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Sansbury LB, Lipson DA, Bains C, Anley GA, Rothnie KJ, Ismaila AS. Disease Burden and Healthcare Utilization Among Patients with Chronic Obstructive Pulmonary Disease (COPD) in England. Int J Chron Obstruct Pulmon Dis 2022; 17:415-426. [PMID: 35264848 PMCID: PMC8901413 DOI: 10.2147/copd.s336158] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 02/06/2022] [Indexed: 01/04/2023] Open
Abstract
Purpose Clinical guidelines for COPD management suggest pharmacologic treatment algorithms based on symptoms and exacerbation history. As previous research has suggested that prescribing patterns are not always aligned with these recommendations, this study investigated the burden of disease in patients with COPD receiving, and persisting on, new inhaled maintenance therapy. Patients and Methods This was a retrospective observational study using two linked electronic databases containing health records of patients in England. Patients aged ≥35 years with a confirmed diagnosis of COPD, and who initiated a new inhaled respiratory pharmacologic maintenance regimen between January 1, 2014 and December 31, 2016 (index date) were eligible for inclusion. New treatments could be long-acting muscarinic antagonist (LAMA) or long-acting β2-agonist (LABA) monotherapy, inhaled corticosteroid (ICS)/LABA or LAMA/LABA dual therapy, or a multiple-inhaler triple therapy (MITT; LAMA/LABA/ICS). Patients were required to have 12 months of available medical history prior to, and after, the index date. Results In total, 25,350 eligible patients were identified, of these 8282 (mean age: 70.9 years; 51.5% male) persisted with their newly prescribed inhaled therapy for ≥12 months and were included in the analysis. In the 12 months prior to index, 54% of patients had moderate or severe dyspnea (Medical Research Council score ≥3). The most common therapy initiated at index was MITT (42%), followed by ICS/LABA dual therapy (31.2%). The proportion of patients with moderate or severe dyspnea in the post-index period ranged from 29.0% of patients receiving ICS to 64.2% of patients receiving MITT. In the post-index period, 48.1% of patients experienced ≥1 exacerbation and 54.9% had ≥5 general practitioner visits. Conclusion Many of the patients with COPD in our study continued to experience symptoms and exacerbations, despite persisting on the same treatment for ≥12 months. This suggests that some patients may benefit from treatment modification in accordance with guideline recommendations.
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Affiliation(s)
- Leah B Sansbury
- Value Evidence and Outcomes, Epidemiology, R&D Global Medical, GlaxoSmithKline, Research Triangle Park, NC, USA
| | - David A Lipson
- Respiratory Clinical Sciences, GlaxoSmithKline, Collegeville, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Chanchal Bains
- Value Evidence and Outcomes, R&D Global Medical, GlaxoSmithKline, Uxbridge, UK
| | | | - Kieran J Rothnie
- Value Evidence and Outcomes, R&D Global Medical, GlaxoSmithKline, Uxbridge, UK
| | - Afisi S Ismaila
- Value Evidence and Outcomes, GlaxoSmithKline, Collegeville, PA, USA
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Correspondence: Afisi S Ismaila, Value Evidence and Outcomes, GlaxoSmithKline, 1250 South Collegeville Road, Collegeville, PA, 19426-0989, USA, Tel +1 919 315 8229, Email
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The Burden of Short-Acting β 2-Agonist Use in Asthma: Is There an Italian Case? An Update from SABINA Program. Adv Ther 2021; 38:3816-3830. [PMID: 34043208 PMCID: PMC8280008 DOI: 10.1007/s12325-021-01772-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 05/01/2021] [Indexed: 12/26/2022]
Abstract
Introduction Preliminary results from the SABINA (SABA use INAsthma) program showed lower overuse of short-acting β2-agonist (SABA) in Italy compared to other European countries. The aim of the present study was to ascertain whether SABINA’s results might have been affected by the Italian National Health System and pharmaceutical market dynamics, by examining patients’ characteristics in relation to SABA prescription/purchase habits. Methods Multiple approaches were used: (1) a retrospective study using the General Practitioners’ (GPs) Italian IQVIA Longitudinal Patient Database (LPD) to assess SABA overuse (more than two canisters/year) and its association with exacerbation risk; (2) a survey conducted across 200 Italian pharmacies to calculate the proportions of SABA purchases without a prescription; (3) a cross-sectional study on the specialists’ IQVIA Patient Analyzer database to understand the SABA prescription habits of specialists. Results Among SABA users identified through IQVIA LPD, the proportion of patients having more than two SABA canisters/year was 32%. Overall, patients prescribed more than two SABA canisters/year by GPs had 30% higher risk of exacerbations than patients with a maximum of two SABA canisters/year. The joint evaluation of IQVIA LPD and survey’s findings revealed that IQVIA LPD tracks three out of four SABA canisters dispensed. The survey showed that, on average, SABA users purchased four canisters/year. Patients prescribed SABA by specialists were more frequently men, younger, thinner, and had higher spirometry values. Conclusion SABA overuse is common in Italy, with a share of consumption not regulated by medical prescriptions. Because SABA overuse increases exacerbation risk, changes to national guidelines should be encouraged to ensure implementation of global recommendations. Supplementary Information The online version contains supplementary material available at 10.1007/s12325-021-01772-0.
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Ehteshami-Afshar S, Crothers K, Rodwin B, Bade B, Brandt C, Akgün KM. Does pulmonary subspecialty referral from primary care affect the adherence to vaccination recommendations in COPD patients? Respir Res 2021; 22:50. [PMID: 33579277 PMCID: PMC7880521 DOI: 10.1186/s12931-021-01639-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 01/27/2021] [Indexed: 01/30/2023] Open
Abstract
The importance of vaccinations for COPD patients has been previously described. However, there is still a gap between guideline recommendations and the implementation of preventive care delivery for these patients. Specially, the rise of SARS-CoV-2 pandemic has made the significance of vaccination adherence more critical to address. Our study showed that referral to pulmonary clinic is associated with increased odds of receiving influenza (OR = 1.97, [95% CI 1.07, 3.65]) and pneumococcal vaccinations (PCV13 OR = 3.55, [1.47, 8.54]; PPSV23 OR = 4.92, [1.51, 16.02]). These data suggest that partnerships between primary care physicians and pulmonologists can potentially improve the vaccination rates for patients with COPD.
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Affiliation(s)
| | - Kristina Crothers
- Veterans Affairs Puget Sound and University of Washington, Seattle, WA, USA
| | - Benjamin Rodwin
- Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.,Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA
| | - Brett Bade
- Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.,Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA
| | - Cynthia Brandt
- Veterans Affairs Connecticut Pain Research, Informatics, Multi-Morbidities, and Education Center, West Haven, CT, USA.,Emergency Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Kathleen M Akgün
- Internal Medicine, Yale University School of Medicine, New Haven, CT, USA. .,Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA. .,Veterans Affairs Connecticut Pain Research, Informatics, Multi-Morbidities, and Education Center, West Haven, CT, USA.
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End-of-Life Spending and Healthcare Utilization Among Older Adults with Chronic Obstructive Pulmonary Disease. Am J Med 2020; 133:817-824.e1. [PMID: 31883772 PMCID: PMC7319886 DOI: 10.1016/j.amjmed.2019.11.024] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 11/19/2019] [Accepted: 11/19/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND End-of-life spending and healthcare utilization among older adults with COPD have not been previously described. METHODS We examined data on Medicare beneficiaries aged 65 years or older with chronic obstructive pulmonary disease (COPD) who died during the period of 2013-2014. End-of-life measures were retrospectively reviewed for 2 years prior to death. Hospital referral regions (HRRs) were categorized into quintiles of age-sex-race-adjusted overall spending during the last 2 years of life. Geographic quintile variation in spending and healthcare utilization was examined across the continuum. RESULTS We investigated data on 146,240 decedents with COPD from 306 HRRs. Age-sex-race-adjusted overall spending per decedent during the last 2 years of life varied significantly nationwide ($61,271±$11,639 per decedent; range: $48,288±$3,665 to $79,453±$9,242). Inpatient care accounted for 40.2% of spending ($24,626±$6,192 per decedent). Overall, 82%±4% of decedents were admitted to the hospital for 13.7±3.1 days, and 55%±11% were admitted to an intensive care unit for 5.4±2.5 days. Compared with HRRs in the lowest spending quintile, HRRs in the highest spending quintile had a 1.5-fold longer hospital length of stay. Skilled nursing facilities accounted for 11.6% of spending ($7101±$2403 per decedent), and these facilities were utilized by 38%±7% of decedents for 18.7±4.9 days. Hospice accounted for 10.3% of spending ($6,307±$2,201 per decedent) and was utilized by 47%±9% of decedents for 39.7±14.8 days. Significant geographic variation in hospice utilization existed nationwide. CONCLUSIONS End-of-life spending and healthcare utilization among older adults with COPD varied substantially nationwide. Decedents with COPD frequently utilized acute care near the end of life. Hospice utilization was higher than expected, with significant geographic disparities.
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Lavorini F, Bianco A, Blasi F, Braido F, Corsico AG, Di Marco F, Gentile A, Paggiaro PL, Pegoraro V, Pelaia G, Rogliani P, Santus P, Scichilone N, Soldi A, Canonica GW. What drives inhaler prescription for asthma patients? Results from a real-life retrospective analysis. Respir Med 2020; 166:105937. [PMID: 32250870 DOI: 10.1016/j.rmed.2020.105937] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 02/27/2020] [Accepted: 03/17/2020] [Indexed: 01/05/2023]
Abstract
BACKGROUND The choice of inhaler device for asthma patients depends upon multiple attributes. We investigated factors that may drive general practitioners (GPs) and respiratory specialists in the prescription of inhaler devices for asthma patients who initiated inhalation therapy. METHODS We retrospectively analysed prescriptions by GPs and respiratory specialists to asthma patients commencing inhaled corticosteroid/long-acting β2-agonist combination therapy available as both pressurised metered-dose inhalers (pMDIs) and dry powder inhalers (DPIs). Patient characteristics were compared by device and multivariate analysis was used to model the likelihood of receiving a pMDI as opposed to a DPI in order to identify drivers for prescription. A sample of the respiratory specialists completed an ad-hoc survey of their perceived success in achieving asthma control in their patients and barriers to attaining full control. RESULTS Prescription of a particular inhaler device was unrelated to the characteristics of the patients. Multivariate analysis revealed that the main driver for the choice of inhaler device was the medication (Odds Ratio and 95% Confidence Interval, respectively for GPs and specialists: 0.19 [0.16-0.23]; 0.17 [0.08-0.37]). Specialists perceived asthma as being inadequately controlled in 41% of their patients, and considered patients' difficulties in using DPIs and pMDIs as instrumental in this, citing a need for a novel, more effective inhaler technology. CONCLUSION Physicians choose inhaler devices according to the prescribed drugs and not to the characteristics of the individual patient. This may reflect a lack of confidence in existing inhaler devices and underlines the need for technologies, which are more reliable and easier to use by patients.
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Affiliation(s)
- F Lavorini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
| | - A Bianco
- Department of Translational Medical Sciences, University of Campania "L. Vanvitelli", Naples, Italy
| | - F Blasi
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico Internal Medicine Department, Respiratory Unit and Adult Cystic Fibrosis Center, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - F Braido
- Department of Internal Medicine, Respiratory Diseases and Allergy Clinic, University of Genova, Azienda Policlinico IRCCs San Martino, Genoa, Italy
| | - A G Corsico
- Division of Respiratory Diseases, IRCCS Policlinico San Matteo Foundation - Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
| | - F Di Marco
- Department of Health Sciences, University of Milan, Italy - Respiratory Unit, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - A Gentile
- Mundipharma Pharmaceuticals, Milan, Italy
| | - P L Paggiaro
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Pisa, Italy
| | | | - G Pelaia
- Department of Medical and Surgical Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - P Rogliani
- Respiratory Medicine Department of Experimental Medicine, University of Rome "Tor Vergata" - Respiratory Unit, Policlinico Tor Vergata, Rome, Italy
| | - P Santus
- Department of Biomedical and Clinical Sciences (DIBIC) - University of Milan. Division of Respiratory Diseases - "L. Sacco" University Hospital - ASST Fatebenefratelli Sacco - Milan, Italy
| | - N Scichilone
- PROMISE Department, University of Palermo, Palermo, Italy
| | - A Soldi
- Mundipharma Pharmaceuticals, Milan, Italy
| | - G W Canonica
- Personalized Medicine, Asthma and Allergy Clinic, Humanitas Research Hospital - Department of Biomedical Sciences, Humanitas University, Milan, Italy
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Agostoni E, Barbanti P, Frediani F, Trifirò G, Burgio L, di Nola L, Pegoraro V, Pulimeno S, Cepparulo M. Real-world insights on the management of migraine patients: an Italian nationwide study. Curr Med Res Opin 2019; 35:1545-1554. [PMID: 30924392 DOI: 10.1080/03007995.2019.1602032] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objectives: Understanding migraine management using data from a sample of patients representative of the Italian general adult population.Methods: Retrospective analysis on IQVIA Italian Longitudinal Patient Database. Two cohorts were created. (a) The triptan user cohort included patients with triptan prescriptions between November 2015 and October 2016. Migraine days were estimated counting triptan and indometacin/caffeine/prochlorperazine (ICP) pills prescribed during the 6 months following first triptan prescription. Patients were categorized as having episodic (EM) or chronic (CM) migraine based on the number of migraine days following International Classification of Headache Disorders criteria. (b) The migraine preventive treatment (MPT) user cohort included patients with MPT prescriptions during the period June 2016-May 2017. MPTs considered included beta-blockers, calcium-channel blockers, antiepileptics, antidepressants and antiserotoninergics. Migraine days experienced by MPTs users were estimated counting triptan and ICP pills prescribed during the 6 months following the most recent MPT prescription, while the number of MPT switches was estimated based on MPT prescriptions during the previous two years.Results: There were 9461 patients with triptan prescriptions to treat migraine acute attacks, which accounted yearly for 0.8% of general adult population. CM patients accounted for 3% of triptan users. There were 2004 patients prescribed with MPTs, which accounted for 0.16% of general adult population. Overall, among MPT users, 291 (15%) were still experiencing at least four migraine days/month, with this proportion increasing with the increase in the number of MPT switches.Conclusions: Results from this study suggest an unmet need in the management of migraine: too many patients did not receive MPTs, with this potentially due to several reasons requiring further investigations. Furthermore, even among patients receiving MPTs, disease control level with now available drugs seems to be sub-optimal.
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Affiliation(s)
- Elio Agostoni
- Neurology and Stroke Unit, Department of Neurosciences, Niguarda Neuro Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Piero Barbanti
- Headache and Pain Unit, Department of Neurological, Motor and Sensorial Sciences, IRCCS San Raffaele Pisana, Rome, Italy
- San Raffaele University, Rome, Italy
| | - Fabio Frediani
- Headache Center, Neurology and Stroke Unit Division, S. Carlo Borromeo Hospital, ASST Santi Paolo e Carlo, Milan, Italy
| | - Gianluca Trifirò
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
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Roche N, Aguilaniu B, Zhi Li P, Hess D. Trends over time in COPD treatment choices by respiratory physicians: An analysis from the COLIBRI-COPD French cohort. Respir Med 2019; 156:8-14. [PMID: 31374262 DOI: 10.1016/j.rmed.2019.07.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 07/24/2019] [Accepted: 07/25/2019] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Over the last decade, new evidence and many guidelines have been published on COPD pharmacological treatments; prescriptions are often not in accordance with guidelines. MATERIALS AND METHODS Trends in physician treatment choices from February 2012 to November 2018 (Feb.2012/Nov.2018) were analyzed using data from COPD patients (spirometry-confirmed diagnosis) included in the COLIBRI-COPD cohort. Inhaled drug treatments (short- or long-acting β2-agonist [SABA or LABA], short- or long-acting anticholinergic [SAMA or LAMA], or corticosteroid [ICS]) were classified into 5 treatment categories: "No initial maintenance treatment (IMT)" (untreated, or only SAMA or SABA); "1 long-acting bronchodilator (LABD)" (LABA or LAMA); "2 LABDs" (LABA + LAMA); "1 LABD + ICS" (LABA or LAMA + ICS); "2 LABDs + ICS" (LABA + LAMA + ICS). For the purpose of the study, 4 periods were defined to achieve balanced samples (T1-T4). RESULTS Data from 4537 patients were collected. Over time, 3 major changes were observed: (1) an increase in treatment category "No IMT", mostly for GOLD 1 or GOLD A categories (GOLD A: from 19.1% at T1 to 41.2% at T4); (2) an increase in treatment category "2 LABDs" for GOLD 2 to 4 and GOLD A to D categories (GOLD B: from 15.4% to 29.7%); (3) a decrease in ICS use ("1 LABD + ICS" or "2 LABDs + ICS"), mostly for GOLD 1 to 3 and GOLD A categories (GOLD A, 2 LABDs + ICS: from 35.3% to 11.1%). CONCLUSION Changes over time in therapeutic profiles suggest that new evidence from scientific publications and recommendations may have had a rapid impact on clinical practice.
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Affiliation(s)
- Nicolas Roche
- Service de Pneumologie, Hôpitaux Universitaires Paris Centre, Hôpital Cochin, AP-HP and Université Paris Descartes (UMR1016, Institut Cochin), Sorbonne Paris Cite, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France.
| | - Bernard Aguilaniu
- Programme Colibri, Association pour la complémentarité des connaissances et des pratiques de la pneumologie (aCCPP), 19 avenue Marcelin Berthelot, 38100, Grenoble, France; Université Grenoble Alpes, Faculté de médecine et pharmacie, 23 Avenue Maquis du Grésivaudan, 38700, La Tronche, France.
| | - Pei Zhi Li
- Respiratory Epidemiology and Clinical Research Unit, Research Institute of the McGill University Health Centre, McGill University, 5252, boul. de Maisonneuve Ouest, Montreal, QC H4a 3s5, Canada.
| | - David Hess
- Programme Colibri, Association pour la complémentarité des connaissances et des pratiques de la pneumologie (aCCPP), 19 avenue Marcelin Berthelot, 38100, Grenoble, France.
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Delclaux C. No need for pulmonologists to interpret pulmonary function tests. Eur Respir J 2019; 54:54/1/1900829. [DOI: 10.1183/13993003.00829-2019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 05/29/2019] [Indexed: 11/05/2022]
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Topalovic M, Das N, Burgel PR, Daenen M, Derom E, Haenebalcke C, Janssen R, Kerstjens HAM, Liistro G, Louis R, Ninane V, Pison C, Schlesser M, Vercauter P, Vogelmeier CF, Wouters E, Wynants J, Janssens W. Artificial intelligence outperforms pulmonologists in the interpretation of pulmonary function tests. Eur Respir J 2019; 53:13993003.01660-2018. [PMID: 30765505 DOI: 10.1183/13993003.01660-2018] [Citation(s) in RCA: 86] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 01/25/2019] [Indexed: 12/29/2022]
Abstract
The interpretation of pulmonary function tests (PFTs) to diagnose respiratory diseases is built on expert opinion that relies on the recognition of patterns and the clinical context for detection of specific diseases. In this study, we aimed to explore the accuracy and interrater variability of pulmonologists when interpreting PFTs compared with artificial intelligence (AI)-based software that was developed and validated in more than 1500 historical patient cases.120 pulmonologists from 16 European hospitals evaluated 50 cases with PFT and clinical information, resulting in 6000 independent interpretations. The AI software examined the same data. American Thoracic Society/European Respiratory Society guidelines were used as the gold standard for PFT pattern interpretation. The gold standard for diagnosis was derived from clinical history, PFT and all additional tests.The pattern recognition of PFTs by pulmonologists (senior 73%, junior 27%) matched the guidelines in 74.4±5.9% of the cases (range 56-88%). The interrater variability of κ=0.67 pointed to a common agreement. Pulmonologists made correct diagnoses in 44.6±8.7% of the cases (range 24-62%) with a large interrater variability (κ=0.35). The AI-based software perfectly matched the PFT pattern interpretations (100%) and assigned a correct diagnosis in 82% of all cases (p<0.0001 for both measures).The interpretation of PFTs by pulmonologists leads to marked variations and errors. AI-based software provides more accurate interpretations and may serve as a powerful decision support tool to improve clinical practice.
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Affiliation(s)
- Marko Topalovic
- Respiratory Medicine, University Hospital Leuven, Chronic Diseases, Metabolism and Ageing, KU Leuven, Leuven, Belgium
| | - Nilakash Das
- Respiratory Medicine, University Hospital Leuven, Chronic Diseases, Metabolism and Ageing, KU Leuven, Leuven, Belgium
| | - Pierre-Régis Burgel
- Cochin Hospital, AP-HP, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Marc Daenen
- Dept of Respiratory Medicine, Hospital Oost-Limburg, Genk, Belgium
| | - Eric Derom
- Dept of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
| | | | - Rob Janssen
- Dept of Pulmonary Medicine, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Huib A M Kerstjens
- Dept of Pulmonary Medicine and Tuberculosis, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Giuseppe Liistro
- Dept of Pneumology, Cliniques Universitaires St-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Renaud Louis
- Dept of Respiratory Medicine, University Hospital, Liege, Belgium
| | - Vincent Ninane
- Dept of Respiratory Medicine, Saint-Pierre Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Christophe Pison
- Service Hospitalier Universitaire de Pneumologie et Physiologie, CHU Grenoble Alpes, Université Grenoble Alpes, Grenoble, France
| | - Marc Schlesser
- Dept of Pulmonary Medicine, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
| | - Piet Vercauter
- Dept of Respiratory Medicine, Onze-Lieve-Vrouw Hospital, Aalst, Belgium
| | - Claus F Vogelmeier
- Dept of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Member of the German Center for Lung Research (DZL), Marburg, Germany
| | - Emiel Wouters
- Dept of Respiratory Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Jokke Wynants
- Dept of Pneumology, Jessa Hospital, Hasselt, Belgium.,For a full list of Pulmonary Function Study Investigators, please refer to the Acknowledgements section
| | - Wim Janssens
- Respiratory Medicine, University Hospital Leuven, Chronic Diseases, Metabolism and Ageing, KU Leuven, Leuven, Belgium
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Wallace AE, Kaila S, Bayer V, Shaikh A, Shinde MU, Willey VJ, Napier MB, Singer JR. Health Care Resource Utilization and Exacerbation Rates in Patients with COPD Stratified by Disease Severity in a Commercially Insured Population. J Manag Care Spec Pharm 2019; 25:205-217. [PMID: 30698096 PMCID: PMC10397829 DOI: 10.18553/jmcp.2019.25.2.205] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality and is associated with substantial economic burden. There is a lack of data regarding COPD outcomes and costs in a real-world setting, particularly by Global Initiative for Chronic Obstructive Lung Disease (GOLD) severity. OBJECTIVES To (a) characterize a commercially insured U.S. population with COPD and (b) assess prevalence of exacerbations, health care resource utilization (HCRU), costs, and treatment patterns in a cohort of patients with confirmed COPD, overall and stratified by GOLD stage. METHODS This retrospective observational cohort study used administrative claims data from the HealthCore Integrated Research Database to identify patients with ≥ 1 inpatient, emergency room (ER), or office visit claim for COPD between January 1, 2012, and November 30, 2013, and continuous enrollment for 1 year before and 2 years after the first COPD diagnosis date. Patients with a spirometry claim within 12 months were eligible for medical record abstraction to confirm COPD diagnosis (forced expiratory volume in 1 second [FEV1]/forced vital capacity ratio < 0.7) and GOLD 1-4 classification (based on postbronchodilator FEV1 percent predicted). HCRU, costs, treatment patterns, and rate of moderate/severe exacerbation were identified from diagnosis up to 24 months. Outcomes were analyzed by univariate analysis stratified by GOLD classification. Multivariable analysis was conducted to assess associations between GOLD classification and outcomes of interest. RESULTS 53,484 patients newly diagnosed with COPD were identified who met initial inclusion criteria: 14,293 (27%) had a qualifying spirometry claim, and 1,505 had confirmed COPD (GOLD 1, 333 [22%]; GOLD 2, 823 [55%]; GOLD 3, 317 [21%]; GOLD 4, 32 [2%]). Patients with greater disease severity had higher rates of moderate/severe COPD exacerbations (GOLD 1 and 2, 40.4 and 48.9 per 100 person-years, respectively; GOLD 3 and 4, 83.6 and 89.1 per 100 person-years, respectively). All-cause and COPD-related inpatient admissions, COPD-related office visits, and COPD-related ER visits were more prevalent with more severe GOLD classification. Mean annual COPD-related medical costs increased with GOLD classification ($5,945 for GOLD 1 patients, $18,070 for GOLD 4). COPD maintenance medication was filled by 42%, 56%, 73%, and 75% of patients in GOLD 1-4 (57% overall), respectively; combination corticosteroid/long-acting beta2-agonist inhalers were the most commonly used medication, regardless of GOLD classification. Patients with more severe disease had greater adherence (range 44%-68% of days covered for GOLD 1-4) and persistence (range 107-209 days for GOLD 1-4). CONCLUSIONS Trends toward increases in exacerbations, HCRU, and costs were observed as airflow limitation worsened. Adherence and persistence with COPD maintenance therapy was suboptimal even with severe disease. DISCLOSURES This study was supported by Boehringer Ingelheim Pharmaceuticals (Ridgefield, CT), which was given the opportunity to review the manuscript for medical and scientific accuracy, as well as intellectual property considerations. Willey and Singer are employees of HealthCore (parent company Anthem), which received funding from Boehringer Ingelheim to complete this study. Wallace and Shinde were employed by HealthCore at the time of this study. Wallace and Singer report stock ownership in Anthem. Napier is an employee of Anthem. Kaila, Bayer, and Shaikh are employees of Boehringer Ingelheim Pharmaceuticsls. Portions of this research were presented at the following conferences: (a) A. Wallace, S. Kaila, V. Zubek, A. Shaikh, M. Shinde, V. Willey, M. Napier, and J. Singer, Healthcare resource utilization, costs, and exacerbation rates in patients with COPD stratified by GOLD airflow limitation classification in a US commercially insured population, presented at AMCP Nexus 2017; October 16-19, 2017; Dallas, TX; and (b) A.E. Wallace, V. Zubek, S. Kaila, A. Shaikh, M. Shinde, V. Willey, M.B. Napier, and J.R. Singer, Real-world treatment patterns among newly diagnosed COPD patients according to GOLD airflow limitation severity classification in a U.S. commercially insured/Medicare Advantage population, presented at CHEST 2017 Annual Meeting; October 28-November 1, 2017; Toronto, Ontario, Canada.
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Affiliation(s)
| | - Shuchita Kaila
- 2 Boehringer Ingelheim Pharmaceuticals, Ridgefield, Connecticut
| | - Valentina Bayer
- 2 Boehringer Ingelheim Pharmaceuticals, Ridgefield, Connecticut
| | - Asif Shaikh
- 2 Boehringer Ingelheim Pharmaceuticals, Ridgefield, Connecticut
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Inhaled corticosteroids and fractures in chronic obstructive pulmonary disease. Curr Opin Pulm Med 2019; 25:165-172. [DOI: 10.1097/mcp.0000000000000554] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Jouleh B, Erdal M, Eagan TM, Bakke P, Gulsvik A, Nielsen R. Guideline adherence in hospital recruited and population based COPD patients. BMC Pulm Med 2018; 18:195. [PMID: 30572869 PMCID: PMC6302492 DOI: 10.1186/s12890-018-0756-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 11/30/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Evidence from several studies show poor guideline adherence to COPD treatment, but no such study has been undertaken in Norway. The objectives of this study, was to estimate and compare the guideline adherence to COPD treatment in general population-based and hospital-recruited COPD patients, and find possible predictors of guideline adherence. METHODS From the prospective, observational EconCOPD-study, we analysed guideline adherence for 90 population-based COPD cases compared to 245 hospital-recruited COPD patients. Overall guideline adherence was defined as correct pharmacological treatment, and influenza vaccination the preceding year, and having received smoking cessation advice. Multivariate logistic regression analysis was performed with the dichotomous outcome overall guideline adherence adjusting for relevant variables. RESULTS The overall guideline adherence for population-based COPD cases was 6.7%, significantly lower than the 29.8% overall guideline-adherence amongst hospital-recruited COPD patients. Adherence to pharmacological treatment guidelines was 10.0 and 35.5%, for the two recruitment sources, respectively. GOLD-stage 3 to 4 was associated with significantly better guideline adherence compared to GOLD-stage 2 (OR (95% CI) 18.9 (8.37,42.7)). The unadjusted difference between the two recruitment sources was completely explained by degree of airflow obstruction. CONCLUSION Overall guideline adherence was very low for both recruitment sources. We call for increased attention from authorities and healthcare personnel to improve the quality of care given to this patient group.
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Affiliation(s)
- Bahareh Jouleh
- Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway
| | - Marta Erdal
- Department of Clinical Science, University of Bergen, N-5021, Bergen, Norway. .,Haukeland, Universitetssjukehus, Laboratoriebygget, Jonas Lies veg 87, 5021, Bergen, Norway.
| | - Tomas Mikal Eagan
- Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Science, University of Bergen, N-5021, Bergen, Norway
| | - Per Bakke
- Department of Clinical Science, University of Bergen, N-5021, Bergen, Norway
| | - Amund Gulsvik
- Department of Clinical Science, University of Bergen, N-5021, Bergen, Norway
| | - Rune Nielsen
- Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Science, University of Bergen, N-5021, Bergen, Norway
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Hsieh MJ, Huang SY, Yang TM, Tao CW, Cheng SL, Lee CH, Kuo PH, Wu YK, Chen NH, Hsu WH, Hsu JY, Lin MS, Wang CC, Wei YF, Tsai YH. The impact of 2011 and 2017 Global Initiative for Chronic Obstructive Pulmonary Disease (GOLD) guidelines on allocation and pharmacological management of patients with COPD in Taiwan: Taiwan Obstructive Lung Disease (TOLD) study. Int J Chron Obstruct Pulmon Dis 2018; 13:2949-2959. [PMID: 30310271 PMCID: PMC6165725 DOI: 10.2147/copd.s176065] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND This nationwide study was performed to evaluate the evolution of distributions of patients with COPD according to the 2011 and 2017 Global Initiative for Chronic Obstructive Pulmonary Disease (GOLD) guidelines and to assess the concordance between the prescribed medications and the pharmacological management recommended by the two distinct classification systems in Taiwan. SUBJECTS AND METHODS Data were retrospectively retrieved from stable COPD patients in 11 participating hospitals across Taiwan. Patients were grouped according to GOLD 2011 and 2017 guidelines respectively. Definitions of undertreatment and overtreatment were based on the pharmacological recommendations in the individual guidelines. RESULTS A total of 1,053 COPD patients were included. The percentages of patients in GOLD 2011 groups A, B, C and D were 18.4%, 40.6%, 6.7% and 34.2%, respectively. When reclassified according to the GOLD 2017, the percentages of group A and B increased to 23.3% and 63.2%, and groups C and D decreased to 1.9% and 11.6%, respectively. Up to 67% of patients in GOLD 2011 groups C and D were reclassified to GOLD 2017 groups A and B. The pharmacological concordance rate was 60.9% for GOLD 2011 and decreased to 44.9% for GOLD 2017. Overtreatment was found in 29.5% of patients according to GOLD 2011 and the rate increased to 46.1% when classified by the GOLD 2017. The major cause of overtreatment was unnecessary inhaled corticosteroids and the main cause of undertreatment was a lack of maintenance long-acting bronchodilators. CONCLUSION The distribution of COPD patients in Taiwan was more uneven with the GOLD 2017 than with the GOLD 2011. A pharmacological discordance to the guidelines was identified. Updated guidelines with reclassification of COPD patients resulted in more discordance between prescribed medications and the guidelines. Physicians should make proper adjustments of the prescriptions according to the updated guidelines to ensure the mostly appropriate treatment for COPD patients.
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Affiliation(s)
- Meng-Jer Hsieh
- Department of Pulmonary and Critical Care Medicine, Chiayi Chang Gung Memorial Hospital, Chang-Gung Medical foundation, Chiayi, Taiwan,
- Department of Respiratory Therapy, School of Medicine, Chang-Gung University, Taoyuan, Taiwan,
| | - Shu-Yi Huang
- Department of Pulmonary and Critical Care Medicine, Chiayi Chang Gung Memorial Hospital, Chang-Gung Medical foundation, Chiayi, Taiwan,
| | - Tsung-Ming Yang
- Department of Pulmonary and Critical Care Medicine, Chiayi Chang Gung Memorial Hospital, Chang-Gung Medical foundation, Chiayi, Taiwan,
| | - Chi-Wei Tao
- Department of Internal Medicine, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Shih-Lung Cheng
- Department of Internal Medicine, Far Eastern Memorial Hospital, Taipei
| | - Chao-Hsien Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan
| | - Ping-Hung Kuo
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Yao-Kuang Wu
- Division of Pulmonary Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Ning-Hung Chen
- Department of pulmonary and critical care medicine, LinKou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Wu-Huei Hsu
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Jeng-Yuan Hsu
- Division of Chest Medicine, Taichung Veterans General Hospital, Taiwan
| | - Ming-Shian Lin
- Dpartment of Internal Medicine, Ditmanson Medical Foundation, Chia-Yi Cristian Hospital, Chia-Yi, Taiwan
| | - Chin-Chou Wang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang-Gung Medical Foundation, Kaohsiung, Taiwan
| | - Yu-Feng Wei
- Department of Internal Medicine E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Ying-Huang Tsai
- Department of Pulmonary and Critical Care Medicine, Chiayi Chang Gung Memorial Hospital, Chang-Gung Medical foundation, Chiayi, Taiwan,
- Department of Respiratory Therapy, School of Medicine, Chang-Gung University, Taoyuan, Taiwan,
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Scalone G, Nava S, Ventrella F, Bussoli G, Catapano GA, Pennisi A, Dadduzio F, Schino P, Pela R, Bartezaghi M, Morini P, Porpiglia PA, Muscianisi E. Pharmacological approach and adherence to treatment recommendations in frequently and non-frequently exacerbating COPD patients from Italy: MISTRAL - The prospective cohort, observational study. Pulm Pharmacol Ther 2018; 53:68-77. [PMID: 30193866 DOI: 10.1016/j.pupt.2018.09.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 09/02/2018] [Accepted: 09/03/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Several documents and guidelines provide recommendations for effective management of COPD patients. However, there is often a significant imbalance between recommended treatment of COPD patients and the actual care provided both in primary care and specialty setting. This imbalance could result in a significant negative impact on patients' health status and quality of life, leading to increased hospitalisations and health resource utilisation in COPD patients METHODS: MISTRAL was an observational, longitudinal, prospective cohort study, designed to assess the overall pharmacological approach of COPD in routine clinical practice in Italy. Eligible patients were divided into two cohorts based on their exacerbation history in the year prior to the enrolment, frequent exacerbators (FEs; ≥2 exacerbations), and non-frequent exacerbators (NFEs; ≤1 exacerbation). The primary objective was to assess adherence to Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2011 treatment recommendations in FEs and NFEs at baseline and follow-up visits RESULTS: Of the 1489 enrolled patients, 1468 (98.6%; FEs, 526; NFEs, 942) were considered evaluable for analyses. At baseline, 57.8% of patients were treated according to GOLD 2011 recommendations; a greater proportion of FEs were treated according to GOLD recommendations, compared with NFEs patients at baseline (77.1% versus 46.7%; P < 0.0001), and all study visits. At baseline, GOLD group D patients were the most adherent (81.2%) to treatment recommendations, while group A patients were the least adherent (30.3%) at baseline, attributed mainly to overuse of inhaled corticosteroids in less severe GOLD groups. Triple therapy with long-acting muscarinic antagonist (LAMA) + long-acting β2-agonist/inhaled corticosteroid (LABA/ICS) was the most frequent prescribed treatment at all study visits, irrespective of patient's exacerbation history. Changes in treatment were more frequent in FEs versus NFEs CONCLUSIONS: The Mistral study reports a scarce adherence to the GOLD 2011 treatment recommendations in routine clinical practice in Italy. The adherence was particularly low in less severe, non-frequent exacerbating patients mostly for ICS overuse, and was higher in high-risk, frequent exacerbating COPD patients.
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Affiliation(s)
- Gino Scalone
- Respiratory Pathophysiology Service - House of Health, Chiaravalle C.le (CZ), Italy.
| | - Stefano Nava
- Alma Mater University, Dept of Clinical, Integrated and Experimental Medicine (DIMES), Respiratory and Critical Care Unit, S. Orsola-Malpighi Hospital, Bologna, Italy.
| | - Francesco Ventrella
- Department of Internal Medicine - G.Tatarella Hospital, Cerignola, Foggia, Italy.
| | - Guglielmo Bussoli
- Pneumology Service at Cittadella Socio-sanitaria- Cavarzere, Venice, Italy.
| | - Giosuè Angelo Catapano
- Pneumology Unit, G. Monasterio Tuscany Foundation/National Research Council, Pisa, Italy.
| | - Alfio Pennisi
- Respiratory Service Phisiopatology Rehab Center, Monsignor Goose, Calaciura, Biancavilla, Catania, Italy.
| | | | - Pietro Schino
- UO Pulmonary Fisiopathology, Miulli General Hospital, Acquaviva delle Fonti (BA), Italy.
| | - Riccardo Pela
- Pneumology Unit, C. e G. Mazzoni Hospital, Ascoli Piceno, Italy.
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Bengtson LG, DePietro M, McPheeters J, Fox KM. Real-world outcomes in patients with chronic obstructive pulmonary disease initiating long-acting mono bronchodilator therapy. Ther Adv Respir Dis 2018; 12:1753466618772750. [PMID: 29737943 PMCID: PMC5961922 DOI: 10.1177/1753466618772750] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 03/15/2018] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Randomized clinical trials have shown long-acting mono bronchodilator therapy to be efficacious in improving lung function and dyspnea, while reducing exacerbations; however, less is known regarding the effectiveness in routine clinical practice. This study examined treatment patterns, rescue medication use, healthcare resource utilization and costs, and exacerbations in patients with chronic obstructive pulmonary disease (COPD) who initiated long-acting mono bronchodilator therapy in real-world settings. METHODS This retrospective study used US claims data from adult patients with COPD initiating long-acting mono bronchodilator therapy between 1 January 2008 and 31 January 2015. Patients were required to have continuous health plan enrollment 12 months prior to (baseline period) and 12 months following therapy initiation (follow-up period). Outcomes, including treatment patterns, rescue medication use, exacerbations, and healthcare utilization and costs, were measured until the earliest of treatment augmentation or discontinuation, death, health plan disenrollment, or the end of the study period. Results were analyzed descriptively for all measures. Baseline and follow-up measures of all-cause and COPD-related healthcare costs and exacerbations [per patient per month (PPPM)] were compared using paired t tests. RESULTS Among 27,394 patients with a mean follow up of 6.3 months, 18.2% augmented, 74.2% discontinued, and 7.6% continued long-acting mono bronchodilator therapy. Rescue medication use was prevalent during the follow-up period, with an average of 1.0 short-acting β agonist (SABA) fills/month and 0.8 short-acting muscarinic antagonist (SAMA) fills/month, among patients with at least one fill for the medication of interest. PPPM mean number of exacerbations was more than triple (0.17 versus 0.05, p < 0.001) and PPPM exacerbation-related costs were more than double over the follow-up period compared with baseline ($1070 versus $485). COPD-related costs accounted for 50% of all-cause costs during the follow-up period and were significantly higher compared with baseline ($1206 versus $592, p < 0.001). CONCLUSIONS Patients initiating long-acting mono bronchodilator therapy had high rates of medication discontinuation or augmentation. Patients used more rescue medications and experienced significantly more COPD exacerbations with higher healthcare costs compared with baseline. Further research is warranted to determine whether more aggressive initial therapy would result in symptom improvement.
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Kahlil NH, Abdel-Hamid HM, Mohammed YM. Assessment of prescription practices according to international chronic obstructive pulmonary disease guidelines on Egyptian doctors. THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2017. [DOI: 10.4103/ejb.ejb_75_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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17
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Celli B, Blasi F, Gaga M, Singh D, Vogelmeier C, Pegoraro V, Caputo N, Agusti A. Perception of symptoms and quality of life - comparison of patients' and physicians' views in the COPD MIRROR study. Int J Chron Obstruct Pulmon Dis 2017; 12:2189-2196. [PMID: 28794623 PMCID: PMC5538543 DOI: 10.2147/copd.s136711] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES The aim of this study was to compare potential differences between the perception that COPD patients have of their disease and the perception that physicians have of how the disease affects their patients. METHODS Surveys in COPD patients and physicians caring for COPD patients were conducted in Spain, Italy, and Germany. Online questionnaires mirrored to explore the same domains, were administered to patients and physicians. Physicians were asked to respond to the questionnaire taking a recently seen patient who represents the majority of COPD patients usually managed, as a reference. Patients with COPD completed a survey containing the same questions offered to the physicians (Medical Investigation of Respiratory COPD Perception [MIRROR] survey). Comparisons between the responses of patients and general practitioners (GPs) and between patients and pulmonologists (PULs) were run separately using the chi-square, Fisher's exact, or Student's t-tests. RESULTS A total of 334 COPD patients, 333 GPs, and 333 PULs participated in the surveys. The typical perception that PULs have of the COPD patient was that of an older man with more severe disease and less likely to be a smoker, than the included COPD patients. COPD was regarded as a major health problem by patients and physicians, but its impact on overall quality of life among more severe patients was less strongly perceived by physicians than by patients. Instead, physicians paid more attention to domains related to clinical features (cough, phlegm, and dyspnea), while underestimating COPD impact on leisure and social activities. The majority of patients stated not being completely frank with their doctors during visits. Both GPs and PULs seemed to recognize this issue but underestimated its extent. CONCLUSION To improve the doctor-patient communication, a more frank reporting by the patients of their symptoms and feelings and an increased awareness of physicians about the impact on nonconventional domains that patients perceive as importantly affected by COPD should be encouraged.
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Affiliation(s)
- Bartolome Celli
- Pulmonary and Critical Care Medicine Division, Brigham and Women’s Hospital
- Harvard Medical School, Boston, MA, USA
| | - Francesco Blasi
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
- Internal Medicine Department, Respiratory Unit and Adult Cystic Fibrosis Center, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Mina Gaga
- 7th Respiratory Medicine Department and Asthma Centre, Athens Chest Hospital, Athens, Greece
| | - Dave Singh
- Medicines Evaluation Unit, University of Manchester, University Hospital of South Manchester, Manchester, UK
| | - Claus Vogelmeier
- Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-Universität Marburg, Marburg, Germany
- German Center for Lung Research (DZL), Giessen, Germany
| | | | | | - Alvar Agusti
- Respiratory Institute, Hospital Clinic, IDIBAPS, CibeRes, University of Barcelona, Barcelona, Spain
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Colivicchi F, Gulizia MM, Franzini L, Imperoli G, Castello L, Aiello A, Ripellino C, Cataldo N. Clinical Implications of Switching Lipid Lowering Treatment from Rosuvastatin to Other Agents in Primary Care. Adv Ther 2016; 33:2049-2058. [PMID: 27671328 PMCID: PMC5083763 DOI: 10.1007/s12325-016-0412-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Indexed: 12/22/2022]
Abstract
Introduction Switching from any statin to another non-equipotent lipid lowering treatment (LLT) may cause a low-density lipoprotein cholesterol increase and has been associated with a higher probability of negative cardiovascular outcomes. The aim of the study was to assess the impact of switching from rosuvastatin to any other LLT on clinical outcomes in primary care. Methods This was a retrospective analysis based on data from IMS Health Longitudinal Patient Database, which is a general practice database including information of more than 1.0 million patients representative of the Italian population by age, and medical conditions. Patients that started on rosuvastatin (10–40 mg/day) between January 2011 and December 2013 were considered. The date of the first prescription was defined as the index date (ID). The observation period lasted from the ID to September 2015 or until LLT discontinuation, or the occurrence of an acute myocardial infarction (AMI), or death. Results The primary end point of the study was the occurrence of an AMI during the observation period. The final study population included 10,368 patients. During the observation period, 2452 (23.6%) patients were switched from rosuvastatin to another LLT. The majority of patients (55.6%) were switched to atorvastatin, followed by simvastatin (24.9%), simvastatin/ezetimibe combination (10.0%) and other statins (9.5%). Female gender (HR, hazard ratio, 1.10, 95% CI, confidence interval, 1.02–1.19, p = 0.04) and the presence of chronic kidney disease (HR 1.47, 95% CI 1.16–1.86, p = 0.05) were associated with a higher probability of switch. During the observation period, 113 patients experienced an AMI (incidence of 6.7 AMI/1000 patient-years). Multivariate analysis with Cox proportional hazards method, including switching as a time-dependent covariate, demonstrated that changing from rosuvastatin to another LLT was an independent predictor of AMI (HR 2.2, 95% CI 1.4–3.5, p = 0.001). Conclusion We conclude that switching from rosuvastatin to another non-equipotent LLT may impart an increased risk of AMI and should be avoided. Funding AstraZeneca SpA.
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Affiliation(s)
- Furio Colivicchi
- Cardiology Division, S. Filippo Neri Hospital, ASL Roma 1, Rome, Italy
| | | | | | - Giuseppe Imperoli
- Internal Medicine Division, S. Filippo Neri Hospital, ASL Roma 1, Rome, Italy
| | - Lorenzo Castello
- Cardiology Division, S. Filippo Neri Hospital, ASL Roma 1, Rome, Italy
| | - Alessandro Aiello
- Cardiology Division, S. Filippo Neri Hospital, ASL Roma 1, Rome, Italy
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