COPD
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To determine if a delay in presentation to the emergency department (ED) after the onset of symptoms of an acute exacerbation of chronic obstructive pulmonary disease (AECOPD) increases the risk of hospital admission. A prospective cohort study utilizing data from 396 patient visits to 29 North American EDs. Inclusion criteria were age > or = 55 years; a diagnosis of COPD; and presentation for treatment of AECOPD, as defined by increasing shortness of breath, worsening cough, or change in sputum production at presentation. ⋯ This increase in risk persisted for delay in presentation > or = 12 hours in place of 24 hours, after restricting the analysis to patients admitted outside the intensive care unit, and to those reporting the ED as their usual site of care. A majority of patients delay presentation to the ED for > or = 24 hours after symptom onset, and are at higher risk of hospitalization. Early presentation should be emphasized to patients and caregivers to advance efforts to decrease the morbidity, mortality, and costs of AECOPD treatment.
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Spirometry is necessary to diagnose and assess severity of COPD, but is used infrequently. Therapy with inhaled medications can improve COPD outcomes, but are not without risks. The use of spirometry may help mitigate the therapy risks if treatment is appropriate based on spirometry results. ⋯ Patients with spirometry were more likely to have been dispensed an inhaled corticosteroid (AOR = 1.22 (95% CI, 1.11-1.36) to 1.61 (1.45-1.79)), long-acting beta-agonists (AOR = 1.41(1.25-1.58) to 1.63(1.45-1.83)), and ipratropium bromide (AOR = 1.25(1.16-1.35) to 1.64 (1.49-1.81)) across quintiles. Patients with spirometry were more likely to have medications added. The use of spirometry around a new diagnosis of COPD was associated with higher likelihood of using and adding respiratory medications after diagnosis.
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Historically, spirometry has been the objective measure used to confirm a symptom-based clinical suspicion of COPD. The third National Health and Nutrition Examination Survey (NHANES III) created a strong rationale for early identification and intervention in COPD by documenting the ability of spirometry to detect mild airflow problems in many asymptomatic smokers. Predicted values for spirometry, however, must be adjusted to account for variations in age, gender, height, ethnicity and race. ⋯ Despite the shortcomings of established diagnostic predicted values, spirometry remains the best available tool for early and accurate diagnosis of COPD in those at risk for the disease, and is also useful in conjunction with other modalities in patients with established disease to determine prognosis and assessing therapeutic benefits. In the clinical trial settings, as well as in day-to-day practice, spirometry results should be combined with other endpoints in order to better reflect overall patient status. This review highlights key medical evidence surrounding both usefulness and limitations of FEV(1) in the setting of COPD.
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Comparative Study
Difference in airflow obstruction between Hispanic and non-Hispanic White female smokers.
Smoking-related respiratory diseases are a major cause of morbidity and mortality. However, the relationship between smoking and respiratory disease has not been well-studied among ethnic minorities in general and among women in particular. The objective of this cross-sectional study was to evaluate the risk of airflow obstruction and to assess lung function among Hispanic and non-Hispanic White (NHW) female smokers in a New Mexico cohort. ⋯ Following adjustment for covariates, Hispanic smokers also had a higher mean absolute and percent predicted post-bronchodilator FEV(1)/FVC ratio, as well as higher mean percent predicted FEV(1) (p < 0.05 for all analyses). Hispanic female smokers in this New Mexico-based cohort had lower risk of airflow obstruction and better lung function than NHW female smokers. Further, smoking history did not completely explain these associations.