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Wen J, Wei C, Giri M, Zhuang R, Shuliang G. Association between serum uric acid/serum creatinine ratios and lung function in the general American population: National Health and Nutrition Examination Survey (NHANES), 2007-2012. BMJ Open Respir Res 2023; 10:10/1/e001513. [PMID: 36882222 PMCID: PMC10008480 DOI: 10.1136/bmjresp-2022-001513] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 02/24/2023] [Indexed: 03/09/2023] Open
Abstract
BACKGROUND Assessment of lung function is essential for the early screening chronic airway diseases (CADs). Nevertheless, it is still not widely used for early diagnosing CADs in epidemiological or primary care settings. Thus, we used data from the US National Health and Nutrition Examination Survey (NHANES) to discuss the relationship between the serum uric acid/serum creatinine (SUA/SCr) ratio and lung function in general adults to gain the role of SUA/SCr in early assessment of lung function abnormalities. METHODS From 2007 to 2012 NHANES, a total of 9569 people were included in our study. Using the regression model, XGBoost algorithm model, generalised linear model and two-piecewise linear regression model, the link between the SUA/SCr ratio and lung function was investigated. RESULTS After correcting for confounding variables, the data revealed that forced vital capacity (FVC) declined by 47.630 and forced expiratory volume in one second (FEV1) decreased by 36.956 for each additional unit of SUA/SCr ratio. However, there was no association between SUA/SCr and FEV1/FVC. In the XGBoost model of FVC, the top five most important were glycohaemoglobin, total bilirubin, SUA/SCr, total cholesterol and aspartate aminotransferase, whereas in FEV1, were glycohaemoglobin, total bilirubin, total cholesterol, SUA/SCr and serum calcium. In addition, we determined the linear and inverse association between SUA/SCr ratio and FVC or FEV1 by constructing a smooth curve. CONCLUSIONS In the general American population, the SUA/SCr ratio is inversely linked with FVC and FEV1, but not with FEV1/FVC, according to our research. Future studies should investigate the impact of SUA/SCr on lung function and identify possible mechanisms of action.
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Affiliation(s)
- Jun Wen
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing Medical University, Chongqing, China
| | - Chengcheng Wei
- Department of Urology, Huazhong University of Science and Technology, Wuhan, China
| | - Mohan Giri
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing Medical University, Chongqing, China
| | - Rongjuan Zhuang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing Medical University, Chongqing, China
| | - Guo Shuliang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing Medical University, Chongqing, China
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2
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Diagnostic differentiation between asthma and COPD in primary care using lung function testing. NPJ Prim Care Respir Med 2022; 32:32. [PMID: 36064807 PMCID: PMC9445018 DOI: 10.1038/s41533-022-00298-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 08/16/2022] [Indexed: 12/02/2022] Open
Abstract
Asthma and COPD are defined as different disease entities, but in practice patients often show features of both diseases making it challenging for primary care clinicians to establish a correct diagnosis. We aimed to establish the added value of spirometry and more advanced lung function measurements to differentiate between asthma and COPD. A cross-sectional study in 10 Dutch general practices was performed. 532 subjects were extensively screened on respiratory symptoms and lung function. Two chest physicians assessed if asthma or COPD was present. Using multivariable logistic regression analysis we assessed the ability of three scenarios (i.e. only patient history; diagnostics available to primary care; diagnostics available only to secondary care) to differentiate between the two conditions. Receiver operator characteristics (ROC) curves and area under the curve (AUC) were calculated for each scenario, with the chest physicians’ assessment as golden standard. Results showed that 84 subjects were diagnosed with asthma, 138 with COPD, and 310 with no chronic respiratory disease. In the scenario including only patient history items, ROC characteristics of the model showed an AUC of 0.84 (95% CI 0.78–0.89) for differentiation between asthma and COPD. When adding diagnostics available to primary care (i.e., pre- and postbronchodilator spirometry) AUC increased to 0.89 (95% CI 0.84–0.93; p = 0.020). When adding more advanced secondary care diagnostic tests AUC remained 0.89 (95% CI 0.85–0.94; p = 0.967). We conclude that primary care clinicians’ ability to differentiate between asthma and COPD is enhanced by spirometry testing. More advanced diagnostic tests used in hospital care settings do not seem to provide a better overall diagnostic differentiation between asthma and COPD in primary care patients.
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Hanibuchi M, Saijo A, Mitsuhashi A, Kajimoto T, Kitagawa T, Nishioka Y. The efficacy of mass screening for chronic obstructive pulmonary disease using screening questionnaires in a medical health check-up population. Respir Investig 2022; 60:815-821. [PMID: 36057534 DOI: 10.1016/j.resinv.2022.07.005] [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: 06/27/2022] [Revised: 07/25/2022] [Accepted: 07/30/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a preventable and treatable disease, highlighting the need for efficient screening strategies to identify patients with COPD. However, there is little evidence regarding the efficacy of mass screening for COPD, and no epidemiological studies on COPD have been conducted in the Shikoku region of Japan. METHODS In this cross-sectional study, we originally investigated the efficacy of mass screening for COPD among community residents in the aforementioned region using two COPD screening questionnaires. RESULTS From July 2018 through January 2019, 688 participants were enrolled. COPD was diagnosed using the Global Initiative for the Chronic Obstructive Lung Disease criteria. Twenty-one patients were newly diagnosed with COPD and 19 (90.5%) had early stages COPD. The prevalence of COPD in this study was 3.1%. The COPD Population Screener (COPD-PS) questionnaire and the International Primary Care Airways Guidelines (IPAG) questionnaire had extremely high negative predictive values in discriminating participants with COPD from those without. The scores of both questionnaires were correlated with spirometric tests and with each other. The COPD-PS questionnaire had significantly better specificity and area under the receiver operating characteristic curve value than the IPAG questionnaire. Moreover, only the COPD-PS questionnaire was identified as an independent factor for predicting COPD diagnosis in the multivariate analysis. CONCLUSIONS Mass screening for COPD using screening questionnaires, particularly the COPD-PS questionnaire, might be useful to identify the early stages of COPD in a medical health check-up population.
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Affiliation(s)
- Masaki Hanibuchi
- Department of Respiratory Medicine, Shikoku Central Hospital of the Mutual aid Association of Public School teachers, 2233 Kawanoe-cho, Shikoku-Chuo, 799-0193, Japan; Department of Community Medicine for Respirology, Hematology, and Metabolism, Graduate School of Biomedical Sciences, Tokushima University, 3-18-15 Kuramoto-cho, Tokushima 770-8503, Japan.
| | - Atsuro Saijo
- Department of Respiratory Medicine, Shikoku Central Hospital of the Mutual aid Association of Public School teachers, 2233 Kawanoe-cho, Shikoku-Chuo, 799-0193, Japan
| | - Atsushi Mitsuhashi
- Department of Respiratory Medicine and Rheumatology, Graduate School of Biomedical Sciences, Tokushima University, 3-18-15 Kuramoto-cho, Tokushima 770-8503, Japan
| | - Tatsuya Kajimoto
- Department of Respiratory Medicine, Shikoku Central Hospital of the Mutual aid Association of Public School teachers, 2233 Kawanoe-cho, Shikoku-Chuo, 799-0193, Japan
| | - Tetsuya Kitagawa
- Department of Cardiovascular Surgery, Shikoku Central Hospital of the Mutual Aid Association of Public School teachers, 2233 Kawanoe-cho, Shikoku-Chuo, 799-0193, Japan
| | - Yasuhiko Nishioka
- Department of Respiratory Medicine and Rheumatology, Graduate School of Biomedical Sciences, Tokushima University, 3-18-15 Kuramoto-cho, Tokushima 770-8503, Japan
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4
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Ahn KM, Lee SY, Lee SH, Kim SS, Park HW. Lung function decline is associated with serum uric acid in Korean health screening individuals. Sci Rep 2021; 11:10183. [PMID: 33986393 PMCID: PMC8119944 DOI: 10.1038/s41598-021-89678-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 04/29/2021] [Indexed: 02/08/2023] Open
Abstract
We performed a retrospective cohort study of 19,237 individuals who underwent at least three health screenings with follow-up periods of over 5 years to find a routinely checked serum marker that predicts lung function decline. Using linear regression models to analyze associations between the rate of decline in the forced expiratory volume in 1 s (FEV1) and the level of 10 serum markers (calcium, phosphorus, uric acid, total cholesterol, total protein, total bilirubin, alkaline phosphatase, aspartate aminotransferase, creatinine, and C-reactive protein) measured at two different times (at the first and third health screenings), we found that an increased uric acid level was significantly associated with an accelerated FEV1 decline (P = 0.0014 and P = 0.037, respectively) and reduced FEV1 predicted % (P = 0.0074 and P = 8.64 × 10–7, respectively) at both visits only in non-smoking individuals. In addition, we confirmed that accelerated forced vital capacity (FVC) and FEV1/FVC ratio declines were observed in non-smoking individuals with increased serum uric acid levels using linear mixed models. The serum uric acid level thus potentially predicts an acceleration in lung function decline in a non-smoking general population.
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Affiliation(s)
- Kyung-Min Ahn
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Suh-Young Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - So-Hee Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.,Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Republic of Korea
| | - Sun-Sin Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea. .,Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Republic of Korea.
| | - Heung-Woo Park
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea. .,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea. .,Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, Republic of Korea.
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5
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Svanes Ø, Bertelsen RJ, Lygre SHL, Carsin AE, Antó JM, Forsberg B, García-García JM, Gullón JA, Heinrich J, Holm M, Kogevinas M, Urrutia I, Leynaert B, Moratalla JM, Le Moual N, Lytras T, Norbäck D, Nowak D, Olivieri M, Pin I, Probst-Hensch N, Schlünssen V, Sigsgaard T, Skorge TD, Villani S, Jarvis D, Zock JP, Svanes C. Cleaning at Home and at Work in Relation to Lung Function Decline and Airway Obstruction. Am J Respir Crit Care Med 2019; 197:1157-1163. [PMID: 29451393 DOI: 10.1164/rccm.201706-1311oc] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Cleaning tasks may imply exposure to chemical agents with potential harmful effects to the respiratory system, and increased risk of asthma and respiratory symptoms among professional cleaners and in persons cleaning at home has been reported. Long-term consequences of cleaning agents on respiratory health are, however, not well described. OBJECTIVES This study aimed to investigate long-term effects of occupational cleaning and cleaning at home on lung function decline and airway obstruction. METHODS The European Community Respiratory Health Survey (ECRHS) investigated a multicenter population-based cohort at three time points over 20 years. A total of 6,235 participants with at least one lung function measurement from 22 study centers, who in ECRHS II responded to questionnaire modules concerning cleaning activities between ECRHS I and ECRHS II, were included. The data were analyzed with mixed linear models adjusting for potential confounders. MEASUREMENTS AND MAIN RESULTS As compared with women not engaged in cleaning (ΔFEV1 = -18.5 ml/yr), FEV1 declined more rapidly in women responsible for cleaning at home (-22.1; P = 0.01) and occupational cleaners (-22.4; P = 0.03). The same was found for decline in FVC (ΔFVC = -8.8 ml/yr; -13.1, P = 0.02; and -15.9, P = 0.002; respectively). Both cleaning sprays and other cleaning agents were associated with accelerated FEV1 decline (-22.0, P = 0.04; and -22.9, P = 0.004; respectively). Cleaning was not significantly associated with lung function decline in men or with FEV1/FVC decline or airway obstruction. CONCLUSIONS Women cleaning at home or working as occupational cleaners had accelerated decline in lung function, suggesting that exposures related to cleaning activities may constitute a risk to long-term respiratory health.
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Affiliation(s)
- Øistein Svanes
- 1 Department of Clinical Science, and.,2 Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway
| | | | - Stein H L Lygre
- 2 Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway
| | - Anne E Carsin
- 3 ISGlobal, Centre for Research in Environmental Epidemiology, Barcelona, Spain.,4 Universitat Pompeu Fabra, Barcelona, Spain.,5 Centro de Investigación Biomédica en Red Epidemiología y Salud Pública, Barcelona, Spain
| | - Josep M Antó
- 3 ISGlobal, Centre for Research in Environmental Epidemiology, Barcelona, Spain
| | - Bertil Forsberg
- 6 Division of Occupational and Environmental Medicine, Umeå University, Umeå, Sweden
| | | | - José A Gullón
- 7 Pneumology Department, University Hospital San Agustín, Avilés, Spain
| | - Joachim Heinrich
- 8 Institute and Outpatient Clinic for Occupational and Environmental Medicine, Clinic Center, Ludwig Maximillian University, Comprehensive Pneumology Centre Munich, German Centre for Lung Research, Muenchen, Germany
| | - Mathias Holm
- 9 Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Manolis Kogevinas
- 3 ISGlobal, Centre for Research in Environmental Epidemiology, Barcelona, Spain
| | - Isabel Urrutia
- 10 Pulmonology Department, Galdakao Hospital, Galdakao, Spain
| | - Bénédicte Leynaert
- 11 Institut National de la Santé et de la Recherche Médicale, U1152, Pathophysiology and Epidemiology of Respiratory Diseases, Paris, France.,12 Unité mixte de recherche 1152, Université Paris Diderot Paris7, Paris, France
| | - Jesús M Moratalla
- 13 Servicio de Numología, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - Nicole Le Moual
- 14 Institut National de la Santé et de la Recherche Médicale, U1168, Aging and Chronic Diseases, Epidemiological and Public Health Approaches, F-94807, Villejuif, France.,15 Université Versailles St-Quentin-en-Yvelines, Unité mixte de recherche-S 1168, Yvelines, France
| | - Theodore Lytras
- 3 ISGlobal, Centre for Research in Environmental Epidemiology, Barcelona, Spain.,16 Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - Dan Norbäck
- 17 Department of Medical Sciences, Occupational and Environmental Medicine, Uppsala University, Uppsala, Sweden
| | - Dennis Nowak
- 8 Institute and Outpatient Clinic for Occupational and Environmental Medicine, Clinic Center, Ludwig Maximillian University, Comprehensive Pneumology Centre Munich, German Centre for Lung Research, Muenchen, Germany
| | | | - Isabelle Pin
- 19 Pneumologie Pédiatrique, Antenne Pédiatrique du Centres d'Investigation Clinique Grenoble, France
| | - Nicole Probst-Hensch
- 20 Swiss Tropical and Public Health Institute, Basel, Switzerland.,21 Department Public Health, University of Basel, Basel, Switzerland
| | - Vivi Schlünssen
- 22 Department of Public Health, Danish Ramazzini Center, Aarhus University, Aarhus, Denmark.,23 National Research Center for the Working Environment, Copenhagen, Denmark
| | - Torben Sigsgaard
- 22 Department of Public Health, Danish Ramazzini Center, Aarhus University, Aarhus, Denmark
| | - Trude D Skorge
- 2 Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway
| | - Simona Villani
- 24 Unit of Biostatistics and Clinical Epidemiology, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy; and
| | - Debbie Jarvis
- 25 National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Jan P Zock
- 3 ISGlobal, Centre for Research in Environmental Epidemiology, Barcelona, Spain
| | - Cecilie Svanes
- 26 Centre for International Health, University of Bergen, Bergen, Norway.,2 Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway
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Abstract
Advanced chronic obstructive pulmonary disease (COPD), is characterized by high morbidity and mortality. Patients with COPD and their families experience a range of stresses and suffering from a variety of sources throughout the disease's progression. COPD is the fourth leading cause of death in the world. It exists as a significant contributor to global morbidity and mortality, and it results in substantial economic and social burden. This review provides some key facts regarding disease burden and encourages clinician to familiarize themselves and use both conventional and palliative approach early in the disease progression for a better quality of life.
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7
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Aaron SD, Boulet LP, Reddel HK, Gershon AS. Underdiagnosis and Overdiagnosis of Asthma. Am J Respir Crit Care Med 2018; 198:1012-1020. [DOI: 10.1164/rccm.201804-0682ci] [Citation(s) in RCA: 134] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Shawn D. Aaron
- The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Louis Philippe Boulet
- Institut de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, Québec, Canada
| | - Helen K. Reddel
- Woolcock Institute of Medical Research, Sydney, Australia; and
| | - Andrea S. Gershon
- Department of Medicine, The University of Toronto, Toronto, Ontario, Canada
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8
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Volpato E, Banfi P, Nicolini A, Pagnini F. A quick relaxation exercise for people with chronic obstructive pulmonary disease: explorative randomized controlled trial. Multidiscip Respir Med 2018; 13:13. [PMID: 29744054 PMCID: PMC5932751 DOI: 10.1186/s40248-018-0124-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 04/04/2018] [Indexed: 11/10/2022] Open
Abstract
Background People with Chronic Obstructive Pulmonary Disease (COPD) suffer from dyspnoea, which may be increased by anxiety. Previous studies suggest that relaxation techniques may have positive effects in pulmonary rehabilitation. The main aim of this study is to explore the clinical impact of a quick, one-session, relaxation training for people with COPD. Methods In this perspective, 38 participants with COPD were recruited and randomly assigned to listen to a relaxing audio or to watch a neutral stimulus, during their routine exams. Participants were assessed for psychological and physiological variables, analysed through non-parametric tests. Results Those who joined the relaxation training showed more positive outcomes about respiratory and cardiac assessments, as well as for state anxiety and positive affections, in comparison with the baseline and the control group. Conclusions Study results suggest that relaxation has a potential to produce improvements in respiratory and cardiac functions, together with a positive emotional effect and a reduction of anxiety. Trial registration ClinicalTrials.gov ID: NCT02698904. Record Registration: February 2016.
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Affiliation(s)
- Eleonora Volpato
- 1Department of Psychology, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 1, Milan, Italy.,IRCCS Santa Maria Nascente, Fondazione Don Carlo Gnocchi, Milan, Italy
| | - Paolo Banfi
- IRCCS Santa Maria Nascente, Fondazione Don Carlo Gnocchi, Milan, Italy
| | - Antonello Nicolini
- Unità di Riabilitazione Respiratoria, ASL 4 Chiavarese, Ospedale di Sestri Levante, Sestri Levante, Italy
| | - Francesco Pagnini
- 1Department of Psychology, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 1, Milan, Italy.,4Department of Psychology, Harvard University, Cambridge, MA USA
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9
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Capozzolo A, Castellana G, Dragonieri S, Carratù P, Liotino V, Vulpi MR, Marra L, Resta E, Intiglietta P, Resta O. Voluntary lung function screening to reveal new COPD cases in southern Italy. Int J Chron Obstruct Pulmon Dis 2017; 12:2035-2042. [PMID: 28744118 PMCID: PMC5513831 DOI: 10.2147/copd.s136357] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background Underdiagnosis of COPD is a relevant issue, and most frequently involves patients at early stages of the disease. Physicians do not routinely recommend smokers to undergo spirometry, unless they are symptomatic. Aims To investigate the effectiveness of voluntary lung function screening in bringing to light patients with previously unknown COPD and to evaluate the relationships among symptoms, smoking status, and airway obstruction. Methods A voluntary screening study for COPD was conducted during two editions of the annual Fiera del Levante (2014 and 2015), an international trade fair in Bari. Subjects were eligible for the study if they fulfilled the following inclusion criteria: age ≥35 years, smoker/ex-smoker ≥5 pack-years (PYs), or at least one chronic respiratory symptom (cough, sputum production, shortness of breath, and wheezing). A free post-β2-agonist spirometry test was performed by trained physicians for each participant using portable spirometers. Post-β2-agonist forced expiratory volume in 1 second (FEV1):forced vital capacity ratio <0.7 was chosen to establish the diagnosis of COPD. Sensitivity, specificity, and negative and positive predictive values (NPVs and PPVs) of symptoms for the presence of obstruction were calculated. Results A total of 1,920 individuals were eligible for the study; 188 subjects (9.8%) met COPD criteria. There was a 10.4% prevalence of COPD in subjects with one or more symptoms who had never smoked or smoked ≤5 PYs. Among COPD patients, prevalence of symptoms increased in the presence of FEV1 <80%. COPD smokers were more symptomatic than smokers without COPD. Sensitivity and specificity in all subjects with one or more symptoms were 87% and 32%, respectively, whereas in smoker subgroups, sensitivity and specificity were 71% and 41% (≥5 PYs) and 74% and 35% (≥10 PYs), respectively. In all subjects, the presence of at least one symptom was associated with a low PPV for COPD of 11%, but a very high NPV (96%). These data did not change if the analysis was limited to smokers. Conclusion Voluntary public lung function screening programs in Italy are effective, and may detect a large number of undiagnosed subjects with COPD in early stages. In our population, COPD symptoms had low specificity and PPV, even considering smokers only.
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Affiliation(s)
- Alberto Capozzolo
- Department of Cardiac, Thoracic, and Vascular Science, Institute of Respiratory Disease, School of Medicine, University of Bari, Bari, Italy
| | - Giorgio Castellana
- Department of Cardiac, Thoracic, and Vascular Science, Institute of Respiratory Disease, School of Medicine, University of Bari, Bari, Italy
| | - Silvano Dragonieri
- Department of Cardiac, Thoracic, and Vascular Science, Institute of Respiratory Disease, School of Medicine, University of Bari, Bari, Italy
| | - Pierluigi Carratù
- Department of Cardiac, Thoracic, and Vascular Science, Institute of Respiratory Disease, School of Medicine, University of Bari, Bari, Italy
| | - Vito Liotino
- Department of Cardiac, Thoracic, and Vascular Science, Institute of Respiratory Disease, School of Medicine, University of Bari, Bari, Italy
| | - Maria Rosaria Vulpi
- Department of Cardiac, Thoracic, and Vascular Science, Institute of Respiratory Disease, School of Medicine, University of Bari, Bari, Italy
| | - Lorenzo Marra
- Department of Cardiac, Thoracic, and Vascular Science, Institute of Respiratory Disease, School of Medicine, University of Bari, Bari, Italy
| | - Emanuela Resta
- Department of Cardiac, Thoracic, and Vascular Science, Institute of Respiratory Disease, School of Medicine, University of Bari, Bari, Italy
| | - Pierluigi Intiglietta
- Department of Cardiac, Thoracic, and Vascular Science, Institute of Respiratory Disease, School of Medicine, University of Bari, Bari, Italy
| | - Onofrio Resta
- Department of Cardiac, Thoracic, and Vascular Science, Institute of Respiratory Disease, School of Medicine, University of Bari, Bari, Italy
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10
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Fukuhara A, Saito J, Sato S, Saito K, Fukuhara N, Tanino Y, Wang X, Rinno K, Suzuki H, Munakata M. The association between risk of airflow limitation and serum uric acid measured at medical health check-ups. Int J Chron Obstruct Pulmon Dis 2017; 12:1213-1219. [PMID: 28458533 PMCID: PMC5402911 DOI: 10.2147/copd.s126249] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The prevalence of COPD and asthma is increasing all over the world; however, their morbidities are thought to be greatly underestimated because of unawareness of patients’ conditions and respiratory symptoms. Spirometry is useful for the early detection of COPD and asthma with airflow limitation (AL), although it is not yet widely used for screening in epidemiological and primary care settings. A simple predictive marker used in combination with spirometry for AL is expected to be established. In medical health check-ups, serum uric acid (s-UA) is measured when screening for gout and has recently been suggested to have an association with several respiratory disorders, including asthma and COPD. However, whether s-UA influences the development of AL remains unclear. Therefore, the aims of this study were to examine the relationship between AL and s-UA and to investigate s-UA as a potential auxiliary marker for predicting AL risk in medical health check-ups. A total of 8,662 subjects aged >40 years were included. They were administered a simple questionnaire and assessed using pulmonary function tests, blood pressure (BP) measurements, and blood samplings. One hundred and fifty-six subjects (1.8%) had AL, just 29% of whom had experienced respiratory symptoms. The subjects with AL had significantly higher s-UA levels compared with never-smoking subjects without AL. Forced expiratory volume in 1 second (FEV1) %predicted showed significant correlations with age, smoking index, body mass index (BMI), mean BP, white blood cells, hemoglobin A1c, s-UA, and high-density lipoprotein cholesterol. In multiple logistic regression analysis, s-UA, in addition to age, smoking index, respiratory symptoms, and BMI, was independently associated with AL. In conclusion, elevated s-UA levels, together with respiratory symptoms, high smoking index, and weight loss, may epidemiologically predict the development of AL risk.
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Affiliation(s)
- Atsuro Fukuhara
- Department of Pulmonary Medicine, School of Medicine, Fukushima Medical University
| | - Junpei Saito
- Department of Pulmonary Medicine, School of Medicine, Fukushima Medical University
| | - Suguru Sato
- Department of Pulmonary Medicine, School of Medicine, Fukushima Medical University
| | - Kazue Saito
- Department of Pulmonary Medicine, School of Medicine, Fukushima Medical University
| | - Naoko Fukuhara
- Department of Pulmonary Medicine, School of Medicine, Fukushima Medical University
| | - Yoshinori Tanino
- Department of Pulmonary Medicine, School of Medicine, Fukushima Medical University
| | - Xintao Wang
- Department of Pulmonary Medicine, School of Medicine, Fukushima Medical University
| | - Katsuaki Rinno
- General Examination Center, Fukushima Preservation Service Association of Health, Fukushima, Japan
| | - Hitoshi Suzuki
- General Examination Center, Fukushima Preservation Service Association of Health, Fukushima, Japan
| | - Mitsuru Munakata
- Department of Pulmonary Medicine, School of Medicine, Fukushima Medical University
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11
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Case finding for COPD in general practice. THE LANCET RESPIRATORY MEDICINE 2016; 4:679-681. [DOI: 10.1016/s2213-2600(16)30181-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 06/20/2016] [Indexed: 11/24/2022]
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12
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Targeted case finding for chronic obstructive pulmonary disease versus routine practice in primary care (TargetCOPD): a cluster-randomised controlled trial. THE LANCET RESPIRATORY MEDICINE 2016; 4:720-730. [PMID: 27444687 DOI: 10.1016/s2213-2600(16)30149-7] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 05/11/2016] [Accepted: 05/24/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND Many individuals with chronic obstructive pulmonary disease (COPD) remain undiagnosed worldwide. Health-care organisations are implementing case-finding programmes without good evidence of which are the most effective and cost-effective approaches. We assessed the effectiveness and cost-effectiveness of two alternative approaches to targeted case finding for COPD compared with routine practice. METHODS In this cluster-randomised controlled trial, participating general practices in the West Midlands, UK, were randomly assigned (1:1), via a computer-generated block randomisation sequence, to either a targeted case-finding group or a routine care group. Eligible patients were ever-smokers aged 40-79 years without a previously recorded diagnosis of COPD. Patients in the targeted case-finding group were further randomly assigned (1:1) via their household to receive either a screening questionnaire at the general practitioner (GP) consultation (opportunistic) or a screening questionnaire at the GP consultation plus a mailed questionnaire (active). Respondents reporting relevant respiratory symptoms were invited for post-bronchodilator spirometry. Patients, clinicians, and investigators were not masked to allocation, but group allocation was concealed from the researchers who performed the spirometry assessments. Primary outcomes were the percentage of the eligible population diagnosed with COPD within 1 year (defined as post-bronchodilator forced expiratory volume in 1 s [FEV1] to forced vital capacity [FVC] ratio <0·7 in patients with symptoms or a new diagnosis on their GP record) and cost per new COPD diagnosis. Multiple logistic and Poisson regression were used to estimate effect sizes. Costs were obtained from the trial. This trial is registered with ISRCTN, number ISRCTN14930255. FINDINGS From Aug 10, 2012, to June 22, 2014, 74 818 eligible patients from 54 diverse general practices were randomly assigned and completed the trial. At 1 year, 1278 (4%) cases of COPD were newly detected in 32 789 eligible patients in the targeted case-finding group compared with 337 (1%) cases in 42 029 patients in the routine care group (adjusted odds ratio [OR] 7·45 [95% CI 4·80-11·55], p<0·0001). The percentage of newly detected COPD cases was higher in the active case-finding group (822 [5%] of 15 378) than in the opportunistic case-finding group (370 [2%] of 15 387; adjusted OR 2·34 [2·06-2·66], p<0·0001; adjusted risk difference 2·9 per 100 patients [95% CI 2·3-3·6], p<0·0001). Active case finding was more cost-effective than opportunistic case finding (£333 vs £376 per case detected, respectively). INTERPRETATION In this well established primary care system, routine practice identified few new cases of COPD. An active targeted approach to case finding including mailed screening questionnaires before spirometry is a cost-effective way to identify undiagnosed patients and has the potential to improve their health. FUNDING National Institute for Health Research.
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Ding Y, Yang D, He P, Yao J, Sun P, Li Q, Xie P, Lin D, Sun D, Niu H, Tian Z. Prevalence and risk factors of chronic obstructive pulmonary diseases in a Hlai community in Hainan Island of China. CLINICAL RESPIRATORY JOURNAL 2016; 12:126-133. [PMID: 27216214 DOI: 10.1111/crj.12497] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 04/30/2016] [Accepted: 05/13/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Yipeng Ding
- Department of Emergency; People's Hospital of Hainan Province; Haikou Hainan People's Republic of China
| | - Danlei Yang
- Department of Respiratory and Critical Care Medicine, Tongji Hospital; Tongji Medical College, Huazhong University of Science and Technology; Wuhan Hubei People's Republic of China
| | - Ping He
- Department of Emergency; People's Hospital of Hainan Province; Haikou Hainan People's Republic of China
| | - Jinjian Yao
- Department of Emergency; People's Hospital of Hainan Province; Haikou Hainan People's Republic of China
| | - Pei Sun
- Department of Emergency; People's Hospital of Hainan Province; Haikou Hainan People's Republic of China
| | - Quanni Li
- Department of Emergency; People's Hospital of Hainan Province; Haikou Hainan People's Republic of China
| | - Pingdong Xie
- Department of Emergency; People's Hospital of Hainan Province; Haikou Hainan People's Republic of China
| | - Daobo Lin
- Department of Emergency; People's Hospital of Hainan Province; Haikou Hainan People's Republic of China
| | - Dingwei Sun
- Department of Emergency; People's Hospital of Hainan Province; Haikou Hainan People's Republic of China
| | - Huan Niu
- Department of Emergency; People's Hospital of Hainan Province; Haikou Hainan People's Republic of China
| | - Zhongjie Tian
- Department of Emergency; People's Hospital of Hainan Province; Haikou Hainan People's Republic of China
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Soumagne T, Laveneziana P, Veil-Picard M, Guillien A, Claudé F, Puyraveau M, Annesi-Maesano I, Roche N, Dalphin JC, Degano B. Asymptomatic subjects with airway obstruction have significant impairment at exercise. Thorax 2016; 71:804-11. [DOI: 10.1136/thoraxjnl-2015-207953] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 04/28/2016] [Indexed: 11/04/2022]
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Rossi AP, Zanardi E, Zamboni M, Rossi A. Optimizing Treatment of Elderly COPD Patients: What Role for Inhaled Corticosteroids? Drugs Aging 2016; 32:679-87. [PMID: 26297533 DOI: 10.1007/s40266-015-0291-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The most recent international documents on the management and therapy of chronic obstructive pulmonary disease (COPD) recommend inhaled corticosteroids (ICS) in addition to long-acting bronchodilators as maintenance treatment for patients at high risk of exacerbations, namely patients with forced expiratory volume in 1 s (FEV1) of <50% predicted and/or more than one exacerbation per year. However, ICS are widely used in up to 70% of COPD patients, including those at low risk of exacerbations. In recent years, concerns about the potential adverse effects of this drug category have been raised, and both observational and clinical studies have shown that elderly subjects with COPD treated with ICS are at high risk of developing cataracts and diabetes and more severe and life-threatening conditions such as pneumonia and osteoporotic fractures. Moreover, aging is characterized by memory impairment, decline in muscle strength and body mass impaired coordination, as well as alterations in eyesight and hearing that can impede proper use of devices currently available for ICS administration. Thus, regular use of ICS in more elderly patients with COPD should follow guideline recommendations, be considered with caution, and be based upon carefully weighing up expected benefits with the risk of undesired, adverse effects.
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Affiliation(s)
- Andrea P Rossi
- Department of Medicine, Section of Geriatrics, University of Verona, Ospedale Maggiore, Piazzale Stefani 1, 37126, Verona, Italy.
| | - Erika Zanardi
- Respiratory Rehabilitation ULSS 20 Verona, Piazzale Lambranzi 1, 37100, Verona, Italy
| | - Mauro Zamboni
- Department of Medicine, Section of Geriatrics, University of Verona, Ospedale Maggiore, Piazzale Stefani 1, 37126, Verona, Italy
| | - Andrea Rossi
- Pulmonary Unit, University of Verona, A.O.U.I Verona, Verona, Italy.
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Badway M, Hamed AF, Yousef FM. Prevalence of chronic obstructive pulmonary disease (COPD) in Qena Governorate. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2016. [DOI: 10.1016/j.ejcdt.2015.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Kim Y, Jung K, Ryu JY, Kim DH, Lee S. A case of fitness to work in a worker with COPD using the exercise stress test. Ann Occup Environ Med 2015; 27:26. [PMID: 26693026 PMCID: PMC4676121 DOI: 10.1186/s40557-015-0074-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 09/21/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a chronic respiratory disease characterized by persistent airflow limitation. Therefore, both work ability and workday length may be affected in individuals with this disease. We studied a worker with suspected COPD and assessed fitness to work using post-bronchodilator spirometry, symptom assessment scales, and the exercise stress test. CASE REPORT The patient was a 58-year-old man due to work as a field supervisor in the ship construction sector. He had a 40 pack-year smoking history and experienced occasional dyspnea when climbing stairs. He visited this hospital to receive cardiopulmonary function tests and to determine his ability to work. Post-bronchodilator spirometry revealed severe irreversible airway obstruction corresponding to a modified Medical Research Council grade of 2 on the dyspnea scale. His COPD Assessment Test score was 12, placing him in patient group D (high risk, more symptoms) based on the Global Initiative for Chronic Obstructive Lung Disease classification system. His maximum oxygen uptake (VO2max) was determined to be 19.16 ml/kg/min, as measured by the exercise stress test, and his acceptable workload for 8 h of physical work was calculated to be 6.51 ml/kg/min. His work tasks required an oxygen demand of 6.89 ml/kg/min, which exceeded the acceptable workload calculated. Accordingly, he was advised to adjust the work tasks that were deemed inappropriate for his exercise capacity. CONCLUSION As COPD incidence is expected to rise, early COPD diagnosis and determination of fitness to work is becoming increasingly important. Performing the exercise stress test, to evaluate the functional capacity of workers with COPD, is considered an acceptable solution.
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Affiliation(s)
- Yewon Kim
- Department of Occupational and Environmental Medicine, Inje University Haeundae Paik Hospital, 875 Haeundae-ro, 612-862 Busan, Haeundae-Gu South Korea
| | - Kyungyong Jung
- Department of Occupational and Environmental Medicine, Inje University Haeundae Paik Hospital, 875 Haeundae-ro, 612-862 Busan, Haeundae-Gu South Korea
| | - Ji Young Ryu
- Department of Occupational and Environmental Medicine, Inje University Haeundae Paik Hospital, 875 Haeundae-ro, 612-862 Busan, Haeundae-Gu South Korea
| | - Dae Hwan Kim
- Department of Occupational and Environmental Medicine, Inje University Haeundae Paik Hospital, 875 Haeundae-ro, 612-862 Busan, Haeundae-Gu South Korea
| | - Sangyoon Lee
- Department of Occupational and Environmental Medicine, Inje University Haeundae Paik Hospital, 875 Haeundae-ro, 612-862 Busan, Haeundae-Gu South Korea
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Costa-Scharplatz M, Ställberg B, Goyal P, Asukai Y, Gruenberger JB, Price D. Cost-Effectiveness of Glycopyrronium Bromide Compared with Tiotropium in Patients with Chronic Obstructive Pulmonary Disease in Sweden. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2015; 13:637-645. [PMID: 26324401 DOI: 10.1007/s40258-015-0193-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVES The objective of this study was to compare the cost effectiveness of once-daily Seebri Breezhaler(®) (glycopyrronium bromide) 50 µg with Spiriva(®) (tiotropium bromide) 18 µg in the maintenance treatment of chronic obstructive pulmonary disease (COPD) in the Swedish setting. METHODS A previously published COPD Markov model accounting for disease progression and treatment discontinuation was used. Disease progression included the annual decline in forced expiratory volume in the first second (FEV1) and occurrence of any exacerbations. Efficacy in the model consisted of FEV1 improvement between baseline and 12 weeks and the annual risk ratio of having an exacerbation compared to placebo. These clinical efficacy inputs were derived from a 1-year head-to-head trial comparing glycopyrronium 50 µg to tiotropium 18 µg. Utility values and cost estimates were obtained from the literature. The base-case analysis was performed for a 3-year time horizon. Cost and effects were discounted with 3% in accordance to Swedish guidelines. Uncertainty was assessed by one-way and probabilistic sensitivity analyses. RESULTS Glycopyrronium was found to be less costly and more effective than tiotropium in moderate to severe COPD patients with cost savings of 5197 Swedish kronor (€570, US$725) per patient over a 3-year time horizon. The probabilistic sensitivity analysis indicated that over 99% of the iterations produced dominant results for glycopyrronium. CONCLUSION Glycopyrronium bromide 50 µg once daily can be considered a cost effective alternative to tiotropium bromide 18 µg once daily in the maintenance treatment of COPD patients in Sweden.
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Affiliation(s)
| | - Björn Ställberg
- Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden
| | | | | | | | - David Price
- Centre of Academic Primary Care, University of Aberdeen, Aberdeen, UK
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Svanes Ø, Skorge TD, Johannessen A, Bertelsen RJ, Bråtveit M, Forsberg B, Gislason T, Holm M, Janson C, Jögi R, Macsali F, Norbäck D, Omenaas ER, Real FG, Schlünssen V, Sigsgaard T, Wieslander G, Zock JP, Aasen T, Dratva J, Svanes C. Respiratory Health in Cleaners in Northern Europe: Is Susceptibility Established in Early Life? PLoS One 2015; 10:e0131959. [PMID: 26168149 PMCID: PMC4500550 DOI: 10.1371/journal.pone.0131959] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 06/08/2015] [Indexed: 11/19/2022] Open
Abstract
RATIONALE There is some evidence that maternal smoking increases susceptibility to personal smoking's detrimental effects. One might question whether early life disadvantage might influence susceptibility to occupational exposure. OBJECTIVES In this cross-sectional study we investigated respiratory symptoms, asthma and self-reported chronic obstructive pulmonary disease (COPD) as related to working as a cleaner in Northern European populations, and whether early life factors influenced susceptibility to occupational cleaning's unhealthy effects. METHODS The RHINE III questionnaire study assessed occupational cleaning in 13,499 participants. Associations with respiratory symptoms, asthma and self-reported COPD were analysed with multiple logistic regressions, adjusting for sex, age, smoking, educational level, parent´s educational level, BMI and participating centre. Interaction of occupational cleaning with early life disadvantage (maternal smoking, severe respiratory infection <5 years, born during winter months, maternal age at birth >35 years) was investigated. MAIN RESULTS Among 2138 ever-cleaners the risks of wheeze (OR 1.4, 95% CI 1.3-1.6), adult-onset asthma (1.5 [1.2-1.8]) and self-reported COPD (1.7 [1.3-2.2]) were increased. The risk increased with years in occupational cleaning (adult-onset asthma: ≤1 year 0.9 [0.7-1.3]; 1-4 years 1.5 [1.1-2.0]; ≥4 years 1.6 [1.2-2.1]). The association of wheeze with cleaning activity ≥4 years was significantly stronger for those with early life disadvantage than in those without (1.8 [1.5-2.3] vs. 1.3 [0.96-1.8]; pinteraction 0.035). CONCLUSIONS Occupational cleaners had increased risk of asthma and self-reported COPD. Respiratory symptom risk was particularly increased in persons with factors suggestive of early life disadvantage. We hypothesize that early life disadvantage may increase airway vulnerability to harmful exposure from cleaning agents later in life.
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Affiliation(s)
- Øistein Svanes
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway
- * E-mail:
| | - Trude Duelien Skorge
- Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway
| | - Ane Johannessen
- Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway
| | | | - Magne Bråtveit
- Department of Public Health and Primary Health Care, University of Bergen, Bergen, Norway
| | - Bertil Forsberg
- Occupational and Environmental Medicine, Umeå University, Umeå, Sweden
| | - Thorarin Gislason
- Department of Respiratory Medicine and Sleep, National University Hospital of Iceland, Reykjavik, Iceland
| | - Mathias Holm
- Department of Occupational and Environmental Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Christer Janson
- Department of Medical Sciences, Occupational and Environmental Medicine, University of Uppsala, Uppsala, Sweden
| | - Rain Jögi
- Lung Clinic, Tartu University Hospital, Tartu, Estonia
| | - Ferenc Macsali
- Department of Gynecology and Obstetrics, Haukeland University Hospital, Bergen, Norway
| | - Dan Norbäck
- Department of Medical Sciences, Occupational and Environmental Medicine, University of Uppsala, Uppsala, Sweden
| | | | - Francisco Gómez Real
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Gynecology and Obstetrics, Haukeland University Hospital, Bergen, Norway
| | - Vivi Schlünssen
- Department of Public Health, Section for Environment, Occupation and Health, Aarhus University, Aarhus, Denmark
| | - Torben Sigsgaard
- Department of Public Health, Section for Environment, Occupation and Health, Aarhus University, Aarhus, Denmark
| | - Gunilla Wieslander
- Department of Medical Sciences, Occupational and Environmental Medicine, University of Uppsala, Uppsala, Sweden
| | - Jan-Paul Zock
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
| | - Tor Aasen
- Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway
| | - Julia Dratva
- Swiss Tropical and Public Health Institute (SwissTPH), University of Basel, Basel, Switzerland
| | - Cecilie Svanes
- Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway
- Centre for International Health, University of Bergen, Bergen, Norway
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Adachi D, Yamada M, Nishiguchi S, Fukutani N, Hotta T, Tashiro Y, Morino S, Shirooka H, Nozaki Y, Hirata H, Yamaguchi M, Aoyama T. Age-related decline in chest wall mobility: a cross-sectional study among community-dwelling elderly women. J Osteopath Med 2015; 115:384-9. [PMID: 26024332 DOI: 10.7556/jaoa.2015.079] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
CONTEXT Chest wall mobility is strongly related to respiratory function; however, the effect of aging on chest wall mobility-and the level at which this mobility is most affected-remains unclear. OBJECTIVE To investigate age-related differences in chest wall mobility and respiratory function among elderly women in different age groups. METHODS This cross-sectional observational study was performed in Himeji City in Hyogo Prefecture and Ayabe City in Kyoto Prefecture in Japan. Inclusion criteria were female sex, age 65 years or older, community resident, and ability to ambulate independently, with or without an assistive device. Thoracic excursion at the axillary and xiphoid levels and at the level of the tenth rib was measured with measuring tape. Respiratory function, including forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1), was assessed by spirometry, and FVC percent predicted (%FVC), FEV1 percent predicted (%FEV1), and FEV1/FVC were calculated. Chest wall mobility and respiratory function were compared among 4 age groups. RESULTS Of 251 potential participants, 132 met the inclusion criteria. Participants were divided into 4 age groups: group 1, 65 to 69 years; group 2, 70 to 74 years; group 3, 75 to 79 years; and group 4, 80 years or older. Statistically significant differences were found in thoracic excursion at the axillary level between groups 1 and 4 and between groups 2 and 4 when adjusted for height and weight (F4.52, P=.01). In addition, statistically significant differences were found in the FVC and FEV1 values between groups 1 and 3 and between groups 2 and 3 (FVC: F4.97, P=.01; FEV1: F6.17, P=.01). CONCLUSION Chest wall mobility at the axillary level and respiratory function decreased with age in community-dwelling women aged 65 years or older. Further longitudinal studies are required to clarify the effects of aging on chest wall mobility and respiratory function.
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Mohammad Y, Yassine F, Khadouj M. Co-morbidities in 99 COPD patients: A case series from Syria. J Transl Int Med 2015; 3:167-170. [PMID: 27847908 PMCID: PMC4936450 DOI: 10.1515/jtim-2015-0029] [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] [Indexed: 11/29/2022] Open
Abstract
Objectives To assess the most frequent co-morbidities in chronic obstructive pulmonary disease (COPD) patients. Patients and Methods We studied 99 patients, including 72 males and 67 smokers, presented to our University Hospital in Lattakia, Syria in 2012, with a mean age of 63 years. Results Overall, there were 61% hypertension, 37% ischemic heart disease, 25% diabetes, 45% anemia, and 47% pulmonary hypertension. Other diseases were less significant. Patients who had more severe Global Initiative for Chronic Obstructive Lung Disease stage had a greater number of co-morbidities. Conclusions We recommend as a general practice, to assess cardiac co-morbidities, hypertension, and other co-morbidities in all COPD patients and vice versa. We also recommend performing spirometry in smokers complaining of chronic cough, sputum, or dyspnea for early diagnosis of COPD.
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Affiliation(s)
- Yousser Mohammad
- National Center for Research on Chronic Respiratory Diseases, Tishreen University, Tishreen Hospital, Lattakia, Syria
- Department of Internal Medicine, Syrian Private University, Damascus, Syria
- Address for Correspondence: Prof. Yousser Mohammad, National Center for Research on Chronic Respiratory Diseases, Tishreen University, Althourah Street, POB 1479, Lattakia, Syria, E-mail:
| | - Fatima Yassine
- National Center for Research on Chronic Respiratory Diseases, Tishreen University, Tishreen Hospital, Lattakia, Syria
| | - Mais Khadouj
- National Center for Research on Chronic Respiratory Diseases, Tishreen University, Tishreen Hospital, Lattakia, Syria
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Donohue JF, Hanania NA, Make B, Miles MC, Mahler DA, Curry L, Tosiello R, Wheeler A, Tashkin DP. One-year safety and efficacy study of arformoterol tartrate in patients with moderate to severe COPD. Chest 2014; 146:1531-1542. [PMID: 25451347 PMCID: PMC4251615 DOI: 10.1378/chest.14-0117] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Accepted: 06/02/2014] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Arformoterol tartrate (arformoterol, 15 μg bid) is a nebulized long-acting β2-agonist approved for maintenance treatment of COPD. METHODS This was a multicenter, double-blind, randomized, placebo-controlled study. Patients (aged ≥ 40 years with baseline FEV1 ≤ 65% predicted, FEV1 > 0.50 L, FEV1/FVC ≤ 70%, and ≥ 15 pack-year smoking history) received arformoterol (n = 420) or placebo (n = 421) for 1 year. The primary assessment was time from randomization to respiratory death or first COPD exacerbation-related hospitalization. RESULTS Among 841 patients randomized, 103 had ≥ 1 primary event (9.5% vs 15.0%, for arformoterol vs placebo, respectively). Patients who discontinued treatment for any reason (39.3% vs 49.9%, for arformoterol vs placebo, respectively) were followed for up to 1 year postrandomization to assess for primary events. Fewer patients receiving arformoterol than placebo experienced COPD exacerbation-related hospitalizations (9.0% vs 14.3%, respectively). Twelve patients (2.9%) receiving arformoterol and 10 patients (2.4%) receiving placebo died during the study. Risk for first respiratory serious adverse event was 50% lower with arformoterol than placebo (P = .003). Numerically more patients on arformoterol (13; 3.1%) than placebo (10; 2.4%) experienced cardiac serious adverse events; however, time-to-first cardiac serious adverse event was not significantly different. Improvements in trough FEV1 and FVC were greater with arformoterol (least-squares mean change from baseline vs placebo: 0.051 L, P = .030 and 0.075 L, P = .018, respectively). Significant improvements in quality of life (overall St. George's Hospital Respiratory Questionnaire and Clinical COPD Questionnaire) were observed with arformoterol vs placebo (P < .05). CONCLUSIONS Arformoterol demonstrated an approximately 40% lower risk of respiratory death or COPD exacerbation-related hospitalization over 1 year vs placebo. Arformoterol was well-tolerated and improved lung function vs placebo. TRIAL REGISTRY ClinicalTrials.gov; No.: NCT00909779; URL: www.clinicaltrials.gov.
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Affiliation(s)
- James F Donohue
- Department of Pulmonary Diseases and Critical Care Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC.
| | - Nicola A Hanania
- Section of Pulmonary, Critical Care, and Sleep Medicine, Baylor College of Medicine, Houston, TX
| | - Barry Make
- Division of Pulmonary, Critical Care, and Sleep Medicine, National Jewish Health, University of Colorado Denver School of Medicine, Denver, CO
| | - Matthew C Miles
- Department of Pulmonary, Critical Care, Allergy, and Immunologic Medicine, Wake Forest School of Medicine, Winston-Salem, NC
| | - Donald A Mahler
- Department of Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Lisa Curry
- Research & Development Division, Sunovion Pharmaceuticals Inc, Marlborough, MA
| | - Robert Tosiello
- Research & Development Division, Sunovion Pharmaceuticals Inc, Marlborough, MA
| | - Alistair Wheeler
- Research & Development Division, Sunovion Pharmaceuticals Inc, Marlborough, MA
| | - Donald P Tashkin
- Department of Medicine/Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
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Johns DP, Walters JAE, Walters EH. Diagnosis and early detection of COPD using spirometry. J Thorac Dis 2014; 6:1557-69. [PMID: 25478197 PMCID: PMC4255165 DOI: 10.3978/j.issn.2072-1439.2014.08.18] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Accepted: 08/12/2014] [Indexed: 01/19/2023]
Abstract
The standard respiratory function test for case detection of chronic obstructive pulmonary disease (COPD) is spirometry. The criterion for diagnosis defined in guidelines is based on the FEV1/FVC ratio forced expiratory ratio (FER) and its severity is based on forced expiratory volume in one second (FEV1) from measurements obtained during maximal forced expiratory manoeuvres. Spirometry is a safe and practical procedure, and when conducted by a trained operator using a spirometer that provides quality feedback, the majority of patients can be coached to provide acceptable and repeatable results. This allows potentially wide application of testing to improve recognition and diagnosis of COPD, such as for case finding in primary care. However, COPD remains substantially under diagnosed in primary care and a major reason for this is underuse of spirometry. The presence of symptoms is not a reliable indicator of disease and diagnosis is often delayed until more severe airflow obstruction is present. Early diagnosis is worthwhile, as it allows risk factors for COPD such as smoking to be addressed promptly and treatment optimised. Paradoxically, investigation of the patho-physiology in COPD has shown that extensive small airway disease exists before it is detectable with conventional spirometric indices, and methods to detect airway disease earlier using the flow-volume curve are discussed.
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Affiliation(s)
- David P Johns
- School of Medicine, University of Tasmania, Hobart, Australia
| | | | - E Haydn Walters
- School of Medicine, University of Tasmania, Hobart, Australia
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Saad N, Sedeno M, Metz K, Bourbeau J. Early COPD Diagnosis in Family Medicine Practice: How to Implement Spirometry? INTERNATIONAL JOURNAL OF FAMILY MEDICINE 2014; 2014:962901. [PMID: 24804099 PMCID: PMC3996931 DOI: 10.1155/2014/962901] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Revised: 02/06/2014] [Accepted: 02/08/2014] [Indexed: 06/03/2023]
Abstract
Introduction. COPD is often diagnosed at an advanced stage because symptoms go unrecognized. Furthermore, spirometry is often not done. Methods. Study was conducted in diverse family medicine practice settings. Patients were targeted if respiratory symptoms were present. Patients had a spirometry to confirm the presence of airflow obstruction and COPD diagnosis. An evaluation of the process was done to better understand facilitating/limiting factors to the implementation of a primary care based spirometry program. Results. 12 of 19 primary care offices participated. 196 of 246 (80%) patients targeted based on the presence of smoking and respiratory symptoms did not have COPD; 18 (7%) and 32 (13%) had COPD, respectively, GOLD I and ≥II. There was no difference in the type and number of respiratory symptoms between non-COPD and COPD patients. Most of the clinics did not have access to a trained healthcare professional to accomplish spirometry. They agreed that giving access to a trained healthcare professional was the easiest and most reliable way of doing spirometry. Conclusion. Spirometry, a simple test, is recommended in guidelines to make the diagnosis of COPD. The lack of allocated time and training of healthcare professionals makes its implementation challenging in family medicine practices.
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Affiliation(s)
- Nathalie Saad
- Respiratory Epidemiology and Clinical Research Unit (RECRU), Montreal Chest Institute, McGill University Health Centre, Montréal, QC, Canada H2X 2P4
| | - Maria Sedeno
- Respiratory Epidemiology and Clinical Research Unit (RECRU), Montreal Chest Institute, McGill University Health Centre, Montréal, QC, Canada H2X 2P4
| | - Katrina Metz
- Respiratory Epidemiology and Clinical Research Unit (RECRU), Montreal Chest Institute, McGill University Health Centre, Montréal, QC, Canada H2X 2P4
| | - Jean Bourbeau
- Respiratory Epidemiology and Clinical Research Unit (RECRU), Montreal Chest Institute, McGill University Health Centre, Montréal, QC, Canada H2X 2P4
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Arslan Z, Ilgazlı A, Etiler N, Hamzaoğlu O. Prevalence of chronic obstructive pulmonary disease in kocaeli: an industrialised city in Turkey. Balkan Med J 2013; 30:387-93. [PMID: 25207146 PMCID: PMC4115957 DOI: 10.5152/balkanmedj.2013.8042] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Accepted: 06/26/2013] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is an important cause of mortality worldwide. AIMS The aim of this study was to establish the prevalence of chronic obstructive pulmonary disease (COPD) in residents who were ≥40 years old and living in a heavily industrialised city of Turkey, Kocaeli, using the Burden of Obstructive Lung Disease Initiative questionnaire. STUDY DESIGN Cross-sectional study. METHODS 1035 residents ≥40 years old and living in Kocaeli were surveyed. Spirometry and the basic BOLD questionnaire was performed. RESULTS 946 subjects entered into the analysis. The prevalence of stage I or higher COPD was 13.3% (8.7% for women and 16.5% for men), the prevalence of COPD at GOLD stage II or higher was 7.1% (4.1% for women and 9.2% for men). We also noted a high prevalence of COPD in never-smokers. CONCLUSION Besides cigarette smoking, occupational exposure to fumes, chemicals and dusts might have also contributed to the high prevalence of COPD noted in residents who were ≥40 years old and living in Kocaeli, Turkey.
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Affiliation(s)
- Zeliha Arslan
- Department of Chest Diseases, Kocaeli University Medical School, Kocaeli, Turkey
| | - Ahmet Ilgazlı
- Department of Chest Diseases, Kocaeli University Medical School, Kocaeli, Turkey
| | - Nilay Etiler
- Department of Public Health, Kocaeli University Medical School, Kocaeli, Turkey
| | - Onur Hamzaoğlu
- Department of Public Health, Kocaeli University Medical School, Kocaeli, Turkey
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van Schayck OCP. Global strategies for reducing the burden from asthma. PRIMARY CARE RESPIRATORY JOURNAL : JOURNAL OF THE GENERAL PRACTICE AIRWAYS GROUP 2013; 22:239-43. [PMID: 23708109 PMCID: PMC6442797 DOI: 10.4104/pcrj.2013.00052] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Revised: 04/05/2013] [Accepted: 04/12/2013] [Indexed: 11/18/2022]
Abstract
Asthma is one of the most important chronic diseases in childhood. For several decades, a steady increase in prevalence has been observed worldwide. In the structural collaboration between the Centre for Population Health Services in Edinburgh and the Research Institute CAPHRI of Maastricht we investigated the possibilities for primary prevention of asthma in childhood. We found that a multifaceted approach might be effective in delaying or preventing asthma, whereas a mono-intervention does not seem to have such a protective effect. The most likely explanation is that the development of a multifactorial disease, such as asthma, is extremely difficult, if not impossible, to prevent by eliminating only one risk factor. Underdiagnosis of asthma is still a big problem in primary care. Most patients do not present bronchial symptoms to the general practitioner, even though they have decreased lung function, so they remain unknown and undiagnosed. However, patients who do present with respiratory problems and who have reduced lung function are not always recognised as such. We found that the perception of dyspnoea seems to determine, at least in part, the presentation to the general practitioner with symptoms. These observations show that both the prevention of the development of asthma in early childhood, as well as case finding of asthma in adulthood, do not seem to be very effective in primary care. More research is needed to clarify what steps can be taken to reduce the global burden from asthma.
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Affiliation(s)
- Onno C P van Schayck
- Department of General Practice, CAPHRI, Maastricht University, Maastricht, the Netherlands.
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Vestbo J, Hurd SS, Agustí AG, Jones PW, Vogelmeier C, Anzueto A, Barnes PJ, Fabbri LM, Martinez FJ, Nishimura M, Stockley RA, Sin DD, Rodriguez-Roisin R. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med 2013; 187:347-65. [PMID: 22878278 DOI: 10.1164/rccm.201204-0596pp] [Citation(s) in RCA: 3597] [Impact Index Per Article: 327.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Affiliation(s)
- Jørgen Vestbo
- Manchester Academic Sciences Health Centre, Respiratory Research Group, University of Manchester, University Hospital South Manchester, Southmoor Road, Manchester M23 9LT, UK.
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Abramson MJ, Schattner RL, Sulaiman ND, Del Colle EA, Aroni R, Thien F. Accuracy of asthma and COPD diagnosis in Australian general practice: a mixed methods study. PRIMARY CARE RESPIRATORY JOURNAL : JOURNAL OF THE GENERAL PRACTICE AIRWAYS GROUP 2012; 21:167-73. [PMID: 22234387 DOI: 10.4104/pcrj.2011.00103] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Spirometry is the 'gold standard' for diagnosing asthma and chronic obstructive pulmonary disease (COPD) but is rarely used in general practice. AIMS To compare doctor diagnoses with patient reports/spirometry and to determine doctors' perceptions of spirometry. METHODS Patients prescribed inhaled medication were recruited from 31 practices. Doctor diagnoses were extracted from practice records. Patients completed a questionnaire and spirometry before and after bronchodilator. In-depth interviews were conducted with a sample of doctors. RESULTS Doctor diagnoses were available for 278 patients: asthma 192 (69%), COPD 38 (14%), asthma/COPD 40 (14%), and eight patients (3%) with other conditions. The diagnosis of asthma was correctly reported by 93% of patients, but only by 61% of those with COPD alone. Among those with both diagnoses, 83% reported asthma and 48% reported COPD. Of those with a diagnosis of COPD, 65% had fixed airflow limitation. Conversely, only 14% of those had been diagnosed with COPD alone. There was no significant difference in reversibility in forced expiratory volume in 1 second between diagnoses. While recognising the value of spirometry in differentiating between asthma and COPD, most general practices only used spirometry in diagnostically difficult cases. CONCLUSIONS Doctor-diagnosed asthma is accurately reported by patients. However, COPD remains substantially under-diagnosed. Spirometry needs to be more widely used to improve the accuracy of respiratory diagnoses in general practice.
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Affiliation(s)
- Michael J Abramson
- Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Albers F, Shaikh A, Iqbal A. Design, rationale, and baseline demographics of SEARCH I: a prospective cluster-randomized study. Int J Chron Obstruct Pulmon Dis 2012; 7:437-45. [PMID: 22848157 PMCID: PMC3402060 DOI: 10.2147/copd.s31418] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Questionnaires are available to identify patients at risk for several chronic diseases, including COPD, but are infrequently utilized in primary care. COPD is often underdiagnosed, while at the same time the US Preventive Services Task Force recommends against spirometric screening for COPD in asymptomatic adults. Use of a symptom-based questionnaire and subsequent handheld spirometric device depending on the answers to the questionnaire is a promising approach to identify patients at risk for COPD. Screening, Evaluating and Assessing Rate CHanges of diagnosing respiratory conditions in primary care 1 (SEARCH I) was a prospective cluster-randomized study in 168 US primary care practices evaluating the effect of the COPD-Population Screener (COPD-PS™) questionnaire. The effect of this questionnaire alone or sequentially with the handheld copd-6TM device was evaluated on new diagnoses of COPD and on respiratory diagnostic practice patterns (including referrals for pulmonary function testing, referrals to pulmonologists, new diagnoses of COPD, and new respiratory medication prescriptions). Participating practices entered a total of 9704 consecutive consenting subjects aged ≥ 40 years attending primary care clinics. Study arm results were compared for new COPD diagnosis rates between usual care and (1) COPD-PS plus copd-6 and (2) COPD-PS alone. A cluster-randomization design allowed comparison of the intervention effects at the practice level instead of individuals being the subjects of the intervention. Regional principal investigators controlled the flow of study information to sub-investigators at participating practices to reduce observation bias (Hawthorne effect). The results of SEARCH I, to be published subsequently, will provide insight into the real world utility of the COPD-PS as well as two-stage COPD case finding with COPD-PS and copd-6.
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Affiliation(s)
- Frank Albers
- Medical Affairs Respiratory, Field Based Medicine-Respiratory, Boehringer Ingelheim Pharmaceuticals, Inc, Ridgefield, CT 06877, USA.
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Lucas AE, Smeenk FJ, Smeele IJ, van Schayck OP. Diagnostic accuracy of primary care asthma/COPD working hypotheses, a real life study. Respir Med 2012; 106:1158-63. [PMID: 22682550 DOI: 10.1016/j.rmed.2012.03.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2011] [Revised: 03/04/2012] [Accepted: 03/05/2012] [Indexed: 11/28/2022]
Abstract
UNLABELLED Misdiagnoses are inevitable when working hypotheses of asthma/COPD of General Practitioners (GPs) are not checked by spirometry. To reduce misdiagnoses, Asthma/COPD-support services (AC-services) offer support by performing spirometry assessed together with written medical history by consulting pulmonologists. RESEARCH QUESTIONS Which criteria do GPs use to justify their asthma/COPD working hypotheses? How do diagnostic assessments by an AC-service change GPs' working hypotheses? Do GPs' justifications for their working hypotheses influence the extent to which working hypotheses correspond with diagnoses given by an AC-service? METHOD We investigated the working hypotheses of 17 GPs for 284 patients with respiratory problems and their justifications: "clinical symptoms", "office spirometry", or "specialist's correspondence". Working hypotheses were compared with diagnoses given by an AC-service, and the influence of the different justifications categories on diagnostic accuracy of the working hypotheses was described. RESULTS 49% of the working hypothesis were only based on clinical information, 21% were also based on office spirometry. For 30% additional specialist information was available. 50% of the working hypotheses were confirmed by the AC-service. The working hypothesis asthma was confirmed more frequently (62%) than the working hypothesis COPD (40%). The justifications for the working hypotheses given by GPs did not influence these results. CONCLUSION Diagnostic assessments of the AC-service differed significantly from the working hypotheses of GPs, even when these were based on previous specialists' correspondence or on office spirometry. To optimize the diagnoses in primary care, diagnostic support of an AC-service is recommended for all primary care patients with respiratory problems.
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Affiliation(s)
- Annelies E Lucas
- University of Maastricht, Dept of Family Medicine, PO Box 616, 6200 MD Maastricht, Netherlands.
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Sokoloff MD, Bortner L, Panos RJ. Development of a Non-Invasive Dynamic Pulmonary Function Monitor. J Med Device 2012. [DOI: 10.1115/1.4006358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Characterizing the complexity of airflow limitation in diagnosing and assessing disease severity in asthma, COPD, cystic fibrosis, and other respiratory diseases can help guide clinicians toward the most appropriate treatments. Current technologies allow obstructive lung disease to be measured with about 5%−10% precision. A noninvasive dynamic pulmonary function monitor (DPFM) can quantify ventilation inhomogeneities, such as those originating in partially blocked or constricted small airways, with 1% precision if inert gas concentrations can be measured accurately and precisely over three to four decades of sensitivity. We have studied the precision and linearity of a commercially available mass spectrometer, sampling the gas exhaled by a mechanical lung analog, mimicking a multibreath inert gas washout measurement. The root mean square deviation of the inert gas concentration measured for each “breath,” compared to the expected value for a purely exponential decay, is found to be about 1.1% over three decades of concentration. The corresponding overall impairment, a specific measure of ventilation inhomogeneity, is found to be about 0.2%, which indicates that were inhomogeneities observed, the corresponding impairment could be measured with 1% precision.
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Affiliation(s)
| | - Larry Bortner
- Physics Department, University of Cincinnati, Cincinnati, OH 45221
| | - Ralph J. Panos
- Pulmonary, Critical Care and Sleep Division,Department of Internal Medicine, University of Cincinnati, Cincinnati, OH 45221;Pulmonary, Critical Care and Sleep Division,Cincinnati VAMC,Cincinnati, OH 45220e-mail:
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Dirven JAM, Muris JWM, van Schayck CP. COPD screening in general practice using a telephone questionnaire. COPD 2011; 7:352-9. [PMID: 20854050 DOI: 10.3109/15412555.2010.510547] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is a growing health problem, and an underestimated and underdiagnosed disease in primary care. The aim of this survey was to study the feasibility of detecting undiagnosed COPD patients in the general practice population with the aid of a telephone questionnaire. The study was held in 2 general practices in the Netherlands. During 2 weeks, all patients registered with these 2 practices and aged between 40 and 75 years were contacted through a call center. Persons known with a previous history or diagnosis of COPD or asthma or comorbidity were excluded from the telephone list. The telephone interview used the Respiratory Health Screening Questionnaire (DB Price, 2006). Based on the score on this instrument, respondents were classified as having a low, moderate or high risk of having COPD. Smoking behaviour and BMI were also recorded. Patients with medium and high risk for COPD were invited for spirometry, performed by 2 experienced registered nurses. The results of the telephone interview and spirometric findings were assessed by the attending GP, who established the final diagnosis. The call center reached 1032 persons, 813 of whom answered the questions. The percentage of smokers was 49.2%, with an average number of pack-years of 17.9 (SD = 17); mean BMI was 26.1. Spirometry and analysis by the GP showed that 15.7% of the medium-risk group had previously undiagnosed COPD, versus 39.6% of the high-risk group. The number of undiagnosed COPD patients in the general practice population is considerable. Case finding can focus on moderate- and high-risk groups after telephone risk assessment.
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Affiliation(s)
- J A M Dirven
- Department of General Practice, Maastricht University Medical Centre, The Netherlands.
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Grzetic-Romcevic T, Devcic B, Sonc S. Spirometric testing on World COPD Day. Int J Chron Obstruct Pulmon Dis 2011; 6:141-6. [PMID: 21468166 PMCID: PMC3064420 DOI: 10.2147/copd.s16605] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2011] [Indexed: 01/09/2023] Open
Abstract
Background: To determine the importance of spirometric testing for early detection of chronic obstructive pulmonary disease (COPD). Methods: Spirometric testing has been performed annually on World COPD Day in Sezana from 2003. Sezana is in a semiurban region of Slovenia, with 12,000 inhabitants. The investigation was performed between January 2003 and December 2008. In total, 770 persons were enrolled (414 females and 356 males). The participants were recruited by mass media appeals. Smokers aged ≥40 years with a smoking history of ≥10 pack-years were invited to visit the local chest clinic. The participants completed a questionnaire and had spirometry performed. Subjects with a postbronchodilator forced expiratory volume in one second/forced vital capacity <0.70 were defined as having COPD, according to the Global Initiative for Chronic Obstructive Lung Disease guidelines. Results: We identified that 16.2% of subjects had impaired lung function. Of these, 10.2% had an obstructive pattern of ventilatory impairment and 6% had a restrictive pattern. We identified 79 individuals with COPD. Subjects with COPD were >70 years in 40.5% in cases. The majority of individuals with COPD were men (74.6%), and 90% were smokers. COPD was mild in 52% of subjects, moderate in 34%, and severe in 14%. The majority of subjects had a milder stage of the disease, and 92% of those with COPD (72/79) had not been recognized to have COPD previously. Conclusion: These results suggest that spirometry testing could detect patients with COPD in the earlier stages of the disease.
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Lee SW, Yoo JH, Park MJ, Kim EK, Yoon HI, Kim DK, Lee CH, Park YB, Park JH, Hwang YI, Jung KS, Yoo KH, Park HY, Lee JS, Huh JW, Oh YM, Lim SY, Jung JY, Kim YS, Kim HJ, Rhee CK, Kim YK, Kim JW, Yoon HK, Lee SD. Early Diagnosis and Management of Chronic Obstructive Pulmonary Disease. Tuberc Respir Dis (Seoul) 2011. [DOI: 10.4046/trd.2011.70.4.293] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Sei Won Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jee-Hong Yoo
- Department of Internal Medicine, Kyung Hee University Hospital, Seoul, Korea
| | - Myung Jae Park
- Department of Internal Medicine, Kyung Hee University Hospital, Seoul, Korea
| | - Eun Kyung Kim
- Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Ho Il Yoon
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Deog Kyeom Kim
- Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Chang Hoon Lee
- Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Yong Bum Park
- Department of Internal Medicine, Kang-Dong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Joo Hun Park
- Department of Pulmonary and Critical Care Medicine, Ajou University School of Medicine, Suwon, Korea
| | - Yong Il Hwang
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Ki-Suck Jung
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Kwang Ha Yoo
- Department of Internal Medicine, Konkuk University College of Medicine, Seoul, Korea
| | - Hye Yoon Park
- Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae Seung Lee
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jin-Won Huh
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yeon Mok Oh
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seong Yong Lim
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji Ye Jung
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Young Sam Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Hui Jung Kim
- Department of Internal Medicine, Wonkwang University Sanbon Hospital, Wonkwang University College of Medicine, Gunpo, Korea
| | - Chin Kook Rhee
- Department of Internal Medicine, Seoul St. Mary's Hospital, Seoul, Korea
| | - Young Kyoon Kim
- Department of Internal Medicine, Seoul St. Mary's Hospital, Seoul, Korea
| | - Jin Woo Kim
- Department of Internal Medicine, Uijeongbu St. Mary's Hospital, Uijeongbu, Korea
| | - Hyoung Kyu Yoon
- Department of Internal Medicine, Yeouido St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Sang-Do Lee
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Abramson MJ, Schattner RL, Sulaiman ND, Birch KE, Simpson PP, Del Colle EA, Aroni RA, Wolfe R, Thien FCK. Do spirometry and regular follow-up improve health outcomes in general practice patients with asthma or COPD? A cluster randomised controlled trial. Med J Aust 2010; 193:104-9. [PMID: 20642418 DOI: 10.5694/j.1326-5377.2010.tb03817.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2009] [Accepted: 12/16/2009] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine whether spirometry with regular medical review improves the quality of life or other health outcomes among patients with asthma or chronic obstructive pulmonary disease (COPD) managed in general practice. DESIGN, SETTING AND PARTICIPANTS Cluster randomised controlled trial conducted in 31 general practices in Melbourne during 2007-2008. Practices recruited 305 adult patients who had been prescribed inhaled medication in the preceding 6 months. INTERVENTION Practices were randomly assigned to one of three groups: Group A patients received 3-monthly spirometry performed by a respiratory scientist with results returned to the practice and regular medical review; Group B patients received spirometry only before and after the trial; and Group C patients received usual care. MAIN OUTCOME MEASURES Quality of life, assessed with the 36-item Short Form (SF-36) Australian (English) Version 2 questionnaire at baseline and 3, 6, 9 and 12 months. Secondary outcomes were assessed with the European Community Respiratory Health Survey at baseline and 12 months. RESULTS The trial was completed by 253 participants: 79 in Group A, 104 in Group B, and 70 in Group C. Median age was 58 years (range, 18-70 years), and 167 participants (66%) were women. There were no significant changes in SF-36 Physical and Mental Component Summary scores from baseline to 12 months, or significant differences between groups on either scale or any subscale of the SF-36. There were also no significant differences in respiratory symptoms, asthma attacks, written asthma action plans, days lost from usual activities or health care utilisation. CONCLUSION Three-monthly spirometry and regular medical reviews by general practitioners are not associated with any significant improvement in quality of life or other health outcomes for patients with asthma and/or COPD. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12606000378527.
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Affiliation(s)
- Michael J Abramson
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
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Lung function in young adults predicts airflow obstruction 20 years later. Am J Med 2010; 123:468.e1-7. [PMID: 20399325 PMCID: PMC2858051 DOI: 10.1016/j.amjmed.2009.07.037] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2009] [Revised: 07/02/2009] [Accepted: 07/20/2009] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The burden of obstructive lung disease is increasing, yet there are limited data on its natural history in young adults. To determine in a prospective cohort of generally healthy young adults the influence of early adult lung function on the presence of airflow obstruction in middle age. METHODS A longitudinal study was performed of 2496 adults who were 18 to 30 years of age at entry, did not report having asthma, and returned at year 20. Airflow obstruction was defined as an forced expiratory volume in 1 second/forced vital capacity ratio less than the lower limit of normal. RESULTS Airflow obstruction was present in 6.9% and 7.8% of participants at years 0 and 20, respectively. Less than 10% of participants with airflow obstruction self-reported chronic obstructive pulmonary disease. In cross-sectional analyses, airflow obstruction was associated with less education, smoking, and self-reported chronic obstructive pulmonary disease. Low forced expiratory volume in 1 second, forced expiratory volume in 1 second/forced vital capacity ratio, and airflow obstruction in young adults were associated with low lung function and airflow obstruction 20 years later. Of those with airflow obstruction at year 0, 52% had airflow obstruction 20 years later. The forced expiratory volume in 1 second/forced vital capacity at year 0 was highly predictive of airflow obstruction 20 years later (c-statistic 0.91; 95% confidence interval, 0.89-0.93). The effect of cigarette smoking on lung function decline with age was most evident in young adults with preexisting airflow obstruction. CONCLUSION Airflow obstruction is mostly unrecognized in young and middle-aged adults. Low forced expiratory volume in 1 second, low forced expiratory volume in 1 second/forced vital capacity ratio, airflow obstruction in young adults, and smoking are highly predictive of low lung function and airflow obstruction in middle age.
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Soler N, Ballester E, Martín A, Gobartt E, Miravitlles M, Torres A. Changes in management of chronic obstructive pulmonary disease (COPD) in primary care: EMMEPOC study. Respir Med 2010; 104:67-75. [DOI: 10.1016/j.rmed.2009.08.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2009] [Revised: 07/31/2009] [Accepted: 08/06/2009] [Indexed: 11/17/2022]
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Schneider A, Gindner L, Tilemann L, Schermer T, Dinant GJ, Meyer FJ, Szecsenyi J. Diagnostic accuracy of spirometry in primary care. BMC Pulm Med 2009; 9:31. [PMID: 19591673 PMCID: PMC2714498 DOI: 10.1186/1471-2466-9-31] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2009] [Accepted: 07/10/2009] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND To evaluate the sensitivity, specificity and predictive values of spirometry for the diagnosis of chronic obstructive pulmonary disease (COPD) and asthma in patients suspected of suffering from an obstructive airway disease (OAD) in primary care. METHODS Cross sectional diagnostic study of 219 adult patients attending 10 general practices for the first time with complaints suspicious for OAD. All patients underwent spirometry and structured medical histories were documented. All patients received whole-body plethysmography (WBP) in a lung function laboratory. The reference standard was the Tiffeneau ratio (FEV1/VC) received by the spirometric maneuver during examination with WBP. In the event of inconclusive results, bronchial provocation was performed to determine bronchial hyper-responsiveness (BHR). Asthma was defined as a PC20 fall after inhaling methacholine concentration < or = 16 mg/ml. RESULTS 90 (41.1%) patients suffered from asthma, 50 (22.8%) suffered from COPD, 79 (36.1%) had no OAD. The sensitivity for diagnosing airway obstruction in COPD was 92% (95%CI 80-97); specificity was 84% (95%CI 77-89). The positive predictive value (PPV) was 63% (95%CI 51-73); negative predictive value (NPV) was 97% (95%CI 93-99). The sensitivity for diagnosing airway obstruction in asthma was 29% (95%CI 21-39); specificity was 90% (95%CI 81-95). PPV was 77% (95%CI 60-88); NPV was 53% (95%CI 45-61). CONCLUSION COPD can be estimated with high diagnostic accuracy using spirometry. It is also possible to rule in asthma with spirometry. However, asthma can not be ruled out only using spirometry. This diagnostic uncertainty leads to an overestimation of asthma presence. Patients with inconclusive spirometric results should be referred for nitric oxide (NO) - measurement and/or bronchial provocation if possible to guarantee accurate diagnosis.
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Affiliation(s)
- Antonius Schneider
- Institute of General Practice, Technische Universität München, München, Germany
| | - Lena Gindner
- Department of General Practice and Health Services Research, University Hospital, University of Heidelberg, Heidelberg, Germany
| | - Lisa Tilemann
- Department of General Practice and Health Services Research, University Hospital, University of Heidelberg, Heidelberg, Germany
| | - Tjard Schermer
- Department of Primary Care Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Geert-Jan Dinant
- Department of General Practice, School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
| | - Franz Joachim Meyer
- Department of Cardiology, Pulmonology and Angiology, Medical Centre, University of Heidelberg, Heidelberg, Germany
| | - Joachim Szecsenyi
- Department of General Practice and Health Services Research, University Hospital, University of Heidelberg, Heidelberg, Germany
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Albers M, Schermer T, Molema J, Kloek C, Akkermans R, Heijdra Y, van Weel C. Do family physicians' records fit guideline diagnosed COPD? Fam Pract 2009; 26:81-7. [PMID: 19228813 DOI: 10.1093/fampra/cmp005] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND In family practice, chronic obstructive pulmonary disease (COPD) is usually not diagnosed until clinically apparent and of moderately advanced severity. OBJECTIVE To analyse the diagnostic process from early development onwards and to assess the current state of underpresentation and underdiagnosis of COPD and asthma in primary care in the Netherlands. METHODS The population-based study sample consisted of formerly undiagnosed subjects (n = 532) from family practice. Family physicians' (FPs) chronic respiratory disease diagnoses (as recorded over 10 years in their patient records) were compared to a cross-sectional but extensive diagnostic assessment by a chest physician. Logistic regression modelling was used for a retrospective analysis on the relation between respiratory symptoms, practice visit rate and FPs' diagnosis of COPD. RESULTS After 10 years, the chest physician diagnosed 26% of subjects as COPD and 16% as (late-onset) asthma. Underpresentation of these patients in family practice was 46%, whereas underdiagnosis occurred in 37% of patients. A chest physician diagnosis of COPD was associated with the presence of chronic cough [odds ratio (OR) = 2.3, 95% confidence interval (CI) 1.1-4.6], a FP diagnosis of COPD with chronic phlegm (OR = 10.6, 95% CI 1.3-83.6). Repeated practice visits (OR = 1.8) and presence of wheeze and breathlessness (OR = 5.5) appeared to trigger the diagnostic process in family practice. CONCLUSIONS There is still considerable underpresentation and underdiagnosis of COPD in family practice. As FPs focus on presented symptoms and as detection increases with the frequency of practice visits, diagnostic guidelines should stress the importance of persistent cough and phlegm to support timely diagnosis of COPD in family practice.
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Affiliation(s)
- Mieke Albers
- Department of Primary Care Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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Guntupalli KK, Reddy RM, Loutfi RH, Alapat PM, Bandi VD, Hanania NA. Evaluation of obstructive lung disease with vibration response imaging. J Asthma 2009; 45:923-30. [PMID: 19085584 DOI: 10.1080/02770900802395496] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
As optimal treatment and prognosis differ between asthma and COPD, a new diagnostic approach to differentiating between the two disorders would be clinically desirable. We evaluated the utility of vibration response imaging in differentiating between asthma and COPD. Sixty-six subjects with asthma or COPD were recorded, before and after the administration of a short-acting bronchodilator, using a computerized lung sound analysis device. Gray-scale images of breath sound distribution in the lungs, quantitative data in breath sound graphs (timing, amplitude) and automatic crackle and wheeze detection programs were used to differentiate between asthma and COPD subjects. Imaging data were compared with the clinical diagnosis, made by the standard methods (medical history, physical examination, and spirometric indices). Blinded evaluation of images demonstrated a significantly higher rate of improvement in image dynamics, shape and overall improvement following bronchodilator in subjects with asthma compared with those with COPD. Quantitative data showed distinct patterns in timing and amplitude for these two pathologies. Combined analyses based on qualitative image evaluation and quantitative data demonstrated an overall 85% accuracy (84% for asthma, 86% for COPD) in differentiating between asthma and COPD. Combined qualitative and quantitative evaluations of lung sounds are quite sensitive in distinguishing between lung sound recordings of COPD and asthma individuals. Lung sound features of synchronization in timing and intensity provide objective data that may further differentiate these two airway disorders.
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Affiliation(s)
- Kalpalatha K Guntupalli
- Baylor College of Medicine, Ben Taub General Hospital, 1504 Taub Loop, Houston, Texas 77030, USA.
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Akazawa M, Halpern R, Riedel AA, Stanford RH, Dalal A, Blanchette CM. Economic burden prior to COPD diagnosis: a matched case-control study in the United States. Respir Med 2008; 102:1744-52. [PMID: 18760581 DOI: 10.1016/j.rmed.2008.07.009] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2008] [Revised: 06/27/2008] [Accepted: 07/02/2008] [Indexed: 11/15/2022]
Abstract
BACKGROUND In the United States, chronic obstructive pulmonary disease (COPD) diagnosis is often a lengthy process, and consequently results in delays in treatment in early stages. Disease progression and complication may result in increased levels of healthcare service use. To understand the economic burden of COPD prior to diagnosis in the U.S., trends in utilization and costs during the period before initial COPD diagnosis were compared with matched controls. METHODS A retrospective case-control study was conducted using medical and pharmacy claims data from a large managed care health plan representing a base population of over 30 million covered lives in the U.S. COPD patients with at least 12 months of continuous enrollment and aged 40 years or older were identified (n=28,968) and matched to up to three random controls (n=81,322) by age, gender, region of plans and index date. Multivariate regression models were used to estimate average incremental service use and cost between COPD patients and controls. Moreover, trends in utilization and costs for the COPD patients were examined over 36 months before diagnosis. RESULTS COPD patients used 1.5-1.6 times more inpatient/emergency department (IP/ED) services and office visits compared to control patients. The average incremental annual costs for IP/ED services, office visits, and medical and pharmacy services were estimated at $550, $238, $1438 and $401, respectively, after adjusting for age, gender, region and comorbid conditions. The 36-month trend analysis showed that COPD patients' healthcare utilization and costs increased gradually over time, often with a marked increase in the month before COPD diagnosis. CONCLUSIONS COPD patients in the U.S. consumed substantial healthcare services and costs prior to diagnosis. More timely diagnosis and subsequent treatment may avoid costly healthcare utilization and unnecessary mortality and morbidity post-diagnosis.
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Affiliation(s)
- Manabu Akazawa
- Department of Health Policy and Administration, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Dal Negro R. Optimizing economic outcomes in the management of COPD. Int J Chron Obstruct Pulmon Dis 2008; 3:1-10. [PMID: 18488425 PMCID: PMC2528207 DOI: 10.2147/copd.s671] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Attention to COPD is increasing worldwide because its high prevalence, morbidity, and mortality present a challenging problem for all healthcare systems. The burden of COPD, which is usually measured in terms of progressive lung function decline, impact on patients' symptoms, patient's disability, and quality of life, together with the corresponding use of health care resources, is still a major aspect of the disease. Recommendations to treat COPD according to the most accepted guidelines have expanded in recent years even though COPD still remains unacceptably under-diagnosed and under-treated worldwide. Obviously, more severe degrees of COPD receive major attention both in terms of monitoring of clinical outcomes and of assessing the economic value of therapeutic interventions. The role of different strategies against COPD should be valued on the basis of their effectiveness in outcome optimization, which primarily depends on the efficacy of prevention activities and of early diagnosis programs. It is generally agreed that the main proportion of COPD burden still depends on the clinically uncontrolled disease and on its high exacerbation rate, which frequently leads to the patient hospitalization. In COPD, the effects of guideline recommendations have been only sporadically investigated in pharmaoeconomic terms, even though symptoms and disability have declined substantially; the corresponding improvement in quality of life, and a significant decrease in both direct and indirect costs have been proved to depend on appropriate rehabilitative and pharmacological long-term treatment of the disease. At present, more precise indices and more fitting outcomes are continuously sought and found in order to assess more effective strategies for controlling COPD.
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Izquierdo Alonso JL, Rodríguez González-Moro JM. [Treatment of mild chronic obstructive pulmonary disease]. Med Clin (Barc) 2008; 130:661-5. [PMID: 18501130 DOI: 10.1157/13120694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Determination of the efficacy of FEV6 as a surrogate for FVC in the diagnostic screening for chronic obstructive pulmonary disease through the comparison of FEV1/FVC and FEV1/FEV6 ratios. J Bras Pneumol 2008; 33:148-51. [PMID: 17724533 DOI: 10.1590/s1806-37132007000200008] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2005] [Accepted: 06/07/2006] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To determine the efficacy of using forced expiratory volume in six seconds (FEV6) as a surrogate for forced vital capacity (FVC) in the diagnostic screening for chronic obstructive pulmonary disease (COPD) by comparing FEV1/FVC ratios with FEV1/FEV6 ratios. METHODS In November of 2003, on World COPD Day, we conducted a campaign of diagnostic screening for COPD. The participants completed the clinical questionnaire of the Global Initiative for Obstructive Lung Disease, and those who responded affirmatively to at least three questions underwent spirometry. RESULTS A total of 134 individuals responded to three questions affirmatively and underwent spirometry. Of those, 59 were excluded: 45 for being non-smokers and 14 due to the fact that their tests did not meet the American Thoracic Society criteria for satisfactory spirometry. The number of tests in which the FEV1/FEV6 ratio was below 70% was similar to that found for the FEV1/FVC ratio. The sensitivity of FEV1/FEV6 in diagnosing airway obstruction (defined as FEV1/FVC below 70%) was 92%, and its specificity was 99%. The positive predictive value was 100%, and the negative predictive value was 98%. The Kendall correlation test revealed r = 0.99 (p < 0.0001). The t-test for paired samples revealed a negative correlation: t = -5.93 (p < 0.0001). CONCLUSION The FEV1/FEV6 proved efficient for use in the diagnostic screening for COPD. There is a strong correlation between FEV1/FVC and FEV1/FEV6.
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Kleerup E. Quality indicators for the care of chronic obstructive pulmonary disease in vulnerable elders. J Am Geriatr Soc 2007; 55 Suppl 2:S270-6. [PMID: 17910547 DOI: 10.1111/j.1532-5415.2007.01332.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Eric Kleerup
- Division of Pulmonary, Critical Care Medicine and Hospitalists, David Geffen School of Medicine at the University of California, Los Angeles, CA 90095, USA.
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Schneider A, Löwe B, Meyer FJ, Biessecker K, Joos S, Szecsenyi J. Depression and panic disorder as predictors of health outcomes for patients with asthma in primary care. Respir Med 2007; 102:359-66. [PMID: 18061424 DOI: 10.1016/j.rmed.2007.10.016] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2007] [Revised: 10/19/2007] [Accepted: 10/28/2007] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Depression and panic disorder are widely acknowledged as complicating factors in asthma patients. However, their impact on health outcomes in primary care patients is less well examined. This study prospectively evaluated the impact of depression and panic disorder on outcomes of primary care patients with asthma over 1 year. METHODS At baseline, 256 asthma patients from 43 primary care practices completed self-report questionnaires including the Patient Health Questionnaire (PHQ), the Asthma Quality of Life Questionnaire (AQLQ), and a structured questionnaire evaluating asthma severity, hospitalisation and emergency visits. One year later, 185 (72.3%) patients completed the same questionnaire. RESULTS At baseline, 3.9% of patients suffered from major depressive disorder, 22.7% from minor depressive disorder, and 7.8% from panic disorder. In the year under evaluation, 17 patients (9.2%) received emergency home visits and 10 patients (5.4%) were admitted to a hospital. Depression at baseline predicted hospitalisation within the subsequent year (OR 6.1; 95% CI 1.5-24.6) and panic disorder predicted unscheduled emergency home visits (OR 4.8; 95% CI 1.3-17.7). Depression but not panic disorder predicted the AQLQ scales activity (p=0.001), symptoms (p=0.001), emotions (p=0.001) and environment (p=0.001) at follow-up. CONCLUSIONS Although rates of hospitalisation and emergency visits in primary care are low, the impact of psychiatric comorbidity on health outcomes for patients with asthma is substantial. It might be helpful to identify patients with psychiatric comorbidity by analysing reasons for hospitalisation and emergency visits. For these patients, intensifying care with psychiatric interventions might help to reduce inappropriate healthcare utilisation and avoid adverse outcomes.
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Affiliation(s)
- Antonius Schneider
- Department of General Practice and Health Services Research, University Hospital, University of Heidelberg, Vossstrasse 2, 69115 Heidelberg, Germany.
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Naberan K, De la Roza C, Lamban M, Gobartt E, Martín A, Miravitlles M. [Use of spirometry in the diagnosis and treatment of chronic obstructive pulmonary disease in primary care]. Arch Bronconeumol 2007; 42:638-44. [PMID: 17178068 DOI: 10.1016/s1579-2129(07)60006-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The aim of this study was to assess the use of spirometry for the diagnosis and follow-up of patients with chronic obstructive pulmonary disease (COPD) in primary care in terms of deficiencies and the requirements for its correct use, and to identify the regimens most commonly used in patients with COPD. METHODS The study included 839 primary care physicians, each of whom completed 2 questionnaires, one on treatment of COPD and the other on the use of spirometry for diagnosis and follow-up of the disease. RESULTS Notable among the results was the high number of questionnaires in which no response was given to the question on classification of patients according to the severity of airway obstruction (10.7% of cases) and the low number of correct responses to questions on treatment with bronchodilators during the stable phase of COPD (15.1%). The highest rate of correct responses was for questions regarding the indication for spirometry, all of which were answered correctly in more than 60% of cases. Only 59.2% of primary health care centers performed spirometry, mainly due to a lack of training. In more than 30% of cases the nursing staff had not received specific training, a finding that was reflected in the poor compliance with guidelines for calibration (10.9% of health care centers performed daily calibrations), cleaning of the spirometer (in 13.9% of cases the equipment was never cleaned), and providing patients with pretest recommendations (30% did not provide recommendations the day before spirometry). CONCLUSIONS Primary care physicians are aware of the usefulness of spirometry for the diagnosis and follow-up of COPD. Although they are able to recognize airflow obstruction, they do not classify patients correctly in terms of severity. Very limited availability of spirometry was observed in primary health care centers and there was little training in the use of the technique, a finding reflected in the poor compliance with guidelines for its use.
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Affiliation(s)
- Karlos Naberan
- Grupo de Neumología de la Sociedad Catalana de Medicina de Familia, España
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Miravitlles M, de la Roza C, Naberan K, Lamban M, Gobartt E, Martin A. Use of spirometry and patterns of prescribing in COPD in primary care. Respir Med 2007; 101:1753-60. [PMID: 17448651 DOI: 10.1016/j.rmed.2007.02.019] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2006] [Revised: 02/13/2007] [Accepted: 02/23/2007] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To investigate the use and interpretation of spirometry in primary care (PC) in the diagnosis of chronic obstructive pulmonary disease (COPD) and to identify the treatment schedules administered. METHODS An observational study was performed in a randomized sample of 251 PC physicians including 2130 patients with COPD. Data on the performance of spirometry and the results and the treatment administered were collected as were sociodemographic and clinical data. RESULTS Spirometric results were obtained in 1243 (58.4%). Most (1118/1243; 89.9%) corresponded to FEV1 (%) values with a mean of 57% (SD=21.5%). It is of note that only 31.8% of spirometric results provided post-bonchodilator results, and 42.9% and 43.1% of the spirometries presented not plausible FVC or FEV1 values, respectively. Treatment varied greatly, with more than 3 drugs being prescribed in 30.6% of the cases. Long-acting beta-2 agonists and inhaled corticosteroids were prescribed in more than 50% of the patients. Tiotropium was administered in 32.4%. According to the GOLD guidelines, 22.8% of the patients in GOLD II, 50% in III and 66.7% in IV were receiving incorrect treatment. CONCLUSIONS Only 58.4% of the cases included had undergone spirometry. Important deficiencies were observed in the interpretation of the results of spirometry. These difficulties may influence the low implementation of treatment guidelines in COPD in PC.
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Affiliation(s)
- Marc Miravitlles
- Department of Pneumology, Institut Clínic del Tòrax (IDIBAPS), Servicio de Neumología, Hospital Clínic, Villarroel 170 08036, Barcelona, Spain.
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Naberan K, de la Roza C, Lamban M, Gobartt E, Martín A, Miravitlles M. Utilización de la espirometría en el diagnóstico y tratamiento de la EPOC en atención primaria. Arch Bronconeumol 2006. [DOI: 10.1157/13095973] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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