Pub Date : 2022-04-09DOI: 10.15326/jcopdf.2022.0288
O. McElvaney, B. Cleary, D. Fraughen, G. Kelly, M. Murphy, O. Mcelvaney, P. Branagan, C. Gunaratnam, T. Carroll, N. McElvaney
Patients with severe alpha-1 antitrypsin deficiency (AATD) are at increased risk for the development of chronic obstructive pulmonary disease (COPD), particularly if they smoke. This, coupled with their predilection for dysregulated inflammation and autoimmunity, makes affected individuals priority candidates for vaccination against Coronavirus Disease 2019 (COVID-19). To promote vaccine uptake effectively, an understanding of the factors motivating people to proceed with vaccination is essential. The attitudes of patients with AATD towards COVID-19 vaccination have yet to be described. We prospectively studied 170 Pi*ZZ AATD patients, 150 patients with nonhereditary (Pi*MM) COPD and 140 Pi*MM individuals without lung disease receiving first-dose vaccination with ChAdOx1 nCoV-19 (AstraZeneca). Patient attitudes towards vaccination and motivations for getting vaccinated were assessed at the time of the vaccine being offered. Following completion of the two-dose vaccine series, Pi*ZZ patients were then re-assessed regarding their attitudes towards booster vaccination. The most common primary motivation for accepting vaccination in Pi*ZZ participants ≥50 years was a fear of illness or death from COVID-19. In contrast, Pi*ZZ patients <50 years most often cited a desire to socialize. The motivation pattern of younger Pi*ZZ AATD patients was similar to that of non-deficient individuals of comparable age, whereas older Pi*ZZ individuals were more closely aligned with Pi*MM COPD and differed from age-matched controls without lung disease. When considering booster vaccination, Pi*ZZ patients were increasingly motivated by a desire to reacquire social freedoms. A desire to reduce the risk of transmission was not a prominent consideration in any of the groups studied. The most commonly cited reason for booster hesitancy was a lack of incentive, given that no additional social freedoms were available to triple-vaccinated individuals compared to those who were double-vaccinated at the time. Taken together, these data may inform policymakers attempting to promote vaccine uptake among patients with AATD.
{"title":"Attitudes Towards Vaccination Against Coronavirus Disease 2019 in Patients with Severe Alpha-1 Antitrypsin Deficiency","authors":"O. McElvaney, B. Cleary, D. Fraughen, G. Kelly, M. Murphy, O. Mcelvaney, P. Branagan, C. Gunaratnam, T. Carroll, N. McElvaney","doi":"10.15326/jcopdf.2022.0288","DOIUrl":"https://doi.org/10.15326/jcopdf.2022.0288","url":null,"abstract":"Patients with severe alpha-1 antitrypsin deficiency (AATD) are at increased risk for the development of chronic obstructive pulmonary disease (COPD), particularly if they smoke. This, coupled with their predilection for dysregulated inflammation and autoimmunity, makes affected individuals priority candidates for vaccination against Coronavirus Disease 2019 (COVID-19). To promote vaccine uptake effectively, an understanding of the factors motivating people to proceed with vaccination is essential. The attitudes of patients with AATD towards COVID-19 vaccination have yet to be described. We prospectively studied 170 Pi*ZZ AATD patients, 150 patients with nonhereditary (Pi*MM) COPD and 140 Pi*MM individuals without lung disease receiving first-dose vaccination with ChAdOx1 nCoV-19 (AstraZeneca). Patient attitudes towards vaccination and motivations for getting vaccinated were assessed at the time of the vaccine being offered. Following completion of the two-dose vaccine series, Pi*ZZ patients were then re-assessed regarding their attitudes towards booster vaccination. The most common primary motivation for accepting vaccination in Pi*ZZ participants ≥50 years was a fear of illness or death from COVID-19. In contrast, Pi*ZZ patients <50 years most often cited a desire to socialize. The motivation pattern of younger Pi*ZZ AATD patients was similar to that of non-deficient individuals of comparable age, whereas older Pi*ZZ individuals were more closely aligned with Pi*MM COPD and differed from age-matched controls without lung disease. When considering booster vaccination, Pi*ZZ patients were increasingly motivated by a desire to reacquire social freedoms. A desire to reduce the risk of transmission was not a prominent consideration in any of the groups studied. The most commonly cited reason for booster hesitancy was a lack of incentive, given that no additional social freedoms were available to triple-vaccinated individuals compared to those who were double-vaccinated at the time. Taken together, these data may inform policymakers attempting to promote vaccine uptake among patients with AATD.","PeriodicalId":10249,"journal":{"name":"Chronic obstructive pulmonary diseases","volume":"84 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83945366","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-04-09DOI: 10.15326/jcopdf.2021.0263
J. Krishnan, Kayley M Ancy, C. Oromendia, K. Hoffman, I. Easthausen, N. Leidy, M. Han, R. Bowler, S. Christenson, D. Couper, G. Criner, J. Curtis, M. Dransfield, N. Hansel, A. Iyer, R. Paine Iii, S. Peters, J. Wedzicha, P. Woodruff, K. Ballman, F. Martinez
Rationale It has been suggested that patients with COPD experience considerable daily respiratory symptom fluctuation. A standardized measure is needed to quantify and understand the implications of day-to-day symptom variability. Objectives To compare standard deviation with other statistical measures of symptom variability and identify characteristics of subjects with higher symptom variability. Methods Individuals in the Subpopulations and Intermediate Outcome Measures in COPD Study (SPIROMICS) Exacerbations sub-study completed an Evaluating Respiratory Symptoms in COPD (E-RS) daily questionnaire. We calculated within-subject standard deviation (WS-SD) for each patient at week 0 and correlated this with measurements obtained four weeks later using Pearson's r and Bland Altman plots. Median WS-SD value dichotomized participants into higher versus lower variability groups. Association between WS-SD and exacerbation risk during four follow up weeks was explored. Measurements and Main Results Diary completion rates were sufficient in 140 (68%) of 205 sub-study participants. Reproducibility (r) of the WS-SD metric from baseline to week four was 0.32. Higher variability participants had higher St. George's Respiratory Questionnaire (SGRQ) scores (47.3 ± 20.3 vs 39.6 ± 21.5, p=.04) than lower variability participants. Exploratory analyses found no relationship between symptom variability and HCRU exacerbations. Conclusions WS-SD of the E-RS can be used as a measure of symptom variability in studies of patients with COPD. Patients with higher variability have worse health-related quality of life. WS-SD should be further validated as a measure to understand the implications of symptom variability.
有研究表明，慢性阻塞性肺病患者每日呼吸症状波动较大。需要一种标准化的措施来量化和理解日常症状变异性的含义。目的比较症状变异性的标准差与其他统计方法的差异，确定症状变异性较高的被试的特征。方法慢性阻塞性肺病研究(SPIROMICS)加重亚研究的亚群个体和中间结局指标完成了COPD呼吸症状评估(E-RS)每日问卷调查。我们计算了每个患者在第0周的受试者内标准差(WS-SD)，并使用Pearson's r和Bland Altman图将其与四周后获得的测量结果相关联。WS-SD值中位数将参与者分为高变异性组和低变异性组。在4周的随访中探讨WS-SD与恶化风险的关系。在205个子研究参与者中，140人(68%)的日记完成率是足够的。WS-SD指标从基线到第4周的重现性(r)为0.32。高变异性受试者的圣乔治呼吸问卷(SGRQ)得分高于低变异性受试者(47.3±20.3 vs 39.6±21.5,p= 0.04)。探索性分析未发现症状变异性与HCRU恶化之间的关系。结论E-RS的sws - sd可作为COPD患者症状变异性的衡量指标。变异性较高的患者健康相关生活质量较差。应该进一步验证WS-SD作为一种度量，以了解症状可变性的含义。
{"title":"Characterizing COPD Symptom Variability in the Stable State Utilizing the Evaluating Respiratory Symptoms in COPD Questionnaire.","authors":"J. Krishnan, Kayley M Ancy, C. Oromendia, K. Hoffman, I. Easthausen, N. Leidy, M. Han, R. Bowler, S. Christenson, D. Couper, G. Criner, J. Curtis, M. Dransfield, N. Hansel, A. Iyer, R. Paine Iii, S. Peters, J. Wedzicha, P. Woodruff, K. Ballman, F. Martinez","doi":"10.15326/jcopdf.2021.0263","DOIUrl":"https://doi.org/10.15326/jcopdf.2021.0263","url":null,"abstract":"Rationale\u0000It has been suggested that patients with COPD experience considerable daily respiratory symptom fluctuation. A standardized measure is needed to quantify and understand the implications of day-to-day symptom variability.\u0000\u0000\u0000Objectives\u0000To compare standard deviation with other statistical measures of symptom variability and identify characteristics of subjects with higher symptom variability.\u0000\u0000\u0000Methods\u0000Individuals in the Subpopulations and Intermediate Outcome Measures in COPD Study (SPIROMICS) Exacerbations sub-study completed an Evaluating Respiratory Symptoms in COPD (E-RS) daily questionnaire. We calculated within-subject standard deviation (WS-SD) for each patient at week 0 and correlated this with measurements obtained four weeks later using Pearson's r and Bland Altman plots. Median WS-SD value dichotomized participants into higher versus lower variability groups. Association between WS-SD and exacerbation risk during four follow up weeks was explored.\u0000\u0000\u0000Measurements and Main Results\u0000Diary completion rates were sufficient in 140 (68%) of 205 sub-study participants. Reproducibility (r) of the WS-SD metric from baseline to week four was 0.32. Higher variability participants had higher St. George's Respiratory Questionnaire (SGRQ) scores (47.3 ± 20.3 vs 39.6 ± 21.5, p=.04) than lower variability participants. Exploratory analyses found no relationship between symptom variability and HCRU exacerbations.\u0000\u0000\u0000Conclusions\u0000WS-SD of the E-RS can be used as a measure of symptom variability in studies of patients with COPD. Patients with higher variability have worse health-related quality of life. WS-SD should be further validated as a measure to understand the implications of symptom variability.","PeriodicalId":10249,"journal":{"name":"Chronic obstructive pulmonary diseases","volume":"75 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73966861","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-04-01DOI: 10.15326/jcopdf.2022.2095
Domenica Di Costanzo, Simon Meredith, B. Mina, A. Esquinas
{"title":"Insights about Human-Centered Design Analysis as a Tool to Improve Patients' Tolerance with Non-Invasive Ventilation.","authors":"Domenica Di Costanzo, Simon Meredith, B. Mina, A. Esquinas","doi":"10.15326/jcopdf.2022.2095","DOIUrl":"https://doi.org/10.15326/jcopdf.2022.2095","url":null,"abstract":"","PeriodicalId":10249,"journal":{"name":"Chronic obstructive pulmonary diseases","volume":"228 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80194770","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-04-01DOI: 10.15326/jcopdf.2021.0280
E. Camac, Natalie A Stumpf, Helen K Voelker, Gerard J. Criner
Background Chronic Obstructive Pulmonary Disease (COPD) patients in the Simvastatin for the prevention of exacerbations in moderate-to-severe COPD (STATCOPE) and Azithromycin for prevention of exacerbations of COPD (MACRO) trials provide an opportunity prospectively study the short-term effect of Acute Exacerbations of COPD (AECOPD). Research Question We hypothesized that those patients with frequent exacerbations (≥ 2 AECOPDs per patient year) would experience greater short-term decline in quality of life as measured by the St. George's Respiratory Questionnaire (SGRQ.). Study Design and Methods 1934 COPD patients were randomized in STATCOPE or MACRO. Patients who were randomized to Azithromycin in MACRO or were followed less than 180 days were excluded. 1219 patients were included. Patients were divided into two groups: infrequent exacerbators (< 2 exacerbations per patient year), and frequent exacerbators (≥2 exacerbations per year.) Data were collected at baseline, measured over time, and compared between groups. Results Of the patients studied, 871 were in the infrequent exacerbators group. 348 were in the frequent exacerbators group. Frequent exacerbators used more respiratory medications, were more likely to have used oxygen, steroids, or antibiotics in the 12 months preceding study entry, had more obstruction on spirometry, and had more severe symptoms as measured by SGRQ at baseline. Over at least 180 days, symptom scores worsened in frequent exacerbators and improved in infrequent exacerbators. Interpretation Patients with frequent exacerbations of COPD experienced a short-term slight worsening of severely impaired SGRQ symptoms scores, while patients with infrequent exacerbations experienced improvement while on COPD therapies.
{"title":"Short-Term Impact of the Frequency of COPD Exacerbations on Quality of Life.","authors":"E. Camac, Natalie A Stumpf, Helen K Voelker, Gerard J. Criner","doi":"10.15326/jcopdf.2021.0280","DOIUrl":"https://doi.org/10.15326/jcopdf.2021.0280","url":null,"abstract":"Background\u0000Chronic Obstructive Pulmonary Disease (COPD) patients in the Simvastatin for the prevention of exacerbations in moderate-to-severe COPD (STATCOPE) and Azithromycin for prevention of exacerbations of COPD (MACRO) trials provide an opportunity prospectively study the short-term effect of Acute Exacerbations of COPD (AECOPD).\u0000\u0000\u0000Research Question\u0000We hypothesized that those patients with frequent exacerbations (≥ 2 AECOPDs per patient year) would experience greater short-term decline in quality of life as measured by the St. George's Respiratory Questionnaire (SGRQ.).\u0000\u0000\u0000Study Design and Methods\u00001934 COPD patients were randomized in STATCOPE or MACRO. Patients who were randomized to Azithromycin in MACRO or were followed less than 180 days were excluded. 1219 patients were included. Patients were divided into two groups: infrequent exacerbators (< 2 exacerbations per patient year), and frequent exacerbators (≥2 exacerbations per year.) Data were collected at baseline, measured over time, and compared between groups.\u0000\u0000\u0000Results\u0000Of the patients studied, 871 were in the infrequent exacerbators group. 348 were in the frequent exacerbators group. Frequent exacerbators used more respiratory medications, were more likely to have used oxygen, steroids, or antibiotics in the 12 months preceding study entry, had more obstruction on spirometry, and had more severe symptoms as measured by SGRQ at baseline. Over at least 180 days, symptom scores worsened in frequent exacerbators and improved in infrequent exacerbators.\u0000\u0000\u0000Interpretation\u0000Patients with frequent exacerbations of COPD experienced a short-term slight worsening of severely impaired SGRQ symptoms scores, while patients with infrequent exacerbations experienced improvement while on COPD therapies.","PeriodicalId":10249,"journal":{"name":"Chronic obstructive pulmonary diseases","volume":"149 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79445230","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-03-23DOI: 10.15326/jcopdf.2022.0273
V. Press, Kelly H. Randall, Amber Hanser
Background Chronic Obstructive Pulmonary Disease (COPD) is the third-leading cause of early readmissions. The Centers for Medicare and Medicaid instituted a financial penalty for excessive COPD readmissions galvanizing hospitals to implement effective strategies to reduce readmissions. We evaluated a 6-month COPD Chronic Care Management Collaborative to support hospitals to reduce preventable COPD-related revisits. Methods Sites were recruited among nearly 300 Vizient members. The Collaborative used performance improvement initiatives to assist with implementation of effective strategies. Participants submitted performance data for two outcome measures: emergency department (ED) and hospital revisits. Results Forty-seven members enrolled (Part I+II: n=33; Part I: n=3; Part II: n=11) of which 23 submitted data (n=23/47). The majority (n=19/23, 83%) reduced rates of COPD-related ED and/or hospital revisits. Among all 23 sites, the change in ED visits went from 11.05% to 10.87%; among 7 sites with reductions in ED visits, the reduction was 12.7% to 9%. Among all 23 sites, there were not reductions hospital readmissions (18.53% to 18.64%); among 7 sites with reductions, the readmission rate went from 20.1% to 15.6%. The mean reach across 17 hospitals reporting reach for their most successful measure at baseline was 35.2% (SD = 26.7%) and for the six reporting reach at follow-up was 73.8%% (SD = 18.3%); of note, only three sites submitted both baseline and follow-up data. Conclusions The Collaborative successfully supported the majority of sites to reduce COPD-related ED and/or hospital revisits using subject matter experts and coaching strategies to support hospitals' implementation of COPD quality improvement interventions.
{"title":"Evaluation of COPD Chronic Care Management Collaborative to Reduce Emergency Department and Hospital Revisits Across U.S. Hospitals.","authors":"V. Press, Kelly H. Randall, Amber Hanser","doi":"10.15326/jcopdf.2022.0273","DOIUrl":"https://doi.org/10.15326/jcopdf.2022.0273","url":null,"abstract":"Background\u0000Chronic Obstructive Pulmonary Disease (COPD) is the third-leading cause of early readmissions. The Centers for Medicare and Medicaid instituted a financial penalty for excessive COPD readmissions galvanizing hospitals to implement effective strategies to reduce readmissions. We evaluated a 6-month COPD Chronic Care Management Collaborative to support hospitals to reduce preventable COPD-related revisits.\u0000\u0000\u0000Methods\u0000Sites were recruited among nearly 300 Vizient members. The Collaborative used performance improvement initiatives to assist with implementation of effective strategies. Participants submitted performance data for two outcome measures: emergency department (ED) and hospital revisits.\u0000\u0000\u0000Results\u0000Forty-seven members enrolled (Part I+II: n=33; Part I: n=3; Part II: n=11) of which 23 submitted data (n=23/47). The majority (n=19/23, 83%) reduced rates of COPD-related ED and/or hospital revisits. Among all 23 sites, the change in ED visits went from 11.05% to 10.87%; among 7 sites with reductions in ED visits, the reduction was 12.7% to 9%. Among all 23 sites, there were not reductions hospital readmissions (18.53% to 18.64%); among 7 sites with reductions, the readmission rate went from 20.1% to 15.6%. The mean reach across 17 hospitals reporting reach for their most successful measure at baseline was 35.2% (SD = 26.7%) and for the six reporting reach at follow-up was 73.8%% (SD = 18.3%); of note, only three sites submitted both baseline and follow-up data.\u0000\u0000\u0000Conclusions\u0000The Collaborative successfully supported the majority of sites to reduce COPD-related ED and/or hospital revisits using subject matter experts and coaching strategies to support hospitals' implementation of COPD quality improvement interventions.","PeriodicalId":10249,"journal":{"name":"Chronic obstructive pulmonary diseases","volume":"7 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78859609","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-03-08DOI: 10.15326/jcopdf.2021.0277
M. Benzo, P. Novotny, R. Benzo
Introduction Self-Management abilities (SM) are a recognized ingredient for living well with COPD, improving all outcomes. Fostering SM requires a personalized program and patient engagement to make lifestyle decisions. While some SM practices are proven effective, like the prompt use of a plan for COPD exacerbations, there is a guideline-recognized gap on specific SM behaviors that can impact particular COPD symptoms and allow for tailored SM programs. We aimed to investigate the association of well-defined self-management behaviors with the most common COPD symptoms in a large cohort of patients with COPD. Methods We analyzed baseline data of stable COPD patients that participated in three NIH-funded studies. Symptoms were defined by the four domains of the Chronic Respiratory Questionnaire: Dyspnea-Fatigue-Emotions-Mastery. The SM behaviors were the individual items of the SM Ability Scale-30. Lasso regression models were built to explore the association of behaviors with symptoms, adjusting for lung function and age. Results We analyzed 512 stable COPD patients, 54% female, age mean (SD) 69.6 (9.9) years, and FEV1% 42.2 (19.0). Dyspnea was associated with exercising and self-efficacy for self-care. Emotion was associated with good relationships, self-efficacy for self-care, positivity, and participating in agreeable activities. Fatigue was associated with self-efficacy for self-care, doing exercise, and participating in agreeable activities. Mastery was associated with self-efficacy for self-care, positivity, exercising, and participating in agreeable activities. Discussion Our findings provide specific SM behaviors associated with common COPD symptoms that may inform SM programs. Positive thinking represents a novel SM approach to COPD emotions and Mastery.
{"title":"Adding Granularity of COPD Self-Management to Impact Quality of Life.","authors":"M. Benzo, P. Novotny, R. Benzo","doi":"10.15326/jcopdf.2021.0277","DOIUrl":"https://doi.org/10.15326/jcopdf.2021.0277","url":null,"abstract":"Introduction\u0000Self-Management abilities (SM) are a recognized ingredient for living well with COPD, improving all outcomes. Fostering SM requires a personalized program and patient engagement to make lifestyle decisions. While some SM practices are proven effective, like the prompt use of a plan for COPD exacerbations, there is a guideline-recognized gap on specific SM behaviors that can impact particular COPD symptoms and allow for tailored SM programs. We aimed to investigate the association of well-defined self-management behaviors with the most common COPD symptoms in a large cohort of patients with COPD.\u0000\u0000\u0000Methods\u0000We analyzed baseline data of stable COPD patients that participated in three NIH-funded studies. Symptoms were defined by the four domains of the Chronic Respiratory Questionnaire: Dyspnea-Fatigue-Emotions-Mastery. The SM behaviors were the individual items of the SM Ability Scale-30. Lasso regression models were built to explore the association of behaviors with symptoms, adjusting for lung function and age.\u0000\u0000\u0000Results\u0000We analyzed 512 stable COPD patients, 54% female, age mean (SD) 69.6 (9.9) years, and FEV1% 42.2 (19.0). Dyspnea was associated with exercising and self-efficacy for self-care. Emotion was associated with good relationships, self-efficacy for self-care, positivity, and participating in agreeable activities. Fatigue was associated with self-efficacy for self-care, doing exercise, and participating in agreeable activities. Mastery was associated with self-efficacy for self-care, positivity, exercising, and participating in agreeable activities.\u0000\u0000\u0000Discussion\u0000Our findings provide specific SM behaviors associated with common COPD symptoms that may inform SM programs. Positive thinking represents a novel SM approach to COPD emotions and Mastery.","PeriodicalId":10249,"journal":{"name":"Chronic obstructive pulmonary diseases","volume":"54 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85195413","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-03-08DOI: 10.15326/jcopdf.2021.0242
J. Dretzke, Jingya Wang, Michael Yao, N. Guan, Myra Ling, Erica Zhang, D. Mukherjee, Ja Hall, S. Jowett, R. Mukherjee, D. Moore, A. Turner
Background Uncertainty remains around the benefit of home non-invasive ventilation (NIV) for stable COPD patients and those with a recent exacerbation ('post-hospital'). The aim of this systematic review was to (i) update the evidence base with studies published in any language, including Chinese language studies not indexed in standard medical databases and (ii) explore the impact of additional studies on the evidence base. Methods Standard systematic review methodology was used for identifying and appraising studies. Randomised controlled trials (RCTs) and non-randomised studies reporting mortality, hospitalisations, exacerbations, quality-of-life, adverse events or adherence were included. Random effects meta-analysis was undertaken for mortality and hospitalisations, with studies sub-grouped by population and study design. Sensitivity analysis was performed to explore the effect of including studies from 'Western' and 'non-Western' countries. Results One hundred and three studies were included, substantially more than in previous reviews. There was no significant effect on mortality for the stable population. There was a benefit from NIV for the post-hospital population based on non-randomised studies, or RCTs from 'non-Western' countries. There was a small but significant reduction in hospital admissions (1-2/year) with NIV across all sub-groups, and a variable reduction in duration of stay with greater reductions in studies from China. Conclusions The evidence base on home NIV is considerably larger than previously presented. Whilst NIV may reduce hospital admissions and improve QoL, there is still little evidence of a reduction in mortality, regardless of country. Individual participant data analysis may clarify which patients would benefit most from NIV.
{"title":"Home Non-Invasive Ventilation in COPD: A Global Systematic Review.","authors":"J. Dretzke, Jingya Wang, Michael Yao, N. Guan, Myra Ling, Erica Zhang, D. Mukherjee, Ja Hall, S. Jowett, R. Mukherjee, D. Moore, A. Turner","doi":"10.15326/jcopdf.2021.0242","DOIUrl":"https://doi.org/10.15326/jcopdf.2021.0242","url":null,"abstract":"Background\u0000Uncertainty remains around the benefit of home non-invasive ventilation (NIV) for stable COPD patients and those with a recent exacerbation ('post-hospital'). The aim of this systematic review was to (i) update the evidence base with studies published in any language, including Chinese language studies not indexed in standard medical databases and (ii) explore the impact of additional studies on the evidence base.\u0000\u0000\u0000Methods\u0000Standard systematic review methodology was used for identifying and appraising studies. Randomised controlled trials (RCTs) and non-randomised studies reporting mortality, hospitalisations, exacerbations, quality-of-life, adverse events or adherence were included. Random effects meta-analysis was undertaken for mortality and hospitalisations, with studies sub-grouped by population and study design. Sensitivity analysis was performed to explore the effect of including studies from 'Western' and 'non-Western' countries.\u0000\u0000\u0000Results\u0000One hundred and three studies were included, substantially more than in previous reviews. There was no significant effect on mortality for the stable population. There was a benefit from NIV for the post-hospital population based on non-randomised studies, or RCTs from 'non-Western' countries. There was a small but significant reduction in hospital admissions (1-2/year) with NIV across all sub-groups, and a variable reduction in duration of stay with greater reductions in studies from China.\u0000\u0000\u0000Conclusions\u0000The evidence base on home NIV is considerably larger than previously presented. Whilst NIV may reduce hospital admissions and improve QoL, there is still little evidence of a reduction in mortality, regardless of country. Individual participant data analysis may clarify which patients would benefit most from NIV.","PeriodicalId":10249,"journal":{"name":"Chronic obstructive pulmonary diseases","volume":"2006 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83043680","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The survival effect of smoking-related chronic obstructive pulmonary disease (COPD) and COPD with acute exacerbation (COPDAE) before surgery on patients with oral cavity squamous cell carcinoma (OCSCC) is unclear. Using the Taiwan Cancer Registry Database, we enrolled patients with OCSCC (pathologic stages I-IVB) receiving surgery. The Cox proportional hazards model was used to analyze all-cause mortality. We categorized the patients into two groups by using propensity score matching based on the pre-existing COPD status (≤1 year before surgery) to compare overall survival outcomes: Group 1 (never smokers without COPD) and Group 2 (current smokers with COPD). In multivariate Cox regression analyses, the adjusted hazard ratio (aHR; 95% confidence interval [CI]) of all-cause mortality in Group 2 compared with Group 1 was 1.07 (1.02-1.16, P = 0.041). The aHRs (95% CIs) of all-cause mortality for ≥1 hospitalizations for COPDAE within 1 year before surgery for patients with OCSCC was 1.31 (1.02-1.64; P = 0.011) compared with no COPDAE in patients with OCSCC receiving surgery. Among patients with OCSCC undergoing curative surgery, current smokers with smoking-related COPD demonstrated poorer survival outcomes than did nonsmokers without COPD, for both OCSCC death and all-cause mortality. Hospitalization for COPDAE within 1 year before surgery was found to be an independent risk factor for overall survival in these patients with OCSCC. Prevention of COPD progression to COPDAE may lead to an increase in overall survival in patients with OCSCC receiving curative surgery.
{"title":"Current-Smoking-Related COPD or COPD With Acute Exacerbation is Associated With Poorer Survival Following Oral Cavity Squamous Cell Carcinoma Surgery.","authors":"Jiaqiang Zhang, Wei-Chun Lin, Kuo-Chin Chiu, Szu-Yuan Wu","doi":"10.15326/jcopdf.2022.0286","DOIUrl":"https://doi.org/10.15326/jcopdf.2022.0286","url":null,"abstract":"The survival effect of smoking-related chronic obstructive pulmonary disease (COPD) and COPD with acute exacerbation (COPDAE) before surgery on patients with oral cavity squamous cell carcinoma (OCSCC) is unclear. Using the Taiwan Cancer Registry Database, we enrolled patients with OCSCC (pathologic stages I-IVB) receiving surgery. The Cox proportional hazards model was used to analyze all-cause mortality. We categorized the patients into two groups by using propensity score matching based on the pre-existing COPD status (≤1 year before surgery) to compare overall survival outcomes: Group 1 (never smokers without COPD) and Group 2 (current smokers with COPD). In multivariate Cox regression analyses, the adjusted hazard ratio (aHR; 95% confidence interval [CI]) of all-cause mortality in Group 2 compared with Group 1 was 1.07 (1.02-1.16, P = 0.041). The aHRs (95% CIs) of all-cause mortality for ≥1 hospitalizations for COPDAE within 1 year before surgery for patients with OCSCC was 1.31 (1.02-1.64; P = 0.011) compared with no COPDAE in patients with OCSCC receiving surgery. Among patients with OCSCC undergoing curative surgery, current smokers with smoking-related COPD demonstrated poorer survival outcomes than did nonsmokers without COPD, for both OCSCC death and all-cause mortality. Hospitalization for COPDAE within 1 year before surgery was found to be an independent risk factor for overall survival in these patients with OCSCC. Prevention of COPD progression to COPDAE may lead to an increase in overall survival in patients with OCSCC receiving curative surgery.","PeriodicalId":10249,"journal":{"name":"Chronic obstructive pulmonary diseases","volume":"49 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80380707","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-05-01DOI: 10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A3030
Jacob S Warner, Jane M Bryan, L. Paulin
Purpose Individuals in rural areas of the US have greater risk of chronic obstructive pulmonary disease (COPD) and have worse COPD outcomes. New Hampshire (NH) is split between non-rural and rural counties. Methods We examined differences in COPD exacerbation rate ((encounters per county/county population of 35 years of age and older) times 100), length of stay (LOS), and total charges by rurality, determined by 2013 NCHS rural-urban classification. Linear regression analysis determined the association of rural status on COPD outcomes, adjusting for age, gender, insurance status, and county-level smoking prevalence. Findings 15916 encounters were analyzed, 5805 inpatient and 10111 emergency department, 7058 (44%) male, and mean age 65.6. 31% were from large fringe metro counties, 25.9% from medium metro counties, 37.6% from micropolitan counties and 5.5% from non-core counties. In multivariable regression, rural counties had higher COPD exacerbation rates compared to urban counties; (non-core beta = 0.18, [CI 0.16, 0.20]; micropolitan beta = 0.02, CI [0.01, 0.03]); medium metro (beta = -0.07, Cl [-0.09, -0.06] had lower rates of COPD exacerbations (P < 0.001 for all). Compared to urban counties, encounters from rural counties had lower total charges (medium metro beta = -1695 [-2410, -980]; micropolitan beta = -2701 [-3315, -2088]; non-core beta = -4453 [-5646, -3260], all p<0.001). LOS did not differ by rurality. Conclusions Accounting for poverty and other sociodemographic factors, the rates of COPD exacerbation encounters were higher in rural vs. non-rural NH counties. Additionally, non-rural areas carried higher total charges, potentially due to more resource availability. These results support the need for future interventions to improve outcomes in rural COPD patients.
{"title":"The Effect of Rurality and Poverty on COPD Outcomes in New Hampshire: an Analysis of Statewide Hospital Discharge Data.","authors":"Jacob S Warner, Jane M Bryan, L. Paulin","doi":"10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A3030","DOIUrl":"https://doi.org/10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A3030","url":null,"abstract":"Purpose\u0000Individuals in rural areas of the US have greater risk of chronic obstructive pulmonary disease (COPD) and have worse COPD outcomes. New Hampshire (NH) is split between non-rural and rural counties.\u0000\u0000\u0000Methods\u0000We examined differences in COPD exacerbation rate ((encounters per county/county population of 35 years of age and older) times 100), length of stay (LOS), and total charges by rurality, determined by 2013 NCHS rural-urban classification. Linear regression analysis determined the association of rural status on COPD outcomes, adjusting for age, gender, insurance status, and county-level smoking prevalence.\u0000\u0000\u0000Findings\u000015916 encounters were analyzed, 5805 inpatient and 10111 emergency department, 7058 (44%) male, and mean age 65.6. 31% were from large fringe metro counties, 25.9% from medium metro counties, 37.6% from micropolitan counties and 5.5% from non-core counties. In multivariable regression, rural counties had higher COPD exacerbation rates compared to urban counties; (non-core beta = 0.18, [CI 0.16, 0.20]; micropolitan beta = 0.02, CI [0.01, 0.03]); medium metro (beta = -0.07, Cl [-0.09, -0.06] had lower rates of COPD exacerbations (P < 0.001 for all). Compared to urban counties, encounters from rural counties had lower total charges (medium metro beta = -1695 [-2410, -980]; micropolitan beta = -2701 [-3315, -2088]; non-core beta = -4453 [-5646, -3260], all p<0.001). LOS did not differ by rurality.\u0000\u0000\u0000Conclusions\u0000Accounting for poverty and other sociodemographic factors, the rates of COPD exacerbation encounters were higher in rural vs. non-rural NH counties. Additionally, non-rural areas carried higher total charges, potentially due to more resource availability. These results support the need for future interventions to improve outcomes in rural COPD patients.","PeriodicalId":10249,"journal":{"name":"Chronic obstructive pulmonary diseases","volume":"36 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83535125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-05-26DOI: 10.1101/2020.05.19.20107110
Patricia B. Koff, Sung‐joon Min, Debora L. P. Diaz, Tammie J. Freitag, Shannon S. James, Norbert F. Voelkel, Derek J. Linderman, F. Diaz del Valle, J. Zakrajsek, Richard K. Albert, Todd M. Bull, A. Beck, T. Stelzner, Debra P. Ritzwoller, C. Kveton, S. Carwin, Moumita Ghosh, Robert L. Keith, John M. Westfall, William Vandivier
Background. Up to 50% of COPD patients do not receive recommended care for COPD. To address this important issue, we developed Proactive Integrated Care (Proactive iCare), a healthcare delivery model that couples integrated care with remote monitoring. Methods. We conducted a prospective, quasi-randomized clinical trial in 511 patients with advanced COPD, or a recent COPD exacerbation, to test whether Proactive iCare impacts patient- centered outcomes and healthcare utilization. Patients were allocated to Proactive iCare (n =352) or Usual Care (n = 159), and were examined for changes in quality of life using the St. Georges Respiratory Questionnaire (SGRQ), symptoms, guideline-based care, and healthcare utilization. Findings. Proactive iCare improved the total SGRQ by 7-9 units (p<0.0001), symptom SGRQ by 9 units (p<0.0001), activity SGRQ by 6-7 units (p<0.001) and impact SGRQ by 7-11 units (p<0.0001) at 3, 6 and 9 months, compared with Usual Care. Proactive iCare increased the 6-minute walk distance by 40 m (p<0.001), reduced COPD-related urgent office visits by 76 visits per 100 subjects (p<0.0001), identified unreported exacerbations, and decreased smoking (p = 0.01). Proactive iCare also improved cough, sputum, shortness of breath, the BODE index and oxygen titration (p<0.05). Mortality in the Proactive iCare group (1.1%) was not significantly different than mortality in the Usual Care group (3.8%; p = 0.08). Interpretation. Results suggest that linking integrated care with remote monitoring improves the lives of people with advanced COPD.
{"title":"Impact of Proactive Integrated Care on Chronic Obstructive Pulmonary Disease","authors":"Patricia B. Koff, Sung‐joon Min, Debora L. P. Diaz, Tammie J. Freitag, Shannon S. James, Norbert F. Voelkel, Derek J. Linderman, F. Diaz del Valle, J. Zakrajsek, Richard K. Albert, Todd M. Bull, A. Beck, T. Stelzner, Debra P. Ritzwoller, C. Kveton, S. Carwin, Moumita Ghosh, Robert L. Keith, John M. Westfall, William Vandivier","doi":"10.1101/2020.05.19.20107110","DOIUrl":"https://doi.org/10.1101/2020.05.19.20107110","url":null,"abstract":"Background. Up to 50% of COPD patients do not receive recommended care for COPD. To address this important issue, we developed Proactive Integrated Care (Proactive iCare), a healthcare delivery model that couples integrated care with remote monitoring. Methods. We conducted a prospective, quasi-randomized clinical trial in 511 patients with advanced COPD, or a recent COPD exacerbation, to test whether Proactive iCare impacts patient- centered outcomes and healthcare utilization. Patients were allocated to Proactive iCare (n =352) or Usual Care (n = 159), and were examined for changes in quality of life using the St. Georges Respiratory Questionnaire (SGRQ), symptoms, guideline-based care, and healthcare utilization. Findings. Proactive iCare improved the total SGRQ by 7-9 units (p<0.0001), symptom SGRQ by 9 units (p<0.0001), activity SGRQ by 6-7 units (p<0.001) and impact SGRQ by 7-11 units (p<0.0001) at 3, 6 and 9 months, compared with Usual Care. Proactive iCare increased the 6-minute walk distance by 40 m (p<0.001), reduced COPD-related urgent office visits by 76 visits per 100 subjects (p<0.0001), identified unreported exacerbations, and decreased smoking (p = 0.01). Proactive iCare also improved cough, sputum, shortness of breath, the BODE index and oxygen titration (p<0.05). Mortality in the Proactive iCare group (1.1%) was not significantly different than mortality in the Usual Care group (3.8%; p = 0.08). Interpretation. Results suggest that linking integrated care with remote monitoring improves the lives of people with advanced COPD.","PeriodicalId":10249,"journal":{"name":"Chronic obstructive pulmonary diseases","volume":"14 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79054808","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：