EuroQoL in assessment of the effect of pulmonary rehabilitation COPD patients

SummaryBackgroundThe effect of pulmonary rehabilitation on EuroQol in COPD patients has not been investigated previously.Methods/materialsTwo hundred and twenty nine consecutive COPD patients who had completed a 7-week pulmonary rehabilitation programme were assessed with EuroQol five-dimension questionnaire (EQ-5D), endurance shuttle walk test (ESWT), and the St George's Respiratory Questionnaire (SGRQ) before and after the programme, and at the 3-month follow-up visit.ResultsTwo hundred and two (88.4%) patients had FEV1<50% predicted and all but four (1.7%) had dyspnoea score at least 3 on MRC scale. At completion of the programme, statistical significant improvements were seen for ESWT 157.3s; p<0.001, EQ-5D utility score −0.019; p=0.03, EQ-5D VAS −2.1; p=0.056, SGRQ total score −2.8units; p<0.001. The effects of rehabilitation on ESWT and SGRQ were maintained at 3-month follow-up (158.9s and −2.9units), while the effect on EQ-5 utility decreased (0.013; p=0.18). At baseline, there was a maximum score (“ceiling effect”) for EQ-5D utility and EQ VAS in 29 (12.7%) and five (2.2%) of the patients, respectively. After rehabilitation these number increased to 41 (17.9%) and seven (3.1%).ConclusionsIn COPD patients receiving rehabilitation, responsiveness of EQ-5D utility was poor. One explanation might be a “ceiling effect” of this instrument

Long-term survival in patients hospitalized for chronic obstructive pulmonary disease: a prospective observational study in the Nordic countries.

To access publisher full text version of this article. Please click on the hyperlink in Additional Links field.Mortality rate is high in patients with chronic obstructive pulmonary disease (COPD). Our aim was to investigate long-term mortality and associated risk factors in COPD patients previously hospitalized for a COPD exacerbation. A total of 256 patients from the Nordic countries were followed for 8.7 ± 0.4 years after the index hospitalization in 2000-2001. Prior to discharge, the St George's Respiratory Questionnaire was administered and data on therapy and comorbidities were obtained. Information on long-term mortality was obtained from national registries in each of the Nordic countries. In total, 202 patients (79%) died during the follow up period, whereas 54 (21%) were still alive. Primary cause of death was respiratory (n = 116), cardiovascular (n = 43), malignancy (n = 28), other (n = 10), or unknown (n = 5). Mortality was related to older age, with a hazard risk ratio (HRR) of 1.75 per 10 years, lower forced expiratory volume in 1 second (FEV(1)) (HRR 0.80), body mass index (BMI) <20 kg/m(2) (HRR 3.21), and diabetes (HRR 3.02). Older age, lower BMI, and diabetes were related to both respiratory and cardiovascular mortality. An association was also found between lower FEV(1) and respiratory mortality, whereas mortality was not significantly associated with therapy, anxiety, or depression. Almost four out of five patients died within 9 years following an admission for COPD exacerbation. Increased mortality was associated with older age, lower lung function, low BMI, and diabetes, and these factors should be taken into account when making clinical decisions about patients who have been admitted to hospital for a COPD exacerbation.Boehringer Ingelheim Swedish Heart and Lung Association Swedish Heart Lung Foundatio

Do telemedical interventions improve quality of life in patients with COPD?:A systematic review

OBJECTIVE: Telehealth is an approach to disease management, which may hold the potential of improving some of the features associated with COPD, including positive impact on disease progression, and thus possibly limiting further reduction in quality of life (QoL). Our objective was, therefore, to summarize studies addressing the impact of telehealth on QoL in patients with COPD. DESIGN: Systematic review. METHODS: A series of systematic searches were carried out using the following databases: PubMed, EMBASE, Cochrane Controlled Trials Register, and ClinicalTrials.gov (last updated November 2015). A predefined search algorithm was utilized with the intention to capture all results related to COPD, QoL, and telehealth published since year 2000. OUTCOME MEASURES: Primary outcome was QoL, assessed by validated measures. RESULTS: Out of the 18 studies fulfilling the criteria for inclusion in this review, three studies found statistically significant improvements in QoL for patients allocated to telemedical interventions. However, all of the other included studies found no statistically significant differences between control and telemedical intervention groups in terms of QoL. CONCLUSION: Telehealth does not make a strong case for itself when exclusively looking at QoL as an outcome, since statistically significant improvements relative to control groups have been observed only in few of the available studies. Nonetheless, this does not only rule out the possibility that telehealth is superior to standard care with regard to other outcomes but also seems to call for more research, not least in large-scale controlled trials

Effect of tele health care on exacerbations and hospital admissions in patients with chronic obstructive pulmonary disease:a randomized clinical trial

BACKGROUND AND OBJECTIVE: Tele monitoring (TM) of patients with chronic obstructive pulmonary disease (COPD) has gained much interest, but studies have produced conflicting results. Our aim was to investigate the effect of TM with the option of video consultations on exacerbations and hospital admissions in patients with severe COPD. MATERIALS AND METHODS: Patients with severe COPD at high risk of exacerbations were eligible for the study. Of 560 eligible patients identified, 279 (50%) declined to participate. The remaining patients were equally randomized to either TM (n=141) or usual care (n=140) for the 6-month study period. TM comprised recording of symptoms, saturation, spirometry, and weekly video consultations. Algorithms generated alerts if readings breached thresholds. Both groups received standard care. The primary outcome was number of hospital admissions for exacerbation of COPD during the study period. RESULTS: Most of the enrolled patients had severe COPD (forced expiratory volume in 1 second <50%pred in 86% and ≥hospital admission for COPD in the year prior to enrollment in 45%, respectively, of the patients). No difference in drop-out rate and mortality was found between the groups. With regard to the primary outcome, no significant difference was found in hospital admissions for COPD between the groups (P=0.74), and likewise, no difference was found in time to first admission or all-cause hospital admissions. Compared with the control group, TM group patients had more moderate exacerbations (ie, treated with antibiotics/corticosteroid, but not requiring hospital admission; P<0.001), whereas the control group had more visits to outpatient clinics (P<0.001). CONCLUSION: Our study of patients with severe COPD showed that TM including video consultations as add-on to standard care did not reduce hospital admissions for exacerbated COPD, but TM may be an alternative to visits at respiratory outpatient clinics. Further studies are needed to establish the optimal role of TM in the management of severe COPD