scholarly journals Persistence and Compliance

2004 ◽  
Vol 11 (1) ◽  
pp. 13-14 ◽  
Author(s):  
Nick R Anthonisen
Keyword(s):  
Flow Problem ◽  
Insurance Coverage ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Inhaled Steroids ◽  
Interesting Study ◽  
Copd Patients ◽  
Number Of Patients ◽  
First Time ◽  
Respiratory Drugs

In this issue of theCanadian Respiratory Journal, Blais et al (pages 27 to 32) publish an interesting study of the use of inhaled steroids in chronic obstructive pulmonary disease (COPD). Using the Quebec provincial database from the years 1990 to 1996, they found that these medications were given to more and more patients during the period of the study, and that the patients tended to be sicker than those who were not given inhaled steroids: they saw more physicians, including specialists; took more bronchodilators; and had more exacerbations. This is the result that I would have predicted if asked and is therefore not surprising. What surprised me is the fact that patients did not continue to use inhaled steroids once they had been started on them; of those given these drugs for the first time, one-half stopped them after approximately 18 months, and after five years, approximately only 20% were still taking them. Further, as the number of patients given inhaled steroids increased, persistence decreased. What are we to make of this? One could argue that the dates covered by the study of Blais et al preceded the clinical trials (1) showing that inhaled steroids reduced exacerbations in COPD and that they were not prescribed with the conviction that present-day physicians would employ. On the other hand, it seems unlikely that COPD patients were given these medications as a temporary expedient; presumably, most prescriptions for inhaled steroids were for chronic maintenance therapy. It is therefore unlikely that the prescribing physicians told COPD patients to take the drugs until they felt better and then discontinue them. It is also possible that inhaled steroids were unique respiratory drugs in that they were expensive and that this impacted persistence negatively. Although these patients had provincial drug insurance coverage, it was probably on a reimbursement basis, as in Manitoba, and inhaled steroids presented a cash flow problem.

scholarly journals The Prevalence of Diabetes Mellitus in Chronic Obstructive Pulmonary Disease Patients

2020 ◽  
Vol 40 (1) ◽  
pp. 48-57
Author(s):  
Mariska Pangaribuan ◽  
Faisal Yunus ◽  
Triya Damayanti ◽  
Rochsismandoko Rochsismandoko
Keyword(s):  
Diabetes Mellitus ◽  
Cross Sectional Study ◽  
Airflow Limitation ◽  
Chronic Obstructive ◽  
Inhaled Corticosteroid ◽  
Cross Sectional ◽  
Obstructive Pulmonary Disease ◽  
Copd Patients ◽  
Number Of Patients

Backgrounds: Type 2 diabetes mellitus (DM) is a common comorbidity of COPD. COPD may be considered as a risk factor for new onset type 2 DM via multiple pathophysiological alterations such as systemic inflammation, smoking, oxidative stress, obesity and inhaled corticosteroid use. Exact prevalence of DM in COPD patients in Indonesia still unclear. Co-morbid conditions like DM have great impact on the outcome of COPD in the form of severity, morbidity and mortality. Methods: A cross sectional study was done in Asthma-COPD clinic Persahabatan Hospital from February to March 2017 to screen COPD patients for DM. Sixty-four subjects were recruited. Interview, physical examination and laboratory testing were performed in all subjects. Results: A total of 64 patients with COPD (Males=60, Female=4) with mean age 65±8.7 were screened for DM. Patients with known history of DM were 12 subjects (18.8%) and were enrolled as known DM cases. Remaining 52 subjects (81.3%) whose DM status was unclear were screened by random or fasting blood sugar and HbA1c. Two subjects (3.1%) were considered as newly diagnosed DM cases. Prevalence of DM in present study was 21.9%. Number of patients with pre-diabetes was 16 subjects (25%). There was no significant relationship between gender, age, smoking, nutritional status, airflow limitation and inhaled corticosteroid use in occurrence of DM among COPD patients. Conclusions: Prevalence of DM in COPD patients in the present study is 21.9%. It is important to screen all COPD patients for DM routinely. (J Respir Indo. 2020; 40(1): 48-57)

scholarly journals Face-to-face Training as an Effective Approach for Instructing Rotahaler Technique in Newly Diagnosed Cases of Asthma and COPD: a Pilot Study

2015 ◽  
Vol 53 (198) ◽  
pp. 150-153 ◽  
Author(s):  
Ramesh Sharma Poudel ◽  
Shakti Shrestha ◽  
Rano Mal Piryani ◽  
Aastha Prajapati ◽  
Dipendra Khatiwada
Keyword(s):  
Chronic Obstructive ◽  
Newly Diagnosed ◽  
Obstructive Pulmonary Disease ◽  
Face To Face ◽  
Copd Patients ◽  
Study Population ◽  
The Mean ◽  
Gina Guidelines ◽  
Keywords Asthma ◽  
First Time

Introduction: This study aimed to evaluate the effectiveness of face-to-face training for instructing rotahaler technique in newly diagnosed cases of asthma and chronic obstructive pulmonary disease. Methods: A hospital-based study was conducted on twenty patients who were prescribed rotahaler for the first time. Patients received face-to-face training on rotahaler technique from pharmacist using GINA guidelines. The patients rotahaler technique was assessed after two weeks of training and scored one for correct and zero for incorrect steps. Descriptive statistics was performed. Results: The mean age of the study population was 48.85±20.49 years. Eleven (55%) patients were females and 13 (65%) were formally uneducated. Fourteen patients (70%) were able to perform all the steps correctly giving overall median score of 8 (7-8). Conclusions: Face-to-face training seems to be effective approach for instructing rotahaler technique in asthma and COPD patients.  Keywords: asthma; COPD; face-to-face training; inhaler technique; pharmacist.

scholarly journals Use of Spirometry and Respiratory Drugs in Manitobans Over 35 Years of Age with Obstructive Lung Diseases

2005 ◽  
Vol 12 (2) ◽  
pp. 69-74 ◽  
Author(s):  
NR Anthonisen ◽  
K Woodlrage ◽  
J Manfreda
Keyword(s):  
Drug Use ◽  
Drug Prescription ◽  
Beta Agonist ◽  
Postal Code ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Physician Visits ◽  
Inhaled Steroids ◽  
Prescription Rates ◽  
Respiratory Drugs

BACKGROUND: Previous data indicated that spirometry was underused in people with obstructive disease, especially those with chronic obstructive pulmonary disease (COPD).OBJECTIVE: To examine the use of respiratory drugs in patients with COPD and asthma, and to relate drug use to spirometry.METHODS: Manitoba Health maintains a database of physician services remunerated by fees that includes spirometry. The database contains the diagnosis and patient identifiers, as well as sex, date of birth and residential postal code. Similar identifiers are used in the provincial pharmacare program that records prescriptions dispensed at retail pharmacies. These databases were examined for the time period between 1996 to 2000, and people over 35 years of age diagnosed with asthma, COPD or both were identified. The frequency of spirometry in these patients and their use of respiratory drugs was determined.RESULTS: Spirometry and drug prescription frequencies increased with the number of physician visits (including those for bronchitis), but their patterns differed. Patients with asthma or asthma plus COPD had considerably higher rates of drug prescription and slightly higher spirometry rates than did those with COPD. Patients with asthma and asthma plus COPD who underwent spirometry were slightly more likely to receive drugs than those who did not undergo spirometry; this trend was more striking in patients with COPD. However, approximately 30% of patients with COPD who had five physician visits and who underwent spirometry did not receive drugs; this was true for approximately 10% of similar patients with asthma. Patients with asthma generally received beta-agonists and inhaled steroids; these agents were less commonly given to patients with COPD, who instead were given anticholinergics much more often than were asthmatics. Patients who were diagnosed with asthma plus COPD had beta-agonist and inhaled corticosteroid prescription rates similar to asthmatics, and anticholinergic prescription rates similar to patients with COPD. Theophylline and antileukotriene drugs were used less often than were inhaled agents. In patients with asthma, drugs were frequently discontinued, and during drug use, prescription refills were consistent with an intake of 30.9% of the prescribed doses. In patients with COPD, discontinuing drugs early was uncommon, and refills were consistent with the use of 54% of the prescribed amounts. The same was true of patients with both COPD and asthma.DISCUSSION: Drug prescription was considerably more common in patients labelled with asthma or COPD plus asthma than in patients with COPD. Spirometry was also less common in patients with COPD but had a distinct influence on the frequency of drug prescription. Patterns of drug prescription were predictable, and patterns of drug use indicated poor compliance, in agreement with other data. The results suggest that COPD symptoms may be discounted and patients systematically undertreated or the diagnosis could frequently be applied to people with trivial disease or both.

scholarly journals SP-D Polymorphisms and the Risk of COPD

2012 ◽  
Vol 33 (2) ◽  
pp. 91-100 ◽  
Author(s):  
Tania A. Shakoori ◽  
Don D. Sin ◽  
S. Nazim Hussain Bokhari ◽  
Farkhanda Ghafoor ◽  
A. R. Shakoori
Keyword(s):  
Restriction Analysis ◽  
Serum Levels ◽  
Surfactant Protein ◽  
Surfactant Protein D ◽  
Chronic Obstructive ◽  
Nucleotide Polymorphisms ◽  
Limited Data ◽  
Obstructive Pulmonary Disease ◽  
Copd Patients ◽  
First Time

Introduction: There are limited data linking serum levels of surfactant protein D, its genetic polymorphisms to the risk of Chronic Obstructive Pulmonary Disease (COPD).Objectives: We sought to investigate these relationships using a case control study design.Methods: Post bronchodilator values of FEV1/FVC <0.7 were used to diagnose COPD patients (n= 115). Controls were healthy subjects with normal spirometry (n= 106) Single nucleotide polymorphisms (rs721917, rs2243639, rs3088308) were genotyped using polymerase chain reaction (PCR) and restriction analysis. Serum SP-D levels were measured using a specific immunoassay.Results:Allele ‘A’ at rs3088308 (p< 0.00,B= −0.41) and ‘C’ allele at rs721917 (p= 0.03; B = −0.30) were associated with reduced serum SP-D levels. Genotype ‘T/T’ at rs721917 was significantly associated with risk of COPD (p= 0.01). Patients with repeat exacerbations had significantly higher serum SP-D even after adjusting for genetic factors.Conclusions:We report for the first time that rs3088308 is an important factor influencing systemic SP-D levels and confirm the previous association of rs721917 to the risk of COPD and serum SP-D levels.

scholarly journals Correlation between sestrin2 expression and airway remodeling in COPD

2020 ◽  
Author(s):  
Da-Wei Zhang ◽  
Yuan-Yuan Wei ◽  
Shuang Ji ◽  
Guang-He Fei
Keyword(s):  
Airway Remodeling ◽  
Chest Ct ◽  
Chronic Obstructive ◽  
Pathological Changes ◽  
Obstructive Pulmonary Disease ◽  
Control Subjects ◽  
Imaging Characteristics ◽  
Copd Patients ◽  
Staining Methods ◽  
First Time

Abstract Background. Airway remodeling is a major pathological characteristic of chronic obstructive pulmonary disease (COPD), and has been shown to be associated with oxidative stress. Sestrin2 has recently drawn attention as an important antioxidant protein. However, the underlying correlation between sestrin2 and airway remodeling in COPD has yet to be clarified.Methods. A total of 124 subjects were enrolled in this study, including 62 control subjects and 62 COPD patients. The pathological changes in airway tissues were assessed by different staining methods. The expression of sestrin2 and matrix metalloproteinase 9 (MMP9) in airway tissues was monitored by immunohistochemistry. Enzyme-linked immunosorbent assays (ELISAs) were used to detect the serum concentrations of sestrin2 and MMP9. The airway parameters on computed tomography (CT) from all participants were measured for evaluating airway remodeling. The relationship between serum sestrin2 and MMP9 concentration and airway parameters in chest CT was also analyzed. Results. In patients with COPD, staining of airway structures showed distinct pathological changes of remodeling, including cilia cluttered, subepithelial fibrosis, and reticular basement membrane (Rbm) fragmentation. Compared with control subjects, the expression of sestrin2 and MMP9 was significantly increased in both human airway tissues and serum. Typical imaging characteristics of airway remodeling and increased airway parameters were also found by chest CT. Additionally, serum sestrin2 concentration was positively correlated with serum MMP9 concentration and airway parameters in chest CT.Conclusion. Increased expression of sestrin2 is related to airway remodeling in COPD. We demonstrated for the first time that sestrin2 may be a novel biomarker for airway remodeling in patients with COPD.

scholarly journals Comparison of treatment of chronic obstructive pulmonary disease (COPD) by family physician and consultants

2016 ◽  
Vol 12 (1) ◽  
Author(s):  
Israrul Haque ◽  
Shamail Zafar ◽  
Tanviruss Salam ◽  
Ali Kashif ◽  
Shid Butt A Rashid ◽  
...  
Keyword(s):  
Family Physician ◽  
Family Physicians ◽  
Oral Steroid ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Inhaled Steroids ◽  
Copd Patients ◽  
Function Test ◽  
Global Initiative ◽  
Better Than

The goal of the study is to determine whether care for COPD patients is more consistent with guidelines when a Consultant rather than a Family Physician treat the patients. We use the Global Initiative for Obstructive Lung Disease Guidelines as a standard 1. We studied seven parameters, offering Pulmonary Function Test, Smoking cassation guidance, vaccination, use of oral steroid, inhaled steroids, inhaled Impratropium bromide, and symptom documentation. We concluded that both Family Physicians and Consultants are not fully following the guidelines. In compression Consultants are better than Family Physicians.

scholarly journals Correlation between sestrin2 expression and airway remodeling in COPD

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Da-Wei Zhang ◽  
Yuan-Yuan Wei ◽  
Shuang Ji ◽  
Guang-He Fei
Keyword(s):  
Airway Remodeling ◽  
Chest Ct ◽  
Chronic Obstructive ◽  
Pathological Changes ◽  
Obstructive Pulmonary Disease ◽  
Control Subjects ◽  
Imaging Characteristics ◽  
Copd Patients ◽  
Staining Methods ◽  
First Time

Abstract Background Airway remodeling is a major pathological characteristic of chronic obstructive pulmonary disease (COPD), and has been shown to be associated with oxidative stress. Sestrin2 has recently drawn attention as an important antioxidant protein. However, the underlying correlation between sestrin2 and airway remodeling in COPD has yet to be clarified. Methods A total of 124 subjects were enrolled in this study, including 62 control subjects and 62 COPD patients. The pathological changes in airway tissues were assessed by different staining methods. The expression of sestrin2 and matrix metalloproteinase 9 (MMP9) in airway tissues was monitored by immunohistochemistry. Enzyme-linked immunosorbent assays (ELISAs) were used to detect the serum concentrations of sestrin2 and MMP9. The airway parameters on computed tomography (CT) from all participants were measured for evaluating airway remodeling. The relationship between serum sestrin2 and MMP9 concentration and airway parameters in chest CT was also analyzed. Results In patients with COPD, staining of airway structures showed distinct pathological changes of remodeling, including cilia cluttered, subepithelial fibrosis, and reticular basement membrane (Rbm) fragmentation. Compared with control subjects, the expression of sestrin2 and MMP9 was significantly increased in both human airway tissues and serum. Typical imaging characteristics of airway remodeling and increased airway parameters were also found by chest CT. Additionally, serum sestrin2 concentration was positively correlated with serum MMP9 concentration and airway parameters in chest CT. Conclusion Increased expression of sestrin2 is related to airway remodeling in COPD. We demonstrated for the first time that sestrin2 may be a novel biomarker for airway remodeling in patients with COPD.

scholarly journals A new protocol for exercise testing in COPD; improved prediction algorithm for WMAX and validation of the endurance test in a placebo-controlled double bronchodilator study

2021 ◽  
Vol 15 ◽  
pp. 175346662110374
Author(s):  
Ellen Tufvesson ◽  
Finn Radner ◽  
Anton Simonsen ◽  
Georgia Papapostolou ◽  
Linnea Jarenbäck ◽  
...  
Keyword(s):  
Exercise Testing ◽  
Cardiopulmonary Exercise Test ◽  
Forced Expiratory Volume ◽  
Prediction Algorithm ◽  
Chronic Obstructive ◽  
Endurance Test ◽  
Endurance Time ◽  
Obstructive Pulmonary Disease ◽  
Copd Patients ◽  
Number Of Patients

Background: Two new protocols have been developed for bicycle exercise testing in chronic obstructive pulmonary disease (COPD) with an individualized cardiopulmonary exercise test (ICPET) and subsequent customized endurance test (CET), which generate less interindividual spread in endurance time compared with the standard endurance test. Main objectives of this study were to improve the prediction algorithm for WMAX for the ICPET and validate the CET by examining treatment effects on exercise performance of indacaterol/glycopyrronium (IND/GLY) compared with placebo. Methods: COPD patients, with forced expiratory volume in 1 s ( FEV1) 40–80% predicted, were recruited. Pooled baseline data from two previous studies ( n = 38) were used for the development of an improved WMAX prediction algorithm. Additional COPD patients ( n = 14) were recruited and performed the ICPET, using the new prediction formula at visit 1. Prior to the CET at visits 2 and 3, they were randomized to a single dose of IND/GLY (110/50 µg) or placebo. Results: The improved multiple regression algorithm for WMAX includes diffusing capacity for carbon monoxide ( DLCO), FEV1, sex, age and height and correlated to measured WMAX ( R2 = 0.89 and slope = 0.89). Treatment with IND/GLY showed improvement in endurance time versus placebo, mean 113 s [95% confidence interval (CI): 6–220], p = 0.037, with more prominent effect in patients with FEV1 < 70% predicted. Conclusion: The two new protocols for ICPET (including the new improved algorithm) and CET were retested with consistent results. In addition, the CET showed a significant and clinically relevant prolongation of endurance time for IND/GLY versus placebo in a small number of patients.

scholarly journals Lung Body Plethysmography: From Functional to Clinical Aspects for Prediction of Quality of Life in Patients with Chronic Pulmonary Obstruction

2019 ◽  
Vol 70 (11) ◽  
pp. 3935-3941
Author(s):  
Roxana Maria Nemes ◽  
Florentina Ligia Furtunescu ◽  
Ioan Sorin Tudorache ◽  
Tudor Harsovescu ◽  
Alexandra Floriana Nemes ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Forced Expiratory Volume ◽  
Normal Weight ◽  
Clinical Aspects ◽  
Chronic Obstructive ◽  
Body Plethysmography ◽  
Obstructive Pulmonary Disease ◽  
Copd Patients ◽  
Number Of Patients

We analyze the lung function using advanced measurement (body plethysmography) and standard measurement (spirometry) in stable COPD (Chronic Obstructive Pulmonary Disease) patients. Subjects and methods: 211 patients with stable COPD (88.6% males) age 61�5 years (mean � standard deviation), exsmokers 78.7%, underwent to: body pletysmography , spirometry, electrocardiography. Parameters obtained: residual volume (RV), forced expiratory volume in 1 second (FEV1), were correlated with different parameters and also for prediction of quality of life in COPD patients. In assessing the quality of life we used the St. George�s Respiratory Questionnaire (SGRQ). According to BMI (body mass index) we classify patients in four groups: 1. underweight ([ 20, n = 34), 2. normal weight (20-24, n = 79), 3. overweight (25-29.9, n = 58), 4. obese ( ]30, n = 40), n = number of patients.

Stratification of telehealthcare for patients with chronic obstructive pulmonary disease using a predictive algorithm as decision support: A pilot study

2016 ◽  
Vol 23 (3) ◽  
pp. 410-415 ◽  
Author(s):  
Mads N Stausholm ◽  
Andreas Egmose ◽  
Simon C Dahl ◽  
Pernille H Lilholt ◽  
Simon L Cichosz ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Decision Support ◽  
Pulmonary Disease ◽  
Chronic Obstructive ◽  
Cost Models ◽  
Future Health ◽  
Obstructive Pulmonary Disease ◽  
Copd Patients ◽  
Predictive Algorithms ◽  
Number Of Patients

Introduction The number of patients needing care who suffer from chronic obstructive pulmonary disease (COPD) is expected to increase in the future. The consequences thereof will increase the socio-economic burden for both patients and society. Telehealthcare technologies have shown potential in reducing hospitalisation-related costs and in improving health-related quality of life (HRQOL) for some COPD patients, but not all. The aim of this study was to investigate the potential of predictive algorithms for helping the general practitioner to stratify telehealthcare for COPD patients in a way that maximises HRQOL and minimises COPD-related costs. Methods Data from 553 COPD patients based in the North Denmark Region were analysed and used as predictors for four multiple linear regression models. The models were trained and evaluated for their abilities to predict individual patient’s future health- and cost-related developments, with and without telehealthcare. Results The average root-mean-square error (RMSE) of the health and cost models was 5.265 HRQOL scores and US dollars (US$)5430.49, respectively. The accuracy regarding the polarity of the predicted changes ranged from 61–65% for the health models and 74–75% for the cost models. While differences in the magnitude of predictions with and without telehealthcare were statistically significant ( p < 0.01), the polarity of predictions was similar across models in 82.05% of all cases. Discussion Our results indicate that it may be possible to predict the magnitude and polarity of a COPD patient’s future health- and cost-related developments with and without telehealthcare. Predictive algorithms may provide a useful decision support tool in stratifying telehealthcare for COPD patients.

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