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Calleja JR, Hernández EMJ, Panedas AM, Carracedo JFS, García CG, Alonso MPB, Tejedor MTC, Alonso JEF. Study on the Association between Cesarean Section Birth and Asthma Risk in the Pediatric Population of the Health Area of Palencia between 1993 and 2020. Allergol Immunopathol (Madr) 2024; 52:68-72. [PMID: 38970267 DOI: 10.15586/aei.v52i4.1084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 05/14/2024] [Indexed: 07/08/2024]
Abstract
INTRODUCTION AND OBJECTIVES Both asthma prevalence and the percentage of cesarean sections have increased in parallel in recent years. Research studies suggest an increased risk of developing atopic diseases and asthma after cesarean section birth compared to vaginal delivery. The main objective of this study is to analyze the risk of asthma admission after cesarean section birth compared to vaginal delivery in the pediatric population. POPULATION AND METHODS Retrospective observational analytical case-control study from 1993 to 2020. The cases include all admitted patients to our health area hospital, for patients aged 7 to 16 diagnosed with asthma. For each case, a control without a diagnosis of asthma is selected with the same age, and that has also caused an episode of admission. RESULTS A total of 290 admission episodes with a diagnosis of asthma were obtained, caused by 155 patients. Out of these, 145 cases with documented delivery types were selected. For cases, 155 controls were selected. The historical proportion of cesarean sections in the asthmatic group is 18.6%, compared to 14.2% in the non-asthmatic group. There is a statistically non-significant difference of 4.4% more cesarean sections in the asthmatic group compared to the control group. DISCUSSION We have not demonstrated a statistically significant association between being born by cesarean section and an increased risk of asthma admission. Based on this finding, we cannot conclude that there is an association between being born by cesarean section and a higher risk of suffering from asthma, unlike what has been postulated in other research studies.
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García Castillo E, Alonso Pérez T, Peláez A, Pérez González P, Miravitlles M, Alfageme I, Casanova C, Cosío BG, de Lucas P, García-Río F, Rodríguez González-Moro JM, Soler-Cataluña JJ, Sánchez G, Soriano JB, Ancochea J. Trends of COPD in Spain: Changes Between Cross Sectional Surveys 1997, 2007 and 2017. Arch Bronconeumol 2023; 59:142-151. [PMID: 36549937 DOI: 10.1016/j.arbres.2022.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/22/2022] [Accepted: 11/23/2022] [Indexed: 12/12/2022]
Abstract
INTRODUCTION We aim to describe the changes in prevalence and risk factors associated to chronic obstructive pulmonary disease (COPD) in Spain, comparing three population-based studies conducted in three timepoints. METHODS We compared participants from IBERPOC conducted in 1997, EPISCAN conducted in 2007 and EPISCAN II in 2017. COPD was defined as a postbronchodilator FEV1/FVC (forced expiratory volume in 1s/forced vital capacity) ratio <0.70, according to GOLD criteria; subsequently, also as the FEV1/FVC below the lower limit of normal (LLN). RESULTS COPD prevalence in the population between 40 and 69 years decreased from 21.6% (95% CI 20.7%-23.2%) in 1997 to 8.8% (95% CI 8.2%-9.5%) in 2017, a 59.2% decline (p<0.001). In 2007, the prevalence was 7.7% (95% CI 6.8%-8.7%) with an upward trend of 1.1 percentage points in 2017 (p=0.073). Overall COPD prevalence decreased in men and women, although a significant increase was observed in the last decade in females (p<0.05). Current smokers significantly increased in the last decades (25.4% in 1997, 29.1% in 2007 and 23.4% in 2017; p<0.001). Regrettably, COPD underdiagnosis was constantly high, 77.6% in 1997, 78.4% in 2007, and to 78.2% in 2017 (p=0.95), higher in younger ages (40-49 yrs and 50-59 yrs) and also higher in women than in men in all three studies (p<0.05). CONCLUSIONS We report a significant reduction of 59.2% in the prevalence of COPD in Spain from 1997 to 2017 in subjects aged 40-69 years. Our study highlights the significant underdiagnosis of COPD, particularly sustained in women and younger populations.
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Affiliation(s)
- Elena García Castillo
- Pulmonary Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria La Princesa, Madrid, Spain; School of Medicine, Universidad Autónoma de Madrid (UAM), Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.
| | - Tamara Alonso Pérez
- Pulmonary Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria La Princesa, Madrid, Spain; School of Medicine, Universidad Autónoma de Madrid (UAM), Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Adrián Peláez
- Pulmonary Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria La Princesa, Madrid, Spain; School of Medicine, Universidad Autónoma de Madrid (UAM), Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Patricia Pérez González
- Pulmonary Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria La Princesa, Madrid, Spain; School of Medicine, Universidad Autónoma de Madrid (UAM), Spain
| | - Marc Miravitlles
- Pulmonary Department, Hospital Universitari Vall d'Hebron-CIBERES, Barcelona, Spain
| | - Inmaculada Alfageme
- Unidad de Gestión Clínica de Neumología, Hospital Universitario Virgen de Valme, Departamento de Medicina, Universidad de Sevilla, Sevilla, Spain
| | - Ciro Casanova
- Pulmonary Department-Research Unit, Hospital Universitario Nuestra Señora de Candelaria, CIBERES, ISCIII, Universidad de La Laguna, Tenerife, Spain
| | - Borja G Cosío
- Pulmonary Department, Hospital Universitario Son Espases-IdISBa-Ciberes, Palma de Mallorca, Baleares, Spain
| | - Pilar de Lucas
- Pulmonary Department, Hospital General Gregorio Marañón, Madrid, Spain
| | - Francisco García-Río
- Pulmonary Department, Hospital Universitario La Paz-IdiPAZ-CIBERES, Madrid, Spain
| | | | - Juan José Soler-Cataluña
- Pulmonary Department, Hospital Arnau de Vilanova-Lliria, Universitat de València, Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | | | - Joan B Soriano
- Pulmonary Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria La Princesa, Madrid, Spain; School of Medicine, Universidad Autónoma de Madrid (UAM), Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Julio Ancochea
- Pulmonary Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria La Princesa, Madrid, Spain; School of Medicine, Universidad Autónoma de Madrid (UAM), Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
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Darbà J, Ascanio M. Incidence and medical costs of chronic obstructive respiratory disease in Spanish hospitals: a retrospective database analysis. J Med Econ 2023; 26:335-341. [PMID: 36800217 DOI: 10.1080/13696998.2023.2182092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
OBJECTIVE This study aimed to assess the comorbidity profile, use of health care resources and medical costs of patients with chronic obstructive pulmonary disease (COPD) treated at the hospital level in Spain. METHODS Admission records of patients with COPD and at least two admissions registered between January 2016 and December 2020 were obtained from a Spanish hospital discharge database and analyzed in a retrospective multicenter study. RESULTS 95,140 patients met the inclusion criteria; 69.1% were males with a median age of 75 years. Mean Charlson comorbidity index (CCI) was 1.9 in the index admission, increasing to 2.1 during the follow-up period. An acute exacerbation of COPD was registered in 93.6% of patients in the index admission; other secondary diagnoses included respiratory failure (56.8%), essential hypertension (36.9%), hypercholesterolemia (26.7%) and diabetes (26.3%). The age-adjusted incidence rate of COPD was 22.6 per 10,000 persons over the study period, decreasing significantly in the year 2020. Mortality rate was 4.1% for COPD patients, increasing to 6.6% in the year 2020. The year 2020, 191 patients registered a COVID-19 infection, with a mortality rate of 23.0%. Length of hospital stay, and intensive care unit (ICU) stay increased in the follow-up period versus the index admission, similar to admission costs. Mean admission cost was €3212 in the index admission, with cost increases being associated with age, length of stay, ICU stay and CCI. CONCLUSIONS Patients' condition worsened significantly over the follow-up period, in terms of comorbidity and dependence on respirator, with an increased mortality rate and higher admission costs.
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Affiliation(s)
- Josep Darbà
- Department of Economics, Universitat de Barcelona, Barcelona, Spain
| | - Meritxell Ascanio
- Department of Health Economics, BCN Health Economics & Outcomes Research S.L, Barcelona, Spain
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Miravitlles M, Soler-Cataluña JJ, Soriano JB, García-Río F, de Lucas P, Alfageme I, Casanova C, Rodríguez González-Moro JM, Sánchez G, Ancochea J, Cosío BG. Respiratory symptoms and their determinants in the general Spanish population: changes over 20 years. ERJ Open Res 2022; 8:00067-2022. [PMID: 36382234 PMCID: PMC9661281 DOI: 10.1183/23120541.00067-2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 04/01/2022] [Indexed: 11/16/2022] Open
Abstract
Background Few large epidemiological studies have analysed the prevalence of respiratory symptoms and their determinants in the general adult population. We investigated the prevalence and determinants of respiratory symptoms and compared their prevalence with that of two previous studies conducted in 1999 and 2009. Method EPISCAN II was a multicentre, cross-sectional, population-based epidemiological study in individuals older than 40 years. Results A total of 9092 individuals were included. Up to 47.5% reported at least one respiratory symptom, being more frequent in women than in men (49.4% versus 45.5%, p=0.0002) and with wheezing being the most frequent (33.7%) followed by dyspnoea (26.8%). The presence of any symptom was associated with female sex, higher body mass index (BMI), lower forced expiratory volume in 1 s (FEV1 % pred), reduced physical activity, a higher Charlson index and the presence of anxiety and depression. Smoking was also significantly associated with having at least one respiratory symptom in a dose–response fashion (OR: 1.415, 1.916, 2.192 and 2.987 for 0–10, 10–20, 20–30 and >30 pack-years, respectively, all p<0.0001). The prevalence of symptoms remained quite similar over the last 20 years (wheezing 40%, 36% and 33.7% and dyspnoea 10.4%, 9.9% and 13.1% in 1999, 2009 and 2019, respectively). Conclusions Approximately half of the adult Spanish population have respiratory symptoms and this prevalence has remained quite stable over the last 20 years. Smoking remains the main factor associated with respiratory symptoms, but female sex, comorbidities, high BMI and low FEV1 and low physical activity are also significantly associated with respiratory symptoms. Approximately half of the adult Spanish population has some respiratory symptoms and this prevalence has remained quite stable over the last 20 yearshttps://bit.ly/37uGRT7
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García Castillo E, Alonso Pérez T, Peláez A, Pérez González P, Soriano JB, Ancochea J. Prevalence of Chronic Obstructive Pulmonary Disease in an Urban Area. Changes in COPD Ten Years on. Int J Chron Obstruct Pulmon Dis 2022; 17:2431-2441. [PMID: 36199759 PMCID: PMC9528798 DOI: 10.2147/copd.s377140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 09/09/2022] [Indexed: 11/25/2022] Open
Abstract
Purpose The prevalence of Chronic obstructive pulmonary disease (COPD) in Spain has been evaluated in the last ten years by EPISCAN in 2007 and EPISCAN II in 2017. This study describes changes in the prevalence of COPD in an urban region of Spain in the last 10 years, its risk factors and underdiagnosis. Patients and Methods Participants from the Autonomous Community of Madrid (Spain) were selected from both studies up to the age of 80 years. A descriptive analysis of their sociodemographic and clinical characteristics, as well as by gender, was conducted. COPD was defined by a post-bronchodilator ratio <0.70. Results The prevalence of COPD in the Autonomous Community of Madrid increased non-significantly from 11.0% (95% CI: 8.9–13.5%) to 12.1% (95% CI: 9.6–15.1, p=0.612). However, the prevalence by gender showed an increase in women (5.6% to 14.7%, p<0.001) and a decrease in men (17.6% to 9.8%, p=0.08). Underdiagnosis was reduced from 81.0% to 67.9% (p=0.006), although with greater underdiagnosis in women (86.4% in EPISCAN and 100% in EPISCAN II). Smoking was higher in men than in women in EPISCAN (31.2% vs 23.0%, p<0.01) but with no differences by gender in EPISCAN II (25.5% men vs 26.0% women, p=0.146). Age, smoking, low BMI, and a sedentary lifestyle were consistently associated with COPD. Conclusion In 10 years in Madrid, there have been no changes in the global prevalence of COPD, but there have been important changes in women, with an increase in its prevalence, smoking habit and underdiagnosis.
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Affiliation(s)
- Elena García Castillo
- Pulmonary Department, Hospital Universitario La Princesa, Instituto de Investigación Sanitaria La Princesa, Madrid, Spain
- School of Medicine, Universidad Autónoma de Madrid (UAM), Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
- Cátedra UAM-GSK “Respira Vida”, Madrid, Spain
- Correspondence: Elena García Castillo, Pulmonology Department, Hospital Universitario La Princesa, C/ Diego de León, 62, Madrid, CP: 28006, Spain, Tel +34 91 520 22 77, Fax +91-520-26-72, Email
| | - Tamara Alonso Pérez
- Pulmonary Department, Hospital Universitario La Princesa, Instituto de Investigación Sanitaria La Princesa, Madrid, Spain
- School of Medicine, Universidad Autónoma de Madrid (UAM), Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
- Cátedra UAM-GSK “Respira Vida”, Madrid, Spain
| | - Adrián Peláez
- Pulmonary Department, Hospital Universitario La Princesa, Instituto de Investigación Sanitaria La Princesa, Madrid, Spain
- School of Medicine, Universidad Autónoma de Madrid (UAM), Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Patricia Pérez González
- Pulmonary Department, Hospital Universitario La Princesa, Instituto de Investigación Sanitaria La Princesa, Madrid, Spain
- School of Medicine, Universidad Autónoma de Madrid (UAM), Madrid, Spain
- Cátedra UAM-GSK “Respira Vida”, Madrid, Spain
| | - Joan B Soriano
- Pulmonary Department, Hospital Universitario La Princesa, Instituto de Investigación Sanitaria La Princesa, Madrid, Spain
- School of Medicine, Universidad Autónoma de Madrid (UAM), Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Julio Ancochea
- Pulmonary Department, Hospital Universitario La Princesa, Instituto de Investigación Sanitaria La Princesa, Madrid, Spain
- School of Medicine, Universidad Autónoma de Madrid (UAM), Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
- Cátedra UAM-GSK “Respira Vida”, Madrid, Spain
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Protocol for assessing mortality reduction with the early use of noninvasive ventilation in prehospital emergency services: A multicentre, observational cohort study in Madrid, Spain. Aust Crit Care 2021; 35:302-308. [PMID: 34419341 DOI: 10.1016/j.aucc.2021.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 05/24/2021] [Accepted: 05/29/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Acute respiratory failure (ARF) has become one of the most prevalent serious pathologies encountered in the emergency medical service (EMS). In hospital settings, noninvasive ventilation (NIV) therapy prevents complications from more aggressive treatments for that condition. However, the scarce evidence on the benefits of NIV in prehospital EMS (i.e., during transport to the hospital) is inconclusive. OBJECTIVES To determine whether the administration of NIV during prehospital EMS in cases of ARF reduces in-hospital mortality compared with starting NIV on arrival to in-patient EMS. METHODS This is a multicentre, observational, prospective cohort study. We recruited a total of 317 patients from the Madrid region (Spain) who were prescribed NIV for their ARF using a nonprobabilistic consecutive sampling method. Analyses of the main outcome (in-hospital mortality) and secondary outcomes (length of hospital stay, readmissions, percentage of intensive care unit admissions, and cost-effectiveness) will include descriptive analyses of patients' characteristics, as well as bivariate and multivariate analyses and cost-effectiveness analysis. DISCUSSION This study will provide data on NIV management in prehospital and in-patient EMS in patients with ARF. Results will contribute to the existing evidence on the benefits of NIV in the context of prehospital EMS while underlining the importance of a standardized formal training for physicians and nurses working in prehospital and in-patient EMSs. CONCLUSION The VentilaMadrid study will provide valuable data on the clinical factors of patients receiving NIV in prehospital EMS. Further, were our hypothesis to be confirmed, our results would strongly suggest that the administration of NIV in prehospital EMS by medical and nursing profesionals formally trained in the technique reduces mortality and improves prognoses.
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Association between Physical Activity and Comorbidities in Spanish People with Asthma-COPD Overlap. SUSTAINABILITY 2021. [DOI: 10.3390/su13147580] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Asthma and chronic obstructive pulmonary disease (COPD) are important conditions which often coexist. Higher rates of comorbidities among people with asthma-COPD overlap (ACO) may complicate clinical management. The aim of this study was to determine the prevalence of 30 different comorbidities and to analyze associations between these comorbidities and physical activity (PA) in Spanish people with ACO. Cross-sectional data from the Spanish National Health Survey 2017 were analyzed. A total of 198 Spanish people with ACO aged 15–69 years (60.6% women) were included in this study. PA was measured with the International Physical Activity Questionnaire (IPAQ) short form. Diagnosis of chronic conditions were self-reported. Associations between PA and comorbidities were analyzed using multivariable logistic regression models. The most prevalent comorbidities were chronic allergy (58.1%), chronic lumbar pain (42.4%), chronic cervical pain (38.4%), hypertension (33.3%) and arthrosis (31.8%). A PA level lower than 600 MET·min/week was significantly associated with urinary incontinence (OR = 3.499, 95% CI = 1.369–8.944) and osteoporosis (OR = 3.056, 95% CI = 1.094–8.538) in the final adjusted model. Therefore, the potential influence of PA on reducing the risk of these conditions among people with ACO should be considered, not only because of the health benefits, but also because PA can contribute to a more sustainable world.
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Sánchez Castillo S, Smith L, Díaz Suárez A, López Sánchez GF. Physical activity behavior in people with asthma and COPD overlap residing in Spain: a cross-sectional analysis. J Asthma 2021; 59:917-925. [PMID: 33567915 DOI: 10.1080/02770903.2021.1888977] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To identify levels of physical activity (PA) among the Spanish population with asthma and chronic obstructive pulmonary disease overlap (ACO). A further aim was to analyze differences in PA levels by sex, age, education, marital status, cohabiting, smoking habits, alcohol consumption and body mass index (BMI). METHODS In this cross sectional study, data from the Spanish National Health Survey 2017 were analyzed. A total of 198 people with ACO aged 15-69 years were included in the analyses. The short version of the international physical activity questionnaire (IPAQ) was used to measure total PA (MET·min/week). PA was further classified as low, moderate and high, and analyzed according to sample characteristics. Data were analyzed using the Mann-Whitney U test, Kruskal-Wallis H test and chi squared test. Statistical significance was set at p < 0.05. RESULTS People with ACO engaged in a mean volume of 2038.1 MET·min/week. Those aged 30-60 years and those with normal weight were significantly more active than those aged ≥60 and those with obesity. When classifying PA level in low, moderate and high, results showed no significant differences between sample characteristics. Overall, moderate and high levels of PA were the most and least frequent levels (48.0% and 16.2%, respectively). CONCLUSIONS More than three out of ten Spanish adults with ACO do not achieve PA recommendations. Therefore, it is recommended to implement programs that promote the importance and benefits of PA among the Spanish population with ACO, and such programs should focus on older adults and those who are obese.
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Affiliation(s)
| | - Lee Smith
- The Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge, UK
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Riesco-Miranda JA, Solano-Reina S, Rábade-Castedo C, de Granda-Orive JI, Pastor-Esplá E, García-Rueda M, Callejas-Gonzalez FJ, Azpeitia-Anadón Á, Mas S, Jiménez-Ruiz CA. Certified Smoking Cessation Units in Spain: High Potential for Detection of Undiagnosed Chronic Obstructive Pulmonary Disease and Profile of Newly Diagnosed Cases. Int J Chron Obstruct Pulmon Dis 2021; 16:443-450. [PMID: 33658774 PMCID: PMC7920505 DOI: 10.2147/copd.s289097] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 02/07/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Smokers attending smoking cessation units (SCUs) may offer a unique opportunity for early recognition of undiagnosed chronic obstructive pulmonary disease (COPD). We aimed at assessing the impact of SCUs on the early diagnosis of COPD and describing the clinical and smoking profile of newly-diagnosed COPD cases at SCUs certified by the Spanish Society of Respiratory Diseases and Thoracic Surgery (SEPAR). PATIENTS AND METHODS A multicenter cross-sectional observational cohort study (DIPREPOQ study) was performed in eight SEPAR-certified SCUs in Spain. Adult current smokers with no previously diagnosed respiratory disease and having one o more respiratory symptoms were included. Lung functional tests were performed and previously undiagnosed COPD cases were identified and characterized based on national guidelines. RESULTS Out of 401 individuals newly attending the SCUs, 252 participants were included and 73 (28.9%) met the definition of previously undiagnosed COPD. A characterization of patients with COPD being newly recognized in SCUs showed: age (mean±SD) 61±9 years; men 59%; active work status 53.1%; functional class I/II dyspnea 82.8%, GOLD state mild/moderate/severe 57%/31%/12%; non-exacerbators 90%, CAT 14±4; emphysema in X-rays 40%. Most common co-morbidities were cardiovascular and psychiatric (anxiety and depression) ones. Usual smoking history included a lengthy smoking history (41±9 years) and a current consumption of 24±9 cigarettes/day. CONCLUSIONS AND IMPLICATIONS Consistently certified SCUs can have a substantial contribution to early diagnosis of COPD. A typical profile of newly detected cases is reported, with most patients being men at their early sixties, with mild symptoms and with high and lengthy smoking history. Our study reports a high usefulness of lung functional tests to detect undiagnosed COPD in appropriately selected participants attending SCUs at a large national scale, using a standardized methodology. This is likely to be facilitated by the certification of SCUs using well-defined requirements by national scientific societies.
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Affiliation(s)
| | | | - Carlos Rábade-Castedo
- Servicio de Neumología, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - José-Ignacio de Granda-Orive
- Servicio de Neumología, Hospital Universitario Doce de Octubre, Universidad Complutense de Madrid, Madrid, Spain
| | - Esther Pastor-Esplá
- Servicio de Neumología, Hospital Universitario San Juan de Alicante, Alicante, Spain
| | | | | | | | - Silvia Mas
- Universidad Pompeu Fabra, Barcelona, Spain
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Sánchez Castillo S, Smith L, Díaz Suárez A, López Sánchez GF. Levels of Physical Activity in Spanish Asthmatics: A Cross-Sectional Study. ACTA ACUST UNITED AC 2020; 56:medicina56120643. [PMID: 33255663 PMCID: PMC7760910 DOI: 10.3390/medicina56120643] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 11/18/2020] [Accepted: 11/23/2020] [Indexed: 12/30/2022]
Abstract
Background and objectives: 339 million people in the world suffer from asthma. Regular physical activity (PA) could help in its control. Therefore, the aim of this research was to determine the level of PA in Spanish people with asthma considering variation by, age, sex, education, marital status, living together, smoking habits, alcohol intake and body mass index (BMI). Materials and Methods: 1014 Spanish people from 15 to 69 years were included in the study. Data of the Spanish Health Survey (year 2017) were analysed. PA levels were measure with the international physical activity questionnaire short version (IPAQ-SF). PA was categorized as low, moderate and high, and analyzed by sample characteristics. Mann-Whitney U test, Kruskall Wallis H and crosstabs were used to calculate statistical significance (p < 0.05). Results: On average, Spanish asthmatics engaged in a weekly volume of 2228.9 metabolic equivalent of task (MET)·min/week. Males revealed significantly higher PA than females (2516.8 vs. 2019.5 MET·min/week; p = 0.005), younger participants (<30 years) compared to people aged 30–60 years and older than 60 years (2699.0; 2243.2; 1619.3 MET·min/week; p < 0.001) and those with tertiary level of education than those without secondary (2368.3 vs. 2168.3 MET·min/week; p = 0.001). Level of PA was lower in those married (p = 0.001) and/or living together (p = 0.010). Alcohol consumers showed a higher level than the participants who did not drink (2378.3 vs. 1907.9 MET·min/week; p = 0.001), but no significant differences were found within current, past and never smokers (p = 0.890). Obese asthmatics engaged in less PA than their normal weight and overweight peers (p < 0.001). Overall, moderate level was significantly the most frequent (47.7%), but 31.6% showed a low level. Conclusions: Three out of ten Spanish people with asthma do not achieve PA recommendations, so PA programs should be executed to make people aware of its benefits in asthma control, focusing on those groups with lower PA levels.
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Affiliation(s)
- Sheila Sánchez Castillo
- Faculty of Sports Sciences, University of Murcia, 30720 Murcia, Spain;
- Correspondence: (S.S.C.); (G.F.L.S.)
| | - Lee Smith
- Cambridge Centre for Sport and Exercise Science, Anglia Ruskin University, Cambridge CB5 8DZ, UK;
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En respuesta a: «Resumen ejecutivo del Documento de consenso de GeSIDA sobre el control y la monitorización de la infección por el VIH». Enferm Infecc Microbiol Clin 2020; 38:459-460. [DOI: 10.1016/j.eimc.2020.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 04/21/2020] [Accepted: 05/03/2020] [Indexed: 11/21/2022]
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Viejo Casas A, Gómez Molleda F, Astruga Tejerina C, Rodríguez Porres M, de Las Cuevas Allende R, Conde Diez S. [Quality of spirometry in Primary Care in Cantabria 10 years later. EspiroCan Study]. Semergen 2020; 46:161-166. [PMID: 32088158 DOI: 10.1016/j.semerg.2019.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 12/12/2019] [Accepted: 12/29/2019] [Indexed: 11/18/2022]
Abstract
INTRODUCTION To study the quality of spirometry performed in Primary Care in Cantabria (Spain) and the level of compliance with the regulations of this technique of the Spanish Society of Chest Diseases and Thoracic Surgery (SEPAR). MATERIAL AND METHODS Cross-sectional descriptive study in the Community of Cantabria using an original questionnaire based on the latest SEPAR regulations. The questionnaire was distributed in 2018 by internal mail to the 42 Primary Care Centres of the Cantabrian Health Service, with the coordinators of the PCC and the nurses responsible having been personally contacted by the researchers or by telephone. This is an original survey, based on the regulations of the SEPAR, which evaluates the quality of the material used (model, years of operation, calibration, cleanliness), as well as the training of personnel who perform spirometry. RESULTS The health personnel responsible for performing spirometry were surveyed in the 42 Primary Care Centres of the Cantabrian Health Service throughout the Cantabrian area. A mean of 564 spirometries are performed per month. A significant number (13%) of spirometers are never calibrated, and only 10.5% of the spirometers are calibrated by the personnel who perform the test in the centre itself. More than half (54, 53.7%) of these professionals have never received specific training to perform spirometry, and only 3.8% of them have experience in performing the test as recommended by SEPAR. As for the cleaning of the devices, 30% of the technicians do not clean the spirometer or the adapter. CONCLUSIONS 10 years after our initial study lack of training is still being observed in the professionals, and probably translates into invalid spirometry.
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Affiliation(s)
- A Viejo Casas
- Médicina de Familia, Servicio Cántabro de Salud, Asociación Cántabra de Investigación en Aparato Respiratorio ACINAR , Santander (Cantabria), España; Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Santander (Cantabria), España; Grupo de Trabajo Respiratorio SEMERGEN, España.
| | - F Gómez Molleda
- Médicina de Familia, Servicio Cántabro de Salud, Asociación Cántabra de Investigación en Aparato Respiratorio ACINAR , Santander (Cantabria), España
| | - C Astruga Tejerina
- Médicina de Familia, Servicio Cántabro de Salud, Asociación Cántabra de Investigación en Aparato Respiratorio ACINAR , Santander (Cantabria), España
| | - M Rodríguez Porres
- Médicina de Familia, Servicio Cántabro de Salud, Asociación Cántabra de Investigación en Aparato Respiratorio ACINAR , Santander (Cantabria), España; Grupo de Trabajo Respiratorio SEMERGEN, España
| | - R de Las Cuevas Allende
- Médicina de Familia, Servicio Cántabro de Salud, Asociación Cántabra de Investigación en Aparato Respiratorio ACINAR , Santander (Cantabria), España
| | - S Conde Diez
- Médicina de Familia, Servicio Cántabro de Salud, Asociación Cántabra de Investigación en Aparato Respiratorio ACINAR , Santander (Cantabria), España
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Bouza E, Alvar A, Almagro P, Alonso T, Ancochea J, Barbé F, Corbella J, Gracia D, Mascarós E, Melis J, Miravitlles M, Pastor M, Pérez P, Rudilla D, Torres A, Soriano JB, Vallano A, Vargas F, Palomo E. Chronic obstructive pulmonary disease (COPD) in Spain and the different aspects of its social impact: a multidisciplinary opinion document. REVISTA ESPANOLA DE QUIMIOTERAPIA : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE QUIMIOTERAPIA 2020; 33:49-67. [PMID: 31933347 PMCID: PMC6987629 DOI: 10.37201/req/2064.2019] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 10/24/2019] [Accepted: 12/02/2019] [Indexed: 12/21/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is one of the most prevalent diseases in the World, and one of the most important causes of mortality and morbidity. In adults 40 years and older, it affects more than 10% of the population and has enormous personal, family and social burden. Tobacco smoking is its main cause, but not the only one, and there is probably a genetic predisposition that increases the risk in some patients. The paradigm of this disease is changing in Spain, with an increase of women that has occurred in recent years. Many of the physio pathological mechanisms of this condition are well known, but the psychological alterations to which it leads, the impact of COPD on relatives and caregivers, the limitation of daily life observed in these patients, and the economic and societal burden that they represent for the health system, are not so well-known. A major problem is the high under-diagnosis, mainly due to difficulties for obtaining, in a systematic way, spirometries in hospitals and health-care centers. For this reason, the Fundación de Ciencias de la Salud and the Spanish National Network Center for Research in Respiratory Diseases (CIBERES) have brought together experts in COPD, patients and their organizations, clinical psychologists, experts in health economics, nurses and journalists to obtain their opinion about COPD in Spain. They also discussed the scientific bibliometrics on COPD that is being carried out from the CIBERES and speculated on the future of this condition. The format of the meeting consisted in the discussion of a series of questions that were addressed by different speakers and discussed until a consensus conclusion was reached.
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Affiliation(s)
- E Bouza
- Emilio Bouza MD, PhD, Instituto de Investigación Sanitaria Gregorio Marañón, C/ Dr. Esquerdo, 46 - 28007 Madrid, Spain.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - E Palomo
- Esteban Palomo, PhD, Director. Fundación de Ciencias de la Salud. C/ Severo Ochoa, 2, - 28760 Tres Cantos. Madrid, Spain. Phone +34 91 3530150
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Vallejo-Aparicio LA, Molina J, Ojanguren I, Viejo Casas A, Huerta A, Svedsater H. Cost-consequence analysis of fluticasone furoate/vilanterol for asthma management in Spain: an analysis based on the Salford Lung Study in asthma. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2020; 21:7-17. [PMID: 31549255 PMCID: PMC7058572 DOI: 10.1007/s10198-019-01101-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 08/09/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES The Salford Lung Study in asthma (SLS asthma) is a 12-month, open-label randomised clinical trial comparing clinical effectiveness of initiating once-daily inhaled combination of fluticasone furoate/vilanterol (FF/VI) 184/22 mcg or 92/22 mcg, with continuing optimized usual care (UC) with inhaled corticosteroids (ICS) alone, or in combination with a long-acting β2-agonist (ICS/LABA), in asthmatic patients followed in primary care in the UK. The objective of the analysis is to estimate the economic impact of these results when applied in Spain. METHODS A 1-year cost-consequence model was populated with SLS asthma, adopting the Spanish National Health System (NHS) perspective. 775,900 of diagnosed asthmatic patients ≥ 18 years old currently managed with UC in Spain were included in the analysis. Effectiveness data included the percentage of patients per Asthma Control Test (ACT) category at 24 and 52 weeks from SLS asthma. Direct costs (pharmacological and per ACT category) were estimated from Spanish public sources and literature (€, 2018). Base case analysis assumed an increased use of FF/VI from 10 to 20% within 1 year. One-way sensitivity analyses were performed. RESULTS Within the 775,900 asthmatic patients analysed, substitution of UC with FF/VI was associated with reduced costs due to ACT improvement, leading to potential total annual savings of €4,927,672. Sensitivity analyses ranged from €6,012,975 to €14,783,015 cost savings associated with FF/VI. An analysis considering patients only on ICS/LABA showed potential cost savings of €8,207,448. CONCLUSIONS The improved asthma control for FF/VI compared with UC observed in SLS asthma could be translated into potential savings for the Spanish NHS. These results may be useful for decision makers.
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Affiliation(s)
| | - Jesús Molina
- Centro de Salud Francia, Fuenlabrada, Madrid, Spain
| | - Iñigo Ojanguren
- Servicio de Neumología, Hospital Universitario Vall d'Hebron, Barcelona, Spain
- Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
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Kim V, Zhao H, Regan E, Han MK, Make BJ, Crapo JD, Jones PW, Curtis JL, Silverman EK, Criner GJ. The St. George's Respiratory Questionnaire Definition of Chronic Bronchitis May Be a Better Predictor of COPD Exacerbations Compared With the Classic Definition. Chest 2019; 156:685-695. [PMID: 31047955 DOI: 10.1016/j.chest.2019.03.041] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 03/11/2019] [Accepted: 03/22/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Chronic bronchitis (CB) increases risk of COPD exacerbations. We have shown that the St. George's Respiratory Questionnaire (SGRQ) CB definition identifies patients with a similar clinical phenotype as classically defined CB. Whether the SGRQ CB definition is a predictor of future COPD exacerbations is unknown. METHODS We analyzed 7,557 smokers with normal spirometry and Global Initiative for Chronic Obstructive Lung Disease stage 1-4 COPD in the Genetic Epidemiology of COPD study with longitudinal follow-up data on exacerbations. Subjects were divided into classic CB+ or classic CB-, using the classic definition. In addition, subjects were divided into SGRQ CB+ or SGRQ CB-. Exacerbation frequency and severe exacerbation frequency were determined in each group. Multivariable linear regressions were performed for exacerbation frequency with either classic CB or SGRQ CB and relevant covariates. RESULTS There were 1,434 classic CB+ subjects and 2,290 SGRQ CB+ subjects. The classic CB+ group had a greater exacerbation frequency compared with the classic CB- group (0.69 ± 1.26 vs 0.36 ± 0.90 exacerbations per patient per year; P < .0001) and a greater severe exacerbation frequency (0.26 ± 0.74 vs 0.13 ± 0.46 severe exacerbations per patient per year; P < .0001). There were similar differences between the SGRQ CB+ and SGRQ CB- groups. In multivariable analysis, both SGRQ CB and classic CB were independent predictors of exacerbation frequency, but SGRQ CB had a higher regression coefficient. In addition, SGRQ CB was an independent predictor of severe exacerbation frequency whereas classic CB was not. CONCLUSIONS The SGRQ CB definition identified more subjects at risk for future exacerbations than the classic CB definition. SGRQ CB was at least a similar if not better predictor of future exacerbations than classic CB.
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Affiliation(s)
- Victor Kim
- Lewis Katz School of Medicine at Temple University, Philadelphia, PA.
| | - Huaqing Zhao
- Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | | | - MeiLan K Han
- University of Michigan Health Care System, Ann Arbor, MI
| | | | | | - Paul W Jones
- St. George's Hospital Medical School, London, UK
| | | | | | - Gerard J Criner
- Lewis Katz School of Medicine at Temple University, Philadelphia, PA
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Kim EJ, Yoon SJ, Kim YE, Go DS, Jung Y. Effects of Aging and Smoking Duration on Cigarette Smoke-Induced COPD Severity. J Korean Med Sci 2019; 34:e90. [PMID: 30923493 PMCID: PMC6434146 DOI: 10.3346/jkms.2019.34.e90] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 08/07/2018] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Aging can serve as an underlying mechanism of chronic obstructive pulmonary disease (COPD). Also, smoking, which is the most common cause of COPD, is responsible for the systemic manifestations of the disease, independently from the lung function alterations. The purpose of this study was to analyze the effect of aging on the occurrence of cigarette smoking induced COPD. METHODS For this analysis, we evaluated smoking status by a lifestyle intervention program and measured the occurrence of COPD by the Korea National Health and Nutrition Examination Survey (KNHANES) from 2005 to 2015. RESULTS Aging and smoking were significantly effected on the lung function of COPD patients. Especially, the smoking duration is exaggerated in the presence of old age for older COPD patients. CONCLUSION The result showed that COPD patients exhibit aging and smoking duration related severity. The prevalence of COPD kept increasing internationally. Knowing the risk factor of COPD quantitatively and finding out the interaction among risk factors could be valuable predictors for preventing COPD.
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Affiliation(s)
- Eun-Jung Kim
- Department of Nursing, Pyeongtaek University, Pyeongtaek, Korea
| | - Seok-Jun Yoon
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea
| | - Young-Eun Kim
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea
| | - Dun-Sol Go
- Department of Public Health, Graduate School, Korea University, Seoul, Korea
| | - Yunsun Jung
- Department of Public Health, Graduate School, Korea University, Seoul, Korea
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Dotan Y, So JY, Kim V. Chronic Bronchitis: Where Are We Now? CHRONIC OBSTRUCTIVE PULMONARY DISEASES-JOURNAL OF THE COPD FOUNDATION 2019; 6:178-192. [PMID: 31063274 DOI: 10.15326/jcopdf.6.2.2018.0151] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Yaniv Dotan
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Jennifer Y So
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Victor Kim
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
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Montserrat-Capdevila J, Seminario MA, Godoy P, Marsal JR, Ortega M, Pujol J, Castañ MT, Alsedà M, Betriu À, Lecube A, Portero M, Purroy F, Valdivielso JM, Barbé F. Prevalence of chronic obstructive pulmonary disease (COPD) not diagnosed in a population with cardiovascular risk factors. Med Clin (Barc) 2018. [PMID: 29525115 DOI: 10.1016/j.medcli.2017.12.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVE The magnitude of undiagnosed COPD in our population with cardiovascular risk factors (CVRF) is unknown. The objective of this study was to estimate the prevalence of undiagnosed COPD and its specific characteristics in a population with CVRF. MATERIALS AND METHODS Study the prevalence of COPD in patients with CVRF. Spirometry was performed between 01/01/2015 and 12/31/2016 and the percentage of patients with COPD, who had not previously been diagnosed, was determined. Each patient's variables of interest were recorded; the records of patients who had spirometry showing COPD were checked to confirm whether a diagnosis had been recorded or not. The association of undiagnosed COPD with different independent variables was determined with adjusted odds ratio (aOR) by non conditional logistic regression models. RESULTS 2,295 patients with CVRF were studied. The overall prevalence of COPD was 14.5%. An underdiagnosis of 73.3% was observed. Newly diagnosed COPD vs. undiagnosed COPD showed to be higher in women (74.1% vs. 36.0%; P=.081), non-smokers (21.3% vs. 12.4%; P=.577), mild cases (GOLD1) (42.6% vs. 32.4%, P=.008) and cases with lower than average HbA1c (5.5% vs. 5.6%; P=.008) and uric acid (5.1mg/dL vs. 5.6mg/dL; P=.011). The variables associated with undiagnosed COPD were: women (aOR=1.27; 95%CI: 0.74-2.17; P=.383); age (aOR=0.94; 95%CI: 0.87-0.99; P=.018); smokers (smoker/non-smoker) (aOR=0.47; 95%CI: 0.22-1.01; P=.054) and HbA1c (%) (aOR=0.45; 95%CI: 0.23-0.88; P=.019). CONCLUSIONS The under-diagnosis of COPD is very high. The contact patients aged between 50 and 65 years-old who have CVRF with their health system should be reassessed, and they need to ask for a spirometry.
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Affiliation(s)
- Josep Montserrat-Capdevila
- Consultorio Local de Bellvís-Els Arcs, UGA Terres de l'Urgell, Atención Primaria, Institut Català de la Salut, Lleida, Cataluña, España; Institut de Recerca Biomèdica de Lleida (IRBLleida), Lleida, Cataluña, España.
| | - María Asunción Seminario
- Grupo de Patología Respiratoria, Institut de Recerca Biomèdica de Lleida (IRBLleida), Lleida, Cataluña, España
| | - Pere Godoy
- Institut de Recerca Biomèdica de Lleida (IRBLleida), Lleida, Cataluña, España; Agència de Salut Pública de Catalunya, Departament de Salut, Lleida, Cataluña, España; Facultat de Medicina, Universitat de Lleida, Lleida, Cataluña, España; CIBER de epidemiología y Salud Pública (CIBERESP), Madrid, España
| | - Josep Ramon Marsal
- Unitat de Suport a la Recerca Lleida, Institut Universitari d'Investigació en Atenció Primària (IDIAP) Jordi Gol, Universitat Autònoma de Barcelona, Cataluña, España; Unitat d'Epidemiologia del Servei de Cardiologia, Hospital Universitari Vall d'Hebron, Barcelona, Cataluña, España
| | - Marta Ortega
- Unitat de Suport a la Recerca Lleida, Institut Universitari d'Investigació en Atenció Primària (IDIAP) Jordi Gol, Universitat Autònoma de Barcelona, Cataluña, España; Atención Primaria, Institut Català de la Salut, Lleida, Cataluña, España
| | - Jesús Pujol
- Institut de Recerca Biomèdica de Lleida (IRBLleida), Lleida, Cataluña, España; Facultat de Medicina, Universitat de Lleida, Lleida, Cataluña, España; ABS Balaguer, Atención Primaria, Institut Català de la Salut, Lleida, Cataluña, España
| | - Maria Teresa Castañ
- Institut de Recerca Biomèdica de Lleida (IRBLleida), Lleida, Cataluña, España; ABS Balaguer, Atención Primaria, Institut Català de la Salut, Lleida, Cataluña, España
| | - Miquel Alsedà
- Institut de Recerca Biomèdica de Lleida (IRBLleida), Lleida, Cataluña, España; Agència de Salut Pública de Catalunya, Departament de Salut, Lleida, Cataluña, España; Facultat de Medicina, Universitat de Lleida, Lleida, Cataluña, España
| | - Àngels Betriu
- Institut de Recerca Biomèdica de Lleida (IRBLleida), Lleida, Cataluña, España; Unidad de Diagnóstico y Tratamiento de Enfermedades Aterotrombóticas (UDETMA), Servicio de Nefrología, Hospital Universitari Arnau de Vilanova, Lleida, Cataluña, España
| | - Albert Lecube
- Servicio de Endocrinología, Hospital Universitari Arnau de Vilanova, Lleida, Cataluña, España
| | - Manel Portero
- Grupo de Fisiopatología Metabólica, Departamento de Medicina Experimental, Institut de Recerca Biomèdica de Lleida (IRBLleida), Lleida, Cataluña, España
| | - Francisco Purroy
- Servicio de Neurología, Hospital Universitari Arnau de Vilanova, Lleida, Cataluña, España
| | - José Manuel Valdivielso
- Laboratorio de Nefrología Experimental, Institut de Recerca Biomèdica de Lleida (IRBLleida), Lleida, Cataluña, España
| | - Ferran Barbé
- Grupo de Patología Respiratoria, Institut de Recerca Biomèdica de Lleida (IRBLleida), Lleida, Cataluña, España; Facultat de Medicina, Universitat de Lleida, Lleida, Cataluña, España; Servicio de Neumología, Hospital Universitari Arnau de Vilanova, Lleida, Cataluña, España; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, España
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Hooper LG, Young MT, Keller JP, Szpiro AA, O'Brien KM, Sandler DP, Vedal S, Kaufman JD, London SJ. Ambient Air Pollution and Chronic Bronchitis in a Cohort of U.S. Women. ENVIRONMENTAL HEALTH PERSPECTIVES 2018; 126:027005. [PMID: 29410384 PMCID: PMC6066337 DOI: 10.1289/ehp2199] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 12/04/2017] [Accepted: 12/05/2017] [Indexed: 05/04/2023]
Abstract
BACKGROUND Limited evidence links air pollution exposure to chronic cough and sputum production. Few reports have investigated the association between long-term exposure to air pollution and classically defined chronic bronchitis. OBJECTIVES Our objective was to estimate the association between long-term exposure to particulate matter (diameter <10 μm, PM10; <2.5μm, PM2.5), nitrogen dioxide (NO2), and both incident and prevalent chronic bronchitis. METHODS We estimated annual average PM2.5, PM10, and NO2 concentrations using a national land-use regression model with spatial smoothing at home addresses of participants in a prospective nationwide U.S. cohort study of sisters of women with breast cancer. Incident chronic bronchitis and prevalent chronic bronchitis, cough and phlegm, were assessed by questionnaires. RESULTS Among 47,357 individuals with complete data, 1,383 had prevalent chronic bronchitis at baseline, and 647 incident cases occurred over 5.7-y average follow-up. No associations with incident chronic bronchitis were observed. Prevalent chronic bronchitis was associated with PM10 [adjusted odds ratio (aOR) per interquartile range (IQR) difference (5.8 μg/m3)=1.07; 95% confidence interval (CI): 1.01, 1.13]. In never-smokers, PM2.5 was associated with prevalent chronic bronchitis (aOR=1.18 per IQR difference; 95% CI: 1.04, 1.34), and NO2 was associated with prevalent chronic bronchitis (aOR=1.10; 95% CI=1.01, 1.20), cough (aOR=1.10; 95% CI: 1.05, 1.16), and phlegm (aOR=1.07; 95% CI: 1.01, 1.14); interaction p-values (nonsmokers vs. smokers) <0.05. CONCLUSIONS PM10 exposure was related to chronic bronchitis prevalence. Among never-smokers, PM2.5 and NO2 exposure was associated with chronic bronchitis and component symptoms. Results may have policy ramifications for PM10 regulation by providing evidence for respiratory health effects related to long-term PM10 exposure. https://doi.org/10.1289/EHP2199.
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Affiliation(s)
- Laura G Hooper
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Michael T Young
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, USA
| | - Joshua P Keller
- Department of Biostatistics, School of Public Health, University of Washington, Seattle, Washington, USA
| | - Adam A Szpiro
- Department of Biostatistics, School of Public Health, University of Washington, Seattle, Washington, USA
| | - Katie M O'Brien
- Biostatistics and Computational Biology Branch, Division of Intramural Research, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, North Carolina, USA
| | - Dale P Sandler
- Epidemiology Branch, Division of Intramural Research, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, North Carolina, USA
| | - Sverre Vedal
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, Washington, USA
| | - Joel D Kaufman
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, Washington, USA
| | - Stephanie J London
- Epidemiology Branch, Division of Intramural Research, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, North Carolina, USA
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Sawalha S, Hedman L, Rönmark E, Lundbäck B, Lindberg A. Pre- and post-bronchodilator airway obstruction are associated with similar clinical characteristics but different prognosis - report from a population-based study. Int J Chron Obstruct Pulmon Dis 2017; 12:1269-1277. [PMID: 28490870 PMCID: PMC5413478 DOI: 10.2147/copd.s127923] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION According to guidelines, the diagnosis of COPD should be confirmed by post-bronchodilator (post-BD) airway obstruction on spirometry; however, in clinical practice, this is not always performed. The aim of this population-based study was to compare clinical characteristics and prognosis, assessed as mortality, between subjects with airway obstruction divided into pre- but not post-BD obstruction, post-BD airway obstruction (COPD), and subjects without airway obstruction. MATERIALS AND METHODS In 2002-2004, four adult population-based cohorts were reexamined with spirometry and structured interview. Subjects with airway obstruction, with a ratio of forced expiratory volume in 1 s to (forced) vital capacity <0.70 (n=993), were identified together with sex- and age-matched referents (n=993). These subjects were further divided into subjects with pre- but not post-BD airway obstruction (pre- not post-BD obstruction) and subjects with post-BD airway obstruction (COPD). Mortality data were collected until December 31, 2014. RESULTS Out of 993 subjects with airway obstruction, 736 (74%) had COPD and 257 (26%) pre- not post-BD obstruction. Any respiratory symptoms, allergic rhinitis, asthma, exacerbations, and comorbidities were equally common among subjects with COPD and pre- not post-BD obstruction, but less common among nonobstructive subjects. Mortality was highest among subjects with COPD and higher in men than in women. In both sexes, COPD, but not pre- not post-BD obstruction, was associated with an increased risk for death compared to those without airway obstruction. When COPD was divided into Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages, GOLD 2 and 3-4 had an increased risk for death when compared to the nonobstructive group, also when adjusted for common confounders and comorbidities such as heart disease, diabetes, and anxiety/depression. CONCLUSION Even though subjects with COPD and pre- not post-BD obstruction had fairly similar presentation of clinical characteristics, only those with COPD, specifically GOLD stage ≥2, had increased risk for death when compared with nonobstructive subjects.
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Affiliation(s)
- Sami Sawalha
- Department of Public Health and Clinical Medicine, Division of Medicine
| | - Linnea Hedman
- Department of Public Health and Clinical Medicine, The OLIN Unit, Division of Occupational and Environmental Medicine, Umeå University, Umeå
| | - Eva Rönmark
- Department of Public Health and Clinical Medicine, The OLIN Unit, Division of Occupational and Environmental Medicine, Umeå University, Umeå
| | - Bo Lundbäck
- Krefting Research Center, Institution of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Anne Lindberg
- Department of Public Health and Clinical Medicine, Division of Medicine
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21
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The chronic bronchitis phenotype in chronic obstructive pulmonary disease: features and implications. Curr Opin Pulm Med 2016; 21:133-41. [PMID: 25575367 DOI: 10.1097/mcp.0000000000000145] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
PURPOSE OF REVIEW Chronic obstructive pulmonary disease (COPD) is a major public health problem that is projected to rank fifth worldwide in terms of disease burden and third in terms of mortality. Chronic bronchitis is associated with multiple clinical consequences, including hastening lung function decline, increasing risk of exacerbations, reducing health-related quality of life, and possibly raising all-cause mortality. Recent data suggest greater elucidation on the risk factors, radiologic characteristics, and treatment regimens. Our goal was to review the literature on chronic bronchitis that has been published in the past few years. RECENT FINDINGS A growing body of literature that more carefully describes environmental risk factors, epidemiology, and genetics associated with chronic bronchitis. In addition, as computed tomography technology continues to improve, the radiologic phenotype associated with chronic bronchitis is better understood. SUMMARY With these new data, the clinician can recognize the newly described risk factors and the associated phenotype for chronic bronchitis and entertain new treatment options for this high-risk population.
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Comparison between an alternative and the classic definition of chronic bronchitis in COPDGene. Ann Am Thorac Soc 2015; 12:332-9. [PMID: 25575351 DOI: 10.1513/annalsats.201411-518oc] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
RATIONALE Previous studies on chronic bronchitis (CB) have used varying definitions. OBJECTIVES We sought to compare an alternative CB definition, using the St. George's Respiratory Questionnaire (SGRQ), a commonly used assessment tool, with the classic definition and to investigate if it had independent or additive value. METHODS We analyzed data from 4,513 subjects from Global Initiative for Chronic Obstructive Lung Disease groups 1 to 4 in the COPDGene cohort. We compared the classic definition of CB with the SGRQ definition, defined by their answers to the questions about both cough and phlegm. We compared the Classic CB+ versus CB- groups, and the SGRQ CB+ and CB- groups. We also analyzed the cohort split into four groups: Classic CB+/SGRQ CB+, Classic CB+/SGRQ CB-, Classic CB-/SGRQ CB+, Classic CB-/SGRQ CB-. MEASUREMENTS AND MAIN RESULTS A total of 26.1% subjects were Classic CB+, whereas 39.9% were SGRQ CB+. When the SGRQ definition was compared with the Classic CB definition, using this as the gold standard, the SGRQ CB definition had a sensitivity and specificity of 0.87 and 0.77, respectively. The SGRQ CB+ and Classic CB+ groups were strikingly similar, with more respiratory symptoms and exacerbations, worse lung function, and greater airway wall thickness. In addition, the Classic CB+/SGRQ CB+, Classic CB+/SGRQ CB-, and Classic CB-/SGRQ CB+ groups shared similar characteristics as well. CONCLUSIONS The SGRQ CB definition identifies more subjects with chronic cough and sputum who share a similar phenotype identified by the Classic CB definition. The addition of the SGRQ CB definition to the classic one can be used to identify more patients with chronic obstructive pulmonary disease at risk for poor outcomes.
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Song WJ, Chang YS, Faruqi S, Kang MK, Kim JY, Kang MG, Kim S, Jo EJ, Lee SE, Kim MH, Plevkova J, Park HW, Cho SH, Morice AH. Defining Chronic Cough: A Systematic Review of the Epidemiological Literature. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2015; 8:146-55. [PMID: 26739408 PMCID: PMC4713878 DOI: 10.4168/aair.2016.8.2.146] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 07/09/2015] [Indexed: 01/29/2023]
Abstract
Purpose Recent evidence suggests a global burden of chronic cough in general populations. However, the definitions vary greatly among epidemiological studies, and none have been validated for clinical relevance. We aimed to examine previous epidemiological definitions in detail and explore the operational characteristics. Methods A systematic review was conducted for epidemiological surveys that reported the prevalence of chronic cough in general adult populations during the years 1980 to 2013. A literature search was performed on Pubmed and Embase without language restriction. Epidemiological definitions for chronic cough were classified according to their components, such as cutoff duration. Meta-analyses were performed for the male-to-female ratio of chronic cough prevalence to explore operational characteristics of epidemiological definitions. Results A total of 70 studies were included in the systematic review. The most common epidemiological definition was identified as 'cough ≥3 months' duration without specification of phlegm (n=50); however, it conflicted with the cutoff duration in current clinical guidelines (cough ≥8 weeks). Meta-analyses were performed for the male-to-female ratio of chronic cough among 28 studies that reported sex-specific prevalence using the most common definition. The pooled male-to-female odds ratio was 1.26 (95% confidence interval 0.92-1.73) with significant heterogeneity (I2=96%, P<0.001), which was in contrast to clinical observations of female predominance from specialist clinics. Subgroup analyses did not reverse the ratio or reduce the heterogeneity. Conclusions This study identified major issues in defining chronic cough in future epidemiological studies. The conflict between epidemiological and clinical diagnostic criteria needs to be resolved. The unexpected difference in the gender predominance between the community and clinics warrants further studies. Clinical validation of the existing definition is required.
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Affiliation(s)
- Woo Jung Song
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Yoon Seok Chang
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.,Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Shoaib Faruqi
- Centre for Cardiovascular and Metabolic Research, Hull York Medical School, Castle Hill Hospital, University of Hull, Cottingham, East Yorkshire, United Kingdom
| | - Min Koo Kang
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Ju Young Kim
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Min Gyu Kang
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Sujeong Kim
- Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
| | - Eun Jung Jo
- Department of Internal Medicine, Pusan National University College of Medicine, Busan, Korea
| | - Seung Eun Lee
- Department of Internal Medicine, Pusan National University College of Medicine, Busan, Korea
| | - Min Hye Kim
- Department of Internal Medicine, Ewha Woman's University School of Medicine, Seoul, Korea
| | - Jana Plevkova
- Department of Pathophysiology and Simulation Centre, Jessenius Faculty of Medicine, Comenius University, Martin, Slovak Republic
| | - Heung Woo Park
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Sang Heon Cho
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
| | - Alyn H Morice
- Centre for Cardiovascular and Metabolic Research, Hull York Medical School, Castle Hill Hospital, University of Hull, Cottingham, East Yorkshire, United Kingdom.
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Elbehairy AF, Raghavan N, Cheng S, Yang L, Webb KA, Neder JA, Guenette JA, Mahmoud MI, O'Donnell DE. Physiologic characterization of the chronic bronchitis phenotype in GOLD grade IB COPD. Chest 2015; 147:1235-1245. [PMID: 25393126 DOI: 10.1378/chest.14-1491] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Smokers with persistent cough and sputum production (chronic bronchitis [CB]) represent a distinct clinical phenotype, consistently linked to negative clinical outcomes. However, the mechanistic link between physiologic impairment, dyspnea, and exercise intolerance in CB has not been studied, particularly in those with mild airway obstruction. We, therefore, compared physiologic abnormalities during rest and exercise in CB to those in patients without symptoms of mucus hypersecretion (non-CB) but with similar mild airway obstruction. METHODS Twenty patients with CB (≥ 3 months cough/sputum in 2 successive years), 20 patients without CB but with GOLD (Global Initiative for Chronic Obstructive Lung Disease) grade IB COPD, and 20 age- and sex-matched healthy control subjects underwent detailed physiologic testing, including tests of small airway function and a symptom-limited incremental cycle exercise test. RESULTS Patients with CB (mean ± SD postbronchodilator FEV1, 93% ± 12% predicted) had greater chronic activity-related dyspnea, poorer health-related quality of life, and reduced habitual physical activity compared with patients without CB and control subjects (all P < .05). The degree of peripheral airway dysfunction and pulmonary gas trapping was comparable in both patient groups. Peak oxygen uptake was similarly reduced in patients with CB and those without compared with control subjects (% predicted ± SD, 70 ± 26, 71 ± 29 and 106 ± 43, respectively), but those with CB had higher exertional dyspnea ratings and greater respiratory mechanical constraints at a standardized work rate than patients without CB (P < .05). CONCLUSIONS Patients with CB reported greater chronic dyspnea and activity restriction than patients without CB and with similar mild airway obstruction. The CB group had greater dynamic respiratory mechanical impairment and dyspnea during exercise than patients without CB, which may help explain some differences in important patient-centered outcomes between the groups.
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Affiliation(s)
- Amany F Elbehairy
- Department of Medicine, Department of Chest Diseases, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Natya Raghavan
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Sicheng Cheng
- Department of Medicine, Department of Chest Diseases, Queen's University & Kingston General Hospital, Kingston, ON, Canada
| | - Ling Yang
- Department of Medicine, Department of Chest Diseases, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Katherine A Webb
- Department of Medicine, Department of Chest Diseases, Queen's University & Kingston General Hospital, Kingston, ON, Canada
| | - J Alberto Neder
- Department of Medicine, Department of Chest Diseases, Queen's University & Kingston General Hospital, Kingston, ON, Canada
| | - Jordan A Guenette
- Department of Physical Therapy and UBC Centre for Heart Lung Innovation, University of British Columbia, Vancouver, BC, Canada
| | - Mahmoud I Mahmoud
- Department of Chest Diseases, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Denis E O'Donnell
- Department of Medicine, Department of Chest Diseases, Queen's University & Kingston General Hospital, Kingston, ON, Canada
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Martínez-Moragón E, Palop M, de Diego A, Serra J, Pellicer C, Casán P, Caloto MT, Nocea G. Factors affecting quality of life of asthma patients in Spain: the importance of patient education. Allergol Immunopathol (Madr) 2014; 42:476-84. [PMID: 24094444 DOI: 10.1016/j.aller.2013.06.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Revised: 06/03/2013] [Accepted: 06/10/2013] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Assessment of demographic and clinical factors that have an impact on the quality of life (QoL) of patients with asthma in Spain. PATIENTS AND METHODS Multicenter, prospective, observational, cohort study, conducted in 40 Spanish Pneumology Units during a 12-month period. Data on sociodemographic, clinical variables, asthma treatment and QoL were collected in a case report form. RESULTS 536 patients (64.6% women, mean age: 54) were recruited. Reported QoL was better for patients from Northern and Central Spain as compared with those from the South and the East (p<0.001), students and employed patients as compared with housewives and unemployed (p<0.01), for those who had received asthma information (p<0.01), for those with milder daytime symptoms (p<0.01) and for patients with higher level of education (p<0.05). CONCLUSIONS Among the factors that have a significant effect on patients' QoL only symptom control and patient education on asthma control are modifiable. Therefore, all the strategies should be tailored to improve such factors when managing asthma patients.
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Affiliation(s)
| | - M Palop
- Hospital Sagunto, Valencia, Spain
| | - A de Diego
- Hospital Universitario La Fe, Valencia, Spain
| | - J Serra
- Hospital General de Vic, Barcelona, Spain
| | | | - P Casán
- Hospital Sant Pau, Barcelona, Spain
| | - M T Caloto
- Merck, Sharp & Dohme de España S.A., Madrid, Spain
| | - G Nocea
- Merck, Sharp & Dohme de España S.A., Madrid, Spain
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Lâm HTFST, Ekerljung L, T Formula See Text Ng NFSTNV, Rönmark E, Larsson K, Lundbäck B. Prevalence of COPD by disease severity in men and women in northern Vietnam. COPD 2014; 11:575-81. [PMID: 24867392 DOI: 10.3109/15412555.2014.898039] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The prevalence of COPD and its risk factor pattern varies between different areas of the world. The aim of this study was to investigate the prevalence of COPD by disease severity in men and women and risk factors for COPD in northern Vietnam. From all 5782 responders to a questionnaire survey, a randomly selected sample of 1500 subjects was invited to a clinical follow-up study. The methods included a structured interview using a modified GA2LEN study questionnaire for registration of symptoms and possible determinants of disease. Spirometry was performed before and after bronchodilation. The age distribution of the sample was 23-72 years. Of 684 subjects attending, 565 completed acceptable spirometric measurements. The prevalence of COPD defined by the GOLD criteria was 7.1%; in men 10.9% and in women 3.9% (p = 0.002). Of those 3.4% had a mild disease, 2.8% a moderate and 0.9% a severe disease. In ages >50 years, 23.5% of men and 6.8% of women had COPD. Among smokers aged >60 years (all men), 47.8% had COPD. None of the women with COPD had been smokers. Increasing age, smoking and male sex were the dominating risk factors, although male sex lost its significance in a multivariate setting. The prevalence of COPD among adults in northern Vietnam was 7.1% and was considerably higher among men than women. The prevalence increased considerably with age. Increasing age and smoking, the latter among men only, were the most important determinants of COPD.
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de Miguel-Díez J, Jiménez-García R, Hernández-Barrera V, López de Andrés A, Villa-Asensi JR, Plaza V, Carrasco-Garrido P. National trends in hospital admissions for asthma exacerbations among pediatric and young adult population in Spain (2002-2010). Respir Med 2014; 108:983-91. [PMID: 24795277 DOI: 10.1016/j.rmed.2014.04.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Revised: 04/08/2014] [Accepted: 04/10/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To assess the changes in incidence, use of mechanical ventilation, length of stay (LOS), costs and mortality of children (0-15 years) and young adults (16-45 years) hospitalized for asthma exacerbations. METHODS We included patients hospitalized for asthma exacerbations in Spain from 2002 to 2010 (ICD9-CM codes 493.0x-493.9x). The data were collected from the National Hospital Discharge Database (entire population). We calculated the yearly age- and sex-specific incidence rates for each of the two groups. RESULTS We included a total of 12,038 pediatric patients and 2792 young adults hospitalized for asthma exacerbations. Overall crude incidence decreased from 20.5 to 18.7 admissions per 100.000 inhabitants in the pediatric group (p < 0.05), and from 4.12 to 3.68 admissions per 100.000 inhabitants among young adults, from 2002 to 2010 (p < 0.05). By contrast, we detected a significant increase in the use of non-invasive ventilation (NIV) in both groups. The average LOS decreased during the study period, from 3.71 (SD 2.28) to 3.16 (SD 2.11) days (p < 0.05) among pediatric patients and there were not changes among young adults. During the study period, the mean cost per patient decreased from 1558.53 (SD 443.63) to 1378.41 (SD 472.71) euros in the pediatric group (p < 0.05), while increased from 2183.44 (SD 783.15) to 2564.32 (SD 1933.98) euros among young adults (p < 0.05). CONCLUSION Our results suggest a decrease in the incidence of hospital admissions for asthma exacerbations with concomitant increase in use of NIV in asthmatic patients, both pediatric and young adults patients. Although LOS and mean cost have decreased among pediatric patients, they have not changed and increased, respectively, among young adults. A better management of the disease at primary care services may explain the improvement in the incidence and outcomes.
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Affiliation(s)
- Javier de Miguel-Díez
- Department of Respiratory Medicine, Hospital General Universitario Gregorio Marañón, Instituto de investigación Sanitaria Gregorio Marañón (IiSGM), Universidad Complutense de Madrid, Madrid, Spain.
| | - Rodrigo Jiménez-García
- Preventive Medicine and Public Health Teaching and Research Unit, Department of Health Sciences, Universidad Rey Juan Carlos, Madrid, Spain
| | - Valentín Hernández-Barrera
- Preventive Medicine and Public Health Teaching and Research Unit, Department of Health Sciences, Universidad Rey Juan Carlos, Madrid, Spain
| | - Ana López de Andrés
- Preventive Medicine and Public Health Teaching and Research Unit, Department of Health Sciences, Universidad Rey Juan Carlos, Madrid, Spain
| | - José Ramón Villa-Asensi
- Department of Respiratory Medicine, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Vicente Plaza
- Department of Respiratory Medicine, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomédica Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Pilar Carrasco-Garrido
- Preventive Medicine and Public Health Teaching and Research Unit, Department of Health Sciences, Universidad Rey Juan Carlos, Madrid, Spain
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Casas Maldonado F. [Integrated care of chronic obstructive pulmonary disease exacerbations: primary care and specialised care working together]. Semergen 2013; 38:345-7. [PMID: 22935829 DOI: 10.1016/j.semerg.2012.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Kim V, Criner GJ. Chronic bronchitis and chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2013; 187:228-37. [PMID: 23204254 PMCID: PMC4951627 DOI: 10.1164/rccm.201210-1843ci] [Citation(s) in RCA: 275] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2012] [Accepted: 11/16/2012] [Indexed: 11/16/2022] Open
Abstract
Chronic bronchitis (CB) is a common but variable phenomenon in chronic obstructive pulmonary disease (COPD). It has numerous clinical consequences, including an accelerated decline in lung function, greater risk of the development of airflow obstruction in smokers, a predisposition to lower respiratory tract infection, higher exacerbation frequency, and worse overall mortality. CB is caused by overproduction and hypersecretion of mucus by goblet cells, which leads to worsening airflow obstruction by luminal obstruction of small airways, epithelial remodeling, and alteration of airway surface tension predisposing to collapse. Despite its clinical sequelae, little is known about the pathophysiology of CB and goblet cell hyperplasia in COPD, and treatment options are limited. In addition, it is becoming increasingly apparent that in the classic COPD spectrum, with emphysema on one end and CB on the other, most patients lie somewhere in the middle. It is known now that many patients with severe emphysema can develop CB, and small airway pathology has been linked to worse clinical outcomes, such as increased mortality and lesser improvement in lung function after lung volume reduction surgery. However, in recent years, a greater understanding of the importance of CB as a phenotype to identify patients with a beneficial response to therapy has been described. Herein we review the epidemiology of CB, the evidence behind its clinical consequences, the current understanding of the pathophysiology of goblet cell hyperplasia in COPD, and current therapies for CB.
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Affiliation(s)
- Victor Kim
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Temple University School of Medicine, Philadelphia, PA 19140, USA.
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Aizpuru F, Latorre A, Ibáñez B, Garcia KL, Vergara I, Pz de Arriba J, Samper R, López-Picado A, Apiñaniz A, Bilbao JL. Variability in the detection and monitoring of chronic patients in primary care according to what is registered in the electronic health record. Fam Pract 2012; 29:696-705. [PMID: 22421060 DOI: 10.1093/fampra/cms019] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The electronic health record (EHR) allows a detailed study of the primary care consultations and assessment of variability among physicians regarding the implementation of practices for prevention, detection and monitoring of chronic diseases. OBJECTIVES To describe the variability in the detection and surveillance of chronic conditions in primary care. METHODS Review of the medical records maintained by 1685 primary care physicians in the Basque Health Service. Estimation of age and sex standardized rates of compliance with evidence-based recommendations and the systematic component of variation (SCV). RESULTS Compliance with screening recommendations varied from 14.2% for chronic obstructive pulmonary disease (COPD) to 37.2% for hypercholesterolaemia of the at-risk populations. Variability between Primary Care Units (PCUs) was low (SCV(5) (-95) < 0.10) for high blood pressure, hypercholesterolaemia and diabetes and high (SCV(5) (-95) ≥ 0.20) for COPD. Based on the EHR registries, recommendations were followed to in at least 50% of relevant patients according to only 10 of the 44 good care practice (GCP) criteria. For 16 of the GCP criteria, the EHR data indicated compliance to the recommendations in <25% of patients diagnosed. CONCLUSIONS EHR data indicate that some of the preventative care practices recommended to detect chronic problems in primary care are unevenly implemented across PCUs. Notably, there is less variation in the case of conditions for which evidence-based clinical practice guidelines have been published. The level of monitoring is inadequate for all the conditions studied; particularly in those in which it is less evident that primary care is the right level of the health service to provide this care.
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Affiliation(s)
- Felipe Aizpuru
- Araba Research Unit-Osakidetza-Basque Health Service, Vitoria-Gasteiz, Spain.
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García Gómez M, Garrido RU, López RC, Menduiña PL. Direct Health Care Costs of Occupational Asthma in Spain: An Estimation From 2008. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/j.arbr.2012.07.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Casas Maldonado F. WITHDRAWN: Atención integral a las agudizaciones de la enfermedad pulmonar obstructiva crónica: atención primaria y atención especializada van de la mano. Semergen 2012. [DOI: 10.1016/j.semerg.2012.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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García Gómez M, Urbanos Garrido R, Castañeda López R, López Menduiña P. Direct health care costs of occupational asthma in Spain: an estimation from 2008. Arch Bronconeumol 2012; 48:355-61. [PMID: 22705259 DOI: 10.1016/j.arbres.2012.04.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Revised: 04/17/2012] [Accepted: 04/20/2012] [Indexed: 11/30/2022]
Abstract
BACKGROUND Occupational asthma (OA) is the most common work-related disease in industrialized countries. In 2008, only 556 cases of OA had been diagnosed in Spain, which is quite far from even the most conservative estimates. In this context, the aim of this paper is to estimate the number of asthma cases attributable to the work setting in Spain in 2008 as well as the related health care costs for the same year. METHODS The number of cases of OA was calculated from estimates of attributable risk given by previous studies. The cost estimation focused on direct health-care costs and it was based both on data from the National Health System's (NHS) analytical accounting and from secondary sources. RESULTS The number of prevalent cases of work-related asthma in Spain during 2008 ranges between 168 713 and 204 705 cases based on symptomatic diagnosis, entailing an associated cost from 318.1 to 355.8 million Euros. These figures fall to a range between 82 635 and 100 264 cases when bronchial hyperreactivity is included as a diagnostic criterion, at a cost of 155.8-174.3 million Euros. Slightly more than 18 million Euros represent the health-care costs of those cases requiring specialized care. CONCLUSIONS Estimations of OA are very relevant to adequately prevent this disease. The treatment of OA, which involves a significant cost, is being financed by the NHS, although it should be covered by Social Security.
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Affiliation(s)
- Montserrat García Gómez
- Subdirección General de Sanidad Ambiental y Salud Laboral. Ministerio de Sanidad, Política Social e Igualdad, Madrid, Spain.
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Díaz-Grávalos GJ, Palmeiro-Fernández G, Valiño-López MD, Robles-Castiñeiras A, Fernández-Silva MJ, Reinoso-Hermida S, Casado-Górriz I. [The adequacy of the diagnostic in chronic obstructive pulmonary disease]. ACTA ACUST UNITED AC 2012; 27:305-10. [PMID: 22284432 DOI: 10.1016/j.cali.2011.12.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2011] [Revised: 07/19/2011] [Accepted: 12/14/2011] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To assess the adequacy to the clinical guides (GOLD/SEPAR) for the diagnosis of the patients classified as COPD. MATERIAL AND METHODS We selected all COPD cases in the registry of chronic patients of 28 general practitioners from 9 Health Centres in the province of Ourense (Spain). A total of 382 cases were included. Diagnostic accuracy was determined according to the results of spirometry. We identify factors associated with correct diagnosis by logistic regression which included age, gender, residence (rural/urban), smoking, severity, level of follow up and time since diagnosis. RESULTS Of the total number included, 297 were male (77.7%) and 172 patients (45.0%) came from rural areas. The average age was 77.0 (SD=±11.0) years, with a mean age at diagnosis of 64.9 (±12.0) years and the time from diagnosis was 11.5 (±8.0) years. Less than half (49.1%) patients had been smokers, and 13.1% still smoked. Twenty-six cases (6.8%) were diagnosed in Primary Care. The FEV(1)/FVC ratio was recorded in 174 (45.5%) patients, with less than 0.7 in 138 cases (36.1%), which were considered as correctly diagnosed. In these patients the FEV(1) had been recorded in 125 cases (90.6%). A correct diagnosis was associated with severe or very severe disease (OR 5.2; 95% CI; 1.5-17.4), urban areas (OR 6.1; 95% CI, 1.7-21.2), and younger than 60 years (OR 3.7; 95% CI, 1.3-11.2). CONCLUSION The number of spirometry results recorded in the Primary Care medical records of patients diagnosed with COPD was found to be low, and with little adaptation to the accepted diagnostic criteria in the guidelines that are used routinely.
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Documento de consenso sobre enfermedad pulmonar obstructiva crónica en Andalucía-2010. Semergen 2011. [DOI: 10.1016/j.semerg.2011.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Serra Batlles J, Plaza V, Comella A. Changes in clinical, pulmonary function, quality of life and costs in a cohort of asthmatic patients followed for 10 years. Arch Bronconeumol 2011; 47:482-7. [PMID: 21852031 DOI: 10.1016/j.arbres.2011.05.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2010] [Revised: 05/24/2011] [Accepted: 05/31/2011] [Indexed: 01/14/2023]
Abstract
UNLABELLED Few studies have comprehensively assessed the evolution asthma disease in recent years. OBJECTIVES To determine changes in morbidity, lung function and quality of life and to establish the impact in terms of cost in a cohort of patients with asthma. METHODS Prospective, descriptive and realistic study that included 220 asthma patients evaluated 10 years after their inclusion (1994-2004). For all the patients, data for symptoms, lung function, quality of life and financial cost were collected. RESULTS There was a decrease in the frequency of health service visits, including: emergency room visits for asthma exacerbations, 0.3 (0.9) versus 0.6 (1) visits per patient per year (P=.003); a reduction in the severity of the disease, with a greater proportion of patients with mild asthma, 121 (54.8%) versus 94 (42.7%) (P=.001); a decrease (improvement in quality of life) in the total SGRQ, 30.1 (16.5) versus 37 (19.6) (P<.001); and reduced total costs, 1,464€ (3,415.8) compared to 2,267€ (4.174) per patient/year (P<.001), mainly due to indirect costs, 617.50€ (2855.9) compared to 1,320.10€ (3,685.3) per patient/year (P=.001). When assessing the changes observed according to asthma severity, no differences were observed between groups. CONCLUSIONS The evolution of the morbidity and quality of life of asthma patients between 1994 and 2004 are clearly favorable. This improvement provided a significant reduction in the total costs of disease treatment.
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Affiliation(s)
- J Serra Batlles
- Unidad de Neumología, Hospital General de Vic, Barcelona, España.
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Rodriguez-Alvarez M, Torán-Monserrat P, Muñoz-Ortiz L, Negrete-Palma A, Montero-Alia JJ, Jiménez-González M, Zurilla-Leonarte E, Marina-Ortega V, Olle-Borque M, Valentin-Moya E, Cortada-Cabrera A, Tena-Domingo A, Martínez-González S, Vila-Palau V, Ramos-Ordoñez A, Rotllant-Estelrich G, Forcada-Vega C, Borrell-Thió E. Effectiveness of regular reporting of spirometric results combined with a smoking cessation advice by a primary care physician on smoking quit rate in adult smokers: a randomized controlled trial. ESPIROTAB study. BMC FAMILY PRACTICE 2011; 12:61. [PMID: 21708047 PMCID: PMC3141513 DOI: 10.1186/1471-2296-12-61] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/20/2011] [Accepted: 06/28/2011] [Indexed: 11/13/2022]
Abstract
BACKGROUND Undiagnosed airflow limitation is common in the general population and is associated with impaired health and functional status. Smoking is the most important risk factor for this condition. Although primary care practitioners see most adult smokers, few currently have spirometers or regularly order spirometry tests in these patients. Brief medical advice has shown to be effective in modifying smoking habits in a large number of smokers but only a small proportion remain abstinent after one year. The aim of this study is to evaluate the effectiveness of regular reporting of spirometric results combined with a smoking cessation advice by a primary care physician on smoking quit rate in adult smokers. METHODS/DESIGN Intervention study with a randomized two arms in 5 primary care centres. A total of 485 smokers over the age of 18 years consulting their primary care physician will be recruited.On the selection visit all participants will undergo a spirometry, peak expiratory flow rate, test of smoking dependence, test of motivation for giving up smoking and a questionnaire on socio-demographic data. Thereafter an appointment will be made to give the participants brief structured advice to give up smoking combined with a detailed discussion on the results of the spirometry. After this, the patients will be randomised and given appointment for follow up visits at 3, 6, 12 and 24 months. Both arms will receive brief structured advice and a detailed discussion of the spirometry results at visit 0. The control group will only be given brief structured advice about giving up smoking on the follow up. Cessation of smoking will be tested with the carbon monoxide test. DISCUSSION Early identification of functional pulmonary abnormalities in asymptomatic patients or in those with little respiratory symptomatology may provide "ideal educational opportunities". These opportunities may increase the success of efforts to give up smoking and may improve the opportunities of other preventive actions to minimise patient risk. Comparing adult smokers in the intervention group with those in the control group, a minimum improvement expected with respect to the rates of smoking cessation would represent a large number of avoided morbimortality. TRIAL REGISTRATION ClinicalTrials.gov: NCT01296295.
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Affiliation(s)
- Mar Rodriguez-Alvarez
- Primary Healthcare Centre Canet de Mar, Catalan Health Institute. Plaça Universitat 1, 08640 Canet de Mar (Barcelona), Spain
- Primary Healthcare Research Support Unit Metropolitana Nord, Catalan Health Institute-IDIAP Jordi Gol. Camí del Mig 36, 08303 Mataró (Barcelona), Spain
| | - Pere Torán-Monserrat
- Primary Healthcare Research Support Unit Metropolitana Nord, Catalan Health Institute-IDIAP Jordi Gol. Camí del Mig 36, 08303 Mataró (Barcelona), Spain
- Primary Healthcare Centre Gatassa, Catalan Health Institute. Camí del Mig 36 (4a planta), 08303 Mataró (Barcelona), Spain
| | - Laura Muñoz-Ortiz
- Primary Healthcare Research Support Unit Metropolitana Nord, Catalan Health Institute-IDIAP Jordi Gol. Camí del Mig 36, 08303 Mataró (Barcelona), Spain
| | - Antonio Negrete-Palma
- Primary Healthcare Research Support Unit Metropolitana Nord, Catalan Health Institute-IDIAP Jordi Gol. Camí del Mig 36, 08303 Mataró (Barcelona), Spain
- Primary Healthcare Centre Gatassa, Catalan Health Institute. Camí del Mig 36 (4a planta), 08303 Mataró (Barcelona), Spain
| | - Juan José Montero-Alia
- Primary Healthcare Centre Rocafonda-Palau, Catalan Health Institute. Ronda Pintor Rafael Estrany 24, 08304 Mataró (Barcelona), Spain
| | - Mercedes Jiménez-González
- Primary Healthcare Centre La Riera, Catalan Health Institute. La Riera 7, 08302 Mataró (Barcelona), Spain
| | - Elena Zurilla-Leonarte
- Primary Healthcare Centre Gatassa, Catalan Health Institute. Camí del Mig 36 (4a planta), 08303 Mataró (Barcelona), Spain
| | - Victoria Marina-Ortega
- Primary Healthcare Centre Canet de Mar, Catalan Health Institute. Plaça Universitat 1, 08640 Canet de Mar (Barcelona), Spain
| | - Montserrat Olle-Borque
- Primary Healthcare Centre Canet de Mar, Catalan Health Institute. Plaça Universitat 1, 08640 Canet de Mar (Barcelona), Spain
| | - Esther Valentin-Moya
- Primary Healthcare Centre Canet de Mar, Catalan Health Institute. Plaça Universitat 1, 08640 Canet de Mar (Barcelona), Spain
| | - Anna Cortada-Cabrera
- Primary Healthcare Centre Canet de Mar, Catalan Health Institute. Plaça Universitat 1, 08640 Canet de Mar (Barcelona), Spain
| | - Alexis Tena-Domingo
- Primary Healthcare Centre Canet de Mar, Catalan Health Institute. Plaça Universitat 1, 08640 Canet de Mar (Barcelona), Spain
| | - Silvia Martínez-González
- Primary Healthcare Centre LLefià, Catalan Health Institute. Carretera Antiga de València s/n, 08913 Badalona (Barcelona), Spain
| | - Victoria Vila-Palau
- Primary Healthcare Centre Canet de Mar, Catalan Health Institute. Plaça Universitat 1, 08640 Canet de Mar (Barcelona), Spain
| | - Adriana Ramos-Ordoñez
- Primary Healthcare Centre Pineda de Mar, Catalan Health Institute. Carrer de Tarragona 49, 08397 Pineda de Mar (Barcelona), Spain
| | - Guida Rotllant-Estelrich
- Primary Healthcare Centre Canet de Mar, Catalan Health Institute. Plaça Universitat 1, 08640 Canet de Mar (Barcelona), Spain
| | - Carme Forcada-Vega
- Primary Healthcare Service Mataró-Maresme, Catalan Health Institute. Carrer Verge de Guadalupe 2, 08303 Mataró (Barcelona), Spain
| | - Eulàlia Borrell-Thió
- Primary Healthcare Research Support Unit Metropolitana Nord, Catalan Health Institute-IDIAP Jordi Gol. Camí del Mig 36, 08303 Mataró (Barcelona), Spain
- Primary Healthcare Centre Sant Roc, Catalan Health Institute. Carrer Vélez Rubio s/n, 08913 Badalona (Barcelona), Spain
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Forey BA, Thornton AJ, Lee PN. Systematic review with meta-analysis of the epidemiological evidence relating smoking to COPD, chronic bronchitis and emphysema. BMC Pulm Med 2011; 11:36. [PMID: 21672193 PMCID: PMC3128042 DOI: 10.1186/1471-2466-11-36] [Citation(s) in RCA: 229] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2010] [Accepted: 06/14/2011] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Smoking is a known cause of the outcomes COPD, chronic bronchitis (CB) and emphysema, but no previous systematic review exists. We summarize evidence for various smoking indices. METHODS Based on MEDLINE searches and other sources we obtained papers published to 2006 describing epidemiological studies relating incidence or prevalence of these outcomes to smoking. Studies in children or adolescents, or in populations at high respiratory disease risk or with co-existing diseases were excluded. Study-specific data were extracted on design, exposures and outcomes considered, and confounder adjustment. For each outcome RRs/ORs and 95% CIs were extracted for ever, current and ex smoking and various dose response indices, and meta-analyses and meta-regressions conducted to determine how relationships were modified by various study and RR characteristics. RESULTS Of 218 studies identified, 133 provide data for COPD, 101 for CB and 28 for emphysema. RR estimates are markedly heterogeneous. Based on random-effects meta-analyses of most-adjusted RR/ORs, estimates are elevated for ever smoking (COPD 2.89, CI 2.63-3.17, n = 129 RRs; CB 2.69, 2.50-2.90, n = 114; emphysema 4.51, 3.38-6.02, n = 28), current smoking (COPD 3.51, 3.08-3.99; CB 3.41, 3.13-3.72; emphysema 4.87, 2.83-8.41) and ex smoking (COPD 2.35, 2.11-2.63; CB 1.63, 1.50-1.78; emphysema 3.52, 2.51-4.94). For COPD, RRs are higher for males, for studies conducted in North America, for cigarette smoking rather than any product smoking, and where the unexposed base is never smoking any product, and are markedly lower when asthma is included in the COPD definition. Variations by sex, continent, smoking product and unexposed group are in the same direction for CB, but less clearly demonstrated. For all outcomes RRs are higher when based on mortality, and for COPD are markedly lower when based on lung function. For all outcomes, risk increases with amount smoked and pack-years. Limited data show risk decreases with increasing starting age for COPD and CB and with increasing quitting duration for COPD. No clear relationship is seen with duration of smoking. CONCLUSIONS The results confirm and quantify the causal relationships with smoking.
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Affiliation(s)
| | | | - Peter N Lee
- P N Lee Statistics and Computing Ltd, Sutton, Surrey, UK
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Abstract
Chronic obstructive pulmonary disease and asthma are both highly prevalent inflammatory diseases characterized by airway obstruction with distinct pathogenic mechanisms and different degrees of response to antiinflammatory therapy. However, forms of presentation that show overlap between both diseases and which are not clearly represented in clinical trials are frequently encountered in clinical practice. These patients may show accelerated loss of pulmonary function and have a worse prognosis. Therefore their early identification is essential. Biomarkers such as bronchial hyperreactivity or nitric oxide in exhaled air have yielded discrepant results. Phenotypic characterization will allow treatment with inhaled corticosteroids to be individually tailored and optimized.
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Deveci F, Deveci SE, Türkoğlu S, Turgut T, Kirkil G, Rahman S, Açik Y, Muz MH. The prevalence of chronic obstructive pulmonary disease in Elazig, Eastern Turkey. Eur J Intern Med 2011; 22:172-6. [PMID: 21402248 DOI: 10.1016/j.ejim.2010.12.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2010] [Revised: 07/19/2010] [Accepted: 12/21/2010] [Indexed: 10/18/2022]
Abstract
BACKGROUND To investigate the prevalence of Chronic Obstructive Pulmonary Disease (COPD) in the urban and rural areas of the Elazig Region of Turkey. METHODS A questionnaire was conducted and spirometric measurements were made, based on the BOLD protocol. A total of 1270 individuals, over 18 years of age, were included in the study, comprising 610 individuals from the city center and 660 from the rural area. The questionnaire included demographics, symptoms and possible risk factors. The description and staging of COPD were in accordance with GOLD (Global Initiative for Chronic Obstructive Lung Disease). RESULTS Of the 1270 cases, 1206 (94.9%) were able to complete the questionnaire and undergo spirometric analysis. Of these 1206 cases, 1188 (98.5%) were used in the final assessment; the remainder were excluded due to errors in the spirometric analysis. Of the cases included in the study, 43.2% (25.9% female; 56.7% male) were current smokers. The prevalence of COPD at ≥ 18 years old was 4.5% (female 2.5%; male 6%); the prevalence at ≥ 45 years old was 11.5% (female 5.9%; male 15.1%). The majority of the COPD cases were at stages I and II (22.6% and 66%, respectively). The prevalence of COPD was higher among current and former smokers (5.8%) than non-smokers (2.8%). In general, the risk factors for COPD were found to be age, male gender, smoking, living in a rural area, and low income. CONCLUSIONS The prevalence of COPD in Elazig, Turkey was highest among the elderly and smokers, and constituted primarily stages I and II of the disease.
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Affiliation(s)
- Figen Deveci
- Department of Chest Diseases, Faculty of Medicine, Firat University, Elazig, Turkey.
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Abstract
Chronic obstructive pulmonary disease (COPD) is one of the main causes of death in Spain and elsewhere in the world, with an estimated 18,000 and 2.75 million deaths annually. Mortality is predicted to increase in the next few years due to smoking and the aging population. Multiple studies confirm that COPD is underreported as a cause of death on death certificates, due to the difficulty of determining the final cause of death in these patients. The main causes of mortality in COPD range from lung cancer and cardiovascular disease in patients with mild COPD to respiratory failure in the most advanced stages. Fortunately, in the latest updates, guidelines for the management and treatment of the disease identify reduction of mortality as one of the main clinical objectives to be achieved in these patients.
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Affiliation(s)
- Joan B Soriano Ortiz
- Programa de Epidemiología e Investigación Clínica, Fundación Caubet-CIMERA, Illes Balears, España.
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Miravitlles M. Cough and sputum production as risk factors for poor outcomes in patients with COPD. Respir Med 2011; 105:1118-28. [PMID: 21353517 DOI: 10.1016/j.rmed.2011.02.003] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2010] [Revised: 01/24/2011] [Accepted: 02/07/2011] [Indexed: 01/15/2023]
Abstract
Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality in developed countries, and its prevalence is projected to increase over the coming decades. According to the World Health Organization, COPD will become the third leading cause of death worldwide by 2020. COPD has a chronic and progressive course, and is often aggravated by exacerbations, which typically arise as a result of bronchial infection. Exacerbations are characterised by periods of increasing acute symptoms, particularly cough, dyspnoea and production of sputum, which worsen airflow obstruction, further impair quality of life and generally require a change in regular medication. Exacerbations are the most common cause of medical visits, hospital admissions and death in patients with COPD, and frequent exacerbations worsen health status and may cause a permanent decline in lung function. Chronic cough and sputum production are common in the general population, but significantly more prevalent in patients with respiratory disorders; these symptoms have been suggested as a risk factor for exacerbations of COPD. This article will review the consequences of chronic cough and sputum production in patients with COPD and analyse whether these risk factors may be useful for identifying a specific phenotype of patient that requires different management to reduce the occurrence of exacerbations.
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Affiliation(s)
- Marc Miravitlles
- Ciber de Enfermedades Respiratorias, Hospital Clinic, Barcelona, 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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Zamarro García C, Bernabé Barrios MJ, Santamaría Rodríguez B, Rodríguez Hermosa JL. Tabaquismo en la enfermedad pulmonar obstructiva crónica. Arch Bronconeumol 2011; 47 Suppl 8:3-9. [DOI: 10.1016/s0300-2896(11)70059-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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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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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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Cabedo García V, Garcés Asemany C. ¿Es útil la prueba de la marcha durante 6min en Atención Primaria? Semergen 2010. [DOI: 10.1016/j.semerg.2009.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Martín-Escudero J. Conducta a seguir ante la EPOC desde Medicina Interna. Rev Clin Esp 2010; 210:171-7. [DOI: 10.1016/j.rce.2009.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2009] [Accepted: 07/24/2009] [Indexed: 10/19/2022]
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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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