Original papers
Conventional forceps or hot biopsy: comparative study of two methods in diagnosis of endobronchial lesions
Hamidreza Jabbari, MD(a), Mohammad Fakhri, MD (b, c), Mojtaba Lotfaliani, MD (b), Arda Kiani, MD (c)a) Tracheal Diseases Research Center, National Research Institute of Tuberculosis and Lung Disease, Shahid Beheshti University of Medical Sciences, Tehran, Iran. (b) School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran. (c) Chronic Respiratory Disease Research Center, National Research Institute of Tuberculosis and Lung Disease, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Estimation of direct medical costs of chronic obstructive pulmonary disease over 12 months
Irina Strâmbu, Ioan Paul StoicescuUniversitatea de Medicină şi Farmacie „Carol Davila” Bucureşti
Estimation of direct medical costs of chronic obstructive pulmonary disease over 12 months. Chronic obstructive pulmonary disease (COPD) is a prevalent and expensive disease, the burden of disease involving the patient, the family and also the society. Aim. Estimation of direct medical costs of COPD in one patient, by adding the costs of all the medical events related to the disease over one year: exacerbations admitted to hospital or ambulatory, chronic treatments, follow-ups. Data were obtained using a questionnaire applied to 85 COPD patients approached in "Marius Nasta" Institute of Pulmonology in 2004. Results. 85 patients were questionned, mean age was 62.5 years, mean FEV1 was 36.65% predicted (72 patients were GOLD stages III and IV). In the previous year they had a mean of 2.2 exacerbations. They received various chronic treatments (bronchodilators, inhaled steroids, combination therapy) but not constant, between 3 and 8 months per year. The direct medical costs of COPD per patient in one year were estimated at 5243.4 lei (1456.5 €), 83% of costs represented the exacerbations (82.5% hospital admittances) and 17% the stable disease costs (16.5% chronic medication). Long term oxygen therapy, transportation, indirect costs were not included. Conclusions. Even if the costs are underestimated, COPD remains an expensive disease especially due to hospital exacerbations. Cost-effective interventions are needed for preventing exacerbations, redistributing resources and improving patients quality of life.
Keywords: COPD, burden of disease, direct medical costs, exacerbation
Article
Benefits of a 7-week outpatient pulmonary rehabilitation program in COPD patients
Alina Croitoru1, Diana Ioniţă2, Carmen Stroescu1, Irina Pele1, Daniela Gologanu3, Andreea Dumitrescu1, Lucia Marinescu1, Dana Anghelescu1, Miron Alexandru Bogdan1Benefits of a 7-week outpatient pulmonary rehabilitation program in COPD patients
Respiratory rehabilitation programs (RR) are essential tools in the management of COPD. Aim: We present the results of a 7-week outpatient rehabilitation program in terms of dyspnea, exercise tolerance and quality of life. Material and method: The following parameters were evaluated before and after RR: dyspnea (mMRC scale), pulmonary function (FEV1, RV - residual volume), exercise tolerance (6MWT - 6 minutes walk test, CPET - cardiopulmonary exercise test), quality of life (SGRQ questionnaire). The RR program was outpatient, hospital based (7 weeks, 3 sessions/ week) and included: exercise training, therapeutic education, and psychological support. Results: 25 patients, COPD stage II-IV GOLD (mean FEV1 44.5 ± 13% predicted), mean age 60.4 ±12 years, 7 females, average BMI 27.14±4 kg/m2, average RV residual volume 221.55±86% predicted. Mean 6MWT distance: 407.48 ± 84 m and mean maximum power (Pmax) obtained on CPET: 75.67±30 Watts. All patients were symptomatic with significant dyspnea (3.06±0.7 on mMRC scale) and showed a significant impairment of quality of life: SGRQ score 46.23±14. At the end of RR program: dyspnea decreased with 0.67 points on mMRC scale (p = 0.000), 6MWT distance increased with 58.5 m (p = 0.001), Pmax obtained during CPET increased with 11.2 W, without reaching statistical significance (p> 0.05). SGRQ score decreased by 5.59 points (p = 0.02). There were no significant improvements in FEV1 and RV values (p> 0.05). Conclusion: In our COPD patients, the 7 week outpatient rehabilitation program was effective, leading to improvement of symptoms, exercise tolerance and quality of life.
Keywords: COPD, rehabilitation, exercise tolerance