Negative impact of chronic obstructive pulmonary disease on the health-related quality of life of patients. Results of the EPIDEPOC study.

BACKGROUND: COPD is currently the fourth cause of morbidity and mortality in the developed world. Patients with COPD experience a progressive deterioration and disability, which lead to a worsening in their health-related quality of life (HRQoL). The aim of this work is to assess the Health-Related Quality of Life (HRQoL) of patients with stable COPD followed in primary care and to identify possible predictors of disease. METHODS: It is a multicenter, epidemiological, observational, descriptive study. Subjects of both sexes, older than 40 years and diagnosed of COPD at least 12 months before starting the study were included. Sociodemographic data, severity of disease, comorbidity, and use of health resources in the previous 12 months were collected. All patients were administered a generic quality-of-life questionnaire, the SF-12, that enables to calculate two scores, the physical (PCS-12) and the mental (MCS-12) component summary scores. RESULTS: 10,711 patients were evaluated (75.6% men, 24.4% women), with a mean age of 67.1 years (SD 9.66). The mean value of FEV1 was 35.9 +/- 10.0%. Mean PCS-12 and MCS-12 scores were 36.0 +/- 9.9 and 48.3 +/- 10.9, respectively. Compared to the reference population, patients with COPD had a reduction of PCS-12, even in mild stages of the disease. The correlation with FEV1 was higher for PCS-12 (r = 0.38) than for MCS-12 (r = 0.12). Predictors for both HRQoL components were sex, FEV1, use of oxygen therapy, and number of visits to emergency rooms and hospital admissions. Other independent predictors of PCS-12 were age, body mass index and educational level. CONCLUSION: Patients with stable COPD show a reduction of their HRQoL, even in mild stages of the disease. The factors determining the HRQoL include sex, FEV1, use of oxygen therapy, and number of visits to emergency rooms and hospital admissions.

Determinants and predictors of the cost of COPD in primary care: a Spanish perspective.

OBJECTIVES: 1) To estimate the annual cost of patients with stable chronic obstructive pulmonary disease (COPD) followed in primary care in Spain; 2) To analyze the possible cost predictor variables. PATIENTS AND METHODS: A multicenter, epidemiological, observational, descriptive study. Sociodemographic data, severity of disease, associated comorbidity, treatment followed by patients, quality of life (SF-12 questionnaire), health care resource utilization in the previous 12 months and duration of working disability due to COPD were collected. RESULTS: A total of 10,711 patients (75.6% men; 24.4% women) with a mean age of 67.1 +/- 9.66 years were evaluated. The mean forced expiratory volume in one second (FEV1) value was 57.4 +/- 13.4%. The total cost per patient per year was Euro1,922.60 +/- 2,306.44. The largest component of this cost was hospitalization (Euro788.72 +/- 1,766.65), followed by cost of drugs (Euro492.87 +/- 412.15) and visits to emergency rooms (Euro134.32 +/- 195.44). Linear regression analysis found associated heart disease, FEV1, physical component of quality of life, number of medical visits (primary care physician, pneumologist and emergency room), hospital admissions (frequency and duration of stay) and duration of working disability to be significant predictors of the total annual cost. CONCLUSIONS: The total annual cost of a COPD patient followed in primary care in Spain was considered high in this study. The presence of associated heart disease, severity of airflow obstruction, physical component of quality of life, health care resource utilization and duration of work disability were found to be predictor of cost.

Compliance with influenza and pneumococcal vaccination among patients with chronic obstructive pulmonary disease consulting their medical practitioners in Catalonia, Spain.

OBJECTIVES: This survey describes influenza and pneumococcal vaccination coverage among patients suffering from chronic obstructive pulmonary disease (COPD), and analyses the factors related to compliance with both vaccine recommendations. METHODS: This is a descriptive study conducted in the primary-care setting in Catalonia, Spain. Information was drawn from patients' clinical histories and personal interviews. As the dependent variable, we took the answer (yes or no) to the questions "were you vaccinated against influenza during the last campaign?" and "have you ever been given a pneumococcal vaccine shot?". As independent variables, we analysed health status, sociodemographic and lifestyle data. RESULTS: A total of 1783 patients were included in the study, 62.5% of whom reported having received both influenza and pneumococcal vaccines. Higher age, more frequent contact with the general practitioner and greater length of disease progression considerably increased the likelihood of having received both vaccines. CONCLUSIONS: Compliance with influenza and pneumococcal vaccination recommendations among Catalonian COPD patients treated in a primary-care setting are better than those found among other high risk groups elsewhere. Nevertheless, different strategies should be implemented to improve compliance among younger patients and those who lead less healthy lifestyles, such as smoking or alcohol consumption.

Determinants of pneumococcal vaccination among patients with chronic obstructive pulmonary disease in Spain.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality in adults. Pneumococcal vaccination is recommended to persons suffering COPD. This study aimed at describing pneumococcal vaccination coverages in patients with COPD and analyzing the factors associated with such vaccination. METHODS: This was designed as a descriptive study conducted in the primary-care setting. Each of the 2422 medical practitioners included in the study had to enroll five COPD patients. As the dependent variable, we took the answer to the question, "Have you ever been given a pneumococcal vaccine shot at some time in your life?". As independent variables, we analyzed sociodemographic, health-status and lifestyle variables, along with history of influenza vaccination. RESULTS: A total of 10,711 patients were enrolled and, 32.5% (95% CI 31.6-33.4) of participants reported receiving pneumococcal vaccination. Female gender, higher age and more advanced COPD stage were the variables associated with a higher likelihood of being vaccinated. History of influenza vaccination in the most recent campaign was also associated with pneumococcal vaccination. CONCLUSION: Pneumococcal vaccination coverages among Spanish COPD patients are low and strategies to improve them must be implemented as a matter of urgency.

Influenza vaccination coverage and related factors among Spanish patients with chronic obstructive pulmonary disease.

This study sought: to describe influenza vaccination coverages among COPD patients treated in a primary-care setting; and to analyse the factors linked to compliance with vaccination recommendations. This was a descriptive study in a primary-care (PC) setting. Each of the 2422 randomly selected medical practitioners included in the study was required to recruit five COPD patients. Information was drawn from patients' clinical histories and personal interviews. As the dependent variable, we took the answer (yes or no) to the question, "did you have an influenza vaccination in the most recent campaign?"; and as independent variables, we analysed socio-demographic data, health-status related variables, lifestyles and history of pneumococcal vaccination. A total of 10,711 patients were enrolled 87.2% reported having been vaccinated in the most recent campaign. In conclusion, Spanish COPD patients treated in a primary-care setting can be said to enjoy good vaccine coverages against the influenza virus. More frequent contact with the general practitioner and a history of pneumococcal vaccination increase the likelihood of being vaccinated considerably, and measures should be implemented with the aim of improving coverages among younger subjects and those who lead less healthy lifestyles.