DEFINITION

Chronic obstructive pulmonary disease is an umbrella term for several conditions, including chronic bronchitis and emphysema as well as a subset of patients with asthma, that impede the flow of air in the bronchi and trachea. COPD has been defined as “a disease state characterized by airflow limitation that is not fully reversible. The airflow limitation is usually both progressive and associated with an abnormal inflammatory response of the lungs to noxious particles or gases” (Crapo et al., 2000; Rabe et al., 2007).

The heterogeneity of COPD has resulted in a variety of different definitions of disease that include components of destruction of the lung parenchyma (emphysema), chronic sputum production (bronchitis), limitation of airflow, and the development of hypoxemia. No single definition is perfect or all-inclusive. For example, some patients will have clinically significant emphysema in the absence of airflow limitation, whereas other patients may have significant airflow limitation in the absence of any emphysema or hypoxemia. In addition, lung function declines with age, resulting in questions about what represents disease versus normal aging. Although there is little debate surrounding moderate or severe disease, a great deal of debate surrounds more mild disease, which, ironically, is probably the most responsive to intervention.

One widely accepted and used classification strategy defines COPD by the presence of obstruction on spirometry: a forced expiratory volume in 1 second/forced vital capacity (FEV1/FVC) ratio of less than 70 percent, measured with a post-bronchodilator lung function (Celli et al., 2004b; WHO, 2008). Although this “fixed” ratio is easy to remember and simple, there is some concern that it may underestimate COPD in younger populations, overestimate it in older ones, and misclassify other patients (Celli et al., 2003; Kohler et al., 2003).

The GOLD and ATS/ERS criteria classify COPD into four stages (Celli et al., 2004b; WHO, 2008):

• Stage 1 (FEV1 ≥ 80 percent predicted);
• Stage 2 (FEV1 50 to < 80 percent predicted);
• Stage 3 (FEV1 30 to < 50 percent predicted); and
• Stage 4 (FEV1 < 30 percent predicted).

In addition, an “at risk” stage (formerly known as GOLD Stage 0) consists of patients with chronic respiratory symptoms (cough, sputum, or dyspnea) and normal lung function. Although this stage has been removed from the 2006 GOLD update because of data suggesting this stage may not progress to GOLD Stage 1 and higher COPD (Vestbo and Lange, 2002; WHO, 2008), people with symptoms and normal lung function have a lower quality of life and a higher risk of hospitalizations and mortality in follow-up investigations (Mannino et al., 2006; Stavem et al., 2006).

As noted above, this classification strategy may miss some patients with disease and overestimate the extent of disease in others. In addition, surveillance of disease typically depends on using information from administrative data sets, requiring the use of diagnostic and procedure codes to infer the presence of disease. This can be particularly problematic when looking at mortality related to COPD because most people with severe COPD who die have their death attributed to another cause (Mannino et al., 2006), and most people who die with a diagnosis of COPD listed on their death certificate do not have this attributed as the underlying cause of death. Therefore, the contribution of this chronic lung disease to observed mortality patterns and trends is underestimated.

EPIDEMIOLOGY

COPD is a common chronic disease. Most estimates of COPD place its prevalence in the adult population at 5 to 10 percent, although these estimates vary by the specific criteria used. Data from the Third National Health and Nutrition Examination Survey (NHANES III), the most recent national health survey that included spirometry, showed a prevalence of COPD in adults of 6.8 percent (Mannino and Buist, 2007). Over 50 percent of people with evidence of COPD have never been diagnosed with this disease. This proportion is even higher among people with mild disease, which is most amenable to intervention (Mannino and Braman, 2007).

COPD is responsible for about 700,000 hospitalizations annually in the United States. In recent years, the hospitalization rate among women has increased and is now similar to the rate among men. In 2009, more than 137,000 adults in the United States died from COPD (Kochanek et al., 2011). Age-adjusted mortality rates per 100,000 vary dramatically by state, from a low of 27.1 in Hawaii to a high of 93.6 in Oklahoma (CDC, 2008).

COPD has an enormous financial burden, with estimated direct medical costs in 1993 of $14.7 billion. The estimated indirect costs related to morbidity (loss of work time and productivity) and premature mortality is an additional $9.2 billion, for a total of $23.9 billion. By 2002 the direct and indirect costs were estimated at $32.1 billion (Mannino and Buist, 2007). The overwhelming risk factor for COPD is cigarette smoking. Other important risk factors include a history of asthma; occupational exposures to dusts, gases, vapors, and fumes; exposure to biomass smoke; and respiratory infections such as tuberculosis. In the developing world, exposures to biomass smoke and respiratory infections are particularly important (Buist et al., 2007). Comorbid diseases include cardiovascular disease, osteoporosis, lung cancer, and depression. In addition, diseases such as pneumonia and pulmonary hypertension are often complications of COPD (Decramer et al., 2008; Holguin et al., 2005).

PREVENTION AND TREATMENT

The classification of chronic respiratory disorders is often based on the pattern of physiologic impairment, either obstructive or restrictive, as measured with pulmonary function tests. Obstructive disorders, asthma, and COPD are the most common chronic respiratory diseases. The restrictive disorders are heterogeneous, including diffuse parenchymal lung diseases (e.g., idiopathic pulmonary fibrosis) and disorders that impair chest movement (e.g., morbid obesity, neuromuscular diseases). The focus of this review is on COPD, which provides an example of how surveillance throughout the life span may contribute to the prevention and control of chronic respiratory diseases.

While asthma and COPD are both characterized by airflow obstruction, asthma is reversible and COPD is incompletely reversible. Other differences also exist. For example, asthma most commonly develops in childhood, and COPD usually begins in the fifth decade or later. Moreover, recent evidence suggests that asthma and COPD have a number of distinct phenotypes with substantial overlap (Gibson and Simpson, 2009), and a number of childhood characteristics—including maternal asthma, paternal asthma, childhood asthma, respiratory infections, and maternal smoking—are risk factors for COPD (Salvi and Barnes, 2009; Svanes et al., 2010).

In adulthood there are multiple determinants of lung function level and decline (Gibson and Simpson, 2009), including cigarette smoking (Griffith et al., 2001), age, race, gender, bronchial hyperreactivity, asthma, occupational and environmental exposures, physical inactivity (Garcia-Aymerich et al., 2007; Pelkonen et al., 2003), chest wall deformity (DiBari et al., 2004), and psychological characteristics (Kubzansky et al., 2002).

Strategies for the prevention and control of asthma and COPD include methods for primary, secondary, or tertiary prevention. Primary prevention is accomplished by elimination of exposures that cause these diseases. Secondary prevention involves early detection and intervention among asymptomatic persons. Tertiary prevention is the management of symptomatic disease. Healthy People 2020 has eight objectives related to asthma and four related to COPD.

Determining the effectiveness of these interventions requires surveillance throughout the life span to measure known risk factors, to conduct early detection, and to monitor outcomes. This chapter uses available data sources and evidence relevant to surveillance activities for COPD as an example of how to describe and evaluate the current state of surveillance, and to serve as background for recommendations on a national surveillance system.

Early Detection and Intervention

Airflow obstruction is common among asymptomatic persons (Mannino et al., 2000), and spirometry offers a feasible method for early detection and intervention to prevent or limit progression to symptomatic disease. An extensive review of available evidence concerning spirometry screening for COPD, conducted by the U.S. Preventive Services Task Force (USPSTF) and published in 2008, addressed eight questions (see Table 3-1) (Lin et al., 2008). While spirometry offers a feasible method for early detection and intervention, available evidence does not support the routine use of spirometry for screening. Results are inconclusive on the use of spirometry as a tool to enhance smoking cessation, and they are not available on the use of pharmacological treatments among asymptomatic persons with chronic airflow obstruction. A major limitation of spirometry screening is the low prevalence of severe and very severe airflow obstruction (FEV1 < 50 percent predicted) in the general population, which is the group most likely to benefit from available medical interventions. Using COPD exacerbation as the primary health outcome, the USPSTF (Lin et al., 2008) estimated that among current smokers and never smokers, 833 and 2,000 persons, respectively, would have to be screened with spirometry to prevent one exacerbation over 6–36 months. The number needed to screen decreased with advancing age and was lowest among persons 70–74 years of age at 400.

TABLE 3-1

Questions and Conclusions on Screening for Chronic Obstructive Pulmonary Disorder (COPD) from U.S. Preventive Services Task Force.

While available evidence does not support the routine use of spirometry for screening, evidence from population-based and clinical studies (discussed in the next section) shows that diagnostic spirometry is underused and contributes to substantial diagnostic misclassification. Using NHANES III data, Mannino and colleagues (2000) found an overall prevalence of spirometry-defined obstructive lung disease of 8.5 percent, and an additional 4.3 percent of the population reported a diagnosis of obstructive lung disease, but did not have spirometric evidence. In a population-based household survey in England, Shahab and colleagues (2006) found spirometry-defined COPD among 13.3 percent of participants over 35 years of age, but only 18.8 percent of these volunteers reported any diagnosis of lung disease, which was lowest for mild impairment (6.4 percent) and increased with moderate (21.3 percent) and severe impairment (46.8 percent). Miravitlles and colleagues (2009) conducted a population-based survey in Spain and found an overall prevalence of spirometry-defined COPD of 10.2 percent, and of these patients only 26.9 percent reported a previous diagnosis of COPD, with 16 percent, 35.2 percent, and 85 percent for mild, moderate, and severe or very severe impairment, respectively.

ROLE OF SURVEILLANCE

Although there have been a number of investigations of outcome-specific data for COPD, there is no U.S. surveillance system that is characterized by data collection, analysis, and interpretation that is ongoing and systematic. Apart from the use of vital statistics for describing mortality from COPD, the use of other data sources to examine COPD-specific outcome data has been a relatively recent phenomenon. Moreover, concerns about the available outcome measures and data limitations (discussed in greater detail below) may contribute to delays in progress (Heffner et al., 2010). Therefore, there has been limited time for dissemination and consensus about results, with little opportunity to link these results to planning, implementation, and evaluation of public health and clinical programs to improve COPD prevention and control.

Data relevant to surveillance of COPD are currently available from a number of national and international sources. In the United States, these sources include vital statistics (Lewis et al., 2009), hospital data reporting (http://www.healthgrades.com; Lindenauer et al., 2006), Medicare (Wennberg et al., 2004; http://www.hospitalcompare.hhs.gov), Medicaid (Bindman et al., 2008), Veterans Administration (Joo et al.. 2007, 2008a; Singh, 2009), population-based surveys (Mannino et al., 2000), and health insurance claims databases (Mapel et al., 2006; McKnight et al., 2005). Examples of international sources of COPD surveillance have been published from meta-analyses of clinical trials (Puhan et al., 2009a,b; Strassmann et al., 2009), the U.K. General Practice Research Database (Khan et al., 2010; Levy et al., 2007; Smith et al., 2008; Soriano et al., 2001), and health administrative data in Canada (Gershon et al., 2009).

Available evidence supports the feasibility of these data sources for surveillance and suggests potential opportunities for their use to guide public health policy and other interventions to improve various components of prevention and healthcare delivery for COPD. For example, Wennberg and colleagues (2004) used Medicare claims data for more than 90,000 patients with COPD, congestive heart failure, and cancer to examine patterns of care at the hospital level, including length of stay, intensive care unit (ICU) days, and physician visits. They found wide variation in healthcare use, ranging from 2.9 to 7.3 times the number of hospital or ICU days used between the lowest and highest use hospitals, respectively. These results suggest the potential for large opportunities to improve efficiency of care.

A number of other recent examples show potential uses of these data sources in a surveillance system for COPD. U.S. examples include:

• use of state Medicaid claims data to identify COPD patients with high healthcare use to target for case management (Yarger et al., 2008),
• use of Medicare claims to identify patient and physician characteristics associated with potentially preventable hospitalizations (O’Malley et al., 2007),
• use of Medicare managed-care data to examine cost of illness and comorbidities (Menzin et al., 2008 and monitoring trends in quality-of-care and healthcare disparities (Trivedi et al., 2005),
• use of Medicaid (Rascati et al., 2007) and Medicare managed-care (Simoni-Wastila et al., 2009 claims data to examine comparative effectiveness of different inhaled medications for COPD,
• voluntary reporting of hospital data for comparative effectiveness research of corticosteroid dose and route of administration during exacerbation of COPD (Lindenauer et al., 2010), and
• use of data on variations in preventable hospitalization rates for COPD and other chronic conditions to target continuing medical education topics (Sumner et al., 2008).

International examples of surveillance activities relevant to COPD have been conducted to monitor quality of primary care and drug safety. In the United Kingdom, the Health Improvement Network was used to demonstrate improvement of spirometry use and combination inhaler use among primary care physicians after release of management guidelines and pay-for-performance incentives (Smith et al., 2008). In another analysis using data from 7,456 general practices in the United Kingdom, higher levels of nurse staffing were associated with improved performance on a number of clinical performance measures for COPD, coronary heart disease, hypertension, and diabetes (Griffiths et al., 2010). Furthermore, surveillance has been conducted to monitor the safety of pharmacological treatments for COPD, albeit with conflicting results (Jara et al., 2007; Johansson et al., 2010; Lee et al., 2008, 2009; Loke et al., 2010; Pujades-Rodriguez et al., 2007; Salpeter, 2009).

A major goal of surveillance is to promote interventions for the prevention and control of COPD, and to evaluate the effectiveness of these interventions through ongoing surveillance of various process and health outcomes. This process may happen at the national, regional, and local levels. Although hospitals do not report quality-of-care indicators for COPD to the Joint Commission and the Centers for Medicare & Medicaid Services—they do for acute myocardial infarction, heart failure, and pneumonia—limited evidence suggests that such reporting, with quarterly feedback on performance to hospitals, has been associated with performance improvement (Jha et al., 2005; Williams et al., 2005). Despite the lack of national reporting, the reporting and feedback process for other diseases may be contributing to a growing interest in local performance improvement initiatives for COPD (Deprez et al., 2009; Roberts et al., 2009).

While a number of data sources for surveillance of COPD are available as discussed above and throughout the chapter, there is no comprehensive surveillance system that contributes to the prevention and control of COPD. Except for the COPD optional module in Behavioral Risk Factor Surveillance System (BRFSS) and some data collected by NHANES, most available data sources have been one-time investigations and are not part of a larger system that is ongoing. However, because these data sources provide evidence of the feasibility and potential usefulness for enhanced surveillance and decision making, they could serve as the basis for developing a system of COPD surveillance. A summary of the current state of surveillance relevant to the primary, secondary, and tertiary prevention of COPD follows.

In terms of primary prevention, cigarette smoking is the major risk factor for COPD. This factor is regularly monitored population-wide through the BRFSS. However, there is no population-based monitoring of other risk factors for COPD such as occupations that expose workers to high levels of dust.

Identifying individuals early in the course of their disease is important to secondary prevention efforts. Although current evidence suggests that widespread screening with spirometry is not effective, this nevertheless remains an important consideration. An analogy to the cardiovascular diseases is identification of increased cholesterol levels, which predict cardiovascular disease. These elevated levels can be followed and targeted for specific interventions. COPD does not, at this point, have such a biomarker available, although several candidates, such as C-reactive protein, fibrinogen, and radiographic changes, are currently being investigated. Filling this gap would result in a better understanding of disease progression and give an additional means of monitoring progression, both in individuals and the population. This may become more important in future years as the prevalence of smoking decreases and the other risk factors for COPD become more important.

The major gap in the surveillance of COPD for tertiary prevention is the lack of pulmonary function data in most databases, which contributes to misdiagnosis. When these data do exist, they may not be accessible or may be in a format that is not easily usable in surveillance activities. Moreover, the underutilization of spirometry in the diagnosis of COPD results in sub-optimal management. To address this gap, the Center for Medicare and Medicaid Services has proposed spirometry evaluation as an indicator of quality of care for patients with a diagnosis of COPD, along with bronchodilator therapy based on FEV1 level and smoking cessation counseling (Berwick, 2011). This policy should contribute to an improvement in the current gaps in diagnosis and management of patients with COPD.

Another gap is the lack or heterogeneity of other objective measures of COPD, such as imaging information, that can better define the presence of bronchial wall thickening or emphysema and are predictors of poor outcomes. Current studies, such as COPDGene, MESA COPD, and Spiromics, will be addressing the scientific aspect of these gaps, such as what may be the best imaging measures to follow over time. Additional studies are needed to assess whether these measures can be routinely used in the clinical evaluation of patients. Filling these gaps would result in a better picture of the true burden of disease and how COPD relates to morbidity and mortality in the population.

The available evidence provides strong support for the feasibility and potential usefulness of a national surveillance system for COPD. A number of limitations, however, need to be considered and addressed to fully realize the benefits of surveillance. As previously discussed, the diagnosis of COPD is under-and overdiagnosed, which limits the usefulness of diagnostic codes from administrative data. While the specificity of diagnostic algorithms show promise for selected applications (Mapel et al., 2006; Yarger et al., 2008), their sensitivity and positive predictive value for COPD are low (Rector et al., 2004; Singh, 2009). Moreover, variations in patterns of diagnostic practices may further bias claims data (Song et al., 2010). A major gap in the surveillance of COPD is the relative paucity of and scant evidence for the effectiveness of COPD-specific performance measures that are currently in use (Heffner et al., 2010). For example, Medicare process performance measures are not strongly associated with hospital risk-adjusted mortality rates (Werner and Bradlow, 2006).

In summary, while components of a surveillance system for COPD are available in the United States and have provided evidence of the need for improvement of the prevention and control of COPD, the committee concluded that further development is needed to create an effective surveillance system. Such development will require the participation of experts from a variety of disciplines to address the important limitations described above. Effectiveness will be determined by the quality of the data; the ongoing, systematic collection, analysis, and interpretation of the data; and the ongoing use of the results to plan and implement prevention and control interventions. None of these characteristics currently exist in the United States for the surveillance of COPD. As previously discussed, the quality of data needs to be improved, with standards for diagnosis to minimize diagnostic misclassification and better COPD-specific outcome data (Heffner et al., 2010). While a number of data sources have been used to examine outcomes, most analyses conducted to date have been one-time studies, and there is no structured or systematic use of these sources for ongoing analyses. Finally, health policy advocates and federal and private institutions in the United States need more well-defined organizational structures and processes for disseminating and using the results from chronic disease surveillance in order to enhance the prevention and control of COPD.

The focus of this chapter has been on COPD, yet the same kinds of data (e.g., those related to risk factors, screening, environmental exposures, availability of care, access to care, patient education, treatments, quality of life, etc.) are needed for other chronic lung diseases, including asthma. In fact, collection of these data on asthma, for example, could lead to improved understanding of the relationship between asthma and COPD. This has important implications not only for improved understanding of the pathophysiology of both diseases but also for improved understanding of corresponding health disparities. An effective surveillance system that encompasses chronic lung disease more broadly could enhance efforts aimed at prevention, diagnosis, treatment, and improved health outcomes.

REFERENCES

1. Abusaid GH, Barbagelata A, Tuero E, Mahmood A, Sharma G. Diastolic dysfunction and COPD exacerbation. Postgraduate Medicine. 2009;121(4):76–81. [PubMed: 19641273]
2. Adams SG, Smith PK, Allan PF, Anzueto A, Pugh JA, Cornell JE. Systematic review of the chronic care model in chronic obstructive pulmonary disease prevention and management. Archives of Internal Medicine. 2007;167(6):551–561. [PubMed: 17389286]
3. Agabiti N, Belleudi V, Davoli M, Forastiere F, Faustini A, Pistelli R, Fusco D, Perucci CA. Profiling hospital performance to monitor the quality of care: The case of COPD. European Respiratory Journal. 2010;35(5):1031–1038. [PubMed: 19840969]
4. Alexeeff SE, Litonjua AA, Sparrow D, Vokonas PS, Schwartz J. Statin use reduces decline in lung function: VA normative aging study. American Journal of Respiratory and Critical Care Medicine. 2007;176(8):742–747. [PMC free article: PMC2020828] [PubMed: 17673694]
5. American Thoracic Society. Pulmonary rehabilitation—1999. American Journal of Respiratory and Critical Care Medicine. 1999;159(5):1666–1682. [PubMed: 10228143]
6. Anthonisen NR, Skeans MA, Wise RA, Manfreda J, Kanner RE, Connett JE. for the Lung Health Study Research Group. The effects of a smoking cessation intervention on 14.5-year mortality. Annals of Internal Medicine. 2005;142(4):233–239. [PubMed: 15710956]
7. Anthonisen NR, Woodlrage K, Manfreda J. Use of spirometry and respiratory drugs in Manitobans over 35 years of age with obstructive lung diseases. Canadian Respiratory Journal. 2005;12(2):69–74. [PubMed: 15785794]
8. Antonelli-Incalzi R, Corsonello A, Trojano L, Pedone C, Acanfora D, Spada A, Izzo O, Rengo F. Screening of cognitive impairment in chronic obstructive pulmonary disease. Dementia and Geriatric Cognitive Disorders. 2007;23(4):264–270. [PubMed: 17351318]
9. Avol EL, Gauderman WJ, Tan SM, London SJ, Peters JM. Respiratory effects of relocating to areas of differing air pollution levels. American Journal of Respiratory and Critical Care Medicine. 2001;164(11):2067–2072. [PubMed: 11739136]
10. Ayanian JZ. The elusive quest for quality and cost savings in the Medicare program. JAMA: The Journal of the American Medical Association. 2009;301(6):668–670. [PubMed: 19211475]
11. Bahadori K, FitzGerald JM. Risk factors of hospitalization and readmission of patients with COPD exacerbation—systematic review. International Journal of Chronic Obstructive Pulmonary Disease. 2007;2(3):241–251. [PMC free article: PMC2695199] [PubMed: 18229562]
12. Barr RG, Celli BR, Martinez FJ, Ries AL, Rennard SI, Reilly JJ, Sciurba FC, Thomashow BM, Wise RA. Physician and patient perceptions in COPD: The COPD resource network needs assessment survey. The American Journal of Medicine. 2005;118(12):1415.e1419–1415.e1417. [PubMed: 16378794]
13. Berwick DM. Launching accountable care organizations—the proposed rule for the Medicare shared savings program. New England Journal of Medicine. 2011;364(16):e32. [PubMed: 21452999]
14. Bickford LS, Hodgkin JE, McInturff SL. National pulmonary rehabilitation survey update. Journal of Cardiopulmonary Rehabilitation and Prevention. 1995;15(6):406–411. [PubMed: 8624965]
15. Bindman AB, Chattopadhyay A, Auerback GM. Interruptions in Medicaid coverage and risk for hospitalization for ambulatory care-sensitive conditions. Annals of Internal Medicine. 2008;149(12):854–860. [PubMed: 19075204]
16. Bourbeau J, Nault D, Dang-Tan T. Self-management and behaviour modification in COPD. Patient Education and Counseling. 2004;52(3):271–277. [PubMed: 14998597]
17. 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. JAMA: The Journal of the American Medical Association. 2005;294(6):716–724. [PubMed: 16091574]
18. Brooks D, Sottana R, Bell B, Hanna M, Laframboise L, Selvanayagarajah S, Goldstein R. Characterization of pulmonary rehabilitation programs in Canada in 2005. Canadian Respiratory Journal. 2007;14(2):87–92. [PMC free article: PMC2676378] [PubMed: 17372635]
19. Buist AS, McBurnie MA, Vollmer WM, Gillespie S, Burney P, Mannino DM, Menezes AMB, Sullivan SD, Lee TA, Weiss KB, Jensen RL, Marks GB, Gulsvik A, Nizankowska-Mogilnicka E. International variation in the prevalence of COPD (The BOLD Study): A population-based prevalence study. The Lancet. 2007;370(9589):741–750. [PubMed: 17765523]
20. CDC (Centers for Disease Control and Prevention). Deaths from chronic obstructive pulmonary disease—United States, 2000–2005. MMWR: Morbidity and Mortality Weekly Report. 2008;57(45):1229–1232. [PubMed: 19008792]
21. Celli BR, Halbert RJ, Isonaka S, Schau B. Population impact of different definitions of airway obstruction. European Respiratory Journal. 2003;22(2):268–273. [PubMed: 12952259]
22. Celli BR, Cote CG, Marin JM, Casanova C, Montes de Oca M, Mendez RA, Pinto Plata V, Cabral HJ. The body-mass index, airflow obstruction, dyspnea, and exercise capacity index in chronic obstructive pulmonary disease. New England Journal of Medicine. 2004;350(10):1005–1012. [PubMed: 14999112]
23. Celli BR, MacNee W, Agusti A, Anzueto A, Berg B, Buist AS, Calverley PMA, Chavannes N, Dillard T, Fahy B, Fein A, Heffner J, Lareau S, Meek P, Martinez F, McNicholas W, Muris J, Austegard E, Pauwels R, Rennard S, Rossi A, Siafakas N, Tiep B, Vestbo J, Wouters E, ZuWallack R. Standards for the diagnosis and treatment of patients with COPD: A summary of the ATS/ERS position paper. European Respiratory Journal. 2004;23(6):932–946. [PubMed: 15219010]
24. Chavez PC, Shokar NK. Diagnosis and management of chronic obstructive pulmonary disease (COPD) in a primary care clinic. COPD. 2009;6(6):446–451. [PubMed: 19938968]
25. Craig B, Kraus C, Chewning B, Davis J. Quality of care for older adults with chronic obstructive pulmonary disease and asthma based on comparisons to practice guidelines and smoking status. BMC Health Services Research. 2008;8(1):144. [PMC free article: PMC2500012] [PubMed: 18611245]
26. Crapo RO, Casaburi R, Coates AL, Enright PL, Hankinson JL, Irvin CG, MacIntyre NR, McKay RT, Wanger JS, Anderson SD, Cockcroft DW, Fish JE, Sterk PJ. Guidelines for methacholine and exercise challenge testing—1999. This official statement of the American Thoracic Society was adopted by the ATS board of directors, July 1999. American Journal of Respiratory and Critical Care Medicine. 2000;161(1):309–329. [PubMed: 10619836]
27. Davis AHT, Carrieri-Kohlman V, Janson SL, Gold WM, Stulbarg MS. Effects of treatment on two types of self-efficacy in people with chronic obstructive pulmonary disease. Journal of Pain and Symptom Management. 2006;32(1):60–70. [PubMed: 16824986]
28. Decramer M, Rennard S, Troosters T, Mapel DW, Giardino N, Mannino D, Wouters E, Sethi S, Cooper CB. COPD as a lung disease with systemic consequences—clinical impact, mechanisms, and potential for early intervention. COPD. 2008;5(4):235–256. [PubMed: 18671149]
29. Deprez R, Kinner A, Millard P, Baggott L, Mellett J, Loo JL. Improving quality of care for patients with chronic obstructive pulmonary disease. Population Health Management. 2009;12(4):209–215. [PubMed: 19663624]
30. Di Bari M, Chiarlone M, Matteuzzi D, Zacchei S, Pozzi C, Bellia V, Tarantini F, Pini R, Masotti G, Marchionni N. Thoracic kyphosis and ventilatory dysfunction in unselected older persons: An epidemiological study in Dicomano, Italy. Journal of the American Geriatrics Society. 2004;52(6):909–915. [PubMed: 15161454]
31. Diette GB, Orr P, McCormack MC, Gandy W, Hamar B. Is pharmacologic care of chronic obstructive pulmonary disease consistent with the guidelines? Population Health Management. 2010;13(1):21–26. [PubMed: 20158320]
32. Disano J, Goulet J, Muhajarine N, Neudorf C, Harvey J. Social-economic status and rates of hospital admission for chronic disease in urban Canada. Canadian Nurse. 2010;106(1):24–29. [PubMed: 20175317]
33. Donaldson GC, Hurst JR, Smith CJ, Hubbard RB, Wedzicha JA. Increased risk of myocardial infarction and stroke following exacerbation of COPD. Chest. 2010;137(5):1091–1097. [PubMed: 20022970]
34. Downs SH, Schindler C, Liu LJ, Keidel D, Bayer-Oglesby L, Brutsche MH, Gerbase MW, Keller R, Kunzli N, Leuenberger P, Probst-Hensch NM, Tschopp JM, Zellweger JP, Rochat T, Schwartz J, Ackermann-Liebrich U. Reduced exposure to pm10 and attenuated age-related decline in lung function. New England Journal of Medicine. 2007;357(23):2338–2347. [PubMed: 18057336]
35. Effing T, Monninkhof EM, van der Valk PD, van der Palen J, van Herwaarden CL, Partidge MR, Walters EH, Zielhuis GA. Self-management education for patients with chronic obstructive pulmonary disease. Cochrane Database Systematic Reviews. 2007;(4):CD002990. [PubMed: 17943778]
36. Epping-Jordan JE, Pruitt SD, Bengoa R, Wagner EH. Improving the quality of health care for chronic conditions. Quality and Safety in Health Care. 2004;13(4):299–305. [PMC free article: PMC1743863] [PubMed: 15289634]
37. Ezzati M, Lopez AD. Estimates of global mortality attributable to smoking in 2000. The Lancet. 2003;362(9387):847–852. [PubMed: 13678970]
38. FitzGerald JM, Haddon JM, Bradly-Kennedy C, Kuramoto L, Ford GT. Resource use study in COPD (rusic): A prospective study to quantify the effects of COPD exacerbations on health care resource use among COPD patients. Canadian Respiratory Journal. 2007;14(3):145–152. [PMC free article: PMC2676835] [PubMed: 17464378]
39. Frost FJ, Petersen H, Tollestrup K, Skipper B. Influenza and COPD mortality protection as pleiotropic, dose-dependent effects of statins*. Chest. 2007;131(4):1006–1012. [PubMed: 17426203]
40. Garcia-Aymerich J, Lange P, Benet M, Schnohr P, Anto JM. Regular physical activity modifies smoking-related lung function decline and reduces risk of chronic obstructive pulmonary disease: A population-based cohort study. American Journal of Respiratory and Critical Care Medicine. 2007;175(5):458–463. [PubMed: 17158282]
41. Gauderman WJ, Gilliland GF, Vora H, Avol E, Stram D, McConnell R, Thomas D, Lurmann F, Margolis HG, Rappaport EB, Berhane K, Peters JM. Association between air pollution and lung function growth in southern California children: Results from a second cohort. American Journal of Respiratory and Critical Care Medicine. 2002;166(1):76–84. [PubMed: 12091175]
42. Gershon AS, Wang C, Guan J, Vasilevska-Ristovska J, Cicutto L, To T. Identifying individuals with physician diagnosed COPD in health administrative databases. COPD. 2009;6(5):388–394. [PubMed: 19863368]
43. Gibson PG, Simpson JL. The overlap syndrome of asthma and COPD: What are its features and how important is it? Thorax. 2009;64(8):728–735. [PubMed: 19638566]
44. Goodman P, Agnew M, McCaffrey M, Paul G, Clancy L. Effects of the Irish smoking ban on respiratory health of bar workers and air quality in Dublin pubs. American Journal of Respiratory and Critical Care Medicine. 2007;175(8):840–845. [PubMed: 17204724]
45. Griffith KA, Sherrill DL, Siegel EM, Manolio TA, Bonekat HW, Enright PL. Predictors of loss of lung function in the elderly: The cardiovascular health study. American Journal of Respiratory and Critical Care Medicine. 2001;163(1):61–68. [PubMed: 11208627]
46. Griffiths P, Murrells T, Maben J, Jones S, Ashworth M. Nurse staffing and quality of care in UK general practice: Cross-sectional study using routinely collected data. British Journal of General Practice. 2010;60:e36–e48. [PMC free article: PMC2801804] [PubMed: 20040166]
47. Griffiths TL, Phillips CJ, Davies S, Burr ML, Campbell IA. Cost effectiveness of an outpatient multidisciplinary pulmonary rehabilitation programme. Thorax. 2001;56(10):779–784. [PMC free article: PMC1745931] [PubMed: 11562517]
48. Han MK, Kim MG, Mardon R, Renner P, Sullivan S, Diette GB, Martinez FJ. Spirometry utilization for COPD: How do we measure up? Chest. 2007;132(2):403–409. [PubMed: 17550936]
49. Heffner JE, Mularski RA, Calverley PM. COPD performance measures: Missing opportunities for improving care. Chest. 2010;137(5):1181–1189. [PubMed: 20348199]
50. Hernandez P, Balter M, Bourbeau J, Hodder R. Living with chronic obstructive pulmonary disease: A survey of patients’ knowledge and attitudes. Respiratory Medicine. 2009;103(7):1004–1012. [PubMed: 19269150]
51. HHS (U.S. Department of Health and Human Services). The health consequences of smoking: A report of the surgeon general. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2004.
52. Holguin F, Folch E, Redd SC, Mannino DM. Comorbidity and mortality in COPD-related hospitalizations in the United States, 1979 to 2001*. Chest. 2005;128(4):2005–2011. [PubMed: 16236848]
53. Howard DL, Hakeem FB, Njue C, Carey T, Jallah Y. Racially disproportionate admission rates for ambulatory care sensitive conditions in North Carolina. Public Health Reports. 2007;122(3):362–372. [PMC free article: PMC1847499] [PubMed: 17518308]
54. Hu Y, Chen B, Yin Z, Jia L, Zhou Y, Jin T. Increased risk of chronic obstructive pulmonary diseases in coke oven workers: Interaction between occupational exposure and smoking. Thorax. 2006;61(4):290–295. [PMC free article: PMC2104593] [PubMed: 16467069]
55. Hung WW, Wisnivesky JP, Siu AL, Ross JS. Cognitive decline among patients with chronic obstructive pulmonary disease. American Journal of Respiratory and Critical Care Medicine. 2009;180(2):134–137. [PubMed: 19423714]
56. Jara M, Lanes SF, Wentworth C 3rd, May C, Kesten S. Comparative safety of long-acting inhaled bronchodilators: A cohort study using the UK thin primary care database. Drug Safety. 2007;30(12):1151–1160. [PubMed: 18035867]
57. Jha AK, Li Z, Orav EJ, Epstein AM. Care in U.S. hospitals—the hospital quality alliance program. New England Journal of Medicine. 2005;353(3):265–274. [PubMed: 16034012]
58. Johansson S, Wallander MA, de Abajo FJ, Garcia Rodriguez LA. Prospective drug safety monitoring using the UK primary-care general practice research database: Theoretical framework, feasibility analysis and extrapolation to future scenarios. Drug Safety. 2010;33(3):223–232. [PubMed: 20158286]
59. Jones R, Dickson-Spillmann M, Mather M, Marks D, Shackell B. Accuracy of diagnostic registers and management of chronic obstructive pulmonary disease: The Devon primary care audit. Respiratory Research. 2008;9(1):62. [PMC free article: PMC2531184] [PubMed: 18710575]
60. Joo MJ, Lee TA, Weiss KB. Geographic variation in chronic obstructive pulmonary disease exacerbation rates. Journal of General Internal Medicine. 2007;22(11):1560–1565. [PMC free article: PMC2219808] [PubMed: 17874272]
61. Joo MJ, Lee TA, Au DH, Fitzgibbon ML, Weiss KB. Medication use patterns associated with spirometry in diagnosing COPD. COPD. 2008;5(6):360–368. [PubMed: 19353350]
62. Joo MJ, Lee TA, Bartle B, van de Graaff WB, Weiss KB. Patterns of healthcare utilization by COPD severity: A pilot study. Lung. 2008;186(5):307–312. [PubMed: 18463921]
63. Joo MJ, Lee TA, Weiss KB. Geographic variation of spirometry use in newly diagnosed COPD. Chest. 2008;134(1):38–45. [PubMed: 18347201]
64. Katz PP, Julian LJ, Omachi TA, Gregorich SE, Eisner MD, Yelin EH, Blanc PD. The impact of disability on depression among individuals with COPD. Chest. 2010;137(4):838–845. [PMC free article: PMC2851560] [PubMed: 19933374]
65. Keddissi JI, Younis WG, Chbeir EA, Daher NN, Dernaika TA, Kinasewitz GT. The use of statins and lung function in current and former smokers*. Chest. 2007;132(6):1764–1771. [PubMed: 17908708]
66. Khan NF, Harrison SE, Rose PW. Validity of diagnostic coding within the general practice research database: A systematic review. British Journal of General Practice. 2010;60(572):e128–136. [PMC free article: PMC2828861] [PubMed: 20202356]
67. Kochanek K, Xu J, Murphy S, Minnino A, Kung H. Deaths: Preliminary data for 2009. National Vital Statistics Reports. 2011;59(4) [PubMed: 25073815]
68. Kohler D, Fischer J, Raschke F, Schonhofer B. Usefulness of GOLD classification of COPD severity. Thorax. 2003;58(9):825. [PMC free article: PMC1746818] [PubMed: 12947152]
69. Kronman AC, Ash AS, Freund KM, Hanchate A, Emanuel EJ. Can primary care visits reduce hospital utilization among Medicare beneficiaries at the end of life? Journal of General Internal Medicine. 2008;23(9):1330–1335. [PMC free article: PMC2518010] [PubMed: 18506545]
70. Kubzansky LD, Wright RJ, Cohen S, Weiss S, Rosner B, Sparrow D. Breathing easy: A prospective study of optimism and pulmonary function in the normative aging study. Annals of Behavioral Medicine. 2002;24(4):345–353. [PubMed: 12434946]
71. Lacasse Y, Goldstein R, Lasserson TJ, Martin S. Pulmonary rehabilitation for chronic obstructive pulmonary disease. Cochrane Database Systematic Reviews. 2006;(4):CD003793. [PubMed: 17054186]
72. Laditka JN, Laditka SB. Race, ethnicity and hospitalization for six chronic ambulatory care sensitive conditions in the USA. Ethnicity & Health. 2006;11(3):247–263. [PubMed: 16774877]
73. Lee TA, Pickard AS, Au DH, Bartle B, Weiss KB. Risk for death associated with medications for recently diagnosed chronic obstructive pulmonary disease. Annals of Internal Medicine. 2008;149(6):380–390. [PubMed: 18794557]
74. Lee TA, Wilke C, Joo M, Stroupe KT, Krishnan JA, Schumock GT, Pickard AS. Outcomes associated with tiotropium use in patients with chronic obstructive pulmonary disease. Archives of Internal Medicine. 2009;169(15):1403–1410. [PubMed: 19667304]
75. Levy ML, Stephenson P, Barritt P, Bellamy D, Haughney J, Hilton S, Holmes S, Jones K, Neville R, Price D, Ryan D, Smith A. The UK general practice airways group (GPIAG): Its formation, development, and influence on the management of asthma and other respiratory diseases over the last twenty years. Primary Care Respiratory Journal. 2007;16(3):132–139. [PMC free article: PMC6634211] [PubMed: 17530149]
76. Lewis DR, Clegg LX, Johnson NJ. Lung disease mortality in the United States: The national longitudinal mortality study. International Journal of Tuberculosis and Lung Disease. 2009;13(8):1008–1014. [PMC free article: PMC2765862] [PubMed: 19723382]
77. Lin K, Watkins B, Johnson T, Rodriguez JA, Barton MB. Screening for chronic obstructive pulmonary disease using spirometry: Summary of the evidence for the U.S. Preventive services task force. Annals of Internal Medicine. 2008;148(7):535–543. [PubMed: 18316746]
78. Lindenauer PK, Pekow P, Gao S, Crawford AS, Gutierrez B, Benjamin EM. Quality of care for patients hospitalized for acute exacerbations of chronic obstructive pulmonary disease. Annals of Internal Medicine. 2006;144(12):894–903. [PubMed: 16785478]
79. Lindenauer PK, Pekow PS, Lahti MC, Lee Y, Benjamin EM, Rothberg MB. Association of corticosteroid dose and route of administration with risk of treatment failure in acute exacerbation of chronic obstructive pulmonary disease. JAMA: The Journal of the American Medical Association. 2010;303(23):2359–2367. [PubMed: 20551406]
80. Loke YK, Kwok CS, Singh S. Risk of myocardial infarction and cardiovascular death associated with inhaled corticosteroids in COPD. European Respiratory Journal. 2010;35(5):1003–1021. [PubMed: 19926743]
81. Mannino DM, Braman S. The epidemiology and economics of chronic obstructive pulmonary disease. Proceedings of the American Thoracic Society. 2007;4(7):502–506. [PubMed: 17878461]
82. Mannino DM, Buist AS. Global burden of COPD: Risk factors, prevalence, and future trends. Lancet. 2007;370(9589):765–773. [PubMed: 17765526]
83. Mannino DM, Gagnon RC, Petty TL, Lydick E. Obstructive lung disease and low lung function in adults in the United States: Data from the national health and nutrition examination survey, 1988–1994. Archives of Internal Medicine. 2000;160(11):1683–1689. [PubMed: 10847262]
84. Mannino DM, Doherty DE, Sonia Buist A. Global initiative on obstructive lung disease (GOLD) classification of lung disease and mortality: Findings from the Atherosclerosis Risk in Communities (ARIC) study. Respiratory Medicine. 2006;100(1):115–122. [PubMed: 15893923]
85. Mapel DW, Frost FJ, Hurley JS, Petersen H, Roberts M, Marton JP, Shah H. An algorithm for the identification of undiagnosed COPD cases using administrative claims data. Journal of Managed Care Pharmacy. 2006;12(6):457–465. [PubMed: 16925453]
86. McKnight J, Scott A, Menzies D, Bourbeau J, Blais L, Lemiere C. A cohort study showed that health insurance databases were accurate to distinguish chronic obstructive pulmonary disease from asthma and classify disease severity. Journal of Clinical Epidemiology. 2005;58(2):206–208. [PubMed: 15680756]
87. Menzies D, Nair A, Williamson PA, Schembri S, Al-Khairalla MZH, Barnes M, Fardon TC, McFarlane L, Magee GJ, Lipworth BJ. Respiratory symptoms, pulmonary function, and markers of inflammation among bar workers before and after a legislative ban on smoking in public places. JAMA: The Journal of the American Medical Association. 2006;296(14):1742–1748. [PubMed: 17032987]
88. Menzin J, Boulanger L, Marton J, Guadagno L, Dastani H, Dirani R, Phillips A, Shah H. The economic burden of chronic obstructive pulmonary disease (COPD) in a U.S. Medicare population. Respiratory Medicine. 2008;102(9):1248–1256. [PubMed: 18620852]
89. Miravitlles M, Murio C, Tirado-Conde G, Levy G, Muellerova H, Soriano JB, Ramirez-Venegas A, Ko FW, Canelos-Estrella B, Giugno E, Bergna M, Cherrez I, Anzueto A. Geographic differences in clinical characteristics and management of COPD: The epoca study. International Journal of Chronic Obstructive Pulmonary Disease. 2008;3(4):803–814. [PMC free article: PMC2650616] [PubMed: 19281096]
90. Miravitlles M, Soriano JB, García-Río F, Muñoz L, Duran-Tauleria E, Sanchez G, Sobradillo V, Ancochea J. Prevalence of COPD in Spain: Impact of undiagnosed COPD on quality of life and daily life activities. Thorax. 2009;64(10):863–868. [PubMed: 19553233]
91. Monninkhof E, van der Valk P, van der Palen J, van Herwaarden C, Partridge MR, Zielhuis G. Self-management education for patients with chronic obstructive pulmonary disease: A systematic review. Thorax. 2003;58(5):394–398. [PMC free article: PMC1746688] [PubMed: 12728158]
92. Mularski RA, Asch SM, Shrank WH, Kerr EA, Setodji CM, Adams JL, Keesey J, McGlynn EA. The quality of obstructive lung disease care for adults in the United States as measured by adherence to recommended processes*. Chest. 2006;130(6):1844–1850. [PubMed: 17167007]
93. National Collaborating Centre for Chronic Conditions. Chronic obstructive pulmonary disease. National clinical guideline on management of chronic obstructive pulmonary disease in adults in primary and secondary care. Thorax. 2004;59(Suppl 1):1–232. [PMC free article: PMC1766028] [PubMed: 15041752]
94. Nieuwenhuijsen ER, Zemper E, Miner KR, Epstein M. Health behavior change models and theories: Contributions to rehabilitation. Disability and Rehabilitation. 2006;28(5):245–256. [PubMed: 16492619]
95. O’Malley AS, Pham HH, Schrag D, Wu B, Bach PB. Potentially avoidable hospitalizations for COPD and pneumonia: The role of physician and practice characteristics. Medical Care. 2007;45(6):562–570. [PubMed: 17515784]
96. Oostenbrink JB, Rutten-van Mölken MPMH. Resource use and risk factors in high-cost exacerbations of COPD. Respiratory Medicine. 2004;98(9):883–891. [PubMed: 15338802]
97. Peikes D, Chen A, Schore J, Brown R. Effects of care coordination on hospitalization, quality of care, and health care expenditures among Medicare beneficiaries: 15 randomized trials. JAMA: The Journal of the American Medical Association. 2009;301(6):603–618. [PubMed: 19211468]
98. Pelkonen M, Notkola I-L, Lakka T, Tukiainen HO, Kivinen P, Nissinen A. Delaying decline in pulmonary function with physical activity: A 25-year follow-up. American Journal of Respiratory and Critical Care Medicine. 2003;168(4):494–499. [PubMed: 12791579]
99. Peytremann-Bridevaux I, Staeger P, Bridevaux P-O, Ghali WA, Burnand B. Effectiveness of chronic obstructive pulmonary disease-management programs: Systematic review and meta-analysis. American Journal of Medicine. 2008;121(5):433–443. e434. [PubMed: 18456040]
100. Pitta F, Troosters T, Spruit MA, Probst VS, Decramer M, Gosselink R. Characteristics of physical activities in daily life in chronic obstructive pulmonary disease. American Journal of Respiratory and Critical Care Medicine. 2005;171(9):972–977. [PubMed: 15665324]
101. Pope CA, Ezzati M, Dockery DW. Fine-particulate air pollution and life expectancy in the United States. New England Journal of Medicine. 2009;360(4):376–386. [PMC free article: PMC3382057] [PubMed: 19164188]
102. Puhan M, Bachmann L, Kleijnen J, ter Riet G, Kessels A. Inhaled drugs to reduce exacerbations in patients with chronic obstructive pulmonary disease: A network meta-analysis. BMC Medicine. 2009;7(1):2. [PMC free article: PMC2636836] [PubMed: 19144173]
103. Puhan M, Scharplatz M, Troosters T, Walters EH, Steurer J. Pulmonary rehabilitation following exacerbations of chronic obstructive pulmonary disease. Cochrane Database Systematic Reviews. 2009;(1):CD005305. [PubMed: 19160250]
104. Puhan MA, Garcia-Aymerich J, Frey M, ter Riet G, Antó JM, Agustí AG, Gómez FP, Rodríguez-Roisín R, Moons KGM, Kessels AG, Held U. Expansion of the prognostic assessment of patients with chronic obstructive pulmonary disease: The updated BODE index and the ADO index. The Lancet. 2009;374(9691):704–711. [PubMed: 19716962]
105. Pujades-Rodriguez M, Smith CJ, Hubbard RB. Inhaled corticosteroids and the risk of fracture in chronic obstructive pulmonary disease. QJM : Monthly Journal of the Association of Physicians. 2007;100(8):509–517. [PubMed: 17609226]
106. Rabe KF, Hurd S, Anzueto A, Barnes PJ, Buist SA, Calverley P, Fukuchi Y, Jenkins C, Rodriguez-Roisin R, van Weel C, Zielinski J. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: Gold executive summary. American Journal of Respiratory and Critical Care Medicine. 2007;176(6):532–555. [PubMed: 17507545]
107. Rascati KL, Akazawa M, Johnsrud M, Stanford RH, Blanchette CM. Comparison of hospitalizations, emergency department visits, and costs in a historical cohort of Texas Medicaid patients with chronic obstructive pulmonary disease, by initial medication regimen. Clinical Therapeutics. 2007;29(6):1203–1213. [PubMed: 17692734]
108. Rascon-Aguilar IE, Pamer M, Wludyka P, Cury J, Coultas D, Lambiase LR, Nahman NS, Vega KJ. Role of gastroesophageal reflux symptoms in exacerbations of COPD*. Chest. 2006;130(4):1096–1101. [PubMed: 17035443]
109. Rector TS, Wickstrom SL, Shah M, Thomas Greeenlee N, Rheault P, Rogowski J, Freedman V, Adams J, Escarce JJ. Specificity and sensitivity of claims-based algorithms for identifying members of Medicare+choice health plans that have chronic medical conditions. Health Services Research. 2004;39(6p1):1839–1858. [PMC free article: PMC1361101] [PubMed: 15533190]
110. Roberts DH, Gilmartin GS, Neeman N, Schulze JE, Cannistraro S, Ngo LH, Aronson MD, Weiss JW. Design and measurement of quality improvement indicators in ambulatory pulmonary care. Chest. 2009;136(4):1134–1140. [PubMed: 19809055]
111. Rodriguez-Roisen R, Anzueto A, Bourbeau J, Calverley PM, de Guia T, Yoshinosuke F, Hui DSC, Jenkins C, Kocabas A, Martinez F, Montes de Oca M, van Weel C, Vestbo J. Global initiative for chronic obstructive lung disease Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease (updated 2009). 2009. [accessed July 7, 2010]. http://www​.goldcopd.com/download​.asp?intId=554 .
112. Rothberg MB, Pekow PS, Lahti M, Brody O, Skiest DJ, Lindenauer PK. Antibiotic therapy and treatment failure in patients hospitalized for acute exacerbations of chronic obstructive pulmonary disease. JAMA: The Journal of the American Medical Association. 2010;303(20):2035–2042. [PubMed: 20501925]
113. Rutschmann OT, Janssens J-P, Vermeulen B, Sarasin FP. Knowledge of guidelines for the management of COPD: A survey of primary care physicians. Respiratory Medicine. 2004;98(10):932–937. [PubMed: 15481268]
114. Rutten FH, Zuithoff NPA, Hak E, Grobbee DE, Hoes AW. Beta-blockers may reduce mortality and risk of exacerbations in patients with chronic obstructive pulmonary disease. Archives of Internal Medicine. 2010;170(10):880–887. [PubMed: 20498416]
115. Salpeter SR. Do inhaled anticholinergics increase or decrease the risk of major cardiovascular events?: A synthesis of the available evidence. Drugs. 2009;69(15):2025–2033. [PubMed: 19791824]
116. Salvi SS, Barnes PJ. Chronic obstructive pulmonary disease in non-smokers. The Lancet. 2009;374(9691):733–743. [PubMed: 19716966]
117. Schindler C, Keidel D, Gerbase MW, Zemp E, Bettschart R, Brandli O, Brutsche MH, Burdet L, Karrer W, Knopfli B, Pons M, Rapp R, Bayer-Oglesby L, Kunzli N, Schwartz J, Liu L-JS, Ackermann-Liebrich U, Rochat T. the SAPALDIA Team. Improvements in pm10 exposure and reduced rates of respiratory symptoms in a cohort of Swiss adults (SAPALDIA). American Journal of Respiratory and Critical Care Medicine. 2009;179(7):579–587. [PubMed: 19151198]
118. Schneider C, Jick SS, Bothner U, Meier CR. COPD and the risk of depression. Chest. 2010;137(2):341–347. [PubMed: 19801582]
119. Schneider C, Bothner U, Jick SS, Meier CR. Chronic obstructive pulmonary disease and the risk of cardiovascular diseases. European Journal of Epidemiology. 2010;25(4):253–260. [PubMed: 20191376]
120. Shahab L, Jarvis MJ, Britton J, West R. Prevalence, diagnosis and relation to tobacco dependence of chronic obstructive pulmonary disease in a nationally representative population sample. Thorax. 2006;61(12):1043–1047. [PMC free article: PMC2117062] [PubMed: 17040932]
121. Simoni-Wastila L, Yang K, Hui-wen, Blanchette C, Zhao L, Qian J, Dalal AA. Hospital and emergengy department utilization associated with treatment for chronic obstructive pulmonary disease in a managed-care Medicare population. Current Medical Research and Opinion. 2009;25(11):2729–2735. [PubMed: 19778165]
122. Simpson AC, Rocker GM. Advanced chronic obstructive pulmonary disease: Rethinking models of care. QJM. 2008;101(9):697–704. [PubMed: 18669555]
123. Sin DD, Anthonisen NR, Soriano JB, Agusti AG. Mortality in COPD: Role of comorbidities. European Respiratory Journal. 2006;28(6):1245–1257. [PubMed: 17138679]
124. Singh JA. Accuracy of Veterans Affairs databases for diagnoses of chronic diseases. Preventing Chronic Disease. 2009;6(4):A126. [PMC free article: PMC2774640] [PubMed: 19755002]
125. Smith CJP, Gribbin J, Challen KB, Hubbard RB. The impact of the 2004 nice guideline and 2003 general medical services contract on COPD in primary care in the UK. QJM. 2008;101(2):145–153. [PubMed: 18180254]
126. Song Y, Skinner J, Bynum J, Sutherland J, Wennberg JE, Fisher ES. Regional variations in diagnostic practices. New England Journal of Medicine. 2010;363(1):45–53. [PMC free article: PMC2924574] [PubMed: 20463332]
127. Soriano JB, Maier WC, Visick G, Pride NB. Validation of general practitioner-diagnosed COPD in the UK general practice research database. European Journal of Epidemiology. 2001;17(12):1075–1080. [PubMed: 12530765]
128. 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):2099–2107. [PubMed: 16236861]
129. Søyseth V, Brekke PH, Smith P, Omland T. Statin use is associated with reduced mortality in COPD. European Respiratory Journal. 2007;29(2):279–283. [PubMed: 17050558]
130. Stavem K, Sandvik L, Erikssen J. Can global initiative for chronic obstructive lung disease stage 0 provide prognostic information on long-term mortality in men? Chest. 2006;130(2):318–325. [PubMed: 16899828]
131. Strassmann R, Bausch B, Spaar A, Kleijnen J, Braendli O, Puhan MA. Smoking cessation interventions in COPD: A network meta-analysis of randomised trials. European Respiratory Journal. 2009;34(3):634–640. [PubMed: 19357145]
132. Sumner W, Schootman M, Asaro P, Yan Y, Hagen MD. Using county-level public health data to prioritize medical education topics. Journal of Continuing Education in the Health Professions. 2008;28(4):197–204. [PubMed: 19058239]
133. Svanes C, Sunyer J, Plana E, Dharmage S, Heinrich J, Jarvis D, de Marco R, Norbäck D, Raherison C, Villani S, Wjst M, Svanes K, Antó JM. Early life origins of chronic obstructive pulmonary disease. Thorax. 2010;65(1):14–20. [PubMed: 19729360]
134. Trivedi AN, Zaslavsky AM, Schneider EC, Ayanian JZ. Trends in the quality of care and racial disparities in Medicare managed care. New England Journal of Medicine. 2005;353(7):692–700. [PubMed: 16107622]
135. Troosters T, Casaburi R, Gosselink R, Decramer M. Pulmonary rehabilitation in chronic obstructive pulmonary disease. American Journal of Respiratory and Critical Care Medicine. 2005;172(1):19–38. [PubMed: 15778487]
136. van Gestel YR, Hoeks SE, Sin DD, Huzeir V, Stam H, Mertens FW, van Domburg RT, Bax JJ, Poldermans D. COPD and cancer mortality: The influence of statins. Thorax. 2009;64(11):963–967. [PubMed: 19720607]
137. Vestbo J, Lange P. Can GOLD stage 0 provide information of prognostic value in chronic obstructive pulmonary disease? American Journal of Respiratory and Critical Care Medicine. 2002;166(3):329–332. [PubMed: 12153965]
138. Vincken W, van Noord JA, Greefhorst APM, Bantje TA, Kesten S, Korducki L, Cornelissen PJG. Improved health outcomes in patients with COPD during 1 yr’s treatment with tiotropium. European Respiratory Journal. 2002;19(2):209–216. [PubMed: 11871363]
139. Wennberg JE, Fisher ES, Stukel TA, Sharp SM. Use of Medicare claims data to monitor provider-specific performance among patients with severe chronic illness. Health Affairs (Millwood). 2004;(Suppl):5–18. [PubMed: 15471771]
140. Werner RM, Bradlow ET. Relationship between Medicare’s hospital compare performance measures and mortality rates. JAMA: The Journal of the American Medical Association. 2006;296(22):2694–2702. [PubMed: 17164455]
141. WHO (World Health Organization). Global strategy for diagnosis, management, and prevention of COPD. 2008. [accessed February 3, 2008]. http://www​.goldcopd.com/Guidelineitem​.asp?l1​=2&l2=1&intId=989 .
142. Williams SC, Schmaltz SP, Morton DJ, Koss RG, Loeb JM. Quality of care in U.S. hospitals as reflected by standardized measures, 2002–2004. New England Journal of Medicine. 2005;353(3):255–264. [PubMed: 16034011]
143. Wilt TJ, Niewoehner D, Kim C, Kane RL, Linabery A, Tacklind J, Macdonald R, Rutks I. Use of spirometry for case finding, diagnosis, and management of chronic obstructive pulmonary disease (COPD). Evidence Report/Technology Assessment (Summary). 2005;(121):1–7. [PMC free article: PMC4781180] [PubMed: 16238364]
144. Wong KW, Wong FKY, Chan MF. Effects of nurse-initiated telephone follow-up on self-efficacy among patients with chronic obstructive pulmonary disease. Journal of Advanced Nursing. 2005;49(2):210–222. [PubMed: 15641953]
145. Xu W, Collet J-P, Shapiro S, Lin Y, Yang T, Platt RW, Wang C, Bourbeau J. Independent effect of depression and anxiety on chronic obstructive pulmonary disease exacerbations and hospitalizations. American Journal of Respiratory and Critical Care Medicine. 2008;178(9):913–920. [PubMed: 18755925]
146. Xu W, Collet J-P, Shapiro S, Lin Y, Yang T, Wang C, Bourbeau J. Negative impacts of unreported COPD exacerbations on health-related quality of life at 1 year. European Respiratory Journal. 2010;35(5):1022–1030. [PubMed: 19897555]
147. Yarger S, Rascati K, Lawson K, Barner J, Leslie R. Analysis of predictive value of four risk models in Medicaid recipients with chronic obstructive pulmonary disease in texas. Clinical Therapeutics. 2008;30:1051–1057. [PubMed: 18640479]
148. Yohannes AM, Connolly MJ. Pulmonary rehabilitation programmes in the UK: A national representative survey. Clinical Rehabilitation. 2004;18(4):444–449. [PubMed: 15180129]