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Santos NCD, Miravitlles M, Camelier AA, Almeida VDCD, Maciel RRBT, Camelier FWR. PREVALENCE AND IMPACT OF COMORBIDITIES IN INDIVIDUALS WITH COPD: A SYSTEMATIC REVIEW. Tuberc Respir Dis (Seoul) 2022; 85:205-220. [PMID: 35618259 PMCID: PMC9263346 DOI: 10.4046/trd.2021.0179] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 05/23/2022] [Indexed: 11/24/2022] Open
Abstract
This study aimed to describe the prevalence of comorbidities associated with chronic obstructive pulmonary disease (COPD) and their relation with relevant outcomes. A systematic review based on the PRISMA methodology was performed from January 2020 until July 2021. The MEDLINE, Lilacs, and Scielo databases were searched to identify studies related to COPD and its comorbidities. Observational studies on the prevalence of comorbidities in COPD patients and costs with health estimates, reduced quality of life, and mortality were included. Studies that were restricted to one or more COPD pain assessments and only specific comorbidities such as osteoporosis, bronchitis, and asthma were excluded. The initial search identified 1,409 studies and after applying the inclusion and exclusion criteria, 20 studies were finally selected for analysis (comprising data from 447,459 COPD subjects). The most frequent COPD comorbidities were: hypertension (range, 17%–64.7%), coronary artery disease (19.9%–47.8%), diabetes (10.2%–45%), osteoarthritis (18%–43.8%), psychiatric conditions (12.1%–33%), and asthma (14.7%–32.5%). Several comorbidities had an impact on the frequency and severity of COPD exacerbations, quality of life, and mortality risk, in particular malignancies, coronary artery disease, chronic heart failure, and cardiac arrhythmias. Comorbidities, especially cardiovascular diseases and diabetes, are frequent in COPD patients, and some of them are associated with higher mortality.
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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: 1.0] [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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Pando-Sandoval A, Ruano-Ravina A, Torres-Durán M, Dacal-Quintas R, Valdés-Cuadrado L, Hernández-Hernández JR, Consuegra-Vanegas A, Candal-Pedreira C, Varela-Lema L, Fernández-Villar A, Pérez-Ríos M. Residential radon and characteristics of chronic obstructive pulmonary disease. Sci Rep 2022; 12:1381. [PMID: 35082364 PMCID: PMC8792000 DOI: 10.1038/s41598-022-05421-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 12/30/2021] [Indexed: 02/07/2023] Open
Abstract
It is not known whether residential radon exposure may be linked to the development of chronic obstructive pulmonary disease (COPD) and/or have an influence on the functional characteristics or exacerbations of COPD. The aim of this study was therefore to ascertain whether there might be an association between residential radon concentrations and certain characteristics of COPD. We analyzed COPD cases drawn from a case-control study conducted in an area of high radon exposure. Data were collected on spirometric pulmonary function variables, hospital admissions, and smoking. Radon measurements were taken using alpha-track-type CR-39 detectors individually placed in patients' homes. All statistical analyses were performed using the IBM SPSS v22 computer software program. The study included 189 COPD cases (79.4% men; median age 64 years). The median radon concentration was 157 Bq/m3. No differences were found between radon concentration and sex, age or severity of breathing obstruction as measured by FEV1%. It should be noted, however, that 48.1% of patients with FEV1% < 50 had radon concentrations below 100 Bq/m3, as compared to 35.6% with the same severity of obstruction who had over 300 Bq/m3. COPD cases with radon concentrations higher than > 600 Bq/m3 exhibited no different characteristics in lung function. Exposure to radon does not appear to have an influence on the clinical characteristics of smokers and ex-smokers with COPD. As exposure to residential radon increases, there is no trend towards a worsening of FEV1%. Further studies are thus needed to analyze this possible association in never-smokers with COPD.
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Affiliation(s)
- Ana Pando-Sandoval
- Department of Pneumology, Central University Teaching Hospital of Asturias, Oviedo, Spain
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, C/San Francisco s/n, 15782, Santiago de Compostela, Spain
| | - Alberto Ruano-Ravina
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, C/San Francisco s/n, 15782, Santiago de Compostela, Spain.
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública- CIBERESP), Madrid, Spain.
- Health Research Institute of Santiago de Compostela (Instituto de Investigación Sanitaria de Santiago de Compostela - IDIS), Santiago de Compostela, Spain.
| | - María Torres-Durán
- Department of Pneumology, University Teaching Hospital Complex of Vigo, Vigo, Spain
- PneumoVigoI+I Research Group, Southern Galician Institute of Health Research (Instituto de Investigación Sanitaria Galicia Sur - IISGS), Vigo, Spain
| | - Raquel Dacal-Quintas
- Department of Pneumology, University Teaching Hospital Complex of Ourense, Ourense, Spain
| | - Luis Valdés-Cuadrado
- Department of Pneumology, University Clinical Teaching Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | | | | | - Cristina Candal-Pedreira
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, C/San Francisco s/n, 15782, Santiago de Compostela, Spain
| | - Leonor Varela-Lema
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, C/San Francisco s/n, 15782, Santiago de Compostela, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública- CIBERESP), Madrid, Spain
| | - Alberto Fernández-Villar
- Department of Pneumology, University Teaching Hospital Complex of Vigo, Vigo, Spain
- PneumoVigoI+I Research Group, Southern Galician Institute of Health Research (Instituto de Investigación Sanitaria Galicia Sur - IISGS), Vigo, Spain
| | - Mónica Pérez-Ríos
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, C/San Francisco s/n, 15782, Santiago de Compostela, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública- CIBERESP), Madrid, Spain
- Health Research Institute of Santiago de Compostela (Instituto de Investigación Sanitaria de Santiago de Compostela - IDIS), Santiago de Compostela, Spain
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Uyttendaele V, Guiot J, Chase JG, Desaive T. Does Facemask Impact Diagnostic During Pulmonary Auscultation? IFAC-PAPERSONLINE 2021; 54:192-197. [PMID: 38621011 PMCID: PMC8562133 DOI: 10.1016/j.ifacol.2021.10.254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Facemasks have been widely used in hospitals, especially since the emergence of the coronavirus 2019 (COVID-19) pandemic, often severely affecting respiratory functions. Masks protect patients from contagious airborne transmission, and are thus more specifically important for chronic respiratory disease (CRD) patients. However, masks also increase air resistance and thus work of breathing, which may impact pulmonary auscultation and diagnostic acuity, the primary respiratory examination. This study is the first to assess the impact of facemasks on clinical auscultation diagnostic. Lung sounds from 29 patients were digitally recorded using an electronic stethoscope. For each patient, one recording was taken wearing a surgical mask and one without. Recorded signals were segmented in breath cycles using an autocorrelation algorithm. In total, 87 breath cycles were identified from sounds with mask, and 82 without mask. Time-frequency analysis of the signals was used to extract comparison features such as peak frequency, median frequency, band power, or spectral integration. All the features extracted in frequency content, its evolution, or power did not significantly differ between respiratory cycles with or without mask. This early stage study thus suggests minor impact on clinical diagnostic outcomes in pulmonary auscultation. However, further analysis is necessary such as on adventitious sounds characteristics differences with or without mask, to determine if facemask could lead to no discernible diagnostic outcome in clinical practice.
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Affiliation(s)
| | - Julien Guiot
- Department of Pneumology, University Hospital of Liège, Belgium
| | - J Geoffrey Chase
- Department of Mechanical Engineering, University of Canterbury, Christchurch, New Zealand
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Groves D, Karsanji U, Evans RA, Greening N, Singh SJ, Quint JK, Whittaker H, Richardson M, Barrett J, Sutch SP, Steiner MC. Predicting Future Health Risk in COPD: Differential Impact of Disease-Specific and Multi-Morbidity-Based Risk Stratification. Int J Chron Obstruct Pulmon Dis 2021; 16:1741-1754. [PMID: 34163156 PMCID: PMC8215908 DOI: 10.2147/copd.s303202] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 05/04/2021] [Indexed: 11/23/2022] Open
Abstract
Objective Multi-morbidity contributes to mortality and hospitalisation in COPD, but it is uncertain how this interacts with disease severity in risk prediction. We compared contributions of multi-morbidity and disease severity factors in modelling future health risk using UK primary care healthcare data. Methods Health records from 103,955 patients with COPD identified from the Clinical Practice Research Datalink were analysed. We compared area under the curve (AUC) statistics for logistic regression (LR) models incorporating disease indices with models incorporating categorised comorbidities. We also compared these models with performance of The John Hopkins Adjusted Clinical Groups® System (ACG) risk prediction algorithm. Results LR models predicting all-cause mortality outperformed models predicting hospitalisation. Mortality was best predicted by disease severity (AUC & 95% CI: 0.816 (0.805–0.827)) and prediction was enhanced only marginally by the addition of multi-morbidity indices (AUC & 95% CI: 0.829 (0.818–0.839)). The model combining disease severity and multi-morbidity indices was a better predictor of hospitalisation (AUC & 95% CI: 0.679 (0.672–0.686)). ACG-derived LR models outperformed conventional regression models for hospitalisation (AUC & 95% CI: 0.697 (0.690–0.704)) but not for mortality (AUC & 95% CI: 0.816 (0.805–0.827)). Conclusion Stratification of future health risk in COPD can be undertaken using clinical and demographic data recorded in primary care, but the impact of disease severity and multi-morbidity varies depending on the choice of health outcome. A more comprehensive risk modelling algorithm such as ACG offers enhanced prediction for hospitalisation by incorporating a wider range of coded diagnoses.
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Affiliation(s)
- David Groves
- NIHR Leicester Biomedical Research Centre - Respiratory, Department of Respiratory Sciences, College of Life Sciences, University of Leicester, Leicester, UK
| | - Urvee Karsanji
- NIHR Leicester Biomedical Research Centre - Respiratory, Department of Respiratory Sciences, College of Life Sciences, University of Leicester, Leicester, UK
| | - Rachael A Evans
- NIHR Leicester Biomedical Research Centre - Respiratory, Department of Respiratory Sciences, College of Life Sciences, University of Leicester, Leicester, UK
| | - Neil Greening
- NIHR Leicester Biomedical Research Centre - Respiratory, Department of Respiratory Sciences, College of Life Sciences, University of Leicester, Leicester, UK
| | - Sally J Singh
- NIHR Leicester Biomedical Research Centre - Respiratory, Department of Respiratory Sciences, College of Life Sciences, University of Leicester, Leicester, UK
| | - Jennifer K Quint
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Hannah Whittaker
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Matthew Richardson
- NIHR Leicester Biomedical Research Centre - Respiratory, Department of Respiratory Sciences, College of Life Sciences, University of Leicester, Leicester, UK
| | - James Barrett
- Johns Hopkins HealthCare Solutions, Baltimore, MD, USA
| | - Stephen P Sutch
- Bloomberg School of Public Health, John Hopkins University, Department of Health Policy and Management, Baltimore, MD, USA
| | - Michael C Steiner
- NIHR Leicester Biomedical Research Centre - Respiratory, Department of Respiratory Sciences, College of Life Sciences, University of Leicester, Leicester, UK
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Kalhan R, Slade D, Ray R, Moretz C, Germain G, Laliberté F, Shen Q, Duh MS, MacKnight SD, Hahn B. Umeclidinium/Vilanterol Compared with Fluticasone Propionate/Salmeterol, Budesonide/Formoterol, and Tiotropium as Initial Maintenance Therapy in Patients with COPD Who Have High Costs and Comorbidities. Int J Chron Obstruct Pulmon Dis 2021; 16:1149-1161. [PMID: 33911860 PMCID: PMC8075186 DOI: 10.2147/copd.s298032] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 03/29/2021] [Indexed: 12/12/2022] Open
Abstract
Background Comorbidities in patients with chronic obstructive pulmonary disease (COPD) are associated with increased medical costs and risk of exacerbations. This study compared COPD-related medical costs and exacerbations in high-cost, high-comorbidity patients with COPD receiving initial maintenance treatment (IMT) with umeclidinium/vilanterol (UMEC/VI) versus fluticasone propionate/salmeterol (FP/SAL), budesonide/formoterol (B/F), or tiotropium (TIO). Methods This retrospective, matched cohort study identified patients from Optum’s de-identified Clinformatics Data Mart database who initiated UMEC/VI, FP/SAL, B/F, or TIO between January 1, 2014 and December 31, 2018 (index date defined as date of the first fill). Eligibility criteria included age ≥40 years at index, ≥1 pre-index COPD diagnosis, no pre-index asthma diagnosis, 12 months of continuous insurance coverage pre-index, and high pre-index costs (≥80th percentile of IMT population) and comorbidities (Quan-Charlson comorbidity index ≥3). Propensity score matching was used to control for potential confounders. On-treatment COPD-related medical costs (primary endpoint) and exacerbations were evaluated. Results Matched cohorts were well balanced on baseline characteristics (UMEC/VI vs FP/SAL: n=1194 each; UMEC/VI vs B/F: n=1441 each; UMEC/VI vs TIO: n=1277 each). Patients receiving UMEC/VI had significantly lower COPD-related medical costs versus FP/SAL (difference: $6587 per patient per year; P=0.048), and numerically lower costs versus B/F and TIO. Patients initiating UMEC/VI had significantly lower risk of COPD-related severe exacerbation versus FP/SAL (hazard ratio [95% CI]: 0.78 [0.62, 0.98]; P=0.032), B/F (0.77 [0.63, 0.95]; P=0.016), and TIO (0.79 [0.64, 0.98]; P=0.028). The rate of COPD-related severe exacerbations was significantly lower with UMEC/VI versus FP/SAL (rate ratio [95% CI]: 0.73 [0.59, 0.91]; P=0.008) and B/F (0.73 [0.59, 0.93]; P=0.012), and numerically lower versus TIO (0.83 [0.68, 1.04]; P=0.080). Conclusion These findings suggest that high-cost, high-comorbidity patients with COPD receiving UMEC/VI compared with FP/SAL, B/F, and TIO as IMT may have lower medical costs and exacerbation risk.
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Affiliation(s)
- Ravi Kalhan
- Asthma and COPD Program, Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - David Slade
- US Medical Affairs, GlaxoSmithKline, Research Triangle Park, NC, USA
| | - Riju Ray
- US Medical Affairs, GlaxoSmithKline, Research Triangle Park, NC, USA
| | - Chad Moretz
- US Value Evidence and Outcomes, GlaxoSmithKline, Research Triangle Park, NC, USA
| | | | | | - Qin Shen
- US Value Evidence and Outcomes, GlaxoSmithKline, Collegeville, PA, USA
| | | | | | - Beth Hahn
- US Value Evidence and Outcomes, GlaxoSmithKline, Research Triangle Park, NC, USA
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Abstract
INTRODUCTION Chronic obstructive pulmonary disease, most commonly caused by tobacco smoking, is increasingly reported in nonsmoking patients exposed to domestic combustion of biomass fuels. This is particularly common among rural women in the low- and middle-income countries. It is highly likely that the disease in these patients is a different clinical phenotype. AREAS COVERED This manuscript covers epidemiological and clinical aspects of biomass-exposed COPD and also dwells upon its different phenotypic characteristics. EXPERT OPINION Chronic obstructive pulmonary disease in biomass-exposed, nonsmoker patients which predominantly presents with features of chronic bronchitis is more likely a distinct phenotype with greater likelihood of small airway involvement.
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Affiliation(s)
- Surinder Jindal
- Emeritus Professor, Department of Pulmonary Medicine, Postgrad Instt Med Edu & Research , Chandigarh, India.,Chest Medicine, Jindal Clinics , Chandigarh, India
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8
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Meijer E, van Eeden AE, Kruis AL, Boland MRS, Assendelft WJJ, Tsiachristas A, Rutten-van Mölken MPMH, Kasteleyn MJ, Chavannes NH. Exploring characteristics of COPD patients with clinical improvement after integrated disease management or usual care: post-hoc analysis of the RECODE study. BMC Pulm Med 2020; 20:176. [PMID: 32552784 PMCID: PMC7302138 DOI: 10.1186/s12890-020-01213-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 06/10/2020] [Indexed: 11/23/2022] Open
Abstract
Background The cluster randomized controlled trial on (cost-)effectiveness of integrated chronic obstructive pulmonary disease (COPD) management in primary care (RECODE) showed that integrated disease management (IDM) in primary care had no effect on quality of life (QOL) in COPD patients compared with usual care (guideline-supported non-programmatic care). It is possible that only a subset of COPD patients in primary care benefit from IDM. We therefore examined which patients benefit from IDM, and whether patient characteristics predict clinical improvement over time. Method Post-hoc analyses of the RECODE trial among 1086 COPD patients. Logistic regression analyses were performed with baseline characteristics as predictors to examine determinants of improvement in QOL, defined as a minimal decline in Clinical COPD Questionnaire (CCQ) of 0.4 points after 12 and 24 months of IDM. We also performed moderation analyses to examine whether predictors of clinical improvement differed between IDM and usual care. Results Regardless of treatment type, more severe dyspnea (MRC) was the most important predictor of clinically improved QOL at 12 and 24 months, suggesting that these patients have most room for improvement. Clinical improvement with IDM was associated with female gender (12-months) and being younger (24-months), and improvement with usual care was associated with having a depression (24-months). Conclusions More severe dyspnea is a key predictor of improved QOL in COPD patients over time. More research is needed to replicate patient characteristics associated with clinical improvement with IDM, such that IDM programs can be offered to patients that benefit the most, and can potentially be adjusted to meet the needs of other patient groups as well. Trial registration Netherlands Trial Register, NTR2268. Registered 31 March 2010.
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Affiliation(s)
- Eline Meijer
- Department of Public Health and Primary Care, Leiden University Medical Centre, PO Box 9600, 2300 RC, Leiden, Netherlands.
| | - Annelies E van Eeden
- Department of Public Health and Primary Care, Leiden University Medical Centre, PO Box 9600, 2300 RC, Leiden, Netherlands
| | - Annemarije L Kruis
- Department of Public Health and Primary Care, Leiden University Medical Centre, PO Box 9600, 2300 RC, Leiden, Netherlands
| | - Melinde R S Boland
- Institute of Health, Policy & Management, Erasmus University Rotterdam, PO Box 1738, 3000 DR, Rotterdam, Netherlands
| | - Willem J J Assendelft
- Department of Primary and Community Care, Radboud University Medical Centre, 6500 HB, Nijmegen, Netherlands
| | - Apostolos Tsiachristas
- Institute of Health, Policy & Management, Erasmus University Rotterdam, PO Box 1738, 3000 DR, Rotterdam, Netherlands.,Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, OX3 7LF, UK
| | | | - Marise J Kasteleyn
- Department of Public Health and Primary Care, Leiden University Medical Centre, PO Box 9600, 2300 RC, Leiden, Netherlands.,Department of Pulmonology, Leiden University Medical Centre, Leiden, PO Box 9600, 2300 RC, Leiden, Netherlands
| | - Niels H Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Centre, PO Box 9600, 2300 RC, Leiden, Netherlands
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Naz I, Sahin H, Varol Y, Kömürcüoğlu B. The effect of comorbidity severity on pulmonary rehabilitation outcomes in chronic obstructive pulmonary disease patients. Chron Respir Dis 2020; 16:1479972318809472. [PMID: 30428708 PMCID: PMC6301838 DOI: 10.1177/1479972318809472] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
CLINICAL TRIAL NUMBER NCT03319108.
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Affiliation(s)
- Ilknur Naz
- 1 Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Izmir Katip Celebi University, Izmir, Turkey
| | - Hulya Sahin
- 2 Dr. Suat Seren Chest Diseases and Surgery Training and Research Hospital, Izmir, Turkey
| | - Yelda Varol
- 2 Dr. Suat Seren Chest Diseases and Surgery Training and Research Hospital, Izmir, Turkey
| | - Berna Kömürcüoğlu
- 2 Dr. Suat Seren Chest Diseases and Surgery Training and Research Hospital, Izmir, Turkey
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T T, D D, A A, Y Z, M K, M G, M D, T V. Association of the MMP7 -181A>G Promoter Polymorphism with Early Onset of Chronic Obstructive Pulmonary Disease. Balkan J Med Genet 2018; 20:59-66. [PMID: 29876234 PMCID: PMC5972504 DOI: 10.1515/bjmg-2017-0023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is characterized by decreased air flow and is associated with abnormal chronic inflammation in the airways and extensive tissue remodeling. Matrix metalloproteinase-7 (MMP7) is produced primarily by the epithelium of many organs, including the lungs. A functional MMP7 -181A>G (rs11568818) promoter polymorphism influences the binding of nuclear regulatory proteins modulating the transcription of the gene. In this study, we genotyped 191 patients with COPD for MMP7 -181A>G single nucleotide polymorphism (SNP) and 215 control subjects using the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method and explored the role of that polymorphism as a risk factor for COPD. There were no differences in the genotype and allele distribution of the MMP7 -181A>G SNP between the COPD patients and control groups (p = 0.341 and p = 0.214). However, the carries of the G allele (AG and GG genotypes), appeared to develop COPD significantly earlier than those with the AA genotype (61.01 ± 10.11 vs. 64.87 ± 9.00 years, p = 0.032). When the genotype distribution was studied only in the groups of patients (n = 76) and controls (n = 106) younger than 60 years, we found significantly higher frequency of the carriers of the G allele in COPD patients than in the controls, determining about a 3-fold higher risk for COPD [odds ratio (OR) -3.33, 1.36-8.14, p = 0.008 for GG, and OR = 2.91, 1.38-6.13, p = 0.005 for AG+GG]. Based on our results, the MMP7 -181A>G promoter variant may influence early development of COPD. This effect could be attributed to the increased production of the enzyme resulting in enhanced airway wall protein degradation and injury.
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Affiliation(s)
- Tacheva T
- Department of Chemistry and Biochemistry, Medical Faculty, Trakia University, Stara Zagora, Bulgaria
| | - Dimov D
- Department of Internal Medicine, Medical Faculty, Trakia University, Stara Zagora, Bulgaria
| | - Anastasov A
- Department of Chemistry and Biochemistry, Medical Faculty, Trakia University, Stara Zagora, Bulgaria
| | - Zhelyazkova Y
- Department of Internal Medicine, Medical Faculty, Trakia University, Stara Zagora, Bulgaria
| | - Kurzawski M
- Department of Experimental and Clinical Pharmacology, Pomeranian Medical University, Szczecin, Poland
| | - Gulubova M
- Department of General and Clinical Pathology, Medical Faculty, Trakia University, Stara Zagora, Bulgaria
| | - Drozdzik M
- Department of Experimental and Clinical Pharmacology, Pomeranian Medical University, Szczecin, Poland
| | - Vlaykova T
- Department of Chemistry and Biochemistry, Medical Faculty, Trakia University, Stara Zagora, Bulgaria
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Hernández M, García G, Falco J, García AR, Martín V, Ibarrola M, Quadrelli S. Impact of using the new GOLD classification on the distribution of COPD severity in clinical practice. Int J Chron Obstruct Pulmon Dis 2018; 13:351-356. [PMID: 29403272 PMCID: PMC5777377 DOI: 10.2147/copd.s112551] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objective The objective of this study was to examine how COPD patients were classified by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) spirometry-based severity system and the distribution of COPD severity using the new GOLD 2011 assessment framework. Materials and methods This was an observational, retrospective cohort study conducted in a single tertiary center on a prospective database, which aimed to evaluate the prevalence, incidence, severity, and comorbidities of COPD. Inclusion criteria were age ≥40 years and COPD diagnosis according to GOLD 2007 classification. Clinical factors were compared between the categories in GOLD 2007 and 2011 groups by using the χ2 test for categorical data and the analysis of variance for continuous data. Results In total, 420 COPD patients were included in the analysis. The distribution of patients into GOLD 2007 categories was as follows: 6.4% (n=27) of them were classified into subgroup I, 42.1% (n=177) into subgroup II, 37.9% (n=159) into subgroup III, and 13.6% (n=57) into subgroup IV. The distribution of patients into GOLD 2011 categories was as follows: 16.4% (n=69) of them were classified into subgroup A (low risk and fewer symptoms), 32.1% (n=135) into subgroup B (low risk and more symptoms), 21.6% (n=91) into subgroup C (high risk and fewer symptoms), and 29.7% (n=125) into subgroup D (high risk and more symptoms). After the application of the new GOLD 2011 (modified Medical Research Council [mMRC] system), 22% (n=94) of patients were upgraded to a higher level than their spirometry level, and 16.2% (n=68) of them were downgraded in their severity category, meaning that almost 40% of patients changed their severity assessment category. In total, 22% of patients in stage I were allocated to group B, and 35% of patients in stage IV were allocated to group C. Patients in stage III were the most frequently upgraded to a higher risk group (D), taking into account mMRC and exacerbation history. Conclusion Classifying patients using the new GOLD 2011 criteria reallocated a relevant proportion of patients to a different risk category and identified larger proportions of patients in the mildest and more severe groups compared with GOLD 2007 classification.
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Affiliation(s)
- Marcos Hernández
- Department of Respiratory Medicine, Güemes Foundation, Buenos Aires, Argentina
| | - Gabriel García
- Department of Respiratory Medicine, Güemes Foundation, Buenos Aires, Argentina
| | - Jimena Falco
- Department of Respiratory Medicine, Güemes Foundation, Buenos Aires, Argentina
| | - Agustín R García
- Department of Respiratory Medicine, Güemes Foundation, Buenos Aires, Argentina
| | - Vanina Martín
- Department of Respiratory Medicine, Güemes Foundation, Buenos Aires, Argentina
| | - Manuel Ibarrola
- Department of Respiratory Medicine, Güemes Foundation, Buenos Aires, Argentina
| | - Silvia Quadrelli
- Department of Respiratory Medicine, Güemes Foundation, Buenos Aires, Argentina
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12
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Kahnert K, Alter P, Young D, Lucke T, Heinrich J, Huber RM, Behr J, Wacker M, Biertz F, Watz H, Bals R, Welte T, Wirtz H, Herth F, Vestbo J, Wouters EF, Vogelmeier CF, Jörres RA. The revised GOLD 2017 COPD categorization in relation to comorbidities. Respir Med 2017; 134:79-85. [PMID: 29413512 DOI: 10.1016/j.rmed.2017.12.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 10/13/2017] [Accepted: 12/02/2017] [Indexed: 02/05/2023]
Abstract
INTRODUCTION The COPD classification proposed by the Global Initiative for Obstructive Lung Disease was recently revised, and the A to D grouping is now based on symptoms and exacerbations only. Potential associations with comorbidities have not been assessed so far. Thus the aim of the present study was to determine the relationship between the revised (2017) GOLD groups A-D and major comorbidities. METHODS We used baseline data from the COPD cohort COSYCONET. Comorbidities were identified from patient self-reports and disease-specific medication: gastrointestinal disorders, asthma, sleep apnea, hyperuricemia, hyperlipidemia, diabetes, osteoporosis, mental disorders, heart failure, hypertension, coronary artery disease. The A-D groups were based on either the COPD Assessment Test or the modified Medical Research Council scale. Exacerbations were also categorized as per GOLD recommendations. RESULTS Data from 2228 patients were analyzed. Using GOLD group A as a reference, group D was associated with nearly all comorbidities, followed by group B and C. When groups A-D were dichotomized as AC vs. BD (symptoms) and AB vs. CD (exacerbations), all comorbidities correlated with symptoms and/or exacerbations. This was true for both mMRC- and CAT-based categorizations. CONCLUSIONS These findings suggest that the recently modified GOLD categorization is clinically relevant beyond being purely an assessment of symptoms and exacerbations. As the A-D groups correlated with the risk of important comorbidities, with some differences in terms of the correlation with symptoms and exacerbations, the findings underline the importance of identifying comorbidities in COPD, particularly in non-responders to therapy who have high symptoms and/or exacerbation rates.
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Affiliation(s)
- Kathrin Kahnert
- Department of Internal Medicine V, University of Munich (LMU), Comprehensive Pneumology Center, Member of the German Center for Lung Research, Ziemssenstr. 1, 80336 Munich, Germany.
| | - Peter Alter
- Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-University Marburg, Germany, Member of the German Center for Lung Research (DZL), Baldingerstrasse, 35043 Marburg, Germany
| | - David Young
- Young Medical Communications and Consulting Ltd, Horsham RH12 3NU, UK
| | - Tanja Lucke
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Comprehensive Pneumology Center Munich (CPC-M), Ludwig-Maximilians-Universität München, Ziemssenstr. 1, 80336 Munich, Germany
| | - Joachim Heinrich
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Comprehensive Pneumology Center Munich (CPC-M), Ludwig-Maximilians-Universität München, Ziemssenstr. 1, 80336 Munich, Germany
| | - Rudolf M Huber
- Department of Internal Medicine V, University of Munich (LMU), Comprehensive Pneumology Center, Member of the German Center for Lung Research, Ziemssenstr. 1, 80336 Munich, Germany
| | - Jürgen Behr
- Department of Internal Medicine V, University of Munich (LMU), Comprehensive Pneumology Center, Member of the German Center for Lung Research, Ziemssenstr. 1, 80336 Munich, Germany
| | - Margarethe Wacker
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München (GmbH) - German Research Center for Environmental Health, Member of the German Center for Lung Research, Comprehensive Pneumology Center Munich (CPC-M), Ingolstaedter Landstr. 1, 85764 Neuherberg, Germany
| | - Frank Biertz
- Institute for Biostatistics, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Henrik Watz
- Pulmonary Research Institute at LungenClinic Grosshansdorf, Airway Research Center North, Member of the German Center for Lung Research, Woehrendamm 80, 22927 Grosshansdorf, Germany
| | - Robert Bals
- Department of Internal Medicine V - Pulmonology, Allergology, Respiratory Intensive Care Medicine, Saarland University Hospital, Kirrberger Straße 1, 66424 Homburg, Germany
| | - Tobias Welte
- Department of Pneumology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Hubert Wirtz
- Department of Internal Medicine I, Pneumology, University of Leipzig, Liebigstr. 20, Haus 4, 04103 Leipzig, Germany
| | - Felix Herth
- Thoraxklinik-Heidelberg gGmbH, Röntgenstraße 1, 69126 Heidelberg, Germany
| | - Jørgen Vestbo
- Division of Infection, Immunity and Respiratory Medicine, Manchester Academic Health Sciences Centre, The University of Manchester and South Manchester University Hospital NHS Foundation Trust, Manchester, UK
| | - Emiel F Wouters
- Department of Respiratory Medicine, Maastricht University Medical Center, P. Debyelaan 25, 6202 AZ Maastricht, The Netherlands
| | - Claus F Vogelmeier
- Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-University Marburg, Germany, Member of the German Center for Lung Research (DZL), Baldingerstrasse, 35043 Marburg, Germany
| | - Rudolf A Jörres
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Comprehensive Pneumology Center Munich (CPC-M), Ludwig-Maximilians-Universität München, Ziemssenstr. 1, 80336 Munich, Germany
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Camargo LACDR, Castellano MVO, Ferreira FC, Faria FVD, Carvas N. Hospitalization due to exacerbation of COPD: "Real-life" outcomes. Rev Assoc Med Bras (1992) 2017; 63:543-549. [PMID: 28876432 DOI: 10.1590/1806-9282.63.06.543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Accepted: 11/20/2016] [Indexed: 11/22/2022] Open
Abstract
Introduction: Hospitalization due to chronic obstructive pulmonary disease exacerbation (eCOPD) may indicate worse prognosis. It is important to know the profile of hospitalized patients and their outcome of hospitalization to customize and optimize treatment. Method: Evaluation of patients hospitalized for eCOPD, with ≥ 10 pack/years and ≥ 1 previous spirometry with airway obstruction over the course of one year at the pulmonology service of a general hospital, applying: COPD assessment test (CAT); mMRc and Visual Analogue Scale (VAS) for dyspnea; hospitalized anxiety and depression questionnaire (HAD); Divo's comorbidities and Cote index; spirometry; and laboratory tests including number of eosinophils, C-reactive protein (CRP), brain natriuretic protein (BNP). Patient progression, number of days of hospitalization and hospitalization outcomes were observed. Results: There were 75 (12%) hospitalizations for eCOPD, with 27 readmissions, nine of which during a period ≤ 30 days after hospital discharge. The main outcomes were: number of days of hospitalization (17±16.5 [2-75]); hospital discharge (30 [62.5%] patients); discharge/rehospitalization (18 [37.5%] patients), eight of them more than once; death (7 [14.5%] patients), five during rehospitalization. We analyzed 48 patients in their first hospitalization. The sample comprised a heterogeneous group separated in three clusters according to age, FEV1, body mass index (BMI) and CAT. The clusters did not correlate with the main outcomes. Conclusion: Hospitalization for eCOPD is frequent. The number of readmissions was high and associated with death as an outcome. Patients hospitalized for eCOPD were a heterogeneous group separated in three clusters with different degrees of disease severity and no correlation with hospitalization outcomes.
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Affiliation(s)
- Lilia Azzi Collet da Rocha Camargo
- MD, MSc in Health Sciences from Instituto de Assistência Médica ao Servidor Público Estadual (Iamspe). Assistant Physician of the Pulmonology Service, Hospital do Servidor Público Estadual (HSPE), São Paulo, SP, Brazil
| | | | | | | | - Nelson Carvas
- Specialist in Statistics and Graduate Program Student at Iamspe, São Paulo, SP, Brazil
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Capozzolo A, Castellana G, Dragonieri S, Carratù P, Liotino V, Vulpi MR, Marra L, Resta E, Intiglietta P, Resta O. Voluntary lung function screening to reveal new COPD cases in southern Italy. Int J Chron Obstruct Pulmon Dis 2017; 12:2035-2042. [PMID: 28744118 PMCID: PMC5513831 DOI: 10.2147/copd.s136357] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background Underdiagnosis of COPD is a relevant issue, and most frequently involves patients at early stages of the disease. Physicians do not routinely recommend smokers to undergo spirometry, unless they are symptomatic. Aims To investigate the effectiveness of voluntary lung function screening in bringing to light patients with previously unknown COPD and to evaluate the relationships among symptoms, smoking status, and airway obstruction. Methods A voluntary screening study for COPD was conducted during two editions of the annual Fiera del Levante (2014 and 2015), an international trade fair in Bari. Subjects were eligible for the study if they fulfilled the following inclusion criteria: age ≥35 years, smoker/ex-smoker ≥5 pack-years (PYs), or at least one chronic respiratory symptom (cough, sputum production, shortness of breath, and wheezing). A free post-β2-agonist spirometry test was performed by trained physicians for each participant using portable spirometers. Post-β2-agonist forced expiratory volume in 1 second (FEV1):forced vital capacity ratio <0.7 was chosen to establish the diagnosis of COPD. Sensitivity, specificity, and negative and positive predictive values (NPVs and PPVs) of symptoms for the presence of obstruction were calculated. Results A total of 1,920 individuals were eligible for the study; 188 subjects (9.8%) met COPD criteria. There was a 10.4% prevalence of COPD in subjects with one or more symptoms who had never smoked or smoked ≤5 PYs. Among COPD patients, prevalence of symptoms increased in the presence of FEV1 <80%. COPD smokers were more symptomatic than smokers without COPD. Sensitivity and specificity in all subjects with one or more symptoms were 87% and 32%, respectively, whereas in smoker subgroups, sensitivity and specificity were 71% and 41% (≥5 PYs) and 74% and 35% (≥10 PYs), respectively. In all subjects, the presence of at least one symptom was associated with a low PPV for COPD of 11%, but a very high NPV (96%). These data did not change if the analysis was limited to smokers. Conclusion Voluntary public lung function screening programs in Italy are effective, and may detect a large number of undiagnosed subjects with COPD in early stages. In our population, COPD symptoms had low specificity and PPV, even considering smokers only.
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Affiliation(s)
- Alberto Capozzolo
- Department of Cardiac, Thoracic, and Vascular Science, Institute of Respiratory Disease, School of Medicine, University of Bari, Bari, Italy
| | - Giorgio Castellana
- Department of Cardiac, Thoracic, and Vascular Science, Institute of Respiratory Disease, School of Medicine, University of Bari, Bari, Italy
| | - Silvano Dragonieri
- Department of Cardiac, Thoracic, and Vascular Science, Institute of Respiratory Disease, School of Medicine, University of Bari, Bari, Italy
| | - Pierluigi Carratù
- Department of Cardiac, Thoracic, and Vascular Science, Institute of Respiratory Disease, School of Medicine, University of Bari, Bari, Italy
| | - Vito Liotino
- Department of Cardiac, Thoracic, and Vascular Science, Institute of Respiratory Disease, School of Medicine, University of Bari, Bari, Italy
| | - Maria Rosaria Vulpi
- Department of Cardiac, Thoracic, and Vascular Science, Institute of Respiratory Disease, School of Medicine, University of Bari, Bari, Italy
| | - Lorenzo Marra
- Department of Cardiac, Thoracic, and Vascular Science, Institute of Respiratory Disease, School of Medicine, University of Bari, Bari, Italy
| | - Emanuela Resta
- Department of Cardiac, Thoracic, and Vascular Science, Institute of Respiratory Disease, School of Medicine, University of Bari, Bari, Italy
| | - Pierluigi Intiglietta
- Department of Cardiac, Thoracic, and Vascular Science, Institute of Respiratory Disease, School of Medicine, University of Bari, Bari, Italy
| | - Onofrio Resta
- Department of Cardiac, Thoracic, and Vascular Science, Institute of Respiratory Disease, School of Medicine, University of Bari, Bari, Italy
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Mulpuru S, McKay J, Ronksley PE, Thavorn K, Kobewka DM, Forster AJ. Factors contributing to high-cost hospital care for patients with COPD. Int J Chron Obstruct Pulmon Dis 2017; 12:989-995. [PMID: 28392683 PMCID: PMC5373828 DOI: 10.2147/copd.s126607] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a leading cause of hospital admission, the fifth leading cause of death in North America, and is estimated to cost $49 billion annually in North America by 2020. The majority of COPD care costs are attributed to hospitalizations; yet, there are limited data to understand the drivers of high costs among hospitalized patients with COPD. In this study, we aimed to determine the patient and hospital-level factors associated with high-cost hospital care, in order to identify potential targets for the reorganization and planning of health services. We conducted a retrospective cohort study at a Canadian academic hospital between September 2010 and 2014, including adult patients with a first-time admission for COPD exacerbation. We calculated total costs, ranked patients by cost quintiles, and collected data on patient characteristics and health service utilization. We used multivariable regression to determine factors associated with highest hospital costs. Among 1,894 patients included in the study, the mean age was 73±12.6 years, median length of stay was 5 (interquartile range 3-9) days, mortality rate was 7.8% (n=147), and 9% (n=170) required intensive care. Hospital spending totaled $19.8 million, with 63% ($12.5 million) spent on 20% of patients. Factors associated with highest costs for COPD care included intensive care unit admission (odds ratio [OR] 32.4; 95% confidence interval [CI] 20.3, 51.7), death in hospital (OR 2.6; 95% CI 1.3, 5.2), discharge to long-term care facility (OR 5.7; 95% CI 3.5, 9.2), and use of the alternate level of care designation during hospitalization (OR 23.5; 95% CI 14.1, 39.2). High hospital costs are driven by two distinct groups: patients who require acute medical treatment for severe illness and patients with functional limitation who require assisted living facilities upon discharge. Improving quality of care and reducing cost in this high-needs population require a strong focus on early recognition and management of functional impairment for patients living with chronic disease.
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Affiliation(s)
- Sunita Mulpuru
- Clinical Epidemiology Program, Ottawa Hospital Research Institute; Department of Medicine, University of Ottawa, Ottawa, ON
| | - Jennifer McKay
- Clinical Epidemiology Program, Ottawa Hospital Research Institute
| | - Paul E Ronksley
- Department of Community Health Sciences, University of Calgary, Calgary, AB
| | - Kednapa Thavorn
- Clinical Epidemiology Program, Ottawa Hospital Research Institute; Institute of Clinical and Evaluative Sciences, Toronto; School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Daniel M Kobewka
- Clinical Epidemiology Program, Ottawa Hospital Research Institute; Department of Medicine, University of Ottawa, Ottawa, ON
| | - Alan J Forster
- Clinical Epidemiology Program, Ottawa Hospital Research Institute; Department of Medicine, University of Ottawa, Ottawa, ON
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16
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Lucke T, Herrera R, Wacker M, Holle R, Biertz F, Nowak D, Huber RM, Söhler S, Vogelmeier C, Ficker JH, Mückter H, Jörres RA. Systematic Analysis of Self-Reported Comorbidities in Large Cohort Studies - A Novel Stepwise Approach by Evaluation of Medication. PLoS One 2016; 11:e0163408. [PMID: 27792735 PMCID: PMC5085029 DOI: 10.1371/journal.pone.0163408] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 09/08/2016] [Indexed: 01/22/2023] Open
Abstract
Objective In large cohort studies comorbidities are usually self-reported by the patients. This way to collect health information only represents conditions known, memorized and openly reported by the patients. Several studies addressed the relationship between self-reported comorbidities and medical records or pharmacy data, but none of them provided a structured, documented method of evaluation. We thus developed a detailed procedure to compare self-reported comorbidities with information on comorbidities derived from medication inspection. This was applied to the data of the German COPD cohort COSYCONET. Methods Approach I was based solely on ICD10-Codes for the diseases and the indications of medications. To overcome the limitations due to potential non-specificity of medications, Approach II was developed using more detailed information, such as ATC-Codes specific for one disease. The relationship between reported comorbidities and medication was expressed by a four-level concordance score. Results Approaches I and II demonstrated that the patterns of concordance scores markedly differed between comorbidities in the COSYCONET data. On average, Approach I resulted in more than 50% concordance of all reported diseases to at least one medication. The more specific Approach II showed larger differences in the matching with medications, due to large differences in the disease-specificity of drugs. The highest concordance was achieved for diabetes and three combined cardiovascular disorders, while it was substantial for dyslipidemia and hyperuricemia, and low for asthma. Conclusion Both approaches represent feasible strategies to confirm self-reported diagnoses via medication. Approach I covers a broad spectrum of diseases and medications but is limited regarding disease-specificity. Approach II uses the information from medications specific for a single disease and therefore can reach higher concordance scores. The strategies described in a detailed and reproducible manner are generally applicable in large studies and might be useful to extract as much information as possible from the available data.
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Affiliation(s)
- Tanja Lucke
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital LMU Munich, München, Germany
- Comprehensive Pneumology Center Munich, DZL, German Center for Lung Research, München, Germany
- * E-mail:
| | - Ronald Herrera
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital LMU Munich, München, Germany
- Center for International Health, Ludwig-Maximilian University Munich, München, Germany
| | - Margarethe Wacker
- German Research Center for Environmental Health, Institute of Health Economics and Health Care Management, Member of the German Center for Lung Research, Comprehensive Pneumology Center Munich (CPC-M), Neuherberg, Germany
| | - Rolf Holle
- German Research Center for Environmental Health, Institute of Health Economics and Health Care Management, Member of the German Center for Lung Research, Comprehensive Pneumology Center Munich (CPC-M), Neuherberg, Germany
| | - Frank Biertz
- Institute for Biostatistics, Hannover Medical School, Hannover, Germany
| | - Dennis Nowak
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital LMU Munich, München, Germany
- Comprehensive Pneumology Center Munich, DZL, German Center for Lung Research, München, Germany
| | - Rudolf M. Huber
- Comprehensive Pneumology Center Munich, DZL, German Center for Lung Research, München, Germany
- Thoracic Oncology Center Munich (TOM), University Hospital LMU Munich, München, Germany
| | - Sandra Söhler
- Pulmonary and Critical Care Medicine, Department of Medicine, University Medical Centre Giessen and Marburg, Philipps-University, Marburg, Germany
| | - Claus Vogelmeier
- Pulmonary and Critical Care Medicine, Department of Medicine, University Medical Centre Giessen and Marburg, Philipps-University, Marburg, Germany
| | - Joachim H. Ficker
- Department of Respiratory Medicine, Allergology and Sleep Medicine, Klinikum Nuremberg, Nürnberg, Germany
- Paracelsus Medical University Nuremberg, Nürnberg, Germany
| | - Harald Mückter
- Walther-Straub-Institute for Pharmacology and Toxicology, Ludwig-Maximilian University Munich, München, Germany
| | - Rudolf A. Jörres
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital LMU Munich, München, Germany
- Comprehensive Pneumology Center Munich, DZL, German Center for Lung Research, München, Germany
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Caram LMDO, Ferrari R, Naves CR, Coelho LS, do Vale SA, Tanni SE, Godoy I. Risk factors for cardiovascular disease in patients with COPD: mild-to-moderate COPD versus severe-to-very severe COPD. J Bras Pneumol 2016; 42:179-84. [PMID: 27383930 PMCID: PMC5569610 DOI: 10.1590/s1806-37562015000000121] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 01/03/2016] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To assess and compare the prevalence of comorbidities and risk factors for cardiovascular disease (CVD) in COPD patients according to disease severity. METHODS The study included 25 patients with mild-to-moderate COPD (68% male; mean age, 65 ± 8 years; mean FEV1, 73 ± 15% of predicted) and 25 with severe-to-very severe COPD (males, 56%; mean age, 69 ± 9 years; mean FEV1, 40 ± 18% of predicted). Comorbidities were recorded on the basis of data obtained from medical charts and clinical evaluations. Comorbidities were registered on the basis of data obtained from medical charts and clinical evaluations. The Charlson comorbidity index was calculated, and the Hospital Anxiety and Depression Scale (HADS) score was determined. RESULTS Of the 50 patients evaluated, 38 (76%) had been diagnosed with at least one comorbidity, 21 (42%) having been diagnosed with at least one CVD. Twenty-four patients (48%) had more than one CVD. Eighteen (36%) of the patients were current smokers, 10 (20%) had depression, 7 (14%) had dyslipidemia, and 7 (14%) had diabetes mellitus. Current smoking, depression, and dyslipidemia were more prevalent among the patients with mild-to-moderate COPD than among those with severe-to-very severe COPD (p < 0.001, p = 0.008, and p = 0.02, respectively). The prevalence of high blood pressure, diabetes mellitus, alcoholism, ischemic heart disease, and chronic heart failure was comparable between the two groups. The Charlson comorbidity index and HADS scores did not differ between the groups. CONCLUSIONS Comorbidities are highly prevalent in COPD, regardless of its severity. Certain risk factors for CVD, themselves classified as diseases (including smoking, dyslipidemia, and depression), appear to be more prevalent in patients with mild-to-moderate COPD. OBJETIVO Avaliar e comparar a prevalência de comorbidades e de fatores de risco de doença cardiovascular (DCV) em pacientes com DPOC de acordo com a gravidade da doença. MÉTODOS O estudo incluiu 25 pacientes com DPOC leve/moderada (homens: 68%; média de idade: 65 ± 8 anos; média de VEF1: 73 ± 15% do previsto) e 25 com DPOC grave/muito grave (homens: 56%; média de idade: 69 ± 9 anos; média de VEF1, 40 ± 18% do previsto). As comorbidades foram registradas com base nos dados dos prontuários médicos e avaliações clínicas. O índice de comorbidades de Charlson foi calculado, e a pontuação na Hospital Anxiety and Depression Scale (HADS) foi determinada. RESULTADOS Dos 50 pacientes avaliados, 38 (76%) receberam diagnóstico de pelo menos uma comorbidade, sendo que 21 (42%) receberam diagnóstico de pelo menos uma DCV. Vinte e quatro pacientes (48%) apresentavam mais de uma DCV. Dezoito pacientes (36%) eram fumantes, 10 (20%) tinham depressão, 7 (14%) apresentavam dislipidemia, e 7 (14%) tinham diabetes mellitus. Tabagismo atual, depressão e dislipidemia foram mais prevalentes nos pacientes com DPOC leve/moderada que naqueles com DPOC grave/muito grave (p < 0,001, p = 0,008 e p = 0,02, respectivamente). A prevalência de pressão arterial elevada, diabetes mellitus, alcoolismo, doença isquêmica do coração e insuficiência cardíaca crônica foi semelhante nos dois grupos. O índice de comorbidades de Charlson e a pontuação na HADS não diferiram entre os grupos. CONCLUSÕES Comorbidades são muito prevalentes na DPOC, independentemente da gravidade da doença. Certos fatores de risco de DCV, eles próprios considerados doenças (incluindo tabagismo, dislipidemia e depressão), parecem ser mais prevalentes nos pacientes com DPOC leve/moderada.
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Affiliation(s)
- Laura Miranda de Oliveira Caram
- . Departamento de Medicina Interna, Área de Pneumologia, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu (SP) Brasil
| | - Renata Ferrari
- . Departamento de Medicina Interna, Área de Pneumologia, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu (SP) Brasil
| | - Cristiane Roberta Naves
- . Departamento de Medicina Interna, Área de Pneumologia, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu (SP) Brasil
| | - Liana Sousa Coelho
- . Departamento de Medicina Interna, Área de Pneumologia, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu (SP) Brasil
| | - Simone Alves do Vale
- . Departamento de Medicina Interna, Área de Pneumologia, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu (SP) Brasil
| | - Suzana Erico Tanni
- . Departamento de Medicina Interna, Área de Pneumologia, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu (SP) Brasil
| | - Irma Godoy
- . Departamento de Medicina Interna, Área de Pneumologia, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu (SP) Brasil
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Denguezli M, Daldoul H, Harrabi I, Gnatiuc L, Coton S, Burney P, Tabka Z. COPD in Nonsmokers: Reports from the Tunisian Population-Based Burden of Obstructive Lung Disease Study. PLoS One 2016; 11:e0151981. [PMID: 27010214 PMCID: PMC4807055 DOI: 10.1371/journal.pone.0151981] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 03/07/2016] [Indexed: 01/17/2023] Open
Abstract
Background It’s currently well known that smoking and increasing age constitute the most important risk factors for chronic obstructive pulmonary disease (COPD). However, little is known about COPD among nonsmokers. The present study aimed to investigate prevalence, risk factors and the profiles of COPD among nonsmokers based on the Tunisian Burden of Obstructive Lung Disease (BOLD) study. Methods 807 adults aged 40 years+ were randomly selected from the general population. We collected information about history of respiratory disease, risk factors for COPD and quality of life. Post-bronchodilator spirometry was performed for assessment of COPD. COPD diagnostic was based on the post-bronchodilator FEV1/FVC ratio, according to the Global Initiative for Obstructive Lung Disease (GOLD) guidelines. The lower limit of normal (LLN) was determined as an alternative threshold for the FEV1/FVC ratio. Results and Conclusions Among 485 nonsmokers, 4.7% met the criteria for GOLD grade I and higher COPD. These proportions were similar even when the LLN was used as a threshold. None of the nonsmokers with COPD reported a previous doctor diagnosis of COPD compared to 7.1% of smokers. Nonsmokers accounted for 45.1% of the subjects fulfilling the GOLD spirometric criteria of COPD. Nonsmokers were predominately men and reported more asthma problems than obstructed smokers. Among nonsmokers significantly more symptoms and higher co-morbidity were found among those with COPD. Increasing age, male gender, occupational exposure, lower body mass index and a previous diagnosis of asthma are associated with increased risk for COPD in nonsmokers. This study confirms previous evidence that nonsmokers comprise a substantial proportion of individuals with COPD. Nonsmokers with COPD have a specific profile and should, thus, receive far greater attention to prevent and treat chronic airway obstruction.
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Affiliation(s)
- Meriam Denguezli
- Laboratory of Physiology, Faculty of Medicine Ibn El Jazzar, Sousse, Tunisia
- * E-mail:
| | - Hager Daldoul
- Laboratory of Physiology, Faculty of Medicine Ibn El Jazzar, Sousse, Tunisia
| | - Imed Harrabi
- Department of Epidemiology, University Hospital Farhat Hached, Sousse, Tunisia
| | - Louisa Gnatiuc
- National Heart and Lung Institute, Imperial College London, Royal Brompton Campus, London, United Kingdom
| | - Sonia Coton
- National Heart and Lung Institute, Imperial College London, Royal Brompton Campus, London, United Kingdom
| | - Peter Burney
- National Heart and Lung Institute, Imperial College London, Royal Brompton Campus, London, United Kingdom
| | - Zouhair Tabka
- Laboratory of Physiology, Faculty of Medicine Ibn El Jazzar, Sousse, Tunisia
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Abstract
Chronic obstructive pulmonary disease (COPD), characterized by chronic airways inflammation and progressive airflow limitation, is a common, preventable and treatable disease. Worldwide, COPD is a major cause of morbidity and mortality; smoking tobacco is the most important risk factor. This translational review of recent updates in COPD care for the primary care audience, includes recommendations from the 2015 Global Initiative for chronic obstructive lung disease (GOLD) report on diagnosis, pharmacological and non-pharmacological treatment, prevalence of comorbidities, management of exacerbations and the asthma and COPD overlap syndrome, with a focus on the importance and benefit of physical activity and exercise in COPD patients. Exacerbations and comorbidities contribute to the overall severity of COPD in individual patients. Management of exacerbations includes reducing the impact of the current exacerbation and preventing development of subsequent episodes. Healthcare professionals need to be alert to comorbidities, such as cardiovascular disease, anxiety/depression, lung cancer, infections and diabetes, which are common in COPD patients and can have a significant impact on HRQoL and prognosis. Pulmonary rehabilitation is recommended by a number of guidelines for all symptomatic COPD patients, regardless of severity, and involves exercise training, patient education, nutritional advice and psychosocial support. At all stages of COPD, regular physical activity and exercise can aid symptom control, improve HRQoL, reduce rates of hospitalization, and improve morbidity and respiratory mortality. Healthcare professionals play a pivotal role in improving HRQoL and health-related outcomes in COPD patients to meet their specific needs and in providing appropriate diagnosis, management and advice on smoking cessation.
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Affiliation(s)
- Christine Garvey
- a Department of Sleep Disorders and Pulmonary Rehabilitation, University of California San Francisco , San Francisco , CA , USA
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Affes Z, Rekik S, Ben Saad H. Defining obstructive ventilatory defect in 2015. Libyan J Med 2015; 10:28946. [PMID: 26452407 PMCID: PMC4600093 DOI: 10.3402/ljm.v10.28946] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 09/16/2015] [Accepted: 09/17/2015] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION There is no clear consensus as to what constitutes an obstructive ventilatory defect (OVD): Is it FEV1/FVC AIM To determine, according to the two definitions, the percentage of subjects having an OVD among them explored in a lung function exploration laboratory. POPULATION AND METHODS This is a retrospective study including 4,730 subjects aged 17-85 years. Subjects were divided according to the presence [physio (+) or operat (+)] or absence [physio (-) or operat (-)] of an OVD, and into younger (<45 years, n=2,076), older (≥45 years, n=2,654), smokers (n=1,208), and non-smokers (n=3,522) groups. RESULTS For the total sample, the younger and older groups [mean±SD of age (years), respectively, 46.7±14.1; 33.9±7.4, and 56.8±9.1], the 'physiological definition' detected, respectively, 13.46, 43.22, and 5.09% more OVD than the 'operational one' (p<0.05). In addition, the operational definition, compared with the physiological one, overdiagnosed OVD in 2.33 and 0.44% of smokers and non-smokers, respectively, and underdiagnosed it in 4.46% and 29.72% of smokers and non-smokers, respectively (p<0.05). Compared with the group 'physio (-), operat (+)', the 'physio (+), operat (-)' one was younger (74.2±4.7 years vs. 40.9±10.3 years) and had significantly higher FEV1 (62±13% vs. 78±17%) and FVC (71±15% vs. 93±19%). CONCLUSION The frequency of OVD much depends on the criteria used for its definition.
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Affiliation(s)
- Zied Affes
- Department of Physiology and Functional Exploration, Farhat HACHED University Hospital of Sousse, Sousse, Tunisia
| | - Salaheddine Rekik
- Department of Physiology and Functional Exploration, Farhat HACHED University Hospital of Sousse, Sousse, Tunisia
| | - Helmi Ben Saad
- Department of Physiology and Functional Exploration, Farhat HACHED University Hospital of Sousse, Sousse, Tunisia
- Laboratory of Physiology, Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia
- Research Laboratory N° LR14ES05: Interactions of the Cardiopulmonary System, Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia;
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Park HJ, Leem AY, Lee SH, Song JH, Park MS, Kim YS, Kim SK, Chang J, Chung KS. Comorbidities in obstructive lung disease in Korea: data from the fourth and fifth Korean National Health and Nutrition Examination Survey. Int J Chron Obstruct Pulmon Dis 2015; 10:1571-82. [PMID: 26300636 PMCID: PMC4535560 DOI: 10.2147/copd.s85767] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Comorbidities can occur frequently in patients with chronic obstructive pulmonary disease (COPD) and can influence mortality and morbidity independently. It is increasingly recognized that many patients with COPD have comorbidities that have a major impact on their quality of life and survival. Therefore, we investigated the prevalence of comorbidities in Korean COPD populations. METHODS We used data obtained in the 6 years of the fourth and fifth Korean National Health and Nutrition Examination Survey (KNHANES) IV and V. Among 50,405 subjects, 16,151 subjects aged ≥40 years who performed spirometry adequately were included in this study. Airway obstruction was defined as forced expiratory volume in 1 second/forced vital capacity <0.7, and the Global Initiative For Chronic Obstructive Lung Disease stage was used to evaluate the severity of airway obstruction. Statistical analyses were performed using SAS 9.2. RESULTS Among the 16,151 subjects (43.2% male, 56.8% female; mean age: 57.1 years for men and 57.2 years for women), 13.1% had obstructive lung function; 11.3%, restrictive lung function; and 75.6%, normal lung function. Among individuals with obstructive lung function, 45.3%, 49.4%, and 5.3% had mild, moderate, and severe and very severe airflow limitation. The prevalence of hypertension, diabetes mellitus (DM), underweight, and hypertriglyceridemia was higher in the obstructive lung function group than in the normal lung function group (49.6% vs 35.2%; 16.8% vs 10.5%; 3.3% vs 1.3%; 19.7% vs 17.0%). According to the severity of airway obstruction, hypertension and underweight were more common as severity increased, although the prevalence of DM and hypertriglyceridemia was lower in subjects with severe airway obstruction. The prevalence of hypercholesterolemia, overweight, and osteoarthritis was lower in the obstructive lung function group, especially in the severe airway obstruction groups. CONCLUSIONS Overall, our analysis is similar to research that was conducted earlier. Our study showed that hypertension and underweight are common comorbidities in COPD patients, and are higher as the severity of airflow obstruction increased in both men and women. DM, hypertriglyceridemia, and low high-density lipoprotein cholesterol are more common in subjects with airway obstruction, although their incidence is lower in the severe group.
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Affiliation(s)
- Hee Jin Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Institute of Chest Disease, Yonsei University College of Medicine, Seoul, South Korea
| | - Ah Young Leem
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Institute of Chest Disease, Yonsei University College of Medicine, Seoul, South Korea
| | - Sang Hoon Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Institute of Chest Disease, Yonsei University College of Medicine, Seoul, South Korea
| | - Ju Han Song
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Institute of Chest Disease, Yonsei University College of Medicine, Seoul, South Korea
| | - Moo Suk Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Institute of Chest Disease, Yonsei University College of Medicine, Seoul, South Korea
| | - Young Sam Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Institute of Chest Disease, Yonsei University College of Medicine, Seoul, South Korea
| | - Se Kyu Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Institute of Chest Disease, Yonsei University College of Medicine, Seoul, South Korea
| | - Joon Chang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Institute of Chest Disease, Yonsei University College of Medicine, Seoul, South Korea
| | - Kyung Soo Chung
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Institute of Chest Disease, Yonsei University College of Medicine, Seoul, South Korea
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Dal Negro RW, Bonadiman L, Turco P. Prevalence of different comorbidities in COPD patients by gender and GOLD stage. Multidiscip Respir Med 2015; 10:24. [PMID: 26246895 PMCID: PMC4525744 DOI: 10.1186/s40248-015-0023-2] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 07/27/2015] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Several comorbidities frequently affect COPD progression. Aim of the study was to assess the prevalence of main comorbidities by gender and disease severity in a cohort of COPD patients referring for the first time to a specialist institution. METHODS The study was a non-interventional, cross-sectional investigation carried out via automatic and anonymous selection from the institutional data base over the period 2012-2015. Inclusion criteria were: subjects of both sex aged ≥40 years; diagnosis of COPD according to GOLD guidelines 2014; the availability of a complete clinical record file. Variables collected were: lung function; smoking history; BMI; the Charlson Comorbidity Index (CCI); number and kind of comorbidities for each patient. RESULTS At least one comorbidity of clinical relevance was found in 78.6 % of patients, but at least two in 68.8 %, and three or more were found in 47.9 % of subjects. Mean CCI was 3.4 ± 1.6sd. The overall prevalence was 2.6 comorbidities per patient, but 2.5 in males, and 3.0 in females, respectively (p < 0.05). Cardio-vascular disorders were the most frequent, but significantly more frequent in males (44.7 vs 30.7 %, respectively), while the metabolic, the digestive and the osteo-articular disorders were prevailing in females (12.4 vs 9.2; 14.2 vs 4.8, and 6.0 vs 3.8, respectively). In particular, chronic cor pumonale and arrhythmias mainly prevailed in men and congestive heart failure in females, while arterial hypertension resulted equally distributed. As concerning respiratory disorders, pneumonia, pleural effusions and chronic respiratory failure were more frequently found in men, while bronchiectasis and asthma-COPD overlap syndrome (ACOS) in females. Anaemia, gall bladder stones, osteoporosis and spontaneous fractures mostly prevailed in females, while gastric disorders of inflammatory origin and arthrosis were more frequent in males. Cognition disorders, dementia and signs of degenerative brain disorders were more frequently found in men, while depression in females. Finally, lung cancer was at the first place in men, but at the second in females. CONCLUSIONS All comorbidities increased their prevalence progressively up to the last stage of COPD severity, except the cardio-vascular and the metabolic ones which dropped in the IV GOLD stage, presumably due to the high mortality rate in this severe COPD stage. The gender-dependency of comorbidities was confirmed in general terms, even if lung cancer proved a dramatic increase almost independently of sex.
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Affiliation(s)
- R. W. Dal Negro
- />National Centre for Respiratory Pharmacoeconomics and Pharmacoepidemiology, CESFAR, Verona, Italy
- />CEMS, Specialist Medical Centre, Verona, Italy
| | | | - P. Turco
- />Research & Clinical Governance, Verona, Italy
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Assessment of the internal structure of GOLD 2011 system. Pulm Pharmacol Ther 2015; 30:87-92. [DOI: 10.1016/j.pupt.2014.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 12/13/2014] [Accepted: 12/18/2014] [Indexed: 11/21/2022]
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