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Cobb K, Kenyon J, Lu J, Krieger B, Perelas A, Nana-Sinkam P, Kim Y, Rodriguez-Miguelez P. COPD is associated with increased cardiovascular disease risk independent of phenotype. Respirology 2024. [PMID: 39019777 DOI: 10.1111/resp.14799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 07/03/2024] [Indexed: 07/19/2024]
Abstract
BACKGROUND AND OBJECTIVE Chronic obstructive pulmonary disease (COPD) is a leading cause of death worldwide that frequently presents with concomitant cardiovascular diseases. Despite the pathological distinction between individual COPD phenotypes such as emphysema and chronic bronchitis, there is a lack of knowledge about the impact of COPD phenotype on cardiovascular disease risk. Thus, this study aimed to utilize a nationally representative sample to investigate cardiovascular disease prevalence in patients with COPD with emphysema and chronic bronchitis phenotypes. METHODS Data from 31,560 adults including 2504 individuals with COPD, collected as part of the National Health and Nutrition Examination Survey (1999-2018), were examined. RESULTS A significantly increased cardiovascular disease risk, including coronary heart disease, heart failure, myocardial infarction and stroke, was identified in patients with COPD among all disease phenotypes. Particularly, compared to those without COPD, individuals with chronic bronchitis presented with 1.76 (95% CI: 1.41-2.20) times greater odds, individuals with emphysema with 2.31 (95% CI: 1.80-2.96) times greater odds, while those with a concurrent phenotype (combined chronic bronchitis and emphysema) exhibited 2.98 (95% CI: 2.11-4.21) times greater odds of reporting cardiovascular diseases. CONCLUSION Our data confirms that patients with COPD present an elevated risk of developing cardiovascular disease among all phenotypes, with the most marked increase being in those with concurrent chronic bronchitis and emphysema phenotypes. These findings emphasize the need for awareness and appropriate cardiovascular screening in COPD.
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Affiliation(s)
- Kolton Cobb
- Department of Kinesiology and Health Sciences, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Jonathan Kenyon
- Department of Kinesiology and Health Sciences, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Juan Lu
- Division of Epidemiology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Benjamin Krieger
- Department of Kinesiology and Health Sciences, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Apostolos Perelas
- Division of Pulmonary and Critical Care, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Patrick Nana-Sinkam
- Division of Pulmonary and Critical Care, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Youngdeok Kim
- Department of Kinesiology and Health Sciences, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Paula Rodriguez-Miguelez
- Department of Kinesiology and Health Sciences, Virginia Commonwealth University, Richmond, Virginia, USA
- Division of Pulmonary and Critical Care, Virginia Commonwealth University, Richmond, Virginia, USA
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2
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Girgis M, Petruncio G, Russo P, Peyton S, Paige M, Campos D, Sanda M. Analysis of N- and O-linked site-specific glycosylation by ion mobility mass spectrometry: State of the art and future directions. Proteomics 2024; 24:e2300281. [PMID: 38171879 DOI: 10.1002/pmic.202300281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 11/22/2023] [Accepted: 12/05/2023] [Indexed: 01/05/2024]
Abstract
Glycosylation, the major post-translational modification of proteins, significantly increases the diversity of proteoforms. Glycans are involved in a variety of pivotal structural and functional roles of proteins, and changes in glycosylation are profoundly connected to the progression of numerous diseases. Mass spectrometry (MS) has emerged as the gold standard for glycan and glycopeptide analysis because of its high sensitivity and the wealth of fragmentation information that can be obtained. Various separation techniques have been employed to resolve glycan and glycopeptide isomers at the front end of the MS. However, differentiating structures of isobaric and isomeric glycopeptides constitutes a challenge in MS-based characterization. Many reports described the use of various ion mobility-mass spectrometry (IM-MS) techniques for glycomic analyses. Nevertheless, very few studies have focused on N- and O-linked site-specific glycopeptidomic analysis. Unlike glycomics, glycoproteomics presents a multitude of inherent challenges in microheterogeneity, which are further exacerbated by the lack of dedicated bioinformatics tools. In this review, we cover recent advances made towards the growing field of site-specific glycosylation analysis using IM-MS with a specific emphasis on the MS techniques and capabilities in resolving isomeric peptidoglycan structures. Furthermore, we discuss commonly used software that supports IM-MS data analysis of glycopeptides.
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Affiliation(s)
- Michael Girgis
- Department of Bioengineering, College of Engineering & Computing, George Mason University, Fairfax, Virginia, USA
- Center for Molecular Engineering, George Mason University, Manassas, Virginia, USA
| | - Gregory Petruncio
- Center for Molecular Engineering, George Mason University, Manassas, Virginia, USA
- Department of Chemistry & Biochemistry, College of Science, George Mason University, Fairfax, Virginia, USA
| | - Paul Russo
- Center for Applied Proteomics and Molecular Medicine, George Mason University, Manassas, Virginia, USA
| | - Steven Peyton
- Center for Molecular Engineering, George Mason University, Manassas, Virginia, USA
| | - Mikell Paige
- Center for Molecular Engineering, George Mason University, Manassas, Virginia, USA
- Department of Chemistry & Biochemistry, College of Science, George Mason University, Fairfax, Virginia, USA
| | - Diana Campos
- Max-Planck-Institut fuer Herz- und Lungenforschung, Bad Nauheim, Germany
| | - Miloslav Sanda
- Max-Planck-Institut fuer Herz- und Lungenforschung, Bad Nauheim, Germany
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3
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Kibbler J, Wade C, Mussell G, Ripley DP, Bourke SC, Steer J. Systematic review and meta-analysis of prevalence of undiagnosed major cardiac comorbidities in COPD. ERJ Open Res 2023; 9:00548-2023. [PMID: 38020568 PMCID: PMC10680032 DOI: 10.1183/23120541.00548-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 09/18/2023] [Indexed: 12/01/2023] Open
Abstract
Background It is often stated that heart disease is underdiagnosed in COPD. Evidence for this statement comes from primary studies, but these have not been synthesised to provide a robust estimate of the burden of undiagnosed heart disease. Methods A systematic review of studies using active diagnostic techniques to establish the prevalence of undiagnosed major cardiac comorbidities in patients with COPD was carried out. MEDLINE, Embase, Scopus and Web of Science were searched for terms relating to heart failure (specifically, left ventricular systolic dysfunction (LVSD), coronary artery disease (CAD) and atrial fibrillation), relevant diagnostic techniques and COPD. Studies published since 1980, reporting diagnosis rates using recognised diagnostic criteria in representative COPD populations not known to have heart disease were included. Studies were classified by condition diagnosed, diagnostic threshold used and whether participants had stable or exacerbated COPD. Random-effects meta-analysis of prevalence was conducted where appropriate. Results In general, prevalence estimates for undiagnosed cardiac comorbidities in COPD had broad confidence intervals, with significant study heterogeneity. Most notably, a prevalence of undiagnosed LVSD of 15.8% (11.1-21.1%) was obtained when defined as left ventricular ejection fraction <50%. Undiagnosed CAD was found in 2.3-18.0% of COPD patients and atrial fibrillation in 1.4% (0.3-3.5%). Conclusion Further studies using recent diagnostic advances, and investigating therapeutic interventions for patients with COPD and heart disease are needed.
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Affiliation(s)
- Joseph Kibbler
- Northumbria Healthcare NHS Foundation Trust, Respiratory Medicine, North Shields, UK
- Newcastle University, Translation and Clinical Research Institute, Newcastle upon Tyne, UK
| | - Clare Wade
- Northumbria University, Sport, Exercise and Rehabilitation, Newcastle upon Tyne, UK
| | - Grace Mussell
- Northumbria Healthcare NHS Foundation Trust, Respiratory Medicine, North Shields, UK
| | - David P. Ripley
- Northumbria Healthcare NHS Foundation Trust, Respiratory Medicine, North Shields, UK
| | - Stephen C. Bourke
- Northumbria Healthcare NHS Foundation Trust, Respiratory Medicine, North Shields, UK
- Newcastle University, Translation and Clinical Research Institute, Newcastle upon Tyne, UK
| | - John Steer
- Northumbria Healthcare NHS Foundation Trust, Respiratory Medicine, North Shields, UK
- Northumbria University, Sport, Exercise and Rehabilitation, Newcastle upon Tyne, UK
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4
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Vaes AW, Sillen MJH, Goërtz YMJ, Machado FVC, Van Herck M, Burtin C, Franssen FME, van 't Hul AJ, Spruit MA. The correlation between quadriceps muscle strength and endurance and exercise performance in patients with COPD. J Appl Physiol (1985) 2021; 131:589-600. [PMID: 34138649 DOI: 10.1152/japplphysiol.00149.2021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
To determine the association between quadriceps muscle strength (QMS) and endurance (QME) and exercise capacity in patients with COPD after stratification for sex and resting lung function (LF). Data were collected from 3,246 patients with COPD (60% men, 64 ± 9 yr), including measures of exercise capacity [peak aerobic capacity (peakV̇o2), 6-min walk distance (6MWD)] and isokinetic QMS and QME. Patients were stratified for sex, forced expiratory volume in 1 s (>50/≤50% predicted), single breath carbon monoxide diffusing capacity (>50/≤50% predicted), and residual volume (>140/≤140% predicted). After stratification for resting LF, QMS and QME were significantly associated with peakV̇o2 (r range: 0.47-0.61 and 0.49-0.65 for men and 0.53-0.66 and 0.48-0.67 for women, respectively) and 6MWD (r range: 0.29-0.42 and 0.44-0.55 for men and 0.25-0.54 and 0.34-0.55 for women, respectively) (P < 0.001). Regression models demonstrated that QMS and QME were significant determinants of peakV̇o2 (explained variance R2 range: 35.6%-48.8% for men and 36.8%-49.0% for women) and 6MWD (R2 range: 24.3%-43.3% for men and 28.4%-40.3% for women), independent of age and fat-free mass. Quadriceps muscle function was significantly associated with peakV̇o2 and 6MWD in male and female patients with COPD after stratification for resting LF, in which QME appear to be a more important determinant than QMS. This underlines the importance of systematically evaluating both quadriceps muscle strength and endurance in in all patients with COPD.NEW & NOTEWORTHY Our findings identified quadriceps muscle function as an important determinant of exercise capacity across a wide spectrum of lung function. Quadriceps muscle endurance appears to be a more important determinant than quadriceps muscle strength, underlining the importance of including both the measurement of quadriceps muscle strength and endurance in routine assessment for all patient with COPD.
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Affiliation(s)
- A W Vaes
- Department of Research and Development, CIRO, Horn, The Netherlands
| | - M J H Sillen
- Department of Physiotherapy, CIRO, Horn, The Netherlands
| | - Y M J Goërtz
- Department of Research and Development, CIRO, Horn, The Netherlands
| | - F V C Machado
- Department of Research and Development, CIRO, Horn, The Netherlands.,Department of Respiratory Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands.,NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands
| | - M Van Herck
- Department of Research and Development, CIRO, Horn, The Netherlands.,REVAL-Rehabilitation Research Center, BIOMED-Biomedical Research Institute, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
| | - C Burtin
- REVAL-Rehabilitation Research Center, BIOMED-Biomedical Research Institute, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
| | - F M E Franssen
- Department of Research and Development, CIRO, Horn, The Netherlands.,Department of Respiratory Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands.,NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands
| | - A J van 't Hul
- Department of Pulmonary Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
| | - M A Spruit
- Department of Research and Development, CIRO, Horn, The Netherlands.,Department of Respiratory Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands.,NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands.,REVAL-Rehabilitation Research Center, BIOMED-Biomedical Research Institute, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
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5
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Huang YC, Lin TY, Wu HT, Chang PJ, Lo CY, Wang TY, Kuo CHS, Lin SM, Chung FT, Lin HC, Hsieh MH, Lo YL. Cardiorespiratory coupling is associated with exercise capacity in patients with chronic obstructive pulmonary disease. BMC Pulm Med 2021; 21:22. [PMID: 33435937 PMCID: PMC7802271 DOI: 10.1186/s12890-021-01400-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 01/04/2021] [Indexed: 12/21/2022] Open
Abstract
Background The interaction between the pulmonary function and cardiovascular mechanics is a crucial issue, particularly when treating patients with chronic obstructive pulmonary disease (COPD). Synchrogram index is a new parameter that can quantify this interaction and has the potential to apply in COPD patients. Our objective in this study was to characterize cardiorespiratory interactions in terms of cardiorespiratory coupling (CRC) using the synchrogram index of the heart rate and respiratory flow signals in patients with chronic obstructive pulmonary disease. Methods This is a cross-sectional and preliminary data from a prospective study, which examines 55 COPD patients. K-means clustering analysis was applied to cluster COPD patients based on the synchrogram index. Linear regression and multivariable regression analysis were used to determine the correlation between the synchrogram index and the exercise capacity assessed by a six-minute walking test (6MWT). Results The 55 COPD patients were separated into a synchronized group (median 0.89 (0.64–0.97), n = 43) and a desynchronized group (median 0.23 (0.02–0.51), n = 12) based on K-means clustering analysis. Synchrogram index was correlated significantly with six minutes walking distance (r = 0.42, p = 0.001) and distance saturation product (r = 0.41, p = 0.001) assessed by 6MWT, and still was an independent variable by multivariable regression analysis. Conclusion This is the first result studying the heart–lung interaction in terms of cardiorespiratory coupling in COPD patients by the synchrogram index, and COPD patients are clustered into synchronized and desynchronized groups. Cardiorespiratory coupling is associated with exercise capacity in patients with COPD.
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Affiliation(s)
- Yu-Chen Huang
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, 199 Tun-Hwa N. Rd., Taipei, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ting-Yu Lin
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, 199 Tun-Hwa N. Rd., Taipei, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hau-Tieng Wu
- Department of Mathematics, Duke University, Durham, NC, USA.,Department of Statistical Sciences, Duke University, Durham, NC, USA
| | - Po-Jui Chang
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, 199 Tun-Hwa N. Rd., Taipei, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chun-Yu Lo
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, 199 Tun-Hwa N. Rd., Taipei, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Tsai-Yu Wang
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, 199 Tun-Hwa N. Rd., Taipei, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chih-Hsi Scott Kuo
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, 199 Tun-Hwa N. Rd., Taipei, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shu-Min Lin
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, 199 Tun-Hwa N. Rd., Taipei, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Fu-Tsai Chung
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, 199 Tun-Hwa N. Rd., Taipei, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Horng-Chyuan Lin
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, 199 Tun-Hwa N. Rd., Taipei, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Meng-Heng Hsieh
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, 199 Tun-Hwa N. Rd., Taipei, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Lun Lo
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, 199 Tun-Hwa N. Rd., Taipei, Taiwan. .,College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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6
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Meys R, Stoffels AAF, Houben-Wilke S, Janssen DJA, Burtin C, van Hees HWH, Franssen FME, van den Borst B, Wouters EFM, Spruit MA. Association between patient-reported outcomes and exercise test outcomes in patients with COPD before and after pulmonary rehabilitation. Health Qual Life Outcomes 2020; 18:300. [PMID: 32891156 PMCID: PMC7487841 DOI: 10.1186/s12955-020-01505-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 07/22/2020] [Indexed: 01/04/2023] Open
Abstract
Background Over the years, the scope of outcomes assessment in chronic obstructive pulmonary disease (COPD) has broadened, allowing for the evaluation of various patient-reported outcomes (PROs). As it still remains unclear whether and to what extent PROs mirror the exercise performance of patients with COPD, the current study aimed to assess the association between different exercise test outcomes and PROs, before and after pulmonary rehabilitation (PR). Methods Correlations between PROs used to describe health-related quality of life (HRQoL), mood status, level of care dependency and dyspnea in patients with COPD and commonly used laboratory- and field-based exercise test outcomes were evaluated in 518 individuals with COPD attending PR. Results Overall, correlations between PROs and exercise test outcomes at baseline were statistically significant. The correlation between modified Medical Research Council (mMRC) dyspnea score and 6-min walking distance (6MWD) was strongest (ρ:-0.65; p<0.001). HRQoL related PROs showed weak correlations with exercise outcomes at baseline. Moderate correlations were found between St George’s Respiratory Questionnaire total score and 6MWD (r:-0.53; p<0.001) and maximal workload achieved during cardiopulmonary exercise testing (ρ:-0.48; p<0.001); and between Clinical COPD Questionnaire (CCQ) total score and 6MWD (r:-0.48; p<0.001) and maximal workload (ρ:-0.43; p<0.001). When significant, correlations between changes in exercise test outcomes and changes in PROs after PR were generally very weak or weak. The highest correlation was found between changes in CCQ total score and changes in 6MWD (ρ: − 0.36; p<0.001). Conclusions PROs and exercise test outcomes, although significantly correlated with each other, assess different disease features in patients with COPD. Individual PROs need to be supported by additional functional measurements whenever possible, in order to get a more detailed insight in the effectiveness of a PR program. Trial registration Netherlands Trial Register (NL3263/NTR3416). Registered 2 May 2012.
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Affiliation(s)
- Roy Meys
- Department of Research and Development, CIRO, Hornerheide 1, 6085NM, Horn, the Netherlands. .,Department of Respiratory Medicine, Maastricht University Medical Centre, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands.
| | - Anouk A F Stoffels
- Department of Research and Development, CIRO, Hornerheide 1, 6085NM, Horn, the Netherlands.,Department of Respiratory Medicine, Maastricht University Medical Centre, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands.,Department of Pulmonary Diseases, Radboud UMC Dekkerswald, Nijmegen, the Netherlands
| | - Sarah Houben-Wilke
- Department of Research and Development, CIRO, Hornerheide 1, 6085NM, Horn, the Netherlands
| | - Daisy J A Janssen
- Department of Research and Development, CIRO, Hornerheide 1, 6085NM, Horn, the Netherlands.,Department of Health Services Research, Care and Public Health Research Institute, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Chris Burtin
- Reval Rehabilitation Research, Biomedical Research Institute, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
| | | | - Frits M E Franssen
- Department of Research and Development, CIRO, Hornerheide 1, 6085NM, Horn, the Netherlands.,Department of Respiratory Medicine, Maastricht University Medical Centre, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands
| | - Bram van den Borst
- Department of Pulmonary Diseases, Radboud UMC Dekkerswald, Nijmegen, the Netherlands
| | - Emiel F M Wouters
- Department of Research and Development, CIRO, Hornerheide 1, 6085NM, Horn, the Netherlands.,Department of Respiratory Medicine, Maastricht University Medical Centre, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands
| | - Martijn A Spruit
- Department of Research and Development, CIRO, Hornerheide 1, 6085NM, Horn, the Netherlands.,Department of Respiratory Medicine, Maastricht University Medical Centre, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands.,Reval Rehabilitation Research, Biomedical Research Institute, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
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7
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Alter P, Mayerhofer BA, Kahnert K, Watz H, Waschki B, Andreas S, Biertz F, Bals R, Vogelmeier CF, Jörres RA. Prevalence of cardiac comorbidities, and their underdetection and contribution to exertional symptoms in COPD: results from the COSYCONET cohort. Int J Chron Obstruct Pulmon Dis 2019; 14:2163-2172. [PMID: 31571852 PMCID: PMC6759215 DOI: 10.2147/copd.s209343] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 07/10/2019] [Indexed: 12/21/2022] Open
Abstract
Background A substantial prevalence of cardiovascular disease is known for COPD, but detection of its presence, relationship to functional findings and contribution to symptoms remains challenging. The present analysis focusses on the cardiovascular contribution to COPD symptoms and their relationship to the patients’ diagnostic status, medication and echocardiographic findings. Methods Patients from the COPD cohort COSYCONET with data on lung function, including FEV1, residual volume/total lung capacity (RV/TLC) ratio, diffusing capacity TLCO, and echocardiographic data on left ventricular ejection fraction (LVEF) and end-diastolic diameter (LVEDD), medical history, medication, modified British Medical Research Council dyspnea scale (mMRC) and Saint Georges Respiratory Questionnaire (SGRQ) were analyzed. Results A total of 1591 patients (GOLD 0–4: n=230/126/614/498/123) fulfilled the inclusion criteria. Ischemic heart disease, myocardial infarction or heart failure were reported in 289 patients (18.2%); 860 patients (54%) received at least one cardiovascular medication, with more than one in many patients. LVEF<50% or LVEDD>56 mm was found in 204 patients (12.8%), of whom 74 (36.3%) had neither a cardiovascular history nor medication. Among 948 patients (59.6%) without isolated hypertension, there were 21/55 (38.2%) patients with LVEF<50% and 47/88 (53.4%) with LVEDD>56 mm, who lacked both a cardiac diagnosis and medication. LVEDD and LVEF were linked to medical history; LVEDD was dependent on RV/TLC and LVEF on FEV1. Exertional COPD symptoms were best described by mMRC and the SGRQ activity score. Beyond lung function, an independent link from LVEDD on symptoms was revealed. Conclusion A remarkable proportion of patients with suspicious echocardiographic findings were undiagnosed and untreated, implying an increased risk for an unfavorable prognosis. Cardiac size and function were dependent on lung function and only partially linked to cardiovascular history. Although the contribution of LV size to COPD symptoms was small compared to lung function, it was detectable irrespective of all other influencing factors. However, only the mMRC and SGRQ activity component were found to be suitable for this purpose.
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Affiliation(s)
- Peter Alter
- Department of Medicine, Pulmonary and Critical Care Medicine, Philipps University of Marburg (UMR), Member of the German Center for Lung Research (DZL), Marburg, Germany
| | - Barbara A Mayerhofer
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Comprehensive Pneumology Center Munich (CPC-M), Member of the Center for Lung Research (DZL), Munich, Germany
| | - Kathrin Kahnert
- Department of Internal Medicine V, University Hospital, LMU Munich, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Henrik Watz
- Pulmonary Research Institute at Lungen Clinic Grosshansdorf, Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Grosshansdorf, Germany
| | - Benjamin Waschki
- Department of Pneumology, LungenClinic Grosshansdorf, Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Grosshansdorf, Germany.,Department of General and Interventional Cardiology, University Heart Center, Hamburg, Germany
| | - Stefan Andreas
- Department of Cardiology and Pneumology, University Medical Center, Goettingen, Germany.,Lung Clinic, Immenhausen, Germany
| | - Frank Biertz
- Institute for Biostatistics, Center for Biometry, Medical Informatics and Medical Technology, Hannover Medical School, Hannover, Germany
| | - Robert Bals
- Department of Internal Medicine V - Pulmonology, Allergology, Intensive Care Medicine, Saarland University Hospital, Homburg, Germany
| | - Claus F Vogelmeier
- Department of Medicine, Pulmonary and Critical Care Medicine, Philipps University of Marburg (UMR), Member of the German Center for Lung Research (DZL), Marburg, Germany
| | - Rudolf A Jörres
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Comprehensive Pneumology Center Munich (CPC-M), Member of the Center for Lung Research (DZL), Munich, Germany
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8
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Perez T, Deslée G, Burgel PR, Caillaud D, Le Rouzic O, Zysman M, Escamilla R, Jebrak G, Chanez P, Court-Fortune I, Brinchault-Rabin G, Nesme-Meyer P, Paillasseur JL, Roche N. Predictors in routine practice of 6-min walking distance and oxygen desaturation in patients with COPD: impact of comorbidities. Int J Chron Obstruct Pulmon Dis 2019; 14:1399-1410. [PMID: 31308646 PMCID: PMC6614586 DOI: 10.2147/copd.s188412] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 04/26/2019] [Indexed: 11/29/2022] Open
Abstract
Background: The 6-min walk test (6MWT) allows exercise tolerance to be assessed, and it has a significant prognostic value in COPD. The goal of this study was to analyse the determinants (obtained in routine practice) of a low 6-min walking distance (6MWD) and exercise-induced desaturation (EID) in COPD, including comorbidities. Methods: Patients were recruited from the real-life French COPD cohort “Initiatives BPCO”. A low 6MWD was defined as <350 m. EID was defined by a minimum pulse oxygen saturation (SpO2)<90% and delta SpO2≥4% from baseline. Multivariate logistic regression analyses assessed the influence on 6MWD and EID of age, sex, obesity (body mass index, BMI >30 kg/m2), low BMI (BMI <18.5 kg/m2), modified Medical Research Council (mMRC) dyspnea scale, FEV1% pred, FVC % pred, hyperinflation and comorbidities including cardiovascular diseases. Results: Among 440 patients with available 6MWT data, a 6MWD <350 m was found in 146 patients (33%), which was positively associated in multivariate analyses with age and mMRC and negatively with resting SpO2 and FVC % pred (rescaled r2=0.34), whereas no comorbidity was associated with a low 6WMD. EID was found in 155 patients (35%). This was positively associated with hypertension and negatively with age, obesity, FEV1% pred and resting SpO2 (rescaled r2=0.37). Conclusion: 6MWD and EID exhibit different determinants in COPD with a minor impact of comorbidities limited to hypertension in EID and to obesity, which was unexpectedly associated with less EID. Other variables including age, routine resting lung function and SpO2 were weakly associated with 6MWD and EID. Altogether, these results suggest that 6MWT performance remains difficult to predict with routine clinical/functional parameters.
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Affiliation(s)
- Thierry Perez
- CHU Lille, Department of Respiratory Diseases, F-59000 Lille and Univ. Lille, Center for Infection and Immunity of Lille, INSERM U1019 - CNRS UMR 8204, F-59000, Lille, France
| | - Gaëtan Deslée
- Department of Respiratory Diseases, Maison Blanche Hospital, CHU de Reims, INSERM UMRS 1250, Reims, France
| | - Pierre Régis Burgel
- Respiratory and Intensive Care Medicine Department, Cochin Hospital, AP-HP and Paris Descartes University (EA 2511), Sorbonne Paris Cité, Paris, France
| | - Denis Caillaud
- Department of Respiratory Diseases, Gabriel Montpied Hospital, CHU de Clermont Ferrand, Clermont Ferrand, France
| | - Olivier Le Rouzic
- CHU Lille, Department of Respiratory Diseases, F-59000 Lille and Univ. Lille, Center for Infection and Immunity of Lille, INSERM U1019 - CNRS UMR 8204, F-59000, Lille, France
| | - Maeva Zysman
- Department of Respiratory Diseases, CHU Nancy, Nancy, France
| | - Roger Escamilla
- Department of Respiratory Diseases, CHU Toulouse, Toulouse, France
| | - Gilles Jebrak
- Department of Respiratory Diseases, Hôpital Bichat, APHP, Paris, France
| | - Pascal Chanez
- Department of Respiratory Diseases, AP-HM, Université de Méditerranée, Inserm U 1077, Marseille, France
| | | | | | | | | | - Nicolas Roche
- Respiratory and Intensive Care Medicine Department, Cochin Hospital, AP-HP and Paris Descartes University (EA 2511), Sorbonne Paris Cité, Paris, France
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9
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Spartano NL, Davis-Plourde KL, Himali JJ, Andersson C, Pase MP, Maillard P, DeCarli C, Murabito JM, Beiser AS, Vasan RS, Seshadri S. Association of Accelerometer-Measured Light-Intensity Physical Activity With Brain Volume: The Framingham Heart Study. JAMA Netw Open 2019; 2:e192745. [PMID: 31002329 PMCID: PMC6481600 DOI: 10.1001/jamanetworkopen.2019.2745] [Citation(s) in RCA: 83] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 03/04/2019] [Indexed: 12/13/2022] Open
Abstract
Importance Dementia risk may be attenuated by physical activity (PA); however, the specific activity levels optimal for dementia prevention are unclear. Moreover, most older adults are unable to meet the nationally recommended PA guidelines, set at 150 minutes of moderate to vigorous PA per week. Objective To assess the association of total steps walked per day and total dose (intensity × duration) of PA with brain volumes on magnetic resonance imaging (MRI) among Framingham Heart Study participants. Design, Setting, and Participants This cross-sectional, community-based cohort study of the association of accelerometry-determined PA with brain MRI measures in Framingham, Massachusetts, included the Framingham Heart Study third-generation (examination 2, 2008-2011) and offspring (examination 9, 2011-2014) cohorts. Of 4021 participants who agreed to wear an accelerometer and had valid data (≥10 hours/day for ≥3 days), 1667 participants who did not undergo brain MRI (n = 1604) or had prevalent dementia or stroke (n = 63) were excluded. Data analysis began in 2016 and was completed in February 2019. Exposures Physical activity achieved using accelerometry-derived total activity (steps per day) and 2 intensity levels (light intensity and moderate to vigorous intensity). Main Outcomes and Measures Differences in total brain volume and other MRI markers of brain aging. Results The study sample of 2354 participants had a mean (SD) age of 53 (13) years, 1276 (54.2%) were women, and 1099 (46.7%) met the PA guidelines. Incremental light-intensity PA was associated with higher total brain volume; each additional hour of light-intensity PA was associated with approximately 1.1 years less brain aging (β estimate, 0.22; SD, 0.07; P = .003). Among individuals not meeting the PA guidelines, each hour of light-intensity PA (β estimate, 0.28; SD, 0.11; P = .01) and achieving 7500 steps or more per day (β estimate, 0.44; SD, 0.18; P = .02) were associated with higher total brain volume, equivalent to approximately 1.4 to 2.2 years less brain aging. After adjusting for light-intensity PA, neither increasing moderate to vigorous PA levels nor meeting the threshold moderate to vigorous PA level recommended by the PA guidelines were significantly associated with total brain volume. Conclusions and Relevance Every additional hour of light-intensity PA was associated with higher brain volumes, even among individuals not meeting current PA guidelines. These data are consistent with the notion that the potential benefits of PA on brain aging may accrue at a lower, more achievable level of intensity or duration.
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Affiliation(s)
- Nicole L. Spartano
- Department of Endocrinology, Diabetes, Nutrition and Weight Management, Boston University School of Medicine, Boston, Massachusetts
- Framingham Heart Study, Framingham, Massachusetts
| | - Kendra L. Davis-Plourde
- Framingham Heart Study, Framingham, Massachusetts
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Jayandra J. Himali
- Framingham Heart Study, Framingham, Massachusetts
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
| | - Charlotte Andersson
- Framingham Heart Study, Framingham, Massachusetts
- Department of Internal Medicine, Glostrup Hospital, Glostrup, Denmark
| | - Matthew P. Pase
- Framingham Heart Study, Framingham, Massachusetts
- Melbourne Dementia Research Centre, The Florey Institute for Neuroscience and Mental Health, Melbourne, Victoria, Australia
- Faculty of Medicine, Dentistry, and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
- Centre for Human Psychopharmacology, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Pauline Maillard
- Department of Neurology and Center for Neuroscience, University of California, Davis
| | - Charles DeCarli
- Department of Neurology and Center for Neuroscience, University of California, Davis
| | - Joanne M. Murabito
- Framingham Heart Study, Framingham, Massachusetts
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - Alexa S. Beiser
- Framingham Heart Study, Framingham, Massachusetts
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
| | - Ramachandran S. Vasan
- Framingham Heart Study, Framingham, Massachusetts
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - Sudha Seshadri
- Framingham Heart Study, Framingham, Massachusetts
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
- Glenn Biggs Institute for Alzheimer’s and Neurodegenerative Diseases, University of Texas Health Sciences Center, San Antonio
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Wouters EF. The Medusa faces of dyspnoea in COPD. Eur Respir J 2019; 53:53/4/1900487. [DOI: 10.1183/13993003.00487-2019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 03/19/2019] [Indexed: 11/05/2022]
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11
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André S, Conde B, Fragoso E, Boléo-Tomé JP, Areias V, Cardoso J. COPD and Cardiovascular Disease. Pulmonology 2018; 25:168-176. [PMID: 30527374 DOI: 10.1016/j.pulmoe.2018.09.006] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Accepted: 09/20/2018] [Indexed: 01/19/2023] Open
Abstract
COPD is one of the major public health problems in people aged 40 years or above. It is currently the 4th leading cause of death in the world and projected to be the 3rd leading cause of death by 2020. COPD and cardiac comorbidities are frequently associated. They share common risk factors, pathophysiological processes, signs and symptoms, and act synergistically as negative prognostic factors. Cardiac disease includes a broad spectrum of entities with distinct pathophysiology, treatment and prognosis. From an epidemiological point of view, patients with COPD are particularly vulnerable to cardiac disease. Indeed, mortality due to cardiac disease in patients with moderate COPD is higher than mortality related to respiratory failure. Guidelines reinforce that the control of comorbidities in COPD has a clear benefit over the potential risk associated with the majority of the drugs utilized. On the other hand, the true survival benefits of aggressive treatment of cardiac disease and COPD in patients with both conditions have still not been clarified. Given their relevance in terms of prevalence and prognosis, we will focus in this paper on the management of COPD patients with ischemic coronary disease, heart failure and dysrhythmia.
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Affiliation(s)
- S André
- Pulmonology Department, Hospital Egas Moniz, Centro Hospitalar de Lisboa Ocidental, EPE (CHLO), Lisbon, Portugal
| | - B Conde
- Pulmonology Department, Centro Hospitalar de Trás-os-Montes e Alto Douro, Vila Real, Portugal
| | - E Fragoso
- Pulmonology Department, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, EPE (CHLN), Lisbon, Portugal
| | - J P Boléo-Tomé
- Pulmonology Department, Hospital Prof. Doutor Fernando Fonseca, EPE, Amadora, Portugal
| | - V Areias
- Pulmonology Department, Hospital de Faro, Centro Hospitalar do Algarve, EPE, Faro, Portugal; Department of Biomedical Sciences and Medicine, Algarve University, Portugal
| | - J Cardoso
- Pulmonology Department, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, EPE (CHLC), Lisbon, Portugal; Nova Medical School, Nova University, Lisbon, Portugal.
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Houben-Wilke S, Janssen DJA, Franssen FME, Vanfleteren LEGW, Wouters EFM, Spruit MA. Contribution of individual COPD assessment test (CAT) items to CAT total score and effects of pulmonary rehabilitation on CAT scores. Health Qual Life Outcomes 2018; 16:205. [PMID: 30376861 PMCID: PMC6208036 DOI: 10.1186/s12955-018-1034-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 10/17/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The COPD Assessment Test (CAT) contains eight items (cough, phlegm, chest tightness, breathlessness, limited activities, confidence leaving home, sleeplessness and energy). The current study aimed 1) to better understand the impact of the respiratory and non-respiratory CAT item scores on the CAT total score; and 2) to determine the impact of pulmonary rehabilitation (PR) on CAT items and CAT total score. METHODS CAT total score of ≥10 or ≥ 18 points was used to classify patients as highly symptomatic, a decrease of 2 points was considered as clinically relevant improvement. 'Cough', 'phlegm', 'chest tightness', 'breathlessness' were defined as respiratory items; ≥3 points on each item was defined as highly symptomatic. RESULTS In total, 497 clinically stable patients (55% male, age 64.0 (57.5-71.0) years, FEV1 46.0 (32.0-63.0)% predicted, CAT total score 22.0 (17.5-26.0) points) were included. 95% had CAT score ≥ 10 points and 75% ≥18 points. Respectively, 45% and 54% of subjects scored high on 3 or 4 of the respiratory CAT items. Following PR, 220 patients (57.7%) reported an improved health status as assessed by CAT total score (- 3.0 (- 7.0-1.0) points). Change in CAT item scores ranged from 0.0 (- 1.0-0.0) to - 1.0 (- 2.0-0.0) points) with best improvements in 'energy' (- 1.0 (- 2.0-0.0)points). CONCLUSIONS A substantial number of patients classified as highly symptomatic did not report a high level of respiratory symptoms, indicating that non-respiratory symptoms impact on disease classification and treatment algorithm. The impact of PR on CAT item scores varied by individual item. TRIAL REGISTRATION Netherlands National Trial Register ( NTR3416 ). Registered 2 May 2012.
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Affiliation(s)
- Sarah Houben-Wilke
- Department of Research and Education, CIRO, Hornerheide 1, Horn, 6085 NM The Netherlands
| | - Daisy J. A. Janssen
- Department of Research and Education, CIRO, Hornerheide 1, Horn, 6085 NM The Netherlands
- Centre of Expertise for Palliative Care, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Frits M. E. Franssen
- Department of Research and Education, CIRO, Hornerheide 1, Horn, 6085 NM The Netherlands
- Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Lowie E. G. W. Vanfleteren
- Department of Research and Education, CIRO, Hornerheide 1, Horn, 6085 NM The Netherlands
- COPD center, Sahlgrenska University Hospital and Institute of Medicine, Gothenburg University, Gothenburg, Sweden
| | - Emiel F. M. Wouters
- Department of Research and Education, CIRO, Hornerheide 1, Horn, 6085 NM The Netherlands
- Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Martijn A. Spruit
- Department of Research and Education, CIRO, Hornerheide 1, Horn, 6085 NM The Netherlands
- Department of Respiratory Medicine, Maastricht University Medical Center, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands
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13
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McNamara RJ, Houben-Wilke S, Franssen FM, Smid DE, Vanfleteren LE, Groenen MT, Uszko-Lencer NH, Wouters EF, Alison JA, Spruit MA. Determinants of functional, peak and endurance exercise capacity in people with chronic obstructive pulmonary disease. Respir Med 2018; 138:81-87. [DOI: 10.1016/j.rmed.2018.03.032] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 02/22/2018] [Accepted: 03/28/2018] [Indexed: 11/26/2022]
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Mantoani LC, Dell'Era S, MacNee W, Rabinovich RA. Physical activity in patients with COPD: the impact of comorbidities. Expert Rev Respir Med 2017; 11:685-698. [PMID: 28699821 DOI: 10.1080/17476348.2017.1354699] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Comorbidities are common in patients with chronic obstructive pulmonary disease (COPD) and it plays an important role on physical activity (PA) in this population. Since low PA levels have been described as a key factor to predict morbi-mortality in COPD, it seems crucial to review the current literature available on this topic. Areas covered: This review covers the most common comorbidities found in COPD, their prevalence and prognostic implications. We explore the differences in PA between COPD patients with and without comorbidities, as well as the impact of the number or type of comorbidities on activity levels of this population. The effect of different comorbidities on activities of daily living in patients with COPD is also reviewed. Finally, we discuss options for the treatment of inactivity in COPD patients considering their comorbidities and limitations. Expert commentary: Comorbidities are highly prevalent in patients with COPD and further deteriorate PA levels in this population. Despite the wide range of interventions available in COPD, the evidence in the field seems to point at PA coaching with feedback on individual goals and longer lasting PR programmes with more than 12 weeks of duration when attempting to raise the activity levels of this population.
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Affiliation(s)
- Leandro Cruz Mantoani
- a ELEGI and COLT Laboratories , Queen's Medical Research Institute, The University of Edinburgh , Edinburgh , UK
| | - Silvina Dell'Era
- a ELEGI and COLT Laboratories , Queen's Medical Research Institute, The University of Edinburgh , Edinburgh , UK.,b Sección de Rehabilitación y Cuidados Respiratorios, Servicio de Kinesiología, Hospital Italiano de Buenos Aires , Buenos Aires , Argentina
| | - William MacNee
- a ELEGI and COLT Laboratories , Queen's Medical Research Institute, The University of Edinburgh , Edinburgh , UK
| | - Roberto A Rabinovich
- a ELEGI and COLT Laboratories , Queen's Medical Research Institute, The University of Edinburgh , Edinburgh , UK
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Physical and psychological status of patients with COPD and impaired LVEF: Two bads don't make a good. Int J Cardiol 2017; 227:249-250. [PMID: 27852446 DOI: 10.1016/j.ijcard.2016.11.123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 11/06/2016] [Indexed: 11/23/2022]
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