Author Affiliations

1. Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham
2. University of Alabama at Birmingham Lung Health Center, Birmingham

Address correspondence to:

Surya P. Bhatt, MD
University of Alabama at Birmingham
Division of Pulmonary, Allergy and Critical Care Medicine
THT 422
1720, 2nd Avenue South
Birmingham, AL 35294
Email: sbhatt@uabmc.edu
Phone: 205-996-6864
Fax: 205-934-6229

Abstract

This article does not contain an abstract.

Citation

Citation: Bhatt SP. Panlobular emphysema: enhancing visibility with quantitative computed tomography. J COPD F. 2016; 3(3): 683-687. doi: http://doi.org/10.15326/jcopdf.3.3.2016.0130

Keywords

computed tomography, panlobular emphysema, quantitative

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Author Affiliations

1. Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
2. Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston
3. 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
4. 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. J COPD F. 2016; 3(3): 620-627. doi: http://doi.org/10.15326/jcopdf.3.3.2015.0156

Keywords

COPD, chronic obstructive pulmonary disease, influenza, vaccination, prevention

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Author Affiliations

1. Olmsted Medical Center, Department of Research, Rochester, Minnesota
2. 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. J COPD F. 2016; 3(3): 628-635. doi: http://doi.org/10.15326/jcopdf.3.3.2015.0168

Keywords

COPD, primary care, survey, therapeutic nihilism, barriers

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Author Affiliations

1. Health Economics and Outcomes Research, Novartis Pharmaceuticals Corporation, East Hanover, New Jersey
2. Adelphi Real World, Adelphi Group, Bollington, Cheshire, United Kingdom
3. 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. J COPD F. 2016; 3(3): 643-652. doi: http://doi.org/10.15326/jcopdf.3.3.2015.0177

Keywords

COPD, health status, symptom burden, GOLD strategy, standard of care

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