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- Ahmadi, Zainab, et al.
(författare)
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Agreement of the modified Medical Research Council and New York Heart Association scales for assessing the impact of self-rated breathlessness in cardiopulmonary disease
- 2022
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Ingår i: ERJ Open Research. - : European Respiratory Society. - 2312-0541. ; 8:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: The functional impact of breathlessness is assessed using the modified Medical Research Council (mMRC) scale for chronic respiratory disease and with the New York Heart Association Functional Classification (NYHA) scale for heart failure. We evaluated agreement between the scales and their concurrent validity with other clinically relevant patient-reported outcomes in cardiorespiratory disease.Methods: Outpatients with stable chronic respiratory disease or heart failure were recruited. Agreement between the mMRC and NYHA scales was analysed using Cramér's V and Kendall's tau B tests. Concurrent validity was evaluated using correlations with clinically relevant measures of breathlessness, anxiety, depression, and health-related quality of life. Analyses were conducted for all participants and separately in chronic obstructive pulmonary disease (COPD) and heart failure.Results: In a total of 182 participants with cardiorespiratory disease, the agreement between the mMRC and NYHA scales was moderate (Cramér's V: 0.46; Kendall's tau B: 0.57) with similar results for COPD (Cramér's V: 0.46; Kendall's tau B: 0.66) and heart failure (Cramér's V: 0.46; Kendall's tau B: 0.67). In the total population, the scales correlated in similar ways to other patient-reported outcomes.Conclusion: In outpatients with cardiorespiratory disease, the mMRC and NYHA scales show moderate to strong correlations and similar associations with other patient-reported outcomes. This supports that the scales are comparable when assessing the impact of breathlessness on function and patient-reported outcomes.
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| 4. |
- Ahmadi, Zainab, et al.
(författare)
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End-of-life care in oxygen-dependent ILD compared with lung cancer : a national population-based study
- 2016
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Ingår i: Thorax. - : BMJ. - 0040-6376 .- 1468-3296. ; 71:6, s. 510-516
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Tidskriftsartikel (refereegranskat)abstract
- Rationale: Advanced fibrosing interstitial lung disease (ILD) is often progressive and associated with a high burden of symptoms and poor prognosis. Little is known about the symptom prevalence and access to palliative care services at end of life (EOL).Objectives: Compare prevalence of symptoms and palliative treatments between patients dying with oxygen-dependent ILD and patients dying of lung cancer.Methods: Nationwide registry-based cohort study of patients with oxygen-dependent ILD and patients with lung cancer who died between 1 January 2011 and 14 October 2013. Prevalence of symptoms and treatments during the last seven days of life were compared using data in Swedish Registry of Palliative Care.Measurements and main results: 285 patients with ILD and 10 822 with lung cancer were included. In ILD, death was more likely to be 'unexpected' (15% vs 4%), less likely to occur in a palliative care setting (17% vs 40%) and EOL discussions with the patients (41% vs 59%) were less common than in lung cancer. Patients with ILD suffered more from breathlessness (75% vs 42%) while patients with lung cancer had more pain (51% vs 73%) (p<0.005 for all comparisons). Patients with ILD had more unrelieved breathlessness, pain and anxiety. The survival time from initiation of oxygen therapy in ILD was a median 8.4 months (IQR 3.4-19.2 months).Conclusions: Patients with ILD receive poorer access to specialist EOL care services and experience more breathlessness than patients with lung cancer. This study highlights the need of better EOL care in oxygen-dependent ILD.
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| 5. |
- Ahmadi, Zainab, et al.
(författare)
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Hypo- and hypercapnia predict mortality in oxygen-dependent chronic obstructive pulmonary disease : a population-based prospective study
- 2014
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Ingår i: Respiratory Research. - : BioMed Central. - 1465-9921 .- 1465-993X. ; 15:1, s. 30-
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The prognostic role of the arterial blood gas tension of carbon dioxide (PaCO2) in severe Chronic Obstructive Pulmonary Disease (COPD) remains unknown. The aim of this study was to estimate the association between PaCO2 and mortality in oxygen-dependent COPD. METHODS: National prospective study of patients starting long-term oxygen therapy (LTOT) for COPD in Sweden between October 1, 2005 and June 30, 2009, with all-cause mortality as endpoint. The association between PaCO2 while breathing air, PaCO2 (air), and mortality was estimated using Cox regression adjusted for age, sex, arterial blood gas tension of oxygen (PaO2), World Health Organization performance status, body mass index, comorbidity, and medications. RESULTS: Of 2,249 patients included, 1,129 (50%) died during a median 1.1 years (IQR 0.6-2.0 years) of observation. No patient was lost to follow-up. PaCO2 (air) independently predicted adjusted mortality (p < 0.001). The association with mortality was U-shaped, with the lowest mortality at approximately PaCO2 (air) 6.5 kPa and increased mortality at PaCO2 (air) below 5.0 kPa and above 7.0 kPa. CONCLUSION: In oxygen-dependent COPD, PaCO2 (air) is an independent prognostic factor with a U-shaped association with mortality.
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| 7. |
- Ahmadi, Zainab, et al.
(författare)
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Long-Term Oxygen Therapy 24 vs 15 h/day and Mortality in Chronic Obstructive Pulmonary Disease
- 2016
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Ingår i: PLOS ONE. - San Francisco : Public Library of Science. - 1932-6203. ; 11:9
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Tidskriftsartikel (refereegranskat)abstract
- Long-term oxygen therapy (LTOT) ≥ 15 h/day improves survival in hypoxemic chronic obstructive pulmonary disease (COPD). LTOT 24 h/day is often recommended but may pose an unnecessary burden with no clear survival benefit compared with LTOT 15 h/day. The aim was to test the hypothesis that LTOT 24 h/day decreases all-cause, respiratory, and cardiovascular mortality compared to LTOT 15 h/day in hypoxemic COPD. This was a prospective, observational, population-based study of COPD patients starting LTOT between October 1, 2005 and June 30, 2009 in Sweden. Overall and cause-specific mortality was analyzed using Cox and Fine-Gray regression, controlling for age, sex, prescribed oxygen dose, PaO2 (air), PaCO2 (air), Forced Expiratory Volume in one second (FEV1), WHO performance status, body mass index, comorbidity, and oral glucocorticoids. A total of 2,249 included patients were included with a median follow-up of 1.1 years (interquartile range, 0.6-2.1). 1,129 (50%) patients died and no patient was lost to follow-up. Higher LTOT duration analyzed as a continuous variable was not associated with any change in mortality rate (hazard ratio [HR] 1.00; (95% confidence interval [CI], 0.98 to 1.02) per 1 h/day increase above 15 h/day. LTOT exactly 24 h/day was prescribed in 539 (24%) patients and LTOT 15-16 h/day in 1,231 (55%) patients. Mortality was similar between the groups for all-cause, respiratory and cardiovascular mortality. In hypoxemic COPD, LTOT 24 h/day was not associated with a survival benefit compared with treatment 15-16 h/day. A design for a registry-based randomized trial (R-RCT) is proposed.
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| 8. |
- Ahmadi, Zainab, et al.
(författare)
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Palliative oxygen for chronic breathlessness : What new evidence?
- 2017
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Ingår i: Current Opinion in Supportive and Palliative Care. - 1751-4258. ; 11:3, s. 159-164
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Forskningsöversikt (refereegranskat)abstract
- Purpose of review Supplemental oxygen improves survival in patients with chronic obstructive pulmonary disease (COPD) and severe hypoxaemia, but the effect of oxygen therapy in mild or moderate hypoxaemia to reduce symptomatic chronic breathlessness remains unclear. This review provides an overview of recent evidence about the role of oxygen therapy for the relief of chronic breathlessness in advanced illness. Recent findings In COPD, a recent Cochrane review strengthens earlier findings regarding the positive effect of supplemental oxygen compared with air during exercise test in the training setting. The novel analysis of effect of oxygen therapy on quality of life (QoL) showed no clear effect. Short-burst oxygen therapy given before exercise had no effect and should not be used. Summary Supplemental oxygen during exercise has been shown to reduce breathlessness in patients with COPD who have no or mild hypoxaemia, but it is not clear whether the reduction in breathlessness shown in the laboratory setting translates into a clinically important benefit. Further studies are needed to establish this.
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| 9. |
- Ahmadi, Zainab, et al.
(författare)
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Prescription of opioids for breathlessness in end-stage COPD : A national population-based study
- 2016
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Ingår i: International Journal of COPD. - 1176-9106. ; 11:1, s. 2651-2657
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Tidskriftsartikel (refereegranskat)abstract
- Background: Low-dose opioids can relieve breathlessness but may be underused in late-stage COPD due to fear of complications, contributing to poor symptom control. Objectives: We aimed to study the period prevalence and indications of opioids actually prescribed in people with end-stage COPD. Methods: The study was a longitudinal, population-based study of patients starting long-term oxygen therapy (LTOT) for COPD between October 1, 2005 and June 30, 2009 in Sweden. A random sample (n=2,000) of their dispensed opioid prescriptions was obtained from the national Prescribed Drugs Register from 91 days before starting LTOT until the first of LTOT withdrawal, death, or study end (December 31, 2009). We analyzed medication type, dispensed quantity, date of dispensing, and indications categorized as pain, breathlessness, other, or unknown. Results: In total, 2,249 COPD patients (59% women) were included. During a median follow-up of 1.1 (interquartile range 0.6–2.0) years, 1,034 patients (46%) were dispensed ≥1 opioid prescription (N=13,722 prescriptions). The most frequently prescribed opioids were tramadol (23%), oxycodone (23%), morphine (16%), and codeine (16%). Average dispensed quantity was 9.3 (interquartile range 3.7–16.7) defined daily doses per prescription. In the random sample, the most commonly stated indication was pain (97%), with only 2% for breathlessness and 1% for other reasons. Conclusion: Despite evidence that supported the use of opioids for the relief of breathlessness predating this study, opioids are rarely prescribed to relieve breathlessness in oxygen-dependent COPD, potentially contributing to less-than-optimal symptom control. This study creates a baseline against which to compare future changes in morphine prescribing in this setting.
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| 10. |
- Ahmadi, Zainab
(författare)
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Prevalence and Pharmacologic Treatment of Breathlessness in Severe Chronic Obstructive Pulmonary Disease
- 2019
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- BackgroundChronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. Chronic breathlessness is a feared and distressing symptom with significant impact on daily life. Little is known of the prevalence of breathlessness at the end of life in severe COPD. International guidelines support the use of opioids to treat breathlessness, but it is unknown how commonly opioids are prescribed for the indication of breathlessness. Supplemental oxygen therapy is commonly prescribed, but data is conflicting on its efficacy in treating breathlessness. Knowledge of physician ability to identify chronic breathlessness and readiness to treat breathlessness with opioids is limited.Aims•To evaluate the prevalence of symptoms and their management at the end of life in patients with oxygen-dependent COPD in Sweden, compared to those with cancer (Study I).•To quantify the reported indications for opioid prescriptions in oxygen-dependent COPD in Sweden (Study II).•To investigate the efficacy of supplemental oxygen therapy for breathlessness in COPD patients with no or mild hypoxemia (Study III).•To assess potential recognition and treatment of chronic breathlessness as compared to chronic pain by physicians in Sweden, using a case-based survey (Study IV).Study DesignNationwide register-based cohort study of patients with oxygen-dependent COPD recorded in the Swedevox register linked with the Swedish Register of Palliative Care (Study I) and with the Swedish Prescribed Drug Register (Study II). Cochrane systematic review and meta-analysis of the efficacy of supplemental oxygen therapy for breathlessness (Study III). Randomized, controlled, double-blind, parallel-group, web-based trial of Swedish physicians treating a hypothetical patient with COPD and severe breathlessness versus a patient with severe pain (Study IV).Results and conclusionsAt the end of life, breathlessness was three times more common in patients with COPD than in those with cancer (Study I). Opioids were commonly prescribed for pain in oxygen-dependent COPD patients but rarely to treat breathlessness, which represented 2% of the stated indications (Study II). Supplemental oxygen therapy modestly reduced breathlessness during exercise in COPD with no or mild hypoxemia, but there was no evidence of an effect in daily life or on quality of life (Study III). In a case presentation of a COPD patient, severe chronic breathlessness was less likely to be identified by physicians as requiring symptomatic treatment and also less likely to be treated with opioids as compared to a patient with chronic pain (Study IV).
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