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Poppele I, Ottiger M, Stegbauer M, Schlesinger T, Müller K. Device-assessed physical activity and sleep quality of post-COVID patients undergoing a rehabilitation program. BMC Sports Sci Med Rehabil 2024; 16:122. [PMID: 38811993 PMCID: PMC11134673 DOI: 10.1186/s13102-024-00909-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 05/20/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND An infection with SARS-CoV-2 can lead to persistent symptoms more than three months after the acute infection and has also an impact on patients' physical activity behaviour and sleep quality. There is evidence, that inpatient post-COVID rehabilitation can improve physical capacity and mental health impairments, but less is known about the change in physical behaviour and sleep quality. METHODS This longitudinal observational study used accelerometery to assess the level of physical activity and sleep quality before and after an inpatient rehabilitation program. The study sample consists of 100 post-COVID patients who acquired COVID-19 in the workplace. Group differences related to sex, age, COVID-19 severity, and pre-existing diseases were also analysed. RESULTS Level of physical activity and sleep quality didn't increase after rehabilitation. Overall, there is a high extent of inactivity time and poor sleep quality at both measurement points. Regarding group differences, male patients showed a significantly higher inactivity time before rehabilitation, and younger patients (< 55 years) spend significant more time in vigorous physical activity than older patients. Post-COVID patients with pre-existing cardiovascular, respiratory, and metabolic disease show slightly less physical activity than post-COVID patients without these comorbidities. Female patients and younger patients showed better sleep quality in some sleep parameters at both measurement points. However, no differences could be detected related to COVID-19 severity. CONCLUSIONS Ongoing strategies should be implemented to address the high amount of inactivity time and the poor sleep quality in post-COVID patients.
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Affiliation(s)
- Iris Poppele
- Institute of Human Movement Science and Health, Faculty of Behavioral and Social Sciences, Chemnitz University of Technology, 09107, Chemnitz, Germany.
| | - Marcel Ottiger
- Institute of Human Movement Science and Health, Faculty of Behavioral and Social Sciences, Chemnitz University of Technology, 09107, Chemnitz, Germany
| | - Michael Stegbauer
- BG Hospital for Occupational Disease Bad Reichenhall, 83435, Bad Reichenhall, Germany
| | - Torsten Schlesinger
- Institute of Human Movement Science and Health, Faculty of Behavioral and Social Sciences, Chemnitz University of Technology, 09107, Chemnitz, Germany
| | - Katrin Müller
- Institute of Human Movement Science and Health, Faculty of Behavioral and Social Sciences, Chemnitz University of Technology, 09107, Chemnitz, Germany
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2
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Silva J, Hipólito N, Machado P, Flora S, Cruz J. Technological features of smartphone apps for physical activity promotion in patients with COPD: A systematic review. Pulmonology 2023:S2531-0437(23)00124-1. [PMID: 37394341 DOI: 10.1016/j.pulmoe.2023.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 06/13/2023] [Accepted: 06/14/2023] [Indexed: 07/04/2023] Open
Abstract
INTRODUCTION Low physical activity (PA) levels have a negative impact on the health status of patients with Chronic Obstructive Pulmonary Disease (COPD). Smartphone applications (apps) focused on PA promotion may mitigate this problem; however, their effectiveness depends on patient adherence, which can be influenced by the technological features of the apps. This systematic review identified the technological features of smartphone apps aiming to promote PA in patients with COPD. METHODS A literature search was performed in the databases ACM Digital Library, IEEE Xplore, PubMed, Scopus and Web of Science. Papers including the description of a smartphone app for PA promotion in patients with COPD were included. Two researchers independently selected studies and scored the apps features based on a previously developed framework (38 possible features). RESULTS Twenty-three studies were included and 19 apps identified, with an average of 10 technological features implemented. Eight apps could be connected to wearables to collect data. The categories 'Measuring and monitoring' and 'Support and Feedback' were present in all apps. Overall, the most implemented features were 'progress in visual format' (n = 13), 'advice on PA' (n = 14) and 'data in visual format' (n = 10). Only three apps included social features, and two included a web-based version of the app. CONCLUSIONS The existing smartphone apps include a relatively small number of features to promote PA, which are mostly related to monitoring and providing feedback. Further research is warranted to explore the relationship between the presence/absence of specific features and the impact of interventions on patients' PA levels.
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Affiliation(s)
- J Silva
- School of Health Sciences (ESSLei), Polytechnic of Leiria, Portugal
| | - N Hipólito
- Center for Innovative Care and Health Technology (ciTechCare), Polytechnic of Leiria, Portugal; Health Data Science of the Department of Community Medicine, Information and Health Decision Sciences of the Faculty of Medicine of the University of Porto, Porto, Portugal
| | - P Machado
- Center for Innovative Care and Health Technology (ciTechCare), Polytechnic of Leiria, Portugal
| | - S Flora
- Center for Innovative Care and Health Technology (ciTechCare), Polytechnic of Leiria, Portugal
| | - J Cruz
- School of Health Sciences (ESSLei), Polytechnic of Leiria, Portugal; Center for Innovative Care and Health Technology (ciTechCare), Polytechnic of Leiria, Portugal.
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3
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Hernández ED, Cobo EA, Cahalin LP, Seron P. Impact of structural-level environmental interventions on physical activity: a systematic review. Int Arch Occup Environ Health 2023:10.1007/s00420-023-01973-w. [PMID: 37099193 DOI: 10.1007/s00420-023-01973-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 03/30/2023] [Indexed: 04/27/2023]
Abstract
OBJECTIVE To determine the effectiveness of structural-level environmental interventions on the changes in PA levels in the populations examined. METHODS Natural experiments that involve environmental intervention with structural modification were included. The primary outcome PA levels with consideration of both objective and subjective measurements. An electronic search was carried out in Medline/Pubmed, SCIENCE DIRECT, WEB OF SCIENCE, and CINAHL up to January 2022. Two reviewers screened titles and abstracts, selected studies, extracted relevant data, and examined study quality. A qualitative synthesis was performed. RESULTS Twenty-six articles were included. The structural-level environmental interventions included 4 fundamental areas: schools, work environments, streets or cities, and neighborhoods or parks. Of the 26 studies, 21 examined outdoor environments like parks, cities, pedestrian walkways, or steps, while 5 examined indoor or closed environments like schools and workplaces revealing that structural-level environmental interventions improve PA levels with the greatest effect in parks and active transportation. A risk of bias is inherent in natural experiments which is a limitation of this study. In schools and work areas, there is evidence of both decrease in sedentary time and an increase in PA related to environmental modifications. CONCLUSION Structural-level environmental modifications in parks and active transportation demonstrated greater effects in promoting PA. Environmental modifications can impact physical activity in the population. Given that the economic and cultural setting is a key variable when considering the effectiveness of structural interventions, and since only 1 of the 26 reviewed articles included such data, more studies examining economic factors are needed especially in low- and middle-income countries like in South America. TRIAL REGISTRATION PROSPERO CRD42021229718.
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Affiliation(s)
- Edgar D Hernández
- Facultad de Medicina, Human Movement Department, Universidad Nacional de Colombia, cra 45 30-00, Bogotá, Colombia.
| | - Elisa A Cobo
- Facultad de Ciencias de la Salud, Universidad de Boyacá, Boyacá, Tunja, Colombia
| | - Lawrence P Cahalin
- Department of Physical Therapy, University of Miami, Miami, Florida, USA
| | - Pamela Seron
- Facultad de Medicina, Universidad de La Frontera, Claro Solar #112, Temuco, Chile
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4
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Grosbois JM, Détrée A, Pierache A, Bautin N, Pérez T, Wallaert B, Chenivesse C, Le Rouzic O. Impact of Cardiovascular and Metabolic Comorbidities on Long-term Outcomes of Home-based Pulmonary Rehabilitation in COPD. Int J Chron Obstruct Pulmon Dis 2023; 18:155-167. [PMID: 36860514 PMCID: PMC9969866 DOI: 10.2147/copd.s381744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 10/31/2022] [Indexed: 02/24/2023] Open
Abstract
Background Cardiovascular and metabolic comorbidities in chronic obstructive pulmonary disease (COPD) are associated with higher symptoms burden. Few center-based studies have evaluated the impact of these comorbidities on short-term pulmonary rehabilitation outcomes with contrasting results. Research Question This study aimed to determine whether cardiovascular diseases and metabolic comorbidities impacted long-term outcomes of a home-based PR program in COPD patients. Study Design and methods Data of 419 consecutive COPD patients addressed to our pulmonary rehabilitation program between January 2010 and June 2016 were retrospectively analyzed. Our program consisted of once-weekly supervised home sessions, including therapeutic education and self-management support, with unsupervised retraining exercises and physical activities the other days for 8 weeks. Exercise capacity (6-min stepper test [6MST]), quality of life (visual simplified respiratory questionnaire), and anxiety and depression (hospital anxiety and depression scale) were assessed respectively, before (M0) and at the end (M2) of the pulmonary rehabilitation program, and at 6 (M8) and 12 months (M14) after its achievement. Results Patients (mean age 64.1±11.2 years, 67% males, mean forced expiratory volume in one second (FEV1) 39.2±17.0% predicted) were classified as having cardiovascular comorbidities (n=195), only metabolic disorders (n=122) or none of these comorbidities (n=102). After adjustment, all outcomes appeared similar between groups at baseline and improved after pulmonary rehabilitation with a greater effect at M14 for patients with only metabolic disorders on anxiety and depression score (-5.0±0.7 vs -2.9±0.8 and -2.6±0.6, p=0.021). Quality of life and exercise capacity improvements were not significantly different between the three groups at M2 and M14. Conclusion Cardiovascular and metabolic comorbidities do not preclude COPD patients from obtaining clinically meaningful improvements in exercise capacity, quality of life and anxiety-depression up to 1 year after a home-based pulmonary rehabilitation.
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Affiliation(s)
| | - Axelle Détrée
- Groupe Hospitalier Loos Haubourdin, Réhabilitation Respiratoire, Loos, F-59120, France
| | - Adeline Pierache
- Université de Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, Lille, F-59000, France,CHU Lille, Department of Biostatistics, Lille, F-59000, France
| | - Nathalie Bautin
- Université de Lille, CHU Lille, CNRS, Inserm, Institut Pasteur de Lille, U1019 - UMR 9017 - CIIL - Center for Infection and Immunity of Lille, Lille, F-59000, France,CHU Lille, Pneumologie et Immuno-Allergologie, Centre de référence constitutif pour les maladies pulmonaires rares, Lille, F-59000, France
| | - Thierry Pérez
- Université de Lille, CHU Lille, CNRS, Inserm, Institut Pasteur de Lille, U1019 - UMR 9017 - CIIL - Center for Infection and Immunity of Lille, Lille, F-59000, France,CHU Lille, Pneumologie et Immuno-Allergologie, Centre de référence constitutif pour les maladies pulmonaires rares, Lille, F-59000, France
| | - Benoit Wallaert
- Université de Lille, CHU Lille, CNRS, Inserm, Institut Pasteur de Lille, U1019 - UMR 9017 - CIIL - Center for Infection and Immunity of Lille, Lille, F-59000, France,CHU Lille, Pneumologie et Immuno-Allergologie, Centre de référence constitutif pour les maladies pulmonaires rares, Lille, F-59000, France
| | - Cécile Chenivesse
- Université de Lille, CHU Lille, CNRS, Inserm, Institut Pasteur de Lille, U1019 - UMR 9017 - CIIL - Center for Infection and Immunity of Lille, Lille, F-59000, France,CHU Lille, Pneumologie et Immuno-Allergologie, Centre de référence constitutif pour les maladies pulmonaires rares, Lille, F-59000, France
| | - Olivier Le Rouzic
- Université de Lille, CHU Lille, CNRS, Inserm, Institut Pasteur de Lille, U1019 - UMR 9017 - CIIL - Center for Infection and Immunity of Lille, Lille, F-59000, France,CHU Lille, Pneumologie et Immuno-Allergologie, Centre de référence constitutif pour les maladies pulmonaires rares, Lille, F-59000, France,Correspondence: Olivier Le Rouzic, Pneumologie et Immuno-Allergologie, Institut Cœur Poumon, 1 boulevard Jules Leclercq, CHU de Lille, Lille, 59037, France, Tel +33 3 20 44 59 48, Fax +33 3 20 44 57 68, Email
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5
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Nicholson JM, Orsso CE, Nourouzpour S, Elangeswaran B, Chohan K, Orchanian-Cheff A, Fidler L, Mathur S, Rozenberg D. Computed tomography-based body composition measures in COPD and their association with clinical outcomes: A systematic review. Chron Respir Dis 2022; 19:14799731221133387. [PMID: 36223552 PMCID: PMC9561670 DOI: 10.1177/14799731221133387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Computed tomography (CT) is commonly utilized in chronic obstructive
pulmonary disease (COPD) for lung cancer screening and emphysema
characterization. Computed tomography-morphometric analysis of body
composition (muscle mass and adiposity) has gained increased recognition as
a marker of disease severity and prognosis. This systematic review aimed to
describe the CT-methodology used to assess body composition and identify the
association of body composition measures and disease severity,
health-related quality of life (HRQL), cardiometabolic risk factors,
respiratory exacerbations, and survival in patients with COPD. Methods Six databases were searched (inception-September 2021) for studies evaluating
adult COPD patients using thoracic or abdominal CT-muscle or adiposity body
composition measures. The systematic review was conducted in accordance with
the PRISMA guidelines. Results Twenty eight articles were included with 15,431 COPD patients, across all
GOLD stages with 77% males, age range (mean/median 59–78 years), and BMI
range 19.8–29.3 kg/m2. There was heterogeneity in assessment of
muscle mass and adiposity using thoracic (n = 22) and
abdominal (n = 8) CT-scans, capturing different muscle
groups, anatomic locations, and adiposity compartments (visceral,
subcutaneous, and epicardial). Low muscle mass and increased adiposity were
associated with increased COPD severity measures (lung function, exercise
capacity, dyspnea) and lower HRQL, but were not consistent across studies.
Increased visceral adiposity (n = 6) was associated with
cardiovascular disease or risk factors (hypertension, hyperlipidemia, and
diabetes). Low muscle CSA was prognostic of respiratory exacerbations or
mortality in three of six studies, whereas the relationship with increased
intermuscular adiposity and greater mortality was only observed in one of
three studies. Conclusion There was significant variability in CT-body composition measures. In several
studies, low muscle mass was associated with increased disease severity and
lower HRQL, whereas adiposity with cardiovascular disease/risk factors.
Given the heterogeneity in body composition measures and clinical outcomes,
the prognostic utility of CT-body composition in COPD requires further
study.
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Affiliation(s)
- John M Nicholson
- Department of Medicine,
Respirology, London
Health Science Center, London, ON,
Canada
| | - Camila E Orsso
- Department of Agricultural, Food
and Nutritional Science, University of
Alberta, Edmonton, AB, Canada
| | - Sahar Nourouzpour
- Temerty Faculty of Medicine,
Respirology, Lung Transplant Program, Toronto General Hospital Research
Institute, University
Health Network, Toronto, ON,
Canada
| | - Brenawen Elangeswaran
- Temerty Faculty of Medicine,
Respirology, Lung Transplant Program, Toronto General Hospital Research
Institute, University
Health Network, Toronto, ON,
Canada
| | - Karan Chohan
- Temerty Faculty of Medicine,
Respirology, Lung Transplant Program, Toronto General Hospital Research
Institute, University
Health Network, Toronto, ON,
Canada
| | - Ani Orchanian-Cheff
- Library and Information Services,
University
Health Network, Toronto, ON,
Canada
| | - Lee Fidler
- Department of Medicine,
Respirology, University
Health Network, Toronto, Canada,Respirology,
Sunnybrook
Health Sciences Centre, Toronto, ON,
Canada
| | - Sunita Mathur
- Deparment of Physical Therapy,
University
of Toronto, Toronto, ON, Canada,School of Rehabilitation Therapy,
Queen’s
University, Kingston, ON, Canada
| | - Dmitry Rozenberg
- Temerty Faculty of Medicine,
Respirology, Lung Transplant Program, Toronto General Hospital Research
Institute, University
Health Network, Toronto, ON,
Canada,Dmitry Rozenberg, Temerty Faculty of
Medicine, Respirology, Lung Transplant Program, Toronto General Hospital
Research Institute, University Health Network, 200 Elizabeth Street, 13-EN 229,
Toronto ON M5G 2C4, Canada.
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6
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Pharmacological, Nutritional, and Rehabilitative Interventions to Improve the Complex Management of Osteoporosis in Patients with Chronic Obstructive Pulmonary Disease: A Narrative Review. J Pers Med 2022; 12:jpm12101626. [PMID: 36294765 PMCID: PMC9604650 DOI: 10.3390/jpm12101626] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 09/27/2022] [Accepted: 09/28/2022] [Indexed: 11/06/2022] Open
Abstract
Osteoporosis is a highly prevalent condition affecting a growing number of patients affected by chronic obstructive pulmonary disease (COPD), with crucial implications for risk of fragility fractures, hospitalization, and mortality. Several risk factors have been identified to have a role in osteoporosis development in COPD patients, including corticosteroid therapy, systemic inflammation, smoke, physical activity levels, malnutrition, and sarcopenia. In this scenario, a personalized multitarget intervention focusing on the pathological mechanisms underpinning osteoporosis is mandatory to improve bone health in these frail patients. Specifically, physical exercise, nutritional approach, dietary supplements, and smoke cessation are the cornerstone of the lifestyle approach to osteoporosis in COPD patients, improving not only bone health but also physical performance and balance. On the other hand, pharmacological treatment should be considered for both the prevention and treatment of osteoporosis in patients at higher risk of fragility fractures. Despite these considerations, several barriers still affect the integration of a personalized approach to managing osteoporosis in COPD patients. However, digital innovation solutions and telemedicine might have a role in optimizing sustainable networking between hospital assistance and community settings to improve bone health and reduce sanitary costs of the long-term management of COPD patients with osteoporosis.
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7
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KARADEDE Ö, KARADEDE H, ŞEREMET H, TARAKTAŞLI GO, ALTIPARMAKOĞLU YA, ÖZALP E, GÜNDOĞDU E, DALKILIÇ F, EROĞLU MN, KÜRKAN M, HARMAN M, ÇAKICI S, KARAALİ R. Determination of Daily Life Activity Levels of Hospitalized Individuals Due to COVID-19 Disease. İSTANBUL GELIŞIM ÜNIVERSITESI SAĞLIK BILIMLERI DERGISI 2022. [DOI: 10.38079/igusabder.1085389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Amaç: Araştırma, COVID-19 hastalığı nedeniyle hastanede yatarak tedavi olan hastaların taburculuk sonrasındaki günlük yaşam aktivite düzeylerini belirlemek amacıyla yapılmıştır.Yöntem: Çalışma, COVID-19 hastalığı nedeniyle hastanede yatmış, taburculuğundan itibaren en az bir ay geçmiş 230 hasta üzerinde yapılmıştır. Veriler Temmuz 2021-Eylül 2021 tarihleri arasında telefon ile görüşme yöntemiyle toplanmıştır. Araştırmanın verileri Tanıtıcı Özellikler Formu ve Katz Günlük Yaşam Aktiviteleri Ölçeği kullanılarak toplanmıştır. Araştırma verileri, normal dağılmayan değişkenler için ortanca ve çeyrekler arası aralık kullanılarak verilmiştir. Verilerilerin karşılaştırılmasında Wilcoxon Sıralı İşaretler testi ile kullanılmıştır.Bulgular: Katılımcıların yaş ortalaması 57,28±14,6, %47,8’i kadın, %16,1’i aşısız olup COVID-19 hastalığı öncesi günlük yaşam aktivitesi puan ortalaması 17,5±2,7, COVID-19 hastalığından sonraki günlük yaşam aktivitesi puan ortalaması 17,3±3,3 olarak tespit edilmiştir. Araştırmada hastalık öncesi ve sonrasındaki günlük yaşam aktiviteleri puan ortalamaları arasında anlamlı fark saptanmamıştır.Sonuçlar: COVID-19 hastalığı nedeniyle hastanede yatmış bireylerin taburculuk sonrasındaki sürecinin sağlık profesyonelleri tarafından takip edilmesi, yaşam aktivitelerinin değerlendirilmesi, bakım ihtiyaçlarının belirlenmesi ve buna yönelik olarak bireyselleştirilmiş sağlık hizmetinin hastane dışında da sürdürülmesi önerilmektedir.
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Affiliation(s)
- Özkan KARADEDE
- İstanbul Üniversitesi-Cerrahpaşa Cerrahpaşa Tıp Fakültesi
| | | | - Hatice ŞEREMET
- İSTANBUL ÜNİVERSİTESİ CERRAHPAŞA CERRAHPAŞA TIP FAKÜLTESİ
| | | | | | - Ebru ÖZALP
- İSTANBUL ÜNİVERSİTESİ CERRAHPAŞA CERRAHPAŞA TIP FAKÜLTESİ
| | - Ebru GÜNDOĞDU
- İSTANBUL ÜNİVERSİTESİ CERRAHPAŞA CERRAHPAŞA TIP FAKÜLTESİ
| | - Fatma DALKILIÇ
- İSTANBUL ÜNİVERSİTESİ CERRAHPAŞA CERRAHPAŞA TIP FAKÜLTESİ
| | | | - Merve KÜRKAN
- İSTANBUL ÜNİVERSİTESİ CERRAHPAŞA CERRAHPAŞA TIP FAKÜLTESİ
| | - Mehmet HARMAN
- İSTANBUL ÜNİVERSİTESİ CERRAHPAŞA CERRAHPAŞA TIP FAKÜLTESİ
| | - Senem ÇAKICI
- İSTANBUL ÜNİVERSİTESİ CERRAHPAŞA CERRAHPAŞA TIP FAKÜLTESİ
| | - Rıdvan KARAALİ
- İstanbul Üniversitesi-Cerrahpaşa Cerrahpaşa Tıp Fakültesi
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8
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Pace WD, Brandt E, Carter VA, Chang KL, Edwards CL, Evans A, Fox C, Gaona G, Han MK, Kaplan AG, Kent R, Kocks JWH, Kruszyk M, Le Lievre CE, Li Voti T, Mahle C, Make B, Ratigan AR, Shaikh A, Skolnik N, Stanley B, Yawn BP, Price DB. COPD Population in US Primary Care: Data From the Optimum Patient Care DARTNet Research Database and the Advancing the Patient Experience in COPD Registry. Ann Fam Med 2022; 20:319-327. [PMID: 35879087 PMCID: PMC9328699 DOI: 10.1370/afm.2829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 12/13/2021] [Accepted: 01/06/2022] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To describe demographic and clinical characteristics of chronic obstructive pulmonary disease patients managed in US primary care. METHODS This was an observational registry study using data from the Chronic Obstructive Pulmonary Disease (COPD) Optimum Patient Care DARTNet Research Database from which the Advancing the Patient Experience COPD registry is derived. Registry patients were aged ≥35 years at diagnosis. Electronic health record data were collected from both registries, supplemented with patient-reported information/outcomes from the Advancing the Patient Experience registry from 5 primary care groups in Texas, Ohio, Colorado, New York, and North Carolina (June 2019 through November 2020). RESULTS Of 17,192 patients included, 1,354 were also in the Advancing the Patient Experience registry. Patients were predominantly female (56%; 9,689/17,192), White (64%; 9,732/15,225), current/ex-smokers (80%; 13,784/17,192), and overweight/obese (69%; 11,628/16,849). The most commonly prescribed maintenance treatments were inhaled corticosteroid with a long-acting β2-agonist (30%) and inhaled corticosteroid with a long-acting muscarinic antagonist (27%). Although 3% (565/17,192) of patitents were untreated, 9% (1,587/17,192) were on short-acting bronchodilator monotherapy, and 4% (756/17,192) were on inhaled corticosteroid monotherapy. Despite treatment, 38% (6,579/17,192) of patients experienced 1 or more exacerbations in the last 12 months. These findings were mirrored in the Advancing Patient Experience registry with many patients reporting high or very high impact of disease on their health (43%; 580/1,322), a breathlessness score 2 or more (45%; 588/1,315), and 1 or more exacerbation in the last 12 months (50%; 646/1,294). CONCLUSIONS Our findings highlight the high exacerbation, symptom, and treatment burdens experienced by COPD patients managed in US primary care, and the need for more real-life effectiveness trials to support decision making at the primary care level.
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Affiliation(s)
- Wilson D Pace
- DARTNet Institute, Aurora, Colorado.,University of Colorado Denver, Denver, Colorado
| | | | | | - Ku-Lang Chang
- University of Florida College of Medicine, Gainesville, Florida
| | | | | | - Chester Fox
- DARTNet Institute, Aurora, Colorado.,University at Buffalo, Buffalo, New York
| | | | | | - Alan G Kaplan
- Observational & Pragmatic Research Institute, Singapore.,Family Physician Airways Group of Canada, Stouffville, Ontario, Canada.,University of Toronto, Toronto, Canada
| | | | - Janwillem W H Kocks
- Observational & Pragmatic Research Institute, Singapore.,General Practitioners Research Institute, Groningen, The Netherlands
| | | | | | | | - Cathy Mahle
- Boehringer Ingelheim, Ridgefield, Connecticut
| | - Barry Make
- Department of Medicine, National Jewish Health, Denver, Colorado
| | | | - Asif Shaikh
- Boehringer Ingelheim, Ridgefield, Connecticut
| | - Neil Skolnik
- Thomas Jefferson University, Woodbury, New Jersey.,Abington Jefferson Health, Jenkintown, Pennsylvania
| | - Brooklyn Stanley
- Optimum Patient Care, Cambridge, United Kingdom.,Observational & Pragmatic Research Institute, Singapore
| | - Barbara P Yawn
- University of Minnesota, Minneapolis, Minnesota.,COPD Foundation, Washington, DC
| | - David B Price
- Observational & Pragmatic Research Institute, Singapore; .,Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
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9
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Bevilacqua G, Zhang J, Parsons C, Laskou F, Fuggle N, Cooper C, Dennison E. Medical history, medication use and physical activity in adults in their eighth and ninth decade of life in the Hertfordshire Cohort Study. EXCLI JOURNAL 2022; 21:695-703. [PMID: 35721573 PMCID: PMC9203985 DOI: 10.17179/excli2022-4874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 04/12/2022] [Indexed: 11/10/2022]
Abstract
While there are many known health benefits to maintained physical activity levels in late adulthood, there have been very few studies that have considered relationships between morbidity profile and physical activity in the eighth decade of life. We studied 1097 participants, 555 men and 542 women from the Hertfordshire Cohort Study, a UK community based sample. Validated questionnaire based data were used to relate self-reported physical activity (PA) levels to medical history, and medication use. Regression analyses were adjusted for age, BMI, smoker status, alcohol consumption. The mean (SD) age of participants in the study was 80.2 (2.7) years for men and 80.2 (2.6) for women. A higher proportion of men (33.7 %) than women (24 %) were in the high activity score group. 20.8 % of female participants and 22.6 % male participants reported having no comorbid disease; 10.5 % men and 8.4 % women were taking no medication. Higher number of chronic conditions was associated with lower levels of PA [men (OR 0.73, 95 % CI 0.63-0.84, p<0.001); women (OR 0.74, 95 % CI 0.64-0.86, p<0.001)] as was being prescribed a higher number of medications [men (OR 0.88, 95 % CI 0.84-0.93, p<0.001); women (OR 0.86, 95 % CI 0.82-0.91, p<0.001)]. All these associations remained robust following adjustments. Strong relationships were seen in both sexes between PA and taking medication for disorders of the central nervous system and gastrointestinal system, with relationships generally stronger in men. We have observed relationships between comorbid medical history and medication use with physical activity in a cohort of community dwelling older adults. These highlight the need to consider medical history when considering how best to optimize PA in older adults.
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Affiliation(s)
| | - Jean Zhang
- MRC Lifecourse Epidemiology Centre, Southampton SO16 6YD, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Camille Parsons
- MRC Lifecourse Epidemiology Centre, Southampton SO16 6YD, UK
| | - Faidra Laskou
- MRC Lifecourse Epidemiology Centre, Southampton SO16 6YD, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Nicholas Fuggle
- MRC Lifecourse Epidemiology Centre, Southampton SO16 6YD, UK
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Centre, Southampton SO16 6YD, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
- NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Elaine Dennison
- MRC Lifecourse Epidemiology Centre, Southampton SO16 6YD, UK
- NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
- Victoria University of Wellington, Wellington, New Zealand
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10
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Targeting exertional breathlessness to improve physical activity: the role of primary care. NPJ Prim Care Respir Med 2021; 31:41. [PMID: 34504091 PMCID: PMC8429707 DOI: 10.1038/s41533-021-00254-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 08/19/2021] [Indexed: 02/08/2023] Open
Abstract
Primary care physicians (PCPs) play a crucial role in the diagnosis and management of chronic obstructive pulmonary disease (COPD). By working together with patients to target exertional breathlessness and increase physical activity, PCPs have an important role to play, early in the disease course, in improving patient outcomes in both the short and long term. In this article, we consider how physical activity affects disease progression from the PCP perspective. We discuss the role of pharmacological therapy, the importance of an holistic approach and the role of PCPs in assessing and promoting physical activity. The complexity and heterogeneity of COPD make it a challenging disease to treat. Patients' avoidance of activity, and subsequent decline in capacity to perform it, further impacts the management of the disease. Improving patient tolerance of physical activity, increasing participation in daily activities and helping patients to remain active are clear goals of COPD management. These may require an holistic approach to management, including pulmonary rehabilitation and psychological programmes in parallel with bronchodilation therapy, in order to address both physiological and behavioural factors. PCPs have an important role to optimise therapy, set goals and communicate the importance of maintaining physical activity to their patients. In addition, optimal treatment that addresses activity-related breathlessness can help prevent the downward spiral of inactivity and get patients moving again, to improve their overall health and long-term prognosis.
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11
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Pinto TF, Fagundes Xavier R, Lunardi AC, Marques da Silva CCB, Moriya HT, Lima Vitorasso R, Torsani V, Amato MBP, Stelmach R, Salge JM, Carvalho-Pinto RM, Carvalho CR. Effects of elastic tape on thoracoabdominal mechanics, dyspnea, exercise capacity, and physical activity level in nonobese male subjects with COPD. J Appl Physiol (1985) 2020; 129:492-499. [DOI: 10.1152/japplphysiol.00690.2019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Elastic tape can be used as a new and low-cost intervention to reduce thoracoabdominal asynchrony and sedentary behavior as well as improve exercise capacity and physical activity level in nonobese male subjects with severe-to-very severe chronic obstructive pulmonary disease.
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Affiliation(s)
- Thiago Fernandes Pinto
- Department of Physical Therapy, Medical School, University of São Paulo, São Paulo, Brazil
| | | | | | | | - Henrique Takachi Moriya
- Biomedical Engineering Laboratory, Escola Politécnica, University of São Paulo, São Paulo, Brazil
| | - Renato Lima Vitorasso
- Biomedical Engineering Laboratory, Escola Politécnica, University of São Paulo, São Paulo, Brazil
| | - Vinicius Torsani
- Pulmonary Division, Heart Institute (InCor), Clinics Hospital, Medical School, University of São Paulo, São Paulo, Brazil
| | - Marcelo Brito Passos Amato
- Pulmonary Division, Heart Institute (InCor), Clinics Hospital, Medical School, University of São Paulo, São Paulo, Brazil
| | - Rafael Stelmach
- Pulmonary Division, Heart Institute (InCor), Clinics Hospital, Medical School, University of São Paulo, São Paulo, Brazil
| | - João Marcos Salge
- Pulmonary Division, Heart Institute (InCor), Clinics Hospital, Medical School, University of São Paulo, São Paulo, Brazil
| | - Regina Maria Carvalho-Pinto
- Pulmonary Division, Heart Institute (InCor), Clinics Hospital, Medical School, University of São Paulo, São Paulo, Brazil
| | - Celso R.F. Carvalho
- Department of Physical Therapy, Medical School, University of São Paulo, São Paulo, Brazil
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12
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Michalovic E, Jensen D, Dandurand RJ, Saad N, Ezer N, Moullec G, Smith BM, Bourbeau J, Sweet SN. Description of Participation in Daily and Social Activities for Individuals with COPD. COPD 2020; 17:543-556. [PMID: 32811208 DOI: 10.1080/15412555.2020.1798373] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This study described the participation in daily and social activities and the perceived barriers and facilitators to participation of individuals with chronic obstructive pulmonary disease (COPD). Individuals, recruited from outpatient clinics, responded to a survey on their participation in, and barriers and facilitators towards, 26 daily and social activities, divided into 3 categories: (1) physical activity and movement (PAM); (2) self-care; and (3) social engagement. For each activity, chi-square analyses were used to examine participation differences by individuals': quartiles of airflow obstruction [percent predicted forced expiratory volume in 1 second (FEV1%predicted)] and breathlessness burden and exacerbation risk. Of the 200 participants (47% women; mean ± standard deviation age = 68 ± 9 years), most wanted to increase their participation in PAM activities (range 21-75%) and significant differences were found in 5/10 PAM activities for individuals' breathlessness burden and exacerbation risk (e.g., more individuals than expected in group A (modified Medical Research Council breathlessness score <2 and 0-1 exacerbations in past 12 months) participated in regular exercise as much as they wanted (χ(9)2=20.43, Cramer's V=.23)). Regardless of the degree of airflow obstruction or breathlessness burden and exacerbation risk, the most common barrier to participation was breathlessness (p<.001, η2p=.86) and the most common facilitator was engaging as part of their routine (p<.001, η2p=.75). Individuals with COPD want to increase their participation in daily and social activities but are limited by breathlessness. Strategies to alleviate breathlessness should be identified/prioritized and incorporated into individuals' daily routines to meet their self-reported participation objectives in daily and social activities.
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Affiliation(s)
- Emilie Michalovic
- Department of Kinesiology and Physical Education, McGill University, Montreal, Quebec, Canada.,McGill Research Centre for Physical Activity and Health, Faculty of Education, McGill University, Montreal, Quebec, Canada.,Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, Quebec, Canada
| | - Dennis Jensen
- Department of Kinesiology and Physical Education, McGill University, Montreal, Quebec, Canada.,McGill Research Centre for Physical Activity and Health, Faculty of Education, McGill University, Montreal, Quebec, Canada
| | - Ronald J Dandurand
- CIUSSS de l'Ouest-de-l'île-de-Montréal, Montreal, Quebec, Canada.,Department of Medicine, Respiratory Division, McGill University, Montreal, Quebec, Canada
| | - Nathalie Saad
- Department of Medicine, Respiratory Division, McGill University, Montreal, Quebec, Canada
| | - Nicole Ezer
- Department of Medicine, Respiratory Division, McGill University, Montreal, Quebec, Canada.,Respiratory Epidemiology and Clinical Research Unit, Research Institute McGill University, Health Centre, McGill University, Montreal, Quebec, Canada
| | - Gregory Moullec
- Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, Quebec, Canada.,Research Center of the Centre Intégré Universitaire de Santé Et De Services Sociaux du Nord-de-l'Île de Montréal, Montreal, Quebec, Canada
| | - Benjamin M Smith
- Department of Medicine, Respiratory Division, McGill University, Montreal, Quebec, Canada.,Respiratory Epidemiology and Clinical Research Unit, Research Institute McGill University, Health Centre, McGill University, Montreal, Quebec, Canada.,Department of Medicine, Columbia University Medical Center, New York, New York, USA
| | - Jean Bourbeau
- Department of Medicine, Respiratory Division, McGill University, Montreal, Quebec, Canada.,Respiratory Epidemiology and Clinical Research Unit, Research Institute McGill University, Health Centre, McGill University, Montreal, Quebec, Canada
| | - Shane N Sweet
- Department of Kinesiology and Physical Education, McGill University, Montreal, Quebec, Canada.,McGill Research Centre for Physical Activity and Health, Faculty of Education, McGill University, Montreal, Quebec, Canada.,Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, Quebec, Canada
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13
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Boutou AK, Zafeiridis A, Pitsiou G, Dipla K, Kioumis I, Stanopoulos I. Cardiopulmonary exercise testing in chronic obstructive pulmonary disease: An update on its clinical value and applications. Clin Physiol Funct Imaging 2020; 40:197-206. [PMID: 32176429 DOI: 10.1111/cpf.12627] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Revised: 02/24/2020] [Accepted: 03/09/2020] [Indexed: 12/25/2022]
Abstract
Chronic obstructive pulmonary disease is a debilitating disorder, characterized by airflow limitation, exercise impairment, reduced functional capacity and significant systemic comorbidity, which complicates the course of the disease. The critical inspiratory constraint to tidal volume expansion during exercise (that may be further complicated by the presence of dynamic hyperinflation), abnormalities in oxygen transportation and gas exchange abnormalities are the major pathophysiological mechanisms of exercise intolerance in COPD patients, and thus, exercise testing has been traditionally used for the functional evaluation of these patients. Compared to various laboratory and field exercise tests, cardiopulmonary exercise testing (CPET) provides a thorough assessment of exercise physiology, involving the integrative respiratory, cardiovascular, muscle and metabolic responses to exercise. This review highlights the clinical utility of CPET in COPD patients, as it provides important information for the determination of the major factors that limit exercise among patients with several comorbidities, allows the assessment of the severity of dynamic hyperinflation, provides valuable prognostic information and can be used to evaluate the response to several therapeutic interventions.
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Affiliation(s)
- Afroditi K Boutou
- Department of Respiratory Medicine, "G. Papanikolaou" Hospital, Thessaloniki, Greece
| | - Antreas Zafeiridis
- Laboratory of Exercise Physiology and Biochemistry, Department of Physical Education and Sports Science at Serres, Aristotle University of Thessaloniki, Serres, Greece
| | - Georgia Pitsiou
- Respiratory Failure Department, "G. Papanikolaou" Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantina Dipla
- Laboratory of Exercise Physiology and Biochemistry, Department of Physical Education and Sports Science at Serres, Aristotle University of Thessaloniki, Serres, Greece
| | - Ioannis Kioumis
- Respiratory Failure Department, "G. Papanikolaou" Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Stanopoulos
- Respiratory Failure Department, "G. Papanikolaou" Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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14
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Effects of Resistance Exercise on Cerebral Redox Regulation and Cognition: An Interplay Between Muscle and Brain. Antioxidants (Basel) 2019; 8:antiox8110529. [PMID: 31698763 PMCID: PMC6912783 DOI: 10.3390/antiox8110529] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 10/31/2019] [Accepted: 11/05/2019] [Indexed: 01/08/2023] Open
Abstract
This review highlighted resistance training as an important training type for the brain. Most studies that use physical exercise for the prevention or treatment of neurodegenerative diseases have focused on aerobic physical exercise, revealing different behavioral, biochemical, and molecular effects. However, recent studies have shown that resistance training can also significantly contribute to the prevention of neurodegenerative diseases as well as to the maintenance, development, and recovery of brain activities through specific neurochemical adaptations induced by the training. In this scenario we observed the results of several studies published in different journals in the last 20 years, focusing on the effects of resistance training on three main neurological aspects: Neuroprotective mechanisms, oxidative stress, and cognition. Systematic database searches of PubMed, Web of Science, Scopus, and Medline were performed to identify peer-reviewed studies from the 2000s. Combinations of keywords related to brain disease, aerobic/resistance, or strength physical exercise were used. Other variables were not addressed in this review but should be considered for a complete understanding of the effects of training in the brain.
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15
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Hyun DG, Oh YM, Lee SW, Lee SD, Lee JS. Clinical Phenotypes, Comorbidities, and Exacerbations according to Serum 25-OH Vitamin D and Plasma Fibrinogen Levels in Chronic Obstructive Pulmonary Disease. J Korean Med Sci 2019; 34:e195. [PMID: 31347309 PMCID: PMC6660320 DOI: 10.3346/jkms.2019.34.e195] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 07/02/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Although vitamin D deficiency is prevalent in patients with chronic obstructive pulmonary disease (COPD), the influence of vitamin D deficiency on COPD has not been fully established. Moreover, the inflammation process is associated with vitamin D deficiency in the general population. Therefore, this study aimed to determine whether clinical phenotypes, comorbidities, and exacerbation rates are affected by the level of plasma fibrinogen, well studied by an inflammatory marker in COPD patients, and 25-hydroxy (25-OH) vitamin D. METHODS This retrospective study analyzed patients with COPD whose inflammatory marker levels, especially plasma fibrinogen and 25-OH vitamin D levels, had been examined. A correlation analysis was conducted for inflammatory markers and 25-OH vitamin D. Clinical characteristics, comorbidities and exacerbation rates were compared among four groups based on plasma fibrinogen concentrations (threshold, 350 mg/dL) and 25-OH vitamin D levels (threshold, 20 ng/mL). RESULTS Among 611 patients with COPD, 236 were included in the study. The levels of inflammatory markers had no statistical correlation with the serum 25-OH vitamin D levels. The four groups showed no statistically significant differences in age, sex, smoking history, inhaler use, and severity of comorbidities. Patients with high plasma fibrinogen concentrations and low 25-OH vitamin D levels had lower lung function, higher severity index, and higher annual rate of severe exacerbations 12 months before (0.23/year) and after (0.41/year) the measurement of 25-OH vitamin D levels than did the other patients. CONCLUSION Our findings suggested an interaction between vitamin D deficiency and COPD. The measurement of plasma fibrinogen concentrations could help identify a severe phenotypic group among patients with vitamin D deficiency.
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Affiliation(s)
- Dong Gon Hyun
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yeon Mok Oh
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sei Won Lee
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang Do Lee
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Seung Lee
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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16
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Benadjaoud MA, Menai M, van Hees VT, Zipunnikov V, Regnaux JP, Kivimäki M, Singh-Manoux A, Sabia S. The association between accelerometer-assessed physical activity and respiratory function in older adults differs between smokers and non-smokers. Sci Rep 2019; 9:10270. [PMID: 31311982 PMCID: PMC6635399 DOI: 10.1038/s41598-019-46771-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 07/03/2019] [Indexed: 01/17/2023] Open
Abstract
The association between physical activity and lung function is thought to depend on smoking history but most previous research uses self-reported measures of physical activity. This cross-sectional study investigates whether the association between accelerometer-derived physical activity and lung function in older adults differs by smoking history. The sample comprised 3063 participants (age = 60–83 years) who wore an accelerometer during 9 days and undertook respiratory function tests. Forced vital capacity (FVC) was associated with moderate-to-vigorous physical activity (MVPA; acceleration ≥0.1 g (gravity)) in smokers but not in never smokers: FVC differences for 10 min increase in MVPA were 58.6 (95% Confidence interval: 21.1, 96.1), 27.8 (4.9, 50.7), 16.6 (7.9, 25.4), 2.8 (−5.2, 10.7) ml in current, recent ex-, long-term ex-, and never-smokers, respectively. A similar trend was observed for forced expiratory volume in 1 second. Functional data analysis, a threshold-free approach using the entire accelerometry distribution, showed an association between physical activity and lung function in all smoking groups, with stronger association in current and recent ex-smokers than in long-term ex- and never-smokers; the associations were evident in never smokers only at activity levels above the conventional 0.1 g MVPA threshold. These findings suggest that the association between lung function and physical activity in older adults is more pronounced in smokers than non-smokers.
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Affiliation(s)
| | - Mehdi Menai
- Inserm U1153, CRESS, Epidemiology of Ageing and Neurodegenerative diseases, Université de Paris, Paris, France
| | | | - Vadim Zipunnikov
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, 21205, USA
| | - Jean-Philippe Regnaux
- EHESP, Center of Research in Epidemiology and Statistics - UMR 1153, F-35000, Rennes, France
| | - Mika Kivimäki
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Archana Singh-Manoux
- Inserm U1153, CRESS, Epidemiology of Ageing and Neurodegenerative diseases, Université de Paris, Paris, France.,Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Séverine Sabia
- Inserm U1153, CRESS, Epidemiology of Ageing and Neurodegenerative diseases, Université de Paris, Paris, France. .,Department of Epidemiology and Public Health, University College London, London, United Kingdom.
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17
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Franssen FME, Alter P, Bar N, Benedikter BJ, Iurato S, Maier D, Maxheim M, Roessler FK, Spruit MA, Vogelmeier CF, Wouters EFM, Schmeck B. Personalized medicine for patients with COPD: where are we? Int J Chron Obstruct Pulmon Dis 2019; 14:1465-1484. [PMID: 31371934 PMCID: PMC6636434 DOI: 10.2147/copd.s175706] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Accepted: 06/05/2019] [Indexed: 12/19/2022] Open
Abstract
Chronic airflow limitation is the common denominator of patients with chronic obstructive pulmonary disease (COPD). However, it is not possible to predict morbidity and mortality of individual patients based on the degree of lung function impairment, nor does the degree of airflow limitation allow guidance regarding therapies. Over the last decades, understanding of the factors contributing to the heterogeneity of disease trajectories, clinical presentation, and response to existing therapies has greatly advanced. Indeed, diagnostic assessment and treatment algorithms for COPD have become more personalized. In addition to the pulmonary abnormalities and inhaler therapies, extra-pulmonary features and comorbidities have been studied and are considered essential components of comprehensive disease management, including lifestyle interventions. Despite these advances, predicting and/or modifying the course of the disease remains currently impossible, and selection of patients with a beneficial response to specific interventions is unsatisfactory. Consequently, non-response to pharmacologic and non-pharmacologic treatments is common, and many patients have refractory symptoms. Thus, there is an ongoing urgency for a more targeted and holistic management of the disease, incorporating the basic principles of P4 medicine (predictive, preventive, personalized, and participatory). This review describes the current status and unmet needs regarding personalized medicine for patients with COPD. Also, it proposes a systems medicine approach, integrating genetic, environmental, (micro)biological, and clinical factors in experimental and computational models in order to decipher the multilevel complexity of COPD. Ultimately, the acquired insights will enable the development of clinical decision support systems and advance personalized medicine for patients with COPD.
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Affiliation(s)
- Frits ME Franssen
- Department of Research and Education, CIRO, Horn, The Netherlands
- Department of Respiratory Medicine, Maastricht University Medical Centre, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands
| | - Peter Alter
- Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps University of Marburg (UMR), Member of the German Center for Lung Research (DZL), Marburg, Germany
| | - Nadav Bar
- Department of Chemical Engineering, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Birke J Benedikter
- Institute for Lung Research, Universities of Giessen and Marburg Lung Centre, Philipps-University Marburg, Member of the German Center for Lung Research (DZL), Marburg, Germany
- Department of Medical Microbiology, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
| | | | | | - Michael Maxheim
- Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps University of Marburg (UMR), Member of the German Center for Lung Research (DZL), Marburg, Germany
| | - Fabienne K Roessler
- Department of Chemical Engineering, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Martijn A Spruit
- Department of Research and Education, CIRO, Horn, The Netherlands
- Department of Respiratory Medicine, Maastricht University Medical Centre, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands
- REVAL - Rehabilitation Research Center, BIOMED - Biomedical Research Institute, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
| | - Claus F Vogelmeier
- Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps University of Marburg (UMR), Member of the German Center for Lung Research (DZL), Marburg, Germany
| | - Emiel FM Wouters
- Department of Research and Education, CIRO, Horn, The Netherlands
- Department of Respiratory Medicine, Maastricht University Medical Centre, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands
| | - Bernd Schmeck
- Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps University of Marburg (UMR), Member of the German Center for Lung Research (DZL), Marburg, Germany
- Institute for Lung Research, Universities of Giessen and Marburg Lung Centre, Philipps-University Marburg, Member of the German Center for Lung Research (DZL), Marburg, Germany
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18
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Maestri R, Bruschi C, Fracchia C, Pinna GD, Fanfulla F, Ambrosino N. Physiological and clinical characteristics of patients with COPD admitted to an inpatient pulmonary rehabilitation program: A real-life study. Pulmonology 2019; 25:71-78. [DOI: 10.1016/j.pulmoe.2018.07.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 05/24/2018] [Accepted: 07/01/2018] [Indexed: 11/16/2022] Open
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19
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Identification of Phenotypes in People with COPD: Influence of Physical Activity, Sedentary Behaviour, Body Composition and Skeletal Muscle Strength. Lung 2018; 197:37-45. [DOI: 10.1007/s00408-018-0177-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 11/07/2018] [Indexed: 12/13/2022]
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20
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Schreiber A, Cemmi F, Ambrosino N, Ceriana P, Lastoria C, Carlucci A. Prevalence and Predictors of Obstructive Sleep Apnea in Patients with Chronic Obstructive Pulmonary Disease Undergoing Inpatient Pulmonary Rehabilitation. COPD 2018; 15:265-270. [PMID: 30239226 DOI: 10.1080/15412555.2018.1500533] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The aim of our study was to evaluate the prevalence and predictors of obstructive sleep apnea (OSA) in patients with chronic obstructive pulmonary disease (COPD) undergoing inpatient pulmonary rehabilitation programs (PRPs). A retrospective data review of consecutive stable patients with a known diagnosis of COPD, admitted for PRP between January 2007 and December 2013. Full overnight polysomnography (PSG) and Epworth Sleepiness Scale (ESS) were assessed in all patients. Out of 422 evaluated patients, 190 (45%) showed an Apnea Hypopnea Index (AHI) ≥ 15 events/hour and underwent OSA treatment. Patients with OSA were significantly younger and had a less severe airway obstruction as compared to patients without OSA. There were no significant differences in cardiac comorbidities nor in arterial blood gases. As expected, patients with OSA showed significantly more severe diurnal symptoms, as assessed by the ESS and higher body mass index (BMI). However, only 69 out of 190 patients with OSA (36.3%) showed an ESS >10, whereas 25% of them had BMI ≤25 and 41% of them had a BMI <30. In all, 68% of patients with OSA were discharged with continuous positive airway pressure (CPAP), 15% with Bilevel ventilation, and 17% without any ventilatory treatment. In conclusion, in the population studied, the combination of OSA and COPD was frequent. BMI and ESS values commonly considered cutoff values for the prediction of OSA in the general population may not be accurate in a subgroup of patients with COPD.
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Affiliation(s)
- Annia Schreiber
- a Respiratory Intensive Care Unit and Pulmonary Rehabilitation Unit , Istituti Clinici Scientifici Maugeri IRCCS, Istituto Scientifico di Pavia , Pavia , Italy
| | - Francesca Cemmi
- b Unità Operativa di Pneumologia, Ospedale Pederzoli , Peschiera del Garda , Verona , Italy
| | - Nicolino Ambrosino
- c Istituti Clinici Scientifici Maugeri IRCCS, Istituto Scientifico di Montescano , Montescano , Pavia , Italy
| | - Piero Ceriana
- a Respiratory Intensive Care Unit and Pulmonary Rehabilitation Unit , Istituti Clinici Scientifici Maugeri IRCCS, Istituto Scientifico di Pavia , Pavia , Italy
| | - Cinzia Lastoria
- a Respiratory Intensive Care Unit and Pulmonary Rehabilitation Unit , Istituti Clinici Scientifici Maugeri IRCCS, Istituto Scientifico di Pavia , Pavia , Italy
| | - Annalisa Carlucci
- a Respiratory Intensive Care Unit and Pulmonary Rehabilitation Unit , Istituti Clinici Scientifici Maugeri IRCCS, Istituto Scientifico di Pavia , Pavia , Italy
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