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Demographic, familial, and social factors have important roles in the process of empowering elderly patients with chronic obstructive pulmonary disease (COPD), according to a study published in PLoS One.
For elderly patients with COPD, empowerment techniques are central to reducing the severity or frequency of exacerbations, preventing hospitalization, and improving health-related quality of life.
Zahra Fotokian, from Babol University of Medical Sciences in Mazandaran, Iran, and colleagues included 24 patients with the goal of exploring people’s experiences of the empowerment of older patients with COPD
Source: Managing elderly patients with COPD through empowerment – The Clinical Advisor
A new collaboration between the Duke Clinical Research Institute, Duke University’s MURDOCK Study, and Boehringer Ingelheim Pharmaceuticals Inc will try to better understand how chronic obstructive pulmonary disease progresses in the real world.
“What are my chances of developing COPD if one of my parents has the disease?” A systematic review and meta-analysis of prevalence of co-occurrence of COPD diagnosis in parents and offspring
Authors Li LSK, Paquet C, Johnston K, Williams MT
Published International Journal of Chronic Obstructive Pulmonary Disease 24 January 2017 Volume 2017:12 Pages 403—415
Introduction: Intergenerational associations in chronic obstructive pulmonary disease (COPD) have been well recognized and may result from genetic, gene environment, or exposure to life course factors. Consequently, adult offspring of parents with COPD may be at a greater risk of developing COPD. The aim of this study was to review the prevalence of co-occurrence of COPD in adult offspring with one or both parents having COPD independent of specific genetic variations.
Methods: In total, five databases were searched for original studies in which prevalence of COPD was reported in both offspring (children) and one or both parents. Studies were excluded if COPD was not clearly defined, COPD was linked to specific genetic variations, COPD was combined with other chronic respiratory conditions, or estimates included other first-degree relatives. Data extraction (ie, sample characteristics, prevalence of COPD, and odds ratio [OR] if reported) was completed by two independent reviewers. A meta-analysis of prevalence and OR was conducted, where possible.
Results: Of the 3,382 citations, 129 full texts were reviewed to include eight studies (six case–control, one cross-sectional, and one cohort) reflecting either prevalence of COPD in offspring of parents with COPD (descendent approach, n=3), which ranged from 0% to 17.3%, or prevalence of people with COPD reporting positive parental history of COPD (antecedent approach, n=5), for which the pooled prevalence was 28.6%. Offspring of people with COPD had 1.57 times greater odds (95% confidence interval =1.29–1.93; P<0.001) of having COPD compared with people not having a parental history of COPD.
Conclusion: The prevalence of COPD in adult offspring of people with COPD is greater than population-based estimates, and the ORs indicate a higher risk in this group. This offers clinicians a potential strategy for opportunistic screening, early identification, and intervention in this at-risk group.
According to the recommendations of the Global Initiative for Chronic Obstructive Lung Disease (GOLD) for chronic obstructive pulmonary disease (COPD), spirometry should be performed to establish the diagnosis of COPD in any patient who has a history of chronic cough, sputum production, difficulty breathing, or exposure to risk factors. A study conducted at the Corpus Christi Medical Center in South Texas assessed the accuracy of diagnoses and utilization of spirometry in multiple primary care clinics.
Sixty-five patient records were reviewed and only 29 percent of the patients had spirometry testing or had results available. Surprisingly, 31.6 percent of the patients diagnosed with COPD were misclassified because the spirometric measurements did not confirm the disease.
“There is a strong need for education and training on multiple levels related to the diagnosis of COPD, one of the most common conditions treated by primary care clinicians. GOLD guidelines provide clear standards on which patients to evaluate with spirometry and how to perform and interpret the tests. Applying the updated guidelines in primary care will greatly improve the rate and accuracy of diagnosis, the first step toward proper treatment.” says Dr. Stephen Eikermann, lead researcher.
The study abstract can be viewed on the website of the journal CHEST.
Abstract
COPD is currently one of the leading causes of hospitalizations in industrialized countries. The future burden of COPD is uncertain as the trends in the prevalence of the main risk factors for COPD, namely cigarette smoking and population aging, are moving in opposite directions in many jurisdictions. Here, we used data from British Columbia (BC), a Canadian Province of 4.7 million people, as an exemplary jurisdiction to illustrate the projected growth of COPD hospitalizations over the next 15 years in developed countries. We combined forecasts of population growth and aging with an Autoregressive Integrated Moving Average (ARIMA) model applied to BC’s population-based administrative health databases (2001 to 2010) to project the trends in the incidence, prevalence, deaths, and total length of inpatient stays to 2030. Based on this model, we predict that the absolute number of COPD cases will increase by more than 150% from 2010 to 2030 with the greatest growth in the older age group (75 years of age and older), where the absolute number will increase by 220%. The burden of inpatient care, measured as the total annual inpatient days, will grow by 185%. Assuming no disruptive changes in the prevention and the treatment of COPD in the near future, the burden of COPD, especially the burden of inpatient care, will significantly escalate over the next 15 years, driven predominantly by population aging. There is a pressing need to develop new preventive strategies and treatments to reduce the future burden of COPD.
Am J Respir Crit Care Med. First published online 14 Sep 2016 as DOI: 10.1164/rccm.201606-1162PP
The Projected Epidemic of COPD Hospitalizations Over the Next 15 Years: A Population Based Perspective
Amir Khakban, Don D Sin, J Mark FitzGerald, Bruce McManus, Raymond Ng, Zsuzsanna Hollander, and Mohsen Sadatsafavi
Read More: http://www.atsjournals.org/doi/abs/10.1164/rccm.201606-1162PP#.V-vEjfArLIX
This survey provides insightful data regarding the impact of COPD on Greek patients’ everyday life, psychology, and productivity, revealing the increased individual morbidity and the significant burden of this condition on society.
International Journal of Chronic Obstructive Pulmonary Disease, 2016 Volume 2016:11(1) Pages 2179—2189
Authors Kourlaba G, Hillas G, Vassilakopoulos T, Maniadakis N
Background: The objective of the study was to estimate the self-reported prevalence of chronic obstructive pulmonary disease (COPD) in Greece and to quantify its burden on patients’ daily activities, productivity, and psychological status.
Methods: A population-based, random digit-dialed telephone nationwide survey was conducted between July 10, 2015 and July 31, 2015 in order to recruit patients with COPD in Greece. Among the 11,471 persons contacted, 3,414 met the inclusion criterion of age ≥40 years and completed the screening questions regarding COPD. Of the 362 subjects who reported that they had been diagnosed with COPD, 351 completed the survey. Data on demographic and lifestyle characteristics, comorbidities, disease history, perceived disease severity, breathlessness severity, symptoms severity, limitations in daily activities, psychological distress, and productivity were collected. All data were collected through the telephone interview method using a structured questionnaire.
Results: The overall self-reported COPD prevalence was 10.6%. Among 351 participants, only 9% reported that they suffered from severe breathlessness. The mean COPD assessment test score was 19.0, with 84% of participants having a COPD assessment test score ≥10. As for the perceived severity of COPD, the majority of subjects considered that their respiratory condition was of moderate (34.2%) or mild severity (33.9%). Overall, the participants reported a significant impact of COPD on their daily life. For instance, 61.5% of them reported that their respiratory condition has affected their sports activities. Moreover, 73% of subjects considered that the health care system could do more for them than it actually does. Almost one-fourth of the participants reported that they had missed work during the past 12 months due to their respiratory symptoms, with the mean number of days lost being 10.
Conclusion: This survey provides insightful data regarding the impact of COPD on Greek patients’ everyday life, psychology, and productivity, revealing the increased individual morbidity and the significant burden of this condition on society.
GlaxoSmithKline and Innoviva’s triple-combination therapy of fluticasone furoate, umeclidinium and vilanterol significantly reduced the amount of exacerbations experienced by patients with chronic obstructive pulmonary disease compared with AstraZeneca’s Symbicort Turbohaler, according to phase 3 study results presented at the 2016 European Respiratory Society International Congress.
Results showed that patients in the triple-combination therapy group had improved lung function and a significantly reduced rate of COPD–related exacerbations. The researchers reported that they observed a 35% and 44% reduction of exacerbations in the FF/UMEC/VI group versus the Symbicort Turbohaler group at 24 and 52 weeks, respectively.
Guidelines on the management of chronic obstructive pulmonary disease (COPD) are based on numerous randomized, controlled trials of efficacy, which are usually generated for registration purposes. However, these trials have included patients who were selected with the use of strict criteria and were closely monitored, and therefore the results have limited relevance to everyday clinical practice. To counter this, it has been proposed that integrated comparative effectiveness trials involve more representative patients and be conducted in much less restricted environments.
The Salford Lung Study was designed to evaluate the effectiveness and safety of the once-daily inhaled combination of fluticasone furoate and vilanterol (fluticasone furoate–vilanterol) as compared with existing maintenance therapy (usual care) in a large, real-world population of patients with COPD in conditions of normal care. The trial was initiated before the approval of fluticasone furoate–vilanterol in the United Kingdom and was conducted in and around Salford, United Kingdom, a community served mainly by a single hospital with an established electronic health record (EHR) system that connects primary and secondary care. This setting permits the unobtrusive observation of patients for effectiveness and safety monitoring, blended into routine clinical care.
Authors: Jørgen Vestbo, D.M.Sc., David Leather, M.B., Ch.B., Nawar Diar Bakerly, M.D., John New, M.B., B.S., J. Martin Gibson, Ph.D., Sheila McCorkindale, M.B., Ch.B., Susan Collier, M.B., Ch.B., Jodie Crawford, M.Sc., Lucy Frith, M.Sc., Catherine Harvey, D.Phil., Henrik Svedsater, Ph.D., and Ashley Woodcock, M.D., for the Salford Lung Study Investigators
The New England Journal of Medicine, September 4, 2016DOI: 10.1056/NEJMoa1608033
Full Article
Methods A literature search was carried out to find studies that might help determine, using a meta-analysis, the impact of pulmonary rehabilitation on AECOPD, defined as unscheduled or emergency hospitalizations and emergency room (ER) visits. Cohort studies and randomised controlled trials (RCTs) reporting hospitalizations for AECOPD as an outcome were included. Meta-analyses compared hospitalization rates between eligible pulmonary rehabilitation recipients and non-recipients, before and after rehabilitation.
Results 18 studies were included in the meta-analysis. Results from ten RCTs showed that the control groups had a higher overall rate of hospitalizations than the pulmonary rehabilitation groups (0.97 hospitalizations/patient-year, 95% Confidence Intervals (CIs) 0.67, 1.40; 0.62 hospitalizations/patient-year, 95% CI 0.33, 1.16 respectively). Five studies compared admission numbers in the 12 months before and after rehabilitation, finding a significantly higher admission rate before compared to after (1.24 hospitalizations/patient-year, 95% CIs 0.66, 2.34; 0.47 hospitalizations/patient-year, 95% CIs 0.28, 0.79 respectively). The pooled result of three cohort studies found the reference group had a lower admission rate compared to the pulmonary rehabilitation group (0.18 hospitalizations/patient-year, 95% CI 0.11, 0.32 for reference group versus 0.28 hospitalizations/patient-year, 95% CI 0.25, 0.32 for pulmonary rehabilitation).
Conclusions Although results from RCTs suggested that pulmonary rehabilitation reduces subsequent admissions, pooled results from the cohort studies did not, likely reflecting the heterogeneous nature of individuals included in observational research and the varying standard of pulmonary rehabilitation programmes.
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