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Wang F, Jia L. BMI moderates the relationship between depression and chronic obstructive pulmonary disease: A cross‑sectional survey. Heart Lung 2024; 68:68-73. [PMID: 38936063 DOI: 10.1016/j.hrtlng.2024.06.013] [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: 04/11/2024] [Revised: 06/19/2024] [Accepted: 06/19/2024] [Indexed: 06/29/2024]
Abstract
BACKGROUND Prior research has established a connection between depression and chronic obstructive pulmonary disease (COPD). However, the influence of age and BMI on this association remains unclear. OBJECTIVES We used the National Health and Nutrition Examination Survey (NHANES) database to explore the relationship between depression and COPD, and to investigate whether age and Body mass index (BMI) act as moderators in this relationship. METHODS We analyzed data from 10,940 participants in the NHANES database. Depression served as the independent variable. COPD status served as the outcome variable. We employed multivariable logistic regression to examine the relationship between depression and COPD. RESULTS Of the 10,940 respondents surveyed, about 3.9 % had COPD and 8.5 % had depression. The prevalence of depression in COPD patients was significantly greater than the prevalence of overall respondents (21.1 % VS.8.5 %). We found that the association between depression and COPD was mediated by BMI status. Controlling for other covariates, the association between depression and COPD increased significantly. For the underweight group, the impact of depression on the risk of COPD was lower compared to the normal BMI group. CONCLUSION This study confirms a significant association between depression and COPD, with BMI serving as a moderator. These findings enhance our understanding of the complex interplay between depression and COPD and underscore the importance of considering individual physical health characteristics in clinical assessments. The results have significant implications for clinical practice and public health policymaking.
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Affiliation(s)
- Feng Wang
- Xin'an International Hospital, Department of Respiratory and Critical Care Medicine, Jiaxing, Zhejiang 314000, PR China
| | - Liangliang Jia
- Xin'an International Hospital, Department of Respiratory and Critical Care Medicine, Jiaxing, Zhejiang 314000, PR China.
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2
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Rahi MS, Mudgal M, Asokar BK, Yella PR, Gunasekaran K. Management of Refractory Chronic Obstructive Pulmonary Disease: A Review. Life (Basel) 2024; 14:542. [PMID: 38792564 PMCID: PMC11122447 DOI: 10.3390/life14050542] [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: 03/11/2024] [Revised: 04/07/2024] [Accepted: 04/20/2024] [Indexed: 05/26/2024] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a common condition with an estimated prevalence of 12% in adults over the age of 30 years worldwide. COPD is a leading cause of morbidity and mortality globally, with a substantial economic and social burden. There are an estimated 3 million deaths annually due to COPD. However, most of the patients with COPD respond to routine interventions like bronchodilator therapy, assessing supplemental oxygen needs, smoking cessation, vaccinations, and pulmonary rehabilitation. There is a significant number of patients who unfortunately progress to have persistent symptoms despite these interventions. Refractory COPD is not yet formally defined. Patients with severe persistent symptoms or exacerbations despite appropriate care can be considered to have refractory COPD. Managing refractory COPD needs a multidimensional approach. In this review article, we will discuss essential interventions like ensuring adequate inhaler techniques, exploring the need for non-invasive ventilatory support, use of chronic antibiotics and phosphodiesterase inhibitors to advanced therapies like bronchoscopic lung volume reduction surgery, and the upcoming role of anti-IL5 agents in managing patients with refractory COPD. We will also discuss non-pharmacologic interventions like psycho-social support and nutritional support. We will conclude by discussing the palliative care aspect of managing patients with refractory COPD. Through this review article, we aim to better the approach to managing patients with refractory COPD and discuss new upcoming therapies.
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Affiliation(s)
- Mandeep Singh Rahi
- Division of Pulmonary Diseases and Critical Care Medicine, Yale-New Haven Health Lawrence and Memorial Hospital, New London, CT 06320, USA
| | - Mayuri Mudgal
- Department of Internal Medicine, Camden Clark Medical Center, Parkersburg, WV 26101, USA;
| | - Bharat Kumar Asokar
- Division of Medical Sciences, The Tamilnadu Dr. MGR University, Chennai 600032, Tamilnadu, India;
| | | | - Kulothungan Gunasekaran
- Division of Pulmonary Diseases and Critical Care Medicine, Yuma Regional Medical Center, Yuma, AZ 85364, USA;
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3
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Weinreich UM, Storgaard LH. A Real-Life Study of Combined Treatment with Long-Term Non-Invasive Ventilation and High Flow Nasal Cannula in Patients with End-Stage Chronic Obstructive Lung Disease. J Clin Med 2023; 12:4485. [PMID: 37445520 DOI: 10.3390/jcm12134485] [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: 05/17/2023] [Revised: 06/26/2023] [Accepted: 07/01/2023] [Indexed: 07/15/2023] Open
Abstract
Patients with end-stage chronic obstructive pulmonary disease (COPD) often develop persistent hypoxic or hypercapnic respiratory failure, or a combination of both. Ventilatory support, in terms of a long-term high-flow nasal cannula (LT-HFNC) and long-term non-invasive ventilation (LT-NIV), may be indicated. Often, clinicians choose either one or the other. This paper explores combined treatment with LT-HFNC and LT-NIV in a real-life setting. In total, 33 patients with COPD and persistent respiratory failure were included in this study. Of those, 17 were initiated on LT-HFNC and used it for 595 (374) days and 16 were initiated on LT-NIV and used it for 558 (479) days. On average, patients used respiratory support continuously for 908 (586) days. Baseline characteristics were comparable, apart from PaCO2 at first ventilatory support initiation (LT-HFNC/LT-NIV 7.1 (1.1) kPa/8.8 (0.9) kPa respectively (p = 0.002)). Both groups experienced a reduction in hospitalizations in the first twelve months after treatment initiation, compared to the twelve months before (LT-HFNC p = 0.022 and LT-NIV p = 0.014). In total, 25% of LT-NIV patients stopped treatment after HFNC initiation due to intolerance and 59% stopped LT-HFNC treatment 126 (36) days after LT-NIV initiation as monotherapy was sufficient. In 44% of these patients, LT-HFNC was re-initiated at the end of life. At the time of analysis, 70% of patients had died. In the last three months of life, patients stopped using LT-NIV, whereas 91% used LT-HFNC. In conclusion, the combined use of LT-NIV and LT-HFNC reduced hospitalizations in patients with COPD and persistent respiratory failure. The study indicates that LT-HFNC is well tolerated, and better tolerated than LT-NIV at the very end stages of COPD.
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Affiliation(s)
- Ulla Møller Weinreich
- Department of Respiratory Diseases, Aalborg University Hospital, DK-9100 Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, DK-9100 Aalborg, Denmark
| | - Line Hust Storgaard
- Department of Respiratory Diseases, Aalborg University Hospital, DK-9100 Aalborg, Denmark
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Yen FS, Chang SH, Wei JCC, Shih YH, Hwu CM. Respiratory Outcomes of Insulin Use in Patients with COPD: A Nationwide Population-Based Cohort Study. Pharmaceuticals (Basel) 2023; 16:ph16050643. [PMID: 37242426 DOI: 10.3390/ph16050643] [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: 03/20/2023] [Revised: 04/14/2023] [Accepted: 04/17/2023] [Indexed: 05/28/2023] Open
Abstract
Acute exacerbations of chronic obstructive pulmonary disease (COPD) with severe hyperglycemia may require insulin to lower glucose levels in people with coexisting type 2 diabetes (T2D) and COPD. We conducted this study to examine the risk of hospitalization for COPD, pneumonia, ventilator use, lung cancer, hypoglycemia, and mortality with and without insulin use in people with T2D and COPD. We adopted propensity-score-matching to identify 2370 paired insulin users and non-users from Taiwan's National Health Insurance Research Database between 1 January 2000 and 31 December 2018. Cox proportional hazards models and the Kaplan-Meier method were utilized to compare the risk of outcomes between study and control groups. The mean follow-up for insulin users and non-users was 6.65 and 6.37 years. Compared with no insulin use, insulin use was associated with a significantly increased risk of hospitalization for COPD (aHR 1.7), bacterial pneumonia (aHR 2.42), non-invasive positive pressure ventilation (aHR 5.05), invasive mechanical ventilation (aHR 2.72), and severe hypoglycemia (aHR 4.71), but with no significant difference in the risk of death. This nationwide cohort study showed that patients with T2D and COPD requiring insulin therapy may have an increased risk of acute COPD exacerbations, pneumonia, ventilator use, and severe hypoglycemia without a significant increase in the risk of death.
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Affiliation(s)
- Fu-Shun Yen
- Dr. Yen's Clinic, No. 15, Shanying Road, Gueishan District, Taoyuan 33354, Taiwan
| | - Shu-Hao Chang
- Division of Pulmonary Medicine, Department of Internal Medicine, Cheng Ching Hospital, No. 139, Pingdeng Street, Central District, Taichung 40045, Taiwan
| | - James Cheng-Chung Wei
- Department of Allergy, Immunology & Rheumatology, Chung Shan Medical University Hospital, No. 110, Section 1, Jianguo N. Road, South District, Taichung 40201, Taiwan
- Institute of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
- Graduate Institute of Integrated Medicine, China Medical University, Taichung 40402, Taiwan
| | - Ying-Hsiu Shih
- Management Office for Health Data, China Medical University Hospital, Taichung 40201, Taiwan
- College of Medicine, China Medical University, Taichung 40402, Taiwan
| | - Chii-Min Hwu
- Faculty of Medicine, National Yang-Ming Chiao Tung University School of Medicine, No. 155, Section 2, Linong Street, Taipei 11221, Taiwan
- Section of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, No. 201, Section 2, Shipai Road, Beitou District, Taipei 11217, Taiwan
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5
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Rahi MS, Thilagar B, Balaji S, Prabhakaran SY, Mudgal M, Rajoo S, Yella PR, Satija P, Zagorulko A, Gunasekaran K. The Impact of Anxiety and Depression in Chronic Obstructive Pulmonary Disease. Adv Respir Med 2023; 91:123-134. [PMID: 36960961 PMCID: PMC10037643 DOI: 10.3390/arm91020011] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 02/28/2023] [Accepted: 03/06/2023] [Indexed: 03/18/2023]
Abstract
Patients with COPD (chronic obstructive pulmonary disease) are at a higher risk of comorbid conditions such as anxiety and/or depression, which in turn increase their symptom burden and rehospitalizations compared to the general population. It is important to investigate the pathophysiology and clinical implications of mental health on patients with COPD. This review article finds that COPD patients with anxiety and/or depression have a higher rehospitalization incidence. It reviews the current screening and diagnosis methods available. There are pharmacological and non-pharmacologic interventions available for treatment of COPD patients with depression based on severity. COPD patients with mild depression benefit from pulmonary rehabilitation and cognitive behavioral therapy, whereas patients with severe or persistent depression can be treated with pharmacologic interventions.
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Affiliation(s)
- Mandeep Singh Rahi
- Department of Pulmonary and Critical Care Medicine, Yale New Haven Health, Lawrence + Memorial Hospital, New London, CT 06320, USA
| | - Bright Thilagar
- Department of Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Swetha Balaji
- Division of Endocrinology and Metabolism, Department of Medicine, University of Illinois, Chicago, IL 60607, USA
| | | | - Mayuri Mudgal
- Department of Medicine, Camden Clark Medical Center, School of Medicine, West Virginia University, Parkersburg, WV 26101, USA
| | - Suganiya Rajoo
- Department of Hematology and Oncology, WakeMed, Raleigh Campus, Raleigh, NC 27610, USA
| | - Prashanth Reddy Yella
- Department of Internal Medicine, Yuma Regional Medical Center, 2400 S Avenue A, Yuma, AZ 85364, USA
| | - Palak Satija
- Department of Internal Medicine, Yuma Regional Medical Center, 2400 S Avenue A, Yuma, AZ 85364, USA
| | - Alsu Zagorulko
- Department of Psychiatry, Illinois Center for Neurological and Behavioral Medicine, Des Plaines, IL 60016, USA
| | - Kulothungan Gunasekaran
- Department of Pulmonary Diseases and Critical Care, Yuma Regional Medical Center, Yuma, AZ 85364, USA
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6
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Elango K, Mudgal M, Murthi S, Yella PR, Nagrecha S, Srinivasan V, Sekar V, Koshy M, Ramalingam S, Gunasekaran K. Trends in the Epidemiology and Outcomes of Pneumocystis Pneumonia among Human Immunodeficiency Virus (HIV) Hospitalizations. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052768. [PMID: 35270461 PMCID: PMC8910294 DOI: 10.3390/ijerph19052768] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 02/16/2022] [Accepted: 02/24/2022] [Indexed: 12/26/2022]
Abstract
Introduction: Pneumocystis Pneumonia (PCP) is a common opportunistic infection among people living with the human immunodeficiency virus (HIV). This study’s objective was to assess temporal trends in PCP epidemiology among hospitalized patients with HIV/AIDS in the US and to compare data for hospitalizations with HIV with PCP to those without PCP. Methods: The national inpatient sample (NIS) data were analyzed from 2002−2014. The discharge coding identified hospitalized patients with HIV or AIDS and with or without PCP. Results: We identified 3,011,725 hospitalizations with HIV/AIDS during the study period; PCP was present in 5% of the patients with a diagnosis of HIV. The rates of PCP progressively declined from 6.7% in 2002 to 3.5 % in 2014 (p < 0.001). Overall mortality in patients with HIV was 3.3% and was significantly higher in those with PCP than without PCP (9.9% vs. 2.9%; p < 0.001). After adjusting for demographics and other comorbidities, PCP had higher odds of hospital mortality 3.082 (OR 3.082; 95% CI, 3.007 to 3.159; p < 0.001). Conclusion: From 2002 to 2014, the rate of PCP in HIV patients has decreased significantly in the United States but is associated with substantially higher mortality.
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Affiliation(s)
- Kalaimani Elango
- Division of Cardiology, University of Nevada, 4505 S Maryland Pkwy, Las Vegas, NV 89154, USA;
| | - Mayuri Mudgal
- Department of Geriatric Medicine, Montefiore Medical Center, Wakefield Campus, 600 E 233rd Street Bronx, New York, NY 10466, USA;
| | - Swetha Murthi
- Department of Endocrinology, Yuma Regional Medical Center, 2400 S Avenue A, Yuma, AZ 85364, USA;
| | - Prashanth Reddy Yella
- Department of Internal Medicine, Yuma Regional Medical Center, 2400 S Avenue A, Yuma, AZ 85364, USA;
| | - Savan Nagrecha
- Department of Pharmacy, Yuma Regional Medical Center, 2400 S Avenue A, Yuma, AZ 85364, USA;
| | - Vedhapriya Srinivasan
- Department of Internal Medicine, Suny Downstate Medical Center, New York, NY 11203, USA;
| | - Vijaykumar Sekar
- Department of Endocrinology, Lehigh Valley Health Center, 1243 S Cedar Crest Blvd, Allentown, PA 18103, USA;
| | - Maria Koshy
- Department of Internal Medicine, Bridgeport Hospital, 267 Grant Street, Bridgeport, CT 06610, USA;
| | - Sathishkumar Ramalingam
- Department of Internal Medicine, Lovelace Medical Center, 601 Dr. Martin Luther King Jr. Avenue NE, Albuquerque, NM 87102, USA;
| | - Kulothungan Gunasekaran
- Department of Pulmonary Diseases and Critical Care, Yuma Regional Medical Center, 2400 S Avenue A, Yuma, AZ 85364, USA
- Correspondence: ; Tel.: +1-928-336-2434
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7
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Chen YY, Li TC, Li CI, Lin SP, Fu PK. Statins Associated with Better Long-Term Outcomes in Aged Hospitalized Patients with COPD: A Real-World Experience from Pay-for-Performance Program. J Pers Med 2022; 12:jpm12020299. [PMID: 35207787 PMCID: PMC8877141 DOI: 10.3390/jpm12020299] [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: 01/11/2022] [Revised: 02/12/2022] [Accepted: 02/15/2022] [Indexed: 11/16/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is the third leading cause of death globally. Previous studies have addressed the impact of comorbidity on short-term mortality in patients with COPD. However, the prevalence of cardiovascular disease (CVD) and the association of statins prescription with mortality for aged COPD patients remains unclear. We enrolled 296 aged, hospitalized patients who were monitored in the pay-for-performance (P-4-P) program of COPD. Factors associated with long-term mortality were identified by Cox regression analysis. The median age of the study cohort was 80 years old, and the prevalence of coronary artery disease (CAD) and statins prescriptions were 16.6% and 31.4%, respectively. The mortality rate of the median 3-year follow-up was 51.4%. Through multivariate analysis, body mass index (BMI), statin prescription, and events of respiratory failure were associated with long-term mortality. A Cox analysis showed that statins prescription was associated with lower mortality (hazard ratio (HR): 0.5, 95% Confident interval, 95% CI: 0.34–0.73, p = 0.0004) and subgroup analysis showed that rosuvastatin prescription had protective effect on long-term mortality (HR: 0.44; 95% CI: 0.20–0.97; p < 0.05). Statin prescriptions might be associated with better long-term survival in aged COPD patients, especially those who experienced an acute exacerbation of COPD (AECOPD) who require hospitalization.
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Affiliation(s)
- Ying-Yi Chen
- Department of Public Health, China Medical University, Taichung 406040, Taiwan; (Y.-Y.C.); (T.-C.L.)
| | - Tsai-Chung Li
- Department of Public Health, China Medical University, Taichung 406040, Taiwan; (Y.-Y.C.); (T.-C.L.)
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung 413305, Taiwan
| | - Chia-Ing Li
- Department of Medical Research, China Medical University Hospital, Taichung 404332, Taiwan;
| | - Shih-Pin Lin
- Department of Information Engineering and Computer Science, Feng Chia University, Taichung 407802, Taiwan;
- Department of Critical Care Medicine, Taichung Veterans General Hospital, Taichung 407219, Taiwan
| | - Pin-Kuei Fu
- Department of Critical Care Medicine, Taichung Veterans General Hospital, Taichung 407219, Taiwan
- Ph.D. Program in Translational Medicine, National Chung Hsing University, Taichung 402010, Taiwan
- College of Human Science and Social Innovation, Hungkuang University, Taichung 433304, Taiwan
- Correspondence: ; Tel.: +886-937-701-592
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8
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Liu M, Li Z, Lu F, Guo M, Tao L, Liu M, Liu Y, Deginet A, Hu Y, Li Y, Wu M, Luo Y, Wang X, Yang X, Gao B, Guo X, Liu X. Acute effect of particulate matter pollution on hospital admissions for cause-specific respiratory diseases among patients with and without type 2 diabetes in Beijing, China, from 2014 to 2020. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2021; 226:112794. [PMID: 34592518 DOI: 10.1016/j.ecoenv.2021.112794] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 09/12/2021] [Accepted: 09/14/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Scientific studies have identified various adverse effects of particulate matter (PM) on respiratory disease (RD) and type 2 diabetes (T2D). However, whether short-term exposure to PM triggers the onset of RD with T2D, compared with RD without T2D, has not been elucidated. METHODS A two-stage time-series study was conducted to evaluate the acute adverse effects of PM on admission for RD and for RD with and without T2D in Beijing, China, from 2014 to 2020. District-specific effects of PM2.5 and PM10 were estimated using the over-dispersed Poisson generalized addictive model after adjusting for weather conditions, day of the week, and long-term and seasonal trends. Meta-analyses were applied to pool the overall effects on overall and cause-specific RD, while the exposure-response (E-R) curves were evaluated using a cubic regression spline. RESULTS A total of 1550,154 admission records for RD were retrieved during the study period. Meta-analysis suggested that per interquartile range upticks in the concentration of PM2.5 corresponded to 1.91% (95% CI: 1.33-2.49%), 2.16% (95% CI: 1.08-3.25%), and 1.92% (95% CI: 1.46-2.39%) increments in admission for RD, RD with T2D, and RD without T2D, respectively, at lag 0-8 days, lag 8 days, and lag 8 days. The effect size of PM2.5 was statistically significantly higher in the T2D group than in the group without T2D (z = 3.98, P < 0.01). The effect sizes of PM10 were 3.86% (95% CI: 2.48-5.27%), 3.73% (95% CI: 1.72-5.79%), and 3.92% (95% CI: 2.65-5.21%), respectively, at lag 0-13 days, lag 13 days, and lag 13 days, respectively, and no statistically significant difference was observed between T2D groups (z = 0.24, P = 0.81). Significant difference was not observed between T2D groups for the associations of PM and different RD and could be found between three groups for effects of PM10 on RD without T2D. The E-R curves varied by sex, age and T2D condition subgroups for the associations between PM and daily RD admissions. CONCLUSIONS Short-term PM exposure was associated with increased RD admission with and without T2D, and the effect size of PM2.5 was higher in patients with T2D than those without T2D.
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Affiliation(s)
- Mengmeng Liu
- School of Public Health, Capital Medical University, Beijing 100069, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing 100069, China; National Institute for Data Science in Health and Medicine, Capital Medical University, China
| | - Zhiwei Li
- School of Public Health, Capital Medical University, Beijing 100069, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing 100069, China
| | - Feng Lu
- Beijing Municipal Health Commission Information Centre, Beijing 100034, China
| | - Moning Guo
- Beijing Municipal Health Commission Information Centre, Beijing 100034, China
| | - Lixin Tao
- School of Public Health, Capital Medical University, Beijing 100069, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing 100069, China
| | - Mengyang Liu
- School of Public Health, Capital Medical University, Beijing 100069, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing 100069, China
| | - Yue Liu
- School of Public Health, Capital Medical University, Beijing 100069, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing 100069, China
| | - Aklilu Deginet
- School of Public Health, Capital Medical University, Beijing 100069, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing 100069, China
| | - Yaoyu Hu
- School of Public Health, Capital Medical University, Beijing 100069, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing 100069, China
| | - Yutong Li
- School of Public Health, Capital Medical University, Beijing 100069, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing 100069, China
| | - Mengqiu Wu
- School of Public Health, Capital Medical University, Beijing 100069, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing 100069, China
| | - Yanxia Luo
- School of Public Health, Capital Medical University, Beijing 100069, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing 100069, China
| | - Xiaonan Wang
- School of Public Health, Capital Medical University, Beijing 100069, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing 100069, China
| | - Xinghua Yang
- School of Public Health, Capital Medical University, Beijing 100069, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing 100069, China
| | - Bo Gao
- School of Public Health, Capital Medical University, Beijing 100069, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing 100069, China
| | - Xiuhua Guo
- School of Public Health, Capital Medical University, Beijing 100069, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing 100069, China; National Institute for Data Science in Health and Medicine, Capital Medical University, China; Centre for Precision Health, School of Medical and Health Sciences, Edith Cowan University, Australia.
| | - Xiangtong Liu
- School of Public Health, Capital Medical University, Beijing 100069, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing 100069, China.
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9
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Al-Moamary MS, Köktūrk N, Idrees MM, Şen E, Juvelekian G, Saleh WA, Zoumot Z, Behbehani N, Hatem A, Masoud HH, Snouber A, van Zyl-Smit RN. Unmet need in the management of chronic obstructive pulmonary disease in the Middle East and Africa region: An expert panel consensus. Respir Med 2021; 189:106641. [PMID: 34649155 DOI: 10.1016/j.rmed.2021.106641] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 09/20/2021] [Accepted: 09/30/2021] [Indexed: 10/20/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) has a significant impact on healthcare systems and health-related quality of life. Increased prevalence of smoking is an important factor contributing to high burden of COPD in the Middle East and Africa (MEA). Several other factors including sedentary lifestyle, urbanization, second-hand smoke, air pollution, and occupational exposure are also responsible for the upsurge of COPD in the MEA. Frequent COPD exacerbations accelerate disease progression, progressively deteriorate the lung function, and negatively affect quality of life. This consensus is based on review of the published evidence, international and regional guidelines, and insights provided by the expert committee members from the MEA region. Spirometry, though the gold standard for diagnosis, is often unavailable and/or underutilized leading to underdiagnosis of COPD in primary care settings. Low adherence to the treatment guidelines and delayed use of appropriate combination therapy including triple therapy are additional barriers in management of COPD in MEA. It is necessary to recognize COPD as a screenable condition and develop easy and simple screening tools to facilitate early diagnosis. Knowledge of the disease symptomatology at patient and physician level and adherence to the international or regional guidelines are important to create awareness about harmful effects of smoking and develop national guidelines to focus on prevention on COPD. Implementation of vaccination program and pulmonary rehabilitation are equally valuable to manage patients with COPD at local and regional level. We present recommendations made by the expert panel for improved screening, diagnosis, and management of COPD in MEA.
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Affiliation(s)
- Mohamed S Al-Moamary
- Department of Medicine, College of Medicine, King Saudi Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
| | - Nurdan Köktūrk
- Department of Pulmonary Medicine, Gazi University School of Medicine, Ankara, Turkey
| | - Majdy M Idrees
- Department of Medicine, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Elif Şen
- Department of Pulmonary Medicine, Ankara University School of Medicine, Ankara, Turkey
| | - George Juvelekian
- Department of Pulmonary and Critical Care Medicine, Saint George Hospital University Medical Centre, Beirut, Lebanon
| | | | - Zaid Zoumot
- Department of Pulmonology, Respiratory Institute, Cleveland Clinic Abu Dhabi, United Arab Emirates
| | - Naser Behbehani
- Department of Medicine, Kuwait University, Kuwait City, Kuwait
| | - Ashraf Hatem
- Department of Chest Diseases, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Hosam H Masoud
- Department of Chest Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
| | | | - Richard N van Zyl-Smit
- Division of Pulmonology and UCT Lung Institute, Department of Medicine, University of Cape Town & Groote Schuur Hospital, Cape Town, South Africa
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