Early avoidable 30-day post discharge readmission among patients diagnosed with chronic obstructive pulmonary disease (COPD) is associated with poor transition care processes. The purpose of this project was to analyze organizational system processes for admission and discharge transition care of patients diagnosed with COPD to identify key intervention strategies that could decrease the rate of 30-day post-discharge readmission by 1%. The project used the transitional care model as the framework to target specific care transition needs and create patient-centered, supportive, evidence-based relationships among the patient, the providers, the community, and the health care system to identify key intervention strategies for implementation. A retrospective chart review was conducted of transitional care management and care coordination practices of providers of patients diagnosed with COPD. Analysis of the data revealed that the local regional organization used a single, generic, computerized discharge planning and care transition process for patients diagnosed with COPD. As a result, missed opportunities to target a patient's specific care needs led to higher rates of readmission. The implications of the findings of this project for social change include identification of evidence-based recommendations and practices that could influence clinician practices and improve patient outcomes and the quality of health care delivery.

Background and Objective: Comorbidity and especially cardiovascular diseases are common among patients with chronic obstructive pulmonary disease (COPD). The primary purpose of this study was to identify drugs for the treatment of cardiovascular diseases in COPD patients. The secondary purpose was to analyze whether the use of cardiovascular drugs differs between patients with mild and severe COPD symptoms.     Method: The study was a retrospective cross-sectional study of 421 COPD patients whose drug lists were analyzed and cardiovascular drugs were identified. These drugs were then divided into eight drug groups, based on the drug's ATC (Anatomic Therapeutic Chemical classification system) codes. Only patients with reported cardiovascular diseases were included in the analysis. Patients with mild and severe COPD symptoms were identified. Thereafter, the patients were divided into two groups based on the COPD symptoms. Chi-squared test was performed to see if the use of cardiovascular drugs differs between patients with mild and severe COPD symptoms.  Setting: Primary and secondary care patients with COPD in Gävle and Dalarna.  Main outcome measures: Identify and analyze the use of cardiovascular drugs in COPD patients with mild and severe symptoms.  Results: The results of the survey showed that cardiovascular drugs were used by 274 (65%) of the COPD patients. Among them, 66 % with severe COPD symptoms and 34 % with mild symptoms. The use of the eight cardiovascular drug groups were similar between patients with mild and severe COPD symptoms. There wasn’t any statistically significant difference in the use of cardiovascular drugs between patients with mild and severe COPD symptoms (p= 0,893).   Conclusions: There wasn’t any difference in the use of cardiovascular drugs among patients with mild and severe COPD symptoms. However, this result needs to be substantiated with a follow-up study with a larger study population and longer study time to be generalizable.

Bakgrund Kronisk obstruktiv lungsjukdom är ett pågående folkhälsoproblem som främst drabbar personer som röker. Det finns även andra faktorer, som passiv rökning samt exponering för luftföroreningar, som kan öka risken att framskrida sjukdomen. Egenvård är mycket viktigt i detta tillstånd, eftersom det i nuläget inte finns något botemedel mot sjukdomen. Syfte Syftet är att belysa patienters upplevelse av att leva med kronisk obstruktiv lungsjukdom. Metod Litteraturöversikt som baserades på tio kvalitativa vetenskapliga artiklar från Cinahl och PubMed. Resultat Resultatet visade att KOL påverkar människor på olika sätt, både psykiskt och fysiskt. Patienterna kan uppleva trötthet och andnöd i vardagen. Sjukdomen kan orsaka känslor som skuld, skam och ensamhet, vilket har visat sig leda till isolering. Slutsats På grund av att KOL är en kronisk sjukdom som varar livet ut är det viktigt att behandlingen effektivt hanterar patientens symtom. Sjuksköterskans uppgift är att identifiera samt förstå patientens unika behov och skräddarsy behandlingen utifrån dennes behov. Sammantaget är vårdens kvalitet en nyckelfaktor som formar relationen mellan sjuksköterska och patient. / Background Chronic obstructive pulmonary disease is an ongoing public health issue primarily affecting individuals who smoke. There are other factors, such as passive smoking and exposure to air pollution, which can also increase the risk of developing the disease. Self-care is crucial in this condition as there is currently no cure for the disease. Aim The aim is to illuminate individuals’ experience of living with chronic obstructive pulmonary disease. Method A literature review based on ten qualitative studies from Cinahl and PubMed. Results The results showed that COPD affects people in various ways, both mentally and physically. Patients may experience fatigue and shortness of breath in their daily lives. The disease can trigger emotions such as guilt, shame, and loneliness, which has been found to lead to isolation. Conclusions Due to COPD being a chronic disease that lasts a lifetime, it is crucial for treatment to effectively manage the patient’s symptoms. The nurse’s responsibility is to identify and comprehend the patient’s unique needs and tailor the treatment accordingly. Overall, the quality of care is a key factor that shapes the relationship between the nurse and the patient.

Bakgrund: Kronisk obstruktiv lungsjukdom(KOL) är en långsiktig sjukdom som tar tid innan den visar symtom. När patienten kommer och vill ha information och åtgärder för sina symtom har sjukdomsförloppet redan pågått ett tag. Eftersom den är långdragen är omvårdnadsåtgärderna olika beroende på vart i tiden man ligger i sjukdomen. År 2020 kommer denna patientgrupp vara den tredje största i världen, finns det omvårdnadsåtgärder som ökar livskvalitén för denna patientgrupp? Syfte: Syftet med litteraturstudien var att sammanställa resultat avseende forskning om omvårdnad vid kronisk obstruktiv lungsjukdom som leder till förbättrad livskvalité. Metod: Litteratur studie. Resultat: Kunskapsutbytet mellan patient och sjuksköterska: Hur viktigt det är med en klar och tydlig information vid möte mellan sjuksköterska och patient. Att ge stöd och trygghet: Viktigt att sjuksköterskan finns tillgänglig för patienten, underlätta för patienten: Sjuksköterskan har en viktig roll hos patienter med KOL för att förbättra deras förutsättningar för god livskvalité. Slutsats: Viktigt att skapa en tillit mellan sjuksköterskan och patienten, detta skapar trygghet och resulterar till en god fysisk omvårdnad. När trygghet och tillit har byggts upp mellan sjuksköterskan och patienten blir kommunikationen god och man kan tillsammans komma fram till den bästa lösningen för varje enskild patient. / Background: Chronic obstructive pulmonary disease (COPD) is a long term disease that takes time before it shows symptoms. When the patient comes and want information and measures for their symptoms, the disease process has already been going on for a while. Because it is lengthy nursing actions different depending on where in time lying in the disease. In the year of 2020 this will be the third largest patient group in the world, are there any nursing interventions that can increase quality of life? Aim: The purpose of this study was to compile results concerning research on nursing care in chronic obstructive pulmonary disease that leads to improve quality of life. Method: Literature. Results: Knowledge exchange between patient and nurse: How important it is with a clear and transparent information at the meeting between the nurse and patient. To provide support and trust: Important that the nurse is available for the patient. Facilitating patient: The nurse has an important role in patients with COPD to improve their conditions for a god quality of life. Conclusion: Important to create trust between the nurse and patient, this creates confidence and results to good physical care. When trust and confidence has been built between nurse and patient communication becomes good and we can together arrive at the best solution for each individual patient.

Cardiovascular disease is common in Chronic Obstructive Pulmonary Disease (COPD), and forced expiratory volume in one second (FEV1) independently predicts cardiovascular morbidity and mortality. Pathological changes in the systemic vasculature have been proposed as potential mechanisms linking COPD to cardiovascular disease, and patients with COPD may be at increased risk of acute myocardial infarction during acute exacerbations. Notwithstanding causation, FEV1 may be a useful prognostic marker in patients undergoing cardiac surgery. This thesis examined these three aspects of cardiovascular co-morbidity in relation to COPD and FEV1. In 2,241 consecutive cardiac surgery patients, FEV1 was associated with length of hospital stay (p<0.001) and mortality (p<0.001) adjusting for age, sex, height, body mass index, socioeconomic status, smoking, cardiovascular risk factors, chronic pulmonary disease, and type/urgency of surgery. In a survey of Scottish Respiratory Consultants there was no consensus regarding the investigation and management of acute coronary syndrome in exacerbation of COPD. In a case-series of 242 patients with exacerbations 2.5% (95% CI 1.0 to 5.6%) had chest pain, raised serum troponin and serial electrocardiogram changes suggestive of acute coronary syndrome. However, over half reported chest pain, while raised troponin was not associated with chest pain or serial ECG changes. Carotid-radial pulse wave velocity (PWV), aortic distensibility, and aortic calcification were measured to assess the relationship of the systemic vasculature to FEV1 and emphysema severity on CT. In adjusted analyses, emphysema was associated with PWV in patients with COPD (p = 0.006) and, in population based samples, with extent of distal aortic calcification (p=0.02) but not with aortic distensibility (p=0.60). This thesis found that FEV1 was associated with mortality and length of hospital stay in patients undergoing cardiac surgery, and that chest pain and raised troponin were common but unrelated in exacerbation of COPD. In the vascular studies distal but not proximal vascular pathology was associated with FEV1, and if COPD is truly related to systemic arterial disease, the distal arterial tree is implicated.

Bakgrund Kronisk obstruktiv lungsjukdom är en sjukdom som är irreversibel och påverkar andningen negativt hos dem som lider av den och visar sig genom ett stort antal symtom. Sjukdomen skapar stort lidande och försvårar förmågan att leva ett normalt liv med hög livskvalité. Det beräknas vara den tredje största dödsorsaken i världen 2030 enligt världshälsoorganisationen. Syfte Att beskriva personers erfarenheter av att leva med Kronisk obstruktiv lungsjukdom  Metod Studien utgörs av en litteraturstudie med fjorton artiklar. Artiklarnas resultat sammanfattades och gick från delarna till en ny helhet. En kvalitetsgranskning och analys utfördes för att skapa resultatet. Resultat Resultatet presenterades med fyra huvudkategorier: Att inte få luft, Förändrad livssituation, Beroende av stöd och Information och hantering. Till huvudkategorierna skapades följande tio underkategorier: Andnöd/andfåddhet, Ångest, Trötthet, Förluster, Skam, Miljöanpassning, Anhöriga, Hjälpmedel, Undervisning och information och Hantering och strategier. Konklusion Litteraturstudien visade att en stor dimension av symtom påverkar personer som lever med Kronisk obstruktiv lungsjukdom. Det behövs vidare forskning angående personers erfarenhet av sjukdomen men denna litteraturstudie har gett en inblick i några av de erfarenheter personerna lever med. / Background Chronic obstructive pulmonary disease is an irreversible disease and it’s effecting the breathing in a negative way for those suffering by the disease and it’s shown by many different symptoms. The disease creates big suffering and obstructs the ability to live a normal life with high quality of life. It is expected to be the third largest cause of death worldwide in 2030, according to the World Health Organization. Aim To describe people's experiences of living with chronic obstructive lung disease. Method The study is a literature study with fourteen articles. The result from the articles were summarized and went from parts into a new whole. An inspection of quality and analysis was performed to create the result. Result The result were presented with four main categories: Unable to breathe, Change of way of life, Depending on support, Information and management. To the main categories were ten under categories created:  Shortness of breath/breathlessness, Anxiety, Fatigue, Losses, Adaptation to environment, Relatives, Utilities, Education and information and Management and strategies. Conclusion The literature study showed that there’s a major dimension of symptoms affecting people living with chronic obstructive pulmonary disease. Chronic obstructive pulmonary disease. The literature review showed that a large dimension of symptoms are affecting people living with chronic obstructive pulmonary disease. We need further research on people's experience of the disease, but this study has provided an insight into some of the experiences people are living with.

Objective: To evaluate the utilization and cost of drugs for the treatment of asthma and COPD in Lithuania in 2006-2009. Methodology: The data on the sales of drugs for asthma and COPD for the year 2006-2009 was obtained from SoftDent, JSC, database. The utilization of the R03 group (drugs for obstructive airway diseases) of the Anatomical Therapeutic Chemical (ATC) classification was analysed. The utilization was expressed as DDD/1000 inhabitants per day. The pharmacoeconomical analysis was performed implementing cost-minimisation and reference pricing methodologies. Results: The total use of drugs for asthma and COPD increased from 23,70 DDD/1000 inhabitants/day in 2006 to 28,67 DDD/1000 inhabitants/day in 2009. The most significant increase is found in the use of inhaled corticosteroid/long-acting β2-agonist combinations. The costs for drugs for the treatment of asthma and COPD increased from 59,71 million Litas in 2006 to 80,12 million Litas in 2008 and decreased to 79,25 million Litas in 2009. The use of drugs of the ATC group R03 is about 2 times higher in Norway, Denmark and Finland and about 1,6 times lower in Estonia. The pharmacoeconomical analysis shows marked savings if the lowest of the second lowest prices of one DDD were implemented as the reference price. The most considerable saving is found to be for inhaled corticosteroid/long-acting β2-agonist combinations – using the lowest basic price of one DDD as the reference price, total 18,04 million Litas would... [to full text] / Tikslas: Įvertinti vaistų, vartojamų astmai ir lėtinei obstrukcinei plaučių ligai (LOPL) gydyti suvartojimą ir išlaidas Lietuvoje 2006-2009 metais. Metodika: Duomenys apie vaistų, vartojamų astmai ir LOPL gydyti pardavimus 2006-2009 metais gauti iš UAB SoftDent duomenų bazės. Analizuojami vaistai yra klasifikuojami R03 grupėje (vaistai obstrukcinėms plaučių ligoms) pagal Anatominę Terapinę Cheminę (ATC) klasifikaciją. Vaistų suvartojimas išreikštas DDD skaičiumi, tenkančiu tūkstančiui gyventojų per vieną dieną. Farmakoekonominė analizė atlikta taikant kaštų mažinimo ir referentinės kainos metodus. Rezultatai: Bendras vaistų astmai ir LOPL gydyti suvartojimas Lietuvoje išaugo nuo 23,70 DDD/1000 gyventojų per dieną 2006 metais iki 28,67 DDD/1000 gyventojų per dieną 2009 metais. Didžiausias suvartojimo augimas nustatytas inhaliuojamų gliukokortikosteroidų/ilgo veikimo β2-agonistų kombinuotų preparatų grupėje. Išlaidos vaistų, vartojamų astmai ir LOPL gydyti augo nuo 59,71 mln. Litų 2006 metais iki 80,12 mln. Litų 2008 metais ir 2009 metais sumažėjo iki 79,25 mln. Litų. Vaistų, klasifikuojamų R03 grupėje pagal ATC klasifikaciją, suvartojimas Lietuvoje yra apie 2 kartus mažesnis nei Norvegijoje, Danijoje ir Suomijoje ir apie 1,6 karto didesnis nei Estijoje. Farmakoekonominė analizė pateikia ženklius galimo taupymo pavyzdžius, jei mažiausia ar antra mažiausia vieno DDD kaina būtų taikoma kaip referentinė kaina. Reikšmingiausi farmakoekonominės analizės rezultatai nustatyti... [toliau žr. visą tekstą]

Uppskattningsvis har mellan 400 000 och 700 000 personer i Sverige kronisk obstruktiv lungsjukdom (KOL). KOL fastställs genom mätning av andningsvolymen på en astma- och KOL-mottagning ledd av en distriktssköterska med en specialistutbildning avseende astma och KOL från vilken fortsatt vård och uppföljning sedan utgår. Syfte : Syftet var att beskriva distriktssköterskeledd patientutbildning och dess effekter på patienter med astma och kronisk obstruktiv lungsjukdom. Metod : Integrativ litteraturstudie. Resultat: Utbildningens innehåll, utbildningsmetoder, effekter av utbildning och effekter av utbildningsmetoder framkom som genomgående teman. Innehållet i utbildningen som erbjuds via en mottagning för patienter med astma och kronisk obstruktiv lungsjukdom är baserat på generella riktlinjer, men valet av utbildningsmetod varierar och baseras på patientens egenskaper och inställning vilket avgör utbildningens effekt på sjukdomen. Genom implementeringen av patientutbildning kan ett stabilt sjukdomsförlopp uppnås, men behovet av uppföljning är genomgående. / Approximately between 400 000 and 700 000 individuals has been diagnosed with Chronic Obstructive Pulmonary Disease (COPD) in. COPD is diagnosed at an asthma- and COPD-reception led by a district nurse with residency in asthma and COPD where the patients will receive further care. Aim : The aim of this study was to describe the district nurse led patient education and the effects on patients with asthma- and chronic obstructive pulmonary disease. Method : The method of choice was an integrative literature review. Results: The content of the education, education method, the effects of education and the effects of education methods were revealed as pervading themes. The content of the education is based on general guidelines, but the method of choice is based on the capacity and attitude of the patient which determines the effect on the disease. Through the implementation of patient education a stable condition can be achieved in the patients with chronic obstructive pulmonary disease.

Bakgrund: Kroniskt obstruktiv lungsjukdom (KOL) är ett sjukdomstillstånd som kännetecknas av ett begränsat luftflöde, främst vid utandning, till följd av exponering av giftiga ämnen i inandningsluften. Sjuksköterskan möter dessa patienter i primärvården, allmän medicinavdelning och specialiserad lungmedicinsk avdelning.   Syfte: Syftet med denna litteraturstudie var att utifrån vetenskaplig litteratur beskriva upplevelser av att leva med kroniskt obstruktiv lungsjukdom (KOL) utifrån ett psykiskt perspektiv. Syftet var även att beskriva artiklarnas datainsamlingsmetoder.   Metod: Deskriptiv design. Tio stycken vetenskapliga artiklar söktes i databaserna CINAHL och Medline via Pubmed. Dessa användes som underlag till resultatet.   Huvudresultat: Många patienter med KOL upplevde oro, rädsla, depression, en känsla av förlorad identitet, förändrad familjesituation och en känsla av otillräcklighet. Resultatet visade även att flertalet patienter med KOL påvisade symtom liknande PTSD-symtom. Generellt tyckte alla KOL-patienter att andnöden var den främsta orsaken till deras oro. Patienterna upplevde att deras familjer blev drabbade då diagnos ställdes. Familjeaktiviteter och individens potential att bidra till hushållet ändrades vilket bidrog till en förändrad familjesituation, en känsla av förlorad identitet och otillräcklighet.   Slutsats: Upplevelsen hos KOL-patienter definieras av oro, rädsla, depression, en känsla av förlorad identitet, förändrad familjesituation och en känsla av otillräcklighet. Symtom liknande PTSD-symtom påvisades dessutom hos denna patientgrupp. Andnöden generaliserades som den främsta orsaken till deras upplevda psykiska ohälsa.

Background: Exercise capacity (EC) is widely recognized as a strong and independent predictor of mortality and disease progression in various diseases, including cardiovascular and pulmonary diseases. Furthermore, it is generally accepted that exercise capacity in healthy individuals and in patients suffering from cardiovascular diseases is mainly limited by the maximum cardiac output. Objectives: This thesis investigated the impact of different lung function indices on EC in healthy individuals, patients with cardiovascular disease (e.g., pulmonary hypertension (PH)) and patients with pulmonary disease (e.g., chronic obstructive pulmonary disease (COPD)). Methods: The present thesis is based on cross-sectional and longitudinal analyses of patients suffering from COPD, attending pulmonary rehabilitation at Uppsala University Hospital (studies I and II), and healthy men enrolled in the “Oslo ischemia study” (study IV). Study III is a cross-sectional study of patients suffering from PH attending the San Giovanni Battista University Hospital in Turin. EC was assessed using a bicycle ergometer in studies I and IV, with 12-minute walk tests (12MWT) in study II and with 6-minute walk tests (6MWT) in study III. Extensive pulmonary function tests, including diffusing capacity of the lung (DLCO), were performed in studies I-III and dynamic spirometry was used to assess lung function in study IV. Results: DLCO is more closely linked to decreased levels of EC than airway obstruction in COPD patients. Furthermore, the decline in 12MWT over a 5-year period was mainly explained by deterioration in DLCO in COPD patients. Spirometric parameters indicating airway obstruction significantly related to EC and exercise-induced desaturation in PH patients. A significant, but weak association between lung function parameters and EC was found in healthy subjects and this association is strengthened with increasing age. Conclusion: DLCO is the strongest predictor of low EC and EC decline in COPD. In PH, airway obstruction is strongly related to reduced 6MWT. Therefore, extensive analysis of lung function, including measurements of diffusing capacity, along with standard assessment of airway obstruction, gives a more comprehensive assessment of the functional exercise capacity in patients suffering from pulmonary hypertension or COPD. Lung function is also significantly linked to EC even in healthy subjects, lacking evident cardiopulmonary diseases.