Pub Date : 2019-09-28DOI: 10.1183/13993003.congress-2019.pa5021
K. Klester, E. Klester, A. Zharikov, A. Balitskaya, A. Denisova
Introduction: Cardiovascular diseases are diagnosed in more than half of patients and aggravate the course of COPD. Objective: To assess the frequency of risk factors of cardiovascular disease and the degree of total cardiovascular risk in patients with COPD. Materials and Methods: 518 patients were under supervision, 122 of them (with mild and moderate СOPD (GOLD, 2018) were included in the final analysis, satisfying the inclusion criteria: the absence of clinical manifestations of cardiovascular disease, MI and stroke history, DM. The European SCORE scale was used to assess coronary risk. Results: Low total cardiovascular risk was diagnosed in 15 (12%), medium – in 29 (24%), high – in 41 (34%), very high risk by SCORE – in 37 (30%) COPD patients. A regression analysis revealed correlation between the risk of COPD exacerbations (mMRC or CAT, severity according to spirometry) and the total cardiovascular risk of SCORE (r = 0.58; p = 0.001), as well as between the comorbidity index by M. Charlson et al. (1987) and risk by SCORE (r = 0.61; p = 0.006). The relationship between BMI and cholesterol in the study was J-shaped. The effect of inhalation therapy on the occurrence of the first manifestation of CVD was not established by Cox regression. Conclusion: in 75% of patients with COPD, an increased 10-year risk of all fatal complications of atherosclerosis is determined. The study indicates the need to assess the risk by SCORE in patients with initial manifestations of COPD in order to timely correction of the identified risk factors for cardiovascular disease.
{"title":"Frequency of occurrence of risk factors of cardiovascular diseases and assessment of the total cardiovascular risk in patients with chronic obstructive pulmonary disease (COPD)","authors":"K. Klester, E. Klester, A. Zharikov, A. Balitskaya, A. Denisova","doi":"10.1183/13993003.congress-2019.pa5021","DOIUrl":"https://doi.org/10.1183/13993003.congress-2019.pa5021","url":null,"abstract":"Introduction: Cardiovascular diseases are diagnosed in more than half of patients and aggravate the course of COPD. Objective: To assess the frequency of risk factors of cardiovascular disease and the degree of total cardiovascular risk in patients with COPD. Materials and Methods: 518 patients were under supervision, 122 of them (with mild and moderate СOPD (GOLD, 2018) were included in the final analysis, satisfying the inclusion criteria: the absence of clinical manifestations of cardiovascular disease, MI and stroke history, DM. The European SCORE scale was used to assess coronary risk. Results: Low total cardiovascular risk was diagnosed in 15 (12%), medium – in 29 (24%), high – in 41 (34%), very high risk by SCORE – in 37 (30%) COPD patients. A regression analysis revealed correlation between the risk of COPD exacerbations (mMRC or CAT, severity according to spirometry) and the total cardiovascular risk of SCORE (r = 0.58; p = 0.001), as well as between the comorbidity index by M. Charlson et al. (1987) and risk by SCORE (r = 0.61; p = 0.006). The relationship between BMI and cholesterol in the study was J-shaped. The effect of inhalation therapy on the occurrence of the first manifestation of CVD was not established by Cox regression. Conclusion: in 75% of patients with COPD, an increased 10-year risk of all fatal complications of atherosclerosis is determined. The study indicates the need to assess the risk by SCORE in patients with initial manifestations of COPD in order to timely correction of the identified risk factors for cardiovascular disease.","PeriodicalId":432006,"journal":{"name":"General practice and primary care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116015423","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 : 2019-09-28DOI: 10.1183/13993003.congress-2019.pa727
F. Mosler, S. Unger
{"title":"Measuring guideline adherence for the diagnosis and management of common cold and pneumonia in rural Gambia. A case for a Clinical Decision Support System in rural sub-Sarahan Africa?","authors":"F. Mosler, S. Unger","doi":"10.1183/13993003.congress-2019.pa727","DOIUrl":"https://doi.org/10.1183/13993003.congress-2019.pa727","url":null,"abstract":"","PeriodicalId":432006,"journal":{"name":"General practice and primary care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117346055","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 : 2019-09-28DOI: 10.1183/13993003.congress-2019.pa3993
Wenjun Koh, E. Khoo, A. I. A. Bakar, N. Hussein, H. Pinnock, S. Liew, N. Hanafi, Y. Pang, B. K. Ho, Mohamed Isa Salbiah
{"title":"Asthma patients’ views and experiences of self-management in Malaysia: a qualitative study","authors":"Wenjun Koh, E. Khoo, A. I. A. Bakar, N. Hussein, H. Pinnock, S. Liew, N. Hanafi, Y. Pang, B. K. Ho, Mohamed Isa Salbiah","doi":"10.1183/13993003.congress-2019.pa3993","DOIUrl":"https://doi.org/10.1183/13993003.congress-2019.pa3993","url":null,"abstract":"","PeriodicalId":432006,"journal":{"name":"General practice and primary care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114723927","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 : 2019-09-28DOI: 10.1183/13993003.congress-2019.pa5010
Mukesh Singh, Ketan Singh
Introduction and Objectives: COPD as being a heterogeneous disease, its patients show variation in disease severity, burden of comorbidity and their need for unscheduled clinical consultations. The aim of this retrospective study was to evaluate patterns in clinical care and COPD related ‘events’ across a single-year in a UK single-practice primary-care cohort. Methods: The clinical record system of practice population of 11474 patients was searched to identify all registered patients with COPD with data available for the period April17–March18. All cases were reviewed including disease duration, account of exacerbations with their treatment, related hospitalizations and mortality, co-morbidities and changes in FEV1. Results: Out of total 331 COPD patients; most had long-standing disease approx 10 years, although this varied widely. Mean % FEV1 was 60.4% (range 14–118%) with 71% with dyspnoea of MRC 2 or 3. 95% of them had at least one co-morbidity, mainly diabetes/arthritis or cardiovascular disease. There was no exacerbation in 137 patients (41.4%). Of patients with at least one event, 111 (33.5%) required treatment with antibiotics + oral steroids and 28 of these patients (8.5%) showed decline in FEV1. 22 patients required emergency COPD-related hospitalisations with 5 in-hospital deaths. The mean FEV1 in those patients without an exacerbation was higher compared to those with an exacerbation (66.6% vs 55.9%) and a further decline was noted in those with hospital admission history (45.8%). Conclusions: A substantial variation was observed in COPD disease burden and healthcare resource usage within the 12 months across a primary-care cohort in UK.
前言和目的:慢性阻塞性肺病是一种异质性疾病，其患者在疾病严重程度、合并症负担和非预定临床会诊需求方面存在差异。本回顾性研究的目的是评估英国单一诊所初级保健队列中一年中临床护理和COPD相关“事件”的模式。方法:检索实践人群11474例COPD患者的临床记录系统，以确定所有登记的COPD患者在4月17日至3月18日期间的数据。对所有病例进行回顾，包括病程、治疗后病情加重的情况、相关住院和死亡率、合并症和FEV1的变化。结果:331例COPD患者中;大多数人都有大约10年的长期疾病，尽管这种情况差别很大。平均FEV1 %为60.4%(范围14-118%)，其中71%为MRC 2或3级呼吸困难。95%的患者至少有一种合并症，主要是糖尿病/关节炎或心血管疾病。137例(41.4%)患者无加重。在至少发生一次事件的患者中，111例(33.5%)需要抗生素+口服类固醇治疗，其中28例(8.5%)出现FEV1下降。22名患者需要与copd相关的紧急住院治疗，其中5人在院内死亡。无急性加重患者的平均FEV1高于有急性加重患者(66.6% vs 55.9%)，有住院史患者的平均FEV1进一步下降(45.8%)。结论:在英国的一个初级保健队列中，在12个月内观察到COPD疾病负担和医疗资源使用的实质性变化。
{"title":"Corerelation of COPD exacerbation with comorbidities, Lung function and mortality within a single-practice primary-care cohort in the UK","authors":"Mukesh Singh, Ketan Singh","doi":"10.1183/13993003.congress-2019.pa5010","DOIUrl":"https://doi.org/10.1183/13993003.congress-2019.pa5010","url":null,"abstract":"Introduction and Objectives: COPD as being a heterogeneous disease, its patients show variation in disease severity, burden of comorbidity and their need for unscheduled clinical consultations. The aim of this retrospective study was to evaluate patterns in clinical care and COPD related ‘events’ across a single-year in a UK single-practice primary-care cohort. Methods: The clinical record system of practice population of 11474 patients was searched to identify all registered patients with COPD with data available for the period April17–March18. All cases were reviewed including disease duration, account of exacerbations with their treatment, related hospitalizations and mortality, co-morbidities and changes in FEV1. Results: Out of total 331 COPD patients; most had long-standing disease approx 10 years, although this varied widely. Mean % FEV1 was 60.4% (range 14–118%) with 71% with dyspnoea of MRC 2 or 3. 95% of them had at least one co-morbidity, mainly diabetes/arthritis or cardiovascular disease. There was no exacerbation in 137 patients (41.4%). Of patients with at least one event, 111 (33.5%) required treatment with antibiotics + oral steroids and 28 of these patients (8.5%) showed decline in FEV1. 22 patients required emergency COPD-related hospitalisations with 5 in-hospital deaths. The mean FEV1 in those patients without an exacerbation was higher compared to those with an exacerbation (66.6% vs 55.9%) and a further decline was noted in those with hospital admission history (45.8%). Conclusions: A substantial variation was observed in COPD disease burden and healthcare resource usage within the 12 months across a primary-care cohort in UK.","PeriodicalId":432006,"journal":{"name":"General practice and primary care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122015833","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 : 2019-09-28DOI: 10.1183/13993003.congress-2019.pa726
V. McMillan, G. Gilworth, A. Wright, P. White
{"title":"Assessing treatment fidelity of lay health worker support to increase uptake and completion of pulmonary rehabilitation in COPD","authors":"V. McMillan, G. Gilworth, A. Wright, P. White","doi":"10.1183/13993003.congress-2019.pa726","DOIUrl":"https://doi.org/10.1183/13993003.congress-2019.pa726","url":null,"abstract":"","PeriodicalId":432006,"journal":{"name":"General practice and primary care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128013242","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 : 2019-09-28DOI: 10.1183/13993003.congress-2019.pa722
Mrityunjaya Singh, G. N. Srivastava, D. Yadav
{"title":"Effect of non-pharmacological interventions on treatment outcomes in COPD patients: Little changes for bigger rewards","authors":"Mrityunjaya Singh, G. N. Srivastava, D. Yadav","doi":"10.1183/13993003.congress-2019.pa722","DOIUrl":"https://doi.org/10.1183/13993003.congress-2019.pa722","url":null,"abstract":"","PeriodicalId":432006,"journal":{"name":"General practice and primary care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126696345","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 : 2019-09-28DOI: 10.1183/13993003.congress-2019.pa728
F. V. Gemert, E. Brakema, R. V. D. Kleij, Siân Williams, Rupert C Jones, B. Kirenga, Shamim Buteme, T. Sooronbaev, Aizhamal K. Tabyshova, M. Mademilov, Thong An Pham Le, null Quynh Nguyen Nhat, C. Jong
{"title":"Development and implementation of an awareness programme addressing household air pollution and tobacco smoke: a FRESH AIR project","authors":"F. V. Gemert, E. Brakema, R. V. D. Kleij, Siân Williams, Rupert C Jones, B. Kirenga, Shamim Buteme, T. Sooronbaev, Aizhamal K. Tabyshova, M. Mademilov, Thong An Pham Le, null Quynh Nguyen Nhat, C. Jong","doi":"10.1183/13993003.congress-2019.pa728","DOIUrl":"https://doi.org/10.1183/13993003.congress-2019.pa728","url":null,"abstract":"","PeriodicalId":432006,"journal":{"name":"General practice and primary care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123506175","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 : 2019-09-28DOI: 10.1183/13993003.congress-2019.pa701
D. Agarwal, R. Parker, Sudipto Roy, H. Pinnock, D. Ghorpade, S. Salvi, P. Khatavkar, S. Juvekar
{"title":"Development of spirometry predictive values for Western Indian population (NIHR-RESPIRE Study)","authors":"D. Agarwal, R. Parker, Sudipto Roy, H. Pinnock, D. Ghorpade, S. Salvi, P. Khatavkar, S. Juvekar","doi":"10.1183/13993003.congress-2019.pa701","DOIUrl":"https://doi.org/10.1183/13993003.congress-2019.pa701","url":null,"abstract":"","PeriodicalId":432006,"journal":{"name":"General practice and primary care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116436888","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 : 2019-09-28DOI: 10.1183/13993003.congress-2019.pa714
C. Criée, Juliane Sünwoldt, Anja Selig
{"title":"The VENTO study: pneumologists evaluate the practicability of German programmes for COPD patients","authors":"C. Criée, Juliane Sünwoldt, Anja Selig","doi":"10.1183/13993003.congress-2019.pa714","DOIUrl":"https://doi.org/10.1183/13993003.congress-2019.pa714","url":null,"abstract":"","PeriodicalId":432006,"journal":{"name":"General practice and primary care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134110311","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 : 2019-09-28DOI: 10.1183/13993003.congress-2019.oa257
R. Jordan, D. Fitzmaurice, James Martin, J. Ayres, K. Cheng, B. Cooper, A. Daley, A. Dickens, A. Enocson, S. Greenfield, Martin R Miller, R. Riley, S. Siebert, R. Stockley, A. Turner, P. Adab
Prognostic scores could be used to guide management of COPD patients and reduce risk of hospital admission but existing scores do not perform well enough and are not practical for primary care. Using data from the Birmingham primary care COPD cohort we developed and internally validated the new BLISS prognostic score from 23 candidate variables. 1558 patients on COPD registers of 71 GP practices and 331 newly-identified patients from a linked case-finding trial were included and their self-reported and clinical data were combined with routine hospital episode statistics. Primary outcome was the record of at least one respiratory admission within 2 years of cohort entry. The model was developed using backward elimination. Missing data were imputed using chained equations. Discrimination and calibration were assessed. Bootstrapping was used for internal validation. Median (min, max) follow up was 2.9 years (1.8, 3.8). 6 variables were retained in the final model: age, CAT score, respiratory admissions previous 12m, BMI, diabetes, FEV1% predicted. After adjustment for optimism, the model performed well in predicting 2yr respiratory admissions (c statistic=0.75 (95%CI 0.72, 0.79). The BLISS score showed better performance in predicting respiratory admissions than existing published scores. All 6 variables are readily available in primary care records or would be easy to collect, and a simple computer programme could calculate the score. Important next steps are external validation, proposing/evaluating a model of use to guide patient management and exploration of the best ways to implement the score in primary care practice.
{"title":"Development of the Birmingham Lung Improvement Studies (BLISS) prognostic score for COPD patients in primary care: data from the Birmingham COPD cohort","authors":"R. Jordan, D. Fitzmaurice, James Martin, J. Ayres, K. Cheng, B. Cooper, A. Daley, A. Dickens, A. Enocson, S. Greenfield, Martin R Miller, R. Riley, S. Siebert, R. Stockley, A. Turner, P. Adab","doi":"10.1183/13993003.congress-2019.oa257","DOIUrl":"https://doi.org/10.1183/13993003.congress-2019.oa257","url":null,"abstract":"Prognostic scores could be used to guide management of COPD patients and reduce risk of hospital admission but existing scores do not perform well enough and are not practical for primary care. Using data from the Birmingham primary care COPD cohort we developed and internally validated the new BLISS prognostic score from 23 candidate variables. 1558 patients on COPD registers of 71 GP practices and 331 newly-identified patients from a linked case-finding trial were included and their self-reported and clinical data were combined with routine hospital episode statistics. Primary outcome was the record of at least one respiratory admission within 2 years of cohort entry. The model was developed using backward elimination. Missing data were imputed using chained equations. Discrimination and calibration were assessed. Bootstrapping was used for internal validation. Median (min, max) follow up was 2.9 years (1.8, 3.8). 6 variables were retained in the final model: age, CAT score, respiratory admissions previous 12m, BMI, diabetes, FEV1% predicted. After adjustment for optimism, the model performed well in predicting 2yr respiratory admissions (c statistic=0.75 (95%CI 0.72, 0.79). The BLISS score showed better performance in predicting respiratory admissions than existing published scores. All 6 variables are readily available in primary care records or would be easy to collect, and a simple computer programme could calculate the score. Important next steps are external validation, proposing/evaluating a model of use to guide patient management and exploration of the best ways to implement the score in primary care practice.","PeriodicalId":432006,"journal":{"name":"General practice and primary care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131830645","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}
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