Prevalence of chronic obstructive pulmonary disease in kocaeli: an industrialised city in Turkey

The CO-MIND Study: Chronic Obstructive Pulmonary Disease Management in Daily Practice and Its Implications for Improved Outcomes According to GOLD 2019 Perspective

Purpose

GOLD 2019 proposed a novel treatment decision tool for follow-up based on the predominant trait (exacerbation or dyspnea) of patients, alongside treatment escalation and de-escalation strategies. This study was designed to provide an up-to-date snapshot of patient and disease characteristics, treatment pathways, and healthcare resource use (HRU) in COPD in real life, and comprehensively examine patients considering GOLD 2019 recommendations.

Patients and Methods

This mixed design, observational, multicenter (14 pulmonology clinics) study included all patients with a documented COPD diagnosis (excluding asthma-COPD overlap [ACO]) for ≥12 months, aged ≥40 years at diagnosis who had a COPD-related hospital visit, spirometry test and blood eosinophil count (BEC) measurement under stable conditions within the 12 months before enrollment between February and December 2020. Data were collected cross-sectionally from patients and retrospectively from hospital medical records.

Results

This study included 522 patients (GOLD group A: 17.2%, B: 46.4%, C: 3.3%, D: 33.1%), of whom 79.5% were highly symptomatic and 36.2% had high risk of exacerbation. Exacerbations (n = 832; 46.6% moderate, 25.5% severe) were experienced by 57.5% of patients in the previous 12 months. Inter-rater agreement between investigators and patients regarding the reason for visit was low (κ coefficient: 0.338, p = 0.001). Inhaled treatment was modified in 88 patients at index, mainly due to symptomatic state (31.8%) and exacerbations (27.3%); treatment was escalated (57.9%, mainly switched to LABA+LAMA+ICS), inhaler device and/or active ingredient was changed (36.4%) or treatment was de-escalated (5.7%). 27% had ≥1 hospital overnight stay over 12 months. Emergency department visits and days with limitation of daily activities were higher in group D (p < 0.001).

Conclusion

Despite being on-treatment, many patients with COPD experience persistent symptoms and exacerbations requiring hospital-related HRU. A treatable trait approach and holistic disease management may improve outcomes by deciding the right treatment for the right patient at the right time.

Thyroid Gland Disease as a Comorbid Condition in COPD

INTRODUCTION

Chronic obstructive pulmonary disease (COPD) is one of the most common causes of morbidity and mortality worldwide. The disease is characterized by progressive airway inflammation, which not only affects the airways but also has systemic effects that are associated with comorbidities. Although comorbid conditions such as hypertension and coronary artery disease are very well-known in COPD patients, diseases of the thyroid gland have not been sufficiently studied. Therefore, thyroid diseases are not considered among the comorbid conditions of COPD. The purpose of this study was to determine the thyroid gland disease (TGD) prevalence in COPD and associated factors. Materials and Method. The study included 309 (297 (96%) male) patients. The patients were subjected to spirometry and thyroid function tests (TFT) in the stable period. The thyroid gland disease they were diagnosed with was recorded after face-to-face meetings and examining their files.

RESULTS

The mean age of the patients who were included in the study was 65.9 ± 9.8 (40-90). Thyroid disease was determined in 68 (22%) individuals. There were hypothyroidism in 7 (2%), euthyroidism in 45 (15%), and hyperthyroidism in 16 (%5) patients. No relationship was found between the severity of airflow limitation and the prevalence of TGD.

CONCLUSION

Thyroid abnormalities are commonly observed in COPD. The most frequently encountered TGDs are euthyroid multinodular goiter, euthyroid sick syndrome (ESS), and toxic multinodular goiter.

Does Nutritional Risk Screening 2002 Correlate with the Dyspnea Status of Patients with GOLD Stage C-D Chronic Obstructive Pulmonary Disease?

OBJECTIVES

Dyspnea is a prominent symptom of chronic obstructive pulmonary disease (COPD). Patients with Global Initiative for Obstructive Lung Disease (GOLD) Stage C-D often complain of dyspnea, but the relationship between their level of dyspnea and their nutritional status has not yet been established. The aim of this study was to evaluate the dyspnea levels and nutritional status ofstable COPD patients in the out patient clinic.

MATERIALS AND METHODS

Medical records including the Modified Medical Research Council (mMRC) Dyspnea Scale and the nutritional status of 41 patients were investigated in the study. The meanage of patients was 71.7±9.2 years. The Nutritional Risk Screening 2002 (NRS-2002) tool, body mass index (BMI), and mid-upper arm circumference were used to evaluate their nutritional status. We used correlation analysis to display the relationship between NRS-2002 score and MRC, COPD stage, and biochemical and anthropometric parameters indicating the nutritional status of patients.

RESULTS

Out of the 41 COPD patients 87.8% (36) enrolled in the study were men and 12.2% (5) were women. The GOLD stages of the patients were 29.3% of patients with stage C and 70.7% with stage D. The risk of malnutrition (NRS ≥3) was detected in 48.8% of the patients, whereas 51.2% of patients (NRS<3) were risk-free. The mid-upper arm circumference of at risk patients was lower (25.6±3.2 vs 29.9±2.7 cm, p=0.032). The NRS-2002 score had a positive correlation with mMRC records (r=0.351, p=0.024). There was a statistically significant negative correlation between the NRS-2002 score and the mid-upper arm circumference (r=0.604, p<0.0001). Also, there was a negative correlation between BMI and mid-upper arm circumference (r=0.699, p<0.0001).

CONCLUSION

The risk of malnutrition was common in stable COPD patients at the outpatient clinic, which seemed to adversely affect their dyspnea level. Therefore, while planning the treatment of COPD patients, evaluating their nutritional status and taking precautions accordingly contribute to the shortness of breath which is one of the most significant symptoms of the disease.

The relation between self-efficacy in patients with chronic obstructive pulmonary disease and caregiver burden

AIM

The study was conducted to examine the relation between self-efficacy in patients with chronic obstructive pulmonary disease (COPD) and caregiver burden.

MATERIAL AND METHODS

This descriptive, cross-sectional study included 200 patients with stage II and III COPD presenting to hospital between June and November in 2017 and their caregivers. Data were gathered with a questionnaire, COPD Assessment Test and COPD Self-Efficacy Scale from the patients. A questionnaire and Caregiver Burden Scale was used to collect data from the caregivers. Obtained data were analysed with the descriptive statistics numbers, percentages, mean, median and standard deviation. Spearman's correlation analysis was utilised to examine the relation between paired groups.

RESULTS

The mean age of the patients with COPD was 63.53 years and 51.1% of the patients were female. The mean age of the caregivers was 48.88 ± 14.09 years. 54.4% of the caregivers were aged 40-60 years, and 59.9% of the caregivers were female. The mean score was 26.97 ± 5.25 for COPD Assessment Test and 2.32 ± 0.43 for COPD Self-Efficacy Scale. Of all the caregivers, 64.8% had mild caregiving burden and 18.1% had moderate caregiving burden. The mean score for Caregiver Burden Scale had a significant, moderate relation with the mean score for the subscale physical effort in COPD Self-Efficacy Scale (r = -0.42; p < 0.01) and had a significant, weak, negative relation with the mean total score for COPD Self-Efficacy Scale and the mean scores for its subscales. There was a significant, moderate, positive relation between the mean scores for Caregiver Burden and COPD Assessment Test (r = 0.51; p < 0.001) and a significant, negative relation between the scores for COPD Self-Efficacy Scale and its subscales and the scores for CAT (r = -0.26 - r = -0.52; p < 0.05).

CONCLUSION

As self-efficacy in COPD patients increases, their health and daily lives are affected less by COPD and caregiver burden decreases.

Geographical distribution of COPD prevalence in Europe, estimated by an inverse distance weighting interpolation technique

Existing data on COPD prevalence are limited or totally lacking in many regions of Europe. The geographic information system inverse distance weighted (IDW) interpolation technique has proved to be an effective tool in spatial distribution estimation of epidemiological variables, when real data are few and widely separated. Therefore, in order to represent cartographically the prevalence of COPD in Europe, an IDW interpolation mapping was performed. The point prevalence data provided by 62 studies from 19 countries (21 from 5 Northern European countries, 11 from 3 Western European countries, 14 from 5 Central European countries, and 16 from 6 Southern European countries) were identified using validated spirometric criteria. Despite the lack of data in many areas (including all regions of the eastern part of the continent), the IDW mapping predicted the COPD prevalence in the whole territory, even in extensive areas lacking real data. Although the quality of the data obtained from some studies may have some limitations related to different confounding factors, this methodology may be a suitable tool for obtaining epidemiological estimates that can enable us to better address this major public health problem.

A multicenter family practitioners’ research on Chronic Obstructive Pulmonary Disease screening using the COPD Assessment Test

Objectives

Spirometry is known to be a gold standard for the diagnosis of chronic obstructive pulmonary disease (COPD). COPD Assessment Test (CAT) is an eight-item questionnaire currently in use to evaluate patients with COPD. In the present study, we aimed to evaluate if CAT is an adequate tool for screening COPD.

Methods

In total, 600 persons aging ⩾40 years old were randomly selected from three different family practice units located in the city center. CAT was asked to the participants and a spirometry was used to assess pulmonary obstruction. Pulmonary obstruction was defined as forced expiratory volume in first second/forced vital capacity (FEV1/FVC)&lt;70% and then COPD diagnosis was confirmed with the reversibility test. The relationship between CAT results and pulmonary function test values was evaluated.

Results

In this sampling, the prevalence of COPD was 4.2%. Reliability of the CAT in the study group was acceptable (Cronbach’s α: 0.84). The CAT scores was significantly higher in patients with COPD (P&lt;0.001). There was a significant negative correlation between CAT score and FEV1, FVC and FEV1/FVC ratio (r=−0.31, P&lt;0.001; r=−0.26, P&lt;0.001; r=0.18, P=0.001). Among smokers, phlegm was the predominating symptom (P=0.01). Sensitivity of CAT was 66.67% and its specificity was 75.15% to determine COPD.

Conclusions

CAT is a reliable questionnaire and there is an apparent relationship between the total CAT scores and COPD. However, CAT’s ability to screen COPD is limited since it may miss the symptom-free cases.

Global and regional estimates of COPD prevalence: Systematic review and meta-analysis

Background

The burden of chronic obstructive pulmonary disease (COPD) across many world regions is high. We aim to estimate COPD prevalence and number of disease cases for the years 1990 and 2010 across world regions based on the best available evidence in publicly accessible scientific databases.

Methods

We conducted a systematic search of Medline, EMBASE and Global Health for original, population–based studies providing spirometry–based prevalence rates of COPD across the world from January 1990 to December 2014. Random effects meta–analysis was conducted on extracted crude prevalence rates of COPD, with overall summaries of the meta–estimates (and confidence intervals) reported separately for World Health Organization (WHO) regions, the World Bank's income categories and settings (urban and rural). We developed a meta–regression epidemiological model that we used to estimate the prevalence of COPD in people aged 30 years or more.

Findings

Our search returned 37 472 publications. A total of 123 studies based on a spirometry–defined prevalence were retained for the review. From the meta–regression epidemiological model, we estimated about 227.3 million COPD cases in the year 1990 among people aged 30 years or more, corresponding to a global prevalence of 10.7% (95% confidence interval (CI) 7.3%–14.0%) in this age group. The number of COPD cases increased to 384 million in 2010, with a global prevalence of 11.7% (8.4%–15.0%). This increase of 68.9% was mainly driven by global demographic changes. Across WHO regions, the highest prevalence was estimated in the Americas (13.3% in 1990 and 15.2% in 2010), and the lowest in South East Asia (7.9% in 1990 and 9.7% in 2010). The percentage increase in COPD cases between 1990 and 2010 was the highest in the Eastern Mediterranean region (118.7%), followed by the African region (102.1%), while the European region recorded the lowest increase (22.5%). In 1990, we estimated about 120.9 million COPD cases among urban dwellers (prevalence of 13.2%) and 106.3 million cases among rural dwellers (prevalence of 8.8%). In 2010, there were more than 230 million COPD cases among urban dwellers (prevalence of 13.6%) and 153.7 million among rural dwellers (prevalence of 9.7%). The overall prevalence in men aged 30 years or more was 14.3% (95% CI 13.3%–15.3%) compared to 7.6% (95% CI 7.0%–8.2%) in women.

Conclusions

Our findings suggest a high and growing prevalence of COPD, both globally and regionally. There is a paucity of studies in Africa, South East Asia and the Eastern Mediterranean region. There is a need for governments, policy makers and international organizations to consider strengthening collaborations to address COPD globally.

Evaluation of malnutrition detected with the Nutritional Risk Screening 2002 (NRS-2002) and the quality of life in hospitalized patients with chronic obstructive pulmonary disease

BACKGROUND

Patients with severe chronic obstructive pulmonary disease (COPD) have impaired quality of life, but the relationship between their nutritional status and quality of life has not been established. The aim of this study was to determine the relationship between quality of life and nutritional status in hospitalized COPD patients.

METHODS

Demographic data, quality of life and nutritional status of 90 inpatients with a mean age of 68.76 ± 10.85 years were enrolled in the study. The Nutritional Risk Screening 2002 (NRS-2002) tool was used to evaluate their nutritional status. The quality of life was assessed using the Short Form-36 (SF-36) questionnaire. The correlation analysis was used for the relationship between SF-36 subscales and nutritional status variables.

RESULTS

Of the 90 COPD patients included in the study, 54.4 % were men, and 45.6 % were women. Moderate, severe, and very severe COPD were detected in 37.8 %, 38.9 %, and 23.3 % of the patients, respectively. At risk of malnutrition were 55.6 % of the 90 COPD patients, whereas 44.4 % were not. The scores for physical function, physical role functioning, pain, general health, emotional role functioning, vitality, social function, and mental function subscales were lower in the patients at risk of malnutrition (p <0.001). There was a statistically significant negative correlation between malnutrition score and the subscores of SF-36 related to physical function, physical role functioning, pain, general health, emotional role functioning, vitality, social function, and mental function (p <0.001).

CONCLUSIONS

COPD patients were found to have a high risk of malnutrition that adversely affects their quality of life. Therefore, the evaluation of the nutritional status of COPD patients should be an integral part of their clinical treatment plans aiming towards improving their quality of life. Hippokratia 2016, 20(2):147-152.

Global and regional estimates of COPD prevalence: Systematic review and meta-analysis

BACKGROUND

The burden of chronic obstructive pulmonary disease (COPD) across many world regions is high. We aim to estimate COPD prevalence and number of disease cases for the years 1990 and 2010 across world regions based on the best available evidence in publicly accessible scientific databases.

METHODS

We conducted a systematic search of Medline, EMBASE and Global Health for original, population-based studies providing spirometry-based prevalence rates of COPD across the world from January 1990 to December 2014. Random effects meta-analysis was conducted on extracted crude prevalence rates of COPD, with overall summaries of the meta-estimates (and confidence intervals) reported separately for World Health Organization (WHO) regions, the World Bank's income categories and settings (urban and rural). We developed a meta-regression epidemiological model that we used to estimate the prevalence of COPD in people aged 30 years or more.

FINDINGS

Our search returned 37 472 publications. A total of 123 studies based on a spirometry-defined prevalence were retained for the review. From the meta-regression epidemiological model, we estimated about 227.3 million COPD cases in the year 1990 among people aged 30 years or more, corresponding to a global prevalence of 10.7% (95% confidence interval (CI) 7.3%-14.0%) in this age group. The number of COPD cases increased to 384 million in 2010, with a global prevalence of 11.7% (8.4%-15.0%). This increase of 68.9% was mainly driven by global demographic changes. Across WHO regions, the highest prevalence was estimated in the Americas (13.3% in 1990 and 15.2% in 2010), and the lowest in South East Asia (7.9% in 1990 and 9.7% in 2010). The percentage increase in COPD cases between 1990 and 2010 was the highest in the Eastern Mediterranean region (118.7%), followed by the African region (102.1%), while the European region recorded the lowest increase (22.5%). In 1990, we estimated about 120.9 million COPD cases among urban dwellers (prevalence of 13.2%) and 106.3 million cases among rural dwellers (prevalence of 8.8%). In 2010, there were more than 230 million COPD cases among urban dwellers (prevalence of 13.6%) and 153.7 million among rural dwellers (prevalence of 9.7%). The overall prevalence in men aged 30 years or more was 14.3% (95% CI 13.3%-15.3%) compared to 7.6% (95% CI 7.0%-8.2%) in women.

CONCLUSIONS

Our findings suggest a high and growing prevalence of COPD, both globally and regionally. There is a paucity of studies in Africa, South East Asia and the Eastern Mediterranean region. There is a need for governments, policy makers and international organizations to consider strengthening collaborations to address COPD globally.