Kroniskt Obstruktiv Lungsjukdom Höjdpunkter från ERS

Transkript

1 Kroniskt Obstruktiv Lungsjukdom Höjdpunkter från ERS Docent Ann Lindberg, överläkare Institutionen för Folkhälsa och Klinisk medicin, Enheten för Medicin, Umeå Universitet Lung- och Allergimottagningen Sunderby sjukhus, Luleå

2 Global and regional trends in mortality from chronic obstructive pulmonary disease: Their relation to poverty, smoking and population change Jämförde KOL-mortalitet 1990 och 2010 Individer > 40 års ålder (BOLD) Ålder, kön, inkomst/capita, kumulativt rökindex Total antal dödsfall sjönk något; 2,995,058 (1990) 2,837,877 (2010) J. Patel, P. G. J. Burney, R. B. Newson, C. Minelli, M. Naghavi

3 Global and regional trends in mortality from chronic obstructive pulmonary disease: Their relation to poverty, smoking and population change Jämförde KOL-mortalitet 1990 och 2010 Individer > 40 års ålder (BOLD) Ålder, kön, inkomst/capita, kumulativt rökindex Total antal dödsfall sjönk något; 2,995,058 (1990) 2,837,877 (2010) Förändring i åldersdistribution ökad mortalitet Förbättrade ekonomiska förhållanden minskade mortalitet J. Patel, P. G. J. Burney, R. B. Newson, C. Minelli, M. Naghavi

4 Distribution and outcomes of the new Spanish phenotype-based guideline for COPD Syfte: - att kartlägga distribution av fenotyper vid KOL och skillnader med avseende på demografi och kliniskt förlopp Metod: - multicenter poliklinisk KOL-kohort i Spanien, n=831 - stabila vid base-line - ett års uppföljning B. G. Cosio et al, poster

5 Distribution and outcomes of the new Spanish phenotype-based guideline for COPD NE ACOS EE ECB non-exacerbator phenotype asthma-copd overlap syndrome frequent exacerbator phenotype with emphysema frequent exacerbator phenotype with bronchitis Fördelning: NE 66.2%, ACOS 15.0%, EE 4.6%, ECB 11.9% 2.3% var freq exacerbators utan att vara EE el ECB B. G. Cosio et al, poster

6 Distribution and outcomes of the new Spanish phenotype-based guideline for COPD Signifikanta skillnader mellan grupperna ålder, kön, symtom, FEV 1 och BODE-index ECB signifikant mest symtom (CAT-score) EE och ECB hade oftare farmakologisk behandling hade signifikant mer exacerbationer vid uppföljn B. G. Cosio et al, poster

7 The BODE index predicts mortality better than 2007 GOLD and GOLD ABCD N= 96 (55 män, 41 kvinnor), uppföljning efter 5 år At baseline: spirometri, 6MWT, mmrc, exacerbationer Mean FEV 1 27 pp+5%, 50% mortalitet Manligt kön och BODE index predikterade död BODE index är en bättre prediktor för död än GOLD-klass J. Bertó Botella et al. E-poster

8 Cause-specific mortality in mild COPD: The Rotterdam Study Cause of death in 257 subjects who had performed spirometry during L. Lahousse, et al. poster

9 LATE-BREAKING ABSTRACT: beta-blockers are associated with a reduction in COPD exacerbations in COPDGene COPDGene : års ålder, GOLD 2-4, ca 3500 individer β-blocker use in moderate to very severe COPD is associated with a significant reduction in exacerbations Benefit persists after adjustment for underlying CVD and propensity to receive these drugs Use of other cardiac medications not associated with a reduction in exacerbation risk Bhatt et al, oral presentation

10 LATE-BREAKING ABSTRACT: beta-blockers are associated with a reduction in COPD exacerbations in COPDGene COPDGene : års ålder, GOLD 2-4, ca 3500 individer β-blocker use in moderate to very severe COPD is associated with a significant reduction in exacerbations Benefit persists after adjustment for underlying CVD and propensity to receive these drugs Use of other cardiac medications not associated with a reduction in exacerbation risk Mortalitet påverkades ej Bhatt et al, oral presentation

11 LATE-BREAKING ABSTRACT: beta-blockers are associated with a reduction in COPD exacerbations in COPDGene Mekanism? Bhatt SP. Transl Res. 2013;162(4): Chronic blockade of β-receptors may up-regulate receptor density Prevention of β-agonist toxicity Reduction in airway inflammation and mucus secretion Anti-ischemic Alleviate diastolic dysfunction Decrease resting tachycardia and prevent arrhythmias Bhatt et al, oral presentation

12 Statin use and risk of exacerbations in individuals with COPD: The Copenhagen general population study N=5798, >40 års ålder med KOL (FEV 1 /FVC<0.70) 3-års uppföljning; exacerbationer moderat/severe case-control design, matchning för kön, ålder, svårighetsgrad av KOL, komorbiditet, rökning Värdera association mellan statinanvändning före exacerbation och risk för exacerbationer statiner och högt crp (>3 mg/l) hög crp och framtida risk för exacerbationer Ingebrigtsen et al. Thorax Oct 2014

13 Statin use and risk of exacerbations in individuals with COPD: The Copenhagen general population study Statiner minskade risken för exacerbationer univariat analys OR 0.68 (95% CI ) multivariat analys OR 0.67 (95% CI ) Statiner minskade risken för högt crp OR 0.69 (95% CI ) Högt crp ökade risken för exacerbationer HR 1.64 (95% CI ) Ingebrigtsen et al. Thorax Oct 2014

14 Availability of pulmonary rehabilitation in primary care for patients with COPD in Sweden Syfte: kartlägga tillgång av rehabiliteringsresurser för KOL i primärvården Metod: frågeformulär till 683 primärvårdsenheter i 12 regioner Rehabiliteringsresurs: fysisk träning + ett av följande: utbildning, nutritionråd, energibesparande teknik, psykosocial stöd M Arne et al, poster

15 Availability of pulmonary rehabilitation in primary care for patients with COPD in Sweden Syfte: kartlägga tillgång av rehabiliteringsresurser för KOL i primärvården Metod: frågeformulär till 683 primärvårdsenheter i 12 regioner Rehabiliteringsresurs: fysisk träning + ett av följande: utbildning, nutritionråd, energibesparande teknik, psykosocial stöd M Arne et al, poster

16 Availability of pulmonary rehabilitation in primary care for patients with COPD in Sweden Resultat (56 % svarsfrekvens) Tillgång: 92% fysioterapeut 92% arabetsterapeut 84% dietist 98% psykolog/motsvarande M Arne et al, poster

17 Availability of pulmonary rehabilitation in primary care for patients with COPD in Sweden Resultat (56 % svarsfrekvens) Tillgång: 92% fysioterapeut 92% arabetsterapeut 84% dietist 98% psykolog/motsvarande KOL-patienterna hade tillgång till PR på 49% av enheterna M Arne et al, poster

18 Population screening initiatives and future strategies Joan B Soriano FISIB-IdISPa, Hospital Universitari Son Espases ERS 2014 Munich; Session 147; Room 14b Sunday, September 7, 14:45-16:45 Symposium: Finding patients with COPD: how, when and where Chairs: F. Burgos, J. Vestbo, D. Marciniuk

19 CONCLUSIONS COPD underdiagnosis is universally high A variety of screening and case-finding COPD options are already available: when, where and how A wider implementation of quality spirometry might/should help to reduce the future COPD burden.

20 Presentationer från OLIN-studierna OLIN s KOL-studie Tre muntliga presentationer Tre posters Poolade data från populationsbaserade kohorter En muntlig presentation

21 Physical activity and fatigue in subjects with COPD A population-based study Mikael Andersson,PhD 1,2, Caroline Stridsman,PhD 3, Eva Rönmark, Prof. 3,4, Anne Lindberg, Ass. Prof. 3,5, Margareta Emtner, Ass.Prof. 1,2 1 Department of Neuroscience, Physiotherapy, Uppsala University, Uppsala, Sweden 2 Department of Medical Science, Respiratory Medicine and Allergology, Uppsala University, Uppsala, Sweden 3 The OLIN studies, Sunderby Hospital, Luleå, Sweden 4 Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine, Umeå University, Umeå, Sweden 5 Department of Public Health and Clinical Medicine, Division of Medicine, Umeå University, Umeå, Sweden Andersson et al, submitted, under review

22 Results Physical activity (continuous outcome) METminutes/week p = p = p = p = Non- COPD (n = 659) COPD (n = 470) GOLD I (n = 309) GOLD II (n = 148) GOLD III-IV (n = 13) Andersson et al, submitted, under review

23 Factors associated with LOW physical activity Non-COPD subjects Variables included Age Gender (female = 1) FEV 1 Underweight Overweight Obese Heart disease (yes = 1) Ex-smoker Current smoker Fatigue (yes = 1) Odds ratio (95% CI) 1.29 ( ) 0.92 ( ) 0.94 ( ) 0.91 ( ) 0.87 ( ) 2.26 ( ) 0.89 ( ) 0.76 ( ) 1.21 ( ) 1.28 ( ) Andersson et al, submitted, under review

24 Factors associated with LOW physical activity COPD subjects Variables included Age Gender (female = 1) FEV 1 Underweight Overweight Obese Heart disease (yes = 1) Ex-smoker Current smoker Fatigue (yes = 1) Odds ratio (95% CI) 1.52 ( ) 1.22 ( ) 0.90 ( ) 0.21 ( ) 1.15 ( ) 0.44 ( ) 2.11 ( ) 0.85 ( ) 1.62 ( ) 2.33 ( ) Andersson et al, submitted, under review

25 CO-MORBIDITY IS THE MAIN COST DRIVER AMONG COPD-SUBJECTS Sven-Arne Jansson, Helena Backman, Eva Rönmark, Bo Lundbäck, Anne Lindberg

26 DISTRIBUTION OF HEALTH-CARE COSTS AMONG SUBJECTS WITH AND WITHOUT COPD Non-COPD Total costs EUR 931 COPD Total costs EUR 1, Outpatient care resp Hospitalization resp Outpatient care non-resp Hospitalization non-resp Hospitalization due to non-respiratory diseases was the main cost driver in COPD. Jansson et al. COPD 2014, in print

27 LTU-logga? Experiences of well-being when living with COPD Caroline Stridsman,PhD 1,2 Karin Zingmark, Ass. Prof. 1, Anne Lindberg, Ass. Prof. 2,3, Lisa Skär, Ass. Prof 1 1 Department of Health Science, Division of Nursing, Luleå University of Technology, Luleå, Sweden. 2 The OLIN studies, Sunderby Hospital, Luleå, Sweden 3 Department of Public Health and Clinical Medicine, Division of Medicine, Umeå University, Umeå, Sweden Stridsman et al. Prim Health Care Res Dev Feb 14:1-11

28 Factors that may contribute to increased well-being Acceptance but not capitulating - Replacement of activities Engaging in meaningful activities - Family, friends, work Taking advantage of good days Learning emotional adaption strategies Ceasing smoking Physical activities - Being outdoor/fresh air Continuity in care

29 Cardiovascular comorbidities among never smokers with COPD Stig Hagstad 1,2 Helena Backman 2,3, Linda Ekerljung, PhD 1, Anne Lindberg, Ass. Prof. 2,4, Anders Bjerg, PhD 1,2 1 Krefting Research Centre, Department of Internal Medicine and Clinical Nutrition, University of Gothenburg, Gothenburg, Sweden 2 The OLIN studies, Sunderby Hospital, Luleå, Sweden 3 Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, The OLIN unit, Umeå University, Sweden 4 Department of Public Health and Clinical Medicine, Division of Medicine, Umeå University, Umeå, Sweden Hagstad et al, submitted

30 % Prevalence of any cardiovascular disease by smoking status and lung function p <0.001 p < No COPD GOLD I GOLD II Neversmokers Eversmokers

31 Association of comorbidities and COPD among never-smokers Any cardiovascular diseasea Crude OR Adjusted OR* OR 95% CI OR 95% CI No COPD 1 1 GOLD I GOLD II * Adjusted for age and sex

32 Posters Fatigue is related to decreased health status in COPD Caroline Stridsman, Lisa Skär, Linnea Hedman, Anne Lindberg Arterial stiffness is increased in subjects with COPD stage 3-4 Ulf Nilsson, Linnea Qvist, Viktor Johansson, Kjell Larsson, Eva Rönmark, Jeremy Langrish, Anders Blomberg, Anne Lindberg The outcome of broncho-dilation among subjects with airway obstruction in the general population Sami Sawalha, Linnea Hedman, Eva Rönmark, Bo Lundbäck, Anne Lindberg

33 Tack!