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Licskai C, Hussey A, Rowley V, Ferrone M, Lu Z, Zhang K, Terebessy E, Scarffe A, Sibbald S, Faulds C, O'Callahan T, To T. Quantifying sustained health system benefits of primary care-based integrated disease management for COPD: a 6-year interrupted time series study. Thorax 2024; 79:725-734. [PMID: 38889973 PMCID: PMC11287652 DOI: 10.1136/thorax-2023-221211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 05/16/2024] [Indexed: 06/20/2024]
Abstract
BACKGROUND Severe exacerbation of chronic obstructive pulmonary disease (COPD) is a trajectory-changing life event for patients and a major contributor to health system costs. This study evaluates the real-world impact of a primary care, integrated disease management (IDM) programme on acute health service utilisation (HSU) in the Canadian health system. METHODS Interrupted time series analysis using retrospective health administrative data, comparing monthly HSU event rates 3 years prior to and 3 years following the implementation of COPD IDM. Primary outcomes were COPD-related hospitalisation and emergency department (ED) visits. Secondary outcomes included hospital bed days and all-cause HSU. RESULTS There were 2451 participants. COPD-related and all-cause HSU rates increased in the 3 years prior to IDM implementation. With implementation, there was an immediate decrease (month 1) in COPD-related hospitalisation and ED visit rates of -4.6 (95% CI: -7.76 to -1.39) and -6.2 (95% CI: -11.88, -0.48) per 1000 participants per month, respectively, compared with the counterfactual control group. After 12 months, COPD-related hospitalisation rates decreased: -9.1 events per 1000 participants per month (95% CI: -12.72, -5.44) and ED visits -19.0 (95% CI: -25.50, -12.46). This difference nearly doubled by 36 months. All-cause HSU also demonstrated rate reductions at 12 months, hospitalisation was -10.2 events per 1000 participants per month (95% CI: -15.79, -4.44) and ED visits were -30.4 (95% CI: -41.95, -18.78). CONCLUSIONS Implementation of COPD IDM in a primary care setting was associated with a changed trajectory of COPD-related and all-cause HSU from an increasing year-on-year trend to sustained long-term reductions. This highlights a substantial real-world opportunity that may improve health system performance and patient outcomes.
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Affiliation(s)
- Christopher Licskai
- Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
- Lawson Health Research Institute, London, Ontario, Canada
- Asthma Research Group Windsor-Essex County Inc, Windsor, Ontario, Canada
| | - Anna Hussey
- Asthma Research Group Windsor-Essex County Inc, Windsor, Ontario, Canada
| | - Véronique Rowley
- Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Madonna Ferrone
- Asthma Research Group Windsor-Essex County Inc, Windsor, Ontario, Canada
- Hôtel-Dieu Grace Healthcare, Windsor, Ontario, Canada
| | - Zihang Lu
- Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Kimball Zhang
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Emilie Terebessy
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Andrew Scarffe
- Telfer School of Management, University of Ottawa, Ottawa, Ontario, Canada
| | - Shannon Sibbald
- Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Cathy Faulds
- Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
- Asthma Research Group Windsor-Essex County Inc, Windsor, Ontario, Canada
| | - Tim O'Callahan
- Asthma Research Group Windsor-Essex County Inc, Windsor, Ontario, Canada
- Amherstburg Family Health Team, Amherstburg, Ontario, Canada
| | - Teresa To
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
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Santus P, Signorello JC, Danzo F, Lazzaroni G, Saad M, Radovanovic D. Anti-Inflammatory and Anti-Oxidant Properties of N-Acetylcysteine: A Fresh Perspective. J Clin Med 2024; 13:4127. [PMID: 39064168 PMCID: PMC11278452 DOI: 10.3390/jcm13144127] [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: 05/30/2024] [Revised: 07/11/2024] [Accepted: 07/12/2024] [Indexed: 07/28/2024] Open
Abstract
N-acetyl-L-cysteine (NAC) was initially introduced as a treatment for mucus reduction and widely used for chronic respiratory conditions associated with mucus overproduction. However, the mechanism of action for NAC extends beyond its mucolytic activity and is complex and multifaceted. Contrary to other mucoactive drugs, NAC has been found to exhibit antioxidant, anti-infective, and anti-inflammatory activity in pre-clinical and clinical reports. These properties have sparked interest in its potential for treating chronic lung diseases, including chronic obstructive pulmonary disease (COPD), bronchiectasis (BE), cystic fibrosis (CF), and idiopathic pulmonary fibrosis (IPF), which are associated with oxidative stress, increased levels of glutathione and inflammation. NAC's anti-inflammatory activity is noteworthy, and it is not solely secondary to its antioxidant capabilities. In ex vivo models of COPD exacerbation, the anti-inflammatory effects have been observed even at very low doses, especially with prolonged treatment. The mechanism involves the inhibition of the activation of NF-kB and neurokinin A production, resulting in a reduction in interleukin-6 production, a cytokine abundantly present in the sputum and breath condensate of patients with COPD and correlates with the number of exacerbations. The unique combination of mucolytic, antioxidant, anti-infective, and anti-inflammatory properties positions NAC as a safe, cost-effective, and efficacious therapy for a plethora of respiratory conditions.
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Affiliation(s)
- Pierachille Santus
- Division of Respiratory Diseases, “L. Sacco” University Hospital, Università degli Studi di Milano, 20122 Milano, Italy; (J.C.S.); (F.D.); (G.L.); (D.R.)
| | - Juan Camilo Signorello
- Division of Respiratory Diseases, “L. Sacco” University Hospital, Università degli Studi di Milano, 20122 Milano, Italy; (J.C.S.); (F.D.); (G.L.); (D.R.)
| | - Fiammetta Danzo
- Division of Respiratory Diseases, “L. Sacco” University Hospital, Università degli Studi di Milano, 20122 Milano, Italy; (J.C.S.); (F.D.); (G.L.); (D.R.)
| | - Giada Lazzaroni
- Division of Respiratory Diseases, “L. Sacco” University Hospital, Università degli Studi di Milano, 20122 Milano, Italy; (J.C.S.); (F.D.); (G.L.); (D.R.)
| | - Marina Saad
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, 20122 Milano, Italy;
| | - Dejan Radovanovic
- Division of Respiratory Diseases, “L. Sacco” University Hospital, Università degli Studi di Milano, 20122 Milano, Italy; (J.C.S.); (F.D.); (G.L.); (D.R.)
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, 20122 Milano, Italy;
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Wang N, Li M, Wang G, Lv L, Yu X, Cheng X, Liu T, Ji W, Hu T, Shi Z. Development and validation of a nomogram for assessing survival in acute exacerbation of chronic obstructive pulmonary disease patients. BMC Pulm Med 2024; 24:287. [PMID: 38898420 PMCID: PMC11186077 DOI: 10.1186/s12890-024-03091-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 06/07/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND Early prediction of survival of hospitalized acute exacerbations of chronic obstructive pulmonary disease (AECOPD) patients is vital. We aimed to establish a nomogram to predict the survival probability of AECOPD patients. METHODS Retrospectively collected data of 4601 patients hospitalized for AECOPD. These patients were randomly divided into a training and a validation cohort at a 6:4 ratio. In the training cohort, LASSO-Cox regression analysis and multivariate Cox regression analysis were utilized to identify prognostic factors for in-hospital survival of AECOPD patients. A model was established based on 3 variables and visualized by nomogram. The performance of the model was assesed by AUC, C-index, calibration curve, decision curve analysis in both cohorts. RESULTS Coexisting arrhythmia, invasive mechanical ventilation (IMV) usage and lower serum albumin values were found to be significantly associated with lower survival probability of AECOPD patients, and these 3 predictors were further used to establish a prediction nomogram. The C-indexes of the nomogram were 0.816 in the training cohort and 0.814 in the validation cohort. The AUC in the training cohort was 0.825 for 7-day, 0.807 for 14-day and 0.825 for 21-day survival probability, in the validation cohort this were 0.796 for 7-day, 0.831 for 14-day and 0.841 for 21-day. The calibration of the nomogram showed a good goodness-of-fit and decision curve analysis showed the net clinical benefits achievable at different risk thresholds were excellent. CONCLUSION We established a nomogram based on 3 variables for predicting the survival probability of AECOPD patients. The nomogram showed good performance and was clinically useful.
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Affiliation(s)
- Na Wang
- Department of Respiratory and Critical Care Medicine, First Affiliated Hospital of Xi'an Jiaotong University, No.277 Yanta Road, Yanta District, Xi'an, Shaanxi, 710061, China
| | - Mengcong Li
- Department of Respiratory and Critical Care Medicine, First Affiliated Hospital of Xi'an Jiaotong University, No.277 Yanta Road, Yanta District, Xi'an, Shaanxi, 710061, China
| | - Guangdong Wang
- Department of Respiratory and Critical Care Medicine, First Affiliated Hospital of Xi'an Jiaotong University, No.277 Yanta Road, Yanta District, Xi'an, Shaanxi, 710061, China
| | - Lin Lv
- Department of Respiratory and Critical Care Medicine, First Affiliated Hospital of Xi'an Jiaotong University, No.277 Yanta Road, Yanta District, Xi'an, Shaanxi, 710061, China
| | - Xiaohui Yu
- Department of Respiratory and Critical Care Medicine, First Affiliated Hospital of Xi'an Jiaotong University, No.277 Yanta Road, Yanta District, Xi'an, Shaanxi, 710061, China
| | - Xue Cheng
- Department of Respiratory and Critical Care Medicine, First Affiliated Hospital of Xi'an Jiaotong University, No.277 Yanta Road, Yanta District, Xi'an, Shaanxi, 710061, China
| | - Tingting Liu
- Department of Respiratory and Critical Care Medicine, First Affiliated Hospital of Xi'an Jiaotong University, No.277 Yanta Road, Yanta District, Xi'an, Shaanxi, 710061, China
| | - Wenwen Ji
- Department of Respiratory and Critical Care Medicine, First Affiliated Hospital of Xi'an Jiaotong University, No.277 Yanta Road, Yanta District, Xi'an, Shaanxi, 710061, China
| | - Tinghua Hu
- Department of Respiratory and Critical Care Medicine, First Affiliated Hospital of Xi'an Jiaotong University, No.277 Yanta Road, Yanta District, Xi'an, Shaanxi, 710061, China
| | - Zhihong Shi
- Department of Respiratory and Critical Care Medicine, First Affiliated Hospital of Xi'an Jiaotong University, No.277 Yanta Road, Yanta District, Xi'an, Shaanxi, 710061, China.
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Gabriel AS, Finkelstein J. Assessing the Barriers and Facilitators to Pulmonary Rehabilitation Referrals Using the Consolidated Framework for Implementation Research (CFIR). AMIA JOINT SUMMITS ON TRANSLATIONAL SCIENCE PROCEEDINGS. AMIA JOINT SUMMITS ON TRANSLATIONAL SCIENCE 2024; 2024:172-181. [PMID: 38827066 PMCID: PMC11141829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/04/2024]
Abstract
Chronic obstructive pulmonary disease (COPD) is a global health issue causing significant illness and death. Pulmonary Rehabilitation (PR) offers non-pharmacological treatment, including education, exercise, and psychological support which was shown to improve clinical outcomes. In both stable COPD and after an acute exacerbation, PR has been demonstrated to increase exercise capacity, decrease dyspnea, and enhance quality of life. Despite these benefits, referrals for PR for COPD treatment remain low. This study aims to evaluate the perceptions of healthcare providers for referring a COPD patient to PR. Semi-structured qualitative interviews were conducted with pulmonary specialists, hospitalists, and emergency department physicians. Domains and constructs from the Consolidated Framework for Implementation Research (CFIR) were applied to the qualitative data to organize, analyze, and identify the barriers and facilitators to referring COPD patients. The findings from this study will help guide strategies to improve the referral process for PR.
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Affiliation(s)
- Aileen S Gabriel
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, USA
| | - Joseph Finkelstein
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, USA
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Athanazio RA, Bernal Villada L, Avdeev SN, Wang HC, Ramírez-Venegas A, Sivori M, Dreyse J, Pacheco M, Man SK, Noriega-Aguirre L, Farouk H. Rate of severe exacerbations, healthcare resource utilisation and clinical outcomes in patients with COPD in low-income and middle-income countries: results from the EXACOS International Study. BMJ Open Respir Res 2024; 11:e002101. [PMID: 38637115 PMCID: PMC11029392 DOI: 10.1136/bmjresp-2023-002101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 02/16/2024] [Indexed: 04/20/2024] Open
Abstract
INTRODUCTION The EXAcerbations of Chronic obstructive lung disease (COPD) and their OutcomeS (EXACOS) International Study aimed to quantify the rate of severe exacerbations and examine healthcare resource utilisation (HCRU) and clinical outcomes in patients with COPD from low-income and middle-income countries. METHODS EXACOS International was an observational, cross-sectional study with retrospective data collection from medical records for a period of up to 5 years. Data were collected from 12 countries: Argentina, Brazil, Chile, Colombia, Costa Rica, Dominican Republic, Guatemala, Hong Kong, Mexico, Panama, Russia and Taiwan. The study population comprised patients ≥40 years of age with COPD. Outcomes/variables included the prevalence of severe exacerbations, the annual rate of severe exacerbations and time between severe exacerbations; change in lung function over time (measured by the forced expiratory volume in 1 s (FEV1)); peripheral blood eosinophil counts (BECs) and the prevalence of comorbidities; treatment patterns; and HCRU. RESULTS In total, 1702 patients were included in the study. The study population had a mean age of 69.7 years, with 69.4% males, and a mean body mass index of 26.4 kg/m2. The mean annual prevalence of severe exacerbations was 20.1%, and 48.4% of patients experienced ≥1 severe exacerbation during the 5-year study period. As the number of severe exacerbations increased, the interval between successive exacerbations decreased. A statistically significant decrease in mean (SD) FEV1 from baseline to post-baseline was observed in patients with ≥1 severe exacerbation (1.23 (0.51) to 1.13 (0.52) L; p=0.0000). Mean BEC was 0.198 x109 cells/L, with 64.7% of patients having a BEC ≥0.1 x109 cells/L and 21.3% having a BEC ≥0.3 x109 cells/L. The most common comorbidity was hypertension (58.3%). An increasing number of severe exacerbations per year was associated with greater HCRU. DISCUSSION The findings presented here indicate that effective treatment strategies to prevent severe exacerbations in patients with COPD remain a significant unmet need in low-income and middle-income countries.
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Affiliation(s)
- Rodrigo Abensur Athanazio
- Pulmonology Division, Heart Institute-InCor-Clinical Hospital, Faculty of Medicine, Universidade de São Paulo, São Paulo, Brazil
| | | | - Sergey N Avdeev
- Department of Pulmonology, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
| | - Hao-Chien Wang
- Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Alejandra Ramírez-Venegas
- Tobacco Smoking and COPD Research Department, Instituto Nacional de Enfermedades Respiratorias Ismael Cosio Villegas, Mexico City, Mexico
| | - Martín Sivori
- Pneumology Unit, Dr J M Ramos Mejía Pulmonology University Center, Faculty of Medicine, University of Buenos Aires, Buenos Aires, Argentina
| | - Jorge Dreyse
- Department of Internal Medicine and Critical Care Center, Clínica Las Condes and School of Medicine Universidad Finis Terrae, Santiago, Chile
| | - Manuel Pacheco
- Internal Medicine Research Group, Universidad Tecnológica de Pereira, Pereira, Colombia
- Fundación Universitaria Visión de las Américas y Respiremos Unidad de Neumología, Pereira, Colombia
| | - Sin Kit Man
- Department of Medicine and Geriatrics, Department of Medicine and Geriatrics, Tuen Mun Hospital, Hong Kong Special Administrative Region (HKSAR), Tuen Mun, People's Republic of China
| | - Lorena Noriega-Aguirre
- Center for Diagnosis and Treatment of Respiratory Diseases (CEDITER), Panama City, Panama
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Zhang J, Yi Q, Zhou C, Luo Y, Wei H, Ge H, Liu H, Zhang J, Li X, Xie X, Pan P, Yi M, Cheng L, Zhou H, Liu L, Aili A, Liu Y, Peng L, Pu J, Zhou H. A simple clinical risk score (ABCDMP) for predicting mortality in patients with AECOPD and cardiovascular diseases. Respir Res 2024; 25:89. [PMID: 38341529 PMCID: PMC10858518 DOI: 10.1186/s12931-024-02704-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 01/24/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND The morbidity and mortality among hospital inpatients with AECOPD and CVDs remains unacceptably high. Currently, no risk score for predicting mortality has been specifically developed in patients with AECOPD and CVDs. We therefore aimed to derive and validate a simple clinical risk score to assess individuals' risk of poor prognosis. STUDY DESIGN AND METHODS We evaluated inpatients with AECOPD and CVDs in a prospective, noninterventional, multicenter cohort study. We used multivariable logistic regression analysis to identify the independent prognostic risk factors and created a risk score model according to patients' data from a derivation cohort. Discrimination was evaluated by the area under the receiver-operating characteristic curve (AUC), and calibration was assessed by the Hosmer-Lemeshow goodness-of-fit test. The model was validated and compared with the BAP-65, CURB-65, DECAF and NIVO models in a validation cohort. RESULTS We derived a combined risk score, the ABCDMP score, that included the following variables: age > 75 years, BUN > 7 mmol/L, consolidation, diastolic blood pressure ≤ 60 mmHg, mental status altered, and pulse > 109 beats/min. Discrimination (AUC 0.847, 95% CI, 0.805-0.890) and calibration (Hosmer‒Lemeshow statistic, P = 0.142) were good in the derivation cohort and similar in the validation cohort (AUC 0.811, 95% CI, 0.755-0.868). The ABCDMP score had significantly better predictivity for in-hospital mortality than the BAP-65, CURB-65, DECAF, and NIVO scores (all P < 0.001). Additionally, the new score also had moderate predictive performance for 3-year mortality and can be used to stratify patients into different management groups. CONCLUSIONS The ABCDMP risk score could help predict mortality in AECOPD and CVDs patients and guide further clinical research on risk-based treatment. CLINICAL TRIAL REGISTRATION Chinese Clinical Trail Registry NO.:ChiCTR2100044625; URL: http://www.chictr.org.cn/showproj.aspx?proj=121626 .
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Affiliation(s)
- Jiarui Zhang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Guo-xue-xiang 37#, Wuhou District, Chengdu, 610041, Sichuan Province, China
| | - Qun Yi
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Guo-xue-xiang 37#, Wuhou District, Chengdu, 610041, Sichuan Province, China
- Sichuan Cancer Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan Province, China
| | - Chen Zhou
- West China School of Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Yuanming Luo
- State Key Laboratory of Respiratory Disease, Guangzhou Medical University, Guangzhou, Guangdong Province, China
| | - Hailong Wei
- Department of Respiratory and Critical Care Medicine, People's Hospital of Leshan, Leshan, Sichuan Province, China
| | - Huiqing Ge
- Department of Respiratory and Critical Care Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Huiguo Liu
- Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Jianchu Zhang
- Department of Respiratory and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Xianhua Li
- Department of Respiratory and Critical Care Medicine, the First People's Hospital of Neijiang City, Neijiang, Sichuan Province, China
| | - Xiufang Xie
- Department of Respiratory and Critical Care Medicine, the First People's Hospital of Neijiang City, Neijiang, Sichuan Province, China
| | - Pinhua Pan
- Department of Respiratory and Critical Care Medicine, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Mengqiu Yi
- Department of Emergency, First People's Hospital of Jiujiang, Jiu jiang, Jiangxi Province, China
| | - Lina Cheng
- Department of Emergency, First People's Hospital of Jiujiang, Jiu jiang, Jiangxi Province, China
| | - Hui Zhou
- Department of Respiratory and Critical Care Medicine, The Affiliated Hospital of Chengdu University, Chengdu, Sichuan Province, China
| | - Liang Liu
- Department of Respiratory and Critical Care Medicine, The Affiliated Hospital of Chengdu University, Chengdu, Sichuan Province, China
| | - Adila Aili
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Guo-xue-xiang 37#, Wuhou District, Chengdu, 610041, Sichuan Province, China
| | - Yu Liu
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Guo-xue-xiang 37#, Wuhou District, Chengdu, 610041, Sichuan Province, China
| | - Lige Peng
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Guo-xue-xiang 37#, Wuhou District, Chengdu, 610041, Sichuan Province, China
| | - Jiaqi Pu
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Guo-xue-xiang 37#, Wuhou District, Chengdu, 610041, Sichuan Province, China
| | - Haixia Zhou
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Guo-xue-xiang 37#, Wuhou District, Chengdu, 610041, Sichuan Province, China.
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Alghamdi SM. Content, Mechanism, and Outcome of Effective Telehealth Solutions for Management of Chronic Obstructive Pulmonary Diseases: A Narrative Review. Healthcare (Basel) 2023; 11:3164. [PMID: 38132054 PMCID: PMC10742533 DOI: 10.3390/healthcare11243164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 12/06/2023] [Accepted: 12/07/2023] [Indexed: 12/23/2023] Open
Abstract
Telehealth (TH) solutions for Chronic Obstructive Pulmonary Disease (COPD) are promising behavioral therapeutic interventions and can help individuals living with COPD to improve their health status. The linking content, mechanism, and outcome of TH interventions reported in the literature related to COPD care are unknown. This paper aims to summarize the existing literature about structured TH solutions in COPD care. We conducted an electronic search of the literature related to TH solutions for COPD management up to October 2023. Thirty papers presented TH solutions as an innovative treatment to manage COPD. TH and digital health solutions are used interchangeably in the literature, but both have the potential to improve care, accessibility, and quality of life. To date, current TH solutions in COPD care have a variety of content, mechanisms, and outcomes. TH solutions can enhance education as well as provide remote monitoring. The content of TH solutions can be summarized as symptom management, prompt physical activity, and psychological support. The mechanism of TH solutions is manipulated by factors such as content, mode of delivery, strategy, and intensity. The most common outcome measures with TH solutions were adherence to treatment, health status, and quality of life. Implementing effective TH with a COPD care bundle must consider important determinants such as patient's needs, familiarity with the technology, healthcare professional support, and data privacy. The development of effective TH solutions for COPD management also must consider patient engagement as a positive approach to optimizing implementation and effectiveness.
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Affiliation(s)
- Saeed Mardy Alghamdi
- Respiratory Care Program, Clinical Technology Department, Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah 21961, Saudi Arabia
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Pereira AM, Jácome C, Jacinto T, Amaral R, Pereira M, Sá-Sousa A, Couto M, Vieira-Marques P, Martinho D, Vieira A, Almeida A, Martins C, Marreiros G, Freitas A, Almeida R, Fonseca JA. Multidisciplinary Development and Initial Validation of a Clinical Knowledge Base on Chronic Respiratory Diseases for mHealth Decision Support Systems. J Med Internet Res 2023; 25:e45364. [PMID: 38090790 PMCID: PMC10753423 DOI: 10.2196/45364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 04/25/2023] [Accepted: 10/11/2023] [Indexed: 12/18/2023] Open
Abstract
Most mobile health (mHealth) decision support systems currently available for chronic obstructive respiratory diseases (CORDs) are not supported by clinical evidence or lack clinical validation. The development of the knowledge base that will feed the clinical decision support system is a crucial step that involves the collection and systematization of clinical knowledge from relevant scientific sources and its representation in a human-understandable and computer-interpretable way. This work describes the development and initial validation of a clinical knowledge base that can be integrated into mHealth decision support systems developed for patients with CORDs. A multidisciplinary team of health care professionals with clinical experience in respiratory diseases, together with data science and IT professionals, defined a new framework that can be used in other evidence-based systems. The knowledge base development began with a thorough review of the relevant scientific sources (eg, disease guidelines) to identify the recommendations to be implemented in the decision support system based on a consensus process. Recommendations were selected according to predefined inclusion criteria: (1) applicable to individuals with CORDs or to prevent CORDs, (2) directed toward patient self-management, (3) targeting adults, and (4) within the scope of the knowledge domains and subdomains defined. Then, the selected recommendations were prioritized according to (1) a harmonized level of evidence (reconciled from different sources); (2) the scope of the source document (international was preferred); (3) the entity that issued the source document; (4) the operability of the recommendation; and (5) health care professionals' perceptions of the relevance, potential impact, and reach of the recommendation. A total of 358 recommendations were selected. Next, the variables required to trigger those recommendations were defined (n=116) and operationalized into logical rules using Boolean logical operators (n=405). Finally, the knowledge base was implemented in an intelligent individualized coaching component and pretested with an asthma use case. Initial validation of the knowledge base was conducted internally using data from a population-based observational study of individuals with or without asthma or rhinitis. External validation of the appropriateness of the recommendations with the highest priority level was conducted independently by 4 physicians. In addition, a strategy for knowledge base updates, including an easy-to-use rules editor, was defined. Using this process, based on consensus and iterative improvement, we developed and conducted preliminary validation of a clinical knowledge base for CORDs that translates disease guidelines into personalized patient recommendations. The knowledge base can be used as part of mHealth decision support systems. This process could be replicated in other clinical areas.
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Affiliation(s)
- Ana Margarida Pereira
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal
- Allergy Unit, Instituto and Hospital CUF-Porto, Porto, Portugal
- PaCeIT - Patient Centered Innovation and Technologies, Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Cristina Jácome
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal
- CINTESIS@RISE, Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal
| | - Tiago Jacinto
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal
- Allergy Unit, Instituto and Hospital CUF-Porto, Porto, Portugal
- CINTESIS@RISE, Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Cardiovascular and Respiratory Sciences, Porto Health School, Polytechnic Institute of Porto, Porto, Portugal
| | - Rita Amaral
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal
- CINTESIS@RISE, Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Cardiovascular and Respiratory Sciences, Porto Health School, Polytechnic Institute of Porto, Porto, Portugal
- Department of Women's and Children's Health, Pediatric Research, Uppsala University, Uppsala, Sweden
| | - Mariana Pereira
- Allergy Unit, Instituto and Hospital CUF-Porto, Porto, Portugal
- PaCeIT - Patient Centered Innovation and Technologies, Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Porto, Portugal
- MEDIDA - Medicina, Educação, Investigação, Desenvolvimento e Avaliação, Porto, Portugal
| | - Ana Sá-Sousa
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal
- CINTESIS@RISE, Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal
| | - Mariana Couto
- Allergy Unit, Instituto and Hospital CUF-Porto, Porto, Portugal
- Allergy Center, CUF Descobertas Hospital, Lisboa, Portugal
| | - Pedro Vieira-Marques
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal
- CINTESIS@RISE, Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal
| | - Diogo Martinho
- Research Group on Intelligent Engineering and Computing for Advanced Innovation and Development, Institute of Engineering, Polytechnic of Porto, Porto, Portugal
| | - Ana Vieira
- Research Group on Intelligent Engineering and Computing for Advanced Innovation and Development, Institute of Engineering, Polytechnic of Porto, Porto, Portugal
| | - Ana Almeida
- Research Group on Intelligent Engineering and Computing for Advanced Innovation and Development, Institute of Engineering, Polytechnic of Porto, Porto, Portugal
| | - Constantino Martins
- Research Group on Intelligent Engineering and Computing for Advanced Innovation and Development, Institute of Engineering, Polytechnic of Porto, Porto, Portugal
| | - Goreti Marreiros
- Research Group on Intelligent Engineering and Computing for Advanced Innovation and Development, Institute of Engineering, Polytechnic of Porto, Porto, Portugal
| | - Alberto Freitas
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal
- CINTESIS@RISE, Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal
| | - Rute Almeida
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal
- CINTESIS@RISE, Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal
| | - João A Fonseca
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal
- Allergy Unit, Instituto and Hospital CUF-Porto, Porto, Portugal
- CINTESIS@RISE, Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal
- MEDIDA - Medicina, Educação, Investigação, Desenvolvimento e Avaliação, Porto, Portugal
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9
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Ahmadian S, Johnson KM, Ho JK, Sin DD, Lynd LD, Harrison M, Sadatsafavi M. A Cost-Effectiveness Analysis of Azithromycin for the Prevention of Acute Exacerbations of Chronic Obstructive Pulmonary Disease. Ann Am Thorac Soc 2023; 20:1735-1742. [PMID: 37703432 DOI: 10.1513/annalsats.202304-301oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 09/13/2023] [Indexed: 09/15/2023] Open
Abstract
Rationale: Daily oral azithromycin therapy can reduce the risk of acute exacerbations of chronic obstructive pulmonary disease (COPD). However, given its adverse events and additional costs, it is not known whether adding long-term azithromycin as an adjunct therapy to inhaled pharmacotherapy is cost effective. Objectives: The objective of this study was to evaluate the cost-effectiveness of add-on azithromycin therapy in COPD as recommended by contemporary COPD management guidelines. Methods: We extended a previously validated Canadian COPD policy model to include azithromycin-related inputs and outcomes. The cost-effectiveness of azithromycin was evaluated over a 20-year time horizon in patients who continue to exacerbate despite receiving maximal inhaled therapies. The benefit of azithromycin was modeled as a reduction in exacerbation rates. Adverse events included cardiovascular death, hearing loss, gastrointestinal symptoms, and antimicrobial resistance. The incremental cost-effectiveness ratio (ICER) was calculated with costs in 2020 Canadian dollars ($) and quality-adjusted life-years (QALYs) discounted at 1.5% per year. The analysis was stratified among patient subgroups based on exacerbation histories. Results: In patients with a positive exacerbation history (one or more events in the previous 12 mo), azithromycin was associated with $49,732 costs, 7.65 QALYs, and 10.95 exacerbations per patient over 20 years. The corresponding values were $48,436, 7.62, and 11.86 for the reference group, resulting in an ICER of $43,200 per QALY gained. In patients defined as frequent exacerbators (two or more moderate or one or more severe events in the past 12 mo), the ICER was reduced to $8,862 per QALY gained. In patients with no history of exacerbation, azithromycin had lower QALYs and higher costs than the reference group. Conclusions: Add-on azithromycin is cost effective in patients with a recent history of exacerbations at commonly accepted willingness-to-pay thresholds of $50,000-$100,000/QALY. Guidelines should consider recommending add-on azithromycin for patients who had at least one moderate or severe exacerbation in the past year, albeit more information about treatment efficacy would strengthen this recommendation.
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Affiliation(s)
- Safa Ahmadian
- Respiratory Evaluation Sciences Program and
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences
| | - Kate M Johnson
- Respiratory Evaluation Sciences Program and
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences
- Centre for Heart Lung Innovation, and
- Division of Respirology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; and
| | - Joseph Khoa Ho
- Respiratory Evaluation Sciences Program and
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences
| | - Don D Sin
- Centre for Heart Lung Innovation, and
- Division of Respirology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; and
| | - Larry D Lynd
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences
- Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Mark Harrison
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences
- Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Mohsen Sadatsafavi
- Respiratory Evaluation Sciences Program and
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences
- Centre for Heart Lung Innovation, and
- Division of Respirology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; and
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10
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Arshid S, Ullah SE, Imran J, Syed MA, Choradia A, Gousy N, Boparai S, Shoaib M, Shah BB, Netha A. The effectiveness of hyaluronic acid in reducing adverse effects associated with inhaled hypertonic saline therapy in patients with cystic fibrosis: A systematic review and meta-analysis. CANADIAN JOURNAL OF RESPIRATORY THERAPY : CJRT = REVUE CANADIENNE DE LA THERAPIE RESPIRATOIRE : RCTR 2023; 59:214-222. [PMID: 37927455 PMCID: PMC10621800 DOI: 10.29390/001c.89093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 10/20/2023] [Indexed: 11/07/2023]
Abstract
Background Inhaled hypertonic saline (HS) is an effective mucolytic agent in patients with cystic fibrosis (CF). However, adverse events can impair the clinical utility of hypertonic saline (HS) in this patient population. In this study, we aimed to investigate the effectiveness of hyaluronic acid (HA) in reducing these adverse events. Methods A literature search was conducted across three electronic databases (Medline, Cochrane Central, and EMBASE) from inception through February 2023. Randomized controlled trials (RCTs) assessing the impact of hyaluronic acid (HA) in reducing adverse events in patients taking hypertonic saline (HS) for CF were included in the analysis. Outcomes of interest included cough, throat irritation, unpleasant taste, and FEV1. Evaluations were reported as risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CI). The Cochrane Risk of Bias Tool (CRBT) was employed to assess the quality of RCTs. The New Castle Ottawa Scale was used to assess the quality of observational studies. Results From the 1960 articles retrieved from the initial search, five relevant studies (n=236 patients) were included in the final analysis. Compared with patients only on HS, patients with HS and HA were significantly less likely to experience cough (RR: 0.45; 95% CI, 0.28-0.72, p=0.001), throat irritation (RR: 0.43; 95% CI, 0.22-0.81, p= 0.009), and unpleasant smell (RR: 0.43; 95% CI, 0.23 - 0.80, p=0.09). In addition, patients with HS with HA had significantly less forced expiratory volume (FEV1) (MD: -2.97; 95% CI, -3.79-2.15, p=0.52) compared to patients only on HS. Discussion The addition of HA to HS was linked to a better tolerability profile. When HS was coupled with HA, there was a reduction in all side effects. This may permit tolerance of the medication in otherwise difficult patients, improve adherence to patients receiving frequent inhalations, and improve therapeutic outcomes. Conclusion The addition of HA is advantageous in CF patients who require continuous HS therapy and have previously shown poor tolerance to therapy.
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Affiliation(s)
| | | | | | | | | | - Nicole Gousy
- Department of MedicineAmerican University of Antigua
| | - Sukhman Boparai
- Department of MedicineAcharya Shri Chander College of Medical Sciences and Hospital
| | | | | | - Aadarsh Netha
- Department of MedicineMelmaruvathur Adhiparasakthi Institute of Medical Sciences and Research
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11
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Seng JJB, Gwee MFR, Yong MHA, Kwan YH, Thumboo J, Low LL. Role of Caregivers in Remote Management of Patients With Type 2 Diabetes Mellitus: Systematic Review of Literature. J Med Internet Res 2023; 25:e46988. [PMID: 37695663 PMCID: PMC10520771 DOI: 10.2196/46988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 04/24/2023] [Accepted: 07/31/2023] [Indexed: 09/12/2023] Open
Abstract
BACKGROUND With the growing use of remote monitoring technologies in the management of patients with type 2 diabetes mellitus (T2DM), caregivers are becoming important resources that can be tapped into to improve patient care. OBJECTIVE This review aims to summarize the role of caregivers in the remote monitoring of patients with T2DM. METHODS We performed a systematic review in MEDLINE, Embase, Scopus, PsycINFO, and Web of Science up to 2022. Studies that evaluated the role of caregivers in remote management of adult patients with T2DM were included. Outcomes such as diabetes control, adherence to medication, quality of life, frequency of home glucose monitoring, and health care use were evaluated. RESULTS Of the 1198 identified citations, 11 articles were included. The majority of studies were conducted in North America (7/11, 64%) and South America (2/11, 18%). The main types of caregivers studied were family or friends (10/11, 91%), while the most common remote monitoring modalities evaluated were interactive voice response (5/11, 45%) and phone consultations (4/11, 36%). With regard to diabetes control, 3 of 6 studies showed improvement in diabetes-related laboratory parameters. A total of 2 studies showed improvements in patients' medication adherence rates and frequency of home glucose monitoring. Studies that evaluated patients' quality of life showed mixed evidence. In 1 study, increased hospitalization rates were noted in the intervention group. CONCLUSIONS Caregivers may play a role in improving clinical outcomes among patients with T2DM under remote monitoring. Studies on mobile health technologies are lacking to understand their impact on Asian populations and long-term patient outcomes.
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Affiliation(s)
- Jun Jie Benjamin Seng
- MOH Holding Private Limited, Singapore, Singapore
- SingHealth Regional Health System PULSES Centre, Singapore Health Services, Singapore, Singapore
| | | | | | - Yu Heng Kwan
- MOH Holding Private Limited, Singapore, Singapore
- SingHealth Regional Health System PULSES Centre, Singapore Health Services, Singapore, Singapore
- Department of Pharmacy, National University of Singapore, Singapore, Singapore
- Program in Health Services and Systems Research, Singapore, Singapore
| | - Julian Thumboo
- SingHealth Regional Health System PULSES Centre, Singapore Health Services, Singapore, Singapore
- Program in Health Services and Systems Research, Singapore, Singapore
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore
| | - Lian Leng Low
- SingHealth Regional Health System PULSES Centre, Singapore Health Services, Singapore, Singapore
- Department of Family Medicine and Continuing Care, Singapore General Hospital, Singapore, Singapore
- Outram Community Hospital, SingHealth Community Hospitals, Singapore, Singapore
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12
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Zhang J, Qin Y, Zhou C, Luo Y, Wei H, Ge H, Liu HG, Zhang J, Li X, Pan P, Yi M, Cheng L, Liu L, Aili A, Peng L, Liu Y, Pu J, Yi Q, Zhou H. Elevated BUN Upon Admission as a Predictor of in-Hospital Mortality Among Patients with Acute Exacerbation of COPD: A Secondary Analysis of Multicenter Cohort Study. Int J Chron Obstruct Pulmon Dis 2023; 18:1445-1455. [PMID: 37465819 PMCID: PMC10351588 DOI: 10.2147/copd.s412106] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 07/09/2023] [Indexed: 07/20/2023] Open
Abstract
Background High blood urea nitrogen (BUN) is observed in a subset of patients with acute exacerbation of COPD (AECOPD) and may be linked to clinical outcome, but findings from previous studies have been inconsistent. Methods We performed a retrospective analysis of patients prospectively enrolled in the MAGNET AECOPD Registry study (ChiCTR2100044625). Receiver operating characteristic (ROC) was used to determine the level of BUN that discriminated survivors and non-survivors. Univariate and multivariate Cox proportional hazards regression analyses were performed to assess the impact of BUN on adverse outcomes. Results Overall, 13,431 consecutive inpatients with AECOPD were included in this study, of whom 173 died, with the mortality of 1.29%. The non-survivors had higher levels of BUN compared with the survivors [9.5 (6.8-15.3) vs 5.6 (4.3-7.5) mmol/L, P < 0.001]. ROC curve analysis showed that the optimal cutoff of BUN level was 7.30 mmol/L for in-hospital mortality (AUC: 0.782; 95% CI: 0.748-0.816; P < 0.001). After multivariate analysis, BUN level ≥7.3 mmol/L was an independent risk factor for in-hospital mortality (HR = 2.099; 95% CI: 1.378-3.197, P = 0.001), also for invasive mechanical ventilation (HR = 1.540; 95% CI: 1.199-1.977, P = 0.001) and intensive care unit admission (HR = 1.344; 95% CI: 1.117-1.617, P = 0.002). Other independent prognostic factors for in-hospital mortality including age, renal dysfunction, heart failure, diastolic blood pressure, pulse rate, PaCO2 and D-dimer. Conclusion BUN is an independent risk factor for in-hospital mortality in inpatients with AECOPD and may be used to identify serious (or severe) patients and guide the management of AECOPD. Clinical Trial Registration MAGNET AECOPD; Chinese Clinical Trail Registry NO.: ChiCTR2100044625; Registered March 2021, URL: http://www.chictr.org.cn/showproj.aspx?proj=121626.
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Affiliation(s)
- Jiarui Zhang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People’s Republic of China
| | - Yichun Qin
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, People’s Republic of China
| | - Chen Zhou
- West China School of Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People’s Republic of China
| | - Yuanming Luo
- State Key Laboratory of Respiratory Disease, Guangzhou Medical University, Guangzhou, Guangdong Province, People’s Republic of China
| | - Hailong Wei
- Department of Respiratory and Critical Care Medicine, People’s Hospital of Leshan, Leshan, Sichuan Province, People’s Republic of China
| | - Huiqing Ge
- Department of Respiratory and Critical Care Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, People’s Republic of China
| | - Hui-Guo Liu
- Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, People’s Republic of China
| | - Jianchu Zhang
- Department of Respiratory and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, People’s Republic of China
| | - Xianhua Li
- Department of Respiratory and Critical Care Medicine, The First People’s Hospital of Neijiang City, Neijiang, Sichuan Province, People’s Republic of China
| | - Pinhua Pan
- Department of Respiratory and Critical Care Medicine, Xiangya Hospital, Central South University, Changsha, Hunan Province, People’s Republic of China
| | - Mengqiu Yi
- Department of Emergency, First People’s Hospital of Jiujiang, Jiujiang, Jiangxi Province, People’s Republic of China
| | - Lina Cheng
- Department of Emergency, First People’s Hospital of Jiujiang, Jiujiang, Jiangxi Province, People’s Republic of China
| | - Liang Liu
- Department of Respiratory and Critical Care Medicine, The Affiliated Hospital of Chengdu University, Chengdu, Sichuan Province, People’s Republic of China
| | - Adila Aili
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People’s Republic of China
| | - Lige Peng
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People’s Republic of China
| | - Yu Liu
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People’s Republic of China
| | - Jiaqi Pu
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People’s Republic of China
| | - Qun Yi
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People’s Republic of China
- Sichuan Cancer Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan Province, People’s Republic of China
| | - Haixia Zhou
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People’s Republic of China
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13
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Kotejoshyer R, Eve J, Priya A, Mazor K, Spitzer KA, Pekow PS, Pack QR, Lindenauer PK. Strategies to Improve Enrollment and Participation in Pulmonary Rehabilitation Following a Hospitalization for COPD: RESULTS OF A NATIONAL SURVEY. J Cardiopulm Rehabil Prev 2023; 43:192-197. [PMID: 36137210 PMCID: PMC10148891 DOI: 10.1097/hcr.0000000000000735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Pulmonary rehabilitation (PR) improves outcomes for patients with chronic obstructive pulmonary disease (COPD); however, very few patients attend. We sought to describe strategies used to promote participation in PR after a hospitalization for COPD. METHODS A random sample of 323 United States based PR programs was surveyed. Using a positive deviance approach, a 39-item survey was developed based on interviews with clinicians at hospitals demonstrating high rates of participation in PR. Items focused on strategies used to promote participation as well as relevant contextual factors. RESULTS Responses were received from 209 programs (65%), of which 88% (n = 184) were hospital-based outpatient facilities. Most (91%, n = 190) programs described enrolling patients continuously, and 80% (n = 167) reported a wait time from referral to the initial PR visit of <4 wk. Organization-level strategies to increase referral to PR included active surveillance (48%, n = 100) and COPD-focused staff (49%, n = 102). Provider-level strategies included clinician education (45%, n = 94), provider outreach (43%, n = 89), order sets (45%, n = 93), and automated referrals (23%, n = 48). Patient-level strategies included bedside education (53%, n = 111), flyers (49%, n = 103), motivational interviewing (33%, n = 69), financial counseling (64%, n = 134), and transportation assistance (35%, n = 73). Fewer than one-quarter (18%, n = 38) of PR programs reported using both bedside education and automatic referral, and 42% (n = 88) programs did not use either strategy. CONCLUSIONS This study describes current practices in the United States, and highlights opportunities for improvement at the organization, provider, and patient level. Future research needs to demonstrate the effectiveness of these strategies, alone or in combination.
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Affiliation(s)
- Rajashree Kotejoshyer
- Department of Healthcare Delivery and Population Sciences, University of Massachusetts Chan Medical School-Baystate, Springfield (Drs Kotejoshyer, Eve, Spitzer, Pekow, Pack, and Lindenauer and Ms Priya); University of Massachusetts Chan Medical School, Worcester (Dr Mazor); and UMass Donahue Institute, Amherst, Massachusetts (Dr Spitzer)
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14
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Guecamburu M, Coquelin A, Rapin A, Le Guen N, Solomiac A, Henrot P, Erbault M, Morin S, Zysman M. Pulmonary rehabilitation after severe exacerbation of COPD: a nationwide population study. Respir Res 2023; 24:102. [PMID: 37029390 PMCID: PMC10082500 DOI: 10.1186/s12931-023-02393-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 03/09/2023] [Indexed: 04/09/2023] Open
Abstract
BACKGROUND Acute exacerbations of chronic obstructive pulmonary disease (COPD) lead to a significant reduction in quality of life and an increased mortality risk. Current guidelines strongly recommend pulmonary rehabilitation (PR) after a severe exacerbation. Studies reporting referral for PR are scarce, with no report to date in Europe. Therefore, we assessed the proportion of French patients receiving PR after hospitalization for COPD exacerbation and factors associated with referral. METHODS This was a national retrospective study based on the French health insurance database. Patients hospitalized in 2017 with COPD exacerbation were identified from the exhaustive French medico-administrative database of hospitalizations. In France, referral to PR has required as a stay in a specialized PR center or unit accredited to provide multidisciplinary care (exercise training, education, etc.) and admission within 90 days after discharge was assessed. Multivariate logistic regression was used to assess the association between patients' characteristics, comorbidities according to the Charlson index, treatment, and PR uptake. RESULTS Among 48,638 patients aged ≥ 40 years admitted for a COPD exacerbation, 4,182 (8.6%) received PR within 90 days after discharge. General practitioner's (GP) density (number of GPs for the population at regional level) and PR center facilities (number of beds for the population at regional level) were significantly correlated with PR uptake (respectively r = 0.64 and r = 0.71). In multivariate analysis, variables independently associated with PR uptake were female gender (aOR 1.36 [1.28-1.45], p < 0.0001), age (p < 0.0001), comorbidities (p = 0.0013), use of non-invasive ventilation and/or oxygen therapy (aOR 1.52 [1.41-1.64], p < 0.0001) and administration of long-acting bronchodilators (p = 0.0038). CONCLUSION This study using the French nationally exhaustive health insurance database shows that PR uptake after a severe COPD exacerbation is dramatically low and must become a high-priority management strategy.
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Affiliation(s)
- Marina Guecamburu
- Service des Maladies Respiratoires et des épreuves fonctionnelles respiratoires CHU Bordeaux, 33604, Pessac, France
| | - Anaëlle Coquelin
- Haute Autorité de la Santé, 93210, La Plaine Saint-Denis, France
| | - Amandine Rapin
- Département de Médecine Physique et de Réadaptation, Centre Hospitalo-Universitaire de Reims, CHU Reims, Hôpital Sébastopol, 51092, Reims, France
- Faculté de Médecine, Université de Reims Champagne-Ardenne, VieFra, EA3797, 51097, Reims, France
| | - Nelly Le Guen
- Haute Autorité de la Santé, 93210, La Plaine Saint-Denis, France
| | - Agnès Solomiac
- Haute Autorité de la Santé, 93210, La Plaine Saint-Denis, France
| | - Pauline Henrot
- Service des Maladies Respiratoires et des épreuves fonctionnelles respiratoires CHU Bordeaux, 33604, Pessac, France
- Faculté de Médecine, Université de Reims Champagne-Ardenne, VieFra, EA3797, 51097, Reims, France
| | - Marie Erbault
- Haute Autorité de la Santé, 93210, La Plaine Saint-Denis, France
| | - Sandrine Morin
- Haute Autorité de la Santé, 93210, La Plaine Saint-Denis, France
| | - Maéva Zysman
- Service des Maladies Respiratoires et des épreuves fonctionnelles respiratoires CHU Bordeaux, 33604, Pessac, France.
- Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, CIC 1401, Univ-Bordeaux, 33604, Pessac, France.
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15
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Hamadi HY, Martinez D, Xu J, Silvera GA, Mallea JM, Hamadi W, Li X, Li Y, Zhao M. Effects of post-discharge telemonitoring on 30-day chronic obstructive pulmonary disease readmissions and mortality. J Telemed Telecare 2023; 29:117-125. [PMID: 33176540 DOI: 10.1177/1357633x20970402] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Much attention has been focused on decreasing chronic obstructive pulmonary disease (COPD) hospital readmissions. The US health system has struggled to meet this goal. The objective of this study was to assess the efficacy of telehealth services on the reduction of hospital readmission and mortality rates for COPD. METHODS We used a cross-sectional design to examine the association between hospital risk-adjusted readmission and mortality rates for COPD and hospital use of post-discharge telemonitoring (TM). Data for 777 hospitals were sourced from the Centers for Medicare & Medicaid Services and the American Hospital Association annual surveys. Propensity score matching using the kennel weights method was applied to calculate the weighted probability of being a hospital that offers post-discharge TM services. RESULTS Hospitals with post-discharge TM had about 34% significantly higher odds (adjusted odds ratio (AOR) = 1.34; 95% confidence interval (CI) 1.06-1.70) of 30-day COPD readmission and 33% significantly lower odds (AOR = 0.67; 95% CI 0.50-0.90) of 30-day COPD mortality compared to hospitals without post-discharge TM services. DISCUSSION Overall, hospitals that offer post-discharge TM services have seen an improvement in 30-day COPD mortality rates. However, those same hospitals have also experienced a significant increase in 30-day COPD readmissions. TM can potentially decrease mortality in patients recently admitted for acute exacerbation of COPD. The results provide further evidence that readmissions present a problematic assessment of health-care quality, as the need for readmission may or may not be directly related to the quality of care received while in hospital.
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Affiliation(s)
- Hanadi Y Hamadi
- Department of Health Administration, Brooks College of Health, University of North Florida, USA
| | - Dayana Martinez
- Department of Health Administration, Brooks College of Health, University of North Florida, USA
| | - Jing Xu
- Department of Health Administration, Brooks College of Health, University of North Florida, USA
| | - Geoffrey A Silvera
- Health Administration, Department of Political Science, Auburn University, USA
| | - Jorge M Mallea
- Division of Pulmonary, Allergy and Sleep Medicine, Department of Medicine, Mayo Clinic, USA
| | - Walaa Hamadi
- Department of Internal Medicine, University of Utah, USA
| | - Xinmei Li
- Department of Health Administration, College of Public Health, Fujian Medical University, PR China
| | - Yueping Li
- Fujian Medical Reform and Development Research Centre, Fujian Medical University, PR China
| | - Mei Zhao
- Department of Health Administration, Brooks College of Health, University of North Florida, USA
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16
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Dysbiosis and leaky gut in hyper-inflated COPD patients: Have smoking and exercise training any role? Respir Med Res 2023; 83:100995. [PMID: 36822132 DOI: 10.1016/j.resmer.2023.100995] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 12/16/2022] [Accepted: 01/05/2023] [Indexed: 01/11/2023]
Abstract
BACKGROUND To characterize the leaky gut syndrome in a cohort of COPD patients with lung hyperinflation according to their clinical history (i.e. hyperinflation severity, chronic respiratory failure [CRF] presence, GOLD stage, prescribed therapy, smoking history) and with or without recent exercise training activity. METHODS At the ambulatory visit, we evaluated selected COPD patients with lung hyperinflation [residual volume (RV)≥110% pred, TLC≤120% pred)] in clinical stability, identifying them as those who have attended a recent program of exercise training and those who were waiting for it. Clinical and respiratory characteristics (forced expiratory volume at the first second, forced vital capacity, and arterial blood gasses) were collected. Microbiota composition (CFU/ml), and intestinal permeability (i.e., Zonulin ng/ml) were measured in the stool and normalized to the normality cutoff value. RESULTS All patients [n = 32, median age: 67 years, median RV: 185.0% pred (IQR: 162.0-206.0) and TLC 125.0% pred (IQR: 113.0-138.0)] showed depletion of Lactobacilli, Bacteroides and a great increase in E. Coli, KES (2 and 6.4 times) and Saccharomyces concentrations (2.5 times) other than normality. All evaluations on gut microbiota composition in the whole population were independent of BMI, CRF, GOLD stage or hyperinflation severity, and inhaled steroid therapy. Smoking habits (smokers vs ex-smokers) influenced only Bacteroides species (p<0.05) and no systemic inflammation was present in these patients. On the contrary, Zonulin concentration, a marker of intestinal permeability, was significantly higher than normal (2.8 times) and was correlated with Saccharomyces (p = 0.013). Zonulin (p = 0.001) and Saccharomyces (p<0.0001) were also significantly different in patients undergoing exercise training with respect to those on the waiting list for training. These findings were not influenced by smoking habits. CONCLUSIONS A marked dysbiosis and leaky gut alteration characterize all COPD hyper-inflated patients, being worse in patients waiting for exercise training. A pre-to-post study is necessary to confirm these preliminary findings.
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van der Braak K, Wald J, Tansey CM, Paes T, Sedeno M, Selzler AM, Stickland MK, Bourbeau J, Janaudis-Ferreira T. Implementation and maintenance of an enhanced pulmonary rehabilitation program in a single centre: An implementation study. Chron Respir Dis 2023; 20:14799731231179105. [PMID: 37471305 PMCID: PMC10363903 DOI: 10.1177/14799731231179105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND Pulmonary rehabilitation (PR) has major benefits for patients with chronic obstructive pulmonary disease (COPD). An enhanced PR program was developed with a self-management education intervention. The objective of our study was to evaluate the implementation of the enhanced PR program into a single centre. METHODS Pre-post implementation study consisted of two evaluation periods: immediately after implementation and 18 months later. Guided by the RE-AIM framework, outcomes included: Reach, Effectiveness, Adoption, Implementation and Maintenance. RESULTS Reach: 70-75% of referred patients agreed to a PR program (n = 26). Effectiveness: Clinically important improvements occurred in some patients in functional exercise capacity (64% of the patients achieved clinical important difference in 6-min walk test in the first evaluation period and 44% in the second evaluation period), knowledge, functional status, and self-efficacy in both evaluation periods. Adoption: All healthcare professionals (HCPs) involved in PR (n = 8) participated. Implementation: Fidelity for the group education sessions ranged from 76 to 95% (first evaluation) and from 82 to 88% (second evaluation). Maintenance: The program was sustained over 18 months with minor changes. Patients and HCPs were highly satisfied with the program. CONCLUSIONS The enhanced PR program was accepted by patients and HCPs and was implemented and maintained at a single expert center with good implementation fidelity.
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Affiliation(s)
- Kim van der Braak
- Physical Therapy Sciences, Program in Clinical Health Sciences, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
- Respiratory Epidemiology and Clinical Research Unit, Centre for Health Outcomes Research, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Joshua Wald
- McMaster University Medical Centre, Hamilton, ON, Canada
| | - Catherine M Tansey
- Respiratory Epidemiology and Clinical Research Unit, Centre for Health Outcomes Research, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Thais Paes
- Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, State University of Londrina, Londrina, Brazil
| | - Maria Sedeno
- Respiratory Epidemiology and Clinical Research Unit, Centre for Health Outcomes Research, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- RESPIPLUS, Mont-Royal, QC, Canada
- Respiratory Epidemiology and Clinical Research Unit (RECRU), Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Anne-Marie Selzler
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Michael K Stickland
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Jean Bourbeau
- Respiratory Epidemiology and Clinical Research Unit, Centre for Health Outcomes Research, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Respiratory Epidemiology and Clinical Research Unit (RECRU), Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Tania Janaudis-Ferreira
- Respiratory Epidemiology and Clinical Research Unit, Centre for Health Outcomes Research, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, State University of Londrina, Londrina, Brazil
- Respiratory Epidemiology and Clinical Research Unit (RECRU), Research Institute of the McGill University Health Centre, Montreal, QC, Canada
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18
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Polsky M, Moraveji N, Hendricks A, Teresi RK, Murray R, Maselli DJ. Use of Remote Cardiorespiratory Monitoring is Associated with a Reduction in Hospitalizations for Subjects with COPD. Int J Chron Obstruct Pulmon Dis 2023; 18:219-229. [PMID: 36895552 PMCID: PMC9990506 DOI: 10.2147/copd.s388049] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 02/02/2023] [Indexed: 03/06/2023] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) is prevalent and results in high healthcare resource utilization. The largest impact on health status and proportion of healthcare costs in COPD are related to hospitalizations for acute exacerbations. Accordingly, the Centers for Medicare & Medicaid Services have advocated for remote patient monitoring (RPM) to aid in chronic disease management. However, there has been a lack of evidence for the effectiveness of RPM in reducing the need for unplanned hospitalizations for patients with COPD. Methods This pre/post study was a retrospective analysis of unplanned hospitalizations in a cohort of COPD subjects started on RPM at a large, outpatient pulmonary practice. The study included all subjects with at least one unplanned, all-cause hospitalization or emergency room visit in the prior year, who had elected to enroll in an RPM service for assistance with clinical management. Additional inclusion criteria included being on RPM for at least 12 months and a patient of the practice for at least two years (12 months pre- and post-initiation of RPM). Results The study included 126 subjects. RPM was associated with a significantly lower rate of unplanned hospitalizations per patient per year (1.09 ± 0.07 versus 0.38 ± 0.06, P<0.001). Conclusion Unplanned, all-cause hospitalization rates were lower in subjects started on RPM for COPD when compared to their prior year. These results support the potential of RPM to improve the long-term management of COPD.
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Affiliation(s)
| | | | | | | | | | - Diego J Maselli
- Division of Pulmonary Diseases & Critical Care, UT Health, San Antonio, TX, USA
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19
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Stolz D, Mkorombindo T, Schumann DM, Agusti A, Ash SY, Bafadhel M, Bai C, Chalmers JD, Criner GJ, Dharmage SC, Franssen FME, Frey U, Han M, Hansel NN, Hawkins NM, Kalhan R, Konigshoff M, Ko FW, Parekh TM, Powell P, Rutten-van Mölken M, Simpson J, Sin DD, Song Y, Suki B, Troosters T, Washko GR, Welte T, Dransfield MT. Towards the elimination of chronic obstructive pulmonary disease: a Lancet Commission. Lancet 2022; 400:921-972. [PMID: 36075255 PMCID: PMC11260396 DOI: 10.1016/s0140-6736(22)01273-9] [Citation(s) in RCA: 189] [Impact Index Per Article: 94.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 05/23/2022] [Accepted: 06/28/2022] [Indexed: 10/14/2022]
Abstract
Despite substantial progress in reducing the global impact of many non-communicable diseases, including heart disease and cancer, morbidity and mortality due to chronic respiratory disease continues to increase. This increase is driven primarily by the growing burden of chronic obstructive pulmonary disease (COPD), and has occurred despite the identification of cigarette smoking as the major risk factor for the disease more than 50 years ago. Many factors have contributed to what must now be considered a public health emergency: failure to limit the sale and consumption of tobacco products, unchecked exposure to environmental pollutants across the life course, and the ageing of the global population (partly as a result of improved outcomes for other conditions). Additionally, despite the heterogeneity of COPD, diagnostic approaches have not changed in decades and rely almost exclusively on post-bronchodilator spirometry, which is insensitive for early pathological changes, underused, often misinterpreted, and not predictive of symptoms. Furthermore, guidelines recommend only simplistic disease classification strategies, resulting in the same therapeutic approach for patients with widely differing conditions that are almost certainly driven by variable pathophysiological mechanisms. And, compared with other diseases with similar or less morbidity and mortality, the investment of financial and intellectual resources from both the public and private sector to advance understanding of COPD, reduce exposure to known risks, and develop new therapeutics has been woefully inadequate.
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Affiliation(s)
- Daiana Stolz
- Clinic of Respiratory Medicine and Pulmonary Cell Research, University Hospital Basel, Basel, Switzerland; Department of Clinical Research, University Hospital Basel, Basel, Switzerland; Clinic of Respiratory Medicine and Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Takudzwa Mkorombindo
- Lung Health Center, Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Desiree M Schumann
- Clinic of Respiratory Medicine and Pulmonary Cell Research, University Hospital Basel, Basel, Switzerland
| | - Alvar Agusti
- Respiratory Institute-Hospital Clinic, University of Barcelona IDIBAPS, CIBERES, Barcelona, Spain
| | - Samuel Y Ash
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Mona Bafadhel
- School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK; Department of Respiratory Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Chunxue Bai
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - James D Chalmers
- Scottish Centre for Respiratory Research, University of Dundee, Dundee, UK
| | - Gerard J Criner
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| | - Shyamali C Dharmage
- Centre for Epidemiology and Biostatistics, School of Population and Global health, University of Melbourne, Melbourne, VIC, Australia
| | - Frits M E Franssen
- Department of Research and Education, CIRO, Horn, Netherlands; Department of Respiratory Medicine, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Urs Frey
- University Children's Hospital Basel, Basel, Switzerland
| | - MeiLan Han
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Nadia N Hansel
- Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Nathaniel M Hawkins
- Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, BC, Canada
| | - Ravi Kalhan
- Department of Preventive Medicine and Division of Pulmonary and Critical Care Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Melanie Konigshoff
- Division of Pulmonary, Allergy and Critical Care Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Fanny W Ko
- The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Trisha M Parekh
- Lung Health Center, Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Maureen Rutten-van Mölken
- Erasmus School of Health Policy & Management and Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Jodie Simpson
- Priority Research Centre for Healthy Lungs, Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW, Australia
| | - Don D Sin
- Centre for Heart Lung Innovation and Division of Respiratory Medicine, Department of Medicine, University of British Columbia, St Paul's Hospital, Vancouver, BC, Canada
| | - Yuanlin Song
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital and National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China; Shanghai Respiratory Research Institute, Shanghai, China; Jinshan Hospital of Fudan University, Shanghai, China
| | - Bela Suki
- Department of Biomedical Engineering, Boston University, Boston, MA, USA
| | - Thierry Troosters
- Department of Rehabilitation Sciences, Research Group for Rehabilitation in Internal Disorders, KU Leuven, Leuven, Belgium
| | - George R Washko
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Tobias Welte
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany; Biomedical Research in Endstage and Obstructive Lung Disease, German Center for Lung Research, Hannover, Germany
| | - Mark T Dransfield
- Lung Health Center, Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA; Birmingham VA Medical Center, Birmingham, AL, USA.
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20
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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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Bourbeau J, Marciniuk J. Non-Pharmacological Treatments of Asthma Chronic Obstructive Pulmonary Disease Overlap and Rehabilitation Programs. Immunol Allergy Clin North Am 2022; 42:e1-e12. [PMID: 37543394 DOI: 10.1016/j.iac.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/07/2023]
Abstract
Non-pharmacologic treatment is a vital, yet often under-utilized aspect of care for patients with ACO. As patients with ACO are often excluded from clinical trials, management decisions should be based on patient characteristic "phenotypes," such as dyspnea or exacerbation, and considering whether COPD or asthma is more pronounced in the individual patient. Self-management interventions in asthma and COPD have an overwhelming amount of supporting evidence and should be an integral part of ACO management. Additionally, pulmonary rehabilitation has widespread benefits in patients with COPD as well as asthma and should be offered in symptomatic patients with ACO. While the COVID-19 pandemic has highlighted some shortcomings, and introduced several challenges, to the delivery of PR world-wide, it has also presented the opportunity for the development and refinement of new models to deliver PR, such as telerehabilitation. While further research and development are necessary, telerehabilitation offers a promising alternative to reach patients, such as those with ACO, who would benefit from the programming. While future research is needed, we can make a more explicit and judicious use of current best evidence in making therapeutic decisions that includes non-pharmacological interventions in patients with ACO.
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Affiliation(s)
- Jean Bourbeau
- Respiratory Epidemiology and Clinical Research Unit, Research Institute of the McGill University Health Centre, 5252 De Maisonneuve, Room 3D.62, Montreal, Quebec, H4A 3S5, Canada.
| | - Jeff Marciniuk
- Respiratory Epidemiology and Clinical Research Unit, Research Institute of the McGill University Health Centre, 5252 De Maisonneuve, Room 3D.62, Montreal, Quebec, H4A 3S5, Canada
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22
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Atwood CE, Bhutani M, Ospina MB, Rowe BH, Leigh R, Deuchar L, Faris P, Michas M, Mrklas KJ, Graham J, Aceron R, Damant R, Green L, Hirani N, Longard K, Meyer V, Mitchell P, Tsai W, Walker B, Stickland MK. Optimizing COPD Acute Care Patient Outcomes Using a Standardized Transition Bundle and Care Coordinator. Chest 2022; 162:321-330. [DOI: 10.1016/j.chest.2022.03.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 03/09/2022] [Accepted: 03/22/2022] [Indexed: 10/18/2022] Open
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23
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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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Evaluation and Management of Asthma and Chronic Obstructive Pulmonary Disease Exacerbation in the Emergency Department. Emerg Med Clin North Am 2022; 40:539-563. [DOI: 10.1016/j.emc.2022.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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25
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Kermelly SB, Bourbeau J. eHealth in Self-Managing at a Distance Patients with COPD. Life (Basel) 2022; 12:life12060773. [PMID: 35743804 PMCID: PMC9225278 DOI: 10.3390/life12060773] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 05/16/2022] [Accepted: 05/18/2022] [Indexed: 11/21/2022] Open
Abstract
Worldwide, healthcare delivery for chronic diseases has been challenging due to the current SARS-COV-2 pandemic. The growing use of information and communication technologies via telehealth has gained popularity in all fields of medicine. In chronic respiratory diseases, self-management, defined as a structured but personalized multi-component intervention with the main goal of achieving healthy behavioral change, is an essential element of long-term care. Iterative interventions delivered by a well-trained health coach in order to empower and provide the patient with the tools and skills needed to adopt sustained healthy behaviors have proven to be effective in chronic obstructive pulmonary disease (COPD). Benefits have been shown to both improve patient quality of life and reduce acute exacerbation events and acute healthcare utilization. In COPD, the evidence so far has shown us that remote technologies such as telemonitoring or remote management may improve patient-reported outcomes and healthcare utilization. However, clear limitations are still present and questions remain unanswered. More and better designed studies are therefore necessary to define the place of eHealth in self-managing at a distance in patients with COPD.
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Affiliation(s)
- Sophie B. Kermelly
- Respiratory Division, Department of Medicine, Montreal Chest Institute of the McGill University Health Center, Montreal, QC H4A 3J1, Canada;
| | - Jean Bourbeau
- Respiratory Division, Department of Medicine, Montreal Chest Institute of the McGill University Health Center, Montreal, QC H4A 3J1, Canada;
- Respiratory Epidemiology and Clinical Research Unit (RECRU), Center of Outcome and Research Evaluation (CORE), Research Institute of the McGill University Health Centre, 5252 De Maisonneuve, Room 3D.62, Montreal, QC H4A 3S5, Canada
- Correspondence: ; Tel.: +1-514-934-1934 (ext. 32185)
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26
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Drwal KR, Hurst D, Wakefield BJ. Effectiveness of a Home-Based Pulmonary Rehabilitation Program in Veterans. Telemed J E Health 2022. [PMID: 35584256 DOI: 10.1089/tmj.2022.0050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: This study examined the effectiveness and safety of a home-based pulmonary rehabilitation (HBPR) program in Veterans. Methods: Patients were evaluated from five Veteran Affairs facilities that enrolled in the 12-week program. Pre- to postchanges were completed on clinical outcomes using paired t-tests and the Wilcoxon signed rank sum test. Descriptive statistics were used for patient demographics, emergency room visits, and hospitalizations. Results: Two hundred eighty-five patients with a mean age of 69.6 ± 8.3 years enrolled in the HBPR program from October 2018 to March 2020. There was a 62% (n = 176) completion rate of both pre- and post assessments. Significant improvements were detected after completion of the HBPR program in dyspnea (modified Medical Research Council: 3.1 ± 1.1 vs. 1.9 ± 1.1; p < 0.0001); exercise capacity (six-minute walk distance: 263.1 m ± 96.6 m vs. 311.0 m ± 103.6 m; p < 0.0001; Duke Activity Status Index: 13.8 ± 9.6 vs. 20.0 ± 12.7; p < 0.0001; self-reported steps per day: 1514.5 ± 1360.4 vs. 3033.8 ± 2716.2; p < 0.0001); depression (patient health questionnaire-9: 8.3 ± 5.7 vs. 6.4 ± 5.1); nutrition habits (rate your plate, heart: 45.3 ± 9.0 vs. 48.9 ± 9.2; p < 0.0001); multicomponent assessment tools (BODE Index: 5.1 ± 2.5 vs. 3.4 ± 2.4; p < 0.0001), GOLD ABCD Assessment: p < 0.0009); and quality of life (chronic obstructive pulmonary disease assessment test: 25.4 ± 7.7 vs. 18.7 ± 8.5; p < 0.0001). No adverse events were reported due to participation in HBPR. Conclusions: The HBPR program is a safe and effective model and provides an additional option to address the gap in pulmonary rehabilitation access and utilization in the Veterans Affairs.
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Affiliation(s)
- Kariann R Drwal
- VA Office of Rural Health (ORH), Veterans Rural Health Resource Center-Iowa City, Iowa City VA Healthcare System, Iowa City, Iowa, USA
- The Center for Access and Delivery Research and Evaluation (CADRE), Iowa City VA Healthcare System, Iowa City, Iowa, USA
| | - Delanie Hurst
- VA Office of Rural Health (ORH), Veterans Rural Health Resource Center-Iowa City, Iowa City VA Healthcare System, Iowa City, Iowa, USA
- The Center for Access and Delivery Research and Evaluation (CADRE), Iowa City VA Healthcare System, Iowa City, Iowa, USA
| | - Bonnie J Wakefield
- VA Office of Rural Health (ORH), Veterans Rural Health Resource Center-Iowa City, Iowa City VA Healthcare System, Iowa City, Iowa, USA
- The Center for Access and Delivery Research and Evaluation (CADRE), Iowa City VA Healthcare System, Iowa City, Iowa, USA
- Sinclair School of Nursing, University of Missouri, Columbia, Missouri, USA
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27
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Fox C, Pace W, Brandt E, Carter V, Chang KL, Edwards C, Evans A, Gaona G, Han MK, Kaplan A, Kent R, Kocks JWH, Kruszyk M, Chantal LL, LiVoti T, Mahle C, Make B, Ratigan A, Shaikh A, Skolnik N, Stanley B, Yawn BP, Price DB. Variation in Demographic and Clinical Characteristics of Patients with COPD Receiving Care in US Primary Care: Data from the Advancing the Patient EXperience (APEX) in COPD Registry. Pragmat Obs Res 2022; 13:17-31. [PMID: 35516162 PMCID: PMC9064065 DOI: 10.2147/por.s342736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 04/15/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Little is known about the variability in chronic obstructive pulmonary disease (COPD) management and how it may be affected by patient characteristics across different healthcare systems in the US. This study aims to describe demographic and clinical characteristics of people with COPD and compare management across five primary care medical groups in the US. Methods This is a retrospective observational registry study utilizing electronic health records stored in the Advancing the Patient Experience (APEX) COPD registry. The APEX registry contains data from five US healthcare organizations located in Texas, Ohio, Colorado, New York, and North Carolina. Data on demographic and clinical characteristics of primary care patients with COPD between December 2019 and January 2020 were extracted and compared. Results A total of 17,192 patients with COPD were included in analysis: Texas (n = 811), Ohio (n = 8722), Colorado (n = 472), New York (n = 1149) and North Carolina (n = 6038). The majority of patients at each location were female (>54%) and overweight/obese (>60%). Inter-location variabilities were noted in terms of age, race/ethnicity, exacerbation frequency, treatment pattern, and prevalence of comorbid conditions. Patients from the Colorado site experienced the lowest number of exacerbations per year while those from the New York site reported the highest number. Hypertension was the most common co-morbidity at 4 of 5 sites with the highest prevalence in New York. Depression was the most common co-morbidity in Ohio. Treatment patterns also varied by site; Colorado had the highest proportion of patients not on any treatment. ICS/LABA was the most commonly prescribed treatment except in Ohio, where ICS/LABA/LAMA was most common. Conclusions and Relevance Our data show heterogeneity in demographic, clinical, and treatment characteristics of patients diagnosed with COPD who are managed in primary care across different healthcare organizations in the US.
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Affiliation(s)
- Chester Fox
- DARTNet Institute, Aurora, CO, USA
- University at Buffalo, Buffalo, NY, USA
| | - Wilson Pace
- DARTNet Institute, Aurora, CO, USA
- University of Colorado, Denver, CO, USA
| | | | - Victoria Carter
- Optimum Patient Care, Cambridge, UK
- Observational and Pragmatic Research Institute, Singapore
| | - Ku-Lang Chang
- University of Florida College of Medicine, Gainesville, FL, USA
| | | | | | | | | | - Alan Kaplan
- Observational and Pragmatic Research Institute, Singapore
- Family Physician Airways Group of Canada, Stouffville, Ontario, Canada
- University of Toronto, Toronto, Canada
| | | | - Janwillem W H Kocks
- Observational and Pragmatic Research Institute, Singapore
- General Practitioners Research Institute, Groningen, the Netherlands
- Groningen Research Institute Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Department of Pulmonology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Maja Kruszyk
- Observational and Pragmatic Research Institute, Singapore
- Optimum Patient Care, Brisbane, Queensland, Australia
| | - Le Lievre Chantal
- Observational and Pragmatic Research Institute, Singapore
- Optimum Patient Care, Brisbane, Queensland, Australia
| | - Tessa LiVoti
- Optimum Patient Care, Cambridge, UK
- Observational and Pragmatic Research Institute, Singapore
| | | | - Barry Make
- Department of Medicine, NJH, Denver, CO, USA
| | | | | | - Neil Skolnik
- Abington Jefferson Health, Jenkintown, PA, USA
- University of Minnesota, Minneapolis, MN, USA
| | | | | | - David B Price
- Optimum Patient Care, Cambridge, UK
- Observational and Pragmatic Research Institute, Singapore
- Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
- Correspondence: David B Price, Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, AB25 2ZD, UK, Tel +65 3105 1489, Email
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Kim JH, Choi HG, Kwon MJ, Kim JH, Park JY, Hwang YI, Jang SH, Jung KS. The Influence of Prior Statin Use on the Prevalence and Exacerbation of Chronic Obstructive Pulmonary Disease in an Adult Population. Front Med (Lausanne) 2022; 9:842948. [PMID: 35402450 PMCID: PMC8987534 DOI: 10.3389/fmed.2022.842948] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 03/01/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundStatins have anti-inflammatory and antioxidant properties, and previous studies have reported the positive effects of statins on chronic obstructive pulmonary disease (COPD) outcomes. However, the effects of statins on the development and acute exacerbations of COPD remain unclear. Therefore, this study aimed to assess the relation between statin use and COPD occurrence in all participants and the link between statin use and COPD acute exacerbations in participants with COPD.MethodsThis case-control study comprised 26,875 COPD participants and 107,500 control participants who were 1:4 matched from the Korean National Health Insurance Service-Health Screening Cohort. Conditional logistic regression was used to evaluate the probability of COPD occurrence associated with previous statin use. In addition, unconditional logistic regression was employed to assess the risk of exacerbations related to statin use among COPD participants. These relations were estimated in subgroup analysis according to statin type (lipophilic vs. hydrophilic).ResultsThe association between previous statin use and the occurrence of COPD did not reach statistical significance in the overall population (adjusted odds ratio [aOR] = 0.96, 95% confidence interval [CI] = 0.93–1.00, P = 0.059). However, statin use decreased the probability of exacerbations in participants with COPD (aOR = 0.79, 95% CI = 0.74–0.85, P < 0.001). Lipophilic statins decreased the probability of exacerbations, whereas hydrophilic statins were not associated with a decreased likelihood of exacerbations (aOR = 0.78, 95% CI = 0.72–0.84, P < 0.001 for lipophilic statins; aOR = 0.89, 95% CI = 0.78–1.02, P = 0.102 for hydrophilic statins).DiscussionStatin use was not associated with the occurrence of COPD in the adult population. However, statin use was associated with a reduced probability of exacerbations in participants with COPD, with a greater risk reduction with lipophilic statin use.
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Affiliation(s)
- Joo-Hee Kim
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, South Korea
| | - Hyo Geun Choi
- Department of Otorhinolaryngology-Head & Neck Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, South Korea
- *Correspondence: Hyo Geun Cho, ;
| | - Mi Jung Kwon
- Department of Pathology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, South Korea
| | - Ji Hee Kim
- Department of Neurosurgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, South Korea
| | - Ji-Young Park
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, South Korea
| | - Yong Il Hwang
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, South Korea
| | - Seung Hun Jang
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, South Korea
| | - Ki-Suck Jung
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, South Korea
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Gelbman BD, Reed CR. An Integrated, Multimodal, Digital Health Solution for Chronic Obstructive Pulmonary Disease: Prospective Observational Pilot Study. JMIR Form Res 2022; 6:e34758. [PMID: 35142291 PMCID: PMC8972120 DOI: 10.2196/34758] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/17/2021] [Accepted: 02/09/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) affects millions of Americans and has a high economic impact partially due to frequent emergency room visits and hospitalizations. Advances in digital health have made it possible to collect data remotely from multiple devices to assist in managing chronic diseases such as COPD. OBJECTIVE In this pilot study, we evaluated the ability of patients with COPD to use the Wellinks mHealth platform to collect information from multiple modalities important to the management of COPD. We also assessed patient satisfaction and engagement with the platform. METHODS A single-site, observational, prospective pilot study (N=19) was conducted using the Wellinks platform in adults with COPD. All patients were aged over 30 years at screening, owned an iPhone, and were currently undergoing a treatment regimen that included nebulized therapy. Enrolled patients received a study kit consisting of the Flyp nebulizer, Smart One spirometer, the Nonin pulse oximeter, plus the Wellinks mHealth app, and training for all devices. For 8 weeks, participants were to enter daily symptoms and medication use manually; spirometry, nebulizer, and pulse oximeter data were automatically recorded. Data were sent to the attending physician in a monthly report. Patient satisfaction was measured via a 5-point scale and the Net Promoter Score (NPS) captured in interviews at the end of the observation period. RESULTS Average age of the patients was 79.6 (range 65-95) years. Participants (10 female; 9 male) had an average FEV1% (forced expiratory volume in 1 second as % of predicted for the patient) of 56.2% of predicted (range 23%-113%) and FEV1/forced vital capacity of 65%. COPD severity, as assessed by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification, was mild in 2 patients, moderate in 6, and severe/very severe in 11; 9 patients were on home oxygen. During this 8-week study, average use of the spirometer was 2.5 times/week, and the pulse oximeter 4.2 times/week. Medication use was manually documented 9.0 times/week, nebulizer use 1.9 times/week, and symptoms recorded 1.2 times/week on average. The correlation coefficients of home to office measurements for peak flow and FEV1 were high (r=0.94 and 0.96, respectively). Patients found the app valuable (13/16, 81%) and easy to use (15/16, 94%). The NPS was 59. CONCLUSIONS This study demonstrates that our cohort of patients with COPD engaged with the Wellinks mHealth platform avidly and consistently over the 8-week period, and that patient satisfaction was high, as indicated by the satisfaction survey and the NPS of 59. In this small, selected sample, patients were both willing to use the technology and capable of doing so successfully regardless of disease severity, age, or gender. The Wellinks mHealth platform was considered useful and valuable by patients, and can assist clinicians in improved, timely decision making for better COPD management.
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Affiliation(s)
- Brian D Gelbman
- Division of Pulmonary and Critical Care Medicine, Weill Cornell Medical Center, New York, NY, United States
| | - Carol R Reed
- Wellinks (Convexity Scientific, Inc), New Haven, CT, United States
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Krishnan JA, Albert RK, Rennard SI. Waiting for Actionable Evidence: Roflumilast or Azithromycin? CHRONIC OBSTRUCTIVE PULMONARY DISEASES (MIAMI, FLA.) 2022; 9:1-3. [PMID: 34783231 PMCID: PMC8893970 DOI: 10.15326/jcopdf.2021.0272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
| | - Richard K. Albert
- Anschutz Medical Campus, University of Colorado, Denver, Colorado, United States
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Chatreewatanakul B, Othaganont P, Hickman RL. Early symptom recognition and symptom management among exacerbation COPD patients: A qualitative study. Appl Nurs Res 2022; 63:151522. [PMID: 35034709 DOI: 10.1016/j.apnr.2021.151522] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 10/29/2021] [Accepted: 10/30/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND An acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is the most cause of deaths in COPD patient. It induces COPD patients often end in unexpected or unpredictable death. OBJECTIVES The purposes were to explore the lived experiences of symptom recognition and to explain the pattern of symptom management successfully among exacerbation COPD patients. DESIGN A Heideggerian hermeneutic phenomenology approach. SETTING The interviews took place in participants' home by using android or iOS (iPhone) phone. PARTICIPANTS Twenty participants were recruited until saturation by purposive sampling technique. METHODS The semi-structured interview was used to capture detailed experiences verbatim. Data analysis based on a seven-stage hermeneutical process. RESULTS Two constitutive patterns with relational themes were identified. First, symptom recognition, consisted of four themes: meaning of AECOPD, pattern of AECOPD, warning signs and prodromal symptoms, and risk factors of AECOPD. Second, symptom management, consisted of four themes: methods of symptom management (during AECOPD state), methods of symptom management (during stable COPD state for helping to prevent AECOPD state), knowledge source of symptom management, and factors influencing symptom recognition and symptom management. CONCLUSIONS The use of a Heideggerian hermeneutic phenomenology as a research methodology fulfilled the aims of this study. It will enable healthcare professionals to select and advise the strategies or methods that will be the most likely to appropriate within the limits set by individual capabilities for promoting the best quality of life in COPD patients.
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Affiliation(s)
| | - Pranom Othaganont
- Department of Adult Nursing and the Aged, Faculty of Nursing, Thammasat University, 99 Khlong 1, Khlong Luang, Pathum Thani 12121, Thailand.
| | - Ronald L Hickman
- Frances Payne Bolton School of Nursing, Case Western Reserve University, 9501 Euclid Ave., Cleveland, OH 44106, USA.
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Zhong CCW, Wong CHL, Cheung WKW, Yeoh EK, Hung CT, Yip BHK, Wong ELY, Wong SYS, Chung VCH. Effectiveness of Peri-Discharge Complex Interventions for Reducing 30-Day Readmissions among COPD Patients: Overview of Systematic Reviews and Network Meta-Analysis. Int J Integr Care 2022; 22:7. [PMID: 35136388 PMCID: PMC8815439 DOI: 10.5334/ijic.6018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 01/27/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND An overview of systematic reviews(SRs) and network meta-analysis(NMA) were conducted to evaluate the comparative effectiveness of peri-discharge complex interventions for reducing 30-day readmissions among chronic obstructive pulmonary disease(COPD) patients. METHODS Five databases were searched for SRs of randomized controlled trials(RCTs). An additional search was conducted for updated RCTs from database inception until Jun 2020. Pooled effect of peri-discharge complex interventions was assessed using random-effect pairwise meta-analyses. Comparative effectiveness across different peri-discharge complex interventions was evaluated using NMA. RESULTS Nine SRs and 11 eligible RCTs(n = 1,422) assessing eight different peri-discharge complex interventions were included. For reducing 30-day all-cause readmissions, pairwise meta-analysis showed no significant difference between peri-discharge complex interventions and usual care, while NMA indicated no significant differences among different peri-discharge complex interventions as well as usual care. For reducing 30-day COPD-related readmissions, peri-discharge complex interventions were significantly more effective than usual care (pooled RR = 0.45, 95% CI:0.24-0.84). CONCLUSIONS Peri-discharge complex interventions may not differ from usual care in reducing 30-day all-cause readmissions among COPD patients but some are more effective for lowering 30-day COPD-related readmission. Thus, complex intervention comprising core components of patient education, self-management, patient-centred discharge instructions, and telephone follow up may be considered for implementation, but further evaluation is warranted.
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Affiliation(s)
- Claire C. W. Zhong
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, HK
| | - Charlene H. L. Wong
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, HK
| | - William K. W. Cheung
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, HK
| | - Eng-kiong Yeoh
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, HK
| | - Chi Tim Hung
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, HK
| | - Benjamin H. K. Yip
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, HK
| | - Eliza L. Y. Wong
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, HK
| | - Samuel Y. S. Wong
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, HK
| | - Vincent C. H. Chung
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, HK
- School of Chinese Medicine, The Chinese University of Hong Kong, Shatin, HK
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Schoonbroodt S, Ichanté JL, Boffé S, Devos N, Devaster JM, Taddei L, Rondini S, Arora AK, Pascal T, Malvaux L. Real-time PCR has advantages over culture-based methods in identifying major airway bacterial pathogens in chronic obstructive pulmonary disease: Results from three clinical studies in Europe and North America. Front Microbiol 2022; 13:1098133. [PMID: 36909845 PMCID: PMC10000296 DOI: 10.3389/fmicb.2022.1098133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 12/29/2022] [Indexed: 03/14/2023] Open
Abstract
Introduction We compared the performance of real-time PCR with culture-based methods for identifying bacteria in sputum samples from patients with chronic obstructive pulmonary disease (COPD) in three studies. Methods This was an exploratory analysis of sputum samples collected during an observational study of 127 patients (AERIS; NCT01360398), phase 2 study of 145 patients (NTHI-004; NCT02075541), and phase 2b study of 606 patients (NTHI-MCAT-002; NCT03281876). Bacteria were identified by culture-based microbiological methods in local laboratories using fresh samples or by real-time PCR in a central laboratory using frozen samples. Haemophilus influenzae positivity with culture was differentiated from H. haemolyticus positivity by microarray analysis or PCR. The feasibility of bacterial detection by culture-based methods on previously frozen samples was also examined in the NTHI-004 study. Results Bacterial detection results from both culture-based and PCR assays were available from 2,293 samples from AERIS, 974 from the NTHI-004 study, and 1736 from the NTHI-MCAT-002 study. Quantitative real-time PCR (qPCR) showed higher positivity rates than culture for H. influenzae (percentages for each study: 43.4% versus 26.2%, 47.1% versus 23.6%, 32.7% versus 10.4%) and Moraxella catarrhalis (12.9% versus 6.3%, 19.0% versus 6.0%, 15.5% versus 4.1%). In the NTHI-004 and NTHI-MCAT-002 studies, positivity rates were higher with qPCR for Streptococcus pneumoniae (15.6% versus 6.1%, 15.5% versus 3.8%); in AERIS, a lower rate with qPCR than with culture (11.0% versus 17.4%) was explained by misidentification of S. pseudopneumoniae/mitis isolates via conventional microbiological methods. Concordance analysis showed lowest overall agreement for H. influenzae (82.0%, 75.6%, 77.6%), due mainly to culture-negative/qPCR-positive samples, indicating lower sensitivity of the culture-based methods. The lowest positive agreement (culture-positive/qPCR-positive samples) was observed for S. pneumoniae (35.1%, 71.2%, 71.2%). Bacterial load values for each species showed a proportion of culture-negative samples with a load detected by qPCR; for some samples, the loads were in line with those observed in culture-positive samples. In the NTHI-004 study, of fresh samples that tested culture-positive, less than 50% remained culture-positive when tested from freeze/thawed samples. In the NTHI-004 study, of fresh samples that tested culture-positive, less than 50% remained culture-positive when tested from freeze/thawed samples. Discussion Real-time PCR on frozen sputum samples has enhanced sensitivity and specificity over culture-based methods, supporting its use for the identification of common respiratory bacterial species in patients with COPD.
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Miravitlles M. [Translated article] GesEPOC 2021 and GOLD 2021. Closer together or further apart? Arch Bronconeumol 2022. [DOI: 10.1016/j.arbres.2021.04.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Ahmadian S, Sin DD, Lynd L, Harrison M, Sadatsafavi M. Benefit-harm analysis of azithromycin for the prevention of acute exacerbations of chronic obstructive pulmonary disease. Thorax 2021; 77:1079-1087. [PMID: 34836921 PMCID: PMC9606520 DOI: 10.1136/thoraxjnl-2021-217962] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 11/03/2021] [Indexed: 12/01/2022]
Abstract
Background Low-dose oral azithromycin therapy is recommended as a preventive treatment for acute exacerbations of COPD. However, the overall benefit–harm balance of this treatment has not been well studied. Methods A probabilistic Markov model of COPD was created to simulate the course of COPD over 20 years. The model was populated with evidence from the literature and dedicated data analysis. The benefit of azithromycin was modelled as a reduction in exacerbation rates. Adverse events, including cardiovascular events, hearing loss, gastrointestinal symptoms and antimicrobial resistance (leading to a gradual decline in the effectiveness of azithromycin), were considered. All outcomes were assigned a health-related utility weight to estimate the overall net change in the quality-adjusted life year (QALY) associated with the use of azithromycin. Results In patients with a positive exacerbation history, azithromycin resulted in a net QALY gain of 17.9 per 100 patients (99.8% probability of expected QALY gain) over 20 years. The net benefit increased to 21.8 QALYs per 100 patients (99.9% probability of expected QALY gain) among the ‘frequent exacerbator’ subgroup. Azithromycin was not net beneficial among those without any moderate/severe exacerbations in the previous year. Findings were robust against series of sensitivity, scenario and threshold analyses. Conclusions Long-term therapy with azithromycin confers a net benefit to ex-smoker patients with COPD with a recent history of exacerbations and an even larger benefit to those who are frequent exacerbators.
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Affiliation(s)
- Safa Ahmadian
- Respiratory Evaluation Sciences Program, Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Don D Sin
- Centre for Heart Lung Innovation, The University of British Columbia, Vancouver, British Columbia, Canada.,Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Larry Lynd
- Respiratory Evaluation Sciences Program, Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Mark Harrison
- Respiratory Evaluation Sciences Program, Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Mohsen Sadatsafavi
- Respiratory Evaluation Sciences Program, Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada .,Centre for Heart Lung Innovation, The University of British Columbia, Vancouver, British Columbia, Canada
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Feng Q, Yu YZ, Meng QH. Blocking tumor necrosis factor-α delays progression of chronic obstructive pulmonary disease in rats through inhibiting MAPK signaling pathway and activating SOCS3/TRAF1. Exp Ther Med 2021; 22:1311. [PMID: 34630665 PMCID: PMC8461615 DOI: 10.3892/etm.2021.10746] [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: 07/28/2020] [Accepted: 01/25/2021] [Indexed: 01/04/2023] Open
Abstract
The present study was conducted in order to study the detailed molecular mechanism of tumor necrosis factor (TNF)-α in chronic obstructive pulmonary disease (COPD). The rats were treated with cigarette smoke (CS) and lipopolysaccharide (LPS) to establish the COPD model. Next, the changes in lung injury in COPD rats with TNF-α knockdown was tested. Meanwhile, the regulation of TNF-α on MAPK pathway and its downstream molecules (SOCS3/TRAF1) was determined by western blotting. On this basis, the activation of MAPK and inhibition of SOCS3/TRAF1 was also examined. Subsequently, the lung function was tested with the plethysmograph, the cells of bronchoalveolar lavage fluid was counted and classified. Furthermore, lung tissue sections were stained with hematoxylin and eosin to verify whether the treatment of MAPK pathway and downstream molecules affected the effect of TNF-α knockdown on COPD. The present study showed that TNF-α knockdown could alleviate the decrease in the function and inflammatory injury of the lungs of rats with COPD. Western blot analysis verified that TNF-α knockdown could inhibit the activation of MAPK pathway and increase the expression of SOCS3/TRAF1. The following experimental results showed that the relief of lung injury caused by TNF-α knockdown could be deteriorated by activating MAPK pathway. It was also found that the symptom of COPD was decreased following transfection with sh-TNF-α but worsened by SOCS3/TRAF1 knockdown. Overall, TNF-α knockdown inhibited the activation of MAPK pathway and increased the expression of SOCS3/TRAF1, thus delaying the process of COPD.
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Affiliation(s)
- Qiong Feng
- Department of Pulmonary and Critical Care Medicine, The Affiliated Hospital of Jianghan University, Wuhan, Hubei 430015, P.R. China
| | - Yan-Zi Yu
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Jianghan University, Wuhan, Hubei 430015, P.R. China
| | - Qing-Hua Meng
- Department of Pulmonary and Critical Care Medicine, The Affiliated Hospital of Jianghan University, Wuhan, Hubei 430015, P.R. China
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Nici L. Pulmonary Rehabilitation after a Chronic Obstructive Pulmonary Disease Exacerbation: Impact on Readmission Risk in a Real-World Setting. Am J Respir Crit Care Med 2021; 204:1005-1006. [PMID: 34411506 PMCID: PMC8663004 DOI: 10.1164/rccm.202107-1768ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Linda Nici
- Providence Veterans Affairs Medical Center and The Warren Alpert Medical School of Brown University Providence, Rhode Island
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Chen L, Chen S. Prediction of readmission in patients with acute exacerbation of chronic obstructive pulmonary disease within one year after treatment and discharge. BMC Pulm Med 2021; 21:320. [PMID: 34654406 PMCID: PMC8518323 DOI: 10.1186/s12890-021-01692-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 09/20/2021] [Indexed: 12/12/2022] Open
Abstract
Background To investigate the risk factors and construct a logistic model and an extreme gradient boosting (XGBoost) model to compare the predictive performances for readmission in acute exacerbation of chronic obstructive pulmonary disease (AECOPD) patients within one year. Methods In total, 636 patients with AECOPD were recruited and divided into readmission group (n = 449) and non-readmission group (n = 187). Backward stepwise regression method was used to analyze the risk factors for readmission. Data were divided into training set and testing set at a ratio of 7:3. Variables with statistical significance were included in the logistic model and variables with P < 0.1 were included in the XGBoost model, and receiver operator characteristic (ROC) curves were plotted. Results Patients with acute exacerbations within the previous 1 year [odds ratio (OR) = 4.086, 95% confidence interval (CI) 2.723–6.133, P < 0.001), long-acting β agonist (LABA) application (OR = 4.550, 95% CI 1.587–13.042, P = 0.005), inhaled corticosteroids (ICS) application (OR = 0.227, 95% CI 0.076–0.672, P = 0.007), glutamic-pyruvic transaminase (ALT) level (OR = 0.985, 95% CI 0.971–0.999, P = 0.042), and total CAT score (OR = 1.091, 95% CI 1.048–1.136, P < 0.001) were associated with the risk of readmission. The AUC value of the logistic model was 0.743 (95% CI 0.692–0.795) in the training set and 0.699 (95% CI 0.617–0.780) in the testing set. The AUC value of XGBoost model was 0.814 (95% CI 0.812–0.815) in the training set and 0.722 (95% CI 0.720–0.725) in the testing set. Conclusions The XGBoost model showed a better predictive value in predicting the risk of readmission within one year in the AECOPD patients than the logistic regression model. The findings of our study might help identify patients with a high risk of readmission within one year and provide timely treatment to prevent the reoccurrence of AECOPD. Supplementary Information The online version contains supplementary material available at 10.1186/s12890-021-01692-3.
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Affiliation(s)
- Lili Chen
- Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Nanjing Medical University, Jiangjiayuan 121#, Gulou District, Nanjing, 210000, Jiangsu, China
| | - Shiping Chen
- Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Nanjing Medical University, Jiangjiayuan 121#, Gulou District, Nanjing, 210000, Jiangsu, China.
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Hudd TR. Emerging role of pharmacists in managing patients with chronic obstructive pulmonary disease. Am J Health Syst Pharm 2021; 77:1625-1630. [PMID: 32699897 PMCID: PMC7499078 DOI: 10.1093/ajhp/zxaa216] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Timothy R Hudd
- Department of Pharmacy Practice, MCPHS University, Boston, MA
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Sun Z, Zhao W, Yang K, Li X, Yu P. Efficacy and safety of traditional Chinese medicine injections in the treatment of chronic obstructive pulmonary disease: A protocol for systematic review and network meta-analysis. Medicine (Baltimore) 2021; 100:e27324. [PMID: 34559151 PMCID: PMC8462615 DOI: 10.1097/md.0000000000027324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 09/08/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a widespread, heterogeneous disease characterized by chronic inflammation of the airway and the gradual blockage of air flow due to bronchial obstruction. At present, a large number of traditional Chinese medicine injections (TCMIs) has been applied in the clinical treatment of COPD. However, there is insufficient evidence of evidence-based medicine of the interaction between them. Therefore, the purpose of this study is through the network meta-analysis to evaluate the efficacy and safety of the different TCMIs treatment of COPD, offering reference and evidence for clinical application. METHODS We will search 7 databases for randomized controlled trials of TCMI for the COPD, including PubMed, the Cochrane Library, EMbase, China National Knowledge Infrastructure, China Biological Medicine, Chinese Scientific Journals Database, and Wan-fang databases, from the date of the establishment of each database to October 31, 2021. The network meta-analysis will be implemented through Aggregate Data Drug Information System 1.16.8 and Stata 13.0 software. Pulmonary function included forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), and FEV1/FVC will be the primary outcomes, FEV1 as a percentage of the estimated value (FEV1%pred), maximal voluntary ventilation (MVV), MVV as a percentage of the estimated value (MVV%pred), 6 minutes walking distance, The St. George's Respiratory Questionnaire score, and safety/adverse event will be evaluated as secondary outcomes. Mean differences or odds ratios will be used for statistical analysis. We will ensure the reliability of the results through node-split model and heterogeneity analysis. In addition, methodological quality will be evaluated based on the Cochrane Collaboration's tool, and the quality of evidence will be evaluated according to the Grading of Recommendations Assessment, Development and Evaluation system. RESULTS This study will provide reliable evidence for the clinical selection of TCMI in the treatment of COPD. CONCLUSION The results of this study will evaluate the efficacy and safety of TCMI in the treatment of COPD, and provide decision-making references for future clinical and scientific research.
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Affiliation(s)
- Zhongli Sun
- Chongqing Three Gorges Medical College, Chongqing, China
| | - Wei Zhao
- Xindu Hospital of Traditional Chinese Medicine Affiliated to Chengdu Medical College, Sichuan, China
| | - Kun Yang
- Chongqing Three Gorges Medical College, Chongqing, China
| | - Xingying Li
- Chongqing Three Gorges Medical College, Chongqing, China
| | - Penglong Yu
- Chongqing Three Gorges Medical College, Chongqing, China
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Abstract
Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality worldwide and results in an economic and social burden that is both substantial and increasing. The natural history of COPD is punctuated by exacerbations, which have major short- and long-term implications on the patient and health care system. Evidence-based guidelines stipulate that early detection and prompt treatment of exacerbations are essential to ensure optimal outcomes and to reduce the burden of COPD. In this review, we provide a concise overview of COPD exacerbations and their risk factors and etiology (infection vs noninfectious), outlining the initial evaluation, triaging, and current management including invasive and noninvasive ventilation, in addition to the prognosis and the preventive strategies.
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Bourbeau J, Echevarria C. Models of care across the continuum of exacerbations for patients with chronic obstructive pulmonary disease. Chron Respir Dis 2021; 17:1479973119895457. [PMID: 31970998 PMCID: PMC6978821 DOI: 10.1177/1479973119895457] [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] [Indexed: 12/11/2022] Open
Abstract
Exacerbations of chronic obstructive pulmonary disease (COPD) are associated with
significant morbidity and mortality, and treatments require a multidisciplinary
approach to address patient needs. This review considers different models of
care across the continuum of exacerbations (1) chronic care and self-management
interventions with the action plan, (2) domiciliary care for severe exacerbation
and the impact on readmission prevention and (3) the discharge care bundle for
management beyond the acute exacerbation episode. Self-management strategies
include written action plans and coaching with patient and family support.
Self-management interventions facilitate the delivery of good care, can reduce
exacerbations associated with admission, be cost-effective and improve quality
of life. Hospitalization as a complication of exacerbation is not always
unavoidable. Domiciliary care has been proposed as a solution to replace part,
and perhaps even all, of the patient’s in-hospital stay, and to reduce hospital
bed days, readmission rates and costs; low-risk patients can be identified using
risk stratification tools. A COPD discharge bundle is another potentially
important approach that can be considered to improve the management of COPD
exacerbations complicated by hospital admission; it comprised treatments that
have demonstrated efficacy, such as smoking cessation, personalized
pharmacotherapy and non-pharmacotherapy such as pulmonary rehabilitation. COPD
bundles may also improve the transition of care from the hospital to the
community following exacerbation and may reduce readmission rates. Future models
of care should be personalized – providing patient education aiming at behaviour
changes, identifying and treating co-morbidities, and including outcomes that
measure quality of care rather than focusing only on readmission quantity within
30 days.
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Affiliation(s)
- Jean Bourbeau
- Respiratory Epidemiology and Clinical Research Unit, Research Institute of the McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - Carlos Echevarria
- Respiratory Department, Royal Victoria Infirmary, Newcastle upon Tyne, UK
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Wakabayashi R, Bourbeau J, Sedeno MF, Motegi T, Kutsuzawa T, Urano T, Kida K. Multicentre comparison of self-management in patients with COPD. ERJ Open Res 2021; 7:00252-2021. [PMID: 34476254 PMCID: PMC8405878 DOI: 10.1183/23120541.00252-2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 06/21/2021] [Indexed: 11/05/2022] Open
Abstract
In patients with COPD, self-management plays an important role in disease management. Recently, self-management programmes have expanded patient education practices to include a variety of disease management techniques. We hypothesised that COPD patients have insufficient and/or different self-management needs according to institution. We compared information needs of patients between specialised clinics in Canada (SCC) and Japan and a hospital outpatient clinic in Japan (HCJ), all employing different self-management interventions. This cross-sectional study evaluated patients' information needs for disease management using the Lung Information Needs Questionnaire (LINQ). Furthermore, we assessed pulmonary function tests, modified Medical Research Council (mMRC) dyspnoea scale and frequencies of hospitalisations and emergency visits. The total number of patients was 183. Those attending SCC were younger (p=0.047), with lower forced expiratory volume in 1 s % predicted (p<0.0001), and scored higher on the mMRC dyspnoea scale. Total LINQ scores showed differences between institutions (p<0.0001). There was no difference for the smoking domain; however, SCC recorded significantly lower information needs for all other domains (p<0.02). No significant difference in emergency visits was seen between institutions, but HCJ recorded the highest rate of emergency visits, while SCC had significantly higher rates of hospitalisation (p=0.004). Differences were seen for frequency and duration of education between institutions. These results highlight the differences in information needs by institution and the importance of assessing individual needs. We believe, despite representing only one aspect of self-management, our findings reflect real-world circumstances, adding to the argument that self-management education should be structured, but flexible, to meet the changing needs of COPD patients.
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Affiliation(s)
- Ritsuko Wakabayashi
- Faculty of Health Care and Nursing, Graduate School of Health Care and Nursing, Juntendo University, Urayasu, Chiba, Japan
| | - Jean Bourbeau
- Dept of Medicine, Division of Experimental Medicine, McGill University, McGill University Health Centre, Montreal, QC, Canada
| | - Maria F. Sedeno
- Research Institute of McGill University Health Centre, Montréal, QC, Canada
| | | | - Tomoko Kutsuzawa
- Faculty of Nursing, Tokai University School of Medicine, Tokai University, Kanagawa, Japan
| | - Tetsuya Urano
- School of Medicine, Tokai University, Kanagawa, Japan
| | - Kozui Kida
- Respiratory Care Clinic Tokyo, Tokyo, Japan
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Zhang L, Zhao Y, Jia J, Huang L, Chu W, Xu Q, Sheng Y, Xu A. Evaluation of the curative effects of Bailing capsules for treating chronic obstructive pulmonary disease: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e25672. [PMID: 34160379 PMCID: PMC8238341 DOI: 10.1097/md.0000000000025672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 04/06/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The goal of the present study is to evaluate the efficacy and safety of Bailing capsules, which is a traditional Chinese drug that can improve lung functionality when used to treat chronic obstructive pulmonary disease (COPD) patients. METHODS A comprehensive search will be performed on the following primary electronic databases: PubMed, EMBASE, Cochrane Library, Chinese National Knowledge Infrastructure, and WanFang database. A search of secondary sources includes reference lists of included studies. Two pairs of review authors will screen and scrutinize selected articles. This study will analyze continuous data as mean differences and dichotomous data as odds ratios, both with 95% confidence intervals. A sensitivity analysis will also be conducted to evaluate the stableness of the outcomes. RevMan 5.3 software was adopted to accomplish all the statistical analysis. RESULTS The results obtained in this research shall be published in a peer-reviewed journal. CONCLUSION Based on the interpretations of the results, useful conclusions will be presented. These conclusions will offer additional insights with useful evidence to assess whether it is viable to use Bailing capsules as an effective and safety treatment option for COPD. ETHICS AND DISSEMINATION The present work does not involve any humans or animals; therefore, ethical approval is not needed. SYSTEMATIC REVIEW REGISTRATION March 26, 2021.osf.io/kvgbu. (https://osf.io/kvgbu/).
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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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Gershon AS, Pequeno P, Machado AA, Aaron SD, Kendzerska T, Luo J, Stanbrook MB, Tan WC, Porter J, To T. FACTORS ASSOCIATED WITH NON-RECEIPT OF RECOMMENDED CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) MEDICATIONS: A POPULATION STUDY. Chest 2021; 160:1670-1680. [PMID: 34144022 DOI: 10.1016/j.chest.2021.05.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 05/04/2021] [Accepted: 05/25/2021] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) medications reduce exacerbations and improve quality of life. Despite this, some individuals do not receive medications recommended by practise guidelines. RESEARCH QUESTION How common is non-receipt of recommended medications among people with COPD and what are factors associated with non-receipt? STUDY DESIGN AND METHODS We conducted a population cohort study in Ontario, Canada, a province with universal health care insurance and medication coverage for those aged 65 and older. Health administrative data were used to identify people 66 years of age or older with physician-diagnosed COPD as of 2018 and group them into lower or higher risk for future COPD exacerbation groups. Proportions of patients in each group who did not receive medications recommended by COPD guidelines were determined. Generalized estimating equation modelling was used to determine associations between patient and physician factors and non-receipt of recommended medications. RESULTS About 54% and 88% of people with COPD receoved sufficient recommended medications in the low and high risk of exacerbation groups, respectively. Longer duration of COPD, higher comorbidity, dementia, and older physician age were associated with non-receipt of recommended medications in both groups. People who had a co-diagnosis of asthma and who received care by a pulmonologist and spirometry were more likely to receive recommended medication . INTERPRETATION COPD medications appear underused by the COPD population and various factors are associated with sub-optimal receipt. Targeting these factors would help improve the care and health of people with COPD.
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Affiliation(s)
- Andrea S Gershon
- Department of Medicine and Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; ICES, Toronto and Ottawa, ON, Canada; Department of Medicine, University of Toronto, Toronto, ON, Canada; The Hospital for Sick Children Research Institute, Toronto, ON, Canada; Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada.
| | | | | | - Shawn D Aaron
- The Ottawa Hospital Research Institute, 1053 Carling Ave, Ottawa, ON, Canada
| | - Tetyana Kendzerska
- ICES, Toronto and Ottawa, ON, Canada; The Ottawa Hospital Research Institute, 1053 Carling Ave, Ottawa, ON, Canada
| | - Jin Luo
- ICES, Toronto and Ottawa, ON, Canada
| | - Matthew B Stanbrook
- ICES, Toronto and Ottawa, ON, Canada; Department of Medicine, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada; University Health Network, Toronto, ON, Canada
| | - Wan C Tan
- University of British Columbia, UBC James Hogg Research Laboratories, Providence Heart and Lung Institute, Vancouver, BC, Canada
| | | | - Teresa To
- ICES, Toronto and Ottawa, ON, Canada; The Hospital for Sick Children Research Institute, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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Zhao S, Lin C, Yang T, Qian X, Lu J, Cheng J. Expression of long non-coding RNA LUCAT1 in patients with chronic obstructive pulmonary disease and its potential functions in regulating cigarette smoke extract-induced 16HBE cell proliferation and apoptosis. J Clin Lab Anal 2021; 35:e23823. [PMID: 34125980 PMCID: PMC8274995 DOI: 10.1002/jcla.23823] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 03/26/2021] [Accepted: 04/10/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD), characterized by persistent airflow limitation, was a disease mediated by a combination of inflammatory factors, immune cells, and immune mediators. COPD was an inflammatory and autoimmune disease involving T-lymphocytes triggered by cigarette smoke and other factors that progressively affected the bronchi, lung parenchyma, and pulmonary blood vessels. LncRNAs were reported to be implicated in COPD pathogenesis and development. METHODS Non-smokers, smokers (non-COPD), and COPD patients were randomly selected in an established COPD surveillance cohort. Demographic and clinical information of all subjects were collected. Pulmonary function was measured by post-bronchodilator testing. qRT-PCR and ELISA assays were performed to detect the expression levels of lncRNA LUCAT1, miR-181a-5p, and inflammatory cytokines. An in vitro exposure model was constructed using cigarette smoke extract (CSE)-induced human bronchial epithelial (16HBE) cells. The dual-luciferase reporter and RNA pull-down assays were used to detect the binding relationship between lncRNA LUCAT1 and miR-181a-5p; meanwhile, Spearman's correlation assay was used to verify the correlation between lncRNA LUCAT1 and miR-181a-5p. Afterward, the lncRNA LUCAT1 silencing plasmid was constructed and co-transfected with a miR-181a-5p inhibitor to evaluate the effects on CSE-induced 16HBE cell proliferation and apoptosis. Finally, a Western blot assay was utilized to determine the mechanism of lncRNA LUCAT1/miR-181a-5p/Wnt/β-catenin axis in COPD. RESULTS LncRNA LUCAT1 was upregulated in the serums of COPD patients. Correlation analysis further confirmed the strong correlation between LUCAT1 expression and inflammatory cytokines IL-1β, IL-6, and TNF-α. Receiver operating characteristic (ROC) analysis verified the potential of LUCAT1 in COPD diagnosis. After treatment with CSE, LUCAT1 was significantly increased while its target miR-181a-5p was decreased in 16HBE cells. Cell proliferation and apoptosis assays showed that LUCAT1 silencing alleviated CSE's effects on 16HBE cell proliferation and apoptosis. Mechanically, rescue assays demonstrated that miR-181a-5p inhibition could partially counteract the impact of LUCAT1 on COPD progression through the Wnt/β-catenin pathway. CONCLUSIONS LncRNA LUCAT1 may be a valuable indicator for differentiating COPD. Moreover, LncRNA LUCAT1/miR-181-5p/Wnt/β-catenin axis behaved as a critical role in COPD development, shedding new sights for clinical treatment.
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Affiliation(s)
- Shan Zhao
- Department of Clinical Laboratory, Affiliated Yixing People's Hospital, Jiangsu University, Wuxi, China
| | - Chunyan Lin
- Department of Blood Transfusion, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Tao Yang
- Department of Clinical Laboratory, Affiliated Yixing People's Hospital, Jiangsu University, Wuxi, China
| | - Xiaoyu Qian
- Department of Clinical Laboratory, Affiliated Yixing People's Hospital, Jiangsu University, Wuxi, China
| | - Junjie Lu
- Department of Critical Care Medicine, Affiliated Yixing People's Hospital, Jiangsu University, Wuxi, China
| | - Jing Cheng
- Department of Blood Transfusion, The First Affiliated Hospital of Soochow University, Suzhou, China
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Evaluation of an Enhanced Pulmonary Rehabilitation Program: A Randomised Controlled Trial. Ann Am Thorac Soc 2021; 18:1650-1660. [PMID: 34004123 DOI: 10.1513/annalsats.202009-1160oc] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
RATIONALE Pulmonary rehabilitation (PR) is the most effective strategy to improve health outcomes in people with COPD, although it has had limited success in promoting sustained physical activity. PR with a strong focus on disease self-management may better facilitate long-term behavior change. OBJECTIVE To compare a newly developed enhanced pulmonary rehabilitation program (EPR) to a traditional PR program on outcome achievement. METHODS In this randomized parallel-group controlled trial, PR classes were block randomized to EPR or traditional PR, which were delivered over 16 sessions each. The EPR incorporated new and updated "Living Well with COPD" education modules which had a stronger focus on chronic disease self-management. Fidelity of the intervention for content and delivery was assessed. Physical activity, self-efficacy, exercise tolerance, and health-related quality of life (HRQoL) were collected before, after, and 6-months following PR. Healthcare visits were collected 2 years before PR and 1 year after. Mortality was recorded 1 year after PR. RESULTS Of the 207 COPD patients enrolled, 108 received the EPR and 99 traditional PR. Physical activity (steps) and self-efficacy improved from pre- to post-PR in both programs, with no differences between groups. These effects were not sustained at 6 months. Exercise tolerance and HRQoL improved from pre- to post-PR with no between group differences, which were maintained at 6 months. Visits to primary care providers and respiratory specialists decreased in the EPR program relative to traditional PR. EPR was delivered as intended and there was no meaningful cross-contamination between the two programs. CONCLUSIONS Enhancing PR to have a greater emphasis on chronic disease self-management did not result in a superior improvement of physical activity and health outcomes compared to traditional PR except for reduced resource utilization from primary and specialist physician visits in the EPR program. Clinical trial registered with ClinicalTrials.gov (NCT02917915).
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Miravitlles M. GesEPOC 2021 and GOLD 2021. Closer Together or Further Apart? Arch Bronconeumol 2021; 58:1-2. [PMID: 33965262 DOI: 10.1016/j.arbres.2021.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 04/12/2021] [Indexed: 11/02/2022]
Affiliation(s)
- Marc Miravitlles
- Servicio de Neumología, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Barcelona, España.
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Yan M, Saxena FE, Calzavara A, Brown KA, Garber G, Gershon AS, Johnstone J, Kumar M, Langford BJ, Lee S, Schwartz KL, Daneman N. Long-term macrolide therapy for chronic obstructive pulmonary disease: a population-based time series analysis. CMAJ Open 2021; 9:E576-E584. [PMID: 34021016 PMCID: PMC8177912 DOI: 10.9778/cmajo.20200157] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Macrolides are recommended as an adjunctive treatment for patients with moderate to severe chronic obstructive pulmonary disease (COPD) who experience recurrent exacerbations. The objective of this study was to examine temporal trends in the provision of long-term macrolide therapy, specifically before and after publication of the landmark MACRO trial in August 2011 showing efficacy of macrolides for this indication. METHODS We performed an interrupted time series analysis using population-level health administrative data. The study cohort consisted of all Ontario residents who had COPD, were using at least 1 long-acting inhaler, and were aged 65 years and older between Apr. 1, 2004, and Mar. 31, 2018. We compared the baseline characteristics of eligible patients before and after publication of the MACRO trial. Our primary outcome was overall prevalence of long-term macrolide therapy; secondary outcomes were incidence of COPD-related hospitalizations, emergency department visits and outpatient exacerbations requiring high-dose steroids in each quarter. We performed an interrupted time series analysis to assess for changes in the incidence of macrolide prophylaxis by quarter-year over the study period. RESULTS The rate of long-term macrolide use increased from 0.8 per 1000 people in 2004 to 13.8 per 1000 people in 2018 (in the severe COPD group, the rate increased from 1.3 to 32.3 per 1000 people). The interrupted time series analysis showed that, before 2011, the prevalence of macrolide prophylaxis increased at a rate of 0.44 (95% confidence interval [CI] 0.39-0.50) per 1000 people per year; after 2011, the rate of increase grew by 1.18 (95% CI 1.07-1.29) per 1000 people to 1.63 (95% CI 1.56-1.69) per 1000 people per year. The seasonal pattern of COPD-related health care visits remained stable over the study period, and there was no detectable reduction in hospitalizations or emergency department visits at the population level. INTERPRETATION In the past decade, there has been a significant rise in the use of long-term macrolide therapy for patients with COPD. As this practice becomes increasingly common, it will be important to monitor its potential benefits on COPD exacerbations but also its potential effects on adverse events and antimicrobial resistance patterns.
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Affiliation(s)
- Marie Yan
- Department of Medicine (Yan, Garber, Gershon), University of Toronto, Toronto, Ont.; Department of Medicine (Yan), University of British Columbia, Vancouver, BC; ICES (Saxena, Calzavara, Brown, Gershon, Kumar, Lee, Schwartz, Daneman), Toronto, Ont.; Dalla Lana School of Public Health (Brown, Johnstone), University of Toronto, Toronto, Ont.; Public Health Ontario (Brown, Garber, Johnstone, Langford, Schwartz, Daneman), Toronto, Ont.; Ottawa Hospital Research Institute (Garber), Ottawa, Ont.; Sunnybrook Health Sciences Centre (Gershon, Daneman); Sinai Health System (Johnstone); Unity Health Toronto (Schwartz), Toronto, Ont
| | - Farah E Saxena
- Department of Medicine (Yan, Garber, Gershon), University of Toronto, Toronto, Ont.; Department of Medicine (Yan), University of British Columbia, Vancouver, BC; ICES (Saxena, Calzavara, Brown, Gershon, Kumar, Lee, Schwartz, Daneman), Toronto, Ont.; Dalla Lana School of Public Health (Brown, Johnstone), University of Toronto, Toronto, Ont.; Public Health Ontario (Brown, Garber, Johnstone, Langford, Schwartz, Daneman), Toronto, Ont.; Ottawa Hospital Research Institute (Garber), Ottawa, Ont.; Sunnybrook Health Sciences Centre (Gershon, Daneman); Sinai Health System (Johnstone); Unity Health Toronto (Schwartz), Toronto, Ont
| | - Andrew Calzavara
- Department of Medicine (Yan, Garber, Gershon), University of Toronto, Toronto, Ont.; Department of Medicine (Yan), University of British Columbia, Vancouver, BC; ICES (Saxena, Calzavara, Brown, Gershon, Kumar, Lee, Schwartz, Daneman), Toronto, Ont.; Dalla Lana School of Public Health (Brown, Johnstone), University of Toronto, Toronto, Ont.; Public Health Ontario (Brown, Garber, Johnstone, Langford, Schwartz, Daneman), Toronto, Ont.; Ottawa Hospital Research Institute (Garber), Ottawa, Ont.; Sunnybrook Health Sciences Centre (Gershon, Daneman); Sinai Health System (Johnstone); Unity Health Toronto (Schwartz), Toronto, Ont
| | - Kevin A Brown
- Department of Medicine (Yan, Garber, Gershon), University of Toronto, Toronto, Ont.; Department of Medicine (Yan), University of British Columbia, Vancouver, BC; ICES (Saxena, Calzavara, Brown, Gershon, Kumar, Lee, Schwartz, Daneman), Toronto, Ont.; Dalla Lana School of Public Health (Brown, Johnstone), University of Toronto, Toronto, Ont.; Public Health Ontario (Brown, Garber, Johnstone, Langford, Schwartz, Daneman), Toronto, Ont.; Ottawa Hospital Research Institute (Garber), Ottawa, Ont.; Sunnybrook Health Sciences Centre (Gershon, Daneman); Sinai Health System (Johnstone); Unity Health Toronto (Schwartz), Toronto, Ont
| | - Gary Garber
- Department of Medicine (Yan, Garber, Gershon), University of Toronto, Toronto, Ont.; Department of Medicine (Yan), University of British Columbia, Vancouver, BC; ICES (Saxena, Calzavara, Brown, Gershon, Kumar, Lee, Schwartz, Daneman), Toronto, Ont.; Dalla Lana School of Public Health (Brown, Johnstone), University of Toronto, Toronto, Ont.; Public Health Ontario (Brown, Garber, Johnstone, Langford, Schwartz, Daneman), Toronto, Ont.; Ottawa Hospital Research Institute (Garber), Ottawa, Ont.; Sunnybrook Health Sciences Centre (Gershon, Daneman); Sinai Health System (Johnstone); Unity Health Toronto (Schwartz), Toronto, Ont
| | - Andrea S Gershon
- Department of Medicine (Yan, Garber, Gershon), University of Toronto, Toronto, Ont.; Department of Medicine (Yan), University of British Columbia, Vancouver, BC; ICES (Saxena, Calzavara, Brown, Gershon, Kumar, Lee, Schwartz, Daneman), Toronto, Ont.; Dalla Lana School of Public Health (Brown, Johnstone), University of Toronto, Toronto, Ont.; Public Health Ontario (Brown, Garber, Johnstone, Langford, Schwartz, Daneman), Toronto, Ont.; Ottawa Hospital Research Institute (Garber), Ottawa, Ont.; Sunnybrook Health Sciences Centre (Gershon, Daneman); Sinai Health System (Johnstone); Unity Health Toronto (Schwartz), Toronto, Ont
| | - Jennie Johnstone
- Department of Medicine (Yan, Garber, Gershon), University of Toronto, Toronto, Ont.; Department of Medicine (Yan), University of British Columbia, Vancouver, BC; ICES (Saxena, Calzavara, Brown, Gershon, Kumar, Lee, Schwartz, Daneman), Toronto, Ont.; Dalla Lana School of Public Health (Brown, Johnstone), University of Toronto, Toronto, Ont.; Public Health Ontario (Brown, Garber, Johnstone, Langford, Schwartz, Daneman), Toronto, Ont.; Ottawa Hospital Research Institute (Garber), Ottawa, Ont.; Sunnybrook Health Sciences Centre (Gershon, Daneman); Sinai Health System (Johnstone); Unity Health Toronto (Schwartz), Toronto, Ont
| | - Matthew Kumar
- Department of Medicine (Yan, Garber, Gershon), University of Toronto, Toronto, Ont.; Department of Medicine (Yan), University of British Columbia, Vancouver, BC; ICES (Saxena, Calzavara, Brown, Gershon, Kumar, Lee, Schwartz, Daneman), Toronto, Ont.; Dalla Lana School of Public Health (Brown, Johnstone), University of Toronto, Toronto, Ont.; Public Health Ontario (Brown, Garber, Johnstone, Langford, Schwartz, Daneman), Toronto, Ont.; Ottawa Hospital Research Institute (Garber), Ottawa, Ont.; Sunnybrook Health Sciences Centre (Gershon, Daneman); Sinai Health System (Johnstone); Unity Health Toronto (Schwartz), Toronto, Ont
| | - Bradley J Langford
- Department of Medicine (Yan, Garber, Gershon), University of Toronto, Toronto, Ont.; Department of Medicine (Yan), University of British Columbia, Vancouver, BC; ICES (Saxena, Calzavara, Brown, Gershon, Kumar, Lee, Schwartz, Daneman), Toronto, Ont.; Dalla Lana School of Public Health (Brown, Johnstone), University of Toronto, Toronto, Ont.; Public Health Ontario (Brown, Garber, Johnstone, Langford, Schwartz, Daneman), Toronto, Ont.; Ottawa Hospital Research Institute (Garber), Ottawa, Ont.; Sunnybrook Health Sciences Centre (Gershon, Daneman); Sinai Health System (Johnstone); Unity Health Toronto (Schwartz), Toronto, Ont
| | - Samantha Lee
- Department of Medicine (Yan, Garber, Gershon), University of Toronto, Toronto, Ont.; Department of Medicine (Yan), University of British Columbia, Vancouver, BC; ICES (Saxena, Calzavara, Brown, Gershon, Kumar, Lee, Schwartz, Daneman), Toronto, Ont.; Dalla Lana School of Public Health (Brown, Johnstone), University of Toronto, Toronto, Ont.; Public Health Ontario (Brown, Garber, Johnstone, Langford, Schwartz, Daneman), Toronto, Ont.; Ottawa Hospital Research Institute (Garber), Ottawa, Ont.; Sunnybrook Health Sciences Centre (Gershon, Daneman); Sinai Health System (Johnstone); Unity Health Toronto (Schwartz), Toronto, Ont
| | - Kevin L Schwartz
- Department of Medicine (Yan, Garber, Gershon), University of Toronto, Toronto, Ont.; Department of Medicine (Yan), University of British Columbia, Vancouver, BC; ICES (Saxena, Calzavara, Brown, Gershon, Kumar, Lee, Schwartz, Daneman), Toronto, Ont.; Dalla Lana School of Public Health (Brown, Johnstone), University of Toronto, Toronto, Ont.; Public Health Ontario (Brown, Garber, Johnstone, Langford, Schwartz, Daneman), Toronto, Ont.; Ottawa Hospital Research Institute (Garber), Ottawa, Ont.; Sunnybrook Health Sciences Centre (Gershon, Daneman); Sinai Health System (Johnstone); Unity Health Toronto (Schwartz), Toronto, Ont
| | - Nick Daneman
- Department of Medicine (Yan, Garber, Gershon), University of Toronto, Toronto, Ont.; Department of Medicine (Yan), University of British Columbia, Vancouver, BC; ICES (Saxena, Calzavara, Brown, Gershon, Kumar, Lee, Schwartz, Daneman), Toronto, Ont.; Dalla Lana School of Public Health (Brown, Johnstone), University of Toronto, Toronto, Ont.; Public Health Ontario (Brown, Garber, Johnstone, Langford, Schwartz, Daneman), Toronto, Ont.; Ottawa Hospital Research Institute (Garber), Ottawa, Ont.; Sunnybrook Health Sciences Centre (Gershon, Daneman); Sinai Health System (Johnstone); Unity Health Toronto (Schwartz), Toronto, Ont.
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