scholarly journals Epidemiology of Chronic Obstructive Pulmonary Disease (COPD) Comorbidities in Lithuanian National Database: A Cluster Analysis

Author(s):  
Elena Jurevičienė ◽  
Greta Burneikaitė ◽  
Laimis Dambrauskas ◽  
Vytautas Kasiulevičius ◽  
Edita Kazėnaitė ◽  
...  

Various comorbidities and multimorbidity frequently occur in chronic obstructive pulmonary disease (COPD), leading to the overload of health care systems and increased mortality. We aimed to assess the impact of COPD on the probability and clustering of comorbidities. The cross-sectional analysis of the nationwide Lithuanian database was performed based on the entries of the codes of chronic diseases. COPD was defined on the code J44.8 entry and six-month consumption of bronchodilators. Descriptive statistics and odds ratios (ORs) for associations and agglomerative hierarchical clustering were carried out. 321,297 patients aged 40–79 years were included; 4834 of them had COPD. A significantly higher prevalence of cardiovascular diseases (CVD), lung cancer, kidney diseases, and the association of COPD with six-fold higher odds of lung cancer (OR 6.66; p < 0.0001), a two-fold of heart failure (OR 2.61; p < 0.0001), and CVD (OR 1.83; p < 0.0001) was found. Six clusters in COPD males and five in females were pointed out, in patients without COPD—five and four clusters accordingly. The most prevalent cardiovascular cluster had no significant difference according to sex or COPD presence, but a different linkage of dyslipidemia was found. The study raises the need to elaborate adjusted multimorbidity case management and screening tools enabling better outcomes.

2016 ◽  
Vol 33 (1) ◽  
pp. 8-14 ◽  
Author(s):  
Amber Lanae Smith ◽  
Valerie Palmer ◽  
Nada Farhat ◽  
James S. Kalus ◽  
Krishna Thavarajah ◽  
...  

Background: No systematic evaluations of a comprehensive clinical pharmacy process measures currently exist to determine an optimal ambulatory care collaboration model for chronic obstructive pulmonary disease (COPD) patients. Objective: Describe the impact of a pharmacist-provided clinical COPD bundle on the management of COPD in a hospital-based ambulatory care clinic. Methods: This retrospective cohort analysis evaluated patients with COPD managed in an outpatient pulmonary clinic. The primary objective of this study was to assess the completion of 4 metrics known to improve the management of COPD: (1) medication therapy management, (2) quality measures including smoking cessation and vaccines, (3) patient adherence, and (4) patient education. The secondary objective was to evaluate the impact of the clinical COPD bundle on clinical and economic outcomes at 30 and 90 days post–initial visit. Results: A total of 138 patients were included in the study; 70 patients served as controls and 68 patients received the COPD bundle from the clinical pharmacist. No patients from the control group had all 4 metrics completed as documented, compared to 66 of the COPD bundle group ( P < .0001). Additionally, a statistically significant difference was found in all 4 metrics when evaluated individually. Clinical pharmacy services reduced the number of phone call consults at 90 days ( P = .04) but did not have a statistically significant impact on any additional pre-identified clinical outcomes. Conclusion: A pharmacist-driven clinical COPD bundle was associated with significant increases in the completion and documentation of 4 metrics known to improve the outpatient management of COPD.


2016 ◽  
Vol 65 (2) ◽  
pp. 342-352 ◽  
Author(s):  
Lan-Eng Tan ◽  
Razak A M ◽  
Chor-Shen Lim

Patients with lung cancer often have chronic obstructive pulmonary disease (COPD), but the impact of COPD on postresection survival of patients with lung cancer is unclear. This study evaluated the impact of COPD on survival of patients with lung cancer following pulmonary resection. Databases searched included PubMed, Cochrane, and Embase until March 2016. Study outcomes were overall survival and pulmonary complication rate (pneumonia, bronchial fistula, and prolonged mechanical ventilation). 6 studies with a total of 3761 patients were included. The presence of COPD was associated with lower overall survival, increased frequency of pneumonia, and prolonged mechanical ventilation (p values ≤0.001). COPD had no influence on bronchial fistula development (p=0.098). In summary, COPD was associated with poorer survival and an increased frequency of certain adverse events in patients with lung cancer following resection.


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