Materiały źródłowe

• #1 Chronic Obstructive Pulmonary Disease (COPD): Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/297664-overview

  Chronic obstructive pulmonary disease (COPD) is the third leading cause of death worldwide, causing 3.23 million deaths in 2019. […] The FEV1 was used to predict outcome in COPD until other factors were identified to play a role in determining the outcome of COPD patients. These discoveries resulted in the creation of the multidimensional BODE index (body mass index, obstruction [FEV1], dyspnea [modified Medical Research Council dyspnea scale], and exercise capacity [6MWD]). […] Prognosis is based on a point system, with all 4 factors used to determine the score, as follows: Body mass index: greater than 21 = 0 points; less than 21 = 1 point; FEV1 (postbronchodilator percent predicted): greater than 65% = 0 points; 50-64% = 1 point; 36-49% = 2 points; less than 35% = 3 points; Modified Medical Research Council (MMRC) dyspnea scale: MMRC 0 = dyspneic on strenuous exercise (0 points); MMRC 1 = dyspneic on walking a slight hill (0 points); MMRC 2 = dyspneic on walking level ground, must stop occasionally due to breathlessness (1 point); MMRC 3 = dyspneic after walking 100 yards or a few minutes (2 points); MMRC 4 = cannot leave house; dyspneic doing activities of daily living (3 points); Six-minute walking distance: greater than 350 meters = 0 points; 250-349 meters = 1 point; 150-249 meters = 2 points; less than 149 meters = 3 points.

• #2 FF #141 Prognosis in End-Stage COPD – Palliative Care Network of Wisconsin

  https://www.mypcnow.org/fast-fact/prognosis-in-end-stage-copd/?print=print

  Prognostic variables in COPD patients are not well described, thus decision making regarding when to move away from aggressive life-sustaining treatments is challenging. […] A FEV1 of less than 35% of the predicted value represents severe disease; 25% of these patients will die within two years and 55% by four years. […] A number of other studies have shown that age, low body mass index (BMI), serum inflammatory biomarkers (such as C-reactive protein, IL-6, and fibrinogen) and low PaO2 were independent predictors that correlated to reduced survival time. […] The BODE scale, consisting of BMI, exercise capacity, and subjective estimates of dyspnea, has been shown to help predict survival over 1-3 years. […] Roughly 10% of patients admitted with a PaCO2 >50 mmHg will die during the index hospitalization, 33% will die within six months, and 43% die within one-year.

• #3 FF #141 Prognosis in End-Stage COPD | Palliative Care Network of Wisconsin

  https://www.mypcnow.org/fast-fact/prognosis-in-end-stage-copd/

  Fast Fact Number: 141 […] Background Prognostic variables in COPD patients are not well described, thus decision making regarding when to move away from aggressive life-sustaining treatments is challenging. This Fast Fact will review prognostication in patients with advanced COPD. […] Ambulatory COPD Patients The forced expiratory volume in one second (FEV1) has traditionally been used to assess COPD severity. A FEV1 of less than 35% of the predicted value represents severe disease; 25% of these patients will die within two years and 55% by four years. A number of other studies have shown that age, low body mass index (BMI), serum inflammatory biomarkers (such as C-reactive protein, IL-6, and fibrinogen) and low PaO2 were independent predictors that correlated to reduced survival time. The BODE scale, consisting of BMI, exercise capacity, and subjective estimates of dyspnea, has been shown to help predict survival over 1-3 years.

• #4 Prognostic models for outcome prediction in patients with chronic obstructive pulmonary disease: systematic review and critical appraisal | The BMJ

  https://www.bmj.com/content/367/bmj.l5358

  Objective To map and assess prognostic models for outcome prediction in patients with chronic obstructive pulmonary disease (COPD). […] The systematic search yielded 228 eligible articles, describing the development of 408 prognostic models, the external validation of 38 models, and the validation of 20 prognostic models derived for diseases other than COPD. […] Overall, the most commonly used predictors were age (n=166; 41%), forced expiratory volume in one second (n=85; 21%), sex (n=74; 18%), body mass index (n=66; 16%), and smoking (n=65; 16%). […] This study constitutes a detailed mapping and assessment of the prognostic models for outcome prediction in COPD patients. […] Future research should focus on the improvement of existing models through update and external validation, as well as the assessment of the safety, clinical effectiveness, and cost effectiveness of the application of these prognostic models in clinical practice through impact studies.

• #5 Prognostic models for outcome prediction in patients with chronic obstructive pulmonary disease: systematic review and critical appraisal | The BMJ

  https://www.bmj.com/content/367/bmj.l5358

  Our systematic review showed several methodological pitfalls in the development of the models, which is also reflected in the risk of bias assessment. […] Only a quarter of the models were internally validated, and a tenth of the models were externally validated. […] An important finding of our systematic review was that only a quarter of the models assessed calibration, which is the accuracy of absolute risk estimates. […] The most extensively validated prognostic models were the BODE index and the ADO index. […] An essential step before the application of prediction models in clinical practice is their external validation in independent populations with different clinical characteristics and comparison of performance among different prediction models to identify the models with the best discrimination and calibration. […] Future prognostic research should steer towards recalibration or update of existing prognostic models with the addition of new predictors to enhance their prognostic performance.

• #6 Chronic Obstructive Pulmonary Disease (COPD): Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/297664-overview

  The approximate 4-year survival based on the point system above is as follows: 0-2 points = 80%; 3-4 points = 67%; 5-6 points = 57%; 7-10 points = 18%. […] The use of a clinical scoring system reinforces that determinants of prognosis in COPD remain multifactorial. […] In a multicenter, prospective, observational study of 201 consecutive patients with moderate-to-severe COPD, Martinez-Garcia et al reported that in addition to smoking, pulmonary hypertension, and declining lung function (known risk factors for mortality in patients with COPD), bronchiectasis (which is common in patients with moderate-to-severe COPD) is independently associated with increased risk of all-cause mortality. […] In this study, those who had bronchiectasis were found to be 2.5 times more likely to die than those who did not.

• #7 Prediction of Mortality Using Different COPD Risk Assessments – | COPD

  https://www.dovepress.com/prediction-of-mortality-using-different-copd-risk-assessments-ndash-a–peer-reviewed-fulltext-article-COPD

  The aim of this study is to compare the prognostic ability for mortality by different COPD assessment systems; spirometric staging, classification by GOLD 2011, GOLD 2017, the age, dyspnea, obstruction (ADO) and the dyspnea, obstruction, smoking, exacerbation (DOSE) indices. […] By the end of follow-up, 49% of the patients were deceased. The mortality rate was higher for patients categorized as stage 3 4, GOLD D in both GOLD classifications and those with a DOSE score above 4 and ADO score above 8. The ADO index was most accurate for predicting mortality, AUC 0.79 (95% CI 0.75 0.83) for all-cause mortality and 0.80 (95% CI 0.75 0.85) for respiratory mortality. […] All of the risk assessment systems predict mortality. The ADO index was in this study the best predictor and could be a helpful tool in COPD risk assessment.

• #8 Prediction of Mortality Using Different COPD Risk Assessments – | COPD

  https://www.dovepress.com/prediction-of-mortality-using-different-copd-risk-assessments-ndash-a–peer-reviewed-fulltext-article-COPD

  The primary finding was that overall, all risk assessment systems predicted all-cause mortality and respiratory mortality. The secondary finding is that the ADO index had the most accurate predictive ability. […] The ADO index was the most accurate, followed by an assessment by lung function. We conclude that the GOLD recommendation to use lung function for prognosis is appropriate and that the ADO index can be a useful tool for COPD risk assessment in clinical practice.

• #9 Development and validation of a multivariable mortality risk prediction model for COPD in primary care | npj Primary Care Respiratory Medicine

  https://www.nature.com/articles/s41533-022-00280-0

  Risk stratification of chronic obstructive pulmonary disease (COPD) patients is important to enable targeted management. […] We sought to develop and validate a prognostic model to predict 10-year mortality in patients with diagnosed COPD. […] According to the validated prognostic model, the two most important risk factors of mortality were heart failure (HR 1.92; 95% CI 1.87-1.96) and current smoking (HR 1.68; 95% CI 1.66-1.71). […] The most significant risk factors associated with mortality (with at least a 50% increased risk) after COPD diagnosis were having heart failure and being a current smoker (compared to non-smoker). […] The extended Cox-regression model developed in this study was internally validated and achieved strong validation performance. […] In summary, we have developed and validated a prognostic model to predict the 10-year mortality of patients diagnosed with COPD using national-level, primary care data (the largest study on the topic to date). The prognostic model found several risk factors to be associated with 10-year mortality, with varying degrees of strength. The most significant of these factors were heart failure and being a current smoker; in contrast, history of ARIs and asthma were not independent risk factors of poor prognosis.

• #10 Development and validation of a multivariable mortality risk prediction model for COPD in primary care

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9156666/

  Risk stratification of chronic obstructive pulmonary disease (COPD) patients is important to enable targeted management. […] We sought to develop and validate a prognostic model to predict 10-year mortality in patients with diagnosed COPD. […] According to the validated prognostic model, the two most important risk factors of mortality were heart failure (HR 1.92; 95% CI 1.87-1.96) and current smoking (HR 1.68; 95% CI 1.66-1.71). […] The most significant risk factors associated with mortality (with at least a 50% increased risk) after COPD diagnosis were having heart failure and being a current smoker (compared to non-smoker). […] A strong rank correlation between socioeconomic status and risk of mortality was observed (i.e., the more deprived a patient, the greater the risk of mortality).

• #11 Development and validation of a multivariable mortality risk prediction model for COPD in primary care

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9156666/

  This study clearly demonstrates that various co-morbidities increase the risk of mortality in patients diagnosed with COPD and underlines the need for a comprehensive COPD management strategy that takes co-morbidities into account. […] Not all co-morbidities modify mortality risk of COPD patients equally. Patients with specific co-morbidities (such as heart failure and IHD) should be prioritised for targeted interventions to help improve their chances of survival. […] In summary, we have developed and validated a prognostic model to predict the 10-year mortality of patients diagnosed with COPD using national-level, primary care data (the largest study on the topic to date). The prognostic model found several risk factors to be associated with 10-year mortality, with varying degrees of strength. The most significant of these factors were heart failure and being a current smoker; in contrast, history of ARIs and asthma were not independent risk factors of poor prognosis.

• #12 Prediction of long-term clinical outcomes using simple functional exercise performance tests in patients with COPD: a 5-year prospective cohort study | Respiratory Research | Full Text

  https://respiratory-research.biomedcentral.com/articles/10.1186/s12931-017-0598-6

  The 1-min sit-to-stand (1-min STS) test and handgrip strength test have been proposed as simple tests of functional exercise performance in chronic obstructive pulmonary disease (COPD) patients. […] We assessed the long-term (5-year) predictive performance of the 1-min sit-to-stand and handgrip strength tests for mortality, health-related quality of life (HRQoL) and exacerbations in COPD patients. […] Our results suggest that the 1-min STS test may be useful for assessing the health status and long-term prognosis of COPD patients. […] The 1-min STS test was statistically significantly associated with 5-year mortality per 3 repetitions (hazard ratio (HR): 0.81, 95% CI 0.65 to 0.86), whereas the handgrip strength test was not statistically significantly associated with mortality. […] We found that over 5 years, the 1-min STS test was strongly associated with mortality and moderately associated with HRQoL.

• #13 Prediction of long-term clinical outcomes using simple functional exercise performance tests in patients with COPD: a 5-year prospective cohort study | Respiratory Research | Full Text

  https://respiratory-research.biomedcentral.com/articles/10.1186/s12931-017-0598-6

  The present study suggests that the 1-min STS test has long-term predictive validity for mortality and that associations with outcomes only diminish slightly over 5 years. […] In conclusion, the 1-min STS test as a measure of functional exercise performance showed good long-term predictive validity for the mortality and moderate predictive validity for HRQoL.

• #14 FF #141 Prognosis in End-Stage COPD | Palliative Care Network of Wisconsin

  https://www.mypcnow.org/fast-fact/prognosis-in-end-stage-copd/

  Hospitalized COPD Patients Mortality statistics vary for patients admitted with COPD exacerbations depending on age, functional status, co-morbidities, and physiological variables such as hypoxia and hypercarbia. Roughly 10% of patients admitted with a PaCO2 >50 mmHg will die during the index hospitalization, 33% will die within six months, and 43% die within one-year. Patients with less severe COPD have lower in-hospital mortality rates. COPD patients who require mechanical ventilation have an-hospital mortality of ~25%. Poor prognostic factors include: co-morbid illnesses, severity of illness (APACHE II score), low serum albumin, and/or low hemoglobin. Previous mechanical ventilation, failed extubation, or intubation for greater than 72 hours all increase mortality. In one study, patients ventilated more than 48 hours had a 50% one year survival; functional status and severity of illness were associated with short term mortality while age and co-morbidities were associated with one year mortality.

• #15 FF #141 Prognosis in End-Stage COPD – Palliative Care Network of Wisconsin

  https://www.mypcnow.org/fast-fact/prognosis-in-end-stage-copd/?print=print

  COPD patients who require mechanical ventilation have an-hospital mortality of ~25%. […] Poor prognostic factors include: co-morbid illnesses, severity of illness (APACHE II score), low serum albumin, and/or low hemoglobin. […] In one study, patients ventilated more than 48 hours had a 50% one year survival; functional status and severity of illness were associated with short term mortality while age and co-morbidities were associated with one year mortality. […] For ambulatory patients, age, degree of dyspnea, weight loss (BMI), functional status, and FEV1 are relevant prognostic factors for predicting 1-3 year survival. For hospitalized patients, the same factors are relevant. […] In addition, the need for prolonged or recurrent mechanical ventilation is predictive of a shorter prognosis.

• #16 Developing and validating prediction models for severe exacerbations and readmissions in patients hospitalised for COPD exacerbation (SERCO) in China: a prospective observational study | BMJ Open Respiratory Research

  https://bmjopenrespres.bmj.com/content/11/1/e001881

  There is a lack of individualised prediction models for patients hospitalised with chronic obstructive pulmonary disease (COPD) for clinical practice. […] The SERCO model provides individual predictions for severe exacerbation and COPD-specific readmission risk, which enables identifying high-risk patients and implementing personalised preventive intervention for patients with COPD. […] Among patients hospitalised for AECOPD, the severe exacerbations and readmissions in patients hospitalised for COPD exacerbation (SERCO) model shows good performance for predicting the risk of severe exacerbations and COPD-specific readmissions at 1, 6 and 12 months after discharge. […] The SERCO model discriminated outcomes better than prior severe exacerbation history. […] The most important finding of the study was the development and validation of SERCO to predict short-term, medium-term and long-term risk of severe exacerbations and COPD-specific readmissions within 12 months after discharge in patients hospitalised for AECOPD. […] SERCO has the potential to be used as a decision tool for personalised treatments and hospital discharge plans.

• #17 Prediction of five-year mortality after COPD diagnosis using primary care records | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0236011

  We have used a large primary care cohort to develop and validate the iCOPD model for the prediction of mortality within 5 years of a COPD diagnosis, using only variables already recorded within health records at the time of diagnosis. […] iCOPD achieved area under the curves of between 0.7830.809 and calibration slopes between 0.9111.04 in validation cohorts from across the UK not used in model development. […] In conclusion, we have developed and validated a model for the prediction of mortality five years after the diagnosis of COPD, providing an online risk calculator.

• #18 Prediction of COPD-specific health-related quality of life in primary care COPD patients: a prospective cohort study | npj Primary Care Respiratory Medicine

  https://www.nature.com/articles/npjpcrm201460

  Health-related quality of life (HRQL) is an important patient-reported outcome for chronic obstructive pulmonary disease (COPD). […] To predict COPD-specific HRQL in primary care COPD patients, previous HRQL was the best predictor in our models. Asking patients explicitly about dyspnoea, fatigue, depression and how they cope with COPD provides additional important information about future HRQL whereas FEV1 or other commonly used predictors add little to the prediction of HRQL. […] We found that COPD-specific HRQL after 6 and 24 months in primary care COPD patients could be reasonably well predicted by the corresponding domain-specific score at baseline. […] Our current study shows that COPD-specific HRQL is no exception to the rule that a previous measurement of a phenomenon usually is a strong predictor of the (probability of) the next occurrence. A prediction model as such only does what the name suggests: predict. By itself, it does not change the course of disease.

• #19 Prediction of COPD-specific health-related quality of life in primary care COPD patients: a prospective cohort study | npj Primary Care Respiratory Medicine

  https://www.nature.com/articles/npjpcrm201460

  In daily clinical practice, our models can be used to inform patients about future HRQL. Since all predictors are available in primary care, general practitioners can use the models to predict their patients courses in different domains of, and in overall, HRQL. […] Future studies should further validate our models in other populations with respect to discrimination and calibration. Also, data from randomised trials and meta-analyses can be incorporated or linked to our models to estimate how the prediction of HRQL is likely to change when adding treatments such as smoking cessation programs, pulmonary rehabilitation or specific drug treatments. […] To predict COPD-specific HRQL in primary care COPD patients, previous HRQL is the best predictor.

• #20 Predicting future health risk in COPD | COPD

  https://www.dovepress.com/predicting-future-health-risk-in-copd-differential-impact-of-disease-s-peer-reviewed-fulltext-article-COPD

  Objective: Multi-morbidity contributes to mortality and hospitalisation in COPD, but it is uncertain how this interacts with disease severity in risk prediction. We compared contributions of multi-morbidity and disease severity factors in modelling future health risk using UK primary care healthcare data. […] Conclusion: Stratification of future health risk in COPD can be undertaken using clinical and demographic data recorded in primary care, but the impact of disease severity and multi-morbidity varies depending on the choice of health outcome. A more comprehensive risk modelling algorithm such as ACG offers enhanced prediction for hospitalisation by incorporating a wider range of coded diagnoses. […] This study demonstrates that the performance of risk stratification models for patients with COPD managed in primary care differs depending on the outcome in question (hospitalisation or mortality) and whether disease-specific characteristics or patterns of multi-morbidity are included as predictor variables.

• #21 Predicting future health risk in COPD | COPD

  https://www.dovepress.com/predicting-future-health-risk-in-copd-differential-impact-of-disease-s-peer-reviewed-fulltext-article-COPD

  Our findings suggest that for mortality prediction, the severity of the reference condition (COPD) is a key indicator, as the addition of clinically important and prevalent multi-morbidity did not further enhance predictive power. […] Our data suggests that hospitalisation is less easy to predict, presumably because hospital admission is influenced by a number of factors which may not be recorded in primary care records, for example social circumstances, family support and accessibility of local health care services. […] Importantly, we have demonstrated this differential effect using routinely collected primary care data in a cohort representative of clinical practice in the UK.

• #22 Predictive score for mortality in patients with COPD exacerbations attending hospital emergency departments | BMC Medicine | Full Text

  https://bmcmedicine.biomedcentral.com/articles/10.1186/1741-7015-12-66

  We developed a clinical prediction rule for a critical outcome, death, for patients attending an ED with eCOPD. The five variables included in our model are easily available in the ED (and also in primary care settings) and the score is easy to estimate. This clinical prediction rule could be employed in the clinical management of patients with eCOPD to guide their treatment and follow-up by in the ED and also by primary care physicians.

• #23 FF #141 Prognosis in End-Stage COPD | Palliative Care Network of Wisconsin

  https://www.mypcnow.org/fast-fact/prognosis-in-end-stage-copd/

  National Hospice and Palliative Care Organization Criteria NHPCO guidelines for hospice admission in COPD include factors such as cor pulmonale and pO2 <55 mmHg while on oxygen, albumin < 2.5 gm/dl, weight loss of > 10%, progression of disease, and poor functional status. However, a study showed when using these factors, 50% of the patients were still alive at six months, implying that the NHPCO criteria have a limited role in predicting six month mortality and thus should be used with caution in determining hospice eligibility under the Medicare Hospice Benefit. […] Summary COPD is a heterogeneous disease without a simple prognostic trajectory. For ambulatory patients, age, degree of dyspnea, weight loss (BMI), functional status, and FEV1 are relevant prognostic factors for predicting 1-3 year survival. For hospitalized patients, the same factors are relevant. In addition, the need for prolonged or recurrent mechanical ventilation is predictive of a shorter prognosis.

• #24 Prognostic models for outcome prediction in patients with chronic obstructive pulmonary disease: systematic review and critical appraisal

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6776831/

  To map and assess prognostic models for outcome prediction in patients with chronic obstructive pulmonary disease (COPD). […] The systematic search yielded 228 eligible articles, describing the development of 408 prognostic models, the external validation of 38 models, and the validation of 20 prognostic models derived for diseases other than COPD. […] This study constitutes a detailed mapping and assessment of the prognostic models for outcome prediction in COPD patients. […] The findings indicate several methodological pitfalls in their development and a low rate of external validation. […] Future research should focus on the improvement of existing models through update and external validation, as well as the assessment of the safety, clinical effectiveness, and cost effectiveness of the application of these prognostic models in clinical practice through impact studies.

• #25

  https://www.who.int/news-room/fact-sheets/detail/chronic-obstructive-pulmonary-disease-(copd)

  COPD is not curable but symptoms can improve if one avoids smoking and exposure to air pollution and gets vaccines to prevent infections. […] COPD should be suspected if a person has typical symptoms, and the diagnosis confirmed by a breathing test called spirometry, which measures how the lungs are working. […] COPD isn’t curable, but it can get better by not smoking, avoiding air pollution and getting vaccines. […] People living with COPD must be given information about their condition, treatment and self-care to help them to stay as active and healthy as possible.

Zobacz więcej