444 32nd World Congress of Internal Medicine (October 24-28, 2014)
The Korean Academy of Tuberculosis and Respiratory Diseases
PS 1548 COPD
Medical Cost and Hospital Utilization for Mild to Moderate COPD Patients
Yong Il Hwang1, Yong Bum Park2, Chin Kook Rhee3, Deog Kyeom Kim4, Kwang Ha Yoo5, Ki-Suck Jung1, Joo Hee Kim1, Seung Hun Jang1, Sunghoon Park1
Hallym University Sacred Heart Hospital, Korea1, Hallym University Kandong Sacred Heart Hospital, Ko- rea2, St. Mary’s Hospital, The Catholic University of Korea College of Medicine, Korea3, Seoul Metropol- itan Government-Seoul National University Boramae Medical Center, Korea4, Konkuk University College of Medicine, Korea5
Background: COPD is known to be under-diagnosed and under-treated. In Korea, the prevalence of COPD is 13.4%. And 94% of patients with COPD have mild-to-moderate disease. However, only 2.4% had been diagnosed by a physician and only 2.1% of patients had been treated. The aim of this study was to explore the health care utili- zation and cost in mild-to-moderate COPD patients.
Methods: We constructed patient cohort who were diagnosed with mild-to-moderate COPD in Korean National Health and Nutritional Examination Survey (KNHANES). We analyzed the health care utilization and cost using the Korean Health Insurance Re- view and Assessment Service database for 6 years from 2007 to 2012.
Results: A total of 2,397 mild-to-moderate COPD patients were enrolled in our cohort.
A total of 70.6% was male. The mean age was 64.5±11.9 years old. The mean FEV1 was 78.6±1.6% of predicted value. During the follow-up period, the proportion of pa- tients using health care utility slowly increased. In 2007, only 3.9% of the patients use hospital for COPD. This fi gure increased to 7.4% in 2012. The mean numbers of outpa- tient clinic visit were 3.8 in 2007 and 4.9 in 2012. The total cost for COPD treatment increased from 244,438 KRW in 2007 to 894,41 2KRW to 2012. Table 1 summarizes the results.
Conclusions: This study showed the increasing trends for health care utilization in mild-to-moderate COPD patients in Korea, However, still majority of COPD patients did not use health care utility. A strategy to reduce the under-treatment of COPD is warranted.
PS 1549 COPD
Risk Factors for Osteoporosis in Patients with COPD:
2008-2011 Korean National Health and Nutrition Examination Survey (KNHANES)
Seok Jeong Lee1, Kyoung Ae Kong2, Yon Ju Ryu1, Jin Hwa Lee1, Jung Hyun Chang1 Division of Pulmonary and Critical Care Medicine, Department of Medicine, Ewha Womans University School of Medicine, Korea1, Ewha Clinical Trial Center, Ewha Womans University School of Medicine, Korea2 Background: Osteoporosis is an important comorbidity in patients with COPD. Os- teoporosis and its complication such as fracture cause poor quality of life and even mortality. We investigated risk factors of osteoporosis in COPD patients.
Methods: We analyzed data from the 2008-2011 KNHANES. Subjects who aged 40 years or more and performed acceptable and qualifi ed spirometry, dual-energy X-ray absorptiometry, the nutrition examination survey, and serum vitamin D measurements were enrolled. COPD was defi ned as an FEV₁/FVC < 0.7. Osteoporosis was defi ned as a bone mineral density (BMD) T-score =-2.5 at femur or lumbar spine.
Results: A total of 881 subjects with COPD were enrolled, and 141 (16%) had oste- oporosis. Epidemiologic and nutritional variables and serum vitamin D levels of oste- oporosis group were compared with those of non-osteoporosis group, and variables for multiple logistic regression model were selected. Old age (60-69 years vs. 40- 49 years, OR 33.78, 95% CI 3.60-317.14), female (OR 15.54, 95% CI 6.71-36.00), low body mass index (BMI) (< 18.5 kg/m² vs. 18.5-25 kg/m², OR 14.24, 95% CI 4.38-46.31), lack of moderate exercise (exercise vs. lack of exercise, OR 0.41, 95% CI 0.19-0.88), and lower intake of carotene (per 1000 mg increase, OR 0.88, 95% CI 0.79-0.97) were independently associated with osteoporosis in COPD subjects. Although vitamin D defi ciency, defi ned as serum levels < 20 ng/mL, was more prevalent in COPD subjects with osteoporosis, multiple logistic analysis failed to show statistical signifi cance.
Conclusions: Old age, female, low BMI, lack of exercise, and lower carotene intake were risk factors of osteoporosis in COPD.
Acknowledgement: This was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Science, ICT & Future Planning (2010-0027945).
PS 1550 COPD
FEV1 and FVC Are Independent Factors Affecting Peptic Ulceration in Chronic Obstructive Pulmonary Disease
Sung Bae Cho1, Jongmin Lee1, Hyeon Hui Kang1, Hwa Sik Moon1, Sang Haak Lee1 St. Paul’s Hospital, The Catholic University of Korea, Korea1
Background: Recent researches suggest that chronic obstructive pulmonary disease (COPD) is associated with an increased risk of peptic ulcer disease, but limited data exist on affecting factors in COPD patient with peptic ulcer disease on gastroduoden- oscopy.
Methods: We retrospectively reviewed medical records on 237 COPD patients who performed gastroduodenoscopy in 2003-2013. Patients were divided into two groups accordingly: peptic ulcer (gastric and/or duodenal ulcer) group and non-ulcerative dis- ease group. Statistical analyses were performed with the logistic regression model to obtain the factors affecting peptic ulceration in COPD patients, controlling confound- ing factors.
Results: The prevalence of peptic ulcer disease was 99 of 237 COPD patients (41.7%) and a male sex had a positive association with peptic ulcer disease (odds ratio[OR], 2.270, 95% confidence interval[CI], 1.189 to 4.332). There was independent rela- tionships between the presence of peptic ulcer disease and both liters of predicted forced expiratory volume in 1s (FEV1) (OR, 0.407, 95% CI, 0.229 to 0.724) and liters of functional vital capacity (FVC) (OR, 1.029, 95% CI, 1.011 to 1.048). Smoking status and corticosteroids, known risk factors of peptic ulcer disease in general population, did not showed expected affect on peptic ulceration.
Conclusions: Our fi ndings provide further evidence that COPD is associated with pep- tic ulcer disease and there is an increased risk for peptic ulcer associated with COPD severity.
