Top PDF Long-acting bronchodilators improve Health Related Quality of Life in patients with COPD

Long-acting bronchodilators improve Health Related Quality of Life in patients with COPD

Long-acting bronchodilators improve Health Related Quality of Life in patients with COPD

A consistent sample of moderate-severe COPD patients has been studied testing 6 drugs, 12 different devices, 22 different dosages with a study duration ranging from 4 weeks to 4 years. SGRQ has been used in 86% of studies and, while total score was always reported, domains were considered in only 60% of cases. A recent review providing a comprehensive evaluation of the content and psychometric property of available HRQoL/HS questionnaires for COPD has recommended the use of specific instruments rather than generic ones. The authors underline that no optimal instrument exists, but the choice of a questionnaire should derive from the aims of the study and from the tool char- acteristics in terms of questions and domains. This aspect is missing in the papers we reviewed, since the use of a questionnaire is not motivated on the basis of the effects on patientslife that researchers expected from the treatment. Each questionnaire focuses on particular areas and ignores other ones. For example, SGRQ, despite being one of the instruments with the strongest positive evi- dences in terms of structural validity and reliability, does not investigate some domains relevant for COPD patients such as mobility, social functioning, sleep [85] .
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Predictive factors over time of health-related quality of life in COPD patients

Predictive factors over time of health-related quality of life in COPD patients

Health-related quality of life (HRQoL) is commonly used as a predictor of other outcomes such as mortality [4, 5] in COPD patients. Nonetheless, HRQoL is consid- ered an important outcome in itself in many diseases and this should also be the case in COPD. In fact, HRQoL is very often assessed in clinical trials but its use in routine clinical practice and the impact of this use on practice has not been thoroughly studied. Considering that HRQoL gives an overall view of the general clinical condition of a patient, it should be used more frequently in daily clinical practice in COPD. Further, several vari- ables have been related to HRQoL in COPD in various different studies, but these have usually been limited to cross-sectional analysis of a small number of variables.
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Costs and health-related quality of life in Alpha-1-Antitrypsin Deficient COPD patients

Costs and health-related quality of life in Alpha-1-Antitrypsin Deficient COPD patients

Methods: Direct and indirect costs (based on self-reported information on healthcare utilization) and health-related quality of life (HRQL, as assessed by SGRQ, CAT, and EQ-5D-3 L) were compared between 131 AATD patients (106 with, 25 without augmentation therapy (AT)) and 2,049 COPD patients without AATD participating in the COSYCONET COPD cohort. The medication costs of AT were excluded from all analyses to reveal differences associated with morbidity profiles. The association of AATD (with/without AT) with costs or HRQL was examined using generalized linear regression modelling (GLM) adjusting for age, sex, GOLD grade, BMI, smoking status, education and comorbidities. Results: Adjusted mean direct annual costs were € 6,099 in AATD patients without AT, € 7,117 in AATD patients with AT (excluding costs for AT), and € 7,460 in COPD patients without AATD. AATD with AT was significantly associated with higher outpatient (+273%) but lower inpatient ( − 35%) and medication costs ( − 10%, disregarding AT) compared with COPD patients without AATD. There were no significant differences between groups regarding indirect costs and HRQL. Conclusion: Apart from AT costs, AATD patients tended to have lower, though not significant, overall costs and similar HRQL compared to COPD patients without AATD. AT was not associated with lower costs or higher HRQL.
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Beta-blockers and health-related quality of life in patients with peripheral arterial disease and COPD

Beta-blockers and health-related quality of life in patients with peripheral arterial disease and COPD

Background: Beta-blockers are frequently withheld in patients with cardiovascular disease who also have chronic obstructive pulmonary disease (COPD) because of concerns that they might provoke bronchospasm and cause deterioration in health status. Although beta1-selective beta-blockers are associated with reduced mortality in COPD patients, their effects on health status are unknown. The aim of this study was to investigate the relationship between beta- blockers and health-related quality of life (HRQOL) in patients with peripheral arterial disease and COPD.
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Do telemedical interventions improve quality of life in patients with COPD? A systematic review

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

ambivalent results based on a different mode of interven- tion. A total of 298 patients (147 and 151, respectively, in the intervention and control groups), completed the study, including a posttreatment assessment after 16 weeks. Out- comes were measured using the Beck Depression Inven- tory-II, the State-Trait Anxiety Inventory-State, the Short Form-36 (SF-36), the Pulmonary Quality of Life Scale, the University of California, San Diego (UCSD) Shortness of Breath Questionnaire, the Brief Fatigue Inventory, and the SGRQ. The intervention consisted of extensive instructions in cognitive-behavioral coping skills delivered by phone to patients and partners on a weekly basis in 30-minute sessions. The control group patients and partners also received weekly COPD education by phone, focusing on topics relevant to COPD but without providing instructions on specific coping strategies. As such, both groups interestingly received some degree of telemedical intervention. In their analysis, the authors reported their results by making an overall distinc- tion between so called “psychological” QoL and “somatic” QoL. Overall, the intervention group made greater improve- ments in psychological QoL than the control group, attaining less depression (Cohen’s d= 0.22, 95% confidence interval [CI] = 0.08–0.36, P-value = 0.002), less anxiety (d= 0.17, 95% CI = 0.02–0.33, P-value = 0.030), better overall mental health (d= 0.17, 95% CI = 0.03–0.32, P-value = 0.021), bet- ter emotional role functioning (d= 0.29, 95% CI = 0.10–0.48, P-value = 0.003), and better social functioning (d= 0.21, 95% CI = 0.03–0.38, P-value = 0.023). Additionally, it was observed that intervention group patients with lower psy- chological QoL at baseline attained the greatest improve- ments compared to the control group. There were also improvements, with varying statistical significance, in the intervention group relative to the control group in terms of somatic QoL, with less fatigue (d= 0.34, 95% CI = 0.18–0.50, P-value = 0.0001), less shortness of breath on the SGRQ
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Effect of home based pulmonary rehabilitation on health related quality of life in COPD patients

Effect of home based pulmonary rehabilitation on health related quality of life in COPD patients

Based on the patients exercise tolerance, health status program should be tailored for each patient. Pulmonary rehabilitation covers a range of non-pulmonary problems that is not adequately addressed by medical therapy for COPD, including exercise de-conditioning, relative social isolation, altered mood states especially depression, muscle wasting, and weight loss. Pulmonary rehabilitation has been carefully evaluated in a large number of clinical trials and shown to increase peak workload, peak oxygen consumption, and endurance time, and a definite improvement in quality of life and depression. 8 Benefits have been reported from
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Health-related quality of life of patients diagnosed with COPD in Extremadura, Spain: results from an observational study

Health-related quality of life of patients diagnosed with COPD in Extremadura, Spain: results from an observational study

Background: COPD is a high prevalence chronic disease that involves large reductions of health-related quality of life (HRQL) of patients. This study aims to describe the HRQL of patients with COPD in Extremadura (Spain). Methods: This is a cross-sectional observational study carried out using a representative sample of patients diagnosed with COPD in Extremadura. The inclusion criteria were patients of legal age, diagnosed with COPD at least 12 months prior to the visit, residing in Extremadura, with electronic medical records available for the 12 months prior to the visit and providing informed consent. The intervention aimed to elicit HRQL indicators obtained from two validated questionnaires: EuroQol - 5 Dimensions - 5 Levels (EQ-5D-5L), and St. George ’ s Respiratory Questionnaire-COPD (SGRQ-C). The main outcome measures were general HRQL (utility and visual analogue scale) and specific quality of life of COPD patients (total score and three component scores: Symptoms, Activity, and Impacts). Stepwise multiple regression analysis was applied to evaluate the association of EQ-5D-5L and SGRQ-C with respect to clinical and sociodemographic characteristics of the patients.
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Stress associated with hospitalization in patients with COPD: the role of social support and health related quality of life

Stress associated with hospitalization in patients with COPD: the role of social support and health related quality of life

Stress is a mental and physical strain due to threats, danger, life changes and everyday challenges. Our study shows that COPD patients hospitalized in this chronic hospital perceived hospitalization as a little stressing event, contrary to prior literature findings already exposed. However, these hospitalized chronic patients were exposed to potentially stressing factors and suffered from the same effects of routine and protocols, consoli- dated throughout their history in these institutions [5,6] which can affect disease evolution and prognosis. Our analysis confirms that, in COPD patients, the most powerful stress factors were related to environmental fac- tors (for example remaining in the same room and sleep- ing in a bed different from the habitual one); however, in previous studies, these items occupied the last positions in hospitalized patients in general hospitals [5,18,19].
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Helping COPD patients change health behavior in order to improve their quality of life

Helping COPD patients change health behavior in order to improve their quality of life

Abstract: Chronic obstructive pulmonary disease (COPD) is one of the most prevalent and debilitating diseases in adults worldwide and is associated with a deleterious effect on the quality of life of affected patients. Although it remains one of the leading causes of global mortality, the prognosis seems to have improved in recent years. Even so, the number of patients with COPD and multiple comorbidities has risen, hindering their management and highlighting the need for futures changes in the model of care. Together with standard medical treatment and therapy adherence – essential to optimizing disease control – several nonpharmacological therapies have proven useful in the management of these patients, improving their health-related quality of life (HRQoL) regardless of lung function parameters. Among these are improved diagnosis and treatment of comorbidities, prevention of COPD exacerbations, and greater attention to physical disability related to hospitalization. Pulmonary rehabilitation reduces symptoms, optimizes functional status, improves activity and daily function, and restores the highest level of independent physical function in these patients, thereby improving HRQoL even more than pharmacological treatment. Greater physical activity is significantly correlated with improvement of dyspnea, HRQoL, and mobility, along with a decrease in the loss of lung function. Nutritional support in malnourished COPD patients improves exercise capacity, while smoking cessation slows disease progression and increases HRQoL. Other treatments such as psychological and behavioral therapies have proven useful in the treatment of depression and anxiety, both of which are frequent in these patients. More recently, telehealthcare has been associated with improved quality of life and a reduction in exacerbations in some patients. A more multidisciplinary approach and individualization of interventions will be essential in the near future.
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Prevalence, risk factors, and health-related quality of life of osteoporosis in patients with COPD at a community hospital in Taiwan

Prevalence, risk factors, and health-related quality of life of osteoporosis in patients with COPD at a community hospital in Taiwan

In conclusion, the prevalence of osteoporosis in COPD patients was high in Taiwan. BMI and FEV 1 were the inde- pendent risk factors for osteoporosis in COPD. Therefore, measuring BMD in COPD patients with lower BMI or pul- monary function should be recommended. As a result, further study may be required to investigate whether the prevention of osteoporosis utilizing such strategies as increasing body weight, encouraging smoke cessation, and/or prescrib- ing medications that can help prevent osteoporosis would improve the quality of life in patients with COPD.
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Impact of current cough on health-related quality of life in patients with COPD

Impact of current cough on health-related quality of life in patients with COPD

Results: One hundred and seventy-eight stable COPD patients were included (age, 62 [56–69] years, 128 male, forced expiratory volume in 1 second [FEV 1 ]: 57 [37–72] % predicted) (median [Q1–Q3]). In univariate analyses, health-related quality of life (Saint George’s respi- ratory questionnaire total score) was associated with each CASA-Q domain and with chronic bronchitis, exacerbations, dyspnea, FEV 1 , depression, and anxiety. All four domains introduced separately were independently associated with health-related quality of life. When introduced together in multivariate analyses, only the cough impact domain remained independently associ- ated with health-related quality of life (R 2 =0.60). With chronic bronchitis (standard definition)
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Bayesian predictors of very poor health related quality of life and mortality in patients with COPD

Bayesian predictors of very poor health related quality of life and mortality in patients with COPD

A total of 844 patients participated in the study. The COPD diagnosis was re-evaluated. This evaluation led to the exclusion of 105 patients (explained in detail in previous study) [28]. Thus, a final cohort of 739 eligible patients with smoking-related symptomatic chronic bron- chitis was included in the modeling. Based on their retro- spective medical records, the clinical and demographic findings of participants are shown in Table 1 on average 5.5 years prior to the evaluation of their HRQoL by using the 15D instrument (Table 1). According to the GOLD criteria, a majority of the patients belonged to stages 2–3, i.e. moderate to severe COPD. So far the cohort has been monitored 1–3 years. After the first follow-up year a total of 49 patients (4.0%) had deceased.
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Greater dyspnea is associated with lower health-related quality of life among European patients with COPD

Greater dyspnea is associated with lower health-related quality of life among European patients with COPD

to report on eight health concepts (physical functioning, role physical, bodily pain, general health, vitality, social func- tioning, role emotional, and mental health). Two summary scores were also calculated: physical component summary (PCS) and mental component summary (MCS) scores. The current study used the standard norm-based scores for both the individual health concept scores and the two-component summary scores as calculated by the scoring software pro- vided by the scale developer. These scores have a mean of 50 and a standard deviation (SD) of 10 for the US population (no pan-European norms are available for scoring, and scores based on the US norms are commonly presented regardless of country). 33 Higher scores indicate better HRQoL. The SF-6D
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Eligibility of real-life patients with COPD for inclusion in trials of inhaled long-acting bronchodilator therapy

Eligibility of real-life patients with COPD for inclusion in trials of inhaled long-acting bronchodilator therapy

COPD patient population. Although previous studies have highlighted important limitations of the generalis- ability of COPD-related RCTs, they themselves suffer from substantial limitations that raise questions about the generalisabilty of their findings. The first is the rep- resentativeness of the chosen patient population. Four previous studies considered a low number of patients (110–696) [16, 19, 21, 22], which likely limits the accur- acy of their estimates. Of these, two [21, 22] considered patients from hospital clinics, who likely have more severe disease on average than patients seen in primary care. A third study [16] identified patients with COPD in a postal survey of randomly selected adults in the com- munity. However, the response rate was low (21 %), and many of those identified as having COPD had not previ- ously been diagnosed, which was likely one of the main reasons for the low reported eligibility. The second im- portant limitation of previously published studies is the OPCRD records
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Short Term Effects of Tiotropium on COPD Patients Treated with Long Acting Bronchodilators

Short Term Effects of Tiotropium on COPD Patients Treated with Long Acting Bronchodilators

Five subtypes of human muscarinic receptors have been discovered (from M1 to M5), but in the airways only three subtypes appear (M1, M2, M3). M1 and M3 receptors are stimulated by acetylcholine with the cholinergic effect of bronchoconstriction, while M2 receptors inhibit the release of acetylcholine producing an inhibitory feedback on bronchoconstriction (3). Tiotropium is a potent and highly specific competitive antagonist especially for M1 and M3 receptors (6). Based on several studies it appears that in patients with COPD tiotropium can significantly reduce the level of dyspnea (7), improve the quality of life (7), and improve the parameters of hyperinflation such as IC, FRC, RV (8) and exercise tolerance (9). Several short and long term studies on tiotropium have shown an improvement in respiratory function tests greater than with ipratropium (10) or with salmeterol twice daily (11).
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Depression in copd: risk determinants and health related quality of life (HRQoL)

Depression in copd: risk determinants and health related quality of life (HRQoL)

(HRQoL), as measured by the disease (COPD) specific St George’s Respiratory Questionnaire (SGRQ) and SF-36 Generic health related quality of life (HRQoL) scale is linked both to respiratory and all-cause mortality (Oga et al., 2003; Domingo-Salvany et al., 2002). The multidimensional concept of HRQoL refers to the quality of life that is directly related to health or illness. Usually it includes the domains of illness related to the physical, social, and psychological impact. The patient’s experience of illness can be defined as the subjective perception of the impact of health status on satisfaction with daily life (Barnes and Celli, 2009; Ozkaya et al., 2011). Major depressive disorder has a direct impact on global disease burden accounting for 8.2% of years living with disability in 2010, noted by Ferrari et al. (2013). Depression is strong predictor for mortality in COPD patients with odds ratios 1.9- 2.7 (Ng et al., 2007). During the past few decades, researchers are more interested in knowing the multiple comorbidities associated with chronic obstructive pulmonary disease (COPD). Of such comorbidities, anxiety and depression contributes to substantial burden of COPD-related morbidity, mainly due to increased functional impairment, disability, decreased quality of life (Yohannes et al., 2006; Hanania et al., 2011; Cully et al., 2006) and decreased treatment adherence (Kosmas et al., 2014). Interestingly, patients with COPD and comorbid depression often prefer psychosocial over pharmacological treatments (Skultety and Zeiss, 2006). Depression is challenging to identify and treat because of overlapping symptoms with those of COPD.
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The effects of long-acting bronchodilators on total mortality in patients with stable chronic obstructive pulmonary disease

The effects of long-acting bronchodilators on total mortality in patients with stable chronic obstructive pulmonary disease

cific mortality alone. Fourthly, we did not evaluate the effects of inhaled corticosteroids on total mortality because recent studies have established that these drugs do not impact on overall mortality and expert guidelines in general do not recommend inhaled corticosteroids as standalone therapies for COPD [13,33]. Fifthly, some recent trials were performed on the background of bron- chodilators, inhaled corticosteroids or both, which may have diluted the possible mortality benefits of the drug in question. This may be of particular concern in the most recent tiotropium trial in which a majority of study patients were taking ICS, LABA or both at the time of recruitment [35]. Additionally, none of the studies included in this meta-analysis except for Calverley et al.' s study [13] was powered on mortality. As such, patients with complex or life-threatening co-morbidities were generally excluded from these trials, which likely reduced the statistical power of the present study and limited the generalizability of the findings to patients with multiple co-morbidities. Another important consideration was the differential drop-out rate between the active treatment and the comparator arms of the study. Collectively, the patients in the comparator arm were more likely to drop- out of the trials compared with those who were assigned to active treatment arm (38% versus 30%; p < .0001). Although the precise effects of differential drop-out rate are not fully known, it may have biased the results in favor of the comparator arm, as patients who drop out are generally sicker, less motivated and have poorer progno- sis than those who remain in the study [36].
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Additive efficacy of short-acting bronchodilators on dynamic hyperinflation and exercise tolerance in stable COPD patients treated with long-acting bronchodilators

Additive efficacy of short-acting bronchodilators on dynamic hyperinflation and exercise tolerance in stable COPD patients treated with long-acting bronchodilators

18 walking distance also significantly increased. If Borg scale score would be obtained at the same load or at the same time during exercise, it is thus speculated that Borg scale score would decrease following inhalation of SABA. Patients with COPD frequently report dyspnea related to everyday tasks. 20,21 They often decrease their physical activity because exercise can worsen dyspnea. As a consequence, they tend to have problems including exercise deconditioning, relative social isolation, altered mood states, especially depression, muscle wasting, weight loss and osteoporosis. 5,22 The progressive deconditioning associated with inactivity initiates a vicious cycle, with dyspnea becoming problematic at ever lower physical demands. 5 To address these problems, it is important to improve dyspnea in daily life leading to decreased physical activity. Therefore, it is noteworthy to pay attention to the additive efficacy of SABA for stable COPD patients together with pulmonary rehabilitation. Single use of SABA before exercise, in addition to regular treatment with LAMA, may therefore be useful in stable COPD patients
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The association between inhaled long-acting bronchodilators and less in-hospital care in newly-diagnosed COPD patients

The association between inhaled long-acting bronchodilators and less in-hospital care in newly-diagnosed COPD patients

The present study had several limitations. First, infor- mation on the risk factors associated with COPD or its exacerbation, particularly smoking, compliance, lung function, exacerbation history and quality of life [29,30], is not available in the Korean HIRA database. Although we attempted to include variables such as age, social class associated with insurance type, and comorbidities as po- tential risk factors, causal inference can be difficult. Pre- vious studies with large database could also have a similar limitation [28,31 e33] . To select proper study population, we excluded patients who used COPD medications less than twice in a year. LA-B group also did not include patients with prescription of inhaled long-acting bronchodilator less than twice in a year. Second, this study focused on initial Figure 1 Component of medical utilization cost. LA-B, long-
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Health-related quality of life is related to COPD disease severity

Health-related quality of life is related to COPD disease severity

factor in the analysis. In all cases age, gender, smoking sta- tus and socio-economic background was used as covari- ates. These variables showed sign of influence on the HRQL measures and for the sake of comparability a uni- fied model was selected for the analysis. An additional classification of severity based on FVC % predicted nor- mal was also investigated with the same model with clas- sification into four groups: stage I: > 95%, stage II: 95- 81%, stage 3: 80-66% and stage IV; < 66%. These levels were chosen to have approximately equal number of patients in each group. Data presented in tables are adjusted least-square means from the adopted model. Results
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