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Kaplan A, Babineau A, Hauptman R, Levitz S, Lin P, Yang M. Breaking down barriers to COPD management in primary care: applying the updated 2023 Canadian Thoracic Society guideline for pharmacotherapy. Front Med (Lausanne) 2024; 11:1416163. [PMID: 39165372 PMCID: PMC11333456 DOI: 10.3389/fmed.2024.1416163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 06/21/2024] [Indexed: 08/22/2024] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a highly prevalent yet under-recognized and sub-optimally managed disease that is associated with substantial morbidity and mortality. Primary care providers (PCPs) are at the frontlines of COPD management, and they play a critical role across the full spectrum of the COPD patient journey from initial recognition and diagnosis to treatment optimization and referral to specialty care. The Canadian Thoracic Society (CTS) recently updated their guideline on pharmacotherapy in patients with stable COPD, and there are several key changes that have a direct impact on COPD management in the primary care setting. Notably, it is the first guideline to formally make recommendations on mortality reduction in COPD, which elevates this disease to the same league as other chronic diseases that are commonly managed in primary care and where optimized pharmacotherapy can reduce all-cause mortality. It also recommends earlier and more aggressive initial maintenance inhaler therapy across all severities of COPD, and preferentially favors the use of single inhaler therapies over multiple inhaler regimens. This review summarizes some of the key guideline changes and offers practical tips on how to implement the new recommendations in primary care. It also addresses other barriers to optimal COPD management in the primary care setting that are not addressed by the guideline update and suggests strategies on how they could be overcome.
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Affiliation(s)
- Alan Kaplan
- Family Physician Airways Group of Canada, University of Toronto, Toronto, ON, Canada
| | - Amanda Babineau
- Respiratory Health Clinic, Vitalité Health Network, Moncton, NB, Canada
| | - Robert Hauptman
- Family Physician Airways Group of Canada, Department of Family Medicine, University of Alberta, Edmonton, AB, Canada
| | - Suzanne Levitz
- Medical Director Inpatient Pulmonary Rehabilitation Program, Mount Sinai Hospital, Montreal, QC, Canada
| | - Peter Lin
- Director Primary Care Initiatives, Canadian Heart Research Centre, Toronto, ON, Canada
| | - Molly Yang
- Wholehealth Pharmacy Partners, Markham, ON, Canada
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2
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Nielsen MH, Lynge AR, Pedersen ML. High burden of symptoms reported among patients diagnosed with chronic obstructive pulmonary disease (COPD) in Greenland after introducing the COPD Assessment Test in clinical practice. Int J Circumpolar Health 2023; 82:2220476. [PMID: 37267504 DOI: 10.1080/22423982.2023.2220476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 05/28/2023] [Accepted: 05/29/2023] [Indexed: 06/04/2023] Open
Abstract
The aim was to test the internal consistency of the Greenlandic version of the COPD Assessment Test (CAT) questionnaire and to estimate the symptom burden in patients with chronic obstructive pulmonary disease (COPD) in Greenland using the CAT questionnaire. A Greenlandic version of the CAT questionnaire was developed including forward translation, reconciliation, backwards translation, and pilot test. Afterwards, a cross-sectional study of patients with COPD was conducted. The internal consistency assessed by the Cronbach α coefficient was 0.823 for the Greenlandic version of the questionnaire (n = 103). The CAT was negatively correlated to spirometry values and current smoking. In the cross-sectional study (n = 250), 81.1% of the patients experienced a high symptom burden (≥10). The main CAT score was 17 (range 0-38). The CAT was used in 9 out of 17 towns in Greenland. The Greenlandic version of the CAT questionnaire demonstrated a good internal consistency. We observed a high burden of symptoms associated with reduced lung function and active smoking status among patient diagnosed with COPD in Greenland. The questionnaire can be used in clinical practice for assessment of symptom burden in patients with COPD in Greenland and may help to increase focus on symptom control and quality of care.
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Affiliation(s)
- Maja Hykkelbjerg Nielsen
- Steno Diabetes Center Greenland, Queen Ingrid's Hospital, Nuuk, Greenland
- Greenlandic Centre for Health Research, Institute of Health and Nature, University of Greenland, Nuuk, Greenland
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Anna Rask Lynge
- Steno Diabetes Center Greenland, Queen Ingrid's Hospital, Nuuk, Greenland
| | - Michael Lynge Pedersen
- Steno Diabetes Center Greenland, Queen Ingrid's Hospital, Nuuk, Greenland
- Greenlandic Centre for Health Research, Institute of Health and Nature, University of Greenland, Nuuk, Greenland
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Müllerová H, Dransfield MT, Thomashow B, Jones PW, Rennard S, Karlsson N, Fageras M, Metzdorf N, Petruzzelli S, Rommes J, Sciurba FC, Tabberer M, Merrill D, Tal-Singer R. Clinical Development and Research Applications of the Chronic Obstructive Pulmonary Disease Assessment Test. Am J Respir Crit Care Med 2020; 201:1058-1067. [PMID: 31815521 DOI: 10.1164/rccm.201907-1369pp] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Hana Müllerová
- Value Evidence and Outcomes, Global Medical R&D, GlaxoSmithKline, Uxbridge, United Kingdom
| | - Mark T Dransfield
- Lung Health Center, University of Alabama at Birmingham, Birmingham, Alabama
| | | | - Paul W Jones
- Value Evidence and Outcomes, Global Medical R&D, GlaxoSmithKline, Uxbridge, United Kingdom
| | - Stephen Rennard
- University of Nebraska, Omaha, Nebraska.,BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | | | - Malin Fageras
- BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | | | | | | | - Frank C Sciurba
- Division of Pulmonary and Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania; and
| | - Maggie Tabberer
- Value Evidence and Outcomes, Global Medical R&D, GlaxoSmithKline, Uxbridge, United Kingdom
| | | | - Ruth Tal-Singer
- Value Evidence and Outcomes, Medical Innovation, Global Medical R&D, GlaxoSmithKline, Collegeville, Pennsylvania
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Bae E, Choi SE, Lee H, Shin G, Kang D. Validity of EQ-5D utility index and minimal clinically important difference estimation among patients with chronic obstructive pulmonary disease. BMC Pulm Med 2020; 20:73. [PMID: 32293387 PMCID: PMC7092534 DOI: 10.1186/s12890-020-1116-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 03/16/2020] [Indexed: 01/21/2023] Open
Abstract
Background The discriminatory ability of multi-attribute utility (MAU) measures compared to condition-specific measures (CSM) in assessing health-related quality of life (HRQoL) among patients with chronic obstructive pulmonary disease (COPD) is an unsettled issue. This study investigated the quality of life of patients with COPD with three different HRQoL instruments and examined whether they could differentiate between adjacent severity groups in a statistically and clinically meaningful manner. In the process, the minimal clinically important differences (MCID) of the EQ-5D utility index were estimated. Methods Cross-sectional survey data were collected from patients with mild to very severe COPD in South Korea. In addition to demographic and clinical information, the following HRQoL questionnaires were used: The three-level five-dimensional Euro-Quality of Life tool (EQ-5D-3L), the EQ-Visual Analog Scale (EQ-VAS), and the Chronic Obstructive Pulmonary Disease Assessment Test (CAT). Patients’ health-related quality of life was analyzed with reference to severity groups based on the Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification. To investigate the discriminatory ability of the HRQoL instruments between COPD severity groups, tests examining variance, covariance, and standardized mean difference were performed. After estimating the MCID of the EQ-5D utility index using the anchor-based method, we investigated whether the differences in the EQ-5D utility scores between groups exceeded the clinically meaningful minimum level. Results A total of 298 patients completed this study. All the quality of life scores showed statistically significant differences between the GOLD severity groups. The pooled MCID estimate for the EQ-5D utility index was 0.028 (range: 0.017–0.033). Even after adjusting for other factors affecting quality of life, the EQ-5D utility index differentiated the GOLD groups well. Conclusions We conclude that the EQ-5D utility index is a valid instrument for measuring the quality of life of patients with COPD, and the pooled MCID estimate for the EQ-5D utility index was 0.028.
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Affiliation(s)
- Eunmi Bae
- College of Pharmacy, Korea University, 2511 Sejong-ro, Sejong, 30019, South Korea
| | - Sang-Eun Choi
- College of Pharmacy, Korea University, 2511 Sejong-ro, Sejong, 30019, South Korea.
| | - Haeyoung Lee
- University of Maryland School of Pharmacy, Baltimore, MD, USA
| | - Gyeongseon Shin
- College of Pharmacy, Korea University, 2511 Sejong-ro, Sejong, 30019, South Korea
| | - Daewon Kang
- College of Pharmacy, Korea University, 2511 Sejong-ro, Sejong, 30019, South Korea
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Nishimura K, Kusunose M, Sanda R, Tsuji Y, Hasegawa Y, Oga T. Comparison between electronic and paper versions of patient-reported outcome measures in subjects with chronic obstructive pulmonary disease: an observational study with a cross-over administration. BMJ Open 2019; 9:e032767. [PMID: 31857313 PMCID: PMC6937099 DOI: 10.1136/bmjopen-2019-032767] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES A wide range of electronic devices can be used for data collection of patient-reported outcome (PRO) measures in subjects with chronic obstructive pulmonary disease (COPD). Although comparisons between electronic and paper-based PRO measures have been undertaken in asthmatics, it is currently uncertain whether electronic questionnaires work equally as well as paper versions in elderly subjects with COPD. The aim of this study was to compare the responses to paper and electronic versions of the Evaluating Respiratory Symptoms in COPD (E-RS) and the COPD Assessment Test (CAT). DESIGN A randomised cross-over design was used to compare the responses to paper and electronic versions of the two tools. The interval between the two administrations was 1 week. SETTING Electronic versions were self-administered under supervision using a tablet computer at our outpatient clinic (secondary care hospital in Japan) while paper questionnaires completed at home were requested to be returned by mail. It was intended that half of the patients completed the electronic versions of both questionnaires first, followed by the paper versions while the other half completed the paper versions first. PARTICIPANTS Eighty-one subjects with stable COPD were included. RESULTS The E-RS total scores (possible range 0-40) were 6.8±7.4 and 5.0±6.6 in the paper-based and electronic versions, respectively, and the CAT scores (possible range 0-40) were 10.0±7.4 and 8.6±7.8. In both questionnaires, higher scores indicate worse status. The relationship between electronic and paper versions showed significant reliability for both the E-RS total score and CAT score (intraclass correlation coefficient=0.82 and 0.89, respectively; both p<0.001). However, both the E-RS total and CAT scores were significantly higher in the paper versions (p<0.05). CONCLUSIONS In both cases, the two versions of the same questionnaire cannot be used interchangeably even though they have both been validated.
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Affiliation(s)
- Koichi Nishimura
- Department of Respiratory Medicine, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan
| | - Masaaki Kusunose
- Department of Respiratory Medicine, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan
| | - Ryo Sanda
- Department of Respiratory Medicine, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan
| | | | | | - Toru Oga
- Department of Respiratory Medicine, Kawasaki Medical School, Kurashiki, Okayama, Japan
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Yount SE, Atwood C, Donohue J, Hays RD, Irwin D, Leidy NK, Liu H, Spritzer KL, DeWalt DA. Responsiveness of PROMIS® to change in chronic obstructive pulmonary disease. J Patient Rep Outcomes 2019; 3:65. [PMID: 31664536 PMCID: PMC6820639 DOI: 10.1186/s41687-019-0155-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 10/01/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a progressive chronic disease characterized by airflow obstruction that leads to shortness of breath and substantial negative impacts on health-related quality of life (HRQL). The course of COPD includes periodic acute exacerbations that require changes in treatment and/or hospitalizations. This study was designed to examine the responsiveness of Patient-Reported Outcomes Measurement Information System® (PROMIS®) measures to changes associated with COPD exacerbation recovery. METHODS A longitudinal analysis using mixed-effects models was conducted of people who were enrolled while stable (n = 100) and those who experienced an acute exacerbation (n = 85). PROMIS (physical function, pain interference, pain behavior, fatigue, anxiety, depression, anger, social roles, discretionary social activities, Global Health, dyspnea severity and dyspnea functional limitations) and COPD-targeted HRQL measures were completed at baseline and at 12 weeks. RESULTS We administered PROMIS measures using computer adaptive testing (CAT), followed by administration of any remaining short form (SF) items that had not yet been administered by CAT. Examination of the difference between group differences from baseline to 12 weeks in the stable and exacerbation groups revealed that the exacerbation group changed (improved) significantly more than the stable group in anxiety (p < .001 to p < .01; f2 effect size [ES] = 0.023/0.021), fatigue (p < .0001; ES = 0.036/0.047) and social roles (p < .001 to p < .05; ES = 0.035/0.024). All effect sizes were small in magnitude and smaller than hypothesized. Depression was also statistically significant (p < .05, SF only) but the ES was trivial. For all other PROMIS domains, the differences were not significant and ES were trivial. CONCLUSIONS This longitudinal study provides some support for the validity of the PROMIS fatigue, anxiety, and social roles domains in COPD, but further evaluation of responsiveness is warranted.
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Affiliation(s)
- Susan E. Yount
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 N. Michigan Avenue, 27th floor, Chicago, IL 60611 USA
| | - Charles Atwood
- Pulmonary Section, VA Pittsburgh Healthcare System and University of Pittsburgh Medical Center, Pittsburgh, PA USA
| | - James Donohue
- Division of Pulmonary Medicine, University of North Carolina School of Medicine, University of North Carolina, Chapel Hill, NC USA
| | - Ron D. Hays
- Department of Medicine, University of California, Los Angeles, Los Angeles, CA USA
| | - Debra Irwin
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina – Chapel Hill, Chapel Hill, NC USA
| | | | - Honghu Liu
- School of Dentistry, University of California, Los Angeles, Los Angeles, CA USA
| | - Karen L. Spritzer
- Department of Medicine, University of California, Los Angeles, Los Angeles, CA USA
| | - Darren A. DeWalt
- Division of General Medicine and Clinical Epidemiology and the Cecil G. Sheps Center for Health Services Research, University of North Carolina School of Medicine – Chapel Hill, Chapel Hill, NC USA
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7
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Improvement in health status with once-daily indacaterol/glycopyrronium 110/50 μg in COPD patients: real-world evidence from an observational study in Ireland. Ir J Med Sci 2019; 188:1251-1259. [PMID: 30924006 DOI: 10.1007/s11845-019-02001-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 03/04/2019] [Indexed: 10/27/2022]
Abstract
AIMS Indacaterol/glycopyrronium (IND/GLY) 110/50 μg is a once-daily (o.d.) fixed-dose combination of long-acting β2-agonist/long-acting muscarinic antagonist approved in over 90 countries, including Ireland, for the management of COPD. The present study was conducted to evaluate health status of COPD patients, initiated on IND/GLY 110/50 μg o.d., using the Clinical COPD Questionnaire (CCQ) tool in a real-world primary care setting in Ireland. METHODS This was a real-world, prospective, open-label study. COPD patients aged > 40 years and with a smoking history of > 10 pack-years were included and switched to once-daily IND/GLY 110/50 μg. Enrolment of patients into the study occurred only after the decision had been made by the physician to prescribe IND/GLY 110/50 μg. Data were collected at baseline and Week 26. Health status was assessed using the validated CCQ. RESULTS A total of 200 patients were included in study. The mean CCQ total score decreased from 2.36 at baseline to 1.44 at Week 26 (Δ, 0.92; P < 0.0005). Of the 156 patients who completed study, 113 (72.4%) achieved minimum clinically important difference in CCQ total score with IND/GLY 110/50 μg. CCQ domain scores also decreased during the study. Improvement in health status was observed across all GOLD groups and irrespective of prior COPD treatment. Adverse events were reported by 20% of patients with COPD exacerbation/infected COPD being the most common AE, reported by 11 patients. CONCLUSIONS In real-life clinical practice in Ireland, IND/GLY 110/50 μg o.d. demonstrated statistically significant and clinically important improvement in health status in patients with COPD.
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8
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Prakash P, Eble TN, Dhar SU. Quality improvement of clinic flow for complex genetic conditions: Using Ehlers-Danlos syndrome as a model. Mol Genet Genomic Med 2018; 6:993-1000. [PMID: 30259710 PMCID: PMC6305640 DOI: 10.1002/mgg3.472] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Revised: 08/14/2018] [Accepted: 08/21/2018] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Genetic providers face the challenge of having adequate time to conduct a comprehensive evaluation. Hypermobile Ehlers-Danlos (hEDS) syndrome has a complex array of symptoms. An initial visit can involve approximately 60-80 min and an additional 45 min for the check-in and checkout process. We propose a model to improve clinic flow and patient satisfaction by using: (a) pre-appointment questionnaire (b) disease information sheet outlining basic management and (c) itinerary detailing the visit. METHODS New patients were given a questionnaire, an EDS information sheet, and a visit itinerary. In the end, a patient satisfaction survey was administered containing 18 questions pertaining to their satisfaction with the questionnaire, the information sheet, and their overall visit. Completed surveys were turned in to the front desk to maintain anonymity. RESULTS Based on the survey results, patient satisfaction toward the implementation of a questionnaire was overwhelmingly positive. Survey responders found that the itinerary was added to their understanding of the appointment process and that the hEDS information sheets were helpful, understandable, and appropriate in length. Respondents said that they strongly agreed or agreed with the following statements: (a) I was satisfied with the visit; (b) I now have a better understanding of my condition; (c) This visit was successful in addressing my most pressing concerns; and (d) I would recommend this clinic to others. CONCLUSION Designing a disease-centered model that implements patient-centered resources improves patient understanding and satisfaction for new hEDS patient visits. This model can be emulated in diagnosis and management of other complex genetic and nongenetic conditions.
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Affiliation(s)
- Preeti Prakash
- Office of BCM Students, Baylor College of Medicine, Houston, Texas
| | - Tanya N Eble
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas
| | - Shweta U Dhar
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas.,Department of Internal Medicine, Baylor College of Medicine, Houston, Texas
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Nishimura K, Nakamura S, Kusunose M, Nakayasu K, Sanda R, Hasegawa Y, Oga T. Comparison of patient-reported outcomes during acute exacerbations of chronic obstructive pulmonary disease. BMJ Open Respir Res 2018; 5:e000305. [PMID: 30397483 PMCID: PMC6203045 DOI: 10.1136/bmjresp-2018-000305] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 08/21/2018] [Indexed: 11/10/2022] Open
Abstract
Introduction The aim of this study was to investigate which patient-reported outcome measure was the best during the recovery phase from severe exacerbation of chronic obstructive pulmonary disease (COPD). Methods The Exacerbations of Chronic Pulmonary Disease Tool (EXACT), the COPD Assessment Test (CAT), the St George’s Respiratory Questionnaire (SGRQ), the Dyspnoea-12 (D-12) and the Hyland Scale (global scale) were recorded every week for the first month and at 2 and 3 months in 33 hospitalised subjects with acute exacerbation of COPD (AECOPD). Results On the day of admission (day 1), the internal consistency of the EXACT total score was high (Cronbach’s alpha coefficient=0.89). The EXACT total, CAT, SGRQ total and Hyland Scale scores obtained on day 1 appeared to be normally distributed. Neither floor nor ceiling effects were observed for the EXACT total and SGRQ total scores. The EXACT total score improved from 50.5±12.4 to 32.5±14.3, and the CAT score also improved from 24.4±8.5 to 13.5±8.4 during the first 2 weeks, and the effect sizes (ES) of the EXACT total and CAT score were −1.40 and −1.36, respectively. The SGRQ, Hyland Scale and D-12 were less responsive, with ES of −0.59, 0.96 and −0.90, respectively. Discussion The EXACT total and CAT scores are shown to be more responsive measures during the recovery phase from severe exacerbation. Considering the conceptual framework, it is recommended that the EXACT total score may be the best measure during the recovery phase from AECOPD. The reasons for the outstanding responsiveness of the CAT are still unknown.
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Affiliation(s)
- Koichi Nishimura
- Department of Respiratory Medicine, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Saya Nakamura
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masaaki Kusunose
- Department of Respiratory Medicine, National Center for Geriatrics and Gerontology, Obu, Japan
| | | | - Ryo Sanda
- Department of Respiratory Medicine, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Yoshinori Hasegawa
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Toru Oga
- Department of Respiratory Care and Sleep Control Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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10
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Alma HJ, de Jong C, Jelusic D, Wittmann M, Schuler M, Kollen BJ, Sanderman R, Schultz K, Kocks JWH, Van der Molen T. Assessing health status over time: impact of recall period and anchor question on the minimal clinically important difference of copd health status tools. Health Qual Life Outcomes 2018; 16:130. [PMID: 29940980 PMCID: PMC6019834 DOI: 10.1186/s12955-018-0950-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 05/30/2018] [Indexed: 12/17/2022] Open
Abstract
Background The Minimal Clinically Important Difference (MCID) assesses what change on a measurement tool can be considered minimal clinically relevant. Although the recall period can influence questionnaire scores, it is unclear if it influences the MCID. This study is the first to examine longitudinally the impact of the recall period of an anchor question and its design on the MCID of COPD health status tools using the COPD Assessment Test (CAT), Clinical COPD Questionnaire (CCQ) and the St. George’s Respiratory Questionnaire (SGRQ). Methods Moderate to very severe COPD patients without respiratory co-morbidities were recruited during 3-week Pulmonary Rehabilitation (PR). CAT, CCQ and SGRQ were completed at baseline, discharge, 3, 6, 9 and 12 months. A 15-point Global Rating of Change scale (GRC) was completed at each follow-up. A five-point GRC was used as second anchor at 12 months. Mean change scores of a subset of patients indicating a minimal improvement on each of the anchor questions were considered the MCID. The MCID estimates over different time periods were compared with one another by evaluating the degree of overlap of Confidence Intervals (CI) adjusted for dependency. Results In total 451 patients were included (57.9 ± 6.6 years, 65% male, 50/39/11% GOLD II/III/IV), of which 309 completed follow-up. Baseline health status scores were 20.2 ± 7.3 (CAT), 2.9 ± 1.2 (CCQ) and 50.7 ± 17.3 (SGRQ). MCID estimates for improvement ranged − 3.1 to − 1.4 for CAT, − 0.6 to − 0.3 for CCQ, and − 10.3 to − 7.6 for SGRQ. Absolute higher – though not significant – MCIDs were observed for CAT and CCQ directly after PR. Significantly absolute lower MCID estimates were observed for CAT (difference − 1.4: CI -2.3 to − 0.5) and CCQ (difference − 0.2: CI -0.3 to −0.1) using a five-point GRC. Conclusions The recall period of a 15-point anchor question seemed to have limited impact on the MCID for improvement of CAT, CCQ and SGRQ during PR; although a 3-week MCID estimate directly after PR might lead to absolute higher values. However, the design of the anchor question was likely to influence the MCID of CAT and CCQ. Trial registration RIMTCORE trial #DRKS00004609 and #12107 (Ethik-Kommission der Bayerischen Landesärztekammer). Electronic supplementary material The online version of this article (10.1186/s12955-018-0950-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- H J Alma
- University of Groningen, University Medical Center Groningen, Department of General Practice and Elderly Care Medicine, HPC FA21, Postbox 196, NL-9700, AD, Groningen, The Netherlands. .,University of Groningen, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD (GRIAC), Groningen, The Netherlands.
| | - C de Jong
- University of Groningen, University Medical Center Groningen, Department of General Practice and Elderly Care Medicine, HPC FA21, Postbox 196, NL-9700, AD, Groningen, The Netherlands.,University of Groningen, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD (GRIAC), Groningen, The Netherlands
| | - D Jelusic
- Klinik Bad Reichenhall, Center for Rehabilitation, Pulmonology and Orthopedics, Bad Reichenhall, Germany
| | - M Wittmann
- Klinik Bad Reichenhall, Center for Rehabilitation, Pulmonology and Orthopedics, Bad Reichenhall, Germany
| | - M Schuler
- University of Wuerzburg, Department of Medical Psychology and Psychotherapy, Medical Sociology and Rehabilitation Sciences, Wuerzburg, Germany
| | - B J Kollen
- University of Groningen, University Medical Center Groningen, Department of General Practice and Elderly Care Medicine, HPC FA21, Postbox 196, NL-9700, AD, Groningen, The Netherlands
| | - R Sanderman
- University of Groningen, University Medical Center Groningen, Department of Health Psychology, Groningen, The Netherlands.,University of Twente, Department of Psychology, Health and Technology, Enschede, The Netherlands
| | - K Schultz
- Klinik Bad Reichenhall, Center for Rehabilitation, Pulmonology and Orthopedics, Bad Reichenhall, Germany
| | - J W H Kocks
- University of Groningen, University Medical Center Groningen, Department of General Practice and Elderly Care Medicine, HPC FA21, Postbox 196, NL-9700, AD, Groningen, The Netherlands.,University of Groningen, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD (GRIAC), Groningen, The Netherlands
| | - T Van der Molen
- University of Groningen, University Medical Center Groningen, Department of General Practice and Elderly Care Medicine, HPC FA21, Postbox 196, NL-9700, AD, Groningen, The Netherlands.,University of Groningen, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD (GRIAC), Groningen, The Netherlands
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11
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Nonlinear analysis of electrodermal activity signals for healthy subjects and patients with chronic obstructive pulmonary disease. AUSTRALASIAN PHYSICAL & ENGINEERING SCIENCES IN MEDICINE 2018; 41:487-494. [PMID: 29774461 DOI: 10.1007/s13246-018-0649-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 05/04/2018] [Indexed: 10/16/2022]
Abstract
It is known that signals recorded from physiological systems represent nonlinear features. Several recent studies report that quantitative information about signal complexity is obtained by using nonlinear analysis algorithms. Chronic obstructive pulmonary disease (COPD) is one of the causes of mortality worldwide with an increasing prevalence. This study aims to investigate nonlinear parameters such as largest Lyapunov exponent (LLE) and correlation dimension of electrodermal activity signals recorded from healthy subjects and patients with COPD. Electrodermal activity signals recorded from 14 healthy subjects and 24 patients with COPD were analysed. Auditory and tactile stimuli were applied at different time intervals during the recording process. Signals were reconstructed in the phase space compatible with theory and LLE and correlation dimension values were calculated. Statistical analysis was performed by using Shapiro-Wilk normality test, one-way analysis of variance (ANOVA) with Bonferroni post-test and Kruskal-Wallis non-parametric test. It was determined that the chaoticity and the complexity of the system increased in the presence of COPD. The systematic auditory stimuli increases chaoticity more than random auditory stimuli. Furthermore it was observed that participants develop habituation to the same auditory stimuli in time. There is no significant difference between COPD groups. Different results were found for the tactile stimuli applied to right or left ear. The results revealed that the nonlinear analysis of physiological data can be used for the development of new strategies for the diagnosis of chronic diseases.
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Kostikas K, Aalamian-Mattheis M, Pagano VA, Nunez X, Fogel R, Patalano F, Clemens A. Early Changes in eDiary COPD Symptoms Predict Clinically Relevant Treatment Response at 12 Weeks: Analysis from the CRYSTAL Study. COPD 2018; 15:185-191. [PMID: 29658810 DOI: 10.1080/15412555.2018.1445213] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Early detection of treatment response is important in the long-term treatment and management of patients with chronic obstructive pulmonary disease (COPD). This analysis evaluated whether early improvement in symptoms, recorded in the first 7 or 14 days via an electronic diary (eDiary) compared with baseline, can predict clinically meaningful treatment responders at 12 weeks. CRYSTAL was a 12-week, randomized, open-label study that demonstrated the increased effectiveness of indacaterol/glycopyrronium (IND/GLY) or glycopyrronium (GLY), after a direct switch from on-going baseline therapies, in patients with symptomatic COPD and moderate airflow obstruction. The co-primary endpoints were trough forced expiratory volume in 1 second (FEV1) and transition dyspnea index (TDI) at Week 12. Patients' symptom status was recorded daily in an eDiary. Of 4,389 patients randomized, 3,936 and 3,855 reported symptoms on Days 7 and 14, respectively. Patients who reported an early decrease in symptoms on Day 7 or 14 were more likely to achieve the minimal clinically important difference of ≥100 mL in trough FEV1 or ≥ 1 point in TDI at Week 12. Using stepwise multivariate regression models we identified as best predictors of FEV1 responders the decrease in wheeze on Day 7, and nighttime symptoms and wheeze on Day 14; best predictors of TDI responders were decrease in nighttime symptoms and wheeze on Day 7, and nighttime symptoms, sputum and wheeze on Day 14. Early symptom improvement at Day 7 or 14, especially wheeze and nighttime symptoms, may identify patients with clinically important improvement in lung function and dyspnea at Week 12.
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Affiliation(s)
| | | | | | | | - Robert Fogel
- c Global Medical Affairs, Novartis Pharmaceuticals Corporation , East Hanover , New Jersey , USA
| | | | - Andreas Clemens
- a Global Medical Affairs, Novartis Pharma AG , Basel , Switzerland.,d Cardiology and Angiology I, Faculty of Medicine, Heart Center Freiburg University , Freiburg , Germany
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Huang H, Yang P, Wang J, Wu Y, Zi S, Tang J, Wang Z, Ma Y, Zhang Y. Investigation into the Individualized Treatment of Traditional Chinese Medicine through a Series of N-of-1 Trials. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2018; 2018:5813767. [PMID: 29552084 PMCID: PMC5820571 DOI: 10.1155/2018/5813767] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 11/08/2017] [Accepted: 01/10/2018] [Indexed: 12/02/2022]
Abstract
PURPOSE To compare the efficacy of individualized herbal decoction with standard decoction for patients with stable bronchiectasis through N-of-1 trials. METHODS We conducted a single center N-of-1 trials in 17 patients with stable bronchiectasis. Each N-of-1 trial contains three cycles. Each cycle is divided into two 4-week intervention including individualized decoction and fixed decoction (control). The primary outcome was patient self-reported symptoms scores on a 1-7 point Likert scale. Secondary outcomes were 24-hour sputum volume and CAT scores. RESULTS Among 14 completed trials, five showed that the individualized decoction was statistically better than the control decoction on symptom scores (P < 0.05) but was not clinically significant. The group data of all the trials showed that individualized decoction was superior to control decoction on symptom scores (2.13 ± 0.58 versus 2.30 ± 0.65, P = 0.002, mean difference and 95% CI: 0.18 (0.10, 0.25)), 24 h sputum volume (P = 0.009), and CAT scores (9.69 ± 4.89 versus 11.64 ± 5.59, P = 0.013, mean difference and 95% CI: 1.95 (1.04, 2.86)) but not clinically significant. CONCLUSION Optimizing the combined analysis of individual and group data and the improvement of statistical models may make contribution in establishing a method of evaluating clinical efficacy in line with the characteristics of traditional Chinese medicine individual diagnosis and treatment.
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Affiliation(s)
- Haiyin Huang
- Department of Respiratory Disease and Department of Pharmacy, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China
| | - Peilan Yang
- Department of Respiratory Disease and Department of Pharmacy, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China
| | - Jie Wang
- Department of Respiratory Disease and Department of Pharmacy, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China
| | - Yingen Wu
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
| | - Suna Zi
- Department of Respiratory Disease and Department of Pharmacy, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China
| | - Jie Tang
- Department of Respiratory Disease and Department of Pharmacy, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China
| | - Zhenwei Wang
- Department of Respiratory Disease and Department of Pharmacy, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China
| | - Ying Ma
- Department of Respiratory Disease and Department of Pharmacy, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China
| | - Yuqing Zhang
- Guang'anmen Hospital, China Academy of Chinese Medical Science, Xicheng District, Beijing, China
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada L8S 4K1
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Tsiligianni IG, Alma HJ, de Jong C, Jelusic D, Wittmann M, Schuler M, Schultz K, Kollen BJ, van der Molen T, Kocks JWH. Investigating sensitivity, specificity, and area under the curve of the Clinical COPD Questionnaire, COPD Assessment Test, and Modified Medical Research Council scale according to GOLD using St George's Respiratory Questionnaire cutoff 25 (and 20) as reference. Int J Chron Obstruct Pulmon Dis 2016; 11:1045-52. [PMID: 27274226 PMCID: PMC4876797 DOI: 10.2147/copd.s99793] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND In the GOLD (Global initiative for chronic Obstructive Lung Disease) strategy document, the Clinical COPD Questionnaire (CCQ), COPD Assessment Test (CAT), or modified Medical Research Council (mMRC) scale are recommended for the assessment of symptoms using the cutoff points of CCQ ≥1, CAT ≥10, and mMRC scale ≥2 to indicate symptomatic patients. The current study investigates the criterion validity of the CCQ, CAT and mMRC scale based on a reference cutoff point of St George's Respiratory Questionnaire (SGRQ) ≥25, as suggested by GOLD, following sensitivity and specificity analysis. In addition, areas under the curve (AUCs) of the CCQ, CAT, and mMRC scale were compared using two SGRQ cutoff points (≥25 and ≥20). MATERIALS AND METHODS Two data sets were used: study A, 238 patients from a pulmonary rehabilitation program; and study B, 101 patients from primary care. Receiver-operating characteristic (ROC) curves were used to assess the correspondence between the recommended cutoff points of the questionnaires. RESULTS Sensitivity, specificity, and AUC scores for cutoff point SGRQ ≥25 were: study A, 0.99, 0.43, and 0.96 for CCQ ≥1, 0.92, 0.48, and 0.89 for CAT ≥10, and 0.68, 0.91, and 0.91 for mMRC ≥2; study B, 0.87, 0.77, and 0.9 for CCQ ≥1, 0.76, 0.73, and 0.82 for CAT ≥10, and 0.21, 1, and 0.81 for mMRC ≥2. Sensitivity, specificity, and AUC scores for cutoff point SGRQ ≥20 were: study A, 0.99, 0.73, and 0.99 for CCQ ≥1, 0.91, 0.73, and 0.94 for CAT ≥10, and 0.66, 0.95, and 0.94 for mMRC ≥2; study B, 0.8, 0.89, and 0.89 for CCQ ≥1, 0.69, 0.78, and 0.8 for CAT ≥10, and 0.18, 1, and 0.81 for mMRC ≥2. CONCLUSION Based on data from these two different samples, this study showed that the suggested cutoff point for the SGRQ (≥25) did not seem to correspond well with the established cutoff points of the CCQ or CAT scales, resulting in low specificity levels. The correspondence with the mMRC scale seemed satisfactory, though not optimal. The SGRQ threshold of ≥20 corresponded slightly better than SGRQ ≥25, recently suggested by GOLD 2015, with the established cutoff points for the CCQ, CAT, and mMRC scale.
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Affiliation(s)
- Ioanna G Tsiligianni
- Department of General Practice, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands, Germany
- GRIAC Research Institute, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands, Germany
| | - Harma J Alma
- Department of General Practice, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands, Germany
- GRIAC Research Institute, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands, Germany
| | - Corina de Jong
- Department of General Practice, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands, Germany
- GRIAC Research Institute, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands, Germany
| | - Danijel Jelusic
- Klinik Bad Reichenhall, Center for Rehabilitation, Pulmonology and Orthopedics, Bad Reichenhall, Germany
| | - Michael Wittmann
- Klinik Bad Reichenhall, Center for Rehabilitation, Pulmonology and Orthopedics, Bad Reichenhall, Germany
| | - Michael Schuler
- Department of Medical Psychology, Psychotherapy and Rehabilitation Sciences, University of Würzburg, Würzburg, Germany
| | - Konrad Schultz
- Klinik Bad Reichenhall, Center for Rehabilitation, Pulmonology and Orthopedics, Bad Reichenhall, Germany
| | - Boudewijn J Kollen
- Department of General Practice, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands, Germany
| | - Thys van der Molen
- Department of General Practice, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands, Germany
- GRIAC Research Institute, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands, Germany
| | - Janwillem WH Kocks
- Department of General Practice, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands, Germany
- GRIAC Research Institute, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands, Germany
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Enhancing the use of Asthma and COPD Assessment Tools in Balearic Primary Care (ACATIB): a region-wide cluster-controlled implementation trial. NPJ Prim Care Respir Med 2016; 26:16003. [PMID: 26960912 PMCID: PMC4785492 DOI: 10.1038/npjpcrm.2016.3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 12/08/2015] [Indexed: 02/01/2023] Open
Abstract
Asthma and chronic obstructive pulmonary disease (COPD) health status assessment tools have demonstrated their value in guiding clinical management. Their use in primary care is still suboptimal. The objective of this study was to assess the effect of an educational intervention programme on the use of the Asthma Control Test (ACT), modified Medical Research Council (mMRC) and COPD Assessment Test (CAT) among primary care settings of the Balearic Islands, Spain. In this region-wide cluster-controlled implementation study, an educational intervention on the use of respiratory health status tools was provided to primary care practices in Mallorca (intervention group). Practices in Ibiza and Menorca functioned as control practices. Written and multimedia materials were provided to all participants to educate their colleagues. Primary outcome was the difference between intervention and control practices in the percentage of practices that increased the use—and recording—of ACT, CAT and mMRC tests between the 6-month period before intervention and the 6-month period after intervention. In the intervention group, 32 out of 45 (71%) centres enhanced the total number of tests, compared with 4 out of 12 (33%) in the non-intervention group (χ2; P=0.02). Before intervention, 399 test scores were recorded in 88,194 patients (asthma: 57,339; COPD: 30,855). After intervention, 1,576 test scores were recorded in 92,714 patients (asthma: 61,841; COPD: 30,873). An educational intervention programme targeted on primary care physicians enhances the use of respiratory health status tools and promotes behavioural changes. However, the effect is very low and difficult to measure in clinical terms.
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Azargon A, Gholami M, Farhadi A, Hadi Chegni M, Zendedel A. Evaluation of the Persian Transcript of the COPD Assessment Test in the Measurement of COPD Health Status in Iranian COPD Patients. Glob J Health Sci 2015; 8:225-30. [PMID: 26652077 PMCID: PMC4877241 DOI: 10.5539/gjhs.v8n5p225] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 08/04/2015] [Indexed: 12/26/2022] Open
Abstract
AIM Chronic obstructive pulmonary disease is a completely irreversible obstructive airway disease. The COPD assessment test (CAT) is one of the standard methods for the clinical assessment of the disease, which is translated into Persian. This study investigated the reliability of the test and its relationship with the severity of the disease. METHODS In this cross-sectional study, 120 patients filled out the Persian transcript of the test. After two weeks, the patients filled out the CAT test again. Obstruction severity was determined for all the patients using spirometry, and the patients were categorized into four groups according to the Global Initiative for Chronic Obstructive Lung Disease criteria. The relationship between the test scores and the disease severity wan validated. RESULTS The mean age of the patients was 51.5 years. The Cronbach's alpha coefficient of the Persian transcript of the test was 0.872 in the first time, and 0.885 in the second time. Intragroup reliability, test re-test and intragroup correlations were significant for all the questions (<0.001). The relationship between the test mean score and obstruction severity was significant, and the correlation between disease categorization in accordance with obstruction severity and categorization according to the test score was significant as well. CONCLUSION The Persian transcript of the assessment test for COPD was reliable and is directly related to the disease severity according to airflow limitation.
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Affiliation(s)
- Alireza Azargon
- School of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran.
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Setoguchi Y, Izumi S, Nakamura H, Hanada S, Marumo K, Kurosaki A, Akata S. Survey to determine the efficacy and safety of guideline-based pharmacological therapy for chronic obstructive pulmonary disease patients not previously receiving maintenance treatment. Expert Opin Pharmacother 2015; 16:2271-81. [PMID: 26290277 DOI: 10.1517/14656566.2015.1074678] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To investigate the potential beneficial effects of guideline-based pharmacological therapy on pulmonary function and quality of life (QOL) in Japanese chronic obstructive pulmonary disease (COPD) patients without prior treatment. RESEARCH DESIGN AND METHODS Multicenter survey, open-label study of 49 Japanese COPD patients aged ≥ 40 years; outpatients with >10 pack years of smoking history; ratio of forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) < 70%; predicted FEV1 < 80%; treated with bronchodilators and/or inhaled corticosteroids as maintenance therapy until week 48. MAIN OUTCOME MEASURES The primary endpoint was change in pulmonary function (trough FEV1, trough FVC); secondary endpoints were QOL and physical activity at 48 weeks after initiation of therapy. RESULTS Airway reversibility was confirmed in untreated patients. Significant changes over time were not observed for FEV1 and FVC, indicating lung function at initiation of treatment was maintained during the observation period. COPD assessment test scores showed statistical and clinical improvements. Cough, sputum, breathlessness, and shortness of breath were significantly improved. CONCLUSIONS Lung function and QOL of untreated Japanese COPD patients improved and improvements were maintained by performing a therapeutic intervention that conformed to published guidelines.
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Affiliation(s)
- Yasuhiro Setoguchi
- a 1 Tokyo Medical University, Department of Respiratory Medicine , 6-7-1 Nishi-Shinjuku, Shinjuku-ku, Tokyo 160-0023, Japan +81 333 426 111 ; +81 333 425 070 ;
| | - Shinyu Izumi
- b 2 National Center for Global Health and Medicine, Department of Respiratory Medicine , Tokyo, Japan
| | - Hidenori Nakamura
- c 3 Seirei Hamamatsu General Hospital, Department of Respiratory Medicine , Shizuoka, Japan
| | - Shigeo Hanada
- d 4 Respiratory Center, Toranomon Hospital, Department of Respiratory Medicine , Tokyo, Japan
| | - Kazuyoshi Marumo
- e 5 Tokyo Metropolitan Police Hospital, Department of Internal Medicine , Tokyo, Japan
| | - Atsuko Kurosaki
- f 6 Fukujuji Hospital, Department of Diagnostic Radiology , Tokyo, Japan
| | - Shouichi Akata
- g 7 Tokyo Medical University, Department of Radiology , Tokyo, Japan
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Siler TM, LaForce CF, Kianifard F, Williams J, Spangenthal S. Once-daily indacaterol 75 μg in moderate- to-severe COPD: results of a Phase IV study assessing time until patients' perceived onset of effect. Int J Chron Obstruct Pulmon Dis 2014; 9:919-25. [PMID: 25214778 PMCID: PMC4159068 DOI: 10.2147/copd.s67356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Indacaterol 75 μg once daily is a long-acting β2 agonist approved for maintenance bronchodilator treatment in patients with chronic obstructive pulmonary disease (COPD). The purpose of this study was to evaluate patients’ perception of onset of effect with a single dose. Methods In this double-blind, crossover, Phase IV study, 40 patients were randomized to receive a single dose of indacaterol 75 μg or placebo via a dry powder inhaler device. The primary variable was time until patient’s perception of onset of effect, using a simple self-administered (nonvalidated) questionnaire that patients answered at nine protocol-specified time points. Exploratory variables included change in forced expiratory volume in 1 second (FEV1) and change in percent predicted FEV1 from predose to postdose (determined 60–75 minutes postdose). Results The least-squares mean time to patient’s perception of onset of effect was 25.4 minutes and 23.9 minutes for indacaterol and placebo, respectively. There was no significant effect for treatment, period, or sequence on the time to patient’s perception. In addition, no statistically significant differences between treatments were observed for patient’s global satisfaction with onset of effect and global expectation of treatment adherence. For the exploratory variable change in FEV1 from predose to postdose, indacaterol showed superiority over placebo with a clinically relevant least-squares mean treatment difference of 0.12 L (P<0.0001). There was little or no association between patient’s perception of time to onset of effect and change in FEV1, or change in percent predicted FEV1. Both treatments were well tolerated. Conclusion A single dose of indacaterol 75 μg did not separate from placebo in terms of patient perception of onset, although there was an improvement in FEV1 for indacaterol compared with placebo. Development and use of a validated questionnaire may be needed to address the inconsistency in evaluating this patient-related outcome.
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Brockwell C, Ampikaipakan S, Sexton DW, Price D, Freeman D, Thomas M, Ali M, Wilson AM. Adjunctive treatment with oral AKL1, a botanical nutraceutical, in chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis 2014; 9:715-21. [PMID: 25031533 PMCID: PMC4096458 DOI: 10.2147/copd.s54276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose The objective of this pilot trial was to evaluate the safety and efficacy of AKL1, a patented botanical formulation containing extracts of Picrorhiza kurroa, Ginkgo biloba, and Zingiber officinale, as add-on therapy for patients with chronic obstructive pulmonary disease (COPD) and chronic cough. Patients and methods This randomized, double-blind, placebo-controlled trial enrolled male and female patients >18 years old with COPD and Leicester Cough Questionnaire (LCQ) score of <18. The 10-week study period comprised a 2-week single-blind placebo run-in period followed by add-on treatment with AKL1 or placebo twice daily for 8 weeks. The primary study endpoint was the change from week 0 to week 8 in cough-related health status, as assessed by the LCQ. Results Of 33 patients enrolled, 20 were randomized to AKL1 and 13 to placebo. Patients included 19 (58%) men and 14 (42%) women of mean (standard deviation [SD]) age of 67 (9.4) years; 15 (45%) patients were smokers and 16 (49%) were ex-smokers. The mean (SD) change from baseline in LCQ score at 8 weeks was 2.3 (4.9) in the AKL1 group and 0.6 (3.7) in the placebo group, with mean difference in change of 1.8 (95% confidence interval: −1.5 to 5.1; P=0.28). The St George’s Respiratory Questionnaire score improved substantially in the AKL1 treatment group by a mean (SD) of −7.7 (11.7) versus worsening in the placebo group (+1.5 [9.3]), with mean difference in change of −9.2 (95% confidence interval: −19.0 to 0.6; P=0.064). There were no significant differences between treatment groups in change from baseline to week 8 in other patient-reported measures, lung function, or the 6-minute walk distance. Conclusion Further study is needed with a larger patient population and over a longer duration to better assess the effects of add-on therapy with AKL1 in COPD.
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Affiliation(s)
| | - Sundari Ampikaipakan
- Norwich Medical School, University of East Anglia, Norwich, UK ; Norfolk and Norwich University Hospital Foundation Trust, Norwich, UK
| | - Darren W Sexton
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - David Price
- Academic Primary Care, University of Aberdeen, Aberdeen, UK ; Research in Real Life, Cambridge, UK
| | | | - Mike Thomas
- Primary Care Research, Aldermoor Health Centre, University of Southampton, Southampton, UK
| | | | - Andrew M Wilson
- Norwich Medical School, University of East Anglia, Norwich, UK ; Norfolk and Norwich University Hospital Foundation Trust, Norwich, UK
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Evolution of the COPD Assessment Test score during chronic obstructive pulmonary disease exacerbations: determinants and prognostic value. Can Respir J 2014; 20:e92-7. [PMID: 24093119 DOI: 10.1155/2013/398120] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND An adequate evaluation of exacerbations is a primary objective in managing patients with chronic obstructive pulmonary disease (COPD). OBJECTIVES To define the profile of health status recovery during severe exacerbations of COPD using the COPD Assessment Test (CAT) questionnaire and to evaluate its prognostic value. METHODS Forty-five patients with previous COPD diagnoses who were hospitalized due to severe exacerbation(s) were included in the study. These patients were treated by their respective physicians following current recommendations; health status was assessed daily using the CAT questionnaire. The CAT score, spirometry and recurrent hospitalizations were recorded one and three months after hospital discharge. RESULTS Global initiative for chronic Obstructive Lung Disease (GOLD) stage was an independent determinant for increased CAT score during the first days of exacerbation with respect to postexacerbation values. From hospitalization day 5, the CAT score was similar to that obtained in the stable phase. Body mass index, GOLD stage and education level were related to health status recovery pattern. CAT score increase and the area under the curve of CAT recovery were inversely related to the forced expiratory volume in 1 s achieved three months after discharge (r=-0.606; P<0.001 and r=-0.532; P<0.001, respectively). Patients with recurrent hospitalizations showed higher CAT score increases and slower recovery. CONCLUSIONS The CAT detects early health status improvement during severe COPD exacerbations. Its initial worsening and recovery pattern are related to lung function and recurrent hospitalizations.
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van der Molen T, Diamant Z, Kocks JWH, Tsiligianni IG. The use of health status questionnaires in the management of chronic obstructive pulmonary disease patients in clinical practice. Expert Rev Respir Med 2014; 8:479-91. [DOI: 10.1586/17476348.2014.918851] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Silva GPFD, Morano MTAP, Viana CMS, Magalhães CBDA, Pereira EDB. Portuguese-language version of the COPD Assessment Test: validation for use in Brazil. J Bras Pneumol 2014; 39:402-8. [PMID: 24068260 PMCID: PMC4075870 DOI: 10.1590/s1806-37132013000400002] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Accepted: 05/07/2013] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To validate a Portuguese-language version of the COPD assessment test (CAT) for use in Brazil and to assess the reproducibility of this version. METHODS This was multicenter study involving patients with stable COPD at two teaching hospitals in the city of Fortaleza, Brazil. Two independent observers (twice in one day) administered the Portuguese-language version of the CAT to 50 patients with COPD. One of those observers again administered the scale to the same patients one week later. At baseline, the patients were submitted to pulmonary function testing and the six-minute walk test (6MWT), as well as completing the previously validated Portuguese-language versions of the Saint George's Respiratory Questionnaire (SGRQ), modified Medical Research Council (MMRC) dyspnea scale, and hospital anxiety and depression scale (HADS). RESULTS Inter-rater and intra-rater reliability was excellent (intraclass correlation coefficient [ICC] = 0.96; 95% CI: 0.93-0.97; p < 0.001; and ICC = 0.98; 95% CI: 0.96-0.98; p < 0.001, respectively). Bland Altman plots showed good test-retest reliability. The CAT total score correlated significantly with spirometry results, 6MWT distance, SGRQ scores, MMRC dyspnea scale scores, and HADS-depression scores. CONCLUSIONS The Portuguese-language version of the CAT is a valid, reproducible, and reliable instrument for evaluating patients with COPD in Brazil.
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Kon SSC, Canavan JL, Jones SE, Nolan CM, Clark AL, Dickson MJ, Haselden BM, Polkey MI, Man WDC. Minimum clinically important difference for the COPD Assessment Test: a prospective analysis. THE LANCET. RESPIRATORY MEDICINE 2014; 2:195-203. [PMID: 24621681 DOI: 10.1016/s2213-2600(14)70001-3] [Citation(s) in RCA: 413] [Impact Index Per Article: 41.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND The COPD Assessment Test (CAT) is responsive to change in patients with chronic obstructive pulmonary disease (COPD). However, the minimum clinically important difference (MCID) has not been established. We aimed to identify the MCID for the CAT using anchor-based and distribution-based methods. METHODS We did three studies at two centres in London (UK) between April 1, 2010, and Dec 31, 2012. Study 1 assessed CAT score before and after 8 weeks of outpatient pulmonary rehabilitation in patients with COPD who were able to walk 5 m, and had no contraindication to exercise. Study 2 assessed change in CAT score at discharge and after 3 months in patients admitted to hospital for more than 24 h for acute exacerbation of COPD. Study 3 assessed change in CAT score at baseline and at 12 months in stable outpatients with COPD. We focused on identifying the minimum clinically important improvement in CAT score. The St George's Respiratory Questionnaire (SGRQ) and Chronic Respiratory Questionnaire (CRQ) were measured concurrently as anchors. We used receiver operating characteristic curves, linear regression, and distribution-based methods (half SD, SE of measurement) to estimate the MCID for the CAT; we included only patients with paired CAT scores in the analysis. FINDINGS In Study 1, 565 of 675 (84%) patients had paired CAT scores. The mean change in CAT score with pulmonary rehabilitation was -2·5 (95% CI -3·0 to -1·9), which correlated significantly with change in SGRQ score (r=0·32; p<0·0001) and CRQ score (r=-0·46; p<0·0001). In Study 2, of 200 patients recruited, 147 (74%) had paired CAT scores. Mean change in CAT score from hospital discharge to 3 months after discharge was -3·0 (95% CI -4·4 to -1·6), which correlated with change in SGRQ score (r=0·47; p<0·0001). In Study 3, of 200 patients recruited, 164 (82%) had paired CAT scores. Although no significant change in CAT score was identified after 12 months (mean 0·6, 95% CI -0·4 to 1·5), change in CAT score correlated significantly with change in SGRQ score (r=0·36; p<0·0001). Linear regression estimated the minimum clinically important improvement for the CAT to range between -1·2 and -2·8 with receiver operating characteristic curves consistently identifying -2 as the MCID. Distribution-based estimates for the MCID ranged from -3·3 to -3·8. INTERPRETATION The most reliable estimate of the minimum important difference of the CAT is 2 points. This estimate could be useful in the clinical interpretation of CAT data, particularly in response to intervention studies. FUNDING Medical Research Council and UK National Institute of Health Research.
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Affiliation(s)
- Samantha S C Kon
- NIHR Respiratory Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust, London, UK; Imperial College, London, UK.
| | - Jane L Canavan
- NIHR Respiratory Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust, London, UK; Imperial College, London, UK
| | - Sarah E Jones
- NIHR Respiratory Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust, London, UK; Imperial College, London, UK
| | - Claire M Nolan
- NIHR Respiratory Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust, London, UK; Harefield Pulmonary Rehabilitation Unit, Royal Brompton & Harefield NHS Foundation Trust, London, UK; Imperial College, London, UK
| | - Amy L Clark
- Harefield Pulmonary Rehabilitation Unit, Royal Brompton & Harefield NHS Foundation Trust, London, UK
| | | | | | - Michael I Polkey
- NIHR Respiratory Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust, London, UK; Imperial College, London, UK
| | - William D-C Man
- NIHR Respiratory Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust, London, UK; Harefield Pulmonary Rehabilitation Unit, Royal Brompton & Harefield NHS Foundation Trust, London, UK; Imperial College, London, UK
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Price D, Lee AJ, Sims EJ, Kemp L, Hillyer EV, Chisholm A, von Ziegenweidt J, Williams A. Characteristics of patients preferring once-daily controller therapy for asthma and COPD: a retrospective cohort study. PRIMARY CARE RESPIRATORY JOURNAL : JOURNAL OF THE GENERAL PRACTICE AIRWAYS GROUP 2014; 22:161-8. [PMID: 23460035 PMCID: PMC6442780 DOI: 10.4104/pcrj.2013.00017] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Background: Patient preference is an important factor when choosing an inhaler device for asthma or chronic obstructive pulmonary disease (COPD). Aims: To identify characteristics of patients with asthma or COPD who prefer a once-daily controller medication regimen. Methods: This retrospective observational study used electronic patient records and linked outcomes from patient-completed questionnaires in a primary care database. We compared the characteristics of patients indicating a preference for once-daily therapy with those who were unsure or indicating no preference. Results: Of 3,731 patients with asthma, 2,174 (58%) were women; the mean age was 46 years (range 2–94). Of 2,138 patients with COPD, 980 (46%) were women; the mean age was 70 years (range 35–98). Approximately half of the patients in each cohort indicated once-daily preference, one-quarter were unsure, and one-quarter did not prefer once-daily therapy. In patients with asthma or COPD, the preference for once-daily controller medication was significantly associated with poor adherence and higher concerns about medication. In asthma, good control and low self-perceived controller medication need were associated with once-daily preference. By contrast, in COPD, a high self-perceived need for controller medication was associated with once-daily preference. There was no significant relationship between once-daily preference and age, sex, disease severity, or exacerbation history. Conclusions: Understanding patient preferences may help prescribers to individualise therapy better for asthma and COPD.
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Affiliation(s)
- David Price
- Academic Centre of Primary Care, University of Aberdeen, UK.
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van der Molen T, Miravitlles M, Kocks JWH. COPD management: role of symptom assessment in routine clinical practice. Int J Chron Obstruct Pulmon Dis 2013; 8:461-71. [PMID: 24143085 PMCID: PMC3798110 DOI: 10.2147/copd.s49392] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Patients with chronic obstructive pulmonary disease (COPD) present with a variety of symptoms that significantly impair health-related quality of life. Despite this, COPD treatment and its management are mainly based on lung function assessments. There is increasing evidence that conventional lung function measures alone do not correlate well with COPD symptoms and their associated impact on patients' everyday lives. Instead, symptoms should be assessed routinely, preferably by using patient-centered questionnaires that provide a more accurate guide to the actual burden of COPD. Numerous questionnaires have been developed in an attempt to find a simple and reliable tool to use in everyday clinical practice. In this paper, we review three such patient-reported questionnaires recommended by the latest Global Initiative for Chronic Obstructive Lung Disease guidelines, ie, the modified Medical Research Council questionnaire, the clinical COPD questionnaire, and the COPD Assessment Test, as well as other symptom-specific questionnaires that are currently being developed.
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Affiliation(s)
- Thys van der Molen
- Department of General Practice, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- GRIAC (Groningen Research Institute for Asthma and COPD), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Marc Miravitlles
- Pneumology Department, Hospital Universitari Vall d’Hebron, Biomedical Research Networking Centre in Respiratory Diseases (CIBERES), Barcelona, Spain
| | - Janwillem WH Kocks
- Department of General Practice, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- GRIAC (Groningen Research Institute for Asthma and COPD), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Jones PW, Shahrour N, Nejjari C, Lahlou A, Doble A, Rashid N, El Hasnaoui A. Psychometric evaluation of the COPD assessment test: data from the BREATHE study in the Middle East and North Africa region. Respir Med 2013; 106 Suppl 2:S86-99. [PMID: 23290707 DOI: 10.1016/s0954-6111(12)70017-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The objective of this study was to assess the validity and performance of the Arabic and Turkish versions of the COPD Assessment Test (CAT) for evaluating the severity and impact of COPD symptoms. The data were obtained from the BREATHE study in the Middle East and North Africa region, a large general population survey of COPD conducted in ten countries of the region (Algeria, Egypt, Jordan, Lebanon, Morocco, Saudi Arabia, Syria, Tunisia, Turkey and United Arab Emirates), using a standardised methodology. A total of 62,086 subjects were screened, of whom a random sample of 5,681 subjects were administered the CAT by telephone. 5,639 evaluable questionnaires were recovered, representing a completion rate of 99%. In addition, the CAT was administered to an additional 833 subjects fulfilling the epidemiological diagnostic criteria for COPD. Mean scores in the general population were 6.99 ± 6.91 for the Arabic version and 9.88 ± 9.04 for the Turkish version. In patients with COPD, mean scores were 16.2 ± 9.1 and 20.9 ± 10.2 respectively. Scores were consistently higher in smokers than in non-smokers. In the general population, the proportion of respondents fulfilling criteria for COPD rose with higher CAT scores, and particularly above the 80th percentile, where 63% of COPD cases were to be found. This suggests that the CAT may be useful as a case-finding tool in the general population. In the COPD population, healthcare resource consumption rose linearly with CAT score above a threshold score of twenty, arguing in favour of the good criterion validity of the CAT. The internal consistency of the CAT was high (Cronbach's α 0.85 for the Arabic and 0.86 for the Turkish versions) and the factorial structure was unidimensional. In conclusion, this study performed in Arabic and Turkish speaking populations confirms the utility and validity of the CAT as a simple tool to collect data on the severity and impact of COPD symptoms, and suggests that it may potentially be useful as a case-finding tool to identify people at risk for COPD in the general population.
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Bratås O, Grønning K, Forbord T. Psychometric properties of the Hospital Anxiety and Depression Scale and The General Health Questionnaire-20 in COPD inpatients. Scand J Caring Sci 2013; 28:413-20. [PMID: 23713548 DOI: 10.1111/scs.12054] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Accepted: 05/06/2013] [Indexed: 11/28/2022]
Abstract
AIM To compare the psychometric properties between the Hospital Anxiety and Depression Scale (HADS) and General Health Questionnaire-version 20 (GHQ-20) in detecting psychological distress in COPD patients referred to pulmonary rehabilitation, and to examine the factor structure of GHQ-20. METHODS The study comprised 161 consecutive patients with mild to very severe COPD. For comparison of mean scores between the HADS and GHQ-20, one sample t-test was used. Potential differences in the detection of possible and normal cases were analysed using Pearson Chi square test. We report Pearson's correlations within and between the questionnaires, and internal consistency was assessed through Chronbach's alpha. The factor structure of the GHQ-20 was examined through principal axis factoring (PAF) with oblique rotation and eigenvalue >1. RESULTS There were no differences in mean scores of psychological distress between HADS and GHQ-20 (12.03 vs. 24.73, p = 0.000), as well as no differences in the prevalence of possible cases of psychological distress (34.6 vs. 36.9, p = 0.000) and normal cases (65.4 vs. 63.1, p = 0.000). The observed difference between HADS and GHQ-20 regarding internal consistency was marginal, with Chronbach's alpha coefficients of 0.91 and 0.94, respectively. The PAF analysis resulted in a three-factor solution for GHQ-20, notably with only two items loading on the third factor, giving an internal consistency <0.70. A two-factor solution, comprising anxiety/depression and coping, may therefore be more appropriate. CONCLUSIONS This study demonstrates no significant differences between the HADS and GHQ-20 in their ability to detect possible cases of psychological distress in a rehabilitation setting for COPD patients. Although the HADS and GHQ-20 are measuring different concepts of psychological distress, both questionnaires can be recommended as screening tools for detection of psychological distress in COPD inpatients. The GHQ-20 appears to be two-dimensional, comprising anxiety/depression as one dimension, and coping as the other dimension.
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Affiliation(s)
- Ola Bratås
- Faculty of Nursing, Sør-Trøndelag University College, Trondheim, Norway
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28
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Blanco-Aparicio M, Vázquez I, Pita-Fernández S, Pértega-Diaz S, Verea-Hernando H. Utility of brief questionnaires of health-related quality of life (Airways Questionnaire 20 and Clinical COPD Questionnaire) to predict exacerbations in patients with asthma and COPD. Health Qual Life Outcomes 2013; 11:85. [PMID: 23706146 PMCID: PMC3701555 DOI: 10.1186/1477-7525-11-85] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Accepted: 05/21/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is some evidence that quality of life measured by long disease-specific questionnaires may predict exacerbations in asthma and COPD, however brief quality of life tools, such as the Airways Questionnaire 20 (AQ20) or the Clinical COPD Questionnaire (CCQ), have not yet been evaluated as predictors of hospital exacerbations. OBJECTIVES To determine the ability of brief specific health-related quality of life (HRQoL) questionnaires (AQ20 and CCQ) to predict emergency department visits (ED) and hospitalizations in patients with asthma and COPD, and to compare them to longer disease-specific questionnaires, such as the St George´s Respiratory Questionnaire (SGRQ), the Chronic Respiratory Disease Questionnaire (CRQ) and the Asthma Quality of Life Questionnaire (AQLQ). METHODS We conducted a two-year prospective cohort study of 208 adult patients (108 asthma, 100 COPD). Baseline sociodemographic, clinical, functional and psychological variables were assessed. All patients completed the AQ20 and the SGRQ. COPD patients also completed the CCQ and the CRQ, while asthmatic patients completed the AQLQ. We registered all exacerbations that required ED or hospitalizations in the follow-up period. Differences between groups (zero ED visits or hospitalizations versus ≥ 1 ED visits or hospitalizations) were tested with Pearson´s X(2) or Fisher´s exact test for categorical variables, ANOVA for normally distributed continuous variables, and Mann-Whitney U test for non-normally distributed variables. Logistic regression analyses were performed to estimate the predictive ability of each HRQoL questionnaire. RESULTS In the first year of follow-up, the AQ20 scores predicted both ED visits (OR: 1.19; p = .004; AUC 0.723) and hospitalizations (OR: 1.21; p = .04; AUC 0.759) for asthma patients, and the CCQ emerged as independent predictor of ED visits in COPD patients (OR: 1.06; p = .036; AUC 0.651), after adjusting for sociodemographic, clinical, and psychological variables. Among the longer disease-specific questionnaires, only the AQLQ emerged as predictor of ED visits in asthma patients (OR: 0.9; p = .002; AUC 0.727). In the second year of follow-up, none of HRQoL questionnaires predicted exacerbations. CONCLUSIONS AQ20 predicts exacerbations in asthma and CCQ predicts ED visits in COPD in the first year of follow-up. Their predictive ability is similar to or even higher than that of longer disease-specific questionnaires.
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Affiliation(s)
| | - Isabel Vázquez
- Departamento de Psicología Clínica y Psicobiología, Facultad de Psicología, Universidad de Santiago de Compostela, Santiago de Compostela, Spain
| | - Salvador Pita-Fernández
- Unidad de Epidemiología Clínica y Bioestadística, Complejo Hospitalario, Universitario A Coruña, A Coruña, Spain
| | - Sonia Pértega-Diaz
- Unidad de Epidemiología Clínica y Bioestadística, Complejo Hospitalario, Universitario A Coruña, A Coruña, Spain
| | - Héctor Verea-Hernando
- Servicio de Neumología, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain
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Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a prevalent respiratory disease and associated with considerable individual and socioeconomic burden. Recent research started examining the role of psychosocial factors for course and management of the disease. PURPOSE This review provides an overview on recent findings on psychosocial factors and behavioral medicine approaches in COPD. RESULTS Research has identified several important psychosocial factors and effective behavioral medicine interventions in COPD. However, there is considerable need for future research in this field. CONCLUSIONS Although beneficial effects of some behavioral medicine interventions have been demonstrated in COPD, future research efforts are necessary to study the effects of distinct components of these interventions, to thoroughly examine promising but yet not sufficiently proven interventions, and to develop new creative interventions.
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Miravitlles M, Iriberri M, Barrueco M, Lleonart M, Villarrubia E, Galera J. Usefulness of the LCOPD, CAFS and CASIS scales in understanding the impact of COPD on patients. ACTA ACUST UNITED AC 2012; 86:190-200. [PMID: 23037958 DOI: 10.1159/000341175] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Accepted: 06/13/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND The Living with COPD (LCOPD), COPD and Asthma Fatigue Scale (CAFS), and COPD and Asthma Sleep Impact Scale (CASIS) are instruments developed to assess the overall impact of chronic obstructive pulmonary disease (COPD) on daily life, fatigue, and sleep impairment, respectively. OBJECTIVES To assess the usefulness of these instruments and to identify factors associated with the concepts they measure. METHOD The questionnaires were administered to patients with moderate to severe COPD. Descriptive analyses of sociodemographic and clinical data were performed, and bivariate and multivariate analyses were used to identify factors associated with the overall impact of COPD on patients' lives, fatigue, and sleep impairment. RESULTS A total of 408 patients was included (mostly males, 91.2%), with an average age of 68 years (SD = 9.3). Statistically significant differences were observed in the scores of the three questionnaires with regard to level of education, presence of chronic cough or expectoration, level of dyspnea, number of exacerbations, physical activity level, presence of depression and anxiety, and number of treatments indicated for COPD. The LCOPD and CAFS questionnaires also discriminated between different levels of airflow obstruction and, in the case of CAFS, age and gender. Linear regression showed that level of dyspnea, physical activity, and presence of anxiety were significantly related to the LCOPD, CAFS and CASIS scores. The presence of depression was significant in the LCOPD and CAFS questionnaires and chronic cough was significant in the CAFS questionnaire. CONCLUSIONS The LCOPD, CAFS, and CASIS instruments are valid and useful in understanding the overall impact of COPD on daily life, fatigue, and sleep impairment in patients with moderate to severe COPD.
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Affiliation(s)
- Marc Miravitlles
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Ciber de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
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Cave AJ, Atkinson L, Tsiligianni IG, Kaplan AG. Assessment of COPD wellness tools for use in primary care: an IPCRG initiative. Int J Chron Obstruct Pulmon Dis 2012; 7:447-56. [PMID: 22927752 PMCID: PMC3422123 DOI: 10.2147/copd.s29868] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
COPD is considered a complex disease and global problem that is predicted to be the third most common cause of death by 2030. While managing this chronic condition, primary health care practitioners are faced with the ongoing challenge of achieving good quality of life and overall "wellness" for those affected. As such, a practical tool for monitoring quality of life in a clinical setting is required. However, due to the wide variety of general and disease-specific tools from which to choose, primary health care practitioners are given minimal guidance as to which tool may be most appropriate. To address these challenges, the International Primary Care Respiratory Group (IPCRG) proposed the creation of a user's guide for primary health care practitioners to assess "wellness" in COPD patients in an everyday clinical setting. This short report outlines the process by which the IPCRG Users' Guide to COPD "Wellness" Tools was developed. It also describes why this guide has the potential to be of great value in guiding primary health care practitioners to improve patient wellness.
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Affiliation(s)
- Andrew J Cave
- Department of Family Medicine, University of Alberta, Edmonton, Canada.
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Tsiligianni IG, van der Molen T, Moraitaki D, Lopez I, Kocks JWH, Karagiannis K, Siafakas N, Tzanakis N. Assessing health status in COPD. A head-to-head comparison between the COPD assessment test (CAT) and the clinical COPD questionnaire (CCQ). BMC Pulm Med 2012; 12:20. [PMID: 22607459 PMCID: PMC3431277 DOI: 10.1186/1471-2466-12-20] [Citation(s) in RCA: 114] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Accepted: 05/03/2012] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Health status provides valuable information, complementary to spirometry and improvement of health status has become an important treatment goal in COPD management. We compared the usefulness and validity of the COPD Assessment Test (CAT) and the Clinical COPD Questionnaire (CCQ), two simple questionnaires, in comparison with the St. George Respiratory Questionnaire (SGRQ). METHODS We administered the CAT, CCQ and SGRQ in patients with COPD stage I-IV during three visits. Spirometry, 6 MWT, MRC scale, BODE index, and patients perspectives on questionnaires were recorded in all visits. Standard Error of Measurement (SEM) was used to calculate the Minimal Clinical Important Difference (MCID) of all questionnaires. RESULTS We enrolled 90 COPD patients. Cronbach's alpha for both CAT and CCQ was high (0.86 and 0.89, respectively). Patients with severe COPD reported worse health status compared to milder subgroups. CAT and CCQ correlated significantly (rho =0.64, p < 0.01) and both with the SGRQ (rho = 0.65; CAT and rho = 0.77; CCQ, p < 0.01). Both questionnaires exhibited a weak correlation with lung function (rho = -0.35;CAT and rho = -0.41; CCQ, p < 0.01). Their reproducibility was high; CAT: ICC = 0.94 (CI 0.92-0.96), total CCQ ICC = 0.95 (0.92-0.96) and SGRQ = 0.97 (CI 0.95-0.98). The MCID calculated using the SEM method showed results similar to previous studies of 3.76 for the CAT, 0.41 for the CCQ and 4.84 for SGRQ. Patients suggested both CAT and CCQ as easier tools than SGRQ in terms of complexity and time considerations. More than half of patients preferred CCQ instead of CAT. CONCLUSIONS The CAT and CCQ have similar psychometric properties with a slight advantage for CCQ based mainly on patients' preference and are both valid and reliable questionnaires to assess health status in COPD patients.
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Affiliation(s)
- Ioanna G Tsiligianni
- Department of Thoracic Medicine, Medical School, University of Crete, Heraklion, Crete, P.O 71003, Greece
- Department of General Practice, University Medical Centre Groningen, Antonius Deusinglaan 1, P.O 9700 AD, Groningen, The Netherlands
- GRIAC research institute, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 1, P.O 9700 AD, Groningen, The Netherlands
| | - Thys van der Molen
- Department of General Practice, University Medical Centre Groningen, Antonius Deusinglaan 1, P.O 9700 AD, Groningen, The Netherlands
- GRIAC research institute, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 1, P.O 9700 AD, Groningen, The Netherlands
| | - Despoina Moraitaki
- Department of Thoracic Medicine, Medical School, University of Crete, Heraklion, Crete, P.O 71003, Greece
| | - Ilaine Lopez
- Department of General Practice, University Medical Centre Groningen, Antonius Deusinglaan 1, P.O 9700 AD, Groningen, The Netherlands
- GRIAC research institute, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 1, P.O 9700 AD, Groningen, The Netherlands
| | - Janwillem WH Kocks
- Department of General Practice, University Medical Centre Groningen, Antonius Deusinglaan 1, P.O 9700 AD, Groningen, The Netherlands
- GRIAC research institute, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 1, P.O 9700 AD, Groningen, The Netherlands
| | - Konstantinos Karagiannis
- Department of Thoracic Medicine, Medical School, University of Crete, Heraklion, Crete, P.O 71003, Greece
| | - Nikolaos Siafakas
- Department of Thoracic Medicine, Medical School, University of Crete, Heraklion, Crete, P.O 71003, Greece
| | - Nikolaos Tzanakis
- Department of Thoracic Medicine, Medical School, University of Crete, Heraklion, Crete, P.O 71003, Greece
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Ninot G. Enjeux cliniques et scientifiques des questionnaires courts de qualité de vie spécifiques à une maladie respiratoire. Rev Mal Respir 2012; 29:367-70. [DOI: 10.1016/j.rmr.2012.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2012] [Accepted: 01/07/2012] [Indexed: 10/28/2022]
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