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Ioannides AE, Tayal U, Quint JK. Spirometry in atrial fibrillation: what's the catch? Expert Rev Respir Med 2023; 17:937-950. [PMID: 37937396 DOI: 10.1080/17476348.2023.2279236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 10/31/2023] [Indexed: 11/09/2023]
Abstract
INTRODUCTION People with COPD rarely have COPD alone, and the commonest co-morbidities occurring with COPD are cardiovascular. Whilst multiple studies have explored the association between major cardiovascular events and COPD, less attention has been paid to arrhythmias, specifically atrial fibrillation (AF). AF and COPD frequently occur together, posing challenges in diagnosis and management. In this review, we describe the relationship between AF and COPD epidemiologically and physiologically, demonstrating the role of spirometry as a diagnostic and disease management tool. AREAS COVERED We provide epidemiological evidence that COPD and AF are independent risk factors for one another, that either disease is highly prevalent amongst people with the other, and that they have shared risk factors; all of which contribute to adverse prognostic. We elucidated common pathophysiological mechanisms implicated in AF-COPD. We ultimately present the epidemiological and physiological evidence with a view to highlight specific areas where we feel spirometry is of value in the management of AF-COPD. EXPERT OPINION AF and COPD commonly co-occur, there is often diagnostic delay, increased risk of reduced cardioversion success, and missed opportunity to intervene to reduce stroke risk. Greater awareness and timelier diagnosis and guideline directed management may improve outcomes for people with both diseases.
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Affiliation(s)
| | - Upasana Tayal
- National Heart and Lung Institute, Imperial College London, London, UK
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2
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Qi C, Osborne T, Bailey R, Cooper A, Hollinghurst JP, Akbari A, Crowder R, Peters H, Law RJ, Lewis R, Smith D, Edwards A, Lyons RA. Impact of COVID-19 pandemic on incidence of long-term conditions in Wales: a population data linkage study using primary and secondary care health records. Br J Gen Pract 2023; 73:e332-e339. [PMID: 37105743 PMCID: PMC9997656 DOI: 10.3399/bjgp.2022.0353] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 11/25/2022] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has directly and indirectly had an impact on health service provision owing to surges and sustained pressures on the system. The effects of these pressures on the management of long-term or chronic conditions are not fully understood. AIM To explore the effects of COVID-19 on the recorded incidence of 17 long-term conditions. DESIGN AND SETTING This was an observational retrospective population data linkage study on the population of Wales using primary and secondary care data within the Secure Anonymised Information Linkage (SAIL) Databank. METHOD Monthly rates of new diagnosis between 2000 and 2021 are presented for each long-term condition. Incidence rates post-2020 were compared with expected rates predicted using time series modelling of pre-2020 trends. The proportion of annual incidence is presented by sociodemographic factors: age, sex, social deprivation, ethnicity, frailty, and learning disability. RESULTS A total of 5 476 012 diagnoses from 2 257 992 individuals are included. Incidence rates from 2020 to 2021 were lower than mean expected rates across all conditions. The largest relative deficit in incidence was in chronic obstructive pulmonary disease corresponding to 343 (95% confidence interval = 230 to 456) undiagnosed patients per 100 000 population, followed by depression, type 2 diabetes, hypertension, anxiety disorders, and asthma. A GP practice of 10 000 patients might have over 400 undiagnosed long-term conditions. No notable differences between sociodemographic profiles of post- and pre-2020 incidences were observed. CONCLUSION There is a potential backlog of undiagnosed patients with multiple long-term conditions. Resources are required to tackle anticipated workload as part of COVID-19 recovery, particularly in primary care.
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Affiliation(s)
- Cathy Qi
- Population Data Science, Swansea University Medical School, Faculty of Medicine, Health & Life Science, Swansea University, Swansea
| | - Tim Osborne
- Population Data Science, Swansea University Medical School, Faculty of Medicine, Health & Life Science, Swansea University, Swansea
| | - Rowena Bailey
- Population Data Science, Swansea University Medical School, Faculty of Medicine, Health & Life Science, Swansea University, Swansea
| | - Alison Cooper
- Wales COVID-19 Evidence Centre, Division of Population Medicine, Cardiff University, Cardiff
| | - Joe P Hollinghurst
- Population Data Science, Swansea University Medical School, Faculty of Medicine, Health & Life Science, Swansea University, Swansea
| | - Ashley Akbari
- Population Data Science, Swansea University Medical School, Faculty of Medicine, Health & Life Science, Swansea University, Swansea
| | - Ruth Crowder
- Directorate of Primary Care and Mental Health, Health and Social Services Group, Welsh Government, Cardiff
| | - Holly Peters
- Centre for Medical Education, Cardiff University, Cardiff
| | - Rebecca-Jane Law
- Technical Advisory Cell, Health and Social Services Group, Welsh Government, Cardiff
| | - Ruth Lewis
- North Wales Centre for Primary Care Research, PRIME Centre Wales, Bangor University, Bangor
| | - Deb Smith
- Wales COVID-19 Evidence Centre, Division of Population Medicine, Cardiff University, Cardiff
| | - Adrian Edwards
- Wales COVID-19 Evidence Centre, Division of Population Medicine, Cardiff University, Cardiff
| | - Ronan A Lyons
- Population Data Science, Swansea University Medical School, Faculty of Medicine, Health & Life Science, Swansea University, Swansea
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3
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Wirth IM, Penz ED, Marciniuk DD. Examination of COPD management in patients hospitalized with an acute exacerbation of COPD. CANADIAN JOURNAL OF RESPIRATORY, CRITICAL CARE, AND SLEEP MEDICINE 2022. [DOI: 10.1080/24745332.2020.1719941] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Ingrid M. Wirth
- Division of Respirology, Critical Care, and Sleep Medicine, Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Erika D. Penz
- Division of Respirology, Critical Care, and Sleep Medicine, Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
- Respiratory Research Center, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Darcy D. Marciniuk
- Division of Respirology, Critical Care, and Sleep Medicine, Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
- Respiratory Research Center, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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4
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Delmas MC, Bénézet L, Ribet C, Iwatsubo Y, Zins M, Nadif R, Roche N, Leynaert B. Underdiagnosis of obstructive lung disease: findings from the French CONSTANCES cohort. BMC Pulm Med 2021; 21:319. [PMID: 34649556 PMCID: PMC8518215 DOI: 10.1186/s12890-021-01688-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 10/04/2021] [Indexed: 11/15/2022] Open
Abstract
Background The burden of undiagnosed obstructive lung disease (OLD) (mainly asthma and chronic obstructive pulmonary disease) is not fully established, and targets for corrective action are yet to be identified. We assessed the underdiagnosis of OLD and its determinants in France. Methods CONSTANCES is a French population-based cohort of adults aged 18–69 years at inception. We analysed data collected at inclusion in 2013–2014. Undiagnosed OLD was defined as spirometry-confirmed airflow limitation (FEV1/FVC < lower limit of normal) without prior diagnosis of asthma, chronic obstructive pulmonary disease, or bronchiectasis. Multivariate analysis was performed with weighted robust Poisson regression models to estimate the adjusted prevalence ratios (aPR) of undiagnosed OLD. Results Spirometry results were available for 19,398 participants. The prevalence of airflow limitation was 4.6%. Overall, 64.4% of adults with airflow limitation did not report a previous diagnosis of OLD. Individuals with high cumulative tobacco consumption (≥ 10 pack-years) (aPR: 1.72 [1.28–2.32]), without respiratory symptoms (aPR: 1.51 [1.28–1.78]), and with preserved lung function (aPR: 1.21 [1.04–1.41] for a 10-point increase in FEV1% predicted) had a higher risk of being undiagnosed. Half of symptomatic individuals with airflow limitation (45% of those with moderate to severe airflow limitation) were undiagnosed with OLD. Conclusion Underdiagnosis of OLD is very common among French adults, even in patients with respiratory symptoms. Efforts should be made in France to raise awareness about OLD in the general population, improve the detection of respiratory symptoms, and increase the use of spirometry among primary care professionals. Supplementary Information The online version contains supplementary material available at 10.1186/s12890-021-01688-z.
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Affiliation(s)
- Marie-Christine Delmas
- Santé Publique France, French National Public Health Agency, 12 Rue du Val d'Osne, 94415, Saint-Maurice Cedex, France.
| | - Laetitia Bénézet
- Santé Publique France, French National Public Health Agency, 12 Rue du Val d'Osne, 94415, Saint-Maurice Cedex, France
| | - Céline Ribet
- Inserm UMS 011, Population-Based Epidemiological Cohorts, Villejuif, France
| | - Yuriko Iwatsubo
- Santé Publique France, French National Public Health Agency, 12 Rue du Val d'Osne, 94415, Saint-Maurice Cedex, France
| | - Marie Zins
- Inserm UMS 011, Population-Based Epidemiological Cohorts, Villejuif, France
| | - Rachel Nadif
- Inserm, Équipe d'Épidémiologie Respiratoire Intégrative, CESP, Université Paris-Saclay, UVSQ, Université Paris-Sud, Villejuif, France
| | - Nicolas Roche
- Inserm, Équipe d'Épidémiologie Respiratoire Intégrative, CESP, Université Paris-Saclay, UVSQ, Université Paris-Sud, Villejuif, France.,APHP Centre, Hôpital et Institut Cochin, Service de Pneumologie, Université de Paris, Paris, France
| | - Bénédicte Leynaert
- Inserm, Équipe d'Épidémiologie Respiratoire Intégrative, CESP, Université Paris-Saclay, UVSQ, Université Paris-Sud, Villejuif, France
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5
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Jacobsen PA, Kragholm KH, Torp-Pedersen C, Janssen DJA, Spruit MA, Weinreich UM. Employment Status, Readmission and Mortality After Acute Exacerbation of COPD. Int J Chron Obstruct Pulmon Dis 2021; 16:2257-2265. [PMID: 34385815 PMCID: PMC8352575 DOI: 10.2147/copd.s319840] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 07/19/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction The understanding of whether and to what extent employment status affects readmission and mortality is limited in patients with COPD. Aim To explore how employment status affects readmission and mortality after first admission to the hospital with acute exacerbation of COPD (AECOPD). Methods This study used Danish national registry-based data. All patients admitted for the first time to the hospital between 1999 and 2014 with a diagnosis of AECOPD, age 35–59, without a previous asthma diagnosis were included in the study. Employment status effect on 30-, 90-, and 365-day readmission and mortality was examined using logistic regression, adjusting for relevant confounders. Results A total of 11,850 COPD patients were included in the study of which 3563 (30%) were working, 1368 (12%) unemployed, 840 (7%) on sick leave, and 6079 (51%) receiving early retirement. Patients receiving early retirement had, compared to patients working, an adjusted increased likelihood of readmission at 30, 90, and 365 days (odds ratio (OR) 1.26 (CI95% (1.06–1.49)), 1.33 (CI95% (1.16–1.53)), and 1.48 (CI95% (1.33–1.66)), respectively). An increased likelihood was also seen in unemployed at 365 days follow-up (OR 1.44 (CI95% (1.22–1.68))). Early retirement was associated with an increased mortality at 30, 90, and 365 days (OR 1.39 (CI95% (1.07–1.80)) 1.37 (CI95% (1.09–1.79)) and 1.48 (CI95% (1.25–1.75)), respectively). An increased likelihood was also seen in patients receiving sick leave (OR 1.57 (CI95% (1.21–2.04))). Conclusion Patients with COPD who are not working at the time of first admission have a higher likelihood of readmission and mortality.
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Affiliation(s)
- Peter Ascanius Jacobsen
- Department of Respiratory Diseases, Aalborg University Hospital, Aalborg, Denmark.,The Clinical Institute, Aalborg University, Aalborg, Denmark
| | - Kristian Hay Kragholm
- The Clinical Institute, Aalborg University, Aalborg, Denmark.,Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | | | - Daisy J A Janssen
- Department of Research and Development, Ciro, Horn, the Netherland.,Department of Health Services Research, Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Martijn A Spruit
- Department of Research and Development, Ciro, Horn, the Netherland.,Nutrim School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands.,Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands
| | - Ulla Møller Weinreich
- Department of Respiratory Diseases, Aalborg University Hospital, Aalborg, Denmark.,The Clinical Institute, Aalborg University, Aalborg, Denmark
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6
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Denguezli M, Daldoul H, Harrabi I, Chouikha F, Ghali H, Burney P, Tabka Z. Prevalence and Characteristics of Undiagnosed COPD in Adults 40 Years and Older - Reports from the Tunisian Population-Based Burden of Obstructive Lung Disease Study. COPD 2020; 17:515-522. [PMID: 32781855 DOI: 10.1080/15412555.2020.1804848] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 07/18/2020] [Accepted: 07/27/2020] [Indexed: 02/09/2023]
Abstract
This study aimed to investigate the underdiagnosis of COPD and its determinants based on the Tunisian Burden of Obstructive Lung Disease study. We collected information on respiratory history symptoms and risk factors for COPD. Post-bronchodilator (Post-BD) FEV1/FVC < the lower limit of normal (LLN) was used to define COPD. Undiagnosed COPD was considered when participants had post-BD FEV1/FVC < LLN but were not given a diagnosis of emphysema, chronic bronchitis or COPD. 730 adults aged ⩾40 years selected from the general population were interviewed, 661 completed spirometry, 35 (5.3%) had COPD and 28 (80%) were undiagnosed with the highest prevalence in women (100%). When compared with patients with an established COPD diagnosis, undiagnosed subjects had a lower education level, milder airway obstruction (Post-BD FEV1 z-score -2.2 vs. -3.7, p < 0.001), fewer occurrence of wheezing (42.9% vs. 100%, p = 0.009), less previous lung function test (3.6% vs. 42.8%, p = 0.019) and less visits to the physician (32.1% vs. 85.7%, p = 0.020) in the past year. Multivaried analysis showed that the probability of COPD underdiagnosis was higher in subjects who had mild to moderate COPD and in those who did not visit a clinician and did not perform a spirometry in the last year. Collectively, our results highlight the need to improve the diagnosis of COPD in Tunisia. Wider use of spirometry should reduce the incidence of undiagnosed COPD. Spirometry should also predominately be performed not only in elderly male smokers but also in younger women in whom the prevalence of underdiagnosis is the highest.
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Affiliation(s)
- Meriam Denguezli
- Laboratoire de recherche physiologie de l'exercice et physiopathologie: de l'intégré au moléculaire, LR19ES09, Faculty of Medicine Ibn El Jazzar, Sousse, Tunisia
- Faculty of Dental Medicine, Monastir, Tunisia
| | - Hager Daldoul
- Laboratoire de recherche physiologie de l'exercice et physiopathologie: de l'intégré au moléculaire, LR19ES09, Faculty of Medicine Ibn El Jazzar, Sousse, Tunisia
| | - Imed Harrabi
- Department of Epidemiology, University Hospital Farhat Hached, Sousse, Tunisia
| | - Firas Chouikha
- Department of Epidemiology, University Hospital Farhat Hached, Sousse, Tunisia
| | - Hela Ghali
- Department of Epidemiology, University Hospital Farhat Hached, Sousse, Tunisia
| | - Peter Burney
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Zouhair Tabka
- Laboratoire de recherche physiologie de l'exercice et physiopathologie: de l'intégré au moléculaire, LR19ES09, Faculty of Medicine Ibn El Jazzar, Sousse, Tunisia
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7
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Fu SN, Yu WC, Wong CKH, Lam MCH. Prevalence of undiagnosed airflow obstruction among people with a history of smoking in a primary care setting. Int J Chron Obstruct Pulmon Dis 2016; 11:2391-2399. [PMID: 27729780 PMCID: PMC5045907 DOI: 10.2147/copd.s106306] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose The purpose of this study was to define the prevalence of undiagnosed airflow obstruction (AO) among subjects with a history of smoking but no previous diagnosis of chronic lung disease. The finding of AO likely represents diagnosis of chronic obstructive pulmonary disease. Patients People aged ≥30 years with a history of smoking who attended public outpatient clinics for primary care services were included in this study. Methods A cross-sectional survey in five clinics in Hong Kong using the Breathlessness, Cough, and Sputum Scale, the Lung Function Questionnaire, and office spirometry was conducted. Results In total, 731 subjects (response rate =97.9%) completed the questionnaires and spirometry tests. Most of the subjects were men (92.5%) in the older age group (mean age =62.2 years; standard deviation =11.7). Of the 731 subjects, 107 had AO, giving a prevalence of 14.6% (95% confidence interval =12.1–17.2); 45 subjects with AO underwent a postbronchodilator test. By classifying the severity of chronic obstructive pulmonary disease using the Global Initiative for Chronic Obstructive Lung Disease, 27 (60%) were considered to be in mild category and 18 (40%) in moderate category. None of them belonged to the severe or very severe category. The total score of Lung Function Questionnaire showed that majority of the subjects with AO also had chronic cough, wheezing attack, or breathlessness, although most did not show any acute respiratory symptoms in accordance with the Breathlessness, Cough, and Sputum Scale. Diagnosis of AO was positively associated with the number of years of smoking (odds ratio =1.044, P=0.035) and being normal or underweight (odds ratio =1.605, P=0.046). It was negatively associated with a history of hypertension (odds ratio =0.491, P=0.003). Conclusion One-seventh of smokers have undiagnosed AO. Spirometry screening of smokers should be considered in order to diagnose AO at an early stage, with an emphasis on smoking cessation.
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Affiliation(s)
- Sau Nga Fu
- Department of Family Medicine and Primary Health Care, Kowloon West Cluster, Hospital Authority
| | - Wai Cho Yu
- Department of Medicine and Geriatrics, Princess Margaret Hospital
| | - Carlos King-Ho Wong
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR
| | - Margaret Choi-Hing Lam
- Department of Family Medicine and Primary Health Care, Kowloon West Cluster, Hospital Authority
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8
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Mochizuki E, Shirai T, Hayashi I, Noguchi R, Sakurai S, Saigusa M, Yamamoto A, Shishido Y, Akita T, Morita S, Asada K, Fujii M. Undiagnosed chronic obstructive pulmonary disease in hospitalized patients with pneumonia in Japan. Respir Investig 2016; 54:369-371. [PMID: 27566386 DOI: 10.1016/j.resinv.2016.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 03/28/2016] [Accepted: 04/19/2016] [Indexed: 06/06/2023]
Affiliation(s)
- Eisuke Mochizuki
- Department of Respiratory Medicine, Shizuoka General Hospital, Shizuoka, Japan
| | - Toshihiro Shirai
- Department of Respiratory Medicine, Shizuoka General Hospital, Shizuoka, Japan.
| | - Ichiro Hayashi
- Department of Respiratory Medicine, Shizuoka General Hospital, Shizuoka, Japan
| | - Rie Noguchi
- Department of Respiratory Medicine, Shizuoka General Hospital, Shizuoka, Japan
| | - Shogo Sakurai
- Department of Respiratory Medicine, Shizuoka General Hospital, Shizuoka, Japan
| | - Mika Saigusa
- Department of Respiratory Medicine, Shizuoka General Hospital, Shizuoka, Japan
| | - Akito Yamamoto
- Department of Respiratory Medicine, Shizuoka General Hospital, Shizuoka, Japan
| | - Yuichiro Shishido
- Department of Respiratory Medicine, Shizuoka General Hospital, Shizuoka, Japan
| | - Takefumi Akita
- Department of Respiratory Medicine, Shizuoka General Hospital, Shizuoka, Japan
| | - Satoru Morita
- Department of Respiratory Medicine, Shizuoka General Hospital, Shizuoka, Japan
| | - Kazuhiro Asada
- Department of Respiratory Medicine, Shizuoka General Hospital, Shizuoka, Japan
| | - Masato Fujii
- Department of Respiratory Medicine, Shizuoka General Hospital, Shizuoka, Japan
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9
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Moon JH, Kong MH, Kim HJ. Implication of Sarcopenia and Sarcopenic Obesity on Lung Function in Healthy Elderly: Using Korean National Health and Nutrition Examination Survey. J Korean Med Sci 2015; 30:1682-8. [PMID: 26539015 PMCID: PMC4630487 DOI: 10.3346/jkms.2015.30.11.1682] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 08/10/2015] [Indexed: 01/01/2023] Open
Abstract
Previous studies have demonstrated a positive association between obesity and decreased lung function. However, the effect of muscle and fat has not been fully assessed, especially in a healthy elderly population. In this study, we evaluated the impact of low muscle mass (LMM) and LMM with obesity on pulmonary impairment in healthy elderly subjects. Our study used data from the Korea National Health and Nutrition Examination Survey from 2008 to 2011. Men and women aged 65 yr or older were included. Muscle mass was measured by dual-energy X-ray absorptiometry. LMM was defined as two standard deviations below the sex-specific mean for young healthy adults. Obesity was defined as body mass index ≥ 25 kg/m(2). The prevalence of LMM in individuals aged over 65 was 11.9%. LMM and pulmonary function (forced vital capacity and forced expiratory volume in 1 second) were independently associated after adjusting for age, sex, body mass index, smoking status, alcohol consumption, and frequency of exercise. LMM with obesity was also related to a decrease in pulmonary function. This study revealed that LMM is an independent risk factor of decreased pulmonary function in healthy Korean men and women over 65 yr of age.
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Affiliation(s)
- Ji Hyun Moon
- Department of Family Medicine, Jeju National University Hospital, Jeju, Korea
- Graduate School of Jeju National University, Jeju, Korea
| | - Mi Hee Kong
- Department of Family Medicine, Jeju National University Hospital, Jeju, Korea
- Department of Family Medicine, School of Medicine, Jeju National University, Jeju, Korea
| | - Hyeon Ju Kim
- Department of Family Medicine, Jeju National University Hospital, Jeju, Korea
- Department of Family Medicine, School of Medicine, Jeju National University, Jeju, Korea
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10
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Ambrosino N, Casaburi R, Chetta A, Clini E, Donner CF, Dreher M, Goldstein R, Jubran A, Nici L, Owen CA, Rochester C, Tobin MJ, Vagheggini G, Vitacca M, ZuWallack R. 8th international conference on management and rehabilitation of chronic respiratory failure: the long summaries – part 1. Multidiscip Respir Med 2015. [PMCID: PMC4595244 DOI: 10.1186/s40248-015-0026-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
This paper summarizes the Part 1 of the proceedings of the 8th International Conference on Management and Rehabilitation of Chronic Respiratory Failure, held in Pescara, Italy, on 7 and 8 May, 2015. It summarizes the contributions from numerous experts in the field of chronic respiratory disease and chronic respiratory failure. The outline follows the temporal sequence of presentations. This paper (Part 1) includes sections regarding: Advances in Asthma and COPD Therapy (Novel Therapeutic Targets for Asthma: Proteinases, Blood Biomarker Changes in COPD Patients); The problem of Hospital Re-Admission following Discharge after the COPD Exacerbation (Characteristics of the Hospitalized COPD Patient, Reducing Hospital Readmissions Following COPD Exacerbation).
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11
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Khakban A, Sin DD, FitzGerald JM, Ng R, Zafarí Z, McManus B, Hollander Z, Marra CA, Sadatsafavi M. Ten-Year Trends in Direct Costs of COPD. Chest 2015; 148:640-646. [DOI: 10.1378/chest.15-0721] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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12
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Haroon SM, Jordan RE, O'Beirne-Elliman J, Adab P. Effectiveness of case finding strategies for COPD in primary care: a systematic review and meta-analysis. NPJ Prim Care Respir Med 2015; 25:15056. [PMID: 26313400 PMCID: PMC4551096 DOI: 10.1038/npjpcrm.2015.56] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2015] [Revised: 06/14/2015] [Accepted: 07/12/2015] [Indexed: 11/12/2022] Open
Abstract
Background: Chronic obstructive pulmonary disease (COPD) is widely underdiagnosed, but the most effective approach for identifying these patients is unknown. Aims: The aim of this study was to summarise and compare the effectiveness of different case finding approaches for undiagnosed COPD in primary care. Methods: A systematic review of primary studies of any design evaluating case finding strategies for COPD in primary care among individuals aged ⩾35 years with no prior diagnosis was conducted. Medline, Embase and other bibliographic databases were searched from 1997 to 2013, and methodological quality was assessed using standard tools. Results were described and meta-analysis of the uptake and yield from different approaches was performed where there was sufficient homogeneity. Results: Three randomised controlled trials (RCTs), 1 controlled trial and 35 uncontrolled studies were identified that assessed the identification of new cases of COPD through systematic case finding. A range of approaches were used including pre-screening with questionnaires (n=13) or handheld flow meters (n=5) or direct invitation to diagnostic spirometry (n=30). Overall, any approach identified more undiagnosed COPD compared with usual care. Targeting those at higher risk (e.g., smokers) and pre-screening (e.g., using questionnaires) is likely to increase the yield. However, studies were heterogeneous and were limited by a lack of comparison groups, inadequate reporting and diversity in the definition of COPD, which limited our ability to draw firm conclusions. Conclusions: There is extensive heterogeneity among studies evaluating case finding strategies for COPD, with few RCTs. Well-conducted RCTs comparing case finding approaches are needed to identify the most effective target population, recruitment strategy and screening tests, using a clinical definition of COPD, and addressing the limitations highlighted in this review. There is also a need to evaluate the impact of case finding on clinical care and patient outcomes.
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Affiliation(s)
- Shamil Mm Haroon
- Public Health, Epidemiology & Biostatistics, School of Health and Population Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - Rachel E Jordan
- Public Health, Epidemiology & Biostatistics, School of Health and Population Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - Joanne O'Beirne-Elliman
- Public Health, Epidemiology & Biostatistics, School of Health and Population Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - Peymane Adab
- Public Health, Epidemiology & Biostatistics, School of Health and Population Sciences, University of Birmingham, Edgbaston, Birmingham, UK
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Abstract
We welcome the important paper by Grønsethet al. [1], which used data from the Burden of Obstructive Lung Disease (BOLD) project to highlight the prevalence of breathlessness across the world. As well as being significant because it is a source of suffering that should be ameliorated, we believe that attention to breathlessness, particularly in midlife, has important implications for sustainable healthcare because it allows timely diagnosis, would drive the promotion of physical activity, forms part of a strategy to reduce the burden of comorbidities and would have beneficial environmental effects. Targeting breathlessness is important for delivering sustainable future healthcarehttp://ow.ly/AgKoA
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Affiliation(s)
- Amina Aitsi-Selmi
- Institute of Health Equity, Dept of Epidemiology and Public Health, London, UK
| | - Nicholas S Hopkinson
- NIHR Respiratory Biomedical Research Unit at Royal Brompton and Harefield NHS Foundation Trust and Imperial College London, London, UK
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14
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Leidy NK, Kim K, Bacci ED, Yawn BP, Mannino DM, Thomashow BM, Barr RG, Rennard SI, Houfek JF, Han MK, Meldrum CA, Make BJ, Bowler RP, Steenrod AW, Murray LT, Walsh JW, Martinez F. Identifying cases of undiagnosed, clinically significant COPD in primary care: qualitative insight from patients in the target population. NPJ Prim Care Respir Med 2015; 25:15024. [PMID: 26028486 PMCID: PMC4532157 DOI: 10.1038/npjpcrm.2015.24] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Revised: 12/17/2014] [Accepted: 12/28/2014] [Indexed: 11/29/2022] Open
Abstract
Background: Many cases of chronic obstructive pulmonary disease (COPD) are diagnosed only after significant loss of lung function or during exacerbations. Aims: This study is part of a multi-method approach to develop a new screening instrument for identifying undiagnosed, clinically significant COPD in primary care. Methods: Subjects with varied histories of COPD diagnosis, risk factors and history of exacerbations were recruited through five US clinics (four pulmonary, one primary care). Phase I: Eight focus groups and six telephone interviews were conducted to elicit descriptions of risk factors for COPD, recent or historical acute respiratory events, and symptoms to inform the development of candidate items for the new questionnaire. Phase II: A new cohort of subjects participated in cognitive interviews to assess and modify candidate items. Two peak expiratory flow (PEF) devices (electronic, manual) were assessed for use in screening. Results: Of 77 subjects, 50 participated in Phase I and 27 in Phase II. Six themes informed item development: exposure (smoking, second-hand smoke); health history (family history of lung problems, recurrent chest infections); recent history of respiratory events (clinic visits, hospitalisations); symptoms (respiratory, non-respiratory); impact (activity limitations); and attribution (age, obesity). PEF devices were rated easy to use; electronic values were significantly higher than manual (P<0.0001). Revisions were made to the draft items on the basis of cognitive interviews. Conclusions: Forty-eight candidate items are ready for quantitative testing to select the best, smallest set of questions that, together with PEF, can efficiently identify patients in need of diagnostic evaluation for clinically significant COPD.
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Balcells E, Gimeno-Santos E, de Batlle J, Ramon MA, Rodríguez E, Benet M, Farrero E, Ferrer A, Guerra S, Ferrer J, Sauleda J, Barberà JA, Agustí À, Rodriguez-Roisin R, Gea J, Antó JM, Garcia-Aymerich J. Characterisation and prognosis of undiagnosed chronic obstructive pulmonary disease patients at their first hospitalisation. BMC Pulm Med 2015; 15:4. [PMID: 25595204 PMCID: PMC4360934 DOI: 10.1186/1471-2466-15-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2015] [Accepted: 01/08/2015] [Indexed: 11/22/2022] Open
Abstract
Background Under-diagnosis of COPD is an important unmet medical need. We investigated the characteristics and prognosis of hospitalised patients with undiagnosed COPD. Methods The PAC-COPD cohort included 342 COPD patients hospitalised for the first time for an exacerbation of COPD (2004–2006). Patients were extensively characterised using sociodemographic, clinical and functional variables, and the cohort was followed-up through 2008. We defined “undiagnosed COPD” by the absence of any self-reported respiratory disease and regular use of any pharmacological respiratory treatment. Results Undiagnosed COPD was present in 34% of patients. They were younger (mean age 66 vs. 68 years, p = 0.03), reported fewer symptoms (mMRC dyspnoea score, 2.1 vs. 2.6, p < 0.01), and had a better health status (SGRQ total score, 29 vs. 40, p < 0.01), milder airflow limitation (FEV1% ref., 59% vs. 49%, p < 0.01), and fewer comorbidities (two or more, 40% vs. 56%, p < 0.01) when compared with patients with an established COPD diagnosis. Three months after hospital discharge, 16% of the undiagnosed COPD patients had stopped smoking (vs. 5%, p = 0.019). During follow-up, annual hospitalisation rates were lower in undiagnosed COPD patients (0.14 vs. 0.25, p < 0.01); however, this difference disappeared after adjustment for severity. Mortality was similar in both groups. Conclusions Undiagnosed COPD patients have less severe disease and lower risk of re-hospitalisation when compared with hospitalised patients with known COPD. Electronic supplementary material The online version of this article (doi:10.1186/1471-2466-15-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Judith Garcia-Aymerich
- Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Doctor Aiguader 88, 08003 Barcelona, Spain.
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Maddocks M, Kon SS, Singh SJ, Man WDC. Rehabilitation following hospitalization in patients with COPD: Can it reduce readmissions? Respirology 2014; 20:395-404. [DOI: 10.1111/resp.12454] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Revised: 10/16/2014] [Accepted: 11/09/2014] [Indexed: 12/14/2022]
Affiliation(s)
- Matthew Maddocks
- King's College London; Cicely Saunders Institute; London UK
- Harefield Pulmonary Rehabilitation Unit; Royal Brompton and Harefield NHS Foundation Trust; London UK
| | - Samantha S.C. Kon
- Harefield Pulmonary Rehabilitation Unit; Royal Brompton and Harefield NHS Foundation Trust; London UK
- NIHR Respiratory Biomedical Research Unit; Royal Brompton and Harefield NHS Foundation Trust and Imperial College; London UK
| | - Sally J. Singh
- Centre for Exercise and Rehabilitation Science and Institute for Lung Health; University Hospitals of Leicester NHS Trust; Leicester UK
| | - William D.-C. Man
- Harefield Pulmonary Rehabilitation Unit; Royal Brompton and Harefield NHS Foundation Trust; London UK
- NIHR Respiratory Biomedical Research Unit; Royal Brompton and Harefield NHS Foundation Trust and Imperial College; London UK
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Mendoza L, Horta P, Espinoza J, Aguilera M, Balmaceda N, Castro A, Ruiz M, Díaz O, Hopkinson NS. Pedometers to enhance physical activity in COPD: a randomised controlled trial. Eur Respir J 2014; 45:347-54. [PMID: 25261324 PMCID: PMC4318658 DOI: 10.1183/09031936.00084514] [Citation(s) in RCA: 132] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Physical inactivity is a cardinal feature of chronic obstructive pulmonary disease (COPD), and is associated with increased morbidity and mortality. Pedometers, which have been used in healthy populations, might also increase physical activity in patients with COPD. COPD patients taking part in a 3-month individualised programme to promote an increase in their daily physical activity were randomised to either a standard programme of physical activity encouragement alone, or a pedometer-based programme. Assessments were performed by investigators blinded to treatment allocation. Change in average 1-week daily step count, 6-min walking distance (6MWD), modified Medical Research Council scale, St George's respiratory questionnaire (SGRQ) and COPD assessment test (CAT) were compared between groups. 102 patients were recruited, of whom 97 completed the programme (pedometer group: n=50; control group: n=47); 60.8% were male with a mean±sd age of 68.7±8.5 years, and forced expiratory volume in 1 s (FEV1) 66.1±19.4% and FEV1/forced vital capacity 55.2±9.5%. Both groups had comparable characteristics at baseline. The pedometer group had significantly greater improvements in: physical activity 3080±3254 steps·day(-1) versus 138.3±1950 steps·day(-1) (p<0.001); SGRQ -8.8±12.2 versus -3.8±10.9 (p=0.01); CAT score -3.5±5.5 versus -0.6±6.6 (p=0.001); and 6MWD 12.4±34.6 versus -0.7±24.4 m (p=0.02) than patients receiving activity encouragement only. A simple physical activity enhancement programme using pedometers can effectively improve physical activity level and quality of life in COPD patients.
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Affiliation(s)
- Laura Mendoza
- Sección Neumología, Departamento de Medicina, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Paula Horta
- Sección Neumología, Departamento de Medicina, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - José Espinoza
- Sección Neumología, Departamento de Medicina, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Miguel Aguilera
- Sección Neumología, Departamento de Medicina, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Nicolás Balmaceda
- Sección Neumología, Departamento de Medicina, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Ariel Castro
- Sección Neumología, Departamento de Medicina, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Mauricio Ruiz
- Sección Neumología, Departamento de Medicina, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Orlando Díaz
- Departamento de Enfermedades Respiratorias, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Nicholas S Hopkinson
- National Institute for Health Research Respiratory Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, Imperial College, London, UK
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Wurst KE, Shukla A, Muellerova H, Davis KJ. Respiratory pharmacotherapy use in patients newly diagnosed with chronic obstructive pulmonary disease in a primary care setting in the UK: a retrospective cohort study. COPD 2014; 11:521-30. [PMID: 24945236 DOI: 10.3109/15412555.2014.922064] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
This retrospective cohort study aimed to analyze the prescribing practices of general practitioners treating patients with newly diagnosed chronic obstructive pulmonary disease (COPD), and to assess characteristics associated with initial pharmacotherapy. Patients were identified in the General Practice Research Database, a population-based UK electronic medical record (EMR) with data from January 1, 2008 to December 31, 2009. Patient characteristics, prescribed COPD pharmacotherapies (≤12 months before diagnosis and within 3 months following diagnosis), co-morbidities, hospitalizations, and events indicative of a possible COPD exacerbation (≤12 months before diagnosis) were analyzed in 7881 patients with newly diagnosed COPD. Most patients (64.4%) were prescribed COPD pharmacotherapy in the 12 months before diagnosis. Following diagnosis, COPD pharmacotherapy was prescribed within 3 months in 85.0% of patients. Short-acting bronchodilators alone (22.9%) or inhaled corticosteroids + long-acting beta-2 agonists (ICS+LABA, 22.1%) were prescribed most frequently. Compared with other pharmacotherapies, the prevalence of severe airflow limitation was highest in patients prescribed ICS+LABA+long-acting muscarinic antagonists (LAMA). Moderate-to-severe dyspnea was identified most frequently in patients prescribed a LAMA-containing regimen. Patients prescribed an ICS-containing regimen had a higher prevalence of asthma or possible exacerbations recorded in the EMR than those not prescribed ICS. In conclusion, pharmacotherapy prescribed at initial COPD diagnosis varied by disease severity indicators as assessed by airflow limitation, dyspnea, history of asthma, and possible exacerbations. Frequent prescription of COPD pharmacotherapies before the first-recorded COPD diagnosis indicates a delay between obstructive lung disease presentation in primary care practice and assignment of a medical diagnosis.
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Affiliation(s)
- Keele E Wurst
- 1Worldwide Epidemiology, GlaxoSmithKline R&D, Research Triangle Park , NC , USA
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19
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van der Molen T, Diamant Z, Kocks JWH, Tsiligianni IG. The use of health status questionnaires in the management of chronic obstructive pulmonary disease patients in clinical practice. Expert Rev Respir Med 2014; 8:479-91. [DOI: 10.1586/17476348.2014.918851] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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20
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Lindgren S, Storli SL, Wiklund-Gustin L. Living in negotiation: patients' experiences of being in the diagnostic process of COPD. Int J Chron Obstruct Pulmon Dis 2014; 9:441-51. [PMID: 24851046 PMCID: PMC4018318 DOI: 10.2147/copd.s60182] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Purpose To illuminate patients’ lived experiences of going through the process of being diagnosed with chronic obstructive pulmonary disease (COPD). Patients and methods A phenomenological-hermeneutic analysis was applied in the interpretation of interviews with eight persons diagnosed with mild or moderate COPD. Results One main theme ‘living in negotiation’, and three themes ‘living with a body out of step with the diagnosis’, ‘dealing with the past’, and ‘being challenged by the future’ reflected the process participants were living through in their quest for acceptance and a new balance in life. Participants found that the diagnostic processes were confusing, and that the diagnosis itself was ‘a slap in the face’. Unclear messages gave rise to fluctuating between an understanding of the condition as ‘not too severe’, insecurity, and fear. Shame and guilt related to the diagnosis had origins in the past, and in combination with the idea of ‘chronic’ the COPD diagnosis interfered with the present moment and gave rise to uncertainty for the future. The understanding of the present is related to negotiations not only with the past, but also with the future. Thus temporal aspects of the diagnosis are of great significance for the process of finding acceptance. Conclusion Regardless of disease severity, the diagnosis seems to be a breakdown of life, which puts life itself at stake. Medical professionals should be aware that the way the diagnosis is disclosed and communicated has considerable significance for how individuals understand and deal with their illness. The diagnosis should be communicated face-to-face, clearly and with empathy, and followed by information about COPD. Physicians should allow time and listen to the patients’ stories, and thus develop a shared understanding of the temporal aspect of the illness and patients’ needs and concerns. Thus, good communication is essential in determining whether the patient remains in negotiation, or enters a process toward acceptance and new understanding.
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Affiliation(s)
- Sari Lindgren
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT Arctic University of Norway, Tromsø, Norway ; Faculty of Health and Society, Narvik University College, Narvik, Norway
| | - Sissel Lisa Storli
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT Arctic University of Norway, Tromsø, Norway
| | - Lena Wiklund-Gustin
- Faculty of Health and Society, Narvik University College, Narvik, Norway ; School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
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Donaldson GC. Exacerbations in non-COPD patients: recognition? Thorax 2014; 69:689-90. [PMID: 24794419 DOI: 10.1136/thoraxjnl-2014-205355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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22
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Spruit MA, Singh SJ, Garvey C, ZuWallack R, Nici L, Rochester C, Hill K, Holland AE, Lareau SC, Man WDC, Pitta F, Sewell L, Raskin J, Bourbeau J, Crouch R, Franssen FME, Casaburi R, Vercoulen JH, Vogiatzis I, Gosselink R, Clini EM, Effing TW, Maltais F, van der Palen J, Troosters T, Janssen DJA, Collins E, Garcia-Aymerich J, Brooks D, Fahy BF, Puhan MA, Hoogendoorn M, Garrod R, Schols AMWJ, Carlin B, Benzo R, Meek P, Morgan M, Rutten-van Mölken MPMH, Ries AL, Make B, Goldstein RS, Dowson CA, Brozek JL, Donner CF, Wouters EFM. An official American Thoracic Society/European Respiratory Society statement: key concepts and advances in pulmonary rehabilitation. Am J Respir Crit Care Med 2013; 188:e13-64. [PMID: 24127811 DOI: 10.1164/rccm.201309-1634st] [Citation(s) in RCA: 2146] [Impact Index Per Article: 195.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Pulmonary rehabilitation is recognized as a core component of the management of individuals with chronic respiratory disease. Since the 2006 American Thoracic Society (ATS)/European Respiratory Society (ERS) Statement on Pulmonary Rehabilitation, there has been considerable growth in our knowledge of its efficacy and scope. PURPOSE The purpose of this Statement is to update the 2006 document, including a new definition of pulmonary rehabilitation and highlighting key concepts and major advances in the field. METHODS A multidisciplinary committee of experts representing the ATS Pulmonary Rehabilitation Assembly and the ERS Scientific Group 01.02, "Rehabilitation and Chronic Care," determined the overall scope of this update through group consensus. Focused literature reviews in key topic areas were conducted by committee members with relevant clinical and scientific expertise. The final content of this Statement was agreed on by all members. RESULTS An updated definition of pulmonary rehabilitation is proposed. New data are presented on the science and application of pulmonary rehabilitation, including its effectiveness in acutely ill individuals with chronic obstructive pulmonary disease, and in individuals with other chronic respiratory diseases. The important role of pulmonary rehabilitation in chronic disease management is highlighted. In addition, the role of health behavior change in optimizing and maintaining benefits is discussed. CONCLUSIONS The considerable growth in the science and application of pulmonary rehabilitation since 2006 adds further support for its efficacy in a wide range of individuals with chronic respiratory disease.
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McDonald CF, Glasgow N. The Burden of Obstructive Lung Disease (BOLD) study in Australia. Med J Aust 2013; 198:124-5. [PMID: 23418680 DOI: 10.5694/mja13.10031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Accepted: 01/28/2013] [Indexed: 11/17/2022]
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Falzon C, Soljak M, Elkin SL, Blake ID, Hopkinson NS. Finding the missing millions - the impact of a locally enhanced service for COPD on current and projected rates of diagnosis: a population-based prevalence study using interrupted time series analysis. PRIMARY CARE RESPIRATORY JOURNAL : JOURNAL OF THE GENERAL PRACTICE AIRWAYS GROUP 2013; 22:59-63. [PMID: 23344778 PMCID: PMC6442776 DOI: 10.4104/pcrj.2013.00008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2012] [Revised: 10/15/2012] [Accepted: 10/19/2012] [Indexed: 02/04/2023]
Abstract
BACKGROUND Many patients with chronic obstructive pulmonary disease (COPD) are not identified until their condition is relatively advanced and there is a considerable gap between the modelled and diagnosed prevalence of the disease. We have previously shown that, in the first year after the introduction of a locally enhanced service (LES) for COPD in 2008, there was a significant step-up in the diagnosed prevalence. AIMS To investigate whether this initial increase in prevalence was sustained, and the impact of this increase on future projected rates of COPD diagnosis. METHODS Using data from 2005-2011, we compared the prevalence of diagnosed COPD in the LES Primary Care Trust (LES-PCT) before and after it was introduced. Data were compared with a neighbouring PCT, the London Strategic Health Authority, and England. The true prevalence of COPD was estimated based on data from the Health Survey for England. Trends were extrapolated to estimate the proportion of patients that would be diagnosed in 2017. RESULTS The introduction of the LES was associated with a significant acceleration in the annual increase in diagnosed COPD (p<0.0001). By 2011 the prevalence was 1.17% in the LES-PCT compared with a predicted value of 0.91% (95% CI 0.86% to 0.95%) based on the pre-LES trend. There was no change in the rate of increase in COPD prevalence for the neighbouring PCT or for London as a whole. The LES-PCT would be expected to diagnose 55.6% of COPD patients by 2017 compared with only 27.3% without the LES, and only 33.3% would be diagnosed in the neighbouring PCT. CONCLUSIONS These data suggest that, with appropriate incentives, it is possible to achieve a sustained improvement in COPD case-finding in primary care and that such policies need to be implemented systematically.
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Affiliation(s)
- Christine Falzon
- Central London Community Healthcare, 64 Victoria Street, Westminster, London, UK
| | - Michael Soljak
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Sarah L Elkin
- Respiratory Medicine, Imperial College NHS Trust, London, UK
| | - Iain D Blake
- Central London Community Healthcare, 64 Victoria Street, Westminster, London, UK
| | - Nicholas S Hopkinson
- NIHR Respiratory Disease Biomedical Research Unit at the Royal Brompton and Harefield NHS Foundation Trust and Imperial College London, London, UK
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Kelly JL, Elkin SL, Fluxman J, Polkey MI, Soljak MA, Hopkinson NS. Breathlessness and skeletal muscle weakness in patients undergoing lung health screening in primary care. COPD 2012; 10:40-54. [PMID: 23272667 DOI: 10.3109/15412555.2012.727923] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Earlier diagnosis of COPD is a major public health challenge as symptoms may be attributed to the normal consequences of aging. The optimum strategy for identifying patients with COPD remains to be determined. People aged 35 and over (n = 1896) on a GP practice register were randomised to either invitation or an opportunistic lung health check which included spirometry, quadriceps strength and MRC dyspnoea score. Then, 101 participants subsequently completed the General Practice Physical Activity Questionnaire. A total of 335 attended over a 15-week period; 156 were in the invitation group and 179 from the opportunist group. In 25 persons, spirometry was unsatisfactory or contraindicated. Spirometry was normal in 204(65.8%) and restrictive in 36(11.6%). 70(22.6%) had airflow obstruction, corresponding to Global Initiative for Chronic Lung Disease (GOLD) stages I-IV in 18(5.8%), 35(11.3%), 14(4.5%) and 3(1.0%), respectively. The opportunist group were significantly more likely to have airflow obstruction 30.1% vs 14.3% (p = 0.001). Breathlessness was reported commonly (40.5%) and quadriceps strength correlated significantly with MRC dyspnoea score independent of age, sex, pack-years smoked, fat-free mass and FEV(1) percent predicted. This relationship was also present in the subgroup of healthy participants (n = 143). 51.5% of participants screened were classified as "inactive" and this group were weaker and more breathless than those who were more active. Airflow obstruction was more common in those screened opportunistically. Breathlessness and inactivity are common in patients taking part in spirometry screening. Breathlessness is significantly associated with leg strength independent of spirometry and should be amenable to interventions to increase physical activity.
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Affiliation(s)
- Julia L Kelly
- NIHR Respiratory Biomedical Research Unit at Royal Brompton and Harefield NHS Foundation Trust and, Imperial College, London, Royal Brompton Hospital, London, United Kingdom
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Johnston K, Grimmer-Somers K, Young M, Antic R, Frith P. Which chronic obstructive pulmonary disease care recommendations have low implementation and why? A pilot study. BMC Res Notes 2012; 5:652. [PMID: 23176312 PMCID: PMC3526413 DOI: 10.1186/1756-0500-5-652] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Accepted: 10/22/2012] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Clinical care components for people with COPD are recommended in guidelines if high-level evidence exists. However, there are gaps in their implementation, and factors which act as barriers or facilitators to their uptake are not well described. The aim of this pilot study was to explore implementation of key high-evidence COPD guideline recommendations in patients admitted to hospital with a disease exacerbation, to inform the development of a larger observational study. METHODS This study recruited consecutive COPD patients admitted to a tertiary hospital. Patient demographic, disease and admission characteristics were recorded. Information about implementation of target guideline recommendations (smoking cessation, pulmonary rehabilitation referral, influenza vaccination, medication use and long-term oxygen use if hypoxaemic) was gained from medical records and patient interviews. Interviews with hospital-based doctors examined their perspectives on recommendation implementation. RESULTS Fifteen patients (aged 76(9) years, FEV1%pred 58(15), mean(SD)) and nine doctors participated. Referral to pulmonary rehabilitation (5/15 patients) was underutilised by comparison with other high-evidence recommendations. Low awareness of pulmonary rehabilitation was a key barrier for patients and doctors. Other barriers for patients were access difficulties, low perceived health benefits, and co-morbidities. Doctors reported they tended to refer patients with severe disease and frequent hospital attendance, a finding supported by the quantitative data. CONCLUSIONS This study provides justification for a larger observational study to test the hypothesis that pulmonary rehabilitation referral is low in suitable COPD patients, and closer investigation of the reasons for this evidence-practice gap.
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Affiliation(s)
- Kylie Johnston
- International Centre for Allied Health Evidence, Division of Health Sciences, University of South Australia, Adelaide, Australia
| | - Karen Grimmer-Somers
- International Centre for Allied Health Evidence, Division of Health Sciences, University of South Australia, Adelaide, Australia
| | - Mary Young
- Transitional and Community Service, Royal Adelaide Hospital, Adelaide, Australia
| | - Ral Antic
- Department of Thoracic Medicine, Royal Adelaide Hospital, Adelaide, Australia
| | - Peter Frith
- Respiratory, Allergy and Sleep Services, Repatriation General Hospital and Flinders University, Adelaide, Australia
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Reproducibility and respiratory function correlates of exhaled breath fingerprint in chronic obstructive pulmonary disease. PLoS One 2012; 7:e45396. [PMID: 23077492 PMCID: PMC3471938 DOI: 10.1371/journal.pone.0045396] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Accepted: 08/22/2012] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND The electronic nose (e nose) provides distinctive breath fingerprints for selected respiratory diseases. Both reproducibility and respiratory function correlates of breath fingerprint are poorly known. OBJECTIVES To measure reproducibility of breath fingerprints and to assess their correlates among respiratory function indexes in elderly healthy and COPD subjects. METHOD 25 subjects (5 COPD patients for each GOLD stage and 5 healthy controls) over 65 years underwent e-nose study through a seven sensor system and respiratory function tests at times 0, 7, and 15 days. Reproducibility of the e nose pattern was computed. The correlation between volatile organic compound (VOC) pattern and respiratory function/clinical parameters was assessed by the Spearman's rho. MEASUREMENTS AND MAIN RESULTS VOC patterns were highly reproducible within healthy and GOLD 4 COPD subjects, less among GOLD 1-3 patients.VOC patterns significantly correlated with expiratory flows (Spearman's rho ranging from 0.36 for MEF25% and sensor Co-Buti-TPP, to 0.81 for FEV1% and sensor Cu-Buti-TPP p<0.001)), but not with residual volume and total lung capacity. CONCLUSIONS VOC patterns strictly correlated with expiratory flows. Thus, e nose might conveniently be used to assess COPD severity and, likely, to study phenotypic variability. However, the suboptimal reproducibility within GOLD 1-3 patients should stimulate further research to identify more reproducible breath print patterns.
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Vial M, Apelt P, Cavalli P, Guerin T, Vercherin P, Vergnon JM. [Possibility to screen COPD in emergency department]. REVUE DE PNEUMOLOGIE CLINIQUE 2012; 68:10-16. [PMID: 22305132 DOI: 10.1016/j.pneumo.2011.06.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2010] [Revised: 05/30/2011] [Accepted: 06/15/2011] [Indexed: 05/31/2023]
Abstract
INTRODUCTION The COPD is a stake of public health because of its prevalence in the world, its morbi-mortality and its considerable cost (2,2 billion euros/year in France). An early screening allows for a fast and effective intervention. MATERIAL AND METHOD The prospective study with in the emergency department of Roanne included smokers and ex-smokers, more than 10PY for the 40 years old and older, more than 20PY for the others, and/or symptomatic of COPD. Screening rested on a questionnaire filled out by the patient. Are excluded patients already diagnosed with COPD. This screening is carried out with the FEV1/FEV6. The criterion of principal judgment rests on the time taken for screening and acceptability by the patients. RESULTS One hundred and twenty-two patients were included, 6.5% refused screening. The average time of screening was 4.8 minutes. There were 27 positive patients with the FEV1/FEV6, 14 came to make the classic spirometry. Only 10.53% have a FEV1/FEV6<0.73. On the whole, 15.86% do not have a COPD, 75,25% are at the risk of COPD, 5,94% have a COPD stage 1, 1,98% are stage 2, 0.99% stage 3 and none stage 4. DISCUSSION The study thus showed that a screening of the COPD in the emergency rooms is possible because of the simple and reproductible process. Its shows, however its limits since the number of inclusion decrease during days of strong attendance in emergency rooms. CONCLUSION The screening of the COPD as foreseen in the study is possible.
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Affiliation(s)
- M Vial
- Service des urgences, CH de Roanne, 42300 Roanne, France.
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Fromer L. Implementing chronic care for COPD: planned visits, care coordination, and patient empowerment for improved outcomes. Int J Chron Obstruct Pulmon Dis 2011; 6:605-14. [PMID: 22162647 PMCID: PMC3232168 DOI: 10.2147/copd.s24692] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Current primary care patterns for chronic obstructive pulmonary disease (COPD) focus on reactive care for acute exacerbations, often neglecting ongoing COPD management to the detriment of patient experience and outcomes. Proactive diagnosis and ongoing multifactorial COPD management, comprising smoking cessation, influenza and pneumonia vaccinations, pulmonary rehabilitation, and symptomatic and maintenance pharmacotherapy according to severity, can significantly improve a patient's health-related quality of life, reduce exacerbations and their consequences, and alleviate the functional, utilization, and financial burden of COPD. Redesign of primary care according to principles of the chronic care model, which is implemented in the patient-centered medical home, can shift COPD management from acute rescue to proactive maintenance. The chronic care model and patient-centered medical home combine delivery system redesign, clinical information systems, decision support, and self-management support within a practice, linked with health care organization and community resources beyond the practice. COPD care programs implementing two or more chronic care model components effectively reduce emergency room and inpatient utilization. This review guides primary care practices in improving COPD care workflows, highlighting the contributions of multidisciplinary collaborative team care, care coordination, and patient engagement. Each primary care practice can devise a COPD care workflow addressing risk awareness, spirometric diagnosis, guideline-based treatment and rehabilitation, and self-management support, to improve patient outcomes in COPD.
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Affiliation(s)
- Len Fromer
- Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
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Ortiz G, Fromer L. Patient-Centered Medical Home in chronic obstructive pulmonary disease. J Multidiscip Healthc 2011; 4:357-65. [PMID: 22096340 PMCID: PMC3210076 DOI: 10.2147/jmdh.s22811] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2011] [Indexed: 11/23/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a progressive and debilitating but preventable and treatable disease characterized by cough, phlegm, dyspnea, and fixed or incompletely reversible airway obstruction. Most patients with COPD rely on primary care practices for COPD management. Unfortunately, only about 55% of US outpatients with COPD receive all guideline-recommended care. Proactive and consistent primary care for COPD, as for many other chronic diseases, can reduce hospitalizations. Optimal chronic disease management requires focusing on maintenance rather than merely acute rescue. The Patient-Centered Medical Home (PCMH), which implements the chronic care model, is a promising framework for primary care transformation. This review presents core PCMH concepts and proposes multidisciplinary team-based PCMH care strategies for COPD.
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Affiliation(s)
| | - Len Fromer
- Department of Family Medicine, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
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