ArticleLiterature Review

The economic burden of COPD

February 2000
Chest 117(2 Suppl):5S-9S

February 2000
117(2 Suppl):5S-9S

DOI:10.1378/chest.117.2_suppl.5S

Source
PubMed

Authors:

Scott D Ramsey

Fred Hutch Cancer Center

Todd A Lee

University of Illinois at Chicago

COPD is one of the leading causes of morbidity and mortality worldwide and imparts a substantial economic burden on individuals and society. Despite the intense interest in COPD among clinicians and researchers, there is a paucity of data on health-care utilization, costs, and social burden in this population. The total economic costs of COPD morbidity and mortality in the United States were estimated at $23.9 billion in 1993. Direct treatments for COPD-related illness accounted for $14.7 billion, and the remaining $9.2 billion were indirect morbidity and premature mortality estimated as lost future earnings. Similar data from another US study suggest that 10% of persons with COPD account for > 70% of all medical care costs. International studies of trends in COPD-related hospitalization indicate that although the average length of stay has decreased since 1972, admissions per 1,000 persons per year for COPD have increased in all age groups > 45 years of age. These trends reflect population aging, smoking patterns, institutional factors, and treatment practices.

Early recognition of lung's air sacs wall collapsing Source: IEEE Xplore CITATIONS 0 READS 28 Early Recognition of Lung's Air Sacs Wall Collapsing

Article

Jun 2010

Self-management of COPD supported by eHealth: Patients’ attitudes towards monitoring, risk prediction and virtual coaching

Preprint

Full-text available

Dec 2023

Purpose Chronic obstructive pulmonary disease (COPD) has a high burden on patients, tremendously affecting their quality of life. For patients to be more pro-active, self-management is important. To improve self-management, health data collection is needed for monitoring, which can be used for risk predictions and personalised coaching. Within the RE-SAMPLE project, we want to include these features in an eHealth technology. This study aims to investigate the attitudes of adults with COPD towards health monitoring, risk predictions and virtual coaching. Methods We conducted workshops and interviews with persons diagnosed with COPD. Six persons participated in the workshops which focused on topics for virtual coaching. 10 Persons participated in the interviews focusing on monitoring, risk prediction and virtual coaching. Results For participants, collecting and having access to health data is an important aspect of health monitoring. Furthermore, participants were positive towards a technology which visualizes health data for monitoring. Regarding risk predictions, participants were not all convinced about its usefulness. Finally, participants were quite positive about including a virtual coach within a self-management eHealth technology. Conclusion Taking all into consideration, we noticed that most participants felt that persons who are more recently diagnosed with COPD would benefit more from using a self-management eHealth technology. Based on our findings, we discuss implications for design in this paper.

Risk of COPD Hospitalizations and Deaths among Rural and Urban Veterans after Successive COPD Hospitalizations

Article

Dec 2023

Predicting severe chronic obstructive pulmonary disease exacerbations using quantitative CT: a retrospective model development and external validation study

Article

Full-text available

Feb 2023

Background: Quantitative CT is becoming increasingly common for the characterisation of lung disease; however, its added potential as a clinical tool for predicting severe exacerbations remains understudied. We aimed to develop and validate quantitative CT-based models for predicting severe chronic obstructive pulmonary disease (COPD) exacerbations. Methods: We analysed the Subpopulations and Intermediate Outcome Measures In COPD Study (SPIROMICS) cohort, a multicentre study done at 12 clinical sites across the USA, of individuals aged 40-80 years from four strata: individuals who never smoked, individuals who smoked but had normal spirometry, individuals who smoked and had mild to moderate COPD, and individuals who smoked and had severe COPD. We used 3-year follow-up data to develop logistic regression classifiers for predicting severe exacerbations. Predictors included age, sex, race, BMI, pulmonary function, exacerbation history, smoking status, respiratory quality of life, and CT-based measures of density gradient texture and airway structure. We externally validated our models in a subset from the Genetic Epidemiology of COPD (COPDGene) cohort. Discriminative model performance was assessed using the area under the receiver operating characteristic curve (AUC), which was also compared with other predictors, including exacerbation history and the BMI, airflow obstruction, dyspnoea, and exercise capacity (BODE) index. We evaluated model calibration using calibration plots and Brier scores. Findings: Participants in SPIROMICS were enrolled between Nov 12, 2010, and July 31, 2015. Participants in COPDGene were enrolled between Jan 10, 2008, and April 15, 2011. We included 1956 participants from the SPIROMICS cohort who had complete 3-year follow-up data: the mean age of the cohort was 63·1 years (SD 9·2) and 1017 (52%) were men and 939 (48%) were women. Among the 1956 participants, 434 (22%) had a history of at least one severe exacerbation. For the CT-based models, the AUC was 0·854 (95% CI 0·852-0·855) for at least one severe exacerbation within 3 years and 0·931 (0·930-0·933) for consistent exacerbations (defined as ≥1 acute episode in each of the 3 years). Models were well calibrated with low Brier scores (0·121 for at least one severe exacerbation; 0·039 for consistent exacerbations). For the prediction of at least one severe event during 3-year follow-up, AUCs were significantly higher with CT biomarkers (0·854 [0·852-0·855]) than exacerbation history (0·823 [0·822-0·825]) and BODE index 0·812 [0·811-0·814]). 6965 participants were included in the external validation cohort, with a mean age of 60·5 years (SD 8·9). In this cohort, AUC for at least one severe exacerbation was 0·768 (0·767-0·769; Brier score 0·088). Interpretation: CT-based prediction models can be used for identification of patients with COPD who are at high risk of severe exacerbations. The newly identified CT biomarkers could potentially enable investigation into underlying disease mechanisms responsible for exacerbations. Funding: National Institutes of Health and the National Heart, Lung, and Blood Institute.

EPOC reagudizada hospitalizada: estudio de costos directos en un hospital público de la Ciudad de Buenos Aires

Article

Jan 2023

No existe información sobre la estructura y costos anuales de una hospitalización por agudización de la EPOC en nuestro país actualmente Objetivos: Determinar la estructura de costos de los pacientes hospitalizados por EPOC reagudizada en un hospital público de la Ciudad Autónoma de Buenos Aires (CABA) en el año 2018.Materiales y métodos: Se evaluaron pacientes con EPOC reagudizada (GOLD), in- ternados durante 2018 en nuestro hospital. Se determinaron costos directos (perspectiva del financiador), según costos de medicamentos y la modulación de internación clínica y Unidad de Terapia Intensiva (UTI) del Gobierno de CABA a junio de 2021, valor dólar Banco Nación al 30 de Junio 2021 de $101,17.Resultados: Se internaron 26 pacientes, edad 64 ± 9,56 años, masculino 73%, 61% tabaquistas actuales y 39% extabaquistas (101,8 ± 47,1 paq.-año), seguro social 31%, FEV % 31 mediana (23-42) y FEV /FVC 0,46 ± 0,12. La duración de internación fue: guardia 1 d (1-1,75); piso, 9 d (4-12); y UTI, 13 d (11-29,5), con mortalidad 23% (n = 6).El costo fnal fue 1462,62 dólares/paciente, mediana (RIQ 25%-75%,763,85-2915,95), 162,44 dólares/d/paciente, y el costo total (n = 26) fue USD 117 480. El costo de UTI fue 9898,28 dólares/paciente, mediana (RIQ 25%-75%, 6700,94-35 780,25). El costo total (n = 3) fue USD 75 064,11. Conclusión: Los pacientes con EPOC reagudizada que se hospitalizan son en su mayoría hombres, más de 60 años, alta carga tabáquica y obstrucción grave. El costo directo desde la perspectiva del fnanciador fue de USD 1462 por paciente; el costo del paciente que se hospitaliza en UTI fue casi siete veces superior. Se deben instrumentar programas sistematizados de manejo de la EPOC para identifcar pacientes con factores de riesgo, educar y permitir acceso a la medicación

Potential clinical and economic impact of optimised maintenance therapy on discharged patients with COPD after hospitalisation for an exacerbation in China

Article

Full-text available

Apr 2021

Objectives Chronic obstructive pulmonary disease (COPD) exacerbations requiring hospitalisation are a considerable burden, both clinically and economically. Although long-acting maintenance therapy is recommended in both the GOLD (Global Initiative for Chronic Obstructive Lung Disease) and Chinese COPD guidelines, proper implementation is lacking. The objective of this study was to assess the clinical and economic impact of prescribing long-acting maintenance therapy to discharged patients with COPD after hospitalisation for an exacerbation in China by using an outcomes model. Design This health economic analysis was conducted using a Markov cohort model from the Chinese healthcare payer perspective. Two health states (alive and dead) were modelled, and exacerbations were included as possible events. Setting The target population was Chinese patients with COPD, >40 years of age, who were hospitalised for an exacerbation, with 1 year of follow-up. A recent COPD national prevalence study was referenced for population calculations. Intervention A hypothetical future scenario, where 100% of patients would receive long-acting maintenance therapy after hospitalisation for an exacerbation, was compared with the current scenario, in which only 38.5% of patients are receiving long-acting maintenance therapy after hospitalisation. Outcome measures Number of exacerbations, deaths and medical costs were measured. Results We estimated that there were approximately 4 million Chinese patients with COPD who were hospitalised annually due to an exacerbation. By prescribing long-acting maintenance therapy, our model predicted that 917 360 exacerbations and 4034 deaths could be avoided, translating into cost savings of ¥3.5 billion (US$0.5 billion). Scenario analysis also showed that if the rate of exacerbations requiring hospitalisation was higher than our base case analysis, cost savings could reach up to ¥10.7 billion (US$1.5 billion). Conclusion Administering long-acting maintenance therapy to more patients with COPD at hospital discharge could considerably reduce exacerbations and healthcare spending in China.

Therapeutic properties of Punica granatum L (pomegranate) and its applications in lung‐based diseases: A detailed review

Article

Full-text available

Mar 2021
J FOOD BIOCHEM

Respiratory diseases are the prime cause of death and disability worldwide. The majority of lung‐based diseases are resistant to treatment. Hence, research on unique drugs/compounds with a more efficient and minimum side effect for treating lung diseases is urgent. Punica granatum L (pomegranate) fruit has been used in the prevention and treatment of various respiratory disorders in recent times. In vivo and in vitro studies have demonstrated that pomegranate fruit, as well as its juice, extract, peel powder, and oil, exert anti‐proliferative, anti‐oxidant, anti‐microbial, anti‐inflammatory, anti‐cancer, and anti‐tumorigenic properties by attenuating various respiratory conditions such as asthma, lung fibrosis, lung cancer, chronic obstructive pulmonary disease (COPD), and alveolar inflammation via modulating various signaling pathways. The current review summarizes the potential properties and medical benefits of pomegranate against different lung‐based diseases, also highlighting its possible role in the lung fibrinolytic system. The available data suggest that pomegranate is effective in controlling the disease progressions and could be a potential therapeutic target benefiting human health status. Furthermore, this review also outlines the preclinical and clinical studies highlighting the role of pomegranate in lung diseases further evoking future studies to investigate the effect of intake of this anti‐oxidant fruit in larger and well‐defined human clinical trials. Practical applications • This review outlines the putative pharmacologic benefits of P. granatum L (pomegranate) in treating various chronic lung‐based diseases such as lung cancer, COPD, ARDS, asthma, lung fibrosis, and cystic fibrosis. • This review also highlights the possible inhibitory role of P. granatum L (pomegranate) in the lung fibrinolytic system triggering the fibrinolytic markers. • This review summarizes the preclinical and clinical studies using in vitro, in vivo, and human models highlighting the potential role of P. granatum L (pomegranate) in lung diseases. • This review evokes future research to investigate the effect of intake of pomegranate fruit in well‐defined human clinical trials.

Self-reported exposure to dust and diesel exhaust, respiratory symptoms, and use of respiratory protective equipment among Arctic miners

Article

Full-text available

Apr 2024
INT J CIRCUMPOL HEAL

Arctic miners face significant risks from diesel exhaust and dust exposure, potentially leading to adverse respiratory health. Employers must limit harmful exposures, using personal protective equipment (PPE) as a last line of defense. This study explored the association between reported respiratory exposure and symptoms, and PPE training and usage. Data from the MineHealth study (2012-2014) included a total of 453 Arctic open pit miners in Norway, Sweden, and Finland. Participants answered questions on exposure to dust and diesel exhaust, respiratory symptoms, and PPE use, in addition to age, gender, BMI, smoking, and self-rated health. Estimated exposure to dust was common, reported by 91%, 80%, and 82% and that of diesel exhaust by 84%, 43%, and 47% of workers in Sweden, Finland, and Norway, respectively. Reported dust exposure was significantly related to respiratory symptoms (OR 2.2, 95% CI 1.3-3.7), diesel exposure increased the occurrence of wheezing (OR 2.6, 95% CI 1.3-5.4). PPE use varied between the studied mines. Non-use was common and related to reduced visibility, wetness, skin irritation and fogging of the respiratory PPE. Future research should employ more precise exposure assessment, respiratory function as well as explore the reasons behind the non-compliance of PPE use.

Addressing Barriers to Chronic Obstructive Pulmonary Disease (COPD) Care: Three Innovative Evidence-Based Approaches: A Review

Article

Full-text available

Jan 2024

Chronic obstructive pulmonary disease (COPD) is a preventable yet widespread and profoundly debilitating respiratory condition, exerting substantial personal and global health ramifications alongside significant economic implications. The first objective of this literature review was to identify reviews the barriers to optimal COPD care, categorizing them into personal patient factors, professional awareness and knowledge, patient-professional relationships, and healthcare service models, including access to care that significantly impacts the quality of COPD management. The second objective was to introduce three approaches for enhancing COPD care outcomes: Self-Management Educational Programs, Health Qigong, and Telehealth service provision, each demonstrating positive effects on COPD patients’ health status. These evidence-based interventions offer promising avenues for enhancing COPD care and patient outcomes. Integrating these approaches into comprehensive COPD management strategies holds potential for improving the well-being and quality of life of individuals living with this chronic condition.

Acupoint Transcutaneous Electrical Nerve Stimulation in Hospitalized COPD Patients with Severe Dyspnoea: A Randomized Controlled Trial

Article

Full-text available

Sep 2023

Objective: To evaluate the effect of acupuncture transcutaneous electrical nerve stimulation (acuTENS) on the reduction of dyspnoea during acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods: A multicentric randomized control trial with masked patients and evaluators was carried out. During hospitalization, AECOPD patients received 45 min of acuTENS (experimental group) or sham acuTENS (controls) daily on 5 consecutive days. The trial was conducted at the Hospital del Mar, Barcelona, and Hospital Sant Joan de Déu, Manresa (both in Spain). Dyspnoea and peak expiratory flow were measured daily from the first to fifth days. Length of stay, readmissions at 3 months and adverse events were also analysed. Results: Finally, 19 patients with moderately to severely exacerbated COPD were included. Although some tendencies in dyspnoea during day 1 and length of hospital stay were found favouring acupuncture, no significant differences were shown between groups. Conclusions: The acuTENS intervention was feasible#well tolerated in AECOPD patients and no important side effects were reported.

Assessment of Knowledge, Practice, and Self-Efficacy for Patients with Chronic Obstructive Pulmonary Disease

Article

Full-text available

Dec 2014

__________________________________________________________________________ Abstract Abstract: Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of morbidity and mortality throughout the world, resulting in a substantial and increasing economic and social burden. The aim of the present study was to assess knowledge, practice, and self efficacy for patients with COPD. A descriptive research design was used in this study. The sample consisted of 100 patients with COPD at the outpatient clinic of Respiratory Medicine, Mansoura University Hospital. Three tools were used to collect data, A structured interviewing questionnaire consisted of patient's sociodemographic characteristics and patient's medical history, patient's knowledge and practice questionnaire, and self-efficacy scale for patients with COPD. The results of the present study concluded that 96%, 93%, and 86.0% of the studied subjects had low self efficacy, unsatisfactory knowledge, and unsatisfactory practices scores about COPD respectively. There was a significant statistical relation between patients' occupation and their total knowledge scores, and between patients' occupation and their total practice scores. However there was no significant statistical relation between patients' knowledge, practice and their self efficacy. The study recommended that an educational program should be conducted to improve knowledge, practice, and self efficacy for patients with COPD. Aim :of the present study was to assess knowledge, practice, and self efficacy for patients with COPD. Materials and Methods: A descriptive research design was used in the study. A convenience sample consisted of all available patients (100) patients with COPD at the outpatient clinic of Respiratory Medicine, Mansoura University Hospital. Three tools were used to collect data. 2 Results: the present study concluded that 93%, 86%, and 96.0% of the studied subjects had unsatisfied knowledge, poor practice, and low self efficacy scores about COPD respectively. There was significant statistical relation between patients' occupation and their total knowledge scores, and a significant statistical relation between patients' occupation and their total practice scores. However there was no significant statistical relation between patients' knowledge, practice and their self efficacy. The study recommended that an educational program should be conducted to improve knowledge, practice, and self efficacy for patient with COPD. Recommendation: The study recommended that an educational program should be conducted to improve knowledge, practice, and self efficacy for patients with COPD.

Enhancing potential impact of hospital discharge interventions for patients with COPD: a qualitative systematic review

Article

Full-text available

Jun 2023
BMC HEALTH SERV RES

Background Patients with chronic obstructive pulmonary disease (COPD) are frequently readmitted to hospital resulting in avoidable healthcare costs. Many different interventions designed to reduce hospital readmissions are reported with limited evidence for effectiveness. Greater insight into how interventions could be better designed to improve patient outcomes has been recommended. Aim To identify areas for optimisation within previously reported interventions provided to reduce COPD rehospitalisation to improve future intervention development. Methods A systematic review was conducted by searching Medline, Embase, CINAHL, PsycINFO, and CENTRAL in June 2022. Inclusion criteria were interventions provided to patients with COPD in the transition from hospital to home or community. Exclusion criteria were lack of empirical qualitative results, reviews, drug trials, and protocols. Study quality was assessed using the Critical Appraisal Skills Programme tool and results were synthesised thematically. Results A total of 2,962 studies were screened and nine studies included. Patients with COPD experience difficulties when transitioning from hospital to home. It is therefore important for interventions to facilitate a smooth transition process and give appropriate follow-up post-discharge. Additionally, interventions should be tailored for each patient, especially regarding information provided. Conclusion Very few studies specifically consider processes underpinning COPD discharge intervention implementation. There is a need to recognise that the transition itself creates problems, which require addressing, before introducing any new intervention. Patients report a preference for interventions to be individually adapted—in particular the provision of patient information. Whilst many intervention aspects were well received, feasibility testing may have enhanced acceptability. Patient and public involvement may address many of these concerns and greater use of process evaluations should enable researchers to learn from each other’s experiences. Trial registration The review was registered in PROSPERO with registration number CRD42022339523.

Clinical profile of disease-causing chronic airflow obstruction in tertiary care centre in Lucknow

Article

Full-text available

May 2023

Background: Chronic airflow obstruction (CAO) is a chronic lung condition that interferes with normal breathing. In common practice, CAO includes chronic obstructive pulmonary disease (COPD), asthma, chronic bronchitis, and emphysema. The present study was planned to be carried out in a tertiary care center to evaluate the profile of patients with chronic airflow obstruction with an aim to establish a cause-effect relationship between various disorders with chronic airflow obstruction. Aims and Objectives: The aim of the study was to find out the prevalence of different respiratory diseases among patients diagnosed as cases of chronic airflow obstruction and to evaluate the clinical and demographic profile of patients to find out risk factors and their role in etiology of chronic obstructive airflow. Materials and Methods: We studied demographic details of the patients, smoking history, biomass exposure, and tubercular history. All the patients were clinically examined and were subjected to pulmonary function assessment. The diagnosis of the patients was made on the basis of clinical features and outcome of spirometry. COPD was graded depending on post-bronchodilator FEV1% predicted as (GOLD, 2022). Results: Among patients with chronic airway obstruction, the number of patients diagnosed as COPD was highest (68%) followed by bronchial asthma (19%) and bronchectasis (13%). Among COPD population, 48% were smokers and 20% were non-smokers. Age of patients with bronchial asthma was significantly lower than that of other groups. In the present study, proportion of males diagnosed as COPD (NS) was significantly lower (P<0.001) as compared to other groups. Conclusion: The findings in the present study highlighted that different types of CAO can affect a wide variety of population groups and share a number of risk factors; however, some demographic and clinical factors help in understanding the specific risks and type of disorder. A Change in environmental conditions and lifestyle can change the spectrum of CAO disorders.

Association of rural living with COPD-related hospitalizations and deaths in US veterans

Article

Full-text available

May 2023

It is unclear whether the high burden of COPD in rural areas is related to worse outcomes in patients with COPD or is because the prevalence of COPD is higher in rural areas. We assessed the association of rural living with acute exacerbations of COPD (AECOPDs)-related hospitalization and mortality. We retrospectively analyzed Veterans Affairs (VA) and Medicare data of a nationwide cohort of veterans with COPD aged ≥ 65 years with COPD diagnosis between 2011 and 2014 that had follow-up data until 2017. Patients were categorized based on residential location into urban, rural, and isolated rural. We used generalized linear and Cox proportional hazards models to assess the association of residential location with AECOPD-related hospitalizations and long-term mortality. Of 152,065 patients, 80,162 (52.7%) experienced at least one AECOPD-related hospitalization. After adjusting for demographics and comorbidities, rural living was associated with fewer hospitalizations (relative risk-RR = 0.90; 95% CI: 0.89–0.91; P < 0.001) but isolated rural living was not associated with hospitalizations. Only after accounting for travel time to the closest VA medical center, neighborhood disadvantage, and air quality, isolated rural living was associated with more AECOPD-related hospitalizations (RR = 1.07; 95% CI: 1.05–1.09; P < 0.001). Mortality did not vary between rural and urban living patients. Our findings suggest that other aspects than hospital care may be responsible for the excess of hospitalizations in isolated rural patients like poor access to appropriate outpatient care.

Clinical and economic outcomes in patients with chronic obstructive pulmonary disease initiating maintenance therapy with tiotropium bromide/olodaterol or fluticasone furoate/umeclidinium/vilanterol

Article

May 2023

BACKGROUND: Clinical practice guidelines recommend dual long-acting muscarinic antagonists (LAMAs)/long-acting β2agonists (LABAs) as maintenance therapy in patients with chronic obstructive pulmonary disease (COPD) and dyspnea or exercise intolerance. Escalation to triple therapy (TT) (LAMA/LABA/inhaled corticosteroid) is conditionally recommended for patients with continued exacerbations on dual LAMA/ LABA therapy. Despite this guidance, TT use is widespread across COPD severities, which could impact clinical and economic outcomes. OBJECTIVE: To compare COPD exacerbations, pneumonia events, and disease-related and all-cause health care resource utilization and costs (in 2020 US dollars) in patients initiating fixed-dose combinations of either LAMA/ LABA (tiotropium/olodaterol [TIO + OLO]) or TT (fluticasone furoate/umeclidinium/vilanterol [FF + UMEC + VI]). METHODS: This retrospective observational study of administrative claims included patients with COPD aged 40 years or older initiating TIO + OLO or FF + UMEC + VI from June 2015 to November 2019. TIO + OLO and FF + UMEC + VI cohorts in the overall and maintenance-naive populations were 1:1 propensity score matched on baseline demographics, comorbidities, COPD medications, health care resource utilization, and costs. Multivariable regression compared clinical and economic outcomes up to 12 months in FF + UMEC + VI vs TIO + OLO postmatched cohorts. RESULTS: After matching, there were 5,658 and 3,025 pairs in the overall and maintenance-naive populations, respectively. In the overall population, the risk of any (moderate or severe) exacerbation was 7% lower in FF + UMEC + VI vs TIO + OLO initiators (adjusted hazard ratio [aHR] = 0.93; 95% CI = 0.86-1.0; P = 0.047). There was no difference in the adjusted risk of any exacerbation in the maintenance-naive population (aHR = 0.99; 95% CI = 0.88-1.10). Pneumonia risk was not statistically different between cohorts in the overall (aHR = 1.12; 95% CI = 0.98-1.27) and maintenance-naive (aHR = 1.13; 95% CI = 0.95-1.36) populations. COPD- and/or pneumonia-related adjusted total annualized costs (95% CI) were significantly greater for FF + UMEC + VI vs TIO + OLO in the overall ($17,633 [16,661-18,604] vs $14,558 [13,709-15,407]; P < 0.001; differences [% of relative increase] = $3,075 [21.1%]) and maintenancenaive ($19,032 [17,466-20,598] vs $15,004 [13,786-16,223]; P < 0.001; $4,028 [26.8%]) populations, with significantly higher pharmacy costs with FF + UMEC + VI (overall: $6,567 [6,503-6,632] vs $4,729 [4,676-4,783]; P < 0.001; $1,838 [38.9%]; maintenance-naive: $6,642 [6,560-6,724] vs $4,750 [4,676-4,825]; P < 0.001; $1,892 [39.8%]). CONCLUSIONS: A lower risk of exacerbation was observed with FF + UMEC + VI vs TIO + OLO in the overall population but not among the maintenance-naive population. Patients with COPD initiating TIO + OLO had lower annualized costs than FF + UMEC + VI initiators in the overall and maintenance-naive populations. Thus, in the maintenance-naive population, initiation with dual LAMA/LABA therapy per practice guidelines can improve real-world economic outcomes. Study registration number: ClinicalTrials.gov (identifier: NCT05127304). DISCLOSURES: The study was funded by Boehringer Ingelheim Pharmaceuticals, Inc (BIPI). To ensure independent interpretation of clinical study results and enable authors to fulfill their role and obligations under the ICMJE criteria, BIPI grants all external authors access to relevant clinical study data. In adherence with the BIPI Policy on Transparency and Publication of Clinical Study Data, scientific and medical researchers can request access to clinical study data after publication of the primary manuscript in a peer-reviewed journal, regulatory activities are complete and other criteria are met. Dr Sethi has received honoraria/ fees for consulting/speaking from Astra-Zeneca, BIPI, and GlaxoSmithKline. He has received consulting fees for serving on data safety monitoring boards from Nuvaira and Pulmotect. He has received consulting fees from Apellis and Aerogen. His institution has received research funds for his participation in clinical trials from Regeneron and AstraZeneca. Ms Palli was an employee of BIPI at the time the study was conducted. Drs Clark and Shaikh are employees of BIPI. Ms Buysman and Mr Sargent are employees and Dr Bengtson was an employee of Optum, which was contracted by BIPI to conduct this study. Dr Ferguson reports grants and personal fees from Boehringer Ingelheim during the conduct of the study; grants from Novartis, Altavant, and Knopp; grants and personal fees from AstraZeneca, Verona, Theravance, Teva, and GlaxoSmithKline; and personal fees from Galderma, Orpheris, Dev.Pro, Syneos, and Ionis outside the submitted work. He was a paid consultant for BIPI for this study. The authors received no direct compensation related to the development of the manuscript. BIPI was given the opportunity to review the manuscript for medical and scientific accuracy as well as intellectual property considerations.

Burden of Disease in Patients with Mild or Mild-to-Moderate Chronic Obstructive Pulmonary Disease (Global Initiative for Chronic Obstructive Lung Disease Group A or B): A Systematic Literature Review

Article

Full-text available

Apr 2023

Background Patients with mild or mild-to-moderate chronic obstructive pulmonary disease (COPD), defined as Global Initiative for Chronic Obstructive Lung Disease (GOLD) group A/B, are regarded as having a lower risk of experiencing multiple or severe exacerbations compared with patients classified as GOLD group C/D. Current guidelines suggest that patients in GOLD A/B should commence treatment with a bronchodilator; however, some patients within this population who have a higher disease burden may benefit from earlier introduction of dual bronchodilator or inhaled corticosteroid-containing therapies. This study aimed to provide research-based insights into the burden of disease experienced by patients classified as GOLD A/B, and to identify characteristics associated with poorer outcomes. Methods A systematic literature review (SLR) was conducted to identify evidence (burden of disease and prevalence data) relating to the population of interest (patients with COPD classified as GOLD A/B). Results A total of 79 full-text publications and four conference abstracts were included. In general, the rates of moderate and severe exacerbations were higher among patients in GOLD group B than among those in group A. Among patients classified as GOLD A/B, the risk of exacerbation was higher in those with more symptoms (modified Medical Research Council or COPD Assessment Test scales) and more severe airflow limitation (forced expiratory volume in 1 second % predicted). Conclusion Data from this SLR provide clear evidence of a heavier burden of disease for patients in GOLD B, compared with those in GOLD A, and highlight factors associated with worse outcomes for patients in GOLD A/B.

Twenty-four Months Longitudinal Study of Acute Exacerbations in a Cohort of Chronic Obstructive Pulmonary Disease Patients

Article

Full-text available

Dec 2013

Nowe możliwości terapeutyczne w POChP

Article

Full-text available

Feb 2013

Ryszarda Chazan

Przewlekła obturacyjna choroba płuc (POChP) to wieloczynnikowa, ogólnoustrojowa choroba zapalna [...]

Acute Exacerbation of COPD: Differential Diagnosis

Chapter

Nov 2022

Chronic obstructive pulmonary disease (COPD) is widely prevalent in patients aged beyond the fourth decade across the globe. It has significant morbidity and impact on quality of life. Acute exacerbation of COPD (AECOPD) has even significant mortality if not detected and treated on time. It is characterized by the acute deterioration of the cough and shortness of breath, often requiring increasing medication and even emergency department visits and hospitalization. Multiple factors can predispose a COPD patient to AECOPD. Many cardiorespiratory conditions also co-exist and even mimic AECOPD when present as an isolated condition. These conditions need to be considered as differentials of AECOPD and managed accordingly. The present chapter briefly enumerates the differentials of AECOPD and puts forward a bedside algorithmic approach to reaching a differential diagnosis.

Safety and Efficacy of Inpatient Pulmonary Rehabilitation for Patients Hospitalized with an AECOPD: Systematic Review and Meta-analyses

Article

Oct 2022

Background: PR during hospitalization for AECOPD occurs during a period of disease instability for the patient, and the safety and efficacy of PR specifically during the hospitalization period has not been established. Objective: The purpose of this review is to determine the safety and efficacy of PR during the hospitalization phase for individuals with an AECOPD. Data sources: Scientific databases were searched up to August 2022 for randomized controlled trials that compared in-hospital PR with usual care. PR programs commenced during the hospitalization and included a minimum of two sessions. Data extraction: Titles and abstracts followed by full-text screening and data extraction were conducted independently by two reviewers. The intervention effect estimates were calculated through meta-analysis using a random-effect model. Synthesis: Twenty-seven studies were included (n=1317). The meta-analysis showed that inpatient PR improved the 6 minute walk distance by 105 meters (p<0.001). Inpatient PR improved the performance on the five repetition sit-to-stand test by -7.02 seconds (p=0.03). QOL as measured by the 5Q-5D-5L and the St. George's Respiratory Questionnaire was significantly improved by the intervention. Inpatient PR increased lower limb muscle strength by 33.35N (p<0.001). There was no change in length of stay. Only one serious adverse event related to the intervention was reported. Conclusion: This review suggests that it is safe and effective to provide PR during hospitalization for individuals with an AECOPD. In-hospital PR improves functional exercise capacity, QOL, and lower limb strength without prolonging the hospital LOS.

Association of Rural Living with COPD-related Hospitalizations and Deaths in US Veterans

Preprint

Full-text available

Sep 2022

It is unclear whether the high burden of COPD in rural areas is related to worse outcomes in patients with COPD or is because the prevalence of COPD is higher in rural areas. We assessed the association of rural living with acute exacerbations of COPD (AECOPDs)-related hospitalization and mortality. We retrospectively analyzed Veterans Affairs (VA) and Medicare data of a nationwide cohort of veterans with COPD aged ≥ 65 years with a COPD encounter between 2011 and 2014 that had a follow-up until 2017. Patients were categorized based on residential location into urban, rural, and isolated rural. We used generalized linear and Cox proportional hazards models to assess the association of residential location with AECOPD-related hospitalizations and mortality. Age, sex, race, travel time to the nearest VA hospital, and comorbidity were included as covariates in the models. Of 165,996 patients with COPD, 45,045 (27.1%) experienced at least one AECOPD-related hospitalization over the study period. Rural (relative risk-RR) = 0.93; 95%CI:0.92 to 0.94;p < 0.001) and isolated rural residence (RR = 0.85;95%CI:0.82 to 0.87;p < 0.001) were associated with fewer AECOPD-related hospitalizations relative to urban residence. Travel time to the closet VA hospital was inversely associated with AECOPD-related hospitalizations. Among patients who were alive after discharge for their second AECOPD-related hospitalization, rural residence was associated with increased mortality risk (hazard ratio = 1.06; 95%CI = 1.01 to 1.10;p = 0.011).Rural living is not associated with AECOPD-related hospitalizations, but it is associated with 6% increased risk for death among patients who were alive after discharge following a second AECOPD-related hospitalization.

Reduction of Emphysema Severity by Human Umbilical Cord-Derived Mesenchymal Stem Cells in Mice

Article

Full-text available

Aug 2022
INT J MOL SCI

Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality in chronic lung disease patients throughout the world. Mesenchymal stem cells (MSCs) have been shown to regulate immunomodulatory, anti-inflammatory, and regenerative responses. However, the effects of human-umbilical-cord-derived mesenchymal stem cells (hUC-MSCs) on the lung pathophysiology of COPD remain unclear. We aimed to investigate the role of hUC-MSCs in emphysema severity and Yes-associated protein (Yap) phosphorylation (p-Yap) in a porcine-pancreatic-elastase (PPE)-induced emphysema model. We observed that the emphysema percentages (normalized to the total lung volume) measured by chest computed tomography (CT) and exercise oxygen desaturation were significantly reduced by hUC-MSCs at 107 cells/kg body weight (BW) via intravenous administration in emphysematous mice (p < 0.05). Consistently, the emphysema index, as assessed by the mean linear intercept (MLI), significantly decreased with hUC-MSC administration at 3 × 106 and 107 cells/kg BW (p < 0.05). Changes in the lymphocytes, monocytes, and splenic cluster of differentiation 4-positive (CD4+) lymphocytes by PPE were significantly reversed by hUC-MSC administration in emphysematous mice (p < 0.05). An increasing neutrophil/lymphocyte ratio was reduced by hUC-MSCs at 3 × 106 and 107 cells/kg BW (p < 0.05). The higher levels of tumor necrosis factor (TNF)-α, keratinocyte chemoattractant (KC), and lactate dehydrogenase (LDH) in bronchoalveolar lavage fluid (BALF) were significantly decreased by hUC-MSC administration (p < 0.05). A decreasing p-Yap/Yap ratio in type II alveolar epithelial cells (AECII) of mice with PPE-induced emphysema was significantly increased by hUC-MSCs (p < 0.05). In conclusion, the administration of hUC-MSCs improved multiple pathophysiological features of mice with PPE-induced emphysema. The effectiveness of the treatment of pulmonary emphysema with hUC-MSCs provides an essential and significant foundation for future clinical studies of MSCs in COPD patients.

Acute Exacerbations of Chronic Obstructive Pulmonary Disease: Causes and Impacts

Article

Jun 2022
Indian J Chest Dis Allied Sci

Respiratory Viral and Bacterial Exacerbations of COPD—The Role of the Airway Epithelium

Article

Full-text available

Apr 2022

COPD is a leading cause of death worldwide, with acute exacerbations being a major contributor to disease morbidity and mortality. Indeed, exacerbations are associated with loss of lung function, and exacerbation frequency predicts poor prognosis. Respiratory infections are important triggers of acute exacerbations of COPD. This review examines the role of bacterial and viral infections, along with co-infections, in the pathogenesis of COPD exacerbations. Because the airway epithelium is the initial site of exposure both to cigarette smoke (or other pollutants) and to inhaled pathogens, we will focus on the role of airway epithelial cell responses in regulating the pathophysiology of exacerbations of COPD. This will include an examination of the interactions of cigarette smoke alone, and in combination with viral and bacterial exposures in modulating epithelial function and inflammatory and host defense pathways in the airways during COPD. Finally, we will briefly examine current and potential medication approaches to treat acute exacerbations of COPD triggered by respiratory infections.

An audit of patients admitted to hospital in Nepal for COPD exacerbation

Article

Full-text available

Mar 2022

Objectives Chronic obstructive pulmonary disease is a large and increasing problem in low- and middle-income countries; Nepal is no exception. We aimed to obtain information on patient characteristics and the level of care provided to patients admitted for acute exacerbation of chronic obstructive pulmonary disease in two Nepalese hospitals and to compare the given care with the Global Initiative for Chronic Obstructive Lung Disease guidelines. Methods This was a cross-sectional, observational, descriptive study. All patients admitted to two Nepalese hospitals due to acute exacerbation of chronic obstructive pulmonary disease between 18 February and 5 April 2019 were asked to participate. Results In total, 108 patients with a median age of 70 years participated. Fifty-three (42.7%) were male, 80 (74.8%) were former smokers, and 46 (45.1%) were farmers. Using the Global Initiative for Chronic Obstructive Lung Disease A-D classification, 97 (90.6%) of the patients were classified in group D. All the patients received supplementary oxygen treatment and 103 (95.4%) were treated with short-acting beta2 agonists. A total of 105 (97.2%) patients received antibiotics, and 80 (74.5%) received systemic corticosteroids. The majority was discharged with triple therapy including long-acting muscarinic antagonist, long-acting beta2 agonist, and inhaled corticosteroids, and 72 (75.8%) were discharged with long-term oxygen treatment. Conclusion All elements of the Global Initiative for Chronic Obstructive Lung Disease guidelines were applied. However, due to a lack of information, it cannot be concluded whether the treatment was provided on the correct indications. The average patient received almost all the treatment alternatives available. This might indicate a very sick population or over-treatment.

Long-Term Outpatient Care and Rehospitalizations in Patients after Cardiac Electrotherapy Device Implantation

Article

Full-text available

Jan 2022

Background and Objectives: Cardiovascular implantable electronic device (CIED) treatment is widely used in modern cardiology. Indications for this type of treatment are increasing. However, a significant proportion of CIED implantation patients require subsequent hospitalization for cardiovascular reasons. Older age and the associated complex clinical picture necessitate multidisciplinary outpatient specialist care for these patients. The aim of this study was to analyze the reasons for subsequent hospitalizations in the cardiology department and the impact of outpatient specialty care on these hospitalizations. To the best of our knowledge, there are no such studies in the available literature. Materials and Methods: This study was conducted on a population of patients treated with CIED. Reasons for subsequent hospitalizations were divided into clinically and statistically valid groups according to the main diagnosis. Using an electronic database, causes of hospitalization were determined based on this diagnosis. Using data on consultations at outpatient specialty clinics, a logistic regression model was created for the probability of subsequent hospitalization for cardiovascular causes according to the specialty of the clinic. Results: The 9-year follow-up included a population of 2071 patients treated with CIED. During the follow-up period, 508 patients (approximately 24.5%) required subsequent hospitalization for cardiovascular reasons. The most common leading causes were heart failure, atrial fibrillation, and coronary artery disease. The need for consultation at outpatient specialty clinics increased the likelihood of hospitalization. Moreover, the need to consult patients in nephrology outpatient, pulmonary disease outpatient, and orthopedic outpatient clinics was the most significant. Conclusions: The use of electronic implantable cardiovascular devices is a very important part of therapy in modern cardiology. The methods for their use are constantly being improved. However, they represent only one stage of cardiac treatment. After CIED procedures, patients require further care in both inpatient and outpatient specialty care settings. In this paper, we outline the reasons for subsequent hospitalizations and the importance of outpatient specialty care in this context. Effective organization of care after CIED procedures may be important in reducing the most expensive component of this care, that is, inpatient treatment.

Diagnostic Performance of Dual-Energy Subtraction Radiography for the Detection of Pulmonary Emphysema: An Intra-Individual Comparison

Article

Full-text available

Oct 2021

Purpose/objectives: To compare the diagnostic performance of dual-energy subtraction (DE) and conventional radiography (CR) for detecting pulmonary emphysema using computed tomography (CT) as a reference standard. Methods and materials: Sixty-six patients (24 female, median age 73) were retrospectively included after obtaining lateral and posteroanterior chest X-rays with a dual-shot DE technique and chest CT within ±3 months. Two experienced radiologists first evaluated the standard CR images and, second, the bone-/soft tissue weighted DE images for the presence (yes/no), degree (1-4), and quadrant-based distribution of emphysema. CT was used as a reference standard. Inter-reader agreement was calculated. Sensitivity and specificity for the correct detection and localization of emphysema was calculated. Further degree of emphysema on CR and DE was correlated with results from CT. A p-value < 0.05 was considered as statistically significant. Results: The mean interreader agreement was substantial for CR and moderate for DE (kCR = 0.611 vs. kDE = 0.433; respectively). Sensitivity, as well as specificity for the detection of emphysema, was comparable between CR and DE (sensitivityCR 96% and specificityCR 75% vs. sensitivityDE 91% and specificityDE 83%; p = 0.157). Similarly, there was no significant difference in the sensitivity or specificity for emphysema localization between CR and DE (sensitivityCR 50% and specificityCR 100% vs. sensitivityDE 57% and specificityDE 100%; p = 0.157). There was a slightly better correlation with CT of emphysema grading in DE compared to CR (rDE = 0.75 vs. rCR = 0.68; p = 0.108); these differences were not statistically significant, however. Conclusion: Diagnostic accuracy for the detection, quantification, and localization of emphysema between CR and DE is comparable. Interreader agreement, however, is better with CR compared to DE.

Chronic Lung Diseases: Treatment, Challenges and Solutions

Chapter

Aug 2021

Lungs are a complex system that undergoes expansion and relaxation for about thousand times a day so as to give in oxygen and release out carbon dioxide. When problems occur in any part of the system associated with lungs, then it give rise to different lung diseases. Lung diseases are one amongst those leading diseases that affects 70 million people and kills 3 to 4million people annually and thereby has turned out to be one of the most common medical conditions across the world. Chronic lung disease (CLD) is the term used for a wide variety of persistent lung disorders that develops slowly and may get worse over a long time run. It impose an immense worldwide health burden and constitute a wide variety of disorders associated with the lungs. Some of the major and most common lung disorders include asthma, bronchitis and chronic obstructive pulmonary disease (COPD). The last decade has witnessed the rise of technology in almost all the field of healthcare sector and with that new advances in the field of treatment strategies and technologies were also introduced and adapted to overcome various obstacles and challenges in the treatment of chronic lung diseases. Even though there are some additional obstacles in the treatment of chronic lung diseases and controlling the mortality rate, yet research is to be carried out further into the field so that the mortality rate associated with different chronic lung diseases can be controlled to a great extent utilizing various aspects of technology.

Scholars Academic Journal of Biosciences (SAJB) COPD Exacerbations and Respiratory Viral Infections: A Perspective

Article

Jan 2017

Respiratory viruses are a major cause of concern for human population worldwide. Respiratory viral infections make it worse for patients suffering with lung diseases, such as, chronic obstructive pulmonary disease (COPD). Viral infections are one of the major inducers of COPD exacerbation. COPD exacerbations are associated with increased inflammation of the lung airways. Infection of upper respiratory tract contributes to disease progression leading to more severe exacerbation, longer duration for recovery from the disease symptoms and increased rate of hospitalization. As COPD is suspected to be one of the leading causes of mortality worldwide, this review discusses the role of respiratory viral infections in exacerbations of COPD and its immunology and genetics. Our current review presents information from articles electronically searched for keywords, such as, COPD, exacerbations, viral infections. Inclusion of articles was restricted to role of viral infections in COPD exacerbations to fulfill the relevance of the present article.

Показатели, оцениваемые в фармакологических исследованиях ХОБЛ: от легочной функции до биомаркеров

Article

Feb 2010

Summary of international clinical recommendations on diagnosis and treatment of chronic obstructive lung disease

Article

Jun 2005

Myocardial injury in patients with chronic obstructive pulmonary disease

Article

Oct 2008

Sixty-three patients with COPD and 82 patients with COPD and concomitant IHD have been examined. A leading role of hypoxemia in development of myocardiodystrophy and advantages of computed electrocardiotopography over other methods in detection myocardial dystrophic lesions have been demonstrated. Those lesions were more severe in the patients with co-existing COPD and IHD.

The effect of consecutive ambient air pollution on the hospital admission from chronic obstructive pulmonary disease in the Chengdu region, China

Article

Full-text available

Mar 2021

Hospitalisation risks for chronic obstructive pulmonary disease (COPD) have been attributed to ambient air pollution worldwide. However, a rise in COPD hospitalisations may indicate a considerable increase in fatality rate in public health. The current study focuses on the association between consecutive ambient air pollution (CAAP) and COPD hospitalisation to offer predictable early guidance towards estimates of COPD hospital admissions in the event of consecutive exposure to air pollution. Big data analytics were collected from 3-year time series recordings (from 2015 to 2017) of both air data and COPD hospitalisation data in the Chengdu region in China. Based on the combined effects of CAAP and unit increase in air pollutant concentrations, a quasi-Poisson regression model was established, which revealed the association between CAAP and estimated COPD admissions. The results show the dynamics and outbreaks in the variations in COPD admissions in response to CAAP. Cross-validation and mean squared error (MSE) are applied to validate the goodness of fit. In both short-term and long-term air pollution exposures, Z test outcomes show that the COPD hospitalisation risk is greater for men than for women; similarly, the occurrence of COPD hospital admissions in the group of elderly people (> 65 years old) is significantly larger than that in lower age groups. The time lag between the air quality and COPD hospitalisation is also investigated, and a peak of COPD hospitalisation risk is found to lag 2 days for air quality index (AQI) and PM10, and 1 day for PM2.5. The big data-based predictive paradigm would be a measure for the early detection of a public health event in post-COVID-19. The study findings can also provide guidance for COPD admissions in the event of consecutive exposure to air pollution in the Chengdu region.

Lena: a Voice-Based Conversational Agent for Remote Patient Monitoring in Chronic Obstructive Pulmonary Disease

Conference Paper

Full-text available

Jul 2021

Chronic obstructive pulmonary disease (COPD) is one of the leading causes of death worldwide. To manage the increasing number of COPD patients and reduce the social and economic burden of treatment, healthcare providers have sought to implement remote patient monitoring (RPM). Screen-based RPM applications, such as filling self-reports on the smartphone or computer, have been shown to increase the quality of life, reduce the frequency and severity of exacerbations, and increase physical activity in patients with COPD. These applications, however, are not without challenges for the elderly target population. They are often used on devices designed by and for a different age group, which makes filling out self-reports prone to error and induces fears of technology malfunctions. Voice-based conversational agents (VCAs) are available on more than 2.5 billion devices and are increasingly present in homes worldwide. Aside from their commercial success, VCAs are also credited with several functionalities, such as hands-free use, that make their adoption in healthcare attractive, especially for the elderly. In this work, we investigate the potential of VCAs for RPM of COPD. Specifically, we designed and evaluated Lena, a single-board computer-based VCA framed as a digital member of the medical team. Lena acts as RPM for the early prediction of COPD exacerbations by asking ten symptom-related questions to determine the patient's daily health status. This paper presents the patients' feedback after their interaction with Lena. Patients evaluated the acceptability of the system. Notably, all patients could imagine using the system once a day in the context of a larger study and wished to integrate Lena into their daily routine.

Prognostic Indicators for Prolonged Hospital Stay in Acute Exacerbation of Chronic Obstructive Pulmonary Disease: An Observational Study

Article

Jun 2024

Akhlesh Rajpoot

Abstract Aims and background: Hospitalization for acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is recognized as a major event in the natural history of COPD. Besides hurting lung function, survival, risk of readmission, and quality of life, it tremendously increases healthcare costs associated with hospitalization. Information on the time course and recovery from AECOPD is important in standardizing the length of treatment, planning appropriate follow-up, and decreasing the loss of working days of the patient. Hence, this study aimed to identify predictive parameters for length of hospitalization in AECOPD patients. Materials and methods: It was a prospective and longitudinal clinical-based descriptive study conducted at a tertiary care center in northern India. After applying the exclusion criteria and obtaining informed consent, 200 consecutive AECOPD patients were enrolled over 1 year. The Rome Proposal classifies AECOPD severity as mild, moderate, or severe, and the term prolonged length of hospital stay (LHS) refers to a stay lasting for 7 or more days. Results: The mean age of the 200 AECOPD patients was 63.9 ± 8.2 years, the mean LHS was 10.9 ± 5.2 days, and prolonged LHS (≥7 days) was seen in 140 (70%) patients. Advanced age, previous hospitalizations for AECOPD, arterial hypoxemia, the need for noninvasive ventilation (NIV), and severe AECOPD upon admission were found to be significantly correlated with the LHS (p < 0.05). However, only severe AECOPD upon admission was identified as an independent factor predicting prolonged hospitalization (p < 0.05). Conclusion: Older patients with a prior hospitalization for AECOPD, arterial hypoxemia, severe exacerbation of COPD, and need for NIV at the time of admission are more likely to have a longer hospitalization. Keywords: Acute respiratory failure, Chronic obstructive pulmonary disease, Noninvasive ventilation, Steroid therapy.

Évaluation médicoéconomique du PRADO-BPCO, programme d’accompagnement post-exacerbation

Article

May 2024
REV MAL RESPIR

Impact of remote-monitored home non-invasive ventilation on patient outcomes: a retrospective cohort study

Preprint

Apr 2024

Introduction Use of home non-invasive ventilation (NIV) to treat persistent hypercapnic respiratory failure in patients with stable chronic obstructive pulmonary disease (COPD) effectively reduces readmission rates and mortality compared with standard therapy. Traditional workflows around the initiation and management of NIV include elective admission for therapy initiation and frequent face-to-face clinic visits for follow-up, but use of telemedicine offers an alternative approach. Aim This retrospective cohort study evaluated the clinical efficacy and health resource use impact of a remote monitoring approach to the initiation and monitoring of home NIV. Methods Individuals with COPD, COPD-obstructive sleep apnoea or obesity-related respiratory failure who were started on remote-monitored home NIV from July 2016 to December 2020 were included. Data were obtained from electronic health records. The primary outcome was healthcare utilisation (hospital admissions and average number of bed days) in the 12 months after versus 12 months before starting NIV; secondary endpoints included 2-year survival and time to readmission, and blood gas analysis. Results In the 12 months after versus before NIV initiation, there was a significant reduction in the mean number of admissions (1.0±2.1 vs. 1.4±2.1; p<0.0001) and occupied bed days (9.6±26.8 vs. 17.2±27.5; p<0.0001); results were consistent across NIV indications. Time to first readmission (hazard ratio [HR] 2.11, 95% confidence interval [CI] 1.58–2.8; p<0.001) and time to death (HR 2.25, 95% CI 1.51–3.34; p<0.0001) were significantly worse in NIV non-users versus users, but did not differ by deprivation quintile. Blood gas analysis showed that NIV significantly reduced carbon dioxide pressure and bicarbonate compared with before NIV. Conclusions A technology-assisted service model for the remote initiation and monitoring of home NIV therapy for individuals with chronic hypercapnic respiratory failure was feasible, had a beneficial effect on healthcare utilisation and outcomes, and offset typical adverse relative survival outcomes associated with deprivation. KEY MESSAGES What is already known on this topic When given at adequate pressures that ensure sufficient reduction in carbon dioxide pressure, home non-invasive ventilation (NIV) is an effective and well tolerated treatment for chronic hypercapnic respiratory failure in individuals with chronic obstructive pulmonary disease or obesity-related respiratory failure. What this study adds This study showed the feasibility and effectiveness of a remote monitoring approach to the initiation and management of home NIV therapy in a real-world setting. How this study might affect research, practice or policy As well as improving outcomes in appropriately selected individuals, the initiation and management of home NIV therapy using remote monitoring has the potential to improve workflow, equitably enhance access to and outcomes from treatment, and provide a rich continuous dataset that could facilitate derivation of actionable artificial intelligence insights to support proactive care interventions.

Do pulmonary rehabilitation programmes improve outcomes in patients with COPD posthospital discharge for exacerbation: a systematic review and meta-analysis

Article

Feb 2024

Introduction Previous systematic reviews have provided heterogeneous and differing estimates for the efficacy of pulmonary rehabilitation following exacerbations of chronic obstructive pulmonary disease (COPD). The aim of this review was to examine the efficacy of pulmonary rehabilitation programmes initiated within 3 weeks of hospital discharge following an exacerbation of COPD. Methods An update of a previous Cochrane review was undertaken using the Cochrane Airways Review Group Specialised Register. Searches were conducted from October 2015 to August 2023 for studies that initiated pulmonary rehabilitation within 3 weeks of hospital discharge. Studies assessing the impact of solely inpatient pulmonary rehabilitation were excluded. Forest plots were generated using a generic inverse variance random effects method. Results Seventeen studies were included. Posthospital discharge pulmonary rehabilitation reduced hospital re-admissions (OR 0.48, 95% CI 0.30 to 0.77, I ² =67%), improved exercise capacity (6 min walk test, mean difference (MD) 57 m, 95% CI 29 to 86, I ² =89%; incremental shuttle walk test, MD 43 m, 95% CI 6 to 79, I ² =81%), health-related quality of life (St. George’s Respiratory Questionnaire, MD −8.7 points, 95% CI −12.5 to −4.9, I ² =59%; Chronic Respiratory Disease Questionnaire (CRQ)-emotion, MD 1.0 points, 95% CI 0.4 to 1.6, I ² =74%; CRQ-fatigue, MD 0.9 points, 95% CI 0.1 to 1.6, I ² =91%), and dyspnoea (CRQ-dyspnoea, MD 1.0 points, 95% CI 0.3 to 1.7, I ² =87%; modified Medical Research Council Dyspnoea Scale, MD −0.3 points, 95% CI −0.5 to −0.1, I ² =60%). Significant effects were not observed for CRQ-mastery, COPD assessment test, EuroQol-5 Dimension-5 Level and mortality. No intervention-related adverse events were reported. Discussion Pulmonary rehabilitation delivered posthospital discharge for exacerbation of COPD results in a reduction in hospital re-admissions and improvements in exercise capacity, health-related quality of life and dyspnoea in the absence of any intervention-related adverse events. Trial registration number CRD42023406397.

Impacts of regular physical activity on hospitalisation in chronic obstructive pulmonary disease: a nationwide population-based study

Article

Full-text available

Feb 2024

Introduction Studies that comprehensively evaluate the association between physical activity (PA) levels, particularly by quantifying PA intensity, and healthcare use requiring emergency department (ED) visit or hospitalisation in patients with chronic obstructive pulmonary disease (COPD) are limited in Korea. Methods The risk of all-cause and respiratory ED visit or hospitalisation according to the presence or absence of COPD and the level of PA was evaluated in a retrospective nationwide cohort comprising 3308 subjects with COPD (COPD cohort) and 293 358 subjects without COPD (non-COPD cohort) from 2009 to 2017. Results The COPD group exhibited a higher relative risk of all-cause and respiratory ED visit or hospitalisation across all levels of PA compared with the highly active control group (≥1500 metabolic equivalents (METs)-min/week). Specifically, the highest risk was observed in the sedentary group (adjusted HR (aHR) (95% CI) = 1.70 (1.59 to 1.81) for all-cause ED visit or hospitalisation, 5.45 (4.86 to 6.12) for respiratory ED visit or hospitalisation). A 500 MET-min/week increase in PA was associated with reductions in all-cause and respiratory ED visit or hospitalisation in the COPD cohort (aHR (95% CI) = 0.92 (0.88 to 0.96) for all-cause, 0.87 (0.82 to 0.93) for respiratory cause). Conclusions Compared with the presumed healthiest cohort, the control group with PA>1500 METs-min/week, the COPD group with reduced PA has a higher risk of ED visit or hospitalisation.

Pulmonary Rehabilitation for Adults with Chronic Respiratory Disease: An Official American Thoracic Society Clinical Practice Guideline

Article

Full-text available

Aug 2023
AM J RESP CRIT CARE

Background Despite the known benefits of pulmonary rehabilitation (PR) for patients with chronic respiratory disease, this treatment is underused. Evidence-based guidelines should lead to greater knowledge of the proven benefits of PR, highlight the role of PR in evidence-based health care, and in turn foster referrals to and more effective delivery of PR for people with chronic respiratory disease. Methods The multidisciplinary panel formulated six research questions addressing PR for specific patient groups (chronic obstructive pulmonary disease [COPD], interstitial lung disease, and pulmonary hypertension) and models for PR delivery (telerehabilitation, maintenance PR). Treatment effects were quantified using systematic reviews. The Grading of Recommendations, Assessment, Development and Evaluation approach was used to formulate clinical recommendations. Recommendations The panel made the following judgments: strong recommendations for PR for adults with stable COPD (moderate-quality evidence) and after hospitalization for COPD exacerbation (moderate-quality evidence), strong recommendation for PR for adults with interstitial lung disease (moderate-quality evidence), conditional recommendation for PR for adults with pulmonary hypertension (low-quality evidence), strong recommendation for offering the choice of center-based PR or telerehabilitation for patients with chronic respiratory disease (moderate-quality evidence), and conditional recommendation for offering either supervised maintenance PR or usual care after initial PR for adults with COPD (low-quality evidence). Conclusions These guidelines provide the basis for evidence-based delivery of PR for people with chronic respiratory disease.

Association Between Oral Health and Airflow Limitation: Analysis Using a Nationwide Survey in Korea

Article

Aug 2023

Background: Although poor oral health is a common comorbidity in individuals with airflow limitation (AFL), few studies have comprehensively evaluated this association. Furthermore, the association between oral health and the severity of AFL has not been well elucidated. Methods: Using a population-based nationwide survey, we classified individuals according to the presence or absence of AFL defined as pre-bronchodilator forced expiratory volume in 1 second/forced vital capacity < 0.7. Using multivariable logistic regression analyses, we evaluated the association between AFL severity and the number of remaining teeth; the presence of periodontitis; the Decayed, Missing, and Filled Teeth (DMFT) index; and denture wearing. Results: Among the 31,839 participants, 14% had AFL. Compared with the control group, the AFL group had a higher proportion of periodontitis (88.8% vs. 79.4%), complete denture (6.2% vs. 1.6%), and high DMFT index (37.3% vs. 27.8%) (P < 0.001 for all). In multivariable analyses, denture status: removable partial denture (adjusted odds ratio [aOR], 1.12; 95% confidence interval [95% CI], 1.04-1.20) and complete denture (aOR, 1.52; 95% CI, 1.01-2.05), high DMFT index (aOR, 1.13; 95% CI, 1.02-1.24), and fewer permanent teeth (0-19; aOR, 1.32; 95% CI, 1.12-1.52) were significantly associated with AFL. Furthermore, those with severe to very severe AFL had a significantly higher proportion of complete denture (aOR, 2.41; 95% CI, 1.11-3.71) and fewer remaining teeth (0-19; aOR, 2.29; 95% CI, 1.57-3.01). Conclusion: Denture wearing, high DMFT index, and fewer permanent teeth are significantly associated with AFL. Furthermore, a reduced number of permanent teeth (0-19) was significantly related to the severity of AFL. Therefore, physicians should pay attention to oral health in managing patients with AFL, such as chronic obstructive pulmonary disease.

Correlation of BODE Index with Diffusing Capacity of Lung for Carbon Monoxide in Assessing Disease Severity in Chronic Obstructive Pulmonary Disease

Article

Jan 2018

Background: Chronic Obstructive Pulmonary Disease (COPD) is the third leading cause of death globally but about 90% of COPD mortality occurs in low-and middle-income nations. There are several studies in the literature on the role of the BODE Index and DLCO (Diffusion capacity of carbon monoxide) as independent factors in predicting prognosis and disease severity in COPD. But there is a paucity of data on the relationship between the BODE Index and DLCO in establishing disease severity in COPD. In this study, we intend to analyze the correlation between the BODE index and DLCO in patients with various stages of COPD. Methods: The study was conducted as an observational, cross-sectional, study involving stable COPD patients(diagnosed and grouped according to GOLD guidelines) of all age groups attending respiratory medicine OPD of a tertiary care hospital. The 73 patients selected were subjected to spirometry, DLCO and Six Minute Walk Test(6MWT) after taking proper history and detailed physical examination. Subsequently, the BODE index was calculated and patients were categorized among four quartiles of the BODE index, similarly, patients were also categorized based on DLCO(Mild, Moderate, Severe, Very severe). Uncategorized and categorized data on the BODE index and DLCO were correlated independently by various groups of GOLD classification (Group A, B, C& D). Association between various study variables was done by chi-square test. The Spearman correlation coefficient was used to correlate BODE Index and DLCO. Results: Most patients in our study belonged to quartile-2 of BODE score, Medium grade according to CAT score and category "D" according to GOLD. In our study, the BODE score was much better in predicting the prognosis of COPD than FEV1. BODE index was correlated well with GOLD scoring. Conclusion: Overall BODE index is accurate in categorizing COPD severity. Cross tabulation with DLCO categories and GOLD categories showed a better correlation compared to the BODE index.

ELECTROLYTE DISTURBANCES IN ACUTE EXACERBATION OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE AT SMS MEDICAL COLLEGE, JAIPUR

Article

Full-text available

Jun 2023

Background: COPD is a leading cause of morbidity and mortality worldwide. With increasing industrialization and smoking, the prevalence of COPD is increasing. Serum electrolyte imbalance is a very common nding in patients with acute exacerbation of COPD which results in signicant morbidity and mortality. This study attempts to measure the concentration of major serum electrolytes (sodium and potassium) in COPD patients with acute exacerbation to determine the possible effects of these electrolyte disorders. Objective: The main objective of this study was to determine the prevalence of electrolyte disturbances in patients with acute exacerbation of COPD and to determine possible effects of these electrolyte disorders. Materials and Methods: A hospital-based observational study was conducted at S.M.S. Medical College, Jaipur. 104 patients with AECOPD were selected after applying inclusion and exclusion criteria. Clinical characteristics, arterial blood gases analysis and serum electrolytes were assessed. Results were interpreted and data analysis was done Results: The proportion of male (75.96%) AECOPD patients was signicantly higher than the female (24.03%) and the mean age (years) of patients were 62.40±9.056. The majority of patients were smokers (77.88%). The proportion of respiratory failure was 79.8% out of which 57.56% was in Type II respiratory failure and 19.2% was in Type I respiratory failure. Low levels of serum sodium (131 ± 5.66 mEq/L) and potassium (3.20 ± 0.44 mEq/L) were found in subjects with acute exacerbation of COPD. In patients with respiratory failure, sodium and potassium levels were markedly reduced. The unfavourable outcome was signicantly higher in patients with hyponatremia. Conclusion: Serum electrolytes in acute exacerbation of COPD patients should be monitored routinely and should be corrected early to avoid poor outcomes.

Survival and health care costs after inpatient elective surgery: comparison of patients with and without chronic obstructive pulmonary disease

Article

Full-text available

Jan 2023

Background: Chronic obstructive pulmonary disease (COPD) is common among surgical patients, and patients with COPD have higher risk for complications and death within 30 days after surgery. We sought to describe the longer-term postoperative survival and costs of patients with COPD compared with those without COPD within 1 year after inpatient elective surgery. Methods: In this retrospective population-based cohort study, we used linked health administrative databases to identify all patients undergoing inpatient elective surgery in Ontario, Canada, from 2005 to 2019. We ascertained COPD status using validated definitions. We followed participants for 1 year after surgery to evaluate survival and costs to the health system. We quantified the association of COPD with survival (Cox proportional hazards models) and costs (linear regression model with log-transformed costs) with partial adjustment (for sociodemographic factors and procedure type) and full adjustment (also adjusting for comorbidities). We assessed for effect modification by frailty, cancer and procedure type. Results: We included 932 616 patients, of whom 170 482 (18%) had COPD. With respect to association with risk of death, COPD had a partially adjusted hazard ratio (HR) of 1.61 (95% confidence interval [CI] 1.58-1.64), and a fully adjusted HR of 1.26 (95% CI 1.24-1.29). With respect to impact on health system costs, COPD was associated with a partially adjusted relative increase of 13.1% (95% CI 12.7%-13.4%), and an increase of 4.6% (95% CI 4.3%-5.0%) with full adjustment. Frailty, cancer and procedure type (such as orthopedic and lower abdominal surgery) modified the association between COPD and outcomes. Interpretation: Patients with COPD have decreased survival and increased costs in the year after surgery. Frailty, cancer and the type of surgical procedure modified associations between COPD and outcomes, and must be considered when risk-stratifying surgical patients with COPD.

Association between Oral Health and Airflow Limitation: Analysis Using a Nationwide Database

Article

Jan 2022

Prognostic values of Neutrophil to Lymphocyte ratio in patient with acute exacerbation of COPD with type 2 respiratory failure

Thesis

Full-text available

Jul 2022

Nabin Simkhada

BACKGROUND Chronic obstructive pulmonary disease (COPD) is a progressive disease and normally progresses without a cure and can result in death. The progression takes a long time and varies greatly from person to person. All anatomical regions of the lung, including the airways, lung parenchyma, and vasculature, are involved in the chronic inflammatory process elicited by cigarette smoking or other noxious particles. Although the exact mechanisms underlying the inflammatory response remain unclear, oxidative stress, protease-antiprotease mismatch, and genetic factors all play a part. Different types of mediators (chemotaxines, cytokines, and growth factors) released by inflammatory cells such as neutrophils and macrophages aid the inflammatory process. METHODOLOGY It is a hospital-based observational, cross-sectional study conducted at Shree Birendra Hospital, Kathmandu in the Department of Internal Medicine. Ninety patients were selected using the purposive sampling technique, admitted with the diagnosis of acute exacerbation of chronic obstructive pulmonary disease with type 2 respiratory failure in Shree Birendra Hospital. Patients' clinical and Laboratory parameters were recorded. Data were analyzed using SPSS version 20. Analysis was done using both descriptive as well as inferential statistics. RESULTS The result shows that the mean age among all patients was 70.84 years and the majority of patients were female (57.77%). The mean length of hospital stay was 7.82 days, with mean Intensive Care Unit (ICU) stay being 2.75 days and mean general ward stay being 5.03 days. Among the admitted patients, sixteen patients had died, with a 17.8% in-hospital mortality rate. Among all patients, the relationship between neutrophil to lymphocyte ratio (NLR) and total length of hospital stay has been assessed and has shown a significant positive correlation (r= 0.540 and P = 0.000). A positive correlation was found between NLR and total duration of Intensive care unit stay (r= 0.468 and P= 0.000). There is also a positive correlation between NLR and general ward stay (r=0.277 and P= 0.008). The mean NLR in the non-survivor group is 9.135 with a standard deviation (SD) of 4.48 while the mean NLR in the survivor group was 7.219 with SD of 7.04. There is a significant association of NLR with mortality (P= 0.016). To assess the NLR as a predictive marker of mortality among patients admitted with acute exacerbation of COPD the ROC curve was used to show the area under the curve (AUC) of 0.693 with a cutoff value of 6.99 with 68% sensitivity and 63% specificity (P= 0.016). CONCLUSION NLR was a strongly valuable inflammatory marker with reported moderate sensitivity and specificity in predicting mortality among COPD patients admitted for acute exacerbation with type 2 respiratory failure.

EFFICACY AND SAFETY FOR THECOMBINATION OF BROMHEXINE, SALBUTAMOL AND ETOFYLLINE IN PATIENTS OF ACUTE EXACERBATIONS OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE: POST-MARKETING SURVEILLANCE STUDY

Article

Aug 2021

Introduction-Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) can be treated with a combination of bronchodilators with various mechanisms of action and durations of action, as well as mucolytic agents. So the combination of Salbutamol, Etofylline and Bromhexine can be used for the treatment of AECOPD and to test the efficacy and safety this post marketing surveillance study was conducted. Methodology-This study was conducted at 12 clinical trial sites and total 180 patients were recruited for the study out of which 168 patients completed the study. The reduction in cough Severity Score (CSS) and increase in %FEV1 were the efficacy assessment parameters for this study. Safety assessment was done by analysing the reported adverse events. Results-CSS at baseline was 5.97 which was reduced to 3.35at day 3 and further reduced to1.01at day 5.FEV1 at baseline was 40.01%increased to59.84%at day 3 and further increased to 81.13% at day 5. Nearly all the Patients showed reduction in CSS and increase in FEV1 at all visits and the majority of Patients had complete relief from the symptom. There were 14 episodes of adverse events, all of them were mild in severity and non-serious in nature. Conclusion-A fixed dose combination of Salbutamol 1mg, Etofylline 50mg and Bromhexine 4mg per 5ml was efficacious and safe for the treatment of AECOPD.

Does Training on Swiss Ball Improve Trunk Performance after Stroke?- A single blinded, quasi experimental study design

Article

Jan 2012

Back Ground: Trunk performance is important for functional outcomes and also a predictor for activities of daily living after stroke. Swiss ball training is superior to ground-based exercise in its ability to recruit trunk muscles by increasing its demand and trunk balance on healthy individuals and athletes. However retrievable literature evidence for Swiss ball training on trunk performance is not available in the stroke population. Objective: To evaluate trunk performance on Swiss ball training after stroke. Design: An assessor-blinded,quasi-experimental study design. Setting: Physiotherapy Department of Kasturba Medical College and hospital, Mangalore, Manipal University. Participants: Twelve subjects having first-ever unilateral stroke who can able to sit on a stable surface independently for one minute were recruited. Intervention: In addition to conventional physiotherapy all the study subjects received 10 hours of individual and supervised trunk exercises on Swiss ball; 45 minutes with adequate rest periods 10-15 minutes, 6 times a week, for 3 weeks. Outcome Measurement: Trunk performance was evaluated by the Trunk Impairment Scale (TIS) by Verheyden. Results: Post-intervention the study group has shown an improvement in TIS score. A significant improvement was seen in dynamic balance and coordination subscales and also in the total score (p-value <0.05) of TIS. Conclusion: Training on Swiss ball improves trunk performance after stroke.

Hospital‐at‐home for chronic obstructive pulmonary disease exacerbation; Will it be an effective readmission avoidance model?

Article

Full-text available

Jun 2021
CLIN RESPIR J

Objectives Hospital‐at‐home (HAH),a pioneering health care model, is an accepted alternative to hospital treatment for patients with a chronic obstructive pulmonary disease (COPD) exacerbations.The aim of the present study was to analyze the effectiveness of HAH for patients with COPD exacerbations. Methods Two hundred six patients with COPD exacerbations who were admitted to our emergency room (ER) received the HAH model between January 2008 and March 2010. Hospitalization rates, admission to emergency room, admissions to outpatient clinic, and the total number of days in hospital were recorded before and after a one‐year period of HAH. Results After the one‐year follow‐up period using the HAH model, hospitalization rates, admission to emergency room, admissions to outpatient clinic and the total number of days in hospital per one year were decreased (40.29%, 21.18%, 54.94%, and 46.35%, respectively). The decreases for all parameters were found to be statistically significant (p<0.001). Conclusion Integrated care services, including home care units where HAH models are performed, are necessary to improve the health of patients with COPD, as well as to better manage their condition in terms of disease burden.Physicians should consider this form of management, especially because there is increasing pressure on inpatient bed requirement in Turkey.

Chronic Obstructive Pulmonary Disease

Chapter

Jan 2010

Comparative cost-effectiveness analysis of theophylline and ipratropium bromide in chronic obstructive pulmonary disease. A three-center study

Article

Full-text available

Apr 1993

The charts of 311 patients receiving theophylline (T) and 289 patients receiving ipratropium bromide (IB) for COPD were reviewed to determine the total costs and cost-effectiveness of these 2 agents in 3 different health-care settings. A direct cost-accounting method assessed cost, and a Markov decision-analysis model calculated cost-effectiveness. Costs to treat toxic effects were greater for T versus IB. The types and incidences of toxic effects, by drug, were similar among the three centers. Overall costs for T were $121.40 per patient per therapy-month versus $84.56 per patient per therapy-month for IB, as determined by the cost-accounting method. The marginal cost was $366 for T over IB when extrapolated over 1 year using the Markov model. The Markov model also predicted that patients receiving IB had a greater number of complication-free therapy-months (measurement of effectiveness) than patients receiving T. We conclude that treatment with IB was less costly and more cost-effective than T.

The Cost of Treating COPD Patients With Long-term Oxygen Therapy in a French Population

Article

Full-text available

Sep 1996

In greater Paris and its surrounding (as it is in all France), oxygen is home delivered by not-for-profit (NP) associations or profit-making (PM) health organizations. Both are financed by the national health insurance. This dual context and the current economic climate justify an economic evaluation of all respiratory care for patients with COPD receiving long-term oxygen therapy (LTO). This pragmatic approach identifies the variables that have the greatest impact on direct medical costs and estimates the annual cost for respiratory care per COPD patient. Retrospective study. Health insurance scheme for self-employed professionals (CANAM). Between July 1985 and March 1994, 234 patients registered in CANAM files began LTO, 24% in the PM sector, 76% in the NP sector, mainly using concentrator (78%), mean age of 74 +/- 10 years, male predominance (74%), PaO2 of 56.2 +/- 10.5 mm Hg, FEV1/FVC of 43 +/- 15%, and 51% having 1 or more severe illness(es) associated. The economic appraisal was performed on a representative sample of 61 patients and measured the total resources consumption for respiratory care per COPD patient and per year (physician visits and tests, drugs, physiotherapy, oxygen therapy, hospitalizations for acute respiratory failure, transport costs). A quarter of the patients in each sector did not meet the LTO prescription guidelines (PaO2 > 60 mm Hg). For patients having their oxygen delivered by NP sector, the total ambulatory cost for respiratory care was lower ($4,506 per patient and per year vs $5,399) because they mainly used concentrator, all the other direct ambulatory costs being equal. The total annual cost for respiratory care of a COPD patient receiving LTO amounted to $11,672 (NP and PM sectors merged). Oxygen therapy represented 73% of the total ambulatory cost. In a multiple linear regression model, hospitalization represented the largest share of cost, significantly higher when PaO2 was 55 mm Hg or less ($2,287 per patient per year vs $8,717). In contrast, none of the covariates (age, sex, PaO2, FEV1/FVC) influenced at a significant level the total cost of visits, tests, drugs, and physiotherapy, amounting to $1,507. As oxygen treatment plays an important role in the variation of costs, further pragmatic studies should help to better understand what are the real motivations to choose one mode of oxygen administration more than another and should determine factors that may lead physicians sometimes not to comply with clinical guidelines.

Economic Aspects of Lung Volume Reduction Surgery

Article

Full-text available

Nov 1996

To investigate the economics of lung volume reduction surgery. Medical center and physician charges obtained from billing records. Academic health center. Twenty-three consecutive patients undergoing lung volume reduction surgery at a single institution who were discharged from the hospital prior to November 1, 1995. Length of hospital stay, mortality, medical center charges and professional fees, and sponsor reimbursement. Median hospital stay was 8.0 days and there were no deaths. The median charge was $26,669 (range, $20,032 to $75,561) of which 73% was for medical center services and 27% was for physician services. Fees for medical center rooms and operating suite time accounted for 71% of medical center charges. Charges by surgeons and anesthesiologists accounted for 77% of professional fees. Total charges were directly related to length of stay (r2 = 0.95). Median reimbursement for medical center services was $22,264 (114%; range, $13,333 to $123,362) and for physician services was $2,783 (34%; range, $2,597 to $11,265), resulting in a median total reimbursement that represented 94% of total charges. The median reimbursement-to-cost ratio was 1.22, compared with 1.05 for all medical services in fiscal year 1995. These data must now be assessed relative to outcomes such as quality of life, patient function, and long-term survival to determine cost-effectiveness of lung volume reduction surgery.

Lung volume reduction surgery - An analysis of hospital costs

Article

Full-text available

May 1998

Lung volume reduction surgery (LVRS) represents a potential breakthrough in the management of advanced emphysema, although questions remain about clinical and economic implications of widespread application of LVRS. In this report, we describe hospital costs, excluding physicians' fees, for LVRS. Hospital charges were obtained from billing records and converted to costs by applying multiple cost-to-charge ratios. A large, urban academic medical center. Fifty-two consecutive patients who received bilateral LVRS through a median sternotomy between April 1995 and August 1996. Median hospital stay was 10 days (mean= 14.8+/-12.8 days; range=3 to 48 days), including 2 days (mean=6+/-9.2 days; range=1 to 35 days) in the ICU. One hospital death occurred. Hospital costs per case ranged from $11,712 to $121,829, with mean costs of $30,976 and median costs of $19,771. Costs were related significantly to duration of ICU stay and length of hospitalization. Patients who accrued the highest costs were significantly older than the remainder of the sample (69.3 years vs 62.4 years). Hospital costs of LVRS vary significantly but are related directly to hospital stay. Identification of factors associated with prolonged stays can be used in assessing benefits and risks of LVRS against utilization of health-care dollars.

Capitation, Managed Care, and Chronic Obstructive Pulmonary Disease

Article

Full-text available

Aug 1998

Expenditure and utilization patterns of aged Medicare beneficiaries with chronic obstructive respiratory disease (COPD) (n = 42,472) were compared with all Medicare beneficiaries (n = 1,221,615) using a 5% nationally representative sample of aged Medicare beneficiaries participating in the fee-for-service program in 1992. Per capita expenditures for an aged Medicare beneficiary with COPD were 2.4 times the per capita expenditures for all Medicare beneficiaries. The most expensive 10% of Medicare beneficiaries with COPD accounted for nearly half of total expenditures for this population. Higher comorbidity, as measured by the Deyo-adapted Charlson index, was associated with higher expenditures. For Medicare Part B claims, internal medicine accounted for the largest portion of physician expenditures (14%). Per capita expenditures for pulmonologists were 7.5 times higher for beneficiaries with COPD compared with all Medicare beneficiaries. Results from this study suggest that there is a subgroup of individuals with COPD who are likely to be very expensive during the year. Additional analytic studies are needed to more specifically identify characteristics associated with these individuals. As more Medicare beneficiaries enroll in managed care and as physicians are increasingly being paid on a capitated basis this information will be useful to physicians as they monitor the care provided to patients and assess the financial risks they accept under capitation.

Guidance for commissioners on the cost effectiveness of smoking cessation interventions

Article

Full-text available

Jan 1999

Characterization of Chronic Obstructive Pulmonary Disease-Pulmonary Hypertension

Conference Paper

May 2019

Costs and effects of inhaled corticosteroids and bronchodilators in asthma and chronic obstructive pulmonary disease.

Article

Apr 1995

The objective of this study was to determine the costs and effects of combined bronchodilator and anti-inflammatory therapy. In a 2.5-yr randomized controlled study, combined beta 2-agonist/corticosteroid therapy (BA + CS) and combined beta 2-agonist/anticholinergic therapy (BA + AC) were compared with beta 2-agonist/placebo therapy (BA + PL). Included in the study were 274 patients 18 to 60 yr of age with moderately severe obstructive airways disease. The main clinical endpoints were lung function, hyperresponsiveness, restricted activity days, and symptom-free days. The economic endpoints were the costs of health care utilization. Compared with BA + PL, BA + CS led to significant improvements in FEV1, PC20, and symptom-free days. BA + AC did not differ from BA + PL in this respect. The respective annual acquisition costs of BA + CS, BA + AC, and BA + PL were 532 US$, 277 US$, and 156 US$. Thus, BA + CS costs 376 US$ more than BA + PL. However, compared with BA + PL therapy, BA + CS led to statistically significant savings in other health care costs of about 175 US$ (95% CI from 46 to 303 US$). Thus, more than half of the additional costs of adding the inhaled corticosteroid are compensated for by a reduction in the costs of other health care services. Overall, inhaled corticosteroids lead to a small but net increase in health care costs of 201 US$ per patient per year.(ABSTRACT TRUNCATED AT 250 WORDS)

Cost development of obstructive airway disease in Sweden

Article

Jan 1996
Eur Respir Rev

Claes-Göran AH Löfdahl

The mortality rate due to chronic obstructive pulmonary disease (COPD) in Sweden has increased both for females and males in the 11 year period between 1980 and 1991. The main increase in mortality from COPD has occurred in patients aged 65-79 yrs and, consequently, the society costs due to mortality show only a small increase. The total indirect cost of COPD in 1980 was 1.32 billion Swedish kronor (SEK) and this rose to 1.43 billion SEK in 1991. For asthma, the corresponding costs were 1.42 and 1.46 billion SEK, respectively, despite a considerable decrease in mortality. In both conditions the costs for sick leave are unchanged, whereas the costs for pensions leave have decreased. The total direct costs for COPD increased from 0.70 to 1.08 billion SEK hospital care costs from 0.34 to 0.51 billion SEK; out-patient care from 0.28 to 0.43 billion SEK; and drug costs from 0.08 to 0.14 billion SEK. The total direct costs for asthma increased from 0.79 to 1.12 billion SEK with a different pattern: hospital costs decreased from 0.47 to 0.31 billion SEK; tout-patient costs increased from 0.23 to 0.47 billion SEK; and drug costs from 0.09 to 0.34 billion SEK.

Five-Hundred LifeSaving Interventions and Their Cost-Effectiveness

Article

Jun 1995
RISK ANAL

We gathered information on the cost-effectiveness of life-saving interventions in the United States from publicly available economic analyses. “Life-saving interventions” were defined as any behavioral and/or technological strategy that reduces the probability of premature death among a specified target population. We defined cost-effectiveness as the net resource costs of an intervention per year of life saved. To improve the comparability of cost-effectiveness ratios arrived at with diverse methods, we established fixed definitional goals and revised published estimates, when necessary and feasible, to meet these goals. The 587 interventions identified ranged from those that save more resources than they cost, to those costing more than 10 billion dollars per year of life saved. Overall, the median intervention costs $42,000 per life-year saved. The median medical intervention costs $19,000/life-year; injury reduction $48,000/life-year; and toxin control $2,800,000/life-year. Cost/life-year ratios and bibliographic references for more than 500 life-saving interventions are provided.

The Cost-effectiveness of Lung Transplantation: A Pilot Study

Article

Dec 1995
CHEST

Objective Lung transplantation is one of the fastest-growing solid organ transplant procedures in the world, yet its cost-effectiveness is unknown. We compared the costs and outcomes of the first 25 patients who received lung transplants at the University of Washington with 24 patients currently on the lung transplant waiting list. Design Inpatient and outpatient charges were obtained from the hospital billing service and home health agencies. Quality-adjusted life year scores (QALYs) were computed from the following: (1) utility scores obtained through standard gamble interviews, and (2) published survival data from an international lung transplant registry and from studies of patients on lung transplant waiting lists. Results Transplantation charges averaged $164,989 (median, $152,071). Average monthly charges posttransplant were $11,917 in year 1 and $4,525 thereafter, vs $3,395 for waiting-list patients. Posttransplant utility scores were significantly higher than waiting-list scores (0.80 vs 0.68; p<0.00l). Life expectancy was not greater for lung transplant vs waiting-list patients (5.89 vs 5.32 years; p>0.05), although quality-adjusted life expectancy did improve significantly. After converting charges to costs, the incremental cost per QALY gained for posttransplant compared with waiting-list patients was $176,817. Conclusions Lung transplantation is very expensive, although it can substantially improve quality of life. Two-thirds of care costs are incurred after transplantation. The principal barriers to cost-effectiveness at present are the high cost of postrecovery care and marginal gains in life expectancy compared with conservative care.

Position Paper of the American Association of Cardiovascular and Pulmonary Rehabilitation Scientific Basis of Pulmonary Rehabilitation

Article

Nov 1990
J CARDIOPULM REHABIL

Andrew L. Ries

The AACVPR thanks the following individuals for their contributions in reviewing this position paper: Michael J. Belman, MD, Eileen Hanafin Breslin, RN, DNSc, Neil F. Gordon, MD, PhD, MPH, John E. Hodgkins, MD, Donald A. Mahler, MD, and William P. Marley, PhD (C) Lippincott-Raven Publishers.

Estimated Growth of Lung Volume Reduction Surgery Among Medicare Enrollees

Article

Dec 1998

Hugh F. Huizenga

Objective To estimate the number of lung volume reduction surgery procedures performed on Medicare enrollees from 1994 to 1996. Design Statistical analysis of national Medicare claims data. Patients All Medicare enrollees with emphysema having claims records for pulmonary resection procedures from January 1, 1993, through December 31, 1996. Main outcome measure Estimated number of lung volume reduction procedures performed per month from July 1994 through December 1996. Results An estimated 1,212 lung volume reduction procedures were performed on Medicare enrollees between July 1994 and December 1995 (95% confidence interval, 1,012 to 1,408). Nearly one half of these procedures were performed in the last 3 months of 1995. At the time Health Care Financing Administration announced that it would suspend reimbursement for the procedure (December 1995), lung volume reduction surgery was being performed in 37 states. The number of claims per month decreased from a peak of 169 in December 1995, to 11 in March 1996. Average Medicare reimbursement per procedure was $31,398. Conclusions Lung volume reduction surgery for patients increased rapidly following its reintroduction in 1994. The growth of lung volume reduction surgery demonstrates that widespread adoption and utilization of a surgical procedure can occur in the absence of data from controlled clinical trials. Medicare expenditures for lung volume reduction surgery were an estimated $30 million to $50 million. Performing the surgery for all current Medicare patients who meet the appropriate clinical criteria would cost an estimated $1 billion.

Ipratropium bromide in the management of chronic obstructive pulmonary disease: Effect on health service expenditures

Article

May 1994
CLIN THER

Chronic obstructive pulmonary disease (COPD), which is estimated to affect 32 million Americans, is the fifth leading cause of death in the United States. This retrospective study was designed to discern the economic utility of initial pharmacotherapy with various individual drugs in the management of COPD, as well as subsequent costs incurred as disease progression necessitated combination therapy. Data for this analysis were derived from the computer archive of a network-model health maintenance organization. During the first 6 months post-diagnosis for COPD, results indicated a significant (P < or = 0.05) increase in expenditures for physicians, hospital care, and total health service utilization for patients prescribed theophylline, a corticosteroid (triamcinolone or beclomethasone) delivered via a metered-dose inhaler, or albuterol delivered via a metered-dose inhaler as initial monotherapy compared with patients prescribed ipratropium bromide (IB) delivered via a metered-dose inhaler. Patients receiving initial pharmacotherapy with ipratropium bromide and subsequently adding albuterol used significantly less health care services (P < or = 0.05) during the first 15 months post-diagnosis for COPD than did patients prescribed all other combination therapies we evaluated.

Education and cost/benefit ratios in pulmonary patients

Article

May 1994

The need for education of pulmonary patients stems from bad symptom perception, problems in using instruments for assessment of the severity of obstruction, problems in understanding and using (inhaled) medications, and lack in insight in the process of the underlying disease. Education of asthma patients usually leads to better management of the disease, less visits to doctors, less hospital admissions, and less days lost at school or at work. The use of medication often increases. Quality of life improves after an education program. The cost-benefit balance usually is favourable. The effects of education in COPD patients is equivocal. The costs usually are high; the benefits are substantially less than in the asthma group.

Further recommendations for prescribing, reimbursement, technology development, and research in long-term oxygen therapy

Article

Oct 1994

Economic Analysis of Respiratory Rehabilitation

Article

Sep 1997

We report on the incremental costs associated with improvements in health-related quality of life (HRQL) following 6 months of respiratory rehabilitation compared with conventional community care. Prospective randomized controlled trial of rehabilitation. A respiratory rehabilitation unit. Eighty-four subjects who completed the rehabilitation trial. Two months of inpatient rehabilitation followed by 4 months of outpatient supervision. All costs (hospitalization, medical care, medications, home care, assistive devices, transportation) were included. Simultaneous allocation was used to determine capital and direct and indirect hospitalization costs. The incremental cost of achieving improvements beyond the minimal clinically important difference in dyspnea, emotional function, and mastery was $11,597 (Canadian). More than 90% of this cost was attributable to the inpatient phase of the program. Of the nonphysician health-care professionals, nursing was identified as the largest cost center, followed by physical therapy and occupational therapy. The number of subjects needed to be treated (NNT) to improve one subject was 4.1 for dyspnea, 4.4 for fatigue, 3.3 for emotion, and 2.5 for mastery. Cost estimates of various approaches to rehabilitation should be combined with valid, reliable, and responsive measures of outcome to enable cost-effectiveness measures to be reported. Comparison studies with the same method are necessary to determine whether the improvements in HRQL that follow inpatient rehabilitation are cheap or expensive. Such information will be important in identifying the extent to which alternative approaches to rehabilitation can influence resource allocation. A consideration of cost-effectiveness from the perspective of NNT may be useful in the evaluation of health-care programs.

Cost-utility of lung transplantation: A pilot study

Article

Dec 1997
J HEART LUNG TRANSPL

The purpose of this study was to conduct a pilot investigation of the cost-utility of lung transplantation. With this study we provide a threshold analysis to estimate the survival gains that must be achieved for lung transplantation to be considered a beneficial use of society's resources. A cross-sectional cohort design was used. All patients having undergone lung transplantation at the University of Pittsburgh Medical Center between March 1 and August 31, 1994, were identified via roster of transplant recipients (n = 20). Surviving patients were interviewed, by telephone, at their 1-year anniversary date. Utility was assessed by use of the quality of well-being scale. Direct cost of care was estimated from adjusted charges for the surgical admission, plus physician fees per the Medicare Physician Fee Schedule. The mean quality of well-being score for this group was 0.54 +/- 0.198 SD (median = 0.599, range 0 to 0.728). Summing the physician cost and the adjusted charges for the inpatient operative admission, the average cost of lung transplantation was $153,921 +/- $133,981 SD (median $94,324, range $63,405 to $598,482). At a cost of $94,324 and a utility of 0.599, the survival gain from surgery must be 2.7 years for the cost of the procedure to be justified from a societal perspective. Because of the many limitations in this pilot study, no firm policy implication may be drawn from these data. Directions for future research are discussed.

Cost-effectiveness of lung transplantation in the Netherlands - A scenario analysis

Article

Feb 1998

To calculate cost-effectiveness of scenarios concerning lung transplantation in The Netherlands. Microsimulation model predicting survival, quality of life, and costs with and without transplantation program, based on data of the Dutch lung transplantation program of 1990 to 1995. Netherlands, University Hospital Groningen. Included were 425 patients referred for lung transplantation, of whom 57 underwent transplantation. Lung transplantation. For the baseline scenario, the costs per life-year gained are G 194,000 (G=Netherlands guilders) and the costs per quality-adjusted life-year (QALY) gained are G 167,000. Restricting patient inflow ("policy scenario") lowers the costs per life-year gained: G 172,000 (costs per QALY gained: G 144,000). The supply of more donor lungs could reduce the costs per life-year gained to G 159,000 (G 135,000 per QALY gained; G1 =US $0.6, based on exchange rate at the time of the study). Lung transplantation is an expensive but effective intervention: survival and quality of life improve substantially after transplantation. The costs per life-year gained are relatively high, compared with other interventions and other types of transplantation. Restricting the patient inflow and/or raising donor supply improves cost-effectiveness to some degree. Limiting the extent of inpatient screening or lower future costs of immunosuppressives may slightly improve the cost-effectiveness of the program.

Pharmacoeconomic Evaluation of a Combination of Ipratropium Plus Albuterol Compared With Ipratropium Alone and Albuterol Alone in COPD*

Article

Apr 1999

To conduct a post hoc pharmacoeconomic evaluation of two double-blind, randomized, prospective, parallel group studies comparing the long-term efficacy and safety of ipratropium combined with albuterol in a single inhalational canister against either bronchodilator agent alone in patients with COPD. Patients: One thousand sixty-seven patients with COPD. The dose of each bronchodilator was two puffs four times a day (42 microg of ipratropium bromide, 240 microg of albuterol sulfate). Pulmonary function testing was performed on days 1, 29, 57, and 85 of treatment. Outcomes, health-care resource consumption, and costs were compared for the three treatment groups over the 85-day study period. A total of 1,067 patients were randomized in the two studies (albuterol alone, n = 347; ipratropium alone, n = 362; albuterol plus ipratropium, n = 358). Improvement in FEV1 and area under the FEV1 response-time curve from time 0 to 4 h (FEV1AUC0-4) was significantly greater for the combination of albuterol plus ipratropium than either agent alone on all test days. Compared with albuterol, patients receiving ipratropium and ipratropium plus albuterol experienced significantly fewer COPD exacerbations and patient-days of exacerbation. In addition, the increased frequency of exacerbations observed in the albuterol group was associated with a significant increase in the number of patient hospital days and antibiotic and corticosteroid use. As a result, the total cost of treatment over the study period was significantly less for ipratropium ($156 per patient) and ipratropium plus albuterol ($197 per patient) than for albuterol ($269 per patient). Increased cost-effectiveness, defined as total estimated treatment cost per mean change in FEV1AUC0-4, was observed in both treatment arms containing ipratropium. The inclusion of ipratropium in a pharmacologic treatment regimen is associated with a lower rate of exacerbations in COPD. The result is lower total treatment costs and improved cost-effectiveness.

Effects of pulmonary rehabilitation on physiologic and psychological and psychosocial outcomes in patients with chronic obstructive pulmonary disease

Jan 1995
823

Ries

Second opinion: why Medicare covers a new lung surgery for just a few patients

Jan 1998
1

Gentry

Further recommendations for prescribing, reimbursement, technology development, and research in long-term oxygen therapy: summary of the Fourth Oxygen Consensus Conference, Washington, DC, October 15–16, 1993

Jan 1994
875

Petty

The economic burden of COPD

Abstract

No full-text available

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