| 1. |
- Hughes, Rod, et al.
(author)
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Frequent productive cough : Symptom burden and future exacerbation risk among patients with asthma and/or COPD in the NOVELTY study
- 2022
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In: Respiratory Medicine. - : Elsevier. - 0954-6111 .- 1532-3064. ; 200
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Journal article (peer-reviewed)abstract
- Introduction: Persistent cough with sputum production is an important clinical trait in chronic obstructive pulmonary disease (COPD). We defined "frequent productive cough" based on 2 questions from the St George's Respiratory Questionnaire (SGRQ) and sought to determine its occurrence and associated outcomes in patients with physician-assigned asthma and/or COPD from the NOVELTY study. Methods: Frequent productive cough was defined as cough and sputum production most or several days/week for the past 3 months (scoring >= 3 for both SGRQ questions). Relationships with baseline disease characteristics and exacerbations over 12 months' follow-up were examined using logistic regression. Results: Baseline SGRQ data were available for 7125 patients, of whom 31.3% had frequent productive cough. It was more common in asthma + COPD (38.8%) and COPD (38.1%) than asthma (25.0%), increasing with physician-assessed severity, and in current versus former and never smokers. Patient-reported symptomatic worsening was more common in patients with versus without frequent productive cough. Reduced post-bronchodilator FEV1 (odds ratio [OR] per 10% decrement 1.14 [95% confidence interval 1.11-1.16]) and history of pollutant exposure at home/work (OR 1.50 [1.33-1.69]) were associated with frequent productive cough in all diagnoses. Patients with baseline frequent productive cough were more likely to have >= 1 exacerbation over the subsequent 12 months (OR 1.71 [1.52-1.93]), including exacerbations requiring hospital admission and those treated with oral corticosteroids. Conclusions: Frequent productive cough represents an important indicator of adverse clinical outcomes across asthma and/or COPD. Research into the underlying pathologic mechanisms is required to support targeted therapy development.
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| 2. |
- Karlsson, Niklas, et al.
(author)
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Validation of a diagnosis-agnostic symptom questionnaire for asthma and/or COPD
- 2021
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In: ERJ Open Research. - : European Respiratory Society. - 2312-0541. ; 7:1
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Journal article (peer-reviewed)abstract
- Background he Respiratory Symptoms Questionnaire (RSQ) is a novel, 4-item patient-reported diagnosis-agnostic tool designed to assess the frequency of respiratory symptoms and their impact on activity, without specifying a particular diagnosis. Our objective was to examine its validity in patients with asthma and/or chronic obstructive pulmonary disease (COPD).Methods Baseline data were randomly sampled from patients who completed the RSQ in the NOVELTY study (NCT02760329). The total sample (N=1530) comprised three randomly selected samples (N=510 each) from each physician-assigned diagnostic group (asthma, asthma+COPD, COPD). The internal consistency and structural validity of the RSQ were evaluated using exploratory and confirmatory factor analyses; psychometric performance was observed using Classical Test Theory and Item Response Theory analyses.Results For the total sample, the mean RSQ score was 5.6 (sd 4.3; range: 0–16). Irrespective of diagnosis, the internal consistency of items was uniformly adequate (Cronbach's alphas range: 0.76–0.80). All items had high factor loadings, and structural characteristics of the measure were invariant across groups. Using the total sample, RSQ items informatively covered the theta score range of –2.0 to 2.8, with discrimination coefficients for individual items being high-to-very high (1.7–2.6). Strong convergent correlations were observed between the RSQ and St George's Respiratory Questionnaire (SGRQ; 0.77, p<0.001).Conclusions he RSQ is a valid, brief, patient-reported tool for assessing respiratory symptoms in patients across the whole spectrum of asthma and/or COPD, rather than using different questionnaires for each diagnosis. It can be used for monitoring respiratory symptoms in clinical practice, clinical trials and real-world studies.
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| 3. |
- Reddel, Helen K., et al.
(author)
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Heterogeneity within and between physician-diagnosed asthma and/or COPD : NOVELTY cohort
- 2021
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In: European Respiratory Journal. - : European Respiratory Society. - 0903-1936 .- 1399-3003. ; 58:3
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Journal article (peer-reviewed)abstract
- Background Studies of asthma and chronic obstructive pulmonary disease (COPD) typically focus on these diagnoses separately, limiting understanding of disease mechanisms and treatment options. NOVELTY is a global, 3-year, prospective observational study of patients with asthma and/or COPD from real-world clinical practice. We investigated heterogeneity and overlap by diagnosis and severity in this cohort. Methods Patients with physician-assigned asthma, COPD or both (asthma+COPD) were enrolled, and stratified by diagnosis and severity. Baseline characteristics were reported descriptively by physician-assigned diagnosis and/or severity. Factors associated with physician-assessed severity were evaluated using ordinal logistic regression analysis. Results Of 11243 patients, 5940 (52.8%) had physician-assigned asthma, 1396 (12.4%) had asthma+COPD and 3907 (34.8%) had COPD; almost half were from primary care. Symptoms, health-related quality of life and spirometry showed substantial heterogeneity and overlap between asthma, asthma COPD and COPD, with 23%, 62% and 64% of patients, respectively, having a ratio of post-bronchodilator forced expiratory volume in 1 s to forced vital capacity below the lower limit of normal. Symptoms and exacerbations increased with greater physician-assessed severity and were higher in asthma+COPD. however, 24.3% with mild asthma and 20.4% with mild COPD had experienced >= 1 exacerbation in the past 12 months. Medication records suggested both under-treatment and over-treatment relative to severity. Blood eosinophil counts varied little across diagnosis and severity groups, but blood neutrophil counts increased with severity across all diagnoses. Conclusion This analysis demonstrates marked heterogeneity within, and overlap between, physician-assigned diagnosis and severity groups in patients with asthma and/or COPD. Current diagnostic and severity classifications in clinical practice poorly differentiate between clinical phenotypes that may have specific risks and treatment implications.
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| 4. |
- Stridsman, Caroline, et al.
(author)
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Fatigue in COPD and the impact of heart disease comorbidity : a population-based study
- 2011
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Conference paper (other academic/artistic)abstract
- Background: Fatigue is a common symptom among people with COPD. However, there are few studies describing fatigue in COPD and the impact of comorbidity, none of them population based.Aim: To describe fatigue in COPD by disease severity according to GOLD, and the impact of self-reported heart disease.Methods: The Functional Assessment of Chronic Illness Therapy (FACIT)- Fatigue scale was used to assess fatigue; lower scores represent worse fatigue (0-52). Data were collected in 2007 from the Obstructive Lung Disease in Northern Sweden (OLIN) COPD cohort; 564 subjects with COPD, with a distribution of disease severity representative for the general population, and 786 non-COPD subjects.Results: Median FACIT-F score was 44.0 in COPD subjects, significantly lower compared to 46.0 in non-COPD (p=0.006). Score decreased by disease severity: 46.0, 43.7, and 37.5 in GOLD stage I, II, and III-IV (I vs II p=0.020, II vs III-IV p=0.035). There was no significant difference between stage I and non-COPD. In subjects without heart disease, there were lower scores in stage II, 45.0 and III-IV, 38.5 compared to non-COPD, 47.0 (p=0.005 and p=0.205). In subjects with heart disease, only stage III-IV had significantly lower scores than non-COPD, 30.5 vs 42.0 (p=0.030). Subjects with heart disease reported lower scores than those without heart disease at all severities of COPD (non-COPD: 42.0 vs 47.0, p<0.001, stage I: 40.5 vs 48.0, p<0.001, stage II: 40.0 vs 45.0, p=0.008 and stage III-IV: 30.5 vs 38.5, p=0.051).Conclusion: Fatigue increases with GOLD-defined disease severity, but the score is not significantly different from non-COPD until stage II. Heart disease increases fatigue in both COPD and non-COPD.
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| 5. |
- Stridsman, Caroline, et al.
(author)
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Fatigue in COPD and the Impact of Respiratory Symptoms and Heart Disease : A Population-based Study
- 2013
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In: COPD. - London : Informa Healthcare. - 1541-2555 .- 1541-2563. ; 10:2, s. 125-132
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Journal article (peer-reviewed)abstract
- Background: Fatigue is reported in COPD and in heart disease; however, there are hardly any population based data on the relationship between these conditions. Aim: To describe fatigue in relation to COPD by disease severity and to evaluate the impact of respiratory symptoms and heart disease. Methods: Data were collected in 2007 from the OLIN COPD study; 564 subjects with COPD (FEV1/FVC < 0.70) and a distribution of disease severity representative for the general population, and 786 subjects without COPD. The Functional Assessment of Chronic Illness Therapy (FACIT)-Fatigue scale was used to assess fatigue (0-52); lower scores represent worse fatigue. Results: Median FACIT-F score was 44.0 in COPD defined by merely spirometric criteria and 42.0 in COPD also reporting respiratory symptoms, significantly lower compared to 46.0 in non-COPD (p = 0.006 and p < 0.001), and decreased by disease severity. The score was lower in COPD stage >= II and in COPD with respiratory symptoms already from stage I when compared to non-COPD. Subjects with heart disease reported lower scores than those without heart disease in COPD by all stages and in non-COPD. COPD with respiratory symptoms stage >= II remained a significant risk factor for clinically significant fatigue also when adjusted for gender, age, heart disease and smoking habits (stage II OR 1.65, CI 1.17-2.31 and stage III-IV OR 2.66, CI 1.11-6.36). Conclusion: Fatigue is common in COPD, and is affected by respiratory symptoms and concomitant heart disease. In COPD with respiratory symptoms stage >= II, there is an increased risk for clinically significant fatigue.
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| 6. |
- Tomaszewski, Erin L., et al.
(author)
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Chronic Airways Assessment Test : psychometric properties in patients with asthma and/or COPD
- 2023
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In: Respiratory Research. - : BioMed Central (BMC). - 1465-9921 .- 1465-993X. ; 24
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Journal article (peer-reviewed)abstract
- Background: No short patient-reported outcome (PRO) instruments assess overall health status across different obstructive lung diseases. Thus, the wording of the introduction to the Chronic Obstructive Pulmonary Disease (COPD) Assessment Test (CAT) was modified to permit use in asthma and/or COPD. This tool is called the Chronic Airways Assessment Test (CAAT).Methods: The psychometric properties of the CAAT were evaluated using baseline data from the NOVELTY study (NCT02760329) in patients with physician-assigned asthma, asthma + COPD or COPD. Analyses included exploratory/confirmatory factor analyses, differential item functioning and analysis of construct validity. Responses to the CAAT and CAT were compared in patients with asthma + COPD and those with COPD.Results: CAAT items were internally consistent (Cronbach's alpha: > 0.7) within each diagnostic group (n = 510). Models for structural and measurement invariance were strong. Tests of differential item functioning showed small differences between asthma and COPD in individual items, but these were not consistent in direction and had minimal overall impact on the total score. The CAAT and CAT were highly consistent when assessed in all NOVELTY patients who completed both (N = 277, Pearson's correlation coefficient: 0.90). Like the CAT itself, CAAT scores correlated moderately (0.4-0.7) to strongly (> 0.7) with other PRO measures and weakly (< 0.4) with spirometry measures.Conclusions: CAAT scores appear to reflect the same health impairment across asthma and COPD, making the CAAT an appropriate PRO instrument for patients with asthma and/or COPD. Its brevity makes it suitable for use in clinical studies and routine clinical practice.Trial registration: NCT02760329.
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