1
|
Muršić D, Glunčić TJ, Ostojić J, Škrinjarić-Cincar S, Kardum LB, Dokoza M, Lazarušić NK, Bešić E, Samaržija M, Dugac AV. Body composition, pulmonary function tests, exercise capacity, and quality of life in chronic obstructive pulmonary disease patients with obesity. Postgrad Med J 2024; 100:469-474. [PMID: 38377471 DOI: 10.1093/postmj/qgae024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 01/21/2024] [Accepted: 01/23/2024] [Indexed: 02/22/2024]
Abstract
PURPOSE OF THE STUDY Larger proportions of chronic obstructive pulmonary disease (COPD) patients are currently overweight or with obesity than underweight, and the combination of COPD and obesity is increasing. The purpose of this study was to investigate differences in the body composition, pulmonary function tests, exercise capacity, and health-related quality of life among normal weight, overweight, and obese patients with COPD. STUDY DESIGN A total of 514 patients with COPD were included in the study. According to the World Health Organization criteria for body mass index, the patients were classified as normal weight, overweight, and obese. Evaluations included fat-free mass, fat-free mass index, phase angle, pulmonary function tests, and 6-minute walk test. Dyspnea was assessed using the modified Medical Research Council dyspnea scale, and the health-related quality of life was evaluated using COPD Assessment Test and St. George's Respiratory Questionnaire. Values were compared among the three groups. RESULTS There were 315 male and 199 female patients, with a mean age of 66.7 ± 8.4 years. Fat-free mass, fat-free mass index, and phase angle values were significantly higher in COPD patients with obesity than in other patients (P < .001, P < .001, P < .001). Forced expiratory volume in 1 s, forced expiratory volume in 1 s/forced vital capacity, and diffusing capacity of lung for carbon monoxide value in pulmonary function tests were significantly higher in COPD patients with obesity than in other patients (P = .046, P < .001, P < .001), while the forced vital capacity values were similar in all groups. Exercise capacity (6-min walk test distance), dyspnea symptoms (modified Medical Research Council scale), and health-related quality of life (COPD Assessment Test and St. George's Respiratory Questionnaire) did not differ significantly between groups. CONCLUSIONS According to our study, obesity has no negative effect on pulmonary function tests, dyspnea perception, exercise capacity, and health-related quality of life.
Collapse
Affiliation(s)
- Davorka Muršić
- Clinic for Respiratory Diseases Jordanovac, University Hospital Centre Zagreb, 10000 Zagreb, Croatia
| | - Tajana Jalušić Glunčić
- Clinic for Respiratory Diseases Jordanovac, University Hospital Centre Zagreb, 10000 Zagreb, Croatia
| | - Jelena Ostojić
- Clinic for Respiratory Diseases Jordanovac, University Hospital Centre Zagreb, 10000 Zagreb, Croatia
| | - Sanda Škrinjarić-Cincar
- Department of Internal Medicine and History of Medicine, Faculty of Medicine, University of Osijek, 31000 Osijek, Croatia
| | | | - Martina Dokoza
- Department of Internal Medicine, Zadar General Hospital, 23000 Zadar, Croatia
| | | | - Erim Bešić
- Department of Biophysics, Faculty of Pharmacy and Biochemistry, University of Zagreb, 10000 Zagreb, Croatia
| | - Miroslav Samaržija
- Clinic for Respiratory Diseases Jordanovac, University Hospital Centre Zagreb, 10000 Zagreb, Croatia
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Andrea Vukić Dugac
- Clinic for Respiratory Diseases Jordanovac, University Hospital Centre Zagreb, 10000 Zagreb, Croatia
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| |
Collapse
|
2
|
Yao S, Zeng L, Wang F, Chen K. Obesity Paradox in Lung Diseases: What Explains It? Obes Facts 2023; 16:411-426. [PMID: 37463570 PMCID: PMC10601679 DOI: 10.1159/000531792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 06/28/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Obesity is a globally increasing health problem that impacts multiple organ systems and a potentially modifiable risk factor for many diseases. Obesity has a significant impact on lung function and is strongly linked to the pathophysiology that contributes to lung diseases. On the other hand, reports have emerged that obesity is associated with a better prognosis than for normal weight individuals in some lung diseases, including pneumonia, acute lung injury/acute respiratory distress syndrome, chronic obstructive pulmonary disease, and lung cancer. The lesser mortality and better prognosis in patients with obesity is known as obesity paradox. While obesity paradox is both recognized and disputed in epidemiological studies, recent research has suggested possible mechanisms. SUMMARY In this review, we attempted to explain and summarize these factors and mechanisms, including immune response, pulmonary fibrosis, lung function, microbiota, fat and muscle reserves, which are significantly altered by obesity and may contribute to the obesity paradox in lung diseases. We also discuss contrary literature that attributes the "obesity paradox" to confounding. KEY MESSAGES The review will illustrate the possible role of obesity in the prognosis or course of lung diseases, leading to a better understanding of the obesity paradox and provide hints for further basic and clinical research in lung diseases.
Collapse
Affiliation(s)
- Surui Yao
- School of Public Health, Chengdu Medical College, Chengdu, PR China
| | - Lei Zeng
- School of Public Health, Chengdu Medical College, Chengdu, PR China
| | - Fengyuan Wang
- College of Animal and Veterinary Sciences, Southwest Minzu University, Chengdu, PR China
| | - Kejie Chen
- School of Public Health, Chengdu Medical College, Chengdu, PR China
| |
Collapse
|
3
|
Gaynor-Sodeifi K, Lewthwaite H, Jenkins AR, Fernandes Belo L, Koch E, Mujaddid A, Raffoul D, Tracey L, Jensen D. The Association between Fat-Free Mass and Exercise Test Outcomes in People with Chronic Obstructive Pulmonary Disease: A Systematic Review. COPD 2022; 19:182-205. [PMID: 35410561 DOI: 10.1080/15412555.2022.2049737] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
People with chronic obstructive pulmonary disease (COPD) tend to have abnormally low levels of fat-free mass (FFM), which includes skeletal muscle mass as a central component. The purpose of this systematic review was to synthesise available evidence on the association between FFM and exercise test outcomes in COPD. MEDLINE, Cochrane Library, EMBASE, Web of Science, and Scopus were searched. Studies that evaluated exercise-related outcomes in relation to measures of FFM in COPD were included. Eighty-three studies, containing 18,770 (39% female) COPD participants, were included. Considerable heterogeneity was identified in the ways that FFM and exercise test outcomes were assessed; however, higher levels of FFM were generally associated with greater peak exercise capacity. This association was stronger for some exercise test outcomes (e.g. peak rate of oxygen consumption during incremental cycle exercise testing) than others (e.g. six-minute walking distance). This review identified heterogeneity in the methods used for measuring FFM and exercise capacity. There was, in general, a positive association between FFM and exercise capacity in COPD. There was also an identified lack of studies investigating associations between FFM and temporal physiological and perceptual responses to exercise. This review highlights the significance of FFM as a determinant of exercise capacity in COPD.
Collapse
Affiliation(s)
- Kaveh Gaynor-Sodeifi
- Clinical Exercise and Respiratory Physiology Laboratory, Department of Kinesiology and Physical Education, McGill University, Montreal, Quebec, Canada
| | - Hayley Lewthwaite
- Clinical Exercise and Respiratory Physiology Laboratory, Department of Kinesiology and Physical Education, McGill University, Montreal, Quebec, Canada.,College of Engineering, Science and Environment, School of Environmental & Life Sciences, University of Newcastle, Ourimbah, New South Wales, Australia
| | - Alex Robert Jenkins
- Clinical Exercise and Respiratory Physiology Laboratory, Department of Kinesiology and Physical Education, McGill University, Montreal, Quebec, Canada
| | - Letícia Fernandes Belo
- Clinical Exercise and Respiratory Physiology Laboratory, Department of Kinesiology and Physical Education, McGill University, Montreal, Quebec, Canada.,Laboratory of Research in Respiratory Physiotherapy, Department of Physiotherapy, State University of Londrina, Londrina, Brazil
| | - Emily Koch
- Clinical Exercise and Respiratory Physiology Laboratory, Department of Kinesiology and Physical Education, McGill University, Montreal, Quebec, Canada
| | - Ahzum Mujaddid
- Clinical Exercise and Respiratory Physiology Laboratory, Department of Kinesiology and Physical Education, McGill University, Montreal, Quebec, Canada
| | - Dana Raffoul
- Clinical Exercise and Respiratory Physiology Laboratory, Department of Kinesiology and Physical Education, McGill University, Montreal, Quebec, Canada
| | - Lauren Tracey
- Clinical Exercise and Respiratory Physiology Laboratory, Department of Kinesiology and Physical Education, McGill University, Montreal, Quebec, Canada
| | - Dennis Jensen
- Clinical Exercise and Respiratory Physiology Laboratory, Department of Kinesiology and Physical Education, McGill University, Montreal, Quebec, Canada.,Research Institute of the McGill University Health Centre, Translational Research in Respiratory Diseases Program, Montreal, Quebec, Canada
| |
Collapse
|
4
|
S Z, B VDB, FJ VDE, JH V, PN D, YF H, PJ V. Adiposity increases weight-bearing exercise-induced dyspnea despite favoring resting lung hyperinflation in COPD. Chron Respir Dis 2022; 19:14799731211052305. [PMID: 35125014 PMCID: PMC8819751 DOI: 10.1177/14799731211052305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objectives Our aim was to study the associations between resting lung hyperinflation, weight-bearing exercise-induced dyspnea and adipose distribution in obese and normal-weight COPD patients. Methods We performed a comparison between 80 obese COPD patients (COPDOB) with 80 age- and FEV1 matched normal-weight COPD patients (COPDNW). Dyspnea was assessed by the mMRC scale and the Borg dyspnea score before and after a 6 min walk test. Further characterization included spirometry, body plethysmography and metronome paced tachypnea (MPT) to estimate dynamic hyperinflation. Body composition was assessed with bioelectrical impedance analysis. Associations between dyspnea scores and BMI and body composition groups were studied using logistic regression models. Results COPDOB patients had attenuated increases in TLC, FRC and RV compared to COPDNW patients ( p < 0.01). The groups had comparable 6 min walking distance and ΔFRC upon MPT ( p > 0.05). Compared to COPDNW, COPDOB patients reported more often a mMRC ≥ 2 (65 vs 46%; p = 0.02; OR 3.0, 95% CI 1.4–6.2, p < 0.01) and had higher ΔBorg upon 6MWT: 2.0 (SEM 0.20) vs. 1.4 (SEM 0.16), p = 0.01; OR for ΔBorg ≥ 2: 2.4, 95% CI 1.1–5.2, p = 0.03. Additional logistic regression analyses on the associations between body composition and dyspnea indicated that increased body fat percentage, fat mass index and waist-to-hip ratio were associated with higher ORs for mMRC ≥ 2 and ΔBorg upon 6MWT ≥ 2. Conclusion Despite its beneficial effect on resting lung hyperinflation, adiposity is associated with increased weight-bearing exercise-induced dyspnea in COPD.
Collapse
Affiliation(s)
- Zewari S
- Department of Pulmonary Disease, Rijnstate Hospital, Arnhem, The Netherlands
| | - van den Borst B
- Department of Pulmonary Disease, Radboud University Medical Center, Nijmegen, The Netherlands
| | - van den Elshout FJ
- Department of Pulmonary Disease, Rijnstate Hospital, Arnhem, The Netherlands
| | - Vercoulen JH
- Department of Medical Psychology and Department of Pulmonary Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Dekhuijzen PN
- Department of Pulmonary Disease, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Heijdra YF
- Department of Pulmonary Disease, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Vos PJ
- Department of Pulmonary Disease, Rijnstate Hospital, Arnhem, The Netherlands
| |
Collapse
|
5
|
Association of metabolic syndrome with mobility in the older adults: a Korean nationwide representative cross-sectional study. Sci Rep 2021; 11:6605. [PMID: 33758283 PMCID: PMC7988047 DOI: 10.1038/s41598-021-86186-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 03/11/2021] [Indexed: 01/31/2023] Open
Abstract
We aimed to examine whether metabolic syndrome (MetS) is associated with mobility in the older adults, using the timed up and go (TUG) test which is one of the most widely used tests for evaluating mobility. This is population-based study with the National Health Insurance Service-National Health Screening Cohort database of National Health Information Database. Participants included were those who completed the TUG as part of the National Screening Program for Transitional Ages. An abnormal TUG result was defined as a time ≥ 10 s. Multiple logistic regression models were used to assess the associations between MetS and TUG results. We constructed three models with different levels of adjustment. Furthermore, we conducted a stratified analysis according to the risk. Among the 40,767 participants included, 19,831 (48.6%) were women. Mean TUG value was 8.34 ± 3.07 s, and abnormal TUG test results were observed in 4,391 (10.8%) participants; 6,888 (16.9%) participants were categorised to have MetS. The worst TUG test results were obtained in participants with three or four MetS features, and a J-shaped relationship of each MetS feature, except triglyceride (TG) and high-density lipoprotein-cholesterol (HDL-C), with TUG test was found. Participants with MetS had 18% higher likelihood of showing abnormal TUG test results in a fully adjusted model (adjusted odds ratio 1.183, 95% confidence interval 1.115-1.254). The stratified analysis revealed that participants with central obesity, high blood pressure, and normal HDL-C and TG were more likely to have abnormal TUG times. Participants with MetS had a higher risk of exhibiting abnormal TUG results, and except for HDL-C and TG, all other MetS features had a J-shaped relationship with TUG. Preventive lifestyle such as lower carbohydrate and higher protein intake, and endurance exercise is needed.
Collapse
|
6
|
Smulders L, van der Aalst A, Neuhaus EDET, Polman S, Franssen FME, van Vliet M, de Kruif MD. Decreased Risk of COPD Exacerbations in Obese Patients. COPD 2020; 17:485-491. [DOI: 10.1080/15412555.2020.1799963] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Lian Smulders
- Department of Pulmonary Medicine, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Anniek van der Aalst
- Department of Pulmonary Medicine, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Erik D. E. T. Neuhaus
- Department of Pulmonary Medicine, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Sharona Polman
- Department of Pulmonary Medicine, Zuyderland Medical Center, Heerlen, The Netherlands
| | | | - M. van Vliet
- Department of Pulmonary Medicine, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Martijn D. de Kruif
- Department of Pulmonary Medicine, Zuyderland Medical Center, Heerlen, The Netherlands
| |
Collapse
|
7
|
Schneider LP, Sartori LG, Machado FVC, Dala Pola D, Rugila DF, Hirata RP, Bertoche MP, Camillo CA, Hernandes NA, Furlanetto KC, Pitta F. Physical activity and inactivity among different body composition phenotypes in individuals with moderate to very severe chronic obstructive pulmonary disease. Braz J Phys Ther 2020; 25:296-302. [PMID: 32792230 DOI: 10.1016/j.bjpt.2020.07.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 05/28/2020] [Accepted: 07/20/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The phenotype profiling of individuals with chronic obstructive pulmonary disease (COPD) according to impairments in body composition and level of physical activity in daily life (PADL) needs to be determined. OBJECTIVE To verify if individuals with COPD classified as physically active/inactive present different characteristics within different body composition phenotypes. METHODS Individuals with COPD were cross-sectionally stratified into four groups according to fat-free and fat mass indexes: Normal Body Composition (NBC), Obese (Ob), Sarcopenic (Sarc), and Sarcopenic/Obese (Sarc/Ob). Additionally, individuals had their PADL level objectively assessed through activity monitoring during two weekdays for at least 10h/day, and then were classified as physically active (Act) or inactive (Inact) according to international recommendations. Lung function (spirometry), exercise capacity (6-minute walking test [6MWT]) and peripheral muscle strength (1-repetition maximum [1RM]) were also assessed. RESULTS 176 individuals with COPD (mean±standard deviation age: 67±8 years, body mass index 26±6kg/m2, FEV1 47±16%predicted) were classified as: NBC+Act (17%), NBC+Inact (22%), Ob+Act (6%), Ob+Inact (10%), Sarc+Act (12%), Sarc+Inact (9%), Sarc/Ob+Act (8%) and Sarc/Ob+Inact (16%). The Sarc/Ob+Inact group presented lower 6MWT and 1RM for knee extension compared to NBC+Act, NBC+Inact, and Ob+Act groups (p<0.05). The Sarc/Ob+Inact group also presented lower FEV1% predicted, 1RM for elbow flexion and elbow extension compared to the NBC+Act and NBC+Inact groups and lower 1RM for elbow extension compared to Ob+Inact group (p<0.05). CONCLUSION The combination of sarcopenia, obesity, and physical inactivity was shown to be detrimental in individuals with COPD. Therefore, this profile is a main therapeutic target for improving PADL level and/or body composition.
Collapse
Affiliation(s)
- Lorena P Schneider
- Department of Physical Therapy, Laboratory of Research in Respiratory Physical Therapy (LFIP), Universidade Estadual de Londrina (UEL), Londrina, PR, Brazil
| | - Larissa G Sartori
- Department of Physical Therapy, Laboratory of Research in Respiratory Physical Therapy (LFIP), Universidade Estadual de Londrina (UEL), Londrina, PR, Brazil
| | - Felipe V C Machado
- Department of Research and Education, CIRO+, Center of Expertise for Chronic Organ Failure, Horn, Netherlands; NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, Netherlands; Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, Netherlands
| | - Daniele Dala Pola
- Department of Physical Therapy, Laboratory of Research in Respiratory Physical Therapy (LFIP), Universidade Estadual de Londrina (UEL), Londrina, PR, Brazil
| | - Diery Fernandes Rugila
- Department of Physical Therapy, Laboratory of Research in Respiratory Physical Therapy (LFIP), Universidade Estadual de Londrina (UEL), Londrina, PR, Brazil; Research Centre in Health Sciences, University Pitágoras UNOPAR, Londrina, PR, Brazil
| | - Raquel P Hirata
- Department of Physical Therapy, Laboratory of Research in Respiratory Physical Therapy (LFIP), Universidade Estadual de Londrina (UEL), Londrina, PR, Brazil
| | - Mariana P Bertoche
- Department of Physical Therapy, Laboratory of Research in Respiratory Physical Therapy (LFIP), Universidade Estadual de Londrina (UEL), Londrina, PR, Brazil
| | - Carlos A Camillo
- Department of Physical Therapy, Laboratory of Research in Respiratory Physical Therapy (LFIP), Universidade Estadual de Londrina (UEL), Londrina, PR, Brazil; Research Centre in Health Sciences, University Pitágoras UNOPAR, Londrina, PR, Brazil
| | - Nidia A Hernandes
- Department of Physical Therapy, Laboratory of Research in Respiratory Physical Therapy (LFIP), Universidade Estadual de Londrina (UEL), Londrina, PR, Brazil
| | - Karina C Furlanetto
- Department of Physical Therapy, Laboratory of Research in Respiratory Physical Therapy (LFIP), Universidade Estadual de Londrina (UEL), Londrina, PR, Brazil; Research Centre in Health Sciences, University Pitágoras UNOPAR, Londrina, PR, Brazil
| | - Fabio Pitta
- Department of Physical Therapy, Laboratory of Research in Respiratory Physical Therapy (LFIP), Universidade Estadual de Londrina (UEL), Londrina, PR, Brazil.
| |
Collapse
|
8
|
Interval Versus Continuous Aerobic Exercise Training in Overweight and Obese Patients With Chronic Obstructive Pulmonary Disease: A RANDOMIZED CONTROLLED STUDY. J Cardiopulm Rehabil Prev 2020; 40:268-275. [PMID: 32604255 DOI: 10.1097/hcr.0000000000000519] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
PURPOSE The aim of this study was to compare the efficacy of the supervised pulmonary rehabilitation programs consisting of either an interval or continuous aerobic exercise program, with a home-based exercise program in patients with chronic obstructive pulmonary disease (COPD) who were overweight or obese. METHODS In this randomized controlled study, 72 overweight and obese patients diagnosed as having COPD were randomly assigned to 3 groups. Group 1 received an interval-type (IT) aerobic exercise program, group 2 received a continuous-type (CT) aerobic exercise program (both groups performed home exercises as well) and group 3 was only given a home-based exercise (HE) program. For the evaluation of patients, anthropometric measures, cardiopulmonary exercise testing (CPX), 6-min walk test (6MWT), modified-Borg dyspnea and leg fatigue scores, St George's Respiratory Questionnaire, and Hospital Anxiety and Depression Scale were used. RESULTS Both IT and CT groups showed significant improvement on CPX parameters, 6MWT distances, mental health, and health-related quality of life (HRQoL) compared with the HE group in overweight and obese patients with COPD (P < .001). Moreover, the IT group demonstrated a significant decrease in the modified-Borg dyspnea and leg fatigue during the CPX compared with both CT and HE groups (P < .001). Furthermore, the Borg dyspnea and leg fatigue during training were lower in the IT group than in the CT group (P < .05). CONCLUSIONS An interval or continuous aerobic exercise program added onto a home-based exercise program improved exercise capacity and HRQoL, and reduced anxiety and depression levels in overweight and obese patients with COPD.
Collapse
|
9
|
Recio Iglesias J, Díez-Manglano J, López García F, Díaz Peromingo JA, Almagro P, Varela Aguilar JM. Management of the COPD Patient with Comorbidities: An Experts Recommendation Document. Int J Chron Obstruct Pulmon Dis 2020; 15:1015-1037. [PMID: 32440113 PMCID: PMC7217705 DOI: 10.2147/copd.s242009] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 03/10/2020] [Indexed: 12/11/2022] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) is associated with multiple comorbidities, which impact negatively on patients and are often underdiagnosed, thus lacking a proper management due to the absence of clear guidelines. Purpose To elaborate expert recommendations aimed to help healthcare professionals to provide the right care for treating COPD patients with comorbidities. Methods A modified RAND-UCLA appropriateness method consisting of nominal groups to draw up consensus recommendations (6 Spanish experts) and 2-Delphi rounds to validate them (23 Spanish experts) was performed. Results A panel of Spanish internal medicine experts reached consensus on 73 recommendations and 81 conclusions on the clinical consequences of the presence of comorbidities. In general, the experts reached consensus on the issues raised with regard to cardiovascular comorbidity and metabolic disorders. Consensus was reached on the use of selective serotonin reuptake inhibitors in cases of depression and the usefulness of referring patients with anxiety to respiratory rehabilitation programmes. The results also showed consensus on the usefulness of investigating the quality of sleep, the treatment of pain with opioids and the evaluation of osteoporosis by lateral chest radiography. Conclusion This study provides conclusions and recommendations that are intended to improve the management of the complexity of patients with COPD and important comorbidities, usually excluded from clinical trials.
Collapse
Affiliation(s)
- Jesús Recio Iglesias
- Internal Medicine Department, Quironsalud Valencia Hospital, Valencia, Valencian Community, Spain
| | - Jesús Díez-Manglano
- Internal Medicine Department, Royo Villanova Hospital, Zaragoza, Aragon, Spain
| | - Francisco López García
- Internal Medicine Department General University Hospital of Elche, Alicante, Valencian Community, Spain
| | - José Antonio Díaz Peromingo
- Internal Medicine Department, University Clinical Hospital of Santiago de Compostela, a Coruña, Galicia, Spain
| | - Pere Almagro
- Internal Medicine Department, Mútua Terrassa University Hospital, Terrassa, Barcelona, Catalonia, Spain
| | - José Manuel Varela Aguilar
- Internal Medicine Department, University Hospital Virgen del Rocío, Seville, Andalusia, Spain
- CIBER of Epidemiology and Public Health, Madrid, Community of Madrid, Spain
| |
Collapse
|
10
|
Wouters EF, Posthuma R, Koopman M, Liu WY, Sillen MJ, Hajian B, Sastry M, Spruit MA, Franssen FM. An update on pulmonary rehabilitation techniques for patients with chronic obstructive pulmonary disease. Expert Rev Respir Med 2020; 14:149-161. [PMID: 31931636 DOI: 10.1080/17476348.2020.1700796] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Introduction: Pulmonary rehabilitation (PR) is one of the core components in the management of patients with chronic obstructive pulmonary disease (COPD). In order to achieve the maximal level of independence, autonomy, and functioning of the patient, targeted therapies and interventions based on the identification of physical, emotional and social traits need to be provided by a dedicated, interdisciplinary PR team.Areas covered: The review discusses cardiopulmonary exercise testing in the selection of different modes of training modalities. Neuromuscular electrical stimulation as well as gait assessment and training are discussed as well as add-on therapies as oxygen, noninvasive ventilator support or endoscopic lung volume reduction in selected patients. The potentials of pulsed inhaled nitric oxide in patients with underlying pulmonary hypertension is explored as well as nutritional support. The impact of sleep quality on outcomes of PR is reviewed.Expert opinion: Individualized, comprehensive intervention based on thorough assessment of physical, emotional, and social traits in COPD patients forms a continuous challenge for health-care professionals and PR organizations in order to dynamically implement and adapt these strategies based on dynamic, more optimal understanding of underlying pathophysiological mechanisms.
Collapse
Affiliation(s)
- Emiel Fm Wouters
- Department of Respiratory Medicine, Maastricht University Medical Center+, The Netherlands.,CIRO+, center of expertise for chronic organ failure, Horn, The Netherlands.,NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center Maastricht, The Netherlands
| | - Rein Posthuma
- Department of Respiratory Medicine, Maastricht University Medical Center+, The Netherlands.,CIRO+, center of expertise for chronic organ failure, Horn, The Netherlands
| | - Maud Koopman
- Department of Respiratory Medicine, Maastricht University Medical Center+, The Netherlands.,NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center Maastricht, The Netherlands
| | - Wai-Yan Liu
- CIRO+, center of expertise for chronic organ failure, Horn, The Netherlands.,NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center Maastricht, The Netherlands
| | - Maurice J Sillen
- Department of Respiratory Medicine, Maastricht University Medical Center+, The Netherlands
| | - Bita Hajian
- Department of Respiratory Medicine, Maastricht University Medical Center+, The Netherlands
| | - Manu Sastry
- Department of Respiratory Medicine, Maastricht University Medical Center+, The Netherlands
| | - Martijn A Spruit
- Department of Respiratory Medicine, Maastricht University Medical Center+, The Netherlands.,CIRO+, center of expertise for chronic organ failure, Horn, The Netherlands.,NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center Maastricht, The Netherlands
| | - Frits M Franssen
- Department of Respiratory Medicine, Maastricht University Medical Center+, The Netherlands.,CIRO+, center of expertise for chronic organ failure, Horn, The Netherlands.,NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center Maastricht, The Netherlands
| |
Collapse
|
11
|
Burke DT, Penna S, Al-Adawi S, Bell RB, Burke DP. The Effect of Body Mass Index on Pulmonary Related Debility Rehabilitation. PM R 2019; 12:363-367. [PMID: 31441990 DOI: 10.1002/pmrj.12243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 08/18/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND Obesity is a known factor for the development of abnormal respiratory physiology. However, several studies have found that obesity does not hinder functional recovery in patients hospitalized for postacute care following a stroke or cardiovascular event. This study was designed to determine the effect of overweight and obesity on patients with acute pulmonary disease, hospitalized in an inpatient rehabilitation facility (IRF). OBJECTIVE To investigate the impact of body mass index (BMI) on indices of function, specifically, the functional independence measure (FIM) among patients with pulmonary related debility admitted to a rehabilitation hospital. DESIGN Retrospective cohort study. SETTING Pulmonary unit in an acute freestanding rehabilitation hospital. PATIENTS All patients admitted to an IRF with a diagnosis of pulmonary related debility over a 6-year period. METHODS The data used in the study included the patient height and weight (measured on admission) and FIM (scored on admission and discharge). MAIN OUTCOME MEASURES The primary study outcome measure was the change in FIM per day by the patients' BMI category. RESULTS For the 381 patients admitted during the observation period, BMI was compared with FIM score changes per day (FIM efficiency). After adjusting for age and sex, the FIM efficiency only slightly differed by BMI, failing to reach statistical significance. However, age did significantly influence the outcome (P = .05). CONCLUSION This study demonstrates that among a large group of patients with a pulmonary related debility, there was no statistically significant correlation between BMI and FIM efficiency. The overweight patients were similar in progression to those who were underweight, normal weight, and obese. However, this study found that increased age adversely affected the outcome of rehabilitation. LEVEL OF EVIDENCE III.
Collapse
Affiliation(s)
- David T Burke
- Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA
| | - Suzanne Penna
- Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA
| | - Samir Al-Adawi
- Department of Behavioral Medicine, College of Medicine and Health Sciences, Sultan Qaboos University, Al-Khoud, Sultanate of Oman
| | - Regina B Bell
- Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA
| | - Daniel P Burke
- Department of Biology, Georgia State University, Atlanta, GA
| |
Collapse
|
12
|
Vanfleteren LEGW, Gloeckl R. Add-on interventions during pulmonary rehabilitation. Respirology 2019; 24:899-908. [PMID: 31115114 DOI: 10.1111/resp.13585] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 04/04/2019] [Accepted: 05/02/2019] [Indexed: 11/30/2022]
Abstract
Both pulmonary rehabilitation (PR) and chronic obstructive pulmonary disease (COPD) are generic terms and it increasingly becomes clear that rehabilitation programmes need to be tailored to the complexity and circumstances of the individual patient. Indeed, PR is described as a comprehensive, individualized intervention based on thorough assessment of identifiable treatable traits. The current review summarizes ongoing developments regarding additional interventions and tools to facilitate PR and improve outcomes in patients with a chronic respiratory disease.
Collapse
Affiliation(s)
- Lowie E G W Vanfleteren
- COPD Center, Sahlgrenska University Hospital, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.,CIRO, Horn, The Netherlands
| | - Rainer Gloeckl
- Institute for Pulmonary Rehabilitation Research, Schoen Klinik Berchtesgadener Land, Schoenau am Koenigssee, Germany.,Department of Prevention, Rehabilitation and Sports Medicine, Technical University of Munich, Munich, Germany
| |
Collapse
|
13
|
Maestri R, Bruschi C, Fracchia C, Pinna GD, Fanfulla F, Ambrosino N. Physiological and clinical characteristics of patients with COPD admitted to an inpatient pulmonary rehabilitation program: A real-life study. Pulmonology 2019; 25:71-78. [DOI: 10.1016/j.pulmoe.2018.07.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 05/24/2018] [Accepted: 07/01/2018] [Indexed: 11/16/2022] Open
|
14
|
Coats V, Després JP, Alméras N, Martin M, Sin DD, Rabasa-Lhoret R, Larose É, Tan WC, Bourbeau J, Maltais F. Ectopic adiposity and cardiometabolic health in COPD. Int J Chron Obstruct Pulmon Dis 2018; 13:3331-3340. [PMID: 30410322 PMCID: PMC6197246 DOI: 10.2147/copd.s168963] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Rationale Obesity/overweight is the most prevalent body composition abnormality in COPD. However, little is known about the impact of fat distribution on cardiometabolic health in COPD. Objective To study the associations between ectopic adiposity, cardiometabolic health, and COPD. Methods A total of 263 subjects (166 males; age=65±9 years) were randomly selected from the general population. Subjects were classified as non-COPD controls and COPD, according to the Global initiative for chronic Obstructive Lung Disease (GOLD) classification, and the presence of cardiometabolic comorbidities was recorded. Ectopic fat accumulation was documented from computed tomography measurements of visceral adipose tissue cross-sectional areas and muscle mean attenuation, assessed at L4–L5. Blood glucose, lipid, and adipokine profiles were also evaluated. Results After correcting for age, sex, and tobacco exposure, visceral adipose tissue cross-sectional area was higher in GOLD 2+ compared to GOLD 1 individuals. Consistent with this, mean muscle tissue attenuation was lower in GOLD 2+ vs GOLD 1 and non-COPD controls (P<0.001). In multiple regression models, visceral adipose tissue cross-sectional area was strongly associated with hypertension (P<0.001) and diabetes (P<0.001), while muscle attenuation was associated with coronary artery disease (P<0.001). Blood glucose, lipid, and adipokine profiles were similar across groups with the exception of leptin level which was higher in GOLD 2+ subjects compared to GOLD 1 and controls. Conclusion GOLD 2+ COPD was associated with ectopic fat accumulation which modulated cardiometabolic health.
Collapse
Affiliation(s)
- Valérie Coats
- Centre de Recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec, QC, Canada,
| | - Jean-Pierre Després
- Centre de Recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec, QC, Canada,
| | - Natalie Alméras
- Centre de Recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec, QC, Canada,
| | - Mickaël Martin
- Centre de Recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec, QC, Canada,
| | - Don D Sin
- University of British Columbia, Vancouver, BC, Canada
| | - Rémi Rabasa-Lhoret
- Institut de Recherches Cliniques de Montréal, Département de Nutrition et Service d'Endocrinologie, Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Éric Larose
- Centre de Recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec, QC, Canada,
| | - Wan C Tan
- University of British Columbia, Vancouver, BC, Canada
| | - Jean Bourbeau
- Respiratory Epidemiology and Clinical Research Unit, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - François Maltais
- Centre de Recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec, QC, Canada,
| | | |
Collapse
|
15
|
Vanfleteren MJ, Koopman M, Spruit MA, Pennings HJ, Smeenk F, Pieters W, van den Bergh JJ, Michels AJ, Wouters EF, Groenen MT, Franssen FM, Vanfleteren LE. Effectiveness of Pulmonary Rehabilitation in Patients With Chronic Obstructive Pulmonary Disease With Different Degrees of Static Lung Hyperinflation. Arch Phys Med Rehabil 2018; 99:2279-2286.e3. [PMID: 29906421 DOI: 10.1016/j.apmr.2018.05.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 03/31/2018] [Accepted: 05/07/2018] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate the effect of pulmonary rehabilitation (PR) on exercise performance and quality of life in patients with chronic obstructive pulmonary disease (COPD) with different degrees of static lung hyperinflation (LH). DESIGN Retrospective cohort study. SETTING PR network. PARTICIPANTS A cohort of 1981 patients with COPD (55% men; age: 66.8±9.3y; forced expiratory volume in the first second%: 50.7±19.5; residual volume [RV]%: 163.0±49.7). INTERVENTION An interdisciplinary PR program for patients with COPD consisting of 40 sessions. MAIN OUTCOME MEASURES Participants were stratified into 5 quintiles according to baseline RV and were evaluated on the basis of pre- and post-PR 6-minute walk distance (6MWD), constant work rate test (CWRT), and Saint George's Respiratory Questionnaire (SGRQ), among other clinical parameters. RESULTS With increasing RV quintile, patients were younger, more frequently women, had lower forced expiratory volume in the first second%, lower body mass index and fat-free mass index, shorter 6MWD, shorter CWRT, and worse SGRQ scores (P<.01). All RV strata improved after PR in all 3 outcomes (P<.001). Nevertheless, higher, compared to lower RV categories, had lower ΔCWRT (P<.01) but similar Δ6MWD (P=.948) and ΔSGRQ (P=.086) after PR. CONCLUSIONS LH in COPD is related to younger age, female sex, lower body weight, worse exercise capacity and health status, but did not prevent patients from benefitting from PR. LH, however, influences walking and cycling response after PR differently.
Collapse
Affiliation(s)
- Michiel J Vanfleteren
- Department of Research and Education, Center of Expertise for Chronic Organ Failure (CIRO), Horn, the Netherlands; Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands.
| | - Maud Koopman
- Department of Research and Education, Center of Expertise for Chronic Organ Failure (CIRO), Horn, the Netherlands
| | - Martijn A Spruit
- Department of Research and Education, Center of Expertise for Chronic Organ Failure (CIRO), Horn, the Netherlands
| | - Herman-Jan Pennings
- Department of Respiratory Medicine, St. Laurentius Hospital, Roermond, the Netherlands
| | - Frank Smeenk
- Department of Respiratory Medicine, Catharina Hospital, Eindhoven, the Netherlands
| | - Willem Pieters
- Department of Respiratory Medicine, Elkerliek Hospital, Helmond, the Netherlands
| | - Jan J van den Bergh
- Department of Respiratory Medicine, St. Jans Gasthuis, Weert, the Netherlands
| | - Arent-Jan Michels
- Department of Respiratory Medicine, St Anna Hospital, Geldrop, the Netherlands
| | - Emiel F Wouters
- Department of Research and Education, Center of Expertise for Chronic Organ Failure (CIRO), Horn, the Netherlands; Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands
| | - Miriam T Groenen
- Department of Research and Education, Center of Expertise for Chronic Organ Failure (CIRO), Horn, the Netherlands
| | - Frits M Franssen
- Department of Research and Education, Center of Expertise for Chronic Organ Failure (CIRO), Horn, the Netherlands; Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands
| | - Lowie E Vanfleteren
- Department of Research and Education, Center of Expertise for Chronic Organ Failure (CIRO), Horn, the Netherlands; Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands; COPD Center, Sahlgrenska University Hospital, Göteborg, Sweden
| |
Collapse
|
16
|
Broderick J, Mc Grath C, Cullen K, Talbot D, Gilmor J, Baily-Scanlan M, O’Dwyer T. Effects of pulmonary rehabilitation on exercise capacity and disease impact in patients with chronic obstructive pulmonary disease and obesity. Physiotherapy 2018; 104:248-250. [DOI: 10.1016/j.physio.2017.08.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 08/02/2017] [Indexed: 11/30/2022]
|
17
|
Yilmaz FT, Aydin HT. The effect of a regular walking program on dyspnoea severity and quality of life in normal weight, overweight, and obese patients with chronic obstructive pulmonary disease. Int J Nurs Pract 2018; 24:e12636. [PMID: 29498156 DOI: 10.1111/ijn.12636] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 01/26/2018] [Accepted: 01/28/2018] [Indexed: 12/01/2022]
Abstract
AIM The objective was to determine the effect of a regular walking program on physical activity (the number of steps and walking duration), dyspnoea severity, and quality of life in normal weight, overweight, and obese patients with chronic obstructive pulmonary disease. METHOD An experimental study; 50 patients with chronic obstructive pulmonary disease admitted to the respiratory clinic of a public hospital in Turkey between November 2014 and July 2015 were included. All the patients underwent a regular walking program (at least 30 minutes every day) using a pedometer for 16 weeks under the supervision of a nurse. RESULTS After the regular walking program, the respiratory function test results of the obese patients were significantly improved. The walking duration, the number of steps taken per day, and the quality of life of all participants improved significantly, and dyspnoea severity was reduced in all participants. CONCLUSION The regular walking program reduced dyspnoea severity and improved quality of life in all participants. Nurses' efforts to increase activity levels in all patients with chronic obstructive pulmonary disease, and particularly those with obesity, through a regular walking program may contribute to reduce the severity of dyspnoea and improve quality of life.
Collapse
Affiliation(s)
- Feride Taskin Yilmaz
- Department of Internal Diseases Nursing, School of Susehri Health High, Cumhuriyet University, Sivas, Turkey
| | - Hatice Tel Aydin
- Department of Internal Diseases Nursing, Faculty of Healthy Science, Cumhuriyet University, Sivas, Turkey
| |
Collapse
|
18
|
Zewari S, Vos P, van den Elshout F, Dekhuijzen R, Heijdra Y. Obesity in COPD: Revealed and Unrevealed Issues. COPD 2017; 14:663-673. [DOI: 10.1080/15412555.2017.1383978] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- S. Zewari
- Department of Pulmonary Disease, Rijnstate hospital, Arnhem, The Netherlands
| | - P. Vos
- Department of Pulmonary Disease, Rijnstate hospital, Arnhem, The Netherlands
| | - F. van den Elshout
- Department of Pulmonary Disease, Rijnstate hospital, Arnhem, The Netherlands
| | - R. Dekhuijzen
- Department of Pulmonary Disease, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Y. Heijdra
- Department of Pulmonary Disease, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| |
Collapse
|
19
|
Exercise testing in patients with diaphragm paresis. Respir Physiol Neurobiol 2017; 248:31-35. [PMID: 29155335 DOI: 10.1016/j.resp.2017.11.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 11/13/2017] [Accepted: 11/14/2017] [Indexed: 11/24/2022]
Abstract
PURPOSE Diaphragm paresis (DP) is characterized by abnormalities of respiratory muscle function. However, the impact of DP on exercise capacity is not well known. This study was performed to assess exercise tolerance in patients with DP and to determine whether inspiratory muscle function was related to exercise capacity, ventilatory pattern and cardiovascular function during exercise. METHODS This retrospective study included patients with DP who underwent both diaphragmatic force measurements, and cardiopulmonary exercise testing (CPET). RESULTS Fourteen patients were included. Dyspnea was the main symptom limiting exertion (86%). Exercise capacity was slightly reduced (median VO2peak: 80% [74.5%-90.5%]), mostly due to ventilatory limitation. Diaphragm and overall inspiratory muscle function were correlated with exercise ventilation. Moreover, overall inspiratory muscle function was related with oxygen consumption (r=0.61) and maximal workload (r=0.68). CONCLUSIONS DP decreases aerobic capacity due to ventilatory limitation. Diaphragm function is correlated with exercise ventilation whereas overall inspiratory muscle function is correlated with both exercise capacity and ventilation suggesting the importance of the accessory inspiratory muscles during exercise for patients with DP. Further larger prospective studies are needed to confirm these results.
Collapse
|
20
|
Khalladi R, Gargouri I, Mahjoub M, Belhareth S, Ben Saad H. [Evaluation of quality of life (QOL) of Tunisians patients with COPD]. REVUE DE PNEUMOLOGIE CLINIQUE 2017; 73:231-239. [PMID: 29054717 DOI: 10.1016/j.pneumo.2017.08.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 07/26/2017] [Accepted: 08/16/2017] [Indexed: 06/07/2023]
Abstract
AIM To test the Arabic version of the St. George's Hospital Respiratory Questionnaire (SGRQ) in stable Tunisian COPD patients. HYPOTHESES A correlation coefficient between the post-bronchodilator FEV1 and the "Total" score of SGRQ higher than "-0.40", and QOL scores lower in COPD with "mild to moderate airway obstruction" than in those with "severe to very severe airway obstruction" will be in favor of a possible application of the Arabic version of the SGRQ in Tunisians COPD patients. METHODS This is a prospective cross-sectional study including 50 clinically stable COPD patients. The Arabic version of the SGRQ was used. Four scores were calculated for the "Symptoms", "Activities", "Impacts" and "Total" components. Patients were divided into two groups according to the severity of their airway obstruction: "mild to moderate, n=30" and "severe to very severe, n=20". The correlation between the QOL "Total" score and postBD FEV1 was evaluated. RESULTS The mean±SD of age, cigarette smoking and post-bronchodilator FEV1 were, respectively, 60±10, 61±36 pack-years and 55±20 %. The correlation between the post-bronchodilator FEV1 and QOL "Total" score was significant at "-0.65". "Symptoms", "Activities", "Impacts" and "Total" scores were significantly less altered in patients with "mild to moderate airway obstruction" than among those with "severe to very severe airway obstruction" (respectively, 52±24 vs. 77±17, 66±28 vs. 87±18, 48±25 vs. 70±23 and 54±22 vs. 76±17). CONCLUSION The application of the Arabic version of the SGRQ in stable COPD patients gives reliable results.
Collapse
Affiliation(s)
- R Khalladi
- Institut supérieur des sciences infirmières de Sousse, université de Sousse, Sousse, Tunisie
| | - I Gargouri
- Service de pneumologie, EPS Farhat Hached, Sousse, Tunisie
| | - M Mahjoub
- Service d'hygiène hospitalière, EPS Farhat Hached, Sousse, Tunisie
| | - S Belhareth
- Institut supérieur des sciences infirmières de Sousse, université de Sousse, Sousse, Tunisie; Service de pneumologie, EPS Farhat Hached, Sousse, Tunisie
| | - H Ben Saad
- Service de physiologie et explorations fonctionnelles, EPS Farhat Hached, Sousse, Tunisie; Laboratoire de physiologie, faculté de médecine « Ibn Eljazzar » de Sousse, université de Sousse, avenue Karoui-Mohamed, 4000 Sousse, Tunisie.
| |
Collapse
|
21
|
Martin M, Almeras N, Després JP, Coxson HO, Washko GR, Vivodtzev I, Wouters EF, Rutten E, Williams MC, Murchison JT, MacNee W, Sin DD, Maltais F. Ectopic fat accumulation in patients with COPD: an ECLIPSE substudy. Int J Chron Obstruct Pulmon Dis 2017; 12:451-460. [PMID: 28203068 PMCID: PMC5293362 DOI: 10.2147/copd.s124750] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Obesity is increasingly associated with COPD, but little is known about the prevalence of ectopic fat accumulation in COPD and whether this can possibly be associated with poor clinical outcomes and comorbidities. The Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints (ECLIPSE) substudy tested the hypothesis that COPD is associated with increased ectopic fat accumulation and that this would be associated with COPD-related outcomes and comorbidities. METHODS Computed tomography (CT) images of the thorax obtained in ECLIPSE were used to quantify ectopic fat accumulation at L2-L3 (eg, cross-sectional area [CSA] of visceral adipose tissue [VAT] and muscle tissue [MT] attenuation, a reflection of muscle fat infiltration) and CSA of MT. A dose-response relationship between CSA of VAT, MT attenuation and CSA of MT and COPD-related outcomes (6-minute walking distance [6MWD], exacerbation rate, quality of life, and forced expiratory volume in 1 second [FEV1] decline) was addressed with the Cochran-Armitage trend test. Regression models were used to investigate possible relationships between CT body composition indices and comorbidities. RESULTS From the entire ECLIPSE cohort, we identified 585 subjects with valid CT images at L2-L3 to assess body composition. CSA of VAT was increased (P<0.0001) and MT attenuation was reduced (indicating more muscle fat accumulation) in patients with COPD (P<0.002). Progressively increasing CSA of VAT was not associated with adverse clinical outcomes. The probability of exhibiting low 6MWD and accelerated FEV1 decline increased with progressively decreasing MT attenuation and CSA of MT. In COPD, the probability of having diabetes (P=0.024) and gastroesophageal reflux (P=0.0048) at baseline increased in parallel with VAT accumulation, while the predicted MT attenuation increased the probability of cardiovascular comorbidities (P=0.042). Body composition parameters did not correlate with coronary artery scores or with survival. CONCLUSION Ectopic fat accumulation is increased in COPD, and this was associated with relevant clinical outcomes and comorbidities.
Collapse
Affiliation(s)
- Mickaël Martin
- Research Centre, Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec, QC
| | - Natalie Almeras
- Research Centre, Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec, QC
| | - Jean-Pierre Després
- Research Centre, Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec, QC
| | - Harvey O Coxson
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - George R Washko
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Isabelle Vivodtzev
- Hypoxia Pathophysiology Laboratory, Grenoble University Hospital, Grenoble, France
| | - Emiel Fm Wouters
- Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht
| | - Erica Rutten
- Research and Development, CIRO, Horn, the Netherlands
| | | | - John T Murchison
- Department of Radiology, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - William MacNee
- Department of Respiratory Medicine, University of Edinburgh
| | - Don D Sin
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - François Maltais
- Research Centre, Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec, QC
| |
Collapse
|
22
|
Joppa P, Tkacova R, Franssen FM, Hanson C, Rennard SI, Silverman EK, McDonald MLN, Calverley PM, Tal-Singer R, Spruit MA, Kenn K, Wouters EF, Rutten EP. Sarcopenic Obesity, Functional Outcomes, and Systemic Inflammation in Patients With Chronic Obstructive Pulmonary Disease. J Am Med Dir Assoc 2016; 17:712-8. [DOI: 10.1016/j.jamda.2016.03.020] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 03/26/2016] [Accepted: 03/29/2016] [Indexed: 01/31/2023]
|
23
|
Vanfleteren LEGW, Spruit MA, Wouters EFM, Franssen FME. Management of chronic obstructive pulmonary disease beyond the lungs. THE LANCET RESPIRATORY MEDICINE 2016; 4:911-924. [PMID: 27264777 DOI: 10.1016/s2213-2600(16)00097-7] [Citation(s) in RCA: 117] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Revised: 03/02/2016] [Accepted: 03/03/2016] [Indexed: 01/26/2023]
Abstract
Chronic obstructive pulmonary disease (COPD) is an umbrella term that covers many clinical subtypes with clearly different pulmonary and extra-pulmonary characteristics, but with persistent airflow limitation in common. This insight has led to the development of a more personalised approach in bronchodilator therapy, prevention of exacerbations, and advanced treatments (such as non-invasive ventilation and lung volume reduction techniques). However, systemic manifestations and comorbidities of COPD also contribute to different clinical phenotypes and warrant an individualised approach as part of integrated disease management. Alterations in bodyweight and composition, from cachexia to obesity, demand specific management. Psychological symptoms are highly prevalent, and thorough diagnosis and treatment are necessary. Moreover, prevention of exacerbations requires interventions beyond the lungs, including treatment of gastro-oesophageal reflux disease, reduction of cardiovascular risks, and management of dyspnoea and anxiety. In this Review, we discuss the management of COPD beyond the respiratory system and propose treatment strategies on the basis of the latest research and best practices.
Collapse
Affiliation(s)
- Lowie E G W Vanfleteren
- Department of Research and Education, CIRO, Horn, Netherlands; Department of Respiratory Medicine, Maastricht University Medical Centre, Maastricht, Netherlands.
| | | | - Emiel F M Wouters
- Department of Research and Education, CIRO, Horn, Netherlands; Department of Respiratory Medicine, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Frits M E Franssen
- Department of Research and Education, CIRO, Horn, Netherlands; Department of Respiratory Medicine, Maastricht University Medical Centre, Maastricht, Netherlands
| |
Collapse
|
24
|
Katz P, Iribarren C, Sanchez G, Blanc PD. Obesity and Functioning Among Individuals with Chronic Obstructive Pulmonary Disease (COPD). COPD 2016; 13:352-9. [PMID: 26683222 PMCID: PMC4951092 DOI: 10.3109/15412555.2015.1087991] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
In COPD, body composition studies have focused primarily on low BMI. We examined obesity (BMI ≥ 30 kg/m(2)) as a risk factor for poor function and longitudinal functional decline. Data from a longitudinal cohort of adults with COPD (n = 1096) and an age- and sex-matched comparison group collected in two in-person visits ∼49 months apart were analyzed. Two measures of functioning were examined: six-minute walk distance (6MWD) and Short Physical Performance Battery (SPPB). Multivariate regression analyses examined relationships of obesity with functioning. Secondary analyses stratified by GOLD classification (GOLD-0/1, GOLD-2, GOLD-3/4). Obesity (53% of COPD cohort) was associated cross-sectionally with 6MWD and SPPB in COPD, and only with 6MWD in the comparison group. Obesity predicted significant functional decline in 6MWD for individuals with COPD (odds ratio (OR) for decline [95% CI] 1.8 [1.1, 2.9]), but not the comparison group. Secondary analyses revealed that the risk of decline was significant only in those with more severe COPD (GOLD 3/4, OR = 2.3 [1.0, 5.4]). Obesity was highly prevalent and was associated with poor function concurrently and with subsequent decline in 6MWD in COPD. Obesity in COPD should be considered a risk not only for more co-morbidities and greater health care use, but also for functional decline.
Collapse
Affiliation(s)
- Patricia Katz
- Department of Medicine, University of California, San Francisco, CA, USA
| | | | | | - Paul D. Blanc
- Department of Medicine, University of California, San Francisco, CA, USA
| |
Collapse
|
25
|
El-Shafey BI, El-Deib AE. Effect of weight reduction on obese patients with COPD and bronchial asthma. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2015. [DOI: 10.1016/j.ejcdt.2015.06.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
26
|
Torres-Sánchez I, Valenza MC, Sáez-Roca G, Cabrera-Martos I, López-Torres I, Rodríguez-Torres J. Results of a Multimodal Program During Hospitalization in Obese COPD Exacerbated Patients. COPD 2015; 13:19-25. [PMID: 26418629 DOI: 10.3109/15412555.2015.1043428] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
The objective of this study was to analyze the results of a multimodal therapeutic program during hospitalization in obese AECOPD patients. This was a randomized, single-blind clinical trial conducted at two university hospitals in Granada, Spain. Forty-nine patients hospitalized due to AECOPD were randomly allocated to a control group (CG), in which patients received standard care, or to an intervention group (IG), in which patients were included in a multimodal therapeutic program, added to the standard care. The main outcome measures were pulmonary, physical (strength and exercise capacity) and perceived (dyspnea, quality of life and psychological distress) variables. Within-group significant improvements (p < 0.05) were found in physical and perceived variables in the IG after the treatment. In the CG, a significant decrease was found in lower limb strength and a significant improvement in dyspnea and in three subscales of the EuroQol-5D questionnaire. The between-groups analysis showed significant differences after the treatment on lower limb strength and exercise capacity values (p < 0.05), in three of the EuroQol-5D subscales, and in the total score and the depression subscale of the Hospital Anxiety and Depression Scale. A multimodal therapeutic program has a beneficial effect on physical functioning and perceived variables in hospitalized obese patients with AECOPD.
Collapse
Affiliation(s)
- Irene Torres-Sánchez
- a Department of Physical Therapy, School of Health Sciences . University of Granada , Spain
| | - Marie Carmen Valenza
- a Department of Physical Therapy, School of Health Sciences . University of Granada , Spain
| | - Germán Sáez-Roca
- b Pulmonary Medicine Service , Virgen de las Nieves University Hospital, Granada, Andalusian Health Service , Spain
| | - Irene Cabrera-Martos
- a Department of Physical Therapy, School of Health Sciences . University of Granada , Spain
| | - Isabel López-Torres
- a Department of Physical Therapy, School of Health Sciences . University of Granada , Spain
| | | |
Collapse
|
27
|
Liu Y, Pleasants RA, Croft JB, Lugogo N, Ohar J, Heidari K, Strange C, Wheaton AG, Mannino DM, Kraft M. Body mass index, respiratory conditions, asthma, and chronic obstructive pulmonary disease. Respir Med 2015; 109:851-9. [PMID: 26006753 DOI: 10.1016/j.rmed.2015.05.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Revised: 05/05/2015] [Accepted: 05/06/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND This study aims to assess the relationship of body mass index (BMI) status with respiratory conditions, asthma, and chronic obstructive pulmonary disease (COPD) in a state population. METHODS Self-reported data from 11,868 adults aged ≥18 years in the 2012 South Carolina Behavioral Risk Factor Surveillance System telephone survey were analyzed using multivariable logistic regression that accounted for the complex sampling design and adjusted for sex, age, race/ethnicity, education, smoking status, physical inactivity, and cancer history. RESULTS The distribution of BMI (kg/m(2)) was 1.5% for underweight (<18.5), 32.3% for normal weight (18.5-24.9), 34.6% for overweight (25.0-29.9), 26.5% for obese (30.0-39.9), and 5.1% for morbidly obese (≥40.0). Among respondents, 10.0% had frequent productive cough, 4.3% had frequent shortness of breath (SOB), 7.3% strongly agreed that SOB affected physical activity, 8.4% had current asthma, and 7.4% had COPD. Adults at extremes of body weight were more likely to report having asthma or COPD, and to report respiratory conditions. Age-adjusted U-shaped relationships of BMI categories with current asthma and strongly agreeing that SOB affected physical activity, but not U-shaped relationship with COPD, persisted after controlling for the covariates (p < 0.001). Morbidly obese but not underweight or obese respondents were significantly more likely to have frequent productive cough and frequent SOB than normal weight adults after adjustment. CONCLUSION Our data confirm that both underweight and obesity are associated with current asthma and obesity with COPD. Increased emphasis on exercise and nutrition may improve respiratory conditions.
Collapse
Affiliation(s)
- Yong Liu
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, GA, USA.
| | - Roy A Pleasants
- Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Janet B Croft
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, GA, USA
| | - Njira Lugogo
- Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Jill Ohar
- Section on Pulmonary, Critical Care, Allergy & Immunologic Disease, Wake Forest University School of Medicine, Winston Salem, NC, USA
| | - Khosrow Heidari
- Chronic Disease Epidemiology Office, South Carolina Department of Health and Environmental Control, Columbia, SC, USA; Department of Epidemiology & Statistics, University of South Carolina, Columbia, SC, USA
| | - Charlie Strange
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Medical University of South Carolina, USA
| | - Anne G Wheaton
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, GA, USA
| | - David M Mannino
- Division of Pulmonary, Critical Care, and Sleep Medicine, Pulmonary Epidemiology Research Laboratory, University of Kentucky, Lexington, KY, USA
| | - Monica Kraft
- Department of Medicine, University of Arizona, Phoenix, AZ, USA
| |
Collapse
|
28
|
van de Bool C, Rutten EP, Franssen FM, Wouters EF, Schols AM. Antagonistic implications of sarcopenia and abdominal obesity on physical performance in COPD. Eur Respir J 2015; 46:336-45. [DOI: 10.1183/09031936.00197314] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Accepted: 02/27/2015] [Indexed: 01/06/2023]
Abstract
Decreased physical performance due to loss of muscle mass (i.e. sarcopenia) is prevalent in ageing and appears more pronounced in chronic disease. A comprehensive profile of the sarcopenic phenotype in chronic obstructive pulmonary disease (COPD) is not yet available. The aim of the present study was to characterise prevalence, functional implications and predictive value of sarcopenia with or without abdominal obesity in Dutch COPD patients eligible for pulmonary rehabilitation.505 COPD patients (aged 37–87 years; 57% male) underwent assessment of lung function, body composition and physical functioning, before entering pulmonary rehabilitation. Sarcopenia was assessed by appendicular skeletal muscle index (ASMI) and abdominal obesity by android/gynoid percentage fat mass (A/G%FM) using dual energy X-ray absorptiometry.86.5% of patients were sarcopenic and showed lower physical functioning, while coexistent abdominal obesity (78.0%) resulted in higher physical functioning. Implications on endurance were less pronounced in women. The predictive value for physical functioning was higher for the “three-compartment” model (ASMI, bone mineral content and A/G%FM) than the “two-compartment” model (fat-free mass index and fat mass index) or “one-compartment” model (body mass index).In patients eligible for pulmonary rehabilitation, sarcopenia is highly prevalent in all body mass index categories and associated with impaired strength, and in men also with decreased endurance. Abdominal obesity seems to have protective effects on physical functioning. ASMI is a better predictor for physical functioning than fat-free mass index.
Collapse
|
29
|
Obesity and extent of emphysema depicted at CT. Clin Radiol 2015; 70:e14-9. [PMID: 25703460 DOI: 10.1016/j.crad.2015.01.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2014] [Revised: 12/23/2014] [Accepted: 01/16/2015] [Indexed: 11/22/2022]
Abstract
AIM To investigate the underlying relationship between obesity and the extent of emphysema depicted at CT. METHODS AND MATERIALS A dataset of 477 CT examinations was retrospectively collected from a study of chronic obstructive pulmonary disease (COPD). The low attenuation areas (LAAs; ≤950 HU) of the lungs were identified. The extent of emphysema (denoted as %LAA) was defined as the percentage of LAA divided by the lung volume. The association between log-transformed %LAA and body mass index (BMI) adjusted for age, sex, the forced expiratory volume in one second as percent predicted value (FEV1% predicted), and smoking history (pack years) was assessed using multiple linear regression analysis. RESULTS After adjusting for age, gender, smoking history, and FEV1% predicted, BMI was negatively associated with severe emphysema in patients with COPD. Specifically, one unit increase in BMI is associated with a 0.93-fold change (95% CI: 0.91-0.96, p<0.001) in %LAA; the estimated %LAA for males was 1.75 (95% CI: 1.36-2.26, p<0.001) times that of females; per 10% increase in FEV1% predicated is associated with a 0.72-fold change (95% CI: 0.69-0.76, p<0.001) in %LAA. CONCLUSION Increasing obesity is negatively associated with severity of emphysema independent of gender, age, and smoking history.
Collapse
|
30
|
When obesity and chronic obstructive pulmonary disease collide. Physiological and clinical consequences. Ann Am Thorac Soc 2015; 11:635-44. [PMID: 24625243 DOI: 10.1513/annalsats.201312-438fr] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
In many parts of the world, the prevalence of both chronic obstructive pulmonary disease (COPD) and obesity is increasing at an alarming rate. Such patients tend to have greater respiratory symptoms, more severe restriction of daily activities, poorer health-related quality of life, and greater health care use than their nonobese counterparts. Physiologically, increasing weight gain is associated with lung volume reduction effects in both health and disease, and this should be considered when interpreting common pulmonary function tests where lung volume is the denominator, such as FEV1/FVC and the ratio of diffusing capacity of carbon monoxide to alveolar volume, or indeed when evaluating the physiological consequences of emphysema in obese individuals. Contrary to expectation, the presence of mild to moderate obesity in COPD appears to have little deleterious effect on respiratory mechanics and muscle function, exertional dyspnea, and peak symptom-limited oxygen uptake during cardiopulmonary exercise testing. Thus, in evaluating obese patients with COPD reporting activity restriction, additional nonpulmonary factors, such as increased metabolic loading, cardiocirculatory impairment, and musculoskeletal abnormalities, should be considered. Care should be taken to recognize the presence of obstructive sleep apnea in obese patients with COPD, as effective treatment of the former condition likely conveys an important survival advantage. Finally, morbid obesity in COPD presents significant challenges to effective management, given the combined effects of erosion of the ventilatory reserve and serious metabolic and cardiovascular comorbidities that collectively predispose to an increased risk of death from respiratory failure.
Collapse
|
31
|
|
32
|
Diaz AA, Zhou L, Young TP, McDonald ML, Harmouche R, Ross JC, San Jose Estepar R, Wouters EFM, Coxson HO, MacNee W, Rennard S, Maltais F, Kinney GL, Hokanson JE, Washko GR. Chest CT measures of muscle and adipose tissue in COPD: gender-based differences in content and in relationships with blood biomarkers. Acad Radiol 2014; 21:1255-61. [PMID: 25088837 DOI: 10.1016/j.acra.2014.05.013] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Revised: 05/01/2014] [Accepted: 05/03/2014] [Indexed: 11/17/2022]
Abstract
RATIONALE AND OBJECTIVES Computed tomography (CT) of the chest can be used to assess pectoralis muscle area (PMA) and subcutaneous adipose tissue (SAT) area. Adipose tissue content is associated with inflammatory mediators in chronic obstructive pulmonary disease (COPD) subjects. Based on gender differences in body composition, we aimed to assess the hypothesis that in subjects with COPD, the relationships between PMA, SAT, and blood biomarkers of inflammation differ by gender. MATERIALS AND METHODS We compared chest CT measures of PMA and SAT on a single slice at aortic arch and supraesternal notch levels from 73 subjects (28 women) with COPD between genders. The relationships of PMA and SAT area to biomarkers were assessed using within-gender regression models. RESULTS Women had a lesser PMA and a greater SAT area than men (difference range for PMA, 13.3-22.8 cm²; for SAT, 11.8-12.4 cm²; P < .05 for all comparisons) at both anatomic levels. These differences in PMA and SAT remained significant after adjustment for age and body mass index. Within-gender regression models adjusted for age showed that SAT was directly associated with C-reactive protein (for aortic arch level, P = .04) and fibrinogen (for both anatomic locations, P = .003) only in women, whereas PMA was not associated with any biomarkers in either gender. CONCLUSIONS It appears that in subjects with COPD, there are gender-based differences in the relationships between subcutaneous adipose tissue and inflammatory biomarkers.
Collapse
Affiliation(s)
- Alejandro A Diaz
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115.
| | - Linfu Zhou
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115
| | - Tom P Young
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115
| | - Merry-Lynn McDonald
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Rola Harmouche
- Surgical Planning Laboratory, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - James C Ross
- Surgical Planning Laboratory, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Raul San Jose Estepar
- Surgical Planning Laboratory, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Harvey O Coxson
- Department of Radiology and James Hogg Research Centre, Institute for Heart and Lung Health, University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | - François Maltais
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, Quebec, Canada
| | - Gregory L Kinney
- Department of Epidemiology, Colorado School of Public Health, University of Colorado, Aurora, Colorado
| | - John E Hokanson
- Department of Epidemiology, Colorado School of Public Health, University of Colorado, Aurora, Colorado
| | - George R Washko
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115
| |
Collapse
|
33
|
Hanson C, Rutten EP, Wouters EFM, Rennard S. Influence of diet and obesity on COPD development and outcomes. Int J Chron Obstruct Pulmon Dis 2014; 9:723-33. [PMID: 25125974 PMCID: PMC4130708 DOI: 10.2147/copd.s50111] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The global increase in the prevalence and incidence of obesity has called serious attention to this issue as a major public health concern. Obesity is associated with many chronic diseases, including cardiovascular disease and diabetes, and recently the role of overweight and obesity in lung disease has received new interest. Independently of obesity, diet also plays a role as a risk factor for many chronic diseases, and evidence is accumulating to support a role for diet in the prevention and management of several lung diseases. Chronic obstructive lung disease is the third-leading cause of death globally, and both obesity and diet appear to play roles in its pathophysiology. Obesity has been associated with decreased lung-function measures in population-based studies, with increased prevalence of several lung diseases and with compromised pulmonary function. In contrast, obesity has a protective effect against mortality in severe chronic obstructive pulmonary disease (COPD). Nutrient intake and dietary patterns have also been associated with lung-function measures and the development and progression of COPD. Taken together, this suggests that a focus on obesity and diet should be part of public health campaigns to reduce the burden of lung disease, and could have important implications for clinicians in the management of their patients. Future research should also focus on elucidating these relationships in diverse populations and age-groups, and on understanding the complex interaction between behavior, environment, and genetics in the development and progression of COPD. The goal of this article is to review current evidence regarding the role that obesity and diet play in the development of COPD, and in COPD-related outcomes.
Collapse
Affiliation(s)
- Corrine Hanson
- Division of Medical Nutrition Education, School of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE, USA
| | - Erica P Rutten
- Research and Education, Centre of Expertise for Chronic Organ Failure, Horn, The Netherlands
| | - Emiel F M Wouters
- Research and Education, Centre of Expertise for Chronic Organ Failure, Horn, The Netherlands ; Department of Pulmonary Diseases, University of Maastricht, Maastricht, The Netherlands
| | - Stephen Rennard
- Division of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| |
Collapse
|
34
|
Theander K, Hasselgren M, Luhr K, Eckerblad J, Unosson M, Karlsson I. Symptoms and impact of symptoms on function and health in patients with chronic obstructive pulmonary disease and chronic heart failure in primary health care. Int J Chron Obstruct Pulmon Dis 2014; 9:785-94. [PMID: 25071370 PMCID: PMC4111648 DOI: 10.2147/copd.s62563] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Patients with chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF) seem to have several symptoms in common that impact health. However, methodological differences make this difficult to compare. Aim Comparisons of symptoms, impact of symptoms on function and health between patients with COPD and CHF in primary health care (PHC). Method The study is cross sectional, including patients with COPD (n=437) and CHF (n=388), registered in the patient administrative systems of PHC. The patients received specific questionnaires – the Memorial Symptom Assessment Scale, the Medical Research Council dyspnea scale, and the Fatigue Impact Scale – by mail and additional questions about psychological and physical health. Results The mean age was 70±10 years and 78±10 years for patients with COPD and CHF respectively (P=0.001). Patients with COPD (n=273) experienced more symptoms (11±7.5) than the CHF patients (n=211) (10±7.6). The most prevalent symptoms for patients with COPD were dyspnea, cough, and lack of energy. For patients with CHF, the most prevalent symptoms were dyspnea, lack of energy, and difficulty sleeping. Experience of dyspnea, cough, dry mouth, feeling irritable, worrying, and problems with sexual interest or activity were more common in patients with COPD while the experience of swelling of arms or legs was more common among patients with CHF. When controlling for background characteristics, there were no differences regarding feeling irritable, worrying, and sexual problems. There were no differences in impact of symptoms or health. Conclusion Patients with COPD and CHF seem to experience similar symptoms. There were no differences in how the patients perceived their functioning according to their cardinal symptoms; dyspnea and fatigue, and health. An intervention for both groups of patients to optimize the management of symptoms and improve function is probably more relevant in PHC than focusing on separate diagnosis groups.
Collapse
Affiliation(s)
- Kersti Theander
- Department of Nursing, Faculty of Health Science and Technology, Karlstad University, Karlstad, Sweden ; Primary Care Research Unit, County Council of Värmland, Karlstad, Sweden
| | - Mikael Hasselgren
- Primary Care Research Unit, County Council of Värmland, Karlstad, Sweden ; Department of Medicine, Örebro University, Örebro, Sweden
| | - Kristina Luhr
- Family Medicine Research Centre, Örebro County Council, Örebro, Sweden
| | - Jeanette Eckerblad
- Department of Social and Welfare Studies, Faculty of Health Sciences, Linköping University, Linköping, Sweden
| | - Mitra Unosson
- Department of Social and Welfare Studies, Faculty of Health Sciences, Linköping University, Linköping, Sweden
| | - Ingela Karlsson
- Department of Nursing, Faculty of Health Science and Technology, Karlstad University, Karlstad, Sweden
| |
Collapse
|
35
|
Abstract
BACKGROUND Overweight⁄obesity is associated with longer survival in chronically ill patients, a phenomenon referred to as the 'obesity paradox'. OBJECTIVE To investigate whether the obesity paradox in patients with chronic obstructive pulmonary disease (COPD) is due to fat accumulation or confounding factors. METHODS A total of 190 patients with stable COPD who underwent a mean (± SD) follow-up period of 72±34 months were enrolled. Anthropometry, pulmonary function tests, midthigh muscle cross-sectional area obtained using computed tomography (MTCSACT), arterial blood gas and exercise testing data were measured at baseline. Patients were categorized into two subgroups according to body mass index (BMI) <25 kg⁄m2 or ≥25 kg⁄m2 (normal and overweight⁄obese, respectively). RESULTS Seventy-two patients (38%) died during the follow-up period. Survival tended to be better in the overweight⁄obese patients but this difference did not reach statistical significance. Overweight⁄obese patients had better lung function and a larger MTCSACT than those with normal BMI (P<0.001). Overweight⁄obese patients also had a significantly higher peak work rate than patients with normal BMI (P<0.001). PaO2 and PaCO2 were not significantly different in the two groups. When adjusted for PaCO2, peak work rate and MTCSACT, the tendency for improved survival in overweight⁄obese patients disappeared. In fact, when these variables were considered in the survival analysis, patients with lower BMI tended to have better survival. CONCLUSION These results suggest that important confounders, such as hypercapnia, exercise capacity and muscle mass, should be considered when interpreting the association between increased BMI and survival in patients with COPD.
Collapse
|
36
|
Abstract
The systemic effects and comorbidities of chronic respiratory disease such as COPD contribute substantially to its burden. Symptoms in COPD do not solely arise from the degree of airflow obstruction as exercise limitation is compounded by the specific secondary manifestations of the disease including skeletal muscle impairment, osteoporosis, mood disturbance, anemia, and hormonal imbalance. Pulmonary rehabilitation targets the systemic manifestations of COPD, the causes of which include inactivity, systemic inflammation, hypoxia and corticosteroid treatment. Comorbidities are common, including cardiac disease, obesity, and metabolic syndrome and should not preclude pulmonary rehabilitation as they may also benefit from similar approaches.
Collapse
Affiliation(s)
- Rachael A Evans
- Department of Respiratory Medicine, Glenfield Hospital, Groby Road, Leicester LE3 9QP, UK
| | - Michael D L Morgan
- Department of Respiratory Medicine, Glenfield Hospital, Groby Road, Leicester LE3 9QP, UK.
| |
Collapse
|
37
|
Turnip H, Ratnawati A, Tulaar A, Yunus F, Kekalih A. Comparison of the effects of treadmill and ergocycle exercise on the functional capacity and quality of life of patients with chronic obstructive pulmonary disease. MEDICAL JOURNAL OF INDONESIA 2014. [DOI: 10.13181/mji.v23i1.726] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
|
38
|
Gagnon P, Guenette JA, Langer D, Laviolette L, Mainguy V, Maltais F, Ribeiro F, Saey D. Pathogenesis of hyperinflation in chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis 2014; 9:187-201. [PMID: 24600216 PMCID: PMC3933347 DOI: 10.2147/copd.s38934] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a preventable and treatable lung disease characterized by airflow limitation that is not fully reversible. In a significant proportion of patients with COPD, reduced lung elastic recoil combined with expiratory flow limitation leads to lung hyperinflation during the course of the disease. Development of hyperinflation during the course of COPD is insidious. Dynamic hyperinflation is highly prevalent in the advanced stages of COPD, and new evidence suggests that it also occurs in many patients with mild disease, independently of the presence of resting hyperinflation. Hyperinflation is clinically relevant for patients with COPD mainly because it contributes to dyspnea, exercise intolerance, skeletal muscle limitations, morbidity, and reduced physical activity levels associated with the disease. Various pharmacological and nonpharmacological interventions have been shown to reduce hyperinflation and delay the onset of ventilatory limitation in patients with COPD. The aim of this review is to address the more recent literature regarding the pathogenesis, assessment, and management of both static and dynamic lung hyperinflation in patients with COPD. We also address the influence of biological sex and obesity and new developments in our understanding of hyperinflation in patients with mild COPD and its evolution during progression of the disease.
Collapse
Affiliation(s)
- Philippe Gagnon
- Faculté de Médecine, Université Laval, Québec, QC, Canada ; Centre de Recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, QC, Canada
| | - Jordan A Guenette
- Centre for Heart Lung Innovation, University of British Columbia, St Paul's Hospital, Vancouver, BC, Canada ; Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Daniel Langer
- Department of Kinesiology and Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Louis Laviolette
- Centre de Recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, QC, Canada
| | | | - François Maltais
- Faculté de Médecine, Université Laval, Québec, QC, Canada ; Centre de Recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, QC, Canada
| | - Fernanda Ribeiro
- Faculté de Médecine, Université Laval, Québec, QC, Canada ; Centre de Recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, QC, Canada
| | - Didier Saey
- Faculté de Médecine, Université Laval, Québec, QC, Canada ; Centre de Recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, QC, Canada
| |
Collapse
|
39
|
Rodríguez DA, Garcia-Aymerich J, Valera JL, Sauleda J, Togores B, Galdiz JB, Gea J, Orozco-Levi M, Ferrer A, Gomez FP, Barberà JA, Serra I, Antó JM, Roca J. Determinants of exercise capacity in obese and non-obese COPD patients. Respir Med 2014; 108:745-51. [PMID: 24565602 DOI: 10.1016/j.rmed.2014.02.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2013] [Revised: 01/30/2014] [Accepted: 02/03/2014] [Indexed: 12/16/2022]
Abstract
BACKGROUND The effects of obesity in combination with chronic obstructive pulmonary disease (COPD) on exercise capacity are receiving increased attention. But, a comprehensive analysis of factors associated with aerobic capacity in obese COPD patients has not been performed. METHODS Six-min walking test (6MWT) was performed in 251 COPD patients, and 159 of those also carried out an incremental cardiopulmonary exercise test (CPET) to evaluate exercise capacity. In all patients, anthropometrics, dyspnea and anxiety-depression scores, lung function, daily physical activity, co-morbidities and circulating inflammatory biomarkers were also assessed. Six-min walking distance (6MWD) and peak oxygen uptake (VO2 peak) during CPET were two primary outcome variables. RESULTS 57% of the patients showed body mass index (BMI) < 30 kg/m2 (COPDN) and the remaining 43% were obese with a BMI ≥ 30 kg/m2 (COPDO). In patients with COPDN, 6MWD showed independent negative associations with age, dyspnea score, sedentarism, depression scores and a positive relationship with arterial oxygenation; whereas in COPDO, 6MWD showed an inverse relationship with BMI. In COPDN, VO2 peak showed a negative association with age and positive relationships with both FEV1 and DLCO. However, in COPDO the dyspnea score was the strongest determinant of VO2 peak. CONCLUSIONS Obese and non-obese COPD patients show different determinants of aerobic capacity, including pulmonary and non-pulmonary factors that are also dependent on the type of exercise protocol. These results could be considered in the evaluation of obese patients with COPD.
Collapse
Affiliation(s)
- Diego A Rodríguez
- Servei de Pneumologia (ICT), Hospital Clinic, IDIBAPS, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Universitat de Barcelona, Villaroel 170, 08036 Barcelona, Catalonia, Spain; Muscle and Respiratory System Research Unit and Respiratory Medicine Department, IMIM-Hospital del Mar, Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Health and Experimental Sciences Department (CEXS), Universitat Pompeu Fabra (UPF), Passeig Maritim 25, 08003 Barcelona, Catalonia, Spain.
| | - Judith Garcia-Aymerich
- Centre for Research in Environmental Epidemiology (CREAL), Department of Experimental and Health Sciences, Universitat Pompeu Fabra, CIBER EpidemiologÍa y Salud Pública (CIBERESP), Doctor Aiguader 88, 08003 Barcelona, Catalonia, Spain
| | - Jose L Valera
- Hospital Son Espases, Carretera de Valldemossa 79, 07120 Palma de Mallorca, Spain
| | - Jaume Sauleda
- Hospital Son Espases, Carretera de Valldemossa 79, 07120 Palma de Mallorca, Spain
| | - Bernat Togores
- Hospital Son Espases, Carretera de Valldemossa 79, 07120 Palma de Mallorca, Spain
| | - Juan B Galdiz
- Hospital Cruces, Universidad del País Vasco, Plaza de Cruces 12, 48903 San Vicente de Barakaldo, Vizcaya, Spain
| | - Joaquim Gea
- Muscle and Respiratory System Research Unit and Respiratory Medicine Department, IMIM-Hospital del Mar, Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Health and Experimental Sciences Department (CEXS), Universitat Pompeu Fabra (UPF), Passeig Maritim 25, 08003 Barcelona, Catalonia, Spain
| | - Mauricio Orozco-Levi
- Muscle and Respiratory System Research Unit and Respiratory Medicine Department, IMIM-Hospital del Mar, Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Health and Experimental Sciences Department (CEXS), Universitat Pompeu Fabra (UPF), Passeig Maritim 25, 08003 Barcelona, Catalonia, Spain; Respiratory Department, Fundación Cardiovascular de Colombia, Calle 155A No. 23-58, Urbanización El Bosque Floridablanca, Santander Floridablanca, Santander, Colombia
| | - Antoni Ferrer
- Muscle and Respiratory System Research Unit and Respiratory Medicine Department, IMIM-Hospital del Mar, Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Health and Experimental Sciences Department (CEXS), Universitat Pompeu Fabra (UPF), Passeig Maritim 25, 08003 Barcelona, Catalonia, Spain
| | - Federico P Gomez
- Servei de Pneumologia (ICT), Hospital Clinic, IDIBAPS, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Universitat de Barcelona, Villaroel 170, 08036 Barcelona, Catalonia, Spain
| | - Joan Albert Barberà
- Servei de Pneumologia (ICT), Hospital Clinic, IDIBAPS, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Universitat de Barcelona, Villaroel 170, 08036 Barcelona, Catalonia, Spain
| | - Ignasi Serra
- Centre for Research in Environmental Epidemiology (CREAL), CIBER EpidemiologÍa y Salud Pública (CIBERESP), Doctor Aiguader 88, 08003 Barcelona, Catalonia, Spain
| | - Josep M Antó
- Centre for Research in Environmental Epidemiology (CREAL), Municipal Institute of Medical Research (IMIM-Hospital del Mar), Department of Experimental and Health Sciences, Universitat Pompeu Fabra, CIBER EpidemiologÍa y Salud Pública (CIBERESP), Doctor Aiguader 88, 08003 Barcelona, Catalonia, Spain
| | - Josep Roca
- Servei de Pneumologia (ICT), Hospital Clinic, IDIBAPS, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Universitat de Barcelona, Villaroel 170, 08036 Barcelona, Catalonia, Spain
| |
Collapse
|
40
|
Bernard S, Ribeiro F, Maltais F, Saey D. Prescribing exercise training in pulmonary rehabilitation: a clinical experience. REVISTA PORTUGUESA DE PNEUMOLOGIA 2014; 20:92-100. [PMID: 24480488 DOI: 10.1016/j.rppneu.2013.10.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Accepted: 10/30/2013] [Indexed: 10/25/2022] Open
Abstract
Built around exercise training, pulmonary rehabilitation (PR) is a multidisciplinary, evidence-based, comprehensive approach to working with the patient as a whole and not just the pulmonary component of the disease. Integrated into the individualized treatment, this intervention aims to reduce symptoms, optimize functional status, increase participation in daily life, and reduce health care costs through stabilizing or reversing systemic manifestations of the disease. Although there are many other components that should be considered to manage the impairment and symptom burden, supervised exercise training is considered the cornerstone of effective pulmonary rehabilitation. This paper addresses our clinical experience at Institut universitaire de cardiologie et de pneumologie de Québec to assess and manage exercise training in line with the current recommendations and guidelines surrounding PR.
Collapse
Affiliation(s)
- S Bernard
- Centre de Recherche, Institut Universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec, Canada
| | - F Ribeiro
- Centre de Recherche, Institut Universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec, Canada
| | - F Maltais
- Centre de Recherche, Institut Universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec, Canada
| | - D Saey
- Centre de Recherche, Institut Universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec, Canada.
| |
Collapse
|
41
|
Li LSK, Caughey GE, Johnston KN. The association between co-morbidities and physical performance in people with chronic obstructive pulmonary disease. Chron Respir Dis 2014; 11:3-13. [DOI: 10.1177/1479972313516879] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
A systematic review was conducted to examine the association between co-morbidity and physical performance in people with chronic obstructive pulmonary disease (COPD). MEDLINE, EMBASE, CINAHL, SCOPUS and Cochrane Central Register of Controlled Trials were searched from inception to end-February 2013, using keywords ‘COPD’, ‘exercise’, ‘physical activity’, ‘rehabilitation’, ‘co-morbidity’ and individual co-morbid conditions. Studies reporting associations of co-morbidities in COPD with at least one objective measure of physical performance were included. Study quality was appraised using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist. Nine studies met inclusion criteria. Mean (standard deviation (SD)) STROBE score was 16 (3) (maximum score = 21). Four studies examined anxiety as a co-morbid condition; three examined depression; two examined obesity and two examined a range of conditions. Reduced physical performance was associated with higher Charlson score (odds ratio (OR) = 0.72, 95% confidence interval (CI) = 0.54–0.98), metabolic disease (OR = 0.58, 95% CI = 0.49–0.67), anxiety (OR = 0.37, 95% CI = 0.23–0.59) and osteoporosis (OR = 0.28, 95% CI = 0.11–0.70). Depression had minimal association with physical performance but was associated with higher dropout rates from pulmonary rehabilitation programmes. Obesity was negatively associated with baseline physical performance but not with change from an exercise intervention. The presence of co-morbid conditions in people with COPD may negatively affect physical performance and should be identified and accounted for analysis of interventions.
Collapse
Affiliation(s)
- Lok Sze Katrina Li
- School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Gillian E Caughey
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Kylie N Johnston
- School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| |
Collapse
|
42
|
Lewko A, Bidgood PL, Jewell A, Garrod R. Evaluation of multidimensional COPD-related subjective fatigue following a Pulmonary Rehabilitation programme. Respir Med 2014; 108:95-102. [DOI: 10.1016/j.rmed.2013.09.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Revised: 09/02/2013] [Accepted: 09/03/2013] [Indexed: 10/26/2022]
|
43
|
Hornikx M, Van Remoortel H, Demeyer H, Marcal Camillo CA, Decramer M, Janssens W, Troosters T. The influence of comorbidities on outcomes of pulmonary rehabilitation programs in patients with COPD: a systematic review. BIOMED RESEARCH INTERNATIONAL 2013; 2013:146148. [PMID: 24490146 PMCID: PMC3888706 DOI: 10.1155/2013/146148] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Accepted: 11/27/2013] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Chronic obstructive pulmonary disease (COPD) is associated with comorbidities such as cardiovascular disease, metabolic disease, osteoporosis, and anxiety and/or depression. Although pulmonary rehabilitation programs are proven to be beneficial in patients with COPD, it is unclear whether comorbidities influence pulmonary rehabilitation outcomes. The aim of the present review was to investigate to what extent the presence of comorbidities can affect pulmonary rehabilitation outcomes. METHODS The systematic literature search (Pubmed, EMBASE, and PEDro) resulted in 4 articles meeting the inclusion criteria. The odds ratios (95% confidence intervals) of the logistic regression analyses, with comorbidities as independent variables and pulmonary rehabilitation outcomes (dyspnea, functional exercise capacity, and quality of life) as dependent variables, were used for data extraction. RESULTS Patients with anxiety and/or depression less likely improve in dyspnea. Osteoporosis is associated with less improvements in functional exercise capacity, while cardiovascular disease does not seem to negatively impact on this outcome. Patients with cardiovascular comorbidity will experience less positive changes in quality of life. CONCLUSION Evidence from literature suggests that comorbidities can have a negative influence on pulmonary rehabilitation outcomes. Screening for comorbidities in pulmonary rehabilitation settings seems useful to readdress the right patients for individually tailored pulmonary rehabilitation.
Collapse
Affiliation(s)
- Miek Hornikx
- Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, KU Leuven, Belgium
- Respiratory Division and Rehabilitation, University Hospital Gasthuisberg, Herestraat 49, 3000 Leuven, Belgium
| | - Hans Van Remoortel
- Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, KU Leuven, Belgium
- Respiratory Division and Rehabilitation, University Hospital Gasthuisberg, Herestraat 49, 3000 Leuven, Belgium
| | - Heleen Demeyer
- Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, KU Leuven, Belgium
- Respiratory Division and Rehabilitation, University Hospital Gasthuisberg, Herestraat 49, 3000 Leuven, Belgium
| | - Carlos Augusto Marcal Camillo
- Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, KU Leuven, Belgium
- Respiratory Division and Rehabilitation, University Hospital Gasthuisberg, Herestraat 49, 3000 Leuven, Belgium
| | - Marc Decramer
- Respiratory Division and Rehabilitation, University Hospital Gasthuisberg, Herestraat 49, 3000 Leuven, Belgium
| | - Wim Janssens
- Respiratory Division and Rehabilitation, University Hospital Gasthuisberg, Herestraat 49, 3000 Leuven, Belgium
| | - Thierry Troosters
- Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, KU Leuven, Belgium
- Respiratory Division and Rehabilitation, University Hospital Gasthuisberg, Herestraat 49, 3000 Leuven, Belgium
| |
Collapse
|
44
|
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: 2176] [Impact Index Per Article: 197.8] [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.
Collapse
|
45
|
Clini E, Crisafulli E, Radaeli A, Malerba M. COPD and the metabolic syndrome: an intriguing association. Intern Emerg Med 2013; 8:283-9. [PMID: 21964838 DOI: 10.1007/s11739-011-0700-x] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2011] [Accepted: 09/17/2011] [Indexed: 11/26/2022]
Abstract
Chronic Obstructive Pulmonary Disease (COPD) has been recently recognized as a condition involving more than the lungs. The presence of common factors in COPD and in other chronic extra-pulmonary diseases, as well as the co-existence of these conditions in the same adult individual, supports the hypothesis of a shared pathogenetic pathway. We will here review the interplay between coexisting COPD and the metabolic syndrome (MS), based on the most updated knowledge. We will discuss this clinical condition from the definition, to the pathophysiology and to the clinical implications. Basically, MS is more likely to be present in a COPD patients, and increased levels of circulatory pro-inflammatory proteins from both the lung and adipose tissue coincide in these patients. The relative impact of the coexisting COPD and MS may depend on several factors: the presence of physical inactivity and of systemic inflammation related to a smoking habit, sedentary lifestyle, airway inflammation and obstruction, adipose tissue and inflammatory marker activation. More studies will be required to elucidate the association between COPD and MS and to formulate individualized management approaches for this specific disease phenotype.
Collapse
Affiliation(s)
- Enrico Clini
- Department of Oncology, Haematology and Pneumology, University of Modena, Modena, Italy.
| | | | | | | |
Collapse
|
46
|
Ribeiro F, Thériault ME, Debigaré R, Maltais F. Should all patients with COPD be exercise trained? J Appl Physiol (1985) 2013; 114:1300-8. [PMID: 23412902 DOI: 10.1152/japplphysiol.01124.2012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Exercise training is one of the most powerful interventions to provide symptomatic relief in patients with chronic obstructive pulmonary disease (COPD). The purpose of this minireview is to discuss how exercise training can improve limb muscle dysfunction in this disease. Various exercise training strategies will be outlined, along with their beneficial effects and potential limitations. Strategies to optimize the gains achievable with exercise training will be presented. Whether exercise training may exert deleterious effects in some patients will also be discussed.
Collapse
Affiliation(s)
- Fernanda Ribeiro
- Centre de Recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, Canada
| | | | | | | |
Collapse
|
47
|
|
48
|
Herer B. [Outcomes of a pulmonary rehabilitation program including singing training]. Rev Mal Respir 2012; 30:194-202. [PMID: 23497929 DOI: 10.1016/j.rmr.2012.10.602] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2012] [Accepted: 10/08/2012] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Respiratory education by singing may be considered in the course of pulmonary rehabilitation to help control breathing and reduce dyspnoea. METHODS We have undertaken singing training during pulmonary rehabilitation in 45 patients, mean age 60.1 ± 10.0 years, suffering from COPD (n=37) or other chronic respiratory disorders (n=8). The parameters measured at the beginning and end of course of rehabilitation were: forced vital capacity, FEV1, total lung capacity, residual volume, 6 min walking distance, VO2max, maximum pressure, MRC dyspnoea score, Cincinnati questionnaires and VSRQ (simplified visual respiratory questionnaire). RESULTS The following were the principal significant variations observed (initial value, % variation, significance): 6 minutes walk (326 ± 114 m, +13.8%, P=0.006); VO2max (18,1 ± 6.1 ml/kg/min, +8.3%, P=0.01); P max (75 ± 31 W, +14.7%, P=0.001); MRC score (2.3 ± 0.6, -21.7%, P<10(-4)); VSRQ score (34 ± 13, +50.0%, P<10(-6)). There was no significant change in the level of dyspnoea evaluated by the Cincinnati score. CONCLUSION These results are in favor of a beneficial effect of singing during pulmonary rehabilitation.
Collapse
Affiliation(s)
- B Herer
- Service de pneumologie, centre médical de Forcilles, 77170 Férolles-Attilly, France.
| |
Collapse
|
49
|
Carlin BW. COPD and associated comorbidities: a review of current diagnosis and treatment. Postgrad Med 2012; 124:225-40. [PMID: 22913911 DOI: 10.3810/pgm.2012.07.2582] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Health care utilization and costs associated with chronic obstructive pulmonary disease (COPD) continue to increase, notwithstanding evidence-based management strategies described by major respiratory societies. Cardiovascular diseases, asthma, diabetes and its precursors (obesity and metabolic syndrome), depression, cognitive impairment, and osteoporosis are examples of common comorbidities that can affect or be affected by COPD. Appropriate diagnosis and management (from a pharmacologic and nonpharmacologic perspective) of COPD and its associated comorbidities are important to ensure optimal patient care. An evolving understanding of COPD as a multimorbid disease that affects an aging population, rather than just a lung-specific disease, necessitates an integrated, tailored disease-management approach to improve prognoses and reduce costs.
Collapse
Affiliation(s)
- Brian W Carlin
- Drexel University School of Medicine, Allegheny General Hospital, Pittsburgh, PA, USA.
| |
Collapse
|
50
|
Prevalence, risk factors, activity limitation and health care utilization of an obese, population-based sample with chronic obstructive pulmonary disease. Can Respir J 2012; 19:e18-24. [PMID: 22679617 DOI: 10.1155/2012/732618] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND To estimate the prevalence and determine the risk factors and health associations among individuals with combined chronic obstructive pulmonary disease and obesity. METHODS Canadian national health survey data from 1994 to 2007 (n=650,000) were used. The presence of COPD was based on health professional-diagnosed self-report. The presence of obesity, defined by body mass index ≥ 30 kg⁄m2, was identified using self-reported and measured height and weight. Hospitalization, homecare use, physical activity assessments and socioeconomic data were all self-reported. RESULTS In 2005, the prevalence of obesity in COPD (n=3470) and non-COPD (n=92,237) individuals was 24.6% and 17.1%, respectively (P<0.0001). In contrast to the non-COPD group, in which obesity prevalence increased by 38% over 14 years, obesity prevalence increased by only 5% in people with COPD over this same time period. Female sex was the only independent risk factor for obesity in COPD. Previous smoking, residing in Atlantic Canada and the Territories, and low education level were independent risk factors for obesity in the non-COPD group, but not in the COPD group. The odds of physical activity limitation and health care utilization were significantly higher among obese individuals with COPD compared with nonobese COPD and obese non-COPD groups. CONCLUSIONS The prevalence of obesity was higher in COPD, and exceeded that of the larger non-COPD group throughout the 13-year observation period. The presence of obesity in COPD was associated with significantly higher risk of severe activity limitation and increased health care utilization. The combination of obesity and COPD has major implications for health care delivery that has not been previously appreciated.
Collapse
|