Comparison between Clinic attendance and unattended treatment in patients with COPD and Asthma. Soidao Hospital, 2015
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1 Comparison between Clinic attendance and unattended treatment in patients with COPD and Asthma Soidao Hospital, 2015 November 19, 2015
2 Editors Meteera Ariyadeh Nawaporn Simarangsan Teerachai Manak 6 th Year Medical student, Prapokklao Hospital Advisers Thawatt Kongkalai MD, Soidao Hospital Patpong Udompat MD, Prapokklao Hospital Urai Poonawagul MD, Prapokklao Hospital
3
4 What is COPD? persistent airflow limitation that usually progressive and associated with an enhanced chronic inflammatory response to noxious particles or gases. Symptoms of COPD are breathlessness, or a 'need for air', excessive sputum production, and a chronic cough
5 It is an under-diagnosed, life threatening lung disease that may progressively lead to death. The more familiar terms of chronic bronchitis and emphysema are no longer used
6 Causes of COPD Smoking Indoor air pollution Outdoor air pollution Occupational dusts and chemicals (vapours, irritants, and fumes) Frequent lower respiratory infections during childhood.
7 Burden of COPD The fourth leading cause of death in the world More than 3 million people died of COPD in 2012 (6% of all deaths globally that year) WHO predicts that COPD will become the third leading cause of death worldwide by More than 90% of COPD deaths occur in low- and middle-income countries.
8 COPD is not curable, but treatment can slow the progress of the disease. Treatment of COPD is now aimed at immediately relieving and reducing impacts of symptoms, as well as reducing the risk of future exacerbations. Appropriate pharmacologic therapy can reduced COPD symptoms, exacerbation, and improve health status
9 Asthma
10 What is asthma? A chronic disease characterized by recurrent attacks of breathlessness and wheezing, vary in severity and frequency from person to person. During an asthma attack, the lining of the bronchial tubes swell, causing the airways to narrow and reducing the flow of air into and out of the lungs.
11 It is a common disease among children. Medication can control asthma. Avoiding asthma triggers can also reduce the severity of asthma. Appropriate management of asthma can enable people to enjoy a good quality of life.
12 Causes of asthma The fundamental causes of asthma are not completely understood. The strongest risk factors for developing asthma are a combination of genetic predisposition with environmental exposure to inhaled substances and particles
13 such as: Indoor allergens (for example, house dust mites in bedding, carpets and stuffed furniture, pollution and pet dander) Outdoor allergens (such as pollens and moulds) Tobacco smoke Chemical irritants in the workplace Air pollution.
14 Burden of Asthma Some 235 million people currently suffer from asthma.(november 2013) Most asthma-related deaths occur in low- and lowermiddle income countries. Asthma has a relatively low fatality rate compared to other chronic diseases, but failure to use appropriate medications or to adhere to treatment can lead to death.
15 Twenty leading causes of DALY (thousands), 2004 Note * DALY rate per 1,000 population Burden of disease in Thailand: changes in health gap between 1999 and 2004 (
16 Objectives To compare Exacerbation, Re-visit and Re-admission between Clinic attendance and unattended treatment in patients with COPD and Asthma
17 Study design Analytic study: Case-control study Duration: October 1,2014 September 30,2015
18 COPD clinic attendance COPD with AE Revisit Admission Readmission COPD patient Unattended group COPD with AE Revisit Admission Readmission
19 COPD 180/593 COPD clinic attendance 129/502 COPD with AE 86/307 21/31 Revisit 16/46 2/2 Admission 80/141 30/41 Readmission 7/10 0/0 Unattended group 51/91 Number of patient/ Event per year
20 Bar graph show the comparison of COPD AE between COPD clinic attendance and unattended group 80.00% 70.00% 60.00% 66.67% 61.16% 50.00% 40.00% 30.00% 41.18% 34.00% COPD clinic attendance Unattended group 20.00% 10.00% 0.00% Patient experienced COPD with AE COPD with AE event per year Odd ratio = 2.86 Odd ratio = % CI = % CI = P value = P value = <0.0001
21 Bar graph show the comparison of the Re-visit between COPD clinic attendance and unattended group 14.00% 12.00% 12.40% 10.00% 9.16% 8.00% 6.00% 4.00% 2.00% 3.90% 2.20% COPD clinic attendance Unattended group 0.00% Patient revisited Revisit per year Odd ratio = 3.47 Odd ratio = % CI = % CI = P value = 0.11 P value = 0.04
22 Bar graph show the comparison of the admission between COPD clinic attendance and unattended group 70.00% 60.00% 62.00% 58.80% 50.00% 40.00% 30.00% 20.00% 10.00% 28.90% 45.06% COPD clinic attendance Unattended group 0.00% Patient admitted in hospital Odd ratio = % CI = P value = 0.69 Admission per year Odd ratio = % CI = P value =
23 Bar graph show the comparison of re-admission between COPD clinic attendance and unattended group 6.00% 5.43% 5.00% 4.00% 3.00% 2.00% 1.99% COPD clinic attendance unattended group 1.00% 0.00% Patient readmitted 0.00% 0.00% Readmission per year Odd ratio = % CI = P value = 0.21 Odd ratio = % CI = P value = 0.35
24 Asthma clinic attendance Asthmatic attack Revisit Admission Readmission Asthmatic patient Unattended group Asthmatic attack Revisit Admission Readmission
25 ASTHMA 208/477 Asthma clinic attendance 121/351 Asthmatic attack 77/179 50/94 Revisit 17/23 4/14 Admission 38/54 18/20 Readmission 0/0 3/5 Unattended group 87/126 Number of patient/ event per year
26 Bar graph show the comparison of asthmatic attack between asthma clinic attendance and unattended group 80.00% 70.00% 60.00% 50.00% 40.00% 30.00% 20.00% 10.00% 0.00% 63.64% 57.47% Patient experienced asthmatic attack Odd ratio = % CI = P value = % 74.60% Asthmatic attack event per year Odd ratio = % CI = P value = <0.001 Asthma clinic attendance Unattended group
27 Bar graph show the comparison of the revisit between asthma clinic attendance and unattended group 16.00% 14.00% 14.05% 12.00% 11.11% 10.00% 8.00% 6.00% 4.60% 6.55% Asthma clinic attendance Unattended group 4.00% 2.00% 0.00% Patient revisited Revisit per year Odd ratio = % CI = P value = 0.03 Odd ratio = % CI = P value = 0.1
28 Bar graph show the comparison of the admission between asthma clinic attendance and unattended group 35.00% 31.40% 30.00% 25.00% 20.00% 15.00% 10.00% 20.69% 15.38% 15.87% Asthma clinic attendance Unattended group 5.00% 0.00% Patient admitted in hospital Admission per year Odd ratio = % CI = P value = 0.09 Odd ratio = % CI = P value = 0.9
29 Bar graph show the comparison of readmission between asthma clinic attendance and unattended group 4.50% 4.00% 3.50% 3.44% 3.97% 3.00% 2.50% 2.00% 1.50% Asthma clinic attendance Unattended group 1.00% 0.50% 0.00% 0.00% 0.00% Patient readmitted Readmission per year Odd ratio = % CI = P value = 0.13 Odd ratio = % CI = P value = 0.02
30 revisit ของผ ป วย COPD ในกล ม clinic และ non-clinic copd clinic attendance Unattended group
31 readmission ของผ ป วย COPD ในกล ม clinic และ non-clinic copd clinic attendance Unattended group
32 revisit ของผ ป วย asthma ในกล ม clinic และ non-clinic Asthma clinic attendance Unattended group 0 0 0
33 readmission ของผ ป วย asthma ในกล ม clinic และ non-clinic asthma clinic attendance Unattended group
34 DISCUSSION
35 Discussion: COPD OR (clinic/non-clinic) 95%CI P value COPD c AE event < COPD c AE patient COPD revisit event COPD admission better-controlled COPD in non-clinic group.
36 Discussion: Asthma asthmatic attack event Asthma revisit patient Asthma readmit event OR (clinic/non-clinic) 95%CI P value < better-controlled asthma in clinic group.
37 Discussion: COPD revisit clinic Non-clinic คนท บ านส บบ หร Upper respiratory tract infection air pollutant คนท บ านส บบ หร, ปฏ เสธการร กษา Upper respiratory tract infection Discussion: COPD readmission clinic Infection, ต วโรคแย คว นเผาขยะ คว นบ หร ในบ าน, active smoker Non-clinic
38 Discussion: Asthma revisit clinic Non-clinic แย ลงเอง Upper respiratory tract infection คนท บ านส บบ หร แย ลงเอง, คนท บ านส บบ หร, loss f/u Upper respiratory tract infection Discussion: Asthma readmission clinic Non-clinic infection กล บบ านโดยท อาการไม ด, ขาดยา
39 Limitation Hos.xp >> not known the true cause of readmission/ revisit/ acute exacerbation Unknown %peak flow (asthma patient) Revisit for other causes Confounder Poor-controlled COPD patient >> assigned to COPD clinic Unknown compliance
40 Question?
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