1
|
|
2
|
Factores pronósticos de mortalidad en pacientes con enfermedad pulmonar obstructiva crónica tras su ingreso en una Unidad de Medicina Intensiva. El papel de la calidad de vida. Med Intensiva 2005. [DOI: 10.1016/s0210-5691(05)74229-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
3
|
Soler JJ, Sánchez L, Román P, Martínez MA, Perpiñá M. [Prevalence of malnutrition in outpatients with stable chronic obstructive pulmonary disease]. Arch Bronconeumol 2004; 40:250-8. [PMID: 15161591 DOI: 10.1016/s1579-2129(06)70095-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To determine the prevalence of malnutrition in outpatients with stable chronic obstructive pulmonary disease (COPD) followed at a respiratory clinic. MATERIAL AND METHOD In this prospective study, we assessed the nutritional status of consecutive outpatients with stable COPD by investigating various anthropometric parameters. Patients were malnourished (low body weight) if their body mass index was within the bottom quartile of a reference population. Muscle mass was determined from the midarm muscle area and if this mass was at or within the bottom quartile, muscle wasting was present. Albumin and transferrin plasma concentrations were used as a measure of visceral protein stores. Fat stores were assessed from body fat and if this value was at or within the bottom quartile, calorific malnutrition was present. All patients underwent arterial blood gas sampling at rest and spirometry. RESULTS A total of 178 patients--one woman (0.6%) and 177 men (99.4%)--were enrolled in the study, with a mean (SD) age of 69 (9) years. We found low body weight in 19.1% of the patients, muscle wasting in 47.2%, visceral protein depletion in 17.4%, and fat depletion in 19.1%. Of the patients with normal weight, 62.9% showed muscle wasting. The proportion of patients with a body mass index or midarm muscle area at or within the bottom quartile increased significantly with increased bronchial obstruction (P<.001 and P=.015, respectively), though 35.7% of the patients showed muscle wasting even when COPD was mild. CONCLUSIONS Many patients with stable COPD suffer malnutrition. Nutritional state is worse with more severe COPD. Depletion involves both fat stores and muscle and visceral protein stores, but the greatest effect is seen in muscle wasting. A significant number of patients with normal weight also suffer muscle wasting. Although changes in body composition were common in our patients, low body weight was less prevalent than has been reported for populations in countries that are socially and economically similar to Spain.
Collapse
Affiliation(s)
- J J Soler
- Unidad de Neumología, Servicio de Medicina Interna, Hospital General de Requena, Requena, Valencia, Spain.
| | | | | | | | | |
Collapse
|
4
|
Clotet J, Gómez-Arbonés X, Ciria C, Albalad JM. [Spirometry is a good method for detecting and monitoring chronic obstructive pulmonary disease in high-risk smokers in primary health care]. Arch Bronconeumol 2004; 40:155-9. [PMID: 15030729 DOI: 10.1016/s1579-2129(06)60207-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Chronic obstructive pulmonary disease (COPD) is a common disease, the early diagnosis of which allows effective management and treatment. The aim of the present study is to show the effectiveness of a screening and monitoring plan for COPD in high-risk patients in primary health care. PATIENTS AND METHODS The subjects in this prospective observational longitudinal study comprised 164 high-risk smokers aged between 40 and 76 years. Age, sex, weight, height, and smoking habit (pack-years) were recorded and spirometry was performed according to the guidelines of the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR). Patients were informed of their results and given brief advice on how to stop smoking. After 3 years, the patients underwent the same evaluation. RESULTS In 1999, 22% of the smokers were diagnosed with COPD. Three years later, an additional 16.3% were diagnosed as having COPD, and the disease had worsened in 38.8% of those already diagnosed. Of the patients with a forced expiratory volume in one second (FEV1) less than 90%, 44.8% developed COPD (relative risk: 10.54). An accelerated decrease in FEV1 was found in 18.1% of the patients (20.7% with COPD and 9.0% without COPD). Mean tobacco consumption in 1999 was 28.1 pack-years in subjects without COPD and 31.7 pack-years in those with COPD, whereas in 2002, consumption was 30.6 pack-years in patients with COPD and 31.9 pack-years in those without. In 3 years, 22.8% had stopped smoking (20.5% without COPD and 30.3% with COPD). CONCLUSIONS Many smokers managed to give up smoking after learning their spirometric results. FEV1 can identify smokers at greatest risk of developing COPD. Spirometric screening and monitoring of smokers at high risk in primary health care can identify those most susceptible to developing COPD while the disease is in an early phase. Therefore the most appropriate strategy can be adopted for each patient.
Collapse
Affiliation(s)
- J Clotet
- Centro de Atención Primaria de Ponts and Departamento de Medicina, Universitat de Lleida, Spain.
| | | | | | | |
Collapse
|
5
|
Casadevall C, Coronell C, Minguella J, Blanco L, Orozco-Levi M, Barreiro E, Broquetas J, Gea J. Analysis of Respiratory Muscle Structure and Tumor Necrosis and Insulin-Like Growth Factor Expression in Chronic Obstructive Pulmonary Disease: Are Samples Valid if Obtained During Thoracotomy Performed Because of Localized Pulmonary Neoplasia? ACTA ACUST UNITED AC 2004; 40:209-17. [PMID: 15117620 DOI: 10.1016/s1579-2129(06)70086-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Various methods have been used to obtain samples to study the structure of human respiratory muscles and the expression of diverse substances in them. Samples are most often obtained from autopsies, from muscle biopsies during thoracotomy performed because of a localized pulmonary lesion (TLL), and from ambulatory thoracoscopic biopsy in patients free of comorbidity (AT). The disadvantage of the first 2 of these methods lies in the possibility of interference from factors related to the patient's death in the first case or from the disease that necessitated surgery in the second. Although AT is free from the disadvantages of the other 2 methods, it is impossible to obtain samples of the diaphragm the principal respiratory muscle with this procedure. The objective of this study was to analyze the fibrous structure of the external intercostal muscle of patients with chronic obstructive pulmonary disease and to quantify the expression of the principal inflammatory cytokine tumor necrosis factor alpha (TNF-alpha)- and of insulin-like growth factor (IGF-1) in the same muscle, comparing the results obtained with TLL and AT samples. METHODS Prospective and consecutive samples were taken of the external intercostal muscle (fifth space, anterior axillary line) in 15 patients with chronic obstructive pulmonary disease (mean [SD] age 66 [6] years; forced expiratory volume in 1 second 49% [9%] of predicted; PaO2 75 [9] mm Hg). Samples were taken during TLL (8 patients, all with pulmonary neoplasms but carefully selected in order to rule out systemic effects) or TA (7 patients). Patients with serious comorbidity were excluded from the second group. Samples were processed for structural analysis of fibers (immunohistochemical and enzymatic histochemical) and genetic expression of TNF-alpha and IGF-1 (real-time polymerase chain reaction). RESULTS No differences in the structure of fibers were found between the 2 groups. No differences were observed in the expression of TNF-alpha or IGF-1. CONCLUSIONS Using rigorous criteria, the TLL method appears to be suitable for studying the structural characteristics and expression of inflammatory cytokines and growth factors in the external intercostal muscle. Moreover, it can also be inferred that TLL is probably also useful for obtaining samples of the diaphragm, a muscle which cannot currently be sampled by any alternative method.
Collapse
Affiliation(s)
- C Casadevall
- Unitat de Recerca en Múscul (URM), IMIM-Hospital del Mar, Barcelona, Spain
| | | | | | | | | | | | | | | |
Collapse
|
6
|
Masa JF, Sobradillo V, Villasante C, Jiménez-Ruiz CA, Fernández-Fau L, Viejo JL, Miravitlles M. [Costs of chronic obstructive pulmonary disease in Spain. Estimation from a population-based study]. Arch Bronconeumol 2004; 40:72-9. [PMID: 14746730 DOI: 10.1016/s1579-2129(06)60198-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE In the studies carried out to date, the cost of chronic obstructive pulmonary disease (COPD) may have been overestimated due to the inclusion of previously diagnosed patients seeking medical attention for their symptoms. As a result, the severity of the cases included in these studies may have been greater than in an unselected sample of the general population. The aim of the present study was to estimate the direct cost of COPD on the basis of a representative sample of the overall Spanish population between 40 and 69 years of age (from the IBERPOC study). METHOD The cost was evaluated retrospectively by means of a questionnaire completed by the 363 patients with COPD from the IBERPOC study with questions referring to the previous year. Standardized spirometry was performed on all the patients by a pneumologist in each of the 7 geographical areas in which the study was carried out. RESULTS Hospitalization accounted for the greatest expenditure (41% of total), followed by drug therapy (37%). The cost was euro;98.39 per patient, and euro;909.50 per previously diagnosed patient. The cost per person of severe COPD was more than 3 times that of moderate COPD and more than 7 times that of mild COPD. The estimated annual cost of COPD in Spain was euro;238.82 million (for 1997). CONCLUSION The present study, which was the first to estimate the cost of COPD in a representative sample of the general population, found the cost to be lower than in studies analyzing samples of patients with previous diagnoses of COPD. The cost distribution is not in line with recommended health care practices, underlining the need to optimize resources used to monitor and treat the disease, with an emphasis on early diagnosis.
Collapse
Affiliation(s)
- J F Masa
- Sección de Neumología. Hospital San Pedro de Alcántara. Cáceres. España
| | | | | | | | | | | | | |
Collapse
|
7
|
Prevalencia de la desnutrición en pacientes ambulatorios con enfermedad pulmonar obstructiva crónica estable. Arch Bronconeumol 2004. [DOI: 10.1016/s0300-2896(04)75516-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
8
|
Masa J, Sobradillo V, Villasante C, Jiménez-Ruiz C, Fernández-Fau L, Viejo J, Miravitlles M. Costes de la EPOC en España. Estimación a partir de un estudio epidemiológico poblacional. Arch Bronconeumol 2004. [DOI: 10.1016/s0300-2896(04)75476-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
9
|
La espirometría es un buen método para la detección y el seguimiento de la EPOC en fumadores de alto riesgo en atención primaria. Arch Bronconeumol 2004. [DOI: 10.1016/s0300-2896(04)75495-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
10
|
Casadevall C, Coronell C, Minguella J, Blanco L, Orozco-Levi M, Barreiro E, Broquetas J, Gea J. Análisis estructural y expresión de los factores de necrosis tumoral y crecimiento insulina-like en los músculos respiratorios de pacientes con EPOC. ¿Son válidas las muestras obtenidas en el curso de una toracotomía por neoplasia pulmonar localizada? Arch Bronconeumol 2004. [DOI: 10.1016/s0300-2896(04)75507-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
11
|
de Miguel Díez J, Izquierdo Alonso JL, Rodríguez González-Moro JM, de Lucas Ramos P, Molina París J. [Drug treatment of chronic obstructive pulmonary disease on two levels of patient care: degree of compliance with recommended protocols]. Arch Bronconeumol 2003; 39:195-202. [PMID: 12749801 DOI: 10.1016/s0300-2896(03)75361-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE The aims of this study were to identify the drug treatment protocols applied by primary care physicians or pneumologists for patients with stable chronic obstructive pulmonary disease (COPD) in Spain, to determine the agreement between prescription practices and current recommendations and to assess differences between the two levels of patient care. PATIENTS AND METHODS The study was observational, descriptive and multicenter. A stratified random sample of patients treated by family physicians or pneumologists was taken for every region in Spain. RESULTS Five hundred sixty-eight (63.2%) of the 898 subjects fulfilled COPD diagnostic criteria; 100 were treated by primary care physicians and 460 by pneumologists. In 8 cases the caregiver was unknown. Obstruction was mild-to-moderate in 144 cases and severe in 416. The drugs most commonly prescribed were ipratropium bromide (77.8%), inhaled short-acting beta(2) agonists (65.8%), inhaled corticosteroids (61.0%), long-acting beta(2) agonists (46.4%) and theophyllines (41.3%). Primary care physicians prescribed inhaled short-acting beta 2-agonists most often, whereas pneumologists prescribed anticholinergics most often. In the primary care setting, no differences in treatment protocols were observed based on severity of COPD, degree of dyspnea or quality of life. More consistent differences were seen in treatment by pneumologists. In both settings, prescription was more frequently given when COPD was severe. The most commonly prescribed inhalation device was the Turbuhaler in primary care and the pressurized canister in pneumology. CONCLUSIONS Treatments prescribed for COPD patients do not follow current guidelines strictly, particularly in the primary care setting. Different prescription protocols are used at the different levels of patient care.
Collapse
Affiliation(s)
- J de Miguel Díez
- Servicio de Neumología. Hospital General Universitario Gregorio Marañón. Madrid. España
| | | | | | | | | |
Collapse
|
12
|
Pascual-Pape T, Badia JR, Marrades RM, Hernández C, Ballester E, Fornas C, Fernández A, Montserrat JM. [Results of a preventive program and assisted hospital discharge for COPD exacerbation. A feasibility study]. Med Clin (Barc) 2003; 120:408-11. [PMID: 12681217 DOI: 10.1016/s0025-7753(03)73720-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVE Exacerbation of chronic obstructive pulmonary disease (COPD) is one of the most frequent causes of hospital admission. We examined the results and feasibility of two programs conducted by a hospital respiratory unit aimed to reduce both the length of hospital stay and the number of hospital admissions for COPD acute exacerbation. PATIENTS AND METHOD a) Assisted hospital discharge program: Patients admitted for acute exacerbation who met our criteria for early discharge were sent home with the support of a respiratory nurse. Home visits were carried out and direct phone contact with the nurse and physician was provided during a limited period of 6 weeks. Outcome variables studied were length of hospital admission and need for hospital reentry. b) Exacerbation prevention program: A group of patients with severe COPD and at least 3 hospital admissions for exacerbation during the previous year were included. These patients underwent an educational program and were given unlimited direct phone access to the respiratory nurse and physician. When necessary, home visits were carried out. The main outcome variable of this program was the number of hospital admissions. RESULTS a) Assisted hospital discharge program: A total of 97 patients were included. The mean length of hospital stay was 5.4 1.7 days, which was significantly shorter than the previous average length of stay in our respiratory unit for a diagnosis of COPD exacerbation (8.52 days). The rate of hospital reentry was 17% (within the first 3 months). b) Exacerbation prevention program: 23 patients were enrolled. In this group, the number of hospital admissions decreased significantly from 5.0 1.8 to 1.7 2.4 per year (p = 0.001). Visits to the emergency department were also decreased, from 1.2 1.6 to 0.4 1.6 per patient (p = 0.05). Finally, the length of hospital stay decreased from 38 17 to 16 20 days (p = 0.0001). CONCLUSIONS A combined use of hospital resources and home care programs which are specifically addressed to severe COPD patients can reduce the need for hospital admission.
Collapse
Affiliation(s)
- Teresa Pascual-Pape
- Servicio de Neumología y Alergia Respiratoria. Institut Clínic de Pneumología i Cirurgía Torácica. Hospital Clínic. Barcelona. IDIBAPS. Universitat de Barcelona. Barcelona. España
| | | | | | | | | | | | | | | |
Collapse
|
13
|
Rodríguez Rodríguez M, Dolores Sánchez Fernández M. Efectividad de una intervención educativa individual y en grupo, en pacientes con enfermedad pulmonar obstructiva crónica. ENFERMERIA CLINICA 2003. [DOI: 10.1016/s1130-8621(03)73795-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
14
|
Rodríguez Roisin R, Alvarez-Sala JL, Sobradillo V. [2002: a good year for turning approach to COPD around]. Arch Bronconeumol 2002; 38:503-5. [PMID: 12435314 DOI: 10.1016/s0300-2896(02)75277-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
15
|
de la Iglesia F, Valiño P, Pita S, Ramos V, Pellicer C, Nicolás R, Diz-Lois F. Factors predicting a hospital stay of over 3 days in patients with acute exacerbation of chronic obstructive pulmonary disease. J Intern Med 2002; 251:500-7. [PMID: 12028505 DOI: 10.1046/j.1365-2796.2002.00989.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To investigate the factors predicting a hospital stay of over 3 days in patients who required hospitalization for acute exacerbation of chronic obstructive pulmonary disease (COPD). DESIGN AND SETTING A cross-sectional study was done at a tertiary hospital serving an area of 500 000 inhabitants. SUBJECTS A total of 273 patients (alpha=0.05; accuracy=5.94%) who had been admitted consecutively to the Short Stay Medical Unit at the Juan Canalejo Hospital in A Coruña, from February 1998 to March 1999, with a diagnosis focusing on exacerbation of COPD. Methods. Demographic variables, past medical history, symptoms, arterial blood gases, functional tests, treatment and the cause of exacerbation were studied in each patient. The hospital stay was dichotomized into <or=3 vs. >3 days. The prognostic factors of a hospital stay were determined by log regression. Results. The mean stay was 4.6 +/- 5.1 days (range: 1-64). After monitoring the associated covariables, the following were found to have an independent effect on the prediction of a hospital stay of over 3 days: weekend admissions (OR=4.17; 95% CI: 2.42-7.18), the presence of cor pulmonale (OR=2.19; 95% CI: 1.27-3.78), and the respiratory rate on admission (OR=1.09; 95% CI: 1.03-1.14). Arterial blood gases and functional tests showed no independent effect. Conclusions. The factors having an independent prognostic value in determining the length of hospital stays in patients with COPD are weekend admission, cor pulmonale and respiratory rate. Additional studies are required to validate these findings.
Collapse
Affiliation(s)
- F de la Iglesia
- Short Stay Medical Unit (SSMU), Juan Canalejo Hospital, A Coruña, Spain.
| | | | | | | | | | | | | |
Collapse
|
16
|
Sauleda Roig J, Agustí García-Navas A. Tratamiento de la enfermedad pulmonar obstructiva crónica (réplica). Rev Clin Esp 2002. [DOI: 10.1016/s0014-2565(02)71133-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
17
|
Quintano J. La enfermedad pulmonar obstructiva crónica: una asignatura pendiente en atención primaria para el siglo XXI. Semergen 2002. [DOI: 10.1016/s1138-3593(02)74399-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
18
|
Haro Estarriol M, Vizcaya Sánchez M, Jiménez López J, Tornero Molina A. [Etiology of hemoptysis: Prospective analysis of 752 cases]. Rev Clin Esp 2001; 201:696-700. [PMID: 11835879 DOI: 10.1016/s0014-2565(01)70953-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To know the etiology of hemoptysis and its distribution in our area compared with other current and historic series. METHODS Prospective, descriptive study of 752 cases of hemoptysis. The etiology of these cases was determined by evaluating the clinical record, chest X-ray, functional respiratory tests and sputum smear for acid-fast bacilli, together with other examinations such as bronchoscopy and computerized tomography (CT) according to previously established criteria. RESULTS The mean age of patients was 60 years (SD: 15 years), 79% were males and 75% smokers. Diagnoses included neoplasms (28%), chronic bronchitis (19.8%), bronchiectasis (14.5%), pneumonia or lung abscess (11.5%), idiopathic forms (8%), and miscellaneous causes with lower percentages such as tuberculosis (1.7%) and its sequelae (4%), cardiac diseases (1.5%) and pulmonary embolism (2.3%). Bronchoscopy was performed in 694 (92.2%) and detected the bleeding site or provided a specific diagnosis in 39% (81% if only neoplasms are considered) and non-specific but abnormal in 57%. The amount of bleeding was small in most cases and kept no relationship with causes. CONCLUSIONS Neoplasms, chronic bronchitis and bronchiectasis are the most common causes of hemoptisis in our area. Bronchiectasis and tuberculosis have decreased compared with previous series used as reference. In contrast, there has been an increase in the number of neoplasms and chronic bronchitis and a plateau in those attributed to cardiac diseases, pneumonia or lung abscess and cryptogenetic forms. To obtain the origin, bronchoscopy complemented by CT remains essential.
Collapse
Affiliation(s)
- M Haro Estarriol
- Sección de Neumologia, Servicio de Medicina Interna, Hospital General de Albacete, Spain.
| | | | | | | |
Collapse
|
19
|
Añón Elizalde JM, García De Lorenzo Mateos A, Alvarez-Sala Walther R, Escuela Gericó MP. [Treatment and prognosis of the severe exacerbation in the chronic obstructive pulmonary disease]. Rev Clin Esp 2001; 201:658-66. [PMID: 11786136 DOI: 10.1016/s0014-2565(01)70941-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
20
|
Alvarez-Sala Walther J, Cimas Hernando E, Naberan Toña K, Simonet Aineto P, Masa Jiménez J, Miravitlles Fernández M, Viejo Bañuelos J. [Recommendations for care of patients with chronic obstructive pulmonary disease]. Aten Primaria 2001; 28:491-500. [PMID: 11718646 PMCID: PMC7675954 DOI: 10.1016/s0212-6567(01)70428-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Affiliation(s)
- J Alvarez-Sala Walther
- Grupo de Trabajo de la Sociedad Española de Neumología y Cirugía Torácica y de la Sociedad Española de Medicina de Familia y Comunitaria, Madrid, Spain.
| | | | | | | | | | | | | |
Collapse
|
21
|
Soler J, Sánchez L, Latorre M, Alamar J, Román P, Perpiñá M. [The impact of COPD on hospital resources: the specific burden of COPD patients with high rates of hospitalization]. Arch Bronconeumol 2001; 37:375-81. [PMID: 11674937 DOI: 10.1016/s0300-2896(01)78818-7] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES 1) To know the impact of chronic obstructive pulmonary disease (COPD) on hospital care (visits to the emergency room and admission); and 2) to identify and describe COPD patients whose use of health care is high (COPD-HC), also assessing the costs generated by such patients. METHOD We reviewed the files of all patients with COPD receiving care at our hospital in 1998, looking at age, sex, smoking, simple spirometry, arterial gases at rest, number of admissions, duration of hospital stay, and number of visits to the emergency room. After describing the sample, patients were stratified in three groups by use of hospital care: group A, patients not requiring hospital care; group B, patients requiring less care than the COPD-HC group; and group C, COPD-HC. The criteria used to define the COPD-HC group were 1) >= 2 admissions in one year, 2) >= 3 visits to the emergency room, without admission in one year, or 3) 1 admission and 2 visits to the emergency room for COPD exacerbation in one year. RESULTS Three hundred twenty cases were studied, 3 women (0.9%) and 317 men (99.1%), mean age 71 9 years. One hundred twenty-six patients (39.4%) made 263 visits in 1998, accounting for 1.1% of all emergencies (n = 23,750) and 4.05% of all medical emergencies (n = 6,489). Ninety-two patients (28.7%) were admitted for exacerbation of COPD. One hundred twenty-six admissions were made over the course of the year, accounting for 9.6% of all admissions to the internal medicine wards (n = 1,309). The 39 patients (12.2%) who were classified COPD-HC generated 160 emergency visits (60.8%) and 72 admissions due to COPD (57.1%). The analysis of variation revealed statistically significant differences among the 3 groups for age, FEV1, FVC and PaO2, but not for PaCO2. COPD-HC patients had the lowest values for FEV1, FVC and PaO2 and were older. CONCLUSIONS COPD generates high demand for hospital care. A small group of COPD patients (12.2%) accounts for nearly 60% of hospital visits for this disease. The group requiring greater care generally has more severe disease (older, more severe bronchial obstruction and hypoxemia).
Collapse
Affiliation(s)
- J Soler
- Unidad de Neumología y Servicio de Medicina Interna. Hospital General de Requena. Valencia, Spain
| | | | | | | | | | | |
Collapse
|
22
|
Miravitlles M, Figueras M. [The cost of chronic obstructive pulmonary disease in Spain: options for optimizing resources]. Arch Bronconeumol 2001; 37:388-93. [PMID: 11674939 DOI: 10.1016/s0300-2896(01)78820-5] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- M Miravitlles
- Servicio de Neumología, Hospital General Vall d'Hebron, Barcelona, Spain.
| | | |
Collapse
|
23
|
Alvarez-Sala J, Cimas E, Masa J, Miravitlles M, Molina J, Naberan K, Simonet P, Viejo J. [Recommendations for the care of the patient with chronic obstructive pulmonary disease]. Arch Bronconeumol 2001; 37:269-78. [PMID: 11481057 DOI: 10.1016/s0300-2896(01)75089-2] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- J Alvarez-Sala
- Grupo de Trabajo de la Sociedad Española de Neumología y Cirugía Torácica (SEPAR).
| | | | | | | | | | | | | | | |
Collapse
|
24
|
Affiliation(s)
- J Sauleda
- Servicio de Neumología, Hospital Universitario Son Dureta, Andrea Doria, 55, 07014 Palma de Mallorca.
| | | | | |
Collapse
|
25
|
Montemayor T, Ortega F. [Strategies for muscular training in chronic obstructive pulmonary disease. Training of resistance, strength, of both?]. Arch Bronconeumol 2001; 37:279-85. [PMID: 11481058 DOI: 10.1016/s0300-2896(01)75090-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- T Montemayor
- Unidad Médico-Quirúrgica. Hospital Universitario Virgen del Rocío. Sevilla.
| | | |
Collapse
|
26
|
Manresa J, Caballol R, Sena F. [Monitoring domiciliary oxygen therapy from a district hospital]. Arch Bronconeumol 2001; 37:237-40. [PMID: 11481054 DOI: 10.1016/s0300-2896(01)75086-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES This study aimed a) to evaluate correct use of domiciliary oxygen therapy (DOT); b) to estimate the prevalence of DOT, and c) to evaluate DOT based on the same parameters after intervention by the monitoring team. PATIENTS AND METHOD Cross-sectional, prospective study of all patients receiving DOT before and after initiation of monitoring. We administered spirometric tests, analyzed indications for and compliance with DOT and monitored pulse oxymetry in order to adjust oxygen flow. RESULTS Seventy-six patients were receiving DOT (63/100,000 inhabitants). Among the 60 patients with COPD, half met ideal indications for prescribing DOT, 65% complied with over 15 h of DOT, and hypoxemia was not corrected for 26%. Monitoring resulted in withdrawal of DOT from 28 patients (reduction of 37%), and DOT was prescribed for 27 new patients, 11 of whom received liquid oxygen. At the end of the study, 46 patients were receiving DOT (38/100,000 inhabitants). CONCLUSIONS a) Ideal indications for DOT, adequate compliance and correction of hypoxemia were observed in 54% of the patients undergoing therapy; b) creation of a special service to care for patients receiving DOT improves monitoring, and c) the prevalence of DOT in our area has been reduced from 63 to 38/100,000 inhabitants.
Collapse
Affiliation(s)
- J Manresa
- Unidad de Neumología. Hospital Verge de la Cinta. Tortosa. Tarragona
| | | | | |
Collapse
|
27
|
Abstract
OBJECTIVE To evaluate the consumption of the direct health resources of primary care (PC) in Spain by a cohort of patients with chronic bronchial pathology: chronic bronchitis (CB) and chronic obstructive pulmonary disease (COPD). DESIGN Prospective cohort study of patients with CB and COPD monitored in PC in Spain. The first 10 adult patients who attended at random each researcher's clinic and who were diagnosed as suffering an exacerbation of their chronic bronchial pathology were included. Scheduled follow-up visits for a year evaluated the cohort's consumption of health resources. Direct health costs were analysed. RESULTS 268 doctors, with 2414 patients, took part. 1510 patients completed the 12 months follow-up (62.6%). All the patients received pharmacological treatment for their pulmonary disease. The most common complementary investigations performed were: general blood analysis (1.5 per patient/year), chest x-ray (1.2) and ECG (0.9), followed by spirometry (0.5) and arterial gasometry (0.4). Mean number of exacerbations per year were 1.9; and admissions, 0.2. Overall cost, including tests, medical visits, hospital expenditure and pharmacological treatment, was 420,264,000 pesetas for the entire cohort. The direct annual cost per patient ran at 278,321 pesetas. The cost caused by patients treated with Cefixime on the first exacerbations was 77,365 pesetas less, which was mostly due to less hospital expense. CONCLUSIONS The direct annual cost per patient with CB or COPD is high, above the cost of other chronic respiratory pathologies such as bronchial asthma. There are notably greater hospital costs for CB and COPD, explained by these patients' mean greater age and the non-reversible and progressive deterioration of their respiratory function.
Collapse
|
28
|
Barberà JA, Peces-Barba G, Agustí AG, Izquierdo JL, Monsó E, Montemayor T, Viejo JL. [Clinical guidelines for the diagnosis and treatment of chronic obstructive pulmonary disease]. Arch Bronconeumol 2001; 37:297-316. [PMID: 11412529 DOI: 10.1016/s0300-2896(01)75074-0] [Citation(s) in RCA: 154] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- J A Barberà
- Servei de Neumologia, Hospital Clinic, Villarroel, Barcelona, Spain
| | | | | | | | | | | | | |
Collapse
|
29
|
Sala E, Alegre L, Carrera M, Ibars M, Orriols FJ, Blanco ML, Cárceles F, Bertran S, Mata F, Font I, Agustí AG. Supported discharge shortens hospital stay in patients hospitalized because of an exacerbation of COPD. Eur Respir J 2001; 17:1138-42. [PMID: 11491156 DOI: 10.1183/09031936.01.00068201] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
This prospective, controlled, but not formally randomized study investigates the feasibility and efficiency of an alternative to standard hospitalization for patients with exacerbated chronic obstructive pulmonary disease (COPD), based upon supported discharge with nurse supervision at home. Over a 12-month period, emergency physicians, not directly involved in the study, admitted 205 patients with exacerbated COPD to the authors' respiratory unit. Patients were included in the supported discharge group (n=105) if they voluntarily chose to participate in the programme and lived in the city of Palma de Mallorca (where adequate home support could be provided). Patients not fulfilling these criteria (mainly residents outside the city) served as controls (n=100). Inpatient treatment was standardized in all patients and included oxygen therapy, bronchodilators, antibiotics and steroids. Both groups were comparable in terms of age (mean +/- SD: 70 +/- 10 versus 65 +/- 11 yr for supported discharge and control group, respectively), severity of airflow obstruction (forced expiratory volume in one second 45 +/- 18% reference versus 46 +/- 19% ref.), comorbidity and socioeconomic status. Length of hospital stay (LOS) in the supported discharge group was shorter (5.9 +/- 2.8 versus 8.0 +/- 5.1 days, p < 0.001). After discharge, a respiratory nurse visited supported discharge patients at home during 7.3 +/- 3.8 days. Only one patient (1%) required hospital readmission during this period of time. The reduced LOS resulted in a lower utilization of hospital beds at any given point in time throughout the study period. Within the framework and potential limitations of this study, the results indicate that the supported discharge programme in Spain: 1) allows a significant reduction in the length of hospital stay of patients hospitalized because of an exacerbation of chronic obstructive pulmonary disease; 2) does not result in an inappropriately increased rate of hospital readmissions; and 3) reduces the utilization of hospital resources.
Collapse
Affiliation(s)
- E Sala
- Hospital Universitari Son Dureta, Palma de Mallorca, Spain
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
30
|
|
31
|
De Lac Iglesia Martínez F, De La Fuente Cid R, Ramos Polledo V, Pellicer Vázquez C, Nicolás Miguel R, Diz-Lois Martínez F. Análisis factorial de la calidad de vida relacionada con la salud de pacientes con enfermedad pulmonar obstructiva crónica estable. Arch Bronconeumol 2001. [DOI: 10.1016/s0300-2896(01)75110-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
32
|
|
33
|
Fernández Vargas AM, Bujalance Zafra MJ, Leiva Fernández F, Martos Crespo F, García Ruiz A, Pradós Torres D. [Correlation between subjective and objective health measurements in patients with chronic obstructive pulmonary disease (COPD)]. Aten Primaria 2001; 28:579-87. [PMID: 11747770 PMCID: PMC7679522 DOI: 10.1016/s0212-6567(01)70457-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
AIMS Analyze the relation between objective health assessment (OHA) -Forced spirometry- and subjective health assessment (SHA) -quality of life- in patients with chronic obstructive pulmonary disease (COPD). Analyze the correlation between two different questionnaires to assess quality of life. DESIGN Cross-sectional study. PARTICIPANTS 278 patients with COPD (confidence level 95%) from two urban health centers. MAIN MEASUREMENTS Personal interview. VARIABLES quality of life (Nottingham Health Profile; St George Respiratory Questionnaire); sociodemographic profile; diagnose of COPD; comorbidity; recent spirometry. STATISTICAL ANALYSES Descriptive statistics; test ji-squared, Kruskal-Wallis and the correlation coefficient. RESULTS Age: 66,9 years; sex: 88% male. Quality of life scales (mean and confidence intervals): Nottingham Health Profile subscales (total score 100 points): energy 40 (35.6-44.4), pain 35.9 (32.3-39.5), emotional reactions 32.5 (29.4-38.6), sleep 41.9 (37.8-45.9), social isolation 15.3 (12.7-17.9), mobility 36.7 (33.9-39.5) and global score 33.4 (30.8-36). St George Respiratory Questionnaire subscales (total scores 100 points): impact 38.01 (35.08-40.18), activity 53.8 (50.2-57.4), symptoms 37.7 (35.2-40.3) and global score 40.0 (38.6-43.2). The correlation coefficients between the two questionnaires ranged between 0.12 (for the sleep and symptoms dimensions: p = 0.03) and 0.66 (for the mobility and activity dimensions; p < 0.0001). There is a positive lineal relation between the two questionnaires and the spirometric stages of COPD (measured by the maximum respiratory volume in the first second). CONCLUSIONS We found a good correlation between the two quality of life questionnaires, but St George was more specific for respiratory illness. There is a mild-light correlation between objective and subjective health assessment in patients with COPD.
Collapse
Affiliation(s)
- A M Fernández Vargas
- Especialista en Medicina Familiar y Comunitaria. Unidad Docente de MFyC Málaga, Spain.
| | | | | | | | | | | |
Collapse
|
34
|
Ruiz Manzano J, Fernández-Martínez P, Morera J, Prats M, Rosell A, Andreo F. Infección y uso de antibióticos en la EPOC en atención primaria. Arch Bronconeumol 2000. [DOI: 10.1016/s0300-2896(15)30152-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
35
|
Casan P, Belda J. [Glucocorticoids in the treatment of chronic obstructive pulmonary disease]. Med Clin (Barc) 2000; 114:694-5. [PMID: 10916790 DOI: 10.1016/s0025-7753(00)71405-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
36
|
|
37
|
[A pharmacoeconomic study of the antibiotic treatment of the acute manifestations of chronic bronchitis in primary care. The DAFNE Group]. Aten Primaria 2000. [PMID: 10730438 DOI: 10.1016/s0212-6567(00)78479-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To evaluate the effectiveness and the cost of antibiotic treatment of chronic bronchitis (CB) crises and COPD in PC. DESIGN Prospective cohort study of patients with CB and COPD monitored in health districts. Information was requested on the first ten patients, without any selection, who attended for consultation with the diagnosis of a crisis in their CB or COPD. They were followed for 30 days and the direct costs of their care were evaluated. The cost-effectiveness of the various types of antibiotic treatment was analysed. RESULTS 268 doctors took part and provided 2354 patients who were valid for the study. 20.8% (490/2354) came back within 30 days because of poor evolution: 79 (3.3%) of these needed hospital admission. The average cost of the failure was 57,687 pesetas. The cost of the use of cephixime was 14,388 pesetas per crisis, with 82.5% effectiveness. The cost for the alternative of "other antibiotics" was 19,775 pesetas, with 73.4% effectiveness. For the alternative amoxycillin-clavulanic acid, the cost was 18,647 pesetas with 74.4% effectiveness. CONCLUSIONS A fifth of the patients evolved poorly, which led to the admission of 3.3%. Cephixime treatment was the dominant treatment, as it is more effective and cheaper than all the other antibiotics and than amoxycillin-clavulanic acid treatment. The cost of the therapeutic failure of crises is more than three times greater than the cost of antibiotic treatment. The rate of failure, which means considerable morbidity at very high cost, must be reduced.
Collapse
|
38
|
|
39
|
de la Iglesia Martínez F, Pellicer Vázquez C, Ramos Polledo V, Nicolás Miguel R, Diz-Lois Martínez F, Pita Fernández S. La enfermedad pulmonar obstructiva crónica y las estaciones del año. Arch Bronconeumol 2000. [DOI: 10.1016/s0300-2896(15)30213-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
40
|
Affiliation(s)
- J Ribas
- Servicio de Medicina-Neumología, Hospital-Residència Sant Camil, Sant Pere de Ribes, Barcelona
| |
Collapse
|
41
|
Miravitlles M, Espinosa C, Fernández-Laso E, Martos JA, Maldonado JA, Gallego M. Relationship between bacterial flora in sputum and functional impairment in patients with acute exacerbations of COPD. Study Group of Bacterial Infection in COPD. Chest 1999; 116:40-6. [PMID: 10424501 DOI: 10.1378/chest.116.1.40] [Citation(s) in RCA: 313] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
STUDY OBJECTIVES To investigate the possible relationship between functional respiratory impairment measured by FEV1 and isolation of diverse pathogens in the sputum of patients with exacerbations of COPD. DESIGN Multicenter, cross-sectional, epidemiologic study. SETTING Pneumology units in six secondary or tertiary hospitals in Spain. PATIENTS Ninety-one patients with acute exacerbation of COPD were included. INTERVENTIONS A quantitative sputum culture was performed, and bacterial growth was considered significant only when the germ was isolated at concentrations > 10(6) cfu (> 10(5) for Streptococcus pneumoniae) in samples with < 10 epithelial cells and > 25 leukocytes per low magnification field (x 100). RESULTS Germs isolated were the following: Haemophilus influenzae (20 cases; 22%), Pseudomonas aeruginosa (14 cases; 15%), S. pneumoniae (9 cases; 10%), Moraxella catarrhalis (8 cases; 9%), other gram-negative bacteria (7 cases; 7%), and non-potentially pathogenic microorganisms (non-PPMs; 33 cases; 36%). P. aeruginosa and H. influenzae were isolated more frequently among the patients with FEV1 < 50% than among those with FEV1 > 50% (p < 0.05). All patients with P. aeruginosa in sputum had FEV1 < 1,700 mL. FEV1 < 50% was associated with a very high risk of P. aeruginosa or H. influenzae isolation: the odds ratios (ORs) are 6.62 (95% confidence interval [CI], 1.2 to 123.6) and 6.85 (95% CI, 1.6 to 52.6), respectively. Furthermore, active tobacco smoking was associated with a high risk of H. influenzae isolation (OR, 8.1; 95% CI, 1.9 to 43.0). CONCLUSIONS Patients with the greatest degree of functional impairment, as measured by their FEV1, presented a higher probability of having an isolation of P. aeruginosa or H. influenzae in significant concentrations in sputum during an exacerbation. The diagnostic yield of sputum in patients with an FEV1 > 50% was low, with a predominance of non-PPMs. Low FEV1 and active tobacco smoking are data that should be considered when establishing an empiric antibiotic treatment for exacerbated COPD.
Collapse
Affiliation(s)
- M Miravitlles
- Pneumology Department, Hospital Vall d'Hebron, Barcelona, Spain.
| | | | | | | | | | | |
Collapse
|
42
|
Elías Hernández M, Ortega Ruiz F, Sánchez Riera H, Otero Candelera R, Sánchez Gil R, Montemayor Rubio T. Papel de la disnea en la calidad de vida del paciente con enfermedad pulmonar obstructiva crónica. Arch Bronconeumol 1999. [DOI: 10.1016/s0300-2896(15)30241-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
43
|
Miravitlles M, Murio C, Guerrero T, Segú JL. [Treatment of chronic bronchitis and chronic pulmonary obstructive disease in primary care]. Arch Bronconeumol 1999; 35:173-8. [PMID: 10330538 DOI: 10.1016/s0300-2896(15)30274-x] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
In spite of the recent publication of various guidelines for the treatment of chronic bronchitis and chronic obstructive pulmonary disease (COPD), no studies have investigated whether or not they are being implemented by caregivers. Our aim was to determine what treatment protocols for patients with chronic bronchitis and COPD are most commonly applied by general practitioners in Spain and to identify factors associated with the prescription of certain drugs. A standardized questionnaire was administered to 268 general practitioners working in the 17 autonomous communities of Spain. The stratified sample of respondents was selected to reflect the population of each community. Valid information on 2,414 patients was collected. Men accounted for 74% of the patients. Mean age was 67 years (SD = 10). Lung function data were available for 1,130 (47%) and mean FEV1 was 1,523 ml (56% of the theoretical reference value). Patients without lung function data in spite of having signs of severe symptoms had suffered more acute exacerbations and generated more visits to the emergency room and to their primary care doctors in the preceding year than had patients who had undergone lung function testing (p < 0.03; p < 0.001; p < 0.003, respectively). The treatments most often prescribed were short-acting inhaled beta-2 agonists (56%), inhaled corticoids (47%), theophylline-containing drugs (43%), and long-lasting beta-2 agonists (41%). Patients who had not undergone function tests received more mucolytics (47% versus 27%, p < 0.001) and fewer anticholinergics (20% versus 35%, p < 0.001). The factor most highly associated with prescription of all drugs was severity of disease measured by dyspnea. Treatment protocols for chronic bronchitis and COPD in general practice in many aspects show differences from current guidelines. Noteworthy is the extensive use of inhaled corticoid therapy and long-lasting beta-2 adrenergic agonists and the infrequent prescription of anticholinergics. The lack of lung function data is associated with poor pharmacologic management of disease and higher rates of morbidity.
Collapse
Affiliation(s)
- M Miravitlles
- Servicio de Neumología, Hospital General Vall d'Hebron.
| | | | | | | |
Collapse
|
44
|
Miravitlles M, Mayordomo C, Artés M, Sánchez-Agudo L, Nicolau F, Segú JL. Treatment of chronic obstructive pulmonary disease and its exacerbations in general practice. EOLO Group. Estudio Observacional de la Limitación Obstructiva al Flujo aEreo. Respir Med 1999; 93:173-9. [PMID: 10464874 DOI: 10.1016/s0954-6111(99)90004-5] [Citation(s) in RCA: 133] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The high prevalence and chronicity of chronic obstructive pulmonary disease (COPD) imply that many of these patients are treated and controlled in primary-care centres, often without contact with specialized pneumologist care. We conducted the present study to evaluate the treatment administered in stable and exacerbated COPD in GP-setting clinics and to investigate which factors could be associated with the different prescriptions. This is a cross-sectional observational study of ambulatory COPD patients. General practitioners (n = 201) were selected throughout Spain by regionally stratified sampling. We recorded the physician-reported prescription drug use in ambulatory treatment of stable COPD and acute exacerbations of COPD through a standard questionnaire. Factors independently associated with the prescription of drugs were ascertained by multiple logistic regression analysis. Of 1078 questionnaires reviewed, 1001 fulfilled quality criteria. There were 878 men (88%) and 123 women (12%); 777 (78%) were smokers or ex-smokers with a mean age of 68 years. Mean FEV1 was 47% predicted (% pred.) (SD = 13%). The median number of exacerbations was two per year (range = 0-16). Regular treatment for COPD was received by 878 (88%): the most commonly used drugs were inhaled beta 2-agonists (71%), theophyllines (53%) and inhaled corticosteroids (ICs) (50%), followed by mucolytics (25%), ipratropium bromide (23%), and oral corticosteroids (OCs) (4%). Treatment for exacerbations included inhaled bronchodilators (90%), antibiotics (89%), ICs (71%) and OCs (43%). Impairment of FEV1 was the factor most strongly associated in multiple regression analysis with increasing drug prescription in stable COPD, except for mucolytics, while the number of previous acute exacerbations was the main factor associated with exacerbation treatment except for OCs, the use of which was associated with more impaired pulmonary function. A significant number of the treatments prescribed in primary care for stable and exacerbated COPD do not follow current recommendations. Impairment in FEV1 is the factor most strongly associated with increasing prescription in stable COPD and the number of previous exacerbations is the main factor associated with exacerbation treatment.
Collapse
Affiliation(s)
- M Miravitlles
- Servei de Pneumologia, Hospital General Universitari Vall d'Hebron, Barcelona, Spain.
| | | | | | | | | | | |
Collapse
|
45
|
Fuerza de los músculos periféricos en pacientes con EPOC estable: correlación con parámetros funcionales respiratorios y de calidad de vida. Arch Bronconeumol 1999. [DOI: 10.1016/s0300-2896(15)30289-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
46
|
Affiliation(s)
- R Zalacain
- Servicio de Neumología, Hospital de Cruces, Vizcaya
| |
Collapse
|
47
|
Blanco Blanco I, Canto Argíz H, Carro del Camino F. Normativa SEPAR sobre diagnóstico y tratamiento de la enfermedad pulmonar obstructiva crónica: propuesta de cambio de la clasificación y otras sugerencias. Arch Bronconeumol 1998. [DOI: 10.1016/s0300-2896(15)30388-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
48
|
Montemayor Rubio T. Respuesta de los autores. Arch Bronconeumol 1998. [DOI: 10.1016/s0300-2896(15)30389-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
49
|
de Granda Orive J, Peña Miguel T. EPOC reagudizada por Escherichia coli. Terapia antibiótica en las reagudizaciones. ¿Debemos ampliar la normativa? Arch Bronconeumol 1998. [DOI: 10.1016/s0300-2896(15)30444-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
50
|
Jiménez-Fuentes MA, Gea J, Pallás O, Gallego F, Félez MA, Broquetas JM. [Fiber morphometry of the external intercostal muscle. Comparison of dominant and nondominant sides in patients with severe COPD]. Arch Bronconeumol 1998; 34:189-93. [PMID: 9611653 DOI: 10.1016/s0300-2896(15)30451-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The general morphometric characteristics of the external intercostal muscle (EIM) of patients with chronic respiratory disease have been well described. Because this muscle is highly accessible, it can provide an ideal model for longitudinal studies using consecutive biopsies of both sides. Whether or not the EIM fiber phenotype is homogeneous on dominant (D) and non dominant (ND) sides is unknown, however. To evaluate possible structural differences in right and left EIM in patients with COPD, eight patients (63 +/- 7 years of age) were enrolled. Lung function, respiratory muscle power, general muscle power and nutritional state were evaluated. Biopsies of the fifth EIM were taken from both sides. Specimens were processed in parallel manner to determine conventional morphometry (hematoxylin-eosin staining), including minimum diameter (Dm) and fiber area (Ar) in cross sections. Fibers were typed by ATPase (at pH 4.2, 4.6 and 9.4) and NADH-TR staining. Nutrition was normal in all patients. All patients had severe COPD (FEV1 27 +/- 7% of reference, limits 13 to 38% of reference) with air entrapment (RV 163 +/- 36% of reference, limits 181 to 276% of reference). None of the patients showed respiratory insufficiency at rest (PaO2 72 +/- 7 mmHg). Peripheral musculoskeletal power measured by manual dynamometer showed no significant right-left differences: D 29 +/- 2 and ND 28 +/- 3 dynes. Morphometric study of 16 muscle specimens showed no significant differences between fiber size on D and ND sides. DmD was 47 +/- 10 microns and ArD, was 2,595 +/- 1,249 microns2. DmD was 49 +/- 9 microns and ArD was 2,636 +/- 953 microns2. Likewise, no significant differences were found between D and ND fiber types: type ID 51 +/- 4% and type IID 49 +/- 5% versus type IND 52 +/- 4% and type IIND 48 +/- 4%. EIM on N and ND sides is homogeneous at the fifth intercostal space. This finding, along with the scarcely invasive nature of the technique for collecting specimens leads us to suggest that longitudinal studies might be performed on the structural effects of various pharmacological or physical treatments followed by COPD patients
Collapse
Affiliation(s)
- M A Jiménez-Fuentes
- Servicio de Neumología, Hospital del Mar-IMIM, Universidad Autónoma de Barcelona
| | | | | | | | | | | |
Collapse
|