Clinical factors predictive of appropriate treatment in COPD: a community hospital setting

Background: Chronic obstructive pulmonary disease (COPD) is a common respiratory disease. The appropriate treatment according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guideline was 19-60%. However, there are limited data on predictors of appropriate treatment in patients with COPD. This study aimed to evaluate risk factors of appropriate treatment in patients with COPD according to the GOLD guideline in a real-world community setting. Methods: This is a retrospective study conducted at a community hospital. Inclusion criteria were adult patients diagnosed as COPD treated at a COPD clinic. The primary outcome was the appropriate treatment, defined by correct pharmacological treatment by the GOLD guideline according to the ABCD severity assessment. Clinical predictors of appropriate treatment were executed by stepwise multivariate logistic regression analysis. Results: 136 patients with COPD met the study criteria. Of those, 100 patients had inappropriate treatment according to the GOLD guideline. Three factors were independently associated with the appropriate treatment including number of admissions, modified Medical Research Council (mMRC) score, and CAT score. These factors had adjusted odds ratio of 3.11, 2.86, and 1.26, respectively. Causes of inappropriate treatment were unavailability of long-acting muscarinic antagonist (LAMA) (51 patients; 79.69%), treated by inhaled corticosteroid (ICS) alone (12 patients; 18.75%), and treated with only bronchodilator (1 patient; 1.56%). Conclusions: Appropriate COPD patients’ treatment according to the GOLD guideline was 26.47% in community setting. Factors associated with severity of COPD were associated with prescribing appropriate treatments.

Download Full-text

RESPIRATORY TUBERCULOSIS AND CHRONIC OBSTRUCTIVE LUNG DISEASE - FEATURES OF THE COMORBIDE STATE

Chronos Journal ◽

10.31618/2658-7556-2019-39-12-8 ◽

2019 ◽

Author(s):

Anna Viktorovna Katicheva ◽

Nikolai Andreyevich Brazhenko ◽

Olga Nikolaevna Brazhenko ◽

Anna Georgievna Chuikova

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Pulmonary Disease ◽

Rapid Development ◽

Chronic Obstructive Lung Disease ◽

Chronic Obstructive ◽

Bronchial Obstruction ◽

Obstructive Pulmonary Disease ◽

Diffusion Capacity ◽

Cardiovascular Pathology ◽

Systemic Arterial Hypertension

In modern conditions, chronic tobacco intoxication and chronic obstructive pulmonary disease are widespread and affect the health and life expectancy of patients. Among patients with tuberculosis, chronic tobacco intoxication and COPD are also widespread. Against the background of smoking and chronic obstructive pulmonary disease in patients with tuberculosis of the respiratory system, bronchial obstruction, hypoxemia, impaired capillary pulmonary blood flow, and a decrease in the diffusion capacity of the lungs are determined. A comorbid state is accompanied by the development of oxidative stress, systemic inflammation, endothelial dysfunction. Such changes in combination with dyslipidemia contribute to the development of multifocal atherogenesis, systemic arterial hypertension and the rapid development of cardiovascular pathology

Download Full-text

Classification of COPD patients and compliance to recommended treatment in Greece according to GOLD 2017 report: the RELICO study

BMC Pulmonary Medicine ◽

10.1186/s12890-021-01576-6 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Nikolaos Tzanakis ◽

Nikolaos Koulouris ◽

Katerina Dimakou ◽

Konstantinos Gourgoulianis ◽

Epameinondas Kosmas ◽

...

Keyword(s):

Chronic Obstructive Lung Disease ◽

Chronic Obstructive ◽

Cross Sectional ◽

Obstructive Pulmonary Disease ◽

Medical Practitioners ◽

Recommended Treatment ◽

Copd Patients ◽

Assessment Approach ◽

Impaired Lung Function ◽

Group B

Abstract Background Chronic obstructive pulmonary disease (COPD) is a multifactorial clinical condition, characterized by chronic progressive (or worsening) respiratory symptoms, structural pulmonary abnormalities, and impaired lung function, and is often accompanied by multiple, clinically significant comorbid disorders. In 2017, the Global Initiative for Chronic Obstructive Lung Disease (GOLD) issued a new report on COPD prevention, diagnosis and management, aiming at personalizing the maintenance therapeutic approach of the stable disease, based on the patients’ symptoms and history of exacerbations (ABCD assessment approach). Our objective was to evaluate the implementation of GOLD suggestions in everyday clinical practice in Greece. Methods This was a cross-sectional observational study. Sixty-five different variables (demographics, vital sign measurements, COPD-related medical history parameters, comorbidities, vaccination data, COPD severity based on spirometry measurements, COPD stage based on the ABCD assessment approach, COPD treatments) were collected from 3615 nation-wide COPD patients (Greece). Results The mean age at the time of initial COPD diagnosis was 63.8 (± 10.2). Almost 60% of the subjects were classified into group B, while the remaining patients were falling into groups A (18%) and D (21%), and only a small minority of patients belonged to Group C, according to the ABCD assessment approach. The compliance of respiratory physicians to the GOLD 2017 therapeutic suggestions is problematic, especially when it comes to COPD patients belonging to Group A. Conclusion Our data provide valuable information regarding the demographic and medical profile of COPD patients in Greece, the domains which the revised ABCD assessment approach may show some clinical significance on, and the necessity for medical practitioners dealing with COPD patients to adhere closer to international recommendations for the proper management of the disease.

Download Full-text

High prevalence of undiagnosed COPD among patients evaluated for suspected myocardial ischaemia

Open Heart ◽

10.1136/openhrt-2018-000848 ◽

2018 ◽

Vol 5 (2) ◽

pp. e000848 ◽

Cited By ~ 1

Author(s):

Andreas Jönsson ◽

Artur Fedorowski ◽

Gunnar Engström ◽

Per Wollmer ◽

Viktor Hamrefors

Keyword(s):

Myocardial Ischaemia ◽

Chronic Obstructive Lung Disease ◽

Chronic Obstructive ◽

Clinical Factors ◽

Obstructive Pulmonary Disease ◽

Presenting Symptoms ◽

High Prevalence ◽

History Of ◽

Artery Disease ◽

Global Initiative

ObjectiveChronic obstructive pulmonary disease (COPD) and coronary artery disease (CAD) are leading causes of global morbidity and mortality. Despite the well-known comorbidity between COPD and CAD, the presence of COPD may be overlooked in patients undergoing coronary evaluation. We aimed to assess the prevalence of undiagnosed COPD among outpatients evaluated due to suspected myocardial ischemia.MethodsAmong 500 outpatients who were referred to myocardial perfusion imaging due to suspected stable myocardial ischaemia, 433 patients performed spirometry. Of these, a total of 400 subjects (age 66 years; 45% women) had no previous COPD diagnosis and were included in the current study. We compared the prevalence of previously undiagnosed COPD according to spirometry criteria from The Global Initiative for Chronic Obstructive Lung Disease (GOLD) or lower limit of normal (LLN) and reversible myocardial ischaemia according to symptoms and clinical factors.ResultsA total of 134 (GOLD criteria; 33.5 %) or 46 patients (LLN criteria; 11.5%) had previously undiagnosed COPD, whereas 55 patients (13.8 %) had reversible myocardial ischaemia. The presenting symptoms (chest discomfort, dyspnoea) did not differ between COPD, myocardial ischaemia and normal findings. Except for smoking, no clinical factors were consistently associated with previously undiagnosed COPD.ConclusionsAmong middle-aged outpatients evaluated due to suspected myocardial ischaemia, previously undiagnosed COPD is at least as common as reversible myocardial ischaemia and the presenting symptoms do not differentiate between these entities. Patients going through a coronary ischaemia evaluation should be additionally tested for COPD, especially if there is a positive history of smoking.

Download Full-text

Chronic Obstructive Lung Disease in young: Alpha 1 anti trypsin deficiency

Journal of Advances in Internal Medicine ◽

10.3126/jaim.v3i2.14067 ◽

2015 ◽

Vol 3 (2) ◽

pp. 65-67

Author(s):

S.S. Dhakal ◽

K.K. Agrawaal ◽

N.K. Bhatta

Keyword(s):

Bronchial Asthma ◽

Clinical Manifestations ◽

Lower Lobe ◽

Chronic Obstructive Lung Disease ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Severe Deficiency ◽

History Of ◽

Pulmonary Arterial ◽

Alpha 1 Antitrypsin

Alpha-1 antitrypsin (AAT) deficiency is a clinically under recognized inherited disorder. The main clinical manifestations relate to three separate organs: the lung, the liver, and the skin. In the lung, severe deficiency of AAT predisposes to chronic obstructive pulmonary disease. We present a case of 34 years male with a history of recurrent chest infections in past and treated in the line of bronchial asthma but not relieved. He was admitted on 22nd May 2011 at BPKIHS. He presented with type 2 respiratory failure and had features of severe pulmonary arterial hypertension and left lower lobe pneumonia. The patient got improved with the treatment and is doing well on follow up. The diagnosis should be strongly suspected in patients with history suggestive of bronchial asthma and with obstructive features.Journal of Advances in Internal Medicine 2014;3(2):65-67

Download Full-text

Detection of exacerbactions of chronic obstructive lung disease in the ambulatory practice

Russian Family Doctor ◽

10.17816/rfd2018118-22 ◽

2018 ◽

Vol 22 (1) ◽

pp. 18-22

Author(s):

Natalia S Maliavko ◽

Nikita O Shatyi ◽

Elena V Alagova ◽

Marina A Pokhaznikova ◽

Anatoliy K Lebedev

Keyword(s):

Lung Disease ◽

Obstructive Lung Disease ◽

Family Doctor ◽

Chronic Obstructive Lung Disease ◽

Self Esteem ◽

Chronic Obstructive ◽

Management Skills ◽

Obstructive Pulmonary Disease ◽

Ambulatory Practice ◽

Exacerbation Of Copd

The article presents the results of a retrospective study aimed at identifying exacerbations in outpatients with chronic obstructive pulmonary disease (COPD) during the previous 12 months. А telephone interview was conducted with 20 patients with COPD from the departments of general medical practice of three polyclinics in the Kalininsky district of St. Petersburg. The obtained data were compared with records in outpatient cards to determine the presence of registered cases of appeals to the polyclinic for exacerbation of the disease.7 patients (35%) were identified retrospectively using the questionnaire, which can be attributed to the phenotype of COPD with frequent exacerbations. Among them, five people were hospitalized in a hospital for exacerbation of COPD, and two patients had 2 or more exacerbations in an outpatient card that did not lead to hospitalization. In 5 patients (33%), among those who were not in hospital for an exacerbation of COPD for the previous 12 months, indirect signs of low self-esteem were revealed, indicating that it is necessary to raise awareness of the exacerbation of COPD and the education patients self-management skills. (For citation: Maliavko NS, Shatyi NO, Alagova EV, et al. Detection of exacerbactions of chronic obstructive lung disease in the ambulatory practice. Russian Family Doctor. 2018;22(1):18-22. doi 10.17816/RFD2018118-22).

Download Full-text

Mechanisms of exercise intolerance in Global Initiative for Chronic Obstructive Lung Disease grade 1 COPD

European Respiratory Journal ◽

10.1183/09031936.00034714 ◽

2014 ◽

Vol 44 (5) ◽

pp. 1177-1187 ◽

Cited By ~ 64

Author(s):

Jordan A. Guenette ◽

Roberto C. Chin ◽

Sicheng Cheng ◽

Paolo B. Dominelli ◽

Natya Raghavan ◽

...

Keyword(s):

Work Of Breathing ◽

Pressure Ratio ◽

Chronic Obstructive Lung Disease ◽

Exercise Intolerance ◽

Chronic Obstructive ◽

Respiratory Drive ◽

Obstructive Pulmonary Disease ◽

Transdiaphragmatic Pressure ◽

Generating Capacity ◽

Neuromuscular Abnormalities

The purpose of this study was to determine if a dissociation existed between respiratory drive, as estimated by diaphragmatic electromyography (EMGdi), and its pressure-generating capacity during exercise in mild chronic obstructive pulmonary disease (COPD) and whether this, if present, had negative sensory consequences.Subjects meeting spirometric criteria for mild COPD (n=16) and age and sex-matched controls (n=16) underwent detailed pulmonary function testing and a symptom limited cycle test while detailed ventilatory, sensory and respiratory mechanical responses were measured.Compared with controls, subjects with mild COPD had greater ventilatory requirements throughout submaximal exercise. At the highest equivalent work rate of 60 W, they had a significantly higher: total work of breathing (32±17 versus 16±7 J·min−1; p<0.01); EMGdi (37.3±17.3 versus 17.9±11.7% of maximum; p<0.001); and EMGdi to transdiaphragmatic pressure ratio (0.87±0.38 versus 0.52±0.27; p<0.01). Dyspnoea–ventilation slopes were significantly higher in mild COPD than controls (0.17±0.12 versus 0.10±0.05; p<0.05). However, absolute dyspnoea ratings reached significant levels only at high levels of ventilation.Increased respiratory effort and work of breathing, and a wider dissociation between diaphragmatic activation and pressure-generating capacity were found at standardised work rates in subjects with mild COPD compared with controls. Despite these mechanical and neuromuscular abnormalities, significant dyspnoea was only experienced at higher work rates.

Download Full-text

Microalbuminuria on admission for acute exacerbation of COPD as a predictor of all-cause mortality and future exacerbations

Postgraduate Medical Journal ◽

10.1136/postgradmedj-2021-141206 ◽

2021 ◽

pp. postgradmedj-2021-141206

Author(s):

Konstantinos Bartziokas ◽

Christos Kyriakopoulos ◽

Evangelia Dounousi ◽

Konstantinos Kostikas

Keyword(s):

Acute Exacerbation ◽

Chronic Obstructive Lung Disease ◽

Multivariate Regression Analysis ◽

Forced Expiratory Volume ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Acute Exacerbation Of Copd ◽

Tertiary Hospitals ◽

Exacerbation Of Copd

ObjectivesMicroalbuminuria (MAB) is a sensitive biomarker of cardiovascular risk that is directly associated with cardiovascular events and mortality. Recent studies have evaluated the presence of MAB in patients with stable chronic obstructive pulmonary disease (COPD) or hospitalised for acute exacerbation of COPD (AECOPD).MethodsWe evaluated 320 patients admitted for AECOPD in respiratory medicine departments of two tertiary hospitals. On admission, demographic, clinical and laboratory values and COPD severity were assessed. Patients were evaluated monthly for 1 year, recording new AECOPD and death from any cause.ResultsPatients with documented MAB (urinary albumin excretion of 30–300 mg/24 hours) on admission had worse lung function (forced expiratory volume in 1 s, %) (mean (SD) 34.2 (13.6)% vs 61.5 (16.7)%), higher modified Medical Research Council (3.6 (1.2) vs 2.1 (0.8)), lower 6 min walk test (171 (63) vs 366 (104)) and more hospitalisation days (9 (2.8) vs 4.7 (1.9)) (p<0.001 for all comparisons). MAB was also correlated with Global Initiative for Chronic Obstructive Lung Disease 2020 COPD stages (p<0.001). In multivariate regression analysis, MAB was a significant predictor of longer hospitalisation duration (OR 6.847, 95% CI 3.050 to 15.370, p<0.0001). Twelve-month follow-up revealed that patients with MAB experienced more AECOPDs (4.6 (3.6) vs 2.2 (3.5), p<0.0001) and deaths, n (%) (52 (36.6) vs 14 (7.8), p<0.001). Kaplan-Meier survival curves demonstrated that patients with MAB presented with increased mortality, AECOPD and hospitalisation for AECOPD risk at 1 year (p<0.001 for all comparisons).ConclusionsThe presence of MAB on admission for AECOPD was associated with more severe COPD and prolonged hospitalisation, as well as with higher rates of AECOPD and mortality risk at 1-year follow-up.

Download Full-text

Interventional Bronchoscopy in the Management of Chronic Obstructive Lung Disease

Current Respiratory Medicine Reviews ◽

10.2174/1573398x15666190211155026 ◽

2019 ◽

Vol 15 (2) ◽

pp. 133-139 ◽

Cited By ~ 1

Author(s):

Semra Bilaçeroğlu

Keyword(s):

Management Strategies ◽

Chronic Obstructive Lung Disease ◽

Lifestyle Changes ◽

Airflow Limitation ◽

Chronic Obstructive ◽

Interventional Bronchoscopy ◽

Obstructive Pulmonary Disease ◽

Mucosal Regeneration ◽

Therapeutic Modalities ◽

Collateral Ventilation

Background: Chronic obstructive pulmonary disease (COPD) is characterized by airflow limitation, hyperinflation and reduced gas exchange that lead to progressive dyspnea. Pulmonary rehabilitation, lifestyle changes, pharmacotherapy, long-term oxygen therapy, noninvasive ventilation and surgical therapeutic approaches are the basic management strategies. Purpose: In the last 15 years, various bronchoscopic therapeutic modalities have emerged for severe COPD. The aim of this review is to summarize the effects of these bronchoscopic treatments compared with lung rehabilitation and pharmacological therapies. Methods: A PubMed search for the eligible studies and reviews on interventional bronchoscopy and COPD has been conducted. Results: Bronchoscopic lung volume reduction (LVR) techniques are targeted to reduce hyperinflation. The efficacy of reversible valve implantation has been confirmed in several randomized controlled trials. It provides clinical benefit in the absence of interlobar collateral ventilation. Nonblocking bronchoscopic LVR with coils, thermal vapor or sealants is independent of collateral ventilation but has not been studied sufficiently. Partially irreversible coil implantation leads to parenchymal compression while irreversible LVR with thermal vapor or sealants induce an inflammatory reaction. Targeted lung denervation ablates parasympathetic pulmonary nerves in COPD for sustainable bronchodilation, and liquid nitrogen metered cryospray destroys hyperplastic goblet cells and excessive submucous glands in the central airways to induce mucosal regeneration in chronic bronchitis. Conclusion: The best-examined bronchoscopic LVR method is the valve therapy. The data from the other modalities are still limited. Further studies are required to select the patients that will optimally benefit from a particular treatment and to predict and treat the procedure-related complications.

Download Full-text

¿Por qué la rehabilitación respiratoria no llega a todos los pacientes de enfermedad pulmonar obstructiva crónica que lo necesitan? Revisión de la literatura

Revista de la Facultad de Medicina ◽

10.15446/revfacmed.v67n2.67252 ◽

2019 ◽

Vol 67 (2) ◽

pp. 325-332

Author(s):

Aina Rigo ◽

Berta Paz-Lourido

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Physical Therapy ◽

Health Services ◽

Obstructive Lung Disease ◽

Health Services Accessibility ◽

Chronic Obstructive Lung Disease ◽

Physical Therapy Modalities ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Enfermedad Pulmonar Obstructiva Crónica

Introducción. La rehabilitación respiratoria (RR) es un tratamiento clave en la enfermedad pulmonar obstructiva crónica, pero aun estando disponible, los pacientes no siempre acceden a ella.Objetivo. Identificar los factores que pueden limitar el acceso a la RR y que se relacionan con los pacientes, los médicos y los fisioterapeutas.Materiales y métodos. Se realizó una revisión de artículos publicados en inglés y español entre 2006 y 2018. Se usaron los términos “COPD”, “chronic obstructive pulmonary disease”, “COLD”, “chronic obstructive lung disease”, “physical therapy modalities”, “rehabilitation”, “health services accessibility” y “patient” en las bases de datos PubMed, PEDro, Scielo e IBECS.Resultados. Se seleccionaron 11 publicaciones. Entre las barreras que afectan a los pacientes destacan el transporte, la condición ambiental, las situaciones personales y algunos factores sociales y contextuales. El conocimiento de los profesionales, sus condiciones de trabajo y sus expectativas sobre beneficio de los protocolos de RR también son factores que condicionan el acceso de los pacientes.Conclusiones. La formación interprofesional de médicos y fisioterapeutas, la implantación de protocolos flexibles a las condiciones de los pacientes y las medidas organizativas e intersectoriales del sistema sanitario pueden facilitar la accesibilidad a la RR de los pacientes.

Download Full-text