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Mosher CL, Nanna MG, Jawitz OK, Raman V, Farrow NE, Aleem S, Casaburi R, MacIntyre NR, Palmer SM, Myers ER. Cost-effectiveness of Pulmonary Rehabilitation Among US Adults With Chronic Obstructive Pulmonary Disease. JAMA Netw Open 2022; 5:e2218189. [PMID: 35731514 PMCID: PMC9218844 DOI: 10.1001/jamanetworkopen.2022.18189] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
IMPORTANCE Pulmonary rehabilitation (PR) after exacerbation of chronic obstructive pulmonary disease (COPD) is effective in reducing COPD hospitalizations and mortality while improving health-related quality of life, yet use of PR remains low. Estimates of the cost-effectiveness of PR in this setting could inform policies to improve uptake. OBJECTIVE To estimate the cost-effectiveness of participation in PR after hospitalization for COPD. DESIGN, SETTING, AND PARTICIPANTS This economic evaluation estimated the cost-effectiveness of participation in PR compared with no PR after COPD hospitalization in the US using a societal perspective analysis. A Markov microsimulation model was developed to estimate the cost-effectiveness in the US health care system with a lifetime horizon, 1-year cycle length, and a discounted rate of 3% per year for both costs and outcomes. Data sources included published literature from October 1, 2001, to April 1, 2021, with the primary source being an analysis of Medicare beneficiaries living with COPD between January 1, 2014, and December 31, 2015. The analysis was designed and conducted from October 1, 2019, to December 15, 2021. A base case microsimulation, univariate analyses, and a probabilistic sensitivity analysis were performed. INTERVENTIONS Pulmonary rehabilitation compared with no PR after COPD hospitalization. MAIN OUTCOMES AND MEASURES Net cost in US dollars, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio. RESULTS Among the hypothetical cohort with a mean age of 76.9 (age range, 60-92) years and 58.6% women, the base case microsimulation from a societal perspective demonstrated that PR resulted in net cost savings per patient of $5721 (95% prediction interval, $3307-$8388) and improved quality-adjusted life expectancy (QALE) (gain of 0.53 [95% prediction interval, 0.43-0.63] years). The findings of net cost savings and improved QALE with PR did not change in univariate analyses of patient age, the Global Initiative for Obstructive Lung Disease stage, or number of PR sessions. In a probabilistic sensitivity analysis, PR resulted in net cost savings and improved QALE in every one of 1000 samples and was the dominant strategy in 100% of simulations at any willingness-to-pay threshold. In a 1-way sensitivity analysis of total cost, assuming completion of 36 sessions, a single PR session would remain cost saving to $171 per session and had an incremental cost-effectiveness ratio of $884 per session for $50 000/QALY and $1597 per session for $100 000/QALY. CONCLUSIONS AND RELEVANCE In this economic evaluation, PR after COPD hospitalization appeared to result in net cost savings along with improvement in QALE. These findings suggest that stakeholders should identify policies to increase access and adherence to PR for patients with COPD.
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Affiliation(s)
- Christopher L. Mosher
- Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University Medical Center, Durham, North Carolina
- Duke Clinical Research Institute, Durham, North Carolina
| | - Michael G. Nanna
- Duke Clinical Research Institute, Durham, North Carolina
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Oliver K. Jawitz
- Duke Clinical Research Institute, Durham, North Carolina
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Vignesh Raman
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Norma E. Farrow
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Samia Aleem
- Duke Clinical Research Institute, Durham, North Carolina
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
| | - Richard Casaburi
- Rehabilitation Clinical Trials Center, Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California
| | - Neil R. MacIntyre
- Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University Medical Center, Durham, North Carolina
| | - Scott M. Palmer
- Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University Medical Center, Durham, North Carolina
- Duke Clinical Research Institute, Durham, North Carolina
| | - Evan R. Myers
- Duke Clinical Research Institute, Durham, North Carolina
- Division of Women’s Community and Population Health, Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina
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Chin PQ, Sheu CC, Tsai JR, Chang HL, Lee LY, Chen CY. Establishing Quality of Life in Southern Taiwan COPD Patients Using Long-Acting Bronchodilator. Patient Prefer Adherence 2022; 16:875-886. [PMID: 35411135 PMCID: PMC8994661 DOI: 10.2147/ppa.s355023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 03/19/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND To assess the health-related quality of life (HRQoL) of Taiwan patients with different stages of chronic obstructive pulmonary disease (COPD) and using different combination therapies and to explore the factors affecting HRQoL in these patients. METHODS This cross-sectional study included outpatient participants aged 35 years old and older who were receiving long-acting bronchodilator treatment in one of two hospitals in Southern Taiwan. Participants were categorized according to their Global Initiative for Obstructive Lung Disease (GOLD) classification as either their COPD group, based on symptoms and exacerbation risk, or their COPD stage, based on spirometry results. Patients' HRQoL was assessed using the St. George's Respiratory Questionnaire score (SGRQ), World Health Organization Quality of Life Quality of Life-BREF (WHOQOL-BREF), and EQ-5D-5L. The total scores of the SGRQ, WHOQOL-BREF, EQ-5D utility index, and EQ-VAS were presented as mean ± standard deviation (SD) among different combination treatments. Univariate and multivariate analyses were used to explore the association of patients' baseline characteristics and environmental factors with HRQoL. RESULTS A total of 218 patients were enrolled in the study. The distribution of patients using GOLD group classification were as follows: 73.39% in group A, 20.19% group B, 1.83% group C and 4.59% group D. Triple therapy patients mostly showed a lower quality of life than other combination therapies, regardless of the GOLD classification system. However, only the SGRQ scores of GOLD groups A and B were significantly different when using different drug combinations (p-value = 0.0072 and 0.0430, respectively). The COPD assessment test (CAT) score, a questionnaire to assess impact of COPD on health status, was found to be associated with all the questionnaires. CONCLUSION The HRQoL is impaired in patients with COPD, and it deteriorates with an increase of severity. The CAT was the strongest predictor of HRQoL.
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Affiliation(s)
- Pik-Qi Chin
- Master Program in Clinical Pharmacy, School of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chau-Chyun Sheu
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Department of Internal Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jong-Rung Tsai
- Division of Respiratory Therapy, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Internal Medicine, Kaohsiung Municipal Cijin Hospital, Kaohsiung, Taiwan
| | - Hsu-Liang Chang
- Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital; Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Li-Yao Lee
- Department of Pharmacy, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Chung-Yu Chen
- Master Program in Clinical Pharmacy, School of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Pharmacy, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Correspondence: Chung-Yu Chen, Master Program in Clinical Pharmacy, School of Pharmacy, Kaohsiung Medical University, No. 100, Shihcyuan 1st Road, Sanmin District, Kaohsiung, 80708, Taiwan, Tel +886-7-3121101 ext 2375, Fax +886-7-3210683, Email
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Gulart AA, Munari AB, Klein SR, Gavenda SG, Sagrillo LM, Mayer AF. Performance in the Glittre-ADL Test is Associated with the Pulmonary Function of Patients with Chronic Obstructive Pulmonary Disease. COPD 2021; 18:637-642. [PMID: 34865582 DOI: 10.1080/15412555.2021.2008339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The relationship between lung function and performance in some functional tests, as the six-minute walk test (6MWT) and Glittre-ADL test (TGlittre) are still discrepant in patients with chronic obstructive pulmonary disease (COPD). This study aimed to verify which test better correlates and is better explained by the pulmonary function, and which test better discriminates patients regarding the severity of the disease. Seventy-four patients with moderate to very severe COPD (54 men; 66 ± 9 years; FEV1: 37.2 ± 14.3%pred) were included. Spirometry, 6MWT and TGlittre were performed. The results showed weak to moderate correlation between pulmonary function variables and 6MWT (0.36 ≤ r ≤ 0.45) and TGlittre (-0.44 ≤ r ≤ -0.53). In patients with performance of ≤400 m in the 6MWT, a strong correlation was observed between TGlittre with FEV1 (%pred) (r = -0.82; p < .001). The pulmonary function variable that better predict the functional tests performance was FEV1 (R2 = 0.17). Both functional tests were able to discriminate patients with COPD GOLD 4 from the other classifications. When compared to GOLD 2 patients, GOLD 4 patients presented higher time spent on TGlittre (p < .001). When compared to GOLD 3 patients, GOLD 4 patients had higher TGlittre (p = .001). No statistical differences were found in the 6MWT between GOLD 3 and 4, as well as between GOLD 2 and 3. In conclusion, the pulmonary function presents stronger correlations and better explain the variability of TGlittre than of the 6MWT, especially in patients with greater functional impairment. The TGlittre seems to better discriminate patients with COPD regarding the severity of lung function.
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Affiliation(s)
- Aline Almeida Gulart
- Núcleo de Assistência, Ensino e Pesquisa em Reabilitação Pulmonar (NuReab), Universidade do Estado de Santa Catarina (UDESC), Florianopolis, Brazil.,Programa de Pós-Graduação em Ciências do Movimento Humano, Centro de Ciências da Saúde e do Esporte (CEFID), Universidade do Estado de Santa Catarina (UDESC), Florianopolis, Brazil
| | - Anelise Bauer Munari
- Núcleo de Assistência, Ensino e Pesquisa em Reabilitação Pulmonar (NuReab), Universidade do Estado de Santa Catarina (UDESC), Florianopolis, Brazil.,Programa de Pós-Graduação em Ciências do Movimento Humano, Centro de Ciências da Saúde e do Esporte (CEFID), Universidade do Estado de Santa Catarina (UDESC), Florianopolis, Brazil
| | - Suelen Roberta Klein
- Núcleo de Assistência, Ensino e Pesquisa em Reabilitação Pulmonar (NuReab), Universidade do Estado de Santa Catarina (UDESC), Florianopolis, Brazil.,Programa de Pós-Graduação em Ciências do Movimento Humano, Centro de Ciências da Saúde e do Esporte (CEFID), Universidade do Estado de Santa Catarina (UDESC), Florianopolis, Brazil
| | - Simone Graciosa Gavenda
- Núcleo de Assistência, Ensino e Pesquisa em Reabilitação Pulmonar (NuReab), Universidade do Estado de Santa Catarina (UDESC), Florianopolis, Brazil.,Programa de Pós-Graduação em Fisioterapia, Centro de Ciências da Saúde e do Esporte (CEFID), Universidade do Estado de Santa Catarina (UDESC), Florianopolis, Brazil
| | - Luiza Minato Sagrillo
- Núcleo de Assistência, Ensino e Pesquisa em Reabilitação Pulmonar (NuReab), Universidade do Estado de Santa Catarina (UDESC), Florianopolis, Brazil.,Programa de Pós-Graduação em Ciências do Movimento Humano, Centro de Ciências da Saúde e do Esporte (CEFID), Universidade do Estado de Santa Catarina (UDESC), Florianopolis, Brazil
| | - Anamaria Fleig Mayer
- Núcleo de Assistência, Ensino e Pesquisa em Reabilitação Pulmonar (NuReab), Universidade do Estado de Santa Catarina (UDESC), Florianopolis, Brazil.,Programa de Pós-Graduação em Ciências do Movimento Humano, Centro de Ciências da Saúde e do Esporte (CEFID), Universidade do Estado de Santa Catarina (UDESC), Florianopolis, Brazil.,Programa de Pós-Graduação em Fisioterapia, Centro de Ciências da Saúde e do Esporte (CEFID), Universidade do Estado de Santa Catarina (UDESC), Florianopolis, Brazil
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The Effect of Nursing Care Applied to Patients with Chronic Obstructive Pulmonary Disease on Their Sexual Experiences and Quality of Life. SEXUALITY AND DISABILITY 2021; 39:529-542. [PMID: 33758442 PMCID: PMC7976671 DOI: 10.1007/s11195-021-09677-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2021] [Indexed: 10/29/2022]
Abstract
This study was conducted for the aim of assessing the effect of nursing care applied to patients with chronic obstructive pulmonary disease on their sexual experiences and quality of life. The sample of the study was determined via power analysis, patients were assigned groups using a simple random sampling method. The data were collected between December 2019-June 2020. The researcher applied the nursing care to patients in the experimental group in their home three times. There was a statistically significant difference between posttest mean scores of the Short Form-36 Health-Related Quality of Life Questionnaire subscales and Arizona Sexual Experiences Scale of the patients in the experimental and control groups (p < 0.05). In this study, it was determined that there was an increase in the Health-Related Quality of Life Questionnaire mean score of patients with COPD after the nursing care; whereas, there was a slight decrease in the Arizona Sexual Experiences Scale mean score.
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Toward a Regulatory Qualification of Real-World Mobility Performance Biomarkers in Parkinson's Patients Using Digital Mobility Outcomes. SENSORS 2020; 20:s20205920. [PMID: 33092143 PMCID: PMC7589106 DOI: 10.3390/s20205920] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 10/12/2020] [Accepted: 10/17/2020] [Indexed: 02/06/2023]
Abstract
Wearable inertial sensors can be used to monitor mobility in real-world settings over extended periods. Although these technologies are widely used in human movement research, they have not yet been qualified by drug regulatory agencies for their use in regulatory drug trials. This is because the first generation of these sensors was unreliable when used on slow-walking subjects. However, intense research in this area is now offering a new generation of algorithms to quantify Digital Mobility Outcomes so accurate they may be considered as biomarkers in regulatory drug trials. This perspective paper summarises the work in the Mobilise-D consortium around the regulatory qualification of the use of wearable sensors to quantify real-world mobility performance in patients affected by Parkinson's Disease. The paper describes the qualification strategy and both the technical and clinical validation plans, which have recently received highly supportive qualification advice from the European Medicines Agency. The scope is to provide detailed guidance for the preparation of similar qualification submissions to broaden the use of real-world mobility assessment in regulatory drug trials.
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Borgmann M, Ivanda M, Hadizamani Y, Mohaupt M, Bals R, Lucas R, Hamacher J, Köllner V. Does the 6-minute walk test in hospitalized COPD patients exclusively correlate with lung function parameters or should psychological factors also be taken into account? PLoS One 2020; 15:e0232587. [PMID: 32365134 PMCID: PMC7197854 DOI: 10.1371/journal.pone.0232587] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 04/18/2020] [Indexed: 11/29/2022] Open
Abstract
The 6-minute walk test is generally considered a standard test for the evaluation of short-term maximal physical performance. It has not been evaluated whether psychological factors, such as anxiety or depression, affect the performance or the results of the test. The main aim of this study was to investigate whether a correlation exists between psychological factors and the data from the 6-minute walking test. The study cohort consisted of 85 (♀ = 34 and ♂ = 51) 66 ± 10 (mean ± SD) year-old patients with chronic obstructive pulmonary disease (COPD) hospitalized for disease exacerbation. Forced Expiratory Volume in the first second (FEV1) (% predicted) as predictor for lung function, as well as anxiety and depression symptoms assessed using the Hospital Anxiety and Depression Scale (HADS) as psychological predictors were collected. Bivariate correlations and hierarchical linear regression models were used to analyse the correlations. Walking distance was on average 260m ± 107m and ranged from 64m to 480m. HADS was negatively correlated with 6-min walking distance (r = 0.441, p = .0009, r = -.523, p = 00006). Hierarchical linear regression showed that FEV1 alone explained 33%, and together with the psychological variables anxiety and depression explained 42% of the variance of results from the 6-minute walking test. These findings demonstrated that 11% of the data correlated with the psychological variables alone (p = .011). The effect size for lung function (f2 = .717) and psychological variables (f2 = .352) were high, whereas the socio-demographic variables sex, age, educational level and BMI could not explain any additional variance in our cohort. In conclusion, our study indicates that psychological factors such as symptoms of depression and anxiety are associated with lower physical functional performance in the 6-minute walking test. As such, these factors should also be assessed. Future research is needed to show if treatments of anxiety and depression can improve the walking distance in COPD patients.
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Affiliation(s)
- Michèle Borgmann
- Internal Medicine and Pneumology, Lindenhofspital, Bern, Switzerland
- Lungen- und Atmungsstiftung Bern, Bern, Switzerland
| | | | - Yalda Hadizamani
- Internal Medicine and Pneumology, Lindenhofspital, Bern, Switzerland
- Lungen- und Atmungsstiftung Bern, Bern, Switzerland
| | - Markus Mohaupt
- Internal Medicine, Sonnenhofspital Bern, Bern, Switzerland
| | - Robert Bals
- Internal Medicine V—Pneumology, Allergology, Respiratory and Environmental Medicine, Faculty of Medicine, Saarland University, Homburg/Saar, Germany
| | - Rudolf Lucas
- Lungen- und Atmungsstiftung Bern, Bern, Switzerland
- Division of Pulmonary Medicine, Vascular Biology Center, Medical College of Georgia, Georgia Regents University, Augusta, GA, United States of America
| | - Jürg Hamacher
- Internal Medicine and Pneumology, Lindenhofspital, Bern, Switzerland
- Lungen- und Atmungsstiftung Bern, Bern, Switzerland
- * E-mail:
| | - Volker Köllner
- Department of Behavioral Therapy and Psychosomatic Medicine, Rehabilitation Center Seehof, Federal German Pension Agency, Teltow, Germany
- Department of Psychosomatic Medicine, Psychosomatic Rehabilitation Research Group, Center for Internal Medicine and Dermatology, Charité—Universitätsmedizin, Berlin, Germany
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Cebrià I Iranzo MÀ, Vos R, Verleden GM, Gosselink R, Langer D. Evolution of Functional Exercise Capacity in Lung Transplant Patients With and Without Bronchiolitis Obliterans Syndrome: A Longitudinal Case-Control Study. Arch Bronconeumol 2018; 55:239-245. [PMID: 30595421 DOI: 10.1016/j.arbres.2018.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 11/05/2018] [Accepted: 11/12/2018] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Bronchiolitis Obliterans Syndrome (BOS) is a debilitating disease with limited treatment options that threatens both the quality of life and long-term survival of lung transplant (LTx) recipients. This retrospective longitudinal case-control study was performed to compare the long-term functional evolution of LTx recipients with and without BOS. METHODS Twenty-four LTx recipients with BOS (BOS=Cases) and 24 without BOS (NON-BOS=Controls) were selected and individually matched according to age, gender, diagnosis and LTx characteristics. Measurements of 6-minute walking distance (6MWD), symptoms of dyspnea (BORG CR-10 scale), and comprehensive pulmonary function testing were performed before LTx and at annual follow-up assessments after LTx. RESULTS Peak FEV1 after LTx was similar in both groups [FEV1 (% predicted) 101±25 vs. 101±31, p=0.96] and BOS diagnosis in cases was established 3.6±2.5 years after LTx. At the final follow-up assessment (6.5±3.2 years after LTx) FEV1 (% predicted) was 86±34 in NON-BOS vs. 44±17 in BOS (p<0.001). Evolution of 6MWD was different between groups (group by time interaction: p=0.002). Borg dyspnea scores were also significantly different between groups at the final evaluation (NON-BOS 3.3±1.7 vs. BOS 5.0±2.2; p=0.024). CONCLUSIONS We observed gradual reductions in functional exercise capacity and increasing symptoms of dyspnea in patients who developed BOS after LTx. As such, prospective studies seem warranted to explore whether rehabilitative interventions might be useful to improve symptoms and slow down deterioration of exercise capacity in these patients from the onset of BOS.
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Affiliation(s)
- Maria À Cebrià I Iranzo
- Department of Physiotherapy, University of Valencia and Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Robin Vos
- Respiratory Division, Lung Transplantation Unit, University Hospitals Leuven and Department of Clinical and Experimental Medicine, KU Leuven, Belgium
| | - Geert M Verleden
- Respiratory Division, Lung Transplantation Unit, University Hospitals Leuven and Department of Clinical and Experimental Medicine, KU Leuven, Belgium
| | - Rik Gosselink
- Respiratory Division, Respiratory Rehabilitation Unit, University Hospitals Leuven and Department of Rehabilitation Sciences, KU Leuven, Belgium
| | - Daniel Langer
- Respiratory Division, Respiratory Rehabilitation Unit, University Hospitals Leuven and Department of Rehabilitation Sciences, KU Leuven, Belgium.
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Strevens Bolmgren V, Olsson P, Wollmer P, Hesselstrand R, Mandl T. Respiratory symptoms are poor predictors of concomitant chronic obstructive pulmonary disease in patients with primary Sjögren's syndrome. Rheumatol Int 2017; 37:813-818. [PMID: 28243798 PMCID: PMC5397441 DOI: 10.1007/s00296-017-3678-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 02/07/2017] [Indexed: 11/28/2022]
Abstract
Involvement of the respiratory system, in particular dry airways and chronic obstructive pulmonary disease (COPD), is common in patients with primary Sjögren’s syndrome (pSS). As respiratory symptoms are also common in pSS patients and may have different etiologies, we wanted to evaluate the amount and impact of respiratory symptoms in out-patients with pSS and to assess if such symptoms are related to concomitant COPD. The St George’s Respiratory Questionnaire (SGRQ) was used to assess respiratory symptoms. SGRQ scores were compared between 51 consecutive pSS patients, in an out-patient setting, and 80 population-based controls. The patients were also studied by pulmonary function tests and CT scans of the lungs to assess signs of obstructive airway disease, including COPD, as well as to assess signs of interstitial lung disease (ILD). 41 and 18% of pSS patients were found to have COPD and radiographic signs of ILD, respectively. pSS patients had significantly higher SGRQ scores compared to controls, but no significant differences in SGRQ scores were found between patients with and without COPD. Neither did the small group of pSS patients with ILD significantly differ in SGRQ scores in comparison to patients without ILD. Respiratory symptoms were common in pSS, but were not more common in patients with concomitant COPD. Since pulmonary involvement in pSS is associated with an increased mortality and respiratory symptoms is a poor marker for pulmonary involvement, we suggest that pulmonary function tests should be performed liberally in all pSS patients regardless of symptoms.
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Affiliation(s)
- Victor Strevens Bolmgren
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.,Department of Rheumatology, Skåne University Hospital, IM Nilssons gata 32, 205 02, Malmö, Sweden
| | - Peter Olsson
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.,Department of Rheumatology, Skåne University Hospital, IM Nilssons gata 32, 205 02, Malmö, Sweden
| | - Per Wollmer
- Department of Translational Medicine, Lund University, Malmö, Sweden.,Department of Clinical Physiology, Skåne University Hospital, Malmö, Sweden
| | - Roger Hesselstrand
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden.,Department of Rheumatology, Skåne University Hospital, Lund, Sweden
| | - Thomas Mandl
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden. .,Department of Rheumatology, Skåne University Hospital, IM Nilssons gata 32, 205 02, Malmö, Sweden.
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Ahmed MS, Neyaz A, Aslami AN. Health-related quality of life of chronic obstructive pulmonary disease patients: Results from a community based cross-sectional study in Aligarh, Uttar Pradesh, India. Lung India 2016; 33:148-53. [PMID: 27051101 PMCID: PMC4797432 DOI: 10.4103/0970-2113.177438] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Background: Chronic obstructive pulmonary disease (COPD) is characterized by airflow limitation that is not fully reversible. It is an incurable disease with improvement in quality of life (QOL) as a major focus area for management. This study assesses the QOL of COPD patients and the factors affecting it. Materials and Methods: All 124 patients diagnosed with COPD in a larger cross-sectional study to determine the prevalence of COPD were assessed for their QOL using St. George's respiratory questionnaire for COPD patients (SGRQ-C). Spirometry was performed to assess lung function and diagnose COPD. Chronic lung disease (CLD) severity index was used to assess the severity of symptoms and the Medical Research Council questionnaire was used to assess the severity of dyspnea. Sociodemographic data regarding the patients were also recorded. Results: Patients with COPD showed significantly reduced health-related quality of life (HRQOL). CLD estimate for severity of lung disease and the Medical Research Council assessment for dyspnea and the duration of illness showed a highly significant positive correlation with HRQOL. There was a statistically significant negative correlation between lung function and SGRQ-C score. Increasing age, increased quantum of smoking, and lower socioeconomic status were correlated with poorer HRQOL. No association between QOL and education, body mass index (BMI), and gender was observed. Conclusion: This study showed that Indian patients with COPD had reduced HRQOL. Poor lung function, increased disease duration and smoking, and worsening symptoms impacted HRQOL negatively.
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Affiliation(s)
| | - Arslan Neyaz
- Department of Community Medicine, NIMS Medical College, Jaipur, Rajasthan, India
| | - Ahmad Nadeem Aslami
- Department of Community Medicine, Travancore Medical College, Kollam, Kerala, India
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10
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Fastenau A, Muris JWM, de Bie RA, Hendriks EJM, Asijee GM, Beekman E, Gosselink R, van Schayck OCP. Efficacy of a physical exercise training programme COPD in primary care: study protocol of a randomized controlled trial. BMC Public Health 2014; 14:788. [PMID: 25086593 PMCID: PMC4246559 DOI: 10.1186/1471-2458-14-788] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Accepted: 07/23/2014] [Indexed: 01/12/2023] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) is recognized as a systemic illness with significant extra-pulmonary features, such as exercise intolerance and muscle weakness. Pulmonary rehabilitation has been shown to be very effective in counteracting these consequences in patients with more advanced COPD. However, limited data is available on the efficacy of a physical exercise training programme in patients with mild to moderate COPD in primary care. Furthermore, it is unknown if improved exercise capacity translates into enhanced daily physical activities. The aim of this paper is to describe the design of a randomized controlled trial to assess the efficacy of a physical exercise training programme in patients with mild to moderate COPD. Methods/design In this randomized controlled trial situated in the primary care setting, 102 patients with mild to moderate airflow obstruction (FEV1 ≥ 50% of predicted), dyspnoea and a physically inactive lifestyle will be randomized to an intervention or control group. The intervention group receives a 4-month physical exercise training programme at a local physiotherapy practice, which includes exercise training, resistance training, breathing exercises and advises on how to increase the level of physical activity. The control group receives usual care, i.e. advises on how to increase the level of physical activity and a sham treatment at a local physiotherapy practice of which no physiological training stimulus can be expected. Primary outcome is functional exercise capacity at 4-months measured on the six-minute walk distance. Secondary outcomes include peripheral muscle strength, physical activity in daily life, health related quality of life, Medical Research Council (MRC) dyspnoea score and patients’ perceived effectiveness. Follow-up measurement will take place at 6 months after baseline. Discussion This will be one of the first studies to evaluate the efficacy of a physical exercise training programme in patients with mild to moderate COPD completely recruited and assessed in primary care. The results of this trial may give a unique insight into the potential of the implementation of an easy, close-to-home rehabilitation programme. Trial registration The Netherlands National Trial Register NTR1471.
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Affiliation(s)
- Annemieke Fastenau
- Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands.
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Athayde FTS, Vieira DSR, Britto RR, Parreira VF. Functional outcomes in patients with chronic obstructive pulmonary disease: a multivariate analysis. Braz J Phys Ther 2014; 18:63-71. [PMID: 24675914 PMCID: PMC4183240 DOI: 10.1590/s1413-35552012005000142] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Accepted: 09/20/2013] [Indexed: 11/21/2022] Open
Abstract
Background Multiple factors can influence the severity of chronic obstructive pulmonary
disease (COPD) and the functioning of patients with COPD, such as personal
characteristics and systemic manifestations. Objective To evaluate the different factors that can influence the activity and
psychosocial impact domains of the Saint George's Respiratory Questionnaire
(SGRQ) in COPD patients. Method Participants, recruited in a university-based hospital, responded to the
SGRQ, and in addition, personal, anthropometric, and clinical data were
collected. The study was approved by the Institutional Ethics Committee.
Data were analyzed using multiple linear regression models, with the SGRQ
activity and psychosocial impact scores as outcome variables, and 10
explanatory variables (age, gender, forced expiratory volume in the first
second - FEV1, smoking load, body mass index, oxygen therapy,
associated diseases, regular physical activity, participation in a formal
rehabilitation program, and SGRQ symptoms score) were considered. Results The best regression model for predicting the SGRQ activity score
(r2=0.477) included gender, FEV1, and SGRQ
symptoms. In contrast, the predictive model with the highest proportion of
explained variance in psychosocial impact score (r2=0.426)
included the variables gender, oxygen therapy, and SGRQ symptoms. Conclusions The results indicate that the outcomes, while based on functioning parameters
in COPD patients, could be partly explained by the personal and clinical
factors analyzed, especially by the symptoms assessed by the SGRQ. Thus, it
appears that the health conditions of these patients cannot be described by
isolated variables, including pulmonary function parameters.
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Affiliation(s)
| | | | - Raquel R Britto
- Physical Therapy Department, UFMG, Belo Horizonte, MG, Brazil
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12
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Perez T, Garcia G, Roche N, Bautin N, Chambellan A, Chaouat A, Court-Fortune I, Delclaux B, Guenard H, Jebrak G, Orvoen-Frija E, Terrioux P. Société de pneumologie de langue française. Recommandation pour la pratique clinique. Prise en charge de la BPCO. Mise à jour 2012. Exploration fonctionnelle respiratoire. Texte long. Rev Mal Respir 2014; 31:263-94. [DOI: 10.1016/j.rmr.2013.11.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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13
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Bonsaksen T, Haukeland-Parker S, Lerdal A, Fagermoen MS. A 1-year follow-up study exploring the associations between perception of illness and health-related quality of life in persons with chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis 2013; 9:41-50. [PMID: 24379660 PMCID: PMC3872010 DOI: 10.2147/copd.s52700] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a progressive respiratory disease with an increasing prevalence worldwide. Its potential consequences, including reduced function and reduced social participation, are likely to be associated with decreased health-related quality of life (HRQoL). However, illness perceptions and self-efficacy beliefs may also play a part in determining HRQoL in persons with COPD. The aim of this study was to explore the relationships between illness perceptions, self-efficacy, and HRQoL in a sample of persons with COPD in a longitudinal perspective. The context of the study was a patient education course from which the participants were recruited. Data concerning sociodemographic variables, social support, physical activity, illness perceptions, general self-efficacy, and HRQoL were collected before the course started and 1 year after completion. Linear regression was used in the analyses. The results showed that less consequences and less symptoms (identity) were associated with higher physical HRQoL (PCS) at baseline and at 1-year follow-up. Less emotional response was similarly associated with higher mental HRQoL (MCS) at both time points. Lower self-efficacy showed a borderline significant association with higher PCS at baseline, but was unrelated to MCS at both time points. Self-efficacy showed no influence on the associations between illness perceptions and HRQoL. In conclusion, the study showed that specific illness perceptions had a stable ability to predict HRQoL in persons with COPD, whereas self-efficacy did not. The associations between illness perceptions and HRQoL were not mediated by self-efficacy.
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Affiliation(s)
- Tore Bonsaksen
- Department of Occupational Therapy, Prosthetics and Orthotics, Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Oslo, Norway
| | | | - Anners Lerdal
- Research Department, Lovisenberg Diakonale Hospital, Oslo, Norway ; Department of Nursing Science, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - May Solveig Fagermoen
- Department of Nursing Science, Institute of Health and Society, University of Oslo, Oslo, Norway ; Department of Gastroenterology, Division of Medicine, Oslo University Hospital, Oslo, Norway
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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: 2126] [Impact Index Per Article: 193.3] [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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Ketata W, Abid T, Feki W, Msaad S, Bahloul N, Rekik WK, Ayadi H, Yangui I, Kammoun S, Ayoub A. [Determinants of quality of life in chronic obstructive pulmonary disease]. REVUE DE PNEUMOLOGIE CLINIQUE 2013; 69:320-325. [PMID: 24183292 DOI: 10.1016/j.pneumo.2013.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Revised: 07/20/2013] [Accepted: 08/04/2013] [Indexed: 06/02/2023]
Abstract
INTRODUCTION Chronic obstructive pulmonary disease (COPD) is considered as a systemic disease with pulmonary starting point. The use of spirometry alone is certainly not the best way to reflect the impact of disease on quality of life for patients. PATIENTS AND METHODS Prospective study concerning 70 patients treated for COPD. Quality of life was assessed using the French version of the Saint-George questionnaire. RESULTS Our population was predominantly male (97%) with a mean age of 63 years. All patients were smokers with an average of 46 pack-years. The total score of the Saint-Georges respiratory questionnaire was 50.7%. The mean scores of different fields were 68% for the field activities, 49% for impact and 26% for the item of symptoms. The multidimensional BODE index was correlated with the quality of life and its various fields were more powerfully than the forced expiratory volume per second, the number of exacerbations, the six-minute walking test and dyspnea score. CONCLUSION It is important to integrate the multidimensional classification indices in assessing the severity of the disease because only these indices can reflect the systemic aspect of the disease.
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Affiliation(s)
- W Ketata
- Service de pneumo-allergologie, CHU Hédi-Chaker, Sfax 3029, Tunisie.
| | - T Abid
- Service de pneumo-allergologie, CHU Hédi-Chaker, Sfax 3029, Tunisie
| | - W Feki
- Service de pneumo-allergologie, CHU Hédi-Chaker, Sfax 3029, Tunisie
| | - S Msaad
- Service de pneumo-allergologie, CHU Hédi-Chaker, Sfax 3029, Tunisie
| | - N Bahloul
- Service de pneumo-allergologie, CHU Hédi-Chaker, Sfax 3029, Tunisie
| | - W K Rekik
- Service de pneumo-allergologie, CHU Hédi-Chaker, Sfax 3029, Tunisie
| | - H Ayadi
- Service de pneumo-allergologie, CHU Hédi-Chaker, Sfax 3029, Tunisie
| | - I Yangui
- Service de pneumo-allergologie, CHU Hédi-Chaker, Sfax 3029, Tunisie
| | - S Kammoun
- Service de pneumo-allergologie, CHU Hédi-Chaker, Sfax 3029, Tunisie
| | - A Ayoub
- Service de pneumo-allergologie, CHU Hédi-Chaker, Sfax 3029, Tunisie
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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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Anwar SK, Mehmood N, Nasim N, Khurshid M, Khurshid B. Sweeper's lung disease: a cross-sectional study of an overlooked illness among sweepers of Pakistan. Int J Chron Obstruct Pulmon Dis 2013; 8:193-7. [PMID: 23626464 PMCID: PMC3632582 DOI: 10.2147/copd.s40468] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Sweepers are prone to develop chronic obstructive pulmonary disease even without tobacco smoking. Purpose To investigate roadside dust as a cause of air flow obstruction among sweepers, and the role of spirometry in its preclinical diagnosis. Material and methods One-hundred nonsmoking sweepers (aged 30–60 years) of both sexes sweeping on roads for 8–12 hours a day for the Capital Development Authority of Islamabad, Pakistan were used as study participants (Group A). One-hundred healthy nonsmokers (aged 30–60 years) in the same socioeconomic group and living in the same environment represented the nonsweeper group (Group B). After proper clinical evaluation and chest X-rays, spirometric evaluation was carried out in both groups. Comparisons were drawn between various spirometric parameters. Results Pulmonary function tests showed that the mean forced vital capacity was 78 ± 1.40 in the sweeper group (Group A) and 83 ± 0.86 in the nonsweeper group (Group B). Mean forced expiratory volume in 1 second was 66 ± 1.67 in Group A and 85 ± 0.85 in Group B (P < 0.05), a difference of 19%. The forced midexpiratory flow was 41% lower in Group A than in Group B (P < 0.0001). The pattern of pulmonary function obstruction was shown to be proportional to the duration of exposure to dust caused by sweeping. Conclusion Occupational exposure to dust leads to an obstructive pattern among sweepers. Spirometry is the simplest, noninvasive technique to detect preclinical disease.
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Affiliation(s)
- Shaikh Khurshid Anwar
- Department of Pulmonary Medicine, Pakistan Institute of Medical Sciences-PIMS, Islamabad, Pakistan.
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Lo Tam Loi AT, Hoonhorst SJM, Franciosi L, Bischoff R, Hoffmann RF, Heijink I, van Oosterhout AJM, Boezen HM, Timens W, Postma DS, Lammers JW, Koenderman L, ten Hacken NHT. Acute and chronic inflammatory responses induced by smoking in individuals susceptible and non-susceptible to development of COPD: from specific disease phenotyping towards novel therapy. Protocol of a cross-sectional study. BMJ Open 2013; 3:e002178. [PMID: 23377993 PMCID: PMC3586075 DOI: 10.1136/bmjopen-2012-002178] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Revised: 12/17/2012] [Accepted: 01/03/2013] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Chronic obstructive pulmonary disease (COPD) is a heterogeneous disease with pulmonary and extra-pulmonary manifestations. Although COPD is a complex disease, diagnosis and staging are still based on simple spirometry measurements. Different COPD phenotypes exist based on clinical, physiological, immunological and radiological observations. Cigarette smoking is the most important risk factor for COPD, but only 15-20% of smokers develop the disease, suggesting a genetic predisposition. Unfortunately, little is known about the pathogenesis of COPD, and even less on the very first steps that are associated with an aberrant response to smoke exposure. This study aims to investigate the underlying local and systemic inflammation of different clinical COPD phenotypes, and acute effects of cigarette smoke exposure in individuals susceptible and non-susceptible for the development of COPD. Furthermore, we will investigate mechanisms associated with corticosteroid insensitivity. Our study will provide valuable information regarding the pathogenetic mechanisms underlying the natural course of COPD. METHODS AND ANALYSIS This cross-sectional study will include young and old individuals susceptible or non-susceptible to develop COPD. At a young age (18-40 years) 60 'party smokers' will be included who are called susceptible or non-susceptible based on COPD prevalence in smoking family members. In addition, 30 healthy smokers (age 40-75 years) and 110 COPD patients will be included. Measurements will include questionnaires, pulmonary function, low-dose CT scanning of the lung, body composition, 6 min walking distance and biomarkers in peripheral blood, sputum, urine, exhaled breath condensate, epithelial lining fluid, bronchial brushes and biopsies. Non-biased approaches such as proteomics will be performed in blood and epithelial lining fluid. ETHICS AND DISSEMINATION This multicentre study was approved by the medical ethical committees of UMC Groningen and Utrecht, the Netherlands. The study findings will be presented at conferences and will be reported in peer-reviewed journals. TRIAL REGISTRATION ClinicalTrials.gov, NCT00807469 (study 1) and NCT00850863 (study 2).
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Affiliation(s)
- Adèle T Lo Tam Loi
- Department of Respiratory Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Susan J M Hoonhorst
- Department of Pulmonary Disease, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- GRIAC Research Institute, University of Groningen, Groningen, The Netherlands
| | - Lorenza Franciosi
- GRIAC Research Institute, University of Groningen, Groningen, The Netherlands
- Department of Pharmacy, Analytical Biochemistry, University of Groningen, Groningen, The Netherlands
| | - Rainer Bischoff
- GRIAC Research Institute, University of Groningen, Groningen, The Netherlands
- Department of Pharmacy, Analytical Biochemistry, University of Groningen, Groningen, The Netherlands
| | - Roland F Hoffmann
- GRIAC Research Institute, University of Groningen, Groningen, The Netherlands
- Department of Pathology & Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Irene Heijink
- GRIAC Research Institute, University of Groningen, Groningen, The Netherlands
- Department of Pathology & Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Antoon J M van Oosterhout
- GRIAC Research Institute, University of Groningen, Groningen, The Netherlands
- Department of Pathology & Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - H Marike Boezen
- GRIAC Research Institute, University of Groningen, Groningen, The Netherlands
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Wim Timens
- GRIAC Research Institute, University of Groningen, Groningen, The Netherlands
- Department of Pathology & Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Dirkje S Postma
- Department of Pulmonary Disease, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- GRIAC Research Institute, University of Groningen, Groningen, The Netherlands
| | - Jan-Willem Lammers
- Department of Respiratory Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Leo Koenderman
- Department of Respiratory Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Nick H T ten Hacken
- Department of Pulmonary Disease, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- GRIAC Research Institute, University of Groningen, Groningen, The Netherlands
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Fischer MJ, Scharloo M, Abbink J, van 't Hul A, van Ranst D, Rudolphus A, Weinman J, Rabe KF, Kaptein AA. Concerns about exercise are related to walk test results in pulmonary rehabilitation for patients with COPD. Int J Behav Med 2012; 19:39-47. [PMID: 21080250 PMCID: PMC3277820 DOI: 10.1007/s12529-010-9130-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background Although international guidelines on pulmonary rehabilitation acknowledge that psychological factors contribute to exercise intolerance in patients with chronic obstructive pulmonary disease (COPD), the few empirical studies investigating this association have found inconsistent results. Purpose The purpose of this study is to investigate whether negative affect and beliefs about exercise of patients with COPD would be related to baseline 6-min walk (6-MW) test results in a pulmonary rehabilitation setting, after correction for physical variables (sex, age, height, weight, and lung function). A second aim was to examine whether patients' beliefs are associated with treatment outcomes, as measured by an improvement in 6-MW distance. Method A 12-week pulmonary rehabilitation program was completed by 166 patients. Beliefs (perceived necessity and concerns) about exercise and negative affect were assessed by a questionnaire. Clinical data were obtained from medical records. Results Baseline 6-MW distance was positively related to younger age, male gender, better pulmonary function, and having fewer concerns about exercise. After rehabilitation, patients had increased their walk distance by 12% (32 m), on average. Baseline physiological and psychological variables were unrelated to patients' response to treatment (increase in walk distance). However, subgroup analysis showed that for patients with mild to moderate airflow obstruction, concerns about exercise were negatively related to response to treatment. Conclusion We conclude that patients' beliefs about the negative consequences of exercise are associated with baseline 6-MW test performance and response to treatment for patients with mild to moderate COPD. We recommend that patients' concerns about exercise are discussed and, if necessary, corrected during the intake phase.
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Affiliation(s)
- Maarten J Fischer
- Medical Psychology, Leiden University Medical Center (LUMC), P.O. Box 9555, 2300, RB, Leiden, the Netherlands.
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20
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Waatevik M, Johannessen A, Hardie JA, Bjordal JM, Aukrust P, Bakke PS, Eagan TM. Different COPD Disease Characteristics are Related to Different Outcomes in the 6-minute Walk Test. COPD 2012; 9:227-34. [DOI: 10.3109/15412555.2011.650240] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Si Y, Fan H, Song Y, Zhou X, Zhang J, Wang Z. Association between periodontitis and chronic obstructive pulmonary disease in a Chinese population. J Periodontol 2012; 83:1288-96. [PMID: 22248220 DOI: 10.1902/jop.2012.110472] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND A relationship between periodontitis and chronic respiratory disease has been suggested by recent studies. The aim of this study is to explore the association between periodontitis and chronic obstructive pulmonary disease (COPD) in a Chinese population. METHODS We conducted a case-control study of 581 COPD cases and 438 non-COPD controls. Lung function examination, a 6-minute walk test, and the British Medical Research Council questionnaire were performed. Periodontal clinical examination index included probing depth (PD), attachment loss (AL), bleeding index (BI), plaque index (PI), and alveolar bone loss. A validated index for predicting COPD prognosis, the body mass index, airflow obstruction, dyspnea, and exercise capacity (BODE) index, was also calculated. RESULTS Participants with more severe COPD were more likely to have severe periodontal disease. PD, AL, PI, alveolar bone loss, and the number of teeth were significantly associated with all stages of COPD (all P <0.001). When compared to controls (BODE = 0), participants with higher BODE scores had significantly higher AL (P <0.001), BI (P = 0.027), PI (P <0.001), alveolar bone loss (P <0.001), and the number of teeth (P <0.001). PI appeared to be the main periodontal health-related factor for COPD, with an odds ratio (OR) = 9.01 (95% CI = 3.98 to 20.4) in the entire study population OR = 8.28 (95% CI = 2.36 to 29.0), OR = 5.89 (95% CI = 2.64 to 13.1), and OR = 2.46 (95% CI = 1.47 to 4.10) for current, smokers, and non-smokers, respectively. CONCLUSION Our study found a strong association between periodontitis and COPD, and PI seemed to be a major periodontal factor for predicting COPD among Chinese adults.
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Affiliation(s)
- Yan Si
- Department of Preventive Dentistry, Peking University School and Hospital of Stomatology, Beijing, China
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22
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van Ranst D, Otten H, Meijer JW, van 't Hul AJ. Outcome of pulmonary rehabilitation in COPD patients with severely impaired health status. Int J Chron Obstruct Pulmon Dis 2011; 6:647-57. [PMID: 22162650 PMCID: PMC3232171 DOI: 10.2147/copd.s24579] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Effects of pulmonary rehabilitation (PR) in chronic obstructive pulmonary disease (COPD) patients with severely impaired health status are poorly documented since these patients are usually excluded from clinical trials. This retrospective, observational study aims to study the impact of disease on health status and the effects of PR on COPD patients referred to a tertiary center for PR in The Netherlands. METHODS Between June 2006 and June 2010, 437 patients with COPD were allocated to our intensive, comprehensive PR program. Patients participated in this interdisciplinary program for 12 weeks for a weekly average of 20-25 hours. Before and directly after, several measures of physical performance and health-related quality of life were determined. RESULTS At baseline, most patients (75%) had a Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage of III-IV. Peak exercise performance on a cycle ergometer was on average reduced to 43 ± 29 Watt, and health-related quality of life was significantly impaired, with a total score on the St George's Respiratory Questionnaire (SGRQ) of 66. Health-care utilization in the year preceding PR was very high. After rehabilitation, all outcome measures improved statistically significantly (P < 0.001). Exercise performance measured with the 6 minute walking distance test improved clinically significantly in 68% of the patients, whereas 75% of the patients showed a clinically meaningful improvement in quality of life as measured with the SGRQ. Multiple regression analysis revealed that 19% of the variation in responses on the 6 minute walking distance test and the SGRQ could be explained on the basis of baseline characteristics. CONCLUSION The present study provides data to indicate that COPD patients may substantially benefit from rehabilitation in a tertiary pulmonary rehabilitation center, despite a severely impaired health status and high level of health-care utilization, in which prior treatment in primary and secondary care have failed to improve health status. Individual rehabilitation responses can only partially be predicted on the basis of baseline characteristics. Consequently, no firm conclusions can be drawn from this study with respect to the selection of candidates that could be deemed eligible for this rehabilitation program when entering the program.
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Affiliation(s)
- Dirk van Ranst
- Revant, Pulmonary Rehabilitation Center Schoondonck, Breda, 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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Eskander A, Waddell TK, Faughnan ME, Chowdhury N, Singer LG. BODE index and quality of life in advanced chronic obstructive pulmonary disease before and after lung transplantation. J Heart Lung Transplant 2011; 30:1334-41. [PMID: 21782467 DOI: 10.1016/j.healun.2011.06.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2010] [Revised: 06/07/2011] [Accepted: 06/13/2011] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The BODE index (Body mass index, Obstruction, Dyspnea, Exercise), predicts the risk of death in patients with chronic obstructive pulmonary disease (COPD), and is used to identify candidates for lung transplantation. We hypothesized that a higher BODE index would be associated with worse health-related quality of life (HRQL) in advanced COPD, and with larger improvements in HRQL after transplantation. METHODS In this cohort study (n = 112), we administered the St. George's Respiratory Questionnaire (SGRQ), 36-Item Short Form (SF-36), Visual Analog Scale, Standard Gamble and EuroQol Group 5-Dimension (EQ-5D) index to otherwise healthy COPD patients with a FEV(1) <50% predicted. We compared mean HRQL values across BODE score groups, and tested for linear trends. In patients who received lung transplants during the study period, we compared SGRQ scores before and early (mean 4 months) after transplantation. RESULTS BODE was directly associated with SGRQ and inversely related to all other HRQL measures (p < 0.05). Early post-transplant improvements in HRQL were also seen across the spectrum of BODE scores from 5 to 10. CONCLUSIONS The BODE score is a significant predictor of HRQL in patients with severe COPD. We noted dramatic improvements in HRQL after transplantation, which appeared similar in magnitude for patients with pre-transplant BODE scores of 5 or 6 and 7 to 10, despite the difference in expected survival between these two groups. The association of the BODE score with HRQL further supports its use in identifying potential candidates for lung transplantation.
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Affiliation(s)
- Antoine Eskander
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Bossenbroek L, de Greef MH, Wempe JB, Krijnen WP, ten Hacken NH. Daily Physical Activity in Patients with Chronic Obstructive Pulmonary Disease: A Systematic Review. COPD 2011; 8:306-19. [DOI: 10.3109/15412555.2011.578601] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Effets d’un programme de réhabilitation respiratoire selon la sévérité de la BPCO. Rev Mal Respir 2011; 28:297-305. [DOI: 10.1016/j.rmr.2010.09.034] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2010] [Accepted: 09/15/2010] [Indexed: 11/20/2022]
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Determinants of poor 6-min walking distance in patients with COPD: The ECLIPSE cohort. Respir Med 2010; 104:849-57. [DOI: 10.1016/j.rmed.2009.12.007] [Citation(s) in RCA: 145] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2009] [Revised: 12/14/2009] [Accepted: 12/15/2009] [Indexed: 11/20/2022]
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Medinas Amorós M, Mas-Tous C, Renom-Sotorra F, Rubí-Ponseti M, Centeno-Flores MJ, Gorriz-Dolz MT. Health-related quality of life is associated with COPD severity: a comparison between the GOLD staging and the BODE index. Chron Respir Dis 2009; 6:75-80. [PMID: 19411567 DOI: 10.1177/1479972308101551] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a highly prevalent disease. Currently, severity Global initiative for chronic Obstructive Lung Disease (GOLD) criteria are used to diagnose the severity of COPD, but a new grading system, the body mass index, bronchial obstruction, dyspnea, exercise (BODE) index, was recently proposed to provide useful prognostic information. The objective of this study is to evaluate the association between health-related quality of life (HRQOL) and COPD severity assessed by two criteria: the GOLD classification and the BODE index. Sixty-four patients with COPD were examined with lung function tests and specific and generic HRQOL questionnaires (St. George's Respiratory Questionnaire [SGRQ], Nottingham Health Profile [NHP]). Participants were divided into four severity groups using the GOLD guidelines and the BODE index quartiles. The association between NHP and SGRQ subscales, and the BODE index was significant (P < 0.01). However, the GOLD classification shows a correlation only with SGRQ total score (P < 0.05) but not with NHP or SGRQ subscales. There was an association of the SGRQ total score between the severity groups of BODE (P = 0.0001), but there was no difference in the SGRQ total score between the severity groups of GOLD classification (P = 0.244). The present study suggests that COPD severity assessed by the BODE index can be more directly related with HRQOL.
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Affiliation(s)
- M Medinas Amorós
- Department of Respiratory Medicine, Joan March Hospital, Bunyola, Baleares, Spain
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