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Zhang S, Lin J. Association of circadian syndrome and lung health: A population-based cohort study. Respir Med 2025; 240:108031. [PMID: 40058667 DOI: 10.1016/j.rmed.2025.108031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2024] [Revised: 02/14/2025] [Accepted: 03/05/2025] [Indexed: 03/16/2025]
Abstract
BACKGROUND Few studies have explored the association between circadian syndrome (CircS) and lung health. OBJECTIVE To assess the relationship between CircS and lung health. METHODS This prospective cohort study enrolled 6252 adults. Multivariable logistic and linear regression models were employed to examine the association between CircS and the prevalence of chronic lung disease, respiratory symptoms, and lung function, as appropriate. Receiver operating characteristic curve analysis was used to compare the predictive power of the number of metabolic syndrome (MetS) and CircS components for lung health. Kaplan-Meier survival and multiple Cox regression analyses were used to assess the relationship between CircS and all-cause mortality. The effects of CircS on health-related quality of life (HQL) and health care use were also evaluated. RESULTS Participants with CircS were significantly associated with a higher prevalence of asthma, chronic bronchitis, cough, wheeze, phlegm production, and exertional dyspnea. The number of CircS components demonstrated better predictive power for the prevalence of asthma, chronic bronchitis, emphysema, cough, wheeze, phlegm production, and exertional dyspnea than the number of MetS components. Higher numbers of CircS components were significantly associated with decreased forced expiratory volume in the first second (FEV1) and forced vital capacity (FVC), worse HQL, and increased health care use. Longitudinally, participants with CircS exhibited a higher risk of all-cause mortality than those without CircS. CONCLUSIONS Our results support the claim of that CircS is a better predictor of lung health than the MetS in adults in the United States. Elevated CircS levels are associated with poorer lung function, increased health care use, worse HQL, and a higher risk of mortality.
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Affiliation(s)
- Shuwen Zhang
- Graduate School of Peking University China-Japan Friendship School of Clinical Medicine, Beijing, 100-029, China; Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, 100-029, China
| | - Jiangtao Lin
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, 100-029, China.
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Calle Rubio M, Miravitlles M, Soler Cataluña JJ, López-Campos JL, Alcázar Navarrete B, Fuentes Ferrer ME, Rodríguez Hermosa JL. Clinical control in COPD and therapeutic implications: The EPOCONSUL audit. PLoS One 2025; 20:e0314299. [PMID: 39787174 PMCID: PMC11717229 DOI: 10.1371/journal.pone.0314299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2024] [Accepted: 11/07/2024] [Indexed: 01/12/2025] Open
Abstract
OBJECTIVE This study aimed to evaluate clinical control in chronic obstructive pulmonary disease (COPD), the consequences in terms of treatment decisions, and their potentially associated factors during follow-up of patients in real-life clinical practice. METHODS EPOCONSUL 2021 is a cross-sectional audit that evaluated the outpatient care provided to patients with a diagnosis of COPD in respiratory clinics in Spain and multivariable logistic regression models to assess the relationships between clinical control and clinical inertia. RESULTS 4225 patients from 45 hospitals in Spain were audited. Clinical control was analyzed in 1804 (42.7%) patients who met all the Spanish COPD Guidelines (GesEPOC) criteria. 49.1% of patients were classified as uncontrolled, and 42.2% of patients disagreed with the level of control determined by their doctor, which was reported as good during the visit. There was therapeutic inertia (TI), in other words not making any change or taking any action in the treatment of COPD, in 68.4% of uncontrolled patients and no action was taken during the visit for 9.1% of uncontrolled patients. Factors associated with TI in uncontrolled patients were disagreement with the degree of control reported by the doctor who performed the examination ☯physician classifies and reports disease as controlled versus uncontrolled, OR: 3.37 (2.33-4.88), p<0.001] and having a lower burden of associated comorbidities ☯Charlson comorbidity index ≥3 versus <3, OR 0.8 (0.1-3.0), p = 0.014]. The probability of disagreeing with the physician's classification of the degree of COPD control in uncontrolled patients was lower in patients with severe exacerbations ☯OR 0.3 (0.17-0.78), p = 0.009] and those with more exacerbations in the last year ☯OR 0.6 (0.4-0.9), p = 0.019]. CONCLUSIONS Therapeutic inertia exists in more than half of uncontrolled patients and is more likely when there is disagreement with the assessment of the physician responsible for the visit, who reported there being good disease control, a situation that was more likely in patients with less history of exacerbations.
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Affiliation(s)
- Myriam Calle Rubio
- Pulmonology Department, Department of Medicine, Hospital Clínico San Carlos, School of Medicine, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), CIBER de Enfermedades Respiratorias (CIBERES), Universidad Complutense de Madrid, Madrid, Spain
| | - Marc Miravitlles
- Pulmonology Department, Hospital Universitari Vall d’Hebron, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Barcelona Hospital Campus, CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
| | - Juan José Soler Cataluña
- Pulmonology Department, Hospital Arnau de Vilanova-Lliria, Valencia, Spain
- Medicine Department, CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Universitat de València, Valencia, Madrid
| | - José Luis López-Campos
- Respiratory Disease Medical-Surgical Unit, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Universidad de Sevilla, Sevilla, Spain
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Bernardino Alcázar Navarrete
- Pulmonology Department, Hospital Virgen de las Nieves, Granada, Spain
- IBS-Granada, Medicine Department, Universidad de Granada, Granada, Spain
| | - Manuel E. Fuentes Ferrer
- Unidad de Investigación, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Juan Luis Rodríguez Hermosa
- Pulmonology Department, Department of Medicine, Hospital Clínico San Carlos, School of Medicine, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), CIBER de Enfermedades Respiratorias (CIBERES), Universidad Complutense de Madrid, Madrid, Spain
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Qiu CJ, Wu S. Depression and anxiety disorders in chronic obstructive pulmonary disease patients: Prevalence, disease impact, treatment. World J Psychiatry 2024; 14:1797-1803. [PMID: 39704377 PMCID: PMC11622031 DOI: 10.5498/wjp.v14.i12.1797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2024] [Revised: 09/27/2024] [Accepted: 10/25/2024] [Indexed: 11/27/2024] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a common respiratory disorder that often co-occurs with depression and anxiety, worsening disease progression and reducing quality of life. A thorough review of the existing literature was conducted, including searches in PubMed, Embase, PsycINFO, and Cochrane Library databases up to 2024. This review encompasses a critical analysis of studies reporting on the prevalence, impact, and management of depression and anxiety in COPD patients. We found a high prevalence of psychological comorbidities in COPD patients, which were associated with worse disease outcomes, including increased exacerbations, hospitalizations, and reduced health-related quality of life. Diagnosing and managing these conditions is complex due to overlapping symptoms, necessitating a comprehensive patient care approach. While there has been progress in understanding COPD comorbidities, there is a need for more personalized and integrated treatments. This review emphasizes the need for increased awareness, tailored treatment plans, and further research for effective interventions.
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Affiliation(s)
- Chang-Jian Qiu
- Department of Psychiatry, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Shuang Wu
- Department of Psychiatry, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
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Karlsen JH, Jørgensen KH, Weinreich UM. Association between impairment of lung function and risk of anxiety and depression in patients with chronic obstructive pulmonary disease-a systematic review. Syst Rev 2024; 13:300. [PMID: 39633466 PMCID: PMC11616382 DOI: 10.1186/s13643-024-02720-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 11/25/2024] [Indexed: 12/07/2024] Open
Abstract
BACKGROUND This systematic review aims to examine the association between impairment of lung function and risk of anxiety and depression, respectively, in patients with chronic obstructive pulmonary disease (COPD). METHODS Literature search were performed 29/01-2024 using Embase and PubMed. Publications reporting association between forced expiratory volume in one second in percentage of expected value (FEV1(%)) and either anxiety or depression or both in patients with COPD were included. The studies were quality assessed using the Newcastle Ottawa Scale. The studies were analysed by assessing whether they showed significant results or not, and if they showed a negative or positive association between lung function and risk anxiety or depression and a pooled analysis was conducted. RESULTS Thirty-seven studies were included in the review, 15 reported anxiety and 31 reported depression, with 9 reporting both outcomes. Most were observational studies. Study population sizes ranged from 40 to 2147 patients. Three studies found a significant negative association between anxiety and FEV1(%), while five studies found a positive non-significant association between anxiety and FEV1(%). Fifteen studies found a significant negative association between FEV1(%) and depression. Especially the studies with larger study population sizes showed significant results. The pooled analysis supported this, as the depression studies showed a significant association between depression and FEV1(%), while the anxiety studies showed part non-significant, part significant associations between anxiety and FEV1(%). CONCLUSION This systematic review did not support an association between anxiety and impairment of pulmonary function as only 3/15 studies showed significant negative associations, and some studies showed positive associations. This review indicated an association between depression and impairment pulmonary function in patients with COPD, as most studies with a larger study population size showed a significant negative association. Sytematic review registration. PROSPERO 2024 CRD42024506065 Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024506065.
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Affiliation(s)
- Johanne Hermann Karlsen
- Department of Respiratory Diseases, Aalborg University Hospital, Hobrovej 18-22, 9000, AalborgC , Denmark.
- Faculty of Medicine, Aalborg University, Frederik Bajers Vej 7K, 9220, Aalborg, Denmark.
- Department of Internal Medicine, Regional Hospital Randers, Skovlyvej 15, 8930, Randers, NØ, Denmark.
| | - Kirstine Hermann Jørgensen
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Palle Juul-Jensens, Boulevard 99, 8200, AarhusN , Denmark
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 99, 8200, AarhusN , Denmark
| | - Ulla Møller Weinreich
- Department of Respiratory Diseases, Aalborg University Hospital, Hobrovej 18-22, 9000, AalborgC , Denmark
- Faculty of Medicine, Aalborg University, Frederik Bajers Vej 7K, 9220, Aalborg, Denmark
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Wu DW, Yang PC, Lin IM. Effects of Heart Rate Variability (HRV) Biofeedback in Pulmonary Indicators and HRV Indices Among Patients with Chronic Obstructive Pulmonary Disease. Appl Psychophysiol Biofeedback 2024:10.1007/s10484-024-09664-z. [PMID: 39254863 DOI: 10.1007/s10484-024-09664-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2024] [Indexed: 09/11/2024]
Abstract
Patients with chronic obstructive pulmonary disease (COPD) exhibit reduced cardiac autonomic activity, linked to poor prognosis and exercise intolerance. While heart rate variability biofeedback (HRVB) can enhance cardiac autonomic activity in various diseases, its use in patients with COPD is limited. This study explored the impact of the HRVB on cardiac autonomic activity and pulmonary indicators in patients with COPD. Fifty-three patients with COPD were assigned to either the HRVB (n = 26) or the control group (n = 27), with both groups receiving standard medical care. The HRVB group also underwent one-hour HRVB sessions weekly for six weeks. All participants had pre- and post-test measurements, including the Six-Minute Walking Test (6MWT), lead II electrocardiogram (ECG) recording, Modified Medical Research Council Dyspnea Scale (mMRC), body mass index, airflow obstruction, dyspnea, and exercise capacity (BODE) index. ECG data were analyzed for heart rate variability (HRV) as an index of cardiac autonomic activity. A two-way mixed analysis of variances demonstrated significant interaction effects of Group × Time in pulmonary indicators and HRV indices. The HRVB group exhibited significant post-test improvements, with decreased mMRC and BODE scores and increased 6MWT distance and HRV indices, compared to pre-test results. The 6MWT distance significantly increased and mMRC significantly decreased at post-test in the HRVB group compared with the control group. This study confirmed the efficacy of HRVB as an adjunct therapy in patients with COPD, showing improvements in exercise capacity, breathing difficulties, and cardiac autonomic activity.
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Affiliation(s)
- Da-Wei Wu
- Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung, 812, Taiwan
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, 807, Taiwan
- Doctoral Degree Program, Department of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, 807, Taiwan
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, 807, Taiwan
- Research Center for Precision Environmental Medicine, Kaohsiung Medical University, Kaohsiung, 807, Taiwan
| | - Po-Chou Yang
- Department of Psychology, College of Humanities and Social Sciences, Kaohsiung Medical University, No.100, Chih-Chuan 1st road, Kaohsiung, 807, Taiwan
| | - I-Mei Lin
- Department of Psychology, College of Humanities and Social Sciences, Kaohsiung Medical University, No.100, Chih-Chuan 1st road, Kaohsiung, 807, Taiwan.
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
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Zhang H, Ye R, Yang H, Liu Y, Zhao L, Zhao Y, Chen L, Shan L, Xia Y. Long-term noise exposure and cause-specific mortality in chronic respiratory diseases, considering the modifying effect of air pollution. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2024; 282:116740. [PMID: 39024955 DOI: 10.1016/j.ecoenv.2024.116740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2024] [Revised: 07/04/2024] [Accepted: 07/13/2024] [Indexed: 07/20/2024]
Abstract
BACKGROUND Chronic respiratory diseases (CRDs) are among the top three causes of human mortality. The relationship between modifiable environmental risk factor of noise and risk of mortality in CRDs is unclear. We investigated the longitudinal association between environmental noise exposure and cause-specific mortality in individuals with CRDs, considering the modifying effect of air pollution. METHODS Residential noise exposure was modelled using Common Noise Assessment Methods in Europe. Information on death causes were acquired from death registry data. Cox proportional-hazards models were used to estimate effect sizes. RESULTS Among 41,222 participants selected from UK Biobank with CRDs in baseline, a total of 3618 death cases occurred during an average follow-up of 12 years with mortality density of 7.16 per 1000 person years. Exposure with highest noise level (> percentile 90) were associated with 22 % (Hazard ratio [HR] = 1.22, 95 % confidence interval [CI]: 1.05, 1.42), 71 % (HR = 1.71, 95 % CI: 1.14, 2.56), and 84 % (HR = 1.84, 95 % CI: 1.10, 3.07) increased risks for all-cause, respiratory disease (RD)-cause, and COPD-cause mortalities, separately. Both multiplicative and additive interactions was found between air pollution and noise with the risk of RD-cause mortality. Participants with high air pollution and noise exposure were associated with a 101 % (HR = 2.01, 95 % CI: 1.10, 3.66) increased risk of RD-cause mortality. CONCLUSION It is imperative to mitigate noise exposure as a preventive measure against incident mortality in individuals with CRDs.
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Affiliation(s)
- Hehua Zhang
- Clinical Trials and Translation Center, Shengjing Hospital of China Medical University, Shenyang, China; Liaoning Key Laboratory of Precision Medical Research on Major Chronic Disease, Shenyang, China
| | - Rui Ye
- Department of Pulmonary and Critical Care Medicine, Shengjing Hospital of China Medical University, Shenyang, China
| | - Honghao Yang
- Liaoning Key Laboratory of Precision Medical Research on Major Chronic Disease, Shenyang, China; Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yashu Liu
- Liaoning Key Laboratory of Precision Medical Research on Major Chronic Disease, Shenyang, China; Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Li Zhao
- Department of Pulmonary and Critical Care Medicine, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yuhong Zhao
- Liaoning Key Laboratory of Precision Medical Research on Major Chronic Disease, Shenyang, China; Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Liangkai Chen
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lishen Shan
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China.
| | - Yang Xia
- Liaoning Key Laboratory of Precision Medical Research on Major Chronic Disease, Shenyang, China; Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China.
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Gregersen NV, Refsgaard B, Sørensen D. Preparing safe discharge in a complex practice: A qualitative study of nurses' approach to patients with COPD's hospital discharge from two pulmonary medicinal wards. Scand J Caring Sci 2024; 38:756-766. [PMID: 38622922 DOI: 10.1111/scs.13262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 03/06/2024] [Accepted: 03/23/2024] [Indexed: 04/17/2024]
Abstract
INTRODUCTION It remains unclear why 17% of patients with acute exacerbations of chronic obstructive pulmonary disease (COPD) treated in Danish hospitals are readmitted within 30 days. Hospital discharge is multifaceted. However, the preparation process and nurses' efforts may be essential in ensuring a successful discharge. AIM To explore the process of preparing discharge for patients with COPD in a hospital setting. METHOD Using constructivist grounded theory, we observed 11 nurses' work at two pulmonary medical wards using participant observation. Data collection and analysis were conducted using a constant comparative process encompassing three phases: initial, focused and theoretical. RESULTS We identified important perspectives influencing nurses when patients with COPD are discharged from two pulmonary medical wards. We generated a substantial theory of how nurses integrate various perspectives into their handling of hospital discharge. The theory contains three discharge approaches: co-creating, hesitating and socialising. The co-creating approach focuses on patient and relative involvement and systematic task solution, embedded in a biopsychosocial process, aiming to achieve a safe and sustainable discharge. In contrast, the hesitating approach focuses on discharging patients in line with system requirements and colleagues' expectations. Finally, the socialising approach focuses on creating a pleasant discharge experience for patients and colleagues alike. CONCLUSION This study illuminates three distinct approaches adopted by nurses when discharging a patient with COPD. The co-creating process encompasses patient involvement and systematic task resolution, incorporating a biopsychosocial process. In contrast, the other approaches are more limited in scope: the hesitating approach aims for harmony and collegial consensus, while the socialising approach focuses on ensuring a pleasant discharge experience for everyone. Nurses should therefore be mindful of the approach they adopt and the values associated with it in order to optimise their management of hospital discharge processes.
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Affiliation(s)
| | - Birgit Refsgaard
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Dorthe Sørensen
- Research Centre for Health and Welfare Technology, Programme for Rehabilitation, VIA University College, Aarhus, Denmark
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Sohanpal R, Mammoliti KM, Barradell A, Kelly M, Newton S, Steed L, Wileman V, Rowland V, Dibao-Dina C, Moore A, Pinnock H, Taylor SJC. Patient perspectives on the Tailored intervention for Anxiety and Depression Management in COPD (TANDEM): a qualitative evaluation. BMC Health Serv Res 2024; 24:960. [PMID: 39169308 PMCID: PMC11337569 DOI: 10.1186/s12913-024-11370-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 07/29/2024] [Indexed: 08/23/2024] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is commonly associated with anxiety/depression which can affect self-management and quality of life. The TANDEM trial evaluated a cognitive behavioural approach intervention targeting COPD-related symptoms of anxiety and/or depression, comprising up to eight one-to-one sessions delivered by respiratory healthcare professionals prior to pulmonary rehabilitation (PR). The intervention showed no improvement in anxiety/depression or uptake/completion of PR. We present patient perspectives of the intervention to help understand these results. METHOD Semi-structured individual interviews, using a semi-structured topic guide informed by Sekhon's Theoretical Framework of Acceptability, were conducted with 19 patients between September 2019 and April 2020. The interviews were audio-recorded, transcribed verbatim and analysed thematically. RESULTS The following could have limited the impact of the intervention: (1) The lives of patients were complex and commonly affected by competing comorbidities or other external stressors which they managed through previously adopted long-standing coping strategies. (2) Some patients were reluctant to talk about their mood despite the Facilitators' training and person centred-skills which aimed to enable patients to talk freely about mood. (3) The intervention handouts and 'home-practice' were perceived as helpful for some, but not suitable for all. (4) Many patients perceived improvements in their physical and mental health, but this was not sustained due to a mix of personal and external factors, and some did not perceive any benefits. (5) PR non-attendance/non-completion was a result of personal and PR service-related reasons. (6) Discussing COPD and mental health with the Facilitator was a novel experience. Many patients felt that TANDEM could be of benefit if it was offered earlier on/at different time points in the COPD illness journey. CONCLUSION We found the delivery of TANDEM prior to PR was not helpful for patients with advanced COPD often experiencing other comorbidities, and/or difficult personal/external events. These patients already utilised long-standing coping strategies to manage their COPD. Holistic interventions, that address the impact of COPD in relation to wider aspects of a patients' life, may be more beneficial. TRIAL REGISTRATION ISRCTN Registry 59,537,391. Registration date 20 March 2017.
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Affiliation(s)
| | | | - Amy Barradell
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | | | | | - Liz Steed
- Queen Mary University of London, London, UK
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Liu Y, Yang M, Zhao Y, Wang Z, He J, Wang Y, Anme T. Social support mediates social frailty with anxiety and depression. BMC Pulm Med 2024; 24:390. [PMID: 39135002 PMCID: PMC11321094 DOI: 10.1186/s12890-024-03202-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 08/07/2024] [Indexed: 08/15/2024] Open
Abstract
BACKGROUND Anxiety and depression are prevalent comorbidities in patients with chronic obstructive pulmonary disease (COPD). However, existing research has yielded conflicting findings regarding the effects of social frailty on anxiety and depression. The primary aim of this study is to validate the relationship between social frailty and social support with anxiety and depression in patients with acute exacerbations of COPD (AECOPD) and to investigate whether social support could explain the variations in prior study outcomes for patients with AECOPD. METHODS Of the 315 patients hospitalized with AECOPD at the respiratory intensive care unit of a large tertiary care institution in Sichuan Province of China, between August 2022 and June 2023 who were surveyed, 306 were included in the analysis after excluding missing data. We conducted a logistic regression analysis to examine the associations of social frailty and social support with anxiety and depression and performed mediation analyses to examine whether social support mediates the relationship of social frailty with anxiety and depression. RESULTS The logistic regression analysis revealed that social frailty did not associate anxiety or depression in patients with AECOPD. The mediation analysis supported this idea and indicated that while social frailty does not directly influence anxiety or depression, it can through social support. CONCLUSIONS The findings suggest that while social frailty may not directly impact anxiety or depression in patients with AECOPD, social support plays a crucial mediating role. Enhancing social support can indirectly alleviate anxiety and depression among these patients. Enhancing social support networks should thus be prioritized by healthcare providers and family members to improve mental health outcomes in this patient population.
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Affiliation(s)
- Yang Liu
- Graduate School of Comprehensive Human Science, University of Tsukuba, Tsukuba, Japan
| | - Mengjiao Yang
- Graduate School of Comprehensive Human Science, University of Tsukuba, Tsukuba, Japan
- Department of Cardiovascular Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong City, 637000, Sichuan Province, China
| | - Yangyang Zhao
- Department of Blood Transfusion, Affiliated Hospital of North Sichuan Medical College, Nanchong City, 637000, Sichuan Province, China
| | - Ziwei Wang
- Department of Respiratory and Critical Care Medicine, Affiliated Hospital of North Sichuan Medical College, Nanchong City, 637000, Sichuan Province, China
| | - Jie He
- Department of Nursing, Affiliated Hospital of North Sichuan Medical College, Nanchong City, 637000, Sichuan Province, China
| | - Yali Wang
- Department of Cardiovascular Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong City, 637000, Sichuan Province, China
| | - Tokie Anme
- Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, 3058577, Ibaraki, Japan.
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Hermann Karlsen J, Jacobsen PA, Kragholm K, Torp-Pedersen C, Nielsen LB, Weinreich UM. Risk of pharmacological treatment of anxiety and depression after admission for acute exacerbation of chronic obstructive pulmonary disease. Respir Med 2024; 229:107680. [PMID: 38815658 DOI: 10.1016/j.rmed.2024.107680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 05/19/2024] [Accepted: 05/24/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND Anxiety and depression are very common in patients with COPD and may lead to lower quality of life and higher risk of exacerbations and mortality. This study aimed to examine the incidence of anxiety and depression within one year after admission with acute exacerbation in COPD (AECOPD). The secondary aim was to examine the characteristics of the patients who develop anxiety and depression. METHODS This retrospective cohort study used the Danish National Patient Registry. Patients aged 40-90 years admitted for COPD between 01.01.99 and 31.12.18 were included. Patients with mental disorders within 10 years before admission were excluded. Age, sex, educational level, inhaled medication, and comorbidities were evaluated. Anxiety or depression were defined by redemption of anxiolytics or antidepressants within one year after admission. RESULTS We included 97,929 patients. Anxiolytics and antidepressants were redeemed by 4 and 5 % of patients respectively. Higher age, male sex, treatment with short acting β2-agonists and short acting muscarinic antagonists, cancer and heart failure were positively associated to risk of anxiety or depression, while diabetes and treatment with triple inhalation therapy showed an inverse association. CONCLUSION Respectively four and five per cent of patients redeemed anxiolytics and antidepressants within the first year after their first severe AECOPD. Several patient characteristics were significantly associated to risk of anxiety or depression. The results from this study support that there is a risk of anxiety and depression after AECOPD in addition to the known risk of preexisting anxiety and depression.
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Affiliation(s)
- Johanne Hermann Karlsen
- Department of Respiratory Diseases, Aalborg University Hospital, Hobrovej 18-22, 9000, Aalborg C, Denmark; Faculty of Medicine, Aalborg University, Frederik Bajers Vej 7K, 9220 Aalborg Ø, Denmark.
| | - Peter Ascanius Jacobsen
- Department of Respiratory Diseases, Aalborg University Hospital, Hobrovej 18-22, 9000, Aalborg C, Denmark.
| | - Kristian Kragholm
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg C, Denmark.
| | - Christian Torp-Pedersen
- Department of Public Health, Section of Biostatistics, University of Copenhagen, Øster Farimagsgade 5, 1353, København K, Denmark; Department of Cardiology, Nordsjaellands Hospital, Gentofte Hospitalsvej 1, 2900 Hellerup, Denmark.
| | - Line Bjerrehave Nielsen
- Department of Respiratory Diseases, Aalborg University Hospital, Hobrovej 18-22, 9000, Aalborg C, Denmark; Faculty of Medicine, Aalborg University, Frederik Bajers Vej 7K, 9220 Aalborg Ø, Denmark.
| | - Ulla Møller Weinreich
- Department of Respiratory Diseases, Aalborg University Hospital, Hobrovej 18-22, 9000, Aalborg C, Denmark; Faculty of Medicine, Aalborg University, Frederik Bajers Vej 7K, 9220 Aalborg Ø, Denmark.
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Byun JY, Chapman Lambert C, Fazeli PL, Iyer AS, Batey DS, Vance DE. Symptomatology and Quality of Life of Older People With HIV and Comorbid Chronic Obstructive Pulmonary Diseases From an HIV Clinic in Birmingham, Alabama. J Assoc Nurses AIDS Care 2024; 35:91-103. [PMID: 38319887 PMCID: PMC11216896 DOI: 10.1097/jnc.0000000000000452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
ABSTRACT Psychological symptomatology and quality of life (QoL) have been studied in older people with HIV (PWH) and those with chronic obstructive pulmonary disease (COPD), respectively, but there is a dearth of studies in older PWH with COPD. Our study compared depressive symptoms, anxiety, and QoL between older PWH with and without COPD using data from an HIV clinic in Birmingham, Alabama, from January 2018 to February 2020. Data on depressive symptoms (Patient Health Questionnaire-9), anxiety (Patient Health Questionnaire-5 Anxiety), and QoL (EuroQoL-5 Dimension) were analyzed. Among 690 PWH aged 50 years or older, 102 individuals (14.8%) had COPD. Significant differences were found between the two groups in depressive symptoms and components of QoL (e.g., mobility, self-care, usual activities, and pain/discomfort), but not in anxiety and general health. Experiencing COPD may worsen depressive symptomatology and QoL in older PWH, highlighting the need for tailored health care and research for this population.
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Affiliation(s)
- Jun Y Byun
- Jun Y. Byun, PhD, MSN, is a Postdoctoral Fellow, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Crystal Chapman Lambert, PhD, MSPH, CRNP, FNP-BC, ACRN, is an Associate Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Pariya L. Fazeli, PhD, is an Associate Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Anand S. Iyer, MD, MSPH, is an Assistant Professor in the Division of Pulmonary, Allergy, and Critical Care Medicine and the School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
- D. Scott Batey, PhD, MSW, is an Associate Professor, School of Social Work, Tulane University, New Orleans, Louisiana, USA
- David E. Vance, PhD, MGS, is a Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Crystal Chapman Lambert
- Jun Y. Byun, PhD, MSN, is a Postdoctoral Fellow, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Crystal Chapman Lambert, PhD, MSPH, CRNP, FNP-BC, ACRN, is an Associate Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Pariya L. Fazeli, PhD, is an Associate Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Anand S. Iyer, MD, MSPH, is an Assistant Professor in the Division of Pulmonary, Allergy, and Critical Care Medicine and the School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
- D. Scott Batey, PhD, MSW, is an Associate Professor, School of Social Work, Tulane University, New Orleans, Louisiana, USA
- David E. Vance, PhD, MGS, is a Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Pariya L Fazeli
- Jun Y. Byun, PhD, MSN, is a Postdoctoral Fellow, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Crystal Chapman Lambert, PhD, MSPH, CRNP, FNP-BC, ACRN, is an Associate Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Pariya L. Fazeli, PhD, is an Associate Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Anand S. Iyer, MD, MSPH, is an Assistant Professor in the Division of Pulmonary, Allergy, and Critical Care Medicine and the School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
- D. Scott Batey, PhD, MSW, is an Associate Professor, School of Social Work, Tulane University, New Orleans, Louisiana, USA
- David E. Vance, PhD, MGS, is a Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Anand S Iyer
- Jun Y. Byun, PhD, MSN, is a Postdoctoral Fellow, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Crystal Chapman Lambert, PhD, MSPH, CRNP, FNP-BC, ACRN, is an Associate Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Pariya L. Fazeli, PhD, is an Associate Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Anand S. Iyer, MD, MSPH, is an Assistant Professor in the Division of Pulmonary, Allergy, and Critical Care Medicine and the School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
- D. Scott Batey, PhD, MSW, is an Associate Professor, School of Social Work, Tulane University, New Orleans, Louisiana, USA
- David E. Vance, PhD, MGS, is a Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - D Scott Batey
- Jun Y. Byun, PhD, MSN, is a Postdoctoral Fellow, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Crystal Chapman Lambert, PhD, MSPH, CRNP, FNP-BC, ACRN, is an Associate Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Pariya L. Fazeli, PhD, is an Associate Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Anand S. Iyer, MD, MSPH, is an Assistant Professor in the Division of Pulmonary, Allergy, and Critical Care Medicine and the School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
- D. Scott Batey, PhD, MSW, is an Associate Professor, School of Social Work, Tulane University, New Orleans, Louisiana, USA
- David E. Vance, PhD, MGS, is a Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - David E Vance
- Jun Y. Byun, PhD, MSN, is a Postdoctoral Fellow, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Crystal Chapman Lambert, PhD, MSPH, CRNP, FNP-BC, ACRN, is an Associate Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Pariya L. Fazeli, PhD, is an Associate Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Anand S. Iyer, MD, MSPH, is an Assistant Professor in the Division of Pulmonary, Allergy, and Critical Care Medicine and the School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
- D. Scott Batey, PhD, MSW, is an Associate Professor, School of Social Work, Tulane University, New Orleans, Louisiana, USA
- David E. Vance, PhD, MGS, is a Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
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12
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Zhao X, Liu G, Liu D, Zou L, Huang Q, Chen M, Li D, Wu B, Wu H, Huang D, Wu D. Clinical and economic burden of anxiety/depression among older adult COPD patients: evidence from the COPD-AD China Registry study. Front Psychiatry 2024; 14:1221767. [PMID: 38260779 PMCID: PMC10800442 DOI: 10.3389/fpsyt.2023.1221767] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 12/15/2023] [Indexed: 01/24/2024] Open
Abstract
Background Anxiety and depression are common in patients with chronic obstructive pulmonary disease (COPD), especially older adult patients. This can complicate the disease progression and lead to increased clinical and economic burden. We sought to investigate the clinical and economic burdens associated with the presence of anxious and/or depressive symptoms among older adult COPD patients. Methods We screened 579 patients aged over 60 years and diagnosed with COPD via a lung function test following the 2017 Global Initiative Chronic Obstructive Lung Disease (GOLD) guidelines. Anxiety and depression were measured using the Hospital Anxiety and Depression Scale (HADS) through face-to-face interviews at admission. Follow-up was conducted by telephone calls at 6, 12, 18, 24, and 36 months after discharge to assess clinical and economic burden. COPD-anxiety and/or depression patients were matched to patients without anxiety and depression (COPD-only) using propensity scores. Multivariate regression models were used to compare clinical and economic burden between COPD-anxiety and/or depression and COPD-only groups. Results Compared with COPD-only patients, COPD patients complicated with anxiety and/or depression had increased clinical burden, including higher COPD-related outpatient visits, COPD-related hospitalizations, and length of COPD-related hospitalizations (p < 0.001). Moreover, they also had an increased economic burden, including higher annual total healthcare costs, medical costs, and pharmacy costs (p < 0.001). Conclusion Older adult COPD patients with anxiety or depression had significantly higher clinical and economic burdens than patients without these comorbidities. These findings deserve further exploration and may be useful for the formulation of relevant healthcare policies.
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Affiliation(s)
- Xuanna Zhao
- Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Gege Liu
- Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
- First College for Clinical Medicine, Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Dewei Liu
- Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
- First College for Clinical Medicine, Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Li Zou
- Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Qiu Huang
- Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Min Chen
- Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Dongming Li
- Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Bin Wu
- Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Hua Wu
- Department of Information Technology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Dan Huang
- Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Dong Wu
- Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
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13
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Levin J, Estey D, Yadgaran E, Perez E, Plotnick I, Gittleman J, Friedman J, Agterberg S, Messer S, Pia T, Birchwale J, Lee J, Cruz LN, Gordon NA, Kashan RS, Min JY, Segal KS, Patton CD, George TP, Weinberger AH. Cigarette Smoking and Psychiatric Illness Among Individuals with COPD: a Systematic Review. CURRENT ADDICTION REPORTS 2024; 11:19-54. [DOI: 10.1007/s40429-023-00532-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2023] [Indexed: 01/06/2025]
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14
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Sohanpal R, Pinnock H, Steed L, Heslop-Marshall K, Kelly MJ, Chan C, Wileman V, Barradell A, Dibao-Dina C, Font Gilabert P, Healey A, Hooper R, Mammoliti KM, Priebe S, Roberts M, Rowland V, Waseem S, Singh S, Smuk M, Underwood M, White P, Yaziji N, Taylor SJ. A tailored psychological intervention for anxiety and depression management in people with chronic obstructive pulmonary disease: TANDEM RCT and process evaluation. Health Technol Assess 2024; 28:1-129. [PMID: 38229579 PMCID: PMC11017633 DOI: 10.3310/pawa7221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2024] Open
Abstract
Background People with chronic obstructive pulmonary disease have high levels of anxiety and depression, which is associated with increased morbidity and poor uptake of effective treatments, such as pulmonary rehabilitation. Cognitive-behavioural therapy improves mental health of people with long-term conditions and could potentially increase uptake of pulmonary rehabilitation, enabling synergies that could enhance the mental health of people with chronic obstructive pulmonary disease. Aim Our aim was to develop and evaluate the clinical effectiveness and cost effectiveness of a tailored cognitive-behavioural approach intervention, which links into, and optimises the benefits of, routine pulmonary rehabilitation. Design We carried out a pragmatic multicentre randomised controlled trial using a 1.25 : 1 ratio (intervention : control) with a parallel process evaluation, including assessment of fidelity. Setting Twelve NHS trusts and five Clinical Commissioning Groups in England were recruited into the study. The intervention was delivered in participant's own home or at a local NHS facility, and by telephone. Participants Between July 2017 and March 2020 we recruited adults with moderate/very severe chronic obstructive pulmonary disease and mild/moderate anxiety and/or depression, meeting eligibility criteria for assessment for pulmonary rehabilitation. Carers of participants were invited to participate. Intervention The cognitive-behavioural approach intervention (i.e. six to eight 40- to 60-minute sessions plus telephone support throughout pulmonary rehabilitation) was delivered by 31 trained respiratory healthcare professionals to participants prior to commencing pulmonary rehabilitation. Usual care included routine pulmonary rehabilitation referral. Main outcome measures Co-primary outcomes were Hospital Anxiety and Depression Scale - anxiety and Hospital Anxiety and Depression Scale - depression at 6 months post randomisation. Secondary outcomes at 6 and 12 months included health-related quality of life, smoking status, uptake of pulmonary rehabilitation and healthcare use. Results We analysed results from 423 randomised participants (intervention, n = 242; control, n = 181). Forty-three carers participated. Follow-up at 6 and 12 months was 93% and 82%, respectively. Despite good fidelity for intervention delivery, mean between-group differences in Hospital Anxiety and Depression Scale at 6 months ruled out clinically important effects (Hospital Anxiety and Depression Scale - anxiety mean difference -0.60, 95% confidence interval -1.40 to 0.21; Hospital Anxiety and Depression Scale - depression mean difference -0.66, 95% confidence interval -1.39 to 0.07), with similar results at 12 months. There were no between-group differences in any of the secondary outcomes. Sensitivity analyses did not alter these conclusions. More adverse events were reported for intervention participants than for control participants, but none related to the trial. The intervention did not generate quality-of-life improvements to justify the additional cost (adjusted mean difference £770.24, 95% confidence interval -£27.91 to £1568.39) to the NHS. The intervention was well received and many participants described positive affects on their quality of life. Facilitators highlighted the complexity of participants' lives and considered the intervention to be of potential valuable; however, the intervention would be difficult to integrate within routine clinical services. Our well-powered trial delivered a theoretically designed intervention with good fidelity. The respiratory-experienced facilitators were trained to deliver a low-intensity cognitive-behavioural approach intervention, but high-intensity cognitive-behavioural therapy might have been more effective. Our broad inclusion criteria specified objectively assessed anxiety and/or depression, but participants were likely to favour talking therapies. Randomisation was concealed and blinding of outcome assessment was breached in only 15 participants. Conclusions The tailored cognitive-behavioural approach intervention delivered with fidelity by trained respiratory healthcare professionals to people with chronic obstructive pulmonary disease was neither clinically effective nor cost-effective. Alternative approaches that are integrated with routine long-term condition care are needed to address the unmet, complex clinical and psychosocial needs of this group of patients. Trial registration This trial is registered as ISRCTN59537391. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 13/146/02) and is published in full in Health Technology Assessment; Vol. 28, No. 1. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Ratna Sohanpal
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Hilary Pinnock
- Allergy and Respiratory Research Group, Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Liz Steed
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | | | - Moira J Kelly
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Claire Chan
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Vari Wileman
- School of Mental Health and Psychological Sciences, Institute of Psychiatry, King's College London, London, UK
| | - Amy Barradell
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | | | - Paulino Font Gilabert
- Health Service and Population Research Department, Institute of Psychiatry, King's College London, London, UK
| | - Andy Healey
- Health Service and Population Research Department, Institute of Psychiatry, King's College London, London, UK
| | - Richard Hooper
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Kristie-Marie Mammoliti
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Stefan Priebe
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Mike Roberts
- Safer Care Victoria, Melbourne, Melbourne, VIC, Australia
| | | | | | - Sally Singh
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Melanie Smuk
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Martin Underwood
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Patrick White
- Department of Population Health, School of Population Health and Environmental Sciences, King's College London, London, UK
| | - Nahel Yaziji
- Health Service and Population Research Department, Institute of Psychiatry, King's College London, London, UK
| | - Stephanie Jc Taylor
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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15
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Byrne CT, Durst CR, Rezzadeh KT, Rockov ZA, Lee A, McKelvey KS, Spitzer AI, Rajaee SS. Preoperative Depression Is Associated With Increased Short-term Complications But Equivalent Long-term Outcomes in Total Knee Arthroplasty. Orthopedics 2024; 47:40-45. [PMID: 37276440 DOI: 10.3928/01477447-20230531-07] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Concomitant depression negatively impacts outcomes following total knee arthroplasty (TKA). Patient-Reported Outcomes Measurement Information System (PROMIS) surveys are validated measures that quantify depression, pain, and physical function. We hypothesized that higher preoperative PROMIS-depression scores would be associated with inferior outcomes following TKA. A total of 258 patients underwent primary TKA at a tertiary academic center between June 2018 and August 2020. PROMIS scores were collected preoperatively and at 6 weeks, 3 months, 1 year, and 2 years postoperatively. Patients with preoperative PROMIS depression scores of 55 or greater were considered PROMIS depressed (PD) and patients with scores less than 55 were considered not PROMIS depressed (ND). The primary outcomes were changes in PROMIS scores. Secondary outcomes included total and daily mean morphine milligram equivalents (MME) received during admission as well as 90-day hospital readmission and 2-year all-cause revision rates. There were 66 (25.58%) patients in the PD group and 192 (74.42%) in the ND group. Patients in the PD group had improved depression scores at all follow-up intervals (P<.001) and decreased pain scores at 1 year (P=.016). Both groups experienced similar changes in function scores at each follow-up interval. Patients in the PD group had higher total (P=.176) and daily (P=.433) mean MME use while admitted. Ninety-day hospital readmissions were higher in the PD group (P=.002). There were no differences in 2-year revision rates (P=.648). Preoperative PROMIS-depression scores of 55 or greater do not negatively impact postoperative function, depression, or pain, and patients with these scores have greater improvement in depression and pain at certain intervals. Patients in the PD group had higher readmission rates. [Orthopedics. 2024;47(1):40-45.].
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16
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Jarab AS, AlQerem WA, Abu Heshmeh SR, Hamarneh YNA, Aburuz S, Eberhardt J. Factors associated with anxiety and depression among patients with chronic obstructive pulmonary disease. Expert Rev Respir Med 2024; 18:59-65. [PMID: 38454777 DOI: 10.1080/17476348.2024.2326512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 02/29/2024] [Indexed: 03/09/2024]
Abstract
OBJECTIVES This study investigated factors associated with anxiety and depression in COPD outpatients. METHODS A cross-sectional study of 702 COPD outpatients from two major Jordanian hospitals using the Hospital Anxiety and Depression Scale (HADS) was conducted. RESULTS Significant associations were found with gender (Anxiety OR: 5.29, 95%CI: 2.38-11.74; Depression OR: 0.20, 95%CI: 0.08-0.51), disease severity (Anxiety OR: 2.97, 95%CI: 1.80-4.91; Depression OR: 15.95, 95%CI: 5.32-52.63), LABA use (Anxiety OR: 16.12, 95%CI: 8.26-32.26; Depression OR: 16.95, 95%CI: 8.33-34.48), medication count (Anxiety OR: 0.73, 95%CI: 0.59-0.90; Depression OR: 0.51, 95%CI: 0.40-0.64), mMRC score (Anxiety OR: 2.41, 95%CI: 1.81-3.22; Depression OR: 2.31, 95%CI: 1.76-3.03), and inhalation technique (Anxiety OR: 0.95, 95%CI: 0.93-0.97; Depression OR: 0.92, 95%CI: 0.90-0.95). Other factors associated with anxiety included high income, urban living, diabetes, hypertension, LAMA use, and fewer COPD medications. Depression was also linked with heart disease, increased age, and longer disease duration. CONCLUSION The prevalence of anxiety and depression among COPD patients necessitates targeted interventions. Future research that recruits a more diverse sample in multiple sites and establishes the cause-effect relationship between the study predictors and outcome could provide a more robust conclusion on factors associated with anxiety and depression among COPD patients.
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Affiliation(s)
- Anan S Jarab
- Department of Clinical Pharmacy, Faculty of Pharmacy, University of Science and Technology, Irbid, Jordan
- College of Pharmacy, AL Ain University, Abu Dhabi, United Arab Emirates
- AAU Health and Biomedical Research Center, Al Ain University, Abu Dhabi, United Arab Emirates
| | - Walid A AlQerem
- Department of Pharmacy, Faculty of Pharmacy, Al-Zaytoonah University of Jordan, Amman, Jordan
| | - Shrouq R Abu Heshmeh
- Department of Clinical Pharmacy, Faculty of Pharmacy, University of Science and Technology, Irbid, Jordan
| | - Yazid N Al Hamarneh
- Department of Pharmacology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Salah Aburuz
- Department of Pharmacology and Therapeutics, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Judith Eberhardt
- Department of Psychology, School of Social Sciences, Humanities and Law, Teesside University, Middlesbrough, UK
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van Dijk SHB, Brusse-Keizer MGJ, Effing T, van der Valk PDLPM, Ploumen EH, van der Palen J, Doggen CJM, Lenferink A. Exploring Patterns of COPD Exacerbations and Comorbid Flare-Ups. Int J Chron Obstruct Pulmon Dis 2023; 18:2633-2644. [PMID: 38022827 PMCID: PMC10657781 DOI: 10.2147/copd.s428960] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 11/09/2023] [Indexed: 12/01/2023] Open
Abstract
Background Comorbidities are known to complicate disease management in patients with Chronic Obstructive Pulmonary Disease (COPD). This is partly due to lack of insight into the interplay of acute exacerbations of COPD (AECOPD) and comorbid flare-ups. This study aimed to explore patterns of AECOPDs and comorbid flare-ups. Methods Data of increased symptoms were extracted from a 12-month daily symptom follow-up database including patients with COPD and comorbidities (chronic heart failure (CHF), anxiety, depression) and transformed to visualizations of AECOPDs and comorbid flare-up patterns over time. Patterns were subsequently categorized using an inductive approach, based on both predominance (ie, which occurs most often) of AECOPDs or comorbid flare-ups, and their simultaneous (ie, simultaneous start in ≥ 50%) occurrence. Results We included 48 COPD patients (68 ± 9 years; comorbid CHF: 52%, anxiety: 40%, depression: 38%). In 25 patients with AECOPDs and CHF flare-ups, the following patterns were identified: AECOPDs predominant (n = 14), CHF flare-ups predominant (n = 5), AECOPDs nor CHF flare-ups predominant (n = 6). Of the 24 patients with AECOPDs and anxiety and/or depression flare-ups, anxiety and depression flare-ups occurred simultaneously in 15 patients. In 9 of these 24 patients, anxiety or depression flare-ups were observed independently from each other. In 31 of the included 48 patients, AECOPDs and comorbid flare-ups occurred mostly simultaneously. Conclusion Patients with COPD and common comorbidities show a variety of patterns of AECOPDs and comorbid flare-ups. Some patients, however, show repetitive patterns that could potentially be used to improve personalized disease management, if recognized.
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Affiliation(s)
- Sanne H B van Dijk
- Health Technology & Services Research, TechMed Centre, University of Twente, Enschede, the Netherlands
- Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Marjolein G J Brusse-Keizer
- Health Technology & Services Research, TechMed Centre, University of Twente, Enschede, the Netherlands
- Medical School Twente, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Tanja Effing
- College of Medicine and Public Health, School of Medicine, Flinders University, Adelaide, Australia
- School of Psychology, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
| | | | - Eline H Ploumen
- Health Technology & Services Research, TechMed Centre, University of Twente, Enschede, the Netherlands
- Department of Cardiology, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Job van der Palen
- Medical School Twente, Medisch Spectrum Twente, Enschede, the Netherlands
- Cognition, Data & Education, BMS Faculty, University of Twente, Enschede, the Netherlands
| | - Carine J M Doggen
- Health Technology & Services Research, TechMed Centre, University of Twente, Enschede, the Netherlands
- Clinical Research Centre, Rijnstate Hospital, Arnhem, the Netherlands
| | - Anke Lenferink
- Health Technology & Services Research, TechMed Centre, University of Twente, Enschede, the Netherlands
- Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, the Netherlands
- Clinical Research Centre, Rijnstate Hospital, Arnhem, the Netherlands
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18
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Taylor SJC, Sohanpal R, Steed L, Marshall K, Chan C, Yaziji N, Barradell AC, Font-Gilabert P, Healey A, Hooper R, Kelly MJ, Mammoliti KM, Priebe S, Rajasekaran A, Roberts CM, Rowland V, Singh SJ, Smuk M, Underwood M, Waseem S, White P, Wileman V, Pinnock H. Tailored psychological intervention for anxiety or depression in COPD (TANDEM): a randomised controlled trial. Eur Respir J 2023; 62:2300432. [PMID: 37620042 PMCID: PMC10620475 DOI: 10.1183/13993003.00432-2023] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 08/08/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND The TANDEM multicentre, pragmatic, randomised controlled trial evaluated whether a tailored psychological intervention based on a cognitive behavioural approach for people with COPD and symptoms of anxiety and/or depression improved anxiety or depression compared with usual care (control). METHODS People with COPD and moderate to very severe airways obstruction and Hospital Anxiety and Depression Scale subscale scores indicating mild to moderate anxiety (HADS-A) and/or depression (HADS-D) were randomised 1.25:1 (242 intervention and 181 control). Respiratory health professionals delivered the intervention face-to-face over 6-8 weeks. Co-primary outcomes were HADS-A and HADS-D measured 6 months post-randomisation. Secondary outcomes at 6 and 12 months included: HADS-A and HADS-D (12 months), Beck Depression Inventory II, Beck Anxiety Inventory, St George's Respiratory Questionnaire, social engagement, the EuroQol instrument five-level version (EQ-5D-5L), smoking status, completion of pulmonary rehabilitation, and health and social care resource use. RESULTS The intervention did not improve anxiety (HADS-A mean difference -0.60, 95% CI -1.40-0.21) or depression (HADS-D mean difference -0.66, 95% CI -1.39-0.07) at 6 months. The intervention did not improve any secondary outcomes at either time-point, nor did it influence completion of pulmonary rehabilitation or healthcare resource use. Deaths in the intervention arm (13/242; 5%) exceeded those in the control arm (3/181; 2%), but none were associated with the intervention. Health economic analysis found the intervention highly unlikely to be cost-effective. CONCLUSION This trial has shown, beyond reasonable doubt, that this cognitive behavioural intervention delivered by trained and supervised respiratory health professionals does not improve psychological comorbidity in people with advanced COPD and depression or anxiety.
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Affiliation(s)
- Stephanie J C Taylor
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
- Joint first authors
| | - Ratna Sohanpal
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
- Joint first authors
| | - Liz Steed
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Karen Marshall
- Chest Clinic, RVI Hospital, Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Claire Chan
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Nahel Yaziji
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Amy C Barradell
- NIHR Leicester Biomedical Research Centre - Respiratory, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Paulino Font-Gilabert
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Andrew Healey
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Richard Hooper
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Moira J Kelly
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Kristie-Marie Mammoliti
- WHO Collaborating Centre on Global Women's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Stefan Priebe
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Arvind Rajasekaran
- Department of Respiratory Medicine, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - C Michael Roberts
- Centre for Digital Transformation of Health, University of Melbourne, Melbourne, Australia
| | - Vickie Rowland
- Department of Population Health, School of Life Course and Population Sciences, King's College London, London, UK
| | - Sally J Singh
- Department of Respiratory Sciences, Department of Health Sciences, University of Leicester, Leicester, UK
| | - Melanie Smuk
- Blizard Institute, Queen Mary University of London, London, UK
| | - Martin Underwood
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
- University Hospitals of Coventry and Warwickshire, Coventry, UK
| | - Sarah Waseem
- Women's Health Division, University College Hospital, London, UK
| | - Patrick White
- Department of Population Health, School of Life Course and Population Sciences, King's College London, London, UK
| | - Vari Wileman
- Health Psychology, School of Mental Health and Psychological Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Hilary Pinnock
- Allergy and Respiratory Research Group, Usher Institute, The University of Edinburgh, Edinburgh, UK
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19
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Annunziata A, Calabrese C, Simioli F, Coppola A, Pierucci P, Mariniello DF, Fiorentino G. Psychological Factors Influencing Adherence to NIV in Neuromuscular Patients Dependent on Non Invasive Mechanical Ventilation: Preliminary Results. J Clin Med 2023; 12:5866. [PMID: 37762807 PMCID: PMC10531532 DOI: 10.3390/jcm12185866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 09/03/2023] [Accepted: 09/06/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Non-invasive ventilation (NIV) is associated with improvement of both morbility and mortality in patients affected by neuromuscular diseases with chronic respiratory failure. Several studies have also shown that long-term NIV positively impacts the patient's quality of life and perception of disease status. Its effectiveness is likely related to the adherence to NIV. Several factors, patient- and not patient-related, may compromise adherence to NIV, such as physical, behavioral, familiar, and social issues. Few data are currently available on the role of psychological factors in influencing NIV adherence. MATERIALS AND METHODS In this pilot study, we evaluated the adherence to NIV in a group of 15 adult patients with neuromuscular diseases (Duchenne muscular dystrophy, myotonic dystrophy, and amyotrophic lateral sclerosis) in relation to their grade of depression assessed by the Beck Depression Inventory (BDI) questionnaire. Other data were collected, such as clinical features (age and sex), use of anxiolytic drugs, the presence of a family or professional caregiver, the quality of patient-physician relationship, the beginning of psychological support after BDI screening, and the family acceptance of NIV. NIV adherence was definied as the use of NIV for at least 4 h per night on 70% of nights in a month. RESULTS The overall rate of NIV adherence was 60%. Based on the BDI questionnaire, patients who were non-adherent to NIV had a higher rate of depression, mainly observed in the oldest patients. The acceptance of NIV by the family and positive physician-patient interaction seem to favor NIV adherence. CONCLUSION Depression can interfere with NIV adherence in patients with neuromuscolar diseases.
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Affiliation(s)
- Anna Annunziata
- Unit of Respiratory Pathophysiology, Critic Area Department, Monaldi—Cotugno Hospital, 80131 Naples, Italy; (A.A.); (F.S.); (G.F.)
| | - Cecilia Calabrese
- Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (C.C.); (D.F.M.)
| | - Francesca Simioli
- Unit of Respiratory Pathophysiology, Critic Area Department, Monaldi—Cotugno Hospital, 80131 Naples, Italy; (A.A.); (F.S.); (G.F.)
| | - Antonietta Coppola
- Unit of Respiratory Pathophysiology, Critic Area Department, Monaldi—Cotugno Hospital, 80131 Naples, Italy; (A.A.); (F.S.); (G.F.)
| | - Paola Pierucci
- Cardiothoracic Department, Respiratory and Critical Care Unit, Bari Policlinic University Hospital, 70121 Bari, Italy;
- Section of Respiratory Diseases, Department of Basic Medical Science Neuroscience and Sense Organs, University of Bari ‘Aldo Moro’, 70122 Bari, Italy
| | - Domenica Francesca Mariniello
- Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (C.C.); (D.F.M.)
| | - Giuseppe Fiorentino
- Unit of Respiratory Pathophysiology, Critic Area Department, Monaldi—Cotugno Hospital, 80131 Naples, Italy; (A.A.); (F.S.); (G.F.)
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20
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Liu M, Wang D, Fang J, Chang Y, Hu Y, Huang K. Validation of the Generalized Anxiety Disorder-7 in patients with COPD: a cross-sectional study. BMC Psychiatry 2023; 23:593. [PMID: 37582707 PMCID: PMC10428582 DOI: 10.1186/s12888-023-05072-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 08/02/2023] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND Patients with chronic obstructive pulmonary disease (COPD) often have comorbid generalized anxiety disorder (GAD), which requires early screening in respiratory clinics. The Generalized Anxiety Disorder-7 (GAD-7) questionnaire is a brief and commonly used screening tool for GAD but has not been validated among patients with COPD in China. METHODS Stable patients with COPD from a cross-sectional observational study were assessed using the GAD-7 questionnaire and then assessed by a senior psychiatrist to confirm a diagnosis of GAD according to the criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Demographic characteristics, spirometry, and patient-reported outcomes were collected. Cronbach's α coefficient was calculated, and receiver operating curve (ROC) analysis was performed to validate the GAD-7. RESULTS A total of 226 patients with COPD were enrolled, and 50 (22.1%) of these patients were diagnosed with GAD. The Cronbach's α coefficient for the GAD-7 was 0.869, which indicated good internal consistency. ROC curve analysis showed that the GAD-7 had an area under the curve (AUC) value of 0.829 (95% CI: 0.774-0.876) for identifying GAD. The optimal cut-off score was ≥ 4, with a sensitivity of 66.0% and a specificity of 89.2%. Higher GAD-7 scores were significantly associated with health-related quality of life and the symptom burden of COPD. The discriminatory power of GAD-7 did not differ statistically when stratified by COPD severity. CONCLUSIONS The GAD-7 was shown to be a reliable and valid screening tool for patients with COPD in China, and its screening performance for GAD was not influenced by disease severity.
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Affiliation(s)
- Meishan Liu
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, No 8, Gongti South Road, 100020, Chaoyang District, Beijing, PR China
| | - Dong Wang
- Department of Clinical Psychology, Beijing Chao-Yang Hospital, Capital Medical University, No 8, Gongti South Road, 100020, Chaoyang District, Beijing, PR China
| | - Jiexin Fang
- Department of Clinical Psychology, Beijing Chao-Yang Hospital, Capital Medical University, No 8, Gongti South Road, 100020, Chaoyang District, Beijing, PR China
| | - Yuhan Chang
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, No 8, Gongti South Road, 100020, Chaoyang District, Beijing, PR China
| | - Yongdong Hu
- Department of Clinical Psychology, Beijing Chao-Yang Hospital, Capital Medical University, No 8, Gongti South Road, 100020, Chaoyang District, Beijing, PR China.
| | - Kewu Huang
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, No 8, Gongti South Road, 100020, Chaoyang District, Beijing, PR China.
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21
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Yanwen L, Mei L, Wenwen Z, Huihui J, Hongbin L, Ying W, Ning L, Le H, Xueyang H, Xue Z. Construction of a Nomogram predictive model for post-discharge psychosomatic review of psychiatric liaison consultation patients based on medical record data. Front Psychiatry 2023; 14:1171741. [PMID: 37502812 PMCID: PMC10368869 DOI: 10.3389/fpsyt.2023.1171741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 06/27/2023] [Indexed: 07/29/2023] Open
Abstract
Epidemiological studies have shown that almost all physical illnesses coexist with psychiatric disorders or psychological problems, and the severity of mental illness is positively correlated with the duration and severity of physical illness. Liaison consultations are valuable in identifying and treating psychiatric disorders, but the rate of psychiatric follow-up after consultation is low in outpatients. This study aimed to investigate the factors influencing post-discharge psychosomatic follow-up visits in patients undergoing psychiatric liaison consultation in general hospitals and construct a Nomogram prediction model for patients' post-discharge psychosomatic follow-up visits. Medical record data of inpatients who received psychiatric liaison consultations at Xi'an International Medical Center Hospital in China from September 2019 to September 2020 were analyzed. Lasso regression and multivariate logistic regression analyses were conducted to screen independent influences on the occurrence of post-discharge psychosomatic follow-ups in patients undergoing psychiatric liaison consultations. Risk prediction column line graphs were constructed using R software, and the models were evaluated. Of the 494 inpatients who received psychiatric liaison consultations, 115 patients (23.279%) (mean age = 54.8 years) went for post-discharge psychosomatic follow-up, while 379 patients (mean age = 59.3 years) had no record of psychosomatic follow-up. Furthermore, occupation, interval.time, diagnosis, out.antipsychotics, and recommendations.followup were independent factors influencing post-discharge psychosomatic follow-up. The model accurately predicted post-discharge psychosomatic follow-up behavior of inpatients who received psychiatric liaison consultations. Lastly, the clinical decision curve analysis showed that the model had good validity for clinical application. Patients who received a psychiatric liaison consultation with a ≤ 10-day interval between admission to the hospital and application for consultation, were discharged with prescribed medication, and had a clear written medical order for a follow-up consultation had an increased probability of psychosomatic follow-up after discharge.
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Affiliation(s)
- Liu Yanwen
- Department of Adolescent Mental Health, Mental Hospital, Xi’an International Medical Center, Hospital of Northwest University, Xi’an, China
- Department of Psychosomatic Medicine, Mental Hospital, Xi’an Physical Education University, Xi’an, China
| | - Li Mei
- Department of Psychosomatic Medicine, Mental Hospital, Xi’an International Medical Center, Hospital of Northwest University, Xi’an, China
| | - Zhang Wenwen
- Department of Psychosomatic Medicine, Mental Hospital, Xi’an International Medical Center, Hospital of Northwest University, Xi’an, China
| | - Jing Huihui
- Department of Psychosomatic Medicine, Mental Hospital, Xi’an International Medical Center, Hospital of Northwest University, Xi’an, China
| | - Lu Hongbin
- Department of Psychosomatic Medicine, Mental Hospital, Xi’an International Medical Center, Hospital of Northwest University, Xi’an, China
| | - Wang Ying
- Department of Psychosomatic Medicine, Mental Hospital, Xi’an International Medical Center, Hospital of Northwest University, Xi’an, China
| | - Liu Ning
- Department of Adolescent Mental Health, Mental Hospital, Xi’an International Medical Center, Hospital of Northwest University, Xi’an, China
| | - Han Le
- Department of Adolescent Mental Health, Mental Hospital, Xi’an International Medical Center, Hospital of Northwest University, Xi’an, China
| | - Han Xueyang
- Department of Adolescent Mental Health, Mental Hospital, Xi’an International Medical Center, Hospital of Northwest University, Xi’an, China
| | - Zou Xue
- Department of Adolescent Mental Health, Mental Hospital, Xi’an International Medical Center, Hospital of Northwest University, Xi’an, China
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22
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Mathews AM. The Functional and Psychosocial Consequences of COPD. Respir Care 2023; 68:914-926. [PMID: 37353332 PMCID: PMC10289619 DOI: 10.4187/respcare.10542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/25/2023]
Abstract
COPD is a chronic respiratory disease that commonly coexists with other chronic conditions. These comorbidities have been shown to influence overall disease burden and mortality in COPD, and these comorbidities have an important impact on functional status and other psychosocial factors. Mental health disorders, especially anxiety and depression are common comorbidities in COPD. However, the mechanisms and interactions of anxiety and depression in COPD are poorly understood and these conditions are often underdiagnosed. The interplay between anxiety and depression and COPD is likely multifactorial and complex. An obvious mechanism is the expected psychological consequences of having a chronic illness. However, there is increasing interest in other potential biological processes, such as systemic inflammation, smoking, hypoxia, and oxidative stress. Recognition and diagnosis of comorbid anxiety and depression in patients with COPD is often challenging because there is no consensus on the appropriate screening tools or rating scales to use in this patient population. Despite the challenges in accurate assessment of anxiety and depression, there is growing evidence to support that these comorbid mental health conditions in COPD result in worse outcomes, including poor health-related quality of life, increased exacerbations with associated health-care utilization and cost, increased functional disability, and increased mortality. There are limited data of variable quality on effective treatment and management strategies, both pharmacologic and non-pharmacologic, for anxiety and depression in COPD. However, cumulative evidence demonstrates that complex psychological and lifestyle interventions, which include a pulmonary rehabilitation component, may offer the greatest benefit. The high prevalence and negative impact of depression and anxiety highlights the need for comprehensive, innovative, and standardized chronic disease management programs for individuals with COPD.
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Affiliation(s)
- Anne M Mathews
- Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado.
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23
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Celli BR, Fabbri LM, Aaron SD, Agusti A, Brook RD, Criner GJ, Franssen FME, Humbert M, Hurst JR, Montes de Oca M, Pantoni L, Papi A, Rodriguez-Roisin R, Sethi S, Stolz D, Torres A, Vogelmeier CF, Wedzicha JA. Differential Diagnosis of Suspected Chronic Obstructive Pulmonary Disease Exacerbations in the Acute Care Setting: Best Practice. Am J Respir Crit Care Med 2023; 207:1134-1144. [PMID: 36701677 PMCID: PMC10161746 DOI: 10.1164/rccm.202209-1795ci] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 01/26/2023] [Indexed: 01/27/2023] Open
Abstract
Patients with chronic obstructive pulmonary disease (COPD) may suffer from acute episodes of worsening dyspnea, often associated with increased cough, sputum, and/or sputum purulence. These exacerbations of COPD (ECOPDs) impact health status, accelerate lung function decline, and increase the risk of hospitalization. Importantly, close to 20% of patients are readmitted within 30 days after hospital discharge, with great cost to the person and society. Approximately 25% and 65% of patients hospitalized for an ECOPD die within 1 and 5 years, respectively. Patients with COPD are usually older and frequently have concomitant chronic diseases, including heart failure, coronary artery disease, arrhythmias, interstitial lung diseases, bronchiectasis, asthma, anxiety, and depression, and are also at increased risk of developing pneumonia, pulmonary embolism, and pneumothorax. All of these morbidities not only increase the risk of subsequent ECOPDs but can also mimic or aggravate them. Importantly, close to 70% of readmissions after an ECOPD hospitalization result from decompensation of other morbidities. These observations suggest that in patients with COPD with worsening dyspnea but without the other classic characteristics of ECOPD, a careful search for these morbidities can help detect them and allow appropriate treatment. For most morbidities, a thorough clinical evaluation supplemented by appropriate clinical investigations can guide the healthcare provider to make a precise diagnosis. This perspective integrates the currently dispersed information available and provides a practical approach to patients with COPD complaining of worsening respiratory symptoms, particularly dyspnea. A systematic approach should help improve outcomes and the personal and societal cost of ECOPDs.
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Affiliation(s)
- Bartolome R. Celli
- Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Leonardo M. Fabbri
- Section of Respiratory Medicine, Department of Translational Medicine, and
| | - Shawn D. Aaron
- The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Alvar Agusti
- Universitat de Barcelona, Barcelona, Spain
- Institut Clínic Respiratori, Hospital Clínic de Barcelona, Barcelona, Spain
- Instituto de Investigaciones Biomédicas August Pi i Sunyer, Barcelona, Spain
- Centro de Investigación Biomédica en Red Enfermedades Respiratorias, Madrid, Spain
| | - Robert D. Brook
- Division of Cardiovascular Medicine, Department of Internal Medicine, Wayne State University, Detroit, Michigan
| | - Gerard J. Criner
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Frits M. E. Franssen
- Department of Research and Education, CIRO, Horn, the Netherlands
- Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Marc Humbert
- Department of Respiratory and Intensive Care Medicine, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris, Le Kremlin-Bicêtre, France
- Université Paris-Saclay and Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 999, Le Kremlin-Bicêtre, France
| | - John R. Hurst
- UCL Respiratory, University College London, London, United Kingdom
| | - Maria Montes de Oca
- Universidad Central de Venezuela, School of Medicine, Centro Medico de Caracas, Caracas, Venezuela
| | - Leonardo Pantoni
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Alberto Papi
- Section of Respiratory Medicine, University of Ferrara, Ferrara, Italy
- Emergency Department, St. Anna University Hospital, Ferrara, Italy
| | - Roberto Rodriguez-Roisin
- Universitat de Barcelona, Barcelona, Spain
- Institut Clínic Respiratori, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Sanjay Sethi
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York
| | - Daiana Stolz
- Clinic of Respiratory Medicine and Pulmonary Cell Research and
- Department of Clinical Research, University Hospital Basel, Basel, Switzerland
- Clinic of Respiratory Medicine and Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Antoni Torres
- Universitat de Barcelona, Barcelona, Spain
- Institut Clínic Respiratori, Hospital Clínic de Barcelona, Barcelona, Spain
- Instituto de Investigaciones Biomédicas August Pi i Sunyer, Barcelona, Spain
- Institució Catalana de Recerca i Estudis Avançats Acadèmia, Centre d’Investigació Biomèdica en Xarxa de Malalties Respiratòries, Barcelona, Spain
| | - Claus F. Vogelmeier
- Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Centre Giessen and Marburg, Philipps University of Marburg, Member of the German Centre for Lung Research (DZL), Marburg, Germany; and
| | - Jadwiga A. Wedzicha
- Respiratory Division, National Heart and Lung Institute, Imperial College, London, United Kingdom
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24
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Bugajski A, Morgan H, Wills W, Jacklin K, Alleyne S, Kolta B, Lengerich A, Rechenberg K. Anxiety and Depressive Symptoms in Patients with COPD: Modifiable Explanatory Factors. West J Nurs Res 2023; 45:316-326. [PMID: 36250352 DOI: 10.1177/01939459221129949] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/15/2023]
Abstract
Anxiety and depressive symptoms affect up to 80% of people with chronic obstructive pulmonary disease (COPD). To reduce this symptom burden, clinicians should target modifiable explanatory factors while accounting for nonmodifiable explanatory factors of these symptoms. The purpose of this secondary data analysis was to examine which modifiable factors explain anxiety and depressive symptoms in COPD. This secondary data analysis of 1,760 COPD patients used multiple regression to explain anxiety and depressive symptoms from sets of modifiable patient characteristics and demographic controls. Clinically significant symptoms of anxiety or depression presented in 29.6% (n = 526) of participants, and 20.6% (n = 363) had both. Significant modifiable explanatory factors of both disorder symptoms were perceived functional status, functional capacity, psychosocial impact, symptom self-management, and significant symptoms for the other. Somatic symptom burden and dyspnea explained anxiety and depressive symptoms, respectively. Addressing these modifiable factors may reduce anxiety and depressive symptoms in patients with COPD.
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Affiliation(s)
- Andrew Bugajski
- Department of Research and Sponsored Studies, Lakeland Regional Health Medical Center, Lakeland, FL, USA
| | - Hailey Morgan
- College of Nursing, University of South Florida, Tampa, FL, USA
| | - Walter Wills
- Department of Research and Sponsored Studies, Lakeland Regional Health Medical Center, Lakeland, FL, USA.,College of Nursing, University of South Florida, Tampa, FL, USA
| | - Kellcee Jacklin
- Department of Research and Sponsored Studies, Lakeland Regional Health Medical Center, Lakeland, FL, USA
| | - Shirley Alleyne
- Department of Psychiatry, Lakeland Regional Health Medical Center, Lakeland, FL, USA
| | - Bishoy Kolta
- Department of Psychiatry, Lakeland Regional Health Medical Center, Lakeland, FL, USA
| | - Alexander Lengerich
- Eastern Colorado VA Health Care System, Rocky Mountain Regional Medical Center, Denver, CO, USA
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25
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Rahi MS, Thilagar B, Balaji S, Prabhakaran SY, Mudgal M, Rajoo S, Yella PR, Satija P, Zagorulko A, Gunasekaran K. The Impact of Anxiety and Depression in Chronic Obstructive Pulmonary Disease. Adv Respir Med 2023; 91:123-134. [PMID: 36960961 PMCID: PMC10037643 DOI: 10.3390/arm91020011] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 02/28/2023] [Accepted: 03/06/2023] [Indexed: 03/18/2023]
Abstract
Patients with COPD (chronic obstructive pulmonary disease) are at a higher risk of comorbid conditions such as anxiety and/or depression, which in turn increase their symptom burden and rehospitalizations compared to the general population. It is important to investigate the pathophysiology and clinical implications of mental health on patients with COPD. This review article finds that COPD patients with anxiety and/or depression have a higher rehospitalization incidence. It reviews the current screening and diagnosis methods available. There are pharmacological and non-pharmacologic interventions available for treatment of COPD patients with depression based on severity. COPD patients with mild depression benefit from pulmonary rehabilitation and cognitive behavioral therapy, whereas patients with severe or persistent depression can be treated with pharmacologic interventions.
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Affiliation(s)
- Mandeep Singh Rahi
- Department of Pulmonary and Critical Care Medicine, Yale New Haven Health, Lawrence + Memorial Hospital, New London, CT 06320, USA
| | - Bright Thilagar
- Department of Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Swetha Balaji
- Division of Endocrinology and Metabolism, Department of Medicine, University of Illinois, Chicago, IL 60607, USA
| | | | - Mayuri Mudgal
- Department of Medicine, Camden Clark Medical Center, School of Medicine, West Virginia University, Parkersburg, WV 26101, USA
| | - Suganiya Rajoo
- Department of Hematology and Oncology, WakeMed, Raleigh Campus, Raleigh, NC 27610, USA
| | - Prashanth Reddy Yella
- Department of Internal Medicine, Yuma Regional Medical Center, 2400 S Avenue A, Yuma, AZ 85364, USA
| | - Palak Satija
- Department of Internal Medicine, Yuma Regional Medical Center, 2400 S Avenue A, Yuma, AZ 85364, USA
| | - Alsu Zagorulko
- Department of Psychiatry, Illinois Center for Neurological and Behavioral Medicine, Des Plaines, IL 60016, USA
| | - Kulothungan Gunasekaran
- Department of Pulmonary Diseases and Critical Care, Yuma Regional Medical Center, Yuma, AZ 85364, USA
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26
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Lin TF, Shune S. The Mind-Body-Breath Link During Oral Intake in Chronic Obstructive Pulmonary Disease: A Grounded Theory Analysis. Dysphagia 2023; 38:367-378. [PMID: 35713729 DOI: 10.1007/s00455-022-10473-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 05/31/2022] [Indexed: 01/27/2023]
Abstract
Both chronic obstructive pulmonary disease (COPD) and dysphagia can be complicated by the shared physiological-psychoemotional manifestations of the conditions, such as anxiety and respiratory dysfunction. Despite their shared comorbidities, clinical research and management often focus on the isolated physiological impairments of each condition separately. Crucially, the oral intake experience of individuals with COPD-central for improved quality of life-remains underexplored. Thus, the purpose of this study was to understand the oral intake experience among individuals with COPD, including perceived barriers, behaviors, and emotions. Fourteen individuals with COPD (mean age 68.9; 7 females; 2 with diagnosed dysphagia) participated. Using grounded theory methodology, semi-structured interviews were conducted and analyzed. Four themes surfaced: (a) participants experience physiological manifestations of COPD (dyspnea, coughing) during eating/drinking; (b) emotions related to eating/drinking, such as concern, fear, anxiety, panic, and frustration stem from the physiological manifestations; (c) these emotions worsen the physiological manifestations; and (d) as a result of the physiological manifestations, they adapt eating/drinking behaviors (e.g., choose easier to eat foods, reduce intake size). The theory 'the mind-body-breath feedback and feedforward loops as a contributor to the oral intake experience in individuals with COPD' is subsequently proposed. Of clinical importance, many participants did not recognize their swallowing status as an issue. Ultimately, to promote patient-centered care, we need to view the oral intake experience for individuals with COPD through a more comprehensive lens that incorporates the interrelationships between the physiological and psychoemotional manifestations of COPD and better educate patients on COPD's impact on eating and drinking.
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Affiliation(s)
- Ting-Fen Lin
- Department of Communicative Sciences and Deaf Studies, California State University, Fresno, 93740, USA.
| | - Samantha Shune
- Communication Disorders and Sciences Program, University of Oregon, Eugene, 97403, USA
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Myers LC, Murray R, Donato B, Liu VX, Kipnis P, Shaikh A, Franchino-Elder J. Risk of hospitalization in a sample of COVID-19 patients with and without chronic obstructive pulmonary disease. Respir Med 2023; 206:107064. [PMID: 36459955 PMCID: PMC9700393 DOI: 10.1016/j.rmed.2022.107064] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 11/21/2022] [Accepted: 11/23/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND OBJECTIVE Patients with chronic obstructive pulmonary disease (COPD) may have worse coronavirus disease-2019 (COVID-19)-related outcomes. We compared COVID-19 hospitalization risk in patients with and without COPD. METHODS This retrospective cohort study included patients ≥40 years, SARS-CoV-2 positive, and with Kaiser Permanente Northern California membership ≥1 year before COVID-19 diagnosis (electronic health records and claims data). COVID-19-related hospitalization risk was assessed by sequentially adjusted logistic regression models and stratified by disease severity. Secondary outcome was death/hospice referral after COVID-19. RESULTS AND DISCUSSION Of 19,558 COVID-19 patients, 697 (3.6%) had COPD. Compared with patients without COPD, COPD patients were older (median age: 69 vs 53 years); had higher Elixhauser Comorbidity Index (5 vs 0) and more median baseline outpatient (8 vs 4), emergency department (2 vs 1), and inpatient (2 vs 1) encounters. Unadjusted analyses showed increased odds of hospitalization with COPD (odds ratio [OR]: 3.93; 95% confidence interval [CI]: 3.40-4.60). After full risk adjustment, there were no differences in odds of hospitalization (OR: 1.14, 95% CI: 0.93-1.40) or death/hospice referral (OR: 0.96, 95% CI: 0.72-1.27) between patients with and without COPD. Primary/secondary outcomes did not differ by COPD severity, except for higher odds of hospitalization in COPD patients requiring supplemental oxygen versus those without COPD (OR: 1.84, 95% CI: 1.02-3.33). CONCLUSIONS Except for hospitalization among patients using supplemental oxygen, no differences in odds of hospitalization or death/hospice referral were observed in the COVID-19 patient sample depending on whether they had COPD.
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Affiliation(s)
- Laura C Myers
- The Permanente Medical Group, Kaiser Permanente Northern California, Oakland, CA, USA; Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA.
| | | | - Bonnie Donato
- Health Economics and Outcomes Research, Boehringer Ingelheim Pharmaceuticals Inc., Ridgefield, CT, USA
| | - Vincent X Liu
- The Permanente Medical Group, Kaiser Permanente Northern California, Oakland, CA, USA; Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Patricia Kipnis
- The Permanente Medical Group, Kaiser Permanente Northern California, Oakland, CA, USA; Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Asif Shaikh
- Clinical Development and Medical Affairs, Boehringer Ingelheim Pharmaceuticals Inc., Ridgefield, CT, USA
| | - Jessica Franchino-Elder
- Health Economics and Outcomes Research, Boehringer Ingelheim Pharmaceuticals Inc., Ridgefield, CT, USA
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Weiss JR, Serdenes R, Madtha U, Zhao H, Kim V, Lopez-Pastrana J, Eakin MN, O'Toole J, Cooper CB, Woodruff P, Kanner RE, Krishnan JA, Iyer AS, Couper D, Morrison MF. Association Among Chronic Obstructive Pulmonary Disease Severity, Exacerbation Risk, and Anxiety and Depression Symptoms in the SPIROMICS Cohort. J Acad Consult Liaison Psychiatry 2023; 64:45-57. [PMID: 35948252 DOI: 10.1016/j.jaclp.2022.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 07/22/2022] [Accepted: 07/29/2022] [Indexed: 01/23/2023]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a common, progressive lung disease that often manifests with psychiatric symptoms. Despite this, patients with COPD are not routinely screened for anxiety and depression, which substantially contribute to COPD-related morbidity. OBJECTIVE To determine the relationship among COPD symptom severity, exacerbation risk, and clinically significant anxiety and depression symptoms in ever smokers with COPD. METHODS We used baseline data from the Subpopulations and Intermediate Outcome Measures In COPD Study (SPIROMICS) cohort to examine ever smokers with COPD across Global Initiative for Obstructive Lung Disease (GOLD) disease severity groups. Multivariable logistic regression models were used to calculate odds ratios for clinically significant anxiety and depression for each GOLD group, which was compared to the control group of ever smokers without COPD. Odds ratios were adjusted for subject demographics, medical comorbidities, and substance use covariates, and comparisons were completed using 2-tailed tests. RESULTS Of the 2664 subjects studied, 784 (29.4%) had clinically significant anxiety, and 497 (18.7%) had clinically significant depression. In the multivariable analysis, high pulmonary symptom groups, groups B and D, had increased adjusted odds of clinically significant anxiety (group B: adjusted odds ratios [AOR] 1.28, P = 0.03; group D: AOR 1.95, P < 0.0001) and depression (group B: AOR 2.09, P < 0.0001; group D: AOR 3.04, P < 0.0001). GOLD group D, the group with high pulmonary symptoms and high COPD exacerbation risk, had the greatest risk of both anxiety and depression among the GOLD groups. CONCLUSIONS High COPD symptom severity, even in the absence of elevated COPD exacerbation risk, is associated with clinically significant anxiety and depression. Our separate analyses of anxiety and depression symptoms in a large, multisite, national cohort are unique within the literature and have important treatment implications for COPD patients. Our findings also highlight the utility of screening patients with high COPD symptom severity for anxiety and depression.
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Affiliation(s)
- Jacob R Weiss
- Department of Psychiatry and Behavioral Science, Temple University Hospital, Philadelphia, PA.
| | - Ryan Serdenes
- Department of Psychiatry and Behavioral Science, Temple University Hospital, Philadelphia, PA
| | - Uchechukwu Madtha
- Department of Psychiatry and Behavioral Science, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Huaqing Zhao
- Department of Biomedical Education and Data Science, Lewis Katz School of Medicine, Philadelphia, PA
| | - Victor Kim
- Department of Thoracic Medicine and Surgery, Temple University Hospital, Philadelphia, PA
| | - Jahaira Lopez-Pastrana
- Department of Psychiatry and Human Behavior, Thomas Jefferson University Hospital, Philadelphia, PA
| | - Michelle N Eakin
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jacqueline O'Toole
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Christopher B Cooper
- Departments of Medicine and Physiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Prescott Woodruff
- Division of Pulmonary, Critical Care and Sleep, University of California San Francisco, San Francisco, CA
| | - Richard E Kanner
- Division of Pulmonary and Critical Care, University of Utah School of Medicine, Salt Lake City, UT
| | - Jerry A Krishnan
- Division of Pulmonary, Critical Care, Sleep and Allergy, University of Illinois at Chicago, Chicago, IL
| | - Anand S Iyer
- Lung Health Center, Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - David Couper
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Mary F Morrison
- Department of Psychiatry and Behavioral Science, Temple University Hospital, Philadelphia, PA
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Hong YJ, Kim Y, Moon JY, Park S, Lee JK, Jung KS, Yoo KH, Kim YI, Choi JY. Associations between depression and anxiety index and frequency of acute exacerbation in chronic obstructive pulmonary disease. Ther Adv Respir Dis 2023; 17:17534666231216591. [PMID: 38108295 PMCID: PMC10729613 DOI: 10.1177/17534666231216591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 11/08/2023] [Indexed: 12/19/2023] Open
Abstract
BACKGROUND Comorbidities of chronic obstructive pulmonary disease (COPD) influence clinical characteristics and prognosis. OBJECTIVES This study compared the clinical characteristics and exacerbation rate of COPD according to the presence of depression or anxiety. DESIGN This study used data from The Korea COPD Subgroup Study (KOCOSS) cohort, a nationwide prospective cohort from 54 medical centers, between April 2012 and 2019. METHODS Depression and anxiety were diagnosed with the Beck Depression Inventory and Beck Anxiety Inventory. Negative binomial regression analysis was performed to analyze the frequency of exacerbations in depressed patients and anxiety. Differences in lung function trajectory according to presence of depression/anxiety were analyzed using a linear mixed model. RESULTS In all, 2147 patients were enrolled. Depressed patients or anxiety had lower lung function, higher modified Medical Research Council (mMRC) grade, St. George Respiratory Questionnaire (SGRQ) score, and COPD assessment test score, and higher rates of exacerbation in the past year than those without depression/anxiety. Depressed patients had a higher frequency of moderate to severe exacerbations [Incidence Rate Ratio (IRR): 1.57, CI: 1.17-2.11, p = 0.002] and those with anxiety had higher frequencies of moderate to severe (IRR: 1.52, CI: 1.03-2.27, p = 0.038) and severe exacerbations (IRR: 2.13, CI: 1.09-4.15, p = 0.025) during 1-year follow-up compared to those without these comorbidities. The differences in the change in annual forced expiratory volume in 1 seconds (FEV1) over 3 years according to the presence of depression or anxiety were not statistically significant. CONCLUSION Depressed and anxious patients showed increased respiratory symptoms and exacerbation rate as well as reduced health-related quality of life, whereas there were no significant differences in changes in lung function between groups with and without depression/anxiety.
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Affiliation(s)
- Yu Jin Hong
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Youlim Kim
- Division of Pulmonary and Allergy, Department of Internal Medicine, Konkuk University Hospital, School of Medicine, Konkuk University, Seoul, Republic of Korea
| | - Ji-Yong Moon
- Division of Pulmonary Medicine and Allergy, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Shinhee Park
- Division of Allergy and Respiratory Medicine, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Jung-Kyu Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Republic of Korea
| | - Ki-Suck Jung
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Hallym University Sacred Heart Hospital, Hallym University Medical School, Anyang, Republic of Korea
| | - Kwang Ha Yoo
- Division of Pulmonary and Allergy, Department of Internal Medicine, Konkuk University Hospital, School of Medicine, Konkuk University, Seoul, Republic of Korea
| | - Yu-Il Kim
- Division of Pulmonary Medicine, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Joon Young Choi
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 21431, Republic of Korea
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Sandau C, Hansen EF, Ringbæk TJ, Kallemose T, Bove DG, Poulsen I, Nørholm V, Pedersen L, Jensen JUS, Ulrik CS. Automated Oxygen Administration Alleviates Dyspnea in Patients Admitted with Acute Exacerbation of COPD: A Randomized Controlled Trial. Int J Chron Obstruct Pulmon Dis 2023; 18:599-614. [PMID: 37096159 PMCID: PMC10122478 DOI: 10.2147/copd.s397782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 03/27/2023] [Indexed: 04/26/2023] Open
Abstract
Objective Devices for Automated Oxygen Administration (AOA) have been developed to optimize the therapeutic benefit of oxygen supplementation. We aimed to investigate the effect of AOA on multidimensional aspects of dyspnea and as-needed consumption of opioids and benzodiazepines, as opposed to conventional oxygen therapy, in hospitalized patients with Acute Exacerbation of COPD (AECOPD). Method and Patients A multicenter randomized controlled trial across five respiratory wards in the Capital Region of Denmark. Patients admitted with AECOPD (n=157) were allocated 1:1 to either AOA (O2matic Ltd), a closed loop device automatically delivering oxygen according to the patient's peripheral oxygen saturation (SpO2), or conventional nurse-administered oxygen therapy. Oxygen flows and SpO2 levels were measured by the O2matic device in both groups, while dyspnea, anxiety, depression, and COPD symptoms were accessed by Patient Reported Outcomes. Results Of the 157 randomized patients, 127 had complete data for the intervention. The AOA reduced patients' perception of overall unpleasantness significantly on the Multidimensional Dyspnea Profile (MDP) with a difference in medians of -3 (p=0.003) between the intervention group (n=64) and the control group (n=63). The AOA also provided a significant between group difference in all single items within the sensory domain of the MDP (all p-values≤0.05) as well as in the Visual Analogue Scale - Dyspnea (VAS-D) within the past three days (p=0.013). All between group differences exceeded the Minimal Clinical Important Difference of the MDP and VAS-D, respectively. AOA did not seem to have an impact on the emotional response domain of the MDP, the COPD Assessment Test, the Hospital Anxiety and Depression Scale, or use of as-needed opioids and/or benzodiazepines (all p-values>0.05). Conclusion AOA reduces both breathing discomfort and physical perception of dyspnea in patients admitted with AECOPD but did not seem to impact the emotional status or other COPD symptoms.
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Affiliation(s)
- Charlotte Sandau
- Department of Respiratory Medicine and Endocrinology, Pulmonary Section, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
- Correspondence: Charlotte Sandau, Email
| | - Ejvind Frausing Hansen
- Department of Respiratory Medicine and Endocrinology, Pulmonary Section, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | | | - Thomas Kallemose
- Department of Clinical Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Dorthe Gaby Bove
- University College Absalon, Centre for Nursing, Roskilde, Denmark
| | - Ingrid Poulsen
- Department of Clinical Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
- Research Unit Nursing and Health Care, Aarhus University, Aarhus, Denmark
| | - Vibeke Nørholm
- Department of Clinical Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Lars Pedersen
- Department of Respiratory Medicine and Infectious Diseases, Copenhagen University Bispebjerg Hospital, Copenhagen, Denmark
| | - Jens Ulrik Stæhr Jensen
- Respiratory Medicine Section, Department of Medicine, Herlev-Gentofte Hospital, Hellerup, Denmark
- Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, København, Denmark
| | - Charlotte Suppli Ulrik
- Department of Respiratory Medicine and Endocrinology, Pulmonary Section, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Pelgrim CE, van Ark I, van Berkum RE, Schuitemaker-Borneman AM, Flier I, Leusink-Muis T, Janbazacyabar H, Diks MAP, Gosker HR, Kelders MCJM, Langen RCJ, Schols AMWJ, Hageman RJJ, Braber S, Garssen J, Folkerts G, van Helvoort A, Kraneveld AD. Effects of a nutritional intervention on impaired behavior and cognitive function in an emphysematous murine model of COPD with endotoxin-induced lung inflammation. Front Nutr 2022; 9:1010989. [PMID: 36466426 PMCID: PMC9714332 DOI: 10.3389/fnut.2022.1010989] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 11/02/2022] [Indexed: 08/29/2023] Open
Abstract
One cluster of the extrapulmonary manifestations in chronic obstructive pulmonary disease (COPD) is related to the brain, which includes anxiety, depression and cognitive impairment. Brain-related comorbidities are related to worsening of symptoms and increased mortality in COPD patients. In this study, a murine model of COPD was used to examine the effects of emphysema and repetitive pulmonary inflammatory events on systemic inflammatory outcomes and brain function. In addition, the effect of a dietary intervention on brain-related parameters was assessed. Adult male C57Bl/6J mice were exposed to elastase or vehicle intratracheally (i.t.) once a week on three consecutive weeks. Two weeks after the final administration, mice were i.t. exposed to lipopolysaccharide (LPS) or vehicle for three times with a 10 day interval. A dietary intervention enriched with omega-3 PUFAs, prebiotic fibers, tryptophan and vitamin D was administered from the first LPS exposure onward. Behavior and cognitive function, the degree of emphysema and both pulmonary and systemic inflammation as well as blood-brain barrier (BBB) integrity and neuroinflammation in the brain were assessed. A lower score in the cognitive test was observed in elastase-exposed mice. Mice exposed to elastase plus LPS showed less locomotion in the behavior test. The enriched diet seemed to reduce anxiety-like behavior over time and cognitive impairments associated with the presented COPD model, without affecting locomotion. In addition, the enriched diet restored the disbalance in splenic T-helper 1 (Th1) and Th2 cells. There was a trend toward recovering elastase plus LPS-induced decreased expression of occludin in brain microvessels, a measure of BBB integrity, as well as improving expression levels of kynurenine pathway markers in the brain by the enriched diet. The findings of this study demonstrate brain-associated comorbidities - including cognitive and behavioral impairments - in this murine model for COPD. Although no changes in lung parameters were observed, exposure to the specific enriched diet in this model appeared to improve systemic immune disbalance, BBB integrity and derailed kynurenine pathway which may lead to reduction of anxiety-like behavior and improved cognition.
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Affiliation(s)
- Charlotte E. Pelgrim
- Division of Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands
| | - Ingrid van Ark
- Division of Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands
| | - Ronja E. van Berkum
- Division of Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands
| | - Anne M. Schuitemaker-Borneman
- Division of Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands
| | - Inge Flier
- Division of Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands
| | - Thea Leusink-Muis
- Division of Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands
| | - Hamed Janbazacyabar
- Division of Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands
| | - Mara A. P. Diks
- Division of Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands
| | - Harry R. Gosker
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, Netherlands
| | - Marco C. J. M. Kelders
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, Netherlands
| | - Ramon C. J. Langen
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, Netherlands
| | - Annemie M. W. J. Schols
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, Netherlands
| | | | - Saskia Braber
- Division of Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands
| | - Johan Garssen
- Division of Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands
- Danone Nutricia Research, Utrecht, Netherlands
| | - Gert Folkerts
- Division of Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands
| | - Ardy van Helvoort
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, Netherlands
- Danone Nutricia Research, Utrecht, Netherlands
| | - Aletta D. Kraneveld
- Division of Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands
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Allado E, Poussel M, Hamroun A, Moussu A, Kneizeh G, Hily O, Temperelli M, Corradi C, Koch A, Albuisson E, Chenuel B. Is There a Relationship between Hyperventilation Syndrome and History of Acute SARS-CoV-2 Infection? A Cross-Sectional Study. Healthcare (Basel) 2022; 10:healthcare10112154. [PMID: 36360494 PMCID: PMC9690850 DOI: 10.3390/healthcare10112154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 10/20/2022] [Accepted: 10/22/2022] [Indexed: 01/08/2023] Open
Abstract
Following COVID-19 infection, many patients suffer from long-lasting symptoms that may greatly impair their quality of life. Persisting dyspnea and other functional respiratory complaints can evoke hyperventilation syndrome (HVS) as a putative contributor to long-COVID presentation in COVID-19 survivors. We aimed to assess the possible relationship between HVS and previous acute COVID-19 infection. We designed a cross-sectional, single-center study, including all patients consecutively referred to our Lung Function and Exercise Testing Department between January and June 2021. Participants completed a systematic Nijmegen Questionnaire, a modified Medical Research Council dyspnea scale assessment, a post-COVID screening questionnaire, and performed a standardized lung function test. The population was divided according to HVS diagnosis, defined as a Nijmegen score of > 23/64. The occurrence of previous COVID-19 infection was compared according to the Nijmegen score after adjustment for potential confounders by multivariate logistic regression. In total, 2846 patients were included: 1472 men (51.7%) with a mean age of 56 (±16.6) years. A total of 455 patients (16%) declared a previous SARS-CoV-2 infection, and 590 patients presented a positive score (>23/64) in the Nijmegen Questionnaire (20.7%). Compared with COVID-19-free patients, there was an increased occurrence of HVS+ in cases of COVID-19 infection that did not require hospitalization (aOR = 1.93 [1.17−3.18]). The results of this large-scale, cross-sectional study suggest an association between HVS diagnosis and a history of COVID-19 disease in patients who were not hospitalized.
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Affiliation(s)
- Edem Allado
- CHRU-Nancy, Exploration Fonctionnelle Respiratoire—Centre Universitaire de Médecine du Sport et Activités Physiques Adaptées, F54000 Nancy, France
- DevAH, Université de Lorraine, F54000 Nancy, France
| | - Mathias Poussel
- CHRU-Nancy, Exploration Fonctionnelle Respiratoire—Centre Universitaire de Médecine du Sport et Activités Physiques Adaptées, F54000 Nancy, France
- DevAH, Université de Lorraine, F54000 Nancy, France
| | - Aghiles Hamroun
- Department of Public Health, Epidemiology, Health Economics and Prevention, Regional and University Hospital Center of Lille, Lille University, F59000 Lille, France
| | - Anthony Moussu
- CHRU-Nancy, Exploration Fonctionnelle Respiratoire—Centre Universitaire de Médecine du Sport et Activités Physiques Adaptées, F54000 Nancy, France
| | - Ghias Kneizeh
- CHRU-Nancy, Exploration Fonctionnelle Respiratoire—Centre Universitaire de Médecine du Sport et Activités Physiques Adaptées, F54000 Nancy, France
| | - Oriane Hily
- CHRU-Nancy, Exploration Fonctionnelle Respiratoire—Centre Universitaire de Médecine du Sport et Activités Physiques Adaptées, F54000 Nancy, France
| | - Margaux Temperelli
- CHRU-Nancy, Exploration Fonctionnelle Respiratoire—Centre Universitaire de Médecine du Sport et Activités Physiques Adaptées, F54000 Nancy, France
| | - Christophe Corradi
- CHRU-Nancy, Exploration Fonctionnelle Respiratoire—Centre Universitaire de Médecine du Sport et Activités Physiques Adaptées, F54000 Nancy, France
| | - Alexandre Koch
- CHRU-Nancy, Exploration Fonctionnelle Respiratoire—Centre Universitaire de Médecine du Sport et Activités Physiques Adaptées, F54000 Nancy, France
| | - Eliane Albuisson
- CHRU-Nancy, Direction de la Recherche Clinique et de l’Innovation, F54000 Nancy, France
- CNRS, IECL, Université de Lorraine, F54000 Nancy, France
- Département du Grand Est de Recherche en Soins Primaires (DEGERESP), Université de Lorraine, F54000 Nancy, France
| | - Bruno Chenuel
- CHRU-Nancy, Exploration Fonctionnelle Respiratoire—Centre Universitaire de Médecine du Sport et Activités Physiques Adaptées, F54000 Nancy, France
- DevAH, Université de Lorraine, F54000 Nancy, France
- Correspondence:
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National Trends in Prevalence of Depression in Men and Women with Chronic Obstructive Pulmonary Disease Hospitalized in Spain, 2016–2020. J Clin Med 2022; 11:jcm11216337. [PMID: 36362570 PMCID: PMC9655616 DOI: 10.3390/jcm11216337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 10/24/2022] [Accepted: 10/25/2022] [Indexed: 11/23/2022] Open
Abstract
(1) Background: To describe trends in the prevalence of depression in men and women with COPD hospitalized in Spain (2016–2020). (2) Methods: We used a nationwide discharge database to select all patients ≥35 years with COPD. (3) Results: The prevalence of depression was 3.54-times higher in women with COPD than in men (OR 3.54; 95%CI 3.48–3.6). It decreased significantly between 2016 and 2020, although the reduction was only significant in women (12.27% in 2016 vs. 10.56% in 2020). Older age, comorbidity and the most recent years of hospital admission were associated with lower prevalence of depression in both men and women, while obesity, obstructive sleep apnea (OSA) and use of oxygen prior to admission were risk factors. In-hospital mortality (IHM) increased significantly over time. Older age, comorbidity, the use of oxygen prior to admission and having been hospitalized in 2020 increased the risk of IHM. Female sex was associated with a lower IHM in patients with depression and COPD. (4) Conclusions: The prevalence of depression has decreased over time in women with COPD while it has not changed significantly in men with this disease. IHM increased over time both in men and women with COPD and depression, with higher prevalence in the former.
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Discussing prognosis and the end of life with patients with advanced cancer or COPD: A qualitative study. PLoS One 2022; 17:e0274201. [PMID: 36084060 PMCID: PMC9462714 DOI: 10.1371/journal.pone.0274201] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 08/23/2022] [Indexed: 11/23/2022] Open
Abstract
Objectives To explore patients’ experiences and recommendations for discussions about their prognosis and end of life with their physicians. Methods Patients with advanced cancer or advanced chronic obstructive pulmonary disease (COPD) were enrolled in qualitative interviews, which were analyzed with a phenomenological and thematic approach. Results During interviews with fourteen patients (median age 64 years), we identified the following themes for discussion about prognosis and the end of life: topics discussed, the timing, the setting, physician–patient relationship, responsibilities for clinicians, and recommendations. Patients preferred the physician to initiate such discussion, but wanted to decide about its continuation and content. The discussions were facilitated by an established physician–patient relationship or attendance of relatives. Patients with cancer had had discussions about prognosis at rather clear-cut moments of deterioration than patients with COPD. Patients with COPD did not consider end-of-life discussions a responsibility of the pulmonologist. Patients recommended an understandable message, involvement of relatives or other clinicians, sufficient time, and sensitive non-verbal communication. Conclusions Patients appreciated open, sensitive, and negotiable discussions about prognosis and the end of life. Practice implications Patients’ recommendations could be used for communication training. Possible differences in the need for such discussions between patients with cancer or COPD warrant further research.
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Pelgrim CE, Wang L, Peralta Marzal LN, Korver S, van Ark I, Leusink-Muis T, Braber S, Folkerts G, Garssen J, van Helvoort A, Kraneveld AD. Increased exploration and hyperlocomotion in a cigarette smoke and LPS-induced murine model of COPD: linking pulmonary and systemic inflammation with the brain. Am J Physiol Lung Cell Mol Physiol 2022; 323:L251-L265. [PMID: 35699308 DOI: 10.1152/ajplung.00485.2021] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 06/08/2022] [Accepted: 06/09/2022] [Indexed: 01/08/2023] Open
Abstract
Brain-related comorbidities are frequently observed in chronic obstructive pulmonary disease (COPD) and are related to increased disease progression and mortality. To date, it is unclear which mechanisms are involved in the development of brain-related problems in COPD. In this study, a cigarette smoke and lipopolysaccharide (LPS) exposure murine model was used to induce COPD-like features and assess the impact on brain and behavior. Mice were daily exposed to cigarette smoke for 72 days, except for days 42, 52, and 62, on which mice were intratracheally exposed to the bacterial trigger LPS. Emphysema and pulmonary inflammation as well as behavior and brain pathology were assessed. Cigarette smoke-exposed mice showed increased alveolar enlargement and numbers of macrophages and neutrophils in bronchoalveolar lavage. Cigarette smoke exposure resulted in lower body weight, which was accompanied by lower serum leptin levels, more time spent in the inner zone of the open field, and decreased claudin-5 and occludin protein expression levels in brain microvessels. Combined cigarette smoke and LPS exposure resulted in increased locomotion and elevated microglial activation in the hippocampus of the brain. These novel findings show that systemic inflammation observed after combined cigarette smoke and LPS exposure in this COPD model is associated with increased exploratory behavior. Findings suggest that neuroinflammation is present in the brain area involved in cognitive functioning and that blood-brain barrier integrity is compromised. These findings can contribute to our knowledge about possible processes involved in brain-related comorbidities in COPD, which is valuable for optimizing and developing therapy strategies.
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Affiliation(s)
- Charlotte E Pelgrim
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, The Netherlands
| | - Lei Wang
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, The Netherlands
| | - Lucía N Peralta Marzal
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, The Netherlands
| | - Stephanie Korver
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, The Netherlands
| | - Ingrid van Ark
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, The Netherlands
| | - Thea Leusink-Muis
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, The Netherlands
| | - Saskia Braber
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, The Netherlands
| | - Gert Folkerts
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, The Netherlands
| | - Johan Garssen
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, The Netherlands
- Platform Immunology, Danone Nutricia Research, Utrecht, The Netherlands
| | - Ardy van Helvoort
- Danone Nutricia Research, Utrecht, The Netherlands
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Aletta D Kraneveld
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, The Netherlands
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Uliński R, Kwiecień I, Domagała-Kulawik J. Lung Cancer in the Course of COPD-Emerging Problems Today. Cancers (Basel) 2022; 14:cancers14153819. [PMID: 35954482 PMCID: PMC9367492 DOI: 10.3390/cancers14153819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 07/26/2022] [Accepted: 08/03/2022] [Indexed: 11/16/2022] Open
Abstract
Tobacco smoking remains the main cause of tobacco-dependent diseases like lung cancer, chronic obstructive pulmonary disease (COPD), in addition to cardiovascular diseases and other cancers. Whilst the majority of smokers will not develop either COPD or lung cancer, they are closely related diseases, occurring as co-morbidities at a higher rate than if they were independently triggered by smoking. A patient with COPD has a four- to six-fold greater risk of developing lung cancer independent of smoking exposure, when compared to matched smokers with normal lung function. The 10 year risk is about 8.8% in the COPD group and only 2% in patients with normal lung function. COPD is not a uniform disorder: there are different phenotypes. One of them is manifested by the prevalence of emphysema and this is complicated by malignant processes most often. Here, we present and discuss the clinical problems of COPD in patients with lung cancer and against lung cancer in the course of COPD. There are common pathological pathways in both diseases. These are inflammation with participation of macrophages and neutrophils and proteases. It is known that anticancer immune regulation is distorted towards immunosuppression, while in COPD the elements of autoimmunity are described. Cytotoxic T cells, lymphocytes B and regulatory T cells with the important role of check point molecules are involved in both processes. A growing number of lung cancer patients are treated with immune check point inhibitors (ICIs), and it was found that COPD patients may have benefits from this treatment. Altogether, the data point to the necessity for deeper analysis and intensive research studies to limit the burden of these serious diseases by prevention and by elaboration of specific therapeutic options.
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Affiliation(s)
- Robert Uliński
- Doctoral School, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Iwona Kwiecień
- Laboratory of Hematology and Flow Cytometry, Department of Internal Medicine and Hematology, Military Institute of Medicine, 04-141 Warsaw, Poland
| | - Joanna Domagała-Kulawik
- Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, 02-097 Warsaw, Poland
- Correspondence:
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Decreasing Hospital Readmissions Utilizing an Evidence-Based COPD Care Bundle. Lung 2022; 200:481-486. [PMID: 35796786 DOI: 10.1007/s00408-022-00548-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 05/31/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE Chronic obstructive pulmonary disease (COPD) is a chronic condition that leads to significant morbidity and mortality. Management of COPD hospitalizations utilizing an evidence-based care bundle can provide consistent quality of care and may reduce readmissions. METHODS This single-center retrospective cohort study evaluated readmission rates in patients hospitalized with a COPD exacerbation. Patients in the pre-intervention cohort received usual care, while patients in the post-intervention cohort received an innovative inpatient COPD care bundle. The bundle focused on optimizing care in five areas: consults, inpatient interventions, education, transitions of care, and after discharge care. RESULTS In this study, 149 subjects were included in the pre-intervention cohort and 214 subjects were included in the post-intervention cohort. Thirty-day readmission rates were lower in the post-intervention cohort compared to the pre-intervention cohort, 22.4% vs. 38.3% (p = 0.001). A reduction in 60-day and 90-day readmission rates was also observed, 13.7% vs. 40.3% (p < 0.001) and 10.1% vs. 32.2% (p < 0.001), respectively. CONCLUSION Bundled care is an effective and inexpensive method for institutions to provide consistent and quality care. The findings of this study demonstrate that the implementation of a COPD care bundle is an effective strategy to decrease hospital readmissions.
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Jin S, Wu Y, Chen S, Zhao D, Guo J, Chen L, Huang Y. The Additional Medical Expenditure Caused by Depressive Symptoms among Middle-Aged and Elderly Patients with Chronic Lung Diseases in China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19137849. [PMID: 35805507 PMCID: PMC9266188 DOI: 10.3390/ijerph19137849] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 06/23/2022] [Accepted: 06/23/2022] [Indexed: 02/04/2023]
Abstract
Depression is one of the most common comorbidities in patients with chronic lung diseases (CLDs). Depressive symptoms have an obvious influence on the health function, treatment, and management of CLD patients. In order to investigate the additional medical expenditure caused by depressive symptoms among middle-aged and elderly patients with CLDs in China, and to estimate urban–rural differences in additional medical expenditure, our study used data from the 2018 China Health and Retirement Longitudinal Study (CHARLS) investigation. A total of 1834 middle-aged and elderly CLD patients were included in this study. A generalized linear regression model was used to analyze the additional medical expenditure on depressive symptoms in CLD patients. The results show that depressive symptoms were associated with an increase in medical costs in patients with CLDs. Nevertheless, the incremental medical costs differed between urban and rural patients. In urban and rural patients with more severe comorbid CLD and depressive symptoms (co-MCDs), the total additional medical costs reached 4704.00 Chinese Yuan (CNY) (USD 711.60) and CNY 2140.20 (USD 323.80), respectively. Likewise, for patients with lower severity co-MCDs, the total additional medical costs of urban patients were higher than those of rural patients (CNY 4908.10 vs. CNY 1169.90) (USD 742.50 vs. USD 176.90). Depressive symptoms were associated with increased medical utilization and expenditure among CLD patients, which varies between urban and rural areas. This study highlights the importance of mental health care for patients with CLDs.
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Anxiety Is a Mediator between Heart Rate Variability and Quality of Life in Chronic Obstructive Pulmonary Disease. J Pers Med 2022; 12:jpm12060960. [PMID: 35743745 PMCID: PMC9225566 DOI: 10.3390/jpm12060960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/08/2022] [Accepted: 06/10/2022] [Indexed: 11/17/2022] Open
Abstract
Autonomic nervous system (ANS) dysregulation is an important pathophysiological mechanism in patients with chronic obstructive pulmonary disease (COPD). Heart rate variability (HRV) is a common index for ANS, and HRV has been used to explore the association between ANS and clinical illnesses. This study aimed to explore the group differences in HRV, depression, anxiety, and quality of life between participants with COPD and healthy controls (HC group), and whether emotion plays a mediating role between HRV and quality of life in participants with COPD. A total of ninety-six participants with COPD and 59 participants in the HC group completed the Beck Depression Inventory-II (BDI-II), Beck Anxiety Inventory (BAI), and Saint George’s Respiratory Questionnaire (SGRQ). Assessment of spirometry pulmonary function and five minute lead II electrocardiography (ECG) were also performed under the resting baseline. The COPD group had higher depression scores (F = 4.10, p = 0.008), and a lower quality of life (F = 14.44, p < 0.001) and HRV indices (such as standard deviation of RR intervals (F = 5.49, p < 0.05) and low frequency (F = 3.03, p < 0.05)) compared to the HC group. Sympathetic activation was positively correlated with depression (r = 0.312, p < 0.01), anxiety (r = 0.420, p < 0.001), and poor quality of life (r = 0.467, p < 0.001) in the COPD group. After controlling for age and sex, anxiety (β = 0.585, p < 0.001) and sympathetic activation (β = 0.231, p < 0.05) positively predicted poor quality of life, and lung function (β = −0.251, p < 0.01) negatively predicted poor quality of life. Therefore, anxiety is a mediator between sympathetic activation and quality of life. Emotional and HRV screening should be applied to COPD patients in clinical practice, and emotional management or HRV biofeedback training can be used to improve anxiety and HRV for future studies.
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Baugh A, Buhr RG, Quibrera P, Barjaktarevic I, Barr RG, Bowler R, Han MK, Kaufman JD, Koch AL, Krishnan J, Labaki W, Martinez FJ, Mkorombindo T, Namen A, Ortega V, Paine R, Peters SP, Schotland H, Sundar K, Zeidler MR, Hansel NN, Woodruff PG, Thakur N. Risk of COPD exacerbation is increased by poor sleep quality and modified by social adversity. Sleep 2022; 45:6602021. [PMID: 35665826 PMCID: PMC9366643 DOI: 10.1093/sleep/zsac107] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 04/19/2022] [Indexed: 02/03/2023] Open
Abstract
STUDY OBJECTIVES Sleep is an important dimension in the care of chronic obstructive pulmonary disease (COPD), but its relevance to exacerbations is unclear. We wanted to assess whether sleep quality as measured by the Pittsburgh Sleep Quality Index (PSQI) is associated with an increased risk of COPD exacerbations and does this differ by socio-environmental exposures. METHODS We included 1647 current and former smokers with spirometrically confirmed COPD from the SPIROMICS cohort. We assessed incidence rate ratios for exacerbation using zero-inflated negative binomial regression adjusting for demographics, medical comorbidities, and multiple metrics of disease severity, including respiratory medications, airflow obstruction, and symptom burden. Our final model adjusted for socio-environmental exposures using the Area Deprivation Index, a composite measure of contemporary neighborhood quality, and Adversity-Opportunity Index, a composite measure of individual-level historic and current socioeconomic indicators. We used a pre-determined threshold of 20% missingness to undertake multiple imputation by chained equations. As sensitivity analyses, we repeated models in those with complete data and after controlling for prior exacerbations. As an exploratory analysis, we considered an interaction between socio-environmental condition and sleep quality. RESULTS After adjustment for all co-variates, increasing PSQI scores (range 0-21) were associated with a 5% increased risk for exacerbation per point (p = .001) in the imputed dataset. Sensitivity analyses using complete cases and after controlling for prior exacerbation history were similar. Exploratory analysis suggested less effect among those who lived in poor-quality neighborhoods (p-for-interaction = .035). CONCLUSIONS Poor sleep quality may contribute to future exacerbations among patients with COPD. This represents one target for improving disease control. CLINICAL TRIAL REGISTRATION Subpopulations and Intermediate Outcome Measures in COPD Study (SPIROMICS). ClinicalTrials.gov Identifier# NCT01969344. Registry URL: https://clinicaltrials.gov/ct2/show/.
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Affiliation(s)
- Aaron Baugh
- Corresponding author. Aaron Baugh, University of California, San Francisco, Box 0111, 505 Parnassus Ave, San Francisco, CA 94143, USA. E-mail:
| | - Russell G Buhr
- Department of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Pedro Quibrera
- Collaborative Studies Coordination Center, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Igor Barjaktarevic
- Department of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - R Graham Barr
- Department of Medicine, Columbia University, New York, NY, USA
| | - Russell Bowler
- Department of Medicine, National Jewish Health, Denver, CO, USA
| | - Meilan King Han
- Department of Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Joel D Kaufman
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Abigail L Koch
- Department of Medicine, Veterans Administration Miami Healthcare, Miami, FL, USA
| | - Jerry Krishnan
- Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Wassim Labaki
- Department of Medicine, University of Michigan, Ann Arbor, MI, USA
| | | | | | - Andrew Namen
- Department of Medicine, Wake Forest Baptist Health, Winston-Salem, NC, USA
| | - Victor Ortega
- Department of Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - Robert Paine
- Department of Medicine, University of Utah, Salt Lake City, UA, USA
| | - Stephen P Peters
- Department of Medicine, Wake Forest Baptist Health, Winston-Salem, NC, USA
| | - Helena Schotland
- Department of Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Krishna Sundar
- Department of Medicine, University of Utah, Salt Lake City, UA, USA
| | - Michelle R Zeidler
- Department of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Nadia N Hansel
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Prescott G Woodruff
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Neeta Thakur
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
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Relationship between clinical anxiety and patient outcomes in patients with chronic obstructive lung disease exacerbation in the emergency department. Med Klin Intensivmed Notfmed 2022; 118:236-241. [PMID: 35661228 PMCID: PMC9166224 DOI: 10.1007/s00063-022-00934-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 02/11/2022] [Accepted: 05/16/2022] [Indexed: 11/17/2022]
Abstract
Purpose Anxiety is a comorbidity that is not routinely addressed in patients with chronic obstructive lung disease (COPD) exacerbation in the emergency department (ED). Anxiety in patients with COPD exacerbation can be related with negative outcomes. The Generalized Anxiety Disorder 7 (GAD-7) score is an easy-to-use tool to determine anxiety. This study aimed to investigate the relationship between GAD‑7 score and patient outcomes in patients with COPD exacerbation in the ED. Methods A prospective, cross-sectional study was conducted in a tertiary academic ED between July 2019 and January 2021. Patients admitted to the ED with COPD exacerbation were included. A GAD‑7 score of ≥ 10 was defined as clinically significant anxiety. Negative outcomes were defined as a composite outcome that included recurrent ED visits, intensive care unit admission, and mortality. The relationship between clinically significant anxiety and negative outcomes within 30 days was determined. Results A total of 92 patients were assessed for eligibility and 80 were included in the study. Thirty-seven patients (46.3%) experienced negative outcomes. Although no significant difference was detected in median GAD‑7 scores between patients with positive and negative outcomes, negative outcomes were significantly higher in patients who had a GAD‑7 score of ≥ 10 (n = 25, p = 0.03). A sensitivity of 43.2%, specificity of 79.1%, positive likelihood ratio of 2.1 and negative likelihood ratio of 0.7 were determined for GAD‑7 score in predicting negative outcome. Conclusion In patients with COPD exacerbation in the ED, a GAD‑7 score of ≥ 10 was associated with 30-day negative outcomes.
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Marcolongo F, Scarlata S, Tomino C, De Dominicis C, Giacconi R, Malavolta M, Bonassi S, Russo P, Prinzi G. Psycho-cognitive assessment and quality of life in older adults with chronic obstructive pulmonary disease-carrying the rs4713916 gene polymorphism (G/A) of gene FKBP5 and response to pulmonary rehabilitation: a proof of concept study. Psychiatr Genet 2022; 32:116-124. [PMID: 35102127 DOI: 10.1097/ypg.0000000000000308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Chronic obstructive pulmonary disease (COPD) is characterized by pulmonary and extra-pulmonary multi-morbidity including depression, anxiety and cognitive disorders. Several studies investigated the association of the FKBP5 gene polymorphisms with susceptibility to anxiety, depression, and behavioral disorders. The FKBP5 gene codifies the FKBP51 protein which modulates the glucocorticoid receptor in the adaptive stress response. Genetic variants of the FKBP5 gene have been associated to a higher risk of developing mental disorders. We analyzed the association of genetic variants and stress exposure investigating the susceptibility to psychological distress and the impact on cognitive balance and quality of life (QoL) of COPD patients carrying the rs4713916 polymorphism (G/A) and we examined its association, with COPD rehabilitative outcomes. MATERIALS AND METHODS A pilot study evaluated cognitive, psychological, clinical alterations/disorders, QoL, and coping strategies in 70 older adults with COPD, undergoing pulmonary rehabilitation, stratified according to the FKBP5 rs4713916 genotype (GG or GA). RESULTS Carriers of rs4713916 polymorphisms (G/A) show better cognitive performances, a higher degree of independence in the daily living activities, better QoL, no presence of depressive mood and anxiety symptoms, no family history of psychiatric disorders, more ability to cope with stressors by avoiding emotions but demanding emotional support, and lesser use of anti-anxiety, anti-depressant, anti-psychotic, hypnotic-sedative drugs. No difference was found in the number of comorbidities. CONCLUSION These results offer valuable insights into the role of FKBP5 in the complex network of mechanisms associated to clinical, psychological and behavioral features of COPD patients.
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Affiliation(s)
- Federica Marcolongo
- Unit of Clinical and Molecular Epidemiology, IRCCS San Raffaele Roma, Via di Val Cannuta
| | - Simone Scarlata
- Unit of Geriatrics, Campus Bio-Medico di Roma, University, Via Alvaro del Portillo
| | - Carlo Tomino
- Scientific Direction, IRCCS San Raffaele Roma, Via di Val Cannuta
| | - Chiara De Dominicis
- Molecular and Cellular Neurobiology, IRCCS San Raffaele Roma, Via di Val Cannuta, Rome
| | - Robertina Giacconi
- Technology Center for Aging Research, Scientific Technological Area, IRCCS-INRCA, Via Giuseppe Birarelli, Ancona
| | - Marco Malavolta
- Technology Center for Aging Research, Scientific Technological Area, IRCCS-INRCA, Via Giuseppe Birarelli, Ancona
| | - Stefano Bonassi
- Unit of Clinical and Molecular Epidemiology, IRCCS San Raffaele Roma, Via di Val Cannuta
- Department of Human Sciences and Quality of Life Promotion, San Raffaele University, Via di Val Cannuta, Rome, Italy
| | - Patrizia Russo
- Unit of Clinical and Molecular Epidemiology, IRCCS San Raffaele Roma, Via di Val Cannuta
- Department of Human Sciences and Quality of Life Promotion, San Raffaele University, Via di Val Cannuta, Rome, Italy
| | - Giulia Prinzi
- Unit of Clinical and Molecular Epidemiology, IRCCS San Raffaele Roma, Via di Val Cannuta
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Köbler P, Krauss-Köstler EK, Stein B, Ficker JH, Wilhelm M, Dechêne A, Waller C. Specialized Biopsychosocial Care in Inpatient Somatic Medicine Units-A Pilot Study. Front Public Health 2022; 10:844874. [PMID: 35493384 PMCID: PMC9039260 DOI: 10.3389/fpubh.2022.844874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 03/21/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Specialized biopsychosocial care concepts are necessary to overcome the dualism between physical and psychosocial treatment in acute care hospitals. For patients with complex and chronic comorbid physical and mental health problems, neither standardized psychiatric/psychosomatic nor somatic care units alone are appropriate to their needs. The “Nuremberg Integrated Psychosomatic Acute Unit” (NIPA) has been developed to integrate treatment of both, psychosocial and physical impairments, in an acute somatic care setting. Method NIPA has been established in inpatient internal medical wards for respiratory medicine, oncology and gastroenterology. One to two patients per ward are regularly enrolled in the NIPA treatment while remaining in the same inpatient bed after completion of the somatic care. In a naturalistic study design, we evaluated treatment effects by assessment of symptom load at admission and at discharge using the Patient Health Questionnaire (PHQ) and the Generalized Anxiety Disorder Scale-7 (GAD-7). Furthermore, we assessed the severity of morbidity using diagnosis data during treatment. At discharge, we measured satisfaction with treatment through the Patient Satisfaction Questionnaire (ZUF-8). Results Data from 41 NIPA patients were analyzed (18–87 years, 76% female). Seventy-eight percent suffered from at least moderate depression and 49% from anxiety disorders. Other diagnoses were somatoform pain disorder, somatoform autonomic dysfunction, eating disorder and posttraumatic stress disorder. Hypertension, chronic lung diseases and musculoskeletal disorders as well as chronic oncological and cardiac diseases were the most common somatic comorbidities. Treatment resulted in a significant reduction of depressive mood (admission: M = 10.9, SD = 6.1, discharge: M = 7.6, SD = 5.3, d = 0.58, p = 0.001), anxiety (admission: M = 10.6, SD = 4.9, discharge: M = 7.3, SD = 4.1, d = 0.65, p< 0.001) and stress (admission: M = 6.0, SD = 3.6, discharge: M = 4.1, SD = 2.5, d = 0.70, p< 0.001). Somatic symptom burden was reduced by NIPA treatment (admission: M = 10.9, SD = 5.8, discharge: M = 9.6, SD = 5.5, d = 0.30), albeit not statistically significant (p = 0.073) ZUF-8 revealed that 89% reported large or full satisfaction and 11% partial dissatisfaction with treatment. Discussion NIPA acute care is bridging the gap for patients in need of psychosocial treatment with complex somatic comorbidity. Further long-term evaluation will show whether psychosocial NIPA care is able to reduce the course of physical illness and hospital costs by preventing hospitalization and short-term inpatient re-admissions.
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Affiliation(s)
- Paul Köbler
- Department of Psychosomatic Medicine and Psychotherapy, Paracelsus Medical Private University, Nuremberg General Hospital, Nuremberg, Germany
| | - Eva K Krauss-Köstler
- Department of Psychosomatic Medicine and Psychotherapy, Paracelsus Medical Private University, Nuremberg General Hospital, Nuremberg, Germany
| | - Barbara Stein
- Department of Psychosomatic Medicine and Psychotherapy, Paracelsus Medical Private University, Nuremberg General Hospital, Nuremberg, Germany
| | - Joachim H Ficker
- Department of Internal Medicine 3, Respiratory Medicine, Paracelsus Medical Private University, Nuremberg General Hospital, Nuremberg, Germany
| | - Martin Wilhelm
- Department of Internal Medicine 5, Oncology/Hematology, Paracelsus Medical Private University, Nuremberg General Hospital, Nuremberg, Germany
| | - Alexander Dechêne
- Department of Internal Medicine 6, Gastroenterology, Paracelsus Medical Private University, Nuremberg General Hospital, Nuremberg, Germany
| | - Christiane Waller
- Department of Psychosomatic Medicine and Psychotherapy, Paracelsus Medical Private University, Nuremberg General Hospital, Nuremberg, Germany
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Anxiety in cirrhosis: a prospective study on prevalence and development of a practical screening nomogram. Eur J Gastroenterol Hepatol 2022; 34:553-559. [PMID: 35421020 DOI: 10.1097/meg.0000000000002301] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVES The prevalence and effects of anxiety on health-related quality of life and clinical outcomes in cirrhosis are not well understood. This is increasingly relevant during COVID-19. Our aim was to use the Mini-International Neuropsychiatric Interview (MINI) to determine the prevalence of anxiety, its association with clinical outcomes in cirrhosis and to develop a rapid cirrhosis-specific anxiety screening nomogram. METHODS Adults with a diagnosis of cirrhosis were prospectively recruited as outpatients at three tertiary care hospitals across Alberta and followed for up to 6 months to determine the association with unplanned hospitalization/death. The Hospital Anxiety and Depression scale (HADS) was used as a screening tool as it is free of influence from somatic symptoms. Anxiety was diagnosed using the MINI. RESULTS Of 304 patients, 17% of patients had anxiety by the MINI and 32% by the HADS. Anxious patients had lower health-related quality of life as assessed by the chronic liver disease questionnaire (P < 0.001) and EuroQol Visual Analogue Scale (P < 0.001), and also had higher levels of frailty using the Clinical Frailty score (P = 0.004). Multivariable analysis revealed smoking and three HADS subcomponents as independent predictors of anxiety. These were used to develop a rapid screening nomogram. CONCLUSION A formal diagnosis of anxiety was made in approximately one in five patients with cirrhosis, and it was associated with worse HrQoL and frailty. The use of a 4-question nonsomatic symptom-based nomogram requires validation but is promising as a rapid screen for anxiety in cirrhosis.
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Lokesh KS, Rao AA, Chaya SK, Jayaraj BS, Praveena AS, Krishna M, Madhivanan P, Padukudru Anand M. Associations of Vitamin D, chronic obstructive pulmonary disease and acute exacerbations of COPD with anxiety and depression: a nested case control study. Wellcome Open Res 2022. [DOI: 10.12688/wellcomeopenres.17439.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Lower vitamin D levels have not only been associated with chronic obstructive pulmonary disease (COPD), exacerbations and lower lung functions, but also with anxiety and depression. We examined the associations of severity of anxiety and depression using HAM-A (Hamilton Anxiety Rating Scale) and HAM-D (Hamilton Depression Rating Scale) scores with COPD and vitamin D levels. Methods: Observational nested case control study was conducted in MUDHRA cohort. One hundred COPD subjects and 100 age- gender- matched non-COPD subjects (controls) underwent evaluation of socioeconomic status, respiratory symptoms, spirometry, severity of anxiety and depression, six minute walk test and estimation of serum vitamin D levels. Independent association of low vitamin D levels with severity of anxiety and depression was assessed by logistic regression. Results: COPD group had higher mean±SD anxiety and depression scores (HAM-A 8.0±3.5, HAM-D 8.72±4) compared to control group (HAM-A 4.51±2.2, HAM-D 4.3±2). The COPD group had 53 subjects with mild/moderate anxiety/depression whereas control group had 16 subjects with mild/moderate anxiety/depression. In COPD group, subjects with mild/moderate anxiety/depression had lower vitamin D levels compared to subjects with no/minimal anxiety/depression, while the difference in control group was not significant. In logistic regression, anxiety and depression levels had independent association with vitamin D levels, lung function variables, six-minute walk distance and presence of COPD. In COPD subgroup, anxiety and depression levels had independent association with breathlessness, GOLD FEV1 staging, CAT score, SGRQ-C Symptom score and exacerbation of COPD. Conclusions: Greater proportion of COPD subjects suffer from anxiety and depression as compared to subjects without COPD. Severity of anxiety and depression was greater in COPD subjects. Poorer lung functions, higher respiratory symptoms and lower vitamin D levels are associated with higher levels of anxiety and depression in COPD subjects. There is an urgent need to recognise anxiety and depression in COPD patients.
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Chronic Obstructive Pulmonary Disease: The Present and Future. Biomedicines 2022; 10:biomedicines10020499. [PMID: 35203708 PMCID: PMC8962403 DOI: 10.3390/biomedicines10020499] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 02/18/2022] [Indexed: 02/07/2023] Open
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Vikjord SAA, Brumpton BM, Mai XM, Romundstad S, Langhammer A, Vanfleteren L. The HUNT study: Association of comorbidity clusters with long-term survival and incidence of exacerbation in a population-based Norwegian COPD cohort. Respirology 2022; 27:277-285. [PMID: 35144315 DOI: 10.1111/resp.14222] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 12/28/2021] [Accepted: 01/16/2022] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND OBJECTIVE Chronic obstructive pulmonary disease (COPD) is a heterogeneous disease often viewed as part of a multimorbidity complex. There is a need for better phenotyping of the disease, characterization of its interplay with other comorbidities and its association with long-term outcomes. This study aims to examine how clusters of comorbidities are associated with severe exacerbations and mortality in COPD. METHODS Participants with potential COPD were recruited from the second (1995-1997) and third (2006-2008) survey of the HUNT Study and followed up until April 2020. Ten objectively identified comorbidities were clustered using self-organizing maps. Severe COPD exacerbations requiring hospitalization were assessed using hospital data. All-cause mortality was collected from national registries. Multivariable Cox regression was used to calculate hazard ratios (HRs) with 95% CIs for the association between comorbidity clusters and all-cause mortality. Poisson regression was used to calculate incidence rate ratios (IRRs) with 95% CI for the cumulative number of severe exacerbations for each cluster. RESULTS Five distinct clusters were identified, including 'less comorbidity', 'psychological', 'cardiovascular', 'metabolic' and 'cachectic' clusters. Using the less comorbidity cluster as reference, the psychological and cachectic clusters were associated with all-cause mortality (HR 1.23 [1.04-1.45] and HR 1.83 [1.52-2.20], adjusted for age and sex). The same clusters also had increased risk of exacerbations (unadjusted IRR of 1.24 [95% CI 1.04-1.48] and 1.50 [95% CI 1.23-1.83], respectively). CONCLUSION During 25 years of follow-up, individuals in the psychological and cachectic clusters had increased mortality. Furthermore, these clusters were associated with increased risk of severe COPD exacerbations.
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Affiliation(s)
- Sigrid Anna Aalberg Vikjord
- HUNT Research Centre, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, NTNU, Levanger, Norway.,Department of Medicine and Rehabilitation, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Ben Michael Brumpton
- Clinic of Thoracic and Occupational Medicine, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway.,K.G. Jebsen Centre for Genetic Epidemiology, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, NTNU, Trondheim, Norway.,MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Xiao-Mei Mai
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, NTNU, Trondheim, Norway
| | - Solfrid Romundstad
- Department of Medicine and Rehabilitation, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway.,Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Arnulf Langhammer
- HUNT Research Centre, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, NTNU, Levanger, Norway.,Department of Medicine and Rehabilitation, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Lowie Vanfleteren
- COPD Centre, Sahlgrenska University, Hospital and Institute of Medicine, Gothenburg University, Gothenburg, Sweden
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Barrueco-Otero E, Refoyo Matellán B, Martín Puente J, Viñado Mañes C, León Subias E, Olivera Pueyo J, Sancho Sanchez C. [Prevalence of Depressive Symptoms, Predictive Factors, and Diagnosis of Suspicion of Depression in Patients with COPD]. Aten Primaria 2022; 54:102236. [PMID: 35144117 PMCID: PMC8841611 DOI: 10.1016/j.aprim.2021.102236] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 06/27/2021] [Accepted: 09/26/2021] [Indexed: 11/26/2022] Open
Abstract
Objetivo Conocer la prevalencia y factores predictores de depresión en pacientes diagnosticados de enfermedad pulmonar obstructiva crónica (EPOC) y remitidos desde Atención Primaria a consultas de Neumología, servicios que comparten la atención al proceso EPOC. Diseño Estudio observacional, multicéntrico, prospectivo con muestreo no probabilístico, transversal. Emplazamiento Dos consultas de neumología de dos hospitales de diferente nivel asistencial. Participantes Se diagnosticaron 293 pacientes de EPOC en fase estable de la enfermedad. Intervenciones Aplicación de cuestionarios clínicos habituales en la EPOC y test HADS (Hospital Anxiety and Depression Scale). Variables Variables demográficas, clínicas y funcionales de la EPOC y escala de depresión del test HADS (Hospital Anxiety and Depression Scale). Resultados Se incluyeron 229 hombres (78,16%) y 64 mujeres (21,8%), con una edad media de 68,2 ± 10,3 años, de los que 93 (31,7%) eran fumadores activos y 200 (68,3%) exfumadores. El 19,45% de los pacientes tenía diagnóstico clínico previo de depresión, pero mediante el test HADS se estableció el diagnóstico de sospecha en el 32,6%. Las variables predictoras fueron: ser mujer, vivir solo y variables relacionadas con la gravedad de la enfermedad (volumen espiratorio forzado en 1 segundo [FEV1] postbroncodilatador, ser paciente de riesgo y fenotipo agudizador según criterios de la Guía Española de la EPOC [GesEPOC] y grados C y D de criterios Global Initiative for Chronic Obstructive Lung Disease [GOLD]). Conclusiones La prevalencia de la depresión en pacientes con EPOC es alta y está infradiagnosticada. El test diagnóstico HADS es útil para establecer el diagnóstico de sospecha en las consultas de Atención Primaria y Neumología. Existen factores personales y clínicos que pueden considerar predictores y servir de orientación para determinar en qué pacientes realizar el test HADS y, en función de los resultados, derivar al paciente a una Unidad de Salud Mental para confirmar o descartar el diagnóstico.
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Affiliation(s)
| | | | - Javier Martín Puente
- Servicio de Neumología, Hospital Universitario de Salamanca e IBSAL, Salamanca, España
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Zheng J, Li J, Pei T, Zhu T, Cheong IH, Li S, Wang X, Hall BJ, Li X, Wang H. Depressive symptoms and chronic lung disease in middle-aged and older Chinese adults: Prospective bidirectional association and mediation analysis. J Affect Disord 2022; 297:283-293. [PMID: 34688671 DOI: 10.1016/j.jad.2021.10.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 10/15/2021] [Accepted: 10/18/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND We investigated the prospective bidirectional association between depressive symptoms and chronic lung disease (CLD) and explored biologically and behaviorally relevant mediators in this bidirectional association among Chinese middle-aged and older population in the China Health and Retirement Longitudinal Study. METHODS Multivariable-adjusted Cox proportional hazard models were used to examine baseline depressive symptoms in relation to incident CLD risk among 12,546 adults and examine CLD condition in association with incidence of elevated depressive symptoms among 6,929 participants from 2011 to 2018. Elevated depressive symptoms were assessed with the 10-item Center for Epidemiologic Studies Depression scale and CLD was determined by self-reported physician diagnosis. Causal mediation analysis was performed to examine the direct and indirect effects of a priori selected nine blood biomarkers and four lifestyle factors in the bidirectional association. RESULTS Elevated depressive symptoms significantly increased CLD risk by 68% (HR=1.68, 95%CI=1.46-1.93) after a mean follow-up of 5.9 years and the strong positive association was consistently shown in almost all the subgroups. Having positive CLD status at baseline was associated with 17% increased risk of developing elevated depressive symptoms (HR=1.17, 95%CI=1.01-1.35) during an average of 4.6 years follow-up period. Significant inflammatory, metabolic or pulmonary function related mediators were not identified. LIMITATIONS Inadequate follow-up time and limited mediator variable information may reduce chance of identifying significant mediators. CONCLUSIONS Elevated depressive symptoms and CLD were mutual risk factors in middle-aged and older Chinese adults. Early screening and treatment of depression is needed to reduce CLD risk and related comorbidities including new-onset depression so as to relieve substantial disease burdens of CLD and depression in China.
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Affiliation(s)
- Jiali Zheng
- Department of Epidemiology and Biostatistics, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025 China
| | - Jingmeng Li
- Department of Food Safety and Toxicology, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025 China
| | - Tianduo Pei
- Department of Food Safety and Toxicology, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025 China
| | - Tianren Zhu
- Department of Food Safety and Toxicology, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025 China
| | - Io Hong Cheong
- State Key Laboratory of Oncogenes and Related Genes, Center for Single-Cell Omics, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025 China
| | - Sha Li
- Department of Food Safety and Toxicology, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025 China
| | - Xiaonan Wang
- Department of Food Safety and Toxicology, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025 China
| | - Brian J Hall
- Global Public Health, New York University Shanghai, Shanghai, 200122 China
| | - Xiaoguang Li
- Department of Food Safety and Toxicology, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025 China; State Key Laboratory of Oncogenes and Related Genes, Center for Single-Cell Omics, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025 China.
| | - Hui Wang
- Department of Food Safety and Toxicology, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025 China; State Key Laboratory of Oncogenes and Related Genes, Center for Single-Cell Omics, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025 China.
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Feng L, Li J, Lv X, Chu S, Li C, Zhang R, Cao X, Liang L. Temporal trends in anxiety and depression prevalence and their association with adverse outcomes in patients hospitalized for acute exacerbations of chronic obstructive pulmonary disease in Beijing, China, from 2004 to 2020. Front Psychiatry 2022; 13:996451. [PMID: 36386980 PMCID: PMC9659583 DOI: 10.3389/fpsyt.2022.996451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 09/29/2022] [Indexed: 11/04/2022] Open
Abstract
AIMS To investigate the temporal trend in anxiety and/or depression prevalence in patients hospitalized for acute exacerbation of chronic obstructive pulmonary disease (AECOPD) in Beijing and their association with adverse outcomes. MATERIALS AND METHODS Hospital admission records from 2004 to 2020 with a primary discharge diagnosis of AECOPD were retrieved from Beijing Public Health Information Centre database. The anxiety and depression were identified from discharge diagnoses of each record. Joinpoint regression was used to analyze the temporal trend and calculate the annual percentage change (APC) for the prevalence of anxiety and/or depression. Generalized linear model was used to analyze the associations between anxiety and/or depression and patients' adverse outcomes. RESULTS A total of 382,125 records were included, most of which were male (66.0%) and aged ≥ 75 years (59.7%). Three segments in the temporal trend were observed, with a mild increase during 2004-2009 (APC: 5.9%, 95% CI: -14.9 to 31.7%), followed by a sharply increase during 2009-2012 (APC: 60.4%, 95% CI: 10.6 to 132.7%), then stabilized at about 3% during 2012-2020 (APC: 1.9%, 95% CI: -0.4 to 4.3%). On average, anxiety, and/or depression was more prevalent in females, the aged and those admitted in secondary hospitals (all P < 0.001). Patients with anxiety and/or depression had lower in-hospital mortality (IHM) (OR = 0.74, 95% CI: 0.63-0.88), but longer hospital stay (OR = 1.10, 95% CI: 1.07-1.13), more medical costs (OR = 1.12, 95% CI: 1.08-1.17) and higher risks of readmission for AECOPD at 30-, 90-, 180-day, and 1-year (ORs ranged from 1.22 to 1.51). CONCLUSION The prevalence of anxiety and/or depression in patients hospitalized for AECOPD in Beijing stabilized at approximately 3% after 2012. Anxiety and/or depression is associated with a heavier burden on patients, health care, and medical insurance systems. Appropriate diagnosis and effective treatment of anxiety and depression is crucial for patients with AECOPD.
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Affiliation(s)
- Lin Feng
- Department of Clinical Epidemiology, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Jiachen Li
- Department of Clinical Epidemiology, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Xiaoshuang Lv
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Shuilian Chu
- Department of Clinical Epidemiology, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Changwei Li
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, United States
| | - Ruiyuan Zhang
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, United States
| | - Xi Cao
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, United States
| | - Lirong Liang
- Department of Clinical Epidemiology, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
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