Long-term smoking increases the need for acute care among asthma patients : a case control study

Peer reviewe

Co-morbidities are the key nominators of the health related quality of life in mild and moderate COPD

BACKGROUND: Co-morbidities are common in chronic obstructive pulmonary disease (COPD). We assessed the contribution of common co-morbidities on health related quality of life (HRQoL) among COPD patients. METHODS: Using both generic (15D) and respiratory-specific (AQ20) instruments, HRQoL was assessed in a hospital based COPD population (N = 739, 64% males, mean age 64 years, SD 7 years) in this observational study with inferential analysis. The prevalence of their co-morbidities was compared with those of 5000 population controls. The patients represented all severity stages of COPD and the patterns of common concomitant disorders differed between patients. RESULTS: Co-morbidities such as psychiatric conditions, alcohol abuse, cardiovascular diseases, and diabetes were more common among COPD patients than in age and gender matched controls. Psychiatric conditions and alcohol abuse were the strongest determinants of HRQoL in COPD and could be detected by both 15D (Odds Ratio 4.7 and 2.3 respectively) and AQ20 (OR 2.0 and 3.0) instruments. Compared to respiratory specific AQ20, generic 15D was more sensitive to the effects of comorbidities while AQ20 was slightly more sensitive for the low FEV1. FEV1 was a strong determinant of HRQoL only at more severe stages of disease (FEV1 < 40% of predicted). Poor HRQoL also predicted death during the next five years. CONCLUSIONS: The results suggest that co-morbidities may impair HRQoL at an early stage of the disease, while bronchial obstruction becomes a significant determinant of HRQoL only in severe COPD.Peer reviewe

Comparison between the disease-specific Airways Questionnaire 20 and the generic 15D instruments in COPD

<p>Abstract</p> <p>Background</p> <p>Given that the assessment of health-related quality of life (HRQoL) is an essential outcome measure to optimize chronic obstructive pulmonary disease (COPD) patient management, there is a need for a short and fast, reliable and valid instrument for routine use in clinical practice. The objective of this study was to analyse the relationship between the disease-specific Airways questionnaire (AQ20) and the generic 15D health-related quality of life (HRQoL) instrument simultaneously in a large cohort of patients with COPD. We also compare the HRQoL of COPD patients with that of the general population.</p> <p>Methods</p> <p>The AQ20 and 15D were administered to 739 COPD patients representing an unselected hospital-based COPD population. The completion rates and validity of, and correlations among the questions and dimension scores were examined. A factor analysis with varimax rotation was performed in order to find subsets of highly correlating items of the questionnaires.</p> <p>Results</p> <p>The summary scores of AQ20 and 15D were highly correlated (r = - 0.71, p < 0.01). In AQ20 over 50% of patients reported frequent cough, breathlessness during domestic work, and chest problem limiting their full enjoyment of life. 15D results showed a noteworthy decrease of HRQoL in breathing, mobility, sleeping, usual activities, discomfort and symptoms, vitality, and sexual activity (scores ≤ 0.75). Compared to the age- and gender-standardized Finnish general population, the COPD patients were statistically significantly worse off on 13 of 15 dimensions.</p> <p>Conclusions</p> <p>The AQ20 and 15D summary scores are comparable in terms of measuring HRQoL in COPD patients. The data support the validity of 15D to measure the quality of life in COPD. COPD compromises the HRQoL broadly, as reflected by the generic instrument. Both questionnaires are simple and short, and could easily be used in clinical practice with high completion rates.</p

Clinical and genetic markers in disease progression – a study among subjects with obstructive lung diseases

Asthma, COPD, and asthma and COPD overlap syndrome (ACOS) are chronic pulmonary diseases with an obstructive component. In COPD, the obstruction is irreversible and the disease is progressive. The aim of the study was to define and analyze factors that affected disease progression and patients’ well-being, prognosis and mortality in Chronic Airway Disease (CAD) cohort. The main focus was on COPD and ACOS patients. Retrospective data from medical records was combined with genetic and prospective follow-up data. Smoking is the biggest risk factor for COPD and even after the diagnosis of the disease, smoking plays an important role in disease development and patient’s prognosis. Sixty percent of the COPD patients had succeeded in smoking cessation. Patients who had managed to quit smoking had lower mortality rates and less psychiatric diseases and alcohol abuse although they were older and had more cardiovascular diseases than patients who continued smoking. Genetic polymorphism rs1051730 in the nicotinic acethylcholine receptor gene (CHRNA3/5) associated with heavy smoking, cancer prevalence and mortality in two Finnish independent cohorts consisting of COPD patients and male smokers. Challenges in smoking cessation and higher mortality rates may be partly due to individual patient’s genetic composition. Approximately 50% of COPD patients are physically inactive and the proportion was higher among current smokers. Physically active and inactive patients didn’t differ from each other in regard to age, gender or comorbidities. Bronchial obstruction explained inactivity only in severe disease. Subjective sensation of dyspnea, however, had very strong association to inactivity and was also associated to low health related quality of life (HRQoL). ACOS patients had a significantly lower HRQoL than either the patients with asthma or with COPD even though they were younger than COPD patients, had better lung functions and smaller tobacco exposure.Kroonisten obstruktiivisten keuhkosairauksien etenemisen ennustaminen kliinisten ja geneettisten muuttujien avulla Astma, keuhkoahtaumatauti ja sekamuotoinen astma-COPD (ACOS) ovat kroonisia, obstruktiivisia keuhkosairauksia. Keuhkoahtaumataudissa obstruktio on pysyvä, ja tauti luonteeltaan etenevä. Tutkimuksen tavoitteena oli tutkia tekijöitä, jotka vaikuttavat taudin etenemisnopeuteen, potilaiden vointiin ja ennusteeseen Chronic Airway Disease (CAD) –kohortin potilailla. Tutkimus keskittyi erityisesti keuhkoahtaumatautipotilaisiin. Sairauskertomusten retrospektiivista dataa pyrittiin hyödyntämään yhdessä geneettisten markkereiden ja seurantakyselyistä kerätyn prospektiivisen tiedon kanssa. Tupakointi on suurin yksittäinen keuhkoahtaumataudin riskitekijä ja taudin puhjettuakin tupakoinnin määrä vaikuttaa potilaan ennusteeseen. 60% keuhko-ahtaumatautipotilaista onnistui lopettamaan tupakoinnin. Lopettaneiden kuolleisuus oli pienempää ja heillä esiintyi vähemmän psykiatrisia sairauksia ja alkoholismia kuin tupakointia jatkavilla, vaikka lopettaneet olivatkin vanhempia ja heillä esiintyi enemmän sydän- ja verisuonisairauksia. Nikotiiniherkän asetyylikoliinireseptorigeenin (CHRNA3/5) polymorfia rs1051730 assosioitui pitkäkestoiseen tupakointiin, syöpäprevalenssiin ja kuolleisuuteen kahdessa erillisessä suomalaiskohortissa, joista toinen koostui keuhkoahtaumatautipotilaista ja toinen tupakoivista miehistä. Erot potilaiden genotyypissä voivat osaltaan vaikuttaa tupakoinnin lopettamiseen ja kuolleisuuteen. Noin 50 % kohortin keuhkoahtaumatautipotilaista oli fyysisesti inaktiivisia. Fyysisesti aktiivisten ja inaktiivisten potilaiden i’issä, sukupuolijakaumassa tai liitännäis-sairauksissa ei havaittu eroja. Obstruktio selitti inaktiivisuutta vasta kun tauti oli vaikea. Sen sijaan subjektiivinen hengenahdistuksen tunne selitti inaktiivisuutta voimakkaasti jo lievässä taudissa. ACOS-potilaiden terveyteen liittyvä elämänlaatunsa oli merkittävästi huonompi kuin astma- tai keuhkoahtaumatautipotilailla.Siirretty Doriast