Despite increased interest and awareness of chronic obstructive pulmonary disease (COPD), nearly half of the people with COPD remain undiagnosed. Inviting people at risk for screening is unlikely to be effective as many will not attend. Co-morbidities are common in people with COPD but COPD is also a comorbidity of other long-term conditions and people with these conditions are under regular review in primary care clinics. This study aimed to develop a pilot programme to case find people with COPD among patients attending other long-term clinics in primary care. Twenty-three general practices were recruited to participate in South West England. All current or ex-smokers aged ≥35 attending a long-term condition clinic who were not known to have COPD were asked to complete a questionnaire designed to help identify people with COPD and to perform microspirometry. Practices were asked to collect data on up to 100 patients. One thousand three hundred and thirty-three patients were assessed. Four hundred and ten people (31%) were current smokers. Six hundred and thirteen (46%) had high questionnaire scores and 287 (22%) of these also had a forced expiratory volume in 1 second (FEV) below the lower limit of normal (LLN). The mean FEV in these patients was 59.0% of predicted (range 22-79.0%). Two hundred and twenty-four had an FEV between 50% and 80% of predicted, 50 had an FEV between 30% and 50% of predicted. One hundred and sixteen (40%) of the people with an FEV below the LLN were still smoking and 55 accepted referral to cessation services. A total of 56% of the other smokers assessed but not thought to have COPD also accepted referral. Assessing symptoms and performing microspirometry in people attending long-term condition clinics in primary care is feasible and has a high yield of identifying people likely to have previously undiagnosed COPD.
Patient‐reported concerns indicate that gastrointestinal (GI) manifestations affect the skeletal dysplasia population, but quantitative information regarding prevalence and severity of GI issues is limited. We examined the frequency and characteristics of GI symptoms in adults with skeletal dysplasias by reviewing 101 responses to the Gastrointestinal Symptom Rating Scale (GSRS). Participant demographics, medication history, and ambulatory status were collected from medical records. Compared to published GSRS reference data, our cohort scored higher on reflux, diarrhea, and total scores, and lower on abdominal pain and indigestion scores; none of these differences were statistically significant. Although osteogenesis imperfecta respondents had more severe symptoms across all domains, only reflux reached significance (p = 0.009). Scores in patients with achondroplasia were higher for indigestion, constipation, diarrhea, and total scores and lower on abdominal pain and reflux scores than the general population; only the diarrhea score was significant (p = 0.034). There were no statistically significant differences in any of the domain or total GSRS scores across ambulatory status groups. Increased height correlated with worse abdominal pain domain score (p = 0.033). The number of medications positively correlated with total GSRS score (p = 0.013). Future studies should include larger numbers of individuals to allow a more in‐depth analysis of patient‐reported symptoms and signs within this population.
Correct inhaler technique is essential for patients to get benefits from their therapy. The South West Respiratory Network formulated a project to develop and deliver an inhaler technique training programme for clinicians
Correct inhaler technique is essential for patients to get benefits from their therapy. Evidence shows that up to 90% of patients do not take their inhaler properly. A number of factors are associated with an increased chance of poor inhaler technique. Health professionals have an important role in teaching patients the correct inhaler technique, but many clinicians themselves do not know how to use inhalers correctly. The South West Respiratory Network formulated a project to develop and deliver an inhaler technique training programme for clinicians. The first wave of training created 50 ‘ambassadors’, who will deliver training locally to other health professionals, thus spreading expertise. An online competency assessment tool will provide assurance of the level of competence in knowledge of inhalers gained through the training and additional practice. The project aims to increase the number of people who are able to use their inhaler correctly, resulting in better disease control and savings to the NHS.
Introduction and Objectives Exacerbations because of COPD are the third largest cause of emergency hospital admissions in the UK. This systematic literature review explored the relationshipbetween hospitalisation rates and the COPD co-morbidities, anxiety and depression. Methods The Centre for Research Dissemination's framework for systematic reviews was followed using search terms relating to COPD, anxiety, depression and hospital admission. Papers identified were assessed for relevance and quality using a suitable CASP tool and the Mixed Methods Assessment Tool (MMAT). Results Quantitative studies (18) indicated that anxiety and depression led to a statistically significant increase in the likelihood of COPD patients being hospitalised. These co-morbidities also led to an increased length of stay and a greater risk of mortality post discharge. Other significant factors included lower BODE scores, female gender, lower socioeconomic status, poorer patient perceived quality of life, increased severity of lung function and less improvement in dyspnoea from admission to discharge. It was also highlighted that only 27-33% of those with depression were being treated for it. Qualitative studies (6), revealed that patients saw anxiety and depression as a major factor that affected their ability to cope with and self-manage their condition. Implications Findings from the systematic review have highlighted a need for better recognition and treatment of anxiety and depression amongst individuals with COPD. On-going research will develop and test strategies for promoting better management and self-management as a means of reducing hospital admissions. M19 THE IMPACT OF CO-MORBIDITIES ON PHYSICAL FUNCTION AND HEALTH STATUS IN CHRONIC OBSTRUCTION PULMONARY DISEASE (COPD)NS Gale, AM Albarrati, IC Munnery, MM Munnery, JC Cockcroft, DJ Shale; Wales Heart Research Institute, Cardiff University, Cardiff, UK 10. 1136/thoraxjnl-2013-204457.429 Background Co-morbidities are of increasing importance in patients with COPD. However, the implications for function and health status have not been fully established. We hypothesised that the number of co-morbidities would relate to physical capacity, health status and impairments as measured by the comprehensive geriatric assessment (CGA) in COPD but not comparator subjects. Method As part of the longitudinal Assessment of Risk in Chronic Airways Disease Evaluation (ARCADE), 500 patients with stable COPD (confirmed with spirometry) were compared to 141 comparator subjects (past or current smokers) free from respiratory disease. In all subjects previously diagnosed co-morbidities including; hypertension, hypercholesterolemia, angina, myocardial infarction, Stroke/TIA, atrial fibrillation, diabetes, and osteoporosis were recorded using a standardised health questionnaire. Spirometry, BMI, six minute walk distance (6MWD), the Timed Up and Go (TUG), and the number of impairments were determined using the CGA. Patients with COPD also completed the St George's Respiratory Questionnaire (SGRQ)....
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