1
|
Borrayo EA, Juarez-Colunga E, Kilbourn K, Waxmonsky J, Jacobson M, Okuyama S, Swaney R, Wamboldt FS, Karam S, Lopez Alvarez S, Jin X, Nguyen J. Stepped-care to improve mental health outcomes among underserved patients with lung and head and neck cancer. Psychooncology 2023; 32:1718-1726. [PMID: 37772984 DOI: 10.1002/pon.6223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 09/13/2023] [Accepted: 09/17/2023] [Indexed: 09/30/2023]
Abstract
BACKGROUND The comparative effectiveness study (ClinicalTrials.gov, NCT03016403) assessed the effects of a stepped-care intervention versus usual care on mental health outcomes, including anxiety, depression, coping self-efficacy, emotional distress (anxiety and depression combined), health-related quality of life (HRQoL), and perceived stress among underserved patients (i.e., low-income, uninsured, underinsured) with lung cancer (LC) and head-and-neck cancer (HNC). METHODS In a randomized controlled trial, we investigated if 147 patients who received the stepped-care intervention had better mental health outcomes compared to 139 patients who received usual care. Using an intent-to-treat approach, we analyzed outcomes with linear mixed models. RESULTS For the primary outcomes estimated mean differences (denoted by "Δ"), depression (Δ = 1.75, 95% CI = 0.52, 2.98, p = 0.01) and coping self-efficacy (Δ = -15.24, 95% CI = -26.12, -4.36, p = 0.01) were better for patients who received the intervention compared to patients who received usual care, but anxiety outcomes were not different. For secondary outcomes, emotional distress (Δ = 1.97, 95% CI: 0.68, 3.54, p =< 0.01) and HRQoL (Δ = -4.16 95% CI: -7.45, -0.87, p = 0.01) were better for patients who received the intervention compared to usual care patients, while perceived stress was not different across groups. CONCLUSIONS The stepped-care intervention influenced depression and coping self-efficacy, important outcomes for patients with acute illnesses like LC and HNC. Although differences in emotional distress met the minimally important differences (MID) previously reported, depression and HRQoL were not above the MID threshold. Our study is among a few to report differences in mental health outcomes for underserved LC and HNC patients after receiving a psychological intervention. CLINICALTRIALS GOV IDENTIFIER NCT03016403.
Collapse
Affiliation(s)
- Evelinn A Borrayo
- Department of Community & Behavioral Health, Colorado School of Public Health, Aurora, Colorado, USA
- Latino Research and Policy Center, Colorado School of Public Health, Denver, Colorado, USA
| | - Elizabeth Juarez-Colunga
- Department of Biostatistics & Informatics, Colorado School of Public Health, Aurora, Colorado, USA
| | - Kristin Kilbourn
- Department of Psychology, College of Liberal Arts and Sciences, Denver, Colorado, USA
| | - Jeanette Waxmonsky
- Department of Family Medicine, School of Medicine, Aurora, Colorado, USA
| | - Marty Jacobson
- Veterans Administration Medical Center, Grand Junction, Colorado, USA
| | - Sonia Okuyama
- Hematology-Oncology, Denver Health and Hospital Authority, Denver, Colorado, USA
| | - Robert Swaney
- Medical Oncology, Ascension St. Vincent Evansville Cancer Center, Newburgh, IN, USA
| | | | - Sana Karam
- Radiation Oncology, School of Medicine, Aurora, Colorado, USA
| | - Samantha Lopez Alvarez
- Latino Research and Policy Center, Colorado School of Public Health, Denver, Colorado, USA
| | - Xin Jin
- Department of Biostatistics & Informatics, Colorado School of Public Health, Aurora, Colorado, USA
| | - Jennifer Nguyen
- Latino Research and Policy Center, Colorado School of Public Health, Denver, Colorado, USA
| |
Collapse
|
2
|
Edinger JD, Wamboldt FS, Johnson RL, Simmons B, Tsai S, Morin CM, Holm KE. Adherence to behavioral recommendations of cognitive behavioral therapy for insomnia predicts medication use after a structured medication taper. J Clin Sleep Med 2023; 19:1495-1503. [PMID: 37086054 PMCID: PMC10394369 DOI: 10.5664/jcsm.10616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 03/31/2023] [Accepted: 03/31/2023] [Indexed: 04/23/2023]
Abstract
STUDY OBJECTIVES Cognitive behavioral therapy for insomnia (CBTI) has been paired with supervised medication tapering to help hypnotic-dependent individuals discontinue their hypnotics. This study examined the hypothesis that higher participant adherence to behavioral recommendations of CBTI will predict lower odds of using sleep medications 3 months after completion of a combined CBTI/sleep medication tapering protocol. METHODS Fifty-eight individuals who used sedative hypnotics completed four CBTI sessions followed by sleep medication tapering. Logistic regression was used to examine the association of stability of time in bed and stability of rise time (measured as the within-person standard deviation) at completion of CBTI with two outcomes at 3-month follow-up: use of sedative hypnotics and use of any medication/substance for sleep. RESULTS Participants with more stability in their rise time after CBTI than at baseline (ie, a decrease in their within-person standard deviation) had 69.5% lower odds of using sedative hypnotics at follow-up (odds ratio = 0.305, 95% confidence interval = 0.095-0.979, P = .046) than individuals who had no change or a decrease in the stability of their rise time. Results were similar for time in bed: participants with more stability in their time in bed after CBTI than at baseline had 83.2% lower odds of using sedative hypnotics (odds ratio = 0.168, 95% confidence interval = 0.049-0.580, P = .005). Increase in stability of rise time and stability of time in bed was also associated with reduced odds of using any medication/substance for sleep at follow-up. CONCLUSIONS Participants who implement behavioral recommendations of CBTI appear to have more success with discontinuing use of sleep medications. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov; Name: The Role of Tapering Pace and Selected Traits on Hypnotic Discontinuation; URL: https://clinicaltrials.gov/ct2/show/NCT02831894; Identifier: NCT02831894. CITATION Edinger JD, Wamboldt FS, Johnson RL, et al. Adherence to behavioral recommendations of cognitive behavioral therapy for insomnia predicts medication use after a structured medication taper. J Clin Sleep Med. 2023;19(8):1495-1503.
Collapse
Affiliation(s)
- Jack D. Edinger
- National Jewish Health, Denver, Colorado
- Duke University Medical Center, Durham, North Carolina
| | | | | | | | | | | | - Kristen E. Holm
- National Jewish Health, Denver, Colorado
- Colorado School of Public Health, Denver, Colorado
| |
Collapse
|
3
|
Wang E, Zahid S, Moudgal AN, Demaestri S, Wamboldt FS. Intimate partner violence and asthma in pediatric and adult populations. Ann Allergy Asthma Immunol 2022; 128:361-378. [PMID: 34995784 DOI: 10.1016/j.anai.2021.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 12/15/2021] [Accepted: 12/28/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate the relationship between intimate partner violence (IPV) and adult and childhood asthma outcomes. DATA SOURCES We conducted a systematic literature review using 4 databases (PubMed, Ovid MEDLINE, Ovid Embase, and Ovid PsycINFO) with asthma and IPV-associated terms. STUDY SELECTIONS We included published studies, available in English, to October 2021, which included IPV as an exposure and asthma as an outcome. Both adult and pediatric populations were included in the following settings: community, health care, and home. RESULTS There were 37 articles identified. There was evidence among multiple studies to support increased prevalence of asthma in adults exposed to IPV and prevalence and incidence in children with parental IPV exposure. There were fewer studies evaluating IPV exposure and adult asthma morbidity, but they found statistically significant associations between IPV and increased rate of asthma exacerbations and worsened asthma control. There was sparse evidence evaluating a relationship between IPV and adult asthma mortality. There were no studies identified evaluating IPV and childhood asthma morbidity or mortality. CONCLUSION The association between IPV and increased asthma prevalence, incidence, and worsened morbidity merits recognition and further investigation into potential mechanisms. Health care providers can implement practical strategies to help mitigate the negative effects of IPV on health and asthma. These include addressing potential impactful biopsychosocial factors and comorbidities, implementing routine screening and referrals, and partnering with community advocacy organizations. Given their positions of respect and power in society, health care providers can have lasting impacts on the lives of pediatric and adult patients affected by IPV.
Collapse
Affiliation(s)
- Eileen Wang
- National Jewish Health, Denver, Colorado; University of Colorado School of Medicine, Aurora, Colorado.
| | | | | | - Sabrina Demaestri
- Kansas City University of Medicine and Biosciences, Kansas City, Missouri
| | | |
Collapse
|
4
|
Lehrer P, Irvin CG, Lu SE, Wamboldt FS. Relationships among pulmonary function, anxiety and depression in mild asthma: An exploratory study. Biol Psychol 2021; 168:108244. [PMID: 34954274 DOI: 10.1016/j.biopsycho.2021.108244] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 12/04/2021] [Accepted: 12/20/2021] [Indexed: 11/25/2022]
Abstract
In a secondary analysis of data from a prior study, we calculated the relationships among depression (PHQ-8), anxiety (GAD-7), and measures of asthma in 69 steroid-naïve patients with mild and moderate symptomatic asthma. Average levels of pulmonary function, depression and anxiety tended to be in the normal range, and asthma tended to be well controlled (Asthma Control Test). Nevertheless, PHQ-8 scores were significantly correlated with forced oscillation (FO) measures of airway reactance (AX) and resistance at a low frequency of stimulation (Rrs5Hz). GAD-7 scores also were significantly related to Rrs5Hz. Exploratory analyses in supplementary data provide no evidence for vagal mediation of the association. Further research is necessary to discover mechanisms for the associations found here. Future studies might examine the utility of assessing and treating mild anxiety and depression in mild to moderate asthma.
Collapse
|
5
|
Bathgate CJ, Kilbourn KM, Murphy NH, Wamboldt FS, Holm KE. Pilot RCT of a telehealth intervention to reduce symptoms of depression and anxiety in adults with cystic fibrosis. J Cyst Fibros 2021; 21:332-338. [PMID: 34366282 DOI: 10.1016/j.jcf.2021.07.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 07/15/2021] [Accepted: 07/24/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Adults with cystic fibrosis (awCF) have higher levels of depression and anxiety than community samples. The Coping and Learning to Manage Stress with CF (CALM) intervention was developed for awCF reporting elevated symptoms of depression or anxiety. METHODS In this pilot study, awCF were randomly assigned to either six telehealth sessions (CALM; n = 15) or treatment-as-usual (TAU; n = 16). Primary outcomes were depression and anxiety. Secondary outcomes were coping self-efficacy and health-related quality of life (HrQOL). Tertiary outcomes were feasibility, acceptability, and satisfaction. Assessments were completed at baseline, post-intervention, and 3-month follow-up. Group differences were examined via independent samples t-tests. Effect size (ES) was calculated via Cohen's d to provide a measure of the magnitude of the treatment effect. RESULTS At post-intervention, the CALM group had a lower mean score than the TAU group for depression (medium ES) and anxiety (large ES). The CALM group had higher (i.e., better) mean scores than the TAU group for coping (large ES) and HrQOL domains of Social Functioning (large ES) and Vitality (large ES). Most treatment gains were not sustained at 3-month follow-up. CALM was feasible, requiring <12 min. for setup and scheduling, and allowed seamless participation when hospitalized. Mean scores for acceptability and satisfaction indicated that most participants either agreed or strongly agreed that CALM was acceptable and satisfactory. CONCLUSIONS CALM shows promise as an intervention to reduce symptoms of depression and anxiety and improve coping and HrQOL. Next steps are to add a booster session and examine CALM via a multi-site RCT.
Collapse
Affiliation(s)
- Christina J Bathgate
- Department of Medicine, National Jewish Health, 1400 Jackson St., M107D, Denver, CO 80206, USA.
| | - Kristin M Kilbourn
- Department of Psychology, University of Colorado Denver, 1200 Larimer St, Denver, CO 80204, USA
| | - Nora H Murphy
- Department of Medicine, National Jewish Health, 1400 Jackson St., M107D, Denver, CO 80206, USA
| | - Frederick S Wamboldt
- Department of Medicine, National Jewish Health, 1400 Jackson St., M107D, Denver, CO 80206, USA
| | - Kristen E Holm
- Department of Medicine, National Jewish Health, 1400 Jackson St., M107D, Denver, CO 80206, USA
| |
Collapse
|
6
|
Brunette AM, Warner K, Holm KE, Meschede K, Wamboldt FS, Kozora E, Moser DJ, Make BJ, Crapo JD, Moreau KL, Weinberger HD, Bowler R, Hoth KF. Daily Activities: The Impact of COPD and Cognitive Dysfunction. Arch Clin Neuropsychol 2021; 36:acaa090 767 779-767. [PMID: 33103191 PMCID: PMC8500183 DOI: 10.1093/arclin/acaa090] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2020] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Chronic obstructive pulmonary disease (COPD) is characterized by airflow limitation; however, pulmonary function does not fully account for patients' functional difficulties. The primary aim of the study was to determine the association between several domains of cognition and daily activity among those with COPD. METHOD Eighty-nine former smokers completed a neuropsychological battery including measures across multiple domains of cognition, pulmonary function measures, and daily activity questionnaires. Using a cross-sectional design, we compared daily activity between former smokers with and without COPD using two measures (St. George's Respiratory Questionnaire [SGRQ] Activity Subscale and Lawton Instrumental Activities of Daily Living [IADL] Scale) and examined the association between cognition and daily activity among those with COPD. RESULTS As expected, former smokers with COPD reported more difficulty than those without COPD on both activity measures (SGRQ Activity Subscale p < .001; Lawton IADL Scale p = .040). Among former smokers with COPD, poorer delayed recall was associated with more difficulty with daily activities (SGRQ Activity Subscale) (p = .038) while adjusting for severity of airflow limitation, exercise tolerance, oxygen use, dyspnea, and symptoms of anxiety and depression. CONCLUSION The findings suggest that cognition is associated with daily activity in patients with COPD. Future research should examine whether cognitive interventions may help to maximize patients' engagement in daily activities.
Collapse
Affiliation(s)
- Amanda M Brunette
- University of Iowa, Department of Psychological and Brain Sciences, Iowa City, IA 52242, USA
| | - Kelsey Warner
- University of Iowa Carver College of Medicine, Department of Psychiatry, Iowa City, IA 52242, USA
- Hennepin Healthcare, Department of Speech-Language Pathology, Minneapolis, MN 55404, USA
| | - Kristen E Holm
- National Jewish Health, Department of Medicine, Denver, CO 80206, USA
- Colorado School of Public Health, Department of Community and Behavioral Health, Aurora, CO 80045, USA
| | - Kimberly Meschede
- National Jewish Health, Department of Medicine, Denver, CO 80206, USA
| | - Frederick S Wamboldt
- National Jewish Health, Department of Medicine, Denver, CO 80206, USA
- University of Colorado School of Medicine at the Anschutz Medical Campus, Department of Psychiatry, Aurora, CO 80045, USA
| | - Elizabeth Kozora
- National Jewish Health, Department of Medicine, Denver, CO 80206, USA
- University of Colorado School of Medicine at the Anschutz Medical Campus, Department of Psychiatry, Aurora, CO 80045, USA
| | - David J Moser
- University of Iowa Carver College of Medicine, Department of Psychiatry, Iowa City, IA 52242, USA
| | - Barry J Make
- National Jewish Health, Department of Medicine, Denver, CO 80206, USA
- University of Colorado School of Medicine at the Anschutz Medical Campus, Department of Medicine, Aurora, CO 80045, USA
| | - James D Crapo
- National Jewish Health, Department of Medicine, Denver, CO 80206, USA
- University of Colorado School of Medicine at the Anschutz Medical Campus, Department of Medicine, Aurora, CO 80045, USA
| | - Kerrie L Moreau
- University of Colorado School of Medicine at the Anschutz Medical Campus, Department of Medicine, Aurora, CO 80045, USA
- Denver Veterans Administration Medical Center, Geriatric Research Education and Clinical Center, Denver, CO 80220 USA
| | - Howard D Weinberger
- National Jewish Health, Department of Medicine, Denver, CO 80206, USA
- University of Colorado School of Medicine at the Anschutz Medical Campus, Department of Medicine, Aurora, CO 80045, USA
| | - Russell Bowler
- National Jewish Health, Department of Medicine, Denver, CO 80206, USA
- University of Colorado School of Medicine at the Anschutz Medical Campus, Department of Medicine, Aurora, CO 80045, USA
| | - Karin F Hoth
- University of Iowa Carver College of Medicine, Department of Psychiatry, Iowa City, IA 52242, USA
- National Jewish Health, Department of Medicine, Denver, CO 80206, USA
- University of Iowa, Iowa Neuroscience Institute, Iowa City, IA 52242, USA
| |
Collapse
|
7
|
Lindsay HG, Wamboldt FS, Holm KE, Make BJ, Hokanson J, Crapo JD, Regan EA. Impact of a Medical Diagnosis on Decision to Stop Smoking and Successful Smoking Cessation. Chronic Obstr Pulm Dis 2021; 8:360-370. [PMID: 34010545 DOI: 10.15326/jcopdf.2020.0167] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Introduction Smoking cessation counseling is a central part of the Medicare guidelines for lung cancer screening. With increasing age, many heavy smokers eventually stop smoking, however, factors influencing the decision to stop smoking are poorly understood. We postulated that declining health or physician-diagnosis of a medical condition may be associated with successful smoking cessation. Methods A total of 4448 current and former smokers in Phase 2 of the COPD Genetic Epidemiology (COPDGene®) study answered a question about reasons for stopping smoking. Participants were classified as successful quitters (n=3345), and unsuccessful quitters (n=1003). Reasons cited for quitting were grouped as: medical diagnoses, social factors, symptoms. Logistic modeling of factors associated with successful quitting were adjusted for age, gender, race, and education. Results The most common factors cited for a quit attempt by all respondents were medical diagnoses (48%), followed by social factors (47%), and respiratory symptoms (36%). Successful quitters were more likely to be older, male, and non-Hispanic White. An adjusted model found increased age, White race, education beyond high school, and male sex favored successful quitting while the cited medical diagnoses, social factors, and "other" reasons were associated with unsuccessful quitting. Fagerstrom Nicotine Dependence scores were ³ 5 in 54% of the unsuccessful group compared to 45% for successful quitters(p<0.0001) suggesting some increased nicotine dependence in the unsuccessful quitters. Conclusions Medical diagnosis was the most common factor cited for considering a quit attempt by both successful and unsuccessful quitters; however, successful quitting was influenced by demographic factors and potentially the severity of nicotine dependence.
Collapse
Affiliation(s)
| | - Frederick S Wamboldt
- National Jewish Health, Denver Colorado, United States.,Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado, United States
| | - Kristen E Holm
- National Jewish Health, Denver Colorado, United States.,Department of Community and Behavioral Health, Colorado School of Public Health, Aurora Colorado, United States
| | - Barry J Make
- National Jewish Health, Denver Colorado, United States
| | - John Hokanson
- Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado, United States
| | - James D Crapo
- National Jewish Health, Denver Colorado, United States
| | - Elizabeth A Regan
- National Jewish Health, Denver Colorado, United States.,Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado, United States
| | | |
Collapse
|
8
|
Hoth KF, Moreau KL, Weinberger HD, Holm KE, Meschede K, Crapo JD, Make BJ, Moser DJ, Kozora E, Bowler RP, Pierce GL, Ten Eyck P, Wamboldt FS. Carotid Artery Stiffness is Associated With Cognitive Performance in Former Smokers With and Without Chronic Obstructive Pulmonary Disease. J Am Heart Assoc 2020; 9:e014862. [PMID: 32338117 PMCID: PMC7428572 DOI: 10.1161/jaha.119.014862] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Heavy smokers perform worse on neuropsychological assessment than age‐matched peers. However, traditional pulmonary measures of airflow limitation and hypoxemia explain only a modest amount of variance in cognition. The current objective was to determine whether carotid artery stiffness is associated with cognition in former smokers beyond the effects of amount of smoking and pulmonary function. Methods and Results Eighty‐four former smokers including individuals across a spectrum of airflow limitation severity were included: 30 without chronic obstructive pulmonary disease (Global Initiative for Chronic Obstructive Lung Disease [GOLD] 0 with normal spirometry and lung computed tomography), 31 with mild‐moderate chronic obstructive pulmonary disease (GOLD 1–2), and 23 with severe‐very severe chronic obstructive pulmonary disease (GOLD 3–4). Participants completed questionnaires, spirometry, carotid ultrasonography, and neuropsychological testing. Multiple linear regression was used to determine whether carotid artery stiffness is associated with neuropsychological performance in 4 cognitive domains after adjusting for age, sex, pack‐years of smoking, estimated premorbid intellectual functioning, and airflow limitation. Higher carotid artery β‐stiffness index was associated with reduced executive functioning‐processing speed in the fully adjusted model (β=−0.49, SE=0.14; P=0.001). Lower premorbid intellectual function, male sex, and presence of airflow limitation (GOLD 1 or 2 and GOLD 3 or 4) were also associated with worse executive functioning‐processing speed. β‐Stiffness index was not significantly associated with performance in other cognitive domains. Conclusions Carotid artery stiffness is associated with worse performance on executive functioning‐processing speed in former smokers beyond the effects of aging, amount of past smoking, severity of airflow limitation, and hypoxemia. Future research should examine whether carotid stiffness can be used to identify former smokers at risk for subsequent cognitive impairment.
Collapse
Affiliation(s)
- Karin F Hoth
- Psychiatry University of Iowa Iowa City IA.,Iowa Neuroscience Institute University of Iowa Iowa City IA.,Medicine National Jewish Health Denver CO
| | - Kerrie L Moreau
- Medicine University of Colorado Anschutz Medical Campus Aurora CO
| | - Howard D Weinberger
- Medicine National Jewish Health Denver CO.,Medicine University of Colorado Anschutz Medical Campus Aurora CO
| | - Kristen E Holm
- Medicine National Jewish Health Denver CO.,Community and Behavioral Health University of Colorado School of Public Health Aurora CO
| | | | - James D Crapo
- Medicine National Jewish Health Denver CO.,Medicine University of Colorado Anschutz Medical Campus Aurora CO
| | - Barry J Make
- Medicine National Jewish Health Denver CO.,Medicine University of Colorado Anschutz Medical Campus Aurora CO
| | | | - Elizabeth Kozora
- Medicine National Jewish Health Denver CO.,Psychiatry University of Colorado Anschutz Medical Campus Aurora CO
| | - Russell P Bowler
- Medicine National Jewish Health Denver CO.,Medicine University of Colorado Anschutz Medical Campus Aurora CO
| | - Gary L Pierce
- Health and Human Physiology University of Iowa Iowa City IA.,Abboud Cardiovascular Research Center University of Iowa Iowa City IA.,Environmental Health Sciences Research Center University of Iowa Iowa City IA
| | - Patrick Ten Eyck
- Institute for Clinical and Translational Science University of Iowa Iowa City IA
| | - Frederick S Wamboldt
- Medicine National Jewish Health Denver CO.,Psychiatry University of Colorado Anschutz Medical Campus Aurora CO
| |
Collapse
|
9
|
Croghan A, Brunette A, Holm KE, Kozora E, Moser DJ, Wamboldt FS, Meschede K, Make BJ, Crapo JD, Weinberger HD, Moreau KL, Bowler RP, Hoth KF. Reduced Attention in Former Smokers with and without COPD. Int J Behav Med 2019; 26:600-607. [PMID: 31732904 PMCID: PMC7269072 DOI: 10.1007/s12529-019-09826-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Attention difficulties are often reported by patients with chronic obstructive pulmonary disease (COPD); however, limited research exists using objective tests designed specifically to measure attention in this population. This study aimed to (1) identify specific attention deficits in COPD and (2) determine which demographic/clinical characteristics are associated with reduced attention. METHODS Eighty-four former smokers (53 COPD, 31 no COPD) completed questionnaires, pulmonary function testing, and the Conner's Continuous Performance Test II (CPT-II). Participants with and without COPD were compared on CPT-II measures of inattention, impulsivity, and vigilance. CPT-II measures that differed significantly between the two groups were further examined using hierarchical regression modeling. Demographic/clinical characteristics were entered into models with attention as the dependent variable. RESULTS Participants with COPD performed worse than those without COPD on CPT measures of inattention and impulsivity (i.e., detectability [discrimination of target from non-target stimuli], perseverations [reaction time under 100 ms], omissions [target stimuli response failures], and commissions [responses to non-target stimuli]). More severe COPD (measured by greater airflow limitation) was associated with poorer ability to detect targets vs. foils and perseverative responding after adjusting for age and other covariates in the model. CONCLUSION Former smokers with COPD experience problems with attention that go beyond slowed processing speed, including aspects of inattention and impulsivity. Clinicians should be aware that greater airflow limitation and older age are associated with attention difficulties, as this may impact functioning.
Collapse
Affiliation(s)
- Anna Croghan
- Department of Psychology, University of North Dakota, Grand Forks, ND, USA
- Department of Psychiatry, University of Iowa Carver College of Medicine, 200 Hawkins Dr., W278GH, Iowa City, IA, 52242, USA
| | - Amanda Brunette
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA, USA
| | - Kristen E Holm
- National Jewish Health, Department of Medicine, Denver, CO, USA
- Colorado School of Public Health, Department of Community and Behavioral Health, Aurora, CO, USA
| | - Elizabeth Kozora
- National Jewish Health, Department of Medicine, Denver, CO, USA
- Department of Psychiatry, University of Colorado School of Medicine at the Anschutz Medical Campus, Aurora, CO, USA
| | - David J Moser
- Department of Psychiatry, University of Iowa Carver College of Medicine, 200 Hawkins Dr., W278GH, Iowa City, IA, 52242, USA
| | - Frederick S Wamboldt
- National Jewish Health, Department of Medicine, Denver, CO, USA
- Department of Psychiatry, University of Colorado School of Medicine at the Anschutz Medical Campus, Aurora, CO, USA
| | | | - Barry J Make
- National Jewish Health, Department of Medicine, Denver, CO, USA
- University of Colorado School of Medicine at the Anschutz Medical Campus, Aurora, CO, USA
| | - James D Crapo
- National Jewish Health, Department of Medicine, Denver, CO, USA
- University of Colorado School of Medicine at the Anschutz Medical Campus, Aurora, CO, USA
| | - Howard D Weinberger
- National Jewish Health, Department of Medicine, Denver, CO, USA
- University of Colorado School of Medicine at the Anschutz Medical Campus, Aurora, CO, USA
| | - Kerrie L Moreau
- University of Colorado School of Medicine at the Anschutz Medical Campus, Aurora, CO, USA
- VA Eastern Colorado Geriatric Research, Education, and Clinical Center Aurora, Denver, CO, USA
| | - Russell P Bowler
- National Jewish Health, Department of Medicine, Denver, CO, USA
- University of Colorado School of Medicine at the Anschutz Medical Campus, Aurora, CO, USA
| | - Karin F Hoth
- Department of Psychiatry, University of Iowa Carver College of Medicine, 200 Hawkins Dr., W278GH, Iowa City, IA, 52242, USA.
| |
Collapse
|
10
|
Lehrer PM, Irvin CG, Lu SE, Scardella A, Roehmheld-Hamm B, Aviles-Velez M, Graves J, Vaschillo EG, Vaschillo B, Hoyte F, Nelson H, Wamboldt FS. Heart Rate Variability Biofeedback Does Not Substitute for Asthma Steroid Controller Medication. Appl Psychophysiol Biofeedback 2019; 43:57-73. [PMID: 29124506 DOI: 10.1007/s10484-017-9382-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Despite previous findings of therapeutic effects for heart rate variability biofeedback (HRVB) on asthma, it is not known whether HRVB can substitute either for controller or rescue medication, or whether it affects airway inflammation. Sixty-eight paid volunteer steroid naïve study participants with mild or moderate asthma were given 3 months of HRVB or a comparison condition consisting of EEG alpha biofeedback with relaxing music and relaxed paced breathing (EEG+), in a two-center trial. All participants received a month of intensive asthma education prior to randomization. Both treatment conditions produced similar significant improvements on the methacholine challenge test (MCT), asthma symptoms, and asthma quality of life (AQOL). MCT effects were of similar size to those of enhanced placebo procedures reported elsewhere, and were 65% of those of a course of a high-potency inhaled steroid budesonide given to a sub-group of participants following biofeedback training. Exhaled nitric oxide decreased significantly only in the HRVB group, 81% of the budesonide effect, but with no significant differences between groups. Participants reported becoming more relaxed during practice of both techniques. Administration of albuterol after biofeedback sessions produced a large improvement in pulmonary function test results, indicating that neither treatment normalized pulmonary function as a potent controller medication would have done. Impulse oscillometry showed increased upper airway (vocal cord) resistance during biofeedback periods in both groups. These data suggest that HRVB should not be considered an alternative to asthma controller medications (e.g., inhaled steroids), although both biofeedback conditions produced some beneficial effects, warranting further research, and suggesting potential complementary effects. Various hypotheses are presented to explain why HRVB effects on asthma appeared smaller in this study than in earlier studies. Clinical Trial Registration NCT02766374.
Collapse
Affiliation(s)
- Paul M Lehrer
- Department of Psychiatry, Rutgers - Robert Wood Johnson Medical School, 671 Hoes Lane, Piscataway, NJ, 08854, USA.
| | - Charles G Irvin
- University of Vermont, Larner College of Medicine, Burlington, VT, USA
| | - Shou-En Lu
- Rutgers School of Public Health, Piscataway, NJ, USA
| | - Anthony Scardella
- Department of Psychiatry, Rutgers - Robert Wood Johnson Medical School, 671 Hoes Lane, Piscataway, NJ, 08854, USA
| | - Beatrix Roehmheld-Hamm
- Department of Psychiatry, Rutgers - Robert Wood Johnson Medical School, 671 Hoes Lane, Piscataway, NJ, 08854, USA
| | - Milisyaris Aviles-Velez
- Department of Psychiatry, Rutgers - Robert Wood Johnson Medical School, 671 Hoes Lane, Piscataway, NJ, 08854, USA
| | | | | | - Bronya Vaschillo
- Rutgers, The State University of New Jersey, Piscataway, NJ, USA
| | - Flavia Hoyte
- University of Colorado School of Medicine, Aurora, CO, USA.,National Jewish Health, Denver, CO, USA
| | - Harold Nelson
- University of Colorado School of Medicine, Aurora, CO, USA.,National Jewish Health, Denver, CO, USA
| | - Frederick S Wamboldt
- University of Colorado School of Medicine, Aurora, CO, USA.,National Jewish Health, Denver, CO, USA
| |
Collapse
|
11
|
Iyer AS, Holm KE, Bhatt SP, Kim V, Kinney GL, Wamboldt FS, Jacobs MR, Regan EA, Armstrong HF, Lowe KE, Martinez CH, Dransfield MT, Foreman MG, Shinozaki G, Hanania NA, Wise RA, Make BJ, Hoth KF. Symptoms of anxiety and depression and use of anxiolytic-hypnotics and antidepressants in current and former smokers with and without COPD - A cross sectional analysis of the COPDGene cohort. J Psychosom Res 2019; 118:18-26. [PMID: 30782350 PMCID: PMC6383809 DOI: 10.1016/j.jpsychores.2019.01.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 01/03/2019] [Accepted: 01/04/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To compare the frequency of anxiety/depressive symptoms and use of anxiolytic-hypnotics/antidepressants in smokers with and without COPD and to identify characteristics associated with having unmedicated symptoms. METHODS Cross-sectional analysis of ambulatory, current/former smokers ≥10 pack years enrolled in the COPDGene study. We measured anxiety/depressive symptoms using the Hospital Anxiety and Depression Scale (subscales ≥8), recorded anxiolytic-hypnotic/antidepressant use, and defined unmedicated symptoms as elevated anxiety/depressive symptoms and not on medications. Regression analysis identified characteristics associated with having unmedicated symptoms. KEY RESULTS Of 5331 current/former smokers (45% with and 55% without COPD), 1332 (25.0%) had anxiety/depressive symptoms. Anxiety symptoms were similar in frequency in smokers with and without COPD (19.7% overall), while depressive symptoms were most frequent in severe-very severe COPD at 20.7% (13.1% overall). In the entire cohort, 1135 (21.2%) were on medications. Anxiolytic-hypnotic use was highest in severe-very severe COPD (range 7.6%-12.0%), while antidepressant use showed no significant variation in smokers with and without COPD (range 14.7%-17.1%). Overall, 881 (66% of those with symptoms) had unmedicated symptoms, which was associated with African American race (adjusted OR 2.95, 95% CI 2.25-3.87), male gender (adjusted OR 1.93, 95% CI 1.57-2.36), no health insurance (adjusted OR 2.38, 95% CI 1.30-4.35), severe-very severe COPD (adjusted OR 1.48, 95% CI 1.04-2.11), and higher respiratory symptoms/exacerbation history (adjusted OR 2.21, 95% CI 1.62-3.02). CONCLUSIONS Significant unmet mental health care needs exist in current and former smokers with and without COPD. One in five have unmedicated symptoms, identified by key demographic and clinical characteristics. PRIMARY FUNDING SOURCE National Institutes of Health and The COPD Foundation.
Collapse
Affiliation(s)
- Anand S Iyer
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA; Lung Health Center, University of Alabama at Birmingham, Birmingham, AL, USA; Health Services, Outcomes, and Effectiveness Research Training Program, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Kristen E Holm
- Department of Medicine, National Jewish Health, Denver, CO, USA; Department of Community and Behavioral Health, Colorado School of Public Health, Aurora, CO, USA
| | - Surya P Bhatt
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA; Lung Health Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Victor Kim
- Department of Thoracic Medicine and Surgery, Temple University School of Medicine Philadelphia, PA, USA
| | - Gregory L Kinney
- Department of Epidemiology, Colorado School of Public Health, University of Colorado, Aurora, CO, USA
| | - Frederick S Wamboldt
- Department of Medicine, National Jewish Health, Denver, CO, USA; Department of Psychiatry, University of Colorado School of Medicine at the Anschutz Medical Campus, Aurora, CO, USA
| | - Michael R Jacobs
- Department of Thoracic Medicine and Surgery, Temple University School of Medicine Philadelphia, PA, USA
| | - Elizabeth A Regan
- Department of Medicine, National Jewish Health, Denver, CO, USA; Department of Epidemiology, Colorado School of Public Health, University of Colorado, Aurora, CO, USA
| | - Hilary F Armstrong
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Katherine E Lowe
- Department of Epidemiology, Colorado School of Public Health, University of Colorado, Aurora, CO, USA
| | - Carlos H Martinez
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Mark T Dransfield
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA; Lung Health Center, University of Alabama at Birmingham, Birmingham, AL, USA; Veterans Affairs Medical Center, Birmingham, AL, USA
| | - Marilyn G Foreman
- Division of Pulmonary and Critical Care Medicine, Morehouse School of Medicine, Atlanta, GA, USA
| | - Gen Shinozaki
- Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City, IA, USA; Iowa Neuroscience Institute, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Nicola A Hanania
- Division of Pulmonary/Critical Care Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Robert A Wise
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Barry J Make
- Department of Medicine, National Jewish Health, Denver, CO, USA
| | - Karin F Hoth
- Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City, IA, USA; Iowa Neuroscience Institute, Carver College of Medicine, University of Iowa, Iowa City, IA, USA; Department of Pulmonary, Critical Care, and Sleep Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA, USA.
| |
Collapse
|
12
|
Brunette AM, Holm KE, Wamboldt FS, Kozora E, Moser DJ, Make BJ, Crapo JD, Meschede K, Weinberger HD, Moreau KL, Bowler RP, Hoth KF. Subjective cognitive complaints and neuropsychological performance in former smokers with and without chronic obstructive pulmonary disease. J Clin Exp Neuropsychol 2018; 40:411-422. [PMID: 28766459 PMCID: PMC5953430 DOI: 10.1080/13803395.2017.1356912] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE This study examined the association of perceived cognitive difficulties with objective cognitive performance in former smokers. We hypothesized that greater perceived cognitive difficulties would be associated with poorer performance on objective executive and memory tasks. METHOD Participants were 95 former smokers recruited from the COPDGene study. They completed questionnaires (including the Cognitive Difficulties Scale [CDS] and the Hospital Anxiety and Depression Scale [HADS]), neuropsychological assessment, and pulmonary function testing. Pearson correlations and t-tests were conducted to examine the bivariate association of the CDS (total score and subscales for attention/concentration, praxis, delayed recall, orientation for persons, temporal orientation, and prospective memory) with each domain of objective cognitive functioning (memory recall, executive functioning/processing speed, visuospatial processing, and language). Simultaneous multiple linear regression was used to further examine all statistically significant bivariate associations. The following covariates were included in all regression models: age, sex, pack-years, premorbid functioning (WRAT-IV Reading), HADS total score, and chronic obstructive pulmonary disease (COPD) status (yes/no based on GOLD criteria). RESULTS In regression models, greater perceived cognitive difficulties overall (using CDS total score) were associated with poorer performance on executive functioning/processing speed tasks (b = -0.07, SE = 0.03, p = .037). Greater perceived cognitive difficulties on the CDS praxis subscale were associated with poorer performance on executive functioning/processing speed tasks (b = -3.65, SE = 1.25, p = .005), memory recall tasks (b = -4.60, SE = 1.75, p = .010), and language tasks (b = -3.89, SE = 1.39, p = .006). CONCLUSIONS Clinicians should be aware that cognitive complaints may be indicative of problems with the executive functioning/processing speed and memory of former smokers with and without COPD.
Collapse
Affiliation(s)
- Amanda M Brunette
- a Department of Psychological and Brain Sciences , University of Iowa , Iowa City , IA , USA
| | - Kristen E Holm
- b Department of Medicine , National Jewish Health , Denver , CO , USA
- c Department of Community and Behavioral Health , Colorado School of Public Health , Aurora , CO , USA
| | - Frederick S Wamboldt
- b Department of Medicine , National Jewish Health , Denver , CO , USA
- d Department of Psychiatry , University of Colorado School of Medicine at the Anschutz Medical Campus , Aurora , CO , USA
| | - Elizabeth Kozora
- b Department of Medicine , National Jewish Health , Denver , CO , USA
- d Department of Psychiatry , University of Colorado School of Medicine at the Anschutz Medical Campus , Aurora , CO , USA
| | - David J Moser
- e Department of Psychiatry , University of Iowa Carver College of Medicine , Iowa City , IA , USA
| | - Barry J Make
- b Department of Medicine , National Jewish Health , Denver , CO , USA
- f Department of Medicine , University of Colorado School of Medicine at the Anschutz Medical Campus , Aurora , CO , USA
| | - James D Crapo
- b Department of Medicine , National Jewish Health , Denver , CO , USA
- f Department of Medicine , University of Colorado School of Medicine at the Anschutz Medical Campus , Aurora , CO , USA
| | - Kimberly Meschede
- b Department of Medicine , National Jewish Health , Denver , CO , USA
| | - Howard D Weinberger
- b Department of Medicine , National Jewish Health , Denver , CO , USA
- f Department of Medicine , University of Colorado School of Medicine at the Anschutz Medical Campus , Aurora , CO , USA
| | - Kerrie L Moreau
- f Department of Medicine , University of Colorado School of Medicine at the Anschutz Medical Campus , Aurora , CO , USA
- g Geriatric Research Education and Clinical Center , Denver Veterans Administration Medical Center , Denver , CO , USA
| | - Russell P Bowler
- b Department of Medicine , National Jewish Health , Denver , CO , USA
- f Department of Medicine , University of Colorado School of Medicine at the Anschutz Medical Campus , Aurora , CO , USA
| | - Karin F Hoth
- b Department of Medicine , National Jewish Health , Denver , CO , USA
- e Department of Psychiatry , University of Iowa Carver College of Medicine , Iowa City , IA , USA
| |
Collapse
|
13
|
Root ED, Graney B, Baird S, Churney T, Fier K, Korn M, McCormic M, Sprunger D, Vierzba T, Wamboldt FS, Swigris JJ. Physical activity and activity space in patients with pulmonary fibrosis not prescribed supplemental oxygen. BMC Pulm Med 2017; 17:154. [PMID: 29169394 PMCID: PMC5701349 DOI: 10.1186/s12890-017-0495-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 11/14/2017] [Indexed: 11/13/2022] Open
Abstract
Background Patients with pulmonary fibrosis (PF) have impaired quality of life, and research suggests that dyspnea and physical activity are primary drivers. As PF progresses, some patients notice the disease “shrinks their worlds”. The objective of this study is to describe movement (both physical activity and activity space) in a cohort of patients with PF of various etiologies who have not been prescribed supplemental oxygen (O2). Methods Subjects with PF not on supplemental O2 during the day were enrolled from across the U.S. from August 2013 to October 2015. At enrollment, each subject completed questionnaires and, for seven consecutive days, wore an accelerometer and GPS tracker. Results One hundred ninety-four subjects had a confirmed diagnosis of PF and complete, analyzable GPS data. The cohort was predominantly male (56%), Caucasian (95%) and had idiopathic pulmonary fibrosis (30%) or connective tissue disease related-PF (31%). Subjects walked a median 7497 (interquartile range [IQR] 5766-9261) steps per day. Steps per day were correlated with symptoms and several quality of life domains. In a model controlling for age, body mass index, wrist- (vs. waist) worn accelerometer and percent predicted diffusing capacity (DLCO%), fatigue (beta coefficient = −51.5 ± 11.7, p < 0.0001) was an independent predictor of steps per day (model R2=0.34). Conclusions Patients with PF, who have not been prescribed O2 for use during the day, have wide variability in their mobility. Day-to-day physical activity is related to several domains that impact quality of life, but GPS-derived activity space is not. Wearable data collection devices may be used to determine whether and how therapeutic interventions impact movement in PF patients. Trial registration NCT01961362. Registered 9 October, 2013. Electronic supplementary material The online version of this article (10.1186/s12890-017-0495-2) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Elisabeth Dowling Root
- Department of Geography and Division of Epidemiology, The Ohio State University, 1036 Derby Hall, 154 N. Oval Mall, Columbus, OH, 43210, USA.
| | - Bridget Graney
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Anschutz Medical Campus, 1400 Jackson Street, Denver, CO, 80206, USA.,Participation Program for Pulmonary Fibrosis (P3F), National Jewish Health, 1400 Jackson Street, Denver, CO, 80206, USA
| | - Susan Baird
- Interstitial Lung Disease Program, National Jewish Health, 1400 Jackson Street, Denver, CO, 80206, USA
| | - Tara Churney
- Participation Program for Pulmonary Fibrosis (P3F), National Jewish Health, 1400 Jackson Street, Denver, CO, 80206, USA.,Interstitial Lung Disease Program, National Jewish Health, 1400 Jackson Street, Denver, CO, 80206, USA
| | - Kailtin Fier
- Participation Program for Pulmonary Fibrosis (P3F), National Jewish Health, 1400 Jackson Street, Denver, CO, 80206, USA.,Interstitial Lung Disease Program, National Jewish Health, 1400 Jackson Street, Denver, CO, 80206, USA
| | - Majorie Korn
- Participation Program for Pulmonary Fibrosis (P3F), National Jewish Health, 1400 Jackson Street, Denver, CO, 80206, USA
| | - Mark McCormic
- Participation Program for Pulmonary Fibrosis (P3F), National Jewish Health, 1400 Jackson Street, Denver, CO, 80206, USA
| | - David Sprunger
- Participation Program for Pulmonary Fibrosis (P3F), National Jewish Health, 1400 Jackson Street, Denver, CO, 80206, USA.,Division of Pulmonary, Critical Care and Sleep Medicine, Sleep & Behavioral Health Sciences Section, National Jewish Health, 1400 Jackson Street, Denver, CO, 80206, USA
| | - Tomas Vierzba
- Participation Program for Pulmonary Fibrosis (P3F), National Jewish Health, 1400 Jackson Street, Denver, CO, 80206, USA
| | - Frederick S Wamboldt
- Participation Program for Pulmonary Fibrosis (P3F), National Jewish Health, 1400 Jackson Street, Denver, CO, 80206, USA.,Division of Pulmonary, Critical Care and Sleep Medicine, Sleep & Behavioral Health Sciences Section, National Jewish Health, 1400 Jackson Street, Denver, CO, 80206, USA
| | - Jeffery J Swigris
- Participation Program for Pulmonary Fibrosis (P3F), National Jewish Health, 1400 Jackson Street, Denver, CO, 80206, USA.,Interstitial Lung Disease Program, National Jewish Health, 1400 Jackson Street, Denver, CO, 80206, USA.,Division of Pulmonary, Critical Care and Sleep Medicine, Sleep & Behavioral Health Sciences Section, National Jewish Health, 1400 Jackson Street, Denver, CO, 80206, USA
| |
Collapse
|
14
|
Olson AL, Graney B, Baird S, Churney T, Fier K, Korn M, McCormick M, Sprunger D, Vierzba T, Wamboldt FS, Swigris JJ. Tracking dyspnea up to supplemental oxygen prescription among patients with pulmonary fibrosis. BMC Pulm Med 2017; 17:152. [PMID: 29166901 PMCID: PMC5700736 DOI: 10.1186/s12890-017-0497-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 11/14/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Dyspnea is the hallmark symptom of pulmonary fibrosis. Supplemental oxygen (O2) is prescribed to many patients with pulmonary fibrosis in hopes of alleviating dyspnea and improving physical functioning. We used response data from the University of California San Diego Shortness of Breath Questionnaire (UCSD) which was administered monthly in the context of a longitudinal, observational study to plot a rich trajectory for dyspnea over time in patients with pulmonary fibrosis. We used other data from that study to identify clinical predictors of being prescribed O2 and to provide additional information for how UCSD scores could be used for clinical purposes. METHODS We used linear mixed-effects models and multivariate Cox proportional hazards to model change in dyspnea scores over time and to identify significant predictors of time-to-O2-prescription among a pool of clinically-meaningful candidate variables. In the longitudinal study, all decisions, including whether or not to prescribe O2, were made by subjects' treating physicians, not members of the research team. RESULTS One-hundred ninety-four subjects with pulmonary fibrosis completed more than one UCSD or were prescribed O2 at some point during the follow-up period (N = 43). Twenty-eight of the 43 had analyzable, longitudinal data and contribute data to the longitudinal UCSD analyses. All 43 were included in the time-to-O2-prescription analyses. Subjects prescribed O2 had more severe dyspnea at enrollment (38.4 ± 19.6 vs. 22.6 ± 18.7, p < 0.0001) and a steeper increase in UCSD scores over time (slope = 1.18 ± 0.53 vs. 0.24 ± 0.09 points per month, p = 0.02) than subjects not prescribed O2. Controlling for baseline UCSD score and FVC%, subjects with a clinical summary diagnosis of idiopathic pulmonary fibrosis (IPF) were far more likely to be prescribed O2 than subjects with other forms of pulmonary fibrosis (hazard ratio = 4.85, (2.19, 10.74), p < 0.0001). CONCLUSIONS Baseline dyspnea and rise in dyspnea over time predict timing of O2 prescription. Accounting for disease severity, patients with IPF are more likely than patients with other forms of pulmonary fibrosis to be prescribed O2. UCSD scores provide clinically useful information; frequent administration could yield timely data on changes in disease status in patients with pulmonary fibrosis. TRIAL REGISTRATION The longitudinal study is registered on ClinicalTrials.gov ( NCT01961362 ). Registered October 9, 2013.
Collapse
Affiliation(s)
- Amy L Olson
- Interstitial Lung Disease Program, National Jewish Health, Southside Building, Office #G011 1400 Jackson Street, Denver, CO, 80206, USA.,Division of Pulmonary, Critical Care and Sleep Medicine, Sleep & Behavioral Health Sciences Section, National Jewish Health, Denver, CO, USA
| | - Bridget Graney
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.,Participation Program for Pulmonary Fibrosis (P3F), Denver, CO, USA
| | - Susan Baird
- Participation Program for Pulmonary Fibrosis (P3F), Denver, CO, USA
| | - Tara Churney
- Interstitial Lung Disease Program, National Jewish Health, Southside Building, Office #G011 1400 Jackson Street, Denver, CO, 80206, USA.,Participation Program for Pulmonary Fibrosis (P3F), Denver, CO, USA
| | - Kaitlin Fier
- Participation Program for Pulmonary Fibrosis (P3F), Denver, CO, USA
| | - Marjorie Korn
- Participation Program for Pulmonary Fibrosis (P3F), Denver, CO, USA
| | - Mark McCormick
- Participation Program for Pulmonary Fibrosis (P3F), Denver, CO, USA
| | - David Sprunger
- Interstitial Lung Disease Program, National Jewish Health, Southside Building, Office #G011 1400 Jackson Street, Denver, CO, 80206, USA.,Division of Pulmonary, Critical Care and Sleep Medicine, Sleep & Behavioral Health Sciences Section, National Jewish Health, Denver, CO, USA
| | - Thomas Vierzba
- Participation Program for Pulmonary Fibrosis (P3F), Denver, CO, USA
| | - Frederick S Wamboldt
- Participation Program for Pulmonary Fibrosis (P3F), Denver, CO, USA.,Division of Pulmonary, Critical Care and Sleep Medicine, Sleep & Behavioral Health Sciences Section, National Jewish Health, Denver, CO, USA
| | - Jeffrey J Swigris
- Interstitial Lung Disease Program, National Jewish Health, Southside Building, Office #G011 1400 Jackson Street, Denver, CO, 80206, USA. .,Participation Program for Pulmonary Fibrosis (P3F), Denver, CO, USA. .,Division of Pulmonary, Critical Care and Sleep Medicine, Sleep & Behavioral Health Sciences Section, National Jewish Health, Denver, CO, USA.
| |
Collapse
|
15
|
Graney BA, Wamboldt FS, Baird S, Churney T, Fier K, Korn M, McCormick M, Vierzba T, Swigris JJ. Informal caregivers experience of supplemental oxygen in pulmonary fibrosis. Health Qual Life Outcomes 2017; 15:133. [PMID: 28668090 PMCID: PMC5494136 DOI: 10.1186/s12955-017-0710-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 06/26/2017] [Indexed: 11/15/2022] Open
Abstract
Background Patients prescribed supplemental oxygen (O2) therapy face challenges as they adjust to being constantly “tethered” to an oxygen delivery device. Informal caregivers (ICs) of patients with pulmonary fibrosis (PF) face their own, often overlooked hardships when O2 is brought into their home and added to their lives. Our aim was to understand the multiple effects of supplemental oxygen therapy on ICs of patients with PF. Methods We conducted single, semi-structured telephone interviews with twenty ICs of patients with PF who were using O2 for at least 8 months. We performed a qualitative, content analysis based in grounded theory to examine data across subjects. Results ICs initially reacted to O2 with trepidation and sadness as they came to recognize the changes it would cause in the lives of their patient-loved one (PLO). ICs recognized both beneficial and negative effects of O2 on their PLOs. ICs also realized that O2 created significant changes in their own lives, including introducing new roles and responsibilities for them, altering their home environments and significantly impacting their relationships with their PLOs. Although O2 was a tangible and constant reminder of disease progression, over time ICs were able to adapt and accept their new lives with O2. Conclusion ICs of patients with PF experience many life changes when their PLO is prescribed O2. Having O2 prescribers anticipate and recognize these challenges provides an opportunity to give support and guidance to ICs of PF patients who require O2 in the hopes of limiting the negative impact of O2 on their lives. Trial registration Clinicaltrials.gov, registration number NCT01961362. Registered 9 October 2013. Electronic supplementary material The online version of this article (doi:10.1186/s12955-017-0710-0) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Bridget A Graney
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Denver, Anschutz Medical Campus, 12700 E 19th Ave, RC2 9th Floor, Aurora, CO, 80045-2563, USA. .,Participation Program for Pulmonary Fibrosis (P3F), P3F Coordinating Center, c/o National Jewish Health, 1400 Jackson Street, F107, Denver, CO, 80206, USA.
| | - Frederick S Wamboldt
- Participation Program for Pulmonary Fibrosis (P3F), P3F Coordinating Center, c/o National Jewish Health, 1400 Jackson Street, F107, Denver, CO, 80206, USA.,Division of Pulmonary, Critical Care and Sleep Medicine, Sleep and Behavioral Health Sciences Section, National Jewish Health, 1400 Jackson Street, Denver, CO, 80206, USA
| | - Susan Baird
- Participation Program for Pulmonary Fibrosis (P3F), P3F Coordinating Center, c/o National Jewish Health, 1400 Jackson Street, F107, Denver, CO, 80206, USA
| | - Tara Churney
- Participation Program for Pulmonary Fibrosis (P3F), P3F Coordinating Center, c/o National Jewish Health, 1400 Jackson Street, F107, Denver, CO, 80206, USA.,Autoimmune Lung Center and Interstitial Lung Disease Program, National Jewish Health, Southside Building, Office #G011 1400 Jackson Street, Denver, CO, 80206, USA
| | - Kaitlin Fier
- Participation Program for Pulmonary Fibrosis (P3F), P3F Coordinating Center, c/o National Jewish Health, 1400 Jackson Street, F107, Denver, CO, 80206, USA.,Autoimmune Lung Center and Interstitial Lung Disease Program, National Jewish Health, Southside Building, Office #G011 1400 Jackson Street, Denver, CO, 80206, USA
| | - Marjorie Korn
- Participation Program for Pulmonary Fibrosis (P3F), P3F Coordinating Center, c/o National Jewish Health, 1400 Jackson Street, F107, Denver, CO, 80206, USA
| | - Mark McCormick
- Participation Program for Pulmonary Fibrosis (P3F), P3F Coordinating Center, c/o National Jewish Health, 1400 Jackson Street, F107, Denver, CO, 80206, USA
| | - Thomas Vierzba
- Participation Program for Pulmonary Fibrosis (P3F), P3F Coordinating Center, c/o National Jewish Health, 1400 Jackson Street, F107, Denver, CO, 80206, USA
| | - Jeffrey J Swigris
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Denver, Anschutz Medical Campus, 12700 E 19th Ave, RC2 9th Floor, Aurora, CO, 80045-2563, USA.,Participation Program for Pulmonary Fibrosis (P3F), P3F Coordinating Center, c/o National Jewish Health, 1400 Jackson Street, F107, Denver, CO, 80206, USA.,Division of Pulmonary, Critical Care and Sleep Medicine, Sleep and Behavioral Health Sciences Section, National Jewish Health, 1400 Jackson Street, Denver, CO, 80206, USA.,Autoimmune Lung Center and Interstitial Lung Disease Program, National Jewish Health, Southside Building, Office #G011 1400 Jackson Street, Denver, CO, 80206, USA
| |
Collapse
|
16
|
Albright K, Walker T, Baird S, Eres L, Farnsworth T, Fier K, Kervitsky D, Korn M, Lederer DJ, McCormick M, Steiner JF, Vierzba T, Wamboldt FS, Swigris JJ. Seeking and sharing: why the pulmonary fibrosis community engages the web 2.0 environment. BMC Pulm Med 2016; 16:4. [PMID: 26754048 PMCID: PMC4709949 DOI: 10.1186/s12890-016-0167-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 01/04/2016] [Indexed: 11/21/2022] Open
Abstract
Background Pulmonary fibrosis (PF) is a rare, progressive disease that affects patients and their loved ones on many levels. We sought to better understand the needs and interests of PF patients and their loved ones (collectively “reader-participants”) by systematically analyzing their engagement with the World Wide Web (the current version referred to as Web 2.0). Methods Data were collected from three PF-focused, interactive websites hosted by physician-investigators with expertise in PF. All data generated by reader-participants for approximately 10 months were downloaded and then analyzed using qualitative content analysis methods. Results PF experts posted 38 blog entries and reader-participants posted 40 forum entries. Blogs received 363 responses, and forum entries received 108 responses from reader-participants. Reader-participants primarily used the three websites to seek information from or offer a contribution to the PF community. Information was sought about PF symptoms, diagnosis, prognosis, treatments, research, pathophysiology, and disease origin; reader-participants also made requests for new posts and pleas for research and sought clarification on existing content. Contributions included personal narratives about experiences with PF, descriptions of activities or behaviors found to be helpful with PF symptoms, resources or information about PF, and supportive comments to other PF sufferers. Conclusions PF patients and their loved ones engage the Web 2.0 environment at these PF-focused sites to satisfy their needs to better understand PF and its impacts and to support others facing similar challenges. Clinicians may find it beneficial to encourage PF patients’ involvement in internet forums that foster dynamic, bi-directional information sharing. Electronic supplementary material The online version of this article (doi:10.1186/s12890-016-0167-7) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Karen Albright
- Department of Community and Behavioral Health, Colorado School of Public Health and the Adult & Child Center for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine, CO University of Colorado Anschutz Medical Campus, Aurora, CO, USA. .,Department of Sociology and Criminology, University of Denver, Denver, CO, USA.
| | - Tarik Walker
- Department of Pediatric Infectious Disease, University of Colorado School of Medicine, Aurora, CO, USA.
| | - Susan Baird
- Participation Program for Pulmonary Fibrosis (P3F), National Jewish Health, Denver, CO, USA.
| | - Linda Eres
- Participation Program for Pulmonary Fibrosis (P3F), National Jewish Health, Denver, CO, USA.
| | - Tara Farnsworth
- Participation Program for Pulmonary Fibrosis (P3F), National Jewish Health, Denver, CO, USA.
| | - Kaitlin Fier
- Participation Program for Pulmonary Fibrosis (P3F), National Jewish Health, Denver, CO, USA.
| | - Dolly Kervitsky
- Participation Program for Pulmonary Fibrosis (P3F), National Jewish Health, Denver, CO, USA. .,PF Strategies, LLC, Black Hawk, CO, USA.
| | - Marjorie Korn
- Participation Program for Pulmonary Fibrosis (P3F), National Jewish Health, Denver, CO, USA.
| | | | - Mark McCormick
- Participation Program for Pulmonary Fibrosis (P3F), National Jewish Health, Denver, CO, USA.
| | | | - Thomas Vierzba
- Participation Program for Pulmonary Fibrosis (P3F), National Jewish Health, Denver, CO, USA.
| | - Frederick S Wamboldt
- Participation Program for Pulmonary Fibrosis (P3F), National Jewish Health, Denver, CO, USA.
| | - Jeffrey J Swigris
- Participation Program for Pulmonary Fibrosis (P3F), National Jewish Health, Denver, CO, USA. .,Interstitial Lung Disease Program, National Jewish Health, 1400 Jackson Street, Denver, CO, 80206, USA.
| |
Collapse
|
17
|
Cao M, Wamboldt FS, Brown KK, Hickman J, Olson AL, Solomon JJ, Swigris JJ. Supplemental oxygen users with pulmonary fibrosis perceive greater dyspnea than oxygen non-users. Multidiscip Respir Med 2015. [DOI: 10.4081/mrm.2015.354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: Exertional dyspnea is a hallmark symptom of fibrosing interstitial lung disease (fILD), and oxygen (O2) desaturation is common among patients with fILD. Supplemental O2 is prescribed to maintain normoxia and alleviate dyspnea. We sought to better understand the associations between O2 and dyspnea in fILD during the 6-min walk test (6MWT).
Methods: 1326 fILD patients compose the sample group. Borg dyspnea and other 6MWT variables were compared between subjects who performed the test without (non-users) versus with O2 (users).
Results: There were 812 users and 514 non-users; users were older, more likely to have smoked, had greater body mass index, and had more severe fILD. Despite a similar 6-min SpO2, users perceived greater dyspnea than non-users (Borg 3.9 ± 2.0 vs 2.9 ± 1.7, p < 0.0001). Whether subjects became hypoxemic (6-min SpO2 < 89 %) or not during the walk, the results were the same: users perceived greater dyspnea than non-users (hypoxemic: users 3.5 ± 2.1 vs non-users 2.7 ± 1.8, p < 0.0001; non-hypoxemic: users 3.4 ± 1.9 vs non-users 2.4 ± 1.6, p < 0.0001). Among subjects who did not desaturate (SpO2 drop < 4 %), users walked a shorter distance (944.9 ± 367.0 vs 1385.3 ± 322.4 feet, p < 0.0001) but perceived greater dyspnea than non-users (3.3 ± 1.6 vs 2.3 ± 1.7, p = 0.005). No combination of potentially influential predictor variables entered in multivariate models explained more than 11 % of the variance in dyspnea ratings.
Conclusion: Dyspnea is a complex perception, and in patients with fILD, O2 may lessen, but does not resolve, it. Further research is needed to clarify why fILD patients who use O2 perceive greater levels of dyspnea with activity than O2 non-users.
Collapse
|
18
|
Cao M, Wamboldt FS, Brown KK, Hickman J, Olson AL, Solomon JJ, Swigris JJ. Supplemental oxygen users with pulmonary fibrosis perceive greater dyspnea than oxygen non-users. Multidiscip Respir Med 2015; 10:37. [PMID: 26693009 PMCID: PMC4676151 DOI: 10.1186/s40248-015-0035-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 11/19/2015] [Indexed: 11/29/2022] Open
Abstract
Background Exertional dyspnea is a hallmark symptom of fibrosing interstitial lung disease (fILD), and oxygen (O2) desaturation is common among patients with fILD. Supplemental O2 is prescribed to maintain normoxia and alleviate dyspnea. We sought to better understand the associations between O2 and dyspnea in fILD during the 6-min walk test (6MWT). Methods 1326 fILD patients compose the sample group. Borg dyspnea and other 6MWT variables were compared between subjects who performed the test without (non-users) versus with O2 (users). Results There were 812 users and 514 non-users; users were older, more likely to have smoked, had greater body mass index, and had more severe fILD. Despite a similar 6-min SpO2, users perceived greater dyspnea than non-users (Borg 3.9 ± 2.0 vs 2.9 ± 1.7, p < 0.0001). Whether subjects became hypoxemic (6-min SpO2 < 89 %) or not during the walk, the results were the same: users perceived greater dyspnea than non-users (hypoxemic: users 3.5 ± 2.1 vs non-users 2.7 ± 1.8, p < 0.0001; non-hypoxemic: users 3.4 ± 1.9 vs non-users 2.4 ± 1.6, p < 0.0001). Among subjects who did not desaturate (SpO2 drop < 4 %), users walked a shorter distance (944.9 ± 367.0 vs 1385.3 ± 322.4 feet, p < 0.0001) but perceived greater dyspnea than non-users (3.3 ± 1.6 vs 2.3 ± 1.7, p = 0.005). No combination of potentially influential predictor variables entered in multivariate models explained more than 11 % of the variance in dyspnea ratings. Conclusion Dyspnea is a complex perception, and in patients with fILD, O2 may lessen, but does not resolve, it. Further research is needed to clarify why fILD patients who use O2 perceive greater levels of dyspnea with activity than O2 non-users.
Collapse
Affiliation(s)
- Mengshu Cao
- Department of Respiratory Medicine, Nanjing Drum Tower Hospital, the affiliated Nanjing University Medical School, 321 Zhongshan Road, Nanjing, Jiangsu 210008 China
| | - Frederick S Wamboldt
- Division of Pulmonary, Critical Care, Sleep and Behavioral Medicine, Department of Medicine, National Jewish Health, Denver, Colorado USA
| | - Kevin K Brown
- Interstitial Lung Disease Program, Department of Medicine, National Jewish Health, 1400 Jackson Street, Denver, 80206 Colorado USA
| | - Jonathon Hickman
- Department of Internal Medicine, Saint Joseph Hospital, 1375 E 19th Ave, Denver, 80218 Colorado USA
| | - Amy L Olson
- Interstitial Lung Disease Program, Department of Medicine, National Jewish Health, 1400 Jackson Street, Denver, 80206 Colorado USA
| | - Joshua J Solomon
- Interstitial Lung Disease Program, Department of Medicine, National Jewish Health, 1400 Jackson Street, Denver, 80206 Colorado USA
| | - Jeffrey J Swigris
- Interstitial Lung Disease Program, Department of Medicine, National Jewish Health, 1400 Jackson Street, Denver, 80206 Colorado USA
| |
Collapse
|
19
|
Fenster BE, Holm KE, Weinberger HD, Moreau KL, Meschede K, Crapo JD, Make BJ, Bowler R, Wamboldt FS, Hoth KF. Right ventricular diastolic function and exercise capacity in COPD. Respir Med 2015; 109:1287-92. [PMID: 26371994 DOI: 10.1016/j.rmed.2015.09.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 09/02/2015] [Accepted: 09/02/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Decreased exercise capacity in chronic obstructive pulmonary disease (COPD) is incompletely explained by pulmonary pathologic and physiologic abnormalities. We evaluated the extent to which right ventricular diastolic function (RVDF) is associated with exercise capacity in COPD. METHODS Fifty-one patients with COPD were evaluated by echocardiography, spirometry, and the 6 min walk test (6MWT). RVDF was assessed using 4 echocardiographic parameters: 1) the ratio of tricuspid valve (TV) early (E) and late (A) inflow velocities (TV E/A) 2) TV early tissue Doppler velocity (TV e') 3) TV deceleration time (DT) and 4) the ratio of TV E and e' velocities (TV E/e'). Multiple linear regression was used to examine the extent to which these parameters were associated with 6MWT distance. All models adjusted for age, sex, post-bronchodilator FEV1/FVC, resting heart rate, and use of supplemental O2 during 6MWT. A regression model was calculated for each of the 4 markers of RVDF. RESULTS Forty-seven percent of the sample had GOLD stage III or IV COPD. All 51 subjects had preserved left ventricular ejection fraction (LVEF, mean = 71.7%, SD = 7.8%). A higher TV E/A ratio was associated with increased 6MWT distance (p = 0.001). TV e', TV DT and TV E/e' did not have a statistically significant association with 6MWT distance in regression models. CONCLUSIONS In a cohort with moderate to severe COPD and normal LVEF, TV E/A was associated with 6MWT distance after adjusting for relevant demographic and medical covariates. RV diastolic dysfunction may independently contribute to exercise intolerance in COPD.
Collapse
Affiliation(s)
- Brett E Fenster
- National Jewish Health, Division of Cardiology, Denver, CO, United States.
| | - Kristen E Holm
- National Jewish Health, Division of Pulmonary, Critical Care and Sleep Medicine, Denver, CO, United States
| | | | - Kerrie L Moreau
- University of Colorado School of Medicine at the Anschutz Medical Campus, Department of Medicine, Aurora, CO, United States
| | - Kimberly Meschede
- National Jewish Health, Division of Pulmonary, Critical Care and Sleep Medicine, Denver, CO, United States
| | - James D Crapo
- National Jewish Health, Division of Pulmonary, Critical Care and Sleep Medicine, Denver, CO, United States
| | - Barry J Make
- National Jewish Health, Division of Pulmonary, Critical Care and Sleep Medicine, Denver, CO, United States
| | - Russell Bowler
- National Jewish Health, Division of Pulmonary, Critical Care and Sleep Medicine, Denver, CO, United States
| | - Frederick S Wamboldt
- University of Colorado School of Medicine at the Anschutz Medical Campus, Department of Psychiatry, Aurora, CO, United States
| | - Karin F Hoth
- University of Iowa Carver College of Medicine, Department of Psychiatry, Iowa City, IA, United States
| |
Collapse
|
20
|
Hoth KF, Wamboldt FS, Ford DW, Sandhaus RA, Strange C, Bekelman DB, Holm KE. The social environment and illness uncertainty in chronic obstructive pulmonary disease. Int J Behav Med 2015; 22:223-32. [PMID: 25008041 DOI: 10.1007/s12529-014-9423-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE Illness uncertainty is associated with worse outcomes in patients with chronic health conditions. Research on social factors associated with uncertainty has focused on the beneficial role of social support. The goal of this study was to develop a more nuanced understanding of the social factors that are associated with uncertainty. METHODS Four hundred sixty-two individuals with alpha-1 antitrypsin deficiency (AATD)-associated chronic obstructive pulmonary disease (COPD) completed a mailed questionnaire. Measures of the social environment included general family functioning, perceived criticism from family members, whether the participant had family members with AATD or COPD, and participation in support groups. Uncertainty was measured using the Mishel Uncertainty in Illness Scale including subscales for ambiguity (uncertainty about physical cues and symptoms) and complexity (uncertainty about treatment and the medical system). Hierarchical regression was used to identify social correlates of ambiguity and complexity while adjusting for demographic and medical characteristics and psychological distress. RESULTS Perceived criticism was associated with more complexity (b = 0.21, SE = 0.09, p = 0.015) and ambiguity (b = 0.40, SE = 0.12, p = 0.001). Having a family member with AATD or COPD was associated with more ambiguity (b = 3.28, SE = 1.00, p = 0.001). Participation in support groups was associated with less ambiguity. Individuals who attended three or more support groups in the prior year reported less ambiguity than individuals who had not attended any (b = -3.31, SE = 1.29, p = 0.010). CONCLUSIONS The social environment is complex and encompasses more than social support. Multiple aspects of the social environment are associated with uncertainty, including perceived criticism, having a family member with a similar illness, and participation in support groups.
Collapse
Affiliation(s)
- Karin F Hoth
- Department of Psychiatry, University of Iowa Carver College of Medicine, 200 Hawkins Drive, W278GH, Iowa City, IA, 52242, USA,
| | | | | | | | | | | | | |
Collapse
|
21
|
Oppenheim D, Wamboldt FS, Gavin LA, Renouf AG, Emde RN. Couples' Co-Construction of the Story of Their Child's Birth: Associations With Marital Adaptation. ACTA ACUST UNITED AC 2015. [DOI: 10.1075/jnlh.6.1.01cou] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Abstract
Recent research showing links between family narratives and emotional adaptation has raised questions regarding the significance of the coherence of marital narratives for couple adaptation, the important distinction between the narratives couples co-construct and the dyadic process during the co-construction, and the roles of individual psychological functioning and marital functioning in co-constructed narratives. In order to address these questions, we investigated the associations between couples' narratives about the birth of their child and their marital satisfaction and individual psychological wellbeing at the time the narrative was constructed as well as 1 and 2 years later. Results show that the emotional coherence of couples' narratives was associated with their marital satisfaction at the time the narrative was constructed as well as 1 and 2 years later, and similar results were found regarding the emotional expressiveness of the narratives. These associations remained significant when the individual psychological distress of marital partners was held constant and suggest that co-constructed marital narratives are important windows into marital relationships. (Psychology)
Collapse
Affiliation(s)
| | - Frederick S. Wamboldt
- National Jewish Hospital for Immunology and Respiratory Medicine and University of Colorado Health Sciences Center
| | - Leslie A. Gavin
- National Jewish Hospital for Immunology and Respiratory Medicine and University of Colorado Health Sciences Center
| | | | | |
Collapse
|
22
|
Walker TD, Desserich J, Albright K, Wamboldt FS, Belkin A, Fier K, Swigris JJ. Development of ATAQ-LAM: a tool to assess quality of life in Lymphangioleiomyomatosis. Health Qual Life Outcomes 2015. [PMID: 26220448 PMCID: PMC4518581 DOI: 10.1186/s12955-015-0294-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background Lymphangioleiomyomatosis (LAM) is a progressive lung disease that impairs health-related quality of life (HRQL). Objective To develop and conduct initial testing of ATAQ-LAM (A Tool to Assess Quality of Life in LAM). Methods A pilot version of the questionnaire was administered to respondents with LAM. We used a deletion algorithm to retain items and then applied multi-trait scaling to place retained items into appropriate domains, thus generating the ATAQ-LAM. Rasch analysis was used to assess item fit to a unidimensional model of HRQL. We determined internal consistency (IC) and floor and ceiling effects of ATAQ-LAM scores and conducted analyses aimed at supporting the validity of ATAQ-LAM. Results Sixty-nine LAM patients provided response data. Thirty-two items survived the deletion algorithm. Scaling suggested ATAQ-LAM should have a four-domain structure (Exertional dyspnea, IC = 0.94; Cough, IC = 0.91; Fatigue, IC = 0.91; Emotional Well-Being, IC = 0.89). All items fit the Rasch model. Among 17 respondents with spirometry within three months of questionnaire completion, three of five ATAQ-LAM scores correlated with FEV1% (Exertional Dyspnea: r = −0.72, p = 0.001; Fatigue: r = −0.62, p = 0.007 and total: r = −0.53, p = 0.02). Compared with those in the highest tertile of FEV1%, subjects in the lowest tertile had greater ATAQ-LAM total (121.8 ± 14.3 vs. 79.8 ± 13.1, p = 0.04), Exertional Dyspnea (54.4 ± 6.3 vs. 25.5 ± 5.8, p = 0.005) and Fatigue (2.8 ± 2.4 vs. 14.8 ± 2.3, p = 0.03) scores, indicating greater impairment in HRQL. Conclusions ATAQ-LAM is a disease-specific instrument designed to assess HRQL in LAM patients. Additional studies are needed to generate data in support of its validity as an instrument capable of assessing HRQL over time in LAM patients. Electronic supplementary material The online version of this article (doi:10.1186/s12955-015-0294-5) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Tarik D Walker
- Department of Pediatric Infectious Disease, University of Colorado School of Medicine, Aurora, CO, USA
| | - Jennifer Desserich
- Autoimmune Lung Center and Interstitial Lung Disease Program, National Jewish Health, 1400 Jackson Street, Denver, CO, 80206, USA
| | - Karen Albright
- Department of Community and Behavioral Health, Colorado School of Public Health and Colorado Health Outcomes Program, University of Colorado School of Medicine, Aurora, CO, USA
| | - Frederick S Wamboldt
- Division of Pulmonary and Critical Care Medicine, Sleep and Behavioral Health Sciences Section, National Jewish Health, Denver, CO, USA
| | - Amanda Belkin
- Autoimmune Lung Center and Interstitial Lung Disease Program, National Jewish Health, 1400 Jackson Street, Denver, CO, 80206, USA
| | - Kaitlin Fier
- Autoimmune Lung Center and Interstitial Lung Disease Program, National Jewish Health, 1400 Jackson Street, Denver, CO, 80206, USA
| | - Jeffrey J Swigris
- Autoimmune Lung Center and Interstitial Lung Disease Program, National Jewish Health, 1400 Jackson Street, Denver, CO, 80206, USA.
| |
Collapse
|
23
|
Bender BG, Cvietusa PJ, Goodrich GK, Lowe R, Nuanes HA, Rand C, Shetterly S, Tacinas C, Vollmer WM, Wagner N, Wamboldt FS, Xu S, Magid DJ. Pragmatic trial of health care technologies to improve adherence to pediatric asthma treatment: a randomized clinical trial. JAMA Pediatr 2015; 169:317-23. [PMID: 25664620 DOI: 10.1001/jamapediatrics.2014.3280] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Most patients with asthma take fewer than half of prescribed doses of controller medication. Interventions to improve adherence have typically been costly, impractical, and at best only minimally successful. OBJECTIVE To test a speech recognition (SR) intervention to improve adherence to pediatric asthma controller medication. DESIGN, SETTING, AND PARTICIPANTS The Breathe Well study was a 24-month pragmatic randomized clinical trial. The study was conducted within Kaiser Permanente Colorado, a large, group-model health maintenance organization. A total of 1187 children aged 3 to 12 years with a persistent asthma diagnosis and prescription for an inhaled corticosteroid were randomized to the computerized SR intervention or usual care condition and followed up for 24 months between October 2009 and February 2013. INTERVENTIONS Speech recognition telephone calls to parents in the intervention condition were triggered when an inhaled corticosteroid refill was due or overdue. Calls were automatically tailored with medical and demographic information from the electronic health record and from parent answers to questions in the call regarding recent refills or a desire to receive help refilling, learn more about asthma control, or speak with an asthma nurse or pharmacy staff member. MAIN OUTCOMES AND MEASURES Adherence to pediatric asthma controller medication, measured as the medication possession ratio over 24 months. RESULTS In the intention-to-treat analysis, inhaled corticosteroid adherence was 25.4% higher in the intervention group than in the usual care group (24-month mean [SE] adherence, 44.5% [1.2%] vs 35.5% [1.1%], respectively; P < .001). Asthma-related urgent care events did not differ between the 2 groups. The intervention effect was consistent in subgroups stratified by age, sex, race/ethnicity, body mass index, and disease-related characteristics. CONCLUSIONS AND RELEVANCE The intervention's significant impact on adherence demonstrates strong potential for low-cost SR adherence programs integrated with an electronic health record. The absence of change in urgent care visits may be attributable to the already low number of asthma urgent care visits within Kaiser Permanente Colorado. Application of electronic health record-leveraged SR interventions may reduce health care utilization when applied in a population with less-controlled asthma. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00958932.
Collapse
Affiliation(s)
- Bruce G Bender
- Division of Pediatric Behavioral Health, National Jewish Health, Denver, Colorado2University of Colorado, Denver
| | - Peter J Cvietusa
- Kaiser Permanente Colorado Institute for Health Research, Denver
| | - Glenn K Goodrich
- Kaiser Permanente Colorado Institute for Health Research, Denver
| | - Ryan Lowe
- Kaiser Permanente Colorado Institute for Health Research, Denver
| | - Heather A Nuanes
- Kaiser Permanente Colorado Institute for Health Research, Denver
| | - Cynthia Rand
- Johns Hopkins Medical School, Baltimore, Maryland
| | - Susan Shetterly
- Kaiser Permanente Colorado Institute for Health Research, Denver
| | - Cathy Tacinas
- Kaiser Permanente Colorado Institute for Health Research, Denver
| | - William M Vollmer
- Kaiser Permanente Center for Health Research Northwest, Portland, Oregon
| | - Nicole Wagner
- Kaiser Permanente Colorado Institute for Health Research, Denver
| | - Frederick S Wamboldt
- Division of Pediatric Behavioral Health, National Jewish Health, Denver, Colorado2University of Colorado, Denver
| | - Stanley Xu
- Kaiser Permanente Colorado Institute for Health Research, Denver
| | - David J Magid
- University of Colorado, Denver3Kaiser Permanente Colorado Institute for Health Research, Denver
| |
Collapse
|
24
|
Belkin A, Fier K, Albright K, Baird S, Crowe B, Eres L, Korn M, Maginn L, McCormick M, Root ED, Vierzba T, Wamboldt FS, Swigris JJ. Protocol for a mixed-methods study of supplemental oxygen in pulmonary fibrosis. BMC Pulm Med 2014; 14:169. [PMID: 25361630 PMCID: PMC4232731 DOI: 10.1186/1471-2466-14-169] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 10/15/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Little is known about whether or how supplemental oxygen affects patients with pulmonary fibrosis. METHODS/DESIGN A mixed-methods study is described. Patients with pulmonary fibrosis, informal caregivers of pulmonary fibrosis patients and practitioners who prescribe supplemental oxygen will be interviewed to gather data on perceptions of how supplemental oxygen impacts patients. In addition, three hundred pulmonary fibrosis patients who do not use daytime supplemental oxygen will be recruited to participate in a longitudinal, pre-/post- study in which patient-reported outcome (PRO) and activity data will be collected at baseline, immediately before daytime supplemental oxygen is initiated, and then once and again 9-12 months later. Activity data will be collected using accelerometers and portable GPS data recorders. The primary outcome is change in dyspnea from before to one month after supplemental oxygen is initiated. Secondary outcomes include scores from PROs to assess cough, fatigue and quality of life as well as the activity data. In exploratory analyses, we will use longitudinal data analytic techniques to assess the trajectories of outcomes over time while controlling for potentially influential variables. DISCUSSION Throughout the study and at its completion, results will be posted on the website for our research program (the Participation Program for Pulmonary Fibrosis or P3F) at http://www.pulmonaryfibrosisresearch.org.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Jeffrey J Swigris
- Autoimmune Lung Center and Interstitial Lung Disease Program, National Jewish Health, Southside Building, Office #G011 1400 Jackson Street Denver, CO 80206, USA.
| |
Collapse
|
25
|
Bender BG, Cvietusa P, Goodrich G, Lowe CR, Nuanes H, Shetterly S, Tacinas CR, Wagner N, Wamboldt FS, Xu S, Magid D. A 24-Month Randomized, Controlled Trial Of An Automated Speech Recognition Program To Improve Adherence In Pediatric Asthma. J Allergy Clin Immunol 2014. [DOI: 10.1016/j.jaci.2013.12.600] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
26
|
Swigris JJ, Streiner DL, Brown KK, Belkin A, Green KE, Wamboldt FS. Assessing exertional dyspnea in patients with idiopathic pulmonary fibrosis. Respir Med 2013; 108:181-8. [PMID: 24388667 DOI: 10.1016/j.rmed.2013.12.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Revised: 11/19/2013] [Accepted: 12/16/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND Dyspnea is a hallmark symptom of idiopathic pulmonary fibrosis (IPF), and dyspnea induced physical activity limitation is a prominent driver of quality of life impairment among IPF patients. METHODS We examined response data for the 21 physical activity items (the first 21 of 24) from the University of California San Diego Shortness of Breath Questionnaire (UCSD) collected at baseline in a recently conducted IPF trial. We used Rasch analysis and hypothesis testing with conventional statistical methodology to achieve three objectives: 1) to examine the items to identify the one characteristic that distinguishes one from another; 2) to asses these items for their ability to measure dyspnea severity in IPF; 3) to use the items to develop a dyspnea ruler. RESULTS The sample comprised 178 subjects. The 21 items fit the Rasch model. There was very strong correlation between Rasch item severity and their metabolic equivalents (METS) values (r = -0.86, p < 0.0001). With the sample stratified on scores from the 21 items, there were significant between group differences in FVC%, DLCO% and distance walked during the six-minute walk test. The dyspnea ruler can be used to put dyspnea levels in a more easily understood clinical context. CONCLUSIONS The first 21 items from the UCSD compose a unidimensional dyspnea-with-activity scale and are both sensibly ordered and distinguished from each other by their METS values. These 21 items can be used confidently to formulate clinically-relevant inferences about IPF patients and should be considered for use as a meaningful endpoint in IPF research.
Collapse
Affiliation(s)
- Jeffrey J Swigris
- Autoimmune Lung Center and Interstitial Lung Disease Program, National Jewish Health, Denver, CO, USA.
| | - David L Streiner
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Ontario, Canada
| | - Kevin K Brown
- Autoimmune Lung Center and Interstitial Lung Disease Program, National Jewish Health, Denver, CO, USA
| | - Amanda Belkin
- Autoimmune Lung Center and Interstitial Lung Disease Program, National Jewish Health, Denver, CO, USA
| | - Kathy E Green
- Morgridge College of Education, University of Denver, Denver, CO, USA
| | - Frederick S Wamboldt
- Division of Pulmonary and Critical Care Medicine, Sleep and Behavioral Health Sciences Section, National Jewish Health, Denver, CO, USA
| | | |
Collapse
|
27
|
Holm KE, Borson S, Sandhaus RA, Ford DW, Strange C, Bowler RP, Make BJ, Wamboldt FS. Differences in adjustment between individuals with alpha-1 antitrypsin deficiency (AATD)-associated COPD and non-AATD COPD. COPD 2013; 10:226-34. [PMID: 23547634 DOI: 10.3109/15412555.2012.719049] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Smokers who have severe alpha-1 antitrypsin deficiency (AATD) are at risk for developing COPD earlier in life than smokers without AATD, and are likely to experience challenges adjusting to their illness because they are in a highly productive life stage when they are diagnosed with COPD. This study examined whether individuals with AATD-associated COPD differ from individuals with non-AATD COPD with regard to depression, anxiety, dyspnea, and health-related quality of life (HRQL). Cross-sectional data were collected via self-report questionnaires completed by 480 individuals with non-AATD COPD and 578 individuals with AATD-associated COPD under protocols with IRB approval. Multiple linear regression models were used to test whether individuals with non-AATD COPD differed from individuals with AATD-associated COPD with regard to depression, anxiety, dyspnea, and HRQL. All models adjusted for demographic and health characteristics. Individuals with AATD-associated COPD did not report more symptoms of depression or anxiety; however, they did report more dyspnea (B = 0.31, 95% CI = 0.16 to 0.47, p < 0.001) and impairment in HRQL (B = 4.75, 95% CI = 2.10 to 7.41, p < 0.001) than other individuals with COPD. Individuals with AATD-associated COPD were more likely to be a member of a couple (rather than single) and had a higher level of education when compared to individuals with non-AATD COPD. Resources available to persons with AATD-associated COPD, such as being in a serious relationship and having higher education, may offset the effect of age when considering symptoms of depression and anxiety in patients with COPD.
Collapse
Affiliation(s)
- Kristen E Holm
- Department of Medicine, National Jewish Health, Denver, CO 80206, USA.
| | | | | | | | | | | | | | | |
Collapse
|
28
|
Hoth KF, Wamboldt FS, Strand M, Ford DW, Sandhaus RA, Strange C, Bekelman DB, Holm KE. Prospective impact of illness uncertainty on outcomes in chronic lung disease. Health Psychol 2013; 32:1170-4. [PMID: 23772888 DOI: 10.1037/a0032721] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To determine which aspect of illness uncertainty (i.e., ambiguity or complexity) has a stronger association with psychological and clinical outcomes over a 2-year period among individuals with a genetic subtype of chronic obstructive pulmonary disease (COPD). Ambiguity reflects uncertainty about physical cues and symptoms, and complexity reflects uncertainty about treatment and the medical system. METHOD Four-hundred and 7 individuals with alpha-1 antitrypsin deficiency-associated COPD completed questionnaires at baseline, 1- and 2-year follow-up. Uncertainty was measured using the Mishel Uncertainty in Illness Scale. Outcomes were measured using the Hospital Anxiety and Depression Scale, St. George's Respiratory Questionnaire, and MMRC Dyspnea Scale. Ambiguity and complexity were examined as predictors of depressive symptoms, anxiety, quality of life, and breathlessness using linear mixed models adjusting for demographic and health characteristics. RESULTS Ambiguity was associated with more depressive symptoms (b = 0.09, SE = 0.02, p < .001) and anxiety (b = 0.13, SE = 0.02, p < .001), worse quality of life (b = 0.57, SE = 0.10, p < .001), and more breathlessness (b = 0.02, SE = 0.006, p < .001). Complexity did not have an independent effect on any outcome. Interactions between ambiguity and time since diagnosis were not statistically significant. CONCLUSIONS Ambiguity was prospectively associated with worse mood, quality of life, and breathlessness. Thus, ambiguity should be targeted in psychosocial interventions. Time since diagnosis did not affect the association between ambiguity and outcomes, suggesting that the impact of ambiguity is equally strong throughout the course of COPD.
Collapse
|
29
|
Holm KE, Wamboldt FS, Ford DW, Sandhaus RA, Strand MJ, Strange C, Hoth KF. The prospective association of perceived criticism with dyspnea in chronic lung disease. J Psychosom Res 2013; 74:450-3. [PMID: 23597335 PMCID: PMC3631318 DOI: 10.1016/j.jpsychores.2013.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2012] [Revised: 02/01/2013] [Accepted: 02/03/2013] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Perceived criticism from family members influences mental health. The link between perceived criticism and physical health has not been thoroughly investigated. The objective of this study was to examine the association of perceived criticism with dyspnea in chronic obstructive pulmonary disease (COPD). METHODS 401 individuals with alpha-1 antitrypsin deficiency-associated COPD completed questionnaires at baseline, 1- and 2-year follow-up. Perceived criticism at baseline was examined as a predictor of dyspnea at all three time points using a linear mixed model that adjusted for demographic and health characteristics. RESULTS There was an interaction between perceived criticism and psychological distress (p=0.038). Perceived criticism was associated with dyspnea only among individuals with elevated psychological distress (b=0.32, SE=0.13, p=0.018). CONCLUSION Further research is needed to replicate these findings and determine the extent to which they apply to other common subjective physical symptoms such as pain.
Collapse
Affiliation(s)
- Kristen E. Holm
- National Jewish Health, Department of Medicine, Denver, CO, United States,Colorado School of Public Health, Department of Community and Behavioral Health, Aurora, CO, United States
| | - Frederick S. Wamboldt
- National Jewish Health, Department of Medicine, Denver, CO, United States,University of Colorado School of Medicine at the Anschutz Medical Campus, Department of Psychiatry, Aurora, CO, United States
| | - Dee W. Ford
- Medical University of South Carolina, Division of Pulmonary and Critical Care Medicine, Charleston, SC, United States
| | - Robert A. Sandhaus
- National Jewish Health, Department of Medicine, Denver, CO, United States,Clinical Director, Alpha-1 Foundation, Miami, FL, United States
| | - Matthew J. Strand
- National Jewish Health, Division of Biostatistics and Bioinformatics, Denver, CO, United States,Colorado School of Public Health, Department of Biostatistics, Aurora, CO, United States
| | - Charlie Strange
- Medical University of South Carolina, Division of Pulmonary and Critical Care Medicine, Charleston, SC, United States
| | - Karin F. Hoth
- National Jewish Health, Department of Medicine, Denver, CO, United States,University of Colorado School of Medicine at the Anschutz Medical Campus, Department of Psychiatry, Aurora, CO, United States,University of Colorado School of Medicine at the Anschutz Medical Campus, Department of Neurology, Aurora, CO, United States
| |
Collapse
|
30
|
Hoth KF, Ford DW, Sandhaus RA, Strange C, Wamboldt FS, Holm KE. Alcohol use predicts ER visits in individuals with alpha-1 antitrypsin deficiency (AATD) associated COPD. COPD 2012; 9:417-25. [PMID: 22651849 DOI: 10.3109/15412555.2012.684414] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Excessive alcohol use in COPD has been associated with increased mortality; however, little is known about alcohol use in AATD-associated COPD. A total of 538 individuals with AATD-associated COPD completed questionnaires at baseline and 330 also completed 2 years of follow-up questionnaires. Demographic and health information was collected, including information about alcohol use, ER visits for COPD, and hospitalizations for COPD. Problem alcohol use was characterized using the CAGE screening questionnaire and recent alcohol consumption. Demographic and clinical characteristics associated with problem drinking were identified using logistic regression. Problem drinking at baseline was examined as a predictor of ER visits and hospital admissions for COPD in the subsequent two years using logistic regression adjusting for demographic variables and baseline health status. 14% of the sample reported a history of problem drinking per the CAGE and 8% reported problem drinking in the past week. Problem drinking was associated with higher education and greater lifetime tobacco exposure. Recent alcohol consumption was a significant predictor of having an ER visit for COPD in the subsequent two years. Compared to individuals who reported problem drinking in the past week, individuals with no consumption (OR = 0.32, 95% CI = 0.10 to 0.97, p = .043) and individuals with low-to-moderate consumption (OR = 0.25, 95% CI = 0.08 to 0.77, p = .016) had significantly lower odds of an ER visit. Neither measure of problem drinking predicted hospital admission. Screening for recent excessive alcohol use in this population may identify individuals at risk for use of costly emergency health services.
Collapse
Affiliation(s)
- Karin F Hoth
- National Jewish Health, Department of Medicine, Denver, CO, United States.
| | | | | | | | | | | |
Collapse
|
31
|
Plaufcan MR, Wamboldt FS, Holm KE. Behavioral and characterological self-blame in chronic obstructive pulmonary disease. J Psychosom Res 2012; 72:78-83. [PMID: 22200527 PMCID: PMC3246615 DOI: 10.1016/j.jpsychores.2011.10.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2010] [Revised: 10/06/2011] [Accepted: 10/14/2011] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To assess behavioral and characterological self-blame, identify demographic and relational correlates of self-blame, and determine the association of self-blame with psychological and clinical outcomes of chronic obstructive pulmonary disease (COPD). METHODS Data were collected via self-report questionnaires completed by 398 individuals with COPD who had at least a 10 pack-year history of smoking. Behavioral and characterological self-blame were measured, and multiple regression was used to identify correlates of both types of self-blame. Multiple regression was also used to determine the association of self-blame with outcomes of COPD. RESULTS More than one-third of participants endorsed the maximum possible score on the measure of behavioral self-blame. The perception that family members blamed the individual for having COPD (p=.001), tobacco exposure (p=.005), and general family functioning (p=.002) were associated with behavioral self-blame. Current smoking status (p=.001) and perception of blame from family (p<.001) were associated with characterological self-blame. While behavioral self-blame was associated with fewer symptoms of depression (p=.02), characterological self-blame was associated with more symptoms of depression (p=.02). CONCLUSIONS Individuals with COPD tend to blame themselves for smoking and other behaviors that may have led to their COPD. Smoking-related variables and the perception that family members blamed the individual for having COPD were associated with self-blame. Findings support the importance of distinguishing between behavioral and characterological self-blame in COPD, as behavioral self-blame had a negative association with depression and characterological self-blame had a positive association with depression.
Collapse
Affiliation(s)
| | - Frederick S. Wamboldt
- Department of Medicine, National Jewish Health,Department of Psychiatry, University of Colorado Denver
| | | |
Collapse
|
32
|
Krishnan JA, Bender BG, Wamboldt FS, Szefler SJ, Adkinson NF, Zeiger RS, Wise RA, Bilderback AL, Rand CS. Adherence to inhaled corticosteroids: an ancillary study of the Childhood Asthma Management Program clinical trial. J Allergy Clin Immunol 2011; 129:112-8. [PMID: 22104610 DOI: 10.1016/j.jaci.2011.10.030] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2010] [Revised: 10/09/2011] [Accepted: 10/17/2011] [Indexed: 11/30/2022]
Abstract
BACKGROUND Information comparing subjective and objective measurements of adherence to study medications and the effects of adherence on treatment-related differences in asthma clinical trials are limited. OBJECTIVE We sought to compare subjective and objective measurements of children's adherence to inhaled corticosteroids or placebo and to determine whether adherence to study medications modified treatment-related differences in outcomes. METHODS In an ancillary study conducted in 3 of 8 Childhood Asthma Management Program Clinical Centers, adherence was assessed by using self-reported and objective data in 5- to 12-year-old children with mild or moderate asthma who were randomly assigned to 200 μg of inhaled budesonide twice per day (n = 84) or placebo (n = 56) for 4 years. The κ statistic was used to evaluate agreement between self-reported adherence (daily diary cards) and objectively measured adherence (number of doses left in study inhalers). Multivariable analyses were used to determine whether adherence to study treatment modified treatment-related differences in outcomes. RESULTS Adherence of less than 80% was seen in 75% of 140 children when adherence was measured objectively but only in 6% of children when measured by means of self-report. There was poor agreement between objective and subjective measurements of adherence of at least 80% (κ = 0.00; 95% CI, -0.05 to 0.04); self-reported adherence over the 4-year period generally overestimated objectively measured adherence (93.6% vs 60.8%, P < .0001). There was little evidence to indicate that adherence modified treatment-related differences in outcomes. CONCLUSION Researchers should use objective rather than self-reported adherence data to identify clinical trial participants with low levels of adherence to study treatment.
Collapse
Affiliation(s)
- Jerry A Krishnan
- Department of Medicine, Section of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois at Chicago, Ill 60612, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Goodwin RD, Wamboldt FS. Childhood physical abuse and respiratory disease in the community: the role of mental health and cigarette smoking. Nicotine Tob Res 2011; 14:91-7. [PMID: 22025544 DOI: 10.1093/ntr/ntr126] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Previous studies have found an association between child abuse and respiratory disease in some populations, but the mechanisms remain unknown, and this association has not been examined in a representative community-based sample. The goal of this study was to examine the relationship between childhood physical abuse and the odds of respiratory disease and to investigate the role of depression, anxiety, and pack-years of smoking in this association. METHODS Data were drawn from the Midlife Development in the United States Survey (n = 3,032), a representative sample of adults aged 25-74 years. Multiple logistic regression analyses were used to determine the association between childhood abuse and current respiratory disease (past 12 months) and to examine whether pack-years of smoking, depression, and anxiety disorders mediated the relationship. RESULTS Individuals who often experienced childhood abuse had a significantly increased odds of respiratory disease (odds ratio [OR] = 1.87 [1.21, 2.90]). The association was attenuated, after adjusting for demographic characteristics and pack-years of smoking, and was no longer significant after adjusting for depression and anxiety disorders. CONCLUSIONS These results are consistent with previous data suggesting a significant association between childhood abuse and respiratory disease and extend existing knowledge by providing initial evidence that demographic differences, depression and anxiety disorders, and lifetime cigarette smoking may mediate this observed relationship. Results require replication with longitudinal data in large community-based samples. Future studies that can explore potential biological mechanisms underlying the observed associations, such as immune factors, are needed next to better understand these relationships.
Collapse
Affiliation(s)
- Renee D Goodwin
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th Street, Room 1505, New York, NY 10032, USA.
| | | |
Collapse
|
34
|
Wamboldt FS, Bender BG, Rankin AE. Adolescent decision-making about use of inhaled asthma controller medication: results from focus groups with participants from a prior longitudinal study. J Asthma 2011; 48:741-50. [PMID: 21854323 DOI: 10.3109/02770903.2011.598204] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Adherence with inhaled controller medications for asthma is known to be highly variable with many patients taking fewer doses than recommended for consistent control of lung inflammation. Adherence also worsens as children become teenagers, although the exact causes are not well established. OBJECTIVE To use focus group methodology to examine beliefs, feelings, and behaviors about inhaled asthma controller medication in adolescents and young adults who had previously participated in a longitudinal study of asthma treatment adherence and outcome in order to develop more effective management strategies. METHODS Twenty-six subjects participated in 6 focus groups comprised of 3-5 young adults (age range 12-20 years). Verbatim transcripts of these groups were analyzed using the long-table method of content analysis to identify key themes raised by participants. RESULTS A variety of beliefs, feelings, and behaviors influence the adolescent's decision about how to use their asthma medication. Some of the adolescents understood the importance of daily medication and were committed to the treatment plan prescribed by their provider. Poorer adherence was the product of misinformation, incorrect assumptions about their asthma, and current life situations. CONCLUSIONS These results, by highlighting potential mechanisms underlying both better and worse adherence, inform the development of strategies to improve adherence behavior in adolescents and young adults with asthma. Knowledge of the specific beliefs, feelings, and behaviors that underlie adolescents' use of inhaled asthma controller medication will help providers maximize treatment adherence in this notoriously difficult patient population.
Collapse
|
35
|
Abstract
Human behavior can prevent or invite disease and is a major determinant of treatment success. Consequently, many efforts have been directed toward developing interventions to promote behaviors essential to managing or preventing respiratory disease. The process of developing, testing, and disseminating health behavior interventions should closely follow the translational research paradigm. However, most behavioral investigators have failed to adequately apply the translational research paradigm to behavioral research. The final stage of translation, consisting of testing the effectiveness of interventions in broad clinical settings after efficacy has been demonstrated in randomized controlled trials, is too often omitted. Additionally, the important task of understanding why any given health behavior intervention succeeds with some people but fails to change behavior in others is inconsistently pursued and seldom used to develop the robust theories of behavior change needed to improve respiratory health. Bringing health behavior research through the full translational process has the potential to significantly enhance respiratory health with specific behavioral targets, including smoking cessation, obesity prevention, TB control, and adherence to a multitude of respiratory treatments.
Collapse
Affiliation(s)
- Bruce G Bender
- Department of Pediatrics, National Jewish Health, Denver, CO; Department of Psychiatry, University of Colorado School of Medicine, Denver, CO.
| | - Mark S Aloia
- Department of Psychosocial Medicine, National Jewish Health, Denver, CO; Department of Psychiatry, University of Colorado School of Medicine, Denver, CO
| | - Allison E Rankin
- Department of Pediatrics, National Jewish Health, Denver, CO; Department of Psychosocial Medicine, National Jewish Health, Denver, CO
| | - Frederick S Wamboldt
- Department of Psychosocial Medicine, National Jewish Health, Denver, CO; Department of Psychiatry, University of Colorado School of Medicine, Denver, CO
| |
Collapse
|
36
|
Abstract
BACKGROUND No formal guidelines exist to guide physicians caring for patients with sarcoidosis in their screening for management of patients with cardiac sarcoidosis. We conducted a modified Delphi study to investigate if a consensus could be reached on the best approaches for screening for and management of cardiac sarcoidosis. METHODS A modified Delphi study design with two rounds of questionnaires was used to investigate if a consensus existed among sarcoid experts in the United States on the best management approaches for cardiac sarcoidosis. Experts were identified based on their national reputation as sarcoid experts and by being actively involved in sarcoidosis clinics at their institutions. RESULTS Overall agreement was low to moderate. Agreement was reached on the role of history, physical examination, and 12-lead ECG in screening, echocardiogram, Holter monitor, myocardial fluorodeoxyglucose PET scan, and cardiac MRI in workup, and steroids in treatment. Agreement was not reached on the role of signal-averaged ECG in screening, optimum dose of prednisone, use of steroid-sparing agents, and duration of treatment. Several comments underscore the diverse approaches and uncertainty that exist in managing cardiac sarcoidosis. CONCLUSIONS Our study highlights the dilemma that sarcoid experts face in their approach to cardiac sarcoidosis. It also highlights the lack of agreement among sarcoid experts on key aspects of diagnosis and management and stresses the importance of collaborative efforts to investigate the best strategies for screening for and management of cardiac sarcoidosis.
Collapse
Affiliation(s)
- Nabeel Y Hamzeh
- Division of Environmental and Occupational Health Sciences, National Jewish Health, Denver, CO; Division of Psychosocial Medicine, National Jewish Health, Denver, CO; Division of Cardiology, National Jewish Health, Denver, CO.
| | - Frederick S Wamboldt
- Division of Environmental and Occupational Health Sciences, National Jewish Health, Denver, CO; Division of Psychosocial Medicine, National Jewish Health, Denver, CO; Division of Cardiology, National Jewish Health, Denver, CO
| | - Howard D Weinberger
- Division of Environmental and Occupational Health Sciences, National Jewish Health, Denver, CO; Division of Psychosocial Medicine, National Jewish Health, Denver, CO; Division of Cardiology, National Jewish Health, Denver, CO
| |
Collapse
|
37
|
Swigris JJ, Fairclough DL, Morrison M, Make B, Kozora E, Brown KK, Wamboldt FS. Benefits of pulmonary rehabilitation in idiopathic pulmonary fibrosis. Respir Care 2011; 56:783-9. [PMID: 21333082 DOI: 10.4187/respcare.00939] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Information on the benefits of pulmonary rehabilitation (PR) in patients with idiopathic pulmonary fibrosis (IPF) is growing, but PR's effects on certain important outcomes is lacking. METHODS We conducted a pilot study of PR in IPF and analyzed changes in functional capacity, fatigue, anxiety, depression, sleep, and health status from baseline to after completion of a standard, 6-week PR program. RESULTS Six-min walk distance improved a mean ± standard error 202 ± 135 feet (P = .01) from baseline. Fatigue Severity Scale score also improved significantly, declining an average 1.5 ± 0.5 points from baseline. There were trends toward improvement in anxiety, depression, and health status. CONCLUSIONS PR improves functional capacity and fatigue in patients with IPF. (Clinical Trials.gov registration NCT00692796.)
Collapse
Affiliation(s)
- Jeffrey J Swigris
- Autoimmune Lung Center and Interstitial Lung Disease Program, National Jewish Health, Denver, Colorado 80206, USA.
| | | | | | | | | | | | | |
Collapse
|
38
|
Swigris JJ, Wilson SR, Green KE, Sprunger DB, Brown KK, Wamboldt FS. Development of the ATAQ-IPF: a tool to assess quality of life in IPF. Health Qual Life Outcomes 2010; 8:77. [PMID: 20673370 PMCID: PMC2920246 DOI: 10.1186/1477-7525-8-77] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2010] [Accepted: 07/31/2010] [Indexed: 11/10/2022] Open
Abstract
Background There is no disease-specific instrument to assess health-related quality of life (HRQL) in patients with idiopathic pulmonary fibrosis (IPF). Methods Patients' perspectives were collected to develop domains and items for an IPF-specific HRQL instrument. We used item variance and Rasch analysis to construct the ATAQ-IPF (A Tool to Assess Quality of life in IPF). Results The ATAQ-IPF version 1 is composed of 74 items comprising 13 domains. All items fit the Rasch model. Domains and the total instrument possess acceptable psychometric characteristics for a multidimensional questionnaire. The pattern of correlations between ATAQ-IPF scores and physiologic variables known to be important in IPF, along with significant differences in ATAQ-IPF scores between subjects using versus those not using supplemental oxygen, support its validity. Conclusions Patient-centered and careful statistical methodologies were used to construct the ATAQ-IPF version 1, an IPF-specific HRQL instrument. Simple summation scoring is used to derive individual domain scores as well as a total score. Results support the validity of the ATAQ-IPF, and future studies will build on that validity.
Collapse
Affiliation(s)
- Jeffrey J Swigris
- Autoimmune Lung Center and Interstitial Lung Disease Program, National Jewish Health, 1400 Jackson Street, Denver, Colorado 80206, USA.
| | | | | | | | | | | |
Collapse
|
39
|
Bekelman DB, Parry C, Curlin FA, Yamashita TE, Fairclough DL, Wamboldt FS. A comparison of two spirituality instruments and their relationship with depression and quality of life in chronic heart failure. J Pain Symptom Manage 2010; 39:515-26. [PMID: 20303028 PMCID: PMC2862901 DOI: 10.1016/j.jpainsymman.2009.08.005] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2008] [Revised: 08/25/2009] [Accepted: 08/29/2009] [Indexed: 10/19/2022]
Abstract
Spirituality is a multifaceted construct related to health outcomes that remains ill defined and difficult to measure. Spirituality in patients with advanced chronic illnesses, such as chronic heart failure, has received limited attention. We compared two widely used spirituality instruments, the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being (FACIT-Sp) and the Ironson-Woods Spirituality/Religiousness Index (IW), to better understand what they measure in 60 outpatients with chronic heart failure. We examined how these instruments related to each other and to measures of depression and quality of life using correlations and principal component analyses. The FACIT-Sp measured aspects of spirituality related to feelings of peace and coping, whereas the IW measured beliefs, coping, and relational aspects of spirituality. Only the FACIT-Sp Meaning/Peace subscale consistently correlated with depression (r=-0.50, P<0.0001) and quality of life (r=0.41, P=0.001). Three items from the depression measure loaded onto the same factor as the FACIT-Sp Meaning/Peace subscale (r=0.43, -0.43, and 0.71), whereas the remaining 12 items formed a separate factor (Cronbach's alpha=0.82) when combined with the spirituality instruments in a principal component analysis. The results demonstrate several clinically useful constructs of spirituality in patients with heart failure and suggest that psychological and spiritual well-being, despite some overlap, remain distinct phenomena.
Collapse
|
40
|
Swigris JJ, Wamboldt FS, Behr J, Bois RMD, King TE, Raghu G, Brown KK. The 6 minute walk in idiopathic pulmonary fibrosis: longitudinal changes and minimum important difference. Thorax 2010; 65:173-7. [PMID: 19996335 PMCID: PMC3144486 DOI: 10.1136/thx.2009.113498] [Citation(s) in RCA: 101] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
RATIONALE The response characteristics of the 6 minute walk test (6MWT) in studies of idiopathic pulmonary fibrosis (IPF) are only poorly understood, and the change in walk distance that constitutes the minimum important difference (MID) over time is unknown. OBJECTIVES To examine changes over time in distance walked (ie, 6MWD) during the 6MWT and to estimate the change in distance that constitutes the MID in patients with IPF. METHODS Data from a recently completed trial that included subjects with IPF who completed the 6MWT, Saint George's Respiratory Questionnaire (SGRQ) and forced vital capacity (FVC) at 6 and 12 months were used to examine longitudinal changes in 6MWD. Both anchor- and distribution-based approaches as well as linear regression analyses were used to determine the MID for 6MWD. The SGRQ Total score and FVC were used as clinical anchors. MAIN RESULTS Among 123 subjects alive and able to complete the 6MWT at both follow-up time points, 6MWD did not change significantly over time (378.1 m at baseline vs 376.8 m at 6 months vs 361.3 m at 12 months, p=0.5). The point estimate for the 6MWD MID was 28 m with a range of 10.8-58.5 m. CONCLUSION In a group of patients with IPF with moderate physiological impairment, for those alive and able to complete a 6MWT, 6MWD does not change over 12 months. At the population level, the MID for 6MWD appears to be approximately 28 m. Further investigation using other anchors and derivation methods is required to refine estimates of the MID for 6MWD in this patient population.
Collapse
Affiliation(s)
- Jeffrey J. Swigris
- Interstitial Lung Disease Program and Autoimmune Lung Center (Drs. Swigris and Brown) and Division of Psychosocial Medicine (Dr. Wamboldt), National Jewish Health; Denver, Colorado
| | - Frederick S. Wamboldt
- Interstitial Lung Disease Program and Autoimmune Lung Center (Drs. Swigris and Brown) and Division of Psychosocial Medicine (Dr. Wamboldt), National Jewish Health; Denver, Colorado
| | - Juergen Behr
- Department of Internal Medicine I, University of Munich, Germany
| | - Roland M du Bois
- Interstitial Lung Disease Program and Autoimmune Lung Center (Drs. Swigris and Brown) and Division of Psychosocial Medicine (Dr. Wamboldt), National Jewish Health; Denver, Colorado
| | - Talmadge E. King
- Division of Pulmonary and Critical Care Medicine, University of California San Francisco, California
| | - Ganesh Raghu
- Division of Pulmonary and Critical Care Medicine, University of Washington; Seattle, Washington
| | - Kevin K. Brown
- Interstitial Lung Disease Program and Autoimmune Lung Center (Drs. Swigris and Brown) and Division of Psychosocial Medicine (Dr. Wamboldt), National Jewish Health; Denver, Colorado
| |
Collapse
|
41
|
Abstract
BACKGROUND Respiratory problems have been shown to be associated with the development of panic anxiety. Family members play an essential role for children to emotionally manage their symptoms. This study aimed to examine the relation between severity of respiratory symptoms in children with asthma and separation anxiety. Relying on direct observation of family interactions during a mealtime, a model is tested whereby family interactions mediate the relation between asthma severity and separation anxiety symptoms. METHODS Sixty-three children (ages 9-12 years) with persistent asthma were interviewed via the Diagnostic Interview Schedule for Children IV; family interactions were assessed via direct observation of a mealtime; primary caregivers completed the Childhood Asthma Severity Scale; youth pulmonary function was ascertained with pre- and post-bronchodilator spirometry; adherence to asthma medications was objectively tracked for six weeks. RESULTS Poorer pulmonary function and higher functional asthma severity were related to higher numbers of separation anxiety symptoms. Controlling for medication adherence, family interaction patterns mediated the relationship between poorer pulmonary function and child separation anxiety symptoms. CONCLUSIONS Family mealtime interactions may be a mechanism by which respiratory disorders are associated with separation anxiety symptoms in children, potentially through increasing the child's capacity to cognitively frame asthma symptoms as less threatening, or through increasing the child's sense of security within their family relationships.
Collapse
|
42
|
Holm KE, LaChance HR, Bowler RP, Make BJ, Wamboldt FS. Family factors are associated with psychological distress and smoking status in chronic obstructive pulmonary disease. Gen Hosp Psychiatry 2010; 32:492-8. [PMID: 20851269 PMCID: PMC2943490 DOI: 10.1016/j.genhosppsych.2010.06.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2010] [Revised: 06/24/2010] [Accepted: 06/29/2010] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective of this study was to test three hypotheses in a sample of individuals with chronic obstructive pulmonary disease (COPD): (1) unsupportive family relationships are associated with psychological distress, (2) psychological distress is associated with smoking status and (3) unsupportive family relationships are indirectly associated with smoking status via psychological distress. METHOD Cross-sectional data were collected via self-report questionnaires completed by 455 individuals with COPD who had at least a 10-pack-year smoking history. The hypotheses were tested with structural equation modeling. RESULTS All three hypotheses were supported. Unsupportive family relationships were associated with psychological distress (β=.67, P<.001), psychological distress was associated with smoking status (β=.40, P<.001), and unsupportive family relationships were indirectly associated with smoking status via psychological distress (β=.27, P<.001). CONCLUSION Results of this study suggest that family relationships are an important factor to include in future longitudinal research that attempts to elucidate social and psychological influences on smoking behavior.
Collapse
Affiliation(s)
| | - Heather R. LaChance
- Department of Medicine, National Jewish Health,Department of Psychiatry, University of Colorado Denver
| | - Russell P. Bowler
- Department of Medicine, National Jewish Health,Department of Medicine, University of Colorado Denver
| | - Barry J. Make
- Department of Medicine, National Jewish Health,Department of Medicine, University of Colorado Denver
| | - Frederick S. Wamboldt
- Department of Medicine, National Jewish Health,Department of Psychiatry, University of Colorado Denver
| |
Collapse
|
43
|
Holm KE, Bowler RP, Make BJ, Wamboldt FS. Family Relationship Quality is Associated with Psychological Distress, Dyspnea, and Quality of Life in COPD. COPD 2009; 6:359-68. [DOI: 10.1080/15412550903143919] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
44
|
Swigris JJ, Brown KK, Behr J, du Bois RM, King TE, Raghu G, Wamboldt FS. The SF-36 and SGRQ: validity and first look at minimum important differences in IPF. Respir Med 2009; 104:296-304. [PMID: 19815403 DOI: 10.1016/j.rmed.2009.09.006] [Citation(s) in RCA: 179] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2009] [Revised: 08/28/2009] [Accepted: 09/06/2009] [Indexed: 02/06/2023]
Abstract
RATIONALE Health-related quality of life (HRQL) is an important outcome in drug trials. Little is known about how the Short Form-36 (SF-36) and Saint George's Respiratory Questionnaire (SGRQ) perform in idiopathic pulmonary fibrosis (IPF). OBJECTIVES To examine the validity of the SF-36 and SGRQ and to determine scores from each that would constitute a minimum important difference (MID). METHODS We analyzed data from a recently completed trial that enrolled subjects with well-defined IPF who completed the SF-36, SGRQ, and Baseline/Transition Dyspnea Index at baseline and six months. We compared mean changes in HRQL scores between groups of subjects whose disease severity changed over six months according to clinical anchors (FVC, DLCO, and dyspnea). We estimated the MID for each domain by using both anchor- and distribution-based approaches. MAIN RESULTS Results supported the validity of the SF-36 and SGRQ for use in longitudinal studies. Mean changes in domain scores differed significantly between subjects whose clinical status improved and those whose clinical status declined according to the anchors. MID estimates for the SF-36 ranged from 2-4 points and from 5-8 points for the SGRQ. CONCLUSION In IPF, the SF-36 and SGRQ possess reasonable validity for differentiating subjects whose disease severity changes over time. More studies are needed to continue the validation process, to refine estimates of the MIDs for the SF-36 or SGRQ, and to determine if a disease-specific instrument will perform better than either of these.
Collapse
Affiliation(s)
- Jeffrey J Swigris
- Interstitial Lung Disease Program in the Autoimmune Lung Center and Division of Psychosocial Medicine, National Jewish Health, Denver, CO, USA.
| | | | | | | | | | | | | |
Collapse
|
45
|
Walders-Abramson N, Wamboldt FS, Curran-Everett D, Zhang L. Encouraging physical activity in pediatric asthma: a case-control study of the wonders of walking (WOW) program. Pediatr Pulmonol 2009; 44:909-16. [PMID: 19658109 PMCID: PMC3971919 DOI: 10.1002/ppul.21077] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVES The complex overlap between asthma and obesity may be explained in part by activity avoidance in asthma. We compared responses to a walking intervention between matched groups of children with and without asthma. We expected youth with asthma to have lower baseline and post-intervention activity levels. Psychosocial, demographic, and physiologic correlates of activity were also examined. DESIGN/PARTICIPANTS We compared baseline and post-intervention activity levels among 59 children aged 10-16 with well-controlled asthma and 59 healthy matched controls. Participants completed spirometry, physical examination, anthropometric measurement, and psychosocial questionnaires. INTERVENTION/OUTCOME MEASURE: Participants wore blinded calibrated pedometers for a baseline typical activity week, returning to complete the Wonders of Walking (WOW) intervention, followed by a week of post-intervention pedometer monitoring. RESULTS Contrary to expectation, no differences between cases (median steps = 6,348/day) and controls (median steps = 6,825/day) in baseline activity were found. Response to the WOW intervention was comparable, with both groups demonstrating an increase of approximately 1,485 steps per day (equivalent to more than 5 additional miles walked during the post-intervention week). Health beliefs did not correlate to activity at baseline or intervention response. No significant associations between activity and asthma control, FEV1, or duration of diagnosis were found. Intervention response was comparable across racial/ethnic groups, children versus adolescents, and between normal weight and overweight youth. CONCLUSIONS Contrary to expectation, we found similar rates of objectively measured physical activity among youth with well-controlled asthma and controls. Importantly, we documented statistically significant increases in physical activity across both groups following a brief, pedometer-based intervention. The intervention was successful even among typically sedentary groups, and represents an effective, safe, and inexpensive walking program.
Collapse
|
46
|
|
47
|
Swigris JJ, Swick J, Wamboldt FS, Sprunger D, du Bois R, Fischer A, Cosgrove GP, Frankel SK, Fernandez-Perez ER, Kervitsky D, Brown KK. Heart rate recovery after 6-min walk test predicts survival in patients with idiopathic pulmonary fibrosis. Chest 2009; 136:841-848. [PMID: 19395579 DOI: 10.1378/chest.09-0211] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND In patients with idiopathic pulmonary fibrosis (IPF), our objectives were to identify predictors of abnormal heart rate recovery (HRR) at 1 min after completion of a 6-min walk test (6MWT) [HRR1] and 2 min after completion of a 6MWT (HRR2), and to determine whether abnormal HRR predicts mortality. METHODS From 2003 to 2008, we identified IPF patients who had been evaluated at our center (n = 76) with a pulmonary physiologic examination and the 6MWT. We used logistic regression to identify predictors of abnormal HRR, the product-limit method to compare survival in the sample stratified on HRR, and Cox proportional hazards analysis to estimate the prognostic capability of abnormal HRR. RESULTS Cutoff values were 13 beats for abnormal HRR1 and 22 beats for HRR2. In a multivariable model, predictors of abnormal HRR1 were diffusing capacity of the lung for carbon monoxide (odds ratio [OR], 0.4 per 10% predicted; 95% confidence interval [CI], 0.2 to 0.7; p = 0.003), change in heart rate from baseline to maximum (OR, 0.9; 95% CI, 0.8 to 0.97; p = 0.01), and having a right ventricular systolic pressure > 35 mm Hg as determined by transthoracic echocardiogram (OR, 12.7; 95% CI, 2.0 to 79.7; p = 0.01). Subjects with an abnormal HRR had significantly worse survival than subjects with a normal HRR (for HRR1, p = 0.0007 [log-rank test]; for HRR2, p = 0.03 [log-rank test]); these results held for the subgroup of 30 subjects without resting pulmonary hypertension (HRR1, p = 0.04 [log-rank test]). Among several candidate variables, abnormal HRR1 appeared to be the most potent predictor of mortality (hazard ratio, 5.2; 95% CI, 1.8 to 15.2; p = 0.004). CONCLUSION Abnormal HRR after 6MWT predicts mortality in IPF patients. Research is needed to confirm these findings prospectively and to examine the mechanisms of HRR in IPF patients.
Collapse
Affiliation(s)
- Jeffrey J Swigris
- Interstitial Lung Disease Program and Autoimmune Lung Center, National Jewish Medical and Research Center, Denver, CO.
| | - Jeff Swick
- Interstitial Lung Disease Program and Autoimmune Lung Center, National Jewish Medical and Research Center, Denver, CO
| | - Frederick S Wamboldt
- Division of Psychosocial Medicine, National Jewish Medical and Research Center, Denver, CO
| | - David Sprunger
- Interstitial Lung Disease Program and Autoimmune Lung Center, National Jewish Medical and Research Center, Denver, CO
| | - Roland du Bois
- Interstitial Lung Disease Program and Autoimmune Lung Center, National Jewish Medical and Research Center, Denver, CO
| | - Aryeh Fischer
- Interstitial Lung Disease Program and Autoimmune Lung Center, National Jewish Medical and Research Center, Denver, CO
| | - Gregory P Cosgrove
- Interstitial Lung Disease Program and Autoimmune Lung Center, National Jewish Medical and Research Center, Denver, CO
| | - Stephen K Frankel
- Interstitial Lung Disease Program and Autoimmune Lung Center, National Jewish Medical and Research Center, Denver, CO
| | - Evans R Fernandez-Perez
- Interstitial Lung Disease Program and Autoimmune Lung Center, National Jewish Medical and Research Center, Denver, CO
| | - Dolly Kervitsky
- Interstitial Lung Disease Program and Autoimmune Lung Center, National Jewish Medical and Research Center, Denver, CO
| | - Kevin K Brown
- Interstitial Lung Disease Program and Autoimmune Lung Center, National Jewish Medical and Research Center, Denver, CO
| |
Collapse
|
48
|
Swigris JJ, Zhou X, Wamboldt FS, du Bois R, Keith R, Fischer A, Cosgrove GP, Frankel SK, Curran-Everett D, Brown KK. Exercise peripheral oxygen saturation (SpO2) accurately reflects arterial oxygen saturation (SaO2) and predicts mortality in systemic sclerosis. Thorax 2009; 64:626-30. [PMID: 19359269 DOI: 10.1136/thx.2008.111393] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Measures of oxygenation have not been assessed for prognostic significance in systemic sclerosis-related interstitial lung disease (SSc-ILD). METHODS 83 subjects with SSc-ILD performed a maximal cardiopulmonary exercise test with an arterial line. The agreement between peripheral oxygen saturation (SpO2) and arterial oxygen saturation (SaO2) was examined and survival differences between subgroups of subjects stratified on SpO2 were analysed. Cox proportional hazards analyses were used to examine the prognostic capabilities of SpO2. RESULTS At maximal exercise the mean (SD) difference between SpO2 and SaO2 was 2.98 (2.98) and only 15 subjects had a difference of >4 points. The survival of subjects with SSc-ILD whose maximum exercise SpO2 (Spo(2)max) fell below 89% or whose SpO2max fell >4 points from baseline was worse than subjects in comparator groups (log rank p = 0.01 and 0.01, respectively). The hazard of death during the median 7.1 years of follow-up was 2.4 times greater for subjects whose SpO2max fell below 89% (hazard ratio 2.4, 95% CI 1.1 to 4.9, p = 0.02) or whose SpO2max fell >4 points from baseline (hazard ratio 2.4, 95% CI 1.1 to 5.0, p = 0.02). CONCLUSION In patients with SSc-ILD, SpO2 is an adequate reflection of SaO2 and radial arterial lines need not be inserted during cardiopulmonary exercise tests in these patients. Given the ease of measurement and its prognostic value, SpO2 should be considered as a meaningful clinical and research outcome in patients with SSc-ILD.
Collapse
Affiliation(s)
- J J Swigris
- Interstitial Lung Disease Program and Autoimmune Lung Center, National Jewish Medical and Research Center, 1400 Jackson Street, Denver, CO 80206, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Swigris JJ, Brown KK, Make BJ, Wamboldt FS. Pulmonary rehabilitation in idiopathic pulmonary fibrosis: a call for continued investigation. Respir Med 2008; 102:1675-80. [PMID: 18848771 DOI: 10.1016/j.rmed.2008.08.014] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2008] [Revised: 07/16/2008] [Accepted: 08/24/2008] [Indexed: 11/28/2022]
Abstract
Idiopathic pulmonary fibrosis (IPF) is a devastating disease that afflicts patients with relentlessly progressive shortness of breath [Joint Statement of the American Thoracic Society and the European Respiratory Society. Idiopathic pulmonary fibrosis: diagnosis and treatment. Am J Respir Crit Care Med 2000;161:646-64(1)]. Despite nearly 30 years of intense investigation, effective therapy for IPF remains elusive; median survival rates have stubbornly remained less than five years from the time of diagnosis [Bjoraker JA, Ryu JH, Edwin MK, Meyers J, Tazelaar H, Schroeder D, et al. Prognostic significance of histopathologic subsets in idiopathic pulmonary fibrosis. Am J Respir Crit Care Med 1998;157:199-203(2), Flaherty KR, Thwaite E, Kazerooni EA, Gross B, Toews GB, Colby TV, et al. Radiological versus histological diagnosis in UIP and NSIP: survival implications. Thorax 2003;58:143-48(3)], and no medical therapy has been proved to be in any way effective for the treatment of this disease. Without medications that help IPF patients live longer, an important question to ask is whether there are interventions that might allow these people to live better-to be more active; to experience less dyspnea, less depression, less anxiety; to possess a greater sense of control over their disease; and to have better quality of life. Pulmonary rehabilitation helps to accomplish many of these goals in patients with chronic obstructive pulmonary disease, and emerging data suggest that it may do the same for patients with IPF.
Collapse
Affiliation(s)
- Jeffrey J Swigris
- Autoimmune Lung Center, National Jewish Medical and Research Center, 1400 Jackson Street, Denver, CO 80206, USA.
| | | | | | | |
Collapse
|
50
|
Bender BG, Rankin A, Tran ZV, Wamboldt FS. Brief-interval telephone surveys of medication adherence and asthma symptoms in the Childhood Asthma Management Program Continuation Study. Ann Allergy Asthma Immunol 2008; 101:382-6. [PMID: 18939726 PMCID: PMC2949348 DOI: 10.1016/s1081-1206(10)60314-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Although it is known that most patients do not consistently take controller medications every day, the impact of nonadherence on asthma control is not well documented. OBJECTIVE To establish the relationship between medication adherence and symptom control in adolescents and young adults with asthma. METHODS A total of 756 adolescents and young adults diagnosed as having mild to moderate asthma on entry into the original study underwent 6 monthly telephone interviews as an ancillary project to the Childhood Asthma Management Program Continuation Study. Participants were queried about medication use and symptom control within each 1-month interview window. Strategies adopted to improve self-report accuracy included use of repeated interviews, confidential reporting to staff unknown to the participants, and use of questions focused on recent behavior. RESULTS Only participants who were consistently on inhaled corticosteroids (ICSs) for the entire 6-month study interval were included. Three groups of patients were contrasted: those not on ICSs (n = 420), those on ICSs with high adherence (> or = 75% of medication taken, n = 90), and those on ICSs with low/medium adherence (< 75% of medication taken, n = 148). Participants in the low/medium adherence group reported, on average, less symptom control and more variability in wheezing, awakening at night, missed activities, and beta2-agonist use during the 6-month period, although most in this group perceived their asthma to be under good control. CONCLUSION Despite extensive patient education and support, diminished ICS adherence was frequent and undermined symptom control in this group of adolescents and young adults with mild to moderate asthma.
Collapse
Affiliation(s)
- Bruce G Bender
- Department of Pediatrics, National Jewish Health, Denver, Colorado 80206, USA.
| | | | | | | |
Collapse
|