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Jones P, Alzaabi A, Casas Herrera A, Polatli M, Rabahi MF, Cortes Telles A, Aggarwal B, Acharya S, Hasnaoui AE, Compton C. Understanding the Gaps in the Reporting of COPD Exacerbations by Patients: A Review. COPD 2024; 21:2316594. [PMID: 38421013 DOI: 10.1080/15412555.2024.2316594] [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: 12/01/2023] [Accepted: 02/05/2024] [Indexed: 03/02/2024]
Abstract
Exacerbations of chronic obstructive pulmonary disease (COPD) are associated with loss of lung function, poor quality of life, loss of exercise capacity, risk of serious cardiovascular events, hospitalization, and death. However, patients underreport exacerbations, and evidence suggests that unreported exacerbations have similar negative health implications for patients as those that are reported. Whilst there is guidance for physicians to identify patients who are at risk of exacerbations, they do not help patients recognise and report them. Newly developed tools, such as the COPD Exacerbation Recognition Tool (CERT) have been designed to achieve this objective. This review focuses on the underreporting of COPD exacerbations by patients, the factors associated with this, the consequences of underreporting, and potential solutions.
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Affiliation(s)
- Paul Jones
- Global Medical, Regulatory and Quality, GSK plc, Brentford, UK
| | - Ashraf Alzaabi
- Internal Medicine Department, College of Medicine and Health Sciences, UAE University, Al Ain, UAE
- Respirology Department, Zayed Military Hospital, Abu Dhabi, UAE
| | - Alejandro Casas Herrera
- AIREPOC (Integrated care and rehabilitation program of COPD), Fundación Neumológica Colombiana, Bogotá, Colombia
| | - Mehmet Polatli
- School of Medicine, Chest Disease Department, Aydin Adnan Menderes University, Aydin, Turkey
| | | | - Arturo Cortes Telles
- Clínica de Enfermedades Respiratorias Hospital Regional de Alta Especialidad de la Península de Yucatán, Yucatán, México
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Wuyts M, Hermans F, Breuls S, Everaerts S, Derom E, Janssens W, Demeyer H, Troosters T. Development and feasibility of an exercise training program in primary care for patients with COPD experiencing an acute exacerbation. Physiotherapy 2024; 123:81-90. [PMID: 38295552 DOI: 10.1016/j.physio.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 05/26/2023] [Accepted: 09/28/2023] [Indexed: 02/02/2024]
Abstract
BACKGROUND Starting rehabilitation soon after an acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is crucial to diminish the detrimental effects of this acute event on muscle function. However, uptake in outpatient pulmonary rehabilitation is low. OBJECTIVES To design and test a feasible, acceptable and accessible exercise training program (ETP) in primary care for patients experiencing an AECOPD. DESIGN (1) A literature review and qualitative study to develop an ETP and (2) A feasibility study of the ETP implemented in primary care. METHODS (1) The development of the ETP proceeded in several phases with input from different stakeholders through focus group discussions. (2) Patients experiencing a moderate or severe AECOPD were included and followed the ETP for two weeks with a physiotherapist in primary care. Interviews with the participants took place and patients were given the choice to complete the eight-week program. RESULTS (1) Six discussion sessions took place. The ETP contained a flexible set of progressively more difficult exercises applicable in a primary care practice. (2) Eight patients experiencing a moderate (n = 1) or severe (n = 7) AECOPD were included. Patients started the first physiotherapy session 5 (2-6) days after the start of their symptoms or hospital discharge. Seven patients wanted to complete the ETP. CONCLUSIONS An ETP in primary care is feasible, acceptable and accessible for patients experiencing a moderate or severe AECOPD, and for physiotherapists. The effectiveness of this ETP on muscle function and physical activity is currently under investigation in a RCT. CONTRIBUTION OF THE PAPER.
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Affiliation(s)
- Marieke Wuyts
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium; Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Fien Hermans
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium; Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Sofie Breuls
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | | | - Eric Derom
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - Wim Janssens
- Clinical department of Respiratory Diseases, UZ Leuven - BREATHE, Department CHROMETA, KU Leuven, Leuven, Belgium
| | - Heleen Demeyer
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium; Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
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Mendes MA, Janssen DJA, Marques A. Integrating palliative care education in pulmonary rehabilitation: a randomized controlled study protocol. BMC Palliat Care 2024; 23:76. [PMID: 38504215 PMCID: PMC10953131 DOI: 10.1186/s12904-024-01363-0] [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: 10/05/2023] [Accepted: 01/18/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND Palliative care addresses multiple unmet needs of people with chronic obstructive pulmonary disease (COPD) or interstitial lung diseases (ILD) and their family and/or friend caregivers, but it remains highly underused. Pulmonary rehabilitation (PR) may provide a key opportunity to introduce palliative care. We aim to explore the effects of palliative care education as part of PR on knowledge about this field in people with COPD or ILD and their family and/or friend caregivers. METHODS A randomized controlled study will compare PR with palliative care education (experimental) with traditional PR (control) in people with COPD or ILD and their family and/or friend caregivers. Family and/or friend caregivers will be invited to take part in education and psychosocial support sessions. In addition to the usual educational content, the experimental group will have a session on palliative care, a "Peer-to-peer session", two "Get-apart sessions" and online sessions. The "Peer-to-peer session" and the "Get-apart sessions" will be discussions about topics suggested by participants. The "Get-apart sessions" will be dedicated to people with COPD or ILD apart from their family and/or friend caregivers and vice versa. The online sessions will be zoom meetings to discuss any health-related issues raised by participants, at a flexible time. A mixed-methods approach will be used to evaluate the outcomes. The primary outcome will be knowledge about palliative care. Secondary outcomes will include attitude towards palliative care referral, symptoms, disease impact, health-related quality of life, needs, knowledge about the disease, burden of providing care, adherence, adverse events and referral to a specialist palliative care team. Quantitative and qualitative data will be collected at baseline and end of PR. At 6-months post-PR, only patient-reported outcomes will be collected. For the primary outcome, time*group interaction will be analyzed with mixed analysis of variance. DISCUSSION This study aims to demonstrate the impact of integrating palliative care into the PR education program. TRIAL REGISTRATION The trial was registered in the ClinicalTrials.gov U.S. National Library of Medicine, on 1st September, 2023 (NCT06046547).
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Affiliation(s)
- M Aurora Mendes
- Pneumologia, Centro Hospitalar do Baixo Vouga (CHBV), Aveiro, Portugal
- Respiratory Research and Rehabilitation Laboratory (Lab3R), School of Health Sciences (ESSUA), University of Aveiro, Aveiro, Portugal
- Institute of Biomedicine (iBiMED), University of Aveiro, Aveiro, Portugal
- Department of Health Services Research, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Daisy J A Janssen
- Department of Health Services Research, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Department of Family Medicine, Faculty of Health Medicine and Life Sciences, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
- Department of Research & Development, Ciro, Horn, The Netherlands
| | - Alda Marques
- Respiratory Research and Rehabilitation Laboratory (Lab3R), School of Health Sciences (ESSUA), University of Aveiro, Aveiro, Portugal.
- Institute of Biomedicine (iBiMED), University of Aveiro, Aveiro, Portugal.
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Wang Y, He R, Dong F, Liu D, Ren X, Yang T, Wang C. Re-exacerbation within 30 days of discharge is associated with poor prognosis in the following year among patients hospitalised with exacerbation of chronic obstructive pulmonary disease: a clinical cohort study. BMJ Open Respir Res 2023; 10:e001759. [PMID: 37640511 PMCID: PMC10462968 DOI: 10.1136/bmjresp-2023-001759] [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: 04/13/2023] [Accepted: 08/04/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Exacerbation of chronic obstructive pulmonary disease (ECOPD) is a complex phenomenon, with marked heterogeneity in the aetiology, pathophysiology and clinical manifestations. This study aimed to evaluate the clinical characteristics and long-term outcomes of patients with 30-day exacerbation among those hospitalised with ECOPD in China. METHODS Data from the Acute Exacerbations of Chronic Obstructive Pulmonary Disease Inpatient Registry were used in this study. The patients were divided into re-event and non-event groups based on the incidence of re-exacerbation within 30 days of discharge. Exacerbation, severe exacerbation and all-cause readmissions in the following 12 months were the outcomes of interest. The cumulative incidence rates and incidence densities were calculated. Multivariate hazard function models were used to determine the association between 30-day re-exacerbation and the long-term outcomes after accounting for the competing risk of death. RESULTS Re-exacerbation within 30 days of discharge was observed in 4.9% (n=242) of the patients (n=4963). The cumulative incidence rates and incidence densities of exacerbation, severe exacerbation and all-cause readmissions in the event group were significantly higher than those in the non-event group. After adjustment, re-exacerbation within 30 days of discharge was associated with increased risks of exacerbation, severe exacerbation and all-cause readmissions in the following 12 months (adjusted HR: 3.85 (95% CI: 3.09 to 4.80), 3.46 (2.66 to 4.50) and 3.28 (2.52 to 4.25) accordingly). CONCLUSION Re-exacerbation of COPD within 30 days of discharge is a significant predictor of long-term prognosis. In clinical practice, short-term re-exacerbation is a significant clinical phenotype of ECOPD that requires careful management at the earliest.
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Affiliation(s)
- Ye Wang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ruoxi He
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Department of Respiratory Medicine, National Key Clinical Specialty, Branch of National Clinical Research Center for Respiratory Disease, Xiangya Hospital, Central South University, Changsha, China
| | - Fen Dong
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
- National Center for Respiratory Medicine, Beijing, China
- National Clinical Research Center for Respiratory Diseases, Beijing, China
- Department of Clinical Research and Data Management, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Dongyan Liu
- School of Medicine, Tsinghua University, Beijing, China
| | - Xiaoxia Ren
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
- National Center for Respiratory Medicine, Beijing, China
- National Clinical Research Center for Respiratory Diseases, Beijing, China
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Ting Yang
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
- National Center for Respiratory Medicine, Beijing, China
- National Clinical Research Center for Respiratory Diseases, Beijing, China
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Chen Wang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
- National Center for Respiratory Medicine, Beijing, China
- National Clinical Research Center for Respiratory Diseases, Beijing, China
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
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