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González-Torralba F, Baloira A, Abad A, Fuster A, García-Rivero JL, García-Sidro P, Márquez-Martín E, Palop M, Soler N, Velasco JL. FIDEPOC: Consensus on Inspiratory Flow and Lung Deposition as Key Decision Factors in COPD Inhaled Therapy. Int J Chron Obstruct Pulmon Dis 2022; 17:1005-1015. [PMID: 35547784 PMCID: PMC9081625 DOI: 10.2147/copd.s360938] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 04/27/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose The pharmacological treatment of chronic obstructive pulmonary disease (COPD) is largely based on inhaled bronchodilators. Inspiratory flow and lung deposition are key parameters to be considered in inhaled therapy; however, the relationship between these two parameters, the patient specificities, and the suitability of the inhaler type for COPD management has not been fully addressed. The present study follows a Delphi Panel methodology to find expert consensus on the role of inspiratory flow and lung deposition as key decision factors in COPD inhaled therapy. Methods A two-round Delphi Panel, consisting of 38 statements (items) and completed by 57 Spanish pulmonologists, was carried out to measure the experts' consensus degree with each item. Results A high degree of consensus was reached on most of the items consulted, among these inspiratory flow or inspiratory capacity should be periodically considered when choosing an inhalation device and to ensure the suitability of the inhaler used; the outflow velocity and particle size of the different devices should be considered to ensure adequate lung deposition; an active device (pressurized metered-dose inhalers (pMDI) or soft mist inhalers (SMI)) should be used in patients with low inspiratory flow to achieve adequate lung deposition; and, the use of dry powder inhalers (DPI) should be re-evaluated in patients with severe obstruction and severe exacerbations. Conclusion This study shows the relevance of inspiratory flow and the degree of particle deposition in the lung in the choice of an inhalation device for COPD management, as well as the convenience of an SMI type device in cases of low inspiratory flow. Moreover, it highlights the scarcity of information on the specific features of inhalation devices in COPD guidelines.
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Affiliation(s)
| | - Adolfo Baloira
- Respiratory Department, University Hospital of Pontevedra, Pontevedra, Spain
| | - Araceli Abad
- Respiratory Department, University Hospital of Getafe, Madrid, Spain
| | - Antonia Fuster
- Respiratory Department, University Hospital Son Llatzer, Palma de Mallorca, Spain
| | | | | | | | - Marta Palop
- Respiratory Department, Hospital of Sagunto, Valencia, Spain
| | - Néstor Soler
- Respiratory Department, Hospital Clinic, Barcelona, Spain
| | - José Luis Velasco
- Respiratory Department, University Hospital Virgen de la Victoria, Málaga, Spain
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Baloira A, Abad A, Fuster A, García Rivero JL, García-Sidro P, Márquez-Martín E, Palop M, Soler N, Velasco JL, González-Torralba F. Lung Deposition and Inspiratory Flow Rate in Patients with Chronic Obstructive Pulmonary Disease Using Different Inhalation Devices: A Systematic Literature Review and Expert Opinion. Int J Chron Obstruct Pulmon Dis 2021; 16:1021-1033. [PMID: 33907390 PMCID: PMC8064620 DOI: 10.2147/copd.s297980] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 03/21/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Our aim was to describe: 1) lung deposition and inspiratory flow rate; 2) main characteristics of inhaler devices in chronic obstructive pulmonary disease (COPD). METHODS A systematic literature review (SLR) was conducted to analyze the features and results of inhaler devices in COPD patients. These devices included pressurized metered-dose inhalers (pMDIs), dry powder inhalers (DPIs), and a soft mist inhaler (SMI). Inclusion and exclusion criteria were established, as well as search strategies (Medline, Embase, and the Cochrane Library up to April 2019). In vitro and in vivo studies were included. Two reviewers selected articles, collected and analyzed data independently. Narrative searches complemented the SLR. We discussed the results of the reviews in a nominal group meeting and agreed on various general principles and recommendations. RESULTS The SLR included 71 articles, some were of low-moderate quality, and there was great variability regarding populations and outcomes. Lung deposition rates varied across devices: 8%-53% for pMDIs, 7%-69% for DPIs, and 39%-67% for the SMI. The aerosol exit velocity was high with pMDIs (more than 3 m/s), while it is much slower (0.84-0.72 m/s) with the SMI. In general, pMDIs produce large-sized particles (1.22-8 μm), DPIs produce medium-sized particles (1.8-4.8 µm), and 60% of the particles reach an aerodynamic diameter <5 μm with the SMI. All inhalation devices reach central and peripheral lung regions, but the SMI distribution pattern might be better compared with pMDIs. DPIs' intrinsic resistance is higher than that of pMDIs and SMI, which are relatively similar and low. Depending on the DPI, the minimum flow inspiratory rate required was 30 L/min. pMDIs and SMI did not require a high inspiratory flow rate. CONCLUSION Lung deposition and inspiratory flow rate are key factors when selecting an inhalation device in COPD patients.
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Affiliation(s)
- Adolfo Baloira
- Complejo Hospitalario Universitario de Pontevedra, Pontevedra, Spain
| | | | - Antonia Fuster
- Hospital Unvidersitario Son Llàtzer, Palma de Mallorca, Spain
| | | | | | - Eduardo Márquez-Martín
- Hospital Virgen del Rocío, Sevilla, Spain
- CIBERES, Instituto de Salud Carlos III, Madrid, Spain
| | | | | | - J L Velasco
- Hospital Universitario Virgen de la Victoria, Málaga, Spain
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García-Rivero JL, Esquinas C, Barrecheguren M, Bonnin-Vilaplana M, García-Sidro P, Herrejón A, Martinez-Rivera C, Malo de Molina R, Marcos PJ, Mayoralas S, Naval E, Ros JA, Valle M, Miravitlles M. Risk Factors of Poor Outcomes after Admission for a COPD Exacerbation: Multivariate Logistic Predictive Models. COPD 2016; 14:164-169. [PMID: 27983876 DOI: 10.1080/15412555.2016.1260538] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The aim of this study was to identify a multivariate model to predict poor outcomes after admission for exacerbation of chronic obstructive pulmonary disease (COPD). We performed a multicenter, observational, prospective study. Patients admitted to hospital for COPD were followed up for 3 months. Relevant clinical variables at admission were selected. For each variable, the best cut-offs for the risk of poor outcome were identified using receiver operating characteristic (ROC) curves. Finally, a stepwise logistic regression model was performed. A total of 106 patients with a mean age of 71.1 (9.8) years were included. The mean maximum expiratory volume in the first second (FEV1)(%) was 45.2%, and the mean COPD assessment test (CAT) score at admission was 24.8 (7.1). At 3 months, 39 (36.8%) patients demonstrated poor outcomes: death (2.8%), readmission (20.8%) or new exacerbation (13.2%). Variables included in the logistic model were: previous hospital admission, FEV1 < 45%, Charlson ≥ 3, hemoglobin (Hb)<13 g/L, PCO2 ≥ 46 mmHg, fibrinogen ≥ 554 g/L, C-reactive protein (CRP)≥45 mg/L, leukocyte count < 9810 × 109/L, purulent sputum, long-term oxygen therapy (LTOT) and CAT ≥ 31 at admission. The final model showed that Hb < 13 g/L (OR = 2.46, 95%CI 1.09-6.36), CRP ≥ 45 mg/L (OR = 2.91, 95%CI: 1.11-7.49) and LTOT (3.07, 95%CI: 1.07-8.82) increased the probability of poor outcome up to 82.4%. Adding a CAT ≥ 31 at admission increased the probability to 91.6% (AUC = 0.75; p = 0.001). Up to 36.8% of COPD patients had a poor outcome within 3 months after hospital discharge, with low hemoglobin and high CRP levels being the risk factors for poor outcome. A high CAT at admission increased the predictive value of the model.
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Affiliation(s)
| | - Cristina Esquinas
- b Pneumology Department , Hospital Universitari Vall d'Hebron, CIBER de Enfermedades Respiratorias (CIBERES) , Barcelona , Spain
| | - Miriam Barrecheguren
- b Pneumology Department , Hospital Universitari Vall d'Hebron, CIBER de Enfermedades Respiratorias (CIBERES) , Barcelona , Spain
| | | | | | | | | | | | | | | | - Elsa Naval
- j Hospital de La Ribera , Alzira , Spain
| | | | - Manuel Valle
- g Hospital Puerta del Hierro , Majadahonda , Spain
| | - Marc Miravitlles
- b Pneumology Department , Hospital Universitari Vall d'Hebron, CIBER de Enfermedades Respiratorias (CIBERES) , Barcelona , Spain
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Martinez Rivera C, Costan Galicia J, Alcázar Navarrete B, Garcia-Polo C, Ruiz Iturriaga LA, Herrejón A, Ros Lucas JA, García-Sidro P, Tirado-Conde G, López-Campos JL, Mayoralas Alises S, de Miguel-Díez J, Esquinas C, Miravitlles M. Factors Associated with Depression in COPD: A Multicenter Study. Lung 2016; 194:335-43. [PMID: 26932809 DOI: 10.1007/s00408-016-9862-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [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: 11/27/2015] [Accepted: 02/23/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Depression is a prevalent comorbidity in COPD and has an impact on the prognosis of these patients, thereby making it important to study the factors associated with depression in patients with COPD. METHOD A multicenter, observational and cross-sectional study was conducted to study the factors associated with depression in patients with COPD measured by the hospital anxiety and depression (HAD) questionnaire. We analyzed anthropometric variables and the number of exacerbations in the previous year and calculated the 6-min walking test and the body mass index, airflow obstruction, dyspnea, and exercise (BODE) index. All the patients completed the quality of life EQ-5D and the LCADL physical activity questionnaires. The relationship of these variables with depression was evaluated with two multiple logistic regression models. RESULTS One hundred fifteen patients were evaluated (93 % male) with a mean age of 66.9 years (SD 8.8) and a mean FEV1 % of 44.4 % (SD 15.7 %). 24.3 % presented symptoms of depression (HAD-D > 8). These latter patients had worse lung function, greater dyspnea, reduced exercise capacity, a higher score in the BODE index, poorer quality of life, reduced physical activity, and more exacerbations. In the first logistic regression model, quality of life and the BODE index were associated with depression (AUC: 0.84; 0.74-0.94). In the second model including the variables in the BODE index, quality of life and dyspnea measured with the MRC scale (AUC: 0.87; 0.79-0.95) were associated with depression. CONCLUSIONS Nearly one-quarter of the patients with COPD in this study presented clinically significant depression associated with worse quality of life, reduced exercise capacity, greater dyspnea, and a higher score in the BODE index.
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Affiliation(s)
- Carlos Martinez Rivera
- Pneumology Service, University Hospital Germans Trias i Pujol, Ctra. Canyet s/n, 08916, Badalona, Spain.
| | | | | | - Cayo Garcia-Polo
- Unit of Clinical Management of Pneumology, Puerta del Mar Hospital, Cádiz, Spain
| | | | | | | | | | | | - Jose Luis López-Campos
- Medical-Surgical Unit of Respiratory Diseases Virgen del Rocio University Hospital, Biomedicine Institute of Seville (IBiS), Seville, Spain
| | | | | | - Cristina Esquinas
- Pneumology Department, Vall d'Hebron University Hospital, CIBER de Enfermedades Respiratorias (CIBERS), Barcelona, Spain
| | - Marc Miravitlles
- Pneumology Department, Vall d'Hebron University Hospital, CIBER de Enfermedades Respiratorias (CIBERS), Barcelona, Spain
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Miravitlles M, García-Sidro P, Fernández-Nistal A, Buendía MJ, Espinosa de Los Monteros MJ, Esquinas C, Molina J. The chronic obstructive pulmonary disease assessment test improves the predictive value of previous exacerbations for poor outcomes in COPD. Int J Chron Obstruct Pulmon Dis 2015; 10:2571-9. [PMID: 26664105 PMCID: PMC4670021 DOI: 10.2147/copd.s91163] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [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] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Chronic obstructive pulmonary disease (COPD) exacerbations have a negative impact on the quality of life of patients and the evolution of the disease. We have investigated the prognostic value of several health-related quality of life questionnaires to predict the appearance of a composite event (new ambulatory or emergency exacerbation, hospitalization, or death) over a 1-year follow-up. METHODS This was a multicenter, prospective, observational study. Patients completed four questionnaires after recovering from an exacerbation (COPD Assessment Test [CAT], a Clinical COPD Questionnaire [CCQ], COPD Severity Score [COPDSS], and Airways Questionnaire [AQ20]). Patients were followed-up until the appearance of the composite event or for 1 year, whichever came first. RESULTS A total of 497 patients were included in the study. The majority of them were men (89.7%), with a mean age of 68.7 (SD 9.2) years, and a forced expiratory volume in 1 second of 47.1% (SD 17.5%). A total of 303 (61%) patients experienced a composite event. Patients with an event had worse mean scores of all questionnaires at baseline compared to patients without event: CAT=12.5 vs 11.3 (P=0.028); CCQ=2.2 vs 1.9 (P=0.013); COPDSS=12.3 vs 10.9 (P=0.001); AQ20=8.3 vs 7.5 (P=0.048). In the multivariate analysis, only previous history of exacerbations and CAT score ≥13.5 were significant risk factors for the composite event. A CAT score ≥13.5 increased the predictive value of previous exacerbations with an area under the receiver operating characteristic curve of 0.864 (95% CI: 0.829-0.899; P=0.001). CONCLUSION The predictive value of previous exacerbations significantly increased only in one of the four trialled questionnaires, namely in the CAT questionnaire. However, previous history of exacerbations was the strongest predictor of the composite event.
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Affiliation(s)
- Marc Miravitlles
- Pneumology Department, Hospital Universitari Vall d'Hebron, Ciber de Enfermedades Respiratorias, Barcelona, Spain
| | | | | | | | | | - Cristina Esquinas
- Pneumology Department, Hospital Universitari Vall d'Hebron, Ciber de Enfermedades Respiratorias, Barcelona, Spain
| | - Jesús Molina
- Centro de Salud "Francia", Fuenlabrada, Madrid, Spain
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Miravitlles M, Alcázar B, Alvarez FJ, Bazús T, Calle M, Casanova C, Cisneros C, de-Torres JP, Entrenas LM, Esteban C, García-Sidro P, Cosio BG, Huerta A, Iriberri M, Izquierdo JL, López-Viña A, López-Campos JL, Martínez-Moragón E, Pérez de Llano L, Perpiñá M, Ros JA, Serrano J, Soler-Cataluña JJ, Torrego A, Urrutia I, Plaza V. What pulmonologists think about the asthma-COPD overlap syndrome. Int J Chron Obstruct Pulmon Dis 2015; 10:1321-30. [PMID: 26270415 PMCID: PMC4507793 DOI: 10.2147/copd.s88667] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Some patients with COPD may share characteristics of asthma; this is the so-called asthma-COPD overlap syndrome (ACOS). There are no universally accepted criteria for ACOS, and most treatments for asthma and COPD have not been adequately tested in this population. MATERIALS AND METHODS We performed a survey among pulmonology specialists in asthma and COPD aimed at collecting their opinions about ACOS and their attitudes in regard to some case scenarios of ACOS patients. The participants answered a structured questionnaire and attended a face-to-face meeting with the Metaplan methodology to discuss different aspects of ACOS. RESULTS A total of 26 pulmonologists with a mean age of 49.7 years participated in the survey (13 specialists in asthma and 13 in COPD). Among these, 84.6% recognized the existence of ACOS and stated that a mean of 12.6% of their patients might have this syndrome. In addition, 80.8% agreed that the diagnostic criteria for ACOS are not yet well defined. The most frequently mentioned characteristics of ACOS were a history of asthma (88.5%), significant smoking exposure (73.1%), and postbronchodilator forced expiratory volume in 1 second/forced vital capacity <0.7 (69.2%). The most accepted diagnostic criteria were eosinophilia in sputum (80.8%), a very positive bronchodilator test (69.2%), and a history of asthma before 40 years of age (65.4%). Up to 96.2% agreed that first-line treatment for ACOS was the combination of a long-acting β2-agonist and inhaled steroid, with a long-acting antimuscarinic agent (triple therapy) for severe ACOS. CONCLUSION Most Spanish specialists in asthma and COPD agree that ACOS exists, but the diagnostic criteria are not yet well defined. A previous history of asthma, smoking, and not fully reversible airflow limitation are considered the main characteristics of ACOS, with the most accepted first-line treatment being long-acting β2-agonist/inhaled corticosteroids.
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Affiliation(s)
- Marc Miravitlles
- Pneumology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain ; CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Bernardino Alcázar
- Respiratory Department, Hospital de Alta Resolucion de Loja, Granada, Spain
| | - Francisco Javier Alvarez
- Medical-Surgical Unit of Respiratory Diseases, Virgen del Rocio University Hospital, Biomedicine Institute of Seville (IBiS), Seville, Spain
| | - Teresa Bazús
- Department of Pneumology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Myriam Calle
- Department of Pneumology, Hospital Clínico San Carlos, Madrid, Spain
| | - Ciro Casanova
- Department of Pneumology, Hospital Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain
| | - Carolina Cisneros
- Department of Pneumology, Hospital Universitario de La Princesa/Instituto de Investigación Sanitaria (IIS-IP), Madrid, Spain
| | - Juan P de-Torres
- Pulmonary Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - Luis M Entrenas
- Department of Pneumology, Hospital Universitario Reina Sofia, Córdoba, Spain
| | - Cristóbal Esteban
- Department of Pneumology, Hospital Galdakao-Usansolo, Galdakao, Spain
| | | | - Borja G Cosio
- Department of Pneumology, Hospital Universitario Son Espases IdISPa, Palma de Mallorca, Spain
| | - Arturo Huerta
- Sección Urgencias Medicina - Neumología, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clinic de Barcelona, Barcelona, Spain
| | - Milagros Iriberri
- Department of Pneumology, Hospital Universitario de Cruces, Bilbao, Spain
| | - José Luis Izquierdo
- Department of Pneumology, Hospital Universitario de Guadalajara, Guadalajara, Spain
| | - Antolín López-Viña
- Department of Pneumology, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - José Luis López-Campos
- CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain ; Medical-Surgical Unit of Respiratory Diseases, Virgen del Rocio University Hospital, Biomedicine Institute of Seville (IBiS), Seville, Spain
| | | | | | - Miguel Perpiñá
- Department of Pneumology, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - José Antonio Ros
- Department of Pneumology, Hospital Clínico Universitario Virgen de la Arrinxaca, Murcia, Spain
| | - José Serrano
- Department of Pneumology, Hospital Comarcal de Inca, Inca, Spain
| | | | - Alfons Torrego
- Department of Respiratory Medicine, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomédica Sant Pau (IIB Sant Pau), Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Isabel Urrutia
- Department of Pneumology, Hospital Galdakao-Usansolo, Galdakao, Spain
| | - Vicente Plaza
- Department of Respiratory Medicine, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomédica Sant Pau (IIB Sant Pau), Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
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Miravitlles M, Huerta A, Valle M, García-Sidro P, Forné C, Crespo C, López-Campos JL. Clinical variables impacting on the estimation of utilities in chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis 2015; 10:367-77. [PMID: 25733826 PMCID: PMC4337593 DOI: 10.2147/copd.s76397] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [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] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Health utilities are widely used in health economics as a measurement of an individual's preference and show the value placed on different health states over a specific period. Thus, health utilities are used as a measure of the benefits of health interventions in terms of quality-adjusted life years. This study aimed to determine the demographic and clinical variables significantly associated with health utilities for chronic obstructive pulmonary disease (COPD) patients. PATIENTS AND METHODS This was a multicenter, observational, cross-sectional study conducted between October 2012 and April 2013. Patients were aged ≥40 years, with spirometrically confirmed COPD. Utility values were derived from the preference-based generic questionnaire EQ-5D-3L applying weighted Spanish societal preferences. Demographic and clinical variables associated with utilities were assessed by univariate and multivariate linear regression models. RESULTS Three hundred and forty-six patients were included, of whom 85.5% were male. The mean age was 67.9 (standard deviation [SD] =9.7) years and the mean forced expiratory volume in 1 second (%) was 46.2% (SD =15.5%); 80.3% were former smokers, and the mean smoking history was 54.2 (SD =33.2) pack-years. Median utilities (interquartile range) were 0.81 (0.26) with a mean value of 0.73 (SD =0.29); 22% of patients had a utility value of 1 (ceiling effect) and 3.2% had a utility value lower than 0. The factors associated with utilities in the multivariate analysis were sex (beta =-0.084, 95% confidence interval [CI]: -0.154; -0.013 for females), number of exacerbations the previous year (-0.027, 95% CI: -0.044; -0.010), and modified Medical Research Council Dyspnea Scale (mMRC) score (-0.123 [95% CI: -0.185; -0.061], -0.231 [95% CI: -0.301; -0.161], and -0.559 [95% CI: -0.660; -0.458] for mMRC scores 2, 3, and 4 versus 1), all P<0.05. CONCLUSION Multivariate analysis showed that female sex, frequent exacerbations, and an increased level of dyspnea were the main factors associated with reduced utility values in patients with COPD.
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Affiliation(s)
- Marc Miravitlles
- Pneumology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain ; CIBER de Enfermedades Respiratorias (CIBERES), Tres Cantos, Madrid, Spain
| | - Alicia Huerta
- Market Access Department, GlaxoSmithKline, Tres Cantos, Madrid, Spain
| | - Manuel Valle
- Pneumology Department, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Patricia García-Sidro
- Pneumology Department, Hospital Universitario de la Plana, Vila-real, Castellón, Spain
| | - Carles Forné
- Health Economics and Outcome Strategies Department, Oblikue Consulting, Barcelona, Spain
| | - Carlos Crespo
- Health Economics and Outcome Strategies Department, Oblikue Consulting, Barcelona, Spain ; Statistics Department, University of Barcelona, Barcelona, Spain
| | - José Luis López-Campos
- CIBER de Enfermedades Respiratorias (CIBERES), Tres Cantos, Madrid, Spain ; Unidad Médico Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Sevilla, Spain
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Miravitlles M, García-Sidro P, Fernández-Nistal A, Buendía MJ, Espinosa de los Monteros MJ, Molina J. Course of COPD assessment test (CAT) and clinical COPD questionnaire (CCQ) scores during recovery from exacerbations of chronic obstructive pulmonary disease. Health Qual Life Outcomes 2013; 11:147. [PMID: 23987232 PMCID: PMC3765881 DOI: 10.1186/1477-7525-11-147] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Accepted: 08/29/2013] [Indexed: 11/10/2022] Open
Abstract
Introduction COPD exacerbations have a negative impact on lung function, decrease quality of life (QoL) and increase the risk of death. The objective of this study was to assess the course of health status after an outpatient or inpatient exacerbation in patients with COPD. Methods This is an epidemiological, prospective, multicentre study that was conducted in 79 hospitals and primary care centres in Spain. Four hundred seventy-six COPD patients completed COPD assessment test (CAT) and Clinical COPD Questionnaire (CCQ) questionnaires during the 24 hours after presenting at hospital or primary care centres with symptoms of an exacerbation, and also at weeks 4–6. The scores from the CAT and CCQ were evaluated and compared at baseline and after recovery from the exacerbation. Results A total of 164 outpatients (33.7%) and 322 inpatients (66.3%) were included in the study. The majority were men (88.2%), the mean age was 69.4 years (SD = 9.5) and the mean FEV1 (%) was 47.7% (17.4%). During the exacerbation, patients presented high scores in the CAT: [mean: 22.0 (SD = 7.0)] and the CCQ: [mean: 4.4 (SD = 1.2)]. After recovery there was a significant reduction in the scores of both questionnaires [CAT: mean: -9.9 (SD = 5.1) and CCQ: mean: -3.1 (SD = 1.1)]. Both questionnaires showed a strong correlation during and after the exacerbation and the best predictor of the magnitude of improvement in the scores was the severity of each score at onset. Conclusions Due to their good correlation, CAT and CCQ can be useful tools to measure health status during an exacerbation and to evaluate recovery. However, new studies are necessary in order to identify which factors are influencing the course of the recovery of health status after a COPD exacerbation.
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Affiliation(s)
- Marc Miravitlles
- Pneumology Department, Hospital Universitari Vall d'Hebron, Ciber de Enfermedades Respiratorias (CIBERS), Barcelona, Spain.
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García-Polo C, Alcázar-Navarrete B, Ruiz-Iturriaga LA, Herrejón A, Ros-Lucas JA, García-Sidro P, Tirado-Conde G, López-Campos JL, Martínez-Rivera C, Costán-Galicia J, Mayoralas-Alises S, De Miguel-Díez J, Miravitlles M. Factors associated with high healthcare resource utilisation among COPD patients. Respir Med 2012; 106:1734-42. [PMID: 23058483 DOI: 10.1016/j.rmed.2012.09.009] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2012] [Revised: 09/11/2012] [Accepted: 09/12/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) places a huge economic burden on healthcare systems, especially patients with frequent exacerbations and co-morbidities. OBJECTIVES To identify factors associated with high utilisation of healthcare resources in a population of patients with COPD. METHOD We conducted an observational, cross-sectional, multicentre study with the aim of identifying the factors associated with high resource utilisation among patients with COPD. Sociodemographic and anthropometric characteristics of the study population, as well as data on health-related quality of life, respiratory symptoms, presence of anxiety and depression, physical activity and lung function were collected. We examined the relationship between these variables and high utilisation of healthcare resources, by performing a multivariate analysis based on a logistic regression model. RESULTS 115 patients (64 were high users of healthcare resources, and 51 control patients) from 13 hospitals were selected. Patients presenting high resource utilisation had worse FEV₁, worse basal SpO₂, less distance walked in the 6-minute walk test, and increased dyspnoea. They also had a worse BODE index, worse scores in all dimensions of the EURO-QOL 5D and the LCADL scale, and displayed a higher prevalence of depression. Multivariate analysis yielded a statistically significant association between SpO₂, LCADL scores, serum fibrinogen values and total leukocyte count, and high healthcare resource utilisation. CONCLUSIONS COPD patients who incur higher healthcare resource utilisation show reduced physical activity, increased respiratory failure and increased systemic inflammation.
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Affiliation(s)
- Cayo García-Polo
- Clinical Management Unit of Pneumology and Allergy, Hospital Universitario Puerta del Mar, Avda Ana de Viya 21, 11009 Cádiz, Spain.
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Alcázar B, García-Polo C, Herrejón A, Ruiz LA, de Miguel J, Ros JA, García-Sidro P, Tirado Conde G, López-Campos JL, Martínez C, Costán J, Bonnin M, Mayoralas S, Miravitlles M. Factors Associated With Hospital Admission for Exacerbation of Chronic Obstructive Pulmonary Disease. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/j.arbr.2012.01.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Alcázar B, García-Polo C, Herrejón A, Ruiz LA, de Miguel J, Ros JA, García-Sidro P, Conde GT, López-Campos JL, Martínez C, Costán J, Bonnin M, Mayoralas S, Miravitlles M. Factors associated with hospital admission for exacerbation of chronic obstructive pulmonary disease. Arch Bronconeumol 2011; 48:70-6. [PMID: 22196478 DOI: 10.1016/j.arbres.2011.10.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2011] [Revised: 10/04/2011] [Accepted: 10/12/2011] [Indexed: 10/14/2022]
Abstract
INTRODUCTION Exacerbations of Chronic Obstructive Pulmonary Disease (COPD) that require hospital admission have a major impact on the progression of disease and generate high health costs. METHOD A multi-center, cross-sectional, observational, study was conducted with the aim to identify factors associated with hospital admission in patients with COPD. We obtained data of socio-demographic and anthropometric characteristics, quality of life, respiratory symptoms, anxiety and depression, physical activity and pulmonary function tests. We analyzed their association with hospital admission with a multivariate analysis using a logistic regression model. RESULTS We analyzed 127 patients, 50 (39%) of whom had been hospitalized. 93.7% were men, mean age 67 years (SD=9) and a FEV1 of 41.9% (SD=15.3). In the first model obtained, the baseline SpO(2), the BODE index and emergency room (ER) visits were associated with hospital admission and the area under the ROC curve (AUC) was 0.809. In a second model we included only variables readily available (without the 6 minutes walking test) and only the SpO(2) and previous visits to the ER were significant with an AUC ROC 0.783. CONCLUSIONS hospital admission for exacerbation of COPD is associated with poor SpO(2), higher BODE index score and a greater number of visits to the ER. In case you do not have the 6 minutes walking test, the other two variables offer a similar discriminative ability.
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Affiliation(s)
- Bernardino Alcázar
- Unidad de Gestión Clínica de Neumología, Complejo Hospitalario de Jaén, Spain.
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