Depression and heart failure associated with clinical COPD questionnaire outcome in primary care COPD patients: a cross-sectional study

Prevention, Population and Disease management (PrePoD

A Prospective Cohort Study on the Effects of Geriatric Rehabilitation Following Acute Exacerbations of COPD

OBJECTIVES: Older patients with chronic obstructive pulmonary disease (COPD),hospitalized for an acute exacerbation, often do not receive recommendedpost-acute pulmonary rehabilitation. This underuse might be related to theimpaired clinical and functional status of these patients, who are more likely topresent with frailty, comorbidities, and disability. Having developed andimplemented a geriatric rehabilitation program for these patients (GR_COPD), theprimary aim of this study was to investigate the effectiveness of this program.DESIGN AND INTERVENTION: A prospective cohort study with a 3-month follow-upperiod. Patients who declined the GR_COPD program were considered as controls.SETTING AND PARTICIPANTS: The study was conducted at the pulmonary department of2 hospitals. Patients were eligible when hospitalized as a result of an acuteexacerbation of COPD and indicated for the GR_COPD program based on standardizedcriteria.METHODS: Primary outcome was defined as change in disease-specific health statusmeasured with the clinical COPD questionnaire (CCQ), secondary outcome as theexacerbation rate ratio during follow-up. To balance potential confoundersbetween the intervention and control group, propensity score-based weightedlinear regression analyses were performed.RESULTS: Of the 158 included patients [78 (49.4%) male, mean age 70.8 (±8.1)years, mean forced expiratory volume in 1 second: 35.5 (±12.8) as % ofpredicted], 78 received the GR_COPD program. The results of the CCQ showed asignificant and clinically relevant treatment effect of -0.56 points [95%confidence interval (CI) -0.89, -0.23; P = .001). Patients in the control grouphad 2.77 times more exacerbations compared with the intervention group (95% CI2.13, 3.58; P CONCLUSIONS/IMPLICATIONS: This study shows a clinically relevant effect of theGR_COPD program on disease-specific health status and exacerbation rate.Implementation of the program for older patients with severe COPD hospitalizedfor an acute exacerbation is recommended.Development and application of statistical models for medical scientific researc

Day-to-day measurement of patient-reported outcomes in exacerbations of chronic obstructive pulmonary disease

<p>Background: Exacerbations of chronic obstructive pulmonary disease (COPD) are a major burden to patients and to society. Little is known about the possible role of day-to-day patient-reported outcomes during an exacerbation. This study aims to describe the day-to-day course of patient-reported health status during exacerbations of COPD and to assess its value in predicting clinical outcomes.</p><p>Methods: Data from two randomized controlled COPD exacerbation trials (n = 210 and n = 45 patients) were used to describe both the feasibility of daily collection of and the day-to-day course of patient-reported outcomes during outpatient treatment or admission to hospital. In addition to clinical parameters, the BORG dyspnea score, the Clinical COPD Questionnaire (CCQ), and the St George's Respiratory Questionnaire were used in Cox regression models to predict treatment failure, time to next exacerbation, and mortality in the hospital study.</p><p>Results: All patient-reported outcomes showed a distinct pattern of improvement. In the multivariate models, absence of improvement in CCQ symptom score and impaired lung function were independent predictors of treatment failure. Health status and gender predicted time to next exacerbation. Five-year mortality was predicted by age, forced expiratory flow in one second % predicted, smoking status, and CCQ score. In outpatient management of exacerbations, health status was found to be less impaired than in hospitalized patients, while the rate and pattern of recovery was remarkably similar.</p><p>Conclusion: Daily health status measurements were found to predict treatment failure, which could help decision-making for patients hospitalized due to an exacerbation of COPD.</p>