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Desachy M, Alexandre F, Varray A, Molinier V, Four E, Charbonnel L, Héraud N. High Prevalence of Non-Responders Based on Quadriceps Force after Pulmonary Rehabilitation in COPD. J Clin Med 2023; 12:4353. [PMID: 37445388 DOI: 10.3390/jcm12134353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 06/22/2023] [Accepted: 06/23/2023] [Indexed: 07/15/2023] Open
Abstract
Pulmonary rehabilitation (PR) in patients with COPD improves quality of life, dyspnea, and exercise tolerance. However, 30 to 50% of patients are "non-responders" (NRs) according to considered variables. Surprisingly, peripheral muscle force is never taken into account to attest the efficacy of PR, despite its major importance. Thus, we aimed to estimate the prevalence of force in NRs, their characteristics, and predictors of non-response. In total, 62 COPD patients were included in this retrospective study (May 2019 to December 2020). They underwent inpatient PR, and their quadriceps isometric maximal force (QMVC) was assessed. The PR program followed international guidelines. Patients with a QMVC increase <7.5 N·m were classified as an NR. COPD patients showed a mean improvement in QMVC after PR (10.08 ± 12.97 N·m; p < 0.001). However, 50% of patients were NRs. NRs had lower pre-PR values for body mass, height, body mass index, PaO2, and QMVC. Non-response can be predicted by low QMVC, high PaCO2, and gender (when male). This model has a sensitivity of 74% and specificity of 81%. The study highlights the considerable number of NRs and potential risk factors for non-response. To systematize the effects, it may be interesting to implement blood gas correction and/or optimize the programs to enhance peripheral and central effects.
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Affiliation(s)
- Marion Desachy
- EuroMov Digital Health in Motion, University Montpellier, IMT Mines Ales, Montpellier, France
- Direction de la Recherche et de l'Innovation en Santé (Research and Health Innovation Department), Clariane, France
| | - François Alexandre
- Direction de la Recherche et de l'Innovation en Santé (Research and Health Innovation Department), Clariane, France
| | - Alain Varray
- EuroMov Digital Health in Motion, University Montpellier, IMT Mines Ales, Montpellier, France
| | - Virginie Molinier
- Direction de la Recherche et de l'Innovation en Santé (Research and Health Innovation Department), Clariane, France
| | - Elodie Four
- Clinique du Souffle Les Clarines, Inicea, France
| | | | - Nelly Héraud
- Direction de la Recherche et de l'Innovation en Santé (Research and Health Innovation Department), Clariane, France
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Oliveira RTD, Santos FMD, Ramos AG, Seki KLM, Müller PDT, Christofoletti G. Pulmonary function and medication effect in mild-stage subjects with Parkinson's disease. ARQUIVOS DE NEURO-PSIQUIATRIA 2022; 80:1233-1238. [PMID: 36580961 PMCID: PMC9800167 DOI: 10.1055/s-0042-1758753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Parkinson's disease (PD) causes a series of movement disorders, many of them starting in the early stage. OBJECTIVE To analyze the pulmonary function of mild-stage subjects with PD and to investigate the effects of levodopa on it. METHODS We included 21 patients with idiopathic PD and 20 healthy control subjects. The participants were submitted to spirometry and impulse oscillometry assessments. The PD patients were evaluated during the "off" and "on" phases of their anti-PD medication, which was was converted to levodopa in an equivalent daily dose. A statistical analysis was performed with cross-sectional (PD patients "off" medication versus controls) and paired (PD patients "off" medication versus PD patients "on" medication) tests. The effect of levodopa was calculated with partial Eta-squared (η2 ρ). Significance was set at 5%. RESULTS The PD patients presented normal values in the impulse oscillometry. Regarding spirometry, the results indicated an incipient obstructive ventilatory disorder in the PD group - confirmed by patients' flow-volume curves. The PD patients received a daily dose of 354.7 ± 148.2 mg of levodopa. The paired analyses showed a small effect of anti-PD medication on pulmonary parameters (η2 ρ = 0.197 for spirometry and η2 ρ= 0.043 for impulse oscillometry). CONCLUSION Patients with PD in the mild stage of the disease present pulmonary compliance and resistance compatible with normal parameters. The differences regarding the spirometric results indicate an incipient obstructive ventilatory disorder in patients with PD. Levodopa had small effect on pulmonary function in the mild stage of the disease.
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Affiliation(s)
- Renata Terra de Oliveira
- Universidade Federal de Mato Grosso do Sul, Faculdade de Medicina, Programa de Saúde e Desenvolvimento, Campo Grande MS, Brazil.
| | - Fabiana Maria dos Santos
- Universidade Federal de Mato Grosso do Sul, Faculdade de Medicina, Programa de Saúde e Desenvolvimento, Campo Grande MS, Brazil.
| | | | - Karla Luciana Magnani Seki
- Hospital Universitário Maria Aparecida Pedrossian, Campo Grande MS, Brazil.,Universidade Federal de Mato Grosso do Sul, Instituto de Saúde, Programa em Ciências do Movimento, Campo Grande MS, Brazil.
| | - Paulo de Tarso Müller
- Universidade Federal de Mato Grosso do Sul, Faculdade de Medicina, Programa de Saúde e Desenvolvimento, Campo Grande MS, Brazil.,Universidade Federal de Mato Grosso do Sul, Instituto de Saúde, Programa em Ciências do Movimento, Campo Grande MS, Brazil.
| | - Gustavo Christofoletti
- Universidade Federal de Mato Grosso do Sul, Faculdade de Medicina, Programa de Saúde e Desenvolvimento, Campo Grande MS, Brazil.,Universidade Federal de Mato Grosso do Sul, Instituto de Saúde, Programa em Ciências do Movimento, Campo Grande MS, Brazil.,Address for correspondence Gustavo Christofoletti
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Gong B, Shang S, Wu C. Association between cognitive declines and disability in activities of daily living in older adults with COPD: evidence from the China health and retirement longitudinal study. BMJ Open 2020; 10:e040098. [PMID: 33115903 PMCID: PMC7594365 DOI: 10.1136/bmjopen-2020-040098] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES This study aimed to investigate the relationship between disability and domain-specific cognitive function in older adults with chronic obstructive pulmonary disease (COPD). DESIGN Cross-sectional analyses combined with retrospective longitudinal analyses. SETTING We included 450 communities in China. PARTICIPANTS In this study, 1022 (mean age: 68.6±6.3; 612 males) and 152 (mean age: 67.0±5.2; 83 males) older adults with COPD from the China Health and Retirement Longitudinal Study were included in a cross-sectional multivariate linear regression analysis and a longitudinal logistic regression analysis, respectively. OUTCOME MEASURES Disability was determined by the difficulty or inability to complete 1 of the 12 activity items in basic activities of daily living (ADL) and instrumental ADL. The cognitive dimensions of episodic memory, attention/numerical ability, orientation to time, and visuospatial ability were assessed via the immediate/delayed recall task, serial sevens task, naming the current date and pentagon-figure-drawing tasks, respectively. RESULTS Of 1022 older respondents with COPD at wave-4, 48.5% had ADL disability. Declines in the global cognitive function (β (95% CI)=-0.627 (-1.214 to -0.040)), orientation to time (β (95% CI)=-0.207 (-0.364 to -0.050)) and visuospatial ability (β (95% CI)=-0.068 (-0.127 to -0.009)) were significantly associated with the presence of ADL disability, when demographic and health-related variables were adjusted. Of 152 older participants with COPD and without ADL disability in wave-2, 61 (40.1 %) developed disability over a 2-year follow-up. Relative to the participants without a decline in orientation to tine, those with the condition had greater odds of incidence of ADL disability increased by a factor of about 1.46 over a 2-year follow-up. CONCLUSIONS In older adults with COPD, orientation to time and visuospatial inability are vulnerable to the presence of a disability. Prevention of a decline in orientation to time might help prevent disability in older people with COPD.
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Affiliation(s)
- Bingyan Gong
- School of Nursing, Peking University, Beijing, China
| | - Shaomei Shang
- School of Nursing, Peking University, Beijing, China
| | - Chao Wu
- School of Nursing, Peking University, Beijing, China
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Alexandre F, Héraud N, Tremey E, Oliver N, Bourgouin D, Varray A. Specific motor cortex hypoexcitability and hypoactivation in COPD patients with peripheral muscle weakness. BMC Pulm Med 2020; 20:1. [PMID: 31900129 PMCID: PMC6942311 DOI: 10.1186/s12890-019-1042-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 12/24/2019] [Indexed: 12/05/2022] Open
Abstract
Background Peripheral muscle weakness can be caused by both peripheral muscle and neural alterations. Although peripheral alterations cannot totally explain peripheral muscle weakness in COPD, the existence of an activation deficit remains controversial. The heterogeneity of muscle weakness (between 32 and 57% of COPD patients) is generally not controlled in studies and could explain this discrepancy. This study aimed to specifically compare voluntary and stimulated activation levels in COPD patients with and without muscle weakness. Methods Twenty-two patients with quadriceps weakness (COPDMW), 18 patients with preserved quadriceps strength (COPDNoMW) and 20 controls were recruited. Voluntary activation was measured through peripheral nerve (VAperipheral) and transcranial magnetic (VAcortical) stimulation. Corticospinal and spinal excitability (MEP/Mmax and Hmax/Mmax) and corticospinal inhibition (silent period duration) were assessed during maximal voluntary quadriceps contractions. Results COPDMW exhibited lower VAcortical and lower MEP/Mmax compared with COPDNoMW (p < 0.05). Hmax/Mmax was not significantly different between groups (p = 0.25). Silent period duration was longer in the two groups of COPD patients compared with controls (p < 0.01). Interestingly, there were no significant differences between all COPD patients taken together and controls regarding VAcortical and MEP/Mmax. Conclusions COPD patients with muscle weakness have reduced voluntary activation without altered spinal excitability. Corticospinal inhibition is higher in COPD regardless of muscle weakness. Therefore, reduced cortical excitability and a voluntary activation deficit from the motor cortex are the most likely cortical mechanisms implicated in COPD muscle weakness. The mechanisms responsible for cortical impairment and possible therapeutic interventions need to be addressed.
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Affiliation(s)
- Francois Alexandre
- Les Cliniques du Souffle, Research Department, Groupe 5 Santé, 800 avenue Joseph Vallot, 34700, Lodève, France. .,Euromov Laboratory, University of Montpellier, Montpellier, France.
| | - Nelly Héraud
- Les Cliniques du Souffle, Research Department, Groupe 5 Santé, 800 avenue Joseph Vallot, 34700, Lodève, France
| | - Emilie Tremey
- Les Cliniques du Souffle, Research Department, Groupe 5 Santé, 800 avenue Joseph Vallot, 34700, Lodève, France
| | - Nicolas Oliver
- Les Cliniques du Souffle, Research Department, Groupe 5 Santé, 800 avenue Joseph Vallot, 34700, Lodève, France
| | - Dominique Bourgouin
- Les Cliniques du Souffle, Research Department, Groupe 5 Santé, 800 avenue Joseph Vallot, 34700, Lodève, France
| | - Alain Varray
- Euromov Laboratory, University of Montpellier, Montpellier, France
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Ceron DM, Garcia Rosa ML, Jorge AJ, Correia DM, Kang HC, Mesquita ET, Grijalba Velasco JC, Gismondi R, de Andrade Martins W. Characterization of dyspnea in chronic diseases and heart failure in patients in a Family Health Program. REVISTA COLOMBIANA DE CARDIOLOGÍA 2020. [DOI: 10.1016/j.rccar.2019.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Associação dos tipos de dispneia e da “flexopneia” com as patologias cardiopulmonares nos cuidados de saúde primários. Rev Port Cardiol 2017; 36:179-186. [DOI: 10.1016/j.repc.2016.08.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 08/04/2016] [Accepted: 08/26/2016] [Indexed: 11/21/2022] Open
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Martínez Cerón DM, Garcia Rosa ML, Lagoeiro Jorge AJ, de Andrade Martins W, Tinoco Mesquita E, Di Calafriori Freire M, da Silva Correia DM, Kang HC. Association of types of dyspnea including ‘bendopnea’ with cardiopulmonary disease in primary care. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2017. [DOI: 10.1016/j.repce.2016.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Abstract
PURPOSE OF REVIEW This review summarizes recent advances concerning respiratory impairment and disability. RECENT FINDINGS The traditional impairment assessment approach, depending heavily on clinical pulmonary function testing to estimate the match between the patient's sustainable oxygen consumption and the workplace requirements, continues to be widely used. Recent work indicates the need to reassess underlying concepts for several reasons: The relationship between basic pulmonary function tests and sustainable oxygen consumption varies among patients and conditions. Studies of the respiratory demands of modern workplaces need to be updated. The concepts are less easily applied to asthma than other disorders. Research studies present differing definitions of 'disability', and therefore the methods of relating impairment (function loss) and disability require reassessment. Recent advances provide improved understanding of the large societal and personal impacts of respiratory impairment and disability. SUMMARY Clinicians, policymakers, and researchers should carefully consider how well the current highly specified impairment rating systems can be improved for accuracy and relevance to current home and work activities. In addition to measuring 'impairment', clinicians should consider factors affecting how impairments lead to disability.
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Addressing Longevity, Life Expectancy and Health Life Expectancy. JOURNAL OF POPULATION AGEING 2015. [DOI: 10.1007/s12062-015-9134-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Diehr P, Diehr M, Arnold A, Yee LM, Odden MC, Hirsch CH, Thielke S, Psaty BM, Johnson WC, Kizer Md JR, Newman A. Predicting Future Years of Life, Health, and Functional Ability: A Healthy Life Calculator for Older Adults. Gerontol Geriatr Med 2015; 1:2333721415605989. [PMID: 28138467 PMCID: PMC5119805 DOI: 10.1177/2333721415605989] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective: To create personalized estimates of future health and ability status for older adults. Method: Data came from the Cardiovascular Health Study (CHS), a large longitudinal study. Outcomes included years of life, years of healthy life (based on self-rated health), years of able life (based on activities of daily living), and years of healthy and able life. We developed regression estimates using the demographic and health characteristics that best predicted the four outcomes. Internal and external validity were assessed. Results: A prediction equation based on 11 variables accounted for about 40% of the variability for each outcome. Internal validity was excellent, and external validity was satisfactory. The resulting CHS Healthy Life Calculator (CHSHLC) is available at http://healthylifecalculator.org. Conclusion: CHSHLC provides a well-documented estimate of future years of healthy and able life for older adults, who may use it in planning for the future.
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Affiliation(s)
| | - Michael Diehr
- California State University San Marcos, San Marcos, CA, USA
| | | | | | | | | | - Stephen Thielke
- University of Washington, Seattle, WA, USA; VA Medical Center, Seattle, WA, USA
| | - Bruce M Psaty
- University of Washington, Seattle, WA, USA; Group Health Research Institute of Group Health Cooperative, Seattle, WA, USA
| | | | - Jorge R Kizer Md
- Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA
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Abstract
The objective of the study was to compare the presence of comorbid medical conditions between patients with a vascular dementia (VaD) and a control group, from the Integrated Healthcare Information Services (IHCIS) database. VaD was defined by the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes 290.40, 290.4, 290.41, 290.42, and, 290.43. An individual matching method was used to select the controls, which were matched to cases on a 15:1 ratio by age, gender, type of health plan, and pharmacy benefits. Alzheimer's disease, any other dementia or cognitive deficits associated were considered exclusion criteria. Among the IHCIS patients 60 years of age or older and full year of eligibility during 2010, there were 898 VaD patients, from which 63.6% were women. Concurrent presence of cerebrovascular disease, atherosclerosis, heart failure, and atrial fibrillation were found at 12.6, 4.6, 2.8, and 1.7 times higher in VaD patients, respectively. Compared to controls, VaD patients had more septicemia, injuries, lung diseases including chronic obstructive pulmonary disease, and urinary diseases (all with df = 897,1; p < 0.0001). The present study confirms that these four medical comorbidities are frequent complications of VaD and physicians should be alert to the presence of them in patients with VaD.
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Chronic obstructive pulmonary disease, cognitive impairment, and development of disability: the health and retirement study. Ann Am Thorac Soc 2015; 11:1362-70. [PMID: 25285360 DOI: 10.1513/annalsats.201405-187oc] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
RATIONALE The relationship between chronic obstructive pulmonary disease (COPD) and cognitive impairment in leading to disability has not been characterized. OBJECTIVES We aimed to investigate the prevalence and cumulative incidence of disability among adults with and without COPD and the association of COPD and cognitive impairment with disability. METHODS We analyzed 2006-2008 waves of the Health and Retirement Study, a nationally representative longitudinal health survey. COPD was self-reported. Prevalent disability was defined as baseline dependency in one or more activities of daily living (ADLs) and incident disability as one or more additional ADL dependencies. We used a validated performance-based measure of cognition to identify dementia and mild cognitive impairment. Covariates included seven chronic diseases, four geriatric syndromes, and sociodemographics. We used logistic regression to test associations between COPD, cognitive status, and prevalent/incident disability. MEASUREMENTS AND MAIN RESULTS Of 17,535 participants at least 53 years of age in wave 2006 (representing 77.7 million Americans), 9.5% reported COPD and 13.5% mild cognitive impairment; 17.5% of those with COPD had mild cognitive impairment. Prevalent disability for COPD was 12.8% (5.2% for no-COPD, P < 0.001). An additional 9.2% with COPD developed incident disability at 2 years (4.0% for no-COPD, P < 0.001). In adjusted models, COPD was associated with baseline (odds ratio, 2.0) and incident disability (odds ratio, 2.1; adjusted for baseline disability). Cognitive impairment had an additive effect to COPD. The COPD-disability association, prevalent/incident, was of similar or greater magnitude than that of other chronic diseases (e.g., stroke, diabetes). The associations were maintained in sensitivity analyses using alternative definitions of disability (dependency in two or more ADLs, dependency in instrumental ADLs), and in analysis excluding respondents with dementia. CONCLUSIONS Both COPD and mild cognitive impairment increase the risk of disability. The risk conferred by COPD is significant and similar or higher than other chronic diseases.
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Braido F, Baiardini I, Scichilone N, Sorino C, Di Marco F, Corsico A, Santus P, Girbino G, Di Maria G, Mereu C, Sabato E, Foschino Barbaro MP, Cuttitta G, Zolezzi A, Bucca C, Balestracci S, Canonica GW. Disability in moderate chronic obstructive pulmonary disease: prevalence, burden and assessment - results from a real-life study. Respiration 2015; 89:100-6. [PMID: 25612914 DOI: 10.1159/000368365] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Accepted: 09/08/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The role of disability and its association with patient-reported outcomes in the nonsevere forms of chronic obstructive pulmonary disease (COPD) has never been explored. OBJECTIVES The aim of this study was to assess, in a cross-sectional real-life study, the prevalence and degree of disability in moderate COPD patients and to assess its association with health status, illness perception, risk of death and well-being. METHODS Moderate COPD outpatients attending scheduled visits were involved in a quantitative research program using a questionnaire-based data collection method. RESULTS Out of 694 patients, 17.4% were classified as disabled and 47.6% reported the loss of at least one relevant function of daily living. Disabled patients did not differ from nondisabled patients in terms of working status (p = 0.06), smoking habits (p = 0.134) and ongoing treatment (p = 0.823); however, the former showed a significantly higher disease burden as measured by illness perception, health status and well-being. The stepwise regression analysis showed that the modified Medical Research Council (mMRC) score was the most relevant factor related to COPD disability (F = 38.248; p = 0.001). Patient stratification was possible according to the forced expiratory volume in 1 s (FEV1) value and an mMRC score ≥2, which identified disabled patients, whereas the mMRC values were differently associated with the risk of disability. CONCLUSION A significant proportion of individuals with moderate COPD reported a limitation of daily life functions, with dyspnea being the most relevant factor inducing disability. Adding the evaluation of patient-reported outcomes to lung function assessment could facilitate the identification of disabled patients.
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Affiliation(s)
- Fulvio Braido
- Allergy and Respiratory Diseases Clinic, DIMI, University of Genoa, IRCCS AOU San Martino-IST, Genova, Italy
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Fan VS, Locke ER, Diehr P, Wilsdon A, Enright P, Yende S, Avdalovic M, Barr G, Kapur VK, Thomas R, Krishnan JA, Lovasi G, Thielke S. Disability and recovery of independent function in obstructive lung disease: the cardiovascular health study. Respiration 2014; 88:329-38. [PMID: 25228204 DOI: 10.1159/000363772] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Accepted: 05/19/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Chronic obstructive lung disease frequently leads to disability. Older patients may experience transitions between states of disability and independence over time. OBJECTIVE To identify factors associated with transition between states of disability and independent function in obstructive lung disease. METHODS We analyzed data on 4,394 participants in the Cardiovascular Health Study who completed prebronchodilator spirometry. We calculated the 1-year probability of developing and resolving impairment in ≥1 instrumental activity of daily living (IADL) or ≥1 activity of daily living (ADL) using transition probability analysis. We identified factors associated with resolving disability using relative risk (RR) regression. RESULTS The prevalence of IADL impairment was higher with moderate (23.9%) and severe (36.9%) airflow obstruction compared to normal spirometry (22.5%; p < 0.001). Among participants with severe airflow obstruction, 23.5% recovered independence in IADLs and 40.5% recovered independence in ADLs. In the adjusted analyses, airflow obstruction predicted the development of IADL, but not ADL impairment. Participants with severe airflow obstruction were less likely to resolve IADL impairment [RR 0.67 and 95% confidence interval (CI) 0.49-0.94]. Compared to the most active individuals (i.e. who walked ≥28 blocks per week), walking less was associated with a decreased likelihood of resolving IADL impairment (7-27 blocks: RR 0.81 and 95% CI 0.69-0.86 and <7 blocks: RR 0.73 and 95% CI 0.61-0.86). Increased strength (RR 1.16 and 95% CI 1.05-1.29) was associated with resolving IADL impairment. CONCLUSIONS Disability is common in older people, especially in those with severe airflow obstruction. Increased physical activity and muscle strength are associated with recovery. Research is needed on interventions to improve these factors among patients with obstructive lung disease and disability.
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Affiliation(s)
- Vincent S Fan
- Health Services Research and Development, Department of Veterans Affairs, Seattle, Wash., USA
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Abstract
The world's population is ageing and an important part of this demographic shift is the development of chronic illness. In short, a person who does not die of acute illnesses, such as infections, and survives with chronic illnesses is more likely to develop additional chronic illnesses. Chronic respiratory diseases are an important component of these diseases associated with ageing. This article reviews the relationship between ageing and chronic respiratory disease, and also how certain chronic diseases cluster with others, either on the basis of underlying risk factors, complication of the primary disease or other factors, such as an increased state of inflammation. While death is inevitable, disabling chronic illnesses are not. Better understanding of how individuals can age healthily without the development of multiple chronic illnesses should lead to an improved global quality of life.
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Affiliation(s)
- Miguel J Divo
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Carlos H Martinez
- Division of Pulmonary Medicine, University of Michigan Health System, Ann Arbor, MI, USA
| | - David M Mannino
- Depts of Preventive Medicine and Environmental Health, University of Kentucky College of Medicine and University of Kentucky College of Public Health, Lexington, KY, USA
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