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Luke JN, Bessarab D, Smith K, LoGiudice D, Flicker L, Gilchrist L, Dow B, Temple J. Counting the Ways That Aboriginal and Torres Strait Islander Older People Participate in Their Communities and Culture. J Gerontol B Psychol Sci Soc Sci 2024; 79:gbae100. [PMID: 38818851 PMCID: PMC11234290 DOI: 10.1093/geronb/gbae100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Indexed: 06/01/2024] Open
Abstract
OBJECTIVES This study aimed to determine the proportion of older Aboriginal and Torres Strait Islander peoples participating in cultural events and activities and determine the demographic and sociocultural characteristics associated with participation. METHODS The Australian Bureau of Statistics National Aboriginal and Torres Strait Islander Social Survey (2014-2015) was used to measure the prevalence of participation in cultural events and activities. Multivariate logistic regression models were used to measure associations. Sociocultural factors were selected by matching survey items to the 12 sociocultural factors described in the Good Spirit Good Life Framework, a culturally validated quality-of-life tool for older people. RESULTS The majority (62.0%) of survey respondents 45 years and older participated in cultural events (e.g., ceremonies, funerals/sorry business, NAIDOC week activities, sports carnivals, festivals/carnivals) or were involved in organizations. Many (58.5%) also participated in activities (e.g., fishing, hunting, gathering wild plants/berries, arts/crafts, music/dance/theater, writing/telling of stories). In regression models including demographic and cultural variables, participation in cultural events was highest among people living remotely (odds ratio [OR] = 2.71), reporting recognition of homelands (OR = 2.39), identifying with a cultural group (OR = 3.56), and those reporting having a say in their communities (OR = 1.57), with similar odds seen for participation in activities. Participation was inversely proportional to increasing age, with a greater proportion of females participating in events and males in activities. DISCUSSION The social lives of older Aboriginal and Torres Strait Islander people were characterized by widespread participation in cultural events and activities. These findings provide important insights into services as they support older people to live a good life.
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Affiliation(s)
- Joanne Nicole Luke
- Centre for Health Policy, School of Population and Global Health, Faculty of Medicine, Dentistry and Health Sciences,The University of Melbourne, Melbourne, Victoria, Australia
| | - Dawn Bessarab
- Centre for Aboriginal Medical and Dental Health, Medical School, The University of Western Australia, Perth, Western Australia, Australia
| | - Kate Smith
- Centre for Aboriginal Medical and Dental Health, Medical School, The University of Western Australia, Perth, Western Australia, Australia
| | - Dina LoGiudice
- Department of Medicine, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Leon Flicker
- Western Australian Centre for Health and Ageing, Medical School, University of Western Australia, Perth, Western Australia, Australia
| | - Lianne Gilchrist
- Centre for Aboriginal Medical and Dental Health, Medical School, The University of Western Australia, Perth, Western Australia, Australia
| | - Briony Dow
- Department of Medicine, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
- National Ageing Research Institute, Melbourne, Victoria, Australia
| | - Jeromey Temple
- Centre for Health Policy, School of Population and Global Health, Faculty of Medicine, Dentistry and Health Sciences,The University of Melbourne, Melbourne, Victoria, Australia
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Ivey MA, Smith SM, Benke G, Toelle BG, Hunter ML, James AL, Maguire GP, Wood-Baker R, Johns DP, Marks GB, Abramson MJ. COPD in Never-Smokers: BOLD Australia Study. Int J Chron Obstruct Pulmon Dis 2024; 19:161-174. [PMID: 38249822 PMCID: PMC10800088 DOI: 10.2147/copd.s439307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 12/21/2023] [Indexed: 01/23/2024] Open
Abstract
Purpose Tobacco smoking is the major risk factor for COPD, and it is common for other risk factors in never-smokers to be overlooked. We examined the prevalence of COPD among never-smokers in Australia and identified associated risk factors. Methods We used data from the Australia Burden of Obstructive Lung Disease (BOLD) study, a cross-section of people aged ≥40 years from six sites. Participants completed interviews and post-bronchodilator spirometry. COPD was primarily defined as an FEV1/FVC ratio <0.70 and secondarily as the ratio less than the lower limit of normal (LLN). Results The prevalence of COPD in the 1656 never-smokers who completed the study was 10.5% (95% CI: 9.1-12.1%) [ratio Conclusion COPD was prevalent in this population of never-smokers aged 40 years and over. This finding highlights the significance of risk factors other than smoking in the development of COPD.
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Affiliation(s)
- Marsha A Ivey
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia
- School of Medicine, Faculty of Medical Sciences, The University of the West Indies, St Augustine, Trinidad and Tobago
| | - Sheree M Smith
- School of Nursing and Midwifery, Campbelltown Campus, Western Sydney University, Penrith, NSW, 2751, Australia
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Geza Benke
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia
| | - Brett G Toelle
- Respiratory and Environmental Epidemiology Group, Woolcock Institute of Medical Research, Sydney, NSW, 2037, Australia
- Sydney Local Health District, Sydney, NSW, 2050, Australia
| | - Michael L Hunter
- School of Population and Global Health, University of Western Australia, Perth, WA, 6009, Australia
| | - Alan L James
- Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital and Medical School, University of Western Australia, Perth, WA, 6009, Australia
| | - Graeme P Maguire
- Curtin Medical School, Curtin University, Perth, WA, 6102, Australia
| | - Richard Wood-Baker
- School of Medicine, University of Tasmania, Hobart, TAS, 7000, Australia
| | - David P Johns
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Guy B Marks
- Respiratory and Environmental Epidemiology Group, Woolcock Institute of Medical Research, Sydney, NSW, 2037, Australia
- School of Clinical Medicine, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Michael J Abramson
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia
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Janetzki JL, Sykes MJ, Ward MB, Pratt NL. Chronic Obstructive Pulmonary Disease Adverse Event Signals Associated with Potential Inhibitors of Glutathione Peroxidase 1: A Sequence Symmetry Analysis. Drug Saf 2024; 47:59-70. [PMID: 37995048 DOI: 10.1007/s40264-023-01374-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2023] [Indexed: 11/24/2023]
Abstract
BACKGROUND AND OBJECTIVE Prior molecular modelling analysis identified several medicines as potential inhibitors of glutathione peroxidase 1 (GPx1) which may contribute to development or progression of chronic obstructive pulmonary disease (COPD). This study investigates 40 medicines (index medicines) for signals of COPD development or progression in a real-world dataset. METHODS Sequence symmetry analysis (SSA) was conducted using a 10% extract of Australian Pharmaceutical Benefits Scheme (PBS) claims data between January 2013 and September 2019. Patients must have been initiated on an index medicine and a medicine for COPD development or progression within 12 months of each other. Sequence ratios were calculated as the number of patients who initiated an index medicine followed by a medicine for COPD development or progression divided by the number who initiated the index medicine second. An adjusted sequence ratio (aSR) was calculated which accounted for changes in prescribing trends. Adverse drug event signals (ADEs) were identified where the aSR lower 95% confidence interval (CI) was greater than 1. RESULTS Twenty-one of 40 (53%) index medicines had at least one ADE signal of COPD development or progression. Signals of COPD development, as identified using initiation of tiotropium, were observed for atenolol (aSR 1.32, 95% CI 1.23-1.42) and naproxen (aSR 1.14, 95% CI 1.06-1.23). Several signals of COPD progression were observed, including initiation of fluticasone propionate/salmeterol following initiation of atenolol (aSR 1.44, 95% CI 1.30-1.60) and initiation of aclidinium/formoterol following initiation of naproxen (aSR 2.21, 95% CI 1.34-3.65). CONCLUSION ADE signals were generated for several potential GPx1 inhibitors; however, further validation of signals is required in large well-controlled observational studies.
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Affiliation(s)
- Jack L Janetzki
- UniSA: Clinical and Health Sciences, University of South Australia, GPO Box 2471, Adelaide, SA, 5001, Australia.
- Quality Use of Medicines and Pharmacy Research Centre, Clinical and Health Sciences, University of South Australia, GPO Box 2471, Adelaide, SA, 5001, Australia.
| | - Matthew J Sykes
- UniSA: Clinical and Health Sciences, University of South Australia, GPO Box 2471, Adelaide, SA, 5001, Australia
| | - Michael B Ward
- UniSA: Clinical and Health Sciences, University of South Australia, GPO Box 2471, Adelaide, SA, 5001, Australia
- Quality Use of Medicines and Pharmacy Research Centre, Clinical and Health Sciences, University of South Australia, GPO Box 2471, Adelaide, SA, 5001, Australia
| | - Nicole L Pratt
- Quality Use of Medicines and Pharmacy Research Centre, Clinical and Health Sciences, University of South Australia, GPO Box 2471, Adelaide, SA, 5001, Australia
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Zhou Y, Ampon MR, Abramson MJ, James AL, Maguire GP, Wood-Baker R, Johns DP, Marks GB, Reddel HK, Toelle BG. Respiratory Symptoms, Disease Burden, and Quality of Life in Australian Adults According to GOLD Spirometry Grades: Data from the BOLD Australia Study. Int J Chron Obstruct Pulmon Dis 2023; 18:2839-2847. [PMID: 38053919 PMCID: PMC10695119 DOI: 10.2147/copd.s425202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 10/30/2023] [Indexed: 12/07/2023] Open
Abstract
Purpose Population data on the burden of chronic obstructive pulmonary disease (COPD) are often based on patient-reported diagnoses of COPD, emphysema or chronic bronchitis, without spirometry. We aimed to investigate the relationship between health burden, quality of life and severity of airway obstruction in Australian adults aged ≥40 years. Methods We used data from the BOLD Australia study, which included randomly selected adults aged ≥40 years from six study sites to reflect the sociodemographic and geographic diversity of the Australian population (n = 3522). Participants with post-bronchodilator airflow limitation (ratio of forced expiratory volume in 1 second FEV1 to forced vital capacity <0.7) were grouped by GOLD spirometry grades 1-4. Quality of life was assessed with Short Form 12 (SF-12) Health Survey Questionnaire. Health burden was assessed as lost time off work or social activities, and healthcare utilization. Results Of the study sample, 2969 participants did not have airflow limitation, 294 (8.4%) were classified as GOLD Grade 1, 212 (6.0%) as GOLD 2 and 43 (1.2%) as GOLD 3-4. Participants with higher GOLD grades had more respiratory symptoms, more comorbidities and greater burden than those with lower GOLD grades. The scores of mental and physical subscales of SF-12 were lower, indicating worse quality of life, from the no airflow limitation group to the GOLD 3-4 group (P = 0.03 and P < 0.001, respectively). Conclusion Greater airflow limitation is associated with greater burden and poor quality of life. Interventions to prevent, or reduce the level of, airflow limitation will reduce the symptom burden and improve quality of life for patients.
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Affiliation(s)
- Yijun Zhou
- The Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia
| | - Maria R Ampon
- Australian Centre for Airways Disease Monitoring, The Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia
| | - Michael J Abramson
- School of Public Health & Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Alan L James
- Sir Charles Gairdner Hospital, Perth, WA, Australia
| | | | - Richard Wood-Baker
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - David P Johns
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Guy B Marks
- The Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia
- South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Helen K Reddel
- Australian Centre for Airways Disease Monitoring, The Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine, Health and Human Science, Macquarie University, Sydney, NSW, Australia
- Sydney Local Health District, Sydney, NSW, Australia
| | - Brett G Toelle
- The Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine, Health and Human Science, Macquarie University, Sydney, NSW, Australia
- Sydney Local Health District, Sydney, NSW, Australia
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Sunjaya A, Martin A, Arnott C, Jenkins C. Management of chronic breathlessness in primary care: what do GPs, non-GP specialists, and allied health professionals think? Aust J Prim Health 2023; 29:375-384. [PMID: 36683165 DOI: 10.1071/py22018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 12/19/2022] [Indexed: 01/24/2023]
Abstract
BACKGROUND To explore the perspectives of GPs, non-GP specialists, and allied health professionals on the role of primary care in diagnosing and managing chronic breathlessness, the barriers faced, and the resources needed to optimise care of patients with chronic breathlessness. METHODS This was a qualitative study involving focus group discussions that included 35GPs, non-GP specialists, and allied health professionals. Topics explored included: (1) views on the role of primary care in diagnosing and managing chronic breathlessness; (2) barriers to optimal assessment in primary care; and (3) facilitators to further optimise the care of patients with chronic breathlessness. RESULTS All participants considered that primary care has a central role to play in the assessment and management of chronic breathlessness, but greater access to referral services, suitable funding structures, and upskilling on the use of diagnostic tests such as spirometry and electrocardiography are required for this to be realised. Both GPs and non-GP specialists described great potential for developing better linkages, including new ways of referral and online consultations, greater ease of referral to allied health services, even if conducted virtually, for patients with functional causes of breathlessness. Participants identified a need to develop integrated breathlessness clinics for patients referred by GPs, which would ensure patients receive optimal care in the shortest possible time frame. CONCLUSIONS GPs are crucial to achieving optimal care for breathless patients, especially given the multifactorial and multimorbid nature of breathlessness; however, there are significant gaps in services and resources at present that limit their ability to perform this role.
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Affiliation(s)
- Anthony Sunjaya
- Respiratory Program, The George Institute for Global Health, Sydney, NSW 2050, Australia; and Faculty of Medicine, University of New South Wales, Sydney, NSW 2052, Australia
| | - Allison Martin
- Respiratory Program, The George Institute for Global Health, Sydney, NSW 2050, Australia; and Faculty of Medicine, University of New South Wales, Sydney, NSW 2052, Australia
| | - Clare Arnott
- Faculty of Medicine, University of New South Wales, Sydney, NSW 2052, Australia; and Cardiovascular Division, The George Institute for Global Health, Sydney, NSW 2050, Australia
| | - Christine Jenkins
- Respiratory Program, The George Institute for Global Health, Sydney, NSW 2050, Australia; and Faculty of Medicine, University of New South Wales, Sydney, NSW 2052, Australia
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Alotaibi N, Borg BM, Abramson MJ, Paul E, Zwar N, Russell G, Wilson S, Holland AE, Bonevski B, Mahal A, George J. Different Case Finding Approaches to Optimise COPD Diagnosis: Evidence from the RADICALS Trial. Int J Chron Obstruct Pulmon Dis 2023; 18:1543-1554. [PMID: 37492489 PMCID: PMC10364814 DOI: 10.2147/copd.s371371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 05/28/2023] [Indexed: 07/27/2023] Open
Abstract
Aim Diagnosis of COPD in primary care is hindered by underuse of spirometry. Case finding using validated symptom and health status questionnaires, and simple handheld devices in high-risk populations may improve diagnosis. This study aimed to determine the best combination of measures to optimise COPD diagnosis in the primary care setting. Methods We recruited 335 current or ex-smokers, including those with an established diagnosis of COPD from general practices. Participants' FEV1 and FEV6 were measured using a handheld spirometry device (COPD-6®). Each completed the COPD assessment test (CAT), a modified Medical Research Council (mMRC) dyspnoea scale, St George's Respiratory Questionnaire (SGRQ) and smoking history questionnaire. From these data we calculated the predictive validity for spirometry-confirmed diagnosis of COPD. Area under the receiver operating characteristic curve (AUROC), sensitivity, specificity, positive and negative predictive values (PPV, NPV) were calculated for each. Kappa coefficient was used to measure the agreement between the Fixed-Ratio (FR) and Lower Limit of Normal (LLN) spirometric criteria in diagnosing COPD. Results FEV1/FEV6 <0.70 alone showed significant association (p<0.0001) with COPD diagnosis and good predictive accuracy (AUROC=0.725). However, no further improvement was found after combining SGRQ, CAT and mMRC with FEV1/FEV6. FEV1/FEV6 <0.70 using the COPD-6® handheld device had moderate sensitivity (65.7%) and high PPV (90.1%), high specificity (79.3%) and NPV (44.8%). There was good agreement between FR and LLN definitions (κ=0.70). Conclusion Handheld micro-spirometers can facilitate case finding of COPD in smokers and ex-smokers attending general practice. The fixed ratio criterion currently recommended by COPD-X guidelines offers the simplest method for diagnosing COPD in Australian primary care.
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Affiliation(s)
- Nawar Alotaibi
- Centre for Medicine Use and Safety, Monash University, Melbourne, VIC, Australia
| | - Brigitte M Borg
- Respiratory Medicine, Alfred Health, Melbourne, VIC, Australia
- School of Public Health & Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Michael J Abramson
- School of Public Health & Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Eldho Paul
- School of Public Health & Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Nicholas Zwar
- Faculty of Health Sciences and Medicine, Bond University, Robina, QLD, Australia
| | - Grant Russell
- Department of General Practice, Monash University, Melbourne, VIC, Australia
| | - Sally Wilson
- Centre for Medicine Use and Safety, Monash University, Melbourne, VIC, Australia
- Department of Infrastructure Engineering, The University of Melbourne, Melbourne, VIC, Australia
| | - Anne E Holland
- Respiratory Medicine, Alfred Health, Melbourne, VIC, Australia
- Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Billie Bonevski
- College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - Ajay Mahal
- The Nossal Institute for Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Johnson George
- Centre for Medicine Use and Safety, Monash University, Melbourne, VIC, Australia
- School of Public Health & Preventive Medicine, Monash University, Melbourne, VIC, Australia
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Zhou Y, Ampon MR, Abramson MJ, James AL, Maguire GP, Wood-Baker R, Johns DP, Marks GB, Reddel HK, Toelle BG. Clinical characteristics of adults with self-reported diagnosed asthma and/or COPD: data from the BOLD Australia Study. ERJ Open Res 2023; 9:00098-2023. [PMID: 37609600 PMCID: PMC10440648 DOI: 10.1183/23120541.00098-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 05/23/2023] [Indexed: 08/24/2023] Open
Abstract
Background Diagnosis of asthma and chronic obstructive pulmonary disease (COPD) in the community is variable, often without spirometry. Some studies report that adults with both diagnostic labels (asthma+COPD) have worse health outcomes than those with asthma or COPD only, but data for Australian adults are limited. We investigated the relationship between clinical characteristics and self-reported diagnoses of asthma, COPD and both. Method We used data from the BOLD Australia study, which included randomly selected adults aged ≥40 years from six study sites. The BOLD questionnaires and spirometry test were used in all sites. Participants were grouped by self-reported diagnosis. Demographic and clinical characteristics and lung function were compared between groups. Results Of the study sample (n=3522), 336 reported asthma only, 172 reported COPD only, 77 reported asthma+COPD and 2937 reported neither. Fewer than half of participants with a COPD diagnosis (with or without asthma) had airflow limitation. Participants with asthma+COPD had more respiratory symptoms and greater airflow limitation than those with either diagnosis alone. Having asthma+COPD was independently associated with a higher probability of having clinically important breathlessness (modified Medical Research Council score ≥2) than asthma only (adjusted OR 3.44, 95% CI 1.86-6.33) or COPD only (adjusted OR 3.28, 95% CI 1.69-6.39). Airflow limitation (Global Initiative for Chronic Obstructive Lung Disease 2 or higher, using post-bronchodilator forced expiratory volume in 1 s/forced vital capacity ratio <0.7) was similar between asthma only and COPD only, but twice as prevalent in asthma+COPD (adjusted OR 2.18 and 2.58, respectively). Conclusions Adults with diagnoses of asthma+COPD have a higher symptom and disease burden than those with diagnoses of asthma only or COPD only. These patients should receive regular comprehensive reviews because of the substantially increased burden of having both diagnoses.
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Affiliation(s)
- Yijun Zhou
- The Woolcock Institute of Medical Research, The University of Sydney, Sydney, Australia
| | - Maria R. Ampon
- Australian Centre for Airways Disease Monitoring, The Woolcock Institute of Medical Research, The University of Sydney, Sydney, Australia
| | - Michael J. Abramson
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | | | | | - Richard Wood-Baker
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - David P. Johns
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Guy B. Marks
- The Woolcock Institute of Medical Research, The University of Sydney, Sydney, Australia
- South Western Sydney Clinical School, University of New South Wales, Sydney, Australia
| | - Helen K. Reddel
- Australian Centre for Airways Disease Monitoring, The Woolcock Institute of Medical Research, The University of Sydney, Sydney, Australia
| | - Brett G. Toelle
- The Woolcock Institute of Medical Research, The University of Sydney, Sydney, Australia
- Sydney Local Health District, Sydney, Australia
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8
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Janetzki JL, Pratt NL, Ward MB, Sykes MJ. Application of an Integrative Drug Safety Model for Detection of Adverse Drug Events Associated With Inhibition of Glutathione Peroxidase 1 in Chronic Obstructive Pulmonary Disease. Pharm Res 2023; 40:1553-1568. [PMID: 37173537 PMCID: PMC10338407 DOI: 10.1007/s11095-023-03516-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 04/07/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Chronic Obstructive Pulmonary Disease is characterised by declining lung function and a greater oxidative stress burden due to reduced activity of antioxidant enzymes such as Glutathione Peroxidase 1. OBJECTIVES The extent to which drugs may contribute to this compromised activity is largely unknown. An integrative drug safety model explores inhibition of Glutathione Peroxidase 1 by drugs and their association with chronic obstructive pulmonary disease adverse drug events. METHODS In silico molecular modelling approaches were utilised to predict the interactions that drugs have within the active site of Glutathione Peroxidase 1 in both human and bovine models. Similarities of chemical features between approved drugs and the known inhibitor tiopronin were also investigated. Subsequently the Food and Drug Administration Adverse Event System was searched to uncover adverse drug event signals associated with chronic obstructive pulmonary disease. RESULTS Statistical and molecular modelling analyses confirmed that the use of several registered drugs, including acetylsalicylic acid and atenolol may be associated with inhibition of Glutathione Peroxidase 1 and chronic obstructive pulmonary disease. CONCLUSION The integration of molecular modelling and pharmacoepidemological data has the potential to advance drug safety science. Ongoing review of medication use and further pharmacoepidemiological and biological analyses are warranted to ensure appropriate use is recommended.
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Affiliation(s)
- Jack L. Janetzki
- UniSA: Clinical and Health Sciences, University of South Australia, GPO Box 2471, Adelaide, South Australia 5001 Australia
- Quality Use of Medicines and Pharmacy Research Centre, Clinical and Health Sciences, University of South Australia, GPO Box 2471, Adelaide, SA 5001 Australia
| | - Nicole L. Pratt
- Quality Use of Medicines and Pharmacy Research Centre, Clinical and Health Sciences, University of South Australia, GPO Box 2471, Adelaide, SA 5001 Australia
| | - Michael B. Ward
- UniSA: Clinical and Health Sciences, University of South Australia, GPO Box 2471, Adelaide, South Australia 5001 Australia
- Quality Use of Medicines and Pharmacy Research Centre, Clinical and Health Sciences, University of South Australia, GPO Box 2471, Adelaide, SA 5001 Australia
| | - Matthew J. Sykes
- UniSA: Clinical and Health Sciences, University of South Australia, GPO Box 2471, Adelaide, South Australia 5001 Australia
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9
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Zhou Y, Ampon MR, Abramson MJ, James AL, Maguire GP, Wood-Baker R, Johns DP, Marks GB, Reddel HK, Toelle BG. Risk factors and clinical characteristics of breathlessness in Australian adults: Data from the BOLD Australia study. Chron Respir Dis 2023; 20:14799731231221820. [PMID: 38126966 DOI: 10.1177/14799731231221820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Breathlessness is a common symptom related to a significant health burden. However, the association of breathlessness with clinical characteristics, especially objective pulmonary test results is scarce. We aimed to identify the characteristics independently associated with breathlessness in Australian adults. METHOD The analysis used data from BOLD Australia, a cross-sectional study that included randomly selected adults aged ≥40 years from six sites in Australia. Clinical characteristics and spirometry results were compared for breathlessness (modified Medical Research Council [mMRC] grade ≥2). RESULTS Among all respondents (n = 3321), 252 participants (7.6%) reported breathlessness. The main univariate associations were obesity, chronic respiratory diseases, heart diseases and being Indigenous Australians (odds ratios [ORs] = 2.78, 5.20, 3.77 and 4.38, respectively). Participants with breathlessness had lower pre-and post-bronchodilator lung function than those without. Impaired spirometry results including FVC or FEV1 below 80% predicted, or FEV1/FVC < LLN were independently associated with breathlessness (adjusted ORs = 2.66, 2.94 and 2.34, respectively). CONCLUSIONS Breathlessness is common among Australian adults and is independently associated with obesity, chronic respiratory diseases, heart diseases, being Indigenous Australians, and impaired spirometry. Multi-disciplinary assessment and comprehensive investigation is needed in clinical practice to address the many factors associated with breathlessness in the population.
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Affiliation(s)
- Yijun Zhou
- The Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia
| | - Maria R Ampon
- Australian Centre for Airways Disease Monitoring, The Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia
| | - Michael J Abramson
- School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
| | | | | | - Richard Wood-Baker
- Melbourne School of Population and Global Health, University of Melbourne, Australia
| | - David P Johns
- Melbourne School of Population and Global Health, University of Melbourne, Australia
| | - Guy B Marks
- The Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia
- South Western Sydney Clinical School, Sydney, NSW, Australia
| | - Helen K Reddel
- Australian Centre for Airways Disease Monitoring, The Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine, Health and Human Science, Macquarie University, Sydney, New South Wales, Australia
- Sydney Local Health District, Sydney, Australia
| | - Brett G Toelle
- The Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine, Health and Human Science, Macquarie University, Sydney, New South Wales, Australia
- Sydney Local Health District, Sydney, Australia
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Heerema J, Hug S, Bear N, Hill K. Characterising hospitalisation risk for chronic obstructive pulmonary disease exacerbations: Bedside and outpatient clinic assessments of easily measured variables. Chron Respir Dis 2023; 20:14799731231211852. [PMID: 37934787 PMCID: PMC10631319 DOI: 10.1177/14799731231211852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 10/15/2023] [Indexed: 11/09/2023] Open
Abstract
OBJECTIVE To identify the characteristics of people with chronic obstructive pulmonary disease (COPD) who require hospitalisation for exacerbations. METHODS People with COPD were recruited either during hospitalisation or from out-patient respiratory medicine clinics. Hospital admissions were tracked throughout the 5-months recruitment period. For participants who were admitted, hospital readmissions were tracked for at least 30 days following discharge. Participants were grouped as either needing; (i) no hospital admission during the study period (no admission; ø-A), (ii) one or more hospital admissions during the study period but no readmission within 30 days of discharge (no rapid readmission; ø-RR) or (iii) one or more hospital admissions with a readmission within 30 days of discharge (rapid readmission; RR). RESULTS Compared with the ø-A group (n=211), factors that independently increased the risk of ø-RR (n=146) and/or RR (n=57) group membership were being aged >60 years, identifying as an Indigenous person (relative risk ratio, 95% confidence interval 7.8 [1.8 to 34.0]) and the use of a support person or community service for activities of daily living (1.5 [1.0 to 2.4]. A body mass index ≥25 kg/m2 was protective. CONCLUSIONS Variables recorded at the bedside or in clinic provided information on hospitalisation risk.
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Affiliation(s)
- Joshua Heerema
- Physiotherapy Department, Sir Charles Gairdner Hospital, Nedlands, Australia
| | - Sarah Hug
- Curtin School of Allied Health, Curtin University, Perth, Australia
- Physiotherapy Department, Royal Perth Hospital, Perth, Australia
| | - Natasha Bear
- Institute of Health Sciences, Notre Dame University, Perth, Australia
| | - Kylie Hill
- Curtin School of Allied Health, Curtin University, Perth, Australia
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11
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Pagano L, Dennis S, Wootton S, Mahadev S, Chan ASL, Zwar N, Pallavicini D, McKeough Z. Identifying airway obstruction in primary care: is there a role for physiotherapists? BMC PRIMARY CARE 2022; 23:324. [PMCID: PMC9748384 DOI: 10.1186/s12875-022-01944-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 12/07/2022] [Indexed: 12/15/2022]
Abstract
Abstract
Aims
To examine the implementation of a physiotherapist-driven spirometry case finding service in primary care to identify new cases of COPD and confirm diagnosis of existing cases of COPD.
Methods
Four general practices were recruited. ‘At risk’ participants (aged ≥ 40 years, current/ex-smoker) and people with ‘existing’ COPD were identified from practice databases and invited to attend an assessment with a cardiorespiratory physiotherapist in each general practice. The physiotherapist performed pre/post-bronchodilator spirometry to identify or confirm a diagnosis of COPD (FEV1/FVC < 0.7). Outcome measures included number (%) of new cases of COPD, number (%) confirmed diagnosis of COPD and number (%) of high quality spirometry assessments with accurate interpretation.
Results
One hundred forty eight participants (mean age 70 years (SD 11.1), 57% female) attended a baseline assessment (117 ‘at risk’, 31’existing’ COPD) from 748 people invited. Physiotherapists performed 145 pre/post bronchodilator spirometry assessments. Obstruction on post-bronchodilator spirometry was confirmed in 17% (19/114) of ‘at risk’ and 77% (24/31) of ‘existing’ COPD. Majority of cases were classified as GOLD Stage II (63%, n = 27). Quality of pre/post bronchodilator spirometries for FEV1 were classified as A (68%), B (19%) and C (5%).
Conclusion
Physiotherapists integrated into primary care performed high quality spirometry testing, successfully case finding ‘at risk’ patients and identifying potential misdiagnosis of obstruction in some ‘existing’ COPD cases.
Trial registration
ANZCTR, ACTRN12619001127190. Registered 12 August 2019 – Retrospectively registered, http://www.ANZCTR.org.au/ACTRN12619001127190.aspx
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12
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Njoku CM, Wimmer BC, Peterson GM, Kinsman L, Bereznicki BJ. Hospital Readmission Due to Chronic Obstructive Pulmonary Disease: A Longitudinal Study. Int J Health Policy Manag 2022; 11:2533-2541. [PMID: 35120405 PMCID: PMC9818089 DOI: 10.34172/ijhpm.2022.5770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 01/08/2022] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND This study aimed to investigate the prevalence of hospital readmission for chronic obstructive pulmonary disease (COPD) at 30, 90 and 365 days, and to determine demographic and socioeconomic risk factors for 30-day and 90-day readmission and time to COPD-related readmission within 365 days in Tasmania. METHODS Patients ≥40 years admitted for COPD between 2011 and 2015 were identified using administrative data from all major public hospitals in Tasmania, Australia. Factors associated with readmission and time to readmission were identified using logistic and Cox regression, respectively. RESULTS The rates of COPD-related readmission were 6.7% within 30 days, 12.2% within 90 days and 23.7% within 365 days. Being male (odds ratio [OR]: 1.49, CI: 1.06-2.09), Indigenous (OR: 2.47, CI: 1.31-4.66) and living in the lower socioeconomic North-West region of Tasmania (OR: 1.80, CI: 1.20-2.69) were risk factors for 30-day readmission. Increased COPD-related (OR: 1.48, CI: 1.22-1.80; OR: 1.52, CI: 1.29-1.78) and non-COPD-related (OR: 1.12, CI: 1.03- 1.23; OR: 1.11, CI: 1.03-1.21) emergency department (ED) visits in the preceding six months were risk factors for both 30-day and 90-day readmissions. Being Indigenous (hazard ratio [HR]: 1.61, CI: 1.10-2.37) and previous COPD-related ED visits (HR: 1.30, CI: 1.21-1.39) decreased, while a higher Charlson Comorbidity Index (CCI) (OR: 0.91, CI: 0.83- 0.99) increased the time to readmission within 365 days. CONCLUSION Being male, Indigenous, living in the North-West region and previous ED visits were associated with increased risk of COPD readmission in Tasmania. Interventions to improve access to primary healthcare for these groups may reduce COPD-related readmissions.
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Affiliation(s)
- Chidiamara Maria Njoku
- School of Pharmacy and Pharmacology, College of Health and Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Barbara Caecilia Wimmer
- School of Pharmacy and Pharmacology, College of Health and Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Gregory Mark Peterson
- School of Pharmacy and Pharmacology, College of Health and Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Leigh Kinsman
- School of Nursing and Midwifery, University of Newcastle, Port Macquarie, NSW, Australia
| | - Bonnie Jayne Bereznicki
- Tasmanian School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, TAS, Australia
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13
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Tang CY, Lavercombe M, Southcott AM, Taylor NF, Blackstock FC. Access to pulmonary rehabilitation for people from culturally and linguistically diverse communities: A cohort study. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e4133-e4143. [PMID: 35352435 DOI: 10.1111/hsc.13807] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 01/11/2022] [Accepted: 03/15/2022] [Indexed: 06/14/2023]
Abstract
Little is known about the extent of cultural and linguistic diversity among people with chronic obstructive pulmonary disease (COPD) in Australia and if ethno-cultural factors influence engagement in pulmonary rehabilitation (PR). We conducted a prospective cohort study to evaluate the extent of cultural and linguistic diversity among people with COPD and identify variables that influence engagement in PR. Patients with COPD attending the respiratory outpatient clinic at a metropolitan health service completed a study-specific questionnaire with results descriptively analysed. Access issues of awareness, referrals, attendance and completion of PR were examined. A multiple regression analysis was conducted to identify variables that influenced engagement in PR. Ninety-seven participants were recruited, of whom 36 (37%) self-identified a culturally and linguistically diverse (CALD) community. While participants from CALD communities had less awareness of PR as compared with the English Australian group (χ2 (df) = 5.3 (1), p = 0.02), there were no significant between-group differences in number of observed referrals (p = 0.30), attendance (p = 0.50) and completions of PR (p = 0.90). Only 11 (11%) out of 97 participants completed PR. Age (p = 0.006) and being from a CALD community (p = 0.03) were independent factors impacting on the awareness of PR while English proficiency (p = 0.04) was an independent factor impacting on referrals to PR. While older age and being from a CALD community were associated with having less awareness in PR, referrals to, attendance and completion rates of PR were similar regardless of ethnicity.
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Affiliation(s)
- Clarice Y Tang
- Physiotherapy Department, Western Health, St Albans, Victoria, Australia
- Physiotherapy, School of Health Sciences, Western Sydney University, Penrith, New South Wales, Australia
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
| | - Mark Lavercombe
- Department of Respiratory & Sleep Disorders Medicine, Western Health, St Albans, Victoria, Australia
- Department of Medical Education, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Medicine, Western Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Anne M Southcott
- Department of Respiratory & Sleep Disorders Medicine, Western Health, St Albans, Victoria, Australia
- Department of Medicine, Western Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Nicholas F Taylor
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
| | - Felicity C Blackstock
- Physiotherapy, School of Health Sciences, Western Sydney University, Penrith, New South Wales, Australia
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
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14
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Salimi F, Stasinska A, Morgan GG, Hankey GJ, Almeida O, Yeap B, Flicker L, Heyworth J. Long-term exposure to low air pollutant concentrations and hospitalisation for respiratory diseases in older men: A prospective cohort study in Perth, Australia. Heliyon 2022; 8:e10905. [PMID: 36276719 PMCID: PMC9578981 DOI: 10.1016/j.heliyon.2022.e10905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 05/22/2022] [Accepted: 09/27/2022] [Indexed: 11/06/2022] Open
Abstract
Background Acute exposure to ambient air pollution even at low concentrations has been associated with increased hospitalisation for respiratory diseases but the effects of long-term exposure are less certain. In this study, we investigated the associations between long-term exposures to PM2.5, PM2.5 absorbance and NO2 and hospitalisation for asthma, chronic obstructive pulmonary disease and pneumonia in a cohort of older men living in Perth, Western Australia, a city where the levels of air pollutants are well below the world standards. Materials and methods The study population of 11,156 men with no prior hospitalisation for respiratory disease was drawn from the Health in Men Study (HIMS) cohort of men aged >65 years living in Perth, Western Australia between 1996-1999. PM2.5, PM2.5 absorbance (PM2.5a) and NO2 were measured across the Perth metropolitan area over three seasons in 2012. Land use regression (LUR) models were used to estimate annual concentrations of PM2.5, PM2.5 absorbance and NO2 at the residential address of each participant from inception (1996) to 2015. Hospitalisation for respiratory disease between inception and 2015 was ascertained using the Western Australian Data Linkage System. The association between exposure to air pollution with hospitalisation for respiratory disease was examined using Cox regression analysis. Results No statistically significant associations were observed in the fully adjusted models. However, positive associations were observed with first hospitalisation for pneumonia (HR 1.08, 95% CI: 1.01–1.16) when adjusted for age, year of enrolment, smoking status, education, BMI and physical activity. Conclusions In this longitudinal study of older men we found no evidence of associations between increased long-term exposure to low-level air pollution with increased risk of hospitalisation for respiratory diseases in Perth, Australia. More studies on respiratory morbidity associated with exposure to low levels of air pollution are needed for more comprehensive understanding of the overall risk.
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Affiliation(s)
- Farhad Salimi
- University Centre for Rural Health, Faculty of Medicine and Health, The University of Sydney, Australia Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Australia,Occupational and Environmental Health Sciences, Public Health and Preventive Medicine, Monash University, Australia,Corresponding author.
| | - Ania Stasinska
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Geoffrey G. Morgan
- University Centre for Rural Health, Faculty of Medicine and Health, The University of Sydney, Australia Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Australia
| | - Graeme J. Hankey
- Medical School, The University of Western Australia, Perth, Western Australia, Australia
| | - Osvaldo Almeida
- Medical School, The University of Western Australia, Perth, Western Australia, Australia
| | - Bu Yeap
- Medical School, The University of Western Australia, Perth, Western Australia, Australia
| | - Leon Flicker
- Medical School, The University of Western Australia, Perth, Western Australia, Australia
| | - Jane Heyworth
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
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15
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Dabscheck E, George J, Hermann K, McDonald CF, McDonald VM, McNamara R, O’Brien M, Smith B, Zwar NA, Yang IA. COPD‐X
Australian guidelines for the diagnosis and management of chronic obstructive pulmonary disease: 2022 update. Med J Aust 2022; 217:415-423. [DOI: 10.5694/mja2.51708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 06/15/2022] [Accepted: 08/02/2022] [Indexed: 11/17/2022]
Affiliation(s)
| | - Johnson George
- Centre for Medicine Use and Safety Monash University Melbourne VIC
| | | | | | | | - Renae McNamara
- Prince of Wales Hospital and Community Health Services Sydney NSW
| | | | | | | | - Ian A Yang
- University of Queensland Brisbane QLD
- Prince Charles Hospital Brisbane QLD
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16
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SINFONIA study protocol: a phase II/III randomised controlled trial examining benefits of guided online group singing in people with chronic obstructive pulmonary disease and interstitial lung disease and their carers. Respir Res 2022; 23:208. [PMID: 35974347 PMCID: PMC9380685 DOI: 10.1186/s12931-022-02133-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 08/06/2022] [Indexed: 11/30/2022] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) and interstital lung disease (ILD) are incurable conditions characterised by airflow limitation, persisting respiratory symptoms, and progressive respiratory failure. People living with COPD or ILD often suffer from chronic and severe breathlessness, with limited treatment options and low engagement rates with current therapies. Group singing represents a potential community-based therapy to improve quality of life for patients with COPD or ILD and breathlessness. Methods This protocol papers describes SINFONIA, a parallel, double-arm, randomised, blinded-analysis, mixed-methods phase II/III trial of guided, online group singing that will be conducted over 24 months. Adults with confirmed COPD or ILD, on stable treatment for at least four weeks at time of recruitment, with a modified Medical Research Council (mMRC) dyspnoea score of two or greater, who are capable and willing to give consent, and not currently participating in pulmonary rehabilitation will be eligible to participate. Carers may optionally enrol in the trial. Data will be collected on quality of life, anxiety and depression, breathlessness, mastery of breathing, exercise tolerance, loneliness, healthcare utilisation, and carer quality of life (optional). Participants will be randomised 1:1 to intervention or control arms with intervention arm attending one 90 min, guided, online, group singing session per week for 12 weeks and control arm continuing routine care. Phase II of the trial aims to determine the feasibility and acceptability of guided, online group singing and will collect preliminary data on effectiveness. Phase III aims to determine whether guided, online group singing has an effect on quality of life with the primary outcome being a between arm difference in quality of life (36-item Short Form Survey) measured at 12 weeks. Discussion SINFONIA is the first study is the first of its kind in Australia and to our knowledge, the first to deliver the singing intervention program entirely online. Determining the feasibility, acceptability, and effectiveness of guided, online group singing is an important step towards improving low-cost, low-risk, community-based therapeutic options for patients living with COPD or ILD and breathlessness. Trial registration: Phase II—ACTRN12621001274864, registered 20th September 2021; Phase III—ACTRN12621001280897, registered 22nd September 2021.
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17
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Meharg DP, Jenkins CR, Maguire GP, Jan S, Shaw T, Dennis SM, McKeough Z, Lee V, Gwynne KG, McCowen D, Rambaldini B, Alison JA. Implementing evidence into practice to improve chronic lung disease management in Indigenous Australians: the breathe easy, walk easy, lungs for life (BE WELL) project (protocol). BMC Pulm Med 2022; 22:239. [PMID: 35729525 PMCID: PMC9210710 DOI: 10.1186/s12890-022-02033-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 06/12/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Strong evidence exists for the benefits of pulmonary rehabilitation (PR) for people with chronic obstructive pulmonary disease (COPD), however the availability of culturally safe PR for Aboriginal and Torres Strait Islander (Indigenous) Peoples is limited. The study aims to determine whether PR can be implemented within Aboriginal Community Controlled Health Services (ACCHS) to improve outcomes for Indigenous people with COPD. METHODS Multi-centre cohort study using participatory action research guided by the Knowledge-to-Action Framework. ACCHS supportive of enhancing services for chronic lung disease will be recruited. Aboriginal Health Workers (AHW) and the exercise physiologist (EP) or physiotherapist (PT) within these ACCHS will attend a workshop aimed at increasing knowledge and skills related to management of COPD and the provision of PR. Indigenous people with COPD will be invited to attend an 8-week, twice weekly, supervised PR program. OUTCOMES AHW, EP/PT knowledge, skills and confidence in the assessment and management of COPD will be measured before and immediately after the BE WELL workshop and at 3, 6 and 12 months using a survey. PR participant measures will be exercise capacity (6-minute walk test (6MWT), health-related quality of life and health status at commencement and completion of an 8-week PR program. Secondary outcomes will include: number, length and cost of hospitalisations for a COPD exacerbation in 12-months prior and 12-months post PR; local contextual factors influencing implementation of PR; specific respiratory services provided by ACCHS to manage COPD prior to project commencement and at project completion. Repeated measures ANOVA will be used to evaluate changes in knowledge and confidence over time of AHWs and EP/PTs. Paired t-tests will be used to evaluate change in patient outcomes from pre- to post-PR. Number of hospital admissions in the 12 months before and after the PR will be compared using unpaired t-tests. DISCUSSION Pulmonary rehabilitation is an essential component of best-practice management of COPD and is recommended in COPD guidelines. Indigenous peoples have limited access to culturally safe PR programs. This study will evaluate whether PR can be implemented within ACCHS and improve outcomes for Indigenous people with COPD. Trial registration Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12617001337369, Registered 2nd September 2017 https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=373585&isClinicalTrial=False.
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Affiliation(s)
- David P Meharg
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Camperdown, NSW, 2006, Australia
- Poche Centre for Indigenous Health, The University of Sydney, Camperdown, NSW, 2006, Australia
| | - Christine R Jenkins
- The George Institute for Global Health, Newtown, NSW, 2042, Australia
- Faculty of Medicine, University of New South Wales, Sydney, Kensington, NSW, 2052, Australia
| | - Graeme P Maguire
- Curtin Medical School, Faculty of Health Sciences, Curtin University, Bentley, WA, 6102, Australia
| | - Stephan Jan
- The George Institute for Global Health, Newtown, NSW, 2042, Australia
| | - Tim Shaw
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Camperdown, NSW, 2006, Australia
| | - Sarah M Dennis
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Camperdown, NSW, 2006, Australia
- South Western Sydney Local Health District, Liverpool, NSW, 2170, Australia
- Ingham Institute for Applied Medical Research, Liverpool, NSW, 2170, Australia
| | - Zoe McKeough
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Camperdown, NSW, 2006, Australia
| | - Vanessa Lee
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Camperdown, NSW, 2006, Australia
| | - Kylie G Gwynne
- Faculty of Medicine, Health and Human Sciences, Macquarie University, North Ryde, NSW, 2109, Australia
| | - Debbie McCowen
- Armajun Aboriginal Health Service, Inverell, NSW, 2360, Australia
| | - Boe Rambaldini
- Faculty of Medicine, Health and Human Sciences, Macquarie University, North Ryde, NSW, 2109, Australia
| | - Jennifer A Alison
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Camperdown, NSW, 2006, Australia.
- Sydney Local Health District, Camperdown, NSW, 2050, Australia.
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Cross AJ, Thomas D, Liang J, Abramson MJ, George J, Zairina E. Educational interventions for health professionals managing chronic obstructive pulmonary disease in primary care. Cochrane Database Syst Rev 2022; 5:CD012652. [PMID: 35514131 PMCID: PMC9073270 DOI: 10.1002/14651858.cd012652.pub2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a common, preventable and treatable health condition. COPD is associated with substantial burden on morbidity, mortality and healthcare resources. OBJECTIVES To review existing evidence for educational interventions delivered to health professionals managing COPD in the primary care setting. SEARCH METHODS We searched the Cochrane Airways Trials Register from inception to May 2021. The Register includes records from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Allied and Complementary Medicine Database (AMED) and PsycINFO. We also searched online trial registries and reference lists of included studies. SELECTION CRITERIA We included randomised controlled trials (RCTs) and cluster-RCTs. Eligible studies tested educational interventions aimed at any health professionals involved in the management of COPD in primary care. Educational interventions were defined as interventions aimed at upskilling, improving or refreshing existing knowledge of health professionals in the diagnosis and management of COPD. DATA COLLECTION AND ANALYSIS Two review authors independently reviewed abstracts and full texts of eligible studies, extracted data and assessed the risk of bias of included studies. We conducted meta-analyses where possible and used random-effects models to yield summary estimates of effect (mean differences (MDs) with 95% confidence intervals (CIs)). We performed narrative synthesis when meta-analysis was not possible. We assessed the overall certainty of evidence for each outcome using Grades of Recommendation, Assessment, Development and Evaluation (GRADE). Primary outcomes were: 1) proportion of COPD diagnoses confirmed with spirometry; 2) proportion of patients with COPD referred to, participating in or completing pulmonary rehabilitation; and 3) proportion of patients with COPD prescribed respiratory medication consistent with guideline recommendations. MAIN RESULTS We identified 38 studies(22 cluster-RCTs and 16 RCTs) involving 4936 health professionals (reported in 19/38 studies) and 71,085 patient participants (reported in 25/38 studies). Thirty-six included studies evaluated interventions versus usual care; seven studies also reported a comparison between two or more interventions as part of a three- to five-arm RCT design. A range of simple to complex interventions were used across the studies, with common intervention features including education provided to health professionals via training sessions, workshops or online modules (31 studies), provision of practice support tools, tool kits and/or algorithms (10 studies), provision of guidelines (nine studies) and training on spirometry (five studies). Health professionals targeted by the interventions were most commonly general practitioners alone (20 studies) or in combination with nurses or allied health professionals (eight studies), and the majority of studies were conducted in general practice clinics. We identified performance bias as high risk for 33 studies. We also noted risk of selection, detection, attrition and reporting biases, although to a varying extent across studies. The evidence of efficacy was equivocal for all the three primary endpoints evaluated: 1) proportion of COPD diagnoses confirmed with spirometry (of the four studies that reported this outcome, two supported the intervention); 2) proportion of patients with COPD who are referred to, participate in or complete pulmonary rehabilitation (of the four studies that reported this outcome, two supported the intervention); and 3) proportion of patients with COPD prescribed respiratory medications consistent with guideline recommendations (12 studies reported this outcome, the majority evaluated multiple drug classes and reported a mixed effect). Additionally, the low quality of evidence and potential risk of bias make the interpretation more difficult. Moderate-quality evidence (downgraded due to risk of bias concerns) suggests that educational interventions for health professionals probably improve the proportion of patients with COPD vaccinated against influenza (three studies) and probably have little impact on the proportion of patients vaccinated against pneumococcal infection (two studies). Low-quality evidence suggests that educational interventions for health professionals may have little or no impact on the frequency of COPD exacerbations (10 studies). There was a high degree of heterogeneity in the reporting of health-related quality of life (HRQoL). Low-quality evidence suggests that educational interventions for health professionals may have little or no impact on HRQoL overall, and when using the COPD-specific HRQoL instrument, the St George's Respiratory Questionnaire (at six months MD 0.87, 95% CI -2.51 to 4.26; 2 studies, 406 participants, and at 12 months MD -0.43, 95% CI -1.52 to 0.67, 4 studies, 1646 participants; reduction in score indicates better health). Moderate-quality evidence suggests that educational interventions for health professionals may improve patient satisfaction with care (one study). We identified no studies that reported adverse outcomes. AUTHORS' CONCLUSIONS The evidence of efficacy was equivocal for educational interventions for health professionals in primary care on the proportion of COPD diagnoses confirmed with spirometry, the proportion of patients with COPD who participate in pulmonary rehabilitation, and the proportion of patients prescribed guideline-recommended COPD respiratory medications. Educational interventions for health professionals may improve influenza vaccination rates among patients with COPD and patient satisfaction with care. The quality of evidence for most outcomes was low or very low due to heterogeneity and methodological limitations of the studies included in the review, which means that there is uncertainty about the benefits of any currently published educational interventions for healthcare professionals to improve COPD management in primary care. Further well-designed RCTs are needed to investigate the effects of educational interventions delivered to health professionals managing COPD in the primary care setting.
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Affiliation(s)
- Amanda J Cross
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Australia
| | - Dennis Thomas
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, University of Newcastle, Newcastle, Australia
| | - Jenifer Liang
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Australia
| | - Michael J Abramson
- School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
| | - Johnson George
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Australia
| | - Elida Zairina
- Department of Pharmacy Practice, Faculty of Pharmacy, Universitas Airlangga, Surabaya, Indonesia
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Sze DFL, Howarth TP, Lake CD, Ben Saad H, Heraganahally SS. Differences in the Spirometry Parameters Between Indigenous and Non-Indigenous Patients with COPD: A Matched Control Study. Int J Chron Obstruct Pulmon Dis 2022; 17:869-881. [PMID: 35480554 PMCID: PMC9037718 DOI: 10.2147/copd.s361839] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 04/11/2022] [Indexed: 12/16/2022] Open
Abstract
Background Comparison of spirometry parameters between Indigenous and non-Indigenous patients with underlying chronic obstructive pulmonary disease (COPD) has been sparsely reported in the past. In this study, differences in the lung function parameters (LFPs), in particular spirometry values for forced vital capacity (FVC), forced expiratory volume in one second (FEV1) and FEV1/FVC ratio between Indigenous and non-Indigenous patients with COPD were assessed. Methods In this retrospective study, Indigenous and non-Indigenous patients with a diagnosis of COPD between 2012-2020 according to spirometry criteria (ie; post-bronchodilator (BD) FEV1/FVC < 0.7) were included. A further analysis was undertaken to compare the differences in the spirometry parameters, including lower limit of normal (LLN) values matching for age, sex, height and smoking status between these two diverse ethnic populations. Results A total of 240/742 (32%) Indigenous and 873/4579 (19%) non-Indigenous patients were identified to fit the criteria for COPD. Indigenous patients were significantly younger (mean difference 9.9 years), with a greater proportion of females (50% vs 33%), underweight (20% vs 8%) and current smokers (47% vs 32%). Prior to matching, Indigenous patients' post-BD percent predicted values for FVC, FEV1, and FEV1/FVC ratio were 17, 17%, and -2 points lower (Hedges G measure of effect size large (0.91), large (0.87), and small (0.25), respectively). Among the matched cohort (111 Indigenous and non-Indigenous), Indigenous patients LFPs remained significantly lower, with a mean difference of 16%, 16%, and -4, respectively (Hedges G large (0.94), large (0.92) and small (0.41), respectively). The differences persisted despite no significant differences in LLN values for these parameters. Conclusion Indigenous Australian patients with COPD display a significantly different demographic and clinical profile than non-Indigenous patients. LFPs were significantly lower, which may or may not equate to greater severity of disease in the absence of normative predictive lung function reference values specific to this population.
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Affiliation(s)
- Dorothy F L Sze
- Department of Respiratory and Sleep Medicine, Royal Darwin Hospital, Darwin, NT, Australia
| | - Timothy P Howarth
- College of Health and Human Sciences, Charles Darwin University, Darwin, NT, Australia.,Darwin Respiratory and Sleep Health, Darwin Private Hospital, Darwin, NT, Australia
| | - Clair D Lake
- Pulmonary Function Laboratory, Royal Darwin Hospital, Darwin, NT, Australia
| | - Helmi Ben Saad
- Laboratory of Physiology, Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia.,Research laboratory "Heart Failure, LR12SP09", Farhat HACHED Hospital, Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia
| | - Subash S Heraganahally
- Department of Respiratory and Sleep Medicine, Royal Darwin Hospital, Darwin, NT, Australia.,Darwin Respiratory and Sleep Health, Darwin Private Hospital, Darwin, NT, Australia.,College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
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20
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Engel RM, de Luca K, Graham PL, Kaboli Farshchi M, Vemulpad S, Byles J. Predictors of chronic obstructive pulmonary disease in women who never smoked: A cohort study. ERJ Open Res 2022; 8:00532-2021. [PMID: 35586447 PMCID: PMC9108965 DOI: 10.1183/23120541.00532-2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 04/06/2022] [Indexed: 11/25/2022] Open
Abstract
COPD is responsible for an increasing number of deaths worldwide. Smoking is the most reliable predictor for developing COPD later in life. However, women make up the majority of patients with COPD who have never smoked. There is therefore a need to identify other factors that can predict COPD in women. The aim of this study is to identify factors associated with increasing the risk of developing COPD later in life in women who have never smoked. Data from the Australian Longitudinal Study on Women's Health (ALSWH) cohort born between 1946 and 1951 were used to investigate potential predictors of COPD. Retrospective analyses were performed on data from two of the ALSWH surveys: wave 1 (1996) and wave 9 (2019). There were 3584 women who self-reported as being never-smokers (at waves 1 and 9) and did not have COPD at baseline, of which 109 had developed COPD at wave 9. Logistic regression showed a significant relationship between COPD at wave 9 and baseline breathing difficulties (p<0.001), asthma (p<0.001) and allergies (p=0.026), though significance of asthma and allergies disappeared when included together in a single model, implying that women with these symptoms earlier in life were more likely to be diagnosed with COPD later in life compared to women without these symptoms. Our study supports the inclusion of lung function testing in primary care settings for women over the age of 45 years who have never smoked and have a history of breathing difficulties, asthma or allergies. A history of breathing difficulties, asthma, allergies, hay fever and sinusitis are associated with an increased risk of developing COPD later in life in women who have never smoked. Lung function testing should be considered for these women.https://bit.ly/3jDX9Mp
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21
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Pagano L, McKeough Z, Wootton S, Zwar N, Dennis S. Accuracy of the COPD diagnostic questionnaire as a screening tool in primary care. BMC PRIMARY CARE 2022; 23:78. [PMID: 35421929 PMCID: PMC9010070 DOI: 10.1186/s12875-022-01685-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 04/01/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND The COPD Diagnostic Questionnaire (CDQ) was developed to identify people who would benefit from spirometry testing to confirm Chronic Obstructive Pulmonary Disease (COPD). The aim of this study was to determine the usefulness of a cut-off score of 16.5 on the CDQ in identifying those at increased risk of obstruction, in a mixed population of people 'at risk' of COPD and those with an 'existing' COPD diagnosis. METHODS People 'at risk' of COPD (aged > 40 years, current/ex-smoker) and those with 'existing' COPD were identified from four general practices and invited to participate. Participants completed the CDQ and those with a CDQ score ≥ 16.5 were categorised as having intermediate to increased likelihood of airflow obstruction. Pre and post-bronchodilator spirometry determined the presence of airway obstruction (FEV1/FVC ratio < 0.7). Sensitivity, specificity and accuracy of the CDQ was determined compared to spirometry as the gold standard. RESULTS One hundred forty-one participants attended an initial assessment ('at risk' = 111 (79%), 'existing' COPD = 30 (21%)). A cut-off score of 16.5 corresponded to a sensitivity of 81%, specificity of 36% and accuracy of 50%, in the entire mixed population. The area under the ROC curve was 0.59 ± 0.50 indicating low diagnostic accuracy of the CDQ. Similar results were found in the 'existing' COPD group alone. CONCLUSION Whilst a cut-off score of 16.5 on the CDQ may result in a large number of false positives, clinicians may still wish to use the CDQ to refine who receives spirometry due to its high sensitivity. TRIAL REGISTRATION ANZCTR, ACTRN12619001127190. Registered 12 August 2019 - Retrospectively registered, http://www.ANZCTR.org.au/ACTRN12619001127190.aspx.
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Affiliation(s)
- Lisa Pagano
- Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Camperdown, Sydney, NSW, 2006, Australia
| | - Zoe McKeough
- Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Camperdown, Sydney, NSW, 2006, Australia
| | - Sally Wootton
- Chronic Disease Community Rehabilitation Service, Northern Sydney Local Health District, Sydney, Australia
| | - Nicholas Zwar
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
| | - Sarah Dennis
- Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Camperdown, Sydney, NSW, 2006, Australia.
- Ingham Institute for Applied Medical Research, Liverpool, Australia.
- South Western Sydney Local Health District, Liverpool, Australia.
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22
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Assessment and diagnosis of chronic dyspnoea: a literature review. NPJ Prim Care Respir Med 2022; 32:10. [PMID: 35260575 PMCID: PMC8904603 DOI: 10.1038/s41533-022-00271-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 12/22/2021] [Indexed: 11/08/2022] Open
Abstract
Dyspnoea or breathlessness is a common presenting symptom among patients attending primary care services. This review aimed to determine whether there are clinical tools that can be incorporated into a clinical decision support system for primary care for efficient and accurate diagnosis of causes of chronic dyspnoea. We searched MEDLINE, EMBASE and Google Scholar for all literature published between 1946 and 2020. Studies that evaluated a clinical algorithm for assessment of chronic dyspnoea in patients of any age group presenting to physicians with chronic dyspnoea were included. We identified 326 abstracts, 55 papers were reviewed, and eight included. A total 2026 patients aged between 20–80 years were included, 60% were women. The duration of dyspnoea was three weeks to 25 years. All studies undertook a stepwise or algorithmic approach to the assessment of dyspnoea. The results indicate that following history taking and physical examination, the first stage should include simply performed tests such as pulse oximetry, spirometry, and electrocardiography. If the patient remains undiagnosed, the second stage includes investigations such as chest x-ray, thyroid function tests, full blood count and NT-proBNP. In the third stage patients are referred for more advanced tests such as echocardiogram and thoracic CT. If dyspnoea remains unexplained, the fourth stage of assessment will require secondary care referral for more advanced diagnostic testing such as exercise tests. Utilising this proposed stepwise approach is expected to ascertain a cause for dyspnoea for 35% of the patients in stage 1, 83% by stage 3 and >90% of patients by stage 4.
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23
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Li Y, Wang C, Peng M. Aging Immune System and Its Correlation With Liability to Severe Lung Complications. Front Public Health 2021; 9:735151. [PMID: 34888279 PMCID: PMC8650611 DOI: 10.3389/fpubh.2021.735151] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 10/08/2021] [Indexed: 12/22/2022] Open
Abstract
Aging is considered to be a decline in physical and physiological events that extensively affect the body's immunity, and is linked with deterioration in both innate and adaptive immune responses. The immune system exhibits profound age-associated variations, known as immunosenescence, comprising a significantly low production of B and T lymphocytes in bone marrow and thymus, a decreased function of mature lymphocytes in secondary lymphoid tissues, a decrease in the synthesis of fresh naïve T cells, and reduced activation of T cells. Elderly individuals face a greater risk for many diseases particularly respiratory diseases due to their poor response to immune challenges as vigorously as the young. The current review explored the aging immune system, highlight the mortality rates of severe lung complications, such as pneumonia, COVID-19, asthma, COPD, lung cancer, IPF, and acute lung injury, and their correlation with aging immunity. This study can be helpful in better understanding the pathophysiology of aging, immune responses, and developing new approaches to improve the average age of the elderly population.
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Affiliation(s)
- Yongtao Li
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Chengfei Wang
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Meilian Peng
- Department of Maternity, Zhejiang Provincial People's Hospital, Hangzhou, China
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24
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Jetmalani K, Brown NJ, Boustany C, Toelle BG, Marks GB, Abramson MJ, Johns DP, James AL, Hunter M, Musk AW, Berend N, Farah CS, Chapman DG, Thamrin C, King GG. Normal limits for oscillometric bronchodilator responses and relationships with clinical factors. ERJ Open Res 2021; 7:00439-2021. [PMID: 34761000 PMCID: PMC8573235 DOI: 10.1183/23120541.00439-2021] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 07/06/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction We aimed to determine normal thresholds for positive bronchodilator responses for oscillometry in an Australian general population sample aged ≥40 years, to guide clinical interpretation. We also examined relationships between bronchodilator responses and respiratory symptoms, asthma diagnosis, smoking and baseline lung function. Methods Subjects recruited from Sydney, Melbourne and Busselton, Australia, underwent measurements of spirometry, resistance (Rrs6) and reactance (Xrs6) at 6 Hz, before and after inhalation of salbutamol 200 μg. Respiratory symptoms and/or medication use, asthma diagnosis, and smoking were recorded. Threshold bronchodilator responses were defined as the fifth percentile of decrease in Rrs6 and 95th percentile increase in Xrs6 in a healthy subgroup. Results Of 1318 participants, 1145 (570 female) were analysed. The lower threshold for ΔRrs6 was −1.38 cmH2O·s·L−1 (−30.0% or −1.42 Z-scores) and upper threshold for ΔXrs6 was 0.57 cmH2O·s·L−1 (1.36 Z-scores). Respiratory symptoms and/or medication use, asthma diagnosis, and smoking all predicted bronchodilator response, as did baseline oscillometry and spirometry. When categorised into clinically relevant groups according to those predictors, ΔXrs6 was more sensitive than spirometry in smokers without current asthma or chronic obstructive pulmonary disease (COPD), ∼20% having a positive response. Using absolute or Z-score change provided similar prevalences of responsiveness, except in COPD, in which responsiveness measured by absolute change was twice that for Z-score. Discussion This study describes normative thresholds for bronchodilator responses in oscillometry parameters, including intra-breath parameters, as determined by absolute, relative and Z-score changes. Positive bronchodilator response by oscillometry correlated with clinical factors and baseline function, which may inform the clinical interpretation of oscillometry. Normative values for bronchodilator responses measured by oscillometry were derived. Responsiveness related to clinical factors and baseline function. Reactance was more sensitive in detecting bronchodilator response than spirometry mild airways disease.https://bit.ly/3wtWVeV
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Affiliation(s)
- Kanika Jetmalani
- The Woolcock Institute of Medical Research, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Nathan J Brown
- The Woolcock Institute of Medical Research, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Royal Brisbane and Women's Hospital, Emergency and Trauma Centre, Herston, QLD, Australia
| | - Chantale Boustany
- The Woolcock Institute of Medical Research, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,School of Nursing, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Brett G Toelle
- The Woolcock Institute of Medical Research, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Sydney Local Health District, Sydney, NSW, Australia
| | - Guy B Marks
- The Woolcock Institute of Medical Research, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia.,Ingham Institute of Applied Medical Research, Sydney, NSW, Australia
| | - Michael J Abramson
- School of Population Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - David P Johns
- College of Health and Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Alan L James
- Busselton Population Medical Research Institute, Busselton, WA, Australia.,School of Medicine and Pharmacology, University of Western Australia, Perth, WA, Australia.,Dept of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Michael Hunter
- Busselton Population Medical Research Institute, Busselton, WA, Australia.,School of Population and Global Health, University of Western Australia, Perth, WA, Australia
| | - Arthur W Musk
- Busselton Population Medical Research Institute, Busselton, WA, Australia.,School of Medicine and Pharmacology, University of Western Australia, Perth, WA, Australia
| | - Norbert Berend
- The Woolcock Institute of Medical Research, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Claude S Farah
- The Woolcock Institute of Medical Research, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Dept of Thoracic Medicine, Concord Repatriation General Hospital, Sydney, NSW, Australia
| | - David G Chapman
- The Woolcock Institute of Medical Research, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Dept of Respiratory Medicine, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Cindy Thamrin
- The Woolcock Institute of Medical Research, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Gregory G King
- The Woolcock Institute of Medical Research, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Sydney Local Health District, Sydney, NSW, Australia
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25
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Habteslassie D, Khorramnia S, Muruganandan S, Romeo N, See K, Hannan LM. Missed diagnosis or misdiagnosis: How often do hospitalised patients with a diagnosis of chronic obstructive pulmonary disease (COPD) have spirometry that supports the diagnosis? Intern Med J 2021; 53:510-516. [PMID: 34719093 DOI: 10.1111/imj.15607] [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: 06/20/2021] [Revised: 09/30/2021] [Accepted: 10/28/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Chronic obstructive pulmonary disease is one of the most common clinical diagnoses among hospital inpatients. Diagnosis requires the demonstration of post-bronchodilator airflow obstruction. However, it is uncertain how often spirometry results are available at the time a diagnostic label of COPD is applied. AIM To identify how frequently spirometry results were available following an inpatient admission with a clinical diagnosis of COPD, and to determine how often the available spirometry results supported a clinical diagnosis of COPD. Inhaler prescription, at discharge, was also evaluated to determine one of the potential implications of diagnostic inaccuracy. METHODS A single centre retrospective observational study was undertaken at a 400-bed metropolitan health service between October 2016 and March 2018. RESULTS A total of 2239 inpatient separations occurred in 1469 individuals who had a clinical diagnosis of COPD during the study. Spirometry results were not available in 43.6% (n = 641) of those with a diagnosis of COPD. A further 19.7% (n = 289) had spirometry results available at the time of admission, that did not demonstrate fixed airflow obstruction. The available prescribing data (n = 443) demonstrated that inhaled medications were prescribed in a similar pattern, regardless of the availability of spirometry, or whether the results supported a clinical diagnosis of COPD. CONCLUSIONS Inpatients with a clinical diagnosis of COPD frequently did not have supportive spirometry results that confirmed the diagnosis or had results inconsistent with COPD. Misdiagnosis and inappropriate prescribing require further attention to improve the quality of care in this setting. This article is protected by copyright. All rights reserved.
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Affiliation(s)
| | - Sadie Khorramnia
- Department of Respiratory Medicine, Northern Health, Victoria, Australia
| | | | - Nicholas Romeo
- Department of Respiratory Medicine, Northern Health, Victoria, Australia
| | - Katharine See
- Department of Respiratory Medicine, Northern Health, Victoria, Australia.,Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Liam M Hannan
- Department of Respiratory Medicine, Northern Health, Victoria, Australia.,Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia.,Institute for Breathing and Sleep, Austin Health, Melbourne, Victoria, Australia
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26
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Janetzki JL, Sykes MJ, Ward MB, Pratt NL. Proton pump inhibitors may contribute to progression or development of chronic obstructive pulmonary disease-A sequence symmetry analysis approach. J Clin Pharm Ther 2021; 46:1687-1694. [PMID: 34431531 DOI: 10.1111/jcpt.13520] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 08/10/2021] [Accepted: 08/17/2021] [Indexed: 01/07/2023]
Abstract
WHAT IS KNOWN AND OBJECTIVE Proton pump inhibitors (PPIs), used to treat and prevent gastro-oesophageal conditions, are well-tolerated but have been associated with risk including pneumonia. The extent to which initiation of PPIs can contribute to other respiratory conditions such as chronic obstructive pulmonary disease (COPD) is largely unknown. METHODS A sequence symmetry analysis (SSA) approach was applied to the Australian Department of Human Services, Pharmaceutical Benefits Scheme 10% extract. Participants were aged 45 years and older and were dispensed PPIs (ATC Codes A02BC01, A02BC02, A02BC03, A02BC04 and A02BC05) and long-acting bronchodilators (LABDs) for COPD (ATC Codes R03BB04 (PBS Item Code 10509D and 08626B), R03BB05, R03BB06, R03BB07 and R03AC18 (PBS Item Code 05137J and 05134F)) between 2013 and 2019. The analysis included patients initiated on an LABD within 12 months before or after their first prescription of a PPI. The crude sequence ratio (cSR) was calculated as the number of patients prescribed their first LABD after starting a PPI divided by the number of patients prescribed their first LABD before starting a PPI. Calculation of the adjusted sequence ratio (aSR) accounted for prescribing trends over time in initiation of each of the medicines. A signal was identified where the aSR lower 95% confidence interval (CI) was greater than one. RESULTS AND DISCUSSION Initiation of omeprazole was associated with a 29% increased risk of initiating a LABD (ASR = 1.29 95% CI 1.22-1.36). Initiation of esomeprazole, rabeprazole, pantoprazole or lansoprazole was associated with 25%, 15%, 8% and 8% increased risk, respectively. WHAT IS NEW AND CONCLUSION There is an established association between gastro-oesophageal reflux disease and COPD which has been confirmed by implementation of a sequence symmetry-based approach which demonstrated that PPI initiation is potentially associated with progression or exacerbation of COPD. The impact PPI use has directly on this association requires further investigation.
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Affiliation(s)
- Jack L Janetzki
- Quality Use of Medicines and Pharmacy Research Centre, University of South Australia, Adelaide, South Australia, Australia.,UniSA Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Matthew J Sykes
- UniSA Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Michael B Ward
- Quality Use of Medicines and Pharmacy Research Centre, University of South Australia, Adelaide, South Australia, Australia.,UniSA Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Nicole L Pratt
- Quality Use of Medicines and Pharmacy Research Centre, University of South Australia, Adelaide, South Australia, Australia.,UniSA Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
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27
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Abramson MJ, Wigmann C, Altug H, Schikowski T. Ambient air pollution is associated with airway inflammation in older women: a nested cross-sectional analysis. BMJ Open Respir Res 2021; 7:7/1/e000549. [PMID: 32209644 PMCID: PMC7206912 DOI: 10.1136/bmjresp-2019-000549] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 03/02/2020] [Accepted: 03/03/2020] [Indexed: 12/30/2022] Open
Abstract
Background Air pollution is a risk factor for chronic obstructive pulmonary disease (COPD). Fraction of exhaled nitric oxide (FeNO) could be a useful biomarker for health effects of air pollutants. However, there were limited data from older populations with higher prevalence of COPD and other inflammatory conditions. Methods We obtained data from the German Study on the influence of Air pollution on Lung function, Inflammation and Ageing. Spirometry and FeNO were measured by standard techniques. Air pollutant exposures were estimated following the European Study of Cohorts for Air Pollution Effects protocols, and ozone (O3) measured at the closest ground level monitoring station. Multiple linear regression models were fitted to FeNO with each pollutant separately and adjusted for potential confounders. Results In 236 women (mean age 74.6 years), geometric mean FeNO was 15.2ppb. Almost a third (n=71, 30.1%) of the women had some chronic inflammatory respiratory condition. A higher FeNO concentration was associated with exposures to fine particles (PM2.5), PM2.5absorbance and respirable particles (PM10). There were no significant associations with PMcoarse, NO2, NOx, O3 or length of major roads within a 1 km buffer. Restricting the analysis to participants with a chronic inflammatory respiratory condition, with or without impaired lung function produced similar findings. Adjusting for diabetes did not materially alter the findings. There were no significant interactions between individual pollutants and asthma or current smoking. Conclusions This study adds to the evidence to reduce ambient PM2.5 concentrations as low as possible to protect the health of the general population.
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Affiliation(s)
- Michael J Abramson
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Claudia Wigmann
- Environmental Epidemiology of Lung, Brain and Skin Aging, Leibniz Research Institute for Environmental Medicine, Dusseldorf, Nordrhein-Westfalen, Germany
| | - Hicran Altug
- Environmental Epidemiology of Lung, Brain and Skin Aging, Leibniz Research Institute for Environmental Medicine, Dusseldorf, Nordrhein-Westfalen, Germany
| | - Tamara Schikowski
- Environmental Epidemiology of Lung, Brain and Skin Aging, Leibniz Research Institute for Environmental Medicine, Dusseldorf, Nordrhein-Westfalen, Germany
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28
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Brassil C, Srigandan S, Murray CP. Sabre-sheath trachea: An underused diagnostic weapon in the thoracic armoury. J Med Imaging Radiat Oncol 2021; 66:49-53. [PMID: 34227257 DOI: 10.1111/1754-9485.13281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 06/15/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION A sabre-sheath trachea is a highly specific sign for chronic obstructive pulmonary disease. It also correlates well with the degree of disease. We hypothesized that the term is vastly under-utilized in radiologic reporting, despite its high diagnostic value. METHODS We interrogated our multisite metropolitan-wide radiology information system to find the number of CT reports containing the phrase 'sabre-sheath trachea' and conceivable variants thereof, over the 10 years to present. We compared this with the entire number of CT chest reports in the same time period in order to estimate the utilization of the sign. RESULTS The results confirmed our hypothesis that the sign is rarely invoked, likely around 1 in 41 times relative to opportunity. CONCLUSIONS This highly specific sign of chronic obstructive small airway disease should be reinforced in training and utilized by radiologists.
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Affiliation(s)
- Colm Brassil
- Department of Medical Imaging, Royal Perth Hospital, Perth, Western Australia, Australia.,ChestRad, Perth, Western Australia, Australia
| | - Shrivuthsun Srigandan
- Department of Medical Imaging, Royal Perth Hospital, Perth, Western Australia, Australia.,Department of Medical Imaging, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Conor P Murray
- ChestRad, Perth, Western Australia, Australia.,Department of Medical Imaging, Perth Children's Hospital, Perth, Western Australia, Australia
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29
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Heraganahally SS, Howarth T, Mo L, Sorger L, Ben Saad H. Critical analysis of spirometric patterns in correlation to chest computed tomography among adult Indigenous Australians with chronic airway diseases. Expert Rev Respir Med 2021; 15:1229-1238. [PMID: 33985393 DOI: 10.1080/17476348.2021.1928496] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background: There is sparse literature evidence in the spirometric patterns of adult Indigenous Australians with and without chest computed tomography (CT)-proven chronic airway diseases (CADs).Methods: Participants spirometry testing graded as acceptable for quality and had a chest CT scan showing radiographic evidence of CADs were included for analysis.Results: Of the 1350 spirometric tests performed between 2012 and 2020, a total of 212 patients with a mean age of 53 years and 54% females were eligible to be included. One-third (30%) had normal chest CT (without CADs), 35% had predominant COPD, 19% bronchiectasis and 16% combined COPD and bronchiectasis. Percentage predicted values for forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) both pre- and post- bronchodilator were significantly reduced for all participants - FVC: CT-normal 64%, 65%; COPD 58%, 62%; bronchiectasis 54%, 54%; combined COPD and bronchiectasis 50%, 53%. FEV1: CT-normal 62%, 65%; COPD 46%, 49%; bronchiectasis 48%,51%; combined COPD and bronchiectasis 36%,40%. FEV1/FVC was only reduced for CT abnormality patients - CT-normal 96%,98%; COPD 77%,77%; bronchiectasis 87%,89%; combined COPD and bronchiectasis 71%,72%.Conclusions: Restrictive spirometric pattern is common and an obstructive pattern with COPD, in isolation or when COPD coexists with bronchiectasis.
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Affiliation(s)
- Subash S Heraganahally
- Department of Respiratory and Sleep Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia.,Flinders University - College of Medicine and Public Health, Adelaide, South Australia, Australia.,Darwin Respiratory and Sleep Health, Darwin Private Hospital, Darwin, Northern Territory, Australia
| | - Timothy Howarth
- Darwin Respiratory and Sleep Health, Darwin Private Hospital, Darwin, Northern Territory, Australia.,College of Health and Human Sciences, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Lin Mo
- Department of Respiratory and Sleep Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Lisa Sorger
- Department of Medical Imaging, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Helmi Ben Saad
- University of Sousse, Farhat HACHED Hospital, Heart Failure Research Laboratory (LR12SP09), Sousse, Tunisia
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30
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Walters EH, Shukla SD, Mahmood MQ, Ward C. Fully integrating pathophysiological insights in COPD: an updated working disease model to broaden therapeutic vision. Eur Respir Rev 2021; 30:200364. [PMID: 34039673 PMCID: PMC9488955 DOI: 10.1183/16000617.0364-2020] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 02/18/2021] [Indexed: 12/17/2022] Open
Abstract
Our starting point is that relatively new findings into the pathogenesis and pathophysiology of airway disease in smokers that lead to chronic obstructive pulmonary disease (COPD) need to be reassessed as a whole and integrated into "mainstream" thinking along with traditional concepts which have stood the test of time. Such a refining of the accepted disease paradigm is urgently needed as thinking on therapeutic targets is currently under active reconsideration. We feel that generalised airway wall "inflammation" is unduly over-emphasised, and highlight the patchy and variable nature of the pathology (with the core being airway remodelling). In addition, we present evidence for airway wall disease in smokers/COPD as including a hypocellular, hypovascular, destructive, fibrotic pathology, with a likely spectrum of epithelial-mesenchymal transition states as significant drivers of this remodelling. Furthermore, we present data from a number of research modalities and integrate this with the aetiology of lung cancer, the role of chronic airway luminal colonisation/infection by a specific group of "respiratory" bacteria in smokers (which results in luminal inflammation) and the central role for oxidative stress on the epithelium. We suggest translation of these insights into more focus on asymptomatic smokers and early COPD, with the potential for fresh preventive and therapeutic approaches.
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Affiliation(s)
- E Haydn Walters
- School of Medicine and Menzies Institute, University of Tasmania, Hobart, Australia
| | - Shakti D Shukla
- Priority Research Centre for Healthy Lungs and School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Malik Q Mahmood
- School of Medicine, Faculty of Health, Deakin University, Waurn Ponds, Australia
| | - Chris Ward
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University Medical School, Newcastle University, UK
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31
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Toelle BG, Ampon RD, Abramson MJ, James AL, Maguire GP, Wood-Baker R, Johns DP, Marks GB. Prevalence of chronic obstructive pulmonary disease with breathlessness in Australia: weighted using the 2016 Australian census. Intern Med J 2021; 51:784-787. [PMID: 34047039 DOI: 10.1111/imj.15325] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 02/01/2021] [Accepted: 02/15/2021] [Indexed: 12/01/2022]
Abstract
Access to up-to-date Australian disease prevalence estimates assists health services and consumer organisations to plan and allocate resources. The Burden of Obstructive Lung Disease study was conducted between 2006 and 2012 and provided chronic obstructive pulmonary disease (COPD) (post-bronchodilator airflow limitation) prevalence estimates weighted to the 2006 Australian census. Using the 2016 Australian census, an updated prevalence estimate of all COPD is 8.30% (95% confidence interval = 6.59%-10.01%) for adults aged 40 or more years in Australia and includes 2.52% with mild breathlessness, 0.99% with moderate breathlessness and 0.91% with severe breathlessness.
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Affiliation(s)
- Brett G Toelle
- Woolcock Emphysema Centre, Woolcock Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia.,Sydney Local Health District, Sydney, New South Wales, Australia
| | - Rosario D Ampon
- Australian Centre for Airways Disease Monitoring, Woolcock Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - Michael J Abramson
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Alan L James
- Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Graeme P Maguire
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Richard Wood-Baker
- College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - David P Johns
- College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Guy B Marks
- Australian Centre for Airways Disease Monitoring, 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
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32
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Deshpande S, Datey N, Liacos A, Joosten SA, Leong P. Acute oxygen use in hospitalised patients with chronic obstructive pulmonary disease is guideline discordant. Intern Med J 2021; 51:780-783. [PMID: 34047025 DOI: 10.1111/imj.15318] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 06/15/2020] [Accepted: 06/23/2020] [Indexed: 11/28/2022]
Abstract
Ample evidence supports an association between acute oxygen over-administration and harm. Australian and international guidelines consistently recommend lower oxygen saturation aims in populations with chronic obstructive pulmonary disease (COPD). We assessed adherence to acute oxygen use guidelines and outcomes in hospitalised patients with COPD at a large Australian metropolitan hospital network.
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Affiliation(s)
- Sheetal Deshpande
- Monash Lung and Sleep, Monash Health, Melbourne, Victoria, Australia
| | - Nainika Datey
- School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia
| | - Alexandra Liacos
- School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia
| | - Simon A Joosten
- Monash Lung and Sleep, Monash Health, Melbourne, Victoria, Australia.,School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia
| | - Paul Leong
- Monash Lung and Sleep, Monash Health, Melbourne, Victoria, Australia.,School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia
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33
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Policy Implications for Protecting Health from the Hazards of Fire Smoke. A Panel Discussion Report from the Workshop Landscape Fire Smoke: Protecting Health in an Era of Escalating Fire Risk. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18115702. [PMID: 34073399 PMCID: PMC8199356 DOI: 10.3390/ijerph18115702] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 05/17/2021] [Accepted: 05/19/2021] [Indexed: 12/21/2022]
Abstract
Globally, and nationally in Australia, bushfires are expected to increase in frequency and intensity due to climate change. To date, protection of human health from fire smoke has largely relied on individual-level actions. Recent bushfires experienced during the Australian summer of 2019–2020 occurred over a prolonged period and encompassed far larger geographical areas than previously experienced, resulting in extreme levels of smoke for extended periods of time. This particular bushfire season resulted in highly challenging conditions, where many people were unable to protect themselves from smoke exposures. The Centre for Air pollution, energy and health Research (CAR), an Australian research centre, hosted a two-day symposium, Landscape Fire Smoke: Protecting health in an era of escalating fire risk, on 8 and 9 October 2020. One component of the symposium was a dedicated panel discussion where invited experts were asked to examine alternative policy settings for protecting health from fire smoke hazards with specific reference to interventions to minimise exposure, protection of outdoor workers, and current systems for communicating health risk. This paper documents the proceedings of the expert panel and participant discussion held during the workshop.
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34
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Poulos LM, Ampon RD, Currow DC, Marks GB, Toelle BG, Reddel HK. Prevalence and burden of breathlessness in Australian adults: The National Breathlessness Survey-a cross-sectional web-based population survey. Respirology 2021; 26:768-775. [PMID: 33971059 DOI: 10.1111/resp.14070] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 03/10/2021] [Accepted: 04/14/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVE Chronic respiratory symptoms (in particular, breathlessness and cough) can cause physical, social and emotional distress, and may indicate the presence of an underlying disease that presages future poor health outcomes. Our aim was to investigate the burden of breathlessness in Australian adults, including breathlessness that may be undiagnosed, unlabelled or untreated. METHODS The National Breathlessness Survey was a cross-sectional, web-based survey conducted in October 2019. Australian adults were randomly selected from a large web-based survey panel with recruitment stratified by age-group, gender and state of residence according to national population data. The main outcome measures were modified Medical Research Council (mMRC) dyspnoea scale, EuroQol visual analog scale, Dyspnoea-12 score and 4-item Patient Health Questionnaire (PHQ-4). RESULTS Among all respondents (n = 10,072; 51.1% female; median age group 40-49 years), 9.5% reported clinically important breathlessness (mMRC dyspnoea grade ≥ 2, 2 = 'I walk slower than people of the same age on the level because of breathlessness or have to stop for breath when walking at my own pace on the level'). Among those with clinically important breathlessness, 49.1% rated their general health as fair or poor and 44.2% had at least moderate depression or anxiety symptoms (PHQ ≥ 6) but over half (50.8%) did not report a current respiratory or heart condition diagnosis. CONCLUSION Breathlessness is common among Australian adults, and is associated with a substantial burden of ill health, including among people without a diagnosed respiratory or heart condition. The extent of underdiagnosis of these conditions or alternative causes of breathlessness requires further investigation.
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Affiliation(s)
- Leanne M Poulos
- Australian Centre for Airways disease Monitoring (ACAM), the Woolcock Institute of Medical Research, The University of Sydney, Sydney, New South Wales, Australia
| | - Rosario D Ampon
- Australian Centre for Airways disease Monitoring (ACAM), the Woolcock Institute of Medical Research, The University of Sydney, Sydney, New South Wales, Australia
| | - David C Currow
- IMPACCT, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Guy B Marks
- Australian Centre for Airways disease Monitoring (ACAM), the Woolcock Institute of Medical Research, The University of Sydney, Sydney, New South Wales, Australia
| | - Brett G Toelle
- Australian Centre for Airways disease Monitoring (ACAM), the Woolcock Institute of Medical Research, The University of Sydney, Sydney, New South Wales, Australia.,Sydney Local Health District, Sydney, New South Wales, Australia
| | - Helen K Reddel
- Australian Centre for Airways disease Monitoring (ACAM), the Woolcock Institute of Medical Research, The University of Sydney, Sydney, New South Wales, Australia
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35
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Heraganahally SS, Wasgewatta SL, McNamara K, Mingi JJ, Mehra S, Eisemberg CC, Maguire G. 2004 chronic obstructive pulmonary disease with and without bronchiectasis in Aboriginal Australians: a comparative study. Intern Med J 2021; 50:1505-1513. [PMID: 31841252 DOI: 10.1111/imj.14718] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 11/23/2019] [Accepted: 12/08/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Chronic respiratory disorders are highly prevalent in Aboriginal Australian population, including chronic obstructive pulmonary disease (COPD) and bronchiectasis. However, there is paucity of information in the literature among Aboriginal patients with underlying COPD with and without bronchiectasis. AIMS In this retrospective study we evaluated the demographic and clinical characteristics of adult Aboriginal Australian patients with a clinical diagnosis of COPD with and without bronchiectasis from the remote communities of the Northern Territory of Australia. METHODS Clinical records were reviewed to extract information on demographics, respiratory and medical comorbid conditions, COPD directed treatment, hospital admission frequency and exacerbations. Chest radiology were reviewed to evaluate the presence or absence of bronchiectasis. Spirometry results, sputum culture and cardiac investigations were also recorded. RESULTS Of the 767 patients assessed in the remote community respiratory outreach clinics 380 (49%) patients had a clinical diagnosis of COPD. Chest X-ray and computed tomography scan were available to evaluate the presence of bronchiectasis in 258 patients. Of the 258/380 patients, 176/258 (68.2%) were diagnosed to have COPD alone and 82/258 (31.8%) had bronchiectasis along with COPD. The mean age was 56 and 59 years among patients with and without bronchiectasis, respectively, and 57% were males with bronchiectasis. Patients with bronchiectasis had lower body mass index (22 vs 24 kg/m2 ), frequent hospital admissions (2.0 vs 1.5/year) and productive cough (32.1% vs 28.9%). Spirometry showed 77% had forced expiratory volume in 1 s (FEV1 )/forced vital capacity ratio <0.7. In 81% and 75% of patients with and without bronchiectasis the FEV1 /forced vital capacity ratio was <0.7 and the mean FEV1 was 39% and 43% respectively. CONCLUSIONS About 32% of Aboriginal Australians had co-existent bronchiectasis with COPD. Lower body mass index, productive cough, frequent hospital admission and marginally more severe reduction in lung function were noted among patients with COPD and bronchiectasis compared to those with COPD in isolation.
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Affiliation(s)
- Subash S Heraganahally
- Department of Respiratory and Sleep Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia.,College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.,Northern Territory Medical School, Charles Darwin University, Darwin, South Australia, Australia.,Darwin Respiratory and Sleep Health, Darwin Private Hospital, Darwin, Northern Territory, Australia
| | - Sanjiwika L Wasgewatta
- Department of Respiratory and Sleep Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Kelly McNamara
- Department of Respiratory and Sleep Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia.,College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.,Northern Territory Medical School, Charles Darwin University, Darwin, South Australia, Australia
| | - Joy J Mingi
- Darwin Respiratory and Sleep Health, Darwin Private Hospital, Darwin, Northern Territory, Australia.,Department of Public Health, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Sumit Mehra
- Department of Respiratory and Sleep Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia.,Department of Respiratory and Sleep Medicine, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Carla C Eisemberg
- Research Institute for the Environment and Livelihoods, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Graeme Maguire
- Department of General Internal Medicine, Western Health, Melbourne, Victoria, Australia.,Department of Medicine, Footscray Hospital, Melbourne, Victoria, Australia.,Department of Medicine, Sunshine Hospital, Melbourne, Victoria, Australia
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36
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Fathima M, Bawa Z, Mitchell B, Foster J, Armour C, Saini B. COPD Management in Community Pharmacy Results in Improved Inhaler Use, Immunization Rate, COPD Action Plan Ownership, COPD Knowledge, and Reductions in Exacerbation Rates. Int J Chron Obstruct Pulmon Dis 2021; 16:519-533. [PMID: 33688177 PMCID: PMC7936701 DOI: 10.2147/copd.s288792] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 01/25/2021] [Indexed: 12/12/2022] Open
Abstract
Purpose To evaluate the effectiveness of a pilot community pharmacy care model for patients with chronic obstructive pulmonary disease (COPD) to improve: 1) inhaler technique; 2) medication adherence; and 3) uptake of non-pharmacological treatment and prevention activities. Patients and Methods Forty "host" pharmacies in Sydney were invited to recruit eligible patients and to provide a counselling room/area in their pharmacy for service provision. Eligible patients were referred to two "consultant" pharmacists, specifically trained to deliver a specialized pharmacy COPD service which involved 3 in-pharmacy visits and 2 follow-up phone calls over a 6-month period. The service consisted of 1) inhaler technique assessment; 2) medication adherence assessment; and 3) referrals to the patient's general practitioner (GP) to facilitate the uptake of non-pharmacological resources as well as to review COPD medications/devices, as required. Pre-post analyses were conducted using paired Student's t-test and Wilcoxon Signed Rank Test for independent variables and chi-squared tests for proportional data. Results Nine "host" pharmacies recruited 40 patients, of whom 37 completed the baseline Visit and 27 completed all Visits. A total of 270 interventions were provided by the "consultant" pharmacists with most provided at Visit 1 (176). The most common interventions were addressing patient gaps in COPD knowledge and inhaler technique. A total of 119 referrals were made to GPs for various reasons, the most common being for a COPD action plan, pulmonary rehabilitation, or pneumonia vaccination. There were significant improvements pre-post intervention in inhaler use competence, COPD knowledge, immunization rate for pneumonia, exacerbation rate and COPD plan ownership. Conclusion In this pilot study, the specialized pharmacy-based COPD care model delivered by "consultant" pharmacists in community pharmacies provided significant health benefits for patients. Further research is needed to assess the model's effectiveness in a larger population as well as when measured against standard care.
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Affiliation(s)
- Mariam Fathima
- Woolcock Institute of Medical Research, University of Sydney, Glebe, New South Wales, Australia
| | - Zeeta Bawa
- Woolcock Institute of Medical Research, University of Sydney, Glebe, New South Wales, Australia
| | - Bernadette Mitchell
- Woolcock Institute of Medical Research, University of Sydney, Glebe, New South Wales, Australia
| | - Juliet Foster
- Woolcock Institute of Medical Research, University of Sydney, Glebe, New South Wales, Australia
| | - Carol Armour
- Woolcock Institute of Medical Research, University of Sydney, Glebe, New South Wales, Australia
| | - Bandana Saini
- Woolcock Institute of Medical Research, University of Sydney, Glebe, New South Wales, Australia.,School of Pharmacy, University of Sydney, Camperdown, New South Wales, Australia
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Huang S, He Q, Zhou L. T cell responses in respiratory viral infections and chronic obstructive pulmonary disease. Chin Med J (Engl) 2021; 134:1522-1534. [PMID: 33655898 PMCID: PMC8280062 DOI: 10.1097/cm9.0000000000001388] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Indexed: 12/21/2022] Open
Abstract
ABSTRACT Respiratory viruses are major human pathogens that cause approximately 200 million pneumonia cases annually and induce various comorbidities with chronic obstructive pulmonary disease (COPD), resulting in significant health concerns and economic burdens. Clinical manifestations in respiratory viral infections and inflammations vary from asymptomatic, mild, to severe, depending on host immune cell responses to pathogens and interactions with airway epithelia. We critically review the activation, effector, and regulation of T cells in respiratory virus infections and chronic inflammations associated with COPD. Crosstalk among T cells, innate immune cells, and airway epithelial cells is discussed as essential parts of pathogenesis and protection in viral infections and COPD. We emphasize the specificity of peptide antigens and the functional heterogeneity of conventional CD4+ and CD8+ T cells to shed some light on potential cellular and molecular candidates for the future development of therapeutics and intervention against respiratory viral infections and inflammations.
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Affiliation(s)
- Shouxiong Huang
- Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, Immunology Graduate Program, Cincinnati Children's Hospital, Cincinnati, OH 45249, USA
| | - Quan He
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Linfu Zhou
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu 210029, China
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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
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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
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Petrie K, Toelle BG, Wood-Baker R, Maguire GP, James AL, Hunter M, Johns DP, Marks GB, George J, Abramson MJ. Undiagnosed and Misdiagnosed Chronic Obstructive Pulmonary Disease: Data from the BOLD Australia Study. Int J Chron Obstruct Pulmon Dis 2021; 16:467-475. [PMID: 33658776 PMCID: PMC7920499 DOI: 10.2147/copd.s287172] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 12/30/2020] [Indexed: 12/18/2022] Open
Abstract
Purpose Spirometry is necessary to confirm COPD, but many patients are diagnosed based on clinical presentation and/or chest x-ray. There are also those who do not present to primary care for case finding and remain undiagnosed. We aimed to identify: (a) factors that are associated with undiagnosed COPD; and (b) factors that are associated with a potential misdiagnosis of COPD. Patients and Methods This analysis used data from the Burden of Obstructive Lung Disease (BOLD), a cross-sectional study of community dwelling adults randomly selected from six study sites, chosen to provide a representative sample of the Australian population (n= 3357). Participants were grouped by COPD diagnostic criteria based on spirometry and self-reported diagnosis. Odds ratios for predictors of undiagnosed and misdiagnosed were estimated using logistic regression. Results Of the BOLD Australia sample, 1.8% had confirmed COPD, of whom only half self-reported a diagnosis of COPD. A further 6.9% probably had COPD, but were undiagnosed. The priority target population for case finding of undiagnosed COPD was aged ≥60 years (particularly those ≥75 years), with wheezing, shortness of breath and a body mass index (BMI) <25kg/m2. The priority target population for identifying and reviewing misdiagnosed COPD was aged <60 years, female, with no wheezing and a BMI ≥25kg/m2. Conclusion Challenges continue in accurately diagnosing COPD and greater efforts are needed to identify undiagnosed and misdiagnosed individuals to ensure an accurate diagnosis and the initiation of appropriate management in order to reduce the burden of COPD.
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Affiliation(s)
- Kate Petrie
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, VIC, Australia
| | - Brett G Toelle
- Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia.,Sydney Local Health District, Sydney, NSW, Australia
| | - Richard Wood-Baker
- College of Health and Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Graeme P Maguire
- Western Clinical School, University of Melbourne, Melbourne, Australia and General Internal Medicine, Western Health, Melbourne, VIC, Australia
| | - Alan L James
- Sir Charles Gairdner Hospital, West Australian Sleep Disorders Research Institute, Department of Pulmonary Physiology and Sleep Medicine, Perth, WA, Australia.,University of Western Australia, Medical School, Perth, WA, Australia
| | - Michael Hunter
- School of Population and Global Health, University of Western Australia, Perth, WA, Australia.,Busselton Population Medical Research Institute, Busselton, WA, Australia
| | - David P Johns
- College of Health and Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Guy B Marks
- Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia.,South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Johnson George
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, VIC, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Michael J Abramson
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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Simmich J, Mandrusiak A, Russell T, Smith S, Hartley N. Perspectives of older adults with chronic disease on the use of wearable technology and video games for physical activity. Digit Health 2021; 7:20552076211019900. [PMID: 34104468 PMCID: PMC8168030 DOI: 10.1177/20552076211019900] [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: 10/22/2020] [Accepted: 05/01/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND There is increasing interest in technology to deliver physical rehabilitation and allow clinicians to monitor progress. Examples include wearable activity trackers and active video games (AVGs), where physical activity is required to play the game. However, few studies have explored what may influence the effectiveness of these as technology-based physical activity interventions in older adults with chronic diseases. OBJECTIVE This study aimed to explore: 1) perceptions about wearable physical activity trackers; 2) perceptions about using technology to share physical activity information with clinicians; 3) barriers and motivators to playing games, including AVGs for rehabilitation. METHODS Qualitative study based on semi-structured interviews with older adults (n = 19) with chronic obstructive pulmonary disease (COPD). RESULTS Wearable activity trackers were perceived as useful to quantify activity, facilitate goal-setting, visualize long-term improvements and provide reminders. Participants generally wished to share data with their clinicians to gain greater accountability, receive useful feedback and improve the quality of clinical care. Participants were motivated to play games (including AVGs) by seeking fun, social interaction and health benefits. Some felt that AVGs were of no benefit or were too difficult. Competition was both a motivator and a barrier. CONCLUSIONS The findings of the present study seek to inform the design of technology to encourage physical activity in older adults with chronic diseases.
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Affiliation(s)
- Joshua Simmich
- Faculty of Health and Behavioural Sciences, School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia
| | - Allison Mandrusiak
- Faculty of Health and Behavioural Sciences, School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia
| | - Trevor Russell
- Faculty of Health and Behavioural Sciences, School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia
| | - Stuart Smith
- School of Health and Human Sciences, Southern Cross University, Coffs Harbour, Australia
| | - Nicole Hartley
- Faculty of Business, Economics and Law, The University of Queensland, St Lucia, Australia
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Ali KM. Childhood asthma as a risk factor for adult chronic obstructive pulmonary disease: a systematic review and meta-analysis. Expert Rev Respir Med 2020; 16:461-467. [PMID: 33317352 DOI: 10.1080/17476348.2021.1864328] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Background: Due to the disagreement in studies, the present study performed a systematic review and meta-analysis to investigate the relationship between childhood asthma and the development of chronic obstructive pulmonary disease (COPD) in adulthood.Methods: Literature search was performed in Medline and Embase databases until the end of 2019. Data were recorded as adjusted odds ratio (OR) and 95% confidence interval (95%CI). Analyses were performed on STATA 14.0 and an overall OR was reported. Subgroup analysis was performed to determine the source of heterogeneity.Results: Data from 11 articles were included in the meta-analysis. Overall, the odds of developing adulthood COPD in children with asthma were 3.0 times higher than that in non-asthmatic children (OR = 3.00; 95%CI: 2.25-4.00; p < 0.001). The relationship between childhood asthma and COPD in adulthood was reported somewhat greater in random sampling method studies than consecutive sampling method studies (OR = 2.89; 95% CI: 1.72-4.86; p = 0.001).Conclusion: Asthma in childhood could be considered as an independent risk factor for COPD in adulthood. Since type of study, sampling method, sample size of study and COPD prevalence are the main sources of heterogeneity, further prospective high-quality studies assessing the relationship of childhood asthma and adulthood COPD are recommended to be performed.
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Heraganahally SS, Howarth T, White E, Sorger L, Biancardi E, Ben Saad H. Lung function parameters among Australian Aboriginal 'apparently healthy' adults: an Australian Caucasian and Global Lung Function Initiative (GLI-2012) various ethnic norms comparative study. Expert Rev Respir Med 2020; 15:833-843. [PMID: 33166208 DOI: 10.1080/17476348.2021.1847649] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background: There is sparse literature evidence evaluating the applicability of the GLI-2012 spirometric norms for Australian Aboriginal adults.Methods: Lung function parameters (LFPs) were compared between Australian Aboriginal and Australian Caucasians, and the fit of Australian Aboriginals LFPs with various ethnic GLI equations was tested.Results: Of 1350 and 5634 Pulmonary function tests (PFTs) in Australian Aboriginal and Australian Caucasian adults, 153 and 208 PFTs matched for anthropometrics and normal chest radiology, respectively. Absolute FVC and FEV1 values were 20% lower in Australian Aboriginals compared to Australian Caucasians. Differences remained significant after accounting for age, sex, height, weight and smoking status in multivariate regression (FVC -0.84 L (-0.98, -0.71), FEV1 - 0.72 L (-0.84, -0.59), but with nearly preserved FEV1/FVC. GLI-2012 transformation resulted in z-scores significantly below zero for each of FVC, FEV1 and FEV1/FVC with z-scores ranging from -4.52 (-4.87, -4.16) for North East Asian FVC transformation for males, to -0.34 (-0.73, 0.05) for Black FVC transformation for females.Conclusions: Australian Aboriginal adults had 20% lower values for FVC and FEV1 but nearly preserved absolute FEV1/FVC in comparison to Australian Caucasians. The GLI-2012 spirometric norms do not appear to fit for Australian Aboriginal adults regardless of which ethnicity options selected, including 'others/mixed'.
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Affiliation(s)
- Subash S Heraganahally
- Department of Respiratory and Sleep Medicine, Royal Darwin Hospital, Darwin, Australia.,College of Medicine and Public Health, Flinders University, Adelaide, Australia.,Darwin Respiratory and Sleep Health, Darwin Private Hospital, Darwin, Australia
| | - Timothy Howarth
- Darwin Respiratory and Sleep Health, Darwin Private Hospital, Darwin, Australia.,College of Health and Human Sciences, Charles Darwin University, Darwin, Australia
| | - Elisha White
- Department of Respiratory and Sleep Medicine, Royal Darwin Hospital, Darwin, Australia
| | - Lisa Sorger
- Department of Medical Imaging, Royal Darwin Hospital, Darwin, Australia
| | - Edwina Biancardi
- Department of Respiratory and Sleep Medicine, Royal Darwin Hospital, Darwin, Australia
| | - Helmi Ben Saad
- Faculté de Médecine de Sousse, Laboratoire de Physiologie, Université de Sousse, Sousse, Tunisia.,Department of Physiology and Functional Exploration, Farhat HACHED Hospital of Sousse, Sousse, Tunisia.,Heart Failure Research Laboratory (LR12SP09), Farhat HACHED Hospital, Sousse, Tunisia
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Hug S, Cavalheri V, Gucciardi DF, Norman R, Hill K. OPTImising the implementation of pulMonary rehAbiLitation in people with chronic obstructive pulmonary disease (the OPTIMAL study): mixed methods study protocol. BMC Pulm Med 2020; 20:286. [PMID: 33138804 PMCID: PMC7607703 DOI: 10.1186/s12890-020-01322-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 10/21/2020] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a common respiratory condition characterised by dyspnoea during daily life. As the disease progresses, people with COPD can experience poor quality of life, reduced exercise capacity, worsening of symptoms and increased hospital admissions. Pulmonary rehabilitation, which includes exercise training, optimises both psychological and physical function, reduces symptoms and mitigates healthcare utilisation in people with COPD. There is, however, a gap in implementation of pulmonary rehabilitation programs, with global access limited to a small fraction of people with COPD. The overall aim of this study is to gather evidence that will optimise the implementation of pulmonary rehabilitation in people with COPD living in Perth, Western Australia. METHODS This is a mixed methods study protocol informed by a critical realist perspective. The study will comprise four phases. In Phase 1, we will quantify target behaviours of healthcare professionals and people with COPD which are related to the implementation of pulmonary rehabilitation at three tertiary hospitals. In Phase 2, we will conduct semi-structured interviews to explore the determinants of these target behaviours from the perspectives of healthcare professionals, people with COPD and their primary support person. In Phase 3, knowledge gained in Phases 1 and 2 will be used by healthcare professionals and people with COPD to co-create, field test and apply strategies that optimise these target behaviours. In Phase 4, we will re-quantify these target behaviours to determine the influence of co-created strategies. The cost effectiveness of implementing the co-created strategies will be explored by an economic analysis. DISCUSSION Understanding current clinical practice and the determinants of target behaviours pertaining to the implementation of pulmonary rehabilitation is crucial when developing strategies that successfully bridge the pulmonary rehabilitation implementation gap. If co-created strategies are effective, more people with COPD living in Perth, Western Australia will have access to pulmonary rehabilitation enabling them to derive the health benefits associated with this intervention.
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Affiliation(s)
- Sarah Hug
- School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Perth, Australia
- Physiotherapy Department, Royal Perth Hospital, Perth, Australia
| | - Vinicius Cavalheri
- School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Perth, Australia
- Allied Health, South Metropolitan Health Service, Perth, Australia
- Institute for Respiratory Health, Perth, Australia
| | - Daniel F Gucciardi
- School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Richard Norman
- School of Public Health, Faculty of Health Science, Curtin University, Perth, Australia
| | - Kylie Hill
- School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Perth, Australia.
- Institute for Respiratory Health, Perth, Australia.
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Pagano L, McKeough Z, Wootton S, Crone S, Pallavicini D, Chan ASL, Mahadev S, Zwar N, Dennis S. The feasibility of an innovative GP-physiotherapist partnership to identify and manage chronic obstructive pulmonary disease (INTEGRATED): study protocol. Pilot Feasibility Stud 2020; 6:138. [PMID: 32983555 PMCID: PMC7513496 DOI: 10.1186/s40814-020-00680-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 09/08/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) contributes significantly to mortality, hospitalisations and health care costs worldwide. There is evidence that the detection, accurate diagnosis and management of COPD are currently suboptimal in primary care. Physiotherapists are well-trained in cardiorespiratory management and chronic care but are currently underutilised in primary care. A cardiorespiratory physiotherapist working in partnership with general practitioners (GPs) has the potential to improve quality of care for people with COPD. METHODS A prospective pilot study will test the feasibility of an integrated model of care between GPs and physiotherapists to improve the diagnosis and management of people with COPD in primary care. Four general practices will be selected to work in partnership with four physiotherapists from their local health district. Patients at risk of developing COPD or those with a current diagnosis of COPD will be invited to attend a baseline assessment with the physiotherapist, including pre- and post-bronchodilator spirometry to identify new cases of COPD or confirm a current diagnosis and stage of COPD. The intervention for those with COPD will involve the physiotherapist and GP working in partnership to develop and implement a care plan involving the following tailored to patient need: referral to pulmonary rehabilitation (PR), physical activity counselling, medication review, smoking cessation, review of inhaler technique and education. Process outcomes will include the number of people invited and reviewed at the practice, the proportion with a new diagnosis of COPD, the number of patients eligible and referred to PR and the number who attended PR. Patient outcomes will include changes in symptoms, physical activity levels, smoking status and self-reported exacerbations. DISCUSSION If feasible, we will test the integration of physiotherapists within the primary care setting in a cluster randomised controlled trial. If the model improves health outcomes for the growing numbers of people with COPD, then it may provide a GP-physiotherapist model of care that could be tested for other chronic conditions. TRIAL REGISTRATION ANZCTR, ACTRN12619001127190. Registered on 12 August 2019-retrospectively registered.
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Affiliation(s)
- Lisa Pagano
- Discipline of Physiotherapy, University of Sydney, Sydney, Australia
| | - Zoe McKeough
- Discipline of Physiotherapy, University of Sydney, Sydney, Australia
| | - Sally Wootton
- Discipline of Physiotherapy, University of Sydney, Sydney, Australia
- Chronic Disease Community Rehabilitation Service, Northern Sydney Local Health District, St Leonards, Australia
| | - Stephen Crone
- Chronic Disease Community Rehabilitation Service, Northern Sydney Local Health District, St Leonards, Australia
| | | | - Andrew S. L. Chan
- Royal North Shore Hospital, St Leonards, Australia
- Northern Clinical School, University of Sydney, Sydney, Australia
| | - Sriram Mahadev
- Royal North Shore Hospital, St Leonards, Australia
- Northern Clinical School, University of Sydney, Sydney, Australia
| | - Nicholas Zwar
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
| | - Sarah Dennis
- Discipline of Physiotherapy, University of Sydney, Sydney, Australia
- Ingham Institute for Applied Medical Research, Liverpool, Australia
- South Western Sydney Local Health District, Liverpool, Australia
- Faculty of Health Sciences, The University of Sydney, 75 East Street, Lidcombe, NSW 2141 Australia
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Morris NR, Hill K, Walsh J, Sabapathy S. Exercise & Sports Science Australia (ESSA) position statement on exercise and chronic obstructive pulmonary disease. J Sci Med Sport 2020; 24:52-59. [PMID: 32928654 DOI: 10.1016/j.jsams.2020.08.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 08/15/2020] [Accepted: 08/17/2020] [Indexed: 12/26/2022]
Abstract
OBJECTIVES Chronic obstructive pulmonary disease (COPD) results in airflow obstruction and a marked reduction in exercise capacity and health-related quality of life (HRQoL). Affecting over 1 in four Australians aged over 75 years, COPD remains one of the major causes of disability and death in the world. To date there have been over 80 randomised controlled trials examining the role of exercise training in a range of settings for individuals with COPD. This review will synthesise existing literature and provide health practitioners with broad evidence-based guidelines for exercise-training in this growing population. DESIGN Position stand. METHODS Synthesis of randomised controlled trials of exercise training and of existing guidelines for exercise in COPD. Systematic reviews of alternative modes of exercise training will also be reviewed. RESULTS There is convincing evidence that in adults with COPD, exercise-training improves exercise capacity, decreases symptoms such as dyspnoea and fatigue, and improves HRQoL. There is emerging evidence in this population that alternative modes of exercise training such as high intensity interval training (HIIT), aquatic based therapy, tai chi and neuromuscular electrical stimulation improve exercise outcomes when compared to no exercise. CONCLUSIONS For individuals with COPD, an exercise program of aerobic and strength exercises delivered over at least an 8-week period, that engages lower and upper body skeletal muscles, will deliver significant health improvements. Programs should be individualised, take into consideration relevant co-morbid conditions and be delivered appropriately qualified health practitioners experienced in clinical exercise prescription.
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Affiliation(s)
- Norman R Morris
- School of Allied Health Sciences, Griffith University, Australia; Metro North Hospital and Health Service, The Prince Charles Hospital. Allied Health Research Collaborative, Australia; Menzies Health Institute, Griffith University, Australia; Queensland Lung Transplant Service, The Prince Charles Hospital, Australia.
| | - Kylie Hill
- School of Physiotherapy and Exercise Science, Curtin University, Australia
| | - James Walsh
- School of Allied Health Sciences, Griffith University, Australia; Queensland Lung Transplant Service, The Prince Charles Hospital, Australia
| | - Surendran Sabapathy
- School of Allied Health Sciences, Griffith University, Australia; Metro North Hospital and Health Service, The Prince Charles Hospital. Allied Health Research Collaborative, Australia; Menzies Health Institute, Griffith University, Australia
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46
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Draft Genome Sequence of an Isolate of Nontypeable Haemophilus influenzae from an Acute Exacerbation of Chronic Obstructive Pulmonary Disease in Tasmania. Microbiol Resour Announc 2020; 9:9/19/e00375-20. [PMID: 32381620 PMCID: PMC7206498 DOI: 10.1128/mra.00375-20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Nontypeable Haemophilus influenzae (NTHi) is an important cause of human illness, including pneumonia and acute exacerbations of chronic obstructive pulmonary disease (COPD). We report here the draft genome of an isolate of NTHi collected from the sputum of a patient presenting with COPD in Tasmania, Australia.
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Cousins JL, Wood-Baker R, Wark PAB, Yang IA, Gibson PG, Hutchinson A, Sajkov D, Hiles SA, Samuel S, McDonald VM. Management of acute COPD exacerbations in Australia: do we follow the guidelines? ERJ Open Res 2020; 6:00270-2019. [PMID: 32337215 PMCID: PMC7167211 DOI: 10.1183/23120541.00270-2019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 02/18/2020] [Indexed: 01/30/2023] Open
Abstract
Objective We aimed to assess adherence to the Australian national guideline (COPD-X) against audited practice, and to document the outcomes of patients hospitalised with an acute exacerbation of chronic obstructive pulmonary disease (COPD) at discharge and 28 days after. Methods A prospective clinical audit of COPD hospital admission from five tertiary care hospitals in five states of Australia was conducted. Post-discharge follow-up was conducted via telephone to assess for readmission and health status. Results There were 207 admissions for acute exacerbation (171 patients; mean 70.2 years old; 50.3% males). Readmission rates at 28 days were 25.4%, with one (0.6%) death during admission and eight (6.1%) post-discharge within 28 days. Concordance to the COPD-X guidance was variable; 22.7% performed spirometry, 81.1% had blood gases collected when forced expiratory volume in 1 s was <1 L, 99.5% had chest radiography performed, 95.1% were prescribed systemic corticosteroids and 95% were prescribed antibiotic therapy. There were 89.1% given oxygen therapy and 92.6% when arterial oxygen tension was <80 mmHg; 65.6% were given ventilatory assistance when pH was <7.35. Only 32.4% were referred to pulmonary rehabilitation but 76.8% had general practitioner follow-up arranged. Conclusion When compared against clinical practice guidelines, we found important gaps in management of patients admitted with COPD throughout tertiary care centres in Australia. Strategies to improve guideline uptake are needed to optimise care. A multisite audit of hospital admissions for patients experiencing #AECOPD in Australia highlighted important gaps in management when compared against national guidelines. Further focus on how we can improve guideline uptake by clinicians is needed.http://bit.ly/2VjGnHw
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Affiliation(s)
- Joyce L Cousins
- School of Nursing and Midwifery, The University of Newcastle, Callaghan, Australia.,Avondale University College, Faculty of Nursing, Wahroonga, Australia.,Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, New Lambton Heights, Australia
| | | | - Peter A B Wark
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, New Lambton Heights, Australia.,School of Medicine and Public Health, The University of Newcastle, Callaghan, Australia.,Dept of Respiratory and Sleep Medicine, Hunter Medical Research Institute, John Hunter Hospital, New Lambton Heights, Australia
| | - Ian A Yang
- The Prince Charles Hospital and University of Queensland, Chermside, Australia
| | - Peter G Gibson
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, New Lambton Heights, Australia.,School of Medicine and Public Health, The University of Newcastle, Callaghan, Australia.,Dept of Respiratory and Sleep Medicine, Hunter Medical Research Institute, John Hunter Hospital, New Lambton Heights, Australia
| | | | - Dimitar Sajkov
- Australian Respiratory and Sleep Medicine Institute, Flinders University and Flinders Medical Centre, Bedford Park, Australia
| | - Sarah A Hiles
- School of Nursing and Midwifery, The University of Newcastle, Callaghan, Australia.,Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Sameh Samuel
- School of Medicine and Public Health, The University of Newcastle, Callaghan, Australia.,Dept of Respiratory and Sleep Medicine, Hunter Medical Research Institute, John Hunter Hospital, New Lambton Heights, Australia
| | - Vanessa M McDonald
- School of Nursing and Midwifery, The University of Newcastle, Callaghan, Australia.,Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, New Lambton Heights, Australia.,Dept of Respiratory and Sleep Medicine, Hunter Medical Research Institute, John Hunter Hospital, New Lambton Heights, Australia
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Schubert J, Kruavit A, Mehra S, Wasgewatta S, Chang AB, Heraganahally SS. Prevalence and nature of lung function abnormalities among Indigenous Australians referred to specialist respiratory outreach clinics in the Northern Territory. Intern Med J 2019; 49:217-224. [PMID: 30239090 DOI: 10.1111/imj.14112] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 08/26/2018] [Accepted: 08/26/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Poor lung function is a predictor of future all-cause mortality. In Australia, respiratory diseases are particularly prevalent among the indigenous population, especially in remote communities. However, there are little published pulmonary function tests' (PFT) data of remote-based adult indigenous patients. AIM To evaluate the severity of airflow obstruction and other PFT abnormalities of adults referred to specialist respiratory clinics in remote indigenous communities. METHODS Retrospective analysis of PFT (pre- and post-bronchodilator spirometry, total lung capacity (TLC) and diffusing capacity to carbon monoxide (DLCO)) of indigenous patients collected during specialist respiratory clinics in remote Northern Territory (NT) indigenous communities (Australia) between 2013 and 2015. The National Health and Nutrition Examination Survey (NHANES) III without ethnic correction was used as the reference. RESULTS Of the 357 patients, 150 had acceptable spirometry, and 71 had acceptable DLCO and TLC studies. Despite the relatively young age (mean = 49 years, SD = 12.9), their lung function was generally low; mean % predicted values were FEV1 = 55% (SD = 20.5%), FVC = 61% (SD = 15.6%), DLCO = 64.0% (SD = 19.7%) and TLC = 70.1% (SD = 18.2%). Mean FEV1 /FVC ratio was preserved (0.71, SD = 0.16). Post-bronchodilator airflow obstruction (FEV1 /FVC < 0.7) was observed in 37% of patients, where a large proportion (67%) demonstrated at least a severe airflow obstruction, with a mean FEV1 of 41% predicted. CONCLUSION In this first study of PFT findings of indigenous adults from a remote-based clinical service, we found a high rate of at least moderate airflow limitation and low FVC along with preserved FEV1/FVC ratio. Increased awareness and screening for reduced lung function needs to be considered in this population.
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Affiliation(s)
- Jonathon Schubert
- Department of Medicine, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Anuk Kruavit
- Department of Respiratory and Sleep Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Sumit Mehra
- Department of Respiratory and Sleep Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Sanjiwika Wasgewatta
- Department of Respiratory and Sleep Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Anne B Chang
- Child Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Subash S Heraganahally
- Department of Respiratory and Sleep Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia
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Bikbov MM, Kazakbaeva GM, Zainullin RM, Salavatova VF, Arslangareeva II, Panda-Jonas S, Gilmanshin TR, Nikitin NA, Mukhamadieva SR, Yakupova DF, Khikmatullin RI, Aminev SK, Nuriev IF, Zaynetdinov AF, Uzianbaeva YV, Jonas JB. Prevalence, Awareness, and Associated Factors of Airflow Obstruction in Russia: The Ural Eye and Medical Study. Front Public Health 2019; 7:350. [PMID: 31824912 PMCID: PMC6879424 DOI: 10.3389/fpubh.2019.00350] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 11/04/2019] [Indexed: 01/16/2023] Open
Abstract
Background: Although chronic obstructive pulmonary disease and asthma belong to the most important causes of disability and death in all world regions, data about the prevalence of airflow obstruction and asthma in Russia and the associated parameters have been scarce so far. We therefore assessed the prevalence of airflow obstruction and asthma in a Russian population. Methods: The population-based Ural Eye and Medical Study, conducted in a rural and urban region of Bashkortostan/Russia, included 5,392 participants (mean age: 58.6 ± 10.6 years; range: 40-94 years) out of 7,328 eligible individuals. Airflow obstruction was defined spirometrically and asthma by self-reported diagnosis. Results: Airflow obstruction was present in 369 individuals (6.8%; 95% confidence interval (CI): 6.2, 7.5) with an awareness rate of 63.4% (95%CI: 58.5, 68.4) and known duration of 19.5 ± 15.8 years (median: 16 years). Prevalence of undiagnosed airflow obstruction was 2.6% (95%CI: 2.2, 3.1). Higher prevalence of airflow obstruction was associated (multivariable analysis) with higher prevalence of current smoking [P < 0.001; odds ratio (OR): 2.91; 95%CI: 1.76, 4.83] and number of cigarette package years (P < 0.001; OR: 1.03; 95%CI: 1.02, 1.08), female gender (P = 0.03; OR: 1.42; 95%CI: 1.04, 1.93), urban region (P = 0.003; OR: 1.43; 95% CI: 1.12, 1.79), higher prevalence of cardiovascular diseases/stroke (P < 0.001; OR: 1.86; 95%CI: 1.45, 2.39), higher depression score (P = 0.002; OR: 1.05; 95%CI: 1.02, 1.08), and lower physical activity (P = 0.01; OR: 0.71; 95%CI: 0.54, 0.93). Asthma prevalence (2.6%; 95%CI: 2.0, 3.1; known duration: 17.2 ± 15.0 years) was associated with less alcohol consumption (OR: 0.53; 95%CI: 0.33, 0.87; P = 0.01), higher depression score (OR: 1.08; 95%CI: 1.03, 1.12; P < 0.001), and urban region (OR: 0.68; 95CI: 0.49, 0.95; P = 0.0.03). Conclusions: In this Russian population aged 40+ years, the prevalence of airflow obstruction was 6.8% with an awareness rate of 63.4% and smoking as main risk factor. Asthma prevalence was 2.6%.
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Affiliation(s)
| | | | | | | | | | - Songhomitra Panda-Jonas
- Department of Ophthalmology, Medical Faculty Mannheim of the Ruprecht-Karls-University of Heidelberg, Heidelberg, Germany
| | | | | | | | | | | | | | | | | | | | - Jost B Jonas
- Department of Ophthalmology, Medical Faculty Mannheim of the Ruprecht-Karls-University of Heidelberg, Heidelberg, Germany
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Shukla SD, Walters EH, Simpson JL, Keely S, Wark PA, O'Toole RF, Hansbro PM. Hypoxia‐inducible factor and bacterial infections in chronic obstructive pulmonary disease. Respirology 2019; 25:53-63. [DOI: 10.1111/resp.13722] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 09/25/2019] [Accepted: 10/08/2019] [Indexed: 12/12/2022]
Affiliation(s)
- Shakti D. Shukla
- School of Biomedical Sciences and Pharmacy, Faculty of Health and MedicineUniversity of Newcastle Newcastle NSW Australia
- Priority Research Centre for Healthy Lungs, Hunter Medical Research InstituteUniversity of Newcastle Newcastle NSW Australia
| | - E. Haydn Walters
- School of Medicine, College of Health and MedicineUniversity of Tasmania Hobart TAS Australia
| | - Jodie L. Simpson
- Priority Research Centre for Healthy Lungs, Hunter Medical Research InstituteUniversity of Newcastle Newcastle NSW Australia
- Respiratory and Sleep Medicine, Priority Research Centre for Healthy LungsUniversity of Newcastle Newcastle NSW Australia
| | - Simon Keely
- School of Biomedical Sciences and Pharmacy, Faculty of Health and MedicineUniversity of Newcastle Newcastle NSW Australia
- Priority Research Centre for Digestive Health and Neurogastroenterology, Hunter Medical Research InstituteUniversity of Newcastle Newcastle NSW Australia
| | - Peter A.B. Wark
- Priority Research Centre for Healthy Lungs, Hunter Medical Research InstituteUniversity of Newcastle Newcastle NSW Australia
- Respiratory and Sleep Medicine, Priority Research Centre for Healthy LungsUniversity of Newcastle Newcastle NSW Australia
| | - Ronan F. O'Toole
- School of Molecular Sciences, College of Science, Health and EngineeringLa Trobe University Melbourne VIC Australia
| | - Philip M. Hansbro
- School of Biomedical Sciences and Pharmacy, Faculty of Health and MedicineUniversity of Newcastle Newcastle NSW Australia
- Priority Research Centre for Healthy Lungs, Hunter Medical Research InstituteUniversity of Newcastle Newcastle NSW Australia
- Centenary Institute and School of Life Sciences, Faculty of Science, University of Technology Sydney Sydney NSW Australia
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