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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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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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Abstract
A loss of physical functioning (i.e., a low physical capacity and/or a low physical activity) is a common feature in patients with chronic obstructive pulmonary disease (COPD). To date, the primary care physiotherapy and specialized pulmonary rehabilitation are clearly underused, and limited to patients with a moderate to very severe degree of airflow limitation (GOLD stage 2 or higher). However, improved referral rates are a necessity to lower the burden for patients with COPD and for society. Therefore, a multidisciplinary group of healthcare professionals and scientists proposes a new model for referral of patients with COPD to the right type of exercise-based care, irrespective of the degree of airflow limitation. Indeed, disease instability (recent hospitalization, yes/no), the burden of disease (no/low, mild/moderate or high), physical capacity (low or preserved) and physical activity (low or preserved) need to be used to allocate patients to one of the six distinct patient profiles. Patients with profile 1 or 2 will not be referred for physiotherapy; patients with profiles 3-5 will be referred for primary care physiotherapy; and patients with profile 6 will be referred for screening for specialized pulmonary rehabilitation. The proposed Dutch model has the intention to get the right patient with COPD allocated to the right type of exercise-based care and at the right moment.
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Verberkt CA, van den Beuken-van Everdingen MHJ, Schols JMGA, Hameleers N, Wouters EFM, Janssen DJA. Effect of Sustained-Release Morphine for Refractory Breathlessness in Chronic Obstructive Pulmonary Disease on Health Status: A Randomized Clinical Trial. JAMA Intern Med 2020; 180:1306-1314. [PMID: 32804188 PMCID: PMC7432282 DOI: 10.1001/jamainternmed.2020.3134] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
IMPORTANCE Morphine is used as palliative treatment of chronic breathlessness in patients with advanced chronic obstructive pulmonary disease (COPD). Evidence on respiratory adverse effects and health status is scarce and conflicting. OBJECTIVE To assess the effects of regular, low-dose, oral sustained-release morphine on disease-specific health status (COPD Assessment Test; CAT), respiratory outcomes, and breathlessness in patients with COPD. INTERVENTIONS Participants were randomly assigned to 10 mg of regular, oral sustained-release morphine or placebo twice daily for 4 weeks, with the possibility to increase to 3 times daily after 1 or 2 weeks. DESIGN, SETTING, AND PARTICIPANTS The Morphine for Treatment of Dyspnea in Patients With COPD (MORDYC) study was a randomized, double-blind, and placebo-controlled study of a 4-week intervention. Patients were enrolled between November 1, 2016, and January 24, 2019. Participants were recruited in a pulmonary rehabilitation center and 2 general hospitals after completion of a pulmonary rehabilitation program. Outpatients with COPD and moderate to very severe chronic breathlessness (modified Medical Research Council [mMRC] breathlessness grades 2-4) despite optimal pharmacological and nonpharmacological treatment were included. A total of 1380 patients were screened, 916 were ineligible, and 340 declined to participate. MAIN OUTCOMES AND MEASURES Primary outcomes were CAT score (higher scores represent worse health status) and arterial partial pressure of carbon dioxide (Paco2). Secondary outcome was breathlessness in the previous 24 hours (numeric rating scale). Data were analyzed by intention to treat. Subgroup analyses in participants with mMRC grades 3 to 4 were performed. RESULTS A total of 111 of 124 included participants were analyzed (mean [SD] age, 65.4 [8.0] years; 60 men [54%]). Difference in CAT score was 2.18 points lower in the morphine group (95% CI, -4.14 to -0.22 points; P = .03). Difference in Paco2 was 1.19 mm Hg higher in the morphine group (95% CI, -2.70 to 5.07 mm Hg; P = .55). Breathlessness remained unchanged. Worst breathlessness improved in participants with mMRC grades 3 to 4 (1.33 points lower in the morphine group; 95% CI, -2.50 to -0.16 points; P = .03). Five participants of 54 in the morphine group (9%) and 1 participant of 57 in the placebo group (2%) withdrew because of adverse effects. No morphine-related hospital admissions or deaths occurred. CONCLUSIONS AND RELEVANCE In this randomized clinical trial, regular, low-dose, oral sustained-release morphine for 4 weeks improved disease-specific health status in patients with COPD without affecting Paco2 or causing serious adverse effects. The worst breathlessness improved in participants with mMRC grades 3 to 4. A larger randomized clinical trial with longer follow-up in patients with mMRC grades 3 to 4 is warranted. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02429050.
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Affiliation(s)
- Cornelia A Verberkt
- Department of Health Services Research, Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | | | - Jos M G A Schols
- Department of Health Services Research, Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands.,Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - Niels Hameleers
- Department of Health Services Research, Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Emiel F M Wouters
- Department of Research & Development, CIRO, Horn, the Netherlands.,Department of Respiratory Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands.,Ludwig Boltzmann Institute for Lung Health, Vienna, Austria
| | - Daisy J A Janssen
- Department of Health Services Research, Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands.,Department of Research & Development, CIRO, Horn, the Netherlands
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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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6
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Vaes AW, Spruit MA, Reynaert NL, Franssen FME, Wouters EFM, Theunis J, De Boever P. Skin auto-fluorescence as a measure of advanced glycation end-products is associated with microvascular health in patients with COPD. Microvasc Res 2020; 132:104053. [PMID: 32763256 DOI: 10.1016/j.mvr.2020.104053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 08/03/2020] [Accepted: 08/03/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND OBJECTIVES Chronic obstructive pulmonary disease (COPD) is associated with systemic inflammation and oxidative stress. These physiological processes can lead to increased formation and accumulation of advanced glycation end-products (AGEs), that can play a role in vascular complications. In this cross-sectional study, we determined the association between skin AGEs and microvascular health in patients with COPD. METHODS Clinical characteristics and cardiovascular parameters, including pulmonary function, metabolic and inflammatory parameters, and blood pressure, were obtained in this observational study with patients with COPD. Skin concentrations of AGEs were assessed non-invasively by measuring skin autofluorescence (AF). Retinal vessel analysis was used as a marker of microvascular health. RESULTS 62 patients with COPD (52% males; mean age: 64.4 ± 8.4 years; mean FEV1: 45.0 ± 20.7%pred.) were analysed. Mean skin AF was 2.75 ± 0.64 arbitrary units. Skin AF in patients with COPD was negatively associated with retinal arteriolar diameter (β -0.021, 95% CI -0.040 to -0.002; p = 0.031) and arteriole-to-venular ratio (β -7.233, 95% CI -9.732 to -4.734; p < 0.001) and positively associated with retinal venular diameter (β 0.029, 95% CI 0.019 to 0.038; p < 0.001) after adjustment for sex, age, lung function, pack-years of smoking and conventional cardiovascular risk factors. CONCLUSION We document for the first time that skin AF in patients with COPD is independently associated with retinal arteriolar and venular vessel diameters, biological indicators for microvascular health. This adds to the evidence that AGEs are an accessible marker of microvascular health.
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Affiliation(s)
- Anouk W Vaes
- Research and Development, CIRO, Horn, the Netherlands; Health Unit, Flemish Institute for Technological Research (VITO), Mol, Belgium.
| | - Martijn A Spruit
- Research and Development, CIRO, Horn, the Netherlands; Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), 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
| | - Niki L Reynaert
- Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands; NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, the Netherlands
| | - Frits M E Franssen
- Research and Development, CIRO, Horn, the Netherlands; Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands; NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, the Netherlands
| | - Emiel F M Wouters
- Research and Development, CIRO, Horn, the Netherlands; Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands; NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, the Netherlands
| | - Jan Theunis
- Health Unit, Flemish Institute for Technological Research (VITO), Mol, Belgium
| | - Patrick De Boever
- Health Unit, Flemish Institute for Technological Research (VITO), Mol, Belgium; Department of Biology, University of Antwerp, Wilrijk, Belgium; Centre for Environmental Sciences, Hasselt University, Hasselt, Belgium
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GPNMB contributes to a vicious circle for chronic obstructive pulmonary disease. Biosci Rep 2020; 40:225097. [PMID: 32478378 PMCID: PMC7308735 DOI: 10.1042/bsr20194459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 05/15/2020] [Accepted: 05/26/2020] [Indexed: 12/13/2022] Open
Abstract
Osteoporosis (OP) is significant and debilitating comorbidity of chronic obstructive pulmonary disease (COPD). We hypothesize that genetic variance identified with OP may also play roles in COPD. We have conducted a large-scale relation data analysis to explore the genes implicated with either OP or COPD, or both. Each gene linked to OP but not to COPD was further explored in a mega-analysis and partial mega-analysis of 15 independently collected COPD RNA expression datasets, followed by gene set enrichment analysis (GSEA) and literature-based pathway analysis to explore their functional linked to COPD. A multiple linear regression (MLR) model was built to study the possible influence of sample size, population region, and study date on the gene expression data in COPD. At the first step of the analysis, we have identified 918 genes associated with COPD, 581 with OP, and a significant overlap (P<2.30e-140; 210 overlapped genes). Partial mega-analysis showed that, one OP gene, GPNMB presented significantly increased expression in COPD patients (P-value = 0.0018; log fold change = 0.83). GPNMB was enriched in multiple COPD pathways and plays roles as a gene hub formulating multiple vicious COPD pathways included gene MMP9 and MYC. GPNMB could be a novel gene that plays roles in both COPD and OP. Partial mega-analysis is valuable in identify case-specific genes for COPD.
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Vaes AW, Spruit MA, Van Keer K, Barbosa-Breda J, Wouters EFM, Franssen FME, Theunis J, De Boever P. Structural analysis of retinal blood vessels in patients with COPD during a pulmonary rehabilitation program. Sci Rep 2020; 10:31. [PMID: 31913345 PMCID: PMC6949286 DOI: 10.1038/s41598-019-56997-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 12/17/2019] [Indexed: 12/14/2022] Open
Abstract
Cardiovascular diseases are frequently present in chronic obstructive pulmonary disease (COPD). Population-based studies found associations between retinal vessel diameters and cardiovascular health, but it is unknown whether this also applies to COPD patients. Therefore, we measured retinal vessel diameters in COPD patients and aimed to determine the association with cardiovascular risk factors, lung function, and functional outcomes. In addition, we investigated whether an exercise-based pulmonary rehabilitation (PR) program would change retinal vessel diameters, as a proxy for improved microvascular health. Demographics and clinical characteristics, including pulmonary function, exercise capacity, blood pressure, blood measurements and level of systemic inflammation were obtained from 246 patients during routine assessment before and after PR. Retinal vessel diameters were measured from digital retinal images. Older age and higher systolic blood pressure were associated with narrower retinal arterioles (β: -0.224; p = 0.042 and β: -0.136; p < 0.001, respectively). Older age, higher systolic blood pressure and lower level of systemic inflammation were associated with narrower retinal venules (β: -0.654; -0.229; and -13.767, respectively; p < 0.05). No associations were found between retinal vessel diameters and lung function parameters or functional outcomes. After PR, no significant changes in retinal venular or arteriolar diameter were found. To conclude, retinal vessel diameters of COPD patients were significantly associated with systolic blood pressure and systemic inflammation, whilst there was no evidence for an association with lung function parameters, functional outcomes or other cardiovascular risk factors. Furthermore, an exercise-based PR program did not affect retinal vessel diameter.
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Affiliation(s)
- Anouk W Vaes
- Research and Education, Ciro, Horn, Netherlands.
- Health Unit, Flemish Institute for Technological Research (VITO), Mol, Belgium.
| | - Martijn A Spruit
- Research and Education, Ciro, Horn, Netherlands
- Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), 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
| | - Karel Van Keer
- Research Group Ophthalmology, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - João Barbosa-Breda
- Research Group Ophthalmology, Department of Neurosciences, KU Leuven, Leuven, Belgium
- Ophthalmology Department, Centro Hospitalar Sao Joao, Porto, Portugal
- Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Emiel F M Wouters
- Research and Education, Ciro, Horn, Netherlands
- Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - Frits M E Franssen
- Research and Education, Ciro, Horn, Netherlands
- Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - Jan Theunis
- Health Unit, Flemish Institute for Technological Research (VITO), Mol, Belgium
| | - Patrick De Boever
- Health Unit, Flemish Institute for Technological Research (VITO), Mol, Belgium
- Centre for Environmental Sciences, Hasselt University, Hasselt, Belgium
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Lin BS, Jhang RJ, Lin BS. Wearable Cardiopulmonary Function Evaluation System for Six-Minute Walking Test. SENSORS (BASEL, SWITZERLAND) 2019; 19:E4656. [PMID: 31717794 PMCID: PMC6865179 DOI: 10.3390/s19214656] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 10/20/2019] [Accepted: 10/24/2019] [Indexed: 01/10/2023]
Abstract
As a submaximal exercise test, a 6-min walking test (6MWT) can be considered a suitable index for the exercise capacity of patients with a respiratory problem. Traditionally, medical staff manually collect cardiopulmonary information using different devices. However, no integrated monitoring system is currently available to simultaneously record the real-time breathing sound, heart rhythm, and precise walking information (i.e., walking distance, speed, and acceleration) during the 6MWT. In this study, a wearable and wireless multiparameter monitoring system is proposed to simultaneously monitor the breathing sound, oxygen saturation (SpO2), electrocardiograph (ECG) signals, and precise walking information during the 6MWT. Here, a wearable mechanical design was successfully used to reduce the effect of motion artifacts on the breathing sound and ECG signal. A multiparameter detection algorithm was designed to effectively estimate heart and breathing rates. Finally, the cardiopulmonary function of smokers was evaluated using the proposed system. The evaluation indicated that this system could reveal dynamic changes and differences in the breathing rate, heart rate, SpO2, walking speed, and acceleration during the 6MWT. The proposed system can serve as a more integrated approach to monitor cardiopulmonary parameters and obtain precise walking information simultaneously during the 6MWT.
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Affiliation(s)
- Bor-Shing Lin
- Department of Computer Science and Information Engineering, National Taipei University, New Taipei City 23741, Taiwan;
| | - Ruei-Jie Jhang
- Institute of Photonic System, National Chiao Tung University, Tainan 71150, Taiwan;
| | - Bor-Shyh Lin
- Institute of Imaging and Biomedical Photonics, National Chiao Tung University, Tainan 71150, Taiwan
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10
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Jaitovich A, Barreiro E. Skeletal Muscle Dysfunction in Chronic Obstructive Pulmonary Disease. What We Know and Can Do for Our Patients. Am J Respir Crit Care Med 2019; 198:175-186. [PMID: 29554438 DOI: 10.1164/rccm.201710-2140ci] [Citation(s) in RCA: 151] [Impact Index Per Article: 30.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Skeletal muscle dysfunction occurs in patients with chronic obstructive pulmonary disease (COPD) and affects both ventilatory and nonventilatory muscle groups. It represents a very important comorbidity that is associated with poor quality of life and reduced survival. It results from a complex combination of functional, metabolic, and anatomical alterations leading to suboptimal muscle work. Muscle atrophy, altered fiber type and metabolism, and chest wall remodeling, in the case of the respiratory muscles, are relevant etiological contributors to this process. Muscle dysfunction worsens during COPD exacerbations, rendering patients progressively less able to perform activities of daily living, and it is also associated with poor outcomes. Muscle recovery measures consisting of a combination of pulmonary rehabilitation, optimized nutrition, and other strategies are associated with better prognosis when administered in stable patients as well as after exacerbations. A deeper understanding of this process' pathophysiology and clinical relevance will facilitate the use of measures to alleviate its effects and potentially improve patients' outcomes. In this review, a general overview of skeletal muscle dysfunction in COPD is offered to highlight its relevance and magnitude to expert practitioners and scientists as well as to the average clinician dealing with patients with chronic respiratory diseases.
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Affiliation(s)
- Ariel Jaitovich
- 1 Division of Pulmonary and Critical Care Medicine and.,2 Department of Molecular and Cellular Physiology, Albany Medical College, Albany, New York
| | - Esther Barreiro
- 3 Pulmonology Department-Muscle Wasting and Cachexia in Chronic Respiratory Diseases and Lung Cancer Research Group, Institut Hospital del Mar d'Investigacions Mèdiques-Hospital del Mar, Parc de Salut Mar, Health and Experimental Sciences Department, Universitat Pompeu Fabra, Barcelona Biomedical Research Park, Barcelona, Spain; and.,4 Centro de Investigación en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
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Szucs B, Szucs C, Petrekanits M, Varga JT. Molecular Characteristics and Treatment of Endothelial Dysfunction in Patients with COPD: A Review Article. Int J Mol Sci 2019; 20:E4329. [PMID: 31487864 PMCID: PMC6770145 DOI: 10.3390/ijms20184329] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 08/23/2019] [Accepted: 08/27/2019] [Indexed: 12/22/2022] Open
Abstract
Patients with chronic obstructive pulmonary disease (COPD) show systemic consequences, such as chronic systemic inflammation leading to changes in the airway, airway penetrability, and endothelial function. Endothelial dysfunction is characterized by a list of alterations of endothelium towards reduced vasodilation, proinflammatory state, detachment and apoptosis of endothelial cells, and development of atherosclerosis. COPD-induced endothelial dysfunction is associated with elevated cardiovascular risk. The increment of physical activities such as pulmonary rehabilitation (PR) training have a significant effect on COPD, thus, PR can be an integrative part of COPD treatment. In this narrative review the focus is on the function of endothelial inflammatory mediators [cytokines, chemokines, and cellular proteases] and pulmonary endothelial cells and endothelial dysfunction in COPD as well as the effects of dysfunction of the endothelium may play in COPD-related pulmonary hypertension. The relationship between smoking and endothelial dysfunction is also discussed. The connection between different pulmonary rehabilitation programs, arterial stiffness and pulse wave velocity (PWV) is presented. Endothelial dysfunction is a significant prognostic factor of COPD, which can be characterized by PWV. We discuss future considerations, like training programs, as an important part of the treatment that has a favorable impact on the endothelial function.
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Affiliation(s)
- Botond Szucs
- PharmaFlight Research and Training Center, H-4030 Debrecen, Hungary
| | - Csilla Szucs
- Department of Anatomy, Histology and Embryology, Faculty of Medicine, University of Debrecen, Debrecen H-4032, Hungary
| | - Mate Petrekanits
- Institute of Exercise Physiology and Sport Medicine, University of Physical Education, H-1123 Budapest, Hungary
| | - Janos T Varga
- Department of Pulmonary Rehabilitation, National Koranyi Institute for Pulmonology, H-1121 Budapest, Hungary.
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12
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Szucs B, Petrekanits M, Varga J. Effectiveness of a 4-week rehabilitation program on endothelial function, blood vessel elasticity in patients with chronic obstructive pulmonary disease. J Thorac Dis 2018; 10:6482-6490. [PMID: 30746192 DOI: 10.21037/jtd.2018.10.104] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background Chronic obstructive pulmonary disease (COPD) may have considerable cardiovascular risk. Physical activity has a paramount role in COPD treatment. Our aim was to evaluate the applicability of arteriograph in COPD and measure the effectiveness of pulmonary rehabilitation on endothelial function. Methods A total of 40 patients with COPD (FEV1: 45.43±20.20%pred, BMI: 27.99±6.98 kg/m2, male: female was 21:19, age: 65.47±7.39 years) participated in a 4-week rehabilitation program. We used a patented, invasively validated Arteriograph. Blood pressure, pulse, augmentation index (AIX), pulse wave velocity (PWV), diastolic area index (DAI) were registered with functional measurements in pulmonary rehabilitation. Results Pulmonary rehabilitation was effective in 6 minutes walking distance (6MWD: 335.32±110.43 vs. 398.32±126.21 m), maximal inspiratory pressure (MIP: 57.72±22.69 vs. 63.63±18.01 cmH2O), chest wall expansion (CWE: 2.84±1.26 vs. 4.00±1.76 cm), breath holding time (BHT: 25.77±10.63 to 29.21±11.60 sec) and grip strength (GS: 24.87±11.88 vs. 27.03±11.43 kg) (P<0.05). Improvement in quality of life was monitored by COPD assessment test marker (CAT: 17.00±8.49 vs. 11.89±7.31, P<0.05). Systolic (133.38±22.15 vs. 126.48±20.22 mmHg) and diastolic blood pressure (76.95±14.37 vs. 75.4±12.7 mmHg) showed a reduction tendency. Pulse also decreased (76.95±14.37 vs. 72.53±13.65 bpm). AIX levels showed slight improvement (3.54±35.59% vs. 2.93±30.79%); 23 patients peripheral circulation progressed. The PWV data showed abnormal elasticity with minimal change (11.74±2.13 vs. 11.4±2.73 m/s); although 20 patients showed improvement. DAI detected slightly diminished coronary circulation with moderate improvement (43.32±6.81 vs. 47.1±7.01 m/s). Conclusions Elevated arterial stiffness, high PWV turned the COPD patients to the high/very high-risk cluster. Rehabilitation resulted significant improvement in MIP, CWE, BHT, 6MWD, CAT with mild, but favorable changes in blood pressure, pulse, AIX, PWV. As a consequence of the four weeks rehabilitation period overall quality of life improved and cardiovascular risk showed a reduction tendency in COPD.
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Affiliation(s)
- Botond Szucs
- PharmaFlight Research and Training Center, Debrecen, Hungary.,Institute of Exercise Physiology and Sport Medicine, University of Physical Education, Budapest, Hungary
| | - Mate Petrekanits
- PharmaFlight Research and Training Center, Debrecen, Hungary.,Institute of Exercise Physiology and Sport Medicine, University of Physical Education, Budapest, Hungary
| | - Janos Varga
- Department of Pulmonary Rehabilitation, National Koranyi Institute for Pulmonology, Budapest, Hungary
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Vaes AW, Spruit MA, Theunis J, Wouters EF, De Boever P. Peripheral endothelial function is positively associated with maximal aerobic capacity in patients with chronic obstructive pulmonary disease. Respir Med 2018; 142:41-47. [DOI: 10.1016/j.rmed.2018.07.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 07/19/2018] [Accepted: 07/20/2018] [Indexed: 01/16/2023]
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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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15
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Rozenberg D, Martelli V, Vieira L, Orchanian-Cheff A, Keshwani N, Singer LG, Mathur S. Utilization of non-invasive imaging tools for assessment of peripheral skeletal muscle size and composition in chronic lung disease: A systematic review. Respir Med 2017; 131:125-134. [DOI: 10.1016/j.rmed.2017.08.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 07/14/2017] [Accepted: 08/07/2017] [Indexed: 11/17/2022]
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Loprinzi PD, Sng E, Walker JF. Muscle strengthening activity associates with reduced all-cause mortality in COPD. Chronic Illn 2017; 13:140-147. [PMID: 27358285 DOI: 10.1177/1742395316657399] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective Emerging research suggests that aerobic-based physical activity may help to promote survival among chronic obstructive pulmonary disease patients. However, the extent to which engagement in resistance training on survival among chronic obstructive pulmonary disease patients is relatively unknown. Therefore, the purpose of this study was to examine the independent associations of muscle strengthening activities on all-cause mortality among a national sample of U.S. adults with chronic obstructive pulmonary disease. We hypothesize that muscle strengthening activities will be inversely associated with all-cause mortality. Methods Data from the 2003-2006 NHANES were employed, with follow-up through 2011. Aerobic-based physical activity was objectively measured via accelerometry, muscle strengthening activities engagement was assessed via self-report, and chronic obstructive pulmonary disease was assessed via physician-diagnosis. Results Analysis included 385 adults (20 + yrs) with chronic obstructive pulmonary disease, who represent 13.3 million chronic obstructive pulmonary disease patients in the USA. The median follow-up period was 78 months (IQR=64-90), with 82 chronic obstructive pulmonary disease patients dying during this period. For a two muscle strengthening activity sessions/week increase (consistent with national guidelines), chronic obstructive pulmonary disease patients had a 29% reduced risk of all-cause mortality (HR=0.71; 95% CI: 0.51-0.99; P = 0.04). Conclusion Participation in muscle strengthening activities, independent of aerobic-based physical activity and other potential confounders, is associated with greater survival among chronic obstructive pulmonary disease patients.
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Affiliation(s)
- Paul D Loprinzi
- 1 Department of Health, Exercise Science and Recreation Management, Center for Health Behavior Research, The University of Mississippi, University, MS, USA
| | | | - Jerome F Walker
- 2 Department of Respiratory Therapy, Bellarmine University, Louisville, KY, USA
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Houben-Wilke S, Spruit MA, Uszko-Lencer NH, Otkinska G, Vanfleteren LE, Jones PW, Wouters EF, Franssen FM. Echocardiographic abnormalities and their impact on health status in patients with COPD referred for pulmonary rehabilitation. Respirology 2016; 22:928-934. [DOI: 10.1111/resp.12968] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 10/12/2016] [Accepted: 10/24/2016] [Indexed: 12/28/2022]
Affiliation(s)
- Sarah Houben-Wilke
- Department of Research and Education; CIRO+, Centre of Expertise for Chronic Organ Failure; Horn The Netherlands
| | - Martijn A. Spruit
- Department of Research and Education; CIRO+, Centre of Expertise for Chronic Organ Failure; Horn The Netherlands
| | - Nicole H.M.K. Uszko-Lencer
- Department of Research and Education; CIRO+, Centre of Expertise for Chronic Organ Failure; Horn The Netherlands
- Department of Cardiology; Maastricht University Medical Centre + (MUMC+); Maastricht The Netherlands
| | - Gosia Otkinska
- Department of Cardiology; Maastricht University Medical Centre + (MUMC+); Maastricht The Netherlands
| | - Lowie E.G.W. Vanfleteren
- Department of Research and Education; CIRO+, Centre of Expertise for Chronic Organ Failure; Horn The Netherlands
- Department of Respiratory Medicine; Maastricht University Medical Centre + (MUMC+); Maastricht The Netherlands
| | - Paul W. Jones
- Division of Clinical Science; St. George's University of London; London UK
| | - Emiel F.M. Wouters
- Department of Research and Education; CIRO+, Centre of Expertise for Chronic Organ Failure; Horn The Netherlands
- Department of Respiratory Medicine; Maastricht University Medical Centre + (MUMC+); Maastricht The Netherlands
| | - Frits M.E. Franssen
- Department of Research and Education; CIRO+, Centre of Expertise for Chronic Organ Failure; Horn The Netherlands
- Department of Respiratory Medicine; Maastricht University Medical Centre + (MUMC+); Maastricht The Netherlands
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Al-Shair K, Kolsum U, Singh D, Vestbo J. The Effect of Fatigue and Fatigue Intensity on Exercise Tolerance in Moderate COPD. Lung 2016; 194:889-895. [PMID: 27549363 PMCID: PMC5093188 DOI: 10.1007/s00408-016-9931-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 08/07/2016] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Fatigue is one of the most disabling symptoms in COPD, but little is known about the impact of fatigue on functional disability. We explored the impact of fatigue and fatigue intensity on exercise tolerance after adjusting for other factors using multivariate analysis and compared it to that of dyspnoea. METHODS A total of 119 patients with mainly moderate-severe stable COPD (38 % women, mean age 66 years) were enrolled. We used the Medical Research Council dyspnoea scores (MRC), Manchester COPD fatigue scale (MCFS) and its three dimensions, Borg scales for fatigue and dyspnoea, six-minute walk distance (6MWD), St George's Respiratory Questionnaire, the BODE index, and the Centre for Epidemiological Study on Depression scale (CES-D), and we measured spirometry, blood gases, systemic inflammatory markers and fat-free mass index (FFMI). RESULTS Fatigue measured using the MCFS was associated with 6MWD and explained 22 % of the variability in 6MWD (p < 0.001). Fatigue remained associated with 6MWD after adjusting for MRC dyspnoea, FFMI and FEV1, FVC, PaO2, PaCO2, CES-D, TNF-alpha, smoking status, age and gender. We found that 33, 50 and 23 % of patients reported an increase by 2 scores on Borg scales for fatigue, dyspnoea or both at the end of the 6MWT. Fatigue scores (both before and after the 6MWT) were negatively correlated with 6MWD after adjusting for FEV1, FFMI, CES-D score and age (p = 0.007 and 0.001, respectively). CONCLUSION In moderate stable COPD, fatigue may be a central driver of functional disability, to the same extent as dyspnoea.
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Affiliation(s)
- Khaled Al-Shair
- Centre for Respiratory Medicine and Allergy, Institute of Inflammation and Repair, Manchester Academic Health Science Centre, The University of Manchester and University Hospital of South Manchester, NHS Foundation Trust, Manchester, UK.
- Respiratory Research Group, 2nd floor The Education and Research Centre, South Manchester University Hospitals Trust, Manchester, M23 9LT, UK.
| | - Umme Kolsum
- Centre for Respiratory Medicine and Allergy, Institute of Inflammation and Repair, Manchester Academic Health Science Centre, The University of Manchester and University Hospital of South Manchester, NHS Foundation Trust, Manchester, UK
| | - Dave Singh
- Centre for Respiratory Medicine and Allergy, Institute of Inflammation and Repair, Manchester Academic Health Science Centre, The University of Manchester and University Hospital of South Manchester, NHS Foundation Trust, Manchester, UK
| | - Jørgen Vestbo
- Centre for Respiratory Medicine and Allergy, Institute of Inflammation and Repair, Manchester Academic Health Science Centre, The University of Manchester and University Hospital of South Manchester, NHS Foundation Trust, Manchester, UK
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Verberkt C, van den Beuken-van Everdingen M, Franssen F, Dirksen C, Schols J, Wouters E, Janssen D. A randomized controlled trial on the benefits and respiratory adverse effects of morphine for refractory dyspnea in patients with COPD: Protocol of the MORDYC study. Contemp Clin Trials 2016; 47:228-34. [DOI: 10.1016/j.cct.2016.01.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 01/18/2016] [Accepted: 01/23/2016] [Indexed: 10/22/2022]
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Rochester CL, Vogiatzis I, Holland AE, Lareau SC, Marciniuk DD, Puhan MA, Spruit MA, Masefield S, Casaburi R, Clini EM, Crouch R, Garcia-Aymerich J, Garvey C, Goldstein RS, Hill K, Morgan M, Nici L, Pitta F, Ries AL, Singh SJ, Troosters T, Wijkstra PJ, Yawn BP, ZuWallack RL. An Official American Thoracic Society/European Respiratory Society Policy Statement: Enhancing Implementation, Use, and Delivery of Pulmonary Rehabilitation. Am J Respir Crit Care Med 2015; 192:1373-86. [DOI: 10.1164/rccm.201510-1966st] [Citation(s) in RCA: 432] [Impact Index Per Article: 48.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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21
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Differences in change in coping styles between good responders, moderate responders and non-responders to pulmonary rehabilitation. Respir Med 2015; 109:1540-5. [PMID: 26603339 DOI: 10.1016/j.rmed.2015.10.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 10/06/2015] [Accepted: 10/11/2015] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Pulmonary rehabilitation (PR) improves exercise tolerance and health status in patients with chronic obstructive pulmonary disease (COPD). Data on the effects of PR on coping styles are limited. Aim of the present study was to compare changes in coping styles between patients who had a good, moderate and no improvement in either exercise tolerance or health status after PR. METHODS Coping styles of 439 COPD patients undergoing PR were assessed by the Utrecht Coping List (UCL) at baseline and after PR. Patients' pulmonary function, six-minute walking distance (6MWD), St. George's Respiratory Questionnaire (SGRQ) and Hospital Anxiety and Depression Scale (HADS-A and HADS-D) were recorded. Good, moderate and non-responders were defined on the basis of minimally clinically important difference (MCID) for SGRQ total score and/or 6MWD. RESULTS Overall, 54.0% of the patients fulfilled the criteria for good responders, while 22.1% were moderate responders. Change in passive reaction pattern coping style differed significantly between good responders and non-responders following PR (p < 0.001). Moreover, within the groups, changes in coping styles after PR occurred among the good responders, whereas the majority of moderate responders' and non-responders' coping styles were not significantly influenced by PR. CONCLUSION Good responders decreased their passive reaction pattern coping style in contrast to non-responders after PR. In general, PR did not change the coping among moderate and non-responders. Further research is warranted to determine whether including interventions targeting coping styles may modify coping behaviour of COPD patients, as well as improvement in exercise tolerance or health status after PR.
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Spruit MA, Augustin IML, Vanfleteren LE, Janssen DJA, Gaffron S, Pennings HJ, Smeenk F, Pieters W, van den Bergh JJAM, Michels AJ, Groenen MTJ, Rutten EPA, Wouters EFM, Franssen FME. Differential response to pulmonary rehabilitation in COPD: multidimensional profiling. Eur Respir J 2015; 46:1625-35. [PMID: 26453626 DOI: 10.1183/13993003.00350-2015] [Citation(s) in RCA: 155] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 06/28/2015] [Indexed: 11/05/2022]
Abstract
The aim of the present study was to profile a multidimensional response to pulmonary rehabilitation in patients with chronic obstructive pulmonary disease (COPD).Dyspnoea, exercise performance, health status, mood status and problematic activities of daily life were assessed before and after a 40-session pulmonary rehabilitation programme in 2068 patients with COPD (mean forced expiratory volume in 1 s of 49% predicted). Patients were ordered by their overall similarity concerning their multidimensional response profile, which comprises the overall response on MRC dyspnoea grade, 6MWD, cycle endurance time, Canadian Occupational Performance Measure performance and satisfaction scores, Hospital Anxiety and Depression Scale anxiety and depression, and St George's Respiratory Questionnaire total score, using a novel non-parametric regression technique.Patients were clustered into four groups with distinct multidimensional response profiles: n=378 (18.3%; "very good responder"), n=742 (35.9%; "good responder"), n=731 (35.4%; "moderate responder"), and n=217 (10.5%; "poor responder"). Patients in the "very good responder" cluster had higher symptoms of dyspnoea, number of hospitalisations <12 months, worse exercise performance, worse performance and satisfaction scores for problematic activities of daily life, more symptoms of anxiety and depression, worse health status, and a higher proportion of patients following an inpatient PR programme compared to the other three clusters.A multidimensional response outcome needs to be considered to study the efficacy of pulmonary rehabilitation services in patients with COPD, as responses to regular outcomes are differential within patients with COPD.
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Affiliation(s)
- Martijn A Spruit
- Dept of Research & Education, CIRO+, Center of Expertise for Chronic Organ Failure, Horn, The Netherlands
| | - Ingrid M L Augustin
- Dept of Research & Education, CIRO+, Center of Expertise for Chronic Organ Failure, Horn, The Netherlands
| | - Lowie E Vanfleteren
- Dept of Research & Education, CIRO+, Center of Expertise for Chronic Organ Failure, Horn, The Netherlands
| | - Daisy J A Janssen
- Dept of Research & Education, CIRO+, Center of Expertise for Chronic Organ Failure, Horn, The Netherlands
| | | | - Herman-Jan Pennings
- Dept of Respiratory Medicine, St. Laurentius Hospital, Roermond, The Netherlands
| | - Frank Smeenk
- Dept of Respiratory Medicine, Catharina Hospital, Eindhoven, The Netherlands
| | - Willem Pieters
- Dept of Respiratory Medicine, Elkerliek Hospital, Helmond, The Netherlands
| | | | - Arent-Jan Michels
- Dept of Respiratory Medicine, St Anna Hospital, Geldrop, The Netherlands
| | - Miriam T J Groenen
- Dept of Research & Education, CIRO+, Center of Expertise for Chronic Organ Failure, Horn, The Netherlands
| | - Erica P A Rutten
- Dept of Research & Education, CIRO+, Center of Expertise for Chronic Organ Failure, Horn, The Netherlands
| | - Emiel F M Wouters
- Dept of Research & Education, CIRO+, Center of Expertise for Chronic Organ Failure, Horn, The Netherlands Dept of Respiratory Medicine, Maastricht University Medical Center (MUMC+), The Netherlands
| | - Frits M E Franssen
- Dept of Research & Education, CIRO+, Center of Expertise for Chronic Organ Failure, Horn, The Netherlands
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Vaes AW, Meijer K, Delbressine JM, Wiechert J, Willems P, Wouters EF, Franssen FM, Spruit MA. Efficacy of walking aids on self-paced outdoor walking in individuals with COPD: A randomized cross-over trial. Respirology 2015; 20:932-9. [DOI: 10.1111/resp.12570] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Revised: 02/17/2015] [Accepted: 03/05/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Anouk W. Vaes
- Program Development Centre; CIRO+; Horn The Netherlands
- Physiotherapy; CIRO+; Horn The Netherlands
| | - Kenneth Meijer
- Department of Human Movement Science; School for Nutrition, Toxicology and Metabolism; MUMC+; Maastricht The Netherlands
| | | | | | - Paul Willems
- Department of Human Movement Science; School for Nutrition, Toxicology and Metabolism; MUMC+; Maastricht The Netherlands
| | - Emiel F.M. Wouters
- Program Development Centre; CIRO+; Horn The Netherlands
- Department of Respiratory Medicine; MUMC+; Maastricht The Netherlands
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Wilke S, Jones PW, Müllerova H, Vestbo J, Tal-Singer R, Franssen FME, Agusti A, Bakke P, Calverley PM, Coxson HO, Crim C, Edwards LD, Lomas DA, MacNee W, Rennard SI, Yates JC, Wouters EFM, Spruit MA. One-year change in health status and subsequent outcomes in COPD. Thorax 2015; 70:420-5. [PMID: 25782757 DOI: 10.1136/thoraxjnl-2014-205697] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 02/21/2015] [Indexed: 11/04/2022]
Abstract
BACKGROUND Poor health status has been associated with morbidity and mortality in patients with COPD. To date, the impact of changes in health status on these outcomes remains unknown. AIMS To explore the relationship of clinically relevant changes in health status with exacerbation, hospitalisation or death in patients with COPD. METHODS Characteristics and health status (St George's Respiratory Questionnaire, SGRQ) were assessed over a period of 3 years in 2138 patients with COPD enrolled in the Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints (ECLIPSE) study: a longitudinal, prospective, observational study. Associations between change in health status (=4 units in SGRQ score) during year 1 and time to first exacerbation, hospitalisation and death during 2-year follow-up were assessed using Kaplan-Meier plots and log-rank test. RESULTS 1832 (85.7%) patients (age 63.4±7.0 years, 65.4% male, FEV1 48.7±15.6% predicted) underwent assessment at baseline and 1 year. Compared with those who deteriorated, patients with improved or stable health status in year 1 have a lower likelihood of exacerbation (HR 0.78 (95% CI 0.67 to 0.89), p<0.001 and 0.84 (0.73 to 0.97), p=0.016, respectively), hospitalisation (0.72 (0.58 to 0.90), p=0.004 and 0.77 (0.62 to 0.96), p=0.023, respectively) or dying (0.61 (0.39 to 0.95), p=0.027 and 0.58 (0.37 to 0.92), p=0.019, respectively) during 2-year follow-up. This effect persisted after stratification for age and the number of exacerbations and hospitalisations during the first year of the study. CONCLUSIONS Patients with stable or improved health status during year 1 of ECLIPSE had a lower likelihood of exacerbation, hospitalisation or dying during 2-year follow-up. Interventions that stabilise and improve health status may also improve outcomes in patients with COPD. TRIAL REGISTRATION NUMBER NCT00292552, registered at ClinicalTrials.gov.
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Affiliation(s)
- Sarah Wilke
- Department of Research & Education, CIRO+, Centre of Expertise for Chronic Organ Failure, Horn, The Netherlands
| | - Paul W Jones
- Division of Clinical Science, St George's University of London, London, UK
| | - H Müllerova
- Respiratory Epidemiology, GlaxoSmithKline, Uxbridge, UK
| | - Jørgen Vestbo
- Department of Respiratory Medicine, Gentofte Hospital Hellerup, Gentofte, Denmark Research Group, Manchester Academic Health Sciences Centre, University Hospital South Manchester NHS Foundation, Manchester, UK
| | - Ruth Tal-Singer
- Research and Development, GlaxoSmithKline, King of Prussia, UK
| | - Frits M E Franssen
- Department of Research & Education, CIRO+, Centre of Expertise for Chronic Organ Failure, Horn, The Netherlands
| | - Alvar Agusti
- Thorax Institute, Hospital Clinic, IDIBAPS, Universitat de Barcelona and CIBER Enfermedades Respiratorias (CIBERES), Barcelona, Spain
| | - Per Bakke
- Department of Thoracic Medicine, Institute of Clinical Science, University of Bergen, Haukeland University Hospital, Bergen, Norway
| | - Peter M Calverley
- Division of Infection and Immunity Clinical Sciences Centre, University Hospital Aintree, Liverpool, UK
| | - Harvey O Coxson
- Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, Canada
| | - Courtney Crim
- GlaxoSmithKline, Research Triangle Park, North Carolina, USA
| | - Lisa D Edwards
- GlaxoSmithKline, Research Triangle Park, North Carolina, USA
| | - David A Lomas
- Wolfson Institute for Biomedical Research, University College London, London, UK
| | - William MacNee
- MRC Centre for Inflammation Research, The Queen's Medical Research Institute, University of Edinburgh, Edingburgh, UK
| | - Stephen I Rennard
- Division of Pulmonary, Critical Care, Sleep & Allergy, University of Nebraska Medical Center, Omaha, USA
| | - Julie C Yates
- GlaxoSmithKline, Research Triangle Park, North Carolina, USA
| | - Emiel F M Wouters
- Department of Research & Education, CIRO+, Centre of Expertise for Chronic Organ Failure, Horn, The Netherlands Department of Respiratory Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Martijn A Spruit
- Department of Research & Education, CIRO+, Centre of Expertise for Chronic Organ Failure, Horn, The Netherlands Faculty of Medicine and Life Sciences, REVAL-Rehabilitation Research Center, BIOMED-Biomedical Research Institute, Hasselt University, Diepenbeek, Belgium
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25
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Oelsner EC, Lima JAC, Kawut SM, Burkart KM, Enright PL, Ahmed FS, Barr RG. Noninvasive tests for the diagnostic evaluation of dyspnea among outpatients: the Multi-Ethnic Study of Atherosclerosis lung study. Am J Med 2015; 128:171-180.e5. [PMID: 25447621 PMCID: PMC4346168 DOI: 10.1016/j.amjmed.2014.09.023] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 09/17/2014] [Accepted: 09/18/2014] [Indexed: 12/11/2022]
Abstract
BACKGROUND Dyspnea on exertion is a common and debilitating symptom, yet evidence for the relative value of cardiac and pulmonary tests for the evaluation of chronic dyspnea among adults without known cardiac or pulmonary disease is limited. METHODS The Multi-Ethnic Study of Atherosclerosis (MESA) enrolled participants aged 45 to 84 years who were free of clinical cardiovascular disease from 6 communities; participants with clinical pulmonary disease were excluded from this report. Dyspnea on exertion was assessed via structured interview. Tests included electrocardiograms, cardiac computed tomography (CT) for coronary artery calcium, cardiac magnetic resonance imaging, spirometry, percent emphysema (percent of lung regions <-950 HU) on CT, inflammatory biomarkers, and N-terminal pro-brain natriuretic peptide (NT-proBNP). Logistic regression was used to identify independent correlates of dyspnea after adjustment for age, sex, body mass index, physical activity, anxiety, and leg pain. RESULTS Among 1969 participants without known cardiopulmonary disease, 9% had dyspnea. The forced expiratory volume in 1 second (FEV1) (P < .001), NT-proBNP (P = .004), and percent emphysema on CT (P = .004) provided independent information on the probability of self-reported dyspnea. Associations with the FEV1 were stronger among smokers and participants with other recent respiratory symptoms or seasonal allergies; associations with NT-proBNP were present only among participants with coexisting symptoms of lower-extremity edema. Only the FEV1 provided a significant improvement in the receiver operating curve. CONCLUSIONS Among adults without known cardiac or pulmonary disease reporting dyspnea on exertion, spirometry, NT-proBNP, and CT imaging for pulmonary parenchymal disease were the most informative tests.
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Affiliation(s)
- Elizabeth C Oelsner
- Department of Medicine, College of Physicians and Surgeons, Columbia University Medical Center, New York, NY; Department of Epidemiology, Mailman School of Public Health of Columbia University, New York, NY.
| | - Joao A C Lima
- Department of Medicine, Johns Hopkins University, Baltimore, Md
| | - Steven M Kawut
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa
| | - Kristin M Burkart
- Department of Medicine, College of Physicians and Surgeons, Columbia University Medical Center, New York, NY
| | - Paul L Enright
- College of Public Health, University of Arizona, Tucson, Ariz
| | - Firas S Ahmed
- Department of Medicine, College of Physicians and Surgeons, Columbia University Medical Center, New York, NY; Department of Radiology, College of Physicians and Surgeons, Columbia University Medical Center, New York, NY
| | - R Graham Barr
- Department of Medicine, College of Physicians and Surgeons, Columbia University Medical Center, New York, NY; Department of Epidemiology, Mailman School of Public Health of Columbia University, New York, NY
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26
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Wilke S, Smid DE, Spruit MA, Janssen DJA, Muris JWM, van der Molen T, van den Akker M, Jones PW, Wouters EFM, Franssen FME. The 2014 Updated GOLD Strategy: A Comparison of the Various Scenarios. CHRONIC OBSTRUCTIVE PULMONARY DISEASES-JOURNAL OF THE COPD FOUNDATION 2014; 1:212-220. [PMID: 28848823 DOI: 10.15326/jcopdf.1.2.2014.0135] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background: The 2014 updated Global initiative for chronic Obstructive Lung Disease (GOLD) strategy added the St. George's Respiratory Questionnaire (SGRQ) as the fourth possible symptoms measure. The impact of the suggested tools for symptoms of COPD and the different definitions of future risk on the frequency distribution and clinical characteristics of the GOLD groups remain unknown. Methods: Demographic and clinical characteristics were assessed in 542 patients with COPD (57.7% male, age 64.6 [9.0] years, FEV1 54.7 [22.3]% predicted). Health status was assessed by the COPD-specific SGRQ and symptoms of anxiety and depression by the Hospital Anxiety and Depression Scale, anxiety (HADS-A) and depression (HADS-D) subscale. Cohen's Kappa was used to assess agreement between groups. Results: Level of agreement in frequency distribution using the modified Medical Research Council dyspnea (mMRC) scale ≥2, COPD Assessment Test (CAT) ≥10, Clinical COPD Questionnaire (CCQ) ≥1 and SGRQ ≥25 was moderate to very good. Best agreement was reached between CCQ and SGRQ (К = 0.838 or 0.851, p<0.001). Patients classified in mMRC GOLD A reported higher SGRQ scores, higher HADS-A and HADS-D scores compared to patients classified in CAT GOLD A or SGRQ GOLD A. Outcomes were comparable between the risk assessment groups. Conclusions: Choice of the symptom measure impacts GOLD groups more than choice of the exacerbation risk assessment. Health care professionals should be aware that patients are heterogeneous in terms of health status and symptoms of anxiety and depression based on the symptom measure used.
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Affiliation(s)
- Sarah Wilke
- Joint first author.,Department of Research and Education, CIRO+, Centre of Expertise for Chronic Organ Failure, Horn, the Netherlands
| | - Dionne E Smid
- Joint first author.,Department of Research and Education, CIRO+, Centre of Expertise for Chronic Organ Failure, Horn, the Netherlands
| | - Martijn A Spruit
- Department of Research and Education, CIRO+, Centre of Expertise for Chronic Organ Failure, Horn, the Netherlands
| | - Daisy J A Janssen
- Department of Research and Education, CIRO+, Centre of Expertise for Chronic Organ Failure, Horn, the Netherlands.,Centre of Expertise for Palliative Care, Maastricht University Medical Centre, the Netherlands
| | - Jean W M Muris
- Caphri School of Public Health and Primary Care, Department of Family Medicine, Maastricht University, the Netherlands
| | - Thys van der Molen
- Department of General Practice, University of Groningen, University Medical Centre Groningen, the Netherlands
| | - Marjan van den Akker
- Caphri School of Public Health and Primary Care, Department of Family Medicine, Maastricht University, the Netherlands.,Department of General Practice, KU Leuven, Leuven, Belgium
| | - Paul W Jones
- Division of Clinical Science, St. George's University of London, United Kingdom
| | - Emiel F M Wouters
- Department of Research and Education, CIRO+, Centre of Expertise for Chronic Organ Failure, Horn, the Netherlands.,Department of Respiratory Medicine, Maastricht University Medical Centre, the Netherlands
| | - Frits M E Franssen
- Department of Research and Education, CIRO+, Centre of Expertise for Chronic Organ Failure, Horn, the Netherlands
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27
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Sillen MJH, Franssen FME, Vaes AW, Delbressine JML, Wouters EFM, Spruit MA. Metabolic load during strength training or NMES in individuals with COPD: results from the DICES trial. BMC Pulm Med 2014; 14:146. [PMID: 25182377 PMCID: PMC4236758 DOI: 10.1186/1471-2466-14-146] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 08/26/2014] [Indexed: 11/10/2022] Open
Abstract
Background Strength training and neuromuscular electrical stimulation (NMES) are effective training modalities for improving muscle function, exercise performance and health status in individuals with COPD. The aim of the present study was to analyze the metabolic load of these training modalities at baseline, half-way, and at the end of an eight-week interdisciplinary pulmonary rehabilitation program in a subgroup of individuals with COPD of the DICES trial. Methods Of 24 individuals with COPD (FEV1: 34 ± 2% predicted, men: 58%, age: 66 (61–68) years), peak oxygen uptake (VO2), peak minute ventilation (VE), heart rate, oxygen saturation and symptom scores were assessed during HF-NMES (75 Hz), LF-NMES (15 Hz) and strength training at three moments during their pulmonary rehabilitation program. Results Intervention-related peak VO2 did not change over time during HF-NMES, LF-NMES or strength training. Intervention-related peak VE did not change over time during strength training or LF-NMES and increased slightly, but significantly over time during HF-NMES. Peak VO2 and VE were significantly higher during strength training compared to HF-NMES or LF-NMES. Oxygen saturation significantly decreased after the first measurements during HF-NMES and strength training group to baseline, while no significant changes in oxygen saturation were observed during the other measurements. Heart rate significantly increased compared to baseline in all groups at all moments and was significantly higher after strength training compared to HF-NMES or LF-NMES. Median end scores (points) for dyspnea, fatigue and muscle pain ranged from 1 to 3, from 0.5 to 2 and from 0 to 6 after HF-NMES, from 2 to 3, from 2 to 5 and from 0 to 9 after LF-NMES and from 2 to 5, from 1.5 to 4 and from 0 to 28 after strength training respectively. Conclusions To conclude, the metabolic load and symptom scores remain acceptable low over time with increasing training loads during HF-NMES, LF-NMES or strength training. Trial registration Trial registration:NTR2322
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Affiliation(s)
- Maurice J H Sillen
- Department of Research & Education, CIRO+, centre of expertise for chronic organ failure, Hornerheide 1, Horn, the Netherlands.
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Wilke S, Spruit MA, Wouters EFM, Schols JMGA, Franssen FME, Janssen DJA. Determinants of 1-year changes in disease-specific health status in patients with advanced chronic obstructive pulmonary disease: A 1-year observational study. Int J Nurs Pract 2014; 21:239-48. [PMID: 24666609 DOI: 10.1111/ijn.12265] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We aimed to identify baseline and longitudinal determinants of change in disease-specific health status in patients with advanced chronic obstructive pulmonary disease (COPD). Demographic and clinical characteristics as well as disease-specific health status (St George's Respiratory Questionnaire, SGRQ) were assessed in 105 outpatients with advanced COPD at baseline and at 4, 8 and 12 months. Eighty-five patients (81.0%) had complete SGRQ data at baseline and 12 months and were included in analyses. Stepwise multiple regression analysis revealed that lower SGRQ total score, higher depression scores and longer time needed to complete the Timed Up and Go (TUG) test at baseline, as well as increase in time needed to complete the TUG test and increase in dyspnoea during the 1-year follow-up period, were predictors of deterioration in disease-specific health status. The current study reinforces the stimulation of physical mobility and the targeting of dyspnoea as components for treatment programs to optimize disease-specific health status in patients with advanced COPD.
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Affiliation(s)
- Sarah Wilke
- Program Development Centre, CIRO+ (Centre of Expertise for Chronic Organ Failure), Horn, The Netherlands
| | - Martijn A Spruit
- Program Development Centre, CIRO+ (Centre of Expertise for Chronic Organ Failure), Horn, The Netherlands
| | - Emiel F M Wouters
- Program Development Centre, CIRO+ (Centre of Expertise for Chronic Organ Failure), Horn, The Netherlands.,Department of Respiratory Medicine, Maastricht University Medical Centre+ (MUMC+), Maastricht, The Netherlands
| | - Jos M G A Schols
- Department of General Practice and Department of Health Services Research, Faculty of Health, Medicine and Life Sciences/CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - Frits M E Franssen
- Program Development Centre, CIRO+ (Centre of Expertise for Chronic Organ Failure), Horn, The Netherlands
| | - Daisy J A Janssen
- Program Development Centre, CIRO+ (Centre of Expertise for Chronic Organ Failure), Horn, The Netherlands
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29
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Cleutjens FAHM, Wouters EFM, Dijkstra JB, Spruit MA, Franssen FME, Vanfleteren LEGW, Ponds RWHM, Janssen DJA. The COgnitive-Pulmonary Disease (COgnitive-PD) study: protocol of a longitudinal observational comparative study on neuropsychological functioning of patients with COPD. BMJ Open 2014; 4:e004495. [PMID: 24589828 PMCID: PMC3948451 DOI: 10.1136/bmjopen-2013-004495] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION Intact cognitive functioning is necessary for patients with chronic obstructive pulmonary disease (COPD) to understand the value of healthy lifestyle guidelines, to make informed decisions and subsequently act on it. Nevertheless, brain abnormalities and cognitive impairment have been found in patients with COPD. To date, it remains unknown which cognitive domains are affected and what the possible consequences are of cognitive impairment. Therefore, objectives of the study described are to determine neuropsychological functioning in patients with COPD, and its influence on health status, daily functioning and pulmonary rehabilitation outcome. Furthermore, structural and functional brain abnormalities and the relationship with cognitive and daily functioning will be explored. METHODS AND ANALYSIS A longitudinal observational comparative study will be performed in 183 patients with COPD referred for pulmonary rehabilitation and in 90 healthy control participants. Demographic and clinical characteristics, activities of daily living and knowledge about COPD will be assessed. Baseline cognitive functioning will be compared between patients and controls using a detailed neuropsychological testing battery. An MRI substudy will be performed to compare brain abnormalities between 35 patients with COPD with cognitive impairment and 35 patients with COPD without cognitive impairment. Patients will be recruited between November 2013 and November 2015. ETHICS AND DISSEMINATION The study has been approved by the Medical Ethics Committee of the University Hospital Maastricht and Maastricht University (NL45127.068.13/METC 13-3-035) and is registered in the Dutch trial register. All participants will provide written informed consent and can withdraw from the study at any point in time. Assessment and home visit data material will be managed anonymously. The results obtained can be used to optimise patient-oriented treatment for cognitively impaired patients with COPD. The findings will be disseminated in international peer-reviewed journals and through research conferences.
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Affiliation(s)
- Fiona A H M Cleutjens
- Department of Research and Education, CIRO+, Centre of Expertise for Chronic Organ Failure, Horn, The Netherlands
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30
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Stoilkova A, Wouters EFM, Spruit MA, Franssen FME, Janssen DJA. The relationship between coping styles and clinical outcomes in patients with COPD entering pulmonary rehabilitation. COPD 2014; 10:316-23. [PMID: 23713594 DOI: 10.3109/15412555.2012.744389] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Symptoms of anxiety, depression and exercise intolerance contribute to an impaired health status in patients with Chronic Obstructive Pulmonary Disease (COPD). Coping styles may also be related to symptoms and health status. Objectives of this study were to assess the distribution of coping styles in patients entering pulmonary rehabilitation (PR) with and without anxiety and/or depression; and to assess whether coping styles contribute to exercise intolerance and reduced health status. METHODS Coping styles were studied in 698 patients using the Utrecht Coping List (UCL). Disease-specific health status (St. George's Respiratory Questionnaire, SGRQ), anxiety and depression (Hospital Anxiety and Depression Scale, HADS), exercise tolerance (6-minute walking distance, 6MWD) and clinical characteristics were assessed. RESULTS High levels (16.5%) of active confronting coping style were rarely reported. A minority of patients used low levels (17.5%) of passive reaction pattern coping style. Differences in coping profiles were present between patients with and without anxiety and/or depression. A higher level of active confronting coping style was associated with a higher 6MWD (Beta 0.092, p < 0.01), while a higher level of avoidance coping style was associated with a lower 6MWD (Beta -0.074, p = 0.017). The UCL subscales were not related to SGRQ total score (p > 0.05). CONCLUSIONS In COPD patients entering PR, coping styles were associated with symptoms of anxiety, depression and exercise intolerance, but not associated with disease-specific health status. Future studies should examine whether interventions aiming at optimizing coping styles during PR can improve outcomes for patients with COPD.
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Affiliation(s)
- Ana Stoilkova
- Department of Respiratory Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands.
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31
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Kozu R, Jenkins S, Senjyu H. Evaluation of activity limitation in patients with idiopathic pulmonary fibrosis grouped according to Medical Research Council dyspnea grade. Arch Phys Med Rehabil 2014; 95:950-5. [PMID: 24502840 DOI: 10.1016/j.apmr.2014.01.016] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2013] [Revised: 01/16/2014] [Accepted: 01/17/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To investigate the relations between Medical Research Council (MRC) dyspnea grade and peripheral muscle force, activities of daily living (ADL) performance, health status, lung function, and exercise capacity in subjects with idiopathic pulmonary fibrosis (IPF). DESIGN Prospective cross-sectional observational study. SETTING University hospital. PARTICIPANTS Subjects with IPF (N=65, 46 men) in a stable clinical state with a mean age of 68±7 years. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Right ventricular systolic pressure (RVSP) via transthoracic echocardiography, pulmonary function, isometric quadriceps force (QF) and handgrip force (HF), 6-minute walk distance (6MWD), ADL score, and health status (Medical Outcomes Study 36-Item Short-Form Health Survey [SF-36]) were assessed and compared between subjects grouped according to MRC grade. RESULTS Of the participants, 16 were in MRC grade 2, 17 were in MRC grade 3, 17 were in MRC grade 4, and 15 were in MRC grade 5. RVSP, pulmonary function, QF, HF, 6MWD, ADL, and SF-36 scores decreased with increasing MRC grade (all P<.001). All measures were lower (P<.05) in subjects with grades 4 and 5 than subjects with grades 2 and 3. Strong associations were found between MRC grade and 6MWD (ρ=-.89, P=.001) and ADL score (ρ=-.82, P=.001). MRC grade was also associated with RVSP, pulmonary function, QF, and HF (all ρ≥.56, P=.001). CONCLUSIONS The MRC dyspnea scale provides a simple and useful method of categorizing individuals with IPF with respect to their activity limitation and may assist in understanding the impact of IPF on an individual.
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Affiliation(s)
- Ryo Kozu
- Department of Rehabilitation Medicine, Nagasaki University Hospital, Nagasaki, Japan; Physiotherapy Department, Sir Charles Gairdner Hospital, Perth, WA, Australia; School of Physiotherapy and Exercise Science, Curtin University, Perth, WA, Australia.
| | - Sue Jenkins
- Physiotherapy Department, Sir Charles Gairdner Hospital, Perth, WA, Australia; School of Physiotherapy and Exercise Science, Curtin University, Perth, WA, Australia; Lung Institute of Western Australia and Centre for Asthma, Allergy and Respiratory Research, University of Western Australia, Perth, WA, Australia
| | - Hideaki Senjyu
- Department of Cardiopulmonary Rehabilitation Science, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
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32
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Sillen MJH, Franssen FME, Delbressine JML, Vaes AW, Wouters EFM, Spruit MA. Efficacy of lower-limb muscle training modalities in severely dyspnoeic individuals with COPD and quadriceps muscle weakness: results from the DICES trial. Thorax 2014; 69:525-31. [PMID: 24399630 DOI: 10.1136/thoraxjnl-2013-204388] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
RATIONALE Strength training and neuromuscular electrical stimulation (NMES) improve lower-limb muscle function in dyspnoeic individuals with chronic obstructive pulmonary disease (COPD). However, high-frequency NMES (HF-NMES) and strength training have never been compared head-to-head; and effects of low-frequency NMES (LF-NMES) have never been studied in COPD. Therefore, the optimal training modality to improve lower-limb muscle function, exercise performance and other patient-related outcomes in individuals with severe COPD remains unknown. OBJECTIVES To study prospectively the efficacy of HF-NMES (75 Hz), LF-NMES (15 Hz) or strength training in severely dyspnoeic individuals with COPD with quadriceps muscle weakness at baseline. METHODS 120 individuals with COPD (FEV1: 33±1% predicted, men: 52%, age: 64.8±0.8 years) were randomised to HF-NMES, LF-NMES or strength training as part of a comprehensive inpatient pulmonary rehabilitation programme. No treadmill walking or stationary cycling was provided. MEASUREMENTS AND MAIN RESULTS Groups were comparable at baseline. Quadriceps muscle strength increased after HF-NMES (+10.8 Newton-metre (Nm)) or strength training (+6.1 Nm; both p<0.01), but not after LF-NMES (+1.4 Nm; p=0.43). Quadriceps muscle endurance, exercise performance, lower-limb fat-free mass, exercise-induced symptoms of dyspnoea and fatigue improved significantly compared with baseline after HF-NMES, LF-NMES or strength training. The increase in quadriceps muscle strength and muscle endurance was greater after HF-NMES than after LF-NMES. CONCLUSIONS HF-NMES is equally effective as strength training in severely dyspnoeic individuals with COPD and muscle weakness in strengthening the quadriceps muscles and thus may be a good alternative in this particular group of patients. HF-NMES, LF-NMES and strength training were effective in improving exercise performance in severely dyspnoeic individuals with COPD and quadriceps weakness. TRIAL REGISTRATION NTR2322.
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Affiliation(s)
- Maurice J H Sillen
- Department of Research & Education, CIRO+, Centre of Expertise for Chronic Organ Failure, Horn, The Netherlands
| | - Frits M E Franssen
- Department of Research & Education, CIRO+, Centre of Expertise for Chronic Organ Failure, Horn, The Netherlands
| | - Jeannet M L Delbressine
- Department of Research & Education, CIRO+, Centre of Expertise for Chronic Organ Failure, Horn, The Netherlands
| | - Anouk W Vaes
- Department of Research & Education, CIRO+, Centre of Expertise for Chronic Organ Failure, Horn, The Netherlands
| | - Emiel F M Wouters
- Department of Research & Education, CIRO+, Centre of Expertise for Chronic Organ Failure, Horn, The Netherlands Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - Martijn A Spruit
- Department of Research & Education, CIRO+, Centre of Expertise for Chronic Organ Failure, Horn, The Netherlands
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Andrianopoulos V, Franssen FM, Peeters JP, Ubachs TJ, Bukari H, Groenen M, Burtin C, Vogiatzis I, Wouters EF, Spruit MA. Exercise-induced oxygen desaturation in COPD patients without resting hypoxemia. Respir Physiol Neurobiol 2014; 190:40-6. [DOI: 10.1016/j.resp.2013.10.002] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Revised: 09/30/2013] [Accepted: 10/01/2013] [Indexed: 10/26/2022]
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Spruit MA, Singh SJ, Garvey C, ZuWallack R, Nici L, Rochester C, Hill K, Holland AE, Lareau SC, Man WDC, Pitta F, Sewell L, Raskin J, Bourbeau J, Crouch R, Franssen FME, Casaburi R, Vercoulen JH, Vogiatzis I, Gosselink R, Clini EM, Effing TW, Maltais F, van der Palen J, Troosters T, Janssen DJA, Collins E, Garcia-Aymerich J, Brooks D, Fahy BF, Puhan MA, Hoogendoorn M, Garrod R, Schols AMWJ, Carlin B, Benzo R, Meek P, Morgan M, Rutten-van Mölken MPMH, Ries AL, Make B, Goldstein RS, Dowson CA, Brozek JL, Donner CF, Wouters EFM. An official American Thoracic Society/European Respiratory Society statement: key concepts and advances in pulmonary rehabilitation. Am J Respir Crit Care Med 2013; 188:e13-64. [PMID: 24127811 DOI: 10.1164/rccm.201309-1634st] [Citation(s) in RCA: 2166] [Impact Index Per Article: 196.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Pulmonary rehabilitation is recognized as a core component of the management of individuals with chronic respiratory disease. Since the 2006 American Thoracic Society (ATS)/European Respiratory Society (ERS) Statement on Pulmonary Rehabilitation, there has been considerable growth in our knowledge of its efficacy and scope. PURPOSE The purpose of this Statement is to update the 2006 document, including a new definition of pulmonary rehabilitation and highlighting key concepts and major advances in the field. METHODS A multidisciplinary committee of experts representing the ATS Pulmonary Rehabilitation Assembly and the ERS Scientific Group 01.02, "Rehabilitation and Chronic Care," determined the overall scope of this update through group consensus. Focused literature reviews in key topic areas were conducted by committee members with relevant clinical and scientific expertise. The final content of this Statement was agreed on by all members. RESULTS An updated definition of pulmonary rehabilitation is proposed. New data are presented on the science and application of pulmonary rehabilitation, including its effectiveness in acutely ill individuals with chronic obstructive pulmonary disease, and in individuals with other chronic respiratory diseases. The important role of pulmonary rehabilitation in chronic disease management is highlighted. In addition, the role of health behavior change in optimizing and maintaining benefits is discussed. CONCLUSIONS The considerable growth in the science and application of pulmonary rehabilitation since 2006 adds further support for its efficacy in a wide range of individuals with chronic respiratory disease.
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Sillen MJH, Franssen FME, Delbressine JML, Uszko-Lencer NHMK, Vanfleteren LEGW, Rutten EPA, Wouters EFM, Spruit MA. Heterogeneity in clinical characteristics and co-morbidities in dyspneic individuals with COPD GOLD D: findings of the DICES trial. Respir Med 2013; 107:1186-94. [PMID: 23706780 DOI: 10.1016/j.rmed.2013.04.020] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Revised: 04/23/2013] [Accepted: 04/24/2013] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Chronic obstructive pulmonary disease (COPD) is a complex and heterogeneous respiratory disease with important extra-pulmonary features and comorbidities. The aim of this study was to assess clinical heterogeneity in a well-defined subgroup of individuals with COPD GOLD D, including possible gender differences. METHODS Pulmonary function, arterial blood gases, exercise performance, quadriceps muscle function, problematic activities of daily life, dyspnea, health status and comorbidities have been assessed in 117 individuals with a MRC dyspnea grade 4/5 and COPD GOLD D entering pulmonary rehabilitation. RESULTS A broad range of values were found for diffusion capacity, exercise capacity, quadriceps muscle function and health status. Indeed, the high coefficients of variation were found for these outcomes. Problematic activities of daily life as well as objectified comorbidities also varied to a great extent. Moreover, significant gender differences were found for exercise performance, lower-limb muscle function and various comorbidities. CONCLUSION The current findings emphasize that COPD is a heterogeneous disease whose clinical presentation varies significantly, even in individuals with very severe COPD with the same degree of dyspnea and all classified as GOLD D. TRIAL REGISTRATION NTR2322.
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Affiliation(s)
- Maurice J H Sillen
- Program Development Centre, CIRO+, Centre of Expertise for Chronic Organ Failure, Hornerheide 1, Horn, The Netherlands.
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Stoilkova A, Janssen DJA, Franssen FME, Spruit MA, Wouters EFM. Coping styles in patients with COPD before and after pulmonary rehabilitation. Respir Med 2013; 107:825-33. [PMID: 23541485 DOI: 10.1016/j.rmed.2013.03.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2012] [Revised: 02/27/2013] [Accepted: 03/01/2013] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Pulmonary rehabilitation (PR) improves physical and psychological symptoms in COPD patients. Patients' coping with daily symptoms and limitations may have more influence on important patient-centred outcomes than the impaired lung function. To date, it remains unknown whether and to what extent coping styles change following PR, and whether coping styles are associated with the outcomes of a comprehensive PR. METHODS Coping styles were assessed in 303 COPD patients before and after a PR programme using the Utrecht Coping List (UCL). Additionally, lung function, St. George's Respiratory Questionnaire (SGRQ), Hospital Anxiety and Depression Scale, anxiety (HADS-A) and depression (HADS-D) subscales and six-minute walking distance (6MWD) were recorded. RESULTS The level of active confronting coping style increased (p < 0.05), whereas the levels of avoidance (p < 0.05), passive reaction pattern and reassuring thoughts coping styles decreased following PR (both p < 0.001). More than 50% of the patients changed their level of active confronting, passive reaction pattern or expressing emotions coping style. Coping styles and/or changes in coping styles after PR were related to changes in exercise tolerance, anxiety and depression, but were not related to changes in health status. Following PR, SGRQ total score, HADS-A and HADS-D scores decreased (all p < 0.001), while 6MWD increased (p < 0.05). CONCLUSION Comprehensive PR results in change in coping styles of COPD patients. Coping styles are related to improvements in exercise tolerance, anxiety and depression, but they are not related with changes in health status after PR. Further studies are needed to evaluate the outcome of interventions actively targeting coping styles.
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Affiliation(s)
- Ana Stoilkova
- Department of Respiratory Medicine, Maastricht University Medical Centre+ (MUMC+), P.O. Box 616, 6200 MD Maastricht, The Netherlands.
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Wilke S, Janssen DJA, Wouters EFM, Schols JMGA, Franssen FME, Spruit MA. Correlations between disease-specific and generic health status questionnaires in patients with advanced COPD: a one-year observational study. Health Qual Life Outcomes 2012; 10:98. [PMID: 22909154 PMCID: PMC3493349 DOI: 10.1186/1477-7525-10-98] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Accepted: 08/16/2012] [Indexed: 11/24/2022] Open
Abstract
Background Longitudinal studies analyzing the correlations between disease-specific and generic health status questionnaires at different time points in patients with advanced COPD are lacking. The aim of this study was to determine whether and to what extent a disease-specific health status questionnaire (Saint George’s Respiratory Questionnaire, SGRQ) correlates with generic health status questionnaires (EuroQol-5-Dimensions, EQ-5D; Assessment of Quality of Life instrument, AQoL; Medical Outcomes Study 36-Item Short-Form Health Survey, SF-36) at four different time points in patients with advanced COPD; and to determine the correlation between the changes in these questionnaires during one-year follow-up. Methods Demographic and clinical characteristics were assessed in 105 outpatients with advanced COPD at baseline. Disease-specific health status (SGRQ) and generic health status (EQ-5D, AQoL, SF-36) were assessed at baseline, four, eight, and 12 months. Correlations were determined between SGRQ and EQ-5D, AQoL, and SF-36 scores and changes in these scores. Agreement in direction of change was assessed. Results Eighty-four patients (80%) completed one-year follow-up and were included for analysis. SGRQ total score and EQ-5D index score, AQoL total score and SF-36 Physical Component Summary measure (SF-36 PCS) score were moderately to strongly correlated. The correlation of the changes between the SGRQ total score and EQ-5D index score, AQoL total score, SF-36 PCS, and SF-36 Mental Component Summary measure (SF-36 MCS) score were weak or absent. The direction of changes in SGRQ total scores agreed slightly with the direction of changes in EQ-5D index score, AQoL total score, and SF-36 PCS score. Conclusions At four, eight and 12 months after baseline, SGRQ total scores and EQ-5D index scores, AQoL total scores and SF-36 PCS scores were moderately to strongly correlated, while SGRQ total scores were weakly correlated with SF-36 MCS scores. The correlations between changes over time were weak or even absent. Disease-specific health status questionnaires and generic health status questionnaires should be used together to gain complete insight in health status and changes in health status over time in patients with advanced COPD.
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Affiliation(s)
- Sarah Wilke
- Program Development Centre, CIRO+, centre of expertise for chronic organ failure, Hornerheide 1, Horn, NM 6085, The Netherlands.
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Vaes AW, Franssen FME, Meijer K, Cuijpers MWJ, Wouters EFM, Rutten EPA, Spruit MA. Effects of body mass index on task-related oxygen uptake and dyspnea during activities of daily life in COPD. PLoS One 2012; 7:e41078. [PMID: 22815922 PMCID: PMC3398871 DOI: 10.1371/journal.pone.0041078] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2012] [Accepted: 06/18/2012] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Patients with COPD use a higher proportion of their peak aerobic capacity during the performance of domestic activities of daily life (ADLs) compared to healthy peers, accompanied by a higher degree of task-related symptoms. To date, the influence of body mass index (BMI) on the task-related metabolic demands remains unknown in patients with COPD. Therefore, the aim of our study was to determine the effects of BMI on metabolic load during the performance of 5 consecutive domestic ADLs in patients with COPD. METHODOLOGY Ninety-four COPD patients and 20 healhty peers performed 5 consecutive, self-paced domestic ADLs putting on socks, shoes and vest; folding 8 towels; putting away groceries; washing up 4 dishes, cups and saucers; and sweeping the floor for 4 min. Task-related oxygen uptake and ventilation were assessed using a mobile oxycon, while Borg scores were used to assess task-related dyspnea and fatigue. PRINCIPAL FINDINGS 1. Relative task-related oxygen uptake after the performance of domestic ADLs was increased in patients with COPD compared to healthy elderly, whereas absolute oxygen uptake is similar between groups; 2. Relative oxygen uptake and oxygen uptake per kilogram fat-free mass were comparable between BMI groups; and 3. Borg symptom scores for dyspnea en fatigue were comparable between BMI groups. CONCLUSION Patients with COPD in different BMI groups perform self-paced domestic ADLs at the same relative metabolic load, accompanied by comparable Borg symptom scores for dyspnea and fatigue.
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Affiliation(s)
- Anouk W Vaes
- Program Development Centre, CIRO +, Horn, The Netherlands.
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Annegarn J, Spruit MA, Savelberg HHCM, Willems PJB, van de Bool C, Schols AMWJ, Wouters EFM, Meijer K. Differences in walking pattern during 6-min walk test between patients with COPD and healthy subjects. PLoS One 2012; 7:e37329. [PMID: 22624017 PMCID: PMC3356256 DOI: 10.1371/journal.pone.0037329] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2012] [Accepted: 04/18/2012] [Indexed: 11/19/2022] Open
Abstract
Background To date, detailed analyses of walking patterns using accelerometers during the 6-min walk test (6MWT) have not been performed in patients with chronic obstructive pulmonary disease (COPD). Therefore, it remains unclear whether and to what extent COPD patients have an altered walking pattern during the 6MWT compared to healthy elderly subjects. Methodology/Principal Findings 79 COPD patients and 24 healthy elderly subjects performed the 6MWT wearing an accelerometer attached to the trunk. The accelerometer features (walking intensity, cadence, and walking variability) and subject characteristics were assessed and compared between groups. Moreover, associations were sought with 6-min walk distance (6MWD) using multiple ordinary least squares (OLS) regression models. COPD patients walked with a significantly lower walking intensity, lower cadence and increased walking variability compared to healthy subjects. Walking intensity and height were the only two significant determinants of 6MWD in healthy subjects, explaining 85% of the variance in 6MWD. In COPD patients also age, cadence, walking variability measures and their interactions were included were significant determinants of 6MWD (total variance in 6MWD explained: 88%). Conclusions/Significance COPD patients have an altered walking pattern during 6MWT compared to healthy subjects. These differences in walking pattern partially explain the lower 6MWD in patients with COPD.
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Affiliation(s)
- Janneke Annegarn
- Human Movement Science, NUTRIM School for Nutrition, Toxicology and Metabolism Maastricht University Medical Centre, Maastricht, Netherlands
| | - Martijn A. Spruit
- Program Development Centre, CIRO+, Centre of expertise for chronic organ failure, Horn, Netherlands
| | - Hans H. C. M. Savelberg
- Human Movement Science, NUTRIM School for Nutrition, Toxicology and Metabolism Maastricht University Medical Centre, Maastricht, Netherlands
| | - Paul J. B. Willems
- Human Movement Science, NUTRIM School for Nutrition, Toxicology and Metabolism Maastricht University Medical Centre, Maastricht, Netherlands
| | - Coby van de Bool
- Respiratory Medicine, NUTRIM School for Nutrition, Toxicology and Metabolism Maastricht University Medical Centre, Maastricht, Netherlands
| | - Annemie M. W. J. Schols
- Respiratory Medicine, NUTRIM School for Nutrition, Toxicology and Metabolism Maastricht University Medical Centre, Maastricht, Netherlands
| | - Emiel F. M. Wouters
- Program Development Centre, CIRO+, Centre of expertise for chronic organ failure, Horn, Netherlands
- Respiratory Medicine, NUTRIM School for Nutrition, Toxicology and Metabolism Maastricht University Medical Centre, Maastricht, Netherlands
| | - Kenneth Meijer
- Human Movement Science, NUTRIM School for Nutrition, Toxicology and Metabolism Maastricht University Medical Centre, Maastricht, Netherlands
- * E-mail:
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Vaes AW, Annegarn J, Meijer K, Cuijpers MW, Franssen FM, Wiechert J, Wouters EF, Spruit MA. The Effects of a “New” Walking Aid on Exercise Performance in Patients With COPD. Chest 2012; 141:1224-1232. [DOI: 10.1378/chest.11-1076] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Problematic Activities of Daily Life are Weakly Associated With Clinical Characteristics in COPD. J Am Med Dir Assoc 2012; 13:284-90. [DOI: 10.1016/j.jamda.2011.01.002] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2010] [Accepted: 01/03/2011] [Indexed: 01/05/2023]
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Graat-Verboom L, Smeenk FWJM, van den Borne BEEM, Spruit MA, Jansen FH, van Enschot JWT, Wouters EFM. Progression of osteoporosis in patients with COPD: a 3-year follow up study. Respir Med 2012; 106:861-70. [PMID: 22369986 DOI: 10.1016/j.rmed.2011.12.020] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2011] [Revised: 12/11/2011] [Accepted: 12/28/2011] [Indexed: 02/05/2023]
Abstract
Currently, our knowledge on the progression of osteoporosis and its determinants is limited in patients with chronic obstructive pulmonary disease (COPD). Bone mineral density generally remains stable in patients with COPD over a period of 3 years. Nevertheless, the progression of vertebral fractures was not assessed, while an increase of vertebral fractures over time may be reasonable. Aims of the current study were to determine the percentage of newly diagnosed osteoporotic patients after a follow up of 3 years and to identify baseline risk factors for the progression of osteoporosis in COPD. Clinically stable COPD outpatients were included. Lung function parameters, body composition measures, six minute walk distance, DXA-scan and X-spine were assessed at baseline and repeated after 3 years. Prevalence of osteoporosis in COPD patients increased from 47% to 61% in 3 years mostly due to an increase of vertebral fractures. Lower baseline T-score at the trochanter independently increased the risk for the development of osteoporosis. Additionally, baseline vitamin D deficiency increased this risk 7.5-fold. In conclusion, the prevalence of osteoporosis increased over a 3-year period in patients with COPD. Baseline risk factors for the development of osteoporosis are osteopenia at the trochanter and vitamin D deficiency.
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Affiliation(s)
- Lidwien Graat-Verboom
- Department of Respiratory Medicine, Catharina Hospital Eindhoven, Michelangelolaan 2, 5623 GS Eindhoven, The Netherlands.
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Sillen MJ, Vercoulen JH, Hul AJV, Klijn PH, Wouters EF, van Ranst D, Peters JB, van Keimpema AR, Franssen FM, Otten HJ, Molema J, Jansen JJ, Spruit MA. Inaccuracy of Estimating Peak Work Rate from Six-Minute Walk Distance in Patients with COPD. COPD 2012; 9:281-8. [DOI: 10.3109/15412555.2012.655866] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Vanfleteren LEGW, Franssen FME, Uszko-Lencer NHMK, Spruit MA, Celis M, Gorgels AP, Wouters EFM. Frequency and relevance of ischemic electrocardiographic findings in patients with chronic obstructive pulmonary disease. Am J Cardiol 2011; 108:1669-74. [PMID: 22077976 DOI: 10.1016/j.amjcard.2011.07.027] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2011] [Revised: 07/10/2011] [Accepted: 07/10/2011] [Indexed: 11/30/2022]
Abstract
Cardiovascular disease is common in patients with chronic obstructive pulmonary disease (COPD) but often remains unrecognized. Ischemic electrocardiographic (ECG) changes are associated with a higher risk of dying from coronary heart disease but have never been systematically evaluated in COPD. Also, their relation to clinical outcome has not been studied. We aimed to determine the frequency of ischemic ECG changes and its relevance in relation to clinical outcome and predictors of impaired survival in patients with COPD. Clinical characteristics, pulmonary function, and co-morbidities were assessed in 536 patients with COPD during baseline assessment of a comprehensive pulmonary rehabilitation program. Moreover, electrocardiograms at rest were obtained in all patients. All electrocardiograms were scored independently by 2 cardiologists using the Minnesota scoring system. Major or minor Q or QS pattern, ST junction and segment depression, T-wave items, or left bundle branch block were considered ischemic ECG changes. One hundred thirteen patients (21%) had ischemic ECG changes. Moreover, 42 of 293 patients (14%) without self-reported cardiovascular co-morbidities had ischemic ECG changes. In addition, patients with ischemic ECG changes had higher dyspnea grades (Modified Medical Research Council (mMRC) 2.9 ± 1.1 vs 2.6 ± 1.1, p = 0.032), worse exercise performance (6-minute walking distance 387 ± 126 vs 425 ± 126 m, p = 0.004), more systemic inflammation (high-sensitivity C-reactive protein 11.2 ± 16.2 vs 7.9 ± 10.7 mmol/l, p = 0.01), higher scores on the Charlson Co-morbidity Index (1.8 ± 0.9 vs 1.5 ± 0.8 points), and higher scores BODE (5.3 ± 3.7 vs 4.5 ± 3.4 points, p = 0.033) and on ADO indexes (5.2 ± 1.7 vs 4.8 ± 1.7 points, p = 0.029) compared to patients without ischemic ECG changes, whereas forced expiratory volume in the first second was similar (40.8 ± 15.2% vs 42.6% ± 15.9%, p = 0.30). In conclusion, ischemic ECG changes are common in patients with COPD and associated with poor clinical outcome irrespective of forced expiratory volume in the first second. These results suggest an important role for cardiovascular disease in impaired survival in these patients.
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Affiliation(s)
- Lowie E G W Vanfleteren
- Program Development Center, CIRO+, Center of Expertise for Chronic Organ Failure, Horn, The Netherlands.
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Janssen DJA, Franssen FME, Wouters EFM, Schols JMGA, Spruit MA. Impaired health status and care dependency in patients with advanced COPD or chronic heart failure. Qual Life Res 2011; 20:1679-88. [PMID: 21442430 PMCID: PMC3220822 DOI: 10.1007/s11136-011-9892-9] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2011] [Indexed: 11/30/2022]
Abstract
PURPOSE Aims of this cross-sectional study were to assess health status and care dependency in patients with advanced chronic obstructive pulmonary disease (COPD) or chronic heart failure (CHF) and to identify correlates of an impaired health status. METHODS The following outcomes were assessed in outpatients with advanced COPD (n = 105) or CHF (n = 80): clinical characteristics; general health status (EuroQol-5 Dimensions (EQ-5D); Assessment of Quality of Life instrument (AQoL); Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36)); disease-specific health status (St. Georges Respiratory Questionnaire (SGRQ), Minnesota Living with Heart Failure Questionnaire (MLHFQ)); physical mobility (timed 'Up and Go' test); and care dependency (Care Dependency Scale). RESULTS Patients with advanced COPD or CHF have an impaired health status and may be confronted with care dependency. Multiple regression analyses have shown that physical and psychological symptoms, care dependency and number of drugs were correlated with impaired health status in advanced COPD or CHF, while demographic and clinical characteristics like age, gender, disease severity and co-morbidities were not correlated. CONCLUSIONS Clinical care should regularly assess symptom burden and care dependency to identify patients with advanced COPD or CHF at risk for an impaired health status.
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Affiliation(s)
- Daisy J A Janssen
- Program Development Centre, CIRO +, centre of expertise for chronic organ failure, Hornerheide 1, 6085 NM Horn, The Netherlands.
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Vaes AW, Wouters EF, Franssen FM, Uszko-Lencer NH, Stakenborg KH, Westra M, Meijer K, Schols AM, Janssen PP, Spruit MA. Task-Related Oxygen Uptake During Domestic Activities of Daily Life in Patients With COPD and Healthy Elderly Subjects. Chest 2011; 140:970-979. [DOI: 10.1378/chest.10-3005] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Kovelis D, Zabatiero J, Oldemberg N, Colange AL, Barzon D, Nascimento CHSC, Probst VS, Pitta F. Responsiveness of three instruments to assess self-reported functional status in patients with COPD. COPD 2011; 8:334-9. [PMID: 21774574 DOI: 10.3109/15412555.2011.594463] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The study aimed to compare the responsiveness of three instruments to assess self-reported changes in functional status after exercise training in patients with COPD: Pulmonary Functional Status and Dyspnea Questionnaire -modified version (PFSDQ-M), London Chest Activity of Daily Living (LCADL) and Medical Research Council scale (MRC). Twenty-two patients (11 female, 66[62-71] years, FEV1 42[33-61]%predicted) participated in a 3-month high-intensity exercise program. The three instruments were applied pre- and post-program, as well as assessment of lung function, muscle strength, exercise capacity (6-minute walking test, 6MWT) and quality of life (St. George's Respiratory Questionnaire, SGRQ). SGRQ, 6MWT and quadriceps femoris, biceps and triceps brachialis strength improved significantly after the program (p < 0.05 for all). Training also yielded significant improvement in the LCADL total score and self-care, domestic and leisure domains and in the PFSDQ-M 'change in activities' domain, with no improvement in the MRC (p = 0.11). Calculation of effects sizes also indicated higher responsiveness in the LCADL than the other instruments. There were no significant correlations between changes in the three instruments and changes in lung function, SGRQ or 6MWT. In conclusion, PFSDQ-M's 'change in activity' domain and specially the LCADL (to a higher extent) showed responsiveness to detect changes in functional status after three months of high-intensity exercise training in patients with COPD, whereas the MRC scale did not. In this population, the improvement in functional status was not related with improvement in exercise capacity, lung function or quality of life.
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Affiliation(s)
- Demetria Kovelis
- Laboratório de Pesquisa em Fisioterapia Pulmonar (LFIP), Departamento de Fisioterapia, Universidade Estadual de Londrina (UEL), Londrina, Brazil
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Spruit MA, Wouters EFM, Eterman RMA, Meijer K, Wagers SS, Stakenborg KHP, Uszko-Lencer NHMK. Task-related oxygen uptake and symptoms during activities of daily life in CHF patients and healthy subjects. Eur J Appl Physiol 2011; 111:1679-86. [PMID: 21210281 PMCID: PMC3156911 DOI: 10.1007/s00421-010-1794-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2010] [Accepted: 12/20/2010] [Indexed: 12/04/2022]
Abstract
Patients with chronic heart failure (CHF) have a significantly lower peak aerobic capacity compared to healthy subjects, and, may therefore experience more inconvenience during the performance of domestic activities of daily life (ADLs). To date, the extent to which task-related oxygen uptake, heart rate, ventilation and symptoms during the performance of ADLs in CHF patients is different than in healthy subjects remains uncertain. General demographics, pulmonary function, body composition and peak aerobic capacity were assessed in 23 CHF outpatients and 20 healthy peers. In addition, the metabolic requirement of five simple self-paced domestic ADLs was assessed using a mobile oxycon. Task-related oxygen uptake (ml/min) was similar or lower in CHF patients compared to healthy subjects. In contrast, patients with CHF performing ADLs consumed oxygen at a higher proportion of their peak aerobic capacity than healthy subjects (p < 0.05). For example, getting dressed resulted in a mean task-related oxygen uptake of 49% of peak aerobic capacity, while sweeping the floor resulted in a mean task-related oxygen uptake of 52% of peak aerobic capacity, accompanied by significantly higher Borg symptom scores for dyspnea and fatigue (p < 0.05). Patients with CHF experience use a higher proportion of their peak aerobic capacity, peak ventilation and peak heart rate during the performance of simple self-paced domestic ADL than their healthy peers. These findings represent a necessary step in improving our understanding of improving what troubles patients the most—not being able to do the things that they could when they were healthy.
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Affiliation(s)
- Martijn A Spruit
- Program Development Centre, CIRO+, A Centre of Expertise for Chronic Organ Failure, Hornerheide 1, 6085, NM, Horn, The Netherlands.
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Janssen DJA, Spruit MA, Leue C, Gijsen C, Hameleers H, Schols JMGA, Wouters EFM. Symptoms of anxiety and depression in COPD patients entering pulmonary rehabilitation. Chron Respir Dis 2010; 7:147-57. [PMID: 20688892 DOI: 10.1177/1479972310369285] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) patients may suffer from symptoms of anxiety and depression. Whether and to what extent symptoms of anxiety and depression may be present in COPD patients entering pulmonary rehabilitation and which patient characteristics are associated with psychological distress remains currently unknown. The objective of the present study is to determine the prevalence and the determinants of clinically relevant symptoms of anxiety and depression in COPD patients entering pulmonary rehabilitation. Symptoms of anxiety and depression have been assessed in 701 COPD patients entering pulmonary rehabilitation using the Hospital Anxiety and Depression Scale. Additionally, disease-specific health status, pulmonary function, body composition, exercise capacity, co-existing morbidities, smoking status, symptoms, long-term oxygen therapy and the use of antidepressant and anxiolytic drugs have been recorded. Patients had mean anxiety scores of 7.6 points and mean depression scores of 7.2 points. Anxiety scores >or=10 points were present in 225 patients (32%) and depression scores >or=10 points were present in 192 patients (27%). Patients at risk of having symptoms of anxiety were female or used antidepressant or anxiolytic drugs. Patients at risk of having symptoms of depression experienced dyspnea, had a body mass index (BMI) <21 kg/m(2) or used antidepressant or anxiolytic drugs. A considerable proportion of the COPD patients entering pulmonary rehabilitation report symptoms of anxiety and/or depression, which may significantly impair disease-specific health status. Patients at risk of having symptoms of anxiety and/or depression are female, experience dyspnea, have a low BMI or use antidepressant and/or anxiolytic drugs.
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Affiliation(s)
- Daisy J A Janssen
- Program Development Centre, Ciro, Centre of Expertise for Chronic Organ Failure, Horn, the Netherlands.
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Sillen MJH, Wouters EFM, Franssen FME, Meijer K, Stakenborg KHP, Spruit MA. Oxygen uptake, ventilation, and symptoms during low-frequency versus high-frequency NMES in COPD: a pilot study. Lung 2010; 189:21-6. [PMID: 21080183 DOI: 10.1007/s00408-010-9265-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2010] [Accepted: 10/25/2010] [Indexed: 11/25/2022]
Abstract
Transcutaneous neuromuscular electrical stimulation (NMES) involves the application of an electrical current through electrodes placed on the skin over the targeted muscles. During high-frequency NMES (HF-NMES), oxygen uptake, minute ventilation, and the degree of symptom perception (dyspnea and fatigue) have been shown to be acceptable in chronic obstructive pulmonary disease (COPD). Currently, oxygen uptake and ventilation load have never been assessed during low-frequency NMES (LF-NMES) of the lower-limb muscles. The purpose of this study was to compare prospectively oxygen uptake, ventilation, and symptom perception during a single session of LF-NMES versus a single session of HF-NMES of quadriceps muscles in patients with COPD. In 17 COPD patients (mean FEV(1) = 45% predicted, mean body mass index = 26.2 kg/m(2)), peak exercise capacity, functional exercise capacity, and the Medical Research Council dyspnea grade were evaluated. In addition, oxygen uptake, minute ventilation, heart rate, and Borg symptom scores were assessed during one session of LF-NMES (15 Hz) and one session of HF-NMES (75 Hz) and compared with peak values. Mean oxygen uptake (LF-NMES: 327 ml/min vs. HF-NMES: 315 ml/min), minute ventilation (LF-NMES: 14 L vs. HF-NMES: 15 L), and heart rate (LF-NMES: 86 BPM vs. HF-NMES: 83 BPM) were similar during both NMES frequencies. Patients used a relatively low proportion of their peak aerobic capacity during both NMES sessions (LF-NMES: 34% vs. HF-NMES: 33%; P = 0.397). In addition, symptom Borg scores for dyspnea and leg fatigue were also comparable. Oxygen uptake, ventilation, and symptoms of dyspnea and fatigue were comparable and tolerable during LF-NMES and HF-NMES in patients with COPD. Therefore, LF-NMES and HF-NMES may both be suitable rehabilitative modalities to be used in severely dyspneic patients with lower-limb muscle dysfunction.
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Affiliation(s)
- Maurice J H Sillen
- Program Development Centre, Ciro+, Hornerheide 1, Horn, The Netherlands.
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