Three-year follow-up study of respiratory and systemic manifestations of chronic obstructive pulmonary disease

Ferrari, Renata; Tanni, Suzana Erico; Faganello, Márcia Maria; Caram, Laura; Lucheta, Paulo Adolfo; Godoy, Irma

doi:10.1590/s0100-879x2010007500150

Cited by 14 publications

(16 citation statements)

References 31 publications

(40 reference statements)

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“…[17][18][19][20] A few studies on the respiratory and systemic manifestations of COPD showed that the FEV 1 , expressed as the percentage of predicted values, did not change significantly in subjects with COPD, 21,22 which is consistent with our findings. Our results show that the decrease in FEV 1 in subjects with stage I and II COPD in the health management group was less pronounced than that in the control group.…”

Section: Discussionsupporting

confidence: 90%

“…However, the impact of COPD on subjects depends mostly on the severity of the symptoms, rather than just the degree of air-flow limitation. 21,[23][24][25] Therefore, the FEV 1 alone is not sufficient to provide an accurate evaluation of the efficacy of a COPD management intervention program. In this study, the efficacy of a community-based intervention program that we developed was assessed regarding multiple aspects of COPD management.…”

Section: Discussionmentioning

confidence: 99%

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A COPD Health Management Program in a Community-Based Primary Care Setting: A Randomized Controlled Trial

Lou¹,

Chen²,

Zhang³

et al. 2014

Respir Care

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BACKGROUND: A number of effective strategies have been developed to improve the quality of life in patients with COPD. However, few have been implemented in patients with COPD at all stages in a community setting. This study evaluated the efficacy of a complex COPD health management intervention in rural communities in China. METHODS: A randomized controlled trial including 8,217 subjects with COPD was implemented from May 2008 to May 2012 in 14 community health-care centers. The control group of subjects received usual care, whereas the management group of subjects participated in a health management program that included assessing the subjects' health status, giving regular health lectures, smoking cessation counseling, encouraging regular exercise, providing rehabilitative training and psychological counseling, and regular followup. As a primary outcome, we examined the changes in the BODE index. Secondary outcomes included depression and anxiety rates, current smoking rate, awareness of COPD, mortality, risk factors, respiratory medication use, hospital admissions, and emergency department visits. RESULTS: After 4 y, the mean cumulative value of the BODE index increased by 0.7 per subject in the control group and decreased by 0.4 per subject in the health management group (difference of 1.1, 95% CI 0.2-2.0, P < .001). Health management reduced anxiety symptoms by 4.8%, depression symptoms by 6.6%, current smoking by 14.3%, mortality due to all causes by 9.0%, hospitalizations due to all causes by 16.1%, and emergency department visits due to all causes by 18.1% (P < .05 for all). However, it increased immunomodulator use by 58.9%, respiratory medication use by 14.1-21.9%, and awareness scores for COPD by 57.2% (P < .05 for all). CONCLUSIONS: The health management program is an effective community-based strategy for the prevention and management of COPD in China, increasing awareness and knowledge among patients and practitioners and improving management within the limitations of access to pharmacotherapy.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

A COPD Health Management Program in a Community-Based Primary Care Setting: A Randomized Controlled Trial

Lou¹,

Chen²,

Zhang³

et al. 2014

Respir Care

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“…There was no difference in the proportion of patients within each disease severity between baseline and after three years (p = 0.99). The comparison of 53 patients’ characteristics between baseline and after three years is shown in Table 1 and has been included in a previous publication with 95 patients [22]. …”

Section: Resultsmentioning

confidence: 99%

Three-year follow-up of Interleukin 6 and C-reactive protein in chronic obstructive pulmonary disease

Ferrari¹,

Tanni²,

Caram³

et al. 2013

Respir Res

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BackgroundPast studies have shown that mean values of Interleukin-6 (IL-6) and C-reactive protein (CRP) do not change significantly in COPD patients over a one-year period. However, longer period follow-up studies are still lacking. Thus, the aim of this study is to evaluate plasma CRP and IL-6 concentration over three years in COPD patients and to test the association between these inflammatory mediators and disease outcome markers.MethodsA cohort of 77 outpatients with stable COPD was evaluated at baseline, and 53 (mean FEV1, 56% predicted) were included in the prospective study. We evaluated Interleukin-6 (IL-6), C-reactive protein (CRP), six-minute walking distance (6MWD), and body mass index (BMI) at baseline and after three years. Plasma concentration of IL-6 was measured by high sensitivity ELISA, and CRP was obtained by high sensitivity particle-enhanced immunonephelometry.ResultsIL-6 increased significantly after 3 years compared to baseline measurements [0.8 (0.5-1.3) vs 2.4 (1.3-4.4) pg/ml; p < 0.001] and was associated with worse 6MWD performance. In the Cox regression, increased IL-6 at baseline was associated with mortality [Hazard Ratio (95% CI) = 2.68 (0.13, 1.84); p = 0.02]. CRP mean values did not change [5 (1.6-7.9) vs 4.7 (1.7-10) pg/L; p = 0.84], although eleven patients (21%) presented with changes >3 mg/L in CRP after 3 years.ConclusionsThe systemic inflammatory process, evaluated by IL-6, seems to be persistent, progressive and associated with mortality and worse physical performance in COPD patients.Trial registrationNo.:NCT00605540

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“…The comparison of patient characteristics between baseline and after three years is shown in Table 1 and has been presented in a previous publication [23]. …”

Section: Resultsmentioning

confidence: 99%

Predictors of health status do not change over three-year periods and exacerbation makes difference in chronic obstructive pulmonary disease

Ferrari

Tanni

Caram

et al. 2011

Health and Quality of Life Outcomes

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BackgroundThe association between disease markers and health status (HS) overtime is unclear. The aim of this study was to verify the predictors of HS at baseline and after three years in Chronic Obstructive Pulmonary Disease (COPD) patients.MethodsNinety-five consecutive COPD patients (66% male, age = 67 ± 9 y, FEV1 = 58 ± 23%) underwent the following evaluations at baseline and after three years: body composition, pulse oximetry (SpO2), six-minute walk distance (6MWD), Modified edical Research Council dyspnea scale (MMRC) and Saint George's Respiratory Questionnaire (SGRQ). The Charlson comorbidity index and BODE index were calculated. COPD exacerbations during the follow-up were evaluated. At baseline, age, gender, smoking, SpO2, BODE index or its components (BMI, MMRC, FEV1 and 6MWD), and Charlson index were included in a multiple linear regression analysis with the baseline SGRQ total score as the dependent variable. After three years, we included the final values of the variables plus the number of exacerbations and the final SGRQ total score as the dependent variable.ResultsSGRQ total score (42 ± 19% vs 44 ± 19%; p = 0.041) and activity domain (52 ± 21% vs 60 ± 22%; p < 0.001) deteriorated during follow-up. At baseline, BODE index was selected as a predictor of SGRQ total score (R2 = 0.46; p < 0.001); after three years, BODE index and age were the predictors (R2 = 0.49; p < 0.001). When the BODE index was replaced by its variables, MMRC was selected as the only variable associated with the SGRQ total score (R2 = 0.58; p < 0.001). After three years, MMRC, FEV1 and number of exacerbations were selected as predictors of SGRQ total score (R2 = 0.63; p < 0.001).ConclusionHS deteriorated significantly over the three-year period and the predictors of HS do not change over time. BODE index and dyspnea were predictors at baseline and after three years. Exacerbation was also a predictor of HS after three years.Trial RegistrationClinicalTrials.gov: NCT00605540

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Three-year follow-up study of respiratory and systemic manifestations of chronic obstructive pulmonary disease

Cited by 14 publications

References 31 publications

A COPD Health Management Program in a Community-Based Primary Care Setting: A Randomized Controlled Trial

A COPD Health Management Program in a Community-Based Primary Care Setting: A Randomized Controlled Trial

Three-year follow-up of Interleukin 6 and C-reactive protein in chronic obstructive pulmonary disease

Predictors of health status do not change over three-year periods and exacerbation makes difference in chronic obstructive pulmonary disease

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