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Hamadi HY, Martinez D, Xu J, Silvera GA, Mallea JM, Hamadi W, Li X, Li Y, Zhao M. Effects of post-discharge telemonitoring on 30-day chronic obstructive pulmonary disease readmissions and mortality. J Telemed Telecare 2023; 29:117-125. [PMID: 33176540 DOI: 10.1177/1357633x20970402] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Much attention has been focused on decreasing chronic obstructive pulmonary disease (COPD) hospital readmissions. The US health system has struggled to meet this goal. The objective of this study was to assess the efficacy of telehealth services on the reduction of hospital readmission and mortality rates for COPD. METHODS We used a cross-sectional design to examine the association between hospital risk-adjusted readmission and mortality rates for COPD and hospital use of post-discharge telemonitoring (TM). Data for 777 hospitals were sourced from the Centers for Medicare & Medicaid Services and the American Hospital Association annual surveys. Propensity score matching using the kennel weights method was applied to calculate the weighted probability of being a hospital that offers post-discharge TM services. RESULTS Hospitals with post-discharge TM had about 34% significantly higher odds (adjusted odds ratio (AOR) = 1.34; 95% confidence interval (CI) 1.06-1.70) of 30-day COPD readmission and 33% significantly lower odds (AOR = 0.67; 95% CI 0.50-0.90) of 30-day COPD mortality compared to hospitals without post-discharge TM services. DISCUSSION Overall, hospitals that offer post-discharge TM services have seen an improvement in 30-day COPD mortality rates. However, those same hospitals have also experienced a significant increase in 30-day COPD readmissions. TM can potentially decrease mortality in patients recently admitted for acute exacerbation of COPD. The results provide further evidence that readmissions present a problematic assessment of health-care quality, as the need for readmission may or may not be directly related to the quality of care received while in hospital.
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Affiliation(s)
- Hanadi Y Hamadi
- Department of Health Administration, Brooks College of Health, University of North Florida, USA
| | - Dayana Martinez
- Department of Health Administration, Brooks College of Health, University of North Florida, USA
| | - Jing Xu
- Department of Health Administration, Brooks College of Health, University of North Florida, USA
| | - Geoffrey A Silvera
- Health Administration, Department of Political Science, Auburn University, USA
| | - Jorge M Mallea
- Division of Pulmonary, Allergy and Sleep Medicine, Department of Medicine, Mayo Clinic, USA
| | - Walaa Hamadi
- Department of Internal Medicine, University of Utah, USA
| | - Xinmei Li
- Department of Health Administration, College of Public Health, Fujian Medical University, PR China
| | - Yueping Li
- Fujian Medical Reform and Development Research Centre, Fujian Medical University, PR China
| | - Mei Zhao
- Department of Health Administration, Brooks College of Health, University of North Florida, USA
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Quan T, Chen FR, Recarey M, Mathur A, Pollard T, Gu A, Wei C, Howard P, Pribaz J. Chronic obstructive pulmonary disease is an independent risk factor for postoperative complications following operative treatment of distal radius fracture. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 32:945-951. [PMID: 34185160 DOI: 10.1007/s00590-021-03067-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 06/21/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE This study aimed to investigate the relationship between chronic obstructive pulmonary disease (COPD) and postoperative complications for patients receiving distal radius fracture (DRF) open reduction internal fixation (ORIF). METHODS From 2007 to 2018, patients undergoing operative treatment for distal radius fracture were identified in the National Surgical Quality Improvement Program database. Patients were separated into 2 cohorts: non-COPD and COPD patients. In this analysis, thirty-day postoperative complications evaluated included wound, cardiac, pulmonary, renal, thromboembolic, sepsis, mortality, urinary tract infections, postoperative transfusion, extended length of stay, reoperation, and readmission. Bivariate and multivariate analyses were performed. RESULTS Of 12,424 total patients who underwent operative treatment for distal radius fracture, 11,957 patients (96.2%) did not have a diagnosis of COPD and 467 (3.8%) had COPD. Following adjustment, compared to patients who did not have COPD, those with COPD had an increased risk of any postoperative complications (OR 2.160; p = 0.010), postoperative transfusion requirement (OR 17.437; p = 0.001), extended length of hospital stay greater than 3 days (OR 1.564; p = 0.038), and readmission (OR 2.515; p < 0.001). CONCLUSION COPD is an independent risk factor for any postoperative complication including transfusions, extended length of stay, and readmission for patients receiving DRF ORIF. Pulmonary evaluation would be a critical step in preoperative management and counseling of these patients before DRF ORIF.
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Affiliation(s)
- Theodore Quan
- Department of Orthopedic Surgery, George Washington Hospital, 2300 M St, 20037, Washington DC, US.
| | | | - Melina Recarey
- Department of Orthopedic Surgery, George Washington Hospital, 2300 M St, 20037, Washington DC, US
| | - Abhay Mathur
- Department of Orthopedic Surgery, George Washington Hospital, 2300 M St, 20037, Washington DC, US
| | - Tom Pollard
- Department of Orthopedic Surgery, George Washington Hospital, 2300 M St, 20037, Washington DC, US
| | - Alex Gu
- Department of Orthopedic Surgery, George Washington Hospital, 2300 M St, 20037, Washington DC, US
| | - Chapman Wei
- Department of Orthopedic Surgery, George Washington Hospital, 2300 M St, 20037, Washington DC, US
| | - Peter Howard
- Department of Orthopedic Surgery, George Washington Hospital, 2300 M St, 20037, Washington DC, US
| | - Jonathan Pribaz
- Department of Orthopedic Surgery, George Washington Hospital, 2300 M St, 20037, Washington DC, US
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Burkes RM, Couper DJ, Barjaktarevic IZ, Cooper CB, Labaki WW, Han MK, Woodruff PG, Lazarus SC, Parekh TM, Paine, III R, Comellas AP, Bowler RP, Loehr LR, Putcha N, Wise RA, Brown TT, Drummond MB. Age-Dependent Associations Between 25-Hydroxy Vitamin D Levels and COPD Symptoms: Analysis of SPIROMICS. CHRONIC OBSTRUCTIVE PULMONARY DISEASES (MIAMI, FLA.) 2021; 8:277-291. [PMID: 33829714 PMCID: PMC8237982 DOI: 10.15326/jcopdf.2020.0180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/31/2021] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Age and vitamin D levels may affect symptom burden in chronic obstructive pulmonary disease (COPD). We used the Subpopulations and Intermediate Outcome Measures in COPD Study (SPIROMICS) to determine independent associations between vitamin D levels and COPD symptoms in different age strata. METHODS Serum 25-hydroxy (OH)-vitamin D levels were modeled continuously and categorically (<20 ng/ml versus ≥20 ng/ml). Stratifying by age group (middle-age: 40-64 years old and older: >65 years old), multivariable modeling was performed to identify relationships between 25-OH-vitamin D levels and the COPD Assessment Test (CAT), the modified Medical Research Council score (mMRC), the St George's Respiratory Questionnaire (SGRQ) total and subdomain scores, the Veterans' Specific Activity Questionnaire, and the 6-minute walk test distance. RESULTS InIn the middle-aged group, each 5 ng/ml higher 25-OH-vitamin D level was independently associated with more favorable CAT score (-0.35 [-0.67 to -0.03], P=0.03), total SGRQ (-0.91 [-1.65 to -0.17]; P=0.02), and the SGRQ subdomains (Symptoms:-1.07 [-1.96 to -0.18], P=0.02; Impact: -0.77 [-1.53 to -0.003], P=0.049; Activity: -1.07 [-1.96 to -0.18], P=0.02). These associations persisted after the addition of comorbidity score, reported vitamin D supplementation, outdoor time, or season of blood draw to models. No associations were observed between 25-OH-vitamin D levels and symptom scores in the older age group. DISCUSSION When controlled for clinically relevant covariates, higher 25-OH-vitamin D levels are associated with more favorable respiratory-specific symptoms and quality-of-life assessments in middle-age but not older COPD individuals. Study of the role of vitamin D supplementation in the symptom burden of younger COPD patients is needed.
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Affiliation(s)
- Robert M. Burkes
- Division of Pulmonary Diseases and Critical Care Medicine, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, United States
| | - David J. Couper
- Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, United States
| | - Igor Z. Barjaktarevic
- Division of Pulmonary, Critical Care, and Sleep Medicine, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California, United States
| | - Christopher B. Cooper
- Departments of Medicine and Physiology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California, United States
| | - Wassim W. Labaki
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan, United States
| | - Meilan K. Han
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan, United States
| | - Prescott G. Woodruff
- Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, University of California-San Francisco, San Francisco, California, United States
| | - Stephen C. Lazarus
- Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, University of California-San Francisco, San Francisco, California, United States
| | - Trisha M. Parekh
- Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, University of Alabama-Birmingham, Birmingham, Alabama, United States
| | - Robert Paine, III
- Division of Pulmonary Medicine, University of Utah, Salt Lake City, Utah, United States
| | - Alejandro P. Comellas
- Division of Pulmonary, Critical Care, and Occupational Medicine, University of Iowa, Iowa City, Iowa, United States
| | - Russell P. Bowler
- Division of Pulmonary, Critical Care, and Sleep Medicine, National Jewish Hospital, Denver, Colorado, United States
| | - Laura R. Loehr
- Division of General Medicine and Clinical Epidemiology, University of North Carolina, Chapel Hill, North Carolina, United States
| | - Nirupama Putcha
- Division of Pulmonary and Critical Care, Johns Hopkins University, Baltimore, Maryland, United States
| | - Robert A. Wise
- Division of Pulmonary and Critical Care, Johns Hopkins University, Baltimore, Maryland, United States
| | - Todd T. Brown
- Division of Endocrinology and Metabolism, Johns Hopkins University, Baltimore, Maryland, United States
| | - M. Bradley Drummond
- Division of Pulmonary Diseases and Critical Care Medicine, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, United States
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Predictive Modelling of Lung Function using Emphysematous Density Distribution. Sci Rep 2019; 9:19763. [PMID: 31875053 PMCID: PMC6930211 DOI: 10.1038/s41598-019-56351-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 12/10/2019] [Indexed: 11/08/2022] Open
Abstract
Target lung tissue selection remains a challenging task to perform for treating severe emphysema with lung volume reduction (LVR). In order to target the treatment candidate, the percentage of low attenuation volume (LAV%) representing the proportion of emphysema volume to whole lung volume is measured using computed tomography (CT) images. Although LAV% have shown to have a correlation with lung function in patients with chronic obstructive pulmonary disease (COPD), similar measurements of LAV% in whole lung or lobes may have large variations in lung function due to emphysema heterogeneity. The functional information of regional emphysema destruction is required for supporting the choice of optimal target. The purpose of this study is to develop an emphysema heterogeneity descriptor for the three-dimensional emphysematous bullae according to the size variations of emphysematous density (ED) and their spatial distribution. The second purpose is to derive a predictive model of airflow limitation based on the regional emphysema heterogeneity. Deriving the bullous representation and grouping them into four scales in the upper and lower lobes, a predictive model is computed using the linear model fitting to estimate the severity of lung function. A total of 99 subjects, 87 patients with mild to very severe COPD (Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage I~IV) and 12 control participants with normal lung functions (forced expiratory volume in one second (FEV1)/forced vital capacity (FVC) > 0.7) were evaluated. The final model was trained with stratified cross-validation on randomly selected 75% of the dataset (n = 76) and tested on the remaining dataset (n = 23). The dispersed cases of LAV% inconsistent with their lung function outcome were evaluated, and the correlation study suggests that comparing to LAV of larger bullae, the widely spread smaller bullae with equivalent LAV has a larger impact on lung function. The testing dataset has the correlation of r = -0.76 (p < 0.01) between the whole lung LAV% and FEV1/FVC, whereas using two ED % of scales and location-dependent variables to predict the emphysema-associated FEV1/FVC, the results shows their correlation of 0.82 (p < 0.001) with clinical FEV1/FVC.
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Foumani AA, Neyaragh MM, Ranjbar ZA, Leyli EK, Ildari S, Jafari A. Waist Circumference and Spirometric Measurements in Chronic Obstructive Pulmonary Disease. Osong Public Health Res Perspect 2019; 10:240-245. [PMID: 31497496 PMCID: PMC6711712 DOI: 10.24171/j.phrp.2019.10.4.07] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 07/15/2019] [Accepted: 07/24/2019] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES The aim of this study was to evaluate whether the waist circumference of patients with chronic obstructive pulmonary disease (COPD), had an impact on lung function. METHODS There were 180 patients with COPD recruited into this prospective cross-sectional study. The age, weight, body mass index and waist circumference (WC) were measured. Spirometry parameters including forced vital capacity (FVC), and forced expiratory volume in the first second (FEV1), were measured and FEV1/FVC calculated. RESULTS The mean FEV1/FVC in both normal weight and overweight patients, did not statistically significantly correlate with WC. The COPD assessment test, positively correlated with WC ( p = 0.031). A positive correlation with body mass index ( p < 0.001), smoking ( p = 0.027), and global initiative for chronic obstructive lung disease score ( p = 0.009), were observed to positively associate with WC. WC, age, C-reactive protein, duration of disease, and gender (male), were observed to be statistically significant risk factors for the severity of COPD. CONCLUSION WC was not observed to impact upon lung function in this study but it was a predictive factor for COPD severity in patients.
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Affiliation(s)
- Ali Alavi Foumani
- Inflammatory Lung Disease Research Center, Department of Internal Medicine, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Mohammad Masoud Neyaragh
- Department of Internal Medicine, Student Research Committee, Faculty of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Zahra Abbasi Ranjbar
- Razi Clinical Research Development Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Ehsan Kazemnezhad Leyli
- Razi Clinical Research Development Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Shima Ildari
- Inflammatory Lung Disease Research Center, Department of Internal Medicine, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Alireza Jafari
- Inflammatory Lung Disease Research Center, Department of Internal Medicine, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
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Chu H, Qu X, Wang F, Chang J, Cheng R, Song X, Chen T, Zhang G. MicroRNA-206 promotes lipopolysaccharide-induced inflammation injury via regulation of IRAK1 in MRC-5 cells. Int Immunopharmacol 2019; 73:590-598. [PMID: 31279225 DOI: 10.1016/j.intimp.2019.05.029] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 05/16/2019] [Accepted: 05/16/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND MicroRNAs (miRNAs) have been reported to play crucial role in the airway inflammatory diseases. However, the involvement of miR-206 in airway inflammatory diseases is still uninvestigated. The study aimed to explore the effect of miR-206 on lipopolysaccharide (LPS)-induced inflammation injury in MRC-5 cells, and point out a potential relevance for chronic obstructive pulmonary disease (COPD). METHODS LPS was utilized to expose MRC-5 cells, then cell viability, cell migration, apoptosis, apoptosis-associated factors, as well as the concentrations and protein levels of IL-6 and IL-8 were explored. After transfected with miR-206 mimic and inhibitor, above parameters were reassessed in LPS-injured cells. Expression level of IRAK1 was examined in miR-206 mimic/inhibitor transfected cells by using RT-qPCR. The effect of IRAK1 on LPS-induced inflammation injury was investigated in MRC-5 cells after transfection with pc-IRAK1 and sh-IRAK1. The effects of miR-206 and IRAK1 on MEK/ERK and JNK pathways were determined by western blot assay. RESULTS LPS significantly triggered inflammation injury in MRC-5 cells by inhibiting cell viability, suppressing the healing of scratches, inducing cell apoptosis, down-regulating Bcl-2 expression and up-regulating Bax, cleaved-Caspase-3 and cleaved-Caspase-9 expression, and concurrently increasing the concentrations and the protein levels of IL-6 and IL-8. MiR-206 overexpression aggravated LPS-induced inflammation injury in MRC-5 cells. Up-regulation of IRAK1 was observed in miR-206 mimic-transfected cells. Moreover, IRAK1 overexpression promoted LPS-induced inflammation injury in MRC-5 cells. MiR-206 activated MEK/ERK and JNK pathways by regulating IRAK1. CONCLUSIONS MiR-206 promotes LPS-induced inflammation injury through regulation of IRAK1 in MRC-5 cells.
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Affiliation(s)
- Heying Chu
- Department of Respiratory, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Xiangwen Qu
- Department of Respiratory, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Feng Wang
- Department of Respiratory, The First People's Hospital of Shangqiu, Shangqiu 476100, China
| | - Jingxia Chang
- Department of Respiratory, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Ruirui Cheng
- Department of Respiratory, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Xiangjin Song
- Department of Respiratory, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Tengfei Chen
- Department of Respiratory, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Guojun Zhang
- Department of Respiratory, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China.
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Chronic obstructive pulmonary disease in the long-term care setting: current practices, challenges, and unmet needs. Curr Opin Pulm Med 2018; 23 Suppl 1:S1-S28. [PMID: 28990958 DOI: 10.1097/mcp.0000000000000416] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
: Chronic obstructive pulmonary disease (COPD) is a prevalent and disabling disorder in the United States, especially affecting older individuals, women, and those with a history of smoking. Studies show that COPD may be underrepresented, underdiagnosed, and undertreated in elderly patients residing in long-term care (LTC) facilities. The quality of care for LTC residents with COPD is heterogeneous in regard to both the facility and the patient. For LTC facilities, care should be driven by staff education, interstaff communication, and interfacility communication. From the perspective of the LTC patient, choice of medication and device should be based on appropriate diagnosis, comorbidities, ability to perform treatment, and patient preferences. Nebulization is currently underutilized in LTC settings, although it would benefit older patients with low peak inspiratory flow, cognitive impairment, and/or physical impairment, which may preclude them from using other inhalation devices. Authors developed a COPD treatment algorithm that focuses on three primary patient aspects to consider when deciding on respiratory device in patients in LTC facilities: inspiratory flow, hand dexterity and coordination, and cognitive capacity.
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Abstract
Objective: The aim of this study was to compare the association between age and disability length across common chronic conditions. Methods: Analysis of 39,915 nonwork-related disability claims with a diagnosis of arthritis, diabetes, hypertension, coronary artery disease, depression, low back pain, chronic pulmonary disease, or cancer. Ordinary least squares regression models examined age-length of disability association across chronic conditions. Results: Arthritis (76.6 days), depression (63.2 days), and cancer (64.9 days) were associated with longest mean disability lengths; hypertension was related to shortest disability lengths (41.5 days). Across chronic conditions, older age was significantly associated with longer work disability. The age–length of disability association was most significant for chronic pulmonary disease and cancer. The relationship between age and length of work disability was linear among most chronic conditions. Conclusions: Work disability prevention strategies should consider both employee age and chronic condition diagnosis.
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Porhomayon J, Pourafkari L, El-Solh A, Nader ND. Novel therapies for perioperative respiratory complications. J Cardiovasc Thorac Res 2017; 9:121-126. [PMID: 29118943 PMCID: PMC5670332 DOI: 10.15171/jcvtr.2017.21] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 08/06/2017] [Indexed: 12/14/2022] Open
Abstract
Postoperative respiratory complications are of paramount clinical importance as they prolong the hospitalization, increase the costs of treatment and contribute to the perioperative mortality. Obesity, preexisting pulmonary disease and advanced age are known risk factors for developing postoperative respiratory complications, which affect exceeding number of patients. Hereby, we present a review on the pathogenesis of post-operative respiratory complications particularly in obese and older patients. We further focus on the standard management and emerging therapies for the post-operative respiratory complications.
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Affiliation(s)
- Jahan Porhomayon
- Clinical Professor of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Buffalo, NY, USA.,State University of New York at Buffalo, Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | - Leili Pourafkari
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ali El-Solh
- State University of New York at Buffalo, Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | - Nader D Nader
- State University of New York at Buffalo, Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
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Wakabayashi R, Kusunoki Y, Hattori K, Motegi T, Furutate R, Itoh A, Jones RC, Hyland ME, Kida K. Effectiveness of home-based exercise in older patients with advanced chronic obstructive pulmonary disease: A 3-year cohort study. Geriatr Gerontol Int 2017; 18:42-49. [PMID: 28762596 DOI: 10.1111/ggi.13134] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 05/09/2017] [Accepted: 06/13/2017] [Indexed: 11/26/2022]
Abstract
AIM To determine whether home-based exercise can improve clinical outcomes in older patients with advanced chronic obstructive pulmonary disease using long-term oxygen therapy. METHODS Information was provided to improve chronic obstructive pulmonary disease self-management before the onset of the present prospective 3-year cohort study. Patients selected either home-based exercise using a lower-limb cycle machine (ergo-bicycle; group E), or usual exercise (group U). To assess self-management, the Lung Information Needs Questionnaire was evaluated every 6 months. Clinical outcomes included the 6-min walk test, pulmonary function tests, the body mass index, airflow obstruction, dyspnea and exercise index, St. George's respiratory questionnaire, and the number of exacerbations and hospitalizations. RESULTS A total of 136 patients (group E = 72; group U = 64), with a mean age of 74.2 years were enrolled. Total Lung Information Needs Questionnaire scores improved over 3 years for group E (P = 0.003). The distance of the 6-min walk test was well maintained in group E, but significantly decreased in group U (P < 0.001). The percentage of forced expiratory volume in 1 s at baseline was lower in group E (P = 0.016), but was maintained over 3 years, whereas a significant reduction was seen in group U (P = 0.001). The body mass index, airflow obstruction, dyspnea and exercise index significantly worsened in both groups over 3 years (group E: P = 0.011; group U: P < 0.001), whereas a significant decrease in the number of exacerbations was noted in group E (P = 0.009). CONCLUSIONS Patients who undertook home-based exercise using an ergo-bicycle were able to maintain clinical outcomes including 6-min walk test distance and percentage of forced expiratory volume in 1 s predicted, and recorded fewer exacerbations over 3 years. Geriatr Gerontol Int 2018; 18: 42-49.
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Affiliation(s)
- Ritsuko Wakabayashi
- College of Nursing, Kanto Gakuin University, Kanagawa, Japan.,Division of Pulmonary Medicine, Department of Internal Medicine, Respiratory Care Clinic, Nippon Medical School, Tokyo, Japan
| | - Yuji Kusunoki
- Division of Pulmonary Medicine, Department of Internal Medicine, Respiratory Care Clinic, Nippon Medical School, Tokyo, Japan
| | - Kumiko Hattori
- Division of Pulmonary Medicine, Department of Internal Medicine, Respiratory Care Clinic, Nippon Medical School, Tokyo, Japan
| | - Takashi Motegi
- Division of Pulmonary Medicine, Department of Internal Medicine, Respiratory Care Clinic, Nippon Medical School, Tokyo, Japan
| | - Ryuko Furutate
- Division of Pulmonary Medicine, Department of Internal Medicine, Respiratory Care Clinic, Nippon Medical School, Tokyo, Japan
| | - Aki Itoh
- Division of Pulmonary Medicine, Department of Internal Medicine, Respiratory Care Clinic, Nippon Medical School, Tokyo, Japan
| | - Rupert Cm Jones
- Respiratory Research Unit, Peninsula Medical School, Plymouth, UK
| | | | - Kozui Kida
- Division of Pulmonary Medicine, Department of Internal Medicine, Respiratory Care Clinic, Nippon Medical School, Tokyo, Japan
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Bennett G, Cushen B, Killane I, Maguire F, Costello RW, Reilly RB. 109INVESTIGATING GAIT AND COGNITION IN ELDERLY COPD PATIENTS HOSPITALISED WITH AN ACUTE EXACERBATION. Age Ageing 2016. [DOI: 10.1093/ageing/afw159.120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Leal A, Couceiro R, Chouvarda I, Maglaveras N, Henriques J, Paiva R, Carvalho P, Teixeira C. Detection of different types of noise in lung sounds. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2016; 2016:5977-5980. [PMID: 28269614 DOI: 10.1109/embc.2016.7592090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Lung sound signal processing has proven to be a great improvement to the traditional acoustic interpretation of lung sounds. However, that analysis can be seriously hindered by the presence of different types of noise originated in the acquisition environment or caused by physiological processes. Consequently, the diagnostic accuracy of pulmonary diseases can be severely affected, especially if the implementation of telemonitoring systems is considered. The present study is focused on the implementation of an algorithm able to identify noisy periods, either voluntarily (vocalizations, chest movement and background voices) or involuntarily produced during acquisitions of lung sounds. The developed approach also had to deal with the presence of simulated cough events, that carry important diagnostic information regarding several pulmonary diseases. Features such as Katz fractal dimension, Teager-Kaiser energy operator and normalized mutual information, were extracted from the time domain of healthy and a pathological lung signals. Noise detection was the result of a good discrimination between uncontaminated lung sounds and both cough and noise episodes and a slightly worse classification of cough events. In fact, detection of cough periods carrying diagnostic information was influenced by the presence of two other types of noise having similar signal characteristics.
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Tang S, Dong D, Ji L, Fu H, Feng Z, Bishwajit G, He Z, Ming H, Fu Q, Xian Y. What Contributes to the Activeness of Ethnic Minority Patients with Chronic Illnesses Seeking Allied Health Services? A Cross-Sectional Study in Rural Western China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:11579-93. [PMID: 26389931 PMCID: PMC4586692 DOI: 10.3390/ijerph120911579] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Revised: 08/23/2015] [Accepted: 08/25/2015] [Indexed: 11/18/2022]
Abstract
Actively seeking health services lies at the core of effective models of chronic disease self-management and contributes to promoting the utilization of allied health services (AHS). However, the use of AHS by ethnic minority Chinese, especially the elderly living in rural areas, has not received much attention. This study, therefore, aims to explore the association between personal characteristics and the activeness of ethnic minority patients with chronic diseases in rural areas of western China seeking AHS. A cross-sectional study was conducted to collect data on the socio-demographic and economic characteristics, health knowledge level and health communication channels of the sampled patients. A logistic regression model was used to examine the association of these predictors with the activeness of the surveyed patients in seeking AHS. A total of 1078 ethnic minorities over 45 years old who had chronic conditions were randomly selected from three western provinces in China and were interviewed in 2014. It is found that the New Cooperative Medical Scheme (NCMS) is the most salient predictor affecting the activeness of Chinese ethnic minorities in seeking AHS. The probability is 8.51 times greater for those insured with NCMS to actively seek AHS than those without (95% Confidence Interval (CI) 4.76–15.21; p < 0.001). Moreover, participants between 60 and 70 years old and those who have five to six household members are more likely to seek AHS compared with other social groups (Odds Ratio (OR) = 1.64, 95% CI 1.28–2.97, p = 0.007; OR = 1.95, 95% CI 1.15–2.36, p = 0.002). However, the activeness of patients seeking AHS is lower for those who have better household economic conditions. Besides socio-demographic predictors, the Chinese ethnic minorities’ activeness in seeking AHS is clearly associated with the communication channels used for receiving health information, which include direct communication with doctors (OR = 5.18, 95% CI 3.58–7.50, p < 0.001) and dissemination of elementary public health knowledge posted on bulletin boards (OR = 2.30, 95% CI 1.61–3.27, p < 0.001) and traditional mass media (OR = 1.74, 95% CI 1.22–2.48, p = 0.002). First, the government should further improve the coverage of NCMS to households suffering from chronic diseases and satisfy the requirements of social groups at different income levels and various ages in their health care to improve their activeness in AHS utilization. Second, doctors’ advice, bulletin boards and traditional media are common health communication channels for those seeking AHS and thus should be continuously employed in rural western China. Third, specified healthcare services should be designed to meet the needs of different patient segmentations.
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Affiliation(s)
- Shangfeng Tang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
| | - Dong Dong
- David C. Lam Institute for East-West Studies, Hong Kong Baptist University, Hong Kong, China.
| | - Lu Ji
- Cancer Center, Sun Yat-sen University, Guangdong 510060, China.
| | - Hang Fu
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
| | - Zhanchun Feng
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
| | - Ghose Bishwajit
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
| | - Zhifei He
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
| | - Hui Ming
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
| | - Qian Fu
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
| | - Yue Xian
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
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Huddlestone L, Walker GM, Hussain-Mills R, Ratschen E. Treating tobacco dependence in older adults: a survey of primary care clinicians' knowledge, attitudes, and practice. BMC FAMILY PRACTICE 2015; 16:97. [PMID: 26246080 PMCID: PMC4527299 DOI: 10.1186/s12875-015-0317-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Accepted: 07/30/2015] [Indexed: 11/10/2022]
Abstract
BACKGROUND The benefits of smoking cessation among older people are well documented. Despite this, evidence suggests that older smokers are rarely engaged in smoking cessation efforts, and that existing tobacco dependence treatments require further tailoring to the specific needs of older smokers. This study assesses the knowledge, attitudes, and clinical practice of primary care clinicians in relation to addressing tobacco dependence among older people. METHODS A cross-sectional survey of 427 NHS primary care clinicians in a large English city was conducted using modified version of a previously validated questionnaire. RESULTS One hundred and seventy one clinicians (40 % response rate) completed the survey. While the majority (90.0 %) of respondents reported enquiring regularly about older patients' smoking status, just over half (59.1 %) reported providing older patients with smoking cessation support. A lack of awareness in relation to the prevalence and impact of smoking in later life were apparent: e.g. only 47 % of respondents were aware of that approximately 10 life years are lost due to smoking related disease, and only 59 % knew that smoking can reduce the effectiveness of medication prescribed for conditions common in later life. Self-reported attendance at smoking-related training was significantly associated with proactive clinical practice. CONCLUSIONS There is a need to improve clinicians' knowledge, in relation to smoking and smoking cessation in older patients and to build clinician confidence in seizing teachable moments.
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Affiliation(s)
- Lisa Huddlestone
- Division of Epidemiology & Public Health, The University Of Nottingham, Clinical Sciences Building, City Hospital Campus, Nottingham, NG5 1PB, UK.
| | - Gemma Michelle Walker
- Department of Medicine, CLAHRC EM, Institute of Mental Health, University of Nottingham, Nottingham, UK.
| | | | - Elena Ratschen
- Division of Epidemiology & Public Health, The University Of Nottingham, Clinical Sciences Building, City Hospital Campus, Nottingham, NG5 1PB, UK.
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Edvardsson M, Levander MS, Ernerudh J, Theodorsson E, Grodzinsky E. Clinical use of conventional reference intervals in the frail elderly. J Eval Clin Pract 2015; 21:229-35. [PMID: 25494854 DOI: 10.1111/jep.12294] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/20/2014] [Indexed: 11/27/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Reference intervals provided by the laboratory are commonly established by measuring samples from apparently healthy subjects in the ages 18-65 years, excluding elderly individuals with chronic diseases and medication. The aim of our study was to establish whether current reference intervals for immune parameters and chemical biomarkers are valid for older individuals including those with chronic diseases, so-called frail elderly. METHODS Data from our cohort of 138 non-infected nursing home residents (NHR), mean age 86.8 years, range 80-98, were compared with raw data, as basis for the development of reference intervals, obtained from reference populations, like blood donors (IgA, IgG, IgM, C3 and C4) and from the Nordic Reference Interval Project (NORIP) (alanine aminotransferase, albumin, aspartate aminotransferase, creatinine, gamma-glutamyl transferase, lactate dehydrogenase, phosphate, sodium and urea). Immune parameters were measured by nephelometry and in NORIP the measurements were performed by means of different routine methods, in more than 100 laboratories. RESULTS Only nine individuals (7%) of NHR were found to be free from chronic disease. C3, C4 (P < 0.001) and IgG levels (P < 0.05) were higher, while IgM levels (P < 0.001) were lower in NHR compared with reference blood donors. Levels of alanine aminotransferase, phosphate (P < 0.001), albumin (P < 0.05) and sodium (P < 0.01) were lower while creatinine and urea levels were higher (P < 0.001) in NHR compared with NORIP subjects. CONCLUSION Comparing laboratory results from elderly people with conventional reference intervals can be misleading or even dangerous, as normal conditions may appear pathological, or vice versa and thus lead to unnecessary or even harmful treatment.
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Affiliation(s)
- Maria Edvardsson
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden; Primary Health Care, Finspång, Sweden
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17
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Chen CZ, Ou CY, Yu CH, Yang SC, Chang HY, Hsiue TR. Comparison of global initiative for chronic obstructive pulmonary disease 2013 classification and body mass index, airflow obstruction, dyspnea, and exacerbations index in predicting mortality and exacerbations in elderly adults with chronic obstructive pulmonary disease. J Am Geriatr Soc 2015; 63:244-50. [PMID: 25641518 DOI: 10.1111/jgs.13258] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVES To examine whether the Global Initiative for Chronic Obstructive Pulmonary Disease (GOLD) 2013 revision offers greater predictive ability than the body mass index, airflow obstruction, dyspnea, and exacerbations (BODEx) index in elderly adults with chronic obstructive pulmonary disease (COPD). DESIGN Prospective cohort study. SETTING University-affiliated medical center. PARTICIPANTS Taiwanese outpatients with COPD (N = 354). MEASUREMENTS Participants were classified as Group A (low risk with mild dyspnea), Group B (low risk with more-severe dyspnea), Group C (high risk with mild dyspnea), and Group D (high risk with more-severe dyspnea) for GOLD 2013 and from Quartile 1 (0-2 points) to 4 (7-9 points) for BODEx score. Ability to predict exacerbations and mortality was compared using logistic regression analysis with receiver operating characteristic (ROC) curve estimations and area under the ROC curve (AUC). RESULTS Mortality was 14.1% for GOLD Group A, 14.5% for Group B, 6.5% for Group C, and 35.8% for Group D and 15.2% for BODEx Quartile 1, 22.5% for Quartile 2, 28.1% for Quartile 3, and 79.2% for Quartile 4. Risk of exacerbation relative to Group A was 1.7 (95% confidence interval (CI) = 0.6-4.3) for Group B, 14.1 (95% CI = 4.6-43.2) for Group C, and 17.9 (95% CI = 7.6-42.0) for Group D. The AUC for the GOLD classification and BODEx index were 0.65 and 0.67 for mortality (P = .60) and 0.79 and 0.73 for exacerbation (P = .03). CONCLUSION The GOLD 2013 classification performed well in identifying individuals at risk of exacerbations, and its predictive ability for exacerbations was better than that of the BODEx index, although the predictive ability for mortality in elderly adults with COPD was poor for both indices.
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Affiliation(s)
- Chiung-Zuei Chen
- Division of Pulmonary Medicine, Department of Internal Medicine, National Cheng Kung University Medical College and Hospital, Tainan, Taiwan; Department of Internal Medicine, National Cheng Kung University Hospital Dou-Liou Branch, Yunlin, Taiwan
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18
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Morley JE. Chronic obstructive pulmonary disease: a disease of older persons. J Am Med Dir Assoc 2014; 15:151-153. [PMID: 24513223 DOI: 10.1016/j.jamda.2013.12.078] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Accepted: 12/18/2013] [Indexed: 12/25/2022]
Affiliation(s)
- John E Morley
- Divisions of Geriatric Medicine and Endocrinology, Saint Louis University School of Medicine, St. Louis, MO.
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Effects of comprehensive therapy based on traditional Chinese medicine patterns on older patients with chronic obstructive pulmonary disease: a subgroup analysis from a four-center, randomized, controlled study. Front Med 2014; 8:368-75. [DOI: 10.1007/s11684-014-0360-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 07/29/2014] [Indexed: 02/02/2023]
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20
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Zhao D, Miller D, Xian X, Tsow F, Forzani ES. A Novel Real-time Carbon Dioxide Analyzer for Health and Environmental Applications. SENSORS AND ACTUATORS. B, CHEMICAL 2014; 195:171-176. [PMID: 24659857 PMCID: PMC3959738 DOI: 10.1016/j.snb.2013.12.110] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
To be able to detect carbon dioxide (CO2) with high accuracy and fast response time is critical for many health and environmental applications. We report on a pocket-sized CO2 sensor for real-time analysis of end-tidal CO2, and environmental CO2. The sensor shows fast and reversible response to CO2 over a wide concentration range, covering the needs of both environmental and health applications. It is also immune to the presence of various interfering gases in ambient or expired air. Furthermore, the sensor has been used for real-time breath analysis, and the results are in good agreement with those from a commercial CO2 detector.
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Affiliation(s)
- Di Zhao
- Center for Bioelectronics and Biosensors, Biodesign Institute, Arizona State University, Tempe, Arizona 85287-5801, United States ; School of Engineering of Matter, Transport and Energy, Arizona State University, Tempe, Arizona 85287-5801, United States
| | - Dylan Miller
- Center for Bioelectronics and Biosensors, Biodesign Institute, Arizona State University, Tempe, Arizona 85287-5801, United States ; School of Engineering of Matter, Transport and Energy, Arizona State University, Tempe, Arizona 85287-5801, United States
| | - Xiaojun Xian
- Center for Bioelectronics and Biosensors, Biodesign Institute, Arizona State University, Tempe, Arizona 85287-5801, United States
| | - Francis Tsow
- Center for Bioelectronics and Biosensors, Biodesign Institute, Arizona State University, Tempe, Arizona 85287-5801, United States
| | - Erica S Forzani
- Center for Bioelectronics and Biosensors, Biodesign Institute, Arizona State University, Tempe, Arizona 85287-5801, United States ; School of Engineering of Matter, Transport and Energy, Arizona State University, Tempe, Arizona 85287-5801, United States
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21
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Hyde N, Casey D, Murphy K, Cooney A, Mee L, Kirwan C, Tully A, Mooney B. COPD in primary care settings in Ireland: stories from usual care. Br J Community Nurs 2013; 18:275-82. [PMID: 24046924 DOI: 10.12968/bjcn.2013.18.6.275] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The aim of the PRINCE study was to determine the effectiveness of a structured education pulmonary rehabilitation programme for those living with COPD in primary care in Ireland. This qualitative element of the larger PRINCE trial aims to describe the constituents of 'usual care' for patients allocated to the control arm of the study. A descriptive qualitative study was used to explore the constituents of usual care. A convenience sample of participants (n=20) allocated to the usual care group were interviewed. Three main themes arose from the study: experiences of having and managing COPD, lifestyle advice, and factors that helped or hindered self-management. Usual care left many people grappling in the dark trying to manage their COPD. It was found that usual care was not at its optimum for people with COPD in the control arm of the PRINCE study.
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Affiliation(s)
- Nicola Hyde
- School of Nursing and Midwifery, Aras Moyola, National University of Ireland, Galway.
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22
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Chronic obstructive pulmonary disease and asthma. ACTA ACUST UNITED AC 2013; 30:603-12; quiz 612-4. [PMID: 23131690 DOI: 10.1097/nhh.0b013e3182705c20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Obstructive lung disorders are responsible for functional limitations and the deaths of millions of Americans. Chronic obstructive pulmonary disease (COPD) is in the top 5 leading causes of death and the incidence is climbing. Home healthcare and hospice nurses should be aware of current management strategies, including nonpharmacologic therapies. A case-study format is used to introduce the subject, a brief review of pathophysiology of COPD and asthma is discussed, and evidence-based treatment strategies are reviewed, including nursing management to improve patient function.
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23
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Yawson AE, Baddoo A, Hagan-Seneadza NA, Calys-Tagoe B, Hewlett S, Dako-Gyeke P, Mensah G, Minicuci N, Naidoo N, Chatterji S, Kowal P, Biritwum R. Tobacco use in older adults in Ghana: sociodemographic characteristics, health risks and subjective wellbeing. BMC Public Health 2013; 13:979. [PMID: 24138966 PMCID: PMC3924352 DOI: 10.1186/1471-2458-13-979] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Accepted: 10/16/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Tobacco use over the life-course threatens to increase disease burden in older adulthood, including lower income countries like Ghana. This paper describes demographic, socioeconomic, health risks and life satisfaction indices related to tobacco use among older adults in Ghana. METHODS This work was based on the World Health Organization's multi-country Study on global AGEing and adult health (SAGE), conducted in six countries including Ghana. Wave one of SAGE in Ghana was conducted in 2007-2008 as collaboration between WHO and the University of Ghana Medical School through the Department of Community Health. A nationally representative sample of 4305 older adults aged 50 years and above were interviewed. Associations between tobacco consumption and sociodemographic, socioeconomic, health risk and life satisfaction were evaluated using chi-square and odds ratio (OR). Logistic regression analyses, adjusted for age, sex and other variables, were conducted to determine predictors of tobacco consumption in older persons. RESULTS Overall prevalence of current daily smokers among older adults in Ghana was 7.6%. Tobacco use (i.e. ever used tobacco) was associated with older males, (AOR = 1.10, CI 1.05-1.15), older adults residing in rural locations (AOR = 1.37, CI 1.083-1.724), and older adults who used alcohol (AOR = 1.13, CI 0.230-2.418). Tobacco use was also associated (although not statistically significant per p-values) with increased self-reporting of angina, arthritis, asthma, chronic lung disease, depression, diabetes, hypertension, and stroke. Older adults who used tobacco and with increased health risks, tended to be without health insurance (AOR = 1.41, CI 1.111-1.787). Satisfaction with life and daily living was much lower for those who use tobacco. Regional differences existed in tobacco use; the three northern regions (Upper East, Northern and Upper West) had higher proportions of tobacco use among older adults in the country. Quitting tobacco use was higher in the 70+ years age group, in women, among urban residents and in those with at least secondary education. Quitting tobacco use also increased with increasing income levels. CONCLUSIONS Tobacco use among older adults in Ghana was associated with older men living in rural locations, chronic ill-health and reduced life satisfaction. A high proportion of older adults have stopped using tobacco, demonstrating the possibilities for effective public health interventions. Health risk reduction strategies through targeted anti-smoking health campaigns, improvement in access to health and social protection (such as health insurance) will reduce health risks among older persons who use tobacco.
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Affiliation(s)
- Alfred E Yawson
- Department of Community Health, University of Ghana Medical School, College of Health Sciences, Room 46, P. O. Box 4236, Korle-Bu, Accra, Ghana
- Public Health Unit, Korle-Bu Teaching Hospital, Korle-Bu, Accra, Ghana
| | - Akosua Baddoo
- Department of Community Health, University of Ghana Medical School, College of Health Sciences, Room 46, P. O. Box 4236, Korle-Bu, Accra, Ghana
- Public Health Unit, Korle-Bu Teaching Hospital, Korle-Bu, Accra, Ghana
| | - Nana Ayegua Hagan-Seneadza
- Department of Community Health, University of Ghana Medical School, College of Health Sciences, Room 46, P. O. Box 4236, Korle-Bu, Accra, Ghana
- Public Health Unit, Korle-Bu Teaching Hospital, Korle-Bu, Accra, Ghana
| | - Benedict Calys-Tagoe
- Department of Community Health, University of Ghana Medical School, College of Health Sciences, Room 46, P. O. Box 4236, Korle-Bu, Accra, Ghana
- Public Health Unit, Korle-Bu Teaching Hospital, Korle-Bu, Accra, Ghana
| | - Sandra Hewlett
- University of Ghana Dental School, College of Health Sciences, University of Ghana, Korle-Bu, Accra, Ghana
| | - Phyllis Dako-Gyeke
- Department of Social and Behavioral Sciences, School of Public Health, College of Health Sciences, University of Ghana, Legon, Accra, Ghana
| | - George Mensah
- Department of Community Health, University of Ghana Medical School, College of Health Sciences, Room 46, P. O. Box 4236, Korle-Bu, Accra, Ghana
| | - Nadia Minicuci
- Department of Community Health, University of Ghana Medical School, College of Health Sciences, Room 46, P. O. Box 4236, Korle-Bu, Accra, Ghana
- National Council Research, Institute of Neuroscience, Padova, Italy
| | - Nirmala Naidoo
- World Health Organization, Multi-Country Studies unit, Geneva, Switzerland
| | - Somnath Chatterji
- World Health Organization, Multi-Country Studies unit, Geneva, Switzerland
| | - Paul Kowal
- World Health Organization, Multi-Country Studies unit, Geneva, Switzerland
- University of Newcastle Research Centre on Gender, Health and Aging, Newcastle, Australia
| | - Richard Biritwum
- Department of Community Health, University of Ghana Medical School, College of Health Sciences, Room 46, P. O. Box 4236, Korle-Bu, Accra, Ghana
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The impact of complex chronic diseases on care utilization among assisted living residents. Geriatr Nurs 2013; 35:26-30. [PMID: 24139207 DOI: 10.1016/j.gerinurse.2013.09.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Revised: 08/28/2013] [Accepted: 09/01/2013] [Indexed: 11/21/2022]
Abstract
PURPOSE Many residents of assisted living (AL) have chronic diseases that are difficult to manage, including congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD) and diabetes mellitus (DM). We estimated the amount and intensity of care delivered by the staff for residents with these conditions. METHODS We performed a secondary data analysis from the Maryland Assisted Living (MDAL) Study (399 residents, 29 facilities). In-person assessments included measures of cognition, function, depression, and general medical health. Diagnosis of CHF, COPD, and DM, as well as current medications was abstracted from AL medical charts. Measures of care utilization were operationalized at the resident level as: 1) minutes per day of direct care (caregiver activity scale [CAS]), 2) subjective staff ratings of care burden, and 3) assigned AL "level of care" (based on state regulatory criteria). RESULTS In best fit regression models, CHF and DM were not significant predictors of the evaluated care utilization measures; however, COPD was independently associated with increased minutes per day of direct care - 34% of the variance in the caregiver activity scale was explained by degree of functional dependency, cognitive impairment, age, and presence of COPD. Functional dependency, depressive symptoms, and age explained almost a quarter (23%) of the variance of staff care burden rating. For the AL level of care intensity rating, degree of functional dependency, level of cognition, and age were significant correlates, together explaining about 28% of the variance. CONCLUSION The presence of COPD was a significant predictor of time per day of direct care. However, CHF and DM were not correlates of care utilization measures. Functional and cognitive impairment was associated with measures of care utilization, reiterating the importance of these characteristics in the utilization and intensity of care consumed by AL residents. Further study of this population could reveal other forms and amounts of care utilization.
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25
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RYU JY, LEE SY, KIM DH. Obstructive pulmonary function impairment among Korean male workers exposed to organic solvents, iron oxide dust, and welding fumes. INDUSTRIAL HEALTH 2013; 51:596-602. [PMID: 24131874 PMCID: PMC4202746 DOI: 10.2486/indhealth.2012-0213] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Accepted: 09/24/2013] [Indexed: 05/26/2023]
Abstract
We evaluated spirometric obstructive pulmonary function impairment among workers who were occupationally exposed to organic solvents, iron oxide dust, or welding fumes. Data were collected from records of periodic health examinations of workers. In total, 448 Korean male workers were enrolled and classified into three exposure groups: exposure to organic solvents, iron oxide dust, or welding fumes. Logistic regression analysis was performed to evaluate the association between occupational exposure and pulmonary function. Compared to exposure to organic solvents, exposure to iron oxide dust was significantly associated with obstructive pulmonary function impairment (odds ratio [OR], 9.61; 95% confidence interval [CI], 2.20-41.97). The group exposed to welding fumes did not show a significantly higher OR compare to those exposed to organic solvents (OR, 2.83; 95% CI, 0.74-10.8). These results suggest that exposure to iron oxide dust has a greater association with obstructive pulmonary function impairment than exposure to organic solvents or welding fumes.
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Affiliation(s)
- Ji Young RYU
- Department of Occupational and Environmental Medicine, Inje
University Haeundae Paik Hospital, Republic of Korea
| | - Sang-Yoon LEE
- Department of Occupational and Environmental Medicine, Inje
University Haeundae Paik Hospital, Republic of Korea
| | - Dae Hwan KIM
- Department of Occupational and Environmental Medicine, Inje
University Haeundae Paik Hospital, Republic of Korea
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Ajmera M, Shen C, Pan X, Findley PA, Rust G, Sambamoorthi U. Inhaled anticholinergic use and all-cause mortality among elderly Medicare beneficiaries with chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis 2013; 8:287-94. [PMID: 23785232 PMCID: PMC3682815 DOI: 10.2147/copd.s45166] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND The purpose of this study was to examine the association between use of inhaled anticholinergics and all-cause mortality among elderly individuals with chronic obstructive pulmonary disease (COPD), after controlling for demographic, socioeconomic, health, functional status, smoking, and obesity. METHODS We used a retrospective longitudinal panel data design. Data were extracted for multiple years (2002-2009) of the Medicare Current Beneficiary Survey (MCBS) linked with fee-for-service Medicare claims. Generic and brand names of inhaled anticholinergics were used to identify inhaled anticholinergic utilization from the self-reported prescription medication files. All-cause mortality was assessed using the vital status variable. Unadjusted group differences in mortality rates were tested using the chi-square statistic. Multivariable logistic regressions with independent variables entered in separate blocks were used to analyze the association between inhaled anticholinergic use and all-cause mortality. All analyses accounted for the complex design of the MCBS. RESULTS Overall, 19.4% of the elderly Medicare beneficiaries used inhaled anticholinergics. Inhaled anticholinergic use was significantly higher (28.5%) among those who reported poor health compared with those reporting excellent or very good health (12.7%). Bivariate analyses indicated that inhaled anticholinergic use was associated with significantly higher rates of all-cause mortality (18.7%) compared with nonusers (13.6%). However, multivariate analyses controlling for risk factors did not suggest an increased likelihood of all-cause mortality (adjusted odds ratio 1.26, 95% confidence interval 0.95-1.67). CONCLUSION Use of inhaled anticholinergics among elderly individuals with COPD is potentially safe in terms of all-cause mortality when we adjust for baseline risk factors.
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Affiliation(s)
- Mayank Ajmera
- Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Morgantown, WV, USA.
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Idrees M, Koniski ML, Taright S, Shahrour N, Polatli M, Ben Kheder A, Alzaabi A, Iraqi G, Khattab A, Javed A, Rashid N, El Hasnaoui A. Management of chronic obstructive pulmonary disease in the Middle East and North Africa: Results of the BREATHE study. Respir Med 2012; 106 Suppl 2:S33-44. [DOI: 10.1016/s0954-6111(12)70013-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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28
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Carlin BW. COPD and associated comorbidities: a review of current diagnosis and treatment. Postgrad Med 2012; 124:225-40. [PMID: 22913911 DOI: 10.3810/pgm.2012.07.2582] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Health care utilization and costs associated with chronic obstructive pulmonary disease (COPD) continue to increase, notwithstanding evidence-based management strategies described by major respiratory societies. Cardiovascular diseases, asthma, diabetes and its precursors (obesity and metabolic syndrome), depression, cognitive impairment, and osteoporosis are examples of common comorbidities that can affect or be affected by COPD. Appropriate diagnosis and management (from a pharmacologic and nonpharmacologic perspective) of COPD and its associated comorbidities are important to ensure optimal patient care. An evolving understanding of COPD as a multimorbid disease that affects an aging population, rather than just a lung-specific disease, necessitates an integrated, tailored disease-management approach to improve prognoses and reduce costs.
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Affiliation(s)
- Brian W Carlin
- Drexel University School of Medicine, Allegheny General Hospital, Pittsburgh, PA, USA.
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van den Borst B, Gosker HR, Koster A, Yu B, Kritchevsky SB, Liu Y, Meibohm B, Rice TB, Shlipak M, Yende S, Harris TB, Schols AMWJ. The influence of abdominal visceral fat on inflammatory pathways and mortality risk in obstructive lung disease. Am J Clin Nutr 2012; 96:516-26. [PMID: 22811442 PMCID: PMC3417214 DOI: 10.3945/ajcn.112.040774] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Low-grade systemic inflammation, particularly elevated IL-6, predicts mortality in chronic obstructive pulmonary disease (COPD). Although altered body composition, especially increased visceral fat (VF) mass, could be a significant contributor to low-grade systemic inflammation, this remains unexplored in COPD. OBJECTIVE The objective was to investigate COPD-specific effects on VF and plasma adipocytokines and their predictive value for mortality. DESIGN Within the Health, Aging, and Body Composition (Health ABC) Study, an observational study in community-dwelling older persons, we used propensity scores to match n = 729 persons with normal lung function to n = 243 persons with obstructive lung disease (OLD; defined as the ratio of forced expiratory volume in 1 s to forced vital capacity < lower limit of normal). Matching was based on age, sex, race, clinic site, BMI, and smoking status. Within this well-balanced match, we compared computed tomography-acquired visceral fat area (VFA) and plasma adipocytokines, analyzed independent associations of VFA and OLD status on plasma adipocytokines, and studied their predictive value for 9.4-y mortality. RESULTS Whereas whole-body fat mass was comparable between groups, persons with OLD had increased VFA and higher plasma IL-6, adiponectin, and plasminogen activator inhibitor 1 (PAI-1). Both OLD status and VFA were independently positively associated with IL-6. Adiponectin was positively associated with OLD status but negatively associated with VFA. PAI-1 was no longer associated with OLD status after VFA was accounted for. Participants with OLD had increased risk of all-cause, respiratory, and cardiovascular mortality, of which IL-6 was identified as an independent predictor. CONCLUSION Our data suggest that excessive abdominal visceral fat contributes to increased plasma IL-6, which, in turn, is strongly associated with all-cause and cause-specific mortality in older persons with OLD.
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Affiliation(s)
- Bram van den Borst
- NUTRIM School for Nutrition, Toxicology and Metabolism, Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, The Netherlands.
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Meijer C, Kokje V, van Tongeren R, Hamming J, van Bockel J, Möller G, Lindeman J. An Association between Chronic Obstructive Pulmonary Disease and Abdominal Aortic Aneurysm beyond Smoking. Eur J Vasc Endovasc Surg 2012; 44:153-7. [DOI: 10.1016/j.ejvs.2012.05.016] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2012] [Accepted: 05/16/2012] [Indexed: 10/28/2022]
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Yawn BP, Colice GL, Hodder R. Practical aspects of inhaler use in the management of chronic obstructive pulmonary disease in the primary care setting. Int J Chron Obstruct Pulmon Dis 2012; 7:495-502. [PMID: 22888221 PMCID: PMC3413176 DOI: 10.2147/copd.s32674] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Sustained bronchodilation using inhaled medications in moderate to severe chronic obstructive pulmonary disease (COPD) grades 2 and 3 (Global Initiative for Chronic Obstructive Lung Disease guidelines) has been shown to have clinical benefits on long-term symptom control and quality of life, with possible additional benefits on disease progression and longevity. Aggressive diagnosis and treatment of symptomatic COPD is an integral and pivotal part of COPD management, which usually begins with primary care physicians. The current standard of care involves the use of one or more inhaled bronchodilators, and depending on COPD severity and phenotype, inhaled corticosteroids. There is a wide range of inhaler devices available for delivery of inhaled medications, but suboptimal inhaler use is a common problem that can limit the clinical effectiveness of inhaled therapies in the real-world setting. Patients' comorbidities, other physical or mental limitations, and the level of inhaler technique instruction may limit proper inhaler use. This paper presents information that can overcome barriers to proper inhaler use, including issues in device selection, steps in correct technique for various inhaler devices, and suggestions for assessing and monitoring inhaler techniques. Ensuring proper inhaler technique can maximize drug effectiveness and aid clinical management at all grades of COPD.
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Affiliation(s)
- Barbara P Yawn
- Department of Research, Olmsted Medical Center, Rochester, MN 55904 , USA.
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Frohnhofen H, Hagen O. Handgrip strength measurement as a predictor for successful dry powder inhaler treatment: application in older individuals with COPD. Z Gerontol Geriatr 2012; 44:245-9. [PMID: 21769511 DOI: 10.1007/s00391-011-0222-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND More than 10% of elderly people suffer from chronic obstructive pulmonary disease (COPD). Drug treatment for COPD involves inhalants. Dry powder inhalers (DPIs) have proven easiest for the elderly to use. Their effectiveness is dependent, however, on the inspiratory flow which can be generated, and it is unclear which geriatric assessment parameter permits inspiratory flow to be assessed. METHODS In a randomly generated group of geriatric hospital patients, manual strength was measured as a complement to basic geriatric assessment and inspiratory flow assessed using a Turbohaler trainer. RESULTS A total of 87 (27%) men (mean age 81 ± 7 years) and 231 (73%) women (mean age 82 ± 8 years) were included in the study. The threshold value of 40 l/min for minimum inspiratory flow was achieved by 194 (61%) of the patients. Manual strength was the only assessment parameter to correlate with the minimum inspiratory flow achieved. ROC analysis produced a threshold value for manual strength of 10 kg. The sensitivity and specificity for this threshold value were 70% each, while the positive and negative predictive values were 79% and 84%, respectively. CONCLUSION A threshold value of 10 kg for manual strength enables the inspiratory flow achievable by elderly patients to be predicted satisfactorily. This is the only parameter which correlates sufficiently with inspiratory flow. Manual strength should be measured in all geriatric patients with COPD and should be taken into account when deciding whether or not to initiate differential treatment.
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Affiliation(s)
- H Frohnhofen
- Zentrum für Altersmedizin, Kliniken Essen Mitte, Am Deimelsberg 34a, 45276, Essen, Deutschland.
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Practical management problems of stable chronic obstructive pulmonary disease in the elderly. Curr Opin Pulm Med 2012; 17 Suppl 1:S43-8. [PMID: 22209930 DOI: 10.1097/01.mcp.0000410747.20958.39] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
PURPOSE OF REVIEW Chronic obstructive pulmonary disease (COPD) is one of the most prevalent and increasing health problems in the elderly on a worldwide scale. The management of COPD in older patients presents practical diagnostic and treatment issues, which are reviewed with reference to the stable stage of the disease. RECENT FINDINGS In the diagnostic approach of COPD in the elderly the use of spirometry is recommended, but both patient conditions (such as inability to correctly perform it due to fatigue, lack of coordination, and cognitive impairment) and metrics characteristics should be taken into account for the test performance. It has been demonstrated in population studies that the use of the fixed ratio determines a substantial overdiagnosis of COPD in the oldest patients. Other parameters have been suggested [such as the evaluation of Lower Limit of Normality (LLN) for the FEV1/FVC ratio], which may be useful to guide the diagnosis. Several nonpharmacologic - such as smoking cessation, vaccination, physical activity, and pulmonary rehabilitation, nutrition, and eventually invasive ventilation - and pharmacologic interventions have been shown to improve outcomes and have been reviewed. Effective management of COPD in older adults should always consider the ability of patients to properly use inhalers and the involvement of caregivers or family members as a useful support to care, especially when treating cognitively impaired patients. Especially in the older population, timely identification and treatment of comorbidities are also crucial, but evidence in this area is still lacking and clinical practice guidelines do not take comorbidities into account in their recommendations. SUMMARY The Global Initiative for Obstructive Lung Disease has recommended criteria for diagnosis and management of COPD in the general population. On the contrary, available evidence suggests practical limitations in diagnostic approach and intervention strategies in older patients with stable COPD that need to be further studied for a translation into clinical practice guidelines.
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Blazer DG, Wu LT. Patterns of tobacco use and tobacco-related psychiatric morbidity and substance use among middle-aged and older adults in the United States. Aging Ment Health 2012; 16:296-304. [PMID: 22292514 PMCID: PMC3323715 DOI: 10.1080/13607863.2011.615739] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
OBJECTIVES To examine prevalence of tobacco use and identify psychiatric symptoms and substance use correlates of tobacco use comparing adults 50-64 years of age with those 65+ years of age (N = 10,891). METHODS Data were from the 2008-2009 US National Surveys on Drug Use and Health. RESULTS Past-year tobacco use was one-half as frequent among adults aged 65+ years (14.1%) compared to adults aged 50-64 years (30.2%); the latter group surpassed the former in rates of cigarette smoking (24.8% vs. 10.6%), daily cigarette smoking (16.5% vs. 7.1%), cigar smoking (7.4% vs. 2.3%), and smokeless tobacco use (2.5% vs. 1.7%). Increased odds of cigarette smoking were noted among men, whites, African Americans, and those who had less education, had lower income, were not currently married, or were binge drinkers or illicit/non-medical drug users. In controlled analyses, odds ratio in those 65+ years of age who had smoked during the past year was 2.2 for binge drinking and 3.5 for illicit or non-medical drug use. Odds ratio of binge drinking among those 65+ years of age for cigar smokers during the past year was 3.1. Past-year cigarette smoking was not associated with reports of symptoms of depression or anxiety in the 65+ age group. CONCLUSIONS Tobacco use is less prevalent among adults 65+ years of age yet continues to be strongly associated with binge drinking and illicit or non-medical drug use. Preventive efforts to decrease these substance use problems should include programs to decrease tobacco use.
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Affiliation(s)
- Dan G. Blazer
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Box 3003, Durham, NC 27710, USA,Corresponding author: Dan G. Blazer, MD, PhD, Box 3003, Duke University Medical Center, Durham, NC 27710; phone: 919-684-4128; fax: 919-684-8569;
| | - Li-Tzy Wu
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Box 3419, Durham, NC 27710, USA;
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Vaz Fragoso CA, Enright PL, McAvay G, Van Ness PH, Gill TM. Frailty and respiratory impairment in older persons. Am J Med 2012; 125:79-86. [PMID: 22195532 PMCID: PMC3246194 DOI: 10.1016/j.amjmed.2011.06.024] [Citation(s) in RCA: 119] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2010] [Revised: 06/30/2011] [Accepted: 06/30/2011] [Indexed: 12/21/2022]
Abstract
BACKGROUND Among older persons, the association between frailty and spirometry-confirmed respiratory impairment has not been evaluated yet. METHODS By using data on white participants aged 65 to 80 years (Cardiovascular Health Study, N=3578), we evaluated cross-sectional and longitudinal associations between frailty and respiratory impairment, including their combined effect on mortality. Baseline assessments included frailty status (Fried phenotype: non-frail, pre-frail, and frail) and spirometry. Outcomes included development of frailty features (pre-frail or frail) at year 3 and respiratory impairment (airflow limitation or restrictive pattern) at year 4, and death (median follow-up, 13.2 years). RESULTS At baseline, 48.3% of participants were pre-frail, 5.8% of participants were frail, 13.8% of participants had airflow limitation, and 9.3% of participants had restrictive pattern; 46.1% of participants subsequently died. At baseline, pre-frail and frail were cross-sectionally associated with airflow limitation (adjusted odds ratio [OR], 1.62; 95% confidence interval [CI], 1.29-2.04 and adjusted OR 1.88; 95% CI, 1.15-3.09) and restrictive pattern (adjusted OR, 1.80; 95% CI, 1.37-2.36 and adjusted OR, 3.05; 95% CI, 1.91-4.88), respectively. Longitudinally, participants with baseline frailty features had an increased likelihood of developing respiratory impairment (adjusted OR, 1.42; 95% CI, 1.11-1.82). Conversely, participants with baseline respiratory impairment had an increased likelihood of developing frailty features (adjusted OR, 1.58; 95% CI, 1.17-2.13). Mortality was highest among participants who were frail and had respiratory impairment (adjusted hazard ratio, 3.91; 95% CI, 2.93-5.22), compared with those who were non-frail and had no respiratory impairment. CONCLUSION Frailty and respiratory impairment are strongly associated with one another and substantially increase the risk of death when both are present. Establishing these associations may inform interventions designed to reverse or prevent the progression of either condition and to reduce adverse outcomes.
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Affiliation(s)
- Carlos A Vaz Fragoso
- Yale University School of Medicine, Department of Internal Medicine, New Haven, CT, USA.
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van den Borst B, Koster A, Yu B, Gosker HR, Meibohm B, Bauer DC, Kritchevsky SB, Liu Y, Newman AB, Harris TB, Schols AMWJ. Is age-related decline in lean mass and physical function accelerated by obstructive lung disease or smoking? Thorax 2011; 66:961-9. [PMID: 21724748 PMCID: PMC3285455 DOI: 10.1136/thoraxjnl-2011-200010] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND and aims Cross-sectional studies suggest that obstructive lung disease (OLD) and smoking affect lean mass and mobility. A study was undertaken to investigate whether OLD and smoking accelerate the ageing-related decline in lean mass and physical functioning. METHODS 260 patients with OLD (mean±SD forced expiratory volume in 1 s (FEV1) 63±18% predicted), 157 smoking controls (FEV(1) 95±16% predicted), 866 former-smoking controls (FEV1 100±16% predicted) and 891 never-smoking controls (FEV1 104±17% predicted) participating in the Health, Aging and Body Composition (ABC) Study were studied. At baseline the mean age was 74±3 years and participants reported no functional limitations. Baseline and 7-year longitudinal data of body composition (by dual-energy x-ray absorptiometry), muscle strength (by hand and leg dynamometry) and Short Physical Performance Battery (SPPB) were investigated. RESULTS Compared with never-smoking controls, patients with OLD and smoking controls had a significantly lower weight, fat mass, lean mass and bone mineral content (BMC) at baseline (p<0.05). While the loss of weight, fat mass, lean mass and strength was comparable between patients with OLD and never-smoking controls, the SPPB declined 0.12 points/year faster in men with OLD (p=0.01) and BMC declined 4 g/year faster in women with OLD (p=0.02). In smoking controls only lean mass declined 0.1 kg/year faster in women (p=0.03) and BMC 8 g/year faster in men (p=0.02) compared with never-smoking controls. CONCLUSIONS Initially well-functioning older adults with mild-to-moderate OLD and smokers without OLD have a comparable compromised baseline profile of body composition and physical functioning, while 7-year longitudinal trajectories are to a large extent comparable to those observed in never-smokers without OLD. This suggests a common insult earlier in life related to smoking.
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Affiliation(s)
- Bram van den Borst
- Department of Respiratory Medicine, NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Center+, P.O. Box 616, 6200 MD Maastricht, The Netherlands.
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Kida K. [108th Scientific Meeting of the Japanese Society of Internal Medicine: educational lecture: 4. COPD as lifestyle-related illness and lung age]. NIHON NAIKA GAKKAI ZASSHI. THE JOURNAL OF THE JAPANESE SOCIETY OF INTERNAL MEDICINE 2011; 100:2605-2611. [PMID: 22117360 DOI: 10.2169/naika.100.2605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Kozui Kida
- Department of Internal Medicine, Respiratory Care Clinic, Nippon Medical School, Japan
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Corcoran TB, Hillyard S. Cardiopulmonary aspects of anaesthesia for the elderly. Best Pract Res Clin Anaesthesiol 2011; 25:329-54. [DOI: 10.1016/j.bpa.2011.07.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2011] [Accepted: 07/12/2011] [Indexed: 02/03/2023]
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Gogol M, Heppner HJ. [Pulmonary diseases in the elderly]. Z Gerontol Geriatr 2011; 44:219-20. [PMID: 21842351 DOI: 10.1007/s00391-011-0187-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
MESH Headings
- Aged
- Aged, 80 and over
- Humans
- Pneumonia, Aspiration/diagnosis
- Pneumonia, Aspiration/etiology
- Pneumonia, Aspiration/mortality
- Pneumonia, Bacterial/diagnosis
- Pneumonia, Bacterial/etiology
- Pneumonia, Bacterial/mortality
- Prognosis
- Pulmonary Disease, Chronic Obstructive/diagnosis
- Pulmonary Disease, Chronic Obstructive/etiology
- Pulmonary Disease, Chronic Obstructive/mortality
- Survival Rate
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Kerr S, Whyte R, Watson H, Tolson D, McFadyen AK. A Mixed-Methods Evaluation of the Effectiveness of Tailored Smoking Cessation Training for Healthcare Practitioners Who Work with Older People. Worldviews Evid Based Nurs 2011; 8:177-86. [DOI: 10.1111/j.1741-6787.2011.00219.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Franceschi C, Pauletto P, Incalzi RA, Fabbri LM. Invecchiamento, infiammazione sistemica e malattie croniche complesse. ITALIAN JOURNAL OF MEDICINE 2011. [DOI: 10.1016/j.itjm.2011.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Current world literature. Curr Opin Pulm Med 2011; 17:126-30. [PMID: 21285709 DOI: 10.1097/mcp.0b013e3283440e26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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