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Bourbeau J. In COPD- right treatment, right patient, right time, right approach? Respir Med 2024; 232:107769. [PMID: 39137863 DOI: 10.1016/j.rmed.2024.107769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2024] [Accepted: 08/10/2024] [Indexed: 08/15/2024]
Affiliation(s)
- Jean Bourbeau
- Respiratory Epidemiology and Clinical Research Unit, Research Institute of the McGill University Health Centre, Montreal, Canada; Department of Medicine, McGill University, Montreal, Quebec, Canada.
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Bhutani M, Bourbeau J, Goodman SG, Hawkins NM, Kaplan AG, Lin PJ, Penz ED, Verma S, Zieroth S. A Multi-Specialty Delphi Consensus on Assessing and Managing Cardiopulmonary Risk in Patients with COPD. Int J Chron Obstruct Pulmon Dis 2024; 19:2051-2062. [PMID: 39318837 PMCID: PMC11420896 DOI: 10.2147/copd.s471952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Accepted: 09/11/2024] [Indexed: 09/26/2024] Open
Abstract
Background In Canada, COPD represents a significant burden to the patient and health system, as it is often under or misdiagnosed and sub-optimally treated. Cardiovascular disease (CVD) is a common co-morbidity in COPD and there is significant interplay between these two chronic conditions. Across all stages of COPD disease severity, deaths can be attributed not only to respiratory causes but also to cardiovascular-related factors. The established links between COPD and CVD suggest the need for a greater degree of collaboration between respirologists and cardiologists. This modified Delphi consensus was initiated to consider how optimal COPD care can be delivered within Canada, with specific consideration of reducing cardiopulmonary risk and outcomes in COPD patients. Methods A steering group with interest in the management of COPD and CVD from primary care, cardiology, and respirology identified 40 statements formed from four key themes. A 4-point Likert scale questionnaire was sent to healthcare professionals working in COPD across Canada by an independent third party to assess agreement (consensus) with these statements. Consensus was defined as high if ≥75% and very high if ≥90% of respondents agreed with a statement. Results A total of 100 responses were received from respirologists (n=30), cardiologists (n=30), and primary care physicians (n=40). Consensus was very strong (≥90%) in 28 (70%) statements, strong (≥75 and <90%) in 7 (17.5%) statements and was not achieved (<75%) in 5 (12.5%) of statements. Conclusion Based on the consensus scores, 9 key recommendations were proposed by the steering group. These focus on the need to comprehensively risk stratify and manage COPD patients to help prevent exacerbations. Consensus within this study provides a call to action for the expeditious implementation of the latest COPD guidelines from the Canadian Thoracic Society.
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Affiliation(s)
- Mohit Bhutani
- Department of Medicine, Division of Pulmonary Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Jean Bourbeau
- Department of Medicine, Division of Pulmonary Medicine, McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - Shaun G Goodman
- Department of Medicine, Division of Cardiology, University of Toronto, Toronto, Ontario, Canada
| | - Nathaniel Mark Hawkins
- Department of Medicine, Division of Cardiology, University of British Columbia, Vancouver, British Columbia
| | - Alan G Kaplan
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Peter James Lin
- The Canadian Heart Research Centre, Primary Care Initiatives, Toronto, Ontario, Canada
| | - Erika Dianne Penz
- College of Medicine, Division of Respirology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Subodh Verma
- Department of Surgery, Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
| | - Shelley Zieroth
- College of Medicine, Section of Cardiology, University of Manitoba, Winnipeg, Manitoba, Canada
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Bourbeau J, Bhutani M, Hernandez P, Penz E, Marciniuk DD. Optimizing Pharmacotherapy Management of Chronic Obstructive Pulmonary Disease: Don't Miss the Forest for the Trees. Am J Respir Crit Care Med 2024; 210:545-547. [PMID: 38626371 PMCID: PMC11389587 DOI: 10.1164/rccm.202402-0338vp] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 04/16/2024] [Indexed: 04/18/2024] Open
Affiliation(s)
- Jean Bourbeau
- Department of Medicine, Respiratory Division, McGill University Health Centre, Montreal, Québec, Canada
| | - Mohit Bhutani
- Department of Medicine, Division of Pulmonary Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Paul Hernandez
- Division of Respirology, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada; and
| | - Erika Penz
- Division of Respirology, Critical Care and Sleep Medicine, and Respiratory Research Centre, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Darcy D Marciniuk
- Division of Respirology, Critical Care and Sleep Medicine, and Respiratory Research Centre, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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Kaplan A, Babineau A, Hauptman R, Levitz S, Lin P, Yang M. Breaking down barriers to COPD management in primary care: applying the updated 2023 Canadian Thoracic Society guideline for pharmacotherapy. Front Med (Lausanne) 2024; 11:1416163. [PMID: 39165372 PMCID: PMC11333456 DOI: 10.3389/fmed.2024.1416163] [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: 04/11/2024] [Accepted: 06/21/2024] [Indexed: 08/22/2024] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a highly prevalent yet under-recognized and sub-optimally managed disease that is associated with substantial morbidity and mortality. Primary care providers (PCPs) are at the frontlines of COPD management, and they play a critical role across the full spectrum of the COPD patient journey from initial recognition and diagnosis to treatment optimization and referral to specialty care. The Canadian Thoracic Society (CTS) recently updated their guideline on pharmacotherapy in patients with stable COPD, and there are several key changes that have a direct impact on COPD management in the primary care setting. Notably, it is the first guideline to formally make recommendations on mortality reduction in COPD, which elevates this disease to the same league as other chronic diseases that are commonly managed in primary care and where optimized pharmacotherapy can reduce all-cause mortality. It also recommends earlier and more aggressive initial maintenance inhaler therapy across all severities of COPD, and preferentially favors the use of single inhaler therapies over multiple inhaler regimens. This review summarizes some of the key guideline changes and offers practical tips on how to implement the new recommendations in primary care. It also addresses other barriers to optimal COPD management in the primary care setting that are not addressed by the guideline update and suggests strategies on how they could be overcome.
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Affiliation(s)
- Alan Kaplan
- Family Physician Airways Group of Canada, University of Toronto, Toronto, ON, Canada
| | - Amanda Babineau
- Respiratory Health Clinic, Vitalité Health Network, Moncton, NB, Canada
| | - Robert Hauptman
- Family Physician Airways Group of Canada, Department of Family Medicine, University of Alberta, Edmonton, AB, Canada
| | - Suzanne Levitz
- Medical Director Inpatient Pulmonary Rehabilitation Program, Mount Sinai Hospital, Montreal, QC, Canada
| | - Peter Lin
- Director Primary Care Initiatives, Canadian Heart Research Centre, Toronto, ON, Canada
| | - Molly Yang
- Wholehealth Pharmacy Partners, Markham, ON, Canada
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Bourbeau J, Sin DD. Global Initiative for Chronic Obstructive Lung Disease and Canadian Thoracic Society COPD Guidelines: Two Sides of the Same Coin or Different Coins? Chest 2024; 166:24-27. [PMID: 38986638 DOI: 10.1016/j.chest.2024.01.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 01/28/2024] [Accepted: 01/29/2024] [Indexed: 07/12/2024] Open
Affiliation(s)
- Jean Bourbeau
- Department of Medicine, Division of Pulmonary Medicine, McGill University Health Centre, McGill University, Montréal, QC, Canada
| | - Don D Sin
- Centre for Heart Lung Innovation, St. Paul's Hospital & Division of Respiratory Medicine, Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
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Mete RE. Examining the Impact of Social Support on Psychological Well-Being Among Canadian Individuals With COPD: Implications for Government Policies. THE YALE JOURNAL OF BIOLOGY AND MEDICINE 2024; 97:125-139. [PMID: 38947110 PMCID: PMC11202116 DOI: 10.59249/okab8606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
Chronic obstructive pulmonary disease (COPD) is a significant respiratory disease and is globally ranked as the third leading cause of death. In Canada, the direct healthcare costs associated with COPD are estimated to be $1.5 billion annually. This study utilized quantitative analyses to examine the impact of specific dimensions of social support, namely, guidance, reliable alliance, reassurance of worth, attachment, and social integration within a clinically identified population of individuals with COPD who exhibit symptoms of depression and anxiety. The study was based on the Social Provisions Theory and stress-buffering hypothesis, utilizing large-scale population data from Statistics Canada's 2012 Canadian Community Health Survey (CCHS) Mental Health component. On a national scale, individuals were more likely to report a decreased sense of belonging to a group of friends (social integration) and struggle to depend on others in stressful times (reliable alliance) while experiencing symptoms of anxiety and depression. These findings underscore the potential benefits of integrating peer support, socialization initiatives, and caregiver training into clinical programs designed for individuals with COPD.
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Saint-Pierre MD. Severe Acute Exacerbations of Chronic Obstructive Pulmonary Disease: Are There Significant Differences Between Hospitalized and Emergency Department Patients? Int J Chron Obstruct Pulmon Dis 2024; 19:133-138. [PMID: 38249827 PMCID: PMC10799575 DOI: 10.2147/copd.s447477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 01/10/2024] [Indexed: 01/23/2024] Open
Abstract
Rationale Current guidelines define a severe acute exacerbation of chronic obstructive pulmonary disease (AECOPD) as an increase in symptoms requiring hospital admission or emergency department (ED) visit. Little is known about whether or not subjects requiring hospitalization and those needing only ED care have similar patient profiles and if their clinical outcomes appear comparable. Objective The main goals of this study were to compare the demographic and clinical characteristics of patients treated for an AECOPD with an inpatient admission versus an ED visit and to review if hospital resource utilization was different between the 2 groups after discharge. Methods Subjects treated in 2022 at Montfort Hospital for an AECOPD were reviewed. Patient demographic information was collected in addition to spirometry results and blood eosinophil counts on file. Supplemental oxygen use and medication lists were also recorded. Patients with an initial hospital admission were compared to those requiring only ED care with univariate and multivariate analyses. We also assessed if subjects were again treated for an AECOPD up to 6 months post initial discharge, and if so, the type of hospital visits (hospitalization or ED). Measurements and Main Results A total of 135 individuals necessitated hospitalization and 79 received ED care for the treatment of an AECOPD. On univariate analysis, patients requiring an inpatient stay appeared older and were more likely to have spirometry results on file. A greater proportion of hospitalized individuals were on supplemental oxygen and prescribed at least one long-acting inhaled medication. These studied variables remained significant after multivariate logistic regression analysis. Subjects with an initial inpatient admission were also more likely to require hospitalization upon repeat presentation for a severe AECOPD. Conclusion Given the important differences observed in both patient characteristics and hospital resource utilization, this study supports considering an AECOPD requiring inpatient admission versus an ED visit as distinct categories of events.
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Affiliation(s)
- Mathieu D Saint-Pierre
- University of Ottawa, Faculty of Medicine, Ottawa, ON, Canada
- Institut du Savoir Montfort, Ottawa, ON, Canada
- Montfort Hospital, Division of Respirology, Ottawa, ON, Canada
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Blazer AJ, Stanbrook MB. De quelle manière les systèmes de santé au Canada peuvent-ils améliorer les soins aux personnes atteintes de maladie pulmonaire obstructive chronique? CMAJ 2023; 195:E1527-E1529. [PMID: 37963620 DOI: 10.1503/cmaj.230998-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023] Open
Affiliation(s)
- Alina J Blazer
- Département de pneumologie (Blazer, Stanbrook), Université de Toronto, Toronto, Ont.
| | - Matthew B Stanbrook
- Département de pneumologie (Blazer, Stanbrook), Université de Toronto, Toronto, Ont
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