scholarly journals P154: Exploring health care connections and transitions in care for patients presenting to emergency departments with acute wheezing illnesses

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S112-S112
Author(s):  
B. H. Rowe ◽  
C. Villa-Roel ◽  
M. Bhutani ◽  
S. Couperthwaite ◽  
N. Runham
Keyword(s):  
Health Care ◽  
Health Professionals ◽  
Health Care Services ◽  
Family Doctor ◽  
Chronic Obstructive ◽  
Cross Sectional ◽  
Obstructive Pulmonary Disease ◽  
Copd Exacerbations ◽  
Patient Interview ◽  
Regular Care

Introduction: Asthma and/or chronic obstructive pulmonary disease (COPD) exacerbations often result in emergency department (ED) visits. This study examined the health-related personnel providing regular care to patients with asthma and/or COPD, as well as, explored the coordination of care between the ED and outpatient settings. Methods: Descriptive cross-sectional examination of patients presenting with asthma and/or COPD exacerbations to two EDs in Edmonton between August and December 2017. Using patient interview methods information on demographics, established health care connections and health system use was collected; information on consultations, disposition and referrals was collected through chart review methods. Results: A total of 50 patients were recruited (14 patients with asthma and 36 patients with COPD). Most of the patients with asthma were female (64%) and their median age was 36 years (interquartile range [IQR]: 29, 46); sex was evenly distributed among the patients with COPD and their median age was 68 years (IQR: 61, 78). The majority reported having a family doctor (86% of the patients with asthma and 94% of the patients with COPD). On the day of admission to the ED, 29% of the patients with asthma visited their family doctor while 42% of the patients with COPD visited their Respirologist; these doctors referred >70% of the patients to the ED. While in the ED, consultations were requested in 21% of the patients with asthma (all to Pulmonary) and in 78% of the patients with COPD (evenly divided between Medicine and Pulmonary). Transition coordinators and social workers were involved in the ED care of <15% of the patients with COPD. Most patients with asthma were discharged home (86%) and 64% of the patients with COPD were hospitalized. After discharge, 14% of the patients with asthma and 50% of the patients with COPD were referred to specialized care. Conclusion: While the study patients with asthma and COPD had different health professionals providing regular care to their respiratory conditions, they both sought care before presenting to the ED. More health professionals were involved in the ED care of patients with COPD than of those with asthma. This study provided important information to support further research projects exploring ways to effectively and efficiently improve the delivery, comprehensiveness and utilization of health care services.

“Safety at Home”: Experiences From Testing of Video Communication Between Patients and Home Health Care Personnel

SAGE Open ◽  
2017 ◽  
Vol 7 (4) ◽  
pp. 215824401774490 ◽  
Author(s):  
Linda Rykkje ◽  
Gunhild H. B. Hjorth
Keyword(s):  
Health Care ◽  
Home Health Care ◽  
Health Care Services ◽  
Video Communication ◽  
Health Care Personnel ◽  
Chronic Obstructive ◽  
Second Phase ◽  
Obstructive Pulmonary Disease ◽  
Care Services ◽  
At Home

The implementation of welfare technology in Norwegian municipals is a governmental priority, but there is little research on transfer of technological solutions into regular health care services. The aim of the project “Safety at home” was to test and evaluate the use of video communication between patients and health care personnel. There were two test periods, with the initial phase focusing on patients with chronic obstructive pulmonary disease (COPD). The second phase focused on patients who most likely would benefit from video communication. Nine patients tested the equipment, and they were interviewed afterward. In addition, nursing personnel evaluated the project through focus group interviews. The results identified that the equipment was user friendly and contributed to the patients’ feelings of safety. However, there were concerns about video calls replacing the “human touch” of home visits. The personnel also experienced that the technological solution had limitations, and new tasks added to their workload. The choice of focusing on COPD patients was considered a disadvantage, and we recommend that future projects should not be restricted by diagnosis and should target the most eligible candidates.

scholarly journals The Importance of Inhaler Adherence to Prevent COPD Exacerbations

2019 ◽  
Vol 7 (4) ◽  
pp. 54 ◽  
Author(s):  
Jose R Jardim ◽  
Oliver A. Nascimento
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Latin American ◽  
Real Life ◽  
Chronic Obstructive ◽  
Good Adherence ◽  
Cross Sectional ◽  
Obstructive Pulmonary Disease ◽  
Life Study ◽  
Copd Exacerbations

It has been shown that the better outcomes of chronic obstructive pulmonary disease (COPD) are closely associated with adherence to drug therapy, independent of the treatment administered. The clinical trial Towards a Revolution in COPD Health (TORCH) study clearly showed in a three year follow up that patients with good adherence to their inhaler treatment presented a longer time before the first exacerbation, a lower susceptibility to exacerbation and lower all-cause mortality. The Latin American Study of 24-hour Symptoms in Chronic Obstructive Pulmonary Disease (LASSYC), a real-life study, evaluated the self-reported inhaler adherence in COPD patients in seven countries in a cross-sectional non-interventional study and found that approximately 50% of the patients had good adherence, 30% moderate adherence and 20% poor adherence. Adherence to inhaler may be evaluated by the specific inhaler adherence questionnaire, the Test of Adherence to Inhalers (TAI). Several factors may predict the incorrect use of inhalers or adherence in COPD outpatient, including the number of devices and the daily dosing frequency. Ideally, patient education, simplicity of the device operation, the use of just one device for multiple medications and the best adaptation of the patient to the inhaler should guide the physician in prescribing the device.

scholarly journals Management of chronic obstructive pulmonary disease exacerbations in Internal Medicine

2013 ◽  
pp. 199-214
Author(s):  
Gelorma Belmonte ◽  
Marilena Muratori ◽  
Paolo Leandri ◽  
Angelo Pasquale ◽  
Massimo Reta ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Chronic Obstructive Pulmonary Disease ◽  
Health Care ◽  
Pulmonary Disease ◽  
Cause Of Death ◽  
Easy Access ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Copd Exacerbations ◽  
Wide Range

Introduction: Chronic obstructive pulmonary disease (COPD) is the second leading cause of hospitalization in Internal Medicine departments in Italy and the fourth leading cause of death all over the word. By 2020, COPD will be the third leading cause of death and the fifth leading cause of disability. It is — along with chronic congestive heart failure — one of the most common causes of unscheduled hospital readmissions, and as such it represents a significant economic burden for the health-care system. Exacerbations of COPD are important events in the natural history of this prevalent condition. Discussion: This review provides a comprehensive state-of-the-art look at prevention and management of COPD exacerbations. Treatment of these episodes has to be tailored to the severity of the clinical presentation. We now have a wide range of therapeutic available options, based on the results of clinical trials. Management of the acute event should include the necessary measures (mainly the administration of inhaled short-acting bronchodilators, inhaled or oral corticosteroids, and antibiotics), with or without oxygen and ventilator support. Conclusions: To improve the management of COPD exacerbations, the focus of care must be shifted from the episodic acute complications to their systematic prevention. The management of COPD, which is often associated with multiple co-morbidities, is complex and requires a tailored, multifaceted and multidisciplinary approach. Integrated care for COPD also requires that patients be informed about their condition, that they participate actively in their care, and that they have easy access to the necessary health-care services.

scholarly journals The role of infectious pathogens in exacerbation of chronic obstructive pulmonary disease in Dakahlia Governorate

2020 ◽  
Vol 14 (1) ◽  
Author(s):  
Elsayed Ahmed Fahmy ◽  
Heba Wagih Abdelwahab ◽  
Heba Elsayed Eldegla ◽  
Mohammed Khairy Fahmy Elbadrawy
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Negative Impact ◽  
Fungal Growth ◽  
Atypical Mycobacteria ◽  
Chronic Obstructive ◽  
Cross Sectional ◽  
Obstructive Pulmonary Disease ◽  
Copd Exacerbations

Abstract Background Exacerbations of chronic obstructive pulmonary disease (COPD) represent important events in the management of COPD because of its negative impact on health status and disease progression. The etiology of acute exacerbations of chronic obstructive pulmonary disease (COPDAE) is heterogeneous and still under discussion. So, this study was planned to investigate the role of infectious pathogens (fungi and atypical mycobacteria in addition to the well-known bacteria) in patients with COPD exacerbation in our locality. Results This observational cross-sectional study was conducted on 100 patients with acute exacerbation of COPD. Sputum specimens were collected for mycobacterial and fungal examination in addition to routine sputum bacteriology. All sputum samples were negative for typical and atypical mycobacteria whereas sputum samples of 18 patients (18%) were negative for fungi. Mixed fungal growth was found in 19 patients (19%). Candida was isolated from 67 patients (67%), Aspergillus was isolated from 27 patients (27%), Alternaria was isolated from 3 patients (3%), and other fungi were isolated from 4 patients (4%). As regards sputum bacteriology, sputum samples of 49 patients (49%) have bacterial growth. Streptococcus pneumoniae was isolated from 16 samples (16%) and represents the most frequent bacterial isolate in this study. Conclusion The present study indicates that typical and atypical mycobacteria have no role in COPD exacerbations in our locality. However, fungi and bacteria may have a role in COPD exacerbations.

scholarly journals Prevalence of different comorbidities in chronic obstructive pulmonary disease among Shahrekord PERSIAN cohort study in southwest Iran

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Fatemeh Zeynab Kiani ◽  
Ali Ahmadi
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Health Care ◽  
Metabolic Syndrome ◽  
Cohort Study ◽  
Pulmonary Disease ◽  
Chronic Obstructive ◽  
Cross Sectional ◽  
Obstructive Pulmonary Disease ◽  
Chronic Lung Diseases ◽  
Copd Patients

AbstractComorbidities are common in chronic obstructive pulmonary disease (COPD) patients. This study was conducted to determine the prevalence of common comorbidities in patients with COPD compared with people without COPD. This cross-sectional, population-based study was performed on 6961 adults aged 35–70 years enrolled in the Shahrekord PERSIAN cohort study. Data (demographic and clinical characteristics, comorbidities, anthropometric and blood pressure measurements, laboratory, and spirometry tests) collection was performed according to the cohort protocol from 2015 to 2019. In the present study, 215 (3.1%) patients were diagnosed with COPD and 1753 (25.18%) ones with restrictive lung patterns. The mean age of COPD patients was 52.5 ± 9.76 years. 55.8% of patients were male, 17.7% were current smokers and 12.1% had a history of smoking or were former smokers. 5.6% of patients had no comorbidity and 94.5% had at least one comorbidity. The most common comorbidities in COPD patients were dyslipidemia (70.2%), hypertension (30.2%), metabolic syndrome (22.8%), and diabetes (16.7%). The most common comorbidities in individuals with a restrictive spirometry pattern were dyslipidemia (68.9%), metabolic syndrome (27.2%), hypertension (26.1%), depression (17.6%), and fatty liver (15.5%). The logistic regression analysis with 95% confidence interval (95%CI) of odds ratio (OR) showed that comorbidities of chronic lung diseases (OR = 2.12, 95% CI 1.30–3.44), diabetes (OR = 1.54, 95%CI 1.03–2.29), cardiovascular disease (OR = 1.52, 95%CI 1.17–2.43), and hypertension (OR = 1.4, 95%CI 1.02–1.99) were more likely to occur in COPD patients than in healthy individuals. Knowing these prevalence rates and related information provides new insights on comorbidities to reduce disease burden and develop preventive interventions and to regulate health care resources to meet the needs of patients in primary health care.

scholarly journals Correlation between FEV1% Predicted and Blood Eosinophils in Patients with Exacerbations of Chronic Obstructive Pulmonary Disease (COPD)

2021 ◽  
Vol 7 (2) ◽  
pp. 59
Author(s):  
Alfian Nurfaizi ◽  
Isnin Anang Marhana ◽  
Gadis Meinar Sari ◽  
Arief Bakhtiar
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Chronic Obstructive ◽  
Blood Eosinophil ◽  
Normal Body Mass Index ◽  
Cross Sectional ◽  
Obstructive Pulmonary Disease ◽  
Copd Exacerbations ◽  
Blood Eosinophils ◽  
Eosinophil Counts

Introduction: Chronic obstructive pulmonary disease (COPD) exacerbations are still the leading causes of mortality. Eosinophil counts were recommended in assessing the risk of exacerbations. This additional examination was preferred rather than the pulmonary function test (PFT), which was considered less precise and had vast differences. Therefore, an analysis of the correlation between the FEV1% predicted and blood eosinophil counts were needed as a reference in the diagnosis of COPD exacerbation. This study aimed to determine the correlation between FEV1% predicted and blood eosinophils counts in patients with COPD exacerbations.Methods: This was a retrospective cross-sectional study by analyzing medical records of patients with COPD exacerbations at Dr. Soetomo General Hospital, Surabaya, from 2017 to 2018.Results: The characteristics of patients with exacerbations of COPD consisted of 91.7% male patients. Most of them were in the age group of 61-70 years old, 58.3% were in the private sector, 75% had a high school diploma, and 41.7% had normal body mass index (BMI). The percentage of the FEV1% predicted is directly proportional to the percentage of blood eosinophils with weak and statistically insignificant strength.Conclusion: The FEV1% predicted and blood eosinophil counts had a very weak correlation and statistically insignificant strength. Thus, it could not be used as a reference for diagnosis using one of the variables. Further research is needed with sputum eosinophils and biopsy as consideration for more accurate results.

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