[Prevalence and impact on quality of life of urinary incontinence in an adult population with chronic obstructive pulmonary diseases, literature review]

Neutral posture education during cough can reduce urine leakage in women with cough-related stress urinary incontinence

BACKGROUND

Current literature highlights the difficulty in identifying an optimal educational technique for maintaining continence during cough.

OBJECTIVE

To characterize the effects of an educational intervention focusing on neutral posture during cough in women with cough-induced urinary incontinence (UI).

METHODS

This interventional study design included women with cough-induced UI. We recorded PFMs surface electromyographic (sEMG) peak activity, and assessed symptoms and quality of life (QoL) 6 weeks after the intervention. The effect of the experimental situation was estimated using a linear mixed model, sEMG measurements during coughing were indexed to each situation and adjusted to the resting value at, and a moderation analysis was used.

RESULTS/FINDINGS

Eighteen participants were included. The measurement situations (control versus experimental) did not have a statistically significant impact on sEMG peak activity during coughing: mean effect [95% CI] 3.42 [-1.28; 7.66]. Six weeks post-intervention, participants reported statistically significant decrease in urinary symptoms (P=0.0246) and significant improvement in QoL (P=0.00776). This was also particularly marked on the dimension related to effort activities (P=0.00162).

CONCLUSION

This study suggests that a brief educational intervention focusing on neutral posture during cough, without voluntary pre-contraction of the PFMs, has no clinically significant influence on sEMG peak activity of the PFMs in women with cough-induced UI. However, this intervention can lead to a significant improvement in urinary symptoms and QoL at 6 weeks. These improvements seem to be independent of electromyographic PFMs peak activity recorded during cough. As such, our preliminary results pave the way for future research.

LEVEL OF EVIDENCE

NP4.

Treatment of urinary incontinence in women with chronic obstructive pulmonary disease-a randomised controlled study

BACKGROUND

Little is known regarding treatment of urinary incontinence (UI) in women with chronic obstructive pulmonary disease (COPD). The aim of the study was to explore the efficacy of pelvic floor muscle training (PFMT) or cough-suppression techniques (CST) on UI in women with COPD.

METHODS

A three-armed, two-centred, single-blinded, randomised controlled study was performed. Subjects were randomised to (a) PFMT for 16 weeks, (b) 2-3 educational sessions in CST, or (c) written information only. All participants completed questionnaires about UI, cough symptoms, and health status and underwent clinical examinations to evaluate the strength of the pelvic floor muscles and exercise capacity. Daily physical activity levels were measured using an activity monitor and lung function with spirometry. With a significance level of 5% and an 80% chance of detecting a significant difference between groups of 2.5 points on the ICIQ UI SF score, our sample size calculation showed that a total of 78 women, 26 in each group, was required to complete the study.

RESULTS

During the period 2016 to 2018, 95 women were invited to the study. A total of 42 were recruited, three were excluded and 10 (24%) dropped out during the follow-up period. Mean ICIQ-UI SF total baseline score was 9.6 (range: 1-17) and 7.0 (range: 0-16) at follow-up. Changes in subjective UI as measured with the ICIQ-UI SF questionnaire were seen in the PFMT group and control group, but not in the CST group.

CONCLUSION

Due to the low number of available participants and recruitment difficulties including practical issues such as travel distance, lack of interest, poor state of health, and high number of comorbidities, our results are inconclusive. However, reduced subjective UI was observed in the PFMT and control groups with a trend towards best effect in the PFMT group. Screening for UI is advisable in all women with COPD to be able to identify and treat these women to reduce symptom burden and improve quality of life. Future studies should focus on barriers to recruitment as well as randomised controlled studies with larger sample sizes.

TRIAL REGISTRATION

ClinicalTrials.gov NCT02614105. 25th November 2015.

Urinary Incontinence in People Referred for Pulmonary Rehabilitation: An Undisclosed Issue but a Real Problem

Pulmonary rehabilitation (PR) is an evidence-based intervention to manage symptoms related to chronic obstructive respiratory diseases (CORD). Paradoxically, few people with CORD actually engage in PR, and of those, up to one-third do not complete the program. Additionally, some of those who complete the program do not achieve worthwhile benefits. Therefore, the main challenge for the next decades is to offer PR to as many people (that would potentially benefit from it) as possible. This raises questions about factors influencing participation, completion, and responsiveness to PR programs. Among these factors, urinary incontinence (UI) is highly prevalent among people with CORD (much more than in the general population) and may worsen during PR exercise sessions. Paradoxically, UI is poorly explored in routine and scarcely assessed in research, and none of the actual guidelines about PR mention it. However, its potential influence on engagement, completion, and response to PR is of real concern. Therefore, the aim of this perspective is to describe the mechanisms of UI, particularly in the context of CORD, as well as to highlight its prevalence among people with CORD, their burden, and how it could affect a PR approach based on sustained and regular physical activity.

Overexpression of the hyperplasia suppressor gene inactivates airway fibroblasts obtained from a rat model of chronic obstructive pulmonary disease by inhibiting the Wnt signaling pathway

The present study aimed to investigate the effects of hyperplasia suppressor gene (HSG) overexpression on the activation of airway fibroblasts in a rat model of chronic obstructive pulmonary disease (COPD) and assess the underlying molecular mechanisms. The rat model of COPD was established by injection of papain and confirmed by hematoxylin and eosin staining. Airway fibroblasts were identified using immunofluorescence, and HSG expression was facilitated by an HSG vector. Cell viability, apoptosis and the levels of matrix metallopeptidase-9 (MMP-9), platelet-derived growth factor (PDGF), and transforming growth factor-β1 (TGF-β1) were measured via Cell Counting Kit-8, flow cytometry and ELISA analyses, respectively, and potential mechanisms were detected by reverse transcription-quantitative polymerase chain reaction and western blotting. Airway fibroblasts from COPD rats were isolated and identified based on vimentin expression. Compared with the control group, HSG overexpression reduced cell viability, promoted apoptosis, and reduced the protein levels of TGF-β1, MMP-9 and PDGF. Additionally, HSG overexpression reduced β-catenin and Ras homology family member A (RhoA) expression at both the mRNA and protein levels. Conversely, Wnt signaling pathway agonists lithium chloride (LiCl) and 4-ethyl-5,6-dihydro-5-methyl- (1,3)dioxolo(4,5-j)phenanthridine (HLY78), significantly reduced the effects of HSG overexpression (P<0.05 vs. HSG). Cell viability in the HSG + LiCl and HSG + HLY78 groups was increased, whereas apoptosis was reduced compared with HSG treatment alone. The protein levels of TGF-β1, MMP-9 and PDGF were also decreased in the HSG + LiCl and HSG + HLY78 groups compared with the HSG group (P<0.05). Furthermore, the expression of β-catenin and RhoA was higher in the HSG + LiCl and HSG + HLY78 groups compared with the HSG group (P<0.05). Collectively, the results indicated that HSG overexpression inactivated airway fibroblasts from COPD by inhibiting the Wnt signaling pathway.