Simple functional performance tests and mortality in COPD.

Eur Respir J. 2013 Mar 21;

Authors: Puhan MA, Siebeling L, Zoller M, Muggensturm P, Ter Riet G

Abstract
Exercise tests are important to characterize COPD patients and predict their prognosis but often not available outside of rehabilitation or research settings. The aim was to assess the predictive performance of the sit-to-stand (STS) and handgrip strength tests.The prospective cohort study in Dutch and Swiss primary care settings included a broad spectrum of patients (n=409) with GOLD stages II to IV. To assess the association of the tests with outcomes, we used Cox proportional hazards (mortality), negative binomial (centrally adjudicated exacerbations) and mixed linear regression models (longitudinal health-related quality of life [HRQL]) while adjusting for age, sex and severity of disease.The STS test was strongly (adjusted hazard ratio per 5 more repetitions of 0.58 [95% CI 0.40-0.85], p=0.004) and the handgrip strength test moderately strongly (0.84 [95% CI 0.72-1.00], p=0.04) associated with mortality. Both tests were also statistically significantly associated with HRQL but not with exacerbations. The STS test alone was a stronger predictor of 2-year mortality (area under curve 0.78) than body mass index (0.52), FEV1 (0.61), dyspnoea (0.63) and handgrip strength (0.62).The STS test may close an important gap in the evaluation of exercise capacity and prognosis of COPD patients across practice settings.

PMID: 23520321 [PubMed - as supplied by publisher]

Use of tiotropium Respimat(R) SMI vs. tiotropium Handihaler(R) and mortality in patients with COPD.

Eur Respir J. 2013 Mar 21;

Authors: Verhamme KM, Afonso A, Romio S, Stricker BC, Brusselle G, Sturkenboom M

Abstract
Tiotropium, a long-acting anticholinergic, is delivered via HandiHaler(®) or via Respimat(®). RCTs suggest that use of Tiotropium Respimat(®) increases the risk of dying. We compared the risk of mortality between tiotropium Respimat(®) vs. HandiHaler(®).Within the Integrated Primary Care Information database, we defined a source population of patients, ≥40 years, with at least 1 year of follow-up. Based on prescription data, we defined episodes of tiotropium use (Respimat(®) or Handihaler(®)). The risk of mortality, within these episodes, was calculated using a Cox proportional hazard regression analysis.From the source population, 11287 patients provided 24522 episodes of tiotropium use. 496 patients died while being exposed to Handihaler(®) or Respimat(®). Use of Respimat(®) was associated with almost 30% increased risk of dying (HRadj 1.27, 95% CI 1.03-1.57) with the highest risk for cardiovascular/cerebrovascular death (HRadj 1.56, 95% CI 1.08-2.25). The risk was higher in patients with co-existing cardiovascular disease (HRadj 1.36, 95% CI 1.07-1.73) than in patients without (HRadj 1.02, 95% CI 0.61-1.71).Use of tiotropium Respimat(®) was associated with an almost 30% increase of mortality compared to Handihaler(®) and the association was the strongest for cardiovascular/cerebrovascular death. It is unclear whether this association is causal or due to residual confounding by COPD severity.

PMID: 23520322 [PubMed - as supplied by publisher]

Is asthma a vanishing disease? A study to forecast the burden of asthma in 2022.

BMC Public Health. 2013 Mar 21;13(1):254

Authors: To T, Stanojevic S, Feldman R, Moineddin R, Atenafu EG, Guan J, Gershon AS

Abstract
BACKGROUND: Recent evidence regarding temporal trends of asthma burden has not been consistent, with some countries reporting decreases in prevalence of asthma. In Ontario, the province in Canada with the highest population, the prevalence of asthma rose at a rate of 0.5% per year between 1996 and 2005. These estimates were based on population-based health services use data spanning more than a decade and provide a powerful source to forecast the trends of asthma burden. The objective of this study was to use observed population trends data of asthma incidence and prevalence to forecast future disease burden. METHODS: The Ontario Asthma Surveillance Information System (OASIS) used health administrative databases to identify and track all individuals in the province with asthma. Individuals with asthma identified between April 1, 1996 and March 31, 2010 were included. Exponential smoothing models were applied to annual data to project incidence to the year 2022, prevalence was estimated by applying the cumulative projected incidence to the projected population. RESULTS: While asthma incidence is falling, the absolute number of prevalent cases will continue to rise. We projected that almost 1 in 8 individuals in Ontario will have asthma by the year 2022, suggesting that asthma will continue to be a major burden on individuals and the health care system. CONCLUSIONS: These projections will help inform health care planners and decision-makers regarding resource allocation to optimize asthma outcomes.

PMID: 23517452 [PubMed - as supplied by publisher]

The association between asthma control, health care costs, and quality of life in France and Spain.

BMC Pulm Med. 2013 Mar 22;13(1):15

Authors: Doz M, Chouaid C, Com-Ruelle L, Calvo E, Brosa M, Robert J, Decuypère L, Pribil C, Huerta A, Detournay B

Abstract
BACKGROUND: Current asthma management guidelines are based on the level of asthma control. The impact of asthma control on health care resources and quality of life (QoL) is insufficiently studied. EUCOAST study was designed to describe costs and QoL in adult patients according to level of asthma control in France and Spain. METHODS: An observational cost of illness study was conducted simultaneously in both countries among patients age greater or equal to 18 with a diagnosis of asthma for at least 12 months. Patients were recruited prospectively by GPs in 2010 in four waves to avoid a seasonal bias. Health care resources utilization of the three months before the inclusion was collected through physician questionnaires. Asthma control was evaluated using 2009 GINA criteria over a 3-month period. QoL was assessed using EQ-5D-3L(R). RESULTS: 2,671 patients (France: 1,154; Spain: 1,517) were enrolled. Asthma was controlled in 40.6% [95% CI: 37.7% - 43.4%] and 29.9% [95% CI: 27.6% - 32.3%] of French and Spanish patients respectively.For all types of costs, the percentage of patients using health care resources varied significantly according to the level of asthma control. The average cost (euros/3-months/patient) of controlled asthma was [euro sign]85.4 (SD: 153.5) in France compared with [euro sign]314.0 (SD: 2,160.4) for partially controlled asthma and [euro sign]537.9 (SD: 2,355.7) for uncontrolled asthma (p<0.0001). In Spain, the corresponding figures were [euro sign]152.6 (SD: 162.1), [euro sign]241.2 (SD: 266.8), and [euro sign]556.8 (SD: 762.4). EQ-5D-3L(R) score was higher (p<0.0001) in patients with controlled asthma compared to partially controlled and uncontrolled asthma in both countries (respectively 0.88; 0.78; 0.63 in France and 0.89; 0.82; 0.69 in Spain). CONCLUSIONS: In both countries, patients presenting with uncontrolled asthma had a significantly higher asthma costs and lower scores of Qol compared to the others.

PMID: 23517484 [PubMed - as supplied by publisher]