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Coquart JB, Heutte N, Terce G, Grosbois JM. Convergent Validity and Minimal Clinically Important Difference of the Maugeri Foundation Respiratory Failure Questionnaire (MRF-28) and the Chronic Obstructive Pulmonary Disease-Specific Health-Related Quality of Life questionnaire (VQ11). Int J Chron Obstruct Pulmon Dis 2019; 14:2895-2903. [PMID: 31853177 PMCID: PMC6916677 DOI: 10.2147/copd.s222165] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Accepted: 09/23/2019] [Indexed: 11/29/2022] Open
Abstract
Purpose Short and easy questionnaires have been developed to assess the health-related quality of life (HRQoL) in patients with chronic obstructive pulmonary disease (COPD), such as the Maugeri Foundation Respiratory Failure Questionnaire (MRF-28) and the COPD-specific HRQoL Questionnaire (VQ11). Both are valid, reliable, and sensitive, but their minimal clinically important differences (MCID) are unknown. Consequently, this study aimed to confirm the convergent validities of the MRF-28 and VQ11 and establish their MCID. A retrospective design was used to evaluate the effect of individual home-based pulmonary rehabilitation (PR) in 400 COPD patients. Patients and methods Exercise tolerance, anxiety and depression based on the Hospital Anxiety and Depression Scale (HADS), and HRQoL using three questionnaires (MRF-28, VQ11, and the Visual Simplified Respiratory Questionnaire: VSRQ) were assessed before and after an individualized home-based PR program (5 sessions of 30-45 mins/week for 8 weeks, including a weekly session supervised by a team member). Results PR improved all measured variables (p < 0.0001). The correlations were significant (p < 0.0001) between VSRQ and MRF-28 (r = -0.685 at baseline and r = -0.686 after the PR program), and between VSRQ and VQ11 (r = -0.691 at baseline and r = -0.753 after the PR program). Moreover, changes in score (delta between after and before PR program) of VSRQ were also significantly correlated (p < 0.0001) to changes in score of MRF-28 (r = -0.372) and VQ11 (r = -0.423). Last, we calculated MCID of -5.2 and -2.0 units for MRF-28 and VQ11, respectively. Conclusion The MRF-28 and VQ11 can be used in routine practice to evaluate the effects of PR on the HRQoL of COPD patients, with MCID of -5.2 and -2.0, respectively.
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Affiliation(s)
- Jérémy B Coquart
- Université de Rouen-Normandie, UFR STAPS, CETAPS, EA 3832, Mont Saint AignanF-76821, France
| | - Natacha Heutte
- Université de Rouen-Normandie, UFR STAPS, CETAPS, EA 3832, Mont Saint AignanF-76821, France
| | - Gaelle Terce
- Centre Hospitalier de Béthune, Service de Pneumologie et de Réhabilitation Respiratoire, BeuvryF-62660, France
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Wang L, Wu K, Chen X, Liu Q. The Effects of Tai Chi on Lung Function, Exercise Capacity and Health Related Quality of Life for Patients With Chronic Obstructive Pulmonary Disease: A Pilot Study. Heart Lung Circ 2019; 28:1206-1212. [DOI: 10.1016/j.hlc.2018.05.204] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 04/12/2018] [Accepted: 05/25/2018] [Indexed: 11/28/2022]
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3
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[Evaluation of permanent disability levels in occupational pulmonary diseases]. Rev Mal Respir 2019; 36:307-325. [PMID: 30902443 DOI: 10.1016/j.rmr.2018.07.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 07/30/2018] [Indexed: 11/21/2022]
Abstract
Compensation for occupational pulmonary diseases requires the establishment of guidelines based on standardized and objective criteria, in order to provide compensation that is as fair as possible to patients who suffer from them. A review of the elements necessary for the examination of an individual file was carried out by a working group. It is accepted that respiratory functional exploration is the key element in assessing the level of permanent disability in all of these conditions, with the exception of thoracic malignancies. Guiding scales have been developed for the respiratory impairment of three types of conditions: occupational asthma, thoracic malignancy, and other respiratory diseases. Additional criteria for increasing the permanent disability level are also proposed in order to take into account professional prejudice, in particular the possibility or not of continuing the occupational activity, in the same job or after changing to another. For certain respiratory diseases, a periodic reassessment of the initially attributed permanent disability level is recommended as well as the initial one at the time of definitive cessation of occupational activity.
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Fishwick D, Lewis L, Darby A, Young C, Wiggans R, Waterhouse J, Wight J, Blanc PD. Determinants of health-related quality of life among residents with and without COPD in a historically industrialised area. Int Arch Occup Environ Health 2014; 88:799-805. [PMID: 25501562 PMCID: PMC4508367 DOI: 10.1007/s00420-014-1008-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Accepted: 12/01/2014] [Indexed: 11/25/2022]
Abstract
Purpose Chronic obstructive pulmonary disease (COPD) is associated with substantial morbidity, including impaired health-related quality of life (HRQoL). Despite the prominent role of occupational factors in the aetiology of COPD, the relationship between these exposures and HRQoL has not been well elucidated. Methods A subpopulation from an epidemiological study, designed to assess the workplace contribution to COPD, was administered the EQ5D HRQoL tool. Demographics, an index of economic deprivation, health endpoints including the presence of COPD and lung function were also recorded. Workplace exposures were categorised using both self-reported exposures and also by the use of an established job exposure matrix (JEM). Results A total of 623 individuals participated (mean age 67.1 years). One hundred and forty-eight (24 %) reported having received a physician diagnosis of COPD, 355 (57 %) were male, and 386 (62 %) were ever smokers. As anticipated, the presence of COPD was associated with a poorer HRQoL. Additionally, however, HRQoL was significantly lower in the presence of both self-reported vapours, gases, dusts and fumes exposure and JEM-based exposure irrespective of the presence of COPD. Regression analysis, adjusting for a variety of covariates including the presence of COPD, confirmed a persisting higher likelihood of occupational exposure categorised by JEM being associated with poorer HRQoL scores (β estimate: −0.069; p < 0.05). Conclusions Our findings suggest that work may have an important link to HRQoL and that this effect can persist even among those who have retired. In those with COPD, HRQoL is worse than among those without this condition, but the work-associated decrement appears to be similar across both groups.
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Affiliation(s)
- David Fishwick
- Health and Safety Laboratory, Centre for Workplace Health, Harpur Hill, Buxton, Derbyshire, SK173JN, UK,
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Lari SM, Attaran D, Tohidi M. Improving communication between the physician and the COPD patient: an evaluation of the utility of the COPD Assessment Test in primary care. PATIENT-RELATED OUTCOME MEASURES 2014; 5:145-52. [PMID: 25422591 PMCID: PMC4231984 DOI: 10.2147/prom.s54484] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. It is now considered a systemic inflammatory syndrome and is associated with important comorbidities. In addition to spirometry for evaluating the severity of airflow obstruction, an instrument is required for comprehensive assessment of the disease. The COPD Assessment Test (CAT) is a simple and valid tool for evaluating patient symptoms. The CAT can improve patient–physician communication during routine clinical visits and is useful for assessing functional status and response to treatment. The CAT has a strong correlation with other health status questionnaires, such as the St George’s Respiratory Questionnaire. The main advantages of the CAT are its thorough coverage of the important clinical aspects of disease burden and the shorter time involved in completing it. The aim of this paper is to review the role of the CAT, to compare it with other health-related quality of life questionnaires in the assessment and management of COPD patients, and to emphasize the importance of patient–physician communication in the management of patients with the disease.
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Affiliation(s)
- Shahrzad M Lari
- COPD Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Davood Attaran
- COPD Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad Tohidi
- COPD Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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Wu W, Liu X, Wang L, Wang Z, Hu J, Yan J. Effects of Tai Chi on exercise capacity and health-related quality of life in patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis. Int J Chron Obstruct Pulmon Dis 2014; 9:1253-63. [PMID: 25404855 PMCID: PMC4230171 DOI: 10.2147/copd.s70862] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Tai Chi is a traditional Chinese mind-body exercise that has been widely practiced in the People's Republic of China for many centuries. This exercise has also been applied as a training modality in pulmonary rehabilitation programs for stable chronic obstructive pulmonary disease (COPD). This systematic review and meta-analysis aimed to assess the effects of Tai Chi on exercise capacity and health-related quality of life (HRQoL) in COPD patients. METHODS Electronic databases (PubMed, Embase, Web of Science, The Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, ClinicalTrials.gov, China National Knowledge Infrastructure, and China Biology Medicine disc) were searched. Entries published from January 1980 to March 2014 were included in the search. Eligible studies included those that involved randomized controlled trials and those that lasted for at least 12 weeks. The primary outcome measures were six-minute walking distance (6 MWD), St George's Respiratory Questionnaire (SGRQ), and Chronic Respiratory Disease Questionnaire (CRQ). Effect estimates were pooled with random-effects meta-analysis. RESULTS Eleven articles involving 824 patients met the inclusion criteria. All included articles compared COPD patients in a Tai Chi group versus COPD patients in nonexercise and/or physical exercise groups. The meta-analysis showed that compared with the nonexercise group, the COPD patients practicing Tai Chi demonstrated significantly enhanced 6 MWD (mean difference 35.99, 95% confidence interval [CI] 15.63-56.35, P=0.0005), decreased SGRQ total score (mean difference -10.02, 95% CI -17.59, -2.45, P=0.009), and increased CRQ total score (mean difference 0.95, 95% CI 0.22-1.67, P=0.01). Compared with the physical exercise group, the Tai Chi group showed significantly reduced SGRQ total score (mean difference -3.52, 95% CI -6.07, -0.97, P=0.007), but no statistical significance was found for 6 MWD between the two groups (mean difference 13.65, 95% CI -1.06, 28.37, P=0.07) in COPD patients. CONCLUSION Preliminary evidence suggests that Tai Chi has beneficial effects on exercise capacity and HRQoL in COPD patients. This exercise can be recommended as an effective alternative training modality in pulmonary rehabilitation programs. Further studies are required to support the preliminary evidence and to observe the long-term effects of Tai Chi.
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Affiliation(s)
- Weibing Wu
- Department of Sports Medicine, Shanghai University of Sport, Shanghai, People’s Republic of China
| | - Xiaodan Liu
- School of Rehabilitation Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
| | - Longbing Wang
- Department of Sports Medicine, Shanghai University of Sport, Shanghai, People’s Republic of China
| | - Zhenwei Wang
- Department of Respiratory Medicine, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai, People’s Republic of China
| | - Jun Hu
- School of Rehabilitation Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
| | - Juntao Yan
- Department of Rehabilitation Medicine, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai, People’s Republic of China
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Lari SM, Ghobadi H, Attaran D, Mahmoodpour A, Shadkam O, Rostami M. COPD assessment test (CAT): simple tool for evaluating quality of life of chemical warfare patients with chronic obstructive pulmonary disease. CLINICAL RESPIRATORY JOURNAL 2013; 8:116-23. [DOI: 10.1111/crj.12047] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Revised: 07/16/2013] [Accepted: 07/25/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Shahrzad M. Lari
- Mashhad University of Medical Sciences; COPD Research Center; School of Medicine; Mashhad Iran
| | - Hassan Ghobadi
- Ardabil University of Medical Sciences; Department of Internal Medicine; Ardabil Iran
| | - Davood Attaran
- Mashhad University of Medical Sciences; COPD Research Center; School of Medicine; Mashhad Iran
| | - Afsoun Mahmoodpour
- Ardabil University of Medical Sciences; Department of Internal Medicine; Ardabil Iran
| | - Omid Shadkam
- Mashhad University of Medical Sciences; COPD Research Center; School of Medicine; Mashhad Iran
| | - Maryam Rostami
- Mashhad University of Medical Sciences; COPD Research Center; School of Medicine; Mashhad Iran
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Ninot G, Soyez F, Préfaut C. A short questionnaire for the assessment of quality of life in patients with chronic obstructive pulmonary disease: psychometric properties of VQ11. Health Qual Life Outcomes 2013; 11:179. [PMID: 24160852 PMCID: PMC3842624 DOI: 10.1186/1477-7525-11-179] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Accepted: 09/25/2013] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND There is a need for a validated short instrument that can be used in routine practice to quantify potential short-term change in Health-Related Quality of Life (HRQoL) in patients with chronic obstructive pulmonary disease (COPD). Our aim is to determine the validity and reliability of the VQ11 questionnaire dedicated to the routine assessment of HRQoL. METHODS 181 COPD patients (40-85 yrs, I to IV GOLD stages) completed the VQ11, and several tests. One week later, 49 of these patients completed the VQ11 again. RESULTS Confirmatory factor analysis supported the two-level hierarchical structure of the VQ11 with 11 items covering three components and HRQoL at a higher level. The VQ11 showed good internal consistency and good reproducibility (r = 0.88). Concurrent validity showed significant correlations between VQ11 total scores and St George's Respiratory Questionnaire-C (r = 0.70), Short Form-36 (r = -0.66 for the physical component and -0.63 for the mental component). We obtained significant correlations with MRC Dyspnea Grades (r = 0.59), the Hospital Anxiety and Depression Scale total score (r = 0.62), and the BODE index (r = 0.53). CONCLUSION The VQ11 has good measurement properties and provides a valid and reliable measure of COPD-specific HRQoL. It is ready for use in routine practice. CLINICAL REGISTRATION The study was approved by the University of Montpellier 1 Ethics Committee and the Regional Ethics Committee (authorization number: A00332-53).
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Affiliation(s)
- Gregory Ninot
- Laboratory Epsylon, EA4556 Dynamics of Human Abilities & Health Behaviors, University MONTPELLIER 1, Montpellier F-34000, France.
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Validation of a new questionnaire with generic and disease-specific qualities: the McGill COPD Quality of Life Questionnaire. Can Respir J 2013; 19:367-72. [PMID: 23248800 DOI: 10.1155/2012/914138] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND A validated health-related quality of life questionnaire in chronic obstructive pulmonary disease (COPD) with advantages of both generic- and disease-specific questionnaires is needed to capture patients' perspectives of severity and impact of the disease. The McGill COPD questionnaire was created to include these advantages in English and French. It assesses three domains: symptoms, physical function and feelings with 29 items (12 from the 36-item Short-Form Health Survey with 17 from the previously developed COPD-specific module). OBJECTIVE To evaluate the psychometric properties of this newly developed hybrid questionnaire in subjects with COPD. METHODS Data from a multicentre, prospective cohort study involving four hospitals with COPD subjects undergoing pulmonary rehabilitation were used. Patient evaluations included health-related quality of life (the new McGill COPD questionnaire, the St Georges Respiratory Questionnaire and the 36-item Short-Form Health Survey) and pulmonary function tests pre-and postrehabilitation. Reliability, validity and responsiveness were tested. RESULTS The study included 246 COPD subjects (111 females) with a mean age of 66 years, 87% ex- and 8% current smokers (mean 61 pack-years) and mean forced expiratory volume in 1 s of 1.12 L (Global initiative for chronic Obstructive Lung Disease stages: 2, 27%; 3, 33%; and 4, 37%). Missing data were <2% and floor and ceiling effects were <5%. Internal consistency (Cronbach's alpha) was 0.68 to 0.82. Test-retest reliability (intracorrelation coefficients) ranged from 0.74 to 0.96 for the subscales, and 0.95 for the total score. Correlation with the St George's Respiratory Questionnaire was moderately high (r=-0.88 [95% CI -0.91 to -0.84]), consistent with the a priori hypothesis for convergent validity. The effect size was 0.33 (pre-postrehabilitation mean score difference = 6), suggesting a small to moderate change. CONCLUSIONS The new McGill COPD questionnaire showed high internal consistency, test-retest reliability, validity and moderate responsiveness in COPD subjects.
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Jingar A, Alaparthi GK, Vaishali K, Krishnan S, Zulfeequer, Unnikrishnan B. Clinical management practices adopted by physiotherapists in India for chronic obstructive pulmonary disease: A national survey. Lung India 2013; 30:131-8. [PMID: 23741094 PMCID: PMC3669553 DOI: 10.4103/0970-2113.110421] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background and Objective: Evidence supports the use of pulmonary rehabilitation in the treatment of chronic obstructive pulmonary disease (COPD) patients both during acute exacerbation and at later stages. It is used in India; but, to date, there has been no study that has investigated the structure of pulmonary rehabilitation programs for COPD patients in India. The recent study aims to determine the current practice patterns of Indian Physiotherapists for COPD patients admitted in Intensive Care Units (ICUs) and wards in terms of assessment and treatment. Materials and Methods: A questionnaire-based survey was conducted across India. Questionnaires were distributed to around 800 physiotherapists via E-mail. Physiotherapists with a Master Degree and a specialization in cardiopulmonary science or a minimum of 1 year of experience in treating cardiopulmonary patients were included. The questionnaires addressed assessment measures and treatment techniques given to COPD patients. Results: A total of 342 completed questionnaires were received, yielding a response rate of 43.8%, with a majority of responses from Karnataka, Maharashtra and Gujarat. The assessment and treatment techniques used were almost similar between ICUs and wards. More than 80% of the responders carried out the assessment of certain respiratory impairments in both ICUs and wards. An objective measure of dyspnea was taken by less than 40% of the responders, with little attention given to functional exercise capacity and health-related quality of life. Eighty-five percent of the responders used Dyspnea-relieving strategies and traditional airway clearance techniques in both ICUs and wards. Eighty-three percent of the responders were giving patients in the wards training for upper and lower extremity. Fifty percent were giving strength training in the wards. Conclusion: Whether patients are admitted in ICUs or Wards, the practice pattern adopted by Physiotherapists to treat them vary very little with respect to certain measures taken. Assessment predominantly focused on respiratory impairment measures, followed by dyspnea-quantifying measures, with little attention given to functional exercise capacity and health-related quality of life measures. Treatment techniques given were concentrated on dyspnea-relieving strategies, airway clearance techniques and upper and lower extremity exercises, with little attention given to strength training.
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Affiliation(s)
- Aripta Jingar
- Department of Physiotherapy, Kasturba Medical College (A constituent institute of Manipal University), Mangalore, India
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Weldam SW, Schuurmans MJ, Liu R, Lammers JWJ. Evaluation of Quality of Life instruments for use in COPD care and research: A systematic review. Int J Nurs Stud 2013; 50:688-707. [DOI: 10.1016/j.ijnurstu.2012.07.017] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2011] [Revised: 07/24/2012] [Accepted: 07/31/2012] [Indexed: 12/17/2022]
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Feldman GJ. Improving the quality of life in patients with chronic obstructive pulmonary disease: focus on indacaterol. Int J Chron Obstruct Pulmon Dis 2013; 8:89-96. [PMID: 23431038 PMCID: PMC3575129 DOI: 10.2147/copd.s31209] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a common disease in the general population and it places a considerable burden on patients, with the disease negatively affecting quality of life. In practice, patients with COPD generally seek medical attention because of symptoms, particularly breathlessness, and the resulting physical limitations, which affect the health-related quality of life (HR-QOL) in patients. The defining feature of COPD is airflow limitation that causes air trapping and increased hyperinflation as the ventilation rate increases during physical effort. Hyperinflation causes or worsens breathlessness as breathing becomes inefficient, with the end result being an avoidance of physical exertion and a cycle of increasing dyspnea caused by inactivity and deconditioning, with deleterious effects on HR-QOL. Current published guidelines for COPD state that the goals of pharmacologic therapy should be to control symptoms, improve health status and exercise tolerance, and reduce the frequency of COPD exacerbations. Effective and sustained bronchodilation has emerged as a key strategy for improving dyspnea and ability to exercise. As there is no cure for COPD, a major goal of treatment and of research into new therapies is to improve HR-QOL in COPD patients.
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Affiliation(s)
- Gregory J Feldman
- S Carolina Pharmaceutical Research, Alliance Biomedical Group International, Spartanburg, SC 29303, USA.
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Mandal P, Sidhu MK, Donaldson LS, Chalmers JD, Smith MP, Turnbull K, Scott J, Hill AT. Eight-weekly intravenous antibiotics is beneficial in severe bronchiectasis. QJM 2013; 106:27-33. [PMID: 23019590 DOI: 10.1093/qjmed/hcs173] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
AIM The aim of our study was to assess the impact of 8-weekly intravenous (IV) antibiotics on exacerbation frequency and health-related quality of life in bronchiectasis. METHODS Patients were recruited prospectively from June 2008 to December 2010. Patients with recurrent exacerbations (five or more exacerbations per year) and subjectively reporting ill health between antibiotic courses were recruited. Eight-weekly IV antibiotics (for 14 days) were initiated. Patients were followed up for 1 year. Main outcome was reduction in exacerbation frequency and improvement in health-related quality of life (HRQoL) at 1 year after starting intravenous antibiotic therapy. Other outcomes recorded were forced expiratory volume in 1 s (FEV(1)), forced vital capacity (FVC), incremental shuttle walk test (ISWT), 24-h sputum volume, sputum microbiology, body mass index (BMI), markers of inflammation--white cell count (WCC), C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). RESULTS In total, 19 patients were recruited. Mean age was 64.1 years and 52.6% were female. With 8-weekly antibiotics, there was a significant reduction in the number of exacerbations [mean (SE): 9.3 (0.5) in the year before vs. 8.0 (0.4) in the year after; P = 0.02]. In 63.2%, Leicester Cough Questionnaire (LCQ) improved by ≥1.3 U (P = 0.006)] and in 42.1% St. George's Respiratory Questionnaire (SGRQ) improved by ≥4 U (P = 0.03). Exercise capacity increased by 58.7 m (P = 0.004). There was no improvement in the other end points. CONCLUSION Treatment with 8-weekly intravenous antibiotics in severe bronchiectasis reduced exacerbation frequency and improved exercise tolerance and health-related quality of life.
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Affiliation(s)
- P Mandal
- MRC Centre for Inflammation Research, Queen's Medical Research Institute, Edinburgh, UK.
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Integrating Values and Consumer Involvement in Guidelines with the Patient at the Center. Ann Am Thorac Soc 2012; 9:262-8. [DOI: 10.1513/pats.201208-061st] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
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Ternesten-Hasséus E, Larsson S, Millqvist E. Sensitivity to environmental irritants and quality of life in COPD. Int J Chron Obstruct Pulmon Dis 2011; 6:685-91. [PMID: 22259245 PMCID: PMC3257954 DOI: 10.2147/copd.s25839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
It is a common clinical experience that patients with chronic obstructive pulmonary disease (COPD) complain of airway symptoms provoked by environmental irritants like chemicals and scents, although few studies can confirm such connections. The aim was to study the prevalence of airway symptoms induced by chemicals and scents in a group of patients with newly diagnosed CPOD and to analyze any relation to illness severity and quality of life. Eighty-one patients with COPD were recruited to the study. By mail they were asked to answer three questionnaires regarding symptoms, quality of life, and social and emotional influence of airway symptoms induced by environmental irritants. A majority (62%) of the COPD patients claimed to be hyperreactive to chemicals and scents. As a group they scored higher on a questionnaire measuring social and emotional influences of such environmental irritants compared to healthy control subjects. Further, high scores were more common among patients with a very severe form of COPD and among patients with regular use of β(2)-stimulants. High scores were also associated with significantly more airway symptoms and, in some aspects, with impaired quality of life. In conclusion, the results of this study show that airway symptoms induced by environmental irritants are common in patients with COPD and that this increased airway sensitivity follows the impairment of lung capacity. The mechanisms behind this remain unclear.
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Affiliation(s)
- Ewa Ternesten-Hasséus
- Department of Internal Medicine/ Respiratory Medicine and Allergology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Sven Larsson
- Department of Internal Medicine/ Respiratory Medicine and Allergology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Eva Millqvist
- Department of Internal Medicine/ Respiratory Medicine and Allergology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Pakhale S, Wood-Dauphinee S, Spahija J, Collet JP, Maltais F, Bernard S, Baltzan M, Rouleau M, Bourbeau J. Combining both generic and disease-specific properties: development of the McGill COPD quality of life questionnaire. COPD 2011; 8:255-63. [PMID: 21728790 DOI: 10.3109/15412555.2011.578600] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
UNLABELLED Presently, a generic and a disease-specific questionnaire are often co-administered to capture the different domains of quality of life in chronic obstructive pulmonary disease (COPD) subjects. A health-related-quality of life (HRQL) questionnaire in COPD combining both generic and disease-specific properties is needed. OBJECTIVE To develop a new, hybrid-HRQL questionnaire, the McGill-COPD-questionnaire, with qualities of both generic and disease-specific instruments. Using pre-defined criteria, we selected items from the SF-36 to complement the items from a COPD-specific-module to create the new hybrid-HRQL-questionnaire. Domains were identified via confirmatory factor analysis. The McGill COPD questionnaire is available in English and French; it assesses three domains: symptoms, physical-function and feelings, has 29 items: 17 from the COPD-specific-module and 12 from the SF-36. The symptom sub-scale has 6 items, all from the COPD-specific-module; the feelings sub-scale has 10 items, 5 each from COPD-specific-module and SF-36 and the physical-function sub-scale has 13 items, 6 from COPD-specific-module and 7 from SF-36. The McGill COPD questionnaire was developed using a novel method of combining items from the SF-36 and a COPD-specific-module. Thus, this new questionnaire has items from a generic-questionnaire and a disease-specific-module and, hence, is promising to be a stand alone quality-of-life questionnaire for COPD subjects.
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Affiliation(s)
- Smita Pakhale
- The University of Ottawa, the Ottawa Hospital, the Ottawa Hospital Research Institute, Canada
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Mazur W, Kupiainen H, Pitkäniemi J, Kilpeläinen M, Sintonen H, Lindqvist A, Kinnula VL, Laitinen T. Comparison between the disease-specific Airways Questionnaire 20 and the generic 15D instruments in COPD. Health Qual Life Outcomes 2011; 9:4. [PMID: 21235818 PMCID: PMC3031191 DOI: 10.1186/1477-7525-9-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2010] [Accepted: 01/16/2011] [Indexed: 11/10/2022] Open
Abstract
Background Given that the assessment of health-related quality of life (HRQoL) is an essential outcome measure to optimize chronic obstructive pulmonary disease (COPD) patient management, there is a need for a short and fast, reliable and valid instrument for routine use in clinical practice. The objective of this study was to analyse the relationship between the disease-specific Airways questionnaire (AQ20) and the generic 15D health-related quality of life (HRQoL) instrument simultaneously in a large cohort of patients with COPD. We also compare the HRQoL of COPD patients with that of the general population. Methods The AQ20 and 15D were administered to 739 COPD patients representing an unselected hospital-based COPD population. The completion rates and validity of, and correlations among the questions and dimension scores were examined. A factor analysis with varimax rotation was performed in order to find subsets of highly correlating items of the questionnaires. Results The summary scores of AQ20 and 15D were highly correlated (r = - 0.71, p < 0.01). In AQ20 over 50% of patients reported frequent cough, breathlessness during domestic work, and chest problem limiting their full enjoyment of life. 15D results showed a noteworthy decrease of HRQoL in breathing, mobility, sleeping, usual activities, discomfort and symptoms, vitality, and sexual activity (scores ≤ 0.75). Compared to the age- and gender-standardized Finnish general population, the COPD patients were statistically significantly worse off on 13 of 15 dimensions. Conclusions The AQ20 and 15D summary scores are comparable in terms of measuring HRQoL in COPD patients. The data support the validity of 15D to measure the quality of life in COPD. COPD compromises the HRQoL broadly, as reflected by the generic instrument. Both questionnaires are simple and short, and could easily be used in clinical practice with high completion rates.
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Affiliation(s)
- Witold Mazur
- Department of Medicine, Pulmonary Division, Helsinki University Central Hospital, Haartmaninkatu 4, Helsinki, Finland.
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Maria S Pinto J, Ramos González J, Ignácio C Arenillas J, Maria M Nogueras A, Pedro G Gómez F. The health-related quality of life of patients with chronic obstructive pulmonary disease and asthma evaluated by the SGRQ. REVISTA PORTUGUESA DE PNEUMOLOGIA 2011; 16:543-58. [PMID: 20700554 DOI: 10.1016/s2173-5115(10)70058-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
AIMS To compare the effects of asthma and chronic obstructive pulmonary disease (COPD) on the quality of life of patients evaluated using the Saint George Respiratory Questionnaire (SGRQ) through correlating the variables, domains and total score. METHODS A cross-sectional study from October 2008 to March 2009 with 75 adult outpatients at the University Hospital of Salamanca, Spain. Patients provided their clinical and socio-demographical data after being informed of the study's aims and ethical aspects. The Spanish version of the SGRQ and the statistical packa ge Statistics SPSS version 17.0 were used for statistical analysis. RESULTS 65.3% were male and 34.7% female with mean age 60.4 years. 68% had a diagnosis of asthma and 30.7% COPD. Statistically significant differences (p<0.05) between diagnosis and the 'activity' domain were found. None were found between gender, smoking, ex-smoking or hypertension and the domains. The income levels were inversely related (p=0.038) with the total score. Statistically significant differences between age and the 'activity' (p<0.01) and 'impact' (p<0.05) domains and the SGRQ total score were found (p<0.01). The forced expiratory volume in one second (FEV1%pred) only correlated with the 'activity' domain (p<0.01) and with the total score (p<0.01). CONCLUSIONS No variable correlated with all domains and the total score of the instrument. Some presented no statistically significant difference.
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Affiliation(s)
- Juliana Maria S Pinto
- Doutoramento em Avances en Investigación sobre Discapacidad, Universidade de Salamanca, Bolseista, Espanha.
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Impacto do exercício físico combinado na percepção do estado de saúde da pessoa com doença pulmonar obstrutiva crónica. REVISTA PORTUGUESA DE PNEUMOLOGIA 2010. [DOI: 10.1016/s0873-2159(15)30069-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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de Sousa Pinto JM, González JR, Arenillas JIC, Nogueras AMM, Gómez FPG. A qualidade de vida relacionada com a saúde de doentes com doença pulmonar obstrutiva crónica e asma avaliada pelo SGRQ. REVISTA PORTUGUESA DE PNEUMOLOGIA 2010. [DOI: 10.1016/s0873-2159(15)30051-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Sarioglu N, Alpaydin AO, Coskun AS, Celik P, Ozyurt BC, Yorgancioglu A. Relationship between BODE index, quality of life and inflammatory cytokines in COPD patients. Multidiscip Respir Med 2010; 5:84-91. [PMID: 22958780 PMCID: PMC3463092 DOI: 10.1186/2049-6958-5-2-84] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2009] [Accepted: 12/17/2009] [Indexed: 01/10/2023] Open
Abstract
Background and aims Recently a multidimensional grading system based on the body mass index (B), degree of airflow obstruction (O), dyspnea (D) and exercise capacity (E) - the BODE index - has begun to be used increasingly for the evaluation of chronic obstructive pulmonary disease (COPD) patients. The aim of our study was to investigate the relationship between the BODE index and disease duration, annual exacerbation and hospitalization rates, health related quality of life and systemic inflammatory markers like C-reactive protein (CRP), tumor necrosis factor (TNF)-α and interleukin (IL)-8. Materials and methods In 88 stable COPD patients we evaluated the body-mass index, pulmonary function tests, Modified Medical Research Council dyspnea scale and six-minute walk test (6 MWT). BODE scores were determined. Disease duration, number of exacerbations and hospitalization in the previous year were recorded. We also performed arterial blood gases analysis, administered the St. George's Respiratory Questionnaire (SGRQ) and measured serum levels of CRP, TNF-α, IL-8. Results According to BODE score 52% of patients were BODE 1, 21% BODE 2, 15% BODE 3 and 12% were BODE 4. There was a significant relationship between BODE index and COPD stage as classified according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) (p < 0.001). Correlations between BODE score and disease duration (p = 0.011), number of exacerbations (p < 0.001) and hospitalizations (p < 0.001) in the last year were also observed. SGRQ symptom, activity, emotion scores and total scores were found to be significantly correlated to BODE (p < 0.001). Serum CRP levels and BODE were also correlated (p = 0.014); however, no correlation was found between serum levels of TNF-α and IL-8 and BODE. Conclusions As the BODE index shows a strong correlation with various prognostic and follow up parameters of COPD and systemic inflammation, its use should be considered for the evaluation of COPD patients.
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Affiliation(s)
- Nurhan Sarioglu
- Celal Bayar University, Medical Faculty, Pulmonary Diseases, Manisa, Turkey.
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Farkas J, Kosnik M, Flezar M, Suskovic S, Lainscak M. Self-rated health predicts acute exacerbations and hospitalizations in patients with COPD. Chest 2010; 138:323-30. [PMID: 20382715 DOI: 10.1378/chest.09-2459] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Self-rated health predicts outcome in chronic disease, but such information is scarce in COPD. We aimed to assess self-rated health as an outcome predictor in carefully characterized patients with this condition. METHODS This was a prospective study in 127 clinically stable patients with COPD (64 +/- 8 years, 79% men, 82% Global Initiative for Chronic Obstructive Lung Disease stage II or III). Self-rated health was assessed using a 5-grade Likert scale ranging from very poor to very good. RESULTS During 26.0 +/- 4.9 months of follow-up, 78 patients experienced acute exacerbation, 39 were hospitalized, and 10 died. Poor or very poor self-rated health was reported by 19 patients (15%) and was more common in patients experiencing acute exacerbations (20% vs 6%, P = .027) and hospitalizations (19% vs 5%, P = .039). Kaplan-Meier curves demonstrated more acute exacerbations (P = .003) and hospitalizations (P = .008) in patients with poor or very poor self-rated health. In a fully adjusted Cox model of proportional hazard, poor or very poor self-rated health remained predictive of acute exacerbations (hazard ratio [HR], 1.80; 95% CI, 1.03-3.11) and hospitalizations (HR, 1.93; 95% CI, 1.12-3.68) but not of death. CONCLUSIONS This study suggests that self-rated health is predictive of acute exacerbations and hospitalizations. Although prediction of mortality was limited, the study is supportive of self-rated health testing in COPD.
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Affiliation(s)
- Jerneja Farkas
- Faculty of Medicine University of Ljubljana, Zaloska cesta 4, SI-1000 Ljubljana, Slovenia.
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Rodríguez-González Moro JM, Izquierdo JL, Antón E, de Lucas P, Martín A. Health-related quality of life in outpatient women with COPD in daily practice: the MUVICE Spanish study. Respir Med 2009; 103:1303-12. [PMID: 19406631 DOI: 10.1016/j.rmed.2009.04.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2009] [Revised: 03/24/2009] [Accepted: 04/01/2009] [Indexed: 01/01/2023]
Abstract
AIMS A cross-sectional multicenter study was designed to assess health-related quality of life (HRQL) in women with chronic obstructive pulmonary disease (COPD) who were attended in the outpatient setting in actual conditions of the daily practice. METHODS A total of 1786 women with COPD (mean age of 66.5 years) and 1661 pairs of men and women matched by age and COPD severity participated in a cross-sectional study. HRQL was measured with the Short Form 12 Health Survey Questionnaire (SF-12). RESULTS The mean PCS-12 and MCS-12 scores were 36.5+/-10.3 and 44.1+/-11.8, respectively. General health and physical functioning domains were those with the lowest scores, whereas role emotional and social functioning were those with the highest scores. The percentage of women with low HRQL increased according to age, whereas the percentage of women with high or normal HRQL decreased significantly. In relation to COPD severity, more women rated HRQL as low in the physical component than in the mental component. HRQL correlated significantly with FEV(1) in both PCS-12 and MCS-12 scales. As expected, an inverse significant correlation between HRQL and degree of dyspnea in the PCS-12 and the MCS-12 scales was observed. Women had also a significantly worse HRQL than men in all physical and mental domains. CONCLUSIONS In outpatient women with COPD, HRQL was impaired especially the physical component of the SF-12. For the same age and severity of COPD, women showed significantly lower scores in all physical and mental domains of the SF-12 than men.
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Martín A, Rodríguez-González Moro JM, Izquierdo JL, Gobartt E, de Lucas P. Health-related quality of life in outpatients with COPD in daily practice: the VICE Spanish Study. Int J Chron Obstruct Pulmon Dis 2009; 3:683-92. [PMID: 19283915 PMCID: PMC2650615 DOI: 10.2147/copd.s4791] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The objective of this study was to measure health-related quality of life (HRQL) in outpatients with chronic obstructive pulmonary disease (COPD) and to assess differences in HRQL according to age, gender, and severity of COPD. METHODS A total of 9405 patients (79% men, mean age 68 years) participated in a cross-sectional study. HRQL was measured with the Short Form 12 Health Survey Questionnaire (SF-12). Severity of COPD was graded into three levels according to forced expiratory volume in one second value. RESULTS COPD severity was mild in 33.8% of cases, moderate in 49.3% and severe in 16.8%. The mean physical component summary (PCS-12) and mental component summary (MCS-12) scores were 36.8 +/- 10.4 and 47.2 +/- 11.2, respectively. General health and physical functioning domains were those with the lowest scores. The mean MCS-12 scores were significantly higher in men (47.9 +/- 10.9) than in women (44.1 +/- 11.8) (P < 0.001). Patients older than 60 years rated HRQL worse than patients aged 40-59 years. There were statistically significant differences according to severity of disease in the mean scores of all domains of the PCS-12 and MCS-12 scales. CONCLUSIONS The present findings show the influence of female gender, older age and moderate-to-severe of airflow limitation on HRQL in outpatients with COPD attended in daily practice.
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Talley CH, Wicks MN. A pilot study of the self-reported quality of life for patients with chronic obstructive pulmonary disease. Heart Lung 2009; 38:141-50. [DOI: 10.1016/j.hrtlng.2008.05.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2007] [Revised: 05/02/2008] [Accepted: 05/24/2008] [Indexed: 11/28/2022]
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Izquierdo JL, Barcina C, Jiménez J, Muñoz M, Leal M. Study of the burden on patients with chronic obstructive pulmonary disease. Int J Clin Pract 2009; 63:87-97. [PMID: 19125996 PMCID: PMC2705822 DOI: 10.1111/j.1742-1241.2008.01936.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Health-related quality of life measures are widely used in patients with chronic obstructive pulmonary disease (COPD). However, they are extremely limited when used to evaluate patients outside the clinical trials. The aim of this study was to analyse the burden of the disease using a simple, validated, self-administered questionnaire specifically developed for patients in daily clinical practice. METHODS A total of 3935 patients (74.5% men; mean age, 67 years) participated in a cross-sectional study. The burden of COPD on patients was measured using the Clinical COPD Questionnaire (CCQ). COPD was rated at four levels by the forced expiratory volume in one second (FEV(1)) according to The Global Initiative for Chronic Obstructive Lung Disease (GOLD) scale. RESULTS The disease mainly affects old men (more than 50% were over 65 years of age) and non-employed men (23% were employed). Of the patients studied, 22.7% continued smoking, especially men (24.4% of men vs. 18.1% of women). Most patients (54%) were diagnosed with moderate stage II COPD. Severity of COPD was lower in women: 29.6% of men had severe COPD compared with 13.7% of women. During the last year, 65.1% had at least one acute exacerbation and 36.6% were admitted to hospital because of COPD exacerbation. No association was found between the body mass index and COPD stage. The variable that most influenced the disease burden was dyspnoea, as progression from grade 0 to grade 4 increased the disease burden by 1.78 points for symptoms, 2.43 for functional state and 1.53 for mental state. The functional classification of COPD also had a significant influence on the disease burden. CONCLUSIONS The present findings show that dyspnoea and the degree of airflow limitation are the clinical variables that most affect the burden of COPD from the patient's point of view.
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Affiliation(s)
- J L Izquierdo
- Sección de Neumología, Hospital General Universitario de Guadalajara, Guadalajara, Spain.
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27
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Liang WM, Chen JJ, Chang CH, Chen HW, Chen SL, Hang LW, Wang JD. An empirical comparison of the WHOQOL-BREF and the SGRQ among patients with COPD. Qual Life Res 2008; 17:793-800. [PMID: 18500580 PMCID: PMC2440950 DOI: 10.1007/s11136-008-9326-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2007] [Accepted: 03/01/2008] [Indexed: 12/13/2022]
Abstract
Aims To compare the psychometric properties of the World Health Organization Quality of Life-BREF (WHOQOL-BREF) instrument and the St. George’s Respiratory Questionnaire (SGRQ), and to examine the association between pulmonary function and domains and items of these questionnaires in patients with chronic obstructive pulmonary disease (COPD). Methods The WHOQOL-BREF and the SGRQ were administered to 211 patients. The reliability and validity of, and correlations among, the domain scores were examined. Multiple regression analyses were performed to identify which items were independently associated with subjects’ lung functions. Results Both questionnaires showed good internal consistency (α > 0.8), except the SGRQ symptoms domain (α = 0.66), minimal ceiling and floor effects, and good item convergent and item discriminant validity. There were moderate correlations between physical domain of the WHOQOL-BREF and activity, impacts and total domains of the SGRQ, and between psychological domain of the WHOQOL-BREF and impacts and total domains of the SGRQ. Eighteen items were significantly associated with lung function, particularly those items relating to mobility/walking and activities of daily living (ADL). Conclusion Both the WHOQOL-BREF and the SGRQ showed comparable reliability and validity. Items related to mobility/walking and ADL may be useful in clinical screening for lung function impairment.
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Affiliation(s)
- Wen-Miin Liang
- Biostatistics and Bioinformatics Center, Institute of Biostatistics, Institute of Environmental Health, China Medical University, Taichung, Taiwan
| | - Jian-Jung Chen
- Department of Chinese Medicine, Buddhist Tzuchi General Hospital Taichung Branch, Taichung, Taiwan
| | - Chih-Hung Chang
- Buehler Center on Aging, Health & Society, Division of General Interal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
| | - Hung-Wei Chen
- Institute of Environmental Health, China Medical University, Taichung, Taiwan
| | - Shiah-Lian Chen
- Department of Nursing, Hungkuang University, Taichung, Taiwan
| | - Liang-Wen Hang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Jung-Der Wang
- Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University, Taipei, Taiwan
- Department of Internal Medicine, Department of Environmental and Occupational Medicine, National Taiwan University Hospital, No. 1 Changde Street, Taipei, 100 Taiwan
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Ilonen IK, Räsänen JV, Sihvo EI, Knuuttila A, Sovijärvi ARA, Sintonen H, Salo JA. Pneumonectomy: Post-operative quality of life and lung function. Lung Cancer 2007; 58:397-402. [PMID: 17716778 DOI: 10.1016/j.lungcan.2007.07.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2007] [Revised: 05/11/2007] [Accepted: 07/04/2007] [Indexed: 11/25/2022]
Abstract
BACKGROUND Pneumonectomy is associated with high morbidity and mortality. After pneumonectomy, data on health-related quality of life (HRQoL) or its correlation with dyspnea and lung function are scarce. Our main aim was to evaluate long-term HRQoL after pneumonectomy. METHODS In a retrospective one-center cross-sectional study, we investigated 31 of 98 patients who underwent pneumonectomy between January 1997 and October 2003 due to primary lung cancer. Pre- or postoperative chemotherapy or radiotherapy was applied according to hospital protocol. In June 2004, all patients alive received the generic HRQoL instrument (15D), as well as the Baseline Dyspnea Index (BDI). Results of the 15D were compared with those for an age- and gender-standardized general population. In April 2005, 20 patients participated in follow-up spirometric pulmonary function tests. RESULTS The 15D total score and its various dimensions were significantly lower after pneumonectomy than in the general population. Females both in 15D score and in the BDI had more dyspnea (p<0.05). No difference appeared between right and left pneumonectomy patients, except for more prominent dyspnea in women with right-sided pneumonectomy. CONCLUSIONS Pneumonectomy had a negative impact on patients' HRQoL. The use of a broad HRQoL instrument like the 15D, which covers multiple dimensions of HRQoL, yields a more accurate evaluation than did a single-dimension HRQoL instrument. Possibilities for sleeve-resection should be considered thoroughly before any pneumonectomy. SUMMARY Quality of life (QoL) after pneumonectomy, as measured with a generic QoL instrument, the 15D, was compared in an age- and gender-standardized population. QoL after pneumonectomy was significantly lower, especially in women after right-sided pneumonectomy.
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Affiliation(s)
- Ilkka K Ilonen
- Division of General Thoracic and Esophageal Surgery, Department of Cardiothoracic Surgery, Helsinki University Central Hospital, Haartmaninkatu 4, 00290 Helsinki, Finland
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Garrido PC, Díez JDM, Gutiérrez JR, Centeno AM, Vázquez EG, de Miguel ÁG, Carballo MG, García RJ. Negative impact of chronic obstructive pulmonary disease on the health-related quality of life of patients. Results of the EPIDEPOC study. Health Qual Life Outcomes 2006; 4:31. [PMID: 16719899 PMCID: PMC1488827 DOI: 10.1186/1477-7525-4-31] [Citation(s) in RCA: 120] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2006] [Accepted: 05/23/2006] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND COPD is currently the fourth cause of morbidity and mortality in the developed world. Patients with COPD experience a progressive deterioration and disability, which lead to a worsening in their health-related quality of life (HRQoL). The aim of this work is to assess the Health-Related Quality of Life (HRQoL) of patients with stable COPD followed in primary care and to identify possible predictors of disease. METHODS It is a multicenter, epidemiological, observational, descriptive study. Subjects of both sexes, older than 40 years and diagnosed of COPD at least 12 months before starting the study were included. Sociodemographic data, severity of disease, comorbidity, and use of health resources in the previous 12 months were collected. All patients were administered a generic quality-of-life questionnaire, the SF-12, that enables to calculate two scores, the physical (PCS-12) and the mental (MCS-12) component summary scores. RESULTS 10,711 patients were evaluated (75.6% men, 24.4% women), with a mean age of 67.1 years (SD 9.66). The mean value of FEV1 was 35.9 +/- 10.0%. Mean PCS-12 and MCS-12 scores were 36.0 +/- 9.9 and 48.3 +/- 10.9, respectively. Compared to the reference population, patients with COPD had a reduction of PCS-12, even in mild stages of the disease. The correlation with FEV1 was higher for PCS-12 (r = 0.38) than for MCS-12 (r = 0.12). Predictors for both HRQoL components were sex, FEV1, use of oxygen therapy, and number of visits to emergency rooms and hospital admissions. Other independent predictors of PCS-12 were age, body mass index and educational level. CONCLUSION Patients with stable COPD show a reduction of their HRQoL, even in mild stages of the disease. The factors determining the HRQoL include sex, FEV1, use of oxygen therapy, and number of visits to emergency rooms and hospital admissions.
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Affiliation(s)
- Pilar Carrasco Garrido
- Preventive Medicine and Public Health Department, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
| | | | - Javier Rejas Gutiérrez
- Department of Health Outcomes Research, Medical Unit, Pfizer España, Parque Empresarial La Moraleja, Avda de Europa, 20-B, 28108 Alcobendas, Madrid, Spain
| | | | - Elena Gobartt Vázquez
- Medical Department, Boehringer Ingelheim SA, Sant Cugat del Vallés, Barcelona, Spain
| | - Ángel Gil de Miguel
- Preventive Medicine and Public Health Department, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
| | - Marta García Carballo
- Preventive Medicine and Public Health Department, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
| | - Rodrigo Jiménez García
- Preventive Medicine and Public Health Department, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
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Yildiz F, Basyigit I, Yildirim E, Boyaci H, Ilgazli A. Different bronchodilator combinations have similar effects on health status in COPD. Pulm Pharmacol Ther 2006; 19:101-6. [PMID: 15967694 DOI: 10.1016/j.pupt.2005.04.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2004] [Revised: 03/21/2005] [Accepted: 04/09/2005] [Indexed: 11/22/2022]
Abstract
BACKGROUND The main treatment in COPD consists of bronchodilator agents. As the severity of disease increases, combined bronchodilators are preferred in place of single agents. Since there is a weak correlation between well being and spirometric parameters, additional life quality questionnaires are used. OBJECTIVES The main aim of this study was to investigate whether different bronchodilator combinations have similar effects on quality of life measures in COPD. METHODS Sixty male patients with COPD were randomized into three groups. After a two-week run-in period, life quality scores were determined using the Turkish version of St George's Respiratory Questionnaire (SGRQ). Group 1 was given ipratropium + theophylline (IP + THEO); Group 2 formoterol + theophylline (FOR + THEO) and Group 3 ipratropium + formoterol (IP + FOR). After a 12-week treatment period, symptom, activity and impact scores were again determined. RESULTS When compared with baseline, all component scores and total scores improved significantly (Delta total score: 16, 15 and 17 units in Groups I, II, and III, respectively), but there was no significant change between groups (p > 0.05). CONCLUSIONS According to these results, combined bronchodilator treatments have a significant effect on life quality in COPD, but the effects were observed to be similar between the three different combinations tested.
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Affiliation(s)
- Fusun Yildiz
- Chest Disease Department, Faculty of Medicine, Kocaeli University, Turkey
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Kim EJ, Park JH, Yoon SJ, Lee SJ, Cha SI, Park JY, Jung TH, Kim CH. Relationship between Dyspnea and Disease Severity, Quality of Life, and Social Factor in Patients with Chronic Obstructive Pulmonary Disease. Tuberc Respir Dis (Seoul) 2006. [DOI: 10.4046/trd.2006.60.4.397] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Eun-Jin Kim
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Korea
| | - Jae-Hyung Park
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Korea
| | - Suk-Jin Yoon
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Korea
| | - Seung-Jun Lee
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Korea
| | - Seung-Ick Cha
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Korea
| | - Jae-Yong Park
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Korea
| | - Tae-Hoon Jung
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Korea
| | - Chang-Ho Kim
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Korea
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[Chronic obstructive pulmonary diseases and asthma in children: diagnostic and therapeutic strategies]. Arch Pediatr 2005; 11 Suppl 2:103s-106s. [PMID: 15301806 DOI: 10.1016/s0929-693x(04)90009-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Asthma and chronic obstructive pulmonary disease are two distinct affections but two chronic inflammatory disorders. Respiratory symptoms are non-specific. There is a possible relationship between airways hyperreactivity and chronic obstructive pulmonary disease. Airway remodeling in asthma can begin in childhood. If natural history is different, treatment strategies become similar.
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Yeh ML, Chen HH, Liao YC, Liao WY. Testing the functional status model in patients with chronic obstructive pulmonary disease. J Adv Nurs 2004; 48:342-50. [PMID: 15500528 DOI: 10.1111/j.1365-2648.2004.03203.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Patients with chronic obstructive pulmonary disease usually experience gradual functional status degradation, especially dyspnoea, which may affect their daily activities and, eventually, quality of life. A full understanding of both their physiological and psychological functional status is therefore beneficial for effective treatment and helping patients regain or maintain control of their lives. METHOD Based on a non-experimental research design, 138 patients to test a hypothesized model of functional status in patients with chronic obstructive pulmonary disease, using structural equation modelling, were recruited from a medical center. Data were collected using questionnaires, 6-minute walking distance measurement, and pulmonary function test results recorded in patients' medical records. The proposed functional status model incorporated the exogenous variables disease severity and dyspnoea, and the endogenous variables age, exercise tolerance, fatigue, depression, anxiety, health perception and functional performance. Structural equation modelling with the lisrel software was used to establish a functional status model with those exogenous and endogenous variables. RESULTS The results indicated a good fit between the proposed functional status model and the data collected [chi(2) = 8.84, P = 0.64, chi(2)/d.f. = 0.80, Goodness of Fit Index (GFI) = 0.98, adjusted GFI (AGFI) = 0.95, root mean square residual (RMR) = 0.04, Critical N (CN) = 384.26]. Coefficients for paths in the functional status model all demonstrated statistical significance. CONCLUSION The functional status model was shown to consist of functional performance, functional capacity and other concepts, including disease severity, dyspnoea, age, exercise tolerance, fatigue, depression, anxiety and health perception. These results can be used to develop a suitable functional status model for chronic obstructive pulmonary disease, and could act as a reference for formulating future strategies and intervention procedures for further development of functional status.
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Affiliation(s)
- Mei-Ling Yeh
- Graduate Institute of Integration of Traditional Chinese Medicine with Western Nursing, National Taipei College of Nursing, Taipei, Taiwan
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Gautier V, Ouksel H, Bajon D, Veale D, Brondel L, Pison C. Réentraînement à l’effort des insuffisants respiratoires à domicile. Rev Mal Respir 2004; 21:829-34. [PMID: 15536388 DOI: 10.1016/s0761-8425(04)71428-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- V Gautier
- Association Nationale de Traitement A Domicile des Insuffisants Respiratoires, Paris, France.
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Sprenkle MD, Niewoehner DE, Nelson DB, Nichol KL. The Veterans Short Form 36 Questionnaire Is Predictive of Mortality and Health-Care Utilization in a Population of Veterans With a Self-Reported Diagnosis of Asthma or COPD. Chest 2004; 126:81-9. [PMID: 15249446 DOI: 10.1378/chest.126.1.81] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
STUDY OBJECTIVE Measures of health-related quality of life (HRQL) correlate with disease stage in persons with COPD. However, as their predictive capacity for mortality or medical utilization is less well defined, we sought to examine the relationship of a general measure of HRQL and outcomes in persons with obstructive lung disease. DESIGN Prospective cohort study. SETTING Upper Midwest Veterans Integrated Service Network (VISN)-13. PARTICIPANTS All veterans in VISN-13 (n = 70,017) were surveyed with the Veterans Short Form 36 (SF-36V). Persons with reported asthma or COPD who completed the SF-36V formed the study cohort (n = 8,354). MEASUREMENTS AND RESULTS For purposes of analysis, individuals were divided into quartiles of HRQL according to their physical component summary (PCS) and mental component summary (MCS), values derived from the SF-36V. Outcomes of mortality, hospitalization, and outpatient visits were recorded for 12 months after the survey. Outpatient utilization was dichotomized into high vs low use, with high use being defined as the upper quartile of visits in the 12 months prior to survey mailing. The study cohort had a mean age of 65 years and was largely male (95%), both consistent with a veteran population. After correcting for potential confounding factors through multivariable regression, the PCS was independently predictive of death, hospitalization, and high outpatient utilization. When using the first quartile of PCS as the reference population, those in the fourth quartile of PCS had a hazard ratio for death of 5.47 (95% confidence interval [CI], 3.63 to 8.26). Similarly, the odds ratios for hospitalization, high primary care visits, and high specialty medicine visits in the fourth quartile of PCS were 1.82 (95% CI, 1.51 to 2.19), 1.54 (95% CI, 1.26 to 1.87), and 1.46 (95% CI, 1.21 to 1.78), respectively. The MCS, through multivariable regression, was predictive of death but unassociated with subsequent hospitalization or high outpatient utilization. CONCLUSION HRQL, as assessed by the SF-36V, is an independent predictor of mortality, hospitalization, and outpatient utilization in persons with self-reported obstructive lung disease.
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Affiliation(s)
- Mark D Sprenkle
- Division of Pulmonary and Critical Care Medicine, Hennepin County Medical Center, Minneapolis, MN 55415, USA.
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Cazzola M, Noschese P, Centanni S, Santus P, Di Marco F, Spicuzza L, Di Maria GU. Salmeterol/fluticasone propionate in a Single Inhaler Device versus theophylline+fluticasone propionate in patients with COPD. Pulm Pharmacol Ther 2004; 17:141-5. [PMID: 15123223 DOI: 10.1016/j.pupt.2004.01.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2003] [Revised: 12/29/2003] [Accepted: 01/26/2004] [Indexed: 11/18/2022]
Abstract
STUDY OBJECTIVES The aim of this study was to compare the relative efficacy in terms of improvement in symptoms and lung function of salmeterol/fluticasone propionate (SLM/FP) combination administered through the Diskus inhaler versus theophylline (THEO) added to FP Diskus in patients with stable chronic obstructive pulmonary disease (COPD). METHODS AND MEASUREMENTS Eighty patients were randomized to receive 4 months of treatment in one of two treatment groups: (1) fixed combination of SLM 50 microg and FP 500 microg Diskus, 1 inhalation twice daily; or (2) FP Diskus 500 microg, 1 inhalation twice daily, plus oral titrated THEO twice daily. Patients attended the clinic before and after 4, 8, 12 and 16 weeks of treatment for evaluations of pulmonary function, and dyspnea, which was assessed using an analogic visual scale. Also the supplemental salbutamol use was measured. RESULTS . Sixty-six patients completed the 4-month treatment period: 37 patients receiving SLM/FP and 29 patients receiving THEO+FP. Patients were withdrawn for various reasons, the most common of which were poor compliance with the protocol, exacerbation and GI events. A gradual increase in FEV(1) was observed with each treatment. Maximum significant increases in FEV(1) over baseline values that were observed after 4 months of treatment were as follows: SLM/FP 0.172 l (95% CI: 0.084-0.260) and THEO+FP 0.155 l (95% CI: 0.054-0.256). SLM/FP experienced significantly (p<0.05) greater improvements in dyspnea, and required significantly fewer supplemental salbutamol treatments than the THEO+FP group. CONCLUSIONS Our results suggest that SLM/FP combination may provide substantial benefits in both physiologic and clinical outcomes in symptomatic patients with COPD. It also causes a more effective control than THEO+FP.
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Affiliation(s)
- Mario Cazzola
- Respiratory Medicine and Allergology Unit, A. Cardarelli Hospital, Via del Parco Margherita 24, 80121 Naples, Italy.
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Sarna L, Evangelista L, Tashkin D, Padilla G, Holmes C, Brecht ML, Grannis F. Impact of respiratory symptoms and pulmonary function on quality of life of long-term survivors of non-small cell lung cancer. Chest 2004; 125:439-45. [PMID: 14769722 DOI: 10.1378/chest.125.2.439] [Citation(s) in RCA: 158] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
PURPOSE To describe respiratory symptoms and pulmonary function among long-term survivors of non-small cell lung cancer (NSCLC), and their relationship to quality of life (QOL). METHODS Cross-sectional survey of disease-free, 5-year minimum survivors of NSCLC (n = 142; 54% women; average age, 71 years); the majority (74%) had received a lobectomy. Analysis included frequency of self-reported respiratory symptoms (cough, phlegm, wheezing, breathlessness) as measured by the American Thoracic Society questionnaire, pulmonary function findings from hand-held spirometry, and QOL (Short Form-36). RESULTS Two thirds of survivors reported at least one respiratory symptom (mean, 1.3; SD, 1.2): 25% cough, 28% phlegm, 31% wheezing, and 39% dyspnea. Twenty-one percent reported that they spent most of the day in bed in the past 12 months because of respiratory symptoms. Average FEV(1) percentage predicted was 68% (SD, 23); 21% had < 50% predicted FEV(1). Based on spirometry results, 36% had a moderate/severe obstructive and/or restrictive ventilatory disorder. Survivors exposed to second-hand smoke (28%) were more than three times as likely to report respiratory symptoms. Respiratory symptom burden contributed to diminished QOL in several domains. CONCLUSIONS The majority of these survivors experienced respiratory symptoms, and more than one third reported dyspnea, including one of five patients with seriously diminished pulmonary function. Symptom burden, rather than ventilatory impairment, contributed to diminished QOL. Further study is needed to determine the patterns and effective management of posttreatment respiratory symptoms on survivors of lung cancer.
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Affiliation(s)
- Linda Sarna
- School of Nursing, University of California-Los Angeles, 700 Tiverton Avenue, Box 9569182, Factor 4-262, Los Angeles, CA 90095-6918, USA.
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Abstract
THERAPEUTIC POSSIBILITIES Chronic obstructive pulmonary disease (COPD) remains under-diagnosed and under-treated despite its growing impact on public health. However several treatments, either pharmacological or not (pulmonary rehabilitation with exercise training), can improve quality of life significantly, even if they can not modify the natural history of the disease, as reflected by the decline in FEV1, which smoking cessation is the only way to alter. THE ACTION OF BRONCHODILATORS: Bronchodilators represent the first-line pharmacological treatment. Their clinical efficacy cannot be predicted by the inconstant changes in FEV1, since their main mechanism of action is the reduction in lung hyperinflation. Besides decreasing dyspnea, they reduce the number of exacerbations and improve quality of life.
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Affiliation(s)
- Nicolas Roche
- Service de pneumologie, Hôpital de l'Hôtel-Dieu 1, place du Parvis de Notre-Dame 75004 Paris.
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Ind P, Laitinen L, Laursen L, Wenzel S, Wouters E, Deamer L, Nystrom P. Early clinical investigation of Viozan™ (sibenadet HCI), a novel D2 dopamine receptor, β2-adrenoceptor agonist for the treatment of chronic obstructive pulmonary disease symptoms. Respir Med 2003. [DOI: 10.1016/s0954-6111(03)80011-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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ZuWallack RL, Mahler DA, Reilly D, Church N, Emmett A, Rickard K, Knobil K. Salmeterol plus theophylline combination therapy in the treatment of COPD. Chest 2001; 119:1661-70. [PMID: 11399688 DOI: 10.1378/chest.119.6.1661] [Citation(s) in RCA: 161] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Patients with COPD often require multiple therapies to improve lung function and decrease symptoms and exacerbations. Salmeterol and theophylline are indicated for the treatment of COPD, but the use of these agents in combination has not been extensively studied. OBJECTIVES To compare the efficacy and safety of salmeterol plus theophylline vs either agent alone in COPD. METHODS Randomized, double-blind, double-dummy, parallel-group trial in 943 patients with COPD. After an open-label theophylline titration period (serum levels, 10 to 20 microg/mL), patients were randomly assigned to receive salmeterol (42 microg bid) plus theophylline, salmeterol (42 microg bid), or theophylline for 12 weeks. Serial pulmonary function tests were completed on day 1 and treatment week 12. Patients kept diary cards and noted their peak flow rates, symptom scores, and albuterol use, and periodically completed quality-of-life and dyspnea questionnaires. RESULTS All three groups significantly improved compared with baseline. Combination treatment with salmeterol plus theophylline provided significantly (p < or = 0.045) greater improvements in pulmonary function; significantly (p < or = 0.048) greater decreases in symptoms, dyspnea, and albuterol use; and significantly fewer COPD exacerbations (p = 0.023 vs theophylline). In general, treatment with salmeterol provided greater improvement in lung function and satisfaction with treatment compared with theophylline. Salmeterol treatment was also associated with significantly fewer drug-related adverse events (p < or = 0.042) than either treatment that included theophylline. The safety profile (adverse events, vital signs, and ECG findings) of the two treatments that included theophylline were similar. CONCLUSION Patients with COPD may benefit from combination treatment with salmeterol plus theophylline, without a resulting increase in adverse events or other adverse sequelae.
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Affiliation(s)
- R L ZuWallack
- Section of Pulmonary Medicine, St. Francis Hospital and Medical Center, Hartford, CT 06105, USA
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Abstract
In spite of growing interest in and knowledge about the causes and progression of COPD, neither the assessment nor pharmacologic treatment of this condition is currently ideal. Tiotropium is the first new treatment for COPD in many years. Tiotropium is a long-acting anticholinergic agent that has a potential role as a once-daily maintenance treatment, and a picture of its effectiveness is gradually emerging. Spirometry data from clinical studies demonstrate that it is a potent bronchodilator in patients with COPD and it is very well tolerated. Further data on health status and quality of life are awaited.
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