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Ibad HA, Hathaway QA, Bluemke DA, Kasaeian A, Klein JG, Budoff MJ, Barr RG, Allison M, Post WS, Lima JAC, Demehri S. CT-derived pectoralis composition and incident pneumonia hospitalization using fully automated deep-learning algorithm: multi-ethnic study of atherosclerosis. Eur Radiol 2024; 34:4163-4175. [PMID: 37951855 DOI: 10.1007/s00330-023-10372-1] [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: 06/13/2023] [Revised: 08/04/2023] [Accepted: 08/14/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND Pneumonia-related hospitalization may be associated with advanced skeletal muscle loss due to aging (i.e., sarcopenia) or chronic illnesses (i.e., cachexia). Early detection of muscle loss may now be feasible using deep-learning algorithms applied on conventional chest CT. OBJECTIVES To implement a fully automated deep-learning algorithm for pectoralis muscle measures from conventional chest CT and investigate longitudinal associations between these measures and incident pneumonia hospitalization according to Chronic Obstructive Pulmonary Disease (COPD) status. MATERIALS AND METHODS This analysis from the Multi-Ethnic Study of Atherosclerosis included participants with available chest CT examinations between 2010 and 2012. We implemented pectoralis muscle composition measures from a fully automated deep-learning algorithm (Mask R-CNN, built on the Faster Region Proposal Network (R-) Convolutional Neural Network (CNN) with an extension for mask identification) for two-dimensional segmentation. Associations between CT-derived measures and incident pneumonia hospitalizations were evaluated using Cox proportional hazards models adjusted for multiple confounders which include but are not limited to age, sex, race, smoking, BMI, physical activity, and forced-expiratory-volume-at-1 s-to-functional-vital-capacity ratio. Stratification analyses were conducted based on baseline COPD status. RESULTS This study included 2595 participants (51% female; median age: 68 (IQR: 61, 76)) CT examinations for whom we implemented deep learning-derived measures for longitudinal analyses. Eighty-six incident pneumonia hospitalizations occurred during a median 6.67-year follow-up. Overall, pectoralis muscle composition measures did not predict incident pneumonia. However, in fully-adjusted models, only among participants with COPD (N = 507), CT measures like extramyocellular fat index (hazard ratio: 1.98, 95% CI: 1.22, 3.21, p value: 0.02), were independently associated with incident pneumonia. CONCLUSION Reliable deep learning-derived pectoralis muscle measures could predict incident pneumonia hospitalization only among participants with known COPD. CLINICAL RELEVANCE STATEMENT Pectoralis muscle measures obtainable at zero additional cost or radiation exposure from any chest CT may have independent predictive value for clinical outcomes in chronic obstructive pulmonary disease patients. KEY POINTS •Identification of independent and modifiable risk factors of pneumonia can have important clinical impact on patients with chronic obstructive pulmonary disease. •Opportunistic CT measures of adipose tissue within pectoralis muscles using deep-learning algorithms can be quickly obtainable at zero additional cost or radiation exposure. •Deep learning-derived pectoralis muscle measurements of intermuscular fat and its subcomponents are independently associated with subsequent incident pneumonia hospitalization.
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Affiliation(s)
- Hamza A Ibad
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Russell H. Morgan, Baltimore, MD, USA
| | - Quincy A Hathaway
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Russell H. Morgan, Baltimore, MD, USA
- West Virginia University School of Medicine, Heart and Vascular Institute, Morgantown, WV, USA
| | - David A Bluemke
- University of Wisconsin School of Medicine and Public Health, Department of Radiology, Madison, WI, USA
| | - Arta Kasaeian
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Russell H. Morgan, Baltimore, MD, USA
| | - Joshua G Klein
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Russell H. Morgan, Baltimore, MD, USA
| | - Matthew J Budoff
- Harbor-UCLA Medical Center, Division of Cardiology, Torrance, CA, USA
| | - R Graham Barr
- Columbia University, Division of General Medicine, New York, NY, USA
| | - Matthew Allison
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, USA
| | - Wendy S Post
- Johns Hopkins University School of Medicine, Division of Cardiology, Baltimore, MD, USA
| | - João A C Lima
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Russell H. Morgan, Baltimore, MD, USA
- Johns Hopkins University School of Medicine, Division of Cardiology, Baltimore, MD, USA
| | - Shadpour Demehri
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Russell H. Morgan, Baltimore, MD, USA.
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2
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Attaway AH, Lopez R, Welch N, Bellar A, Hatipoğlu U, Zein J, Engelen MP, Dasarathy S. Muscle loss phenotype in COPD is associated with adverse outcomes in the UK Biobank. BMC Pulm Med 2024; 24:186. [PMID: 38632546 PMCID: PMC11025247 DOI: 10.1186/s12890-024-02999-7] [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: 12/06/2023] [Accepted: 04/08/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory disorder with systemic consequences that can cause a muscle loss phenotype (MLP), which is characterized by the loss of muscle mass, muscle strength, or loss of both muscle and fat mass. There are limited data comparing the individual traits of MLP with clinical outcomes in a large unbiased cohort of COPD patients. Our aim was to determine the proportion of patients who met criteria for MLP in an unbiased sample of COPD patients at the population-level. We also determined if specific MLP features were associated with all-cause and COPD-related mortality. METHODS A retrospective population-based cohort analysis of the UK Biobank was performed. COPD was defined by a FEV1/FVC ratio < 0.7, physician established diagnosis of COPD, or those with a COPD-related hospitalization before baseline assessment. MLP included one or more of the following: 1) Low fat-free mass index (FFMI) on bioelectric impedance analysis (BIA) or 2) Appendicular skeletal muscle index (ASMI) on BIA, 3) Low muscle strength defined by handgrip strength (HGS), or 4) Low muscle and fat mass based on body mass index (BMI). Cox regression was used to determine the association between MLP and all-cause or COPD-related mortality. All models were adjusted for sex, age at assessment, ethnicity, BMI, alcohol use, smoking status, prior cancer diagnosis and FEV1/FVC ratio. RESULTS There were 55,782 subjects (56% male) with COPD followed for a median of 70.1 months with a mean(± SD) age at assessment of 59 ± 7.5 years, and FEV1% of 79.2 ± 18.5. Most subjects had mild (50.4%) or moderate (42.8%) COPD. Many patients had evidence of a MLP, which was present in 53.4% of COPD patients (34% by ASMI, 26% by HGS). Of the 5,608 deaths in patients diagnosed with COPD, 907 were COPD-related. After multivariate adjustment, COPD subjects with MLP had a 30% higher hazard-ratio for all-cause death and 70% higher hazard-ratio for COPD-related death. CONCLUSIONS Evidence of MLP is common in a large population-based cohort of COPD and is associated with higher risk for all-cause and COPD-related mortality.
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Affiliation(s)
- Amy H Attaway
- Departments of Pulmonary Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Rocio Lopez
- Center for Populations Health Research, Cleveland Clinic, Cleveland, OH, USA
| | - Nicole Welch
- Inflammation and Immunity, Cleveland Clinic, Cleveland, OH, USA
- Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, OH, USA
| | - Annette Bellar
- Inflammation and Immunity, Cleveland Clinic, Cleveland, OH, USA
| | - Umur Hatipoğlu
- Departments of Pulmonary Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Joe Zein
- Department of Medicine, Mayo Clinic, Scottsdale, AZ, USA
| | | | - Srinivasan Dasarathy
- Inflammation and Immunity, Cleveland Clinic, Cleveland, OH, USA.
- Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, OH, USA.
- Department of Inflammation and Immunity, Lerner Research Institute, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
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Wienker J, Darwiche K, Rüsche N, Büscher E, Karpf-Wissel R, Winantea J, Özkan F, Westhölter D, Taube C, Kersting D, Hautzel H, Salhöfer L, Hosch R, Nensa F, Forsting M, Schaarschmidt BM, Zensen S, Theysohn J, Umutlu L, Haubold J, Opitz M. Body composition impacts outcome of bronchoscopic lung volume reduction in patients with severe emphysema: a fully automated CT-based analysis. Sci Rep 2024; 14:8718. [PMID: 38622275 PMCID: PMC11018765 DOI: 10.1038/s41598-024-58628-0] [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: 10/09/2023] [Accepted: 04/01/2024] [Indexed: 04/17/2024] Open
Abstract
Chronic Obstructive Pulmonary Disease (COPD) is characterized by progressive and irreversible airflow limitation, with individual body composition influencing disease severity. Severe emphysema worsens symptoms through hyperinflation, which can be relieved by bronchoscopic lung volume reduction (BLVR). To investigate how body composition, assessed through CT scans, impacts outcomes in emphysema patients undergoing BLVR. Fully automated CT-based body composition analysis (BCA) was performed in patients with end-stage emphysema receiving BLVR with valves. Post-interventional muscle and adipose tissues were quantified, body size-adjusted, and compared to baseline parameters. Between January 2015 and December 2022, 300 patients with severe emphysema underwent endobronchial valve treatment. Significant improvements were seen in outcome parameters, which were defined as changes in pulmonary function, physical performance, and quality of life (QoL) post-treatment. Muscle volume remained stable (1.632 vs. 1.635 for muscle bone adjusted ratio (BAR) at baseline and after 6 months respectively), while bone adjusted adipose tissue volumes, especially total and pericardial adipose tissue, showed significant increase (2.86 vs. 3.00 and 0.16 vs. 0.17, respectively). Moderate to strong correlations between bone adjusted muscle volume and weaker correlations between adipose tissue volumes and outcome parameters (pulmonary function, QoL and physical performance) were observed. Particularly after 6-month, bone adjusted muscle volume changes positively corresponded to improved outcomes (ΔForced expiratory volume in 1 s [FEV1], r = 0.440; ΔInspiratory vital capacity [IVC], r = 0.397; Δ6Minute walking distance [6MWD], r = 0.509 and ΔCOPD assessment test [CAT], r = -0.324; all p < 0.001). Group stratification by bone adjusted muscle volume changes revealed that groups with substantial muscle gain experienced a greater clinical benefit in pulmonary function improvements, QoL and physical performance (ΔFEV1%, 5.5 vs. 39.5; ΔIVC%, 4.3 vs. 28.4; Δ6MWDm, 14 vs. 110; ΔCATpts, -2 vs. -3.5 for groups with ΔMuscle, BAR% < -10 vs. > 10, respectively). BCA results among patients divided by the minimal clinically important difference for forced expiratory volume of the first second (FEV1) showed significant differences in bone-adjusted muscle and intramuscular adipose tissue (IMAT) volumes and their respective changes after 6 months (ΔMuscle, BAR% -5 vs. 3.4 and ΔIMAT, BAR% -0.62 vs. 0.60 for groups with ΔFEV1 ≤ 100 mL vs > 100 mL). Altered body composition, especially increased muscle volume, is associated with functional improvements in BLVR-treated patients.
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Affiliation(s)
- Johannes Wienker
- Division of Interventional Pneumology, Department of Pulmonary Medicine, University Medicine Essen-Ruhrlandklinik, Tüschener Weg 40, 45239, Essen, Germany.
| | - Kaid Darwiche
- Division of Interventional Pneumology, Department of Pulmonary Medicine, University Medicine Essen-Ruhrlandklinik, Tüschener Weg 40, 45239, Essen, Germany
| | - Nele Rüsche
- Division of Interventional Pneumology, Department of Pulmonary Medicine, University Medicine Essen-Ruhrlandklinik, Tüschener Weg 40, 45239, Essen, Germany
| | - Erik Büscher
- Division of Interventional Pneumology, Department of Pulmonary Medicine, University Medicine Essen-Ruhrlandklinik, Tüschener Weg 40, 45239, Essen, Germany
| | - Rüdiger Karpf-Wissel
- Division of Interventional Pneumology, Department of Pulmonary Medicine, University Medicine Essen-Ruhrlandklinik, Tüschener Weg 40, 45239, Essen, Germany
| | - Jane Winantea
- Division of Interventional Pneumology, Department of Pulmonary Medicine, University Medicine Essen-Ruhrlandklinik, Tüschener Weg 40, 45239, Essen, Germany
| | - Filiz Özkan
- Division of Interventional Pneumology, Department of Pulmonary Medicine, University Medicine Essen-Ruhrlandklinik, Tüschener Weg 40, 45239, Essen, Germany
| | - Dirk Westhölter
- Department of Pulmonary Medicine, University Medicine Essen-Ruhrlandklinik, Essen, Germany
| | - Christian Taube
- Department of Pulmonary Medicine, University Medicine Essen-Ruhrlandklinik, Essen, Germany
| | - David Kersting
- Department of Nuclear Medicine, University Hospital Essen, Essen, Germany
| | - Hubertus Hautzel
- Department of Nuclear Medicine, University Hospital Essen, Essen, Germany
| | - Luca Salhöfer
- Institute for Artificial Intelligence in Medicine, University Hospital Essen, Essen, Germany
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - René Hosch
- Institute for Artificial Intelligence in Medicine, University Hospital Essen, Essen, Germany
| | - Felix Nensa
- Institute for Artificial Intelligence in Medicine, University Hospital Essen, Essen, Germany
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Michael Forsting
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Benedikt M Schaarschmidt
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Sebastian Zensen
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Jens Theysohn
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Lale Umutlu
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Johannes Haubold
- Institute for Artificial Intelligence in Medicine, University Hospital Essen, Essen, Germany
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Marcel Opitz
- Institute for Artificial Intelligence in Medicine, University Hospital Essen, Essen, Germany
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
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Mahler DA, Halpin DMG. Consideration and Assessment of Patient Factors When Selecting an Inhaled Delivery System in COPD. Chest 2024; 165:323-332. [PMID: 37977266 DOI: 10.1016/j.chest.2023.11.011] [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: 08/14/2023] [Revised: 10/23/2023] [Accepted: 11/09/2023] [Indexed: 11/19/2023] Open
Abstract
Because guidelines and strategies for pharmacologic treatment of COPD focus on specific classes of inhaled medications, there is an unmet need for information to guide health care professionals for selecting an inhaled medication delivery system that matches the unique characteristics of individual patients. This article provides guidance for selecting an inhaled medication delivery system based on three "key" patient factors: cognitive function, manual dexterity/strength, and peak inspiratory flow. In addition, information is provided about specific tests to assess these patient factors. Cognitive impairment with an estimated prevalence of 25% among patients with COPD adversely affects patients' ability to correctly use a handheld device. To our knowledge, the prevalence of impaired manual dexterity/strength has not been reported in those with COPD. However, 79% of patients with COPD have reported one or more physical impediments that could influence their ability to manipulate an inhaler device. The measurement of peak inspiratory flow against the simulated resistance (PIFr) of a dry powder inhaler establishes whether the patient has the inhalation ability for creating optimal turbulent energy within the device. A suboptimal PIFr for low to medium-high resistance dry powder inhalers has been reported in 19% to 84% of stable outpatients with COPD. Health care professionals should consider cognitive function, manual dexterity/strength, and PIFr in their patients with COPD when prescribing inhaled pharmacotherapy. Impairments in these patient factors are common among those with COPD and can affect the individual's competency and effectiveness of using inhaled medications delivered by handheld devices.
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Affiliation(s)
- Donald A Mahler
- Geisel School of Medicine at Dartmouth, Hanover, NH; Respiratory Services, Valley Regional Hospital, Claremont, NH.
| | - David M G Halpin
- Respiratory Medicine, University of Exeter Medical School, University of Exeter, Exeter, England
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5
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Qian Y, Cai C, Sun M, Lv D, Zhao Y. Analyses of Factors Associated with Acute Exacerbations of Chronic Obstructive Pulmonary Disease: A Review. Int J Chron Obstruct Pulmon Dis 2023; 18:2707-2723. [PMID: 38034468 PMCID: PMC10683659 DOI: 10.2147/copd.s433183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 11/09/2023] [Indexed: 12/02/2023] Open
Abstract
Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) is the exacerbation of a range of respiratory symptoms during the stable phase of chronic obstructive pulmonary disease (COPD). AECOPD is thus a dangerous stage and key event in the course of COPD, as its deterioration and frequency seriously affects the quality of life of patients and shortens their survival. Acute exacerbations occur and develop due to many factors such as infection, tobacco smoke inhalation, air pollution, comorbidities, airflow limitation, various biomarkers, history of previous deterioration, natural killer cell abnormalities, immunoglobulin G deficiency, genetics, abnormal muscle and nutritional status, negative psychology, and seasonal temperature changes. There is relatively limited research on the impact of the role of standardized management on the alleviation of AECOPD. However, with the establishment of relevant prevention and management systems and the promotion of artificial intelligence technology and Internet medical approaches, long-term effective and standardized management of COPD patients may help to achieve the quality of life and disease prognosis in COPD patients and reduce the risk of AE.
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Affiliation(s)
- Yang Qian
- The First Affiliated Hospital of Ningbo University, Ningbo, People’s Republic of China
| | - Chenting Cai
- The First Affiliated Hospital of Ningbo University, Ningbo, People’s Republic of China
| | - Mengqing Sun
- The First Affiliated Hospital of Ningbo University, Ningbo, People’s Republic of China
| | - Dan Lv
- The First Affiliated Hospital of Ningbo University, Ningbo, People’s Republic of China
| | - Yun Zhao
- The First Affiliated Hospital of Ningbo University, Ningbo, People’s Republic of China
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6
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Mahler DA, Halpin DMG. Personalizing Selection of Inhaled Delivery Systems in Chronic Obstructive Pulmonary Disease. Ann Am Thorac Soc 2023; 20:1389-1396. [PMID: 37499210 PMCID: PMC10559134 DOI: 10.1513/annalsats.202304-384cme] [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: 04/27/2023] [Accepted: 07/27/2023] [Indexed: 07/29/2023] Open
Abstract
It can be challenging for healthcare professionals (HCPs) to prescribe inhaled therapy for patients with chronic obstructive pulmonary disease (COPD) because of the multiple individual and combinations of inhaled medications available in numerous delivery systems. Guidance on the selection of an inhaled delivery system has received limited attention compared with the emphasis on prescribing the class of the inhaled molecule(s). Although numerous recommendations and algorithms have been proposed to guide the selection of an inhaled delivery system for patients with COPD, no specific approach has been endorsed in COPD guidelines/strategies or by professional organizations. To provide recommendations for an inhaler selection strategy at initial and follow-up appointments, we examined the impact of patient errors using handheld inhalers on clinical outcomes and performed a focused narrative review to consider patient factors (continuity of the inhaled delivery system, cognitive function, manual function/dexterity, and peak inspiratory flow) when selecting an inhaled delivery system. On the basis of these findings, five questions are proposed for HCPs to consider in the initial selection of an inhaler delivery system and three questions to consider at follow-up. We propose that HCPs consider the inhaled medication delivery system as a unit and to match appropriate medication(s) with the unique features of the delivery system to individual patient factors. Assessment of inhaler technique and adherence together with patient outcomes/satisfaction at each visit is essential to determine whether the inhaled medication delivery system is providing benefits. Continued and repeated education on device features and correct technique is warranted to optimize efficacy.
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Affiliation(s)
- Donald A. Mahler
- Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire
- Valley Regional Hospital, Claremont, New Hampshire; and
| | - David M. G. Halpin
- University of Exeter Medical School, University of Exeter, Exeter, United Kingdom
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7
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Cazzola M, Rogliani P, Barnes PJ, Blasi F, Celli B, Hanania NA, Martinez FJ, Miller BE, Miravitlles M, Page CP, Tal-Singer R, Matera MG. An Update on Outcomes for COPD Pharmacological Trials: A COPD Investigators Report - Reassessment of the 2008 American Thoracic Society/European Respiratory Society Statement on Outcomes for COPD Pharmacological Trials. Am J Respir Crit Care Med 2023; 208:374-394. [PMID: 37236628 DOI: 10.1164/rccm.202303-0400so] [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: 03/08/2023] [Accepted: 05/23/2023] [Indexed: 05/28/2023] Open
Abstract
Background: In 2008, a dedicated American Thoracic Society/European Respiratory Society task force published a paper on the possible use and limitations of clinical outcomes and biomarkers to evaluate the impact of pharmacological therapy in patients with chronic obstructive pulmonary disease. Since then, our scientific understanding of chronic obstructive pulmonary disease has increased considerably; there has been a progressive shift from a one-size-fits-all diagnostic and therapeutic approach to a personalized approach; and many new treatments currently in development will require new endpoints to evaluate their efficacy adequately. Objectives: The emergence of several new relevant outcome measures motivated the authors to review advances in the field and highlight the need to update the content of the original report. Methods: The authors separately created search strategies for the literature, primarily based on their opinions and assessments supported by carefully chosen references. No centralized examination of the literature or uniform criteria for including or excluding evidence were used. Measurements and Main Results: Endpoints, outcomes, and biomarkers have been revisited. The limitations of some of those reported in the American Thoracic Society/European Respiratory Society task force document have been highlighted. In addition, new tools that may be useful, especially in evaluating personalized therapy, have been described. Conclusions: Because the "label-free" treatable traits approach is becoming an important step toward precision medicine, future clinical trials should focus on highly prevalent treatable traits, and this will influence the choice of outcomes and markers to be considered. The use of the new tools, particularly combination endpoints, could help better identify the right patients to be treated with the new drugs.
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Affiliation(s)
- Mario Cazzola
- Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Paola Rogliani
- Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Peter J Barnes
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Francesco Blasi
- Pulmonology and Cystic Fibrosis Unit, Internal Medicine Department, Foundation Scientific Institute for Research, Hospitalization and Healthcare Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Bartolome Celli
- Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Nicola A Hanania
- Section of Pulmonary and Critical Care Medicine, Baylor College of Medicine, Houston, Texas
| | - Fernando J Martinez
- Joan and Sanford I. Weill Department of Medicine, Weill Cornell Medicine, New York, New York
| | | | - Marc Miravitlles
- Pneumology Department, Hospital Universitari Vall d'Hebron/Vall d'Hebron Institut de Recerca, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Clive P Page
- Sackler Institute of Pulmonary Pharmacology, King's College London, London, United Kingdom
| | - Ruth Tal-Singer
- TalSi Translational Medicine Consulting, LLC, Media, Pennsylvania; and
| | - Maria Gabriella Matera
- Unit of Pharmacology, Department of Experimental Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
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8
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Choi YJ, Kim T, Park HJ, Cho JH, Byun MK. Long-Term Clinical Outcomes of Patients with Chronic Obstructive Pulmonary Disease with Sarcopenia. Life (Basel) 2023; 13:1628. [PMID: 37629485 PMCID: PMC10455166 DOI: 10.3390/life13081628] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 07/20/2023] [Accepted: 07/21/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Sarcopenia with muscle wasting and weakness is a common occurrence among patients with chronic obstructive pulmonary disease (COPD). We aimed to evaluate the clinical outcomes of sarcopenia in patients with COPD. METHODS We reviewed the electronic medical records of 71 patients with COPD between 1 January 2012, and 31 December 2018. We longitudinally analyzed clinical outcomes in patients with COPD with and without sarcopenia. RESULTS Compared to the non-sarcopenia group COPD, the sarcopenia group showed a higher rate of acute exacerbation events of COPD (AE COPD, 84.6% vs. 31.0%, p = 0.001), all-cause mortality (30.8% vs. 5.2%, p = 0.022), and pneumonia occurrence per year (median [first quartile-third quartile]; 0.2 [0.0-1.6] vs. 0.0 [0.0-0.2], p = 0.025). Sarcopenia was an independent risk factor for AE COPD in Cox regression analysis (hazard ratio, 5.982; 95% confidence interval, 1.576-22.704). Hand grip strength was associated with the COPD Assessment Test (CAT) score and annual Charlson's comorbidity index score change. Total skeletal muscle mass index (SMMI) was associated with the modified medical research council dyspnea scale score, CAT score, body mass index, airflow obstruction, dyspnea, and exercise (BODE) index, and alanine transaminase. Trunk SMMI was significantly associated with AE COPD, while appendicular SMMI was associated with BODE index and annual intensive care unit admissions for AE COPD. CONCLUSIONS Sarcopenia is associated with clinical prognosis, pneumonia occurrence, and the acute exacerbation of COPD requiring intensive care in patients with COPD. Therefore, it is important to carefully monitor sarcopenia development as well as recommend appropriate exercise and nutritional supplementation in patients with COPD.
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Affiliation(s)
| | | | | | | | - Min Kwang Byun
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Republic of Korea; (Y.J.C.); (T.K.); (H.J.P.); (J.H.C.)
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9
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Zou RH, Nouraie SM, Rossiter HB, McDonald ML, DeMeo DL, Mason S, Washko GR, Saha PK, Make BJ, Casaburi R, Regan EA, Bon J. Associations Between Muscle Weakness and Clinical Outcomes in Current and Former Smokers. CHRONIC OBSTRUCTIVE PULMONARY DISEASES (MIAMI, FLA.) 2023; 10:112-121. [PMID: 36599111 PMCID: PMC9995230 DOI: 10.15326/jcopdf.2022.0365] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/30/2022] [Indexed: 01/06/2023]
Abstract
Introduction Smokers with chronic obstructive pulmonary disease (COPD) are at increased risk of muscle weakness. There are limited data describing weakness in smokers with normal spirometry and preserved ratio-impaired spirometry (PRISm), 2 subgroups at risk of respiratory symptom burden and activity limitations. In this study, we evaluated the associations of 2 weakness measures, sit-to-stand (STS) and handgrip strength (HGS), with clinical outcomes in smokers with COPD, normal spirometry, and PRISm. Methods We evaluated 1972 current and former smokers from the COPD Genetic Epidemiology (COPDGene®) cohort with STS and HGS measurements at their 10-year study visit. Multivariable regression modeling was used to assess associations between weakness measures and the 6-minute walk distance (6MWD) test, the St George's Respiratory Questionnaire (SGRQ), the Short-Form-36 (SF-36), severe exacerbations, and prospective mortality, reported as standardized coefficients (β), odds ratios (ORs), or hazard ratios (HRs). Results Compared with HGS, STS was more strongly associated with the 6MWD (β=0.45, p<0.001 versus. β=0.25, p<0.001), SGRQ (β=-0.24, p<0.001 versus β=-0.18, p<0.001), SF-36 Physical Functioning (β=0.36, p<0.001 versus β=0.25, p<0.001), severe exacerbations (OR 0.95, p=0.04 versus OR 0.97, p=0.01), and prospective mortality (HR 0.83, p=0.001 versus HR 0.94, p=0.03). Correlations remained after stratification by spirometric subgroups. Compared with males, females had larger magnitude effect sizes between STS and clinical outcomes. Conclusions STS and HGS are easy to perform weakness measures that provide important information about functional performance, health-related quality of life, severe exacerbations, and survival in smokers, regardless of spirometric subgroup. This iterates the importance of screening current and former smokers for weakness in the outpatient setting.
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Affiliation(s)
- Richard H. Zou
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - S. Mehdi Nouraie
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Harry B. Rossiter
- The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California, United States
| | - Merry-Lynn McDonald
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Dawn L. DeMeo
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States
| | - Stefanie Mason
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States
| | - George R. Washko
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States
| | - Punam K. Saha
- Department of Radiology, University of Iowa, Iowa City, Iowa, United States
| | - Barry J. Make
- Department of Medicine, National Jewish Health, Denver, Colorado, United States
| | - Richard Casaburi
- The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California, United States
| | - Elizabeth A. Regan
- Department of Medicine, National Jewish Health, Denver, Colorado, United States
| | - Jessica Bon
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
- Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, United States
| | - for the COPDGene Investigators
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
- The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California, United States
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States
- Department of Radiology, University of Iowa, Iowa City, Iowa, United States
- Department of Medicine, National Jewish Health, Denver, Colorado, United States
- Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, United States
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10
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Wilson AC, Bon JM, Mason S, Diaz AA, Lutz SM, Estepar RSJ, Kinney GL, Hokanson JE, Rennard SI, Casaburi R, Bhatt SP, Irvin MR, Hersh CP, Dransfield MT, Washko GR, Regan EA, McDonald ML. Increased chest CT derived bone and muscle measures capture markers of improved morbidity and mortality in COPD. Respir Res 2022; 23:311. [PMID: 36376854 PMCID: PMC9664607 DOI: 10.1186/s12931-022-02237-w] [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: 09/14/2022] [Accepted: 11/03/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a disease of accelerated aging and is associated with comorbid conditions including osteoporosis and sarcopenia. These extrapulmonary conditions are highly prevalent yet frequently underdiagnosed and overlooked by pulmonologists in COPD treatment and management. There is evidence supporting a role for bone-muscle crosstalk which may compound osteoporosis and sarcopenia risk in COPD. Chest CT is commonly utilized in COPD management, and we evaluated its utility to identify low bone mineral density (BMD) and reduced pectoralis muscle area (PMA) as surrogates for osteoporosis and sarcopenia. We then tested whether BMD and PMA were associated with morbidity and mortality in COPD. METHODS BMD and PMA were analyzed from chest CT scans of 8468 COPDGene participants with COPD and controls (smoking and non-smoking). Multivariable regression models tested the relationship of BMD and PMA with measures of function (6-min walk distance (6MWD), handgrip strength) and disease severity (percent emphysema and lung function). Multivariable Cox proportional hazards models were used to evaluate the relationship between sex-specific quartiles of BMD and/or PMA derived from non-smoking controls with all-cause mortality. RESULTS COPD subjects had significantly lower BMD and PMA compared with controls. Higher BMD and PMA were associated with increased physical function and less disease severity. Participants with the highest BMD and PMA quartiles had a significantly reduced mortality risk (36% and 46%) compared to the lowest quartiles. CONCLUSIONS These findings highlight the potential for CT-derived BMD and PMA to characterize osteoporosis and sarcopenia using equipment available in the pulmonary setting.
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Affiliation(s)
- Ava C Wilson
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, 701, 19th Street S., LHRB 440, Birmingham, AL, 35233, USA
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jessica M Bon
- Division of Pulmonary, Allergy and Critical Medicine, University of Pittsburgh Health System, Pittsburgh, PA, USA
- VA Pittsburgh Health System, Pittsburgh, PA, USA
| | - Stephanie Mason
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Alejandro A Diaz
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Sharon M Lutz
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Raul San Jose Estepar
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Gregory L Kinney
- Department of Epidemiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - John E Hokanson
- Department of Epidemiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | | | - Richard Casaburi
- Rehabilitation Clinical Trials Center, Lundquist Institute for Biomedical Innovation at Harbor Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Surya P Bhatt
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Marguerite R Irvin
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, 701, 19th Street S., LHRB 440, Birmingham, AL, 35233, USA
| | - Craig P Hersh
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Mark T Dransfield
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - George R Washko
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Merry-Lynn McDonald
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, 701, 19th Street S., LHRB 440, Birmingham, AL, 35233, USA.
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
- Department of Genetics, University of Alabama at Birmingham, Birmingham, AL, USA.
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11
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Nicholson JM, Orsso CE, Nourouzpour S, Elangeswaran B, Chohan K, Orchanian-Cheff A, Fidler L, Mathur S, Rozenberg D. Computed tomography-based body composition measures in COPD and their association with clinical outcomes: A systematic review. Chron Respir Dis 2022; 19:14799731221133387. [PMID: 36223552 PMCID: PMC9561670 DOI: 10.1177/14799731221133387] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Computed tomography (CT) is commonly utilized in chronic obstructive
pulmonary disease (COPD) for lung cancer screening and emphysema
characterization. Computed tomography-morphometric analysis of body
composition (muscle mass and adiposity) has gained increased recognition as
a marker of disease severity and prognosis. This systematic review aimed to
describe the CT-methodology used to assess body composition and identify the
association of body composition measures and disease severity,
health-related quality of life (HRQL), cardiometabolic risk factors,
respiratory exacerbations, and survival in patients with COPD. Methods Six databases were searched (inception-September 2021) for studies evaluating
adult COPD patients using thoracic or abdominal CT-muscle or adiposity body
composition measures. The systematic review was conducted in accordance with
the PRISMA guidelines. Results Twenty eight articles were included with 15,431 COPD patients, across all
GOLD stages with 77% males, age range (mean/median 59–78 years), and BMI
range 19.8–29.3 kg/m2. There was heterogeneity in assessment of
muscle mass and adiposity using thoracic (n = 22) and
abdominal (n = 8) CT-scans, capturing different muscle
groups, anatomic locations, and adiposity compartments (visceral,
subcutaneous, and epicardial). Low muscle mass and increased adiposity were
associated with increased COPD severity measures (lung function, exercise
capacity, dyspnea) and lower HRQL, but were not consistent across studies.
Increased visceral adiposity (n = 6) was associated with
cardiovascular disease or risk factors (hypertension, hyperlipidemia, and
diabetes). Low muscle CSA was prognostic of respiratory exacerbations or
mortality in three of six studies, whereas the relationship with increased
intermuscular adiposity and greater mortality was only observed in one of
three studies. Conclusion There was significant variability in CT-body composition measures. In several
studies, low muscle mass was associated with increased disease severity and
lower HRQL, whereas adiposity with cardiovascular disease/risk factors.
Given the heterogeneity in body composition measures and clinical outcomes,
the prognostic utility of CT-body composition in COPD requires further
study.
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Affiliation(s)
- John M Nicholson
- Department of Medicine,
Respirology, London
Health Science Center, London, ON,
Canada
| | - Camila E Orsso
- Department of Agricultural, Food
and Nutritional Science, University of
Alberta, Edmonton, AB, Canada
| | - Sahar Nourouzpour
- Temerty Faculty of Medicine,
Respirology, Lung Transplant Program, Toronto General Hospital Research
Institute, University
Health Network, Toronto, ON,
Canada
| | - Brenawen Elangeswaran
- Temerty Faculty of Medicine,
Respirology, Lung Transplant Program, Toronto General Hospital Research
Institute, University
Health Network, Toronto, ON,
Canada
| | - Karan Chohan
- Temerty Faculty of Medicine,
Respirology, Lung Transplant Program, Toronto General Hospital Research
Institute, University
Health Network, Toronto, ON,
Canada
| | - Ani Orchanian-Cheff
- Library and Information Services,
University
Health Network, Toronto, ON,
Canada
| | - Lee Fidler
- Department of Medicine,
Respirology, University
Health Network, Toronto, Canada,Respirology,
Sunnybrook
Health Sciences Centre, Toronto, ON,
Canada
| | - Sunita Mathur
- Deparment of Physical Therapy,
University
of Toronto, Toronto, ON, Canada,School of Rehabilitation Therapy,
Queen’s
University, Kingston, ON, Canada
| | - Dmitry Rozenberg
- Temerty Faculty of Medicine,
Respirology, Lung Transplant Program, Toronto General Hospital Research
Institute, University
Health Network, Toronto, ON,
Canada,Dmitry Rozenberg, Temerty Faculty of
Medicine, Respirology, Lung Transplant Program, Toronto General Hospital
Research Institute, University Health Network, 200 Elizabeth Street, 13-EN 229,
Toronto ON M5G 2C4, Canada.
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12
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Lupton-Smith A, Fourie K, Mazinyo A, Mokone M, Nxaba S, Morrow B. Measurement of hand grip strength: A cross-sectional study of two dynamometry devices. SOUTH AFRICAN JOURNAL OF PHYSIOTHERAPY 2022; 78:1768. [PMID: 36262213 PMCID: PMC9575361 DOI: 10.4102/sajp.v78i1.1768] [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: 01/07/2022] [Accepted: 06/20/2022] [Indexed: 11/06/2022] Open
Abstract
Background Grip strength has been identified as an important indicator of health status and predictor of clinical outcomes. The gold standard for measuring grip strength is the JAMAR® Hydraulic Hand Dynamometer. Less expensive dynamometers are available but have not been validated within a hospital setting. Objectives To validate the Camry Digital Handgrip Dynamometer (Model EH101) against the validated JAMAR® Dynamometer (Model J00105) in a hospital population. Methods A cross-sectional observational study with a randomised single-blind cross-over component was conducted on consenting adult patients admitted to general hospital wards. The best of three measurements taken using the dominant hand was used for analysis. Results Fifty-one participants (median [interquartile range] age 42 [30–58] years; n = 27 [52.9%] female) were included. The mean difference between the Jamar® and Camry measurements was 1.9 kg ± 3.6 kg (t-value 0.9; p = 0.4). There was a strong positive correlation between the Jamar® and the Camry devices (R = 0.94; r² = 0.88; p < 0.0001). Excellent agreement was found between Jamar® and Camry measurements (interclass correlational coefficient 0.97, 95% CI 0.94–0.99, p < 0.0001). Hand dominance significantly affected the agreement between devices (p = 0.002). Conclusions The Camry Digital Handgrip Dynamometer is a valid tool for assessing grip strength in hospitalised adult patients. Clinical implications The Camry Digital Handgrip Dynamometer could be used as an inexpensive tool to measure grip strength.
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Affiliation(s)
- Alison Lupton-Smith
- Division of Physiotherapy, Health and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Kyla Fourie
- Department of Rehabilitation Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Anele Mazinyo
- Department of Rehabilitation Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Molebogeng Mokone
- Department of Rehabilitation Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Siwelile Nxaba
- Department of Rehabilitation Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Brenda Morrow
- Department of Paediatrics, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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13
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Wang L, van Iersel LEJ, Pelgrim CE, Lu J, van Ark I, Leusink-Muis T, Gosker HR, Langen RCJ, Schols AMWJ, Argilés JM, van Helvoort A, Kraneveld AD, Garssen J, Henricks PAJ, Folkerts G, Braber S. Effects of Cigarette Smoke on Adipose and Skeletal Muscle Tissue: In Vivo and In Vitro Studies. Cells 2022; 11:cells11182893. [PMID: 36139468 PMCID: PMC9497292 DOI: 10.3390/cells11182893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 08/31/2022] [Accepted: 09/06/2022] [Indexed: 11/25/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD), often caused by smoking, is a chronic lung disease with systemic manifestations including metabolic comorbidities. This study investigates adaptive and pathological alterations in adipose and skeletal muscle tissue following cigarette smoke exposure using in vivo and in vitro models. Mice were exposed to cigarette smoke or air for 72 days and the pre-adipose cell line 3T3-L1 was utilized as an in vitro model. Cigarette smoke exposure decreased body weight, and the proportional loss in fat mass was more pronounced than the lean mass loss. Cigarette smoke exposure reduced adipocyte size and increased adipocyte numbers. Adipose macrophage numbers and associated cytokine levels, including interleukin-1β, interleukine-6 and tumor necrosis factor-α were elevated in smoke-exposed mice. Muscle strength and protein synthesis signaling were decreased after smoke exposure; however, muscle mass was not changed. In vitro studies demonstrated that lipolysis and fatty acid oxidation were upregulated in cigarette smoke-exposed pre-adipocytes. In conclusion, cigarette smoke exposure induces a loss of whole-body fat mass and adipose atrophy, which is likely due to enhanced lipolysis.
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Affiliation(s)
- Lei Wang
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, 3584 CG Utrecht, The Netherlands or
| | - Lieke E. J. van Iersel
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre +, 6200 MD Maastricht, The Netherlands
| | - Charlotte E. Pelgrim
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, 3584 CG Utrecht, The Netherlands or
| | - Jingyi Lu
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, 3584 CG Utrecht, The Netherlands or
| | - Ingrid van Ark
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, 3584 CG Utrecht, The Netherlands or
| | - Thea Leusink-Muis
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, 3584 CG Utrecht, The Netherlands or
| | - Harry R. Gosker
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre +, 6200 MD Maastricht, The Netherlands
| | - Ramon C. J. Langen
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre +, 6200 MD Maastricht, The Netherlands
| | - Annemie M. W. J. Schols
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre +, 6200 MD Maastricht, The Netherlands
| | - Josep M. Argilés
- Biochemistry and Molecular Biology of Cancer, Faculty of Biology, University of Barcelona, 08007 Barcelona, Spain
| | - Ardy van Helvoort
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre +, 6200 MD Maastricht, The Netherlands
- Danone Nutricia Research, 3584 CT Utrecht, The Netherlands
| | - Aletta D. Kraneveld
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, 3584 CG Utrecht, The Netherlands or
| | - Johan Garssen
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, 3584 CG Utrecht, The Netherlands or
- Danone Nutricia Research, 3584 CT Utrecht, The Netherlands
| | - Paul A. J. Henricks
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, 3584 CG Utrecht, The Netherlands or
| | - Gert Folkerts
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, 3584 CG Utrecht, The Netherlands or
| | - Saskia Braber
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, 3584 CG Utrecht, The Netherlands or
- Correspondence: ; Tel.: +31-0-622-483-913
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14
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Jo YS. Long-term outcome of chronic obstructive pulmonary disease: A review. Tuberc Respir Dis (Seoul) 2022; 85:289-301. [PMID: 35822318 PMCID: PMC9537656 DOI: 10.4046/trd.2022.0074] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 07/06/2022] [Indexed: 11/24/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a chronic airway inflammation characterized by fixed airflow limitation and chronic respiratory symptoms, such as cough, sputum, and dyspnea. COPD is a progressive disease characterized by a decline in lung function. During the natural course of the disease, acute deterioration of symptoms leading to hospital visits can occur and influence further disease progression and subsequent exacerbation. Moreover, COPD is not only restricted to pulmonary manifestations but can present with other systemic diseases as comorbidities or systemic manifestations, including lung cancer, cardiovascular disease, pulmonary hypertension, sarcopenia, and metabolic abnormalities. These pulmonary and extrapulmonary conditions lead to the aggravation of dyspnea, physical inactivity, decreased exercise capacity, functional decline, reduced quality of life, and increased mortality. In addition, pneumonia, which is attributed to both COPD itself and an adverse effect of treatment (especially the use of inhaled and/or systemic steroids), can occur and lead to further deterioration in the prognosis of COPD. This review summarizes the long-term outcomes of patients with COPD. In addition, recent studies on the prediction of adverse outcomes are summarized in the last part of the review.
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Affiliation(s)
- Yong Suk Jo
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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15
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Kim S, Yoon HK, Rhee CK, Jung HW, Lee H, Jo YS. Hand Grip Strength and Likelihood of Moderate-to-Severe Airflow Limitation in the General Population. Int J Chron Obstruct Pulmon Dis 2022; 17:1237-1245. [PMID: 35642183 PMCID: PMC9148604 DOI: 10.2147/copd.s364351] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 05/19/2022] [Indexed: 11/28/2022] Open
Abstract
Background and Objective Sarcopenia is mainly results from aging; however, it is more prevalent in chronic airway disease such as obstructive pulmonary disease (COPD). Hand grip strength (HGS) can be used as an indicator to evaluate sarcopenia. We aimed to assess the association between HGS and severity of airflow limitation (AFL) in the general population. Methods We conducted a cross-sectional study using data from the Korea National Health and Nutrition Examination Survey (KNHANES) from 2014 to 2018. Subjects aged ≥40 years who underwent both spirometry and HGS tests were included. AFL was defined by spirometry revealed forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC) <0.70). A propensity score-matched comparison was performed, and the risk for moderate-to-very severe AFL was analyzed using logistic regression analysis. Results Among 15,950 subjects, 2277 (14.3%) had AFL with mean FEV1 was 77.1% of the predicted value. Male was predominant in both individuals without AFL and with AFL (74.2% vs 73.5%, p = 0.613). The HGS was 32.9 ± 9.5 kg and 33.3 ± 9.5 kg in participants without AFL and with AFL (p = 0.109). However, HGS was significantly decreased as AFL getting more severe: 34.0 ± 9.6 kg in mild, 33.0 ± 9.5 kg in moderate, and 30.8 ± 8.5 kg in severe to very severe AFL group (p<0.001). As HGS decreased, adjusted odds for moderate-to-very severe AFL increased compared to those with mild AFL (adjusted odds ratio [aOR], 0.97; 95% confidence interval [CI], 0.951–0.987) and both without AFL and mild AFL group (aOR, 0.98; 95% CI, 0.967–0.995) in age-, sex-, and body mass index (BMI)-matched comparisons. Conclusion Lower HGS is significantly associated with moderate-to-very severe AFL in age-, sex-, and BMI-matched comparisons.
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Affiliation(s)
- Sunyoung Kim
- Department of Family Medicine, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Hyoung Kyu Yoon
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Yeouido St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Chin Kook Rhee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hee-Won Jung
- Division of Geriatrics, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyun Lee
- Division of Pulmonary Medicine and Allergy, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Yong Suk Jo
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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16
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Hamakawa Y, Tanabe N, Shima H, Terada K, Shiraishi Y, Maetani T, Kubo T, Kozawa S, Koizumi K, Kanezaki M, Shimizu K, Oguma T, Sato A, Sato S, Hirai T. Associations of pulmonary and extrapulmonary computed tomographic manifestations with impaired physical activity in symptomatic patients with chronic obstructive pulmonary disease. Sci Rep 2022; 12:5608. [PMID: 35379884 PMCID: PMC8980059 DOI: 10.1038/s41598-022-09554-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 03/25/2022] [Indexed: 11/20/2022] Open
Abstract
In patients with chronic obstructive pulmonary disease (COPD), emphysema, airway disease, and extrapulmonary comorbidities may cause various symptoms and impair physical activity. To investigate the relative associations of pulmonary and extrapulmonary manifestations with physical activity in symptomatic patients, this study enrolled 193 patients with COPD who underwent chest inspiratory/expiratory CT and completed COPD assessment test (CAT) and the Life-Space Assessment (LSA) questionnaires to evaluate symptom and physical activity. In symptomatic patients (CAT ≥ 10, n = 100), emphysema on inspiratory CT and air-trapping on expiratory CT were more severe and height-adjusted cross-sectional areas of pectoralis muscles (PM index) and adjacent subcutaneous adipose tissue (SAT index) on inspiratory CT were smaller in those with impaired physical activity (LSA < 60) than those without. In contrast, these findings were not observed in less symptomatic patients (CAT < 10). In multivariable analyses of the symptomatic patients, severe air-trapping and lower PM index and SAT index, but not CT-measured thoracic vertebrae bone density and coronary artery calcification, were associated with impaired physical activity. These suggest that increased air-trapping and decreased skeletal muscle and subcutaneous adipose tissue quantity are independently associated with impaired physical activity in symptomatic patients with COPD.
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Affiliation(s)
- Yoko Hamakawa
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Naoya Tanabe
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Hiroshi Shima
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Kunihiko Terada
- Terada Clinic, Respiratory Medicine and General Practice, Himeji, Hyogo, Japan
| | - Yusuke Shiraishi
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Tomoki Maetani
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Takeshi Kubo
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Satoshi Kozawa
- Division of Clinical Radiology Service, Kyoto University Hospital, Kyoto, Japan
| | - Koji Koizumi
- Division of Clinical Radiology Service, Kyoto University Hospital, Kyoto, Japan
| | - Masashi Kanezaki
- Department of Physical Therapy, School of Health Sciences, Tokyo International University, Kawagoe, Saitama, Japan
| | - Kaoruko Shimizu
- Department of Respiratory Medicine, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Tsuyoshi Oguma
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Atsuyasu Sato
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Susumu Sato
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Toyohiro Hirai
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
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17
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Huang D, Xie C, Sun C, Chen M, Li L, Yi H, Liao J, Zhao X, Shen X, He D, Li D, Wu D. Serum Creatinine to Cystatin C Ratio is an Effective Indicator for Muscle Strength Decline in Men with Acute Exacerbation of Chronic Obstructive Pulmonary Disease. Int J Chron Obstruct Pulmon Dis 2022; 17:781-789. [PMID: 35422619 PMCID: PMC9004674 DOI: 10.2147/copd.s356314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 03/28/2022] [Indexed: 12/26/2022] Open
Abstract
Purpose This study explored the value of the serum creatinine/cystatin C (Cr/CysC) ratio in diagnosing the reduction of muscle strength in men with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Patients and Methods In this study, we enrolled 72 male patients with AECOPD and 32 male patients with stable chronic obstructive pulmonary disease (COPD). We compared clinical characteristics between the AECOPD and stable COPD groups. Then, we subdivided AECOPD patients into normal muscle strength and low muscle strength groups; we compared the clinical characteristics between these two groups. We analyzed the relationships of serum creatinine (Cr), cystatin C (CysC), and Cr/CysC ratio with clinical characteristics in male AECOPD patients. We also investigated whether the Cr/CysC ratio could aid in the diagnosis of muscle strength decline via receiver operating characteristic curve and binary logistic regression analysis. Results We found that handgrip strength, Cr/CysC ratio, serum Cr, FEV1, FVC, and FEV1%pred were lower in AECOPD patients than in stable COPD patients. Among AECOPD patients, BMI, weight, FEV1, FVC, FEV1%pred, and Cr/CysC ratio were lower in the low muscle strength group than in the normal muscle strength group; there were more patients with ≥2 acute exacerbations within the past year in the low muscle strength group. The Cr/CysC ratio was correlated with handgrip strength, FEV1, FVC, FEV1%pred, BMI and weight. The area under curve for low handgrip strength was greater for the Cr/CysC ratio than for Cr. Binary logistic regression analysis showed that a Cr/CysC ratio <0.99 was a risk factor for decreased muscle strength in male patients with AECOPD. Conclusion The Cr/CysC ratio is a useful predictor of muscle strength decline in male AECOPD patients, while a low Cr/CysC ratio is a risk factor for muscle strength decline in male patients with AECOPD.
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Affiliation(s)
- Dan Huang
- Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Guangdong Medical University, Zhanjiang, People’s Republic of China
| | - Canhui Xie
- Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Guangdong Medical University, Zhanjiang, People’s Republic of China
| | - Chaoqun Sun
- Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Guangdong Medical University, Zhanjiang, People’s Republic of China
| | - Min Chen
- Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Guangdong Medical University, Zhanjiang, People’s Republic of China
| | - Lian Li
- Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Guangdong Medical University, Zhanjiang, People’s Republic of China
| | - Huajuan Yi
- Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Guangdong Medical University, Zhanjiang, People’s Republic of China
| | - Jinyu Liao
- Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Guangdong Medical University, Zhanjiang, People’s Republic of China
| | - Xuanna Zhao
- Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Guangdong Medical University, Zhanjiang, People’s Republic of China
| | - Xiaoping Shen
- Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Guangdong Medical University, Zhanjiang, People’s Republic of China
| | - Donglan He
- Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Guangdong Medical University, Zhanjiang, People’s Republic of China
| | - Dongming Li
- Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Guangdong Medical University, Zhanjiang, People’s Republic of China
| | - Dong Wu
- Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Guangdong Medical University, Zhanjiang, People’s Republic of China
- Correspondence: Dong Wu; Dongming Li, Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Guangdong Medical University, 57th South Renmin Road, Zhanjiang, 524001, Guangdong, People’s Republic of China,Tel/Fax +867592387413, Email ;
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18
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Roberts MH, Mapel DW, Ganvir N, Dodd MA. Frailty Among Older Individuals with and without COPD: A Cohort Study of Prevalence and Association with Adverse Outcomes. Int J Chron Obstruct Pulmon Dis 2022; 17:701-717. [PMID: 35411140 PMCID: PMC8994612 DOI: 10.2147/copd.s348714] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 03/12/2022] [Indexed: 12/14/2022] Open
Abstract
Rationale Frailty prevalence estimates among individuals with COPD have varied widely, and few studies have investigated relationships between frailty and adverse outcomes in a COPD population. Objective(s) Describe frailty prevalence among individuals with and without COPD and examine associations between frailty and mortality and other adverse outcomes in the next two years. Methods This was an observational cohort study using Health and Retirement Study data (2006–2018) of community living individuals ages 50–64 and ≥65 with and without COPD (non-COPD). Frailty (Fried phenotype [5 items], and a modified Frailty Index-Comprehensive Geriatric Assessment [Enhanced FI-CGA] [37 items], and debility (modified BODE Index [4 items]) were assessed. Two-year post-assessment outcomes (mortality, ≥1 inpatient stay, home health and skilled nursing facility (SNF) use) were reviewed in a population matched 3:1 (non-COPD: COPD) on age, sex, race, and year using univariate and multivariate logistic regression (adjusted for morbidities). Area-under-the-curve (AUC) was used to evaluate regressions. Results The study included 18,979 survey observations for age 50–64, and 24,162 age ≥65; 7.8% and 12.0% respectively reporting a diagnosis of COPD. Fried phenotype frailty prevalence for age ≥65 was 23.1% (COPD) and 9.4% (non-COPD), and for the Enhanced FI-CGA, 45.9% (COPD) and 22.4% (non-COPD). Two-year mortality for COPD was more than double non-COPD for age 50–64 (95% CI: 3.8–5.9% vs 0.7–1.3%) and age ≥65 (95% CI: 11.9–14.3% vs 5.6–6.6%). Inpatient utilization, home health care use, or at least temporary SNF placement were also more frequent for COPD. Measures were predictive of adverse outcomes. In adjusted models, the Fried phenotype and modified BODE score performed similarly, and both performed better than the Enhanced FI-CGA index. AUC values were higher for morality regressions. Conclusion Frailty prevalence among individuals with COPD in this national survey is substantially greater than without COPD, even at pre-retirement (50–64 years). These measures identify patients with increased risk of poor outcomes.
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Affiliation(s)
- Melissa H Roberts
- College of Pharmacy, The University of New Mexico, Albuquerque, NM, USA
- Correspondence: Melissa H Roberts, College of Pharmacy, The University of New Mexico, 2502 Marble Ave, Albuquerque, NM, 87106, USA, Tel +1 505 925 0953, Fax +1 505 272 6749, Email
| | - Douglas W Mapel
- College of Pharmacy, The University of New Mexico, Albuquerque, NM, USA
- Northern Arizona Pulmonary Associates/Critical Care Consultants of Arizona, Flagstaff, AZ, USA
| | - Nikhil Ganvir
- Department of Economics, The University of New Mexico, Albuquerque, NM, USA
| | - Melanie A Dodd
- College of Pharmacy, The University of New Mexico, Albuquerque, NM, USA
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19
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Karagiannis C, Savva C, Korakakis V, Adamide T, Georgiou A, Matheou I, Prodromou A, Xanthos T. Effect of Strength Versus Strength and Endurance Upper Limb Exercise Training in Patients With Chronic Obstructive Pulmonary Disease: A RANDOMIZED CLINICAL TRIAL. J Cardiopulm Rehabil Prev 2021; 41:426-431. [PMID: 34117184 DOI: 10.1097/hcr.0000000000000620] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Pulmonary rehabilitation (PR) including exercise training improves muscle strength, exercise capacity, and health-related quality of life in patients with chronic obstructive pulmonary disease (COPD). However, the evidence of the effect of upper limb exercise training (ULET) on activities of daily living (ADL) is sparse. This study investigated the effect of two different types of ULET on ADL in addition to standard PR. METHODS Patients were randomly assigned to a strength or a combined ULET group. Both groups exercised 2 d/wk for 12 wk. Outcome measures were handgrip strength and muscle strength of biceps and triceps muscles. Moreover, health-related quality of life was assessed through the COPD assessment test (CAT) and Saint George Respiratory Questionnaire. Ability to perform ADL was evaluated through an ADL simulation test. Dyspnea was evaluated by a modified Medical Research Council scale, whereas dyspnea and fatigue perception during strength and ADL tests were measured through a modified Borg scale. RESULTS Thirty-six patients with COPD (67.4 ± 5.3 yr) participated in the study. Significant improvements in upper limb strength and CAT were found within both groups. At the end of the study period, patients in the combined group improved time of the ADL test (P = .02) with reduced perception of fatigue (P = .03) compared with patients in the strength group. CONCLUSIONS In addition to standard PR of patients with COPD, the combined endurance and resistance ULET program improved ADL and muscle strength, whereas resistance training only increased strength.
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Affiliation(s)
- Christos Karagiannis
- Department of Health Sciences, School of Sciences, European University Cyprus, Nicosia, Cyprus (Drs Karagiannis and Savva and Ms Matheou); Aspetar, Orthopaedic and Sports Medicine Hospital, Doha, Qatar (Dr Korakakis); Respiratory Clinic, Nicosia General Hospital, Nicosia, Cyprus (Dr Adamide); Private Doctor, Nicosia, Cyprus (Dr Georgiou); Physiotherapy Department, Nicosia General Hospital, and Department of Life and Health Sciences, School of Sciences and Engineering, University of Nicosia, Nicosia, Cyprus (Ms Prodromou); and School of Medicine, European University Cyprus, Nicosia, Cyprus (Dr Xanthos)
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20
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Dynapenia is highly prevalent in older patients with advanced idiopathic pulmonary fibrosis. Sci Rep 2021; 11:17884. [PMID: 34504219 PMCID: PMC8429581 DOI: 10.1038/s41598-021-97424-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 07/12/2021] [Indexed: 02/06/2023] Open
Abstract
Body composition and muscle strength are emerging aspects in idiopathic pulmonary fibrosis (IPF) clinical assessment. We aimed to study the relationships of handgrip strength (HGS) with anthropometric variables, body composition, and disease staging, and to evaluate the prevalence of dynapenia in 102 clinically stable IPF patients (70 M; mean age: 69.4 years). Fat-free mass (FFM), skeletal muscle (SM) were estimated with bioimpedance analysis. HGS was measured with a digital handle dynamometer for both dominant and non-dominant body sides. Dynapenia was identified according to six recognized criteria sets. Mean body mass index (BMI) was 28.2 ± 4.7 kg/m2, with a prevalence of overweight (BMI > 25 and < 30 kg/m2) and obesity (BMI ≥ 30 kg/m2) of 35% and 37%, respectively. FFM and SM were greater in males, whereas percentage body fat was higher in women. HGS was higher and declined with age slightly more rapidly in men, showing a stronger correlation with FFM and SM. Dynapenia prevalence ranged from 20.6 to 56.9%, depending on the criteria used, and was more frequent in older patients and advanced disease. Dynapenia is highly prevalent in IPF. HGS is a promising proxy marker of muscle function to be used in clinical evaluation and follow-up programs.
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21
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King L, White H, Clifton I, Spoletini G, Ispoglou T, Peckham DG. Nutritional status and intake in patients with non-cystic fibrosis bronchiectasis (NCFB) - a cross sectional study. Clin Nutr 2021; 40:5162-5168. [PMID: 34461590 DOI: 10.1016/j.clnu.2021.07.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 07/06/2021] [Accepted: 07/28/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND & AIMS Bronchiectasis is a heterogeneous, chronic respiratory condition, in which the role of nutrition remains unclear and nutritional guidance is lacking. Few studies have explored the role of nutrition in disease management, and little is known about nutritional requirements during periods of stability or metabolic stress. The aim of this study was to characterise nutritional status and intakes in a cohort of patients and identify potential associations with body composition and functional capacity. METHODS A prospective observational cohort study was undertaken in an adult population (>17 years). Bronchiectasis was confirmed by high-resolution computerised tomography (HRCT). Anthropometric (weight, height, Body Mass Index (BMI), triceps skinfold thickness (TSF), mid upper-arm circumference (MUAC) and mid arm muscle circumference (MAMC)] lung function and nutritional intakes were measured. Results were analysed as a whole and by disease aetiology [primary ciliary dyskinesia (PCD), Idiopathic cause (IC), bronchiectasis in association with asthma and other] and associations tested. RESULTS In total, 128 participants (65.5% female) completed the study. Median handgrip strength (HGS) in the total sample was only 66.5% (IQR 60.5-89.8) of reference population norms and was low for those with PCD [58.0% (IQR 43.5-70.0))]. Univariate regression indicated that BMI was a statistically significant predictor of lung function in the whole population with HGS and weight identified as statistically significant predictors of lung function in PCD. The total population and each sub-group failed to meet estimated average requirements for energy but exceeded the Reference nutrient intake (RNI) for protein. Vitamin D was consistently <35% of the RNI. CONCLUSION BMI lay within normal to overweight ranges within the whole population and sub-groups, but masked important functional, body composition and nutritional deficits. This was particularly so within a younger sub-group with PCD, who had impaired muscle function, when compared to other causal and associative diseases.
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Affiliation(s)
- Linsey King
- University Leeds, Clinical Science Building, Beckett Street, Leeds, LS97TF, UK; Leeds Beckett University, Calverley Street, Leeds, LS1 3HE, UK.
| | - Helen White
- Leeds Beckett University, Calverley Street, Leeds, LS1 3HE, UK.
| | - Ian Clifton
- Leeds Teaching Hospitals Trusts, Beckett Street, Leeds, LS97TF, UK
| | - Giulia Spoletini
- Leeds Teaching Hospitals Trusts, Beckett Street, Leeds, LS97TF, UK
| | | | - Daniel G Peckham
- University Leeds, Clinical Science Building, Beckett Street, Leeds, LS97TF, UK; Leeds Beckett University, Calverley Street, Leeds, LS1 3HE, UK.
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22
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Lee CT, Wang PH. Handgrip strength during admission for COPD exacerbation: impact on further exacerbation risk. BMC Pulm Med 2021; 21:245. [PMID: 34289815 PMCID: PMC8296662 DOI: 10.1186/s12890-021-01610-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 07/13/2021] [Indexed: 11/22/2022] Open
Abstract
Background Low handgrip strength (HGS) is independently associated with a higher exacerbation risk in stable chronic obstructive pulmonary disease (COPD); however, the relationship between HGS while being admitted for COPD exacerbation and further exacerbation risk after discharge remains unclear. Methods We enrolled patients admitted for COPD exacerbation between January 2018 and June 2019. HGS tests were done within 3 days after admission. The primary endpoint was exacerbations within 12 months after the index admission, which needed emergency room visits or hospital admission. We analyzed the relationships among demographics, HGS, pulmonary function parameters, and acute exacerbation events. Results Among 43 enrolled patients, 31 (72.1%) participants (HGSw) had HGS weakness (22.1 ± 4.1 kg). The other 12 (27.9%) participants (non-HGSw) had the strength of handgrips 33.7 ± 3.1 kg. HGSw group showed a significantly higher rate of emergency room visits within 6, 9, and 12 months after the index admission than non-HGSw group (0.81 ± 1.30 vs. 0.08 ± 0.29, p = 0.045; 1.26 ± 1.59 vs. 0.17 ± 0.38, P = 0.019; 1.48 ± 1.86 vs. 0.25 ± 0.62, P = 0.027, respectively). There was a trend to have higher admission rate within 9 and 12 months in HGSw group, which did not achieve statistical significance (0.77 ± 1.38 vs. 0.08 ± 0.29, P = 0.064; 0.94 ± 1.56 vs. 0.08 ± 0.29, P = 0.062, respectively). Conclusions HGS weakness measured upon admission for COPD exacerbation was associated with a higher risk of exacerbation in the next year. Trial registration ClinicalTrials.gov Identifier: NCT04885933. Supplementary Information The online version contains supplementary material available at 10.1186/s12890-021-01610-7.
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Affiliation(s)
- Chi-Tai Lee
- Division of Pulmonology, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, 220, Taiwan, ROC
| | - Ping-Huai Wang
- Division of Pulmonology, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, 220, Taiwan, ROC. .,Department of Nursing, Oriental Institute of Technology, New Taipei City, Taiwan, ROC.
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23
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Holden M, Fyfe M, Poulin C, Bethune B, Church C, Hepburn P, Afreixo V, Brooks D, Oliveira A. Handgrip Strength in People With Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis. Phys Ther 2021; 101:6131769. [PMID: 33561266 DOI: 10.1093/ptj/pzab057] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 11/20/2020] [Accepted: 12/31/2020] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The purpose of this study was to systematically review the association between handgrip strength (HGS) and mortality, morbidity, and health-related quality of life (HRQL) in individuals with chronic obstructive pulmonary disease (COPD). METHODS The following databases were used: CENTRAL, CINAHL, EMBASE, MEDLINE Ovid, SPORTDiscus, and PsycINFO. Studies published between 2000 and 2020 in English, Portuguese, or French that examined the association of HGS with mortality, morbidity, and HRQL in individuals with stable COPD were selected. Two authors independently extracted data and assessed the quality of evidence using the Grading of Recommendations Assessment, Development and Evaluation framework. The study effects were pooled using random effects meta-analysis models after assessing heterogeneity. The search generated 710 studies, and 18 were included in the review. Studies evaluated a total of 12,046 individuals with stable COPD (mean percent of the predicted forced expiratory volume in 1 second = 34%-80%) using over 10 diverse protocols for HGS measurement. Statistically significant, small, and negative relationships were found between HGS and mortality (r = -0.03; 95% CI = -0.05 to -0.02). Independent of the outcome measure used to assess morbidity, the estimate of the overall relationship was small to moderate and negative: Body Mass Index, Airflow Obstruction, Dyspnea, and Exercise Index Updated (r = -0.42; 95% CI = -0.61 to -0.03); exacerbations (r = -0.02; 95% CI = -0.04 to -0.00); and hospitalizations (r = -0.69; 95% CI = -1.70 to 0.32). Similarly, for HRQL, independent of the outcome measure, the estimate of the overall relationship was small to fair and negative: COPD Assessment Test (weighted r = -0.22; 95% CI = -0.32 to -0.12), Chronic Respiratory Disease Questionnaire domains (-0.24 < r < -0.14), EuroQol Five-Dimension Questionnaire (utility score) (r = -0.17; 95% CI = -0.26 to -0.07), EuroQol Five-Dimension Questionnaire domains (-0.32 < r < -0.06), and St George Respiratory Questionnaire total (r = -0.26; 95% CI = -0.33 to -0.17). The quality of the evidence ranged from low to very low across outcomes. CONCLUSION Although heterogeneity was present among HGS measurement protocols, small to moderate associations were found, indicating that those with lower HGS have an increased likelihood of death, a higher risk of increased COPD morbidity (as assessed with Body Mass Index, Airflow Obstruction, Dyspnea and Exercise Capacity indexes), and poorer HRQL.
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Affiliation(s)
- Mackenzie Holden
- School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Madeline Fyfe
- School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Camille Poulin
- School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Brianna Bethune
- School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Chloe Church
- School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Paula Hepburn
- School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Vera Afreixo
- Center for Research and Development in Mathematics and Applications (CIDMA), Department of Mathematics, University of Aveiro, Aveiro, Portugal
| | - Dina Brooks
- School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.,Westpark Healthcare Centre, Toronto, Ontario, Canada
| | - Ana Oliveira
- School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.,Westpark Healthcare Centre, Toronto, Ontario, Canada.,Lab3R - Respiratory Research and Rehabilitation Laboratory, School of Health Sciences, University of Aveiro (ESSUA), Aveiro, Portugal
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24
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Fonseca J, Machado FVC, Santin LC, Andrello AC, Schneider LP, Fernandes Belo L, Rodrigues A, Fernandes Rugila D, Furlanetto KC, Hernandes NA, Pitta F. Handgrip Strength as a Reflection of General Muscle Strength in Chronic Obstructive Pulmonary Disease. COPD 2021; 18:299-306. [PMID: 33961519 DOI: 10.1080/15412555.2021.1919608] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Muscle dysfunction is one of the main features in individuals with chronic obstructive pulmonary disease (COPD). Handgrip strength (HS) has been used as a representation of general muscle strength in various populations, and a few studies found correlation between HS and other measures of upper and lower limbs' muscle strength in the general population, although this was not yet studied in depth in COPD. The aims of this study were to verify if HS is cross-sectionally well correlated with upper and lower limbs' muscle strength in individuals with COPD, and to identify a new cutoff for handgrip weakness in this population. HS was assessed by a dynamometer, whereas other muscle strength assessments comprised maximal voluntary contraction (MVC) of the quadriceps femoris and 1-repetition maximum (1RM) of biceps and triceps brachii, pectoralis major, latissimus dorsi and quadriceps femoris. Additional assessments included pulmonary function and volumes, body composition and exercise capacity. Fifty individuals with COPD were studied (65 ± 7 years; FEV1 51 ± 14%pred). HS showed moderate-to-strong correlations with all 1-RM assessments (0.62<r < 0.75) and especially with MVC of the quadriceps femoris (r = 0.83) (p < 0.05 for all). Correlations were stronger for male than female individuals, and the assessment performed on right, left or dominant hand did not present significant differences. A cutoff of 0.3892 for HS/weight yielded an AUC = 0.90 to identify weakness. In conclusion, HS is a good reflection of upper and lower limbs' muscle strength in individuals with COPD. Its usefulness as a surrogate for more complex assessments must be based on the settings and conditions.
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Affiliation(s)
- Jéssica Fonseca
- Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, State University of Londrina (UEL), Londrina, Brazil
| | - Felipe Vilaça Cavallari Machado
- Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, State University of Londrina (UEL), Londrina, Brazil.,Department of Research and Education, CIRO+, Center of Expertise for Chronic Organ Failure, Horn, The Netherlands.,NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Laís Carolini Santin
- Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, State University of Londrina (UEL), Londrina, Brazil
| | - Ana Carolina Andrello
- Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, State University of Londrina (UEL), Londrina, Brazil
| | - Lorena Paltanin Schneider
- Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, State University of Londrina (UEL), Londrina, Brazil
| | - Letícia Fernandes Belo
- Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, State University of Londrina (UEL), Londrina, Brazil
| | - Antenor Rodrigues
- Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, State University of Londrina (UEL), Londrina, Brazil.,Rehabilitation Aimed at Muscle Performance Laboratory - RAMP, Department of Physiotherapy, University of Toronto, Toronto, ON, Canada
| | - Diery Fernandes Rugila
- Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, State University of Londrina (UEL), Londrina, Brazil.,Biological and Health Sciences Research Center, University Pitágoras UNOPAR, Londrina, Brazil
| | - Karina Couto Furlanetto
- Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, State University of Londrina (UEL), Londrina, Brazil.,Biological and Health Sciences Research Center, University Pitágoras UNOPAR, Londrina, Brazil
| | - Nidia Aparecida Hernandes
- Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, State University of Londrina (UEL), Londrina, Brazil
| | - Fabio Pitta
- Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, State University of Londrina (UEL), Londrina, Brazil
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25
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Mgbemena N, Jones A, Leicht AS. Relationship between handgrip strength and lung function in adults: a systematic review. Physiother Theory Pract 2021; 38:1908-1927. [PMID: 33870831 DOI: 10.1080/09593985.2021.1901323] [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] [Indexed: 10/21/2022]
Abstract
Handgrip strength (HGS) is a functional test that has been directly associated with lung function in some healthy populations; however, inconsistent findings have been reported for populations with chronic diseases. The aim of this study was to identify the relationship between HGS and lung function in both healthy and unhealthy adults. A systematic search was conducted using six databases from their earliest inception to February 29, 2020. Two authors reviewed and assessed methodological quality of eligible studies using the Crowe Critical Appraisal Tool (CCAT). Twenty-five studies met the inclusion criteria with 8 and 17 studies examining healthy and unhealthy populations, respectively. Reported average methodological quality of all included studies using the CCAT was 38-85% with most rated as Good to Excellent. Despite the use of heterogeneous equipment and protocols during HGS and lung function assessments, significant positive and moderate correlations and/or regression coefficients were reported for healthy populations consistently. Conversely, the reported relationships between HGS and lung function for unhealthy counterparts were variable. Handgrip strength was significantly associated with lung function in most healthy adults. Future robust studies are needed to confirm the suitability of HGS to assess lung function for healthy and unhealthy adults.
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Affiliation(s)
- Nnamdi Mgbemena
- Department of Physiotherapy, James Cook University, Townsville, Queensland, Australia.,Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia
| | - Anne Jones
- Department of Physiotherapy, James Cook University, Townsville, Queensland, Australia.,Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia
| | - Anthony S Leicht
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia.,Department of Sport and Exercise Science, James Cook University, Townsville, Queensland, Australia
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26
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Witt LJ, Spacht WA, Carey KA, Arora VM, White SR, Huisingh-Scheetz M, Press VG. Weak Handgrip at Index Admission for Acute Exacerbation of COPD Predicts All-Cause 30-Day Readmission. Front Med (Lausanne) 2021; 8:611989. [PMID: 33898475 PMCID: PMC8058414 DOI: 10.3389/fmed.2021.611989] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 03/10/2021] [Indexed: 12/30/2022] Open
Abstract
Rationale: Identifying patients hospitalized for acute exacerbations of COPD (AECOPD) who are at high risk for readmission is challenging. Traditional markers of disease severity such as pulmonary function have limited utility in predicting readmission. Handgrip strength, a component of the physical frailty phenotype, may be a simple tool to help predict readmission. Objective(s): To investigate if handgrip strength, a component of the physical frailty phenotype and surrogate for weakness, is a predictive biomarker of COPD readmission. Methods: This was a prospective, observational study of patients admitted to the inpatient general medicine unit at the University of Chicago Medicine, US. This study evaluated age, sex, ethnicity, degree of obstructive lung disease by spirometry (FEV1 percent predicted), and physical frailty phenotype (components include handgrip strength and walk speed). The primary outcome was all-cause hospital readmission within 30 days of discharge. Results: Of 381 eligible patients with AECOPD, 70 participants agreed to consent to participate in this study. Twelve participants (17%) were readmitted within 30 days of discharge. Weak grip at index hospitalization, defined as grip strength lower than previously established cut-points for sex and body mass index (BMI), was predictive of readmission (OR 11.2, 95% CI 1.3, 93.2, p = 0.03). Degree of airway obstruction (FEV1 percent predicted) did not predict readmission (OR 1.0, 95% CI 0.95, 1.1, p = 0.7). No non-frail patients were readmitted. Conclusions: At a single academic center weak grip strength was associated with increased 30-day readmission. Future studies should investigate whether geriatric measures can help risk-stratify patients for likelihood of readmission after admission for AECOPD.
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Affiliation(s)
- Leah J. Witt
- Divisions of Geriatrics and Pulmonary, Critical Care, Allergy and Sleep Medicine, University of California, San Francisco, San Francisco, CA, United States
| | | | - Kyle A. Carey
- Department of Medicine, University of Chicago, Chicago, IL, United States
| | - Vineet M. Arora
- Department of Medicine, University of Chicago, Chicago, IL, United States
| | - Steven R. White
- Department of Medicine, University of Chicago, Chicago, IL, United States
| | | | - Valerie G. Press
- Department of Medicine, University of Chicago, Chicago, IL, United States
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Deutz NE, Ziegler TR, Matheson EM, Matarese LE, Tappenden KA, Baggs GE, Nelson JL, Luo M, Hegazi R, Jonnalagadda SS. Reduced mortality risk in malnourished hospitalized older adult patients with COPD treated with a specialized oral nutritional supplement: Sub-group analysis of the NOURISH study. Clin Nutr 2021; 40:1388-1395. [DOI: 10.1016/j.clnu.2020.08.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 08/05/2020] [Accepted: 08/26/2020] [Indexed: 01/22/2023]
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28
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Wu K, Mendes PL, Sykes J, Stephenson AL, Mathur S. Limb muscle size and contractile function in adults with cystic fibrosis: A systematic review and meta-analysis. J Cyst Fibros 2021; 20:e53-e62. [PMID: 33648899 DOI: 10.1016/j.jcf.2021.02.010] [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: 08/23/2020] [Revised: 02/17/2021] [Accepted: 02/17/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND There is conflicting evidence regarding the presence of limb muscle impairments in adults with cystic fibrosis (CF), and the factors associated with these muscle impairments. The objectives of this study were to compare limb muscle size and function between adults with CF and healthy controls; and to examine their associations with demographic and clinical variables in adults with CF. METHODS The systematic review was performed using PRISMA guidelines. Studies were included if they measured any aspect of limb muscle size or function in adults with CF. Meta-analyses were performed to compare muscle variables between CF and healthy controls; and to examine their associations with demographic and clinical variables. RESULTS Twenty-eight studies were included, with 747 adults with CF. The meta-analyses showed that adults with CF have smaller thigh muscles [standardized mean difference (SMD) = 0.57, p<.0011, I2=0%], and lower handgrip strength (SMD = 0.89, p=.0034, I2=74.03%), which was weakly correlated with forced expiratory volume in one second (FEV1) (r=0.24, p=.035, I2=0%) and lower in females with CF (SMD = 2.05, p<.0001, I2=0%). There is no significant difference between adults with CF and controls in knee extensor strength (SMD = 0.25, p=.095, I2=42.79%). CONCLUSIONS Leg muscle atrophy and lower handgrip strength were noted. There may be a subgroup of adults with CF with knee extensor (quadriceps) weakness. Future studies are needed to better understand muscle impairments in people with CF; to explore the factors that can predict these muscle impairments; and to investigate their clinical significance in people with CF.
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Affiliation(s)
- Kenneth Wu
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Toronto Adult Cystic Fibrosis Centre, Department of Respirology, St. Michael's Hospital, Unity Health Toronto, Toronto, ON Canada; Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
| | - Polyana L Mendes
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Department of Gastro/General Surgery, St. Michael's Hospital, Unity Health Toronto, Toronto, ON Canada
| | - Jenna Sykes
- Toronto Adult Cystic Fibrosis Centre, Department of Respirology, St. Michael's Hospital, Unity Health Toronto, Toronto, ON Canada
| | - Anne L Stephenson
- Toronto Adult Cystic Fibrosis Centre, Department of Respirology, St. Michael's Hospital, Unity Health Toronto, Toronto, ON Canada; Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON Canada
| | - Sunita Mathur
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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29
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Gosker HR, Langen RC, Simons SO. Role of acute exacerbations in skeletal muscle impairment in COPD. Expert Rev Respir Med 2020; 15:103-115. [PMID: 33131350 DOI: 10.1080/17476348.2021.1843429] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Introduction: Muscle impairments are prevalent in COPD and have adverse clinical implications in terms of physical performance capacity, disease burden, quality of life and even mortality. During acute exacerbations of COPD (AECOPDs) the respiratory symptoms worsen and this might also apply to the muscle impairments. Areas covered: This report includes a review of both clinical and pre-clinical peer-reviewed literature of the past 20 years found in PubMed providing a comprehensive view on the role of AECOPD in muscle dysfunction in COPD, the putative underlying mechanisms and the treatment perspectives. Expert opinion: The contribution of AECOPD and its recurrent nature to muscle impairment in COPD cannot be ignored and can be attributed to the acutely intensifying and converging disease-related drivers of muscle deterioration, in particular disuse, systemic inflammation and corticosteroid treatment. The search for novel treatment options should focus on the AECOPD-enhanced drivers of muscle dysfunction as well as on the underlying, mainly catabolic, mechanisms. Considering the impact of AECOPD on muscle function, and that of muscle impairment on the recurrence of exacerbations, counteracting muscle deterioration in AECOPD provides an unprecedented therapeutic opportunity.
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Affiliation(s)
- Harry R Gosker
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre, Department of Respiratory Medicine , Maastricht, The Netherlands
| | - Ramon C Langen
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre, Department of Respiratory Medicine , Maastricht, The Netherlands
| | - Sami O Simons
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre, Department of Respiratory Medicine , Maastricht, The Netherlands
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30
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Tsekoura M, Tsepis E, Billis E, Gliatis J. Sarcopenia in patients with chronic obstructive pulmonary disease: A study of prevalence and associated factors in Western Greek population. Lung India 2020; 37:479-484. [PMID: 33154208 PMCID: PMC7879857 DOI: 10.4103/lungindia.lungindia_143_20] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background: Chronic obstructive pulmonary disease (COPD) is associated with a progressive loss of muscle mass and function and a systemic inflammatory process that can cause sarcopenia. Objective: The objective of this study is to estimate the prevalence rate of sarcopenia in COPD patients and to determine the factors associated with sarcopenic patients living in Western Greece. Methods: European Working Group on Sarcopenia in Older People criteria were applied to 69 outpatients with stable COPD. Body composition, exercise capacity, functional performance, physical activity, and health status were also assessed. COPD disease severity (COPD stage) was evaluated with the Global Initiative for chronic obstructive lung disease. The study protocol was approved by the Ethical Committee of the Technological Educational Institute of Western Greece. Results: The sample comprised 69 patients (59 women and 10 men), with a mean age of 71.33 ± 7.48 years. The prevalence of sarcopenia was 24.6% (n = 17). A high percentage (82.6%; n = 57) of the 69 Greek participants did not perform any regular exercise. The findings of this study demonstrated that sarcopenia was positively associated with COPD, age, body mass index, skeletal muscle mass, hand grip strength, and 4 m test. Conclusions: In conclusion, there is a 24.6% prevalence of sarcopenia in patients with COPD. Further research with larger samples would be indicated to clarify the precise association of specific characteristics of patients with sarcopenia and COPD.
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Affiliation(s)
- Maria Tsekoura
- Department of Physiotherapy, School of Health Rehabilitation Sciences, University of Patras, Patras, Greece
| | - Elias Tsepis
- Department of Physiotherapy, School of Health Rehabilitation Sciences, University of Patras, Patras, Greece
| | - Evdokia Billis
- Department of Physiotherapy, School of Health Rehabilitation Sciences, University of Patras, Patras, Greece
| | - John Gliatis
- Department of Medicine, School of Health Sciences, University of Patras, Patras, Greece
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31
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Dolliver WR, Diaz AA. Advances in Chronic Obstructive Pulmonary Disease Imaging. ACTA ACUST UNITED AC 2020; 6:128-143. [PMID: 33758787 DOI: 10.23866/brnrev:2019-0023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Chest computed tomography (CT) imaging is a useful tool that provides in vivo information regarding lung structure. Imaging has contributed to a better understanding of COPD, allowing for the detection of early structural changes and the quantification of extra-pulmonary structures. Novel CT imaging techniques have provided insight into the progression of the main COPD subtypes, such as emphysema and small airway disease. This article serves as a review of new information relevant to COPD imaging. CT abnormalities, such as emphysema and loss of airways, are present even in smokers who do not meet the criteria for COPD and in those with mild-to-moderate disease. Subjects with mild-to-moderate COPD, with the highest loss of airways, also experience the highest decline in lung function. Extra-pulmonary manifestations of COPD, such as right ventricle enlargement and low muscle mass measured on CT, are associated with increased risk for all-cause mortality. CT longitudinal data has also given insight into the progression of COPD. Mechanically affected areas of lung parenchyma adjacent to emphysematous areas are associated with a greater decline in FEV1. Subjects with the greatest percentage of small airway disease, as measured on matched inspiratory-expiratory CT scan, also present with the greatest decline in lung function.
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Affiliation(s)
- Wojciech R Dolliver
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Alejandro A Diaz
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA, USA
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32
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Rozenberg D, Orsso CE, Chohan K, Orchanian‐Cheff A, Nourouzpour S, Nicholson JM, Elangeswaran B, Vagaon A, Fidler L, Singer LG, Mathur S. Clinical outcomes associated with computed tomography‐based body composition measures in lung transplantation: a systematic review. Transpl Int 2020; 33:1610-1625. [DOI: 10.1111/tri.13749] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 04/24/2020] [Accepted: 09/13/2020] [Indexed: 12/16/2022]
Affiliation(s)
- Dmitry Rozenberg
- Department of Medicine University of Toronto Toronto ON Canada
- Lung Transplant Program Respirology Toronto General Hospital Research InstituteUniversity Health Network Toronto ON Canada
| | - Camila E. Orsso
- Department of Agricultural, Food and Nutritional Science University of Alberta Edmonton AB Canada
| | - Karan Chohan
- Department of Medicine University of Toronto Toronto ON Canada
| | - Ani Orchanian‐Cheff
- Library and Information Services University Health Network Toronto ON Canada
| | - Sahar Nourouzpour
- Lung Transplant Program Respirology Toronto General Hospital Research InstituteUniversity Health Network Toronto ON Canada
| | | | - Brenawen Elangeswaran
- Lung Transplant Program Respirology Toronto General Hospital Research InstituteUniversity Health Network Toronto ON Canada
| | - Andrei Vagaon
- Department of Medicine University of Toronto Toronto ON Canada
| | - Lee Fidler
- Department of Medicine University of Toronto Toronto ON Canada
- Respirology Sunnybrook Health Sciences Centre Toronto ON Canada
| | - Lianne G. Singer
- Department of Medicine University of Toronto Toronto ON Canada
- Lung Transplant Program Respirology Toronto General Hospital Research InstituteUniversity Health Network Toronto ON Canada
| | - Sunita Mathur
- Department of Physical Therapy University of Toronto Toronto ON Canada
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33
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Karagiannis C, Savva C, Korakakis V, Matheou I, Adamide T, Georgiou A, Xanthos T. Test-Retest Reliability of Handgrip Strength in Patients with Chronic Obstructive Pulmonary Disease. COPD 2020; 17:568-574. [PMID: 32814452 DOI: 10.1080/15412555.2020.1808604] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The purpose of this study was to investigate the intra-rater reliability and agreement of handgrip strength (HGS) measurement using a hydraulic hand dynamometer in patients with chronic obstructive pulmonary disease (COPD). A sample of 19 COPD patients (18 males and 1 female; mean ± SD age, 66.9 ± 6.3 years) was evaluated using a hand dynamometer by the same rater in two different testing sessions with a 7-d interval. During each session, patients were asked to exert three maximal isometric contractions on the dominant hand and the mean value of the 3 efforts (measured in kilogram-force [Kgf]) was used for data analysis. The intraclass correlation coefficient (ICC2,1), the standard error of measurement (SEM), the minimal detectable change (MDC), and Bland-Altman methods were used to estimate the degree of test-retest reliability and the measurement error, respectively. HGS in COPD patients revealed an ICC2,1 score of 0.99, suggesting excellent test-retest reliability. The calculated SEM was relatively small (0.59 Kgf), and the MDC presented a clinically acceptable value of 1.64 Kgf. These findings, in conjunction with the narrow width of the 95% limits of agreements (95% limits of agreement, -2.5-2.1 Kgf) in the Bland-Altman plot, reflected the measurement precision and the narrow variation of the differences during the 2 testing sessions. The results of this study demonstrated an excellent test-retest reliability of HGS measurement, indicating that this method is reliable for repeated monitoring of peripheral muscle strength in patients with COPD.
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Affiliation(s)
- Christos Karagiannis
- Department of Health Sciences, School of Sciences, European University of Cyprus, Nicosia, Cyprus
| | - Christos Savva
- Department of Health Sciences, School of Sciences, European University of Cyprus, Nicosia, Cyprus
| | | | - Ioanna Matheou
- Department of Health Sciences, School of Sciences, European University of Cyprus, Nicosia, Cyprus
| | - Tonia Adamide
- Respiratory Clinic, Nicosia General Hospital, Nicosia, Cyprus
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Ahmadi A, Eftekhari MH, Mazloom Z, Masoompour M, Fararooei M, Eskandari MH, Mehrabi S, Bedeltavana A, Famouri M, Zare M, Nasimi N, Sohrabi Z. Fortified whey beverage for improving muscle mass in chronic obstructive pulmonary disease: a single-blind, randomized clinical trial. Respir Res 2020; 21:216. [PMID: 32807165 PMCID: PMC7430110 DOI: 10.1186/s12931-020-01466-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Accepted: 07/23/2020] [Indexed: 04/22/2024] Open
Abstract
Background The development of effective nutritional supports for patients with chronic obstructive pulmonary diseases (COPD) is still challenging. This study was conducted to investigate the efficacy of daily consumption of fortified whey on inflammation, muscle mass, functionality, and quality of life in patients with moderate-to-severe COPD. Methods A single-blind, randomized trial study was performed on patients with COPD (n = 46). Participants in the intervention group (n = 23) daily received 250 ml of whey beverage fortified with magnesium and vitamin C for 8 weeks. Any changes in inflammatory cytokines (including interleukin- 6 (IL-6) and tumor necrosis factor (TNFα)) were the primary outcomes and the secondary outcomes were fat-free mass, handgrip strength, malnutrition, glutathione and malondialdehyde serum concentrations, and health-related quality of life (HRQoL). Body composition and muscle strength were measured by Bioelectrical Impedance Analysis (BIA) and hydraulic hand dynamometer, respectively. Fat-free mass index (FFMI) was also calculated. Results At the end of the study, 44 patients were analyzed. There were significant decreases in IL-6 concentrations in the intervention group compared to the control group. Also, FFMI, body protein, and handgrip strength increased significantly in the intervention group with significant changes between two groups. Moreover, improvement in health-related quality of life was observed in the intervention group compared to the control group. There were no significant changes in other study variables. Conclusions This novel nutritional intervention decreased inflammatory cytokines levels, improved indices of skeletal muscle mass and muscle strength, and ultimately, increased HRQoL in patients with moderate-to-severe COPD. Thus, it is suggested to do further studies to assess the effects of nutrition intervention on COPD progression. Trial registration IR.SUMS.REC.1396.85 (https://www.irct.ir/).
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Affiliation(s)
- Afsane Ahmadi
- Research Center for Health Sciences, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Hassan Eftekhari
- Department of Clinical Nutrition, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Zohreh Mazloom
- Department of Clinical Nutrition, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Masoom Masoompour
- Non-communicable Disease Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Fararooei
- Department of Epidemiology, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Hadi Eskandari
- Department of Food Sciences and Technology, School of Agriculture, Shiraz University, Shiraz, Iran
| | - Samrad Mehrabi
- Department of Internal Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Bedeltavana
- Dairy Expert at Research and Development of Zarrin Ghazal Company (DAITY), Shiraz, Iran
| | - Mandana Famouri
- Dairy Expert at Research and Development of Zarrin Ghazal Company (DAITY), Shiraz, Iran
| | - Morteza Zare
- Nutrition Reasearch Center, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nasrin Nasimi
- Department of Community Nutrition, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Sohrabi
- Department of Community Nutrition, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
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Yee N, Locke ER, Pike KC, Chen Z, Lee J, Huang JC, Nguyen HQ, Fan VS. Frailty in Chronic Obstructive Pulmonary Disease and Risk of Exacerbations and Hospitalizations. Int J Chron Obstruct Pulmon Dis 2020; 15:1967-1976. [PMID: 32848382 PMCID: PMC7429100 DOI: 10.2147/copd.s245505] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 05/24/2020] [Indexed: 12/12/2022] Open
Abstract
Background Frailty is a complex clinical syndrome associated with vulnerability to adverse health outcomes. While frailty is thought to be common in chronic obstructive pulmonary disease (COPD), the relationship between frailty and COPD-related outcomes such as risk of acute exacerbations of COPD (AE-COPD) and hospitalizations is unclear. Purpose To examine the association between physical frailty and risk of acute exacerbations, hospitalizations, and mortality in patients with COPD. Methods A longitudinal analysis of data from a cohort of 280 participants was performed. Baseline frailty measures included exhaustion, weakness, low activity, slowness, and undernutrition. Outcome measures included AE-COPD, hospitalizations, and mortality over 2 years. Negative binomial regression and Cox proportional hazard modeling were used. Results Sixty-two percent of the study population met criteria for pre-frail and 23% were frail. In adjusted analyses, the frailty syndrome was not associated with COPD exacerbations. However, among the individual components of the frailty syndrome, weakness measured by handgrip strength was associated with increased risk of COPD exacerbations (IRR 1.46, 95% CI 1.09–1.97). The frailty phenotype was not associated with all-cause hospitalizations but was associated with increased risk of non-COPD-related hospitalizations. Conclusion This longitudinal cohort study shows that a high proportion of patients with COPD are pre-frail or frail. The frailty phenotype was associated with an increased risk of non-COPD hospitalizations but not with all-cause hospitalizations or COPD exacerbations. Among the individual frailty components, low handgrip strength was associated with increased risk of COPD exacerbations over a 2-year period. Measuring handgrip strength may identify COPD patients who could benefit from programs to reduce COPD exacerbations.
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Affiliation(s)
- Nathan Yee
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Emily R Locke
- Department of Health Services Research and Development, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
| | - Kenneth C Pike
- Department of Child, Family, and Population Health Nursing, School of Nursing, University of Washington, Seattle, WA, USA
| | - Zijing Chen
- Department of Child, Family, and Population Health Nursing, School of Nursing, University of Washington, Seattle, WA, USA
| | - Jungeun Lee
- College of Nursing, University of Rhode Island, Kingston, RI, USA
| | - Joe C Huang
- Division of Gerontology & Geriatric Medicine, University of Washington, Seattle, WA, USA
| | - Huong Q Nguyen
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Vincent S Fan
- Department of Health Services Research and Development, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA.,Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle, WA, USA
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36
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Mathur S, Rozenberg D, Verweel L, Orsso CE, Singer LG. Chest computed tomography is a valid measure of body composition in individuals with advanced lung disease. Clin Physiol Funct Imaging 2020; 40:360-368. [PMID: 32544296 DOI: 10.1111/cpf.12652] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 04/03/2020] [Accepted: 06/07/2020] [Indexed: 01/06/2023]
Abstract
There is growing interest in evaluating body composition using routine clinical computed tomography (CT) scans; however, the validity of this technique in lung transplant patients has not been described. The study objectives were to determine the reliability of measuring fat compartments from thoracic CT and evaluate the validity of muscle and fat cross-sectional area (CSA) from thoracic CT by comparing to bioelectrical impedance analysis (BIA). Thoracic CT scans from lung transplant assessments were obtained for analysis. Total thoracic muscle CSA, pectoral muscle CSA, subcutaneous adipose tissue (SAT), and mediastinal adipose tissue (MAT) were manually segmented by two independent raters. Reliability was analysed using intra-class correlation coefficient (ICC). Correlations were determined between CT measures with fat-free mass index (FFMI), body fat mass index (BFMI) and per cent body fat (%BF) from BIA; and anthropometrics [body mass index (BMI) and waist circumference (WC)]. High inter- and intra-rater reliability were found for SAT and MAT (ICCs = 0.99). Pectoral and total muscle CSA were correlated with FFMI (r = .41, p = .003 and r = .57, p < .001, respectively). SAT was associated with whole-body fat from BIA and with BMI and WC (r = .61 to .80, p < .001). MAT was associated with BMI (r = .58, p < .001) and WC (r = .61, p < .001). This study supports the reliability and validity of using thoracic CT to measure muscle and fat. Future studies are needed to investigate whether these CT-based measures are predictive of clinical and post-transplant outcomes in advanced lung disease.
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Affiliation(s)
- Sunita Mathur
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - Dmitry Rozenberg
- Division of Respirology, Toronto Lung Transplant Program, Toronto General Hospital, Toronto, ON, Canada
| | - Lee Verweel
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - Camila E Orsso
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, AB, Canada
| | - Lianne G Singer
- Division of Respirology, Toronto Lung Transplant Program, Toronto General Hospital, Toronto, ON, Canada
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Evaluation of nutritional status in COPD according to the GOLD-2015 staging system: a prospective observational study. Eur J Clin Nutr 2020; 74:1354-1361. [PMID: 32424356 DOI: 10.1038/s41430-020-0663-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 05/04/2020] [Accepted: 05/05/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVES This study aimed to assess nutritional statuses of chronic obstructive pulmonary disease (COPD) patients in four categories of the Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2015 classification and to evaluate associations of body mass index (BMI) and fat-free mass index with respiratory and skeletal muscle strengths. METHODS This prospective observational study included COPD patients (≥40 years old) who were followed-up for at least 1 year. Medical histories, smoking status, and anthropometric, spirometry, and hand grip strength measurements were recorded. RESULTS This study included 463 COPD patients. They were classified as Group A (n = 119), Group B (n = 58), Group C (n = 117), and Group D (n = 169) according to GOLD. Group D was older (p = 0.001) than other groups. No difference was found among the groups regarding sex (p = 0.163). Fat-free body mass was significantly decreased in Group D compared with Group A (p = 0.014) and BMI were lower in Groups C and D than in other groups (p = 0.001). Spirometry and hand grip strength showed a significant decreasing trend toward Group D (p < 0.001 for both). CONCLUSIONS Patients with COPD in advanced-stages had decreased BMI, fat-free body mass, hand grip strength, and respiratory and skeletal muscle functions. Nutritional status should be routinely monitored and considered an important indicator in COPD.
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38
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Kanai M, Kanai O, Fujita K, Mio T, Ito M. Decreased handgrip strength can predict lung function impairment in male workers: a cross sectional study. BMC Pulm Med 2020; 20:97. [PMID: 32312258 PMCID: PMC7171731 DOI: 10.1186/s12890-020-1135-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 04/06/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Spirometry is useful for evaluating respiratory health status and predicting health-related outcomes. As spirometry requires skilled technician and takes time, it is useful to find simple way for predicting lung function impairment. The aim of this study was to investigate which tests could predict lung function impairment among workers. METHODS This prospective study included workers of manufacturing industry who underwent health check-ups in 2017. Subjects underwent the chronic obstructive pulmonary disease (COPD) assessment test (CAT), spirometry, and physical fitness assessments, including handgrip strength (HGS). Lung function impairment was defined as a decline in any of forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), or a FEV1/FVC ratio less than the lower limit of normal (LLN). RESULTS Complete data on 475 workers (366 men, 50.4% ever smokers) were available. Lung function impairment was observed in 99 subjects (64 men). Men with lung function impairment had significantly higher rate of ever-smoking, passive smoking at home in childhood, high CAT scores, and decreased HGS, compared with those without. On multivariate analyses, ever-smoking (odds ratio [OR], 2.50; 95% confidence intervals [CI], 1.25-4.97), passive smoking at home in childhood (OR, 2.71; 95% CI, 1.16-6.32), CAT scores (OR, 1.06; 95% CI, 1.01-1.12), and HGS (OR, 0.73; 95% CI, 0.57-0.92) were independently associated with lung function impairment in men. CONCLUSIONS Ever-smoking, passive smoking at home in childhood, high CAT scores, and decreased HGS are significantly associated with lung function impairment in men. TRIAL REGISTRATION Registration number: UMIN000028011. Date of registration: July 1, 2017.
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Affiliation(s)
- Makiko Kanai
- Panasonic Health Care Center, Panasonic Health Insurance Organization, 5-55 Sotojima-cho, Moriguchi-city, Osaka, 570-0096 Japan
- Division of Respiratory Medicine, National Hospital Organization Kyoto Medical Center, 1-1 Fukakusa-Mukaihata-Cho, Fushimi-Ku, Kyoto, 612-8555 Japan
| | - Osamu Kanai
- Division of Respiratory Medicine, National Hospital Organization Kyoto Medical Center, 1-1 Fukakusa-Mukaihata-Cho, Fushimi-Ku, Kyoto, 612-8555 Japan
| | - Kohei Fujita
- Division of Respiratory Medicine, National Hospital Organization Kyoto Medical Center, 1-1 Fukakusa-Mukaihata-Cho, Fushimi-Ku, Kyoto, 612-8555 Japan
| | - Tadashi Mio
- Division of Respiratory Medicine, National Hospital Organization Kyoto Medical Center, 1-1 Fukakusa-Mukaihata-Cho, Fushimi-Ku, Kyoto, 612-8555 Japan
| | - Masato Ito
- Panasonic Health Care Center, Panasonic Health Insurance Organization, 5-55 Sotojima-cho, Moriguchi-city, Osaka, 570-0096 Japan
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Qaisar R, Karim A, Muhammad T. Circulating Biomarkers of Handgrip Strength and Lung Function in Chronic Obstructive Pulmonary Disease. Int J Chron Obstruct Pulmon Dis 2020; 15:311-321. [PMID: 32103930 PMCID: PMC7023869 DOI: 10.2147/copd.s225765] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Accepted: 01/24/2020] [Indexed: 01/10/2023] Open
Abstract
Purpose COPD is a multisystem disease and there is a need for clinical serum markers that can assess the decline in lung and muscle function in COPD. The goal of this study was to evaluate the potential association of serum club-cell protein 16 (CC16), α-1 acid glycoprotein (AGP) and total sialic acid (TSA) with spirometry, hand-grip strength and quality of life to assess important disease outcomes. Methods This is a population-based cross-sectional study and data were collected from the patients at teaching hospitals of Gomal University and the University of Health Sciences in Pakistan. The study population included 1582 participants (Non-COPD; N = 788, COPD; N = 845) >55 years of age from both sexes, with data from structural interviews, clinical examinations, laboratory investigations, spirometry and hand-grip strength measurements. Results Serum TSA and CC16 were significant predictors of FEV1% (p < 0.05) and hand-grip strength in advanced stages of COPD (p < 0.05 each) in both sexes. Men had higher absolute and adjusted hand-grip strength than women in all groups (p < 0.05). Hand-grip strength was significantly associated with FEV1% in both genders (p < 0.05) with stronger effect in women (r2 = 0.075). Serum HDL-C was an independent predictor of hand-grip strength and FEV1% (p < 0.05) in both genders. Participants with extreme problem on EQ-5D parameters had more severe COPD and reduced hand-grip strength (all p values < 0.05). Conclusion Taken together, these studies show that the serum expressions of TSA and CC16 have correlations with spirometry and muscle decline in COPD. Further studies should be conducted to establish their efficacy in monitoring disease progression in COPD.
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Affiliation(s)
- Rizwan Qaisar
- Basic Medical Sciences, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Asima Karim
- Basic Medical Sciences, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates.,University of Health Sciences, Lahore, Pakistan
| | - Tahir Muhammad
- Department of Biochemistry, Gomal Medical College, Gomal University, Dera Ismail Khan, Pakistan
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Nunes MF, Hervé BB, Lukrafka JL, Monteiro MB. Handgrip strength and its relation to isokinetic dynamometry in COPD. FISIOTERAPIA EM MOVIMENTO 2020. [DOI: 10.1590/1980-5918.033.ao56] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract Introduction: Muscle dysfunction is one of the major changes found in chronic obstructive pulmonary disease (COPD) and associated with loss of functionality, morbidity and mortality. Objective: correlate two strength assessment methods: manual dynamometry for handgrip strength and isokinetic dynamometry for quadriceps strength in patients with COPD, and assess the body mass index, airflow obstruction, dyspnea, and exercise capacity (BODE), quality of life and muscle strength. Method: twenty-five patients with moderate to very severe COPD were evaluated by pulmonary function parameters, anthropometric variables, functional capacity, via the six-minute walk test, dyspnea, applying the modified Medical Research Council (mMRC) scale, BODE, quality of life, using the Saint George's Respiratory Questionnaire (SGRQ), handgrip strength with manual dynamometer and quadriceps force using an isokinetic dynamometer. Muscle strength was assessed with a manual portable dynamometer and isokinetic dynamometer. For statistical analysis, ANOVA with Bonferroni’s post-test, the chi-squared test and Pearson's correlation coefficient were used. Results: There was a strong correlation between the strength measurements and the two instruments (torque and quadriceps extension power with right handgrip strength: r = 0.74; p <0.001). The patients classified as very severe exhibited worse performance in the strength tests when compared to the moderate group, albeit with no statistically significant difference. Conclusion: In muscle strength measurements, a strong correlation was detected between the isokinetic dynamometer for quadriceps and the manual dynamometer for handgrip strength. These findings indicate that, in clinical practice, the manual dynamometer for handgrip strength could be used to assess peripheral muscle strength in patients with COPD.
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Massierer D, Alsowayan W, Lima VP, Bourbeau J, Janaudis-Ferreira T. Prognostic value of simple measures of physical function and muscle strength in COPD: A systematic review. Respir Med 2019; 161:105856. [PMID: 32056729 DOI: 10.1016/j.rmed.2019.105856] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 12/17/2019] [Accepted: 12/18/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE There has been an increased interest in simple measures of physical function and muscle strength that can be used in all clinical settings to assess individuals with chronic obstructive pulmonary disease (COPD) and predict their prognosis. The main objective was to examine the prognostic value of simple measures of physical function and muscle strength in relation to exacerbation, hospitalization and mortality in individuals with COPD. METHODS Medline, EMBASE, Cochrane and Web of Science were searched. We included prospective observational studies that examined the prognostic value of simple performed-based tests or self-reported measures of physical function or muscle strength in relation to exacerbation, hospitalization and mortality in individuals with COPD. RESULTS Seven articles met the inclusion criteria. The most commonly used tests were the handgrip strength (HGS) (n = 4) and 1-min sit-to-stand (STS) (n = 2). There were considerable variations in terms of characteristics of patients included, setting of recruitment, type of tests used, duration of follow-up and outcome measures of interest. The majority of the studies were classified as having "fair" or "poor" methodological quality. CONCLUSIONS There is a limited number of studies examining the prognostic value of simple measures of physical function and muscle strength in relation to exacerbations, hospitalizations and mortality in individuals with COPD. To date, the HGS and 1-min STS tests are the most studied tests and seem to be suitable for prognosis purposes in individuals with COPD. However, more studies with better methodological quality are needed to confirm these findings.
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Affiliation(s)
- Daniela Massierer
- School of Physical and Occupational Therapy, McGill University, 3654 Prom Sir-William-Osler, Hosmer House, Room #200, Montreal, QC, H3G 1Y5, Canada; Translational Research in Respiratory Diseases Program, Research Institute of the McGill University Health Centre, 1001 Decarie Blvd, Block E, Montreal, QC, H4A 3J1, Canada; Centre for Health Outcomes Research and Evaluation (CORE), Research Institute of the McGill University Health Centre, 5252 Boul. de Maisonneuve Ouest, Room # 3E.01, Montreal, QC, H4A 3S5, Canada
| | - Waleed Alsowayan
- Respiratory Division, McGill University Health Center, 1001 Decarie Blvd, Montreal, QC, H4A 3J, Canada
| | - Vanessa Pereira Lima
- Department of Physical Therapy, Universidade Federal dos Vales do Jequitinhonha e Mucuri-UFVJM, Campus JK, Rodovia MGT 367, Km 583, Nº 5000, Alto da Jacuba CEP: 39100-000, Diamantina, Minas Gerais, Brazil
| | - Jean Bourbeau
- Respiratory Epidemiology and Clinical Research Unit (RECRU), McGill University Health Centre, 5252 Boul. de Maisonneuve Ouest, Montreal, QC, H4A 3S5, Canada; Translational Research in Respiratory Diseases Program, Research Institute of the McGill University Health Centre, 1001 Decarie Blvd, Block E, Montreal, QC, H4A 3J1, Canada
| | - Tania Janaudis-Ferreira
- School of Physical and Occupational Therapy, McGill University, 3654 Prom Sir-William-Osler, Hosmer House, Room #200, Montreal, QC, H3G 1Y5, Canada; Respiratory Epidemiology and Clinical Research Unit (RECRU), McGill University Health Centre, 5252 Boul. de Maisonneuve Ouest, Montreal, QC, H4A 3S5, Canada; Translational Research in Respiratory Diseases Program, Research Institute of the McGill University Health Centre, 1001 Decarie Blvd, Block E, Montreal, QC, H4A 3J1, Canada; Centre for Health Outcomes Research and Evaluation (CORE), Research Institute of the McGill University Health Centre, 5252 Boul. de Maisonneuve Ouest, Room # 3E.01, Montreal, QC, H4A 3S5, Canada.
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Lima TRL, Almeida VP, Ferreira AS, Guimarães FS, Lopes AJ. Handgrip Strength and Pulmonary Disease in the Elderly: What is the Link? Aging Dis 2019; 10:1109-1129. [PMID: 31595206 PMCID: PMC6764733 DOI: 10.14336/ad.2018.1226] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 12/26/2018] [Indexed: 12/15/2022] Open
Abstract
Societies in developed countries are aging at an unprecedented rate. Considering that aging is the most significant risk factor for many chronic lung diseases (CLDs), understanding this process may facilitate the development of new interventionist approaches. Skeletal muscle dysfunction is a serious problem in older adults with CLDs, reducing their quality of life and survival. In this study, we reviewed the possible links between handgrip strength (HGS)—a simple, noninvasive, low-cost measure of muscle function—and CLDs in the elderly. Different mechanisms appear to be involved in this association, including systemic inflammation, chronic hypoxemia, physical inactivity, malnutrition, and corticosteroid use. Respiratory and peripheral myopathy, associated with muscle atrophy and a shift in muscle fiber type, also seem to be major etiological contributors to CLDs. Moreover, sarcopenic obesity, which occurs in older adults with CLDs, impairs common inflammatory pathways that can potentiate each other and further accelerate the functional decline of HGS. Our findings support the concept that the systemic effects of CLDs may be determined by HGS, and HGS is a relevant measurement that should be considered in the clinical assessment of the elderly with CLDs. These reasons make HGS a useful practical tool for indirectly evaluating functional status in the elderly. At present, early muscle reconditioning and optimal nutrition appear to be the most effective approaches to reduce the impact of CLDs and low muscle strength on the quality of life of these individuals. Nonetheless, larger in-depth studies are needed to evaluate the link between HGS and CLDs.
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Affiliation(s)
- Tatiana Rafaela Lemos Lima
- 1Rehabilitation Sciences Post-Graduate Program, Augusto Motta University Center (UNISUAM), Bonsucesso, 21041-010, Rio de Janeiro, Brazil
| | - Vívian Pinto Almeida
- 1Rehabilitation Sciences Post-Graduate Program, Augusto Motta University Center (UNISUAM), Bonsucesso, 21041-010, Rio de Janeiro, Brazil
| | - Arthur Sá Ferreira
- 1Rehabilitation Sciences Post-Graduate Program, Augusto Motta University Center (UNISUAM), Bonsucesso, 21041-010, Rio de Janeiro, Brazil
| | - Fernando Silva Guimarães
- 1Rehabilitation Sciences Post-Graduate Program, Augusto Motta University Center (UNISUAM), Bonsucesso, 21041-010, Rio de Janeiro, Brazil
| | - Agnaldo José Lopes
- 1Rehabilitation Sciences Post-Graduate Program, Augusto Motta University Center (UNISUAM), Bonsucesso, 21041-010, Rio de Janeiro, Brazil.,2Post-graduate Program in Medical Sciences, School of Medical Sciences, State University of Rio de Janeiro (UERJ), Vila Isabel, 20550-170, Rio de Janeiro, Brazil
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Turan Z, Özyemişçi Taşkıran Ö, Erden Z, Köktürk N, Kaymak Karataş G. Does hand grip strength decrease in chronic obstructive pulmonary disease exacerbation? A cross-sectional study. Turk J Med Sci 2019; 49:802-808. [PMID: 31190519 PMCID: PMC7018388 DOI: 10.3906/sag-1811-22] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background/aim Respiratory and peripheral muscle strength are reduced in chronic obstructive pulmonary disease (COPD). There is a well-known correlation between handgrip strength (HGS) and strenght extremity muscles. Our aim in this study was to measure HGS and investigate the related factors in COPD patients with exacerbation. Materials and methods Subjects with COPD exacerbation (n = 101) and stable COPD (n = 22), and subjects without COPD (n = 201), were enrolled in this study. Age, sex, and body mass index were similar. HGS was measured using a Vigorimeter. Pulmonary function tests and 6-min walk tests were performed. Results The mean HGS was significantly lower in subjects with COPD exacerbation than those with stable COPD and subjects without COPD. The mean HGS was similar between stable COPD and non-COPD subjects. The mean 6-min walk distance (6MWD) was significantly lower in subjects with COPD exacerbation than stable COPD. There was a significant correlation between HGS and 6MWD but no correlation between HGS and pulmonary function tests. Conclusion In subjects with COPD exacerbation, the HGS was lower than that of stable COPD patients, and this difference was not explained by age, comorbidities, severity of obstruction, or smoking. Physical inactivity and steroid use during exacerbation might be possible factors affecting HGS. HGS was moderately correlated with 6MWD in cases of exacerbation. It may be used as a measure of muscle performance in COPD exacerbation, especially when the 6-min walk test cannot be performed.
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Affiliation(s)
- Zeynep Turan
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Koç University, İstanbul, Turkey
| | - Özlem Özyemişçi Taşkıran
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Koç University, İstanbul, Turkey
| | - Zeynep Erden
- Department of Physical Medicine and Rehabilitation, Balıkesir Ayvalık State Hospital, Balıkesir, Turkey
| | - Nurdan Köktürk
- Department of Pulmonary Medicine, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Gülçin Kaymak Karataş
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Gazi University, Ankara, Turkey
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Handgrip Strength in Chronic Obstructive Pulmonary Disease: Ready for Prime Time or Frailty Research Tool? Ann Am Thorac Soc 2019; 14:1630-1631. [PMID: 29090996 DOI: 10.1513/annalsats.201706-487ed] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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45
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Guler SA, Hur SA, Lear SA, Camp PG, Ryerson CJ. Body composition, muscle function, and physical performance in fibrotic interstitial lung disease: a prospective cohort study. Respir Res 2019; 20:56. [PMID: 30866948 PMCID: PMC6417197 DOI: 10.1186/s12931-019-1019-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 02/27/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients with fibrotic interstitial lung disease (ILD) are frequently physically inactive and many ILD subtypes are characterized by risk factors for myopathy; however, the importance of body composition, muscle strength, and physical performance in this population is largely unknown. METHODS Patients were prospectively recruited from a specialized ILD clinic, baseline characteristics were collected from the clinical record, pulmonary function tests were performed per established protocols, and dyspnea was measured using the University of California San Diego Shortness of Breath Questionnaire. Dual-energy X-ray absorptiometry (DXA) was used to assess body composition; handgrip strength to determine muscle strength, and 4-m gait speed to measure physical performance. RESULTS One hundred and fifteen patients with fibrotic ILD including 40 patients with idiopathic pulmonary fibrosis were recruited. The mean age was 69+/- 10 years in men (62% of the cohort), and 66+/- 9 years in women, with mild and moderate reduction in FVC and DLCO, respectively, for both sexes. ILD severity (measured by FVC %-predicted, DLCO %-predicted, or the Composite Physiologic Index in separate models) significantly predicted muscle mass and percent body fat including with adjustment for age, sex, and weight. ILD severity was associated with grip strength and gait speed independent from body composition. CONCLUSIONS ILD severity has an important impact on body composition, particularly in men. Future studies are needed to confirm and further explore the possibility of additional pathways through which ILD directly impacts limb muscle function and physical performance.
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Affiliation(s)
- Sabina A. Guler
- Department of Medicine, University of British Columbia, Vancouver, Canada
- Centre for Heart Lung Innovation, University of British Columbia, Vancouver, Canada
- Department of Pulmonary Medicine, University Hospital and University of Bern, Bern, Switzerland
| | - Seo Am Hur
- Centre for Heart Lung Innovation, University of British Columbia, Vancouver, Canada
| | - Scott A. Lear
- Department of Medicine, University of British Columbia, Vancouver, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Pat G. Camp
- Centre for Heart Lung Innovation, University of British Columbia, Vancouver, Canada
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada
| | - Christopher J. Ryerson
- Department of Medicine, University of British Columbia, Vancouver, Canada
- Centre for Heart Lung Innovation, University of British Columbia, Vancouver, Canada
- St. Paul’s Hospital, 1081 Burrard St, Ward 8B, Vancouver, BC V6Z 1Y6 Canada
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Diaz AA, Martinez CH, Harmouche R, Young TP, McDonald ML, Ross JC, Han ML, Bowler R, Make B, Regan EA, Silverman EK, Crapo J, Boriek AM, Kinney GL, Hokanson JE, Estepar RSJ, Washko GR. Pectoralis muscle area and mortality in smokers without airflow obstruction. Respir Res 2018; 19:62. [PMID: 29636050 PMCID: PMC5894181 DOI: 10.1186/s12931-018-0771-6] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 04/04/2018] [Indexed: 12/25/2022] Open
Abstract
Background Low muscle mass is associated with increased mortality in the general population but its prognostic value in at-risk smokers, those without expiratory airflow obstruction, is unknown. We aimed to test the hypothesis that reduced muscle mass is associated with increased mortality in at-risk smokers. Methods Measures of both pectoralis and paravertebral erector spinae muscle cross-sectional area (PMA and PVMA, respectively) as well as emphysema on chest computed tomography (CT) scans were performed in 3705 current and former at-risk smokers (≥10 pack-years) aged 45–80 years enrolled into the COPDGene Study between 2008 and 2013. Vital status was ascertained through death certificate. The association between low muscle mass and mortality was assessed using Cox regression analysis. Results During a median of 6.5 years of follow-up, 212 (5.7%) at-risk smokers died. At-risk smokers in the lowest (vs. highest) sex-specific quartile of PMA but not PVMA had 84% higher risk of death in adjusted models for demographics, smoking, dyspnea, comorbidities, exercise capacity, lung function, emphysema on CT, and coronary artery calcium content (hazard ratio [HR] 1.85 95% Confidence interval [1.14–3.00] P = 0.01). Results were consistent when the PMA index (PMA/height2) was used instead of quartiles. The association between PMA and death was modified by smoking status (P = 0.04). Current smokers had a significantly increased risk of death (lowest vs. highest PMA quartile, HR 2.25 [1.25–4.03] P = 0.007) while former smokers did not. Conclusions Low muscle mass as measured on chest CT scans is associated with increased mortality in current smokers without airflow obstruction. Trial registration NCT00608764 Electronic supplementary material The online version of this article (10.1186/s12931-018-0771-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Alejandro A Diaz
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
| | - Carlos H Martinez
- Division of Pulmonary & Critical Care Medicine, University of Michigan Health System, Ann Arbor, MI, USA
| | - Rola Harmouche
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Thomas P Young
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Merry-Lynn McDonald
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - James C Ross
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Mei Lan Han
- Division of Pulmonary & Critical Care Medicine, University of Michigan Health System, Ann Arbor, MI, USA
| | - Russell Bowler
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, National Jewish Health, Denver, CO, USA
| | - Barry Make
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, National Jewish Health, Denver, CO, USA
| | - Elizabeth A Regan
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, National Jewish Health, Denver, CO, USA
| | - Edwin K Silverman
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.,Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - James Crapo
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, National Jewish Health, Denver, CO, USA
| | - Aladin M Boriek
- Division of Pulmonary and Critical Care Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Gregory L Kinney
- Colorado School of Public Health, University of Colorado-Denver, Aurora, CO, USA
| | - John E Hokanson
- Colorado School of Public Health, University of Colorado-Denver, Aurora, CO, USA
| | - Raul San Jose Estepar
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - George R Washko
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
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