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Kazuyoshi Kurashima, MD, PhD1 Yotaro Takaku, MD1 Keitaro Nakamoto, MD1 Tetsu Kanauchi, MD2 Noboru Takayanagi, MD1 Tsutomu Yanagisawa, MD1 Yutaka Sugita, MD1 Ryuichiro Araki, MD3
Author Affiliations
- Respiratory Medicine, Saitama Cardiovascular and Respiratory Center, Kumagaya City, Saitama, Japan
- Radiology, Saitama Cardiovascular and Respiratory Center, Kumagaya City, Saitama, Japan
- Community Health Science Center, Saitama Medical University, Moroyama-machi, Saitama, Japan
Address correspondence to:
KazuyoshiKurashima, MD, PhD
Department of Respiratory Medicine, Saitama Cardiovascular and Respiratory Center
Itai 1696, Kumagaya City
Saitama 360-0197, Japan
Phone: 81-49-223-8638
Fax: 81-49-223-8638
E-mail: kurashima.kazuyoshi@pref.saitama.lg.jp
Abstract
Background: To evaluate the risk factors for pneumonia and the efficacy of the pneumococcal polysaccharide vaccine (PPV) in patients with chronic airflow obstruction.
Methods: We retrospectively studied the risk factors for pneumonia in 820 consecutive patients with chronic obstructive pulmonary disease (COPD) (n=509) and patients with asthma-COPD overlap syndrome (ACOS) (n=311). The effects of asthma, age, smoking history, chronic sputum, use of inhaled corticosteroids, percent predicted forced vital capacity (%FVC), percent predicted forced expiratory volume in 1 second (%FEV1), body mass index (BMI), computed tomography (CT)-diagnosed emphysema, and the pneumococcal vaccination on the frequency of pneumonia were assessed.
Results: There was no difference in the frequency of pneumonia in patients with COPD and those with ACOS. In a univariate analysis, age (p= 0.031), %FVC (p< 0.001), %FEV1 (p < 0.001), BMI (p = 0.003), the presence of emphysema (p < 0.001) and a history of vaccination with the PPV (p = 0.034) were associated with the frequency of pneumonia. A multivariate analysis identified low BMI, the presence of emphysema and the absence of a pneumococcal vaccination as independent risk factors. The combination index of these factors, the BOVE index, which is calculated from low BMI (<22 kg/m2), low %FEV1 (<60%), vaccination history and emphysema was associated with the overall frequency of pneumonia.
Conclusions:The index of multidimensional risk factors is useful to predict the frequency of pneumonia in patients with chronic airflow obstruction. The pneumococcal vaccination was associated with significantly lower incidence of pneumonia.
Citation
Citation: Kurashima K, Takaku Y, Nakamoto K, et al. Risk factors for pneumonia and the effect of the pneumococcal vaccine in patients with chronic airflow obstruction. Chronic Obstr Pulm Dis (Miami). 2016; 3(3): 610-619. doi: http://dx.doi.org/10.15326/jcopdf.3.3.2015.0167
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Douglas J. Hsu, MD1 Crystal M. North, MD2 Sarah K. Brode, MD3 Bartolome R. Celli, MD4
Author Affiliations
- Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston
- Joint Division of Respirology, Department of Medicine, University Health Network and Mount Sinai Hospital, Toronto, Ontario; Canada West Park Healthcare Centre, Toronto, Ontario; Canada Department of Medicine, University of Toronto, Ontario, Canada
- Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
Address correspondence to:
Douglas Hsu, MD
330 Brookline Ave, KSB-23
Boston, MA 02215
Phone: (617) 667-4437
Email: dhsu@bidmc.harvard.edu
Abstract
Introduction: Patients with chronic obstructive pulmonary disease (COPD) are at increased risk for influenza-related morbidity and mortality. Influenza vaccination is known to decrease influenza incidence, severity, hospitalizations, and mortality. Identification of barriers to influenza vaccination among patients with COPD may aid in efforts to increase vaccination rates. This study aims to identify predictors of influenza vaccination in COPD patients.
Methods: This study used data from the 2012 Behavioral Risk Factor Surveillance System (BRFSS). Participants with self-reported COPD and receiving an influenza vaccination in the prior 12 months were identified. Independent predictors of the exposure were identified by estimating a parsimonious logistic regression model of influenza vaccination. All analyses were performed using weighted data.
Results: The final study sample consisted of 36,811 COPD participants, with 48.5% of COPD patients reporting having been vaccinated and 51.5% reporting being unvaccinated. A total of 15 independent predictors of influenza vaccination in COPD patients were identified. Negative predictors included predisposing factors (younger age, male gender, household children, black or non-white/non-Hispanic/non-black race/ethnicity, lower education level, heavy alcohol use, current tobacco use) and enabling factors that reflect access to medical care (insurance status, ability to afford care, having a recent check-up). Positive predictors of influenza vaccination included need factors (chronic comorbidities), being a military veteran, or being a former smoker.
Conclusions: This analysis identifies multiple predictors of influenza vaccination in persons with COPD. Identification of at risk-groups provides the foundation for development of focused efforts to improve influenza vaccination rates in patients with COPD.
Citation
Citation: Hsu DJ, North CM, Brode SK, Celli BR. Identification of barriers to influenza vaccination in patients with chronic obstructive pulmonary disease: analysis of the 2012 Behavioral Risk Factors Surveillance System. Chronic Obstr Pulm Dis (Miami). 2016; 3(3): 620-627. doi: http://dx.doi.org/10.15326/jcopdf.3.3.2015.0156
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Barbara P. Yawn, MD, MSc1 Peter C. Wollan, PhD1 Kyle B. Textor, BS2 Roy A. Yawn, MD, MBA1
Author Affiliations
- Olmsted Medical Center, Department of Research, Rochester, Minnesota
- University of Illinois, Champaign
Address correspondence to:
Barbara P. Yawn, MD, MSc
Email: byawn47@gmail.com
Phone: (507)261-3096
Abstract
To assess current primary care physicians’, nurse practitioners’ (NP) and physicians assistants’ (PA) knowledge, attitudes and beliefs regarding chronic obstructive pulmonary disease (COPD) and changes from a similar 2007 assessment, we surveyed attendees of 3 regional continuing medical education programs and compared the 2013/2014 responses with responses to a similar survey completed in 2007. Survey data included information on personal demographics, agreement with perceived barriers to COPD diagnosis, awareness, and use of COPD guidelines, and beliefs regarding the value of available COPD therapies. In 2013/2014, 426 primary care clinicians (278 medical doctors [MDs] and doctors of osteopathic medicine [DO] and 148 NPs/PAs) provided useable responses (overall response rate 61%). Overall these physicians were older and more experienced than the NPs/PAs but with few other differences in responses except significantly greater physician reported use of spirometry for COPD diagnosis. About half of the clinicians reported having in-office spirometers but less than two thirds reported using them for all COPD diagnoses. All respondents reported multiple barriers to COPD diagnosis but with fewer than in 2007 reporting lack of knowledge or awareness of COPD guidelines as a major barrier. The most striking difference between 2007 and 2013/2014 responses was the marked increase in beliefs by all clinicians in the ability of COPD treatments to reduce symptoms and numbers of exacerbations. These data affirm that primary care clinicians continue to report multiple barriers to COPD diagnosis including lack of easy access to spirometry and frequent failure to include spirometry in diagnostic confirmation. However, since 2007, the clinicians report a remarkable decline in therapeutic nihilism, which may enhance their interest in learning more about diagnosing and managing COPD.
Citation
Citation: Yawn B, Wollan PC, Textor KB, Yawn RA.Primary care physicians’, nurse practitioners’ and physician assistants’ knowledge, attitudes and beliefs regarding COPD: 2007 to 2014. Chronic Obstr Pulm Dis (Miami). 2016; 3(3): 628-635. doi: http://dx.doi.org/10.15326/jcopdf.3.3.2015.0168
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Valentin Prieto-Centurion, MD1 Nina Bracken, APN1,2 Lourdes Norwick, RN1,2 Farhan Zaidi, MD1 Amelia A. Mutso, PhD2 Victoria Morken, BS2,3 David B. Coultas, MD4 Cynthia S. Rand, PhD5 David X. Marquez, PhD6 Jerry A. Krishnan, MD, PhD1,2,3
Author Affiliations
- Division of Pulmonary, Critical Care, Sleep & Allergy, University of Illinois at Chicago
- Population Health Sciences Program, University of Illinois Hospital & Health Sciences System, Chicago
- Jesse Brown VA Medical Center, Chicago, Illinois
- Portland VA Medical Center, Portland, Oregon
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland
- Department of Kinesiology and Nutrition, University of Illinois at Chicago
Address correspondence to:
Valentin Prieto-Centurion, MD
University of Illinois at Chicago
1220 S Wood St. M/C 619
Chicago, IL 60608
Email: vprieto@uic.edu
Phone: (312) 413-1960
Fax: (312) 355-4100
Abstract
Background: Commercially available pedometers have been used as tools to measure endpoints in studies evaluating physical activity promotion programs. However, their accuracy in patients recovering from COPD exacerbations is unknown. The objectives of this study were to 1) assess the relative accuracy of different commercially available pedometers in healthy volunteers and 2) evaluate the accuracy of the top-performing commercially available pedometer in patients recovering from COPD exacerbations following hospital discharge.
Methods: Twelve healthy volunteers wore 2 pedometers, 2 smartphones with pedometer apps and an accelerometer for 15 minutes of indoor activity. The top-performing device in healthy volunteers was evaluated in 4 patients recovering from COPD exacerbations following hospital discharge during 6 minutes of walking performed at home. Bland-Altman plots were employed to evaluate accuracy of each device compared with direct observation (the reference standard).
Results: In healthy volunteers, the mean percent error compared to direct observation of the various devices ranged from -49% to +1%. The mean percent error [95% confidence interval (CI)] of the top-performing device in healthy volunteers, the Fitbit Zip®, was +1% [-33 to +35%], significantly lower than that of the accelerometer (-13% [-56 to +29%], p=0.01). The mean percent error [95% CI] for the Fitbit Zip® in patients recovering from COPD exacerbations was -3% [-7 to +12%].
Conclusions: The accuracy of commercially available pedometers in healthy volunteers is highly variable. The top-performing pedometer in our study, the Fitbit Zip,® accurately measures step counts in both healthy volunteers and patients recovering from COPD exacerbations.
Citation
Citation: Prieto-Centurion V, Bracken N, Norwick L, et al. Can commercially available pedometers be used for physical activity monitoring in patients with COPD following exacerbations? Chronic Obstr Pulm Dis (Miami). 2016; 3(3): 636-642. doi: http://dx.doi.org/10.15326/jcopdf.3.3.2015.0164
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Jessica Marvel, MPH1 Tzy-Chyi Yu, MHA, PhD1 Robert Wood, BSc2 Mark Small, BSc2 Victoria S. Higgins, BA2 Barry J. Make, MD3
Author Affiliations
- Health Economics and Outcomes Research, Novartis Pharmaceuticals Corporation, East Hanover, New Jersey
- Adelphi Real World, Adelphi Group, Bollington, Cheshire, United Kingdom
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, National Jewish Health, Denver, Colorado
Address correspondence to:
Mark Small
Adelphi Real World
Adelphi Mill
Bollington, Macclesfield
Cheshire
SK10 5JB
United Kingdom
Phone: +44 1625 577366
Fax: +44 1625 577294
Abstract
Background: Despite receiving treatment, patients with chronic obstructive pulmonary disease (COPD) often continue to experience symptoms that impact their health status. We determined the relationship between overall symptom burden and health status, and assessed the treatments patients were receiving.
Methods: Data from 3 cross-sectional surveys of U.S. patients with COPD (2011–2013) were analyzed. Patients receiving inhaled COPD treatment for ≥3 months completed the COPD Assessment Test (CAT) symptom burden and respiratory health status measure, EuroQol 5-dimension (EQ-5D-3L) general health status questionnaire, and Jenkins Sleep Evaluation Questionnaire (JSEQ). CAT scores were used to identify high- (CAT ≥24) and low-symptom patients (CAT <24), who were matched using 1:1 propensity score matching with replacement. Match balance was assessed with standardized mean differences. EQ-5D-3L and JSEQ scores, and current treatment were compared between groups post-matching. Sensitivity was assessed with Rosenbaum bounds.
Results: A total of 638 patients were included. Compared with low-symptom patients, high-symptom patients had worse health status and greater sleep disturbance by EQ-5D utility index (0.85 versus 0.71, respectively; p<0.0001) and JSEQ scores (3.73 versus 7.35, respectively; p<0.0001). High-symptom patients were prescribed single-maintenance bronchodilators ± inhaled corticosteroids (46.0%), triple therapy (40.5%), and short-acting therapy only (8.2%). Results were robust and insensitive to unobserved confounders.
Conclusions: Increased COPD symptom burden is associated with worse general health status in patients receiving COPD treatment. High-symptom patients frequently received single inhaled medication. The results suggest that health care providers should monitor and tailor therapy, based on level of symptom burden to improve symptom control and health status.
Citation
Citation: Marvel J, Yu T-C, Wood R, Small M, Higgins VS, Make BJ. Health status of patients with chronic obstructive pulmonary disease by symptom level. Chronic Obstr Pulm Dis (Miami). 2016; 3(3): 643-652. doi: http://dx.doi.org/10.15326/jcopdf.3.3.2015.0177
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