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Jacobsen PA, van 't Hul AJ, Djamin RS, Antons JC, de Man M, Weinreich UM, Spruit MA, Janssen DJA. Characteristics and treatable traits of patients with chronic obstructive pulmonary disease (COPD) with and without paid employment. Respir Res 2021; 22:147. [PMID: 33980226 PMCID: PMC8117298 DOI: 10.1186/s12931-021-01736-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 05/02/2021] [Indexed: 01/11/2023] Open
Abstract
Introduction Patients with COPD are vulnerable to workforce detachment. Better knowledge of features associated with paid work loss might be of help to design and select appropriate interventions. Method This cross-sectional study aimed to explore the presence of treatable traits in COPD patients without paid work. Patients with COPD below 65 years at first referral to a hospital-based patient clinic were included. Using binary logistic regression analysis, the relationship between paid work and the following characteristics was explored: low daily physical activity, exercise, active smoking, Medical Research Council dyspnea scale (MRC), poor nutritional status, exacerbations, and fatigue (checklist individual strength (CIS)). Variables were adjusted for age, sex, forced expiratory volume in 1 s (FEV 1), and education level. Results In total, 191 patients (47.3%) were without paid work. The following treatable traits were related to not being in paid work: < 5000 steps/day (OR 2.36, 95% CI (1.52–3.68)), MRC ≥ 3 (OR 1.78, 95%CI (1.14–2.77)), CIS ≥ 36 points (OR 1.78, 95% CI (1.10–2.87)), six-minute walk distance (6MWD) < 70% of predicted (OR 2.62, 95% CI (1.69–4.06)), and ≥ 2 exacerbations per year (OR 1.80, 95% CI (1.12–2.92)). Significant differences were also seen in age (OR 1.06, 95% CI (1.02–1.10) per year), FEV 1% predicted (OR 0.98, 95% CI (0.97–1.00) per % predicted increase), and medium/high education level (OR 0.62, 95% CI (0.41–0.93)). When adjusting for all variables the only treatable trait that remained significant was 6MWD. Conclusion Patients without paid work are more likely to have treatable traits with 6MWD revealing the most significant association. Supplementary Information The online version contains supplementary material available at 10.1186/s12931-021-01736-6.
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Affiliation(s)
- Peter A Jacobsen
- Department of Respiratory Diseases, Aalborg University Hospital, Mølleparkvej 4, 9100, Aalborg, Denmark. .,The Clinical Institute, Aalborg University, Aalborg, Denmark.
| | - Alex J van 't Hul
- Department of Respiratory Diseases, Radboud University Medical Center, Radboud Institute for Health Sciences, 6525 GA, Nijmegen, The Netherlands
| | - Remco S Djamin
- Department of Respiratory Diseases, Amphia Hospital, 4818 CK, Breda, The Netherlands
| | - Jeanine C Antons
- Department of Respiratory Diseases, Radboud University Medical Center, Radboud Institute for Health Sciences, 6525 GA, Nijmegen, The Netherlands
| | - Marianne de Man
- Department of Respiratory Diseases, 5406, Uden, The Netherlands
| | - Ulla Møller Weinreich
- Department of Respiratory Diseases, Aalborg University Hospital, Mølleparkvej 4, 9100, Aalborg, Denmark.,The Clinical Institute, Aalborg University, Aalborg, Denmark
| | - Martijn A Spruit
- Department of Research and Development, Ciro, Horn, The Netherlands.,Faculty of Health, Medicine and Life Sciences, Nutrim School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands.,Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - Daisy J A Janssen
- Department of Research and Development, Ciro, Horn, The Netherlands.,Department of Health Services Research, Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
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2
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Schofield SJ, Woods A, Szram J, Newman Taylor AJ, Cullinan P. Chronic Obstructive Pulmonary Disease and Breathlessness in Older Workers Predict Economic Inactivity. A Prospective Cohort Study. Am J Respir Crit Care Med 2020; 200:1228-1233. [PMID: 31348686 DOI: 10.1164/rccm.201902-0297oc] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Rationale: There is an aspiration to retain increasing numbers of older workers in employment, and strategies to achieve this need to make provision for the increasing prevalence of chronic diseases with age. There is a consistent body of cross-sectional evidence that suggests that patients with chronic obstructive pulmonary disease are more likely to have adverse employment outcomes.Objectives: We report the findings of the first longitudinal study of this issue.Methods: We recruited full-time employed men and women in their 50s and followed them for a period of 18 months; we examined, after adjustment for potential confounders, the associations between breathlessness and airway obstruction at baseline and loss of employment in the intervening period.Measurements and Main Results: Among participants responding to the follow-up questionnaire (1,656 of 1,773 [93%]), the majority (78.5%) continued in full-time employment, but 10.6% were in part-time employment and 10.9% were no longer in paid employment. The adjusted risk of loss of employment was significantly increased for those with moderate or severe chronic obstructive pulmonary disease (risk ratio, 2.89; 95% confidence interval, 1.80-4.65) or breathlessness (risk ratio, 3.07; 95% confidence interval, 2.16-4.37) at baseline. There was no evident modification by sex or by manual/nonmanual work.Conclusions: Airway obstruction and breathlessness are independently associated with premature loss from the workforce in older workers; these observations provide strong support to the available cross-sectional evidence and suggest that interventions to help those with chronic obstructive pulmonary disease who wish to remain in work need to be tested.
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Affiliation(s)
- Susie J Schofield
- Occupational and Environmental Medicine, National Heart and Lung Institute, Imperial College London, London, United Kingdom; and
| | - Annette Woods
- Occupational and Environmental Medicine, National Heart and Lung Institute, Imperial College London, London, United Kingdom; and
| | - Joanna Szram
- Occupational and Environmental Medicine, National Heart and Lung Institute, Imperial College London, London, United Kingdom; and.,Respiratory Medicine, Royal Brompton Hospital, London, United Kingdom
| | - Anthony J Newman Taylor
- Occupational and Environmental Medicine, National Heart and Lung Institute, Imperial College London, London, United Kingdom; and
| | - Paul Cullinan
- Occupational and Environmental Medicine, National Heart and Lung Institute, Imperial College London, London, United Kingdom; and.,Respiratory Medicine, Royal Brompton Hospital, London, United Kingdom
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3
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Abstract
The PLATINO and PREPOCOL population-based studies documented the prevalence of chronic obstructive pulmonary disease (COPD) in several Latin American (Mexico City, Sao Paulo, Montevideo, Santiago and Caracas) and Colombian (Medellin, Bogota, Barranquilla, Bucaramanga and Cali) cities. COPD ranged between 6.2 and 19.6% in individuals ≥40 years of age, with substantial rates of underdiagnosis (up to 89%) but also overdiagnosis, mostly due to the lack of spirometric confirmation. The main risk factor was tobacco smoking, but male gender and age were also associated with COPD. COPD in never smokers represented about one third of the cases and was associated with previous history of tuberculosis or a diagnosis of asthma. COPD associated with biomass smoke exposure was a common clinical phenotype in Latin America, found as a risk factor in PREPOCOL and other observational studies in the region. Smoking has been decreasing in Latin America and efforts have been made to implement cleaner biomass stoves. Unfortunately, treatment of COPD in Latin America remains highly variable with low rates of smoking cessation counselling, low use of inhaled bronchodilators and influenza vaccination. A primary-care approach to COPD, particularly in the form of integrated programs is lacking but would be critical to improving rates of diagnosis and treatment of COPD.
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4
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Rai KK, Adab P, Ayres JG, Jordan RE. Systematic review: chronic obstructive pulmonary disease and work-related outcomes. Occup Med (Lond) 2019. [PMID: 29528460 DOI: 10.1093/occmed/kqy012] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Several studies have assessed the impact of chronic obstructive pulmonary disease (COPD) on work ability and work productivity; however, this relationship is poorly understood. Aims To undertake a systematic review to assess the effects of COPD on employment, absenteeism and presenteeism. Methods A comprehensive search using CINAHL, Embase, MEDLINE and the Cochrane Library was conducted to include epidemiological studies from 1937 to August 2017. One reviewer screened all citations. Shortlisted full-text articles were independently assessed by a second reviewer. Data were extracted by one reviewer with a random sample of papers (45%) checked by a second reviewer. Results Forty-four studies were included; the majority of evidence was from cross-sectional studies, and some cohort studies. COPD patients had lower employment rates than those without COPD. Among those in work, most studies showed patients with COPD took more time off work than those without and reported poorer work performance (presenteeism), although evidence for this association was weaker. The influence of disease severity on these outcomes was unclear; however, it appeared that increasing severity of airflow obstruction was associated with reduced likelihood of being employed. A number of methodological limitations were found among the evidence, including the lack of adjustment for important confounders. Conclusions Future studies are required which assess the impact of COPD on presenteeism using validated presenteeism instruments and consistent reporting methods. Robust studies are now needed to identify modifiable factors associated with these poorer working outcomes to inform future interventions aimed at improving work productivity among those with COPD.
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Affiliation(s)
- K K Rai
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, UK
| | - P Adab
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, UK
| | - J G Ayres
- Institute of Clinical Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - R E Jordan
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, UK
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5
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Grønseth R, Erdal M, Tan WC, Obaseki DO, Amaral AFS, Gislason T, Juvekar SK, Koul PA, Studnicka M, Salvi S, Burney P, Buist AS, Vollmer WM, Johannessen A. Unemployment in chronic airflow obstruction around the world: results from the BOLD study. Eur Respir J 2017; 50:50/3/1700499. [PMID: 28931661 PMCID: PMC5898950 DOI: 10.1183/13993003.00499-2017] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 06/20/2017] [Indexed: 11/05/2022]
Abstract
We aimed to examine associations between chronic airflow obstruction (CAO) and unemployment across the world. Cross-sectional data from 26 sites in the Burden of Obstructive Lung Disease (BOLD) study were used to analyse effects of CAO on unemployment. Odds ratios for unemployment in subjects aged 40–65 years were estimated using a multilevel mixed-effects generalised linear model with study site as random effect. Site-by-site heterogeneity was assessed using individual participant data meta-analyses. Out of 18 710 participants, 11.3% had CAO. The ratio of unemployed subjects with CAO divided by subjects without CAO showed large site discrepancies, although these were no longer significant after adjusting for age, sex, smoking and education. The site-adjusted odds ratio (95% CI) for unemployment was 1.79 (1.41–2.27) for CAO cases, decreasing to 1.43 (1.14–1.79) after adjusting for sociodemographic factors, comorbidities and forced vital capacity. Of other covariates that were associated with unemployment, age and education were important risk factors in high-income sites (4.02 (3.53–4.57) and 3.86 (2.80–5.30), respectively), while female sex was important in low- to middle-income sites (3.23 (2.66–3.91)). In the global BOLD study, CAO was associated with increased levels of unemployment, even after adjusting for sociodemographic factors, comorbidities and lung function. Chronic airflow obstruction increases risk of unemployment, and is a burden to welfare systems worldwidehttp://ow.ly/cxzv30cQ17A
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Affiliation(s)
- Rune Grønseth
- Dept of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway
| | - Marta Erdal
- Dept of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway .,Dept of Clinical Science, University of Bergen, Bergen, Norway
| | - Wan C Tan
- UBC James Hogg Research Centre, St Paul's Hospital, Vancouver, BC, Canada
| | | | - Andre F S Amaral
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Thorarinn Gislason
- Dept of Respiratory Medicine and Sleep, Faculty of Medicine, University of Iceland, Landspitali University Hospital, Reykjavik, Iceland
| | - Sanjay K Juvekar
- Vadu Health and Demographic Surveillance System, KEM Hospital Research Centre Pune, Pune, India
| | - Parvaiz A Koul
- Dept of Internal and Pulmonary Medicine, SheriKashmir Institute of Medical Sciences, Srinagar, India
| | - Michael Studnicka
- Dept of Pulmonary Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Sundeep Salvi
- Chest Research Foundation, Chest Research Foundation, Pune, India
| | - Peter Burney
- National Heart and Lung Institute, Imperial College London, London, UK
| | - A Sonia Buist
- Pulmonary and Critical Care Medicine, UHN67, Oregon Health and Science University, Portland, OR, USA
| | | | - Ane Johannessen
- Centre for International Health, Dept of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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6
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Rai KK, Jordan RE, Siebert WS, Sadhra SS, Fitzmaurice DA, Sitch AJ, Ayres JG, Adab P. Birmingham COPD Cohort: a cross-sectional analysis of the factors associated with the likelihood of being in paid employment among people with COPD. Int J Chron Obstruct Pulmon Dis 2017; 12:233-242. [PMID: 28138233 PMCID: PMC5238806 DOI: 10.2147/copd.s119467] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Employment rates among those with chronic obstructive pulmonary disease (COPD) are lower than those without COPD, but little is known about the factors that affect COPD patients' ability to work. METHODS Multivariable analysis of the Birmingham COPD Cohort Study baseline data was used to assess the associations between lifestyle, clinical, and occupational characteristics and likelihood of being in paid employment among working-age COPD patients. RESULTS In total, 608 of 1,889 COPD participants were of working age, of whom 248 (40.8%) were in work. Older age (60-64 years vs 30-49 years: odds ratio [OR] =0.28; 95% confidence interval [CI] =0.12-0.65), lower educational level (no formal qualification vs degree/higher level: OR =0.43; 95% CI =0.19-0.97), poorer prognostic score (highest vs lowest quartile of modified body mass index, airflow obstruction, dyspnea, and exercise (BODE) score: OR =0.10; 95% CI =0.03-0.33), and history of high occupational exposure to vapors, gases, dusts, or fumes (VGDF; high VGDF vs no VGDF exposure: OR =0.32; 95% CI =0.12-0.85) were associated with a lower probability of being employed. Only the degree of breathlessness of BODE was significantly associated with employment. CONCLUSION This is the first study to comprehensively assess the characteristics associated with employment in a community sample of people with COPD. Future interventions should focus on managing breathlessness and reducing occupational exposures to VGDF to improve the work capability among those with COPD.
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Affiliation(s)
| | | | | | - Steven S Sadhra
- Institute of Clinical Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | | | | | - Jon G Ayres
- Institute of Applied Health Research
- Institute of Clinical Sciences, University of Birmingham, Edgbaston, Birmingham, UK
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7
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Montes de Oca M, Aguirre C, Lopez Varela MV, Laucho-Contreras ME, Casas A, Surmont F. Exacerbations and health care resource utilization in patients with airflow limitation diseases attending a primary care setting: the PUMA study. Int J Chron Obstruct Pulmon Dis 2016; 11:3059-3067. [PMID: 27994446 PMCID: PMC5153276 DOI: 10.2147/copd.s120776] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background COPD, asthma, and asthma–COPD overlap increase health care resource consumption, predominantly because of hospitalization for exacerbations and also increased visits to general practitioners (GPs) or specialists. Little information is available regarding this in the primary care setting. Objectives To describe the prevalence and number of GP and specialist visits for any cause or due to exacerbations in patients with COPD, asthma, and asthma–COPD overlap. Methods COPD was defined as post-bronchodilator forced expiratory volume in 1 second/forced vital capacity (FEV1/FVC) ratio <0.70; asthma was defined as prior medical diagnosis, wheezing in the last 12 months, or wheezing plus reversibility (post-bronchodilator FEV1 or FVC increase ≥200 mL and ≥12%); asthma–COPD overlap was defined as post-bronchodilator FEV1/FVC <0.70 plus prior asthma diagnosis. Health care utilization was evaluated as GP and/or specialist visits in the previous year. Results Among the 1,743 individuals who completed the questionnaire, 1,540 performed acceptable spirometry. COPD patients had a higher prevalence of any medical visits to any physician versus those without COPD (37.2% vs 21.8%, respectively) and exacerbations doubled the number of visits. The prevalence of any medical visits to any physician was also higher in asthma patients versus those without asthma (wheezing: 47.2% vs 22.7%; medical diagnosis: 54.6% vs 21.6%; wheezing plus reversibility: 46.2% vs 23.8%, respectively). Asthma patients with exacerbations had twice the number of visits versus those without an exacerbation. The number of visits was higher (2.8 times) in asthma–COPD overlap, asthma (1.9 times), or COPD (1.4 times) patients versus those without these respiratory diseases; the number of visits due to exacerbation was also higher (4.9 times) in asthma–COPD overlap, asthma (3.5 times), and COPD (3.8 times) patients. Conclusion COPD, asthma, and asthma–COPD overlap increase the prevalence of medical visits and, therefore, health care resource utilization. Attempts to reduce health care resource use in these patients require interventions aimed at preventing exacerbations.
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Affiliation(s)
- Maria Montes de Oca
- Service of Pneumology, Hospital Universitario de Caracas, Facultad de Medicina, Universidad Central de Venezuela, Caracas, Venezuela
| | | | | | - Maria E Laucho-Contreras
- Service of Pneumology, Hospital Universitario de Caracas, Facultad de Medicina, Universidad Central de Venezuela, Caracas, Venezuela
| | | | - Filip Surmont
- Medical Affairs, AstraZeneca Latin America, Coral Gables, FL, USA
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8
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Reséndiz-Hernández JM, Sansores RH, Hernández-Zenteno RDJ, Vargas-Alarcón G, Colín-Barenque L, Velázquez-Uncal M, Camarena A, Ramírez-Venegas A, Falfán-Valencia R. Identification of genetic variants in the TNF promoter associated with COPD secondary to tobacco smoking and its severity. Int J Chron Obstruct Pulmon Dis 2015; 10:1241-51. [PMID: 26170653 PMCID: PMC4493967 DOI: 10.2147/copd.s83298] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is an inflammatory disease that arises in response to noxious particles or gases. Associations of genetic polymorphisms in TNF have been reported in Asians and Caucasians, but not in Mestizo populations. A case-control study was conducted in two stages: in the first stage, patients with COPD (COPD group, n=165) and smokers without disease (SNC group, n=165) were included and the TNF promoter sequence was determined using direct sequencing. In the second stage, the identified polymorphisms were validated by real-time polymerase chain reaction (PCR) in COPD (n=260) and SNC (n=506). In the first stage, 11 different sets of “contig” alignments were determined, of which contig 10 was found to be associated with susceptibility (P=5.0E-04, OR [odds ratio] =3.64) and contig 1 with Global Initiative for COPD (GOLD) greater grade (P=1.0E-02, OR =3.82). The single nucleotide polymorphisms found in this region were individually identified; the GA genotypes of rs1800629 (P=0.038, OR =2.07), rs56036015 (P=0.0082, OR =3.18), and rs361525 (P=1.0E-02, OR =4.220) were higher in the COPD group vs the SNC group; after second-stage validation, rs1800629 (P=6.00E-03, OR =2.26) and rs56036015 (P=1.10E-03, OR =2.54) are maintained. There are genetic variants in the TNF promoter associated with increased risk of COPD secondary to smoking and with a higher GOLD grade in the Mexican Mestizo population.
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Affiliation(s)
- Juan Manuel Reséndiz-Hernández
- Laboratory HLA, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico ; Graduate Program in Biological Sciences, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Raúl H Sansores
- Research Department in smoking and COPD, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
| | - Rafael de Jesús Hernández-Zenteno
- Research Department in smoking and COPD, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
| | - Gilber Vargas-Alarcón
- Department of Molecular Biology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | - Laura Colín-Barenque
- Department of Neuroscience, Facultad de Estudios Superiores Iztacala, Universidad Nacional Autónoma de México, Tlalnepantla de Baz, Mexico State, Mexico
| | - Mónica Velázquez-Uncal
- Research Department in smoking and COPD, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
| | - Angel Camarena
- Laboratory HLA, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
| | - Alejandra Ramírez-Venegas
- Research Department in smoking and COPD, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
| | - Ramcés Falfán-Valencia
- Laboratory HLA, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
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9
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Hunt T, Madigan S, Williams MT, Olds TS. Use of time in people with chronic obstructive pulmonary disease--a systematic review. Int J Chron Obstruct Pulmon Dis 2014; 9:1377-88. [PMID: 25548519 PMCID: PMC4271726 DOI: 10.2147/copd.s74298] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
“Physical inactivity” and “sedentary lifestyles” are phrases often used when describing lifestyles of people with chronic obstructive pulmonary disease (COPD). Evidence suggests activity types, independent of energy expenditure, influence health outcomes, so understanding patterns of time use is important, particularly in chronic disease. We aimed to identify reports of time use in people with COPD. Predefined search strategies were used with six electronic databases to identify individual activity reports (including frequencies and/or durations) in which community-dwelling people with COPD engaged. Eligible studies were assessed independently against predefined criteria and data were extracted by two reviewers. Data synthesis was achieved by aggregating activity reports into activity domains (sports/exercise, screen time, transport, quiet time, self-care, sociocultural, work/study, chores, and sleep). Twenty-six publications reported 37 specific daily activities. People with COPD were found to spend extended periods in sedentary behaviors (eg, standing [194 min/day]; sitting [359 min/day]; lying [88 min/day]), have limited engagement in physical activity (eg, walking [51 min/day]; exercising [1.2 episodes per week {ep/w}, 13 min/day]), have high health care needs (medical appointments [1.0 ep/w]), and experience difficulties associated with activities of daily living (eg, showering [2.5 ep/w, 60 minutes per episode]; preparing meals [4.7 ep/w]). Little data could be found describing how people with COPD use their time, and data synthesis was problematic because of variations in methodologies, population differences, and research emphases. Identified data largely referred to posture and were skewed according to country, assessment methods, and disease severity. Comparisons with age-matched population data showed people with COPD spent less time engaged in personal-care activities (self-care and sleeping) and chores than people in similar age groups. The incorporation of time-use outcomes in future research designs should be encouraged. Ideally, these tools should use consistent frameworks and comparable outcome measures in order to provide clearer descriptions of time use in chronic disease.
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Affiliation(s)
- Toby Hunt
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), Sansom Institute for Health Research, School of Health Sciences, University of South Australia, City East Campus, Adelaide, SA, Australia ; Respiratory Clinical Research Unit, Repatriation General Hospital, Daw Park, SA, Australia
| | - Sarah Madigan
- Respiratory Clinical Research Unit, Repatriation General Hospital, Daw Park, SA, Australia
| | - Marie T Williams
- School of Population Health, University of South Australia, City East Campus, Adelaide, SA, Australia
| | - Tim S Olds
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), Sansom Institute for Health Research, School of Health Sciences, University of South Australia, City East Campus, Adelaide, SA, Australia
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Erdal M, Johannessen A, Askildsen JE, Eagan T, Gulsvik A, Grønseth R. Productivity losses in chronic obstructive pulmonary disease: a population-based survey. BMJ Open Respir Res 2014; 1:e000049. [PMID: 25553244 PMCID: PMC4256604 DOI: 10.1136/bmjresp-2014-000049] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Revised: 09/23/2014] [Accepted: 10/26/2014] [Indexed: 12/04/2022] Open
Abstract
Objectives We aimed to estimate incremental productivity losses (sick leave and disability) of spirometry-defined chronic obstructive pulmonary disease (COPD) in a population-based sample and in hospital-recruited patients with COPD. Furthermore, we examined predictors of productivity losses by multivariate analyses. Methods We performed four quarterly telephone interviews of 53 and 107 population-based patients with COPD and controls, as well as 102 hospital-recruited patients with COPD below retirement age. Information was gathered regarding annual productivity loss, exacerbations of respiratory symptoms and comorbidities. Incremental productivity losses were estimated by multivariate quantile median regression according to the human capital approach, adjusting for sex, age, smoking habits, education and lung function. Main effect variables were COPD/control status, number of comorbidities and exacerbations of respiratory symptoms. Results Altogether 55%, 87% and 31% of population-based COPD cases, controls and hospital patients, respectively, had a paid job at baseline. The annual incremental productivity losses were 5.8 (95% CI 1.4 to 10.1) and 330.6 (95% CI 327.8 to 333.3) days, comparing population-recruited and hospital-recruited patients with COPD to controls, respectively. There were significantly higher productivity losses associated with female sex and less education. Additional adjustments for comorbidities, exacerbations and FEV1% predicted explained all productivity losses in the population-based sample, as well as nearly 40% of the productivity losses in hospital-recruited patients. Conclusions Annual incremental productivity losses were more than 50 times higher in hospital-recruited patients with COPD than that of population-recruited patients with COPD. To ensure a precise estimation of societal burden, studies on patients with COPD should be population-based.
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Affiliation(s)
- Marta Erdal
- Department of Thoracic Medicine , Haukeland University Hospital , Bergen , Norway
| | - Ane Johannessen
- Centre for Clinical Research, Haukeland University Hospital , Bergen , Norway
| | | | - Tomas Eagan
- Department of Thoracic Medicine , Haukeland University Hospital , Bergen , Norway ; Department of Clinical Science , University of Bergen , Norway
| | - Amund Gulsvik
- Department of Clinical Science , University of Bergen , Norway
| | - Rune Grønseth
- Department of Thoracic Medicine , Haukeland University Hospital , Bergen , Norway ; Department of Clinical Science , University of Bergen , Norway
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