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Qiu CJ, Wu S. Depression and anxiety disorders in chronic obstructive pulmonary disease patients: Prevalence, disease impact, treatment. World J Psychiatry 2024; 14:1797-1803. [PMID: 39704377 PMCID: PMC11622031 DOI: 10.5498/wjp.v14.i12.1797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2024] [Revised: 09/27/2024] [Accepted: 10/25/2024] [Indexed: 11/27/2024] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a common respiratory disorder that often co-occurs with depression and anxiety, worsening disease progression and reducing quality of life. A thorough review of the existing literature was conducted, including searches in PubMed, Embase, PsycINFO, and Cochrane Library databases up to 2024. This review encompasses a critical analysis of studies reporting on the prevalence, impact, and management of depression and anxiety in COPD patients. We found a high prevalence of psychological comorbidities in COPD patients, which were associated with worse disease outcomes, including increased exacerbations, hospitalizations, and reduced health-related quality of life. Diagnosing and managing these conditions is complex due to overlapping symptoms, necessitating a comprehensive patient care approach. While there has been progress in understanding COPD comorbidities, there is a need for more personalized and integrated treatments. This review emphasizes the need for increased awareness, tailored treatment plans, and further research for effective interventions.
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Affiliation(s)
- Chang-Jian Qiu
- Department of Psychiatry, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Shuang Wu
- Department of Psychiatry, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
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Cornick RV, Petersen I, Levitt NS, Kredo T, Mudaly V, Cragg C, David N, Kathree T, Rabe M, Awotiwon A, Curran RL, Fairall LR. Clinically sound and person centred: streamlining clinical decision support guidance for multiple long-term condition care. BMJ Glob Health 2024; 9:e013816. [PMID: 39467589 DOI: 10.1136/bmjgh-2023-013816] [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] [Received: 03/22/2024] [Accepted: 08/20/2024] [Indexed: 10/30/2024] Open
Abstract
The care of people with multiple long-term conditions (MLTCs) is complex and time-consuming, often denying them the agency to self-manage their conditions-or for the clinician they visit to provide streamlined, person-centred care. We reconfigured The Practical Approach to Care Kit, our established, evidence-based, policy-aligned clinical decision support tool for low-resource primary care settings, to provide consolidated clinical guidance for a patient journey through a primary care facility. This places the patient at the centre of that journey and shifts the screening, monitoring and health education activities of multimorbidity care more equitably among the members of the primary care team. This work forms part of a study called ENHANCE, exploring how best to streamline MLTC care in South Africa with its high burden of communicable, non-communicable and mental health conditions. This practice paper describes the four steps of codeveloping this clinical decision support tool for eleven common long-term conditions with local stakeholders (deciding the approach, constructing the content, clinical editing, and design and formatting) along with the features of the tool designed to facilitate its usability at point of care. The process highlighted tensions around prioritising one condition over another, curative over preventive treatment and pharmacological therapies over advice-giving, along with the challenges of balancing the large volume of content with a person-centred approach. If successful, the tool could augment the response to MLTC care in South Africa and other low-resource settings. In addition, our development process may contribute to scant literature around methodologies for clinical decision support development.
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Affiliation(s)
- Ruth Vania Cornick
- Knowledge Translation Unit, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Inge Petersen
- Centre for Rural Health, University of KwaZuluNatal, Durban, South Africa
| | - Naomi S Levitt
- University of Cape Town, Cape Town, Western Cape, South Africa
| | - Tamara Kredo
- South African Medical Research Council, Cape Town, South Africa
| | - Vanessa Mudaly
- Department of Health and Wellness, Western Cape Provincial Government, Cape Town, Western Cape, South Africa
| | - Carol Cragg
- Department of Health and Wellness, Western Cape Provincial Government, Cape Town, Western Cape, South Africa
| | - Neal David
- Department of Health and Wellness, Western Cape Provincial Government, Cape Town, Western Cape, South Africa
| | - Tasneem Kathree
- Centre for Rural Health, University of KwaZuluNatal, Durban, South Africa
| | - Mareike Rabe
- Knowledge Translation Unit, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Ajibola Awotiwon
- Knowledge Translation Unit, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Robyn Leigh Curran
- Knowledge Translation Unit, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Lara R Fairall
- Knowledge Translation Unit, Department of Medicine, University of Cape Town, Cape Town, South Africa
- School of Life Course & Population Sciences, King's College London, London, UK
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Moretta P, Cavallo ND, Candia C, Lanzillo A, Marcuccio G, Santangelo G, Marcuccio L, Ambrosino P, Maniscalco M. Psychiatric Disorders in Patients with Chronic Obstructive Pulmonary Disease: Clinical Significance and Treatment Strategies. J Clin Med 2024; 13:6418. [PMID: 39518558 PMCID: PMC11546101 DOI: 10.3390/jcm13216418] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2024] [Revised: 10/11/2024] [Accepted: 10/19/2024] [Indexed: 11/16/2024] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a debilitating lung disease characterized by chronic airflow limitation and persistent respiratory symptoms. It is a major cause of morbidity and mortality worldwide, significantly impacting healthcare systems with considerable socioeconomic consequences. The main risk factors include exposure to tobacco smoke, environmental pollutants, occupational dust, and genetic factors such as alpha-1 antitrypsin deficiency. COPD is often associated with extrapulmonary comorbidities, particularly psychiatric disorders like depression and anxiety, which worsen patients' quality of life and prognosis. The prevalence of these disorders in patients with COPD varies significantly but is always higher than in healthy controls. Psychiatric disorders can negatively influence COPD management and vice versa, creating a complex bidirectional interaction. Depression and anxiety are the most common psychiatric comorbidities in patients with COPD, influenced by factors such as social isolation, physical limitations, and fear of exacerbations. Diagnosis of these psychiatric disorders is complicated by the overlap of symptoms with those of COPD. However, some screening tools can facilitate early detection. The treatment of psychiatric disorders in patients with COPD in a rehabilitation setting requires a multidisciplinary approach involving pulmonologists, neurologists and psychologists. Pharmacological therapy with antidepressants shows mixed results in terms of efficacy and safety, with some studies reporting benefits on quality of life and others suggesting an increased risk of exacerbations and pneumonia. An integrated approach that includes the assessment and intervention of mental disorders is essential to improve the overall management of COPD and the quality of life of patients. This narrative review provides an overview of the main psychiatric comorbidities in COPD patients, aiming to fill gaps in the literature and suggest areas for future research.
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Affiliation(s)
- Pasquale Moretta
- Istituti Clinici Scientifici Maugeri IRCCS, Neurorehabilitation Unit of Telese Terme Institute, 82037 Telese Terme, Italy; (N.D.C.); (L.M.)
| | - Nicola Davide Cavallo
- Istituti Clinici Scientifici Maugeri IRCCS, Neurorehabilitation Unit of Telese Terme Institute, 82037 Telese Terme, Italy; (N.D.C.); (L.M.)
- Department of Psychology, Università della Campania ‘Luigi Vanvitelli’, 81100 Caserta, Italy;
| | - Claudio Candia
- Istituti Clinici Scientifici Maugeri IRCCS, Pulmonary Rehabilitation Unit of Telese Terme Institute, 82037 Telese Terme, Italy; (C.C.); (A.L.); (G.M.); (M.M.)
| | - Anna Lanzillo
- Istituti Clinici Scientifici Maugeri IRCCS, Pulmonary Rehabilitation Unit of Telese Terme Institute, 82037 Telese Terme, Italy; (C.C.); (A.L.); (G.M.); (M.M.)
| | - Giuseppina Marcuccio
- Istituti Clinici Scientifici Maugeri IRCCS, Pulmonary Rehabilitation Unit of Telese Terme Institute, 82037 Telese Terme, Italy; (C.C.); (A.L.); (G.M.); (M.M.)
| | - Gabriella Santangelo
- Department of Psychology, Università della Campania ‘Luigi Vanvitelli’, 81100 Caserta, Italy;
| | - Laura Marcuccio
- Istituti Clinici Scientifici Maugeri IRCCS, Neurorehabilitation Unit of Telese Terme Institute, 82037 Telese Terme, Italy; (N.D.C.); (L.M.)
| | - Pasquale Ambrosino
- Istituti Clinici Scientifici Maugeri IRCCS, Scientific Directorate of Telese Terme Institute, 82037 Telese Terme, Italy;
| | - Mauro Maniscalco
- Istituti Clinici Scientifici Maugeri IRCCS, Pulmonary Rehabilitation Unit of Telese Terme Institute, 82037 Telese Terme, Italy; (C.C.); (A.L.); (G.M.); (M.M.)
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Alwafi H, Naser AY, Ashoor DS, Alsharif A, Aldhahir AM, Alghamdi SM, Alqarni AA, Alsaleh N, Samkari JA, Alsanosi SM, Alqahtani JS, Dairi MS, Hafiz W, Tashkandi M, Ashoor A, Badr OI. Prevalence and predictors of polypharmacy and comorbidities among patients with chronic obstructive pulmonary disease: a cross-sectional retrospective study in a tertiary hospital in Saudi Arabia. BMC Pulm Med 2024; 24:453. [PMID: 39272014 PMCID: PMC11401255 DOI: 10.1186/s12890-024-03274-5] [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] [Received: 11/26/2023] [Accepted: 09/04/2024] [Indexed: 09/15/2024] Open
Abstract
OBJECTIVE This study aimed to determine the prevalence of polypharmacy, comorbidities and to investigate factors associated with polypharmacy among adult patients with Chronic Obstructive Pulmonary Disease (COPD). METHODS This was a retrospective single-centre cross-sectional study. Patients with a confirmed diagnosis of COPD according to the GOLD guidelines between 28 February 2020 and 1 March 2023 were included in this study. Patients were excluded if a pre-emptive diagnosis of COPD was made clinically without spirometry evidence of fixed airflow limitation. Population characteristics were presented as frequency for categorical variable. Logistic regression analysis was used to identify predictors of polypharmacy. RESULTS The study sample included a total of 705 patients with COPD. Most of the study sample were males (60%). The mean age of the study population was 65 years old. The majority of the study population had comorbid diseases (68%), hypertension and diabetes were the most common co-existent diseases. Around 55% of the study sample had polypharmacy. Females were significantly less likely to be on polypharmacy compared to males (OR = 0.68, 95% CI = [0.50-0.92], P-value = 0.012)). On the other hand, older patients aged 65.4 or more (OR = 2.31, 95% CI = [1.71-3.14], P-value ≤ 0.001), those with high BMI (≥ 29.2) (OR = 1.42, 95% CI = [1.05-1.92], P-value = 0.024), current smokers (OR = 1.9, 95% CI = [1.39-2.62], P-value ≤ 0.001), those who are receiving home care (OR = 5.29, 95% CI = [2.46-11.37], P-value ≤ 0.001), those who have comorbidities (OR = 19.74, 95% CI = [12.70-30.68], P-value ≤ 0.001) were significantly more likely to be on polypharmacy (p ≤ 0.05). CONCLUSIONS Polypharmacy is common among patients with COPD. Patients with high BMI, previous ICU hospitalization and older age are more likely to have polypharmacy. Future analytical studies are warranted to investigate outcomes in patients with COPD and polypharmacy.
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Affiliation(s)
- Hassan Alwafi
- Department of Pharmacology and Toxicology, College of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Abdallah Y Naser
- Department of Applied Pharmaceutical Sciences and Clinical Pharmacy, Faculty of Pharmacy, Isra University, Amman, Jordan.
| | - Deema S Ashoor
- Faculty of Medicine, Umm Al-Qura University, Mecca, Saudi Arabia
| | - Alaa Alsharif
- Department of Pharmacy Practice, College of Pharmacy, Princess Noura Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Abdulelah M Aldhahir
- Respiratory Therapy Department, Faculty of Applied Medical Sciences, Jazan, Saudi Arabia
| | - Saeed M Alghamdi
- Clinical Technology Department, Respiratory Care Program, Faculty of Applied Sciences, Umm Al-Qura University, Mecca, Saudi Arabia
| | - Abdallah A Alqarni
- Department of Respiratory Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah, 22230, Saudi Arabia
- Respiratory Therapy Unity, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Nada Alsaleh
- Department of Pharmacy Practice, College of Pharmacy, Princess Noura Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Jamil A Samkari
- Family and Community Medicine Department, Faculty of Medicine in Rabigh, King Abdulaziz University, Rabigh, Saudi Arabia
| | - Safaa M Alsanosi
- Department of Pharmacology and Toxicology, College of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Jaber S Alqahtani
- Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam, 34313, Saudi Arabia
| | - Mohammad Saleh Dairi
- Department of Medicine, College of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Waleed Hafiz
- Department of Medicine, College of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | | | - Abdullah Ashoor
- Faculty of Medicine, Umm Al-Qura University, Mecca, Saudi Arabia
| | - Omaima Ibrahim Badr
- Department of Chest Medicine, Faculty of Medicine, Mansoura University, Mansoura, 35516, Egypt
- Department of Pulmonary Medicine, Al Noor Specialist Hospital, Mecca, 20424, Saudi Arabia
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Sohanpal R, Mammoliti KM, Barradell A, Kelly M, Newton S, Steed L, Wileman V, Rowland V, Dibao-Dina C, Moore A, Pinnock H, Taylor SJC. Patient perspectives on the Tailored intervention for Anxiety and Depression Management in COPD (TANDEM): a qualitative evaluation. BMC Health Serv Res 2024; 24:960. [PMID: 39169308 PMCID: PMC11337569 DOI: 10.1186/s12913-024-11370-9] [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] [Received: 04/15/2024] [Accepted: 07/29/2024] [Indexed: 08/23/2024] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is commonly associated with anxiety/depression which can affect self-management and quality of life. The TANDEM trial evaluated a cognitive behavioural approach intervention targeting COPD-related symptoms of anxiety and/or depression, comprising up to eight one-to-one sessions delivered by respiratory healthcare professionals prior to pulmonary rehabilitation (PR). The intervention showed no improvement in anxiety/depression or uptake/completion of PR. We present patient perspectives of the intervention to help understand these results. METHOD Semi-structured individual interviews, using a semi-structured topic guide informed by Sekhon's Theoretical Framework of Acceptability, were conducted with 19 patients between September 2019 and April 2020. The interviews were audio-recorded, transcribed verbatim and analysed thematically. RESULTS The following could have limited the impact of the intervention: (1) The lives of patients were complex and commonly affected by competing comorbidities or other external stressors which they managed through previously adopted long-standing coping strategies. (2) Some patients were reluctant to talk about their mood despite the Facilitators' training and person centred-skills which aimed to enable patients to talk freely about mood. (3) The intervention handouts and 'home-practice' were perceived as helpful for some, but not suitable for all. (4) Many patients perceived improvements in their physical and mental health, but this was not sustained due to a mix of personal and external factors, and some did not perceive any benefits. (5) PR non-attendance/non-completion was a result of personal and PR service-related reasons. (6) Discussing COPD and mental health with the Facilitator was a novel experience. Many patients felt that TANDEM could be of benefit if it was offered earlier on/at different time points in the COPD illness journey. CONCLUSION We found the delivery of TANDEM prior to PR was not helpful for patients with advanced COPD often experiencing other comorbidities, and/or difficult personal/external events. These patients already utilised long-standing coping strategies to manage their COPD. Holistic interventions, that address the impact of COPD in relation to wider aspects of a patients' life, may be more beneficial. TRIAL REGISTRATION ISRCTN Registry 59,537,391. Registration date 20 March 2017.
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Affiliation(s)
| | | | - Amy Barradell
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | | | | | - Liz Steed
- Queen Mary University of London, London, UK
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Matsunaga K, Yoshida Y, Makita N, Nishida K, Rhodes K, Nordon C. Increased Risk of Severe Cardiovascular Events Following Exacerbations of Chronic Obstructive Pulmonary Disease: Results of the EXACOS-CV Study in Japan. Adv Ther 2024; 41:3362-3377. [PMID: 38976123 PMCID: PMC11263248 DOI: 10.1007/s12325-024-02920-y] [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: 04/18/2024] [Accepted: 06/05/2024] [Indexed: 07/09/2024]
Abstract
INTRODUCTION Severe exacerbations of chronic obstructive pulmonary disease (COPD) are known to increase the risk of cardiovascular events. However, this association has not been investigated specifically in patients with COPD in Japan, whose characteristics may differ from those of Western patients (i.e., western Europe, the US, and Canada). METHODS This longitudinal retrospective cohort study analyzed secondary claims data and included patients aged ≥ 40 years with COPD (International Classification of Diseases-10 codes J41-J44). All exacerbations occurring during follow-up were measured. Time-dependent Cox models were used to estimate hazard ratios (HRs) for the association between time periods following an exacerbation of COPD (vs. time prior to a first exacerbation) and occurrence of a first hospitalization for a severe fatal or non-fatal cardiovascular event. RESULTS The analysis included 152,712 patients with COPD with a mean age of 73.8 years and 37.6% of whom were female. During a median follow-up of 37 months, 63,182 (41.4%) patients experienced ≥ 1 exacerbation and 13,314 (8.7%) patients experienced ≥ 1 severe cardiovascular event. Following an exacerbation of COPD, the risk of a severe cardiovascular event was increased in the first 30 days [adjusted HR (aHR) 1.44, 95% confidence interval (CI) 1.33-1.55] and remained elevated for 365 days post-exacerbation (aHR 1.13, 95% CI 1.04-1.23). Specifically, the risks of acute coronary syndrome or arrhythmias remained significantly increased for up to 180 days, and the risk of decompensated heart failure for 1 year. CONCLUSION Among Japanese patients with COPD, the risk of experiencing a severe cardiovascular event increased following a COPD exacerbation and remained elevated for 365 days, emphasizing the need to prevent exacerbations.
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Affiliation(s)
- Kazuto Matsunaga
- Department of Respiratory Medicine and Infectious Disease, Graduate School of Medicine, Yamaguchi University, 1-1-1 Minami-kogushi, Ube, Yamaguchi, 755-8505, Japan.
| | - Yuri Yoshida
- Medical Department, AstraZeneca K.K., 3-1 Ofukacho, Kita-ku, Osaka, 530-0011, Japan
| | - Naoyuki Makita
- Medical Department, AstraZeneca K.K., 3-1 Ofukacho, Kita-ku, Osaka, 530-0011, Japan
| | - Kenichiro Nishida
- Medical Department, AstraZeneca K.K., 3-1 Ofukacho, Kita-ku, Osaka, 530-0011, Japan
| | - Kirsty Rhodes
- Real-World Science and Analytics, BioPharmaceuticals Medical Evidence, AstraZeneca UK, Academy House, 136 Hills Road, Cambridge, CB2 8PA, UK
| | - Clementine Nordon
- Medical and Payer Evidence Strategy, AstraZeneca UK, Academy House, 136 Hills Road, Cambridge, CB2 8PA, UK
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Smith C, Hiyoshi A, Hasselgren M, Sandelowsky H, Ställberg B, Montgomery S. The Increased Burden of Morbidity Over the Life-Course Among Patients with COPD: A Register-Based Cohort Study in Sweden. Int J Chron Obstruct Pulmon Dis 2024; 19:1375-1389. [PMID: 38912053 PMCID: PMC11194007 DOI: 10.2147/copd.s459784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 05/07/2024] [Indexed: 06/25/2024] Open
Abstract
Purpose Patients with a diagnosis of chronic obstructive pulmonary disease (COPD) often have other chronic disorders. This study aims to describe the life-course pattern of morbidity in patients with COPD. Patients and Methods Among all residents aged 50-90 years in Sweden in 1997, people with a hospital COPD diagnosis were identified using Swedish national registers (1997-2018). Each patient with COPD was matched by sex, birthyear and county of residency with up to five COPD-free controls. Other chronic disease diagnoses were identified during 1987-2018. Conditional logistic regression calculated risk of diseases diagnosed prior to first COPD diagnosis, producing odds ratios (OR) and 95% confidence intervals (95% CI). Cox regression estimated risk of diagnoses after first COPD diagnosis, producing hazard ratios (HR) and 95% CI. Results Among 2,706,814 individuals, 225,159 (8.3%) had COPD. The nested case-control sample included 223,945 COPD-cases with 1,062,731 controls. Prior to first COPD diagnosis, future COPD patients had higher risks than controls for most examined conditions. Highest risks were seen for chronic heart failure (OR = 3.25, 3.20-3.30), peripheral arterial disease (OR = 3.12, 3.06-3.18) and lung cancer (OR = 12.73, 12.12-13.37). Following the COPD diagnosis, individuals with COPD had higher risks of most conditions than individuals without COPD. Chronic heart failure (HR = 3.50, 3.46-3.53), osteoporosis (HR = 3.35, 3.30-3.42), depression (HR = 2.58, 2.53-2.64) and lung cancer (HR = 6.04, 5.90-6.18) predominated. The risk of vascular dementia was increased after COPD diagnosis (HR = 1.53, 1.48-1.58) but not Alzheimer's disease. Conclusion Accumulation of chronic morbidity may precede COPD. Following the diagnosis, an increased burden of cardiovascular disease and cancer is to be expected, but subsequent depression, osteoporosis, and vascular dementia should also be noted. Management strategies for patients with COPD should consider the higher-than-average risk of multimorbidity.
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Affiliation(s)
- Carolina Smith
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Centre for Clinical Research and Education, Region Värmland, Karlstad, Sweden
| | - Ayako Hiyoshi
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
| | - Mikael Hasselgren
- Centre for Clinical Research and Education, Region Värmland, Karlstad, Sweden
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Hanna Sandelowsky
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Neurobiology, Care Sciences and Society, Division of Family Medicine and Primary Care, Karolinska Institutet, Stockholm, Sweden
- Academic Primary Health Care Center, Region Stockholm, Stockholm, Sweden
| | - Björn Ställberg
- Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden
| | - Scott Montgomery
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Epidemiology and Public Health, University College, London, UK
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Orlowski A, Ettinger J, Bottle A, Snow S, Ashton R, Quint JK. Modifiable risk factors that may be addressed in routine care to prevent progression to and extension of multimorbidity in people with COPD: a systematic literature review. BMJ Open Respir Res 2024; 11:e002272. [PMID: 38653506 PMCID: PMC11043725 DOI: 10.1136/bmjresp-2023-002272] [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] [Received: 12/22/2023] [Accepted: 03/07/2024] [Indexed: 04/25/2024] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a multisystem disease, and many patients have multiple conditions. We explored multimorbidity patterns that might inform intervention planning to reduce health-care costs while preserving quality of life for patients. Literature searches up to February 2022 revealed 4419 clinical observational and comparative studies of risk factors for multimorbidity in people with COPD, pulmonary emphysema, or chronic bronchitis at baseline. Of these, 29 met the inclusion criteria for this review. Eight studies were cluster and network analyses, five were regression analyses, and 17 (in 16 papers) were other studies of specific conditions, physical activity and treatment. People with COPD more frequently had multimorbidity and had up to ten times the number of disorders of those without COPD. Disease combinations prominently featured cardiovascular and metabolic diseases, asthma, musculoskeletal and psychiatric disorders. An important risk factor for multimorbidity was low socioeconomic status. One study showed that many patients were receiving multiple drugs and had increased risk of adverse events, and that 10% of medications prescribed were inappropriate. Many patients with COPD have mainly preventable or modifiable multimorbidity. A proactive multidisciplinary approach to prevention and management could reduce the burden of care.
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Affiliation(s)
- Andi Orlowski
- Health Economics Unit, London, UK
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | | | - Alex Bottle
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | | | | | - Jennifer K Quint
- Department of Primary Care and Public Health, Imperial College London, London, UK
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Athanazio RA, Bernal Villada L, Avdeev SN, Wang HC, Ramírez-Venegas A, Sivori M, Dreyse J, Pacheco M, Man SK, Noriega-Aguirre L, Farouk H. Rate of severe exacerbations, healthcare resource utilisation and clinical outcomes in patients with COPD in low-income and middle-income countries: results from the EXACOS International Study. BMJ Open Respir Res 2024; 11:e002101. [PMID: 38637115 PMCID: PMC11029392 DOI: 10.1136/bmjresp-2023-002101] [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: 10/02/2023] [Accepted: 02/16/2024] [Indexed: 04/20/2024] Open
Abstract
INTRODUCTION The EXAcerbations of Chronic obstructive lung disease (COPD) and their OutcomeS (EXACOS) International Study aimed to quantify the rate of severe exacerbations and examine healthcare resource utilisation (HCRU) and clinical outcomes in patients with COPD from low-income and middle-income countries. METHODS EXACOS International was an observational, cross-sectional study with retrospective data collection from medical records for a period of up to 5 years. Data were collected from 12 countries: Argentina, Brazil, Chile, Colombia, Costa Rica, Dominican Republic, Guatemala, Hong Kong, Mexico, Panama, Russia and Taiwan. The study population comprised patients ≥40 years of age with COPD. Outcomes/variables included the prevalence of severe exacerbations, the annual rate of severe exacerbations and time between severe exacerbations; change in lung function over time (measured by the forced expiratory volume in 1 s (FEV1)); peripheral blood eosinophil counts (BECs) and the prevalence of comorbidities; treatment patterns; and HCRU. RESULTS In total, 1702 patients were included in the study. The study population had a mean age of 69.7 years, with 69.4% males, and a mean body mass index of 26.4 kg/m2. The mean annual prevalence of severe exacerbations was 20.1%, and 48.4% of patients experienced ≥1 severe exacerbation during the 5-year study period. As the number of severe exacerbations increased, the interval between successive exacerbations decreased. A statistically significant decrease in mean (SD) FEV1 from baseline to post-baseline was observed in patients with ≥1 severe exacerbation (1.23 (0.51) to 1.13 (0.52) L; p=0.0000). Mean BEC was 0.198 x109 cells/L, with 64.7% of patients having a BEC ≥0.1 x109 cells/L and 21.3% having a BEC ≥0.3 x109 cells/L. The most common comorbidity was hypertension (58.3%). An increasing number of severe exacerbations per year was associated with greater HCRU. DISCUSSION The findings presented here indicate that effective treatment strategies to prevent severe exacerbations in patients with COPD remain a significant unmet need in low-income and middle-income countries.
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Affiliation(s)
- Rodrigo Abensur Athanazio
- Pulmonology Division, Heart Institute-InCor-Clinical Hospital, Faculty of Medicine, Universidade de São Paulo, São Paulo, Brazil
| | | | - Sergey N Avdeev
- Department of Pulmonology, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
| | - Hao-Chien Wang
- Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Alejandra Ramírez-Venegas
- Tobacco Smoking and COPD Research Department, Instituto Nacional de Enfermedades Respiratorias Ismael Cosio Villegas, Mexico City, Mexico
| | - Martín Sivori
- Pneumology Unit, Dr J M Ramos Mejía Pulmonology University Center, Faculty of Medicine, University of Buenos Aires, Buenos Aires, Argentina
| | - Jorge Dreyse
- Department of Internal Medicine and Critical Care Center, Clínica Las Condes and School of Medicine Universidad Finis Terrae, Santiago, Chile
| | - Manuel Pacheco
- Internal Medicine Research Group, Universidad Tecnológica de Pereira, Pereira, Colombia
- Fundación Universitaria Visión de las Américas y Respiremos Unidad de Neumología, Pereira, Colombia
| | - Sin Kit Man
- Department of Medicine and Geriatrics, Department of Medicine and Geriatrics, Tuen Mun Hospital, Hong Kong Special Administrative Region (HKSAR), Tuen Mun, People's Republic of China
| | - Lorena Noriega-Aguirre
- Center for Diagnosis and Treatment of Respiratory Diseases (CEDITER), Panama City, Panama
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10
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Touilloux B, Casutt A, Strippoli MPF, Lenoir A, Janett S, Vollenweider P, Vaucher J, Nicod L, Preisig M, von Garnier C. Associations of Depressive and Anxiety Disorders with Pulmonary Disorders in the Community: The PneumoLaus and PsyCoLaus Studies. Respiration 2024; 103:503-512. [PMID: 38417406 PMCID: PMC11309049 DOI: 10.1159/000537918] [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] [Received: 11/29/2023] [Accepted: 02/14/2024] [Indexed: 03/01/2024] Open
Abstract
INTRODUCTION Mental health disorders figure among the many comorbidities of obstructive respiratory diseases. The multisystemic characteristics of chronic respiratory disease and its impact on quality of life could affect depressive and/or anxiety disorders. We aimed to evaluate the association of spirometric indices, ventilatory disorders, and self-reported respiratory diseases with psychiatric disorders considering potential confounders. METHODS We analysed data from CoLaus|PsyCoLaus, a Swiss population-based cohort study, consisting of 2'774 participants (56% women; mean age: 62.3 (standard deviation = ±9.9) years) who performed spirometry and completed semi-structured psychiatric interviews. We defined ventilatory disorders using GLI-2012 references. Major depressive episode (MDE) and anxiety disorders were defined using the DSM-IV (Diagnostic and Statistical Manual). RESULTS 630 subjects (22.7%) presented a recent MDE. Reversible obstructive ventilatory disorders were associated with recent MDE (OR = 1.94, 95% confidence interval (95% CI) 1.10-3.43) and recent anxiety disorders (2.21 [1.16-4.22]) only in unadjusted model. Self-reported chronic obstructive pulmonary (COPD) and asthma were associated with MDE with ORs of 2.49 (95% CI, 1.19-5.27) and 1.56 (95% CI, 1.04-2.35) after adjustment, respectively. Possible restrictive ventilatory impairment was positively associated with recent anxiety disorders (OR = 2.46, 1.10-5.51). Z-scores of FEV1, FVC, and maximal mid-expiratory flow were not associated with psychiatric disorders. There was no association between ventilatory disorders and MDE in adjusted models. CONCLUSIONS In this cross-sectional population-based study, the association between respiratory disorders and depressive disorders was observed for self-reported COPD and asthma, but not with objective diagnoses based on spirometry. Lung volumes are not associated with psychiatric disorders. Further prospective studies will be necessary to understand the significance of the association.
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Affiliation(s)
- Brice Touilloux
- Division of Pulmonology, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Division of Pulmonology, Department of Medicine and Specialties, Fribourg Hospital and University of Fribourg, Fribourg, Switzerland
| | - Alessio Casutt
- Division of Pulmonology, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Division of Pneumology, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Marie-Pierre F. Strippoli
- Psychiatric Epidemiology and Psychopathology Research Center, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Prilly, Switzerland
| | - Alexandra Lenoir
- Division of Pulmonology, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Department of Internal Medicine V, Ludwig-Maximilians-University (LMU) of Munich, Munich, Germany
| | - Simone Janett
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - Peter Vollenweider
- Division of Internal Medicine, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Julien Vaucher
- Division of Internal Medicine, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Division of Internal Medicine, Department of Medicine and Specialties, Fribourg Hospital and University of Fribourg, Fribourg, Switzerland
| | - Laurent Nicod
- Division of Pulmonology, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Martin Preisig
- Psychiatric Epidemiology and Psychopathology Research Center, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Prilly, Switzerland
| | - Christophe von Garnier
- Division of Pulmonology, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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11
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Li N, Li X, Liu M, Wang Y, Wang J. Sex differences in comorbidities and mortality risk among patients with chronic obstructive pulmonary disease: a study based on NHANES data. BMC Pulm Med 2023; 23:481. [PMID: 38031050 PMCID: PMC10687794 DOI: 10.1186/s12890-023-02771-3] [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: 05/20/2023] [Accepted: 11/17/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Patients with chronic obstructive pulmonary disease (COPD) commonly have coexisting comorbidities that contribute to higher exacerbation frequency, poorer health status, and increased all-cause mortality; however, there are only a few studies available on the sex discrepancy in the comorbidity distribution and outcomes among COPD patients, and there is limited information about the discrepancy in all-cause mortality between men and women. METHODS Based on data from the U.S. National Health and Nutrition Examination Survey conducted between 2007 and 2012, we compared participants aged 40-79 years with spirometry-defined COPD to compare the prevalence of comorbidities between men and women. The survival of the subjects was documented, and the sex discrepancy was determined using Kaplan-Meier analysis. Comorbidities and all-cause mortality were analyzed by using a Cox proportional hazards model to determine their strength of association in different sex groups. RESULTS Compared to men, women had a significantly higher prevalence of asthma (OR 1.93, 95% CI 1.46 to 2.57, p < 0.001) and arthritis (OR 1.77, 95% CI 1.39 to 2.24, p < 0.001). Women had a significantly lower prevalence of coronary heart disease (OR 0.48, 95% CI 0.27 to 0.87, p = 0.015) and gout (OR 0.42, 95% CI 0.25 to 0.67, p = 0.001). Kaplan-Meier analysis revealed that compared with that of the female group, the survival rate of the male group was significantly lower (p < 0.001). Among men, the presence of anemia (HR 2.38, [95% CI 1.52-3.73], p < 0.001), gout (HR 1.55, [95% CI 1.04-2.30], p = 0.029) and congestive heart failure comorbidities (HR 1.85, [95% CI 1.12-3.04] p = 0.016) was associated with a higher risk of mortality; among women, the presence of anemia (HR 2.21, [95% CI 1.17-4.20], p = 0.015) and stroke (HR 2.04, [95% CI 1.07-3.88], p = 0.031) comorbidities was associated with a higher risk of mortality after adjusting for age, race/Hispanic status, BMI, smoking status, FEV1% predicted and prevalent comorbidities. CONCLUSIONS COPD-related comorbidities and all-cause mortality were discrepant between men and women, and men had poorer survival than women in the nationally representative data that were analyzed.
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Affiliation(s)
- Na Li
- Department of Respiratory, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, 710054, People's Republic of China
| | - Xiaoli Li
- Department of Respiratory, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, 710054, People's Republic of China
| | - Minjie Liu
- Department of Respiratory, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, 710054, People's Republic of China
| | - Yakang Wang
- Department of Orthopaedics, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, 710054, People's Republic of China
| | - Junning Wang
- Department of Respiratory, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, 710054, People's Republic of China.
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12
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Miravitlles M, Bhutani M, Hurst JR, Franssen FME, van Boven JFM, Khoo EM, Zhang J, Brunton S, Stolz D, Winders T, Asai K, Scullion JE. Implementing an Evidence-Based COPD Hospital Discharge Protocol: A Narrative Review and Expert Recommendations. Adv Ther 2023; 40:4236-4263. [PMID: 37537515 PMCID: PMC10499689 DOI: 10.1007/s12325-023-02609-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 07/06/2023] [Indexed: 08/05/2023]
Abstract
Discharge bundles, comprising evidence-based practices to be implemented prior to discharge, aim to optimise patient outcomes. They have been recommended to address high readmission rates in patients who have been hospitalised for an exacerbation of chronic obstructive pulmonary disease (COPD). Hospital readmission is associated with increased morbidity and healthcare resource utilisation, contributing substantially to the economic burden of COPD. Previous studies suggest that COPD discharge bundles may result in fewer hospital readmissions, lower risk of mortality and improvement of patient quality of life. However, evidence for their effectiveness is inconsistent, likely owing to variable content and implementation of these bundles. To ensure consistent provision of high-quality care for patients hospitalised with an exacerbation of COPD and reduce readmission rates following discharge, we propose a comprehensive discharge protocol, and provide evidence highlighting the importance of each element of the protocol. We then review care bundles used in COPD and other disease areas to understand how they affect patient outcomes, the barriers to implementing these bundles and what strategies have been used in other disease areas to overcome these barriers. We identified four evidence-based care bundle items for review prior to a patient's discharge from hospital, including (1) smoking cessation and assessment of environmental exposures, (2) treatment optimisation, (3) pulmonary rehabilitation, and (4) continuity of care. Resource constraints, lack of staff engagement and knowledge, and complexity of the COPD population were some of the key barriers inhibiting effective bundle implementation. These barriers can be addressed by applying learnings on successful bundle implementation from other disease areas, such as healthcare practitioner education and audit and feedback. By utilising the relevant implementation strategies, discharge bundles can be more (cost-)effectively delivered to improve patient outcomes, reduce readmission rates and ensure continuity of care for patients who have been discharged from hospital following a COPD exacerbation.
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Affiliation(s)
- Marc Miravitlles
- Pneumology Department, Vall d'Hebron University Hospital/Vall d'Hebron Research Institute (VHIR), Vall d'Hebron Barcelona Hospital Campus, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain.
| | - Mohit Bhutani
- Division of Pulmonary Medicine, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - John R Hurst
- UCL Respiratory, University College London, London, UK
| | - Frits M E Franssen
- Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, Netherlands
| | - Job F M van Boven
- Department of Clinical Pharmacy & Pharmacology, Groningen Research Institute for Asthma and COPD (GRIAC), University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Ee Ming Khoo
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
- International Primary Care Respiratory Group, Leicester, UK
| | - Jing Zhang
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | | | - Daiana Stolz
- Clinic of Respiratory Medicine and Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Tonya Winders
- Global Allergy and Airways Patient Platform, Vienna, Austria
| | - Kazuhisa Asai
- Department of Respiratory Medicine, Osaka Metropolitan University, Osaka, Japan
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13
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Russell DI, Reynolds AC, Appleton SL, Adams RJ, Correia H, Bowman JA, Gill TK, Metse AP. Use of Insomnia Treatments and Discussions About Sleep with Health Professionals Among Australian Adults with Mental Health Conditions. Nat Sci Sleep 2023; 15:623-637. [PMID: 37577358 PMCID: PMC10417743 DOI: 10.2147/nss.s412468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 07/20/2023] [Indexed: 08/15/2023] Open
Abstract
Background Insomnia is a common issue among individuals with mental health conditions, yet the frequency of insomnia treatment remains unclear. The purpose of this study was to investigate the prevalence of probable insomnia, discussions regarding sleep with health professionals, and the utilisation of commonly delivered insomnia treatments in Australian adults diagnosed with mental health conditions. Methods This study represents a secondary analysis of data collected through a cross-sectional, national online survey conducted in 2019. A subset included participants (n = 624, age 18-85y) who self-reported a diagnosis of depression, bipolar disorder, anxiety, panic disorder, or post-traumatic stress disorder. Participants were classed as having probable insomnia based on self-reported symptoms and a minimum availability of 7.5 hours in bed. Results Among individuals with probable insomnia (n = 296, 47.4%), 64.5% (n = 191) reported discussing sleep with one or more health professionals, predominantly with general practitioners (n = 160, 83.8%). However, 35.4% (n = 105) of people with probable insomnia had not discussed their sleep with a health professional. Additionally, 35.1% (n = 104) used prescribed medication for sleep, while only 15.9% (n = 47) had used the first line recommended treatment of cognitive-behavioral therapy for insomnia in the last 12 months. Conclusion Although most participants who met the criteria for probable insomnia had engaged in discussions about sleep with health professionals, utilisation of first line recommended treatment was low. Interventions that promote routine assessment of sleep and first line treatment for insomnia by health professionals would likely benefit people with mental health conditions.
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Affiliation(s)
- Daniel I Russell
- College of Science, Health, Engineering and Education (SHEE), Murdoch University, Murdoch, Western Australia, 6150, Australia
| | - Amy C Reynolds
- Flinders Health and Medical Research Institute (Sleep Health), College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Sarah L Appleton
- Flinders Health and Medical Research Institute (Sleep Health), College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
- The Freemasons Centre for Male Health & Wellbeing, The University of Adelaide, Adelaide, South Australia, 5005, Australia
| | - Robert J Adams
- Flinders Health and Medical Research Institute (Sleep Health), College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
- The Freemasons Centre for Male Health & Wellbeing, The University of Adelaide, Adelaide, South Australia, 5005, Australia
| | - Helen Correia
- Psychological Sciences, Australian College of Applied Professions Perth, Northbridge, Western Australia, 6003, Australia
| | - Jenny A Bowman
- School of Psychological Sciences, University of Newcastle, Callaghan, New South Wales, 2308, Australia
- Hunter Medical Research Institute (HMRI), New Lambton Heights, NSW, 2305, Australia
| | - Tiffany K Gill
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, 5005, Australia
| | - Alexandra P Metse
- School of Psychological Sciences, University of Newcastle, Callaghan, New South Wales, 2308, Australia
- Hunter Medical Research Institute (HMRI), New Lambton Heights, NSW, 2305, Australia
- School of Health, University of the Sunshine Coast, Sippy Downs, Queensland, 4556, Australia
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14
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Weinreich UM, Storgaard LH. A Real-Life Study of Combined Treatment with Long-Term Non-Invasive Ventilation and High Flow Nasal Cannula in Patients with End-Stage Chronic Obstructive Lung Disease. J Clin Med 2023; 12:4485. [PMID: 37445520 DOI: 10.3390/jcm12134485] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 06/26/2023] [Accepted: 07/01/2023] [Indexed: 07/15/2023] Open
Abstract
Patients with end-stage chronic obstructive pulmonary disease (COPD) often develop persistent hypoxic or hypercapnic respiratory failure, or a combination of both. Ventilatory support, in terms of a long-term high-flow nasal cannula (LT-HFNC) and long-term non-invasive ventilation (LT-NIV), may be indicated. Often, clinicians choose either one or the other. This paper explores combined treatment with LT-HFNC and LT-NIV in a real-life setting. In total, 33 patients with COPD and persistent respiratory failure were included in this study. Of those, 17 were initiated on LT-HFNC and used it for 595 (374) days and 16 were initiated on LT-NIV and used it for 558 (479) days. On average, patients used respiratory support continuously for 908 (586) days. Baseline characteristics were comparable, apart from PaCO2 at first ventilatory support initiation (LT-HFNC/LT-NIV 7.1 (1.1) kPa/8.8 (0.9) kPa respectively (p = 0.002)). Both groups experienced a reduction in hospitalizations in the first twelve months after treatment initiation, compared to the twelve months before (LT-HFNC p = 0.022 and LT-NIV p = 0.014). In total, 25% of LT-NIV patients stopped treatment after HFNC initiation due to intolerance and 59% stopped LT-HFNC treatment 126 (36) days after LT-NIV initiation as monotherapy was sufficient. In 44% of these patients, LT-HFNC was re-initiated at the end of life. At the time of analysis, 70% of patients had died. In the last three months of life, patients stopped using LT-NIV, whereas 91% used LT-HFNC. In conclusion, the combined use of LT-NIV and LT-HFNC reduced hospitalizations in patients with COPD and persistent respiratory failure. The study indicates that LT-HFNC is well tolerated, and better tolerated than LT-NIV at the very end stages of COPD.
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Affiliation(s)
- Ulla Møller Weinreich
- Department of Respiratory Diseases, Aalborg University Hospital, DK-9100 Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, DK-9100 Aalborg, Denmark
| | - Line Hust Storgaard
- Department of Respiratory Diseases, Aalborg University Hospital, DK-9100 Aalborg, Denmark
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15
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Løkke A, Hilberg O, Lange P, Ibsen R, Telg G, Stratelis G, Lykkegaard J. Exacerbations Predict Severe Cardiovascular Events in Patients with COPD and Stable Cardiovascular Disease–A Nationwide, Population-Based Cohort Study. Int J Chron Obstruct Pulmon Dis 2023; 18:419-429. [PMID: 37034899 PMCID: PMC10075268 DOI: 10.2147/copd.s396790] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 03/27/2023] [Indexed: 04/03/2023] Open
Abstract
Objective Patients with chronic obstructive pulmonary disease (COPD) commonly present with cardiovascular disease (CVD). We investigated the association between COPD exacerbations and major cardiovascular (CV) events in a COPD population with a history of CVD. Methods This population-based and register-based cohort study identified all Danish COPD patients aged ≥40 years who visited a hospital-based, pulmonary outpatient clinic for COPD between 1st January, 2010, and 31st December, 2016, from a nationwide COPD registry. Patients with a history of a major CV event 36‒6 months prior to their COPD measurement date and no CV event 6 months before this date were included. During a 6-month assessment period, the risks of a new CV event (hospitalization with fatal/non-fatal stroke, myocardial infarction, or heart failure) and moderate and severe COPD exacerbations were evaluated. Odds ratios with 95% confidence intervals for CV events and death were estimated using adjusted logistic regression models. Results Of the 1501 COPD patients included, 55% experienced a COPD exacerbation and 13% experienced both an exacerbation and a CV event during follow-up (6 months). The odds of a CV event were 1.5 times higher in patients with a moderate exacerbation and more than 6-times higher in those with a severe exacerbation vs patients with no exacerbation(s). The majority of CV events occurred within 30 days post exacerbation in patients who experienced both an exacerbation and a CV event. In total, 113 patients died during the study period: 28% of deaths were caused by CVD and 72% by reasons other than CVD, mostly COPD. Conclusion In patients with known CVD, severe COPD exacerbations are associated with increased odds of major CV events that occur within 30 days post exacerbation, highlighting the need to prevent exacerbations in COPD patients with concomitant CVD to potentially improve both respiratory and CV health.
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Affiliation(s)
- Anders Løkke
- Department of Medicine, Little Belt Hospital, Vejle, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Correspondence: Anders Løkke, Department of Medicine, Little Belt Hospital, Vejle, Denmark, Email
| | - Ole Hilberg
- Department of Medicine, Little Belt Hospital, Vejle, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Peter Lange
- Medical Department, Copenhagen University Hospital-Herlev, Herlev, Denmark
- Department of Public Health, Section of Epidemiology, University of Copenhagen, Copenhagen, Denmark
| | | | | | | | - Jesper Lykkegaard
- Research Unit for General Practice, Institute of Public Health, University of Southern Denmark, Odense, Denmark
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16
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Golovina E, Fadason T, Jaros RK, Kumar H, John J, Burrowes K, Tawhai M, O'Sullivan JM. De novo discovery of traits co-occurring with chronic obstructive pulmonary disease. Life Sci Alliance 2023; 6:6/3/e202201609. [PMID: 36574990 PMCID: PMC9795035 DOI: 10.26508/lsa.202201609] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 12/06/2022] [Accepted: 12/08/2022] [Indexed: 12/28/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a heterogeneous group of chronic lung conditions. Genome-wide association studies have identified single-nucleotide polymorphisms (SNPs) associated with COPD and the co-occurring conditions, suggesting common biological mechanisms underlying COPD and these co-occurring conditions. To identify them, we have integrated information across different biological levels (i.e., genetic variants, lung-specific 3D genome structure, gene expression and protein-protein interactions) to build lung-specific gene regulatory and protein-protein interaction networks. We have queried these networks using disease-associated SNPs for COPD, unipolar depression and coronary artery disease. COPD-associated SNPs can control genes involved in the regulation of lung or pulmonary function, asthma, brain region volumes, cortical surface area, depressed affect, neuroticism, Parkinson's disease, white matter microstructure and smoking behaviour. We describe the regulatory connections, genes and biochemical pathways that underlay these co-occurring trait-SNP-gene associations. Collectively, our findings provide new avenues for the investigation of the underlying biology and diverse clinical presentations of COPD. In so doing, we identify a collection of genetic variants and genes that may aid COPD patient stratification and treatment.
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Affiliation(s)
| | - Tayaza Fadason
- Liggins Institute, University of Auckland, Auckland, New Zealand.,Maurice Wilkins Centre, University of Auckland, Auckland, New Zealand
| | - Rachel K Jaros
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Haribalan Kumar
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Joyce John
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Kelly Burrowes
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Merryn Tawhai
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Justin M O'Sullivan
- Liggins Institute, University of Auckland, Auckland, New Zealand .,Maurice Wilkins Centre, University of Auckland, Auckland, New Zealand.,MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK.,Garvan Institute of Medical Research, Sydney, Australia.,Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
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17
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Smith C, Hasselgren M, Janson C, Kisiel MA, Lisspers K, Nager A, Sandelowsky H, Ställberg B, Sundh J, Montgomery S. Does multimorbidity result in de-prioritisation of COPD in primary care? NPJ Prim Care Respir Med 2023; 33:2. [PMID: 36641480 PMCID: PMC9840635 DOI: 10.1038/s41533-023-00326-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 01/03/2023] [Indexed: 01/15/2023] Open
Abstract
The aim of this study was to describe factors associated with having COPD regularly reviewed in primary care by a nurse or physician and assess whether there was de-prioritisation for COPD in multimorbid patients. We defined de-prioritisation as not having at least one check-up by a physician during a two-year period. Among 713 COPD patients in the Swedish PRAXIS study, 473 (66%) had at least one check-up during the study period (ending in 2014). Patients with check-ups were more likely to have three or more comorbid conditions (31.9% vs. 24.6%) and exacerbations (35.1% vs. 21.7%) than those without. Compared with those without comorbidity, those with three or more diagnoses had increased relative risk ratios (and 95% CI) for consultations discussing COPD with only a physician (5.63 (2.68-11.79)), COPD-nurse only (1.67 (0.83-3.37)) or both (2.11 (1.09-4.06)). COPD patients received more frequent check-ups considering COPD if they had comorbidity or a history of exacerbations. We found no evidence of de-prioritisation for COPD in multimorbid patients.
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Affiliation(s)
- Carolina Smith
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
- Centre for Clinical Research and Education, Region Värmland, Karlstad, Sweden.
| | - Mikael Hasselgren
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Christer Janson
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Marta A Kisiel
- Department of Medical Sciences, Occupational and Environment Medicine, Uppsala University, Uppsala, Sweden
| | - Karin Lisspers
- Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden
| | - Anna Nager
- NVS, Division of Family Medicine and Primary Care, Karolinska Institutet, Stockholm, Sweden
| | - Hanna Sandelowsky
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Neurobiology, Care Sciences and Society, Division of Family Medicine and Primary Care, Karolinska Institutet, Stockholm, Sweden
- Academic Primary Health Care Centre, Region Stockholm, Stockholm, Sweden
| | - Björn Ställberg
- Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden
| | - Josefin Sundh
- Department of Respiratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Scott Montgomery
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Department of Epidemiology and Public Health, University College London, London, UK
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Bahrami M, Forouharnejad K, Mirgaloyebayat H, Ghasemi Darestani N, Ghadimi M, Masaeli D, Fazeli P, Mohammadi H, Shabani M, Emami Ardestani M. Correlations and diagnostic tools for metabolic syndrome (MetS) and chronic obstructive pulmonary disease (COPD). INTERNATIONAL JOURNAL OF PHYSIOLOGY, PATHOPHYSIOLOGY AND PHARMACOLOGY 2022; 14:311-315. [PMID: 36741201 PMCID: PMC9890204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 12/08/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Regarding the importance of obesity in patients with chronic obstructive pulmonary disease (COPD), we aimed to evaluate of correlation between metabolic syndrome (MetS) and COPD. METHODS In this cross-sectional study, 96 patients with COPD were evaluated. This study was conducted in 2016-2018. The severity of COPD was determined by Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2017 criteria. We investigated the correlations between MetS with COPD and possible diagnostic tools. RESULTS Of all COPD patients, 86.5% had MetS, and the means of waist circumference, fasting blood glucose, systolic and diastolic blood pressure, body mass index, and triglyceride in patients with MetS were significantly higher than the patients without MetS (P < 0.05). We showed that forced expiratory volume in 1 second (FEV1) with a 37% cutoff had 92.8% and 69.2% sensitivity and specificity, respectively (area of the curve: 0.51, 0.31-0.71). CONCLUSION MetS is prevalent among COPD and FEV1 could be considered as important diagnostic tool for COPD.
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Affiliation(s)
- Mahshid Bahrami
- Department of Radiology, Isfahan University of Medical SciencesIsfahan, Iran
| | | | | | | | - Mozhgan Ghadimi
- School of Medicine, Isfahan University of Medical SciencesIsfahan, Iran
| | - Dorna Masaeli
- School of Medicine, Isfahan University of Medical SciencesIsfahan, Iran
| | - Pooya Fazeli
- School of Medicine, Isfahan University of Medical SciencesIsfahan, Iran
| | - Hossein Mohammadi
- School of Medicine, Isfahan University of Medical SciencesIsfahan, Iran
| | - Mahdi Shabani
- Department of Internal Medicine, School of Medicine, Isfahan University of Medical SciencesIsfahan, Iran
| | - Mohammad Emami Ardestani
- Department of Internal Medicine, School of Medicine, Isfahan University of Medical SciencesIsfahan, Iran
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19
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Flor-Escriche X, Sanz Bas A, Álvarez Álvarez S, Zamora Putin V, Monteagudo Zaragoza M. Riesgos, fenotipos y comparación de tratamiento de EPOC en atención primaria según guías GOLD y GesEPOC. Semergen 2022; 48:101839. [DOI: 10.1016/j.semerg.2022.101839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 08/22/2022] [Accepted: 09/02/2022] [Indexed: 11/22/2022]
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20
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Sandelowsky H, Janson C, Wiklund F, Telg G, de Fine Licht S, Ställberg B. Lack of COPD-Related Follow-Up Visits and Pharmacological Treatment in Swedish Primary and Secondary Care. Int J Chron Obstruct Pulmon Dis 2022; 17:1769-1780. [PMID: 35971390 PMCID: PMC9375582 DOI: 10.2147/copd.s372266] [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: 04/26/2022] [Accepted: 07/18/2022] [Indexed: 11/23/2022] Open
Abstract
Objective The Swedish guidelines recommend that patients with chronic obstructive pulmonary disease (COPD) on maintenance treatment are monitored annually, and within six weeks after an exacerbation. We describe the patterns of COPD-related visits in Sweden, both regular follow-up and post-exacerbation visits. Methods Patients (>40 years) with a first-time COPD diagnosis between 2006 and 2017 were identified in primary care medical records and linked to hospital contacts and administered drug data. The index date was defined as the first collection of inhaled COPD maintenance treatment after the diagnosis. Regular COPD visits within 15-months after the index, and post-exacerbation visits for COPD within six weeks and 15-months after an exacerbation were estimated using the cumulative incidence function adjusted for competing risk. Visits without a ICD code for COPD were not included in the analyses. Results A total of 19,857 patients (mean age 69 years, 57% females) were included. The overall probability of having a regular follow-up visit for COPD within 15 months post-index was 39.1%. In total, 15,095 (76%) patients experienced at least one COPD exacerbation during the observation period. Among them, the probability of having a post-exacerbation visit was 7.0% within six weeks and 29.7% within 15-months. Patients without a regular COPD follow-up visit claimed significantly more oral corticosteroids (25.6% vs 15.6%), more respiratory antibiotics (39.1% vs 23.1%), and less maintenance treatment (10.9% vs 16.5%). Conclusion Only 39% of COPD patients attended a regular follow-up visit within 15-months from the COPD diagnosis and one-third had a post-exacerbation visit. The adherence to guideline recommendations need to be improved.
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Affiliation(s)
- Hanna Sandelowsky
- Department of Medicine, Solna, Division of Clinical Epidemiology, Karolinska Institutet, Stockholm, Sweden.,Department of Neurobiology, Care Sciences and Society, Division of Family Medicine and Primary Care, Karolinska Institutet, Solna, Sweden.,Academic Primary Health Care Centre, Region Stockholm, Stockholm, Sweden
| | - Christer Janson
- Department of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | | | | | | | - Björn Ställberg
- Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden
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21
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Kim-Dorner SJ, Schmidt T, Kuhlmann A, Graf von der Schulenburg JM, Welte T, Lingner H. Age- and gender-based comorbidity categories in general practitioner and pulmonology patients with COPD. NPJ Prim Care Respir Med 2022; 32:17. [PMID: 35501357 PMCID: PMC9061861 DOI: 10.1038/s41533-022-00278-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 02/11/2022] [Indexed: 11/25/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a debilitating medical condition often accompanied by multiple chronic conditions. COPD is more frequent among older adults and affects both genders. The aim of the current cross-sectional survey was to characterize chronic comorbidities stratified by gender and age among patients with COPD under the care of general practitioners (GP) and pulmonologists, using real-world patient data. A total of 7966 COPD patients (women: 45%) with more than 5 years of the observation period in the practice were examined using 60 different Chronic comorbid conditions (CCC) and Elixhauser measures. More than 9 in 10 patients had at least one, and 51.7% had more than three comorbidities. No gender difference was found in the number of comorbidities. However, men had higher Elixhauser-van Walraven index scores than women, and the types of comorbidities differed by gender. An increasing number of comorbidities was seen with aging but the patients in their 30s and 40s also had a high number of comorbidities. Moreover, GP patients had a higher number and a wider array of documented comorbidities than pulmonology patients did. Psychological comorbidities were common in all patients, but particularly among younger patients. These findings around gender- and age-stratified comorbidities under the care of GPs and pulmonologists have implications for the choice of data provenience for decision-making analysis and treatment selection and success.
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22
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Kearney L, Wiener RS, Dahodwala M, Fix GM, Hicks J, Little F, Howard J, Foreman AG, Wakeman C, O'Donnell C, Bulekova K, Drainoni ML, Kathuria H. A mixed methods study to inform and evaluate a longitudinal nurse practitioner/community health worker intervention to address social determinants of health and chronic obstructive pulmonary disease self-management. BMC Pulm Med 2022; 22:74. [PMID: 35232414 PMCID: PMC8889692 DOI: 10.1186/s12890-022-01863-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 02/11/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Individuals with low socioeconomic status experience higher prevalence and worse outcomes of chronic obstructive pulmonary disease (COPD). We undertook a quality improvement initiative at our safety net hospital in which a nurse practitioner (NP)/community health worker (CHW) team followed patients with COPD, frequent admissions, and unmet SDOH needs from hospitalization through one month post-discharge. We report our mixed methods approach to inform development and preliminary evaluation of this intervention. METHODS We first assessed characteristics of patients admitted with COPD in 2018 (n = 1811), performing multivariable logistic regression to identify factors associated with ≥ 2 admissions per year. We then tested a standardized tool to screen for unmet SDOH needs in a convenience sample of 51 frequently hospitalized patients with COPD. From January-July 2019, we pilot tested the NP/CHW intervention with 57 patients, reviewed NP/CHW logs, and conducted qualitative interviews with 16 patient participants to explore impressions of the intervention. RESULTS Patients with Medicaid insurance, mental health disorders, cardiac disease, and substance use disorder had increased odds of having ≥ 2 admissions. COPD severity, comorbidities, and unmet SDOH needs made COPD self-management challenging. Seventy-four percent of frequently admitted patients with COPD completing SDOH screening had unmet SDOH needs. Patients perceived that the NP/CHW intervention addressed these barriers by connecting them to resources and providing emotional support. CONCLUSIONS Many patients with COPD admitted at our safety-net hospital experience unmet SDOH needs that impede COPD self-management. A longitudinal NP/CHW intervention to address unmet SDOH needs following discharge appears feasible and acceptable.
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Affiliation(s)
- Lauren Kearney
- The Pulmonary Center, Department of Medicine, Boston University School of Medicine, 72 East Concord Street, R304, Boston, MA, 02118, USA
| | - Renda Soylemez Wiener
- The Pulmonary Center, Department of Medicine, Boston University School of Medicine, 72 East Concord Street, R304, Boston, MA, 02118, USA.,Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System, Boston, MA, USA
| | - Mohsin Dahodwala
- The Pulmonary Center, Department of Medicine, Boston University School of Medicine, 72 East Concord Street, R304, Boston, MA, 02118, USA
| | - Gemmae M Fix
- Center for Healthcare Organization & Implementation Research, VA Bedford Healthcare System, Bedford, MA, USA.,Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, MA, USA.,Department of Health Law Policy & Management, Boston University School of Public Health, Boston, MA, USA
| | - Jacqueline Hicks
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Frederic Little
- The Pulmonary Center, Department of Medicine, Boston University School of Medicine, 72 East Concord Street, R304, Boston, MA, 02118, USA
| | - Jinesa Howard
- The Pulmonary Center, Department of Medicine, Boston University School of Medicine, 72 East Concord Street, R304, Boston, MA, 02118, USA
| | - Alexis Gallardo Foreman
- The Pulmonary Center, Department of Medicine, Boston University School of Medicine, 72 East Concord Street, R304, Boston, MA, 02118, USA
| | - Cornelia Wakeman
- The Pulmonary Center, Department of Medicine, Boston University School of Medicine, 72 East Concord Street, R304, Boston, MA, 02118, USA
| | - Charles O'Donnell
- The Pulmonary Center, Department of Medicine, Boston University School of Medicine, 72 East Concord Street, R304, Boston, MA, 02118, USA
| | - Katia Bulekova
- Research Computing Services (RCS) Group, Information Services & Technology, Boston University, Boston, MA, USA
| | - Mari-Lynn Drainoni
- Department of Health Law Policy & Management, Boston University School of Public Health, Boston, MA, USA.,Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, MA, USA.,Evans Center for Implementation and Improvement Sciences, Boston University, Boston, MA, USA
| | - Hasmeena Kathuria
- The Pulmonary Center, Department of Medicine, Boston University School of Medicine, 72 East Concord Street, R304, Boston, MA, 02118, USA.
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23
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Cravo A, Attar D, Freeman D, Holmes S, Ip L, Singh SJ. The Importance of Self-Management in the Context of Personalized Care in COPD. Int J Chron Obstruct Pulmon Dis 2022; 17:231-243. [PMID: 35095272 PMCID: PMC8791295 DOI: 10.2147/copd.s343108] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 12/20/2021] [Indexed: 01/13/2023] Open
Abstract
Despite current guidelines and decades of evidence on the benefits of a self-management approach, self-management of COPD remains relatively under-utilized in clinical care compared with other chronic diseases. However, self-management interventions can play a valuable role in supporting people with COPD to respond to changing symptoms, and thereby make appropriate decisions regarding the management of their own chronic condition. In this review, we discuss the history and evolution of the concept of self-management, assess current multidisciplinary support programs and clinical interactions designed to optimize self-management, and reflect on how effective these are in terms of clinical and humanistic outcomes. We also evaluate the mechanisms for encouraging change from protocol-based care towards a more personalized care approach, and discuss the role of digital self-management interventions and the importance of addressing health inequalities in COPD treatment, which have been accelerated by the COVID-19 pandemic. Reflecting on the importance of self-management in the context of symptom monitoring and provision of educational support, including information from patient organizations and charities, we discuss the ideal components of a self-management plan for COPD and provide six key recommendations for its implementation: 1) better education for healthcare professionals on disease management and consultation skills; 2) new targets and priorities for patient-focused outcomes; 3) skills gap audits to identify barriers to self-management; 4) best practice sharing within primary care networks and ongoing professional development; 5) enhanced initial consultations to establish optimal self-management from the outset; and 6) negotiation and sharing of self-management plans at the point of diagnosis.
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Affiliation(s)
- Ana Cravo
- Medical Affairs, Boehringer Ingelheim Ltd, Bracknell, UK
| | - Darush Attar
- North Central London Clinical Commissioning Group (CCG), London, UK
| | | | - Steve Holmes
- The Park Medical Practice, Shepton Mallet, UK
- Correspondence: Steve Holmes The Park Medical Practice, Cannard’s Grave Road, Shepton Mallet, Somerset, BA4 5RT, UKTel +44 1749 334383 Email
| | - Lindsay Ip
- King’s Health Partners and Ealing Community Partners, London, UK
| | - Sally J Singh
- Faculty of Health and Life Sciences, Coventry University, Coventry, UK
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
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24
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Silva EAP, Santos DM, de Carvalho FO, Menezes IAC, Barreto AS, Souza DS, Quintans-Júnior LJ, Santos MRV. Monoterpenes and their derivatives as agents for cardiovascular disease management: A systematic review and meta-analysis. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2021; 88:153451. [PMID: 33483251 DOI: 10.1016/j.phymed.2020.153451] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 11/16/2020] [Accepted: 12/22/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Monoterpenes are one of the most studied plant's secondary metabolites, they are found abundantly in essential oils of aromatic plants. They also have a great range of pharmacological properties, such as antihypertensive, bradycardic, antiarrhythmic and hypotensive. In the face of the burden caused by cardiovascular disease (CVDs) worldwide, studies using monoterpenes to assess their cardiovascular effects have increased over the years. PURPOSE This systematic review aimed to summarize the use of monoterpenes in animal models of any CVDs. METHODS PubMed, SCOPUS, LILACS and Web of Science databases were used to search for articles that used monoterpenes, in any type of administration, to treat or prevent CVDs in animal models. The PRISMA guidelines were followed. Two independent researchers extracted main characteristics of studies, methods and outcomes. Data obtained were analyzed qualitatively and quantitatively. RESULTS At the ending of the search process, 33 articles were selected for the systematic review. Of these, 17 articles were included in the meta-analysis. A total of 16 different monoterpenes were found for the treatment of hypertension, myocardial infarction, pulmonary hypertension, cardiac hypertrophy and arrhythmia. The main actions include hypotension, bradycardia, vasodilatation, antiarrhythmic, and antioxidant and antiapoptotic properties. From our data, it can be suggested that monoterpenes may be a significant source for new drug development. However, there is still a need to apply these knowledge into clinical research and a long path to pursue before putting them in the market. CONCLUSION The variability of cardiovascular effects demonstrated by the monoterpenes highlighted them as a promising candidates for treatment or prevention of CVDs. Nevertheless, studies that investigate their biological sites of action needs to be further encouraged.
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Affiliation(s)
- Eric Aian P Silva
- Department of Physiology, Universidade Federal de Sergipe, Av. Marechal Rondon, S/N, Cidade Universitaria, São Cristovao-SE, 49100-000, Brazil; Biotechnology Graduate Program - Rede Nordeste de Biotecnologia (RENORBIO), Universidade Federal de Sergipe, Av. Marechal Rondon, S/N, Cidade Universitaria, São Cristovao-SE, 49100-000, Brazil
| | - Danillo M Santos
- Department of Physiology, Universidade Federal de Sergipe, Av. Marechal Rondon, S/N, Cidade Universitaria, São Cristovao-SE, 49100-000, Brazil; Health Sciences Graduate Program, Universidade Federal de Sergipe, Rua Claudio Batista S/N, Sanatorio, Aracaju-SE, 49.060-100, Brazil
| | - Fernanda Oliveira de Carvalho
- Department of Physiology, Universidade Federal de Sergipe, Av. Marechal Rondon, S/N, Cidade Universitaria, São Cristovao-SE, 49100-000, Brazil; Health Sciences Graduate Program, Universidade Federal de Sergipe, Rua Claudio Batista S/N, Sanatorio, Aracaju-SE, 49.060-100, Brazil
| | - Igor A Cortes Menezes
- Hospital de Clínicas, Universidade Federal do Paraná, Rua General Carneiro, 181, Curitiba-PR, 80060-900, Brazil
| | - André S Barreto
- Department of Health Education, Universidade Federal de Sergipe, Av. Governador Marcelo Deda, 13, Centro, Lagarto-SE, CEP 49400-000, Brazil
| | - Diego S Souza
- Department of Anesthesiology, University of Arizona, Tucson, AZ, USA
| | - Lucindo J Quintans-Júnior
- Department of Physiology, Universidade Federal de Sergipe, Av. Marechal Rondon, S/N, Cidade Universitaria, São Cristovao-SE, 49100-000, Brazil; Health Sciences Graduate Program, Universidade Federal de Sergipe, Rua Claudio Batista S/N, Sanatorio, Aracaju-SE, 49.060-100, Brazil
| | - Márcio R V Santos
- Department of Physiology, Universidade Federal de Sergipe, Av. Marechal Rondon, S/N, Cidade Universitaria, São Cristovao-SE, 49100-000, Brazil; Health Sciences Graduate Program, Universidade Federal de Sergipe, Rua Claudio Batista S/N, Sanatorio, Aracaju-SE, 49.060-100, Brazil; Biotechnology Graduate Program - Rede Nordeste de Biotecnologia (RENORBIO), Universidade Federal de Sergipe, Av. Marechal Rondon, S/N, Cidade Universitaria, São Cristovao-SE, 49100-000, Brazil.
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25
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Association between Obstructive Lung Disease and Cardiovascular Disease: Results from the Vermont Diabetes Information System. JOURNAL OF RESPIRATION 2021. [DOI: 10.3390/jor1030016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The association between obstructive lung disease and cardiovascular disease (CVD) has been suggested previously, but few studies have looked at this association in a diabetic cohort, a population highly susceptible to both comorbidities. A total of 1003 subjects in community practice settings were interviewed at home at the time of enrolment into the Vermont Diabetes Information System, a clinical decision support program. Patients self-reported their personal and clinical characteristics, including any obstructive lung disease. Laboratory data were obtained directly from the clinical laboratory. We performed a cross-sectional analysis of the interviewed subjects to assess a possible association between obstructive lung disease and CVD. In a multivariate logistic regression model, obstructive lung disease was significantly associated with CVD, even after correcting for potential confounders, including gender, obesity, low income, cigarette smoking, alcohol problems, and high comorbidity (odds ratio = 1.96; 95% confidence interval 1.37–2.81; p < 0.01). All components of CVD, including coronary artery disease (CAD), congestive heart failure (CHF), peripheral vascular disease (PVD), and cerebrovascular accidents (CVA), were also significantly associated with obstructive lung disease. These data suggest an association between obstructive lung disease and CVD in patients with diabetes. Future studies are needed to identify the mechanism supporting this association
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26
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Tsiligianni I, Hoeines KJ, Jensen C, Kocks JWH, Ställberg B, Vicente C, Peché R. Towards Rational Prescription of Common Inhaler Medication in the Multimorbid COPD Patient. Int J Chron Obstruct Pulmon Dis 2021; 16:1315-1327. [PMID: 34012259 PMCID: PMC8127323 DOI: 10.2147/copd.s298345] [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: 12/20/2020] [Accepted: 03/31/2021] [Indexed: 11/23/2022] Open
Abstract
COPD is a chronic disease, typically accompanied by multiple comorbid conditions. The need to apply several, and sometimes conflicting, disease-specific treatment guidelines, complicates the management of individual patients. Moreover, national and international recommendations evolve rapidly but provide limited guidance on the integrated approach in the multimorbid patient. Particularly bothersome is the fact that the presence of comorbidities may deteriorate the course of COPD, and inversely COPD may affect the outcome of the comorbid diseases. In addition, some effects of commonly prescribed COPD inhaler medications, including beta2-agonists, long-acting antimuscarinics and especially inhaled corticosteroids, mimic or worsen COPD-related comorbidities. Therefore, the authors combined their perspectives to formulate advice that may help physicians to improve COPD patient care in daily practice when comorbidities are present. Diabetes, atrial fibrillation, osteoporosis/fractures, infections (pneumonia and tuberculosis) and asthma were identified as areas where practicing clinicians should give special attention to the risk-benefit ratio of the inhaled medication. Overall, the presence of multimorbidity in a COPD patient should act as a signal to carefully reconsider the treatment choices.
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Affiliation(s)
| | | | | | - Janwillem W H Kocks
- General Practitioners Research Institute, Groningen, the Netherlands
- University of Groningen, University Medical Center Groningen, GRIAC Research Institute, Groningen, the Netherlands
- Observational and Pragmatic Research Institute, Singapore
| | - Björn Ställberg
- Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden
| | | | - Rudi Peché
- Department of Pneumology, ISPPC, CHU Charleroi, Charleroi, Belgium
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27
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Fens T, Zhou G, Postma MJ, van Puijenbroek EP, van Boven JFM. Economic evaluations of chronic obstructive pulmonary disease pharmacotherapy: how well are the real-world issues of medication adherence, comorbidities and adverse drug-reactions addressed? Expert Opin Pharmacother 2021; 22:923-935. [PMID: 33435700 DOI: 10.1080/14656566.2021.1873953] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION When estimating the cost-effectiveness or budget impact of chronic obstructive pulmonary disease (COPD) medication, it is common practice to use trial data for clinical inputs. However, such inputs do not always reflect the real-world situation. Previous reviews recognized the need for taking real-world data (medication adherence, comorbidity and adverse drug reactions [ADRs]) into account. Whether recent cost-effectiveness analyses of COPD medication implemented those recommendations is unknown. AREAS COVERED The authors reviewed recent economic evaluations of COPD-maintenance treatments focusing on medication adherence, comorbidity and ADRs. EXPERT OPINION In most registration trials of COPD treatment, strict inclusion and exclusion criteria are applied. During trials, patient monitoring is well controlled. As such, medication adherence is often higher than seen in less controlled, real-world environments with more heterogeneous characteristics. Additionally, safety data collected in trials may not be widely generalizable due to more comorbidity and polypharmacy in the real-world. Consequently, when merely relying on trial data, the impact of adherence, comorbidity and ADRs on the cost-effectiveness can be underestimated. To overcome these real-world data gaps, use of pragmatic trials and observational studies in addition to strictly controlled trial data is recommended. To catalyze implementation of these real-world issues, reporting checklists should be updated.
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Affiliation(s)
- Tanja Fens
- University of Groningen, Groningen Research Institute of Pharmacy, Groningen, The Netherlands.,Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Guiling Zhou
- Department of Clinical Pharmacy & Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Maarten J Postma
- University of Groningen, Groningen Research Institute of Pharmacy, Groningen, The Netherlands.,Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,University of Groningen, University Medical Center Groningen, Institute of Science in Healthy Aging & healthcaRE (SHARE), Groningen, The Netherlands.,Faculty of Economics & Business, Department of Economics, Econometrics & Finance, University of Groningen, Groningen, The Netherlands
| | - Eugène P van Puijenbroek
- University of Groningen, Groningen Research Institute of Pharmacy, Groningen, The Netherlands.,Netherlands Pharmacovigilance Centre Lareb, 's-Hertogenbosch, MH, The Netherlands.,Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Job F M van Boven
- Department of Clinical Pharmacy & Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,University of Groningen, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD (GRIAC), Groningen, The Netherlands.,Medication Adherence Expertise Center of the Northern Netherlands (MAECON), Groningen, The Netherlands
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Dummer J, Stokes T. Improving continuity of care of patients with respiratory disease at hospital discharge. Breathe (Sheff) 2020; 16:200161. [PMID: 33447276 PMCID: PMC7792832 DOI: 10.1183/20734735.0161-2020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 08/04/2020] [Indexed: 11/06/2022] Open
Abstract
Continuity of care refers to the delivery of coherent, logical and timely care to an individual. It is threatened during the transition of care at hospital discharge, which can contribute to worse patient outcomes. In a traditional acute care model, the roles of hospital and community healthcare providers do not overlap and this can be a barrier to continuity of care at hospital discharge. Furthermore, the transition from inpatient to outpatient care is associated with a transition from acute to chronic disease management and, in a busy hospital, attention to this can be crowded out by the pressures of providing acute care. This model is suboptimal for the large proportion of patients admitted to hospital with acute-on-chronic respiratory disease. In a chronic care model, the healthcare system is designed to give adequate priority to care of chronic disease. Integrated care for the patient with respiratory disease fits the chronic care model and responds to the fragmentation of care in a traditional acute care model: providers integrate their respiratory services to provide continuous, holistic care tailored to individuals. This promotes greater continuity of care for individuals, and can improve patient outcomes both at hospital discharge and more widely. EDUCATIONAL AIMS To understand the concept of continuity of care and its effect at the transition between inpatient and outpatient care.To understand the difference between the acute and chronic models of healthcare.To understand the effect of integration of care on continuity of care for patients with respiratory disease and their health outcomes.
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Affiliation(s)
- Jack Dummer
- Dept of Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Tim Stokes
- Dept of General Practice and Rural Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
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29
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Stellefson M, Wang MQ, Balanay JAG, Wu R. Health Risk Disparities among Employed Adults with COPD Living in Central Appalachian U.S. States. AMERICAN JOURNAL OF HEALTH EDUCATION 2020. [DOI: 10.1080/19325037.2020.1802373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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30
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Wang Y, Bahar MA, Jansen AME, Kocks JWH, Alffenaar JWC, Hak E, Wilffert B, Borgsteede SD. Improving antibacterial prescribing safety in the management of COPD exacerbations: systematic review of observational and clinical studies on potential drug interactions associated with frequently prescribed antibacterials among COPD patients. J Antimicrob Chemother 2020; 74:2848-2864. [PMID: 31127283 PMCID: PMC6814093 DOI: 10.1093/jac/dkz221] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 04/13/2019] [Accepted: 04/26/2019] [Indexed: 02/07/2023] Open
Abstract
Background Guidelines advise the use of antibacterials (ABs) in the management of COPD exacerbations. COPD patients often have multiple comorbidities, such as diabetes mellitus and cardiac diseases, leading to polypharmacy. Consequently, drug–drug interactions (DDIs) may frequently occur, and may cause serious adverse events and treatment failure. Objectives (i) To review DDIs related to frequently prescribed ABs among COPD patients from observational and clinical studies. (ii) To improve AB prescribing safety in clinical practice by structuring DDIs according to comorbidities of COPD. Methods We conducted a systematic review by searching PubMed and Embase up to 8 February 2018 for clinical trials, cohort and case–control studies reporting DDIs of ABs used for COPD. Study design, subjects, sample size, pharmacological mechanism of DDI and effect of interaction were extracted. We evaluated levels of DDIs and quality of evidence according to established criteria and structured the data by possible comorbidities. Results In all, 318 articles were eligible for review, describing a wide range of drugs used for comorbidities and their potential DDIs with ABs. DDIs between ABs and co-administered drugs could be subdivided into: (i) co-administered drugs altering the pharmacokinetics of ABs; and (ii) ABs interfering with the pharmacokinetics of co-administered drugs. The DDIs could lead to therapeutic failures or toxicities. Conclusions DDIs related to ABs with clinical significance may involve a wide range of indicated drugs to treat comorbidities in COPD. The evidence presented can support (computer-supported) decision-making by health practitioners when prescribing ABs during COPD exacerbations in the case of co-medication.
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Affiliation(s)
- Yuanyuan Wang
- Department of PharmacoTherapy, -Epidemiology & -Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Muh Akbar Bahar
- Department of PharmacoTherapy, -Epidemiology & -Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands.,Faculty of Pharmacy, Hasanuddin University, Makassar, Indonesia
| | - Anouk M E Jansen
- Department of PharmacoTherapy, -Epidemiology & -Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Janwillem W H Kocks
- Department of General Practice and Elderly Care Medicine, Groningen Research Institute for Asthma and COPD, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Jan-Willem C Alffenaar
- Department of Clinical Pharmacy & Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Faculty of Medicine and Health, School of Pharmacy and Westmead Hospital, University of Sydney, Sydney, Australia
| | - Eelko Hak
- Department of PharmacoTherapy, -Epidemiology & -Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Bob Wilffert
- Department of PharmacoTherapy, -Epidemiology & -Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands.,Department of Clinical Pharmacy & Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Sander D Borgsteede
- Department of Clinical Decision Support, Health Base Foundation, Houten, The Netherlands.,Department of Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, The Netherlands
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31
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Irritable bowel syndrome increases the risk of chronic obstructive pulmonary disease: A retrospective cohort study. Sci Rep 2020; 10:10008. [PMID: 32561774 PMCID: PMC7305148 DOI: 10.1038/s41598-020-66707-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Accepted: 05/19/2020] [Indexed: 12/16/2022] Open
Abstract
Both inflammation and infection are associated with the development of irritable bowel syndrome (IBS) and chronic obstructive pulmonary disease (COPD). The purpose of this study is to further elucidate the association between IBS and COPD through a retrospective cohort study. We enrolled IBS patients diagnosed between 2000 and 2011 with follow-up for at least one year. The non-IBS patients as comparison group were selected with 1:3 matching by propensity score. Statistical analysis was utilized to assess the differences in characteristic distribution, and to compare the cumulative incidence of COPD between the IBS and non-IBS cohorts. We selected 14,021 IBS patients and 42,068 non-IBS patients for comparison. The IBS patients exhibited a significant risk to develop COPD compared with non-IBS patients. Additionally, the cumulative incidence rate of COPD in the IBS cohort increased significantly during the follow-up period of more than ten years, compared to the non-IBS cohort, based on the Kaplan-Meier analysis. The risk of COPD was also significantly decreased in those patients with more than eighteen IBS-related clinical visits. This retrospective cohort study demonstrates the significantly increased risk of COPD in patients with IBS. Therefore, early inspection and prevention of COPD is essential for patients with IBS.
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Brown R, Nath S, Lora A, Samaha G, Elgamal Z, Kaiser R, Taggart C, Weldon S, Geraghty P. Cathepsin S: investigating an old player in lung disease pathogenesis, comorbidities, and potential therapeutics. Respir Res 2020; 21:111. [PMID: 32398133 PMCID: PMC7216426 DOI: 10.1186/s12931-020-01381-5] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 05/01/2020] [Indexed: 12/13/2022] Open
Abstract
Dysregulated expression and activity of cathepsin S (CTSS), a lysosomal protease and a member of the cysteine cathepsin protease family, is linked to the pathogenesis of multiple diseases, including a number of conditions affecting the lungs. Extracellular CTSS has potent elastase activity and by processing cytokines and host defense proteins, it also plays a role in the regulation of inflammation. CTSS has also been linked to G-coupled protein receptor activation and possesses an important intracellular role in major histocompatibility complex class II antigen presentation. Modulated CTSS activity is also associated with pulmonary disease comorbidities, such as cancer, cardiovascular disease, and diabetes. CTSS is expressed in a wide variety of immune cells and is biologically active at neutral pH. Herein, we review the significance of CTSS signaling in pulmonary diseases and associated comorbidities. We also discuss CTSS as a plausible therapeutic target and describe recent and current clinical trials examining CTSS inhibition as a means for treatment.
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Affiliation(s)
- Ryan Brown
- Airway Innate Immunity Research (AiiR) Group, Wellcome-Wolfson Institute for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Sridesh Nath
- Division of Pulmonary & Critical Care Medicine, Department of Medicine, State University of New York Downstate Medical Centre, Brooklyn, NY, USA
| | - Alnardo Lora
- Division of Pulmonary & Critical Care Medicine, Department of Medicine, State University of New York Downstate Medical Centre, Brooklyn, NY, USA
| | - Ghassan Samaha
- Division of Pulmonary & Critical Care Medicine, Department of Medicine, State University of New York Downstate Medical Centre, Brooklyn, NY, USA
| | - Ziyad Elgamal
- Division of Pulmonary & Critical Care Medicine, Department of Medicine, State University of New York Downstate Medical Centre, Brooklyn, NY, USA
| | - Ryan Kaiser
- Division of Pulmonary & Critical Care Medicine, Department of Medicine, State University of New York Downstate Medical Centre, Brooklyn, NY, USA
| | - Clifford Taggart
- Airway Innate Immunity Research (AiiR) Group, Wellcome-Wolfson Institute for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Sinéad Weldon
- Airway Innate Immunity Research (AiiR) Group, Wellcome-Wolfson Institute for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Patrick Geraghty
- Division of Pulmonary & Critical Care Medicine, Department of Medicine, State University of New York Downstate Medical Centre, Brooklyn, NY, USA.
- Department of Cell Biology, State University of New York Downstate Medical Centre, Brooklyn, NY, USA.
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33
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Ives SJ, Layec G, Hart CR, Trinity JD, Gifford JR, Garten RS, Witman MAH, Sorensen JR, Richardson RS. Passive leg movement in chronic obstructive pulmonary disease: evidence of locomotor muscle vascular dysfunction. J Appl Physiol (1985) 2020; 128:1402-1411. [PMID: 32324478 DOI: 10.1152/japplphysiol.00568.2019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD), characterized by pulmonary dysfunction, is now also recognized to be associated with free radical-mediated vascular dysfunction. However, as previous investigations have utilized the brachial artery flow-mediated dilation technique, whether such vascular dysfunction exists in the locomotor muscle of patients with COPD remains unclear. Therefore, in patients with COPD (n = 13, 66 ± 6 yr) and healthy age- and sex-matched control subjects (n = 12, 68 ± 6 yr), second-by-second measurements of leg blood flow (LBF) (ultrasound Doppler), mean arterial pressure (MAP) (Finapres), and leg vascular conductance (LVC) were recorded before and during both 2 min of continuous upright seated continuous-movement passive leg movement (PLM) and a single-movement PLM (sPLM). In response to PLM, both peak change in LBF (COPD 321 ± 54, Control 470 ± 55 ∆mL/min) and LVC (COPD 3.0 ± 0.5, Control 5.4 ± 0.5 ∆mL·min-1·mmHg-1) were significantly attenuated in patients with COPD compared with control subjects (P < 0.05). This attenuation in the patients with COPD was also evident in response to sPLM, with peak change in LBF tending to be lower (COPD 142 ± 26, Control 169 ± 14 ∆mL/min) and LVC being significantly lower (P < 0.05) in the patients than the control subjects (COPD 1.6 ± 0.4, Control 2.5 ± 0.3 ∆mL·min-1·mmHg-1). Therefore, utilizing both PLM and sPLM, this study provides evidence of locomotor muscle vascular dysfunction in patients with COPD, perhaps due to redox imbalance and reduced nitric oxide bioavailability, which is in agreement with an increased cardiovascular disease risk in this population. This locomotor muscle vascular dysfunction, in combination with the clearly dysfunctional lungs, may contribute to the exercise intolerance associated with COPD.NEW & NOTEWORTHY Utilizing both the single and continuous passive leg movement (PLM) models, which induce nitric oxide (NO)-dependent hyperemia, this study provides evidence of vascular dysfunction in the locomotor muscle of patients with chronic obstructive pulmonary disease (COPD), independent of central hemodynamics. This impaired hyperemia may be the result of an oxidant-mediated attenuation in NO bioavailability. In addition to clearly dysfunctional lungs, vascular dysfunction in locomotor muscle may contribute to the exercise intolerance associated with COPD and increased cardiovascular disease risk.
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Affiliation(s)
- Stephen J Ives
- Geriatric Research, Education, and Clinical Center, George E. Whalen Department of Veterans Affairs Medical Center, Salt Lake City, Utah.,Division of Geriatrics, Department of Internal Medicine, University of Utah, Salt Lake City, Utah.,Health and Human Physiological Sciences Department, Skidmore College, Saratoga Springs, New York
| | - Gwenael Layec
- Geriatric Research, Education, and Clinical Center, George E. Whalen Department of Veterans Affairs Medical Center, Salt Lake City, Utah.,Division of Geriatrics, Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Corey R Hart
- Geriatric Research, Education, and Clinical Center, George E. Whalen Department of Veterans Affairs Medical Center, Salt Lake City, Utah.,Division of Geriatrics, Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Joel D Trinity
- Geriatric Research, Education, and Clinical Center, George E. Whalen Department of Veterans Affairs Medical Center, Salt Lake City, Utah.,Division of Geriatrics, Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Jayson R Gifford
- Geriatric Research, Education, and Clinical Center, George E. Whalen Department of Veterans Affairs Medical Center, Salt Lake City, Utah.,Division of Geriatrics, Department of Internal Medicine, University of Utah, Salt Lake City, Utah.,Department of Exercise Sciences, Brigham Young University, Provo, Utah
| | - Ryan S Garten
- Geriatric Research, Education, and Clinical Center, George E. Whalen Department of Veterans Affairs Medical Center, Salt Lake City, Utah.,Division of Geriatrics, Department of Internal Medicine, University of Utah, Salt Lake City, Utah.,Department of Kinesiology and Health Sciences, Virginia Commonwealth University, Richmond, Virginia
| | - Melissa A H Witman
- Geriatric Research, Education, and Clinical Center, George E. Whalen Department of Veterans Affairs Medical Center, Salt Lake City, Utah.,Division of Geriatrics, Department of Internal Medicine, University of Utah, Salt Lake City, Utah.,Department of Kinesiology and Applied Physiology, University of Delaware, Wilmington, Delaware
| | - Jacob R Sorensen
- Department of Exercise Sciences, Brigham Young University, Provo, Utah
| | - Russell S Richardson
- Geriatric Research, Education, and Clinical Center, George E. Whalen Department of Veterans Affairs Medical Center, Salt Lake City, Utah.,Division of Geriatrics, Department of Internal Medicine, University of Utah, Salt Lake City, Utah.,Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, Utah
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Dummer J, Tumilty E, Hannah D, McAuley K, Baxter J, Doolan-Noble F, Donlevy S, Stokes T. Health Care Utilisation and Health Needs of People with Severe COPD in the Southern Region of New Zealand: A Retrospective Case Note Review. COPD 2020; 17:136-142. [PMID: 32037897 DOI: 10.1080/15412555.2020.1724275] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
We examined health care utilisation and needs of people with severe COPD in the low-population-density setting of the Southern Region of New Zealand (NZ). We undertook a retrospective case note review of patients with COPD coded as having an emergency department attendance and/or admission with at least one acute exacerbation during 2015 to hospitals in the Southern Region of NZ. Data were collected and analysed from 340 case notes pertaining to: demographics, hospital admissions, outpatient contacts, pulmonary rehabilitation, advance care planning and comorbidities. Geometric mean (95%CI) length of stay for hospital admissions in urban and rural hospitals was 3.0 (2.7-3.4) and 4.0 (2.9-5.4) days respectively. More patients were from areas of higher deprivation but median hospital length of stay for patients from the least deprived areas was 2.0 days longer than others (p = 0.04). There was a median of 4 (range 0-16) comorbidities and 10 medications (range 0-25) per person. Of 169 cases where data was available, 26 (15%) were offered, 17 (10%) declined, and 5 (3%) completed, pulmonary rehabilitation at or in the year prior to the index admission. Patients were less likely to be offered pulmonary rehabilitation if they lived >20km away from the hospital where it took place (odds ratio of 0.12 for those living further away [95%CI 0.02-0.93, p = 0.04]). There were deficits in care: provision and uptake of non-pharmacological interventions was suboptimal and unevenly distributed across the region. Further research is needed to develop and evaluate strategies for delivering non-pharmacological interventions in this setting.
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Affiliation(s)
- Jack Dummer
- Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.,Southern District Health Board, Respiratory Services, Dunedin Hospital, Dunedin, New Zealand
| | - Emma Tumilty
- Department of General Practice and Rural Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Debbie Hannah
- Southern District Health Board, Respiratory Services, Dunedin Hospital, Dunedin, New Zealand
| | - Kathryn McAuley
- Department of General Practice and Rural Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Jo Baxter
- Kōhatu Centre for Hauora Māori, Division of Health Sciences, University of Otago, Dunedin, New Zealand
| | - Fiona Doolan-Noble
- Department of General Practice and Rural Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Simon Donlevy
- Southern District Health Board, Respiratory Services, Dunedin Hospital, Dunedin, New Zealand
| | - Tim Stokes
- Department of General Practice and Rural Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
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35
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Khalil MM, Salem HM, Abdil-Hamid HEM, Zakaria MY. Correlation between ventricular function as assessed by echocardiography and six-minute walk test as a surrogate of functional capacity in patients with chronic obstructive pulmonary disease. THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2019. [DOI: 10.4103/ejb.ejb_48_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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36
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Linalyl acetate prevents three related factors of vascular damage in COPD-like and hypertensive rats. Life Sci 2019; 232:116608. [DOI: 10.1016/j.lfs.2019.116608] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 06/25/2019] [Accepted: 06/26/2019] [Indexed: 12/20/2022]
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37
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Sirois C, Ouali A, Simard M. Polypharmacy among Older Individuals with COPD: Trends between 2000 and 2015 in Quebec, Canada. COPD 2019; 16:234-239. [PMID: 31401851 DOI: 10.1080/15412555.2019.1646716] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The treatment of chronic obstructive pulmonary disease (COPD) and concomitant diseases requires several medications. Yet there is little data on how the pharmacological burden progressed over time among older individuals with COPD. We aimed to: 1) describe the proportion of older adults with COPD in Quebec, Canada, that were exposed to polypharmacy (≥10, ≥15 or ≥20 medications/year) between 2000 and 2015; 2) calculate the proportion of individuals receiving specific prescriptions for COPD during this period. We conducted a population-based cohort study with the Quebec Integrated Chronic Disease Surveillance System. Individuals aged ≥66 years with COPD and covered by the universal public drug plan were included. We calculated the total number of drugs used at least once by each individual during each of the studied years, and used age-standardized proportions to compare proportions of users between the years. The average number of drugs used increased from 12.0 in 2000 to 14.8 in 2015. The proportion of individuals exposed to polypharmacy increased (≥10 drugs: 62.0% to 74.6%;≥15 drugs: 31.2% to 45.4%; ≥20 drugs: 12.3% to 22.4%). The proportion of individuals receiving long-acting bronchodilators increased from 18.7% in 2000 to 69.6% in 2015. The use of short-acting bronchodilators decreased from 81.5% to 67.9%, and that of inhaled corticosteroids from 60.6% to 26.0%. The proportion of users of methylxanthines decreased from 15.0% to 1.9%. Older individuals with COPD are increasingly exposed to polypharmacy. Identifying which polypharmacy is beneficial is a priority.
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Affiliation(s)
- Caroline Sirois
- Faculty of Medicine, Université Laval , Québec , Canada.,Institut national de santé publique du Québec , Québec , Canada.,Centre d'excellence sur le vieillissement de Québec , Québec , Canada
| | - Amina Ouali
- Faculty of Medicine, Université Laval , Québec , Canada
| | - Marc Simard
- Institut national de santé publique du Québec , Québec , Canada
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38
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Morales DR, Slattery J, Pacurariu A, Pinheiro L, McGettigan P, Kurz X. Relative and Absolute Risk of Tendon Rupture with Fluoroquinolone and Concomitant Fluoroquinolone/Corticosteroid Therapy: Population-Based Nested Case-Control Study. Clin Drug Investig 2019; 39:205-213. [PMID: 30465300 PMCID: PMC6394638 DOI: 10.1007/s40261-018-0729-y] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND OBJECTIVE Tendon rupture can result from fluoroquinolone exposure. The objective of this study was to quantify relative and absolute risk and determine how risk is affected by timing of exposure. METHODS The UK Health Improvement Network primary care database was used to perform a nested case-control study measuring the association between fluoroquinolone exposure and tendon rupture. Adults with tendon rupture were matched on age, sex, general practice and calendar time to four controls selected from a cohort prescribed systemic fluoroquinolone or co-amoxiclav antibiotics. The relative and absolute risk of tendon rupture with fluoroquinolone exposure was calculated. RESULTS Current fluoroquinolone exposure was associated with an increased risk of any tendon rupture (adjusted incidence rate ratio [aIRR] 1.61, 95% CI 1.25-2.09) and Achilles tendon rupture (aIRR 3.14, 95% CI 2.11-4.65) that persisted for 60 days. Risk increased with cumulative exposure and was greatest when co-prescribed with oral corticosteroids (aIRR 19.36, 95% CI 7.78-48.19 for Achilles tendon rupture). The adjusted rate difference (aRD) with fluoroquinolone exposure was 2.9 and 2.1 per 10,000 patients for any and Achilles tendon rupture, respectively, and was greatest in people aged ≥ 60 years prescribed concomitant oral corticosteroid therapy (aDR 19.6 for any tendon and 6.6 Achilles tendon rupture per 10,000). No association was seen with co-amoxiclav or statin exposure, or with biceps or other tendon ruptures. CONCLUSIONS Risk of tendon rupture with fluoroquinolones depends on timing, cumulative dose and concomitant exposure to oral corticosteroids. Absolute risk significantly varied by age and concomitant corticosteroid exposure, affecting elderly patients the greatest.
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Affiliation(s)
- Daniel R Morales
- Division of Population Health and Genomics, School of Medicine, University of Dundee, Mackenzie Building, Kirsty Semple Way, Dundee, DD2 4BF, UK.
| | - Jim Slattery
- Pharmacovigilance and Epidemiology Department, European Medicines Agency, London, UK
| | - Alexandra Pacurariu
- Pharmacovigilance and Epidemiology Department, European Medicines Agency, London, UK
| | - Luis Pinheiro
- Pharmacovigilance and Epidemiology Department, European Medicines Agency, London, UK
| | - Patricia McGettigan
- Pharmacovigilance and Epidemiology Department, European Medicines Agency, London, UK
- William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Xavier Kurz
- Pharmacovigilance and Epidemiology Department, European Medicines Agency, London, UK
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39
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Li H, Lee DJ. Epidemiology and Immunopathogenesis of Psoriasis and Its Comorbidities. CURRENT DERMATOLOGY REPORTS 2018. [DOI: 10.1007/s13671-018-0243-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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40
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Depressive and anxiety disorders associated with chronic obstructive pulmonary disease. MIDDLE EAST CURRENT PSYCHIATRY 2018. [DOI: 10.1097/01.xme.0000544292.07930.70] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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41
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Braillard O, Slama-Chaudhry A, Joly C, Perone N, Beran D. The impact of chronic disease management on primary care doctors in Switzerland: a qualitative study. BMC FAMILY PRACTICE 2018; 19:159. [PMID: 30205832 PMCID: PMC6134721 DOI: 10.1186/s12875-018-0833-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 08/14/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND Patient-centeredness and therapeutic relationship are widely explored as a means to address the challenge of chronic disease and multi-morbidity management, however research focusing on the perspective of doctors is still rare. In this study, we aimed to explore the impact of the patient's chronic disease(s) on their healthcare provider. METHODS A qualitative approach was taken using semi-structured interviews with general practitioners working in outpatient clinics either in individual practices or in a hospital setting in Geneva, Switzerland. Codes were developed through an iterative process and using grounded theory an inductive coding scheme was performed to identify the key themes. Throughout the analysis process the research team reviewed the analysis and refined the coding scheme. RESULTS Twenty interviews, 10 in each practice type, allowed for saturation to be reached. The following themes relevant to the impact of managing chronic diseases emerge around the issue of feeling powerless as a doctor; facing the patient's socio-economic context; guidelines versus the reality of the patient; time; and taking on the patient's burden. Primary care practitioners face an emotional burden linked with their powerlessness and work conditions, but also with the empathetic bond with their patients and their circumstances. Doctors seem poorly prepared for this emotional strain. The health system is also not facilitating this with time constraints and guidelines unsuitable for the patient's reality. CONCLUSIONS Chronic disease and multi-morbidity management is a challenge for healthcare providers. This has its roots in patient characteristics, the overall health system and healthcare providers themselves. Structural changes need to be implemented at different levels: medical education; health systems; adapted guidelines; leading to an overall environment that favors the development of the therapeutic relationship.
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Affiliation(s)
- Olivia Braillard
- Department of Community Medicine, Primary and Emergency Care, Geneva University Hospitals, 1205, Geneva, Switzerland.
| | - Anbreen Slama-Chaudhry
- Department of Community Medicine, Primary and Emergency Care, Geneva University Hospitals, 1205, Geneva, Switzerland
| | - Catherine Joly
- Department of Community Medicine, Primary and Emergency Care, Geneva University Hospitals, 1205, Geneva, Switzerland
| | - Nicolas Perone
- Department of Community Health and Care, Geneva University Hospitals, 1205, Geneva, Switzerland
| | - David Beran
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals and University of Geneva, 1205, Geneva, Switzerland
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42
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Malpass A, Feder G, Dodd JW. Understanding changes in dyspnoea perception in obstructive lung disease after mindfulness training. BMJ Open Respir Res 2018; 5:e000309. [PMID: 29955365 PMCID: PMC6018883 DOI: 10.1136/bmjresp-2018-000309] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Indexed: 12/03/2022] Open
Abstract
Introduction Dyspnoea has been defined as a ‘subjective experience of breathing discomfort that consists of qualitatively distinct sensations that vary in intensity’. However, the majority of available dyspnoea measures treat it as a single entity and rely on quantitative methodology. We propose that qualitative research can enhance our understanding of dyspnoea, in particular, how perception varies so much among patients with similar disease states. In this paper, we focus on how a specific type of inner attention—mindfulness—may alter perceptions of dyspnoea. The aim is to characterise mindfulness attention, which impacts on perceptions of dyspnoea and relate these to the multidimensional model of dyspnoea. We explore how an individual can change their perception and therefore relationship to similar disease states. Method 22 patients with asthma or chronic obstructive pulmonary disease were recruited from primary and secondary care to an 8-week course in mindfulness-based cognitive therapy (MBCT). 12 patients took part in an in-depth qualitative interview 2 months after completing the MBCT course. Data were recorded, transcribed and then analysed using a framework approach, drawing on components of the multidimensional model of dyspnoea (multidimensional dyspnoea profile, MDP). Results We found that MBCT training involves developing three types of mindful attention (broad attention, informative attention and re-directive attention), which impact on perceptions of the sensory dimension of dyspnoea. MBCT appears to target affective and sensory perceptions articulated in the MDP model. Conclusion More research is needed into how mindfulness-based interventions may mediate the relationship between affective experience and the sensory perception of dyspnoea symptoms.
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Affiliation(s)
- Alice Malpass
- Centre for Academic Primary Care (CAPC), Bristol Medical School, University of Bristol, Bristol, UK
| | - Gene Feder
- Centre for Academic Primary Care (CAPC), Bristol Medical School, University of Bristol, Bristol, UK
| | - James W Dodd
- Academic Respiratory Unit, University of Bristol, Southmead Hospital, Bristol, UK.,Academic Respiratory Medicine, University of Bristol, Bristol, UK
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