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Angaben zur Quelle [Bearbeiten]

Autor     B.R. Celli, P.J. Barnes
Titel    Exacerbations of chronic obstructive pulmonary disease
Zeitschrift    European Respiratory journal
Ausgabe    29
Jahr    2007
Nummer    6
Seiten    1224-1238
ISSN    1399-3003
DOI    10.1183/09031936.00109906
URL    http://www.erj.ersjournals.com/content/29/6/1224.full.pdf

Literaturverz.   

yes
Fußnoten    yes
Fragmente    2


Fragmente der Quelle:
[1.] Analyse:Amm/Fragment 007 12 - Diskussion
Zuletzt bearbeitet: 2014-12-25 20:27:57 Hindemith
Amm, Celli and Barnes 2007, Fragment, KomplettPlagiat, SMWFragment, Schutzlevel, ZuSichten

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Quelle: Celli and Barnes 2007
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COPD is a condition that becomes clinically apparent in mid-to-late life. Comorbidity is relatively common in patients with COPD and this raises the issue as to whether such a comorbidity is age-related, related to a common factor, such as smoking and cardiovascular disease, due to the effect of drugs like corticosteroids and the development of diabetes, or a reflection of the increase in systemic inflammatory cytokine concentrations, which are a feature of COPD with systemic involvement. Data are emerging that the same inflammatory mediators are central to the pathogenesis of other diseases and, to illustrate this, focus was directed towards type 2 diabetes and cardiovascular diseases. COPD is a condition that becomes clinically apparent in mid-to-late life. Comorbidity is relatively common in patients with COPD and this raises the issue as to whether such a comorbidity is age-related, related to a common factor, such as smoking and cardiovascular disease, due to the effect of drugs like corticosteroids and the development of diabetes, or a reflection of the increase in systemic inflammatory cytokine concentrations, which are a feature of COPD with systemic involvement. Data are emerging that the same inflammatory mediators are central to the pathogenesis of other diseases and, to illustrate this, focus was directed towards type 2 diabetes and cardiovascular diseases.
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[2.] Analyse:Amm/Fragment 014 04 - Diskussion
Zuletzt bearbeitet: 2014-12-25 20:33:26 Hindemith
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Economic impact of exacerbations

Some studies have determined that hospitalisation costs represent 40–57% of total direct costs generated by patients with COPD, and this percentage may be as high as 63% in severe patients (Hilleman DE et al, 2000). Since acute exacerbations are the main cause of hospitalisation among COPD patients, it is evident that the economic burden of acute exacerbations is considerable. Observational studies performed in primary care centres observed that 16–22% of patients having exacerbations were admitted during 1 year (Pena VS et al, 2000). The costs of exacerbations that require hospitalisation increase dramatically compared with those that can be treated in an ambulatory setting. An analysis derived from a clinical trial in patients with COPD demonstrated that the 15% of exacerbations requiring hospital admission generated 90% of the costs associated with exacerbations (Miravitlles M et al, 2002). In a recent study in primary care in Spain, the mean total cost of an acute exacerbation of COPD was estimated to be US$159, with the main part being due to hospitalisations, which represented 58% of the total cost, followed by the drug costs amounting to 32% of the total (Miravitlles M et al, 2005). Failure implies a cost that is three times higher than the cost of management of the exacerbation, particularly due to the high cost of hospitalisation. If the percentage of relapses could be reduced, especially in severe cases, or if switching a patient from parenteral to oral therapy could reduce the length of hospital stay, valuable resources could be saved. The costs of managing acute exacerbations of chronic bronchitis are high, particularly because of the high costs associated with relapse (Feenstra TL et al, 2001; Jacobson L et al, 2000). Strategies to improve the outcome of ambulatory treatment of exacerbations should be very cost-effective, especially in more severe patients who are at increased risk of being admitted to hospital as a consequence of therapeutic failure.

Economic consequences

Some studies have determined that hospitalisation costs represent 40–57% of total direct costs generated by patients with COPD, and this percentage may be as high as 63% in severe patients [85]. [...] Since acute exacerbations are the main cause of hospitalisation among COPD patients, it is evident that the economic burden of acute exacerbations is considerable. Observational studies performed in primary care centres observed that 16–22% of patients having exacerbations were admitted during 1 yr [86]. The costs of exacerbations that require hospitalisation increase dramatically compared with those that can be treated in an ambulatory setting. An analysis derived from a clinical trial in patients with COPD demonstrated that the 15% of exacerbations requiring hospital admission generated 90% of the costs associated with exacerbations [87]. In a recent study in primary care in Spain, the mean total cost of an acute exacerbation of COPD was estimated to be US$159, with the main part being due to hospitalisations, which represented 58% of the total cost, followed by the drug costs amounting to 32% of the total [88]. [...] Failure implies a cost that is three times higher than the cost of management of the exacerbation, particularly due to the high cost of hospitalisation. If the percentage of relapses could be reduced, especially in severe cases, or if switching a patient from parenteral to oral therapy could reduce the length of hospital stay, valuable resources could be saved. [...] The costs of managing acute exacerbations of chronic bronchitis are high, particularly because of the high costs associated with relapse [89, 90]. Strategies to improve the outcome of ambulatory treatment of exacerbations should be very cost-effective, especially in more severe patients who are at increased risk of being admitted to hospital as a consequence of therapeutic failure.


85 Hilleman DE, Dewan N, Malesker M, Friedman M. Pharmacoeconomic evaluation of COPD. Chest 2000; 118: 1278–1285.

86 Pena VS, Miravitlles M, Gabriel R, et al. Geographic variations in prevalence and underdiagnosis of COPD: results of the IBERPOC multicentre epidemiological study. Chest 2000; 118: 981–989.

87 Miravitlles M, Murio C, Guerrero T, Gisbert R. Pharmacoeconomic evaluation of acute exacerbations of chronic bronchitis and COPD. Chest 2002; 121: 1449–1455.

88 Miravitlles M, Ferrer M, Pont A, et al. Characteristics of a population of COPD patients identified from a population-based study. Focus on previous diagnosis and never smokers. Respir Med 2005; 99: 985–995.

89 Feenstra TL, van Genugten ML, Hoogenveen RT, Wouters EF, Rutten-van Molken MP. The impact of aging and smoking on the future burden of chronic obstructive pulmonary disease: a model analysis in the Netherlands. Am J Respir Crit Care Med 2001; 164: 590–596.

90 Jacobson L, Hertzman P, Lofdahl CG, Skoogh BE, Lindgren B. The economic impact of asthma and chronic obstructive pulmonary disease (COPD) in Sweden in 1980 and 1991. Respir Med 2000; 94: 247–255.

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