Biomedical subjects

David G Tinkelman

Publications and source records attributed to David G Tinkelman.

8 recordsLinked to original sources

PubMed2006

Scoring system and clinical application of COPD diagnostic questionnaires.

OBJECTIVES: In most primary care settings, spirometric screening of all patients at risk is not practical. In prior work, we developed questionnaires to help identify COPD in two risk groups: (1) persons with a positive smoking history but no history of obstructive lung disease (case finding), and (2) patients with prior evidence of obstructive lung disease (differential diagnosis). For these questionnaires, we now present a scoring system for use in primary care. METHODS: Scores for individual questions were based on the regression coefficients from logistic regression models using a spirometry-based diagnosis of obstruction as the reference outcome. Receiver operator characteristic analysis was used to determine performance characteristics for each questionnaire. Several simplified scoring systems were developed and tested. RESULTS: For both scenarios, we created a scoring system with two cut points intended to place subjects within one of three zones: persons with a high likelihood of having obstruction (high predictive value of a positive test result); persons with a low likelihood of obstruction (high predictive value of a negative test result); and an intermediate zone. Using these scoring systems, we achieved sensitivities of 54 to 82%, specificities of 58 to 88%, positive predictive values of 30 to 78%, and negative predictive values of 71 to 93%. CONCLUSIONS: These questionnaires can be used to help identify persons likely to have COPD among specific risk groups. The use of a simplified scoring system makes these tools beneficial in the primary care setting. Used in conjunction with spirometry, these tools can help improve the efficiency and accuracy of COPD diagnosis in primary care.

Adult↗

PubMed2005

Symptom-based questionnaire for differentiating COPD and asthma.

BACKGROUND: Many patients with obstructive lung disease (OLD) carry an inaccurate diagnostic label. Symptom-based questionnaires could identify persons likely to need spirometry. OBJECTIVES: We prospectively tested questions derived from a comprehensive literature review and an international Delphi panel to help identify chronic OLD (COPD) in persons with prior evidence of OLD. METHODS: Subjects were recruited via random mailing to primary-care practices in Aberdeen, Scotland, and Denver, Colorado. Persons aged 40 and older reporting any prior diagnosis of OLD or any respiratory medications in the past year were enrolled. Participants answered 54 questions covering demographics and symptoms and underwent spirometry with reversibility testing. A study diagnosis of COPD was defined by fixed airway obstruction as measured by post-bronchodilator FEV(1)/FVC <0.70. We examined ability of individual questions in a multivariate framework to discriminate between persons with and without the study diagnosis of COPD. RESULTS: 597 persons completed all investigations and proceeded to analysis. The list of 54 questions yielded 52 items for analyses, which was reduced to 19 items for entry into a multivariate regression model. Nine items had significant relationships with the study diagnosis of COPD, including increased age, pack-years, worsening cough, breathing-related disability or hospitalization, worsening dyspnea, phlegm quantity, cold going to the chest, and receipt of treatment for breathing. Individual items yielded odds ratios ranging from 0.33 to 20.7. This questionnaire demonstrated a sensitivity of 72.0 and a specificity of 82.7. CONCLUSIONS: A short, symptom-based questionnaire identifies persons more likely to have COPD among persons with prior evidence of OLD.

Adult↗

PubMed2005

Symptom-based questionnaire for identifying COPD in smokers.

BACKGROUND: Symptom-based questionnaires may enhance chronic obstructive pulmonary disease (COPD) screening in primary care. OBJECTIVES: We prospectively tested questions to help identify COPD among smokers without prior history of lung disease. METHODS: Subjects were recruited via random mailing to primary care practices in Aberdeen, UK, and Denver, Colo., USA. Current and former smokers aged 40 or older with no prior respiratory diagnosis and no respiratory medications in the past year were enrolled. Participants answered questions covering demographics and symptoms and then underwent spirometry with reversibility testing. A study diagnosis of COPD was defined as fixed airway obstruction as measured by post-bronchodilator FEV(1)/FVC <0.70. We examined the ability of individual questions in a multivariate framework to correctly discriminate between persons with and without COPD. RESULTS: 818 subjects completed all investigations and proceeded to analysis. The list of 54 questions yielded 52 items for analysis, which was reduced to 17 items for entry into multivariate regression. Eight items had significant relationships with the study diagnosis of COPD, including age, pack-years, body mass index, weather-affected cough, phlegm without a cold, morning phlegm, wheeze frequency, and history of any allergies. Individual items yielded odds ratios ranging from 0.23 to 12. This questionnaire demonstrated a sensitivity of 80.4 and specificity of 72.0. CONCLUSIONS: A simple patient self-administered questionnaire can be used to identify patients with a high likelihood of having COPD, for whom spirometric testing is particularly important. Implementation of this questionnaire could enhance the efficiency and diagnostic accuracy of current screening efforts.

Adult↗

PubMed2005

Chronic obstructive pulmonary disease in patients under age 65: utilization and costs from a managed care sample.

OBJECTIVES: Chronic obstructive pulmonary disease (COPD) affects all adult age groups, not just elderly males. We assessed the health care utilization and cost impact of COPD in different age groups. METHODS: We compared burden of illness, utilization, and charges for younger versus older COPD patients and versus age- and gender-matched controls. RESULTS: A total of 16.9% of patients with COPD were under age 65. Patients with COPD (n=19,338) had higher comorbidity than age-matched controls (n=94,384) across all age groups. Younger patients with COPD had lower comorbidity scores and fewer hospitalizations but more COPD-related emergency services than older patients with COPD. Average COPD-related charges were higher for younger patients. Facility-based care was the cost driver across all age groups. CONCLUSIONS: COPD is a burden to younger individuals in the workforce, who are likely to be enrolled in a commercial health plan.

Age Factors↗

PubMed2003

Efficacy and safety of budesonide inhalation powder (Pulmicort Turbuhaler) during 52 weeks of treatment in adults and children with persistent asthma.

BACKGROUND: Inhaled corticosteroids are the agents of choice for treating persistent asthma. OBJECTIVE: To evaluate the long-term efficacy and safety of budesonide inhalation powder (Pulmicort Turbuhaler) in patients with mild to severe persistent asthma. METHODS: Patients (n=1133) received open-label budesonide (dose range, 100-800 microg b.i.d.) for 52 weeks following 2 weeks to 5 months of treatment in one of four double-blind, placebo-controlled studies. Patients, identified before the double-blind studies, included adults (n=249) not receiving corticosteroids, adults (n=384) and children (n=356) previously maintained on inhaled corticosteroids, and adults (n=144) previously maintained on oral corticosteroids. RESULTS: Mean forced expiratory volume in 1 sec was 68.2% of predicted normal (n=1133) at baseline (mean from two visits before randomization), 74.4% (n=1132) at the end of double-blind treatment, 81.3% (n=971) at week 52, and 80.1% (n=1125) at last observation (including patients who discontinued early). Sixty-four patients maintained on oral corticosteroids before double-blind treatment entered the open-label study off oral corticosteroids, 58 of whom (91%) remained oral corticosteroid-free throughout the study. There was no evidence of basal or cosyntropin-stimulated hypothalamic-pituitary-adrenal axis function suppression, and the most commonly occurring adverse events were respiratory infection, sinusitis, and pharyngitis. CONCLUSIONS: During this 52-week, open-label study, budesonide maintained the improved pulmonary function and decreased oral corticosteroid use observed during previous double-blind treatment and was well tolerated, supporting its long-term use in adults and children with mild to severe persistent asthma.

Administration, Inhalation↗

PubMed2002

Relationships between self-reported asthma utilization and patient characteristics.

BACKGROUND: Identifying asthmatic individuals most likely to utilize medical care in the future will help to direct intervention and medical resources; however, there are currently limited models for future utilization. OBJECTIVE: This study investigated the relationship between patient characteristics and medical utilization, using an asthma disease management patient population. METHODS: We analyzed a sample of 1412 adults, enrolled for 6 months in an asthma disease management program, for relationships with utilization. Individuals answered demographic, socioeconomic, and medical questions via telephonic contact upon enrollment. Follow-up regarding medical utilization occurred during the subsequent 6 months. Relationships between utilization and enrollment answers were statistically modeled. RESULTS: Oral steroid bursts, day and night symptom frequencies, age, gender, education level, and employment status all had a significant relationship to medical utilization. Those individuals who had used oral steroids 6 months prior to enrollment, patients with more than five night-time asthma symptoms per month, and those with "continuous" day symptoms were more likely to report utilization. Those patients under 44 years old, females, those who were not high school graduates, and patients who defined themselves as unemployed because of their asthma were also more likely to report utilization. While those unemployed because of asthma were already more likely to report utilization, individuals in the 45+ age category were more likely than those 18-44. CONCLUSIONS: Identifying asthma patients likely to utilize medical care is feasible, although more investigation is needed to demonstrate applicability to a general asthma population.

Adolescent↗

PubMedDate not supplied

Misdiagnosis of COPD and asthma in primary care patients 40 years of age and over.

Chronic obstructive pulmonary disease (COPD) is often misdiagnosed as asthma, leading to inappropriate treatment and suboptimal patient outcomes. As part of a prospective study of patients with a history consistent with obstructive lung disease, we compared prior diagnostic labels with a study diagnosis based on spirometric results. We enrolled persons 40 years of age or older with prior diagnoses or medications consistent with obstructive lung disease. Patients were recruited via random mailing to primary care practices in Aberdeen, Scotland, and Denver, Colorado. Prior diagnoses of chronic bronchitis or emphysema (CBE) and asthma were reported by the subjects. Participants underwent pre- and post-bronchodilator spirometry. A study diagnosis of COPD was defined using post-bronchodilator forced expiratory volume in 1 second/forced vital capacity (FEV(1)/FVC) < 0.70. Spirometric examination was complete in 597 patients, of whom 235 (39.4%) had a study diagnosis of COPD. Among subjects with a spirometry-based study diagnosis of COPD, 121 (51.5%) reported a prior diagnosis of asthma without concurrent CBE diagnosis, 89 (37.9%) reported a prior diagnosis of CBE, and 25 (10.6%) reported no prior diagnosis of obstructive lung disease. Despite the availability of consensus guideline diagnostic recommendations, diagnostic confusion between COPD and asthma appears common. Increased awareness of the differences between the two conditions is needed to promote optimal patient management and treatment.

Adrenal Cortex Hormones↗

PubMedDate not supplied

Operating a sustainable disease management program for chronic obstructive pulmonary disease.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is one of our nation's most rapidly growing chronic health conditions. It is estimated that over 16 million individuals are diagnosed with COPD (Friedman & Hilleman, 2001). In addition, another 16 million are misdiagnosed as asthma or not diagnosed at all. COPD is a condition that affects the working-age as well as the elderly. Despite the high mortality rate, COPD is a treatable and modifiable condition. Disease management programs (DMPs) for asthma are a common initiative within many health insurance plans and integrated delivery networks. Similar initiatives are not as common for COPD. This article will highlight the National Jewish Medical and Research Center's COPD DMP interventions and outcomes. OBJECTIVE: To outline interventions and operational strategies critical in developing and operating a sustainable and effective disease management program for COPD. CONCLUSIONS: Disease Management is an effective model for managing individuals with COPD. Applying a case management model that includes (1) risk-identification and stratification; (2) education and empowerment regarding self-monitoring and management; (3) lifestyle modification; (4) communication and collaboration amongst patients, healthcare providers, and case managers to enhance the treatment plan; (5) providing after-hours support; and (6) monitoring care outcomes is crucial. Applying these interventions in a credible manner will improve the quality of life and quality of care delivered to individuals with mild, moderate, severe, and very severe COPD. Additionally, these interventions can significantly reduce utilization events.

Aged↗