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      An assessment of health-related quality of life among patients with chronic obstructive pulmonary diseases attending a tertiary care hospital in Bhubaneswar City, India

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          Abstract

          Background:

          Chronic obstructive pulmonary disease (COPD) is a major public health challenge in India with significant economic burden and healthcare utilization and contributes to patients’ daily life limitations. Health-related quality of life (HRQoL) reflects the health- and disease-related aspects of QoL. Limited studies have examined this dimension in healthcare settings. We explored the HRQoL among patients with COPD attending a tertiary care facility and the factors (enablers and constraints) influencing it.

          Materials and Methods:

          A parallel mixed-method study design was adopted to undertake the study. Data were collected from 110 patients with COPD attending the outpatient department of the tertiary care hospital at Bhubaneswar, Odisha, during June and July 2014. The translated and pretested version of St. George Respiratory Questionnaire (SGRQ) was used. In addition, in-depth interviews were held with 11 patients.

          Results:

          The overall HRQoL was significantly lower in females and patients from rural area. It declined with increasing age and was worst in patients age 70 years or above. Patients having two or more comorbid conditions had the poorest HRQoL. Reason for not using inhalers was mentioned to be perceived harm due to prolonged use. Family support and better financial condition were enablers while easy accessibility of healthcare facilities helped in early interventions.

          Conclusion:

          COPD has considerable negative impact on the QoL with advancing age and is worse among the geriatric age group population. Acute exacerbations impair HRQoL. The degree of severity of COPD could be determined by SGRQ which reflects the impairment of their HRQoL.

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          Most cited references21

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          Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. NHLBI/WHO Global Initiative for Chronic Obstructive Lung Disease (GOLD) Workshop summary.

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            Global and regional estimates of COPD prevalence: Systematic review and meta–analysis

            Background The burden of chronic obstructive pulmonary disease (COPD) across many world regions is high. We aim to estimate COPD prevalence and number of disease cases for the years 1990 and 2010 across world regions based on the best available evidence in publicly accessible scientific databases. Methods We conducted a systematic search of Medline, EMBASE and Global Health for original, population–based studies providing spirometry–based prevalence rates of COPD across the world from January 1990 to December 2014. Random effects meta–analysis was conducted on extracted crude prevalence rates of COPD, with overall summaries of the meta–estimates (and confidence intervals) reported separately for World Health Organization (WHO) regions, the World Bank's income categories and settings (urban and rural). We developed a meta–regression epidemiological model that we used to estimate the prevalence of COPD in people aged 30 years or more. Findings Our search returned 37 472 publications. A total of 123 studies based on a spirometry–defined prevalence were retained for the review. From the meta–regression epidemiological model, we estimated about 227.3 million COPD cases in the year 1990 among people aged 30 years or more, corresponding to a global prevalence of 10.7% (95% confidence interval (CI) 7.3%–14.0%) in this age group. The number of COPD cases increased to 384 million in 2010, with a global prevalence of 11.7% (8.4%–15.0%). This increase of 68.9% was mainly driven by global demographic changes. Across WHO regions, the highest prevalence was estimated in the Americas (13.3% in 1990 and 15.2% in 2010), and the lowest in South East Asia (7.9% in 1990 and 9.7% in 2010). The percentage increase in COPD cases between 1990 and 2010 was the highest in the Eastern Mediterranean region (118.7%), followed by the African region (102.1%), while the European region recorded the lowest increase (22.5%). In 1990, we estimated about 120.9 million COPD cases among urban dwellers (prevalence of 13.2%) and 106.3 million cases among rural dwellers (prevalence of 8.8%). In 2010, there were more than 230 million COPD cases among urban dwellers (prevalence of 13.6%) and 153.7 million among rural dwellers (prevalence of 9.7%). The overall prevalence in men aged 30 years or more was 14.3% (95% CI 13.3%–15.3%) compared to 7.6% (95% CI 7.0%–8.2%) in women. Conclusions Our findings suggest a high and growing prevalence of COPD, both globally and regionally. There is a paucity of studies in Africa, South East Asia and the Eastern Mediterranean region. There is a need for governments, policy makers and international organizations to consider strengthening collaborations to address COPD globally.
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              St. George's Respiratory Questionnaire: MCID.

              The SGRQ is a disease-specific measure of health status for use in COPD. A number of methods have been used for estimating its minimum clinically important difference (MCID). These include both expert and patient preference-based estimates. Anchor-based methods have also been used. The calculated MCID from those studies was consistently around 4 units, regardless of assessment method. By contrast, the MCID calculated using distribution-based methods varied across studies and permitted no consistent estimate. All measurements of clinical significance contain sample and measurement error. They also require value judgements, if not about the calculation of the MCID itself then about the anchors used to estimate it. Under these circumstances, greater weight should be placed upon the overall body of evidence for an MCID, rather than one single method. For that reason, estimates of MCID should be used as indicative values. Methods of analysing clinical trial results should reflect this, and use appropriate statistical tests for comparison with the MCID. Treatments for COPD that produced an improvement in SGRQ of the order of 4 units in clinical trials have subsequently found wide acceptance once in clinical practice, so it seems reasonable to expect any new treatment proposed for COPD to produce an advantage over placebo that is not significantly inferior to a 4-unit difference.
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                Author and article information

                Journal
                J Family Med Prim Care
                J Family Med Prim Care
                JFMPC
                Journal of Family Medicine and Primary Care
                Medknow Publications & Media Pvt Ltd (India )
                2249-4863
                2278-7135
                Sep-Oct 2018
                : 7
                : 5
                : 1047-1053
                Affiliations
                [1 ] Department of Health and FW, Government of Odisha, Bhubaneswar, Odisha, India
                [2 ] Department of Research, Indian Institute of Public Health, Public Health Foundation of India, Bhubaneswar, Odisha, India
                [3 ] Population Council, India Habitat Centre, New Delhi, India
                [4 ] Department of Research, Public Health Foundation of India, Gurugram, Haryana, India
                [5 ] Department of Psychiatry, Kalinga Institute of Medical Sciences, KIIT University, Bhubaneswar, Odisha, India
                [6 ] Department of Health Research, ICMR-Regional Medical Research Centre, Bhubaneswar, Odisha, India
                Author notes
                Address for correspondence: Dr. Sanghamitra Pati, Department of Health Research, ICMR-Regional Medical Research Centre, Chandrasekharpur, Bhubaneswar, Odisha - 751 023, India. E-mail: drsanghamitra12@ 123456gmail.com
                Article
                JFMPC-7-1047
                10.4103/jfmpc.jfmpc_37_18
                6259520
                d93841dc-5fc5-45ef-ba84-4fcc9993beb4
                Copyright: © 2018 Journal of Family Medicine and Primary Care

                This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

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                Original Article

                chronic obstructive pulmonary disease,health-related quality of life,st. george respiratory questionnaire,tertiary care hospital

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