Exacerbations of chronic obstructive pulmonary disease (COPD) are associated with loss of lung function, poor quality of life, loss of exercise capacity, risk of serious cardiovascular events, hospitalization, and death. However, patients underreport exacerbations, and evidence suggests that unreported exacerbations have similar negative health implications for patients as those that are reported. Whilst there is guidance for physicians to identify patients who are at risk of exacerbations, they do not help patients recognise and report them. Newly developed tools, such as the COPD Exacerbation Recognition Tool (CERT) have been designed to achieve this objective. This review focuses on the underreporting of COPD exacerbations by patients, the factors associated with this, the consequences of underreporting, and potential solutions.
The drug consumption level in France is often considered as being one of the most important in Europe. This study aims at confirming this assertion over the period 2000-2004 by comparing drug consumption in Germany, Spain, France, Italy and the United-Kingdom. The results show that in 2004 drug consumption in France was no more the biggest for all the seven studied classes. Moreover, the consumption levels of the five countries have converged between 2000 and 2004, as well as the consumption structures.
Objectif : Evaluer l’impact du syndrome de l’intestin irritable (SII) sur la qualite de vie (QdV) des malades.
Methode : Deux echelles de QdV ont ete administrees par voie telephonique a un echantillon de 253 malades francais atteints de SII recrutes en population generale. Le SII a ete diagnostique a partir des criteres de Manning, Rome I et Rome II. Les malades qui presentaient une maladie organique etaient exclus de l’etude. Une echelle generique, la SF-36 et une echelle specifique, l’IBSQOL, ont ete utilises.
Resultats : Chez les malades avec SII, les scores de QdV etaient significativement inferieurs (p < 0,05) pour toutes les dimensions de l’echelle SF-36 compares a ceux observes en population generale. Les femmes (N = 192) presentaient une QdV significativement plus deterioree (p < 0,05) que les hommes (N = 61) pour les deux echelles et dans toutes leurs dimensions a l’exception de la dimension « vitalite » de l’echelle SF-36 et de la dimension « sommeil » de l’IBSQOL. La QdV se degradait avec l’anciennete des troubles pour certaines dimensions telles que les habitudes alimentaires. Pour les deux instruments, une correlation positive entre les faibles scores de QdV des malades et l’intensite des douleurs ou genes a pu etre observee. La QdV des malades avec predominance de diarrhee (N = 72) etait significativement plus degradee que celle des sujets a predominance de constipation (N = 65) pour la dimension « etat emotionnel » (P _ 0,05).
Conclusion : Le SII a un fort impact sur la QdV des malades. Des caracteristiques specifiques tels que le sexe feminin, la severite des symptomes ainsi que l’anciennete des troubles peuvent predire une qualite de vie encore plus deterioree.
Introduction In patients with chronic obstructive pulmonary disease (COPD), dual bronchodilator (long-acting muscarinic antagonist (LAMA)/long-acting beta2-agonist (LABA)) and triple therapy (inhaled corticosteroid (ICS)/LAMA/LABA) reduce risk of exacerbations and lung function decline in short-mid-term, but their long-term impact is unknown. This modelling study explores long-term impact of these therapies on lung function decline, quality of life (QoL) and all-cause mortality. Methods This modelling approach used a longitudinal non-parametric superposition model using published data regarding exacerbations, QoL (assessed by St. George's Respiratory Questionnaire (SGRQ)), and mortality. The model simulated disease progression from 40 to 75 years of age and assessed the impact of initiating dual bronchodilator at age 45 years (“LAMA/LABA only” group) and escalation to triple therapy at age 50 years (“Escalation to triple” group) on forced expiratory volume in 1 s (FEV 1 ) decline, QoL, and mortality. Results Model simulation predicted that by 75 years of age: “LAMA/LABA only” preserves 159.1 mL of FEV 1 versus no treatment, “Escalation to triple” preserves an additional 376.5 mL and 217.3 mL of FEV 1 versus no pharmacotherapy and “LAMA/LABA only”, respectively. In “LAMA/LABA only”, SGRQ score reduces (−3.2) versus no treatment, which further reduces to −7.5 therapy in “Escalation to triple”. In “LAMA/LABA only”, mortality reduces by 5.4% by 75 years versus no treatment, while the “Escalation to triple” shows further decrease in mortality by 12.0%. Conclusion Early pharmacotherapy initiation and escalation from dual bronchodilator to triple therapy could slow disease progression by preserving lung function and improving QoL and survival in patients with COPD.
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