Is er een verschil in de gezondheidsstatus van COPD patiënten tussen verschillende seizoenen?

Panman, S. (Simone) (2013) Is er een verschil in de gezondheidsstatus van COPD patiënten tussen verschillende seizoenen? thesis, Medicine.

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Abstract

Introduction: Chronic Obstructive Pulmonary Disease (COPD) is a generic term for non-reversible obstructive diseases of the airways. It is expected by the WHO that it will be the third highest cause of death worldwide in 2030. It is characterized by a persistent airflow limitation which is progressive most of the time and is associated with an increased inflammatory response in de lungs. The health status is a way of measuring the direct influence of the disease on functional status, symptoms and well-being of the patient. Health status is used to get an indication of the condition of the patient and also to find out how the disease is experienced by the patient. Outside the pulmonary manifestations it also depends on the extra-pulmonary symptoms of COPD and the exacerbation frequency. Seasons influence the exacerbation frequency of the COPD patients and it is expected that the health status will be influenced by the different seasons autumn and spring. Aim: The aim of this study is to investigate if there is a difference in the health status of COPD patients between the different seasons, autumn and spring. Methods: The current study is set amidst the IMI PROactive study and is divided in baseline, short-term follow-up and a 6 month follow-up. During the visits the health status was measured using the CCQ and CAT, pulmonary function tests have been done, the strength of the quadriceps and endurance were examined and the fat(free)mass and BMI have been mapped. The statistical analysis for all the non-parametric data has been done with the wilcoxon signed rank test, parametric data has been analysed with the paired t-test and correlations have been calculated with the spearmans correlation coefficient and the intraclass correlation coefficient. MCID values have been analyzed on both group level and patient level. Results: At baseline 36 patients were admitted in the study(mean 64,28 year,63,90% men and 91,6% mild to moderate GOLD class), during the 6 months follow-up this number decreased to 27 patients. There was no sign of selective attrition. A significant difference has been found between autumn and the spring for the CCQ (p=0,031) as well as the CAT (p=0,049), with an mean outcome in the autumn respectively spring for the CCQ of 1,46 and 1,34 and for the CAT of 11,45 and 10,41. On group level the MCID was neither exceeded for the CCQ nor for the CAT. On patient level there are 15 patients who exceed the MCID of the CCQ from which 11 had a more positive outcome in the spring than in the autumn. For the CAT there were seven patients who exceed the MCID, from whom five scored more positive in the spring. The secondary measurements did not show any difference on a significant level on for instance the areas of pulmonary function, endurance, quality of life and dyspnea. Conclusion: This study shows a significant difference in health status of COPD patients between the different seasons, autumn and spring. In which the patients show a better health status in the spring than during autumn. As a result of the many variables affected by the different seasons and a lack of literature on standard seasonal variation of the health status, it is difficult to find the cause of the measured difference in health status. Although not researched in this study, the common cold can be a cause of an increase in exacerbation frequency in the autumn possible causing a decline in health status. The lesson to be learned out of this study is that there is a variation in the health status during the year. The patients report a better health status in the spring than during autumn. Perhaps the general practitioner could indent on this variation and consider for example the stronger feelings of anxiety for an attack of dyspnea. Because of this the general practitioner will adapt to the needs of the CODP patient, who will receive adequate counsel in the primary care.

Item Type:	Thesis (Thesis)
Supervisor name:	Jong, Msc. C. de and Oosterom, Mw. H. and Molen, Prof. Dr. T. van der
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 11:05
Last Modified:	25 Jun 2020 11:05
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/2478

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