Intergrated care programme for patients with chronic obstructive pulmonary disease (COPD) – a randomized controlled trial [Abstract]

Introduction: COPD has significant morbidity and incurs heavy utilization ofhealthcare resources.Objectives: To assess whether a comprehensive care programme candecrease hospital admissions and length of hospital stay (LOS) for COPDpatients.Methods: In a randomized control trial of patients discharged from hospitalafter an episode of acute exacerbation of COPD, patients were randomized toan Intervention Group (IG) or Usual Care Group (UG). The IG received acomprehensive, individualized care plan which included respiratory nurse edu-cation, physiotherapist support for pulmonary rehabilitation, 3-monthly tele-phone calls by a respiratory nurse for a period of 1 year, and followed up inrespiratory clinic by a respiratory specialist once every 3 months for 1 year. TheUG were managed according to standard practice. All patients had assess-ments (spirometry, 6 minute walk test, dyspnoea score [Modified MedicalResearch Council Dyspnoea Scale {MMRC}], and quality of life [QOL] [St.Georges Respiratory Questionnaire {SGRQ}]) at baseline and at 12 months.The primary outcome was 12-month hospital readmission.Results: 180 patients were recruited (IG N = 90,UG N = 90; mean age74.7 ± 8.2yrs, 172(95.6%) males; mean FEV1 45.4 ± 16.6% predicted). At 12months, the IG had fewer readmissions (1.56 ± 2.13 vs 2.38 ± 2.14times,p = 0.0008) and shorter LOS (7.41 ± 11.29 vs 12.21 ± 12.87days, p = 0.0003)for COPD than UG. IG at 12 months had improved mean MMRC (-0.1 ± 0.7 vs0.2 ± 0.6, p = 0.033) and SGRQ score (-8.5 ± 16.6 vs −0.1 ± 15.7, p = 0.002)compared with UG.Conclusion: Comprehensive COPD programme can reduce hospital read-missions for COPD and LOS, and improve symptoms and QOL of the patients

Identifying uncontrolled asthma in young children: clinical scores or objective variables?

Objective: Several international asthma guidelines emphasize the importance of assessing asthma control. However, there is limited data on the usefulness of available assessment tools in indicating disease control in young asthmatics. This study investigated the ability of Chinese version of Childhood Asthma Control Test (C-ACT) and other disease-related factors in identifying uncontrolled asthma (UA) in young children. Methods: During the same clinic visit, asthma patients 4 to 11 years of age completed C-ACT and underwent exhaled nitric oxide and spirometric measurements. Blinded to these results, the same investigator assigned Disease Severity Score (DSS) and rated asthma control according to Global Initiative for Asthma. Results: The mean (SD) age of 113 recruited patients was 9.1 (2.0) years, and 35% of them had UA. C-ACT, DSS and forced expiratory volume in 1 second (FEV1) differed among patients with different control status (p \u3c 0.001 for C-ACT and DSS; p = 0.014 for FEV1). Logistic regression confirmed that UA was associated with DSS (p \u3c 0.001), PEF (p = 0.002), C-ACT (p = 0.011), and FEV1 (p = 0.012). By ROC analysis, C-ACT and DSS were the best predictors for UA (p \u3c 0.001), followed by PEF (p = 0.006) and FEV1 (p = 0.007). When analyzed by the Classification and Regression Tree (CART) approach, the sequential use of DSS and C-ACT had 77% sensitivity and 84% specificity in identifying UA. Conclusions: C-ACT is better than objective parameters in identifying young Chinese children with UA

Association between candidate genes and spirometric variables in Chinese

Background: Asthma is caused by complex interactions between multiple susceptibility genes and environmental factors. Three genes (ARG1, ADRB2 and CRHR2) were reported to be associated with bronchodilator response in Caucasians, whereas NOS1 and NOS3 were important components of the arginase 1 pathway. GSDM1 and TOP2A, located on chromosome 17q21 as a reproducible locus identified by asthma genome-wide association study in other ethnic groups, were also candidate genes for asthma and atopy in our Chinese children. This study investigated the associations between spirometric variables and single-nucleotide polymorphisms (SNPs) of these seven candidate genes. Methods: This study recruited both children (312 cases and 70 controls; aged 6-17 years) and adults (345 cases and 652 controls; aged ≥ 18 years). Spirometry was performed before and 30 minutes following salbutamol inhalation. Their forced expiratory volume in 1-second (FEV1) and forced vital capacity (FVC) were then measured. Thirteen SNPs of ARG1, ADRB2, CRHR2, NOS1, NOS3, GSDM1 and TOP2A were genotyped by TaqMan SNP genotyping assays using ABI Prism 7900HT thermocycler, and their associations with spirometric variables in our subjects were analyzed by multivariate linear regression. Results: All SNPs followed Hardy-Weinberg equilibrium. In our adults, the minor allele of rs3756780 on ARG1 was associated with an additive protective effect against asthma (odds ratio 0.71, 95% confidence interval 0.54-0.93; P=0.013). Multivariate linear regression revealed FEV1 to be associated with SNPs of ARG1, CRHR2, GSDM1 and TOP2A (P=0.002-0.044), whereas FEV1/FVC was associated with SNPs of ARG1 and TOP2A (P=0.021-0.050). No significant association was found between spirometric variables and ADRB2. Among our children, FEV1 reversibility was associated with rs1003929 of CRHR2 and rs1007654 of GSDM1 (P=0.014 and 0.004, respectively). Conclusions: This study identifies discrepant genetic associations for spirometric parameters between Chinese adults and children. Both CRHR2 and GSDM1 are associated with FEV1 in adults and FEV1 reversibility in children, whereas ARG1 and TOP2A are associated with FEV1 and FEV1/FVC only in adults. These findings highlight the importance of these candidate genes in modulating airflow limitation. None of ADRB2, NOS1 or NOS3 is a major gene for spirometric variables in the Chinese population

[en] TACTICAL LESS-THAN-TRUCKLOAD TRANSPORTATION PLANNING: MODELS AND ALGORITHMS

Early diagnosis and smoking cessation are the only available methods to stop the progression of chronic obstructive pulmonary disease (COPD). The aim of this study was to evaluate the effects of early detection of airflow limitation (AL) in a population with high risk for COPD, using spirometric screening. Smokers aged ≥40 yrs with a smoking history of ≥10 pack-yrs were invited to visit a local outpatient chest clinic for simple spirometry (forced expiratory volume in one second (FEV1) and forced vital capacity (FVC)). Smoking history was recorded, followed by smoking cessation advice relating the results of spirometry to the smoking behaviour. Subjects who did not fulfil the above criteria (younger and/or nonsmokers) were also screened. A total 110,355 subjects were investigated; they were aged 53.5±11.5 yrs and 58.2% were males. Of the total amount of subjects, 64% were current smokers, 25.1% were former smokers and 10.9% were lifelong nonsmokers. Spirometry tests were within normal values for 70.3%, and 20.3% showed signs of AL: this was mild in 7.6%, moderate in 6.7% and severe in 5.9%. The remaining 8.3% of subjects presented with a restrictive pattern of ventilatory impairment. Airflow limitation was found in 23% of smokers aged ≥40 yrs with a history of ≥10 pack-yrs. This study concluded that large-scale voluntary spirometry screening of the population with high risk for COPD detects a large number of subjects with AL. Copyright © ERS Journals Ltd 2006.link_to_subscribed_fulltex

Relationship between asthma control status, the Asthma Control Test™ and urgent health-care utilization in Asia

10.1111/j.1440-1843.2011.01954.xRespirology164688-697RSPI