Lung Disease and Social Justice: Chronic Obstructive Pulmonary Disease as a Manifestation of Structural Violence

Williams, Parris J.; Buttery, Sara C.; Laverty, Anthony A.; Hopkinson, Nicholas S.

doi:10.1164/rccm.202309-1650ci

Cited by 6 publications

(2 citation statements)

References 89 publications

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“…14 Authors have recently argued that COPD as a condition should be viewed as a manifestation of 'structural violence', something that has been done to individuals (eg, growing up and living in poverty) not that something they have done to themselves (eg, smoking). 15 This model also highlights the effects of low status of COPD, delayed diagnosis and poor care.…”

Section: Discussionmentioning

confidence: 96%

Impact of omitting annual reviews for COPD on patient reported care quality– outcomes from the Asthma+Lung COPD patient passport

Williams,

Bachir,

Philip

et al. 2024

BMJ Open

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BackgroundRegular clinical reviews of people with COPD provide an opportunity to optimise management and are recommended in national and international guidelines. However, there are limited data about the relationship between having an annual review and other aspects of care quality, which might influence decision-making by healthcare professionals and commissioners.MethodUsing data from 74 827 people with COPD completing the Asthma+Lung UK COPD Patient Passport, between 2014 and 2022, we conducted adjusted logistic regression (adjusting for year) and compared receipt of key items of care between those reporting that they had had an annual review (65.3%) and those who did not (34.7%). To further capture patient experience, we also analysed 4228 free-text responses to the 2021 Asthma+Lung UK annual COPD survey to the question ‘What is the one thing that could improve your COPD care?’ResultsWe found that the absence of an annual review was associated with significantly worse COPD care across all domains studied; in particular, inhaler training (yes: 80.8% vs no: 38.4%, adjusted OR (AOR): 8.18, 95% CI (7.89 to 8.47), having a written care plan (89.6% vs 56.9%, AOR 6.68 (95% CI 6.35 to 7.05) and medication knowledge (72.6% vs 33.6%, AOR 5.73 (95% CI 5.51 to 5.96). Thematic analysis of the 2021 COPD survey responses identified three areas to improve care: (1) access and support from healthcare services, (2) improved treatment effectiveness and (3) interaction between COPD and the social environment.DiscussionFailure to deliver annual COPD reviews is associated with worse patient-reported experience of care quality. In parallel, people with COPD express a desire for greater support and access to healthcare services.

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Section: Discussionmentioning

confidence: 96%

Impact of omitting annual reviews for COPD on patient reported care quality– outcomes from the Asthma+Lung COPD patient passport

Williams,

Bachir,

Philip

et al. 2024

BMJ Open

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“…Limited knowledge, experience, and comfort level with technology has been associated with older age as well as with lower educational level and lower socioeconomic status (Cimperman et al, 2013;Western et al, 2021;Jiang et al, 2023). These factors, all of which have been consistently reported in the COPD patient population (Townend et al, 2017;Williams et al, 2024), can represent important barriers to participation and inclusion in e-health, telehealth, and technology-based innovations to care. Despite these important challenges, participants in the present study demonstrated excellent autonomy and a clear capacity to independently operate wearable technology and to record and upload physiologic data in a remote manner after only 1 single training session which occurred at the time of initial recruitment.…”

Section: Feasibility Of Wearable Technology Use In the Study Populationmentioning

confidence: 99%

Feasibility, functionality, and user experience with wearable technologies for acute exacerbation monitoring in patients with severe COPD

Iorio,

Coutu,

Malaeb

et al. 2024

Front. Signal Process.

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Background: The increasing interest in remote patient monitoring technologies in patients with chronic obstructive pulmonary disease (COPD) requires a phased and stepwise investigative approach, which includes high-risk clinical subgroups who stand to benefit most from such innovations.Methods: Patients aged > 40 with spirometry-confirmed COPD presenting with a current acute exacerbation (ECOPD) were recruited from a tertiary centre Day Hospital in this prespecified feasibility study. Heart rate, respiratory rate, oxygen saturation, skin temperature, and daily activity and overnight sleep quality parameters were collected remotely by a wearable biometric wristband and ring for 21 consecutive days. “Total ambulatory wear time” and “percent of useable data” for eligible vital sign parameters were calculated. Correlation and agreement between cardiorespiratory vital sign data were performed using Spearman’s correlation rho and the Bland-Altman test, respectively. User experience was measured with end-of-study System Usability Scale (SUS) questionnaires.Results: Nine participants (mean age 66.8 ± 8.4 years, 22% female, mean FEV1 1.4L (34.1% predicted), with “severe” (56%) or “very severe” (44%) COPD) experiencing a current ECOPD were included. Wear time was 94% (wristband) and 88.2% (ring) of the total ambulatory study period. Wristband-obtained data (every 1 min, artefact-free) revealed 99.2% and 98.6% of all heart rate and temperature data, respectively, was useable, whereas only 17.6% of all respiratory rate data was useable. Ring-obtained data (every 5 min, “average” and “good” quality) revealed 84.5% of all heart rate data was useable. Cross-sectional analyses with nurse-obtained vital signs revealed correlation coefficients of 0.56 (p = 0.11) and 0.81 (p = 0.0086) for wristband-obtained and ring-obtained heart rate, respectively, and only 0.15 (p = 0.74) for wristband-obtained respiratory rate, without evidence of systematic/proportional bias. Longitudinal heart rate and respiratory rate inter-device analyses demonstrated correlations of 0.86 (p < 0.001) and 0.65 (p < 0.001), respectively. Finally, end-of-study SUS scores were 86.4/100 (wristband) and 89.2/100 (ring).Conclusion: Older adults with severe/very severe COPD experiencing a current ECOPD were capable of autonomous physiological data collection/upload/transmission from their home environment over several weeks using sophisticated wearable biometric technology, with favourable user experiences. Cross-sectional and longitudinal comparative results call into question the paradigm of single sets of infrequent/interval vital sign checks as the current “gold-standard” in frontline clinical practice.

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Social Determinants of Respiratory Health: Opening the Door

Perpiñá-Tordera,

Almonacid,

Perpiñá-Tordera

et al. 2024

Archivos de Bronconeumología

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Lung Disease and Social Justice: Chronic Obstructive Pulmonary Disease as a Manifestation of Structural Violence

Cited by 6 publications

References 89 publications

Impact of omitting annual reviews for COPD on patient reported care quality– outcomes from the Asthma+Lung COPD patient passport

Impact of omitting annual reviews for COPD on patient reported care quality– outcomes from the Asthma+Lung COPD patient passport

Feasibility, functionality, and user experience with wearable technologies for acute exacerbation monitoring in patients with severe COPD

Social Determinants of Respiratory Health: Opening the Door

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