Geographic differences in clinical characteristics and management of COPD: the EPOCA study

Miravitlles, Marc; Murio, Cristina; Tirado-Conde, Gema; Levy, Gur; Muellerova, Hana; Soriano, Joan B.; Ramírez‐Venegas, Alejandra; Ko, Fanny Wai San; Canelos-Estrella, Byron; Giugno, Eduardo; Bergna, Miguel; Chérrez, Ivan; Anzueto, Antonio

doi:10.2147/copd.s4257

Cited by 54 publications

(55 citation statements)

References 40 publications

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“…4 In an international, multicentre study reviewing the geographic differences in management of COPD patients, LAMA (tiotropium) usage was 36% and combined use of LABA and inhaled corticosteroids (ICS) was 46% globally. 16 In Hong Kong, the usage of LAMA was less than 2% and combined LABA/ICS was only 13%. 16 The higher exacerbation rate in Hong Kong might be related to the lower prescription rates for LAMA and/or LABA/ICS drugs.…”

Section: Discussionmentioning

confidence: 99%

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Severity of airflow limitation, co-morbidities and management of chronic obstructive pulmonary disease patients acutely admitted to hospital

Au¹,

Chan²

2013

Hong Kong Med J

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Objective To assess the disease spectrum, severity of airflow limitation, admission pattern, co-morbidities, and management of patients admitted for acute exacerbations of chronic obstructive pulmonary disease. Design Case series.Setting An acute regional hospital in Hong Kong.Patients Adult subjects admitted during January 2010 to December 2010 with the principal discharge diagnosis of chronic obstructive pulmonary disease. ResultsIn all, the records of 253 patients with physician-diagnosed chronic obstructive pulmonary disease were analysed. The majority were old (mean age, 78 years). The median number of admissions per patient for this condition in 2010 was two. About two thirds (64%) had had spirometry at least once. Mean forced expiratory volume in one second predicted was 55%. Almost 90% had moderate-to-very severe airflow limitation by spirometry. Overall, long-acting bronchodilators (beta agonists and/or antimuscarinics) were being prescribed for only 21% of the patients. ConclusionMost of the patients admitted to hospital for acute exacerbations of chronic obstructive pulmonary disease were old, had multiple co-morbidities, and the majority had moderate-to-severe airflow limitation by spirometry. Almost half of them (around 46%) had two or more admissions in 2010. Adherence to the latest treatment guidelines seemed inadequate, there being a low prescription rate of long-acting bronchodilators. Chronic obstructive pulmonary disease patients warranting emergency admissions are at risk of future exacerbations and mortality. Management by a designated multidisciplinary team is recommended. Severity of airflow limitation, co-morbidities and management of chronic obstructive pulmonary disease patients acutely admitted to hospital O R I G I N A L A R T I C L E LH Au HS Chan 區力行陳學深New knowledge added by this study • Almost 90% of chronic obstructive pulmonary disease (COPD) subjects with spirometry performed had moderate-to-very severe disease when hospital admission ensued. • About half of these patients had two or more admissions in 1 year.• Despite the severity of their illness, long-acting bronchodilators were underused by these Hong Kong COPD patients.• Long-term oxygen therapy and non-invasive ventilation (acute and long term) were used by significant numbers of patients with severe-to-very severe disease. Implications for clinical practice or policy• As many COPD patients warranting hospital admissions were already at high risk, preferably they should be managed by a multidisciplinary team in a designated respiratory or COPD ward.• Patients with a clinical diagnosis of COPD should have confirmatory spirometry.• Patients with moderate-to-severe COPD disease warrant planned interventions (including use of long-acting bronchodilators) to reduce future exacerbations and hospital admissions.• COPD patients with hypercapnic respiratory failure are at risk of mortality, and if feasible, should be managed by trained staff in a dedicated team.

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Section: Discussionmentioning

confidence: 99%

“…16 In Hong Kong, the usage of LAMA was less than 2% and combined LABA/ICS was only 13%. 16 The higher exacerbation rate in Hong Kong might be related to the lower prescription rates for LAMA and/or LABA/ICS drugs. Thus, adherence to treatment guidelines appears insufficient, and may be partly related to cost concerns.…”

Section: Discussionmentioning

confidence: 99%

Severity of airflow limitation, co-morbidities and management of chronic obstructive pulmonary disease patients acutely admitted to hospital

Au¹,

Chan²

2013

Hong Kong Med J

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“…However, Spanish study reported that sputum production and cough had the highest circadian variability (6), whereas breathlessness was reported as the most common and troublesome symptom among European populations (5). All these fluctuations could be attributed to geographic variations, genetic background, exposure to risk factors and management strategies around the world (12)(13)(14).…”

Section: Prevalence Variation and Severity Of Copd Symptomsmentioning

confidence: 99%

Perception of circadian variation of symptoms in Chinese patients with chronic obstructive pulmonary disease

Wang

Cai

et al. 2017

J. Thorac. Dis.

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Background: Although, the variable pattern of asthmatic symptoms is well recognized, little is known about the respiratory symptoms variability in patients of chronic obstructive pulmonary disease (COPD). The present study evaluated the variability of the respiratory symptoms in a day and their influence on the daily activities in a cohort of Chinese COPD patients. Methods: An observational cross-sectional study was conducted in 11 medical centers of China.Participants were outpatient ≥40 years old with stable COPD, post-bronchodilator forced expiratory volume in 1 second (FEV1) <80% predicted. Overall, data of 1,032 eligible patients were valid for final analysis.Results: Mean post bronchodilator FEV1 (predicted %) was 46.5%. Cough, expectoration and dyspnea were the most commonly observed symptoms (73.6%, 68.8% and 61.4%, respectively). Daily symptom variability was experienced by 50.2% of symptomatic patients. The wake up time in the morning was the worst and the most troublesome time during the day (39.3%), followed by the nighttime (21.3%). The morning activities were most affected by COPD symptoms. Multivariate analyses revealed that COPD assessment test (CAT) scores was the only factor correlated with patients' symptom variability [odds ratio (OR) =0.463, P<0.0001]. Conclusions: Patient-perceived symptoms vary during the day in Chinese COPD patients. They experience the greatest increase in respiratory symptoms early in the morning. This variation should be considered as a potential new target in the long-term COPD management.

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“…Patients included in clinical trials have a mean of 1-3 exacerbations per year [8]. In an international observational study there was a significant relationship between the severity of airflow obstruction and an increased number of exacerbations per year; however, this relationship was weak, indicating that many other factors influence the risk of having an exacerbation [9].…”

Section: Definition and Frequency Of Exacerbationsmentioning

confidence: 99%

“…These products have been frequently used [9], but the scientific evidence supporting their use has traditionally been insufficient.…”

Section: Mucolyticsmentioning

confidence: 99%

Prevention of exacerbations of COPD with pharmacotherapy

Miravitlles¹

2010

Eur Respir Rev

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Exacerbations are a frequent event in the evolution of chronic obstructive pulmonary disease (COPD) patients. Individuals with COPD have a mean of 1-3 episodes per year, some of which lead to hospital admission and may even be a cause of death. The importance of COPD exacerbations has become increasingly apparent due to the impact these episodes have on the natural history of disease. It is now known that frequent exacerbations can adversely affect health-related quality of life and short-and long-term pulmonary function. Optimising treatment for stable COPD will help to reduce exacerbations.Long-acting bronchodilators, alone or combined with inhaled corticosteroids, have demonstrated efficacy in reducing the rate of exacerbations in patients with COPD. Other innovative approaches are being investigated, such as the long-term use of macrolides or the use of antibiotics in an effort to suppress bronchial colonisation and consequent exacerbations. Other drugs, such as mucolytics and immunomodulators, have recently provided positive results.Non-pharmacological interventions such as rehabilitation, self-management plans and the maintenance of high levels of physical activity in daily life are also useful strategies to prevent exacerbations in patients with COPD and should be implemented in regular clinical practice.

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Geographic differences in clinical characteristics and management of COPD: the EPOCA study

Cited by 54 publications

References 40 publications

Severity of airflow limitation, co-morbidities and management of chronic obstructive pulmonary disease patients acutely admitted to hospital

Severity of airflow limitation, co-morbidities and management of chronic obstructive pulmonary disease patients acutely admitted to hospital

Perception of circadian variation of symptoms in Chinese patients with chronic obstructive pulmonary disease

Prevention of exacerbations of COPD with pharmacotherapy

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