A new perspective on optimal care for patients with COPD

Postma, Dirkje S.; Anzueto, Antonio; Calverley, Peter M.A.; Jenkins, Christine; Make, Barry J.; Sciurba, Frank C.; Similowski, Thomas; Molen, Thys van der; Eriksson, Göran

doi:10.4104/pcrj.2011.00041

Cited by 38 publications

(28 citation statements)

References 19 publications

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“…that patients with COPD may require hospitalisation (and/or die) for reasons not directly related to COPD (comorbidities). Because they are amenable to therapy [22], this observation supports the emphasis made by the 2011 GOLD document on the importance of actively looking for, and adequately treating if present, the comorbidities known to frequently occur in COPD patients [2]. 5) Since ECLIPSE does not have information on specific causes of death, we explored factors associated with increased risk of mortality (and hospitalisations) using a Cox proportional hazards regression model.…”

Section: Novel Observationsmentioning

confidence: 58%

Characteristics, stability and outcomes of the 2011 GOLD COPD groups in the ECLIPSE cohort

Agustí

Edwards

Celli³

et al. 2013

Eur Respir J

172

193

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The 2011 Global Initiative for Chronic Obstructive Lung Disease (GOLD) classifies patients with chronic obstructive pulmonary disease (COPD) into four groups (A to D).We explored the characteristics, stability and relationship to outcomes of these groups within the ECLIPSE study (Evaluation of COPD Longitudinally to Identify Predictive Surrogate End-points) (n52101).Main results showed that: 1) these groups differed in several clinical, functional, imaging and biological characteristics in addition to those used for their own definition; 2) A and D groups were relatively stable over time, whereas groups B and C showed more temporal variability; 3) the risk of exacerbation over 3 years increased progressively from A to D, whereas that of hospitalisation and mortality were lowest in A, highest in D and intermediate and similar in B and C, despite the former having milder airflow limitation. The prevalence of comorbidities and persistent systemic inflammation were highest in group B.The different longitudinal behaviour of group A versus B and C versus D (each pair with similar forced expiratory volume in1 s (FEV1) values supports the 2011 GOLD proposal of assessing COPD patients by more than FEV1 only. However the assumption that symptoms do not equate to risk appears to be naïve, as groups B and C carry equally poor clinical outcomes, though for different reasons. @ERSpublications Exploring distribution, characteristics, temporal stability and relationship with 2011 GOLD group outcomes in ECLIPSE

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Section: Novel Observationsmentioning

confidence: 58%

Characteristics, stability and outcomes of the 2011 GOLD COPD groups in the ECLIPSE cohort

Agustí

Edwards

Celli³

et al. 2013

Eur Respir J

172

193

View full text Add to dashboard Cite

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“…Ideally, they should serve to work towards 'optimal COPD care', based on the concept that here-and-now goals should be integrated with goals to improve long-term outcomes and reduce future risk. 1 However, this integration has (until recently) been overlooked, largely because multidimensional indices have usually been developed in selected patient groups and thus lack external validity in the community.…”

Section: Editorialsmentioning

confidence: 99%

Using COPD multidimensional indices in routine clinical practice: DOSE meets all criteria

Chavannes

Jones

Postma

et al. 2012

Primary Care Respiratory Journal

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EditorialsHow should we employ multidimensional indices of COPD? Ideally, they should serve to work towards 'optimal COPD care', based on the concept that here-and-now goals should be integrated with goals to improve long-term outcomes and reduce future risk.1 However, this integration has (until recently) been overlooked, largely because multidimensional indices have usually been developed in selected patient groups and thus lack external validity in the community.In this issue of the PCRJ, Josefin Sundh and colleagues present a large study assessing the merits of the DOSE (dyspnea, obstruction, smoking, exacerbations) index in predicting mortality in both primary and secondary care patients.2 This is an important paper, since it adds knowledge to the existing applicability of DOSE which previously has been shown to predict hospitalisation, respiratory failure and exacerbation risk. 3 The authors investigated 1,111 COPD patients aged 34-75 years, randomly selected from 70 Swedish primary and secondary care centres. 562 patients had complete data on all DOSE index components, i.e. MRC dyspnoea scale, forced expiratory volume in 1 second (FEV1) expressed as percent predicted (FEV1 %pred), smoking status, and exacerbation rate. Over the course of five years, 116 patients (20.6%) died. Mortality was higher in patients with a DOSE index score >4 (42.4%) than for lower scores (11.0%) (p<0.0001). Compared with a DOSE index score of 0-3, the hazard ratio for mortality was 3.48 (95% CI 2.32 to 5.22) for a score of 4-5, and 8.00 (95% CI 4.67 to 13.7) for a score of 6-8. Thus, the DOSE index has now been shown to be associated with mortality in COPD patients in both primary and secondary care, and can be used to assess prognosis in addition to other clinically relevant issues.Originally, DOSE was designed as a predictor of health status, whereas both BODE (BMI, Obstruction, Dyspnoea, Exercise) and ADO (Age, Dyspnoea, Obstruction) were derived as predictors of mortality. ADO has the disadvantage that it is affected by age; younger people with worse COPD based on MRC or FEV1 score better than their older counterparts. This is counterintuitive, since one would expect younger people with advanced COPD to have more serious disease than older people.4 BODE has been studied extensively, yet has the major practical drawback that it requires a 6-minute walking test. This stems from its original development in a rehabilitation setting. However, the majority of COPD patients are managed in primary care where this test is not usually performed -although it could be, provided trained personnel and a 30m hallway were available.To use any given index in primary care it should be able to identify individuals with the highest current burden of disease who are at risk of future morbidity and mortality. General criteria for the use of an index in routine clinical practice are that it should be: (i) simple to record and calculate, (ii) the component items should be easy to assess and record, (iii) the component items should be clinically imp...

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“…It has been found that GPs intentionally avoid early diagnosis as a result of misperception of patients’ unwillingness to be given a diagnosis and their own pessimistic attitude to prognosis 4. To achieve ‘optimal’ COPD care, holistic management is proposed based on the concept that immediate goals should be integrated with goals to improve long-term outcomes 10. COPD has been described as ‘a story with no beginning’,11 as early symptoms are seen as a normal way of life 3,11–13.…”

Section: Introductionmentioning

confidence: 99%

Living in negotiation: patients’experiences of being in the diagnostic process of COPD

Lindgren¹,

Storli²,

Gustin³

2014

COPD

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PurposeTo illuminate patients’ lived experiences of going through the process of being diagnosed with chronic obstructive pulmonary disease (COPD).Patients and methodsA phenomenological-hermeneutic analysis was applied in the interpretation of interviews with eight persons diagnosed with mild or moderate COPD.ResultsOne main theme ‘living in negotiation’, and three themes ‘living with a body out of step with the diagnosis’, ‘dealing with the past’, and ‘being challenged by the future’ reflected the process participants were living through in their quest for acceptance and a new balance in life. Participants found that the diagnostic processes were confusing, and that the diagnosis itself was ‘a slap in the face’. Unclear messages gave rise to fluctuating between an understanding of the condition as ‘not too severe’, insecurity, and fear. Shame and guilt related to the diagnosis had origins in the past, and in combination with the idea of ‘chronic’ the COPD diagnosis interfered with the present moment and gave rise to uncertainty for the future. The understanding of the present is related to negotiations not only with the past, but also with the future. Thus temporal aspects of the diagnosis are of great significance for the process of finding acceptance.ConclusionRegardless of disease severity, the diagnosis seems to be a breakdown of life, which puts life itself at stake. Medical professionals should be aware that the way the diagnosis is disclosed and communicated has considerable significance for how individuals understand and deal with their illness. The diagnosis should be communicated face-to-face, clearly and with empathy, and followed by information about COPD. Physicians should allow time and listen to the patients’ stories, and thus develop a shared understanding of the temporal aspect of the illness and patients’ needs and concerns. Thus, good communication is essential in determining whether the patient remains in negotiation, or enters a process toward acceptance and new understanding.

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A new perspective on optimal care for patients with COPD

Cited by 38 publications

References 19 publications

Characteristics, stability and outcomes of the 2011 GOLD COPD groups in the ECLIPSE cohort

Characteristics, stability and outcomes of the 2011 GOLD COPD groups in the ECLIPSE cohort

Using COPD multidimensional indices in routine clinical practice: DOSE meets all criteria

Living in negotiation: patients’experiences of being in the diagnostic process of COPD

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A new perspective on optimal care for patients with COPD

Cited by 38 publications

References 19 publications

Characteristics, stability and outcomes of the 2011 GOLD COPD groups in the ECLIPSE cohort

Characteristics, stability and outcomes of the 2011 GOLD COPD groups in the ECLIPSE cohort

Using COPD multidimensional indices in routine clinical practice: DOSE meets all criteria

Living in negotiation: patients&rsquo;experiences of being in the diagnostic process of COPD

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Living in negotiation: patients’experiences of being in the diagnostic process of COPD