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Efil S, Kalkan Ugurlu Y, Akça Doğan D, Budak D. Perceived Spousal Support and Activities of Daily Living in Individuals With COPD. West J Nurs Res 2024; 46:436-444. [PMID: 38655927 DOI: 10.1177/01939459241248218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
BACKGROUND The relationship between perceived spousal support and activities of daily living in patients with chronic obstructive pulmonary disease (COPD) is unclear. PURPOSE The aim of this study was to explore the relationship between spousal support perceived by those with COPD and their activities of daily living. METHODS This study was a cross-sectional and descriptive study. Data collection was conducted between September 2022 and April 2023. A Data Gathering Form, the Spousal Support Scale, and the London Chest Activity of Daily Living Scale were used to collect data. A total of 132 adults were included in this study. RESULTS The mean (SD) scores of individuals with COPD for perceived spousal support and activities of daily living were 62.40 (14.66) and 32.91 (15.72), respectively. Levels of perceived spousal support and activities of daily living varied according to sex, employment status, admission to the emergency service or hospitalization, use of antidepressants, and the severity of the illness (P < .05). Those with better spousal support felt less dyspnea when performing the activities of daily living (r = -0.205, P < .05). CONCLUSIONS Knowing the potential factors affecting perceived spousal support and activities of daily living can provide an opportunity to determine appropriate strategies to increase the level of independence of individuals with COPD. Educational interventions to help spouses understand COPD may help increase spousal support.
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Affiliation(s)
- Sevda Efil
- Department of Nursing, Faculty of Health Sciences, Canakkale Onsekiz Mart University, Canakkale, Turkey
| | - Yasemin Kalkan Ugurlu
- Department of Internal Medicine Nursing, Faculty of Health Sciences, Ordu University, Ordu, Turkey
| | - Derya Akça Doğan
- Department of Internal Medicine Nursing, Faculty of Health Sciences, Bursa Uludag University, Bursa, Turkey
| | - Dilek Budak
- Pulmonology Department, Canakkale Onsekiz Mart University Hospital, Canakkale, Turkey
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Liao Y, Yu J, Zhan Y, Liu Y, Zhou Y, Wang H, Liu X, Wang W, Ma Y, Lan F. Motivating factors for physical activity participation among individuals with chronic obstructive pulmonary disease: A qualitative study applying the motivation, opportunity, and ability model. PLoS One 2024; 19:e0303858. [PMID: 38781270 PMCID: PMC11115224 DOI: 10.1371/journal.pone.0303858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 05/02/2024] [Indexed: 05/25/2024] Open
Abstract
OBJECTIVE The study aims to explore the driving forces behind physical activity engagement among patients with chronic obstructive pulmonary disease, focusing on motivation, opportunity, and capability. DESIGN A phenomenological qualitative study applied the motivation, opportunity, and capability model, conducted in two respiratory units of a Chinese university hospital. METHODS Participants, selected by age, gender, and illness duration, included inpatients during the interview sessions and those recently discharged within six months. One-on-one semi-structured interviews were recorded, transcribed, and analyzed by the Colaizzi seven-step method. RESULTS Seventeen participants diagnosed with chronic obstructive pulmonary disease for over one year aged between 66 (range: 42-96) participated. Three major themes were identified: Inspiring participation motivation-transitioning from recognizing significance to habit formation; Offering participation opportunities-reiterating demand for personalized strategies and ideal environmental settings; Enhancing participation capability-addressing strategies for overcoming fears, setting goals, ensuring safety, and adjusting activity levels. CONCLUSIONS This research underscores the vital role of inspiring participation motivation, offering opportunities, and enhancing the capability for participation in effective engagement. Advocating increased attention from healthcare departments, fostering interdisciplinary collaboration, improving activity guidance and counseling effectiveness, and considering individual preferences can significantly benefit those patients with chronic obstructive pulmonary disease who hesitate or are unable to participate in physical activities, thereby increasing the dose of non-leisure time physical activity.
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Affiliation(s)
- Yuanyu Liao
- Nursing Department, Tongji Medical College Affiliated Union Hospital, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Jiaohua Yu
- Nursing Department, Tongji Medical College Affiliated Union Hospital, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Yuxin Zhan
- Department of Neurosurgery, Tongji Medical College Affiliated Union Hospital, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Yunfang Liu
- Department of Thoracic Surgery, Tongji Medical College Affiliated Union Hospital, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Yaoling Zhou
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
- School of Nursing, Huanggang Polytechnic College, Huanggang, Hubei Province, China
| | - Huan Wang
- Department of Thoracic Surgery, Tongji Medical College Affiliated Union Hospital, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Xinghong Liu
- Department of Cardiovascular Surgery, Tongji Medical College Affiliated Union Hospital, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Weiwei Wang
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Yu Ma
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Fenfen Lan
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
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Llamas-Saez C, Saez-Vaquero T, Jiménez-García R, López-de-Andrés A, Carabantes-Alarcón D, Zamorano-León JJ, Cuadrado-Corrales N, Omaña-Palanco R, de Miguel Diez J, Pérez-Farinos N. Physical activity among adults with chronic obstructive pulmonary disease in Spain (2014-2020): Temporal trends, sex differences, and associated factors. Respir Med 2023; 220:107458. [PMID: 37951312 DOI: 10.1016/j.rmed.2023.107458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 10/07/2023] [Accepted: 11/03/2023] [Indexed: 11/13/2023]
Abstract
OBJECTIVES To evaluate trends in the prevalence of physical activity (PA) from 2014 to 2020; to identify sex differences and sociodemographic and health-related factors associated with PA in individuals with chronic obstructive pulmonary disease (COPD); and to compare PA between individuals with and without COPD. METHODS Cross-sectional and case-control study. SOURCE European Health Interview Surveys for Spain (EHISS) conducted in 2014 and 2020. We included sociodemographic and health-related covariates. We compared individuals with and without COPD after matching for age and sex. RESULTS The number of adults with COPD was 1086 and 910 in EHISS2014 and EHISS2020, respectively. In this population, self-reported "Medium or high frequency of PA" remained stable (42.9% in 2014 and 43.5% in 2020; p = 0.779). However, the percentage who walked on two or more days per week rose significantly over time (63.4%-69.9%; p = 0.004). Men with COPD reported more PA than women with COPD in both surveys. After matching, significantly lower levels of PA were recorded in COPD patients than in adults without COPD. Multivariable logistic regression confirmed this trend in COPD patients and showed that male sex, younger age, higher educational level, very good/good self-perceived health, and absence of comorbidities, obesity, and smoking were associated with more frequent PA. CONCLUSIONS The temporal trend in PA among Spanish adults with COPD is favorable, although there is much room for improvement. Insufficient PA is more prevalent in these patients than in the general population. Sex differences were found, with significantly more frequent PA among males with COPD.
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Affiliation(s)
- Carlos Llamas-Saez
- Department of Public Health and Maternal & Child Health, Faculty of Medicine, Universidad Complutense de Madrid, 28040, Madrid, Spain
| | | | - Rodrigo Jiménez-García
- Department of Public Health and Maternal & Child Health, Faculty of Medicine, Universidad Complutense de Madrid, 28040, Madrid, Spain.
| | - Ana López-de-Andrés
- Department of Public Health and Maternal & Child Health, Faculty of Medicine, Universidad Complutense de Madrid, 28040, Madrid, Spain
| | - David Carabantes-Alarcón
- Department of Public Health and Maternal & Child Health, Faculty of Medicine, Universidad Complutense de Madrid, 28040, Madrid, Spain
| | - José J Zamorano-León
- Department of Public Health and Maternal & Child Health, Faculty of Medicine, Universidad Complutense de Madrid, 28040, Madrid, Spain
| | - Natividad Cuadrado-Corrales
- Department of Public Health and Maternal & Child Health, Faculty of Medicine, Universidad Complutense de Madrid, 28040, Madrid, Spain
| | - Ricardo Omaña-Palanco
- Department of Public Health and Maternal & Child Health, Faculty of Medicine, Universidad Complutense de Madrid, 28040, Madrid, Spain
| | - Javier de Miguel Diez
- Respiratory Care Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Universidad Complutense de Madrid, 28007, Madrid, Spain
| | - Napoleón Pérez-Farinos
- Epi-PHAAN Research Group, School of Medicine, Universidad de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), 29071, Málaga, Spain
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Santana AV, Fontana AD, de Almeida RC, Mantoani LC, Camillo CA, Furlanetto KC, Rodrigues F, Cruz J, Marques A, Jácome C, Demeyer H, Dobbels F, Garcia-Aymerich J, Troosters T, Hernandes NA, Pitta F. Cultural adaptation and validation of the Brazilian Portuguese version of the PROactive Physical Activity in COPD-clinical visit instrument for individuals with COPD. J Bras Pneumol 2023; 49:e20220372. [PMID: 37610957 PMCID: PMC10578924 DOI: 10.36416/1806-3756/e20220372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 05/03/2023] [Indexed: 08/25/2023] Open
Abstract
OBJECTIVE To adapt the PROactive Physical Activity in COPD-clinical visit (C-PPAC) instrument to the cultural setting in Brazil and to determine the criterion validity, test-retest reliability agreement, and internal consistency of this version. METHODS A protocol for cultural adaptation and validation was provided by the authors of the original instrument and, together with another guideline, was applied in a Portuguese-language version developed by a partner research group from Portugal. The adapted Brazilian Portuguese version was then cross-sectionally administered twice within a seven-day interval to 30 individuals with COPD (57% were men; mean age was 69 ± 6 years; and mean FEV1 was 53 ± 18% of predicted) to evaluate internal consistency and test-retest reliability. Participants also completed the International Physical Activity Questionnaire (IPAQ), the modified Medical Research Council scale, the COPD Assessment Test, and Saint George's Respiratory Questionnaire to evaluate criterion validity. RESULTS The C-PPAC instrument showed good internal consistency and excellent test-retest reliability: "amount" domain = 0.87 (95% CI, 0.73-0.94) and "difficulty" domain = 0.90 (95% CI, 0.76-0.96). Bland & Altman plots, together with high Lin's concordance correlation coefficients, reinforced that agreement. Criterion validity showed moderate-to-strong correlations of the C-PPAC with all of the other instruments evaluated, especially with the IPAQ (rho = -0.63). CONCLUSIONS The Brazilian Portuguese version of the C-PPAC is a reliable and valid instrument for evaluating the experience of Brazilian individuals with COPD with their physical activity in daily life.
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Affiliation(s)
- André Vinicius Santana
- . Laboratório de Pesquisa em Fisioterapia Pulmonar - LFIP - Departamento de Fisioterapia, Universidade Estadual de Londrina - UEL - Londrina (PR) Brasil
| | - Andrea Daiane Fontana
- . Laboratório de Pesquisa em Fisioterapia Pulmonar - LFIP - Departamento de Fisioterapia, Universidade Estadual de Londrina - UEL - Londrina (PR) Brasil
| | - Rafaela Cristina de Almeida
- . Laboratório de Pesquisa em Fisioterapia Pulmonar - LFIP - Departamento de Fisioterapia, Universidade Estadual de Londrina - UEL - Londrina (PR) Brasil
| | - Leandro Cruz Mantoani
- . Laboratório de Pesquisa em Fisioterapia Pulmonar - LFIP - Departamento de Fisioterapia, Universidade Estadual de Londrina - UEL - Londrina (PR) Brasil
| | - Carlos Augusto Camillo
- . Laboratório de Pesquisa em Fisioterapia Pulmonar - LFIP - Departamento de Fisioterapia, Universidade Estadual de Londrina - UEL - Londrina (PR) Brasil
- . Centro de Pesquisas em Ciências Biológicas e da Saúde, Universidade Pitágoras/Universidade Norte do Paraná - UNOPAR - Londrina (PR) Brasil
| | - Karina Couto Furlanetto
- . Laboratório de Pesquisa em Fisioterapia Pulmonar - LFIP - Departamento de Fisioterapia, Universidade Estadual de Londrina - UEL - Londrina (PR) Brasil
- . Centro de Pesquisas em Ciências Biológicas e da Saúde, Universidade Pitágoras/Universidade Norte do Paraná - UNOPAR - Londrina (PR) Brasil
| | - Fátima Rodrigues
- . Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- . Unidade de Reabilitação Respiratória, Hospital Pulido Valente, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal
| | - Joana Cruz
- . Center for Innovative Care and Health Technology - ciTechCare - Escola Superior de Saúde - ESSLEI - Politécnico de Leiria, Leiria, Portugal
| | - Alda Marques
- . Laboratório de Investigação e Reabilitação Respiratória - Lab3R - Escola Superior de Saúde e Instituto de Biomedicina - ESSUA/iBiMED - Universidade de Aveiro, Aveiro, Portugal
| | - Cristina Jácome
- . Departamento de Medicina da Comunidade, Informação e Decisão em Saúde - MEDCIDS - Faculdade de Medicina, Universidade do Porto, Porto, Portugal
- . Centro de Investigação em Tecnologias e Serviços de Saúde - CINTESIS - Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Heleen Demeyer
- . Department of Rehabilitation Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Fabienne Dobbels
- . Academic Center for Nursing and Midwifery, Department of Public Health and Primary Care, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Judith Garcia-Aymerich
- . Instituto de Salud Global - ISGlobal - Barcelona, España
- . Universitat Pompeu Fabra - UPF - Barcelona, España
- . Centro de Investigación Biomedica En Red de Epidemiología y Salud Pública - CIBERESP - Barcelona, España
| | - Thierry Troosters
- . Department of Rehabilitation Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Nidia Aparecida Hernandes
- . Laboratório de Pesquisa em Fisioterapia Pulmonar - LFIP - Departamento de Fisioterapia, Universidade Estadual de Londrina - UEL - Londrina (PR) Brasil
| | - Fabio Pitta
- . Laboratório de Pesquisa em Fisioterapia Pulmonar - LFIP - Departamento de Fisioterapia, Universidade Estadual de Londrina - UEL - Londrina (PR) Brasil
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Miravitlles M, Soler-Cataluña JJ, Soriano JB, García-Río F, de Lucas P, Alfageme I, Casanova C, Rodríguez González-Moro JM, Sánchez G, Ancochea J, Cosío BG. Respiratory symptoms and their determinants in the general Spanish population: changes over 20 years. ERJ Open Res 2022; 8:00067-2022. [PMID: 36382234 PMCID: PMC9661281 DOI: 10.1183/23120541.00067-2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 04/01/2022] [Indexed: 11/16/2022] Open
Abstract
Background Few large epidemiological studies have analysed the prevalence of respiratory symptoms and their determinants in the general adult population. We investigated the prevalence and determinants of respiratory symptoms and compared their prevalence with that of two previous studies conducted in 1999 and 2009. Method EPISCAN II was a multicentre, cross-sectional, population-based epidemiological study in individuals older than 40 years. Results A total of 9092 individuals were included. Up to 47.5% reported at least one respiratory symptom, being more frequent in women than in men (49.4% versus 45.5%, p=0.0002) and with wheezing being the most frequent (33.7%) followed by dyspnoea (26.8%). The presence of any symptom was associated with female sex, higher body mass index (BMI), lower forced expiratory volume in 1 s (FEV1 % pred), reduced physical activity, a higher Charlson index and the presence of anxiety and depression. Smoking was also significantly associated with having at least one respiratory symptom in a dose–response fashion (OR: 1.415, 1.916, 2.192 and 2.987 for 0–10, 10–20, 20–30 and >30 pack-years, respectively, all p<0.0001). The prevalence of symptoms remained quite similar over the last 20 years (wheezing 40%, 36% and 33.7% and dyspnoea 10.4%, 9.9% and 13.1% in 1999, 2009 and 2019, respectively). Conclusions Approximately half of the adult Spanish population have respiratory symptoms and this prevalence has remained quite stable over the last 20 years. Smoking remains the main factor associated with respiratory symptoms, but female sex, comorbidities, high BMI and low FEV1 and low physical activity are also significantly associated with respiratory symptoms. Approximately half of the adult Spanish population has some respiratory symptoms and this prevalence has remained quite stable over the last 20 yearshttps://bit.ly/37uGRT7
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Xiang X, Huang L, Fang Y, Cai S, Zhang M. Physical activity and chronic obstructive pulmonary disease: a scoping review. BMC Pulm Med 2022; 22:301. [PMID: 35932050 PMCID: PMC9354440 DOI: 10.1186/s12890-022-02099-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 07/31/2022] [Indexed: 11/25/2022] Open
Abstract
Background Reduced physical activity (PA) was the strongest predictor of all-cause mortality in patients with chronic obstructive pulmonary disease (COPD). This scoping review aimed to map the evidence on the current landscape of physical activity, barriers and facilitators, and assessment tools across COPD patients. Methods Arksey and O’Malley’s scoping review methodology framework guided the conduct of this review. An electronic search was conducted on five English databases (PubMed, Cochrane Library, PsycINFO, CINAHL and Web of Science) and three Chinese databases (CNKI, CQVIP and WAN-FANG) in January 2022. Two authors independently screened the literature, extracted the studies characteristics. Results The initial search yielded 4389 results, of which 1954 were duplicates. Of the remaining 135 articles, 42 studies met the inclusion criteria. Among the reviewed articles, there were 14 (33.3%) cross-sectional study, 9 (21.4%) cohort study, 4 (9.5%) longitudinal study, 3 qualitative study, 12 (28.7%) randomized control trials. The main barriers identified were older age, women, lung function, comorbidities, COPD symptoms (fear of breathlessness and injury, severe fatigue, anxiety and depression), GOLD stage, frequency of exacerbation, oxygen use, lack of motivation and environment-related (e.g., season and weather). Twelve studies have evaluated the effects of physical exercise (e.g., walking training, pulmonary rehabilitation (PR), pedometer, self-efficacy enhancing intervention and behavioral modification intervention) on PA and showed significant positive effects on the prognosis of patients. However, in real life it is difficult to maintain PA in people with COPD. Conclusions Changing PA behavior in patients with COPD requires multidisciplinary collaboration. Future studies need to identify the best instruments to measure physical activity in clinical practice. Future studies should focus on the effects of different types, time and intensity of PA in people with COPD and conduct randomized, adequately-powered, controlled trials to evaluate the long-term effectiveness of behavioral change interventions in PA. Supplementary Information The online version contains supplementary material available at 10.1186/s12890-022-02099-4.
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Affiliation(s)
- Xinyue Xiang
- Department of Nursing, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Lihua Huang
- Department of Nursing, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China.
| | - Yong Fang
- Department of Nursing, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Shasha Cai
- Department of Nursing, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Mingyue Zhang
- Department of Nursing, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
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Miravitlles M, García-Rivero JL, Ribera X, Galera J, García A, Palomino R, Pomares X. Exercise capacity and physical activity in COPD patients treated with a LAMA/LABA combination: a systematic review and meta-analysis. Respir Res 2022; 23:347. [PMID: 36522735 PMCID: PMC9753337 DOI: 10.1186/s12931-022-02268-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 11/29/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Persistent airflow limitation and dyspnoea may reduce chronic obstructive pulmonary disease (COPD) patients exercise capacity and physical activity, undermining their physical status and quality of life. Long-acting muscarinic antagonists and long-acting beta-2 agonists (LAMA/LABA) combinations are amongst moderate-to-severe COPD recommended treatments. This article analyses LAMA/LABA combinations effect on COPD patients exercise capacity and physical activity outcomes. METHODS A systematic review and meta-analysis of double-blind randomized controlled trials comparing LAMA/LABA combinations against monotherapy or placebo was conducted. RESULTS Seventeen articles were identified (N = 4041 patients). In endurance shuttle walk test and constant work rate cycle ergometry, LAMA/LABA combinations obtained better results than placebo, but not monotherapy, whereas in 6-min walking test, results favoured LAMA/LABA over monotherapy (four studies), but not over placebo (one study). Moreover, LAMA/LABA combinations obtained better results than placebo in number of steps per day, reduction in percentage of inactive patients and daily activity-related energy expenditure, and better than monotherapy when measuring time spent on ≥ 1.0-1.5, ≥ 2.0 and ≥ 3.0 metabolic equivalents of task activities. CONCLUSIONS LAMA/LABA combinations in COPD patients provided better results than monotherapy or placebo in most exercise capacity and physical activity outcomes.
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Affiliation(s)
- Marc Miravitlles
- Pneumology Department, Hospital Universitari Vall d’HebronVall d’Hebron Institut de Recerca, Vall d’Hebron Barcelona Hospital Campus, Pg. Vall d’Hebron 119-129, 08035 Barcelona, Spain
| | - Juan Luís García-Rivero
- grid.411325.00000 0001 0627 4262Pneumology Department, President of ACINAR, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Xavier Ribera
- grid.488221.50000 0004 0544 6204Boehringer Ingelheim España S.A., Barcelona, Spain
| | | | | | | | - Xavier Pomares
- grid.7080.f0000 0001 2296 0625Pneumology Department, Hospital de Sabadell, Hospital Universitari Parc TaulíInstitut Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Spain
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