1
|
Fiore M, Ricci M, Rosso A, Flacco ME, Manzoli L. Chronic Obstructive Pulmonary Disease Overdiagnosis and Overtreatment: A Meta-Analysis. J Clin Med 2023; 12:6978. [PMID: 38002593 PMCID: PMC10672453 DOI: 10.3390/jcm12226978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 10/31/2023] [Accepted: 11/06/2023] [Indexed: 11/26/2023] Open
Abstract
This meta-analysis of observational studies aimed at estimating the overall prevalence of overdiagnosis and overtreatment in subjects with a clinical diagnosis of Chronic Obstructive Pulmonary Disease (COPD). MedLine, Scopus, Embase and Cochrane databases were searched, and random-effect meta-analyses of proportions were stratified by spirometry criteria (Global Initiative for COPD (GOLD) or Lower Limit of Normal (LLN)), and setting (hospital or primary care). Forty-two studies were included. Combining the data from 39 datasets, including a total of 23,765 subjects, the pooled prevalence of COPD overdiagnosis, according to the GOLD definition, was 42.0% (95% Confidence Interval (CI): 37.3-46.8%). The pooled prevalence according to the LLN definition was 48.2% (40.6-55.9%). The overdiagnosis rate was higher in primary care than in hospital settings. Fourteen studies, including a total of 8183 individuals, were included in the meta-analysis estimating the prevalence of COPD overtreatment. The pooled rates of overtreatment according to GOLD and LLN definitions were 57.1% (40.9-72.6%) and 36.3% (17.8-57.2%), respectively. When spirometry is not used, a large proportion of patients are erroneously diagnosed with COPD. Approximately half of them are also incorrectly treated, with potential adverse effects and a massive inefficiency of resources allocation. Strategies to increase the compliance to current guidelines on COPD diagnosis are urgently needed.
Collapse
Affiliation(s)
- Matteo Fiore
- Section of Hygiene and Preventive Medicine, University of Bologna, 40126 Bologna, Italy; (M.F.); (M.R.)
| | - Matteo Ricci
- Section of Hygiene and Preventive Medicine, University of Bologna, 40126 Bologna, Italy; (M.F.); (M.R.)
| | - Annalisa Rosso
- Department of Environmental and Prevention Sciences, University of Ferrara, 44121 Ferrara, Italy; (A.R.); (M.E.F.)
| | - Maria Elena Flacco
- Department of Environmental and Prevention Sciences, University of Ferrara, 44121 Ferrara, Italy; (A.R.); (M.E.F.)
| | - Lamberto Manzoli
- Section of Hygiene and Preventive Medicine, University of Bologna, 40126 Bologna, Italy; (M.F.); (M.R.)
| |
Collapse
|
2
|
Lin CH, Cheng SL, Chen CZ, Chen CH, Lin SH, Wang HC. Current Progress of COPD Early Detection: Key Points and Novel Strategies. Int J Chron Obstruct Pulmon Dis 2023; 18:1511-1524. [PMID: 37489241 PMCID: PMC10363346 DOI: 10.2147/copd.s413969] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 07/09/2023] [Indexed: 07/26/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality worldwide, with approximately 70% to 80% of adults with COPD being undiagnosed. Patients with undiagnosed COPD are at increased risk of poor outcomes and a worsened quality of life, making early detection a crucial strategy to mitigate the impact of COPD and reduce the burden on healthcare systems. In the past decade, increased interest has been focused on the development of effective strategies and instrument for COPD early detection. However, identifying undiagnosed cases of COPD is still challenging. Both screening and case-finding approaches have been adopted to identify undiagnosed COPD, with case-finding being recommended by the 2023 Global Initiative for Chronic Obstructive Lung Disease (GOLD) guideline and the updated United States Preventive Services Task Force (USPTF) recommendation. Nonetheless, the approaches, criteria, and instruments used for early detection of COPD are varied. However, advances in the taxonomy and risk factors of COPD are continuously being investigated. It is important to continuously assess the current state of knowledge on COPD early detection, given the challenges associated with identifying undiagnosed COPD. This review aims to highlight recent advances in early detection of COPD. To discuss the current challenge and opportunity in COPD early detection, providing an overview of existing literature on COPD case-finding strategies, including the approaches, criteria for subjects, and instruments. The review also summarizes the current progress in COPD case-findings and proposes a COPD case-finding flowchart as an efficient method for identifying at risk COPD patients.
Collapse
Affiliation(s)
- Ching-Hsiung Lin
- Division of Chest Medicine, Changhua Christian Hospital, Changhua, 500, Taiwan
- Institute of Genomics and Bioinformatics, National Chung Hsing University, Taichung, 402, Taiwan
- Ph.D. Program in Translational Medicine, National Chung Hsing University, Taichung, Taiwan
- Department of Recreation and Holistic Wellness, MingDao University, Changhua, Taiwan
| | - Shih-Lung Cheng
- Department of Internal Medicine, Far Eastern Memorial Hospital, Taipei, 220, Taiwan
- Department of Chemical Engineering and Materials Science, Yuan Ze University, Taoyuan, 320, Taiwan
| | - Chiung-Zuei Chen
- Division of Pulmonary Medicine, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chia-Hung Chen
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, 404, Taiwan
| | - Sheng-Hao Lin
- Division of Chest Medicine, Changhua Christian Hospital, Changhua, 500, Taiwan
| | - Hao-Chien Wang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, 100, Taiwan
| |
Collapse
|
3
|
Athlin Å, Lisspers K, Hasselgren M, Ställberg B, Janson C, Montgomery S, Giezeman M, Kisiel M, Nager A, Sandelowsky H, Arne M, Sundh J. Diagnostic spirometry in COPD is increasing, a comparison of two Swedish cohorts. NPJ Prim Care Respir Med 2023; 33:23. [PMID: 37264017 DOI: 10.1038/s41533-023-00345-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 05/15/2023] [Indexed: 06/03/2023] Open
Abstract
Spirometry should be used to confirm a diagnosis of chronic obstructive pulmonary disease (COPD). This test is not always performed, leading to possible misdiagnosis. We investigated whether the proportion of patients with diagnostic spirometry has increased over time as well as factors associated with omitted or incorrectly interpreted spirometry. Data from medical reviews and a questionnaire from primary and secondary care patients with a doctors' diagnosis of COPD between 2004 and 2010 were collected. Data were compared with a COPD cohort diagnosed between 2000 and 2003. Among 703 patients with a first diagnosis of COPD between 2004 and 2010, 88% had a diagnostic spirometry, compared with 59% (p < 0.001) in the previous cohort. Factors associated with not having diagnostic spirometry were current smoking (OR 2.21; 95% CI 1.36-3.60), low educational level (OR 1.81; 1.09-3.02) and management in primary care (OR 2.28; 1.02-5.14). The correct interpretation of spirometry results increased (75% vs 82%; p = 0.010). Among patients with a repeated spirometry, 94% had a persistent FEV1/FVC or FEV1/VC ratio <0.70.
Collapse
Affiliation(s)
- Åsa Athlin
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
| | - Karin Lisspers
- Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden
| | - Mikael Hasselgren
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Centre for Clinical Research and Education, Region Värmland, Karlstad, Sweden
| | - Björn Ställberg
- Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden
| | - Christer Janson
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Scott Montgomery
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Maaike Giezeman
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Centre for Clinical Research and Education, Region Värmland, Karlstad, Sweden
| | - Marta Kisiel
- Department of Medical Sciences, Occupational and Environment Medicine, Uppsala University, Uppsala, Sweden
| | - Anna Nager
- Division of Family Medicine and Primary Care, Inst NVS, Karolinska Institutet, Stockholm, Sweden
| | - Hanna Sandelowsky
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
- Division of Family Medicine and Primary Care, Inst NVS, Karolinska Institutet, Stockholm, Sweden
- Academic Primary Health Care Centre, Region Stockholm, Stockholm, Sweden
| | - Mats Arne
- Centre for Clinical Research and Education, Region Värmland, Karlstad, Sweden
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Josefin Sundh
- Department of Respiratory Medicine, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| |
Collapse
|
4
|
Paier-Abuzahra ME, Mahlknecht A, Piccoliori G, Engl A, Sönnichsen A. Quality of chronic care in general practices in Salzburg, Austria, and South Tyrol, Italy: a comparative process of care intervention study. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2022; 170:14-20. [PMID: 35431151 DOI: 10.1016/j.zefq.2022.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 12/20/2021] [Accepted: 01/24/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Quality indicators to assess the quality of primary care have only been applied on a national or regional level in European countries, and there have been no comparisons between regions of different countries. In the interventional pre-post-study "Improvement of Quality by Benchmarking - IQuaB" (level of evidence: 3), we aimed to improve and compare quality of process care in 57 participating general practices in Salzburg, Austria, and South Tyrol, Italy. METHODS The intervention consisted of self-audit, benchmarking and quality circles. Quality indicators for eight common chronic diseases (e. g., diabetes) were extracted from the electronic health records in 2012, 2013 and 2014. Based on 19 quality indicators, a supra-regional quality score was calculated and compared using Mann-Whitney U tests. RESULTS A relatively weak baseline performance was identified in both regions. In all three assessments, the median quality score increased in both regions and was significantly higher in South Tyrol than in Salzburg. During the study period the median supra-regional quality score increased from 20.00 to 38.00 in the Salzburg sample and from 47.00 to 79.50 in the South Tyrolian sample. The differences between the two regions were significant at baseline and after intervention (2012: p=0.015, 2014: p=0.001). DISCUSSION Despite data extraction challenges in Austria, we are convinced that our data highlight real differences in (processual) quality of care between the two regions. CONCLUSIONS The reasons underlying the persisting differences between the two regions may include: (1) different functions in electronic health records, (2) benchmarking as an integral part of the electronic health record, (3) gate-keeping system and use of registration lists, (4) state-supported quality initiatives.
Collapse
Affiliation(s)
- Muna E Paier-Abuzahra
- Institute of General Practice, Family Medicine and Preventive Medicine, Paracelsus Medical University Salzburg, Salzburg, Austria; Institute for General Medicine and Evidence-based Health Services Research, Medical University of Graz, Graz, Austria.
| | - Angelika Mahlknecht
- Institute of General Practice, Family Medicine and Preventive Medicine, Paracelsus Medical University Salzburg, Salzburg, Austria; Institute of General Practice, College of Health Care Professions, Bolzano, Italy
| | - Giuliano Piccoliori
- Institute of General Practice, College of Health Care Professions, Bolzano, Italy; Southtyrolean Academy of General Practice, Bolzano, Italy
| | - Adolf Engl
- Institute of General Practice, College of Health Care Professions, Bolzano, Italy; Southtyrolean Academy of General Practice, Bolzano, Italy
| | - Andreas Sönnichsen
- Institute of General Practice, Family Medicine and Preventive Medicine, Paracelsus Medical University Salzburg, Salzburg, Austria; IWIMED (Institute for Worldwide Informationtransfer in MEDicine), Salzburg, Austria
| |
Collapse
|
5
|
Huang WC, Fox GJ, Pham NY, Nguyen TA, Vu VG, Ngo QC, Nguyen VN, Jan S, Negin J, Le TTL, Marks GB. A syndromic approach to assess diagnosis and management of patients presenting with respiratory symptoms to healthcare facilities in Vietnam. ERJ Open Res 2021; 7:00572-2020. [PMID: 33681343 PMCID: PMC7917231 DOI: 10.1183/23120541.00572-2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 11/05/2020] [Indexed: 12/05/2022] Open
Abstract
Background The aim of the study was to establish syndromic diagnoses in patients presenting with respiratory symptoms to healthcare facilities in Vietnam and to compare the diagnoses with facility-level clinical diagnoses and treatment decisions. Methods A representative sample of patients aged ≥5 years, presenting with dyspnoea, cough, wheezing, and/or chest tightness to healthcare facilities in four provinces of Vietnam were systematically evaluated. Eight common syndromes were defined using data obtained. Results We enrolled 977 subjects at 39 facilities. We identified fixed airflow limitation (FAL) in 198 (20.3%) patients and reversible airflow limitation (RAL) in 26 (2.7%) patients. Patients meeting the criteria for upper respiratory tract infection (URTI) alone constituted 160 (16.4%) patients and 470 (48.1%) did not meet the criteria for any of the syndromes. Less than half of patients with FAL were given long-acting bronchodilators. A minority of patients with either RAL or FAL with eosinophilia were prescribed inhaled corticosteroids. Antibiotics were given to more than half of all patients, even among those with URTI alone. Conclusion This study identified a substantial discordance between prescribed treatment, clinician diagnosis and a standardised syndromic diagnosis among patients presenting with respiratory symptoms. Increased access to spirometry and implementation of locally relevant syndromic approaches to management may help to improve patient care in resource-limited settings. This study identified discordance between a standardised syndromic diagnosis of respiratory diseases and the diagnosis reached within the Vietnamese health system. Implementing a syndromic approach to case management might help to improve patient care.https://bit.ly/36oJORg
Collapse
Affiliation(s)
- Wan-Chun Huang
- Woolcock Institute of Medical Research, Hanoi, Vietnam.,South Western Sydney Clinical School, University of New South Wales, Sydney, Australia.,Division of Thoracic Medicine, Dept of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Gregory J Fox
- Woolcock Institute of Medical Research, Hanoi, Vietnam.,Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Ngoc Yen Pham
- Woolcock Institute of Medical Research, Hanoi, Vietnam
| | | | - Van Giap Vu
- Respiratory Center, Bach Mai Hospital, Hanoi, Vietnam
| | - Quy Chau Ngo
- Respiratory Center, Bach Mai Hospital, Hanoi, Vietnam
| | | | - Stephen Jan
- Health Economics and Process Evaluation Program, George Institute for Global Health, Sydney, Australia
| | - Joel Negin
- School of Public Health, University of Sydney, Sydney, Australia
| | - Thi Tuyet Lan Le
- Society of Asthma and Allergy & Clinical Immunology, Ho Chi Minh City, Vietnam
| | - Guy B Marks
- Woolcock Institute of Medical Research, Hanoi, Vietnam.,South Western Sydney Clinical School, University of New South Wales, Sydney, Australia
| |
Collapse
|
6
|
Jørgensen IF, Brunak S. Time-ordered comorbidity correlations identify patients at risk of mis- and overdiagnosis. NPJ Digit Med 2021; 4:12. [PMID: 33514862 PMCID: PMC7846731 DOI: 10.1038/s41746-021-00382-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 01/05/2021] [Indexed: 11/08/2022] Open
Abstract
Diagnostic errors are common and can lead to harmful treatments. We present a data-driven, generic approach for identifying patients at risk of being mis- or overdiagnosed, here exemplified by chronic obstructive pulmonary disease (COPD). It has been estimated that 5-60% of all COPD cases are misdiagnosed. High-throughput methods are therefore needed in this domain. We have used a national patient registry, which contains hospital diagnoses for 6.9 million patients across the entire Danish population for 21 years and identified statistically significant disease trajectories for COPD patients. Using 284,154 patients diagnosed with COPD, we identified frequent disease trajectories comprising time-ordered comorbidities. Interestingly, as many as 42,459 patients did not present with these time-ordered, common comorbidities. Comparison of the individual disease history for each non-follower to the COPD trajectories, demonstrated that 9597 patients were unusual. Survival analysis showed that this group died significantly earlier than COPD patients following a trajectory. Out of the 9597 patients, we identified one subgroup comprising 2185 patients at risk of misdiagnosed COPD without the typical events of COPD patients. In all, 10% of these patients were diagnosed with lung cancer, and it seems likely that they are underdiagnosed for lung cancer as their laboratory test values and survival pattern are similar to such patients. Furthermore, only 4% had a lung function test to confirm the COPD diagnosis. Another subgroup with 2368 patients were found to be at risk of "classically" overdiagnosed COPD that survive >5.5 years after the COPD diagnosis, but without the typical complications of COPD.
Collapse
Affiliation(s)
- Isabella Friis Jørgensen
- Novo Nordisk Foundation Center for Protein Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Søren Brunak
- Novo Nordisk Foundation Center for Protein Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| |
Collapse
|
7
|
Rice RD, Han X, Wang X, Al-Jaghbeer MJ. COPD Overdiagnosis and Its Effect on 30-Day Hospital Readmission Rates. Respir Care 2021; 66:11-17. [PMID: 32606075 PMCID: PMC9993816 DOI: 10.4187/respcare.07536] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Although specific guidelines exist for diagnosing COPD on the basis of spirometry testing data (FEV1/FVC < 0.70 or above the lower limit of normal), the literature suggests that overdiagnosis is common. Whether overdiagnosis increases 30-d readmission rates has not yet been explored. The objective of this study was to determine the prevalence of COPD overdiagnosis and its effect on 30-d hospital readmission rates in our institution. METHODS We retrospectively identified all subjects who were coded with a COPD hospital discharge in 2018 at Cleveland Clinic main campus and had spirometry data available, including FEV1 and FVC. FEV1/FVC was calculated and compared with the predicted lower limit of normal values. Hospital discharge diagnosis and 30-d hospital readmission data were captured along with comorbidities and other demographics. RESULTS In 2018, there were 424 hospital discharges with a COPD diagnosis with spirometry testing available. Of these subjects, 124 (29%) were overdiagnosed in the lower limit of normal group and 99 (23.3%) were in the ≥ 0.70 group. One hundred subjects (23.6%) had a 30-d hospital readmission. Of these subjects, 35 had FEV1/FVC that was greater than their predicted lower limit of normal on spirometry. Of the 324 subjects who were not readmitted within 30 d, 89 (27.5%) had FEV1/FVC greater than the lower limit of normal. If the 35 readmitted subjects had not been coded with COPD, the 30-d readmission rate would have decreased significantly from 23.6% to 16.7% (100 of 424 vs 65 of 389, P = .01). Even if all of the 124 subjects who had pulmonary function test data greater than the lower limit of normal had not been counted, the readmission rate would still have decreased from 23.6% to 21.7%, but this was not significant (from 100 of 424 to 65 of 300, P = .3). CONCLUSIONS COPD was overdiagnosed in our cohort of subjects; this was true whether the FEV1/FVC < 0.70 standard or the lower limit of normal standard was used. Furthermore, this overdiagnosis artificially inflated the 30-d readmission rate. These results illustrate the caution providers should use when making a COPD diagnosis.
Collapse
Affiliation(s)
- Richard D Rice
- Respiratory Institute, Cleveland Clinic Main Campus, Cleveland, Ohio.
| | - Xiaozhen Han
- Department of Quantitative Health Sciences, Cleveland Clinic Main Campus, Cleveland, Ohio
| | - Xiaofeng Wang
- Department of Quantitative Health Sciences, Cleveland Clinic Main Campus, Cleveland, Ohio
| | | |
Collapse
|
8
|
Sator L, Horner A, Studnicka M, Lamprecht B, Kaiser B, McBurnie MA, Buist AS, Gnatiuc L, Mannino DM, Janson C, Bateman ED, Burney P. Overdiagnosis of COPD in Subjects With Unobstructed Spirometry: A BOLD Analysis. Chest 2019; 156:277-288. [PMID: 30711480 DOI: 10.1016/j.chest.2019.01.015] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Revised: 01/10/2019] [Accepted: 01/14/2019] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND There are several reports on underdiagnosis of COPD, while little is known about COPD overdiagnosis and overtreatment. We describe the overdiagnosis and the prevalence of spirometrically defined false positive COPD, as well as their relationship with overtreatment across 23 population samples in 20 countries participating in the BOLD Study between 2003 and 2012. METHODS A false positive diagnosis of COPD was considered when participants reported a doctor's diagnosis of COPD, but postbronchodilator spirometry was unobstructed (FEV1/FVC > LLN). Additional analyses were performed using the fixed ratio criterion (FEV1/FVC < 0.7). RESULTS Among 16,177 participants, 919 (5.7%) reported a previous medical diagnosis of COPD. Postbronchodilator spirometry was unobstructed in 569 subjects (61.9%): false positive COPD. A similar rate of overdiagnosis was seen when using the fixed ratio criterion (55.3%). In a subgroup analysis excluding participants who reported a diagnosis of "chronic bronchitis" or "emphysema" (n = 220), 37.7% had no airflow limitation. The site-specific prevalence of false positive COPD varied greatly, from 1.9% in low- to middle-income countries to 4.9% in high-income countries. In multivariate analysis, overdiagnosis was more common among women, and was associated with higher education; former and current smoking; the presence of wheeze, cough, and phlegm; and concomitant medical diagnosis of asthma or heart disease. Among the subjects with false positive COPD, 45.7% reported current use of respiratory medication. Excluding patients with reported asthma, 34.4% of those with normal spirometry still used a respiratory medication. CONCLUSIONS False positive COPD is frequent. This might expose nonobstructed subjects to possible adverse effects of respiratory medication.
Collapse
Affiliation(s)
- Lea Sator
- Department of Pulmonary Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Andreas Horner
- Department of Pulmonology, Kepler University Hospital, Linz, Austria; Faculty of Medicine, Johannes-Kepler-University, Linz, Austria; Institute of General Practice, Family Medicine and Preventive Medicine, Paracelsus Medical University, Salzburg, Austria.
| | - Michael Studnicka
- Department of Pulmonary Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Bernd Lamprecht
- Department of Pulmonology, Kepler University Hospital, Linz, Austria; Faculty of Medicine, Johannes-Kepler-University, Linz, Austria
| | - Bernhard Kaiser
- Department of Pulmonology, Kepler University Hospital, Linz, Austria
| | - Mary Ann McBurnie
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | | | - Luisa Gnatiuc
- Respiratory Epidemiology and Public Health Group, Imperial College, London, London, United Kingdom
| | - David M Mannino
- Department of Preventive Medicine and Environmental Health, College of Public Health, University of Kentucky, Lexington, KY
| | - Christer Janson
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Eric D Bateman
- Division of Pulmonology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Peter Burney
- Respiratory Epidemiology and Public Health Group, Imperial College, London, London, United Kingdom
| |
Collapse
|
9
|
Perez-Padilla R, Thirion-Romero I, Guzman N. Underdiagnosis of chronic obstructive pulmonary disease: should smokers be offered routine spirometry tests? Expert Rev Respir Med 2017; 12:83-85. [DOI: 10.1080/17476348.2018.1419868] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Rogelio Perez-Padilla
- Department of COPD, Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico
| | - Ireri Thirion-Romero
- Department of COPD, Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico
| | - Nicolas Guzman
- Department of COPD, Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico
| |
Collapse
|
10
|
Dennis S, Reddel HK, Middleton S, Hasan I, Hermiz O, Phillips R, Crockett AJ, Vagholkar S, Marks GB, Zwar N. Barriers and outcomes of an evidence-based approach to diagnosis and management of chronic obstructive pulmonary disease (COPD) in Australia: a qualitative study. Fam Pract 2017; 34:485-490. [PMID: 27694575 DOI: 10.1093/fampra/cmw103] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is commonly managed in primary care but there is poor awareness of evidence-based guidelines and the quality and interpretation of spirometry is suboptimal. OBJECTIVES The aims of this qualitative study were to explore how an intervention involving case finding and management of COPD was implemented, and the extent to which the GPs and practice nurses (PNs) worked in partnership to diagnose and manage COPD. METHODS Semi-structured interviews with PNs (n = 7), GPs (n = 4) and patients (n = 26) who had participated in the Primary care EarLy Intervention for Copd mANagement (PELICAN) study. The Theoretical Domains Framework was used to guide the coding and analysis of the interviews with PN and GPs. The patient interviews were analysed thematically. RESULTS PNs developed technical skills and understood the requirements for good-quality spirometry. However, many lacked confidence in its interpretation and felt this was not part of their professional role. This was reflected in responses from the GPs. Once COPD was diagnosed, the GPs tended to manage the patients with the PNs less involved. This was in contrast with PNs' active role in managing patients with other chronic diseases such as diabetes. The extent to which the GPs and PNs worked in partnership to manage COPD varied. CONCLUSIONS PNs improved their skills and confidence in performing spirometry. Beliefs about their professional role, identity and confidence influenced the extent to which PNs were involved in interpretation of the spirometry results and managing the patient in partnership with the GP.
Collapse
Affiliation(s)
- Sarah Dennis
- Faculty of Health Sciences, University of Sydney, Sydney, New South Wales, Australia.,Center for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia
| | - Helen K Reddel
- Woolcock Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - Sandy Middleton
- Nursing Research Institute, St Vincent's Health Australia, Sydney, New South Wales, Australia.,Australian Catholic University, Sydney, New South Wales, Australia
| | - Iqbal Hasan
- Center for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia
| | - Oshana Hermiz
- Center for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia
| | - Rosemary Phillips
- Nursing Research Institute, St Vincent's Health Australia, Sydney, New South Wales, Australia.,Australian Catholic University, Sydney, New South Wales, Australia
| | - Alan J Crockett
- School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Sanjyot Vagholkar
- School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Guy B Marks
- Woolcock Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia.,South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Nicholas Zwar
- School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
| |
Collapse
|
11
|
Weiss G, Steinacher I, Lamprecht B, Kaiser B, Mikes R, Sator L, Hartl S, Wagner H, Studnicka M. Development and validation of the Salzburg COPD-screening questionnaire (SCSQ): a questionnaire development and validation study. NPJ Prim Care Respir Med 2017; 27:4. [PMID: 28127061 PMCID: PMC5434771 DOI: 10.1038/s41533-016-0005-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 09/30/2016] [Accepted: 10/25/2016] [Indexed: 12/21/2022] Open
Abstract
Chronic obstructive pulmonary disease prevalence rates are still high. However, the majority of subjects are not diagnosed. Strategies have to be implemented to overcome the problem of under-diagnosis. Questionnaires could be used to pre-select subjects for spirometry and thereby help reducing under-diagnosis. We report a brief, simple, self-administrable and validated chronic obstructive pulmonary disease questionnaire to increase the pre-test probability for chronic obstructive pulmonary disease diagnosis in subjects undergoing confirmatory spirometry. In 2005, we completed the Austrian Burden of Obstructive Lung Disease-study in 1258 subjects aged >40 years. Post-bronchodilator spirometry was performed, and non-reversible airflow limitation defined by FEV1/FVC ratio below the lower limit of normal. Questions from the Salzburg chronic obstructive pulmonary disease screening-questionnaire were selected using a logistic regression model, and risk scores were based on regression-coefficients. A training sub-sample (n = 800) was used to create the score, and a test sub-sample (n = 458) was used to test it. In 2008, an external validation study was done, using the same protocol in 775 patients from primary care. The Salzburg chronic obstructive pulmonary disease screening questionnaire was composed of items related to "breathing problems", "wheeze", "cough", "limitation of physical activity", and "smoking". At the >=2 points cut-off of the Salzburg chronic obstructive pulmonary disease screening questionnaire, sensitivity was 69.1% [95%CI: 56.6%; 79.5%], specificity 60.0% [95%CI: 54.9%; 64.9%], the positive predictive value 23.2% [95%CI: 17.7%; 29.7%] and the negative predictive value 91.8% [95%CI: 87.5%; 95.7%] to detect post bronchodilator airflow limitation. The external validation study in primary care confirmed these findings. The Salzburg chronic obstructive pulmonary disease screening questionnaire was derived from the highly standardized Burden of Obstructive Lung Disease study. This validated and easy to use questionnaire can help to increase the efficiency of chronic obstructive pulmonary disease case-finding. CHRONIC OBSTRUCTIVE PULMONARY DISEASE QUESTIONNAIRE FOR PRE-SCREENING POTENTIAL SUFFERERS: Scientists in Austria have developed a brief, simple questionnaire to identify patients likely to have early-stage chronic lung disease. Chronic obstructive pulmonary disease (COPD) is notoriously difficult to diagnose, and the condition often causes irreversible lung damage before it is identified. Finding a simple, cost-effective method of pre-screening patients with suspected early-stage COPD could potentially improve treatment responses and limit the burden of extensive lung function ('spirometry') tests on health services. Gertraud Weiss at Paracelsus Medical University, Austria, and co-workers have developed and validated an easy-to-use, self-administered questionnaire that could prove effective for pre-screening patients. The team trialed the five-point Salzburg COPD-screening questionnaire on 1258 patients. Patients scoring 2 points or above on the questionnaire underwent spirometry tests. The questionnaire seems to provide a sensitive and cost-effective way of pre-selecting patients for spirometry referral.
Collapse
Affiliation(s)
- Gertraud Weiss
- Department of Pneumology, Paracelsus Medical University, Salzburg, Austria.
| | - Ina Steinacher
- Department of Pneumology, Paracelsus Medical University, Salzburg, Austria
| | - Bernd Lamprecht
- Department of Pulmonary Medicine, Kepler-University-Hospital, Linz, Austria
- Faculty of Medicine, Johannes-Kepler-University, Linz, Austria
| | - Bernhard Kaiser
- Department of Pneumology, Paracelsus Medical University, Salzburg, Austria
| | - Romana Mikes
- Department of Pneumology, Paracelsus Medical University, Salzburg, Austria
| | - Lea Sator
- Department of Pneumology, Paracelsus Medical University, Salzburg, Austria
| | - Sylvia Hartl
- Ludwig Boltzmann Institute of COPD and Respiratory Epidemiology, Otto Wagner Hospital, Vienna, Austria
| | - Helga Wagner
- Department for Statistics, University of Linz, Linz, Austria
| | - M Studnicka
- Department of Pneumology, Paracelsus Medical University, Salzburg, Austria
| |
Collapse
|
12
|
Mahlknecht A, Abuzahra ME, Piccoliori G, Enthaler N, Engl A, Sönnichsen A. Improving quality of care in general practices by self-audit, benchmarking and quality circles. Wien Klin Wochenschr 2016; 128:706-718. [PMID: 27599700 PMCID: PMC5052301 DOI: 10.1007/s00508-016-1064-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 07/28/2016] [Indexed: 11/27/2022]
Abstract
Guideline adherence of general practitioners (GP) regarding treatment of chronic conditions shows room for improvement. Thus, concepts have to be designed to promote quality of care. The aim of the interventional study “Improvement of Quality by Benchmarking” was to assess whether quality can be improved by self-auditing, benchmarking and quality circles in Salzburg (Austria) and South Tyrol (Italy). In this publication we present the Austrian results. Quality indicators were developed in a consensus process for eight chronic diseases based on pre-existing quality management systems. A quality score consisting of 35 indicators was calculated (0–5 points per indicator depending on fulfilment, maximum 175 points). Data were extracted from the electronic health records of participating practices in 2012, 2013 and 2014. A statistical pre-post analysis was performed using Wilcoxon signed-rank tests. A total of 20 GPs participated in the project. The mean quality score increased from 62.0 at baseline to 84.0 at the second follow-up (p = 0.003). Regarding the individual quality indicators, strong improvements were achieved between baseline and first follow-up, especially in process indicators concerning documentation. Between the first and second follow-up, quality remained in most cases at the same level. The validity of results is limited because of structural and technical problems. Due to the uncontrolled pre-post design we cannot exclude external influences on the results. Nevertheless, the intervention was able to improve measured quality of care. Barriers were detected that should be considered in a possible implementation of quality control programs.
Collapse
Affiliation(s)
- Angelika Mahlknecht
- Institut für Allgemein-, Familien- und Präventivmedizin, Paracelsus Medizinische Universität Salzburg, Strubergasse 21, 5020, Salzburg, Austria.
| | - Muna E Abuzahra
- Institut für Allgemeinmedizin und evidenzbasierte Versorgungsforschung, Medizinische Universität Graz, Auenbruggerplatz 2/9, 8036, Graz, Austria.,Institut für Allgemeinmedizin und Familienmedizin, Universität Witten/Herdecke, Alfred-Herrhausen-Str. 50, 58448, Witten, Germany
| | - Giuliano Piccoliori
- Südtiroler Akademie für Allgemeinmedizin, Wangergasse 18, 39100, Bolzano, Italy
| | - Nina Enthaler
- Institut für Allgemein-, Familien- und Präventivmedizin, Paracelsus Medizinische Universität Salzburg, Strubergasse 21, 5020, Salzburg, Austria
| | - Adolf Engl
- Südtiroler Akademie für Allgemeinmedizin, Wangergasse 18, 39100, Bolzano, Italy
| | - Andreas Sönnichsen
- Institut für Allgemeinmedizin und Familienmedizin, Universität Witten/Herdecke, Alfred-Herrhausen-Str. 50, 58448, Witten, Germany
| |
Collapse
|
13
|
Use of spirometry among chest physicians and primary care physicians in India. NPJ Prim Care Respir Med 2016; 26:16036. [PMID: 27385406 PMCID: PMC4936052 DOI: 10.1038/npjpcrm.2016.36] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 03/19/2016] [Accepted: 04/22/2016] [Indexed: 11/08/2022] Open
Abstract
Although spirometry is the gold-standard diagnostic test for obstructive airways diseases, it remains poorly utilised in clinical practice. We aimed to investigate the use of spirometry across India, the change in its usage over a period of time and to understand the reasons for its under-utilisation. Two nationwide surveys were conducted in the years 2005 and 2013, among four groups of doctors: chest physicians (CPs), general physicians (GenPs), general practitioners (GPs) and paediatricians (Ps). A total of 1,000 physicians from each of the four groups were randomly selected from our database in the years 2005 and 2013. These surveys were conducted in 52 cities and towns across 15 states in India. A questionnaire was administered to the physicians, which captured information about their demographic details, type of practice and use of spirometry. The overall response rates of the physicians in 2005 and 2013 were 42.8% and 54.9%, respectively. Spirometry was reported to be used by 55% CPs, 20% GenPs, 10% GPs and 5% Ps in 2005, and this increased by 30.9% among CPs (P value <0.01), 18% among GenPs (P value=0.01), 20% among GPs (P value: not significant) and 224% among Ps (P value <0.01). The reasons for not using spirometry varied between 2005 and 2013. In all, 32.2% of physicians were unaware of which predicted equation they were using. The use of spirometry in India is low, although it seems to have improved over the years. The reasons identified in this study for under-utilisation should be used to address initiatives to improve the use of spirometry in clinical practice.
Collapse
|
14
|
Turkeshi E, Zelenukha D, Vaes B, Andreeva E, Frolova E, Degryse JM. Predictors of poor-quality spirometry in two cohorts of older adults in Russia and Belgium: a cross-sectional study. NPJ Prim Care Respir Med 2015; 25:15048. [PMID: 26201999 PMCID: PMC4532161 DOI: 10.1038/npjpcrm.2015.48] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Revised: 04/17/2015] [Accepted: 06/05/2015] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Spirometry is an important test for the diagnosis of respiratory diseases, yet it is underused especially in older adults. Several predictors of good-quality spirometry in this age group have been reported, based mainly on in/outpatients of geriatric and/or respiratory units. AIMS This study aims to assess predictors of poor-quality spirometry in community-dwelling older adults from two primary care cohorts in Russia and Belgium. METHODS Spirograms from two population-based cohort studies in Russia (CRYSTAL) and Belgium (BELFRAIL) were assessed in accordance with the American Thoracic Society/European Respiratory Society (ATS/ERS) acceptability and repeatability criteria and grouped into good and poor quality. Multivariable analysis assessed the association of poor-quality spirometry with socio-demographics, functional dependency, physical and mental functioning and co-morbidities. RESULTS In all, 43.3% of the 522 BELFRAIL participants (84.71 ± 3.67 years old) and 57.7% of the 605 CRYSTAL participants (75.11 ± 5.97 years old) achieved all ATS/ERS acceptability and repeatability criteria. In both cohorts, those with poor-quality spirometry had lower cognitive function (mini-mental state examination (MMSE) ⩽ 24). After adjustment in multivariable analysis, MMSE ⩽ 24 had an odds ratio for poor-quality spirometry of 1.33 (95% CI = 0.78-2.28) in the BELFRAIL and 1.30 (95% CI = 0.88-1.91) in the CRYSTAL cohort. CONCLUSIONS In community-dwelling older adults, including those over 80 years old, impaired cognition measured by the MMSE may not be an independent predictor of poor-quality spirometry. Further research is needed in this area, and spirometry should be used more often in older adults in primary care.
Collapse
Affiliation(s)
- Eralda Turkeshi
- Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium
| | - Dmitry Zelenukha
- Department of Family Medicine, North-Western State Medical University, St Petersburg, Russia
| | - Bert Vaes
- Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium
- Department of Public Health and Primary Care, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Elena Andreeva
- Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium
| | - Elena Frolova
- Department of Family Medicine, North-Western State Medical University, St Petersburg, Russia
| | - Jean-Marie Degryse
- Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium
- Department of Public Health and Primary Care, Katholieke Universiteit Leuven, Leuven, Belgium
| |
Collapse
|
15
|
Robitaille C, Dajczman E, Hirsch AM, Small D, Ernst P, Porubska D, Palayew M. Implementation of a targeted screening program to detect airflow obstruction suggestive of chronic obstructive pulmonary disease within a presurgical screening clinic. Can Respir J 2015; 22:209-14. [PMID: 25961279 PMCID: PMC4530853 DOI: 10.1155/2015/306720] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Targeted spirometry screening for chronic obstructive pulmonary disease (COPD) has been studied in primary care and community settings. Limitations regarding availability and quality of testing remain. A targeted spirometry screening program was implemented within a presurgical screening (PSS) clinic to detect undiagnosed airways disease and identify patients with COPD/asthma in need of treatment optimization. OBJECTIVE The present quality assurance study evaluated airflow obstruction detection rates and examined characteristics of patients identified through the targeted screening program. METHODS The targeted spirometry screening program was implemented within the PSS clinic of a tertiary care university hospital. Current or ex-smokers with respiratory symptoms and patients with a history of COPD or asthma underwent prebronchodilator spirometry. History of airways disease and smoking status were obtained during the PSS assessment and confirmed through chart reviews. RESULTS After exclusions, the study sample included 449 current or ex-smokers. Abnormal spirometry results were found in 184 (41%) patients: 73 (16%) had mild, 93 (21%) had moderate and 18 (4%) had severe or very severe airflow obstruction. One hundred eighteen (26%) new cases of airflow obstruction suggestive of COPD were detected. One-half of these new cases had moderate or severe airflow obstruction. Only 34% of patients with abnormal spirometry results had reported a previous diagnosis of COPD. More than one-half of patients with abnormal spirometry results were current smokers. CONCLUSIONS Undiagnosed airflow obstruction was detected in a significant number of smokers and ex-smokers through a targeted screening program within a PSS clinic. These patients can be referred for early intervention and secondary preventive strategies.
Collapse
Affiliation(s)
| | - Esther Dajczman
- Airways Centre, Division of Pulmonary Diseases, McGill University
- Department of Nursing, Jewish General Hospital, McGill University
- Mount Sinai Hospital, Montreal, Quebec
| | - Andrew M Hirsch
- Airways Centre, Division of Pulmonary Diseases, McGill University
| | - David Small
- Airways Centre, Division of Pulmonary Diseases, McGill University
| | - Pierre Ernst
- Airways Centre, Division of Pulmonary Diseases, McGill University
| | - Dana Porubska
- Department of Nursing, Jewish General Hospital, McGill University
| | - Mark Palayew
- Airways Centre, Division of Pulmonary Diseases, McGill University
| |
Collapse
|
16
|
Strong M, Green A, Goyder E, Miles G, Lee ACK, Basran G, Cooke J. Accuracy of diagnosis and classification of COPD in primary and specialist nurse-led respiratory care in Rotherham, UK: a cross-sectional study. PRIMARY CARE RESPIRATORY JOURNAL : JOURNAL OF THE GENERAL PRACTICE AIRWAYS GROUP 2014; 23:67-73. [PMID: 24477772 PMCID: PMC6442286 DOI: 10.4104/pcrj.2014.00005] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Revised: 10/02/2013] [Accepted: 12/12/2013] [Indexed: 11/21/2022]
Abstract
BACKGROUND Studies have suggested that chronic obstructive pulmonary disease (COPD) is commonly misdiagnosed and misclassified in primary care, but less is known about the quality of diagnosis in specialist respiratory care. AIMS To measure the accuracy of COPD diagnosis and classification of airway obstruction in primary care and at a specialist respiratory centre, and to explore associations between misdiagnosis and misclassification and a range of explanatory factors. METHODS Data were obtained for 1,205 referrals to a specialist respiratory centre between 2007 and 2010. Standard analysis methods were used. RESULTS The majority of patients were referred for pulmonary rehabilitation (676/1,205, 56%). Of 1,044 patients with a primary care diagnosis of COPD, 211 (20%) had spirometry inconsistent with COPD. In comparison, of 993 specialist centre diagnoses, 65 (6.5%) had inconsistent spirometry. There was poor agreement between the airflow obstruction grade recorded on the referral and that based on spirometry (kappa=0.26, n=448), whereas agreement between the respiratory centre assessment of airflow obstruction and spirometry was good (kappa=0.88, n=1,016). Referral by practice nurse was associated with accuracy of airflow obstruction classification in primary care (OR 1.85, 95% CI 1.33 to 2.57). Males were more likely than females to have an accurate specialist care classification of airway obstruction (OR 1.40, 95% CI 1.01 to 1.93). Grade of airway obstruction changed between referral and assessment in 56% of cases. CONCLUSIONS In primary care, a proportion of patients diagnosed with COPD do not have COPD, and misclassification of grade of airflow obstruction is common. Misdiagnosis and misclassification is less common in the specialist care setting of BreathingSpace.
Collapse
Affiliation(s)
- Mark Strong
- School for Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Angela Green
- National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for South Yorkshire, NHS Rotherham Clinical Commissioning Group, Rotherham, UK
| | - Elizabeth Goyder
- School for Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Gail Miles
- BreathingSpace, The Rotherham NHS Foundation Trust, Rotherham, UK
| | - Andrew CK Lee
- School for Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Gurnam Basran
- BreathingSpace, The Rotherham NHS Foundation Trust, Rotherham, UK
| | - Jo Cooke
- NIHR CLAHRC for South Yorkshire, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| |
Collapse
|
17
|
Weiss G, Steinacher I, Lamprecht B, Schirnhofer L, Kaiser B, Sönnichsen A, Studnicka M. Detection of chronic obstructive pulmonary disease in primary care in Salzburg, Austria: findings from the real world. ACTA ACUST UNITED AC 2013; 87:136-43. [PMID: 24296512 DOI: 10.1159/000354796] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Accepted: 07/22/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a major public health burden and profoundly affects individuals suffering from the disease. However, the majority of subjects with COPD are still undiagnosed. OBJECTIVES To evaluate COPD prevalence and detection strategies for COPD in the primary-care setting. METHODS The study was conducted in a random sample of general practitioner (GP) offices in Salzburg (Austria). A questionnaire and post-bronchodilator (PBD) spirometry was administered to patients aged ≥ 40 years. Nonreversible airway obstruction was considered when PBD FEV1/FVC was <0.70. Severity of spirometrically defined COPD was graded according to the GOLD recommendations. RESULTS 60 GP offices were randomly selected for study participation, however only 30 (50.0%) were willing to participate. 1,230 of 9,820 (12.52%) patients consented to the protocol. Quality of PBD spirometry was evaluated, and 882 (71.7%) met ATS/ERS quality criteria. 7.5% (95% CI: 5.7-9.4%) of the patients had COPD grade II+ (FEV1/FVC <0.7 and FEV1 <80% of predicted), but only 22.4% of them reported a prior physician's diagnosis of COPD. Similar results were seen for the 2005 Salzburg BOLD (Burden of Obstructive Lung Disease) sample with regard to COPD GOLD II+ prevalence (10.7%) and proportion of underdiagnosis (82.3%). CONCLUSION COPD in the primary-care setting is as prevalent and underdiagnosed as reported recently for the BOLD study. The surprisingly low participation rate of GPs and patients indicates that prevention of COPD is not a health priority, and that awareness for COPD has to heightened before case-finding strategies will be successful.
Collapse
|
18
|
Marks GB. Evaluation of patients with symptoms of chronic lung disease in primary care. PRIMARY CARE RESPIRATORY JOURNAL : JOURNAL OF THE GENERAL PRACTICE AIRWAYS GROUP 2013; 22:145-7. [PMID: 23708115 PMCID: PMC6442807 DOI: 10.4104/pcrj.2013.00054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Affiliation(s)
- Guy B Marks
- Clinical Professor and Head, Respiratory and Environmental Epidemiology, Woolcock Institute of Medical Research, Sydney, Australia
- Senior Staff Specialist Physician, Department of Respiratory Medicine, Liverpool Hospital, Sydney, Australia
- PO Box M77 Missenden Road PO, NSW 2050, Australia Tel: +61 2 9114 0466 Fax: +61 2 9114 0412 E-mail:
| |
Collapse
|
19
|
Koblizek V, Chlumsky J, Zindr V, Neumannova K, Zatloukal J, Zak J, Sedlak V, Kocianova J, Zatloukal J, Hejduk K, Pracharova S. Chronic Obstructive Pulmonary Disease: official diagnosis and treatment guidelines of the Czech Pneumological and Phthisiological Society; a novel phenotypic approach to COPD with patient-oriented care. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2013; 157:189-201. [PMID: 23733084 DOI: 10.5507/bp.2013.039] [Citation(s) in RCA: 92] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2013] [Accepted: 05/20/2013] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND COPD is a global concern. Currently, several sets of guidelines, statements and strategies to managing COPD exist around the world. METHODS The Czech Pneumological and Phthisiological Society (CPPS) has commissioned an Expert group to draft recommended guidelines for the management of stable COPD. Subsequent revisions were further discussed at the National Consensus Conference (NCC). Reviewers' comments contributed to the establishment of the document's final version. DIAGNOSIS The hallmark of the novel approach to COPD is the integrated evaluation of the patient's lung functions, symptoms, exacerbations and identifications of clinical phenotype(s). The CPPS defines 6 clinically relevant phenotypes: frequent exacerbator, COPD-asthma overlap, COPD-bronchiectasis overlap, emphysematic phenotype, bronchitic phenotype and pulmonary cachexia phenotype. TREATMENT Treatment recommendations can be divided into four steps. 1(st) step = Risk exposure elimination: reduction of smoking and environmental tobacco smoke (ETS), decrease of home and occupational exposure risks. 2(nd) step = Standard treatment: inhaled bronchodilators, regular physical activity, pulmonary rehabilitation, education, inhalation training, comorbidity treatment, vaccination. 3(rd) step = Phenotype-specific therapy: PDE4i, ICS+LABA, LVRS, BVR, AAT augmentation, physiotherapy, mucolytic, ABT. 4(th) step = Care for respiratory insufficiency and terminal COPD: LTOT, lung transplantation, high intensity-NIV and palliative care. CONCLUSION Optimal treatment of COPD patients requires an individualised, multidisciplinary approach to the patient's symptoms, clinical phenotypes, needs and wishes. The new Czech COPD guideline reflects and covers these requirements.
Collapse
Affiliation(s)
- Vladimir Koblizek
- Pulmonary Department, Faculty of Medicine in Hradec Kralove, Charles University in Prague and University Hospital Hradec Kralove, Czech Republic.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|