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Montiel AM, Ruiz-Esteban P, Del Río AD, Valdivielso P, Chaparro MÁS, Olveira C. Differences in cardiovascular risk and health-related quality of life in COPD patients according to clinical phenotype. Sci Rep 2024; 14:9687. [PMID: 38678074 PMCID: PMC11055945 DOI: 10.1038/s41598-024-60406-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 04/23/2024] [Indexed: 04/29/2024] Open
Abstract
Chronic obstructive pulmonary disease (COPD) has a high prevalence and a major impact on health-related quality of life (HRQL). COPD exacerbations are an important cause of morbidity and mortality, affecting cardiovascular risk, and are associated with poorer health status. The aim of this study was to assess the association between cardiovascular risk (CVR) and HRQL, according to exacerbator or non-exacerbator phenotype. We undertook a cross-sectional, observational, descriptive study of 107 patients with COPD. Patients with two or more moderate exacerbations or one severe exacerbation in the previous year were considered as exacerbators. The CVR was calculated with the Framingham scale and SCORE (Systematic Coronary Risk Evaluation) and the HRQL was assessed with the generic questionnaire Short Form-36 Health Survey (SF-36), the St George Respiratory Questionnaire (SGRQ) and the COPD Assessment Test (CAT). Statistical analysis was done with SPSS version 26.0 for Windows. The SF-36 and the SGRQ showed lower values for the exacerbator phenotype, indicating a poorer quality of life. The CAT questionnaire showed values above 10 for the exacerbator phenotype, and lower values in the non-exacerbator group. After categorizing the sample according to their median age (65 years), we found a greater deterioration in HRQL in patients under 65 years of age according to the SF-36, the SGRQ and the CAT. We also detected differences in HRQL between non-exacerbator patients with a high CVR according to the Framingham (≥ 20%) and SCORE (≥ 5%) scales compared to those without this risk. A tendency towards worse HRQL was observed in non-exacerbator patients with a high CVR, which was statistically significant for the SGRQ impact domain on the SCORE scale. The CAT also showed a worse quality of life in non-exacerbator patients with a high CVR, which was significant in the Framingham model (Framingham high risk 8.41 vs non-high risk 6.05, p < 0.01). These differences were not observed in exacerbator patients. Our findings confirm that a high CVR influences HRQL in patients with COPD, especially in non-exacerbator patients with a high CVR, measured according to the SGRQ and the CAT.
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Affiliation(s)
- Ana Muñoz Montiel
- Pulmonology Service. Monographic COPD Office, Regional University Hospital of Malaga, University of Malaga, Malaga, Spain
| | - Pedro Ruiz-Esteban
- Nephrology Department, The Biomedical Research Institute of Malaga (IBIMA-Plataforma BIONAND), Regional University Hospital of Malaga, University of Malaga, RICORS2040 (RD21/0005/0012), Malaga, Spain.
| | - Adolfo Doménech Del Río
- Pulmonology Service. Monographic COPD Office, Regional University Hospital of Malaga, University of Malaga, Malaga, Spain
| | - Pedro Valdivielso
- Laboratory of Lipids and Atherosclerosis, Medico-Sanitarias Research Center (IBIMA), University of Malaga, Malaga, Spain
- Internal Medicine, University Hospital Virgen de La Victoria, Department of Medicine and Dermatology and Biomedical Research Institute of Malaga (IBIMA), Platform Bionand, University of Malaga, Malaga, Spain
| | - Miguel Ángel Sánchez Chaparro
- Internal Medicine, University Hospital Virgen de La Victoria, Department of Medicine and Dermatology and Biomedical Research Institute of Malaga (IBIMA), Platform Bionand, University of Malaga, Malaga, Spain
| | - Casilda Olveira
- Pulmonology Service, Regional University Hospital of Malaga, Department of Medicine and Dermatology and Biomedical Research Institute of Malaga (IBIMA), Platform Bionand, University of Malaga, Malaga, Spain
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Mansouri A, Khosravi Farsani A, Mohammadifard N, Nouri F, Jozan M, Tabatabaei GA, Salehidoost R, Rafiee H. Self-rated health and its determinants in patients with hypertension in Isfahan in 2019. BMC Public Health 2024; 24:480. [PMID: 38360624 PMCID: PMC10870428 DOI: 10.1186/s12889-024-17887-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 01/25/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Self-rated health (SRH) serves as an assessment of contentment regarding one's social, mental, and physical well-being and has been linked to both cardiovascular mortality and morbidity. Nonetheless, the relationship between SRH and medical outcomes in individuals with hypertension unsettled. This research endeavors to pinpoint the determinants that affect SRH in Iranian patients with hypertension. MATERIALS AND METHODS This cross-sectional study took place in Isfahan, Iran, from November 2018 to August 2019 and involved 886 patients with essential HTN. The data collection methods included a checklist for demographic information and risk factors, blood pressure measurements (systolic and diastolic), the Persian version of the 8-Item Morisky Medication Adherence scale, and a self-rated health questionnaire recommended by the World Health Organization. Independent sample T-test and chi squared test were used for comparison of variables between two groups of SRH. Additionally, multivariable logistic regression was used to analyze the factors influencing self-rated health status. RESULTS Among 886 participants (mean age 57.8 ± 8.8 years, 71.9% women), 89.62% reported good SRH. Comorbid conditions were significantly associated with poorer SRH (p < 0.05). Notably, higher education (odd ratio (OR) = 1.88, 95% confidence interval (CI) = 1.13-3.11, p = 0.015) and increased income (OR = 4.34, 95% CI = 1.43-13.18, p = 0.010) were identified as positive determinants of good SRH. CONCLUSION We concluded that socioeconomic factors (education and income) and comorbid conditions (diabetes, hyperlipidemia, and pulmonary diseases) are risk factors for poor SRH among hypertensive patients. These findings could help planning of health enhancement initiative.
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Affiliation(s)
- Asieh Mansouri
- Hypertension Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
- Department of Biostatistics and Epidemiology, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Alireza Khosravi Farsani
- Hypertension Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Noushin Mohammadifard
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fatemeh Nouri
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mahnaz Jozan
- Hypertension Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ghazaal Alavi Tabatabaei
- Hypertension Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Rezvan Salehidoost
- Centre for Endocrinology, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Hamed Rafiee
- Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
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Miron RJ, Estrin NE, Sculean A, Zhang Y. Understanding exosomes: Part 2-Emerging leaders in regenerative medicine. Periodontol 2000 2024; 94:257-414. [PMID: 38591622 DOI: 10.1111/prd.12561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 02/16/2024] [Accepted: 02/21/2024] [Indexed: 04/10/2024]
Abstract
Exosomes are the smallest subset of extracellular signaling vesicles secreted by most cells with the ability to communicate with other tissues and cell types over long distances. Their use in regenerative medicine has gained tremendous momentum recently due to their ability to be utilized as therapeutic options for a wide array of diseases/conditions. Over 5000 publications are currently being published yearly on this topic, and this number is only expected to dramatically increase as novel therapeutic strategies continue to be developed. Today exosomes have been applied in numerous contexts including neurodegenerative disorders (Alzheimer's disease, central nervous system, depression, multiple sclerosis, Parkinson's disease, post-traumatic stress disorders, traumatic brain injury, peripheral nerve injury), damaged organs (heart, kidney, liver, stroke, myocardial infarctions, myocardial infarctions, ovaries), degenerative processes (atherosclerosis, diabetes, hematology disorders, musculoskeletal degeneration, osteoradionecrosis, respiratory disease), infectious diseases (COVID-19, hepatitis), regenerative procedures (antiaging, bone regeneration, cartilage/joint regeneration, osteoarthritis, cutaneous wounds, dental regeneration, dermatology/skin regeneration, erectile dysfunction, hair regrowth, intervertebral disc repair, spinal cord injury, vascular regeneration), and cancer therapy (breast, colorectal, gastric cancer and osteosarcomas), immune function (allergy, autoimmune disorders, immune regulation, inflammatory diseases, lupus, rheumatoid arthritis). This scoping review is a first of its kind aimed at summarizing the extensive regenerative potential of exosomes over a broad range of diseases and disorders.
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Affiliation(s)
- Richard J Miron
- Department of Periodontology, University of Bern, Bern, Switzerland
| | - Nathan E Estrin
- Advanced PRF Education, Venice, Florida, USA
- School of Dental Medicine, Lake Erie College of Osteopathic Medicine, Bradenton, Florida, USA
| | - Anton Sculean
- Department of Periodontology, University of Bern, Bern, Switzerland
| | - Yufeng Zhang
- Department of Oral Implantology, University of Wuhan, Wuhan, China
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Morena D, Izquierdo JL, Rodríguez J, Cuesta J, Benavent M, Perralejo A, Rodríguez JM. The Clinical Profile of Patients with COPD Is Conditioned by Age. J Clin Med 2023; 12:7595. [PMID: 38137664 PMCID: PMC10743861 DOI: 10.3390/jcm12247595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 11/21/2023] [Accepted: 12/07/2023] [Indexed: 12/24/2023] Open
Abstract
In recent years, many studies have analyzed the importance of integrating time, or aging, into the equation that relates genetics and the environment to the development and origin of COPD. Under conditions of daily clinical practice, our study attempts to identify the differences in the clinical profile of patients with COPD according to age and the impact on the global burden of the disease. This study is non-interventional and observational, using artificial intelligence and data captured from electronic medical records. The study population included patients who were diagnosed with COPD between 2011 and 2021. A total of 73,901 patients had a diagnosis of COPD. The mean age was 73 years (95% CI: 72.9-73.1), and 56,763 were men (76.8%). We observed a specific prevalence of obesity, heart failure, depression, and hiatal hernia in women (p < 0.001), and ischemic heart disease and obstructive sleep apnea (OSA) in men (p < 0.001). In the analysis by age ranges, a progressive increase in cardiovascular risk factors was observed with age. In conclusion, in a real-life setting, COPD is a disease that primarily affects older subjects and frequently presents with comorbidities that are decisive in the evolutionary course of the disease.
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Affiliation(s)
- Diego Morena
- Pulmonology Department, Respiratory Medicine, Hospital Universitario de Guadalajara, 19002 Guadalajara, Spain;
- Doctoral Program in Health Sciences, University of Alcalá, 28871 Alcalá de Henares, Spain
| | - José Luis Izquierdo
- Pulmonology Department, Respiratory Medicine, Hospital Universitario de Guadalajara, 19002 Guadalajara, Spain;
- Department of Medicine and Medical Specialties, University of Alcalá, 28871 Alcalá de Henares, Spain; (J.C.); (J.M.R.)
| | - Juan Rodríguez
- Geriatric Medicine, Hospital Universitario de Guadalajara, 19002 Guadalajara, Spain;
| | - Jesús Cuesta
- Department of Medicine and Medical Specialties, University of Alcalá, 28871 Alcalá de Henares, Spain; (J.C.); (J.M.R.)
| | | | | | - José Miguel Rodríguez
- Department of Medicine and Medical Specialties, University of Alcalá, 28871 Alcalá de Henares, Spain; (J.C.); (J.M.R.)
- Respiratory Medicine, Hospital Universitario Príncipe de Asturias, 28805 Alcalá de Henares, Spain
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Khazen M, Abu Ahmad W, Spolter F, Golan-Cohen A, Merzon E, Israel A, Vinker S, Rose AJ. Greater temporal regularity of primary care visits was associated with reduced hospitalizations and mortality, even after controlling for continuity of care. BMC Health Serv Res 2023; 23:777. [PMID: 37474968 PMCID: PMC10360299 DOI: 10.1186/s12913-023-09808-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 07/11/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND Previous studies have shown that more temporally regular primary care visits are associated with improved patient outcomes. OBJECTIVE To examine the association of temporal regularity (TR) of primary care with hospitalizations and mortality in patients with chronic illnesses. Also, to identify threshold values for TR for predicting outcomes. DESIGN Retrospective cohort study. PARTICIPANTS We used data from the electronic health record of a health maintenance organization in Israel to study primary care visits of 70,095 patients age 40 + with one of three chronic conditions (diabetes mellitus, heart failure, chronic obstructive pulmonary disease). MAIN MEASURES We calculated TR for each patient during a two-year period (2016-2017), and divided patients into quintiles based on TR. Outcomes (hospitalization, death) were observed in 2018-2019. Covariates included the Bice-Boxerman continuity of care score, demographics, and comorbidities. We used multivariable logistic regression to examine TR's association with hospitalization and death, controlling for covariates. KEY RESULTS Compared to patients receiving the most regular care, patients receiving less regular care had increased odds of hospitalization and mortality, with a dose-response curve observed across quintiles (p for linear trend < 0.001). For example, patients with the least regular care had an adjusted odds ratio of 1.40 for all-cause mortality, compared to patients with the most regular care. Analyses stratified by age, sex, ethnic group, area-level SES, and certain comorbid conditions did not show strong differential associations of TR across groups. CONCLUSIONS We found an association between more temporally regular care in antecedent years and reduced hospitalization and mortality of patients with chronic illness in subsequent years, after controlling for covariates. There was no clear threshold value for temporal regularity; rather, more regular primary care appeared to be better across the entire range of the variable.
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Affiliation(s)
- Maram Khazen
- Braun School of Public Health and Community Medicine, Faculty of Medicine, Hebrew University of Jerusalem, Ein Kerem Campus, Jerusalem, Israel.
- Department of Health Systems Management, The Max Stern Yezreel Valley College, Yezreel Valley, Israel.
| | - Wiessam Abu Ahmad
- Braun School of Public Health and Community Medicine, Faculty of Medicine, Hebrew University of Jerusalem, Ein Kerem Campus, Jerusalem, Israel
| | - Faige Spolter
- Braun School of Public Health and Community Medicine, Faculty of Medicine, Hebrew University of Jerusalem, Ein Kerem Campus, Jerusalem, Israel
| | - Avivit Golan-Cohen
- Leumit Health Services, Research Institute, Tel Aviv, Israel
- Sackler School of Medicine, Tel Aviv, Israel
| | - Eugene Merzon
- Leumit Health Services, Research Institute, Tel Aviv, Israel
- Adelson School of Medicine, Ariel University, Ariel, Israel
| | - Ariel Israel
- Leumit Health Services, Research Institute, Tel Aviv, Israel
- Sackler School of Medicine, Tel Aviv, Israel
| | - Shlomo Vinker
- Leumit Health Services, Research Institute, Tel Aviv, Israel
- Sackler School of Medicine, Tel Aviv, Israel
| | - Adam J Rose
- Braun School of Public Health and Community Medicine, Faculty of Medicine, Hebrew University of Jerusalem, Ein Kerem Campus, Jerusalem, Israel
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6
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Mathews AM. The Functional and Psychosocial Consequences of COPD. Respir Care 2023; 68:914-926. [PMID: 37353332 PMCID: PMC10289619 DOI: 10.4187/respcare.10542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/25/2023]
Abstract
COPD is a chronic respiratory disease that commonly coexists with other chronic conditions. These comorbidities have been shown to influence overall disease burden and mortality in COPD, and these comorbidities have an important impact on functional status and other psychosocial factors. Mental health disorders, especially anxiety and depression are common comorbidities in COPD. However, the mechanisms and interactions of anxiety and depression in COPD are poorly understood and these conditions are often underdiagnosed. The interplay between anxiety and depression and COPD is likely multifactorial and complex. An obvious mechanism is the expected psychological consequences of having a chronic illness. However, there is increasing interest in other potential biological processes, such as systemic inflammation, smoking, hypoxia, and oxidative stress. Recognition and diagnosis of comorbid anxiety and depression in patients with COPD is often challenging because there is no consensus on the appropriate screening tools or rating scales to use in this patient population. Despite the challenges in accurate assessment of anxiety and depression, there is growing evidence to support that these comorbid mental health conditions in COPD result in worse outcomes, including poor health-related quality of life, increased exacerbations with associated health-care utilization and cost, increased functional disability, and increased mortality. There are limited data of variable quality on effective treatment and management strategies, both pharmacologic and non-pharmacologic, for anxiety and depression in COPD. However, cumulative evidence demonstrates that complex psychological and lifestyle interventions, which include a pulmonary rehabilitation component, may offer the greatest benefit. The high prevalence and negative impact of depression and anxiety highlights the need for comprehensive, innovative, and standardized chronic disease management programs for individuals with COPD.
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Affiliation(s)
- Anne M Mathews
- Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado.
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7
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Papaporfyriou A, Bartziokas K, Gompelmann D, Idzko M, Fouka E, Zaneli S, Bakakos P, Loukides S, Papaioannou AI. Cardiovascular Diseases in COPD: From Diagnosis and Prevalence to Therapy. Life (Basel) 2023; 13:1299. [PMID: 37374082 DOI: 10.3390/life13061299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 05/27/2023] [Accepted: 05/30/2023] [Indexed: 06/29/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is considered one of the leading causes of mortality. Cardiovascular comorbidities are diagnosed often in COPD patients, not only because of the common risk factors these two diseases share, but also because of the systemic inflammation which characterizes COPD and has deleterious effects in the cardiovascular system. The comorbid cardiovascular diseases in COPD result in several difficulties in the holistic treatment of these patients and affect outcomes such as morbidity and mortality. Several studies have reported that mortality from cardiovascular causes is common among COPD patients, while the risk for acute cardiovascular events increases during COPD exacerbations and remains high for a long time even after recovery. In this review, we focus on the prevalence of cardiovascular comorbidities in COPD patients, presenting the evidence regarding the interaction of the pathophysiological pathways which characterize each disease. Furthermore, we summarize information regarding the effects of cardiovascular treatment on COPD outcomes and vice versa. Finally, we present the current evidence regarding the impact of cardiovascular comorbidities on exacerbations, quality of life and survival of COPD patients.
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Affiliation(s)
- Anastasia Papaporfyriou
- Division of Pulmonology, Department of Internal Medicine II, Medical University of Vienna, 1090 Vienna, Austria
| | | | - Daniela Gompelmann
- Division of Pulmonology, Department of Internal Medicine II, Medical University of Vienna, 1090 Vienna, Austria
| | - Marco Idzko
- Division of Pulmonology, Department of Internal Medicine II, Medical University of Vienna, 1090 Vienna, Austria
| | - Evangelia Fouka
- General Hospital G. Papanikolaou, Pulmonary Department of Aristotle University of Thessaloniki, 57010 Thessaloniki, Greece
| | - Stavrina Zaneli
- 1st University Department of Respiratory Medicine, "Sotiria" Chest Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Petros Bakakos
- 1st University Department of Respiratory Medicine, "Sotiria" Chest Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Stelios Loukides
- 2nd Respiratory Medicine Department, "Attikon" University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Andriana I Papaioannou
- 1st University Department of Respiratory Medicine, "Sotiria" Chest Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece
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Cazorla S, Busegnies Y, D’Ans P, Héritier M, Poncin W. Breathing Control Exercises Delivered in a Group Setting for Patients with Chronic Obstructive Pulmonary Disease: A Randomized Controlled Trial. Healthcare (Basel) 2023; 11:healthcare11060877. [PMID: 36981534 PMCID: PMC10048700 DOI: 10.3390/healthcare11060877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 03/01/2023] [Accepted: 03/14/2023] [Indexed: 03/19/2023] Open
Abstract
Breathing control exercises are an important component of occupational therapy in patients with chronic obstructive pulmonary disease (COPD). Delivering these exercises in group settings may enhance their benefits. Therefore, this study assessed the effectiveness of breathing control exercises delivered in a group format to patients with severe COPD remitting from an acute pulmonary exacerbation. This randomized controlled trial of 6 weeks’ duration compared the addition of breathing exercise sessions delivered in a group setting to a standard exercise inpatient rehabilitation program (usual care) versus usual care alone. The standard exercise program consisted of endurance and strength training and therapeutic patient education. The intervention group received, in addition to usual care, 20 sessions of 30 min duration of breathing control exercises in a group setting. The primary outcome was quality of life (Saint George’s Respiratory Questionnaire). Secondary outcomes were the COPD assessment test, modified Borg scale, handgrip strength test, and five-time sit-to-stand test. Thirty-seven patients aged 69 ± 7 years were recruited. After the 6-week period, all outcomes significantly improved and exceeded the minimal clinically important difference in the intervention group only. Between-group changes were significant for each outcome. Conclusions: breathing control exercises in a group setting provide clinically relevant benefits in patients with severe COPD who are remitting from an acute pulmonary exacerbation.
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Affiliation(s)
- Sibylle Cazorla
- Haute École Libre de Bruxelles Ilya Prigogine (HELB), 1070 Brussels, Belgium
- Correspondence:
| | - Yves Busegnies
- Haute École Libre de Bruxelles Ilya Prigogine (HELB), 1070 Brussels, Belgium
| | - Pierre D’Ans
- Haute École Libre de Bruxelles Ilya Prigogine (HELB), 1070 Brussels, Belgium
| | | | - William Poncin
- Institut de Recherche Expérimentale et Clinique (IREC), Pôle de Pneumologie, ORL et Dermatologie, Université Catholique de Louvain, 1200 Brussels, Belgium
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Sangeetha T, Anand AV, Begum TN. Assessment of Inter-relationship between Anemia and COPD In Accordance with Altitude. Open Respir Med J 2022. [DOI: 10.2174/18743064-v16-e2206270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:
Anemia, a common blood disorder has been analysed for the risk for chronic obstructive pulmonary disease (COPD), a predominant respiratory condition. The COPD patients have been found to have anemia due to inflammation, accounting for about 7.5-33%.
Objectives:
To predict the influence of anemia in the COPD occurrence as well as to depict the role of change in altitudes in the occurrence of anemic as well as COPD.
Methodology:
A total of 17 hematological parameters has been analysed in the anemic and COPD patients along with the control samples of low and high altitude regions and the significance of the results has been calculated.
Results:
The hematological parameter comparison between anemia and COPD samples of two different altitudes showed highly significant variations (p<0.001) as well as slighter significant variations (p<0.01, p<0.05 and p<0.1) in most of the parameters as well as the prevalence of anemic condition among the COPD patients was significant.
Conclusion:
The considered hematological parameters shown to have a considerable influence in the occurrence of anemia and COPD as well as in the occurrence of anemia in COPD patients along with the change in altitudes.
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Jin S, Wu Y, Chen S, Zhao D, Guo J, Chen L, Huang Y. The Additional Medical Expenditure Caused by Depressive Symptoms among Middle-Aged and Elderly Patients with Chronic Lung Diseases in China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19137849. [PMID: 35805507 PMCID: PMC9266188 DOI: 10.3390/ijerph19137849] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 06/23/2022] [Accepted: 06/23/2022] [Indexed: 02/04/2023]
Abstract
Depression is one of the most common comorbidities in patients with chronic lung diseases (CLDs). Depressive symptoms have an obvious influence on the health function, treatment, and management of CLD patients. In order to investigate the additional medical expenditure caused by depressive symptoms among middle-aged and elderly patients with CLDs in China, and to estimate urban–rural differences in additional medical expenditure, our study used data from the 2018 China Health and Retirement Longitudinal Study (CHARLS) investigation. A total of 1834 middle-aged and elderly CLD patients were included in this study. A generalized linear regression model was used to analyze the additional medical expenditure on depressive symptoms in CLD patients. The results show that depressive symptoms were associated with an increase in medical costs in patients with CLDs. Nevertheless, the incremental medical costs differed between urban and rural patients. In urban and rural patients with more severe comorbid CLD and depressive symptoms (co-MCDs), the total additional medical costs reached 4704.00 Chinese Yuan (CNY) (USD 711.60) and CNY 2140.20 (USD 323.80), respectively. Likewise, for patients with lower severity co-MCDs, the total additional medical costs of urban patients were higher than those of rural patients (CNY 4908.10 vs. CNY 1169.90) (USD 742.50 vs. USD 176.90). Depressive symptoms were associated with increased medical utilization and expenditure among CLD patients, which varies between urban and rural areas. This study highlights the importance of mental health care for patients with CLDs.
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Briggs-Price S, Daynes E, Chaplin E, Ward S, Houchen-Wolloff L, Singh SJ. Exploring the prevalence and impact of hip and knee pain in pulmonary rehabilitation: a propensity-matched cohort study. Respir Res 2022; 23:146. [PMID: 35659221 PMCID: PMC9164348 DOI: 10.1186/s12931-022-02049-y] [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: 02/24/2022] [Accepted: 05/03/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Musculoskeletal pain is more common in individuals with chronic respiratory diseases than the aged-matched general population. This investigation aimed to understand the prevalence and impact of hip and knee pain on pulmonary rehabilitation outcomes and completion rates. METHODS Participants who experienced hip/knee pain in the 4 weeks prior to pulmonary rehabilitation completed an Oxford Hip and/or Knee Score alongside a routine pulmonary rehabilitation assessment. Participants engaged in a twice-weekly, 6-week outpatient pulmonary rehabilitation programme. A 1:1 propensity score match for age, sex, BMI, sessions attended and MRC score was completed prior to group comparison for a pulmonary rehabilitation cohort without hip/knee pain. RESULTS 6.5% (n = 97) of pulmonary rehabilitation participants reported pain: hip (n = 27), knee (n = 40) or hip and knee pain (n = 30). 75 participants with hip/knee pain provided sufficient data for pre pulmonary rehabilitation matching and were propensity matched with a pulmonary rehabilitation group without hip/knee pain. The average Oxford Score across all reported joints was 28.7 (8.5) indicating moderate/severe pain at baseline. Statistically significant improvements were made in Oxford Scores for the left hip, left knee and right knee (P < 0.01) but not the right hip following pulmonary rehabilitation. There was no statistically significant difference between groups for improvements in quadriceps strength, walking tests or depression scores, both groups achieved within group significance. There were no significant differences in pulmonary rehabilitation completion rates between groups. CONCLUSIONS Prevalence of hip/knee pain in individuals presenting to pulmonary rehabilitation is 6.5%. Pain improved in the majority of joints following pulmonary rehabilitation and pain did not impact the effectiveness or completion of the programme. TRIAL REGISTRATION This trial was an evaluation of a clinical service and has not been registered in a public domain.
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Affiliation(s)
- Samuel Briggs-Price
- Centre for Exercise and Rehabilitation Science, NIHR Leicester Biomedical Research Centre - Respiratory, Glenfield Hospital, Groby Road, Leicester, LE3 9QP, UK.
| | - Enya Daynes
- Centre for Exercise and Rehabilitation Science, NIHR Leicester Biomedical Research Centre - Respiratory, Glenfield Hospital, Groby Road, Leicester, LE3 9QP, UK.,Department of Pulmonary Rehabilitation, University Hospitals of Leicester, Glenfield Hospital, Groby Road, Leicester, LE3 9QP, UK.,Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Emma Chaplin
- Centre for Exercise and Rehabilitation Science, NIHR Leicester Biomedical Research Centre - Respiratory, Glenfield Hospital, Groby Road, Leicester, LE3 9QP, UK.,Department of Pulmonary Rehabilitation, University Hospitals of Leicester, Glenfield Hospital, Groby Road, Leicester, LE3 9QP, UK
| | - Sarah Ward
- Centre for Exercise and Rehabilitation Science, NIHR Leicester Biomedical Research Centre - Respiratory, Glenfield Hospital, Groby Road, Leicester, LE3 9QP, UK.,Department of Pulmonary Rehabilitation, University Hospitals of Leicester, Glenfield Hospital, Groby Road, Leicester, LE3 9QP, UK
| | - Linzy Houchen-Wolloff
- Centre for Exercise and Rehabilitation Science, NIHR Leicester Biomedical Research Centre - Respiratory, Glenfield Hospital, Groby Road, Leicester, LE3 9QP, UK.,Department of Pulmonary Rehabilitation, University Hospitals of Leicester, Glenfield Hospital, Groby Road, Leicester, LE3 9QP, UK.,Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Sally J Singh
- Centre for Exercise and Rehabilitation Science, NIHR Leicester Biomedical Research Centre - Respiratory, Glenfield Hospital, Groby Road, Leicester, LE3 9QP, UK.,Department of Pulmonary Rehabilitation, University Hospitals of Leicester, Glenfield Hospital, Groby Road, Leicester, LE3 9QP, UK.,Department of Respiratory Sciences, University of Leicester, Leicester, UK
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12
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La kinésithérapie en per- et post-exacerbation immédiate de BPCO. Rev Mal Respir 2022; 39:386-397. [DOI: 10.1016/j.rmr.2022.02.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 01/04/2022] [Indexed: 11/21/2022]
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13
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The effects of medications for treating COPD and allied conditions on stroke: a population-based cohort study. NPJ Prim Care Respir Med 2022; 32:4. [PMID: 35039513 PMCID: PMC8764093 DOI: 10.1038/s41533-021-00267-3] [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: 06/12/2021] [Accepted: 12/06/2021] [Indexed: 11/26/2022] Open
Abstract
Patients with chronic obstructive pulmonary disease (COPD) are at higher risk of stroke. This study aimed to investigate the clinical factors of stroke risk in COPD and allied conditions patients and associations between medications for treating COPD and allied conditions. The population-based study cohort comprised 24,173 patients diagnosed with COPD and allied conditions between 2000 and 2013, and 24,170 selected matched patients without COPD comprised the comparison cohort from a nationwide database. Cox-proportional hazard regression was performed to determine the impact of medical therapies, comorbidities, and other clinical factors on stroke risk. Of the 48,343 included patients, 1394 (2.9%) experienced stroke during follow-up, with a significant difference between COPD and allied conditions cohort (1003/4.2%) and comparison cohort (391/1.6%) (adjusted hazard ratio [aHR]: 2.72, p < 0.001). Cox-regression analysis revealed that COPD and allied conditions patients who were older (>65 years) (HR: 1.06); male (HR: 1.39); with hypertension (HR: 1.46), diabetes mellitus (HR: 1.33) and atrial fibrillation (HR: 1.63) had increased stroke risk. Mucolytics (HR: 0.44) and combination therapy with inhaled corticosteroids (ICS) and long-acting β2-agonists (LABA) (HR: 0.75) were associated with decreased stroke risk in COPD and allied conditions patients. Among COPD and allied conditions patients, major comorbidities increase risk of stroke. Therapy with mucolytic agents and combination ICS/LABA is associated with risk reduction.
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14
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Ierodiakonou D, Theodorou E, Sifaki-Pistolla D, Bouloukaki I, Antonopoulou M, Poulorinakis I, Tsakountakis N, Voltiraki F, Chliveros K, Tsiligianni I. Clinical characteristics and outcomes of polypharmacy in chronic obstructive pulmonary disease patients: A cross-sectional study from Crete, Greece. THE CLINICAL RESPIRATORY JOURNAL 2021; 15:1310-1319. [PMID: 34425633 DOI: 10.1111/crj.13434] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 07/29/2021] [Accepted: 08/09/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES Polypharmacy and multimorbidity in chronic obstructive pulmonary disease (COPD) are highly prevalent, with potential associations with worse COPD outcomes. The aim of this study was to identify the clinical characteristics and outcomes of polypharmacy, investigate the relationship of polypharmacy with health status and exacerbations and assess the prevalence of inappropriate medication (PIM), risk of adverse drug reactions (ADRs) and drug-to-drug interactions in COPD patients. METHODS A total of 245 COPD patients were enrolled from primary care in Crete, Greece. Patients completed a questionnaire and the COPD Assessment Test (CAT). Multimorbidity was defined as having two or more comorbidities and polypharmacy was defined as taking five or more drugs per day. RESULTS Most of COPD patients (77.0%) and the majority (83.6%) of elderly (≥65 years) had multimorbidity, while polypharmacy was evident in 55.2% of all patients and 62.4% in elderly. After adjustments for age, gender and pack-years, polypharmacy was associated with CAT ≥ 10, multimorbidity, several cardiometabolic diseases, cancer and depression-anxiety and prostate disorders (all p values > 0.05). PIMs were found in 9.6% of subjects aged ≥65 years and were mainly mental health medication. Due to coadministration of medications, 22.3% of the population were at cumulative risk for falls, 17% for constipation and 12.8% for cardiovascular events. Finally, 15 pairs of drug-to-drug interactions were identified in 11.5% of patients. CONCLUSION Our data suggest that polypharmacy is highly prevalent and associated with worse health status and prescription risks in COPD patients. These findings potentially introduce an additional challenge on effective management of these patients.
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Affiliation(s)
- Despo Ierodiakonou
- Health Planning Unit, Department of Social Medicine, Faculty of Medicine, University of Crete, Crete, Greece
| | - Erotokritos Theodorou
- Health Planning Unit, Department of Social Medicine, Faculty of Medicine, University of Crete, Crete, Greece
| | - Dimitra Sifaki-Pistolla
- Health Planning Unit, Department of Social Medicine, Faculty of Medicine, University of Crete, Crete, Greece
- Clinic of Social and Family Medicine, Faculty of Medicine, University of Crete, Crete, Greece
| | | | | | | | | | - Filothei Voltiraki
- Primary Care, 4th Public Primary Care Unit of Heraklion, Heraklion, Crete, Greece
| | | | - Ioanna Tsiligianni
- Health Planning Unit, Department of Social Medicine, Faculty of Medicine, University of Crete, Crete, Greece
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15
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Le TT, Qato DM, Magder L, Bjarnadóttir M, Zafari Z, Simoni-Wastila L. Prevalence and Newly Diagnosed Rates of Multimorbidity in Older Medicare Beneficiaries with COPD. COPD 2021; 18:541-548. [PMID: 34468243 DOI: 10.1080/15412555.2021.1968815] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Few studies have quantified the multimorbidity burden in older adults with chronic obstructive pulmonary disease (COPD) using large and generalizable data. Such evidence is essential to inform evidence-based research, clinical care, and resource allocation. This retrospective cohort study used a nationally representative sample of Medicare beneficiaries aged 65 years or older with COPD and 1:1 matched (on age, sex, and race) non-COPD beneficiaries to: (1) quantify the prevalence of multimorbidity at COPD onset and one-year later; (2) quantify the rates [per 100 person-years (PY)] of newly diagnosed multimorbidity during in the year prior to and in the year following COPD onset; and (3) compare multimorbidity prevalence in beneficiaries with and without COPD. Among 739,118 eligible beneficiaries with and without COPD, the average number of multimorbidity was 10.0 (SD = 4.7) and 1.0 (SD = 3.3), respectively. The most prevalent multimorbidity at COPD onset and at one-year after, respectively, were hypertension (70.8% and 80.2%), hyperlipidemia (52.2% and 64.8%), anemia (42.1% and 52.0%), arthritis (39.8% and 47.7%), and congestive heart failure (CHF) (31.3% and 38.8%). Conditions with the highest newly diagnosed rates before and following COPD onset, respectively, included hypertension (39.8 and 32.3 per 100 PY), hyperlipidemia (22.8 and 27.6), anemia (17.8 and 20.3), CHF (16.2 and 13.2), and arthritis (12.9 and 13.2). COPD was significantly associated with increased odds of all measured conditions relative to non-COPD controls. This study updates existing literature with more current, generalizable findings of the substantial multimorbidity burden in medically complex older adults with COPD-necessary to inform patient-centered, multidimensional care.Supplemental data for this article is available online at https://doi.org/10.1080/15412555.2021.1968815 .
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Affiliation(s)
- Tham T Le
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD, USA.,Peter Lamy Center for Drug Therapeutic and Aging, University of Maryland, College Park, MD, USA
| | - Danya M Qato
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD, USA.,Peter Lamy Center for Drug Therapeutic and Aging, University of Maryland, College Park, MD, USA.,Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Larry Magder
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Margrét Bjarnadóttir
- Department of Decision, Operation, and Information Technologies, University of Maryland, College Park, MD, USA
| | - Zafar Zafari
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD, USA
| | - Linda Simoni-Wastila
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD, USA.,Peter Lamy Center for Drug Therapeutic and Aging, University of Maryland, College Park, MD, USA
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16
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Gesselman AN, Wion RK, Garcia JR, Miller WR. Relationship and sexual satisfaction are associated with better disease self-management in persons with epilepsy. Epilepsy Behav 2021; 119:107937. [PMID: 33892288 PMCID: PMC8154732 DOI: 10.1016/j.yebeh.2021.107937] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 03/12/2021] [Accepted: 03/12/2021] [Indexed: 01/23/2023]
Abstract
Prior research has demonstrated that PWEs view intimate interpersonal relationships as personally important and as a substantive challenge in their lives. This is significant as high-quality intimate relationships have been linked with greater well-being and better healthcare self-management in other disease contexts. For persons with epilepsy (PWEs), self-management is critical for seizure control, lower mortality, and better quality of life. In the current study, we conducted the first known investigation into the quality of PWEs' intimate relationships and their self-management abilities. In a sample of 88 PWEs, using the Adult Epilepsy Self-Management Instrument, results demonstrate links between greater relationship satisfaction and sexual satisfaction with better self-management on seven of the eleven subscales: health communication, coping skills, social support, seizure tracking, seizure response, stress management, and wellness; satisfaction was unrelated to the treatment, safety, medical adherence, and proactivity subscales. Importantly, these results held while controlling for age, gender, social support, and presence of comorbidities. These findings provide some evidence of the importance of intimate relationships in understanding PWEs' healthcare management abilities. Given that intimate relationship dynamics have been shown to be highly amenable to intervention, this is an area of potential interest for improving self-management in PWEs.
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Affiliation(s)
| | - Rachel K Wion
- School of Nursing, Indiana University, United States
| | - Justin R Garcia
- The Kinsey Institute, Indiana University, United States; Department of Gender Studies, Indiana University, United States
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17
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Liu W, Liu Y, Li X. Impact of Exercise Capacity Upon Respiratory Functions, Perception of Dyspnea, and Quality of Life in Patients with Chronic Obstructive Pulmonary Disease. Int J Chron Obstruct Pulmon Dis 2021; 16:1529-1534. [PMID: 34103910 PMCID: PMC8179731 DOI: 10.2147/copd.s311221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 05/20/2021] [Indexed: 11/23/2022] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) is associated with a high prevalence of morbidity and mortality worldwide. We investigated the effects of exercise capacity upon respiratory functions, perception of dyspnea, and quality of life (QoL) in patients with COPD. Methods A total of 512 COPD patients formed the study cohort. They were divided into four subgroups according to the distance walked in the 6-minute walking test (6MWT). We compared respiratory functions, perception of dyspnea, and QoL between groups. Results Patients who walked >350 m had significantly better disease-specific QoL scores (p < 0.001) than those of other groups. A negative correlation was found between the walking distance and anxiety, depression, and dyspnea scores (p < 0.001). Conclusions In patients who walked <350 m, the reduced walking distance adversely affected respiratory functions, psychological symptoms, and QoL.
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Affiliation(s)
- Wenjun Liu
- Department of Human Movement Science in Graduate School, Harbin Sport University, Harbin, 150000, People's Republic of China.,Department of Sports Science and Health, Harbin Sport University, Harbin, 150000, People's Republic of China
| | - Yufei Liu
- Department of Human Movement Science in Graduate School, Harbin Sport University, Harbin, 150000, People's Republic of China.,Department of Sports Science and Health, Harbin Sport University, Harbin, 150000, People's Republic of China
| | - Xiaolin Li
- Department of Human Movement Science in Graduate School, Harbin Sport University, Harbin, 150000, People's Republic of China.,Department of Sports Science and Health, Harbin Sport University, Harbin, 150000, People's Republic of China
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18
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Wang C, Wang L, Hou L, Lu H, Shang S. Determinants of Self-Rated Health Among Middle-Aged and Elderly Patients with COPD: The China Health and Retirement Longitudinal Study. Clin Nurs Res 2021; 31:80-88. [PMID: 34044630 DOI: 10.1177/10547738211018818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study aimed to assess self-rated health (SRH) status and its determinants in patients with chronic obstructive pulmonary disease (COPD). Participants aged at least 45 years were included from a nationally representative investigation in 2015. The SRH assessment was divided into two groups: "good" and "not good." Independent samples t-tests, chi-square tests, and Fisher's exact tests were used to determine differences in patient characteristics between the two groups. Multiple logistic models were used to determine factors influencing SRH. A total of 1,215 patients with COPD were included in the final analysis, of whom 21.2% reported favorable SRH status. The results indicated that female gender, non-smoking, and elevated peak expiratory flow correlated with better SRH, while nighttime sleep duration less than 7 hours, asthma, and disability, negatively impacted SRH. Our findings provide new evidence for the development of effective health promotion programs for the well-being of patients with COPD.
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Affiliation(s)
- Cui Wang
- Peking University School of Nursing, Beijing, China
| | - Limin Wang
- Peking University School of Nursing, Beijing, China
| | - Luoya Hou
- Peking University School of Nursing, Beijing, China
| | - Han Lu
- Peking University School of Nursing, Beijing, China
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19
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Park SK. Frailty in Korean patients with chronic obstructive pulmonary disease, using data from the Korea National Health and Nutrition Examination Survey, 2015 and 2016. Appl Nurs Res 2021; 59:151417. [PMID: 33947511 DOI: 10.1016/j.apnr.2021.151417] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 03/03/2021] [Accepted: 03/07/2021] [Indexed: 10/21/2022]
Abstract
AIM To describe frailty, to identify its determinants, and to examine how it affected functioning in Korean patients with chronic obstructive pulmonary disease (COPD). This analysis was based on datasets from the Korea National Health and Nutrition Examination Survey (KNHANES). BACKGROUND Most of what is known about the prevalence and determinants of frailty in patients with COPD has come from countries other than Korea. Examining this issue with a representative sample of COPD patients in Korea will shed light on frailty in this population. METHODS This cross-sectional study, a secondary data analysis, used datasets from the KNHANES VI (2015) and VII (2016) to understand frailty in 417 patients with COPD (mean age = 65.36; FEV1%predicted value = 78.91). Demographic and clinical data, symptoms, self-rated health, frailty, and functioning were collected in health interviews and health examinations. Descriptive and inferential statistics were used to analyze the data. RESULTS One hundred forty-eight participants (35.5%) were frail, 156 (37.4%) were pre-frail, and 113 (27.1%) exhibited no frailty. Multivariate logistic regression showed that self-rated health, stage of COPD based on the Global Initiative for Chronic Obstructive Lung Disease, pain/discomfort, and arthritis were significant predictors of frailty. Multivariate logistic regression also showed that frail participants were more likely to experience limitations in usual activities, after controlling for other covariates. CONCLUSION Health care providers who know the determinants of frailty and its relationship with poor functioning will be better prepared to identify at-risk patients with COPD who might benefit from pulmonary rehabilitation.
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Affiliation(s)
- Soo Kyung Park
- College of Nursing, Korea University, 145 Anam-Ro, Seongbuk-gu, Seoul, Republic of Korea.
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20
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Martucci VL, Richmond B, Davis LK, Blackwell TS, Cox NJ, Samuels D, Velez Edwards D, Aldrich MC. Fate or coincidence: do COPD and major depression share genetic risk factors? Hum Mol Genet 2021; 30:619-628. [PMID: 33704461 DOI: 10.1093/hmg/ddab068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 02/24/2021] [Accepted: 02/27/2021] [Indexed: 01/12/2023] Open
Abstract
Major depressive disorder (MDD) is a common comorbidity in chronic obstructive pulmonary disease (COPD), affecting up to 57% of patients with COPD. Although the comorbidity of COPD and MDD is well established, the causal relationship between these two diseases is unclear. A large-scale electronic health record clinical biobank and genome-wide association study summary statistics for MDD and lung function traits were used to investigate potential shared underlying genetic susceptibility between COPD and MDD. Linkage disequilibrium score regression was used to estimate genetic correlation between phenotypes. Polygenic risk scores (PRS) for MDD and lung function traits were developed and used to perform a phenome-wide association study (PheWAS). Multi-trait-based conditional and joint analysis identified single-nucleotide polymorphisms (SNPs) influencing both lung function and MDD. We found genetic correlations between MDD and all lung function traits were small and not statistically significant. A PRS-MDD was significantly associated with an increased risk of COPD in a PheWAS [odds ratio (OR) = 1.12, 95% confidence interval (CI): 1.09-1.16] when adjusting for age, sex and genetic ancestry, but this relationship became attenuated when controlling for smoking history (OR = 1.08, 95% CI: 1.04-1.13). No significant associations were found between the lung function PRS and MDD. Multi-trait-based conditional and joint analysis identified three SNPs that may contribute to both traits, two of which were previously associated with mood disorders and COPD. Our findings suggest that the observed relationship between COPD and MDD may not be driven by a strong shared genetic architecture.
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Affiliation(s)
- Victoria L Martucci
- Vanderbilt Genetics Institute, Vanderbilt University School of Medicine, Nashville, TN 37232, USA.,Division of Genetic Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Bradley Richmond
- Department of Veterans Affairs Medical Center, Nashville, TN 37212, USA.,Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Lea K Davis
- Vanderbilt Genetics Institute, Vanderbilt University School of Medicine, Nashville, TN 37232, USA.,Division of Genetic Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37232, USA.,Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Timothy S Blackwell
- Department of Veterans Affairs Medical Center, Nashville, TN 37212, USA.,Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN 37232, USA.,Department of Cell and Developmental Biology, Vanderbilt University School of Medicine, Nashville, TN 37232, USA
| | - Nancy J Cox
- Vanderbilt Genetics Institute, Vanderbilt University School of Medicine, Nashville, TN 37232, USA.,Division of Genetic Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - David Samuels
- Vanderbilt Genetics Institute, Vanderbilt University School of Medicine, Nashville, TN 37232, USA.,Department of Molecular Physiology and Biophysics, Vanderbilt University School of Medicine, Nashville, TN 37232, USA
| | - Digna Velez Edwards
- Vanderbilt Genetics Institute, Vanderbilt University School of Medicine, Nashville, TN 37232, USA.,Division of Quantitative Sciences, Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN 37232, USA.,Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Melinda C Aldrich
- Vanderbilt Genetics Institute, Vanderbilt University School of Medicine, Nashville, TN 37232, USA.,Division of Genetic Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37232, USA.,Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN 37232, USA.,Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, TN 37232, USA.,Division of Epidemiology, Vanderbilt University Medical Center, Nashville, TN 37232, USA
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21
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Bocquet L, Gravier FE, Smondack P, Prieur G, Combret Y, Muir JF, Cuvelier A, Boujibar F, Medrinal C, Bonnevie T. Urinary Incontinence in People Referred for Pulmonary Rehabilitation: An Undisclosed Issue but a Real Problem. Phys Ther 2021; 101:6044307. [PMID: 33351935 DOI: 10.1093/ptj/pzaa217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 08/20/2020] [Accepted: 11/10/2020] [Indexed: 11/14/2022]
Abstract
Pulmonary rehabilitation (PR) is an evidence-based intervention to manage symptoms related to chronic obstructive respiratory diseases (CORD). Paradoxically, few people with CORD actually engage in PR, and of those, up to one-third do not complete the program. Additionally, some of those who complete the program do not achieve worthwhile benefits. Therefore, the main challenge for the next decades is to offer PR to as many people (that would potentially benefit from it) as possible. This raises questions about factors influencing participation, completion, and responsiveness to PR programs. Among these factors, urinary incontinence (UI) is highly prevalent among people with CORD (much more than in the general population) and may worsen during PR exercise sessions. Paradoxically, UI is poorly explored in routine and scarcely assessed in research, and none of the actual guidelines about PR mention it. However, its potential influence on engagement, completion, and response to PR is of real concern. Therefore, the aim of this perspective is to describe the mechanisms of UI, particularly in the context of CORD, as well as to highlight its prevalence among people with CORD, their burden, and how it could affect a PR approach based on sustained and regular physical activity.
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Affiliation(s)
- Léna Bocquet
- Rouen University Hospital, School of Physiotherapy, Rouen, France
| | - Francis-Edouard Gravier
- ADIR Association, Rouen University Hospital, Rouen, France.,Normandy University UNIROUEN, UPRES EA 3830, Haute Normandie Research and Biomedical Innovation, Rouen, France
| | | | - Guillaume Prieur
- Normandy University UNIROUEN, UPRES EA 3830, Haute Normandie Research and Biomedical Innovation, Rouen, France.,Intensive Care Unit Department, Le Havre Hospital, Le Havre, France.,Institute of Experimental and Clinical Research (IREC), Pole of Pulmonology, ORL and Dermatology, Catholic University of Louvain, Brussels, Belgium
| | - Yann Combret
- Institute of Experimental and Clinical Research (IREC), Pole of Pulmonology, ORL and Dermatology, Catholic University of Louvain, Brussels, Belgium.,Physiotherapy Department, Le Havre Hospital, Le Havre, France
| | - Jean-François Muir
- ADIR Association, Rouen University Hospital, Rouen, France.,Normandy University UNIROUEN, UPRES EA 3830, Haute Normandie Research and Biomedical Innovation, Rouen, France.,Pulmonary, Thoracic Oncology and Respiratory Intensive Care Department, Rouen University Hospital, Rouen, France
| | - Antoine Cuvelier
- Normandy University UNIROUEN, UPRES EA 3830, Haute Normandie Research and Biomedical Innovation, Rouen, France.,Pulmonary, Thoracic Oncology and Respiratory Intensive Care Department, Rouen University Hospital, Rouen, France
| | - Fairuz Boujibar
- Department of General and Thoracic Surgery, Rouen University Hospital, Rouen, France.,Inserm U1096, Rouen University Hospital, Rouen, France
| | - Clément Medrinal
- Normandy University UNIROUEN, UPRES EA 3830, Haute Normandie Research and Biomedical Innovation, Rouen, France.,Intensive Care Unit Department, Le Havre Hospital, Le Havre, France
| | - Tristan Bonnevie
- ADIR Association, Rouen University Hospital, Rouen, France.,Normandy University UNIROUEN, UPRES EA 3830, Haute Normandie Research and Biomedical Innovation, Rouen, France
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22
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Kiani FZ, Ahmadi A. Prevalence of different comorbidities in chronic obstructive pulmonary disease among Shahrekord PERSIAN cohort study in southwest Iran. Sci Rep 2021; 11:1548. [PMID: 33452286 PMCID: PMC7810834 DOI: 10.1038/s41598-020-79707-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 12/11/2020] [Indexed: 12/24/2022] Open
Abstract
Comorbidities are common in chronic obstructive pulmonary disease (COPD) patients. This study was conducted to determine the prevalence of common comorbidities in patients with COPD compared with people without COPD. This cross-sectional, population-based study was performed on 6961 adults aged 35-70 years enrolled in the Shahrekord PERSIAN cohort study. Data (demographic and clinical characteristics, comorbidities, anthropometric and blood pressure measurements, laboratory, and spirometry tests) collection was performed according to the cohort protocol from 2015 to 2019. In the present study, 215 (3.1%) patients were diagnosed with COPD and 1753 (25.18%) ones with restrictive lung patterns. The mean age of COPD patients was 52.5 ± 9.76 years. 55.8% of patients were male, 17.7% were current smokers and 12.1% had a history of smoking or were former smokers. 5.6% of patients had no comorbidity and 94.5% had at least one comorbidity. The most common comorbidities in COPD patients were dyslipidemia (70.2%), hypertension (30.2%), metabolic syndrome (22.8%), and diabetes (16.7%). The most common comorbidities in individuals with a restrictive spirometry pattern were dyslipidemia (68.9%), metabolic syndrome (27.2%), hypertension (26.1%), depression (17.6%), and fatty liver (15.5%). The logistic regression analysis with 95% confidence interval (95%CI) of odds ratio (OR) showed that comorbidities of chronic lung diseases (OR = 2.12, 95% CI 1.30-3.44), diabetes (OR = 1.54, 95%CI 1.03-2.29), cardiovascular disease (OR = 1.52, 95%CI 1.17-2.43), and hypertension (OR = 1.4, 95%CI 1.02-1.99) were more likely to occur in COPD patients than in healthy individuals. Knowing these prevalence rates and related information provides new insights on comorbidities to reduce disease burden and develop preventive interventions and to regulate health care resources to meet the needs of patients in primary health care.
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Affiliation(s)
- Fatemeh Zeynab Kiani
- Modeling in Health Research Center, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Ali Ahmadi
- Modeling in Health Research Center, Shahrekord University of Medical Sciences, Shahrekord, Iran.
- Department of Epidemiology and Biostatistics, School of Health and Modeling in Health Research Center, Shahrekord University of Medical Sciences, Shahrekord, Iran.
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23
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Wang N, Wang Q, Du T, Gabriel ANA, Wang X, Sun L, Li X, Xu K, Jiang X, Zhang Y. The Potential Roles of Exosomes in Chronic Obstructive Pulmonary Disease. Front Med (Lausanne) 2021; 7:618506. [PMID: 33521025 PMCID: PMC7841048 DOI: 10.3389/fmed.2020.618506] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 12/17/2020] [Indexed: 12/17/2022] Open
Abstract
Currently, chronic obstructive pulmonary disease (COPD) is one of the most common chronic lung diseases. Chronic obstructive pulmonary disease is characterized by progressive loss of lung function due to chronic inflammatory responses in the lungs caused by repeated exposure to harmful environmental stimuli. Chronic obstructive pulmonary disease is a persistent disease, with an estimated 384 million people worldwide living with COPD. It is listed as the third leading cause of death. Exosomes contain various components, such as lipids, microRNAs (miRNAs), long non-coding RNAs(lncRNAs), and proteins. They are essential mediators of intercellular communication and can regulate the biological properties of target cells. With the deepening of exosome research, it is found that exosomes are strictly related to the occurrence and development of COPD. Therefore, this review aims to highlight the unique role of immune-cell-derived exosomes in disease through complex interactions and their potentials as potential biomarkers new types of COPD.
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Affiliation(s)
- Nan Wang
- School of Public Health, Shandong First Medical University and Shandong Academy of Medical Sciences, Taian, China
| | - Qin Wang
- Department of Anesthesiology, Qilu Hospital, Shandong University, Jinan, China
| | - Tiantian Du
- Department of Clinical Laboratory, Cheeloo College of Medicine, The Second Hospital, Shandong University, Jinan, China
| | | | - Xue Wang
- Department of Pharmacy, Binzhou Medical University Hospital, Binzhou, China
| | - Li Sun
- School of Public Health, Shandong First Medical University and Shandong Academy of Medical Sciences, Taian, China
| | - Xiaomeng Li
- School of Public Health, Shandong First Medical University and Shandong Academy of Medical Sciences, Taian, China
| | - Kanghong Xu
- School of Public Health, Shandong First Medical University and Shandong Academy of Medical Sciences, Taian, China
| | - Xinquan Jiang
- School of Public Health, Shandong First Medical University and Shandong Academy of Medical Sciences, Taian, China
| | - Yi Zhang
- Respiratory and Critical Care Medicine Department, Qilu Hospital, Shandong University, Jinan, China
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The Impact of COPD in Trends of Urinary Tract Infection Hospitalizations in Spain, 2001-2018: A Population-Based Study Using Administrative Data. J Clin Med 2020; 9:jcm9123979. [PMID: 33316870 PMCID: PMC7763854 DOI: 10.3390/jcm9123979] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 12/03/2020] [Accepted: 12/04/2020] [Indexed: 02/07/2023] Open
Abstract
(1) Background: To examine trends in incidence and outcomes of urinary tract infections (UTIs) among men and women with or without chronic obstructive pulmonary disease (COPD), and to identify the predictors for in-hospital mortality (IHM). (2) Methods: We included patients (aged ≥40 years) who were hospitalized with UTIs between 2001 and 2018. Data were collected from the Spanish National Hospital Discharge Database. (3) Results: We identified 748,458 UTI hospitalizations, 6.53% with COPD. The UTIs incidence increased over time. It was 1.55 times higher among men COPD patients than among non-COPD men (incidence rate ratio (IRR) 1.55; 95% CI 1.53-1.56). The opposite happened in women with COPD compared to non-COPD women (IRR 0.30; 95% CI 0.28-0.32). IHM was higher in men with COPD than non-COPD men (5.58% vs. 4.47%; p < 0.001) and the same happened in women (5.62% vs. 4.92%; p < 0.001). The risk of dying increased with age and comorbidity, but the urinary catheter was a protective factor among men (OR 0.75; 95% CI 0.64-0.89). Multivariable analysis showed a significant reduction in the IHM over time for men and women with COPD. Suffering from COPD only increased the risk of IHM among men (OR 1.07; 95% CI 1.01-1.13). (4) Conclusions: The incidence of UTIs increased over time. Suffering COPD increased the risk of IHM among men, but not among women.
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Sengupta R, Loftus TM, Doers M, Jandarov RA, Phillips M, Ko J, Panos RJ, Zafar MA. Resting Borg score as a predictor of safe discharge of chronic obstructive pulmonary disease from the emergency department observation unit. Acad Emerg Med 2020; 27:1302-1311. [PMID: 32678934 DOI: 10.1111/acem.14091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 06/26/2020] [Accepted: 07/14/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Chronic obstructive pulmonary disease exacerbations (eCOPD) can be life-threatening and costly. Emergency department (ED) observation units (ED-Obs) offer short-term care to safely reduce preventable hospitalizations. Accurately identifying eCOPD patients who can be discharged safely will improve outcomes. OBJECTIVES The objective were to: I) evaluate utility of conventional clinical variables as predictors of safe discharge and II) assess utility of serial resting Borg score and novel Dyspnea Assessment Score (DAS) for identifying eCOPD patients who can be safely discharged from ED-Obs. METHODS This study was carried out in a 680-bed tertiary, academic hospital with >700 annual eCOPD ED encounters and a 16-bed ED-Obs. A two-phase study of eCOPD patients admitted to ED-Obs was performed. Objective I was a retrospective study including all eCOPD admits from April 2016 to May 2017. Predictor variables (demographics, COPD severity, comorbid conditions, exacerbation severity, clinical care in ED) and outcome variables (ED-Obs disposition, ED revisits) were obtained through electronic medical records. Safe discharge was defined as home disposition from ED-Obs without 7-day revisit. A stepwise regression was performed for predictors of safe discharge. Objective II was a prospective observation study for change in every 4-hour serial resting Borg score and DAS as identifiers of safe discharge. Comparative and receiver operating characteristic (ROC) analyses were performed. A p-value of <0.05 was considered significant. RESULTS In Objective I, 171 patients with age, FEV1 %, and body mass index of 59.8 (±9.5) years, 35 (±24)%, and 28.8 (±8) m2 /kg were included. After ED-Obs treatment 78 (45.6%) were hospitalized and 93 (54.4%) were discharged home, of whom 11 (6.4%) had 7-day ED revisit. Safe discharge occurred in 82 (48%). None of the predictor variables correlated with safe discharge. In Objective II, of 38 patients included, 20 (52.6%) had safe discharge. Among others, 16 (42%) were hospitalized and two (5.2%) had 7-day ED revisit. The admission Borg scores and DASs were similar in both groups. The predisposition Borg score was significantly lower in patients with safe discharge (2.75 vs. 5.28, p < 0.001) and had the highest area under curve on ROC (0.77) for safe discharge. DAS was not significantly different between groups. CONCLUSIONS Routine clinical variables do not identify eCOPD patients who can be safely discharged from ED-Obs. Change in resting Borg score during the course of ED-Obs treatment safely identifies patients for discharge. Prospective, external validation is needed to incorporate serial Borg scores in ED-Obs disposition decision for improved safety.
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Affiliation(s)
- Ruchira Sengupta
- From the Division of Pulmonary and Critical Care Medicine Department of Internal Medicine University of Cincinnati College of Medicine CincinnatiOHUSA
| | - Timothy M. Loftus
- the Department of Emergency Medicine Northwestern University Feinberg School of Medicine Chicago ILUSA
| | - Matthew Doers
- From the Division of Pulmonary and Critical Care Medicine Department of Internal Medicine University of Cincinnati College of Medicine CincinnatiOHUSA
| | - Roman A. Jandarov
- and the Division of Biostatistics and Bioinformatics Department of Environmental Health University of Cincinnati College of Medicine CincinnatiOHUSA
| | - Michael Phillips
- and the Department of Respiratory Therapy University of Cincinnati Medical Center Cincinnati OHUSA
| | - Jonathan Ko
- and the Department of Respiratory Therapy University of Cincinnati Medical Center Cincinnati OHUSA
| | - Ralph J. Panos
- From the Division of Pulmonary and Critical Care Medicine Department of Internal Medicine University of Cincinnati College of Medicine CincinnatiOHUSA
- and the Department of Medicine Veterans Affairs Medical Center Cincinnati OHUSA
| | - Muhammad A. Zafar
- From the Division of Pulmonary and Critical Care Medicine Department of Internal Medicine University of Cincinnati College of Medicine CincinnatiOHUSA
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Xiao F, Yang J, Fan R. Effects of COPD on in-hospital outcomes of transcatheter aortic valve implantation: Results from the National Inpatient Sample database. Clin Cardiol 2020; 43:1524-1533. [PMID: 33089881 PMCID: PMC7724217 DOI: 10.1002/clc.23475] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 09/18/2020] [Accepted: 09/24/2020] [Indexed: 01/23/2023] Open
Abstract
Background Comorbid chronic obstructive pulmonary disease (COPD) increases morbidity and mortality among aortic valve replacement patients undergoing conventional surgery. The impact of COPD in patients undergoing less invasive transcatheter aortic valve insertion (TAVI) is unclear. Hypothesis This study evaluates the in‐hospital outcomes of TAVI in patients with and without COPD. Methods This population‐based, retrospective study of 8466 TAVI patients (29.87% with COPD) evaluates the effects of COPD on short‐term clinical outcomes (in‐hospital mortality, length of hospital stay, and postoperative complications) using data from the National Inpatient Sample database from 2011 to 2014. Logistic regression analysis was used to determine factors associated with in‐hospital mortality and postoperative complications. Linear regression analysis was used to identify factors associated with length of hospital stay. Results COPD is significantly associated with increased risk of respiratory complications and pneumonia after TAVI (aOR = 1.43, 95% CI: 1.24‐1.64; P < .001) but not in‐hospital mortality, length of hospital stay, or non‐respiratory postoperative complications as compared to non‐COPD patients. Concomitant COPD is significantly associated with increased risk of respiratory complications or pneumonia after TAVI but may still be the best treatment option for some patients. Conclusions Patients with comorbid COPD who receive TAVI have greater risk of developing postoperative respiratory complications and pneumonia. Vigilance for specific respiratory complications is highly warranted when treating this subgroup. Treatment decisions must be individualized.
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Affiliation(s)
- Fei Xiao
- Department of Cardiovascular Surgery, Guangdong Provincial People's Hospital, Guangdong, China.,Guangdong Academy of Medical Sciences, Guangdong, China.,Guangdong Cardiovascular Institute, Guangdong, China.,Guangdong Provincial Key Laboratory of South Structural Heart Disease, Guangdong, China
| | - Jue Yang
- Department of Cardiovascular Surgery, Guangdong Provincial People's Hospital, Guangdong, China.,Guangdong Academy of Medical Sciences, Guangdong, China.,Guangdong Cardiovascular Institute, Guangdong, China.,Guangdong Provincial Key Laboratory of South Structural Heart Disease, Guangdong, China
| | - Ruixin Fan
- Department of Cardiovascular Surgery, Guangdong Provincial People's Hospital, Guangdong, China.,Guangdong Academy of Medical Sciences, Guangdong, China.,Guangdong Cardiovascular Institute, Guangdong, China.,Guangdong Provincial Key Laboratory of South Structural Heart Disease, Guangdong, China
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Mollica M, Aronne L, Paoli G, Flora M, Mazzeo G, Tartaglione S, Polito R, Tranfa C, Ceparano M, Komici K, Mazzarella G, Iadevaia C. Elderly with COPD: comoborbitidies and systemic consequences. JOURNAL OF GERONTOLOGY AND GERIATRICS 2020. [DOI: 10.36150/2499-6564-434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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28
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Shah CH, Reed RM, Villalonga-Olives E, Slejko JF, Eakin MN, So JY, Zafari Z. Quantifying heterogeneity of physical and mental health-related quality of life in chronic obstructive pulmonary disease patients in the United States. Expert Rev Respir Med 2020; 14:937-947. [PMID: 32500756 DOI: 10.1080/17476348.2020.1776612] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a heterogenous condition. This study aims to quantify the heterogeneity of Health-related Quality of Life (HRQoL), and identify subgroups with the lowest HRQoL, in COPD patients in the United States (US). Methods Data from 2008-2015 Medical Expenditure Panel Survey were used to examine the heterogeneity of HRQoL between different COPD subgroups using mixed-effects modeling and G-computation. The Physical Composite Summary (PCS) and Mental Composite Summary (MCS) scores from the Short-Form-12 questionnaire were utilized. We also compared the heterogeneity of HRQoL in our COPD cohort against that in a matched non-COPD cohort. Results The final sample consisted of 1,866 (weighted = 19,952,143) COPD patients with a mean age of 63.2 years (Standard error (SE):0.38), mean MCS score of 46.84 (SE:0.35), and mean PCS score of 35.65 (SE:0.32). The adjusted MCS and PCS scores ranged from 36.19 to 53.06, and from 25.52 to 48.27, respectively, for COPD subgroups. COPD patients had statistically significantly lower MCS and PCS scores by 4.61, and 5.86 points, respectively, compared to the matched non-COPD cohort, and MCS scores showed a wider variability in the COPD cohort. Conclusion Our study quantifies substantial heterogeneity of HRQoL in COPD in the US and provides evidence for prioritizing COPD subgroups with the lowest HRQoL for targeted interventions.
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Affiliation(s)
- Chintal H Shah
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy , Baltimore, MD, USA
| | - Robert M Reed
- Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine , Baltimore, MD, USA
| | - Ester Villalonga-Olives
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy , Baltimore, MD, USA
| | - Julia F Slejko
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy , Baltimore, MD, USA
| | - Michelle N Eakin
- Division of Pulmonary Medicine and Critical Care, Johns Hopkins University , Baltimore, MD, USA
| | - Jennifer Y So
- Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine , Baltimore, MD, USA
| | - Zafar Zafari
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy , Baltimore, MD, USA
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29
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Manage urinary incontinence in COPD depending on whether it is stress, urge or mixed. DRUGS & THERAPY PERSPECTIVES 2020. [DOI: 10.1007/s40267-020-00735-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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30
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Recio Iglesias J, Díez-Manglano J, López García F, Díaz Peromingo JA, Almagro P, Varela Aguilar JM. Management of the COPD Patient with Comorbidities: An Experts Recommendation Document. Int J Chron Obstruct Pulmon Dis 2020; 15:1015-1037. [PMID: 32440113 PMCID: PMC7217705 DOI: 10.2147/copd.s242009] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 03/10/2020] [Indexed: 12/11/2022] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) is associated with multiple comorbidities, which impact negatively on patients and are often underdiagnosed, thus lacking a proper management due to the absence of clear guidelines. Purpose To elaborate expert recommendations aimed to help healthcare professionals to provide the right care for treating COPD patients with comorbidities. Methods A modified RAND-UCLA appropriateness method consisting of nominal groups to draw up consensus recommendations (6 Spanish experts) and 2-Delphi rounds to validate them (23 Spanish experts) was performed. Results A panel of Spanish internal medicine experts reached consensus on 73 recommendations and 81 conclusions on the clinical consequences of the presence of comorbidities. In general, the experts reached consensus on the issues raised with regard to cardiovascular comorbidity and metabolic disorders. Consensus was reached on the use of selective serotonin reuptake inhibitors in cases of depression and the usefulness of referring patients with anxiety to respiratory rehabilitation programmes. The results also showed consensus on the usefulness of investigating the quality of sleep, the treatment of pain with opioids and the evaluation of osteoporosis by lateral chest radiography. Conclusion This study provides conclusions and recommendations that are intended to improve the management of the complexity of patients with COPD and important comorbidities, usually excluded from clinical trials.
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Affiliation(s)
- Jesús Recio Iglesias
- Internal Medicine Department, Quironsalud Valencia Hospital, Valencia, Valencian Community, Spain
| | - Jesús Díez-Manglano
- Internal Medicine Department, Royo Villanova Hospital, Zaragoza, Aragon, Spain
| | - Francisco López García
- Internal Medicine Department General University Hospital of Elche, Alicante, Valencian Community, Spain
| | - José Antonio Díaz Peromingo
- Internal Medicine Department, University Clinical Hospital of Santiago de Compostela, a Coruña, Galicia, Spain
| | - Pere Almagro
- Internal Medicine Department, Mútua Terrassa University Hospital, Terrassa, Barcelona, Catalonia, Spain
| | - José Manuel Varela Aguilar
- Internal Medicine Department, University Hospital Virgen del Rocío, Seville, Andalusia, Spain
- CIBER of Epidemiology and Public Health, Madrid, Community of Madrid, Spain
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31
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Lin YC, Huang CC, Lin MC, Huang ST. Chinese herbal medicine reduces the risk of urinary incontinence in patients with chronic obstructive pulmonary disease: A population-based retrospective cohort study. Int J Urol 2020; 27:415-422. [PMID: 32153068 DOI: 10.1111/iju.14211] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 02/02/2020] [Indexed: 01/23/2023]
Abstract
OBJECTIVES To investigate the effectiveness of Chinese herbal medicine for the treatment of urinary incontinence in patients with chronic obstructive pulmonary disease. METHODS We carried out a retrospective cohort study using the National Health Insurance Research Database. From a cohort of 1 million records between 1996 and 2013, a total of 202 279 patients with newly onset chronic obstructive pulmonary disease were initially recruited. We matched with propensity score 3967 patients who received Chinese herbal medicine by age, sex, year of chronic obstructive pulmonary disease diagnosis, urbanization, comorbidities and chronic obstructive pulmonary disease medications. All participants received follow-up visits until the end of 2013 to record the incidence rate of urinary incontinence. The Cox proportional hazards model was applied to assess the association between Chinese herbal medicine use and the risk of urinary incontinence among chronic obstructive pulmonary disease patients. RESULTS The incidence rates of urinary incontinence were 57.33 and 108.15 (per 10 000 person-years) in the Chinese herbal medicine and non-Chinese herbal medicine cohorts, respectively, showing a significantly lower risk of urinary incontinence in Chinese herbal medicine users (aHR = 0.56, 95% CI = 0.45-0.69, P < 0.001). The Chinese herbal medicine prescription pattern analysis showed that Fritillariae thunbergii bulbus (Zhebeimu), Semen armeniacae amarum (Kuxingren), Platycodonis radix (Jiegeng), Xiao Qing Long Tang and Ding Chuan Tang constituted the core of Chinese herbal medicine prescriptions applied to treat chronic obstructive pulmonary disease. CONCLUSION The use of Chinese herbal medicine in chronic obstructive pulmonary disease patients can reduce their risk of urinary incontinence.
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Affiliation(s)
- Yu-Chun Lin
- Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Chao-Chun Huang
- Division of General Surgery, Ministry of Health and Welfare Pingtung Hospital, Pingtung, Taiwan
| | - Mei-Chen Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Sheng-Teng Huang
- Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan.,School of Chinese Medicine, China Medical University, Taichung, Taiwan.,An-Nan Hospital, China Medical University, Tainan, Taiwan.,Chinese Medicine Research Center, China Medical University, Taichung, Taiwan.,Research Center for Chinese Herbal Medicine, China Medical University, Taichung, Taiwan.,Cancer Research Center for Traditional Chinese Medicine, Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
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Gandhi K, Lim E, Davis J, Chen JJ. Racial-ethnic disparities in self-reported health status among US adults adjusted for sociodemographics and multimorbidities, National Health and Nutrition Examination Survey 2011-2014. ETHNICITY & HEALTH 2020; 25:65-78. [PMID: 29092622 PMCID: PMC6117214 DOI: 10.1080/13557858.2017.1395812] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 10/16/2017] [Indexed: 06/07/2023]
Abstract
Objective: To investigate racial-ethnic disparities in self-reported health status adjusting for sociodemographic factors and multimorbidities.Design: A total of 9499 adult participants aged 20 years and older from the United States (US); reported by the National Health and Nutrition Examination Survey (NHANES), a cross-sectional survey - for years 2011-2014. The main outcome measure was self-reported health status categorized as excellent/very good, good (moderate), and fair/poor.Results: Of the NHANES participants, 40.7% reported excellent/very good health, 37.2% moderate health and 22.1% fair/poor health. There were 42.8% who were non-Hispanic whites, 20.2% were Hispanic, 23.8% were non-Hispanic blacks, and 13.2% were non-Hispanic Asians. Compared to non-Hispanic whites, Hispanics [Odds Ratio (OR) = 2.91, 95% Confidence Interval (CI) = 2.28-3.71] and non-Hispanic blacks [OR = 1.51, 95% CI = 1.26-1.83] were more likely to report fair/poor health, whereas, non-Hispanic Asians [OR = 1.42, 95% CI = 1.14-1.76] were more likely to report moderate health than excellent/very good health. Compared to those with no chronic conditions, participants with two or three chronic conditions [OR = 9.35, 95% CI = 7.26-12.00] and with four or more chronic conditions [OR = 38.10, 95% CI = 26.50-54.90] were more likely to report fair/poor health than excellent/very good health status.Conclusion: The racial-ethnic differences in self-reported health persisted even after adjusting for sociodemographics and number of multimorbidities. The findings highlight the potential importance of self-reported health status and the need to increase health awareness through health assessment and health-promotional programs among the vulnerable minority US adults.
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Affiliation(s)
- Krupa Gandhi
- Office of Biostatistics and Quantitative Health Sciences, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, USA
| | - Eunjung Lim
- Office of Biostatistics and Quantitative Health Sciences, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, USA
| | - James Davis
- Office of Biostatistics and Quantitative Health Sciences, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, USA
| | - John J Chen
- Office of Biostatistics and Quantitative Health Sciences, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, USA
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Chen YF, Cheng YC, Chou CH, Chen CY, Yu CJ. Major comorbidities lead to the risk of adverse cardiovascular events in chronic obstructive pulmonary disease patients using inhaled long-acting bronchodilators: a case-control study. BMC Pulm Med 2019; 19:233. [PMID: 31795986 PMCID: PMC6889444 DOI: 10.1186/s12890-019-0999-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 11/19/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND While inhaled bronchodilators reduce symptoms and acute exacerbations of chronic obstructive pulmonary disease (COPD), their use is associated with increased cardiovascular events in some studies. This study investigates the risk of adverse events associated with the use of inhaled bronchodilators in COPD patients with multimorbidity. METHODS A case-control study was conducted between January 2015 and December 2017, and patients with spirometry-confirmed diagnosis of COPD (N = 1565) using inhaled long-acting bronchodilators were enrolled. Medical records were reviewed and clinical data, including age, gender, smoking status, major comorbidities, lung function stage, history of exacerbations, bronchodilator regimens, and treatment duration were analyzed. Major adverse cardiovascular events occurring during long-acting bronchodilator use were recorded. RESULTS The most common comorbidities were cardiovascular disease (CVD) (53.6%) and chronic kidney disease (CKD) (25.8%). We observed that CVD (odds ratio [OR], 5.77), CKD (OR, 2.02) and history of frequent exacerbations (OR, 2.37) were independent risk factors for cardiovascular events, regardless of the type of bronchodilators use. Moreover, COPD patients with both CKD and CVD had higher risk (6.32-fold) of adverse cardiovascular effects than those with neither comorbidity. Eighty-seven of 1565 (5.56%) COPD patients died during this study period. Of them, 21.8% (19/87) were cardiovascular-related and 73.6% (64/87) patients were respiratory-related mortality. Among COPD patients using long-acting bronchodilators, CKD was the only risk factor to predict cardiovascular events and cardiovascular-related mortality (OR, 4.87; 95% confidence interval [CI], 1.75-13.55]. CONCLUSIONS COPD patients had higher risk of cardiovascular events were associated with their CVD and/or CKD comorbidities and history of frequent exacerbations, rather than associated with their use of inhaled bronchodilators.
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Affiliation(s)
- Yen-Fu Chen
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, National Taiwan University Hospital Yunlin Branch, No.579, Sec. 2, Yunlin Rd., Douliu City, Yunlin County, 640, Taiwan, Republic of China
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, National Taiwan University Hospital, and College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yi-Ching Cheng
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, National Taiwan University Hospital Yunlin Branch, No.579, Sec. 2, Yunlin Rd., Douliu City, Yunlin County, 640, Taiwan, Republic of China
| | - Chien-Hong Chou
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, National Taiwan University Hospital Yunlin Branch, No.579, Sec. 2, Yunlin Rd., Douliu City, Yunlin County, 640, Taiwan, Republic of China
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, National Taiwan University Hospital, and College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chung-Yu Chen
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, National Taiwan University Hospital Yunlin Branch, No.579, Sec. 2, Yunlin Rd., Douliu City, Yunlin County, 640, Taiwan, Republic of China.
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, National Taiwan University Hospital, and College of Medicine, National Taiwan University, Taipei, Taiwan.
| | - Chong-Jen Yu
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, National Taiwan University Hospital, and College of Medicine, National Taiwan University, Taipei, Taiwan
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Ozretić P, da Silva Filho MI, Catalano C, Sokolović I, Vukić-Dugac A, Šutić M, Kurtović M, Bubanović G, Popović-Grle S, Skrinjarić-Cincar S, Vugrek O, Jukić I, Rumora L, Bosnar M, Samaržija M, Bals R, Jakopović M, Försti A, Knežević J. Association of NLRP1 Coding Polymorphism with Lung Function and Serum IL-1β Concentration in Patients Diagnosed with Chronic Obstructive Pulmonary Disease (COPD). Genes (Basel) 2019; 10:genes10100783. [PMID: 31601004 PMCID: PMC6826440 DOI: 10.3390/genes10100783] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 09/05/2019] [Accepted: 10/01/2019] [Indexed: 02/06/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a chronic disease characterized by a progressive decline in lung function due to airflow limitation, mainly related to IL-1β-induced inflammation. We have hypothesized that single nucleotide polymorphisms (SNPs) in NLRP genes, coding for key regulators of IL-1β, are associated with pathogenesis and clinical phenotypes of COPD. We recruited 704 COPD individuals and 1238 healthy controls for this study. Twenty non-synonymous SNPs in 10 different NLRP genes were genotyped. Genetic associations were estimated using logistic regression, adjusting for age, gender, and smoking history. The impact of genotypes on patients' overall survival was analyzed with the Kaplan-Meier method with the log-rank test. Serum IL-1β concentration was determined by high sensitivity assay and expression analysis was done by RT-PCR. Decreased lung function, measured by a forced expiratory volume in 1 s (FEV1% predicted), was significantly associated with the minor allele genotypes (AT + TT) of NLRP1 rs12150220 (p = 0.0002). The same rs12150220 genotypes exhibited a higher level of serum IL-1β compared to the AA genotype (p = 0.027) in COPD patients. NLRP8 rs306481 minor allele genotypes (AG + AA) were more common in the Global Initiative for Chronic Obstructive Lung Disease (GOLD) definition of group A (p = 0.0083). Polymorphisms in NLRP1 (rs12150220; OR = 0.55, p = 0.03) and NLRP4 (rs12462372; OR = 0.36, p = 0.03) were only nominally associated with COPD risk. In conclusion, coding polymorphisms in NLRP1 rs12150220 show an association with COPD disease severity, indicating that the fine-tuning of the NLRP1 inflammasome could be important in maintaining lung tissue integrity and treating the chronic inflammation of airways.
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Affiliation(s)
- Petar Ozretić
- Ruđer Bošković Institute, Division of Molecular Medicine, 10 000 Zagreb, Croatia.
| | | | - Calogerina Catalano
- Division of Molecular Genetic Epidemiology, DKFZ, 69 120 Heidelberg, Germany.
| | - Irena Sokolović
- Department for Respiratory Diseases Jordanovac, University of Zagreb School of Medicine, University Hospital Centre Zagreb, 10 000 Zagreb, Croatia.
| | - Andrea Vukić-Dugac
- Department for Respiratory Diseases Jordanovac, University of Zagreb School of Medicine, University Hospital Centre Zagreb, 10 000 Zagreb, Croatia.
| | - Maja Šutić
- Ruđer Bošković Institute, Division of Molecular Medicine, 10 000 Zagreb, Croatia.
| | - Matea Kurtović
- Ruđer Bošković Institute, Division of Molecular Medicine, 10 000 Zagreb, Croatia.
| | - Gordana Bubanović
- Department for Respiratory Diseases Jordanovac, University of Zagreb School of Medicine, University Hospital Centre Zagreb, 10 000 Zagreb, Croatia.
| | - Sanja Popović-Grle
- Department for Respiratory Diseases Jordanovac, University of Zagreb School of Medicine, University Hospital Centre Zagreb, 10 000 Zagreb, Croatia.
| | - Sanda Skrinjarić-Cincar
- Josip Juraj Strossmayer University of Osijek, School of Medicine, 31 000 Osijek, Croatia.
- Department of Pulmology, Universitiy Hospital Center Osijek, 31 000 Osijek, Croatia.
| | - Oliver Vugrek
- Ruđer Bošković Institute, Division of Molecular Medicine, 10 000 Zagreb, Croatia.
| | - Irena Jukić
- Croatian Institute of Transfusion Medicine, 10 000 Zagreb, Croatia.
| | - Lada Rumora
- Department of Medical Biochemistry and Hematology, Faculty of Pharmacy and Biochemistry, University of Zagreb, 10 000 Zagreb, Croatia.
| | - Martina Bosnar
- Fidelta d.o.o., Prilaz baruna Filipovića 29, 10 000 Zagreb, Croatia.
| | - Miroslav Samaržija
- Department for Respiratory Diseases Jordanovac, University of Zagreb School of Medicine, University Hospital Centre Zagreb, 10 000 Zagreb, Croatia.
| | - Robert Bals
- Department of Internal Medicine V-Pulmonology, Allergology, Intensive Care Medicine, Saarland University, 66 424 Homburg, Germany.
| | - Marko Jakopović
- Department for Respiratory Diseases Jordanovac, University of Zagreb School of Medicine, University Hospital Centre Zagreb, 10 000 Zagreb, Croatia.
| | - Asta Försti
- Division of Molecular Genetic Epidemiology, DKFZ, 69 120 Heidelberg, Germany.
| | - Jelena Knežević
- Ruđer Bošković Institute, Division of Molecular Medicine, 10 000 Zagreb, Croatia.
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Battaglia S, Benfante A, Principe S, Basile L, Scichilone N. Urinary Incontinence in Chronic Obstructive Pulmonary Disease: A Common Co-morbidity or a Typical Adverse Effect? Drugs Aging 2019; 36:799-806. [DOI: 10.1007/s40266-019-00687-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Charikiopoulou M, Nikolaidis PT, Knechtle B, Rosemann T, Rapti A, Trakada G. Subjective and Objective Outcomes in Patients With COPD After Pulmonary Rehabilitation - The Impact of Comorbidities. Front Physiol 2019; 10:286. [PMID: 30967792 PMCID: PMC6438881 DOI: 10.3389/fphys.2019.00286] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Accepted: 03/04/2019] [Indexed: 11/13/2022] Open
Abstract
Background: Chronic obstructive pulmonary disease (COPD) is a heterogeneous disease with multiple systemic manifestations and comorbidities, which contribute independently to its total morbidity and mortality. Pulmonary rehabilitation is an evidence-based intervention that is indicated for COPD patients who remain symptomatic, despite optimal pharmacological therapy. Although it is well documented in pure COPD, the role of pulmonary rehabilitation is uncertain in coexisting comorbidities. The aim of the present study was to clarify the effect of a pulmonary rehabilitation program in COPD patients with concomitant comorbidities. Methods: Thirty two patients with COPD were evaluated before and after a comprehensive pulmonary rehabilitation program, in terms of dyspnea, quality of life (QOL), pulmonary function tests and exercise capacity. The patients were also divided into two groups, according to the presence or the absence of comorbidities. Patients with none or only one comorbidity (Group 1, n = 11) were compared to those who had two or more comorbidities (Group 2, n = 21). Results: All patients significantly improved in dyspnea, as expressed by modified Medical Research Council scale and the COPD assessment Test (p < 0.001), QOL as assessed by the St. George respiratory questionnaire (p < 0.001) and exercise tolerance in six minute walking test (p < 0.001). Peak oxygen uptake relatively increased and body mass decreased in Group 1 compared to Group 2 (p < 0.05). Conclusion: Pulmonary rehabilitation in COPD seems to be beneficial for all patients, independently of the presence, the number or the nature of their comorbidities. Thus, the presence of comorbidities must not represent an exclusion criterion for patients that are referred to pulmonary rehabilitation programs. Trial Registration: Current controlled trials ISRCTN14648515 Retrospectively registered 15 February 2018.
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Affiliation(s)
- Maria Charikiopoulou
- Pulmonary Rehabilitation Department, General Hospital for Chest Diseases of Athens “SOTIRIA”, Athens, Greece
- 2nd Pulmonary Department, General Hospital for Chest Diseases of Athens “SOTIRIA”, Athens, Greece
| | | | - Beat Knechtle
- Institute of Primary Care, University of Zurich, Zurich, Switzerland
| | - Thomas Rosemann
- Institute of Primary Care, University of Zurich, Zurich, Switzerland
| | - Aggeliki Rapti
- Pulmonary Rehabilitation Department, General Hospital for Chest Diseases of Athens “SOTIRIA”, Athens, Greece
- 2nd Pulmonary Department, General Hospital for Chest Diseases of Athens “SOTIRIA”, Athens, Greece
| | - Georgia Trakada
- Division of Pulmonology, Department of Clinical Therapeutics, School of Medicine, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Aramburu A, Arostegui I, Moraza J, Barrio I, Aburto M, García-Loizaga A, Uranga A, Zabala T, Quintana JM, Esteban C. COPD classification models and mortality prediction capacity. Int J Chron Obstruct Pulmon Dis 2019; 14:605-613. [PMID: 30880950 PMCID: PMC6410748 DOI: 10.2147/copd.s184695] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective Our aim was to assess the impact of comorbidities on existing COPD prognosis scores. Patients and methods A total of 543 patients with COPD (FEV1 <80% and FEV1/FVC <70%) were included between January 2003 and January 2004. Patients were stable for at least 6 weeks before inclusion and were followed for 5 years without any intervention by the research team. Comorbidities and causes of death were established from medical reports or information from primary care medical records. The GOLD system and the body mass index, obstruction, dyspnea and exercise (BODE) index were used for COPD classification. Patients were also classified into four clusters depending on the respiratory disease and comorbidities. Cluster analysis was performed by combining multiple correspondence analyses and automatic classification. Receiver operating characteristic curves and the area under the curve (AUC) were calculated for each model, and the DeLong test was used to evaluate differences between AUCs. Improvement in prediction ability was analyzed by the DeLong test, category-free net reclassification improvement and the integrated discrimination index. Results Among the 543 patients enrolled, 521 (96%) were male, with a mean age of 68 years, mean body mass index 28.3 and mean FEV1% 55%. A total of 167 patients died during the study follow-up. Comorbidities were prevalent in our cohort, with a mean Charlson index of 2.4. The most prevalent comorbidities were hypertension, diabetes mellitus and cardiovascular diseases. On comparing the BODE index, GOLDABCD, GOLD2017 and cluster analysis for predicting mortality, cluster system was found to be superior compared with GOLD2017 (0.654 vs 0.722, P=0.006), without significant differences between other classification models. When cardiovascular comorbidities and chronic renal failure were added to the existing scores, their prognostic capacity was statistically superior (P<0.001). Conclusion Comorbidities should be taken into account in COPD management scores due to their prevalence and impact on mortality.
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Affiliation(s)
- Amaia Aramburu
- Respiratory Department, Hospital Galdakao-Usansolo, Galdakao, Bizkaia, Spain,
| | - Inmaculada Arostegui
- Department of Applied Mathematics, Statistics and Operative Research, University of the Basque Country (UPV/EHU), Basque Country, Spain.,Health Services Research on Chronic Patients Network (REDISSEC), Galdakao-Usansolo Hospital, Bizkaia, Spain.,Basque Center for Applied Mathematics (BCAM), University of Basque Country, Leioa, Bizkaia, Spain
| | - Javier Moraza
- Respiratory Department, Hospital Galdakao-Usansolo, Galdakao, Bizkaia, Spain,
| | - Irantzu Barrio
- Department of Applied Mathematics, Statistics and Operative Research, University of the Basque Country (UPV/EHU), Basque Country, Spain
| | - Myriam Aburto
- Respiratory Department, Hospital Galdakao-Usansolo, Galdakao, Bizkaia, Spain,
| | | | - Ane Uranga
- Respiratory Department, Hospital Galdakao-Usansolo, Galdakao, Bizkaia, Spain,
| | - Txomin Zabala
- Respiratory Department, Hospital Galdakao-Usansolo, Galdakao, Bizkaia, Spain,
| | - José María Quintana
- Health Services Research on Chronic Patients Network (REDISSEC), Galdakao-Usansolo Hospital, Bizkaia, Spain.,Research Unit, Hospital Galdakao-Usansolo, Galdakao, Bizkaia, Spain
| | - Cristóbal Esteban
- Respiratory Department, Hospital Galdakao-Usansolo, Galdakao, Bizkaia, Spain, .,Health Services Research on Chronic Patients Network (REDISSEC), Galdakao-Usansolo Hospital, Bizkaia, Spain
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Button B, Holland A, Sherburn M, Chase J, Wilson J, Burge A. Prevalence, impact and specialised treatment of urinary incontinence in women with chronic lung disease. Physiotherapy 2019; 105:114-119. [DOI: 10.1016/j.physio.2018.07.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 07/24/2018] [Indexed: 10/28/2022]
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Gergianaki I, Tsiligianni I. Chronic obstructive pulmonary disease and rheumatic diseases: A systematic review on a neglected comorbidity. JOURNAL OF COMORBIDITY 2019; 9:2235042X18820209. [PMID: 31309081 PMCID: PMC6612910 DOI: 10.1177/2235042x18820209] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 11/06/2018] [Indexed: 12/11/2022]
Abstract
Background: Although, both chronic obstructive pulmonary disease (COPD) and rheumatic diseases (RDs) are common, and each has significant impact on patients’ overall health/quality of life, their co-occurrence has received little attention, while 15% of COPD remains undiagnosed in RDs. Objective: To update the information regarding the comorbid state of RD/COPD (prevalence, incidence), to examine whether patients with RD have increased risk of developing COPD and vice versa, and what implications this comorbidity has on patients’ outcomes (mortality, hospitalizations, exacerbations). Methods: We performed a systematic literature review regarding the comorbidity of an RD (rheumatoid arthritis (RA), ankylosing spondylitis (AS), psoriatic arthritis (PsA), systemic lupus erythematosus (SLE), primary Sjogren syndrome disease (pSS), and systemic sclerosis (SSc)) with COPD. From 2803 reports retrieved, 33 articles were further screened. Finally, 27 articles were included. Results: Robust evidence supports that COPD develops up to 68% more frequently in patients with RA, as compared to the general population. Similarly, COPD is increased in every other RD that was studied. Further, self-referred arthritis is more common in COPD patients versus non-COPD controls and a predictor of worst self-rated health status. Patients with inflammatory arthritis/COPD have increased mortality (threefold in RA-COPD, irrespectively of which is first diagnosed), hospitalizations, and emergency visits. Conclusion: COPD is more common in patients with RA, AS, PsA, SLE, pSS, and SSc; yet, the association, vice versa, warrants further investigation. Nevertheless, COPD/RDs coexistence has significant prognostic value for worst outcomes; therefore, awareness is required to track early identification, especially in primary care.
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Affiliation(s)
- Irini Gergianaki
- Health Planning Unit, Department of Social Medicine, School of Medicine, University of Crete Heraklion, Greece
| | - Ioanna Tsiligianni
- Health Planning Unit, Department of Social Medicine, School of Medicine, University of Crete Heraklion, Greece
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Rambaran K, Bhagan B, Ali A, Ali F, Toolsie S, Lobin R, Beharry S, Ghany S, Mohammed S, Davis G, Sakhamuri S, Teelucksingh S, Seemungal T. High Prevalence of Diabetes Mellitus in a Cohort of Patients with Chronic Obstructive Pulmonary Disease in Trinidad, West Indies. Turk Thorac J 2019; 20:12-17. [PMID: 30664421 DOI: 10.5152/turkthoracj.2018.18036] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 06/04/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Both chronic obstructive pulmonary disease (COPD) and diabetes mellitus (DM) are highly prevalent in Trinidad, West Indies. Our objective was to evaluate the prevalence of DM in a cohort of Trinidadian patients with COPD and investigate the possible impact of diabetes on COPD using standard outcome measures, that is, lung function, exacerbations, quality of life and depression questionnaires, as well as mortality. MATERIALS AND METHODS This was a cross-sectional follow-up study utilizing a cohort of 105 patients from chest clinics in the three major general hospitals in Trinidad. RESULTS Diabetes was diagnosed based on a glycated hemoglobin (HbA1c) level of ≥6.5% (or a prior self-reported history), and for pre-diabetes, of 5.7%-6.4%. Of 105 patients, 40% fulfilled the criteria for diabetes and 40% for pre-diabetes. Of those diagnosed with diabetes, 38% obtained this diagnosis de novo. A history of intravenous corticosteroid use was associated with higher HbA1c levels (p=0.043) upon diagnosis. The percentage of predicted forced vital capacity was negatively related to HbA1c (p=0.033), but those with diabetes also had a greater body mass index (p=0.001). After a 1-year follow-up, mortality was significantly greater among patients with diabetes (p=0.026). Patients with at least one exacerbation in the past year or poorer lung function parameters had worse quality of life (p≤0.040) and depression (p≤0.018) scores. Notably, 31.4% of the total cohort exhibited clinically significant depression scores. CONCLUSION This study revealed that a high proportion of COPD patients in tertiary care had diabetes or pre-diabetes.
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Affiliation(s)
- Kirin Rambaran
- Department of Clinical Medical Sciences, Faculty of Medical Sciences, the University of the West Indies (St Augustine Campus), Trinidad and Tobago
| | - Bryan Bhagan
- Department of Clinical Medical Sciences, Faculty of Medical Sciences, the University of the West Indies (St Augustine Campus), Trinidad and Tobago
| | - Amanda Ali
- Department of Clinical Medical Sciences, Faculty of Medical Sciences, the University of the West Indies (St Augustine Campus), Trinidad and Tobago
| | - Firas Ali
- Department of Clinical Medical Sciences, Faculty of Medical Sciences, the University of the West Indies (St Augustine Campus), Trinidad and Tobago
| | - Shivan Toolsie
- Department of Clinical Medical Sciences, Faculty of Medical Sciences, the University of the West Indies (St Augustine Campus), Trinidad and Tobago
| | - Rekha Lobin
- Department of Clinical Medical Sciences, Faculty of Medical Sciences, the University of the West Indies (St Augustine Campus), Trinidad and Tobago
| | - Shivani Beharry
- Department of Clinical Medical Sciences, Faculty of Medical Sciences, the University of the West Indies (St Augustine Campus), Trinidad and Tobago
| | - Sabrina Ghany
- Department of Clinical Medical Sciences, Faculty of Medical Sciences, the University of the West Indies (St Augustine Campus), Trinidad and Tobago
| | - Saeeda Mohammed
- Department of Clinical Medical Sciences, Faculty of Medical Sciences, the University of the West Indies (St Augustine Campus), Trinidad and Tobago
| | - Gershwin Davis
- Department of Para-clinical Sciences, Faculty of Medical Sciences, the University of the West Indies (St Augustine Campus), Trinidad and Tobago
| | - Sateesh Sakhamuri
- Department of Clinical Medical Sciences, Faculty of Medical Sciences, the University of the West Indies (St Augustine Campus), Trinidad and Tobago
| | - Surujpal Teelucksingh
- Department of Clinical Medical Sciences, Faculty of Medical Sciences, the University of the West Indies (St Augustine Campus), Trinidad and Tobago
| | - Terence Seemungal
- Department of Clinical Medical Sciences, Faculty of Medical Sciences, the University of the West Indies (St Augustine Campus), Trinidad and Tobago
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Figueira Gonçalves JM, Martín Martínez MD, Pérez Méndez LI, García Bello MÁ, Garcia-Talavera I, Hernández SG, Díaz Pérez D, Bethencourt Martín N. Health Status in Patients with COPD According to GOLD 2017 Classification: Use of the COMCOLD Score in Routine Clinical Practice. COPD 2018; 15:326-333. [DOI: 10.1080/15412555.2018.1531388] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
| | | | | | | | | | - Sara García Hernández
- Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain
| | - David Díaz Pérez
- Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain
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[Prevalence and impact on quality of life of urinary incontinence in an adult population with chronic obstructive pulmonary diseases, literature review]. Prog Urol 2018; 28:962-972. [PMID: 30366709 DOI: 10.1016/j.purol.2018.08.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 08/27/2018] [Accepted: 08/29/2018] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Patients with obstructive lung diseases (OLD) are at-risk population for urinary incontinence (UI) with high frequency of increased intra-abdominal pressure because of chronic cough symptoms. AIM OF THE STUDY This review is aimed at determining the prevalence of UI and its impact on quality of life, patient healthcare research, diagnosis and treatment of UI among this population. MATERIALS AND METHOD Literature review from January 2001 to 2018 on Medline (PubMed) using keywords urinary incontinence, chronic obstructive pulmonary disease (COPD), asthma, cystic fibrosis, quality of life. RESULTS The largest study showed that in a population of 14,828 people, whose 995 were diagnosed COPD, UI prevalence was 34.9% in people with COPD, versus 27.3% among the general population of the study (P=0.0048). Results in the other studies of the review were similar. UI was more severe in OLD patients and occurred on young subjects. Stress urinary incontinence symptoms were predominant, during cough but also during spirometry and chest rehabilitation sessions. Despite an impact on quality of life and treatment of OLD, UI was neglected. CONCLUSION UI prevalence seemed higher on population with OLD, to a greater degree of severity. Quality of life self-evaluation was further decreased when UI was associated with pulmonary disease.
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Meireles M, Machado A, Lopes J, Abreu S, Furtado I, Gonçalves J, Costa AR, Mateus A, Neves J. Age-adjusted Charlson Comorbidity Index Does Not Predict Outcomes in Patients Submitted to Noninvasive Ventilation. Arch Bronconeumol 2018; 54:503-509. [DOI: 10.1016/j.arbres.2018.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 02/14/2018] [Accepted: 03/04/2018] [Indexed: 10/16/2022]
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Diaz AA, Martinez CH, Harmouche R, Young TP, McDonald ML, Ross JC, Han ML, Bowler R, Make B, Regan EA, Silverman EK, Crapo J, Boriek AM, Kinney GL, Hokanson JE, Estepar RSJ, Washko GR. Pectoralis muscle area and mortality in smokers without airflow obstruction. Respir Res 2018; 19:62. [PMID: 29636050 PMCID: PMC5894181 DOI: 10.1186/s12931-018-0771-6] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 04/04/2018] [Indexed: 12/25/2022] Open
Abstract
Background Low muscle mass is associated with increased mortality in the general population but its prognostic value in at-risk smokers, those without expiratory airflow obstruction, is unknown. We aimed to test the hypothesis that reduced muscle mass is associated with increased mortality in at-risk smokers. Methods Measures of both pectoralis and paravertebral erector spinae muscle cross-sectional area (PMA and PVMA, respectively) as well as emphysema on chest computed tomography (CT) scans were performed in 3705 current and former at-risk smokers (≥10 pack-years) aged 45–80 years enrolled into the COPDGene Study between 2008 and 2013. Vital status was ascertained through death certificate. The association between low muscle mass and mortality was assessed using Cox regression analysis. Results During a median of 6.5 years of follow-up, 212 (5.7%) at-risk smokers died. At-risk smokers in the lowest (vs. highest) sex-specific quartile of PMA but not PVMA had 84% higher risk of death in adjusted models for demographics, smoking, dyspnea, comorbidities, exercise capacity, lung function, emphysema on CT, and coronary artery calcium content (hazard ratio [HR] 1.85 95% Confidence interval [1.14–3.00] P = 0.01). Results were consistent when the PMA index (PMA/height2) was used instead of quartiles. The association between PMA and death was modified by smoking status (P = 0.04). Current smokers had a significantly increased risk of death (lowest vs. highest PMA quartile, HR 2.25 [1.25–4.03] P = 0.007) while former smokers did not. Conclusions Low muscle mass as measured on chest CT scans is associated with increased mortality in current smokers without airflow obstruction. Trial registration NCT00608764 Electronic supplementary material The online version of this article (10.1186/s12931-018-0771-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Alejandro A Diaz
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
| | - Carlos H Martinez
- Division of Pulmonary & Critical Care Medicine, University of Michigan Health System, Ann Arbor, MI, USA
| | - Rola Harmouche
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Thomas P Young
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Merry-Lynn McDonald
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - James C Ross
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Mei Lan Han
- Division of Pulmonary & Critical Care Medicine, University of Michigan Health System, Ann Arbor, MI, USA
| | - Russell Bowler
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, National Jewish Health, Denver, CO, USA
| | - Barry Make
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, National Jewish Health, Denver, CO, USA
| | - Elizabeth A Regan
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, National Jewish Health, Denver, CO, USA
| | - Edwin K Silverman
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.,Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - James Crapo
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, National Jewish Health, Denver, CO, USA
| | - Aladin M Boriek
- Division of Pulmonary and Critical Care Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Gregory L Kinney
- Colorado School of Public Health, University of Colorado-Denver, Aurora, CO, USA
| | - John E Hokanson
- Colorado School of Public Health, University of Colorado-Denver, Aurora, CO, USA
| | - Raul San Jose Estepar
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - George R Washko
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
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de Miguel-Diez J, Lopez-de-Andres A, Herandez-Barrera V, Jimenez-Trujillo I, Puente-Maestu L, Cerezo-Lajas A, Jimenez-Garcia R. Effect of the economic crisis on the use of health and home care services among Spanish COPD patients. Int J Chron Obstruct Pulmon Dis 2018. [PMID: 29535513 PMCID: PMC5836665 DOI: 10.2147/copd.s150308] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) is a major cause of disability and death worldwide. Consequently, COPD patients are frequent users of health and social resources. Therefore, they are highly vulnerable to decreases in investment in healthcare services. We aimed to describe the utilization of health and home care services among Spanish COPD patients during the economic crisis to identify factors independently associated with changes in the utilization of these services and to study the time trends from 2009 to 2014. Methods We used data from the European Health Interview Surveys for Spain (EHSS) conducted between 2009/2010 (n=22,188) and 2014 (n=22,842). We included responses from adults with COPD aged 40 years or over. Dependent variables included self-reported hospitalizations during the previous year, general practitioner (GP) visits during the last 4 weeks, other health care services used during the previous year (nursing, rehabilitation, and psychological services), and home care services use during the previous year. Independent variables included demographic and socioeconomic characteristics, health status variables, and lifestyles. Results We identified 1,328 and 1,008 COPD patients from EHSS 2009 and EHSS 2014, respectively. We observed a significant increase in non-GP services use (30.6% in 2009 vs 39.11% in 2014; p<0.001). No changes were found for hospitalizations, GP visits, and home care services use over time. Multivariable models showed that associated factors with a higher use included any chronic comorbidity and worse self-rated health. Physical activity was a strong predictor of fewer hospitalizations and less home care service use. Female sex was associated with significantly fewer hospitalizations (OR 0.72; 95% CI 0.58-0.89). Conclusion We found an increase in the use of non-GP services (nursing, rehabilitation, and psychological) but not in other health and home care services. The only differences in hospitalizations were observed according to sex. Therefore, the effect of the economic crisis, if any, seems to have been of small magnitude.
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Affiliation(s)
- Javier de Miguel-Diez
- Respiratory Department, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid (UCM), Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Ana Lopez-de-Andres
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
| | - Valentin Herandez-Barrera
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
| | - Isabel Jimenez-Trujillo
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
| | - Luis Puente-Maestu
- Respiratory Department, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid (UCM), Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Alicia Cerezo-Lajas
- Respiratory Department, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid (UCM), Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Rodrigo Jimenez-Garcia
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
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Hanlon P, Nicholl BI, Jani BD, McQueenie R, Lee D, Gallacher KI, Mair FS. Examining patterns of multimorbidity, polypharmacy and risk of adverse drug reactions in chronic obstructive pulmonary disease: a cross-sectional UK Biobank study. BMJ Open 2018; 8:e018404. [PMID: 29332840 PMCID: PMC5781016 DOI: 10.1136/bmjopen-2017-018404] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 11/23/2017] [Accepted: 11/29/2017] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE This study aims: (1) to describe the pattern and extent of multimorbidity and polypharmacy in UK Biobank participants with chronic obstructive pulmonary disease (COPD) and (2) to identify which comorbidities are associated with increased risk of adverse drug reactions (ADRs) resulting from polypharmacy. DESIGN Cross-sectional. SETTING Community cohort. PARTICIPANTS UK Biobank participants comparing self-reported COPD (n=8317) with no COPD (n=494 323). OUTCOMES Multimorbidity (≥4 conditions) and polypharmacy (≥5 medications) in participants with COPD versus those without. Risk of ADRs (taking ≥3 medications associated with falls, constipation, urinary retention, central nervous system (CNS) depression, bleeding or renal injury) in relation to the presence of COPD and individual comorbidities. RESULTS Multimorbidity was more common in participants with COPD than those without (17% vs 4%). Polypharmacy was highly prevalent (52% with COPD taking ≥5 medications vs 18% in those without COPD). Adjusting for age, sex and socioeconomic status, those with COPD were significantly more likely than those without to be prescribed ≥3 medications contributing to falls (OR 2.27, 95% CI 2.13 to 2.42), constipation (OR 3.42, 95% CI 3.10 to 3.77), urinary retention (OR 3.38, 95% CI 2.94 to 3.87), CNS depression (OR 3.75, 95% CI 3.31 to 4.25), bleeding (OR 4.61, 95% CI 3.35 to 6.19) and renal injury (OR 2.22, 95% CI 1.86 to 2.62). Concomitant cardiovascular disease was associated with the greatest risk of taking ≥3 medications associated with falls/renal injury. Concomitant mental health conditions were most strongly associated with medications linked with CNS depression/urinary retention/bleeding. CONCLUSIONS Multimorbidity is common in COPD and associated with high levels of polypharmacy. Co-prescription of drugs with various ADRs is common. Future research should examine the effects on healthcare outcomes of co-prescribing multiple drugs with similar potential ADRs. Clinical guidelines should emphasise assessment of multimorbidity and ADR risk.
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Affiliation(s)
- Peter Hanlon
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Barbara I Nicholl
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Bhautesh Dinesh Jani
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Ross McQueenie
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Duncan Lee
- School of Mathematics and Statistics, University of Glasgow, Glasgow, UK
| | - Katie I Gallacher
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Frances S Mair
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
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Lin YH, Liao XN, Fan LL, Qu YJ, Cheng DY, Shi YH. Long-term treatment with budesonide/formoterol attenuates circulating CRP levels in chronic obstructive pulmonary disease patients of group D. PLoS One 2017; 12:e0183300. [PMID: 28832630 PMCID: PMC5568104 DOI: 10.1371/journal.pone.0183300] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 07/31/2017] [Indexed: 02/05/2023] Open
Abstract
Background The systemic inflammation is associated with clinical outcome and mortality in chronic obstructive pulmonary disease (COPD) patients. To investigate the effects of tiotropium (Tio) and/or budesonide/formoterol (Bud/Form) on systemic inflammation biomarkers in stable COPD patients of group D, a randomized, open-label clinical trial was conducted. Methods Eligible participants (n = 324) were randomized and received either Tio 18ug once daily (group I), Bud/Form 160/4.5ug twice daily (group II), Bud/Form 320/9ug twice daily (group III), or Tio 18ug once daily with Bud/Form 160/4.5ug twice daily (group IV) for 6 months. Systemic inflammation biomarkers were measured before randomization and during the treatment, including C-reactive protein (CRP), interleukin-6 (IL-6), interleukin-8 (IL-8), serum amyloid A (SAA), tumor necrosis factor-α (TNF-α), fibrinogen (Fib), and white blood cell (WBC). Results After 6-month treatment, CRP levels in group II, group III and group IV changed by a median (interquartile range) of -1.25 (-3.29, 1.18) mg/L, -1.13 (-2.55, 0.77) mg/L, and -1.56 (-4.64, 0.22) mg/L respectively, all of which with statistical differences compared with group I. In addition, there were no treatment differences in terms of IL-8, SAA, TNF-α, Fib and WBC levels. Conclusions A long-term treatment with Bud/Form alone or together with Tio can attenuate circulating CRP levels in COPD patients of group D, compared with Tio alone.
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Affiliation(s)
- Yi-Hua Lin
- Department of Respiratory Medicine, the First Affiliated Hospital of Xiamen University, Xiamen, Fujian, China
- Department of Respiratory Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Xi-Ning Liao
- Department of Respiratory Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Li-Li Fan
- Department of Respiratory Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Yue-Jin Qu
- Department of Respiratory Medicine, the First Affiliated Hospital of Xiamen University, Xiamen, Fujian, China
| | - De-Yun Cheng
- Department of Respiratory Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Yong-Hong Shi
- Department of Respiratory Medicine, the First Affiliated Hospital of Xiamen University, Xiamen, Fujian, China
- * E-mail:
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Westney G, Foreman MG, Xu J, Henriques King M, Flenaugh E, Rust G. Impact of Comorbidities Among Medicaid Enrollees With Chronic Obstructive Pulmonary Disease, United States, 2009. Prev Chronic Dis 2017; 14:E31. [PMID: 28409741 PMCID: PMC5392445 DOI: 10.5888/pcd14.160333] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Multimorbidity, the presence of 2 or more chronic conditions, frequently affects people with chronic obstructive pulmonary disease (COPD). Many have high-cost, highly complex conditions that have a substantial impact on state Medicaid programs. We quantified the cost of Medicaid-insured patients with COPD co-diagnosed with other chronic disorders. METHODS We used nationally representative Medicaid claims data to analyze the impact of comorbidities (other chronic conditions) on the disease burden, emergency department (ED) use, hospitalizations, and total health care costs among 291,978 adult COPD patients. We measured the prevalence of common conditions and their influence on COPD-related and non-COPD-related resource use by using the Elixhauser Comorbidity Index. Elixhauser comorbidity counts were clustered from 0 to 7 or more. We performed multivariable logistic regression to determine the odds of ED visits by Elixhauser scores adjusting for age, sex, race/ethnicity, and residence. RESULTS Acute care, hospital bed days, and total Medicaid-reimbursed costs increased as the number of comorbidities increased. ED visits unrelated to COPD were more common than visits for COPD, especially in patients self-identified as black or African American (designated black). Hypertension, diabetes, affective disorders, hyperlipidemia, and asthma were the most prevalent comorbid disorders. Substance abuse, congestive heart failure, and asthma were commonly associated with ED visits for COPD. Female sex was associated with COPD-related and non-COPD-related ED visits. CONCLUSION Comorbidities markedly increased health services use among people with COPD insured with Medicaid, although ED visits in this study were predominantly unrelated to COPD. Achieving excellence in clinical practice with optimal clinical and economic outcomes requires a whole-person approach to the patient and a multidisciplinary health care team.
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Affiliation(s)
- Gloria Westney
- Pulmonary and Critical Care Division, Morehouse School of Medicine, Atlanta, Georgia
| | - Marilyn G Foreman
- Pulmonary and Critical Care Division, Morehouse School of Medicine, 720 Westview Dr SW, Atlanta, GA 30080.
| | - Junjun Xu
- National Center for Primary Care, Morehouse School of Medicine, Atlanta, Georgia
| | | | - Eric Flenaugh
- Pulmonary and Critical Care Division, Morehouse School of Medicine, Atlanta, Georgia
| | - George Rust
- National Center for Primary Care, Morehouse School of Medicine, Atlanta, Georgia
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Evaluation of Pregnancy-Associated Plasma Protein-A Levels in Patients with Chronic Obstructive Pulmonary Disease and Associations with Disease Severity. Inflammation 2017; 39:1130-3. [PMID: 27090654 DOI: 10.1007/s10753-016-0345-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) represents a systemic disorder characterized by chronic airflow limitation and an increased inflammatory response of the airways. Comorbidities are frequent in COPD and it is crucial to predict these in early stage for adequate management of COPD. Recent studies have reported that elevated levels of pregnancy-associated plasma protein-A (PAPP-A), a zinc-binding metalloproteinase, detected in patients with asthma, lung cancer, and pulmonary embolism and independently associated with cardiovascular events. We aimed to assess serum PAPP-A levels in COPD and the associations between disease severity. The study population consisted of 75 COPD patients and 35 healthy subjects as a control group. PAPP-A levels were measured by using ultrasensitive enzyme-linked immunosorbent assay. Elevated levels of PAPP-A were observed in patients with COPD on comparison with the controls (p = 0.000). The levels in stage 1 (34.73 ± 22.97) and stage 2 (48.29 ± 53.35) were significantly higher than stage 3 (20.58 ± 22.98) and stage 4 (27.36 ± 21.46) (p = 0.049). Increased PAPP-A levels may be a useful marker in management of COPD that seeks to prevent the development of comorbidities such as adverse cardiovascular diseases.
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Mohamed AZ, Moharrm AM, Ghanem MK, Makhlouf HA, El-Gezawy EM, Youssif SF. Role of comorbidities in acquiring pulmonary fungal infection in chronic obstructive pulmonary disease patients. THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2016. [DOI: 10.4103/1687-8426.193629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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