New Cases Of Chronic Obstructive Pulmonary Disease Research Articles

INCIDENCE TREND OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Chronic Obstructive Pulmonary Disease (COPD) is associated with high morbidity and complications, decreased quality of life, increasing mortality. The objective of the paper was to determine incidence trends of COPD in the population of the Nisava District from 2002 to 2014. The descriptive study was used. Data about new cases of COPD were extracted from the Population Registry of COPD for the population of the Nisava District. Data about population originated from Censuses 2002 and 2011. Crude incidence, age, and gender specific rates were calculated per 100 000 inhabitants. Trend lines were estimated using linear regression. The total number of registered new cases were 7527 (4575 in males and 2952 in females). The average annual new cases was 627 and the annual average crude incidence rate was 164.3/100 000 inhabitants. The lowest annual incidence rate was in 2014 (36.7/100 000) and the highest one was in 2006 (232.6/100 000). Males represent 61 % and females 39 %. Females were significantly older than males (78.5 ± 2.0 vs 81.4 ± 1.8, p < 0.001). Patients older than 50 years of age represent 86% of all registered patients. Incidence rate increased with age. Incidence trend rapidly decreased in 2014 both in males and females; in males: y = 3.874x + 160.3, R2 = 0.038, in females: y = 0.631x+112.5, R2 = 0.002. There were 1.6 more new cases of COPD in males than in females but females were older compared with males. COPD wasn't common before the age of 40 and incidence increased with age. Under reporting and under registration of new cases of COPD was observed.

Détection précoce de la BPCO en soins primaires : un essai contrôlé randomisé

Chronic obstructive pulmonary disease (COPD) is a common but under-diagnosed pathology in primary care. The objective was to study the feasibility of a randomized controlled trial in general practice to detect new cases of COPD at an earlier stage. A cluster randomized, controlled, multicenter intervention study comparing, according to a 2×2 factorial plan, two case finding strategies: a systematic GOLD-HAS hetero-questionnaire and coordination of the patient's path to facilitate access to spirometry. The PIL-DISCO pilot study took place in 2017. Patients between 40 and 80 years old, with no previous history of COPD, consulting their GP on a given day regardless of the reason, were included. 176 patients were included in 1.5 days. Spirometry was performed in none of the control arm, in 13 (29.5%) of the questionnaire arm, in 22 (50%) in the coordination arm and in 32 (72.7%) with the combination of the two strategies. Two cases of stage 2 COPD and thirteen other respiratory diseases were diagnosed. This study confirms the feasibility of the protocol in primary care in terms of speed of inclusion and acceptability. An extension phase aiming to include 3200patients will assess the diagnostic value of the two strategies tested in general practice.

Targeted case finding for chronic obstructive pulmonary disease versus routine practice in primary care (TargetCOPD): a cluster-randomised controlled trial

Many individuals with chronic obstructive pulmonary disease (COPD) remain undiagnosed worldwide. Health-care organisations are implementing case-finding programmes without good evidence of which are the most effective and cost-effective approaches. We assessed the effectiveness and cost-effectiveness of two alternative approaches to targeted case finding for COPD compared with routine practice. In this cluster-randomised controlled trial, participating general practices in the West Midlands, UK, were randomly assigned (1:1), via a computer-generated block randomisation sequence, to either a targeted case-finding group or a routine care group. Eligible patients were ever-smokers aged 40-79 years without a previously recorded diagnosis of COPD. Patients in the targeted case-finding group were further randomly assigned (1:1) via their household to receive either a screening questionnaire at the general practitioner (GP) consultation (opportunistic) or a screening questionnaire at the GP consultation plus a mailed questionnaire (active). Respondents reporting relevant respiratory symptoms were invited for post-bronchodilator spirometry. Patients, clinicians, and investigators were not masked to allocation, but group allocation was concealed from the researchers who performed the spirometry assessments. Primary outcomes were the percentage of the eligible population diagnosed with COPD within 1 year (defined as post-bronchodilator forced expiratory volume in 1 s [FEV1] to forced vital capacity [FVC] ratio <0·7 in patients with symptoms or a new diagnosis on their GP record) and cost per new COPD diagnosis. Multiple logistic and Poisson regression were used to estimate effect sizes. Costs were obtained from the trial. This trial is registered with ISRCTN, number ISRCTN14930255. From Aug 10, 2012, to June 22, 2014, 74 818 eligible patients from 54 diverse general practices were randomly assigned and completed the trial. At 1 year, 1278 (4%) cases of COPD were newly detected in 32 789 eligible patients in the targeted case-finding group compared with 337 (1%) cases in 42 029 patients in the routine care group (adjusted odds ratio [OR] 7·45 [95% CI 4·80-11·55], p<0·0001). The percentage of newly detected COPD cases was higher in the active case-finding group (822 [5%] of 15 378) than in the opportunistic case-finding group (370 [2%] of 15 387; adjusted OR 2·34 [2·06-2·66], p<0·0001; adjusted risk difference 2·9 per 100 patients [95% CI 2·3-3·6], p<0·0001). Active case finding was more cost-effective than opportunistic case finding (£333 vs £376 per case detected, respectively). In this well established primary care system, routine practice identified few new cases of COPD. An active targeted approach to case finding including mailed screening questionnaires before spirometry is a cost-effective way to identify undiagnosed patients and has the potential to improve their health. National Institute for Health Research.

Effectiveness of case finding strategies for COPD in primary care: a systematic review and meta-analysis.

Background:Chronic obstructive pulmonary disease (COPD) is widely underdiagnosed, but the most effective approach for identifying these patients is unknown.Aims:The aim of this study was to summarise and compare the effectiveness of different case finding approaches for undiagnosed COPD in primary care.Methods:A systematic review of primary studies of any design evaluating case finding strategies for COPD in primary care among individuals aged ⩾35 years with no prior diagnosis was conducted. Medline, Embase and other bibliographic databases were searched from 1997 to 2013, and methodological quality was assessed using standard tools. Results were described and meta-analysis of the uptake and yield from different approaches was performed where there was sufficient homogeneity.Results:Three randomised controlled trials (RCTs), 1 controlled trial and 35 uncontrolled studies were identified that assessed the identification of new cases of COPD through systematic case finding. A range of approaches were used including pre-screening with questionnaires (n=13) or handheld flow meters (n=5) or direct invitation to diagnostic spirometry (n=30). Overall, any approach identified more undiagnosed COPD compared with usual care. Targeting those at higher risk (e.g., smokers) and pre-screening (e.g., using questionnaires) is likely to increase the yield. However, studies were heterogeneous and were limited by a lack of comparison groups, inadequate reporting and diversity in the definition of COPD, which limited our ability to draw firm conclusions.Conclusions:There is extensive heterogeneity among studies evaluating case finding strategies for COPD, with few RCTs. Well-conducted RCTs comparing case finding approaches are needed to identify the most effective target population, recruitment strategy and screening tests, using a clinical definition of COPD, and addressing the limitations highlighted in this review. There is also a need to evaluate the impact of case finding on clinical care and patient outcomes.

Incidence of chronic obstructive pulmonary disease based on three spirometric diagnostic criteria in Sao Paulo, Brazil: a nine-year follow-up since the PLATINO prevalence study.

Chronic obstructive pulmonary disease (COPD) is a respiratory disease of high prevalence and socioeconomic impact worldwide. It affects approximately 16% of the population of São Paulo. The incidence of COPD is still unknown in Brazil. The aim of this study was to estimate new cases of COPD in a population-based sample in São Paulo, Brazil, using three different spirometric diagnostic criteria, and to assess the concordance between these criteria. Prospective cohort study, in the city of São Paulo, Brazil. A questionnaire was applied and anthropometry and pre and post-bronchodilator spirometry were performed on the same subjects as in the initial PLATINO study (2003) in São Paulo. Data from this follow-up study were added to the original database of the initial phase. Incident COPD cases refer to subjects who developed the disease in accordance with each spirometric criterion during the nine-year follow-up period. The Statistical Package for the Social Sciences, version 17.0 (SPSS Inc., Chicago, IL, USA) was used in the analysis and the significance level was set at P < 0.05. 613 subjects participated in the follow-up. New COPD cases ranged in frequency from 1.4% to 4.0%, depending on the diagnostic criterion used. The concordance between the criteria ranged from 35% to 60%. The incidence of COPD after a nine-year follow-up was high, but varied according to the spirometric criterion used. The agreement between the criteria for identifying new cases of the disease ranged from 35% to 60%.

COPD detected with screening: impact on patient management and prognosis.

It is uncertain whether screening of older persons for chronic obstructive pulmonary disease (COPD) is worthwhile because the effects on patient management and prognosis are unknown. We aimed to assess the short-term consequences of detecting COPD in frail elderly subjects with dyspnoea, considering pulmonary drug use, hospitalisations and all-cause mortality. Community-dwelling frail elderly subjects, aged 65 years and older, with dyspnoea, participating in a screening study on COPD and heart failure were included. Final diagnoses were assigned by an expert panel based on all data from the screening strategy, including spirometry. Follow-up data were collected from the general practitioners. Of the 386 patients, 84 (21.8%) were received a new diagnosis of COPD. Overall, changes in pulmonary drug prescription during 6 months of follow-up were infrequent (n = 53, 13.7%; among new cases of COPD, 15 (17.9%) out of 84). Of all participants, 25.9% were hospitalised in the first year of follow-up, with the highest rate in patients with newly detected COPD (32.1%). Many new cases of COPD could be detected by screening frail elderly subjects with dyspnoea, but the impact on patient management seems limited. Our study underlines the importance of obtaining follow-up data to assess the true impact of a (screen-detected) diagnosis of COPD on patient management and outcome.

Identifying Patients with Undiagnosed COPD in Primary Care Settings: Insight from Screening Tools and Epidemiologic Studies.

Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality, yet research suggests this disease is greatly underdiagnosed. This literature review sought to summarize the most common and significant variables associated with case-finding or missed cases of COPD to inform more effective and efficient detection of high-risk COPD patients in primary care. PubMed and EMBASE were searched for articles describing case-finding and epidemiologic research to detect or characterize new cases of COPD. International studies in primary and non-primary care settings, published in English from 2002-2014, were eligible for inclusion. Studies related to risk factors for development of COPD were excluded. Of the 33 studies identified and reviewed, 21 were case-finding or screening and 12 were epidemiological, including cross-sectional, longitudinal, and retrospective designs. A range of variables were identified within and across studies. Variables common to both screening and epidemiological studies included age, smoking status, and respiratory symptoms. Seven significant predictors from epidemiologic studies did not appear in screening tools. No studies targeted discovery of higher risk patients such as those with reduced lung function or risks for exacerbations. Variables used to identify new cases of COPD or differentiate COPD cases and non-cases are wide- ranging, (from sociodemographic to self-reported health or health history variables), providing insight into important factors for case identification. Further research is underway to develop and test the best, smallest variable set that can be used as a screening tool to identify people with undiagnosed, high-risk COPD in primary care.

Upgrading to cleaner household stoves and reducing chronic obstructive pulmonary disease among women in rural China — A cost-benefit analysis

Exposure to fine particles ≤2.5μm in aerodynamic diameter (PM2.5) from incomplete combustion of solid fuels in household stoves is recognized as a major contributor to global ill health. Still there are few attempts to estimate the economic costs and health benefits of interventions to reduce exposure. The objective of this paper is to estimate costs and health benefits to women of possible interventions to replace current biomass stoves in Guizhou Province, southwest China, with cleaner burning stoves. Prevalence of chronic obstructive pulmonary disease (COPD) was measured in women ≥30y living in households using biomass as fuel. In a sub-sample of households indoor PM2.5 concentrations were measured. Reduced exposure from replacing stoves in individual homes and at the community level was estimated using information about stoves, concentration levels, and time-activity patterns. Annual avoided new cases of COPD were estimated. The economic value of avoided cases was compared to intervention costs. Probabilistic cost-benefit analysis was performed using Monte-Carlo simulation and the impact of uncertainty in single parameters was explored. The mean reduction in annual average PM2.5 exposure is estimated at 127–294μg/m3, which corresponds to a 41–77% reduction. Annually 0.6–3.2 new cases of COPD among women may be avoided per 1000 households. The present value net benefit is 1766–22,500 Yuan (Yuan/USD≈0.16) per household and mean benefit/cost-ratios (B/C) are 3.3–14.7. We conclude that policy interventions to increase access to cleaner burning stoves may bring large net benefits to rural women and their families, and to society.

Increased Risk of Chronic Obstructive Pulmonary Disease in Patients with Schizophrenia: A Population-Based Study

We investigated the prevalence and incidence of chronic obstructive pulmonary disease (COPD) among patients with schizophrenia in Taiwan. From the database provided by the National Health Research Institute, we obtained a random sample of 766,427 subjects aged ≥18 years in 2005. Subjects with a primary or secondary diagnosis of COPD during 2005 were identified. We compared the prevalence of COPD in schizophrenic patients with that in the general population. We also detected new cases of COPD from 2006 to 2008. The prevalence of COPD in patients with schizophrenia was higher than that in the general population (3.83% vs. 2.88%, odds ratio [OR] 1.66; 95% confidence interval [CI]),1.42-1.94) in 2005. Compared with the general population, patients with schizophrenia had a higher prevalence of COPD in individuals <50 years old and ≥70 years old; among both sexes, and among insurance amount of a fixed premium and an amount less than US$640. Patients with schizophrenia had a higher annual incidence of COPD than that in the general population (2.21% vs. 1.43%, risk ratio 1.83; 95% CI, 1.62-2.07). The higher incidence of COPD in patients with schizophrenia was associated with increased age and male sex. Patients with schizophrenia had a higher prevalence and incidence of COPD than individuals in the general population in Taiwan. Younger adults and men with schizophrenia had a much higher prevalence of COPD compared with those groups in the general population, a result deserving further study.

DPOC na população sob vigilância pela rede Médicos Sentinela de 2007 a 2009

COPD IN THE POPULATION UNDER SURVEILLANCE BY THE PORTUGUESE SENTINEL PRACTICE NETWORK FROM 2007 TO 2009 Objectives: To determine the number of chronic obstructive pulmonary disease (COPD)-related consultations among patients registered in the Portuguese Sentinel Practice Network (PSPN) between 2007 and 2009, to calculate the reasons for visits re- lated to COPD, to estimate the incidence of COPD, and to characterize COPD-related therapy. Study design: Dynamic cohort. Setting: Muticentric. Participants: Patients 45 years old from the lists of general practitioners in the PSPN between 2007 and 2009. Methods: A study of COPD-related consultations over a three-year period, reporting the frequency, the reasons for consulta- tion and treatments was conducted. The estimated incidence rate of COPD was calculated and extrapolated to the Portuguese population. The chi-square test to compare proportions and the t-student test for comparison of means were used. Results: During the study period, the population under observation was 106,953 individuals and 2,916 consultations related to COPD were reported. Of these, 62.5% were for males. New cases of COPD were reported in 173 persons 45 years old, of which 59.5% were males, with a median age of 66.9 years,. No significant age difference was found between genders. We cal- culated an annual incidence rate of 161.8/100,000 (95% CI: 139.4-187.7), higher in men. The reasons for consulting were re- newal of prescriptions (61.9%), follow-up appointments (22.9%) and exacerbation of symptoms (15.6%). Medication was pre- scribed in 87.3% of consultations, mainly for inhaled bronchodilators, including anti-cholinergic drugs (25.1%) and adrener- gic agonists (20.3%). Conclusions: There were more COPD-related visits and a higher incidence rate of COPD for men, though the value observed was lower than expected. This was probably due to under-diagnosis or to the fact that patients who do not attend Primary Health Care clinics were excluded. The prescription pattern found was consistent with the recommendations of the Global Ini- tiative for Chronic Obstructive Lung Disease.

Comparison of a network of primary care physicians and an open spirometry programme for COPD diagnosis

Early diagnosis of Chronic Obstructive Pulmonary Disease (COPD) remains the cornerstone for effective management. In this study we compared an open spirometry programme and a case-finding programme providing spirometry to high-risk subjects selected by primary care physicians. A network of primary care physicians was created after invitation and all participants received training on COPD and spirometry. The study team visited 12 primary care settings in each programme in a 1-year period. Spirometry was performed in all eligible participants. COPD diagnosis and classification was based on GOLD guidelines and evaluation by a chest physician. Patients with acceptable spirometry were evaluated (n = 201 in the case-finding and n = 905 in the open spirometry programme). The proportion of newly diagnosed COPD was 27.9% in the case-finding programme compared to 8.4% in the open spirometry programme (p < 0.0001). The number needed-to-screen (NNS) for a new diagnosis of COPD was 3.6 in the case-finding programme compared to 11.9 in the open spirometry programme. The majority of newly diagnosed patients were classified in GOLD stages I an II. The average cost for a new diagnosis of COPD was 173 € in the open spirometry programme and 102 € in the case-finding programme. A case-finding programme involving primary care physicians was more cost-effective for the identification of new cases of COPD compared to an open spirometry programme. The development of networks of primary care physicians with access to good quality spirometry and specialist consultation for early diagnosis of COPD is justified.

Consumption of cured meats and prospective risk of chronic obstructive pulmonary disease in women

BackgroundMost cured meats contain nitrites. Nitrites generate oxidative-nitrative stress and were shown in animal models to cause emphysema. Prospective epidemiologic data on cured meats and chronic obstructive pulmonary disease (COPD), however, are sparse. ObjectiveWe examined the relation between cured meat consumption and the prospective risk of newly diagnosed COPD in women. DesignThis was a prospective cohort study of 71 531 women from the Nurses' Health Study who completed a validated dietary questionnaire at baseline in 1984 and had no baseline COPD or a report of asthma. Participants were aged 38–63 y in 1984 and were followed for 16 y. ResultsA total of 750 new cases of COPD were documented during the follow-up. Cured meat consumption was positively associated with COPD risk after adjustment for age, smoking, and multiple other potential confounders. The adjusted relative risks of COPD across categories of cured meat consumption (never or almost never, 1–3 servings/mo, 1 serving/wk, 2–3 servings/wk, and ≥4 servings/wk) were 1.0, 1.14 (95% CI: 0.78, 1.66), 1.15 (95% CI: 0.79, 1.69), 1.40 (95% CI: 0.96, 2.05), and 1.51 (95% CI: 1.00, 2.27), respectively, (P for trend = 0.005). This positive association was present among both past (P for trend = 0.02) and current (P for trend = 0.03) smokers. No association was observed among never smokers, probably because of the small number of COPD cases in these women. ConclusionFrequent cured meat consumption was associated with an increased risk of newly diagnosed COPD among women who smoke.

Pharmacologic Therapy: Novel Approaches for Chronic Obstructive Pulmonary Disease

Chronic obstructive pulmonary disease (COPD) is increasing in the United States and throughout the world. There have been a number of advances in the treatment of this disease within the last several decades, and these improved therapies continue to become available, making the prospects for the future encouraging. Bronchodilation is the treatment of choice, and we point out in this article the potential availability of many new bronchodilators. There will be several options in the beta(2)-agonist and the anticholinergic categories for once-a-day preparations. There will also be a number of products combining these categories of bronchodilators and inhaled steroids, and the combination products will be available in once-a-day preparations. Also under development are several candidates for specific and effective antiinflammatory agents in COPD. It is likely that our ability to control the inflammation underlying COPD will be a reality in the future. Although many new cases of COPD are being diagnosed in former smokers, for patients who smoke, the most important treatment is smoking cessation. A number of new drugs are available, and more will be brought to market in the future. We have highlighted the details of this important area.

What is the Cost to Employers of Direct Medical Care for Chronic Obstructive Pulmonary Disease?

Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality in the United States. In 2000, an estimated 10.5 million people had COPD, of which more than 7.2 million were from the under-age 65 employed population. The prevalence of COPD in the workforce population was substantial with 46.5% of current employment among adults having the disease. However, the cost burden in the employed population is unknown. We examined COPD prevalence and costs in a large employment-based population. Using claims data from 1999 to 2003, we estimated the cost associated with COPD-related hospitalizations, emergency department visits, outpatient services, and prescription drug use. Per patient use of hospital care for COPD decreased during 1999 through 2003, including a decrease in the number of hospital admissions (from 0.10 in 1999 to 0.04 in 2003) and in the length of stay in hospitals (from 0.53 in 1999 to 0.17 in 2003). The number of outpatient visits, however, increased from 3.45 in 1999 to 3.80 in 2003. COPD-related per patient total medical costs decreased from $1460 in 1999 to $1138 in 2003 largely because of a decrease in the cost of hospitalizations for COPD. In contrast, mean per patient expenditures for outpatient services increased over the same period from $243 in 1999 to $295 in 2003. The cost of COPD to employers is high, but the cost could be reduced by programs aimed at preventing new cases of COPD, reducing hospitalizations, and providing more outpatient services to COPD patients.