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Aldhahi MI, Baattaiah BA, Alharbi MD, Alotaibi M, Nazer R, Albarrati A. Multifaceted associations between walking performance, physical fitness, extremity function, health status, and depression in individuals with COPD. Ann Med 2024; 56:2338248. [PMID: 38590164 PMCID: PMC11005873 DOI: 10.1080/07853890.2024.2338248] [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: 10/18/2023] [Accepted: 03/06/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND/OBJECTIVE(S) Chronic obstructive pulmonary disease (COPD) can precipitate a deterioration of an individual's physical performance and overall health. Evidence suggests that, along with pulmonary functions, several other factors are related to the significant impairment of walking performance in individuals with COPD. This study compared the depressive symptoms, health status, upper and lower extremity functions, and peak oxygen uptake (VO2peak) in a group of individuals with COPD based on walking performance using a cutoff distance of 350 m in the six-minute walking test (6MWT). The study also investigated the associations between these factors and walking performance. MATERIALS AND METHODS Participants performed the 6MWT according to the guidelines and were classified into high (>350 m; n = 40) or low (<350 m; n = 30) walking performance groups according to distance. The forced expiratory volume (FEV1), forced vital capacity (FVC), and FEV1/FVC ratio were recorded. Participants completed the Patient Health Questionnaire-9 (PHQ-9), St. George's Respiratory Questionnaire (SGRQ), and the Upper and Lower Extremity Functional Index (UEFI/LEFI). Predicted VO2peak was measured using the Duke Activity Status Index (DASI). RESULTS Seventy participants with a mean age of 63 ± 11 years (20% female) were enrolled in this study. Patients with high walking performance demonstrated significantly better health status than those with low walking performance (SGRQ: 49 ± 25 vs. 56 ± 21, p = 0.03). Participants with low walking performance had lower predicted VO2peak compared to their higher performing counterparts (p = 0.002). The overall model was significant (F(8, 61) = 7.48, p = 0.0006), with PHQ-9, SGRQ, UEFI/LEFI, VO2peak, and FEV1/FVC explaining approximately 49.5% of the variance in the 6MWT distance. CONCLUSION This study shed light on the association of depressive symptoms, health status, extremity function, and VO2peak with walking performance, providing valuable insights that may impact the management and care of individuals with COPD.
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Affiliation(s)
- Monira I. Aldhahi
- Department of Rehabilitation Sciences, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Baian A. Baattaiah
- Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mutasim D. Alharbi
- Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mansour Alotaibi
- Department of Rehabilitation, Faculty of Applied Medical Sciences, Northern Border University, Arar, Saudi Arabia
| | - Rakan Nazer
- Cardiac Sciences Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ali Albarrati
- Rehabilitation Sciences Department, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
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Coleman SRM, Menson KE, Katz BR, DeSarno MJ, Gaalema DE. Examining Associations Between Baseline Health-Related Quality of Life and Depression and Physical Functioning Improvement Following Pulmonary Rehabilitation. J Cardiopulm Rehabil Prev 2024; 44:187-193. [PMID: 38488134 PMCID: PMC11065617 DOI: 10.1097/hcr.0000000000000844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/03/2024]
Abstract
PURPOSE This study examined whether health-related quality of life (HRQL) and depression assessed prior to pulmonary rehabilitation (PR) participation (ie, at baseline) predicted change in 6-min walk distance (6MWD) from baseline to end of PR. METHODS Patients with pulmonary disease were consecutively referred/enrolled in a PR program from 2009-2022 (N = 503). Baseline 6MWD was assessed along with self-report measures of HRQL (St George's Respiratory Questionnaire [SGRQ]) and depression (Geriatric Depression Scale [GDS]). The SGRQ total score was used to assess overall HRQL, and SGRQ subscales assessed pulmonary symptoms, activity limitations, and psychosocial impacts of pulmonary disease. Multiple linear regression was used to examine whether baseline SGRQ scores and depression predicted Δ6MWD. RESULTS Baseline SGRQ total score ( F(1,389) = 8.4, P = .004) and activity limitations ( F(1,388) = 4.8, P = .03) predicted Δ6MWD. Patients with an SGRQ activity limitation score ≤ 25th percentile showed the most 6MWD improvement (mean = 79.7 m, SE = 6.7), and significantly more improvement than participants scoring between the 50-75th percentiles (mean = 54.4 m, SE = 6.0) or >75th percentile (mean = 48.7 m, SE = 7.5). Patients scoring between the 25-50th percentiles (mean = 70.2 m, SE = 6.1) did not differ significantly from other groups. The SGRQ symptoms and impacts subscales were unrelated to Δ6MWD ( F(1,388) = 1.2-1.9, P > .05), as was depression ( F(1,311) = 0.0, P > .85). CONCLUSIONS Patients with greater HRQL at baseline may experience greater physical functioning improvement following PR. Additional support for patients with lower HRQL (eg, adjunctive self-management interventions) may enhance PR outcomes, particularly for patients who report greater activity limitations. Alternatively, early referral to PR (ie, when less symptomatic) may also benefit physical function outcomes.
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Affiliation(s)
- Sulamunn R. M. Coleman
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT
- Department of Psychiatry, University of Vermont, Burlington, VT
| | - Katherine E. Menson
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT
- Division of Pulmonary and Critical Care Medicine, University of Vermont, Burlington, VT
| | - Brian R. Katz
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT
- Department of Psychiatry, University of Vermont, Burlington, VT
| | - Michael J. DeSarno
- Department of Medical Biostatistics, University of Vermont, Burlington, VT
| | - Diann E. Gaalema
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT
- Department of Psychiatry, University of Vermont, Burlington, VT
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Robson LS, Abulimiti A, Granados JZ, Zia AN, Balmain BN, Pawelczyk JA, Babb TG. Pediatric patients diagnosed as overweight and obese have an elevated risk of dyspnea. Respir Physiol Neurobiol 2024; 323:104230. [PMID: 38340972 PMCID: PMC10947832 DOI: 10.1016/j.resp.2024.104230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 01/28/2024] [Accepted: 02/02/2024] [Indexed: 02/12/2024]
Abstract
We investigated whether pediatric patients with overweight and obesity are more likely to have dyspnea compared with those who are non-overweight. We collected de-identified data from TriNetX, a global federated multicenter research database, using both the UT Southwestern Medical Center and multinational Research Networks. Our analysis focused on patients aged 8-12 years. We identified overweight and obesity using ICD-10-CM codes E66 and dyspnea using code R06.0. Patients with overweight and obesity had a significantly higher risk of dyspnea compared with those who were non-overweight. This association was observed in both the UT Southwestern Network (risk ratio: 1.81, p < 0.001) and the Research Network (risk ratio: 2.70, p < 0.001). Furthermore, within the UT Southwestern Network, the risk was found to be higher in females compared with males (risk ratio: 2.17 vs. 1.67). These results have significant clinical implications, suggesting that clinicians should consider overweight and obesity as independent risk factors for dyspnea in pediatric patients after excluding other possible contributing factors.
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Affiliation(s)
- Lydia S Robson
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, USA
| | - Abidan Abulimiti
- Institute for Exercise and Environmental Medicine, University of Texas Southwestern Medical Center and Texas Health Presbyterian Hospital Dallas, USA
| | - Jorge Z Granados
- Institute for Exercise and Environmental Medicine, University of Texas Southwestern Medical Center and Texas Health Presbyterian Hospital Dallas, USA
| | - Ayesha N Zia
- Department of Pediatrics, University of Texas Southwestern Medical Center, USA
| | - Bryce N Balmain
- Institute for Exercise and Environmental Medicine, University of Texas Southwestern Medical Center and Texas Health Presbyterian Hospital Dallas, USA
| | - James A Pawelczyk
- Noll Physiological Research Center, Department of Kinesiology, Penn State University, USA
| | - Tony G Babb
- Institute for Exercise and Environmental Medicine, University of Texas Southwestern Medical Center and Texas Health Presbyterian Hospital Dallas, USA.
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Liang KJ, Cheng CH, Liu CY, Hsu SC, von Leupoldt A, Jelinčić V, Chan PYS. Neural oscillations underlying the neural gating of respiratory sensations in generalized anxiety disorder. Respir Physiol Neurobiol 2024; 321:104215. [PMID: 38211904 DOI: 10.1016/j.resp.2024.104215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 12/16/2023] [Accepted: 01/04/2024] [Indexed: 01/13/2024]
Abstract
Individuals with generalized anxiety disorder (GAD) have been shown to have altered neural gating of respiratory sensations (NGRS) using respiratory-related evoked potentials (RREP); however, corresponding neural oscillatory activities remain unexplored. The present study aimed to investigate altered NGRS in individuals with GAD using both time and time-frequency analysis. Nineteen individuals with GAD and 28 healthy controls were recruited. Paired inspiratory occlusions were delivered to elicit cortical neural activations measured from electroencephalography. The GAD group showed smaller N1 amplitudes to the first stimulus (S1), lower evoked gamma and larger evoked beta oscillations compared to controls. Both groups showed larger N1, P3, beta power and theta power in response to S1 compared to S2, suggesting a neural gating phenomenon. These findings suggest that N1, gamma and beta frequency oscillations may be indicators for altered respiratory sensation in GAD populations and that the N1, P3, beta and theta oscillations can reflect the neural gating of respiratory sensations.
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Affiliation(s)
- Kai-Jie Liang
- Department of Occupational Therapy, College of Medical Science and Technology, Chung Shan Medical University, Taichung, Taiwan; Department of Occupational Therapy, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chia-Hsiung Cheng
- Department of Occupational Therapy, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Psychiatry, Chang Gung Memorial Hospital at Linkuo, Taoyuan, Taiwan; Laboratory of Brain Imaging and Neural Dynamics (BIND Lab), Chang Gung University, Taoyuan, Taiwan
| | - Chia-Yih Liu
- Department of Psychiatry, Chang Gung Memorial Hospital at Linkuo, Taoyuan, Taiwan; Department of Psychiatry, New Taipei City Municipal Tucheng Hospital
| | - Shih-Chieh Hsu
- Department of Psychiatry, Chang Gung Memorial Hospital at Linkuo, Taoyuan, Taiwan; Department of Psychiatry, New Taipei City Municipal Tucheng Hospital
| | | | | | - Pei-Ying S Chan
- Department of Occupational Therapy, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Psychiatry, Chang Gung Memorial Hospital at Linkuo, Taoyuan, Taiwan.
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Pavy F, Torta DM, von Leupoldt A. The effect of unpredictability on the perception of breathlessness: a narrative review. FRONTIERS IN REHABILITATION SCIENCES 2024; 4:1339072. [PMID: 38264214 PMCID: PMC10803486 DOI: 10.3389/fresc.2023.1339072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 12/21/2023] [Indexed: 01/25/2024]
Abstract
Breathlessness is an aversive bodily sensation impacting millions of people worldwide. It is often highly detrimental for patients and can lead to profound distress and suffering. Notably, unpredictable breathlessness episodes are often reported as being more severe and unpleasant than predictable episodes, but the underlying reasons have not yet been firmly established in experimental studies. This review aimed to summarize the available empirical evidence about the perception of unpredictable breathlessness in the adult population. Specifically, we examined: (1) effects of unpredictable relative to predictable episodes of breathlessness on their perceived intensity and unpleasantness, (2) potentially associated neural and psychophysiological correlates, (3) potentially related factors such as state and trait negative affectivity. Nine studies were identified and integrated in this review, all of them conducted in healthy adult participants. The main finding across studies suggested that unpredictable compared to predictable, breathlessness elicits more frequently states of high fear and distress, which may contribute to amplify the perception of unpredictable breathlessness, especially its unpleasantness. Trait negative affectivity did not seem to directly affect the perception of unpredictable breathlessness. However, it seemed to reinforce state fear and anxiety, hence possible indirect modulatory pathways through these affective states. Studies investigating neural correlates of breathlessness perception and psychophysiological measures did not show clear associations with unpredictability. We discuss the implication of these results for future research and clinical applications, which necessitate further investigations, especially in clinical samples suffering from breathlessness.
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Affiliation(s)
- Fabien Pavy
- Research Group Health Psychology, Department of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
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6
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Liang KJ, Cheng CH, Liu CY, von Leupoldt A, Jelinčić V, Chan PYS. Neural oscillatory markers of respiratory sensory gating in human cortices. Biomed J 2023; 47:100683. [PMID: 38081385 PMCID: PMC11401183 DOI: 10.1016/j.bj.2023.100683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 11/09/2023] [Accepted: 12/05/2023] [Indexed: 09/01/2024] Open
Abstract
BACKGROUND Human respiratory sensory gating is a neural process associated with inhibiting the cortical processing of repetitive respiratory mechanical stimuli. While this gating is typically examined in the time domain, the neural oscillatory dynamics, which could offer supplementary insights into respiratory sensory gating, remain unknown. The purpose of the present study was to investigate central neural gating of respiratory sensation using both time- and frequency-domain analyses. METHODS A total of 37 healthy adults participated in this study. Two transient inspiratory occlusions were presented within one inspiration, while responses in the electroencephalogram (EEG) were recorded. N1 amplitudes and oscillatory activities to the first stimulus (S1) and the second stimulus (S2) were measured. The perceived level of breathlessness and level of unpleasantness elicited by the occlusions were measured after the experiment. RESULTS As expected, the N1 peak amplitude to the S1 was significantly larger than to the S2. The averaged respiratory sensory gating S2/S1 ratio for the N1 peak amplitude was 0.71. For both the evoked- and induced-oscillations, time-frequency analysis showed higher theta activations in response to S1 relative to S2. A positive correlation was observed between the perceived unpleasantness and induced theta power. CONCLUSIONS Our results suggest that theta oscillations, evoked as well as induced, reflect the "gating" of respiratory sensation. Theta oscillation, particularly theta-induced power, may be indicative of the emotional processing of respiratory mechanosensation. The findings of this study serve as a foundation for future investigations into the underlying mechanisms of respiratory sensory gating, particularly in patient populations.
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Affiliation(s)
- Kai-Jie Liang
- Department of Occupational Therapy, College of Medical Science and Technology, Chung Shan Medical University, Taichung, Taiwan; Department of Occupational Therapy, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chia-Hsiung Cheng
- Department of Occupational Therapy, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Psychiatry, Chang Gung Memorial Hospital at Linkuo, Taoyuan, Taiwan; Laboratory of Brain Imaging and Neural Dynamics (BIND Lab), Chang Gung University, Taoyuan, Taiwan
| | - Chia-Yih Liu
- Department of Psychiatry, Chang Gung Memorial Hospital at Linkuo, Taoyuan, Taiwan
| | - Andreas von Leupoldt
- Research Group Health Psychology, Faculty of Psychology and Educational Sciences, KU Leuven, Belgium
| | - Valentina Jelinčić
- Research Group Health Psychology, Faculty of Psychology and Educational Sciences, KU Leuven, Belgium
| | - Pei-Ying S Chan
- Department of Occupational Therapy, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Psychiatry, Chang Gung Memorial Hospital at Linkuo, Taoyuan, Taiwan.
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Norweg A, Hofferber B, Oh C, Spinner M, Stavrolakes K, Pavol M, DiMango A, Raveis VH, Murphy CG, Allegrante JP, Buchholz D, Zarate A, Simon N. Capnography-Assisted Learned, Monitored (CALM) breathing therapy for dysfunctional breathing in COPD: A bridge to pulmonary rehabilitation. Contemp Clin Trials 2023; 134:107340. [PMID: 37730198 DOI: 10.1016/j.cct.2023.107340] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 07/20/2023] [Accepted: 09/15/2023] [Indexed: 09/22/2023]
Abstract
BACKGROUND Although dyspnea is a primary symptom of chronic obstructive pulmonary disease (COPD), its treatment is suboptimal. In both COPD and acute anxiety, breathing patterns become dysregulated, contributing to abnormal CO2, dyspnea, and inefficient recovery from breathing challenges. While pulmonary rehabilitation (PR) improves dyspnea, only 1-2% of patients access it. Individuals with anxiety who use PR have worse outcomes. METHODS We present the protocol of a randomized controlled trial designed to determine the feasibility and acceptability of a new, four-week mind-body intervention that we developed, called "Capnography-Assisted Learned, Monitored (CALM) Breathing," as an adjunct to PR. Eligible participants are randomized in a 1:1 ratio to either CALM Breathing program or Usual Care. CALM Breathing consists of 10 core, slow breathing exercises combined with real time biofeedback (of end-tidal CO2, respiratory rate, and airflow) and motivational interviewing. CALM Breathing promotes self-regulated breathing, linking CO2 changes to dyspnea and anxiety symptoms and targeting breathing efficiency and self-efficacy in COPD. Participants are randomized to CALM Breathing or a Usual Care control group. RESULTS Primary outcomes include feasibility and acceptability metrics of recruitment efficiency, participant retention, intervention adherence and fidelity, PR facilitation, patient satisfaction, and favorable themes from interviews. Secondary outcomes include breathing biomarkers, symptoms, health-related quality of life, six-minute walk distance, lung function, mood, physical activity, and PR utilization and engagement. CONCLUSION By disrupting the cycle of dyspnea and anxiety, and providing a needed bridge to PR, CALM Breathing may address a substantive gap in healthcare and optimize treatment for patients with COPD.
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Affiliation(s)
- Anna Norweg
- Department of Rehabilitation and Regenerative Medicine, Columbia University Irving Medical Center, New York, NY, USA.
| | - Brittany Hofferber
- Department of Rehabilitation and Regenerative Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Cheongeun Oh
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Michael Spinner
- Department of Rehabilitation and Regenerative Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Kimberly Stavrolakes
- Outpatient Pulmonary Rehabilitation Program, New York Presbyterian Hospital, New York, NY, USA
| | - Marykay Pavol
- Department of Rehabilitation and Regenerative Medicine, Columbia University Irving Medical Center, New York, NY, USA; Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - Angela DiMango
- Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Victoria H Raveis
- Department of Cariology and Comprehensive Care, College of Dentistry, New York University, New York, NY, USA
| | - Charles G Murphy
- Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - John P Allegrante
- Department of Health and Behavior Studies, Teachers College, Columbia University, New York, NY, USA; Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - David Buchholz
- Department of Primary Care, Columbia University Irving Medical Center, New York, NY, USA
| | - Alejandro Zarate
- Department of Rehabilitation Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Naomi Simon
- Department of Psychiatry, New York University Grossman School of Medicine, New York, NY, USA
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Chauvin SR, Otoo-Appiah J, Zheng A, Ibrahim CH, Ma JE, Rozenberg D, Reid WD. Dyspnea induced by inspiratory loading limits dual-tasking in healthy young adults. PLoS One 2023; 18:e0286265. [PMID: 37228125 DOI: 10.1371/journal.pone.0286265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 05/12/2023] [Indexed: 05/27/2023] Open
Abstract
OBJECTIVES Dyspnea is a common and multidimensional experience of healthy adults and those with respiratory disorders. Due to its neural processing, it may limit or interfere with cognition, which may be examined with a dual-task paradigm. The aim of this study was to compare single-task performance of Stroop Colour and Word Test (SCWT) or inspiratory threshold loading (ITL) to their combined dual-task performance. Secondly, whether mood was related to dyspnea or cognitive performance was also evaluated. MATERIALS & METHODS A virtual pre-post design examined single (SCWT and ITL) and dual-task (SCWT+ITL) performance. For ITL, a Threshold Trainer™ was used to elicit a "somewhat severe" rating of dyspnea. The SCWT required participants to indicate whether a colour-word was congruent or incongruent with its semantic meaning. The Depression, Anxiety and Stress Scale-21 (DASS-21) was completed to assess mood. Breathing frequency, Borg dyspnea rating, and breathing endurance time were ascertained. RESULTS Thirty young healthy adults (15F, 15M; median age = 24, IQR [23-26] years) completed the study. SCWT+ITL had lower SCWT accuracy compared to SCWT alone (98.6%, [97.1-100.0] vs 99.5%, [98.6-100.0]; p = 0.009). Endurance time was not different between ITL and SCWT+ITL (14.5 minutes, [6.9-15.0]) vs 13.7 minutes, [6.1-15.0]; p = 0.59). DASS-21 scores positively correlated with dyspnea scores during ITL (rho = 0.583, p<0.001) and SCWT+ITL (rho = 0.592, p<0.001). CONCLUSIONS ITL significantly reduced dual-task performance in healthy young adults. Lower mood was associated with greater perceived dyspnea during single and dual-task ITL. Considering the prevalence of dyspnea in respiratory disorders, the findings of this dual task paradigm warrant further exploration to inform dyspnea management during daily activities.
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Affiliation(s)
| | | | - Anna Zheng
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - Chris H Ibrahim
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - James E Ma
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - Dmitry Rozenberg
- Respirology, Ajmera Transplant Center, University Health Network, Toronto, ON, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - W Darlene Reid
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
- KITE-Toronto-Rehab-University Health Network, Toronto, ON, Canada
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Volpato E, Farver-Vestergaard I, Brighton LJ, Peters J, Verkleij M, Hutchinson A, Heijmans M, von Leupoldt A. Nonpharmacological management of psychological distress in people with COPD. Eur Respir Rev 2023; 32:32/167/220170. [PMID: 36948501 PMCID: PMC10032611 DOI: 10.1183/16000617.0170-2022] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 12/31/2022] [Indexed: 03/24/2023] Open
Abstract
Psychological distress is prevalent in people with COPD and relates to a worse course of disease. It often remains unrecognised and untreated, intensifying the burden on patients, carers and healthcare systems. Nonpharmacological management strategies have been suggested as important elements to manage psychological distress in COPD. Therefore, this review presents instruments for detecting psychological distress in COPD and provides an overview of available nonpharmacological management strategies together with available scientific evidence for their presumed benefits in COPD. Several instruments are available for detecting psychological distress in COPD, including simple questions, questionnaires and clinical diagnostic interviews, but their implementation in clinical practice is limited and heterogeneous. Moreover, various nonpharmacological management options are available for COPD, ranging from specific cognitive behavioural therapy (CBT) to multi-component pulmonary rehabilitation (PR) programmes. These interventions vary substantially in their specific content, intensity and duration across studies. Similarly, available evidence regarding their efficacy varies significantly, with the strongest evidence currently for CBT or PR. Further randomised controlled trials are needed with larger, culturally diverse samples and long-term follow-ups. Moreover, effective nonpharmacological interventions should be implemented more in the clinical routine. Respective barriers for patients, caregivers, clinicians, healthcare systems and research need to be overcome.
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Affiliation(s)
- Eleonora Volpato
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
- IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
- Shared first authorship
| | | | - Lisa Jane Brighton
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Jeannette Peters
- Department of Pulmonary Diseases, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Marieke Verkleij
- Department of Paediatric Psychology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | - Monique Heijmans
- Netherlands Institute for Health Services Research (Nivel), Utrecht, The Netherlands
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Rahi MS, Thilagar B, Balaji S, Prabhakaran SY, Mudgal M, Rajoo S, Yella PR, Satija P, Zagorulko A, Gunasekaran K. The Impact of Anxiety and Depression in Chronic Obstructive Pulmonary Disease. Adv Respir Med 2023; 91:123-134. [PMID: 36960961 PMCID: PMC10037643 DOI: 10.3390/arm91020011] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 02/28/2023] [Accepted: 03/06/2023] [Indexed: 03/18/2023]
Abstract
Patients with COPD (chronic obstructive pulmonary disease) are at a higher risk of comorbid conditions such as anxiety and/or depression, which in turn increase their symptom burden and rehospitalizations compared to the general population. It is important to investigate the pathophysiology and clinical implications of mental health on patients with COPD. This review article finds that COPD patients with anxiety and/or depression have a higher rehospitalization incidence. It reviews the current screening and diagnosis methods available. There are pharmacological and non-pharmacologic interventions available for treatment of COPD patients with depression based on severity. COPD patients with mild depression benefit from pulmonary rehabilitation and cognitive behavioral therapy, whereas patients with severe or persistent depression can be treated with pharmacologic interventions.
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Affiliation(s)
- Mandeep Singh Rahi
- Department of Pulmonary and Critical Care Medicine, Yale New Haven Health, Lawrence + Memorial Hospital, New London, CT 06320, USA
| | - Bright Thilagar
- Department of Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Swetha Balaji
- Division of Endocrinology and Metabolism, Department of Medicine, University of Illinois, Chicago, IL 60607, USA
| | | | - Mayuri Mudgal
- Department of Medicine, Camden Clark Medical Center, School of Medicine, West Virginia University, Parkersburg, WV 26101, USA
| | - Suganiya Rajoo
- Department of Hematology and Oncology, WakeMed, Raleigh Campus, Raleigh, NC 27610, USA
| | - Prashanth Reddy Yella
- Department of Internal Medicine, Yuma Regional Medical Center, 2400 S Avenue A, Yuma, AZ 85364, USA
| | - Palak Satija
- Department of Internal Medicine, Yuma Regional Medical Center, 2400 S Avenue A, Yuma, AZ 85364, USA
| | - Alsu Zagorulko
- Department of Psychiatry, Illinois Center for Neurological and Behavioral Medicine, Des Plaines, IL 60016, USA
| | - Kulothungan Gunasekaran
- Department of Pulmonary Diseases and Critical Care, Yuma Regional Medical Center, Yuma, AZ 85364, USA
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Norweg AM, Wu Y, Troxel A, Whiteson JH, Collins E, Haas F, Skamai A, Goldring R, Jean-Louis G, Reibman J, Ehrlich-Jones L, Simon N. Mind-Body Intervention for Dysfunctional Breathing in Chronic Obstructive Pulmonary Disease: Feasibility Study and Lessons Learned. JOURNAL OF INTEGRATIVE AND COMPLEMENTARY MEDICINE 2023; 29:156-168. [PMID: 36800224 PMCID: PMC10024272 DOI: 10.1089/jicm.2022.0552] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Purpose: Dysfunctional breathing behaviors are prevalent in chronic obstructive pulmonary disease (COPD). Although these behaviors contribute to dyspnea, abnormal carbon dioxide (CO2) levels, and COPD exacerbations, they are modifiable. Current dyspnea treatments for COPD are suboptimal, because they do not adequately address dysfunctional breathing behaviors and anxiety together. We developed a complementary mind-body breathlessness therapy, called capnography-assisted respiratory therapy (CART), that uses real-time CO2 biofeedback at the end of exhalation (end-tidal CO2 or ETCO2), to target dysfunctional breathing habits and improve dyspnea treatment and pulmonary rehabilitation (PR) adherence in COPD. The study aim was to test the feasibility of integrating CART with a traditional, clinic-based PR program in an urban setting. Methods: We used a feasibility pre- and post-test design, with 2:1 randomization to CART+PR or control (PR-alone) groups, to test and refine CART. Multi-component CART consisted of six, 1-h weekly sessions of slow breathing and mindfulness exercises, ETCO2 biofeedback, motivational counseling, and a home program. All participants were offered twice weekly, 1-h sessions of PR over 10 weeks (up to 20 sessions). Results: Thirty-one participants with COPD were enrolled in the study. Approximately a third of participants had symptoms of psychological distress. Results showed that CART was feasible and acceptable based on 74% session completion and 91.7% homework exercise completion (n = 22). Within-group effect sizes for CART+PR were moderate to large (Cohen's d = 0.51-1.22) for reduction in resting Borg dyspnea (anticipatory anxiety) and respiratory rate, St. George's Respiratory Questionnaire (SGRQ) respiratory symptoms; and increase in Patient-Reported Outcomes Measurement Information System (PROMIS) physical function and physical activity; all p < 0.05. Conclusions: CART is a new mind-body breathing therapy that targets eucapnic breathing, interoceptive function, and self-regulated breathing to relieve dyspnea and anxiety symptoms in COPD. Study findings supported the feasibility of CART and showed preliminary signals that CART may improve exercise tolerance, reduce dyspnea, and enhance PR completion by targeting reduced dysfunctional breathing patterns (CTR No. NCT03457103).
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Affiliation(s)
- Anna Migliore Norweg
- Department of Rehabilitation and Regenerative Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Yinxiang Wu
- Department of Population Health, New York University (NYU) Grossman School of Medicine, New York, NY, USA
| | - Andrea Troxel
- Department of Population Health, New York University (NYU) Grossman School of Medicine, New York, NY, USA
| | - Jonathan H. Whiteson
- Department of Rehabilitation, and New York University (NYU) Grossman School of Medicine, New York, NY, USA
| | - Eileen Collins
- Department of Biobehavioral Nursing Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Francois Haas
- Department of Rehabilitation, and New York University (NYU) Grossman School of Medicine, New York, NY, USA
| | - Anne Skamai
- Department of Family and Community Medicine, Downstate Medical Center, State University of New York, New York, NY, USA
| | - Roberta Goldring
- Department of Medicine, New York University (NYU) Grossman School of Medicine, New York, NY, USA
| | - Girardin Jean-Louis
- Department of Population Health, New York University (NYU) Grossman School of Medicine, New York, NY, USA
- Department of Psychiatry, New York University (NYU) Grossman School of Medicine, New York, NY, USA
| | - Joan Reibman
- Department of Medicine, New York University (NYU) Grossman School of Medicine, New York, NY, USA
| | | | - Naomi Simon
- Department of Psychiatry, New York University (NYU) Grossman School of Medicine, New York, NY, USA
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12
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Aldhahi MI, Baattaiah BA, Nazer RI, Albarrati A. Impact of Psychological Factors on Functional Performance among Patients with Chronic Obstructive Pulmonary Disease. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1285. [PMID: 36674041 PMCID: PMC9859091 DOI: 10.3390/ijerph20021285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 01/02/2023] [Accepted: 01/06/2023] [Indexed: 06/17/2023]
Abstract
The role of anxiety and depression in functional performance during walking in patients with chronic obstructive pulmonary disease (COPD) is controversial. In this cross-sectional study, we aimed to assess the effects of anxiety, depression, and health-related quality of life (HRQOL) on the functional performance of this patient population. Seventy COPD patients aged 63 ± 11 years participated in the study. To measure their functional performance, the six-minute walk test (6MWT) was used. Anxiety and depression were assessed using two questionnaires: the Anxiety Inventory for Respiratory Disease (AIR) scale and the Hospital Anxiety and Depression Scale (HADS). The St. George’s Respiratory Questionnaire (SGRQ) was used to assess HRQOL. Based on their anxiety levels, the patients were divided into a no anxiety group and a high anxiety group. There were no significant differences between the two groups in terms of pulmonary function profile or smoking status. The mean AIR and HADS (depression) scores were high (12.78 ± 4.07 and 9.90 ± 3.41, respectively). More than one-third of the patients (46%) reported high anxiety levels (above the standard cutoff score of 8). The mean score of the aggregated HADS scale was significantly higher in the high anxiety group (20.87 ± 6.13) than in the no anxiety group (9.26 ± 4.72; p = 0.01). Patients with high anxiety had poorer functional performance (6MWT: 308.75 ± 120.16 m) and HRQOL (SGRQ: 56.54 ± 22.36) than patients with no anxiety (6MWT: 373.76 ± 106.56 m; SGRQ: 42.90 ± 24.76; p < 0.01). The final multivariate model explained 33% of the variance in functional performance after controlling for COPD severity (F = 8.97). The results suggest that anxiety, depression, and poor health status are significantly associated with poor functional performance. This study highlights the need to screen patients with COPD at all stages for anxiety and depression.
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Affiliation(s)
- Monira I. Aldhahi
- Department of Rehabilitation Sciences, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia
| | - Baian A. Baattaiah
- Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Rakan I. Nazer
- Cardiac Sciences Department, College of Medicine, King Saud University, Riyadh 11451, Saudi Arabia
| | - Ali Albarrati
- Rehabilitation Sciences Department, College of Applied Medical Sciences, King Saud University, Riyadh 11451, Saudi Arabia
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13
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Bamonti PM, Wiener CH, Weiskittle RE, Goodwin CL, Silberbogen AK, Finer EB, Moy ML. The Impact of Depression and Exercise Self-Efficacy on Benefits of Pulmonary Rehabilitation in Veterans with COPD. Behav Med 2023; 49:72-82. [PMID: 34743677 DOI: 10.1080/08964289.2021.1983755] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Pulmonary rehabilitation (PR) improves health-related quality of life (HRQoL) and exercise capacity. Little is known about the impact of depression symptoms and exercise self-efficacy on improvements in these key PR outcomes. This study examined the impact of baseline depression status and change in depression symptoms (Beck Depression Inventory-II [BDI-II] score) over the course of PR on change in HRQoL assessed by the Chronic Respiratory Disease Questionnaire-Self Reported (CRQ-SR) and exercise capacity as measured by the 6-Minute Walk Test (6MWT). We also examined whether baseline exercise self-efficacy moderated the association between baseline depression symptoms and change in these key PR outcomes. We studied 112 US veterans (aged 70.38 ± 8.49 years) with chronic obstructive pulmonary disease (COPD) who completed PR consisting of twice-weekly 2-hour classes for 18 sessions. Depressed (BDI-II >13) and nondepressed (BDI-II ≤13) patients at baseline demonstrated comparable and significant improvement in CRQ-SR total score, subscales, and 6MWT. Greater reduction in depression over the course of treatment was significantly associated with greater improvement in CRQ-SR total score and the following subscales: fatigue, mastery, and emotional function. Change in depression did not predict change in 6MWT distance. Baseline exercise self-efficacy moderated the association between baseline depression symptoms and change in CRQ-SR fatigue. Specifically, when baseline exercise self-efficacy was <30.4, greater baseline depression was associated with less improvement in CRQ-SR fatigue. When baseline self-efficacy was >152.0, greater baseline depression was associated with greater improvement in CRQ-SR fatigue. PR programs should address mood and confidence to exercise given their impact on key PR outcomes.
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Affiliation(s)
- Patricia M Bamonti
- VA New England Geriatric Research Education and Clinical Center (GRECC), VA Boston Healthcare System.,Department of Psychiatry, Harvard Medical School
| | | | - Rachel E Weiskittle
- VA New England Geriatric Research Education and Clinical Center (GRECC), VA Boston Healthcare System
| | | | | | - Elizabeth B Finer
- Pulmonary and Critical Care Medicine Section, VA Boston Healthcare System
| | - Marilyn L Moy
- Pulmonary and Critical Care Medicine Section, VA Boston Healthcare System.,Department of Medicine, Harvard Medical School
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14
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Pelgrim CE, van Ark I, van Berkum RE, Schuitemaker-Borneman AM, Flier I, Leusink-Muis T, Janbazacyabar H, Diks MAP, Gosker HR, Kelders MCJM, Langen RCJ, Schols AMWJ, Hageman RJJ, Braber S, Garssen J, Folkerts G, van Helvoort A, Kraneveld AD. Effects of a nutritional intervention on impaired behavior and cognitive function in an emphysematous murine model of COPD with endotoxin-induced lung inflammation. Front Nutr 2022; 9:1010989. [PMID: 36466426 PMCID: PMC9714332 DOI: 10.3389/fnut.2022.1010989] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 11/02/2022] [Indexed: 08/29/2023] Open
Abstract
One cluster of the extrapulmonary manifestations in chronic obstructive pulmonary disease (COPD) is related to the brain, which includes anxiety, depression and cognitive impairment. Brain-related comorbidities are related to worsening of symptoms and increased mortality in COPD patients. In this study, a murine model of COPD was used to examine the effects of emphysema and repetitive pulmonary inflammatory events on systemic inflammatory outcomes and brain function. In addition, the effect of a dietary intervention on brain-related parameters was assessed. Adult male C57Bl/6J mice were exposed to elastase or vehicle intratracheally (i.t.) once a week on three consecutive weeks. Two weeks after the final administration, mice were i.t. exposed to lipopolysaccharide (LPS) or vehicle for three times with a 10 day interval. A dietary intervention enriched with omega-3 PUFAs, prebiotic fibers, tryptophan and vitamin D was administered from the first LPS exposure onward. Behavior and cognitive function, the degree of emphysema and both pulmonary and systemic inflammation as well as blood-brain barrier (BBB) integrity and neuroinflammation in the brain were assessed. A lower score in the cognitive test was observed in elastase-exposed mice. Mice exposed to elastase plus LPS showed less locomotion in the behavior test. The enriched diet seemed to reduce anxiety-like behavior over time and cognitive impairments associated with the presented COPD model, without affecting locomotion. In addition, the enriched diet restored the disbalance in splenic T-helper 1 (Th1) and Th2 cells. There was a trend toward recovering elastase plus LPS-induced decreased expression of occludin in brain microvessels, a measure of BBB integrity, as well as improving expression levels of kynurenine pathway markers in the brain by the enriched diet. The findings of this study demonstrate brain-associated comorbidities - including cognitive and behavioral impairments - in this murine model for COPD. Although no changes in lung parameters were observed, exposure to the specific enriched diet in this model appeared to improve systemic immune disbalance, BBB integrity and derailed kynurenine pathway which may lead to reduction of anxiety-like behavior and improved cognition.
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Affiliation(s)
- Charlotte E. Pelgrim
- Division of Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands
| | - Ingrid van Ark
- Division of Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands
| | - Ronja E. van Berkum
- Division of Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands
| | - Anne M. Schuitemaker-Borneman
- Division of Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands
| | - Inge Flier
- Division of Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands
| | - Thea Leusink-Muis
- Division of Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands
| | - Hamed Janbazacyabar
- Division of Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands
| | - Mara A. P. Diks
- Division of Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands
| | - Harry R. Gosker
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, Netherlands
| | - Marco C. J. M. Kelders
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, Netherlands
| | - Ramon C. J. Langen
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, Netherlands
| | - Annemie M. W. J. Schols
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, Netherlands
| | | | - Saskia Braber
- Division of Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands
| | - Johan Garssen
- Division of Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands
- Danone Nutricia Research, Utrecht, Netherlands
| | - Gert Folkerts
- Division of Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands
| | - Ardy van Helvoort
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, Netherlands
- Danone Nutricia Research, Utrecht, Netherlands
| | - Aletta D. Kraneveld
- Division of Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands
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15
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Wu D, Zhao X, Huang D, Dai Z, Chen M, Li D, Wu B. Outcomes associated with comorbid anxiety and depression among patients with stable COPD: A patient registry study in China. J Affect Disord 2022; 313:77-83. [PMID: 35760193 DOI: 10.1016/j.jad.2022.06.059] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 05/28/2022] [Accepted: 06/20/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Anxiety and depression are common among patients with chronic obstructive pulmonary disease (COPD), but the associations between psychiatric symptoms and specific COPD outcomes are uncertain. METHODS Associations of psychiatric symptoms (anxiety and depression) and COPD outcomes (COPD Assessment Test (CAT), modified Medical Research Council dyspnea scale (mMRC), number of acute exacerbations and percentage predicted forced expiratory volume in 1 second (FEV1% predicted)) sets were performed by canonical correlation analysis in 876 patients with COPD. RESULTS In primary analysis, we discovered a statistically significant relationship between symptoms of anxiety/depression and COPD outcomes sets (1 - Λ = 0.11; P < .001). Symptoms of anxiety/depression and four COPD outcomes sets shared 11 % of variance. CAT was the main driver of the relationship (rs = -0.930; rs2 = 0.8649) followed by mMRC (rs = -0.632; rs2 = 0.3994) and exacerbation history (rs = -0.478; rs2 = 0.2285); FEV1% predicted did't make a significant contribution to the relationship (rs = 0.134; rs2 = 0.018). In secondary analysis, women were associated with a stronger correlation based on the shared variance between psychiatric symptoms and COPD outcomes sets (17.4 %) than men (9.8 %). LIMITATIONS Some confounding factors such as education level, income, didn't be included. There were considerably fewer women enrolled in this study than men. CONCLUSION Psychiatric symptoms were associated with COPD subjective outcomes, and more related to COPD outcomes in women.
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Affiliation(s)
- Dong Wu
- Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Xuanna Zhao
- Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Dan Huang
- Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Zhun Dai
- Department of Psychiatry, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Min Chen
- Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Dongming Li
- Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Bin Wu
- Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China.
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16
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Pelgrim CE, Wang L, Peralta Marzal LN, Korver S, van Ark I, Leusink-Muis T, Braber S, Folkerts G, Garssen J, van Helvoort A, Kraneveld AD. Increased exploration and hyperlocomotion in a cigarette smoke and LPS-induced murine model of COPD: linking pulmonary and systemic inflammation with the brain. Am J Physiol Lung Cell Mol Physiol 2022; 323:L251-L265. [PMID: 35699308 DOI: 10.1152/ajplung.00485.2021] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 06/08/2022] [Accepted: 06/09/2022] [Indexed: 01/08/2023] Open
Abstract
Brain-related comorbidities are frequently observed in chronic obstructive pulmonary disease (COPD) and are related to increased disease progression and mortality. To date, it is unclear which mechanisms are involved in the development of brain-related problems in COPD. In this study, a cigarette smoke and lipopolysaccharide (LPS) exposure murine model was used to induce COPD-like features and assess the impact on brain and behavior. Mice were daily exposed to cigarette smoke for 72 days, except for days 42, 52, and 62, on which mice were intratracheally exposed to the bacterial trigger LPS. Emphysema and pulmonary inflammation as well as behavior and brain pathology were assessed. Cigarette smoke-exposed mice showed increased alveolar enlargement and numbers of macrophages and neutrophils in bronchoalveolar lavage. Cigarette smoke exposure resulted in lower body weight, which was accompanied by lower serum leptin levels, more time spent in the inner zone of the open field, and decreased claudin-5 and occludin protein expression levels in brain microvessels. Combined cigarette smoke and LPS exposure resulted in increased locomotion and elevated microglial activation in the hippocampus of the brain. These novel findings show that systemic inflammation observed after combined cigarette smoke and LPS exposure in this COPD model is associated with increased exploratory behavior. Findings suggest that neuroinflammation is present in the brain area involved in cognitive functioning and that blood-brain barrier integrity is compromised. These findings can contribute to our knowledge about possible processes involved in brain-related comorbidities in COPD, which is valuable for optimizing and developing therapy strategies.
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Affiliation(s)
- Charlotte E Pelgrim
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, The Netherlands
| | - Lei Wang
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, The Netherlands
| | - Lucía N Peralta Marzal
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, The Netherlands
| | - Stephanie Korver
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, The Netherlands
| | - Ingrid van Ark
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, The Netherlands
| | - Thea Leusink-Muis
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, The Netherlands
| | - Saskia Braber
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, The Netherlands
| | - Gert Folkerts
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, The Netherlands
| | - Johan Garssen
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, The Netherlands
- Platform Immunology, Danone Nutricia Research, Utrecht, The Netherlands
| | - Ardy van Helvoort
- Danone Nutricia Research, Utrecht, The Netherlands
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Aletta D Kraneveld
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, The Netherlands
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17
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Wen-tao D, Xue-xiu C, Zun-jiang C, Wei C, Cheng-feng P, Xing-ken F. The Relationship Between Hospitalization Frequency of Acute Exacerbation of Chronic Obstructive Pulmonary Disease and Anxiety and Depression. Front Genet 2022; 13:817727. [PMID: 35495165 PMCID: PMC9053749 DOI: 10.3389/fgene.2022.817727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 03/03/2022] [Indexed: 11/21/2022] Open
Abstract
Depression and anxiety are common in patients with COPD (chronic obstructive pulmonary disease), and anxiety and depression can increase the risk of hospitalization and the acute exacerbation of chronic obstructive pulmonary disease. The relationship between the frequency of hospitalization for acute exacerbation of COPD (AECOPD) and the anxiety and depression of patients is not fully understood. This study aims to analyze the relationship between the frequency of hospitalizations and anxiety and depression of patients of acute exacerbation of chronic obstructive pulmonary disease (AECOPD). A collection of 309 AECOPD patients admitted to the emergency department in our hospital from 2019 to 2020 were divided into anxiety group A and depression group D according to the Hospital Anxiety and Depression Scale (HADS) score and divided into A1 and D1 negative groups (≤7 Score), A2 and D2 suspicious groups (8-10 points), A3 and D3 confirmed groups (≥11 points) for paired analysis of anxiety and depression correlation and difference and comparison of the frequency of hospitalization in each group within 2 years. The results found that anxiety and depression were significantly positively correlated (r = 0.654, p = 0.000). Intra-group comparison shows that the difference between the anxiety-diagnosed and non-diagnosed groups and the depression subgroups are statistically p < 0.05; the comparison between the anxiety subgroup and the depression subgroup showed that there was a statistical difference between the confirmed group and the non-diagnosed group (p < 0.01). In short, AECOPD anxiety is positively correlated with depression, and depression is affected by the frequency of hospitalization earlier and gradually, and anxiety should be prioritized in the acute phase.
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Affiliation(s)
| | | | | | | | | | - Fan Xing-ken
- Department of Emergency, The Affiliated Cangnan Hospital of Wenzhou Medical University, Zhejiang, China
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18
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Müller K, Zwingmann K, Auerswald T, Berger I, Thomas A, Schultz AL, Wilhelm E, Weber RC, Kolb F, Wastlhuber A, Meder S, Stegbauer M. Rehabilitation and Return-to-Work of Patients Acquiring COVID-19 in the Workplace: A Study Protocol for an Observational Cohort Study. FRONTIERS IN REHABILITATION SCIENCES 2022; 2:754468. [PMID: 36188830 PMCID: PMC9397694 DOI: 10.3389/fresc.2021.754468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 12/20/2021] [Indexed: 11/15/2022]
Abstract
Background In 2020, the novel coronavirus disease (COVID-19) developed into a worldwide pandemic. The course of COVID-19 is diverse, non-specific, and variable: Affected persons suffer from physical, cognitive, and psychological acute and long-term consequences. The symptoms influence everyday life activities, as well as work ability in the short or long-term. Healthcare professionals are considered particularly vulnerable to COVID-19 compared to the general population. In Germany, COVID-19 is recognized as an occupational disease or a work-related accident under certain conditions. Disease-specific rehabilitation is recommended for patients following acute COVID-19 to recover physical and neuropsychological performance and to improve work ability. Currently, there are limited findings on the short-term or long-term impact of COVID-19 as a recognized occupational disease or work-related accident, as well as on rehabilitation programs and associated influencing factors. Thus, the present research project will investigate these questions. Methods For this observational cohort study, post-acute patients with COVID-19 as a recognized occupational disease or work-related accident according to the insurance regulations for COVID-19 will be recruited at the BG Hospital for Occupational Disease in Bad Reichenhall, Germany. All participants will complete a comprehensive multimodal and interdisciplinary inpatient rehabilitation program for a duration of at least 3 weeks, beginning after their acute COVID-19 infection and depending on their individual indication and severity of disease. Participants will complete medical, functional, motor, psychological, and cognitive measurements at four time points (at the beginning (T1) and end (T2) of inpatient rehabilitation; 6 (T3) and 12 (T4) months after the beginning of inpatient rehabilitation). Discussion The present research project will help to assess and describe long-term effects of COVID-19 as a recognized occupational disease or work-related accident on physical and neuropsychological health, as well as on everyday activities and work ability of affected insured persons. In addition, this study will investigate influencing factors on severity and course of COVID-19. Furthermore, we will examine rehabilitation needs, measures, occurring specifics, and the feasibility of the rehabilitation procedure and disease development in the patients. The results of the intended study will further advance common recommendations for targeted and tailored rehabilitation management and participation in inpatient rehabilitation. Clinical Trial Registration www.drks.de, identifier: DRKS00022928.
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Affiliation(s)
- Katrin Müller
- Department of Social Science of Physical Activity and Health, Institute of Human Movement Science and Health, Faculty of Behavioural and Social Sciences, Chemnitz University of Technology, Chemnitz, Germany
| | - Katharina Zwingmann
- Department of Social Science of Physical Activity and Health, Institute of Human Movement Science and Health, Faculty of Behavioural and Social Sciences, Chemnitz University of Technology, Chemnitz, Germany
| | - Tina Auerswald
- Department of Social Science of Physical Activity and Health, Institute of Human Movement Science and Health, Faculty of Behavioural and Social Sciences, Chemnitz University of Technology, Chemnitz, Germany
| | - Ivo Berger
- BG Hospital for Occupational Disease Bad Reichenhall, Bad Reichenhall, Germany
| | - Andreas Thomas
- BG Hospital for Occupational Disease Bad Reichenhall, Bad Reichenhall, Germany
| | - Anna-Lena Schultz
- BG Hospital for Occupational Disease Bad Reichenhall, Bad Reichenhall, Germany
| | - Eva Wilhelm
- BG Hospital for Occupational Disease Bad Reichenhall, Bad Reichenhall, Germany
| | | | - Franziska Kolb
- BG Hospital for Occupational Disease Bad Reichenhall, Bad Reichenhall, Germany
| | - Alois Wastlhuber
- BG Hospital for Occupational Disease Bad Reichenhall, Bad Reichenhall, Germany
| | - Sylvia Meder
- BG Hospital for Occupational Disease Bad Reichenhall, Bad Reichenhall, Germany
| | - Michael Stegbauer
- BG Hospital for Occupational Disease Bad Reichenhall, Bad Reichenhall, Germany
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19
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Iyer AS, Parekh TM, O’Toole J, Bhatt SP, Eakin MN, Krishnan JA, Yohannes AM, Woodruff PG, Cooper CB, Kanner RE, Hanania NA, Dransfield MT, Regan EA, Hoth KF, Kim V. Clinically Significant and Comorbid Anxiety and Depression Symptoms Predict Severe Respiratory Exacerbations in Smokers: A Post Hoc Analysis of the COPDGene and SPIROMICS Cohorts. Ann Am Thorac Soc 2022; 19:143-146. [PMID: 34343034 PMCID: PMC9797036 DOI: 10.1513/annalsats.202103-240rl] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Affiliation(s)
- Anand S. Iyer
- University of Alabama at
BirminghamBirmingham, Alabama
| | | | | | | | | | | | | | | | | | | | | | - Mark T. Dransfield
- University of Alabama at
BirminghamBirmingham, Alabama
- Birmingham Veterans Affairs Medical
CenterBirmingham, Alabama
| | | | | | - Victor Kim
- Temple UniversityPhiladelphia,
Pennsylvania
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20
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Jordan A, Sivapalan P, Eklöf J, Vestergaard JB, Meteran H, Saeed MI, Biering-Sørensen T, Løkke A, Seersholm N, Jensen JUS. The Association between Use of ICS and Psychiatric Symptoms in Patients with COPD-A Nationwide Cohort Study of 49,500 Patients. Biomedicines 2021; 9:biomedicines9101492. [PMID: 34680609 PMCID: PMC8533368 DOI: 10.3390/biomedicines9101492] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 10/09/2021] [Accepted: 10/13/2021] [Indexed: 11/21/2022] Open
Abstract
Psychiatric side effects are well known from treatment with systemic corticosteroids. It is, however, unclear whether inhaled corticosteroids (ICS) have psychiatric side effects in patients with COPD. We conducted a nationwide cohort study in all Danish COPD outpatients who had respiratory medicine specialist-verified COPD, age ≥40 years, and no previous cancer. Prescription fillings of antidepressants and risk of admissions to psychiatric hospitals with either depression, anxiety or bipolar disorder were assessed by Cox proportional hazards models. We observed a dose-dependent increase in the risk of antidepressant-use with ICS cumulated dose (HR 1.05, 95% CI 1.03–1.07, p = 0.0472 with low ICS exposure, HR 1.10, 95% CI 1.08–1.12, p < 0.0001 with medium exposure, HR 1.15, 95% CI 1.11–1.15, p < 0.0001 with high exposure) as compared to no ICS exposure. We found a discrete increased risk of admission to psychiatric hospitals in the medium and high dose group (HR 1.00, 95% CI 0.98–1.03, p = 0.77 with low ICS exposure, HR 1.07, 95% CI 1.05–1.10, p < 0.0001 with medium exposure, HR 1.13, 95% CI 1.10–1.15, p < 0.0001 with high exposure). The association persisted when stratifying for prior antidepressant use. Thus, exposure to ICS was associated with a small to moderate increase in antidepressant-use and psychiatric admissions.
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Affiliation(s)
- Alexander Jordan
- Section of Respiratory Medicine, Herlev-Gentofte Hospital, 2900 Hellerup, Denmark; (P.S.); (J.E.); (J.B.V.); (H.M.); (M.I.S.); (T.B.-S.); (N.S.); (J.U.S.J.)
- Correspondence:
| | - Pradeesh Sivapalan
- Section of Respiratory Medicine, Herlev-Gentofte Hospital, 2900 Hellerup, Denmark; (P.S.); (J.E.); (J.B.V.); (H.M.); (M.I.S.); (T.B.-S.); (N.S.); (J.U.S.J.)
| | - Josefin Eklöf
- Section of Respiratory Medicine, Herlev-Gentofte Hospital, 2900 Hellerup, Denmark; (P.S.); (J.E.); (J.B.V.); (H.M.); (M.I.S.); (T.B.-S.); (N.S.); (J.U.S.J.)
| | - Jakob B. Vestergaard
- Section of Respiratory Medicine, Herlev-Gentofte Hospital, 2900 Hellerup, Denmark; (P.S.); (J.E.); (J.B.V.); (H.M.); (M.I.S.); (T.B.-S.); (N.S.); (J.U.S.J.)
| | - Howraman Meteran
- Section of Respiratory Medicine, Herlev-Gentofte Hospital, 2900 Hellerup, Denmark; (P.S.); (J.E.); (J.B.V.); (H.M.); (M.I.S.); (T.B.-S.); (N.S.); (J.U.S.J.)
| | - Mohamad Isam Saeed
- Section of Respiratory Medicine, Herlev-Gentofte Hospital, 2900 Hellerup, Denmark; (P.S.); (J.E.); (J.B.V.); (H.M.); (M.I.S.); (T.B.-S.); (N.S.); (J.U.S.J.)
| | - Tor Biering-Sørensen
- Section of Respiratory Medicine, Herlev-Gentofte Hospital, 2900 Hellerup, Denmark; (P.S.); (J.E.); (J.B.V.); (H.M.); (M.I.S.); (T.B.-S.); (N.S.); (J.U.S.J.)
| | - Anders Løkke
- Department of Medicine, Hospital Lillebælt, 7100 Vejle, Denmark;
- Department of Regional Health Research, University of Southern Denmark, 5000 Odense, Denmark
| | - Niels Seersholm
- Section of Respiratory Medicine, Herlev-Gentofte Hospital, 2900 Hellerup, Denmark; (P.S.); (J.E.); (J.B.V.); (H.M.); (M.I.S.); (T.B.-S.); (N.S.); (J.U.S.J.)
| | - Jens Ulrik Stæhr Jensen
- Section of Respiratory Medicine, Herlev-Gentofte Hospital, 2900 Hellerup, Denmark; (P.S.); (J.E.); (J.B.V.); (H.M.); (M.I.S.); (T.B.-S.); (N.S.); (J.U.S.J.)
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
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21
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Souto-Miranda S, Rodrigues G, Spruit MA, Marques A. Pulmonary rehabilitation outcomes in individuals with chronic obstructive pulmonary disease: a systematic review. Ann Phys Rehabil Med 2021; 65:101564. [PMID: 34329794 DOI: 10.1016/j.rehab.2021.101564] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 06/08/2021] [Accepted: 06/14/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND The magnitude of response to pulmonary rehabilitation (PR) is influenced by the selection of outcomes and measures. OBJECTIVES This systematic review aimed to review all outcomes and measures used in clinical trials of PR for individuals with chronic obstructive pulmonary disease (COPD). METHODS The review involved a search of Scopus, Web of Knowledge, Cochrane Library, EBSCO, Science Direct and PubMed databases for studies of stable individuals with COPD undergoing PR. Frequency of reporting for each domain, outcome and measure was synthesized by using Microsoft Excel. RESULTS We included 267 studies (43153 individuals with COPD). A broad range of domains (n=22), outcomes (n=163) and measures (n=217) were reported. Several measures were used for the same outcome. The most reported outcomes were exercise capacity (n=218) assessed with the 6-min walk test (n=140), health-related quality of life (n=204) assessed with the Saint George's respiratory questionnaire (n=99), and symptoms (n=158) assessed with the modified Medical Research Council dyspnea scale (n=56). The least reported outcomes were comorbidities, adverse events and knowledge. CONCLUSIONS This systematic review reinforces the need for a core outcome set for PR in individuals with COPD because of high heterogeneity in reported outcomes and measures. Future studies should assess the importance of each outcome for PR involving different stakeholders. PROSPERO ID CRD42017079935.
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Affiliation(s)
- Sara Souto-Miranda
- Lab3R - Respiratory Research and Rehabilitation Laboratory, School of Health Sciences (ESSUA), University of Aveiro, Aveiro, Portugal; iBiMED: Institute of Biomedicine, University of Aveiro, Aveiro, Portugal; Department of Respiratory Medicine, Maastricht University Medical Centre, NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Guilherme Rodrigues
- Lab3R - Respiratory Research and Rehabilitation Laboratory, School of Health Sciences (ESSUA), University of Aveiro, Aveiro, Portugal
| | - Martijn A Spruit
- Department of Respiratory Medicine, Maastricht University Medical Centre, NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands; Department of Research and Development, CIRO, Horn, Netherlands
| | - Alda Marques
- Lab3R - Respiratory Research and Rehabilitation Laboratory, School of Health Sciences (ESSUA), University of Aveiro, Aveiro, Portugal; iBiMED: Institute of Biomedicine, University of Aveiro, Aveiro, Portugal.
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22
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Is there a relationship between anxiety and depression with respiratory functions in patients with relapsing-remitting multiple sclerosis? Mult Scler Relat Disord 2021; 52:103023. [PMID: 34049218 DOI: 10.1016/j.msard.2021.103023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 04/24/2021] [Accepted: 05/07/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Psychiatric symptoms are common in multiple sclerosis. The relationship of emotional state with respiratory function is unclear in these patients. We aimed to evaluate the relationship between the clinical characteristics, anxiety and depression status, and respiratory functions of patients with relapsing-remitting multiple sclerosis (RRMS). METHOD The research was planned as a prospective case-control study. Ninety RRMS patients and 50 healthy controls were included in the study. The MS diagnosis was confirmed according to the revised 2017 McDonald's criteria. Disability was divided into two subgroups according to the Expanded Disability Status Scale (EDSS) (under 3.5 and 3.5-5.5). Beck anxiety and Beck depression inventories evaluated. A pulmonary function test was performed with a computerized spirometry device. Forced expiratory volume-1st second (FEV1), forced vital capacity (FVC), FEV/FVC, peak expiratory flow (PEF), maximal expiratory flow (MEF), peak inspiratory flow (PIF), and maximal inspiratory flow (MIF) values were obtained. RESULTS There were 90 RRMS patients with a mean age of 38.68±10.95 years, and 58 (64.40%) were female in the study. The anxiety and depression scores of the patients were significantly higher than the control group (p=0.02, 0.002). FVC and FEV1 values were lower in patients with higher Beck depression scores (p=0.012, 0.007). FVC, FEV1, MEF50, and PIF values were lower in patients with higher Beck anxiety scores (p=0.002, 0.002, 0.030, 0.027). When EDSS and number of attacks were fixed, there was a low to moderate correlation between anxiety and FEV1-FVC (p=0.001, r=-367, -0.360 respectively), and a low negative correlation between depression and FEV1 (p=0.045, r=-0.214). CONCLUSION Anxiety and depression scores are higher in patients with RRMS. Depression and anxiety are particularly associated with low FVC and FEV1 in patients.
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23
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Peiffer G, Underner M, Perriot J, Fond G. [COPD, anxiety-depression and cognitive disorders: Does inflammation play a major role?]. Rev Mal Respir 2021; 38:357-371. [PMID: 33820658 DOI: 10.1016/j.rmr.2021.03.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 01/11/2021] [Indexed: 02/08/2023]
Abstract
COPD is a chronic respiratory disease, often associated with extrapulmonary manifestations. Co-morbidities, including anxiety, depression and cognitive impairment, worsen its progression and quality of life. The prevalence of these disorders is high, yet they are often poorly understood and inadequately managed. In the development of psychological disorders, there is accumulated evidence highlighting the major role of systemic inflammation, as well as chronic disease, genetics, the consequences of smoking, hypoxaemia, oxidative stress, and the gut microbiome In addition to traditional treatments such as bronchodilatator medications, respiratory rehabilitation and smoking cessation, systemic inflammation is an interesting therapeutic target, with the use of anti-inflammatory drugs, anti-cytokines, and nutritional interventions.
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Affiliation(s)
- G Peiffer
- Service de pneumologie - tabacologie, CHR Metz-Thionville, 57085 Metz cedex 3, France.
| | - M Underner
- Unité de recherche clinique, université de Poitiers, centre hospitalier Henri-Laborit, 86021 Poitiers, France
| | - J Perriot
- Dispensaire Émile-Roux, CLAT 63, centre de tabacologie, 63100 Clermont-Ferrand, France
| | - G Fond
- CEReSS, hôpital de la Conception, Marseille Université, Assistance publique-Hôpitaux de Marseille (AP-HM), Marseille, France
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24
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Aldhahir AM, Aldabayan YS, Alqahtani JS, Ridsdale HA, Smith C, Hurst JR, Mandal S. A double-blind randomised controlled trial of protein supplementation to enhance exercise capacity in COPD during pulmonary rehabilitation: a pilot study. ERJ Open Res 2021; 7:00077-2021. [PMID: 33816594 PMCID: PMC8005591 DOI: 10.1183/23120541.00077-2021] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 02/01/2021] [Indexed: 11/17/2022] Open
Abstract
Background Pulmonary rehabilitation is a cost-effective management strategy in chronic obstructive pulmonary disease (COPD) which improves exercise performance and health-related quality of life. Nutritional supplementation may counter malnutrition and enhance pulmonary rehabilitation outcomes but rigorous evidence is absent. We aimed to investigate the effect of high-protein supplementation (Fortisip Compact Protein (FCP)) during pulmonary rehabilitation on exercise capacity. Methods This was a double-blind randomised controlled trial comparing FCP (intervention) with PreOp (a carbohydrate control supplement) in COPD patients participating in a pulmonary rehabilitation programme. Participants consumed the supplement twice a day during pulmonary rehabilitation and attended twice-weekly pulmonary rehabilitation sessions, with pre- and post-pulmonary rehabilitation measurements, including the incremental shuttle walk test (ISWT) distance at 6 weeks as the primary outcome. Participants’ experience using supplements was assessed. Results 68 patients were recruited (intervention n=36 and control n=32). The trial was stopped early due to the COVID-19 pandemic. Although statistical significance was not reached, there was the suggestion of a clinically meaningful difference in the ISWT distance at 6 weeks favouring the intervention group (intervention 342±149 m (n=22) versus control 305±148 m (n=22); p=0.1). Individuals who achieved an improvement in the ISWT had a larger mid-thigh circumference at baseline (responders 62±4 cm versus nonresponders 55±6 cm; p=0.006). 79% of the patients were satisfied with the taste and 43% would continue taking the FCP. Conclusions Although the data did not demonstrate a statistically significant difference in the ISWT, high-protein supplementation in COPD during pulmonary rehabilitation may result in a clinically meaningful improvement in exercise capacity and was acceptable to patients. Large, adequately powered studies are justified. High-protein supplementation combined with pulmonary rehabilitation in COPD did not statistically improve exercise capacity but may be associated with a clinically meaningful improvement. Larger trials are needed to confirm this.https://bit.ly/3tMtX9O
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Affiliation(s)
- Abdulelah M Aldhahir
- UCL Respiratory, Royal Free Campus, University College London, London, UK.,Respiratory Therapy Dept, Faculty of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
| | - Yousef S Aldabayan
- UCL Respiratory, Royal Free Campus, University College London, London, UK.,Respiratory Care Dept, College of Applied Medical Sciences, King Faisal University, Al-Hasa, Saudi Arabia
| | - Jaber S Alqahtani
- UCL Respiratory, Royal Free Campus, University College London, London, UK.,Dept of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam, Saudi Arabia
| | | | - Colette Smith
- Research Dept of Infection and Population Health, University College London, London, UK
| | - John R Hurst
- UCL Respiratory, Royal Free Campus, University College London, London, UK.,Royal Free London NHS Foundation Trust, London, UK.,These authors contributed equally to this work
| | - Swapna Mandal
- UCL Respiratory, Royal Free Campus, University College London, London, UK.,Royal Free London NHS Foundation Trust, London, UK.,These authors contributed equally to this work
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25
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von Leupoldt A, Ashoori M, Jelinčić V, Herzog M, Van Diest I. The impact of unpredictability of dyspnea offset on dyspnea perception, fear, and respiratory neural gating. Psychophysiology 2021; 58:e13807. [PMID: 33682134 DOI: 10.1111/psyp.13807] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 02/23/2021] [Accepted: 02/24/2021] [Indexed: 01/25/2023]
Abstract
Dyspnea is a debilitating and threatening symptom in various diseases. Affected patients often report the unpredictability of dyspnea episodes being particularly anxiety-provoking and amplifying the perception of dyspnea. Experimental studies testing dyspnea unpredictability together with related neural processes, physiological fear responses, and dyspnea-related personality traits are sparse. Therefore, we investigated the impact of unpredictability of dyspnea offset on dyspnea perception and fear ratings, respiratory neural gating and physiological fear indices, as well as the influence of interindividual differences in fear of suffocation (FoS). Forty healthy participants underwent a task manipulating the offset predictability of resistive load-induced dyspnea including one unloaded safety condition. Respiratory variables, self-reports of dyspnea intensity, dyspnea unpleasantness, and fear were recorded. Moreover, respiratory neural gating was measured in a paired inspiratory occlusion paradigm using electroencephalography, while electrodermal activity, startle eyeblink, and startle probe N100 were assessed as physiological fear indices. Participants reported higher dyspnea unpleasantness and fear when dyspnea offset was unpredictable compared to being predictable. Individuals with high levels of FoS showed the greatest increase in fear and overall higher levels of fear and physiological arousal across all conditions. Respiratory neural gating, startle eyeblink, and startle probe N100 showed general reductions during dyspnea conditions but no difference between unpredictable and predictable dyspnea conditions. Together, the current results suggest that the unpredictable offset of dyspnea amplifies dyspnea perception and fear, especially in individuals with high levels of FoS. These effects were unrelated to respiratory neural gating or physiological fear responses, requiring future studies on underlying mechanisms.
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Affiliation(s)
| | - Minoo Ashoori
- Research Group Health Psychology, University of Leuven, Leuven, Belgium
| | | | - Michaela Herzog
- Research Group Health Psychology, University of Leuven, Leuven, Belgium
| | - Ilse Van Diest
- Research Group Health Psychology, University of Leuven, Leuven, Belgium
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26
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Witcraft SM, Dixon LJ, Leukel P, Lee AA. Anxiety sensitivity and respiratory disease outcomes among individuals with chronic obstructive pulmonary disease. Gen Hosp Psychiatry 2021; 69:1-6. [PMID: 33444938 DOI: 10.1016/j.genhosppsych.2020.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 12/07/2020] [Accepted: 12/11/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. Depression and anxiety worsen COPD and lead to greater respiratory symptom severity and health care utilization. Fear of physical sensations of anxiety (AS-P) is known to exacerbate respiratory symptoms. The current study investigated the unique contribution of AS-P in respiratory symptom exacerbations, emergency department visits, hospitalizations, and COPD-related functional health status, controlling for medical characteristics, depression, and anxiety. METHOD The sample included 535 adults with COPD (Mage = 56.57; 58.1% male). Participants were recruited from a web-based panel of adults with chronic respiratory disease and completed an online battery of self-report measures. RESULTS Consistent with hypotheses, AS-P significantly increased the likelihood of acute symptom exacerbations by 12% and respiratory-related emergency department visits and hospitalizations by 7% during the prior 12 month period. Additionally, AS-P demonstrated a unique, large effect (f2 = 0.37) on COPD-related functional health status. CONCLUSION Fear of physical sensations contributed to worse respiratory outcomes and health care utilization among adults with COPD. Screening for AS-P may effectively identify at-risk COPD patients, while reducing AS-P through targeted interventions may result in decreased symptom severity, functional limitations, and burden on the health care system.
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Affiliation(s)
- Sara M Witcraft
- Department of Psychology, University of Mississippi, P.O. Box 1848, University, MS, 38677, USA.
| | - Laura J Dixon
- Department of Psychology, University of Mississippi, P.O. Box 1848, University, MS, 38677, USA.
| | - Patric Leukel
- Department of Psychology, University of Mississippi, P.O. Box 1848, University, MS, 38677, USA.
| | - Aaron A Lee
- Department of Psychology, University of Mississippi, P.O. Box 1848, University, MS, 38677, USA.
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27
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Assessment of Stress, Depressive and Anxiety Symptoms in Patients with COPD during In-Hospital Pulmonary Rehabilitation: An Observational Cohort Study. ACTA ACUST UNITED AC 2021; 57:medicina57030197. [PMID: 33669130 PMCID: PMC7996584 DOI: 10.3390/medicina57030197] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 02/18/2021] [Accepted: 02/20/2021] [Indexed: 12/21/2022]
Abstract
Background and Objectives: The relationship between physical health and mental health has been considered for years. A number of studies have shown a correlation between depressive states and the progress of somatic diseases. It seems that the proper cooperation of specialists may result in the improvement of the patient’s well-being and a positive effect on the course of the rehabilitation process. The aim of this study was to assess the symptoms of depression, anxiety, and stress in patients with chronic obstructive pulmonary disease (COPD) as well as the assessment of the relationship of psychological symptoms with sociodemographic factors and physical condition. Materials and Methods: The study enrolled 51 COPD patients who underwent a three-week pulmonary rehabilitation program. After admission to the rehabilitation department, the subjects were asked to complete the Hospital Anxiety and Depression Scale (HADS) questionnaire, the Perception of Stress Questionnaire (PSQ), and a sociodemographic questionnaire. Results: Anxiety states were diagnosed in 70% of respondents and depressive states were diagnosed in 54% of patients. Some of the respondents (14%) also showed a tendency to experience various grounded stresses. Additionally, there were correlations between the mental state and the results of fitness and respiratory tests. Conclusions: Patients with COPD are at risk for mental disorders, which may adversely affect their general health and significantly limit their physical and respiratory efficiencies. The development of widely available therapeutic solutions to reduce symptoms associated with depression, anxiety, and stress seems to be an important challenge for the management of patients with COPD.
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28
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Fukushi I, Pokorski M, Okada Y. Mechanisms underlying the sensation of dyspnea. Respir Investig 2020; 59:66-80. [PMID: 33277231 DOI: 10.1016/j.resinv.2020.10.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 10/13/2020] [Accepted: 10/17/2020] [Indexed: 01/17/2023]
Abstract
Dyspnea is defined as a subjective experience of breathing discomfort that consists of qualitatively distinct sensations that vary in intensity. It is a common symptom among patients with respiratory diseases that reduces daily activities, induces deconditioning, and is self-perpetuating. Although clinical interventions are needed to reduce dyspnea, its underlying mechanism is poorly understood depending on the intertwined peripheral and central neural mechanisms as well as emotional factors. Nonetheless, experimental and clinical observations suggest that dyspnea results from dissociation or a mismatch between the intended respiratory motor output set caused by the respiratory neuronal network in the lower brainstem and the ventilatory output accomplished. The brain regions responsible for detecting the mismatch between the two are not established. The mechanism underlying the transmission of neural signals for dyspnea to higher sensory brain centers is not known. Further, information from central and peripheral chemoreceptors that control the milieu of body fluids is summated at higher brain centers, which modify dyspneic sensations. The mental status also affects the sensitivity to and the threshold of dyspnea perception. The currently used methods for relieving dyspnea are not necessarily fully effective. The search for more effective therapy requires further insights into the pathophysiology of dyspnea.
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Affiliation(s)
- Isato Fukushi
- Faculty of Health Sciences, Uekusa Gakuen University, 1639-3 Ogura-cho, Wakaba-ku, Chiba, 264-0007, Japan; Clinical Research Center, Murayama Medical Center, 2-37-1 Gakuen, Musashimurayama, Tokyo, 208-0011, Japan.
| | - Mieczyslaw Pokorski
- Clinical Research Center, Murayama Medical Center, 2-37-1 Gakuen, Musashimurayama, Tokyo, 208-0011, Japan; Faculty of Health Sciences, The Jan Dlugosz University in Czestochowa, 4/8 Jerzego Waszyngtona Street, 42-200, Czestochowa, Poland
| | - Yasumasa Okada
- Clinical Research Center, Murayama Medical Center, 2-37-1 Gakuen, Musashimurayama, Tokyo, 208-0011, Japan
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29
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Vestergaard JH, Sivapalan P, Sørensen R, Eklöf J, Achir Alispahic I, von Bülow A, Seersholm N, Jensen JUS. Depressive symptoms among patients with COPD according to smoking status: a Danish nationwide case-control study of 21 184 patients. ERJ Open Res 2020; 6:00036-2020. [PMID: 33294426 PMCID: PMC7701339 DOI: 10.1183/23120541.00036-2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 09/08/2020] [Indexed: 11/05/2022] Open
Abstract
Introduction Depressive symptoms appear more often among patients with COPD and are associated with reduced disease control and increased mortality. Both smoking and COPD increase the risk of depressive symptoms. Whether smoking cessation among COPD patients affects the occurrence of depressive symptoms is unknown. We hypothesised that smoking cessation in patients with COPD leads to reduced use of antidepressants and fewer admissions to psychiatric hospitals with depression, anxiety or bipolar disorder. Methods We conducted a nationwide retrospective case-control study, in patients from The Danish Register for COPD with spirometry-verified COPD, age ≥40 years, a history of smoking and absence of cancer. Consistent smokers were matched 1:1 with ex-smokers using a propensity score model. Prescription fillings of antidepressants and risk of admissions to psychiatric hospitals with either depression, anxiety or bipolar disorder both descriptively was assessed by Cox proportional hazard models. Results We included 21 184 patients. A total of 2011 consistent smokers collected antidepressant prescriptions compared with 1821 ex-smokers. Consistent smoking was associated with increased risk of filling prescription on antidepressants (HR 1.4, 95% CI 1.3-1.5, p<0.0001) and with increased risk of psychiatric hospital admission with either depression, anxiety or bipolar disorder (HR 2.0, 95% CI 1.6-2.5). The associations persisted after adjustment for former use of antidepressants. Conclusion Consistent smoking among COPD patients was associated with increased use of antidepressants and admissions to psychiatric hospitals with either depression, anxiety or bipolar disorder, compared to smoking cessation.
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Affiliation(s)
- Jakob Hedemark Vestergaard
- Dept of Internal Medicine, Respiratory Medicine Section, Herlev and Gentofte Hospital, University Hospital of Copenhagen, Hellerup, Denmark
| | - Pradeesh Sivapalan
- Dept of Internal Medicine, Respiratory Medicine Section, Herlev and Gentofte Hospital, University Hospital of Copenhagen, Hellerup, Denmark.,Dept of Internal Medicine, Zealand University Hospital, Roskilde, Denmark
| | - Rikke Sørensen
- Dept of Cardiology, Rigshospitalet, University Hospital of Copenhagen, University of Copenhagen, Copenhagen, Denmark
| | - Josefin Eklöf
- Dept of Internal Medicine, Respiratory Medicine Section, Herlev and Gentofte Hospital, University Hospital of Copenhagen, Hellerup, Denmark
| | - Imane Achir Alispahic
- Dept of Internal Medicine, Respiratory Medicine Section, Herlev and Gentofte Hospital, University Hospital of Copenhagen, Hellerup, Denmark
| | - Anna von Bülow
- Dept of Internal Medicine, Respiratory Medicine Section, Herlev and Gentofte Hospital, University Hospital of Copenhagen, Hellerup, Denmark
| | - Niels Seersholm
- Dept of Internal Medicine, Respiratory Medicine Section, Herlev and Gentofte Hospital, University Hospital of Copenhagen, Hellerup, Denmark
| | - Jens-Ulrik Stæhr Jensen
- Dept of Internal Medicine, Respiratory Medicine Section, Herlev and Gentofte Hospital, University Hospital of Copenhagen, Hellerup, Denmark.,PERSIMUNE, Dept of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
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30
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Kong LN, Yao Y, Li L, Zhao QH, Wang T, Li YL. Psychological distress and self-management behaviours among patients with chronic hepatitis B receiving oral antiviral therapy. J Adv Nurs 2020; 77:266-274. [PMID: 33074555 DOI: 10.1111/jan.14610] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 08/18/2020] [Accepted: 09/28/2020] [Indexed: 12/31/2022]
Abstract
AIMS To assess the prevalence and associated factors of psychological distress among patients with chronic hepatitis B receiving oral antiviral therapy and explore the association between psychological distress and self-management behaviours among this population. DESIGN A cross-sectional study. METHODS A convenience sample of 188 patients with chronic hepatitis B receiving oral antiviral therapy was recruited from March-October 2018 to complete a self-report questionnaire including the Chinese version of Depression Anxiety Stress Scale-21 and Chronic Hepatitis B Self-Management Scale. Logistic regression analysis and hierarchical multiple regression analysis were used to determine the factors associated with psychological distress and the association between psychological distress and self-management behaviours respectively. RESULTS The prevalence of depression, anxiety, and stress symptoms were 33.0%, 38.3% and 17.6% respectively. Depression was associated with older age, female gender, lower education level and longer treatment duration; anxiety was associated with female gender and longer treatment duration; and stress was associated with age of 31-40 years, female gender and unmarried status. There were significant associations between depression and anxiety symptoms and self-management behaviours. CONCLUSION Psychological distress was prevalent among patients with chronic hepatitis B receiving oral antiviral therapy and had a negative impact on self-management. Interventions targeting depression and anxiety symptoms may be beneficial to improve self-management behaviours for this population. IMPACT This study explored the factors associated with psychological distress in patients with chronic hepatitis B receiving oral antiviral therapy. The findings showed psychological distress was more common in patients who were with older age, female, less educated, unmarried and receiving longer duration of treatment and psychological distress was significantly associated with self-management behaviours. Nurses and other healthcare providers should provide interventions to reduce the risk of psychological distress and improve self-management behaviours for this population.
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Affiliation(s)
- Ling-Na Kong
- School of Nursing, The First Affiliated Hospital of Chongqing Medical University, Chongqing, PR China.,School of Nursing, Chongqing Medical University, Chongqing, PR China
| | - Yu Yao
- School of Nursing, Chongqing Medical and Pharmaceutical College, Chongqing, PR China
| | - Lin Li
- Department of liver disease, Chongqing Hospital of Traditional Chinese Medicine, Chongqing, PR China
| | - Qing-Hua Zhao
- Department of Nursing, The First Affiliated Hospital of Chongqing Medical University, Chongqing, PR China
| | - Tian Wang
- Department of infectious disease, The First Affiliated Hospital of Chongqing Medical University, Chongqing, PR China
| | - Yi-Lan Li
- Department of infectious disease, The First Affiliated Hospital of Chongqing Medical University, Chongqing, PR China
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Luo H, Lou VWQ, Chen C, Chi I. The Effectiveness of the Positive Mood and Active Life Program on Reducing Depressive Symptoms in Long-Term Care Facilities. THE GERONTOLOGIST 2020; 60:193-204. [PMID: 30295729 DOI: 10.1093/geront/gny120] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Depression is prevalent among long-term care facility (LTCF) residents. However, interventions are not normally part of the management of these residents due to a shortage of mental health professionals. On the basis of Lewinsohn's behavioral model of depression, we developed a 12-week pleasant activity scheduling intervention, the Positive Mood and Active Life (PMAL) program. This study evaluated the effectiveness of the PMAL program on reducing depressive symptoms and improving quality of life among at-risk LTCF residents. RESEARCH DESIGN AND METHODS We adopted a cluster randomized controlled trial design. Four LTCFs were randomly assigned as treatment sites and three provided care as usual. At-risk LTCF residents (N = 68) were identified using the Mood Resident Assessment Protocol from the Minimum Data Set 2.0. The PMAL program was delivered to 34 residents. The primary and secondary outcomes were depressive symptoms and quality of life, as measured by the Geriatric Depression Scale-15 (GDS-15) and the World Health Organization Quality of Life scale-BREF (WHOQoL-BREF), respectively. RESULTS After 12 weeks, the GDS-15 score in the intervention group showed a reduction from 7.59 to 5.67, with a significant treatment by time effect (p = .006), based on the mixed model analysis; the WHOQoL-BREF score also substantially increased from 69.83 to 86.61 (p = .000). DISCUSSION AND IMPLICATIONS The PMAL program is effective in reducing depressive symptoms of at-risk LTCF residents. It is a feasible intervention that requires minimum resources and can be integrated with standardized assessment systems.
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Affiliation(s)
- Hao Luo
- Department of Social Work and Social Administration, The University of Hong Kong.,Department of Computer Science, The University of Hong Kong.,Sau Po Centre on Ageing, Department of Social Work and Social Administration, The University of Hong Kong
| | - Vivian W Q Lou
- Department of Social Work and Social Administration, The University of Hong Kong.,Sau Po Centre on Ageing, Department of Social Work and Social Administration, The University of Hong Kong
| | - Chunhua Chen
- Sau Po Centre on Ageing, Department of Social Work and Social Administration, The University of Hong Kong
| | - Iris Chi
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles
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McNaughton A, Levack W, McNaughton H. Taking Charge: A Proposed Psychological Intervention to Improve Pulmonary Rehabilitation Outcomes for People with COPD. Int J Chron Obstruct Pulmon Dis 2020; 15:2127-2133. [PMID: 32982205 PMCID: PMC7494383 DOI: 10.2147/copd.s267268] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 08/20/2020] [Indexed: 01/19/2023] Open
Abstract
Pulmonary rehabilitation (PR) is an important, evidence-based treatment that improves outcomes for people with COPD. Individualized exercise programmes aim to improve exercise capacity; self-management education and psychological support are also provided. Translating increased exercise capacity into sustained behavioural change of increased physical activity is difficult. Other unresolved problems with PR programmes include improving uptake, completion, response and sustaining long-term benefit. We offer a different perspective drawn from clinical experience of PR, quantitative and qualitative studies of singing groups for people with COPD, and stroke rehabilitation research that gives psychological factors a more central role in determining outcomes after PR. We discuss Take Charge; a simple but effective psychological intervention promoting self-management--that could be used as part of a PR programme or in situations where PR was declined or unavailable. This may be particularly relevant now when traditional face-to-face group programmes have been disrupted by COVID-19 precautions.
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Affiliation(s)
- Amanda McNaughton
- Department of Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - William Levack
- Department of Medicine, University of Otago, Wellington, New Zealand
| | - Harry McNaughton
- Medical Research Institute of New Zealand, Wellington, New Zealand
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Trevisan C, Vianello A, Zanforlini BM, Curreri C, Maggi S, Noale M, De Rui M, Corti MC, Perissinotto E, Manzato E, Sergi G. The mutual association between dyspnea and depressive symptoms in older adults: a 4-year prospective study. Aging Ment Health 2020; 24:993-1000. [PMID: 30835502 DOI: 10.1080/13607863.2019.1582005] [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] [Indexed: 10/27/2022]
Abstract
Objectives: dyspnea in daily living (DDL), night-time dyspnea (NTD) and depression are common symptoms in older people. However, how changes in dyspnea may influence and be influenced by modifications in depressive symptoms, so far has not been fully evaluated. We aimed to estimate the extent to which both DDL and NTD could be mutually associated to depressive symptoms in older adults with chronic conditions.Methods: this prospective study includes 2322 community-dwelling individuals aged ≥65 years enrolled in the Progetto Veneto Anziani (Pro.V.A.). At baseline and after 4.4 years, we evaluated the following parameters: DDL, assessed by the Medical Research Council dyspnea scale (MRC); self-reported NTD, assessed by personal interview; depressive symptoms, assessed using the Geriatric Depression Scale (GDS). The strength of the association between dyspnea and depression over the follow-up was evaluated through logistic regression and estimated by odds ratios and 95%Confidence Intervals (95%CI). Corrected risk ratios (RR) were then approximated from odds ratios.Results: GDS changes over the follow-up positively correlated with MRC changes (β = 0.938). Individuals with baseline DDL or NTD and those with incident/worsening DDL showed higher risk of developing or worsening depressive symptoms compared with their counterparts (RR = 3.36 [95%CI 2.11-5.06] for incident depression in people with worsening DDL). Incident or persistent depression increased more than twice the risk of developing DDL and NTD (for incident depression RR = 2.33 [95%CI 1.85-2.83] for DDL, and RR = 2.01 [95%CI 1.27-3.11] for NTD).Conclusions: older people may benefit from a comprehensive evaluation of respiratory and psychological symptoms, which seem to be related to each other in advanced age.
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Affiliation(s)
- Caterina Trevisan
- Department of Medicine (DIMED), Geriatrics Division, University of Padova, Padova, Italy
| | - Andrea Vianello
- Respiratory Pathophysiology Division, University of Padova, Padova, Italy
| | - Bruno M Zanforlini
- Department of Medicine (DIMED), Geriatrics Division, University of Padova, Padova, Italy
| | - Chiara Curreri
- Department of Medicine (DIMED), Geriatrics Division, University of Padova, Padova, Italy
| | - Stefania Maggi
- National Research Council, Neuroscience Institute, Padova, Italy
| | - Marianna Noale
- National Research Council, Neuroscience Institute, Padova, Italy
| | - Marina De Rui
- Department of Medicine (DIMED), Geriatrics Division, University of Padova, Padova, Italy
| | | | - Egle Perissinotto
- Department of Cardiac, Thoracic and Vascular Sciences, Biostatistics, Epidemiology and Public Health Unit, University of Padova, Italy
| | - Enzo Manzato
- Department of Medicine (DIMED), Geriatrics Division, University of Padova, Padova, Italy.,National Research Council, Neuroscience Institute, Padova, Italy
| | - Giuseppe Sergi
- Department of Medicine (DIMED), Geriatrics Division, University of Padova, Padova, Italy
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Barlow R, Jones B, Rogerson M, Bannister H, Stuart R, Iqbal J, Andrews L, Easton I. An Evaluation of Service Provision and Novel Strength Assessment on Patient Outcomes in a UK-Based Pulmonary Rehabilitation Setting. COPD 2020; 17:280-288. [PMID: 32419522 DOI: 10.1080/15412555.2020.1764519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This study's purpose was to (i) assess the impact of a 7-week pulmonary rehabilitation (PR) programme upon patient outcomes; incremental shuttle walk test (ISWT), COPD assessment tool (CAT), Clinical COPD Questionnaire (CCQ) and the Hospital Anxiety and Depression Scale (HADS); (ii) assess the impact of COPD severity on ISWT, psychological functioning and quality of life measures following PR; (iii) assess the feasibility of incorporating individually prescribed one repetition maximum (1RM) training loads into the existing strength training programme. Patients were people with COPD enrolled onto one of three versions (locations A, B and C) of a 7-week PR programme, which consisted of group exercise sessions and a social plus education element. Two locations incorporated individually prescribed training loads. Minimal clinically important changes (MCICs) are reported for the ISWT across all locations. Statistically significant changes in both CAT and the CCQ were found, with MCIC's evident for CAT score overall and individually at location B. MCIC's were not found for the CCQ. No statistically significant or MCICs were evident for the HADS. MCIC's were present only in patients with mild to moderate severity for the ISWT. For the CAT, moderate, severe and very severe patients with COPD experienced MCIC's. MCIC's and statistically significant increases in 1RM strength were seen at both locations. These findings evidence an effective PR service. Basic strength exercise programming and assessment are feasible and should be implemented in PR services to maximise patient outcomes.
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Affiliation(s)
| | - Ben Jones
- School of Sport, Rehabilitation and Exercise Sciences, University of Essex, Colchester, UK
| | - Mike Rogerson
- School of Sport, Rehabilitation and Exercise Sciences, University of Essex, Colchester, UK
| | | | | | - Jawadh Iqbal
- School of Health and Social Care, University of Essex, Colchester, UK
| | - Leanne Andrews
- School of Health and Social Care, University of Essex, Colchester, UK
| | - Izzie Easton
- School of Sport, Rehabilitation and Exercise Sciences, University of Essex, Colchester, UK
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Kozlov E, Dong X, Kelley AS, Ankuda CK. The Epidemiology of Depressive Symptoms in the Last Year of Life. J Am Geriatr Soc 2020; 68:321-328. [PMID: 31691265 PMCID: PMC7899291 DOI: 10.1111/jgs.16197] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Revised: 09/05/2019] [Accepted: 09/06/2019] [Indexed: 01/29/2023]
Abstract
BACKGROUND/OBJECTIVE Depression impacts quality of life at all life stages, but the epidemiology of depression in the last year of life is unknown. This study's objectives were to document the epidemiology of depressive symptoms in the year prior to death and to assess how the trajectory of depressive symptoms varies by sociodemographic and clinical factors. DESIGN Observational, cross-sectional, cohort study using the Health and Retirement Study. SETTING Population-based survey. PARTICIPANTS A total of 3274 individuals who died within 12 months after assessment. MEASURES Primary outcome: eight-item Center for Epidemiologic Studies Depression Scale (CESD-8). Covariates included sociodemographics, self-reported illnesses, and activity of daily living (ADL) limitations. RESULTS Average CESD-8 score increased over the last year of life, with 59.3% screening positive for depression in the last month before death. Depression symptoms increased gradually from 12 to 4 months before death (increase of 0.05 points/month; 95% confidence interval [CI] = 0.01-0.08 points/month) and then escalated from 4 to 1 months before death (increase of 0.29 points/month; 95% CI = 0.16-0.39 points/month). Women, younger adults, and nonwhite adults all demonstrated higher rates of depressive symptoms. Individuals with cancer reported escalating rates of depressive symptoms at the end of life, while individuals with lung disease and ADL impairment demonstrated persistently high rates throughout the year before death. CONCLUSIONS This study revealed high rates of depressive symptoms in the last year of life as well as differences in the burden of depressive symptoms. A public health approach must be taken to screen for and appropriately treat symptoms of depression across the lifespan. J Am Geriatr Soc 68:321-328, 2020.
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Affiliation(s)
- Elissa Kozlov
- Institute for Health, Health Policy, and Aging Research, Rutgers University, New Brunswick, New Jersey
| | - XinQi Dong
- Institute for Health, Health Policy, and Aging Research, Rutgers University, New Brunswick, New Jersey
| | - Amy S. Kelley
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
- Geriatric Research Education and Clinical Center, James J. Peters Veterans Affairs Medical Center, Bronx, New York
| | - Claire K. Ankuda
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
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Miranda JJ, Bernabe-Ortiz A, Gilman RH, Smeeth L, Malaga G, Wise RA, Checkley W. Multimorbidity at sea level and high-altitude urban and rural settings: The CRONICAS Cohort Study. JOURNAL OF COMORBIDITY 2019; 9:2235042X19875297. [PMID: 34249770 PMCID: PMC8240099 DOI: 10.1177/2235042x19875297] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Accepted: 08/19/2019] [Indexed: 12/19/2022]
Abstract
Objective: To characterize the prevalence and clustering of multimorbidity in four
diverse geographical settings in Peru. Methods: Multimorbidity, defined as having ≥2 chronic conditions, was studied in
adults aged ≥35 years in four diverse settings in Peru: Lima, Tumbes, and
urban and rural Puno. Six of these conditions (alcohol disorder, asthma,
chronic obstructive pulmonary disease, depression, diabetes, and
hypertension) were cataloged as objectively ascertained chronic conditions
and paired in dyads to explore clusters of multimorbidity. Results: We analyzed data from 2890 adults, mean age 55.2 years, 49% males. Overall,
19.1% of participants had multimorbidity, ranging from 14.7% in semi-urban
Tumbes to 22.8% in Lima. The dyads with the highest coexistence
(approximately 20%) were observed in hypertension and diabetes in Tumbes,
whereas the dyads with lowest coexistence (approximately 1%) were those
involving asthma in all study sites. In terms of clusters, Tumbes showed a
predominance of hypertension and diabetes, urban and rural Puno a
predominance of depression and alcohol disorders, and Lima a higher degree
of coexistence of all of the six conditions than in the other clusters. Conclusion: Multimorbidity is common and the pattern of clusters is highly heterogeneous.
The conditions to prioritize will vary in each setting.
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Affiliation(s)
- J Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru.,Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Antonio Bernabe-Ortiz
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Robert H Gilman
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru.,Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.,Biomedical Research Unit, Asociación Benéfica PRISMA, Lima, Peru
| | - Liam Smeeth
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru.,Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - German Malaga
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru.,Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Robert A Wise
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - William Checkley
- Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.,Biomedical Research Unit, Asociación Benéfica PRISMA, Lima, Peru.,Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
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Lim JU, Park CK, Kim TH, Jang AS, Park YB, Rhee CK, Jung KS, Yoo KH, Lee WY, Yoon HK. The Difficulty Of Improving Quality Of Life In COPD Patients With Depression And Associated Factors. Int J Chron Obstruct Pulmon Dis 2019; 14:2331-2341. [PMID: 31632002 PMCID: PMC6790330 DOI: 10.2147/copd.s216746] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 09/16/2019] [Indexed: 11/23/2022] Open
Abstract
Objectives Depression is a major comorbidity that affects clinical outcomes in patients with chronic obstructive pulmonary disease (COPD). COPD patients with depression are hospitalized more frequently, and show more acute exacerbations, decreased physical and social activities, and higher mortality compared to their non-depressed counterparts. In the present study, we investigated the clinical impact of depressive symptoms and associated clinical factors in Korean patients with COPD by evaluating multicenter cohort data. Materials and methods Patients with COPD enrolled in the Korean COPD Subtype Study, a multicenter observational study, from December 2011 to October 2014 were selected for evaluation. The initial evaluation of all patients included pulmonary function tests, 6 min walk distance (6MWD), the COPD Assessment Test (CAT), and the COPD-specific version of the St. George’s Respiratory Questionnaire (SGRQ-C). Significant depression was defined as a Beck Depression Inventory-II (BDI-II) score ≥17. Results Among the 270 study patients, 19.6% had significant depression. The depressed group showed a higher proportion of females (41.4%), lower body mass index (BMI), and lower education level compared to the non-depressed group (p = 0.002, p = 0.008, and p = 0.019, respectively). The depressed group had significantly higher CAT and SGRQ-C scores, as well as a lower 6MWD, compared to the non-depressed group based on 6 month-interval serial measurements over 3 years. The total SGRQ-C score and the symptoms, activity, and impact domain scores were significant predictors of depression (area under curves [AUCs] of 0.699 [0.613–0.786], 0.670 [0.581–0.758], 0.680 [0.589–0.770], and 0.689 [0.603–0.776], respectively). From CAT score domains, sleep and energy scores were significant predictors of depression (AUCs of 0.619 [0.522–0.715] and 0.595 [0.504–0.685], respectively). SGRQ-C score, low BMI, and decreased 6MWD were significantly associated with depression in a multivariable analysis. Conclusion A considerable proportion of patients with COPD had depression, and a high SGRQ-C score, low BMI, and low 6MWD were significantly associated with depression. As improving quality of life in this subgroup is difficult, physicians should be more active in screening patients with significant depression.
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Affiliation(s)
- Jeong Uk Lim
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Chan Kwon Park
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Tae-Hyung Kim
- Division of Pulmonary and Critical Care Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Republic of Korea
| | - An-Soo Jang
- Division of Respiratory and Allergy, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Yong Bum Park
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Hallym University Kangdong Sacred Heart Hospital, Seoul, Republic of Korea
| | - Chin Kook Rhee
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ki Suck Jung
- Division of Pulmonary Medicine, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University Medical School, Anyang, Republic of Korea
| | - Kwang Ha Yoo
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Won-Yeon Lee
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Hyoung Kyu Yoon
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Impact of Disease-Specific Fears on Pulmonary Rehabilitation Trajectories in Patients with COPD. J Clin Med 2019; 8:jcm8091460. [PMID: 31540306 PMCID: PMC6780973 DOI: 10.3390/jcm8091460] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 09/10/2019] [Accepted: 09/10/2019] [Indexed: 01/23/2023] Open
Abstract
Disease-specific fears predict health status in chronic obstructive pulmonary disease (COPD), but their role in pulmonary rehabilitation (PR) remains poorly understood and especially longer-term evaluations are lacking. We therefore investigated changes in disease-specific fears over the course of PR and six months after PR, and investigated associations with PR outcomes (COPD assessment test (CAT) and St. Georges respiratory questionnaire (SGRQ)) in a subset of patients with COPD (n = 146) undergoing a 3-week inpatient PR program as part of the STAR study (Clinicaltrials.gov, ID: NCT02966561). Disease-specific fears as measured with the COPD anxiety questionnaire improved after PR. For fear of dyspnea, fear of physical activity and fear of disease progression, improvements remained significant at six-month follow-up. Patients with higher disease-specific fears at baseline showed elevated symptom burden (CAT and SGRQ Symptom scores), which persisted after PR and at follow-up. Elevated disease-specific fears also resulted in reduced improvements in Quality of Life (SGRQ activity and impact scales) after PR and at follow-up. Finally, improvement in disease-specific fears was associated with improvement in symptom burden and quality of life. Adjustment for potential confounding variables (sex, smoking status, age, lung function, and depressive symptoms) resulted in comparable effects. These findings show the role of disease-specific fears in patients with COPD during PR and highlight the need to target disease-specific fears to further improve the effects of PR.
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Abstract
PURPOSE OF REVIEW Breathlessness debilitates countless people with a wide range of common diseases. For some people, the experience of breathlessness is poorly explained by the findings of medical tests. This disparity complicates diagnostic and treatment options and means that disease-modifying treatments do not always have the expected effect upon symptoms. These observations suggest that brain processing of respiratory perceptions may be somewhat independent of disease processes. This may help to explain the dissonance observed in some patients between physical disease markers and the lived experience of breathlessness. RECENT FINDINGS A body of breathlessness research using functional neuroimaging has identified a relatively consistent set of brain areas that are associated with breathlessness. These areas include the insula, cingulate and sensory cortices, the amygdala and the periaqueductal gray matter. We interpret these findings in the context of new theories of perception that emphasize the importance of distributed brain networks. Within this framework, these perceptual networks function by checking an internal model (a set of expectations) against peripheral sensory inputs, instead of the brain acting as a passive signal transducer. Furthermore, other factors beyond the physiology of breathlessness can influence the system. SUMMARY A person's expectations and mood are major contributors to the function of the brain networks that generate perceptions of breathlessness. Breathlessness, therefore, arises from inferences made by the brain's integration of both expectations and sensory inputs. By better understanding individual differences across these contributing perceptual factors, we will be better poised to develop targeted and individualized treatments for breathlessness that could complement disease-modifying therapies.
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Affiliation(s)
- Lucy L. Marlow
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Olivia K. Faull
- Translational Neuromodeling Unit, Institute for Biomedical Engineering, University of Zurich and ETH Zurich, Zurich, Switzerland
| | - Sarah L. Finnegan
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Kyle T.S. Pattinson
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
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40
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Rochester CL. Patient assessment and selection for pulmonary rehabilitation. Respirology 2019; 24:844-853. [PMID: 31251443 DOI: 10.1111/resp.13616] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 04/10/2019] [Accepted: 05/28/2019] [Indexed: 11/26/2022]
Abstract
Pulmonary rehabilitation (PR) is beneficial for people with several forms of chronic respiratory disease. Given the existing limitations on availability of PR services, it is important to identify participants who are most likely to benefit from it. Identification of criteria for patient referral to PR is challenging, as chronic respiratory diseases and their medical and psychosocial co-morbidities place a complex and multifaceted burden on patients. Although research studies have attempted to identify key parameters predictive of 'responsiveness to PR', to date no firm physiological, psychosocial or other criteria exist by which optimal patient candidacy can be determined. Moreover, individual factors do not reliably predict successful multidimensional PR outcomes. In general, individuals who remain symptomatic with dyspnoea, fatigue and exercise intolerance; who have difficulty performing activities of daily living (ADL); and who are having difficulty coping with or managing their disease despite optimized pharmacological therapy are potential candidates for PR. Patient assessment and outcome measurement are core essential features of PR. To be considered as a PR programme, rehabilitation programmes must demonstrate, at a minimum, assessment and outcome measurement in regard to exercise capacity, dyspnoea and health-related quality of life. Additional parameters, including physical activity, nutritional status, tobacco use status, patient knowledge and self-efficacy, performance of ADL, fatigue, disease exacerbations, hospitalizations and other urgent healthcare utilization, and behavioural outcomes, including coping styles, patient satisfaction and programme metrics, are other relevant and important aspects of patient assessment and outcome measurement that should be considered and undertaken in PR, where feasible.
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Affiliation(s)
- Carolyn L Rochester
- Section of Pulmonary, Critical Care and Sleep Medicine, Yale University School of Medicine, New Haven, CT, USA.,VA Connecticut Healthcare System, West Haven, CT, USA
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Tan Y, Van den Bergh O, Qiu J, von Leupoldt A. The Impact of Unpredictability on Dyspnea Perception, Anxiety and Interoceptive Error Processing. Front Physiol 2019; 10:535. [PMID: 31130876 PMCID: PMC6509155 DOI: 10.3389/fphys.2019.00535] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 04/15/2019] [Indexed: 12/18/2022] Open
Abstract
Dyspnea is a prevalent interoceptive sensation and the aversive cardinal symptom in many cardiorespiratory diseases as well as in mental disorders. Especially the unpredictability of the occurrence of dyspnea episodes has been suggested to be highly anxiety provoking for affected patients. Moreover, previous studies demonstrated that unpredictable exteroceptive stimuli increased self-reports and electrophysiological responses of anxiety such as the startle probe N100 as well as amplified the processing of errors as reflected by greater error-related negativity (ERN). However, studies directly examining the role of unpredictability on dyspnea perception, anxiety, and error processing are widely absent. Using high-density electroencephalography, the present study investigated whether unpredictable compared to predictable dyspnea would increase the perception of dyspnea, anxiety and interoceptive error processing. Thirty-two healthy participants performed a respiratory forced choice reaction time task to elicit an interoceptive ERN during two conditions: an unpredictable and a predictable resistive load-induced dyspnea condition. Predictability was manipulated by pairing (predictable condition) or not pairing (unpredictable condition) dyspnea with a startle tone probe. Self-reports of dyspnea and affective state as well as the startle probe N100 and interoceptive ERN were measured. The results demonstrated greater dyspnea unpleasantness in the unpredictable compared to the predictable condition. Post hoc analyses revealed that this was paralleled by greater anxiety, and greater amplitudes for the startle probe N100 and the interoceptive ERN during the unpredictable relative to the predictable condition, but only when the unpredictable condition was experienced in the first experimental block. Furthermore, higher trait-like anxiety sensitivity was associated with higher ratings for dyspnea unpleasantness and experimental state anxiety ratings. The present findings suggest that unpredictability increases the perception of dyspnea unpleasantness. This effect seems related to increased state and trait anxiety and interoceptive error processing, especially when upcoming dyspnea is particularly unpredictable, such as in early experimental phases. Future studies are required to further substantiate these findings in patients suffering from dyspnea.
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Affiliation(s)
- Yafei Tan
- Faculty of Psychology, Southwest University, Chongqing, China
- Health Psychology, KU Leuven, Leuven, Belgium
| | | | - Jiang Qiu
- Faculty of Psychology, Southwest University, Chongqing, China
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Gordon CS, Waller JW, Cook RM, Cavalera SL, Lim WT, Osadnik CR. Effect of Pulmonary Rehabilitation on Symptoms of Anxiety and Depression in COPD: A Systematic Review and Meta-Analysis. Chest 2019; 156:80-91. [PMID: 31034818 DOI: 10.1016/j.chest.2019.04.009] [Citation(s) in RCA: 85] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 03/01/2019] [Accepted: 04/02/2019] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Pulmonary rehabilitation (PR) improves exercise capacity and quality of life in people with COPD; however, its effect on anxiety and depression symptoms is less clear. Existing data are difficult to apply to clinical PR because of diverse interventions and comparators. This review evaluated the effectiveness of PR on anxiety and depression symptoms in people with COPD. METHODS A systematic review and meta-analysis (PROSPERO CRD42018094172) was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines on randomized controlled trials comparing PR (≥ 4 weeks' duration) with usual care. Four electronic databases were searched to February 2018 using terms related to COPD, PR, anxiety, and depression. Data were extracted by two assessors using standardized templates. Study quality was appraised via the PEDro scale, and evidence was rated according to the Grading of Recommendations Assessment, Development and Evaluation. Data were analyzed in RevMan 5.3, with pooled effect estimates reported as standardized mean differences (SMDs). The effect of the program duration (≤ 8 vs > 8 weeks) was explored via subgroup analysis. RESULTS Eleven studies comprising 734 participants (median PEDro score, 4/10) were included. Compared with usual care, PR conferred significant benefits of a moderate magnitude for anxiety symptoms (SMD, -0.53; 95% CI, -0.82 to -0.23) and large magnitude for depression symptoms (SMD, -0.70; 95% CI, -0.87 to -0.53). The certainty of evidence for each outcome was moderate. Effects were not moderated by program duration. CONCLUSIONS PR confers significant, clinically relevant benefits on anxiety and depression symptoms. Because further studies involving no treatment control groups are not indicated, these robust estimates of treatment effects are likely to endure.
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Affiliation(s)
- Carla S Gordon
- Department of Physiotherapy, Monash University, Melbourne, VIC; Department of Physiotherapy, Monash Health, Melbourne, VIC
| | - Jacob W Waller
- Department of Physiotherapy, Monash University, Melbourne, VIC
| | - Rylee M Cook
- Department of Physiotherapy, Monash University, Melbourne, VIC
| | | | - Wing T Lim
- Department of Physiotherapy, Monash University, Melbourne, VIC
| | - Christian R Osadnik
- Department of Physiotherapy, Monash University, Melbourne, VIC; Monash Lung and Sleep, Monash Health, Melbourne, VIC, Australia.
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The presence of others reduces dyspnea and cortical neural processing of respiratory sensations. Biol Psychol 2019; 140:48-54. [DOI: 10.1016/j.biopsycho.2018.11.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 11/12/2018] [Accepted: 11/15/2018] [Indexed: 12/25/2022]
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Figueira Gonçalves JM, Martín Martínez MD, Pérez Méndez LI, García Bello MÁ, Garcia-Talavera I, Hernández SG, Díaz Pérez D, Bethencourt Martín N. Health Status in Patients with COPD According to GOLD 2017 Classification: Use of the COMCOLD Score in Routine Clinical Practice. COPD 2018; 15:326-333. [DOI: 10.1080/15412555.2018.1531388] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
| | | | | | | | | | - Sara García Hernández
- Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain
| | - David Díaz Pérez
- Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain
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Schuler M, Wittmann M, Faller H, Schultz K. The interrelations among aspects of dyspnea and symptoms of depression in COPD patients - a network analysis. J Affect Disord 2018; 240:33-40. [PMID: 30048834 DOI: 10.1016/j.jad.2018.07.021] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 05/21/2018] [Accepted: 07/08/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND Depression is a frequent comorbidity in COPD. COPD symptoms such as dyspnea may play an important role in the causal relationship between COPD and depression. We investigated the interrelations among different aspects of dyspnea and other COPD parameters and symptoms of depression in COPD patients. METHODS This is a secondary analysis of N = 590 COPD patients. At the beginning (T0) and the end (T1) of a 3-week inpatient pulmonary rehabilitation, dyspnea aspects intensity (BORG scale), frequency (2 CCQ items), functioning (CCQ-function) and cognitive/emotional response (2 SGRQ items) as well as cough (2 CCQ items), functional capacity (6MWD), lung function (FEV1) and symptoms of depression (PHQ-9) were assessed. Regression analyses with PHQ-9 sum score as dependent variable as well as network analysis using PHQ-9 single items were performed. Structural invariance over time was examined. RESULTS Dyspnea frequency, function, and cognitive/emotional response showed conditional independent relationships with PHQ-9 sum score. Network analysis showed that dyspnea frequency and dyspnea functioning were primarily associated with somatic depression symptoms (for example, sleep problems, loss of energy), while cognitive/emotional response was primarily related to cognitive-affective depression symptoms (for example, feeling down/depressed/hopeless). Regression parameters, network structure and network global strength did not differ between T0 and T1. LIMITATIONS Models are based on between-person relationships. Results should be confirmed using time-series data. CONCLUSIONS Dyspnea and depression seem to be interrelated through a variety of different and complex pathways in COPD patients. Results may be used to explain intervention effects and develop new intervention strategies to reduce depression in COPD.
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Affiliation(s)
- Michael Schuler
- Department of Medical Psychology and Psychotherapy, Medical Sociology and Rehabilitation Science, University of Würzburg, Würzburg, Germany.
| | - Michael Wittmann
- Klinik Bad Reichenhall, Center of Rehabilitation, Pulmonology and Orthopedics, Bad Reichenhall, Germany
| | - Hermann Faller
- Department of Medical Psychology and Psychotherapy, Medical Sociology and Rehabilitation Science, University of Würzburg, Würzburg, Germany
| | - Konrad Schultz
- Klinik Bad Reichenhall, Center of Rehabilitation, Pulmonology and Orthopedics, Bad Reichenhall, Germany
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Pelgrim CE, Peterson JD, Gosker HR, Schols AMWJ, van Helvoort A, Garssen J, Folkerts G, Kraneveld AD. Psychological co-morbidities in COPD: Targeting systemic inflammation, a benefit for both? Eur J Pharmacol 2018; 842:99-110. [PMID: 30336140 DOI: 10.1016/j.ejphar.2018.10.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 09/24/2018] [Accepted: 10/08/2018] [Indexed: 12/15/2022]
Abstract
COPD is a chronic lung disease characterized by persistent respiratory symptoms and airflow limitation due to airway and/or alveolar abnormalities. Furthermore, COPD is often characterized by extrapulmonary manifestations and comorbidities worsening COPD progression and quality of life. A neglected comorbidity in COPD management is mental health impairment defined by anxiety, depression and cognitive problems. This paper summarizes the evidence for impaired mental health in COPD and focuses on current pharmacological intervention strategies. In addition, possible mechanisms in impaired mental health in COPD are discussed with a central role for inflammation. Many comorbidities are associated with multi-organ-associated systemic inflammation in COPD. Considering the accumulative evidence for a major role of systemic inflammation in the development of neurological disorders, it can be hypothesized that COPD-associated systemic inflammation also affects the function of the brain and is an interesting therapeutic target for nutra- and pharmaceuticals.
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Affiliation(s)
- Charlotte E Pelgrim
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, the Netherlands
| | - Julia D Peterson
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, the Netherlands
| | - Harry R Gosker
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Department of Respiratory Medicine, Maastricht, the Netherlands
| | - Annemie M W J Schols
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Department of Respiratory Medicine, Maastricht, the Netherlands
| | - Ardy van Helvoort
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Department of Respiratory Medicine, Maastricht, the Netherlands; Nutrition, Metabolism and Muscle Sciences, Nutricia Research, Utrecht, the Netherlands
| | - Johan Garssen
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, the Netherlands; Platform Immunology, Nutricia Research, Utrecht, the Netherlands
| | - Gert Folkerts
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, the Netherlands
| | - Aletta D Kraneveld
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, the Netherlands; Veterinary Pharmacology & Therapeutics, Institute of Risk Assessment Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, the Netherlands.
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Zhang Q, Li YX, Li XL, Yin Y, Li RL, Qiao X, Li W, Ma HF, Ma WH, Han YF, Zeng GQ, Wang QY, Kang J, Hou G. A comparative study of the five-repetition sit-to-stand test and the 30-second sit-to-stand test to assess exercise tolerance in COPD patients. Int J Chron Obstruct Pulmon Dis 2018; 13:2833-2839. [PMID: 30237707 PMCID: PMC6136403 DOI: 10.2147/copd.s173509] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Purpose The sit-to-stand test (STST) has been used to evaluate the exercise tolerance of patients with COPD. However, mutual comparisons to predict poor exercise tolerance have been hindered by the variety of STST modes used in previous studies, which also did not consider patients’ subjective perceptions of different STST modes. Our aim was to compare the five-repetition sit-to-stand test (5STS) with the 30-second sit-to-stand test (30STS) for predicting poor performance in the six-minute walking test and to evaluate patients’ subjective perceptions to determine the optimal mode for clinical practice. Patients and methods Patients with stable COPD performed 5STS, 30STS and the 6MWT and then evaluated their feelings about the two STST modes by Borg dyspnea score and a questionnaire. Moreover, we collected data through the pulmonary function test, mMRC dyspnea score, COPD assessment test and quadriceps muscle strength (QMS). A receiver operating characteristic curve analysis of the 5STS and 30STS results was used to predict 6-minute walk distance (6MWD) <350 m. Results The final analysis included 128 patients. Similar moderate correlations were observed between 6MWT and 5STS (r=−0.508, P<0.001) and between 6MWT and 30STS (r=0.528, P<0.001), and there were similar correlations between QMS and 5STS (r=−0.401, P<0.001) and between QMS and 30STS (r=0.398, P<0.001). The 5STS and 30STS score cutoffs produced sensitivity, specificity and positive and negative predictive values of 76.0%, 62.8%, 56.7% and 80.3% (5STS) and 62.0%, 75.0%, 62.0% and 75.0% (30STS), respectively, for predicting poor 6MWT performance. The 5STS exhibited obvious superiority in terms of the completion rate and the subjective feelings of the participants. Conclusion As a primary screening test for predicting poor 6MWD, the 5STS is similar to the 30STS in terms of sensitivity and specificity, but the 5STS has a better patient experience.
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Affiliation(s)
- Qin Zhang
- Institute of Respiratory Disease, First Hospital of China Medical University, Shenyang, China,
| | - Yan-Xia Li
- Department of Respiratory Medicine, First Hospital of Dalian Medical University, Dalian, China
| | - Xue-Lian Li
- Department of Epidemiology, School of Public Health, China Medical University, Shenyang, China
| | - Yan Yin
- Institute of Respiratory Disease, First Hospital of China Medical University, Shenyang, China,
| | - Rui-Lan Li
- Institute of Respiratory Disease, First Hospital of China Medical University, Shenyang, China,
| | - Xin Qiao
- Institute of Respiratory Disease, First Hospital of China Medical University, Shenyang, China,
| | - Wei Li
- Institute of Respiratory Disease, First Hospital of China Medical University, Shenyang, China,
| | - Hai-Feng Ma
- Institute of Respiratory Disease, First Hospital of China Medical University, Shenyang, China,
| | - Wen-Hui Ma
- Institute of Respiratory Disease, First Hospital of China Medical University, Shenyang, China,
| | - Yu-Feng Han
- Institute of Respiratory Disease, First Hospital of China Medical University, Shenyang, China,
| | - Guang-Qiao Zeng
- State Key Laboratory of Respiratory Disease, National Clinical Research Center of Respiratory Disease, Guangzhou Institute of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China,
| | - Qiu-Yue Wang
- Institute of Respiratory Disease, First Hospital of China Medical University, Shenyang, China,
| | - Jian Kang
- Institute of Respiratory Disease, First Hospital of China Medical University, Shenyang, China,
| | - Gang Hou
- Institute of Respiratory Disease, First Hospital of China Medical University, Shenyang, China,
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Stoeckel MC, Esser RW, Gamer M, von Leupoldt A. Breathlessness amplifies amygdala responses during affective processing. Psychophysiology 2018; 55:e13092. [PMID: 29667212 DOI: 10.1111/psyp.13092] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 03/26/2018] [Accepted: 03/27/2018] [Indexed: 12/11/2022]
Abstract
Breathlessness is an aversive symptom in many prevalent somatic and psychiatric diseases and is usually experienced as highly threatening. It is strongly associated with negative affect, but the underlying neural processes remain poorly understood. Therefore, using fMRI, the present study examined the effects of breathlessness on the neural processing of affective visual stimuli within candidate brain areas including the amygdala, insula, and anterior cingulate cortex (ACC). During scanning, 42 healthy volunteers, mean (SD) age: 29.0 (6.0) years, 14 female, were presented with affective picture series of negative, neutral, and positive valence while experiencing either no breathlessness (baseline conditions) or resistive-load induced breathlessness (breathlessness conditions). Respiratory measures and self-reports suggested successful induction of breathlessness and affective experiences. Self-reports of breathlessness intensity and unpleasantness were significantly higher during breathlessness conditions, mean (SD): 45.0 (16.6) and 32.3 (19.8), as compared to baseline conditions, mean (SD): 1.9 (3.0) and 2.9 (5.5). Compared to baseline conditions, stronger amygdala activations were observed during breathlessness conditions for both negative and positive affective picture series relative to neutral picture series, while no such effects were observed in insula and ACC. The present findings demonstrate that breathlessness amplifies amygdala responses during affective processing, suggesting an important role of the amygdala for mediating the interactions between breathlessness and affective states.
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Affiliation(s)
- M Cornelia Stoeckel
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Roland W Esser
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Matthias Gamer
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Psychology 1, University of Würzburg, Würzburg, Germany
| | - Andreas von Leupoldt
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Health Psychology, University of Leuven, Leuven, Belgium
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Effect of Baseline Anxiety and Depression Symptoms on Selected Outcomes Following Pulmonary Rehabilitation. J Cardiopulm Rehabil Prev 2018. [PMID: 28640172 DOI: 10.1097/hcr.0000000000000258] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Anxiety and depression are prevalent comorbidities in people with chronic respiratory diseases (CRDs). This study sought to quantify the influence of varying degrees of anxiety and depression on functional performance and disease impact in a population with CRDs following pulmonary rehabilitation (PR) intervention. METHODS The Hospital Anxiety and Depression Scale (HADS), the 6-Minute Walk Test (6MWT), and the Chronic Obstructive Pulmonary Disease Assessment Test (CAT) were assessed pre- and post-PR. Participants were categorized into 3 groups (None, Probable, and Present) based on their level of anxiety and depression. Functional performance and disease impact outcomes were compared pre- and post-PR. RESULTS Patients consisted of a total of 134 program completers (72 males, 62 females; mean age = 67.8 years). Significant improvements in functional performance with regard to 6MWT scores were observed across all groups postintervention (P < .05). The Present group, in both the anxiety and depression domains, failed to reach a minimally clinically important difference postintervention. The Probable and Present groups achieved a significant improvement in CAT scores postintervention (P < .05). CONCLUSIONS This study showed that symptoms of anxiety and depression in people with CRDs were significantly related to lower exercise tolerance levels and higher levels of disease impact. People with increased levels of anxiety and depression have the potential to significantly improve disease impact outcomes post-PR. The results demonstrated that the detection and treatment of anxiety and depression symptoms in people with CRDs are likely to be clinically important.
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Management of Dyspnea and Anxiety in Chronic Obstructive Pulmonary Disease: A Critical Review. J Am Med Dir Assoc 2017; 18:1096.e1-1096.e17. [DOI: 10.1016/j.jamda.2017.09.007] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 09/11/2017] [Accepted: 09/13/2017] [Indexed: 11/19/2022]
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