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Ladeira I, Oliveira P, Gomes J, Lima R, Guimarães M. Can static hyperinflation predict exercise capacity in COPD? Pulmonology 2023; 29 Suppl 4:S44-S53. [PMID: 34629326 DOI: 10.1016/j.pulmoe.2021.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 07/29/2021] [Accepted: 08/02/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The diagnosis and severity assessment of COPD relies on spirometry, and in particular the FEV1. However, it has been proposed that hyperinflation and air-trapping are better predictors of exercise capacity and mortality than the FEV1. RESEARCH QUESTION: Does static hyperinflation predict exercise capacity? METHODS We conducted an observational prospective study. Patients with COPD referred to the lung function laboratory were consecutively recruited. Patients with hyperinflation (the experimental group) were compared to patients without hyperinflation (the control group). The sample sizes were determined assuming an effect size of 0.5 and a power of 0.80. RESULTS We recruited 124 participants, of whom 87% were male, the mean age was 66.1 ± 8.8 years. 67% were symptomatic (GOLD B or D). Airflow limitation was moderate to severe in the majority of patients (median FEV1 47%, IQR 38-65%) and 43% of patients had static hyperinflation. The median 6MWD was 479 meters (404-510) and peak workload in CPET was 64 watts (46-88) with peak VO2 1.12 L/min, 0.89-1.31 L/min. Patients with lower FEV1, DLCO and IC/TLC and higher RV/TLC had reduced exercise capacity in both 6MWT and CPET, measured as lower distance, greater desaturation and ∆Borg dyspnoea, and reduced workload, peak VO2 and peak VE and higher desaturation and ventilatory limitation (VE/MVV). An IC/TLC < 0.33 predicted reduced exercise performance (peak O2 <60%). Dyspnoea assessed by mMRC and QoL measured by CAT and CCQ were also worse in the hyperinflation in COPD patients. CONCLUSION In COPD patients, IC/TLC and RV/TLC are valuable predictors of exercise performance in both 6MWT and CPET and PRO.
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Affiliation(s)
- I Ladeira
- Department of Pulmonology; Centro Hospitalar de Vila Nova de Gaia e Espinho, EPE; Vila Nova de Gaia; Portugal; Medicine Department, Faculdade de Medicina da Universidade do Porto; Porto; Portugal.
| | - P Oliveira
- EPIUnit, Instituto de Saúde Pública, Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto; Porto; Portugal
| | - J Gomes
- Department of Pulmonology; Centro Hospitalar de Vila Nova de Gaia e Espinho, EPE; Vila Nova de Gaia; Portugal
| | - R Lima
- Department of Pulmonology; Centro Hospitalar de Vila Nova de Gaia e Espinho, EPE; Vila Nova de Gaia; Portugal
| | - M Guimarães
- Department of Pulmonology; Centro Hospitalar de Vila Nova de Gaia e Espinho, EPE; Vila Nova de Gaia; Portugal
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Çiftçi R, Kurtoğlu A, Eken Ö, Durmaz D, Eler S, Eler N, Aldhahi MI. Investigation of Factors Affecting Shuttle Walking Performance at Increased Speed for Patients with Chronic Obstructive Pulmonary Disease. J Clin Med 2023; 12:4752. [PMID: 37510866 PMCID: PMC10381562 DOI: 10.3390/jcm12144752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 07/12/2023] [Accepted: 07/16/2023] [Indexed: 07/30/2023] Open
Abstract
The aim of this study was to examine the factors affecting the shuttle walking test (SWT) in patients with chronic obstructive pulmonary disease (COPD). A total of 29 patients with COPD (the COPD group) and a healthy group (HG) of 34 women aged between 55 and 74 years were included in the study. After the pulmonary function profiles of the participants were assessed, and the SWT was performed. Walking distances, walking speeds, and SWT levels (SWT-L) were determined with the SWT. Before and after the SWT, the heart rate (HR), oxygen saturation level (SPO2), and Borg scale (perceived exertion (BSe) and dyspnea (BSd)) results were analyzed with a paired sample t-test. The dyspnea levels during activity of daily living were determined with the Medical Research Council (MRC) dyspnea scale, and the relationship between MRC dyspnea (MRCD) and walking distance, speed, and SWT-L was tested using multiple linear regression and Pearson correlation analysis. The walking distance, speed, and SWT-L were lower in the COPD group (p < 0.001) than in the HG. The HR values before and after the SWT changed significantly in the COPD group and the HG (p< 0.001), and the effect size was higher in the COPD group. Although the BSe and BSd results before and after the SWT in the COPD group increased significantly (p < 0.001), they did not change in the HG. There was a highly negative correlation between MRCD and walking distance, speed, and SWT-L in the COPD group (p = 0.002, p = 0.000, and p = 0.001, respectively), but no correlation was found in the HG. The results showed that the HR, perceived exertion, and dyspnea levels of women with COPD whose respiratory functions were lower than the HG were significantly affected on the SWT.
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Affiliation(s)
- Rukiye Çiftçi
- Department of Anatomy, Medical Faculty, Gaziantep Islamic Science and Technology University, Gaziantep 27260, Turkey;
| | - Ahmet Kurtoğlu
- Department of Coaching Education, Sport Science Faculty, Bandirma Onyedi Eylul University, Balikesir 10250, Turkey;
| | - Özgür Eken
- Department of Physical Education and Sport Teaching, Inonu University, Malatya 44000, Turkey;
| | - Dilber Durmaz
- Department of Thoracic Diseases, Balikesir, Medical Faculty, Bandirma Onyedi Eylul University, Bandırma 10250, Turkey;
| | - Serdar Eler
- Department of Coaching Education, Faculty of Sport Sciences, Gazi University, Ankara 06560, Turkey;
| | - Nebahat Eler
- Department of Coaching Education, School of Physical Education and Sports, Zonguldak Bulent Ecevit University, Zonguldak 67100, Turkey;
| | - Monira I. Aldhahi
- Department of Rehabilitation Sciences, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia
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Han Y, Wu Z, Zhao Q, Jiang B, Miao X, Lu X, Qian H, Niu M. Association Between Anthropometric Indices and Skeletal-Muscle Atrophy in Chinese Patients with Stable Chronic Obstructive Pulmonary Disease: A Cross-Sectional Study. Int J Chron Obstruct Pulmon Dis 2022; 17:2529-2539. [PMID: 36254164 PMCID: PMC9569238 DOI: 10.2147/copd.s373880] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 09/24/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Anthropometric indices are simple indicators of patient nutritional status. However, the association between these indices and skeletal-muscle atrophy in patients with stable chronic obstructive pulmonary disease (COPD) has not been fully investigated. In this study, we evaluated this association. Patients and Methods We recruited 123 outpatients with stable COPD from a general hospital in China from 2020 to 2021. We recorded their demographic characteristics, including age, sex, course of illness, dyspnea score, body mass index (BMI), force expiratory volume in 1 second (FEV1), forced vital capacity (FVC), smoking status, and severity grading. In addition, patients' anthropometric indices, including fat-free mass index (FFMI) and appendicular skeletal-muscle mass index (ASMI), were measured using a body composition analyzer, and measurements were taken of the triceps skinfold (TSF), midarm circumference (MAC), and calf circumference (CC). We drew and analyzed a receiver operating characteristic (ROC) curve to identify the best intercept point value for the assessment of skeletal-muscle atrophy. Results The TSF, MAC, CC, FFMI, and ASMI of COPD patients were 1.08 ± 0.44 cm, 26.39 ± 2.92 cm, 34.5 ± 3.06 cm, 17.49 ± 1.86 kg/m2, and 8.17 ± 0.90 kg/m2, respectively. These anthropometric indices had a significant positive correlation with skeletal-muscle mass (correlation values, 0.481-0.820). CC was strongly correlated with both FFMI and ASMI. The ROC curve showed an area-under-the-curve (AUC) value of 0.873-0.959. Conclusion Anthropometric indices were correlated with skeletal-muscle mass. CC showed the best diagnostic value in COPD patients, suggesting its effectiveness as a simple method for assessing skeletal-muscle atrophy and identifying patients with a noticeable reduction in muscle mass. Such patients require early, multidisciplinary intervention.
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Affiliation(s)
- Yanxia Han
- Department of Respiratory Medicine, The First Affiliated Hospital of Soochow University, Suzhou, People’s Republic of China
| | - Zhenyun Wu
- Department of Respiratory Medicine, The First Affiliated Hospital of Soochow University, Suzhou, People’s Republic of China
| | - Qian Zhao
- Department of Respiratory Medicine, The First Affiliated Hospital of Soochow University, Suzhou, People’s Republic of China
| | - Bo Jiang
- School of Nursing, Soochow University, Suzhou, People’s Republic of China
| | - Xiaolang Miao
- School of Nursing, Soochow University, Suzhou, People’s Republic of China
| | - Xiangmin Lu
- School of Nursing, Soochow University, Suzhou, People’s Republic of China
| | - Hongying Qian
- Department of Respiratory Medicine, The First Affiliated Hospital of Soochow University, Suzhou, People’s Republic of China
| | - Meie Niu
- Department of Respiratory Medicine, The First Affiliated Hospital of Soochow University, Suzhou, People’s Republic of China,Correspondence: Meie Niu, Department of Respiratory Medicine, The First Affiliated Hospital of Soochow University, 188th, Shizi Street, Suzhou, 215006, People’s Republic of China, Tel +86 13812671786, Email
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Response to the letter from Rodrigues M and Vaz IM regarding the article "Effectiveness of a preoperative breathing exercise intervention in patients undergoing cardiac surgery: a systematic review". Rev Port Cardiol 2021; 40:809-810. [PMID: 34857124 DOI: 10.1016/j.repce.2021.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Rodrigues SN, Henriques HR, Henriques MA. Response to the letter from Rodrigues M and Vaz IM regarding the article "Effectiveness of a preoperative breathing exercise intervention in patients undergoing cardiac surgery: a systematic review". Rev Port Cardiol 2021; 40:S0870-2551(21)00351-6. [PMID: 34465491 DOI: 10.1016/j.repc.2021.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Soraia Nicola Rodrigues
- Lisbon University, Lisbon, Portugal; Lisbon Nursing School, Lisbon, Portugal; Centro Hospitalar de Vila Nova de Gaia/Espinho, Oporto, Portugal.
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Moon SM, Lim JH, Hong YS, Shin KC, Lee CY, Kim DJ, Lee SH, Jung KS, Lee CH, Yoo KH, Lee H, Park HY. Clinical impact of forced vital capacity on exercise performance in patients with chronic obstructive pulmonary disease. J Thorac Dis 2021; 13:837-846. [PMID: 33717557 PMCID: PMC7947547 DOI: 10.21037/jtd-20-1098a] [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] [Indexed: 11/06/2022]
Abstract
Background Forced vital capacity (FVC) has been suggested to be a good biomarker for decreased exercise performance in patients with chronic obstructive pulmonary disease (COPD). However, as FVC is highly correlated with forced expiratory volume in 1 second (FEV1), the relationship between FVC and exercise capacity should be assessed within the category of FEV1, i.e., COPD severity. However, this was not considered in previous studies. Thus, limited data are available on the association between reduced FVC and exercise capacity measured by 6-min walk distance (6MWD) based on COPD severity. Methods We performed a cross-sectional study using data from the Korean COPD Subgroup Study (KOCOSS) cohort. We evaluated 1,386 patients with moderate (n=895) and severe-to-very severe (n=491) COPD. Reduced FVC was defined as FVC <80% predicted and short 6MWD as <350 m. Multivariable logistic regression was used to evaluate the association between reduced FVC and short 6MWD. Results There were no significant differences in respiratory symptoms and quality of life between the patients with reduced FVC and those with preserved FVC. However, patients with reduced FVC had shorter 6MWD (30.5 cm in moderate and 34.5 cm in severe-to-very severe COPD) and higher BODE index scores than those with preserved FVC. The cubic spline model revealed 6MWD peaked around 93% predicted of FVC in moderate COPD, whereas FVC showed a positive association with 6MWD in severe-to-very severe COPD. Multivariable analyses showed that reduced FVC was significantly associated with short 6MWD in both moderate [adjusted odds ratio (aOR) =1.44, 95% confidence interval (CI): 1.03-2.02] and severe-to-very severe (adjusted OR =1.55, 95% CI: 1.01-2.40) COPD. Conclusions Reduced FVC was significantly associated with shorter 6MWD in moderate-to-very severe COPD patients, suggesting that reduced FVC might be reflective of 6MWD-measured exercise capacity in moderate-to-very severe COPD.
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Affiliation(s)
- Seong Mi Moon
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, South Korea
| | - Jun Hyeok Lim
- Division of Pulmonology, Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, Incheon, South Korea
| | - Yun Soo Hong
- Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kyeong-Cheol Shin
- Division of Pulmonology and Allergy, Regional Center for Respiratory Disease, Yeungnam University Medical Center, Daegu, South Korea
| | - Chang Youl Lee
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Chuncheon Sacred Heart Hospital, Hallym University, Chuncheon, Gangwon-do, South Korea
| | - Do Jin Kim
- Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, South Korea
| | - Sang Haak Lee
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, Department of Internal Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Ki Suck Jung
- Division of Pulmonary Medicine, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University Medical School, Anyang, South Korea
| | - Chang-Hoon Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Kwang Ha Yoo
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, South Korea
| | - Hyun Lee
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, South Korea
| | - Hye Yun Park
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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Selzler AM, Moore V, Habash R, Ellerton L, Lenton E, Goldstein R, Brooks D. The Relationship between Self-Efficacy, Functional Exercise Capacity and Physical Activity in People with COPD: A Systematic Review and Meta-Analyses. COPD 2020; 17:452-461. [PMID: 32633148 DOI: 10.1080/15412555.2020.1782866] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Anne-Marie Selzler
- Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, Canada
| | - Veronica Moore
- Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, Canada
| | - Razanne Habash
- Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, Canada
| | - Lauren Ellerton
- Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, Canada
| | - Erica Lenton
- Gerstein Science Information Centre, University of Toronto, Toronto, Canada
| | - Roger Goldstein
- Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, Canada
- Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Dina Brooks
- Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Canada
- School of Rehabilitation Sciences, McMaster University, Hamilton, Canada
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Henriquez AR, Snow SJ, Schladweiler MC, Miller CN, Dye JA, Ledbetter AD, Richards JE, Hargrove MM, Williams WC, Kodavanti UP. Beta-2 Adrenergic and Glucocorticoid Receptor Agonists Modulate Ozone-Induced Pulmonary Protein Leakage and Inflammation in Healthy and Adrenalectomized Rats. Toxicol Sci 2019; 166:288-305. [PMID: 30379318 DOI: 10.1093/toxsci/kfy198] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
We have shown that acute ozone inhalation activates sympathetic-adrenal-medullary and hypothalamus-pituitary-adrenal stress axes, and adrenalectomy (AD) inhibits ozone-induced lung injury and inflammation. Therefore, we hypothesized that stress hormone receptor agonists (β2 adrenergic-β2AR and glucocorticoid-GR) will restore the ozone injury phenotype in AD, while exacerbating effects in sham-surgery (SH) rats. Male Wistar Kyoto rats that underwent SH or AD were treated with vehicles (saline + corn oil) or β2AR agonist clenbuterol (CLEN, 0.2 mg/kg, i.p.) + GR agonist dexamethasone (DEX, 2 mg/kg, s.c.) for 1 day and immediately prior to each day of exposure to filtered air or ozone (0.8 ppm, 4 h/day for 1 or 2 days). Ozone-induced increases in PenH and peak-expiratory flow were exacerbated in CLEN+DEX-treated SH and AD rats. CLEN+DEX affected breath waveform in all rats. Ozone exposure in vehicle-treated SH rats increased bronchoalveolar lavage fluid (BALF) protein, N-acetyl glucosaminidase activity (macrophage activation), neutrophils, and lung cytokine expression while reducing circulating lymphocyte subpopulations. AD reduced these ozone effects in vehicle-treated rats. At the doses used herein, CLEN+DEX treatment reversed the protection offered by AD and exacerbated most ozone-induced lung effects while diminishing circulating lymphocytes. CLEN+DEX in air-exposed SH rats also induced marked protein leakage and reduced circulating lymphocytes but did not increase BALF neutrophils. In conclusion, circulating stress hormones and their receptors mediate ozone-induced vascular leakage and inflammatory cell trafficking to the lung. Those receiving β2AR and GR agonists for chronic pulmonary diseases, or with increased circulating stress hormones due to psychosocial stresses, might have altered sensitivity to air pollution.
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Affiliation(s)
- Andres R Henriquez
- Curriculum in Toxicology and Environmental Medicine, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina 27599
| | - Samantha J Snow
- Environmental Public Health Division, National Health and Environmental Effects Research Laboratory, U.S. Environmental Protection Agency, Research Triangle Park, North Carolina 27711
| | - Mette C Schladweiler
- Environmental Public Health Division, National Health and Environmental Effects Research Laboratory, U.S. Environmental Protection Agency, Research Triangle Park, North Carolina 27711
| | - Colette N Miller
- Environmental Public Health Division, National Health and Environmental Effects Research Laboratory, U.S. Environmental Protection Agency, Research Triangle Park, North Carolina 27711
| | - Janice A Dye
- Environmental Public Health Division, National Health and Environmental Effects Research Laboratory, U.S. Environmental Protection Agency, Research Triangle Park, North Carolina 27711
| | - Allen D Ledbetter
- Environmental Public Health Division, National Health and Environmental Effects Research Laboratory, U.S. Environmental Protection Agency, Research Triangle Park, North Carolina 27711
| | - Judy E Richards
- Environmental Public Health Division, National Health and Environmental Effects Research Laboratory, U.S. Environmental Protection Agency, Research Triangle Park, North Carolina 27711
| | - Marie M Hargrove
- Oak Ridge Institute for Science and Education, Research Triangle Park, North Carolina 27709
| | - Wanda C Williams
- Environmental Public Health Division, National Health and Environmental Effects Research Laboratory, U.S. Environmental Protection Agency, Research Triangle Park, North Carolina 27711
| | - Urmila P Kodavanti
- Environmental Public Health Division, National Health and Environmental Effects Research Laboratory, U.S. Environmental Protection Agency, Research Triangle Park, North Carolina 27711
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