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Biomedical subjects

Niels Chavannes

Publications and source records attributed to Niels Chavannes.

7 recordsLinked to original sources
PubMed2006

Chronic obstructive pulmonary disease in Brazilian primary care: Diagnostic competence and case-finding.

AIMS: The developing world is particularly at risk of an increasing health burden due to an increased prevalence of Chronic Obstructive Pulmonary Disease (COPD) secondary to increasing tobacco consumption. However, research is scarce. The objectives of this study were to assess the current competence for diagnosing COPD in primary care in a resource-limited setting in Brazil, and to develop a local patient profile for case-finding. METHODS: 34 general practitioners (GPs) in five areas of northern Brazil recruited adult patients with principal complaints of cough and/or shortness of breath who then had spirometry (n = 142). RESULTS: For the dichotomous variable 'COPD' the degree of agreement between GP diagnosis (n = 64, 18.3%) and spirometric outcome (n = 36, 25.4%) was poor, with Kappa = 0.055 (SE 0.087) and DOR = 1.35. False-positive and false-negative diagnosis proportions were 19.8% and 75%, respectively. Independent risk factors were 'smoking history of more than five pack years' and 'presence of both dyspnoea and cough'. It requires the testing of 2.2 smokers with more than five pack years to detect one patient at risk. CONCLUSIONS: COPD is a common yet underdiagnosed disease in Brazilian primary care. Spirometry improves diagnostic competence and case-finding substantially. If applied in a pre-selected high-risk population, we believe spirometry can be a cost-effective diagnostic tool for case-finding in the resource-limited setting. This study provides important baseline information for effective guideline implementation.

Adolescent↗
PubMed2006

Exacerbations of chronic obstructive pulmonary disease--a patients' perspective.

BACKGROUND: Exacerbations are now an important clinical variable for research into, and management of, chronic obstructive pulmonary disease (COPD). Emphasis is usually on reductions in the incidence of exacerbations and their impact on quality of life. For such research to be useful and comparable there needs to be a clearly defined understanding of what is meant by the term 'exacerbation'. The aim of this study was to explore the notion of COPD exacerbations from the viewpoint of patients who had recently suffered an exacerbation. METHODS: Using principles from grounded theory we conducted semi-structured, in-depth interviews with 23 volunteers from Denmark, the Netherlands and the UK who were identified as having had a COPD exacerbation. Interviews were recorded locally and translated into English for analysis. Notable themes were identified for each informant and their occurrences compared. RESULTS: Patients' reasons for consulting fell into four categories: 'frightening change'; 'change in sputum colour'; 'gradual deterioration'; and 'opportunistic diagnosis'. Most patients consulted frequently about their COPD, but did not afford their exacerbations the same degree of prominence as healthcare professionals (HCPs). CONCLUSIONS: These data provide a new way of thinking about COPD exacerbations, offering a greater understanding and classification of the reasons underlying the decision of COPD patients to consult with HCPs. They suggest that the patient perspective of exacerbations is more complex than previously thought. These findings could be applied to clinical practice and research, facilitating focussed decisions on COPD management.

Acute Disease↗
PubMed2004

The necessity for spirometry in the primary care management of COPD.

Implementation of spirometry in the primary care setting is controversial. Spirometry allows a unique non-invasive look into the functioning of the lungs, which can be both medically informative and of practical value. Respiratory complaints are among the most prevalent in primary care, while smoking rates remain globally high, illustrating the need for proper tools to investigate the possible causes of chronic pulmonary symptoms. Smoking cessation programs and disease management programs are the preferred treatment strategies for COPD; these rely on a valid spirometric diagnosis, as promoted by international COPD guidelines. In addition, involving the patient in treatment plans and explaining the detrimental effects of smoking can be greatly facilitated by the visual impact of a flow-volume curve, have promoted the use of spirometry. While there are difficulties in implementation of spirometry in primary care. Provided that quality standards of performance and training are sufficiently met, evidence suggests that spirometry is a valid, feasible and interpretable diagnostic tool in a primary care setting. COPD is a growing problem for society, which should not be underestimated, and with sufficient funding, adequate training and motivated healthcare workers, there is no good reason why spirometric testing cannot be widely implemented.

Journal Article↗
PubMed2004

Impact of spirometry on GPs' diagnostic differentiation and decision-making.

BACKGROUND: Spirometry is increasingly implemented in general practice, while the ability of general practitioners (GPs) to interpret flow volume curves (F-V curves) has been questioned. Furthermore, the role of spirometry in the GPs decision-making process has barely been studied. AIM: To compare the achievements of trained GPs in spirometric diagnosis with an expert consensus panel (1) and to assess the influence of spirometry on the GPs decision-making (2). METHOD: Twelve cases including a wide range of F-V curves were interpreted by 39 GPs as well as the expert panel. Diagnostic test characteristics were calculated using multi-level analysis and summarised by diagnostic odds ratios (DOR). Differences in decision-making indicators were expressed as odds ratios and 95% confidence intervals. RESULTS: Normal F-V curves (DOR 65.0) and obstructive F-V curves (DOR 48.9) were reasonably well diagnosed, while rare and mixed pathological patterns achieved considerably lower scores (DOR 3.8). Intermediate scores were obtained in the recognition of incorrect test manoeuvres (DOR 24.4). Spirometry influenced the GPs decision-making in reducing the number of alternative diagnoses (OR 0.266 [0.200, 0.353]), but also increased referral rates (7.26 [4.71, 11.2]) and the use of diagnostic prednisolone courses (4.55 [3.12, 6.64]) substantially. CONCLUSION: Trained GPs were able to differentiate between normal and obstructive disease patterns, while F-V curves suggestive of rare and mixed pathology were often missed. Spirometry seems to influence the decision-making process of the GP; whether this represents an initial or a more sustained effect remains to be evaluated in studies of daily primary care practice.

Adult↗
PubMed2002

Effects of physical activity in mild to moderate COPD: a systematic review.

Pulmonary rehabilitation has become an evidence-based treatment for patients with severe chronic obstructive pulmonary disease (COPD). However, large numbers of patients who suffer from mild to moderate COPD receive treatment from their general practitioners (GPs). To encourage compliance, advice given to patients in general practice should be clear, practical, and acceptable. This is particularly true of the advice that is given by GPs to improve their patients' physical condition by walking, cycling or swimming, as recommended by the Dutch College of General Practitioners in their guideline for the treatment of COPD. We performed a literature search on the effects of physical activity in patients with mild to moderate COPD on exercise tolerance, dyspnoea and quality of life (QOL). We also looked at the numbers of hospitalisation days and exacerbations, expressed as oral prednisolone courses. The literature search included Medline (1983 to 1999), EMBASE (1984 to 2000), and the Cochrane Library (2000). All hits were screened for subject and language and abstracts were selected on the basis of a protocol that included disease severity, hypothesis, outcome parameters, and control group. Review articles on physical exercise and COPD were examined and reference lists of selected articles were screened for relevant studies The broad literature search generated 4,968 articles and, after exclusion according to title and abstract, 35 original studies and 27 review articles were analysed. Of these, five original studies fitted the criteria and none of the review articles was selected. A positive influence of physical activity on exercise tolerance in mild to moderate COPD was reported in four out of five studies. There was no clear effect on dyspnoea or QOL, probably because of the low numbers of subjects. No studies that addressed the number of hospitalisation days or prednisolone courses as outcomes were included. Physical exercise training (usually as part of a package of rehabilitation) can improve the fitness of patients with mild or moderate COPD, but it has not been shown to benefit QOL or dyspnoea significantly, or indeed long-term disease progression.

Dyspnea↗