Mieke Albers

Radboud University Medical Centre (Radboudumc), Nymegen, Gelderland, Netherlands

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Publications (8)38.73 Total impact

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    ABSTRACT: In family practice, chronic obstructive pulmonary disease (COPD) is usually not diagnosed until clinically apparent and of moderately advanced severity. To analyse the diagnostic process from early development onwards and to assess the current state of underpresentation and underdiagnosis of COPD and asthma in primary care in the Netherlands. The population-based study sample consisted of formerly undiagnosed subjects (n = 532) from family practice. Family physicians' (FPs) chronic respiratory disease diagnoses (as recorded over 10 years in their patient records) were compared to a cross-sectional but extensive diagnostic assessment by a chest physician. Logistic regression modelling was used for a retrospective analysis on the relation between respiratory symptoms, practice visit rate and FPs' diagnosis of COPD. After 10 years, the chest physician diagnosed 26% of subjects as COPD and 16% as (late-onset) asthma. Underpresentation of these patients in family practice was 46%, whereas underdiagnosis occurred in 37% of patients. A chest physician diagnosis of COPD was associated with the presence of chronic cough [odds ratio (OR) = 2.3, 95% confidence interval (CI) 1.1-4.6], a FP diagnosis of COPD with chronic phlegm (OR = 10.6, 95% CI 1.3-83.6). Repeated practice visits (OR = 1.8) and presence of wheeze and breathlessness (OR = 5.5) appeared to trigger the diagnostic process in family practice. There is still considerable underpresentation and underdiagnosis of COPD in family practice. As FPs focus on presented symptoms and as detection increases with the frequency of practice visits, diagnostic guidelines should stress the importance of persistent cough and phlegm to support timely diagnosis of COPD in family practice.
    Family Practice 03/2009; 26(2):81-7. · 1.83 Impact Factor
  • Thorax 12/2008; 63(11):1028. · 8.38 Impact Factor
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    ABSTRACT: Chronic obstructive pulmonary disease (COPD) is an insidiously starting disease. Early detection has high priority because of the possibility of early implementation of smoking cessation interventions. An evidence based model for case finding of COPD is not yet available. To describe the early development of COPD, and to assess the predictive value of early signs (respiratory symptoms, lung function below the normal range, reversibility). In a prospective study, based in general practice, formerly undiagnosed subjects (n = 464) were assessed at baseline and at 5 years for respiratory symptoms and pulmonary function. Odds ratios for early signs were calculated (adjusted for age, gender, pack-years at baseline and smoking behaviour during follow-up), and defined as possible indicators of disease progression. Over a 5 year period, the percentage of subjects with obstruction increased from 7.5% (n = 35) at baseline to 24.8% (n = 115) at 5 years. The presence of mild early signs and lung function below the normal range at baseline were related to an increased risk of developing mild to moderate COPD (GOLD I: OR 1.87 (95% CI 1.22 to 2.87); GOLD II: OR 2.08 (95% CI 1.29 to 3.37) to 2.54 (95% CI 1.25 to 5.19)) at 5 years. Lung function below the normal range and early respiratory signs predict the development and progression of COPD.
    Thorax 04/2008; 63(3):201-7. · 8.38 Impact Factor
  • Chest 07/2006; 129(6):1733-4; author reply 1734. · 5.85 Impact Factor
  • Chest 11/2005; 128(4):1898-900. · 5.85 Impact Factor
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    ABSTRACT: COPD leads to a progressive decline of pulmonary function. Family physicians treat a substantial number of patients with COPD and are encouraged to start treatment at as early a stage as is possible. This study analyzed the effectiveness of early inhaled corticosteroid treatment on the decline of pulmonary function in COPD patients. Subjects with a rapid decline in lung function (ie, FEV(1) decline, > 80 mL/yr) who had never before received a diagnosis of asthma or COPD. Two-year, randomized, controlled, double-blind clinical trial of fluticasone propionate (250 microg bid; 24 patients) or placebo (25 patients), followed by a 7-month open-label study in which all subjects received fluticasone propionate. The primary outcome was the post-bronchodilator therapy FEV(1,) and secondary outcomes were respiratory symptoms, exacerbations, health state, quality of life, and health-care utilization. After 31 months, there were no statistical differences in post-bronchodilator therapy FEV(1) between the intervention group and the control group. No statistical differences were observed for symptoms, exacerbations, or quality of life, although tendencies were consistently in favor of treatment. There was no significant impact on the direct or indirect costs. There are no indications that early treatment with inhaled corticosteroids modifies a rapid decline in lung function or respiratory symptoms and quality of life.
    Chest 12/2004; 126(6):1815-24. · 5.85 Impact Factor
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    ABSTRACT: Early treatment with inhaled corticosteroids may prevent progression of irreversible obstruction in COPD, especially in patients with bronchial hyperresponsiveness. We investigated the clinical effects of early introduction of inhaled steroids in subjects showing early signs and symptoms of COPD without a prior clinical diagnosis. Study subjects were detected in a general population screening and monitoring program. Those with a moderately accelerated annual FEV1 decline and persistent respiratory symptoms were invited to participate in a 2-year randomized controlled trial comparing fluticasone propionate DPI 250 microg b.i.d. with placebo. Pre- and post-bronchodilator (BD) FEV1, PC20 histamine, functional status (COOP/WONCA charts) and occurrence of exacerbations were periodically assessed. Subjects recorded respiratory symptoms. Post-BD FEV1 decline served as the main outcome. Multivariable repeated measurements analysis techniques were applied. 48 subjects were randomized (24 fluticasone, 24 placebo). After 3 months, the post-BD FEV1 had increased with 125 ml (SE = 68, P = 0.075) and the pre-BD FEV1 with 174 ml (SE 90, P = 0.059) in the fluticasone relative to the placebo group. The subsequent post-BD and pre-BD FEV1 decline were not beneficially modified by fluticasone treatment. There were no statistically significant differences in respiratory symptoms, functional status, or exacerbations favoring fluticasone. Subgroup analysis indicated that the presence of bronchial hyperresponsiveness modified the initial FEV1 response on fluticasone, but not the subsequent annual FEV1 decline. Early initiation of inhaled steroid treatment does not seem to affect the progressive deterioration of lung function or other respiratory health outcomes in subjects with early signs and symptoms of COPD. In subjects at risk for, or in an early stage of COPD, long-term inhaled steroid treatment should not be based on a single spirometric evaluation after 3 months.
    Respiratory Medicine 01/2004; 97(12):1303-12. · 2.59 Impact Factor
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    ABSTRACT: The burdens of chronic obstructive airway diseases among the elderly in Europe, and worldwide, are increasing. Although asthma is common in all ages, the main airway disease affecting the elderly is chronic obstructive pulmonary disease (COPD). The aim of this paper is to review the prevalence and incidence of COPD on the basis of population studies. As the prevalence estimates of asthma are probably well known, only the incidence and remission of asthma will be discussed. The underdiagnosis of obstructive airway diseases is huge. A Dutch programme for early detection of obstructive airway disease among the elderly has, thus, been included in the presentation. A prerequisite for fighting COPD is to acquire data on illnesses and death. COPD has only recently been defined by cut-off points of spirometric outcomes, which is why measures of the prevalence of COPD have been distorted by use of a large number of different diagnostic terms and lung function criteria. The prevalence of clinically-relevant COPD has been estimated in several community studies to 4-6% in adult population samples, with a considerable increase by age, particularly among smokers. The incidence of COPD not only increases heavily with age and smoking, but also occupational exposure to dust, gas and damp. Precise estimates of the incidence of COPD or spirometric airflow limitation are not available. Demographic changes will result in a further substantial increase of chronic obstructive airway disorders, mainly chronic obstructive pulmonary disease, among the elderly. The increasing burden of chronic obstructive pulmonary disease has to come to the awareness of the public, governments, health authorities, and industry.
    The European respiratory journal. Supplement 06/2003; 40:3s-9s.