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de-Torres JP, Casanova C, Marín JM, Cabrera C, Marín M, Ezponda A, Cosio BG, Martínez C, Solanes I, Fuster A, Calle M, Peces-Barba G, Gotera C, Feu-Collado N, Marin A, Alcaide AB, Sangro M, Bastarrika G, Celli BR. Impact of Applying the Global Lung Initiative Criteria for Airway Obstruction in GOLD Defined COPD Cohorts: The BODE and CHAIN Experience. Arch Bronconeumol 2024; 60:10-15. [PMID: 37925245 DOI: 10.1016/j.arbres.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 09/26/2023] [Accepted: 10/05/2023] [Indexed: 11/06/2023]
Abstract
INTRODUCTION The Global Lung Function Initiative (GLI) has proposed new criteria for airflow limitation (AL) and recommends using these to interpret spirometry. The objective of this study was to explore the impact of the application of the AL GLI criteria in two well characterized GOLD-defined COPD cohorts. METHODS COPD patients from the BODE (n=360) and the COPD History Assessment In SpaiN (CHAIN) cohorts (n=722) were enrolled and followed. Age, gender, pack-years history, BMI, dyspnea, lung function measurements, exercise capacity, BODE index, history of exacerbations and survival were recorded. CT-detected comorbidities were registered in the BODE cohort. The proportion of subjects without AL by GLI criteria was determined in each cohort. The clinical, CT-detected comorbidity, and overall survival of these patients were evaluated. RESULTS In total, 18% of the BODE and 15% of the CHAIN cohort did not meet GLI AL criteria. In the BODE and CHAIN cohorts respectively, these patients had a high clinical burden (BODE≥3: 9% and 20%; mMRC≥2: 16% and 45%; exacerbations in the previous year: 31% and 9%; 6MWD<350m: 15% and 19%, respectively), and a similar prevalence of CT-diagnosed comorbidities compared with those with GLI AL. They also had a higher rate of long-term mortality - 33% and 22% respectively. CONCLUSIONS An important proportion of patients from 2 GOLD-defined COPD cohorts did not meet GLI AL criteria at enrolment, although they had a significant burden of disease. Caution must be taken when applying the GLI AL criteria in clinical practice.
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Affiliation(s)
- Juan P de-Torres
- Pulmonary Department, Clínica Universidad de Navarra, Pamplona, Spain; Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain.
| | - Ciro Casanova
- Pulmonary Department-Research Unit, Hospital Universitario Nuestra Señora de Candelaria, CIBERES, ISCIII, Universidad de La Laguna, Tenerife, Spain
| | - José M Marín
- Pulmonary Department, Hospital Universitario Miguel Servet, IIS Aragon & CIBERES, University of Zaragoza, Zaragoza, Spain
| | - Carlos Cabrera
- Pulmonary Department, Hospital Universitario Doctor Negrín, Las Palmas, Spain
| | - Marta Marín
- Pulmonary Department, Clínica Universidad de Navarra, Pamplona, Spain; Hospital Universitario Lozano Blesa, Zaragoza, Spain
| | - Ana Ezponda
- Radiology Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - Borja G Cosio
- Hospital Universitario Son Espases, Instituto de Investigación Sanitaria de Baleares (IdISBa), Palma, Mallorca, Spain; Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Cristina Martínez
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA-FINBA), Spain
| | - Ingrid Solanes
- Pulmonary Department, Hospital Santa Creu i Sant Pau, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Antonia Fuster
- Pulmonary Department, Hospital Universitario Son Llatzer, Palma de Mallorca, Spain
| | - Myriam Calle
- Department of Respiratory Medicine, Hospital Clínico San Carlos, Department of Medicine, School of Medicine, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Germán Peces-Barba
- Department of Respiratory Medicine, Hospital Universitario Fundación Jiménez Díaz, CIBERES, Madrid, Spain
| | - Carolina Gotera
- Department of Respiratory Medicine, Hospital Universitario Fundación Jiménez Díaz, CIBERES, Madrid, Spain
| | - Nuria Feu-Collado
- Pulmonary Department, Hospital Universitario Reina Sofía, Instituto Maimónides de Investigación Biomédica de Córdoba, Universidad de Córdoba, Córdoba, Spain
| | - Alicia Marin
- Pulmonary Department, Hospital Universitario German Trias y Pujol, Barcelona, Spain
| | - Ana Belén Alcaide
- Pulmonary Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - Matilde Sangro
- Pulmonary Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - Gorka Bastarrika
- Radiology Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - Bartolome R Celli
- Pulmonary Department, Brigham and Women's Hospital, Boston, MA, United States
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Palones E, Curto E, Pelegrí A, Arilla M, Solanes I, Crespo-Lessmann A. Erratum to "Iatrogenic Adrenal Insufficiency Following Post COVID-19 Organizing Pneumonia" [Archivos de Bronconeumologia 59 (2023) 63-65]. Arch Bronconeumol 2024; 60:69. [PMID: 38040573 PMCID: PMC10838013 DOI: 10.1016/j.arbres.2023.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2023]
Affiliation(s)
- Esther Palones
- Servicio de Neumología y Alergia, Hospital de la Santa Creu i Sant Pau, Institut de Recerca IIB Sant Pau, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Elena Curto
- Servicio de Neumología y Alergia, Hospital de la Santa Creu i Sant Pau, Institut de Recerca IIB Sant Pau, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Anna Pelegrí
- Servicio de Neumología y Alergia, Hospital de la Santa Creu i Sant Pau, Institut de Recerca IIB Sant Pau, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Marina Arilla
- Servicio de Neumología y Alergia, Hospital de la Santa Creu i Sant Pau, Institut de Recerca IIB Sant Pau, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Ingrid Solanes
- Servicio de Neumología y Alergia, Hospital de la Santa Creu i Sant Pau, Institut de Recerca IIB Sant Pau, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Astrid Crespo-Lessmann
- Servicio de Neumología y Alergia, Hospital de la Santa Creu i Sant Pau, Institut de Recerca IIB Sant Pau, Universitat Autonoma de Barcelona, Barcelona, Spain.
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Palones E, Curto E, Pelegrí A, Arilla M, Solanes I, Crespo-Lessmann A. Iatrogenic Adrenal Insufficiency Following Post COVID-19 Organizing Pneumonia. Arch Bronconeumol 2023; 59:63-65. [PMID: 35970652 PMCID: PMC9329133 DOI: 10.1016/j.arbres.2022.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 07/20/2022] [Accepted: 07/21/2022] [Indexed: 01/05/2023]
Affiliation(s)
- Esther Palones
- Servicio de Neumología y Alergia, Hospital de la Santa Creu i Sant Pau, Institut de Recerca IIB Sant Pau, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Elena Curto
- Servicio de Neumología y Alergia, Hospital de la Santa Creu i Sant Pau, Institut de Recerca IIB Sant Pau, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Anna Pelegrí
- Servicio de Neumología y Alergia, Hospital de la Santa Creu i Sant Pau, Institut de Recerca IIB Sant Pau, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Marina Arilla
- Servicio de Neumología y Alergia, Hospital de la Santa Creu i Sant Pau, Institut de Recerca IIB Sant Pau, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Ingrid Solanes
- Servicio de Neumología y Alergia, Hospital de la Santa Creu i Sant Pau, Institut de Recerca IIB Sant Pau, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Astrid Crespo-Lessmann
- Servicio de Neumología y Alergia, Hospital de la Santa Creu i Sant Pau, Institut de Recerca IIB Sant Pau, Universitat Autonoma de Barcelona, Barcelona, Spain.
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de-Torres JP, O'Donnell DE, Marín JM, Cabrera C, Casanova C, Marín M, Ezponda A, Cosio BG, Martinez C, Solanes I, Fuster A, Neder JA, Gonzalez-Gutierrez J, Celli BR. Clinical and Prognostic Impact of Low Diffusing Capacity for Carbon Monoxide Values in Patients With Global Initiative for Obstructive Lung Disease I COPD. Chest 2021; 160:872-878. [PMID: 33901498 DOI: 10.1016/j.chest.2021.04.033] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 03/01/2021] [Accepted: 04/12/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The Global Initiative for Obstructive Lung Disease (GOLD) does not promote diffusing capacity for carbon monoxide (Dlco) values in the evaluation of COPD. In GOLD spirometric stage I COPD patients, the clinical and prognostic impact of a low Dlco has not been explored. RESEARCH QUESTION Could a Dlco threshold help define an increased risk of death and a different clinical presentation in these patients? STUDY DESIGN AND METHODS GOLD stage I COPD patients (n = 360) were enrolled and followed over 109 ± 50 months. Age, sex, pack-years' history, BMI, dyspnea, lung function measurements, exercise capacity, BODE index, and history of exacerbations were recorded. A cutoff value for Dlco was identified for all-cause mortality and the clinical and physiological characteristics of patients above and below the threshold compared. Cox regression analysis explored the predictive power of that cutoff value for all-cause mortality. RESULTS A Dlco cutoff value of <60% predicted was associated with all-cause mortality (Dlco ≥ 60%: 9% vs Dlco < 60%: 23%, P = .01). At a same FEV1% predicted and Charlson score, patients with Dlco < 60% had lower BMI, more dyspnea, lower inspiratory capacity (IC)/total lung capacity (TLC) ratio, lower 6-min walk distance (6MWD), and higher BODE. Cox multiple regression analysis confirmed that after adjusting for age, sex, pack-years history, smoking status, and BMI, a Dlco < 60% is associated with all-cause mortality (hazard ratio [HR], 95% CI = 3.37, 1.35-8.39; P = .009) INTERPRETATION: In GOLD I COPD patients, a Dlco < 60% predicted is associated with increased risk of death and worse clinical presentation. What the cause(s) of this association are and whether they can be treated need to be determined.
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Affiliation(s)
- Juan P de-Torres
- Respirology and Sleep Medicine Division, Queen's University, Kingston, Canada.
| | - Denis E O'Donnell
- Respirology and Sleep Medicine Division, Queen's University, Kingston, Canada
| | - Jose M Marín
- Pulmonary Department, Hospital Universitario Miguel Servet, Instituto Aragonés Ciencias Salud & CIBERES, Zaragoza, Spain
| | - Carlos Cabrera
- Pulmonary Department, Hospital Universitario Doctor Negrín, Las Palmas, Spain
| | - Ciro Casanova
- Pulmonary Department, Hospital Ntra Sra de Candelaria, Tenerife, Spain and Respiratory Research Unit, Hospital Ntra Sra de Candelaria, Tenerife, Spain
| | - Marta Marín
- Pulmonary Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - Ana Ezponda
- Radiology Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - Borja G Cosio
- Hospital Universitario Son Espases, Instituto de Investigación Sanitaria de Baleares (IdISBa), Palma, Mallorca, Spain, and Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Madrid, España
| | - Cristina Martinez
- Department of Respiratory Medicine, Hospital Central de Asturias, Oviedo, Spain
| | - Ingrid Solanes
- Pulmonary Department, Hospital Santa Creu i Sant Pau, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Antonia Fuster
- Pulmonary Department, Hospital Universitario Son Llatzer, Palma de Mallorca, Spain
| | - J Alberto Neder
- Respirology and Sleep Medicine Division, Queen's University, Kingston, Canada
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Calle Rubio M, Rodriguez Hermosa JL, de Torres JP, Marín JM, Martínez-González C, Fuster A, Cosío BG, Peces-Barba G, Solanes I, Feu-Collado N, Lopez-Campos JL, Casanova C. COPD Clinical Control: predictors and long-term follow-up of the CHAIN cohort. Respir Res 2021; 22:36. [PMID: 33541356 PMCID: PMC7863480 DOI: 10.1186/s12931-021-01633-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 01/21/2021] [Indexed: 11/17/2022] Open
Abstract
Background Control in COPD is a dynamic concept that can reflect changes in patients’ clinical status that may have prognostic implications, but there is no information about changes in control status and its long-term consequences. Methods We classified 798 patients with COPD from the CHAIN cohort as controlled/uncontrolled at baseline and over 5 years. We describe the changes in control status in patients over long-term follow-up and analyze the factors that were associated with longitudinal control patterns and related survival using the Cox hazard analysis. Results 134 patients (16.8%) were considered persistently controlled, 248 (31.1%) persistently uncontrolled and 416 (52.1%) changed control status during follow-up. The variables significantly associated with persistent control were not requiring triple therapy at baseline and having a better quality of life. Annual changes in outcomes (health status, psychological status, airflow limitation) did not differ in patients, regardless of clinical control status. All-cause mortality was lower in persistently controlled patients (5.5% versus 19.1%, p = 0.001). The hazard ratio for all-cause mortality was 2.274 (95% CI 1.394–3.708; p = 0.001). Regarding pharmacological treatment, triple inhaled therapy was the most common option in persistently uncontrolled patients (72.2%). Patients with persistent disease control more frequently used bronchodilators for monotherapy (53%) at recruitment, although by the end of the follow-up period, 20% had scaled up their treatment, with triple therapy being the most frequent therapeutic pattern. Conclusions The evaluation of COPD control status provides relevant prognostic information on survival. There is important variability in clinical control status and only a small proportion of the patients had persistently good control. Changes in the treatment pattern may be relevant in the longitudinal pattern of COPD clinical control. Further studies in other populations should validate our results. Trial registration: Clinical Trials.gov: identifier NCT01122758.
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Affiliation(s)
- Myriam Calle Rubio
- Pulmonology Department, Hospital Clínico San Carlos, C/ Martin Lagos S/N, 28040, Madrid, Spain.,Medical Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Juan Luis Rodriguez Hermosa
- Pulmonology Department, Hospital Clínico San Carlos, C/ Martin Lagos S/N, 28040, Madrid, Spain. .,Medical Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain.
| | - Juan P de Torres
- Respirology and Sleep Division, Queen's University, Kingston, ON, Canada
| | - José María Marín
- Respiratory Department. Hospital, Universitario Miguel Servet and IISAragón, Ciber Enfermedades Respiratorias, Madrid, Spain
| | - Cristina Martínez-González
- Pulmonology Department, Hospital Universitario Central de Asturias, Universidad de Oviedo, Oviedo, Spain
| | - Antonia Fuster
- Pulmonology Department, Hospital Universitario Son Llàtzer, Palma de Mallorca, Spain
| | - Borja G Cosío
- Department of Respiratory Medicine, Hospital Universitario Son Espases-IdISBa and CIBERES, Palma de Mallorca, Spain
| | - Germán Peces-Barba
- Pulmonology Department, IIS-Fundación Jiménez Díaz-CIBERES, Madrid, Spain
| | - Ingrid Solanes
- Pulmonology Department, Hospital de La Santa Creu Y San Pau, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Nuria Feu-Collado
- Pulmonology Department, Hospital Universitario Reina Sofía, Instituto Maimónides de Investigación Biomédica de Córdoba, Universidad de Córdoba, Córdoba, Spain
| | - Jose Luis Lopez-Campos
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBIS), Hospital Universitario Virgen del Rocio, Universidad de Sevilla, CIBERES, Seville, Spain
| | - Ciro Casanova
- Pulmonology Department, Hospital Universitario Nuestra Señora de Candelaria, Universidad de La Laguna, Tenerife, Spain
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Martínez-González C, Casanova C, de-Torres JP, Marín JM, de Lucas P, Fuster A, Cosío BG, Calle M, Peces-Barba G, Solanes I, Agüero R, Feu-Collado N, Alfageme I, Romero Plaza A, Balcells E, de Diego A, Marín Royo M, Moreno A, Llunell Casanovas A, Galdiz JB, Golpe R, Lacárcel Bautista C, Cabrera C, Marin A, Soriano JB, Lopez-Campos JL. Changes and Clinical Consequences of Smoking Cessation in Patients With COPD. Chest 2018; 154:274-285. [DOI: 10.1016/j.chest.2018.02.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Revised: 12/27/2017] [Accepted: 02/01/2018] [Indexed: 10/18/2022] Open
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Casanova C, Celli BR, de-Torres JP, Martínez-Gonzalez C, Cosio BG, Pinto-Plata V, de Lucas-Ramos P, Divo M, Fuster A, Peces-Barba G, Calle-Rubio M, Solanes I, Aguero R, Feu-Collado N, Alfageme I, De Diego A, Romero A, Balcells E, Llunell A, Galdiz J, Marin M, Moreno A, Cabrera C, Golpe R, Lacarcel C, Soriano JB, López-Campos JL, Soler-Cataluña JJ, Marin JM. Prevalence of persistent blood eosinophilia: relation to outcomes in patients with COPD. Eur Respir J 2017; 50:50/5/1701162. [DOI: 10.1183/13993003.01162-2017] [Citation(s) in RCA: 103] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Accepted: 07/27/2017] [Indexed: 01/21/2023]
Abstract
The impact of blood eosinophilia in chronic obstructive pulmonary disease (COPD) remains controversial.To evaluate the prevalence and stability of a high level of blood eosinophils (≥300 cells·μL–1) and its relationship to outcomes, we determined blood eosinophils at baseline and over 2 years in 424 COPD patients (forced expiratory volume in 1 s (FEV1) 60% predicted) and 67 smokers without COPD from the CHAIN cohort, and in 308 COPD patients (FEV1 60% predicted) in the BODE cohort. We related eosinophil levels to exacerbations and survival using Cox hazard analysis.In COPD patients, 15.8% in the CHAIN cohort and 12.3% in the BODE cohort had persistently elevated blood eosinophils at all three visits. A significant proportion (43.8%) of patients had counts that oscillated above and below the cut-off points, while the rest had persistent eosinophil levels <300 cells·μL–1. A similar eosinophil blood pattern was observed in controls. Exacerbation rates did not differ in patients with and without eosinophilia. All-cause mortality was lower in patients with high eosinophils compared with those with values <300 cells·μL–1 (15.8% versus 33.7%; p=0.026).In patients with COPD, blood eosinophils ≥300 cells·μL–1 persisting over 2 years was not a risk factor for COPD exacerbations. High eosinophil count was associated with better survival.
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Solanes I, Bolíbar I, Llauger MA, Peiro M, Valverde P, Fraga M, Medrano C, Bigorra T, Freixas M, Ligüerre I, Pou MA, Domínguez L, Valero C, Solà J, Giner J, Plaza V. [Is the introduction of clinical management programs for patients with chronic obstructive pulmonary disease useful? Comparison of the effectiveness of two interventions on the clinical progress and care received]. Aten Primaria 2017; 50:184-196. [PMID: 28735722 PMCID: PMC6837048 DOI: 10.1016/j.aprim.2017.01.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 01/02/2017] [Accepted: 01/24/2017] [Indexed: 11/30/2022] Open
Abstract
Objetivo Evaluar la efectividad de dos programas de gestión en pacientes con enfermedad pulmonar obstructiva crónica (EPOC). Diseño Estudio de diseño cuasi-experimental para evaluar la efectividad de dos intervenciones (I1, I2) para la asistencia de pacientes con EPOC, tras un seguimiento medio de 31,2 meses. Emplazamiento Centros de atención primaria de dos áreas sanitarias de Barcelona y sus hospitales de referencia. Participantes Pacientes EPOC seleccionados por muestreo aleatorio simple en los que constara algún código correspondiente a EPOC. Intervenciones I1: Programa de gestión integral que optimizaba y coordinaba los recursos. Se hizo formación y control de calidad de la espirometría. I2: Intervenciones aisladas, como el call-center. Compartían circuitos asistenciales y la historia clínica informatizada. Mediciones principales variables de función pulmonar, gravedad, uso de inhaladores, estilos de vida, calidad de vida y exacerbaciones. Resultados De los 393 pacientes evaluados al inicio, 120 y 104 (I1 e I2, respectivamente) realizaron la evaluación final. Con la I1 hubo una reducción de los pacientes fumadores (p = 0,034). En ambos grupos, la función pulmonar y la calidad de vida se mantuvieron y la disnea mostró un leve empeoramiento. El correcto uso de inhaladores aumentó, aunque solo alcanzó el 48 y el 61% con la I1 e I2, respectivamente. El porcentaje de pacientes exacerbados disminuyó con la I1 (respecto I2 [p < 0,001]) y el de ingresos hospitalarios por exacerbación disminuyó con la I2 (respecto I1 [p < 0,003]). Conclusiones Ambas intervenciones consiguieron mejoras relevantes y el no empeoramiento global de una enfermedad crónica y progresiva como es la EPOC.
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Affiliation(s)
- Ingrid Solanes
- Servicio de Neumología, Hospital de la Santa Creu i Sant Pau, Institut de recerca biomèdica (IIB Sant Pau), Universidad Autónoma de Barcelona, Barcelona, España.
| | - Ignasi Bolíbar
- Servicio de Epidemiologia Clínica y Salud Pública, Hospital de la Santa Creu i Sant Pau, Institut de recerca biomèdica (IIB Sant Pau), Universidad Autónoma de Barcelona, Ciber de Epidemiología y Salud Pública (CIBERESP), Barcelona, España
| | | | - Meritxell Peiro
- Servicio de Neumología, Hospital de la Santa Creu i Sant Pau, Institut de recerca biomèdica (IIB Sant Pau), Universidad Autónoma de Barcelona, Barcelona, España
| | - Pepi Valverde
- EAP Gaudí, Consorci Sanitari Integral, Barcelona, España
| | - Mar Fraga
- EAP Xafarinas, Institut Català de la Salut, Barcelona, España
| | | | - Teresa Bigorra
- Servicio de Neumología, Hospital de la Santa Creu i Sant Pau, Institut de recerca biomèdica (IIB Sant Pau), Universidad Autónoma de Barcelona, Barcelona, España
| | | | - Iskra Ligüerre
- Àmbit d'Atenció Primària Barcelona Ciutat, Institut Català de la Salut, Barcelona, España
| | | | | | - Carles Valero
- Unitat d'Avaluació de Sistemes d'Informació i Qualitat, Àmbit d'Atenció Primària Barcelona Ciutat, Institut Català de la Salut, Barcelona, España
| | - Judit Solà
- Departamento de Epidemiologia Clínica y Salud Pública. Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - Jordi Giner
- Servicio de Neumología, Hospital de la Santa Creu i Sant Pau, Institut de recerca biomèdica (IIB Sant Pau), Universidad Autónoma de Barcelona, Barcelona, España
| | - Vicente Plaza
- Servicio de Neumología, Hospital de la Santa Creu i Sant Pau, Institut de recerca biomèdica (IIB Sant Pau), Universidad Autónoma de Barcelona, Barcelona, España
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Huertas D, Montón C, Marín A, Solanes I, López-Sánchez M, Pomares X, Muñoz-Esquerre M, Dorca J, Santos S. Effectiveness of a Respiratory Day Hospital Program to Reduce Admissions for Exacerbation in Patients with Severe COPD: A Prospective, Multicenter Study. COPD 2017; 14:304-310. [DOI: 10.1080/15412555.2017.1279598] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Daniel Huertas
- Respiratory Department, Hospital Universitari de Bellvitge, Institut d'Investigació Biomedica de Bellvitge (IDIBELL), Universitat de Barcelona, Hospitalet de Llobregat, Barcelona, Spain
- CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Concepción Montón
- Respiratory Department, Hospital de Sabadell, Institut Universitari Parc Taulí-UAB, Sabadell, Barcelona, Spain
- Universitat Autònoma de Barcelona, Esfera UAB, Barcelona, Spain
- REDISSEC: Red de Investigación en Servicios de Salud en Enfermedades Crónicas, Madrid, Spain
| | - Alicia Marín
- CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain
- Respiratory Department, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Ingrid Solanes
- Respiratory Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Biomedical Research Institute Sant Pau, Barcelona, Spain
| | - Marta López-Sánchez
- Respiratory Department, Hospital Universitari de Bellvitge, Institut d'Investigació Biomedica de Bellvitge (IDIBELL), Universitat de Barcelona, Hospitalet de Llobregat, Barcelona, Spain
| | - Xavier Pomares
- CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain
- Respiratory Department, Hospital de Sabadell, Institut Universitari Parc Taulí-UAB, Sabadell, Barcelona, Spain
- Universitat Autònoma de Barcelona, Esfera UAB, Barcelona, Spain
| | - Mariana Muñoz-Esquerre
- Respiratory Department, Hospital Universitari de Bellvitge, Institut d'Investigació Biomedica de Bellvitge (IDIBELL), Universitat de Barcelona, Hospitalet de Llobregat, Barcelona, Spain
| | - Jordi Dorca
- Respiratory Department, Hospital Universitari de Bellvitge, Institut d'Investigació Biomedica de Bellvitge (IDIBELL), Universitat de Barcelona, Hospitalet de Llobregat, Barcelona, Spain
| | - Salud Santos
- Respiratory Department, Hospital Universitari de Bellvitge, Institut d'Investigació Biomedica de Bellvitge (IDIBELL), Universitat de Barcelona, Hospitalet de Llobregat, Barcelona, Spain
- CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain
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Cosio BG, Soriano JB, López-Campos JL, Calle M, Soler JJ, de-Torres JP, Marín JM, Martínez C, de Lucas P, Mir I, Peces-Barba G, Feu-Collado N, Solanes I, Alfageme I. Distribution and Outcomes of a Phenotype-Based Approach to Guide COPD Management: Results from the CHAIN Cohort. PLoS One 2016; 11:e0160770. [PMID: 27684372 PMCID: PMC5042557 DOI: 10.1371/journal.pone.0160770] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 07/25/2016] [Indexed: 01/19/2023] Open
Abstract
Rationale The Spanish guideline for COPD (GesEPOC) recommends COPD treatment according to four clinical phenotypes: non-exacerbator phenotype with either chronic bronchitis or emphysema (NE), asthma-COPD overlap syndrome (ACOS), frequent exacerbator phenotype with emphysema (FEE) or frequent exacerbator phenotype with chronic bronchitis (FECB). However, little is known on the distribution and outcomes of the four suggested phenotypes. Objective We aimed to determine the distribution of these COPD phenotypes, and their relation with one-year clinical outcomes. Methods We followed a cohort of well-characterized patients with COPD up to one-year. Baseline characteristics, health status (CAT), BODE index, rate of exacerbations and mortality up to one year of follow-up were compared between the four phenotypes. Results Overall, 831 stable COPD patients were evaluated. They were distributed as NE, 550 (66.2%); ACOS, 125 (15.0%); FEE, 38 (4.6%); and FECB, 99 (11.9%); additionally 19 (2.3%) COPD patients with frequent exacerbations did not fulfill the criteria for neither FEE nor FECB. At baseline, there were significant differences in symptoms, FEV1 and BODE index (all p<0.05). The FECB phenotype had the highest CAT score (17.1±8.2, p<0.05 compared to the other phenotypes). Frequent exacerbator groups (FEE and FECB) were receiving more pharmacological treatment at baseline, and also experienced more exacerbations the year after (all p<0.05) with no differences in one-year mortality. Most of NE (93%) and half of exacerbators were stable after one year. Conclusions There is an uneven distribution of COPD phenotypes in stable COPD patients, with significant differences in demographics, patient-centered outcomes and health care resources use.
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Affiliation(s)
- Borja G. Cosio
- Department of Respiratory Medicine, Hospital Son Espases-IdISPa, Palma de Mallorca, Spain
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
- * E-mail:
| | - Joan B. Soriano
- Instituto de Investigación Hospital Universitario de la Princesa (IISP), Universidad Autónoma de Madrid, Cátedra UAM-Linde, Madrid, Spain
| | - Jose Luis López-Campos
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
- Department of Respiratory Medicine, Hospital Universitario Virgen del Rocío- IBiS, Sevilla, Spain
| | - Myriam Calle
- Department of Respiratory Medicine, Hospital Clinico San Carlos, Madrid, Spain
| | - Juan José Soler
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
- Department of Respiratory Medicine, Hospital Arnau de Vilanova, Valencia, Spain
| | - Juan Pablo de-Torres
- Department of Respiratory Medicine, Clínica Universidad de Navarra, Pamplona, Spain
| | - Jose Maria Marín
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
- Department of Respiratory Medicine, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Cristina Martínez
- Department of Respiratory Medicine Hospital Central de Asturias, Oviedo, Spain
| | - Pilar de Lucas
- Department of Respiratory Medicine, Hospital Gregorio Marañon, Madrid, Spain
| | - Isabel Mir
- Department of Respiratory Medicine, Hospital Son Llátzer, Palma de Mallorca, Spain
| | - Germán Peces-Barba
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
- Department of Respiratory Medicine, Fundación Jimenez Diaz, Madrid, Spain
| | - Nuria Feu-Collado
- Department of Respiratory Medicine, Hospital Universitario Reina Sofía, Cordoba-IMIBIC.UCO, Spain
| | - Ingrid Solanes
- Department of Respiratory Medicine, Hospital San Pablo y la Santa Cruz, Barcelona, Spain
| | - Inmaculada Alfageme
- Department of Respiratory Medicine, Hospital Universitario de Valme, Sevilla, Spain
| | - CHAIN study
- Department of Respiratory Medicine, Hospital Ntra. Sra. de Candelaria, Tenerife, Spain
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11
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Santos S, Marin A, Serra-Batlles J, de la Rosa D, Solanes I, Pomares X, López-Sánchez M, Muñoz-Esquerre M, Miravitlles M. Treatment of patients with COPD and recurrent exacerbations: the role of infection and inflammation. Int J Chron Obstruct Pulmon Dis 2016; 11:515-25. [PMID: 27042040 PMCID: PMC4795571 DOI: 10.2147/copd.s98333] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Exacerbations of COPD represent an important medical and health care problem. Certain susceptible patients suffer recurrent exacerbations and as a consequence have a poorer prognosis. The effects of bronchial infection, either acute or chronic, and of the inflammation characteristic of the disease itself raise the question of the possible role of antibiotics and anti-inflammatory agents in modulating the course of the disease. However, clinical guidelines base their recommendations on clinical trials that usually exclude more severe patients and patients with more comorbidities, and thus often fail to reflect the reality of clinicians attending more severe patients. In order to discuss aspects of clinical practice of relevance to pulmonologists in the treatment and prevention of recurrent exacerbations in patients with severe COPD, a panel discussion was organized involving expert pulmonologists who devote most of their professional activity to day hospital care. This article summarizes the scientific evidence currently available and the debate generated in relation to the following aspects: bacterial and viral infections, chronic bronchial infection and its treatment with cyclic oral or inhaled antibiotics, inflammatory mechanisms and their treatment, and the role of computerized tomography as a diagnostic tool in patients with severe COPD and frequent exacerbations.
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Affiliation(s)
- Salud Santos
- Pneumology Department, Hospital Universitari de Bellvitge, Universidad de Barcelona, Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet de Llobregat, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Alicia Marin
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain; Pneumology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | | | - David de la Rosa
- Pneumology Unit, Hospital Plató, Universidad Autónoma, Barcelona, Spain
| | - Ingrid Solanes
- Pneumology Department, Biomedical Research Institute Sant Pau, Hospital de la Santa Creu i Sant Pau, Universidad Autónoma, Barcelona, Spain
| | - Xavier Pomares
- Pneumology Department, Hospital Universitari Parc Taulí, Sabadell, Spain
| | - Marta López-Sánchez
- Pneumology Department, Hospital Universitari de Bellvitge, Universidad de Barcelona, Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet de Llobregat, Barcelona, Spain
| | - Mariana Muñoz-Esquerre
- Pneumology Department, Hospital Universitari de Bellvitge, Universidad de Barcelona, Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet de Llobregat, Barcelona, Spain
| | - Marc Miravitlles
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain; Pneumology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
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12
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Cosio BG, Soriano JB, López-Campos JL, Calle-Rubio M, Soler-Cataluna JJ, de-Torres JP, Marín JM, Martínez-Gonzalez C, de Lucas P, Mir I, Peces-Barba G, Feu-Collado N, Solanes I, Alfageme I, Casanova C. Defining the Asthma-COPD Overlap Syndrome in a COPD Cohort. Chest 2016; 149:45-52. [PMID: 26291753 DOI: 10.1378/chest.15-1055] [Citation(s) in RCA: 193] [Impact Index Per Article: 24.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Asthma-COPD overlap syndrome (ACOS) has been recently described by international guidelines. A stepwise approach to diagnosis using usual features of both diseases is recommended although its clinical application is difficult. METHODS To identify patients with ACOS, a cohort of well-characterized patients with COPD and up to 1 year of follow-up was analyzed. We evaluated the presence of specific characteristics associated with asthma in this COPD cohort, divided into major criteria (bronchodilator test > 400 mL and 15% and past medical history of asthma) and minor criteria (blood eosinophils > 5%, IgE > 100 IU/mL, or two separate bronchodilator tests > 200 mL and 12%). We defined ACOS by the presence of one major criterion or two minor criteria. Baseline characteristics, health status (COPD Assessment Test [CAT]), BMI, airflow obstruction, dyspnea, and exercise capacity (BODE) index, rate of exacerbations, and mortality up to 1 year of follow-up were compared between patients with and without criteria for ACOS. RESULTS Of 831 patients with COPD included,125 (15%) fulfilled the criteria for ACOS, and 98.4% of them sustained these criteria after 1 year. Patients with ACOS were predominantly male (81.6%), with symptomatic mild to moderate disease (67%), who were receiving inhaled corticosteroids (63.2%). There were no significant differences in baseline characteristics, and only survival was worse in patients with non-ACOS COPD after 1 year of follow-up (P < .05). CONCLUSIONS The proposed ACOS criteria are present in 15% of a cohort of patients with COPD and these patients show better 1-year prognosis than clinically similar patients with COPD with no ACOS criteria. TRIAL REGISTRY ClinicalTrials.gov; No.: NCT01122758; URL: www.clinicaltrials.gov.
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Affiliation(s)
- Borja G Cosio
- Department of Respiratory Medicine, Hospital Son Espases-IdISPa, Palma de Mallorca, Mallorca, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.
| | - Joan B Soriano
- Instituto de Investigación Hospital Universitario de la Princesa (IISP), Universidad Autónoma de Madrid (UAM), Cátedra UAM-Linde, Madrid, Spain
| | - Jose Luis López-Campos
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain; Department of Respiratory Medicine, Hospital Universitario Virgen del Rocío-IBiS, Sevilla, Spain
| | - Myriam Calle-Rubio
- Department of Respiratory Medicine, Hospital Clinico San Carlos, Madrid, Spain
| | - Juan José Soler-Cataluna
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain; Department of Respiratory Medicine, Hospital Arnau de Vilanova, Valencia, Spain
| | - Juan P de-Torres
- Department of Respiratory Medicine, Clínica Universidad de Navarra, Pamplona, Spain
| | - Jose M Marín
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain; Department of Respiratory Medicine, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | | | - Pilar de Lucas
- Department of Respiratory Medicine, Hospital Gregorio Marañon, Madrid, Spain
| | - Isabel Mir
- Department of Respiratory Medicine, Hospital Son Llátzer, Palma de Mallorca, Spain
| | - Germán Peces-Barba
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain; Department of Respiratory Medicine, Fundación Jimenez Diaz, Madrid, Spain
| | - Nuria Feu-Collado
- Department of Respiratory Medicine, Hospital Universitario Reina Sofía, Cordoba-IMIBIC.UCO, Spain
| | - Ingrid Solanes
- Department of Respiratory Medicine, Hospital San Pablo y la Santa Cruz, Barcelona, Spain
| | - Inmaculada Alfageme
- Department of Respiratory Medicine, Hospital Universitario deValme, Sevilla, Spain
| | - Ciro Casanova
- Department of Respiratory Medicine, Hospital Ntra. Sra. de Candelaria, Tenerife, Spain
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Bolíbar I, Plaza V, Llauger M, Amado E, Antón PA, Espinosa A, Domínguez L, Fraga M, Freixas M, de la Fuente JA, Liguerre I, Medrano C, Peiro M, Pou M, Sanchis J, Solanes I, Valero C, Valverde P. Assessment of a primary and tertiary care integrated management model for chronic obstructive pulmonary disease. BMC Public Health 2009; 9:68. [PMID: 19239679 PMCID: PMC2661072 DOI: 10.1186/1471-2458-9-68] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2008] [Accepted: 02/24/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The diagnosis and treatment of patients with chronic obstructive pulmonary disease (COPD) in Spain continues to present challenges, and problems are exacerbated when there is a lack of coordinated follow-up between levels of care. This paper sets out the protocol for assessing the impact of an integrated management model for the care of patients with COPD. The new model will be evaluated in terms of 1) improvement in the rational utilization of health-care services and 2) benefits reflected in improved health status and quality of life for patients. METHODS/DESIGN A quasi-experimental study of the effectiveness of a COPD management model called COPD PROCESS. The patients in the study cohorts will be residents of neighborhoods served by two referral hospitals in Barcelona, Spain. One area comprises the intervention group (n = 32,248 patients) and the other the control group (n = 32,114 patients). The study will include pre- and post-intervention assessment 18 months after the program goes into effect. Analyses will be on two datasets: clinical and administrative data available for all patients, and clinical assessment information for a cohort of 440 patients sampled randomly from the intervention and control areas. The main endpoints will be the hospitalization rates in the two health-care areas and quality-of-life measures in the two cohorts. DISCUSSION The COPD PROCESS model foresees the integrated multidisciplinary management of interventions at different levels of the health-care system through coordinated routine clinical practice. It will put into practice diagnostic and treatment procedures that are based on current evidence, multidisciplinary consensus, and efficient use of available resources. Care pathways in this model are defined in terms of patient characteristics, level of disease severity and the presence or absence of exacerbation. The protocol covers the full range of care from primary prevention to treatment of complex cases.
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Affiliation(s)
- Ignasi Bolíbar
- Department of Clinical Epidemiology and Public Health, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, CIBER Epidemiology and Public Health (CIBERESP), Barcelona, Spain
| | - Vicente Plaza
- Department of Respiratory Medicine, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Spain
| | | | - Ester Amado
- Àmbit Barcelona. Catalan Health Institute, Barcelona, Spain
| | - Pedro A Antón
- Department of Respiratory Medicine, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Spain
| | - Ana Espinosa
- Department of Clinical Epidemiology and Public Health, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, CIBER Epidemiology and Public Health (CIBERESP), Barcelona, Spain
| | - Leandra Domínguez
- EAP Encants, CAP Maragall, Catalan Health Institute, Barcelona, Spain
| | - Mar Fraga
- EAP Xafarinas. Catalan Health Institute, Barcelona, Spain
| | | | | | - Iskra Liguerre
- CAP Sant Andreu, Catalan Health Institute, Barcelona, Spain
| | | | - Meritxell Peiro
- Department of Respiratory Medicine, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Spain
| | - Mariantònia Pou
- EAP Encants, CAP Maragall, Catalan Health Institute, Barcelona, Spain
| | - Joaquin Sanchis
- Department of Respiratory Medicine, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Spain
| | - Ingrid Solanes
- Department of Respiratory Medicine, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Spain
| | - Carles Valero
- SAP Dreta, Catalan Health Institute, Barcelona, Spain
| | - Pepi Valverde
- EAP Gaudí (CAP Sagrada Familia), Consorci Sanitari Integral, Barcelona, Spain
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Abstract
OBJECTIVE Although the factors predictive of survival in patients with chronic obstructive pulmonary disease (COPD) have been widely studied, full consensus has yet to be reached. The objective of this study was to further clarify how lung function parameters, exercise tolerance, and quality of life influence survival in patients with COPD. PATIENTS AND METHODS This prospective study included 60 patients diagnosed with COPD. At the start of the study, patients underwent respiratory function tests, exercise testing, and 6-minute walk test. They also answered a chronic respiratory disease questionnaire to measure health-related quality of life. Follow-up lasted 7 years. RESULTS Five of the 60 patients withdrew from the study. Twenty-six of the remaining 55 patients (47%) died during the study. Univariate Cox regression analysis showed a correlation between survival and age, degree of obstruction, inspiratory capacity, carbon monoxide diffusing capacity, and peak exercise tolerance. No correlation was found between survival and body mass index, PaO2, PaCO2, total lung capacity, residual volume, maximal respiratory pressures, 6-minute walk distance, or health-related quality of life. Age, degree of obstruction (measured as the ratio of forced expiratory volume in 1 second to forced vital capacity after administration of bronchodilator), and maximum minute ventilation in the exercise test were introduced initially in the multivariate Cox stepwise regression analysis, but only maximum minute ventilation remained in the final model (relative risk, 0.926; P< .001). CONCLUSIONS Our findings show that peak exercise tolerance is the best predictor of survival in patients with COPD.
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Affiliation(s)
- Ingrid Solanes
- Departamento de Neumología, Hospital de la Santa Creu i de Sant Pau, Facultad de Medicina, Universitat Autònoma de Barcelona, Barcelona, España.
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Mota S, Güell R, Barreiro E, Solanes I, Ramírez-Sarmiento A, Orozco-Levi M, Casan P, Gea J, Sanchis J. Clinical outcomes of expiratory muscle training in severe COPD patients. Respir Med 2007; 101:516-24. [PMID: 16942867 DOI: 10.1016/j.rmed.2006.06.024] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2005] [Revised: 06/22/2006] [Accepted: 06/29/2006] [Indexed: 02/07/2023]
Abstract
UNLABELLED The most common symptoms in chronic obstructive pulmonary disease (COPD) patients are breathlessness and exercise limitation. Although both general and inspiratory muscle training have shown clinical benefits, the effects of specific expiratory muscle training remain controversial. OBJECTIVE To investigate the effects of expiratory training on lung function, exercise tolerance, symptoms and health-related quality of life in severe COPD patients. METHODS Sixteen patients (FEV(1), 28+/-8% pred.) were randomised to either expiratory muscle or sham training groups, both completing a 5-week programme (30 min sessions breathing through an expiratory threshold valve 3 times per week) (50% of their maximal expiratory pressure (MEP) vs. placebo, respectively). Lung function, exercise capacity (bicycle ergometry and walking test), and clinical outcomes (dyspnoea and quality of life (St. George Respiratory Questionnaire (SGRQ)) were evaluated both at baseline and following the training period. RESULTS Although lung function remained roughly unchanged after training, exercise capacity, symptoms and quality of life significantly improved. The improvement in both walking distance and the SGRQ score significantly correlated with changes in MEP. CONCLUSION Our results confirm that a short outpatient programme of expiratory training can improve symptoms and quality of life in severe COPD patients. These effects could be partially explained by changes in expiratory muscle strength.
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Affiliation(s)
- Susana Mota
- Departament de Pneumologia, Hospital de la Santa Creu i de Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
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Solanes I, Codina E, Casan P. [Carboxyhemoglobin and hemolytic anemia]. Med Clin (Barc) 1999; 113:678-9. [PMID: 10618788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
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