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Sun Y, Zhang Y, Bai W, Liu X. Relationship between depression severity and respiratory symptoms in US adults: A national cross-sectional study. Respir Med 2023; 220:107451. [PMID: 37926180 DOI: 10.1016/j.rmed.2023.107451] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 10/19/2023] [Accepted: 10/28/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVE The relationship between depression severity and cough, wheeze and exertional dyspnoea is unclear. The aim of this study was to explore this relationship. METHODS We used weighted logistic regression analysis and fitted curves to explore the relationship between depression severity and respiratory symptoms. In addition, we examined the relationship between depression and COPD and asthma. Stratified analyses were used to analyse specific populations. RESULTS We weighted 10,142 subjects to reflect the entire US population. Using the population without depression as a reference, the risk of cough and asthma in the severely depressed population was 3.32 times (OR 3.324, 95% CI 1.567-7.050) and 2.84 times (OR 2.842, 95% CI 1.521-5.311) higher than that in the population without depressive symptoms, and the risk of asthma and COPD was 2.4 times and 2.6 times (OR 2.410, 95% CI 1.371-4.236; OR 2.566, 95% CI 1.236-4.921). In subgroup analyses, the correlation between depression scores and prevalence of cough and wheeze was corrected for gender level. In addition, smoking status and marital status were interaction factors between depression score and prevalence of cough. The prevalence of exertional dyspnoea by depression score was influenced by CVD. CONCLUSIONS Depression severity was associated with respiratory symptoms, asthma, and COPD. Gender corrected the correlation between depression and cough and asthma, and depressive state was an independent risk factor for asthma and COPD. This finding provides new ideas for the management of respiratory symptoms and diseases.
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Affiliation(s)
- Yuefeng Sun
- The First Clinical College, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Yueyang Zhang
- The First Clinical College, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Wenzhe Bai
- The First Clinical College, Shandong University of Traditional Chinese Medicine, Jinan, China.
| | - Xue Liu
- Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China.
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2
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Hirons B, Rhatigan K, Kesavan H, Turner RD, Birring SS, Cho PSP. Cough in chronic lung disease: a state of the art review. J Thorac Dis 2023; 15:5823-5843. [PMID: 37969279 PMCID: PMC10636467 DOI: 10.21037/jtd-22-1776] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 09/01/2023] [Indexed: 11/17/2023]
Abstract
Chronic cough (CC; ≥8 weeks in duration) is a common and burdensome feature of respiratory diseases. The understanding of cough has progressed significantly in recent years, albeit largely in refractory (unexplained) chronic cough (RCC) in the absence of other respiratory conditions. The prevalence of CC in respiratory diseases is poorly described, but estimates have been reported: asthma (8-58%), chronic obstructive pulmonary disease (COPD; 10-74%), bronchiectasis (82-98%), interstitial lung disease (ILD; 50-89%) and sarcoidosis (3-64%). CC in respiratory conditions generally predicts impaired health status and more severe disease. It is associated with increased symptom burden and disease severity in asthma, COPD, bronchiectasis and ILD, higher exacerbation frequency in asthma and bronchiectasis, and increased mortality and lung transplantation in idiopathic pulmonary fibrosis (IPF). Physiologically, heightened cough reflex sensitivity (CRS) has been reported and postulated to be mechanistic in isolated RCC. Cough reflex hypersensitivity (CRH) has also been reported in asthma, COPD, bronchiectasis, ILD and sarcoidosis. Unlike recent advances in isolated RCC, there are limited studies and understanding of central cough neuropathways in other respiratory conditions. Of note, dysfunctional central voluntary cough suppression neuropathways and physiology were observed in isolation in RCC; cough suppression is preserved in COPD. Understanding in the mechanism of RCC cannot be simply extrapolated to other respiratory conditions. The restricted understanding of cough mechanisms in these conditions has limited cough-specific therapeutic options in this context. There is currently an unmet need to expand our understanding of cough in chronic respiratory conditions, both in order to improve the quality of life of patients, and to improve knowledge of cough in general. This review aims to describe the prevalence, impact, pathophysiology and management of CC in asthma, COPD, bronchiectasis, ILD and sarcoidosis.
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Affiliation(s)
- Barnaby Hirons
- Department of Respiratory Medicine, King’s College Hospital, London, UK
- Centre for Human and Applied Physiological Sciences, School of Basic and Medical Biosciences, Faculty of Life Sciences and Medicine, King’s College London, London, UK
| | - Katherine Rhatigan
- Department of Respiratory Medicine, King’s College Hospital, London, UK
- Centre for Human and Applied Physiological Sciences, School of Basic and Medical Biosciences, Faculty of Life Sciences and Medicine, King’s College London, London, UK
| | - Harini Kesavan
- Department of Respiratory Medicine, King’s College Hospital, London, UK
| | - Richard D. Turner
- Department of Respiratory Medicine, Gold Coast University Hospital, Queensland, Australia
- School of Medicine and Dentistry, Griffith University, Queensland, Australia
| | - Surinder S. Birring
- Department of Respiratory Medicine, King’s College Hospital, London, UK
- Centre for Human and Applied Physiological Sciences, School of Basic and Medical Biosciences, Faculty of Life Sciences and Medicine, King’s College London, London, UK
| | - Peter S. P. Cho
- Department of Respiratory Medicine, King’s College Hospital, London, UK
- Centre for Human and Applied Physiological Sciences, School of Basic and Medical Biosciences, Faculty of Life Sciences and Medicine, King’s College London, London, UK
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3
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Kosse NJ, Windisch W, Koryllos A, Lopez-Pastorini A, Piras D, Schroiff HW, Straßmann SE, Stoelben E, Schwarz SB. Development of the Diaphragmatic Paralysis Questionnaire: a simple tool for patient relevant outcome. Interact Cardiovasc Thorac Surg 2021; 32:244-249. [PMID: 33221909 DOI: 10.1093/icvts/ivaa258] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 09/02/2020] [Accepted: 10/04/2020] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVES Measurement tools of health-related quality of life (HRQL) that are specific for the underlying disorder are inevitably needed to assess HRQL changes following specific treatment strategies. The aim of the current study was to develop a questionnaire assessing HRQL in patients with unilateral diaphragmatic paresis. METHODS Firstly, topics of health impairments covering physical, psychological, social and functional aspects were predefined by a physician expert panel to ensure face validity. Secondly, all predefined topics were rated by a patient group with unilateral diaphragmatic paresis (untreated: n = 11; postoperative: n = 9) using a 5-point Likert scale ranging from 'not relevant at all' (-2) to 'absolutely relevant' (+2) to guarantee content validity. Thirdly, only relevant topics (0 to +2) were used for item development, while non-relevant items (<0) were not subject for item development. RESULTS In total, 20 patients rated a total of 43 topics covering a broad spectrum of health impairment. 21 were considered as relevant for item development. Items are answered on a 5-point Likert scale ranging from 'completely untrue' (-2) to 'always true' (+2). The Diaphragmatic Paralysis Questionnaire (DPQ) Summary Score ranges from 0 (worst HRQL) to 100 (best HRQL). Finally, the German DPQ was professionally translated and transculturally adapted into English, Italian, Dutch, French, Greek and Spanish, using translation/back-translation procedures. CONCLUSIONS The DPQ is the first diseases-specific HRQL measure developed for patients with diaphragmatic paresis. In addition, the DPQ is available in 7 languages free of charge for non-profit purposes. CLINICAL TRIAL REGISTRATION German clinical trials register: DRKS00017056.
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Affiliation(s)
- Nils Jurriaan Kosse
- Cologne Merheim Hospital, Department of Thoracic Surgery, Kliniken der Stadt Köln gGmbH, Witten/Herdecke University, Cologne, Germany
| | - Wolfram Windisch
- Cologne Merheim Hospital, Department of Pneumology, Kliniken der Stadt Köln gGmbH, Witten/Herdecke University, Cologne, Germany
| | - Aris Koryllos
- Cologne Merheim Hospital, Department of Thoracic Surgery, Kliniken der Stadt Köln gGmbH, Witten/Herdecke University, Cologne, Germany
| | - Alberto Lopez-Pastorini
- Cologne Merheim Hospital, Department of Thoracic Surgery, Kliniken der Stadt Köln gGmbH, Witten/Herdecke University, Cologne, Germany
| | - Denis Piras
- Sankt Marienhospital Birkesdorf, Department of Surgery, Düren, Germany
| | - Hans-Willi Schroiff
- RWTH Business School, Marketing Department, Rheinische-Westfälische Technische Hochschule, Aachen, Germany
| | - Stephan Eric Straßmann
- Cologne Merheim Hospital, Department of Pneumology, Kliniken der Stadt Köln gGmbH, Witten/Herdecke University, Cologne, Germany
| | - Erich Stoelben
- Cologne Merheim Hospital, Department of Thoracic Surgery, Kliniken der Stadt Köln gGmbH, Witten/Herdecke University, Cologne, Germany
| | - Sarah Bettina Schwarz
- Cologne Merheim Hospital, Department of Pneumology, Kliniken der Stadt Köln gGmbH, Witten/Herdecke University, Cologne, Germany
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Avdeev SN, Vizel AA, Abrosimov VN, Zaicev AA, Ignatova GL, Khamitov RF, Mikhaylusova MP, Shapovalova JS, Pavlysh EF, Trofimov BI, Emelyanov AV, Martynenko TI, Martynenko VA, Kostina NE, Chizhov DA, Chizhova OY, Kuzubova NA, Makova EV, Makarova EV. Management of Cough in Patients with Chronic Obstructive Pulmonary Disease: Results of the Multicenter Randomized Placebo-Controlled Clinical Trial. Int J Chron Obstruct Pulmon Dis 2021; 16:1243-1253. [PMID: 33981141 PMCID: PMC8107011 DOI: 10.2147/copd.s292109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 03/14/2021] [Indexed: 12/20/2022] Open
Abstract
Background Chronic cough declines quality of life and increases risk of complications in patients with chronic obstructive pulmonary disease (COPD). Reducing cough severity and associated negative effects is important therapeutic goal in COPD. Rengalin with anti- and protussive activity is based on technologically processed antibodies to bradykinin, histamine and morphine. Aim To evaluate efficacy and safety of Rengalin in treatment of cough in patients with COPD. Methods Patients (n=238, mean age 64.3±8.2 years) with stable COPD and persistent cough despite maintenance therapy (anticholinergics, beta-2-adrenergic agonists, inhaled corticosteroids) were included and randomized in the study. The severity of cough assessment (according to the “Cough Severity Score”), COPD impact on patient’s life (COPD Assessment Test, CAT), and spirometry were performed at screening. Patients took Rengalin or Placebo 2 tablets 2 times daily for 4 weeks. The endpoints were proportion of patients who responded to treatment, dynamics of cough severity, and severity of COPD symptoms. Intention-to-treat (per protocol) analysis was performed. Results Positive response to Rengalin was recorded in 83.6 [85.7]% (vs 72.6 [72.7]% in Placebo group, p=0.0422 [p=0.0163]). Double decrease of cough severity was reported in 42.2 [43.8]% in Rengalin group (versus 32.7 [32.7]% in Placebo; p=0.1373 [p=0.0907]). The total CAT score decreased by 3.3±4.2 [3.6±3.9] points (versus 2.5±4.1 [2.5±4.2] in Placebo group); the difference between groups was 0.79±4.16 [1.04±4.02] points (p=0.0870 [p=0.0416]). The number of patients with adverse events (AEs) in Rengalin (n=13) and Placebo (n=12) groups did not have significant differences (p=1.00). No AEs with certain relationship with study drug were registered. Conclusion Rengalin is an effective and safe drug in patients with stable COPD and persistent cough, despite stable doses of maintenance therapy according to the GOLD guidelines. Four-week therapy decreases severity of cough by two times in more than 40% of patients. Trial Registration ClinicalTrials.gov (id: NCT03159091).
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Affiliation(s)
- Sergey N Avdeev
- I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | | | - Vladimir N Abrosimov
- Ryazan State Medical University Named After Academician I.P. Pavlov, Ryazan, Russia
| | - Andrey A Zaicev
- The Main Military Clinical Hospital Named After Academician N.N. Burdenko, Moscow, Russia
| | | | | | | | | | - Elena F Pavlysh
- Nikiforov's All-Russian Center for Emergency and Radiation Medicine of the Emergencies, St. Petersburg, Russia
| | - Basil I Trofimov
- I.P. Pavlov First Saint Petersburg State Medical University, St. Petersburg, Russia
| | - Alexander V Emelyanov
- North-Western State Medical University Named After I.I. Mechnikov, St. Petersburg, Russia
| | | | | | | | - Danila A Chizhov
- St. Petersburg State City Polyclinic No. 106, St. Petersburg, Russia
| | - Olga Yu Chizhova
- North-Western State Medical University Named After I.I. Mechnikov, St. Petersburg, Russia
| | - Natalia A Kuzubova
- St. Petersburg State Vvedenskaya City Clinical Hospital, St. Petersburg, Russia
| | | | - Ekaterina V Makarova
- Privolzhsky Research Medical University, Nizhny Novgorod, Russia.,State City Clinical Hospital No. 10, Nizhny Novgorod, Russia
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5
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Buttery SC, Zysman M, Vikjord SAA, Hopkinson NS, Jenkins C, Vanfleteren LEGW. Contemporary perspectives in COPD: Patient burden, the role of gender and trajectories of multimorbidity. Respirology 2021; 26:419-441. [PMID: 33751727 DOI: 10.1111/resp.14032] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 02/21/2021] [Indexed: 12/13/2022]
Abstract
An individual's experience of COPD is determined by many factors in addition to the pathological features of chronic bronchitis and emphysema and the symptoms that derive directly from them. Multimorbidity is the norm rather than the exception, so most people with COPD are living with a range of other medical problems which can decrease overall quality of life. COPD is caused by the inhalation of noxious particles or gases, in particular tobacco smoke, but also by early life disadvantage impairing lung development and by occupations where inhaled exposures are common (e.g. industrial, farming and cleaning work). Wealthy people are therefore relatively protected from developing COPD and people who do develop the condition may have reduced resources to cope. COPD is also no longer a condition that predominantly affects men. The prevalence of COPD among women has equalled that of men since 2008 in many high-income countries, due to increased exposure to tobacco, and in low-income countries due to biomass fuels. COPD is one of the leading causes of death in women in the USA, and death rates attributed to COPD in women in some countries are predicted to overtake those of men in the next decade. Many factors contribute to this phenomenon, but in addition to socioeconomic and occupational factors, there is increasing evidence of a higher susceptibility of females to smoking and pollutants. Quality of life is also more significantly impaired in women. Although most medications (bronchodilators and inhaled corticosteroids) used to treat COPD demonstrate similar trends for exacerbation prevention and lung function improvement in men and women, this is an understudied area and clinical trials frequently have a preponderance of males. A better understanding of gender-based predictors of efficacy of all therapeutic interventions is crucial for comprehensive patient care. There is an urgent need to recognize the increasing burden of COPD in women and to facilitate global improvements in disease prevention and management in this specific population. Many individuals with COPD follow a trajectory of both lung function decline and also multimorbidity. Unfavourable lung function trajectories throughout life have implications for later development of other chronic diseases. An enhanced understanding of the temporal associations underlying the development of coexisting diseases is a crucial first step in unravelling potential common disease pathways. Lessons can be learned from exploring disease trajectories of other NCD as well as multimorbidity development. Further research will be essential to explain how early life risk factors commonly influence trajectories of COPD and other diseases, how different diseases develop in relation to each other in a temporal way and how this ultimately leads to different multimorbidity patterns in COPD. This review integrates new knowledge and ideas pertaining to three broad themes (i) the overall burden of disease in COPD, (ii) an unappreciated high burden in women and (iii) the contrast of COPD trajectories and different multimorbidity patterns with trajectories of other NCD. The underlying pathology of COPD is largely irreversible, but many factors noted in the review are potentially amenable to intervention. Health and social care systems need to ensure that effective treatment is accessible to all people with the condition. Preventive strategies and treatments that alter the course of disease are crucial, particularly for patients with COPD as one of many problems.
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Affiliation(s)
- Sara C Buttery
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Maéva Zysman
- Centre de Recherche cardio-thoracique de Bordeaux, Univ-Bordeaux, Pessac, France.,Service des Maladies Respiratoires, CHU Bordeaux, Pessac, France
| | - Sigrid A A Vikjord
- Department of Medicine and Rehabilitation, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway.,HUNT Research Centre, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Levanger, Norway
| | | | - Christine Jenkins
- Respiratory Group, The George Institute for Global Health, Sydney, NSW, Australia
| | - Lowie E G W Vanfleteren
- COPD Center, Department of Respiratory Medicine and Allergology, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Smith JA, McGarvey L, Morice AH, Birring SS, Wedzicha JA, Notari M, Zapata A, Segarra R, Seoane B, Jarreta D. The Effect of Aclidinium on Symptoms Including Cough in Chronic Obstructive Pulmonary Disease: A Phase 4, Double-Blind, Placebo-controlled, Parallel-Group Study. Am J Respir Crit Care Med 2020; 200:642-645. [PMID: 30951372 PMCID: PMC6727161 DOI: 10.1164/rccm.201901-0048le] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Jaclyn A Smith
- Manchester University NHS Foundation TrustManchester, United Kingdom.,University of ManchesterManchester, United Kingdom
| | | | | | - Surinder S Birring
- King's College LondonLondon, United Kingdom.,King's College HospitalLondon, United Kingdom
| | | | - Massimo Notari
- A. Menarini Farmaceutica Internazionale s.r.l.Florence, Italy
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7
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Rebelo P, Oliveira A, Paixão C, Valente C, Andrade L, Marques A. Minimal Clinically Important Differences for Patient-Reported Outcome Measures of Cough and Sputum in Patients with COPD. Int J Chron Obstruct Pulmon Dis 2020; 15:201-212. [PMID: 32099345 PMCID: PMC6996113 DOI: 10.2147/copd.s219480] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 10/31/2019] [Indexed: 11/23/2022] Open
Abstract
Background Cough and sputum are highly prevalent in patients with chronic obstructive pulmonary disease (COPD). Pulmonary rehabilitation (PR) has shown to be effective in managing these symptoms. However, the interpretation of the magnitude of PR effects is hindered by the lack of minimal clinically important differences (MCIDs). Purpose This study established MCIDs for the Leicester cough questionnaire (LCQ) and the cough and sputum assessment questionnaire (CASA-Q), in patients with COPD after PR. Patients and Methods An observational prospective study was conducted in patients with COPD who participated in a 12-weeks community-based PR program. Anchor- (mean change, receiver operating characteristic curves and linear regression analysis) and distribution-based methods [0.5*standard deviation; standard error of measurement (SEM); 1.96*SEM; minimal detectable change and effect size] were used to compute the MCIDs. The anchors used were: i) patients and physiotherapists global rating of change scale, ii) COPD assessment test, iii) St. George's respiratory questionnaire and iv) occurrence of an exacerbation during PR. Pooled MCIDs were computed using the arithmetic weighted mean (2/3 for anchor- and 1/3 for distribution-based methods). Results Forty-nine patients with COPD (81.6% male, 69.8±7.4years, FEV150.4±19.4%predicted) were used in the analysis. The pooled MCIDs were 1.3 for LCQ and for CASA-Q domains were: 10.6 - cough symptoms; 10.1 - cough impact; 9.5 - sputum symptoms and 7.8 - sputum impact. Conclusion The MCIDs found in this study are potential estimates to interpret PR effects on cough and sputum, and may contribute to guide interventions.
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Affiliation(s)
- Patrícia Rebelo
- Respiratory Research and Rehabilitation Laboratory (Lab3R), School of Health Sciences, University of Aveiro (ESSUA), Aveiro, Portugal
- Institute of Biomedicine, School of Health Sciences (iBiMED), University of Aveiro (ESSUA), Aveiro, Portugal
| | - Ana Oliveira
- Respiratory Research and Rehabilitation Laboratory (Lab3R), School of Health Sciences, University of Aveiro (ESSUA), Aveiro, Portugal
- Institute of Biomedicine, School of Health Sciences (iBiMED), University of Aveiro (ESSUA), Aveiro, Portugal
| | - Cátia Paixão
- Respiratory Research and Rehabilitation Laboratory (Lab3R), School of Health Sciences, University of Aveiro (ESSUA), Aveiro, Portugal
- Institute of Biomedicine, School of Health Sciences (iBiMED), University of Aveiro (ESSUA), Aveiro, Portugal
| | - Carla Valente
- Pulmonology Department, Centro Hospitalar Do Baixo Vouga (CHBV), Aveiro, Portugal
| | - Lília Andrade
- Pulmonology Department, Centro Hospitalar Do Baixo Vouga (CHBV), Aveiro, Portugal
| | - Alda Marques
- Respiratory Research and Rehabilitation Laboratory (Lab3R), School of Health Sciences, University of Aveiro (ESSUA), Aveiro, Portugal
- Institute of Biomedicine, School of Health Sciences (iBiMED), University of Aveiro (ESSUA), Aveiro, Portugal
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8
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Correlation between disease severity factors and EQ-5D utilities in chronic obstructive pulmonary disease. Qual Life Res 2019; 29:607-617. [PMID: 31673922 DOI: 10.1007/s11136-019-02340-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE Impaired health-related quality of life (HRQoL) is associated with poor health outcomes in chronic obstructive pulmonary disease (COPD). The aim of this study was to determine health utilities in patients with COPD and to identify the variables with the greatest impact. METHODS This is a pooled analysis of data from 4 observational studies performed in stable COPD patients. Evaluation of patient HRQoL utilities was performed using the Spanish version of the self-administered EuroQoL 5 Dimensions (EQ-5D) questionnaire. EQ-5D utilities were described and compared according to several markers of disease severity. RESULTS 6198 patients reported a mean (SD) EQ-5D index of 0.67 (0.26). A linear dose response relationship between EQ-5D utility and modified Medical Research Council (mMRC) score, forced expiratory volume in one 1 s (% predicted), COPD hospital admissions in the previous year, self-reported daily walking time, Charlson index, body mass index, obstruction, dyspnoea and exacerbation (BODEx) index, COPD assessment test (CAT), hospital anxiety and depression scale was observed (p for trend < 0.001). In multivariate analysis, patients reporting lower utility values were those with more dyspnoea, more comorbidities, using long-term oxygen therapy, with previous hospitalisations due to a COPD exacerbation and higher (worse) CAT score. CONCLUSION HRQoL measures such as EQ-5D can assist clinicians to understand the impact of respiratory disease on COPD patients.
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9
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Fisk M, McMillan V, Brown J, Holzhauer-Barrie J, Khan MS, Baxter N, Roberts CM. Inaccurate diagnosis of COPD: the Welsh National COPD Audit. Br J Gen Pract 2019; 69:e1-e7. [PMID: 30559109 PMCID: PMC6301368 DOI: 10.3399/bjgp18x700385] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Accepted: 08/20/2018] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND The diagnosis of chronic obstructive pulmonary disease (COPD) is confirmed with spirometry demonstrating persistent airflow obstruction. AIM To evaluate the clinical characteristics and management of patients in primary care on COPD registers with spirometry incompatible with COPD. DESIGN AND SETTING A primary care audit of Welsh COPD Read-Coded patient data from the Quality and Outcomes Framework (QOF) COPD register in Wales. METHOD Patients on the QOF COPD register with incompatible spirometry (post-bronchodilator forced expiratory lung volume in 1 second/forced vital capacity [FEV1/FVC] ratio ≥0.70) were compared with those with compatible spirometry (FEV1/FVC <0.70). RESULTS This audit included 63% of Welsh practices contributing 48 105 patients. Only 19% (n = 8957) of patients were post-bronchodilator FEV1/FVC Read-Coded and were included in this study. Of these, 75% (n = 6702) had compatible spirometry and 25% (n = 2255) did not. Patients with incompatible spirometry were more likely female (P = 0.009), never-smokers (P<0.001), had higher body mass index (P<0.001), and better mean FEV1 (P<0.001). Medical Research Council (MRC) breathlessness scores, exacerbation frequency, and asthma co-diagnosis were similar between groups. Patients in both groups were just as likely to receive inhaled corticosteroid (ICS) and long-acting beta-agonists (LABAs), but patients with incompatible spirometry were less likely to receive long-acting muscarinic antagonists (LAMAs) (P<0.001) or LABA/ICS (P = 0.002) combinations. CONCLUSION Patients on the COPD QOF register with spirometry incompatible with COPD are symptomatic and managed using significant resources. If quality of care and effective resource use are to be improved, focus must be given to correct diagnosis in this group.
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Affiliation(s)
- Marie Fisk
- Experimental Medicine and Immunotherapeutics (EMIT) Department, University of Cambridge, Cambridge
| | | | - James Brown
- Royal Free London NHS Foundation Trust and UCL Respiratory, Division of Medicine, University College London, London
| | | | | | - Noel Baxter
- National COPD Audit Programme Primary Care Workstream, Royal College of Physicians, London
| | - C Michael Roberts
- National COPD Audit Programme; associate director, Clinical Effectiveness and Evaluation Unit, Care Quality Improvement Department, Royal College of Physicians, London
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10
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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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11
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D'Urzo AD, Cazzola M, Hanania NA, Buhl R, Maleki-Yazdi MR. New developments in optimizing bronchodilator treatment of COPD: a focus on glycopyrrolate/formoterol combination formulated by co-suspension delivery technology. Int J Chron Obstruct Pulmon Dis 2018; 13:2805-2819. [PMID: 30233171 PMCID: PMC6135066 DOI: 10.2147/copd.s113306] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
COPD causes considerable health and economic burden worldwide, with incidence of the disease expected to continue to rise. Inhaled bronchodilators, such as long-acting muscarinic antagonists (LAMAs) and long-acting β2-agonists (LABAs), are central to the maintenance treatment of patients with COPD. Clinical studies have demonstrated that combined LAMA + LABA therapies improve efficacy while retaining a safety profile similar to LAMA or LABA alone. This has led to the development of several LAMA/LABA fixed-dose combination (FDC) therapies, which provide patients with the convenience of two active compounds in a single inhaler. GFF MDI (Bevespi Aerosphere®) is an FDC of glycopyrrolate/formoterol fumarate 18/9.6 µg formulated using innovative co-suspension delivery technology for administration via metered dose inhaler (MDI). GFF MDI was developed to make a treatment option available for patients who have a requirement or preference to use an MDI, rather than a dry powder or soft mist inhaler. Now that several LAMA/LABA FDCs have been approved for use in COPD, we review the impact of dual-bronchodilator treatment on COPD therapy and discuss recent clinical studies that are helping to develop a more comprehensive understanding of how LAMA/LABA FDCs can improve patient outcomes.
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Affiliation(s)
- Anthony D D'Urzo
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada,
| | - Mario Cazzola
- Department of Experimental Medicine and Surgery, Tor Vergata University of Rome, Rome, Italy
| | - Nicola A Hanania
- Section of Pulmonary and Critical Care Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Roland Buhl
- Pulmonary Department, Mainz University Hospital, Mainz, Germany
| | - M Reza Maleki-Yazdi
- Division of Respiratory Medicine, Women's College Hospital, University of Toronto, Toronto, ON, Canada
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12
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Hareendran A, Make BJ, Zaiser E, Garcia Gil E. Evaluation of the psychometric properties of the Early Morning Symptoms of COPD Instrument (EMSCI). Int J Chron Obstruct Pulmon Dis 2018; 13:1633-1645. [PMID: 29849455 PMCID: PMC5965389 DOI: 10.2147/copd.s152087] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Early morning respiratory symptoms impact quality of life and are often the most troublesome for patients with COPD. Reduction in symptoms and their impact are important treatment outcomes for COPD. The Early Morning Symptoms of COPD Instrument (EMSCI) is a daily diary designed to collect patients’ report of the occurrence, severity, and impact of morning COPD symptoms. Methods To assess the psychometric properties of the EMSCI, a split-half sample of data from a COPD clinical trial where participants completed the EMSCI daily was used for conducting descriptive statistics, factor analyses, and Rasch model analyses to examine item performance and inform scoring. Once the final scoring algorithm was determined, data from the second split-half sample were used to examine the properties of the EMSCI. Test–retest reliability was assessed using intraclass correlation coefficient (ICC). Correlations with other study assessments were used to evaluate convergent and known-groups validity. Results Data from 1,663 patients with COPD aged 40–93 years were analyzed. Factor analysis and Rasch analysis confirmed a one-factor structure for the 6 individual symptom items. Item analyses supported the generation of 4 scores. All scores demonstrated good test–retest reliability: 6-item symptom severity (ICC, 0.84); overall morning symptom severity (ICC, 0.84); activity limitation (ICC, 0.85); and rescue medication (ICC, 0.62). Significant correlations between EMSCI scores, St George’s Respiratory Questionnaire scores, and EXAcerbations of Chronic pulmonary disease Tool (EXACT)-Respiratory Symptoms scores supported the tool’s convergent validity. Significant differences (p<0.0001) in all EMSCI domain scores were found between known-groups based on median split St George’s Respiratory Questionnaire and EXACT-Respiratory Symptoms scores. Conclusion The EMSCI consists of 4 scores: 6-item symptom severity, overall symptom severity, activity limitation, and rescue medication. The EMSCI is a reliable and valid instrument for evaluating patients’ experience of early morning COPD symptoms.
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Affiliation(s)
| | - Barry J Make
- Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, CO, USA
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13
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Miravitlles M, Ribera A. Understanding the impact of symptoms on the burden of COPD. Respir Res 2017; 18:67. [PMID: 28431503 PMCID: PMC5399825 DOI: 10.1186/s12931-017-0548-3] [Citation(s) in RCA: 235] [Impact Index Per Article: 33.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Accepted: 04/07/2017] [Indexed: 12/21/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) imposes a substantial burden on individuals with the disease, which can include a range of symptoms (breathlessness, cough, sputum production, wheeze, chest tightness) of varying severities. We present an overview of the biomedical literature describing reported relationships between COPD symptoms and disease burden in terms of quality of life, health status, daily activities, physical activity, sleep, comorbid anxiety, and depression, as well as risk of exacerbations and disease prognosis. In addition, the substantial variability of COPD symptoms encountered (morning, daytime, and nighttime) is addressed and their implications for disease burden considered. The findings from this narrative review, which mainly focuses on real-world and observational studies, demonstrate the impact of COPD symptoms on the burden of disease and that improved recognition and understanding of their impact is central to alleviating this burden.
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Affiliation(s)
- Marc Miravitlles
- Pneumology Department, Vall d'Hebron University Hospital, CIBER de Enfermedades Respiratorias (CIBERES), P. de la Vall d'Hebron 119-129, 08035, Barcelona, Spain.
| | - Anna Ribera
- AstraZeneca PLC, Avda. Diagonal 615, 08028, Barcelona, Spain
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14
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Affiliation(s)
- Christine Jenkins
- Senior staff specialist, Department of Thoracic Medicine, Concord Hospital
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15
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Health Status of Patients with Moderate to Severe COPD after Treatment with Nebulized Arformoterol Tartrate or Placebo for 1 Year. Clin Ther 2016; 39:66-74. [PMID: 28011247 DOI: 10.1016/j.clinthera.2016.11.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 11/22/2016] [Accepted: 11/24/2016] [Indexed: 11/22/2022]
Abstract
PURPOSE Chronic obstructive pulmonary disease (COPD) is a progressive disease that impairs both objectively measured lung function and patient-reported health status. In a randomized clinical trial of patients with moderate to severe COPD, we compared changes in health status after adding arformoterol tartrate or placebo to patients' treatment regimens. METHODS In this multicenter, double-blind trial, patients were randomized to receive nebulized arformoterol 15 µg BID (n = 420) or matched placebo (n = 421). Treatment with other COPD medications was permitted, except for long-acting β2-agonists. Inclusion criteria were a forced expiratory volume in 1 second (FEV1) ≤65% of predicted, FEV1 >0.50 L, age ≥40 years, smoking history ≥15 pack-years, and a baseline breathlessness severity grade ≥2. The Clinical COPD Questionnaire (CCQ) was used to measure health status at randomization and at months 3, 6, and 12. CCQ scores range from 0 to 6, with higher scores indicating worse health status, and a decrease from baseline in total score by 0.4 point is considered clinically significant. Outcomes were analyzed by using mixed models for repeated measures. FINDINGS At baseline, patients' mean age was 63.8 years; 42.9% of patients were female, and 51.4% were current smokers. The mean baseline CCQ total scores were 2.88 and 2.91 for the arformoterol and placebo groups, respectively. A total of 841 patients were randomized to receive either arformoterol (n = 420) or placebo (n = 421); among them, 211 (50.1%) who received placebo and 255 (60.7%) who received arformoterol completed the trial. Arformoterol-treated patients had greater mean improvement from baseline in CCQ total score (-0.18 vs 0.02; P = 0.001), symptoms (-0.21 vs 0.01; P = 0.002), functional state (-0.15 vs 0.02; P = 0.018), and mental state (-0.18 vs 0.02; P = 0.023) than patients receiving placebo. At study end, 38.3% of the arformoterol-treated patients and 30.8% of patients receiving placebo reported clinically significant improvements on the CCQ (P = 0.026). These improvements were only modestly correlated with improvements in FEV1 (r = -0.15; P < 0.01). IMPLICATIONS In this 52-week trial, arformoterol-treated patients had greater improvements in health status than patients receiving placebo. Assessing health status along with lung function seems to provide additional information regarding the effectiveness of COPD maintenance treatments. ClinicalTrials.gov identifier: NCT00909779.
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16
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Zwar NA, Bunker JM, Reddel HK, Dennis SM, Middleton S, van Schayck OCP, Crockett AJ, Hasan I, Hermiz O, Vagholkar S, Xuan W, Marks GB. Early intervention for chronic obstructive pulmonary disease by practice nurse and GP teams: a cluster randomized trial. Fam Pract 2016; 33:663-670. [PMID: 27535327 DOI: 10.1093/fampra/cmw077] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Early detection and intervention for chronic obstructive pulmonary disease (COPD) could potentially slow disease progress and minimize harm. OBJECTIVES To assess the effectiveness of early intervention by a practice nurse-GP team on quality of life (QoL) and process of care in patients with newly diagnosed COPD, compared with usual care. Nurses and GPs in intervention practices were educated to develop and implement disease management plans for COPD. METHODS A 12-month, multicentre, pragmatic randomized controlled trial with blinded outcome assessment was conducted. Participants were current and former smokers aged 40 to 85 years newly identified as having COPD on post-bronchodilator spirometry. The primary outcome was health-related QoL, assessed with the St George's Respiratory Questionnaire (SGRQ). Secondary outcome measures were other QoL measures, lung function, disease knowledge, smoking and immunization status, inhaler technique and health service use. RESULTS Of the 10 234 patients from 36 practices in Sydney invited to a case-finding appointment, 1641 (16%) attended and 287 (18%) were diagnosed with COPD. Nineteen practices (144 patients) were randomized to the intervention group and 17 practices (110 patients) to the control group. Only 15.3% (n = 22) patients in the intervention group saw the nurse for COPD care following case finding. There was no between-group difference in SGRQ score at follow-up (mean difference -0.21; P = 0.86). Influenza vaccination was higher in the intervention group (OR 2.31: P = 0.035), but there were no other significant between-group differences in outcomes. CONCLUSION Intervention uptake was low and had no additional beneficial effect, over usual care, on participants' health-related QoL.
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Affiliation(s)
- Nicholas A Zwar
- School of Public Health and Community Medicine, UNSW Australia, UNSW Sydney, Australia,
| | - Jeremy M Bunker
- School of Public Health and Community Medicine, UNSW Australia, UNSW Sydney, Australia
| | - Helen K Reddel
- Woolcock Institute of Medical Research, University of Sydney, Glebe, Australia
| | - Sarah M Dennis
- Faculty of Health Sciences, University of Sydney, Lidcombe, Australia.,Centre for Primary Health Care and Equity, UNSW Australia, UNSW Sydney, Australia
| | - Sandy Middleton
- Nursing Research Institute, St Vincent's Health Australia (Sydney) and Australian Catholic University, Darlinghurst, Australia
| | | | - Alan J Crockett
- School of Health Sciences, University of South Australia, Adelaide, Australia
| | - Iqbal Hasan
- Centre for Primary Health Care and Equity, UNSW Australia, UNSW Sydney, Australia
| | - Oshana Hermiz
- Centre for Primary Health Care and Equity, UNSW Australia, UNSW Sydney, Australia
| | - Sanjyot Vagholkar
- School of Public Health and Community Medicine, UNSW Australia, UNSW Sydney, Australia
| | - Wei Xuan
- Ingham Institute for Applied Medical Research, Liverpool, Australia and
| | - Guy B Marks
- Woolcock Institute of Medical Research, University of Sydney, Glebe, Australia.,South Western Sydney Clinical School, UNSW Australia, Liverpool, Australia
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17
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Smid DE, Spruit MA, Houben-Wilke S, Muris JWM, Rohde GGU, Wouters EFM, Franssen FME. Burden of COPD in patients treated in different care settings in the Netherlands. Respir Med 2016; 118:76-83. [PMID: 27578474 DOI: 10.1016/j.rmed.2016.07.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 07/22/2016] [Accepted: 07/22/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Care for patients with chronic obstructive pulmonary disease (COPD) can be provided in primary, secondary or tertiary care. Whether and to what extent patients with COPD treated in various healthcare settings differ in disease burden and healthcare utilization remains unknown. Therefore, daily symptoms, functional mobility, mood status, health status and healthcare utilization were compared between COPD patients in various care settings, to explore possibilities for healthcare-optimization. METHODS Current data are part of the Chance study. Demographics, functional mobility (Care Dependency Scale (CDS); Timed-Up-and-Go (TUG) test), mood status (Hospital Anxiety and Depression scale (HADS)), health status (COPD Assessment test (CAT); Clinical COPD questionnaire (CCQ); COPD specific St. George Respiratory questionnaire (SGRQ-C)), received treatments and severity of physical and psychological symptoms were assessed in subjects with and without COPD. RESULTS 836 subjects (100 primary care patients, 100 secondary care patients, 518 tertiary care patients and 118 non-COPD subjects) were included. The burden of disease significantly increased from primary care to tertiary care. However, in all three healthcare settings a high percentage of patients with an impaired health status was observed (i.e. CAT ≥10 points, 68.0% vs. 91.0% vs. 94.5%, respectively). Furthermore, many patients treated in secondary care remain highly symptomatic despite treatment, while others with low burden of disease would allow for de-intensification of care. CONCLUSION This study revealed important shortcomings and challenges for the care of COPD patients in the Netherlands. It emphasizes the need for detailed patient characterization and more individualized treatment, independent of the healthcare setting.
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Affiliation(s)
- Dionne E Smid
- Department of Research & Education, CIRO, Hornerheide 1, 6085 NM, Horn, The Netherlands.
| | - Martijn A Spruit
- Department of Research & Education, CIRO, Hornerheide 1, 6085 NM, Horn, The Netherlands
| | - Sarah Houben-Wilke
- Department of Research & Education, CIRO, Hornerheide 1, 6085 NM, Horn, The Netherlands
| | - Jean W M Muris
- Caphri School of Public Health and Primary Care, Department of Family Medicine, P.O. Box 616, 6200 MD, Maastricht University, Maastricht, The Netherlands
| | - Gernot G U Rohde
- Department of Respiratory Medicine, Maastricht University Medical Centre, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - Emiel F M Wouters
- Department of Research & Education, CIRO, Hornerheide 1, 6085 NM, Horn, The Netherlands; Department of Respiratory Medicine, Maastricht University Medical Centre, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - Frits M E Franssen
- Department of Research & Education, CIRO, Hornerheide 1, 6085 NM, Horn, The Netherlands; Department of Respiratory Medicine, Maastricht University Medical Centre, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
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18
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Breland JY, Hundt NE, Barrera TL, Mignogna J, Petersen NJ, Stanley MA, Cully JA. Identification of Anxiety Symptom Clusters in Patients with COPD: Implications for Assessment and Treatment. Int J Behav Med 2016; 22:590-6. [PMID: 25622813 DOI: 10.1007/s12529-014-9450-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Treatment of chronic obstructive pulmonary disease (COPD) is palliative, and quality of life is important. Increased understanding of correlates of quality of life and its domains could help clinicians and researchers better tailor COPD treatments and better support patients engaging in those treatments or other important self-management behaviors. PURPOSE Anxiety is common in those with COPD; however, overlap of physical and emotional symptoms complicates its assessment. The current study aimed to identify anxiety symptom clusters and to assess the association of these symptom clusters with COPD-related quality of life. METHODS Participants (N = 162) with COPD completed the Beck Anxiety Inventory (BAI), Chronic Respiratory Disease Questionnaire, Patient Health Questionnaire-9, and Medical Research Council dyspnea scale. Anxiety clusters were identified, using principal component analysis (PCA) on the BAI's 21 items. Anxiety clusters, along with factors previously associated with quality of life, were entered into a multiple regression designed to predict COPD-related quality of life. RESULTS PCA identified four symptom clusters related to (1) general somatic distress, (2) fear, (3) nervousness, and (4) respiration-related distress. Multiple regression analyses indicated that greater fear was associated with less perceived mastery over COPD (β = -0.19, t(149) = -2.69, p < 0.01). CONCLUSION Anxiety symptoms associated with fear appear to be an important indicator of anxiety in patients with COPD. In particular, fear was associated with perceptions of mastery, an important psychological construct linked to disease self-management. Assessing the BAI symptom cluster associated with fear (five items) may be a valuable rapid assessment tool to improve COPD treatment and physical health outcomes.
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Affiliation(s)
- Jessica Y Breland
- Center for Innovation to Implementation, VA Palo Alto Health Care System, 795 Willow Road (152-MPD), Menlo Park, CA, 94025, USA.,Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Rd, Stanford, CA, 94304, USA
| | - Natalie E Hundt
- Houston VA Health Services Research and Development Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center (MEDVAMC 152), 2002 Holcombe Blvd, Houston, TX, 77030, USA.,Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza, BCM 350, Houston, TX, 77030, USA.,Veterans Affairs South Central Mental Illness Research, Education, and Clinical Center, Houston, TX, USA
| | - Terri L Barrera
- Houston VA Health Services Research and Development Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center (MEDVAMC 152), 2002 Holcombe Blvd, Houston, TX, 77030, USA.,Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza, BCM 350, Houston, TX, 77030, USA.,Veterans Affairs South Central Mental Illness Research, Education, and Clinical Center, Houston, TX, USA
| | - Joseph Mignogna
- Houston VA Health Services Research and Development Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center (MEDVAMC 152), 2002 Holcombe Blvd, Houston, TX, 77030, USA.,Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza, BCM 350, Houston, TX, 77030, USA.,Veterans Affairs South Central Mental Illness Research, Education, and Clinical Center, Houston, TX, USA
| | - Nancy J Petersen
- Houston VA Health Services Research and Development Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center (MEDVAMC 152), 2002 Holcombe Blvd, Houston, TX, 77030, USA.,Veterans Affairs South Central Mental Illness Research, Education, and Clinical Center, Houston, TX, USA.,Department of Medicine, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030, USA
| | - Melinda A Stanley
- Houston VA Health Services Research and Development Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center (MEDVAMC 152), 2002 Holcombe Blvd, Houston, TX, 77030, USA.,Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza, BCM 350, Houston, TX, 77030, USA.,Veterans Affairs South Central Mental Illness Research, Education, and Clinical Center, Houston, TX, USA
| | - Jeffery A Cully
- Houston VA Health Services Research and Development Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center (MEDVAMC 152), 2002 Holcombe Blvd, Houston, TX, 77030, USA. .,Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza, BCM 350, Houston, TX, 77030, USA. .,Veterans Affairs South Central Mental Illness Research, Education, and Clinical Center, Houston, TX, USA.
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Zbozinkova Z, Barczyk A, Tkacova R, Valipour A, Tudoric N, Zykov K, Somfay A, Miravitlles M, Koblizek V. POPE study: rationale and methodology of a study to phenotype patients with COPD in Central and Eastern Europe. Int J Chron Obstruct Pulmon Dis 2016; 11:611-22. [PMID: 27042048 PMCID: PMC4809323 DOI: 10.2147/copd.s88846] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Introduction Chronic obstructive pulmonary disease (COPD) constitutes a major health challenge in Central and Eastern European (CEE) countries. However, clinical phenotypes, symptom load, and treatment habits of patients with COPD in CEE countries remain largely unknown. This paper provides a rationale for phenotyping COPD and describes the methodology of a large study in CEE. Methods/design The POPE study is an international, multicenter, observational cross-sectional survey of patients with COPD in CEE. Participation in the study is offered to all consecutive outpatients with stable COPD in 84 centers across the CEE region if they fulfill the following criteria: age >40 years, smoking history ≥10 pack-years, a confirmed diagnosis of COPD with postbronchodilator FEV1/FVC <0.7, and absence of COPD exacerbation ≥4 weeks. Medical history, risk factors for COPD, comorbidities, lung function parameters, symptoms, and pharmaceutical and nonpharmaceutical treatment are recorded. The POPE project is registered in ClinicalTrials.gov with the identifier NCT02119494. Outcomes The primary aim of the POPE study was to phenotype patients with COPD in a real-life setting within CEE countries using predefined classifications. Secondary aims of the study included analysis of differences in symptoms, and diagnostic and therapeutic behavior in participating CEE countries. Conclusion There is increasing acceptance toward a phenotype-driven therapeutic approach in COPD. The POPE study may contribute to reveal important information regarding phenotypes and therapy in real-life CEE.
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Affiliation(s)
- Zuzana Zbozinkova
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Adam Barczyk
- Department of Pneumology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Ruzena Tkacova
- Department of Respiratory Medicine, Faculty of Medicine, P.J. Safarik University, Kosice, Slovakia
| | - Arschang Valipour
- Department of Respiratory and Critical Care Medicine, Ludwig-Boltzmann-Institute for COPD and Respiratory Epidemiology, Otto-Wagner-Spital, Wien, Austria
| | - Neven Tudoric
- School of Medicine Zagreb, University Hospital Dubrava, Zagreb, Croatia
| | - Kirill Zykov
- Laboratory of Pulmonology, Moscow State University of Medicine and Dentistry named after A.I. Evdokimov, Moscow, Russia
| | - Attila Somfay
- Department of Pulmonology, University of Szeged, Deszk, Hungary
| | - Marc Miravitlles
- Pneumology Department, Hospital Universitari Vall d'Hebron, CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
| | - Vladimir Koblizek
- Department of Pneumology, Faculty of Medicine in Hradec Kralove, University Hospital Hradec Kralove, Charles University in Prague, Hradec Kralove, Czech Republic
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20
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Vaske I, Kenn K, Keil DC, Rief W, Stenzel NM. Illness perceptions and coping with disease in chronic obstructive pulmonary disease: Effects on health-related quality of life. J Health Psychol 2016; 22:1570-1581. [DOI: 10.1177/1359105316631197] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
This study investigated the effects of illness perceptions and coping with disease on health-related quality of life in chronic obstructive pulmonary disease. Therefore, participants ( N = 444) completed online questionnaires assessing illness severity (chronic obstructive pulmonary disease stage), Illness Perceptions Questionnaire, coping with disease (Essener Coping Questionnaire), and health-related quality of life (short form-12). Hierarchical regression and moderation analyses were conducted. The results showed that health-related quality of life was predicted by illness perceptions and several aspects of coping with disease. The association between illness perceptions and health-related quality of life was mediated by the corresponding coping with disease subscales. It is concluded that in order to prevent decreasing health-related quality of life in chronic obstructive pulmonary disease, treatment may be adjusted by promoting coping with disease and functional illness perceptions.
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Affiliation(s)
| | - Klaus Kenn
- Schön Klinik Berchtesgadener Land, Germany
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21
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Prevalence and Burden of Dyspnoea Among Patients with Chronic Obstructive Pulmonary Disease in Five European Countries. Pulm Ther 2016. [DOI: 10.1007/s41030-016-0011-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
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22
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Vaske I, Thöne MF, Kühl K, Keil DC, Schürmann W, Rief W, Stenzel NM. For better or for worse: a longitudinal study on dyadic coping and quality of life among couples with a partner suffering from COPD. J Behav Med 2015; 38:851-62. [PMID: 26156120 DOI: 10.1007/s10865-015-9657-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Accepted: 06/20/2015] [Indexed: 11/29/2022]
Abstract
In chronic obstructive pulmonary disease, impairments of dyadic coping are associated with reduced quality of life. However, existing studies have a cross-sectional design. The present study explores changes in dyadic coping over time and its long-term effects on quality of life of both patients suffering from COPD and their partners. Dyadic coping, psychological distress, health-related quality of life, and exercise capacity were assessed in 63 patients suffering from COPD with their partners, at baseline and 3-year-follow-up. Correlation analyses and actor-partner interdependence models (APIMs) were conducted. Patients' delegated dyadic coping (taking over tasks) and common dyadic coping (mutual coping efforts when both partners are stressed) rated by the spouses decreased. Correlation analyses showed that patients' quality of life at follow-up was positively influenced by partners' stress communication (signaling stress). Partners' quality of life at follow-up was negatively influenced by patients' negative dyadic coping (reacting superficially, ambivalently or hostilely) and positively influenced by partners' delegated dyadic coping rated by patients (taking over tasks). APIMs mostly supported these results. It seems important that both partners communicate about stress and provide appropriate instrumental and emotional support to maintain quality of life.
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Affiliation(s)
- Isabelle Vaske
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Philipps-University Marburg, Gutenbergstraße 18, 35032, Marburg, Germany.
| | - Maximiliane Florentine Thöne
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Philipps-University Marburg, Gutenbergstraße 18, 35032, Marburg, Germany
| | - Kerstin Kühl
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Philipps-University Marburg, Gutenbergstraße 18, 35032, Marburg, Germany.
| | - Daniel Christian Keil
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Philipps-University Marburg, Gutenbergstraße 18, 35032, Marburg, Germany.
| | | | - Winfried Rief
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Philipps-University Marburg, Gutenbergstraße 18, 35032, Marburg, Germany.
| | - Nikola Maria Stenzel
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, University of Leipzig, Neumarkt 9-19, 04081, Leipzig, Germany.
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Sundh J, Johansson G, Larsson K, Lindén A, Löfdahl CG, Janson C, Sandström T. Comorbidity and health-related quality of life in patients with severe chronic obstructive pulmonary disease attending Swedish secondary care units. Int J Chron Obstruct Pulmon Dis 2015; 10:173-83. [PMID: 25653516 PMCID: PMC4310343 DOI: 10.2147/copd.s74645] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
INTRODUCTION Our understanding of how comorbid diseases influence health-related quality of life (HRQL) in patients with chronic obstructive pulmonary disease (COPD) is limited and in need of improvement. The aim of this study was to examine the associations between comorbidities and HRQL as measured by the instruments EuroQol-5 dimension (EQ-5D) and the COPD Assessment Test (CAT). METHODS Information on patient characteristics, chronic bronchitis, cardiovascular disease, diabetes, renal impairment, musculoskeletal symptoms, osteoporosis, depression, and EQ-5D and CAT questionnaire results was collected from 373 patients with Forced Expiratory Volume in one second (FEV1) <50% of predicted value from 27 secondary care respiratory units in Sweden. Correlation analyses and multiple linear regression models were performed using EQ-5D index, EQ-5D visual analog scale (VAS), and CAT scores as response variables. RESULTS Having more comorbid conditions was associated with a worse HRQL as assessed by all instruments. Chronic bronchitis was significantly associated with a worse HRQL as assessed by EQ-5D index (adjusted regression coefficient [95% confidence interval] -0.07 [-0.13 to -0.02]), EQ-5D VAS (-5.17 [-9.42 to -0.92]), and CAT (3.78 [2.35 to 5.20]). Musculoskeletal symptoms were significantly associated with worse EQ-5D index (-0.08 [-0.14 to -0.02]), osteoporosis with worse EQ-5D VAS (-4.65 [-9.27 to -0.03]), and depression with worse EQ-5D index (-0.10 [-0.17 to -0.04]). In stratification analyses, the associations of musculoskeletal symptoms, osteoporosis, and depression with HRQL were limited to female patients. CONCLUSION The instruments EQ-5D and CAT complement each other and emerge as useful for assessing HRQL in patients with COPD. Chronic bronchitis, musculoskeletal symptoms, osteoporosis, and depression were associated with worse HRQL. We conclude that comorbid conditions, in particular chronic bronchitis, depression, osteoporosis, and musculoskeletal symptoms, should be taken into account in the clinical management of patients with severe COPD.
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Affiliation(s)
- Josefin Sundh
- Department of Respiratory Medicine, Örebro University, Örebro, Sweden
| | - Gunnar Johansson
- Department of Public Health and Caring Science, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden
| | - Kjell Larsson
- Unit for Lung and Airway Research, Institute of environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Anders Lindén
- Unit for Lung and Airway Research, Institute of environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Claes-Göran Löfdahl
- Department of Respiratory Medicine and Allergology, Lund University, Lund, Sweden
| | - Christer Janson
- Department of Medical Sciences: Respiratory Medicine and Allergology, Uppsala University, Uppsala, Sweden
| | - Thomas Sandström
- Department of Public Health and Clinical Medicine, Division of Medicine/Respiratory Medicine, Umeå University, Umeå, Sweden
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Small M, Higgins V, Lees A, Johns N, Mastrangelo A, Nazareth T, Turner SJ. Physician-Patient Concordance in Pharmacological Management of Patients with COPD. COPD 2015; 12:473-83. [PMID: 26244570 PMCID: PMC4776681 DOI: 10.3109/15412555.2014.995287] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
A retrospective analysis of a cross-sectional, multicenter survey was conducted in United States (US) medical practices to evaluate the concordance between patients with COPD and their physicians on disease-specific characteristics. Associations between patient and disease-related characteristics with monotherapy, dual therapy, or triple therapy prescribed as COPD maintenance regimens were also examined. Eligible physicians completed patient record forms (PRFs) for up to 6 consecutive patients with COPD. Patients for whom a PRF was completed were invited to complete a patient self-completion (PSC) survey consisting of questions similar to those on the PRF, as well as several validated measures to assess the impact of COPD on patients' lives. A total of 469 patients completed a PSC that was matched with the PRF completed by their physician, forming the sample for the concordance analysis. Moderate agreement (kappa (κ) = 0.41-0.60) was observed for 79% of measures, with the lowest concordance rating corresponding to hemoptysis (κ = 0.22). There were few differences in demographic or clinical characteristics between patients prescribed monotherapy and dual therapy. Triple therapy rather than monotherapy or dual therapy was more often prescribed for patients with greater frequency of symptoms, negative impact of COPD on daily life and interpersonal relationships, and respiratory impairment based on the most recent FEV1. Diverse factors influence US physicians' perceptions of disease and treatment choices, including patient symptoms, quality of life, and disease impact. Our results highlight that concordance between physicians and patients regarding symptoms and physical function may contribute to optimal management of COPD.
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Affiliation(s)
- Mark Small
- Adelphi Real World, Adelphi Mill, Bollington, Cheshire, United Kingdom
| | - Victoria Higgins
- Adelphi Real World, Adelphi Mill, Bollington, Cheshire, United Kingdom
| | - Adam Lees
- Adelphi Real World, Adelphi Mill, Bollington, Cheshire, United Kingdom
| | - Nicola Johns
- Adelphi Real World, Adelphi Mill, Bollington, Cheshire, United Kingdom
| | | | - Tara Nazareth
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, USA
| | - Stuart J. Turner
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, USA
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Novotna B, Koblizek V, Zatloukal J, Plutinsky M, Hejduk K, Zbozinkova Z, Jarkovsky J, Sobotik O, Dvorak T, Safranek P. Czech multicenter research database of severe COPD. Int J Chron Obstruct Pulmon Dis 2014; 9:1265-74. [PMID: 25419124 PMCID: PMC4235208 DOI: 10.2147/copd.s71828] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Purpose Chronic obstructive pulmonary disease (COPD) has been recognized as a heterogeneous, multiple organ system-affecting disorder. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) places emphasis on symptom and exacerbation management. The aim of this study is examine the course of COPD and its impact on morbidity and all-cause mortality of patients, with respect to individual phenotypes and GOLD categories. This study will also evaluate COPD real-life patient care in the Czech Republic. Patients and methods The Czech Multicentre Research Database of COPD is projected to last for 5 years, with the aim of enrolling 1,000 patients. This is a multicenter, observational, and prospective study of patients with severe COPD (post-bronchodilator forced expiratory volume in 1 second ≤60%). Every consecutive patient, who fulfils the inclusion criteria, is asked to participate in the study. Patient recruitment is done on the basis of signed informed consent. The study was approved by the Multicentre Ethical Committee in Brno, Czech Republic. Results The objective of this paper was to outline the methodology of this study. Conclusion The establishment of the database is a useful step in improving care for COPD subjects. Additionally, it will serve as a source of data elucidating the natural course of COPD, comorbidities, and overall impact on the patients. Moreover, it will provide information on the diverse course of the COPD syndrome in the Czech Republic.
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Affiliation(s)
- Barbora Novotna
- Department of Pneumology, University Hospital Hradec Kralove, Charles University in Prague, Faculty of Medicine in Hradec Kralove, Hradec Kralove, the Czech Republic
| | - Vladimir Koblizek
- Department of Pneumology, University Hospital Hradec Kralove, Charles University in Prague, Faculty of Medicine in Hradec Kralove, Hradec Kralove, the Czech Republic
| | - Jaromir Zatloukal
- Department of Pulmonology, University Hospital, Palacky University, Olomouc, the Czech Republic
| | - Marek Plutinsky
- Department of Pulmonology, University Hospital, Masaryk University, Brno, the Czech Republic
| | - Karel Hejduk
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, the Czech Republic
| | - Zuzana Zbozinkova
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, the Czech Republic
| | - Jiri Jarkovsky
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, the Czech Republic
| | - Ondrej Sobotik
- Department of Pulmonology, University Hospital Motol, Charles University, Praha, the Czech Republic
| | - Tomas Dvorak
- Department of Pulmonology, Hospital Bulovka, Praha, the Czech Republic
| | - Petr Safranek
- Department of Pulmonology, University Hospital, Charles University, Plzen, the Czech Republic
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Lari SM, Attaran D, Tohidi M. Improving communication between the physician and the COPD patient: an evaluation of the utility of the COPD Assessment Test in primary care. PATIENT-RELATED OUTCOME MEASURES 2014; 5:145-52. [PMID: 25422591 PMCID: PMC4231984 DOI: 10.2147/prom.s54484] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. It is now considered a systemic inflammatory syndrome and is associated with important comorbidities. In addition to spirometry for evaluating the severity of airflow obstruction, an instrument is required for comprehensive assessment of the disease. The COPD Assessment Test (CAT) is a simple and valid tool for evaluating patient symptoms. The CAT can improve patient–physician communication during routine clinical visits and is useful for assessing functional status and response to treatment. The CAT has a strong correlation with other health status questionnaires, such as the St George’s Respiratory Questionnaire. The main advantages of the CAT are its thorough coverage of the important clinical aspects of disease burden and the shorter time involved in completing it. The aim of this paper is to review the role of the CAT, to compare it with other health-related quality of life questionnaires in the assessment and management of COPD patients, and to emphasize the importance of patient–physician communication in the management of patients with the disease.
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Affiliation(s)
- Shahrzad M Lari
- COPD Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Davood Attaran
- COPD Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad Tohidi
- COPD Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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Abstract
The COPD assessment test (CAT) is a self-administered questionnaire that measures health-related quality of life. We aimed to systematically evaluate the literature for reliability, validity, responsiveness and minimum clinically important difference (MCID) of the CAT. Multiple databases were searched for studies analysing the psychometric properties of the CAT in adults with chronic obstructive pulmonary disease. Two reviewers independently screened, selected and extracted data, and assessed methodological quality of relevant studies using the COSMIN checklist. From 792 records identified, 36 studies were included. The number of participants ranged from 45 to 6469, mean age from 56 to 73 years, and mean forced expiratory volume in 1 s from 39% to 98% predicted. Internal consistency (reliability) was 0.85-0.98, and test-retest reliability was 0.80-0.96. Convergent and longitudinal validity using Pearson's correlation coefficient were: SGRQ-C 0.69-0.82 and 0.63, CCQ 0.68-0.78 and 0.60, and mMRC 0.29-0.61 and 0.20, respectively. Scores differed with GOLD stages, exacerbation and mMRC grades. Mean scores decreased with pulmonary rehabilitation (2.2-3 units) and increased at exacerbation onset (4.7 units). Only one study with adequate methodology reported an MCID of 2 units and 3.3-3.8 units using the anchor-based approach and distribution-based approach, respectively. Most studies had fair methodological quality. We conclude that the studies support the reliability and validity of the CAT and that the tool is responsive to interventions, although the MCID remains debatable.
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Affiliation(s)
- Nisha Gupta
- Respiratory Epidemiology and Clinical Research Unit, McGill University Health Centre, McGill University, Montréal, QC, Canada Dept of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, QC, Canada
| | - Lancelot M Pinto
- Respiratory Epidemiology and Clinical Research Unit, McGill University Health Centre, McGill University, Montréal, QC, Canada
| | - Andreea Morogan
- Respiratory Epidemiology and Clinical Research Unit, McGill University Health Centre, McGill University, Montréal, QC, Canada
| | - Jean Bourbeau
- Respiratory Epidemiology and Clinical Research Unit, McGill University Health Centre, McGill University, Montréal, QC, Canada Dept of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, QC, Canada
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Wurst KE, Shukla A, Muellerova H, Davis KJ. Respiratory pharmacotherapy use in patients newly diagnosed with chronic obstructive pulmonary disease in a primary care setting in the UK: a retrospective cohort study. COPD 2014; 11:521-30. [PMID: 24945236 DOI: 10.3109/15412555.2014.922064] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
This retrospective cohort study aimed to analyze the prescribing practices of general practitioners treating patients with newly diagnosed chronic obstructive pulmonary disease (COPD), and to assess characteristics associated with initial pharmacotherapy. Patients were identified in the General Practice Research Database, a population-based UK electronic medical record (EMR) with data from January 1, 2008 to December 31, 2009. Patient characteristics, prescribed COPD pharmacotherapies (≤12 months before diagnosis and within 3 months following diagnosis), co-morbidities, hospitalizations, and events indicative of a possible COPD exacerbation (≤12 months before diagnosis) were analyzed in 7881 patients with newly diagnosed COPD. Most patients (64.4%) were prescribed COPD pharmacotherapy in the 12 months before diagnosis. Following diagnosis, COPD pharmacotherapy was prescribed within 3 months in 85.0% of patients. Short-acting bronchodilators alone (22.9%) or inhaled corticosteroids + long-acting beta-2 agonists (ICS+LABA, 22.1%) were prescribed most frequently. Compared with other pharmacotherapies, the prevalence of severe airflow limitation was highest in patients prescribed ICS+LABA+long-acting muscarinic antagonists (LAMA). Moderate-to-severe dyspnea was identified most frequently in patients prescribed a LAMA-containing regimen. Patients prescribed an ICS-containing regimen had a higher prevalence of asthma or possible exacerbations recorded in the EMR than those not prescribed ICS. In conclusion, pharmacotherapy prescribed at initial COPD diagnosis varied by disease severity indicators as assessed by airflow limitation, dyspnea, history of asthma, and possible exacerbations. Frequent prescription of COPD pharmacotherapies before the first-recorded COPD diagnosis indicates a delay between obstructive lung disease presentation in primary care practice and assignment of a medical diagnosis.
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Affiliation(s)
- Keele E Wurst
- 1Worldwide Epidemiology, GlaxoSmithKline R&D, Research Triangle Park , NC , USA
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Villar Balboa I, Carrillo Muñoz R, Regí Bosque M, Marzo Castillejo M, Arcusa Villacampa N, Segundo Yagüe M. [Factors associated with the quality of life in patients with chronic obstructive pulmonary disease]. Aten Primaria 2014; 46:179-87. [PMID: 24262284 PMCID: PMC6983611 DOI: 10.1016/j.aprim.2013.09.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2013] [Revised: 09/05/2013] [Accepted: 09/14/2013] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To describe the relationship between individual or combined prognostic factors in the multidimensional classifications (BODE and ADO), and health-related quality of life (HRQOL) in patients with chronic obstructive pulmonary disease (COPD). DESIGN Cross-sectional descriptive study. SETTING Primary care. PARTICIPANTS Systematic random sample of 102 patients diagnosed with COPD, excluding those patients with acute exacerbation, dementia, terminal illness or those who receive home care. MAIN MEASUREMENTS Demographics variables, smoking habits, body mass index and number of exacerbations. Comorbidity. Degree of dyspnea. Respiratory function tests. Exercise capacity. The BODE index and the ADO index. The EuroQol-5D questionnaire (EQ-5D), and visual analogue scale (VAS). RESULTS EQ-5D: mobility: 43.9%; personal care: 13.3%; daily-life activities: 29.6%; pain/discomfort: 55.1%; anxiety/depression: 37.8%, and 34.7% VAS ≤ 60%. Exacerbations: Mobility, OR: 1.85 (95%CI: 1.08-3.20); personal care, OR: 2.12 (95%CI: 1.3-4.76); daily-life activities, OR: 2.35 (95%CI: 1.17-4.71); VAS, regression coefficient: -3.50 (95%CI: 6.31- -0.70). Dyspnea: mobility, OR: 4.47 (95%CI: 1.39-14.42); daily-life activities, OR: 7.71 (95%CI: 2.03-12.34); VAS, regression coefficient: -7.15 (95%CI: 11.71- -2.59). BODE: mobility, OR: 1.53 (95%CI: 1.15-2.02); personal care, OR: 2.08 (95%CI: 1.40-3.11); daily-life activities, OR: 1.97 (95%CI: 1.38-2.80); VAS, regression coefficient: -3.96 (95%CI: -5.51- -2.42). ADO: mobility, OR: 2.42 (95%CI: 1.39-4.20); personal care, OR: 3.21 (95%CI: 1.67-6.18); daily-life activities, OR: 3.17 (95%CI: 1.69-5.93); VAS, regression coefficient: -3.53 (95%CI: -5.57- -1.49). CONCLUSIONS The BODE index and the ADO index showed a significant association with HRQOL. Exacerbations and dyspnea were the best individual factors related to HRQoL.
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Affiliation(s)
- Iván Villar Balboa
- Medicina de Familia y Comunitaria, Equipo de Atención Primaria Florida Sud, Unitat Docent Multiprofessional d'Atenció Familiar i Comunitària Costa de Ponent, Institut Català de la Salut, L'Hospitalet de Llobregat, Barcelona, España.
| | - Ricard Carrillo Muñoz
- Medicina de Familia y Comunitaria, Equipo de Atención Primaria Florida Sud, Unitat Docent Multiprofessional d'Atenció Familiar i Comunitària Costa de Ponent, Institut Català de la Salut, L'Hospitalet de Llobregat, Barcelona, España
| | - Meritxell Regí Bosque
- Medicina de Familia y Comunitaria, Equipo de Atención Primaria Can Serra, Unitat Docent Multiprofessional d'Atenció Familiar i Comunitària Costa de Ponent, Institut Català de la Salut, L'Hospitalet de Llobregat, Barcelona, España
| | - Mercè Marzo Castillejo
- Medicina de Familia y Comunitaria, Salud Pública y Medicina Preventiva, Unitat de Suport a la Recerca de Costa de Ponent-Institut d'Investigació en Atenció Primària (IDIAP) Jordi Gol, Direcció d'Atenció Primària Costa de Ponent, Institut Català de la Salut, Barcelona, España
| | - Núria Arcusa Villacampa
- Medicina de Familia y Comunitaria, Equipo de Atención Primaria Florida Sud, Unitat Docent Multiprofessional d'Atenció Familiar i Comunitària Costa de Ponent, Institut Català de la Salut, L'Hospitalet de Llobregat, Barcelona, España
| | - Marta Segundo Yagüe
- Medicina de Familia y Comunitaria, Equipo de Atención Primaria Molí Nou, Unitat Docent Multiprofessional d'Atenció Familiar i Comunitària Costa de Ponent, Institut Català de la Salut, Sant Boi de Llobregat, Barcelona, España
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Negro RWD, Bonadiman L, Turco P. Sensitivity of the COPD assessment test (CAT questionnaire) investigated in a population of 681 consecutive patients referring to a lung clinic: the first Italian specific study. Multidiscip Respir Med 2014; 9:15. [PMID: 24629022 PMCID: PMC3977871 DOI: 10.1186/2049-6958-9-15] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Accepted: 03/04/2014] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Chronic Obstructive Pulmonary Disease (COPD) is a major cause of morbidity and mortality at global level even if still underestimated. The insufficient use of specific tools for an objective definition and staging, the inadequate awareness of COPD, but also a difficult patient-to-doctor communication, can contribute to the poor management of COPD. A very simple, short and sensitive questionnaire (the "COPD Assessment Test" - CAT questionnaire) is now available for assessing the impact of COPD on the patient's health. The present study was designed to provide such evidence using data generated throughout Italy. METHODS The Italian validated version of the CAT questionnaire was distributed to 681 consecutive COPD patients of different severity (males = 480), well matched for age, gender, smoking habit, geographical distribution, BMI, dyspnoea score and educational level. The CAT score variability was investigated vs all anagraphic, and clinical variables, and spirometric indices of lung function (regression). No Italian data are available to our knowledge on the CAT use, neither in General Medicine, nor in the specialist setting. RESULTS Data of this study confirmed that the CAT questionnaire is a sensitive, simple, and quick tool for assessing the respiratory status of COPD patients. The CAT score proved not conditioned by the patient's age, gender, body size, geographical origin, and educational level. It was inversely correlated with the spirometric values, even if not uniquely linked to them. CONCLUSIONS The CAT score does not represent a surrogate measurement of lung function: it is an instrument which focuses on different areas of respiratory health in COPD patients, thus providing an useful and objective tool for the long-term clinical and therapeutic monitoring of COPD patients in the specialist outpatient setting.
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Affiliation(s)
| | - Luca Bonadiman
- CESFAR - Centro Studi Nazionale di Farmacoeconomia e Farmacoepidemiologia Respiratoria, Verona, Italy
| | - Paola Turco
- Research & Clinical Governance, Verona, Italy
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Kwok TMK, Tong CY. Effects on centre-based training and home-based training on physical function, quality of life and fall incidence in community dwelling older adults. Physiother Theory Pract 2013; 30:243-8. [DOI: 10.3109/09593985.2013.867387] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Solem CT, Sun SX, Sudharshan L, Macahilig C, Katyal M, Gao X. Exacerbation-related impairment of quality of life and work productivity in severe and very severe chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis 2013; 8:641-52. [PMID: 24376348 PMCID: PMC3864879 DOI: 10.2147/copd.s51245] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Purpose Exacerbation-associated health-related quality of life (HRQoL) in patients with severe and very severe chronic obstructive pulmonary disease (COPD) is ill-defined. This study describes patterns, HRQoL, and the work productivity impact of COPD-related moderate and SEV exacerbations in patients with SEV/VSEV COPD, focusing on the chronic bronchitis subtype. Patients and methods A US sample of SEV and VSEV COPD patients with recent moderate or SEV exacerbation was recruited. Along with the demographic and clinical data collected from medical records, patients reported on exacerbation frequency, health-related quality of life (HRQoL) (using the St George’s Respiratory Questionnaire for COPD [SGRQ-C] and the European Quality of Life-5 Dimensions [EQ-5D]™ index), and work productivity and activity impairment (using the Work Productivity and Activity Impairment Questionnaire – Specific Health Problem [WPAI-SHP]). The HRQoL-related impacts of exacerbation frequency, time since exacerbation, and last exacerbation severity were evaluated via linear regressions. Results A total of 314 patients (190 SEV/124 VSEV, mean age =68.0 years, 51% male, 28% current smokers) were included. In the previous 12 months, patients reported an average of 1.8 moderate exacerbations and 0.9 SEV exacerbations. Overall, 16% of patients were employed and reported a high percentage of overall work impairment (42.4% ± 31.1%). Activity impairment was positively associated with recent exacerbation severity (SEV 64.6% ± 26.8% versus moderate 55.6% ± 28.2%) (P=0.006). The HRQoL was significantly worse for SEV versus VSEV COPD (EQ-5D: 0.62 ± 0.23 versus 0.70 ± 0.17, respectively, and SGRQ-C: 70.1 ± 21.3 versus 61.1 ± 19.0, respectively) (P<0.001). Worse current HRQoL was reported by patients with a SEV versus moderate recent exacerbation (EQ-5D: 0.63 ± 0.21 versus 0.70 ± 0.20, respectively) (P=0.003); SGRQ-C: 70.3 ± 19.9 versus 61.7 ± 20.1, respectively (P<0.001). One additional exacerbation in the previous 12 months was associated with a 2.4-point SGRQ-C increase and a 0.02-point EQ-5D index decrease. Conclusion The severity and frequency of COPD-related moderate/SEV exacerbations in SEV and VSEV COPD patients were positively associated with poor HRQoL and work productivity and activity impairment.
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Affiliation(s)
| | - Shawn X Sun
- Forest Research Institute, Jersey City, NJ, USA
| | | | | | | | - Xin Gao
- Pharmerit International, Bethesda, MD, USA
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Fležar M, Jahnz-Różyk K, Enache G, Martynenko T, Kristufek P, Škrinjarić-Cincar S, Kadlecová P, Martinovic G. SOSPES: SPIRIVA® observational study measuring SGRQ score in routine medical practice in Central and Eastern Europe. Int J Chron Obstruct Pulmon Dis 2013; 8:483-92. [PMID: 24159258 PMCID: PMC3806120 DOI: 10.2147/copd.s45640] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The long-acting inhaled anticholinergic agent, tiotropium, is recommended as first-line maintenance therapy for moderate to very severe Chronic Obstructive Pulmonary Disease (COPD) to improve symptoms, exercise tolerance, health status, and to reduce exacerbations. Few studies have evaluated the therapeutic efficacy of tiotropium in patients in routine clinical conditions. The current study was designed to investigate the therapeutic efficacy of tiotropium delivered via the HandiHaler® device on the health status of patients with COPD with Global initiative for chronic Obstructive Lung Disease (GOLD) disease classification 2-4 in six central and eastern European countries in a real-life clinical setting. METHODS The study was an open-label, prospective, uncontrolled, and single-arm surveillance study with three clinic visits during a 6-month observation period (baseline, and months 3 and 6). Health status was measured using the disease-specific St George's Respiratory Questionnaire (SGRQ). The primary efficacy endpoint was the mean change from baseline in SGRQ total score at the end of the 6-month observational period. RESULTS Patients treated with tiotropium 18 μg once daily showed statistically significant and clinically meaningful reduction (improvement) of 21.7 units in the SGRQ total score, regardless of smoking status or cardiac comorbidities at enrollment (P < 0.0001). The analysis also showed that age, treatment compliance, and GOLD disease classification were significant factors that impact the health status of patients with COPD differently. CONCLUSION These results provide further support for the use of the tiotropium HandiHaler® as first-line maintenance treatment of patients with COPD with a clinician-assessed disease.
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Affiliation(s)
- Matjaž Fležar
- University Clinic of Respiratory and Allergic Diseases Golnik, Golnik, Slovenia
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Braido F, Baiardini I, Cazzola M, Brusselle G, Marugo F, Canonica GW. Long-acting bronchodilators improve Health Related Quality of Life in patients with COPD. Respir Med 2013; 107:1465-80. [DOI: 10.1016/j.rmed.2013.08.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Revised: 07/25/2013] [Accepted: 08/08/2013] [Indexed: 11/28/2022]
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Langhammer A, Jones R. Usefulness of the COPD assessment test (CAT) in primary care. PRIMARY CARE RESPIRATORY JOURNAL : JOURNAL OF THE GENERAL PRACTICE AIRWAYS GROUP 2013; 22:8-9. [PMID: 23429862 PMCID: PMC6442760 DOI: 10.4104/pcrj.2013.00022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Arnulf Langhammer
- Professor, HUNT Research Centre, Department of Public Health and General Practice, Norwegian University of Science and Technology, Levanger, Norway
- HUNT Research Centre, Department of Public Health and General Practice, Norwegian University of Science and Technology, Forskningsveien 2, 7600 Levanger, Norway Tel: +47 74075187 Fax: +47 74141255 E-mail:
| | - Rupert Jones
- Clinical Research Fellow, Plymouth University Peninsula School of Medicine and Dentistry, Plymouth, UK
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Lopez-Campos JL, Calero C, Quintana-Gallego E. Symptom variability in COPD: a narrative review. Int J Chron Obstruct Pulmon Dis 2013; 8:231-8. [PMID: 23687444 PMCID: PMC3653762 DOI: 10.2147/copd.s42866] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) has traditionally been considered an inexorably progressive disease, associated with a constant increase of symptoms that occur as the forced expiratory volume in 1 second (FEV1) worsens, only intermittently interrupted by exacerbations. However, this paradigm has been challenged in recent decades by the available evidence. Recent studies have pointed out that COPD-related symptoms are not consistently perceived by patients in the same way, showing not only seasonal variation, but also changes in symptom perception during a week or even within a single day. According to the available data, patients experience the biggest increase in respiratory symptoms during the first hours of the early morning, followed by the nighttime. This variation over time is of considerable importance, since it impacts on daily life activities and health-related quality of life, as measured by a recently developed ad hoc questionnaire. Additionally, recent clinical trials have suggested that the use of rapid-onset long-acting bronchodilators may have an impact on morning symptoms, despite their current use as maintenance treatment for a determined period. Although this hypothesis is to be validated in future long-term clinical trials comparing fast-onset versus slow-onset inhaled drugs in COPD, it may bring forward a new concept of long-term bronchodilator therapy. At the present time, the two available long-acting, fast-onset bronchodilators used in the treatment of COPD are formoterol and the recently marketed indacaterol. Newer drugs have also been shown to have a rapid onset of action in preclinical studies. Health care professionals caring for COPD patients should consider this variation in the perception of symptoms during their clinical interview as a potential new target in the long-term treatment plan.
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Affiliation(s)
- Jose Luis Lopez-Campos
- Unidad Medico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocio, Seville, Spain.
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