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Kurian V, Ghadipasha N, Gee M, Chalant A, Hamill T, Okossi A, Chen L, Yu B, Ogunnaike BA, Beris AN. Systems Engineering Approach to Modeling and Analysis of Chronic Obstructive Pulmonary Disease. ACS OMEGA 2023; 8:20524-20535. [PMID: 37332794 PMCID: PMC10268641 DOI: 10.1021/acsomega.3c00854] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 05/15/2023] [Indexed: 06/20/2023]
Abstract
Chronic obstructive pulmonary disease (COPD) is a progressive lung disease characterized by airflow limitation. This study develops a systems engineering framework for representing important mechanistic details of COPD in a model of the cardiorespiratory system. In this model, we present the cardiorespiratory system as an integrated biological control system responsible for regulating breathing. Four engineering control system components are considered: sensor, controller, actuator, and the process itself. Knowledge of human anatomy and physiology is used to develop appropriate mechanistic mathematical models for each component. Following a systematic analysis of the computational model, we identify three physiological parameters associated with reproducing clinical manifestations of COPD: changes in the forced expiratory volume, lung volumes, and pulmonary hypertension. We quantify the changes in these parameters (airway resistance, lung elastance, and pulmonary resistance) as the ones that result in a systemic response that is diagnostic of COPD. A multivariate analysis of the simulation results reveals that the changes in airway resistance have a broad impact on the human cardiorespiratory system and that the pulmonary circuit is stressed beyond normal under hypoxic environments in most COPD patients.
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Affiliation(s)
- Varghese Kurian
- Department
of Chemical and Biomolecular Engineering, University of Delaware, Newark, Delaware 19716, United States
| | - Navid Ghadipasha
- Department
of Chemical and Biomolecular Engineering, University of Delaware, Newark, Delaware 19716, United States
| | - Michelle Gee
- Department
of Chemical and Biomolecular Engineering, University of Delaware, Newark, Delaware 19716, United States
- Daniel
Baugh Institute of Functional Genomics/Computational Biology, Department
of Pathology and Genomic Medicine, Thomas
Jefferson University, Philadelphia, Pennsylvania 19107, United States
| | - Anais Chalant
- American
Air Liquide Inc., Innovation Campus Delaware, Newark, Delaware 19702, United States
| | - Teresa Hamill
- American
Air Liquide Inc., Innovation Campus Delaware, Newark, Delaware 19702, United States
| | - Alphonse Okossi
- American
Air Liquide Inc., Innovation Campus Delaware, Newark, Delaware 19702, United States
| | - Lucy Chen
- American
Air Liquide Inc., Innovation Campus Delaware, Newark, Delaware 19702, United States
| | - Bin Yu
- American
Air Liquide Inc., Innovation Campus Delaware, Newark, Delaware 19702, United States
| | - Babatunde A. Ogunnaike
- Department
of Chemical and Biomolecular Engineering, University of Delaware, Newark, Delaware 19716, United States
| | - Antony N. Beris
- Department
of Chemical and Biomolecular Engineering, University of Delaware, Newark, Delaware 19716, United States
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Are we missing lifetime COPD diagnosis among people with COPD recorded death? A population-based retrospective cohort study. BJGP Open 2022; 6:BJGPO.2022.0060. [PMID: 35788026 PMCID: PMC9904773 DOI: 10.3399/bjgpo.2022.0060] [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: 04/29/2022] [Revised: 04/29/2022] [Accepted: 06/16/2022] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND The British Lung Foundation (BLF) has previously estimated that there are 2.2 million people in the UK who have symptoms, but no diagnosis, of chronic obstructive pulmonary disease (COPD). AIM To investigate the proportion of patients with a missed COPD diagnosis among those with COPD as the cause of death on their death certificate, and how this has changed over a period of 17 years (2000-2017). DESIGN & SETTING Clinical Practice Research Datalink (CPRD) Aurum and GOLD primary care data were linked with Office for National Statistics (ONS) mortality data and Hospital Episode Statistics (HES) data. Adults who died between 2000 and 2017 with COPD as their main cause of death were included. METHOD Using a range of diagnostic COPD criteria, the proportion of patients with a missed COPD diagnosis was estimated, and the demographic and clinical characteristics of patients with and without prior COPD diagnosis were described, using a mixed-effect logistic regression model. RESULTS Depending on the COPD definition used, between 96% and 27% of the 78 621 patients included received a diagnosis of COPD before death. Using presence of a COPD Read or SNOMED CT code and performed spirometry as a main definition, just over half of the patients (52%) had received a COPD diagnosis overall, with a proportion of those who did not decreasing from 91% in 2000 to 31% in 2017 (Ptrend <0.001). CONCLUSION The proportion of people with COPD-recorded death and who had received a diagnosis of COPD has improved (increased) over time, and currently represents the majority of them. This suggests that few patients are now being missed.
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Pagano L, McKeough Z, Wootton S, Zwar N, Dennis S. Accuracy of the COPD diagnostic questionnaire as a screening tool in primary care. BMC PRIMARY CARE 2022; 23:78. [PMID: 35421929 PMCID: PMC9010070 DOI: 10.1186/s12875-022-01685-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 04/01/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND The COPD Diagnostic Questionnaire (CDQ) was developed to identify people who would benefit from spirometry testing to confirm Chronic Obstructive Pulmonary Disease (COPD). The aim of this study was to determine the usefulness of a cut-off score of 16.5 on the CDQ in identifying those at increased risk of obstruction, in a mixed population of people 'at risk' of COPD and those with an 'existing' COPD diagnosis. METHODS People 'at risk' of COPD (aged > 40 years, current/ex-smoker) and those with 'existing' COPD were identified from four general practices and invited to participate. Participants completed the CDQ and those with a CDQ score ≥ 16.5 were categorised as having intermediate to increased likelihood of airflow obstruction. Pre and post-bronchodilator spirometry determined the presence of airway obstruction (FEV1/FVC ratio < 0.7). Sensitivity, specificity and accuracy of the CDQ was determined compared to spirometry as the gold standard. RESULTS One hundred forty-one participants attended an initial assessment ('at risk' = 111 (79%), 'existing' COPD = 30 (21%)). A cut-off score of 16.5 corresponded to a sensitivity of 81%, specificity of 36% and accuracy of 50%, in the entire mixed population. The area under the ROC curve was 0.59 ± 0.50 indicating low diagnostic accuracy of the CDQ. Similar results were found in the 'existing' COPD group alone. CONCLUSION Whilst a cut-off score of 16.5 on the CDQ may result in a large number of false positives, clinicians may still wish to use the CDQ to refine who receives spirometry due to its high sensitivity. TRIAL REGISTRATION ANZCTR, ACTRN12619001127190. Registered 12 August 2019 - Retrospectively registered, http://www.ANZCTR.org.au/ACTRN12619001127190.aspx.
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Affiliation(s)
- Lisa Pagano
- Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Camperdown, Sydney, NSW, 2006, Australia
| | - Zoe McKeough
- Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Camperdown, Sydney, NSW, 2006, Australia
| | - Sally Wootton
- Chronic Disease Community Rehabilitation Service, Northern Sydney Local Health District, Sydney, Australia
| | - Nicholas Zwar
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
| | - Sarah Dennis
- Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Camperdown, Sydney, NSW, 2006, Australia.
- Ingham Institute for Applied Medical Research, Liverpool, Australia.
- South Western Sydney Local Health District, Liverpool, Australia.
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Fang Y, Shepherd TA, Smith HE. Examining the Trends in Online Health Information-Seeking Behavior About Chronic Obstructive Pulmonary Disease in Singapore: Analysis of Data From Google Trends and the Global Burden of Disease Study. J Med Internet Res 2021; 23:e19307. [PMID: 34661539 PMCID: PMC8561404 DOI: 10.2196/19307] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 10/20/2020] [Accepted: 06/04/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is the third leading cause of death globally, and timely health care seeking is imperative for its prevention, early detection, and management. While online health information-seeking behavior (OHISB) is increasingly popular due to widespread internet connectivity, little is known about how OHISB for COPD has changed in comparison with the COPD disease burden, particularly at a country-specific level. OBJECTIVE This study aimed to examine the trends in OHISB for COPD and how that compared with the estimates of COPD disease burden in Singapore, a highly wired country with a steadily increasing COPD disease burden. METHODS To examine the trends in OHISB for COPD, we performed Prais-Winsten regression analyses on monthly search volume data for COPD from January 2004 to June 2020 downloaded from Google Trends. We then conducted cross-correlational analyses to examine the relationship between annualized search volume on COPD topics and estimates of COPD morbidity and mortality reported in the Global Burden of Disease study from 2004 to 2017. RESULTS From 2004 to 2020, the trend in COPD search volume was curvilinear (β=1.69, t194=6.64, P<.001), with a slope change around the end of 2006. There was a negative linear trend (β=-0.53, t33=-3.57, P=.001) from 2004 to 2006 and a positive linear trend (β=0.51, t159=7.43, P<.001) from 2007 to 2020. Cross-correlation analyses revealed positive associations between COPD search volume and COPD disease burden indicators: positive correlations between search volume and prevalence, incidence, years living with disability (YLD) at lag 0, and positive correlations between search volume and prevalence, YLD at lag 1. CONCLUSIONS Google search volume on COPD increased from 2007 to 2020; this trend correlated with the upward trajectory of several COPD morbidity estimates, suggesting increasing engagement in OHISB for COPD in Singapore. These findings underscore the importance of making high-quality, web-based information accessible to the public, particularly COPD patients and their carers.
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Affiliation(s)
- Yang Fang
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
| | | | - Helen E Smith
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
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Román-Rodríguez M, Kocks JWH. Targeting exertional breathlessness to improve physical activity: the role of primary care. NPJ Prim Care Respir Med 2021; 31:41. [PMID: 34504091 PMCID: PMC8429707 DOI: 10.1038/s41533-021-00254-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 08/19/2021] [Indexed: 02/08/2023] Open
Abstract
Primary care physicians (PCPs) play a crucial role in the diagnosis and management of chronic obstructive pulmonary disease (COPD). By working together with patients to target exertional breathlessness and increase physical activity, PCPs have an important role to play, early in the disease course, in improving patient outcomes in both the short and long term. In this article, we consider how physical activity affects disease progression from the PCP perspective. We discuss the role of pharmacological therapy, the importance of an holistic approach and the role of PCPs in assessing and promoting physical activity. The complexity and heterogeneity of COPD make it a challenging disease to treat. Patients' avoidance of activity, and subsequent decline in capacity to perform it, further impacts the management of the disease. Improving patient tolerance of physical activity, increasing participation in daily activities and helping patients to remain active are clear goals of COPD management. These may require an holistic approach to management, including pulmonary rehabilitation and psychological programmes in parallel with bronchodilation therapy, in order to address both physiological and behavioural factors. PCPs have an important role to optimise therapy, set goals and communicate the importance of maintaining physical activity to their patients. In addition, optimal treatment that addresses activity-related breathlessness can help prevent the downward spiral of inactivity and get patients moving again, to improve their overall health and long-term prognosis.
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Affiliation(s)
- Miguel Román-Rodríguez
- Son Pisà Primary Health Care Centre, Balearic Health System, Mallorca, Spain.
- Primary Care Chronic Respiratory Research Unit, Instituto de Investigación Sanitaria de las Islas Baleares (IdISBa), Mallorca, Spain.
| | - Janwillem W H Kocks
- General Practitioners Research Institute, Groningen, The Netherlands
- Groningen Research Institute for Asthma and COPD (GRIAC), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Observational and Pragmatic Research Institute, Singapore, Singapore
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6
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Slevin P, Kessie T, Cullen J, Butler MW, Donnelly SC, Caulfield B. A qualitative study of clinician perceptions regarding the potential role for digital health interventions for the management of COPD. Health Informatics J 2021; 27:1460458221994888. [PMID: 33653189 DOI: 10.1177/1460458221994888] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Effective self-management of chronic obstructive pulmonary disease (COPD) can lead to increased patient control and reduced health care costs. However, both patients and healthcare professionals encounter significant challenges. Digital health interventions, such as smart oximeters and COPD self-management applications, promise to enhance the management of COPD, yet, there is little evidence to support their use and user-experience issues are still common. Understanding the needs of healthcare professionals is central for increasing adoption and engagement with digital health interventions but little is known about their perceptions of digital health interventions in COPD. This paper explored the perceptions of healthcare professionals regarding the potential role for DHI in the management of COPD. Snowball sampling was used to recruit the participants (n = 32). Each participant underwent a semi-structured interview. Using NVivo 12 software, thematic analysis was completed. Healthcare professionals perceive digital health interventions providing several potential benefits to the management of COPD including the capture of patient status indicators during the interappointment period, providing new patient data to support the consultation process and perceived digital health interventions as a potential means to improve patient engagement. The findings offer new insights regarding potential future use-cases for digital health interventions in COPD, which can help ease user-experience issues as they align with the needs of healthcare professionals.
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Affiliation(s)
| | | | - John Cullen
- Tallaght University Hospital, Ireland.,Trinity College Dublin, Ireland
| | - Marcus W Butler
- University College Dublin, Ireland.,St. Vincent's University Hospital, Ireland
| | - Seamas C Donnelly
- Tallaght University Hospital, Ireland.,Trinity College Dublin, Ireland
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7
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MacDonell R, Woods O, Whelan S, Cushen B, Carroll A, Brennan J, Kelly E, Bolger K, McNamara N, Lanigan A, McDonnell T, Prihodova L. Interventions to standardise hospital care at presentation, admission or discharge or to reduce unnecessary admissions or readmissions for patients with acute exacerbation of chronic obstructive pulmonary disease: a scoping review. BMJ Open Respir Res 2020; 7:e000733. [PMID: 33262103 PMCID: PMC7709517 DOI: 10.1136/bmjresp-2020-000733] [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: 07/31/2020] [Revised: 10/01/2020] [Accepted: 11/08/2020] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Chronic obstructive pulmonary disease (COPD) is a chronic respiratory disease that may be punctuated by episodes of worsening symptoms, called exacerbations. Acute exacerbations of COPD (AECOPD) are detrimental to clinical outcomes, reduce patient quality of life and often result in hospitalisation and cost for the health system. Improved diagnosis and management of COPD may reduce the incidence of hospitalisation and death among this population. This scoping review aims to identify improvement interventions designed to standardise the hospital care of patients with AECOPD at presentation, admission and discharge, and/or aim to reduce unnecessary admissions/readmissions. METHODS The review followed a published protocol based on methodology set out by Arksey and O'Malley and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Electronic database searches for peer-reviewed primary evidence were conducted in Web of Science, EMBASE (Elsevier) and PubMed. Abstract, full-text screening and data extraction were completed independently by a panel of expert reviewers. Data on type of intervention, implementation supports and clinical outcomes were extracted. Findings were grouped by theme and are presented descriptively. RESULTS 21 articles met the inclusion criteria. Eight implemented a clinical intervention bundle at admission and/or discharge; six used a multidisciplinary care pathway; five used coordinated case management and two ran a health coaching intervention with patients. CONCLUSION The findings indicate that when executed reliably, improvement initiatives are associated with positive outcomes, such as reduction in length of stay, readmissions or use of health resources. Most of the studies reported an improvement in staff compliance with the initiatives and in the patient's understanding of their disease. Implementation supports varied and included quality improvement methodology, multidisciplinary team engagement, staff education and development of written or in-person delivery of patient information. Consideration of the implementation strategy and methods of support will be necessary to enhance the likelihood of success in any future intervention.
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Affiliation(s)
- Rachel MacDonell
- Quality Improvement, Royal College of Physicians of Ireland, Dublin, Ireland
| | - Orla Woods
- Research Department, Royal College of Physicians of Ireland, Dublin, Ireland
| | - Stephanie Whelan
- Research Department, Royal College of Physicians of Ireland, Dublin, Ireland
| | - Breda Cushen
- Dept. of Respiratory Medicine, Beaumont Hospital, Dublin, Ireland
| | - Aine Carroll
- Healthcare Integration and Improvement, University College Dublin, Dublin, Ireland
| | - John Brennan
- Quality Improvement, Royal College of Physicians of Ireland, Dublin, Ireland
| | - Emer Kelly
- Acute Medicine & Respiratory Medicine, St Vincent's University Hospital, Dublin, Ireland
| | - Kenneth Bolger
- Dept. of Respiratory Medicine, South Tipperary General Hospital, Clonmel, Tipperary, Ireland
| | - Nora McNamara
- Dept. of Respiratory Medicine, South Tipperary General Hospital, Clonmel, Tipperary, Ireland
| | - Anne Lanigan
- Respiratory Physiotherapy, Midland Regional Hospital Portlaoise, Portlaoise, Laois, Ireland
| | - Timothy McDonnell
- National Clinical Programme Respiratory, Health Service Executive, Dublin, Ireland
| | - Lucia Prihodova
- Research Department, Royal College of Physicians of Ireland, Dublin, Ireland
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De Ramón Fernández A, Ruiz Fernández D, Marcos-Jorquera D, Gilart Iglesias V. Support System for Early Diagnosis of Chronic Obstructive Pulmonary Disease Based on the Service-Oriented Architecture Paradigm and Business Process Management Strategy: Development and Usability Survey Among Patients and Health Care Providers. J Med Internet Res 2020; 22:e17161. [PMID: 32181744 PMCID: PMC7109614 DOI: 10.2196/17161] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 01/06/2020] [Accepted: 01/26/2020] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a chronic respiratory disease with a high global prevalence. The main scientific societies dedicated to the management of this disease have published clinical practice guidelines for quality practice. However, at present, there are important weaknesses in COPD diagnosis criteria that often lead to underdiagnosis or misdiagnosis. OBJECTIVE We sought to develop a new support system for COPD diagnosis. The system was designed to overcome the weaknesses detected in current guidelines with the goals of enabling early diagnosis, and improving the diagnostic accuracy and quality of care provided. METHODS We first analyzed the main clinical guidelines for COPD to detect weaknesses that exist in the current diagnostic process, and then proposed a redesign based on a business process management (BPM) strategy for its optimization. The BPM system acts as a backbone throughout the process of COPD diagnosis in this proposed approach. The newly developed support system was integrated into a health information system for validation of its use in a hospital environment. The system was qualitatively evaluated by experts (n=12) and patients (n=36). RESULTS Among the 12 experts, 10 (83%) positively evaluated our system with respect to increasing the speed for making the diagnosis, helping in interpreting results, and encouraging opportunistic diagnosis. With an overall rating of 4.29 on a 5-point scale, 27/36 (75%) of patients considered that the system was very useful in providing a warning about possible cases of COPD. The overall assessment of the system was 4.53 on a 5-point Likert scale with agreement to extend its use to all primary care centers. CONCLUSIONS The proposed system provides a functional method to overcome the weaknesses detected in the current diagnostic process for COPD, which can help foster early diagnosis, while improving the diagnostic accuracy and quality of care provided.
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Affiliation(s)
| | - Daniel Ruiz Fernández
- Department of Computer Technology, University of Alicante, San Vicente del Raspeig, Alicante, Spain
| | - Diego Marcos-Jorquera
- Department of Computer Technology, University of Alicante, San Vicente del Raspeig, Alicante, Spain
| | - Virgilio Gilart Iglesias
- Department of Computer Technology, University of Alicante, San Vicente del Raspeig, Alicante, Spain
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9
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Bhowmik M, Majumdar S, Dasgupta A, Gupta Bhattacharya S, Saha S. Pilot-Scale Study Of Human Plasma Proteomics Identifies ApoE And IL33 As Markers In Atopic Asthma. J Asthma Allergy 2019; 12:273-283. [PMID: 31571934 PMCID: PMC6759800 DOI: 10.2147/jaa.s211569] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 08/12/2019] [Indexed: 12/12/2022] Open
Abstract
Background The pathobiology of atopic asthma is complex and the symptoms similar to other respiratory diseases. As such, identification of biomarkers of atopic asthma is of prime importance for better diagnosis and control of the disease. Objectives We sought to study the changes in plasma proteome and cytokine-expression profile across healthy and atopic asthmatics for identifying biomarkers and exploring aberrant pathways for atopic asthma. Methods A pilot-scale study in humans was performed to identify differentially expressed proteins in blood plasma of healthy controls (n=5) and treatment-naïve atopic asthma patients (n=5) using quantitative label-free liquid chromatography-tandem mass spectrometry proteomics and ELISA. Results Mass spectrometry-based proteomic analysis revealed ApoE to be significantly downregulated in atopic asthmatics compared to healthy volunteers. Decreased expression of ApoE in atopic asthmatics was validated by immunoblotting (50.74% decrease). Comparison with atopic asthmatics and COPD patients showed that ApoE was decreased (36.33%) in atopic asthma compared to COPD. IL33 was significantly upregulated in atopic asthmatics compared to healthy subjects (3.84-fold). Conclusion ApoE was downregulated and IL33 upregulated in atopic asthma patients compared to healthy volunteers. These two proteins' profiles were distinct in atopic asthma from healthy and COPD plasma samples. Differential expression of these proteins could serve as a probable candidate for a two-protein classifier-based prognostic biomarker of atopic asthma.
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Affiliation(s)
- Moumita Bhowmik
- Division of Plant Biology, Bose Institute, Kolkata, West Bengal, India
| | - Sreyashi Majumdar
- Division of Bioinformatics, Bose Institute, Kolkata, West Bengal, India
| | - Angira Dasgupta
- BR Singh Hospital and Centre for Medical Education and Research, Kolkata, West Bengal, India
| | | | - Sudipto Saha
- Division of Bioinformatics, Bose Institute, Kolkata, West Bengal, India
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Brożek GM, Nowak M, Zejda JE, Jankowski M, Lawson J, Pierzchała W. Consequences of Changing the GOLD Reports (2007–2011–2017) on the Treatment Regimen of Patients with COPD. COPD 2019; 16:126-132. [DOI: 10.1080/15412555.2019.1615872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Grzegorz Marek Brożek
- Department of Epidemiology, School of Medicine in Katowice, Medical University of Silesia in Katowice, Katowice, Poland
| | | | - Jan Eugeniusz Zejda
- Department of Epidemiology, School of Medicine in Katowice, Medical University of Silesia in Katowice, Katowice, Poland
| | - Mateusz Jankowski
- Department of Epidemiology, School of Medicine in Katowice, Medical University of Silesia in Katowice, Katowice, Poland
| | - Joshua Lawson
- Canadian Centre for Health and Safety in Agriculture, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
- Department of Medicine, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
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11
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Alcázar-Navarrete B, Trigueros JA, Riesco JA, Campuzano A, Pérez J. Geographic variations of the prevalence and distribution of COPD phenotypes in Spain: "the ESPIRAL-ES study". Int J Chron Obstruct Pulmon Dis 2018; 13:1115-1124. [PMID: 29692606 PMCID: PMC5901135 DOI: 10.2147/copd.s158031] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose The purpose of this study was to assess the prevalence of COPD phenotypes at a national level and to determine their geographic distribution among different autonomous communities in Spain. Patients and methods A total of 1,610 patients (82% men, median age 67 years) recruited in primary care centers and pneumology services participated in an observational, cross-sectional, and multicenter study. Phenotypes evaluated were the non-exacerbator phenotype, the asthma–COPD overlap syndrome (ACOS), the exacerbator phenotype with emphysema, and the exacerbator phenotype with chronic bronchitis. Results The non-exacerbator phenotype was the most common (46.7%) followed by exacerbator with chronic bronchitis (22.4%) and exacerbator with emphysema (16.4%). The ACOS phenotype accounted for the lowest rate (14.5%). For each phenotype, the highest prevalence rates were concentrated in two or three autonomous communities, with relatively similar rates for the remaining regions. Overall prevalence rates were higher for the non-exacerbator and the exacerbator with chronic bronchitis phenotypes than for ACOS and the exacerbator with chronic bronchitis phenotypes. Differences in the distribution of COPD phenotypes according to gender, age, physician specialty, smoking habit, number of comorbidities, quality of life assessed with the COPD Assessment Test, and BODEx index (body mass index, airflow obstruction, dyspnea, and exacerbations) were all statistically significant. Conclusion Differences in the prevalence rates of COPD phenotypes among the Spanish autonomous communities have been documented. Mapping the distribution of COPD phenotypes is useful to highlight regional differences as starting point for comparisons across time. This geographic analysis provides health-care planners a valuable platform to assess changes in COPD burden at nationwide and regional levels.
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Affiliation(s)
| | | | - Juan Antonio Riesco
- Pulmonology Department, Hospital San Pedro de Alcántara.,Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Cáceres
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12
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Eikhof KD, Olsen KR, Wrengler NCH, Nielsen C, Bodtger U, Titlestad IL, Weinreich UM. Undiagnosed chronic obstructive pulmonary disease in patients admitted to an acute assessment unit. Eur Clin Respir J 2017; 4:1292376. [PMID: 28326181 PMCID: PMC5345577 DOI: 10.1080/20018525.2017.1292376] [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] [Received: 06/19/2016] [Accepted: 01/17/2017] [Indexed: 10/27/2022] Open
Abstract
Introduction: Chronic obstructive pulmonary disease (COPD) is very prevalent worldwide, yet underdiagnosed. Aim: This study investigates feasibility of performing spirometry in patients in need of acute hospital admission as well as the prevalence of undiagnosed COPD in the same cohort. Methods: During a two-week period, all patients admitted to three large acute assessment units were evaluated. Patients ≥ 18 years, able to perform spirometry, with no surgery to the thorax or abdomen within the last weeks and no known COPD was included. Patients with FEV1/FEV6 ≤ 0.7 or FEV1 < 80% or FEV6 < 80% were offered follow-up visit after 6 weeks. Results: Of the 1145 admitted patients, 46% were eligible: 28% of those had an abnormal spirometry. The offered follow-up visit was attended by 51% and in this group 17% were diagnosed with lung disease. COPD was the most prevalent diagnosis (73%), and 2/3 was in GOLD group A. In total, 75% of the patients with airflow obstruction at the initial examination remained obstructive. Conclusion: Performing spirometry in patients in need of acute hospital admission is feasible, abnormal findings are common, and COPD is the most prevalent diagnosis.
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Affiliation(s)
- Karin D. Eikhof
- The Acute Assessment Unit, Aalborg University Hospital, Aalborg, Denmark
| | - Kristine R. Olsen
- Department of Respiratory Medicine, Naestved Hospital, Naestved, Denmark
| | - N. C. H. Wrengler
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
| | - Carl Nielsen
- Department of Respiratory Diseases, Aalborg University Hospital, Aalborg, Denmark
| | - Uffe Bodtger
- Department of Respiratory Medicine, Naestved Hospital, Naestved, Denmark
- Institute for Regional Health Research, University of Southern Odense, Denmark
- Department of Respiratory Medicine, Zealand University Hospital, Roskilde, Odense, Denmark
| | - Ingrid L. Titlestad
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
| | - Ulla M. Weinreich
- Department of Respiratory Diseases, Aalborg University Hospital, Aalborg, Denmark
- The Clinical Institute, Aalborg University Hospital, Aalborg, Denmark
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Dixon LC, Ward DJ, Smith J, Holmes S, Mahadeva R. New and emerging technologies for the diagnosis and monitoring of chronic obstructive pulmonary disease: A horizon scanning review. Chron Respir Dis 2016; 13:321-336. [PMID: 26968787 PMCID: PMC5084418 DOI: 10.1177/1479972316636994] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
There is a need for straightforward, novel diagnostic and monitoring technologies to enable the early diagnosis of COPD and its differentiation from other respiratory diseases, to establish the cause of acute exacerbations and to monitor disease progression. We sought to establish whether technologies already in development could potentially address these needs. A systematic horizon scanning review was undertaken to identify technologies in development from a wide range of commercial and non-commercial sources. Technologies were restricted to those likely to be available within 18 months, and then evaluated for degree of innovation, potential for impact, acceptability to users and likelihood of adoption by clinicians and patients with COPD. Eighty technologies were identified, of which 25 were considered particularly promising. Biomarker tests, particularly those using sputum or saliva samples and/or available at the point of care, were positively evaluated, with many offering novel approaches to early diagnosis and to determining the cause for acute exacerbations. Several wrist-worn devices and smartphone-based spirometers offering the facility for self-monitoring and early detection of exacerbations were also considered promising. The most promising identified technologies have the potential to improve COPD care and patient outcomes. Further research and evaluation activities should be focused on these technologies.
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Affiliation(s)
- Louise C Dixon
- NIHR Horizon Scanning Research & Intelligence Centre, University of Birmingham, Edgbaston, Birmingham, UK
| | - Derek J Ward
- NIHR Horizon Scanning Research & Intelligence Centre, University of Birmingham, Edgbaston, Birmingham, UK
- Derek J Ward, NIHR Horizon Scanning Research & Intelligence Centre, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
| | - Joanna Smith
- NIHR Horizon Scanning Research & Intelligence Centre, University of Birmingham, Edgbaston, Birmingham, UK
| | - Steve Holmes
- The Park Medical Practice, Shepton Mallet, Somerset, UK
| | - Ravi Mahadeva
- Department of Respiratory Medicine, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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14
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Haroon S, Jordan R, Takwoingi Y, Adab P. Diagnostic accuracy of screening tests for COPD: a systematic review and meta-analysis. BMJ Open 2015; 5:e008133. [PMID: 26450427 PMCID: PMC4606431 DOI: 10.1136/bmjopen-2015-008133] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Revised: 09/03/2015] [Accepted: 09/11/2015] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is widely underdiagnosed. A number of studies have evaluated the accuracy of screening tests for COPD, but their findings have not been formally summarised. We therefore sought to determine and compare the diagnostic accuracy of such screening tests in primary care. METHODS Systematic review and meta-analysis of the diagnostic accuracy of screening tests for COPD confirmed by spirometry in primary care. We searched MEDLINE, EMBASE and other bibliographic databases from 1997 to 2013 for diagnostic accuracy studies that evaluated 1 or more index tests in primary care among individuals aged ≥35 years with no prior diagnosis of COPD. Bivariate meta-analysis of sensitivity and specificity was performed where appropriate. Methodological quality was assessed independently by 2 reviewers using the QUADAS-2 tool. RESULTS 10 studies were included. 8 assessed screening questionnaires (the COPD Diagnostic Questionnaire (CDQ) was the most evaluated, n=4), 4 assessed handheld flow meters (eg, COPD-6) and 1 assessed their combination. Among ever smokers, the CDQ (score threshold ≥19.5; n=4) had a pooled sensitivity of 64.5% (95% CI 59.9% to 68.8%) and specificity of 65.2% (52.9% to 75.8%), and handheld flow meters (n=3) had a sensitivity of 79.9% (95% CI 74.2% to 84.7%) and specificity of 84.4% (68.9% to 93.0%). Inadequate blinding between index tests and spirometry was the main risk of bias. CONCLUSIONS Handheld flow meters demonstrated higher test accuracy than the CDQ for COPD screening in primary care. The choice of alternative screening tests within whole screening programmes should now be fully evaluated. PROSPERO REGISTRATION NUMBER CRD42012002074.
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Affiliation(s)
- Shamil Haroon
- Public Health, Epidemiology & Biostatistics, School of Health and Population Sciences, University of Birmingham, Birmingham, UK
| | - Rachel Jordan
- Public Health, Epidemiology & Biostatistics, School of Health and Population Sciences, University of Birmingham, Birmingham, UK
| | - Yemisi Takwoingi
- Public Health, Epidemiology & Biostatistics, School of Health and Population Sciences, University of Birmingham, Birmingham, UK
| | - Peymane Adab
- Public Health, Epidemiology & Biostatistics, School of Health and Population Sciences, University of Birmingham, Birmingham, UK
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15
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Haroon SM, Jordan RE, O'Beirne-Elliman J, Adab P. Effectiveness of case finding strategies for COPD in primary care: a systematic review and meta-analysis. NPJ Prim Care Respir Med 2015; 25:15056. [PMID: 26313400 PMCID: PMC4551096 DOI: 10.1038/npjpcrm.2015.56] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2015] [Revised: 06/14/2015] [Accepted: 07/12/2015] [Indexed: 11/12/2022] Open
Abstract
Background: Chronic obstructive pulmonary disease (COPD) is widely underdiagnosed, but the most effective approach for identifying these patients is unknown. Aims: The aim of this study was to summarise and compare the effectiveness of different case finding approaches for undiagnosed COPD in primary care. Methods: A systematic review of primary studies of any design evaluating case finding strategies for COPD in primary care among individuals aged ⩾35 years with no prior diagnosis was conducted. Medline, Embase and other bibliographic databases were searched from 1997 to 2013, and methodological quality was assessed using standard tools. Results were described and meta-analysis of the uptake and yield from different approaches was performed where there was sufficient homogeneity. Results: Three randomised controlled trials (RCTs), 1 controlled trial and 35 uncontrolled studies were identified that assessed the identification of new cases of COPD through systematic case finding. A range of approaches were used including pre-screening with questionnaires (n=13) or handheld flow meters (n=5) or direct invitation to diagnostic spirometry (n=30). Overall, any approach identified more undiagnosed COPD compared with usual care. Targeting those at higher risk (e.g., smokers) and pre-screening (e.g., using questionnaires) is likely to increase the yield. However, studies were heterogeneous and were limited by a lack of comparison groups, inadequate reporting and diversity in the definition of COPD, which limited our ability to draw firm conclusions. Conclusions: There is extensive heterogeneity among studies evaluating case finding strategies for COPD, with few RCTs. Well-conducted RCTs comparing case finding approaches are needed to identify the most effective target population, recruitment strategy and screening tests, using a clinical definition of COPD, and addressing the limitations highlighted in this review. There is also a need to evaluate the impact of case finding on clinical care and patient outcomes.
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Affiliation(s)
- Shamil Mm Haroon
- Public Health, Epidemiology & Biostatistics, School of Health and Population Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - Rachel E Jordan
- Public Health, Epidemiology & Biostatistics, School of Health and Population Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - Joanne O'Beirne-Elliman
- Public Health, Epidemiology & Biostatistics, School of Health and Population Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - Peymane Adab
- Public Health, Epidemiology & Biostatistics, School of Health and Population Sciences, University of Birmingham, Edgbaston, Birmingham, UK
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16
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Leidy NK, Kim K, Bacci ED, Yawn BP, Mannino DM, Thomashow BM, Barr RG, Rennard SI, Houfek JF, Han MK, Meldrum CA, Make BJ, Bowler RP, Steenrod AW, Murray LT, Walsh JW, Martinez F. Identifying cases of undiagnosed, clinically significant COPD in primary care: qualitative insight from patients in the target population. NPJ Prim Care Respir Med 2015; 25:15024. [PMID: 26028486 PMCID: PMC4532157 DOI: 10.1038/npjpcrm.2015.24] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Revised: 12/17/2014] [Accepted: 12/28/2014] [Indexed: 11/29/2022] Open
Abstract
Background: Many cases of chronic obstructive pulmonary disease (COPD) are diagnosed only after significant loss of lung function or during exacerbations. Aims: This study is part of a multi-method approach to develop a new screening instrument for identifying undiagnosed, clinically significant COPD in primary care. Methods: Subjects with varied histories of COPD diagnosis, risk factors and history of exacerbations were recruited through five US clinics (four pulmonary, one primary care). Phase I: Eight focus groups and six telephone interviews were conducted to elicit descriptions of risk factors for COPD, recent or historical acute respiratory events, and symptoms to inform the development of candidate items for the new questionnaire. Phase II: A new cohort of subjects participated in cognitive interviews to assess and modify candidate items. Two peak expiratory flow (PEF) devices (electronic, manual) were assessed for use in screening. Results: Of 77 subjects, 50 participated in Phase I and 27 in Phase II. Six themes informed item development: exposure (smoking, second-hand smoke); health history (family history of lung problems, recurrent chest infections); recent history of respiratory events (clinic visits, hospitalisations); symptoms (respiratory, non-respiratory); impact (activity limitations); and attribution (age, obesity). PEF devices were rated easy to use; electronic values were significantly higher than manual (P<0.0001). Revisions were made to the draft items on the basis of cognitive interviews. Conclusions: Forty-eight candidate items are ready for quantitative testing to select the best, smallest set of questions that, together with PEF, can efficiently identify patients in need of diagnostic evaluation for clinically significant COPD.
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Mun SY, Hwang YI, Kim JH, Park S, Jang SH, Seo JY, Kim JK, Park YB, Shim JJ, Jung KS. Awareness of chronic obstructive pulmonary disease in current smokers: a nationwide survey. Korean J Intern Med 2015; 30:191-7. [PMID: 25750560 PMCID: PMC4351325 DOI: 10.3904/kjim.2015.30.2.191] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2013] [Revised: 04/07/2014] [Accepted: 07/10/2014] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIMS Cigarette smoking is the most common risk factor for chronic obstructive pulmonary disease (COPD). However, few studies of the attitudes toward COPD of smokers, the group at risk of developing this condition, have been conducted. The purpose of this study was to explore the awareness of and attitudes toward COPD of current smokers. METHODS The sample consisted of 502 individuals aged 45 and older from throughout Korea who smoked at least 10 packs of cigarettes per year. Telephone interviews using a structured questionnaire were conducted with respondents. RESULTS First, we evaluated the health status of subjects, finding that 45.4% considered themselves to be in good health. We also asked about COPD-related symptoms, and 60.6% of subjects reported such symptoms. However, only 1.2% of subjects had been diagnosed with or treated for COPD, only 0.4% spontaneously mentioned COPD as a respiratory disease, and only 26.5% recognized COPD as a respiratory disease after seeing a list of such diseases. Television ranked as the top source of information about COPD. The willingness of 45.0% of subjects to stop smoking increased after being informed about COPD. CONCLUSIONS Despite having COPD-related symptoms, most smokers did not know that COPD is a respiratory disease. The attitudes of smokers toward COPD and smoking cessation varied according to socioeconomic status. In summary, a continuous effort to increase the awareness of COPD among smokers is needed. Additionally, strategies tailored according to different socioeconomic groups will also be necessary.
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Affiliation(s)
- So Yeong Mun
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Hallym University Medical Center, Anyang, Korea
| | - Yong Il Hwang
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Hallym University Medical Center, Anyang, Korea
| | - Joo Hee Kim
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Hallym University Medical Center, Anyang, Korea
| | - Sunghoon Park
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Hallym University Medical Center, Anyang, Korea
| | - Seung Hun Jang
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Hallym University Medical Center, Anyang, Korea
| | - Jae Yong Seo
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Hallym University Medical Center, Anyang, Korea
| | - Ja Kyung Kim
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Hallym University Medical Center, Anyang, Korea
| | - Yong Bum Park
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Hallym University Medical Center, Anyang, Korea
| | - Jae Jung Shim
- Department of Pulmonary, Allergy and Critical Care Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Ki-Suck Jung
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Hallym University Medical Center, Anyang, Korea
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Seo JY, Hwang YI, Mun SY, Kim JH, Kim JH, Park SH, Jang SH, Park YB, Shim JJ, Jung KS. Awareness of COPD in a high risk Korean population. Yonsei Med J 2015; 56:362-7. [PMID: 25683982 PMCID: PMC4329345 DOI: 10.3349/ymj.2015.56.2.362] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Increased awareness and understanding of chronic obstructive pulmonary disease (COPD) is an important aspect of disease management. The aim of this study was to explore COPD awareness among smokers participating in a smoking cessation program. MATERIALS AND METHODS Face-to-face interviews were conducted with 289 subjects in three smoking cessation clinics, using a structured questionnaire. RESULTS A total of 68.2% of subjects had COPD-related symptoms, and 19.7% were in poor health. Only 1.0% of the subjects knew that COPD was a respiratory disease. A total of 2.4% of subjects had been diagnosed with COPD and received treatment. Television was the most common source of information about COPD, with 57.1% of the subjects receiving information in this way. After being informed about COPD, smoking-cessation willingness increased in 84.1% of the study group. It increased in 86.3% of the subjects without awareness of COPD and in 81.2% of subjects with COPD-related symptoms. CONCLUSION We found that awareness of COPD is very poor among current smokers in Korea. Many smokers perceived their health status as good, despite the presence of COPD-related symptoms. As the level of smoking-cessation willingness was different between those with and without awareness of COPD or COPD-related symptoms, a personalized education program with various educational tools may be needed to enhance awareness of the disease and to motivate smokers to quit.
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Affiliation(s)
- Jae Yong Seo
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Yong Il Hwang
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - So Yeong Mun
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Jin Hee Kim
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Joo Hee Kim
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Sung Hoon Park
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Seung Hun Jang
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Yong Bum Park
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Jae Jung Shim
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Ki-Suck Jung
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea.
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19
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van Dijk W, Tan W, Li P, Guo B, Li S, Benedetti A, Bourbeau J. Clinical relevance of fixed ratio vs lower limit of normal of FEV1/FVC in COPD: patient-reported outcomes from the CanCOLD cohort. Ann Fam Med 2015; 13:41-8. [PMID: 25583891 PMCID: PMC4291264 DOI: 10.1370/afm.1714] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE The way in which spirometry is interpreted can lead to misdiagnosis of chronic obstructive pulmonary disease (COPD) resulting in inappropriate treatment. We compared the clinical relevance of 2 criteria for defining a low ratio of forced expiratory volume in 1 second to forced vital capacity (FEV1/FVC): the fixed ratio and the lower limit of normal. METHODS We analyzed data from the cross-sectional phase of the population-based Canadian Cohort of Obstructive Lung Disease (CanCOLD) study. We determined associations of the spirometric criteria for airflow limitation with patient-reported adverse outcomes, including respiratory symptoms, disability, health status, exacerbations, and cardiovascular disease. Sensitivity analyses were used to explore the impact of age and severity of airflow limitation on these associations. RESULTS We analyzed data from 4,882 patients aged 40 years and older. The prevalence of airflow limitation was 17% by fixed ratio and 11% by lower limit of normal. Patients classified as having airflow limitation by fixed ratio only had generally small, nonsignificant increases in the odds of adverse outcomes. Patients having airflow limitation based on both fixed ratio and lower limit of normal had larger, significant increases in odds. But strongest associations were seen for patients who had airflow limitation by both fixed ratio and lower limit of normal and also had a low FEV1, defined as one less than 80% of the predicted value. CONCLUSIONS Our results suggest that use of the fixed ratio alone may lead to misdiagnosis of COPD. A diagnosis established by both a low FEV1/FVC (according to fixed ratio and/or lower limit of normal) and a low FEV1 is strongly associated with clinical outcomes. Guidelines should be reconsidered to require both spirometry abnormalities so as to reduce overdiagnosis of COPD.
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Affiliation(s)
- Wouter van Dijk
- Department of Primary and Community Care, Radboud University, Nijmegen Medical Centre, Nijmegen, the Netherlands Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, McGill University, Montreal, Quebec, Canada
| | - Wan Tan
- UBC James Hogg Research Centre, Providence Heart and Lung Institute, University of British Columbia, St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Pei Li
- Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, McGill University, Montreal, Quebec, Canada
| | - Best Guo
- UBC James Hogg Research Centre, Providence Heart and Lung Institute, University of British Columbia, St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Summer Li
- UBC James Hogg Research Centre, Providence Heart and Lung Institute, University of British Columbia, St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Andrea Benedetti
- Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, McGill University, Montreal, Quebec, Canada
| | - Jean Bourbeau
- Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, McGill University, Montreal, Quebec, Canada
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20
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Sanguinetti CM, Ambrosino N, Andò F, De Benedetto F, Donner CF, Nardini S, Polverino M, Torchio R, Vagheggini G, Visconti A. Standards of suitability for the management of chronic obstructive respiratory diseases. Multidiscip Respir Med 2014; 9:65. [PMID: 25584191 PMCID: PMC4290399 DOI: 10.1186/2049-6958-9-65] [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: 11/04/2014] [Accepted: 11/28/2014] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Chronic Obstructive Pulmonary Disease (COPD) ranks third as cause of mortality and disability-adjusted life years (DALY) worldwide and also in Italy it imposes a huge health, social and economic load. Early symptoms of COPD are often disregarded by patients and physicians, spirometry is underutilized, and the diagnosis is delayed till the disease has reached a distinct severity level. Despite the availability of various guidelines, the behavior of health workers involved in the management of COPD is still rather unlike. These considerations are the reason why in October 2013 AIMAR (Interdisciplinary Scientific Association for Research in Lung Disease) devised and organized a "Third Consensus Conference", aimed at pointing out the standards of suitability for COPD management. In this context three important topics of discussion were identified: early and more widespread diagnosis, management of acute and subacute phases, long-term assistance to chronic patients. METHODS The procedure recommended by the Italian Health Superior Institute (ISS) for Consensus Conferences organization was applied. The Conference was structured in three sessions, each dealing with one of the above mentioned topics and including a short update of the subject-matter and presentation, discussion and voting of some statements with a choice ranging from total agreement to total disagreement or no knowledge. The results of voting were eventually recorded in the document, reviewed by an independent jury, that forms the substance of this paper. RESULTS The essential role of spirometry, the need for distinguish between different COPD phenotypes, and the obligatoriness to base on the blood gas analysis findings the long-term oxygen therapy, were largely agreed, as well as the need for interventions aimed at decreasing the rate of acute exacerbations. More specific topics like the use of noninvasive ventilation, recognizing the factors affecting outcome and mortality, the choice of pharmacological and non pharmacological treatments in COPD patients led to lively discussing, but they did not always reach the total agreement, probably because of insufficient familiarity with these problems and of diversities in organization and instruments availability. The chronic respiratory assistance was treated with particular regard to smoking cessation, whose implementation is still insufficient. Many doubts rose due to uncertainty, lack of ability and standardization of procedures, insufficient institutional support, and difficulties to realize a network for assistance to chronic patients. CONCLUSIONS The results of this Third Consensus Conference revealed some certainties and many doubts and diversities of view also on topics whose importance is well demonstrated in scientific literature. Thus, there is still a long distance to cover before reaching a suitable standardization of COPD management and such situation urges the need for improving not only the health professional's operativeness but also the organizational support by competent institutions. In this context some initiatives organized by AIMAR in cooperation with other respiratory scientific societies and patients' associations are going on.
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Affiliation(s)
- Claudio M Sanguinetti
- />Managing Director Multidisciplinary Respiratory Disease, Senior Consultant Respiratory Diseases, Quisisana Clinical Center, Rome, Italy, Rome, Italy
| | - Nicolino Ambrosino
- />Center of Respiratory Weaning and Rehabilitation Auxilium Vitae, Volterra, (PI) Italy
| | - Filippo Andò
- />Pneumology Unit, G.Martino General Hospital, Messina, Italy
| | | | - Claudio F Donner
- />Mondo Medico, Multidisciplinary and Rehabilitation Outpatient Clinic, Borgomanero, (NO) Italy
| | - Stefano Nardini
- />Pneumology Unit, General Hospital, Vittorio Veneto, (TV) Italy
| | - Mario Polverino
- />High Specialty Provincial Pulmonologic Unit, “Scarlato” Hospital, Scafati, (SA) Italy
| | - Roberto Torchio
- />Lung Function and Sleep Unit, AOU S. Luigi, Orbassano, (TO) Italy
| | - Guido Vagheggini
- />Internal Medicine and Respiratory Diseases, Center of Respiratory Weaning and Rehabilitation Auxilium Vitae, Volterra, (PI) Italy
| | | | - on behalf of the Consensus Conference 2013 Group
- />Managing Director Multidisciplinary Respiratory Disease, Senior Consultant Respiratory Diseases, Quisisana Clinical Center, Rome, Italy, Rome, Italy
- />Center of Respiratory Weaning and Rehabilitation Auxilium Vitae, Volterra, (PI) Italy
- />Pneumology Unit, G.Martino General Hospital, Messina, Italy
- />Pneumology Unit, SS.Annunziata General Hospital, Chieti, Italy
- />Mondo Medico, Multidisciplinary and Rehabilitation Outpatient Clinic, Borgomanero, (NO) Italy
- />Pneumology Unit, General Hospital, Vittorio Veneto, (TV) Italy
- />High Specialty Provincial Pulmonologic Unit, “Scarlato” Hospital, Scafati, (SA) Italy
- />Lung Function and Sleep Unit, AOU S. Luigi, Orbassano, (TO) Italy
- />Internal Medicine and Respiratory Diseases, Center of Respiratory Weaning and Rehabilitation Auxilium Vitae, Volterra, (PI) Italy
- />Scientific Secretariat, AIMAR, Arona, (NO) Italy
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21
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Al Omari M, Khassawneh BY, Khader Y, Dauod AS, Bergus G. Prevalence of chronic obstructive pulmonary disease among adult male cigarettes smokers: a community-based study in Jordan. Int J Chron Obstruct Pulmon Dis 2014; 9:753-8. [PMID: 25092972 PMCID: PMC4113569 DOI: 10.2147/copd.s62898] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. The prevalence of COPD among cigarette smokers in the Middle East is not well studied. A prospective descriptive study was performed in the north of Jordan. Male cigarette smokers (≥10 pack-year) aged 35 years and older were recruited from the community. They completed a questionnaire and a postbronchodilator spirometry. Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria (postbronchodilator forced expiratory volume in 1 second <70%) was used to define COPD. A total of 512 subjects completed the study protocol. According to the GOLD criteria, 42 subjects (8.2%) had COPD. Of those, 27 subjects (64.3%) had symptomatic COPD. Using the GOLD criteria, eight subjects (19%) with COPD had mild disease, 24 (57.1%) had moderate disease, eight (19%) had severe disease, and two (4.8%) had very severe disease. Only 10.6% were aware of COPD as a smoking-related respiratory illness, and 6.4% had received counseling about risk for COPD by a physician. Chronic bronchitis (cough for 3 months in 2 consecutive years) was reported by 15% of the subjects, wheezes by 44.1%, and dyspnea by 65.2%. Subjects with COPD reported having more chronic bronchitis 18/42 (42.9%) and wheezing 28/42 (66.7%) than subjects without COPD. The prevalence of COPD increased with increased number of pack-years smoked. In conclusion, COPD prevalence among cigarette-smoking men in Jordan is lower than in the developed world. COPD was largely underdiagnosed, despite the majority of participants being symptomatic and having moderate to severe disease.
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Affiliation(s)
- Mousa Al Omari
- Department of Community Medicine, Public Health and Family Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Basheer Y Khassawneh
- Department of Internal Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Yousef Khader
- Department of Community Medicine, Public Health and Family Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Ali Shakir Dauod
- Department of Community Medicine, Public Health and Family Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - George Bergus
- Department of Family Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
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22
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Lindgren S, Storli SL, Wiklund-Gustin L. Living in negotiation: patients' experiences of being in the diagnostic process of COPD. Int J Chron Obstruct Pulmon Dis 2014; 9:441-51. [PMID: 24851046 PMCID: PMC4018318 DOI: 10.2147/copd.s60182] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Purpose To illuminate patients’ lived experiences of going through the process of being diagnosed with chronic obstructive pulmonary disease (COPD). Patients and methods A phenomenological-hermeneutic analysis was applied in the interpretation of interviews with eight persons diagnosed with mild or moderate COPD. Results One main theme ‘living in negotiation’, and three themes ‘living with a body out of step with the diagnosis’, ‘dealing with the past’, and ‘being challenged by the future’ reflected the process participants were living through in their quest for acceptance and a new balance in life. Participants found that the diagnostic processes were confusing, and that the diagnosis itself was ‘a slap in the face’. Unclear messages gave rise to fluctuating between an understanding of the condition as ‘not too severe’, insecurity, and fear. Shame and guilt related to the diagnosis had origins in the past, and in combination with the idea of ‘chronic’ the COPD diagnosis interfered with the present moment and gave rise to uncertainty for the future. The understanding of the present is related to negotiations not only with the past, but also with the future. Thus temporal aspects of the diagnosis are of great significance for the process of finding acceptance. Conclusion Regardless of disease severity, the diagnosis seems to be a breakdown of life, which puts life itself at stake. Medical professionals should be aware that the way the diagnosis is disclosed and communicated has considerable significance for how individuals understand and deal with their illness. The diagnosis should be communicated face-to-face, clearly and with empathy, and followed by information about COPD. Physicians should allow time and listen to the patients’ stories, and thus develop a shared understanding of the temporal aspect of the illness and patients’ needs and concerns. Thus, good communication is essential in determining whether the patient remains in negotiation, or enters a process toward acceptance and new understanding.
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Affiliation(s)
- Sari Lindgren
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT Arctic University of Norway, Tromsø, Norway ; Faculty of Health and Society, Narvik University College, Narvik, Norway
| | - Sissel Lisa Storli
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT Arctic University of Norway, Tromsø, Norway
| | - Lena Wiklund-Gustin
- Faculty of Health and Society, Narvik University College, Narvik, Norway ; School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
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García-Olmos L, Alberquilla A, Ayala V, García-Sagredo P, Morales L, Carmona M, de Tena-Dávila MJ, Pascual M, Muñoz A, Salvador CH, Monteagudo JL. Comorbidity in patients with chronic obstructive pulmonary disease in family practice: a cross sectional study. BMC FAMILY PRACTICE 2013; 14:11. [PMID: 23324308 PMCID: PMC3556139 DOI: 10.1186/1471-2296-14-11] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Accepted: 01/14/2013] [Indexed: 11/10/2022]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is frequent and often coexists with other diseases. The aim of this study was to quantify the prevalence of COPD and related chronic comorbidity among patients aged over 40 years visiting family practices in an area of Madrid. METHODS An observational, descriptive, cross-sectional study was conducted in a health area of the Madrid Autonomous Region (Comunidad Autónoma de Madrid). The practice population totalled 198,670 persons attended by 129 Family Physicians (FPs), and the study population was made up of persons over the age of 40 years drawn from this practice population. Patients were deemed to have COPD if this diagnosis appeared on their clinical histories. Prevalence of COPD; prevalence of a further 25 chronic diseases in patients with COPD; and standardised prevalence ratios, were calculated. RESULTS Prevalence of COPD in family medicine was 3.2% (95% CI 3.0-3.3) overall, 5.3% among men and 1.4% among women; 90% of patients presented with comorbidity, with a mean of 4 ± 2.04 chronic diseases per patient, with the most prevalent related diseases being arterial hypertension (52%), disorders of lipid metabolism (34%), obesity (25%), diabetes (20%) and arrhythmia (15%). After controlling for age and sex, the observed prevalence of the following ten chronic diseases was higher than expected: heart failure; chronic liver disease; asthma; generalised artherosclerosis; osteoporosis; ischaemic heart disease; thyroid disease; anxiety/depression; arrhythmia; and obesity. CONCLUSIONS Patients with COPD, who are frequent in family practice, have a complex profile and pose a clinical and organisational challenge to FPs.
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Affiliation(s)
- Luis García-Olmos
- Multiprofessional Education Unit for Family and Community Care (South-east), Hacienda de Pavones, 271, Madrid, 28030, Spain.
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