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Vaezi A, Mirsaeidi M. Proposing the potential of utilizing the CAT score for early detection of COPD in asymptomatic patients, shifting towards a patient-centered approach: A review. Medicine (Baltimore) 2024; 103:e37715. [PMID: 38608107 PMCID: PMC11018188 DOI: 10.1097/md.0000000000037715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 03/04/2024] [Indexed: 04/14/2024] Open
Abstract
Chronic obstructive pulmonary disease (COPD) constitutes a significant public health challenge, with delayed diagnosis and underdiagnosis being pervasive issues. The United States Preventive Service Task Force recommends restricting COPD screening to symptomatic smokers, a focus that has exhibited limitations, leading to delayed diagnoses, and imposing a substantial burden on patients, their families, and the healthcare system. This paper explores an alternative approach, highlighting the potential utility of the COPD assessment test (CAT) score as a prescreening tool. A CAT score of 10 or higher could serve as an appropriate threshold for further diagnostic procedures, given its robust correlation with pulmonary function test parameters and is valuable capacity to quantify patients' symptoms. The utilization of CAT as a prescreening tool in primary care signifies a transition towards a more patient-centered and comprehensive approach to COPD diagnosis and care.
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Affiliation(s)
- Atefeh Vaezi
- Division of Pulmonary, Critical Care, and Sleep Medicine, College of Medicine-Jacksonville, University of Florida, Jacksonville, FL
| | - Mehdi Mirsaeidi
- Division of Pulmonary, Critical Care, and Sleep Medicine, College of Medicine, University of Florida, Jacksonville, FL
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2
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Toychiev A, Gafner N, Belotserkovets V, Sekler D, Tashpulatova S, Osipova S. Impact of Ascaris lumbricoides infection on the development of chronic pulmonary aspergillosis in patients with COPD. Trop Doct 2024; 54:149-156. [PMID: 38291709 DOI: 10.1177/00494755241226488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
The aetiopathogenesis of chronic obstructive pulmonary disease (COPD) remains unclear. The aim of our study was to determine the possible influence of Ascaris lumbricoides on the development of chronic pulmonary aspergillosis (CPA) in patients with COPD. The prevalence of A. lumbricoides in patients with COPD with CPA (19.05%) was significantly higher than that in those without (9.20%) and controls (4.9%) (p < 0.05). Trends in levels of Interleukin-1β and of tumour necrosis factor α suggest ascariasis increases susceptibility to Aspergillus sp. in patients with COPD and can be considered an additional risk factor for CPA.
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Affiliation(s)
- Abdurakhim Toychiev
- Postdoctoral Researcher, Department of Immunology of Parasitic and Fungal Diseases, Republican Specialized Research and Practical Medical Center of Epidemiology, Microbiology, Infectious and Parasitic Diseases, Tashkent, Uzbekistan
| | - Natalya Gafner
- Pulmonologist, Department of Therapy, Republican Specialized Scientific and Practical Medical Center of Tuberculosis and Pulmonology, Tashkent, Uzbekistan
| | - Vera Belotserkovets
- Pulmonologist, Department of Therapy, Republican Specialized Scientific and Practical Medical Center of Tuberculosis and Pulmonology, Tashkent, Uzbekistan
| | - Dildora Sekler
- Senior Researcher, Department of Immunology of Parasitic and Fungal Diseases, Republican Specialized Research and Practical Medical Center of Epidemiology, Microbiology, Infectious and Parasitic Diseases, Tashkent, Uzbekistan
| | - Shakhnoza Tashpulatova
- Associate Professor, Department of Infectious and Child Infectious Diseases, Tashkent Medical Academy, Tashkent, Uzbekistan
| | - Svetlana Osipova
- Principal Investigator, Department of Immunology of Parasitic and Fungal Diseases, Republican Specialized Research and Practical Medical Center of Epidemiology, Microbiology, Infectious and Parasitic Diseases, Tashkent, Uzbekistan
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Taherkhani H, KavianFar A, Aminnezhad S, Lanjanian H, Ahmadi A, Azimzadeh S, Masoudi-Nejad A. Deciphering the impact of microbial interactions on COPD exacerbation: An in-depth analysis of the lung microbiome. Heliyon 2024; 10:e24775. [PMID: 38370212 PMCID: PMC10869780 DOI: 10.1016/j.heliyon.2024.e24775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 01/04/2024] [Accepted: 01/14/2024] [Indexed: 02/20/2024] Open
Abstract
In microbiome studies, the diversity and types of microbes have been extensively explored; however, the significance of microbial ecology is equally paramount. The comprehension of metabolic interactions among the wide array of microorganisms in the lung microbiota is indispensable for understanding chronic pulmonary disease and for the development of potent treatments. In this investigation, metabolic networks were simulated, and ecological theory was employed to assess the diagnosis of COPD, subsequently suggesting innovative treatment strategies for COPD exacerbation. Lung sputum 16S rRNA paired-end data from 112 COPD patients were utilized, and a supervised machine-learning algorithm was applied to identify taxa associated with sex and mortality. Subsequently, an OTU table with Greengenes 99 % dataset was generated. Finally, the interactions between bacterial species were analyzed using a simulated metabolic network. A total of 1781 OTUs and 1740 bacteria at the genus level were identified. We employed an additional dataset to validate our analyses. Notably, among the more abundant genera, Pseudomonas was detected in females, while Lactobacillus was detected in males. Additionally, a decrease in bacterial diversity was observed during COPD exacerbation, and mortality was associated with the high abundance of the Staphylococcus and Pseudomonas genera. Moreover, an increase in Proteobacteria abundance was observed during COPD exacerbations. In contrast, COPD patients exhibited decreased levels of Firmicutes and Bacteroidetes. Significant connections between microbial ecology and bacterial diversity in COPD patients were discovered, highlighting the critical role of microbial ecology in the understanding of COPD. Through the simulation of metabolic interactions among bacteria, the observed dysbiosis in COPD was elucidated. Furthermore, the prominence of anaerobic bacteria in COPD patients was revealed to be influenced by parasitic relationships. These findings have the potential to contribute to improved clinical management strategies for COPD patients.
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Affiliation(s)
- Hamidreza Taherkhani
- Laboratory of Systems Biology and Bioinformatics (LBB), Department of Bioinformatics, Kish International Campus, University of Tehran, Kish Island, Iran
| | - Azadeh KavianFar
- Laboratory of Systems Biology and Bioinformatics (LBB), Department of Bioinformatics, Kish International Campus, University of Tehran, Kish Island, Iran
| | - Sargol Aminnezhad
- Laboratory of Systems Biology and Bioinformatics (LBB), Institute of Biochemistry and Biophysics, University of Tehran, Tehran, Iran
| | - Hossein Lanjanian
- Cellular and Molecular Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Ahmadi
- Molecular Biology Research Center, Systems Biology and Poisonings Institute, Tehran, Iran
| | - Sadegh Azimzadeh
- Chemical Injuries Research Center, Systems Biology and Poisonings Institute, Tehran, Iran
| | - Ali Masoudi-Nejad
- Laboratory of Systems Biology and Bioinformatics (LBB), Department of Bioinformatics, Kish International Campus, University of Tehran, Kish Island, Iran
- Laboratory of Systems Biology and Bioinformatics (LBB), Institute of Biochemistry and Biophysics, University of Tehran, Tehran, Iran
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4
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Wen C, Yu Z, Wang J, Deng Q, Deng J, Sun Z, Ye Q, Ye Z, Qin K, Peng X. Inhalation of Citrus Reticulata essential oil alleviates airway inflammation and emphysema in COPD rats through regulation of macrophages. JOURNAL OF ETHNOPHARMACOLOGY 2024; 320:117407. [PMID: 37981111 DOI: 10.1016/j.jep.2023.117407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 11/01/2023] [Accepted: 11/07/2023] [Indexed: 11/21/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory respiratory disease. Citrus Reticulata peel, the dried ripe peel of Citrus Reticulata species, has been found to have anti-inflammatory and cough attenuation effects. However, the therapeutic effects and its precise underlying mechanisms of atomizing inhalation using Citrus Reticulata essential oil (CREO) have not yet been fully elucidated. AIM OF THE STUDY The aim of this study was to assess the therapeutic effects of Citrus Reticulata essential oil and its associated anti-inflammatory mechanisms in COPD rat model. METHODS A total of 80 SD rats were randomized into four groups: control group (Con), COPD model group (COPD), COPD + ipratropium bromide (IB), and COPD + citrus reticulata essential oil (CREO). To induce COPD in rats, cigarette smoke (CS) exposure was used, while CREO and IB groups were administered through atomizing inhalation. The clinical signs, pathological lesions of the lung, percentages of antigen-presenting lung macrophages (CD11b/c+/CD86+ cells) and CD8+ T cells, and the content and mRNA expression of cytokines of the lung were analyzed. RESULTS The findings revealed that atomizing inhalation of Citrus reticulata essential oil had therapeutic effects on COPD rats. The treatment resulted in improvement in the body weight and mental status of COPD rats, reduced pathological injury of the lung, and increased proportion of CD11b/c+/CD86+ cells in lung macrophages, while also decreasing the number of CD8+ T cells. In addition, the Citrus Reticulata essential oil reduced the contents of IL-18, IL-17A, IL-12p70, and GM-CSF, downregulated the relative mRNA expression of IFN-γ, IL-4, and MMP-12, and upregulated the mRNA expression of IL-10. CONCLUSIONS Citrus reticulata essential oil can alleviate histological injury of the lung and regulate macrophages and CD8+ T cells in COPD rats. The study suggests that citrus reticulata essential oil could be a potential therapeutic agent for COPD.
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Affiliation(s)
- Changlin Wen
- Sichuan Industrial Institute of Antibiotics, School of Pharmacy, Chengdu University, No. 2025, Chengluo Avenue, Chengdu, 610106, China
| | - Zhengqiang Yu
- Department of Technology, Sichuan Youngster Technology Co., Ltd, No. 733, Furong Avenue, Wenjiang District, Chengdu, 611130, China
| | - Juan Wang
- College of Culture and Education, Tianfu College of Swufe, Mianyang, 621000, China
| | - Qing Deng
- Department of Technology, Sichuan Youngster Technology Co., Ltd, No. 733, Furong Avenue, Wenjiang District, Chengdu, 611130, China
| | - Jiajia Deng
- Department of Technology, Sichuan Youngster Technology Co., Ltd, No. 733, Furong Avenue, Wenjiang District, Chengdu, 611130, China
| | - Zhenhua Sun
- Department of Technology, Sichuan Youngster Technology Co., Ltd, No. 733, Furong Avenue, Wenjiang District, Chengdu, 611130, China
| | - Qiaobo Ye
- School of Basic Medicine Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu, 611137, China.
| | - Zhen Ye
- School of Basic Medicine Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu, 611137, China
| | - Kaihua Qin
- School of Basic Medicine Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu, 611137, China
| | - Xi Peng
- Sichuan Industrial Institute of Antibiotics, School of Pharmacy, Chengdu University, No. 2025, Chengluo Avenue, Chengdu, 610106, China.
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Benmaamar S, Es-Sabbahi B, Taghyioullah Haiba M, Omari M, El Harch I, Youbi M, Belakhhel L, Abousselham L, Hachri H, El Menchawyi I, El Fakir S, Benjelloun MC, Tachfouti N. Economic burden of chronic obstructive pulmonary disease in Morocco: a cost of illness study. Monaldi Arch Chest Dis 2024. [PMID: 38226692 DOI: 10.4081/monaldi.2024.2745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 12/29/2023] [Indexed: 01/17/2024] Open
Abstract
Chronic obstructive pulmonary disease (COPD) carries an important economic burden worldwide. However, the cost of this disease in Morocco is not well explored. This study aimed to estimate the economic cost associated with COPD in Morocco and identify its determinants. A cost of illness, prevalence-based study using a bottom-up approach method, including COPD patients, was carried out in 2021-2022. The cost was estimated from a societal perspective, and the time horizon was 1 year. Data collection was performed using a questionnaire including socio-demographic, clinical data, and utilization of health care resources in 2019: hospitalization, medical tests, medications, and medical visits. Direct health cost (DHC) was estimated by multiplying the use of health services by the official prices (unit costs) published by the National Agency for Health Insurance. The indirect cost (IC) represented by labor productivity losses was calculated using the human capital method. Costs were compared according to different socio-demographic and clinical factors. We included 159 patients; 82.4% were men, 80.4% were current or former smokers, and 78.7% were categorized as "high-risk" groups (grades C-D). The DHC was estimated at $1816.6 per patient per year. Pharmaceutical and hospitalization costs represented the highest part of the total DHC (42.5% and 22.1%, respectively). The IC was estimated at $709.5±1081.3 per patient per year. DHC increased with increasing disease severity and with the number of severe exacerbations (p<0.001). Current and former smokers were more costly to the healthcare system than nonsmokers (p=0.029). IC also increased with the number of severe exacerbations (p=0.003). In this study, we showed that COPD in Morocco generates important costs for the health system, mainly related to smoking and the severity of the disease. It is therefore important to strengthen tobacco control measures in our country.
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Affiliation(s)
- Soumaya Benmaamar
- Department of Epidemiology, Clinical Research and Community Health, Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University, Fez.
| | | | | | - Mohamed Omari
- Department of Epidemiology, Clinical Research and Community Health, Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University, Fez.
| | - Ibtissam El Harch
- Department of Epidemiology, Clinical Research and Community Health, Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University, Fez.
| | - Mohammed Youbi
- Department of Epidemiology and Disease Control, Ministry of Health and Social Protection, Rabat.
| | - Latifa Belakhhel
- Department of Epidemiology and Disease Control, Ministry of Health and Social Protection, Rabat.
| | - Loubna Abousselham
- Department of Epidemiology and Disease Control, Ministry of Health and Social Protection, Rabat.
| | | | | | - Samira El Fakir
- Department of Epidemiology, Clinical Research and Community Health, Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University, Fez.
| | | | - Nabil Tachfouti
- Department of Epidemiology, Clinical Research and Community Health, Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University, Fez.
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Fernandes G, Williams S, Adab P, Gale N, de Jong C, de Sousa JC, Cheng KK, Chi C, Cooper BG, Dickens AP, Enocson A, Farley A, Jolly K, Jowett S, Maglakelidze M, Maghlakelidze T, Martins S, Sitch A, Stamenova A, Stavrikj K, Stelmach R, Turner A, Pan Z, Pang H, Zhang J, Jordan RE. Engaging stakeholders to level up COPD care in LMICs: lessons learned from the "Breathe Well" programme in Brazil, China, Georgia, and North Macedonia. BMC Health Serv Res 2024; 24:66. [PMID: 38216986 PMCID: PMC10790249 DOI: 10.1186/s12913-023-10525-4] [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: 05/31/2023] [Accepted: 12/24/2023] [Indexed: 01/14/2024] Open
Abstract
BACKGROUND Effective stakeholder engagement in health research is increasingly being recognised and promoted as an important pathway to closing the gap between knowledge production and its use in health systems. However, little is known about its process and impacts, particularly in low-and middle-income countries. This opinion piece draws on the stakeholder engagement experiences from a global health research programme on Chronic Obstructive Pulmonary Disease (COPD) led by clinician researchers in Brazil, China, Georgia and North Macedonia, and presents the process, outcomes and lessons learned. MAIN BODY Each country team was supported with an overarching engagement protocol and mentored to develop a tailored plan. Patient involvement in research was previously limited in all countries, requiring intensive efforts through personal communication, meetings, advisory groups and social media. Accredited training programmes were effective incentives for participation from healthcare providers; and aligning research findings with competing policy priorities enabled interest and dialogue with decision-makers. The COVID-19 pandemic severely limited possibilities for planned engagement, although remote methods were used where possible. Planned and persistent engagement contributed to shared knowledge and commitment to change, including raised patient and public awareness about COPD, improved skills and practice of healthcare providers, increased interest and support from clinical leaders, and dialogue for integrating COPD services into national policy and practice. CONCLUSION Stakeholder engagement enabled relevant local actors to produce and utilise knowledge for small wins such as improving day-to-day practice and for long-term goals of equitable access to COPD care. For it to be successful and sustained, stakeholder engagement needs to be valued and integrated throughout the research and knowledge generation process, complete with dedicated resources, contextualised and flexible planning, and commitment.
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Affiliation(s)
- Genevie Fernandes
- International Primary Care Respiratory Group, London, UK.
- Usher Institute, University of Edinburgh, Edinburgh, UK.
| | - Siân Williams
- International Primary Care Respiratory Group, London, UK
| | - Peymané Adab
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Nicola Gale
- Health Services Management Centre, School of Social Policy, College of Social Sciences, University of Birmingham, Birmingham, UK
| | - Corina de Jong
- International Primary Care Respiratory Group, London, UK
| | - Jaime Correia de Sousa
- International Primary Care Respiratory Group, London, UK
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- PT Government Associate Laboratory, ICVS/3B's, Braga/Guimarães, Portugal
| | - K K Cheng
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Chunhua Chi
- Department of General Practice, Peking University First Hospital, Beijing, China
| | | | - Andrew P Dickens
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Observational and Pragmatic Research Institute, Midview City, Singapore
| | - Alexandra Enocson
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Amanda Farley
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Kate Jolly
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Sue Jowett
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Maka Maglakelidze
- Georgian Respiratory Association, Tbilisi, Georgia
- Petre Shotadze Tbilisi Medical Academy, Tbilisi, Georgia
| | - Tamaz Maghlakelidze
- Georgian Respiratory Association, Tbilisi, Georgia
- Ivane Javakhishvili Tbilisi State University, Tbilisi, Georgia
| | - Sonia Martins
- Family Medicine, ABC Medical School, São Paolo, Brazil
| | - Alice Sitch
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
| | - Aleksandra Stamenova
- Faculty of Medicine, Institute of Social Medicine, Ss. Cyril and Methodius University in Skopje, Skopje, Republic of North Macedonia
| | - Katarina Stavrikj
- Center for Family Medicine, Faculty of Medicine, Ss.Cyril and Methodius University in Skopje, Skopje, Republic of North Macedonia
| | - Rafael Stelmach
- Pulmonary Division, Heart Institute (InCor), Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, São Paolo, Brazil
| | - Alice Turner
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Zihan Pan
- Department of General Practice, Peking University First Hospital, Beijing, China
| | - Hui Pang
- Department of Emergency, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Jianxin Zhang
- Department of General Practice, Peking University First Hospital, Beijing, China
| | - Rachel E Jordan
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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Boers E, Barrett M, Su JG, Benjafield AV, Sinha S, Kaye L, Zar HJ, Vuong V, Tellez D, Gondalia R, Rice MB, Nunez CM, Wedzicha JA, Malhotra A. Global Burden of Chronic Obstructive Pulmonary Disease Through 2050. JAMA Netw Open 2023; 6:e2346598. [PMID: 38060225 PMCID: PMC10704283 DOI: 10.1001/jamanetworkopen.2023.46598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 10/25/2023] [Indexed: 12/08/2023] Open
Abstract
Importance Chronic obstructive pulmonary disease (COPD) is a respiratory condition that is associated with significant health and economic burden worldwide. Previous studies assessed the global current-day prevalence of COPD, but to better facilitate resource planning and intervention development, long-term projections are needed. Objective To assess the global burden of COPD through 2050, considering COPD risk factors. Design, Setting, and Participants In this modeling study, historical data on COPD prevalence was extracted from a recent meta-analysis on 2019 global COPD prevalence, and 2010 to 2018 historical prevalence was estimated using random-effects meta-analytical models. COPD risk factor data were obtained from the Global Burden of Disease database. Main Outcomes and Measures To project global COPD prevalence to 2050, generalized additive models were developed, including smoking prevalence, indoor and outdoor air pollution, and development indices as predictors, and stratified by age, sex, and World Bank region. Results The models estimated that the number of COPD cases globally among those aged 25 years and older will increase by 23% from 2020 to 2050, approaching 600 million patients with COPD globally by 2050. Growth in the burden of COPD was projected to be the largest among women and in low- and middle-income regions. The number of female cases was projected to increase by 47.1% (vs a 9.4% increase for males), and the number of cases in low- and middle-income regions was expected to be more than double that of high-income regions by 2050. Conclusions and Relevance In this modeling study of future COPD burden, projections indicated that COPD would continue to affect hundreds of millions of people globally, with disproportionate growth among females and in low-middle income regions through 2050. Further research, prevention, and advocacy are needed to address these issues so that adequate preparation and resource allocation can take place.
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Affiliation(s)
- Elroy Boers
- ResMed Science Center, Halifax, Nova Scotia, Canada
| | | | | | | | - Sanjeev Sinha
- All India Institute of Medical Sciences, New Delhi, India
| | - Leanne Kaye
- ResMed Science Center, San Diego, California
| | - Heather J. Zar
- Department of Paediatrics and Child Health and SA-MRC Unit on Child & Adolescent Health, University of Cape Town, South Africa
| | - Vy Vuong
- ResMed Science Center, San Diego, California
| | | | | | - Mary B. Rice
- Division of Pulmonary, Sleep and Critical Care Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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8
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Ingenhoff R, Robertson N, Munana R, Bodnar BE, Weswa I, Sekitoleko I, Gaal J, Kirenga BJ, Kalyesubula R, Knauf F, Siddharthan T. Challenges to Implementation of Community Health Worker-Led Chronic Obstructive Pulmonary Disease (COPD) Screening and Referral in Rural Uganda: A Qualitative Study using the Implementation Outcomes Framework. Int J Chron Obstruct Pulmon Dis 2023; 18:2769-2783. [PMID: 38046984 PMCID: PMC10693197 DOI: 10.2147/copd.s420137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 10/30/2023] [Indexed: 12/05/2023] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) is the third leading cause of death globally. The burden of COPD is expected to increase in low- and middle-income countries (LMICs). COPD screening and diagnostics tools are often inaccessible in rural settings of LMICs. To contribute to the growing body of evidence on the effectiveness of Community Health Worker (CHW) interventions, this study aims to understand the facilitators and barriers of implementing a CHW-led COPD screening and referral program in rural Uganda. Methods This qualitative study was conducted from September to October 2022 to explore Community Members, CHWs, and Healthcare Providers (HCPs) perceptions on the challenges of CHW-delivered COPD programming in Nakaseke, rural Uganda. In total, we held eight individual in-depth interviews with CHWs, ten in-depth interviews with HCPs and six focus group discussions with 34 Community Members. Research assistants audio-recorded and transcribed interviews verbatim. The implementation outcomes framework guided the thematic analysis. Results Implementation acceptability was constrained by a lack of COPD awareness, a lack of perceived utility in COPD screening as well as stigma around the diagnostic process. Limited spirometry adoption was also attributed to Community Member accessibility and willingness to participate in the COPD diagnostic referral process. The high patient volume and the complex, time-consuming diagnostic and referral process hindered successful implementation. To enhance program sustainability, all participants suggested increasing CHW support, medication access, decentralizing COPD care and upscaling follow-up of Community Members by CHWs. Conclusion CHW-led interventions remain a potentially critical tool to alleviate barriers to treatment and self-management in settings where access to care is limited. While community-based interventions can create sustainable infrastructure to improve health outcomes, formative assessments of the potential barriers prior to intervention are required. Evidence-based, localized approaches and sustained funding are imperative to achieve this.
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Affiliation(s)
- Rebecca Ingenhoff
- Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Charité Center for Global Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | - Richard Munana
- School of Public Health, Makerere University College of Health Sciences, Makerere University, Kampala, Uganda
- African Community Center for Social Sustainability, Nakaseke, Uganda
| | - Benjamin E Bodnar
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ivan Weswa
- African Community Center for Social Sustainability, Nakaseke, Uganda
| | - Isaac Sekitoleko
- MRC/UVRI and LSHTM Uganda Research Unit, Kampala, Uganda
- London School of Hygiene and Tropical Medicine, London, UK
| | - Julia Gaal
- Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | - Robert Kalyesubula
- African Community Center for Social Sustainability, Nakaseke, Uganda
- Department of Physiology, Department of Internal Medicine, Makerere University College of Health Sciences, Kampala, Uganda
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Felix Knauf
- Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Trishul Siddharthan
- Department of Pulmonary, Critical Care and Sleep Medicine, University of Miami, Coral Gables, FL, USA
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9
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Salvi S, Ghorpade D. Role of Community Health Workers in Chronic Obstructive Pulmonary Disease Care in Low- and Middle-Income Countries. Am J Respir Crit Care Med 2023; 208:1012-1013. [PMID: 37787613 PMCID: PMC10867929 DOI: 10.1164/rccm.202309-1640ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 10/02/2023] [Indexed: 10/04/2023] Open
Affiliation(s)
- Sundeep Salvi
- Pulmocare Research and Education Foundation Pune, India
- School of Health Sciences Symbiosis International Deemed University Pune, India
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10
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Fiore M, Ricci M, Rosso A, Flacco ME, Manzoli L. Chronic Obstructive Pulmonary Disease Overdiagnosis and Overtreatment: A Meta-Analysis. J Clin Med 2023; 12:6978. [PMID: 38002593 PMCID: PMC10672453 DOI: 10.3390/jcm12226978] [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: 09/02/2023] [Revised: 10/31/2023] [Accepted: 11/06/2023] [Indexed: 11/26/2023] Open
Abstract
This meta-analysis of observational studies aimed at estimating the overall prevalence of overdiagnosis and overtreatment in subjects with a clinical diagnosis of Chronic Obstructive Pulmonary Disease (COPD). MedLine, Scopus, Embase and Cochrane databases were searched, and random-effect meta-analyses of proportions were stratified by spirometry criteria (Global Initiative for COPD (GOLD) or Lower Limit of Normal (LLN)), and setting (hospital or primary care). Forty-two studies were included. Combining the data from 39 datasets, including a total of 23,765 subjects, the pooled prevalence of COPD overdiagnosis, according to the GOLD definition, was 42.0% (95% Confidence Interval (CI): 37.3-46.8%). The pooled prevalence according to the LLN definition was 48.2% (40.6-55.9%). The overdiagnosis rate was higher in primary care than in hospital settings. Fourteen studies, including a total of 8183 individuals, were included in the meta-analysis estimating the prevalence of COPD overtreatment. The pooled rates of overtreatment according to GOLD and LLN definitions were 57.1% (40.9-72.6%) and 36.3% (17.8-57.2%), respectively. When spirometry is not used, a large proportion of patients are erroneously diagnosed with COPD. Approximately half of them are also incorrectly treated, with potential adverse effects and a massive inefficiency of resources allocation. Strategies to increase the compliance to current guidelines on COPD diagnosis are urgently needed.
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Affiliation(s)
- Matteo Fiore
- Section of Hygiene and Preventive Medicine, University of Bologna, 40126 Bologna, Italy; (M.F.); (M.R.)
| | - Matteo Ricci
- Section of Hygiene and Preventive Medicine, University of Bologna, 40126 Bologna, Italy; (M.F.); (M.R.)
| | - Annalisa Rosso
- Department of Environmental and Prevention Sciences, University of Ferrara, 44121 Ferrara, Italy; (A.R.); (M.E.F.)
| | - Maria Elena Flacco
- Department of Environmental and Prevention Sciences, University of Ferrara, 44121 Ferrara, Italy; (A.R.); (M.E.F.)
| | - Lamberto Manzoli
- Section of Hygiene and Preventive Medicine, University of Bologna, 40126 Bologna, Italy; (M.F.); (M.R.)
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11
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Clark J, Salins N, Pearson M, Spathis A, Currow DC, Williams S, Johnson M. BREATHLEssness in INDIA (BREATHE-INDIA)-Study protocol for the co-design of a community breathlessness intervention in India using realist methods and intervention mapping. PLoS One 2023; 18:e0293918. [PMID: 37917762 PMCID: PMC10621994 DOI: 10.1371/journal.pone.0293918] [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: 03/07/2023] [Accepted: 10/21/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND Breathlessness that persists despite treatment of causal disease(s) is disabling, associated with high therapy-related costs and poor socioeconomic outcomes. Low resource countries bear a disproportionate burden of respiratory problems, often characterised by disabling breathlessness. Low-cost self-management breathlessness-targeted interventions are effective and deliverable in community settings but have been developed in high-income countries. We aim to understand how breathlessness self-management works in 'real life' populations and cultural contexts, to develop programme theory and co-design a prototype intervention to improve persistent breathlessness management in India. METHODS AND ANALYSIS Using a Realist approach, Intervention Mapping and the Medical Research Council Complex Intervention Framework we will undertake two phases of work supported by our Expert Group (of respiratory, primary, palliative care physicians) and key stakeholder groups (opinion leader clinicians, community health workers and people with lived experiences of breathlessness). 1) Realist review and evaluation to identify and refine evidence and theory for breathlessness self-management, producing intervention and implementation programme theory. We will identify literature through our Expert Group, scoping searches and systematic searches (Medline, Ebscohost, CINAHL, Scopus, Psychinfo). We will map intervention components to 'what works, for whom, and where.' 2) Intervention development using Intervention Mapping to map intervention and implementation programme theory to intervention components, develop materials to support intervention delivery, and co-design a prototype educational intervention ready for early acceptability and delivery-feasibility testing and evaluation planning in India. Use of stakeholder groups is to allow people with experience of breathlessness and/or its management to contribute their views on content developed by our team based upon review of secondary data sources. Experts and Stakeholders are therefore not research subjects but are included as extended members of the study team and will not follow informed consent procedures. Experts and stakeholders will be acknowledge in outputs arising from our project if they wish to be. Our review conduct will be consistent with RAMESES quality standards. DISCUSSION At the conclusion of our study, we will have co-designed a breathlessness intervention for use in the community setting in India ready for further evaluation of: effectiveness, socioeconomic outcomes, acceptability and transferability to other low resource settings.
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Affiliation(s)
- Joseph Clark
- Wolfson Palliative Care Research Centre, University of Hull, Hull, United Kingdom
| | - Naveen Salins
- Department of Palliative Medicine and Supportive Care, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Mark Pearson
- Wolfson Palliative Care Research Centre, University of Hull, Hull, United Kingdom
| | - Anna Spathis
- Department of Public Health and Primary Care, University of Cambridge, United Kingdom
| | - David C. Currow
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, Australia
| | - Siân Williams
- Joint Chief Executive Officer, International Primary Care Respiratory Group, London, United Kingdom
| | - Miriam Johnson
- Wolfson Palliative Care Research Centre, University of Hull, Hull, United Kingdom
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12
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Agustí A, Sisó-Almirall A, Roman M, Vogelmeier CF. Gold 2023: Highlights for primary care. NPJ Prim Care Respir Med 2023; 33:28. [PMID: 37524724 PMCID: PMC10390461 DOI: 10.1038/s41533-023-00349-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 07/14/2023] [Indexed: 08/02/2023] Open
Affiliation(s)
- Alvar Agustí
- Cátedra Salud Respiratoria, Univ. Barcelona, Hospital Clinic, IDIBAPS and CIBERES, Barcelona, Spain.
| | - Antoni Sisó-Almirall
- Consorci d'Atenció Primària de Salut Barcelona Esquerre (CAPSBE). Grup de Recerca Transversal en Atenció Primària (IDIBAPS). Departament de Medicina, Universitat de Barcelona, Barcelona, Spain
| | - Miguel Roman
- Univ. Islas Baleares, Instituto de Investigación Sanitaria de las Islas Baleares (IdISBa), centro de salud Son Pisa Palma de Mallorca, Palma de Mallorca, Spain
| | - Claus F Vogelmeier
- Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-University, German Center for Lung Research (DZL), Marburg, Germany
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13
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Sarno G, Stanisci I, Maio S, Williams S, Ming KE, Diaz SG, Ponte EV, Lan LTT, Soronbaev T, Behera D, Tagliaferro S, Baldacci S, Viegi G. Issue 2 - "Update on adverse respiratory effects of indoor air pollution". Part 2): Indoor air pollution and respiratory diseases: Perspectives from Italy and some other GARD countries. Pulmonology 2023:S2531-0437(23)00083-1. [PMID: 37211526 DOI: 10.1016/j.pulmoe.2023.03.007] [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: 03/20/2023] [Accepted: 03/20/2023] [Indexed: 05/23/2023] Open
Abstract
OBJECTIVE to synthesize the Italian epidemiological contribution to knowledge on indoor pollution respiratory impact, and to analyze the perspective of some GARD countries on the health effects of indoor air pollution. RESULTS Italian epidemiological analytical studies confirmed a strong relationship between indoor air pollution and health in general population. Environmental tobacco smoke, biomass (wood/coal) fuel for cooking/heating and indoor allergens (house dust mites, cat and dog dander, mold/damp) are the most relevant indoor pollution sources and are related to respiratory and allergic symptoms/diseases in Italy and in other GARD countries such as Mexico, Brazil, Vietnam, India, Nepal and Kyrgyzstan. Community-based global health collaborations are working to improve prevention, diagnosis and care of respiratory diseases around the world, specially in low- and middle-income countries, through research and education. CONCLUSIONS in the last thirty years, the scientific evidence produced on respiratory health effects of indoor air pollution has been extensive, but the necessity to empower the synergies between scientific community and local administrations remains a challenge to address in order to implement effective interventions. Based on abundant evidence of indoor pollution health effect, WHO, scientific societies, patient organizations and other members of the health community should work together to pursue the GARD vision of "a world where all people breathe freely" and encourage policy makers to increase their engagement in advocacy for clean air.
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Affiliation(s)
- G Sarno
- CNR Institute of Clinical Physiology (IFC), Via Trieste, 41, 56126 Pisa, Italy
| | - I Stanisci
- CNR Institute of Clinical Physiology (IFC), Via Trieste, 41, 56126 Pisa, Italy
| | - S Maio
- CNR Institute of Clinical Physiology (IFC), Via Trieste, 41, 56126 Pisa, Italy
| | - S Williams
- International Primary Care Respiratory Group (IPCRG), 19 Armour Mews, Larbert FK5 4FF, Scotland, United Kingdom
| | - K E Ming
- International Primary Care Respiratory Group (IPCRG), 19 Armour Mews, Larbert FK5 4FF, Scotland, United Kingdom
| | - S G Diaz
- Universidad Autónoma de Nuevo León, Faculty of Medicine and University Hospital "Dr. José Eleuterio González", Regional Center of Allergy and Clinical Immunology, Av. Dr. José Eleuterio González 235, Mitras Centro, 64460 Monterrey, N.L., Mexico
| | - E V Ponte
- Faculdade de Medicina de Jundiaí - Department of Internal Medicine, R. Francisco Teles, 250, Vila Arens II, Jundiaí SP, 13202-550, Brazil
| | - L T T Lan
- University Medical Center, 217 Hong Bang, dist.5, Ho Chi Minh City 17000, Vietnam
| | - T Soronbaev
- Department of Respiratory Medicine, National Center for Cardiology and Internal Medicine, Togolok Moldo str., Bishkek 720040, Kyrgyzstan
| | - D Behera
- Department of Microbiology, National Institute of Tuberculosis and Respiratory Diseases (NITRD), Sri Aurobindo Marg Near Qutub Minar, Mehrauli, New Delhi 110030, India
| | - S Tagliaferro
- CNR Institute of Clinical Physiology (IFC), Via Trieste, 41, 56126 Pisa, Italy
| | - S Baldacci
- CNR Institute of Clinical Physiology (IFC), Via Trieste, 41, 56126 Pisa, Italy
| | - G Viegi
- CNR Institute of Clinical Physiology (IFC), Via Trieste, 41, 56126 Pisa, Italy.
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14
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Tamondong-Lachica DR, Skolnik N, Hurst JR, Marchetti N, Rabe APJ, Montes de Oca M, Celli BR. GOLD 2023 Update: Implications for Clinical Practice. Int J Chron Obstruct Pulmon Dis 2023; 18:745-754. [PMID: 37180752 PMCID: PMC10168197 DOI: 10.2147/copd.s404690] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 04/06/2023] [Indexed: 05/16/2023] Open
Abstract
In 2022, over 3 million people died of chronic obstructive pulmonary disease (COPD) and the global burden of the disease is expected to increase over the coming decades. Recommendations for the treatment and management of patients with COPD are published by the Global Initiative for Chronic Obstructive Lung Disease, and updated annually with scientific evidence-based recommendations. The 2023 updates, published in November 2022, contain key changes to recommendations for diagnosis and treatment of COPD that are anticipated to have a significant impact on clinical practice for patients with COPD. Updates to how COPD is defined and diagnosed, including the expansion of contributing factors beyond tobacco use, have the potential to lead to the diagnosis of more patients and to allow for the implementation of early interventions for patients during early stages of the disease. Simplification of the treatment algorithms, and placement of triple therapy within these algorithms, will support clinicians in providing appropriate, timely treatment for patients with COPD with a focus on reducing the risk of future exacerbations. Finally, recognition of mortality reduction as a treatment goal in COPD supports an increase in the use of triple therapy, the only pharmacological intervention that has been demonstrated to improve survival for patients with COPD. Although further guidance and clarification are needed in some areas, such as use of blood eosinophil counts in guiding treatment decisions and implementation of treatment protocols following hospitalizations, recent updates to the GOLD recommendations will support clinicians in addressing current gaps in patient care. Clinicians should utilize these recommendations to drive the early diagnosis of patients with COPD, the identification of exacerbations, and the selection of appropriate, timely treatments for patients.
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Affiliation(s)
| | - Neil Skolnik
- Sidney Kimmel Medical College, Thomas Jefferson University, Abington, Philadelphia, PA, USA
| | - John R Hurst
- UCL Respiratory, University College London, London, UK
| | - Nathaniel Marchetti
- Department of Thoracic Medicine and Surgery, Temple University, Philadelphia, PA, USA
| | - Adrian Paul J Rabe
- Department of Primary Care and Public Health, Imperial College London, London, UK
- Biopharmaceuticals Medical, AstraZeneca, Cambridge, UK
| | - Maria Montes de Oca
- Pulmonary and Thoracic Surgery Department, Universidad Central de Venezuela, School of Medicine, Centro Médico de Caracas, Caracas, Venezuela
| | - Bartolome R Celli
- Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
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15
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Zhao L, Zhao Q. Knowledge, attitude, and practice toward disease prevention among a high-risk population for chronic obstructive pulmonary disease: A cross-sectional study. Int J Nurs Sci 2023; 10:238-244. [PMID: 37128490 PMCID: PMC10148251 DOI: 10.1016/j.ijnss.2023.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 02/08/2023] [Accepted: 03/19/2023] [Indexed: 04/07/2023] Open
Abstract
Objective This study aimed to describe the current situation of knowledge, attitude, and practice (KAP) of chronic obstructive pulmonary disease (COPD) prevention among a high-risk population for COPD. Methods A cross-sectional survey was conducted. A total of 241 participants at risk of COPD were selected who visited the respiratory outpatient department of a Class A tertiary hospital in Chongqing, China from January to December 2021. A self-developed COPD prevention KAP assessment was used for evaluation which included knowledge (21 items), attitude (9 items), and practice (9 items) three dimension, 39 items. Results The average overall KAP score was 68.29 ± 12.91, with scores for the knowledge, attitude, and practice dimension was 68.75 ± 18.07, 71.13 ± 15.09 and 65.00 ± 20.93, respectively. Among the people at risk of COPD, 76.8% experienced a moderate level of KAP toward COPD prevention, while 22.0% were at a poor level. Significant differences in the KAP scores were based on gender, educational level, occupation, type of medical insurance, smoking, and passive smoking status (P < 0.05). The male COPD high-risk group has better KAP toward COPD prevention than the female group (P < 0.05). The knowledge and attitude of COPD prevention present worse in people with a high risk of COPD aged 70 or above, primary school and below educational level, and farmers (P < 0.05). Smoking and passive smoking groups have higher recognition of the knowledge but the lower practice of COPD prevention (P < 0.05). Conclusion The participants with a high risk of COPD had a moderate level of KAP for COPD prevention, in which the understanding and action on vaccination and lung function test was weak, but an active attitude for health. It is necessary to implement tailored health education interventions to their characteristics to reduce the incidence and development of COPD.
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Affiliation(s)
- Lulu Zhao
- Department of Nursing, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Department of Nursing, The People’s Hospital of Dazu, Chongqing, China
| | - Qinghua Zhao
- Department of Nursing, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Corresponding author.
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16
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Burden of respiratory problems in low-income and middle-income countries. Curr Opin Support Palliat Care 2022; 16:210-215. [PMID: 36102933 DOI: 10.1097/spc.0000000000000615] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
PURPOSE OF REVIEW Chronic respiratory diseases are a leading cause of morbidity and mortality in low-income and middle-income countries (LMICs). We aim to review prevalence of respiratory diseases and related symptoms, which contribute significantly to burden of disease in LMICs. We report global estimates of respiratory problems amongst adults in LMICs and recent findings relating to community prevalence and impact of respiratory problems. We conclude by identifying research priorities for improved recognition and palliation of respiratory problems. RECENT FINDINGS We report findings from 16 studies, highlighting key issues relevant to burden of respiratory problems in LMICs. COPD and associated symptoms are identified as important drivers of increasing respiratory problems in LMICs, with an estimated prevalence of 7.2%. Negative impacts of respiratory diseases include: reduced physical function (capacity to work), quality of life (depression; anxiety) and socioeconomic wellbeing (healthcare costs; earning potential). Locally appropriate palliative care interventions may improve quality of life without increasing costs. SUMMARY Prevention and treatment of respiratory diseases is essential for improved wellbeing. We identify missed opportunities for measurement and understanding of burden caused by respiratory problems within efforts to measure illness prevalence. We highlight need for symptom management interventions, developed in context of local cultural beliefs and behaviours.
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Zhou L, Yang H, Zhang Y, Li H, Zhang S, Li D, Ma Y, Hou Y, Lu W, Wang Y. Association of impaired lung function with dementia, and brain magnetic resonance imaging indices: a large population-based longitudinal study. Age Ageing 2022; 51:6834143. [PMID: 36413587 DOI: 10.1093/ageing/afac269] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 09/04/2022] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE to examine the association between different patterns of impaired lung function with the incident risk of dementia and magnetic resonance imaging (MRI)-based brain structural features. METHODS in UK Biobank, a total of 308,534 dementia-free participants with valid lung function measures (forced expiratory volume in 1 s [FEV1] and forced vital capacity [FVC]) were included. Association was assessed using Cox proportional hazards regression model. Furthermore, the association between impaired lung function and brain MRI biomarkers related to cognitive function was analysed among 30,159 participants. RESULTS during a median follow-up of 12.6 years, 3,607 incident all-cause dementia cases were recorded. Restrictive impairment (hazard ratio [HR], 1.42; 95% confidence interval [CI], 1.27-1.60) and obstructive impairment (HR, 1.28; 95% CI, 1.15-1.42) were associated with higher risk of all-cause dementia. The restricted cubic splines indicated FEV1% predicted and FVC % predicted had reversed J-shaped associations with dementia. Participants with impaired lung function have higher risks of all-cause dementia across all apolipoprotein E (APOE) risk categories, whereas associations were stronger among those of low APOE risk (P for interaction = 0.034). In addition, restrictive and obstructive impairment were linked to lower total (β: -0.075, SE: 0.021, Pfdr = 0.002; β: -0.033, SE: 0.017, Pfdr = 0.069) and frontoparietal grey matter volumes, higher white matter hyperintensity, poorer white matter integrity, lower hippocampus (β: -0.066, SE: 0.024, Pfdr = 0.017; β: -0.051, SE: 0.019, Pfdr = 0.019) and other subcortical volumes. CONCLUSIONS participants with restrictive and obstructive impairments had a higher risk of dementia. Brain MRI indices further supported adverse effects and provided insight into potential pathophysiology biomarkers.
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Affiliation(s)
- Lihui Zhou
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Hongxi Yang
- Department of Bioinformatics, School of Basic Medical Sciences, Tianjin Medical University, Tianjin, China
| | - Yuan Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Huiping Li
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China.,Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden
| | - Shunming Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China.,Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden
| | - Dun Li
- Department of Basic Integrated Medicine, School of Integrative Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Yue Ma
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Yabing Hou
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Wenli Lu
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Yaogang Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China.,Department of Basic Integrated Medicine, School of Integrative Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
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