Quality of Well-being Outcomes in the National Emphysema Treatment Trial

Kaplan, Robert M.; Sun, Qiankun; Ries, Andrew L.

doi:10.1378/chest.14-0528

Cited by 9 publications

(5 citation statements)

References 30 publications

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“…Cigarette smoking is a major causal factor in the pathogenesis of COPD and smoking cessation is obviously an important part of COPD management, apart from other life style adjustments ( 1 ). In addition, lung volume reduction surgery may offer benefit to some patients with severe emphysema ( 2 – 4 ). The focus of the current review is on pharmacotherapy and clearly there is an unmet need to find new and effective pharmacological treatments that could either counter the effects of cigarette smoking, or alternatively slow the rate of progression of this disease.…”

mentioning

confidence: 99%

Pharmacology of novel treatments for COPD: are fixed dose combination LABA/LAMA synergistic?

Spina

2015

European Clinical Respiratory Journal

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Bronchodilators are mainstay for the symptomatic treatment of chronic obstructive pulmonary disease (COPD) and the introduction of long-acting bronchodilators has led to an improvement in the maintenance treatment of this disease. Various clinical trials have evaluated the effects of fixed dose long-acting β2-agonists (LABA)/long-acting anti-muscarinics (LAMA) combinations and documented greater improvements in spirometry but such improvements do not always translate to greater improvements in symptom scores or reduction in the rates of exacerbation compared with a single component drug. An analysis of whether this significantly greater change in spirometry with combination therapy is additive or synergistic was undertaken and is the subject of this review. Bronchodilators are not disease modifiers and whilst glucocorticosteroids have been shown to reduce rates of exacerbation in moderate to severe COPD, the increase risk of pneumonia and bone fractures is a motivation enough to warrant developing novel anti-inflammatory and disease-modifying drugs and with the expectation of positive outcomes.

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confidence: 99%

Pharmacology of novel treatments for COPD: are fixed dose combination LABA/LAMA synergistic?

Spina

2015

European Clinical Respiratory Journal

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“…To calculate QALYs, the Quality of Well-Being Scale (QWB), which has a range between 0 (death) and 1 (optimum health), is used as the quality-of-life measurement. 25 QWB is a comprehensive scale that asks about 58-item symptoms and problems and covers acute and chronic symptoms, self-care, mobility, physical activity and functioning, and social activity. 26 The QWB scale has been used in other medical conditions such as diabetes, 27 depression, 28 HIV, 29 and cystic fibrosis.…”

Section: Methodsmentioning

confidence: 99%

Utilizing Clinical Trial Data to Assess Timing of Surgical Treatment for Emphysema Patients

et al. 2022

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Background Lung volume reduction surgery (LVRS) and medical therapy are 2 available treatment options in dealing with severe emphysema, which is a chronic lung disease. However, or there are currently limited guidelines on the timing of LVRS for patients with different characteristics. Objective The objective of this study is to assess the timing of receiving LVRS in terms of patient outcomes, taking into consideration a patient’s characteristics. Methods A finite-horizon Markov decision process model for patients with severe emphysema was developed to determine the short-term (5 y) and long-term timing of emphysema treatment. Maximizing the expected life expectancy, expected quality-adjusted life-years, and total expected cost of each treatment option were applied as the objective functions of the model. To estimate parameters in the model, the data provided by the National Emphysema Treatment Trial were used. Results The results indicate that the treatment timing strategy for patients with upper-lobe predominant emphysema is to receive LVRS regardless of their specific characteristics. However, for patients with non–upper-lobe–predominant emphysema, the optimal strategy depends on the age, maximum workload level, and forced expiratory volume in 1 second level. Conclusion This study demonstrates the utilization of clinical trial data to gain insights into the timing of surgical treatment for patients with emphysema, considering patient age, observable health condition, and location of emphysema. Highlights Both short-term and long-term Markov decision process models were developed to assess the timing of receiving lung volume reduction surgery in patients with severe emphysema. How clinical trial data can be used to estimate the parameters and obtain short-term results from the Markov decision process model is demonstrated. The results provide insights into the timing of receiving lung volume reduction surgery as a function of a patient’s characteristics, including age, emphysema location, maximum workload, and forced expiratory volume in 1 second level.

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“…Surgery offers the opportunity to improve lung function and decrease dyspnea. Although LVRS does not cure the patient’s illness, it may provide an improved quality of life, decreased oxygen requirement, and increased life satisfaction (1 –3, 5 –11). Lung volume reduction surgery is a delicate and difficult procedure for the patient requiring a lengthy workup phase with multiple appointments, assessments, and laboratory/diagnostic tests over several months.…”

Section: Introduction and Statement Of Purposementioning

confidence: 99%

“…Patients who have this surgery have a long-standing history of breathlessness and oxygen lack related to one or more kinds of severe, chronic respiratory diseases that are not curable. Although not curative, LVRS may improve dyspnea, quality of life, and satisfaction (5,7 –11,13). Patients have multiple self-care management milestones (such as quitting smoking, or losing/gaining weight) to prepare their bodies for the surgery.…”

Section: Introduction and Statement Of Purposementioning

confidence: 99%

The Expressions of Hope in the Face of Complex Surgery: Experiences of Patients and Their Loved Ones

Baur

Chamberlain

Wendler

et al. 2018

Journal of Patient Experience

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Background:Lung volume reduction surgery (LVRS), a reduction in damaged lung tissue in end-stage chronic obstructive pulmonary disease, is a breakthrough surgical procedure requiring months of rigorous screening, testing, and conditioning. Engaging in this process is prolonged and challenging with no research found exploring patients and loved ones’ experiences through this demanding process.Objective:The purpose was to examine the experience of LVRS for patients and loved ones as they encounter the complex preparation required prior to, during, and throughout the extended convalescence following surgery.Methods:A mixed-methods approach was used, combining health outcomes with interview data. Participants and loved ones were purposefully selected, invited, and consented during the perioperative phase of LVRS. Quantitative data were obtained via chart review, while qualitative data were gathered through a 2-stage interview process, preoperatively and postoperatively. Qualitative data were analyzed using naturalistic inquiry approaches.Results:Patients and loved ones described difficulties of living with illness during the preoperative phase, and expressed relief and joy for an improved quality of life afterward. The overarching theme uncovered was hope. Preoperatively, hope was coupled with anxiety about the upcoming surgery and potential outcomes, whereas the hope expressed after surgery focused on the future, in particular, a shared future. Statistically significant differences were found in the quality of life measures.Conclusion:For both patients and loved ones, LVRS is filled with hope for a more expansive future. Although that future is unclear prior to surgery, clarification and a new normal signals hope for a shared future following LVRS.

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Quality of Well-being Outcomes in the National Emphysema Treatment Trial

Abstract: BACKGROUND: Surgical and medical treatments for emphysema may aff ect both quality and quantity of life. Th e purpose of this article is to report outcomes from the National Emphysema Treatment Trial (NETT) using an index that combines quality and quantity of life.

Cited by 9 publications

References 30 publications

Pharmacology of novel treatments for COPD: are fixed dose combination LABA/LAMA synergistic?

Pharmacology of novel treatments for COPD: are fixed dose combination LABA/LAMA synergistic?

Utilizing Clinical Trial Data to Assess Timing of Surgical Treatment for Emphysema Patients

The Expressions of Hope in the Face of Complex Surgery: Experiences of Patients and Their Loved Ones

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