1
|
Thomas M, Beasley R. The treatable traits approach to adults with obstructive airways disease in primary and secondary care. Respirology 2023; 28:1101-1116. [PMID: 37877554 DOI: 10.1111/resp.14610] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 10/02/2023] [Indexed: 10/26/2023]
Abstract
The treatable traits approach is based on the recognition that the different clinical phenotypes of asthma and chronic obstructive airways disease (COPD) are a heterogeneous group of conditions with different underlying mechanisms and clinical manifestations, and that the identification and treatment of the specific clinical features or traits facilitates a personalised approach to management. Fundamentally, it recognises two important concepts. Firstly, that treatment for obstructive lung disease can achieve better outcomes if guided by specific clinical characteristics. Secondly, that in patients with a diagnosis of asthma, and/or COPD, poor respiratory health may also be due to numerous overlapping disorders that can present with symptoms that may be indistinguishable from asthma and/or COPD, comorbidities that might require treatment in their own right, and lifestyle or environmental factors that, if addressed, might lead to better control rather than simply increasing airways directed treatment. While these concepts are well accepted, how best to implement this personalised medicine approach in primary and secondary care within existing resource constraints remains uncertain. In this review, we consider the evidence base for this management approach and propose that the priority now is to assess different prototype templates for the identification and management of treatable traits in both asthma and COPD, in primary, secondary and tertiary care, to provide the evidence that will guide their use in clinical practice in different health care systems.
Collapse
Affiliation(s)
- Mike Thomas
- Primary Care Research, School of Primary Care, Population Sciences and Medical Education (PPM), Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Richard Beasley
- Medicine, Medical Research Institute of New Zealand, Wellington, New Zealand
- Victoria University of Wellington, Wellington, New Zealand
| |
Collapse
|
2
|
Lewis A, Kal E, Nolan CM, Cave P, Grillo L, Conway J, Jones M. Pilot study of physiotherapist-led versus music therapist-led breathing control exercises for young adults living with breathing pattern disorder: a randomised controlled trial protocol. BMJ Open Respir Res 2022; 9:e001414. [PMID: 36104105 PMCID: PMC9476152 DOI: 10.1136/bmjresp-2022-001414] [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: 08/15/2022] [Accepted: 08/22/2022] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Breathing pattern disorder (BPD) is an abnormal breathing pattern associated with biochemical, biomechanical and psychophysiological changes. While physiotherapy is often offered, limited evidence-based therapies for BPD are available. Music therapy-based singing exercises have been shown to improve quality of life for individuals with respiratory conditions and may also be beneficial for individuals living with BPD. No study has previously compared these participatory interventions in the treatment of people living with BPD. METHODS AND ANALYSIS This is a study protocol for an assessor blinded 1:1 randomised controlled trial and qualitative interview study. Forty participants aged 18-40 years who score at least 19 on the Nijmegen Questionnaire (NQ) and do not have any underlying respiratory conditions will be recruited. Participants will be randomised to receive either physiotherapy-led or music therapy-led breathing exercises for 6 weeks. The primary outcome will be between-group difference in NQ post-intervention. Semistructured interviews with a purposive sample of participants will be performed. Qualitative data will be analysed using thematic analysis to better understand participants' intervention and trial experiences. ETHICS AND DISSEMINATION This study has received ethical approval by Brunel University London College of Health, Medicine and Life Science's Research Ethics Committee (32483-MHR-Mar/2022-38624-3). The anonymised completed dataset will be made available as an open-access file via Brunel University London Figshare and the manuscript containing anonymised patient data will be published in an open-access journal. TRIAL REGISTRATION NUMBER This trial is registered on the Open Science Framework Registry (https://osf.io/u3ncw).
Collapse
Affiliation(s)
- Adam Lewis
- Department of Health Sciences, Brunel University London, College of Health Medicine and Life Sciences, Uxbridge, UK
| | - Elmar Kal
- Department of Health Sciences, Brunel University London, College of Health Medicine and Life Sciences, Uxbridge, UK
| | - Claire Marie Nolan
- Department of Health Sciences, Brunel University London, College of Health Medicine and Life Sciences, Uxbridge, UK
- Harefield Respiratory Research Group, Royal Brompton and Harefield Hospitals, London, UK
| | - Phoene Cave
- Department of Health Sciences, Brunel University London, College of Health Medicine and Life Sciences, Uxbridge, UK
| | - Lizzie Grillo
- National Heart and Lung Institute, Imperial College London, London, UK
- Physiotherapy Department, Royal Brompton and Harefield Hospitals, London, UK
| | - Joy Conway
- Department of Health Sciences, Brunel University London, College of Health Medicine and Life Sciences, Uxbridge, UK
| | - Mandy Jones
- Department of Health Sciences, Brunel University London, College of Health Medicine and Life Sciences, Uxbridge, UK
| |
Collapse
|
3
|
Lewis A, Philip KEJ, Lound A, Cave P, Russell J, Hopkinson NS. The physiology of singing and implications for 'Singing for Lung Health' as a therapy for individuals with chronic obstructive pulmonary disease. BMJ Open Respir Res 2021; 8:8/1/e000996. [PMID: 34764199 PMCID: PMC8587358 DOI: 10.1136/bmjresp-2021-000996] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 10/20/2021] [Indexed: 11/09/2022] Open
Abstract
Singing is an increasingly popular activity for people with chronic obstructive pulmonary disease (COPD). Research to date suggests that ‘Singing for Lung Health’ may improve various health measures, including health-related quality-of-life. Singing and breathing are closely linked processes affecting one another. In this narrative review, we explore the physiological rationale for ‘Singing for Lung Health’ as an intervention, focusing on the abnormalities of pulmonary mechanics seen in COPD and how these might be impacted by singing. The potential beneficial physiological mechanisms outlined here require further in-depth evaluation.
Collapse
Affiliation(s)
- Adam Lewis
- Department of Health Sciences, Brunel University London, London, UK
| | | | - Adam Lound
- Patient Experience Research Centre, Imperial College London, London, UK
| | - Phoene Cave
- Department of Health Sciences, Brunel University London, London, UK
| | - Juliet Russell
- Department of Health Sciences, Brunel University London, London, UK
| | | |
Collapse
|
4
|
Adab P, Jordan RE, Fitzmaurice D, Ayres JG, Cheng KK, Cooper BG, Daley A, Dickens A, Enocson A, Greenfield S, Haroon S, Jolly K, Jowett S, Lambe T, Martin J, Miller MR, Rai K, Riley RD, Sadhra S, Sitch A, Siebert S, Stockley RA, Turner A. Case-finding and improving patient outcomes for chronic obstructive pulmonary disease in primary care: the BLISS research programme including cluster RCT. PROGRAMME GRANTS FOR APPLIED RESEARCH 2021. [DOI: 10.3310/pgfar09130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background
Chronic obstructive pulmonary disease is a major contributor to morbidity, mortality and health service costs but is vastly underdiagnosed. Evidence on screening and how best to approach this is not clear. There are also uncertainties around the natural history (prognosis) of chronic obstructive pulmonary disease and how it impacts on work performance.
Objectives
Work package 1: to evaluate alternative methods of screening for undiagnosed chronic obstructive pulmonary disease in primary care, with clinical effectiveness and cost-effectiveness analyses and an economic model of a routine screening programme. Work package 2: to recruit a primary care chronic obstructive pulmonary disease cohort, develop a prognostic model [Birmingham Lung Improvement StudieS (BLISS)] to predict risk of respiratory hospital admissions, validate an existing model to predict mortality risk, address some uncertainties about natural history and explore the potential for a home exercise intervention. Work package 3: to identify which factors are associated with employment, absenteeism, presenteeism (working while unwell) and evaluate the feasibility of offering formal occupational health assessment to improve work performance.
Design
Work package 1: a cluster randomised controlled trial with household-level randomised comparison of two alternative case-finding approaches in the intervention arm. Work package 2: cohort study – focus groups. Work package 3: subcohort – feasibility study.
Setting
Primary care settings in West Midlands, UK.
Participants
Work package 1: 74,818 people who have smoked aged 40–79 years without a previous chronic obstructive pulmonary disease diagnosis from 54 general practices. Work package 2: 741 patients with previously diagnosed chronic obstructive pulmonary disease from 71 practices and participants from the work package 1 randomised controlled trial. Twenty-six patients took part in focus groups. Work package 3: occupational subcohort with 248 patients in paid employment at baseline. Thirty-five patients took part in an occupational health intervention feasibility study.
Interventions
Work package 1: targeted case-finding – symptom screening questionnaire, administered opportunistically or additionally by post, followed by diagnostic post-bronchodilator spirometry. The comparator was routine care. Work package 2: twenty-three candidate variables selected from literature and expert reviews. Work package 3: sociodemographic, clinical and occupational characteristics; occupational health assessment and recommendations.
Main outcome measures
Work package 1: yield (screen-detected chronic obstructive pulmonary disease) and cost-effectiveness of case-finding; effectiveness of screening on respiratory hospitalisation and mortality after approximately 4 years. Work package 2: respiratory hospitalisation within 2 years, and barriers to and facilitators of physical activity. Work package 3: work performance – feasibility and acceptability of the occupational health intervention and study processes.
Results
Work package 1: targeted case-finding resulted in greater yield of previously undiagnosed chronic obstructive pulmonary disease than routine care at 1 year [n = 1278 (4%) vs. n = 337 (1%), respectively; adjusted odds ratio 7.45, 95% confidence interval 4.80 to 11.55], and a model-based estimate of a regular screening programme suggested an incremental cost-effectiveness ratio of £16,596 per additional quality-adjusted life-year gained. However, long-term follow-up of the trial showed that at ≈4 years there was no clear evidence that case-finding, compared with routine practice, was effective in reducing respiratory admissions (adjusted hazard ratio 1.04, 95% confidence interval 0.73 to1.47) or mortality (hazard ratio 1.15, 95% confidence interval 0.82 to 1.61). Work package 2: 2305 patients, comprising 1564 with previously diagnosed chronic obstructive pulmonary disease and 741 work package 1 participants (330 with and 411 without obstruction), were recruited. The BLISS prognostic model among cohort participants with confirmed airflow obstruction (n = 1894) included 6 of 23 candidate variables (i.e. age, Chronic Obstructive Pulmonary Disease Assessment Test score, 12-month respiratory admissions, body mass index, diabetes and forced expiratory volume in 1 second percentage predicted). After internal validation and adjustment (uniform shrinkage factor 0.87, 95% confidence interval 0.72 to 1.02), the model discriminated well in predicting 2-year respiratory hospital admissions (c-statistic 0.75, 95% confidence interval 0.72 to 0.79). In focus groups, physical activity engagement was related to self-efficacy and symptom severity. Work package 3: in the occupational subcohort, increasing dyspnoea and exposure to inhaled irritants were associated with lower work productivity at baseline. Longitudinally, increasing exacerbations and worsening symptoms, but not a decline in airflow obstruction, were associated with absenteeism and presenteeism. The acceptability of the occupational health intervention was low, leading to low uptake and low implementation of recommendations and making a full trial unfeasible.
Limitations
Work package 1: even with the most intensive approach, only 38% of patients responded to the case-finding invitation. Management of case-found patients with chronic obstructive pulmonary disease in primary care was generally poor, limiting interpretation of the long-term effectiveness of case-finding on clinical outcomes. Work package 2: the components of the BLISS model may not always be routinely available and calculation of the score requires a computerised system. Work package 3: relatively few cohort participants were in paid employment at baseline, limiting the interpretation of predictors of lower work productivity.
Conclusions
This programme has addressed some of the major uncertainties around screening for undiagnosed chronic obstructive pulmonary disease and has resulted in the development of a novel, accurate model for predicting respiratory hospitalisation in people with chronic obstructive pulmonary disease and the inception of a primary care chronic obstructive pulmonary disease cohort for longer-term follow-up. We have also identified factors that may affect work productivity in people with chronic obstructive pulmonary disease as potential targets for future intervention.
Future work
We plan to obtain data for longer-term follow-up of trial participants at 10 years. The BLISS model needs to be externally validated. Our primary care chronic obstructive pulmonary disease cohort is a unique resource for addressing further questions to better understand the prognosis of chronic obstructive pulmonary disease.
Trial registration
Current Controlled Trials ISRCTN14930255.
Funding
This project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 9, No. 13. See the NIHR Journals Library website for further project information.
Collapse
Affiliation(s)
- Peymané Adab
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Rachel E Jordan
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - David Fitzmaurice
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Jon G Ayres
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - KK Cheng
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Brendan G Cooper
- Lung Function and Sleep, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Amanda Daley
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Andrew Dickens
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Alexandra Enocson
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Sheila Greenfield
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Shamil Haroon
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Kate Jolly
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Sue Jowett
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Tosin Lambe
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - James Martin
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Martin R Miller
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Kiran Rai
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Richard D Riley
- Centre for Prognosis Research, Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK
| | - Steve Sadhra
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Alice Sitch
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Robert A Stockley
- Respiratory Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Alice Turner
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Respiratory Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| |
Collapse
|
5
|
Abu Tabar N, Al Qadire M, Thultheen I, Alshraideh J. Health-Related Quality Of Life, Uncertainty, and Anxiety among Patients with Chronic Obstructive Pulmonary Disease. F1000Res 2021; 10:420. [PMID: 34804495 PMCID: PMC8577057 DOI: 10.12688/f1000research.51936.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/11/2021] [Indexed: 11/24/2022] Open
Abstract
Patients' with Chronic Obstructive Pulmonary Disease suffer from serious respiratory symptoms that increase anxiety, stress, and uncertainty, and affect quality of life. The aim of this study was to assess level of anxiety, uncertainty, and health related quality of life (HRQoL) among COPD patients in Jordan. Correlational cross-sectional survey design was used to collect data from 153 COPD patients. The study was conducted at pulmonary clinics in three major referral hospitals in Jordan that provide care for COPD patients from different parts of the country. To assess HRQoL, St. George Respiratory Questionnaire was completed. Uncertainty and anxiety level was measured by Mishel's uncertainty of illness scale and state anxiety inventory respectively. The mean age of participants was 66.8 (SD= 10.3) and most participants were males (94.1%) with. The mean score of HRQoL was 57.9 (SD = 20.5). The mean score of participants' level of anxiety was 38.1 (SD = 11.1). The mean score of uncertainty was 66.1 (SD= 11.1). There is a statistically significant positive relationship between HRQoL and anxiety (r =.433, p< .01), and uncertainty (r=.483, p<.01). Increased anxiety and uncertainty among COPD patients was associated with low HRQoL. Health care providers need to pay attention the effect of anxiety and uncertainty on COPD patients' quality of life and institute appropriate management.
Collapse
Affiliation(s)
| | - Mohammad Al Qadire
- College of Nursing, Sultan Qaboos University, Muscat, Oman
- Faculty of Nursing, Al Al-Bayt University, Mafraq, 25113, Jordan
| | - Imad Thultheen
- Nursing Department, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestinian Territory
| | | |
Collapse
|
6
|
Hulya S, Ilknur N, Gulru P. Effect of exercise capacity on perception of dyspnea, psychological symptoms and quality of life in patients with chronic obstructive pulmonary disease. Heart Lung 2020; 49:753-757. [PMID: 32979640 DOI: 10.1016/j.hrtlng.2020.09.008] [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: 06/23/2020] [Revised: 09/07/2020] [Accepted: 09/11/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND The negative impact of COPD on patients is not only physical, but also social and psychological. OBJECTIVES To examine the effects of decreased exercise capacity on health outcomes in patients with COPD. METHODS 516 COPD patients divided into four groups according to the six-minute walking distances. Perception of dyspnea, quality of life, psychological symptoms were compared between groups. RESULTS All the disease-specific quality of life scores of patients walking over 350 m were significantly better than other groups (p<0,001). Anxiety, depression and dyspnea scores were found to be lower (p<0.001) in all those walking over 350 m (p<0,001). CONCLUSIONS It has been observed that markers such as quality of life, anxiety and depression, which are known to be affected in COPD patients, progress better especially in patients walking over 350 m.
Collapse
Affiliation(s)
- Sahin Hulya
- Dr. Suat Seren Chest Diseases and Thoracic Surgery Training and Research Hospital, Chest Diseases Clinic, Izmir, Turkey.
| | - Naz Ilknur
- Izmir Katip Celebi University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Izmir, Turkey
| | - Polat Gulru
- Dr. Suat Seren Chest Diseases and Thoracic Surgery Training and Research Hospital, Chest Diseases Clinic, Izmir, Turkey
| |
Collapse
|
7
|
Comparing health status between patients with COPD in primary, secondary and tertiary care. NPJ Prim Care Respir Med 2020; 30:39. [PMID: 32901030 PMCID: PMC7478961 DOI: 10.1038/s41533-020-00196-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 08/07/2020] [Indexed: 11/15/2022] Open
Abstract
In this study, we compare health status between COPD patients treated in three different care levels in the Netherlands and assess determinants that influence their health status. We applied the Nijmegen Clinical Screening Instrument to measure eight health status subdomains in primary (n = 289), secondary (n = 184) and tertiary care (n = 433) COPD patient cohorts. Proportions of patients with severe problems in ≥3 subdomains are 47% in primary, 71% in secondary and 94% in tertiary care. Corrected for patient characteristics, differences between the care levels are statistically significant for nearly all health status subdomains. The pooled cohort data show female sex, age, FEV1 % predicted and BMI to be determinants of one or more subdomains. We conclude that the proportion of COPD patients with severe health status problems is substantial, not just in tertiary care but also in primary and secondary care. Use of detailed health status information may support patient-tailored COPD care.
Collapse
|
8
|
Guo SE, Chi MC, Hwang SL, Lin CM, Lin YC. Effects of Particulate Matter Education on Self-Care Knowledge Regarding Air Pollution, Symptom Changes, and Indoor Air Quality among Patients with Chronic Obstructive Pulmonary Disease. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E4103. [PMID: 32526832 PMCID: PMC7312676 DOI: 10.3390/ijerph17114103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 05/23/2020] [Accepted: 06/01/2020] [Indexed: 11/16/2022]
Abstract
The burden of illness resulting from adverse environmental exposure is significant. Numerous studies have examined self-care behaviors among patients with chronic obstructive pulmonary disease (COPD), but seldom assess these behaviors in relation to air pollution. The study aims to examine the effects of particulate matter (PM) education on prevention and self-care knowledge regarding air pollution, symptom changes, and indoor PM concentration levels among patients with COPD. A longitudinal, quasi-experimental design using a generalized estimating equation examined the effectiveness of the education intervention. Participants were 63 patients with COPD, of whom only 25 received intervention. Levels of PM2.5 and PM10 decreased in the first-month follow-up in the experimental group. Improvement of knowledge and prevention regarding PM in the first and third months were also greater in the experimental group compared to the control. Regarding the COPD assessment test and physical domain scores, the experimental group exhibited a greater improvement in the first-month follow-up. Scores on the psychological domain significantly changed in the sixth-month follow-up. The PM education coordinated by nurses improved the health of participants, maintaining six-month effects. Further studies should evaluate the practice barriers and effects of health education on preventive self-care behaviors regarding indoor PM among patients with COPD.
Collapse
Affiliation(s)
- Su-Er Guo
- Department of Nursing and Graduate Institute of Nursing, College of Nursing, Chang Gung University of Science and Technology (CGUST), Chiayi County 613016, Taiwan;
- Division of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, Chiayi County 613016, Taiwan; (M.-C.C.); (C.-M.L.); (Y.-C.L.)
- Chronic Diseases and Health Promotion Research Center, Chang Gung University of Science and Technology (CGUST), Chiayi County 613016, Taiwan
- Department of Safety Health and Environmental Engineering, Ming Chi University of Technology, New Taipei City 243303, Taiwan
| | - Miao-Ching Chi
- Division of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, Chiayi County 613016, Taiwan; (M.-C.C.); (C.-M.L.); (Y.-C.L.)
- Chronic Diseases and Health Promotion Research Center, Chang Gung University of Science and Technology (CGUST), Chiayi County 613016, Taiwan
- Department of Safety Health and Environmental Engineering, Ming Chi University of Technology, New Taipei City 243303, Taiwan
- Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi County 613016, Taiwan
| | - Su-Lun Hwang
- Department of Nursing and Graduate Institute of Nursing, College of Nursing, Chang Gung University of Science and Technology (CGUST), Chiayi County 613016, Taiwan;
- Division of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, Chiayi County 613016, Taiwan; (M.-C.C.); (C.-M.L.); (Y.-C.L.)
- Chronic Diseases and Health Promotion Research Center, Chang Gung University of Science and Technology (CGUST), Chiayi County 613016, Taiwan
| | - Chieh-Mo Lin
- Division of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, Chiayi County 613016, Taiwan; (M.-C.C.); (C.-M.L.); (Y.-C.L.)
- Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi County 613016, Taiwan
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan City 333324, Taiwan
| | - Yu-Ching Lin
- Division of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, Chiayi County 613016, Taiwan; (M.-C.C.); (C.-M.L.); (Y.-C.L.)
- Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi County 613016, Taiwan
- School of Medicine, Colledge of Medicine, Chang Gung University, Taoyuan City 333324, Taiwan
| |
Collapse
|
9
|
Wang YC, Wang C, Shih PW, Tang PL. Analysis of the relationship between lifestyle habits and glycosylated hemoglobin control based on data from a Health Management Plan. Nutr Res Pract 2020; 14:218-229. [PMID: 32528629 PMCID: PMC7263898 DOI: 10.4162/nrp.2020.14.3.218] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 11/20/2019] [Accepted: 12/17/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND/OBJECTIVES Type 2 Diabetes mellitus (T2DM) is a hereditary disease that is also strongly dependent on environmental factors, lifestyles, and dietary habits. This study explored the relationship between lifestyle habits and glycosylated hemoglobin management in T2DM patients to provide empirical outcomes to improve T2DM management and patient health literacy. SUBJECTS/METHODS This study enrolled 349 diabetic patients with more than 5 care visits to a Diabetes Mellitus care network under the Health Management Plan led by Taiwan Department of Health (DOH). Based on relevant literature, an Outpatient Record Form of Diabetes Mellitus Care was designed and lipid profile tests were conducted for data collection and analysis. RESULTS When modeling the data, the results showed that the odds for HbA1c > 7.5% in T2DM patients duration over 10 years was 3.785 (P = 0.002) times that in patients with disease duration of fewer than 3 years. The odds of HbA1c > 7.5% in illiterate patients was 3.128 (P = 0.039) times that in patients with senior high school education or above. The odds of HbA1c > 7.5% in patients with other chronic illness was 2.207 (P = 0.019) times that in participants without chronic illness. Among 5 beneficial lifestyle habits, the odds of HbA1c > 7.5% in patients with 2 or 3 good habits were 3.243 (P = 0.003) and 3.424 (P = 0.001) times that in patients with more than 3 good habits, respectively. CONCLUSION This empirical outcome shows that maintaining a good lifestyle improves T2DM management and patients' knowledge, motivation, and ability to use health information. Patients with longer disease duration, education, or good lifestyle habits had optimal HbA1c management than those in patients who did not. Thus, effective self-management and precaution in daily life and improved health literacy of diabetic patients are necessary to increase the quality of T2DM care.
Collapse
Affiliation(s)
- Ya-Chun Wang
- Nutrition and Food Service Department, Kaohsiung Veterans General Hospital, Kaohsiung City 81362, Taiwan (ROC).,Department of Food Science and Nutrition, Meiho University, Pingtung 91202, Taiwan (ROC)
| | - Chi Wang
- Department of Nursing, Kaohsiung Veterans General Hospital, Kaohsiung City 81362, Taiwan (ROC)
| | - Ping-Wen Shih
- Nutrition and Food Service Department, Kaohsiung Veterans General Hospital, Kaohsiung City 81362, Taiwan (ROC)
| | - Pei-Ling Tang
- Research Center of Medical Informatics, Kaohsiung Veterans General Hospital, Kaohsiung City 81362, Taiwan (ROC).,Department of Health-Business Administration, Fooyin University, Kaohsiung City 83102, Taiwan (ROC).,College of Nursing, Kaohsiung Medical University, Kaohsiung City 80708, Taiwan (ROC)
| |
Collapse
|
10
|
Ter Beek L, van der Vaart H, Wempe JB, Krijnen WP, Roodenburg JLN, van der Schans CP, Jager-Wittenaar H. Coexistence of malnutrition, frailty, physical frailty and disability in patients with COPD starting a pulmonary rehabilitation program. Clin Nutr 2019; 39:2557-2563. [PMID: 31796229 DOI: 10.1016/j.clnu.2019.11.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Revised: 07/02/2019] [Accepted: 11/07/2019] [Indexed: 01/07/2023]
Abstract
BACKGROUND & AIMS Malnutrition, frailty, physical frailty, and disability are common conditions in patients with chronic obstructive pulmonary disease (COPD). Insight in the coexistence and relations between these conditions may provide information on the nature of the relationship between malnutrition and frailty. Such information may help to identify required interventions to improve the patient's health status. We therefore aimed to explore whether malnutrition, frailty, physical frailty, and disability coexist in patients with COPD at the start of pulmonary rehabilitation. METHODS For this cross-sectional study, from March 2015 to May 2017, patients with COPD were assessed at the start of a pulmonary rehabilitation program. Nutritional status was assessed with the Scored Patient-Generated Subjective Global Assessment (PG-SGA) based Pt-Global app. Frailty was assessed by the Evaluative Frailty Index for Physical activity (EFIP), physical frailty by Fried's criteria, and disability by the Dutch version of World Health Organization Disability Assessment Schedule 2.0 (WHODAS). These variables were dichotomized to determine coexistence of malnutrition, frailty, physical frailty, and disability. Associations between PG-SGA score and respectively EFIP score, Fried's criteria, and WHODAS score were analyzed by Pearson's correlation coefficient. Two tailed P-values were used, and significance was set at P < 0.05. RESULTS Of the 57 participants included (age 61.2 ± 8.7 years), malnutrition and frailty coexisted in 40%. Malnutrition and physical frailty coexisted in 18%, and malnutrition and disability in 21%. EFIP score and PG-SGA score were significantly correlated (r = 0.43, P = 0.001), as well as Fried's criteria and PG-SGA score (r = 0.37, P = 0.005). CONCLUSIONS In this population, malnutrition substantially (40%) coexists with frailty. Although the prevalence of each of the four conditions is quite high, the coexistence of all four conditions is limited (11%). The results of our study indicate that nutritional interventions should be delivered by health care professionals across multiple disciplines.
Collapse
Affiliation(s)
- L Ter Beek
- Hanze University of Applied Sciences, Research Group Healthy Ageing, Allied Health Care and Nursing, Petrus Driessenstraat 3, 9714 CA, Groningen, the Netherlands; University of Groningen, University Medical Center Groningen, Department of Pulmonary Diseases and Tuberculosis, Center for Rehabilitation, PO Box 30.002, Haren, 9750 RA, Groningen, the Netherlands; University of Groningen, University Medical Center Groningen, Department of Maxillofacial Surgery, PO Box 30.001, 9700 RB, Groningen, the Netherlands.
| | - H van der Vaart
- University of Groningen, University Medical Center Groningen, Department of Pulmonary Diseases and Tuberculosis, Center for Rehabilitation, PO Box 30.002, Haren, 9750 RA, Groningen, the Netherlands.
| | - J B Wempe
- University of Groningen, University Medical Center Groningen, Department of Pulmonary Diseases and Tuberculosis, Center for Rehabilitation, PO Box 30.002, Haren, 9750 RA, Groningen, the Netherlands.
| | - W P Krijnen
- Hanze University of Applied Sciences, Research Group Healthy Ageing, Allied Health Care and Nursing, Petrus Driessenstraat 3, 9714 CA, Groningen, the Netherlands; University of Groningen, Faculty of Science and Engineering, Groningen, the Netherlands.
| | - J L N Roodenburg
- University of Groningen, University Medical Center Groningen, Department of Maxillofacial Surgery, PO Box 30.001, 9700 RB, Groningen, the Netherlands
| | - C P van der Schans
- Hanze University of Applied Sciences, Research Group Healthy Ageing, Allied Health Care and Nursing, Petrus Driessenstraat 3, 9714 CA, Groningen, the Netherlands; University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Groningen, the Netherlands; University of Groningen, University Medical Center Groningen, Health Psychology Research, Groningen, the Netherlands.
| | - H Jager-Wittenaar
- Hanze University of Applied Sciences, Research Group Healthy Ageing, Allied Health Care and Nursing, Petrus Driessenstraat 3, 9714 CA, Groningen, the Netherlands; University of Groningen, University Medical Center Groningen, Department of Maxillofacial Surgery, PO Box 30.001, 9700 RB, Groningen, the Netherlands.
| |
Collapse
|
11
|
Correlation between disease severity factors and EQ-5D utilities in chronic obstructive pulmonary disease. Qual Life Res 2019; 29:607-617. [PMID: 31673922 DOI: 10.1007/s11136-019-02340-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE Impaired health-related quality of life (HRQoL) is associated with poor health outcomes in chronic obstructive pulmonary disease (COPD). The aim of this study was to determine health utilities in patients with COPD and to identify the variables with the greatest impact. METHODS This is a pooled analysis of data from 4 observational studies performed in stable COPD patients. Evaluation of patient HRQoL utilities was performed using the Spanish version of the self-administered EuroQoL 5 Dimensions (EQ-5D) questionnaire. EQ-5D utilities were described and compared according to several markers of disease severity. RESULTS 6198 patients reported a mean (SD) EQ-5D index of 0.67 (0.26). A linear dose response relationship between EQ-5D utility and modified Medical Research Council (mMRC) score, forced expiratory volume in one 1 s (% predicted), COPD hospital admissions in the previous year, self-reported daily walking time, Charlson index, body mass index, obstruction, dyspnoea and exacerbation (BODEx) index, COPD assessment test (CAT), hospital anxiety and depression scale was observed (p for trend < 0.001). In multivariate analysis, patients reporting lower utility values were those with more dyspnoea, more comorbidities, using long-term oxygen therapy, with previous hospitalisations due to a COPD exacerbation and higher (worse) CAT score. CONCLUSION HRQoL measures such as EQ-5D can assist clinicians to understand the impact of respiratory disease on COPD patients.
Collapse
|
12
|
Antoniu SA, Apostol A, Boiculese LV. Extra‐respiratory symptoms in patients hospitalized for a COPD exacerbation: Prevalence, clinical burden and their impact on functional status. CLINICAL RESPIRATORY JOURNAL 2019; 13:735-740. [DOI: 10.1111/crj.13083] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 07/23/2019] [Accepted: 07/26/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Sabina Antonela Antoniu
- Department of Medicine II‐Nursing/Palliative Care University of Medicine and Pharmacy Grigore T Popa Iasi Romania
| | - Anca Apostol
- Faculty of Medicine University of Medicine and Pharmacy Grigore T Popa Iasi Romania
| | - Lucian Vasile Boiculese
- Department of Interdisciplinarity‐Biostatistics University of Medicine and Pharmacy Grigore T Popa Iasi Romania
| |
Collapse
|
13
|
Medina-Mirapeix F, Bernabeu-Mora R, Sánchez-Martínez MP, Gacto-Sánchez M, Martín San Agustín R, Montilla-Herrador J. Patterns and Predictors of Recovery from Poor Health Status Measured with the Chronic Obstructive Pulmonary Disease (COPD) Assessment Test in Patients with Stable COPD: A Longitudinal Study. J Clin Med 2019; 8:jcm8070946. [PMID: 31261894 PMCID: PMC6679022 DOI: 10.3390/jcm8070946] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 06/24/2019] [Accepted: 06/27/2019] [Indexed: 01/26/2023] Open
Abstract
Recent recommendations for chronic obstructive pulmonary disease (COPD) suggest that evaluation and management should focus on patient health status. Despite the frequency of poor health status and its negative impact on patients with COPD, little is known about how poor or non-poor health status persists and/or remits over time or what factors might predict recovery from a poor health status. The aim was to determine the likelihood of transitioning between poor and non-poor health status in patients with stable COPD followed for 2 years and to investigate factors that might predict recovery from poor health status. We prospectively included 137 patients with stable COPD (mean age, 66.9 years ± 8.3). Health status was measured at baseline and after 1 and 2 years with the COPD assessment test (CAT). Higher scores indicated worse health status, and 10 was the cut-off score for discriminating between non-poor and poor health status. The likelihoods of annual transitions to new episodes and recovery were calculated. We evaluated demographic, non-respiratory, and respiratory variables as potential predictors with generalized estimating equations. At baseline, 37 patients (27%) reported non-poor health status. Within the group of patients displaying poor health status at the beginning of the year, 176 annual transitions were identified during the study period: 15.9% were transitions to recovery from poor health status. In contrast, of the 70 transitions from a starting non-poor health status, 32.4% worsened. Predictors of transitions to recovery were: current non-smoker status (odds ratio (OR) = 3.88; 95% confidence interval (CI): 0.64–5.54) and handgrip strength (OR = 1.08; 95% CI: 1.00–1.16). This study suggests that self-reported health status, measured with the CAT, has a dynamic nature in patients with COPD. Annual transitions towards recovery from poor health status are most likely among current non-smoking patients and those with high handgrip strength.
Collapse
Affiliation(s)
- Francesc Medina-Mirapeix
- Department of Physical Therapy, University of Murcia, 30100 Murcia, Spain
- Research group Fisioterapia y Discapacidad, Instituto Murciano de Investigación Biosanitaria-Virgen de la Arrixaca (IMIB-Arrixaca), 30120 El Palmar Murcia, Spain
| | - Roberto Bernabeu-Mora
- Department of Physical Therapy, University of Murcia, 30100 Murcia, Spain.
- Research group Fisioterapia y Discapacidad, Instituto Murciano de Investigación Biosanitaria-Virgen de la Arrixaca (IMIB-Arrixaca), 30120 El Palmar Murcia, Spain.
- Department of Pneumology, Hospital General Universitario J M Morales Meseguer, 30008 Murcia, Spain.
| | - Maria Piedad Sánchez-Martínez
- Department of Physical Therapy, University of Murcia, 30100 Murcia, Spain
- Research group Fisioterapia y Discapacidad, Instituto Murciano de Investigación Biosanitaria-Virgen de la Arrixaca (IMIB-Arrixaca), 30120 El Palmar Murcia, Spain
| | - Mariano Gacto-Sánchez
- Department of Physical Therapy, EUSES University School, University of Girona, 17190 Salt Girona, Spain
| | | | - Joaquina Montilla-Herrador
- Department of Physical Therapy, University of Murcia, 30100 Murcia, Spain
- Research group Fisioterapia y Discapacidad, Instituto Murciano de Investigación Biosanitaria-Virgen de la Arrixaca (IMIB-Arrixaca), 30120 El Palmar Murcia, Spain
| |
Collapse
|
14
|
Tabar NA, Alshraideh JA. Correlates and Predictors of Health-Related Quality of Life among Patients with COPD: An Integrative Review. ACTA ACUST UNITED AC 2019. [DOI: 10.4236/ojn.2019.912088] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
15
|
Tzitzikos G, Kotrotsiou E, Bonotis K, Gourgoulianis K. Assessing hostility in patients with chronic obstructive pulmonary disease (COPD). PSYCHOL HEALTH MED 2018; 24:605-619. [PMID: 30522331 DOI: 10.1080/13548506.2018.1554253] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
COPD is a disease that can adversely affect patients' psychology. The purpose of this study is to investigate whether COPD patients feel increased hostility, and if hostility is associated with socio-economic factors. A cross-sectional study was conducted in 203 COPD patients in primary health care services in Greece, using the hostility and direction of hostility questionnaire HDHQ. Patient demographics, smoking habits, body mass index (BMI) and disease grade were also recorded. The results showed significant differences between males and females, with women exhibiting higher hostility (p = 0.004). Age correlates negatively with hostility, with younger patients showing higher values. Patients who continue to smoke (p = 0.005), and those in a very poor financial situation, have a much higher level of hostility. Regarding family status, married patients show the least hostility. In patients with very severe COPD and those with low education (p = 0.035) there is a high level of self-criticism. In conclusion, patients with COPD, still smokers, single, low-income and low-educated, especially female patients, have a higher risk of developing hostility. These findings suggest a need for further research in order to clarify the complexity of the different risk factors.
Collapse
|