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Mendes Xavier D, Lanza Galvão E, Aliane Fonseca A, de Souza GM, Pereira Lima V. Effects of Home-Based Pulmonary Rehabilitation on Dyspnea, Exercise Capacity, Quality of Life and Impact of the Disease in COPD Patients: A Systematic Review. COPD 2022; 19:18-46. [PMID: 35000507 DOI: 10.1080/15412555.2021.2020234] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Conventional pulmonary rehabilitation programs are used as therapies for the treatment of chronic obstructive pulmonary disease (COPD). However, this modality presents barriers that make rehabilitation difficult. For this reason, home-based pulmonary rehabilitation (HBPR) has been used to overcome these barriers. The objective was to systematically compare a structured program with HBPR or a control group for participants with COPD. The primary outcome was an improvement in symptoms in the level of dyspnea and secondary outcomes were parameters in lung function, exercise capacity, health-related quality of life (HRQoL) and the impact of the disease on the individual. The Medline (via PubMed), Virtual Health Library and Cochrane Library databases were searched until May 10, 2021. Randomized controlled trials were included without restrictions on the year of publication or language. The risk of bias was evaluated using the Cochrane risk-of-bias tool for randomized trials (RoB). Our results showed that there was a significant decrease in the level of dyspnea, (MD: 5.46; 95% CI: 1.97 to 8.96), increased distance covered (MD: 61.75; 95% CI: 42, 94 to 80.56, significant improvement in HRQoL (MD: -11.30; 95% CI: -19.81 to -2.79) and reduction in the impact of the disease (DM: -4.71; 95% CI: -7.95 to -1.47). All results found were comparing the intervention group versus the control group. To conclude we found a reduction in the levels of dyspnea, an increase in the distance covered on the six-minute walk test, improving HRQoL and decreasing the impact of the disease in COPD patients in home-based pulmonary rehabilitation.Supplemental data for this article is available online at https://doi.org/10.1080/15412555.2021.2020234 .
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Affiliation(s)
- Diêgo Mendes Xavier
- Department of Physiotherapy, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil Diamantina
| | - Endi Lanza Galvão
- Department of Dentistry, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil
| | - Alenice Aliane Fonseca
- Department of Physiotherapy, Faculdade Verde - Norte, Montes Claros, Brazil.,Programa de Pós-Graduação em Reabilitação e Desempenho Funcional, Department of Physiotherapy, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil
| | - Glaciele Maria de Souza
- Department of Dentistry, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil
| | - Vanessa Pereira Lima
- Department of Physiotherapy, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil Diamantina.,Programa de Pós-Graduação em Reabilitação e Desempenho Funcional, Department of Physiotherapy, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil
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Miner B, Tinetti ME, Van Ness PH, Han L, Leo-Summers L, Newman AB, Lee PJ, Vaz Fragoso CA. Dyspnea in Community-Dwelling Older Persons: A Multifactorial Geriatric Health Condition. J Am Geriatr Soc 2016; 64:2042-2050. [PMID: 27549914 DOI: 10.1111/jgs.14290] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVES To evaluate the associations between a broad array of cardiorespiratory and noncardiorespiratory impairments and dyspnea in older persons. DESIGN Cross-sectional. SETTING Cardiovascular Health Study. PARTICIPANTS Community-dwelling persons (N = 4,413; mean age 72.6, 57.1% female, 4.5% African American, 27.2% <high school education, 54.7% ever-smokers). MEASUREMENTS Dyspnea severity (moderate to severe defined as American Thoracic Society Grade ≥2) and several impairments, including those established using spirometry (forced expiratory volume in 1 second (FEV1 )), maximal inspiratory pressure (respiratory muscle strength), echocardiography, ankle-brachial index, blood pressure, whole-body muscle mass (bioelectrical impedance), single chair stand (lower extremity function), grip strength, serum hemoglobin and creatinine, Center for Epidemiologic Studies Depression Scale (CES-D), Mini-Mental State Examination, medication use, and body mass index (BMI). RESULTS In a multivariable logistic regression model, impairments that had strong associations with moderate to severe dyspnea were FEV1 less than the lower limit of normal (adjusted odds ratio (aOR) = 2.88, 95% confidence interval (CI) = 2.37-3.49), left ventricular ejection fraction less than 45% (aOR = 2.12, 95% CI = 1.43, 3.16), unable to perform a single chair stand (aOR = 2.10, 95% CI = 1.61-2.73), depressive symptoms (CES-D score ≥16; aOR = 2.02, 95% CI = 1.26-3.23), and obesity (BMI ≥30; aOR = 2.07, 95% CI = 1.67-2.55). Impairments with modest but still statistically significant associations with moderate to severe dyspnea included respiratory muscle weakness, diastolic cardiac dysfunction, grip weakness, anxiety symptoms, and use of cardiovascular and psychoactive medications (aORs = 1.31-1.71). CONCLUSION In community-dwelling older persons, several cardiorespiratory and noncardiorespiratory impairments were significantly associated with moderate to severe dyspnea, akin to a multifactorial geriatric health condition.
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Affiliation(s)
- Brienne Miner
- Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut.
| | - Mary E Tinetti
- Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut.,Department of Chronic Disease Epidemiology, School of Public Health, Yale University, New Haven, Connecticut
| | - Peter H Van Ness
- Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut
| | - Ling Han
- Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut.,Veterans Affairs Clinical Epidemiology Research Center, West Haven, Connecticut
| | - Linda Leo-Summers
- Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut
| | - Anne B Newman
- Department of Epidemiology and Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Patty J Lee
- Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut
| | - Carlos A Vaz Fragoso
- Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut.,Veterans Affairs Clinical Epidemiology Research Center, West Haven, Connecticut
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Kupper N, Bonhof C, Westerhuis B, Widdershoven J, Denollet J. Determinants of Dyspnea in Chronic Heart Failure. J Card Fail 2016; 22:201-9. [DOI: 10.1016/j.cardfail.2015.09.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 08/25/2015] [Accepted: 09/22/2015] [Indexed: 10/22/2022]
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Intensive symptom control of opioid-refractory dyspnea in congestive heart failure: Role of milrinone in the palliative care unit. Palliat Support Care 2015; 13:1781-5. [PMID: 25908519 DOI: 10.1017/s1478951514000935] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE We describe an exemplary case of congestive heart failure (CHF) symptoms controlled with milrinone. We also analyze the benefits and risks of milrinone administration in an unmonitored setting. METHOD We describe the case of a patient with refractory leukemia and end-stage CHF who developed severe dyspnea after discontinuation of milrinone. At that point, despite starting opioids, she had been severely dyspneic and anxious, requiring admission to the palliative care unit (PCU) for symptom control. After negotiation with hospital administrators, milrinone was administered in an unmonitored setting such as the PCU. A multidisciplinary team approach was also provided. RESULTS Milrinone produced a dramatic improvement in the patient's symptom scores and performance status. The patient was eventually discharged to home hospice on a milrinone infusion with excellent symptom control. SIGNIFICANCE OF RESULTS This case suggests that milrinone may be of benefit for short-term inpatient administration for dyspnea management, even in unmonitored settings and consequently during hospice in do-not-resuscitate (DNR) patients. This strategy may reduce costs and readmissions to the hospital related to end-stage CHF.
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Vaz Fragoso CA, Araujo K, Leo-Summers L, Van Ness PH. Lower Extremity Proximal Muscle Function and Dyspnea in Older Persons. J Am Geriatr Soc 2015. [PMID: 26200804 DOI: 10.1111/jgs.13529] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To evaluate the association between performance on a single chair stand and moderate to severe exertional dyspnea. DESIGN Cross-sectional. SETTING Cardiovascular Health Study. PARTICIPANTS Community-dwelling individuals aged 65 and older (N = 4,413; mean age 72.6; female, n = 2,518 (57.1%); nonwhite, n = 199 (4.5%); obese, n = 788 (17.9%); history of smoking, n = 2,410 (54.6%)). MEASUREMENTS Performance on single chair stand (poor (unable to rise without arm use) vs normal (able to rise without arm use)), moderate to severe exertional dyspnea (American Thoracic Society grade ≥2), age, sex, ethnicity, obesity, smoking, frailty status (Fried-defined nonfrail, prefrail, frail), high cardiopulmonary risk (composite of cardiopulmonary diseases and diabetes mellitus), spirometric impairment, arthritis, depression, stroke, and kidney disease. RESULTS Poor performance on the single chair stand was established in 369 (8.4%) and moderate to severe exertional dyspnea in 773 (17.5%). Prefrail status was established in 2,210 (50.1%), frail status in 360 (8.2%), arthritis in 2,241 (51.4%), high cardiopulmonary risk in 2,469 (55.9%), spirometric impairment in 1,076 (24.4%), kidney disease in 111 (2.5%), depression in 107 (2.4%), and stroke in 93 (2.1%). In multivariable regression models, poor performance on the single chair stand was associated with moderate to severe exertional dyspnea (unadjusted odds ratio (OR) = 3.48, 95% confidence interval (CI) = 2.78-4.36; adjusted OR = 1.85, 95% CI = 1.41-2.41). CONCLUSION Poor performance on a single chair stand was associated with an adjusted 85% greater likelihood of moderate to severe exertional dyspnea than normal performance. These results suggest that reduced proximal muscle function of the lower extremities is associated with moderate to severe exertional dyspnea, even after adjusting for multiple confounders.
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Affiliation(s)
- Carlos A Vaz Fragoso
- Department of Internal Medicine, School of Medicine, Yale University, West Haven, Connecticut.,Clinical Epidemiology Research Center, Veterans Affairs Connecticut, West Haven, Connecticut
| | - Katy Araujo
- Department of Internal Medicine, School of Medicine, Yale University, West Haven, Connecticut
| | - Linda Leo-Summers
- Department of Internal Medicine, School of Medicine, Yale University, West Haven, Connecticut
| | - Peter H Van Ness
- Department of Internal Medicine, School of Medicine, Yale University, West Haven, Connecticut
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Cancelliero-Gaiad KM, Ike D, Soave L, Gomes ELDFD, Dias FD, Costa D. Correlation between functional capacity and health-related quality of life in COPD: a case series. FISIOTERAPIA EM MOVIMENTO 2014. [DOI: 10.1590/0103-5150.027.004.ao02] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective To correlate functional capacity test scores from chronic obstructive pulmonary disease (COPD) subjects with their functional state as assessed by health-related quality of life questionnaires (one respiratory disease-specific [SGRQ] and one generic [SF-36] questionnaire). Materials and methods Study of a case series of 8 COPD patients. The following tests were performed: 1) Six-minute walk test (6-MWT); 2) Shuttle walking test (SWT); 3) Six-minute step test (6-MST); 4) Two-minute sit-to-stand test (STST); and 5) Pegboard and ring test (PBRT). Besides these tests, two health-related quality of life questionnaires were administered: The St George's Respiratory Questionnaire (SGRQ) and the Short Form 36 (SF-36) health survey questionnaire. The statistical analysis was carried out by using the Shapiro-Wilk normality test, while correlations were assessed using Pearson's (parametric data) or Spearman's (non-parametric data) rank tests, with p < 0.05. Results The 6-MWT showed strong correlation with the SF-36 scales of physical functioning, general health, vitality, social functioning and mental health. Conversely, the other functional capacity tests showed no correlation with this questionnaire. The SGRQ showed no correlation with any of the tests. Conclusions The 6-MWT may be a good test to reflect the health-related quality of life of COPD subjects.
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Santos KD, Karloh M, Araujo CLPD, D’Aquino AB, Mayer AF. Relationship between the functional status constructs and quality of life in COPD. FISIOTERAPIA EM MOVIMENTO 2014. [DOI: 10.1590/0103-5150.027.003.ao06] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction Functional status is an important component of health related quality of life (QOL) in patients with chronic obstructive pulmonary disease (COPD). However there is a lack of studies aiming to evaluate the association between QOL and the different methods for assessing patient´s limitation to perform ADL. Objectives To investigate the association between QOL and functional status, measured by four different instruments: London Chest Activity of Daily Living scale (LCADL), six-minute walking test (6MWT), Glittre ADL-test (TGlittre) and assessment of physical activities in daily living (PADL). Methods Twenty-three patients with COPD, GOLD 2 to 4, were submitted to the following evaluations: spirometry, the Saint George Respiratory Questionnaire (SGRQ), LCADL, 6MWT, TGlittre and assessment of PADL. Pearson or Spearman correlation coefficients were used to verify the association between the variables. Results It was observed correlation between all domains of the SGRQ and the 6MWT, between TGlittre and ‘leisure’ domain of LCADL; and between the domain ‘activity’ of the SGRQ with the total score of LCADL (r = 0.53), LCADL% (r = 0.54), ‘self care’ (r = 0.49) and ‘leisure’ (r = 0.82). The number of steps correlated with the SGRQ (r = -0.59) and with ‘activity’ (r = -0.70) and ‘impact’ (r = -0.52) domains. The standing time correlated with the domain ‘activitiy’ (r = -0.47) of the SGRQ (p < 0.05 for all). Conclusions Both functional performance and capacity are able to reflect the impact that ADL limitation has on QOL in patients with COPD
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Fan X, Meng Z. The mutual association between depressive symptoms and dyspnea in Chinese patients with chronic heart failure. Eur J Cardiovasc Nurs 2014; 14:310-6. [PMID: 24634388 DOI: 10.1177/1474515114528071] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Accepted: 02/24/2014] [Indexed: 11/16/2022]
Affiliation(s)
| | - Zhu Meng
- Shandong University, PR China
- Shandong Provincial Hospital, PR China
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Akinci AC, Yildirim E. Factors affecting health status in patients with chronic obstructive pulmonary disease. Int J Nurs Pract 2013; 19:31-8. [PMID: 23432886 DOI: 10.1111/ijn.12034] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The aim of this study is to determine the correlation between the quality of life (QOL) and subjective dyspnoea, subjective fatigue, sleep quality, and the forced expiratory volume in first second (FEV(1)) % predicted value and collective contribution of these variables on QOL. The study was conducted with 102 patients. Pulmonary function tests (FEV(1) % predicted value, FEV(1) /forced vital capacity), subjective dyspnoea, subjective fatigue, sleep quality were assessed. There were negative correlations between QOL total score and pulmonary function tests, positive correlations between QOL total score and subjective dyspnoea score, subjective fatigue and sleep quality total scores. In addition, subjective dyspnoea, subjective fatigue and sleep quality total scores and FEV(1) % predicted value accounted for 68.1% of the variance on QOL. As a conclusion of these findings, it has been recommended that these variables should be considered when planning an approach towards improving the QOL in chronic obstructive pulmonary disease patients.
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Affiliation(s)
- Ayse Cil Akinci
- Nursing Department, College of Health, Kirklareli University, Kirklareli, Turkey.
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Akinci AC, Pinar R, Demir T. The relation of the subjective dyspnoea perception with objective dyspnoea indicators, quality of life and functional capacity in patients with COPD. J Clin Nurs 2012; 22:969-76. [DOI: 10.1111/j.1365-2702.2012.04161.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Effects of patient teaching, educational materials, and coaching using telephone on dyspnea and physical functioning among persons with heart failure. Appl Nurs Res 2011; 24:e59-66. [DOI: 10.1016/j.apnr.2010.02.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2009] [Revised: 02/05/2010] [Accepted: 02/15/2010] [Indexed: 11/15/2022]
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Frequency and significance of unrecognized chronic obstructive pulmonary disease in elderly patients with stable heart failure. Aging Clin Exp Res 2011; 23:337-42. [PMID: 20940533 DOI: 10.1007/bf03337759] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND AIMS Due to prolonged life-spans and modern therapeutic approaches, there has been an increase in the number of patients aged ≥ 65 years with chronic heart failure (CHF). The duration and quality of life in elderly patients with CHF also depend on accompanying diseases. Although frequency of chronic obstructive pulmonary disease (COPD) in patients with CHF is about 30%, it is hard to find similar data in the elderly population. COPD is defined as a spirometrically assessed ratio of a post-dilatory forced expiratory volume in the first second, divided by forced vital capacity (FEV1/FVC) <70%. The aims of our study were to assess the prevalence of previously undiagnosed COPD in outpatients (≥ 65 yrs) with stable CHF and to determine the effect of the combination of COPD and CHF on patients' functional capacity as measured by a 6-minute walking test. METHODS AND RESULTS Of the 174 study patients, 126 (72.4%) were men. In 48 patients (27.6%) we found previously unrecognized COPD. They were significantly older (75.6 ± 5.8 vs 73 ± 4.5 years, p<0.01) and more frequently had abdominal obesity and a greater waist circumference (98.8 ± 10.2 vs 94.9 ± 9.1 cm, p<0.05). Patients with COPD had significantly shorter 6-min walking distance (275.5 ± 112.9 vs 291.3 ± 96.7 m, p<0.05). Only patient's age had a positive prognostic association with unrecognized COPD (OR=1.16; 95% CI 1.01- 1.34, p<0.01). Patients with COPD showed a significant correlation between actual/predicted FEV1 and the 6-min walking distance (r=0.39, p<0.01). CONCLUSIONS We found a high prevalence of unrecognized COPD in elderly patients with CHF and central obesity. Chronic obstructive pulmonary disease influenced functional capacity in CHF patients, as determined by the 6-minute walking test. Closer co-operation between pulmonologists and cardiologists is necessary to optimize management of this large proportion of CHF patients.
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Di Naso FC, Pereira JS, Beatricci SZ, Bianchi RG, Dias AS, Monteiro MB. A classe da NYHA tem relação com a condição funcional e qualidade de vida na insuficiência cardíaca. FISIOTERAPIA E PESQUISA 2011. [DOI: 10.1590/s1809-29502011000200010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A insuficiência cardíaca (IC) é uma síndrome que se apresenta com crescente prevalência, podendo limitar o indivíduo quanto à capacidade físico-funcional, condição pulmonar e qualidade de vida. Este estudo tem como objetivo verificar as limitações pulmonares e físicas, bem como a qualidade de vida dos pacientes e compará-las com as classes funcionais da New York Heart Association (NYHA). Estudo transversal, com amostra de 66 pacientes (45 homens). Foram aplicados uma ficha de avaliação padronizada e o questionário de qualidade de vida Short Form-36 (SF-36). Foram realizados espirometria, manovacuometria e o teste da caminhada de seis minutos (TC6M). Os pacientes (classe I: 24 indivíduos, classe II: 27 e classe III: 15) possuíam uma média de idade de 57,95±10,96 anos e representaram uma amostra com características antropométricas homogêneas. Para a condição pulmonar, observou-se diferença estatística quanto a Capacidade Vital Forçada (CVF), Pico de Fluxo Expiratório e Pressão Expiratória Máxima (Pemáx). Na distância do TC6M houve diferença entre classe I e III e entre II e III (classe I: 439,27±58,85 m, classe II: 370,96±74,41 m e classe III: 268,96±83,88 m), com p<0,001. Para o SF-36, houve decréscimo da qualidade de vida conforme o agravo das classes funcionais. Pacientes com IC apresentam diminuição da condição pulmonar, capacidade físico-funcional e qualidade de vida relacionada ao aumento da classe funcional da NYHA.
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Guazzi M, Myers J, Vicenzi M, Bensimhon D, Chase P, Pinkstaff S, Arena R. Cardiopulmonary exercise testing characteristics in heart failure patients with and without concomitant chronic obstructive pulmonary disease. Am Heart J 2010; 160:900-5. [PMID: 21095278 DOI: 10.1016/j.ahj.2010.07.014] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2010] [Accepted: 07/11/2010] [Indexed: 12/18/2022]
Abstract
BACKGROUND The assessment of aerobic exercise capacity is an important component in the clinical management of patients with heart failure (HF). Although a significant percentage of patients diagnosed with HF also present with chronic obstructive pulmonary disease (COPD) comorbidity, the combined impact of these chronic conditions on the aerobic exercise response is unknown and is therefore the purpose of the present investigation. METHODS Sixty-nine subjects with HF and COPD were matched to 69 subjects solely diagnosed with HF according to age, sex, and HF etiology. All subjects underwent resting pulmonary function and diffusion capacity testing, echocardiography with tissue Doppler imaging, and cardiopulmonary exercise testing (CPX). RESULTS Subjects with COPD comorbidity had significantly lower pulmonary function testing and diffusion capacity values versus HF alone (P < .05). In addition, subjects with both HF and COPD had significantly higher pulmonary artery systolic pressures (51.9 ± 9.0 vs 37.0 ± 7.8 mm Hg, P < .001) as assessed by pulsed Doppler echocardiography. Cardiopulmonary exercise testing revealed a significantly poorer response in subjects with HF and COPD by all variables that were analyzed, including peak oxygen consumption (12.1 ± 4.3 vs 16.3 ± 4.3 mL kg⁻¹ min⁻¹, P < .001), minute ventilation/carbon dioxide production slope (42.7 ± 7.4 vs 33.3 ± 6.6, P < .001) and heart rate recovery at 1 minute (12.1 ± 2.5 vs 14.2 ± 2.9 beats, P < .001). CONCLUSIONS Patients with HF and the comorbidity of COPD have significantly impaired CPX responses. This novel finding may impact the clinical interpretation of CPX data in patients with HF who also present with this chronic pulmonary condition.
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Abstract
UNLABELLED COPD is a preventable and treatable disease caused by exposure to tobacco smoke and poisonous gases. It is characterised by progressive obstruction of the airflow, irreversible once lesions occur in the parenchyma. This article aims to systematically review the disease and its treatment. DISCUSSION Smoking is the main cause of COPD and leads to decreased oxygenation via lung hyperinflation with reduced airflow as a systemic inflammatory process. This reduces resistance to fatigue of the skeletal musculature, leading to hypoxemia, decreased peripheral blood flow and also miscarriages and premature births. Inflammatory markers such as interleukins and TNF-alpha maintain the systemic picture. While smoking cessation improves hypoxemia and exercise intolerance, it does not repair damaged tissue. COPD is a serious disease which can be avoided by a wider understanding by the population of the harm smoking causes.
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Affiliation(s)
- Artur Laizo
- Universidade Presidente Antônio Carlos - Campus VI - Juiz de Fora.
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Current World Literature. Curr Opin Support Palliat Care 2009; 3:144-51. [DOI: 10.1097/spc.0b013e32832c6adb] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hatta M, Joho S, Inoue H, Origasa H. A health-related quality of life questionnaire in symptomatic patients with heart failure: validity and reliability of a Japanese version of the MRF28. J Cardiol 2009; 53:117-26. [PMID: 19167647 DOI: 10.1016/j.jjcc.2008.09.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2008] [Revised: 09/15/2008] [Accepted: 09/30/2008] [Indexed: 11/25/2022]
Abstract
BACKGROUND Major characteristics of symptomatic patients with heart failure are exercise intolerance, poor prognosis, and poor quality of life (QOL). However, most QOL questionnaires are applicable for patients with mild to moderate heart failure, and are not sufficiently sensitive to discriminate between patients with NYHA classes III and IV. Therefore, it is necessary to prepare a questionnaire focused on patients with severe heart failure. OBJECTIVES We developed a Japanese version of the Maugeri Foundation Respiratory Failure (MRF28) questionnaire and assessed validity and reliability of MRF28 in heart failure patients. METHODS The MRF28 questionnaire was evaluated in 124 patients with heart failure (NYHA classes: I, 24; II, 31; III, 52; IV, 17). Reliability was evaluated by internal consistency and test-retest reliability. Validity was determined by correlation with World Health Organization Quality of Life (WHOQOL) questionnaire and physiological parameters. RESULTS The MRF28 showed high internal consistency and reproducibility. The total score and subscores were all increased with the progress of heart failure. The total score could differentiate patients among NYHA II, III, and IV, but could not between NYHA I and II. However, all subscores and total score changed consistently with changes in symptoms of heart failure. CONCLUSION MRF28 is a valid and reliable disease-specific questionnaire for assessing QOL in symptomatic patients with heart failure. Thus, this questionnaire may be useful for a QOL evaluation of patients with moderate to severe heart failure.
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Affiliation(s)
- Motonori Hatta
- Division of Biostatistics, Graduate School of Medicine, University of Toyama, Toyama, Japan
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