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Xie H, Jiang Y, Liu L, Peng H, Li J, Chen Z. Global prevalence and risk factors of depression in patients with chronic obstructive pulmonary disease: A systematic review and meta-analysis from 2000 to 2022. J Psychosom Res 2023; 175:111537. [PMID: 37907038 DOI: 10.1016/j.jpsychores.2023.111537] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 10/22/2023] [Accepted: 10/23/2023] [Indexed: 11/02/2023]
Abstract
OBJECTIVE This study aims to assess the global and regional prevalence and the potential risk factors for depression among COPD patients. METHODS Web of Science, EMBASE, PubMed, and PsycINFO databases were searched for the literature related to the prevalence and risk factors of depression in COPD. Random-effect models were performed to pool the global prevalence. Sub-group analysis and meta-regression were conducted to investigate the potential heterogeneity. Meta-analysis was performed only on the risk factors that have been reported in a minimum of three studies. RESULTS A total of 79 studies from 25 countries were included. The pooled global prevalence of variably defined depression among COPD patients was 34.5% (95% CI: 30.9-38.1). The odds of depression in COPD patients were 3.53 times higher than in non-COPD participants (95% CI: 2.35-5.29). Meta-regression results showed that region, income level, and research setting are the main sources of heterogeneity. Female sex (OR=1.92), living alone (OR=2.29), BODE index (OR=1.48), dyspnea (OR=3.02), impaired quality of life (OR=1.26), and GOLD stage III∼IV (OR=1.96) were found to be significant risk factors for depression in meta-analyses. CONCLUSIONS More than one-third of COPD patients experience depression, with marked variations in prevalence across countries and regions. This study further highlights the need for the consolidation of mental health considerations into COPD treatments. High-quality, longitudinal studies and further research are needed to gain a better understanding of risk and protective factors.
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Affiliation(s)
- Hongmei Xie
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Yunlan Jiang
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China.
| | - Lu Liu
- Department of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Hanmei Peng
- Department of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Jie Li
- Department of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Zengli Chen
- Department of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
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2
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Roberts M, Smith T, Wheatley J, Cho JG. Symptom Burden of Patients with Chronic Obstructive Pulmonary Disease Attending the Westmead Breathlessness Service: Prevalence, Associations, and Sex-Related Differences. Int J Chron Obstruct Pulmon Dis 2023; 18:2825-2837. [PMID: 38053921 PMCID: PMC10695132 DOI: 10.2147/copd.s433541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 11/09/2023] [Indexed: 12/07/2023] Open
Abstract
Purpose Chronic obstructive pulmonary disease (COPD) is a progressive disease resulting in a range of symptoms including breathlessness. "Symptom burden" describes the severity and impact of multiple symptoms in an individual and is best quantified using validated symptom instruments but is not routinely measured in clinical practice. Therefore, we wanted to assess overall symptom burden in patients with moderate-to-severe COPD and find associated independent predictors. Patients and methods A single-centre cross-sectional study of patients with COPD who attended the Westmead Breathlessness Service between March 2017 and May 2022 was conducted. We obtained baseline demographic data, lung function, assessed quality of life (CAT), anxiety/depression (HADS), and measured symptom burden (CMSAS). We compared variables between men and women using unpaired t tests or Mann-Whitney tests for continuous variables, and Fisher's exact tests for categorical variables. We used multiple regression to look for independent predictors of overall symptom burden. Data were analysed using Stata/IC 15.1. Results Eighty-nine patients with COPD, mean age 72.6 years, 55% male, mean FEV1 32% predicted, reported an average of 8.9 symptoms including 6.9 physical and 1.6 psychological symptoms. The most common physical symptoms were shortness of breath (100%) and lack of energy (80%), and the most common psychological symptoms were worrying (65%) and feeling anxious (61%). Median CMSAS total score was higher in women than men (1.34 versus 1.04, respectively; p=0.03) with more women experiencing nervousness (p=0.011) and anxiety (p=0.005). Female sex (p=0.003), HADS-Anxiety (p=0.0001), and HADS-Depression (p=0.0001) were independently associated with total CMSAS score in a multiple linear regression model and explained 63% of total CMSAS variability. Conclusion Very high physical and psychological symptom burden exists among patients with severe COPD. Anxiety, depression, and female sex were independently associated with increasing symptom burden. Identifying and understanding sex differences for COPD symptoms, and interventions targeting anxiety and depression may help to reduce overall symptom burden within this population.
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Affiliation(s)
- Mary Roberts
- Department of Respiratory and Sleep Medicine, Westmead Hospital, Westmead, NSW, Australia
- University of Sydney at Westmead Hospital, Westmead, NSW, Australia
- Ludwig Engel Centre for Respiratory Research, Westmead Institute for Medical Research, Westmead, NSW, Australia
| | - Tracy Smith
- Department of Respiratory and Sleep Medicine, Westmead Hospital, Westmead, NSW, Australia
| | - John Wheatley
- Department of Respiratory and Sleep Medicine, Westmead Hospital, Westmead, NSW, Australia
- University of Sydney at Westmead Hospital, Westmead, NSW, Australia
- Ludwig Engel Centre for Respiratory Research, Westmead Institute for Medical Research, Westmead, NSW, Australia
| | - Jin-Gun Cho
- Department of Respiratory and Sleep Medicine, Westmead Hospital, Westmead, NSW, Australia
- University of Sydney at Westmead Hospital, Westmead, NSW, Australia
- Ludwig Engel Centre for Respiratory Research, Westmead Institute for Medical Research, Westmead, NSW, Australia
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3
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Tang S, Ding Y, Zhou Z, Yang W. Identification and bioinformatic analysis of CircRNAs in the plasma of patients with very severe chronic obstructive pulmonary disease. BMC Pulm Med 2023; 23:211. [PMID: 37328740 DOI: 10.1186/s12890-023-02513-5] [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: 12/12/2022] [Accepted: 06/07/2023] [Indexed: 06/18/2023] Open
Abstract
BACKGROUND The differential expression of circular RNAs (circRNAs) in individuals with very severe chronic obstructive pulmonary disease (COPD) and healthy individuals was screened using microarray technology. The related functions and mechanisms were analyzed using bioinformatic methods to explore the potential of target circRNAs as biomarkers of COPD and provide insights for future pathogenesis. PATIENTS AND METHODS Thirty patients with very severe COPD and thirty healthy controls were diagnosed at The Second People's Hospital of Hefei from September 2021 to September 2022. The differential expression of circRNAs was compared and analyzed using a gene microarray and verified using quantitative real-time polymerase chain reaction (qRT-PCR) technology. RESULTS A total of 90 upregulated and 29 downregulated circRNAs were screened in patients with very severe COPD and compared with those in healthy controls. qRT-PCR analysis showed that hsa_circ_0062683 of patients with very severe COPD was significantly upregulated, and hsa_circ_0089763 and hsa_circ_0008882 were significantly downregulated. By constructing the circRNA-miRNA interaction network, it was found that hsa-miR-612, hsa-miR-593-5p, hsa-miR-765, and hsa-miR-103a-2-5p are the miRNAs regulated by more differentially expressed circRNAs (DEcircRNAs). DEcircRNAs may participate in the development of COPD through hypoxia or regulation of various immune cells. CONCLUSION Plasma circRNAs may play a helpful role in the diagnosis and assessment of COPD and be valuable disease biomarkers.
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Affiliation(s)
- Sihui Tang
- Department of Respiratory and Critical Care Medicine, Hefei Hospital Affiliated to Anhui Medical University, The Second People's Hospital of Hefei, Hefei, Anhui, 230011, China
- The Fifth Clinical College of Anhui Medical University, Hefei, Anhui, 230032, China
- Department of Respiratory and Critical Care Medicine, The Second People's Hospital of Hefei Affiliated to Bengbu Medical University, Bengbu, Anhui, 230030, China
| | - Yichuan Ding
- Department of Respiratory and Critical Care Medicine, Hefei Hospital Affiliated to Anhui Medical University, The Second People's Hospital of Hefei, Hefei, Anhui, 230011, China
- The Fifth Clinical College of Anhui Medical University, Hefei, Anhui, 230032, China
| | - Zihan Zhou
- Department of Respiratory and Critical Care Medicine, Hefei Hospital Affiliated to Anhui Medical University, The Second People's Hospital of Hefei, Hefei, Anhui, 230011, China
- The Fifth Clinical College of Anhui Medical University, Hefei, Anhui, 230032, China
| | - Wanchun Yang
- Department of Respiratory and Critical Care Medicine, Hefei Hospital Affiliated to Anhui Medical University, The Second People's Hospital of Hefei, Hefei, Anhui, 230011, China.
- The Fifth Clinical College of Anhui Medical University, Hefei, Anhui, 230032, China.
- Department of Respiratory and Critical Care Medicine, The Second People's Hospital of Hefei Affiliated to Bengbu Medical University, Bengbu, Anhui, 230030, China.
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4
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Koons B, Aryal S, Blumenthal N, Courtwright A, O'Connor M, Christie JD, Singer JP, Riegel B. Mismatch identified in symptom burden profiles in lung transplantation. Heart Lung 2023; 59:165-172. [PMID: 36841013 PMCID: PMC10072907 DOI: 10.1016/j.hrtlng.2023.02.011] [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: 09/13/2022] [Revised: 02/13/2023] [Accepted: 02/13/2023] [Indexed: 02/27/2023]
Abstract
BACKGROUND There is considerable heterogeneity in symptom burden among lung transplant candidates that may not be explained by objective measures of illness severity. OBJECTIVES This study aimed to characterize symptom burden, identify distinct profiles based on symptom burden and illness severity, and determine whether observed profiles are defined by differences in social determinates of health (SDOH). METHODS This was a prospective study of adult lung transplant candidates. Symptoms were assessed within 3 months of transplant with the Memorial Symptom Assessment Scale (MSAS). MSAS subscale (physical and psychological) scores range 0-4 (higher=more symptom burden). The lung allocation score (LAS) (range 0-100) was our proxy measure of illness severity. The MSAS subscales and LAS were used as continuous indicators in a latent profile analysis to identify distinct symptom-illness severity profiles. Comparative statistics were used to identify SDOH differences among observed profiles. RESULTS Among 93 candidates, 3 distinct symptom-illness severity profiles were identified: 71% had a mild profile in which mild symptoms (MSAS physical 0.49; MSAS psychological 0.57) paired with mild illness severity (LAS 38.59). Of the 29% mismatched participants, 9% had moderate symptoms (MSAS physical 0.88; MSAS psychological 1.47) but severe illness severity (LAS 88.02) and 20% had severe symptoms (MSAS physical 1.30; MSAS psychological 1.94) but mild illness severity (LAS 42.13). The two mismatch profiles were younger, more racially diverse, and had higher psychosocial risk scores. CONCLUSION Symptom burden is heterogenous, does not always reflect objective measures of illness severity, and may be linked to SDOH.
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Affiliation(s)
- Brittany Koons
- M. Louise Fitzpatrick College of Nursing, Villanova University, Villanova, PA, United States.
| | - Subhash Aryal
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Nancy Blumenthal
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Andrew Courtwright
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, United States
| | - Melissa O'Connor
- M. Louise Fitzpatrick College of Nursing, Villanova University, Villanova, PA, United States
| | - Jason D Christie
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, United States
| | - Jonathan P Singer
- Division of Pulmonary and Critical Care, Department of Medicine, University of California, San Francisco, School of Medicine, San Francisco, California, United States
| | - Barbara Riegel
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, United States
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5
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Stability of distinct symptom experiences in patients with chronic obstructive pulmonary disease (COPD). Respir Med 2022; 201:106944. [PMID: 35970058 DOI: 10.1016/j.rmed.2022.106944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 07/06/2022] [Accepted: 07/24/2022] [Indexed: 11/20/2022]
Abstract
PURPOSE This study aimed to examine reclassification rates among classes of chronic obstructive pulmonary disease (COPD) patients based on their distinct symptom experiences and to assess how these subgroups differed in symptom scores and health-related quality of life (HRQoL) outcomes over one year. Moreover, we wished to assess how these subgroups differed in demographic and clinical characteristics at 12 months. PATIENTS AND METHODS This is a follow-up study of 267 patients with moderate, severe, and very severe COPD. Based on their distinct symptom experiences using the Memorial Symptom Assessment Scale (MSAS), three subgroups (i.e., "high", "intermediate", and "low") were identified at baseline. In the present study, transitions between the subgroups at three, six, nine, and 12 months were investigated and calculated as reclassification rates. Differences among the subgroups in symptom scores and HRQoL at each time point and demographic and clinical characteristics at 12 months were evaluated using analysis of variance with post hoc comparisons. RESULTS Almost 65% were still in the "high" class after 12 months. At 12 months, pairwise comparisons for respiratory function measurements were not significantly different. Compared to the "intermediate" and "low" class, patients in the "high" class were more likely to be women and had significantly more comorbidities, reported a significantly higher number of symptoms at all time points, and worse HRQoL scores. CONCLUSION Our findings suggest that the pattern of a high symptom burden in COPD is consistent over time. The patients' individual symptom experiences should be the primary focus of treatment.
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Siltanen H, Aine T, Huhtala H, Kaunonen M, Paavilainen E. The information needs of people with COPD-The holistic approach with special reference to gender and time since diagnosis. Nurs Open 2021; 8:2498-2508. [PMID: 33755324 PMCID: PMC8363367 DOI: 10.1002/nop2.773] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 12/07/2020] [Accepted: 12/18/2020] [Indexed: 12/12/2022] Open
Abstract
AIMS The aim of this study was to determine what kinds of unmet information needs people with COPD have and whether there are differences in information needs between genders or based on the time since COPD diagnosis. DESIGN A descriptive cross-sectional study. METHODS Data on people with COPD (N = 169) were collected from a two-part questionnaire distributed via website. On the first part, information needs concerning the medical aspects of self-management were measured by the Lung Information Needs Questionnaire (LINQ). On the second part, which was developed specifically for this study, a more holistic view of self-management counselling was sought. Statistical methods were used to analyse the data. RESULTS The respondents had wide-ranging information needs in many areas of COPD self-management. The most often reported areas of unmet information needs included exacerbations, diet, fatigue, stress and anxiety, palliative care and sexual life. The information needs varied by gender and time since COPD diagnosis.
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Affiliation(s)
- Hannele Siltanen
- Department of Health SciencesFaculty of Social SciencesTampere UniversityTampereFinland
| | - Tiina Aine
- Faculty of Medicine and Health TechnologyTampere UniversityTampereFinland
| | - Heini Huhtala
- Department of Health SciencesFaculty of Social SciencesTampere UniversityTampereFinland
| | - Marja Kaunonen
- Department of Health SciencesFaculty of Social SciencesTampere UniversityTampereFinland
- Pirkanmaa Hospital DistrictTampereFinland
| | - Eija Paavilainen
- Department of Health SciencesFaculty of Social SciencesTampere UniversityTampereFinland
- Etelä‐Pohjanmaa Hospital DistrictSeinäjokiFinland
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7
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Wahl AK, Osborne RH, Larsen MH, Andersen MH, Holter IA, Borge CR. Exploring health literacy needs in Chronic obstructive pulmonary disease (COPD): Associations between demographic, clinical variables, psychological well-being and health literacy. Heart Lung 2021; 50:417-424. [PMID: 33618148 DOI: 10.1016/j.hrtlng.2021.02.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 01/25/2021] [Accepted: 02/05/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND The World Health Organization (WHO) points to health literacy as an important factor in prevention and control of non-communicable diseases (NCDs), including COPD. OBJECTIVE To investigate associations between selected demographic and clinical variables, psychological well-being and health literacy. METHODS Health literacy was measured using the nine domain Health Literacy Questionnaire (HLQ) and one domain from the eHealth Literacy Questionnaire (eHLQ). Using data from a cross-sectional sample of 158 people with COPD, recruited from a hospital-based patient list period (2014-2016), multiple regression analyses were performed. RESULTS The strongest associated variables with health literacy were psychological well-being, measured by the WHO-5 well-being index and education, indicating that higher psychological well-being and educational level are associated with higher levels of health literacy. CONCLUSION The present study highlights the importance of specifically looking to psychological factors in determining potentially health literacy needs among people with COPD.
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Affiliation(s)
- Astrid K Wahl
- Department of Interdisciplinary Health Sciences, University of Oslo, Norway.
| | - Richard H Osborne
- Centre of Global Health and Equity, Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, Australia
| | - Marie H Larsen
- Department of Interdisciplinary Health Sciences, University of Oslo, Norway; Lovisenberg Diaconal University College, Oslo, Norway
| | - Marit H Andersen
- Department of Interdisciplinary Health Sciences, University of Oslo, Norway; Department of Transplantation Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | | | - Christine R Borge
- Department of Interdisciplinary Health Sciences, University of Oslo, Norway; Lovisenberg Diaconal Hospital, Oslo, Norway
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8
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Siltanen H, Jylhä V, Holopainen A, Paavilainen E. Family members' experiences and expectations of self-management counseling while caring for a person with chronic obstructive pulmonary disease: a systematic review of qualitative evidence. ACTA ACUST UNITED AC 2020; 17:2214-2247. [PMID: 31567526 DOI: 10.11124/jbisrir-d-19-00056] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE The objective of this review was to identify and synthesize existing evidence on the experiences and expectations of self-management counseling of adult family members who are informal caregivers of a person with chronic obstructive pulmonary disease (COPD) in the context of inpatient or outpatient care. INTRODUCTION Chronic obstructive pulmonary disease is the fourth leading cause of mortality and morbidity worldwide. It is a progressive, lifelong and unpredictable disease. As the disease progresses, both the people with COPD and their family members require information and practical skills to manage the disease. The role of family members is particularly important at the advanced stage of COPD. This systematic review examined family members' experiences and expectations of self-management counseling. INCLUSION CRITERIA This review considered qualitative studies that investigated adult (older than18 years) family members' experiences or expectations of COPD self-management counseling in the context of inpatient or outpatient care. "Family member" refers to a person who is an informal caregiver because of his or her relationship to the person with COPD. METHODS A three-step search strategy was utilized in this review. The search strategy aimed to find published and unpublished studies in English and Finnish. The databases MEDLINE, CINAHL, PsycINFO, Scopus and the Finnish medical bibliographic database, Medic, were searched. The search was conducted in December 2015 and updated in September 2018. Titles and abstracts were screened by two independent reviewers for the review's inclusion criteria. Eligible studies were then critically appraised by two independent reviewers for methodological quality. The findings and illustrations of the findings were extracted and assigned a level of credibility. The qualitative research findings were pooled using the JBI method of meta-aggregation. RESULTS Ten papers were selected for inclusion in this review. These studies were published from 2002 to 2017. The quality of all included studies was at least moderate. Each study had a total score between 7 and 10 on the JBI Critical Appraisal Checklist for Qualitative Research. The following four synthesized findings were aggregated from nine categories and 39 study findings: i) Family members' experiences with unresponsive behavior from health professionals, ii) Family members' experiences of unmet needs in self-management counseling, iii) Family members' information needs concerning COPD management, and iv) Family members' information needs concerning coping strategies. CONCLUSIONS The synthesized findings indicate that family members are frustrated by the shortcomings of self-management counseling. They also feel unprepared for and uncertain about their caring role. They need more information about COPD and coping strategies for COPD. Counseling is essential to high-quality care and should be offered to family members caring for a loved one at any stage of COPD.
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Affiliation(s)
- Hannele Siltanen
- Department of Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland.,Nursing Research Foundation, Helsinki, Finland.,Finnish Centre for Evidence-Based Health Care: a Joanna Briggs Institute Affiliated Group
| | - Virpi Jylhä
- Finnish Centre for Evidence-Based Health Care: a Joanna Briggs Institute Affiliated Group.,Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland
| | - Arja Holopainen
- Nursing Research Foundation, Helsinki, Finland.,Finnish Centre for Evidence-Based Health Care: a Joanna Briggs Institute Affiliated Group
| | - Eija Paavilainen
- Department of Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland.,Etelä-Pohjanmaa Hospital District, Seinäjoki, Finland
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9
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Lee AHY, Snowden CP, Hopkinson NS, Pattinson KTS. Pre-operative optimisation for chronic obstructive pulmonary disease: a narrative review. Anaesthesia 2020; 76:681-694. [PMID: 32710678 DOI: 10.1111/anae.15187] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2020] [Indexed: 12/26/2022]
Abstract
Chronic obstructive pulmonary disease is a condition commonly present in older people undergoing surgery and confers an increased risk of postoperative complications and mortality. Although predominantly a respiratory disease, it frequently has extra-pulmonary manifestations and typically occurs in the context of other long-term conditions. Patients experience a range of symptoms that affect their quality of life, functional ability and clinical outcomes. In this review, we discuss the evidence for techniques to optimise the care of people with chronic obstructive pulmonary disease in the peri-operative period, and address potential new interventions to improve outcomes. The article centres on pulmonary rehabilitation, widely available for the treatment of stable chronic obstructive pulmonary disease, but less often used in a peri-operative setting. Current evidence is largely at high risk of bias, however. Before surgery it is important to ensure that what have been called the 'five fundamentals' of chronic obstructive pulmonary disease treatment are achieved: smoking cessation; pulmonary rehabilitation; vaccination; self-management; and identification and optimisation of co-morbidities. Pharmacological treatment should also be optimised, and some patients may benefit from lung volume reduction surgery. Psychological and behavioural factors are important, but are currently poorly understood in the peri-operative period. Considerations of the risk and benefits of delaying surgery to ensure the recommended measures are delivered depends on patient characteristics and the nature and urgency of the planned intervention.
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Affiliation(s)
- A H Y Lee
- Nuffield Department of Clinical Neurosciences, University of Oxford, UK
| | - C P Snowden
- Newcastle Hospitals NHS Trust, Newcastle, UK.,Newcastle University, Newcastle, UK
| | - N S Hopkinson
- National Heart and Lung Institute, Imperial College, London, UK.,The Royal Brompton Hospital, London, UK
| | - K T S Pattinson
- Nuffield Department of Clinical Neurosciences, University of Oxford, UK.,Nuffield Department of Anaesthetics, John Radcliffe Hospital, Oxford, UK
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10
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Helvaci A, Izgu N, Ozdemir L. Relationship between symptom burden, medication adherence and spiritual well-being in patients with chronic obstructive pulmonary disease. J Clin Nurs 2020; 29:2388-2396. [PMID: 32221991 DOI: 10.1111/jocn.15251] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 01/29/2020] [Accepted: 03/14/2020] [Indexed: 12/28/2022]
Abstract
AIMS AND OBJECTIVES To investigate the relationship between symptom burden, medication adherence and spiritual well-being in patients with chronic obstructive pulmonary disease (COPD). BACKGROUND The relationship between spirituality and medication adherence has been investigated in different chronic conditions. However, the relationship between symptom burden, medication adherence and spiritual well-being in patients with COPD has not been explored. DESIGN A descriptive correlational study design was adopted. METHODS A total of 112 patients with COPD were included in the study. Data were collected using the COPD Assessment Test (CAT), the Adherence to Refills and Medications Scale-7 (ARMS-7) and the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale (FACIT-Sp). The data were analysed using descriptive and correlational statistics. The Strengthening the Reporting of Observational studies in Epidemiology (STROBE) Checklist was used. RESULTS The CAT score was significantly higher in patients on long-term oxygen therapy and those who had more than three comorbid conditions (p < .05). The mean score of ARMS-7 was significantly associated with age (p < .05). Current smokers had higher ARMS-7 and lower FACIT-Sp scores (p < .001). The FACIT-Sp score was negatively and moderately associated with the CAT and ARMS-7 scores (p < .001). CONCLUSION This study concluded that individuals with higher spiritual well-being had lower symptom burden and higher medication adherence. The need for long-term oxygen therapy and a high number of comorbid conditions were associated with increased symptom burden. Current smokers had lower spiritual well-being and medication adherence. RELEVANCE TO CLINICAL PRACTICE Spiritual well-being should be evaluated when assessing symptom burden and medication adherence in clinical practice. In addition, further studies examining the causal relationship between symptom burden, spiritual well-being and medication adherence in different populations are warranted.
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Affiliation(s)
- Aylin Helvaci
- Faculty of Nursing, Medical Nursing Department, Hacettepe University, Ankara, Turkey
| | - Nur Izgu
- Faculty of Nursing, Medical Nursing Department, Hacettepe University, Ankara, Turkey
| | - Leyla Ozdemir
- Faculty of Nursing, Medical Nursing Department, Hacettepe University, Ankara, Turkey
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11
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Iyer AS, Dionne-Odom JN, Khateeb DM, O'Hare L, Tucker RO, Brown CJ, Dransfield MT, Bakitas MA. A Qualitative Study of Pulmonary and Palliative Care Clinician Perspectives on Early Palliative Care in Chronic Obstructive Pulmonary Disease. J Palliat Med 2020; 23:513-526. [PMID: 31657654 PMCID: PMC7104897 DOI: 10.1089/jpm.2019.0355] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2019] [Indexed: 12/25/2022] Open
Abstract
Background: Guidelines recommend that pulmonary clinicians involve palliative care in chronic obstructive pulmonary disease (COPD); however, integration before advanced stage, that is, early palliative care, is rare. Objective: To explore and compare pulmonary and palliative care clinician perspectives on barriers, facilitators, and potential referral criteria for early palliative care in COPD. Design: Qualitative descriptive formative evaluation study. Setting/Subjects: Pulmonary and palliative care clinicians at a tertiary academic medical center. Measurements: Transcribed interviews were thematically analyzed by specialty to identify within- and across-specialty perspectives on barriers, facilitators, and referral criteria. Results: Twelve clinicians (n = 6 pulmonary, n = 6 palliative care) participated. Clinicians from both specialties agreed that early palliative care could add value to disease-focused COPD care. Perspectives on many barriers and facilitators were shared between specialties along broad educational, clinical, and operational categories. Pulmonary and palliative care clinicians shared concerns about the misconception that palliative care was synonymous to end-of-life care. Pulmonologists were particularly concerned about the potential risks of opioids and benzodiazepines in COPD. Both specialties stressed the need for clearly defined roles, consensus referral criteria, and novel delivery models. Although no single referral criterion was discussed by all, frequent hospitalizations and emotional symptoms were raised by most across disciplines. Multimorbidity and poor prognosis were discussed only by palliative care clinicians, whereas medication adherence was discussed only by pulmonary clinicians. Conclusions: Pulmonary and palliative care clinicians supported early palliative care in COPD. Continued needs include addressing pulmonologists' misconceptions of palliative care, establishing consensus referral criteria, and implementing novel early palliative care models.
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Affiliation(s)
- Anand S. Iyer
- Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama
- Department of Medicine, Center for Outcomes and Effectiveness Research and Education, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
- Department of Medicine, Lung Health Center, University of Alabama at Birmingham, Birmingham, Alabama
| | - James Nicholas Dionne-Odom
- Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
- Department of Medicine, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama
| | - Dina M. Khateeb
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Lanier O'Hare
- Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Rodney O. Tucker
- Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Cynthia J. Brown
- Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
- Department of Medicine, Birmingham Veterans Affairs Medical Center, Birmingham, Alabama
| | - Mark T. Dransfield
- Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama
- Department of Medicine, Lung Health Center, University of Alabama at Birmingham, Birmingham, Alabama
- Department of Medicine, Birmingham Veterans Affairs Medical Center, Birmingham, Alabama
| | - Marie A. Bakitas
- Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
- Department of Medicine, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama
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12
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Siltanen H, Aine T, Huhtala H, Kaunonen M, Vasankari T, Paavilainen E. Psychosocial issues need more attention in COPD self-management education. Scand J Prim Health Care 2020; 38:47-55. [PMID: 32024406 PMCID: PMC7054946 DOI: 10.1080/02813432.2020.1717087] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objective: To find out how regularly the contents of patient education regarded as essential for COPD patients' self-management are provided by healthcare professionals in specialised healthcare (SHC) and primary healthcare (PHC) in Finland.Design: A cross-sectional study based on an e-questionnaire with 42 items on the content of self-management education of COPD patients.Setting: The study sample included all public SHC units with pulmonary outpatient clinics (n = 29) and nine out of 160 health centres in Finland.Subjects: 83 doctors and 162 nurses.Main outcome measures: The respondents' answers on how regularly they included the contents regarded as essential for COPD patients' self-management in their education of COPD patients.Results: COPD patients were educated regularly on medical issues regarding COPD treatment, such as smoking cessation, exercise and pharmacological treatment. However, issues vital for coping with the disease, such as psychological well-being, stress management or fatigue, were often ignored. Patient education in SHC seemed to be more systematic than education in PHC. The education provided by the asthma/COPD nurses (n = 70) was more systematic than the education provided by the other nurses (n = 84).Conclusion: Healthcare professionals' continuous education should cover not only the medical but also the psychosocial aspects of coping with COPD. The role of doctors and nurses should be considered to ensure that there is no gap in COPD patients' education. Training asthma/COPD nurses and promoting specialised nurse-led asthma/COPD clinics in primary care could be beneficial while improving practices of patient education that enhance patients' ability to cope with the disease.KEY POINTSIssues vital for coping with chronic obstructive pulmonary disease (COPD), such as psychological well-being, stress and fatigue, are irregularly included in self-management education both in primary and specialised healthcare.Patient education provided by asthma/COPD nurses is more regular than patient education provided by other nurses.The distribution of work between doctors and nurses should be considered to ensure that there is no gap in COPD patients' education.
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Affiliation(s)
- Hannele Siltanen
- Department of Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland;
- Nursing Research Foundation, Helsinki, Finland;
- The Finnish Centre for Evidence-Based Health Care: A Joanna Briggs Institute Affiliated Group, Helsinki, Finland;
- CONTACT Hannele Siltanen Department of Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Tiina Aine
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland;
| | - Heini Huhtala
- Department of Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland;
| | - Marja Kaunonen
- Department of Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland;
- Pirkanmaa Hospital District, Tampere, Finland;
| | - Tuula Vasankari
- Division of Medicine, Department of Pulmonary Disease and Clinical Allergology, University of Turku, Turku, Finland;
- Finnish Lung Health Association (FILHA), Helsinki, Finland;
| | - Eija Paavilainen
- Department of Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland;
- Etelä-Pohjanmaa Hospital District, Seinäjoki, Finland
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13
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Cheng W, Li X, Duan J, Zhou Z, Zhou A, Zhao Y, Zeng Y, Chen Y, Cai S, Chen P. Prevalence and Characteristics of Pain in Patients of Chronic Obstructive Pulmonary Disease: A Cross-Sectional Study in China. COPD 2020; 17:90-100. [PMID: 31948299 DOI: 10.1080/15412555.2020.1713076] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The purposes of this study were to: (1) study the prevalence of pain in patients with mild-to-very severe chronic obstructive pulmonary disease (COPD) in China; (2) compare the differences in pain characteristics between stable COPD and acute exacerbation of COPD (AECOPD); (3) explore the clinical associations with pain in those with COPD. This cross-sectional study was conducted in China from October 24, 2017, to January 11, 2019. A face-to-face interview was conducted to collect data. The Chinese version of the brief pain inventory (BPI-C) was applied to investigate the pain characteristics in patients with COPD. Of the 901 patients in this study, 226 (25.1%) patients reported pain problems. The prevalence of pain in patients with mild to very severe COPD was 32.9%, 23.9%, 25.2%, and 23.5%, respectively (p = 0.447). According to the BPI-C results, 31.3% (31/99) of patients reported pain of AECOPD, compared to 24.3% (195/802) of stable COPD (p = 0.13). Reported pain intensity and pain interference evaluated by the BPI-C were significantly higher in AECOPD than stable COPD (p < 0.001, p < 0.05, respectively). Those with body mass index (BMI) ≥ 24kg/m2 or COPD assessment test (CAT) score > 20 were significantly more likely to have pain problems than BMI < 24kg/m2 (aOR = 1.568, a95IC = 1.132-2.170, p = 0.007) or CAT ≤ 20 (aOR= 1.754, a95IC = 1.213-2.536, p = 0.003). Pain was common in patients with both stable COPD and AECOPD. AECOPD patients had a significantly higher pain intensity than stable COPD. Overweight and CAT > 20 were significantly related to higher prevalence of pain.
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Affiliation(s)
- Wei Cheng
- Department of Respiratory and Critical Care Medicine, The Second Xiangya Hospital; Research Unit of Respiratory Disease; Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, Hunan, China
| | - Xiaoyun Li
- Department of Respiratory and Critical Care Medicine, The Second Xiangya Hospital; Research Unit of Respiratory Disease; Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, Hunan, China
| | - Jiaxi Duan
- Department of Respiratory and Critical Care Medicine, The Second Xiangya Hospital; Research Unit of Respiratory Disease; Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, Hunan, China
| | - Zijing Zhou
- Department of Respiratory and Critical Care Medicine, The Second Xiangya Hospital; Research Unit of Respiratory Disease; Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, Hunan, China
| | - Aiyuan Zhou
- Department of Respiratory and Critical Care Medicine, The Second Xiangya Hospital; Research Unit of Respiratory Disease; Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, Hunan, China
| | - Yiyang Zhao
- Department of Respiratory and Critical Care Medicine, The Second Xiangya Hospital; Research Unit of Respiratory Disease; Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, Hunan, China
| | - Yuqin Zeng
- Department of Respiratory and Critical Care Medicine, The Second Xiangya Hospital; Research Unit of Respiratory Disease; Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, Hunan, China
| | - Yan Chen
- Department of Respiratory and Critical Care Medicine, The Second Xiangya Hospital; Research Unit of Respiratory Disease; Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, Hunan, China
| | - Shan Cai
- Department of Respiratory and Critical Care Medicine, The Second Xiangya Hospital; Research Unit of Respiratory Disease; Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, Hunan, China
| | - Ping Chen
- Department of Respiratory and Critical Care Medicine, The Second Xiangya Hospital; Research Unit of Respiratory Disease; Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, Hunan, China
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14
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Wu M, Zan T, Zhao Q, Ge S, Li K, Li J. Symptom Clusters and Health-related Quality of Life in Chinese patients with Chronic Obstructive Pulmonary Disease. West J Nurs Res 2019; 42:437-445. [PMID: 31342864 DOI: 10.1177/0193945919866475] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study aimed to identify symptom clusters of chronic obstructive pulmonary disease (COPD) and to examine the relationship between symptom clusters and health-related quality of life (HRQoL). It included 154 hospitalized patients with COPD. The majority of the participants (88.6%) were aged 60 years and above, and the numbers of men and women were approximately equal (men: 55.2%). The Charlson Comorbidity Index (CCI), the Memorial Symptom Assessment Scale (MSAS), and the Chinese version of the Clinical COPD Questionnaire (CCQ) were used to evaluate comorbidity, participant's symptoms, and HRQoL, respectively. Five symptom clusters were identified using exploratory factor analysis, and symptom clusters, especially the Psychological, Pain and Fatigue, GI, and Dyspnea-Sweat symptom clusters, had negative effects on HRQoL in patients with COPD. Understanding the patterns and occurrences of symptom clusters could be essential for developing effective interventions to manage COPD symptoms and improve the patients' HRQoL.
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Affiliation(s)
- Maochun Wu
- School of Nursing, Jilin University, Changchun, Jilin province, China.,Equal contributors
| | - Tao Zan
- Intensive Care Unit, The First Hospital of Jilin University, Changchun, China.,Equal contributors
| | - Qiheng Zhao
- Orthopedics Department, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Song Ge
- Department of natural sciences and Nursing, University of Houston-Downtown, Houston, TX, USA
| | - Kun Li
- School of Nursing, Jilin University, Changchun, China
| | - Junxin Li
- School of Nursing, Johns Hopkins University, Baltimore, MD, USA
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15
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Steindal SA, Torheim H, Oksholm T, Christensen VL, Lee K, Lerdal A, Markussen HØ, Gran G, Leine M, Borge CR. Effectiveness of nursing interventions for breathlessness in people with chronic obstructive pulmonary disease: A systematic review and meta-analysis. J Adv Nurs 2018; 75:927-945. [PMID: 30397940 DOI: 10.1111/jan.13902] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Revised: 08/31/2018] [Accepted: 09/13/2018] [Indexed: 12/20/2022]
Abstract
AIM To critically review and synthesize the findings of studies that evaluated the effectiveness of nursing interventions for improving breathlessness in adults with chronic obstructive pulmonary disease. BACKGROUND Systematic reviews of nursing interventions for breathlessness in people with chronic obstructive pulmonary disease have not been specifically addressed. DESIGN Systematic review with meta-analysis. DATA SOURCES A systematic search of Medline, CINAHL, PsycINFO and Embase was performed for studies published between January 2000 and June 2017. REVIEW METHODS Risk of bias, data extraction and meta-analysis were conducted using Cochrane methodology. The quality of evidence was assessed using the GRADE approach. RESULTS Twenty papers were included. A meta-analysis of interventions performed at home, including two trials, showed a significant effect in favour of experimental groups for the symptom score of the St. George Respiratory Questionnaire compared with controls. A meta-analysis of interventions performed in clinics with home follow-up showed a significant effect in favour of experimental groups for the mastery and fatigue scores of the Chronic Respiratory Questionnaire compared with controls. In this category of intervention, an additional meta-analysis showed a significant effect in favour of experimental groups for the symptom, activity and total scores of the St. George Respiratory Questionnaire compared with controls. The quality of evidence was assessed to be very low to moderate. CONCLUSION The results are equivocal as to whether nursing interventions performed at home and nursing interventions performed in hospital with follow-up improve breathlessness in people with chronic obstructive pulmonary disease.
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Affiliation(s)
| | - Henny Torheim
- Department of Health Sciences Ålesund, Faculty of Medicine and Health Sciences, NTNU-Norwegian University of Science and Technology, Ålesund, Norway
| | - Trine Oksholm
- Faculty of Health Studies, VID Specialised University, Oslo, Norway
| | | | - Kathryn Lee
- Department of Family Health Care Nursing, San Francisco, California
| | - Anners Lerdal
- Department of Nursing Science, Faculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway.,Department for Patient Safety and Research, Lovisenberg Diaconal Hospital, Oslo, Norway
| | - Heidi Øksnes Markussen
- Department of Thoracic Medicine, The Norwegian National Advisory Unit on Longterm Mechanical Ventilation, Haukeland University Hospital, Bergen, Norway.,Department of Global Public Health and Primary Care, University in Bergen, Bergen, Norway
| | - Gerd Gran
- Helse Bergen HF, Haukeland University Hospital, Bergen, Norway
| | | | - Christine Råheim Borge
- Department for Patient Safety and Research, Lovisenberg Diaconal Hospital, Oslo, Norway.,Department of Health Science, University of Oslo, Oslo, Norway
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16
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Lee J, Nguyen HQ, Jarrett ME, Mitchell PH, Pike KC, Fan VS. Effect of symptoms on physical performance in COPD. Heart Lung 2018; 47:149-156. [PMID: 29395264 DOI: 10.1016/j.hrtlng.2017.12.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 12/26/2017] [Indexed: 01/03/2023]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) patients experience multiple symptoms including dyspnea, anxiety, depression, and fatigue, which are highly correlated with each other. Together, those symptoms may contribute to impaired physical performance. OBJECTIVES The purpose of this study was to examine interrelationships among dyspnea, anxiety, depressive symptoms, and fatigue as contributing factors to physical performance in COPD. METHODS This study used baseline data of 282 COPD patients from a longitudinal observational study to explore the relationship between depression, inflammation, and functional status. Data analyses included confirmatory factor analyses and structural equation modeling. RESULTS Dyspnea, anxiety and depression had direct effects on fatigue, and both dyspnea and anxiety had direct effects on physical performance. Higher levels of dyspnea were significantly associated with impaired physical performance whereas higher levels of anxiety were significantly associated with enhanced physical performance. CONCLUSION Dyspnea was the strongest predictor of impaired physical performance in patients with COPD.
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Affiliation(s)
- Jungeun Lee
- School of Nursing, University of Washington, Seattle, WA, USA.
| | - Huong Q Nguyen
- Reseach & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | | | | | - Kenneth C Pike
- School of Nursing, University of Washington, Seattle, WA, USA
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17
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Stridsman C, Svensson M, Johansson Strandkvist V, Hedman L, Backman H, Lindberg A. The COPD Assessment Test (CAT) can screen for fatigue among patients with COPD. Ther Adv Respir Dis 2018; 12:1753466618787380. [PMID: 30035671 PMCID: PMC6056783 DOI: 10.1177/1753466618787380] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 06/14/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Fatigue is one of the most common symptoms among subjects with chronic obstructive pulmonary disease (COPD), but is rarely identified in clinical practice. The aim of this study was to evaluate the association between fatigue and health-related quality of life (HRQoL) assessed with clinically useful instruments, both among subjects with and without COPD. Further, to investigate the association between fatigue and the COPD Assessment Test (CAT)-energy question. METHODS Data were collected in 2014 within the population-based OLIN COPD study. Subjects with ( n = 367) and without ( n = 428) COPD participated in clinical examinations including spirometry and completed questionnaires about fatigue (FACIT-Fatigue, clinically relevant fatigue ⩽43), and HRQoL (EQ-5D-VAS, lower score = worse health; CAT, lower score = fewer symptoms/better health). RESULTS Subjects with clinically relevant fatigue had worse HRQoL measured with EQ-5D-VAS, regardless of having COPD or not. Decreasing EQ-5D-VAS scores, any respiratory symptoms and anxiety/depression were associated with clinically relevant fatigue also when adjusted for confounders. Among subjects with COPD, clinically relevant fatigue was associated with increasing total CAT score, and CAT score ⩾10. The proportion of subjects with clinically relevant fatigue increased significantly, with a higher score on the CAT-energy question, and nearly 50% of those with a score of 2, and 70% of those with a score of ⩾3, had clinically relevant fatigue. CONCLUSIONS Fatigue was associated with respiratory symptoms, anxiety/depression and worse HRQoL when using the clinically useful instruments EQ-5D-VAS and CAT. The CAT-energy question can be used to screen for fatigue in clinical practice, using a cut-off of ⩾2.
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Affiliation(s)
- Caroline Stridsman
- Department of Health Sciences, Division of
Nursing, Luleå University of Technology, The OLIN Studies, Robertsviksgatan
9, Luleå, S-971 89, Sweden
| | - My Svensson
- Department of Public Health and Clinical
Medicine, The OLIN Unit/Division of Medicine, Umeå University, Umeå,
Sweden
| | - Viktor Johansson Strandkvist
- Department of Health Sciences, Division of
Health and Rehabilitation, Luleå University of Technology, Luleå,
Sweden
| | - Linnea Hedman
- Department of Health Sciences, Division of
Nursing, Luleå University of Technology, Luleå, Sweden Department of Public
Health and Clinical Medicine, The OLIN Unit/Division of Occupational and
Environmental Medicine, Umeå University, Umeå, Sweden
| | - Helena Backman
- Department of Public Health and Clinical
Medicine, The OLIN Unit/Division of Occupational and Environmental Medicine,
Umeå University, Umeå, Sweden
| | - Anne Lindberg
- Department of Public Health and Clinical
Medicine, The OLIN Unit/Division of Medicine, Umeå University, Umeå,
Sweden
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18
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Zhou T, Yang K, Thapa S, Liu H, Wang B, Yu S. Differences in Symptom Burden Among Cancer Patients With Different Stages of Cachexia. J Pain Symptom Manage 2017; 53:919-926. [PMID: 28062340 DOI: 10.1016/j.jpainsymman.2016.12.325] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 11/12/2016] [Accepted: 12/07/2016] [Indexed: 12/01/2022]
Abstract
CONTEXT Cancer patients with cachexia may suffer from significant burden of symptoms and it can severely impair patients' quality of life. However, only few studies have targeted the symptom burden in cancer cachexia patients, and whether the symptom burden differed in different cachexia stages is still unclear. OBJECTIVES The aims of this study were to evaluate the symptom burden in cancer cachexia patients and to compare the severity and occurrence rates of symptoms among cancer patients with non-cachexia, pre-cachexia, cachexia, and refractory cachexia. METHODS Advanced cancer patients (n = 306) were included in this cross-sectional study. Patients were divided into four groups, based on the cachexia stages of the international consensus. The M.D. Anderson Symptom Inventory added with eight more cachexia-specific symptoms were evaluated in our patients. Differences in symptom severity and occurrence rates among the four groups were compared using one-way ANOVA or Kruskal-Wallis test analyses. RESULTS Lack of appetite, disturbed sleep, fatigue, lack of energy, and distress were the symptoms with highest occurrence rates and severity scores in all four groups and were exacerbated by the severity of cachexia stages. After confounders were adjusted for, significant differences were seen in symptoms of pain, fatigue, disturbed sleep, remembering problems, lack of appetite, dry mouth, vomiting, numbness, feeling dizzy, early satiety, lack of energy, tastes/smell changes, and diarrhea. CONCLUSION This study identified higher symptom burden in cancer patients with cachexia and it increased with the stages of cachexia, which emphasized the importance of screening in multiple co-occurring symptoms for cachexia patients.
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Affiliation(s)
- Ting Zhou
- Cancer Center of Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, People' Republic of China
| | - Kaixiang Yang
- Department of Orthopedic Surgery, Keck School of Medicine, University of Southern California, California, USA
| | - Sudip Thapa
- Cancer Center of Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, People' Republic of China
| | - Huiquan Liu
- Cancer Center of Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, People' Republic of China
| | - Bangyan Wang
- Cancer Center of Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, People' Republic of China
| | - Shiying Yu
- Cancer Center of Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, People' Republic of China.
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