Chronic Obstructive Pulmonary Disease Outpatients Research Articles

Особенности течения хронической обструктивной болезни легких у пациентов, перенесших COVID-19

Aim. To evaluate the course of chronic obstructive pulmonary disease (COPD) in patients who had SARS-CoV-2 infection of various severity. Design. Three-centre cross-sectional study under the STROBE standard (STrengthening the Reporting of OBservational studies in Epidemiology). Materials and methods. We conducted a complete medical examination of 46 patients with COPD who had COVID-19 during the past year: without viral damage to pulmonary tissue (CT 0, n = 18), with viral damage to pulmonary tissue of max. 50 % (CT 1–2, n = 24) and with viral damage to pulmonary tissue of at least 50 % (CT 3–4, n = 4). Examinations included analysis of clinical information, laboratory and functional tests, as well as assessment of physical and emotional condition of patients using questionnaires and scales. Results. After the novel coronavirus infection (NCI), 69.6 % of patients developed COPD complications, 26.1 % of patients presented with COPD symptoms for the first time, which required medical assistance. Disease exacerbation was observed approximately 24 weeks after COVID-19. Post-COVID-19 patients required intensification of baseline therapy. COPD patients who had NCI with viral pulmonary involvement had elevated D-dimer levels; CT 3–4 group also had significant impairment of diffusive capacity of lungs. Patients with pulmonary involvement, corresponding to CT 3–4, had statistically higher (p < 0.001) risk of reduction in the quality of life and aggravated anxiety and depression. Conclusion. In post-COVID-19 period, patients with COPD are at high risk of disease exacerbation requiring review of outpatient COPD baseline therapy in post-COVID-19-patients. COPD patients who had mild SARS-CoV-2 require long-term monitoring of their coagulation profile and diffusive capacity of lungs and are recommended long-term psychological support. Keywords: COPD, COVID-19, post-COVID, body plethysmography, diffusive capacity of lungs.

Acceptability, Appropriateness, and Feasibility of an Educational Program to Promote Treatment Adherence in Patients with Chronic Obstructive Pulmonary Disease.

The mortality rate due to chronic obstructive pulmonary disease (COPD) has increased annually, and non-adherence to treatment is one reason for this rise. Developing intervention programs to enhance treatment adherence for people with COPD is essential. The purpose of this mixed-methods study was to determine the acceptability, appropriateness, and feasibility of such a program. We sought the opinions of 15 healthcare managers and 15 practicing nurses from three hospitals across Vietnam and conducted group discussions and interviews with 30 patients with COPD. We then formulated integrated conclusions on the acceptability, appropriateness, and feasibility of the program. The overall average score of 12 items to test the acceptability, appropriateness, and feasibility of the program from both healthcare managers and practicing nurses was high (M = 4.31; SD = 0.11) and (M = 4.37; SD = 0.12), respectively. Thirty COPD outpatients agreed the content and plan of the program were necessary for them to enhance their treatment adherence at home. The document content was appropriate, easy to understand, and the support and education provided by nurses was helpful. The educational intervention program to promote treatment adherence for patients with COPD was acceptable, appropriate, and feasible from the views of healthcare managers, nurses, and patients with COPD.

Effectiveness of clinical pharmacist intervention on medication adherence in patients with chronic obstructive pulmonary disease - A randomized controlled study

ObjectivesIn patients with chronic obstructive pulmonary disease (COPD), non-adherence remains challenging to achieve optimal disease control. Our study aimed to determine the impact of pharmacist-led educational interventions on COPD management, focusing mainly on medication adherence. MethodsWe conducted a 1-month open-labeled, randomized, controlled study at Ba Ria Hospital, Vietnam. COPD outpatients were randomly assigned to the intervention group or control group. Pharmacist-delivered education emphasized medication adherence, disease, and medication knowledge. The primary outcome was the between-group difference in medication adherence after the intervention, as assessed by the general medication adherence scale (GMAS). ResultsOf 181 recruited patients, 180 completed the follow-up. After the intervention, the results indicated a significant improvement in medication adherence rate between the two groups (90.1% vs. 66.3%, p < 0.001). Patient behavior was the most common barrier to non-adherence but was effectively reduced at the endpoint. The Modified Medical Research Council (mMRC) scale of dyspnea and inhalation technique also improved significantly in intervention patients. ConclusionsPharmacist intervention can considerably improve medication adherence and knowledge of COPD patients. Practice implicationsThis study promotes the value of clinical pharmacists in patient education to achieve better adherence and enhance population health, especially in resource-limited nations like Vietnam.

Unintentional weight loss is reflected in worse one-year clinical outcomes among COPD outpatients

Unintentional weight loss (UWL) is prevalent among patients with chronic obstructive pulmonary disease (COPD). However, little research has been done on UWL as an independent variable in terms of clinical outcome. The aim of this study was to investigate the association between BMI, UWL, and clinical outcome in terms of hospitalization, length of stay, exacerbations, mortality, and quality of life (QoL) within six months and one year in a hospital outpatient setting. A prospective single-center cohort study enrolled 200 patients from the COPD outpatient clinic between October 2020 and May 2021at a Danish Hospital. At baseline, data was collected using patients' electronic journals and a quantitative questionnaire was gathered with a patient-reported UWL of 5% of body weight within three months. At six months and one-year follow-ups, data was collected using the patients' medical journals and a telephonic interview with the EQ-5D-5L and SARC-F questionnaire and the number of non-hospitalization exacerbations since inclusion. Data were analyzed using logistic and Cox hazard regression analysis. A total of 187 patients were eligible for follow-up (mean age 69.2 years, 43.9% males, median BMI 26.8kg/m2), and the prevalence of UWL was 13.4%. UWL was associated with an almost trifold risk of >five days stay (OR=2.94, p=0.021). Additionally, UWL was associated with a worse QoL. A higher risk of exacerbation was found in the underweight patients (OR=4.94, p=0.014). No significant difference in mortality was found. UWL as a solitary factor is associated with increased hospital length of stay and a worse QoL. The results provide further evidence that implementation of regular screening for UWL in addition to BMI might be beneficial to include in international COPD guidelines for outpatient settings.

Inhalation devices and inhaled corticosteroids particle size influence on severe pneumonia in patients with chronic obstructive pulmonary disease: a nationwide cohort study

BackgroundInhaled corticosteroids (ICSs) are associated with an increased risk of pneumonia among patients with chronic obstructive pulmonary disease (COPD). The introduction of extrafine particle ICS has aimed to improve the...

The short- and long-term effects of lower limb endurance training on outpatients with chronic obstructive pulmonary disease

Objective To explore the short- and long-term effects of lower-limb endurance training on chronic obstructive pulmonary disease outpatients. Design Prospective quasi-experimental study. Setting 1383-bed teaching hospital in Taiwan. Participants Overall, 69 outpatients diagnosed with chronic obstructive pulmonary disease were enrolled. A total of 60 patients completed the study. Intervention Training group: Lower-limb endurance training; control group: Education only. Main measures The modified medical research council score, chronic obstructive pulmonary disease assessment test score, pulmonary function test, and number of acute exacerbation within a year. Results The training group showed significant improvement in the chronic obstructive pulmonary disease assessment test total score, modified medical research council score (both P < 0.001) at third month sustaining to 12th month (P < 0.001) and presented less events of acute exacerbation (P = 0.011) at 12th month. The chronic obstructive pulmonary disease assessment test decreased by 8 points sustaining to 12th month. The training group presented significant post-training functional capacity improvements in 6-min walking distance, lowest oxygen saturation during 6-min walking test, peak workload, maximum inspiratory/ expiratory pressures, and calf circumference. Conclusions The lower-limb endurance training improved perceived dyspnea in daily activity and health status after completion of training and sustaining for a year. The lower-limb endurance training alleviated disease impacted on reduced acute exacerbations.

Prevalence and Risk Factors of GERD among Stable COPD Patients

Introduction: Gastroesophageal reflux disease (GERD) is one of the most common causes of a chronic cough and is a potential risk factor for chronic obstructive pulmonary disease (COPD) exacerbation. This study aimed to determine the prevalence of GERD in COPD patients. Methods: This was a cross-sectional study involving 40 stable COPD patients recruited from outpatient asthma and COPD clinics at Persahabatan National Respiratory Referral Hospital, Jakarta, from May to November 2018. COPD was defined as having a ratio of post-bronchodilator FEV1/FVC &lt; 0.7 and no abnormality on a chest X-ray except emphysematous. Diagnosis of GERD was based on oesophageal mucosal lining break surrounding the distal esophageal sphincter through esophagogastroduodenoscopy (EGD). Asthma patients with known esophageal diseases such as cancer, achalasia, and active peptic ulcer and patients who had used proton pump inhibitors in the last 15 days were excluded. Results: Patients were divided into GERD (+) (16/40, 40%) and GERD (-) (24/40, 60%). Subjects were predominantly elderly (25/40, 62.5%) and had a smoking history (36/40, 90%). Exacerbation and COPD assessment test (CAT) score was significantly associated with GERD (p &lt; 0.05). No significant difference regarding age, sex, Brinkman Index, lung function, and body mass index (BMI) was found between groups. However, the GERD (+) group showed a slightly higher BMI and more severe airflow obstruction. Conclusion: The prevalence of GERD in COPD patients found in this study was as high as 40%. A cohort study and preventive strategy of GERD in COPD should be studied further.

Peripheral blood eosinophil count as a biomarker of exacerbation in stable chronic obstructive pulmonary disease outpatients: a prospective observational study

Peripheral blood eosinophil count as a biomarker of exacerbation in stable chronic obstructive pulmonary disease outpatients: a prospective observational study

Assessment of the Medication Adherence Among Chronic Obstructive Pulmonary Disease Patients in ALSha’ab Teaching Hospital, Sudan

Background: Adherence to therapy is one of the basic predilections to successfully treating chronic obstructive pulmonary disease (COPD). Unfortunately, predictors of medication adherence are not well-known in chronic obstructive pulmonary disease (COPD) in Sudan. Objective: To assess the medication adherence in the patients treated for COPD in ALSha’ab Teaching Hospital. Methods: An observational, hospital-based cross-sectional study conducted on a sample of COPD outpatients. The following information was obtained: adherence to COPD therapy (Morisky Medication Adherence Scale - 4 items), age, gender, smoking status, treatment regimen for COPD, and COPD medication costs per month paid by the patients. Data was analyzed by using SPSS version 21.0. Results: Among 100 COPD patients, 73 (73%) were males, and (47%) belonged to the age group 40- 60 years. Regarding adherence, 47 (47%) reported as medium adherent, 38 (38%) as low adherents, and 15 (15%) patients as high adherent. High Adherence to COPD therapy was associated with older age (27%), married (16.5%), literate (23.3%), drugs with less frequent dosing (50%), oral medications (75%), aware of the inhaler usage (22.7%), a smaller number of drugs (41.4%), and affordable drugs (28.8%). Conclusion: The level of adherence to COPD therapy is low. Understanding factors associated with medication adherence could help enhance health outcomes in COPD. Non-adherence was associated with middle age, unmarried patients, number of respiratory drugs and daily COPD drug doses, Low knowledge and increased difficulties in inhaler technique, and non-affordability of drugs.

Electrocardiogram Characteristics of Chronic Obstructive Pulmonary Disease Patients are Associated with Severity and Disease Duration

Chronic obstructive pulmonary disease (COPD) is characterized by persistent airflow limitations associated with an increase in chronic inflammatory responses to the airways and lungs. COPD patients are more likely to be hospitalized and die from cardiovascular disease. This study aims to determine the factors associated with the incidence of electrocardiogram (ECG) abnormalities in COPD patients. This is a cross-sectional study with an analytical observational design. From October 30 to December 5, 2019, data was collected on 42 COPD patients, inpatients, and outpatients at Muhammadiyah Palembang Hospital who met the inclusion and exclusion criteria. A questionnaire was used to collect data, and spirometry and an electrocardiogram test were used to measure pulmonary function and detect ECG abnormalities. Research variables included age, sex, smoking habits, severity, and duration of COPD. Data analysis using the chi-square test and followed by a logistic regression test found a significant relationship between very heavy-weight COPD and ≥5 years of suffering from COPD with the incidence of ECG abnormality (p value&lt;0.05). The severity and the length of time of suffering from COPD are significantly related to the incidence of ECG abnormalities in outpatients and inpatients.

The Efficacy, Tolerance and Acceptance of a New Fixed-Dose Salmeterol and Fluticasone Propionate Dry-Powder Inhaler—Salflumix Easyhaler® in COPD Patients in the Daily Clinical Practice

The efficacy of the fix-dose salmeterol/fluticasone propionate combination in chronic obstructive pulmonary disease (COPD) was only shown for the original product. This investigator-initiated study aimed to prove the efficacy and safety of Salflumix Easyhaler®, a second-entry product (dry-powder inhaler) in a real-life setting. The efficacy of the therapy was assessed in 440 COPD outpatients (36.1% classified as C&amp;D groups according to GOLD) using the COPD assessment test (CAT) and the modified Medical Research Council (mMRC). During 86 ± 30 days, the frequency of COPD with a big and very big impact on life (CAT &gt; 20 pts); and high scores of dyspnea (mMRC ≥ 2) decreased from 60.7% and 57.5% at I visit to 15.2% and 22.6% at III visits, respectively (p &lt; 0.001). There was a greater improvement in newly diagnosed patients than those who switched from other devices due to insufficient disease control or patient dissatisfaction with the used inhaler. Patients’ satisfaction was scored 3.2–3.5 in a 4 pts scale. Physicians scored the burden related to the use of Salflumix Easyhaler® as very low. Adherence exceeded 90%. This study supports effectiveness, satisfaction, and convenience with the use of this new product in COPD, and shows that ICS-containing DPI therapy is still improperly prescribed for patients with a low risk of COPD exacerbation in real-life settings.

Cost-Effectiveness Analysis of Budesonide/Formoterol and Fluticasone/Salmeterol for Stable Chronic Obstructive Lung Disease

Background: Chronic Obstructive Pulmonary Disease (COPD) is one of the four largest types of non-communicable diseases in the world, requiring long-term and routine treatment. Treatment with the inhalation route is in the form of a dry-powder inhaler (DPI) which is easy to use and carry. Combination of corticosteroid and long-acting beta-2 agonist (LABA) in the form of DPI available in Indonesia are budesonide/formoterol and salmeterol/fluticasone. The purpose was to identify therapy was more cost-effective between budesonide/formoterol than fluticasone/salmeterol in clinical symptoms using COPD assessment test (CAT) value and lung function in FEV1/FVC (Forced Expiratory Volume in First Seconds/Forced Vital Capacity) ratio.Methods: This research study was pre-post design with cost-effectiveness analysis, in outpatient COPD patients in a hospital in Gresik Regency, from October 2019 to January 2020. There were two outcomes of respondents in this study, namely lung function seen from the value of FEV1, and clinical symptoms seen from the value of CAT. The study used hospital perspective.Results: There were 38 respondents involved. Fluticasone/salmeterol therapy was more effective than the budesonide/formoterol group in improving FEV1/FVC ratio, while budesonide/formoterol was more effective than the fluticasone/salmeterol group in improving clinical symptoms by CAT assessment. The average cost effectiveness ratio (ACER) value of lung function between the fluticasone/salmeterol group (IDR.176.465/Liter) was lower than that of budesonide/formoterol (IDR.296.832/Liter). The ACER clinical symptoms value between the fluticasone/salmeterol group (IDR.16,283/score) was smaller than that of budesonide/formoterol (IDR.17,340/score). Conclusion: Fluticasone/salmeterol was more cost-effective than budesonide/formoterol in improving lung function. Meanwhile, for clinical symptoms, fluticasone/salmeterol was trade-off with budesonide/formoterol.

Muscle function and functional performance after pulmonary rehabilitation in patients with chronic obstructive pulmonary disease: a prospective observational study

This study aimed to measure changes in different properties of skeletal muscles and evaluate their contribution and relationship to changes in functional performance after pulmonary rehabilitation (PR) in patients with chronic obstructive pulmonary disease (COPD). COPD outpatients attending 5 weeks of conventional PR were recruited. Functional performance [5-repetitions sit-to-stand (5STS), and 4-m gait speed (4mGS)], and muscle function (maximal isometric strength, power, force control, and relative concentric and eccentric activation during 5STS) were assessed after PR and 3 months of follow-up. Twenty patients (71 years; 52% of predicted FEV1) completed the study. 4mGS and relative concentric activation during 5STS decreased respectively by 7.7% and 26% between the beginning of PR and follow-up. Quadriceps strength, power, and force control improved by 10.4%, 27.3%, and 15.2%, respectively, from the beginning of PR to follow-up the relative eccentric activation during 5STS explained 31% of the variance in 4mGS changes. In conclusion, functional performance appeared to decline after conventional PR, whereas several properties of skeletal muscles were maintained at follow-up in COPD outpatients. Of note, eccentric contractions might play a role in the improvement of functional performance. Therefore, future studies with interventional design should include eccentric training in PR programs during clinical COPD practice.

Filling the Gap: A Feasibility Study of a COPD-Specific Breathlessness Service

Refractory breathlessness is a devastating symptom in chronic obstructive pulmonary disease (COPD). Symptom-focused breathlessness services, involving palliative care teams, offer individualized support but are not yet widely available for people with nonmalignant disease among which COPD. Our primary aim was to demonstrate the feasibility of setting up a breathlessness service specifically for COPD patients within a respiratory outpatient clinic. Our secondary aims were to assess how many sessions patients need to complete the intervention; to obtain an indication of effect size (on the Chronic Respiratory Questionnaire (CRQ), subset mastery domain); and to evaluate patient and professional satisfaction. We conducted a non-randomized single-center feasibility study. Participants had COPD and refractory breathlessness. During at least one session with a respiratory nurse and a pulmonologist, and one session with a physiotherapist, patients learned non-pharmacological interventions to manage breathlessness. Of 34 screened patients, 19 were included. All completed the intervention. A median of two clinical visits and two telephone calls were needed to complete the intervention. The mean improvement of 1.55 in CRQ, mastery domain, significantly exceeded the clinically important difference of 0.5. The service was rated as excellent by the eight patients who completed the survey. The health professional team gave positive feedback on the experience of delivering the intervention. Delivery of a breathlessness service for COPD outpatients with refractory breathlessness appears feasible, easy to implement in a respiratory outpatient clinic, and has the potential to be effective. A randomized controlled clinical trial is needed to test effectiveness and cost-effectiveness in this context.

Chronic obstructive pulmonary disease outpatients bear risks of both unplanned weight loss and obesity.

Malnutrition is commonly seen in chronic obstructive pulmonary disease (COPD) and has been associated with negative outcomes. The objective of this study was to examine unintended weight loss (UWL) within three months, as a primary indicator for disease related malnutrition among COPD outpatients, to evaluate the prevalence of UWL, and to identify possible characteristics for UWL. A cross-sectional study including a patient questionnaire and medical record data extraction was made with all patients visiting a Danish COPD outpatient clinic. Among the 200 included patients (68.7±11.2 years of age), UWL was seen in 21.5%, with a median weight loss of 3.5 (2-16) kg. Underweight (BMI<18.5kg/m2) was recognized in 13.5%, while 34.5% were obese (BMI>30kg/m2). Reduced food intake (RFI) within the past week was experienced among 22.0% of the patients. The most common nutrition impact symptoms (NIS) were shortness of breath, reduced appetite and nausea. NIS, RFI and BMI<18.5kg/m2 were associated to UWL, while co-morbidities, hospitalization within three months and resent exacerbations showed no association to UWL. A high prevalence of UWL was found in COPD outpatients, and NIS and RFI as characteristics associated with UWL. Shortness of breath, reduced appetite and nausea were the most common NIS. This study found 13.5% of patients underweight, 23.5 overweight and 34.5% obese. Underweight as well as obesity may have negative consequences for the patient and the community.

The Relation of Brinkman Index and Body Mass Index with Spirometry Result of Chronic Obstructive Pulmonary Disease (COPD) Outpatients in the Pulmonology and Respiratory Medicine Department of Zainoel Abidin General Hospital

Background: Chronic Obstructive Pulmonary Disease (COPD) is one of the major health problems worldwide. Smoking is the main risk factor of the COPD development. Not only COPD has clinical manifestations in the lungs, it also manifest outside lungs called systemic effects.One of systemic effects found in COPD patients is weight loss leading to declining lung function. This study aims to determine the relation of Brinkman Index and Body Mass Index (BMI) with spirometry result of COPD outpatients in RSUDZA.&#x0D; Methods: The study was held in lung outpatients department in RSUDZA Banda Aceh on December 5th until 28th with cross sectional design The sampling method is nonprobability sampling with accidental sampling technique. Respondents consisted of 30 patients who had agreed to informed consent given. Medical record used to obtain Brinkman index, BMI, and spirometry result of the patients.&#x0D; Results: The results of analysis shows majority of respondents are male (83,3%), dominated by 56-65 years age range (40,0%) and had moderate Brinkman Index (46,7%). The majority of respondents (53,3%) had an abnormal BMI (severe underweight (13,3%), underweight (6,7%), overweight (23,3%), and obese (10,0%)) and severe spirometry result (53,3%). The data was analyzed by the Spearman Correlation. With the Spearman Correlation, there was no association between Brinkman Index and spirometry result with p value 0,412 (p value &gt;0,05). Meanwhile, there was an association between the BMI and spirometry result with p value 0,006 (p &lt; 0,05). The strength of the correlation is moderate (rs =-0,488).&#x0D; Conclusion: The lower the BMI, the more severe the spirometry result.&#x0D;

Subgroup analysis reveals higher reliability of the new comprehensive evaluation of Global Initiative for Chronic Obstructive Lung Disease 2019

To estimate the severity of the disease in outpatients with chronic obstructive pulmonary disease (COPD) in Hunan Province, China and use the subgroup analysis to evaluate the reliability of the new comprehensive evaluation of Global Initiative for Chronic Obstructive Lung Disease (GOLD). COPD outpatients from 12 medical centers in Hunan Province, China were stratified into groups A–D, and group D patients were further stratified into subgroups D1–D3 according to the GOLD 2016 and 2019 comprehensive assessment. Demography, clinical characteristics and medications were compared among groups. In 1017 COPD outpatients, the distribution from group A to D and subgroup D1 to D3 was 41 (4.0%), 249 (24.5%), 17 (1.7%), 710 (69.8%) and 214 (30.2%), 204 (28.7%), 292 (41.1%), according to GOLD 2016. In terms of demographic and clinical characteristics related to A–D groups, there was a significant difference in COPD assessment test (CAT), modified Medical British Research Council (mMRC), the clinical COPD questionnaire(CCQ), age, BMI, education level, smoking history, comorbidities, the course of chronic bronchitis/emphysema, number of exacerbations/hospitalisations in the previous year, treatment protocols, forced expiratory volume in one second (FEV1) % predicted, and FEV1/forced vital capacity (FVC) (p < 0.01). Furthermore, some patients in groups C–D regrouped to groups A–B were all C1 and D1 subgroups according to GOLD 2019. Comparing subgroup D1 with group B, subgroup D2 and subgroup D3, it was found that the demography, clinical characteristics and medications of subgroup D1 were the closest to group B, according to GOLD 2016 (p < 0.01). The disease severity of outpatients with COPD in Hunan Province was more pronounced in group B and D and patients in groups A–D had different demography, clinical characteristics and medications. Subgroup analysis can explain to a certain extent that GOLD2019’s new comprehensive assessment is more reliable than GOLD 2016.

Association of Patient and Primary Care Provider Factors with Outpatient COPD Care Quality.

Large gaps exist between guideline-recommended outpatient chronic obstructive pulmonary disease (COPD) care and clinical practice. Seeking to design effective interventions, we identified patient and primary care provider (PCP) characteristics associated with receiving evidence-based COPD care. We performed an observational study of adults aged ≥ 40 years with clinically diagnosed COPD who received care at 2 University of Washington-affiliated primary care clinics between June 1, 2011, and June 1, 2013. Our primary outcome was the proportion of evidence-based outpatient COPD quality measures received through primary or pulmonary care. Among all patients, we assessed spirometry completion, respiratory symptom identification, smoking status ascertainment, oxygen saturation measurement, and guideline-concordant inhaled therapy prescription. We also determined confirmation of airflow obstruction, oxygen prescription, smoking cessation intervention, and pulmonary rehabilitation referral if eligible. We used multivariable mixed effects linear regression to estimate the association of patient and PCP characteristics with the primary outcome. Among 641 patients, 382 were male (59.6%) with mean age 63.6 (standard deviation [SD] 10.6) years. Most patients currently smoked (N=386, 60.2%). Patients saw 150 unique PCPs during 5.3 (SD 3.2) PCP visits, with 107 completing pulmonary referrals (16.7%). Patients received 67.5% (SD 18.4%) of eligible (median 7 [interquartile range 6-7]) evidence-based quality measures. After adjustment, pulmonary referral was associated with a higher receipt of outpatient quality measures (ß117.7%, 95% confidence interval: 12.6%, 22.7%). Patient demographics, comorbidities, and PCP identity/characteristics were not associated with outpatient care quality. The quality of outpatient COPD care was suboptimal. Future studies should investigate if engaging pulmonologists in COPD management improves care quality.

Prevalence of Oral Candidiasis in Asthma and COPD Patients Using Inhaled Corticosteroids in the Philippine General Hospital Department of Out-patient Services

Background and Objectives. Oral candidiasis (OC) is a well-known local side effect of inhaled corticosteroid (ICS) therapy in patients with asthma and chronic obstructive pulmonary disease (COPD). This study aimed to determine the prevalence of OC and its association with ICS-related factors in out-patient asthma and COPD patients of the Departments of Pulmonology and Pediatric Pulmonology of the Philippine General Hospital (PGH).Methods. This is a cross-sectional study conducted from October 2019 to January 2020. Data was collected through a two-part questionnaire accomplished by doctors and patients with asthma or COPD.Results. A total of 67 patients were included in the study. Oral candidiasis was observed in 4 (5.97%) ICS users, and the prevalence was 1.65% to 14.59% (95% CI, SE: 0.028946).Conclusion. This study determined the prevalence of oral candidiasis in asthma and COPD patients and its association with ICS-related factors, including the dosage, medication, device, and duration of therapy. The prevalence of OC in ICS users in PGH cannot be interpreted as high or low due to the small number of respondents, but is consistent with OC prevalence found in related literature. Increased prevalence was observed in adult females with asthma under low dose ICS therapy with Fluticasone/Salmeterol DPI for more than a year. There was no statistically significant correlation among OC prevalence, age, sex, and components of ICS-therapy including dosage, medication, device, frequency, and duration of therapy. A large-scale study is recommended for more accurate assessment of OC prevalence in the population and to determine statistically significant associations among the factors. It is also recommended to quantifiably measure patient compliance, inhalation technique and instruction, and its association to OC prevalence. Findings may be used to strengthen patient education, preventive measures, and disease management to facilitate improved compliance and effective treatment outcomes.

Atrial electromechanical delay, neutrophil-to-lymphocyte ratio, and echocardiographic changes in patients with acute and stable chronic obstructive pulmonary disease.

Atrial electromechanical delay (AEMD) is the time interval between the beginning of P wave on surface electrocardiography and starting of the late diastolic wave on tissue Doppler imaging. We investigated the prolongation of AEMD, echocardiographic changes, and correlation of these findings with neutrophil-to-lymphocyte ratio (NLR) in patients with chronic obstructive pulmonary disease (COPD). The study consisted of 105 (49 females and 56 males; mean age: 65.1 ± 9) patients with COPD exacerbation and 104 (21 females and 83 males; mean age: 64.8 ± 9.6) stable COPD outpatients. Demographics, body mass index, pulmonary function tests, and transthoracic echocardiography of the patients were evaluated. Echocardiography was performed in the first 6 h for stable COPD outpatients and in the first 24 h for COPD exacerbation patients. Diameters of right ventricle (RV), left ventricle (LV) and left atrium, aortic root diameters, left ventricular ejection fraction (LVEF), Emax, Amax, Emax/Amax, tricuspid annular plane systolic excursion (TAPSE), Ea, Aa, Ea/Aa, Emax/Ea, and tricuspid regurgitation velocity (TRV) were evaluated. AEMD measurements were obtained from lateral/tricuspid, lateral/mitral, and septal annulus from apical four-chamber views with tissue Doppler imaging and corrected for heart rate. Complete blood count including NLR was also assessed. The mean age of patients in exacerbation period (65.1 ± 9) was higher than the stable group (64.8 ± 9.6). RV basal and mid diameters (P < 0.001), Amax (P < 0.001), Ea tricuspid (P = 0.040), Aa tricuspid (P < 0.001), TRV, and systolic pulmonary artery pressure (P < 0.001) were higher; TAPSE and tricuspid Emax/Amax (P < 0.001) were significantly lower in patients with COPD exacerbation. LV end-diastolic diameter (P = 0.002) and LVEF (P = 0.005), Emax/Amax mitral (P < 0.001), Ea/Aa mitral (P < 0.001), and Ea/Aa septal (P < 0.001) were significantly lower; Amax mitral (P = 0.002), Aa mitral (P < 0.001), Aa septal (P < 0.001), and systolic motion mitral (P = 0.011) were significantly higher in patients with exacerbation. AEMD lateral/tricuspid (P < 0.001), lateral/mitral (P < 0.001), and septal (P < 0.001) were significantly higher in patients with COPD exacerbation. Neutrophil and lymphocyte count (P < 0.001) and NLR (P = 0.003) were significantly higher in the acute group. A weak correlation of NLR with LV end-diastolic diameter (P = 0.003; r = 0.357), Emax/Ea mitral (P = 0.019; r = 0.285), Emax tricuspid (P = 0.045; r = -0.244), and systolic motion septal (P = 0.003; r = 0.352) was detected in patients with stable COPD. In COPD exacerbation patients, prolongation of AEMD intervals was determined. Acute period of COPD may trigger atrial dysrhythmias including atrial fibrillation and flutter, multifocal atrial tachycardia, premature beats, and both systolic and diastolic dysfunctions frequently.