scholarly journals Predictive factors for exacerbation and reexacerbation in chronic obstructive pulmonary disease: an extension of the Cox model to analyze data from the Swiss COPD cohort

2019 ◽  
Vol 14 ◽  
Author(s):  
Pascal Urwyler ◽  
Nebal Abu Hussein ◽  
Pierre O. Bridevaux ◽  
Prashant N. Chhajed ◽  
Thomas Geiser ◽  
...  
Keyword(s):  
Primary Care ◽  
Predictive Factors ◽  
Cox Model ◽  
Protective Role ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Systemic Corticosteroids ◽  
Cerebrovascular Insult ◽  
Long Acting ◽  
Extended Cox Model

Background: The Swiss COPD cohort was established in 2006 to collect data in a primary care setting. The objective of this study was to evaluate possible predictive factors for exacerbation and re-exacerbation. Methods: In order to predict exacerbation until the next visit based on the knowledge of exacerbation since the last visit, a multistate model described by Therneau and Grambsch was performed. Results: Data of 1,247 patients (60.4% males, 46.6% current smokers) were analyzed, 268 (21.5%) did not fulfill spirometric diagnostic criteria for COPD. Data of 748 patients (63% males, 44.1% current smokers) were available for model analysis. In order to predict exacerbation an extended Cox Model was performed. Mean FEV1/FVC-ratio was 53.1% (±11.5), with a majority of patients in COPD GOLD classes 2 or 3. Hospitalization for any reason (HR1.7; P = 0.04) and pronounced dyspnea (HR for mMRC grade four 3.0; P < 0.001) at most recent visit as well as prescription of short-acting bronchodilators (HR1.7; P < 0.001), inhaled (HR1.2; P = 0.005) or systemic corticosteroids (HR1.8; P = 0.015) were significantly associated with exacerbation when having had no exacerbation at most recent visit. Higher FEV1/FVC (HR0.9; P = 0.008) and higher FEV1 values (HR0.9; P = 0.001) were protective. When already having had an exacerbation at the most recent visit, pronounced dyspnea (HR for mMRC grade 4 1.9; P = 0.026) and cerebrovascular insult (HR2.1; P = 0.003) were significantly associated with re-exacerbation. Physical activity (HR0.6; P = 0.031) and treatment with long-acting anticholinergics (HR0.7; P = 0.044) seemed to play a significant protective role. In a best subset model for exacerbation, higher FEV1 significantly reduced and occurrence of sputum increased the probability of exacerbation. In the same model for re-exacerbation, coronary heart disease increased and hospitalization at most recent visit seemed to reduce the risk for re-exacerbation. Conclusion: Our data confirmed well-established risk factors for exacerbations whilst analyzing their predictive association with exacerbation and re-exacerbation. This study confirmed the importance of spirometry in primary care, not only for diagnosis but also as a risk evaluation for possible future exacerbations. Trial registration: Our study got approval by local ethical committee in 2006 (EK Nr. 170/06) and was registered retrospectively on ClinicalTrials.gov (NCT02065921, 19th of February 2014).

scholarly journals [Acute exacerbations in Chronic Obstructive Pulmonary Disease (COPD)]

2017 ◽  
Vol 11 (2) ◽  
Author(s):  
Domenico Lorenzo Urso
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Bacterial Infections ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Systemic Corticosteroids ◽  
Acute Exacerbations ◽  
History Of ◽  
Long Acting ◽  
Β2 Agonists

Chronic obstructive pulmonary disease (COPD) is the third leading cause of death worldwide. Acute exacerbations of COPD (AECOPD) are important events in the natural history of this condition because they negatively impact health status, rate of hospitalization, disease progression, and mortality.Viral and/or bacterial infections are the main cause of exacerbations. The treatments include systemic corticosteroids, bronchodilators, anticholinergics and/or short- or long-acting β2-agonists, and antibiotics in case of bacterial infections. In some cases, oxygen-therapy is indicated.This article focuses on several aspects of AECOPD, including epidemiology, diagnostic approach, i.e. investigations and management of AECOPD.

scholarly journals Practice Patterns in the Management of Chronic Obstructive Pulmonary Disease in Primary Practice: The Cage Study

2008 ◽  
Vol 15 (1) ◽  
pp. 13-19 ◽  
Author(s):  
Jean Bourbeau ◽  
Rolf J Sebaldt ◽  
Anna Day ◽  
Jacques Bouchard ◽  
Alan Kaplan ◽  
...  
Keyword(s):  
Primary Care ◽  
Primary Care Practice ◽  
Care Practice ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Recommended Care ◽  
Smoking Cessation Counselling ◽  
Copd Patients ◽  
Long Acting ◽  
Severe Copd

BACKGROUND: The information on usual care for patients with chronic obstructive pulmonary disease (COPD) in primary care is limited in Canada.OBJECTIVE: To evaluate primary care practice in patients with COPD in Quebec and Ontario compared with recommended care.METHODS: The COPD Care Gap Evaluation (CAGE) was a prospective, cross-sectional study. Physicians’ self-reported data of enrolled COPD patients were compared with the recommended care for the level of disease severity (using the Canadian Thoracic Society classification by symptoms) and stability, derived from Canadian Thoracic Society COPD guidelines. Pharmacological treatment, spirometric confirmation of diagnosis and nonpharmacological management, including smoking cessation counselling, influenza immunization and referral for pulmonary rehabilitation, were assessed.RESULTS: Participating physicians (n=161; 44 in Quebec, 117 in Ontario) recruited 1090 patients (320 in Quebec, 770 in Ontario). The mean (± SD) age of the patients was 69.9±10.4 years; 60% were male and 40% were currently smoking. Pharmacological treatment that matched guideline recommendations was identified in 34% of patients. Discrepancies between reported and recommended treatment stemmed from nonprescription of long-acting bronchodilators (LABDs) for patients with moderate (27%) and severe (21%) COPD, nonprescription of two long-acting beta agonists (a beta2-agonist and an anticholinergic) for patients with severe COPD (51%), and prescription of inhaled corticosteroids (63%) and LABDs (47%) for patients with mild COPD for which the treatment is not recommended. Spirometric confirmation of diagnosis, as recommended by the guidelines, was reported in 56% of patients. For non-pharmacological management, smoking cessation counselling (95%) and influenza immunization (80%) were near optimal. Referral for pulmonary rehabilitation (9%) was not common. Differences between provinces were seen mainly in the prescription of short-acting bronchodilators (89% in Quebec, 76% in Ontario) and LABDs (60% in Quebec, 80% in Ontario).CONCLUSIONS: Substantial gaps between recommended and current care exist in the management of COPD patients in primary care practice. Undertreatment of patients with severe COPD has potential clinical implications, including loss of autonomy and hospitalization.

scholarly journals Inaccurate diagnosis of COPD: the Welsh National COPD Audit

2018 ◽  
Vol 69 (678) ◽  
pp. e1-e7 ◽  
Author(s):  
Marie Fisk ◽  
Viktoria McMillan ◽  
James Brown ◽  
Juliana Holzhauer-Barrie ◽  
Muhammad S Khan ◽  
...  
Keyword(s):  
Primary Care ◽  
Correct Diagnosis ◽  
Airflow Obstruction ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Beta Agonists ◽  
Quality And Outcomes ◽  
Never Smokers ◽  
Long Acting ◽  
To Receive

BackgroundThe diagnosis of chronic obstructive pulmonary disease (COPD) is confirmed with spirometry demonstrating persistent airflow obstruction.AimTo evaluate the clinical characteristics and management of patients in primary care on COPD registers with spirometry incompatible with COPD.Design and settingA primary care audit of Welsh COPD Read-Coded patient data from the Quality and Outcomes Framework (QOF) COPD register in Wales.MethodPatients on the QOF COPD register with incompatible spirometry (post-bronchodilator forced expiratory lung volume in 1 second/forced vital capacity [FEV1/FVC] ratio ≥0.70) were compared with those with compatible spirometry (FEV1/FVC <0.70).ResultsThis audit included 63% of Welsh practices contributing 48 105 patients. Only 19% (n = 8957) of patients were post-bronchodilator FEV1/FVC Read-Coded and were included in this study. Of these, 75% (n = 6702) had compatible spirometry and 25% (n = 2255) did not. Patients with incompatible spirometry were more likely female (P = 0.009), never-smokers (P<0.001), had higher body mass index (P<0.001), and better mean FEV1 (P<0.001). Medical Research Council (MRC) breathlessness scores, exacerbation frequency, and asthma co-diagnosis were similar between groups. Patients in both groups were just as likely to receive inhaled corticosteroid (ICS) and long-acting beta-agonists (LABAs), but patients with incompatible spirometry were less likely to receive long-acting muscarinic antagonists (LAMAs) (P<0.001) or LABA/ICS (P = 0.002) combinations.ConclusionPatients on the COPD QOF register with spirometry incompatible with COPD are symptomatic and managed using significant resources. If quality of care and effective resource use are to be improved, focus must be given to correct diagnosis in this group.

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