Correlating changes in lung function with patient outcomes in chronic obstructive pulmonary disease: a pooled analysis

Jones, Paul; Donohue, James F.; Nedelman, Jerry; Pascoe, Steven; Pinault, Gregory; Lassen, Cheryl

doi:10.1186/1465-9921-12-161

Cited by 69 publications

(70 citation statements)

References 31 publications

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“…It does not alter the role of HCRU exacerbations as an outcome in COPD trials, but it does show that unreported events appear to have important short-to medium-term consequences in terms of symptoms and health status. There was no difference between reported and unreported events in terms of effect on FEV1, but this may have been because FEV1 had recovered 3 months after the event and the relationship between reduction in exacerbations and improvement in FEV1 is weak [21]. Further studies are needed to examine the impact of unreported EXACT events on outcomes such as FEV1 decline and exercise capacity and to test whether unreported exacerbations are predictors of future events.…”

Section: Impact Of Exact Events and Hcru Events On Health Status And mentioning

confidence: 96%

Characterisation and impact of reported and unreported exacerbations: results from ATTAIN

Jones

Lamarca²,

Chuecos³

et al. 2014

Eur Respir J

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The frequency and impact of exacerbations identified using healthcare resource utilisation (HCRU) or the EXAcerbations of Chronic pulmonary disease Tool (EXACT) were compared prospectively in a 24-week, phase III trial (ATTAIN). Patients with moderate-to-severe chronic obstructive pulmonary disease received twice-daily aclidinium 200 μg, aclidinium 400 μg or placebo. All HCRU events were reported to physicians. “EXACT-identified” events were categorised as “EXACT-reported” (detected by EXACT and reported to the physician) and “EXACT-unreported” (detected but not reported). Health status was measured using the St George’s Respiratory Questionnaire (SGRQ).Annualised EXACT-identified event rates were higher in all study arms (placebo 1.39, aclidinium 200 μg 1.00 and aclidinium 400 μg 0.98 per patient per year) versus HCRU (placebo 0.60, aclidinium 200 μg 0.43 and aclidinium 400 μg 0.40 per patient per year). Concordance between methods was low (kappa 0.16). Aclidinium reduced EXACT-identified events (rate ratio versus placebo: aclidinium 200 μg 0.72 and aclidinium 400 μg 0.71; both p<0.05); HCRU events were similarly reduced.At week 24, SGRQ scores improved (-6.6 versus baseline) in patients with no event during weeks 1–12; improvements were significantly smaller in patients with HCRU events (-3.4; p=0.036) or EXACT-unreported events (-3.0; p=0.002).Unreported events were more frequent than reported events. Both had similar negative impact on health status. Aclidinium reduced the frequency of both types of event.

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Section: Impact Of Exact Events and Hcru Events On Health Status And mentioning

confidence: 96%

Characterisation and impact of reported and unreported exacerbations: results from ATTAIN

Jones

Lamarca²,

Chuecos³

et al. 2014

Eur Respir J

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“…Indeed, also subgroups of patients with chronic neurological diseases [35], chronic cardiac diseases [36], or chronic musculoskeletal diseases [37] respond poorly to specialised rehabilitative interventions. Moreover, response to pharmacological therapy [38,39], ambulatory oxygen therapy [40], bronchoscopic interventions [41] and lung volume reduction surgery [42] is also poor in subgroups of patients with COPD. These findings emphasise the need for a personalised approach of patients with chronic conditions, and the awareness that a "one size fits all" approach will not result in optimal chronic disease management [43].…”

Section: Poor Response To Pulmonary Rehabilitationmentioning

confidence: 99%

Differential response to pulmonary rehabilitation in COPD: multidimensional profiling

et al. 2015

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The aim of the present study was to profile a multidimensional response to pulmonary rehabilitation in patients with chronic obstructive pulmonary disease (COPD).Dyspnoea, exercise performance, health status, mood status and problematic activities of daily life were assessed before and after a 40-session pulmonary rehabilitation programme in 2068 patients with COPD (mean forced expiratory volume in 1 s of 49% predicted). Patients were ordered by their overall similarity concerning their multidimensional response profile, which comprises the overall response on MRC dyspnoea grade, 6MWD, cycle endurance time, Canadian Occupational Performance Measure performance and satisfaction scores, Hospital Anxiety and Depression Scale anxiety and depression, and St George's Respiratory Questionnaire total score, using a novel non-parametric regression technique.Patients were clustered into four groups with distinct multidimensional response profiles: n=378 (18.3%; "very good responder"), n=742 (35.9%; "good responder"), n=731 (35.4%; "moderate responder"), and n=217 (10.5%; "poor responder"). Patients in the "very good responder" cluster had higher symptoms of dyspnoea, number of hospitalisations <12 months, worse exercise performance, worse performance and satisfaction scores for problematic activities of daily life, more symptoms of anxiety and depression, worse health status, and a higher proportion of patients following an inpatient PR programme compared to the other three clusters.A multidimensional response outcome needs to be considered to study the efficacy of pulmonary rehabilitation services in patients with COPD, as responses to regular outcomes are differential within patients with COPD. @ERSpublications Efficacy of pulmonary rehabilitation in patients with COPD needs to be assessed using a multidimensional response http://ow.ly/RsfYK

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“…Th e impairment of airfl ow obstruction measured by the forced expiratory volume in one second (FEV1) is the most widely used marker of severity www.copdjournal.com and prognosis in chronic obstructive pulmonary disease (COPD); however, the FEV 1 alone is not enough to evaluate the impact of lung disease in patients with COPD (5). Th e diff erent questionnaires developed and validated to assess diff erent aspects of health status in COPD provide more complete and complementary information on the consequences of the respiratory disease in the everyday life of patients with chronic respiratory disease (6,7).…”

Section: Introductionmentioning

confidence: 99%

Usefulness of the CAT, LCOPD, EQ-5D and COPDSS Scales in Understanding the Impact of Lung Disease in Patients with Alpha-1 Antitrypsin Deficiency

Manca

Rodrı́guez

Huerta

et al. 2014

COPD: Journal of Chronic Obstructive Pulmonary Disease

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Alpha-1-antitrypsin deficiency (AATD) is an inherited disorder responsible for early onset emphysema associated with a significant impairment of health-related quality of life (HRQoL). Our aim was to assess the usefulness of different instruments to evaluate the HRQoL in patients with AATD compared to non-AATD COPD. Observational, cross-sectional study in which all patients filled out a series of questionnaires: the COPD severity score (COPDSS), the EuroQoL 5-Dimensions (EQ-5D), the Living with COPD (LCOPD) and the COPD Assessment Test (CAT). A total of 96 patients were included, 35 with AATD (mean age 56.5 yrs, 57.1% male and mean FEV1(%) 48.7% and 61 non-AATD COPD (70.3 yrs, 80.3% men and FEV1(%) 47%. The questionnaire scores were similar, with a tendency towards worse scores in AATD for the EQ-5D (VAS) (64.8 (20.2) vs. 71.6 (17.1); p = 0.08). The correlations between the different scores and FEV1(%) were significant in both groups for COPDSS and LCOPD, but not for CAT and EQ-5D. In general, the correlations of scores with FEV1(%) were stronger for AATD compared with non-AATD COPD patients: COPDSS r = -0.570, p < 0.01 for AATD and r = -0.260, p < 0.05 for COPD; LCOPD r = -0.502, p < 0.001 for AATD and r = -0.304, p < 0.05 for non-AATD COPD. Patients with AATD have a similar degree of HRQoL impairment as older subjects with non-AATD COPD and showed a stronger correlation between HRQoL measurements and lung function impairment compared with non-AATD COPD. This may be related to the characteristics of the disease in these patients who are usually younger, with less co-morbidity and lower smoking consumption.

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Correlating changes in lung function with patient outcomes in chronic obstructive pulmonary disease: a pooled analysis

Cited by 69 publications

References 31 publications

Characterisation and impact of reported and unreported exacerbations: results from ATTAIN

Characterisation and impact of reported and unreported exacerbations: results from ATTAIN

Differential response to pulmonary rehabilitation in COPD: multidimensional profiling

Usefulness of the CAT, LCOPD, EQ-5D and COPDSS Scales in Understanding the Impact of Lung Disease in Patients with Alpha-1 Antitrypsin Deficiency

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