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Albarqouni L, Palagama S, Chai J, Sivananthajothy P, Pathirana T, Bakhit M, Arab-Zozani M, Ranakusuma R, Cardona M, Scott A, Clark J, Smith CF, Effa E, Ochodo E, Moynihan R. Overuse of medications in low- and middle-income countries: a scoping review. Bull World Health Organ 2023; 101:36-61D. [PMID: 36593777 PMCID: PMC9795388 DOI: 10.2471/blt.22.288293] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 08/09/2022] [Accepted: 08/10/2022] [Indexed: 01/04/2023] Open
Abstract
Objective To identify and summarize the evidence about the extent of overuse of medications in low- and middle-income countries, its drivers, consequences and potential solutions. Methods We conducted a scoping review by searching the databases PubMed®, Embase®, APA PsycINFO® and Global Index Medicus using a combination of MeSH terms and free text words around overuse of medications and overtreatment. We included studies in any language published before 25 October 2021 that reported on the extent of overuse, its drivers, consequences and solutions. Findings We screened 3489 unique records and included 367 studies reporting on over 5.1 million prescriptions across 80 low- and middle-income countries - with studies from 58.6% (17/29) of all low-, 62.0% (31/50) of all lower-middle- and 60.0% (33/55) of all upper-middle-income countries. Of the included studies, 307 (83.7%) reported on the extent of overuse of medications, with estimates ranging from 7.3% to 98.2% (interquartile range: 30.2-64.5). Commonly overused classes included antimicrobials, psychotropic drugs, proton pump inhibitors and antihypertensive drugs. Drivers included limited knowledge of harms of overuse, polypharmacy, poor regulation and financial influences. Consequences were patient harm and cost. Only 11.4% (42/367) of studies evaluated solutions, which included regulatory reforms, educational, deprescribing and audit-feedback initiatives. Conclusion Growing evidence suggests overuse of medications is widespread within low- and middle-income countries, across multiple drug classes, with few data of solutions from randomized trials. Opportunities exist to build collaborations to rigorously develop and evaluate potential solutions to reduce overuse of medications.
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Affiliation(s)
- Loai Albarqouni
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, 14 University Dr, Robina, QLD, 4229, Australia
| | - Sujeewa Palagama
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, 14 University Dr, Robina, QLD, 4229, Australia
| | - Julia Chai
- Cumming School of Medicine, University of Calgary, Alberta, Canada
| | | | - Thanya Pathirana
- School of Medicine and Dentistry, Griffith University, Sunshine Coast, Australia
| | - Mina Bakhit
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, 14 University Dr, Robina, QLD, 4229, Australia
| | - Morteza Arab-Zozani
- Social Determinants of Health Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | - Respati Ranakusuma
- Clinical Epidemiology and Evidence-Based Medicine Unit, Dr Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Magnolia Cardona
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, 14 University Dr, Robina, QLD, 4229, Australia
| | - Anna Scott
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, 14 University Dr, Robina, QLD, 4229, Australia
| | - Justin Clark
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, 14 University Dr, Robina, QLD, 4229, Australia
| | | | - Emmanuel Effa
- Department of Internal Medicine, University of Calabar, Calabar, Nigeria
| | - Eleanor Ochodo
- Centre for Global Health Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Ray Moynihan
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, 14 University Dr, Robina, QLD, 4229, Australia
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Gunen H, Kokturk N, Naycı S, Ozkaya S, Yıldız BP, Turan O, Gumus A, Akgun M, Gurgun A, Ogus C, Mirici A, Sen E, Bayram N, Eken V, Erkus H. The CO-MIND Study: Chronic Obstructive Pulmonary Disease Management in Daily Practice and Its Implications for Improved Outcomes According to GOLD 2019 Perspective. Int J Chron Obstruct Pulmon Dis 2022; 17:1883-1895. [PMID: 36003323 PMCID: PMC9394660 DOI: 10.2147/copd.s372439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 08/02/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose GOLD 2019 proposed a novel treatment decision tool for follow-up based on the predominant trait (exacerbation or dyspnea) of patients, alongside treatment escalation and de-escalation strategies. This study was designed to provide an up-to-date snapshot of patient and disease characteristics, treatment pathways, and healthcare resource use (HRU) in COPD in real life, and comprehensively examine patients considering GOLD 2019 recommendations. Patients and Methods This mixed design, observational, multicenter (14 pulmonology clinics) study included all patients with a documented COPD diagnosis (excluding asthma-COPD overlap [ACO]) for ≥12 months, aged ≥40 years at diagnosis who had a COPD-related hospital visit, spirometry test and blood eosinophil count (BEC) measurement under stable conditions within the 12 months before enrollment between February and December 2020. Data were collected cross-sectionally from patients and retrospectively from hospital medical records. Results This study included 522 patients (GOLD group A: 17.2%, B: 46.4%, C: 3.3%, D: 33.1%), of whom 79.5% were highly symptomatic and 36.2% had high risk of exacerbation. Exacerbations (n = 832; 46.6% moderate, 25.5% severe) were experienced by 57.5% of patients in the previous 12 months. Inter-rater agreement between investigators and patients regarding the reason for visit was low (κ coefficient: 0.338, p = 0.001). Inhaled treatment was modified in 88 patients at index, mainly due to symptomatic state (31.8%) and exacerbations (27.3%); treatment was escalated (57.9%, mainly switched to LABA+LAMA+ICS), inhaler device and/or active ingredient was changed (36.4%) or treatment was de-escalated (5.7%). 27% had ≥1 hospital overnight stay over 12 months. Emergency department visits and days with limitation of daily activities were higher in group D (p < 0.001). Conclusion Despite being on-treatment, many patients with COPD experience persistent symptoms and exacerbations requiring hospital-related HRU. A treatable trait approach and holistic disease management may improve outcomes by deciding the right treatment for the right patient at the right time.
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Affiliation(s)
- Hakan Gunen
- Department of Pulmonary Medicine, Sureyyapasa Training and Research Centre for Chest Diseases and Thoracic Surgery, Istanbul, Turkey
| | - Nurdan Kokturk
- Department of Pulmonary Medicine, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Sibel Naycı
- Department of Pulmonary Medicine, Mersin University School of Medicine, Mersin, Turkey
| | - Sevket Ozkaya
- Department of Pulmonary Medicine, VM Medical Park Samsun Hospital, Samsun, Turkey
| | - Birsen Pınar Yıldız
- University of Health Sciences, Yedikule Chest Disease and Surgery Training and Research Hospital, Pulmonology, Istanbul, Turkey
| | - Onur Turan
- Department of Pulmonary Medicine, Izmir Katip Çelebi University, İzmir, Turkey
| | - Aziz Gumus
- Department of Pulmonary Medicine, Recep Tayyip Erdogan University, Faculty of Medicine, Rize, Turkey
| | - Metin Akgun
- Department of Pulmonary Medicine, Atatürk University School of Medicine, Erzurum, Turkey
| | - Alev Gurgun
- Department of Pulmonary Medicine, Ege University School of Medicine, İzmir, Turkey
| | - Candan Ogus
- Department of Pulmonary Medicine, Akdeniz University Medical Faculty, Antalya, Turkey
| | - Arzu Mirici
- Department of Pulmonary Medicine, Canakkale 18 Mart University, Canakkale, Turkey
| | - Elif Sen
- Department of Pulmonary Medicine, Ankara University School of Medicine, Ankara, Turkey
| | - Nazan Bayram
- Department of Pulmonary Medicine, Gaziantep University, Sahinbey Research Hospital, Gaziantep, Turkey
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What Are the Most Effective Factors in Determining Future Exacerbations, Morbidity Weight, and Mortality in Patients with COPD Attack? Medicina (B Aires) 2022; 58:medicina58020163. [PMID: 35208487 PMCID: PMC8880362 DOI: 10.3390/medicina58020163] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 01/14/2022] [Accepted: 01/19/2022] [Indexed: 01/08/2023] Open
Abstract
Background and Objectives: This study aimed to investigate the important factors that affect COPD prognosis. Materials and Methods: We included 160 hospitalized patients with COPD exacerbation in the study. The hemoglobin (HB), hematocrit (HCT), leukocytes, red cell distribution width (RDW), mean platelet volume, platelet distribution width, plateletcrits, platelets, neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, eosinophils, uric acid, albumin, C-reactive protein (CRP), procalcitonin, arterial blood gases (PO2 and PCO2), pulmonary function test (FEV1 and FVC), echocardiography (ejection fraction-EF), Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage, Modified Medical Research Council (mMRC) and Borg scales, Charlson comorbidity index, body mass index (BMI), and the length of hospital stay were examined on the first day of hospitalization. Admission to the hospital with a new attack, hospitalization in the intensive care unit (ICU), and mortality during the six months after discharge were evaluated. Results: High CRP and procalcitonin levels were observed in the group with a long hospital stay. In the mortality group, the HB, HCT, BMI, and PO2 values were significantly lower than in the group without mortality, while the age and GOLD stage were higher. The age, Borg and mMRC scores, number of exacerbations experienced in the previous year, RDW, eosinophil count, and PCO2 were significantly higher in the ICU group than that without an ICU stay. The HCT and EF values were lower in the ICU group than that without an ICU stay. The FEV1 and FVC values were significantly lower in the follow-up attack group than those without a follow-up attack. The duration of COPD and the number of attacks that were experienced in the previous year were high. Conclusion: Scoring combining selected biomarkers and other factors is a strong determinant of the prognosis.
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Dai Z, Zeng H, Cui Y, Chen P, Chen Y. Subgroup analysis reveals higher reliability of the new comprehensive evaluation of Global Initiative for Chronic Obstructive Lung Disease 2019. Sci Rep 2022; 12:757. [PMID: 35031681 PMCID: PMC8760288 DOI: 10.1038/s41598-021-04756-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 12/22/2021] [Indexed: 11/17/2022] Open
Abstract
To estimate the severity of the disease in outpatients with chronic obstructive pulmonary disease (COPD) in Hunan Province, China and use the subgroup analysis to evaluate the reliability of the new comprehensive evaluation of Global Initiative for Chronic Obstructive Lung Disease (GOLD). COPD outpatients from 12 medical centers in Hunan Province, China were stratified into groups A–D, and group D patients were further stratified into subgroups D1–D3 according to the GOLD 2016 and 2019 comprehensive assessment. Demography, clinical characteristics and medications were compared among groups. In 1017 COPD outpatients, the distribution from group A to D and subgroup D1 to D3 was 41 (4.0%), 249 (24.5%), 17 (1.7%), 710 (69.8%) and 214 (30.2%), 204 (28.7%), 292 (41.1%), according to GOLD 2016. In terms of demographic and clinical characteristics related to A–D groups, there was a significant difference in COPD assessment test (CAT), modified Medical British Research Council (mMRC), the clinical COPD questionnaire(CCQ), age, BMI, education level, smoking history, comorbidities, the course of chronic bronchitis/emphysema, number of exacerbations/hospitalisations in the previous year, treatment protocols, forced expiratory volume in one second (FEV1) % predicted, and FEV1/forced vital capacity (FVC) (p < 0.01). Furthermore, some patients in groups C–D regrouped to groups A–B were all C1 and D1 subgroups according to GOLD 2019. Comparing subgroup D1 with group B, subgroup D2 and subgroup D3, it was found that the demography, clinical characteristics and medications of subgroup D1 were the closest to group B, according to GOLD 2016 (p < 0.01). The disease severity of outpatients with COPD in Hunan Province was more pronounced in group B and D and patients in groups A–D had different demography, clinical characteristics and medications. Subgroup analysis can explain to a certain extent that GOLD2019’s new comprehensive assessment is more reliable than GOLD 2016.
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Affiliation(s)
- Zhongshang Dai
- Second Xiangya Hospital of Central South University, Changsha, China.
| | - Huihui Zeng
- Second Xiangya Hospital of Central South University, Changsha, China
| | - Yanan Cui
- Second Xiangya Hospital of Central South University, Changsha, China
| | - Ping Chen
- Second Xiangya Hospital of Central South University, Changsha, China.
| | - Yan Chen
- Second Xiangya Hospital of Central South University, Changsha, China.
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ODABAŞ ÖK, DOĞAN D, YILMAZ TE, ÖZKARA A. Evaluation of Adaptation to Guidelines on the Management of Chronic Obstructive Pulmonary Diseases in Family Medicine. KONURALP TIP DERGISI 2021. [DOI: 10.18521/ktd.905234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Candemir I. The narrative review of chronic obstructive pulmonary disease management in Turkey: medical treatment, pulmonary rehabilitation and endobronchial volume reduction. J Thorac Dis 2021; 13:3907-3917. [PMID: 34277080 PMCID: PMC8264693 DOI: 10.21037/jtd-20-2271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 04/25/2021] [Indexed: 11/15/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is one of the most common chronic diseases. In Turkey, the prevalence of COPD has been shown at rates of 9.1% to 19.1%, and COPD was found to be the third leading cause of mortality and eighth leading cause of disability. In several national multicentral studies, a high rate of non-adherence to pharmacologic treatment according to GOLD was found to be high, and the most commonly prescribed treatment was the triple regimen. The most important non-pharmacologic treatment of COPD is pulmonary rehabilitation (PR), which is also highly recommended in Turkey, but it is also underutilized, like in other countries. Awareness of healthcare professionals and patients should increase in Turkey. The recommendations in content and modality of programs are similar to international guidelines. Another non-pharmacologic treatment is endobronchial volume reduction (EBVR). Although there is limited number of studies about EBVR, in national reports, the importance of patient selection, method, close follow-up after intervention, and applications in experienced centers are emphasized to decrease the economic burden of this expensive treatment. There is still great need for further randomized studies about pharmacologic and non-pharmacologic treatment and additionally, a close collaboration between healthcare professionals, physicians, professional societies of pulmonology, planners of reimbursement system, patients, patient advocacy groups and the general public should be established.
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Affiliation(s)
- Ipek Candemir
- Ataturk Chest Disease and Chest Surgery Education and Research Hospital, Ankara, Turkey
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Baha A, Kokturk N. Physician's attitude against COPD guidelines and the choice of first-line treatment for COPD. Respir Med 2020; 176:106273. [PMID: 33271467 DOI: 10.1016/j.rmed.2020.106273] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 10/30/2020] [Accepted: 11/26/2020] [Indexed: 10/22/2022]
Abstract
AIM Our aim was to evaluate changes in attitudes of pulmonologists in Turkey towards COPD guidelines and their choice of first-line treatments for COPD patients. MATERIAL-METHOD 333 physicians who completed the questionnaire were included in this cross-sectional questionnaire study. The questionnaire contained demographic data, professional information, extent of guideline use, rationales behind using or not using a guideline. The data was compared with the same survey conducted previously in 2011 and was analyzed by appropriate statistical methods. RESULTS 80 physicians were resident pulmonologists (24%), 250 physicians were specialists (75.1%). 298 (89.5%) physicians reported that they follow at least one guideline for selection of the appropriate treatment in COPD. The current application of guidelines when compared with the first survey in 2011, was found to be decreased, 91.2% and 89.5%, respectively (p = 0.07). 46.8% (n = 156) of participants thought that guidelines provided the physicians more legal protection (p < 0.001). The number of physicians who didn't follow the guidelines due to workload increased over this period of time (36.8% in 2011, 85.3% in 2018, p < 0.001). The number of physicians using inhaler steroid combinations as their first choice of treatment was found to be similar with the previous survey (p = 0.909). CONCLUSION According to the results of previous questionnaire, the application of COPD guidelines has decreased. The number of pulmonologists who declared they have no time for following or applying guidelines has profoundly increased since 2011. Despite the warnings of these guidelines, the use of inhaler steroid combination as a first treatment option in COPD is still common.
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Affiliation(s)
- Ayse Baha
- Near East University Faculty of Medicine, Department of Pulmonary Medicine, Mersin-10, Turkey.
| | - Nurdan Kokturk
- Gazi University Faculty of Medicine, Department of Pulmonary Medicine, Ankara, Turkey
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Yazar EE, Yiğitbaş B, Niksarlıoğlu EY, Bayraktaroğlu M, Kul S. Is group C really needed as a separate group from D in COPD? A single-center cross-sectional study. Pulmonology 2020; 29:188-193. [PMID: 32753319 DOI: 10.1016/j.pulmoe.2020.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 05/28/2020] [Accepted: 06/10/2020] [Indexed: 10/23/2022] Open
Abstract
INTRODUCTION GOLD 2017 report proposed that the combined COPD assessment should be done according only to symptom burden and exacerbation history in the previous year. OBJECTIVE This study aims to investigate the change in the COPD groups after the GOLD 2017 revision and also to discuss the evaluation of group C and D as a single group after the GOLD 2019 report. METHOD The study was designed as a cross-sectional. 251 stable COPD patients admitted to our out-patient clinic; aged ≥40 years, at least one-year diagnosis of COPD and ≥10 pack-year smoking history were consecutively recruited for the study. RESULTS In GOLD 2017, a significant difference was found between the distribution of all groups compared to GOLD 2011 (P = 0,001). 31 patients included in group C were reclassified into group A and 37 patients in group D were reclassified into group B. The FEV1 values of group A and B patients were significantly low and group C and D patients had had exacerbations in more frequently the previous year in GOLD 2017 compared to GOLD 2011. CONCLUSION After the GOLD 2017 revision, the rate of group C patients decreased even more compared to GOLD 2011 and the group C and D may be considered as a single group in terms of the treatment recommendations with the GOLD 2019 revision. We think that future prospective studies are needed to support this suggestion.
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Affiliation(s)
- E E Yazar
- İstanbul Aydın University, Faculty of Medicine, Department of Chest Diseases, Küçükçekmece, Istanbul, 34295, Turkey.
| | - B Yiğitbaş
- Yedikule Chest Disease and Thorasic Surgery Training and Research Hospital, Zeytinburnu, Istanbul, TR 34100, Turkey
| | - E Y Niksarlıoğlu
- Yedikule Chest Disease and Thorasic Surgery Training and Research Hospital, Zeytinburnu, Istanbul, TR 34100, Turkey
| | - M Bayraktaroğlu
- İstanbul Aydın University, Faculty of Medicine, Department of Chest Diseases, Küçükçekmece, Istanbul, 34295, Turkey
| | - S Kul
- Seval KUL, School of Medicine, University of Gaziantep, Gaziantep, TR 27310, Turkey
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Maniscalco M, Martucci M, Fuschillo S, de Felice A, D'Anna SE, Cazzola M. A case scenario study on adherence to COPD GOLD recommendations by general practitioners in a rural area of southern Italy: The "progetto PADRE". Respir Med 2020; 170:105985. [PMID: 32843161 DOI: 10.1016/j.rmed.2020.105985] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 04/07/2020] [Accepted: 04/19/2020] [Indexed: 01/19/2023]
Abstract
The aim of the present study was to evaluate in a sample of 200 patients diagnosed with COPD and selected from the physician database of 15 general practices from Valle Telesina (Benevento, Italy) if the diagnostic-therapeutic algorithm adopted by GPs operating in a non-urban district in Southern Italy adhered to GOLD 2018 recommendations for COPD. Each patient underwent a specialist visit by an experienced chest physician that collected anamnesis, assessed mMRC and CAT scores, and performed a spirometry. In case of diagnostic doubt, a second visit was performed at the Pulmonary Rehabilitation Unit of the Istituti Clinici Scientifici Maugeri IRCCS in Telese Terme where other diagnostic tests were performed. Our results showed that GPs participating in the study often diagnosed and empirically treated COPD without a confirmative spirometry or even despite a spirometry that was not diagnostic of obstructive lung disease. Furthermore, real-life implementation of GOLD strategy, as regards patients' ABCD categorization, was poor and many patients belonging to groups A and B (39% and 48%, respectively) were over-treated and 19% of those belonging to group D were under-treated. The discrepancy between guidelines and daily clinical practice present also in this study supports the opinion of many that those who develop guidelines for the management of COPD must seriously try to understand if and why the guidelines might not reflect real life and therefore how it could be improved.
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Affiliation(s)
- Mauro Maniscalco
- Pulmonary Rehabilitation Unit, ICS Maugeri SpA, IRCCS, Telese Terme (Benevento), Italy
| | - Michele Martucci
- Pulmonary Rehabilitation Unit, ICS Maugeri SpA, IRCCS, Telese Terme (Benevento), Italy
| | - Salvatore Fuschillo
- Pulmonary Rehabilitation Unit, ICS Maugeri SpA, IRCCS, Telese Terme (Benevento), Italy
| | - Alberto de Felice
- Pulmonary Rehabilitation Unit, ICS Maugeri SpA, IRCCS, Telese Terme (Benevento), Italy
| | | | - Mario Cazzola
- Respiratory Medicine Unit, Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy.
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Ozoglu Aytac S, Kilic SP, Ovayolu N. Effect of inhaler drug education on fatigue, dyspnea severity, and respiratory function tests in patients with COPD. PATIENT EDUCATION AND COUNSELING 2020; 103:709-716. [PMID: 31733985 DOI: 10.1016/j.pec.2019.11.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 10/30/2019] [Accepted: 11/04/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE This study was conducted to examine the effect of inhaler drug education on fatigue, dyspnea severity, and respiratory function tests in patients with chronic obstructive pulmonary disease (COPD). METHODS This randomized controlled study was conducted with a total of 85 patients treated at the chest diseases clinic and outpatient clinic of a state hospital. The data were collected using questionnaires, respiratory function tests, and the COPD and Asthma Fatigue Scale (CAFS) and Visual Analogue Scale (VAS-for dyspnea severity). RESULTS It was determined that after 4 weeks of inhaler drug education, the CAFS mean score decreased to 35.32 ± 14.36, the dyspnea severity mean score decreased to 4.76 ± 2.50, and the respiratory function tests mean scores increased to forced expiratory volume in 1 s (FEV1) = 58.83 ± 25.48, forced vital capacity (FVC) = 59.04 ± 19.19, and FEV1/FVC = 88.39 ± 21.59 in the intervention group (p < 0.05). No change was observed in the patients in the control group except for FEV1 and FVC mean scores (p > 0.05). CONCLUSION These results demonstrate that inhaler drug education can improve fatigue, dyspnea severity, and respiratory function tests of patients with COPD. PRACTICE IMPLICATIONS The training by nurses of every patient hospitalized in the clinic regarding inhaler drug therapy, and the regular checking of patients' way of using the inhaled drugs, will contribute to COPD management.
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Affiliation(s)
- Sema Ozoglu Aytac
- Gaziantep University, Şahinbey, Research and Application Hospital, Gaziantep, Turkey
| | - Serap Parlar Kilic
- İnonu University Faculty of Nursing, Department of Internal Medicine Nursing, Battalgazi/Malatya, 44000, Turkey.
| | - Nimet Ovayolu
- Gaziantep University Faculty of Health Sciences, Department of Internal Medicine Nursing, Gaziantep, Turkey
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ÖZDEMİR T, YILMAZ DEMİRCİ N, KILIÇ H, KOÇ O, KAYA A, ÖZTÜRK C. An epidemiologic study of physician-diagnosed chronic obstructive pulmonary disease in the Turkish population: COPDTURKEY-1. Turk J Med Sci 2020; 50:132-140. [PMID: 31759382 PMCID: PMC7080360 DOI: 10.3906/sag-1908-35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 11/24/2019] [Indexed: 11/23/2022] Open
Abstract
Background/aim Chronic obstructive pulmonary disease (COPD) is a common disease characterized by persistent airflow limitation and respiratory symptoms. It is a leading cause of morbidity and mortality all over the world. Our data on COPD in Turkey are limited. This study was intended to examine the epidemiologic characteristics of COPD in the Turkish population, between 2012 and 2016. Materials and methods This population-based, descriptive, surveillance study examined physician-diagnosed COPD prevalence, incidence, and mortality in Turkey. The database of the Social Security System of Turkey was scanned and ICD-10 J44.0-J44.9 codes for diagnostic and/ or therapeutic purposes were evaluated retrospectively. Results In 2016, there were 3,434,262 cases of COPD (56.2% men) in Turkey, and the mean age of patients was 61.62 ± 14.76 years. From 2012 to 2016, the annual overall prevalence rates of physician-diagnosed COPD rose from 4.3% to 5.8%, which was a 35.0% relative increase (P < 0.05). In women, this rate rose from 3.7% to 5.1% (38% increase), and in men, it rose from 4.9% to 6.7% (37% increase). During the study period, the overall incidence decreased from 8.5 per 1000 adults in 2012 to 6.3 per 1000 adults in 2016, representing a decrease of 26.6% (P < 0.001). The annual incidence rates of physician-diagnosed COPD decreased 25.4% in women and 27.9% in men. The overall mortality was 4.3% in 2012, and 4.2% in 2016. The mortality rate in women was 3.5% in 2012 and 3.7% in 2016, and 5% in 2012 and 4.7% in 2016 in men. The mean prevalence by region was 5.26% (range 3.79%–7.65%). The Black Sea region had the highest COPD prevalence. Conclusion COPD is a very common and serious cause of morbidity and mortality in Turkey, as it is worldwide. Current data will contribute to a better understanding of the epidemiologic dimension of COPD in our country.
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Affiliation(s)
- Tarkan ÖZDEMİR
- Department of Chest Diseases, University of Health Sciences, Dr. Abdurrahman Yurtaslan Ankara Oncology Research andTraining Hospital, AnkaraTurkey
| | | | - Hatice KILIÇ
- Department of Chest Diseases, School of Medicine, Yildirim Beyazit University, AnkaraTurkey
| | - Orhan KOÇ
- Department of Management, Social Security Institution, AnkaraTurkey
| | - Akın KAYA
- Department of Chest Diseases, Faculty of Medicine, Ankara University, AnkaraTurkey
| | - Can ÖZTÜRK
- Department of Chest Diseases, Faculty of Medicine, Gazi University, AnkaraTurkey
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Suerdem M, Gunen H, Akyildiz L, Cilli A, Ozlu T, Uzaslan E, Abadoglu O, Bayram H, Cimrin AH, Gemicioglu B, Misirligil Z. Demographic, Clinical and Management Characteristics of Newly Diagnosed COPD Patients in Turkey: A Real-Life Study. Int J Chron Obstruct Pulmon Dis 2020; 15:261-267. [PMID: 32103925 PMCID: PMC7010334 DOI: 10.2147/copd.s211838] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 08/15/2019] [Indexed: 11/23/2022] Open
Abstract
Purpose In order to determine the clinical and sociodemographic characteristics of newly diagnosed treatment-naïve asthma and COPD patients in Turkey, a multicenter study in 2012 was initiated . We aimed to investigate the characteristics and therapies of COPD patients in the original study in more detail. Patients and Methods This nation-wide, multicentric, non-interventional, prospective, real-life observational cohort study was conducted in 122 centers. The newly diagnosed patients were not receiving any treatment before the recruitment. Their general characteristics, the combined GOLD 2011 COPD categories and exacerbation histories were noted. The patients were followed up with 3 voluntary visits for 1 year. Their adherence to the inhaled treatment according to GOLD 2011 was evaluated during follow-up visits. Results The study included 776 COPD patients. Their mean age was 59.4±9.1 years, and 11.9% of the patients were female. 35.1% of the patients were in the GOLD 2011 C and D category. 12.6% are frequent exacerbators, and 52.8% had at least one comorbid condition. 71.8% overtreatment rate was detected. Their attendance rates for three follow-up visits became 55.9%, 32.9% and 18.7%, respectively. The adherence rate to the treatment was measured as 81.9%. Conclusion Although these patients were diagnosed for the first time, the GOLD C and D categories and frequent exacerbator phenotype were found at a high rate. They were usually prescribed an overtreatment regimen. We think that newly diagnosed COPD patients should be evaluated carefully, and best effort should be made to treat these patients in accordance with the recommendations of the major COPD guidelines.
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Affiliation(s)
- Mecit Suerdem
- Department of Chest Diseases, Faculty of Medicine, Selcuk University, Konya, Turkey
| | - Hakan Gunen
- Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Health Sciences University, Istanbul, Turkey
| | - Levent Akyildiz
- Department of Pulmonary Medicine, Memorial Dicle Hospital, Diyarbakır, Turkey
| | - Aykut Cilli
- Department of Chest Diseases, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Tevfik Ozlu
- Department of Chest Diseases, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Esra Uzaslan
- Department of Chest Diseases, Faculty of Medicine, Uludag University, Bursa, Turkey
| | - Oznur Abadoglu
- Private Office of Pulmonary and Allergic Diseases, Istanbul, Turkey
| | - Hasan Bayram
- Koc University Research Center for Translational Medicine (KUTTAM), Department of Pulmonary Medicine, Koc University School of Medicine, Istanbul, Turkey
| | - Arif Hikmet Cimrin
- Department of Chest Diseases, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Bilun Gemicioglu
- Department of Pulmonary Diseases, Faculty of Cerrahpasa Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Zeynep Misirligil
- Department of Pulmonary and Allergic Diseases, Ankara Liv Hospital, Ankara, Turkey
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Kokturk N, Abuharbid W, Albanna AS, Gunen H, Gurgun A, Khadadah M, Malvolti E, Soliman M, van Zyl-Smit R, Zidouni N, Alzaabi A. A Cross-Sectional Study in Patients with Severe COPD to Assess the Perception of Symptom Variability (COPVAR) in the Middle East and Africa. Int J Chron Obstruct Pulmon Dis 2020; 14:2959-2970. [PMID: 31908444 PMCID: PMC6929940 DOI: 10.2147/copd.s215859] [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] [Received: 05/15/2019] [Accepted: 11/11/2019] [Indexed: 01/04/2023] Open
Abstract
Purpose This study was performed to assess symptom variability and its impact on morning activities in stable patients with severe COPD in the Middle East and Africa (MEA) countries. Patients and methods Non-interventional, cross-sectional study (NCT03425760) in patients with severe COPD (GOLD 2015, C, or D categories). Symptom variability was assessed directly by interviewing the patient and using the Global Chest Symptoms Questionnaire (GCSQ). The impact on morning activities was assessed using the Capacity of Daily Living during the Morning (CDLM) and the Morning Activities and Symptoms Questionnaire (MASQ). Results A total of 3253 patients (mean±SD age: 64.1±9.5 years, 90.3% males) were enrolled. Overall, 81.6% and 83.4% of patients reported weekly and daily symptom variability, respectively. The number of exacerbations in the previous year, smoking cessation, and COPD GOLD D were the most consistent factors associated with symptom variability. The GCSQ score was significantly higher (p<0.001) in GOLD D than in GOLD C patients at each time during the day. In GOLD D, the mean (±SD) GCSQ score was higher at night (1.6±1.2, p<0.001) and in the morning (1.5±1.0, p<0.001) than in the afternoon (1.3±0.9), suggesting daytime variability of breathlessness and chest tightness. Overall, 60.0% of GOLD D patients (versus 13.6% GOLD C, p<0.0001) had difficulty getting out of bed due to COPD. Patients with symptom variability had significantly more difficulty to get out of bed, especially patients with chest tightness variability (p<0.0001) and wheezing variability (p<0.0001). The CDLM global score was significantly lower (p<0.0001) in GOLD D than in GOLD C patients (3.5±1.1 and 4.6 ± 3.5, respectively). Daily variability in chest tightness and wheezing was also significantly associated with CDLM scores (p<0.0001). Conclusion In MEA countries, patients with severe stable COPD reported significant daily and weekly symptom variability which affects morning activities, particularly in GOLD D patients.
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Affiliation(s)
- Nurdan Kokturk
- Department of Chest Diseases, Faculty of Medicine, Gazi University, Ankara, Turkey
| | | | - Amr S Albanna
- King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Hakan Gunen
- Clinic of Chest Diseases, Sureyyapasa Chest Diseases and Chest Surgery Training and Research Hospital, Istanbul, Turkey
| | - Alev Gurgun
- Department of Chest Diseases, Ege University Faculty of Medicine, Izmir, Turkey
| | - Mousa Khadadah
- Department of Medicine, Faculty of Medicine, Kuwait University, Jabriya, Kuwait
| | | | - Medhat Soliman
- Kasr El Aini Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Richard van Zyl-Smit
- University of Cape Town Lung Institute, Department of Medicine and Division of Pulmonology, Groote Schuur Hospital, Cape Town, South Africa
| | - Noureddine Zidouni
- Department of Pulmonology, University Hospital Issad Hassani, Béni Messous, Alger, Algeria
| | - Ashraf Alzaabi
- Respiratory Medicine Division, Zayed Military Hospital, Abu Dhabi, UAE
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14
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Cui Y, Dai Z, Luo L, Chen P, Chen Y. Classification and treatment of chronic obstructive pulmonary disease outpatients in China according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2017: comparison with GOLD 2014. J Thorac Dis 2019; 11:1303-1315. [PMID: 31179072 DOI: 10.21037/jtd.2019.03.99] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background In 2017, the Global Initiative for Chronic Obstructive Lung Disease (GOLD) proposed new classification criteria for patients with chronic obstructive pulmonary disease (COPD), which categorizes them into groups A-D based on risk of exacerbations and symptoms. The impact of the 2017 revisions on categorization and subsequent drug selection has been insufficiently studied in China. Methods This observational, multicenter, cross-sectional study recruited patients attending the outpatient clinics of 12 tertiary hospitals in China between April 2016 and July 2018. Patients were classified according to the GOLD 2014 and 2017 classification criteria and profiled based on categorization, demographics, clinical characteristics, and treatment regimens. Results In total, 1,278 COPD patients [mean age (±SD), 62.4±8.4 years; body mass index (BMI), 22.3±3.4 kg/m2] were included. According to the GOLD 2014 and 2017 classification criteria, the distribution in groups A-D was 58 (4.5%), 288 (22.5%), 28 (2.2%), 904 (70.7%) and 71 (5.6%), 573 (44.8%), 15 (1.2%), 619 (48.4%), respectively. Overall, 32% of patients in groups C-D were reclassified to groups A-B. Based on both GOLD 2014 and 2017, low BMI and education level were independent risk factors for high risk of exacerbation (i.e., being in groups C-D) (P<0.05). The patients who were reclassified from group D to B were younger and had fewer symptoms than those who remained in group D. The most frequently prescribed regimen was triple inhaled treatment (39.4%). Inhaled corticosteroids (ICS) were prescribed across all groups, and 205 (71.9%) of the 285 patients who were reclassified from group D to B were treated with ICS. Conclusions GOLD 2017 reclassified COPD patients to low-risk groups. The risk of exacerbation increased with decreased BMI or education levels. Overtreatment was observed in many patients, and physicians should reexamine treatment patterns for patients reclassified into low-risk groups.
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Affiliation(s)
- Yanan Cui
- Department of Respiratory Medicine, the Second Xiangya Hospital of Central South University, Changsha 410000, China
| | - Zhongshang Dai
- Department of Respiratory Medicine, the Second Xiangya Hospital of Central South University, Changsha 410000, China
| | - Lijuan Luo
- Department of Respiratory Medicine, the Second Xiangya Hospital of Central South University, Changsha 410000, China
| | - Ping Chen
- Department of Respiratory Medicine, the Second Xiangya Hospital of Central South University, Changsha 410000, China
| | - Yan Chen
- Department of Respiratory Medicine, the Second Xiangya Hospital of Central South University, Changsha 410000, China
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15
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Kilinc O, Konya A, Akgun M, Uzaslan E, Sayiner A. A case scenario study for the assessment of physician's behavior in the management of COPD: the WHY study. Int J Chron Obstruct Pulmon Dis 2018; 13:2751-2758. [PMID: 30233165 PMCID: PMC6130535 DOI: 10.2147/copd.s154616] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Purpose COPD diagnosis is mainly based on clinical judgment of physicians. Physicians do not also refer to COPD guidelines in their daily practice. This study aimed to assess attitudes of physicians regarding COPD diagnosis, treatment, and follow-up and to identify the factors influencing physicians’ decisions in clinical practice. Patients and methods Fifty physicians were selected from 12 EuroStat NUTS 2 regions and asked to assess seven fictitious case scenarios. The following five scenarios described patients with COPD: Case Global Initiative for Chronic Obstructive Lung Disease (GOLD) A-smoker and Case GOLD A-nonsmoker were previously undiagnosed patients presenting with dyspnea, Case GOLD D-smoker and GOLD B-exsmoker were COPD patients presenting with exacerbation, Case GOLD B-smoker was a previously diagnosed COPD patient with dyspnea in stable phase, Case asthma–COPD overlap syndrome, and Case obesity hypoventilation syndrome. Patients’ history, physical examination findings, pulmonary function tests, and X-ray images were prepared before the study by an experts’ committee and provided to the physicians upon their request, until they reached a final decision. The physicians completed a questionnaire including information about their clinical practices and institutions. Results According to the GOLD 2015 recommendations, of the physicians, 44% performed guideline-concordant diagnosis in the first five scenarios, who were all COPD patients, and 6% performed guideline-concordant diagnosis in all cases. There was a negative correlation between high workload and making a guideline-concordant diagnosis (P=0.038, rho =−0.417). Even when the physicians made a guideline-concordant diagnosis of COPD, only a minority (10%–22%) used the GOLD classification. Logistic regression analysis revealed that working in a tertiary health care center was a significant factor in favor of establishing a guideline-concordant diagnosis of COPD (P=0.029, OR =6.139 [95% CI: 1.20–31.32]). Conclusion Management of COPD patients in Turkey does not generally follow the GOLD criteria but is rather based on physicians’ clinical experience. Heavy workload appears to adversely affect the correctness of clinical decisions.
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Affiliation(s)
- Oguz Kilinc
- Department of Chest Diseases, Dokuz Eylül University Medical Faculty, Izmir, Turkey,
| | - Aylin Konya
- Department of Medical Management, Novartis Pharmaceuticals, Istanbul, Turkey
| | - Metin Akgun
- Department of Chest Diseases, Atatürk University Medical Faculty, Erzurum, Turkey
| | - Esra Uzaslan
- Department of Chest Diseases, Uludağ University Medical Faculty, Bursa, Turkey
| | - Abdullah Sayiner
- Department of Chest Diseases, Ege University Medical Faculty, Izmir, Turkey
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16
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Köktürk N, Gürgün A, Şen E, Kocabaş A, Polatlı M, Naycı SA, Çöplü L, Tellioğlu E, Elmas F, Erdinç E. The View of the Turkish Thoracic Society on the Report of the GOLD 2017 Global Strategy for the Diagnosis, Management, and Prevention of COPD. Turk Thorac J 2017; 18:57-64. [PMID: 29404162 PMCID: PMC5783082 DOI: 10.5152/turkthoracj.2017.060417] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 03/25/2017] [Indexed: 01/07/2023]
Abstract
Since the Global Initiative for Obstructive Lung Disease (GOLD) published its first guidelines on chronic obstructive pulmonary disease (COPD) in 2001, much has changed till 2017. Previous versions of GOLD guidelines mentioned the forced expiratory volume in one second (FEV1)-based approach for staging and treatment modalities. Since 2011, a composite multi-dimensional approach has been introduced to cover various aspects of the disease. Unfortunately, this approach was not found to be correlated with mortality as well as the FEV1-based approach, despite the fact that it was better for estimating exacerbation rates. Although this assessment tool has been considered as a big step in personalized medicine, the system was rather complex to use in daily practice. In 2017, GOLD introduced a major revision in many aspects of the disease. This mainly includes a revised assessment tool and treatment algorithm. This new ABCD algorithm has excluded spirometry for guiding pharmacological therapy. Treatment recommendations are mainly based on symptoms and exacerbation rates. Escalation and de-escalation strategies have been proposed for the first time. The spirometric measurement has only been retained to confirm the diagnosis and lead to nonpharmacological therapies. In this report, the Turkish Thoracic Society COPD assembly aimed to summarize and give an insight to the Turkish interpretation of GOLD 2017.
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Affiliation(s)
- Nurdan Köktürk
- Department of Pulmonary Medicine, Gazi University School of Medicine, Ankara, Turkey
| | - Alev Gürgün
- Department of Pulmonary Medicine, Ege University School of Medicine, İzmir, Turkey
| | - Elif Şen
- Department of Pulmonary Medicine, Ankara University School of Medicine, Ankara, Turkey
| | - Ali Kocabaş
- Department of Pulmonary Medicine, Çukurova University School of Medicine, Adana, Turkey
| | - Mehmet Polatlı
- Department of Pulmonary Medicine, Adnan Menderes University School of Medicine, Aydın, Turkey
| | - Sibel Atış Naycı
- Department of Pulmonary Medicine, Mersin University School of Medicine, Mersin, Turkey
| | - Lütfi Çöplü
- Department of Pulmonary Medicine, Hacettepe University School of Medicine, Ankara, Turkey
| | - Emel Tellioğlu
- Department of Pulmonary Medicine, Health Sciences University, İzmir Dr. Suat Seren Chest Diseases and Surgery Training and Research Hospital, İzmir, Turkey
| | - Funda Elmas
- Department of Pulmonary Medicine, Ege University School of Medicine, İzmir, Turkey
| | - Ertürk Erdinç
- Department of Pulmonary Medicine, Ege University School of Medicine, İzmir, Turkey
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17
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Gunen H, Kilinc O, Polatli M, Suerdem M, Uzaslan E. Modification of the GOLD recommendations for chronic obstructive pulmonary disease to broaden their usage in Turkey. Expert Rev Respir Med 2016; 10:625-8. [PMID: 27015415 DOI: 10.1586/17476348.2016.1171146] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Despite the introduction of numerous national and international COPD guidelines designed to provide clinicians with optimal evidence-based disease management strategies, COPD remains an underdiagnosed and poorly treated disease. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines recommend disease specific diagnosis and management strategies, and they are widely used internationally. In this short report we present the outcomes of a meeting of respiratory experts in Turkey who reviewed the GOLD guidelines and their applicability to the Turkish healthcare system. In particular, we were interested to investigate the possibility of developing a simplified version of the combined assessment model which we believe will be more acceptable to Turkish pulmonologists and will increase its use in everyday clinical practice.
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Affiliation(s)
- H Gunen
- a Department of Chest Disease , Ministry of Health, Süreyyapasa Research and Training Center for Chest Diseases and Thoracic Surgery , İstanbul , Turkey
| | - O Kilinc
- b Department of Chest Diseases, Faculty of Medicine , Dokuz Eylul University , Izmir , Turkey
| | - M Polatli
- c Department of Chest Diseases, Faculty of Medicine , Adnan Menderes University , Aydın , Turkey
| | - M Suerdem
- d Department of Chest Diseases, Faculty of Medicine , Selcuk University , Konya , Turkey
| | - E Uzaslan
- e Department of Chest Diseases, Faculty of Medicine , Uludag University , Bursa , Turkey
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