| 1. |
- Berkius, Johan, et al.
(författare)
-
Long-term survival according to ventilation mode in acute respiratory failure secondary to chronic obstructive pulmonary disease: A multicenter, inception cohort study
- 2010
-
Ingår i: JOURNAL OF CRITICAL CARE. - : Elsevier Science B. V., Amsterdam. - 0883-9441 .- 1557-8615. ; 25:3
-
Tidskriftsartikel (refereegranskat)abstract
- Purpose: The aim of the study was to investigate 5-year survival stratified by mechanical ventilation modality in chronic obstructive pulmonary disease (COPD) patients treated in the ICU. Materials and Methods: Prospective, observational study of COPD patients with acute respiratory failure admitted to 9 multidisciplinary ICUs in Sweden. Characteristics on admission, including illness severity scores and the first blood gas, and survival were analyzed stratified by ventilation modality (noninvasive [NIV] vs invasive mechanical ventilation). Results: Ninety-three patients, mean age of 70.6 (SD, 9.6) years, were included. Sixteen patients were intubated immediately, whereas 77 were started on NIV. Patients who were started on NIV had a lower median body mass index (BMI) (21.9 vs 27.0; P andlt; .01) and were younger compared to those who were intubated immediately (median age, 70 vs 74.5 years; P andlt; .05). There were no differences in the initial blood gas results between the groups. Long-term survival was greater in patients with NIV (P andlt; .05, log rank). The effect of NIV on survival remained after including age, Acute Physiology and Chronic Health Evaluation II score, and BMI in a multivariate Cox regression model (NIV hazard ratio, 0.44; 95% confidence interval, 0.21-0.92). Fifteen patients with failed NIV were intubated and mechanically ventilated. Long-term survival in patients with failed NIV was not significantly different from patients who were intubated immediately. Conclusion: The short-term survival benefit of NIV previously found in randomized controlled trials still applies after 5 years of observation.
|
|
| 2. |
|
|
| 3. |
|
|
| 4. |
- Kämpe, Mary, et al.
(författare)
-
Determinants of uncontrolled asthma in a Swedish asthma population : cross-sectional observational study
- 2014
-
Ingår i: European Clinical Respiratory Journal. - : Taylor & Francis Group. - 2001-8525. ; 1
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Asthma control is achieved in a low proportion of patients. The primary aim was to evaluate risk factors for uncontrolled asthma. The secondary aim was to assess quality of life associated with asthma control.Methods: In a cross-sectional study, asthma patients aged 18–75 were randomly selected from primary and secondary health care centers. Postal questionnaires were sent to 1,675 patients and the response rate was 71%. A total of 846 patients from primary and 341 patients from secondary care were evaluated. Data were collected using a questionnaire and review of medical records. The questionnaire included questions about asthma control and a quality-of-life questionnaire, the mini-AQLQ, with four domains (symptoms, activity limitation, emotional function, and environmental stimuli). The mean score for each domain and the overall score were calculated. Asthma control was divided into three levels according to the GINA guidelines and partly and uncontrolled asthma were combined into one group – poorly controlled asthma.Results: Asthma control was achieved in 36% of the sample: 38% in primary and 29% in secondary care. In primary and secondary care, 35 and 45% had uncontrolled asthma, respectively. Risk factors for poorly controlled asthma were female sex [OR 1.31 (1.003–1.70)], older age [OR 2.18 (1.28–3.73)], lower educational level [OR 1.63 (1.14–2.33)], and current smoking [OR 1.68 (1.16–2.43)]. Older age and lower educational level remained statistically significantly associated with poorly controlled asthma when the analyses were limited to never-smokers. Depression was an independent risk factor for poorly controlled asthma in men [OR 3.44 (1.12–10.54)]. The mini-AQLQ scores and the mean overall score were significantly lower in uncontrolled asthma.Conclusion: Risk factors for poorly controlled asthma were female sex, older age, low educational level, and smoking. Uncontrolled asthma was significantly associated with lower quality of life.
|
|
| 5. |
|
|
| 6. |
|
|
| 7. |
|
|
| 8. |
- Sundh, Josefin, et al.
(författare)
-
Can the organization of COPD care in primary health care centres help preventing exacerbations in COPD patients
- 2012
-
Ingår i: European Respiratory Journal 2012. - : European Respiratory Society.
-
Konferensbidrag (refereegranskat)abstract
- Introduction: COPD exacerbations are associated with lung function decline,lower quality of life and increased mortality, and can be prevented by pharmacologicaltreatment and rehabilitation. The aim of this study was to explore if theorganization of the COPD care in primary health care centres influences the riskfor new exacerbations.Methods: A clinical population of 775 COPD patients was randomly selected from70 Swedish primary health care centres (PHCCs). Data on COPD exacerbationsand following preventive measures were obtained from medical record review.Cox regression analyses were used to estimate the risk of a new exacerbation withadjustment for age and sex.Results: During a study period of four years 458 patients had an exacerbation,and of these 278 patients (61%) had a second exacerbation during the follow-upperiod. Patients with a scheduled extra visit to an asthma/COPD nurse followingan exacerbation had a decreased risk of a new exacerbation compared to patientswith no extra follow-up besides regularly scheduled visits (adjusted hazard ratio(95% CI) 0.54 (0.32 to 0.93), p=0.026).Conclusion: Scheduling an extra visit to an asthma/COPD nurse following aCOPD exacerbation decreased the risk of reexacerbations in primary care patients.We conclude that a close cooperation between professional categories is importantin the prevention of COPD exacerbations in primary care.
|
|
| 9. |
- Sundh, Josefin, 1972-, et al.
(författare)
-
Clinical COPD questionnaire score (CCQ) and mortality
- 2012
-
Ingår i: The International Journal of Chronic Obstructive Pulmonary Disease. - Auckland, New Zealand : Dove Medical Press. - 1176-9106 .- 1178-2005. ; 7, s. 833-842
-
Tidskriftsartikel (refereegranskat)abstract
- Introduction: The Clinical COPD Questionnaire (CCQ) measures health status and can be used to assess health-related quality of life (HRQL). We investigated whether CCQ is also associated with mortality.Methods: Some 1111 Swedish primary and secondary care chronic obstructive pulmonary disease (COPD) patients were randomly selected. Information from questionnaires and medical record review were obtained in 970 patients. The Swedish Board of Health and Welfare provided mortality data. Cox regression estimated survival, with adjustment for age, sex, heart disease, and lung function (for a subset with spirometry data, n = 530). Age and sex-standardized mortality ratios were calculated.Results: Over 5 years, 220 patients (22.7%) died. Mortality risk was higher for mean CCQ ≥ 3 (37.8% died) compared with mean CCQ < 1 (11.4%), producing an adjusted hazard ratio (HR) (and 95% confidence interval [CI]) of 3.13 (1.98 to 4.95). After further adjustment for 1 second forced expiratory volume (expressed as percent of the European Community for Steel and Coal reference values ), the association remained (HR 2.94 [1.42 to 6.10]). The mortality risk was higher than in the general population, with standardized mortality ratio (and 95% CI) of 1.87 (1.18 to 2.80) with CCQ < 1, increasing to 6.05 (4.94 to 7.44) with CCQ ≥ 3.Conclusion: CCQ is predictive of mortality in COPD patients. As HRQL and mortality are both important clinical endpoints, CCQ could be used to target interventions.
|
|
| 10. |
- Sundh, Josefin, et al.
(författare)
-
Co-morbidity, body mass index and quality of life in COPD using the clinical COPD questionnaire
- 2011
-
Ingår i: COPD: Journal of Chronic Obstructive Pulmonary Disease. - : Informa UK Limited. - 1541-2555 .- 1541-2563. ; 8:3, s. 173-181
-
Tidskriftsartikel (refereegranskat)abstract
- Introduction: Quality of life is an important patient-oriented measure in COPD. The Clinical COPD Questionnaire (CCQ) is a validated instrument for estimating quality of life. The impact of different factors on the CCQ-score remains an understudied area. The aim of this study was to investigate the association of co-morbidity and body mass index with quality of life measured by CCQ. Methods: A patient questionnaire including the CCQ and a review of records were used. A total of 1548 COPD patients in central Sweden were randomly selected. Complete data were collected for 919 patients, 639 from primary health care and 280 from hospital clinics. Multiple linear regression with adjustment for sex, age, level of education, smoking habits and level of care was performed. Subanalyses included additional adjustment for lung function in the subgroup (n == 475) where spirometry data were available. Results: Higher mean CCQ score indicating lower quality of life was statistically significant and independently associated with heart disease (adjusted regression coefficient (95%%CI) 0.26; 0.06 to 0.47), depression (0.50; 0.23 to 0.76) and underweight (0.58; 0.29 to 0.87). Depression and underweight were associated with higher scores in all CCQ subdomains. Further adjustment for lung function in the subgroup with this measure resulted in statistically significant and independent associations with CCQ for heart disease, depression, obesity and underweight. Conclusion: The CCQ identified that heart disease, depression and underweight are independently associated with lower health-related quality of life in COPD.
|
|
