Disability related to COPD tool (DIRECT): towards an assessment of COPD-related disability in routine practice.

BACKGROUND: Chronic Obstructive Pulmonary Disease (COPD) is a worldwide public health concern. It is also a major source of disability that is often overlooked, depriving patients of effective treatments. This study describes the development and validation of a questionnaire specifically assessing COPD-related disability. METHODS: The DIsability RElated to COPD Tool (DIRECT) was developed according to reference methods, including literature review, patient and clinician interviews and test in a pilot study. A 12-item questionnaire was included for finalization and validation in an observational cross-sectional study conducted by 60 French pulmonologists, who recruited 275 COPD patients of stage II, III and IV according to the GOLD classification. Rasch modeling was conducted and psychometric properties were assessed (internal consistency reliability; concurrent and clinical validity). RESULTS: The DIRECT score was built from the 10 items retained in the Rasch model. Their internal consistency reliability was excellent (Cronbach's alpha = 0.95). The score was highly correlated with the Saint George's Respiratory Questionnaire Activity score (r = 0.83) and the London Handicap Scale (r = -0.70), a generic disability measure. It was highly statistically significantly associated to four clinical parameters (P < 0.001): GOLD classification, BODE index, FEV1 and 6-minute walk distance. CONCLUSION: DIRECT is a promising tool that could help enhance the management of COPD patients by integrating an evaluation of the COPD-related disability into daily practice.

[The profile of the patients referred by general practitioners to respiratory physicians for assessment of undiagnosed bronchial disease]. / Profil des patients adressés par les médecins généralistes aux pneumologues pour bilan d'une bronchopathie non diagnostiquée - résultats de l'étude Bilan.

INTRODUCTION: In general practice, COPD is often under-diagnosed and inappropriate pharmacological treatment given. OBJECTIVES: To determine the profile of patients over 40 years old, smokers or ex-smokers, referred by general practitioners to respiratory physicians for assessment of undiagnosed bronchial disease. METHODS: Observational study carried-out among 103 respiratory physicians in France in 2007. RESULTS: The diagnosis of COPD was confirmed by the respiratory physicians in 433/486 (89%) patients. COPD patients were aged 61 years on average, male (63%) and often current smokers (46%). Most of them had more than three respiratory symptoms. The diagnosis of COPD was made after a long history of symptoms. We found 148 (34.2%) COPD patients with a FEV(1)/FVC greater than 0.7 and were classified as mild (61 patients), moderate (77 patients) or severe (10 patients). CONCLUSIONS: In patients at risk, smokers or ex-smokers with respiratory symptoms, COPD was the diagnosis most often confirmed by the respiratory physician. A significant proportion of respiratory physicians diagnosed and assessed the severity of COPD, not strictly on the basis of national recommendations, but rather on the association of risk factors, respiratory symptoms and even isolated changes in FEV(1).

[The "Compli'Asthme" therapeutic observation survey on good use of inhaled drugs for asthma: perception by general practitioners]. / Enquête "Compli'Asthme": observance thérapeutique et bonne utilisation des médicaments inhalés dans l'asthme perçues par les médecins praticiens.

A cross sectional survey was conducted in 2000 in coordination with the CHIESI medical representatives among 1758 French physicians caring for patients with persistent asthma (80% general practitioners, 20% specialists). This "Compli'Asthme" survey was based on a self-administered questionnaire designed to learn more about the physicians' experience with good use of inhaled drugs and to collect information on therapeutic observance, corticophobia, and use of prescribed inhalers. Poor observance was noted as an important problem by 58-85% of the participants. Most of the problems were related to inability to use the inhaler properly (children, elderly subjects) or to patients forgetting to take their medications (adults, parents). For 58% of the participating physicians, corticophobia is frequent. The patients are worried about the anabolizing effect, secondary effects, and dependence. When there is a potential problem with corticophobia, physicians generally question the patients and provide explanations to achieve good observance. Patient preference is taken into consideration by 86% of the physicians prescribing inhalation devices; 90% demonstrate use of the device at the first prescription and 68% make repeated demonstrations at subsequent consultations. For 56-87% of the physicians, poor therapeutic observance, corticophobia, and poor use of the inhaler can be detected and corrected. Patient education is an important element for 77% of the physicians for improving observance and achieving good use of the inhaler. When poor observance and poor use of the inhaler occur, the physicians responding to this questionnaire applied the currently recommended guidelines.

The response of two different dosages of beclometasone dipropionate suspension for nebulization versus a standard dose of beclometasone dipropionate via a metered-dose inhaler on bronchoprovocation testing in adults with asthma.

The objective of this double-blind, randomized, placebo-controlled, parallel-group study was to compare the pharmacodynamic effects and safety of beclometasone dipropionate (BDP) given by nebulization or metered-dose inhalation in adult patients with asthma. Following a 1-week run-in period, 40 patients, aged 18-60 years, with intermittent bronchial asthma were randomized to one of four treatment groups for 3 weeks (n = 10 in each group): beclometasone dipropionate (BDP) suspension for nebulization 1,600 microg day(-1) b.i.d. via a nebulizer, BDP suspension for nebulization 3,200 microg day(-1) b.i.d. via a nebulizer, BDP 800 microg day(-1) b.i.d. via a metered-dose inhaler (MDI) plus spacer, or placebo. At study end, comparable effects were reported for all active treatment groups on the primary pharmacodynamic endpoint of FEV1 in response to methacholine bronchial provocation testing, with a statistically significant improvement shown in the BDP 3,200 microg day(-1) suspension for nebulization group compared with pre-treatment for other parameters, including FEV1 and peak expiratory flow rates. All treatments were comparable. All treatments were equally well tolerated. No significant effects on cortisol levels were reported in any of the treatment groups.