1
|
Schneiderman AI, Dougherty DD, Fonseca VP, Wolters CL, Bossarte RM, Arjomandi M. Diagnosing Chronic Obstructive Pulmonary Disease Among Afghanistan and Iraq Veterans: Veterans Affair's Concordance With Clinical Guidelines for Spirometry Administration. Mil Med 2018; 182:e1993-e2000. [PMID: 28885968 DOI: 10.7205/milmed-d-16-00332] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Early diagnosis and treatment of chronic obstructive pulmonary disease (COPD) can slow disease progression. The Department of Veterans Affairs (VA)/Department of Defense Clinical Practice Guidelines (CPG), established to improve patient outcomes, recommend the use of spirometry in the COPD diagnostic process. The aims of this study were to assess VA health care providers' performance related to CPG-recommended spirometry administration in the evaluation of newly diagnosed COPD among veterans, determine the patient characteristics that may influence the adherence rate, and compare VA concordance rates to those of other health plans. METHODS Administrative health care data related to Operations Enduring Freedom/Iraqi Freedom/New Dawn (OEF/OIF/OND) veterans was used to identify newly diagnosed COPD cases and the proportion of cases receiving spirometry. Cases were defined as veterans who had their first medical encounter with a coded diagnosis of COPD ≥ 6 months after their initial VA health care evaluation. The relationship between prediagnostic and comorbid conditions and the administration of CPG-concordant spirometry was examined using regression analyses. FINDINGS Among the 923,646 OEF/OIF/OND veterans receiving VA health care between January 2002 and December 2014, 32,076 (3%) had a coded diagnosis of COPD. Among those, 22,156 (69%) were identified as newly diagnosed COPD cases; only 6,827 (31%) had CPG-concordant spirometry. Concordant spirometry was more likely to occur in veterans aged ≥40. A pre-existing tobacco use disorder marginally changed the concordance rate. DISCUSSION VA provider adherence to CPG-concordant spirometry would decrease the prevalence of false-positive COPD cases and lead to more targeted disease treatment. Future research should focus on such cases by assessing the association between COPD diagnosis and bronchodilator responsiveness.
Collapse
Affiliation(s)
- Aaron I Schneiderman
- Department of Veterans Affairs (10P4Q), Post-Deployment Health Services, Epidemiology Program, 810 Vermont Avenue, Washington, DC 20420
| | - Deborah D Dougherty
- Under Contract to Intellica Corporation, 8521 Leesburg Pike Suite 600, Vienna, VA 22182
| | - Vincent P Fonseca
- Intellica Corporation, 209 West Poplar Street, San Antonio, TX 78212
| | - Charles L Wolters
- Under Contract to Intellica Corporation, 8521 Leesburg Pike Suite 600, Vienna, VA 22182
| | - Robert M Bossarte
- West Virginia University Injury Control Research Center, Research Ridge Suite 201, 3606 Collins Ferry Road, Morgantown, WV 26505
| | - Mehrdad Arjomandi
- San Francisco VAMC and University of California San Francisco, 4150 Clement Street, San Francisco, CA 94121
| |
Collapse
|
2
|
Vrbica Ž, Labor M, Gudelj I, Labor S, Jurić I, Plavec D. Early detection of COPD patients in GOLD 0 population: an observational non-interventional cohort study - MARKO study. BMC Pulm Med 2017; 17:36. [PMID: 28187733 PMCID: PMC5303263 DOI: 10.1186/s12890-017-0378-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 02/01/2017] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Main risk factor for the development of chronic obstructive pulmonary disease (COPD) is smoking, although only less than 1/3 of smokers develop clinically manifest COPD. COPD's progressive nature with high disability and mortality makes it plausible to detect it as early as possible thus allowing for an early intervention. The only tool for an early diagnosis that could be used on the global scale is spirometry, even though symptoms and deprivation of health related quality of life (HRQoL) precede relevant spirometric changes. Existing HRQoL questionnaires are too complicated or not developed for an early detection of COPD. The aim of our study was to develop a new simple HRQoL tool that will allow (alone or in combination with other markers) early detection of patients with COPD. METHODS A multicenter prospective cohort study recruiting 500 subjects at risk for COPD (smokers/ex-smokers ≥20 pack-years, 40-65 years, both sexes, with no prior diagnosis of COPD) will be carried out in two phases: (1) cross-sectional - development and validation of a new questionnaire; and (2) prospective - follow-up of a cohort of patients at risk for COPD. Subjects were recruited by 25 GPs and assessed for COPD by dedicated pulmonologists in 7 hospital centers using a predefined protocol: HRQoL, history, physical, blood sampling, exhaled breath temperature (EBT), lung function, 6-min walk test (6MWT). Patients without COPD and those in GOLD stage 1 at initial assessment will be reassessed for disease progression by the same pulmonologist after 2 and 5 years. DISCUSSION This is one of the first cohort studies attempting to establish the incidence of COPD in the pre-symptomatic stage before significant end organ damage. We intend to assess the validity, predictability and discriminative power ('healthy' smokers vs. pre-symptomatic phase in newly developed COPD) of newly developed HRQoL tool alone or in combination with other markers; EBT, lung function, 6MWT, genomics, transcriptomics, proteomics). We expect that the results of this study can improve our understanding of the development of COPD, identify some new underlying pathophysiological pathways, and offer to sensitive smokers/ex-smokers new preventive and early intervention measures thus improving the management of COPD. TRIAL REGISTRATION Clinicaltrial.gov NCT01550679 retrospectively registered February 28, 2012.
Collapse
Affiliation(s)
- Žarko Vrbica
- Department of Pulmonology and Immunology, General Hospital Dubrovnik, Dr. Roka Mišetića 2, Dubrovnik, Croatia.,University of Dubrovnik, Branitelja Dubrovnika 29, Dubrovnik, Croatia
| | - Marina Labor
- Department of Pulmonology, University Hospital Center Osijek, Josipa Huttlera 4, Osijek, Croatia.,Faculty of Medicine, J.J. Strossmayer University of Osijek, Ulica cara Hadrijana 10E, Osijek, Croatia
| | - Ivan Gudelj
- Department of Pulmonology, University Hospital Center Split, Spinčićeva 1, Split, Croatia
| | - Slavica Labor
- Department of Pulmonology, University Hospital Center Osijek, Josipa Huttlera 4, Osijek, Croatia.,Faculty of Medicine, J.J. Strossmayer University of Osijek, Ulica cara Hadrijana 10E, Osijek, Croatia
| | - Iva Jurić
- Department of Internal Medicine, University Hospital Center Osijek, Josipa Huttlera 4, Osijek, Croatia
| | - Davor Plavec
- Faculty of Medicine, J.J. Strossmayer University of Osijek, Ulica cara Hadrijana 10E, Osijek, Croatia. .,Research Department, Children's Hospital Srebrnjak, Srebrnjak 100, Zagreb, Croatia.
| | | |
Collapse
|
3
|
Ward BW, Nugent CN, Blumberg SJ, Vahratian A. Measuring the Prevalence of Diagnosed Chronic Obstructive Pulmonary Disease in the United States Using Data From the 2012-2014 National Health Interview Survey. Public Health Rep 2017; 132:149-156. [PMID: 28135423 PMCID: PMC5349479 DOI: 10.1177/0033354916688197] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES This study, measuring the prevalence of chronic obstructive pulmonary disease (COPD), examined (1) whether a single survey question asking explicitly about diagnosed COPD is sufficient to identify US adults with COPD and (2) how this measure compares with estimating COPD prevalence using survey questions on diagnosed emphysema and/or chronic bronchitis and all 3 survey questions together. METHODS We used data from the 2012-2014 National Health Interview Survey to examine different measures of prevalence among 7211 US adults who reported a diagnosed respiratory condition (ie, emphysema, chronic bronchitis, and/or COPD). RESULTS We estimated a significantly higher prevalence of COPD by using a measure accounting for all 3 diagnoses (6.1%; 95% CI, 5.9%-6.3%) than by using a measure of COPD diagnosis only (3.0%; 95% CI, 2.8%-3.1%) or a measure of emphysema and/or chronic bronchitis diagnoses (4.7%; 95% CI, 4.6%-4.9%). This pattern was significant among all subgroups examined except for non-Hispanic Asian adults. The percentage difference between measures of COPD was larger among certain subgroups (adults aged 18-39, Hispanic adults, and never smokers); additional analyses showed that this difference resulted from a large proportion of adults in these subgroups reporting a diagnosis of chronic bronchitis only. CONCLUSIONS With the use of self- or patient-reported health survey data such as the National Health Interview Survey, it is recommended that a measure asking respondents only about COPD diagnosis is not adequate for estimating the prevalence of COPD. Instead, a measure accounting for diagnoses of emphysema, chronic bronchitis, and/or COPD may be a better measure. Additional analyses should explore the reliability and validation of survey questions related to COPD, with special attention toward questions on chronic bronchitis.
Collapse
Affiliation(s)
- Brian W. Ward
- Division of Health Interview Statistics, National Center for Health Statistics, Hyattsville, MD, USA
| | - Colleen N. Nugent
- Division of Health Interview Statistics, National Center for Health Statistics, Hyattsville, MD, USA
| | - Stephen J. Blumberg
- Division of Health Interview Statistics, National Center for Health Statistics, Hyattsville, MD, USA
| | - Anjel Vahratian
- Division of Health Interview Statistics, National Center for Health Statistics, Hyattsville, MD, USA
| |
Collapse
|
4
|
Dixon LC, Ward DJ, Smith J, Holmes S, Mahadeva R. New and emerging technologies for the diagnosis and monitoring of chronic obstructive pulmonary disease: A horizon scanning review. Chron Respir Dis 2016; 13:321-336. [PMID: 26968787 PMCID: PMC5084418 DOI: 10.1177/1479972316636994] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
There is a need for straightforward, novel diagnostic and monitoring technologies to enable the early diagnosis of COPD and its differentiation from other respiratory diseases, to establish the cause of acute exacerbations and to monitor disease progression. We sought to establish whether technologies already in development could potentially address these needs. A systematic horizon scanning review was undertaken to identify technologies in development from a wide range of commercial and non-commercial sources. Technologies were restricted to those likely to be available within 18 months, and then evaluated for degree of innovation, potential for impact, acceptability to users and likelihood of adoption by clinicians and patients with COPD. Eighty technologies were identified, of which 25 were considered particularly promising. Biomarker tests, particularly those using sputum or saliva samples and/or available at the point of care, were positively evaluated, with many offering novel approaches to early diagnosis and to determining the cause for acute exacerbations. Several wrist-worn devices and smartphone-based spirometers offering the facility for self-monitoring and early detection of exacerbations were also considered promising. The most promising identified technologies have the potential to improve COPD care and patient outcomes. Further research and evaluation activities should be focused on these technologies.
Collapse
Affiliation(s)
- Louise C Dixon
- NIHR Horizon Scanning Research & Intelligence Centre, University of Birmingham, Edgbaston, Birmingham, UK
| | - Derek J Ward
- NIHR Horizon Scanning Research & Intelligence Centre, University of Birmingham, Edgbaston, Birmingham, UK
- Derek J Ward, NIHR Horizon Scanning Research & Intelligence Centre, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
| | - Joanna Smith
- NIHR Horizon Scanning Research & Intelligence Centre, University of Birmingham, Edgbaston, Birmingham, UK
| | - Steve Holmes
- The Park Medical Practice, Shepton Mallet, Somerset, UK
| | - Ravi Mahadeva
- Department of Respiratory Medicine, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| |
Collapse
|
5
|
Burkhardt R, Pankow W. The diagnosis of chronic obstructive pulmonary disease. DEUTSCHES ARZTEBLATT INTERNATIONAL 2014; 111:834-45, quiz 846. [PMID: 25556602 PMCID: PMC4284520 DOI: 10.3238/arztebl.2014.0834] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Revised: 08/07/2014] [Accepted: 08/07/2014] [Indexed: 12/21/2022]
Abstract
BACKGROUND Estimates of the prevalence of chronic obstructive pulmonary disease (COPD) in Germany range from 1.9% to 13.2%, depending on the population studied and the investigative methods used. About 30% of all patients already have severe airway obstruction by the time the condition is diagnosed. METHODS Review of pertinent literature retrieved by a selective search, including current guidelines and textbooks. RESULTS Smoking is the main risk factor for COPD. The diagnosis is based on characteristic symptoms that patients at risk should be actively asked about-cough, dyspnea, diminished physical reserve, and frequent airway infections-together with abnormal pulmonary function tests. Spirometry usually suffices to document impaired air flow. The clinical evaluation and the treatment strategy are based on the severity of airway obstruction and dyspnea, and the frequency of exacerbations. According to a European study, dyspnea is present in 73% of persons with severe COPD, expectoration in 64%, cough in 59%, and wheezing in 42%. Asthma, congestive heart failure, and interstitial lung disease are the main differential diagnoses. CONCLUSION COPD may begin with symptoms that are only mild at first even in a longstanding smoker. The available diagnostic techniques need better prospective validation with respect to relevant endpoints, including mortality, symptom progression, quality of life, and frequency of exacerbations.
Collapse
Affiliation(s)
- Rainer Burkhardt
- Lower Saxony State Association of Statutory Health Insurance Physicians, Office Oldenburg
| | - Wulf Pankow
- Vivantes Klinikum Berlin-Neukölln, Department of Internal Medicine, Pneumology, and Infectious Diseases
| |
Collapse
|