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Patel K, Smith DJ, Huntley CC, Channa SD, Pye A, Dickens AP, Gale N, Turner AM. Exploring the causes of COPD misdiagnosis in primary care: A mixed methods study. PLoS One 2024; 19:e0298432. [PMID: 38446828 PMCID: PMC10917297 DOI: 10.1371/journal.pone.0298432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 01/24/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Within primary care there exists a cohort of patients misdiagnosed with Chronic Obstructive Pulmonary Disease (COPD). Misdiagnosis can have a detrimental impact on healthcare finances and patient health and so understanding the factors leading to misdiagnosis is crucial in order to reduce misdiagnosis in the future. The objective of this study is to understand and explore the perceived causes of COPD misdiagnosis in primary care. METHODS A sequential mixed methods study, quantifying prevalence and features of patients misdiagnosed with COPD in primary care followed by a qualitative analysis to explore perceived causes of misdiagnosis. Quantitative data was collected for 206 patients identified as misdiagnosed with COPD within the INTEGR COPD study (NCT03482700). Qualitative data collected from 21 healthcare professionals involved in providing COPD care and 8 misdiagnosed patients who were recruited using a maximum variation purposive sampling. RESULTS Misinterpretation of spirometry results was the prevailing factor leading to patients initially being misdiagnosed with COPD, affecting 59% of misdiagnosed patients in this cohort. Of the 99 patients who were investigated for their underlying diagnosis; 41% had normal spirometry and 40% had asthma. Further investigation through qualitative methodology uncovered reluctance to challenge historical misdiagnoses and challenges in differential diagnosis as the underlying explanations for COPD misdiagnosis in this cohort. CONCLUSIONS Patients historically diagnosed with COPD without spirometric evidence are at risk of remaining labelled and treated for COPD despite non-obstructive respiratory physiology, leading to a persistent cohort of patients misdiagnosed with COPD in primary care. The lack of spirometry services during and after the COVID19 pandemic in primary care risks adding to the cohort of misdiagnosed patients. Support from respiratory specialists can potentially help to reduce the prevalence of COPD misdiagnosis in primary care. TRIAL REGISTRATION NCT03482700.
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Affiliation(s)
- Ketan Patel
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | | | | | - Sunita D. Channa
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Anita Pye
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Andrew P. Dickens
- Observational and Pragmatic Research Institute, Midview City, Singapore
| | - Nicola Gale
- School of Social Policy, University of Birmingham, Birmingham, United Kingdom
| | - Alice M. Turner
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
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Islam R, Ahmed S, Chakma SK, Mahmud T, Al Mamun A, Islam Z, Islam MM. Smoking and pre-existing co-morbidities as risk factors for developing severity of COVID-19 infection: Evidence from a field hospital in a rural area of Bangladesh. PLoS One 2023; 18:e0295040. [PMID: 38064450 PMCID: PMC10707513 DOI: 10.1371/journal.pone.0295040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 11/15/2023] [Indexed: 12/18/2023] Open
Abstract
Since August 2020; the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) in collaboration with UNICEF has been operating a COVID-19 field hospital at the Teknaf sub-district of Cox's Bazar in Bangladesh. This paper is focused on estimating the effects of a history of tobacco smoking and pre-existing co-morbidities on the severity of COVID-19 infection among adult patients admitted into the aforesaid hospital. We conducted a retrospective data analysis of COVID-19 adult patients hospitalized from August 27, 2020 to April 20, 2022. Based on inclusion criteria; a total of 788 admitted patients were included in the analysis. We conducted a Chi-squared test and Fisher's exact test for the categorical variables to see their associations. Multinomial logistic regression models were performed to explore the risk factors for the severity of COVID-19 infection. Among 788 patients, 18.4%, 18.8%, 13%, 7.1%, 3.4%, and 1.9% have had a history of smoking, hypertension, diabetes, chronic obstructive pulmonary disease (COPD), cardiovascular diseases (CVD), and asthma respectively. Overall, the mean age of the patients was 40.3 ± 16.4 years and 51% were female. In multivariate analysis, history of smoking and co-morbidities were identified as the risk factors for the severity of COVID-19 infection; the history of smoking was found linked with an increase in the risk of developing critical, severe, and moderate level of COVID-19 infection- notably 3.17 times (RRR = 3.17; 95% CI: 1.3-7.68), 2.98 times (RRR = 2.98; 95% CI: 1.87-4.76) and 1.96 times (RRR = 1.96; 95% CI: 1.25-3.08) respectively more than the patients who never smoked. It was evident that patients with at least one of the selected co-morbidities such as hypertension, diabetes, COPD, CVD, and asthma exhibited a significantly higher likelihood of experiencing severe illness of COVID-19 compared to patients without any co-morbidity. History of tobacco smoking and pre-existing co-morbidities were significantly associated with an increased severity of COVID-19 infection.
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Affiliation(s)
- Rashadul Islam
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Sayem Ahmed
- Health Economics and Health Technology Assessment, Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Samar Kishor Chakma
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Tareq Mahmud
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Abdullah Al Mamun
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Ziaul Islam
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - M. Munirul Islam
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
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Beyer C, Boehm A, Pizzini A, Grubwieser P, Feuchtner G, Bauer A, Weiss G, Loeffler-Ragg J, Friedrich G, Plank F. Undiagnosed chronic respiratory disorders in symptomatic patients with initially suspected and excluded coronary artery disease: insights from a prospective pilot study. Front Med (Lausanne) 2023; 10:1181831. [PMID: 37396893 PMCID: PMC10310789 DOI: 10.3389/fmed.2023.1181831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 05/24/2023] [Indexed: 07/04/2023] Open
Abstract
Background Chronic respiratory diseases represent the third-leading cause of death on a global scale. Due to mutual symptoms with cardiovascular diseases and potential inappropriate attribution of symptoms, pulmonary diseases often remain undiagnosed. Therefore, we aimed to evaluate the prevalence of chronic respiratory disorders among symptomatic patients in whom suspected coronary artery disease (CAD) was ruled out. Methods After CAD was excluded by invasive coronary angiography (ICA), 50 patients with chest pain or dyspnea were prospectively enrolled in this study. All patients underwent lung function testing, including spirometry and diffusion measurements. At baseline and the 3-month follow-up, standardized assessments of symptoms (CCS chest pain, mMRC score, CAT score) were performed. Results Chronic respiratory disease was diagnosed in 14% of patients, with a prevalence of 6% for chronic obstructive ventilation disorders. At 3-month follow-up, patients with normal lung function tests revealed a substantial improvement in symptoms (mean mMRC 0.70 to 0.33, p = 0.06; median CAT 8 to 2, p = 0.01), while those with pulmonary findings showed non-significant alterations or unchanged symptoms (mean mMRC 1.14 to 0.71, p = 0.53; median CAT 6 to 6, p = 0.52). Conclusion A substantial proportion of patients with an initial suspicion of coronary artery disease was diagnosed with underlying chronic respiratory diseases and exhibited persistent symptoms.
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Affiliation(s)
- Christoph Beyer
- Department of Internal Medicine III – Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Anna Boehm
- Department of Internal Medicine II – Infectious Diseases, Pneumology and Rheumatology, Medical University of Innsbruck, Innsbruck, Austria
| | - Alex Pizzini
- Department of Internal Medicine II – Infectious Diseases, Pneumology and Rheumatology, Medical University of Innsbruck, Innsbruck, Austria
- Servizio Pneumologico Aziendale, Azienda Sanitaria dell’ Alto Adige, Bolzano, Italy
| | - Philipp Grubwieser
- Department of Internal Medicine II – Infectious Diseases, Pneumology and Rheumatology, Medical University of Innsbruck, Innsbruck, Austria
| | - Gudrun Feuchtner
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Axel Bauer
- Department of Internal Medicine III – Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Guenter Weiss
- Department of Internal Medicine II – Infectious Diseases, Pneumology and Rheumatology, Medical University of Innsbruck, Innsbruck, Austria
| | - Judith Loeffler-Ragg
- Department of Internal Medicine II – Infectious Diseases, Pneumology and Rheumatology, Medical University of Innsbruck, Innsbruck, Austria
| | - Guy Friedrich
- Department of Internal Medicine III – Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Fabian Plank
- Department of Internal Medicine III – Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria
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Perret J, Yip SWS, Idrose NS, Hancock K, Abramson MJ, Dharmage SC, Walters EH, Waidyatillake N. Undiagnosed and 'overdiagnosed' COPD using postbronchodilator spirometry in primary healthcare settings: a systematic review and meta-analysis. BMJ Open Respir Res 2023; 10:10/1/e001478. [PMID: 37130651 DOI: 10.1136/bmjresp-2022-001478] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 03/24/2023] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND Despite chronic obstructive pulmonary disease (COPD) being a major global cause of mortality and hospitalisation, it is often undiagnosed or inaccurately diagnosed in clinical settings. OBJECTIVE To systematically synthesise all peer-reviewed papers from primary healthcare settings that have reported data on: (1) undiagnosed COPD, that is, patients with respiratory symptoms and postbronchodilator airflow obstruction consistent with COPD, without a formal clinician's diagnosis of COPD either documented in health records or reported by patients and (2) 'overdiagnosed COPD', that is, clinician's diagnosis without postbronchodilator airflow obstruction. METHODS Studies investigating these diagnostic metrics in patients from primary healthcare clinics (according to predefined inclusion/exclusion criteria) were sourced from Medline and Embase and assessed for bias (Johanna Briggs Institute tools for prevalence studies and case series). Meta-analyses of studies of adequate sample size used random effect modelling stratified by risk factor categories. RESULTS Of 26 eligible articles, 21 cross-sectional studies investigated 3959 cases of spirometry-defined COPD (with or without symptoms), and 5 peer-reviewed COPD case series investigated 7381 patients. The prevalence of spirometry-confirmed COPD without a diagnosis documented in their health records was 14%-26% in studies of symptomatic smokers (N=3). 1 in 4 patients taking inhaled therapies (25% (95% CI 22% to 28%), N=2) and 1 in 6 smokers irrespective of symptoms (16% (95% CI 14% to 18%), N=6) fulfilled diagnostic spirometry criteria but did not report receiving a COPD-related diagnosis. In an adequately powered series of COPD cases documented in primary healthcare records (N=4), only between 50% and 75% of subjects had any airflow obstruction on postbronchodilator spirometry performed by study researchers, therefore, COPD was clinically 'overdiagnosed' in 25%-50% of subjects. DISCUSSION Although data were heterogeneous and of modest quality, undiagnosed COPD was common in primary healthcare, especially for symptomatic smokers and patients treated with inhaled therapies. In contrast, frequent COPD 'overdiagnosis' may represent treatment of asthma/reversible component or another medical diagnosis. PROSPERO REGISTRATION NUMBER CRD42022295832.
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Affiliation(s)
- Jennifer Perret
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia
- Institute for Breathing and Sleep (IBAS), Melbourne, Victoria, Australia
| | - Sui Wah Sean Yip
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Nur Sabrina Idrose
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Centre for Food and Allergy Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Kerry Hancock
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Chandlers Hill Surgery, Happy Valley, South Australia, Australia
| | - Michael J Abramson
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Shyamali C Dharmage
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - E Haydn Walters
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Nilakshi Waidyatillake
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Medical Education, The University of Melbourne, Melbourne, Victoria, Australia
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Cross AJ, Thomas D, Liang J, Abramson MJ, George J, Zairina E. Educational interventions for health professionals managing chronic obstructive pulmonary disease in primary care. Cochrane Database Syst Rev 2022; 5:CD012652. [PMID: 35514131 PMCID: PMC9073270 DOI: 10.1002/14651858.cd012652.pub2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a common, preventable and treatable health condition. COPD is associated with substantial burden on morbidity, mortality and healthcare resources. OBJECTIVES To review existing evidence for educational interventions delivered to health professionals managing COPD in the primary care setting. SEARCH METHODS We searched the Cochrane Airways Trials Register from inception to May 2021. The Register includes records from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Allied and Complementary Medicine Database (AMED) and PsycINFO. We also searched online trial registries and reference lists of included studies. SELECTION CRITERIA We included randomised controlled trials (RCTs) and cluster-RCTs. Eligible studies tested educational interventions aimed at any health professionals involved in the management of COPD in primary care. Educational interventions were defined as interventions aimed at upskilling, improving or refreshing existing knowledge of health professionals in the diagnosis and management of COPD. DATA COLLECTION AND ANALYSIS Two review authors independently reviewed abstracts and full texts of eligible studies, extracted data and assessed the risk of bias of included studies. We conducted meta-analyses where possible and used random-effects models to yield summary estimates of effect (mean differences (MDs) with 95% confidence intervals (CIs)). We performed narrative synthesis when meta-analysis was not possible. We assessed the overall certainty of evidence for each outcome using Grades of Recommendation, Assessment, Development and Evaluation (GRADE). Primary outcomes were: 1) proportion of COPD diagnoses confirmed with spirometry; 2) proportion of patients with COPD referred to, participating in or completing pulmonary rehabilitation; and 3) proportion of patients with COPD prescribed respiratory medication consistent with guideline recommendations. MAIN RESULTS We identified 38 studies(22 cluster-RCTs and 16 RCTs) involving 4936 health professionals (reported in 19/38 studies) and 71,085 patient participants (reported in 25/38 studies). Thirty-six included studies evaluated interventions versus usual care; seven studies also reported a comparison between two or more interventions as part of a three- to five-arm RCT design. A range of simple to complex interventions were used across the studies, with common intervention features including education provided to health professionals via training sessions, workshops or online modules (31 studies), provision of practice support tools, tool kits and/or algorithms (10 studies), provision of guidelines (nine studies) and training on spirometry (five studies). Health professionals targeted by the interventions were most commonly general practitioners alone (20 studies) or in combination with nurses or allied health professionals (eight studies), and the majority of studies were conducted in general practice clinics. We identified performance bias as high risk for 33 studies. We also noted risk of selection, detection, attrition and reporting biases, although to a varying extent across studies. The evidence of efficacy was equivocal for all the three primary endpoints evaluated: 1) proportion of COPD diagnoses confirmed with spirometry (of the four studies that reported this outcome, two supported the intervention); 2) proportion of patients with COPD who are referred to, participate in or complete pulmonary rehabilitation (of the four studies that reported this outcome, two supported the intervention); and 3) proportion of patients with COPD prescribed respiratory medications consistent with guideline recommendations (12 studies reported this outcome, the majority evaluated multiple drug classes and reported a mixed effect). Additionally, the low quality of evidence and potential risk of bias make the interpretation more difficult. Moderate-quality evidence (downgraded due to risk of bias concerns) suggests that educational interventions for health professionals probably improve the proportion of patients with COPD vaccinated against influenza (three studies) and probably have little impact on the proportion of patients vaccinated against pneumococcal infection (two studies). Low-quality evidence suggests that educational interventions for health professionals may have little or no impact on the frequency of COPD exacerbations (10 studies). There was a high degree of heterogeneity in the reporting of health-related quality of life (HRQoL). Low-quality evidence suggests that educational interventions for health professionals may have little or no impact on HRQoL overall, and when using the COPD-specific HRQoL instrument, the St George's Respiratory Questionnaire (at six months MD 0.87, 95% CI -2.51 to 4.26; 2 studies, 406 participants, and at 12 months MD -0.43, 95% CI -1.52 to 0.67, 4 studies, 1646 participants; reduction in score indicates better health). Moderate-quality evidence suggests that educational interventions for health professionals may improve patient satisfaction with care (one study). We identified no studies that reported adverse outcomes. AUTHORS' CONCLUSIONS The evidence of efficacy was equivocal for educational interventions for health professionals in primary care on the proportion of COPD diagnoses confirmed with spirometry, the proportion of patients with COPD who participate in pulmonary rehabilitation, and the proportion of patients prescribed guideline-recommended COPD respiratory medications. Educational interventions for health professionals may improve influenza vaccination rates among patients with COPD and patient satisfaction with care. The quality of evidence for most outcomes was low or very low due to heterogeneity and methodological limitations of the studies included in the review, which means that there is uncertainty about the benefits of any currently published educational interventions for healthcare professionals to improve COPD management in primary care. Further well-designed RCTs are needed to investigate the effects of educational interventions delivered to health professionals managing COPD in the primary care setting.
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Affiliation(s)
- Amanda J Cross
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Australia
| | - Dennis Thomas
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, University of Newcastle, Newcastle, Australia
| | - Jenifer Liang
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Australia
| | - Michael J Abramson
- School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
| | - Johnson George
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Australia
| | - Elida Zairina
- Department of Pharmacy Practice, Faculty of Pharmacy, Universitas Airlangga, Surabaya, Indonesia
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Environmental Substances Associated with Chronic Obstructive Pulmonary Disease-A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19073945. [PMID: 35409627 PMCID: PMC8997594 DOI: 10.3390/ijerph19073945] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/16/2022] [Accepted: 03/23/2022] [Indexed: 12/13/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is a slowly developing non-communicable disease (NCD), causing non-reversible obstruction and leading to marked morbidity and mortality. Besides traditional risk factors such as smoking, some environmental substances can augment the risk of COPD. The European Human Biomonitoring Initiative (HBM4EU) is a program evaluating citizens’ exposure to various environmental substances and their possible health impacts. Within the HBM4EU, eighteen priority substances or substance groups were chosen. In this scoping review, seven of these substances or substance groups are reported to have an association or a possible association with COPD. Main exposure routes, vulnerable and high-exposure risk groups, and matrices where these substances are measured are described. Pesticides in general and especially organophosphate and carbamate insecticides, and some herbicides, lead (Pb), and polycyclic aromatic hydrocarbons (PAHs) showed an association, and cadmium (Cd), chromium (Cr and CrVI), arsenic (As), and diisocyanates, a possible association with COPD and/or decreased lung function. Due to long latency in COPD’s disease process, the role of chemical exposure as a risk factor for COPD is probably underestimated. More research is needed to support evidence-based conclusions. Generally, chemical exposure is a growing issue of concern, and prompt action is needed to safeguard public health.
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Ayuk A, Ndukwu C, Uwaezuoke S, Ekop E. Spirometry practice and the impact of a phase 1 training workshop among health workers in southern Nigeria: a cross-sectional study. BMC Pulm Med 2020; 20:258. [PMID: 33023557 PMCID: PMC7538053 DOI: 10.1186/s12890-020-01291-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 09/16/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Global standards require that spirometry should be performed by trained and experienced personnel, who would be able to assess the correct performance of tests by patients and assure good quality of the result. The complete achievement of this requires a two-step assessment where competency in both knowledge and skills are tested. This study aims to assess the impact of a one-day hands-on spirometry training (Phase1), on the knowledge and application of spirometry among health workers. METHODS This was a descriptive cross-sectional study, which describes a one-day (seven hours) spirometry training and skills impartation done at two conference city locations in Enugu and Calabar in the southern part of Nigeria. All the verbally consenting attendees who completed the training assessment tests constituted the study population. The assessment of the spirometry knowledge base before and after the theory and practical sessions, on the various aspects of spirometry, according to international best practices, quality assurance and the interpretation of results, was done and the outcome was analyzed. Factors that could affect the outcome were also assessed. RESULTS There were 64 consenting participants of whom 54.7% (35/64) were females. Theparticipants demonstrated much improved post-intervention knowledge and could satisfactorily perform spirometry, calibration, interpretation of test results and quality control as evidenced by the post test scores after practical sessions were conducted. Pre-test mean scores improved by a mean difference of 12% (p < 001) and were affected by the year of academic graduation and availability of spirometers at the place of work, an effect that was no longer seen at post-test following the hands-on spirometry training. CONCLUSION The present study has shown that a one-day spirometry workshop significantly improved the knowledge of spirometry practice. There is need to set up more frequent locally-organized spirometry workshops since a one-day seven-hour effective knowledge and practical training would most likely have significant impact on participants' spirometry practice with its expected positive outcome on respiratory health in Nigeria.
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Affiliation(s)
- Adaeze Ayuk
- College of Medicine, University of Nigeria Ituku-Ozalla Enugu Campus, Enugu, Nigeria
- Department of Pediatrics, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
| | - Chizalu Ndukwu
- Department of Paediatrics, College of Medicine, Nnamdi Azikiwe University, Awka, Anambra Nigeria
| | - Samuel Uwaezuoke
- College of Medicine, University of Nigeria Ituku-Ozalla Enugu Campus, Enugu, Nigeria
- Department of Pediatrics, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
| | - Eno Ekop
- College of Health Science, University of Abuja, Abjua, Nigeria
- Department of Paediatrics, Gwagwalada Teaching Hospital Abuja FCT, Abuja, Nigeria
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Naranjo L, Torres-Duque CA, Colodenco D, Lopardo G, Rodriguez P, Agra de Albuquerque-Neto A, Hernandez-Zenteno RJ, Septien L, Chandler R, Ortega-Barria E, Juliao P, Guzman-Holst A. Highlights of an Expert Advisory Board on Acute Exacerbations of Chronic Obstructive Pulmonary Disease (AE-COPD) in Latin America. Int J Chron Obstruct Pulmon Dis 2020; 15:1919-1929. [PMID: 32821094 PMCID: PMC7418149 DOI: 10.2147/copd.s261258] [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: 05/05/2020] [Accepted: 07/21/2020] [Indexed: 12/02/2022] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) is a preventable and usually progressive lung disease that affects millions of people worldwide and is the sixth leading cause of death in the Americas. Viral and bacterial respiratory tract infections and air pollution may cause acute exacerbations of COPD (AE-COPD) ranging from mild, moderate to severe. The greatest proportion of the overall COPD burden on the health system is due to disease exacerbations. There is limited evidence regarding the etiology and burden of AE-COPD in Latin America (LATAM). Methods To respond to this gap in evidence, an Advisory Board with regional pneumologists and infectious disease experts was convened in September 2018 in Panama City, Panama, to: 1) review the burden of AE-COPD in LATAM; 2) evaluate the etiology of AE-COPD in LATAM; and 3) assess and compare the local/regional guidelines to confirm the etiology, characterize, and manage AE-COPD. Results The results of the meeting showed that there is a high prevalence of AE-COPD in LATAM countries, limited evidence on etiology data, and discrepancies in the case definitions and symptomology (ie, severity) classifications used in LATAM. Conclusion The Advisory Board discussions further resulted in recommendations for future research on the impact on the epidemiology and burden of disease, on establishing standardized AE-COPD case definition guidelines, and on studying the etiology of both moderate and severe AE-COPD cases.
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Affiliation(s)
| | | | - Daniel Colodenco
- Director of Pneumology Specialization Course, University of Buenos Aires, Buenos Aires, Argentina
| | | | - Pablo Rodriguez
- Pulmonary and Critical Care Medicine, CEMIC, Buenos Aires, Argentina
| | | | | | - Luis Septien
- Pulmonary and Critical Care Division, National Institute of Nutrition Salvador Zubiran, Mexico City, Mexico
| | - Reynaldo Chandler
- Education and Investigation Coordination Unit, San Miguel Arcangel Hospital, Ministry of Health, Panama City, Panama
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Saba M, Davoodabadi A, Ghaffari A, Gilasi H, Haghpanah B. Combination adjunctive nebulized furosemide and salbutamol versus single agent therapy in COPD patients: A randomized controlled trial. Ann Med Surg (Lond) 2020; 57:85-90. [PMID: 32728436 PMCID: PMC7381425 DOI: 10.1016/j.amsu.2020.07.005] [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: 04/24/2020] [Revised: 07/04/2020] [Accepted: 07/06/2020] [Indexed: 11/02/2022] Open
Abstract
Background COPD patients often require multiple therapies to enhance their lung function and reduce their symptoms in exacerbations. This study aimed to investigate the relative effects of combination adjunctive nebulized furosemide and salbutamol therapy versus single agent treatment in COPD patients. Methods Sixty-nine COPD patients were randomly divided into two groups. The first group (G1, 34 cases) received salbutamol in their first episode. The second group (G2, 35 cases) received furosemide in their first episode. Spirometry indices (FEV1, FVC, and FEV1/FVC), mMRC and BORG (COPD assessment) were assessed and recorded for all patients.To study the efficacy of combination adjunctive therapy, in 2nd episodes, the nebulized furosemide was added to nebulized salbutamol in the G1, and nebulized salbutamol was added to nebulized furosemide in G2. The aforementioned indices were then re-assessed. Results The mean age was (64.92 ± 11.71 years, 55% males. The use of nebulized furosemide and salbutamol as single agents slightly improved the spirometeric parameters, but it was not noteworthy compared to the significant improvement of the FEV1, FVC, FEV1/FVC, mMRC, and Borg parameters with combination therapy (p-value< 0.001). In the first episode, there was no difference in spirometeric indices, between groups (p-value > 0.1), so furosemide is considered as effective as nebulized salbutamol. Also, the results of sequential drugs administration, in the two groups was similar. Conclusion Conjunction of nebulized furosemide and salbutamol is more effective than single therapy and can be considered as preferred drug regimen without any reported side effect in the treatment of COPD.
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Affiliation(s)
| | | | - Azin Ghaffari
- Internal Medicine, Shahid Beheshti Hospital, Kashan, Iran
| | - Hamidreza Gilasi
- Departments of Epidemiology & Biostatistics, Kashan University of Medical Sciences, Kashan, Iran
| | - Babak Haghpanah
- Orthopedic Surgery, Kashan University of Medical Sciences, Kashan, Iran
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Saranya V, Kuppusamy S, Pal P, Malathi M, Rajappa M, Fredrick J. Pulmonary function severity in relation to interleukin-23 levels in patients with psoriasis vulgaris. J Basic Clin Physiol Pharmacol 2020; 31:jbcpp-2019-0229. [PMID: 33258363 DOI: 10.1515/jbcpp-2019-0229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Accepted: 02/01/2020] [Indexed: 11/15/2022]
Abstract
Background Interleukin-23 (IL-23), a key inflammatory regulator in the pathogenesis of psoriasis, is suspected to play a role in the onset of pulmonary dysfunction (chronic obstructive pulmonary disease) in psoriasis. Despite that, pulmonary function tests are rarely studied in these subjects. This study aims to seek a possible relation between pulmonary function in psoriasis patients serum IL-23. Methods For this analytical cross-sectional study, male psoriasis patients in the age group of 25-45 years were recruited from dermatology out patient department (n = 40). Age and BMI matched apparently healthy individuals were recruited as control group (n = 40). After obtaining demographic and personal details, anthropometric parameters and blood pressure were recorded. The severity of psoriasis was assessed using Psoriasis Area and Severity Index score. Pulmonary function was assessed using computerized spirometry, and serum IL-23 was measured using ELISA. Results Forced vital capacity, forced expiratory volume in 1 s, peak expiratory flow rate, and forced expiratory flow at 25%-75% of the pulmonary volume (FEF25%-75%) were significantly reduced in psoriasis. Based on the percentage of predicted values FEF25%-75% was significantly reduced in psoriasis. Serum IL-23 (pg/mL) was significantly higher in psoriasis. The increase in IL-23 in psoriasis subjects does not correlate with their pulmonary function. Conclusions Psoriasis may be associated with a reduced lung function even when the disease is in the mild stage. Increased IL-23 found in these subjects is suggestive of systemic inflammation, which indirectly lowers lung function.
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Affiliation(s)
| | | | - Pravati Pal
- Department of Physiology, JIPMER, Puducherry, India
| | | | - Medha Rajappa
- Department of Biochemistry, JIPMER, Puducherry, India
| | - Jean Fredrick
- Department of Physiology, Mahatma Gandhi Medical College and Research Institute, Puducherry, India
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11
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Uzzaman MN, Banu S, Habib GM, Hossain AE, Kabir MJ, Karim MR, Islam MR, Sarker MHR, Uddin MJ, Uddin A. Improving Physicians' Capacity for Chronic Obstructive Pulmonary Disease Care through Blended E-learning: A Pilot Study in Bangladesh. Cureus 2018; 10:e3808. [PMID: 30868022 PMCID: PMC6402724 DOI: 10.7759/cureus.3808] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Patients with chronic obstructive pulmonary disease (COPD) are often under diagnosed and managed without evidence-based approach in primary care settings. This may be due to gaps in knowledge and practice of using updated COPD guidelines by the physicians in public and private sectors in Bangladesh. To our knowledge, this is the first study in Bangladesh which aims to evaluate a blended e-learning approach for building capacity of physicians working at low-resource environments on COPD patient care. In total, 32 practicing physicians were enrolled where 16 received training via blended approach and 16 received training via traditional classroom-based approach. Using a standard examination procedure and assessment approach both groups were assessed and results were documented. No statistically significant differences were found in the scores of theory (knowledge) and in the total scores (theory plus practicum) of both groups indicating that learning objectives were achieved in both the groups though the scores were significantly higher in practicum of the traditional learning group. Besides, Likert-scale-based self-reported pre-post changes indicate that both the groups were confident (statistically significant) in the management of COPD. Most importantly, the blended group had a minimal disruption of their services as they attended face-to-face only during the practicum sessions. Overall, the blended e-learning appears to be a feasible approach of training for physicians on standard management of COPD especially in health human resource-poor settings in Bangladesh.
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Affiliation(s)
- Md Nazim Uzzaman
- Epidemiology and Public Health, International Centre for Diarrhoeal Disease Research, Dhaka, BGD
| | - Shakila Banu
- Epidemiology and Public Health, International Centre for Diarrhoeal Disease Research, Dhaka, BGD
| | - Gm Monsur Habib
- Internal Medicine, Bangladesh Primary Care Respiratory Society, Dhaka, USA
| | | | | | - Md Rizwanul Karim
- Epidemiology and Public Health, Directorate General of Health Services, Dhaka, BGD
| | | | | | - Md Jasim Uddin
- Epidemiology and Public Health, International Centre for Diarrhoeal Disease Research, Dhaka, BGD
| | - Aftab Uddin
- Epidemiology and Public Health, International Centre for Diarrhoeal Disease Research, Dhaka, BGD
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12
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van der Molen T, Kocks JWH, Tsiligianni IG. Finding the Missing Millions: Can a New Questionnaire Help to Detect Undiagnosed Chronic Obstructive Pulmonary Disease? Am J Respir Crit Care Med 2017; 195:708-710. [PMID: 28294653 DOI: 10.1164/rccm.201610-2146ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Thys van der Molen
- 1 Department of General Practice and Elderly Care Medicine.,2 Groningen Research Institute for Asthma and COPD University of Groningen, University Medical Center Groningen Groningen, the Netherlands and
| | - Janwillem W H Kocks
- 1 Department of General Practice and Elderly Care Medicine.,2 Groningen Research Institute for Asthma and COPD University of Groningen, University Medical Center Groningen Groningen, the Netherlands and
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13
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De Giorgio A, Dante A, Cavioni V, Padovan AM, Rigonat D, Iseppi F, Graceffa G, Gulotta F. The IARA Model as an Integrative Approach to Promote Autonomy in COPD Patients through Improvement of Self-Efficacy Beliefs and Illness Perception: A Mixed-Method Pilot Study. Front Psychol 2017; 8:1682. [PMID: 29062286 PMCID: PMC5640890 DOI: 10.3389/fpsyg.2017.01682] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 09/12/2017] [Indexed: 01/09/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is one of the most deadly and costly chronic diseases in the world characterized by many breathing problems. The management of COPD and the prevention of exacerbations are a priority goals to improve the quality of life in patients affected by this illness. In addition, it is also crucial to improve the patients' adherence to care which, in turn, depends on their knowledge and understanding of some factors such as the prescribed medical treatment, changes in dailylife, and the process of breathing. In turn, the adherence to care leads to greater autonomy for the patient who is thus able to better manage his illness. Here we presented the application of the Model IARA in patients affected by COPD in order to achieve their autonomy in illness management which, in turn, leads to a better quality of life. IARA is an intervention program which improve the awareness and knowledge of patients with respect to both the disease and symptoms through health education. Moreover, through IARA the patients are encouraged to become more actively involved in COPD care process, also regarding drug therapy adherence. Using St. George's Respiratory Questionnaire combined with qualitative analysis, we demonstrated that IARA could be considered a useful approach in COPD management.
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Affiliation(s)
- Andrea De Giorgio
- Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
- Kiara Association, Turin, Italy
- Psychology, Università degli Studi eCampus, Novedrate, Italy
| | - Angelo Dante
- Department of Medicine, Surgery and Health Sciences, Nursing School, University of Trieste, Trieste, Italy
- Department of Health, Life and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Valeria Cavioni
- Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | | | - Desiree Rigonat
- Engineering and Architecture, University of Trieste, Trieste, Italy
| | - Francesca Iseppi
- Department of Medicine, Surgery and Health Sciences, Nursing School, University of Trieste, Trieste, Italy
| | - Giuseppina Graceffa
- Department of Medicine, Surgery and Health Sciences, Nursing School, University of Trieste, Trieste, Italy
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14
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Bodas M, Vij N. Augmenting autophagy for prognosis based intervention of COPD-pathophysiology. Respir Res 2017; 18:83. [PMID: 28472967 PMCID: PMC5418861 DOI: 10.1186/s12931-017-0560-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 04/20/2017] [Indexed: 12/15/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is foremost among the non-reversible fatal ailments where exposure to tobacco/biomass-smoke and aging are the major risk factors for the initiation and progression of the obstructive lung disease. The role of smoke-induced inflammatory-oxidative stress, apoptosis and cellular senescence in driving the alveolar damage that mediates the emphysema progression and severe lung function decline is apparent, although the central mechanism that regulates these processes was unknown. To fill in this gap in knowledge, the central role of proteostasis and autophagy in regulating chronic lung disease causing mechanisms has been recently described. Recent studies demonstrate that cigarette/nicotine exposure induces proteostasis/autophagy-impairment that leads to perinuclear accumulation of polyubiquitinated proteins as aggresome-bodies, indicative of emphysema severity. In support of this concept, autophagy inducing FDA-approved anti-oxidant drugs control tobacco-smoke induced inflammatory-oxidative stress, apoptosis, cellular senescence and COPD-emphysema progression in variety of preclinical models. Hence, we propose that precise and early detection of aggresome-pathology can allow the timely assessment of disease severity in COPD-emphysema subjects for prognosis-based intervention. While intervention with autophagy-inducing drugs is anticipated to reduce alveolar damage and lung function decline, resulting in a decrease in the current mortality rates in COPD-emphysema subjects.
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Affiliation(s)
- Manish Bodas
- Molecular & Cell Biology, College of Medicine, Central Michigan University, Mt Pleasant, 2630 Denison Drive, Room# 120 (Office) & 126-127 (Lab), College of Medicine Research Building, Mt. Pleasant, MI 48859 USA
| | - Neeraj Vij
- Molecular & Cell Biology, College of Medicine, Central Michigan University, Mt Pleasant, 2630 Denison Drive, Room# 120 (Office) & 126-127 (Lab), College of Medicine Research Building, Mt. Pleasant, MI 48859 USA
- Department of Pediatrics and Pulmonary Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland USA
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15
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Eftekhari P, Forder PM, Majeed T, Byles JE. Impact of asthma on mortality in older women: An Australian cohort study of 10,413 women. Respir Med 2016; 119:102-108. [PMID: 27692129 DOI: 10.1016/j.rmed.2016.08.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Revised: 08/26/2016] [Accepted: 08/27/2016] [Indexed: 01/06/2023]
Abstract
BACKGROUND Comorbid conditions frequently coexist with asthma in older adults and can alter the natural history of asthma, complicating management and affecting overall prognosis and survival. OBJECTIVES This study investigates the impact of asthma on mortality among older women, with a specific interest in influence of comorbidities and social factors on survival of older women with asthma. DESIGN Participants were from the Australian Longitudinal Study on Women's Health and were born between 1921 and 1926. Cox proportional hazards were used to evaluate mortality rates for women with and without asthma, after adjustment for comorbidities and other factors. RESULTS Of 10,413 women aged 73-78, 829 (8%) reported having been diagnosed by a doctor for asthma. Women with asthma had a higher likelihood of heart disease, hypertension, thrombosis, bronchitis/emphysema, osteoporosis and major illnesses (p < 0.0001). Asthma was associated with increased risk of death (HR = 1.31, 95%CI 1.18-1.45, p < 0.0001). After adjusting for age, demographic factors, comorbidities, risk factors, residential area and social support, women with asthma retained a 17% increased risk of death compared to women without asthma (HR = 1.17, 95%CI 1.03-1.32, p = 0.016). CONCLUSION Older women with asthma have a higher rate of mortality compared with other women of the same age. This increased risk of death remains after age, demographic factors, comorbidities, risk factors, residential area and social support have been taken into account.
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Affiliation(s)
- Parivash Eftekhari
- Research Centre for Generational Health and Ageing, School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia.
| | - Peta M Forder
- Research Centre for Generational Health and Ageing, School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia.
| | - Tazeen Majeed
- Research Centre for Generational Health and Ageing, School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia.
| | - Julie E Byles
- Research Centre for Generational Health and Ageing, School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia.
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16
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Zhang Q, Wang M, Li X, Wang H, Wang J. Do symptom-based questions help screen COPD among Chinese populations? Sci Rep 2016; 6:30419. [PMID: 27456860 PMCID: PMC4960647 DOI: 10.1038/srep30419] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 07/05/2016] [Indexed: 01/05/2023] Open
Abstract
Spirometry is required to confirm a chronic obstructive pulmonary disease (COPD) diagnosis, but it is difficult to perform in resource-limited settings. This study aimed to evaluate symptom-based questions for screening of individuals with COPD among Chinese populations. We recruited 3969 adult subjects from the First Affiliated Hospital of Nanjing Medical University. Spirometric measurements of forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) were collected to confirm the COPD diagnosis. A symptom-based questionnaire was administered to collect data related to COPD. The sensitivity and specificity together with the area under the curve (AUC) were calculated. The traditional IPAG eight-item questionnaire yielded an AUC of 0.80(95% CI: 0.78–0.82), with a sensitivity of 67.8% and specificity of 76.8%. After removing and adding questions, a revised eleven-item questionnaire exhibited a significantly increased diagnostic accuracy, with an AUC of 0.85(95% CI: 0.84–0.87). At the inflection point of the curve, it demonstrated a sensitivity of 82.5% and specificity of 72.9%. We showed that the revised symptom-based questionnaire could be used to screen individuals with a high likelihood of COPD among Chinese populations. Further validation is required before we claim it is a useful diagnostic for primary care populations.
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Affiliation(s)
- Qun Zhang
- Department of Respiratory, the First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China.,Health Management Center, the First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Min Wang
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, 211166, China
| | - Xiaona Li
- Health Management Center, the First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Hong Wang
- Department of Respiratory, the First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Jianming Wang
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, 211166, China.,Department of Social Medicine and Health Education, School of Public Health, Nanjing Medical University, Nanjing, 211166, China
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