Abstract
Many recent studies suggest that individuals with chronic obstructive pulmonary disease (COPD) are predisposed to comorbidity. Data on the prevalence of individual comorbidities among patients with COPD are highly variable. This may partly be due to differences in the methods of data acquisition, which range from self-reported survey data to administrative database analysis. There is also variability in comorbidity selection and the patient demographics among studies. When trying to determine the best diagnostic or treatment modality for a given patient, physicians often look to disease-specific clinical guidelines for recommendations to guide clinical decisions. These guidelines evaluate the body of evidence behind clinical questions and formulate recommendations, with the intent to influence clinical decision making. The strength of a recommendation is partially based on the quality of evidence from which it is derived. Even the strongest recommendations, however, are meant to be interpreted within the context of individual patient preferences and goals of care. A physician must use his or her clinical judgment when applying these guidelines to medical practice. One important question that must always be asked is whether or not these recommendations apply to the patient in question who may be elderly or have multiple comorbidities.
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References
Barr RG, Celli BR, Mannino DM, et al. Comorbidities, patient knowledge, and disease management in a national sample of patients with COPD. Am J Med. 2009;122(4):348–55.
Mapel DW, Hurley JS, Frost FJ, Petersen HV, Picchi MA, Coultas DB. Health care utilization in chronic obstructive pulmonary disease. A case-control study in a health maintenance organization. Arch Intern Med. 2000;160(17):2653–8.
van Manen JG, Bindels PJ, IJzermans CJ, van der Zee JS, Bottema BJ, Schade E. Prevalence of comorbidity in patients with a chronic airway obstruction and controls over the age of 40. J Clin Epidemiol. 2001;54(3):287–93.
Sidney S, Sorel M, Quesenberry Jr CP, DeLuise C, Lanes S, Eisner MD. COPD and incident cardiovascular disease hospitalizations and mortality: Kaiser Permanente Medical Care Program. Chest. 2005;128(4):2068–75.
Soriano JB, Visick GT, Muellerova H, Payvandi N, Hansell AL. Patterns of comorbidities in newly diagnosed COPD and asthma in primary care. Chest. 2005;128(4):2099–107.
Kinnunen T, Saynajakangas O, Tuuponen T, Keistinen T. Impact of comorbidities on the duration of COPD patients’ hospital episodes. Respir Med. 2003;97(2):143–6.
Hayward RS, Wilson MC, Tunis SR, Bass EB, Guyatt G. Users’ guides to the medical literature. VIII. How to use clinical practice guidelines. A. Are the recommendations valid? The Evidence-Based Medicine Working Group. JAMA. 1995;274(7):570–4.
Garber AM. Evidence-based guidelines as a foundation for performance incentives. Health Aff (Millwood). 2005;24(1):174–9.
Boyd CM, Darer J, Boult C, Fried LP, Boult L, Wu AW. Clinical practice guidelines and quality of care for older patients with multiple comorbid diseases: implications for pay for performance. JAMA. 2005;294(6):716–24.
Anderson G, Horvath J. Chronic conditions: making the case for ongoing care. Princeton, NJ: Partnership for Solutions; 2002.
Current estimates from the National Health Interview Survey, 1994. Vital Health Stat 1995;10(193): 1–116.
Shiffman RN, Shekelle P, Overhage JM, Slutsky J, Grimshaw J, Deshpande AM. Standardized reporting of clinical practice guidelines: a proposal from the Conference on Guideline Standardization. Ann Intern Med. 2003;139(6):493–8.
Greer AL, Goodwin JS, Freeman JL, Wu ZH. Bringing the patient back in. Guidelines, practice variations, and the social context of medical practice. Int J Technol Assess Health Care. 2002;18(4):747–61.
Cluzeau FA, Littlejohns P, Grimshaw JM, Feder G, Moran SE. Development and application of a generic methodology to assess the quality of clinical guidelines. Int J Qual Health Care. 1999;11(1):21–8.
The AGREE Collaboration. Appraisal of Guidelines for Research and Evaluation (AGREE) Instrument. Vol 2005, 2001. http://www.agreecollaboration.org/pdf/agreeinstrumentfinal.pdf
Shaneyfelt TM, Mayo-Smith MF, Rothwangl J. Are guidelines following guidelines? The methodological quality of clinical practice guidelines in the peer-reviewed medical literature. JAMA. 1999;281(20):1900–5.
Graham ID, Calder LA, Hebert PC, Carter AO, Tetroe JM. A comparison of clinical practice guideline appraisal instruments. Int J Technol Assess Health Care. 2000;16(4):1024–38.
Weiss CO, Boyd CM, Yu Q, Wolff JL, Leff B. Patterns of prevalent major chronic disease among older adults in the United States. JAMA. 2007;298(10):1160–2.
Pham HH, Schrag D, O’Malley AS, Wu B, Bach PB. Care patterns in Medicare and their implications for pay for performance. N Engl J Med. 2007;356(11):1130–9.
American Thoracic Society/European Respiratory Society. ATS/ERS Standards for the Diagnosis and Management of Patients with COPD, 2004. http://www.thoracic.org/clinical/copd-guidelines/resources/copddoc.pdf.
Qaseem A, Snow V, Shekelle P, et al. Diagnosis and management of stable chronic obstructive pulmonary disease: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2007;147(9):633–8.
National Institute for Health and Clinical Excellence. Chronic obstructive pulmonary disease. Management of chronic obstructive pulmonary diseases in adults in primary and secondary care (partial update). NICE clinical guideline 101. Developed by the National Collaborating Centre for Acute and Chronic Conditions. http://guidance.nice.org.uk/CG101.
Rabe KF, Hurd S, Anzueto A, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med. 2007;176(6):532–55.
Schunemann HJ, Woodhead M, Anzueto A, et al. A vision statement on guideline development for respiratory disease: the example of COPD. Lancet. 2009;373(9665):774–9.
Guyatt GH, Oxman AD, Vist GE, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ. 2008;336(7650):924–6.
Fabbri L, Boyd CM, Boschetto P, et al. How to deal with multiple comorbidities in guideline development: an official ATS/ERS Workshop Report. Manuscript submitted for publication, 2010.
Krishnan JA, Mularski RA. Acting on comparative effectiveness research in COPD. JAMA. 2010;303(23):2409–10.
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Frogale, K., Schnell, K.M., Boyd, C.M. (2012). COPD, Comorbidity, and Disease-Specific Clinical Practice Guidelines. In: Nici, L., ZuWallack, R. (eds) Chronic Obstructive Pulmonary Disease. Respiratory Medicine. Humana Press. https://doi.org/10.1007/978-1-60761-673-3_12
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