early detection of COPD in primary care--the Copenhagen COPD Screening Project. BMC Public Health 2010; 10:524. [PMID: 20809934 PMCID: PMC2940916 DOI: 10.1186/1471-2458-10-524] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2010] [Accepted: 09/01/2010] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Chronic Obstructive Pulmonary Disease (COPD) is among the leading causes of death in the world, and further increases in the prevalence and mortality are predicted. Delay in diagnosing COPD appears frequently even though current consensus guidelines emphasize the importance of early detection of the disease. The aim of the present study is to evaluate the effectiveness of a screening programme in general practice. METHODS/DESIGN Subjects aged 65 years and older registered with a General Practitioner (GP) in the eastern Copenhagen will receive a written invitation and a simple questionnaire focusing on risk factors and symptoms of COPD. Subjects who meet the following criteria will be encouraged to undergo spirometric testing at their GP: current smokers, former smokers, and subjects with no smoking history but who have dyspnea and/or chronic cough with sputum. DISCUSSION The Copenhagen COPD Screening Project evaluates the effectiveness of a two-stage screening program for COPD in general practice and provides important information on how to organize early detection of COPD in general practice in the future.
Collapse
Affiliation(s)
- Anne Marie Lyngsø
- Department of Integrated Healthcare, Bisbebjerg University Hospital, Copenhagen, Denmark
| | - Vibeke Backer
- Department of Pulmonary medicine, Bisbebjerg University Hospital, Copenhagen, Denmark
| | - Vibeke Gottlieb
- Department of Pulmonary medicine, Bisbebjerg University Hospital, Copenhagen, Denmark
| | - Birgitte Nybo
- Department of Pulmonary medicine, Bisbebjerg University Hospital, Copenhagen, Denmark
| | - Marianne S Østergaard
- Department of Health Services Research, Institute of General Medicine, Copenhagen University, Denmark
| | - Anne Frølich
- Department of Integrated Healthcare, Bisbebjerg University Hospital, Copenhagen, Denmark
| |
Collapse
|
9
|
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]
|
10
|
Diaz P, Bruns A, Rittinger M, Kadiev S. Role of early detection and pharmacotherapy in chronic obstructive pulmonary disease. Expert Rev Respir Med 2008; 2:779-89. [PMID: 20477239 DOI: 10.1586/17476348.2.6.779] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is defined as airflow limitation that is not fully reversible, usually progressive and associated with an abnormal inflammatory response to noxious particles or gases. By the time COPD has progressed to the point of clinical symptoms, over half of lung function may have been lost. This review will first describe studies that have examined the feasibility and yield of early detection of COPD using spirometry as a gold standard. Next, we will review existing studies that have examined the effects of pharmacotherapy on early (mild-to-moderate) COPD, specifically focusing on studies that have attempted to alter the natural history of disease. Finally, we will briefly discuss studies that have tested the effects of various pharmacologic interventions on biomarkers felt to be relevant to disease pathogenesis. Discovery of effective pharmacotherapy that can prevent disease progression in early-stage COPD has enormous public-health implications, given the current global burden of disease and the proportion of individuals at risk - aging current and former smokers.
Collapse
Affiliation(s)
- Philip Diaz
- COPD Treatment Program, 201 Davis Heart Lung Research Institute, 473 West 12th Avenue, The Ohio State University, Columbus, OH 43210, USA.
| | | | | | | |
Collapse
|
11
|
Miravitlles M, de la Roza C, Naberan K, Lamban M, Gobartt E, Martin A. Use of spirometry and patterns of prescribing in COPD in primary care. Respir Med 2007; 101:1753-60. [PMID: 17448651 DOI: 10.1016/j.rmed.2007.02.019] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2006] [Revised: 02/13/2007] [Accepted: 02/23/2007] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To investigate the use and interpretation of spirometry in primary care (PC) in the diagnosis of chronic obstructive pulmonary disease (COPD) and to identify the treatment schedules administered. METHODS An observational study was performed in a randomized sample of 251 PC physicians including 2130 patients with COPD. Data on the performance of spirometry and the results and the treatment administered were collected as were sociodemographic and clinical data. RESULTS Spirometric results were obtained in 1243 (58.4%). Most (1118/1243; 89.9%) corresponded to FEV1 (%) values with a mean of 57% (SD=21.5%). It is of note that only 31.8% of spirometric results provided post-bonchodilator results, and 42.9% and 43.1% of the spirometries presented not plausible FVC or FEV1 values, respectively. Treatment varied greatly, with more than 3 drugs being prescribed in 30.6% of the cases. Long-acting beta-2 agonists and inhaled corticosteroids were prescribed in more than 50% of the patients. Tiotropium was administered in 32.4%. According to the GOLD guidelines, 22.8% of the patients in GOLD II, 50% in III and 66.7% in IV were receiving incorrect treatment. CONCLUSIONS Only 58.4% of the cases included had undergone spirometry. Important deficiencies were observed in the interpretation of the results of spirometry. These difficulties may influence the low implementation of treatment guidelines in COPD in PC.
Collapse
Affiliation(s)
- Marc Miravitlles
- Department of Pneumology, Institut Clínic del Tòrax (IDIBAPS), Servicio de Neumología, Hospital Clínic, Villarroel 170 08036, Barcelona, Spain.
| | | | | | | | | | | |
Collapse
|
12
|
Miravitlles M, de la Roza C, Morera J, Montemayor T, Gobartt E, Martín A, Alvarez-Sala JL. Chronic respiratory symptoms, spirometry and knowledge of COPD among general population. Respir Med 2006; 100:1973-80. [PMID: 16626950 DOI: 10.1016/j.rmed.2006.02.024] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2005] [Revised: 01/30/2006] [Accepted: 02/24/2006] [Indexed: 11/23/2022]
Abstract
RATIONALE Infradiagnosis of chronic obstructive pulmonary disease (COPD) may be related to the lack of knowledge about the disease and/or the scarce use of diagnostic procedures. This study analyses the frequency of respiratory symptoms and the knowledge about COPD in the general population, together with the use of spirometry in individuals at risk of COPD. POPULATION AND METHOD A telephone survey was carried out in 6758 subjects older than 40 years, stratified by age, habitat (urban or rural) and region, screened by random-digit dialling. RESULTS Up to 24% reported having at least one chronic respiratory symptom and 20.9% had a self-reported respiratory diagnosis. A total of 19.2% were active smokers and 40% had never tried to quit. Only 60% of the individuals with chronic symptoms had consulted a physician and, of them, only 45% had undergone spirometry. Spirometry was mentioned more frequently by subjects attended by pulmonologists than by GPs (67.6 vs. 28.6%; P<0.001). The term COPD was identified only by 8.6% of the participants. CONCLUSIONS Many individuals with respiratory symptoms do not request medical attention and do not attempt to quit smoking. There is a lack of knowledge about COPD. Physicians should more actively inform about the disease and increase the use of spirometry for early detection.
Collapse
Affiliation(s)
- Marc Miravitlles
- Servei de Pneumologia, Institut Clínic del Tòrax (IDIBAPS), Hospital Clinic, Barcelona, Catalonia, Spain.
| | | | | | | | | | | | | |
Collapse
|
13
|
Bohadana A, Nilsson F, Martinet Y. Detecting airflow obstruction in smoking cessation trials: a rationale for routine spirometry. Chest 2005; 128:1252-7. [PMID: 16162715 DOI: 10.1378/chest.128.3.1252] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Spirometry is not routinely performed in smoking cessation trials. Smokers with airflow obstruction who are unavailable for follow-up incur the risk of accelerated loss in lung function. We evaluated the prevalence of airflow obstruction among smokers enrolled in smoking cessation trials and the proportion of subjects with obstruction unavailable for follow-up. DESIGN, SETTING, AND PARTICIPANTS The study was performed in a university research laboratory; 598 smokers participating in two smoking cessation trials were included. All subjects underwent spirometry at entry and after 1 year of follow-up. All received nicotine replacement therapy. At completion, they were classified into quitters, reducers, or continuing smokers. MEASUREMENTS AND RESULTS At enrollment, spirometry findings were normal in 493 subjects (82.4%). Airway obstruction (FEV1 < 80% predicted) was found in 105 subjects (17.6%): mild obstruction (FEV1 70 to 80% predicted) in 75 subjects, moderate obstruction (FEV1 50 to 69% predicted) in 22 subjects, and severe obstruction (FEV1 < 50% predicted) in 8 subjects. From these subjects, 75 were unavailable for follow-up: airflow obstruction was mild in 52 subjects (69.3%), moderate in 17 subjects (22.7%), and severe in 6 subjects (8%). CONCLUSIONS Spirometry detected a high prevalence yield of airflow obstruction in participants in smoking cessation trials. Most subjects with airflow obstruction were unavailable for follow-up; they would have remained unaware of their condition if not for spirometry. Smokers with airflow obstruction should be identified and advised to seek further care.
Collapse
Affiliation(s)
- Abraham Bohadana
- INSERM, ESPRI EP2R, Faculté de Médecine, B.P. 184 - 9, Av de la Forêt de Haye, 54505 Vandoeuvre-lès-Nancy, France.
| | | | | |
Collapse
|
14
|
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
|
15
|
Miravitlles M, Ferrer M, Pont A, Luis Viejo J, Fernando Masa J, Gabriel R, Jiménez-Ruiz CA, Villasante C, Fernández-Fau L, Sobradillo V. Characteristics of a population of COPD patients identified from a population-based study. Focus on previous diagnosis and never smokers. Respir Med 2005; 99:985-95. [PMID: 15950139 DOI: 10.1016/j.rmed.2005.01.012] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2004] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To identify factors associated with diagnosis and health-related quality of life (HRQL) impairment in chronic obstructive pulmonary disease (COPD) patients from a population-based epidemiological study. DESIGN AND PARTICIPANTS This was an epidemiologic, multicenter, population-based study. Three hundred and sixty-three individuals diagnosed with COPD from a randomly general population sample of 4035 individuals aged 40-69 were included in the analyses. INTERVENTIONS Forced spirometry was performed on eligible subjects, and the European Commission for Steel and Coal (ECSC) and the St. George's Respiratory Questionnaires (SGRQ) were completed. Logistic regression models were constructed to identify variables associated with the previous diagnosis of COPD and with COPD in never smokers. A multiple linear regression model attempted to identify variables influencing HRQL impairment. RESULTS Only 79 (21.7%) COPD patients had been previously diagnosed. Disease severity based on FEV(1), worse SGRQ score, previous respiratory disease, as well as the presence of wheezing were significantly associated with previous diagnosis. Being a woman, older than 55, with previous respiratory disease and without expectoration or wheezing characterized COPD in never smokers. A worse HRQL was associated with chronic symptoms, especially dyspnea; and with older age, cardiac comorbidity and impairment in lung function. CONCLUSIONS Diagnosis of COPD in the community is more likely in patients with worse lung function and HRQL, and wheezing is the symptom most strongly associated with a diagnosis of COPD. Women older than 55, with previous respiratory diseases, without respiratory symptoms and mild airflow obstruction constitute the majority of individuals with COPD who have never smoked. Chronic respiratory symptoms are strongly associated with impairment in HRQL.
Collapse
Affiliation(s)
- Marc Miravitlles
- Servei de Pneumologia, Institut Clínic del Tòrax (IDIBAPS), Red Respira FIS-ISCIII-RTIC-03/11, Hospital Clinic, Villarroel 170, 08036 Barcelona, Catalonia, Spain.
| | | | | | | | | | | | | | | | | | | |
Collapse
|