1
|
Tang X, Xu C, Zhou T, Qiang Y, Wu Y. Association of low attenuation area scores with pulmonary function and clinical prognosis in patients with chronic obstructive pulmonary disease. Open Life Sci 2024; 19:20220871. [PMID: 39156987 PMCID: PMC11330171 DOI: 10.1515/biol-2022-0871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 11/20/2023] [Accepted: 11/24/2023] [Indexed: 08/20/2024] Open
Abstract
The objective of this study was to investigate the relationship between low attenuation area (LAA) scores, pulmonary function parameters, and clinical prognosis in patients with chronic obstructive pulmonary disease (COPD). COPD patients were divided into four LAA-based grades. Various lung function parameters were measured and correlated with LAA scores. Patient symptoms were examined using the St. George's Respiratory Questionnaire (SGRQ) and exercise capacity using the 6-min walk test (6MWT). Statistical analysis determined the significance of differences. Higher levels of LAA were associated with decreased lung function and airflow limitations, suggesting a positive relationship between the two. Clinical symptom scores increased as COPD severity based on LAA stratification worsened. Reduced exercise capacity was shown by a substantial decline in 6MWT scores as COPD severity increased. As LAA scores increased, SGRQ scores increased, indicating a decreased quality of life (QOL). The study demonstrated a relationship between LAA scores and COPD severity. High LAA scores were associated with poor lung function, worse clinical symptoms, limited exercise capacity, and lower QOL. These findings show that LAA scores are clinically relevant for disease severity assessment and COPD management. Further research is required to determine LAA scores' prognostic significance in disease progression and treatment response to enhance COPD therapy.
Collapse
Affiliation(s)
- Xiangli Tang
- Department of Radiology, Changxing People’s Hospital, Huzhou313100, Zhejiang, China
| | - Chentao Xu
- Department of Radiology, Changxing People’s Hospital, Huzhou313100, Zhejiang, China
| | - Tianjin Zhou
- Department of Radiology, Changxing People’s Hospital, Huzhou313100, Zhejiang, China
| | - Yanfei Qiang
- Department of Respiratory, Changxing People’s Hospital, Huzhou313100, Zhejiang, China
| | - Yingzhe Wu
- Department of Radiology, Changxing People’s Hospital, Huzhou313100, Zhejiang, China
| |
Collapse
|
2
|
de Vries MI, Effing TW, van der Palen J, Schrijver J, van der Valk P, Lenferink A. Evaluation of Exacerbation and Symptom-Free Time in Patients with COPD. COPD 2023; 20:9-17. [PMID: 37552476 DOI: 10.1080/15412555.2022.2136066] [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: 06/06/2022] [Revised: 10/07/2022] [Accepted: 10/08/2022] [Indexed: 08/09/2023]
Abstract
In clinical practice, clinicians mainly focus on Chronic Obstructive Pulmonary Disease (COPD) exacerbations and symptoms, while patients may prefer to evaluate periods free of COPD exacerbations and deteriorated symptoms. The latter would suit the positive health approach that centralizes people and their beliefs. We aimed to identify patient characteristics and health outcomes relating to: 1) COPD exacerbation-free days; 2) days with no more symptoms than usual; and 3) combined COPD exacerbation and comorbid flare-up-free days (i.e. chronic heart failure, anxiety, depression flare-ups) using negative binomial regression analyzes. Data were obtained from two self-management intervention trials including COPD patients with and without comorbidities. 313 patients (mean age 66.0 years, 63.6% male, 68.7% comorbidity) were included. Better baseline chronic respiratory questionnaire (CRQ) fatigue (incidence rate ratio (IRR) = 1.03 (95% CI 1.01-1.05), p = 0.02) and mastery scores (IRR = 1.03 (95% CI 1.00-1.06), p = 0.04) and fewer courses of antibiotics (IRR = 0.95 (95% CI 0.94-0.96), p < 0.01) were related to more COPD exacerbation-free days. Additionally, better baseline CRQ fatigue (IRR = 1.05 (95% CI 1.00-1.10), p = 0.04) and mastery scores (IRR = 1.06 (95% CI 1.00-1.12), p = 0.04), fewer courses of antibiotics (IRR = 0.94 (95% CI 0.91-0.96), p < 0.01), and improved CRQ dyspnea scores over 12 months of follow-up (IRR = 1.07 (95% CI 1.01-1.12), p < 0.01) were correlated to more days free of deteriorated symptoms. Less baseline dyspnea (modified Medical Research Council score) (IRR = 0.95 (95% CI 0.92-0.98), p < 0.01) and fewer courses of antibiotics (IRR = 0.94 (95% CI 0.93-0.95), p < 0.01) were associated with more combined COPD exacerbation and comorbid flare-up-free days. Healthcare professionals should be aware that less fatigue and better mastering of COPD relate to more exacerbation and symptom-free time in COPD patients.
Collapse
Affiliation(s)
- Mirthe I de Vries
- Health Technology and Services Research, Faculty of Behavioral, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, Netherlands
- Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, Netherlands
| | - Tanja W Effing
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
- School of Psychology, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
| | - Job van der Palen
- Medical School Twente, Medisch Spectrum Twente, Enschede, Netherlands
- Cognition, Data and Education, Faculty of Behavioral, Management and Social Sciences, University of Twente, Enschede, Netherlands
| | - Jade Schrijver
- Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, Netherlands
- Cognition, Data and Education, Faculty of Behavioral, Management and Social Sciences, University of Twente, Enschede, Netherlands
| | - Paul van der Valk
- Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, Netherlands
| | - Anke Lenferink
- Health Technology and Services Research, Faculty of Behavioral, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, Netherlands
- Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, Netherlands
- Clinical Research Centre, Rijnstate Hospital, Arnhem, Netherlands
| |
Collapse
|
3
|
Bischoff EWMA, Ariens N, Boer L, Vercoulen J, Akkermans RP, van den Bemt L, Schermer TR. Effects of Adherence to an mHealth Tool for Self-Management of COPD Exacerbations. Int J Chron Obstruct Pulmon Dis 2023; 18:2381-2389. [PMID: 37933244 PMCID: PMC10625742 DOI: 10.2147/copd.s431199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 10/17/2023] [Indexed: 11/08/2023] Open
Abstract
Purpose Poor adherence to COPD mobile health (mHealth) has been reported, but its association with exacerbation-related outcomes is unknown. We explored the effects of mHealth adherence on exacerbation-free weeks and self-management behavior. We also explored differences in self-efficacy and stages of grief between adherent and non-adherent COPD patients. Patients and Methods We conducted secondary analyses using data from a recent randomized controlled trial (RCT) that compared the effects of mHealth (intervention) with a paper action plan (comparator) for COPD exacerbation self-management. We used data from the intervention group only to assess differences in exacerbation-free weeks (primary outcome) between patients who were adherent and non-adherent to the mHealth tool. We also assessed differences in the type and timing of self-management actions and scores on self-efficacy and stages of grief (secondary outcomes). We used generalized negative binomial regression analyses with correction for follow-up length to analyze exacerbation-free weeks and multilevel logistic regression analyses with correction for clustering for secondary outcomes. Results We included data of 38 patients of whom 13 (34.2%) (mean (SD) age 69.2 (11.2) years) were adherent and 25 (65.8%) (mean (SD) age 68.7 (7.8) years) were non-adherent. Adherent patients did not differ from non-adherent patients in exacerbation-free weeks (mean (SD) 31.5 (14.5) versus 33.5 (10.2); p=0.63). Although statistically not significant, adherent patients increased their bronchodilator use more often and more timely, contacted a healthcare professional and/or initiated prednisolone and/or antibiotics more often, and showed at baseline higher scores of self-efficacy and disease acceptance and lower scores of denial, resistance, and sorrow, compared with non-adherent patients. Conclusion Adherence to mHealth may be positively associated with COPD exacerbation self-management behavior, self-efficacy and disease acceptance, but its association with exacerbation-free weeks remains unclear. Our results should be interpreted with caution by this pilot study's explorative nature and small sample size.
Collapse
Affiliation(s)
- Erik W M A Bischoff
- Radboud Institute for Health Sciences, Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Nikki Ariens
- Radboud Institute for Health Sciences, Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Lonneke Boer
- Radboud Institute for Health Sciences, Department of Clinical Psychology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Jan Vercoulen
- Radboud Institute for Health Sciences, Department of Clinical Psychology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Reinier P Akkermans
- Radboud Institute for Health Sciences, Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Lisette van den Bemt
- Radboud Institute for Health Sciences, Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Tjard R Schermer
- Radboud Institute for Health Sciences, Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands
- Science Support Office, Gelre Hospitals, Apeldoorn, the Netherlands
| |
Collapse
|
4
|
Machado A, Barusso M, De Brandt J, Quadflieg K, Haesevoets S, Daenen M, Thomeer M, Ruttens D, Marques A, Burtin C. Impact of acute exacerbations of COPD on patients' health status beyond pulmonary function: A scoping review. Pulmonology 2023; 29:518-534. [PMID: 35715333 DOI: 10.1016/j.pulmoe.2022.04.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 03/30/2022] [Accepted: 04/10/2022] [Indexed: 11/21/2022] Open
Abstract
This scoping review summarized the evidence regarding the impact of acute exacerbations of COPD (AECOPD) on patients' health status beyond pulmonary function. PubMed, Embase, and Web of Science were searched. Prospective cohort studies assessing the health status of patients with COPD in a stable phase of the disease and after a follow-up period (where at least one AECOPD occurred) were included. An integrated assessment framework of health status (i.e., physiological functioning, complaints, functional impairment, quality of life) was used. Twenty-two studies were included. AECOPD acutely affected exercise tolerance, quadriceps muscle strength, physical activity levels, symptoms of dyspnoea and fatigue, and impact of the disease. Long-term effects on quadriceps muscle strength, symptoms of dyspnoea and depression, and quality of life were found. Repeated exacerbations negatively impacted the fat-free mass, levels of dyspnoea, impact of the disease and quality of life. Conflicting evidence was found regarding the impact of repeated exacerbations on exercise tolerance and physical activity levels. AECOPD have well-established acute and long-term adverse effects on health status beyond pulmonary function; nevertheless, the recovery trajectory and the impact of repeated exacerbations are still poorly studied. Further prospective research is recommended to draw firm conclusions on these aspects.
Collapse
Affiliation(s)
- A Machado
- Respiratory Research and Rehabilitation Laboratory (Lab 3R), School of Health Sciences (ESSUA), University of Aveiro, Aveiro, Portugal; Institute of Biomedicine (iBiMED), University of Aveiro, Aveiro, Portugal; REVAL - Rehabilitation Research Center, Faculty of Rehabilitation Sciences, BIOMED Biomedical Research Institute, Hasselt University, Agoralaan Gebouw A, Diepenbeek 3590, Belgium; BIOMED - Biomedical Research Institute, Hasselt University, Diepenbeek, Belgium
| | - M Barusso
- REVAL - Rehabilitation Research Center, Faculty of Rehabilitation Sciences, BIOMED Biomedical Research Institute, Hasselt University, Agoralaan Gebouw A, Diepenbeek 3590, Belgium; Laboratory of Spirometry and Respiratory Physiotherapy-LEFiR, Universidade Federal de São Carlos-UFSCar, São Carlos, São Paulo, Brazil
| | - J De Brandt
- REVAL - Rehabilitation Research Center, Faculty of Rehabilitation Sciences, BIOMED Biomedical Research Institute, Hasselt University, Agoralaan Gebouw A, Diepenbeek 3590, Belgium; BIOMED - Biomedical Research Institute, Hasselt University, Diepenbeek, Belgium
| | - K Quadflieg
- REVAL - Rehabilitation Research Center, Faculty of Rehabilitation Sciences, BIOMED Biomedical Research Institute, Hasselt University, Agoralaan Gebouw A, Diepenbeek 3590, Belgium; BIOMED - Biomedical Research Institute, Hasselt University, Diepenbeek, Belgium
| | - S Haesevoets
- REVAL - Rehabilitation Research Center, Faculty of Rehabilitation Sciences, BIOMED Biomedical Research Institute, Hasselt University, Agoralaan Gebouw A, Diepenbeek 3590, Belgium; BIOMED - Biomedical Research Institute, Hasselt University, Diepenbeek, Belgium
| | - M Daenen
- Department of Respiratory Medicine, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - M Thomeer
- Department of Respiratory Medicine, Ziekenhuis Oost-Limburg, Genk, Belgium; Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
| | - D Ruttens
- Department of Respiratory Medicine, Ziekenhuis Oost-Limburg, Genk, Belgium; Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
| | - A Marques
- Respiratory Research and Rehabilitation Laboratory (Lab 3R), School of Health Sciences (ESSUA), University of Aveiro, Aveiro, Portugal; Institute of Biomedicine (iBiMED), University of Aveiro, Aveiro, Portugal
| | - C Burtin
- REVAL - Rehabilitation Research Center, Faculty of Rehabilitation Sciences, BIOMED Biomedical Research Institute, Hasselt University, Agoralaan Gebouw A, Diepenbeek 3590, Belgium; BIOMED - Biomedical Research Institute, Hasselt University, Diepenbeek, Belgium.
| |
Collapse
|
5
|
Machado A, Almeida S, Burtin C, Marques A. Giving Voice to People - Experiences During Mild to Moderate Acute Exacerbations of COPD. CHRONIC OBSTRUCTIVE PULMONARY DISEASES (MIAMI, FLA.) 2022; 9:336-348. [PMID: 35532921 PMCID: PMC9448013 DOI: 10.15326/jcopdf.2022.0283] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/04/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Acute exacerbations of chronic obstructive pulmonary disease (AECOPDs) have a negative impact on health status and disease progression, but their clinical presentation is heterogenous. A comprehensive understanding of individuals' experiences during an AECOPD is needed to develop person-centered interventions, such as pulmonary rehabilitation (PR). This study aimed to explore people's experiences during mild to moderate AECOPDs, and their thoughts on PR during this period. METHODS Short, semi-structured interviews were conducted with people with mild to moderate AECOPDs treated on an outpatient basis within 48 hours of the diagnosis. Interviews were audio recorded, transcribed, and analyzed by deductive thematic analysis using the Web Qualitative Data Analysis software. RESULTS Eleven people with AECOPDs (9 male, 67±10 years, forced expiratory volume in 1 second 41±16%predicted) participated. Four themes and 17 subthemes were identified: impact of an AECOPD (symptoms, physiological changes, limitations in activities of daily living, social constraints, psychological and emotional challenges, family disturbances); dealing with an AECOPD, ([not] depending on others, planning and compensation strategies); main needs during an AECOPD (breathe better, feel less tired, get rid of sputum, be able to walk); and (un)certainty about PR (lack of knowledge, getting better, exercises, design and timing, trust in health professionals). CONCLUSION AECOPDs, even when not requiring hospital admission, have a huge negative impact on people's lives. Individuals' thoughts about PR reflect the need to raise awareness for this intervention during AECOPDs. This study provides a foundation for the development of meaningful person-centered interventions during AECOPDs.
Collapse
Affiliation(s)
- Ana Machado
- Institute of Biomedicine, University of Aveiro, Aveiro, Portugal
- Department of Medical Sciences, University of Aveiro, Aveiro, Portugal
- Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
- Biomedical Research Institute, Hasselt University, Diepenbeek, Belgium
| | - Sara Almeida
- Institute of Biomedicine, University of Aveiro, Aveiro, Portugal
- Respiratory Research and Rehabilitation Laboratory, School of Health Sciences, University of Aveiro, Aveiro, Portugal
| | - Chris Burtin
- Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
- Biomedical Research Institute, Hasselt University, Diepenbeek, Belgium
| | - Alda Marques
- Institute of Biomedicine, University of Aveiro, Aveiro, Portugal
- Respiratory Research and Rehabilitation Laboratory, School of Health Sciences, University of Aveiro, Aveiro, Portugal
| |
Collapse
|
6
|
Ebadi Z, Goërtz YMJ, Van Herck M, Janssen DJA, Spruit MA, Burtin C, Thong MSY, Muris J, Otker J, Looijmans M, Vlasblom C, Bastiaansen J, Prins J, Wouters EFM, Vercoulen JH, Peters JB. The prevalence and related factors of fatigue in patients with COPD: a systematic review. Eur Respir Rev 2021; 30:30/160/200298. [PMID: 33853886 DOI: 10.1183/16000617.0298-2020] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 01/04/2021] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Fatigue is a distressing symptom in patients with COPD. Little is known about the factors that contribute to fatigue in COPD. This review summarises existing knowledge on the prevalence of fatigue, factors related to fatigue and the instruments most commonly used to assess fatigue in COPD. METHODS Pubmed, PsycINFO, EMBASE, Cochrane and CINAHL databases were searched for studies from inception up to 7 January 2020 using the medical subject headings "COPD" and "Fatigue". Studies were reviewed in accordance with PRISMA guidelines. RESULTS 196 studies were evaluated. The prevalence of fatigue ranged from 17-95%. Age (r=-0.23 to r=0.27), sex (r=0.11), marital status (r=-0.096), dyspnoea (r=0.13 to r=0.78), forced expiatory volume in 1 s % predicted (r=-0.55 to r=-0.076), number of exacerbations (r=0.27 to r=0.38), number of comorbidities (r=0.10), number of medications (r=0.35), anxiety (r=0.36 to r=0.61), depression (r=0.41 to r=0.66), muscle strength (r=-0.78 to r=-0.45), functional capacity (r=-0.77 to r=-0.14) and quality of life (r=0.48 to r=0.77) showed significant associations with fatigue. CONCLUSIONS Fatigue is a prevalent symptom in patients with COPD. Multiple physical and psychological factors seem to be associated with fatigue. Future studies are needed to evaluate these underlying factors in integral analyses in samples of patients with COPD.
Collapse
Affiliation(s)
- Zjala Ebadi
- Dept of Medical Psychology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands.,Joint first authors
| | - Yvonne M J Goërtz
- Dept of Research and Development, Ciro, Horn, The Netherlands.,Dept of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands.,NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands.,Joint first authors
| | - Maarten Van Herck
- Dept of Research and Development, Ciro, Horn, The Netherlands.,Dept of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands.,NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands.,REVAL - Rehabilitation Research Center, BIOMED - Biomedical Research Institute, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
| | - Daisy J A Janssen
- Dept of Research and Development, Ciro, Horn, The Netherlands.,Dept of Health Services Research, Care and Public Health Research Institute, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Martijn A Spruit
- Dept of Research and Development, Ciro, Horn, The Netherlands.,Dept of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands.,NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands
| | - Chris Burtin
- REVAL - Rehabilitation Research Center, BIOMED - Biomedical Research Institute, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
| | - Melissa S Y Thong
- Dept of Medical Psychology, Amsterdam University Medical Centers, location AMC, Amsterdam, The Netherlands
| | - Jean Muris
- Dept of Family Medicine, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | | | - Milou Looijmans
- Dept of Medical Psychology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Christel Vlasblom
- Dept of Medical Psychology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Joëlle Bastiaansen
- Dept of Medical Psychology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Judith Prins
- Dept of Medical Psychology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Emiel F M Wouters
- Dept of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands.,Ludwig Boltzmann Institute for Lung Health, Vienna, Austria
| | - Jan H Vercoulen
- Dept of Medical Psychology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Jeannette B Peters
- Dept of Medical Psychology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| |
Collapse
|
7
|
Rodríguez Hermosa JL, Fuster Gomila A, Puente Maestu L, Amado Diago CA, Callejas González FJ, Malo De Molina Ruiz R, Fuentes Ferrer ME, Alvarez-Sala JL, Calle Rubio M. Assessing the Usefulness of the Prevexair Smartphone Application in the Follow-Up High-Risk Patients with COPD. Int J Chron Obstruct Pulmon Dis 2021; 16:53-65. [PMID: 33447026 PMCID: PMC7802911 DOI: 10.2147/copd.s279394] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 12/11/2020] [Indexed: 01/02/2023] Open
Abstract
Introduction This manuscript analyzes the exacerbations recorded by the Prevexair application through the daily analysis of symptoms in high-risk patients with COPD and explores its usefulness in assessing clinical stability with respect to that reported in visits. Patients and Methods This study is a multi-centre cohort of COPD patients with the exacerbator phenotype who were monitored over 6 months. The Prevexair application was installed on the patients' smartphones. Patients used the app to record symptom changes, use of medication and use of healthcare resources. It is not established a recommended action plan when worsening of symptoms. At their clinical visit during the follow-up period, patients were asked about exacerbations suffered during these 6 months of monitoring. The investigators who conducted the visit were blinded about the Prevexair app records. Results The patients experienced a total of 185 exacerbations according to daily records in the app whereas only 64 exacerbations were recalled during medical visits. Perception became more accurate for severe exacerbations (kappa 0.6577), although we found no factors that predicted poor recall. The proportion of 72.5% patients were classified as unstable if the exacerbations captured by Prevexair were used to define stability, versus 47.8% if the exacerbations recall in visit was used. Two-thirds of the exacerbations recorded in the Prevexair application were not reported to doctors during their clinical visits. Almost half were treated with oral corticosteroids and/or antibiotics and more than one-quarter of the exacerbations treated did not seek medical attention. Conclusion The findings of this cohort study confirm that patients do not always remember the exacerbations suffered during their medical visit. The prevexair application is useful in monitoring COPD patients at high risk, in order to a better assessment of exacerbations of COPD during medical visits. Further research must be carried out to evaluate this strategy in clinical practice.
Collapse
Affiliation(s)
- Juan Luis Rodríguez Hermosa
- Pulmonology Department, Hospital Clínico San Carlos, Madrid, Spain.,Department of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Antonia Fuster Gomila
- Pulmonology Department, Hospital U. Son Llátzer, Palma De Mallorca, Balearic Islands, Spain
| | | | - Carlos Antonio Amado Diago
- Pulmonology Department, Hospital U. Marqués de Valdecilla, Santander, Cantabria, Spain.,Department of Medicine, Universidad de Cantabria, Santander, Spain
| | | | | | - Manuel E Fuentes Ferrer
- Department of Medicine Preventive, San Carlos Health Research Institute (IdISSC), Madrid, Spain.,Department of Medicine, Universidad Alfonso X El Sabio, Madrid, Spain
| | - Jose Luis Alvarez-Sala
- Pulmonology Department, Hospital Clínico San Carlos, Madrid, Spain.,Department of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Myriam Calle Rubio
- Pulmonology Department, Hospital Clínico San Carlos, Madrid, Spain.,Department of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| |
Collapse
|
8
|
Rodriguez Hermosa JL, Fuster Gomila A, Puente Maestu L, Amado Diago CA, Callejas González FJ, Malo De Molina Ruiz R, Fuentes Ferrer ME, Álvarez Sala-Walther JL, Calle Rubio M. Compliance and Utility of a Smartphone App for the Detection of Exacerbations in Patients With Chronic Obstructive Pulmonary Disease: Cohort Study. JMIR Mhealth Uhealth 2020; 8:e15699. [PMID: 32191213 PMCID: PMC7118552 DOI: 10.2196/15699] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 10/14/2019] [Accepted: 12/16/2019] [Indexed: 12/31/2022] Open
Abstract
Background In recent years, mobile health (mHealth)–related apps have been developed to help manage chronic diseases. Apps may allow patients with a chronic disease characterized by exacerbations, such as chronic obstructive pulmonary disease (COPD), to track and even suspect disease exacerbations, thereby facilitating self-management and prompt intervention. Nevertheless, there is insufficient evidence regarding patient compliance in the daily use of mHealth apps for chronic disease monitoring. Objective This study aimed to provide further evidence in support of prospectively recording daily symptoms as a useful strategy to detect COPD exacerbations through the smartphone app, Prevexair. It also aimed to analyze daily compliance and the frequency and characteristics of acute exacerbations of COPD recorded using Prevexair. Methods This is a multicenter cohort study with prospective case recruitment including 116 patients with COPD who had a documented history of frequent exacerbations and were monitored over the course of 6 months. At recruitment, the Prevexair app was installed on their smartphones, and patients were instructed on how to use the app. The information recorded in the app included symptom changes, use of medication, and use of health care resources. The patients received messages on healthy lifestyle behaviors and a record of their cumulative symptoms in the app. There was no regular contact with the research team and no mentoring process. An exacerbation was considered reported if medical attention was sought and considered unreported if it was not reported to a health care professional. Results Overall, compliance with daily records in the app was 66.6% (120/180), with a duration compliance of 78.8%, which was similar across disease severity, age, and comorbidity variables. However, patients who were active smokers, with greater dyspnea and a diagnosis of depression and obesity had lower compliance (P<.05). During the study, the patients experienced a total of 262 exacerbations according to daily records in the app, 99 (37.8%) of which were reported exacerbations and 163 (62.2%) were unreported exacerbations. None of the subject-related variables were found to be significantly associated with reporting. The duration of the event and number of symptoms present during the first day were strongly associated with reporting. Despite substantial variations in the COPD Assessment Test (CAT), there was improvement only among patients with no exacerbation and those with reported exacerbations. Nevertheless, CAT scores deteriorated among patients with unreported exacerbations. Conclusions The daily use of the Prevexair app is feasible and acceptable for patients with COPD who are motivated in their self-care because of frequent exacerbations of their disease. Monitoring through the Prevexair app showed great potential for the implementation of self-care plans and offered a better diagnosis of their chronic condition.
Collapse
Affiliation(s)
- Juan Luis Rodriguez Hermosa
- Pulmonology Department, Hospital Clínico San Carlos, Madrid, Spain.,Medical Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | | | - Luis Puente Maestu
- Pulmonology Department, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Carlos Antonio Amado Diago
- Pulmonology Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain.,Medical Department, School of Medicine, Universidad de Cantabria, Santander, Spain
| | | | | | - Manuel E Fuentes Ferrer
- Departament of Preventive Medicine, Hospital Clínico San Carlos, Madrid, Spain.,Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain
| | - Jose Luis Álvarez Sala-Walther
- Pulmonology Department, Hospital Clínico San Carlos, Madrid, Spain.,Medical Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Myriam Calle Rubio
- Pulmonology Department, Hospital Clínico San Carlos, Madrid, Spain.,Medical Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| |
Collapse
|
9
|
Dankers M, Nelissen-Vrancken MHJMG, Surminski SMK, Lambooij AC, Schermer TR, van Dijk L. Healthcare Professionals' Preferred Efficacy Endpoints and Minimal Clinically Important Differences in the Assessment of New Medicines for Chronic Obstructive Pulmonary Disease. Front Pharmacol 2020; 10:1519. [PMID: 32116657 PMCID: PMC7016298 DOI: 10.3389/fphar.2019.01519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 11/25/2019] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Registration authorities evaluate effects of new medicines for chronic obstructive pulmonary disease (COPD) on airway obstruction, dyspnea, health status and exacerbations. To establish clinical relevance, minimal clinically important differences (MCIDs) are used. The aim of this study was to investigate which efficacy endpoints and MCIDs healthcare professionals consider clinically relevant for new COPD medicines. MATERIALS AND METHODS 7,731 Healthcare professionals received an electronic questionnaire. Participants were asked for: 1) preferred efficacy endpoints for new COPD medicines and 2) cut-off values defining clinical relevance for forced expiratory volume in 1 sec (FEV1), Transition Dyspnea Index (TDI) and St. George's Respiratory Questionnaire (SGRQ). Those cut-off values were compared to the MCIDs used by registration authorities, namely 100 ml for FEV1, 1 unit for TDI and 4 units for SGRQ. RESULTS 227 Healthcare professionals responded to the questionnaire. Most preferred efficacy endpoints were exacerbations (51.0%), airway obstruction (46.9%) and health status (44.9%). Mean cut-off values for TDI and SGRQ were significantly higher than the corresponding MCIDs, mean differences 1.5 (95%CI = 1.3-1.8, p < 0.001) and 7.0 (95%CI = 5.1-8.8, p < 0.001), respectively. The mean cut-off value for FEV1 was comparable to the MCID (mean difference 2.2, 95%CI = -19.9-24.3, p = 0.84). CONCLUSIONS Healthcare professionals largely agree with efficacy endpoints used for the evaluation of new COPD medicines. However, they seem to prefer higher cut-off values for clinical relevance for TDI and SGRQ than the registration authorities. Effects of new medicines on TDI and SGRQ that are considered clinically relevant by registration authorities do, therefore, not necessarily reflect healthcare professionals' perspectives on clinical relevance.
Collapse
Affiliation(s)
- Marloes Dankers
- Dutch Institute for Rational Use of Medicine, Utrecht, Netherlands
| | | | | | - Anke C. Lambooij
- Dutch Institute for Rational Use of Medicine, Utrecht, Netherlands
| | - Tjard R. Schermer
- Nivel Netherlands Institute for Health Services Research, Utrecht, Netherlands
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Liset van Dijk
- Nivel Netherlands Institute for Health Services Research, Utrecht, Netherlands
- Department of Pharmacotherapy, Pharmacoepidemiology and Pharmacoeconomics (PTEE), Faculty of Mathematics and Natural Sciences, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, Netherlands
| |
Collapse
|
10
|
Calverley PM, Page C, Dal Negro RW, Fontana G, Cazzola M, Cicero AF, Pozzi E, Wedzicha JA. Effect of Erdosteine on COPD Exacerbations in COPD Patients with Moderate Airflow Limitation. Int J Chron Obstruct Pulmon Dis 2019; 14:2733-2744. [PMID: 31819405 PMCID: PMC6896911 DOI: 10.2147/copd.s221852] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 10/31/2019] [Indexed: 12/13/2022] Open
Abstract
Background The RESTORE study, a multi-national randomized, placebo-controlled study, showed that erdosteine - a muco-active antioxidant that modulates bacterial adhesiveness - reduced the rate and duration of exacerbations in moderate and severe COPD with a history of exacerbations. How much benefit patients with less severe disease experience when taking this drug remains unclear. Methods This post hoc analysis of the 254 RESTORE participants with spirometrically-defined moderate COPD (post-bronchodilator forced expiratory volume in 1 second [FEV1] 50‒79% predicted) examined exacerbation rate and duration, time to first exacerbation, and exacerbation-free time. Data were analyzed using descriptive statistics and comparisons between treatment groups used Wilcoxon rank-sum tests, Mann-Whitney U-tests, or log rank tests. Results Patients with moderate COPD received erdosteine 300 mg twice daily (n=126) or placebo (n=128) added to usual COPD therapy for 12 months. During this time, there were 53 exacerbations in the erdosteine group and 74 in the placebo group, with 42.1% and 57.8% of patients, respectively, experiencing an exacerbation. There was a 47% reduction in the mean exacerbation rate with erdosteine compared to placebo (0.27 vs 0.51 exacerbations per-patient per-year, respectively, P=0.003), and a 58.3% reduction in the mild exacerbation rate (0.23 vs 0.53 mild exacerbations per-patient per-year, P=0.001). Mean duration of exacerbations was 26% shorter in erdosteine-treated patients (9.1 vs 12.3 days for placebo, P=0.022), with significant reductions in the duration of mild and moderate-to-severe exacerbations. Mean time to first exacerbation was prolonged by 7.7% (182 days for erdosteine vs 169 days for placebo, P<0.001) and the mean exacerbation-free time was increased by 51 days (279 days for erdosteine vs 228 days for placebo; P<0.001). Conclusion These results indicate that adding erdosteine to usual COPD maintenance therapy reduces the number of mild, and duration of all, exacerbations in patients with moderate COPD and a history of exacerbations.
Collapse
Affiliation(s)
- Peter Ma Calverley
- Department of Medicine, Clinical Sciences Centre, University Hospital Aintree, Liverpool, UK
| | - Clive Page
- Faculty of Life Sciences and Medicine, King's College, London, UK
| | - Roberto W Dal Negro
- Lung Unit, National Centre for Respiratory Pharmacoeconomics and Pharmacoepidemiology, Verona, Italy
| | - Giovanni Fontana
- Pulmonology Department, Cough Centre, Careggi University Hospital, Firenze, Italy
| | - Mario Cazzola
- Department of Systems Medicine, Chair of Respiratory Medicine, University of Rome 'Tor Vergata', Rome, Italy
| | - Arrigo F Cicero
- Medical and Surgical Department, University of Bologna, Bologna, Italy
| | - Edoardo Pozzi
- Medical Affairs Department, Edmond Pharma, Paderno, Italy
| | - Jadwiga A Wedzicha
- Respiratory Division, National Heart And Lung Institute, Imperial College London, London, UK
| |
Collapse
|
11
|
Boer L, Bischoff E, van der Heijden M, Lucas P, Akkermans R, Vercoulen J, Heijdra Y, Assendelft W, Schermer T. A Smart Mobile Health Tool Versus a Paper Action Plan to Support Self-Management of Chronic Obstructive Pulmonary Disease Exacerbations: Randomized Controlled Trial. JMIR Mhealth Uhealth 2019; 7:e14408. [PMID: 31599729 PMCID: PMC6811767 DOI: 10.2196/14408] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 07/25/2019] [Accepted: 08/18/2019] [Indexed: 01/02/2023] Open
Abstract
Background Many patients with chronic obstructive pulmonary disease (COPD) suffer from exacerbations, a worsening of their respiratory symptoms that warrants medical treatment. Exacerbations are often poorly recognized or managed by patients, leading to increased disease burden and health care costs. Objective This study aimed to examine the effects of a smart mobile health (mHealth) tool that supports COPD patients in the self-management of exacerbations by providing predictions of early exacerbation onset and timely treatment advice without the interference of health care professionals. Methods In a multicenter, 2-arm randomized controlled trial with 12-months follow-up, patients with COPD used the smart mHealth tool (intervention group) or a paper action plan (control group) when they experienced worsening of respiratory symptoms. For our primary outcome exacerbation-free time, expressed as weeks without exacerbation, we used an automated telephone questionnaire system to measure weekly respiratory symptoms and treatment actions. Secondary outcomes were health status, self-efficacy, self-management behavior, health care utilization, and usability. For our analyses, we used negative binomial regression, multilevel logistic regression, and generalized estimating equation regression models. Results Of the 87 patients with COPD recruited from primary and secondary care centers, 43 were randomized to the intervention group. We found no statistically significant differences between the intervention group and the control group in exacerbation-free weeks (mean 30.6, SD 13.3 vs mean 28.0, SD 14.8 weeks, respectively; rate ratio 1.21; 95% CI 0.77-1.91) or in health status, self-efficacy, self-management behavior, and health care utilization. Patients using the mHealth tool valued it as a more supportive tool than patients using the paper action plan. Patients considered the usability of the mHealth tool as good. Conclusions This study did not show beneficial effects of a smart mHealth tool on exacerbation-free time, health status, self-efficacy, self-management behavior, and health care utilization in patients with COPD compared with the use of a paper action plan. Participants were positive about the supportive function and the usability of the mHealth tool. mHealth may be a valuable alternative for COPD patients who prefer a digital tool instead of a paper action plan. Trial Registration ClinicalTrials.gov NCT02553096; https://clinicaltrials.gov/ct2/show/NCT02553096.
Collapse
Affiliation(s)
- Lonneke Boer
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Erik Bischoff
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | | | - Peter Lucas
- Institute for Computing and Information Science, Radboud University, Nijmegen, Netherlands
| | - Reinier Akkermans
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Jan Vercoulen
- Department of Medical Psychology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Yvonne Heijdra
- Department of Pulmonary Diseases, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Willem Assendelft
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Tjard Schermer
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands.,Netherlands Institute for Health Services Research (NIVEL), Utrecht, Netherlands
| |
Collapse
|
12
|
Oliveira A, Machado A, Marques A. Minimal Important and Detectable Differences of Respiratory Measures in Outpatients with AECOPD †. COPD 2018; 15:479-488. [PMID: 30512981 DOI: 10.1080/15412555.2018.1537366] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Interpreting clinical changes during acute exacerbations of chronic obstructive pulmonary disease (AECOPD) is challenging due to the absence of established minimal detectable (MDD) and important (MID) differences for most respiratory measures. This study established MDD and MID for respiratory measures in outpatients with AECOPD following pharmacological treatment. COPD assessment test (CAT), modified Borg scale (MBS), modified British Medical Research Council (mMRC) questionnaire, peripheral oxygen saturation (SpO2), computerised respiratory sounds and forced expiratory volume in one second (FEV1) were collected within 24-48 hour of an AECOPD and after 45 days of pharmacological treatment. MID and MDD were calculated using anchor- (receiver operating characteristic and linear regression analysis) and distribution-based methods (effect size, SEM, 0.5*SD and MDC95) and pooled using Meta XL. Forty-four outpatients with AECOPD (31♂; 68.2 ± 9.1 years; FEV1 51.1 ± 20.3%predicted) participated. Significant correlations with CAT were found for the MBS (r = 0.34), mMRC (r = 0.39) and FEV1 (r = 0.33), resulting in MIDs of 0.8, 0.5-0.6 and 0.03L, respectively. MDD of 0.5-1.4 (MBS), 0.4-1.2 (mMRC), 0.10-0.28L (FEV1), 3.6-10.1% (FEV1%predicted), 0.9-2.4% (SpO2), 0.7-1.9 (number of inspiratory crackles), 1.1-4.5 (number of expiratory crackles), 7.1-25.8% (inspiratory wheeze rate) and 11.8-63.0% (expiratory wheeze rate) were found. Pooled data of MID/MDD showed that improvements of 0.9 for the MBS, 0.6 for the mMRC, 0.15L for the FEV1, 7.6% for the FEV1%predicted, 1.5% for the SpO2, 1.1 for the inspiratory and 2.4 for the number of expiratory number of crackles, 14.1% for the inspiratory and 32.5% for the expiratory wheeze rate are meaningful following an AECOPD managed with pharmacological treatment on an outpatient basis.
Collapse
Affiliation(s)
- Ana Oliveira
- a Faculty of Sports , University of Porto , Porto , Portugal.,b Lab 3R - Respiratory Research and Rehabilitation Laboratory, School of Health Sciences , University of Aveiro , Aveiro , Portugal.,c Institute of Biomedicine (iBiMED) , University of Aveiro , Aveiro , Portugal
| | - Ana Machado
- b Lab 3R - Respiratory Research and Rehabilitation Laboratory, School of Health Sciences , University of Aveiro , Aveiro , Portugal.,c Institute of Biomedicine (iBiMED) , University of Aveiro , Aveiro , Portugal
| | - Alda Marques
- b Lab 3R - Respiratory Research and Rehabilitation Laboratory, School of Health Sciences , University of Aveiro , Aveiro , Portugal.,c Institute of Biomedicine (iBiMED) , University of Aveiro , Aveiro , Portugal
| |
Collapse
|