Сomplex assessment of the degree of chronic obstructive pulmonary disease copd severity on out-patient visit

Abstract

Аim. Analysis of the possibility and reasonability of a comprehensive assessment of clinical condition of patients with chronic obstructive pulmonary disease (COPD) on outpatient visit in conditions of a small territorial municipal polyclinic.

Materials and Methods. The study was carried out on the base of municipal Outpatient clinic №12 (total adult population 7177 people) of Ryazan from October 2012 to December 2014. In history taking, positive family history, existence of unfavorable factors that could provoke development and progress of the disease, coughing episodes in history, phase of the disease, medicinal treatment were evaluated. This was followed by a screening epidemiological examination (questionnaire). In result, an observation group was formed (n=50, aged 19-81 years, mean age 56.1±2.3 years) from patients with chronic respiratory symptoms (cough, dyspnea) seeking medical care, where screening spirography, evaluation of the degree of severity of COPD according to GOLD 2014 were conducted, and four observation groups (A, B, C, D) were formed.

Results. COPD was confirmed in 100% of patients of the observation group, of them the 1^st stage COPD was found in 18.7% of cases, 2^nd – in 43.3% of cases, 3^rd– in 30.0%, 4^th – in 8.0%. The number of exacerbations was 1-8 per year. The most common concomitant diseases were ischemic heart disease (53.2%), arterial hypertension (74.3%), chronic gastroduodenitis (34.5%). A combination of 2 or more chronic diseases was observed in 31% of cases. Depending on the degree of airflow rate limitation, symptoms (mMRC results), history of exacerbations, patients were divided into the following groups according to GOLD 2014: group A – 59 patients (39.3%), group B – 30 patients (20.0%), group C – 29 patients (19.0%), and D – 32 patients (21.7%). There were no statistically significant differences between the groups in age, gender and smoking status (p>0.05).

Conclusion. The analysis showed a possibility and convenience of using stratification of patients with COPD by the degree of severity of the disease (according to GOLD 2014) with the aim of individualization of further management of such patients.

Keywords

COPD / GOLD / ambulance situation / spirometry / dyspnea scale / mMRS / CAT questionnaire

References

[1] Carone M, Antoniu S, Baiardi P, et al. Predictors of Mortality in Patients with COPD and Chronic Respiratory Failure: The Quality-of-Life Evaluation and Survival Study (QuESS): A Three-Year Study. COPD Journal of Chronic Obstructive Pulmonary Disease. 2015;13(2):1-9. doi:10.3109/15412555. 2015.1067294

[2] Carone M., Antoniu S., Baiardi P., et al. Predictors of Mortality in Patients with COPD and Chronic Respiratory Failure: The Quality-of-Life Evaluation and Survival Study (QuESS): A Three-Year Study // COPD Journal of Chronic Obstructive Pulmonary Disease. 2015. Vol. 13, №2. P. 1-9. doi:10.3109/ 15412555.2015.1067294

[3] Loddenkemper R., editor. European Lung White Book. The first comprehensive survey on respiratory health in Europe. 2003.

[4] van der Molen T, Miravitlles M, Kocks JW. COPD management: role of symptom assessment in routine clinical practice. International Journal of Chronic Obstructive Pulmonary Disease. 2013; 8:461-71. doi:10.2147/COPD.S49392

[5] van der Molen T., Miravitlles M., Kocks J.W. COPD management: role of symptom assessment in routine clinical practice // International Journal of Chronic Obstructive Pulmonary Disease. 2013. Vol. 8. P. 461-471. doi:10.2147/COPD.S49392

[6] Cazzola M, MacNee W, Martinez FJ, et al. Outcomes for COPD pharmacological trials: from lung function to biomarkers. European Respiratory Journal. 2008;31(2):416-69. doi:10.1183/09031936. 00099306

[7] Cazzola M., MacNee W., Martinez F.J., et al. Outcomes for COPD pharmacological trials: from lung function to biomarkers // European Respiratory Journal. 2008. Vol. 31, №2. P. 416-469. doi:10.1183/ 09031936.00099306

[8] Tsiligianni IG, van der Molen T, Moraitaki D, et al. Assessing health status in COPD. A head-to-head comparison between the COPD assessment test (CAT) and the clinical COPD questionnaire (CCQ). BMC Pulmonary Medicine. 2012;12:20. doi:10. 1186/1471-2466-12-20

[9] Tsiligianni I.G., van der Molen T., Moraitaki D., et al. Assessing health status in COPD. A head-to-head comparison between the COPD assessment test (CAT) and the clinical COPD questionnaire (CCQ) // BMC Pulmonary Medicine. 2012. Vol. 12. P.20. doi:10.1186/1471-2466-12-20

[10] Kotlarov SN. Spirometry screening in evaluation of chronic obstructive pulmonary disease at primary care. I.P. Pavlov Russian Medical Biological Herald. 2011;19(1):91-5. (In Russ).

[11] Котляров С.Н. Скрининг спирометрии в оценке хронической обструктивной болезни легких на уровне первичного звена медицинской помощи // Российский медико-биологический вестник имени академика И.П. Павлова. 2011. Т. 19, №1. С. 91-95.

[12] Abrossimov VN, Shoutov AV. Multipurpose effect of inhaled ipratropium bromid in patients with chronic obstructive pulmonary disease. I.P. Pavlov Russian Medical Biological Herald. 2004;(3-4): 181-5. (In Russ).

[13] Абросимов В.Н., Шутов А.В. Комплексная оценка действия ипратропиума бромида у больных хронической обструктивной болезнью легких // Российский медико-биологический вестник имени академика И.П. Павлова. 2004. №3-4. С. 181-185.

[14] Ponomareva IB, Subbotin SV. Possibilities of volumetric capnography method in the study of pulmonary functions in patients with COPD. Nauka molodyh (Eruditio Juvenium). 2016;(1):68-73. (In Russ).

[15] Пономарева И.Б., Субботин С. В. Возможности метода объемной капнографии в изучении легочных функций у больных ХОБЛ // Наука молодых (Eruditio Juvenium). 2016. №1. С. 68-73.

RIGHTS & PERMISSIONS

Nizov A.A., Ermachkova A.N., Abrosimov V.N., Ponomareva I.B.