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copd, breathlessness, primary care

Charles C Reilly, Claudia Bausewein, Rachel Garrod, Caroline J Jolley, John Moxham, Irene J Higginson
BACKGROUND: The London Chest Activities of Daily Living Scale measures the impact of breathlessness on both activity and social functioning. However, the London Chest Activities of Daily Living Scale is not routinely used in patients with advanced disease. AIM: To assess the psychometric properties of the London Chest Activities of Daily Living Scale in patients with refractory breathlessness due to advanced disease. DESIGN: A cross-sectional secondary analysis of data from a randomised controlled parallel-group, pragmatic, single-blind fast-track trial (randomised controlled trial) investigating the effectiveness of an integrated palliative and respiratory care service for patients with advanced disease and refractory breathlessness, known as the Breathlessness Support Service (NCT01165034)...
December 8, 2016: Palliative Medicine
Steffen T Simon, Irene J Higginson, Sara Booth, Richard Harding, Vera Weingärtner, Claudia Bausewein
BACKGROUND: This is an updated version of the original Cochrane review published in Issue 1, 2010, on 'Benzodiazepines for the relief of breathlessness in advanced malignant and non-malignant diseases in adults'. Breathlessness is one of the most common symptoms experienced in the advanced stages of malignant and non-malignant disease. Benzodiazepines are widely used for the relief of breathlessness in advanced diseases and are regularly recommended in the literature. At the time of the previously published Cochrane review, there was no evidence for a beneficial effect of benzodiazepines for the relief of breathlessness in people with advanced cancer and chronic obstructive pulmonary disease (COPD)...
October 20, 2016: Cochrane Database of Systematic Reviews
Sau Nga Fu, Wai Cho Yu, Carlos King-Ho Wong, Margaret Choi-Hing Lam
PURPOSE: The purpose of this study was to define the prevalence of undiagnosed airflow obstruction (AO) among subjects with a history of smoking but no previous diagnosis of chronic lung disease. The finding of AO likely represents diagnosis of chronic obstructive pulmonary disease. PATIENTS: People aged ≥30 years with a history of smoking who attended public outpatient clinics for primary care services were included in this study. METHODS: A cross-sectional survey in five clinics in Hong Kong using the Breathlessness, Cough, and Sputum Scale, the Lung Function Questionnaire, and office spirometry was conducted...
2016: International Journal of Chronic Obstructive Pulmonary Disease
N J Roberts, I S Patel, M R Partridge
BACKGROUND: Females with exacerbations of Chronic Obstructive Pulmonary Disease now account for one half of all hospital admissions for that condition and rates have been increasing over the last few decades. Differences in presentations of disease between genders have been shown in several conditions and this study explores whether there are inter gender biases in probable diagnoses in those suspected to have COPD. METHODS: 445 individuals with a provisional diagnosis by their General Practitioner of "suspected COPD" or "definite COPD" were referred to a community Respiratory Assessment unit (CRAU) for tests including spirometry...
February 2016: Respiratory Medicine
Julia H Vermylen, Eytan Szmuilowicz, Ravi Kalhan
COPD is a leading cause of morbidity and mortality worldwide. Patients suffer from refractory breathlessness, unrecognized anxiety and depression, and decreased quality of life. Palliative care improves symptom management, patient reported health-related quality of life, cost savings, and mortality though the majority of patients with COPD die without access to palliative care. There are many barriers to providing palliative care to patients with COPD including the difficulty in prognosticating a patient's course causing referrals to occur late in a patient's disease...
2015: International Journal of Chronic Obstructive Pulmonary Disease
Richard A Hayward, Ying Chen, Peter Croft, Kelvin P Jordan
OBJECTIVE: General practitioners can record patients' presenting symptoms by using a code or free text. We compared breathlessness and wheeze symptom codes and free text recorded prior to diagnosis of ischaemic heart disease (IHD), chronic obstructive pulmonary disease (COPD) and asthma. DESIGN: A case-control study. SETTING: 11 general practices in North Staffordshire, UK, contributing to the Consultations in Primary Care Archive consultation database...
June 12, 2015: BMJ Open
Steve Holmes, Jane Scullion
Chronic obstructive pulmonary disease (COPD) is a common and often particularly debilitating disease. Progressively worsening breathlessness can limit normal daily functioning, reduce quality of life (QoL) and increase the risk of premature death. Importantly, early diagnosis, improving symptoms and QoL, along with minimising exacerbations and hospital admissions, are primary goals of patient care. In recent years, the assessment of COPD has moved away from equating disease severity solely with the degree of obstructive lung impairment to include patient symptoms, exacerbation history and comorbidities, as well as smoking status...
April 23, 2015: British Journal of Nursing: BJN
Young Seok Lee, Seunghee Baek, Yousang Ko, Mi-Yeong Kim, Hyun-Kyung Lee, Tae-Bum Kim, You Sook Cho, Hee-Bom Moon, Sang-Do Lee, Yeon-Mok Oh
BACKGROUND AND OBJECTIVE: It remains difficult to differentiate between chronic obstructive pulmonary disease (COPD) and asthma in clinical practice, especially in a primary care setting. The purpose of this study was to develop a new scoring system for differentiating between COPD and asthma, and to evaluate its effectiveness. METHODS: First, to identify important variables differentiating COPD from asthma, the data of 197 patients with COPD and 138 patients with asthma were assessed retrospectively...
May 2015: Respirology: Official Journal of the Asian Pacific Society of Respirology
Irene J Higginson, Claudia Bausewein, Charles C Reilly, Wei Gao, Marjolein Gysels, Mendwas Dzingina, Paul McCrone, Sara Booth, Caroline J Jolley, John Moxham
BACKGROUND: Breathlessness is a common and distressing symptom, which increases in many diseases as they progress and is difficult to manage. We assessed the effectiveness of early palliative care integrated with respiratory services for patients with advanced disease and refractory breathlessness. METHODS: In this single-blind randomised trial, we enrolled consecutive adults with refractory breathlessness and advanced disease from three large teaching hospitals and via general practitioners in South London...
December 2014: Lancet Respiratory Medicine
Alda Marques, Raquel Gabriel, Cristina Jácome, Joana Cruz, Dina Brooks, Daniela Figueiredo
PURPOSE: This study explored the expectations of patients with chronic obstructive pulmonary disease (COPD) and family members about a family-based pulmonary rehabilitation (PR) programme; developed and implemented a family-based PR programme and explored the impacts of the intervention on patients and family members. METHOD: Patients with COPD and family members were interviewed. A family-based PR programme was designed. Patients' breathlessness, muscle strength, exercise tolerance, functional balance and health-related quality of life were collected pre/post-programme...
2015: Disability and Rehabilitation
Rebecca T Disler, Anna Green, Tim Luckett, Phillip J Newton, Sally Inglis, David C Currow, Patricia M Davidson
CONTEXT: Chronic obstructive pulmonary disease (COPD) is a life-limiting illness. Despite best available treatments, individuals continue to experience symptom burden and have high health care utilization. OBJECTIVES: To increase understanding of the experience and ongoing needs of individuals living with COPD. METHODS: Medline, PsycINFO, CINAHL, and Sociological Abstracts were searched for articles published between January 1990 and June 2013...
December 2014: Journal of Pain and Symptom Management
Lindsay D Apps, Samantha L Harrison, Johanna E A Williams, Nicky Hudson, Michael Steiner, Mike D Morgan, Sally J Singh
BACKGROUND: There is much description in the literature of how patients with chronic obstructive pulmonary disease (COPD) manage their breathlessness and engage in self-care activities; however, little of this is from the perspective of those with less severe disease, who are primarily managed in primary care. This study aimed to understand the self-care experiences of patients with COPD who are primarily managed in primary care, and to examine the challenges of engaging in such behaviors...
2014: International Journal of Chronic Obstructive Pulmonary Disease
S Brenner, G Güder
Dyspnea is the uncomfortable awareness of difficult breathing. It is a common symptom in primary and nonprimary care settings. Although multiple disorders and diseases may cause breathlessness, the majority of the conditions are of cardiac or pulmonary origin. The challenge is to establish the diagnosis timely and with minimized investigations. Frequently, information about onset, progression, and circumstances of occurrence considerably narrow the underlying etiology. In most cases, a carefully taken history and a comprehensive physical examination lead to the correct diagnosis...
February 2014: Herz
Hana Müllerová, Chao Lu, Hao Li, Maggie Tabberer
BACKGROUND & AIMS: Breathlessness is a primary clinical feature of chronic obstructive pulmonary disease (COPD). We aimed to describe the frequency of and factors associated with breathlessness in a cohort of COPD patients identified from the Clinical Practice Research Datalink (CPRD), a general practice electronic medical records database. METHODS: Patients with a record of COPD diagnosis after January 1 2008 were identified in the CPRD. Breathlessness was assessed using the Medical Research Council (MRC) dyspnoea scale, with scoring ranging from 1-5, which has been routinely administered as a part of the regular assessment of patients with COPD in the general practice since April 2009...
2014: PloS One
David Price, Mark Small, Gary Milligan, Victoria Higgins, Esther Garcia Gil, Jordi Estruch
BACKGROUND: Sleep quality is often poor in patients with chronic obstructive pulmonary disease (COPD). A cross-sectional European survey investigated the prevalence of night-time symptoms in COPD to evaluate the level of disconnect between physician and patient perceptions of the presence of night-time symptoms, and to compare the characteristics of patients with and without night-time symptoms. METHODS: A total of 251 primary care physicians and 251 respiratory specialists completed record forms on 2,807 patients with COPD...
2013: International Journal of Chronic Obstructive Pulmonary Disease
Alan Kaplan, Kevin Gruffydd-Jones, Frederik van Gemert, Bruce J Kirenga, Andrew R L Medford
Worsening breathless in a patient with severe chronic obstructive pulmonary disease (COPD) is a common diagnostic and management challenge in primary care. A systematic approach to history-taking and examination combined with targeted investigation of pulmonary, cardiovascular, thromboembolic and systemic causes is essential if co-morbidities are to be identified and managed. Distinguishing between heart failure and COPD is a particular challenge as symptoms and signs overlap. In low and middle income countries additional priorities are the detection of infections such as tuberculosis and human immunodeficiency virus (HIV)...
December 2013: Primary Care Respiratory Journal: Journal of the General Practice Airways Group
Henry Chrystyn, Mark Small, Gary Milligan, Victoria Higgins, Esther Garcia Gil, Jordi Estruch
OBJECTIVE: To examine the relationships between inhaler satisfaction, treatment compliance and health status in patients with chronic obstructive pulmonary disease (COPD). METHODS: In a large, multinational, cross-sectional, real-world survey, respiratory specialists and primary care physicians provided information on six consecutive patients with COPD, who were then asked to complete a questionnaire. Physician-assessed compliance was scored (5-point Likert scale) and patients rated overall satisfaction with their maintenance inhaler (7-point Likert scale)...
February 2014: Respiratory Medicine
David C Currow, Katherine Clark, Geoffrey K Mitchell, Miriam J Johnson, Amy P Abernethy
INTRODUCTION: Breathlessness is a subjective sensation, so understanding its impacts requires patients' reports, including prospective patient-defined breathlessness as a reason for presenting to general practitioners (GP).The aim of this study was to define the prevalence of breathlessness as a reason for GP consultations while defining the clinico-demographic factors of these patients and the characteristics and outcomes of those consultations. METHODS: Using nine years of the Family Medicine Research Centre database of 100 consecutive encounters from 1,000 practices annually, the patient-defined reason for encounter 'breathlessness' was explored using prospectively collected data in people ≥ 18 years with clinical data coded using the International Classification for Primary Care V2...
2013: PloS One
Lindsay D Apps, Katy E Mitchell, Samantha L Harrison, Louise Sewell, Johanna E Williams, Hannah Ml Young, Michael Steiner, Mike Morgan, Sally J Singh
PURPOSE: There is no independent standardized self-management approach available for chronic obstructive pulmonary disease (COPD). The aim of this project was to develop and test a novel self-management manual for individuals with COPD. PATIENTS: Participants with a confirmed diagnosis of COPD were recruited from primary care. METHODS: A novel self-management manual was developed with health care professionals and patients. Five focus groups were conducted with individuals with COPD (N = 24) during development to confirm and enhance the content of the prototype manual...
2013: International Journal of Chronic Obstructive Pulmonary Disease
Anthony J Guarascio, Shauntá M Ray, Christopher K Finch, Timothy H Self
Chronic obstructive pulmonary disease (COPD) is the third most common cause of death in the USA. In 2010, the cost of COPD in the USA was projected to be approximately US$50 billion, which includes $20 billion in indirect costs and $30 billion in direct health care expenditures. These costs can be expected to continue to rise with this progressive disease. Costs increase with increasing severity of disease, and hospital stays account for the majority of these costs. Patients are diagnosed with COPD following a multifactorial assessment that includes spirometry, clinical presentation, symptomatology, and risk factors...
2013: ClinicoEconomics and Outcomes Research: CEOR
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