The impact of exercise on activities of daily living and quality of life: a primary care physician's perspective.
*Activities of Daily Living; *Physician's Role; *Primary Health Care; *Quality of Life; Aged; Chronic Obstructive/physiopathology/*therapy; Exercise/*physiology; Female; Humans; Male; Middle Aged; Pulmonary Disease
Evaluation of the environment of patients is an important function of the primary care physician and assists the caregiver in providing an improved quality of life for one's patients. In addition to data collection and therapy, assessment of both the basic and instrumental activities of daily living is a primary concern, especially in patients with chronic diseases such as chronic obstructive pulmonary disease. This article presents the perspective and observation of a primary care physician's management of chronic obstructive pulmonary disease and will give examples of how combined pulmonary rehabilitation and medication improved the quality of life for three patients and show how activities of daily living and quality of life may be seen as a continuum in chronic obstructive pulmonary disease.
Belfer Mark H
COPD
2007
2007-09
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1080/15412550701521993" target="_blank" rel="noreferrer noopener">10.1080/15412550701521993</a>
Over diagnosis of chronic obstructive pulmonary disease in an underserved patient population.
Adult; Female; Humans; Male; Middle Aged; Retrospective Studies; Risk Factors; Predictive Value of Tests; Prevalence; *Diagnostic Errors; *Medically Underserved Area; Ohio/epidemiology; *Vulnerable Populations; *Spirometry; Bronchodilator Agents/administration & dosage; Cholinergic Antagonists/administration & dosage; chronic obstructive pulmonary disease; COPD; Forced Expiratory Volume; Lung/drug effects/*physiopathology; Medically Uninsured; misdiagnosis; over diagnosis; Smoking/adverse effects/epidemiology; spirometry; underserved; uninsured; Vital Capacity; Administration; Pulmonary Disease; Inhalation; Chronic Obstructive/*diagnosis/drug therapy/epidemiology/physiopathology
INTRODUCTION: While cross-national studies have documented rates of chronic obstructive pulmonary disease (COPD) misdiagnosis among patients in primary care, US studies are scarce. Studies investigating diagnosis among uninsured patients are lacking. OBJECTIVE: The purpose of this study is to identify patients who are over diagnosed and thus, mistreated, for COPD in a federally qualified health center. METHODS: A descriptive study was conducted for a retrospective cohort from February 2011 to June 2012. Spirometry was performed by trained personnel following American Thoracic Society recommendations. Patients were referred for spirometry to confirm previous COPD diagnosis or to assess uncontrolled COPD symptoms. Airway obstruction was defined as a forced expiratory volume in the first second of expiration (FEV1) to forced vital capacity ratio less than 0.7. Reversibility was defined as a postbronchodilator increase in FEV1 greater than 200 mL and greater than 12%. RESULTS: Eighty patients treated for a previous diagnosis of COPD (n = 72) or on anticholinergic inhalers (n = 8) with no COPD diagnosis were evaluated. The average age was 52.9 years; 71% were uninsured. Only 17.5% (14/80) of patients reported previous spirometry. Spirometry revealed that 42.5% had no obstruction, 22.5% had reversible obstruction, and 35% had non-reversible obstruction. CONCLUSION: Symptoms and smoking history are insufficient to diagnose COPD. Prevalence of COPD over diagnosis among uninsured patient populations may be higher than previously reported. Confirming previous COPD diagnosis with spirometry is essential to avoid unnecessary and potentially harmful treatment.
Ghattas Christian; Dai Allen; Gemmel David J; Awad Magdi H
International journal of chronic obstructive pulmonary disease
2013
1905-07
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.2147/COPD.S45693" target="_blank" rel="noreferrer noopener">10.2147/COPD.S45693</a>