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Zaripova TN, Dorozhinskaya EV, Titskaya EV, Reshetova GG. [On the assessment of medical rehabilitation effectiveness in patients with chronic obstructive pulmonary disease in the resort setting]. VOPROSY KURORTOLOGII, FIZIOTERAPII, I LECHEBNOI FIZICHESKOI KULTURY 2022; 99:20-27. [PMID: 35236062 DOI: 10.17116/kurort20229901120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
UNLABELLED Despite significant successes of health resort rehabilitation in patients with chronic obstructive pulmonary disease (COPD), the assessment of rehabilitation effectiveness remains challenging for resort physicians in Russia. OBJECTIVE To perform a comparative analysis of methods for assessing the medical rehabilitation outcomes in COPD patients in the resort setting. MATERIAL AND METHODS The study involved 71 patients with stage I-II COPD, with bronchitis (66.2%) and mixed (COPD + asthma, 33.8%) phenotypes in the clinical remission phase. The mean age of the patients was 57.0±9.8 years, and the mean duration of disease was 7.8±5.1 years. Within 14 days, all patients received an identical set of rehabilitation measures with natural and preformed physical therapeutic resort factors. Before and after the medical rehabilitation course, clinical, laboratory, functional tests and questionnaires were performed on each patient. The effectiveness of course-based complex rehabilitation was assessed using one of three methods: CAT (COPD [chronic obstructive pulmonary disease] Assessment Test), the International Classification of Functioning, Disability and Health (ICF), the COPD control and control stability criteria system. RESULTS Comparison of the three methods of assessment of COPD patients' rehabilitation outcomes in resort settings showed that the CAT score is the easiest to use, the least time-consuming, highly valid, and informative. According to the CAT score, the resort medical rehabilitation effectiveness was 96.4%, with «improvement» and «significant improvement» recorded in 82.1% of cases. The use of ICF provides reliable information about the rehabilitation complex effect on the main pathogenetic links of the disease, which allows proper adjusting of rehabilitation procedures to improve effectiveness in the resort setting. Specified grades of ICF domains make it possible to translate qualitative and quantitative attributes inherent to a particular subject into points. The points trend during the medical rehabilitation indicates its effectiveness in terms of recovery of specific functions impaired by the disease. At the same time, the ICF does not allow to rank the medical rehabilitation outcomes in the resort setting in terms of the currently accepted concepts of «significant improvement,» «improvement,» «slight improvement,» «no change,» «deterioration,» which limits its application in resorts. We believe that assessment of rehabilitation outcomes based on COPD control and control stability is not applicable to resort setting due to possible discrepancy between the impression formed in a short time (14 days) about these characteristics of the pathological process and the actual status, as well as due to lack of knowledge about the effect of achieved/not achieved disease control on the choice of rehabilitation technology. CONCLUSION A simple and highly informative CAT score can be recommended to assess the effectiveness of resort medical rehabilitation in patients with chronic obstructive pulmonary disease.
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Affiliation(s)
- T N Zaripova
- Tomsk Research Institute of Balneology and Physiotherapy of the Siberian Federal Research and Clinical Center of the Federal Medical and Biological Agency, Tomsk, Russia
- Altai Research Institute of Resort Medicine and Health Tourism of the Siberian Federal Research and Clinical Center of the Federal Medical and Biological Agency, Belokurikha, Russia
| | - E V Dorozhinskaya
- Altai Research Institute of Resort Medicine and Health Tourism of the Siberian Federal Research and Clinical Center of the Federal Medical and Biological Agency, Belokurikha, Russia
| | - E V Titskaya
- Tomsk Research Institute of Balneology and Physiotherapy of the Siberian Federal Research and Clinical Center of the Federal Medical and Biological Agency, Tomsk, Russia
- Altai Research Institute of Resort Medicine and Health Tourism of the Siberian Federal Research and Clinical Center of the Federal Medical and Biological Agency, Belokurikha, Russia
| | - G G Reshetova
- Tomsk Research Institute of Balneology and Physiotherapy of the Siberian Federal Research and Clinical Center of the Federal Medical and Biological Agency, Tomsk, Russia
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Rê AD, Fonseca FR, Queiroz AP, Reis CMD, Bahl MM, Kocks J, Molen TVD, Maurici R. Brazilian version of the Clinical COPD Questionnaire, administered by interview: reliability and validity measurement properties. ACTA ACUST UNITED AC 2021; 47:e20200371. [PMID: 34076173 PMCID: PMC8332715 DOI: 10.36416/1806-3756/e20200371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 02/06/2021] [Indexed: 11/22/2022]
Abstract
Objective: To test the reliability, validity, and interpretability of the Brazilian version of the Clinical COPD Questionnaire (CCQ) in patients with COPD. Methods: Fifty patients with COPD completed the CCQ by interview on two occasions. At the first visit, the CCQ was administered twice, by two different raters, approximately 10 min apart; the patients also underwent spirometry and were administered the COPD Assessment Test, the modified Medical Research Council scale, and Saint George’s Respiratory Questionnaire (SGRQ). At the second visit (1-2 weeks later), the CCQ was readministered. We tested the hypothesis that the CCQ total score would correlate positively with the total and domain SGRQ scores (r ≥ 0.5). Results: Of the 50 patients, 30 (60%) were male. The mean age was 66 ± 8 years, and the mean FEV1 was 44.7 ± 17.9% of the predicted value. For all CCQ items, Cronbach’s alpha coefficient (95% CI) was 0.93 (0.91-0.96). To analyze the interrater reliability and test-retest reliability of the CCQ, we calculated the two-way mixed effects model/single measure type intraclass correlation coefficient (0.97 [95% CI: 0.95-0.98] and 0.92 [95% CI: 0.86-0.95], respectively); the agreement standard error of measurement (0.65 for both); the smallest detectable change at the individual level (1.81 and 1.80, respectively) and group level (0.26 and 0.25, respectively); and the limits of agreement (−0.58 to 0.82 and −1.14 to 1.33, respectively). The CCQ total score correlated positively with all SGRQ scores (r ≥ 0.70 for all). Conclusions: The Brazilian version of the CCQ showed an indeterminate measurement error, as well as satisfactory interrater/test-retest reliability and construct validity.
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Affiliation(s)
- Alexânia de Rê
- . Programa de Pós-Graduação em Ciências Médicas, Universidade Federal de Santa Catarina, Florianópolis (SC) Brasil.,. Núcleo de Pesquisa em Asma e Inflamação das Vias Aéreas, Universidade Federal de Santa Catarina, Florianópolis (SC) Brasil
| | - Fernanda Rodrigues Fonseca
- . Programa de Pós-Graduação em Ciências Médicas, Universidade Federal de Santa Catarina, Florianópolis (SC) Brasil.,. Núcleo de Pesquisa em Asma e Inflamação das Vias Aéreas, Universidade Federal de Santa Catarina, Florianópolis (SC) Brasil
| | - Ana Paula Queiroz
- . Programa de Pós-Graduação em Ciências Médicas, Universidade Federal de Santa Catarina, Florianópolis (SC) Brasil.,. Núcleo de Pesquisa em Asma e Inflamação das Vias Aéreas, Universidade Federal de Santa Catarina, Florianópolis (SC) Brasil
| | - Cardine Martins Dos Reis
- . Programa de Pós-Graduação em Ciências Médicas, Universidade Federal de Santa Catarina, Florianópolis (SC) Brasil
| | - Marina Mônica Bahl
- . Programa de Pós-Graduação em Ciências Médicas, Universidade Federal de Santa Catarina, Florianópolis (SC) Brasil
| | - Janwillem Kocks
- . General Practitioners Research Institute, Groningen, The Netherlands.,. University of Groningen, University Medical Center Groningen, GRIAC Research Institute, Groningen, The Netherlands.,. Observational and Pragmatic Research Institute, Singapore
| | - Thys van der Molen
- . Department of General Practice, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Rosemeri Maurici
- . Programa de Pós-Graduação em Ciências Médicas, Universidade Federal de Santa Catarina, Florianópolis (SC) Brasil.,. Núcleo de Pesquisa em Asma e Inflamação das Vias Aéreas, Universidade Federal de Santa Catarina, Florianópolis (SC) Brasil.,. Departamento de Clínica Médica, Universidade Federal de Santa Catarina, Florianópolis (SC) Brasil.,. Hospital Universitário, Universidade Federal de Santa Catarina, Florianópolis (SC) Brasil
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Valipour A, Avdeev S, Barczyk A, Bayer V, Fridlender Z, Georgieva M, Kudela O, Medvedchikov A, Miron R, Sanzharovskaya M, Šileikienė V, Šorli J, Spielmanns M, Szalai Z. Therapeutic Success of Tiotropium/Olodaterol, Measured Using the Clinical COPD Questionnaire (CCQ), in Routine Clinical Practice: A Multinational Non-Interventional Study. Int J Chron Obstruct Pulmon Dis 2021; 16:615-628. [PMID: 33731991 PMCID: PMC7956863 DOI: 10.2147/copd.s291920] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 02/07/2021] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND The Clinical COPD Questionnaire (CCQ) is a simple patient-reported tool to measure clinical control of chronic obstructive pulmonary disease (COPD). OBJECTIVE This open-label, single-arm, non-interventional study (NCT03663569) investigated changes in CCQ score during treatment with tiotropium/olodaterol in clinical practice. METHODS Data were included from consenting COPD patients, enrolled in Bulgaria, Czech Republic, Hungary, Israel, Lithuania, Poland, Romania, Russia, Slovenia, Switzerland and Ukraine, who were receiving a new prescription for tiotropium/olodaterol according to the treating physician in a real-world environment. The primary endpoint was the occurrence of therapeutic success, defined as a 0.4-point decrease in CCQ score after treatment with tiotropium/olodaterol for approximately 6 weeks. RESULTS Overall, 4819 patients were treated; baseline and Week 6 CCQ scores were available for 4700 patients, mostly classified as Global Initiative for Chronic Obstructive Lung Disease (GOLD) B (51.6%) or D (42.7%). After 6 weeks' treatment, 81.4% (95% confidence interval [95% CI] 80.24-82.49) of patients achieved therapeutic success; mean improvement in overall CCQ score was 1.02 points (95% CI 1.00-1.05). Improved CCQ score was seen in 92.2% of patients (95% CI 91.43-92.98), 2.5% had no change and 5.3% showed a worsening. When stratified by prior treatment, the greatest benefit was seen in treatment-naïve patients, with 85.7% achieving therapeutic success, compared with 79.5% of those pretreated with long-acting β2-agonist (LABA)/inhaled corticosteroid (ICS) and 74.2% of those pretreated with LABA or long-acting muscarinic antagonist (LAMA) monotherapy. Overall, rescue medication decreased by 1.25 puffs/day (95% CI 1.19-1.31) versus baseline. In total, 29 patients (0.6%) reported drug-related adverse events and 7 patients reported serious adverse events (0.15%). CONCLUSION In 4700 COPD patients, 6 weeks' treatment with tiotropium/olodaterol, as initial treatment or follow-up to LAMA or LABA monotherapy or LABA/ICS, improved CCQ and decreased rescue medication use. The adverse event profile was consistent with the known safety profile of tiotropium/olodaterol.
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Affiliation(s)
- Arschang Valipour
- Department of Respiratory and Critical Care Medicine, Karl-Landsteiner-Institute for Lung Research and Pulmonary Oncology, Vienna Health Care Group, Klinik Floridsdorf, Vienna, Austria
| | - Sergey Avdeev
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Adam Barczyk
- Wydział Nauk Medycznych Śląskiego Uniwersytetu Medycznego, Katowice, Poland
| | - Valentina Bayer
- Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, CT, USA
| | - Zvi Fridlender
- Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | | | - Ondřej Kudela
- Department of Pneumology, Faculty of Medicine in Hradec Kralove, University Hospital Hradec Kralove, Charles University in Prague, Hradec Kralove, Czech Republic
| | | | - Ramona Miron
- Clinical Pneumophtysiology Hospital Iasi, Iasi, Romania
| | | | - Virginija Šileikienė
- Faculty of Medicine, Clinic of Chest Diseases, Immunology and Allergology, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania
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Calle Rubio M, Rodriguez Hermosa JL, de Torres JP, Marín JM, Martínez-González C, Fuster A, Cosío BG, Peces-Barba G, Solanes I, Feu-Collado N, Lopez-Campos JL, Casanova C. COPD Clinical Control: predictors and long-term follow-up of the CHAIN cohort. Respir Res 2021; 22:36. [PMID: 33541356 PMCID: PMC7863480 DOI: 10.1186/s12931-021-01633-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 01/21/2021] [Indexed: 11/17/2022] Open
Abstract
Background Control in COPD is a dynamic concept that can reflect changes in patients’ clinical status that may have prognostic implications, but there is no information about changes in control status and its long-term consequences. Methods We classified 798 patients with COPD from the CHAIN cohort as controlled/uncontrolled at baseline and over 5 years. We describe the changes in control status in patients over long-term follow-up and analyze the factors that were associated with longitudinal control patterns and related survival using the Cox hazard analysis. Results 134 patients (16.8%) were considered persistently controlled, 248 (31.1%) persistently uncontrolled and 416 (52.1%) changed control status during follow-up. The variables significantly associated with persistent control were not requiring triple therapy at baseline and having a better quality of life. Annual changes in outcomes (health status, psychological status, airflow limitation) did not differ in patients, regardless of clinical control status. All-cause mortality was lower in persistently controlled patients (5.5% versus 19.1%, p = 0.001). The hazard ratio for all-cause mortality was 2.274 (95% CI 1.394–3.708; p = 0.001). Regarding pharmacological treatment, triple inhaled therapy was the most common option in persistently uncontrolled patients (72.2%). Patients with persistent disease control more frequently used bronchodilators for monotherapy (53%) at recruitment, although by the end of the follow-up period, 20% had scaled up their treatment, with triple therapy being the most frequent therapeutic pattern. Conclusions The evaluation of COPD control status provides relevant prognostic information on survival. There is important variability in clinical control status and only a small proportion of the patients had persistently good control. Changes in the treatment pattern may be relevant in the longitudinal pattern of COPD clinical control. Further studies in other populations should validate our results. Trial registration: Clinical Trials.gov: identifier NCT01122758.
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Affiliation(s)
- Myriam Calle Rubio
- Pulmonology Department, Hospital Clínico San Carlos, C/ Martin Lagos S/N, 28040, Madrid, Spain.,Medical Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Juan Luis Rodriguez Hermosa
- Pulmonology Department, Hospital Clínico San Carlos, C/ Martin Lagos S/N, 28040, Madrid, Spain. .,Medical Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain.
| | - Juan P de Torres
- Respirology and Sleep Division, Queen's University, Kingston, ON, Canada
| | - José María Marín
- Respiratory Department. Hospital, Universitario Miguel Servet and IISAragón, Ciber Enfermedades Respiratorias, Madrid, Spain
| | - Cristina Martínez-González
- Pulmonology Department, Hospital Universitario Central de Asturias, Universidad de Oviedo, Oviedo, Spain
| | - Antonia Fuster
- Pulmonology Department, Hospital Universitario Son Llàtzer, Palma de Mallorca, Spain
| | - Borja G Cosío
- Department of Respiratory Medicine, Hospital Universitario Son Espases-IdISBa and CIBERES, Palma de Mallorca, Spain
| | - Germán Peces-Barba
- Pulmonology Department, IIS-Fundación Jiménez Díaz-CIBERES, Madrid, Spain
| | - Ingrid Solanes
- Pulmonology Department, Hospital de La Santa Creu Y San Pau, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Nuria Feu-Collado
- Pulmonology Department, Hospital Universitario Reina Sofía, Instituto Maimónides de Investigación Biomédica de Córdoba, Universidad de Córdoba, Córdoba, Spain
| | - Jose Luis Lopez-Campos
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBIS), Hospital Universitario Virgen del Rocio, Universidad de Sevilla, CIBERES, Seville, Spain
| | - Ciro Casanova
- Pulmonology Department, Hospital Universitario Nuestra Señora de Candelaria, Universidad de La Laguna, Tenerife, Spain
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Cabrera López C, Mascarós E, Azpeitia A, Villarrubia E. A Simplified Algorithm for the Diagnosis, Treatment, and Management of COPD in Routine Primary Care Practice. Int J Chron Obstruct Pulmon Dis 2020; 15:3347-3355. [PMID: 33364753 PMCID: PMC7751579 DOI: 10.2147/copd.s281422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 11/16/2020] [Indexed: 11/23/2022] Open
Abstract
Background Diagnostic and treatment strategies for chronic obstructive pulmonary disease (COPD) vary greatly. Despite international efforts to standardize the management of COPD, two-thirds of primary care patients are not diagnosed, treated, or managed according to current evidence-based guidelines, probably because of the difficulty of applying these in routine practice. The aim of this study was to develop a simplified algorithm for diagnosing, treating, and managing COPD in primary care whose consistency, scientific relevance, and applicability to routine clinical practice met approval bct 3y family doctors (FDs) and pulmonologists. Methods The algorithm was developed in a series of sequential phases, consisting of a preliminary meeting among group coordinators to design the initial structure, an input meeting with FDs and pulmonologists to refine and validate the proposal, an algorithm design stage, and a Delphi survey in which FDs and pulmonologists evaluated and approved the final version. A target of 75% or more was established for each of the 20 items in the Delphi survey in the FDs group as well as the pulmonologists group. It was estimated that at least two Delphi rounds would be needed to reach consensus. Results In total, 118 physicians (75 FDs and 43 pulmonologists) participated in the Delphi process. Fourteen of the 20 items (70%) were approved in the first round. In the second round (in which 74 FDs and 42 pulmonologists participated), the remaining six items, which had been reformulated based on feedback from the first round, were approved, together with an additional question on the face validity of the algorithm as a whole. Dyspnea was positioned as the main determinant of treatment decisions in the new algorithm. Conclusion According to the experts consulted, this new simplified algorithm for the diagnosis, treatment, and management of COPD in primary care is a clear, functional, and useful tool for routine practice and meets the requirements for the correct management of this condition.
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Affiliation(s)
- Carlos Cabrera López
- Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain
| | | | | | - Elena Villarrubia
- Health Outcomes Research Department, Advanced Outcomes Research, SL. Barcelona, Spain
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Alcazar-Navarrete B, Fuster A, García Sidro P, García Rivero JL, Abascal-Bolado B, Pallarés-Sanmartín A, Márquez E, Valido-Morales A, Boldova Loscertales A, Callejas-Gonzalez FJ, Palop M, Riesco JA, Golpe R, Soler-Cataluña JJ, Miravitlles M. Relationship Between Clinical Control, Respiratory Symptoms and Quality of Life for Patients with COPD. Int J Chron Obstruct Pulmon Dis 2020; 15:2683-2693. [PMID: 33149566 PMCID: PMC7604255 DOI: 10.2147/copd.s265470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 08/28/2020] [Indexed: 11/23/2022] Open
Abstract
Background The concept of clinical control has been proposed as an instrument for evaluating patients with COPD. However, the possible association between clinical control, reduced symptom severity and HRQoL has yet to be confirmed. Methods This multicentre, prospective and observational study was carried out in 15 pulmonology clinics in Spain. The patients were followed up for six months, with a baseline visit (V0), followed by visits at three months (V1) and six months (V2). Clinical control was determined at V1, with the application of both clinical criteria and the COPD assessment test (CAT). All patients reported their symptoms by a validated symptom diary (E-RS) using a portable device, and their HRQoL was assessed using the EQ5D questionnaire. The relationship between clinical control and E-RS and HRQoL during follow-up was assessed with t-test. Results A total of 126 patients were screened. After application of the inclusion/exclusion criteria, 93 were finally included (mean age 66 ± 8 years, 84.9% male), with a mean FEV1 predicted of 49.8% ± 16.5%. Of these patients, 44 (47.3%) achieved clinical control at V1, according to CAT criteria, and 50 (53.8%), according to clinical criteria. The E-RS scores differed between controlled and uncontrolled patients at all time points, both according to CAT (mean differences of -4.6, -5.6 and -6.2 units at V0, V1 and V2, respectively, p<0.005 for all comparisons) and to clinical criteria (mean differences of -3.3, -5-6 and -4.99 units, respectively, p<0.005 for all comparisons). The controlled patients also presented a significantly better HRQoL, measured by the EQ5D questionnaire (mean difference 0.13 and 0.10 at V2 by CAT or clinical criteria, respectively, p<0.05). Conclusion Clinical control in patients with COPD, whether measured by CAT or by clinical criteria, is associated with a lower symptom load and a better HRQoL.
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Affiliation(s)
- Bernardino Alcazar-Navarrete
- AIG De Medicina. Hospital De Alta Resolución De Loja. Agencia Sanitaria Hospital De Poniente, Loja, Granada, Spain
- CIBERES. Instituto De Salud Carlos III, Madrid, Spain
| | - Antonia Fuster
- Servicio De Neumología. Hospital Universitario De Son Llatzer, Palma De Mallorca, Spain
| | | | | | | | | | - Eduardo Márquez
- CIBERES. Instituto De Salud Carlos III, Madrid, Spain
- Unidad Médico-Quirúrgica De Enfermedades Respiratorias. Hospital Virgen Del Rocío, Sevilla, Spain
| | | | | | | | - Marta Palop
- Servicio De Neumología. Hospital De Sagunto, Sagunto, Spain
| | - Juan Antonio Riesco
- CIBERES. Instituto De Salud Carlos III, Madrid, Spain
- Servicio De Neumología. Hospital San Pedro De Alcántara, Cáceres, Spain
| | - Rafael Golpe
- Servicio De Neumología. Hospital Universitario Lucus Augusti, Lugo, Spain
| | - Juan Jose Soler-Cataluña
- CIBERES. Instituto De Salud Carlos III, Madrid, Spain
- Servicio De Neumología. Hospital Arnau De Villanova- Lliria, Valencia, Spain
| | - Marc Miravitlles
- CIBERES. Instituto De Salud Carlos III, Madrid, Spain
- Servicio De Neumología. Hospital Universitari Vall De Hebron/Vall d’Hebron Institut De Recerca, Barcelona, Spain
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Avdeev SN, Aisanov ZR, Belevsky AS, Beeh KM, Vizel AA, Zyryanov SK, Ignatova GL, Kostikas K, Leshchenko IV, Ovcharenko SI, Sinopal'nikov AI, Titova ON, Shmelev EI. [The concept of chronic obstructive pulmonary disease clinical control as a decision - making tool in real clinical practice for optimizing of basic pharmacotherapy]. TERAPEVT ARKH 2020; 92:89-95. [PMID: 32598669 DOI: 10.26442/00403660.2020.01.000489] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Indexed: 11/22/2022]
Abstract
The main goals of COPD therapy are to achieve clinical stability with minimal clinical manifestations and low risk of relapse. The proposed COPD control concept by analogy with asthma has not been quite well characterized yet. COPD control is defined as "the long - term maintenance of a clinical situation with a low impact of symptoms on the patient's life and absence of exacerbations." The situation of clinical control in COPD is considered desirable and potentially achievable for most patients with COPD. Pharmacotherapeutic options for COPD are constantly expanding. The control concept may be useful when the decision on treatment of COPD is made for dynamic adjustment of the therapy volume.
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Affiliation(s)
- S N Avdeev
- I.M. Sechenov First Moscow State Medical University (Sechenovskiy University)
| | - Z R Aisanov
- N.I. Pirogov Russian State National Research Medical University
| | - A S Belevsky
- N.I. Pirogov Russian State National Research Medical University
| | - K M Beeh
- Insaf Respiratory Research Institute
| | | | | | | | - K Kostikas
- University of Ioannina School of Medicine
| | | | - S I Ovcharenko
- I.M. Sechenov First Moscow State Medical University (Sechenovskiy University)
| | | | - O N Titova
- The 1 St. Petersburg Pavlov state medical university, Scientific research institute of pulmonology
| | - E I Shmelev
- Federal Central Research Institute of Tuberculosis
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Calle Rubio M, Soler-Cataluña JJ, López-Campos JL, Alcázar Navarrete B, Rodríguez González-Moro JM, Soriano JB, Fuentes Ferrer ME, Rodriguez Hermosa JL. Assessing the clinical practice in specialized outpatient clinics for chronic obstructive pulmonary disease: Analysis of the EPOCONSUL clinical audit. PLoS One 2019; 14:e0211732. [PMID: 30726278 PMCID: PMC6364994 DOI: 10.1371/journal.pone.0211732] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 01/18/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is one of the main reasons for healthcare appointments and use of healthcare resources. In recent years, clinics specializing in COPD have been developed to offer improved care and optimization of recourses for patients with high complexity and frequent decompensations. However, little is known about the clinical practice in this clinical model specializing in COPD. The objectives of this study were to assess the prevalence, characteristics of specialized COPD outpatient respiratory clinics and to evaluate clinical practice in this healthcare model. METHODS EPOCONSUL is a Spanish nationwide, observational, cross-sectional, clinical audit with prospective case recruitment including the clinical records for 4508 COPD cases from outpatient respiratory clinics over a 12-month period (May 2014-May 2015). The study evaluated clinical practice in 2378 cases from 28 hospitals with both general and specialized COPD outpatient respiratory clinics. RESULTS Only 28 (47.5%) centers had an outpatient clinic specializing in COPD, which was characterized by longer patient visits and a higher prevalence of written protocols compared to a general clinic. Patients treated in a specialized clinic had greater obstruction severity, a higher degree of dyspnea and also suffered from more comorbidities. The majority of patients at both types of clinic were classified as high risk (81.1% versus 83%, p = 0.384) according to GesEPOC criteria. Clinical control of COPD was more frequent at specialized clinics, with significant differences in non-severe patients (70.5% versus 56.1%, p < 0.001). Testing was done more frequently in specialized clinics, with better adherence to good clinical practice recommendations. CONCLUSION A specialized COPD outpatient clinic is a healthcare model found in few pulmonology departments that treats more severe patients and those with increased comorbidities. The COPD patients treated in a specialized clinic had a better clinical control, as defined by impact and clinical stability. It is a healthcare model to offer improved care with a higher degree of adherence to guidelines.
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Affiliation(s)
- Myriam Calle Rubio
- Pulmonology Department, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Hospital Clínico San Carlos, Madrid, Spain
- Medical Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | | | - José Luis López-Campos
- Respiratory Disease Medical-Surgical Unit. Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Universidad de Sevilla, Sevilla, Spain
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | | | | | - Joan B. Soriano
- Instituto de Investigación Hospital Universitario de la Princesa (IISP), Universidad Autónoma de Madrid, Madrid, Spain
| | - Manuel E. Fuentes Ferrer
- Medical Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
- Preventative Medicine CMU, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Juan Luis Rodriguez Hermosa
- Pulmonology Department, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Hospital Clínico San Carlos, Madrid, Spain
- Medical Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
- * E-mail:
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Oliveira A, Machado A, Marques A. Minimal Important and Detectable Differences of Respiratory Measures in Outpatients with AECOPD †. COPD 2018; 15:479-488. [PMID: 30512981 DOI: 10.1080/15412555.2018.1537366] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Interpreting clinical changes during acute exacerbations of chronic obstructive pulmonary disease (AECOPD) is challenging due to the absence of established minimal detectable (MDD) and important (MID) differences for most respiratory measures. This study established MDD and MID for respiratory measures in outpatients with AECOPD following pharmacological treatment. COPD assessment test (CAT), modified Borg scale (MBS), modified British Medical Research Council (mMRC) questionnaire, peripheral oxygen saturation (SpO2), computerised respiratory sounds and forced expiratory volume in one second (FEV1) were collected within 24-48 hour of an AECOPD and after 45 days of pharmacological treatment. MID and MDD were calculated using anchor- (receiver operating characteristic and linear regression analysis) and distribution-based methods (effect size, SEM, 0.5*SD and MDC95) and pooled using Meta XL. Forty-four outpatients with AECOPD (31♂; 68.2 ± 9.1 years; FEV1 51.1 ± 20.3%predicted) participated. Significant correlations with CAT were found for the MBS (r = 0.34), mMRC (r = 0.39) and FEV1 (r = 0.33), resulting in MIDs of 0.8, 0.5-0.6 and 0.03L, respectively. MDD of 0.5-1.4 (MBS), 0.4-1.2 (mMRC), 0.10-0.28L (FEV1), 3.6-10.1% (FEV1%predicted), 0.9-2.4% (SpO2), 0.7-1.9 (number of inspiratory crackles), 1.1-4.5 (number of expiratory crackles), 7.1-25.8% (inspiratory wheeze rate) and 11.8-63.0% (expiratory wheeze rate) were found. Pooled data of MID/MDD showed that improvements of 0.9 for the MBS, 0.6 for the mMRC, 0.15L for the FEV1, 7.6% for the FEV1%predicted, 1.5% for the SpO2, 1.1 for the inspiratory and 2.4 for the number of expiratory number of crackles, 14.1% for the inspiratory and 32.5% for the expiratory wheeze rate are meaningful following an AECOPD managed with pharmacological treatment on an outpatient basis.
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Affiliation(s)
- Ana Oliveira
- a Faculty of Sports , University of Porto , Porto , Portugal.,b Lab 3R - Respiratory Research and Rehabilitation Laboratory, School of Health Sciences , University of Aveiro , Aveiro , Portugal.,c Institute of Biomedicine (iBiMED) , University of Aveiro , Aveiro , Portugal
| | - Ana Machado
- b Lab 3R - Respiratory Research and Rehabilitation Laboratory, School of Health Sciences , University of Aveiro , Aveiro , Portugal.,c Institute of Biomedicine (iBiMED) , University of Aveiro , Aveiro , Portugal
| | - Alda Marques
- b Lab 3R - Respiratory Research and Rehabilitation Laboratory, School of Health Sciences , University of Aveiro , Aveiro , Portugal.,c Institute of Biomedicine (iBiMED) , University of Aveiro , Aveiro , Portugal
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10
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Baloira A, Gonzalez-Moro JMR, Sanjuán E, Trigueros JA, Casamor R. Degree of control of patients with chronic obstructive pulmonary disease in Spain: SINCON study. BMC Pulm Med 2018; 18:183. [PMID: 30509238 PMCID: PMC6276221 DOI: 10.1186/s12890-018-0749-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 11/21/2018] [Indexed: 11/10/2022] Open
Abstract
Background Disease control is an important objective of COPD management. The SINCON study evaluated the level of control in terms of respiratory symptoms and exacerbations in Spanish patients with COPD for ≥2 years. Methods SINCON was a descriptive, cross-sectional, multicenter study that assessed degree of control using a combined index comprising COPD assessment test (CAT), modified Medical Research Council dyspnea scale (mMRC), and number of moderate/severe exacerbations in the last year. Based on this score, patients were categorized as “well controlled” or “poorly controlled”. Degree of control was also assessed relative to patient phenotype, setting (primary care [PC] vs respiratory care [RC]), and impact of treatment on morning symptoms. Results Of the 481 patients (PC: 307, RC: 174) analyzed, COPD was poorly controlled in 63.2%. Some differences were found between clinical settings: PC patients were more poorly controlled (PC: 66.4% vs RC: 57.5%; P = 0.06) and had higher CAT score (PC: 17.9 vs RC: 15.5; P < 0.05), and higher rate of moderate/severe exacerbations during previous year (PC: 1.5 vs RC: 1.1; P < 0.05), while dyspnea degree was similar in both settings. Regarding phenotypes, non-exacerbators demonstrated better control vs exacerbators. Morning symptoms score improved between waking and 3 h after bronchodilator treatment (P < 0.05), with greater improvements in PC patients (PC: − 6.5 vs RC: − 5.0 points; P < 0.05). Conclusions Most COPD patients were poorly controlled with some differences observed between PC and RC settings and between patient phenotypes. Our index may be easily used in PC settings to optimize COPD treatment.
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Affiliation(s)
- Adolfo Baloira
- Hospital de Montecelo, Mourente, s/n, 36071, Pontevedra, Spain.
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11
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Soler-Cataluña JJ, Marzo M, Catalán P, Miralles C, Alcazar B, Miravitlles M. Validation of clinical control in COPD as a new tool for optimizing treatment. Int J Chron Obstruct Pulmon Dis 2018; 13:3719-3731. [PMID: 30532528 PMCID: PMC6241720 DOI: 10.2147/copd.s178149] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background It has recently been proposed that the concept of clinical control in COPD may be useful for deciding treatment in COPD, but the original control criteria (OCC) were considered too restrictive. Objective Define and subsequently validate "modified" control criteria (MCC) of COPD. Method Prospective observational study in COPD patients with a 1-year follow-up. Control was defined as the presence of low clinical impact and clinical stability. To evaluate clinical impact, the following clinical parameters were assessed: the degree of dyspnea, use of rescue medication, physical activity, and sputum color. Stability was assessed by clinical changes and exacerbations in the last 3 months. The COPD assessment test score and their changes were also evaluated as alternative control criteria. To define the MCC, adjustment for disease severity using BODEx index (MCC-B) or FEV1 (MCC-F) was evaluated, and the best cutoff point was established. Time to first combined event (emergency visit, hospitalization, or death) was analyzed to evaluate the predictive capacity of risk of the OCC, MCC-B, and MCC-F. Results We included 265 patients, 224 (83.9%) men, with a mean age (±SD) of 68±9 years and FEV1 of 58%±17%. The proportion of controlled patients was higher using clinical MCC-B or MCC-F (61.5% and 59.6%) than OCC (27.5%). Similar percentages were found using COPD assessment test scores. The time to the first combined event was significantly greater in controlled patients using MCC criteria (P<0.001, all cases). The predictive capacity of risk was similar in MCC-B (c-statistic [C]=0.639) and MCC-F (C=0.637) and higher than OCC (C=0.589). Conclusions The new MCC identified a higher number of controlled COPD patients. These patients have a better quality of life and lower risk of poor outcomes. The concept of control and the new MCC could be a useful tool to optimize therapy.
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Affiliation(s)
- Juan José Soler-Cataluña
- Pneumology Department, Hospital Arnau de Vilanova, Valencia, Spain.,CIBER of Respiratory Diseases (CIBERES), Spain,
| | - Maribel Marzo
- Emergency Department, Hospital General de Requena, Valencia, Spain
| | - Pablo Catalán
- Pneumology Department, Hospital Arnau de Vilanova, Valencia, Spain
| | | | - Bernardino Alcazar
- CIBER of Respiratory Diseases (CIBERES), Spain, .,Respiratory Department, Hospital de Alta Resolución de Loja, Granada, Spain
| | - Marc Miravitlles
- CIBER of Respiratory Diseases (CIBERES), Spain, .,Pneumology Department, University Hospital Vall d'Hebron/Vall d'Hebron Research Institute (VHIR), Barcelona, Spain,
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12
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Lopez-Campos JL, Centanni S. Current Approaches for Phenotyping as a Target for Precision Medicine in COPD Management. COPD 2018; 15:108-117. [PMID: 29558165 DOI: 10.1080/15412555.2018.1443064] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The study of airway diseases continues to present several challenges for modern medicine. The different disease presentations with variables and overlapping features may result in a real challenge for the clinician. In this context, the concept of precision medicine has started to emerge in order to give answers to some of these challenges from a diagnostic and therapeutic point of view. The main reasons to target for precision medicine in chronic obstructive pulmonary disease (COPD) include that there is variability in the clinical presentation, there is no correlation between the different clinical variables at the patient level, there are a number of relevant clinical variables associated with outcomes, we do have specific therapies for specific patient types, and that there is variability in the clinical response to different therapies. To bring precision medicine into clinical practice several approaches have been used, including the use of independent variables to identify subjects, the use of multidimensional indexes, the so-called clinical phenotypes, and the approximation by the so-called treatable traits. All these approaches have their strengths and weaknesses which are reviewed in the present document. Although there is no universally accepted proposal, the available initiatives provide us with a framework on which to start working and move toward precision medicine in COPD, with the ultimate goal of bringing the best possible medicine to each patient in particular.
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Affiliation(s)
- Jose Luis Lopez-Campos
- a Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Universidad de Sevilla , Seville , Spain.,b Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III , Madrid , Spain
| | - Stefano Centanni
- c Respiratory Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, Department of Health Sciences , Università degli Studi di Milano , Milan , Italy
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13
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Thomas M, Halpin DMG, Miravitlles M. When is dual bronchodilation indicated in COPD? Int J Chron Obstruct Pulmon Dis 2017; 12:2291-2305. [PMID: 28814857 PMCID: PMC5546730 DOI: 10.2147/copd.s138554] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Inhaled bronchodilator medications are central to the management of COPD and are frequently given on a regular basis to prevent or reduce symptoms. While short-acting bronchodilators are a treatment option for people with relatively few COPD symptoms and at low risk of exacerbations, for the majority of patients with significant breathlessness at the time of diagnosis, long-acting bronchodilators may be required. Dual bronchodilation with a long-acting β2-agonist and long-acting muscarinic antagonist may be more effective treatment for some of these patients, with the aim of improving symptoms. This combination may also reduce the rate of exacerbations compared with a bronchodilator-inhaled corticosteroid combination in those with a history of exacerbations. However, there is currently a lack of guidance on clinical indicators suggesting which patients should step up from mono- to dual bronchodilation. In this article, we discuss a number of clinical indicators that could prompt a patient and physician to consider treatment escalation, while being mindful of the need to avoid unnecessary polypharmacy. These indicators include insufficient symptomatic response, a sustained increased requirement for rescue medication, suboptimal 24-hour symptom control, deteriorating symptoms, the occurrence of exacerbations, COPD-related hospitalization, and reductions in lung function. Future research is required to provide a better understanding of the optimal timing and benefits of treatment escalation and to identify the appropriate tools to inform this decision.
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Affiliation(s)
- Mike Thomas
- Primary Care and Population Sciences, University of Southampton, Southampton
| | - David MG Halpin
- Department of Respiratory Medicine, Royal Devon and Exeter Hospital, Exeter, UK
| | - Marc Miravitlles
- Pneumology Department, Hospital Universitari Vall d’Hebron, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
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14
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Blasi F, Canonica GW, Miravitlles M. Is aclidinium alone or combined with a LABA a rational choice for symptomatic COPD patients? Respir Res 2017; 18:19. [PMID: 28100244 PMCID: PMC5242048 DOI: 10.1186/s12931-017-0506-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Accepted: 01/13/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND As emphasized by international recommendations and largely confirmed by clinical experience, long-acting bronchodilators play a central role in the maintenance treatment of chronic obstructive pulmonary disease (COPD) due to their proven efficacy in reducing airflow obstruction and improving symptoms. MAIN BODY There are some important aspects to define with regard to inhalation therapy for COPD, particularly those concerning the selection criteria and the optimal use of long-acting bronchodilators. First of all, it needs to be determined in which patients and clinical situations monotherapy with one bronchodilator, such as a long-acting muscarinic antagonist (LAMA), should be considered adequate, and in which cases the use of combination therapies, such as the "double bronchodilation" with a LAMA and a long-acting β2-agonist (LABA), should be preferred. Another critical issue concerns the effect of the frequency of daily administration of inhaled agents on the control of symptoms during the 24 h. COPD symptoms are known to exhibit considerable circadian variability with worsening in the early morning, and a significant proportion of patients have disease-related sleep disorders which can adversely affect their quality of life. The worsening of symptoms in the early morning may be due, at least in part, to a reduction in airway caliber caused by an increased "cholinergic tone" at night. As such, the coverage of nighttime and early morning symptoms is a reasonable therapeutic goal, which can be achieved by many patients using LAMAs such as aclidinium bromide twice daily (BID). Therapeutic adherence is known to be a multifactorial phenomenon that is frequently affected by other aspects than dosing frequency, including the technical features and ease of use of the inhalers. To this end, it should be mentioned that certain new-generation inhalers such as Genuair® have been associated in clinical trials with higher patient preference. CONCLUSION In this work, in addition to presenting an overview of the main evidence on the efficacy of COPD treatment with the LAMA aclidinium bromide BID, we suggest some selection criteria for the monotherapy with one long-acting bronchodilator or the combination therapy with LAMA and LABA in COPD patients, with particular reference to specific clinical scenarios.
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Affiliation(s)
- F Blasi
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Cardio-thoracic unit and Cystic Fibrosis Adult Center Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico Milano, Milan, Italy.
| | - G W Canonica
- Department of Biomedical Science, Personalized Medicine Clinic: Asthma & Allergy - Humanitas Clinical and Research Center, Humanitas University -Rozzano (Milano), Milan, Italy
| | - M Miravitlles
- Pneumology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
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15
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Tapp H, Shade L, Mahabaleshwarkar R, Taylor YJ, Ludden T, Dulin MF. Results from a pragmatic prospective cohort study: Shared decision making improves outcomes for children with asthma. J Asthma 2016; 54:392-402. [PMID: 27813670 DOI: 10.1080/02770903.2016.1227333] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Patient/provider shared decision making (SDM) improves asthma control in a pragmatic clinical trial setting. This study evaluated the impact of an evidence-based SDM toolkit on outcomes for patients with asthma implemented by providers in a real world setting. We hypothesized that these patients with asthma would demonstrate improved outcomes such as reduced emergency department (ED) visits, hospitalizations, and oral steroid use in the 12 months following a SDM visit compared to those who did not receive the intervention. METHODS Patients with asthma were identified within six primary care practices that serve vulnerable populations in Charlotte, NC (746 children; 718 adult patients). Propensity scores were used to match 200 children and 206 adults for analysis. The primary outcome variable was asthma exacerbation defined as an ED visit or hospitalization for asthma or outpatient prescription of an oral steroid. Patients were monitored at 3, 6, and 12 months after the intervention date. The outcome variables of ED visits, hospitalizations, and oral steroids were compared between intervention and matched control patients. RESULTS The proportion of pediatric patients with one or more exacerbations was significantly lower in the SDM intervention group compared to controls during 12 months after exposure to the intervention (33% vs. 47%, p = 0.023). For adults, there was not a strong association between use of the SDM intervention and outcomes improvement. CONCLUSIONS The evidence-based SDM intervention implemented in this study was associated with improved asthma outcomes for pediatric patients but not adult patients in a real world clinical setting.
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Affiliation(s)
- Hazel Tapp
- a Department of Family Medicine , Carolinas HealthCare System , Charlotte , NC , USA
| | - Lindsay Shade
- a Department of Family Medicine , Carolinas HealthCare System , Charlotte , NC , USA
| | - Rohan Mahabaleshwarkar
- b Center for Outcome Research and Evaluation, Carolinas HealthCare System , Charlotte , NC , USA
| | - Yhenneko J Taylor
- b Center for Outcome Research and Evaluation, Carolinas HealthCare System , Charlotte , NC , USA
| | - Thomas Ludden
- a Department of Family Medicine , Carolinas HealthCare System , Charlotte , NC , USA
| | - Michael F Dulin
- a Department of Family Medicine , Carolinas HealthCare System , Charlotte , NC , USA
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16
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Miravitlles M, Vogelmeier C, Roche N, Halpin D, Cardoso J, Chuchalin AG, Kankaanranta H, Sandström T, Śliwiński P, Zatloukal J, Blasi F. A review of national guidelines for management of COPD in Europe. Eur Respir J 2016; 47:625-37. [PMID: 26797035 PMCID: PMC4733567 DOI: 10.1183/13993003.01170-2015] [Citation(s) in RCA: 127] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 10/24/2015] [Indexed: 12/23/2022]
Abstract
The quality of care can be improved by the development and implementation of evidence-based treatment guidelines. Different national guidelines for chronic obstructive pulmonary disease (COPD) exist in Europe and relevant differences may exist among them.This was an evaluation of COPD treatment guidelines published in Europe and Russia in the past 7 years. Each guideline was reviewed in detail and information about the most important aspects of patient diagnosis, risk stratification and pharmacotherapy was extracted following a standardised process. Guidelines were available from the Czech Republic, England and Wales, Finland, France, Germany, Italy, Poland, Portugal, Russia, Spain and Sweden. The treatment goals, criteria for COPD diagnosis, consideration of comorbidities in treatment selection and support for use of long-acting bronchodilators, were similar across treatment guidelines. There were differences in measures used for stratification of disease severity, consideration of patient phenotypes, criteria for the use of inhaled corticosteroids and recommendations for other medications (e.g. theophylline and mucolytics) in addition to bronchodilators.There is generally good agreement on treatment goals, criteria for diagnosis of COPD and use of long-acting bronchodilators as the cornerstone of treatment among guidelines for COPD management in Europe and Russia. However, there are differences in the definitions of patient subgroups and other recommended treatments.
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Affiliation(s)
- Marc Miravitlles
- Pneumology Dept, University Hospital Vall d'Hebron, Ciber de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
| | - Claus Vogelmeier
- Dept of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-University Marburg, German Center for Lung Research (DZL), Marburg, Germany
| | - Nicolas Roche
- Service de Pneumologie et Soins Intensifs Respiratoires, Hôpital Cochin, University Paris Descartes (EA2511), Paris, France
| | | | - João Cardoso
- Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, Universidade Nova de Lisboa, Lisbon, Portugal
| | | | - Hannu Kankaanranta
- Dept of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland Dept of Respiratory Medicine, University of Tampere, Tampere, Finland
| | - Thomas Sandström
- Department of Public Health and Clinical Medicine, Medicine Unit, Umeå University, Umeå, Sweden
| | - Paweł Śliwiński
- 2nd Department of Respiratory Medicine, Institute of Tuberculosis and Lung Diseases, Warsaw, Poland
| | - Jaromir Zatloukal
- Dept of Respiratory Medicine, University Hospital Olomouc, Olomouc, Czech Republic
| | - Francesco Blasi
- Dept of Pathophysiology and Transplantation, Università degli Studi di Milano, IRCCS Fondazione Ospedale Maggiore Policlinico Cà Granda, Milan, Italy
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Miravitlles M, García-Sidro P, Fernández-Nistal A, Buendía MJ, Espinosa de Los Monteros MJ, Esquinas C, Molina J. The chronic obstructive pulmonary disease assessment test improves the predictive value of previous exacerbations for poor outcomes in COPD. Int J Chron Obstruct Pulmon Dis 2015; 10:2571-9. [PMID: 26664105 PMCID: PMC4670021 DOI: 10.2147/copd.s91163] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Chronic obstructive pulmonary disease (COPD) exacerbations have a negative impact on the quality of life of patients and the evolution of the disease. We have investigated the prognostic value of several health-related quality of life questionnaires to predict the appearance of a composite event (new ambulatory or emergency exacerbation, hospitalization, or death) over a 1-year follow-up. METHODS This was a multicenter, prospective, observational study. Patients completed four questionnaires after recovering from an exacerbation (COPD Assessment Test [CAT], a Clinical COPD Questionnaire [CCQ], COPD Severity Score [COPDSS], and Airways Questionnaire [AQ20]). Patients were followed-up until the appearance of the composite event or for 1 year, whichever came first. RESULTS A total of 497 patients were included in the study. The majority of them were men (89.7%), with a mean age of 68.7 (SD 9.2) years, and a forced expiratory volume in 1 second of 47.1% (SD 17.5%). A total of 303 (61%) patients experienced a composite event. Patients with an event had worse mean scores of all questionnaires at baseline compared to patients without event: CAT=12.5 vs 11.3 (P=0.028); CCQ=2.2 vs 1.9 (P=0.013); COPDSS=12.3 vs 10.9 (P=0.001); AQ20=8.3 vs 7.5 (P=0.048). In the multivariate analysis, only previous history of exacerbations and CAT score ≥13.5 were significant risk factors for the composite event. A CAT score ≥13.5 increased the predictive value of previous exacerbations with an area under the receiver operating characteristic curve of 0.864 (95% CI: 0.829-0.899; P=0.001). CONCLUSION The predictive value of previous exacerbations significantly increased only in one of the four trialled questionnaires, namely in the CAT questionnaire. However, previous history of exacerbations was the strongest predictor of the composite event.
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Affiliation(s)
- Marc Miravitlles
- Pneumology Department, Hospital Universitari Vall d'Hebron, Ciber de Enfermedades Respiratorias, Barcelona, Spain
| | | | | | | | | | - Cristina Esquinas
- Pneumology Department, Hospital Universitari Vall d'Hebron, Ciber de Enfermedades Respiratorias, Barcelona, Spain
| | - Jesús Molina
- Centro de Salud "Francia", Fuenlabrada, Madrid, Spain
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