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Hopkinson NS, Bush A, Allinson JP, Faner R, Zar HJ, Agustí A. Early Life Exposures and the Development of Chronic Obstructive Pulmonary Disease across the Life Course. Am J Respir Crit Care Med 2024; 210:572-580. [PMID: 38861321 DOI: 10.1164/rccm.202402-0432pp] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Accepted: 06/10/2024] [Indexed: 06/13/2024] Open
Affiliation(s)
- Nicholas S Hopkinson
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Andrew Bush
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - James P Allinson
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Royal Brompton Hospital, London, United Kingdom
| | - Rosa Faner
- Unitat Immunologia, Departament de Biomedicina, Universitat de Barcelona, Fundació Clinic Recerca Biomedica-IDIBAPS, Centro Investigación Biomedica en Red, Barcelona, Spain
| | - Heather J Zar
- Department of Pediatrics and Child Health, Red Cross Children's Hospital, University of Cape Town, Cape Town, South Africa; and
| | - Alvar Agustí
- Hospital Clinic Barcelona, Universitat de Barcelona, Fundació Clinic Recerca Biomedica-IDIBAPS, Centro Investigación Biomedica en Red, Barcelona, Spain
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Younas A, Zeb H, Durante A, Vellone E. Sex based differences in depression, anxiety, and quality of life and predictors of quality of life among South Asian individuals with chronic obstructive pulmonary disease: A Bayesian analysis. Soc Sci Med 2024; 351:116989. [PMID: 38788430 DOI: 10.1016/j.socscimed.2024.116989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 04/19/2024] [Accepted: 05/15/2024] [Indexed: 05/26/2024]
Abstract
BACKGROUND COPD can affect both men and women leading to deteriorating impact on general well-being, personal, and family life and decreased quality of life. Anxiety, depression, and self-care behaviours can affect the quality of life of individuals with COPD. There is a dearth of sex-based comparative analyses of anxiety, depression, quality of life, and predictors of quality of life among South Asian individuals with COPD. PURPOSE To identify the sex-based differences in depression, anxiety, and quality of life and the predictors of quality of life among South Asian individuals with COPD. METHODS A cross-sectional survey of 294 men and 114 women with COPD was conducted in Khyber Pakhtunkhwa, Pakistan. Hospital Anxiety and Depression scale, World Health Organization Quality of Life-brief version, Self-Care of Chronic Obstructive Pulmonary Disease Inventory, the Self-Care Self-Efficacy in COPD Scale were used for data collection. Bayesian independent sample t-test was used to compare mean differences in depression, anxiety, and quality of life among men and women. Two regression models were examined to determine if age, years of living with COPD, anxiety, depression, self-care self-efficacy, self-care monitoring, management, and maintenance were predictors of quality of life among men and women. FINDINGS Bayesian analysis showed anecdotal evidence that women had higher levels of depression, but lower levels of anxiety compared to men. Anecdotal evidence indicated that the physical quality of life of men was better than women, but strong evidence that their social relationship and environmental quality of life was better than women. Years of living with COPD, anxiety, depression, self-care self-efficacy, self-care management, self-care monitoring, and self-care maintenance were stronger predictors of women's quality of life. Anxiety and depression only predicted men's psychological quality of life, but predicted women's psychological, social relationships, and environmental quality of life. CONCLUSIONS The findings contribute to literature highlighting sex-based differences in anxiety, depression, and quality of life among South Asian men and women with COPD. Men generally reported higher levels of quality of life than women across all domains. Women's social relationships and environmental quality of life were greatly impacted by anxiety and depression. Quality of life interventions for women should be targeted at improving their social relationships and environmental satisfaction and addressing anxiety and depression.
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Affiliation(s)
- Ahtisham Younas
- Memorial University of Newfoundland, Canada; Swat College of Nursing, Swat, Pakistan.
| | - Hussan Zeb
- Swat College of Nursing, Swat, Pakistan; Tor Vergata University of Rome, Italy
| | - Angela Durante
- Health Science Interdisciplinary Center, Scuola Superiore Sant'Anna, Pisa, Italy; Health Science Interdisciplinary Center, Scuola Superiore Sant'Anna, Pisa, Italy
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Zysman M, Coquelin A, Le Guen N, Solomiac A, Guecamburu M, Erbault M, Blanchard E, Roche N, Morin S. Prevalence and disparities in influenza vaccination among patients with COPD: A French nationwide population study. Respir Med 2024; 226:107606. [PMID: 38522592 DOI: 10.1016/j.rmed.2024.107606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 03/15/2024] [Accepted: 03/17/2024] [Indexed: 03/26/2024]
Abstract
INTRODUCTION Despite concordant international recommendations, many surveys found disappointing rates of influenza vaccination in at-risk populations, ranging from 23% in overall COPD population to more than 70% in more severe COPD subjects. Therefore, we assessed the proportion of French COPD patients non-vaccinated for influenza and their clinical and socio-demographic factors. MATERIEL AND METHODS This was a national retrospective study based on the French health insurance database. We identified "diagnosed COPD", defined as subjects hospitalized at least once in 2017 with a principal or associated diagnosis of COPD, and "suspected COPD" as those who were prescribed at least thrice long-acting bronchodilators (LAB), after exclusion of patients with a principal diagnosis or secondary associated diagnosis of asthma or cystic fibrosis, patients deceased before the influenza season and patients hospitalized in long-term or in palliative care unit. Multivariate logistic regression was used to assess the association between patients' characteristics and the lack of influenza vaccination. RESULTS From the national database, 1 474 396 subjects were identified as "suspected COPD" of whom 528 114 were excluded because of previous diagnosis of asthma or cystic fibrosis, and 350 566 as "diagnosed COPD". Among the 1 296 848 patients included, 646 687 patients (53.3%) were vaccinated against influenza. Non-vaccinated subjects were significantly younger (62.1 vs 71.6 years old), more often women (47.9% vs 43.1%) and had fewer comorbidities assessed by Charlson's index (3.0 ± 2.2 vs 4.3 ± 2.1). Lack of vaccination was also associated with a lower LAB usage. Also, non-vaccinated subjects neither had severe exacerbation during the study period. Besides there was a significant heterogeneity in vaccination rate by geographic region, from 47% to 57%. In multivariate analysis, variables independently associated with the lack of influenza vaccination were female gender, younger age, fewer comorbidities and lower socio-economic level. CONCLUSIONS This study using the French exhaustive health insurance database shows that influenza vaccination among COPD patients remains dramatically low and must become a high-priority public-health strategy.
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Affiliation(s)
- Maéva Zysman
- Service des Maladies Respiratoires et des épreuves fonctionnelles respiratoires CHU Bordeaux, 33604, Pessac, France; Univ-Bordeaux, Centre de Recherche cardio-thoracique de Bordeaux, U1045, CIC 1401, F-33604, Pessac, France.
| | - Anaëlle Coquelin
- Haute autorité de la santé, 93210, La Plaine Saint-Denis, France
| | - Nelly Le Guen
- Haute autorité de la santé, 93210, La Plaine Saint-Denis, France
| | - Agnès Solomiac
- Haute autorité de la santé, 93210, La Plaine Saint-Denis, France
| | - Marina Guecamburu
- Service des Maladies Respiratoires et des épreuves fonctionnelles respiratoires CHU Bordeaux, 33604, Pessac, France
| | - Marie Erbault
- Haute autorité de la santé, 93210, La Plaine Saint-Denis, France
| | - Elodie Blanchard
- Service des Maladies Respiratoires et des épreuves fonctionnelles respiratoires CHU Bordeaux, 33604, Pessac, France; Univ-Bordeaux, Centre de Recherche cardio-thoracique de Bordeaux, U1045, CIC 1401, F-33604, Pessac, France
| | - Nicolas Roche
- Service de Pneumologie, Hôpital et Institut Cochin (INSERM UMR 1016), APHP, Université de Paris, Paris, France
| | - Sandrine Morin
- Haute autorité de la santé, 93210, La Plaine Saint-Denis, France
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Williams PJ, Buttery SC, Laverty AA, Hopkinson NS. Lung Disease and Social Justice: Chronic Obstructive Pulmonary Disease as a Manifestation of Structural Violence. Am J Respir Crit Care Med 2024; 209:938-946. [PMID: 38300144 DOI: 10.1164/rccm.202309-1650ci] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 02/01/2024] [Indexed: 02/02/2024] Open
Abstract
Lung health, the development of lung disease, and how well a person with lung disease is able to live all depend on a wide range of societal factors. These systemic factors that adversely affect people and cause injustice can be thought of as "structural violence." To make the causal processes relating to chronic obstructive pulmonary disease (COPD) more apparent, and the responsibility to interrupt or alleviate them clearer, we have developed a taxonomy to describe this. It contains five domains: 1) avoidable lung harms (processes impacting lung development, processes that disadvantage lung health in particular groups across the life course), 2) diagnostic delay (healthcare factors; norms and attitudes that mean COPD is not diagnosed in a timely way, denying people with COPD effective treatment), 3) inadequate COPD care (ways in which the provision of care for people with COPD falls short of what is needed to ensure they are able to enjoy the best possible health, considered as healthcare resource allocation and norms and attitudes influencing clinical practice), 4) low status of COPD (ways COPD as a condition and people with COPD are held in less regard and considered less of a priority than other comparable health problems), and 5) lack of support (factors that make living with COPD more difficult than it should be, i.e., socioenvironmental factors and factors that promote social isolation). This model has relevance for policymakers, healthcare professionals, and the public as an educational resource to change clinical practices and priorities and stimulate advocacy and activism with the goal of the elimination of COPD.
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Affiliation(s)
| | | | - Anthony A Laverty
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, United Kingdom
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Ekdahl A, Söderberg S, Holmström Rising M. Striving for moments of easier breathing despite being trapped in breathlessness: meanings of feeling well for women with chronic obstructive pulmonary disease stage III or IV. Int J Qual Stud Health Well-being 2023; 18:2225937. [PMID: 37331013 DOI: 10.1080/17482631.2023.2225937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 06/12/2023] [Indexed: 06/20/2023] Open
Abstract
BACKGROUND Living with chronic obstructive pulmonary disease stage III or IV means living an everyday life, severely restricted by breathlessness. AIM The aim of this study was to elucidate meanings of feeling well for women with chronic obstructive pulmonary disease stage III or IV. METHOD The study has used a phenomenological hermeneutical design. Individual narrative interviews were conducted with 14 women with chronic obstructive pulmonary disease at stages III or IV. RESULTS The results revealed one theme: striving for moments of easier breathing despite being trapped in breathlessness with four subthemes: acting in rhythm with breathing, taking care of oneself, taking advantage of better moments, and being in togetherness in everyday life. CONCLUSION This study shows that women with chronic obstructive pulmonary disease at stages III or IV strived for moments of feeling well despite living with a severe illness. Feeling well meant that when connected to nature, they felt alive, free, and less trapped in breathlessness, which provided a sense of being unconscious of their breathing rhythm. They could do what healthy people tend to take for granted during everyday life. To feel well, the women found it important to receive tailored support from their close relatives.
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Affiliation(s)
- Ann Ekdahl
- Department of Health Sciences Mid Sweden University, Sundsvall, Sweden
| | - Siv Söderberg
- Department of Health Sciences Mid Sweden University, Sundsvall, Sweden
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Zhu W, Han L, Wu Y, Tong L, He L, Wang Q, Yan Y, Pan T, Shen J, Song Y, Shen Y, Zhu Q, Zhou J. Keratin 15 protects against cigarette smoke-induced epithelial mesenchymal transformation by MMP-9. Respir Res 2023; 24:297. [PMID: 38007424 PMCID: PMC10675954 DOI: 10.1186/s12931-023-02598-w] [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] [Received: 05/04/2023] [Accepted: 11/07/2023] [Indexed: 11/27/2023] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD), a chronic inflammatory lung disease, is a leading cause of morbidity and mortality worldwide. Prolonged cigarette smoking (CS) that causes irreversible airway remodeling and significantly reduces lung function is a major risk factor for COPD. Keratin15+ (Krt15+) cells with the potential of self-renewal and differentiation properties have been implicated in the maintenance, proliferation, and differentiation of airway basal cells; however, the role of Krt15 in COPD is not clear. METHODS Krt15 knockout (Krt15-/-) and wild-type (WT) mice of C57BL/6 background were exposed to CS for six months to establish COPD models. Krt15-CrePGR;Rosa26-LSL-tdTomato mice were used to trace the fate of the Krt15+ cells. Hematoxylin and eosin (H&E) and Masson stainings were performed to assess histopathology and fibrosis, respectively. Furthermore, lentivirus-delivered short hairpin RNA (shRNA) was used to knock down KRT15 in human bronchial epithelial (HBE) cells stimulated with cigarette smoke extract (CSE). The protein expression was assessed using western blot, immunohistochemistry, and enzyme-linked immunosorbent assay. RESULTS Krt15-/- CS mice developed severe inflammatory cell infiltration, airway remodeling, and emphysema. Moreover, Krt15 knockout aggravated CS-induced secretion of matrix metalloproteinase-9 (MMP-9) and epithelial-mesenchymal transformation (EMT), which was reversed by SB-3CT, an MMP-9 inhibitor. Consistent with this finding, KRT15 knockdown promoted MMP-9 expression and EMT progression in vitro. Furthermore, Krt15+ cells gradually increased in the bronchial epithelial cells and were transformed into alveolar type II (AT2) cells. CONCLUSION Krt15 regulates the EMT process by promoting MMP-9 expression and protects the lung tissue from CS-induced injury, inflammatory infiltration, and apoptosis. Furthermore, Krt15+ cells transformed into AT2 cells to protect alveoli. These results suggest Krt15 as a potential therapeutic target for COPD.
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Affiliation(s)
- Wensi Zhu
- Department of Pulmonary and Critical Care Medicine, Shanghai Respiratory Research Institute, Zhongshan Hospital, Fudan University, 180 Fenglin Rd, Shanghai, 200032, China
- Shanghai Engineering Research Center of Internet of Things for Respiratory Medicine, 180 Fenglin Road, Shanghai, 200032, China
- Shanghai Key Laboratory of Lung Inflammation and Injury, 180 Fenglin Road, Shanghai, 200032, China
| | - Linxiao Han
- Department of Pulmonary and Critical Care Medicine, Shanghai Respiratory Research Institute, Zhongshan Hospital, Fudan University, 180 Fenglin Rd, Shanghai, 200032, China
- Shanghai Engineering Research Center of Internet of Things for Respiratory Medicine, 180 Fenglin Road, Shanghai, 200032, China
- Shanghai Key Laboratory of Lung Inflammation and Injury, 180 Fenglin Road, Shanghai, 200032, China
| | - Yuanyuan Wu
- Department of Pulmonary and Critical Care Medicine, Shanghai Respiratory Research Institute, Zhongshan Hospital, Fudan University, 180 Fenglin Rd, Shanghai, 200032, China
- Shanghai Engineering Research Center of Internet of Things for Respiratory Medicine, 180 Fenglin Road, Shanghai, 200032, China
- Shanghai Key Laboratory of Lung Inflammation and Injury, 180 Fenglin Road, Shanghai, 200032, China
| | - Lin Tong
- Department of Pulmonary and Critical Care Medicine, Shanghai Respiratory Research Institute, Zhongshan Hospital, Fudan University, 180 Fenglin Rd, Shanghai, 200032, China
- Shanghai Engineering Research Center of Internet of Things for Respiratory Medicine, 180 Fenglin Road, Shanghai, 200032, China
- Shanghai Key Laboratory of Lung Inflammation and Injury, 180 Fenglin Road, Shanghai, 200032, China
| | - Ludan He
- Shanghai Institute of Infectious Disease and Biosecurity, Fudan University, Shanghai, 200032, China
- Shanghai Engineering Research Center of Internet of Things for Respiratory Medicine, 180 Fenglin Road, Shanghai, 200032, China
- Shanghai Key Laboratory of Lung Inflammation and Injury, 180 Fenglin Road, Shanghai, 200032, China
| | - Qin Wang
- Department of Pulmonary and Critical Care Medicine, Shanghai Respiratory Research Institute, Zhongshan Hospital, Fudan University, 180 Fenglin Rd, Shanghai, 200032, China
- Shanghai Engineering Research Center of Internet of Things for Respiratory Medicine, 180 Fenglin Road, Shanghai, 200032, China
- Shanghai Key Laboratory of Lung Inflammation and Injury, 180 Fenglin Road, Shanghai, 200032, China
| | - Yu Yan
- Department of Pulmonary and Critical Care Medicine, Shanghai Respiratory Research Institute, Zhongshan Hospital, Fudan University, 180 Fenglin Rd, Shanghai, 200032, China
- Shanghai Engineering Research Center of Internet of Things for Respiratory Medicine, 180 Fenglin Road, Shanghai, 200032, China
- Shanghai Key Laboratory of Lung Inflammation and Injury, 180 Fenglin Road, Shanghai, 200032, China
| | - Ting Pan
- Department of Pulmonary and Critical Care Medicine, Shanghai Respiratory Research Institute, Zhongshan Hospital, Fudan University, 180 Fenglin Rd, Shanghai, 200032, China
- Shanghai Engineering Research Center of Internet of Things for Respiratory Medicine, 180 Fenglin Road, Shanghai, 200032, China
- Shanghai Key Laboratory of Lung Inflammation and Injury, 180 Fenglin Road, Shanghai, 200032, China
| | - Jie Shen
- Research Center for Chemical Injury, Emergency and Critical Medicine of Fudan University, Fudan University, Shanghai, 200540, China
- Center of Emergency and Critical Medicine in Jinshan Hospital of Fudan University, Fudan University, Shanghai, 200540, China
- Key Laboratory of Chemical Injury, Emergency and Critical Medicine of Shanghai Municipal Health Commission, Shanghai, 200540, China
| | - Yuanlin Song
- Shanghai Institute of Infectious Disease and Biosecurity, Fudan University, Shanghai, 200032, China
- Shanghai Key Laboratory of Lung Inflammation and Injury, 180 Fenglin Road, Shanghai, 200032, China
| | - Yao Shen
- Department of Respiratory and Critical Care Medicine, Shanghai Pudong Hospital, 2800 Gongwei Rd, Shanghai, 201399, China.
| | - Qiaoliang Zhu
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.
| | - Jian Zhou
- Department of Pulmonary and Critical Care Medicine, Shanghai Respiratory Research Institute, Zhongshan Hospital, Fudan University, 180 Fenglin Rd, Shanghai, 200032, China.
- Shanghai Engineering Research Center of Internet of Things for Respiratory Medicine, 180 Fenglin Road, Shanghai, 200032, China.
- Shanghai Key Laboratory of Lung Inflammation and Injury, 180 Fenglin Road, Shanghai, 200032, China.
- Research Center for Chemical Injury, Emergency and Critical Medicine of Fudan University, Fudan University, Shanghai, 200540, China.
- Center of Emergency and Critical Medicine in Jinshan Hospital of Fudan University, Fudan University, Shanghai, 200540, China.
- Key Laboratory of Chemical Injury, Emergency and Critical Medicine of Shanghai Municipal Health Commission, Shanghai, 200540, China.
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Guecamburu M, Coquelin A, Rapin A, Le Guen N, Solomiac A, Henrot P, Erbault M, Morin S, Zysman M. Pulmonary rehabilitation after severe exacerbation of COPD: a nationwide population study. Respir Res 2023; 24:102. [PMID: 37029390 PMCID: PMC10082500 DOI: 10.1186/s12931-023-02393-7] [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: 10/26/2022] [Accepted: 03/09/2023] [Indexed: 04/09/2023] Open
Abstract
BACKGROUND Acute exacerbations of chronic obstructive pulmonary disease (COPD) lead to a significant reduction in quality of life and an increased mortality risk. Current guidelines strongly recommend pulmonary rehabilitation (PR) after a severe exacerbation. Studies reporting referral for PR are scarce, with no report to date in Europe. Therefore, we assessed the proportion of French patients receiving PR after hospitalization for COPD exacerbation and factors associated with referral. METHODS This was a national retrospective study based on the French health insurance database. Patients hospitalized in 2017 with COPD exacerbation were identified from the exhaustive French medico-administrative database of hospitalizations. In France, referral to PR has required as a stay in a specialized PR center or unit accredited to provide multidisciplinary care (exercise training, education, etc.) and admission within 90 days after discharge was assessed. Multivariate logistic regression was used to assess the association between patients' characteristics, comorbidities according to the Charlson index, treatment, and PR uptake. RESULTS Among 48,638 patients aged ≥ 40 years admitted for a COPD exacerbation, 4,182 (8.6%) received PR within 90 days after discharge. General practitioner's (GP) density (number of GPs for the population at regional level) and PR center facilities (number of beds for the population at regional level) were significantly correlated with PR uptake (respectively r = 0.64 and r = 0.71). In multivariate analysis, variables independently associated with PR uptake were female gender (aOR 1.36 [1.28-1.45], p < 0.0001), age (p < 0.0001), comorbidities (p = 0.0013), use of non-invasive ventilation and/or oxygen therapy (aOR 1.52 [1.41-1.64], p < 0.0001) and administration of long-acting bronchodilators (p = 0.0038). CONCLUSION This study using the French nationally exhaustive health insurance database shows that PR uptake after a severe COPD exacerbation is dramatically low and must become a high-priority management strategy.
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Affiliation(s)
- Marina Guecamburu
- Service des Maladies Respiratoires et des épreuves fonctionnelles respiratoires CHU Bordeaux, 33604, Pessac, France
| | - Anaëlle Coquelin
- Haute Autorité de la Santé, 93210, La Plaine Saint-Denis, France
| | - Amandine Rapin
- Département de Médecine Physique et de Réadaptation, Centre Hospitalo-Universitaire de Reims, CHU Reims, Hôpital Sébastopol, 51092, Reims, France
- Faculté de Médecine, Université de Reims Champagne-Ardenne, VieFra, EA3797, 51097, Reims, France
| | - Nelly Le Guen
- Haute Autorité de la Santé, 93210, La Plaine Saint-Denis, France
| | - Agnès Solomiac
- Haute Autorité de la Santé, 93210, La Plaine Saint-Denis, France
| | - Pauline Henrot
- Service des Maladies Respiratoires et des épreuves fonctionnelles respiratoires CHU Bordeaux, 33604, Pessac, France
- Faculté de Médecine, Université de Reims Champagne-Ardenne, VieFra, EA3797, 51097, Reims, France
| | - Marie Erbault
- Haute Autorité de la Santé, 93210, La Plaine Saint-Denis, France
| | - Sandrine Morin
- Haute Autorité de la Santé, 93210, La Plaine Saint-Denis, France
| | - Maéva Zysman
- Service des Maladies Respiratoires et des épreuves fonctionnelles respiratoires CHU Bordeaux, 33604, Pessac, France.
- Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, CIC 1401, Univ-Bordeaux, 33604, Pessac, France.
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Martínez-Pérez I, González-Iglesias V, Suárez VR, Fernández-Somoano A. Spatial distribution of unscheduled hospital admissions for chronic obstructive pulmonary disease in the central area of Asturias, Spain. BMC Pulm Med 2023; 23:101. [PMID: 36978049 PMCID: PMC10053433 DOI: 10.1186/s12890-023-02395-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 03/21/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is one of the major causes of mortality worldwide and also reports high morbidity rates and the global burden COPD has continued to rise over the last several decades. The best-known COPD risk factors are tobacco smoke and air pollution, but genetics, age, sex, and socioeconomic status are additional factors. This study aimed to assess the spatial distribution of unscheduled COPD hospital admissions of men and women in the central area of Asturias during 2016-2018 and identify trends, spatial patterns, or clusters in the area. METHODS Unscheduled COPD hospital admissions in the central area of Asturias were registered, geocoded, and grouped by census tracts (CTs), age, and sex. Standardized admission ratio, smoothed relative risk, posterior risk probability, and spatial clusters between relative risks throughout the study area were calculated and mapped. RESULTS The spatial distribution of COPD hospital admissions differed between men and women. For men, high-risk values were located primarily in the northwestern area of the study, whereas for women the cluster pattern was not as clear and high-risk CTs also reached central and southern areas. In both men and women, the north-northwest area included the majority of CTs with high-risk values. CONCLUSIONS The present study showed the existence of a spatial distribution pattern of unscheduled COPD hospital admissions in the central area of Asturias that was more pronounced for men than for women. This study could provide a starting point for generating knowledge about COPD epidemiology in Asturias.
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Affiliation(s)
- Isabel Martínez-Pérez
- Departamento de Medicina, IUOPA-Área de Medicina Preventiva y Salud Pública, Universidad de Oviedo, C/Julián Clavería s/n, Oviedo (Asturias), 33006, Spain
| | - Verónica González-Iglesias
- Departamento de Medicina, IUOPA-Área de Medicina Preventiva y Salud Pública, Universidad de Oviedo, C/Julián Clavería s/n, Oviedo (Asturias), 33006, Spain
| | - Valentín Rodríguez Suárez
- Dirección General de Salud Pública. Consejería de Salud, Principado de Asturias. C/Ciriaco Miguel Vigil, 9, Oviedo, 33006, Spain
| | - Ana Fernández-Somoano
- Departamento de Medicina, IUOPA-Área de Medicina Preventiva y Salud Pública, Universidad de Oviedo, C/Julián Clavería s/n, Oviedo (Asturias), 33006, Spain.
- CIBER Epidemiología y Salud Pública (CIBERESP) - Instituto de Salud Carlos III, Monforte de Lemos Avenue, 3-5, Madrid, 28029, Spain.
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Roma Avenue s/n, Oviedo, Asturias, 33001, Spain.
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Agusti A, Ambrosino N, Blackstock F, Bourbeau J, Casaburi R, Celli B, Crouch R, Negro RD, Dreher M, Garvey C, Gerardi D, Goldstein R, Hanania N, Holland AE, Kaur A, Lareau S, Lindenauer PK, Mannino D, Make B, Maltais F, Marciniuk JD, Meek P, Morgan M, Pepin JL, Reardon JZ, Rochester C, Singh S, Spruit MA, Steiner MC, Troosters T, Vitacca M, Clini E, Jardim J, Nici L, Raskin J, ZuWallack R. COPD: Providing the right treatment for the right patient at the right time. Respir Med 2023; 207:107041. [PMID: 36610384 DOI: 10.1016/j.rmed.2022.107041] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 11/07/2022] [Indexed: 12/14/2022]
Abstract
Chronic Obstructive Pulmonary Disease (COPD) is a common disease associated with significant morbidity and mortality that is both preventable and treatable. However, a major challenge in recognizing, preventing, and treating COPD is understanding its complexity. While COPD has historically been characterized as a disease defined by airflow limitation, we now understand it as a multi-component disease with many clinical phenotypes, systemic manifestations, and associated co-morbidities. Evidence is rapidly emerging in our understanding of the many factors that contribute to the pathogenesis of COPD and the identification of "early" or "pre-COPD" which should provide exciting opportunities for early treatment and disease modification. In addition to breakthroughs in our understanding of the origins of COPD, we are optimizing treatment strategies and delivery of care that are showing impressive benefits in patient-centered outcomes and healthcare utilization. This special issue of Respiratory Medicine, "COPD: Providing the Right Treatment for the Right Patient at the Right Time" is a summary of the proceedings of a conference held in Stresa, Italy in April 2022 that brought together international experts to discuss emerging evidence in COPD and Pulmonary Rehabilitation in honor of a distinguished friend and colleague, Claudio Ferdinando Donor (1948-2021). Claudio was a true pioneer in the field of pulmonary rehabilitation and the comprehensive care of individuals with COPD. He held numerous leadership roles in in the field, provide editorial stewardship of several respiratory journals, authored numerous papers, statement and guidelines in COPD and Pulmonary Rehabilitation, and provided mentorship to many in our field. Claudio's most impressive talent was his ability to organize spectacular conferences and symposia that highlighted cutting edge science and clinical medicine. It is in this spirit that this conference was conceived and planned. These proceedings are divided into 4 sections which highlight crucial areas in the field of COPD: (1) New concepts in COPD pathogenesis; (2) Enhancing outcomes in COPD; (3) Non-pharmacologic management of COPD; and (4) Optimizing delivery of care for COPD. These presentations summarize the newest evidence in the field and capture lively discussion on the exciting future of treating this prevalent and impactful disease. We thank each of the authors for their participation and applaud their efforts toward pushing the envelope in our understanding of COPD and optimizing care for these patients. We believe that this edition is a most fitting tribute to a dear colleague and friend and will prove useful to students, clinicians, and researchers as they continually strive to provide the right treatment for the right patient at the right time. It has been our pleasure and a distinct honor to serve as editors and oversee such wonderful scholarly work.
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Affiliation(s)
- Alvar Agusti
- Clinic Barcelona Hospital University, Barcelona, Spain.
| | | | | | - Jean Bourbeau
- Department of Medicine, Division of Experimental Medicine, McGill University Health Centre, Montreal, QC, CA, USA.
| | | | | | | | - Roberto Dal Negro
- National Centre for Pharmacoeconomics and Pharmacoepidemiology (CESFAR), Verona, Italy.
| | - Michael Dreher
- Clinic of Cardiology, Angiology, Pneumology and Intensive Medicine, University Hospital Aachen, Aachen, 52074, DE, USA.
| | | | | | - Roger Goldstein
- Respiratory Rehabilitation Service, West Park Health Care Centre, Toronto, Ontario, CA, USA.
| | | | - Anne E Holland
- Departments of Physiotherapy and Respiratory Medicine, Alfred Health, Melbourne, Australia; Central Clinical School, Monash University, Melbourne, Australia; Institute for Breathing and Sleep, Melbourne, Australia.
| | - Antarpreet Kaur
- Section of Pulmonary, Critical Care, and Sleep Medicine, Trinity Health of New England, Hartford, CT, USA; University of Colorado School of Nursing, Aurora, CO, USA.
| | - Suzanne Lareau
- University of Colorado School of Nursing, Aurora, CO, USA.
| | - Peter K Lindenauer
- Department of Healthcare Delivery and Population Sciences, University of Massachusetts Chan Medical School - Baystate, Springfield, MA, USA.
| | | | - Barry Make
- National Jewish Health, Denver, CO, USA.
| | - François Maltais
- Institut Universitaire de cardiologie et de pneumologie de Québec, Université Laval, Quebec, CA, USA.
| | - Jeffrey D Marciniuk
- Division of Respirology, Critical Care and Sleep Medicine, Department of Medicine, University of Saskatchewan, Saskatoon, CA, USA.
| | - Paula Meek
- University of Utah College of Nursing, Salt Lake City, UT, USA.
| | - Mike Morgan
- Dept of Respiratory Medicine, University Hospitals of Leicester, UK.
| | - Jean-Louis Pepin
- CHU de Grenoble - Clin Univ. de physiologie, sommeil et exercice, Grenoble, France.
| | - Jane Z Reardon
- Section of Pulmonary, Critical Care, and Sleep Medicine, Trinity Health of New England, Hartford, CT, USA.
| | | | - Sally Singh
- Department of Respiratory Diseases, University of Leicester, UK.
| | | | - Michael C Steiner
- Department of Respiratory Sciences, Leicester NIHR Biomedical Research Centre, Professor, University of Leicester, UK.
| | - Thierry Troosters
- Laboratory of Respiratory Diseases and Thoracic Surgery, KU Leuven: Leuven, Vlaanderen, Belgium.
| | - Michele Vitacca
- Department of Respiratory Rehabilitation, ICS S. Maugeri Care and Research Institutes, IRCCS Pavia, Italy.
| | - Enico Clini
- University of Modena and Reggio Emilia, Italy.
| | - Jose Jardim
- Federal University of Sao Paulo Paulista, Brazil.
| | - Linda Nici
- nBrown University School of Medicine, USA.
| | | | - Richard ZuWallack
- Section of Pulmonary, Critical Care, and Sleep Medicine, Saint Francis Hospital and Medical Center, 114 Woodland Street, Hartford, CT, 06105, USA.
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Beaumont M, Latiers AC, Prieur G. [The role of the physiotherapist in the assessment and management of dyspnea]. Rev Mal Respir 2023; 40:169-187. [PMID: 36682956 DOI: 10.1016/j.rmr.2022.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 12/20/2022] [Indexed: 01/21/2023]
Abstract
The role of the physiotherapist in the assessment and management of dyspnea. Dyspnea is the most common symptom in cardio-respiratory diseases. Recently improved comprehension of dyspnea mechanisms have underlined the need for three-faceted assessment. The three key aspects correspond to the "breathing, thinking, functioning" clinical model, which proposes a multidimensional - respiratory, emotional and functional - approach. Before initiating treatment, it is essential for several reasons to assess each specific case, determining the type of dyspnea affecting the patient, appraising the impact of shortness of breath, and estimating the effectiveness of the treatment applied. The physiotherapist has a major role to assume in the care of dyspneic patients, not only in assessment followed by treatment but also as a major collaborator in a multidisciplinary team, especially with regard to pulmonary rehabilitation. The aim of this review is to inventory the existing assessment tools and the possible physiotherapies for dyspnea, using a holistic approach designed to facilitate the choice of techniques and to improve quality of care by fully addressing the patient's needs.
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Affiliation(s)
- M Beaumont
- Service de réadaptation respiratoire, Centre Hospitalier des Pays de Morlaix, Morlaix, France; Inserm, Univ Brest, CHRU Brest, UMR 1304, GETBO, Brest, France.
| | - A C Latiers
- Service ORL, Stomatologie et Soins Continus, Cliniques universitaires Saint-Luc, 1200 Brussels, Belgique
| | - G Prieur
- Institut de Recherche Expérimentale et Clinique (IREC), Pôle de Pneumologie, ORL & Dermatologie, Groupe de Recherche en Kinésithérapie Respiratoire, Université Catholique de Louvain, 1200 Brussels, Belgique; Université de Normandie, UNIROUEN, EA3830-GRHV, 76000 Rouen, France; Groupe Hospitalier du Havre, Service de pneumologie et de réadaptation respiratoire, avenue Pierre Mendes France, 76290 Montivilliers, France; Institut de Recherche et Innovation en Biomédecine (IRIB), 76000 Rouen, France
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Seidl H, Schunk M, Le L, Syunyaeva Z, Streitwieser S, Berger U, Mansmann U, Szentes BL, Bausewein C, Schwarzkopf L. Cost-Effectiveness of a Specialized Breathlessness Service Versus Usual Care for Patients With Advanced Diseases. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2023; 26:81-90. [PMID: 36182632 DOI: 10.1016/j.jval.2022.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 07/13/2022] [Accepted: 08/05/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVES The Munich Breathlessness Service (MBS) significantly improved control of breathlessness measured by the Chronic Respiratory Questionnaire (CRQ) Mastery in a randomized controlled fast track trial with waitlist group design spanning 8 weeks in Germany. This study aimed to assess the within-trial cost-effectiveness of MBS from a societal perspective. METHODS Data included generic (5-level version of EQ-5D) health-related quality of life and disease-specific CRQ Mastery. Quality-adjusted life years (QALYs) were calculated based on 5-level version of EQ-5D utilities valued with German time trade-off. Direct medical costs and productivity loss were calculated based on standardized unit costs. Incremental cost-effectiveness ratios (ICER) and cost-effectiveness-acceptance curves were calculated using adjusted mean differences (AMD) in costs (gamma-distributed model) and both effect parameters (Gaussian-distributed model) and performing 1000 simultaneous bootstrap replications. Potential gender differences were investigated in stratified analyses. RESULTS Between March 2014 and April 2019, 183 eligible patients were enrolled. MBS intervention demonstrated significantly better effects regarding generic (AMD of QALY gains of 0.004, 95% confidence interval [CI] 0.0003 to 0.008) and disease-specific health-related quality of life at nonsignificantly higher costs (AMD of €605 [95% CI -1109 to 2550]). At the end of the intervention, the ICER was €152 433/QALY (95% CI -453 545 to 1 625 903) and €1548/CRQ Mastery point (95% CI -3093 to 10 168). Intervention costs were on average €357 (SD = 132). Gender-specific analyses displayed dominance for MBS in males and higher effects coupled with significantly higher costs in females. CONCLUSIONS Our results show a high ICER for MBS. Considering dominance for MBS in males, implementing MBS on approval within the German health care system should be considered.
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Affiliation(s)
- Hildegard Seidl
- Health Economics and Health Care Management (IGM) Helmholtz Zentrum München (GmbH) German Research Center for Environmental Health, Munich, Germany; Pettenkofer School of Public Health, Munich, Germany; Quality Management and Gender Medicine, München Klinik gGmbH, Munich, Germany.
| | - Michaela Schunk
- Pettenkofer School of Public Health, Munich, Germany; Department of Palliative Medicine, LMU Hospital, LMU Munich, Munich, Germany
| | - Lien Le
- Institute for Medical Information Processing, Biometry and Epidemiology, Faculty of Medicine, LMU Munich, Munich, Germany
| | - Zulfiya Syunyaeva
- Department of Medicine V, LMU Hospital, LMU Munich, Munich, Germany; Department of Pediatric Pulmonology, Immunology and Critical Care Medicine and Cystic Fibrosis Center, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Sabine Streitwieser
- Department of Palliative Medicine, LMU Hospital, LMU Munich, Munich, Germany
| | - Ursula Berger
- Pettenkofer School of Public Health, Munich, Germany; Institute for Medical Information Processing, Biometry and Epidemiology, Faculty of Medicine, LMU Munich, Munich, Germany
| | - Ulrich Mansmann
- Pettenkofer School of Public Health, Munich, Germany; Institute for Medical Information Processing, Biometry and Epidemiology, Faculty of Medicine, LMU Munich, Munich, Germany
| | - Boglarka Lilla Szentes
- Health Economics and Health Care Management (IGM) Helmholtz Zentrum München (GmbH) German Research Center for Environmental Health, Munich, Germany
| | - Claudia Bausewein
- Department of Palliative Medicine, LMU Hospital, LMU Munich, Munich, Germany
| | - Larissa Schwarzkopf
- Health Economics and Health Care Management (IGM) Helmholtz Zentrum München (GmbH) German Research Center for Environmental Health, Munich, Germany; Pettenkofer School of Public Health, Munich, Germany; IFT-Institut fuer Therapieforschung, Munich, Germany
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12
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Lee K, Lee H, Lee K, Hong S, Shin H, Lee G. Gender differences in pulmonary function, physical activity, and quality of life of patients with COPD based on data from the Korea National Health and Nutrition Examination Survey 2015 to 2019 from the Perspective of Pulmonary Rehabilitation. Medicine (Baltimore) 2022; 101:e31413. [PMID: 36343059 PMCID: PMC9646631 DOI: 10.1097/md.0000000000031413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
The prevalence of chronic obstructive pulmonary disease (COPD) is increasing worldwide, with the fourth highest mortality rate. This study aims to analyze pulmonary function, physical activity, and quality of life (QoL) between genders from the perspective of pulmonary rehabilitation in Korean patients with COPD. This study investigated raw data from the Korea National Health and Nutrition Examination Survey from 2015 to 2019 and included 151 COPD patients (men: 66.55 ± 10.07 years, women: 65.21 ± 11.73) out of 39,759 participants. Pulmonary function, such as forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1), and frequency of physical activities (e.g., physical activity for work and leisure, strengthening exercise, and sitting time a day) and QoL by using EQ-5D-3L, were compared between genders in patients with COPD. Smoking status differed in health-related characteristics between genders (P < .001). In pulmonary function, the FVC (men: 3.48 ± 0.98ℓ, women: 2.53 ± 0.56ℓ, P < .05), FEV1 (men: 2.13 ± 0.93 ℓ, women: 1.88 ± 0.53 ℓ, P < .001), FEV6 (men: 3.16 ± 1.00ℓ, women: 2.46 ± 1.56ℓ, P < .001) and peak expiratory flow (men: 5.61 ± 2.44ℓ/s, women: 4.68 ± 1.53ℓ/s, P < .05) was higher in men, however, predicted FEV1 (men: 66.03% ± 23.13%, women: 79.95% ± 18.45%, P < .05) and predicted FEV1/FVC ratio (men: 59.67% ± 15.02%, women: 74.10% ± 10.49%, P < .001) in women. The frequency of strengthening exercise was higher in men (P < .05). QoL of patients with COPD was not significantly different between genders. To provide correct interventions and pulmonary rehabilitation to patients with COPD, gender differences, including physiological and psychological differences, must be considered.
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Affiliation(s)
- Kyeongbong Lee
- Department of Physical Therapy, Kangwon National University, Samcheok, Republic of Korea
| | - HyoSun Lee
- Department of Physical Therapy, Graduate School of Kyungnam University, Changwon, Republic of Korea
| | - KyungJune Lee
- Department of Broadcasting and Communication Policy, Seoul National University of Science and Technology, Seoul, Republic of Korea
| | - SungKyun Hong
- Department of Physical Therapy, Woosuk University, Wanju, Republic of Korea
| | - HyeonHui Shin
- Department of Occupational Therapy, Dongseo University, Busan, Republic of Korea
| | - GyuChang Lee
- Department of Physical Therapy, Kyungnam University, Changwon, Republic of Korea
- *Correspondence: GyuChang Lee, Department of Physical Therapy, Kyungnam University, 7 Kyungnamdaehak-ro, Masanhappo-gu, Changwon, Gyeongsangnam-do 51767, Republic of Korea (e-mail: )
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13
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Lu Z, Coll P, Maitre B, Epaud R, Lanone S. Air pollution as an early determinant of COPD. Eur Respir Rev 2022; 31:31/165/220059. [PMID: 35948393 DOI: 10.1183/16000617.0059-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 06/09/2022] [Indexed: 11/05/2022] Open
Abstract
COPD is a progressive and debilitating disease often diagnosed after 50 years of age, but more recent evidence suggests that its onset could originate very early on in life. In this context, exposure to air pollution appears to be a potential contributor. Although the potential role of air pollution as an early determinant of COPD is emerging, knowledge gaps still remain, including an accurate qualification of air pollutants (number of pollutants quantified and exact composition) or the "one exposure-one disease" concept, which might limit the current understanding. To fill these gaps, improvements in the field are needed, such as the use of atmosphere simulation chambers able to realistically reproduce the complexity of air pollution, consideration of the exposome, as well as improving exchanges between paediatricians and adult lung specialists to take advantage of reciprocal expertise. This review should lead to a better understanding of the current knowledge on air pollution as an early determinant of COPD, as well as identify the existing knowledge gaps and opportunities to fill them. Hopefully, this will lead to better prevention strategies to scale down the development of COPD in future generations.
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Affiliation(s)
- Zhuyi Lu
- Univ Paris Est Creteil, INSERM, IMRB, Creteil, France
| | - Patrice Coll
- Université Paris Cité and Univ Paris Est Créteil, CNRS, LISA, Paris, France
| | - Bernard Maitre
- Univ Paris Est Creteil, INSERM, IMRB, Creteil, France.,Dept of Pneumology, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Ralph Epaud
- Univ Paris Est Creteil, INSERM, IMRB, Creteil, France.,Dept of General Pediatrics, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Sophie Lanone
- Univ Paris Est Creteil, INSERM, IMRB, Creteil, France
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Sav A, Thomas ST, Cardona M, Michaleff ZA, Dobler CC. Treatment Burden Discussion in Clinical Encounters: Priorities of COPD Patients, Carers and Physicians. Int J Chron Obstruct Pulmon Dis 2022; 17:1929-1942. [PMID: 36039166 PMCID: PMC9419722 DOI: 10.2147/copd.s366412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 07/21/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Many people with chronic obstructive pulmonary disease (COPD) feel overburdened with the treatment and management of their illness. Although research has begun to shed light on how COPD patients experience treatment burden, most of what we know is limited to personal experiences of patients. The aim of this study is to identify and prioritise areas of treatment burden that should be discussed during the clinical encounter from the perspectives of COPD patients, carers, and respiratory physicians. Patients and Methods Data were collected from participants using the nominal group technique. Five nominal group sessions were conducted in total (n = 31); three sessions with patients (n = 18), one with carers (n = 7) and another with respiratory physicians (pulmonologists or chest physicians) (n = 6). Each session was recorded and analyzed using thematic analysis. Results Going beyond understanding patients’ and carers’ experiences of treatment burden, this study offers a practical viewpoint of what should be discussed in a clinical encounter. Each group of participants contextualized treatment burden issues for discussion from their own perspectives. There was strong agreement, however, across the groups that difficulties accessing healthcare, lack of education and information, and worry about COPD treatment and prognosis were the most important treatment burden priorities for discussion. Conclusion Understanding and creating opportunities to discuss these issues in a clinical encounter is important in not only reducing treatment burden but also improving health outcomes and quality of life for COPD patients and their carers.
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Affiliation(s)
- Adem Sav
- School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Sarah T Thomas
- Gold Coast University Hospital, Southport, Queensland, Australia
| | - Magnolia Cardona
- Evidence-Based Practice Professorial Unit, Gold Coast Hospital, Southport, Queensland, Australia.,Institute for Evidence Based Healthcare, Bond University, Gold Coast, Queensland, Australia
| | - Zoe A Michaleff
- Institute for Evidence Based Healthcare, Bond University, Gold Coast, Queensland, Australia.,Northern NSW Local Health District, Lismore, New South Wales, Australia
| | - Claudia C Dobler
- Evidence-Based Practice Professorial Unit, Gold Coast Hospital, Southport, Queensland, Australia.,Institute for Evidence Based Healthcare, Bond University, Gold Coast, Queensland, Australia.,The George Institute for Global Health, University of New South Wales, Kensington, New South Wales, Australia
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Skou ST, Mair FS, Fortin M, Guthrie B, Nunes BP, Miranda JJ, Boyd CM, Pati S, Mtenga S, Smith SM. Multimorbidity. Nat Rev Dis Primers 2022; 8:48. [PMID: 35835758 PMCID: PMC7613517 DOI: 10.1038/s41572-022-00376-4] [Citation(s) in RCA: 262] [Impact Index Per Article: 131.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/08/2022] [Indexed: 02/06/2023]
Abstract
Multimorbidity (two or more coexisting conditions in an individual) is a growing global challenge with substantial effects on individuals, carers and society. Multimorbidity occurs a decade earlier in socioeconomically deprived communities and is associated with premature death, poorer function and quality of life and increased health-care utilization. Mechanisms underlying the development of multimorbidity are complex, interrelated and multilevel, but are related to ageing and underlying biological mechanisms and broader determinants of health such as socioeconomic deprivation. Little is known about prevention of multimorbidity, but focusing on psychosocial and behavioural factors, particularly population level interventions and structural changes, is likely to be beneficial. Most clinical practice guidelines and health-care training and delivery focus on single diseases, leading to care that is sometimes inadequate and potentially harmful. Multimorbidity requires person-centred care, prioritizing what matters most to the individual and the individual's carers, ensuring care that is effectively coordinated and minimally disruptive, and aligns with the patient's values. Interventions are likely to be complex and multifaceted. Although an increasing number of studies have examined multimorbidity interventions, there is still limited evidence to support any approach. Greater investment in multimorbidity research and training along with reconfiguration of health care supporting the management of multimorbidity is urgently needed.
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Affiliation(s)
- Søren T Skou
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Slagelse, Denmark.
| | - Frances S Mair
- Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Martin Fortin
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Quebec, Canada
| | - Bruce Guthrie
- Advanced Care Research Centre, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Bruno P Nunes
- Postgraduate Program in Nursing, Faculty of Nursing, Universidade Federal de Pelotas, Pelotas, Brazil
| | - J Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
- The George Institute for Global Health, UNSW, Sydney, New South Wales, Australia
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Cynthia M Boyd
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Epidemiology and Health Policy & Management, Johns Hopkins University, Baltimore, MD, USA
| | - Sanghamitra Pati
- ICMR Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | - Sally Mtenga
- Department of Health System Impact Evaluation and Policy, Ifakara Health Institute (IHI), Dar Es Salaam, Tanzania
| | - Susan M Smith
- Discipline of Public Health and Primary Care, Institute of Population Health, Trinity College Dublin, Russell Building, Tallaght Cross, Dublin, Ireland
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Williams PJ, Cumella A, Philip KEJ, Laverty AA, Hopkinson NS. Smoking and socioeconomic factors linked to acute exacerbations of COPD: analysis from an Asthma + Lung UK survey. BMJ Open Respir Res 2022; 9:9/1/e001290. [PMID: 35853736 PMCID: PMC9315910 DOI: 10.1136/bmjresp-2022-001290] [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: 04/29/2022] [Accepted: 06/27/2022] [Indexed: 11/25/2022] Open
Abstract
Background Understanding the factors driving acute exacerbations of chronic obstructive pulmonary disease (COPD) is key to reducing their impact on human health and well-being. Methods 5997 people with COPD, mean 66 years, 64% female, completed an online survey between December 2020 and May 2021 about living with COPD, developed by the charity Asthma + Lung UK. Results The 3731 (62.2%) survey participants reporting frequent (≥2/year) exacerbations were more likely to smoke (adjusted OR (AOR) 1.70, 95% CI 1.470 to 1.98), have lower annual household income (≤£20 000 (AOR 1.72, 95% CI 1.36 to 2.17), live in a cold and damp home (AOR 1.78, 95% CI 1.50 to 2.11) and report previous occupational exposure to dust, fumes and chemicals. Smokers were more likely to report attending hospital to manage their most recent acute exacerbation of COPD compared with ex-smokers (AOR 1.25, 95% CI 0.99 to 1.59). Discussion Strategies to improve COPD outcomes must address issues of deprivation and social justice.
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Affiliation(s)
- Parris J Williams
- National Heart and Lung Institute, Imperial College London, London, UK
| | | | | | - Anthony A Laverty
- Department Primary Care and Public Health, Imperial College London School of Public Health, London, UK
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Troianova N, Mariotti B, Micheletti V, Calzetti F, Donini M, Salvagno G, Ferrari M, Crisafulli E, Bazzoni F. Impact of Sex on Circulating Leukocytes Composition in COPD Patients. Int J Chron Obstruct Pulmon Dis 2022; 16:3539-3550. [PMID: 34992361 PMCID: PMC8715798 DOI: 10.2147/copd.s341623] [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: 10/01/2021] [Accepted: 12/06/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose Chronic obstructive pulmonary disease is characterized by chronic inflammatory response both at the lung site and at the systemic level. Abnormalities in circulating leukocytes have been reported to occur in COPD patients and have been often shown to correlate with the decline in lung function. COPD affects men and women at a virtually comparable rate, even though distinct sex specific symptoms, progression and therapeutic implications have been described. Nonetheless, these sex-associated differences have not been analyzed in terms of circulating leukocytes. To assess the impact of sex on the changes of circulating immune cells in COPD patients. Patients and Methods Blood samples were collected from 50 COPD patients (31 males, 19 females) and 63 age and sex-matched controls (35 males, 28 females) enrolled in this pilot study. Complete blood cell count and multi-parametric flow cytometry analysis were performed to characterize the leukocyte populations and subsets. Results Male COPD patients are distinguished from controls by a significant increase in white blood cell counts, neutrophil total and differential counts, and neutrophil-to-lymphocyte ratio. Conversely, a generalized leukocyte decrease discriminated female COPD patients from the related controls. The impact of sex is further remarked by a decrease in adaptive immune cell subpopulations in males as opposed to a consistent increase of innate immune cell types in females correlating with disease severity. Conclusion These data indicate that the definition of specific changes of circulating leukocytes to be used as reliable biomarkers of the disease severity cannot be accomplished irrespectively of sex.
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Affiliation(s)
- Natalia Troianova
- Department of Medicine, Division of General Pathology, University of Verona, Verona, Italy
| | - Barbara Mariotti
- Department of Medicine, Division of General Pathology, University of Verona, Verona, Italy
| | - Valentina Micheletti
- Department of Medicine, Respiratory Medicine Unit, University of Verona and Verona University Hospital, Verona, Italy.,Department of Medicine, Section of Internal Medicine, University of Verona and Verona University Hospital, Verona, Italy
| | - Federica Calzetti
- Department of Medicine, Division of General Pathology, University of Verona, Verona, Italy
| | - Marta Donini
- Department of Medicine, Division of General Pathology, University of Verona, Verona, Italy
| | - Gianluca Salvagno
- Section of Clinical Biochemistry, University Hospital of Verona, Verona, Italy.,Service of Laboratory Medicine, Pederzoli Hospital, Peschiera del Garda, Italy
| | - Marcello Ferrari
- Department of Medicine, Respiratory Medicine Unit, University of Verona and Verona University Hospital, Verona, Italy.,Department of Medicine, Section of Internal Medicine, University of Verona and Verona University Hospital, Verona, Italy
| | - Ernesto Crisafulli
- Department of Medicine, Respiratory Medicine Unit, University of Verona and Verona University Hospital, Verona, Italy.,Department of Medicine, Section of Internal Medicine, University of Verona and Verona University Hospital, Verona, Italy
| | - Flavia Bazzoni
- Department of Medicine, Division of General Pathology, University of Verona, Verona, Italy
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Ramírez-Venegas A, Montiel-Lopez F, Falfan-Valencia R, Pérez-Rubio G, Sansores RH. The "Slow Horse Racing Effect" on Lung Function in Adult Life in Chronic Obstructive Pulmonary Disease Associated to Biomass Exposure. Front Med (Lausanne) 2021; 8:700836. [PMID: 34307427 PMCID: PMC8295605 DOI: 10.3389/fmed.2021.700836] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 06/15/2021] [Indexed: 01/31/2023] Open
Abstract
Although different trajectories in lung function decline have been identified in patients with COPD associated to tobacco exposure (TE-COPD), genetic, environmental, and infectious factors affecting lung function throughout life have not been fully elucidated in patients with COPD associated to biomass (BE-COPD). In this review, we present current epidemiological findings and notable advances in the natural history of lung decline in BE-COPD, as well as conditions modeling the FEV1 trajectory, such as health insults, during the first years of childhood. Evidence shows that women exposed to biomass smoke reach adult life with a lower FEV1 than expected. However, in contrast to the “horse racing effect” predicting an excessive lung-function decline in forthcoming years, as observed in smokers, this decline is slower in non-smokers, and no rapid decliners are observed. Accordingly, BE-COPD might be considered another phenotype of COPD based on assessments of lung function decline. Likewise, other functional and clinical aspects described in this review suggest that this condition might be similar to TE-COPD. More research is needed to fully characterize this subgroup of variants of COPD.
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Affiliation(s)
- Alejandra Ramírez-Venegas
- Department of Tobacco Smoking and COPD Research, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
| | - Francisco Montiel-Lopez
- Department of Tobacco Smoking and COPD Research, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
| | - Ramces Falfan-Valencia
- HLA Laboratory, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
| | - Gloria Pérez-Rubio
- HLA Laboratory, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
| | - Raúl H Sansores
- Department of Respiratory Medicine, Medica Sur Clinic and Foundation, Mexico City, Mexico
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Jenkins CR. Epilogue to contemporary perspectives in COPD: New Horizons. Respirology 2021; 26:742-744. [PMID: 34184367 DOI: 10.1111/resp.14105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 06/09/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Christine R Jenkins
- Respiratory Group, The George Institute for Global Health, Sydney, NSW, Australia.,Faculty of Medicine, UNSW Sydney, NSW, Australia.,Concord Clinical School, University of Sydney, Sydney, NSW, Australia
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