Care Of Chronic Obstructive Pulmonary Disease Patients Research Articles

Diagnosis of Anxiety in COPD Patients: Usefulness of the HADS Test in Primary Care and Pulmonology Services.

Anxiety disorders, characterized by excessive fear and anxiety, are increasingly recognized as significant comorbidities in chronic diseases such as chronic obstructive pulmonary disease (COPD). This study aimed to evaluate the prevalence of anxiety in COPD patients referred from primary care centers to pulmonology services and to identify predictive factors for anxiety. This was a multicentric, observational, and prospective study in which 293 COPD patients were recruited, and they underwent comprehensive respiratory and smoking histories, spirometry, and anxiety assessments using the Hospital Anxiety and Depression Scale (HADS). The results showed a diagnosis of suspected anxiety in 85 patients (29.0%): 17 possible and 68 with a strong suspicion. The study found significant associations between anxiety and factors such as gender (women had a risk that was 3.5 times higher than men), weight, and body mass index (BMI). Disease severity, smoking status, and clinical manifestations did not significantly influence anxiety prevalence. These findings underscore the need for systematic psychological evaluations in COPD management and support the use of simple diagnostic tools like the HADS to facilitate referrals to mental health services. Addressing anxiety in COPD patients could potentially improve their quality of life and disease outcomes. This study highlights the importance of a multidisciplinary approach involving family medicine, pulmonology, and psychiatry to optimize COPD patient care and suggests that future research should focus on the impact of anxiety treatment on COPD progression. These insights call for integrating psychological assessments into routine clinical practice for comprehensive COPD management. The registration number is 10.14201/gredos.148549.

COPD patients with high blood eosinophil counts exhibit a lower rate of omicron infection and milder post-infection symptoms.

The emergence of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its subsequent Omicron variant has raised concerns for chronic obstructive pulmonary disease (COPD) patients due to the potential risk of disruptions to healthcare services and unknown comorbidities between COPD and Omicron. In this study, we conducted a follow-up investigation of 315 COPD patients during the Omicron outbreak at Shanxi Bethune Hospital to understand the impact of the pandemic on this vulnerable population. Among all patients, 228 were infected with Omicron, of which 82 needed hospitalizations. We found that COPD patients with high blood eosinophil (EOS) counts exhibited lower susceptibility to Omicron infection and were more likely to have milder symptoms that did not require hospitalization. Conversely, patients with low EOS counts showed higher rates of infection and hospitalization. Moreover, EOS count was positively correlated with T lymphocyte counts in hospitalized patients after Omicron infection, suggesting potential associations between EOS and specific immune responses in COPD patients during viral infections. Correlation analysis revealed a positive correlation between EOS count and lymphocyte and T-cells, and a negative correlation between EOS count and age, neutrophil, and C-reactive protein. Overall, our study contributes to the knowledge of COPD management during the COVID-19 Omicron outbreak and emphasizes the importance of considering individual immune profiles to improve care for COPD patients in the face of the ongoing global health crisis.

Therapeutic Targets and Precision Medicine in COPD: Inflammation, Ion Channels, Both, or Neither?

The development of a wider range of therapeutic options is a key objective in drug discovery for chronic obstructive pulmonary disease (COPD). Fundamental advances in lung biology have the potential to greatly expand the number of therapeutic targets in COPD. The recently reported successful Phase 3 clinical trial of the first biologic agent for COPD, the monoclonal antibody dupilumab, adds additional support to the importance of targeting inflammatory pathways in COPD. However, numerous other cellular mechanisms are important targets in COPD therapeutics, including airway remodeling, the CFTR ion channel, and mucociliary function. Some of these emerging targets can be exploited by the expanded use of existing COPD drugs, such as roflumilast, while targeting others will require the development of novel molecular entities. The identification of additional therapeutic targets and agents has the potential to greatly expand the value of using clinical and biomarker data to classify COPD into specific subsets, each of which can be predictive of an enhanced response to specific subset(s) of targeted therapies. The author reviews established and emerging drug targets in COPD and uses this as a framework to define a novel classification of COPD based on therapeutic targets. This novel classification has the potential to enhance precision medicine in COPD patient care and to accelerate clinical trials and pre-clinical drug discovery efforts.

Evaluation of the Effect of Comfort Nursing on Patients with Chronic Obstructive Pulmonary Disease Complicated with Respiratory Failure

Objective: To explore and analyze the effect of comfort nursing in patients with chronic obstructive pulmonary disease (COPD) complicated with respiratory failure. Methods: 60 patients with COPD and respiratory failure who were admitted to the Department of Respiratory Medicine of our hospital from May 2020 to May 2023 were selected as subjects of this study, and they were divided into comfort group and reference group by odd and even number draw method, with 30 cases in each group. The comfort group received comfort nursing, and the reference group received general nursing. The lung function performance and living conditions were compared between the groups. Results: Before the intervention, there was no statistically significant difference (P > 0.05) in terms of lung functions such as forced expiratory volume in the first second (FEV1), forced vital capacity (FVC), and the ratio FEV1/FVC between the groups; after the intervention, the lung functions of the comfort group were significantly better than those in the reference group (P < 0.05). Before the intervention, there was no statistically significant difference (P > 0.05) between the groups in terms of mental state, physical function, social situation, and spiritual aspects; after the intervention, the mental state, physical function, social situation, and spiritual aspects of the comfort group were significantly better than those of the reference group (P < 0.05). Conclusion: Comfort nursing care for COPD patients with respiratory failure can improve their lung function and quality of life, and achieve ideal nursing effects.

Cost Analysis of a Transition Care Bundle Compared with Usual Care for COPD Patients Being Discharged from Hospital: Evaluation of a Randomized Controlled Trial.

Appropriate management of chronic obstructive pulmonary disease (COPD) patients following acute exacerbations can reduce the risk of future exacerbations, improve health status, and lower care costs. While a transition care bundle (TCB) was associated with lower readmissions to hospitals than usual care (UC), it remains unclear whether the TCB was associated with cost savings. The aim of this study was to evaluate how this TCB was associated with future Emergency Department (ED)/outpatient visits, hospital readmissions, and costs in Alberta, Canada. Patients who were aged 35 years or older, who were admitted to hospital for a COPD exacerbation, and had not been treated with a care bundle received either TCB or UC. Those who received the TCB were then randomized to either TCB alone or TCB enhanced with a care coordinator. Data collected were ED/outpatient visits, hospital admissions and associated resources used for index admissions, and 7-, 30- and 90-day post-index discharge. A decision model with a 90-day time horizon was developed to estimate the cost. A generalized linear regression was conducted to adjust for imbalance in patient characteristics and comorbidities, and a sensitivity analysis was conducted on the proportion of patients' combined ED/outpatient visits and inpatient admissions as well as the use of a care coordinator. Differences in length of stay (LOS) and costs between groups were statistically significant, although with some exceptions. Inpatient LOS and costs were 7.1 days (95% confidence interval [CI] 6.9-7.3) and Canadian dollars (CAN$) 13,131 (95% CI CAN$12,969-CAN$13,294) in UC, 6.1 days (95% CI 5.8-6.5) and CAN$7634 (95% CI CAN$7546-CAN$7722) in TCB with a coordinator, and 5.9 days (95% CI 5.6-6.2) and CAN$8080 (95% CI CAN$7975-CAN$8184) in TCB without a coordinator. Decision modelling indicated TCB was less costly than UC, with a mean (standard deviation [SD]) of CAN$10,172 (40) versus CAN$15,588 (85), and TCB with a coordinator was slightly less costly than without a coordinator (CAN$10,109 [49] versus CAN$10,244 [57]). This study suggests that the use of the TCB, with or without a care coordinator, appears to be an economically attractive intervention compared with UC.

Impact of clinical factors on hospital stay and hospital readmission rate after acute exacerbation of COPD: a retrospective cross-sectional study

Background: Chronic obstructive pulmonary disease (COPD) is a condition with high morbidity and cost to health services due to a high number of exacerbations necessitating multiple and prolonged hospitalizations. The length of hospital stays and hospital readmission rate is related to patient age, sex, disease severity, current smoking status, comorbidities, dyspnea grade, carbon dioxide partial pressures, use of mechanical ventilation, previous exacerbation, long-term oxygen therapy, and inpatient diuretics use. The purpose of the study was to identify the differential effects of patient and treatment-related factors on the length of hospital stay and hospital readmission for COPD exacerbation-related admissions. Methods: A hospital-based retrospective cross-sectional study was conducted among 151 patients with acute exacerbation of COPD admitted at Civil Service Hospital, Kathmandu from August 2021 to March 2022. Ethical approval was taken from the Institutional Review Committee, Civil Service Hospital (Reference no. 18/ 2022). A convenience sampling method was followed. Data regarding different clinical factors were collected in a semi-structured questionnaire. The data were entered and analyzed through Microsoft Excel 365 and SPSS version 22.0 using a binary regression model. Results: Comorbidities, current smoking, dyspnea grade mMRC IV, mechanical ventilation, and long-term oxygen therapy were significantly associated with prolonged hospital stays for COPD exacerbation-related admissions. The corresponding odd ratio is (OR 3.4, 95% CI: 1.24–9.29); (OR 21.4, 95% CI: 6.17–74.57); (OR 2.5, 95% CI: 1.20–5.45); (OR 5.6, 95% CI: 1.20–26.35); (OR 2.4, 95% CI: 1.02–5.90), respectively. Conclusions: The effect of clinical factors such as comorbidities status, current smoking habits, higher grade of mMRC dyspnea scale, mechanical ventilation, and long-term oxygen therapy needed to be considered to optimize care for COPD patients needing hospital admissions and hence decrement in hospital costs.

Perspectives and Attitudes of General Practitioners Towards Pharmacological and Non-Pharmacological COPD Management in a Belgian Primary Care Setting: A Qualitative Study.

Chronic obstructive pulmonary disease (COPD) is a complex and heterogeneous condition that requires multidisciplinary management. In Belgium, the treatment of COPD is mainly managed by general practitioners (GPs). Several clinical practice guidelines (CPGs) recommend the use of non-pharmacological treatments, such as pulmonary rehabilitation, and interdisciplinary care for COPD patients. Although considerable research has been devoted to addressing the multitude of reasons for the lack of adherence to these aspects of the CPGs, less attention has been paid to understanding the perspectives and attitudes of GPs that lead to this suboptimal implementation. This study aimed to 1) explore Belgian GPs' perceptions regarding COPD management in a primary care setting and 2) collect their views on the importance of pulmonary rehabilitation and interprofessional care in COPD management. A descriptive study, conducted between August 2014 and May 2015, used interviews from a sample of 30 Flemish GPs. Data were analyzed following the principles of thematic analysis. COPD management was patient-centered, focusing on immediate symptom relief and reducing future risks through pharmacotherapy and proper patient education. Deviations from the CPGs were noted, with only a few GPs performing spirometry themselves. Conditions to prescribe respiratory physiotherapy were not well known. Some GPs remained unconvinced about the (cost-)effectiveness of respiratory physiotherapy despite the fast-expanding scientific evidence. Interprofessional care was limited to GP-respiratory physician (re)-referral and communication. GPs showed a reactive attitude towards interprofessional collaboration for non-pharmacological therapies, which is not in line with the proactive approach recommended in CPGs. GPs managed COPD patients mainly by reducing symptoms with pharmacological therapy. Integrated care regarding non-pharmacological treatments was not well implemented due to the obstacles in interprofessional collaboration. Future care models incorporating personalized care planning could provide a solution to manage COPD's complex healthcare demands.

General practice management of COPD patients following acute exacerbations: a qualitative study.

Exacerbations are the strongest risk factor for future exacerbations for patients living with chronic obstructive pulmonary disease (COPD). The period immediately following exacerbation is a high-risk period for recurrence and hospital admission, and is a critical time to intervene. GPs are ideally positioned to deliver this care. To explore perceptions of GPs regarding the care of patients following exacerbations of COPD and to identify factors affecting the provision of evidence-based care. A descriptive qualitative study was undertaken involving semi-structured, in-depth interviews with Australian GPs who volunteered to participate following a national survey of general practice care for COPD patients following exacerbations. Interviews were conducted via the Zoom video conference platform, which were audio-recorded and transcribed verbatim. QSR NVivo was used to support data management, coding, and inductive thematic analysis. Eighteen GPs completed interviews. Six key themes were identified: 1) GPs' perceptions and knowledge in the management of COPD patients following exacerbation and admission to hospital; 2) pharmacological management; 3) consultation time; 4) communication between healthcare professionals; 5) access to other health services; and 6) patient compliance. Delivery of post-exacerbation care to COPD patients is affected by GPs, patients, and health service-related factors. The care of COPD patients may be further improved by supporting GPs to overcome identified barriers.

Faktor-Faktor Yang Mempengaruhi Saturasi Oksigen dan Lama Hari Rawat Pada Pasien PPOK yang Mendapatkan Posisi Semifowler di RS Hermina Ciputat

Chronic Obstructive Pulmonary Disease (COPD) is a lung disease which has a chronic obstruction in airway that can interefere normal respiration led to death. Patients with COPD usually show symptoms such as dyspnea that are most frustrating in patients with COPD that can trigger the appearance of tightness and decreased saturation. The semi-fowler position is a position that can be chosen by patients who have difficulty breathing and in COPD patients is expected to optimize lung development so that oxygen saturation becomes increased. Given the many factors that contribute to oxygen saturation in patients, it is important to control the factors that affect oxygen saturation in patients who get a semi-fowler position. In addition, given the high prevalence of COPD, it is important for hospitals to identify factors that affect the length of day of treatment of patients with COPD. Identification of these factors can help health workers to plan treatment programs to plan the length of the day of treatment of patients who enter the hospital. The study aimed to identify factors that influence oxygen saturation and the length of days of treatment in COPD patients who get semi-fowler positions at Hermina Ciputat Hospital. Data collection was carried out from January 2020 to October 2021 using the cross-sectional method, namely by taking data at once at the same time through medical record data on 84 inpatients. The analysis test used in this study is the T-test and subsequently multivariate analysis is carried out using linear regression tests. Based on the analysis test, the factors that affect oxygen saturation are gender, smoking history, and initial saturation value. While the factors that affect the length of treatment are the history of smokers and the history of comorbid. Respondents who had a history of smoking would experience a decrease in oxygen saturation by 0.3888. Preventive interventions through smoking-related health education need to be done to reduce the severity in patients with COPD who are hospitalized.

Computed tomographic imaging in chronic obstructive pulmonary disease : What pulmonologists and thoracic surgeons want to know

Chronic obstructive pulmonary disease (COPD) begins with chronic inflammation of the bronchial system and leads to the development of emphysema in many patients. COPD patients are characterized by reduced performance, dyspnea in the context of an obstructive respiratory disorder and increased susceptibility to infections. COPD has amajor impact on public health, as it is very common and many patients die from it. The most important preventable cause of COPD is tobacco smoke inhalation, which is why consistent smoking cessation is the most important component of any COPD treatment. There is no causal therapy, but in severely symptomatic patients with advanced emphysema, respiratory mechanics can be improved by lung volume reduction if all conservative treatment options have been exhausted. Diagnostic imaging is of great importance in the care of COPD patients. This article summarizes which indications warrant the performance of computed tomography (CT) and what we should pay special attention to during image analysis in order to provide optimal advice to our clinical partners.

Humanistic and socioeconomic burden of COPD patients and their caregivers in Malaysia

Chronic obstructive pulmonary disease (COPD) is associated with substantial humanistic and socioeconomic burden on patients and their caregivers. COPD is expected to be 7th leading cause of disease burden till 2030. The objective of the current study was to assess the humanistic and socioeconomic burden of COPD patients and their caregivers in Malaysia. The burden includes the cost of management of COPD, QOL of COPD patients and their caregivers, work productivity and activity impairment of COPD patients and their caregivers due to COPD. One hundred and fifty COPD patients and their caregivers from the chest clinic of Penang Hospital were included in the study from August 2018 to August 2019. Caregiving cost was estimated using the replacement cost approach, while humanistic and social burden was assessed with the help of health status questionnaires. Overall, 64.66% and 7.1% of COPD patients reported to depend on informal caregivers and professional caregivers respectively. COPD patients reported dyspnoea score as 2.31 (1.31), EQ-5D-5L utility index 0.57 (0.23), CCI 2.3 (1.4), SGRQ-C 49.23 (18.61), productivity loss 31.87% and activity impairment 17.42%. Caregivers reported dyspnoea score as 0.72 (0.14), EQ-5D-5L utility index 0.57 (0.23), productivity loss 7.19% and social activity limitation as 21.63% due to taking care of COPD patients. In addition to the huge direct cost of management, COPD is also associated with substantial burden on society in terms of compromised quality of life, reduced efficiency at the workplace, activity impairment and caregiver burden.

Cross Sectional E-Health Evaluation Study for Telemedicine and M-Health Approaches in Monitoring COVID-19 Patients with Chronic Obstructive Pulmonary Disease (COPD).

Monitoring COVID-19 patients with COPD has become one of the major tasks in preventing transmission and delivering emergency healthcare services after vaccination in case of any issues. Most COVID-19-affected patients are suggested to self-quarantine at home or in institutionalized quarantine centers. In such cases, it is essential to provide remote healthcare services. For remote healthcare monitoring, two approaches are being considered in this study, which include mHealth and Telehealth. A mixed-methods approach is adopted, where survey questionnaires are used for collecting information from 108 patients and semi-structured interviews are used with seven physicians regarding mHealth and Telehealth approaches. Survey results indicated that mHealth is rated to be slightly more effective than Telehealth, and interview results indicated that Telehealth is identified to be slightly more effective than mHealth in relation to parameters including usefulness, ease of use and learnability, interface and interaction quality, reliability, and satisfaction. However, both physicians and patients opined that both mHealth and Telehealth have a promising future with increasing adoption. Based on the findings, it can be concluded that both mHealth and Telehealth are considered to be effective in delivering remote care for COPD patients infected with COVID-19 at home. Implications of the study findings are discussed.

Challenges and opportunities for telehealth in the management of chronic obstructive pulmonary disease: a qualitative case study in Greece

BackgroundTelehealth (TH) was introduced as a promising tool to support integrated care for the management of chronic obstructive pulmonary disease (COPD). It aims at improving self-management and providing remote support for continuous disease management. However, it is often not clear how TH-supported services fit into existing pathways for COPD management. The objective of this study is to uncover where TH can successfully contribute to providing care for COPD patients exemplified in a Greek care pathway. The secondary objective is to identify what conditions need to be considered for successful implementation of TH services.MethodsBuilding on a single case study, we used a two-phase approach to identify areas in a Greek COPD care pathway where care services that are recommended in clinical guidelines are currently not implemented (challenges) and areas that are not explicitly recommended in the guidelines but that would benefit from TH services (opportunities). In phase I, we used the care delivery value chain framework to identify the divergence between the clinical guidelines and the actual practice captured by a survey with COPD healthcare professionals. In phase II, we conducted in-depth interviews with the same healthcare professionals based on the discovered divergences. The responses were analyzed with respect to identified opportunities for TH and care pathway challenges.ResultsOur results reveal insights in two areas. First, several areas with challenges were identified: patient education, self-management, medication adherence, physical activity, and comorbidity management. TH opportunities were perceived as offering better bi-directional communication and a tool for reassuring patients. Second, considering the identified challenges and opportunities together with other case context details a set of conditions was extracted that should be fulfilled to implement TH successfully.ConclusionsThe results of this case study provide detailed insights into a care pathway for COPD in Greece. Addressing the identified challenges and opportunities in this pathway is crucial for adopting and implementing service innovations. Therefore, this study contributes to a better understanding of requirements for the successful implementation of integrated TH services in the field of COPD management. Consequently, it may encourage healthcare professionals to implement TH-supported services as part of routine COPD management.

Palliative Care Initiation in Chronic Obstructive Pulmonary Disease: Prognosis-Based, Symptoms-Based or Needs-Based?

The absence or late initiation of palliative care (PC) in chronic obstructive pulmonary disease (COPD) is multidimensional. To provide palliative care from the moment of COPD diagnosis remains utopic. Even the advanced forms or the end-of-life stages benefit late or never from these services. In this context, the research questions for the present systematic review were focused on the prognosis variables or multicomponent indices in COPD patients alongside the symptoms and unmet needs, which may be useful for the palliative care initiation. The aim was to help clinicians to identify not only the tools reliable to predict poor survival in COPD patients but also to identify the criteria for appropriateness for early palliative care onset. The search included systematic reviews and reviews published in English in the PUBMED database from Jan 1, 2015 to Jan 6, 2020. From a total of 202 findings, after applying filters, using additional sources, and eliminating duplicates, the search strategy screened 16 articles, out of which 10 were selected and included. A Preferred Reporting Items for Systematic Review and Meta-analysis Protocols (PRISMA-P) flow diagram was constructed. The main domains identified as barriers in providing palliative care in COPD patients were complex: from the prognosis difficulties to the prognostic variables and scores proposed for initiating PC; from the troublesome symptoms or the unidimensional symptom tools to the unmet needs of COPD patients. The review concluded that none of the existing prognostic variables and multicomponent indices are reliable enough to exclusively predict poor survival in COPD patients and the decision to initiate PC should be rather based on the presence of refractory symptoms and patients’ unmet needs and preferences. Despite the current advances, the ideal model to initiate palliative care from the moment COPD is diagnosed is a goal for clinicians trained in, and capable of providing palliative care in any COPD patient.

Amid COVID-19 pandemic: Challenges with access to care for COPD patients.

Chronic Obstructive Pulmonary Disease (COPD) is a chronic inflammation in the lungs that causes obstruction in the airway, poor airflow, and irreversible loss of lung function. In clinical practice, comprehensive care for COPD patients includes the diagnosis using spirometry, clinical examination and comprehensive pharmacological and non-pharmacological management. The diagnosis is based on symptoms, dyspnea and lung function impairment and can be mild to very severe. Symptoms are examined using the COPD assessment test (CAT) score, and dyspnea grade are examined using a modified MRC from GOLD guidelines. When mild, the care includes self-management education, smoking cessation, lifestyle modifications, vaccination, and short-acting bronchodilators. Self-management education involves inhaler device training, breathing technique, early recognition of acute exacerbations and writing action plans. As the disease progresses, other care measures are added. These measures include the addition of long-acting inhaler therapies, pulmonary rehabilitation, oral therapies, oxygen and lung transplantation. During the final stages of COPD, patients receive end-of-life care (Bourbeau et al., 2019).1The novel coronavirus disease (COVID-19) is a viral infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that is spread through respiratory droplets. This infectious disease has led to a pandemic and is affecting the lives of many around the world, including Canadians. During this pandemic, the non-essential health services, including caring for patients with COPD, have been put on hold to reduce the risk of spread. Other implications of this pandemic for COPD patients include the health risk in case of infection. A meta-analysis including studies from January to March 2020 in Wuhan showed that pre-existing COPD worsens the risk of COVID-19 progression and leads to poorer prognostics. The sub-group analysis showed a significantly higher risk of ICU requirements and death in COPD patients who are infected with the SARS-CoV-2 virus. Studies suggest strong efforts to mitigate the risk of infection in this population (Zhao et al., May 2020).2 This makes caring for this population even more critical during the pandemic.

Clinical effects of transitional care model in COPD patients

Objective To explore the effects of transitional care model (TCM) for chronic obstructive pulmonary disease (COPD) patients on the transition time, functional status and self-care behavior. Methods From March 2015 to March 2018, we selected 168 COPD patients at Zhengzhou Central Hospital Affiliated to Zhengzhou University as subjects by convenience sampling. All of patients were divided into observation group (n=96) and control group (n=72) according to admission time. Control group carried out routine nursing management, while observation group implemented TCM management. This study recorded the transition time, and compared the 6-Minute Walk Distance (6MWD) as well as lung function indexes of patients between two groups before and after intervention. The scores of self-care behavior of patients between two groups were also compared with the Self-care Behavior Questionnaire. Results The transition time of patients in observation group and control group was (5.02±1.79) months and (3.75±1.33) months respectively with a statistical difference (t=3.578, P<0.01) . After intervention, the 6MWD and forced expiratory volume in one second percentage occupied by forced vital capacity (FEV1/FVC%) of patients in observation group was (278.15±51.26) m and (67.48±10.21) % respectively, higher than those in control group with statistical differences (t=3.068, 3.224; P<0.05) ; the scores of general self-care need and health deviation self-care need of observation group were (46.12±4.54) and (50.74±4.81) respective higher, than those of control group with statistical differences (t=11.991, 9.626; P<0.01) . Conclusions Application of TCM management in transitional care for COPD patients helps to improve patients' lung function, exercise tolerance and self-care behavior. Key words: Pulmonary disease, chronic obstructive; Transitional care model; Lung function; Self-care behavior

Primary care risk stratification in COPD using routinely collected data: a secondary data analysis

Most clinical contacts with chronic obstructive pulmonary disease (COPD) patients take place in primary care, presenting opportunity for proactive clinical management. Electronic health records could be used to risk stratify diagnosed patients in this setting, but may be limited by poor data quality or completeness. We developed a risk stratification database algorithm using the DOSE index (Dyspnoea, Obstruction, Smoking and Exacerbation) with routinely collected primary care data, aiming to calculate up to three repeated risk scores per patient over five years, each separated by at least one year. Among 10,393 patients with diagnosed COPD, sufficient primary care data were present to calculate at least one risk score for 77.4%, and the maximum of three risk scores for 50.6%. Linked secondary care data revealed primary care under-recording of hospital exacerbations, which translated to a slight, non-significant cohort average risk score reduction, and an understated risk group allocation for less than 1% of patients. Algorithmic calculation of the DOSE index is possible using primary care data, and appears robust to the absence of linked secondary care data, if unavailable. The DOSE index appears a simple and practical means of incorporating risk stratification into the routine primary care of COPD patients, but further research is needed to evaluate its clinical utility in this setting. Although secondary analysis of routinely collected primary care data could benefit clinicians, patients and the health system, standardised data collection and improved data quality and completeness are also needed.

End-of-life care for patients with advanced lung cancer and chronic obstructive pulmonary disease: survey among Polish pulmonologists.

INTRODUCTION There is evidence that people with nonmalignant disease receive poorer end‑of‑life (EOL) care compared with people with cancer. OBJECTIVES The aim of the study was to assess the selected aspects of symptomatic treatment and communication between physicians and patients diagnosed with either advanced chronic obstructive pulmonary disease (COPD) or lung cancer. METHODS A questionnaire survey was conducted online among members of the Polish Respiratory Society. RESULTS Properly completed questionnaires were returned by 174 respondents (27.2% of those proved to be contacted by email). In COPD, 32% of respondents always or often used opioids in chronic breathlessness and 18.3% always or often referred patients to a palliative care (PC) specialist. Nearly 80% of the respondents claimed that bedside discussions on EOL issues with people with COPD are essential, although only 20% would always or often initiate them. In people with lung cancer, opioids were routinely used for relief of chronic breathlessness by 80% of physicians; 81.7% referred patients to a PC specialist. More than half of the respondents always or often discussed EOL issues only with the patient's caregivers or relatives. Younger physicians, those at an earlier stage of their career, those caring for higher numbers of patients with lung cancer, and those who were better acquainted with Polish Respiratory Society recommendations for PC in chronic lung diseases seemed to provide better EOL care for COPD patients. CONCLUSIONS Patients with COPD, as compared with patients with lung cancer, were less frequently treated with opioids to relieve chronic breathlessness or referred for a PC consultation. Discussing the EOL issues with a patient was generally found challenging by physicians, and most often pursued with caregivers instead. The COPD recommendations on PC may prove helpful in providing better EOL care by pulmonologists.

Effects of a long-term home-based exercise training programme using minimal equipment vs. usual care in COPD patients: a study protocol for two multicentre randomised controlled trials (HOMEX-1 and HOMEX-2 trials)

BackgroundExercise training is an important component of pulmonary rehabilitation (PR) programmes in chronic obstructive pulmonary disease (COPD), but the great majority of COPD patients who would benefit from PR never follow such programmes or fail to maintain exercise training after PR completion. Against this background, we developed an exercise training programme that requires minimal equipment and can be implemented long-term in the patient’s home-setting. The aims of the HOMEX-1 and HOMEX-2 trials are to assess the effectiveness of this home-based exercise training programme in two groups of COPD patients over the course of one year: patients who have completed PR (HOMEX-1 trial) and patients who did not enrol in existing PR programmes within the last two years (HOMEX-2 trial).MethodsHOMEX-1 and HOMEX-2 are multicentre, parallel group, randomised controlled trials. For both trials each, it is planned to include 120 study participants with a diagnosis of COPD. Participants will be randomised with a 1:1 ratio into the intervention group or the control group (usual care/no intervention). The intervention consists of minimal-equipment exercise training elements with progressive level of intensity, conducted by the participant during six days per week and instructed and coached by a trained health care professional during three home visits and regular telephone calls during one year. Primary outcome is change in dyspnoea (domain of Chronic Respiratory Questionnaire) from baseline to 12-months follow-up. Secondary outcomes are change in dyspnoea over the course of the year (assessed at 3, 6 and 12 month) and change in functional exercise capacity, physical activity, health-related quality of life, health status, exacerbations and symptoms from baseline to 12 months follow-up. In addition, explanatory, safety and cost-effectiveness outcomes will be assessed. We will conduct intention-to-treat analyses separately per trial and per protocol analyses as sensitivity analyses.DiscussionThe HOMEX-1 and HOMEX-2 trials assess a novel intervention that provides an innovative way of making exercise training as accessible as possible for COPD patients. If the intervention proves to be effective long-term, it will fill the gap of providing an easily accessible and feasible intervention so that more COPD patients can follow an exercise programme.Trial registrationClinicalTrials.gov Identifier: HOMEX-1 NCT03461887 (registration date: March 12, 2018; retrospectively registered); HOMEX-2 NCT03654092 (registration date: August 31, 2018).

Improving Physicians' Capacity for Chronic Obstructive Pulmonary Disease Care through Blended E-learning: A Pilot Study in Bangladesh.

Patients with chronic obstructive pulmonary disease (COPD) are often under diagnosed and managed without evidence-based approach in primary care settings. This may be due to gaps in knowledge and practice of using updated COPD guidelines by the physicians in public and private sectors in Bangladesh. To our knowledge, this is the first study in Bangladesh which aims to evaluate a blended e-learning approach for building capacity of physicians working at low-resource environments on COPD patient care.In total, 32 practicing physicians were enrolled where 16 received training via blended approach and 16 received training via traditional classroom-based approach. Using a standard examination procedure and assessment approach both groups were assessed and results were documented.No statistically significant differences were found in the scores of theory (knowledge) and in the total scores (theory plus practicum) of both groups indicating that learning objectives were achieved in both the groups though the scores were significantly higher in practicum of the traditional learning group. Besides, Likert-scale-based self-reported pre-post changes indicate that both the groups were confident (statistically significant) in the management of COPD. Most importantly, the blended group had a minimal disruption of their services as they attended face-to-face only during the practicum sessions.Overall, the blended e-learning appears to be a feasible approach of training for physicians on standard management of COPD especially in health human resource-poor settings in Bangladesh.