[Cognitive deficits in patients with chronic obstructive pulmonary disease (COPD)]

A conceptual model of functional health literacy to improve chronic airway disease outcomes

Background

Current conceptual models of health literacy (HL) illustrate the link between HL and health outcomes. However, these models fail to recognize and integrate certain elements of disease management, health system factors, and socio-demographic factors into their framework. This article outlines the development of Chronic Airway Disease (CAD) Management and Health Literacy (CADMaHL) conceptual model that integrates the aforementioned elements and factors into a single framework.

Methods

Information obtained during the following stages informed the development of our model: (1) a systematic review of existing CAD HL measurement tools that apply core HL domains; (2) patient-oriented focus group sessions to understand HL barriers to CAD self-management practices; (3) key-informant interviews to obtain potential strategies to mitigate CAD management barriers, and validate disease self-management topics; (4) elicited the perspectives of Canadian respirologist’s on the ideal functional HL skills for asthma and COPD patients.

Results

Throughout the study process many stakeholders (i.e., patients, key-informants, and an international HL advisory panel) contributed to and reviewed the model. The process enabled us to organize the CADMaHL model into 6 primary modules, including: INPUT, consisting of four HL core components (access, understand, communicate, evaluate,) and numeracy skills; OUTPUT, including application of the obtained information; OUTCOME, covering patient empowerment in performing self-management practices by applying HL skills; ASSESSMENT, consisting of information about functionality and relevancy of CADMaHL; IMPACT, including mediators between HL and health outcomes; CROSSCUTTING FACTORS, consisting of diverse socio-demographics and health-system factors with applicability across the HL domains.

Conclusions

We developed the CADMaHL model, with input from key-stakeholders, which addresses a knowledge gap by integrating various disease management, health-system and socio-demographic factors absent from previous published frameworks. We anticipate that our model will serve as the backbone for the development of a comprehensive HL measurement tool, which may be utilized for future HL interventions for CAD patients.

Trial registration

NCT01474928- Date of registration: 11/26/2017.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-10313-x.

Neuropsychological functioning in patients with interstitial lung disease

OBJECTIVE

We undertook the present study to investigate the cognitive status of patients with interstitial lung disease (ILD) and its relationship to pulmonary function and cardiovascular efficiency.

METHOD

Fifty-one patients with a diagnosis of ILD [mean duration = 3.13 years (SD = 3.01)] received a respiratory examination, including spirometry and the six-minute walk test, and completed a neuropsychological assessment including several cognitive domains. Eighty-eight healthy individuals matched on age, education, and gender, completed the neuropsychological test battery.

RESULTS

Patients performed more poorly than their healthy peers on cognitive tasks related to verbal and visual memory, visual perception, and working memory, but not attention, processing speed and executive functioning. Stepwise linear regression analyses showed that exercise-related measures (heart rate, oxygen saturation and distance walked) predicted performance on neuropsychological tests of psychomotor speed, verbal memory and word production. Additionally, an index of pulmonary function, specifically, lung diffusion capacity, predicted performance on selective and sustained attention and word generation.

CONCLUSION

The present preliminary findings may have implications for the quality of life and treatment compliance of patients with ILD and warrant further study with a larger sample of patients.

Abnormal intrinsic brain activities in stable patients with COPD: a resting-state functional MRI study

OBJECTIVE

The majority of previous neuroimaging studies have reported both structural and functional changes in COPD, whereas the intrinsic low-frequency oscillations changes and the relationship between the abnormal brain regions and the clinical performances remain unknown. The present study was conducted with the aim of evaluating the intrinsic brain activity in COPD patients using the amplitude of low-frequency fluctuation (ALFF) method.

METHODS

All participants, including 19 stable patients with COPD and 20 normal controls (NCs) matched in age, sex, and education, underwent resting-state functional MRI scans and performed cognitive function tests and respiratory functions tests. The local spontaneous brain activity was examined using the voxel-wise ALFF. Pearson's correlation analysis was used to investigate the relationships between the brain regions with altered ALFF signal values and the clinical features in COPD patients.

RESULTS

Compared with the NCs, COPD patients showed significantly lower cognitive function scores. Also, lower ALFF areas in the cluster of the posterior cingulate cortex (PCC) and precuneus, as well as a higher ALFF area in the brainstem were also found in COPD patients. The mean ALFF values in the PCC, precuneus, and brainstem showed high sensitivity and specificity in operating characteristic curves analysis, which might have the ability to distinguish COPD from NCs. Meanwhile, the mean signal values of the lower ALFF cluster displayed significant positive correlations with FEV₁/FVC proportion and significant negative correlation with PaCO₂; the higher ALFF cluster showed significant positive correlation with FEV₁ proportion in COPD.

CONCLUSION

According to the results of the present study, the COPD patients showed abnormal intrinsic brain activities in the precuneus, PCC, and brainstem, which might provide useful information to better understand the underlying pathophysiology of cognitive impairment.

Effects of chronic obstructive pulmonary disease and obstructive sleep apnea on cognitive functions: evidence for a common nature

Patients with chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea syndrome (OSAS) show similar neurocognitive impairments. Effects are more apparent in severe cases, whereas in moderate and mild cases the effects are equivocal. The exact mechanism that causes cognitive dysfunctions in both diseases is still unknown and only suggestions have been made for each disease separately. The primary objective of this review is to present COPD and OSAS impact on cognitive functions. Secondly, it aims to examine the potential mechanisms by which COPD and OSAS can be linked and provide evidence for a common nature that affects cognitive functions in both diseases. Patients with COPD and OSAS compared to normal distribution show significant deficits in the cognitive abilities of attention, psychomotor speed, memory and learning, visuospatial and constructional abilities, executive skills, and language. The severity of these deficits in OSAS seems to correlate with the physiological events such as sleep defragmentation, apnea/hypopnea index, and hypoxemia, whereas cognitive impairments in COPD are associated with hypoventilation, hypoxemia, and hypercapnia. These factors as well as vascocerebral diseases and changes in systemic hemodynamic seem to act in an intermingling and synergistic way on the cause of cognitive dysfunctions in both diseases. However, low blood oxygen pressure seems to be the dominant factor that contributes to the presence of cognitive deficits in both COPD and OSAS.

Teaching inhaler use in chronic obstructive pulmonary disease patients

PURPOSE

To review barriers to the successful use of inhalers in patients with chronic obstructive pulmonary disease (COPD), and the role of the nurse practitioner (NP) in facilitating optimum inhaler use.

DATA SOURCES

Review of the national and international scientific literature.

CONCLUSIONS

Pharmacologic treatment of COPD patients comprises mainly inhaled medications. Incorrect use of inhalers is very common in these individuals. Some of the consequences of poor inhaler technique include reduced therapeutic dosing, medication adherence, and disease stability, which can lead to increased morbidity, decreased quality of life, and a high burden on the healthcare system. Knowledgeable evaluation and frequent reassessment of inhaler use coupled with education of patients, caregivers, and healthcare professionals can significantly improve the benefits COPD patients derive from inhaled therapy.

IMPLICATIONS FOR PRACTICE

Patient education is vital for correct use of inhalers and to ensure the effectiveness of inhaled medications. The NP has a critical role in assessing potential barriers to successful learning by the patient and improving inhaler technique and medication management. The NP can also facilitate success with inhaled medications by providing up-to-date inhaler education for other healthcare team members, who may then act as patient educators.

Cognition and chronic hypoxia in pulmonary diseases

Lung disease with chronic hypoxia has been associated with cognitive impairment of the subcortical type.

Impact of chronic obstructive pulmonary disease (COPD) on attention functions

The present study investigates the influence of COPD on attention functions, learning, and logical thinking. Therefore, 60 COPD patients and 60 healthy controls were recruited into a cross-sectional study and underwent extensive neuropsychological testing. The Attention Network Test was used for assessment of tonic and phasic alertness, orienting, and executive attention. Logical thinking and learning were determined with the Standard Progressive Matrices and the Verbal and Nonverbal Learning Test, respectively. Significant group differences were found in phasic alertness (p=0.001) and orienting (p=0.01) but not in executive attention. In addition overall reaction time was significantly slower in the COPD group (p=0.001). Further group differences were found in verbal (p<0.001) and visual learning (p<0.001) and logical thinking (p<0.001). Regression analysis revealed significant correlations for age (p=0.024) and blood carbon dioxide levels (p=0.043) in reaction time, a correlation for age and orienting (p=0.019) and finally for age (p=0.011) as well as for blood carbon dioxide values (p=0.048) and performance in logical thinking. Results are indicating a global impairment in cognitive functions of COPD patients which is negatively influenced by accelerated aging and increasing with disease severity.

Dry Powder Inhalers: Which Factors Determine the Frequency of Handling Errors?

BACKGROUND

Dry powder inhalers are often used ineffectively, resulting in a poor level of disease control.

OBJECTIVES

To determine how often essential mistakes are made in the use of Aerolizer, Discus, HandiHaler and Turbuhaler and to study the effects of age, severity of airflow obstruction and previous training in inhalational technique by medical personnel on the error rate.

METHODS

Two hundred and twenty-four newly referred outpatients (age 55.1 +/- 20 years) were asked how they had been acquainted with the inhaler and to demonstrate their inhalational technique.

RESULTS

The inhaler-specific error rates were as follows: Aerolizer 9.1%, Discus 26.7%, HandiHaler 53.1% and Turbuhaler 34.9%. Compared to Aerolizer, the odds ratio of an ineffective inhalation was higher for HandiHaler (9.82, p < 0.01) and Turbuhaler (4.84, p < 0.05). The error rate increased with age and with the severity of airway obstruction (p < 0.01). When training had been given as opposed to no training, the odds ratio of ineffective inhalation was 0.22 (p < 0.01). If Turbuhaler is used, the estimated risks range from 9.8% in an 18-year-old patient with normal lung function and previous training to 83.2% in an 80-year-old patient with moderate or severe obstruction who had not received any training.

CONCLUSIONS

Dry powder inhalers are useful in the management of younger patients with normal lung function or mild airway obstruction. In older patients with advanced chronic obstructive pulmonary disease, the risk of ineffective inhalation remains high despite training in inhalational technique. A metered-dose inhaler with a spacer might be a valuable treatment alternative in a substantial proportion of these patients.

The evaluation of cognitive functions with P300 test for chronic obstructive pulmonary disease patients in attack and stable period

OBJECTIVES

Hypoxia, in chronic obstructive pulmonary disease (COPD), leads to a decrease in cerebral perfusion and an impairment of some cognitive abilities. We aimed to investigate the relation between arterial blood gas analysis (ABA) and pulmonary function test (PFT) parameters with cognitive function of COPD patients during attack and stable period.

PATIENTS AND METHODS

ABA, PFT, P300 tests of 30 patients in stabilized period and 30 patients in attack, and 17 healthy controls were evaluated.

RESULTS

When both COPD groups and controls were compared, it was seen that latency of P300 was shorter in the control group (p<0.001), but there was no difference between COPD groups (p>0.05). P300 amplitude measures were lower in both COPD groups than control group, but it was not statistically significant (p>0.05). When we compared the measures of attack group, we saw that arterial oxygen tension (PaO(2)), arterial oxygen saturation (SaO(2)), forced expiratory volume in 1s (FEV(1)), FEV(1)/forced vital capacity (FVC) values increased (p<0.001), and P300 latency shortened (p<0.05) in attack group during stable period. P300 latency correlated significantly with PaO(2) (r=-0.557, p<0.001), SaO(2) (r=-0.424, p<0.001), FEV(1) (r=-0.441, p<0.001), FEV(1)/FVC (r=-0.477, p<0.001) values, and age (r=0.329, p<0.05). P300 amplitude is only correlated with PaO(2) (r=0.236, p<0.05).

CONCLUSION

Longer latency of P300 appears to be an expected sequel of COPD. P300 test can be considered as a potential objective marker of cognitive impairment.