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Devereux G, Cotton S, Nath M, McMeekin N, Campbell K, Chaudhuri R, Choudhury G, De Soyza A, Fielding S, Gompertz S, Haughney J, Lee AJ, MacLennan G, Morice A, Norrie J, Price D, Short P, Vestbo J, Walker P, Wedzicha J, Wilson A, Wu O, Lipworth BJ. Bisoprolol in Patients With Chronic Obstructive Pulmonary Disease at High Risk of Exacerbation: The BICS Randomized Clinical Trial. JAMA 2024; 332:462-470. [PMID: 38762800 PMCID: PMC11322848 DOI: 10.1001/jama.2024.8771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 04/25/2024] [Indexed: 05/20/2024]
Abstract
Importance Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. Observational studies report that β-blocker use may be associated with reduced risk of COPD exacerbations. However, a recent trial reported that metoprolol did not reduce COPD exacerbations and increased COPD exacerbations requiring hospital admission. Objective To test whether bisoprolol decreased COPD exacerbations in people with COPD at high risk of exacerbations. Design, Setting, and Participants The Bisoprolol in COPD Study (BICS) was a double-blind placebo-controlled randomized clinical trial conducted in 76 UK sites (45 primary care clinics and 31 secondary clinics). Patients with COPD who had at least moderate airflow obstruction on spirometry (ratio of forced expiratory volume in the first second of expiration [FEV1] to forced vital capacity <0.7; FEV1 <80% predicted) and at least 2 COPD exacerbations treated with oral corticosteroids, antibiotics, or both in the prior 12 months were enrolled from October 17, 2018, to May 31, 2022. Follow-up concluded on April 18, 2023. Interventions Patients were randomly assigned to bisoprolol (n = 261) or placebo (n = 258). Bisoprolol was started at 1.25 mg orally daily and was titrated as tolerated during 4 sessions to a maximum dose of 5 mg/d, using a standardized protocol. Main Outcomes and Measures The primary clinical outcome was the number of patient-reported COPD exacerbations treated with oral corticosteroids, antibiotics, or both during the 1-year treatment period. Safety outcomes included serious adverse events and adverse reactions. Results Although the trial planned to enroll 1574 patients, recruitment was suspended from March 16, 2020, to July 31, 2021, due to the COVID-19 pandemic. Two patients in each group were excluded postrandomization. Among the 515 patients (mean [SD] age, 68 [7.9] years; 274 men [53%]; mean FEV1, 50.1%), primary outcome data were available for 514 patients (99.8%) and 371 (72.0%) continued taking the study drug. The primary outcome of patient-reported COPD exacerbations treated with oral corticosteroids, antibiotics, or both was 526 in the bisoprolol group, with a mean exacerbation rate of 2.03/y, vs 513 exacerbations in the placebo group, with a mean exacerbation rate of 2.01/y. The adjusted incidence rate ratio was 0.97 (95% CI, 0.84-1.13; P = .72). Serious adverse events occurred in 37 of 255 patients in the bisoprolol group (14.5%) vs 36 of 251 in the placebo group (14.3%; relative risk, 1.01; 95% CI, 0.62-1.66; P = .96). Conclusions and Relevance Among people with COPD at high risk of exacerbation, treatment with bisoprolol did not reduce the number of self-reported COPD exacerbations requiring treatment with oral corticosteroids, antibiotics, or both. Trial Registration isrctn.org Identifier: ISRCTN10497306.
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Affiliation(s)
- Graham Devereux
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Centre for Healthcare Randomised Trials (CHaRT), University of Aberdeen, Aberdeen, United Kingdom
- Liverpool University Hospitals Foundation NHS Trust, University Hospital Aintree, Liverpool, United Kingdom
| | - Seonaidh Cotton
- Centre for Healthcare Randomised Trials (CHaRT), University of Aberdeen, Aberdeen, United Kingdom
| | - Mintu Nath
- Medical Statistics Team, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
| | - Nicola McMeekin
- School of Health & Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Karen Campbell
- Centre for Healthcare Randomised Trials (CHaRT), University of Aberdeen, Aberdeen, United Kingdom
| | - Rekha Chaudhuri
- School of Infection & Immunity, University of Glasgow, Glasgow, United Kingdom
| | | | - Anthony De Soyza
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Shona Fielding
- Medical Statistics Team, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
| | - Simon Gompertz
- Department of Respiratory Medicine, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - John Haughney
- Centre of Academic Primary Care, University of Aberdeen, Aberdeen, United Kingdom
| | - Amanda J. Lee
- Medical Statistics Team, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
| | - Graeme MacLennan
- Centre for Healthcare Randomised Trials (CHaRT), University of Aberdeen, Aberdeen, United Kingdom
| | - Alyn Morice
- Cardiovascular and Respiratory Studies, Castle Hill Hospital, Hull, United Kingdom
| | - John Norrie
- Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh BioQuarter, Edinburgh, United Kingdom
| | - David Price
- Centre of Academic Primary Care, University of Aberdeen, Aberdeen, United Kingdom
| | - Philip Short
- Respiratory Medicine, Ninewells Hospital, Dundee, United Kingdom
| | - Jorgen Vestbo
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, United Kingdom
| | - Paul Walker
- Liverpool University Hospitals Foundation NHS Trust, University Hospital Aintree, Liverpool, United Kingdom
| | - Jadwiga Wedzicha
- Imperial College London, National Heart and Lung Institute, London, United Kingdom
| | - Andrew Wilson
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Olivia Wu
- School of Health & Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Brian J. Lipworth
- Ninewells Hospital and Medical School, University of Dundee, Dundee, United Kingdom
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2
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Brozek J, Borowiack E, Sadowska E, Nowak A, Sousa-Pinto B, Vieira RJ, Bognanni A, Yepes Nuñez JJ, Zhang Y, Zuberbier T, Bousquet J, Schünemann HJ. Patients' values and preferences for health states in allergic rhinitis-An artificial intelligence supported systematic review. Allergy 2024; 79:1812-1830. [PMID: 38551028 DOI: 10.1111/all.16100] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 02/21/2024] [Accepted: 02/29/2024] [Indexed: 07/11/2024]
Abstract
BACKGROUND Allergic rhinitis (AR) impacts patients' physical and emotional well-being. Assessing patients' values and preferences (V&P) related to AR is an essential part of patient-centered care and of the guideline development process. We aimed to systematically summarize the information about patients' V&P on AR and its symptoms and impact on daily life. METHODS We conducted systematic review in a MEDLINE, Embase, PsychInfo, and CINAHL databases. We included studies which quantitatively assessed patients' V&P for specific outcomes in AR by assessing utilities, applying discrete choice approaches, or rating and ranking outcomes. We grouped outcomes as AR symptoms, functional status, and care-related patient experience. Study selection and data extraction were supported by the Laser AI tool. We rated the certainty of evidence (CoE) using the GRADE approach. RESULTS Thirty-six studies (41 records) were included: nine utility studies, seven direct-choice studies and 21 studies of rating or ranking outcomes. Utilities were lower with increased AR severity and with the concomitant presence of asthma, but not with whether AR was seasonal or perennial (CoE = low-high). Patients rated AR symptom-related outcomes as more important than those related to care-related patient experience and functional status (CoE = very low-moderate). Nasal symptoms (mainly nasal congestion) followed by breathing disorders, general and ocular symptoms were rated as the symptoms with the highest impact. CONCLUSIONS This systematic review provides a comprehensive overview of V&P of patients with AR. Patients generally considered nasal symptoms as the most important. Future studies with standardized methods are needed to provide more information on V&P in AR.
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Affiliation(s)
- Jan Brozek
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Michael G. DeGroote Cochrane Canada & McMaster GRADE Centres, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Canada
- Evidence Prime, Hamilton, Ontario, Canada
| | | | | | | | - Bernardo Sousa-Pinto
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal
- Centre for Health Technology and Services Research, Health Research Network (CINTESIS@RISE), Faculty of Medicine, University of Porto, Porto, Portugal
| | - Rafael José Vieira
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal
- Centre for Health Technology and Services Research, Health Research Network (CINTESIS@RISE), Faculty of Medicine, University of Porto, Porto, Portugal
| | - Antonio Bognanni
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, Evidence in Allergy Group, McMaster University, Hamilton, Canada
| | - Juan Jose Yepes Nuñez
- School of Medicine, Universidad de los Andes, Bogotá, Colombia
- Fundación Santa Fe de Bogotá Hospital University, Bogotá, Colombia
| | - Yuan Zhang
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Torsten Zuberbier
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
- Fraunhofer Cluster of Excellence for Immune-Mediated Diseases CIMD, Frankfurt/Main, Germany
| | - Jean Bousquet
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
- Fraunhofer Cluster of Excellence for Immune-Mediated Diseases CIMD, Frankfurt/Main, Germany
| | - Holger J Schünemann
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Michael G. DeGroote Cochrane Canada & McMaster GRADE Centres, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Canada
- Clinical Epidemiology and Research Center (CERC), Humanitas University and Humanitas Research Hospital, Milan, Italy
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3
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Karam SG, Zhang Y, Pardo-Hernandez H, Siebert U, Koopman L, Noyes J, Tarride JE, Stevens AL, Welch V, Saz-Parkinson Z, Ens B, Devji T, Xie F, Hazlewood G, Mbuagbaw L, Alonso-Coello P, Brozek JL, Schünemann HJ. ROBVALU: a tool for assessing risk of bias in studies about people's values, utilities, or importance of health outcomes. BMJ 2024; 385:e079890. [PMID: 38866410 PMCID: PMC11167527 DOI: 10.1136/bmj-2024-079890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/09/2024] [Indexed: 06/14/2024]
Affiliation(s)
- Samer G Karam
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Michael G DeGroote Cochrane Canada and McMaster GRADE Centres, McMaster University, Hamilton, ON, Canada
| | - Yuan Zhang
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Michael G DeGroote Cochrane Canada and McMaster GRADE Centres, McMaster University, Hamilton, ON, Canada
| | - Hector Pardo-Hernandez
- Iberoamerican Cochrane Centre, Sant Antoni Maria Claret, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Uwe Siebert
- Department of Public Health, Health Services Research and Health Technology Assessment, Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT TIROL-University for Health Sciences and Technology, Hall in Tirol, Austria
- Center for Health Decision Science and Departments of Epidemiology and Health Policy and Management, Harvard T H Chan School of Public Health, Boston, MA, USA
- Institute for Technology Assessment and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Laura Koopman
- Department of Specialist Medical Care, National Health Care Institute, Diemen, Netherlands
| | - Jane Noyes
- School of Medical and Health Sciences, Bangor University, Wales, UK
| | - Jean-Eric Tarride
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Centre for Health Economics and Policy Analysis, McMaster University Faculty of Health Sciences, Hamilton, ON, Canada
- Programs for Assessment of Technologies in Health, St Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Adrienne L Stevens
- Centre for Immunisation Programmes, Public Health Agency of Canada, ON, Canada
| | - Vivian Welch
- Bruyère Research Institute and, School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | | | - Brendalynn Ens
- Implementation Support and Knowledge Mobilisation, Canadian Agency for Drugs and Technologies in Health, Ottawa, ON, Canada
| | - Tahira Devji
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Feng Xie
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Centre for Health Economics and Policy Analysis, McMaster University Faculty of Health Sciences, Hamilton, ON, Canada
| | - Glen Hazlewood
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Department of Anaesthesia, McMaster University, Hamilton, ON, Canada
- Department of Paediatrics, McMaster University, Hamilton, ON, Canada
- Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare, Hamilton, ON, Canada
- Centre for Development of Best Practices in Health, Yaoundé Central Hospital, Yaoundé, Cameroon
- Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Pablo Alonso-Coello
- Iberoamerican Cochrane Centre, Sant Antoni Maria Claret, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Institut de Recerca Sant Pau (IR SANT PAU), Sant Quintí, Barcelona, Spain
| | - Jan L Brozek
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Michael G DeGroote Cochrane Canada and McMaster GRADE Centres, McMaster University, Hamilton, ON, Canada
| | - Holger J Schünemann
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Clinical Epidemiology and Research Centre (CERC), Humanitas Universityand Humanitas Research Hospital, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy
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4
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Price E, Ahmad S, Althobiani MA, Ayoob T, Burgoyne T, De Soyza A, Dobson M, Echevarria C, Martin G, Mendes RG, Preston AM, Rahman NM, Sapey E, Usmani OS, Hurst JR. Development and evaluation of a tool to optimise inhaler selection prior to hospital discharge following an exacerbation of COPD. ERJ Open Res 2024; 10:00010-2024. [PMID: 38444664 PMCID: PMC10910267 DOI: 10.1183/23120541.00010-2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 01/08/2024] [Indexed: 03/07/2024] Open
Abstract
Introduction Rates of mortality and re-admission after a hospitalised exacerbation of COPD are high and resistant to change. COPD guidelines do not give practical advice about the optimal selection of inhaled drugs and device in this situation. We hypothesised that a failure to optimise inhaled drug and drug delivery prior to discharge from hospital after an exacerbation would be associated with a modifiable increased risk of re-admission and death. We designed a study to 1) develop a practical inhaler selection tool to use at the point of hospital discharge and 2) implement this tool to understand the potential impact on modifying inhaler prescriptions, clinical outcomes, acceptability to clinicians and patients, and the feasibility of delivering a definitive trial to demonstrate potential benefit. Methods We iteratively developed an inhaler selection tool for use prior to discharge following a hospitalised exacerbation of COPD using surveys with multiprofessional clinicians and a focus group of people living with COPD. We surveyed clinicians to understand their views on the minimum clinically important difference (MCID) for death and re-admission following a hospitalised exacerbation of COPD. We conducted a mixed-methods implementation feasibility study using the tool at discharge, and collated 30- and 90-day follow-up data including death and re-admissions. Additionally, we observed the tool being used and interviewed clinicians and patients about use of the tool in this setting. Results We completed the design of an inhaler selection tool through two rounds of consultations with 94 multiprofessional clinicians, and a focus group of four expert patients. Regarding MCIDs, there was majority consensus for the following reductions from baseline being the MCID: 30-day readmissions 5-10%, 90-day readmissions 10-20%, 30-day mortality 5-10% and 90-day mortality 5-10%. 118 patients were assessed for eligibility and 26 had the tool applied. A change in inhaled medication was recommended in nine (35%) out of 26. Re-admission or death at 30 days was seen in 33% of the switch group and 35% of the no-switch group. Re-admission or death at 90 days was seen in 56% of the switch group and 41% of the no-switch group. Satisfaction with inhalers was generally high, and switching was associated with a small increase in the Feeling of Satisfaction with Inhaler questionnaire of 3 out of 50 points. Delivery of a definitive study would be challenging. Conclusion We completed a mixed-methods study to design and implement a tool to aid optimisation of inhaled pharmacotherapy prior to discharge following a hospitalised exacerbation of COPD. This was not associated with fewer re-admissions, but was well received and one-third of people were eligible for a change in inhalers.
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Affiliation(s)
- Evleen Price
- THIS Institute, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Shanaz Ahmad
- Respiratory Medicine, Royal Free London NHS Foundation Trust, London, UK
| | | | - Tareq Ayoob
- Respiratory Medicine, Royal Free London NHS Foundation Trust, London, UK
| | | | - Anthony De Soyza
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Melissa Dobson
- Oxford Respiratory Trials Unit, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Carlos Echevarria
- Respiratory Department, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
- Translational and Clinical Research, Newcastle University, Newcastle upon Tyne, UK
| | - Graham Martin
- THIS Institute, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Renata Gonçalves Mendes
- Cardiopulmonary Physiotherapy Laboratory, Federal University of Sao Carlos, Sao Carlos, Brazil
| | - Anne-Marie Preston
- Respiratory Medicine, Royal Free London NHS Foundation Trust, London, UK
| | - Najib M. Rahman
- Oxford Respiratory Trials Unit, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Elizabeth Sapey
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham NIHR Biomedical Research Unit, and HDR UK Medicines Driver Programme, Birmingham, UK
| | - Omar S. Usmani
- National Heart and Lung Institute, Imperial College London, London, UK
| | - John R. Hurst
- UCL Respiratory, University College London, London, UK
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5
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Kham-Ai P, Heaton K, Xiao C, Wheeler P. Systematic Review and Meta-Analysis of Psychological Distress and Acute Exacerbation of Chronic Obstructive Pulmonary Disease and Consequences. Nurs Res 2024; 73:62-71. [PMID: 37768970 DOI: 10.1097/nnr.0000000000000694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
BACKGROUND People with chronic obstructive pulmonary disease (COPD) occasionally develop acute exacerbation of COPD-a potentially fatal condition. Psychological distress was associated with acute exacerbation of COPD. However, the evidence on the effect of psychological distress on acute exacerbation of COPD remains unclear. OBJECTIVE The aim of this study was to explore the influence of psychological distress on acute exacerbation of COPD and its consequences. METHODS The current review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines using three databases (PubMed, CINAHL, and PsyINFO) that were searched to identify relevant articles. Pooled risk ratios and 95% confidential interval were calculated from the included studies' data with random-effect methods to estimate the effect of psychological distress on acute exacerbation of COPD and its consequences. RESULTS Nineteen articles were included in the review. Most revealed that psychological distress was significantly associated with increased risk of acute exacerbation of COPD and its consequences. The meta-analyses showed that psychological distress increased risk of acute exacerbation of COPD, COPD-related hospitalization, and death. CONCLUSION Psychological distress had negative effects on acute exacerbation of COPD and its consequences. The results of the meta-analyses show that persons with COPD and psychological distress had a greater risk of acute exacerbation of COPD, hospitalization, and death.
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Niño-de-Guzmán E, Bracchiglione J, Vásquez-Mejía A, de Graaf G, Rocha Calderón C, Alonso-Coello P. How Do Patients With Type 2 Diabetes Mellitus Value the Importance of Outcomes? An Overview of Reviews. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2023; 26:1782-1794. [PMID: 37516195 DOI: 10.1016/j.jval.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 04/16/2023] [Accepted: 07/16/2023] [Indexed: 07/31/2023]
Abstract
OBJECTIVES We aimed to assess how patients value the importance of type 2 diabetes mellitus (T2DM) related outcomes. METHODS Overview of systematic reviews (SRs) reporting patients' utilities or disutilities for T2DM outcomes. We searched 3 databases from inception until June 2021. Study selection and data extraction were conducted in pairs. We evaluated the quality of SRs with the Joanna Briggs Institute Checklist, and the overlap with the corrected covered area. We estimated descriptive statistics, and, when possible, conducted metanalysis. RESULTS We identified 11 SRs, including 119 studies and 70 outcomes. Most reviews were high-quality SRs. The outcomes with the lowest utilities were hypoglycemia with very severe symptoms (acute complications), stroke (macrovascular complications), diabetic peripheral neuropathy with severe pain (microvascular complications), extreme obesity (comorbidities), and insulin only or combined (management of diabetes). Good/excellent glucose control and noninsulin injectable showed higher values than T2DM without complications. The outcomes with the highest disutilities were amputation, depression, major hypoglycemia, stroke, and management using only insulin. CONCLUSIONS We provide standardized, reliable utility values (or associated disutilities) for T2DM, acute, microvascular and macrovascular complications, related comorbidities and treatments that may support judgments when making clinical recommendations, designing decision support tools, and developing interventions and economic analysis.
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Affiliation(s)
- Ena Niño-de-Guzmán
- Iberoamerican Cochrane Centre, Sant Pau Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain; Cancer Prevention and Control Programme, Catalan Institute of Oncology, IDIBELL, Hospitalet de Llobregat, Barcelona, Spain; Department of Pediatrics, Obstetrics, Gynecology and Preventive Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Javier Bracchiglione
- Iberoamerican Cochrane Centre, Sant Pau Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain; Interdisciplinary Centre for Health Studies (CIESAL), Universidad de Valparaíso, Valparaíso, Chile; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Adrián Vásquez-Mejía
- Facultad de Medicina Humana, Universidad Nacional Mayor de San Marcos, Lima, Perú
| | - Gimon de Graaf
- Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Claudio Rocha Calderón
- Iberoamerican Cochrane Centre, Sant Pau Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain
| | - Pablo Alonso-Coello
- Iberoamerican Cochrane Centre, Sant Pau Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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7
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Bourbeau J, Bhutani M, Hernandez P, Aaron SD, Beauchesne MF, Kermelly SB, D'Urzo A, Lal A, Maltais F, Marciniuk JD, Mulpuru S, Penz E, Sin DD, Van Dam A, Wald J, Walker BL, Marciniuk DD. 2023 Canadian Thoracic Society Guideline on Pharmacotherapy in Patients With Stable COPD. Chest 2023; 164:1159-1183. [PMID: 37690008 DOI: 10.1016/j.chest.2023.08.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/11/2023] Open
Abstract
Chronic obstructive pulmonary disease patient care must include confirming a diagnosis with postbronchodilator spirometry. Because of the clinical heterogeneity and the reality that airflow obstruction assessed by spirometry only partially reflects disease severity, a thorough clinical evaluation of the patient should include assessment of symptom burden and risk of exacerbations that permits the implementation of evidence-informed pharmacologic and nonpharmacologic interventions. This guideline provides recommendations from a comprehensive systematic review with a meta-analysis and expert-informed clinical remarks to optimize maintenance pharmacologic therapy for individuals with stable COPD, and a revised and practical treatment pathway based on new evidence since the 2019 update of the Canadian Thoracic Society (CTS) Guideline. The key clinical questions were developed using the Patients/Population (P), Intervention(s) (I), Comparison/Comparator (C), and Outcome (O) model for three questions that focuses on the outcomes of symptoms (dyspnea)/health status, acute exacerbations, and mortality. The evidence from this systematic review and meta-analysis leads to the recommendation that all symptomatic patients with spirometry-confirmed COPD should receive long-acting bronchodilator maintenance therapy. Those with moderate to severe dyspnea (modified Medical Research Council ≥ 2) and/or impaired health status (COPD Assessment Test ≥ 10) and a low risk of exacerbations should receive combination therapy with a long-acting muscarinic antagonist/long-acting ẞ2-agonist (LAMA/LABA). For those with a moderate/severe dyspnea and/or impaired health status and a high risk of exacerbations should be prescribed triple combination therapy (LAMA/LABA/inhaled corticosteroids) azithromycin, roflumilast or N-acetylcysteine is recommended for specific populations; a recommendation against the use of theophylline, maintenance systemic oral corticosteroids such as prednisone and inhaled corticosteroid monotherapy is made for all COPD patients.
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Affiliation(s)
- Jean Bourbeau
- Department of Medicine, McGill University Health Centre, McGill University, Montréal, QC, Canada.
| | - Mohit Bhutani
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Paul Hernandez
- Department of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Shawn D Aaron
- The Ottawa Hospital, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | | | - Sophie B Kermelly
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, QC, Canada
| | - Anthony D'Urzo
- Primary Care Lung Clinic, University of Toronto, Toronto, ON, Canada
| | - Avtar Lal
- Canadian Thoracic Society, Ottawa, ON, Canada
| | - François Maltais
- Department of Medicine, McGill University Health Centre, McGill University, Montréal, QC, Canada
| | - Jeffrey D Marciniuk
- Respiratory Research Centre, University of Saskatchewan, Saskatoon, SK, Canada
| | - Sunita Mulpuru
- The Ottawa Hospital, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Erika Penz
- Respiratory Research Centre, University of Saskatchewan, Saskatoon, SK, Canada
| | - Don D Sin
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | | | - Joshua Wald
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Brandie L Walker
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Darcy D Marciniuk
- Respiratory Research Centre, University of Saskatchewan, Saskatoon, SK, Canada
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Gálvez-Barrón C, Pérez-López C, Villar-Álvarez F, Ribas J, Formiga F, Chivite D, Boixeda R, Iborra C, Rodríguez-Molinero A. Machine learning for the development of diagnostic models of decompensated heart failure or exacerbation of chronic obstructive pulmonary disease. Sci Rep 2023; 13:12709. [PMID: 37543661 PMCID: PMC10404284 DOI: 10.1038/s41598-023-39329-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 07/24/2023] [Indexed: 08/07/2023] Open
Abstract
Heart failure (HF) and chronic obstructive pulmonary disease (COPD) are two chronic diseases with the greatest adverse impact on the general population, and early detection of their decompensation is an important objective. However, very few diagnostic models have achieved adequate diagnostic performance. The aim of this trial was to develop diagnostic models of decompensated heart failure or COPD exacerbation with machine learning techniques based on physiological parameters. A total of 135 patients hospitalized for decompensated heart failure and/or COPD exacerbation were recruited. Each patient underwent three evaluations: one in the decompensated phase (during hospital admission) and two more consecutively in the compensated phase (at home, 30 days after discharge). In each evaluation, heart rate (HR) and oxygen saturation (Ox) were recorded continuously (with a pulse oximeter) during a period of walking for 6 min, followed by a recovery period of 4 min. To develop the diagnostic models, predictive characteristics related to HR and Ox were initially selected through classification algorithms. Potential predictors included age, sex and baseline disease (heart failure or COPD). Next, diagnostic classification models (compensated vs. decompensated phase) were developed through different machine learning techniques. The diagnostic performance of the developed models was evaluated according to sensitivity (S), specificity (E) and accuracy (A). Data from 22 patients with decompensated heart failure, 25 with COPD exacerbation and 13 with both decompensated pathologies were included in the analyses. Of the 96 characteristics of HR and Ox initially evaluated, 19 were selected. Age, sex and baseline disease did not provide greater discriminative power to the models. The techniques with S and E values above 80% were the logistic regression (S: 80.83%; E: 86.25%; A: 83.61%) and support vector machine (S: 81.67%; E: 85%; A: 82.78%) techniques. The diagnostic models developed achieved good diagnostic performance for decompensated HF or COPD exacerbation. To our knowledge, this study is the first to report diagnostic models of decompensation potentially applicable to both COPD and HF patients. However, these results are preliminary and warrant further investigation to be confirmed.
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Affiliation(s)
- César Gálvez-Barrón
- Research Area, Consorci Sanitari Alt Penedès i Garraf, Sant Pere de Ribes-Barcelona, Barcelona, Spain.
| | - Carlos Pérez-López
- Research Area, Consorci Sanitari Alt Penedès i Garraf, Sant Pere de Ribes-Barcelona, Barcelona, Spain
| | | | - Jesús Ribas
- Department of Pneumology, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Francesc Formiga
- Geriatric Unit, Department of Internal Medicine, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - David Chivite
- Geriatric Unit, Department of Internal Medicine, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Ramón Boixeda
- Department of Internal Medicine, Hospital de Mataró, Mataró-Barcelona, Spain
| | - Cristian Iborra
- Department of Cardiology, IIS Fundación Jiménez Díaz, Madrid, Spain
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Taylor A, Cushing A, Dow M, Anderson J, McDowell G, Lua S, Manthe M, Padmanabhan S, Burns S, McGinness P, Lowe DJ, Carlin C. Long-Term Usage and Improved Clinical Outcomes with Adoption of a COPD Digital Support Service: Key Findings from the RECEIVER Trial. Int J Chron Obstruct Pulmon Dis 2023; 18:1301-1318. [PMID: 37378275 PMCID: PMC10292615 DOI: 10.2147/copd.s409116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 06/14/2023] [Indexed: 06/29/2023] Open
Abstract
Purpose Digital tools may improve chronic obstructive pulmonary disease (COPD) management, but further evidence of significant, persisting benefits are required. The RECEIVER trial was devised to evaluate the Lenus COPD support service by determining if people with severe COPD would continue to utilize the co-designed patient web application throughout study follow-up and to explore the impact of this digital service on clinical outcomes with its adoption alongside routine care. Patients and Methods The prospective observational cohort hybrid implementation-effectiveness study began in September 2019 and included 83 participants. Recruitment stopped in March 2020 due to COVID-19, but follow-up continued as planned. A contemporary matched control cohort was identified to compare participant clinical outcomes with and minimize biases associated with wider COVID-19 impacts. Utilization was determined by daily COPD assessment test (CAT) completion through the application. Survival metrics and post-index date changes in annual hospitalizations were compared between the RECEIVER and control cohorts. Longitudinal quality of life and symptom burden data and community-managed exacerbation events were also captured through the application. Results High and sustained application utilization was noted across the RECEIVER cohort with a mean follow-up of 78 weeks (64/83 participants completed at least one CAT entry on ≥50% of possible follow-up weeks). Subgroup analysis of participants resident in more socioeconomically deprived postcode areas revealed equivalent utilization. Median time to death or a COPD or respiratory-related admission was higher in the RECEIVER cohort compared to control (335 days vs 155 days). Mean reduction in annual occupied bed days was 8.12 days vs 3.38 days in the control cohort. Quality of life and symptom burden remained stable despite the progressive nature of COPD. Conclusion The sustained utilization of the co-designed patient application and improvements in participant outcomes observed in the RECEIVER trial support scale-up implementation with continued evaluation of this digital service.
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Affiliation(s)
- Anna Taylor
- Departments of Respiratory and Emergency Medicine, Queen Elizabeth University Hospital, NHS Greater Glasgow & Clyde, Glasgow, Scotland
| | | | | | - Jacqueline Anderson
- Departments of Respiratory and Emergency Medicine, Queen Elizabeth University Hospital, NHS Greater Glasgow & Clyde, Glasgow, Scotland
| | - Grace McDowell
- Departments of Respiratory and Emergency Medicine, Queen Elizabeth University Hospital, NHS Greater Glasgow & Clyde, Glasgow, Scotland
| | - Stephanie Lua
- Departments of Respiratory and Emergency Medicine, Queen Elizabeth University Hospital, NHS Greater Glasgow & Clyde, Glasgow, Scotland
| | - Maureen Manthe
- Departments of Respiratory and Emergency Medicine, Queen Elizabeth University Hospital, NHS Greater Glasgow & Clyde, Glasgow, Scotland
| | - Sandosh Padmanabhan
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Scotland
| | | | | | - David J Lowe
- Departments of Respiratory and Emergency Medicine, Queen Elizabeth University Hospital, NHS Greater Glasgow & Clyde, Glasgow, Scotland
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland
| | - Christopher Carlin
- Departments of Respiratory and Emergency Medicine, Queen Elizabeth University Hospital, NHS Greater Glasgow & Clyde, Glasgow, Scotland
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Requena G, Banks V, Czira A, Wood R, Tritton T, Wild R, Compton C, Ismaila AS. Treatment Patterns, Healthcare Utilization and Clinical Outcomes of Patients with Chronic Obstructive Pulmonary Disease Initiating Single-Inhaler Long-Acting β 2-Agonist/Long-Acting Muscarinic Antagonist Dual Therapy in Primary Care in England. Int J Chron Obstruct Pulmon Dis 2023; 18:231-245. [PMID: 36908830 PMCID: PMC9997204 DOI: 10.2147/copd.s389281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 02/15/2023] [Indexed: 03/07/2023] Open
Abstract
Purpose Selection of treatments for patients with chronic obstructive pulmonary disease (COPD) may impact clinical outcomes, healthcare resource use (HCRU) and direct healthcare costs. We aimed to characterize these outcomes along with treatment patterns, for patients with COPD following initiation of single-inhaler long-acting muscarinic antagonist/long-acting β2-agonist (LAMA/LABA) dual therapy in the primary care setting in England. Patients and Methods This retrospective cohort study used linked primary care electronic medical record data (Clinical Practice Research Datalink-Aurum) and secondary care administrative data (Hospital Episode Statistics) in England to assess outcomes for patients with COPD who had a prescription for one of four single-inhaler LAMA/LABA dual therapies between 1st June 2015-31st December 2018 (indexing period). Outcomes were assessed during a 12-month follow-up period from the index date (date of earliest prescription of a single-inhaler LAMA/LABA within the indexing period). Incident users were those without previous LAMA/LABA dual therapy prescriptions prior to index; this manuscript focuses on a subset of incident users: non-triple therapy users (patients without concomitant inhaled corticosteroid use at index). Results Of 10,991 incident users included, 9888 (90.0%) were non-triple therapy users, indexed on umeclidinium/vilanterol (n=4805), aclidinium/formoterol (n=2109), indacaterol/glycopyrronium (n=1785) and tiotropium/olodaterol (n=1189). At 3 months post-index, 63.3% of non-triple therapy users remained on a single-inhaler LAMA/LABA, and 22.1% had discontinued inhaled therapy. Most patients (86.9%) required general practitioner consultations in the first 3 months post-index. Inpatient stays were the biggest contributor to healthcare costs. Acute exacerbations of COPD (AECOPDs), adherence, time-to-triple therapy, time-to-first on-treatment moderate-to-severe AECOPD, time-to-index treatment discontinuation, HCRU and healthcare costs were similar across indexed therapies. Conclusion Patients initiating treatment with single-inhaler LAMA/LABA in primary care in England were unlikely to switch treatments in the first three months following initiation, but some may discontinue respiratory medication. Outcomes were similar across indexed treatments.
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Affiliation(s)
- Gema Requena
- Value Evidence and Outcomes, GSK, R&D Global Medical, Brentford, Middlesex, UK
| | - Victoria Banks
- Real-World Evidence, Adelphi Real World, Bollington, Cheshire, UK
| | - Alexandrosz Czira
- Value Evidence and Outcomes, GSK, R&D Global Medical, Brentford, Middlesex, UK
| | - Robert Wood
- Real-World Evidence, Adelphi Real World, Bollington, Cheshire, UK
| | - Theo Tritton
- Real-World Evidence, Adelphi Real World, Bollington, Cheshire, UK
| | - Rosie Wild
- Real-World Evidence, Adelphi Real World, Bollington, Cheshire, UK
| | - Chris Compton
- Value Evidence and Outcomes, GSK, R&D Global Medical, Brentford, Middlesex, UK
| | - Afisi S Ismaila
- Value Evidence and Outcomes, GSK, Collegeville, PA, USA.,Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
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11
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Choudhary D, Thomas M, Pacheco-Barrios K, Zhang Y, Alonso-Coello P, Schünemann H, Hazlewood G. Methods to Summarize Discrete-Choice Experiments in a Systematic Review: A Scoping Review. THE PATIENT 2022; 15:629-639. [PMID: 35829927 DOI: 10.1007/s40271-022-00587-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/16/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND OBJECTIVE Systematic reviews of discrete-choice experiments (DCEs) are being increasingly conducted. The objective of this scoping review was to identify and describe the methodologies that have been used to summarize results across DCEs. METHODS We searched the electronic databases MEDLINE and EMBASE from inception to March 18, 2021, to identify English-language systematic reviews of patient preferences that included at least two DCEs and extracted data on attribute importance. The methods used to summarize results across DCEs were classified into narrative, semi-quantitative, and quantitative (meta-analytic) approaches and compared. Approaches to characterize the extent of preference heterogeneity were also described. RESULTS From 7362 unique records, we identified 54 eligible reviews from 2010 to Mar 2021, across a broad range of health conditions. Most (83%) used a narrative approach to summarize findings of DCEs, often citing differences in studies as the reason for not formally pooling findings. Semi-quantitative approaches included summarizing the frequency of the most important attributes, the frequency of attribute statistical significance, or tabulated comparisons of attribute importance for each pair of attributes. One review conducted a meta-analysis using the maximum acceptable risk. While reviews often commented on the heterogeneity of patient preferences, few (6%) addressed this systematically across studies. CONCLUSION While not commonly used, several semi-quantitative and one quantitative approach for synthesizing results of DCEs were identified, which may be useful for generating summary estimates across DCEs when appropriate. Further work is needed to assess the validity and usefulness of these approaches.
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Affiliation(s)
- Daksh Choudhary
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Megan Thomas
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Kevin Pacheco-Barrios
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Boston, MA, USA
- Universidad San Ignacio de Loyola, Vicerrectorado de Investigación, Unidad de Investigación para la Generación y Sintesis de Evidencias en Salud, Lima, Peru
| | - Yuan Zhang
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Pablo Alonso-Coello
- Instituto de Investigación Biomédica (IIB Sant Pau), Centro Cochrane Iberoamericano, Barcelona, Spain
| | - Holger Schünemann
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Glen Hazlewood
- Department of Medicine, University of Calgary, Calgary, AB, Canada.
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.
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12
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León-García M, Humphries B, Maraboto A, Rabassa M, Boehmer KR, Perestelo-Perez L, Xie F, Pelayo I, Eckman M, Bates S, Selva A, Alonso-Coello P. Women's values and preferences on low-molecular-weight heparin and pregnancy: a mixed-methods systematic review. BMC Pregnancy Childbirth 2022; 22:747. [PMID: 36199014 PMCID: PMC9533610 DOI: 10.1186/s12884-022-05042-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 09/09/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Venous thromboembolism (VTE) in pregnancy is an important cause of maternal morbidity and mortality. Low-molecular-weight heparin (LMWH) is the cornerstone of prophylaxis and treatment of thrombotic events during pregnancy. LMWH has fewer adverse effects than other anticoagulants, does not cross the placenta, and is safe for the fetus. However, the use of LMWH during pregnancy is sensitive to womens' underlying preferences. The objective of this review is to systematically assess women's values and preferences research evidence on this topic. METHODS We searched four electronic databases from inception to March 2022, and included studies examining values and preferences of using LMWH among pregnant women at risk of VTE. We followed a convergent integrated mixed-methods design to compare and contrast quantitative outcomes (utility and non-utility measures) and qualitative findings. We assessed the certainty of the values and preferences evidence with the GRADE approach for quantitative findings, and with GRADE-CERqual for qualitative evidence. Results were presented in a conjoint display. RESULTS We screened 3,393 references and identified seven eligible studies. The mixed methods analysis resulted in four themes. Datasets confirmed each other in that: 1) the majority of women consider that benefits of treatment outweigh the inconveniences of daily injections; and 2) main concerns around medication are safety and injections administration. Quantitative outcomes expanded on the qualitative findings in that: 3) participants who perceived a higher risk of VTE were more willing to take LMWH. Finally, we found a discrepancy between the datasets around: 4) the amount of information preferred to make the decision; however, qualitative data expanded to clarify that women prefer making informed decisions and receive support from their clinician in their decision-making process. CONCLUSIONS We are moderately confident that in the context of pregnancy, using LMWH is preferred by women given its net beneficial balance. Integrating data from different sources of evidence, and representing them in a jointly manner helps to identify patient's values and preferences. Our results may inform clinical practice guidelines and support shared decision-making process in the clinical encounter for the management of VTE in the context of pregnancy.
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Affiliation(s)
- Montserrat León-García
- Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain.
- Department of Pediatrics, Obstetrics, Gynaecology and Preventive Medicine, Universidad Autónoma de Barcelona, Barcelona, Spain.
- Knowledge and Evaluation Research Unit, Department of Medicine, Mayo Clinic, Rochester, MN, USA.
| | - Brittany Humphries
- Cytel Inc, Toronto, ON, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Andrea Maraboto
- Knowledge and Evaluation Research Unit, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Kasey R Boehmer
- Knowledge and Evaluation Research Unit, Department of Medicine, Mayo Clinic, Rochester, MN, USA
- Division of Health Care Delivery Research, Mayo Clinic, Rochester, MN, USA
| | - Lilisbeth Perestelo-Perez
- Evaluation Unit (SESCS), Canary Islands Health Service (SCS), Tenerife, Spain
- Research Network On Health Services in Chronic Diseases (REDISSEC), Tenerife, Spain
- Network for Research On Chronicity, Primary Care, and Health Promotion (RICAPPS), Tenerife, Spain
| | - Feng Xie
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada
| | - Irene Pelayo
- Department of Obstetrics and Gynecology, Ramón y Cajal Hospital, Madrid, Spain
- Faculty of Medicine, Alcalá de Henares University, Madrid, Spain
| | - Mark Eckman
- Division of General Internal Medicine and Center for Clinical Effectiveness, University of Cincinnati School of Medicine, Cincinnati, OH, USA
| | - Shannon Bates
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Anna Selva
- Department of Pediatrics, Obstetrics, Gynaecology and Preventive Medicine, Universidad Autónoma de Barcelona, Barcelona, Spain
- Clinical Epidemiology and Cancer Screening, Corporació Sanitaria Parc Taulí, Sabadell, Barcelona, Spain
| | - Pablo Alonso-Coello
- Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
- CIBER of Epidemiology and Public Health, CIBERESP, Madrid, Spain
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13
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Hurst JR, Han MK, Singh B, Sharma S, Kaur G, de Nigris E, Holmgren U, Siddiqui MK. Prognostic risk factors for moderate-to-severe exacerbations in patients with chronic obstructive pulmonary disease: a systematic literature review. Respir Res 2022; 23:213. [PMID: 35999538 PMCID: PMC9396841 DOI: 10.1186/s12931-022-02123-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 07/20/2022] [Indexed: 11/30/2022] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. COPD exacerbations are associated with a worsening of lung function, increased disease burden, and mortality, and, therefore, preventing their occurrence is an important goal of COPD management. This review was conducted to identify the evidence base regarding risk factors and predictors of moderate-to-severe exacerbations in patients with COPD. Methods A literature review was performed in Embase, MEDLINE, MEDLINE In-Process, and the Cochrane Central Register of Controlled Trials (CENTRAL). Searches were conducted from January 2015 to July 2019. Eligible publications were peer-reviewed journal articles, published in English, that reported risk factors or predictors for the occurrence of moderate-to-severe exacerbations in adults age ≥ 40 years with a diagnosis of COPD. Results The literature review identified 5112 references, of which 113 publications (reporting results for 76 studies) met the eligibility criteria and were included in the review. Among the 76 studies included, 61 were observational and 15 were randomized controlled clinical trials. Exacerbation history was the strongest predictor of future exacerbations, with 34 studies reporting a significant association between history of exacerbations and risk of future moderate or severe exacerbations. Other significant risk factors identified in multiple studies included disease severity or bronchodilator reversibility (39 studies), comorbidities (34 studies), higher symptom burden (17 studies), and higher blood eosinophil count (16 studies). Conclusions This systematic literature review identified several demographic and clinical characteristics that predict the future risk of COPD exacerbations. Prior exacerbation history was confirmed as the most important predictor of future exacerbations. These prognostic factors may help clinicians identify patients at high risk of exacerbations, which are a major driver of the global burden of COPD, including morbidity and mortality. Supplementary Information The online version contains supplementary material available at 10.1186/s12931-022-02123-5.
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Affiliation(s)
- John R Hurst
- UCL Respiratory, University College London, London, WC1E 6BT, UK.
| | - MeiLan K Han
- Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor, MI, USA
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14
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Burge AT, Malaguti C, Hoffman M, Shiell A, McDonald CF, Berlowitz DJ, Holland AE. Efficacy of Repeating Pulmonary Rehabilitation in People with COPD: A Systematic Review. Int J Chron Obstruct Pulmon Dis 2022; 17:1871-1882. [PMID: 35999942 PMCID: PMC9393021 DOI: 10.2147/copd.s368336] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 07/21/2022] [Indexed: 11/23/2022] Open
Abstract
Background Pulmonary rehabilitation is an effective intervention for people with chronic obstructive pulmonary disease (COPD). People with COPD undertake repeat programs, but synthesis of evidence regarding such practice has not been undertaken. The aim of this systematic review was to establish the effects of repeating pulmonary rehabilitation subsequent to an initial program in people with COPD. Methods Studies where participants with COPD undertook >1 pulmonary rehabilitation program were included, incorporating RCT (randomized controlled trial) and non-randomized studies. Electronic database searches were undertaken. Two authors independently undertook study identification, data extraction and risk of bias assessment. The primary outcome was health-related quality of life (HRQoL); secondary outcomes were exercise capacity, hospitalizations and exacerbations, adherence, mortality and adverse events. Narrative synthesis was undertaken for clinically heterogeneous trials. Data from RCTs and non-randomized studies were not combined for analysis. Results Ten included studies (2 RCTs) involved 907 participants with COPD (n=653 had undertaken >1 program). The majority of studies were at high risk of bias. One RCT (n=33) reported no difference in HRQol after a repeat program vs usual care following exacerbation (Chronic Respiratory Disease Questionnaire dyspnea domain score MD 0.4, 95% CI -0.5 to 3). In stable patients, clinically important and statistically significant improvements in HRQoL and exercise capacity were reported after repeat programs, but of a smaller magnitude than initial programs. There was evidence for reductions in exacerbations and hospitalizations, and shorter hospital length of stay for patients who repeated a program twice in 12 months compared to those who repeated once. No data for mortality or adverse events were available. Conclusion This systematic review provides limited evidence for benefits of repeating pulmonary rehabilitation in people with COPD, including improved HRQoL and exercise capacity, and reduced hospitalizations. However, most studies have high risk of bias, which reduces the certainty of these conclusions. Study Registration PROSPERO (CRD42020215093).
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Affiliation(s)
- Angela T Burge
- Respiratory Research@Alfred, Central Clinical School, Monash University, Melbourne, VIC, Australia
- Physiotherapy Department, Alfred Health, Melbourne, VIC, Australia
- Institute for Breathing and Sleep, Heidelberg, VIC, Australia
| | - Carla Malaguti
- Respiratory Research@Alfred, Central Clinical School, Monash University, Melbourne, VIC, Australia
- Faculty of Physiotherapy, Federal University of Juiz de Fora, Juiz de Fora, Brazil
| | - Mariana Hoffman
- Respiratory Research@Alfred, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Alan Shiell
- Department of Public Health, La Trobe University, Bundoora, VIC, Australia
| | - Christine F McDonald
- Institute for Breathing and Sleep, Heidelberg, VIC, Australia
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, VIC, Australia
- Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, VIC, Australia
| | - David J Berlowitz
- Institute for Breathing and Sleep, Heidelberg, VIC, Australia
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, VIC, Australia
- Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, VIC, Australia
| | - Anne E Holland
- Respiratory Research@Alfred, Central Clinical School, Monash University, Melbourne, VIC, Australia
- Physiotherapy Department, Alfred Health, Melbourne, VIC, Australia
- Institute for Breathing and Sleep, Heidelberg, VIC, Australia
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15
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Khabsa J, Jain S, El-Harakeh A, Rizkallah C, Pandey DK, Manaye N, Honein-AbouHaidar G, Halleux C, Dagne DA, Akl EA. Stakeholders’ views and perspectives on treatments of visceral leishmaniasis and their outcomes in HIV-coinfected patients in East Africa and South-East Asia: A mixed methods study. PLoS Negl Trop Dis 2022; 16:e0010624. [PMID: 35969636 PMCID: PMC9410553 DOI: 10.1371/journal.pntd.0010624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 08/25/2022] [Accepted: 06/29/2022] [Indexed: 12/03/2022] Open
Abstract
Background In visceral leishmaniasis (VL) patients coinfected with human immunodeficiency virus (HIV), combination therapy (liposomal amphotericin B infusion and oral miltefosine) is being considered as an alternative to liposomal amphotericin B monotherapy. We aimed to assess the views of stakeholders in relation to these treatment options. Methodology In a mixed methods study, we surveyed and interviewed patients, government functionaries, programme managers, health service providers, nongovernmental organizations, researchers, and World Health Organization (WHO) personnel. We used the Evidence to Decision (EtD) framework for data collection planning and analysis. Constructs of interest included valuation of outcomes, impact on equity, feasibility and acceptability of the treatment options, implementation considerations, monitoring and evaluation, and research priorities. Principal findings/Conclusion Mortality and non-serious adverse events were rated as “critical” by respectively the highest (61%) and lowest percentages (47%) of survey participants. Participants viewed clinical cure as essential for patients to regain productivity. Non-patient stakeholders emphasized the importance of “sustained” clinical cure. For most survey participants, combination therapy, compared with monotherapy, would increase health equity (40%), and be more acceptable (79%) and feasible (57%). Interviews revealed that combination therapy was more feasible and acceptable than monotherapy when associated with a shorter duration of hospitalization. The findings of the interviews provided insight into those of the survey. When choosing between alternative options, providers should consider the outcomes that matter to patients as well as the impact on equity, feasibility, and acceptability of the options. In East Africa and South Asia, the number of patients with visceral leishmaniasis (VL) co-infected with human immunodeficiency virus (HIV) has been increasing over the years. In addition to independently posing major health challenges, the two conditions have detrimental effects on each other. In light of new evidence on treatment regimens for this patient population, the World Health Organization (WHO) recently updated its evidence-based region-specific treatment recommendations. To inform this process, we assessed the views of stakeholders on the outcomes of interest and on medication treatment options. The mixed methods study consisted of an online survey and semi-structured interviews. Outcomes such as mortality, complications, clinical cure, relapse and serious adverse events were viewed as important because of the burden associated with their experience, their consequences, and the co-infection status of the patients. Outcomes such as non-serious adverse events were viewed as less important for reasons relating to patient tolerability and ease of treatment. As compared to monotherapy, combination therapy was found to be more equitable, acceptable, and feasible. While our findings are important to consider by clinicians treating patients with VL patients coinfected with HIV, they also inform decisions made by other stakeholders such as guideline developers and program managers.
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Affiliation(s)
- Joanne Khabsa
- Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Saurabh Jain
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Amena El-Harakeh
- Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Cynthia Rizkallah
- Hariri School of Nursing, American University of Beirut, Beirut, Lebanon
| | - Dhruv K. Pandey
- Kala-azar Elimination Programme, World Health Organization Country Office, New Delhi, India
| | - Nigus Manaye
- Neglected Tropical Diseases, World Health Organization Country Office, Addis Ababa, Ethiopia
| | | | - Christine Halleux
- Special Programme for Research and Training in Tropical Diseases (TDR), World Health Organization, Geneva, Switzerland
| | - Daniel Argaw Dagne
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Elie A. Akl
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- * E-mail:
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16
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Jones AW, McKenzie JE, Osadnik CR, Stovold E, Cox NS, Burge AT, Lahham A, Lee JYT, Hoffman M, Holland AE. Non-pharmacological interventions for the prevention of hospitalisations in stable chronic obstructive pulmonary disease: component network meta-analysis. Hippokratia 2022. [DOI: 10.1002/14651858.cd015153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Arwel W Jones
- Respiratory Research@Alfred, Department of Immunology and Pathology; Monash University; Melbourne Australia
| | - Joanne E McKenzie
- School of Public Health and Preventive Medicine; Monash University; Melbourne Australia
| | | | - Elizabeth Stovold
- Population Health Research Institute; St George's, University of London; London UK
| | - Narelle S Cox
- Respiratory Research@Alfred, Department of Immunology and Pathology; Monash University; Melbourne Australia
- Institute for Breathing and Sleep; Melbourne Australia
| | - Angela T Burge
- Respiratory Research@Alfred, Department of Immunology and Pathology; Monash University; Melbourne Australia
- Institute for Breathing and Sleep; Melbourne Australia
- Department of Physiotherapy; Alfred Health; Melbourne Australia
| | - Aroub Lahham
- Respiratory Research@Alfred, Department of Immunology and Pathology; Monash University; Melbourne Australia
| | - Joanna YT Lee
- Respiratory Research@Alfred, Department of Immunology and Pathology; Monash University; Melbourne Australia
| | - Mariana Hoffman
- Respiratory Research@Alfred, Department of Immunology and Pathology; Monash University; Melbourne Australia
| | - Anne E Holland
- Respiratory Research@Alfred, Department of Immunology and Pathology; Monash University; Melbourne Australia
- Institute for Breathing and Sleep; Melbourne Australia
- Department of Physiotherapy; Alfred Health; Melbourne Australia
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17
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Holland AE, Bondarenko J. Breathlessness: Remembering the worst of it. Respirology 2022; 27:806-807. [PMID: 35821602 DOI: 10.1111/resp.14329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 07/04/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Anne E Holland
- Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Department of Physiotherapy, Alfred Health, Melbourne, Victoria, Australia.,Department of Respiratory Medicine, Alfred Health, Melbourne, Victoria, Australia.,Institute for Breathing and Sleep, Melbourne, Victoria, Australia
| | - Janet Bondarenko
- Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Department of Physiotherapy, Alfred Health, Melbourne, Victoria, Australia
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18
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Jeyachandran V, Hurst JR. Advances in chronic obstructive pulmonary disease: management of exacerbations. Br J Hosp Med (Lond) 2022; 83:1-7. [DOI: 10.12968/hmed.2022.0275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Exacerbations of chronic obstructive pulmonary disease are important events to people living with this condition and a common cause of emergency hospital admission. In the absence of a confirmatory biomarker, an exacerbation remains a clinical diagnosis of exclusion and clinicians must be alert to alternative diagnoses. Most exacerbations are caused by airway infection, particularly with respiratory viruses. The mainstay of exacerbation treatment is an increase in the dose and/or frequency of short-acting beta-agonists, with short-course oral corticosteroids and/or antibiotics. Although there have been no new interventions to treat exacerbations in many years, there is still much variation in care and opportunity to improve outcomes. There has been a new focus on both the management of comorbidities and the optimisation of future care to reduce the risk of further events. This review summarises advances in managing exacerbations of chronic obstructive pulmonary disease, focusing on hospitalised patients.
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Affiliation(s)
| | - John R Hurst
- UCL Respiratory, University College London, London, UK
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19
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Chalupsky MR, Craddock KM, Schivo M, Kuhn BT. Remote patient monitoring in the management of chronic obstructive pulmonary disease. J Investig Med 2022; 70:1681-1689. [PMID: 35710143 DOI: 10.1136/jim-2022-002430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2022] [Indexed: 11/03/2022]
Abstract
Remote patient monitoring allows monitoring high-risk patients through implementation of an expanding number of technologies in coordination with a healthcare team to augment care, with the potential to provide early detection of exacerbation, prompt access to therapy and clinical services, and ultimately improved patient outcomes and decreased healthcare utilization.In this review, we describe the application of remote patient monitoring in chronic obstructive pulmonary disease including the potential benefits and possible barriers to implementation both for the individual and the healthcare system.
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Affiliation(s)
- Megan R Chalupsky
- Division of Pulmonary and Critical Care Medicine, University of California Davis School of Medicine, Sacramento, California, USA.,VA Northern California Health Care System, Mather, California, USA
| | - Krystal M Craddock
- Department of Respiratory Care, University of California Davis Health System, Sacramento, California, USA
| | - Michael Schivo
- Division of Pulmonary and Critical Care Medicine, University of California Davis School of Medicine, Sacramento, California, USA.,VA Northern California Health Care System, Mather, California, USA
| | - Brooks T Kuhn
- Division of Pulmonary and Critical Care Medicine, University of California Davis School of Medicine, Sacramento, California, USA .,VA Northern California Health Care System, Mather, California, USA
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20
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Mathioudakis AG, Abroug F, Agusti A, Ananth S, Bakke P, Bartziokas K, Beghe B, Bikov A, Bradbury T, Brusselle G, Cadus C, Coleman C, Contoli M, Corlateanu A, Corlateanu O, Criner GJ, Csoma B, Emelyanov A, Faner R, Fernandez Romero G, Hammouda Z, Horváth P, Huerta Garcia A, Jacobs M, Jenkins C, Joos G, Kharevich O, Kostikas K, Lapteva E, Lazar Z, Leuppi JD, Liddle C, Linnell J, López-Giraldo A, McDonald VM, Nielsen R, Papi A, Saraiva I, Sergeeva G, Sioutkou A, Sivapalan P, Stovold E, Wang H, Wen F, Yorke J, Williamson PR, Vestbo J, Jensen JU. ERS statement: a core outcome set for clinical trials evaluating the management of COPD exacerbations. Eur Respir J 2022; 59:2102006. [PMID: 34649975 DOI: 10.1183/13993003.02006-2021] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 09/03/2021] [Indexed: 02/05/2023]
Abstract
Clinical trials evaluating the management of acute exacerbations of COPD assess heterogeneous outcomes, often omitting those that are clinically relevant or more important to patients. We have developed a core outcome set, a consensus-based minimum set of important outcomes that we recommend are evaluated in all future clinical trials on exacerbations management, to improve their quality and comparability. COPD exacerbations outcomes were identified through methodological systematic reviews and qualitative interviews with 86 patients from 11 countries globally. The most critical outcomes were prioritised for inclusion in the core outcome set through a two-round Delphi survey completed by 1063 participants (256 patients, 488 health professionals and 319 clinical academics) from 88 countries in five continents. Two global, multi-stakeholder, virtual consensus meetings were conducted to 1) finalise the core outcome set and 2) prioritise a single measurement instrument to be used for evaluating each of the prioritised outcomes. Consensus was informed by rigorous methodological systematic reviews. The views of patients with COPD were accounted for at all stages of the project. Survival, treatment success, breathlessness, quality of life, activities of daily living, the need for a higher level of care, arterial blood gases, disease progression, future exacerbations and hospital admissions, treatment safety and adherence were all included in the core outcome set. Focused methodological research was recommended to further validate and optimise some of the selected measurement instruments. The panel did not consider the prioritised set of outcomes and associated measurement instruments to be burdensome for patients and health professionals to use.
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Affiliation(s)
- Alexander G Mathioudakis
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- The North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
- A.G. Mathioudakis and J-U. Jensen are the co-chairs of the COS-AECOPD ERS task force
| | | | - Alvar Agusti
- Respiratory Institute, Hospital Clinic and Catedra de Salud Respiratoria, University of Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), National Spanish Network for Respiratory Research (CIBERES), Barcelona, Spain
| | | | - Per Bakke
- Dept of Clinical Science, University of Bergen, Bergen, Norway
| | | | - Bianca Beghe
- Section of Respiratory Diseases, Dept of Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Andras Bikov
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- The North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Thomas Bradbury
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Guy Brusselle
- Depts of Epidemiology and Respiratory Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
- Dept of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - Cordula Cadus
- University Department of Medicine, Cantonal Hospital Basell and Liestal, Basel, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | | | - Marco Contoli
- Research Center on Asthma and COPD, Dept of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Alexandru Corlateanu
- Dept of Respiratory Medicine, State University of Medicine and Pharmacy 'Nicolae Testemitanu', Chisinau, Moldova
| | - Olga Corlateanu
- Dept of Internal Medicine, State University of Medicine and Pharmacy 'Nicolae Testemitanu', Chisinau, Moldova
| | - Gerard J Criner
- Dept of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Balazs Csoma
- Dept of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Alexander Emelyanov
- Dept of Respiratory Medicine and Allergy, North-Western Medical University St Petersburg, St Petersburg, Russian Federation
| | - Rosa Faner
- Respiratory Institute, Hospital Clinic and Catedra de Salud Respiratoria, University of Barcelona, Barcelona, Spain
| | - Gustavo Fernandez Romero
- Dept of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | | | - Peter Horváth
- Dept of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Arturo Huerta Garcia
- Respiratory Institute, Hospital Clinic and Catedra de Salud Respiratoria, University of Barcelona, Barcelona, Spain
- Respiratory Intensive Care Division, Clinica Sagrada Familia, Barcelona, Spain
| | - Michael Jacobs
- Dept of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Christine Jenkins
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Guy Joos
- Dept of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - Olga Kharevich
- Dept of Pulmonology and Tuberculosis, Belarusian Medical Academy of Postgraduate Education, Minsk Belarus
| | - Konstantinos Kostikas
- Respiratory Medicine Dept, University of Ioannina School of Medicine, Ioannina, Greece
| | - Elena Lapteva
- Dept of Pulmonology and Tuberculosis, Belarusian Medical Academy of Postgraduate Education, Minsk Belarus
| | - Zsofia Lazar
- Dept of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Joerg D Leuppi
- University Department of Medicine, Cantonal Hospital Basell and Liestal, Basel, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | | | | | - Alejandra López-Giraldo
- Respiratory Institute, Hospital Clinic and Catedra de Salud Respiratoria, University of Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), National Spanish Network for Respiratory Research (CIBERES), Barcelona, Spain
| | - Vanessa M McDonald
- Dept of Respiratory and Sleep Medicine, Medical and Interventional Services, John Hunter Hospital, Hunter New England Local Health District, New Lambton Heights, Australia
- Priority Research Centre for Healthy Lungs, University of Newcastle, Callaghan, Australia
- School of Nursing and Midwifery, University of Newcastle, Callaghan, Australia
| | - Rune Nielsen
- Dept of Clinical Science, University of Bergen, Bergen, Norway
- Dept of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway
| | - Alberto Papi
- Research Center on Asthma and COPD, Dept of Medical Sciences, University of Ferrara, Ferrara, Italy
| | | | - Galina Sergeeva
- Dept of Respiratory Medicine and Allergy, North-Western Medical University St Petersburg, St Petersburg, Russian Federation
| | - Agni Sioutkou
- Respiratory Medicine Dept, University of Ioannina School of Medicine, Ioannina, Greece
| | - Pradeesh Sivapalan
- Section of Respiratory Medicine, Dept of Internal Medicine, Herlev-Gentofte Hospital, Hellerup, Denmark
- Dept of Internal Medicine, Zealand University Hospital, Roskilde, Denmark
| | - Elizabeth Stovold
- Cochrane Airways Group, Population Health Research Institute, St George's University of London, London, UK
| | - Hao Wang
- Dept of Respiratory and Critical Care Medicine, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, China
| | - Fuqiang Wen
- Dept of Respiratory and Critical Care Medicine, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, China
| | - Janelle Yorke
- School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Christie Patient Centred Research, The Christie NHS Foundation Trust, Manchester, UK
| | - Paula R Williamson
- MRC/NIHR Trials Methodology Research Partnership, Dept of Health Data Science, University of Liverpool (a member of Liverpool Health Partners), Liverpool, UK
| | - Jørgen Vestbo
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- The North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Jens-Ulrik Jensen
- Section of Respiratory Medicine, Dept of Internal Medicine, Herlev-Gentofte Hospital, Hellerup, Denmark
- Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
- A.G. Mathioudakis and J-U. Jensen are the co-chairs of the COS-AECOPD ERS task force
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21
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Holland AE, Jones AW, Mahal A, Lannin NA, Cox N, Hepworth G, O'Halloran P, McDonald CF. Implementing a choice of pulmonary rehabilitation models in chronic obstructive pulmonary disease (HomeBase2 trial): protocol for a cluster randomised controlled trial. BMJ Open 2022; 12:e057311. [PMID: 35410931 PMCID: PMC9003613 DOI: 10.1136/bmjopen-2021-057311] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION There is compelling evidence that either centre-based or home-based pulmonary rehabilitation improves clinical outcomes in chronic obstructive pulmonary disease (COPD). There are known health service and personal barriers which prevent potentially eligible patients from accessing the benefits of pulmonary rehabilitation. The aim of this hybrid effectiveness-implementation trial is to examine the effects of offering patients a choice of pulmonary rehabilitation locations (home or centre) compared with offering only the traditional centre-based model. METHOD AND ANALYSIS This is a two-arm cluster randomised, controlled, assessor-blinded trial of 14 centre-based pulmonary rehabilitation services allocated to intervention (offering choice of home-based or centre-based pulmonary rehabilitation) or control (continuing to offer centre-based pulmonary rehabilitation only), stratified by centre-based programme setting (hospital vs non-hospital). 490 participants with COPD will be recruited. Centre-based pulmonary rehabilitation will be delivered according to best practice guidelines including supervised exercise training for 8 weeks. At intervention sites, the home-based pulmonary rehabilitation will be delivered according to an established 8-week model, comprising of one home visit, unsupervised exercise training and telephone calls that build motivation for exercise participation and facilitate self-management. The primary outcome is all-cause, unplanned hospitalisations in the 12 months following rehabilitation. Secondary outcomes include programme completion rates and measurements of 6-minute walk distance, chronic respiratory questionnaire, EQ-5D-5L, dyspnoea-12, physical activity and sedentary time at the end of rehabilitation and 12 months following rehabilitation.Direct healthcare costs, indirect costs and changes in EQ-5D-5L will be used to evaluate cost-effectiveness. A process evaluation will be undertaken to understand how the choice model is implemented and explore sustainability beyond the clinical trial. ETHICS AND DISSEMINATION Alfred Hospital Ethics Committee has approved this protocol. The trial findings will be published in peer-reviewed journals, submitted for presentation at conferences and disseminated to patients across Australia with support from national lung charities and societies. TRIAL REGISTRATION NUMBER NCT04217330.
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Affiliation(s)
- Anne E Holland
- Respiratory Research@Alfred, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Department of Physiotherapy, Alfred Health, Melbourne, Victoria, Australia
- Institute for Breathing and Sleep, Heidelberg, Victoria, Australia
| | - Arwel W Jones
- Respiratory Research@Alfred, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Ajay Mahal
- The Nossal Global Institute for Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Natasha A Lannin
- Department of Clinical Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Allied Health (Occupational Therapy), Alfred Health, Melbourne, Victoria, Australia
| | - Narelle Cox
- Respiratory Research@Alfred, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Institute for Breathing and Sleep, Heidelberg, Victoria, Australia
| | - Graham Hepworth
- Statistical Consulting Centre, The University of Melbourne, Melbourne, Victoria, Australia
| | - Paul O'Halloran
- Department of Public Health, La Trobe University, Bundoora, Victoria, Australia
| | - Christine F McDonald
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
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22
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GRADE summary of findings tables Enhanced Understanding of Values and Preferences Evidence. J Clin Epidemiol 2022; 147:60-68. [PMID: 35364232 DOI: 10.1016/j.jclinepi.2022.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 03/08/2022] [Accepted: 03/20/2022] [Indexed: 11/20/2022]
Abstract
OBJECTIVE We conceptualize patient values and preferences as the relative importance of health outcomes (RIO) which are often obtained through utility elicitation research. A transparent and structured approach to present synthesized RIO evidence and the certainty of this evidence is needed. This study aims to adapt the summary of findings (SoF) table to describe the RIO. STUDY DESIGN AND SETTING We performed three interactive workshops with a protype version of the SoF table for RIO evidence adapted from the SoF table for intervention effects. We then tested the new format through semi-structured interviews with professionals who interpret RIO evidence (e.g., systematic review authors and guideline developers). RESULTS We adapted the SoF table for the presentation of RIO evidence. This SoF table may be easy to use but bears one risk: some participants misunderstood the utility information and the variability around the RIO. We added a visual analogue scale to clarify the concept of utilities. CONCLUSION Through a multi-stage process including brainstorming sessions and interviews, we adapted the SoF table to present RIO evidence. This table may enhance understanding of evidence synthesis of values and preferences, facilitating the incorporation of this type of evidence in decision making.
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23
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Alqahtani JS, Mandal S, Hurst JR. The Impact of Re-Admissions in COPD. Arch Bronconeumol 2022; 58:109-110. [DOI: 10.1016/j.arbres.2021.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 06/08/2021] [Indexed: 11/15/2022]
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24
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Lawless M, Burgess M, Bourke S. Impact of COVID-19 on Hospital Admissions for COPD Exacerbation: Lessons for Future Care. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58010066. [PMID: 35056374 PMCID: PMC8778793 DOI: 10.3390/medicina58010066] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 12/21/2021] [Accepted: 12/30/2021] [Indexed: 12/24/2022]
Abstract
Background and Objectives: Chronic obstructive pulmonary disease (COPD) is a leading cause of death worldwide. Acute exacerbations (AECOPD) are common and often triggered by viral infection. During the COVID-19 pandemic social restrictions, including ‘shielding’ and ‘lockdowns’, were mandated. Multiple, worldwide studies report a reduction in AECOPD admissions during this period. This study aims to assess the effect of the pandemic and Lockdown on the rates of admission with AECOPD and severity of hospitalised exacerbations in the North-East of England. Materials and Methods: Data were extracted for patients presenting with a diagnosis of AECOPD or respiratory failure secondary to AECOPD during the ‘COVID-19 period’ (26/3/20–31/12/20) and a date-matched control period from the year previous. We present descriptive statistics and regression analysis of the effects of the COVID-19 period on the rates of hospital admission. Results: Compared to the matched control period, the COVID-19 period was associated with fewer AECOPD admissions (COVID-19 = 719, control = 1257; rate ratio 0.57, p < 0.001) and shorter length of stay (COVID-19 = 3.9 ± 0.2, control = 4.78 ± 0.2 days; p = 0.002), with similar in-hospital plus 30-day post-discharge mortality. Demographics were similar between periods. Only six patients had a positive COVID-19 PCR test. Conclusion: During the COVID-19 period there was a substantial reduction in AECOPD admissions, but no increase in overall severity of exacerbations or mortality. Rather than fear driving delayed hospital presentation, physical and behavioural measures taken during this period to limit transmission of COVID-19 are likely to have reduced transmission of other respiratory viruses. This has important implications for control of future AECOPD.
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25
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Cowan J, Mulpuru S, Abdallah SJ, Chopra A, Purssell A, McGuinty M, Alvarez GG, Giulivi A, Corrales-Medina V, MacFadden D, Boyle L, Hasimja D, Thavorn K, Mallick R, Aaron SD, Cameron DW. A Randomized Double-Blind Placebo-Control Feasibility Trial of Immunoglobulin Treatment for Prevention of Recurrent Acute Exacerbations of COPD. Int J Chron Obstruct Pulmon Dis 2021; 16:3275-3284. [PMID: 34887657 PMCID: PMC8650772 DOI: 10.2147/copd.s338849] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 11/23/2021] [Indexed: 11/30/2022] Open
Abstract
Background Observational studies suggest that immunoglobulin treatment may reduce the frequency of acute exacerbations of COPD (AECOPD). Objective To inform the design of a future randomised control trial (RCT) of intravenous immunoglobulin (IVIG) treatment efficacy for AECOPD prevention. Methods A pilot RCT was conducted. We recruited patients with COPD hospitalized for AECOPD, or from ambulatory clinics with one severe, or two moderate AECOPD in the previous year regardless of their serum IgG level. Patients were allocated in a 1:1 ratio with balanced randomisation to monthly IVIG or normal saline for 1 year. The primary outcome was feasibility defined as pre-specified accrual, adherence, and follow-up rates. Secondary outcomes included safety, tolerance, AECOPD rates, time to first AECOPD, quality of life, and healthcare costs. Results Seventy patients were randomized (37 female; mean age 67.7; mean FEV1 35.1%). Recruitment averaged 4.5±0.9 patients per month (range 0–8), 34 (49%) adhered to at least 80% of planned treatments, and four (5.7%) were lost to follow-up. There were 35 serious adverse events including seven deaths and one thromboembolism. None was related to IVIG. There were 56 and 48 moderate and severe AECOPD in the IVIG vs control groups. In patients with at least 80% treatment adherence, median time to first moderate or severe AECOPD was 275 vs 114 days, favoring the IVIG group (HR 0.76, 95% CI 0.3–1.92). Conclusion The study met feasibility criteria for recruitment and retention, but adherence was low. A trend toward more robust treatment efficacy in adherent patients supports further study, but future trials must address treatment adherence. Trial registration number NCT0290038, registered 24 February 2016, https://clinicaltrials.gov/ct2/show/NCT02690038 and NCT03018652, registered January 12, 2017, https://clinicaltrials.gov/ct2/show/NCT03018652.
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Affiliation(s)
- Juthaporn Cowan
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Sunita Mulpuru
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Sara J Abdallah
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Anchal Chopra
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Andrew Purssell
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Gonzalo G Alvarez
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Antonio Giulivi
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Department of Pathology and Laboratory Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Vicente Corrales-Medina
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Derek MacFadden
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Loree Boyle
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Delvina Hasimja
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Kednapa Thavorn
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Ranjeeta Mallick
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Shawn D Aaron
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - D William Cameron
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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26
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Ashdown HF, Smith M, McFadden E, Pavord ID, Butler CC, Bafadhel M. Blood eosinophils to guide inhaled maintenance therapy in a primary care COPD population. ERJ Open Res 2021; 8:00606-2021. [PMID: 35141324 PMCID: PMC8819252 DOI: 10.1183/23120541.00606-2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 11/08/2021] [Indexed: 12/27/2022] Open
Abstract
Blood eosinophils are a potentially useful biomarker for guiding inhaled corticosteroid (ICS) treatment decisions in COPD. We investigated whether existing blood eosinophil counts predict benefit from initiation of ICS compared to bronchodilator therapy.We used routinely collected data from UK primary care in the Clinical Practice Research Datalink. Participants were aged ≥40 years with COPD, were ICS-naïve and starting a new inhaled maintenance medication (intervention group: ICS; comparator group: long-acting bronchodilator, non-ICS). Primary outcome was time to first exacerbation, compared between ICS and non-ICS groups, stratified by blood eosinophils (“high” ≥150 cells·µL−1 and “low” <150 cells·µL−1).Out of 9475 eligible patients, 53.9% initiated ICS and 46.1% non-ICS treatment with no difference in eosinophils between treatment groups (p=0.71). Exacerbation risk was higher in patients prescribed ICS than those prescribed non-ICS treatment, but with a lower risk in those with high eosinophils (hazard ratio (HR) 1.04, 95% CI 0.98–1.10) than low eosinophils (HR 1.19, 95% CI 1.09–1.31) (p-value for interaction 0.01). Risk of pneumonia hospitalisation with ICS was greatest in those with low eosinophils (HR 1.26, 95% CI 1.05–1.50; p-value for interaction 0.04). Results were similar whether the most recent blood eosinophil count or the mean of blood eosinophil counts was used.In a primary care population, the most recent blood eosinophil count could be used to guide initiation of ICS in COPD patients. We suggest that ICS should be considered in those with higher eosinophils and avoided in those with lower eosinophils (<150 cells·µL−1).
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27
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Mathioudakis AG, Ananth S, Bradbury T, Csoma B, Sivapalan P, Stovold E, Fernandez-Romero G, Lazar Z, Criner GJ, Jenkins C, Papi A, Jensen JU, Vestbo J. Assessing Treatment Success or Failure as an Outcome in Randomised Clinical Trials of COPD Exacerbations. A Meta-Epidemiological Study. Biomedicines 2021; 9:biomedicines9121837. [PMID: 34944653 PMCID: PMC8698292 DOI: 10.3390/biomedicines9121837] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 12/02/2021] [Accepted: 12/03/2021] [Indexed: 11/16/2022] Open
Abstract
A recently published ERS core outcome set recommends that all trials of COPD exacerbation management should assess the treatment success (or “cure” of the exacerbation), defined as a dichotomous measure of the overall outcome of an exacerbation. This methodological systematic review describes and compares the instruments that were used to assess treatment success or failure in 54 such RCTs, published between 2006–2020. Twenty-three RCTs used composite measures consisting of several undesirable outcomes of an exacerbation, together defining an overall unfavourable outcome, to define treatment failure. Thirty-four RCTs used descriptive instruments that used qualitative or semi-quantitative descriptions to define cure, marked improvement, improvement of the exacerbation, or treatment failure. Treatment success and failure rates among patients receiving guidelines-directed treatments at different settings and timepoints are described and could be used to inform power calculations in future trials. Descriptive instruments appeared more sensitive to treatment effects compared to composite instruments. Further methodological studies are needed to optimise the evaluation of treatment success/failure. In the meantime, based on the findings of this systematic review, the ERS core outcome set recommends that cure should be defined as sufficient improvement of the signs and symptoms of the exacerbation such that no additional systemic treatments are required.
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Affiliation(s)
- Alexander G. Mathioudakis
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, The University of Manchester, Manchester M23 9LT, UK;
- North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester M23 9LT, UK
- Correspondence:
| | - Sachin Ananth
- West Hertfordshire Hospital NHS Trust, Watford WD18 0HB, UK;
| | - Thomas Bradbury
- The George Institute for Global Health, University of New South Wales, Sydney 1466, Australia; (T.B.); (C.J.)
| | - Balazs Csoma
- Department of Pulmonology, Faculty of Medicine, Semmelweis University, 1085 Budapest, Hungary; (B.C.); (Z.L.)
| | - Pradeesh Sivapalan
- Section of Respiratory Medicine, Department of Internal Medicine, Herlev-Gentofte Hospital, 2900 Hellerup, Denmark; (P.S.); (J.-U.J.)
- Department of Internal Medicine, Zealand University Hospital, 4000 Roskilde, Denmark
| | - Elizabeth Stovold
- Cochrane Airways Group, Population Health Research Institute, St George’s University of London, London SW17 0RE, UK;
| | - Gustavo Fernandez-Romero
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA 19140, USA; (G.F.-R.); (G.J.C.)
| | - Zsofia Lazar
- Department of Pulmonology, Faculty of Medicine, Semmelweis University, 1085 Budapest, Hungary; (B.C.); (Z.L.)
| | - Gerard J. Criner
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA 19140, USA; (G.F.-R.); (G.J.C.)
| | - Christine Jenkins
- The George Institute for Global Health, University of New South Wales, Sydney 1466, Australia; (T.B.); (C.J.)
| | - Alberto Papi
- Research Center on Asthma and COPD, Faculty of Medical Sciences, University of Ferrara, 44121 Ferrara, Italy;
| | - Jens-Ulrik Jensen
- Section of Respiratory Medicine, Department of Internal Medicine, Herlev-Gentofte Hospital, 2900 Hellerup, Denmark; (P.S.); (J.-U.J.)
- Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, 1165 Copenhagen, Denmark
| | - Jørgen Vestbo
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, The University of Manchester, Manchester M23 9LT, UK;
- North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester M23 9LT, UK
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Al Rajeh A, Bhogal AS, Zhang Y, Costello JT, Hurst JR, Mani AR. Application of oxygen saturation variability analysis for the detection of exacerbation in individuals with COPD: A proof-of-concept study. Physiol Rep 2021; 9:e15132. [PMID: 34851045 PMCID: PMC8634631 DOI: 10.14814/phy2.15132] [Citation(s) in RCA: 7] [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: 07/14/2021] [Revised: 10/30/2021] [Accepted: 11/13/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Individuals with chronic obstructive pulmonary disease (COPD) commonly experience exacerbations, which may require hospital admission. Early detection of exacerbations, and therefore early treatment, could be crucial in preventing admission and improving outcomes. Our previous research has demonstrated that the pattern analysis of peripheral oxygen saturation (Sp O2 ) fluctuations provides novel insights into the engagement of the respiratory control system in response to physiological stress (hypoxia). Therefore, this pilot study tested the hypothesis that the pattern of Sp O2 variations in overnight recordings of individuals with COPD would distinguish between stable and exacerbation phases of the disease. METHODS Overnight pulse oximetry data from 11 individuals with COPD, who exhibited exacerbation after a period of stable disease, were examined. Stable phase recordings were conducted overnight and one night prior to exacerbation recordings were also analyzed. Pattern analysis of Sp O2 variations was carried examined using sample entropy (for assessment of irregularity), the multiscale entropy (complexity), and detrended fluctuation analysis (self-similarity). RESULTS Sp O2 variations displayed a complex pattern in both stable and exacerbation phases of COPD. During an exacerbation, Sp O2 entropy increased (p = 0.029) and long-term fractal-like exponent (α2) decreased (p = 0.002) while the mean and standard deviation of Sp O2 time series remained unchanged. Through ROC analyses, Sp O2 entropy and α2 were both able to classify the COPD phases into either stable or exacerbation phase. With the best positive predictor value (PPV) for sample entropy (PPV = 70%) and a cut-off value of 0.454. While the best negative predictor value (NPV) was α2 (NPV = 78%) with a cut-off value of 1.00. CONCLUSION Alterations in Sp O2 entropy and the fractal-like exponent have the potential to detect exacerbations in COPD. Further research is warranted to examine if Sp O2 variability analysis could be used as a novel objective method of detecting exacerbations.
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Affiliation(s)
- Ahmed Al Rajeh
- UCL RespiratoryRoyal Free CampusDivision of MedicineUniversity College LondonLondonUK
- Department of Respiratory CareKing Faisal UniversityAl‐AhsaSaudi Arabia
| | - Amar S. Bhogal
- Network Physiology LaboratoryDivision of MedicineUCLLondonUK
- Medical SchoolUniversity of BirminghamBirminghamUK
| | - Yunkai Zhang
- Network Physiology LaboratoryDivision of MedicineUCLLondonUK
| | - Joseph T. Costello
- Extreme Environment LaboratorySchool of Sport, Health and Exercise ScienceUniversity of PortsmouthPortsmouthUK
| | - John R Hurst
- UCL RespiratoryRoyal Free CampusDivision of MedicineUniversity College LondonLondonUK
| | - Ali R. Mani
- Network Physiology LaboratoryDivision of MedicineUCLLondonUK
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Wiercioch W, Nieuwlaat R, Zhang Y, Alonso-Coello P, Dahm P, Iorio A, Manja V, Mustafa RA, Neumann I, Ortel TL, Rochwerg B, Santesso N, Vesely SK, Akl EA, Schünemann HJ. New methods facilitated the process of prioritizing questions and health outcomes in guideline development. J Clin Epidemiol 2021; 143:91-104. [PMID: 34843861 DOI: 10.1016/j.jclinepi.2021.11.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 11/06/2021] [Accepted: 11/22/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Health guideline development requires sequential prioritization of the guideline topic, questions, and health outcomes. In this paper we report on new approaches for prioritizing questions and outcomes in guidelines. METHODS Ten guideline panels on venous thromboembolism rated potential guideline questions on a 9-point scale according to their overall importance and 6 criteria: common in practice, uncertainty in practice, variation in practice, new evidence available, cost consequences, not previously addressed. We randomized panelists to rate one potential question with and without the 6 criteria. Panelists rated importance of outcomes, defined with health outcome descriptors (HODs), using a 9-point scale, and health utility of outcomes on a visual analogue scale. RESULTS Of 469 potential questions identified, 72.5% were rated as important but not of high priority, and 25.4% as high priority. Each criterion was significantly associated with the overall importance rating. The overall importance rating means were 5.96 (SD 2.38) and 6.53 (SD 2.45) (P = 0.25) for those randomized to rate questions with and without the criteria, respectively. The mean importance rating for 121 outcomes was 6.01 (SD 1.25), with 35.5% rated as critical for decision-making. Panelists provided health utility ratings for 127 outcomes, with a minimum mean rating of 0.12 (SD 0.10) and maximum of 0.91 (SD 0.15). CONCLUSION Our structured process provided information to help explain perspectives of question importance, to facilitate panels' outcome prioritization, and to facilitate decision-making in guideline development.
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Affiliation(s)
- Wojtek Wiercioch
- Michael G. DeGroote Cochrane Canada & McMaster GRADE Centres, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Robby Nieuwlaat
- Michael G. DeGroote Cochrane Canada & McMaster GRADE Centres, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Yuan Zhang
- Michael G. DeGroote Cochrane Canada & McMaster GRADE Centres, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Pablo Alonso-Coello
- Iberoamerican Cochrane Center, Biomedical Research Institute Sant Pau (IIB Sant Pau-CIBERESP), Barcelona, Spain
| | - Philipp Dahm
- Minneapolis VAMC, Urology Section and University of Minnesota Department of Urology, Minneapolis, Minnesota
| | - Alfonso Iorio
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, McMaster University, Hamilton, Canada
| | - Veena Manja
- Department of Surgery, University of California Davis, California, USA; Department of Medicine, Veterans Affairs Northern California Health Care System, Mather, California
| | - Reem A Mustafa
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada; Division of Nephrology and Hypertension, Department of Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Ignacio Neumann
- Department of Internal Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Thomas L Ortel
- Departments of Medicine and Pathology, Duke University Medical Center, Durham, North Carolina
| | - Bram Rochwerg
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, McMaster University, Hamilton, Canada
| | - Nancy Santesso
- Michael G. DeGroote Cochrane Canada & McMaster GRADE Centres, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Sara K Vesely
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Elie A Akl
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Internal Medicine, American University of Beirut, Lebanon
| | - Holger J Schünemann
- Michael G. DeGroote Cochrane Canada & McMaster GRADE Centres, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, McMaster University, Hamilton, Canada; Institut für Evidence in Medicine, Medical Center & Faculty of Medicine, University of Freiburg, Freiburg, Germany.
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McDowell G, Sumowski M, Toellner H, Karok S, O'Dwyer C, Hornsby J, Lowe DJ, Carlin CM. Assistive technologies for home NIV in patients with COPD: feasibility and positive experience with remote-monitoring and volume-assured auto-EPAP NIV mode. BMJ Open Respir Res 2021; 8:8/1/e000828. [PMID: 34782327 PMCID: PMC8593724 DOI: 10.1136/bmjresp-2020-000828] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 10/20/2021] [Indexed: 12/04/2022] Open
Abstract
Background Outcomes for patients with chronic obstructive pulmonary disease (COPD) with persistent hypercapnic respiratory failure are improved by long-term home non-invasive ventilation (NIV). Provision of home-NIV presents clinical and service challenges. The aim of this study was to evaluate outcomes of home-NIV in hypercapnic patients with COPD who had been set-up at our centre using remote-monitoring and iVAPS-autoEPAP NIV mode (Lumis device, ResMed). Methods Retrospective analysis of a data set of 46 patients with COPD who commenced remote-monitored home-NIV (AirView, ResMed) between February 2017 and January 2018. Events including time to readmission or death at 12 months were compared with a retrospectively identified cohort of 27 patients with hypercapnic COPD who had not been referred for consideration of home-NIV. Results The median time to readmission or death was significantly prolonged in patients who commenced home-NIV (median 160 days, 95% CI 69.38 to 250.63) versus the comparison cohort (66 days, 95% CI 21.9 to 110.1; p<0.01). Average time to hospital readmission was 221 days (95% CI, 47.77 to 394.23) and 70 days (95% CI, 55.31 to 84.69; p<0.05), respectively. Median decrease in bicarbonate level of 4.9 mmol/L (p<0.0151) and daytime partial pressure of carbon dioxide 2.2 kPa (p<0.032) in home-NIV patients with no required increase in nurse home visits is compatible with effectiveness of this service model. Median reduction of 14 occupied bed days per annum was observed per patient who continued home-NIV throughout the study period (N=32). Conclusion These findings demonstrate the feasibility and provide initial utility data for a technology-assisted service model for the provision of home-NIV therapy for patients with COPD.
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Affiliation(s)
- Grace McDowell
- Respiratory Medicine, Queen Elizabeth University Hospital, Glasgow, UK
| | | | - Hannah Toellner
- Respiratory Medicine, Queen Elizabeth University Hospital, Glasgow, UK
| | - Sophia Karok
- ResMed Data Solutions, ResMed Science Centre, Dublin, Ireland
| | - Ciara O'Dwyer
- ResMed Data Solutions, ResMed Science Centre, Dublin, Ireland
| | - James Hornsby
- Respiratory Medicine, Queen Elizabeth University Hospital, Glasgow, UK
| | - David J Lowe
- Respiratory Medicine, Queen Elizabeth University Hospital, Glasgow, UK
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Chronotropic Index and Acute Exacerbations of Chronic Obstructive Pulmonary Disease: A Secondary Analysis of BLOCK COPD. Ann Am Thorac Soc 2021; 18:1795-1802. [PMID: 33784233 PMCID: PMC9795809 DOI: 10.1513/annalsats.202008-1085oc] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Rationale: The chronotropic index quantifies the proportion of the expected heart rate increase that is attained during exercise. The relationship between the chronotropic index and acute exacerbations of chronic obstructive pulmonary disease (AECOPDs) has not been evaluated. Objectives: To determine whether a higher chronotropic index during a 6-minute walk (CI-6MW) is associated with lower risk of AECOPD and whether the CI-6MW is a marker of susceptibility to adverse effects of metoprolol in chronic obstructive pulmonary disease (COPD). Methods: We analyzed data from the BLOCK COPD (Beta-Blockers for the Prevention of AECOPDs) trial. We used Cox proportional hazards models to investigate the relationship between the CI-6MW and the time to AECOPDs. We also tested for interactions between study group assignment (metoprolol vs. placebo) and the CI-6MW on the time to AECOPDs. Results: Four hundred seventy-seven participants with exacerbation-prone COPD (mean forced expiratory volume in 1 second, 41% of predicted) were included in this analysis. A higher CI-6MW was independently associated with a decreased risk of AECOPDs of any severity (adjusted hazard ratio per 0.1 increase in CI-6MW of 0.88; 95% confidence interval, 0.80-0.96) but was not independently associated with AECOPDs requiring hospitalization (adjusted hazard ratio, 0.94; 95% confidence interval, 0.81-1.05). There was a significant interaction by treatment assignment, and in a stratified analysis, the protective effects of a higher CI-6MW on AECOPDs were negated by metoprolol use. Conclusions: A higher CI-6MW is associated with a decreased risk of AECOPDs and may be an indicator of susceptibility to the adverse effects of metoprolol.
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32
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Niño de Guzmán Quispe E, Martínez García L, Orrego Villagrán C, Heijmans M, Sunol R, Fraile-Navarro D, Pérez-Bracchiglione J, Ninov L, Salas-Gama K, Viteri García A, Alonso-Coello P. The Perspectives of Patients with Chronic Diseases and Their Caregivers on Self-Management Interventions: A Scoping Review of Reviews. THE PATIENT 2021; 14:719-740. [PMID: 33871808 PMCID: PMC8563562 DOI: 10.1007/s40271-021-00514-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 03/26/2021] [Indexed: 01/28/2023]
Abstract
BACKGROUND Self-management (SM) interventions are supportive interventions systematically provided by healthcare professionals, peers, or laypersons to increase the skills and confidence of patients in their ability to manage chronic diseases. We had two objectives: (1) to summarise the preferences and experiences of patients and their caregivers (informal caregivers and healthcare professionals) with SM in four chronic diseases and (2) to identify and describe the relevant outcomes for SM interventions from these perspectives. METHODS We conducted a mixed-methods scoping review of reviews. We searched three databases until December 2020 for quantitative, qualitative, or mixed-methods reviews exploring patients' and caregivers' preferences or experiences with SM in type 2 diabetes mellitus (T2DM), obesity, chronic obstructive pulmonary disease (COPD), and heart failure (HF). Quantitative data were narratively synthesised, and qualitative data followed a three-step descriptive thematic synthesis. Identified themes were categorised into outcomes or modifiable factors of SM interventions. RESULTS We included 148 reviews covering T2DM (n = 53 [35.8%]), obesity (n = 20 [13.5%]), COPD (n = 32 [21.6%]), HF (n = 38 [25.7%]), and those with more than one disease (n = 5 [3.4%]). We identified 12 main themes. Eight described the process of SM (disease progression, SM behaviours, social support, interaction with healthcare professionals, access to healthcare, costs for patients, culturally defined roles and perceptions, and health knowledge), and four described their experiences with SM interventions (the perceived benefit of the intervention, individualised care, sense of community with peers, and usability of equipment). Most themes and subthemes were categorised as outcomes of SM interventions. CONCLUSION The process of SM shaped the perspectives of patients and their caregivers on SM interventions. Their perspectives were influenced by the perceived benefit of the intervention, the sense of community with peers, the intervention's usability, and the level of individualised care. Our findings can inform the selection of patient-important outcomes, decision-making processes, including the formulation of recommendations, and the design and implementation of SM interventions.
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Affiliation(s)
- Ena Niño de Guzmán Quispe
- Iberoamerican Cochrane Centre (IbCC)-Sant Pau Biomedical Research Institute (IIB-Sant Pau), C/ Sant Antoni Maria Claret 167. Pabellón 18, Planta 0, 08025, Barcelona, Spain.
| | - Laura Martínez García
- Iberoamerican Cochrane Centre (IbCC)-Sant Pau Biomedical Research Institute (IIB-Sant Pau), C/ Sant Antoni Maria Claret 167. Pabellón 18, Planta 0, 08025, Barcelona, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Carola Orrego Villagrán
- Avedis Donabedian Research Institute (FAD), Barcelona, Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Monique Heijmans
- Netherlands Institute for Health Services Research (Nivel), Utrecht, The Netherlands
| | - Rosa Sunol
- Avedis Donabedian Research Institute (FAD), Barcelona, Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
| | - David Fraile-Navarro
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
- Madrid Primary Health Care Service, Madrid, Spain
| | | | | | - Karla Salas-Gama
- Health Services Research Group, Institut de Recerca Vall d'Hebron Hospital, Barcelona, Spain
- Vall d'Hebron University Hospital, Barcelona, Spain
| | - Andrés Viteri García
- Centro de Investigación de Salud Pública y Epidemiología Clínica (CISPEC), Universidad UTE, Quito, Ecuador
- Centro Asociado Cochrane de Ecuador, Universidad UTE, Quito, Ecuador
| | - Pablo Alonso-Coello
- Iberoamerican Cochrane Centre (IbCC)-Sant Pau Biomedical Research Institute (IIB-Sant Pau), C/ Sant Antoni Maria Claret 167. Pabellón 18, Planta 0, 08025, Barcelona, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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Cox NS, Lahham A, McDonald CF, Mahal A, O'Halloran P, Hepworth G, Spencer L, McNamara RJ, Bondarenko J, Macdonald H, Gavin S, Burge AT, Le Maitre C, Ringin C, Webb E, Nichols A, Tsai LL, Luxton N, van Hilten S, Santos M, Crute H, Byrne M, Boursinos H, Broe J, Corbett M, Marceau T, Warrick B, Boote C, Melinz J, Holland AE. Home-based pulmonary rehabilitation early after hospitalisation in COPD (early HomeBase): protocol for a randomised controlled trial. BMJ Open Respir Res 2021; 8:e001107. [PMID: 34819323 PMCID: PMC8614151 DOI: 10.1136/bmjresp-2021-001107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 11/05/2021] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Chronic obstructive pulmonary disease (COPD) is characterised by exacerbations of respiratory disease, frequently requiring hospital admission. Pulmonary rehabilitation can reduce the likelihood of future hospitalisation, but programme uptake is poor. This study aims to compare hospital readmission rates, clinical outcomes and costs between people with COPD who undertake a home-based programme of pulmonary rehabilitation commenced early (within 2 weeks) of hospital discharge with usual care. METHODS A multisite randomised controlled trial, powered for superiority, will be conducted in Australia. Eligible patients admitted to one of the participating sites for an exacerbation of COPD will be invited to participate. Participants will be randomised 1:1. Intervention group participants will undertake an 8-week programme of home-based pulmonary rehabilitation commencing within 2 weeks of hospital discharge. Control group participants will receive usual care and a weekly phone call for attention control. Outcomes will be measured by a blinded assessor at baseline, after the intervention (week 9-10 posthospital discharge), and at 12 months follow-up. The primary outcome is hospital readmission at 12 months follow-up. ETHICS AND DISSEMINATION Human Research Ethics approval for all sites provided by Alfred Health (Project 51216). Findings will be published in peer-reviewed journals, conferences and lay publications. TRIAL REGISTRATION NUMBER ACTRN12619001122145.
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Affiliation(s)
- Narelle S Cox
- Respiratory Research@Alfred, Department of Immunology & Pathology, Monash University, Melbourne, Victoria, Australia
- Institute for Breathing and Sleep, Melbourne, Victoria, Australia
| | - Aroub Lahham
- Respiratory Research@Alfred, Department of Immunology & Pathology, Monash University, Melbourne, Victoria, Australia
| | - Christine F McDonald
- Institute for Breathing and Sleep, Melbourne, Victoria, Australia
- Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia
- Faculty of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Ajay Mahal
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Paul O'Halloran
- School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Graham Hepworth
- Statistical Consulting Centre, University of Melbourne, Melbourne, Victoria, Australia
| | - Lissa Spencer
- Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | | | - Janet Bondarenko
- Respiratory Research@Alfred, Department of Immunology & Pathology, Monash University, Melbourne, Victoria, Australia
- Alfred Health, Melbourne, Victoria, Australia
| | | | - Samantha Gavin
- Coffs Harbour Health Campus, Coffs Harbour, New South Wales, Australia
| | - Angela T Burge
- Respiratory Research@Alfred, Department of Immunology & Pathology, Monash University, Melbourne, Victoria, Australia
- Institute for Breathing and Sleep, Melbourne, Victoria, Australia
- Alfred Health, Melbourne, Victoria, Australia
| | | | - Cade Ringin
- Respiratory Research@Alfred, Department of Immunology & Pathology, Monash University, Melbourne, Victoria, Australia
- Alfred Health, Melbourne, Victoria, Australia
| | - Elizabeth Webb
- Respiratory Research@Alfred, Department of Immunology & Pathology, Monash University, Melbourne, Victoria, Australia
- Alfred Health, Melbourne, Victoria, Australia
| | - Amanda Nichols
- Respiratory Research@Alfred, Department of Immunology & Pathology, Monash University, Melbourne, Victoria, Australia
| | - Ling-Ling Tsai
- Respiratory Research@Alfred, Department of Immunology & Pathology, Monash University, Melbourne, Victoria, Australia
- Prince of Wales Hospital, Sydney, New South Wales, Australia
- Sydney Local Health District, Sydney, New South Wales, Australia
| | - Nia Luxton
- Respiratory Research@Alfred, Department of Immunology & Pathology, Monash University, Melbourne, Victoria, Australia
| | - Stephanie van Hilten
- Respiratory Research@Alfred, Department of Immunology & Pathology, Monash University, Melbourne, Victoria, Australia
| | - Mary Santos
- Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Hayley Crute
- Wimmera Health Care Group, Horsham, Victoria, Australia
| | - Megan Byrne
- Wimmera Health Care Group, Horsham, Victoria, Australia
| | - Helen Boursinos
- Respiratory Research@Alfred, Department of Immunology & Pathology, Monash University, Melbourne, Victoria, Australia
| | - Jennifer Broe
- Respiratory Research@Alfred, Department of Immunology & Pathology, Monash University, Melbourne, Victoria, Australia
| | - Monique Corbett
- Respiratory Research@Alfred, Department of Immunology & Pathology, Monash University, Melbourne, Victoria, Australia
- Alfred Health, Melbourne, Victoria, Australia
| | - Tunya Marceau
- Respiratory Research@Alfred, Department of Immunology & Pathology, Monash University, Melbourne, Victoria, Australia
- Alfred Health, Melbourne, Victoria, Australia
| | - Brooke Warrick
- Respiratory Research@Alfred, Department of Immunology & Pathology, Monash University, Melbourne, Victoria, Australia
- Wimmera Health Care Group, Horsham, Victoria, Australia
| | | | - Joanna Melinz
- Coffs Harbour Health Campus, Coffs Harbour, New South Wales, Australia
| | - Anne E Holland
- Respiratory Research@Alfred, Department of Immunology & Pathology, Monash University, Melbourne, Victoria, Australia
- Alfred Health, Melbourne, Victoria, Australia
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Taylor A, Lowe DJ, McDowell G, Lua S, Burns S, McGinness P, Carlin CM. Remote-Management of COPD: Evaluating the Implementation of Digital Innovation to Enable Routine Care (RECEIVER): the protocol for a feasibility and service adoption observational cohort study. BMJ Open Respir Res 2021; 8:8/1/e000905. [PMID: 34462271 PMCID: PMC8407208 DOI: 10.1136/bmjresp-2021-000905] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 08/07/2021] [Indexed: 11/14/2022] Open
Abstract
Introduction Reductions in exacerbation and hospitalisations are the outcomes rated as most important by people with chronic obstructive pulmonary disease (COPD). Most COPD management is currently based on a reactive approach, and delays in recognising treatable opportunities underpin COPD care quality gaps. Innovations that empower COPD self-management, facilitate integrated clinical care and support delivery of evidence-based treatment interventions are urgently required. Methods and analysis The Remote-Management of COPD: Evaluating the Implementation of Digital Innovation to Enable Routine Care trial is a prospective observational cohort hybrid implementation and effectiveness study that will explore the adoption of a digital service model for people with ‘high-risk’ COPD and evaluate the feasibility of this approach versus current standards of care. People with COPD, who have had recent severe exacerbation and/or COPD–obstructive sleep apnoea overlap or chronic hypercapnic respiratory failure requiring home non-invasive ventilation (NIV) or continuous positive airway pressure (CPAP), with internet access will be recruited into the study and enrolled into the digital service. Study endpoints will examine participant utilisation, clinical service impact and clinical outcomes compared with historical and contemporary control patient data. The digital infrastructure will also provide a foundation to explore the feasibility of approaches to predict outcomes and exacerbation in people with COPD through machine learning analysis. Ethics and dissemination Ethical approval for this clinical trial has been obtained from the West of Scotland Research Ethics Service. The trial will commence in September 2019 for a duration of 2 years. Results will be presented at local, national and international meetings, as well as submission for publication to peer-reviewed journals. Trial registration number NCT04240353.
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Affiliation(s)
- Anna Taylor
- Respiratory Medicine, Queen Elizabeth University Hospital, Glasgow, UK
| | - David J Lowe
- Emergency Medicine, Queen Elizabeth University Hospital, Glasgow, UK
| | - Grace McDowell
- Respiratory Medicine, Queen Elizabeth University Hospital, Glasgow, UK
| | - Stephanie Lua
- Respiratory Medicine, Queen Elizabeth University Hospital, Glasgow, UK
| | - Shane Burns
- Lenus Digital Health, StormID, Edinburgh, UK
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Alqahtani JS, Oyelade T, Aldhahir AM, Mendes RG, Alghamdi SM, Miravitlles M, Mandal S, Hurst JR. Reduction in hospitalised COPD exacerbations during COVID-19: A systematic review and meta-analysis. PLoS One 2021; 16:e0255659. [PMID: 34343205 PMCID: PMC8330941 DOI: 10.1371/journal.pone.0255659] [Citation(s) in RCA: 82] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 07/21/2021] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Reports have suggested a reduction in exacerbations of chronic obstructive pulmonary disease (COPD) during the coronavirus disease 2019 (COVID-19) pandemic, particularly hospital admissions for severe exacerbations. However, the magnitude of this reduction varies between studies. METHOD Electronic databases were searched from January 2020 to May 2021. Two independent reviewers screened titles and abstracts and, when necessary, full text to determine if studies met inclusion criteria. A modified version of the Newcastle-Ottawa Scale was used to assess study quality. A narrative summary of eligible studies was synthesised, and meta-analysis was conducted using a random effect model to pool the rate ratio and 95% confidence intervals (95% CI) for hospital admissions. Exacerbation reduction was compared against the COVID-19 Containment and Health Index. RESULTS A total of 13 of 745 studies met the inclusion criteria and were included in this review, with data from nine countries. Nine studies could be included in the meta-analysis. The pooled rate ratio of hospital admissions for COPD exacerbations during the pandemic period was 0.50 (95% CI 0.44-0.57). Findings on the rate of community-treated exacerbations were inconclusive. Three studies reported a significant decrease in the incidence of respiratory viral infections compared with the pre-pandemic period. There was not a significant relationship between exacerbation reduction and the COVID-19 Containment and Health Index (rho = 0.20, p = 0.53). CONCLUSION There was a 50% reduction in admissions for COPD exacerbations during the COVID-19 pandemic period compared to pre-pandemic times, likely associated with a reduction in respiratory viral infections that trigger exacerbations. Future guidelines should consider including recommendations on respiratory virus infection control measures to reduce the burden of COPD exacerbations beyond the pandemic period.
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Affiliation(s)
- Jaber S. Alqahtani
- UCL Respiratory, University College London, London, United Kingdom
- Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam, Saudi Arabia
| | - Tope Oyelade
- UCL Division of Medicine, London, United Kingdom
| | - Abdulelah M. Aldhahir
- Respiratory Care Department, Faculty of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
| | - Renata Gonçalves Mendes
- Department of Physical Therapy, Cardiopulmonary Physiotherapy Laboratory, Federal University of São Carlos, São Paulo, Brazil
| | - Saeed M. Alghamdi
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Marc Miravitlles
- Pneumology Department, Hospital Universitari Vall d´Hebron/Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Hospital Campus; CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
| | - Swapna Mandal
- UCL Respiratory, University College London, London, United Kingdom
- Royal Free London NHS Foundation Trust, London, United Kingdom
| | - John R. Hurst
- UCL Respiratory, University College London, London, United Kingdom
- Royal Free London NHS Foundation Trust, London, United Kingdom
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Alcázar-Navarrete B, García-Rio F, Sánchez G, Mariscal E, García A, Cuesta M, Uría E, Miravitlles M. Burden of Disease Among Exacerbating Patients with COPD Treated with Triple Therapy in Spain. Int J Chron Obstruct Pulmon Dis 2021; 16:2149-2161. [PMID: 34321874 PMCID: PMC8312318 DOI: 10.2147/copd.s310319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 06/19/2021] [Indexed: 12/28/2022] Open
Abstract
Background The cost of chronic obstructive pulmonary disease (COPD) in Spain has been studied from different perspectives, but parameters such as the patient's phenotype have seldom been considered. Our aim was to describe the disease burden of COPD patients with frequent exacerbator phenotype, treated with triple therapy. Methods An observational, multicenter study was carried out from December 2017 to November 2018 in pulmonology services among patients ≥40 years with COPD confirmed diagnosis receiving triple therapy (ICS/LAMA/LABA) and history of ≥2 moderate or ≥1 severe exacerbation in the 12 months prior to the inclusion visit. COPD-related healthcare resources were collected over a 12-months period prior to the inclusion visit: pharmacological and non-pharmacological treatments, medical and ER visits, hospitalizations, tests and productivity loss. Costs were updated to €2019. Patients were classified according to blood eosinophil levels: <150 cells/µL and ≥150 cells/µL. Results A total of 306 patients were included (77.1% men), with mean age of 69.9 years. Mean COPD exacerbation rate was 2.5/patient/year and 51.3% of patients had ≥150 cells/µL eosinophil level. On average, for the total population, COPD-related visits/patients/year were 6.2. Resource use in moderate exacerbation was higher in patients with eosinophils ≥150 cells/µL, whereas in severe exacerbation was higher in patients with eosinophils <150cells/µL. According to eosinophil levels, total annual mean (SD) costs/patient accounted for €8382 (9863) and €5144 (5444) for patients with eosinophils <150 cells/µL and ≥150 cells/µL, respectively. Conclusion The impact of exacerbating COPD patients treated with triple therapy in Spain is large, especially among those with eosinophils <150 cells/µL.
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Affiliation(s)
- Bernardino Alcázar-Navarrete
- Respiratory Department. Hospital Universitario Virgen de las Nieves, Granada, Spain
- CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Francisco García-Rio
- CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain
- Hospital Universitario La Paz, IdiPAZ, Madrid, Spain
| | | | | | | | | | | | - Marc Miravitlles
- CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain
- Pneumology Department, Hospital Universitari Vall d’Hebron, Vall D’Hebron Institut de Recerca (VHIR), Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
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Dual LABA/LAMA Therapy versus LABA or LAMA Monotherapy for Chronic Obstructive Pulmonary Disease. A Systematic Review and Meta-analysis in Support of the American Thoracic Society Clinical Practice Guideline. Ann Am Thorac Soc 2021; 17:1133-1143. [PMID: 32530702 DOI: 10.1513/annalsats.201912-915oc] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Rationale: There is uncertainty on the optimal first-line therapy for symptomatic chronic obstructive pulmonary disease (COPD). Long-acting β2-receptor agonists (LABAs) and long-acting muscarinic antagonists (LAMAs) have long been mainstays of treatment, though it is still not clear if dual therapy with LABA/LAMA is superior to monotherapy for symptomatic COPD.Objectives: To clarify the evidence landscape, we conducted a systematic review to answer the following question: in patients with COPD who complain of dyspnea and/or exercise intolerance, is LABA/LAMA combination therapy more effective and equally safe compared with LABA or LAMA monotherapy?Methods: A search of Medline, EMBASE, and the Cochrane Library databases was conducted by a medical librarian for randomized controlled trials enrolling patients with COPD who complain of dyspnea and/or exercise intolerance that compare LABA/LAMA combination therapy to LABA or LAMA monotherapy. A systematic approach was used to screen, abstract, and critically appraise the emerging study evidence. The Grading of Recommendations Assessment, Development, and Evaluation method was applied to rate the certainty and quality of the evidence.Results: A total of 24 studies were eligible for inclusion (n = 45,441). Pairwise random-effects meta-analysis revealed reductions in hospital admissions (11% reduction; P < 0.01) and acute exacerbations of COPD (20% reduction; P < 0.002), all in favor of LABA/LAMA dual therapy. Although there is reduced dyspnea (0.10 standardized mean difference; P < 0.001) and improved health-related quality of life (-0.13 standardized mean difference; P < 0.001), both values did not meet a clinical meaningful difference threshold. LABA/LAMA combination therapy showed no difference in treatment-emergent adverse effects (risk ratio, 0.99; P = 0.34) when compared with either LAMA or LABA monotherapy.Conclusions: Based on the reviewed evidence, in patients with symptomatic COPD who complain of dyspnea and/or exercise intolerance, dual LABA/LAMA therapy is superior to either LABA or LAMA monotherapy based on the reduced risk of exacerbations and hospitalizations.
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Patel N, Kinmond K, Jones P, Birks P, Spiteri MA. Validation of COPDPredict™: Unique Combination of Remote Monitoring and Exacerbation Prediction to Support Preventative Management of COPD Exacerbations. Int J Chron Obstruct Pulmon Dis 2021; 16:1887-1899. [PMID: 34188465 PMCID: PMC8232856 DOI: 10.2147/copd.s309372] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 05/20/2021] [Indexed: 12/21/2022] Open
Abstract
Background COPDPredict™ is a novel digital application dedicated to providing early warning of imminent COPD (chronic obstructive pulmonary disease) exacerbations for prompt intervention. Exacerbation prediction algorithms are based on a decision tree model constructed from percentage thresholds for disease state changes in patient-reported wellbeing, forced expiratory volume in one second (FEV1) and C-reactive protein (CRP) levels. Our study determined the validity of COPDPredict™ to identify exacerbations and provide timely notifications to patients and clinicians compared to clinician-defined episodes. Methods In a 6-month prospective observational study, 90 patients with COPD and frequent exacerbations registered wellbeing self-assessments daily using COPDPredict™ App and measured FEV1 using connected spirometers. CRP was measured using finger-prick testing. Results Wellbeing self-assessment submissions showed 98% compliance. Ten patients did not experience exacerbations and treatment was unchanged. A total of 112 clinician-defined exacerbations were identified in the remaining 80 patients: 52 experienced 1 exacerbation; 28 had 2.2±0.4 episodes. Sixty-two patients self-managed using prescribed rescue medication. In 14 patients, exacerbations were more severe but responded to timely escalated treatment at home. Four patients attended the emergency room; with 2 hospitalised for <72 hours. Compared to the 6 months pre-COPDPredict™, hospitalisations were reduced by 98% (90 vs 2, p<0.001). COPDPredict™ identified COPD-related exacerbations at 7, 3 days (median, IQR) prior to clinician-defined episodes, sending appropriate alerts to patients and clinicians. Cross-tabulation demonstrated sensitivity of 97.9% (95% CI 95.7-99.2), specificity of 84.0% (95% CI 82.6-85.3), positive and negative predictive value of 38.4% (95% CI 36.4-40.4) and 99.8% (95% CI 99.5-99.9), respectively. Conclusion High sensitivity indicates that if there is an exacerbation, COPDPredict™ informs patients and clinicians accurately. The high negative predictive value implies that when an exacerbation is not indicated by COPDPredict™, risk of an exacerbation is low. Thus, COPDPredict™ provides safe, personalised, preventative care for patients with COPD.
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Affiliation(s)
- Neil Patel
- Directorate of Respiratory Medicine, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, Staffordshire, UK.,Directorate of Respiratory Medicine, University Hospitals Birmingham NHS Foundation Trust, Heartlands Hospital, Birmingham, UK
| | - Kathryn Kinmond
- Directorate of Respiratory Medicine, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, Staffordshire, UK.,Department of Health & Social care, Staffordshire University, Stoke-on-Trent, Staffordshire, UK
| | - Pauline Jones
- Directorate of Respiratory Medicine, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, Staffordshire, UK
| | - Pamela Birks
- Directorate of Respiratory Medicine, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, Staffordshire, UK
| | - Monica A Spiteri
- Directorate of Respiratory Medicine, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, Staffordshire, UK
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Cui Y, Zhan Z, Zeng Z, Huang K, Liang C, Mao X, Zhang Y, Ren X, Yang T, Chen Y. Blood Eosinophils and Clinical Outcomes in Patients With Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Propensity Score Matching Analysis of Real-World Data in China. Front Med (Lausanne) 2021; 8:653777. [PMID: 34179040 PMCID: PMC8219875 DOI: 10.3389/fmed.2021.653777] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 05/18/2021] [Indexed: 11/20/2022] Open
Abstract
Background and Objective: Elevated eosinophils in chronic obstructive pulmonary disease (COPD) are recognized as a biomarker to guide inhaled corticosteroids use, but the value of blood eosinophils in hospitalized exacerbations of COPD remains controversial. This study aimed to evaluate the accuracy of eosinophils in predicting clinical outcomes in acute exacerbation of COPD (AECOPD). Methods: We analyzed data from the acute exacerbation of chronic obstructive pulmonary disease inpatient registry (ACURE) study, which is an ongoing nationwide multicenter, observational real-world study in patients admitted for AECOPD. Data collected between January 2018 and December 2019 in 163 centers were first reviewed. The eligible patients were divided into eosinophilic and non-eosinophilic groups, according to blood eosinophil with 2% of the total leukocyte count as the threshold. Propensity score (PS) matching was performed to adjust for confounders. Results: A total of 1,566 patients (median age: 69 years; 80.3% male) were included and 42.7% had an eosinophilic AECOPD. Eosinophil count <2% was associated with the development of respiratory failure and pneumonia. After PS matching, 650 pairs in overall patients, 468 pairs in patients with smoking history and 177 pairs in patients without smoking were selected, respectively. Only in patients with smoking history, the non-eosinophilic AECOPD was associated with longer median hospital stays (9 vs. 8 days, P = 0.034), higher dosage of corticosteroid use, higher economic burden of hospitalization, and poorer response to corticosteroid therapy compared to the eosinophilic AECOPD. No significant difference was found in patients without smoking. Eosinophil levels had no relationship with the change of COPD Assessment Test scores and readmissions or death after 30 days. Conclusion: Elevated eosinophils were associated with better short-term outcomes only in patients with a smoking history. Eosinophil levels cannot be confidently used as a predictor alone for estimating prognosis.
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Affiliation(s)
- Yanan Cui
- Department of Respiratory and Critical Care Medicine, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Zijie Zhan
- Department of Respiratory and Critical Care Medicine, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Zihang Zeng
- Department of Respiratory and Critical Care Medicine, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Ke Huang
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, China.,National Clinical Research Center for Respiratory Diseases, Beijing, China.,Institute of Respiratory Medicine, Chinese Academy of Medical Science, Beijing, China
| | - Chen Liang
- Chinese Alliance for Respiratory Diseases in Primary Care, Beijing, China
| | - Xihua Mao
- Chinese Alliance for Respiratory Diseases in Primary Care, Beijing, China
| | - Yaowen Zhang
- Chinese Alliance for Respiratory Diseases in Primary Care, Beijing, China
| | - Xiaoxia Ren
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, China.,National Clinical Research Center for Respiratory Diseases, Beijing, China.,Institute of Respiratory Medicine, Chinese Academy of Medical Science, Beijing, China
| | - Ting Yang
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, China.,National Clinical Research Center for Respiratory Diseases, Beijing, China.,Institute of Respiratory Medicine, Chinese Academy of Medical Science, Beijing, China
| | - Yan Chen
- Department of Respiratory and Critical Care Medicine, The Second Xiangya Hospital, Central South University, Changsha, China
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Cherian M, Jensen D, Tan WC, Mursleen S, Goodall EC, Nadeau GA, Awan AM, Marciniuk DD, Walker BL, Aaron SD, O'Donnell DE, Chapman KR, Maltais F, Hernandez P, Sin DD, Benedetti A, Bourbeau J. Dyspnoea and symptom burden in mild-moderate COPD: the Canadian Cohort Obstructive Lung Disease Study. ERJ Open Res 2021; 7:00960-2020. [PMID: 33898621 PMCID: PMC8053913 DOI: 10.1183/23120541.00960-2020] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 12/21/2020] [Indexed: 12/31/2022] Open
Abstract
Studies assessing dyspnoea and health-related quality of life (HRQoL) in chronic obstructive pulmonary disease (COPD) have focussed on patients in clinical settings, not the general population. The aim of this analysis was to compare the prevalence and severity of dyspnoea and impaired HRQoL in individuals with and without COPD from the general population, focussing on mild-moderate COPD. Analysis of the 3-year Canadian Cohort Obstructive Lung Disease (CanCOLD) study included four subgroups: mild COPD (Global Initiative for Chronic Obstructive Lung Disease (GOLD) 1); moderate COPD (GOLD 2); non-COPD smokers; and non-COPD never-smokers. The primary outcome was dyspnoea (Medical Research Council (MRC) scale), and the secondary outcome was HRQoL (COPD Assessment Test (CAT) score; Saint George's Respiratory Questionnaire (SGRQ) score). Subgroups were analysed by sex, physician-diagnosed COPD status and exacerbations. 1443 participants (mild COPD (n=397); moderate COPD (n=262(; smokers (n=449) and never-smokers (n=335)) were studied. People with mild COPD were more likely to report more severe dyspnoea (MRC 2 versus 1) than those without COPD (OR (95% CI) 1.42 (1.05-1.91)), and non-COPD never-smokers (OR (95%CI) 1.64 (1.07-2.52)). Among people with mild COPD, more severe dyspnoea was reported in women versus men (MRC2 versus 1; OR (95% CI) 3.70 (2.23-6.14)); people with, versus without, physician-diagnosed COPD (MRC2 versus 1; OR (95% CI) 3.27 (1.71-6.23)), and people with versus without recent exacerbations (MRC2 versus 1; ≥2 versus 0 exacerbations: OR (95% CI) 3.62 (1.02-12.86); MRC ≥3 versus 1; 1 versus 0 exacerbation: OR (95% CI): 9.24 (2.01-42.42)). Similar between-group differences were obtained for CAT and SGRQ scores. Careful assessment of dyspnoea and HRQoL could help identify individuals for earlier diagnosis and treatment.
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Affiliation(s)
- Mathew Cherian
- Division of Respiratory Medicine, Dept of Medicine, McGill University Health Centre, Montreal, QC, Canada
| | - Dennis Jensen
- Clinical Exercise and Respiratory Physiology Laboratory, Dept of Kinesiology and Physical Education, Faculty of Education, McGill University, Montréal, QC, Canada
- Research Institute of the McGill University Health Centre, Translational Research in Respiratory Diseases Program and Respiratory Epidemiology and Clinical Research Unit, Montréal, QC, Canada
- Research Centre for Physical Activity and Health, Faculty of Education, McGill University, Montréal, QC, Canada
| | - Wan C. Tan
- Centre for Heart Lung Innovation, Dept of Medicine, University of British Columbia, Vancouver, BC, Canada
| | | | | | | | | | - Darcy D. Marciniuk
- Respiratory Research Centre, University of Saskatchewan, Saskatoon, SK, Canada
| | - Brandie L. Walker
- Division of Respirology, Dept of Medicine, University of Calgary, Calgary, AB, Canada
| | - Shawn D. Aaron
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | | | - Kenneth R. Chapman
- Asthma and Airway Centre, University Health Network and University of Toronto, Toronto, ON, Canada
| | - François Maltais
- Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec, QC, Canada
| | - Paul Hernandez
- Faculty of Medicine, Division of Respirology, Dalhousie University, Halifax, NS, Canada
| | - Don D. Sin
- Centre for Heart Lung Innovation, Dept of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Andrea Benedetti
- Depts of Medicine and of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
- Respiratory Epidemiology and Clinical Research Unit, McGill University, Montreal, QC, Canada
| | - Jean Bourbeau
- Division of Respiratory Medicine, Dept of Medicine, McGill University Health Centre, Montreal, QC, Canada
- Research Institute of the McGill University Health Centre, Translational Research in Respiratory Diseases Program and Respiratory Epidemiology and Clinical Research Unit, Montréal, QC, Canada
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Give a Little or Give a Lot?: The Question of Long-term Maintenance After Pulmonary Rehabilitation. Chest 2021; 159:893-894. [PMID: 33678267 DOI: 10.1016/j.chest.2020.11.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 11/23/2020] [Indexed: 11/20/2022] Open
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Camus-García E, González-González AI, Heijmans M, Niño de Guzmán E, Valli C, Beltran J, Pardo-Hernández H, Ninov L, Strammiello V, Immonen K, Mavridis D, Ballester M, Suñol R, Orrego C. Self-management interventions for adults living with Chronic Obstructive Pulmonary Disease (COPD): The development of a Core Outcome Set for COMPAR-EU project. PLoS One 2021; 16:e0247522. [PMID: 33647039 PMCID: PMC7920347 DOI: 10.1371/journal.pone.0247522] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 02/09/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND A large body of evidence suggests that self-management interventions (SMIs) may improve outcomes in chronic obstructive pulmonary disease (COPD). However, accurate comparisons of the relative effectiveness of SMIs are challenging, partly due to heterogeneity of outcomes across trials and uncertainty about the importance of these outcomes for patients. We aimed to develop a core set of patient-relevant outcomes (COS) for SMIs trials to enhance comparability of interventions and ensure person-centred care. METHODS We undertook an innovative approach consisting of four interlinked stages: i) Development of an initial catalogue of outcomes from previous EU-funded projects and/or published studies, ii) Scoping review of reviews on patients and caregivers' perspectives to identify outcomes of interest, iii) Two-round Delphi online survey with patients and patient representatives to rate the importance of outcomes, and iv) Face-to-face consensus workshop with patients, patient representatives, health professionals and researchers to develop the COS. RESULTS From an initial list of 79 potential outcomes, 16 were included in the COS plus one supplementary outcome relevant to all participants. These were related to patient and caregiver knowledge/competence, self-efficacy, patient activation, self-monitoring, adherence, smoking cessation, COPD symptoms, physical activity, sleep quality, caregiver quality of life, activities of daily living, coping with the disease, participation and decision-making, emergency room visits/admissions and cost effectiveness. CONCLUSION The development of the COPD COS for the evaluation of SMIs will increase consistency in the measurement and reporting of outcomes across trials. It will also contribute to more personalized health care and more informed health decisions in clinical practice as patients' preferences regarding COPD outcomes are more systematically included.
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Affiliation(s)
- Estela Camus-García
- Avedis Donabedian Research Institute (FAD), Universitat Autonòma de Barcelona, Barcelona, Spain
| | - Ana Isabel González-González
- Avedis Donabedian Research Institute (FAD), Universitat Autonòma de Barcelona, Barcelona, Spain
- Institute of General Practice, Goethe University, Frankfurt, Germany
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Spain
| | - Monique Heijmans
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | - Ena Niño de Guzmán
- Iberoamerican Cochrane Centre Barcelona, Department of Clinical Epidemiology and Public Health, Biomedical Research Institute San Pau (IIB Sant Pau), Barcelona, Spain
| | - Claudia Valli
- Department of Paediatrics, Obstetrics, Gynaecology and Preventive Medicine, Universidad Atónoma de Barcelona, Barcelona, Spain
- Iberoamerican Cochrane Centre Barcelona, Biomedical Research Institute San Pau (IIB Sant Pau), Barcelona, Spain
| | - Jessica Beltran
- Iberoamerican Cochrane Centre Barcelona, Biomedical Research Institute San Pau (IIB Sant Pau), Barcelona, Spain
| | - Hector Pardo-Hernández
- Iberoamerican Cochrane Centre Barcelona, Biomedical Research Institute San Pau (IIB Sant Pau) - CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | | | | | | | - Dimitris Mavridis
- Department of Primary Education, University of Ioannina, Ioannina, Greece
| | - Marta Ballester
- Avedis Donabedian Research Institute (FAD), Universitat Autonòma de Barcelona, Barcelona, Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Spain
| | - Rosa Suñol
- Avedis Donabedian Research Institute (FAD), Universitat Autonòma de Barcelona, Barcelona, Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Spain
| | - Carola Orrego
- Avedis Donabedian Research Institute (FAD), Universitat Autonòma de Barcelona, Barcelona, Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Spain
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Slejko JF, Hong YD, Sullivan JL, Reed RM, dosReis S. Prioritization and Refinement of Patient-Informed Value Elements as Attributes for Chronic Obstructive Pulmonary Disease Treatment Preferences. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2021; 14:569-579. [PMID: 33554310 DOI: 10.1007/s40271-021-00495-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/07/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVE Formative research studies can inform stated-preference instrument development to quantify the importance of various attributes of healthcare treatments. The objective of this study was to elicit from patients with chronic obstructive pulmonary disease the prioritization of an established set of patient-informed value elements. METHODS Using an iterative mixed-methods study design, we engaged individuals living with chronic obstructive pulmonary disease in Phase 1 value element elicitation and Phase 2 language refinement. Study participants were recruited from March to July 2019. Four guided activities, administered in an online instrument, elicited individual preferences for 40 disease-agnostic value elements that were aligned with treatment, outcomes, or care process. Responses from the guided activities were summarized and then presented to a patient advocate and additional patient participants for further refinement of the value elements and the phrasing. RESULTS Twenty-three participants, 18 male and five female, mean age of 66 years (standard deviation = 7) were enrolled in Phase 1. Participant responses informed the selection of eight elements as the key candidates for the Phase 2 language refinement: Side Effects, New Therapeutic Option, Available Treatment, Appropriateness of Care, Predictable Healthcare Needs, Physical Activities: Endurance and Symptom Control, and Explanation of Treatment. With feedback from a patient advocate and additional patient participants, elements were refined, rephrased, or modified and this list was narrowed to six value elements (Side Effects, New Therapeutic Option, Willingness to Pay, Physical Activities, Explanation of Treatment, and Access to Care) to serve as attributes in a conceptual framework for a future quantitative stated-preference instrument. CONCLUSIONS This patient-engaged formative work identified patients with chronic obstructive pulmonary disease key attributes of value-based decision making that underpin benefit-risk trade-offs between physical endurance, treatment side effects, care access, and cost. This study illustrates an iterative process for eliciting and refining a comprehensive list of value elements, resulting in a subgroup of elements important to a specific patient population.
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Affiliation(s)
- Julia F Slejko
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, 220 Arch Street, 12th Floor, Room 01-214, Baltimore, MD, 21201, USA.
| | - Yoon Duk Hong
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, 220 Arch Street, 12th Floor, Room 01-214, Baltimore, MD, 21201, USA
| | | | - Robert M Reed
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - Susan dosReis
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, 220 Arch Street, 12th Floor, Room 01-214, Baltimore, MD, 21201, USA
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Affiliation(s)
- Daryl O Cheng
- UCL Respiratory, University College London, London, UK
| | - John R Hurst
- UCL Respiratory, University College London, London, UK
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Machado A, Marques A, Burtin C. Extra-pulmonary manifestations of COPD and the role of pulmonary rehabilitation: a symptom-centered approach. Expert Rev Respir Med 2020; 15:131-142. [PMID: 33225762 DOI: 10.1080/17476348.2021.1854737] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Introduction: Chronic obstructive pulmonary disease (COPD) is a complex and heterogenous disease that is associated with a range of respiratory and non-respiratory symptoms, which highly contribute to the daily burden of the disease. Symptoms burden remains high despite optimal bronchodilator therapy, but pulmonary rehabilitation (PR) is an effective intervention to improve patients' symptoms. A comprehensive interdisciplinary approach within the framework of a PR program is warranted to tackle these complex symptoms and their consequences. Areas covered: This narrative review describes how symptoms of dyspnea, fatigue, cough, sputum, anxiety, depression, pain, sleep disturbances, and cognitive decline arise in COPD and can contribute to several non-pulmonary manifestations of the disease. It also describes evidence of the effectiveness of interdisciplinary PR programs to counteract these symptoms. A literature search was performed on PubMed and Scopus between June and July 2020. Expert opinion: Respiratory and non-respiratory symptoms are highly prevalent, often not comprehensively assessed, and result in several extra-pulmonary manifestations of the disease (physical, emotional and social). Interdisciplinary PR programs can improve these negative manifestations through different pathways, contributing for an effective symptoms' management. A thorough assessment of symptoms (beyond dyspnea) should be routinely performed and may support the identification of treatable traits, allowing the tailoring of PR interventions and assessment of their real-life impact.
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Affiliation(s)
- Ana Machado
- Respiratory Research and Rehabilitation Laboratory (Lab 3R), School of Health Sciences (ESSUA), University of Aveiro , Aveiro, Portugal.,Institute of Biomedicine (Ibimed), University of Aveiro , Aveiro, Portugal
| | - Alda Marques
- Respiratory Research and Rehabilitation Laboratory (Lab 3R), School of Health Sciences (ESSUA), University of Aveiro , Aveiro, Portugal.,Institute of Biomedicine (Ibimed), University of Aveiro , Aveiro, Portugal
| | - Chris Burtin
- REVAL - Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University , Diepenbeek, Belgium.,BIOMED - Biomedical Research Institute, Hasselt University , Diepenbeek, Belgium
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Mathioudakis AG, Vestbo J, Singh D. Long-Acting Bronchodilators for Chronic Obstructive Pulmonary Disease: Which One(S), How, and When? Clin Chest Med 2020; 41:463-474. [PMID: 32800199 DOI: 10.1016/j.ccm.2020.05.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Long-acting bronchodilators represent the mainstay of maintenance treatment of chronic obstructive pulmonary disease (COPD). This state-of-the-art review summarizes currently available data on the safety, efficacy, and clinical effectiveness of long-acting bronchodilators and describes their role in the management of COPD, as defined by current national and international guidelines. Data from extensive clinical trials and real-life studies have demonstrated that long-acting beta-2 agonists and long-acting muscarinic antagonists can safely reduce the frequency of exacerbations, alleviate symptoms, and improve quality of life, exercise tolerance, and lung function of patients with COPD. They are recommended as first-line maintenance treatment of COPD.
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Affiliation(s)
- Alexander G Mathioudakis
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, The University of Manchester, Manchester Academic Health Science Centre, UK; North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, 2nd Floor ERC Building, Southmoor Road, Manchester M23 9LT, UK
| | - Jørgen Vestbo
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, The University of Manchester, Manchester Academic Health Science Centre, UK; North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, 2nd Floor ERC Building, Southmoor Road, Manchester M23 9LT, UK.
| | - Dave Singh
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, The University of Manchester, Manchester Academic Health Science Centre, UK; North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, 2nd Floor ERC Building, Southmoor Road, Manchester M23 9LT, UK; Medicines Evaluation Unit, Manchester, UK
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47
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Controversy and Debate Series on Core Outcome Sets: The SOLAR (Standardized Outcomes Linking Across StakeholdeRs) system and hub and spokes model for direct core outcome measures in health care and its relation to GRADE. J Clin Epidemiol 2020; 125:216-221. [DOI: 10.1016/j.jclinepi.2020.05.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 05/05/2020] [Indexed: 01/06/2023]
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Müllerová H, Dransfield MT, Thomashow B, Jones PW, Rennard S, Karlsson N, Fageras M, Metzdorf N, Petruzzelli S, Rommes J, Sciurba FC, Tabberer M, Merrill D, Tal-Singer R. Clinical Development and Research Applications of the Chronic Obstructive Pulmonary Disease Assessment Test. Am J Respir Crit Care Med 2020; 201:1058-1067. [PMID: 31815521 DOI: 10.1164/rccm.201907-1369pp] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Hana Müllerová
- Value Evidence and Outcomes, Global Medical R&D, GlaxoSmithKline, Uxbridge, United Kingdom
| | - Mark T Dransfield
- Lung Health Center, University of Alabama at Birmingham, Birmingham, Alabama
| | | | - Paul W Jones
- Value Evidence and Outcomes, Global Medical R&D, GlaxoSmithKline, Uxbridge, United Kingdom
| | - Stephen Rennard
- University of Nebraska, Omaha, Nebraska.,BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | | | - Malin Fageras
- BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | | | | | | | - Frank C Sciurba
- Division of Pulmonary and Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania; and
| | - Maggie Tabberer
- Value Evidence and Outcomes, Global Medical R&D, GlaxoSmithKline, Uxbridge, United Kingdom
| | | | - Ruth Tal-Singer
- Value Evidence and Outcomes, Medical Innovation, Global Medical R&D, GlaxoSmithKline, Collegeville, Pennsylvania
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Mathioudakis AG, Sivapalan P, Papi A, Vestbo J. The DisEntangling Chronic Obstructive pulmonary Disease Exacerbations clinical trials NETwork (DECODE-NET): rationale and vision. Eur Respir J 2020; 56:56/1/2000627. [PMID: 32616552 DOI: 10.1183/13993003.00627-2020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 05/13/2020] [Indexed: 12/21/2022]
Affiliation(s)
- Alexander G Mathioudakis
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.,The North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Pradeesh Sivapalan
- Section of Respiratory Medicine, Dept of Internal Medicine, Herlev-Gentofte Hospital, Hellerup, Denmark.,Dept of Internal Medicine, Zealand University Hospital, Roskilde, Denmark
| | - Alberto Papi
- Research Center on Asthma and COPD, Dept of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Jørgen Vestbo
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK .,The North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
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Hurst JR, Quint JK, Stone RA, Silove Y, Youde J, Roberts CM. National clinical audit for hospitalised exacerbations of COPD. ERJ Open Res 2020; 6:00208-2020. [PMID: 32984418 PMCID: PMC7502696 DOI: 10.1183/23120541.00208-2020] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 06/10/2020] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION Exacerbations of COPD requiring hospital admission are burdensome to patients and health services. Audit enables benchmarking performance between units and against national standards, and supports quality improvement. We summarise 23 years of UK audit for hospitalised COPD exacerbations to better understand which features of audit design have had most impact. METHOD Pilot audits were performed in 1997 and 2001, with national cross-sectional audits in 2003, 2008 and 2014. Continuous audit commenced in 2017. Overall, 96% of eligible units took part in cross-sectional audit, 86% in the most recent round of continuous audit. We synthesised data from eight rounds of national COPD audit. RESULTS Clinical outcomes were observed to change at the same time as changes in delivery of care: length of stay halved from 8 to 4 days between 1997 and 2014, alongside wider availability of integrated care. Process indicators did not generally improve with sequential cross-sectional audit. Under continuous audit with quality improvement support, process indicators linked to financial incentives (early specialist review (55-66%) and provision of a discharge bundle (53-74%)) improved more rapidly than those not linked (availability of spirometry (40-46%) and timely noninvasive ventilation (21-24%)). CONCLUSION Careful piloting and engagement can result in successful roll-out of cross-sectional national audit in a high-burden disease. Audit outcome measures and process indicators may be affected by changes in care pathways. Sequential cross-sectional national audit alone was not generally accompanied by improvements in care. However, improvements in process indicators were seen when continuous audit was combined with quality improvement support and, in particular, financial incentives.
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Affiliation(s)
- John R. Hurst
- National Asthma and COPD Audit Programme, Royal College of Physicians, London, UK
- UCL Respiratory, University College London, London, UK
- Royal Free London NHS Foundation Trust, London, UK
| | - Jennifer K. Quint
- National Asthma and COPD Audit Programme, Royal College of Physicians, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | | | - Yvonne Silove
- National Clinical Audit and Patient Outcomes Programme, Healthcare Quality Improvement Partnership, London, UK
| | - Jane Youde
- Care Quality Improvement Dept, Royal College of Physicians, London, UK
| | - C. Michael Roberts
- National Asthma and COPD Audit Programme, Royal College of Physicians, London, UK
- School of Medicine and Dentistry, Queen Mary University of London, London, UK
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