Factors affecting the outcomes in stable chronic obstructive pulmonary disease patients at an Army Central Hospital

Main Article Content

Nunik U Nurwulandari
Zulfan Zazuli https://orcid.org/0000-0002-1264-9558
Retno Wihastuti
Pratiwi Wikaningtyas https://orcid.org/0000-0003-0702-8033

Keywords

COPD, clinical outcomes, factors, therapeutic outcomes

Abstract

Background: Of the four Asian countries, Indonesian COPD patients have the worst clinical features, which puts them at a high risk for treatment failure. There are a number of variables and patient traits that influence clinical results as a predictor of therapy outcomes. Objective: to identify the contributing components and how much they influence COPD patients’ therapy results. Methods: This cross-sectional descriptive-observational study at a tertiary army hospital involved 74 patients. A questionnaire and medical records were utilized to obtain sociodemographic characteristics and clinical data. Correlation and logistic regression analysis were conducted to identify significant factors. Results: The results showed that tumor/cancer comorbidities affected the worsening of CAT values (OR=10.89, 95%CI=1.01-117.23, p=0.049), use of ICS/LABA drugs affected the improvement of mMRC values (OR= 0.26, 95%CI=0.08-0.84, p=0.024), history of TBC disease affected the increase in exacerbation severity (OR=7.25, 95%CI=1.05-50.23, p=0.045), age from smoking >20 years affected the reduction in exacerbation severity (OR=0.03, 95%CI=0.002-0.61, p=0.022). History of alcohol use (OR=7.26 and 167.56, p=0.014 and 0.004) and comorbid pneumonia (OR=28.14 and 44.25, p=0.035 and 0.014) contributed to an increase in the frequency of exacerbations and hospitalization per year. Medium economic status affects the decrease in hospitalizations per year (OR=0.06, 95%CI=0.00-0.91, p=0.043) while the diagnosis of severe COPD and history of alcohol affected the decrease in COPD severity (ABCD) (OR=0.12 and 0.24, p=0.039 and 0.009). Conclusion: comorbidities, disease history, history of alcohol use, COPD status and the use of COPD medications contributed to variations therapeutic outcomes COPD patients. Therefore, it must be taken into account when making clinical decisions.

Abstract 1028 | PDF Downloads 214

References

1. GOLD. Global Strategy for Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease [Internet]. 2022nd ed. Langefeld K, editor. Illinois, USA: GOLD; 2022 [cited 2022 Feb 28]. 1-165 p. Available from: https://goldcopd.org/ wp-content/uploads/2021/12/GOLD-REPORT-2022-v1.1-22Nov2021_WMV.pdf
2. Confalonieri M, Braga L, Salton F, et al. COPD Definition: Is It Time to Incorporate Also the Concept of Lung Regeneration’s Failure?. Am J Respir Crit Care Med. 2022;207(3):202208-9.
3. Celli B, Fabbri L, Criner G, et al. Definition and Nomenclature of Chronic Obstructive Pulmonary Disease: Time for Its Revision. Am J Respir Crit Care Med. 2022;206(11):1317-25. https://doi.org/10.1164/rccm.202204-0671pp
4. Choi JY, Ph D, Milne S, et al. Current Chronic Obstructive Pulmonary Disease Treatment Status in Asia : A Position Statement of the Asian Pacific Society of Respirology. Tuberc Respir Disease. 2022;85(3):279-82. https://doi.org/10.4046/trd.2022.0020
5. Duarte-de-Araújo A, Teixeira P, Hespanhol V, et al. COPD: Analysing factors associated with a successful treatment. Pulmonology [Internet]. 2020;26(2):66-72. Available from: https://doi.org/10.1016/j.pulmoe.2019.05.012
6. Barnes PJ. Oxidative stress-based therapeutics in COPD. Redox Biol [Internet]. 2020;33(April):101544. Available from: https:// doi.org/10.1016/j.redox.2020.101544
7. De Marco R, Accordini S, Marcon A, et al. Risk factors for chronic obstructive pulmonary disease in a European cohort of young adults. Am J Respir Crit Care Med. 2011;183(7):891-7. https://doi.org/10.1164/rccm.201007-1125oc
8. Lou P, Zhu Y, Chen P, et al. Interaction of depressive and anxiety symptoms on the mortality of patients with COPD: A preliminary study. COPD J Chronic Obstr Pulm Dis. 2014;11(4):444-50. https://doi.org/10.3109/15412555.2013.822856
9. Mercado N, Ito K, Barnes PJ. Accelerated ageing of the lung in COPD: New concepts. Thorax. 2015;70(5):482-9. https://doi. org/10.1136/thoraxjnl-2014-206084
10. Quy Ngo C, Minh Phan D, Van Vu G, et al. Inhaler Technique and Adherence to Inhaled Medications among Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease in Vietnam. Int J Environ Res Public Heal [Internet]. 2019;16(2):185. https://doi.org/10.3390/ijerph16020185
11. Molimard M, Raherison C, Lignot S,et al. Chronic obstructive pulmonary disease exacerbation and inhaler device handling: Reallife assessment of 2935 patients. Eur Respir J [Internet]. 2017;49(2). Available from: http://dx.doi.org/10.1183/13993003.01794- 2016
12. Sharif R, Cuevas CR, Wang Y, et al. Guideline adherence in management of stable chronic obstructive pulmonary disease. Respir Med [Internet]. 2013;107(7):1046-52. Available from: http://dx.doi.org/10.1016/j.rmed.2013.04.001
13. Pradiftha,Chyntia S; Suci Hanifah, Rosdiana Rosdiana YA. The COPD (Chronic Obstructive Pulmonary Disease) Assessment Test: Assessment of Therapeutic Outcomes of Patients at Private Hospitals in Yogyakarta. J Pharm Bioallied Sci. 2020;12(Suppl 2):S821-S825. https://doi.org/10.4103/jpbs.jpbs_302_19
14. Chubachi S, Sato M, Kameyama N, et al. Identification of five clusters of comorbidities in a longitudinal Japanese chronic obstructive pulmonary disease cohort. Respir Med [Internet]. 2016;117:272-9. Available from: http://dx.doi.org/10.1016/j. rmed.2016.07.002
15. Mursiany A, Oktaviani N. Pengaruh Kepatuhan Mengkonsumsi Obat Pada Pasien Penyakit Paru Obstruksi Kronik (PPOK) DI RSUD Dr. MOEWARDI Surakarta Periode Januari 2012. Pros Semin Nas Pangan, Energi dan Lingkung. 2015;205-10.
16. Audrina GW, Purhadi, Purwanto H. Faktor-Faktor Yang Mempengaruhi Tingkat Keberhasilan Pemberian Kemoterapi Pada Pasien Penderita Kanker Payudara Di RSUD Dr . Soetomo Dengan Menggunakan Regresi Logistik Ordinal. J Statisika [Internet]. 2014;3(1):D36-41. Available from: https://media.neliti.com/media/publications/15402-ID-faktor-faktor-yang-mempengaruhitingkat- keberhasilan-pemberian-kemoterapi-pada-p.pdf
17. Kwon N, Amin M, Hui DS, et al. Validity of the COPD assessment test translated into local languages for asian patients. Chest [Internet]. 2013;143(3):703-10. Available from: http://dx.doi.org/10.1378/chest.12-0535
18. Firdausi, Nurul Layli; Artanti, et al. Analysis of risk factors affecting the occurrence of chronic obstructive pulmonary disease in indonesia. J Berk Epidemiol. 2021;9(1):18-25.
19. Nishimura K, Izumi T, Tsukino M, et al. Dyspnea Is a Better Predictor of 5-Year Survival Than Airway Obstruction in Patients With COPD *. 2012;121(5):1434-40. https://doi.org/10.1378/chest.121.5.1434
20. Shahab L, Jarvis MJ, Britton J, et al. Prevalence, diagnosis and relation to tobacco dependence of chronic obstructive pulmonary disease in a nationally representative population sample. Thorax. 2006;61(12):1043-7. https://doi.org/10.1136/ thx.2006.064410
21. Marchetti N, Garshick E, Kinney GL, et al. Association between occupational exposure and lung function, respiratory symptoms, and high-resolution computed tomography imaging in COPDGene. Am J Respir Crit Care Med. 2014;190(7):756-62. https:// doi.org/10.1164/rccm.201403-0493oc
22. Beran D, Zar HJ, Perrin C, et al. Burden of asthma and chronic obstructive pulmonary disease and access to essential medicines in low-income and middle-income countries. Lancet Respir Med [Internet]. 2015;3(2):159-170. Available from: http://dx.doi. org/10.1016/S2213-2600(15)00004-1
23. Salawati L, Husnah H, Nawawi YS, et al. Relationship between smoking activity and chronic obstructive pulmonary disease inthe Zainoel Abidin General Hospital, Banda Aceh, Indonesia. Open Access Maced J Med Sci. 2020;8(November 2015):705-7.
24. Asyrofy A, Arisdiani T, Aspihan M. Karakteristik dan kualitas hidup pasien Penyakit Paru Obstruksi Konik (PPOK). NURSCOPE J Penelit dan Pemikir Ilm Keperawatan. 2021;7(1):13.
25. Chairunnissa, T. et al. Gambaran Karakteristik dan Komorbiditas Pasien PPOK Rawat Inap di Rsud Al-Ihsan Bandung 2016. 2017;(2):154-61.
26. Burney P, Patel J, Minelli C, et al. Prevalence and Population-Attributable Risk for Chronic Airflow Obstruction in a Large Multinational Study. Am J Respir Crit Care Med. 2021;203(11):1353-1365. https://doi.org/10.1164/rccm.202005-1990oc
27. Shuai T, Zhang C, Zhang M, et al. Low-dose theophylline in addition to ICS therapy in COPD patients: A systematic review and meta-analysis. PLoS One [Internet]. 2021;16(5 May):1-12. Available from: http://dx.doi.org/10.1371/journal.pone.0251348
28. Gain R, T. A RK, Sen P, et al. Comparison of Efficacy and Safety of Theophylline, Doxophylline and Acebrophylline as an Add-On in the Management of Chronic Obstructive Pulmonary Disease. J Evol Med Dent Sci. 2020;9(04):191-4.
29. Frantz S, Wollmer P, Dencker M, et al. Associations between lung function and alcohol consumption - Assessed by both a questionnaire and a blood marker. Respir Med. 2014;108(1):114-21. https://doi.org/10.1016/j.rmed.2013.08.041
30. Ray R, Tombs L, Naya I, et al. Pulmonary Pharmacology & Therapeutics Efficacy and safety of the dual bronchodilator combination umeclidinium / vilanterol in COPD by age and airflow limitation severity : A pooled post hoc analysis of seven clinical trials. Pulm Pharmacol Therauptics [Internet]. 2019;57(May):101802. Available from: https://doi.org/10.1016/j.pupt.2019.101802
31. Eisner MD, Blanc PD, Omachi TA, et al. Socioeconomic status, race and COPD health outcomes. J Epidemiol Community Health. 2011;65(1):26-34. https://doi.org/10.1136/jech.2009.089722
32. Ratih. Kajian Epidemiologis Penyakit Paru Obstruktif Kronik (PPOK). Media Litbangkes. 2013;23(2):82-8.
33. Lee YG et al. Effects of air pollutants on airway diseases. Int J Environ Res Public Health. 2021;18(18):9905. https://doi. org/10.3390/ijerph18189905
34. Garshick E, Segal MR, Worobec TG, et al. Alcohol consumption and chronic obstructive pulmonary disease. Am Rev Respir Dis. 1989;140(2):373-8. https://doi.org/10.1164/ajrccm/140.2.373
35. Kaluza J, Harris HR, Linden A, et al. Alcohol Consumption and Risk of Chronic Obstructive Pulmonary Disease: A Prospective Cohort Study of Men. Am J Epidemiol. 2019;188(5):907-16. https://doi.org/10.1093/aje/kwz020
36. Paulin LM, Diette GB, Blanc PD, et al. Occupational exposures are associated with worse morbidity in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2015;191(5):557-65. https://doi.org/10.1164/rccm.201408-1407oc
37. PDPI. P P O K Diagnosis dan Penatalaksanaan Perhimpunan Dokter Paru Indonesia (PDPI) EDITOR TIM KELOMPOK POKJA PPOK. 2011.
38. Cho SH, Lin HC, Ghoshal AG, et al. Respiratory disease in the Asia-Pacific region: Cough as a key symptom. Allergy Asthma Proc. 2016;37(2):131-40. https://doi.org/10.2500/aap.2016.37.3925
39. Miller J, Edwards LD, Agustí A, et al. Comorbidity, systemic inflammation and outcomes in the ECLIPSE cohort. Respir Med. 2013;107(9):1376-84. https://doi.org/10.1016/j.rmed.2013.05.001
40. Cheng SL, Lin CH, Wang CC, et al. Comparison between COPD Assessment Test (CAT) and modified Medical Research Council (mMRC) dyspnea scores for evaluation of clinical symptoms, comorbidities and medical resources utilization in COPD patients. J Formos Med Assoc [Internet]. 2019;118(1P3):429-35. Available from: https://doi.org/10.1016/j.jfma.2018.06.018
41. Dahl M, Nordestgaard BG. Markers of early disease and prognosis in COPD. Int J COPD. 2009;4(1):157-67. https://doi. org/10.2147/copd.s3106
42. Yeh F, Dixon AE, Marion S, et al. Obesity in adults is associated with reduced lung function in metabolic syndrome and diabetes: The strong heart study. Diabetes Care. 2011;34(10):2306-13. https://doi.org/10.2337/dc11-0682
43. Makhlouf HA, Sadek SH, Nafady AAH. Platelet function in diabetic and nondiabetic patients with chronic obstructive pulmonary disease: a case control study. Clin Respir J. 2018;12(1):48-56. https://doi.org/10.1111/crj.12477
44. Park HJ, Byun MK, Kim HJ, et al. History of pulmonary tuberculosis affects the severity and clinical outcomes of COPD. Respirology. 2018;23(1):100-6. https://doi.org/10.1111/resp.13147
45. Fan H, Wu F, Liu J, et al. Pulmonary tuberculosis as a risk factor for chronic obstructive pulmonary disease: a systematic review and meta-analysis. Ann Transl Med. 2021;9(5):390-390. https://doi.org/10.21037/atm-20-4576
46. Yakar HI, Gunen H, Pehlivan E, et al. The role of tuberculosis in COPD. Int J COPD [Internet]. 2017;12:323-9. Available from: https://doi.org/10.2147/COPD.S116086
47. Wedzicha JA, Decramer M, Ficker JH, et al. Analysis of chronic obstructive pulmonary disease exacerbations with the dual bronchodilator QVA149 compared with glycopyrronium and tiotropium ( SPARK ): a randomised , double-blind , parallel-group study. Lancet Respir [Internet]. 1(3):199-209. Available from: http://dx.doi.org/10.1016/S2213-2600(13)70052-3
48. Mckay SE, Howie CA, Thomson AH, et al. Value of theophylline treatment in patients handicapped by chronic obstructive lung disease. 1993;227-32. https://doi.org/10.1136/thx.48.3.227
49. Hurul Aini QS, Adrianison A, Fridayenti F. Gambaran Jumlah Neutrofil Darah Tepi Pasien Penyakit Paru Obstruktif Kronik (PPOK) di Ruang Rawat Inap RSUD Arifin Achmad Provinsi Riau Tahun 2017. J Ilmu Kedokt. 2019;13(2):63.
50. Mannino DM, Buist AS. Global burden of COPD : risk factors , prevalence , and future trends. Lancet [Internet]. 2007;370(9589):765-73. Available from: http://dx.doi.org/10.1016/S0140-6736(07)61380-4
51. Mannino DM, Higuchi K, Yu TC, et al. Economic burden of COPD in the presence of comorbidities. Chest [Internet].2015;148(1):138-50. Available from: http://dx.doi.org/10.1378/chest.14-2434
52. Shidara K, Hoshi D, Inoue E, et al. Incidence of and risk factors for interstitial pneumonia in patients with rheumatoid arthritis in a large Japanese observational cohort, IORRA. Mod Rheumatol. 2010;20(3):280-6. https://doi.org/10.1007/s10165-010- 0280-z
53. Van Der Molen T, Pieters W, Bellamy D, et al. Measuring the success of treatment for chronic obstructive pulmonary disease - Patient, physician and healthcare payer perspectives. Respir Med. 2002;96(Supp C):S17-21 https://doi.org/10.1016/s0954- 6111(02)80030-0
54. Soriano JB et al. Global , regional , and national deaths , prevalence , disability-adjusted life years , and years lived with disability for chronic obstructive pulmonary disease and asthma , 1990 - 2015 : a systematic analysis for the Global Burden of Disease St. Lancet Respir Med 2017. 2017;5(9):691-706. https://doi.org/10.1016/s2213-2600(17)30293-x
55. Ho J, He W, Chan MTV, et al. Eosinophilia and clinical outcome of chronic obstructive pulmonary disease: A meta-analysis. Sci Rep [Internet]. 2017;7(1):1-10. Available from: http://dx.doi.org/10.1038/s41598-017-13745-x
56. Bernd L, B SJ, Michael S, et al. Determinants of Underdiagnosis of COPD in national and international surveys. Off Publ Am Coll Chest Physicians. 2015;148(4):971-985. https://doi.org/10.1378/chest.14-2535
57. Barnes PJ, Burney PGJ, Silverman EK, et al. Chronic obstructive pulmonary disease. Nat Rev Dis Prim [Internet]. 2015;1(December):1-22. http://dx.doi.org/10.1038/nrdp.2015.76
58. Divo MJ, Celli BR, Poblador-Plou B, et al. Chronic Obstructive Pulmonary Disease (COPD) as a disease of early aging: Evidence from the EpiChron Cohort. Vol. 13, PLoS ONE. 2018;13(2):e0193143 https://doi.org/10.1371/journal.pone.0193143
59. Fabbri LM, Luppi F, Beghé B, et al. Complex chronic comorbidities of COPD. Eur Respir J. 2008;31(1):204-12. https://doi. org/10.1183/09031936.00114307
60. Pelgrim CE, Peterson JD, Gosker HR, et al. Psychological co-morbidities in COPD: Targeting systemic inflammation, a benefit for both? Eur J Pharmacol. 2019;842:99-110. https://doi.org/10.1016/j.ejphar.2018.10.001
61. Skeoch S, Weatherley N, Swift AJ, et al. Drug-induced interstitial lung disease: A systematic review. J Clin Med. 2018;7(10):1-30. https://doi.org/10.3390/jcm7100356

Most read articles by the same author(s)

1 2 3 4 5 6 7 8 9 10 > >>