Undiagnosed Chronic Obstructive Pulmonary Disease Contributes to the Burden of Health Care Use. Data from the CanCOLD Study

Labonté, Laura; Tan, Wan C.; Li, Pei Z.; Mancino, Palmina; Aaron, Shawn D.; Benedetti, Andrea; Chapman, Kenneth R.; Cowie, Robert L.; FitzGerald, J. Mark; Hernández, Paul; Maltais, François; Marciniuk, Darcy; OʼDonnell, Dennis; Sin, Don D.; Bourbeau, Jean

doi:10.1164/rccm.201509-1795oc

Cited by 123 publications

(95 citation statements)

References 33 publications

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“…those requiring health care utilization including emergency department (ED) visits and/or hospital admissions) among undiagnosed COPD patients is similar to that among diagnosed individuals. 12 These findings further support the need to diagnose COPD using objective measures when symptoms are present, in order to prevent this morbidity by providing proper therapy. Spirometry is a safe, practical and reproducible breathing test that can be used in primary care to objectively determine lung function.…”

Section: Spirometry Measurements In Targeted Populations For Case Finmentioning

confidence: 65%

“…19 In the CanCOLD study, individuals with diagnosed COPD reported 0.63 exacerbations per person-year. 12 Overall, exacerbations of any severity were reported by 40%, and moderate to severe exacerbations by 32% of individuals with diagnosed COPD. An important and achievable goal of therapy in the management of stable COPD is to decrease the frequency and reduce the severity of AECOPD.…”

Section: Summary Of Evidencementioning

confidence: 91%

“…Fifty percent or more of patients with COPD are still undiagnosed in Canadian family medicine practices. 11,12 Early diagnosis is a contentious issue, but it optimizes the opportunities to prevent worsening of disease and prevention of exacerbations. The population-based cohort study CanCOLD has shed light on the question of undiagnosed COPD.…”

Section: Spirometry Measurements In Targeted Populations For Case Finmentioning

confidence: 99%

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CTS position statement: Pharmacotherapy in patients with COPD—An update

Bourbeau

Bhutani

Hernández

et al. 2017

Canadian Journal of Respiratory, Critical Care, and Sleep Medic

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RATIONALE: Since the last published Canadian Thoracic Society (CTS) COPD guideline in 2007 and the 2008 update -highlights for primary care, many new clinical trials have challenged COPD treatment practices. The current Canadian position statement provides the reader with an update on pharmacotherapy of patients with COPD as reviewed by the CTS. OBJECTIVES: The objectives of this position statement are: 1) to summarize the literature on topics relevant to the pharmacological therapy of patients with stable COPD; and 2) to provide clinical guidance with evidence-based recommendations and expert-informed key messages for the pharmacological therapy for patients with stable COPD. METHODS: The authors systematically reviewed the relevant literature focusing on randomized controlled trials and when available, systematic reviews of randomized controlled trials. The proposed key messages, based on scientific evidence and expert-informed opinion, were agreed upon by a majority consensus. MAIN RESULTS: There is typically a significant delay in seeking medical care by patients with dyspnea, often waiting until symptoms affect the performance of activities of daily living. The diagnosis of COPD requires spirometry to confirm the presence of airflow obstruction in any patient presenting with symptoms and/or risk factors of COPD. An effective management plan for individuals with COPD should include: smoking cessation, vaccination and education. A number of non-pharmacological treatments are available for COPD patients with symptoms to improve outcomes such as self-management with coaching from a health care professional; pulmonary rehabilitation; supplemental oxygen in selected patients; and surgery.Current pharmacotherapy for COPD has been shown to alleviate symptoms and prevent exacerbations and related complications such as hospital admissions. In symptomatic patients with stable COPD not having or having infrequent exacerbation, treatment should be started with inhaled LAMA or LABA monotherapy, and if experiencing persistent or increased dyspnea, exercise intolerance, and/or reduced health status despite use of monotherapy, patients should be considered for treatment "step up" with an inhaled LAMA plus LABA dual therapy. In this situation, the use of a single inhaler would be preferred to simplify the treatment regimen and minimize the cost. In patients with stable COPD experiencing exacerbations despite the use of LAMA or LABA monotherapy, treatment "step up" with inhaled LAMA plus LABA dual therapy should be considered unless a patient has concomitant asthma (Asthma/COPD overlap (ACO)). There has been recent interest in using biomarkers to identify patients who are more likely to respond to ICS. Most of the studies have demonstrated that high blood eosinophils could be valuable to predict an increase response in terms of reduction of exacerbation rate when treated with combination ICS/LABA; there is still uncertainty about the exact cut-off level of blood eosinophils having potential therapeutic value. If a pa...

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Section: Spirometry Measurements In Targeted Populations For Case Finmentioning

confidence: 65%

Section: Summary Of Evidencementioning

confidence: 91%

Section: Spirometry Measurements In Targeted Populations For Case Finmentioning

confidence: 99%

See 1 more Smart Citation

CTS position statement: Pharmacotherapy in patients with COPD—An update

Bourbeau

Bhutani

Hernández

et al. 2017

Canadian Journal of Respiratory, Critical Care, and Sleep Medic

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“…However, it remains unclear how beneficial diagnosing these "missed" individuals would be (41)(42)(43). An uncomfortable tension exists between ensuring those with clinically relevant COPD are correctly identified and appropriately treated versus overmedicalizing individuals with mildly abnormal spirometric results.…”

Section: Case Finding and Accurate Diagnosismentioning

confidence: 99%

Update in Chronic Obstructive Pulmonary Disease 2014

Seemungal

Wedzicha

2015

Am J Respir Crit Care Med

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“…A concept that was firstly reported for congestive heart failure (CHF) (80% undiagnosed CHF in COPD) by Rutten et al 35 more than 10 years ago, and recently re-addressed in review articles 36,37 .…”

mentioning

confidence: 99%

Chronic Respiratory Abnormalities in the Multi-Morbid Frail Elderly

Beghè¹,

Clini²,

Fabbri³

2017

BRN

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Two-thirds of people aged ≥65 years have multi-morbidity. Multi-morbidity includes both physical and mental health conditions, as anxiety and depression, that almost invariably affect patients with multiple symptomatic chronic diseases. Management of a patient with any of the chronic diseases that are part of multi-morbidity is not just the management of that single index disease, but must include the active search and proper treatment of concomitant chronic diseases. The presence of concomitant chronic diseases should not alter the management of the index disease (e.g., chronic obstructive pulmonary disease [COPD]), and concomitant chronic diseases should be treated according to single diseases guidelines regardless of the presence of the index disease, obviously with careful consideration that this choice implies complex management, polypharmacy and potential adverse effects. Preliminary management programs suggest that a holistic integrated approach might improve quality of life and reduce hospital admissions and death in these multimorbid patients. (BRN Rev. 2017;3:247-66)

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Undiagnosed Chronic Obstructive Pulmonary Disease Contributes to the Burden of Health Care Use. Data from the CanCOLD Study

Cited by 123 publications

References 33 publications

CTS position statement: Pharmacotherapy in patients with COPD—An update

CTS position statement: Pharmacotherapy in patients with COPD—An update

Update in Chronic Obstructive Pulmonary Disease 2014

Chronic Respiratory Abnormalities in the Multi-Morbid Frail Elderly

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