Das Patienten-Questionnnaire „Monitoring of Exacerbation Probability (MEP)“

Zusammenfassung

Exazerbationen bestimmen das Krankheitsgeschehen COPD in oft entscheidender Weise, wohingegen ihre Detektion und Dokumentation in der Versorgung bisher nicht befriedigend gelöst ist. Hierfür wurde ein einfaches kurzes Patienten-Questionnaire mit maximal fünf positiven Antworten entwickelt und evaluiert. Werte von 2 und mehr positiven Antworten verstärken das Signal für eine Exazerbation, während das Vorliegen nur 1 positiven Antwort im Sinne einer möglichen, nicht jedoch einer wahrscheinlichen Exazerbation gewertet werden darf. Das MEP ist gut geeignet für eine fortlaufende Dokumentation in Praxis-Verwaltungssystemen (PVS).

Abstract

Exacerbations determine the disease process in COPD often decisively, whereas their detection and documentation has not been established satisfactory yet. For this purpose, a simple short Patient Questionnaire with a maximum of five positive answers was developed and evaluated. Values of 2 or more positive responses amplify the signal for an exacerbation, while with the presence of only 1 positive response a potential, but not a likely exacerbation must be considered. The MEP is well suited for a continuous documentation in computer-based administration systems.

• Literatur

• 1 Soler-Cataluna JJ, Martinez-Garcia MA, Roman Sanchez P et al. Severe acute exacerbations and mortality in patients with chronic obstructive pulmonary disease. Thorax 2005; 60: 925-931
• 2 Suissa S, Dell'Aniello S, Ernst P. Long-term natural history of chronic obstructive pulmonary disease: severe exacerbations and mortality. Thorax 2012; 67: 957-963
• 3 Donaldson GC, Seemungal TA, Bhowmik A et al. Relationship between exacerbation frequency and lung function decline in chronic obstructive pulmonary disease. Thorax 2002; 57: 847-852
• 4 Makris D, Moschandreas J, Damianaki A et al. Exacerbations and lung function decline in COPD: new insights in current and ex-smokers. Respir Med 2007; 101: 1305-1312
• 5 Hurst JR, Vestbo J, Anzueto A et al. Susceptibility to exacerbation in chronic obstructive pulmonary disease. N Engl J Med 2010; 363: 1128-1138
• 6 Hurst JR, Donaldson GC, Quint JK et al. Temporal clustering of exacerbations in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2009; 179: 369-374
• 7 Dalal AA, Patel J, D'Souza A et al. Impact of COPD Exacerbation Frequency on Costs for a Managed Care Population. J Manag Care Spec Pharm 2015; 21: 575-583
• 8 Nowak D, Dietrich ES, Oberender P et al. [Cost-of-illness Study for the Treatment of COPD in Germany]. Pneumologie 2004; 58: 837-844
• 9 Targowski T, Jahnz-Rozyk K, From S et al. [Relationship between disease severity, smoking index age and direct costs of hospital treatment of COPD exacerbations]. Pneumonol Alergol Pol 2005; 73: 32-35
• 10 Global Strategy for the Diagnosis, Managemenmt and Prevention of COPD. www.goldcopd.org updated 2015. 2015
• 11 Hellmann A. Betreuung von COPD Patienten unter Alltagsbedingungen in der pneumologischen Praxis. Berufspolitische Mitteilungen des BdP 2014; 3: 24-25
• 12 Hering T, Andres J. Die Klassifikationen GOLD I–IV vs. GOLD A–D in der Alltagsversorgung. Pneumologie 2015; 69: 645-653
• 13 Effing TW, Kerstjens HA, Monninkhof EM et al. Definitions of exacerbations: does it really matter in clinical trials on COPD?. Chest 2009; 136: 918-923
• 14 Hurst JR, Wedzicha JA. What is (and what is not) a COPD exacerbation: thoughts from the new GOLD guidelines. Thorax 2007; 62: 198-9
• 15 Jones PW, Lamarca R, Chuecos F et al. Characterisation and impact of reported and unreported exacerbations: results from ATTAIN. Eur Respir J 2014; 44: 1156-1165
• 16 Magnussen H, Disse B, Rodriguez-Roisin R. Withdrawal of inhaled glucocorticoids and exacerbations of COPD. N Engl J Med 2014; 371: 1285-1294
• 17 Moll K, Sun SX, Ellis JJ. Impact of roflumilast on exacerbations of COPD, health care utilization, and costs in a predominantly elderly Medicare Advantage population. Int J Chron Obstruct Pulmon Dis 2015; 10: 565-576
• 18 Seemungal TA, Wilkinson TM, Hurst JR. Long-term erythromycin therapy is associated with decreased chronic obstructive pulmonary disease exacerbations. Am J Respir Crit Care Med 2008; 178: 1139-1147
• 19 Albert RK, Connett J, Bailey WC. Azithromycin for prevention of exacerbations of COPD. N Engl J Med 2011; 365: 689-698
• 20 Agusti A, Anto JM, Auffray C et al. Personalized respiratory medicine: exploring the horizon, addressing the issues. Summary of a BRN-AJRCCM workshop held in Barcelona on June 12, 2014. Am J Respir Crit Care Med 2015; 191: 391-401
• 21 McDonald VM, Higgins I, Wood LG et al. Multidimensional assessment and tailored interventions for COPD: respiratory utopia or common sense?. Thorax 2013; 68: 691-694
• 22 Woodruff PG, Agusti A, Roche N et al. Current concepts in targeting chronic obstructive pulmonary disease pharmacotherapy: making progress towards personalised management. Lancet 2015; 385: 1789-1798
• 23 Vestbo J. Clinical assessment, staging, and epidemiology of chronic obstructive pulmonary disease exacerbations. Proc Am Thorac Soc 2006; 3: 252-256
• 24 Agustí A, Soler JJ, Molina J et al. Is the CAT questionnaire sensitive to changes in health status in patients with severe COPD exacerbations?. COPD 2012; 9: 492-498