Clinical Management of COPD in a Real-World Setting. A Big Data Analysis

Izquierdo, José Luis; Morena, Diego; González, Yolanda; Paredero, José Manuel; Pérez, Bernardino Gago; Graziani, Desirée; Gutiérrez, Matilde; Rodríguez, José Miguel

doi:10.1016/j.arbr.2019.12.023

Cited by 42 publications

(29 citation statements)

References 23 publications

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“…Future approaches should focus on targeted community support and social prescribing schemes that purport to engage vulnerable individuals in social interaction in a suitable and risk‐free environment 103 . There has been encouraging progress in more diverse approaches to complement conventional PR, including Singing for Lung Health, 104 dance 105 and Tai Chi 106 which as well as being enjoyable may bring physical and psychological benefits.…”

Section: Addressing the Burden Of Copdmentioning

confidence: 99%

Contemporary perspectives in COPD: Patient burden, the role of gender and trajectories of multimorbidity

et al. 2021

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An individual's experience of COPD is determined by many factors in addition to the pathological features of chronic bronchitis and emphysema and the symptoms that derive directly from them. Multimorbidity is the norm rather than the exception, so most people with COPD are living with a range of other medical problems which can decrease overall quality of life. COPD is caused by the inhalation of noxious particles or gases, in particular tobacco smoke, but also by early life disadvantage impairing lung development and by occupations where inhaled exposures are common (e.g. industrial, farming and cleaning work). Wealthy people are therefore relatively protected from developing COPD and people who do develop the condition may have reduced resources to cope. COPD is also no longer a condition that predominantly affects men. The prevalence of COPD among women has equalled that of men since 2008 in many high‐income countries, due to increased exposure to tobacco, and in low‐income countries due to biomass fuels. COPD is one of the leading causes of death in women in the USA, and death rates attributed to COPD in women in some countries are predicted to overtake those of men in the next decade. Many factors contribute to this phenomenon, but in addition to socioeconomic and occupational factors, there is increasing evidence of a higher susceptibility of females to smoking and pollutants. Quality of life is also more significantly impaired in women. Although most medications (bronchodilators and inhaled corticosteroids) used to treat COPD demonstrate similar trends for exacerbation prevention and lung function improvement in men and women, this is an understudied area and clinical trials frequently have a preponderance of males. A better understanding of gender‐based predictors of efficacy of all therapeutic interventions is crucial for comprehensive patient care. There is an urgent need to recognize the increasing burden of COPD in women and to facilitate global improvements in disease prevention and management in this specific population. Many individuals with COPD follow a trajectory of both lung function decline and also multimorbidity. Unfavourable lung function trajectories throughout life have implications for later development of other chronic diseases. An enhanced understanding of the temporal associations underlying the development of coexisting diseases is a crucial first step in unravelling potential common disease pathways. Lessons can be learned from exploring disease trajectories of other NCD as well as multimorbidity development. Further research will be essential to explain how early life risk factors commonly influence trajectories of COPD and other diseases, how different diseases develop in relation to each other in a temporal way and how this ultimately leads to different multimorbidity patterns in COPD. This review integrates new knowledge and ideas pertaining to three broad themes (i) the overall burden of disease in COPD, (ii) an unappreciated high burden in women and (iii) the contrast...

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Section: Addressing the Burden Of Copdmentioning

confidence: 99%

Contemporary perspectives in COPD: Patient burden, the role of gender and trajectories of multimorbidity

et al. 2021

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“…They are also a good indicator of a worse prognosis since COPD mortality rate is 26.2% in the first year and 64.3% at 5 years [3] following an exacerbation requiring hospital admission. In addition, COPD patients frequently show comorbidities such as bronchiectasis, arterial hypertension, diabetes or heart failure, which interfere with both the diagnosis and the therapeutic management [4][5][6].…”

Section: Introductionmentioning

confidence: 99%

Variability of blood eosinophil count and prognosis of COPD exacerbations

Martínez-Gestoso¹,

García-Sanz²,

Calvo-Álvarez

et al. 2021

Annals of Medicine

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Background: Eosinophils in peripheral blood are one of the emerging biomarkers in chronic obstructive pulmonary disease (COPD) patients. However, when analysing the relationship between peripheral eosinophilia and COPD prognosis, highly variable results are obtained. The aim of our study is to describe the serum eosinophilia levels in COPD patients and to analyse their relationship to prognosis following hospital admission. Methods: A prospective observational study was conducted from 1 October 2016 to 1 October 2018 in the following Spanish centres: Saln es County Hospital in Vilagarc ıa de Arousa, Arquitecto Marcide Hospital in Ferrol and the University Hospital Complex in Santiago de Compostela. The patients were classified using three cut-off points of blood eosinophil count (BEC): 150 cells/mL, 300 cells/mL, and 400 cells/mL; in addition, the peripheral BEC was analysed on admission. Results: 615 patients were included in the study, 86.2% male, mean age 73.9 years, and mean FEV1 52.7%. The mean stay was 8.4 days, and 6% of all patients were readmitted early. No significant relationship was observed between the BEC, neither in the stable phase nor in the acute phase, and hospital stay, readmissions, deaths during admission, the need for intensive care, or the condition of frequent exacerbator. Conclusion:The results of our study do not seem to support the usefulness of BEC as a COPD biomarker. KEY MESSAGES1. There is evidence that BEC participates in pathophysiological mechanisms of the COPD. 2. BEC may be useful as a biomarker in COPD for aspects such as the optimization of treatments. 3. We did not find any relationship between BEC levels and prognosis following hospital admission for AECOPD.

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“…The importance and complexity of improving cNLP systems has given rise to a strong engagement among researchers in developing methods capable of doing so [10][11][12][13][14][15][16]. This resulted in improved cNLP systems that have dramatically changed the scale at which information contained in the free-text portion of EHRs can be utilized [17][18][19][20] and has provided valuable insights into clinical populations [21][22][23][24][25][26][27], epidemiology trends [28][29][30], patient management [31], pharmacovigilance [32], and optimization of hospital resources [33].…”

Section: Introductionmentioning

confidence: 99%

Assessing the Performance of Clinical Natural Language Processing Systems: Development of an Evaluation Methodology

Canales¹,

Menke²,

Marchesseau³

et al. 2021

JMIR Med Inform

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Background Clinical natural language processing (cNLP) systems are of crucial importance due to their increasing capability in extracting clinically important information from free text contained in electronic health records (EHRs). The conversion of a nonstructured representation of a patient’s clinical history into a structured format enables medical doctors to generate clinical knowledge at a level that was not possible before. Finally, the interpretation of the insights gained provided by cNLP systems has a great potential in driving decisions about clinical practice. However, carrying out robust evaluations of those cNLP systems is a complex task that is hindered by a lack of standard guidance on how to systematically approach them. Objective Our objective was to offer natural language processing (NLP) experts a methodology for the evaluation of cNLP systems to assist them in carrying out this task. By following the proposed phases, the robustness and representativeness of the performance metrics of their own cNLP systems can be assured. Methods The proposed evaluation methodology comprised five phases: (1) the definition of the target population, (2) the statistical document collection, (3) the design of the annotation guidelines and annotation project, (4) the external annotations, and (5) the cNLP system performance evaluation. We presented the application of all phases to evaluate the performance of a cNLP system called “EHRead Technology” (developed by Savana, an international medical company), applied in a study on patients with asthma. As part of the evaluation methodology, we introduced the Sample Size Calculator for Evaluations (SLiCE), a software tool that calculates the number of documents needed to achieve a statistically useful and resourceful gold standard. Results The application of the proposed evaluation methodology on a real use-case study of patients with asthma revealed the benefit of the different phases for cNLP system evaluations. By using SLiCE to adjust the number of documents needed, a meaningful and resourceful gold standard was created. In the presented use-case, using as little as 519 EHRs, it was possible to evaluate the performance of the cNLP system and obtain performance metrics for the primary variable within the expected CIs. Conclusions We showed that our evaluation methodology can offer guidance to NLP experts on how to approach the evaluation of their cNLP systems. By following the five phases, NLP experts can assure the robustness of their evaluation and avoid unnecessary investment of human and financial resources. Besides the theoretical guidance, we offer SLiCE as an easy-to-use, open-source Python library.

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Clinical Management of COPD in a Real-World Setting. A Big Data Analysis

Cited by 42 publications

References 23 publications

Contemporary perspectives in COPD: Patient burden, the role of gender and trajectories of multimorbidity

Contemporary perspectives in COPD: Patient burden, the role of gender and trajectories of multimorbidity

Variability of blood eosinophil count and prognosis of COPD exacerbations

Assessing the Performance of Clinical Natural Language Processing Systems: Development of an Evaluation Methodology

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