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Machado A, Barusso M, De Brandt J, Quadflieg K, Haesevoets S, Daenen M, Thomeer M, Ruttens D, Marques A, Burtin C. Impact of acute exacerbations of COPD on patients' health status beyond pulmonary function: A scoping review. Pulmonology 2023; 29:518-534. [PMID: 35715333 DOI: 10.1016/j.pulmoe.2022.04.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 03/30/2022] [Accepted: 04/10/2022] [Indexed: 11/21/2022] Open
Abstract
This scoping review summarized the evidence regarding the impact of acute exacerbations of COPD (AECOPD) on patients' health status beyond pulmonary function. PubMed, Embase, and Web of Science were searched. Prospective cohort studies assessing the health status of patients with COPD in a stable phase of the disease and after a follow-up period (where at least one AECOPD occurred) were included. An integrated assessment framework of health status (i.e., physiological functioning, complaints, functional impairment, quality of life) was used. Twenty-two studies were included. AECOPD acutely affected exercise tolerance, quadriceps muscle strength, physical activity levels, symptoms of dyspnoea and fatigue, and impact of the disease. Long-term effects on quadriceps muscle strength, symptoms of dyspnoea and depression, and quality of life were found. Repeated exacerbations negatively impacted the fat-free mass, levels of dyspnoea, impact of the disease and quality of life. Conflicting evidence was found regarding the impact of repeated exacerbations on exercise tolerance and physical activity levels. AECOPD have well-established acute and long-term adverse effects on health status beyond pulmonary function; nevertheless, the recovery trajectory and the impact of repeated exacerbations are still poorly studied. Further prospective research is recommended to draw firm conclusions on these aspects.
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Affiliation(s)
- A Machado
- Respiratory Research and Rehabilitation Laboratory (Lab 3R), School of Health Sciences (ESSUA), University of Aveiro, Aveiro, Portugal; Institute of Biomedicine (iBiMED), University of Aveiro, Aveiro, Portugal; REVAL - Rehabilitation Research Center, Faculty of Rehabilitation Sciences, BIOMED Biomedical Research Institute, Hasselt University, Agoralaan Gebouw A, Diepenbeek 3590, Belgium; BIOMED - Biomedical Research Institute, Hasselt University, Diepenbeek, Belgium
| | - M Barusso
- REVAL - Rehabilitation Research Center, Faculty of Rehabilitation Sciences, BIOMED Biomedical Research Institute, Hasselt University, Agoralaan Gebouw A, Diepenbeek 3590, Belgium; Laboratory of Spirometry and Respiratory Physiotherapy-LEFiR, Universidade Federal de São Carlos-UFSCar, São Carlos, São Paulo, Brazil
| | - J De Brandt
- REVAL - Rehabilitation Research Center, Faculty of Rehabilitation Sciences, BIOMED Biomedical Research Institute, Hasselt University, Agoralaan Gebouw A, Diepenbeek 3590, Belgium; BIOMED - Biomedical Research Institute, Hasselt University, Diepenbeek, Belgium
| | - K Quadflieg
- REVAL - Rehabilitation Research Center, Faculty of Rehabilitation Sciences, BIOMED Biomedical Research Institute, Hasselt University, Agoralaan Gebouw A, Diepenbeek 3590, Belgium; BIOMED - Biomedical Research Institute, Hasselt University, Diepenbeek, Belgium
| | - S Haesevoets
- REVAL - Rehabilitation Research Center, Faculty of Rehabilitation Sciences, BIOMED Biomedical Research Institute, Hasselt University, Agoralaan Gebouw A, Diepenbeek 3590, Belgium; BIOMED - Biomedical Research Institute, Hasselt University, Diepenbeek, Belgium
| | - M Daenen
- Department of Respiratory Medicine, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - M Thomeer
- Department of Respiratory Medicine, Ziekenhuis Oost-Limburg, Genk, Belgium; Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
| | - D Ruttens
- Department of Respiratory Medicine, Ziekenhuis Oost-Limburg, Genk, Belgium; Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
| | - A Marques
- Respiratory Research and Rehabilitation Laboratory (Lab 3R), School of Health Sciences (ESSUA), University of Aveiro, Aveiro, Portugal; Institute of Biomedicine (iBiMED), University of Aveiro, Aveiro, Portugal
| | - C Burtin
- REVAL - Rehabilitation Research Center, Faculty of Rehabilitation Sciences, BIOMED Biomedical Research Institute, Hasselt University, Agoralaan Gebouw A, Diepenbeek 3590, Belgium; BIOMED - Biomedical Research Institute, Hasselt University, Diepenbeek, Belgium.
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Karanikas I, Karayiannis D, Karachaliou A, Papanikolaou A, Chourdakis M, Kakavas S. Body composition parameters and functional status test in predicting future acute exacerbation risk among hospitalized patients with chronic obstructive pulmonary disease. Clin Nutr 2021; 40:5605-5614. [PMID: 34656957 DOI: 10.1016/j.clnu.2021.09.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 05/15/2021] [Accepted: 09/17/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND & AIMS Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. Nutritional and functional status derangement is a commonly seen in COPD patients, and this is associated with a higher disease severity and mortality. To assess body composition analysis - measured by segmental multi-frequency bioelectrical impedance analysis (BIA)- and functional status and investigate their relationship with the COPD acute exacerbation risk. METHODS Eighty COPD patients admitted to hospital for COPD acute exacerbation were prospectively followed-up for one year after discharge, focusing on a new incidence of COPD acute exacerbation. Following discharge, participants' body composition was assessed with the use of segmental multi-frequency BIA, whereas physical function by performing 5-repetitions and 30 s sit-to-stand (STS) tests. Unadjusted and multivariate logistic regression analyses were performed to evaluate the ability of the various measures to predict incidence of future COPD acute exacerbation in one-year period. RESULTS Seventy-six out of 80 participants completed the study and were analyzed. Fifty-one [24 male (47.1%)] out of 76 participants (67.1%), mean aged of 69.3 ± 8.9 years, developed at least one new COPD acute exacerbation during the one year follow-up. The probability of COPD acute exacerbation in one year was significantly related to BMI (OR = 0.75, 95% CI; 0.61-0.91, p = 0.004) and Fat Free Mass (OR = 0.88, 95% CI; 0.79-0.97, p = 0.012) after adjustment for sex, age and smoking index (pack × years). Both 5-repetitions and 30 s STS tests had a good predictive ability for the incidence of COPD acute exacerbation in one year (AUC = 0.80, 95% CI; 0.65-0.95, p = 0.009 and AUC = 0.83, 95% CI; 0.70-0.96, p = 0.004, respectively). CONCLUSION In an observational study among patients admitted with COPD acute exacerbation, body composition analysis parameters and functional status are related to acute exacerbation risk incidence.
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Affiliation(s)
- Ioannis Karanikas
- Department of Clinical Nutrition, "Evangelismos" General Hospital of Athens, Ypsilantou 45-47, 10676, Athens, Greece.
| | - Dimitrios Karayiannis
- Department of Clinical Nutrition, "Evangelismos" General Hospital of Athens, Ypsilantou 45-47, 10676, Athens, Greece.
| | - Alexandra Karachaliou
- Department of Clinical Nutrition, "Evangelismos" General Hospital of Athens, Ypsilantou 45-47, 10676, Athens, Greece.
| | - Aggeliki Papanikolaou
- 1st Pulmonary Department, "Evangelismos" General Hospital of Athens, Ypsilantou 45-47, 10676, Athens, Greece.
| | - Michail Chourdakis
- Laboratory of Hygiene, Social & Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, University Campus, Thessaloniki, GR 54124, Greece.
| | - Sotirios Kakavas
- 1st Pulmonary Department, "Evangelismos" General Hospital of Athens, Ypsilantou 45-47, 10676, Athens, Greece.
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Fermont JM, Masconi KL, Jensen MT, Ferrari R, Di Lorenzo VAP, Marott JM, Schuetz P, Watz H, Waschki B, Müllerova H, Polkey MI, Wilkinson IB, Wood AM. Biomarkers and clinical outcomes in COPD: a systematic review and meta-analysis. Thorax 2019; 74:439-446. [PMID: 30617161 PMCID: PMC6484697 DOI: 10.1136/thoraxjnl-2018-211855] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 10/31/2018] [Accepted: 11/19/2018] [Indexed: 01/06/2023]
Abstract
Background Conventional measures to evaluate COPD may fail to capture systemic problems, particularly musculoskeletal weakness and cardiovascular disease. Identifying these manifestations and assessing their association with clinical outcomes (ie, mortality, exacerbation and COPD hospital admission) is of increasing clinical importance. Objective To assess associations between 6 min walk distance (6MWD), heart rate, fibrinogen, C reactive protein (CRP), white cell count (WCC), interleukins 6 and 8 (IL-6 and IL-8), tumour necrosis factor-alpha, quadriceps maximum voluntary contraction, sniff nasal inspiratory pressure, short physical performance battery, pulse wave velocity, carotid intima-media thickness and augmentation index and clinical outcomes in patients with stable COPD. Methods We systematically searched electronic databases (August 2018) and identified 61 studies, which were synthesised, including meta-analyses to estimate pooled HRs, following Meta-analysis of Observational Studies in Epidemiology (MOOSE) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Results Shorter 6MWD and elevated heart rate, fibrinogen, CRP and WCC were associated with higher risk of mortality. Pooled HRs were 0.80 (95% CI 0.73 to 0.89) per 50 m longer 6MWD, 1.10 (95% CI 1.02 to 1.18) per 10 bpm higher heart rate, 3.13 (95% CI 2.14 to 4.57) per twofold increase in fibrinogen, 1.17 (95% CI 1.06 to 1.28) per twofold increase in CRP and 2.07 (95% CI 1.29 to 3.31) per twofold increase in WCC. Shorter 6MWD and elevated fibrinogen and CRP were associated with exacerbation, and shorter 6MWD, higher heart rate, CRP and IL-6 were associated with hospitalisation. Few studies examined associations with musculoskeletal measures. Conclusion Findings suggest 6MWD, heart rate, CRP, fibrinogen and WCC are associated with clinical outcomes in patients with stable COPD. Use of musculoskeletal measures to assess outcomes in patients with COPD requires further investigation. Trial registration number CRD42016052075.
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Affiliation(s)
- Jilles M Fermont
- Department of Medicine, Experimental Medicine and Immunotherapeutics, University of Cambridge, Cambridge, UK.,Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Katya L Masconi
- Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Magnus T Jensen
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.,Copenhagen City Heart Study, Frederiksberg Hospital, Copenhagen, Denmark
| | - Renata Ferrari
- Division of Pulmonology, Department of Internal Medicine, Botucatu Medical School, Univ Estadual Paulista, UNESP, Botucatu, Brazil
| | - Valéria A P Di Lorenzo
- Department of Physiotherapy, Federal University of Sao Carlos (UFSCar), São Carlos/São Paulo, Brazil
| | - Jacob M Marott
- Copenhagen City Heart Study, Frederiksberg Hospital, Copenhagen, Denmark
| | - Philipp Schuetz
- Internal Medicine and Emergency Medicine, Kantonsspital Aarau, Univertsity of Basel, Aarau, Switzerland
| | - Henrik Watz
- LungenClinic Grosshansorf, Airway Research Center North, German Center for Lung Research, Grosshansdorf, Germany
| | - Benjamin Waschki
- LungenClinic Grosshansorf, Airway Research Center North, German Center for Lung Research, Grosshansdorf, Germany
| | - Hana Müllerova
- Worldwide Epidemiology, GlaxoSmithKline R&D, Uxbridge, UK
| | - Michael I Polkey
- Respiratory Muscle Laboratory, Royal Brompton Hospital, London, UK
| | - Ian B Wilkinson
- Department of Medicine, Experimental Medicine and Immunotherapeutics, University of Cambridge, Cambridge, UK
| | - Angela M Wood
- Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
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Silva ALGD, Garmatz E, Goulart CDL, Carvalho LL, Cardoso DM, Paiva DN. Handgrip and functional capacity in Chronic Obstructive Pulmonary Disease patients. FISIOTERAPIA EM MOVIMENTO 2017. [DOI: 10.1590/1980-5918.030.003.ao08] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract Introduction: In the Chronic Obstructive Pulmonary Disease (COPD) both pulmonary and systemic condition increase dyspnea, intolerance to exercise and inactivity. Objective: To evaluate possible association between Hand Grip Strength (HGS) and the distance covered in the Six-Minute Walk Test (6MWT) in patients with Chronic Obstructive Pulmonary Disease (COPD). Methods: A cross-sectional study that evaluated 34 patients with COPD from moderate to very severe stages. The HGS test was performed with a manual hydraulic dynamometer (Jamar®, California, USA) with three bilateral measures, allowing 60-seconds rest time in-between measurements. Afterwards, the patients were submitted to the 6MWT along a 30-meters level corridor following the rules of the American Thoracic Society. Results: Average age 62.7±7.2 years old, body mass index 26.7±6.9 Kg/m². The value of the HGS in the dominant hand was 28.0±8.7 Kgf and in the non-dominant hand was 26.7±7.7 Kgf (99.2% of the predicted value and 106.3% of the predicted value, respectively). The subjects covered in average 421.0±110.4 meters in the 6MWT and there has been detected direct and significant correlation between the distance covered and the HGS of the dominant hand (r=0,430; p=0,011) and non-dominant (r=0,502; p=0,002). The patients with COPD that presented lower HGS also covered less distance in the 6MWT. Conclusion: The hand grip strength was directly associated with the functional capacity assessed through the distance covered in the Six-Minute Walk Test in the evaluated trial.
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Affiliation(s)
| | | | | | | | - Dannuey Machado Cardoso
- Universidade de Santa Cruz do Sul, Brazil; Universidade Federal do Rio Grande do Sul, Brazil
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Josephs L, Culliford D, Johnson M, Thomas M. Improved outcomes in ex-smokers with COPD: a UK primary care observational cohort study. Eur Respir J 2017; 49:1602114. [PMID: 28536250 PMCID: PMC5460640 DOI: 10.1183/13993003.02114-2016] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 02/15/2017] [Indexed: 12/15/2022]
Abstract
Smoking cessation in chronic obstructive pulmonary disease (COPD) reduces accelerated forced expiratory volume in 1 s decline, but impact on key health outcomes is less clear. We studied the relationship of smoking status to mortality and hospitalisation in a UK primary care COPD population.Using patient-anonymised routine data in the Hampshire Health Record Analytical Database, we identified a prevalent COPD cohort, categorising patients by smoking status (current, ex- or never-smokers). Three outcomes were measured over 3 years (2011-2013): all-cause mortality, respiratory-cause unplanned hospital admission and respiratory-cause emergency department attendance. Survival analysis using multivariable Cox regression after multiple imputation was used to estimate hazard ratios for each outcome by smoking status, adjusting for measured confounders (including age, lung function, socioeconomic deprivation, inhaled medication and comorbidities).We identified 16 479 patients with COPD, mean±sd age 70.1±11.1 years. Smoking status was known in 91.3%: 35.1% active smokers, 54.3% ex-smokers, 1.9% never-smokers. Active smokers predominated among younger patients. Compared with active smokers (n=5787), ex-smokers (n=8941) had significantly reduced risk of death, hazard ratio (95% confidence interval) 0.78 (0.70-0.87), hospitalisation, 0.82 (0.74-0.89) and emergency department attendance, 0.78 (0.70-0.88).After adjusting for confounders, ex-smokers had significantly better outcomes, emphasising the importance of effective smoking cessation support, regardless of age or lung function.
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Affiliation(s)
- Lynn Josephs
- Dept of Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- NIHR Collaboration for Leadership in Applied Health Research and Care for Wessex, University of Southampton, Southampton, UK
| | - David Culliford
- NIHR Collaboration for Leadership in Applied Health Research and Care for Wessex Methodological Hub, Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Matthew Johnson
- NIHR Collaboration for Leadership in Applied Health Research and Care for Wessex Methodological Hub, Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Mike Thomas
- Dept of Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- NIHR Collaboration for Leadership in Applied Health Research and Care for Wessex, University of Southampton, Southampton, UK
- NIHR Respiratory Biomedical Research Unit, Southampton General Hospital, Southampton, UK
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Utiyama DMO, Yoshida CT, Goto DM, de Santana Carvalho T, de Paula Santos U, Koczulla AR, Saldiva PHN, Nakagawa NK. The effects of smoking and smoking cessation on nasal mucociliary clearance, mucus properties and inflammation. Clinics (Sao Paulo) 2016; 71:344-50. [PMID: 27438569 PMCID: PMC4930664 DOI: 10.6061/clinics/2016(06)10] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 04/05/2016] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE The aim of the present study was to assess nasal mucociliary clearance, mucus properties and inflammation in smokers and subjects enrolled in a Smoking Cessation Program (referred to as quitters). METHOD A total of 33 subjects with a median (IQR) smoking history of 34 (20-58) pack years were examined for nasal mucociliary clearance using a saccharine transit test, mucus properties using contact angle and sneeze clearability tests, and quantification of inflammatory and epithelial cells, IL-6 and IL-8 concentrations in nasal lavage fluid. Twenty quitters (mean age: 51 years, 9 male) were assessed at baseline, 1 month, 3 months and 12 months after smoking cessation, and 13 smokers (mean age: 52 years, 6 male) were assessed at baseline and after 12 months. Clinicaltrials.gov: NCT02136550. RESULTS Smokers and quitters showed similar demographic characteristics and morbidities. At baseline, all subjects showed impaired nasal mucociliary clearance (mean 17.6 min), although 63% and 85% of the quitters demonstrated significant nasal mucociliary clearance improvement at 1 month and 12 months, respectively. At 12 months, quitters also showed mucus sneeze clearability improvement (∼26%), an increased number of macrophages (2-fold) and no changes in mucus contact angle or cytokine concentrations. CONCLUSION This study showed that smoking cessation induced early improvements in nasal mucociliary clearance independent of mucus properties and inflammation. Changes in mucus properties were observed after only 12 months of smoking cessation.
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Affiliation(s)
- Daniela Mitiyo Odagiri Utiyama
- Faculdade de Medicina da Universidade de São Paulo, Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional</org-name>LIM-34, São Paulo/SP, Brazil
- Faculdade de Medicina da Universidade de São Paulo, Departamento de Patologia, LIM-5, São Paulo/SP, Brazil
| | - Carolina Tieko Yoshida
- Faculdade de Medicina da Universidade de São Paulo, Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional</org-name>LIM-34, São Paulo/SP, Brazil
- Faculdade de Medicina da Universidade de São Paulo, Departamento de Patologia, LIM-5, São Paulo/SP, Brazil
| | | | - Tômas de Santana Carvalho
- Faculdade de Medicina da Universidade de São Paulo, Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional</org-name>LIM-34, São Paulo/SP, Brazil
- Faculdade de Medicina da Universidade de São Paulo, Departamento de Patologia, LIM-5, São Paulo/SP, Brazil
| | - Ubiratan de Paula Santos
- Faculdade de Medicina da Universidade de São Paulo, Heart Institute (InCor), Pulmonary Division, Smoking Cessation Group, São Paulo/SP, Brazil
| | | | | | - Naomi Kondo Nakagawa
- Faculdade de Medicina da Universidade de São Paulo, Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional</org-name>LIM-34, São Paulo/SP, Brazil
- Faculdade de Medicina da Universidade de São Paulo, Departamento de Patologia, LIM-5, São Paulo/SP, Brazil
- E-mail:
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