Two-year mortality of patients with COPD in primary health care: an observational study

Minas, Markos; Verrou-Katsarou, Ioanna; Mystridou, Parthena; Apostolidou, Eleni; Hatzoglou, Chrissi; Gourgoulianis, Konstantinos

doi:10.2147/ijgm.s27411

Cited by 10 publications

(8 citation statements)

References 36 publications

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“…The high rate of comorbidities, along with an unhealthy clinical profile calls for urgent action. As hypertension and coronary heart disease are the major comorbidities, counseling with other specialists and a systematic follow-up in community settings should be a priority 26. The proper individualized management of patients with more severe symptoms by an outreach care specialist can prevent hospitalization.…”

Section: Discussionmentioning

confidence: 99%

COPD patients' medical care and support in Greece during financial crisis

Mitonas¹,

Juvana²,

Daniil³

et al. 2016

IJGM

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BackgroundThe need to follow a multidisciplinary strategy in chronic obstructive pulmonary disease (COPD) management and rehabilitation in community settings in Greece raises significant questions, given the severe austerity measures being imposed at present. The aim of this study was to investigate the clinical profile of patients with COPD along with the care provided in rural community settings in Greece.MethodsTwo primary health care centers and 200 newly diagnosed patients over a 12-month period were involved in the study. A self-assessment questionnaire, including questions about smoking habits, the presence of comorbidities and chronic respiratory symptoms, as well as the COPD Assessment Test were used. Spirometry was performed with a dry spirometer. Obstructive spirometry was defined as forced expiratory volume in 1 second/forced vital capacity ratio <0.7, according to Global Initiative for Chronic Obstructive Lung Disease guidelines.ResultsMales comprised 70% of the sample, with cough and sputum being the prominent signs. Regarding COPD staging, 68.5% were classified in stages I/II. Arterial hypertension and coronary heart disease were the most common comorbidities. Current smokers accounted for 88.5%, while 88% were heavy drinkers. A general practitioner made the diagnosis in 68.5% of the cases, among which offspring and spouses provided home care in 38% and 8% of the cases, respectively, while an informal caregiver other than a relative was reported in 34% of the cases. No caregiver (self-care) was reported in 20% of the cases. All patients of stage III and IV had a COPD Assessment Test score >10.ConclusionPatients with COPD dwelling in the community exhibit an overall mild-to-moderate type of COPD. General practitioner is in charge of COPD management. Informal caregiving is the major type of home care, with nonfamily members playing a significant role. The patients’ profile permits limited optimism about their future perspective and urges for immediate action at primary care level.

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Section: Discussionmentioning

confidence: 99%

COPD patients' medical care and support in Greece during financial crisis

Mitonas¹,

Juvana²,

Daniil³

et al. 2016

IJGM

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“… 4 – 6 , 8 , 11 , 12 However, the diagnosis of COPD by PCPs is not always consistent to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines in daily clinical practice, mainly because of underuse of spirometry in primary health care (PHC) settings. 5 , 11 , 13 – 18 As a result, COPD is a disease that is largely underestimated and underdiagnosed. 5 , 11 In the USA and Europe, the rate of underdiagnosis varies greatly with the highest estimates reaching up to 86%.…”

Section: Introductionmentioning

confidence: 99%

Missed diagnosis and overtreatment of COPD among smoking primary care population in Central Greece: old problems persist

Stafyla¹,

Kotsiou²,

Deskata³

et al. 2018

COPD

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BackgroundThe diagnosis of COPD is not always consistent with the Global Initiative for Chronic Obstructive Lung Disease (GOLD) strategy in daily clinical practice, especially in primary care. This study aimed to estimate the overall COPD prevalence and severity, to identify differences between newly and previously diagnosed patients, and to evaluate the potential COPD overtreatment in a smoking population attending a primary care spirometry surveillance program.MethodsA study was conducted in 10 primary health care centers of Central Greece during a 7-month period. Eligible participants were aged ≥40 years and were either current smokers or exsmokers.ResultsA total of 186 subjects were included (68% males, mean age 62.3±12.6 years, mean life-time tobacco exposure 50 pack-years). COPD prevalence was 17.8%, identified to be higher in elderly males. Forty-two percent of the COPD group were newly diagnosed patients, who were of younger age, current smokers, presented with less dyspnea and better health status, and mainly appeared with mild-to-moderate disease. Interestingly, 61.4% of non-COPD and 85.7% of newly diagnosed COPD individuals had been using inhaled medication under primary care provider’s prescription without ever undergoing spirometry or further evaluation by a pulmonologist; thus, the phenomena of COPD overdiagnosis and missed diagnosis came into the spotlight. Moreover, only 26.3% of known COPD patients were properly medicated according to GOLD guidelines, while half of them were inappropriately treated with triple inhaled therapy.ConclusionWe reported a significant prevalence of COPD in smoking population attending this spirometry program. A remarkable proportion of COPD patients were undiagnosed and made case finding worthwhile. Underutilization of spirometry in the diagnosis and management of COPD as well as general practitioners’ nonadherence to the GOLD treatment guidelines was confirmed by our data. These findings highlight the need for a major overhaul and culture change in primary care settings of Central Greece.

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“…Associated with global social and economic burdens, it is estimated to increase in both developed and developing countries due to the continuous use of tobacco and biomass fuels among aging populations 24 . This lung disease is under-diagnosed, life-threatening, obtrusive to normal breathing and not fully reversible 25 . In the later stages, COPD greatly impairs quality of life and leads to repeated costly hospital stays.…”

Section: Discussionmentioning

confidence: 99%

Do symptom-based questions help screen COPD among Chinese populations?

Zhang

Wang

et al. 2016

Sci Rep

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Spirometry is required to confirm a chronic obstructive pulmonary disease (COPD) diagnosis, but it is difficult to perform in resource-limited settings. This study aimed to evaluate symptom-based questions for screening of individuals with COPD among Chinese populations. We recruited 3969 adult subjects from the First Affiliated Hospital of Nanjing Medical University. Spirometric measurements of forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) were collected to confirm the COPD diagnosis. A symptom-based questionnaire was administered to collect data related to COPD. The sensitivity and specificity together with the area under the curve (AUC) were calculated. The traditional IPAG eight-item questionnaire yielded an AUC of 0.80(95% CI: 0.78–0.82), with a sensitivity of 67.8% and specificity of 76.8%. After removing and adding questions, a revised eleven-item questionnaire exhibited a significantly increased diagnostic accuracy, with an AUC of 0.85(95% CI: 0.84–0.87). At the inflection point of the curve, it demonstrated a sensitivity of 82.5% and specificity of 72.9%. We showed that the revised symptom-based questionnaire could be used to screen individuals with a high likelihood of COPD among Chinese populations. Further validation is required before we claim it is a useful diagnostic for primary care populations.

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Two-year mortality of patients with COPD in primary health care: an observational study

Cited by 10 publications

References 36 publications

COPD patients' medical care and support in Greece during financial crisis

COPD patients' medical care and support in Greece during financial crisis

Missed diagnosis and overtreatment of COPD among smoking primary care population in Central Greece: old problems persist

Do symptom-based questions help screen COPD among Chinese populations?

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Two-year mortality of patients with COPD in primary health care: an observational study

Cited by 10 publications

References 36 publications

COPD patients&#39; medical care and support in Greece during financial crisis

COPD patients&#39; medical care and support in Greece during financial crisis

Missed diagnosis and overtreatment of COPD among smoking primary care population in Central Greece: old problems persist

Do symptom-based questions help screen COPD among Chinese populations?

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Product

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COPD patients' medical care and support in Greece during financial crisis

COPD patients' medical care and support in Greece during financial crisis