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A Machine Learning Approach to Predict the Rehabilitation Outcome in Convalescent COVID-19 Patients. J Pers Med 2022; 12:jpm12030328. [PMID: 35330328 PMCID: PMC8953386 DOI: 10.3390/jpm12030328] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 02/18/2022] [Accepted: 02/18/2022] [Indexed: 11/18/2022] Open
Abstract
Background: After the acute disease, convalescent coronavirus disease 2019 (COVID-19) patients may experience several persistent manifestations that require multidisciplinary pulmonary rehabilitation (PR). By using a machine learning (ML) approach, we aimed to evaluate the clinical characteristics predicting the effectiveness of PR, expressed by an improved performance at the 6-min walking test (6MWT). Methods: Convalescent COVID-19 patients referring to a Pulmonary Rehabilitation Unit were consecutively screened. The 6MWT performance was partitioned into three classes, corresponding to different degrees of improvement (low, medium, and high) following PR. A multiclass supervised classification learning was performed with random forest (RF), adaptive boosting (ADA-B), and gradient boosting (GB), as well as tree-based and k-nearest neighbors (KNN) as instance-based algorithms. Results: To train and validate our model, we included 189 convalescent COVID-19 patients (74.1% males, mean age 59.7 years). RF obtained the best results in terms of accuracy (83.7%), sensitivity (84.0%), and area under the ROC curve (94.5%), while ADA-B reached the highest specificity (92.7%). Conclusions: Our model enables a good performance in predicting the rehabilitation outcome in convalescent COVID-19 patients.
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Sundh J, Tanash H, Arian R, Neves-Guimaraes A, Broberg K, Lindved G, Kern T, Zych K, Nielsen HB, Halling A, Ohlsson B, Jönsson D. Advanced Dental Cleaning is Associated with Reduced Risk of COPD Exacerbations - A Randomized Controlled Trial. Int J Chron Obstruct Pulmon Dis 2021; 16:3203-3215. [PMID: 34858021 PMCID: PMC8629912 DOI: 10.2147/copd.s327036] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 09/13/2021] [Indexed: 01/02/2023] Open
Abstract
Purpose Infections from the oral microbiome may lead to exacerbations of chronic obstructive pulmonary disease (COPD). We investigated whether advanced dental cleaning could reduce exacerbation frequency. Secondary outcomes were disease-specific health status, lung function, and whether the bacterial load and composition of plaque microbiome at baseline were associated with a difference in outcomes. Patients and Methods One-hundred-one primary and secondary care patients with COPD were randomized to intervention with advanced dental cleaning or to dental examination only, repeated after six months. At baseline and at 12 months, data of exacerbations, lung function, COPD Assessment Test (CAT) score, and periodontal status were collected from questionnaires, record review, and periodontal examination. Student’s t-test and Mann–Whitney-U (MWU) test compared changes in outcomes. The primary outcome variable was also assessed using multivariable linear regression with adjustment for potential confounders. Microbiome analyses of plaque samples taken at baseline were performed using Wilcoxon signed ranks tests for calculation of alpha diversity, per mutational multivariate analysis of variance for beta diversity, and receiver operating characteristic curves for prediction of outcomes based on machine learning models. Results In the MWU test, the annual exacerbation frequency was significantly reduced in patients previously experiencing frequent exacerbations (p = 0.020) and in those with repeated advanced dental cleaning (p = 0.039) compared with the non-treated control group, but not in the total population including both patients with a single and repeated visits (p = 0.207). The result was confirmed in multivariable linear regression, where the risk of new exacerbations was significantly lower in patients both in the intention to treat analysis (regression coefficient 0.36 (95% CI 0.25–0.52), p < 0.0001) and in the population with repeated dental cleaning (0.16 (0.10–0.27), p < 0.0001). The composition of microbiome at baseline was moderately predictive of an increased risk of worsened health status at 12 months (AUC = 0.723). Conclusion Advanced dental cleaning is associated with a reduced frequency of COPD exacerbations. Regular periodontal examination and dental cleaning may be of clinical importance to prevent COPD exacerbations.
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Affiliation(s)
- Josefin Sundh
- Department of Respiratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Hanan Tanash
- Department of Respiratory Medicine, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Rahi Arian
- Department of Periodontology and Implantology, Public Dental Service, Örebro, Sweden
| | | | | | | | - Timo Kern
- Clinical Microbiomics, Copenhagen, Denmark
| | | | | | - Anders Halling
- Center for Primary Health Care Research, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Bodil Ohlsson
- Department of Internal Medicine, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Daniel Jönsson
- Public Dental Service of Skåne, Lund, Sweden.,Hypertension and Cardiovascular Disease, Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden.,Faculty of Odontology, Malmö University, Malmö, Sweden
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Chushkin MI, Popova LA, Mandrykin SY, Kaprina NL. [Use of exercise tests and physical training in pulmonary rehabilitation]. VOPROSY KURORTOLOGII, FIZIOTERAPII, I LECHEBNOĬ FIZICHESKOĬ KULTURY 2021; 98:64-70. [PMID: 33605132 DOI: 10.17116/kurort20219801164] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The use of pulmonary rehabilitation reduces symptoms, improves life quality and exercise tolerance. The article presents indications for physical training, their characteristics and assessment of their effectiveness in the rehabilitation of patients with chronic lung diseases. It was noted that the execution of exercise tests (a monitoring with a progressive load increase on a bicycle ergometer or treadmill, a test with a constant load, a 6-minute walk test, a shuttle test with an increasing load and a shuttle test with a constant load) is appropriate for physical training before rehabilitation course. Physical endurance training programs are an essential component of pulmonary rehabilitation. Strength training, flexibility training and upper limb exercises give a good additional effect. To assess the effectiveness after rehabilitation programs, it is advisable to perform tests with physical activity. To assess the effectiveness of rehabilitation, the constant load exercise test and the constant load shuttle test are more sensitive to changes than the increasing load tests.
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Affiliation(s)
- M I Chushkin
- Central Research Institute of Tuberculosis, Moscow, Russia
| | - L A Popova
- Central Research Institute of Tuberculosis, Moscow, Russia
| | - S Yu Mandrykin
- Multidisciplinary Medical Center of the Bank of Russia, Moscow, Russia
| | - N L Kaprina
- Central Research Institute of Tuberculosis, Moscow, Russia
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Abstract
Pulmonary rehabilitation (PR) is an essential intervention in the management of patients with chronic obstructive pulmonary disease. To guide health care professionals in the implementation and evaluation of a PR program, this article discusses the current key concepts regarding exercise testing, prescription, and training, as well as self-management intervention as essential parts of PR and post-rehabilitation maintenance. Moreover, new approaches (alternative forms of organization and delivery, tele-rehabilitation, exercise adjuncts) and unique and challenging situations (patients experiencing acute exacerbations, advanced disease) are thoroughly reviewed. Finally, validated point-of-care resources and online tools are provided.
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Affiliation(s)
- Jean Bourbeau
- Respiratory Epidemiology and Clinical Research Unit, Montréal Chest Institute, McGill University Health Centre, 5252 De Maisonneuve, Room 3D.62, Montréal, Québec H4A 3S5, Canada.
| | - Sebastien Gagnon
- Respiratory Epidemiology and Clinical Research Unit, Montréal Chest Institute, McGill University Health Centre, 5252 De Maisonneuve, Room 3D.62, Montréal, Québec H4A 3S5, Canada
| | - Bryan Ross
- Respiratory Epidemiology and Clinical Research Unit, Montréal Chest Institute, McGill University Health Centre, 5252 De Maisonneuve, Room 3D.62, Montréal, Québec H4A 3S5, Canada
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Sade I, ŞİRİNTAŞ E, İNANIR M, ÇEKMECE Ç, BAŞYİĞİT İ. Kronik Obstrüktif Akciğer Hastalarında Solunum Egzersizlerinin Etkinliği. KOCAELI ÜNIVERSITESI SAĞLIK BILIMLERI DERGISI 2020. [DOI: 10.30934/kusbed.619753] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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Machado A, Quadflieg K, Oliveira A, Keytsman C, Marques A, Hansen D, Burtin C. Exercise Training in Patients with Chronic Respiratory Diseases: Are Cardiovascular Comorbidities and Outcomes Taken into Account?-A Systematic Review. J Clin Med 2019; 8:E1458. [PMID: 31540240 PMCID: PMC6780679 DOI: 10.3390/jcm8091458] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 09/06/2019] [Accepted: 09/10/2019] [Indexed: 12/16/2022] Open
Abstract
Patients with chronic obstructive pulmonary disease (COPD), asthma and interstitial lung diseases (ILD) frequently suffer from cardiovascular comorbidities (CVC). Exercise training is a cornerstone intervention for the management of these conditions, however recommendations on tailoring programmes to patients suffering from respiratory diseases and CVC are scarce. This systematic review aimed to identify the eligibility criteria used to select patients with COPD, asthma or ILD and CVC to exercise programmes; assess the impact of exercise on cardiovascular outcomes; and identify how exercise programmes were tailored to CVC. PubMed, Scopus, Web of Science and Cochrane were searched. Three reviewers extracted the data and two reviewers independently assessed the quality of studies with the Quality Assessment Tool for Quantitative Studies. MetaXL 5.3 was used to calculate the individual and pooled effect sizes (ES). Most studies (58.9%) excluded patients with both stable and unstable CVC. In total, 26/42 studies reported cardiovascular outcomes. Resting heart rate was the most reported outcome measure (n = 13) and a small statistically significant effect (ES = -0.23) of exercise training on resting heart rate of patients with COPD was found. No specific adjustments to exercise prescription were described. Few studies have included patients with CVC. There was a lack of tailoring of exercise programmes and limited effects were found. Future studies should explore the effect of tailored exercise programmes on relevant outcome measures in respiratory patients with CVC.
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Affiliation(s)
- Ana Machado
- REVAL-Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, 3590 Diepenbeek, Belgium
- Respiratory Research and Rehabilitation Laboratory (Lab3R), School of Health Sciences (ESSUA), University of Aveiro, 3810 Aveiro, Portugal
| | - Kirsten Quadflieg
- REVAL-Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, 3590 Diepenbeek, Belgium
| | - Ana Oliveira
- Respiratory Research and Rehabilitation Laboratory (Lab3R), School of Health Sciences (ESSUA), University of Aveiro, 3810 Aveiro, Portugal
- Respiratory Medicine, West Park Healthcare Centre, Toronto, ON M6M 2J5, Canada
- School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, Hamilton, ON L8S 4K1, Canada
| | - Charly Keytsman
- REVAL-Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, 3590 Diepenbeek, Belgium
- BIOMED-Biomedical Research Institute, Hasselt University, 3590 Diepenbeek, Belgium
| | - Alda Marques
- Respiratory Research and Rehabilitation Laboratory (Lab3R), School of Health Sciences (ESSUA), University of Aveiro, 3810 Aveiro, Portugal
- Institute of Biomedicine (iBiMED), University of Aveiro, 3810 Aveiro, Portugal
| | - Dominique Hansen
- REVAL-Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, 3590 Diepenbeek, Belgium
- BIOMED-Biomedical Research Institute, Hasselt University, 3590 Diepenbeek, Belgium
- Jessa hospital, Heart Centre Hasselt, 3500 Hasselt, Belgium
| | - Chris Burtin
- REVAL-Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, 3590 Diepenbeek, Belgium.
- BIOMED-Biomedical Research Institute, Hasselt University, 3590 Diepenbeek, Belgium.
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Tarigan AP, Ananda FR, Pandia P, Sinaga BY, Maryaningsih M, Anggriani A. The Impact of Upper Limb Training with Breathing Maneuver in Lung Function, Functional Capacity, Dyspnea Scale, and Quality of Life in Patient with Stable Chronic Obstructive of Lung Disease. Open Access Maced J Med Sci 2019; 7:567-572. [PMID: 30894913 PMCID: PMC6420952 DOI: 10.3889/oamjms.2019.113] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 01/25/2019] [Accepted: 01/26/2019] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND: Exercise tolerance is one of the main impacts of COPD. COPD patients often experience dyspnea and fatigue after doing daily activities using their limb parts, even in simple thing such as lifting or grooming. Nowadays, many pulmonologists concerned in pulmonary rehabilitation to modify some limb training with breathing manoeuvre to get positive impact in stable COPD patient. AIM: The purpose of this study is to examine the impact of this modified upper limb training in lung function, functional capacity, dyspnea scale, and quality of life in patients with stable COPD. METHOD: This was a quasi-experimental study held in 2017 on 22 stable COPD patients (based on GOLD 2018 criteria). Patients were given modified upper limb training with breathing manoeuvre that leads and monitored by a physiotherapist and physician in 10-20 minutes twice a week for 8 weeks. Before and after completed all sessions of training, we measured pulmonary functions test include FEV1 and FVC, functional capacity by 6 MWT, dyspnea scale by mMRC, and quality of life by CAT assessment. Statistical analysis was performed by Wilcoxon and paired t-test. RESULTS: There was an improvement of lung function, both FEV1 (40.7 ± 13.8 to 47.3 ± 14.2; p-value 0.001) and FVC (50.7 ± 14.1 to 54.1 ± 14.7; p-value: 0.207) after training. There was a significant change of functional capacity in 6 MWT mean (277.3 ± 80.8 to 319.1 ± 78.3; p-value: 0.001). There was an improved quality of life after training, measured by decreasing in CAT score (23.9 ± 5.5 to 18.3 ± 5.2; p-value: 0.000). There was no significant change in the mMRC scale (p-value: 0.429) CONCLUSION: There was an improvement of lung function, functional capacity, and quality of life in stable COPD after upper limb training with breathing manoeuvre in stable COPD patients.
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Affiliation(s)
- Amira Permatasari Tarigan
- Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia
| | | | - Pandiaman Pandia
- Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia
| | - Bintang Ym Sinaga
- Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia
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Volpato E, Banfi P, Nicolini A, Pagnini F. A quick relaxation exercise for people with chronic obstructive pulmonary disease: explorative randomized controlled trial. Multidiscip Respir Med 2018; 13:13. [PMID: 29744054 PMCID: PMC5932751 DOI: 10.1186/s40248-018-0124-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 04/04/2018] [Indexed: 11/10/2022] Open
Abstract
Background People with Chronic Obstructive Pulmonary Disease (COPD) suffer from dyspnoea, which may be increased by anxiety. Previous studies suggest that relaxation techniques may have positive effects in pulmonary rehabilitation. The main aim of this study is to explore the clinical impact of a quick, one-session, relaxation training for people with COPD. Methods In this perspective, 38 participants with COPD were recruited and randomly assigned to listen to a relaxing audio or to watch a neutral stimulus, during their routine exams. Participants were assessed for psychological and physiological variables, analysed through non-parametric tests. Results Those who joined the relaxation training showed more positive outcomes about respiratory and cardiac assessments, as well as for state anxiety and positive affections, in comparison with the baseline and the control group. Conclusions Study results suggest that relaxation has a potential to produce improvements in respiratory and cardiac functions, together with a positive emotional effect and a reduction of anxiety. Trial registration ClinicalTrials.gov ID: NCT02698904. Record Registration: February 2016.
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Affiliation(s)
- Eleonora Volpato
- 1Department of Psychology, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 1, Milan, Italy.,IRCCS Santa Maria Nascente, Fondazione Don Carlo Gnocchi, Milan, Italy
| | - Paolo Banfi
- IRCCS Santa Maria Nascente, Fondazione Don Carlo Gnocchi, Milan, Italy
| | - Antonello Nicolini
- Unità di Riabilitazione Respiratoria, ASL 4 Chiavarese, Ospedale di Sestri Levante, Sestri Levante, Italy
| | - Francesco Pagnini
- 1Department of Psychology, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 1, Milan, Italy.,4Department of Psychology, Harvard University, Cambridge, MA USA
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Berry MJ, Sheilds KL, Adair NE. Comparison of Effects of Endurance and Strength Training Programs in Patients with COPD. COPD 2018; 15:192-199. [PMID: 29658804 DOI: 10.1080/15412555.2018.1446926] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Comparisons between endurance and strength training in chronic obstructive pulmonary disease (COPD) patients have produced equivocal findings when examining physical function and health-related quality of life (HRQL). One reason for these differences may be due to individual patient responses to the different training modalities. PURPOSE To compare changes in physical function and HRQL in a group of COPD patients completing both an endurance and a strength training program. METHODS Eleven mildly diseased patients completed a three month endurance training program and, approximately 5 years later, completed a three month strength training program. Changes in 6 minute walk distance (6 MW), time to rise from a chair five times (CRT), and the total score and subscores from the SF-36 and Chronic Respiratory Disease Questionnaire (CRQ) were examined. RESULTS The forced expiratory volume as a percent of predicted remained relatively constant over the 5 years (61.1 ± 5.9 vs. 60.0 ± 10.3). Endurance and strength training increased 6 MW by 48.2 ± 11.2 (p = 0.008) and 39.8 ± 9.8 (p = 0.001) meters, respectively. Endurance and strength training decreased CRT by 4.8 ± 0.7 (p = 0.001) and 1.3 ± 1.2 (p = 0.056) seconds, respectively. Endurance training resulted in greater improvements in HRQL as compared to strength training. CONCLUSION These results show that walk distance improves as a result of participating in either an endurance or a strength training program. However, an endurance training program leads to greater improvements in both general and disease specific measures of HRQL.
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Affiliation(s)
- Michael J Berry
- a Health and Exercise Science Department , Wake Forest University , Winston-Salem , North Carolina , USA
| | - Katherine L Sheilds
- a Health and Exercise Science Department , Wake Forest University , Winston-Salem , North Carolina , USA
| | - Norman E Adair
- b Department of Medicine , Wake Forest University , Winston-Salem , North Carolina , USA
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Pulmonary Rehabilitation Improves Outcomes in Chronic Obstructive Pulmonary Disease Independent of Disease Burden. Ann Am Thorac Soc 2017; 14:26-32. [PMID: 27739881 DOI: 10.1513/annalsats.201607-551oc] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
RATIONALE Current practice guidelines recommend pulmonary rehabilitation as an adjunct to standard pharmacologic therapy for individuals with moderate to severe chronic obstructive pulmonary disease (COPD). Whether pulmonary rehabilitation benefits all subjects with COPD independent of baseline disease burden is not known. OBJECTIVES To test whether pulmonary rehabilitation benefits patients with COPD independent of baseline exercise capacity, dyspnea, and lung function. METHODS Data from a prospectively maintained database of participants with COPD enrolled in pulmonary rehabilitation at the University of Alabama at Birmingham from 1996 to 2013 were retrospectively analyzed. Subjects were divided into four quartiles based on their baseline level of dyspnea as assessed by the San Diego Shortness of Breath Questionnaire at the initial visit. Similar quartiles were assessed for FEV1 percent predicted as well as the 6-minute-walk distance (6MWD). The primary outcome was the change in quality of life as measured by the 36-item Short Form Health Survey (SF-36). Secondary outcomes were change in dyspnea, 6MWD, and depression scores assessed using the Beck Depression Inventory-II. Differences between baseline and final scores were compared using paired t tests and across quartiles using analysis of variance. MEASUREMENTS AND MAIN RESULTS A total of 229 subjects were included. Their mean age was 66.5 (SD, 9) years. Ninety-one (40%) were female, and 42 (18%) were African American. The mean FEV1 percent predicted was 46.3% (20.0%). On completion of pulmonary rehabilitation, clinically significant improvements were seen in most components of SF-36: physical function, 11.5 (95% confidence interval [CI], 7.4-15.5; P < 0.001); health perception, 2.1 (95% CI, -0.7 to 4.8; P = 0.12); physical role, 16.7 (95% CI, 10.3-23.1; P < 0.001); emotional role, 14.7 (95% CI, 7.1-22.3; P < 0.001); social function, 16.4 (95% CI, 11.3-21.5; P < 0.001); mental health, 5.4 (95% CI, 2.6-8.3; P < 0.001); pain, 5 (95% CI, 1-9.1; P = 0.02); vitality, 12.4 (95% CI, 8.8-16.1; P < 0.001); and depression, 0.01 (95% CI, -0.11 to 0.07; P = 0.54). There was no difference in improvement in SF-36 across quartiles of San Diego Shortness of Breath Questionnaire, 6MWD, and FEV1 percent predicted. CONCLUSIONS Pulmonary rehabilitation results in significant improvement in quality of life, dyspnea, and functional capacity independent of baseline disease burden.
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Dimitrova A, Izov N, Maznev I, Vasileva D, Nikolova M. Physiotherapy in Patients with Chronic Obstructive Pulmonary Disease. Open Access Maced J Med Sci 2017; 5:720-723. [PMID: 29104679 PMCID: PMC5661708 DOI: 10.3889/oamjms.2017.176] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Revised: 09/07/2017] [Accepted: 09/08/2017] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Physiotherapy is an essential for the treatment of patients with chronic respiratory non-inflammatory diseases especially for chronic obstructive pulmonary disease (COPD). AIM To assess the effect of six months physiotherapy (PT) program on functional status in patients with COPD. MATERIAL AND METHODS The patients were divided into two groups according to the severity of the disease. Group A included 33 patients (mean age 68.6 ± 7.3; GOLD II - III stages). Group B included 32 patients (mean age 71.7 ± 6.9; GOLD I -II). They were referred to supervised PT program performed three times weekly for a half a year. All the patients were on standard medical care. At entry and after PT, six minutes walking test (6 MWT), Borg scale and modified Medical Research Council (mMRC) scale were assessed. RESULTS Significant changes in 6 MWT (p < 0.001) and mMRC scale (p < 0.001) were found after applied physical therapy program in patients of group A. Exertional dyspnoea decreased significantly in patients with group A (p < 0.001). Positive changes were found in physical tolerance in the patients of group B (p < 0.001). CONCLUSIONS The present study revealed the positive effect of six months physiotherapy in physical tolerance and dyspnoea in patients with COPD at different stages of the disease.
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Affiliation(s)
- Antoaneta Dimitrova
- Department of Physiotherapy and Rehabilitation, National Sports Academy “V. Levski”, Sofia, Bulgaria
| | - Nikolay Izov
- Department of Aquatic Sports, National Sports Academy “V. Levski”, Sofia, Bulgaria
| | - Ivan Maznev
- Department of Sports Medicine, National Sports Academy “V. Levski”, Sofia, Bulgaria
| | - Dance Vasileva
- Faculty of Medical Sciences, Goce Delchev University, Shtip, Republic of Macedonia
| | - Milena Nikolova
- Department of Physiotherapy and Rehabilitation, National Sports Academy “V. Levski”, Sofia, Bulgaria
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Sundh J, Lindgren H, Hasselgren M, Montgomery S, Janson C, Ställberg B, Lisspers K. Pulmonary rehabilitation in COPD - available resources and utilization in Swedish primary and secondary care. Int J Chron Obstruct Pulmon Dis 2017; 12:1695-1704. [PMID: 28652722 PMCID: PMC5473485 DOI: 10.2147/copd.s135111] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Pulmonary rehabilitation is effective in all stages of COPD. The availability and utilization of pulmonary rehabilitation resources, and the characteristics of COPD patients receiving rehabilitation, were investigated in primary and secondary care in central Sweden. MATERIALS AND METHODS Data on available pulmonary rehabilitation resources were collected using questionnaires, to 14 hospitals and 54 primary health care centers, and information on utilization of different rehabilitation professionals was obtained from questionnaires completed by 1,329 COPD patients from the same centers. Multivariable logistic regression examined associations with having received rehabilitation in the previous year. RESULTS In primary care, nurse-based asthma/COPD clinics were common (87%), with additional separate access to other rehabilitation professionals. In secondary care, rehabilitation was more often offered as part of a multidisciplinary teamwork (71%). In total, 36% of the patients met an asthma/COPD nurse in the previous year. Utilization was lower in primary than in secondary care for physiotherapists (7% vs 16%), occupational therapists (3% vs 10%), nutritionists (5% vs 13%), and counselors (1% vs 4%). A higher COPD Assessment Test score and frequent exacerbations were associated with higher utilization of all rehabilitation professionals. CONCLUSION Pulmonary rehabilitation resources are available but underutilized, and receiving rehabilitation is more common in severe COPD. Treatment recommendations need to be better implemented, especially in mild and moderate COPD.
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Affiliation(s)
- Josefin Sundh
- Department of Respiratory Medicine, School of Medical Sciences
| | | | | | - Scott Montgomery
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro
- Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Epidemiology and Public Health, University College, London, UK
| | - Christer Janson
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research
| | - Björn Ställberg
- Department of Public Health and Caring Science, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden
| | - Karin Lisspers
- Department of Public Health and Caring Science, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden
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Elbehairy AF, Parraga G, Webb KA, Neder JA, O’Donnell DE. Mild chronic obstructive pulmonary disease: why spirometry is not sufficient! Expert Rev Respir Med 2017; 11:549-563. [DOI: 10.1080/17476348.2017.1334553] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Amany F. Elbehairy
- Department of Medicine, Queen’s University and Kingston General Hospital, Kingston, ON, Canada
- Department of Chest Diseases, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Grace Parraga
- Department of Medical Biophysics, Robarts Research Institute, Western University, London, Canada
| | - Katherine A. Webb
- Department of Medicine, Queen’s University and Kingston General Hospital, Kingston, ON, Canada
| | - J Alberto Neder
- Department of Medicine, Queen’s University and Kingston General Hospital, Kingston, ON, Canada
| | - Denis E. O’Donnell
- Department of Medicine, Queen’s University and Kingston General Hospital, Kingston, ON, Canada
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Albuquerque ALPD, Quaranta M, Chakrabarti B, Aliverti A, Calverley PM. Exercise performance and differences in physiological response to pulmonary rehabilitation in severe chronic obstructive pulmonary disease with hyperinflation. J Bras Pneumol 2017; 42:121-9. [PMID: 27167433 PMCID: PMC4853065 DOI: 10.1590/s1806-37562015000000078] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 11/04/2015] [Indexed: 12/04/2022] Open
Abstract
Objective: Pulmonary rehabilitation (PR) improves exercise capacity in most but not all COPD patients. The factors associated with treatment success and the role of chest wall mechanics remain unclear. We investigated the impact of PR on exercise performance in COPD with severe hyperinflation. Methods: We evaluated 22 COPD patients (age, 66 ± 7 years; FEV1 = 37.1 ± 11.8% of predicted) who underwent eight weeks of aerobic exercise and strength training. Before and after PR, each patient also performed a six-minute walk test and an incremental cycle ergometer test. During the latter, we measured chest wall volumes (total and compartmental, by optoelectronic plethysmography) and determined maximal workloads. Results: We observed significant differences between the pre- and post-PR means for six-minute walk distance (305 ± 78 vs. 330 ± 96 m, p < 0.001) and maximal workload (33 ± 21 vs. 39 ± 20 W; p = 0.02). At equivalent workload settings, PR led to lower oxygen consumption, carbon dioxide production (VCO2), and minute ventilation. The inspiratory (operating) rib cage volume decreased significantly after PR. There were 6 patients in whom PR did not increase the maximal workload. After PR, those patients showed no significant decrease in VCO2 during exercise, had higher end-expiratory chest wall volumes with a more rapid shallow breathing pattern, and continued to experience symptomatic leg fatigue. Conclusions: In severe COPD, PR appears to improve oxygen consumption and reduce VCO2, with a commensurate decrease in respiratory drive, changes reflected in the operating chest wall volumes. Patients with severe post-exercise hyperinflation and leg fatigue might be unable to improve their maximal performance despite completing a PR program.
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15
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Liu SF, Kuo HC, Liu GH, Ho SC, Chang HC, Huang HT, Chen YM, Huang KT, Chen KY, Fang WF, Lin MC. Inhaled corticosteroids can reduce osteoporosis in female patients with COPD. Int J Chron Obstruct Pulmon Dis 2016; 11:1607-14. [PMID: 27478374 PMCID: PMC4951067 DOI: 10.2147/copd.s106054] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background Whether the use of inhaled corticosteroids (ICSs) in patients with COPD can protect from osteoporosis remains undetermined. The aim of this study is to assess the incidence of osteoporosis in patients with COPD with ICS use and without. Patients and methods This is a retrospective cohort and population-based study in which we extracted newly diagnosed female patients with COPD between 1997 and 2009 from Taiwan’s National Health Insurance (TNHI) database between 1996 and 2011 (International Classification of Diseases, Ninth Revision – Clinical Modification [ICD-9-CM] 491, 492, 496). The patients with COPD were defined by the presence of two or more diagnostic codes for COPD within 12 months on either inpatient or outpatient service claims submitted to TNHI. Patients were excluded if they were younger than 40 years or if osteoporosis had been diagnosed prior to the diagnosis of COPD and cases of asthma (ICD-9 CM code 493.X) before the index date. These enrolled patients were followed up till 2011, and the incidence of osteoporosis was determined. The Cox proportional hazards regression model was also used to estimate hazard ratios (HRs) for incidences of lung cancer. Results Totally, 10,723 patients with COPD, including ICS users (n=812) and nonusers (n=9,911), were enrolled. The incidence rate of osteoporosis per 100,000 person years is 4,395 in nonusers and 2,709 in ICS users (HR: 0.73, 95% confidence interval [CI]: 0.63–084). The higher ICS dose is associated with lower risk of osteoporosis (0 mg to ≤20 mg, HR: 0.84, 95% CI: 0.69–1.04; >20 mg to ≤60 mg, HR: 0.78, 95% CI: 0.59–1.04; and >60 mg, HR: 0.72, 95% CI: 0.55–0.96; P for trend =0.0023) after adjusting for age, income, and medications. The cumulative osteoporosis probability significantly decreased among the ICS users when compared with the nonusers (P<0.001). Conclusion Female patients with COPD using ICS have a dose–response protective effect for osteoporosis.
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Affiliation(s)
- Shih-Feng Liu
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine; Department of Respiratory Therapy, Kaohsiung Chang Gung Memorial Hospital; Chang Gung University College of Medicine
| | - Ho-Chang Kuo
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine; Department of Respiratory Therapy, Kaohsiung Chang Gung Memorial Hospital; Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital
| | | | - Shu-Chen Ho
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital
| | - Huang-Chih Chang
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine; Chang Gung University College of Medicine
| | - Hung-Tu Huang
- Department of Anatomy, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, Republic of China
| | - Yu-Mu Chen
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine
| | - Kuo-Tung Huang
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine; Chang Gung University College of Medicine
| | - Kuan-Yi Chen
- Department of Respiratory Therapy, Kaohsiung Chang Gung Memorial Hospital
| | - Wen-Feng Fang
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine; Department of Respiratory Therapy, Kaohsiung Chang Gung Memorial Hospital; Chang Gung University College of Medicine
| | - Meng-Chih Lin
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine; Department of Respiratory Therapy, Kaohsiung Chang Gung Memorial Hospital; Chang Gung University College of Medicine
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16
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O'Reilly S. Chronic Obstructive Pulmonary Disease. Am J Lifestyle Med 2016; 11:296-302. [PMID: 30202345 DOI: 10.1177/1559827616656593] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Revised: 05/31/2016] [Accepted: 06/02/2016] [Indexed: 11/16/2022] Open
Abstract
COPD is a common, preventable, and treatable disease characterized by persistent airflow obstruction associated with enhanced inflammation in the airways and the lung in response to noxious particles or gases. Clinical history and pulmonary function testing are necessary for accurate diagnosis. While exposure to tobacco smoke remains a common cause, other etiologies and underlying genetic predisposition play significant roles. Treatment options are numerous and should be individualized based on symptoms and exacerbation frequency.
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Affiliation(s)
- Sean O'Reilly
- Pulmonary, Critical Care, and Sleep Medicine, Sentara Martha Jefferson Medical Group, Sentara Martha Jefferson Hospital, Charlottesville, Virginia
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17
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Han MK, Martinez CH, Au DH, Bourbeau J, Boyd CM, Branson R, Criner GJ, Kalhan R, Kallstrom TJ, King A, Krishnan JA, Lareau SC, Lee TA, Lindell K, Mannino DM, Martinez FJ, Meldrum C, Press VG, Thomashow B, Tycon L, Sullivan JL, Walsh J, Wilson KC, Wright J, Yawn B, Zueger PM, Bhatt SP, Dransfield MT. Meeting the challenge of COPD care delivery in the USA: a multiprovider perspective. THE LANCET RESPIRATORY MEDICINE 2016; 4:473-526. [PMID: 27185520 DOI: 10.1016/s2213-2600(16)00094-1] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 03/01/2016] [Accepted: 03/01/2016] [Indexed: 12/21/2022]
Abstract
The burden of chronic obstructive pulmonary disease (COPD) in the USA continues to grow. Although progress has been made in the the development of diagnostics, therapeutics, and care guidelines, whether patients' quality of life is improved will ultimately depend on the actual implementation of care and an individual patient's access to that care. In this Commission, we summarise expert opinion from key stakeholders-patients, caregivers, and medical professionals, as well as representatives from health systems, insurance companies, and industry-to understand barriers to care delivery and propose potential solutions. Health care in the USA is delivered through a patchwork of provider networks, with a wide variation in access to care depending on a patient's insurance, geographical location, and socioeconomic status. Furthermore, Medicare's complicated coverage and reimbursement structure pose unique challenges for patients with chronic respiratory disease who might need access to several types of services. Throughout this Commission, recurring themes include poor guideline implementation among health-care providers and poor patient access to key treatments such as affordable maintenance drugs and pulmonary rehabilitation. Although much attention has recently been focused on the reduction of hospital readmissions for COPD exacerbations, health systems in the USA struggle to meet these goals, and methods to reduce readmissions have not been proven. There are no easy solutions, but engaging patients and innovative thinkers in the development of solutions is crucial. Financial incentives might be important in raising engagement of providers and health systems. Lowering co-pays for maintenance drugs could result in improved adherence and, ultimately, decreased overall health-care spending. Given the substantial geographical diversity, health systems will need to find their own solutions to improve care coordination and integration, until better data for interventions that are universally effective become available.
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Affiliation(s)
- MeiLan K Han
- Division of Pulmonary and Critical Care, University of Michigan Health System, Ann Arbor, MI, USA.
| | - Carlos H Martinez
- Division of Pulmonary and Critical Care, University of Michigan Health System, Ann Arbor, MI, USA
| | - David H Au
- Center of Innovation for Veteran-Centered and Value-Driven Care, and VA Puget Sound Health Care System, US Department of Veteran Affairs, Seattle, WA, USA; Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle, WA, USA
| | - Jean Bourbeau
- McGill University Health Centre, McGill University, Montreal, QC, Canada
| | - Cynthia M Boyd
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Richard Branson
- Department of Surgery, University of Cincinnati, Cincinnati, OH, USA
| | - Gerard J Criner
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Ravi Kalhan
- Asthma and COPD Program, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | | | - Jerry A Krishnan
- University of Illinois Hospital & Health Sciences System, University of Illinois, Chicago, IL, USA
| | - Suzanne C Lareau
- University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
| | - Todd A Lee
- Department of Pharmacy Systems, Outcomes and Policy, University of Illinois, Chicago, IL, USA
| | | | - David M Mannino
- Department of Preventive Medicine and Environmental Health, University of Kentucky, Lexington, KY, USA
| | - Fernando J Martinez
- Department of Internal Medicine, Weill Cornell School of Medicine, New York, NY, USA
| | - Catherine Meldrum
- Division of Pulmonary and Critical Care, University of Michigan Health System, Ann Arbor, MI, USA
| | - Valerie G Press
- Section of Hospital Medicine, University of Chicago Medicine, Chicago, IL, USA
| | - Byron Thomashow
- Division of Pulmonary, Critical Care and Sleep Medicine, Columbia University Medical Center, New York, NY, USA
| | - Laura Tycon
- Palliative and Supportive Institute, Pittsburgh, PA, USA
| | | | | | - Kevin C Wilson
- Boston University School of Medicine, Boston, MA, USA; American Thoracic Society, New York, NY, USA
| | - Jean Wright
- Carolinas HealthCare System, Charlotte, NC, USA
| | - Barbara Yawn
- Family and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Patrick M Zueger
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois, Chicago, IL, USA
| | - Surya P Bhatt
- Division of Pulmonary, Allergy and Critical Care Medicine, and UAB Lung Health Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Mark T Dransfield
- Division of Pulmonary, Allergy and Critical Care Medicine, and UAB Lung Health Center, University of Alabama at Birmingham, Birmingham, AL, USA; Birmingham VA Medical Center, Birmingham, AL, USA
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18
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Han SJ, Lim JY, Suh JH. Obesity and Pulmonary Function in Polio Survivors. Ann Rehabil Med 2016; 39:888-96. [PMID: 26798602 PMCID: PMC4720764 DOI: 10.5535/arm.2015.39.6.888] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 06/25/2015] [Indexed: 11/25/2022] Open
Abstract
Objective To examine the correlation between obesity and pulmonary function in polio survivors. Methods This study was conducted based on a questionnaire survey and physical examination. The questionnaire included gender, age, paralyzed regions, physical activity levels, and accompanying diseases. The physical examination included measuring body mass index, waist circumference, muscle power, total fat amount, body fat percentage, and lean body mass. In addition, pulmonary function was tested based on forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), ratio of FEV1 to FVC, and chest circumference. Five university hospitals and a local health clinic participated in this study. Results Pearson and partial correlation coefficients that used data collected from 73 polio survivors showed that obesity had a negative correlation with pulmonary function. Conclusion This study found that pulmonary function has a negative correlation with obesity for polio survivors. Therefore, it is necessary to develop specialized exercise programs to help polio survivors reduce their weight and strengthen their respiratory muscles.
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Affiliation(s)
- Soo Jeong Han
- Department of Rehabilitation Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Jae-Young Lim
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jee Hyun Suh
- Department of Rehabilitation Medicine, Ewha Womans University School of Medicine, Seoul, Korea
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Akgün Şahin Z, Dayapoğlu N. Effect of progressive relaxation exercises on fatigue and sleep quality in patients with chronic obstructive lung disease (COPD). Complement Ther Clin Pract 2015; 21:277-81. [DOI: 10.1016/j.ctcp.2015.10.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 10/06/2015] [Accepted: 10/15/2015] [Indexed: 11/26/2022]
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20
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Vooijs M, Siemonsma PC, Heus I, Sont JK, Rövekamp TA, van Meeteren NL. Therapeutic validity and effectiveness of supervised physical exercise training on exercise capacity in patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis. Clin Rehabil 2015; 30:1037-1048. [PMID: 26451006 DOI: 10.1177/0269215515609413] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Our aim was to determine the effectiveness of supervised physical exercise training on exercise capacity in patients with chronic obstructive pulmonary disease taken into consideration indices such as therapeutic validity of interventions, methodological quality of studies, and exercise volume. DATA RESOURCES MEDLINE, Cochrane Central Register of Controlled Trials, EMBASE, CINAHL, and PEDro databases were searched from inception until 17 July 2015 for randomized controlled trials comparing the effect of supervised exercise training vs. usual care in patients with chronic obstructive pulmonary disease. The references of included studies and review articles were hand searched for additional references and key authors of included trials were crosschecked in PubMed for any missed references. REVIEW METHODS Two reviewers independently assessed therapeutic validity of exercise training and methodological quality of included studies. Overall effects were calculated using a random effects model. RESULTS A total of 13 studies involving 756 patients with chronic obstructive pulmonary disease were included. Significant differences in maximal exercise capacity (standardized mean difference 0.52, 95% CI 0.31 to 0.74) and endurance exercise capacity (standardized mean difference 0.73, 95% CI 0.50 to 0.96) in favor of physical exercise training were found. The volume of physical exercise per week, the total volume of physical exercise, or their associations did not significantly influence the effect of training. CONCLUSION Effects of supervised physical exercise was not significantly altered by therapeutic validity. A combination of aerobic exercise and strength training was found to be more effective than strength training or endurance training alone in increasing the 6-minute walking distance.
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Affiliation(s)
- Martijn Vooijs
- 1 Department of Medical Decision Making, Leiden University Medical Centre, Leiden, The Netherlands.,2 Rijnlands Rehabilitation Centre, Leiden, The Netherlands.,3 TNO Healthy Living, Leiden, The Netherlands
| | | | - Inge Heus
- 2 Rijnlands Rehabilitation Centre, Leiden, The Netherlands
| | - Jacob K Sont
- 1 Department of Medical Decision Making, Leiden University Medical Centre, Leiden, The Netherlands
| | | | - Nico Lu van Meeteren
- 4 Department of Epidemiology and CAPHRI Research School, Maastricht University Medical Center, Maastricht, The Netherlands.,5 Health~Holland, Topsector Life Sciences and Health, The Hague, The Netherlands
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21
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Narsingam S, Bozarth AL, Abdeljalil A. Updates in the management of stable chronic obstructive pulmonary disease. Postgrad Med 2015; 127:758-70. [PMID: 26330087 DOI: 10.1080/00325481.2015.1084212] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is a preventable and treatable disease state characterized by persistent airflow limitation that is usually progressive and associated with an enhanced chronic inflammatory process. It is increasingly recognized as a major public health problem, affecting more than 20 million adults in the US. It is also recognized as a leading cause of hospitalizations and is the fourth leading cause of death in the US. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) operates to promote evidence-based management of COPD, increase awareness and encourage research. In 2011, GOLD published a consensus report detailing evidence-based management strategies for COPD, which were last updated in 2015. In recent years, newer strategies and a growing number of new pharmacologic agents to treat symptoms of COPD have also been introduced and show promise in improving the management of COPD. We aim to provide an evidence-based review of the available and upcoming pharmacologic and non-pharmacologic treatment options for stable COPD, with continued emphasis on evidence-based management.
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Affiliation(s)
- Saiprasad Narsingam
- a 1 Department of Internal Medicine, University of Missouri-Kansas City School of Medicine , Kansas City, MO, USA
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22
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Tawara Y, Senjyu H, Tanaka K, Tanaka T, Asai M, Kozu R, Tabusadani M, Honda S, Sawai T. Value of systematic intervention for chronic obstructive pulmonary disease in a regional Japanese city based on case detection rate and medical cost. Int J Chron Obstruct Pulmon Dis 2015; 10:1531-42. [PMID: 26347397 PMCID: PMC4529261 DOI: 10.2147/copd.s82872] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE We established a COPD taskforce for early detection, diagnosis, treatment, and intervention. We implemented a pilot intervention with a prospective and longitudinal design in a regional city. This study evaluates the usefulness of the COPD taskforce and intervention based on COPD case detection rate and per capita medical costs. METHOD We distributed a questionnaire to all 8,878 inhabitants aged 50-89 years, resident in Matsuura, Nagasaki Prefecture in 2006. Potentially COPD-positive persons received a pulmonary function test and diagnosis. We implemented ongoing detection, examination, education, and treatment interventions, performed follow-up examinations or respiratory lessons yearly, and supported the health maintenance of each patient. We compared COPD medical costs in Matsuura and in the rest of Nagasaki Prefecture using data from 2004 to 2013 recorded by the association of Nagasaki National Health Insurance Organization, assessing 10-year means and annual change. RESULTS As of 2014, 256 people have received a definitive diagnosis of COPD; representing 31% of the estimated total number of COPD patients. Of the cases detected, 87.5% were mild or moderate in severity. COPD medical costs per patient in Matsuura were significantly lower than the rest of Nagasaki Prefecture, as was rate of increase in cost over time. CONCLUSION The COPD program in Matsuura enabled early detection and treatment of COPD patients and helped to lower the associated burden of medical costs. The success of this program suggests that a similar program could reduce the economic and human costs of COPD morbidity throughout Japan.
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Affiliation(s)
- Yuichi Tawara
- Department of Cardiopulmonary Rehabilitation Science, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Hideaki Senjyu
- Department of Cardiopulmonary Rehabilitation Science, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Kenichiro Tanaka
- Department of Cardiopulmonary Rehabilitation Science, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Takako Tanaka
- Department of Cardiopulmonary Rehabilitation Science, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Masaharu Asai
- Department of Cardiopulmonary Rehabilitation Science, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Ryo Kozu
- Department of Rehabilitation Medicine, Nagasaki University Hospital, Nagasaki, Japan
| | - Mitsuru Tabusadani
- Center for Industry, University and Government Cooperation, Nagasaki University, Nagasaki, Japan
| | - Sumihisa Honda
- Department of Cardiopulmonary Rehabilitation Science, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Terumitsu Sawai
- Department of Cardiopulmonary Rehabilitation Science, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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23
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Comorbidity associated with referral to pulmonary rehabilitation in people hospitalized with chronic obstructive pulmonary disease. J Cardiopulm Rehabil Prev 2015; 34:430-6. [PMID: 25166258 DOI: 10.1097/hcr.0000000000000080] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE Comorbid conditions are common in people with chronic obstructive pulmonary disease (COPD) and may affect therapeutic management. The aim of this study was to examine the association of comorbidity in people with COPD with referral to a pulmonary rehabilitation (PR) program. METHODS An analysis of data was conducted from an observational study of 88 people admitted to hospital with a primary diagnosis of COPD. Demographic and admission-related data were extracted and comorbidity scores (Charlson and Rx-Risk-V) were calculated. RESULTS Total comorbidity scores were not associated with referral to PR; however specific comorbid conditions were. The presence of anxiety (from medical records) was more frequent in those referred to PR (χ = 4.20; P = .04; OR, 7.0; 95% CI, 0.8-59.0). The presence of hypertension (as determined by Rx-Risk-V) was more likely to result in PR referral (χ = 6.69; P = .01; OR, 6.8; 95% CI, 1.6-29.1), and, in those with arrhythmia, PR referral was less likely (χ = 4.22; P = .04; OR, 0.28; 95% CI, 0.08-0.99). Patients who had been referred to PR had lower forced expiratory volume in 1 second (FEV1 percent predicted) (P < .001) and greater hospital bed days in previous 3 years (P = .051). In a multivariate analysis, FEV1 percent predicted, bed days in the last 3 years, and Rx-Risk-V categories of hypertension and arrhythmia accounted for 25% of variance in referral to PR. CONCLUSIONS In addition to COPD disease severity and hospital utilization, specific comorbidities identified with a comprehensive system (ie, the Rx-Risk score) were associated with referral to PR in this sample.
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Debeaumont D, Dupuis J, Viacroze C, Demangeon S, Muir JF, Tardif C. [A comparison of pulmonary rehabilitation delivered in the home or at a centre for patients with COPD]. Rev Mal Respir 2014; 32:913-20. [PMID: 25511813 DOI: 10.1016/j.rmr.2014.11.063] [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: 02/22/2014] [Accepted: 09/29/2014] [Indexed: 10/24/2022]
Abstract
AIM There are few data showing how pulmonary rehabilitation (PR) for COPD patients carried out at home impacts on health-related quality of life (HRQL). The aim of this study was to determine if PR conducted at home improves quality of life. METHODS We compared the results of home-based PR versus PR performed in an outpatient center. The outcomes were the HRQL measured by the Saint-George's Hospital questionnaire and the 6-minute walk test distance (6MWT). Fifty-six COPD patients were included for PR either at home (n=27) or in the outpatient center (n=29) depending on distance from the center and patients preference. The two groups were similar for sex, age, BMI, lung function, and initial peak oxygen uptake. RESULTS 6MWT showed a similar non-significant improvement in both groups after PR (+12±46m in home-based PR,+13±34m in outpatient center). HRQL was significantly improved in the home-based group in 2 domains : "Activity" (-8.6±6.4 vs -0.7±17.7, P<0.05), "Impact" (-8.4±6.5 vs 1.6±11.7, P<0.001) and total score (-8.2±4.0 vs 0.0±8.8, P<0.001). CONCLUSION Pulmonary rehabilitation at home is associated with improvements in health-related quality of life, and thus can be considered where availability of treatment in specialized centers is limited.
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Affiliation(s)
- D Debeaumont
- Unité de physiologie respiratoire et sportive, CHU de Rouen, 147, avenue du Maréchal-Juin, 76230 Bois-Guillaume, France.
| | - J Dupuis
- ADIR association, 147, avenue du Maréchal-Juin, 76230 Bois-Guillaume, France; Service de pneumologie et soins intensifs respiratoires, CHU de Rouen, 147, avenue du Maréchal-Juin, 76230 Bois-Guillaume, France
| | - C Viacroze
- ADIR association, 147, avenue du Maréchal-Juin, 76230 Bois-Guillaume, France; Service de pneumologie et soins intensifs respiratoires, CHU de Rouen, 147, avenue du Maréchal-Juin, 76230 Bois-Guillaume, France
| | - S Demangeon
- CRMPR Les Herbiers, 111, rue Herbeuse, 76235 Bois-Guillaume, France
| | - J F Muir
- ADIR association, 147, avenue du Maréchal-Juin, 76230 Bois-Guillaume, France; Service de pneumologie et soins intensifs respiratoires, CHU de Rouen, 147, avenue du Maréchal-Juin, 76230 Bois-Guillaume, France; UPRES EA3830, université de Rouen, 76031 Rouen cedex, France
| | - C Tardif
- Unité de physiologie respiratoire et sportive, CHU de Rouen, 147, avenue du Maréchal-Juin, 76230 Bois-Guillaume, France; ADIR association, 147, avenue du Maréchal-Juin, 76230 Bois-Guillaume, France; UPRES EA3830, université de Rouen, 76031 Rouen cedex, France
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25
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O'Donnell DE, Gebke KB. Examining the role of activity, exercise, and pharmacology in mild COPD. Postgrad Med 2014; 126:135-45. [PMID: 25295658 DOI: 10.3810/pgm.2014.09.2808] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide and, although it is a preventable and treatable disease, it often remains undiagnosed in patients with mild disease. It is now evident that pathologic changes and physiologic impairment start early in disease progression, and even patients with mild airflow limitation have impairment in the form of exertional dyspnea, general fatigue, and exercise intolerance. Primary care physicians are optimally positioned to recognize these progressive activity restrictions in their patients, usually involving little more than a detailed patient history and a simple symptom questionnaire. Once a patient with persistent activity-related dyspnea has been diagnosed with COPD, bronchodilators can effectively address expiratory airflow limitation and lung hyperinflation that underlie symptoms. These pharmacologic interventions work in conjunction with nonpharmacologic interventions, including smoking cessation, exercise training, and pulmonary rehabilitation. Although the benefits of exercise intervention are well established in patients with more severe COPD, a small amount of new data is emerging that supports the benefits of both pharmacologic treatment and exercise training for improving exercise endurance in patients with mild-to-moderate COPD. This review examines the growing body of data that suggests that early identification-most likely by primary care physicians-and appropriate intervention can favorably impact the symptoms, exercise tolerance, health status, quality of life, hospitalizations, and economic costs of COPD.
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Affiliation(s)
- Denis E O'Donnell
- Queen's University and Kingston General Hospital, Kingston, Ontario, Canada;1Queen's University and Kingston General Hospital, Kingston, Ontario, Canada.
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Berry MJ, Justus NW, Hauser JI, Case AH, Helms CC, Basu S, Rogers Z, Lewis MT, Miller GD. Dietary nitrate supplementation improves exercise performance and decreases blood pressure in COPD patients. Nitric Oxide 2014; 48:22-30. [PMID: 25445634 DOI: 10.1016/j.niox.2014.10.007] [Citation(s) in RCA: 86] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 09/26/2014] [Accepted: 10/22/2014] [Indexed: 11/28/2022]
Abstract
Dietary nitrate (NO3(-)) supplementation via beetroot juice has been shown to increase the exercise capacity of younger and older adults. The purpose of this study was to investigate the effects of acute NO3(-) ingestion on the submaximal constant work rate exercise capacity of COPD patients. Fifteen patients were assigned in a randomized, single-blind, crossover design to receive one of two treatments (beetroot juice then placebo or placebo then beetroot juice). Submaximal constant work rate exercise time at 75% of the patient's maximal work capacity was the primary outcome. Secondary outcomes included plasma NO3(-) and nitrite (NO2(-)) levels, blood pressure, heart rate, oxygen consumption (VO2), dynamic hyperinflation, dyspnea and leg discomfort. Relative to placebo, beetroot ingestion increased plasma NO3(-) by 938% and NO2(-) by 379%. Median (+interquartile range) exercise time was significantly longer (p = 0.031) following the ingestion of beetroot versus placebo (375.0 + 257.0 vs. 346.2 + 148.0 s, respectively). Compared with placebo, beetroot ingestion significantly reduced iso-time (p = 0.001) and end exercise (p = 0.008) diastolic blood pressures by 6.4 and 5.6 mmHg, respectively. Resting systolic blood pressure was significantly reduced (p = 0.019) by 8.2 mmHg for the beetroot versus the placebo trial. No other variables were significantly different between the beetroot and placebo trials. These results indicate that acute dietary NO3(-) supplementation can elevate plasma NO3(-) and NO2(-) concentrations, improve exercise performance, and reduce blood pressure in COPD patients.
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Affiliation(s)
- Michael J Berry
- Health and Exercise Science Department, Wake Forest University, Winston-Salem, NC 27109, USA; Translational Science Center, Wake Forest University, Winston-Salem, NC 27109, USA.
| | - Nicholas W Justus
- Health and Exercise Science Department, Wake Forest University, Winston-Salem, NC 27109, USA
| | - Jordan I Hauser
- Health and Exercise Science Department, Wake Forest University, Winston-Salem, NC 27109, USA
| | - Ashlee H Case
- Health and Exercise Science Department, Wake Forest University, Winston-Salem, NC 27109, USA
| | - Christine C Helms
- Physics Department, Wake Forest University, Winston-Salem, NC 27109, USA; Translational Science Center, Wake Forest University, Winston-Salem, NC 27109, USA
| | - Swati Basu
- Physics Department, Wake Forest University, Winston-Salem, NC 27109, USA; Translational Science Center, Wake Forest University, Winston-Salem, NC 27109, USA
| | - Zachary Rogers
- Health and Exercise Science Department, Wake Forest University, Winston-Salem, NC 27109, USA
| | - Marc T Lewis
- Health and Exercise Science Department, Wake Forest University, Winston-Salem, NC 27109, USA
| | - Gary D Miller
- Health and Exercise Science Department, Wake Forest University, Winston-Salem, NC 27109, USA; Translational Science Center, Wake Forest University, Winston-Salem, NC 27109, USA
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Abstract
Chronic obstructive pulmonary disease (COPD) is a common and often progressive inflammatory disease of the airways that is both preventable and treatable. It is well established that those with mild-to-moderate disease severity represent the majority of patients with COPD, yet this subpopulation is relatively under-studied. Because of an insidious pre-clinical phase, COPD is both under-diagnosed and under-treated. Recent studies have confirmed that even patients with mild, grade 1 COPD [i.e. those with a reduced forced expiratory volume in one second (FEV1)/forced vital capacity ratio but normal FEV1], have measurable physiological impairment with increased morbidity and a higher risk of mortality compared with non-smoking healthy controls. Beyond the imperative of smoking cessation-the pivotal intervention in all COPD stages-the role of pharmacotherapy for prevention of disease progression has yet to be established. The main objective of this review is to provide a concise overview of the heterogeneous pathophysiology of COPD with only mild airway obstruction on spirometry and obstacles for early diagnosis. We emphasize that the absence of sufficiently powered trials involving a large number of patients precludes definitive recommendations in support of (or against) long-term pharmacological treatment in mild COPD. Despite these limitations, we present a rationale for earlier pharmacological intervention derived from recent physiological studies performed in symptomatic patients with mild COPD.
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Early exercise rehabilitation of muscle weakness in acute respiratory failure patients. Exerc Sport Sci Rev 2014; 41:208-15. [PMID: 23873130 DOI: 10.1097/jes.0b013e3182a4e67c] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Acute respiratory failure patients experience significant muscle weakness, which contributes to prolonged hospitalization and functional impairments after hospital discharge. Based on our previous work, we hypothesize that an exercise intervention initiated early in the intensive care unit aimed at improving skeletal muscle strength could decrease hospital stay and attenuate the deconditioning and skeletal muscle weakness experienced by these patients.
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Furness T, Joseph C, Naughton G, Welsh L, Lorenzen C. Benefits of whole-body vibration to people with COPD: a community-based efficacy trial. BMC Pulm Med 2014; 14:38. [PMID: 24606997 PMCID: PMC3975320 DOI: 10.1186/1471-2466-14-38] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Accepted: 03/03/2014] [Indexed: 12/26/2022] Open
Abstract
Background Benefits of community-based whole-body vibration (WBV) as a mode of exercise training for people with chronic obstructive pulmonary disease (COPD) have not been investigated. The low skill demand of WBV may enhance habitual sustainability to physical activity by people with COPD, provided efficacy of WBV can be established. The purpose of this trial was to compare a community-based WBV intervention with a sham WBV (SWBV) intervention and monitor exacerbations, exercise tolerance, and functional performance of the lower limbs of people with COPD. Methods Community-dwelling adults with a GOLD clinical diagnosis of COPD were recruited to the trial. This was a Phase II efficacy trial with crossover to sham intervention interspersed with two-week washout. Each six-week intervention consisted of two sessions per week of either WBV or SWBV. The interventions were completed in the home of each participant under supervision. The outcome measures were selected psychological (perceived dyspnoea) and physiological (heart rate and oxygen saturation) responses to exercise, simulated activities of daily living (timed-up-and got test and 5-chair stands test), and selected kinematic variables of gait across the 14-week trial. Results Sixteen adults with stable COPD were recruited to the trial. No exacerbations were reported during the WBV or SWBV interventions. After WBV, performance of activities of daily living (ADLs) and gait improved (p ≤ 0.05), while there was no change after SWBV (p > 0.05). Despite five withdrawals during the washout period, a 100% compliance to each six-week intervention was noted. Conclusions Results showed that WBV did not exacerbate symptoms of COPD that can be associated with physical inactivity. The WBV intervention improved tests to simulate ADLs such as rising from a chair, turning, and walking gait with greater effect than a SWBV intervention. If a placebo effect was systemic to the WBV intervention, the effect was negligible. As a standalone community-based intervention, WBV was an efficacious mode of exercise training for people with stable COPD that did not negatively effect exercise tolerance or exacerbate the disease, while concurrently improving functional performance of the lower limbs. Trial registration Australian and New Zealand Clinical Trials Registry ACTRN12612000508875.
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Affiliation(s)
- Trentham Furness
- School of Nursing, Midwifery & Paramedicine, Australian Catholic University, Fitzroy, Australia.
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30
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Bozarth AL, Covey A, Gohar A, Salzman G. Chronic obstructive pulmonary disease: clinical review and update on consensus guidelines. Hosp Pract (1995) 2014; 42:79-91. [PMID: 24566600 DOI: 10.3810/hp.2014.02.1095] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
In the last 2 decades, chronic obstructive pulmonary disease (COPD) has been increasingly recognized as a major public health problem. Since the introduction of the Global Initiative for Chronic Obstructive Lung Disease in 1998, growing interest in the pathogenesis and management of patients with COPD has led to notable improvements in patient care and quality of life. Despite greater awareness of this common preventable disease and major therapeutic advances during this period, the global impact of COPD remains strikingly large. We provide an evidence-based clinical review on COPD, with a focus on internists as the target audience.
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Affiliation(s)
- Andrew L Bozarth
- University of Missouri-Kansas City School of Medicine, Kansas City, MO.
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31
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Spruit MA, Singh SJ, Garvey C, ZuWallack R, Nici L, Rochester C, Hill K, Holland AE, Lareau SC, Man WDC, Pitta F, Sewell L, Raskin J, Bourbeau J, Crouch R, Franssen FME, Casaburi R, Vercoulen JH, Vogiatzis I, Gosselink R, Clini EM, Effing TW, Maltais F, van der Palen J, Troosters T, Janssen DJA, Collins E, Garcia-Aymerich J, Brooks D, Fahy BF, Puhan MA, Hoogendoorn M, Garrod R, Schols AMWJ, Carlin B, Benzo R, Meek P, Morgan M, Rutten-van Mölken MPMH, Ries AL, Make B, Goldstein RS, Dowson CA, Brozek JL, Donner CF, Wouters EFM. An official American Thoracic Society/European Respiratory Society statement: key concepts and advances in pulmonary rehabilitation. Am J Respir Crit Care Med 2013; 188:e13-64. [PMID: 24127811 DOI: 10.1164/rccm.201309-1634st] [Citation(s) in RCA: 2099] [Impact Index Per Article: 190.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Pulmonary rehabilitation is recognized as a core component of the management of individuals with chronic respiratory disease. Since the 2006 American Thoracic Society (ATS)/European Respiratory Society (ERS) Statement on Pulmonary Rehabilitation, there has been considerable growth in our knowledge of its efficacy and scope. PURPOSE The purpose of this Statement is to update the 2006 document, including a new definition of pulmonary rehabilitation and highlighting key concepts and major advances in the field. METHODS A multidisciplinary committee of experts representing the ATS Pulmonary Rehabilitation Assembly and the ERS Scientific Group 01.02, "Rehabilitation and Chronic Care," determined the overall scope of this update through group consensus. Focused literature reviews in key topic areas were conducted by committee members with relevant clinical and scientific expertise. The final content of this Statement was agreed on by all members. RESULTS An updated definition of pulmonary rehabilitation is proposed. New data are presented on the science and application of pulmonary rehabilitation, including its effectiveness in acutely ill individuals with chronic obstructive pulmonary disease, and in individuals with other chronic respiratory diseases. The important role of pulmonary rehabilitation in chronic disease management is highlighted. In addition, the role of health behavior change in optimizing and maintaining benefits is discussed. CONCLUSIONS The considerable growth in the science and application of pulmonary rehabilitation since 2006 adds further support for its efficacy in a wide range of individuals with chronic respiratory disease.
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Troosters T, van der Molen T, Polkey M, Rabinovich RA, Vogiatzis I, Weisman I, Kulich K. Improving physical activity in COPD: towards a new paradigm. Respir Res 2013; 14:115. [PMID: 24229341 PMCID: PMC4176094 DOI: 10.1186/1465-9921-14-115] [Citation(s) in RCA: 100] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Accepted: 08/22/2013] [Indexed: 11/20/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a debilitating disease affecting patients in daily life, both physically and emotionally. Symptoms such as dyspnea and muscle fatigue, lead to exercise intolerance, which, together with behavioral issues, trigger physical inactivity, a key feature of COPD. Physical inactivity is associated with adverse clinical outcomes, including hospitalization and all-cause mortality. Increasing activity levels is crucial for effective management strategies and could lead to improved long-term outcomes. In this review we summarize objective and subjective instruments for evaluating physical activity and focus on interventions such as pulmonary rehabilitation or bronchodilators aimed at increasing activity levels. To date, only limited evidence exists to support the effectiveness of these interventions. We suggest that a multimodal approach comprising pulmonary rehabilitation, pharmacotherapy, and counselling programs aimed at addressing emotional and behavioural aspects of COPD may be an effective way to increase physical activity and improve health status in the long term.
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Affiliation(s)
- Thierry Troosters
- Pulmonary Rehabilitation and Respiratory Division, UZ Gasthuisberg, Herestraat 49, B3000 Leuven, Belgium.
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33
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O'Connell C, Stokes EK. Fatigue – concepts for physiotherapy management and measurement. PHYSICAL THERAPY REVIEWS 2013. [DOI: 10.1179/108331907x223100] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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34
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Kirby M, Owrangi A, Svenningsen S, Wheatley A, Coxson HO, Paterson NAM, McCormack DG, Parraga G. On the role of abnormal DLCOin ex-smokers without airflow limitation: symptoms, exercise capacity and hyperpolarised helium-3 MRI. Thorax 2013; 68:752-9. [DOI: 10.1136/thoraxjnl-2012-203108] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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35
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Selzler AM, Simmonds L, Rodgers WM, Wong EYL, Stickland MK. Pulmonary rehabilitation in chronic obstructive pulmonary disease: predictors of program completion and success. COPD 2013; 9:538-45. [PMID: 23030585 DOI: 10.3109/15412555.2012.705365] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Although participation in pulmonary rehabilitation (PR) improves the health outcomes in patients with Chronic Obstructive Pulmonary Disease (COPD), there are insufficient resources to provide PR to all patients with COPD. Thus, predicting which patients are at risk for drop-out and non-response to rehabilitation is necessary in order to optimize limited resources. This study examined which patient characteristics are predictive of PR drop-out and non-response. 814 patients with COPD took part in standard out-patient PR for 8 weeks. Demographic and standard clinical data were collected before the rehabilitation program had started. Data was analyzed retrospectively to determine if baseline patient characteristics could predict drop-out and non-response to rehabilitation. Drop-out was defined as participation in less than 50% of the rehabilitation sessions. Non-response was defined as improvement less than 4% on the St. George's Respiratory Questionnaire (SGRQ). A discriminant function analysis identified age, smoking history, and health status as predictors of patient drop-out, p < .0001, with younger, current smokers and patients with lower health status being at risk for drop-out. No variables measured significantly predicted who those at risk would be for non-response to rehabilitation, p > .05. Pulmonary function data did not predict drop-out or non-response to PR. These findings indicate that perceived impairment (i.e., health status) is more likely to influence completion of rehabilitation than actual pulmonary impairment and that demographic and standard clinical data do not adequately predict patient drop-out and non-response to rehabilitation.
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Affiliation(s)
- Anne-Marie Selzler
- Faculty of Physical Education and Recreation, University of Alberta, Edmonton, Alberta, Canada.
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36
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Kruis AL, Boland MRS, Schoonvelde CH, Assendelft WJJ, Rutten-van Mölken MPMH, Gussekloo J, Tsiachristas A, Chavannes NH. RECODE: design and baseline results of a cluster randomized trial on cost-effectiveness of integrated COPD management in primary care. BMC Pulm Med 2013; 13:17. [PMID: 23522095 PMCID: PMC3637448 DOI: 10.1186/1471-2466-13-17] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Accepted: 03/18/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Favorable effects of formal pulmonary rehabilitation in selected moderate to severe COPD patients are well established. Few data are available on the effects and costs of integrated disease management (IDM) programs on quality of care and health status of COPD patients in primary care, representing a much larger group of COPD patients. Therefore, the RECODE trial assesses the long-term clinical and cost-effectiveness of IDM in primary care. METHODS/DESIGN RECODE is a cluster randomized trial with two years of follow-up, during which 40 clusters of primary care teams (including 1086 COPD patients) are randomized to IDM or usual care. The intervention started with a 2-day multidisciplinary course in which healthcare providers are trained as a team in essential components of effective COPD IDM in primary care. During the course, the team redesigns the care process and defines responsibilities of different caregivers. They are trained in how to use feedback on process and outcome data to guide implement guideline-driven integrated healthcare. Practice-tailored feedback reports are provided at baseline, and at 6 and 12 months. The team learns the details of an ICT program that supports recording of process and outcome measures. Afterwards, the team designs a time-contingent individual practice plan, agreeing on steps to be taken in order to integrate a COPD IDM program into daily practice. After 6 and 12 months, there is a refresher course for all teams simultaneously to enable them to learn from each other's experience. Health status of patients at 12 months is the primary outcome, measured by the Clinical COPD Questionnaire (CCQ). Secondary outcomes include effects on quality of care, disease-specific and generic health-related quality of life, COPD exacerbations, dyspnea, costs of healthcare utilization, and productivity loss. DISCUSSION This article presents the protocol and baseline results of the RECODE trial. This study will allow to evaluate whether IDM implemented in primary care can positively influence quality of life and quality of care in mild to moderate COPD patients, thereby making the benefits of multidisciplinary rehabilitation applicable to a substantial part of the COPD population. TRIAL REGISTRATION Netherlands Trial Register (NTR): NTR2268.
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Affiliation(s)
- Annemarije L Kruis
- Dept of Public Health and Primary Care, Leiden University Medical Centre, P.O. Box 9600 2300 RC, Leiden, The Netherlands.
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Vestbo J, Hurd SS, Agustí AG, Jones PW, Vogelmeier C, Anzueto A, Barnes PJ, Fabbri LM, Martinez FJ, Nishimura M, Stockley RA, Sin DD, Rodriguez-Roisin R. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med 2013; 187:347-65. [PMID: 22878278 DOI: 10.1164/rccm.201204-0596pp] [Citation(s) in RCA: 3575] [Impact Index Per Article: 325.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Affiliation(s)
- Jørgen Vestbo
- Manchester Academic Sciences Health Centre, Respiratory Research Group, University of Manchester, University Hospital South Manchester, Southmoor Road, Manchester M23 9LT, UK.
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38
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Strasser B, Siebert U, Schobersberger W. Effects of resistance training on respiratory function in patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis. Sleep Breath 2012; 17:217-26. [PMID: 22395963 DOI: 10.1007/s11325-012-0676-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2010] [Revised: 12/07/2010] [Accepted: 12/20/2010] [Indexed: 11/29/2022]
Abstract
PURPOSE Over the last decade, the potential use of resistance training (RT) for patients with chronic obstructive pulmonary disease (COPD) has gained increasing attention. Many COPD patients experience muscle dysfunction and reduced muscle mass, primarily as a result of chronic immobilization. These symptoms have been associated with reduced exercise tolerance and complaints of fatigue and dyspnea (even after minimal exertion). This paper presents findings from a systematic review that sought to: (1) present a meta-analysis of randomized controlled trials (RCT) investigating the effects of RT on respiratory function measures in patients with COPD and (2) investigate the existence of a dose-response relationship between intensity, duration and frequency of RT and assessed outcomes. METHODS A systematic literature search of MEDLINE electronic database (January 1980 to December 2009) produced a body of research on the effects of RT with a control group in patients with COPD. Data analysis involved a random effects meta-analysis, in order to determine weighted mean differences with 95 confidence intervals (95% CI) for each endpoint. All data were analyzed with the software package Review Manager V 4.2.10 (of the Cochrane Collaboration); 14 RCTs were included in the meta-analysis. RESULTS Findings demonstrated that RT did not substantially increase forced expiratory volume in 1 s. In addition, the weighted mean difference was 2.71% of predicted (95% CI, -1.86 to 7.27; p = 0.25) or by absolute 0.08 L (95% CI, -0.03 to 0.19; p = 0.14). It appeared that maximum minute ventilation increased by 3.77 L/min (95% CI, -0.51 to 8.04; p = 0.08). CONCLUSIONS Based on findings from the meta-analysis, RT produces a clinically and statistically significant effect on respiratory function (such as forced vital capacity) and is therefore recommended in the management of COPD.
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Affiliation(s)
- Barbara Strasser
- University for Health Sciences, Medical Informatics and Technology, Eduard Wallnöfer-Zentrum 1, Austria.
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39
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Optimizing pulmonary rehabilitation in chronic obstructive pulmonary disease--practical issues: a Canadian Thoracic Society Clinical Practice Guideline. Can Respir J 2011; 17:159-68. [PMID: 20808973 DOI: 10.1155/2010/425975] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Pulmonary rehabilitation (PR) participation is the standard of care for patients with chronic obstructive pulmonary disease (COPD) who remain symptomatic despite bronchodilator therapies. However, there are questions about specific aspects of PR programming including optimal site of rehabilitation delivery, components of rehabilitation programming, duration of rehabilitation, target populations and timing of rehabilitation. The present document was compiled to specifically address these important clinical issues, using an evidence-based, systematic review process led by a representative interprofessional panel of experts. The evidence reveals there are no differences in major patient-related outcomes of PR between nonhospital- (community or home sites) or hospital-based sites. There is strong support to recommend that COPD patients initiate PR within one month following an acute exacerbation due to benefits of improved dyspnea, exercise tolerance and health-related quality of life relative to usual care. Moreover, the benefits of PR are evident in both men and women, and in patients with moderate, severe and very severe COPD. The current review also suggests that longer PR programs, beyond six to eight weeks duration, be provided for COPD patients, and that while aerobic training is the foundation of PR, endurance and functional ability may be further improved with both aerobic and resistance training.
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40
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Perez X, Wisnivesky JP, Lurslurchachai L, Kleinman LC, Kronish IM. Barriers to adherence to COPD guidelines among primary care providers. Respir Med 2011; 106:374-81. [PMID: 22000501 DOI: 10.1016/j.rmed.2011.09.010] [Citation(s) in RCA: 113] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2011] [Revised: 09/21/2011] [Accepted: 09/22/2011] [Indexed: 10/16/2022]
Abstract
BACKGROUND Despite efforts to disseminate guidelines for managing chronic obstructive pulmonary disease (COPD), adherence to COPD guidelines remains suboptimal. Barriers to adhering to guidelines remain poorly understood. METHODS Clinicians from two general medicine practices in New York City were surveyed to identify barriers to implementing seven recommendations from the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines. Barriers assessed included unfamiliarity, disagreement, low perceived benefit, low self-efficacy, and time constraints. Exact conditional regression was used to identify barriers independently associated with non-adherence. RESULTS The survey was completed by 154 clinicians. Adherence was lowest to referring patients with a forced expiratory volume in 1 s (FEV(1)) <80% predicted to pulmonary rehabilitation (5%); using FEV(1) to guide management (12%); and ordering pulmonary function tests (PFTs) in smokers (17%). Adherence was intermediate to prescribing inhaled corticosteroids when FEV(1) <50% predicted (41%) and long-acting bronchodilators when FEV(1) <80% predicted (54%). Adherence was highest for influenza vaccination (90%) and smoking cessation counseling (91%). In unadjusted analyses, low familiarity with the guidelines, low self-efficacy, and time constraints were significantly associated with non-adherence to ≥2 recommendations. In adjusted analyses, low self-efficacy was associated with less adherence to prescribing inhaled corticosteroids (OR: 0.28; 95% CI: 0.10, 0.74) and time constraints were associated with less adherence to ordering PFTs in smokers (OR: 0.31; 95% CI: 0.08, 0.99). CONCLUSIONS Poor familiarity with recommendations, low self-efficacy, and time constraints are important barriers to adherence to COPD guidelines. This information can be used to develop tailored interventions to improve guideline adherence.
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Affiliation(s)
- Xavier Perez
- Division of General Internal Medicine, Mount Sinai School of Medicine, One Gustave L Levy Place, Box 1087, New York, NY 10029, United States
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41
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Dechman G. Clinician's Commentary. Physiother Can 2011; 62:374-7. [PMID: 21886378 DOI: 10.3138/physio.62.4.374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Gail Dechman
- Assistant Professor School of Physiotherapy Dalhousie University Halifax, Nova Scotia
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Ergün P, Kaymaz D, Günay E, Erdoğan Y, Turay UY, Demir N, Canak E, Sengül F, Egesel N, Köse SK. Comprehensive out-patient pulmonary rehabilitation: Treatment outcomes in early and late stages of chronic obstructive pulmonary disease. Ann Thorac Med 2011; 6:70-6. [PMID: 21572695 PMCID: PMC3081559 DOI: 10.4103/1817-1737.78420] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2010] [Accepted: 01/21/2011] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND: The aim was to evaluate the outcomes of a comprehensive pulmonary rehabilitation (PR) in chronic obstructive pulmonary disease (COPD) and to establish whether in early disease stage PR is as effective as in late stages of disease. METHODS: A total of 55 stable COPD patients, 28 with early and 27 with late disease stages, were assessed. Patients underwent a comprehensive out-patient PR program for 8 weeks. To eluciate the effects of PR and compare the level of improvement; lung function, dyspnea sensation [Medical Research Council (MRC)], body composition [body mass index (BMI), fat free mass (FFM), fat free mass index (FFMI)], exercise capacity [incremental shuttle walking test, endurance shuttle walking test], health related quality of life (HRQoL) with St. George Respiratory Disease Questionnaire, psycohological status (Hospital anxiety–depression (HAD) scale) were evaluated before and after PR. RESULTS: At the end of PR in the early disease stage group, the improvement in forced vital capacity (FVC) reached a statistically significant level (P < 0.05). In both disease stages, there were no significant differences in BMI, FFM, and FFMI. The decrease in exertional dyspnea for the two groups evaluated with the modified BORG scale were not found statistically significant, though the dyspnea scores evaluated with MRC showed significant improvements (P < 0.001). HRQoL and exercise capacity were significantly improved for the two groups (P < 0.001). Psychological status evaluated with the HAD scale improved after PR (P < 0.001) both in early and late stages. Gainings in the study parameters did not differ in the early and the late disease stages. CONCLUSIONS: These results showed that patients with COPD had benefited from a comprehensive PR program in an out-patient setting regardless of disease severity. Even patients with earlier stage of disease should be referred and encouraged to participate in a PR program.
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Affiliation(s)
- Pinar Ergün
- Division of Pulmonary Rehabilitation and Home Care Center, Ankara, Turkey
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Meng NH, Chen FN, Lo SF, Lo SF, Cheng WE. Reliability and validity of the Taiwan (Mandarin Chinese) version of the chronic respiratory questionnaire. Qual Life Res 2011; 20:1745-51. [PMID: 21476117 DOI: 10.1007/s11136-011-9906-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2011] [Indexed: 10/18/2022]
Abstract
PURPOSE The chronic respiratory disease questionnaire (CRQ) has been validated and proved useful in assessing therapies for pulmonary diseases. We translated the CRQ into a Taiwan (Mandarin Chinese) version and surveyed its validity and reliability. METHODS The CRQ includes 20 items divided into four domains: dyspnea, fatigue, emotional function, and mastery. We followed a forward-back translation procedure to create the Taiwan version. A cross-sectional survey was conducted among outpatients with chronic obstructive pulmonary disease. Participants underwent tests including the CRQ, the medical outcomes study short form (SF-36), the St. George respiratory questionnaire (SGRQ), lung function tests (LFTs), and a graded exercise test (GET). We used Cronbach's alpha to evaluate the internal consistency of the CRQ, intraclass coefficient for test-retest reliability, and Spearman's correlation for validity. RESULTS Thirty-six men and 4 women (mean age 67.9 ± 9.9 years) were recruited. Evidence of good internal consistency, test-retest reliability, convergent, discriminant, concurrent, and construct validity of the CRQ was shown. Spearman's correlation showed moderate-to-strong correlation between the CRQ scores and scores of the SGRQ, subscales of the SF-36, and the results of LFTs and GET. CONCLUSIONS The Taiwan version of the CRQ shows good validity, internal consistency, and test-retest reliability.
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Affiliation(s)
- Nai-Hsin Meng
- Department of Physical Medicine and Rehabilitation, China Medical University Hospital, Taichung, Taiwan, Republic of China
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Effets d’un programme de réhabilitation respiratoire selon la sévérité de la BPCO. Rev Mal Respir 2011; 28:297-305. [DOI: 10.1016/j.rmr.2010.09.034] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2010] [Accepted: 09/15/2010] [Indexed: 11/20/2022]
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Raghavan N, Guenette JA, O’Donnell DE. The role of pharmacotherapy in mild to moderate chronic obstructive pulmonary disease. Ther Adv Respir Dis 2011; 5:245-54. [DOI: 10.1177/1753465811398373] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a major health problem worldwide and most of those afflicted have mild to moderate disease as measured by spirometry. There is mounting evidence that even mild airway obstruction is associated with activity-related dyspnea, exercise limitation, impaired quality of life, increased hospitalization and mortality. As our understanding of the complex, heterogeneous pathophysiology and clinical consequences of milder COPD continues to grow, there is increasing interest in the potential impact of therapeutic interventions beyond smoking cessation. Unfortunately, few clinical trials have included patients with mild to moderate disease and the evidence base for pharmacological treatment in this subpopulation is currently lacking. Recent short-term mechanistic studies confirm that reversal of airway smooth muscle cholinergic tone consistently improves respiratory mechanics during rest and exercise in mild COPD but long-term clinical benefits remain to be evaluated. Secondary analysis of large, prospective studies designed to evaluate the efficacy of long-acting bronchodilators, inhaled corticosteroids and combination therapy indicate that patients with moderate COPD achieve comparable benefits to those with advanced disease. In the absence of evidence-based guidelines for the management of milder COPD, treatment choices are driven mainly by clinical presentation: for those with persistent and troublesome activity-related dyspnea a trial of inhaled bronchodilator therapy is justified; for those with a propensity for recurrent infective exacerbations, consideration of additional anti-inflammatory treatment seems reasonable. In this paper, we review the current knowledge base and emerging paradigm for the pharmacological treatment of mild to moderate COPD.
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Affiliation(s)
- Natya Raghavan
- Respiratory Investigation Unit, Department of Medicine, Queen's University and Kingston General Hospital, Kingston, ON, Canada
| | - Jordan A. Guenette
- Respiratory Investigation Unit, Department of Medicine, Queen's University and Kingston General Hospital, Kingston, ON, Canada
| | - Denis E. O’Donnell
- Division of Respiratory and Critical Care Medicine, Queen’s University, 102 Stuart Street, Kingston, Ontario, Canada K7L-2V6
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Demkow U, van Overveld FJ. Role of elastases in the pathogenesis of chronic obstructive pulmonary disease: implications for treatment. Eur J Med Res 2011; 15 Suppl 2:27-35. [PMID: 21147616 PMCID: PMC4360323 DOI: 10.1186/2047-783x-15-s2-27] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Neutrophil elastase, metalloproteinases, and their inhibitors play an important role in the development of chronic obstructive pulmonary disease (COPD), resulting in extensive tissue damage and malfunctioning of the airways. Nearly fifty years after the protease-antiprotease imbalance hypothesis has been suggested for the cause of emphysema, it is still appealing, but it does not explain the considerable variation in the clinical expressions of emphysema. However, there are many recent research findings to support the imbalance hypothesis as will be shown in this review. Although limited, there might be openings for the treatment of the disease.
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Affiliation(s)
- Urszula Demkow
- Dept. Lab. Diagn. and Clin. Immunol., Warsaw Medical University, Warsaw, Poland.
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Jenkins S, Hill K, Cecins NM. State of the art: how to set up a pulmonary rehabilitation program. Respirology 2011; 15:1157-73. [PMID: 20920127 DOI: 10.1111/j.1440-1843.2010.01849.x] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Pulmonary rehabilitation plays an essential role in the management of symptomatic patients with COPD. The benefits of rehabilitation include a decrease in dyspnoea and fatigue, and improvements in exercise tolerance and health-related quality of life. Importantly, rehabilitation reduces hospitalization for acute exacerbations and is cost-effective. Although most of the evidence for pulmonary rehabilitation has been obtained in patients with COPD, symptomatic individuals with other respiratory diseases have been shown to benefit. In this review we outline a stepwise approach to establish, deliver and evaluate a pulmonary rehabilitation program (PRP) that would be feasible in most settings. Throughout the review we have specified the minimum requirements for a PRP to facilitate the establishment of programs using limited resources. Recommendations for staffing and other resources required for a PRP are presented in the first section. Exercise training is a focus of the section on program delivery as this is the component of rehabilitation that has the strongest level of evidence for benefit. Program considerations for patients with respiratory conditions other than COPD are described. Different approaches for delivering the education component of a PRP are outlined and recommendations are made regarding topics for group and individual sessions. The problems commonly encountered in pulmonary rehabilitation, together with recommendations to avoid these problems and strategies to assist in their resolution, are discussed. The review concludes with recommendations for evaluating a PRP.
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Affiliation(s)
- Sue Jenkins
- Physiotherapy Department, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.
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La transplantation pulmonaire: avant, pendant et après… — Spécificités de la prise en charge sur la liste d’attente. MEDECINE INTENSIVE REANIMATION 2011. [DOI: 10.1007/s13546-010-0215-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Garvey C, Fromer L, Saver DF, Yawn BP. Pulmonary rehabilitation: an underutilized resource in primary COPD care. PHYSICIAN SPORTSMED 2010; 38:54-60. [PMID: 21150142 DOI: 10.3810/psm.2010.12.1825] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Pulmonary rehabilitation (PR) is an important component of chronic obstructive pulmonary disease (COPD) management. Physician use of PR for patients with COPD lags behind national and international guideline recommendations. In this article, we discuss the important components of PR, including exercise training, self-management education, and psychosocial and nutritional interventions, as based on the American Thoracic Society/European Respiratory Society and Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines. We also discuss the potential benefits of PR, including reduction of respiratory symptoms, decreased disability, and increased participation in physical and social activities. Increased activity promotes independence, improves quality of life, and reduces the number of COPD exacerbations and hospitalizations. In all stages of COPD, PR has been shown to result in improved exercise tolerance, with reduced dyspnea and fatigue, although the greatest improvement has been seen in patients with GOLD stages II to IV. Pulmonary rehabilitation is now a well-recognized therapy that should be available to all patients with symptomatic COPD. To facilitate inclusion of PR in COPD management, primary care physicians need to recognize and diagnose COPD, and regularly decide when PR best fits in an individual's COPD treatment program.
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Fromer L, Barnes T, Garvey C, Ortiz G, Saver DF, Yawn B. Innovations to achieve excellence in COPD diagnosis and treatment in primary care. Postgrad Med 2010; 122:150-64. [PMID: 20861599 DOI: 10.3810/pgm.2010.09.2212] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Recognition of chronic obstructive pulmonary disease (COPD) is often missed or delayed in primary care. Once recognized, COPD is often undertreated or episodically treated, focusing on acute exacerbations without establishing maintenance treatment to control ongoing disease. Diagnostic and therapeutic pessimism result in missed opportunities to reduce exacerbations, maintain physical functioning, and reduce emergent health care requirements. Proactive diagnosis and evidence-based management can alleviate the impact of COPD on patients' lives. Smoking cessation has been proven to slow the rate of lung function decline. Maintenance pharmacotherapy and immunizations reduce exacerbations. Pulmonary rehabilitation improves respiratory symptoms and physical functioning and reduces rehospitalizations after exacerbations. Self-management education improves health-related quality of life and reduces inpatient and emergency care usage. Maintenance treatment with long-acting inhaled bronchodilators is appropriate beginning in moderate COPD to maintain airway patency and reduce exacerbations. Tiotropium is US Food and Drug Administration (FDA) approved to treat bronchospasm and reduce exacerbations in patients with COPD; salmeterol/fluticasone is FDA approved to treat airflow obstruction in COPD and reduce exacerbations in patients with a history of exacerbations. Other maintenance long-acting bronchodilators-salmeterol, formoterol, and budesonide/formoterol-are FDA approved to treat airway obstruction in COPD but lack an approved indication against exacerbations. FDA warnings on the use of long-acting beta-adrenergic agents (LABAs) in asthma specifically exempt COPD and do not apply to LABA/inhaled corticosteroid combinations used in COPD. The actual effectiveness achieved in practice with any COPD therapies depends on patients' inhaler technique, adherence, and persistence. Medication usage rates and inhaler proficiency may be improved by concordance, in which the health care provider and patient collaborate to make treatment plans sustainable in the patient's daily life. Practice redesign for whole-patient primary care provides additional tools for comprehensive COPD management. Innovations such as group visits and the patient-centered medical home provide newer ways to interact with COPD patients and their families. Patient-focused and evidence-based options enable primary care practices to manage COPD longitudinally and improve patient outcomes through the course of the disease.
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Affiliation(s)
- Len Fromer
- Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
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