1
|
van Geffen WH, Tan DJ, Walters JA, Walters EH. Inhaled corticosteroids with combination inhaled long-acting beta2-agonists and long-acting muscarinic antagonists for chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2023; 12:CD011600. [PMID: 38054551 PMCID: PMC10698842 DOI: 10.1002/14651858.cd011600.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
BACKGROUND Management of chronic obstructive pulmonary disease (COPD) commonly involves a combination of long-acting bronchodilators including beta2-agonists (LABA) and muscarinic antagonists (LAMA). LABA and LAMA bronchodilators are now available in single-combination inhalers. In individuals with persistent symptoms or frequent exacerbations, inhaled corticosteroids (ICS) are also used with combination LABA and LAMA inhalers. However, the benefits and risks of adding ICS to combination LABA/LAMA inhalers as a triple therapy remain unclear. OBJECTIVES To assess the effects of adding an ICS to combination LABA/LAMA inhalers for the treatment of stable COPD. SEARCH METHODS We searched the Cochrane Airways Group Register of Trials, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, and Embase up to 30 November 2022. We also searched ClinicalTrials.gov and the WHO ICTRP up to 30 November 2022. SELECTION CRITERIA We included parallel-group randomised controlled trials of three weeks' duration or longer that compared the treatment of stable COPD with ICS in addition to combination LABA/LAMA inhalers against combination LABA/LAMA inhalers alone. DATA COLLECTION AND ANALYSIS We used standard Cochrane methodological procedures. The primary outcomes were acute exacerbations of COPD, respiratory health-related quality of life, pneumonia and other serious adverse events. The secondary outcomes were symptom scores, lung function, physical capacity, and mortality. We used GRADE to assess certainty of evidence for studies that contributed data to our prespecified outcomes. MAIN RESULTS Four studies with a total of 15,412 participants met the inclusion criteria. The mean age of study participants ranged from 64.4 to 65.3 years; the proportion of female participants ranged from 28% to 40%. Most participants had symptomatic COPD (COPD Assessment Test Score ≥ 10) with severe to very severe airflow limitation (forced expiratory volume in one second (FEV1) < 50% predicted) and one or more moderate-to-severe COPD exacerbations in the last 12 months. Trial medications differed amongst studies. The duration of follow-up was 52 weeks in three studies and 24 weeks in one study. We assessed the risk of selection, performance, and detection bias to be low in the included studies; one study was at high risk of attrition bias, and one study was at high risk of reporting bias. Triple therapy may reduce rates of moderate-to-severe COPD exacerbations compared to combination LABA/LAMA inhalers (rate ratio (RR) 0.74, 95% confidence interval (CI) 0.67 to 0.81; n = 15,397; low-certainty evidence). Subgroup analysis stratifying by blood eosinophil counts showed there may be a greater reduction in rate of moderate-to-severe COPD exacerbations with triple therapy in participants with high-eosinophils (RR 0.67, 95% CI 0.60 to 0.75) compared to low-eosinophils (RR 0.87, 95% CI 0.81 to 0.93) (test for subgroup differences: P < 0.01) (high/low cut-offs: 150 eosinophils/µL in three studies; 200 eosinophils/µL in one study). However, moderate-to-substantial heterogeneity was observed in both high- and low-eosinophil subgroups. These subgroup analyses are observational by nature and thus results should be interpreted with caution. Triple therapy may be associated with reduced rates of severe COPD exacerbations (RR 0.75, 95% CI 0.67 to 0.84; n = 14,131; low-certainty evidence). Triple therapy improved health-related quality of life assessed using the St George's Respiratory Questionnaire (SGRQ) by the minimal clinically important difference (MCID) threshold (4-point decrease) (35.3% versus 42.4%, odds ratio (OR) 1.35, 95% CI 1.26 to 1.45; n = 14,070; high-certainty evidence). Triple therapy may result in fewer symptoms measured using the Transition Dyspnoea Index (TDI) (OR 1.33, 95% CI 1.13 to 1.57; n = 3044; moderate-certainty evidence) and improved lung function as measured by change in trough FEV1 (mean difference 38.68 mL, 95% CI 22.58 to 54.77; n = 11,352; low-certainty evidence). However, these benefits fell below MCID thresholds for TDI (1-unit decrease) and trough FEV1 (100 mL), respectively. Triple therapy is probably associated with a higher risk of pneumonia as a serious adverse event compared to combination LABA/LAMA inhalers (3.3% versus 1.9%, OR 1.74, 95% CI 1.39 to 2.18; n = 15,412; moderate-certainty evidence). In contrast, all-cause serious adverse events may be similar between groups (19.7% versus 19.7%, OR 0.95, 95% CI 0.87 to 1.03; n = 15,412; low-certainty evidence). All-cause mortality may be lower with triple therapy (1.4% versus 2.0%, OR 0.70, 95% CI 0.54 to 0.90; n = 15,397; low-certainty evidence). AUTHORS' CONCLUSIONS The available evidence suggests that triple therapy may reduce rates of COPD exacerbations (low-certainty evidence) and results in an improvement in health-related quality of life (high-certainty evidence) compared to combination LABA/LAMA inhalers, but probably confers an increased pneumonia risk as a serious adverse event (moderate-certainty evidence). Triple therapy probably improves respiratory symptoms and may improve lung function (moderate- and low-certainty evidence, respectively); however, these benefits do not appear to be clinically significant. Triple therapy may reduce the risk of all-cause mortality compared to combination LABA/LAMA inhalers (low-certainty evidence). The certainty of the evidence was downgraded most frequently for inconsistency or indirectness. Across the four included studies, there were important differences in inclusion criteria, trial medications, and duration of follow-up. Investigation of heterogeneity was limited due to the small number of included studies. We found limited data on the effects of triple therapy compared to combination LABA/LAMA inhalers in patients with mild-moderate COPD and those without a recent exacerbation history.
Collapse
Affiliation(s)
- Wouter H van Geffen
- Department of Pulmonary Diseases, Medical Center Leeuwarden, Leeuwarden, Netherlands
| | - Daniel J Tan
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | | | - E Haydn Walters
- NHMRC Centre of Research Excellence for Chronic Respiratory Disease, School of Medicine, University of Tasmania, Hobart, Australia
| |
Collapse
|
2
|
Pagano L, Dennis S, Wootton S, Chan ASL, Zwar N, Mahadev S, Pallavicini D, McKeough Z. The effects of an innovative GP-physiotherapist partnership in improving COPD management in primary care. BMC PRIMARY CARE 2023; 24:142. [PMID: 37430190 DOI: 10.1186/s12875-023-02097-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 06/29/2023] [Indexed: 07/12/2023]
Abstract
BACKGROUND Evidence suggests that management of people with Chronic Obstructive Pulmonary Disease (COPD) in primary care has been suboptimal, in particular, with low referral rates to pulmonary rehabilitation (PR). The aim of this study was to evaluate the effectiveness of a GP-physiotherapist partnership in optimising management of COPD in primary care. METHODS A pragmatic, pilot, before and after study was conducted in four general practices in Australia. A senior cardiorespiratory physiotherapist was partnered with each general practice. Adults with a history of smoking and/or COPD, aged ≥ 40 years with ≥ 2 practice visits in the previous year were recruited following spirometric confirmation of COPD. Intervention was provided by the physiotherapist at the general practice and included PR referral, physical activity and smoking cessation advice, provision of a pedometer and review of inhaler technique. Intervention occurred at baseline, one month and three months. Main outcomes included PR referral and attendance. Secondary clinical outcomes included changes in COPD Assessment Test (CAT) score, dyspnoea, health activation and pedometer step count. Process outcomes included count of initiation of smoking cessation interventions and review of inhaler technique. RESULTS A total of 148 participants attended a baseline appointment where pre/post bronchodilator spirometry was performed. 31 participants with airflow obstruction on post-bronchodilator spirometry (mean age 75yrs (SD 9.3), mean FEV1% pred = 75% (SD 18.6), 61% female) received the intervention. At three months, 78% (21/27) were referred to PR and 38% (8/21) had attended PR. No significant improvements were seen in CAT scores, dyspnoea or health activation. There was no significant change in average daily step count at three months compared to baseline (mean difference (95% CI) -266 steps (-956 to 423), p = 0.43). Where indicated, all participants had smoking cessation interventions initiated and inhaler technique reviewed. CONCLUSION The results of this study suggest that this model was able to increase referrals to PR from primary care and was successful in implementing some aspects of COPD management, however, was insufficient to improve symptom scores and physical activity levels in people with COPD. TRIAL REGISTRATION ANZCTR, ACTRN12619001127190. Registered 12 August 2019 - Retrospectively registered, http://www.ANZCTR.org.au/ACTRN12619001127190.aspx .
Collapse
Affiliation(s)
- Lisa Pagano
- Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Sarah Dennis
- Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Ingham Institute for Applied Medical Research, Sydney, Australia
- South Western Sydney Local Health District, Liverpool, Australia
| | - Sally Wootton
- Chronic Disease Community Rehabilitation Service, Northern Sydney Local Health District, Sydney, Australia
| | - Andrew S L Chan
- Chronic Disease Community Rehabilitation Service, Northern Sydney Local Health District, Sydney, Australia
- Royal North Shore Hospital, St Leonards, Australia
- Northern Clinical School, University of Sydney, Sydney, Australia
| | - Nicholas Zwar
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
| | - Sriram Mahadev
- Chronic Disease Community Rehabilitation Service, Northern Sydney Local Health District, Sydney, Australia
- Royal North Shore Hospital, St Leonards, Australia
- Northern Clinical School, University of Sydney, Sydney, Australia
| | | | - Zoe McKeough
- Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
| |
Collapse
|
3
|
Ho EH, Verkuilen J, Fischer F. Measuring individual true change with PROMIS using IRT-based plausible values. Qual Life Res 2023; 32:1369-1379. [PMID: 36282446 PMCID: PMC10849110 DOI: 10.1007/s11136-022-03264-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2022] [Indexed: 10/31/2022]
Abstract
AIMS A primary advantage of IRT-based patient-reported outcome measures such as PROMIS short forms and computer-adaptive tests is that each estimate of the latent trait comes with a standard error. Such measurement error needs to be acknowledged, in particular when monitoring individual patients over time. In this study, we use plausible values to account for measurement error and analyze the probability of true within-individual change. METHODS We use a longitudinal, observational study of stable and exacerbated COPD patients (N = 185), providing PROMIS Physical Function and Fatigue T-scores over 3 months. At each measurement, we imputed 1000 plausible values from the scores' posterior distribution. These were then used to calculate probability of true change using a pre-specified threshold such as minimally important difference supported by the literature, or [Formula: see text] > 0. We demonstrate assessment of change in individuals and in groups, across different measures (Short Forms and CATs), and at various levels of confidence. RESULTS Using plausible value imputation and with 95% certainty, 47.5% of participants in the exacerbated group reported less fatigue, compared with 26.5% of participants in the stable group. Comparison of Short Forms and CATs suggests that CATs have better ability to detect change compared to short forms. We also illustrate this method using an individual's probability of change at different time points. CONCLUSION Plausible values offer a flexible way to include measurement error in analysis of individuals and on sample level. Assessment of probability of true change can complement existing distribution-based approaches and facilitates interpretation of improvement or decline.
Collapse
Affiliation(s)
- Emily H Ho
- Feinberg School of Medicine, Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA.
| | - Jay Verkuilen
- Graduate Center, Ph.D. Program in Educational Psychology, City University of New York, New York, NY, USA
| | - Felix Fischer
- Charité-Universitätsmedizin Berlin, Department for Psychosomatic, Corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Clinical Study Center, German PROMIS® National Center, Berlin, Germany
| |
Collapse
|
4
|
Sami R, Savari MA, Mansourian M, Ghazavi R, Meamar R. Effect of Long-Term Oxygen Therapy on Reducing Rehospitalization of Patients with Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis. Pulm Ther 2023; 9:255-270. [PMID: 37093408 DOI: 10.1007/s41030-023-00221-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 03/17/2023] [Indexed: 04/25/2023] Open
Abstract
INTRODUCTION The aim of this work is to evaluate whether the addition of home oxygen therapy (HOT) would reduce readmission in chronic obstructive pulmonary disease (COPD) patients. METHODS PubMed, ScopeMed, Cochrane, Scopus, and Google Scholar databases were searched. The search strategy used the following keywords "chronic obstructive pulmonary disease", the intervention "long-term oxygen therapy", and the outcome "readmission" combined with the AND operator. The Newcastle-Ottawa Scale and Jadad Scale were used for assessing the quality of cohort studies and clinical trials, respectively. A random-effects model was employed in this study after calculating the standard errors by 95% confidence intervals. The I2 statistic and Cochran's Q-test were used to measure heterogeneity. To address heterogeneity, subgroup analyses were carried out according to the length of LTOT, which was classified as "over 8 months" and "under 8 months". RESULTS Seven studies were included in the analysis. In the pooled analysis, the RR [CI95%, p value], heterogeneity criteria for readmission reduced by 1.542 [1.284-1.851, < 0.001], I2 = 60%, and 1.693 [1.645-1.744, < 0.001], I2 = 60% for patients with a length of LTOT treatment under and above 8 months, respectively. A sensitivity analysis was conducted by systematically omitting each study, and it showed no influential studies. Egger's test indicated no publication bias (p = 0.64). CONCLUSIONS Based on our results in this systematic review, long-tern oxygen therapy (LTOT) at home was associated with a significantly lower risk ratio of hospital readmission. However, the sample sizes in the studies necessitate larger RCTs to evaluate the effect of LTOT on readmission in COPD patients.
Collapse
Affiliation(s)
- Ramin Sami
- Department of Internal Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mahsa Akafzadeh Savari
- Isfahan Clinical Toxicology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Marjan Mansourian
- Department of Epidemiology and Biostatistics, School of Public Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Roghayeh Ghazavi
- Department of Knowledge and Information Sciences, Faculty of Education and Psychology, Shahid Chamran University of Ahvaz, Ahvaz, Iran
| | - Rokhsareh Meamar
- Isfahan Clinical Toxicology Research Center, Isfahan University of Medical Sciences, Khorshid Hospital, Ostandari Street, Hasht Behest Avenue, Isfahan, 81458-31451, Iran.
| |
Collapse
|
5
|
Makwana S, Patel A, Sonagara M. Correlation Between Serum Magnesium Level and Acute Exacerbation in Patients With Chronic Obstructive Pulmonary Disease (COPD). Cureus 2022; 14:e26229. [PMID: 35898387 PMCID: PMC9308137 DOI: 10.7759/cureus.26229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2022] [Indexed: 11/11/2022] Open
Abstract
Introduction Although chronic obstructive pulmonary disease (COPD) is preventable and treatable, it is a major public health problem. The mortality risks are higher in patients with exacerbations. Magnesium (Mg) is crucial in numerous physiological processes, including membrane stabilization. However, incomplete information is available regarding the effect of magnesium on the frequency of acute exacerbation of COPD. Objectives To determine the serum magnesium level in COPD patients and its correlation with acute exacerbation of COPD. Materials and methods This cross-sectional study included 100 patients diagnosed with acute exacerbation of COPD. The serum magnesium level was measured in all patients with acute exacerbation of COPD at admission. Serum Mg level <1.7 mg/dl was considered hypomagnesemia. The correlation between serum magnesium level and duration of hospital stay and patient outcome was studied. Results In the present study, hypomagnesemia was reported in 57% of patients with acute exacerbation of COPD. The duration of hospital stay (more than seven days) among hypomagnesemia (80.7%) patients was significantly higher than that of the normomagnesemia patients (55.8%). Mortality in patients with hypomagnesemia was higher than in patients with normomagnesemia, although not statistically significant. Conclusion Hypomagnesaemia is a common finding in acute exacerbation of COPD. The level of magnesium found is related to the length of hospital stay, but it is not related to mortality among patients with acute exacerbation of COPD. Further studies with larger sample sizes and extended follow-up periods are required to validate the results.
Collapse
|
6
|
Enam A, Dreyer HC, De Boer L. Impact of distance monitoring service in managing healthcare demand: a case study through the lens of cocreation. BMC Health Serv Res 2022; 22:802. [PMID: 35729627 PMCID: PMC9209829 DOI: 10.1186/s12913-022-08164-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 06/08/2022] [Indexed: 12/02/2022] Open
Abstract
Background There is a consensus among healthcare providers, academics, and policy-makers that spiraling demand and diminishing resources are threatening the sustainability of the current healthcare system. Different telemedicine services are seen as potential solutions to the current challenges in healthcare. This paper aims to identify how distance monitoring services rendered for patients with chronic conditions can affect the escalating demand for healthcare. First, we identify how distance monitoring service changes the care delivery process using the lens of service cocreation. Next, we analyze how these changes can impact healthcare demand using the literature on demand and capacity management. Method In this qualitative study, we explore a distance monitoring service in a primary healthcare setting in Norway. We collected primary data from nurses and general physicians using the semi-structured interview technique. We used secondary patient data collected from a study conducted to evaluate the distance monitoring project. The deductive content analysis method was used to analyze the data. Result This study shows that the application of distance monitoring services changes the care delivery process by creating new activities, new channels for interaction, and new roles for patients, general physicians, and nurses. We define patients’ roles as proactive providers of health information, general physicians’ roles as patient selectors, and nurses’ roles as technical coordinators, data workers, and empathetic listeners. Thus, the co-creation aspect of the service becomes more prominent demonstrating potential for better management of healthcare demand. However, these changes also render the management of demand and resources more complex. To reduce the complexities, we propose three mechanisms: foreseeing and managing new roles, developing capabilities, and adopting a system-wide perspective. Conclusion The main contribution of the paper is that it demonstrates that, although distance monitoring services have the potential to have a positive impact on healthcare demand management, in the absence of adequate managerial mechanisms, they can also adversely affect healthcare demand management. This study provides a means for practitioners to reflect upon and refine the decisions that they make regarding telemedicine deployment and resource planning for delivering care. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08164-2.
Collapse
Affiliation(s)
- Amia Enam
- Department of Industrial Economics and Technology Management, Faculty of Economics and Management, Norwegian University of Science and Technology, Sentralbygg 1, 1365, Gløshaugen, Alfred Getz' vei 3, Trondheim, Norway.
| | - Heidi Carin Dreyer
- Department of Industrial Economics and Technology Management, Faculty of Economics and Management, Norwegian University of Science and Technology, Sentralbygg 1, Gløshaugen, Alfred Getz vei 3, Trondheim, Norway
| | - Luitzen De Boer
- Department of Industrial Economics and Technology Management, Faculty of Economics and Management, Norwegian University of Science and Technology, Sentralbygg 1, Gløshaugen, Alfred Getz vei 3, Trondheim, Norway
| |
Collapse
|
7
|
Shin SH, Kim DK, Kim SH, Shin TR, Jung KS, Yoo KH, Hwang KE, Park HY, Jo YS. Lack of Association between Inhaled Corticosteroid Use and the Risk of Future Exacerbation in Patients with GOLD Group A Chronic Obstructive Pulmonary Disease. J Pers Med 2022; 12:jpm12060916. [PMID: 35743701 PMCID: PMC9224662 DOI: 10.3390/jpm12060916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 05/07/2022] [Accepted: 05/30/2022] [Indexed: 11/16/2022] Open
Abstract
Background: As most clinical trials have been performed in more symptomatic and higher-risk patients, evidence regarding treatment in patients with Global Initiative for Chronic Obstructive Lung Disease (GOLD) group A chronic obstructive pulmonary disease (COPD) is limited. We assessed the distribution of inhaler treatment and sought to investigate the association between inhaled corticosteroid (ICS) use and future exacerbation in GOLD group A COPD patients. Methods: Patients with GOLD group A COPD who received maintenance inhalers were identified from a multicentre, prospective cohort in South Korea. Patients were categorized as group A when they had fewer symptoms and did not experience severe exacerbation in the previous year. Development of moderate or severe exacerbation during the 1-year follow-up was analysed according to baseline inhaler treatment. Results: In 286 patients with GOLD group A COPD, mono-bronchodilator (37.8%), dual-bronchodilator (29.0%), triple therapy (17.5%), and ICS/long-acting beta-2 agonist (15.4%) were used. Compared to patients without ICS-containing inhalers (N = 191), those using ICS (N = 95) were more dyspnoeic, and more likely to have asthma history, lower lung function, and bronchodilator response. During the 1-year follow-up, moderate or severe exacerbations occurred in 66 of 286 (23.1%) patients. In the multivariable logistic regression analysis, ICS-containing inhaler use was not associated with the development of exacerbation, even in the subgroup with a high probability of asthma–COPD overlap. Conclusion: Although about one-third of patients with GOLD group A COPD were using ICS-containing inhalers, use of ICS was not associated with a reduction in the future development of exacerbation.
Collapse
Affiliation(s)
- Sun Hye Shin
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea;
| | - Deog Kyeom Kim
- Department of Internal Medicine, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul 07061, Korea;
| | - Sang-Heon Kim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul 04763, Korea;
| | - Tae Rim Shin
- Lung Research Institute, Hallym University College of Medicine, Chuncheon 24252, Korea; (T.R.S.); (K.-S.J.)
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Seoul 07441, Korea
| | - Ki-Suck Jung
- Lung Research Institute, Hallym University College of Medicine, Chuncheon 24252, Korea; (T.R.S.); (K.-S.J.)
- Department of Pulmonary, Allergy and Critical Care Medicine, Hallym University Sacred Heart Hospital, Anyang 14068, Korea
| | - Kwang Ha Yoo
- Division of Pulmonary and Allergy, Department of Internal Medicine, Konkuk University School of Medicine, Seoul 05030, Korea;
| | - Ki-Eun Hwang
- Department of Internal Medicine, Wonkwang University School of Medicine, Iksan 54538, Korea;
| | - Hye Yun Park
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea;
- Correspondence: (H.Y.P.); (Y.S.J.); Tel.: +82-2-3410-3429 (H.Y.P.); +82-2-2258-6067 (Y.S.J.); Fax: +82-2-599-3589 (Y.S.J.)
| | - Yong Suk Jo
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul 06591, Korea
- Correspondence: (H.Y.P.); (Y.S.J.); Tel.: +82-2-3410-3429 (H.Y.P.); +82-2-2258-6067 (Y.S.J.); Fax: +82-2-599-3589 (Y.S.J.)
| | | |
Collapse
|
8
|
Saeed MI, Sivapalan P, Eklöf J, Ulrik CS, Browatzki A, Weinreich UM, Jensen TT, Biering-Sørensen T, Jensen JUS. Social Distancing in Relation to Severe Exacerbations of Chronic Obstructive Pulmonary Disease: A Nationwide Semi-Experimental Study During the COVID-19 Pandemic. Am J Epidemiol 2022; 191:874-885. [PMID: 34999742 PMCID: PMC9383148 DOI: 10.1093/aje/kwab292] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 12/09/2021] [Accepted: 12/21/2021] [Indexed: 12/30/2022] Open
Abstract
Social distancing measures introduced on March 12, 2020, in Denmark during the COVID-19 pandemic may affect non–COVID-19 admissions for severe acute exacerbation of chronic obstructive pulmonary disease (s-AECOPD). We compared rates of s-AECOPD in a nationwide, observational, semi-experimental cohort study using data from all Danish inhabitants between calendar week 1 through 25 in 2019 and 2020. In a sub-cohort of patients with chronic obstructive pulmonary disease, we examined incidence of s-AECOPD, admissions to an intensive care unit, and all-cause mortality. A total of 3.0 million inhabitants aged ≥40 years, corresponding to 3.0 million person-years, were followed for s-AECOPD. In the social distancing period in 2020, there were 6,212 incidents of s-AECOPD, compared with 11,260 incidents in 2019, resulting in a 45% relative risk reduction. In the cohort with chronic obstructive pulmonary disease (n = 16,675), we observed a lower risk of s-AECOPD in the social distancing period (subdistribution hazard ratio (HR) = 0.34, 95% confidence interval (CI): 0.33, 0.36; absolute risk: 25.4% in 2020 and 42.8% in 2019). The risk of admissions to an intensive care unit was reduced (subdistribution HR = 0.64, 95% CI: 0.47, 0.87), as was all-cause mortality (HR = 0.83, 95% CI: 0.76, 0.90). Overall, the social distancing period was associated with a significant risk reduction for hospital admittance with s-AECOPD.
Collapse
Affiliation(s)
- Mohamad Isam Saeed
- Correspondence to Mohamad Isam Saeed, Section of Respiratory Medicine, Department of Medicine, Herlev and Gentofte Hospital, University of Copenhagen, Gentofte Hospitalssvej 7, Ground Floor, DK-2900 Hellerup, Denmark (e-mail: )
| | | | | | | | | | | | | | | | | |
Collapse
|
9
|
Gillespie D, Francis N, Ahmed H, Hood K, Llor C, White P, Thomas-Jones E, Stanton H, Sewell B, Phillips R, Naik G, Melbye H, Lowe R, Kirby N, Cochrane A, Bates J, Alam MF, Butler C. Associations with Post-Consultation Health-Status in Primary Care Managed Acute Exacerbation of COPD. Int J Chron Obstruct Pulmon Dis 2022; 17:383-394. [PMID: 35210767 PMCID: PMC8859472 DOI: 10.2147/copd.s340710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 12/20/2021] [Indexed: 11/23/2022] Open
Abstract
Background It has been demonstrated that antibiotic prescribing for Acute Exacerbations of Chronic Obstructive Pulmonary Disease (AECOPD) can be safely reduced in primary care when general practitioners have access to C-reactive protein (CRP) rapid testing. Aim To investigate the factors associated with post-consultation COPD health status in patients presenting with AECOPD in this setting. Design and Setting A cohort study of patients enrolled in a randomised controlled trial. Patients aged 40+ years with a clinical diagnosis of COPD who presented in primary care across England and Wales with an AECOPD were included. Methods Participants were contacted for follow-up at one- and two-weeks by phone and attended the practice four weeks after the index consultation. The outcome of interest was the Clinical COPD Questionnaire (CCQ) score. Multivariable multilevel linear regression models fitted to examine the factors associated with COPD health status in the four-weeks following consultation for an AECOPD. Results A total of 649 patients were included, with 1947 CCQ total scores analysed. Post-consultation CCQ total scores were significantly higher (worse) in participants with diabetes (adjusted mean difference [AMD]=0.26; 95% confidence interval (CI) 0.08–0.45), obese patients compared to those with normal body mass index (AMD = 0.25, 95% CI 0.07–0.43), and those who were prescribed oral antibiotics in the prior 12 months (AMD = 0.26; 95% CI 0.11–0.41), but only the two latter associations remained after adjusting for other sociodemographic variables. Conclusion COPD health status was worse in the four weeks following primary care consultation for AECOPD in patients with obesity and those prescribed oral antibiotics in the preceding year.
Collapse
Affiliation(s)
- David Gillespie
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, England, UK
- Centre for Trials Research, School of Medicine, College of Biomedical & Life Sciences, Cardiff University, Cardiff, Wales, UK
- Correspondence: David Gillespie, Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, England, OX2 6GG, UK, Email
| | - Nick Francis
- Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, England, UK
| | - Haroon Ahmed
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, Wales, UK
| | - Kerenza Hood
- Centre for Trials Research, School of Medicine, College of Biomedical & Life Sciences, Cardiff University, Cardiff, Wales, UK
| | - Carl Llor
- University Institute in Primary Care Research Jordi Gol, Via Roma Health Centre, Barcelona, Spain
| | - Patrick White
- School of Population Health and Environmental Sciences, Kings College London, London, England, UK
| | - Emma Thomas-Jones
- Centre for Trials Research, School of Medicine, College of Biomedical & Life Sciences, Cardiff University, Cardiff, Wales, UK
| | - Helen Stanton
- Centre for Trials Research, School of Medicine, College of Biomedical & Life Sciences, Cardiff University, Cardiff, Wales, UK
| | - Bernadette Sewell
- Swansea Centre for Health Economics, Swansea University, Swansea, Wales, UK
| | - Rhiannon Phillips
- Cardiff School of Sport & Health Science, Cardiff Metropolitan University, Cardiff, Wales, UK
| | - Gurudutt Naik
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, Wales, UK
| | - Hasse Melbye
- General Practice Research Unit, Department of Community Medicine, UIT the Arctic University of Norway, Tromsø, Norway
| | - Rachel Lowe
- Centre for Trials Research, School of Medicine, College of Biomedical & Life Sciences, Cardiff University, Cardiff, Wales, UK
| | - Nigel Kirby
- Centre for Trials Research, School of Medicine, College of Biomedical & Life Sciences, Cardiff University, Cardiff, Wales, UK
| | - Ann Cochrane
- York Trials Unit, Department of Health Sciences, University of York, York, England, UK
| | - Janine Bates
- Centre for Trials Research, School of Medicine, College of Biomedical & Life Sciences, Cardiff University, Cardiff, Wales, UK
| | - Mohammed Fasihul Alam
- Department of Public Health, College of Health Sciences, QU-Health, Qatar University, Doha, Qatar
| | - Christopher Butler
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, England, UK
| |
Collapse
|
10
|
Iversen BR, Løkke A, Bregnballe V, Rodkjaer LØ. Does affiliation to a cross-sectorial lung team impact well-being, health-related quality of life, symptoms of anxiety and depression and patient involvement in patients with COPD? A randomised controlled trial. Scand J Caring Sci 2021; 36:730-741. [PMID: 34533847 DOI: 10.1111/scs.13034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 08/23/2021] [Accepted: 08/29/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a progressive lung disease causing limitations in daily life. A cross-sectorial lung team was established for COPD patients at risk of hospitalisation due to exacerbation of COPD. AIMS To investigate the impact of affiliation to a cross-sectorial lung team on well-being, health-related quality of life, symptoms of anxiety and depression and patient involvement in patients with severe COPD. METHODS A randomised controlled trial was conducted from September 2017 to March 2020. In total, 109 patients were included for analysis in the study: 53 patients were affiliated to a cross-sectorial lung team and 56 patients received usual care. The patients were included for 1 year. Data were collected at baseline and at follow-up after 1 year. Data were collected using COPD Assessment Test (CAT), Hospital Anxiety and Depression Scale (HADS), EuroQol 5-Dimensions (EQ-5D) and Patient Assessment of Chronic Illness Care (PACIC). RESULTS The questionnaire response rate was between 84% and 96%. No statistically significant differences were detected between patients affiliated to the cross-sectorial lung team and patients receiving usual care, in either patient's well-being, health-related quality of life, symptoms of anxiety and depression, or patient involvement. However, CAT-total score decreased with -0.21(95%CI: -1.63; 1.20) for patients affiliated to the cross-sectorial lung team and increased with 1.44(95%CI; -0.11; 3.00) for patients receiving usual care. CONCLUSION Affiliation to the cross-sectorial lung team seems safe as it did not deteriorate the patients' well-being, symptoms of anxiety and depression, health-related quality of life or patient involvement. Further research is needed and interviewing patients to obtain more knowledge on their experiences might be preferable.
Collapse
Affiliation(s)
- Birgit Refsgaard Iversen
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark.,ResCenPI - Research Centre for Patient Involvement, Aarhus University & Central Denmark Region, Aarhus, Denmark
| | - Anders Løkke
- Department of Medicine,, Lillebaelt Hospital, Vejle, Denmark.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Vibeke Bregnballe
- ResCenPI - Research Centre for Patient Involvement, Aarhus University & Central Denmark Region, Aarhus, Denmark.,Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Lotte Ørneborg Rodkjaer
- ResCenPI - Research Centre for Patient Involvement, Aarhus University & Central Denmark Region, Aarhus, Denmark.,Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| |
Collapse
|
11
|
Sivapalan P, Jørgensen NR, Mathioudakis AG, Eklöf J, Lapperre T, Ulrik CS, Andreassen HF, Armbruster K, Sivapalan P, Janner J, Godtfredsen N, Weinreich UM, Nielsen TL, Seersholm N, Wilcke T, Schuetz P, Klausen TW, Marså K, Vestbo J, Jensen JU. Bone turnover biomarkers in COPD patients randomized to either a regular or shortened course of corticosteroids: a substudy of the randomized controlled CORTICO-COP trial. Respir Res 2020; 21:263. [PMID: 33046053 PMCID: PMC7552546 DOI: 10.1186/s12931-020-01531-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 10/04/2020] [Indexed: 12/01/2022] Open
Abstract
Background Long-term treatment with corticosteroids causes loss of bone density, but the effects of using short-term high-dose systemic-corticosteroid therapy to treat acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are unclear. Our aim was to determine whether high-dose corticosteroid therapy affected bone turnover markers (BTMs) to a greater extent compared to low-dose corticosteroid therapy. Methods The CORTICO-COP trial (NCT02857842) showed that an eosinophil-guided corticosteroid intervention led to approximately 60% lower accumulated corticosteroid dose for hospitalized patients with AECOPD (low-dose group) compared with 5-day standard corticosteroid treatment (high-dose group). We compared the levels of BTMs C-terminal telopeptide of type 1 collagen (CTX) and procollagen type 1 N-terminal propeptide (P1NP) in 318 participants during AECOPD and at 1- and 3-month follow-up visits. Results CTX decreased and P1NP increased significantly over time in both treatment groups. There were no significant differences between the groups at 1- or 3-months follow-up for P1NP. A significant drop in CTX was seen at 3 months (down Δ24% from the baseline, p = 0.017) for the high dose group. Conclusion Short-term, high-dose systemic corticosteroid treatment caused a rapid suppression of biomarkers of bone resorption. Corticosteroids did not suppress biomarkers of bone formation, regardless of patients receiving low or high doses of corticosteroids. This therapy was, therefore, harmless in terms of bone safety, in our prospective series of COPD patients. Trial registration ClinicalTrials.gov Identifier: NCT02857842. Submitted August 2nd, 2016.
Collapse
Affiliation(s)
- Pradeesh Sivapalan
- Section of Respiratory Medicine, Department of Medicine, Herlev and Gentofte Hospital, University of Copenhagen, Gentofte Hospitalsvej 7, Ground Floor, DK-2900, Hellerup, Denmark. .,Department of Internal Medicine, Zealand Hospital, University of Copenhagen, Roskilde, Denmark.
| | - Niklas R Jørgensen
- Department of Clinical Biochemistry, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Alexander G Mathioudakis
- The North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK.,Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Josefin Eklöf
- Section of Respiratory Medicine, Department of Medicine, Herlev and Gentofte Hospital, University of Copenhagen, Gentofte Hospitalsvej 7, Ground Floor, DK-2900, Hellerup, Denmark
| | - Therese Lapperre
- Department of Respiratory Medicine, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Charlotte Suppli Ulrik
- Department of Respiratory Medicine, Amager and Hvidovre University Hospital, Copenhagen, Denmark
| | - Helle F Andreassen
- Department of Respiratory Medicine, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Karin Armbruster
- Section of Respiratory Medicine, Department of Medicine, Herlev and Gentofte Hospital, University of Copenhagen, Gentofte Hospitalsvej 7, Ground Floor, DK-2900, Hellerup, Denmark
| | - Praleene Sivapalan
- Section of Respiratory Medicine, Department of Medicine, Herlev and Gentofte Hospital, University of Copenhagen, Gentofte Hospitalsvej 7, Ground Floor, DK-2900, Hellerup, Denmark
| | - Julie Janner
- Department of Respiratory Medicine, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Nina Godtfredsen
- Department of Respiratory Medicine, Amager and Hvidovre University Hospital, Copenhagen, Denmark
| | - Ulla M Weinreich
- Department of Respiratory Diseases, Aalborg University Hospital, Aalborg, Denmark; The Clinical Institute, Aalborg University, Aalborg, Denmark
| | - Thyge L Nielsen
- Department of Respiratory and Infectious Diseases, Frederiksund and Hillerød Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Niels Seersholm
- Section of Respiratory Medicine, Department of Medicine, Herlev and Gentofte Hospital, University of Copenhagen, Gentofte Hospitalsvej 7, Ground Floor, DK-2900, Hellerup, Denmark
| | - Torgny Wilcke
- Section of Respiratory Medicine, Department of Medicine, Herlev and Gentofte Hospital, University of Copenhagen, Gentofte Hospitalsvej 7, Ground Floor, DK-2900, Hellerup, Denmark
| | - Philipp Schuetz
- Medical University Department, Kantonsspital Aarau, 5001, Aarau, Switzerland.,Faculty of Medicine, University of Basel, 4001, Basel, Switzerland
| | - Tobias W Klausen
- Clinical Research Unit, Department of Hematology, Herlev Hospital, Herlev, Denmark
| | - Kristoffer Marså
- Palliative Medicine Section Unit, Herlev and Gentofte Hospital, Herlev, Denmark
| | - Jørgen Vestbo
- The North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK.,Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Jens-Ulrik Jensen
- Section of Respiratory Medicine, Department of Medicine, Herlev and Gentofte Hospital, University of Copenhagen, Gentofte Hospitalsvej 7, Ground Floor, DK-2900, Hellerup, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
12
|
Saeed MI, Sivapalan P, Eklöf J, Ulrik CS, Pisinger C, Lapperre T, Tønnesen P, Hoyer N, Janner J, Karlsson ML, Bech CS, Marså K, Godtfredsen N, Brøndum E, Munk B, Raaschou M, Browatzski A, Lütken P, Jensen JUS. TOB-STOP-COP (TOBacco STOP in COPd trial): study protocol-a randomized open-label, superiority, multicenter, two-arm intervention study of the effect of "high-intensity" vs. "low-intensity" smoking cessation intervention in active smokers with chronic obstructive pulmonary disease. Trials 2020; 21:730. [PMID: 32825845 PMCID: PMC7441548 DOI: 10.1186/s13063-020-04653-z] [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: 09/27/2019] [Accepted: 08/05/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cigarette smoking is the leading cause of chronic obstructive pulmonary disease (COPD), and it contributes to the development of many other serious diseases. Smoking cessation in COPD patients is known to improve survival and reduce the number of hospitalization-requiring acute exacerbations of COPD. However, smoking cessation interventions in these patients have only been successful for approximately 15-20% for consistent smoking abstinence in 12 months. Thus, more effective interventions are needed for this patient group. The aim of this study is to determine whether a high-intensity intervention compared to a low-intensity intervention can increase the proportion of persistent (> 12 months) anamnestic and biochemical smoking cessation in active smokers with COPD. METHODS This study is a randomized controlled trial. A total of 600 active smokers with COPD will be randomly assigned 1:1 to either a standard treatment (guideline-based municipal smoking cessation program, "low intensity" group) or an intervention ("high-intensity" group) group, which consists of group sessions, telephone consultations, behavior design, hotline, and "buddy-matching" (smoker matched with COPD patient who has ceased smoking). Both groups will receive pharmacological smoking cessation. The primary endpoint is anamnestic and biochemical (cotinine analysis in urine) validated smoking cessation after 12 months. DISCUSSION The potential benefit of this project is to improve smoking cessation rates and thereby reduce smoking-related exacerbations of COPD. In addition, the project can potentially benefit from increasing the quality of life and longevity of COPD patients and reducing the risk of other smoking-related diseases. TRIAL REGISTRATION ClinicalTrials.gov NCT04088942 . Registered on 13 September 2019.
Collapse
Affiliation(s)
- Mohamad Isam Saeed
- Department of Internal Medicine C, Section of Respiratory Medicine, Herlev and Gentofte University Hospital, Hellerup, Denmark.
| | - Pradeesh Sivapalan
- Department of Internal Medicine C, Section of Respiratory Medicine, Herlev and Gentofte University Hospital, Hellerup, Denmark.,Department of Internal Medicine, Zealand University Hospital, Roskilde, Denmark
| | - Josefin Eklöf
- Department of Internal Medicine C, Section of Respiratory Medicine, Herlev and Gentofte University Hospital, Hellerup, Denmark
| | | | - Charlotta Pisinger
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
| | - Therese Lapperre
- Department of Respiratory Medicine, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Philip Tønnesen
- Department of Respiratory Medicine, Rigshospitalet, Copenhagen, Denmark
| | - Nils Hoyer
- Department of Internal Medicine C, Section of Respiratory Medicine, Herlev and Gentofte University Hospital, Hellerup, Denmark
| | - Julie Janner
- Department of Respiratory Medicine, Hvidovre University Hospital, Hvidovre, Denmark
| | - Marie Lavesen Karlsson
- Department of Respiratory and Infectious Medicine, Nordsjællands Hospital, Hillerød, Denmark
| | | | - Kristoffer Marså
- Palliation Unit, Herlev and Gentofte University Hospital, Herlev, Denmark
| | - Nina Godtfredsen
- Department of Respiratory Medicine, Hvidovre University Hospital, Hvidovre, Denmark
| | - Eva Brøndum
- Department of Respiratory Medicine, Hvidovre University Hospital, Hvidovre, Denmark
| | - Birgit Munk
- Rygestopcaféen, Hvidovre University Hospital, Hvidovre, Denmark
| | | | - Andrea Browatzski
- Department of Respiratory and Infectious Medicine, Nordsjællands Hospital, Hillerød, Denmark
| | | | - Jens-Ulrik Stæhr Jensen
- Department of Internal Medicine C, Section of Respiratory Medicine, Herlev and Gentofte University Hospital, Hellerup, Denmark.,PERSIMUNE & CHIP, Department of Infectious Medicine, Rigshospitalet, Copenhagen, Denmark
| |
Collapse
|
13
|
Adler D, Cavalot G, Brochard L. Comorbidities and Readmissions in Survivors of Acute Hypercapnic Respiratory Failure. Semin Respir Crit Care Med 2020; 41:806-816. [PMID: 32746468 DOI: 10.1055/s-0040-1710074] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Chronic obstructive pulmonary disease (COPD) is defined by chronic airflow obstruction, but is presently considered as a complex, heterogeneous, and multicomponent disease in which comorbidities and extrapulmonary manifestations make important contributions to disease expression. COPD-related hospital readmission. In particular frequent intensive care unit (ICU) readmissions for exacerbations represent a major challenge and place a high burden on patient outcomes and health-related quality of life, as well as on the healthcare system.In this narrative review, we first address major and often undiagnosed comorbidities associated with COPD that could have an impact on hospital readmission after an index ICU admission for acute hypercapnic respiratory failure. Some guidance for treatment is discussed. Second, we present predictors of hospital and ICU readmission and discuss various strategies to reduce such events.There is a strong rationale to detect and treat major comorbidities early after index ICU admission for acute hypercapnic respiratory failure. It still remains unclear, however, if a comprehensive and holistic approach to comorbidities in frail patients surviving hypercapnic respiratory failure can efficiently reduce the readmission rate.
Collapse
Affiliation(s)
- Dan Adler
- Division of Lung Diseases, Geneva University Hospitals, Geneva, Switzerland.,Faculty of Medicine, University of Geneva Medical School, Geneva, Switzerland
| | - Giulia Cavalot
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada.,Keenan Research Centre, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Canada.,Division of Internal Medicine, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Laurent Brochard
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada.,Keenan Research Centre, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Canada
| |
Collapse
|
14
|
Mathews KS, Goel NN, Vargas-Torres C, Olson AD, Zhou J, Powell CA, Mazumdar M, Stock GN, McDermott CM. A Cross-sectional Study of Hospital Performance on ICU Utilization Practices for Patients with Chronic Obstructive Pulmonary Disease. Lung 2020; 198:637-644. [PMID: 32495192 DOI: 10.1007/s00408-020-00364-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 05/19/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Intensive care unit (ICU) resources are a costly but effective commodity used in the management of critically ill patients with chronic obstructive pulmonary disease (COPD). ICU admission decisions are determined by patient diagnosis and severity of illness, but also may be affected by hospital differences in quality and performance. We investigate the variability in ICU utilization for patients with COPD and its association with hospital characteristics. METHODS Using a 3M administrative dataset spanning 2008-2013, we conducted a retrospective cohort study of adult patients discharged with COPD at hospitals in three state to determine variability in ICU utilization. Quality metrics were calculated for each hospital using observed-to-expected (O/E) ratios for overall mortality and length of stay. Logistic and multilevel multivariate regression models were constructed, estimating the association between hospital quality metrics on ICU utilization, after adjustment for available clinical factors and hospital characteristics. RESULTS In 434 hospitals with 570,517 COPD patient visits, overall ICU admission rate was 33.1% [range 0-89%; median (IQR) 24% (8, 54)]. The addition of patient, hospital, and quality characteristics decreased the overall variability attributable to individual hospital differences seen within our cohort from 40.9 to 33%. Odds of ICU utilization were increased for larger hospitals and those seeing lower pulmonary case volume. Hospitals with better overall O/E ratios for length of stay or mortality had lower ICU utilization. CONCLUSIONS Hospital characteristics, including quality metrics, are associated with variability in ICU utilization for COPD patients, with higher ICU utilization seen for lower performing hospitals.
Collapse
Affiliation(s)
- Kusum S Mathews
- Division of Pulmonary, Critical Care, & Sleep Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1232, New York, NY, USA.,Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Neha N Goel
- Division of Pulmonary, Critical Care, & Sleep Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1232, New York, NY, USA.
| | - Carmen Vargas-Torres
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ashley D Olson
- Department of Population Health Science and Policy, Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jing Zhou
- Department of Population Health Science and Policy, Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Charles A Powell
- Division of Pulmonary, Critical Care, & Sleep Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1232, New York, NY, USA
| | - Madhu Mazumdar
- Department of Population Health Science and Policy, Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Gregory N Stock
- College of Business, University of Colorado at Colorado Springs, Colorado Springs, CO, USA
| | | |
Collapse
|
15
|
Peepratoom B, Low G, Malathum P, Chai-Aroon T, Chuchottaworn C, Arpanantikul M. A structural equation model of health-related quality of life among Thai men with chronic obstructive pulmonary disease. J Clin Nurs 2020; 29:2638-2651. [PMID: 32279357 DOI: 10.1111/jocn.15286] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 01/31/2020] [Accepted: 03/29/2020] [Indexed: 01/07/2023]
Abstract
AIM AND OBJECTIVES To identify physiological, psychological and socioenvironmental factors that affect the health-related quality of life of Thai men living with chronic obstructive pulmonary disease. The vast majority of Thai persons living with chronic obstructive pulmonary disease are men. BACKGROUND Little is known about the health-related quality of life of Thai people living with chronic obstructive pulmonary disease or about the physiological and psychosocial factors that most affect it. Applying a prevailing theoretical model of health-related quality of life, we explored how physiological, psychological and socioenvironmental factors simultaneously affect the health-related quality of life of Thai men with chronic obstructive pulmonary disease. DESIGN A cross-sectional study design was used, together with the STROBE checklist. METHODS In this study, 290 Thai male outpatients at a chronic obstructive pulmonary disease specialist clinic near Bangkok were recruited using purposive sampling. The participants completed the Satisfaction With Life Scale, the St. George Respiratory Questionnaire, the Center for Epidemiologic Studies Depression Scale, the Short Form Health Survey Version 2, the chronic obstructive pulmonary disease Self-Efficacy Scale and the Social Support Questionnaire. A structural equation model was used to examine the relationships between the assessed variables. RESULTS Biological function (FEV-1, chronic obstructive pulmonary disease exacerbations), symptoms (chronic obstructive pulmonary disease and depression), functional status, general health perceptions and individual characteristics (age and self-efficacy to control dyspnoea) accounted for 56.9% of the variance in health-related quality of life. CONCLUSIONS Symptoms of chronic obstructive pulmonary disease and depression were the main factors with statistically significant direct and indirect effects on the health-related quality of life of the Thai men in this study. The effects of both symptoms included an indirect effect on health-related quality of life through functional status and general health perceptions. RELEVANCE TO CLINICAL PRACTICE The study findings may help nurses to better understand factors affecting health-related quality of life among men with chronic obstructive pulmonary disease. Preventing or minimising symptom exacerbations could be important in nursing practice. Cognitive-behavioural interventions addressing chronic obstructive pulmonary disease symptom management, depression screening and smoking cessation may improve health-related quality of life among Thai men with chronic obstructive pulmonary disease.
Collapse
Affiliation(s)
- Bangorn Peepratoom
- Ramathibodi School of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Gail Low
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Porntip Malathum
- Ramathibodi School of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Teeradej Chai-Aroon
- Faculty of Humanistic and Social Science, Mahidol University, Salaya, Nakhon Pathom, Thailand
| | | | - Manee Arpanantikul
- Ramathibodi School of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| |
Collapse
|
16
|
Kong CW, Wilkinson TM. Predicting and preventing hospital readmission for exacerbations of COPD. ERJ Open Res 2020; 6:00325-2019. [PMID: 32420313 PMCID: PMC7211949 DOI: 10.1183/23120541.00325-2019] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 02/06/2020] [Indexed: 12/17/2022] Open
Abstract
More than a third of patients hospitalised for acute exacerbation of COPD are readmitted to hospital within 90 days. Healthcare professionals and service providers are expected to collaboratively drive efforts to improve hospital readmission rates, which can be challenging due to the lack of clear consensus and guidelines on how best to predict and prevent readmissions. This review identifies these risk factors, highlighting the contribution of multimorbidity, frailty and poor socioeconomic status. Predictive models of readmission that address the multifactorial nature of readmissions and heterogeneity of the disease are reviewed, recognising that in an era of precision medicine, in-depth understanding of the intricate biological mechanisms that heighten the risk of COPD exacerbation and re-exacerbation is needed to derive modifiable biomarkers that can stratify accurately the highest risk groups for targeted treatment. We evaluate conventional and emerging strategies to reduce these potentially preventable readmissions. Here, early recognition of exacerbation symptoms and the delivery of prompt treatment can reduce risk of hospital admissions, while patient education can improve treatment adherence as a key component of self-management strategies. Care bundles are recommended to ensure high-quality care is provided consistently, but evidence for their benefit is limited to date. The search continues for interventions which are effective, sustainable and applicable to a diverse population of patients with COPD exacerbations. Further research into mechanisms that drive exacerbation and affect recovery is crucial to improve our understanding of this complex, highly prevalent disease and to advance the development of more effective treatments.
Collapse
Affiliation(s)
- Chia Wei Kong
- Southampton NIHR Respiratory Biomedical Research Unit, University Hospital Southampton, Southampton, UK
- Clinical and Experimental Sciences, Faculty of Medicine, University Hospital Southampton, Southampton, UK
| | - Tom M.A. Wilkinson
- Southampton NIHR Respiratory Biomedical Research Unit, University Hospital Southampton, Southampton, UK
- Clinical and Experimental Sciences, Faculty of Medicine, University Hospital Southampton, Southampton, UK
| |
Collapse
|
17
|
Iheanacho I, Zhang S, King D, Rizzo M, Ismaila AS. Economic Burden of Chronic Obstructive Pulmonary Disease (COPD): A Systematic Literature Review. Int J Chron Obstruct Pulmon Dis 2020; 15:439-460. [PMID: 32161455 PMCID: PMC7049777 DOI: 10.2147/copd.s234942] [Citation(s) in RCA: 181] [Impact Index Per Article: 45.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 01/24/2020] [Indexed: 01/01/2023] Open
Abstract
Background and Objectives Chronic obstructive pulmonary disease (COPD) affects over 250 million people globally, carrying a notable economic burden. This systematic literature review aimed to highlight the economic burden associated with moderate-to-very severe COPD and to investigate key drivers of healthcare resource utilization (HRU), direct costs and indirect costs for this patient population. Materials and Methods Relevant publications published between January 1, 2006 and November 14, 2016 were captured from the Embase, MEDLINE and MEDLINE In-Process databases. Supplemental searches from relevant 2015-2016 conferences were also performed. Titles and abstracts were reviewed by two independent researchers against pre-defined inclusion and exclusion criteria. Studies were grouped by the type of economic outcome presented (HRU or costs). Where possible, data were also grouped according to COPD severity and/or patient exacerbation history. Results In total, 73 primary publications were included in this review: 66 reported HRU, 22 reported direct costs and one reported indirect costs. Most of the studies (94%) reported on data from either Europe or North America. Trends were noted across multiple studies for higher direct costs (including mean costs per patient per year and mean costs per exacerbation) being associated with increasingly severe COPD and/or a history of more frequent or severe exacerbations. Similar trends were noted according to COPD severity and/or exacerbation history for rate of hospitalization and primary care visits. Multivariate analyses were reported by 29 studies and demonstrated the statistical significance of these associations. Several other drivers of increased costs and HRU were highlighted for patients with moderate-to-very severe COPD, including comorbidities, and treatment history. Conclusion Moderate-to-very severe COPD represents a considerable economic burden for healthcare providers despite the availability of efficacious treatments and comprehensive guidelines on their use. Further research is warranted to ensure cost-efficient COPD management, to improve treatments and ease budgetary pressures.
Collapse
Affiliation(s)
| | - Shiyuan Zhang
- Value Evidence and Outcomes, GlaxoSmithKline plc., Collegeville, PA, USA
| | - Denise King
- Value Evidence and Outcomes, GlaxoSmithKline plc., Brentford, UK
| | | | - Afisi S Ismaila
- Value Evidence and Outcomes, GlaxoSmithKline plc., Collegeville, PA, USA
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| |
Collapse
|
18
|
Chen X, Wang Q, Hu Y, Zhang L, Xiong W, Xu Y, Yu J, Wang Y. A Nomogram for Predicting Severe Exacerbations in Stable COPD Patients. Int J Chron Obstruct Pulmon Dis 2020; 15:379-388. [PMID: 32110006 PMCID: PMC7035888 DOI: 10.2147/copd.s234241] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 12/18/2019] [Indexed: 12/16/2022] Open
Abstract
Objective To develop a practicable nomogram aimed at predicting the risk of severe exacerbations in COPD patients at three and five years. Methods COPD patients with prospective follow-up data were extracted from Subpopulations and Intermediate Outcome Measures in COPD Study (SPIROMICS) obtained from National Heart, Lung and Blood Institute (NHLBI) Biologic Specimen and Data Repository Information Coordinating Center. We comprehensively considered the demographic characteristics, clinical data and inflammation marker of disease severity. Cox proportional hazard regression was performed to identify the best combination of predictors on the basis of the smallest Akaike Information Criterion. A nomogram was developed and evaluated on discrimination, calibration, and clinical efficacy by the concordance index (C-index), calibration plot and decision curve analysis, respectively. Internal validation of the nomogram was assessed by the calibration plot with 1000 bootstrapped resamples. Results Among 1711 COPD patients, 523 (30.6%) suffered from at least one severe exacerbation during follow-up. After stepwise regression analysis, six variables were determined including BMI, severe exacerbations in the prior year, comorbidity index, post-bronchodilator FEV1% predicted, and white blood cells. Nomogram to estimate patients' likelihood of severe exacerbations at three and five years was established. The C-index of the nomogram was 0.74 (95%CI: 0.71-0.76), outperforming ADO, BODE and DOSE risk score. Besides, the calibration plot of three and five years showed great agreement between nomogram predicted possibility and actual risk. Decision curve analysis indicated that implementation of the nomogram in clinical practice would be beneficial and better than aforementioned risk scores. Conclusion Our new nomogram was a useful tool to assess the probability of severe exacerbations at three and five years for COPD patients and could facilitate clinicians in stratifying patients and providing optimal therapies.
Collapse
Affiliation(s)
- Xueying Chen
- Department of Respiratory and Critical Care Medicine, Key Laboratory of Pulmonary Diseases of Health Ministry, Key Cite of National Clinical Research Center for Respiratory Disease, Wuhan Clinical Medical Research Center for Chronic Airway Diseases, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, People's Republic of China
| | - Qi Wang
- Department of Respiratory and Critical Care Medicine, Key Laboratory of Pulmonary Diseases of Health Ministry, Key Cite of National Clinical Research Center for Respiratory Disease, Wuhan Clinical Medical Research Center for Chronic Airway Diseases, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, People's Republic of China
| | - Yinan Hu
- Department of Respiratory and Critical Care Medicine, Key Laboratory of Pulmonary Diseases of Health Ministry, Key Cite of National Clinical Research Center for Respiratory Disease, Wuhan Clinical Medical Research Center for Chronic Airway Diseases, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, People's Republic of China
| | - Lei Zhang
- Department of Respiratory and Critical Care Medicine, Key Laboratory of Pulmonary Diseases of Health Ministry, Key Cite of National Clinical Research Center for Respiratory Disease, Wuhan Clinical Medical Research Center for Chronic Airway Diseases, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, People's Republic of China
| | - Weining Xiong
- Department of Respiratory and Critical Care Medicine, Key Laboratory of Pulmonary Diseases of Health Ministry, Key Cite of National Clinical Research Center for Respiratory Disease, Wuhan Clinical Medical Research Center for Chronic Airway Diseases, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, People's Republic of China
| | - Yongjian Xu
- Department of Respiratory and Critical Care Medicine, Key Laboratory of Pulmonary Diseases of Health Ministry, Key Cite of National Clinical Research Center for Respiratory Disease, Wuhan Clinical Medical Research Center for Chronic Airway Diseases, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, People's Republic of China
| | - Jun Yu
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, People's Republic of China
| | - Yi Wang
- Department of Respiratory and Critical Care Medicine, Key Laboratory of Pulmonary Diseases of Health Ministry, Key Cite of National Clinical Research Center for Respiratory Disease, Wuhan Clinical Medical Research Center for Chronic Airway Diseases, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, People's Republic of China
| |
Collapse
|
19
|
Yoon S, Kim TE, Kim TH, Na JO, Shin KC, Rhee CK, Jung SS, Choe KH, Yoo KH. Clinical Role of the Chronic Obstructive Pulmonary Disease Assessment Test in Prediction of the Response to Treatment for Exacerbations. J Korean Med Sci 2020; 35:e10. [PMID: 31920016 PMCID: PMC6955431 DOI: 10.3346/jkms.2020.35.e10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 11/21/2019] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The chronic obstructive pulmonary disease (COPD) assessment test (CAT) is a validated, eight-item questionnaire used to quantify the health status of patients. The aim of this study was to evaluate the usefulness of the CAT questionnaire as a tool to assess the response to treatment in acute exacerbations of COPD in an outpatient setting. METHODS A multicenter, phase 3 randomized controlled trial was conducted previously to examine the efficacy and safety of oral zabofloxacin for the treatment of COPD exacerbations. In the present post hoc analysis of the original study, patients with COPD exacerbation were categorized as responders or non-responders according to the respiratory symptoms persisting on day 10 (visit 3) of treatment. The CAT questionnaire was completed daily by patients at home from the initial visit to the second visit on day 5. Subsequently, the questionnaire was completed in the presence of a physician on days 10 (visit 3) and 36 (visit 4). Multivariate regression analysis was performed to determine the association between CAT scores and the therapeutic response. RESULTS The CAT scores decreased more rapidly in responders compared to non-responders during the first 5 days (23.3-20.4 vs. 23.5-22). Among responders, patients with higher severity of illness also revealed higher CAT scores on the first day of an exacerbation (mild, 19.8; moderate, 21.4; severe, 23.8; very severe, 28.6). Multivariate analysis revealed that a change in the CAT score during the first 3 days influenced the therapeutic response. A significant decrease in scores in the domains of sputum production, chest tightness, and activities of daily living was seen among responders. CONCLUSION Early improvement in CAT scores may be associated with a more favorable response to the treatment of COPD exacerbations. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01658020. TRIAL REGISTRATION Clinical Research Information Service Identifier: KCT0000532.
Collapse
Affiliation(s)
- Sunyoung Yoon
- Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Tae Eun Kim
- Department of Clinical Pharmacology, Konkuk University School of Medicine, Seoul, Korea
| | - Tae Hyung Kim
- Division of Pulmonology, Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
| | - Ju Ok Na
- Division of Allergy and Respiratory Disease, Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Kyeong Cheol Shin
- Regional Center for Respiratory Disease, Department of Internal Medicine, Yeungnam University Medical Center, Yeungnam University College of Medicine, Daegu, Korea
| | - Chin Kook Rhee
- Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sung Soo Jung
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea
| | - Kang Hyeon Choe
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Kwang Ha Yoo
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea.
| |
Collapse
|
20
|
Chabowski M, Juzwiszyn J, Bolanowska Z, Brzecka A, Jankowska-Polańska B. Acceptance of Illness Associates with Better Quality of Life in Patients with Nonmalignant Pulmonary Diseases. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1176:19-24. [PMID: 31119580 DOI: 10.1007/5584_2019_386] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Chronic nonmalignant pulmonary diseases impose a heavy burden on patients, generate health-care costs, and contribute to poor health-related quality of life. It has been found that a wide range of factors negatively affects quality of life, but the role of acceptance of illness needs to be further investigated. The aim of the study was to evaluate the relationship between acceptance of illness and quality of life in patients with chronic nonmalignant pulmonary diseases. The study encompassed 200 patients of the mean age 58 ± 16 years who were mainly diagnosed with asthma (n = 72; 36%), COPD (n = 52; 26%), and obstructive sleep apnea (n = 38; 19%). The patients answered the Acceptance of Illness Scale (AIS) and the St. George's Respiratory Questionnaire (SGRQ). Sociodemographical and clinical data were collected. The level of acceptance of illness significantly associated with each of the SGRQ domains. The greater the acceptance of illness, the lowest was the SGRQ score. The mean total score of SGRQ was 44.6 ± 24.9 and that of AIS was 26.1 ± 8.2. Higher AIS scores significantly associated with lower SGRQ scores, i.e., with better quality of life (p < 0.001 for each domain). We conclude that in patients with chronic nonmalignant pulmonary diseases, acceptance of illness plays an important role and is closely related to the general level of quality of life. Interventions aimed at improving acceptance of illness may be considered to improve quality of life.
Collapse
Affiliation(s)
- Mariusz Chabowski
- Division of Surgical Specialties, Department of Clinical Nursing, Faculty of Health Science, Wroclaw Medical University, Wroclaw, Poland.
- Department of Surgery, Fourth Military Teaching Hospital, Wroclaw, Poland.
| | - Jan Juzwiszyn
- Division of Surgical Specialties, Department of Clinical Nursing, Faculty of Health Science, Wroclaw Medical University, Wroclaw, Poland
| | - Zofia Bolanowska
- Division of Surgical Specialties, Department of Clinical Nursing, Faculty of Health Science, Wroclaw Medical University, Wroclaw, Poland
| | - Anna Brzecka
- Department of Pulmonology and Lung Cancer, Faculty of Postgraduate Medical Training, Wroclaw Medical University, Wroclaw, Poland
| | - Beata Jankowska-Polańska
- Department of Clinical Nursing, Faculty of Health Science, Wroclaw Medical University, Wroclaw, Poland
| |
Collapse
|
21
|
Kraskovsky V, Schneider J, Mador MJ, Provost KA. Longer Duration of Palliative Care in Patients With COPD Is Associated With Death Outside the Hospital. J Palliat Care 2019; 37:125-133. [PMID: 31262230 DOI: 10.1177/0825859719851486] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Patients with advanced chronic obstructive pulmonary disease (COPD) have a significant symptom burden despite maximal medical therapy, yet few are referred for concomitant palliative care. OBJECTIVE To evaluate the utilization and impact of palliative care on the location of death and to identify clinical variables associated with palliative care contact. DESIGN Retrospective chart review from 2010 to 2016 at the VA Western New York Healthcare System using ICD-9/10 diagnosis of COPD. Palliative care contact was identified by Z51.5 or stop code 353. RESULTS Only 0.5% to 2% of living patients received palliative care, increasing abruptly at death (6%). Lower diffusion capacity for carbon monoxide (DLCO) (greater emphysema) was associated with palliative care contact, independent of comorbid disease burden or age. Initial outpatient contact was associated with a longer duration of palliative care (P = .003) and death in a home-like setting. Outpatient palliative care was associated with more severe airflow obstruction (forced expiratory volume in 1 second, percent predicted [FEV1%]), whereas greater disease exacerbation frequency was associated with inpatient contact. COPD patients not referred to palliative care had a greater comorbid disease burden, similar FEV1%, fewer disease exacerbations, and a greater DLCO. CONCLUSION Few patients with COPD received palliative care, similar to national trends. Initial outpatient palliative contact had the longest duration of care and death in the preferred home environment. The extent of emphysema (DLCO reduction) and more frequent disease exacerbations identified in patients were more likely to receive palliative care. Our study begins to define the benefits of palliative care in advanced COPD and confirms underutilization in the years before death, where a prolonged impact on the quality of life may be realized.
Collapse
Affiliation(s)
- Valeri Kraskovsky
- 1 Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Jaclyn Schneider
- 2 Department of Geriatrics and Palliative Medicine, Veterans Health Administration, VA Western New York Healthcare System at Buffalo, Buffalo, NY, USA.,3 Division of Geriatrics and Palliative Medicine, Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - M Jeffery Mador
- 4 Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Veterans Health Administration, VA Western New York Healthcare System at Buffalo, Buffalo, NY, USA.,5 Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Karin A Provost
- 4 Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Veterans Health Administration, VA Western New York Healthcare System at Buffalo, Buffalo, NY, USA.,5 Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| |
Collapse
|
22
|
Gómez-Angelats E, Sánchez C. Care Bundles after Discharging Patients with Chronic Obstructive Pulmonary Disease Exacerbation from the Emergency Department. Med Sci (Basel) 2018; 6:E63. [PMID: 30087300 PMCID: PMC6164584 DOI: 10.3390/medsci6030063] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 08/02/2018] [Accepted: 08/06/2018] [Indexed: 12/02/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is the second leading cause of emergency department (ED) admissions to hospital, and nearly a third of patients with acute exacerbation (AE) of COPD are re-admitted to hospital within 28 days after discharge. It has been suggested that nearly a third of COPD admissions could be avoided through the implementation of evidence-based care interventions. A COPD discharge bundle is a set of evidence-based practices, aimed at improving patient outcomes after discharge from AE COPD; body of evidence supports the usefulness of discharge care bundles after AE of COPD, although there is a lack of consensus of what interventions should be implemented. On the other hand, the implementation of those interventions also involves different challenges. Important care gaps remain regarding discharge care bundles for patients with acute exacerbation of COPD discharged from EDs There is an urgent need for investigations to guide future implementation of care bundles for those patients discharged from EDs.
Collapse
Affiliation(s)
- Elisenda Gómez-Angelats
- Emergency Department, Hospital Clínic de Barcelona, C/Villarroel 170, 08036 Barcelona, Spain.
| | - Carolina Sánchez
- Emergencies Group: Processes and Pathologies, Institut d'Investigacions Biomèdiques August Pi i Sunyer, C/Rosselló 149, 08036 Barcelona, Spain.
| |
Collapse
|
23
|
Yan W, Shah P, Hiebert B, Pozeg Z, Ghorpade N, Singal RK, Manji RA, Arora RC. Long-term non-institutionalized survival and rehospitalization after surgical aortic and mitral valve replacements in a large provincial cardiac surgery centre. Interact Cardiovasc Thorac Surg 2018; 27:131-138. [PMID: 29462406 DOI: 10.1093/icvts/ivy018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 01/14/2018] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Long-term quality of life following open surgical valve replacement is an increasingly important outcome to patients and their caregivers. This study examines non-institutionalized survival and rehospitalization within our surgical aortic valve replacement (AVR) and mitral valve replacement (MVR) populations. METHODS A retrospective single-centre study of all consecutive open surgical valve replacements between 1995 and 2014 was undertaken. Clinical data were linked to provincial administrative data for 3219 patients who underwent AVR, MVR or double (aortic and mitral) valve replacement with or without concomitant coronary artery bypass grafting (CABG). Non-institutionalized survival and cumulative incidence of rehospitalization was examined up to 15 years. RESULTS Follow-up was complete for 96.9% of the 2146 patients who underwent AVR ± CABG (66.7% of the overall cohort), 878 who underwent MVR ± CABG (27.3%) and 195 who underwent double (aortic and mitral) valve replacement ± CABG (6.0%) with a median follow-up time of 5.6 years. Overall non-institutionalized survival was 35.4% at 15 years, and the cumulative incidence of rehospitalization was 34.4%, 63.2% and 87.0% at 1, 5 and 15 years, respectively, without significant differences between valve procedure cohorts. Both non-institutionalized survival and cumulative incidence of rehospitalization improved in more recent eras, despite increasing age and comorbidities. CONCLUSIONS Non-institutionalized survival and rehospitalization data for up to 15 years suggest good functional outcomes long after surgical AVR and/or MVR. Continued improvements are seen in these metrics over the past 2 decades. This provides a unique insight into the quality of life after surgical valve replacement in the ageing demographics with valvular heart disease.
Collapse
Affiliation(s)
- Weiang Yan
- Section of Cardiac Surgery, Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada.,Cardiac Sciences Program, Winnipeg Regional Health Authority, Winnipeg, MB, Canada
| | - Pallav Shah
- Section of Cardiac Surgery, Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada.,Cardiac Sciences Program, Winnipeg Regional Health Authority, Winnipeg, MB, Canada
| | - Brett Hiebert
- Cardiac Sciences Program, Winnipeg Regional Health Authority, Winnipeg, MB, Canada
| | - Zlatko Pozeg
- Section of Cardiac Surgery, Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada.,Cardiac Sciences Program, Winnipeg Regional Health Authority, Winnipeg, MB, Canada
| | - Nitin Ghorpade
- Section of Cardiac Surgery, Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada.,Cardiac Sciences Program, Winnipeg Regional Health Authority, Winnipeg, MB, Canada
| | - Rohit K Singal
- Section of Cardiac Surgery, Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada.,Cardiac Sciences Program, Winnipeg Regional Health Authority, Winnipeg, MB, Canada
| | - Rizwan A Manji
- Section of Cardiac Surgery, Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada.,Cardiac Sciences Program, Winnipeg Regional Health Authority, Winnipeg, MB, Canada
| | - Rakesh C Arora
- Section of Cardiac Surgery, Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada.,Cardiac Sciences Program, Winnipeg Regional Health Authority, Winnipeg, MB, Canada
| |
Collapse
|
24
|
Marcos PJ, López-Campos JL. Shall We Focus on the Eosinophil to Guide Treatment with Systemic Corticosteroids during Acute Exacerbations of Chronic Obstructive Pulmonary Disease (COPD)? CON. Med Sci (Basel) 2018; 6:E49. [PMID: 29890705 PMCID: PMC6024798 DOI: 10.3390/medsci6020049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 05/25/2018] [Accepted: 06/07/2018] [Indexed: 12/13/2022] Open
Abstract
The employment of systemic corticosteroids in the treatment of acute exacerbations of chronic obstructive pulmonary disease (COPD) has been shown to improve airway limitation, decrease treatment failure and risk of relapse, and may improve symptoms in addition to decreasing the length of hospital stay. Nowadays, all clinical guidelines recommend systemic corticosteroids to treat moderate or severe COPD exacerbations. However, their use is associated with potential side effects, mainly hyperglycemia. In the era of precision medicine, the possibility of employing blood eosinophil count has emerged as a potential way of optimizing therapy. Issues regarding the intra-individual variability of blood eosinophil count determination, a lack of clear data regarding the real prevalence of eosinophilic acute exacerbations, the fact that previously published studies have demonstrated the benefit of systemic corticosteroids irrespective of eosinophil levels, and especially the fact that there is only one well-designed study justifying this approach have led us to think that we are not ready to use eosinophil count to guide treatment with systemic corticosteroids during acute exacerbations of COPD.
Collapse
Affiliation(s)
- Pedro J Marcos
- Dirección de Procesos Asistenciales, Servicio de Neumología, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complejo Hospitalario Universitario de A Coruña (CHUAC), Estructura Organizativa de Xerencia de Xestión Integrada (EOXI) de A Coruña Sergas, Universidade da Coruña (UDC), 15006 A Coruña, Spain.
| | - José Luis López-Campos
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Universidad de Sevilla, 41013 Seville, Spain.
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, 28029 Madrid, Spain.
| |
Collapse
|
25
|
Pendharkar SR, Ospina MB, Southern DA, Hirani N, Graham J, Faris P, Bhutani M, Leigh R, Mody CH, Stickland MK. Effectiveness of a standardized electronic admission order set for acute exacerbation of chronic obstructive pulmonary disease. BMC Pulm Med 2018; 18:93. [PMID: 29843772 PMCID: PMC5975274 DOI: 10.1186/s12890-018-0657-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 05/21/2018] [Indexed: 11/16/2022] Open
Abstract
Background Variation in hospital management of patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) may prolong length of stay, increasing the risk of hospital-acquired complications and worsening quality of life. We sought to determine whether an evidence-based computerized AECOPD admission order set could improve quality and reduce length of stay. Methods The order set was designed by a provincial COPD working group and implemented voluntarily among three physician groups in a Canadian tertiary-care teaching hospital. The primary outcome was length of stay for patients admitted during order set implementation period, compared to the previous 12 months. Secondary outcomes included length of stay of patients admitted with and without order set after implementation, all-cause readmissions, and emergency department visits. Results There were 556 admissions prior to and 857 admissions after order set implementation, for which the order set was used in 47%. There was no difference in overall length of stay after implementation (median 6.37 days (95% confidence interval 5.94, 6.81) pre-implementation vs. 6.02 days (95% confidence interval 5.59, 6.46) post-implementation, p = 0.26). In the post-implementation period, order set use was associated with a 1.15-day reduction in length of stay (95% confidence interval − 0.5, − 1.81, p = 0.001) compared to patients admitted without the order set. There was no difference in readmissions. Conclusions Use of a computerized guidelines-based admission order set for COPD exacerbations reduced hospital length of stay without increasing readmissions. Interventions to increase order set use could lead to greater improvements in length of stay and quality of care. Electronic supplementary material The online version of this article (10.1186/s12890-018-0657-x) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Sachin R Pendharkar
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada. .,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada. .,O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada. .,University of Calgary, TRW Building, Rm 3E23, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada.
| | - Maria B Ospina
- Respiratory Health Strategic Clinical Network, Alberta Health Services, Edmonton, AB, Canada
| | - Danielle A Southern
- O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,W21C Research and Innovation Centre, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Naushad Hirani
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Jim Graham
- Respiratory Health Strategic Clinical Network, Alberta Health Services, Edmonton, AB, Canada
| | - Peter Faris
- Research Priorities and Implementation, Alberta Health Services, Calgary, AB, Canada
| | - Mohit Bhutani
- Division of Pulmonary Medicine, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Richard Leigh
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Christopher H Mody
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Respiratory Health Strategic Clinical Network, Alberta Health Services, Edmonton, AB, Canada
| | - Michael K Stickland
- Division of Pulmonary Medicine, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| |
Collapse
|
26
|
Inhaled corticosteroids in COPD: Personalising the therapeutic choice. Afr J Thorac Crit Care Med 2018; 24:10.7196/AJTCCM.2018.v24i1.184. [PMID: 34541493 PMCID: PMC8432921 DOI: 10.7196/ajtccm.2018.v24i1.184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2017] [Indexed: 11/08/2022] Open
Abstract
There has been a recent surge in interest in the role of inhaled corticosteroids (ICS) in the treatment of COPD, especially regarding patients with high eosinophil counts. Evidence has shown that despite the increase in localised adverse effects and a small increase in non-fatal pneumonia events with ICS use, ICS still have an important role to play in reducing exacerbation rates and addressing the inflammation that is at the heart of the pathogenesis of COPD. Current international guidelines recommend the use of ICS only in patients with severe disease. This review examines the potential role of ICS in all COPD patients.
Collapse
|
27
|
Sivapalan P, Moberg M, Eklöf J, Janner J, Vestbo J, Laub RR, Browatzki A, Armbruster K, Wilcke JT, Seersholm N, Weinreich UM, Titlestad IL, Andreassen HF, Ulrik CS, Bødtger U, Nielsen TL, Hansen EF, Jensen JUS. A multi-center randomized, controlled, open-label trial evaluating the effects of eosinophil-guided corticosteroid-sparing therapy in hospitalised patients with COPD exacerbations - The CORTICO steroid reduction in COPD (CORTICO-COP) study protocol. BMC Pulm Med 2017; 17:114. [PMID: 28810909 PMCID: PMC5558695 DOI: 10.1186/s12890-017-0458-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 08/08/2017] [Indexed: 11/10/2022] Open
Abstract
Background The most commonly applied treatment for acute exacerbations of chronic obstructive pulmonary disease (AECOPD) is a 5-day course of high-dose systemic corticosteroids. However, this treatment has not been shown to reduce mortality and can potentially have serious side effects. Recent research has shown that, presumably, only a subgroup of COPD patients identifieable by blood eosinophil count benefit from a rescue course of prednisolone. By applying a biomarker-guided strategy, the aim of this study is to determine whether it is possible to reduce the use of systemic corticosteroids in AECOPD without influencing the outcome. Methods This is an ongoing prospective multicenter randomized controlled open label trial comprising 320 patients with AECOPD recruited from four hospitals in Denmark. The patients are randomized 1:1 to either standard care or eosinophil-guided corticosteroid-sparing therapy where prednisolone is not administered if the daily blood sampling reveals an eosinophil level below 0.3 × 109 cells/L. The primary endpoint is length of hospital stay within 14 days after recruitment. The secondary endpoints are treatment failure, 30-day mortality rate, COPD related re-admission rate, change in FEV1, and a number of adverse effect measures obtained within 3 months after the index hospitalisation date related to corticosteroid usage. Discussion This will be a very large RCT providing knowledge about the effectiveness of individualized biomarker-guided corticosteroid therapy in hospitalised patients with AECOPD. Trial registration Clinicaltrials.gov, NCT02857842, 02-august-2016. Clinicaltrialregister.eu: Classification Code: 10,010,953, 02-marts-2016.
Collapse
Affiliation(s)
- Pradeesh Sivapalan
- Department of Internal Medicine, Herlev and Gentofte University Hospital, Hellerup, Denmark.
| | - Mia Moberg
- Department of Respiratory Medicine, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Josefin Eklöf
- Department of Internal Medicine, Herlev and Gentofte University Hospital, Hellerup, Denmark
| | - Julie Janner
- Department of Respiratory Medicine, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Jørgen Vestbo
- Division of Infection, Inflammation and Respiratory Medicine, University of Manchester, Manchester, UK
| | - Rasmus Rude Laub
- Department of Pulmonary Medicine, Hvidovre University Hospital, Hvidovre, Denmark
| | - Andrea Browatzki
- Department of Pulmonary and Infectious Diseases, North Zealand University Hospital, Hilleroed, Denmark
| | - Karin Armbruster
- Department of Internal Medicine, Herlev and Gentofte University Hospital, Hellerup, Denmark
| | - Jon Torgny Wilcke
- Department of Internal Medicine, Herlev and Gentofte University Hospital, Hellerup, Denmark
| | - Niels Seersholm
- Department of Internal Medicine, Herlev and Gentofte University Hospital, Hellerup, Denmark
| | | | - Ingrid Louise Titlestad
- Department of Respiratory Medicine, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | | | | | - Uffe Bødtger
- Department of Respiratory Medicine, Naestved University Hospital, Naestved, Denmark
| | - Thyge Lynghøj Nielsen
- Department of Pulmonary and Infectious Diseases, North Zealand University Hospital, Hilleroed, Denmark
| | | | - Jens Ulrik Stæhr Jensen
- Department of Internal Medicine, Herlev and Gentofte University Hospital, Hellerup, Denmark.,CHIP, Department of Infectious Diseases, University of Copenhagen, Rigshospitalet, Finsencentret, Copenhagen, Denmark
| |
Collapse
|
28
|
Ferguson GT, Beck B, Clerisme-Beaty E, Liu D, Thomashow BM, Wise RA, ZuWallack R, Make BJ. Recruiting Patients After Hospital Discharge for Acute Exacerbation of COPD: Challenges and Lessons Learned. CHRONIC OBSTRUCTIVE PULMONARY DISEASES (MIAMI, FLA.) 2017; 4:265-278. [PMID: 29354671 PMCID: PMC5764840 DOI: 10.15326/jcopdf.4.4.2016.0176] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/16/2017] [Indexed: 11/21/2022]
Abstract
Background: Hospitalizations for acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are associated with increased mortality and decreased quality of life. Replicate hospital discharge studies were initiated to examine efficacy and safety of once-daily tiotropium HandiHaler® versus placebo, in addition to usual care, in patients discharged from the hospital after an AECOPD. Methods: Both studies were randomized, placebo-controlled, double-blind, parallel-group, multicenter, with inclusion/exclusion criteria providing a diverse COPD patient cohort hospitalized for ≤14 days with AECOPD. Patients received tiotropium or placebo, initiated within 10 days post-discharge. Target recruitment was 604 patients/study and planned duration was event-driven, ending after 631 clinical outcome events across both studies. Inability to reach targeted site numbers and patient recruitment/retention difficulties led to early study termination. Recruitment/retention challenges and protocol amendment impacts were assessed qualitatively to understand the major issues. Results: Over 18 months, 219 patients were enrolled; 158 were randomized and 61 failed screening. Premature treatment discontinuation occurred in 49(31%) patients, of whom 20(41%) completed health status follow-up. All-cause, 30-day hospital readmission was low (8[5%] patients). A total of 154(98%) patients had a concomitant diagnosis and most took pulmonary medication pre-randomization (143[91%]) and during study treatment (144[92%]). Inclusion/exclusion criteria changes failed to improve recruitment. Recruitment/retention barriers were identified, relating to patient and clinician factors, health care infrastructure, and clinical practices. Conclusions: Although AECOPD hospitalization is clinically important and incurs high costs, significant challenges exist in studying this population in clinical trials after hospitalization. Studies are needed to evaluate effective management of AECOPD patients at high risk of adverse clinical outcomes.
Collapse
Affiliation(s)
- Gary T. Ferguson
- Pulmonary Research Institute of Southeast Michigan, Farmington Hills, Michigan
| | - Bonnie Beck
- Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, Connecticut
| | | | - Dacheng Liu
- Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, Connecticut
| | - Byron M. Thomashow
- College of Physicians and Surgeons, Columbia University, New York, New York
| | - Robert A. Wise
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | | |
Collapse
|
29
|
Sørensen SS, Pedersen KM, Weinreich UM, Ehlers L. Economic Evaluation of Community-Based Case Management of Patients Suffering From Chronic Obstructive Pulmonary Disease. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2017; 15:413-424. [PMID: 27928660 DOI: 10.1007/s40258-016-0298-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVES To analyse the cost effectiveness of community-based case management for patients suffering from chronic obstructive pulmonary disease (COPD). METHODS The study took place in the third largest municipality in Denmark and was conducted as a randomised controlled trial with 12 months of follow-up. A total of 150 patients with COPD were randomised into two groups receiving usual care and case management in addition to usual care. Case management included among other things self care proficiency, medicine compliance, and care coordination. Outcome measure for the analysis was the incremental cost-effectiveness ratio (ICER) as cost per quality-adjusted life year (QALY) from the perspective of the healthcare sector. Costs were valued in British Pounds (£) at price level 2016. Scenario analyses and probabilistic sensitivity analyses were conducted in order to assess uncertainty of the ICER estimate. RESULTS The intervention resulted in a QALY improvement of 0.0146 (95% CI -0.0216; 0.0585), and a cost increase of £494 (95% CI -1778; 2766) per patient. No statistically significant difference was observed either in costs or effects. The ICER was £33,865 per QALY gained. Scenario analyses confirmed the robustness of the result and revealed slightly lower ICERs of £28,100-£31,340 per QALY. CONCLUSIONS Analysis revealed that case management led to a positive incremental QALY, but were more costly than usual care. The highly uncertain ICER somewhat exceeds for instance the threshold value used by the National Institute of Health and Care Excellence (NICE). No formally established Danish threshold value exists. ClinicalTrials.gov Identifier: NCT01512836.
Collapse
Affiliation(s)
- Sabrina Storgaard Sørensen
- Department of Business and Management, Danish Center for Healthcare Improvements, Aalborg University, Fibigerstræde 11, 9220, Aalborg, Denmark.
| | - Kjeld Møller Pedersen
- Department of Business and Management, Danish Center for Healthcare Improvements, Aalborg University, Fibigerstræde 11, 9220, Aalborg, Denmark
- University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark
| | - Ulla Møller Weinreich
- Department of Respiratory Diseases, Aalborg University Hospital, Hobrovej 18-22, 9000, Aalborg, Denmark
- The Clinical Institute, Aalborg University Hospital, Hobrovej 18-22, 9000, Aalborg, Denmark
| | - Lars Ehlers
- Department of Business and Management, Danish Center for Healthcare Improvements, Aalborg University, Fibigerstræde 11, 9220, Aalborg, Denmark
| |
Collapse
|
30
|
Tan DJ, White CJ, Walters JA, Walters EH. Inhaled corticosteroids with combination inhaled long-acting beta 2-agonists and long-acting muscarinic antagonists for chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2016; 11:CD011600. [PMID: 27830584 PMCID: PMC6464947 DOI: 10.1002/14651858.cd011600.pub2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Management of chronic obstructive pulmonary disease (COPD) commonly involves long-acting bronchodilators including beta-agonists (LABA) and muscarinic antagonists (LAMA). In individuals with persistent symptoms or frequent exacerbations, inhaled corticosteroids (ICS) are also used. LABA and LAMA bronchodilators are now available in single combination inhalers. However, the benefits and risks of adding ICS to combination LABA/LAMA inhalers remains unclear. OBJECTIVES To assess the effect of adding an inhaled corticosteroid (ICS) to combination long-acting beta₂-agonist (LABA)/long-acting muscarinic antagonist (LAMA) inhalers for the treatment of stable COPD. SEARCH METHODS We carried out searches using the Cochrane Airways Group Specialised Register of Trials (searched 20 September 2016), Cochrane Central Register of Controlled Trials (CENTRAL; 2015, Issue 12) in the Cochrane Library (searched 15 December 2015) and MEDLINE (searched 15 December 2015). We also searched ClinicalTrials.gov, World Health Organisation (WHO) trials portal and pharmaceutical company clinical trials' databases up to 7 Janurary 2016. SELECTION CRITERIA We included parallel-group, randomised controlled trials (RCTs) of three weeks' duration or longer which compared treatment of stable COPD with ICS in addition to combination LABA/LAMA inhalers against combination LABA/LAMA inhalers alone. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. MAIN RESULTS We identified a total of 586 records in our search. Following removal of duplicates, 386 abstracts were assessed for inclusion. Six studies were identified as potentially relevant; however, all failed to meet the inclusion criteria on full-text assessment or after contacting the corresponding author to clarify study characteristics. AUTHORS' CONCLUSIONS There are currently no studies published assessing the effect of ICS in addition to combination LABA/LAMA inhalers for the treatment of stable COPD. As combination LABA/LAMA inhalers are now widely available, there is a need for well-designed RCTs to investigate whether ICS provides any added therapeutic benefit.
Collapse
Affiliation(s)
- Daniel J Tan
- School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | | | | | | |
Collapse
|
31
|
Ospina MB, Mrklas K, Deuchar L, Rowe BH, Leigh R, Bhutani M, Stickland MK. A systematic review of the effectiveness of discharge care bundles for patients with COPD. Thorax 2016; 72:31-39. [PMID: 27613539 DOI: 10.1136/thoraxjnl-2016-208820] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 07/28/2016] [Accepted: 08/13/2016] [Indexed: 11/04/2022]
Abstract
BACKGROUND A COPD discharge bundle is a set of evidence-based practices aimed at improving patient outcomes after discharge from acute care settings following an exacerbation. We conducted a systematic review on the effectiveness of COPD discharge bundles and summarised their individual care elements. METHODS Biomedical electronic databases and clinical trial registries were searched from database inception through April 2016 to identify experimental studies evaluating care bundles offered to patients with COPD at discharge. Random-effects meta-analyses of clinical trials data were conducted for hospital readmissions, mortality, and quality of life (QoL). RESULTS The review included 14 studies (5 clinical trials, 7 uncontrolled trials, and 2 interrupted time series). A total of 26 distinct elements of care were included in the bundles of individual studies. Evidence from four clinical trials with moderate-to-high risk of bias showed that COPD discharge bundles reduced hospital readmissions (pooled risk ratio (RR): 0.80; 95% CI 0.65 to 0.99). There was insufficient evidence that care bundles influence long-term mortality (RR: 0.74; 95% CI 0.43 to 1.28; four trials) or QoL (mean difference in St. George's Respiratory Questionnaire: 1.84; 95% CI -2.13 to 5.8). CONCLUSIONS Discharge bundles for patients with COPD led to fewer readmissions but did not significantly improve mortality or QoL. Future studies should employ higher quality research methods, fully report care bundle elements, implementation strategies and intervention fidelity to better evaluate the effectiveness of packaging evidence-based interventions together to improve outcomes of patients with COPD discharged from acute care settings.
Collapse
Affiliation(s)
| | - Kelly Mrklas
- Alberta Health Services, Edmonton, Alberta, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Brian H Rowe
- Alberta Health Services, Edmonton, Alberta, Canada.,Department of Emergency Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada.,School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Richard Leigh
- Division of Respirology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Mohit Bhutani
- Division of Pulmonary Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Michael K Stickland
- Alberta Health Services, Edmonton, Alberta, Canada.,Division of Pulmonary Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada.,G.F. MacDonald Centre for Lung Health, Covenant Health, Edmonton, Alberta, Canada
| |
Collapse
|
32
|
Jeong SH, Lee H, Carriere KC, Shin SH, Moon SM, Jeong BH, Koh WJ, Park HY. Comorbidity as a contributor to frequent severe acute exacerbation in COPD patients. Int J Chron Obstruct Pulmon Dis 2016; 11:1857-65. [PMID: 27536097 PMCID: PMC4976810 DOI: 10.2147/copd.s103063] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Comorbidities have a serious impact on the frequent severe acute exacerbations (AEs) in patients with COPD. Previous studies have used the Charlson comorbidity index to represent a conglomerate of comorbidities; however, the respective contribution of each coexisting disease to the frequent severe AEs remains unclear. Methods A retrospective, observational study was performed in 77 COPD patients who experienced severe AE between January 2012 and December 2014 and had at least 1-year follow-up period from the date of admission for severe AE. We explored the incidence of frequent severe AEs (≥2 severe AEs during 1-year period) in these patients and investigated COPD-related factors and comorbidities as potential risk factors of these exacerbations. Results Out of 77 patients, 61 patients (79.2%) had at least one comorbidity. During a 1-year follow-up period, 29 patients (37.7%) experienced frequent severe AEs, approximately two-thirds (n=19) of which occurred within the first 90 days after admission. Compared with patients not experiencing frequent severe AEs, these patients were more likely to have poor lung function and receive home oxygen therapy and long-term oral steroids. In multiple logistic regression analysis, coexisting asthma (adjusted odds ratio [OR] =4.02, 95% confidence interval [CI] =1.30–12.46, P=0.016), home oxygen therapy (adjusted OR =9.39, 95% CI =1.60–55.30, P=0.013), and C-reactive protein (adjusted OR =1.09, 95% CI =1.01–1.19, P=0.036) were associated with frequent severe AEs. In addition, poor lung function, as measured by forced expiratory volume in 1 second (adjusted OR =0.16, 95% CI =0.04–0.70, P=0.015), was inversely associated with early (ie, within 90 days of admission) frequent severe AEs. Conclusion Based on our study, among COPD-related comorbidities, coexisting asthma has a significant impact on the frequent severe AEs in COPD patients.
Collapse
Affiliation(s)
- Suk Hyeon Jeong
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hyun Lee
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - K C Carriere
- Department of Mathematical and Statistical Sciences, University of Alberta, Edmonton, Alberta, Canada; Biostatistics and Clinical Epidemiology Center, Samsung Medical Center, Seoul, South Korea
| | - Sun Hye Shin
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Seong Mi Moon
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Byeong-Ho Jeong
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Won-Jung Koh
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hye Yun Park
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| |
Collapse
|
33
|
Chalela R, González-García JG, Chillarón JJ, Valera-Hernández L, Montoya-Rangel C, Badenes D, Mojal S, Gea J. Impact of hyponatremia on mortality and morbidity in patients with COPD exacerbations. Respir Med 2016; 117:237-42. [DOI: 10.1016/j.rmed.2016.05.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 04/28/2016] [Accepted: 05/03/2016] [Indexed: 11/24/2022]
|
34
|
Garcia-Gutierrez S, Quintana JM, Unzurrunzaga A, Esteban C, Baré M, Fernández de Larrea N, Pulido E, Rivas P, -Copd Group I. Predictors of Change in Dyspnea Level in Acute Exacerbations of COPD. COPD 2015; 13:303-11. [PMID: 26667827 DOI: 10.3109/15412555.2015.1078784] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The aim of this study was to identify factors related to changes in dyspnoea level in the acute and short-term periods after acute exacerbation of chronic obstructive pulmonary disease. This was a prospective cohort study of patients with symptoms of acute chronic obstructive pulmonary disease exacerbation who attended one of 17 hospitals in Spain between June 2008 and September 2010. Clinical data and patient reported measures (dyspnoea level, health-related quality of life, anxiety and depression levels, capacity to perform physical activity) were collected from arrival to the emergency department up to a week after the visit in discharged patients and to discharge in admitted patients (short term). Main outcomes were time course of dyspnoea over the acute (first 24 hours) and short-term periods, mortality and readmission within 2 months of the index episode. Changes in dyspnoea in both periods were related capacity to perform physical activity as well as clinical variables. Short-term changes in dyspnoea were also related to dyspnoea at 24 hours after the ED visit, and anxiety and depression levels. Dyspnoea worsening or failing to improve over the studied periods was associated with poor clinical outcomes. Patient-reported measures are predictive of changes in dyspnoea level.
Collapse
Affiliation(s)
- Susana Garcia-Gutierrez
- a Research Unit, Health Services Research on Chronic Diseases Network [REDISSEC], Galdakao-Usansolo Hospital [Osakidetza] Galdakao , Bizkaia , Spain
| | - José M Quintana
- a Research Unit, Health Services Research on Chronic Diseases Network [REDISSEC], Galdakao-Usansolo Hospital [Osakidetza] Galdakao , Bizkaia , Spain
| | - Anette Unzurrunzaga
- a Research Unit, Health Services Research on Chronic Diseases Network [REDISSEC], Galdakao-Usansolo Hospital [Osakidetza] Galdakao , Bizkaia , Spain
| | - Cristóbal Esteban
- b Respiratory Department, Health Services Research on Chronic Diseases Network [REDISSEC], Galdakao-Usansolo Hospital [Osakidetza] , Galdakao , Bizkaia , Spain
| | - Marisa Baré
- c Clinical Epidemiology Unit, Health Services Research on Chronic Diseases Network [REDISSEC], Corporacio Parc Tauli , Barcelona , Spain
| | - Nerea Fernández de Larrea
- d Agencia Lain Entralgo, Health Services Research on Chronic Diseases Network [REDISSEC] , Madrid , Spain
| | - Esther Pulido
- e Emergency Department, Galdakao-Usansolo Hospital , Galdakao , Bizkaia , Spain
| | - Paco Rivas
- f Research Unit, Health Services Research on Chronic Diseases Network [REDISSEC] , Hospital Costa del Sol , Marbella , Málaga
| | - Iryss -Copd Group
- f Research Unit, Health Services Research on Chronic Diseases Network [REDISSEC] , Hospital Costa del Sol , Marbella , Málaga
| |
Collapse
|
35
|
Gaude GS, Rajesh BP, Chaudhury A, Hattiholi J. Outcomes associated with acute exacerbations of chronic obstructive pulmonary disorder requiring hospitalization. Lung India 2015; 32:465-72. [PMID: 26628761 PMCID: PMC4587001 DOI: 10.4103/0970-2113.164150] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Acute exacerbations of chronic obstructive pulmonary disorder (AECOPD) are known to be associated with increased morbidity and mortality and have a significant socioeconomic impact. The factors that determine frequent hospital readmissions for AECOPD are poorly understood. The present study was done to ascertain failures rates following AECOPD and to evaluate factors associated with frequent readmissions. MATERIALS AND METHODS We conducted a prospective study among 186 patients with COPD with one or more admissions for acute exacerbations in a tertiary care hospital. Frequency of previous re-admissions for AECOPD in the past year, and clinical characteristics, including spirometry were ascertained in the stable state both before discharge and at 6-month post-discharge. Failure rates following treatment were ascertained during the follow-up period. All the patients were followed up for a period of 2 years after discharge to evaluate re-admissions for the AECOPD. RESULTS Of 186 COPD patients admitted for AECOPD, 54% had one or more readmission, and another 45% had two or more readmissions over a period of 2 years. There was a high prevalence of current or ex-heavy smokers, associated co-morbidity, underweight patients, low vaccination prevalence and use of domiciliary oxygen therapy among COPD patients. A total of 12% mortality was observed in the present study. Immediate failure rates after first exacerbation was observed to be 34.8%. Multivariate analysis showed that duration >20 years (OR = 0.37; 95% CI: 0.10-0.86), use of Tiotropium (OR = 2.29; 95% CI: 1.12-4.69) and use of co-amoxiclav during first admission (OR = 2.41; 95% CI: 1.21-4.79) were significantly associated with higher immediate failure rates. The multivariate analysis for repeated admissions revealed that disease duration >10 years (OR = 0.50; 95% CI: 0.27-0.93), low usage of inhaled ICS + LABA (OR = 2.21; 95% CI: 1.08-4.54), and MRC dyspnea grade >3 (OR = 2.51; 95% CI: 1.08-5.82) were independently associated with frequent re-admissions for AECOPD. CONCLUSIONS The outcomes of patients admitted for an acute exacerbation of COPD were poor. The major factors influencing frequency of repeated COPD exacerbations were disease duration, low usage of inhaled ICS + LABA, and MRC dyspnea grade >3.
Collapse
Affiliation(s)
- Gajanan S Gaude
- Department of Pulmonary Medicine, Jawaharlal Nehru Medical College, Belgaum, Karnataka, India
| | - B P Rajesh
- Department of Pulmonary Medicine, Jawaharlal Nehru Medical College, Belgaum, Karnataka, India
| | - Alisha Chaudhury
- Department of Pulmonary Medicine, Jawaharlal Nehru Medical College, Belgaum, Karnataka, India
| | - Jyothi Hattiholi
- Department of Pulmonary Medicine, Jawaharlal Nehru Medical College, Belgaum, Karnataka, India
| |
Collapse
|
36
|
Takahashi S, Ishii M, Namkoong H, Hegab AE, Asami T, Yagi K, Sasaki M, Haraguchi M, Sato M, Kameyama N, Asakura T, Suzuki S, Tasaka S, Iwata S, Hasegawa N, Betsuyaku T. Pneumococcal Infection Aggravates Elastase-Induced Emphysema via Matrix Metalloproteinase 12 Overexpression. J Infect Dis 2015; 213:1018-30. [PMID: 26563237 DOI: 10.1093/infdis/jiv527] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 10/27/2015] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Acute exacerbation of chronic obstructive pulmonary disease (COPD)--typically caused by bacterial or viral infection--is associated with poor prognosis and emphysema progression through unknown mechanisms. We aimed to elucidate the mechanisms responsible for the poor prognosis and emphysema progression associated with COPD exacerbation. METHODS We established a mouse model mimicking acute human COPD exacerbation, wherein mice with elastase-induced emphysema were intranasally infected with Streptococcus pneumoniae. RESULTS In mice with elastase-induced emphysema, infection with S. pneumoniae resulted in increased mortality, an increased number of inflammatory cells in bronchoalveolar lavage fluid (BALF), and increased matrix metalloproteinase 12 (MMP-12) production in the lungs, as well as enhanced emphysema progression. The increased MMP-12 production was mostly due to alveolar type II cells, alveolar macrophages, and lymphocytes that aggregated around vessels and bronchioles. Dexamethasone treatment suppressed the mortality rate and number of inflammatory cells in BALF but not emphysema progression, possibly owing to the failure of MMP-12 suppression in the lungs, whereas treatment with the MMP inhibitor ONO-4817 dramatically suppressed both mortality rate and emphysema progression. CONCLUSIONS These results suggest that MMP-12 production during COPD exacerbation results in increased mortality and emphysema progression. Our study identifies MMP-12 as a target to prevent further aggravation of COPD.
Collapse
Affiliation(s)
| | - Makoto Ishii
- Division of Pulmonary Medicine, Department of Medicine
| | - Ho Namkoong
- Division of Pulmonary Medicine, Department of Medicine
| | - Ahmed E Hegab
- Division of Pulmonary Medicine, Department of Medicine
| | | | - Kazuma Yagi
- Division of Pulmonary Medicine, Department of Medicine
| | - Mamoru Sasaki
- Division of Pulmonary Medicine, Department of Medicine
| | | | - Minako Sato
- Division of Pulmonary Medicine, Department of Medicine
| | | | | | - Shoji Suzuki
- Division of Pulmonary Medicine, Department of Medicine
| | | | - Satoshi Iwata
- Department of Infectious Diseases Center for Infectious Disease and Infection Control, Keio University School of Medicine, Tokyo, Japan
| | - Naoki Hasegawa
- Center for Infectious Disease and Infection Control, Keio University School of Medicine, Tokyo, Japan
| | | |
Collapse
|
37
|
Dang-Tan T, Ismaila A, Zhang S, Zarotsky V, Bernauer M. Clinical, humanistic, and economic burden of chronic obstructive pulmonary disease (COPD) in Canada: a systematic review. BMC Res Notes 2015; 8:464. [PMID: 26391471 PMCID: PMC4578756 DOI: 10.1186/s13104-015-1427-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 09/09/2015] [Indexed: 11/23/2022] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) is a chronic, irreversible disease and a leading cause of worldwide morbidity and mortality. In Canada, COPD is the fourth leading cause of death. This systematic review was undertaken to update healthcare professionals and decision makers regarding the recent clinical, humanistic and economic burden evidence in Canada. Methods A systematic literature search was conducted in PubMed, EMBASE, and Cochrane databases to identify original research published January 2000 through December 2012 on the burden of COPD in Canada. Each search was conducted using controlled vocabulary and key words, with “COPD” as the main search concept and limited to Canadian studies, written in English and involving human subjects. Selected studies included randomized controlled trials, observational studies and systematic reviews/meta-analyses that reported healthcare resource utilization, quality of life and/or healthcare costs. Results Of the 972 articles identified through the literature searches, 70 studies were included in this review. These studies were determined to have an overall good quality based on the quality assessment. COPD patients were found to average 0–4 annual emergency department visits, 0.3–1.5 annual hospital visits, and 0.7–5 annual physician visits. Self-care management was found to lessen the overall risk of emergency department (ED) visits, hospitalization and unscheduled physician visits. Additionally, integrated care decreased the mean number of hospitalizations and telephone support reduced the number of annual physician visits. Overall, 60–68 % of COPD patients were found to be inactive and 60–72 % reported activity restriction. Pain was found to negatively correlate with physical activity while breathing difficulties resulted in an inability to leave home and reduced the ability to handle activities of daily living. Evidence indicated that treating COPD improved patients’ overall quality of life. The average total cost per patient ranged between CAN $2444–4391 from a patient perspective to CAN $3910–6693 from a societal perspective. Furthermore, evidence indicated that COPD exacerbations lead to higher costs. Conclusions The clinical, humanistic and economic burden of COPD in Canada is substantial. Use of self-care management programs, telephone support, and integrated care may reduce the overall burden to Canadian patients and society.
Collapse
Affiliation(s)
- Tam Dang-Tan
- GlaxoSmithKline, 7333 Mississauga Road, Mississauga, ON, L5N 6L4, Canada.
| | - Afisi Ismaila
- GlaxoSmithKline, Research Triangle Park, NC, USA. .,Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada.
| | - Shiyuan Zhang
- GlaxoSmithKline, 7333 Mississauga Road, Mississauga, ON, L5N 6L4, Canada.
| | | | | |
Collapse
|
38
|
Srivastava K, Thakur D, Sharma S, Punekar YS. Systematic review of humanistic and economic burden of symptomatic chronic obstructive pulmonary disease. PHARMACOECONOMICS 2015; 33:467-488. [PMID: 25663178 DOI: 10.1007/s40273-015-0252-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND An understanding of the humanistic and economic burden of individuals with symptomatic chronic obstructive pulmonary disease (COPD) is required to inform payers and healthcare professionals about the disease burden. OBJECTIVES The aim of this systematic review was to identify and present humanistic [health-related quality of life (HRQoL)] and economic burdens of symptomatic COPD. METHODS A comprehensive search of online databases (reimbursement or claims databases/other databases), abstracts from conference proceedings, published literature, clinical trials, medical records, health ministries, financial reports, registries, and other sources was conducted. Adult patients of any race or gender with symptomatic COPD were included. Humanistic and economic burdens included studies evaluating HRQoL and cost and resource use, respectively, associated with symptomatic COPD. RESULTS Thirty-two studies reporting humanistic burden and 74 economic studies were identified. Symptomatic COPD led to impairment in the health state of patients, as assessed by HRQoL instruments. It was also associated with high economic burden across all countries. The overall, direct, and indirect costs per patient increased with an increase in symptoms, dyspnoea severity, and duration of disease. Across countries, the annual societal costs associated with symptomatic COPD were higher among patients with comorbidities. CONCLUSIONS Symptomatic COPD is associated with a substantial economic burden. The HRQoL of patients with symptomatic COPD is, in general, low and influenced by dyspnoea.
Collapse
Affiliation(s)
- Kunal Srivastava
- HERON Health PVT (Now Parexel), 3rd Floor, DLF Tower E, Rajiv Gandhi IT Park, Chandigarh, India
| | | | | | | |
Collapse
|
39
|
Sousa KH, Weiss J, Welton J, Reeder B, Ozkaynak M. The Colorado Collaborative for Nursing Research: nurses shaping nursing's future. Nurs Outlook 2015; 63:204-10. [PMID: 25771194 DOI: 10.1016/j.outlook.2014.08.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Revised: 07/30/2014] [Accepted: 08/19/2014] [Indexed: 01/20/2023]
Abstract
Nurses in the present health care environment have been reduced too often to being providers of safe, competent care rather than quality care. In response, the Institute of Medicine has recommended that nurses become more involved in making changes to the health care system and use data more effectively. If nursing intends to follow these recommendations, the profession needs (a) fresh perspectives to assist in making health care system changes, (b) partnerships between nurse scientists and nurse clinicians to generate and implement data, and (c) capture of the proper value of nursing as distinct from other elements of health care delivery. The Colorado Collaborative for Nursing Research is an effort to meet the recommendations of the Institute of Medicine. The Colorado Collaborative for Nursing Research has a three-arm structure: a research forum where nurse academicians and nurse clinicians can launch collaborative projects; a research support services arm from which nurse collaborators can obtain help with modeling, statistics, writing, and funding; and a data extraction/data sharing mechanism to inform the decision making of nurse leaders.
Collapse
Affiliation(s)
- Karen H Sousa
- College of Nursing, University of Colorado Denver, Aurora, CA.
| | | | | | | | | |
Collapse
|
40
|
Titova E, Steinshamn S, Indredavik B, Henriksen AH. Long term effects of an integrated care intervention on hospital utilization in patients with severe COPD: a single centre controlled study. Respir Res 2015; 16:8. [PMID: 25645122 PMCID: PMC4335409 DOI: 10.1186/s12931-015-0170-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 01/12/2015] [Indexed: 11/10/2022] Open
Abstract
UNLABELLED Chronic obstructive pulmonary disease (COPD) is one of the main causes of morbidity and mortality globally. In Trondheim in 2008 an integrated care model (COPD-Home) consisting of an education program, self-management plan, home visits and a call centre for patient support and communication was developed. The objective was to determine the efficacy of an intervention according to the COPD-Home model in reducing hospital utilization among patients with COPD stage III and IV (GOLD 2007) discharged after hospitalization for acute exacerbations of COPD (AECOPD). METHODS A single centre, prospective, open, controlled clinical study comparing COPD-Home integrated care (IC) with usual care (UC). RESULTS Ninety-one versus 81 patients mean age 73.4 ± 9.3 years (57% women) were included in the IC group (ICG) and the UC group (UCG) respectively, and after 2 years 51 and 49 patients were available for control in the respective groups. During the year prior to study start there were 71 hospital admissions (HA) in the ICG and 84 in the UCG. There was a 12.6% reduction in HA in the ICG during the first year of follow-up and a 46.5% reduction during the second year (p = 0.01) compared to an 8.3% increase during the first year and no change during the second year in the ICG. During the year prior to study start, the number of hospital days (HD) was 468 in the ICG and 479 in the UCG. In the IC group, the number of HD was reduced by 48.3% during the first year (p = 0.01), and remained low during the second year of follow-up (p=0.02). In the UC group, the number of HD remained unchanged during the follow-up period. There was a trend towards a shorter survival time among patients in the ICG compared to the UCG, hazard ratio 1.33 [95% CI 0.77 to 2.33]. CONCLUSION Intervention according to the COPD-Home model reduced hospital utilization in patients with COPD III and IV with a persisting effect throughout the 2 years of follow-up. However, there was a trend towards a shorter survival time in the intervention group.
Collapse
Affiliation(s)
- Elena Titova
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, 7006, Norway. .,Department of Thoracic and Occupational Medicine, Trondheim University Hospital, Trondheim, 7006, Norway.
| | - Sigurd Steinshamn
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, 7006, Norway. .,Department of Thoracic and Occupational Medicine, Trondheim University Hospital, Trondheim, 7006, Norway.
| | - Bent Indredavik
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, 7006, Norway. .,Department of Stroke, Trondheim University Hospital, Trondheim, 7006, Norway. .,Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, 7491, Norway.
| | - Anne Hildur Henriksen
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, 7006, Norway. .,Department of Thoracic and Occupational Medicine, Trondheim University Hospital, Trondheim, 7006, Norway.
| |
Collapse
|
41
|
Del Vecchio AM, Branigan PJ, Barnathan ES, Flavin SK, Silkoff PE, Turner RB. Utility of animal and in vivo experimental infection of humans with rhinoviruses in the development of therapeutic agents for viral exacerbations of asthma and chronic obstructive pulmonary disease. Pulm Pharmacol Ther 2015; 30:32-43. [PMID: 25445932 PMCID: PMC7110859 DOI: 10.1016/j.pupt.2014.10.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Revised: 10/24/2014] [Accepted: 10/29/2014] [Indexed: 12/16/2022]
Abstract
There is an association with acute viral infection of the respiratory tract and exacerbations of asthma and chronic obstructive pulmonary disease (COPD). Although these exacerbations are associated with several types of viruses, human rhinoviruses (HRVs) are associated with the vast majority of disease exacerbations. Due to the lack of an animal species that is naturally permissive for HRVs to use as a facile model system, and the limitations associated with animal models of asthma and COPD, studies of controlled experimental infection of humans with HRVs have been used and conducted safely for decades. This review discusses how these experimental infection studies with HRVs have provided a means of understanding the pathophysiology underlying virus-induced exacerbations of asthma and COPD with the goal of developing agents for their prevention and treatment.
Collapse
Affiliation(s)
- Alfred M Del Vecchio
- Janssen Research and Development, Immunology Clinical Research and Development, Welsh and McKean Roads, Spring House, PA 19477, USA
| | - Patrick J Branigan
- Janssen Research and Development, Immunology Clinical Research and Development, Welsh and McKean Roads, Spring House, PA 19477, USA
| | - Elliot S Barnathan
- Janssen Research and Development, Immunology Clinical Research and Development, Welsh and McKean Roads, Spring House, PA 19477, USA
| | - Susan K Flavin
- Janssen Research and Development, Immunology Clinical Research and Development, Welsh and McKean Roads, Spring House, PA 19477, USA
| | - Philip E Silkoff
- Janssen Research and Development, Immunology Clinical Research and Development, Welsh and McKean Roads, Spring House, PA 19477, USA.
| | - Ronald B Turner
- University of Virginia, School of Medicine, Charlottesville, VA 22908, USA
| |
Collapse
|
42
|
Lykkegaard J, Larsen PV, Paulsen MS, Søndergaard J. General practitioners' home visit tendency and readmission-free survival after COPD hospitalisation: a Danish nationwide cohort study. NPJ Prim Care Respir Med 2014; 24:14100. [PMID: 25429436 PMCID: PMC4304430 DOI: 10.1038/npjpcrm.2014.100] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Revised: 09/08/2014] [Accepted: 09/16/2014] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND The tendency of general practitioners (GPs) to conduct home visits is considered an important aspect of practices' accessibility and quality of care. AIMS To investigate whether GPs' tendency to conduct home visits affects 30-day readmission or death after hospitalisation with chronic obstructive pulmonary disease. METHODS All Danish patients first-time hospitalised with COPD during the years 2006-2008 were identified. The association between the GP's tendency to conduct home visits and the time from hospital discharge until death or all-cause readmission was analysed by means of Cox regression adjusted for multiple patient and practice characteristics. RESULTS The study included 14,425 patients listed with 1,389 general practices. Approximately 31% of the patients received a home visit during the year preceding their first COPD hospitalisation, and within 30 days after discharge 19% had been readmitted and 1.6% had died without readmission. A U-shaped dose-response relationship was found between GP home visit tendency and readmission-free survival. The lowest adjusted risk of readmission or death was recorded among patients who were listed with a general practice in which >20-30% of other listed first-time COPD-hospitalised patients had received a home visit. The risk was higher if either 0% (hazard rate ratio 1.18 (1.01-1.37)) or >60% (hazard rate ratio 1.23 (1.04-1.44)) of the patients had been visited. CONCLUSION A moderate GP tendency to conduct home visits is associated with the lowest 30-day risk of COPD readmission or death. A GP's tendency to conduct home visits should not be used as a unidirectional indicator of the ability to prevent COPD hospital readmissions.
Collapse
Affiliation(s)
- Jesper Lykkegaard
- Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Pia V Larsen
- Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Maja S Paulsen
- Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Jens Søndergaard
- Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
43
|
|
44
|
Johannesdottir SA, Christiansen CF, Johansen MB, Olsen M, Xu X, Parker JM, Molfino NA, Lash TL, Fryzek JP. Hospitalization with acute exacerbation of chronic obstructive pulmonary disease and associated health resource utilization: a population-based Danish cohort study. J Med Econ 2013; 16:897-906. [PMID: 23621504 DOI: 10.3111/13696998.2013.800525] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Health resource utilization (HRU) and outcomes associated with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) are not well described. Therefore, a population-based cohort study was conducted to characterize patients hospitalized with AECOPD with regard to HRU, mortality, recurrence, and predictors of readmission with AECOPD. METHODS Using Danish healthcare databases, this study identified COPD patients with at least one AECOPD hospitalization between 2005-2009 in Northern Denmark. Hospitalized AECOPD patients' HRU, in-hospital mortality, 30-day, 60-day, 90-day, and 180-day post-discharge mortality and recurrence risk, and predictors of readmission with AECOPD in the year following study inclusion were characterized. RESULTS This study observed 6612 AECOPD hospitalizations among 3176 prevalent COPD patients. Among all AECOPD hospitalizations, median length of stay was 6 days (interquartile range [IQR] 3-9 days); 5 days (IQR 3-9) among those without ICU stay and 11 days (IQR 7-20) among the 8.6% admitted to the ICU. Mechanical ventilation was provided to 193 (2.9%) and non-invasive ventilation to 479 (7.2%) admitted patients. In-hospital mortality was 5.6%. Post-discharge mortality was 4.2%, 7.8%, 10.5%, and 17.4% at 30, 60, 90, and 180 days, respectively. Mortality and readmission risk increased with each AECOPD hospitalization experienced in the first year of follow-up. Readmission at least twice in the first year of follow-up was observed among 286 (9.0%) COPD patients and was related to increasing age, male gender, obesity, asthma, osteoporosis, depression, myocardial infarction, diabetes I and II, any malignancy, and hospitalization with AECOPD or COPD in the prior year. LIMITATIONS The study included only hospitalized AECOPD patients among prevalent COPD patients. Furthermore, information was lacking on clinical variables. CONCLUSION These findings indicate that AECOPD hospitalizations are associated with substantial mortality and risk of recurrence.
Collapse
|
45
|
Slenter RHJ, Sprooten RTM, Kotz D, Wesseling G, Wouters EFM, Rohde GGU. Predictors of 1-year mortality at hospital admission for acute exacerbations of chronic obstructive pulmonary disease. Respiration 2012; 85:15-26. [PMID: 23037178 DOI: 10.1159/000342036] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2012] [Accepted: 07/04/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Acute exacerbations of chronic obstructive pulmonary disease (AE-COPD) are related to high mortality, especially in hospitalized patients. Predictors for severe outcomes are still not sufficiently defined. OBJECTIVES To assess the mortality rate and identify potential determinants of mortality in a cohort of patients hospitalized for AE-COPD. METHODS A retrospective, observational cohort study including all consecutive patients admitted between January 1, 2009, and April 1, 2010, for AE-COPD. Potential predictors were assessed at initial presentation at the emergency room. The primary outcome was mortality during 1-year follow-up. Univariate and multivariate time-to-event analyses using Cox proportional hazard models were employed for statistical analysis. RESULTS A total of 260 patients were enrolled in this study. Mean age was 70.5 ± 10.8 years, 50.0% were male and 63.4% had severe COPD. The in-hospital mortality rate was 5.8% and the 1-year mortality rate was 27.7%. Independent risk factors for mortality were age [hazard ratio (HR) = 1.04; 95% confidence interval (CI) = 1.01-1.07], male sex (HR = 2.00; 95% CI = 1.15-3.48), prior hospitalization for AE-COPD in the last 2 years (HR = 2.56; 95% CI = 1.52-4.30), prior recorded congestive heart failure (HR = 1.75; 95% CI = 1.03-2.97), PaCO₂ ≥6.0 kPa (HR = 2.90; 95% CI = 1.65-5.09) and urea ≥8.0 mmol/l (HR = 2.38; 95% CI = 1.42-3.99) at admission. CONCLUSIONS Age, male sex, prior hospitalization for AE-COPD in the last 2 years, prior recorded congestive heart failure, hypercapnia and elevated levels of urea at hospital admission are independent predictors of mortality within the first year after admission.
Collapse
Affiliation(s)
- R H J Slenter
- Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | | | | | | | | | | |
Collapse
|
46
|
Verhage T, Boer L, Molema J, Heijdra Y, Dekhuijzen R, Vercoulen JH. Decline of health status sub-domains by exacerbations of chronic obstructive pulmonary disease: a prospective survey. ACTA ACUST UNITED AC 2012; 85:236-43. [PMID: 22922171 DOI: 10.1159/000339925] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Accepted: 05/24/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND Exacerbations of chronic obstructive pulmonary disease (COPD) are held responsible for a decline in health status (HS). This may not apply equally to all exacerbations, because different definitions are required for quite different illnesses. Selection of definitions and the sensitivity of the HS instrument may affect results regarding the impact of exacerbations. Sensitivity of a new HS instrument, which covers different and more aspects, has not yet been tested, with respect to exacerbations. OBJECTIVES Confirmation of the negative HS effect of exacerbations by using a highly differentiated instrument, and to evaluate which aspects of HS are affected most. METHODS One hundred and sixty-eight ambulatory patients with COPD were evaluated prospectively with regard to a wide range of HS aspects, at the beginning and end of a 1-year follow-up. Recording of symptom changes and treatment on monthly diary cards resulted in the identification of event-based exacerbations. HS was assessed via a newly validated instrument integrating both physiological and non-physiological sub-domains. Parametric correlations were calculated between exacerbation frequency and HS scores at the end of the study. Partial corre-lations were then explored using HS scores at baseline to correct for prior HS levels. RESULTS Correlations between -exacerbation frequency and HS sub-domains were found to be frequent, predominantly in non-physiological sub--domains. After correction for hs scores at baseline, only 2 sub-domains (belonging to the main domain 'complaints') remained significantly but weakly correlated. CONCLUSION Exacerbation frequency and HS show weak correlations after a year, but most of these disappear after correction for prior HS levels. In such exacerbations, aggravated HS probably takes much longer to manifest itself.
Collapse
Affiliation(s)
- Tewe Verhage
- Department of Pulmonary Disease Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
| | | | | | | | | | | |
Collapse
|
47
|
Lodewijckx C, Sermeus W, Panella M, Deneckere S, Leigheb F, Troosters T, Boto PA, Mendes RV, Decramer M, Vanhaecht K. Quality indicators for in-hospital management of exacerbation of chronic obstructive pulmonary disease: results of an international Delphi study. J Adv Nurs 2012; 69:348-62. [PMID: 22716665 DOI: 10.1111/j.1365-2648.2012.06013.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM To report a Delphi study that was conducted to select process and outcome indicators that are relevant to study quality of care and impact of care pathways for patients hospitalized with exacerbation of chronic obstructive pulmonary disease. BACKGROUND Management of patients hospitalized with exacerbation of chronic obstructive pulmonary disease is suboptimal and outcomes are poor. To evaluate the impact of care pathways properly, relevant indicators need to be selected. DESIGN Delphi study. METHODS The study was conducted over 4 months in 2008, with 35 experts out of 15 countries, including 19 medical doctors, 8 nurses and 8 physiotherapists. Participants were asked to rate, for 72 process and 21 outcome indicators, the relevance for follow-up in care pathways for in-hospital management of exacerbation of chronic obstructive pulmonary disease. Consensus (agreement by at least 75% of the participants) that an indicator is relevant for follow-up was sought in two rounds. RESULTS Consensus was reached for 26 of 72 process indicators (36·1%) and 10 of 21 outcome indicators (47·6%). Highest consensus levels were found for the process indicators regarding oxygen therapy (100%), pulmonary rehabilitation (100%) and patient education (94·5-88·6%) and for the outcome indicators concerning understanding of therapy (91·4-85·7%) and self-management (88·6-88·2%). CONCLUSION The selected indicators appear to be sensitive for improvement. Therefore, researchers and clinicians that want to study and improve the care for patients hospitalized with exacerbation of chronic obstructive pulmonary disease should primarily focus on these indicators.
Collapse
|
48
|
|
49
|
Kelly JL, Bamsey O, Smith C, Lord VM, Shrikrishna D, Jones PW, Polkey MI, Hopkinson NS. Health status assessment in routine clinical practice: the chronic obstructive pulmonary disease assessment test score in outpatients. ACTA ACUST UNITED AC 2012; 84:193-9. [PMID: 22441322 DOI: 10.1159/000336549] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2011] [Accepted: 01/05/2012] [Indexed: 01/31/2023]
Abstract
BACKGROUND The chronic obstructive pulmonary disease (COPD) assessment test (CAT) is a simple, self-completion questionnaire developed to measure health status in patients with COPD, which is potentially suitable for routine clinical use. OBJECTIVES The purpose of this study was to establish the determinants of the CAT score in routine clinical practice. METHODS Patients attending the clinic completed the CAT score before being seen. Clinical data, including, where available, plethysmographic lung volumes, transfer factor and arterial blood gas analysis, were recorded on a pro forma in the clinic. RESULTS In 224 patients (36% female), mean forced expiratory volume in 1 s (FEV₁) was 40.1% (17.9) of predicted (%pred); CAT score was associated with exacerbation frequency [0-1/year 20.1 (7.6); 2-4/year 23.5 (7.8); >4/year 28.5 (7.3), p < 0.0001; 41/40/19% in each category] and with Medical Research Council (MRC) dyspnoea score (r² = 0.26, p < 0.0001) rising approximately 4 points with each grade. FEV(1) %pred had only a weak influence. Using stepwise regression, CAT score = 2.48 + 4.12 [MRC (1-5) dyspnoea score] + 0.08 (FEV(1) %pred) + 1.06 (exacerbation rate/year)] (r² = 0.36, p < 0.0001). The CAT score was higher in patients (n = 54) with daily sputum production [25.9 (7.5) vs. 22.2 (8.2); p = 0.004]. Detailed lung function (plethysmography and gas transfer) was available in 151 patients but had little influence on the CAT score. CONCLUSION The CAT score is associated with clinically important variables in patients with COPD and enables health status measurement to be performed in routine clinical practice.
Collapse
Affiliation(s)
- Julia L Kelly
- NIHR Respiratory Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust and Imperial College, London, UK
| | | | | | | | | | | | | | | |
Collapse
|
50
|
Respuesta. Med Clin (Barc) 2012. [DOI: 10.1016/j.medcli.2011.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|