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Fernández Villar A, Golpe Gómez R, González Montaos A, Fernández García S, Pazos Area L, Priegue Carrera A, Ruano Raviña A, Represas Represas C. The impact of the SARS-CoV-2 pandemic on the demographic, clinical and social profiles of patients admitted to the Pneumology Department for a COPD exacerbation. PLoS One 2023; 18:e0290156. [PMID: 37708160 PMCID: PMC10501653 DOI: 10.1371/journal.pone.0290156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 08/02/2023] [Indexed: 09/16/2023] Open
Abstract
INTRODUCTION Although a reduction in admissions for pathologies other than SARS-CoV-2 has been reported during the pandemic, there are hardly any specific studies in relation to COPD. The objective of this study was to analyse differences in the profile of those admitted for AEPOC and their prognosis during this period. METHODS Prospective study (SocioEPOC validation cohort) conducted in two hospitals. Demographic, clinical and social characteristics were compared among patients admitted for an AECOPD before and after the declaration of the COVID-19 healthcare emergency. Mortality and the need for hospital care in the following 3 months were analysed. RESULTS 340 patients (76.6% male, 72 years, FEV1 43.5%) were included, 174 in the post-pandemic phase. During pandemic, especially before population-level vaccination, admissions for AECOPD were in patients with more severe disease and with a higher level of eosinophils. No differences were found in social profile, except they had more informal caregivers. The mortality rate at 90 days was the same (9%), although those admitted during the pandemic came for more hospital visits in the following 3 months (53.8% vs. 42%; p = 0.003), with the pandemic phase being an independent predictor of this possibility (OR = 1.6.; 95% IC = 1.1-2.6). CONCLUSIONS In the first few months of the pandemic, the clinical profile of patients hospitalised for an AECOPD differed from that both prior to this period and during the latter months of the pandemic, with minimal changes at the social level. Although the mortality rate were similar, unscheduled hospital visits increased during the COVID-19 pandemic.
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Affiliation(s)
- Alberto Fernández Villar
- Pulmonology Department, Álvaro Cunqueiro University Hospital, Vigo, Spain
- Institute of Health Research Galicia Sur (IISGS), Neumo I + i. Research Group, Pontevedra, Spain
| | | | - Almudena González Montaos
- Pulmonology Department, Álvaro Cunqueiro University Hospital, Vigo, Spain
- Institute of Health Research Galicia Sur (IISGS), Neumo I + i. Research Group, Pontevedra, Spain
| | - Sara Fernández García
- Institute of Health Research Galicia Sur (IISGS), Neumo I + i. Research Group, Pontevedra, Spain
| | - Luis Pazos Area
- Pulmonology Department, Álvaro Cunqueiro University Hospital, Vigo, Spain
- Institute of Health Research Galicia Sur (IISGS), Neumo I + i. Research Group, Pontevedra, Spain
| | - Ana Priegue Carrera
- Institute of Health Research Galicia Sur (IISGS), Neumo I + i. Research Group, Pontevedra, Spain
| | - Alberto Ruano Raviña
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública—CIBERESP), Barcelona, Spain
| | - Cristina Represas Represas
- Pulmonology Department, Álvaro Cunqueiro University Hospital, Vigo, Spain
- Institute of Health Research Galicia Sur (IISGS), Neumo I + i. Research Group, Pontevedra, Spain
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Fernández-García A, Pérez-Ríos M, Fernández-Villar A, Candal-Pedreira C, Naveira-Barbeito G, Santiago-Pérez MI, Rey-Brandariz J, Represas-Represas C, Malvar-Pintos A, Ruano-Ravina A. Hospitalizations due to and with chronic obstructive pulmonary disease in Galicia: 20 years of evolution. Rev Clin Esp 2022; 222:569-577. [PMID: 35882597 DOI: 10.1016/j.rceng.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 05/26/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE This work aims to analyze the evolution of COPD-related hospitalizations in Galicia from 1996 to 2018 both as main cause of admission (DUE TO COPD) or when coded in any diagnostic order (WITH COPD), assessing the influence of age, sex, seasonality, and other main causes of the hospitalization. METHODS An analysis was conducted of administrative healthcare database (CMBD) data on index COPD-related hospitalizations in Galicia from 1996 to 2018. Crude, specific, and standardized rates were calculated for the entire sample and according to age and sex groups. RESULTS In the period from 1996 to 2018, there were 310,883 index admissions WITH COPD in Galicia, of which 29.6% were DUE TO COPD. Both WITH COPD and DUE TO COPD admission rates increased, mainly in men. There was a clear seasonality that was especially relevant in the DUE TO COPD group. The mean male-to-female ratio was approximately 4:1 in both groups, although it was lower in the extreme age groups, with no change over time. The mean age at admission increased three years in men during this period; there were no changes among women. The main causes of admission in those not hospitalized DUE TO COPD were heart failure and pneumonia. CONCLUSION The combined evaluation of records of hospital admissions WITH COPD and DUE TO COPD offers additional information for a better understanding of the trends of this disease and allows for establishing hypotheses that explain the results described, providing information for better healthcare planning.
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Affiliation(s)
- A Fernández-García
- Área de Medicina Preventiva y Salud Pública, Universidad de Santiago de Compostela, Santiago de Compostela, La Coruña, Spain; Hospital POVISA, Vigo, Pontevedra, Spain
| | - M Pérez-Ríos
- Área de Medicina Preventiva y Salud Pública, Universidad de Santiago de Compostela, Santiago de Compostela, La Coruña, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Spain; Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Santiago de Compostela, La Coruña, Spain.
| | - A Fernández-Villar
- Servicio de Neumología, Hospital Universitario Álvaro Cunqueiro, Vigo, Pontevedra, Spain; Grupo NeumoVigo I+i, Instituto de Investigación Sanitaria Galicia Sur (IISGS), Servicio de Neumología, Hospital Álvaro Cunqueiro, Vigo, Pontevedra, Spain
| | - C Candal-Pedreira
- Área de Medicina Preventiva y Salud Pública, Universidad de Santiago de Compostela, Santiago de Compostela, La Coruña, Spain
| | - G Naveira-Barbeito
- Servicio de Epidemiología, Dirección General de Salud Pública, Xunta de Galicia, Santiago de Compostela, La Coruña, Spain
| | - M I Santiago-Pérez
- Área de Medicina Preventiva y Salud Pública, Universidad de Santiago de Compostela, Santiago de Compostela, La Coruña, Spain; Servicio de Epidemiología, Dirección General de Salud Pública, Xunta de Galicia, Santiago de Compostela, La Coruña, Spain
| | - J Rey-Brandariz
- Área de Medicina Preventiva y Salud Pública, Universidad de Santiago de Compostela, Santiago de Compostela, La Coruña, Spain
| | - C Represas-Represas
- Servicio de Neumología, Hospital Universitario Álvaro Cunqueiro, Vigo, Pontevedra, Spain; Grupo NeumoVigo I+i, Instituto de Investigación Sanitaria Galicia Sur (IISGS), Servicio de Neumología, Hospital Álvaro Cunqueiro, Vigo, Pontevedra, Spain
| | - A Malvar-Pintos
- Servicio de Epidemiología, Dirección General de Salud Pública, Xunta de Galicia, Santiago de Compostela, La Coruña, Spain
| | - A Ruano-Ravina
- Área de Medicina Preventiva y Salud Pública, Universidad de Santiago de Compostela, Santiago de Compostela, La Coruña, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Spain; Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Santiago de Compostela, La Coruña, Spain
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Fernández-García A, Pérez-Ríos M, Fernández-Villar A, Candal-Pedreira C, Naveira-Barbeito G, Santiago-Pérez M, Rey-Brandariz J, Represas-Represas C, Malvar-Pintos A, Ruano-Ravina A. Hospitalizaciones por y con enfermedad pulmonar obstructiva crónica en Galicia: 20 años de evolución. Rev Clin Esp 2022. [DOI: 10.1016/j.rce.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Abstract
There are many differences between men and women in risk factor vulnerability and impact, symptom development, presentation, clinical manifestations, and outcomes of chronic obstructive pulmonary disease (COPD). These differences have been inadequately explored, which is of particular concern in view of the delay in diagnosis and treatment that occurs for both men and women, and the need to use all therapies in a targeted and tailored way for best clinical gain and least harm. Women are generally underrepresented in randomized trials, as are non-tobacco-related phenotypes of COPD. We must garner the information available to better describe optimal treatment approaches.
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Affiliation(s)
- Christine Jenkins
- Respiratory Group, The George Institute for Global Health, Sydney, Level 5, 1 King Street, Newtown, New South Wales 2042 Australia; UNSW Medicine and Health, UNSW Sydney, NSW, Australia; Concord Clinical School, University of Sydney, NSW, Australia.
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Buttery SC, Zysman M, Vikjord SAA, Hopkinson NS, Jenkins C, Vanfleteren LEGW. Contemporary perspectives in COPD: Patient burden, the role of gender and trajectories of multimorbidity. Respirology 2021; 26:419-441. [PMID: 33751727 DOI: 10.1111/resp.14032] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 02/21/2021] [Indexed: 12/13/2022]
Abstract
An individual's experience of COPD is determined by many factors in addition to the pathological features of chronic bronchitis and emphysema and the symptoms that derive directly from them. Multimorbidity is the norm rather than the exception, so most people with COPD are living with a range of other medical problems which can decrease overall quality of life. COPD is caused by the inhalation of noxious particles or gases, in particular tobacco smoke, but also by early life disadvantage impairing lung development and by occupations where inhaled exposures are common (e.g. industrial, farming and cleaning work). Wealthy people are therefore relatively protected from developing COPD and people who do develop the condition may have reduced resources to cope. COPD is also no longer a condition that predominantly affects men. The prevalence of COPD among women has equalled that of men since 2008 in many high-income countries, due to increased exposure to tobacco, and in low-income countries due to biomass fuels. COPD is one of the leading causes of death in women in the USA, and death rates attributed to COPD in women in some countries are predicted to overtake those of men in the next decade. Many factors contribute to this phenomenon, but in addition to socioeconomic and occupational factors, there is increasing evidence of a higher susceptibility of females to smoking and pollutants. Quality of life is also more significantly impaired in women. Although most medications (bronchodilators and inhaled corticosteroids) used to treat COPD demonstrate similar trends for exacerbation prevention and lung function improvement in men and women, this is an understudied area and clinical trials frequently have a preponderance of males. A better understanding of gender-based predictors of efficacy of all therapeutic interventions is crucial for comprehensive patient care. There is an urgent need to recognize the increasing burden of COPD in women and to facilitate global improvements in disease prevention and management in this specific population. Many individuals with COPD follow a trajectory of both lung function decline and also multimorbidity. Unfavourable lung function trajectories throughout life have implications for later development of other chronic diseases. An enhanced understanding of the temporal associations underlying the development of coexisting diseases is a crucial first step in unravelling potential common disease pathways. Lessons can be learned from exploring disease trajectories of other NCD as well as multimorbidity development. Further research will be essential to explain how early life risk factors commonly influence trajectories of COPD and other diseases, how different diseases develop in relation to each other in a temporal way and how this ultimately leads to different multimorbidity patterns in COPD. This review integrates new knowledge and ideas pertaining to three broad themes (i) the overall burden of disease in COPD, (ii) an unappreciated high burden in women and (iii) the contrast of COPD trajectories and different multimorbidity patterns with trajectories of other NCD. The underlying pathology of COPD is largely irreversible, but many factors noted in the review are potentially amenable to intervention. Health and social care systems need to ensure that effective treatment is accessible to all people with the condition. Preventive strategies and treatments that alter the course of disease are crucial, particularly for patients with COPD as one of many problems.
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Affiliation(s)
- Sara C Buttery
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Maéva Zysman
- Centre de Recherche cardio-thoracique de Bordeaux, Univ-Bordeaux, Pessac, France.,Service des Maladies Respiratoires, CHU Bordeaux, Pessac, France
| | - Sigrid A A Vikjord
- Department of Medicine and Rehabilitation, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway.,HUNT Research Centre, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Levanger, Norway
| | | | - Christine Jenkins
- Respiratory Group, The George Institute for Global Health, Sydney, NSW, Australia
| | - Lowie E G W Vanfleteren
- COPD Center, Department of Respiratory Medicine and Allergology, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Akbarshahi H, Ahmadi Z, Currow DC, Sandberg J, Vandersman Z, Shanon-Honson A, Ekström M. No gender-related bias in COPD diagnosis and treatment in Sweden: a randomised, controlled, case-based trial. ERJ Open Res 2020; 6:00342-2020. [PMID: 33263044 PMCID: PMC7682677 DOI: 10.1183/23120541.00342-2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 08/18/2020] [Indexed: 12/02/2022] Open
Abstract
Introduction COPD is a major cause of morbidity and mortality. The prevalence, morbidity and mortality of COPD among females have increased. Previous studies indicate a possible gender bias in the diagnosis and management of COPD. The present study aims to determine if there is gender bias in the management of COPD in Sweden. Methods This was a double-blind, randomised (1:1), controlled, parallel-group, web-based trial using the hypothetical case scenario of a former smoker (40 pack-years and quit smoking 3 years ago) who was male or female. The participants were blind to the randomisation and the purpose of the trial. The case progressively revealed more information with associated questions on how the physician would manage the patient. Study participants chose from a list of tests and treatments at each step of the case scenario. Results In total, 134 physicians were randomised to a male (n=62) or a female (n=72) case. There was no difference in initial diagnosis (61 (98%) male cases and 70 (97%) female cases diagnosed with COPD) and planned diagnostic procedures between the male and female cases. Spirometry was chosen by all the physicians as one of the requested diagnostic tests. The management of the hypothetical COPD case did not differ by sex of the responding physician. Conclusion In Sweden, diagnosis and management of a hypothetical patient with COPD did not differ by the gender of the patient or physician. No gender-related bias in COPD managementhttps://bit.ly/3gTsWoG
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Affiliation(s)
- Hamid Akbarshahi
- Dept of Clinical Sciences, Division of Respiratory Medicine and Allergology, Lund University, Lund, Sweden
| | - Zainab Ahmadi
- Dept of Clinical Sciences, Division of Respiratory Medicine and Allergology, Lund University, Lund, Sweden
| | - David C Currow
- IMPACCT, Faculty of Health, University of Technology Sydney, Ultimo, Australia
| | - Jacob Sandberg
- Dept of Clinical Sciences, Division of Respiratory Medicine and Allergology, Lund University, Lund, Sweden
| | - Zac Vandersman
- IMPACCT, Faculty of Health, University of Technology Sydney, Ultimo, Australia
| | - Aaron Shanon-Honson
- IMPACCT, Faculty of Health, University of Technology Sydney, Ultimo, Australia
| | - Magnus Ekström
- Dept of Clinical Sciences, Division of Respiratory Medicine and Allergology, Lund University, Lund, Sweden.,IMPACCT, Faculty of Health, University of Technology Sydney, Ultimo, Australia
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