The worldwide epidemiology of chronic obstructive pulmonary disease

Development of a self-scored persistent airflow obstruction screening questionnaire in a general Japanese population: the Hisayama study

BACKGROUND

The use of a simple screening questionnaire to detect persistent airflow obstruction (AO) in COPD may facilitate the early, accurate diagnosis of COPD in general practice settings.

OBJECTIVE

This study developed an original persistent AO questionnaire for screening individuals with COPD in a general Japanese population.

METHODS

A working group was established to generate initial draft questionnaire items about COPD. Eligible subjects aged 40 and older living in Japan were solicited to participate in a health checkup from 2014 to 2015. In study I, 2,338 subjects who fully completed the initial draft questionnaire and who had valid spirometry measurements were statistically analyzed to determine the final questionnaire items as a COPD screening questionnaire (COPD-Q). Persistent AO was defined as a post-bronchodilator FEV₁/FVC <0.70. In study II, the working group analyzed the weighted scores for individual items and established a cutoff point for the COPD-Q based on the data of 2,066 subjects in the Hisayama study. Receiver operating characteristic (ROC) curves were used to examine the ability of the COPD-Q to discriminate between subjects with and without AO.

RESULTS

The five-item COPD-Q was established based on 19 initial draft items in study I and the weighted scores of individual items. The overall area under the ROC curve for the COPD-Q was 0.796 (95% confidence interval, 0.707-0.788). A cutoff of 4 points resulted in a sensitivity of 71.0% and a specificity of 70.1%. The positive predictive value was 10.8%, and the negative predictive value was 97.9%. The crude odds ratio of the COPD-Q for AO was 5.8.

CONCLUSION

The five-item COPD-Q is a useful questionnaire for diagnosing persistent AO in a general Japanese population and is expected to be an effective first-stage screening tool for detecting COPD.

Do symptom-based questions help screen COPD among Chinese populations?

Spirometry is required to confirm a chronic obstructive pulmonary disease (COPD) diagnosis, but it is difficult to perform in resource-limited settings. This study aimed to evaluate symptom-based questions for screening of individuals with COPD among Chinese populations. We recruited 3969 adult subjects from the First Affiliated Hospital of Nanjing Medical University. Spirometric measurements of forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) were collected to confirm the COPD diagnosis. A symptom-based questionnaire was administered to collect data related to COPD. The sensitivity and specificity together with the area under the curve (AUC) were calculated. The traditional IPAG eight-item questionnaire yielded an AUC of 0.80(95% CI: 0.78–0.82), with a sensitivity of 67.8% and specificity of 76.8%. After removing and adding questions, a revised eleven-item questionnaire exhibited a significantly increased diagnostic accuracy, with an AUC of 0.85(95% CI: 0.84–0.87). At the inflection point of the curve, it demonstrated a sensitivity of 82.5% and specificity of 72.9%. We showed that the revised symptom-based questionnaire could be used to screen individuals with a high likelihood of COPD among Chinese populations. Further validation is required before we claim it is a useful diagnostic for primary care populations.

Pulmonary Rehabilitation in Patients Undergoing Lung-Volume Reduction Surgery

Chronic obstructive pulmonary disease (COPD) is the most common form of primary pulmonary disability. Few effective treatment options exist for it, but recently, lung-volume reduction surgery (LVRS) has been shown to be effective in selected patients with emphysema. Pulmonary rehabilitation is an integral part of the preparation for and recovery from the procedure and has significant benefit in helping to improve the quality of life and conditioning of patients with COPD who undergo LVRS.

OVERALL ARTICLE OBJECTIVES

(a) To describe the role of pulmonary rehabilitation in LVRS, (b) to understand the components of a comprehensive pulmonary rehabilitation program, and (c) to describe the effects of a pulmonary rehabilitation program.

Characteristics of adults dying with COPD

STUDY OBJECTIVE

To describe factors associated with COPD deaths in the United States.

DESIGN

Cross-sectional survey.

PARTICIPANTS

A total of 12,803 decedents in the National Mortality Followback Survey, a nationally representative sample of US deaths in 1993.

METHODS

We compared the characteristics of adults > or = 35 years of age who died with COPD (bronchitis, emphysema, chronic airway obstruction) with those dying without COPD listed on their death certificates.

RESULTS

Of the estimated 225,400 adults who died with COPD in 1993, 16.7% had never smoked. People dying with COPD were more likely than those dying without COPD to be current smokers (odds ratio [OR], 6.5; 95% confidence interval [CI], 4.3 to 9.9) or former smokers (OR, 3.7; 95% CI, 2.5 to 5.3), have a history of asthma (OR, 5.0; 95% CI, 3.2 to 7.8), be underweight (OR, 4.5; 95% CI, 2.8 to 7.2), and be of the white race (OR, 3.1; 95% CI, 2.4 to 4.0), after controlling for age group and sex.

CONCLUSIONS

A significant proportion of COPD-related deaths occurs in never-smokers. Factors such as a history of asthma and being underweight are associated with COPD mortality and may provide additional opportunities for intervention.

Clinical experience in Germany of treating community-acquired respiratory infections with the new 8-methoxyfluoroquinolone, moxifloxacin

Moxifloxacin, a new 8-methoxyfluoroquinolone, was evaluated in a large community-based study involving 16,007 patients over a 9-month period. This study was designed as a large post-marketing observational study of the speed, efficacy and tolerability of moxifloxacin when used in clinical practice for the treatment of community-acquired bacterial pneumonia, or acute exacerbations of chronic bronchitis. Physicians and patients were specifically questioned about overall efficacy and safety as well as symptom relief. According to physicians' assessments 96.3% of patients were cured or improved after moxifloxacin treatment. Symptom relief ('feeling better') occurred in almost 70% of patients by day 3 and only 2.3% reported an adverse drug reaction. No individual adverse drug reaction was reported at a frequency above 1%. Among the 209 events considered as serious, only 34 were regarded as possibly or probably related to therapy. There were no moxifloxacin-related clinically relevant cases of phototoxicity, hepatotoxicity or cardiotoxicity. Overall, 92.1% of patients considered moxifloxacin to have been beneficial.

Can 'old' lungs be restored? Strategies for preserving lung health and preventing and treating COPD

COPD is a disease that clusters in families, usually related to smoking and evolving over a long period, often 30 years. Early diagnosis is possible with use of spirometric tests, and smoking cessation slows the rate of decline and improves survival, even at late stages of disease. Vaccines, bronchoactive drugs, and antibiotics also help preserve lung health and prevent advanced stages of COPD. Early identification of lung dysfunction is a key step in encouraging patients to quit smoking. Testing for "lung age" may be helpful in motivating patients who need to make difficult lifestyle changes.

Disease management of COPD with pulmonary rehabilitation

Pulmonary rehabilitation is a set of tools and disciplines that attends to the multiple needs of the COPD patient. It extends beyond standard care by addressing the disabling features of chronic and progressive lung disease. It centers on self-management, exercise, functional training, psychosocial skills, and contributes to the optimization of medical management. Exercise enables other components by building strength, endurance, confidence, and reducing dyspnea. Patients who have undergone rehabilitation often enjoy a reduced need for health-care utilization. On the downside, rehabilitation is a one-time intervention, the benefits of which dissolve over time. The patient's physician is rarely a participant in the program; thus, the physician is at a disadvantage in being able to support a long-term response. Rehabilitation is available to a small percentage of a large patient population who could benefit. Optimal disease management would entail redesigning standard medical care to integrate rehabilitative elements into a system of patient self-management and regular exercise. It should emphasize physician involvement in self-management, which is essential in developing and maintaining an effective exacerbation protocol. Pulmonary rehabilitation should take its place in the mainstream of disease management through its integrative and reconciliative role in the multidisciplinary continuum of services, as defined by the National Institutes of Health, Pulmonary Rehabilitation Research, Workshop of 1994.