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Chest Oct 2020OSA, a common comorbidity in interstitial lung disease (ILD), could contribute to a worsened course if untreated. It is unclear if adherence to CPAP therapy improves... (Observational Study)
Observational Study
BACKGROUND
OSA, a common comorbidity in interstitial lung disease (ILD), could contribute to a worsened course if untreated. It is unclear if adherence to CPAP therapy improves outcomes.
RESEARCH QUESTION
Does adherence to CPAP therapy improve outcomes in patients with concurrent interstitial lung disease and OSA?
STUDY DESIGN AND METHODS
We conducted a 10-year retrospective observational multicenter cohort study, assessing adult patients with ILD who had undergone polysomnography. Subjects were categorized based on OSA severity into no/mild OSA (apnea-hypopnea index score < 15) or moderate/severe OSA (apnea-hypopnea index score ≥ 15). All subjects prescribed and adherent to CPAP were deemed to have treated OSA. Cox regression models were used to examine the association of OSA severity and CPAP adherence with all-cause mortality risk and progression-free survival (PFS).
RESULTS
Of 160 subjects that met inclusion criteria, 131 had OSA and were prescribed CPAP. Sixty-six patients (41%) had no/mild untreated OSA, 51 (32%) had moderate/severe untreated OSA, and 43 (27%) had treated OSA. Subjects with no/mild untreated OSA did not differ from those with moderate/severe untreated OSA in mean survival time (127 ± 56 vs 138 ± 93 months, respectively; P = .61) and crude mortality rate (2.9 per 100 person-years vs 2.9 per 100 person-years, respectively; P = .60). Adherence to CPAP was not associated with improvement in all-cause mortality risk (hazard ratio [HR], 1.1; 95% CI, 0.4-2.9; P = .79) or PFS (HR, 0.9; 95% CI, 0.5-1.5; P = .66) compared with those that were nonadherent or untreated. Among subjects requiring supplemental oxygen, those adherent to CPAP had improved PFS (HR, 0.3; 95% CI, 0.1-0.9; P = .03) compared with nonadherent or untreated subjects.
INTERPRETATION
Neither OSA severity nor adherence to CPAP was associated with improved outcomes in patients with ILD except those requiring supplemental oxygen.
Topics: Aged; Cohort Studies; Continuous Positive Airway Pressure; Female; Humans; Lung Diseases, Interstitial; Male; Middle Aged; Patient Compliance; Progression-Free Survival; Retrospective Studies; Severity of Illness Index; Sleep Apnea, Obstructive
PubMed: 32450237
DOI: 10.1016/j.chest.2020.04.067 -
International Journal of Chronic... 2023Exercise compliance was known as important to improve long-term health conditions for Chronic obstructive pulmonary disease (COPD) patients, however, little was known...
BACKGROUND AND AIM
Exercise compliance was known as important to improve long-term health conditions for Chronic obstructive pulmonary disease (COPD) patients, however, little was known about the determinants which affect their exercise compliance. This study aimed to investigate factors related to exercise compliance of COPD elderly patients.
METHODS
This cross-sectional study included elderly patients with stable COPD participants. Random cluster sampling and a survey, including the Exercise Compliance Scale, mMRC Dyspnea Index Scale, Social Support Scale, Anxiety Self-Assessment Scale, and Self-rating Depression Scale, were used. Data were analyzed using Spearman correlation and backward logistic regression.
RESULTS
124 participants (45.90%) had poor exercise compliance while 146 had good compliance (54.10%). The backward logistic regression showed household monthly income (¥501-¥1500: OR=21.54, P<0.05; ¥3001-¥5000: OR=32.76, P<0.05), two chronic comorbidities (OR=17.13, P<0.05), and the moderate dyspnea (OR=16.87, P<0.05) might help to improve exercise compliance. While female COPD patients (OR=0.11, P<0.01) who had server dyspnea (OR=0.02, P<0.05) and depression (OR=0.84, P<0.05) might have more difficulties adhering to exercise.
CONCLUSION
Low exercise compliance in community-dwelling elderly COPD patients could be affected by sex, monthly income level, number of chronic comorbidities, dyspnea, and depression.
Topics: Aged; Humans; Female; Pulmonary Disease, Chronic Obstructive; Cross-Sectional Studies; Patient Compliance; Dyspnea; Exercise
PubMed: 37705674
DOI: 10.2147/COPD.S424137 -
Thorax Sep 2008Patient adherence to treatment in chronic obstructive pulmonary disease (COPD) is essential to optimise disease management. As with other chronic diseases, poor... (Review)
Review
Patient adherence to treatment in chronic obstructive pulmonary disease (COPD) is essential to optimise disease management. As with other chronic diseases, poor adherence is common and results in increased rates of morbidity, healthcare expenditures, hospitalisations and possibly mortality, as well as unnecessary escalation of therapy and reduced quality of life. Examples include overuse, underuse, and alteration of schedule and doses of medication, continued smoking and lack of exercise. Adherence is affected by patients' perception of their disease, type of treatment or medication, the quality of patient provider communication and the social environment. Patients are more likely to adhere to treatment when they believe it will improve disease management or control, or anticipate serious consequences related to non-adherence. Providers play a critical role in helping patients understand the nature of the disease, potential benefits of treatment, addressing concerns regarding potential adverse effects and events, and encouraging patients to develop self-management skills. For clinicians, it is important to explore patients' beliefs and concerns about the safety and benefits of the treatment, as many patients harbour unspoken fears. Complex regimens and polytherapy also contribute to suboptimal adherence. This review addresses adherence related issues in COPD, assesses current efforts to improve adherence and highlights opportunities to improve adherence for both providers and patients.
Topics: Attitude to Health; Caregivers; Communication; Humans; Patient Compliance; Perception; Polypharmacy; Professional-Patient Relations; Pulmonary Disease, Chronic Obstructive
PubMed: 18728206
DOI: 10.1136/thx.2007.086041 -
Minerva Anestesiologica May 2009Acute respiratory distress syndrome (ARDS) and ventilator induced lung injury (VILI) continue to challenge clinicians who care for the critically ill. Current research... (Review)
Review
Acute respiratory distress syndrome (ARDS) and ventilator induced lung injury (VILI) continue to challenge clinicians who care for the critically ill. Current research in ARDS has focused on ventilator strategies to improve the outcome for these patients. In this review, we emphasize the limitations of managing ventilators based on airway pressures alone. Specifically, basic pulmonary mechanics including chest wall compliance and transpulmonary pressure are reviewed. This review suggests that perturbations in chest wall compliance and transpulmonary pressure may explain the lack of efficacy observed in recent clinical trials of ventilator management. We present a method for estimating pleural and transpulmonary pressures from esophageal manometry. Quantifying these variables and individualizing ventilator management based on individual patient physiology may be useful to intensive care clinicians who treat patients with ARDS.
Topics: Acute Lung Injury; Compliance; Critical Care; Esophagus; Humans; Lung Compliance; Manometry; Multicenter Studies as Topic; Pleural Cavity; Positive-Pressure Respiration; Pressure; Randomized Controlled Trials as Topic; Respiratory Distress Syndrome; Thoracic Wall
PubMed: 19412147
DOI: No ID Found -
European Respiratory Review : An... Sep 2019Obstructive sleep apnoea (OSA) is a highly prevalent disease, and there is an increased demand for OSA diagnosis and treatment. However, resources are limited compared... (Review)
Review
Obstructive sleep apnoea (OSA) is a highly prevalent disease, and there is an increased demand for OSA diagnosis and treatment. However, resources are limited compared with the growing needs for OSA diagnosis and management, and alternative strategies need to be developed to optimise the OSA clinical pathway. In this review, we propose a management strategy for OSA, and in general for sleep-disordered breathing, to be implemented from diagnosis to follow-up. For this purpose, the best current options seem to be: 1) networking at different levels of care, from primary physicians to specialised sleep laboratories; and 2) use of telemedicine. Telemedicine can contribute to the improved cost-effectiveness of OSA management during both the diagnostic and therapeutic phases. However, although the technology is already in place and different commercial platforms are in use, it is still unclear how to use telemedicine effectively in the sleep field. Application of telemedicine for titration of positive airway pressure treatment, follow-up to improve compliance to treatment through early identification and solution of problems, and teleconsultation all appear to be promising areas for improved OSA management.
Topics: Delivery of Health Care, Integrated; Health Services Needs and Demand; Humans; Lung; Needs Assessment; Patient Compliance; Predictive Value of Tests; Recovery of Function; Respiration; Respiratory Therapy; Sleep; Sleep Apnea Syndromes; Telemedicine; Treatment Outcome
PubMed: 31511256
DOI: 10.1183/16000617.0059-2019 -
Respiratory Care Jul 2018We sought to compare treatment satisfaction with inhaled medications among asthmatics using a metered-dose inhaler (MDI) or a dry-powder inhaler (DPI), and to correlate...
BACKGROUND
We sought to compare treatment satisfaction with inhaled medications among asthmatics using a metered-dose inhaler (MDI) or a dry-powder inhaler (DPI), and to correlate satisfaction with treatment adherence, pulmonary function, and airway inflammation.
METHODS
Spirometry, fraction of expired nitric oxide (F), and asthma control were assessed in 200 adult subjects with asthma (69 men, 131 women) using MDI or DPI. Treatment satisfaction with inhaled therapy was assessed with the Treatment Satisfaction Questionnaire for Medication (TSQM) in 4 domains: Effectiveness, Side Effects, Convenience, and Global Satisfaction. The Medication Adherence Questionnaire (MAQ) was used to evaluate adherence to treatment.
RESULTS
There were 115 and 85 subjects with asthma, using MDI and DPI, respectively. More MDI users (40.9%) had well-controlled asthma as compared to DPI users (17.6%). MDI users had greater treatment adherence and better TSQM domain scores for Effectiveness, Convenience, and Global Satisfaction than did DPI users. Multivariate linear regression analysis revealed no significant association between MDI/DPI use and TSQM domain scores. TSQM Convenience and Global Satisfaction domain scores were significantly correlated with MAQ scores (Spearman's coefficients 0.211 and 0.218, = .003 and = .002, respectively). There was no significant correlation between any TSQM domain score and pulmonary function or F concentration.
CONCLUSIONS
MDIs were associated with better disease control and treatment adherence among subjects with asthma. Both MDI and DPI are likely to provide equivalent treatment satisfaction.
Topics: Administration, Inhalation; Adult; Asthma; Dry Powder Inhalers; Female; Humans; Linear Models; Lung; Male; Medication Adherence; Metered Dose Inhalers; Middle Aged; Multivariate Analysis; Patient Satisfaction; Spirometry; Surveys and Questionnaires
PubMed: 29559538
DOI: 10.4187/respcare.05544 -
Revue Des Maladies Respiratoires Apr 2017
Review
Topics: Acute Disease; Disease Progression; Environmental Pollution; France; Humans; Infections; Patient Compliance; Pulmonary Disease, Chronic Obstructive; Risk Factors
PubMed: 28476417
DOI: 10.1016/j.rmr.2017.03.005 -
Respiratory Medicine Jan 2008The delivery of drugs by inhalation is an integral component of asthma and chronic obstructive pulmonary disease (COPD) management. However, even with effective inhaled... (Review)
Review
The delivery of drugs by inhalation is an integral component of asthma and chronic obstructive pulmonary disease (COPD) management. However, even with effective inhaled pharmacological therapies, asthma, particularly, remains poorly controlled around the world. The reasons for this are manifold, but limitations of treatment guidelines in terms of content, implementation and relevance to everyday clinical life, including insufficient patient education, access to health care and cost of medication as well as poor inhaler technique are likely to contribute. Considering that inhalation therapy is a cornerstone in asthma and COPD management, little advice is provided in the guidelines regarding inhaler selection. The pressurised metered dose inhaler (pMDI) is still the most frequently prescribed device worldwide, but even after repeated tuition many patients fail to use it correctly. In addition, the correct technique can be lost over time. Although several improvements in pMDIs such as a change in the propellant and actuation have resulted in improvements in lung deposition, many dry powder inhalers (DPIs) are easier to use. However, these devices also have limitations such as dependency of drug particle size on flow rate and loss of the metered dose if the patient exhales through the device before inhaling. Improvements in using inhalation devices more efficiently, in inhaler design for supporting patient compliance, and advances in inhaler technology to assure drug delivery to the lungs, have the potential to improve asthma and COPD management and control. New and advanced devices are considered being helpful to minimise the most important problems patients have with current DPIs.
Topics: Anti-Asthmatic Agents; Asthma; Dose-Response Relationship, Drug; Equipment Design; Humans; Nebulizers and Vaporizers; Particle Size; Patient Compliance; Pulmonary Disease, Chronic Obstructive; Self Administration; Treatment Outcome
PubMed: 17923402
DOI: 10.1016/j.rmed.2007.07.031 -
The Lancet. Respiratory Medicine Dec 2020Patients with COVID-19 can develop acute respiratory distress syndrome (ARDS), which is associated with high mortality. The aim of this study was to examine the... (Comparative Study)
Comparative Study Observational Study
BACKGROUND
Patients with COVID-19 can develop acute respiratory distress syndrome (ARDS), which is associated with high mortality. The aim of this study was to examine the functional and morphological features of COVID-19-associated ARDS and to compare these with the characteristics of ARDS unrelated to COVID-19.
METHODS
This prospective observational study was done at seven hospitals in Italy. We enrolled consecutive, mechanically ventilated patients with laboratory-confirmed COVID-19 and who met Berlin criteria for ARDS, who were admitted to the intensive care unit (ICU) between March 9 and March 22, 2020. All patients were sedated, paralysed, and ventilated in volume-control mode with standard ICU ventilators. Static respiratory system compliance, the ratio of partial pressure of arterial oxygen to fractional concentration of oxygen in inspired air, ventilatory ratio (a surrogate of dead space), and D-dimer concentrations were measured within 24 h of ICU admission. Lung CT scans and CT angiograms were done when clinically indicated. A dataset for ARDS unrelated to COVID-19 was created from previous ARDS studies. Survival to day 28 was assessed.
FINDINGS
Between March 9 and March 22, 2020, 301 patients with COVID-19 met the Berlin criteria for ARDS at participating hospitals. Median static compliance was 41 mL/cm HO (33-52), which was 28% higher than in the cohort of patients with ARDS unrelated to COVID-19 (32 mL/cm HO [25-43]; p<0·0001). 17 (6%) of 297 patients with COVID-19-associated ARDS had compliances greater than the 95th percentile of the classical ARDS cohort. Total lung weight did not differ between the two cohorts. CT pulmonary angiograms (obtained in 23 [8%] patients with COVID-19-related ARDS) showed that 15 (94%) of 16 patients with D-dimer concentrations greater than the median had bilateral areas of hypoperfusion, consistent with thromboembolic disease. Patients with D-dimer concentrations equal to or less than the median had ventilatory ratios lower than those of patients with D-dimer concentrations greater than the median (1·66 [1·32-1·95] vs 1·90 [1·50-2·33]; p=0·0001). Patients with static compliance equal to or less than the median and D-dimer concentrations greater than the median had markedly increased 28-day mortality compared with other patient subgroups (40 [56%] of 71 with high D-dimers and low compliance vs 18 [27%] of 67 with low D-dimers and high compliance, 13 [22%] of 60 with low D-dimers and low compliance, and 22 [35%] of 63 with high D-dimers and high compliance, all p=0·0001).
INTERPRETATION
Patients with COVID-19-associated ARDS have a form of injury that, in many aspects, is similar to that of those with ARDS unrelated to COVID-19. Notably, patients with COVID-19-related ARDS who have a reduction in respiratory system compliance together with increased D-dimer concentrations have high mortality rates.
FUNDING
None.
Topics: Aged; COVID-19; Computed Tomography Angiography; Female; Fibrin Fibrinogen Degradation Products; Humans; Lung; Male; Middle Aged; Pandemics; Prospective Studies; Respiration, Artificial; Respiratory Distress Syndrome; SARS-CoV-2
PubMed: 32861276
DOI: 10.1016/S2213-2600(20)30370-2 -
Sensors (Basel, Switzerland) Apr 2022Continuous positive airway pressure (CPAP) telemonitoring (TMg) has become widely implemented in routine clinical care. Objective measures of CPAP compliance, residual... (Review)
Review
Continuous positive airway pressure (CPAP) telemonitoring (TMg) has become widely implemented in routine clinical care. Objective measures of CPAP compliance, residual respiratory events, and leaks can be easily monitored, but limitations exist. This review aims to assess the role of TMg in CPAP-treated obstructive sleep apnea (OSA) patients. We report recent data related to the accuracy of parameters measured by CPAP and try to determine the role of TMg in CPAP treatment follow-up, from the perspective of both healthcare professionals and patients. Measurement and accuracy of CPAP-recorded data, clinical management of these data, and impacts of TMg on therapy are reviewed in light of the current literature. Moreover, the crucial questions of who and how to monitor are discussed. TMg is a useful tool to support, fine-tune, adapt, and control both CPAP efficacy and compliance in newly-diagnosed OSA patients. However, clinicians should be aware of the limits of the accuracy of CPAP devices to measure residual respiratory events and leaks and issues such as privacy and cost-effectiveness are still a matter of concern. The best methods to focus our efforts on the patients who need TMg support should be properly defined in future long-term studies.
Topics: Continuous Positive Airway Pressure; Follow-Up Studies; Humans; Monitoring, Physiologic; Patient Compliance; Sleep Apnea, Obstructive
PubMed: 35408395
DOI: 10.3390/s22072782