Quality of life of COPD patients treated by long-term oxygen

Oxygen therapy during exercise training in chronic obstructive pulmonary disease

BACKGROUND

Exercise training within the context of pulmonary rehabilitation improves outcomes of exercise capacity, dyspnea and health-related quality of life in individuals with chronic obstructive pulmonary disease (COPD). Supplemental oxygen in comparison to placebo increases exercise capacity in patients performing single-assessment exercise tests. The addition of supplemental oxygen during exercise training may enable individuals with COPD to tolerate higher levels of activity with less exertional symptoms, ultimately improving quality of life.

OBJECTIVES

To determine how supplemental oxygen in comparison to control (compressed air or room air) during the exercise-training component of a pulmonary rehabilitation program affects exercise capacity, dyspnea and health-related quality of life in individuals with COPD.

SEARCH STRATEGY

All records in the Cochrane Airways Group Specialized Register of trials coded as 'COPD' were searched using the following terms: (oxygen* or O2*) AND (exercis* or train* or rehabilitat* or fitness* or physical* or activ* or endur* or exert* or walk* or cycle*). Searching the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library), MEDLINE, EMBASE and CINAHL databases identified studies. The last search was carried out in June 2006.

SELECTION CRITERIA

Only randomized controlled trials (RCTs) comparing oxygen-supplemented exercise training to non-supplemented exercise training (control group) were considered for inclusion. Participants were 18 years or older, diagnosed with COPD and did not meet criteria for long-term oxygen therapy. No studies with mixed populations (pulmonary fibrosis, cystic fibrosis, etc) were included. Exercise training was greater than or equal to three weeks in duration and included a minimum of two sessions a week.

DATA COLLECTION AND ANALYSIS

Two review authors independently selected trials for inclusion in the review and extracted data. Weighted mean differences (WMD) with 95% confidence intervals (CI) were calculated using a random-effects model. Missing data were requested from authors of primary studies.

MAIN RESULTS

Five RCTs met the inclusion criteria. The maximum number of studies compared in the meta-analysis was three (31 on oxygen versus 32 control participants), because all included studies did not measure the same outcomes. When two studies were pooled, statistically significant improvements of oxygen-supplemented exercise training were found in constant power exercise time, WMD 2.68 minutes (95% CI 0.07 to 5.28 minutes). Supplemental oxygen increased the average exercise time from 6 to 14 minutes; the control intervention increased average exercise time from 6 to 12 minutes. Constant power exercise end-of-test Borg score (on a scale from 1 to 10) also showed statistically significant improvements with oxygen-supplemented exercise training, WMD -1.22 units (95% CI -2.39 to -0.06). One study showed a significant improvement in the change of Borg score after the shuttle walk test, by -1.46 units (95% CI -2.72 to -0.19). There were no significant differences in maximal exercise outcomes, functional exercise outcomes (six-minute walk test), shuttle walk distance, health-related quality of life or oxygenation status. According to the GRADE system most outcomes were rated as low quality because they were limited by study quality.

AUTHORS' CONCLUSIONS

This review provides little support for oxygen supplementation during exercise training for individuals with COPD, but the evidence is very limited. Studies with larger number of participants and strong design are required to permit strong conclusions, especially for functional outcomes such as symptom alleviation, health-related quality of life and ambulation.

[Quality of life. An important parameter in respiratory tract diseases]

Sinusitis is one of the most frequent diseases in humans. Despite severe complications sinusitis may be considered a non-serious disease compared to other illnesses. Therefore, sinusitis is sometimes erroneously regarded as a banal disorder. It is mostly unknown that patients suffering from sinusitis may have a marked impairment of their quality of life (QOL). The term health-related QOL comprises physical and psychological well-being as well as aspects of daily life and social life from the patient's perspective. Validated measures (questionnaires) are able to quantify the impairment of QOL as well as the influence of therapy on QOL. Especially in the treatment of sinusitis, QOL becomes a relevant additional parameter due to the fact that clinical and subjective, patient-based criteria do not correlate sufficiently. This article provides an overview of available QOL questionnaires on sinusitis, highlights results of QOL studies in sinusitis, and elucidates the relevance of QOL in clinical trials as well as in the relation between the physician and the patient.

Quality of life in survivors of prolonged mechanical ventilatory support

OBJECTIVE

To examine the long-term quality of life (QOL) in a group of patients after prolonged mechanical ventilatory support.

DESIGN

Prospective cohort study.

SETTING

Outpatient follow-up.

PATIENTS

Survivors of prolonged mechanical ventilatory support who were discharged from a ventilator rehabilitation unit (VRU).

INTERVENTIONS

Measurement of health-related QOL using the Sickness Impact Profile (SIP).

MEASUREMENTS AND MAIN RESULTS

Forty-six patients were contacted approximately 2 yrs after their discharge from the VRU and asked to complete the SIP. Twenty-five patients (age, 59 +/- 17 yrs; duration of mechanical ventilatory support, 45 +/- 36 days [mean +/- sd]) agreed to participate in this study and completed the SIP questionnaire 23 +/- 18 months after their discharge from the VRU. Patients' VRU stay was 29 +/- 21 days. Two patients were discharged with nocturnal ventilatory support, and the rest were completely weaned of mechanical ventilatory support before discharge. Fifteen patients (60%) were discharged to home, eight patients (32%) were discharged to a rehabilitation facility, and two patients (8%) were discharged to a skilled-care facility. Most patients had mild dysfunction, and the global SIP score was 12 +/- 10, the physical dimension score was 12 +/- 12, and the psychosocial dimension score was 9 +/- 11 (SIP scores range from 0 to 100, with higher scores indicating worse QOL). Subgroup analysis showed that postoperative patients had lower SIP scores compared with patients with chronic respiratory diseases (global SIP, 7 +/- 6 vs. 19 +/- 8; p <.05). Moreover, the patients in the postoperative group were older, but had similar SIP scores as patients who had acute lung injury (17 +/- 15). Global SIP scores correlated with age (r = -.40; p =.046), but not with duration of mechanical ventilatory support (r = -.23) or VRU admission Acute Physiology and Chronic Health Evaluation II scores (r = -.39; p =.06).

CONCLUSIONS

In survivors of prolonged mechanical ventilatory support, using specific selection criteria shows that there is minimal impairment in the QOL at long-term follow-up. Although some patients continue to have moderate to severe limitations, it is the cause of respiratory failure and the underlying disease, rather than duration of ventilatory support, that have a significant impact on QOL.

Quality of life in severe chronic obstructive pulmonary disease: correlation with lung and muscle function

Chronic obstructive pulmonary disease (COPD) patients suffer from significant impairment in quality of life (QL), but the variables related to this impairment are not well known. The aim of this study has been to identify physiological parameters related to QL in severe COPD patients undergoing long-term oxygen therapy.

MATERIALS AND METHODS

We studied 47 COPD patients using long-term oxygen therapy (43 men/four women, 65.17 SD 8.21 years, 3.17 SD 2.61 years on oxygen). The Nottingham Health Profile (NHP) and activities of daily living (ADL) questionnaire were used to measure QL. Subjective assessment of dyspnoea was performed using a visual analogue scale. The physiological parameters determined were lung function (spirometry, arterial blood gases, lung volumes and carbon monoxide diffusing capacity), muscle function (maximum inspiratory and expiratory pressures, deltoid muscle and handgrip strength), and nutrition status (tricipital skin fold and mid-arm muscle circumference).

RESULTS

High ADL (8.32 SD 6.97) and NHP scores (energy 63.3 SD 40.43, pain 35.11 SD 31.56, emotional reactions 43.03 SD 25.13, sleep 51.91 SD 32.75, social isolation 30.64 SD 26.98, physical mobility 49.73 SD 24.93) demonstrated clinically significant QL impairment in the severe COPD patients studied. Stepwise multiple regression analysis found a correlation between lung function and QL. Low FEV1% was associated with impairment in energy, physical mobility and social isolation NHP scores and ADL score (r = -0.3, P < 0.05). RV/TLC also correlated with ADL and social isolation scores (r = 0.3, P < 0.05). Lung function explained 39-45% of the variation in these QL dimensions. QL did not correlate with other lung function parameters, muscle function or nutrition status.

CONCLUSION

COPD patients using long-term oxygen suffer from severe QL impairment affecting not only energy and mobility but also emotional reactions, social isolation and sleep. Lung function is related to energy, mobility and social isolation dimensions, but muscle function is unrelated to QL in these patients.

Assessing quality of life in chronic non-specific lung disease--a review of empirical studies published between 1980 and 1994

Chronic non-specific lung disease (CNSLD), a chronic disease with considerable prevalence and mortality rates, is not only a medical problem, it also has significant psychological and social consequences for the patients concerned. Quality of life research on CNSLD has been rather underdeveloped for quite a long period of time, but has recently become an important topic in research as well as in patient care. In order to get insight into the state of the art of empirical research on quality of life (QOL) in CNSLD, a review of the literature between 1980-1994 on this topic is presented. Special attention is paid to definitions and operationalizations of the QOL concept as well as on questionnaires used to assess QOL and the aims of QOL research. Analysis reveals that QOL is seldom defined clearly and is operationalized in a variety of ways. Most studies have a descriptive nature or pertain to clinical trials. The negative impact of CNSLD on QOL is well-documented and shows the importance of incorporating assessment of QOL in research as well as in patient care. Future research is called for, which should be theory-driven, taking into account recent developments concerning disease-specific measures of QOL.

Functional performance in people with chronic obstructive pulmonary disease

The extent to which individuals with a chronic physical illness perform their day-to-day activities and maintain the independence and autonomy they desire is both an indicator of adaptation and an important clinical outcome criterion. Yet the concept of functional performance is not well understood. Studies of people with chronic obstructive pulmonary disease (COPD) have attempted to identify physiologic and psychosocial factors that contribute to functioning in this population. These studies have used a melange of terms, including functional status, functional ability, quality of life, and health status interchangeably. They have also employed a variety of instruments to operationalize functional performance and an assortment of predictors to understand the phenomena. Perhaps as a result of this disarray, no attempt has been made to synthesize the literature for nursing research and practice. The purpose of this paper is to summarize the research on functional performance in people with COPD, indicate areas of understanding and quandary, suggest possible flaws, and propose several new directions for practice and research.