Balance impairment and systemic inflammation in chronic obstructive pulmonary disease

Exploring Balance Impairment and Determinants in Chronic Obstructive Pulmonary Disease: A Comparative Study with Healthy Subjects

Background: Many pulmonary and extrapulmonary factors may impair balance in patients with chronic obstructive pulmonary disease (COPD), but the determinants of this impairment are still debated. The primary aim was to compare both balance-related and independent variables that may affect balance with healthy subjects. The secondary aim was to investigate the potential determinants of balance in patients with COPD. Methods: This comparative study recruited 23 patients with COPD and 23 age- and comorbidity-matched healthy subjects. Participants were assessed regarding demographic and clinical data, "Postural Stability Test" (PST), "Limits of Stability Test" (LOST), "Clinical Test of Sensory Integration of Balance" (CTSIB), pulmonary function, respiratory and peripheral muscle strength, functional capacity, and cognitive function. Results: There were significant differences in all outcome measures assessing balance, pulmonary function, respiratory muscle strength, peripheral muscle strength, and functional capacity, but not cognitive function, in the COPD group compared to the healthy group (p < 0.05). The PST had a significant and strong correlation with maximal inspiratory pressure (MIP) (r = -0.630, p = 0.001) and a significant and moderate correlation with m. quadriceps strength and 6 min walk test (6MWT) distance (r = -0.472, p = 0.023; r = -0.496, p = 0.016; respectively). MIP, m. quadriceps strength, and 6MWT distance were independent predictors to explain the PST with an R2 = 0.336 (p = 0.004). Conclusions: The present study revealed that balance is impaired in adults with COPD, even if compared with age- and comorbidity-matched healthy subjects. Assessing and improving balance and its determinants, inspiratory and peripheral muscle strength, and functional capacity may be important for fall prevention and disease management in patients with COPD.

The association of systemic immune-inflammation index with lung function, risk of COPD and COPD severity: A population-based study

PURPOSE

The relationship between the levels of Systemic Immune-inflammation Index (SII) and chronic obstructive pulmonary disease (COPD), lung function, and COPD severity were not fully understood. We conducted this cross-sectional, population-based study to investigate the complex association between SII and COPD, lung function, and COPD severity among the US adults.

METHODS

Overall, 18,349 participants were included in the National Health and Nutrition Examination Survey (NHANES) between 2005 and 2018. The exposure variable was SII, calculated from platelet counts, neutrophil counts, and lymphocyte counts. Weighted univariable and multivariable logistic regression, subgroup analysis, and restricted cubic spline (RCS) regression were performed to assess the relationship between COPD, lung function, COPD severity and SII. Last, we used a propensity score matching (PSM) analysis to reduce selective bias and validate these relationships.

RESULTS

Approximately 1,094 (5.96%) of the participants were diagnosed as COPD. The multivariable-adjusted odds ratio (OR) (95% confidence interval, CI) for the Q2 group (Log-SII > 2.740) was 1.39 (1.16 to 1.68). Before and after matching, multivariable logistic regression models revealed that increased Log-SII levels (SII Logarithmic transformation) associated positively with the risk of COPD. The subgroup analysis showed no interaction between Log-SII and a variety of variables (P for interaction > 0.05). RCS showed a reversed L-shaped relationship between Log-SII with COPD (P for nonlinear = 0.001) in individuals. In addition, we observed negative significant correlations between forced expiratory volume in one second (FEV1) / forced vital capacity (FVC) %, FEV1/FVC% predicted and SII, and reversed U-shaped curve relationships between FEV1, FEV1% predicted and SII. High SII level is associated with severity of COPD, especially at Global Initiative on Obstructive Lung Disease (GOLD) 1 and GOLD 3.

CONCLUSIONS

In summary, the Log-SII level is associated with COPD risk, lung function, and COPD severity.

Impairment and characteristics of postural control sub-components in people with COPD: a scoping review

PURPOSE

Impairment of postural control is common in people with COPD. However, the precise characteristics of this alteration are not clearly known. The "Systems Framework for Postural Control" which define postural control sub-components, represents an interesting tool to explore this field. The main aim of this review was to identify which postural control sub-components are impaired in people with COPD and to summarise characteristics for each sub-component. A secondary aim was to precise the relation between postural control and activities of daily living (ADL).

MATERIALS AND METHODS

A scoping review was conducted, according to the JBI methodology. Medline, Cochrane Library, Scielo, Google Scholar, OpenGrey, and HAL were searched from inception to May 2022. The search was performed in English and French.

RESULTS

Eighty-nine articles were included. There was evidence of a potential impairment for most of the postural control sub-components. Characteristics of every sub-component alteration were heterogeneous. Reduced postural control could be associated with difficulties in ADL.

CONCLUSIONS

People with COPD may have impairment in a wide range of postural control sub-components. Further research is needed to clarify if a common pattern of modification exits for this alteration and to precise the link with ADL.Implications for rehabilitationImpairment of postural control is a common extra-respiratory manifestation in people with COPD and so clinicians must include it in their clinical reasoning.Numerous postural control sub-components could be altered in people with COPD, suggesting that postural control assessment must be holistic.This scoping review shows that characteristics of postural control impairment are varied and that there may be no common pattern at the COPD population level.The relationship between impaired postural control and activities of daily living remains unclear, but clinicians should be alert to potential negative interactions between these two areas.

Associations Between Cognitive Function, Balance, and Gait Speed in Community-Dwelling Older Adults with COPD

BACKGROUND AND PURPOSE

Older adults with chronic obstructive pulmonary disease (COPD) are at risk for physical and cognitive impairment. Cognitive function is associated with falls in older adults. However, it is unknown whether a relationship exists between cognitive function and falls in patients with COPD. The aim of this study was to examine the relationships between cognitive function, balance, and gait speed in older adults with COPD.

PATIENTS AND METHODS

A secondary analysis was performed using data from the 2010 wave of the Health and Retirement Study (HRS). Cognitive (immediate and delayed recall, executive function) and physical (gait speed, tandem balance time) measure data were extracted for older adults with COPD (n = 382) and an age-matched control group without COPD (n = 382) who met inclusion/exclusion criteria. Multivariate linear regression modeling was performed to examine associations between cognitive function and mobility or balance while controlling for age, gender, body mass index, grip strength, and education.

RESULTS

In older adults with COPD, delayed recall was significantly associated with tandem balance performance (β= 1.42, P < .05). Other cognitive measures were not associated with gait speed or balance.

CONCLUSION

In older adults with COPD, one of four cognitive functions was associated with a static standing balance task. Screening of cognitive function, specifically delayed recall, should be a part of the management of falls in this population.

Clinical assessment of balance and functional impairments in people with stable chronic obstructive pulmonary disease: a systematic review and meta-analysis

The objective of this study was to compare the balance and functional capacity between stable chronic obstructive pulmonary disease (COPD) patients versus healthy controls using clinical tests. A comprehensive search of PubMed/MEDLINE, the Cochrane Central Register of Controlled Trials (CENTRAL), Embase and Web of Science was conducted from inception to 21 January 2022. Studies reporting the association between COPD status and balance or functional capacity using clinical tests were included. Two independent reviewers examined the titles and abstracts, extracted the data using a standardised form, and assessed the risk of bias of the included articles. A total of 27 studies with 2420 individuals with stable COPD were included. Overall, the risk of bias in the included studies was low to moderate. The meta-analysis showed a higher history of falls in individuals with COPD (odds ratio 1.59, 95% CI 1.25-2.02). Furthermore, an overall effect in favour of the healthy controls was observed in the Timed Up and Go (mean difference: 2.61 s, 95% CI 1.79-3.43), Berg Balance Scale (mean difference: -6.57 points, 95% CI -8.31 to -4.83), static balance tests (standardised mean difference: -1.36, 95% CI -2.10 to -0.62) and the 6-min walk test (mean difference: -148.21 m, 95% CI -219.37 to -77.39). In conclusion, individuals with stable COPD have worse balance and functional capacity compared to healthy controls. These results may guide clinicians to elaborate on therapeutic strategies focused on screening of balance and functional impairments. This is in addition to generating rehabilitation guidelines aimed at reducing the risk of falling in people with COPD.

Updated Perspectives on the Role of Biomechanics in COPD: Considerations for the Clinician

Patients with chronic obstructive pulmonary disease (COPD) demonstrate extra-pulmonary functional decline such as an increased prevalence of falls. Biomechanics offers insight into functional decline by examining mechanics of abnormal movement patterns. This review discusses biomechanics of functional outcomes, muscle mechanics, and breathing mechanics in patients with COPD as well as future directions and clinical perspectives. Patients with COPD demonstrate changes in their postural sway during quiet standing compared to controls, and these deficits are exacerbated when sensory information (eg, eyes closed) is manipulated. If standing balance is disrupted with a perturbation, patients with COPD are slower to return to baseline and their muscle activity is differential from controls. When walking, patients with COPD appear to adopt a gait pattern that may increase stability (eg, shorter and wider steps, decreased gait speed) in addition to altered gait variability. Biomechanical muscle mechanics (ie, tension, extensibility, elasticity, and irritability) alterations with COPD are not well documented, with relatively few articles investigating these properties. On the other hand, dyssynchronous motion of the abdomen and rib cage while breathing is well documented in patients with COPD. Newer biomechanical technologies have allowed for estimation of regional, compartmental, lung volumes during activity such as exercise, as well as respiratory muscle activation during breathing. Future directions of biomechanical analyses in COPD are trending toward wearable sensors, big data, and cloud computing. Each of these offers unique opportunities as well as challenges. Advanced analytics of sensor data can offer insight into the health of a system by quantifying complexity or fluctuations in patterns of movement, as healthy systems demonstrate flexibility and are thus adaptable to changing conditions. Biomechanics may offer clinical utility in prediction of 30-day readmissions, identifying disease severity, and patient monitoring. Biomechanics is complementary to other assessments, capturing what patients do, as well as their capability.

Endothelial dysfunction: The possible link between cardiovascular comorbidities and phenomenon of inflammaging from COPD

Aging is a risk factor for many chronic noncommunicable diseases, including chronic obstructive pulmonary disease (COPD), which is often associated with cardiovascular disease (CVD). Moreover, aging is associated with a mild form of systemic inflammation. The aim of our study was to analyze the relationship between age, systemic and vascular inflammation, and the presence of CVD comorbidities in a stable COPD population. Forty COPD patients were divided into 2 age groups (<65 and ≥65 years of age), from which we collected the following inflammatory biomarkers: C-reactive protein, tumor necrosis factor alpha (TNF-α), interleukin-6 (IL-6), and endothelin-1 (ET-1). Elderly COPD patients had more frequent exacerbation events per year (2 vs 1, P = .06), a higher prevalence of CVD (3 vs 2, P = .04), more limited exercise tolerance (6-minute walking test distance, 343 [283-403] vs 434 [384-484]; P = .02), and mild systemic inflammation (TNF-α, 9.02 [7.08-10.96] vs 6.48 [5.21-7.76]; P = .03; ET-1, 2.24 [1.76-2.71] vs 1.67 [1.36-1.98] pg/mL; P = .04). A weak correlation between age and ET-1 (r = 0.32, P = .04) was observed. Mild systemic inflammation, characterized by a slightly increased level of TNF-α, and endothelial dysfunction, marked by elevated ET-1, could be liaisons between aging, COPD, and CVD comorbidities.

Impaired Balance and Gait Characteristics in Patients With Chronic Heart Failure

BACKGROUND AND AIMS

Heart failure affects most systems of the body and causes various problems in patients. Balance deficits and gait deviations can be a result of these effects. There is little information in the literature about balance and gait parameters in chronic heart failure (CHF). This study aimed to investigate balance abnormalities together with gait deficits for possible associations in patients with CHF and compare them to healthy controls.

METHODS

Twenty-two (22) patients with CHF (59±2.5 years) and 22 age- and gender-matched healthy subjects (59.4±6.8 years) participated in the study. This study is a cross-sectional/comparison study. Balance was evaluated using the Activity-Specific Balance Confidence Scale (ABC) and the Mini-Balance Evaluation Systems Test (Mini-BESTest) balance battery, which includes the timed up-and-go test (TUG) and dual-task TUG. Gait analysis was performed using a Biodex Gait Trainer. Peripheral muscle strength (quadriceps muscle and handgrip strength) was assessed using a hand dynamometer and exercise capacity using the six-minute walk test (6MWT).

RESULTS

The CHF patients had significantly lower Mini-BESTest total, reactive postural control, and gait stability scores, significantly longer TUG/dual-task TUG time, and lower ABC score compared to the healthy control group (p<0.05). Chronic heart failure patients also showed significantly lower gait speed, stride length, gait cycle and step length (p<0.05). Dominant-side quadriceps muscle and handgrip strength and 6MWT distance were significantly reduced in CHF (p<0.05). Anticipatory postural adjustments and sensory orientation did not differ between groups.

CONCLUSIONS

Our study demonstrated impaired balance and gait performance and reduced muscle strength and exercise capacity in patients with CHF. Cardiac rehabilitation including balance and walking training should be planned for CHF patients to eliminate balance disorders, gait impairment and prevent falls in this patient group.

Clinical Effects of Rehabilitation on Balance in People With Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis

Background

Patients with chronic obstructive pulmonary disease (COPD) have systemic damage secondary to the primary pulmonary impairment, expressed in impaired peripheral musculature and a deficit in postural control compared to healthy subjects. This study aimed to determine the effects of rehabilitation on balance in patients with COPD.

Methods

An exhaustive search was conducted in four databases (Pubmed, Cochrane Library, EMBASE, Web of Science). Articles with a population of COPD receiving rehabilitation (therapeutic exercise, pulmonary rehabilitation, or physical therapy modalities) in an outpatient setting were included. Two independent reviewers selected and assessed the study quality. The risk of bias was assessed with the Cochrane Risk of Bias Tool for Randomized Controlled Trials.

Results

A total of eight studies involving 284 patients were included in the qualitative synthesis. The meta-analysis showed an overall result in favor of balance training for the Berg Balance Scale (mean difference 3.91 points; 95% CI: 1.51 to 6.31; P = 0.001), Timed Up and Go test (mean difference -1.58 s; 95% CI: -2.63 to -0.53; P = 0.003) and Unipedal stance test (mean difference 3.56 s, 95% CI: 2.58 to 4.54; P).

Conclusion

This meta-analysis revealed that rehabilitation improve static and dynamic balance in patients with COPD.

Systematic Review Registration

PROSPERO ID: CRD42020218367.

Balance impairment and cognitive dysfunction in patients with chronic obstructive pulmonary disease under 65 years

Objective

Balance and cognitive problems may develop in COPD. Studies investigating cognitive functions are mostly in elderly patients, and the number of studies on balance impairment is less than studies about cognitive dysfunction in COPD. We aimed to evaluate both balance and cognitive functions in patients with COPD under 65 years.

Methods

A total of 60 COPD patients and 60 healthy control group were enrolled. The patients with COPD were divided into two groups due to dyspnea severity. Demographic data and dyspnea scores of all patients were recorded. BECK depression scale, standardized Mini Mental Test (MMT), and BERG balance scale were applied to the individuals. Factors affecting BERG balance scale were evaluated.

Results

BERG balance scale and MMT values were found to be significantly lower in patients with COPD compared with the control group (p = 0.009). It was observed that the mean values of BERG balance scale and MMT were significantly low in the severe dyspnea group. BERG scale had significant correlations with MMT (rho = 0.331, p = 0.001), BECK (rho = −0.222, p = 0.016), age (rho = −0.318, p = 0.018), MMRC (rho = −0.368, p < 0.001), CAT (rho = −0.338, p = 0.008), FEV1% (rho = 0.307, p = 0.017), SpO₂ (rho = 0.448, p < 0.001), and number of hospitalization per year (rho = −0.316, p = 0.014). According to the results of multiple linear regression analysis, the effect of oxygen saturation on BERG was found to be statistically significant (B = 0.512, p = 0.008).

Conclusions

Balance tests in patients with COPD under the age of 65 are significantly low when compared with healthy controls at the same age. Balance and cognitive functions are significantly associated with each other. It may be beneficial to perform balance and cognitive function tests earlier even at the beginning of the treatment period of COPD, and strategies should be planned to prevent the progression of functional losses.

A pilot study on the feasibility and effectiveness of treadmill-based perturbations for assessing and improving walking stability in chronic obstructive pulmonary disease

BACKGROUND

Falls risk is elevated in chronic obstructive pulmonary disease (COPD). However, there is a lack of evidence regarding the contributing factors. Here, we examined the feasibility of, and initial responses to, large walking perturbations in COPD, as well as the adaptation potential of people with COPD to repeated walking perturbations that might indicate potential for perturbation-based balance training in COPD.

METHODS

12 participants with COPD undergoing inpatient pulmonary rehabilitation and 12 age-gender-matched healthy control participants walked on an instrumented treadmill and experienced repeated treadmill-belt acceleration perturbations (leading to a forward balance loss). Three-dimensional motion capture was used to quantify the stability of participants body position during perturbed walking. Feasibility, stability following the initial perturbations and adaptation to repeated perturbations were assessed.

FINDINGS

Using perturbations in this manner was feasible in this population (no harness assists and participants completed the minimum number of perturbations). No clear, specific deficit in reactive walking stability in COPD was found (no significant effects of participant group on stability or recovery step outcomes). There were mixed results for the adaptability outcomes which overall indicated some adaptability to repeated perturbations, but not to the same extent as the healthy control participants.

INTERPRETATION

Treadmill-based perturbations during walking are feasible in COPD. COPD does not appear to result in significant deficits in stability following sudden perturbations and patients do demonstrate some adaptability to repeated perturbations. Perturbation-based balance training may be considered for fall prevention in research and practice in people with COPD.

Inflammatory and oxidative biomarkers as determinants of functional capacity in patients with COPD assessed by 6-min walk test-derived outcomes

INTRODUCTION

Reduction in functional capacity is a negative clinical outcome of chronic obstructive pulmonary disease (COPD). Studies have shown association between inflammatory and oxidative stress biomarkers and functional capacity. However, it is unclear whether these biomarkers are associated with outcomes of functional capacity. Therefore, the aim of this study was to evaluate whether plasma biomarkers of inflammation and oxidative stress are predictors of the 6-min walking test (6MWT)-derived outcomes.

METHODS

Twenty COPD patients were assessed on three consecutive days with different clinical measures, including functional capacity, and blood sampling. Plasma concentrations of IL-6, IL-8, TNF-ɑ, IL-10 and soluble TNF-ɑ receptors (sTNFR1 and sTNFR2) were determined by immunoassays. Oxidative stress was evaluated by determining lipid peroxidation products based on the enzymatic activity of superoxide dismutase (SOD) and catalase, and total antioxidant capacity of plasma. Functional capacity was assessed considering the six-minute walking distance (6MWD) and the estimate of six-minute walking work (6MWW). The association between biomarkers (i.e. inflammation and oxidative stress) and functional exercise capacity was investigated through the Pearson's correlation coefficient. To identify the determinants of the 6MWT, multiple linear stepwise regression analyses were performed with adjustment for age, sex and GOLD classification.

RESULTS

Patients were predominantly male (65%), with mean age of 64 years and moderate airflow obstruction and impaired functional capacity. There were positive correlations between SOD activity and 6MWD (r = 0.520; p = 0.02) and 6MWW (r = 0.554; p = 0.01), as well as a negative correlation between sTNF-R1 and 6MWD (r = -0.437; p = 0.05). SOD was an independent determinant of the functional capacity, explaining 23% of the variability of 6MWD (p = 0.019) and 27% of the variability of 6MWW (p = 0.011). sTNF-R1 levels were associated with 6MWD and, together with SOD explained 40% of variability in 6MWD (p = 0.005).

CONCLUSION

SOD activity was an independent determinant of performance in the 6MWT, and together with sTNFR1 explained 40% of the variations in walking distance in COPD patients. SOD activity and sTNFR1 levels might be seen as potential biomarkers of the functional capacity in patients with COPD.

The relationship between height of vertical jumps, functionality and fall episodes in patients with chronic obstructive pulmonary disease: A case-control study

This study aimed to compare the height of jumps and functional parameters in patients with chronic obstructive pulmonary disease (COPD) to those in healthy people, in addition to assessing the relationship among variables in patients with COPD. Twenty patients with COPD (forced expiratory volume [FEV1] % of predicted: 39.98 ± 11.69%; age: 62.95 ± 8.06 years) and 16 healthy people (FEV1% of predicted: 97.44 ± 14.45%; age: 59.94 ± 6.43 years) were evaluated, and all participants performed the Squat Jump (SJ) and Counter Movement Jump (CMJ) tests to assess rapid force considering the jumping height. Functional capacity was assessed using the self-selected walking speed tests, walking speed in 10 m, walking test in 6 min, balance on one leg, sitting and standing, timed up and go, and a stair-climbing test. In addition, the questionnaires on recall of falls, Falls Efficacy Scale-International (concern with falling), International Physical Activity Questionnaires, and Saint George Respiratory Questionnaire were administered. The height of the jumps showed no difference between the groups, but the COPD group performed worse in most functional tests and was more afraid of falling. The number of falls was correlated with height in the SJ (r = -0.51) and CMJ (r = -0.62) jumps (p < 0.05), and with the performance in different functional tests. We suggest that interventions targeting rapid force may bring improvements in functional mobility and physical fitness as well as reducing fall episodes in patients with COPD.

Effects of coenzyme Q10 supplementation on inflammation, angiogenesis, and oxidative stress in breast cancer patients: a systematic review and meta-analysis of randomized controlled- trials

BACKGROUND/OBJECTIVE

Systemic inflammation and oxidative stress (OS) are associated with breast cancer. CoQ10 as an adjuvant treatment with conventional anti-cancer chemotherapy has been demonstrated to help in the inflammatory process and OS. This systematic review and meta-analysis of randomized clinical trials (RCTs) aimed to evaluate the efficacy of CoQ10 supplementation on levels of inflammatory markers, OS parameters, and matrix metalloproteinases/tissue inhibitor of metalloproteinases (MMPs/TIMPs) in patients with breast cancer.

METHODS

A systematic literature search was carried out using electronic databases, including PubMed, Web of Science, Scopus, Google Scholar, and Embase, up to December 2020 to identify eligible RCTs evaluating the effect of CoQ10 supplementation on OS biomarkers, inflammatory cytokines, and MMPs/TIMPs. From 827 potential reports, 5 eligible studies consisting of 9 trials were finally included in the current meta-analysis. Quality assessment and heterogeneity tests of the selected trials were performed using the PRISMA checklist protocol and the I² statistic, respectively. Fixed and random-effects models were assessed based on the heterogeneity tests, and pooled data were determined as the standardized mean difference (SMD) with a 95% confidence interval (CI).

RESULTS

Our meta-analysis of the pooled findings for inflammatory biomarkers of OS and MMPs showed that CoQ10 supplementation (100 mg/day for 45-90 days) significantly decreased the levels of VEGF [SMD: - 1.88, 95% CI: (- 2. 62 to - 1.13); I² = 93.1%, p < 0.001], IL-8 [SMD: - 2.24, 95% CI: (- 2.68 to - 1.8); I² = 79.6%, p = 0.001], MMP-2 [SMD: - 1.49, 95% CI: (- 1.85 to - 1.14); I² = 76.3%, p = 0.005] and MMP-9 [SMD: - 1.58, 95% CI: (- 1.97 to - 1.19); I² = 79.6%, p = 0.002], but no significant difference was observed between CoQ10 supplementation and control group on TNF-α [SMD: - 2.30, 95% CI: (- 2.50 to - 2.11); I² = 21.8%, p = 0.280], IL-6 [SMD: - 1.56, 95% CI: (- 1.73 to - 1.39); I² = 0.0%, p = 0.683], IL-1β [SMD: - 3.34, 95% CI: (- 3.58 to - 3.11); I² = 0.0%, p = 0.561], catalase (CAT) [SMD: 1.40, 95% CI: (1.15 to 1.65); I² = 0.0%, p = 0.598], superoxide dismutase (SOD) [SMD: 2.42, 95% CI: (2.12 to 2.71); I² = 0.0%, p = 0.986], glutathione peroxidase (GPx) [SMD: 2.80, 95% CI: (2.49 to 3.11); I² = 0.0%, p = 0.543]], glutathione (GSH) [SMD: 4.71, 95% CI: (4.26 to 5.16); I² = 6.1%, p = 0.302] and thiobarbituric acid reactive substances (TBARS) [SMD: - 3.20, 95% CI: (- 3.53 to - 2.86); I² = 29.7%, p = 0.233].

CONCLUSION

Overall, the findings showed that CoQ10 supplementation reduced some of the important markers of inflammation and MMPs in patients with breast cancer. However, further studies with controlled trials for other types of cancer are needed to better understand and confirm the effect of CoQ10 on tumor therapy.

Fibrinogen is a promising biomarker for chronic obstructive pulmonary disease: evidence from a meta-analysis

Backgrounds: Some studies have reported association of circulating fibrinogen with the risk of chronic obstructive pulmonary disease (COPD), and the results are conflicting. To yield more information, we aimed to test the hypothesis that circulating fibrinogen is a promising biomarker for COPD by a meta-analysis.

Methods: Data extraction and quality assessment were independently completed by two authors. Effect-size estimates are expressed as weighted mean difference (WMD) with 95% confidence interval (95% CI).

Results: Forty-five articles involving 5586/18604 COPD patients/controls were incorporated. Overall analyses revealed significantly higher concentrations of circulating fibrinogen in COPD patients than in controls (WMD: 84.67 mg/dl; 95% CI: 64.24–105.10). Subgroup analyses by COPD course showed that the degree of increased circulating fibrinogen in patients with acute exacerbations of COPD (AECOPD) relative to controls (WMD: 182.59 mg/dl; 95% CI: 115.93–249.25) tripled when compared in patients with stable COPD (WMD: 56.12 mg/dl; 95% CI: 34.56–77.67). By COPD severity, there was a graded increase in fibrinogen with the increased severity of COPD relative to controls (Global Initiative for Obstructive Lung Disease (GOLD) I, II, III, and IV: WMD: 13.91, 29.19, 56.81, and 197.42 mg/dl; 95% CI: 7.70–20.11, 17.43–40.94, 39.20–74.41, and −7.88 to 402.73, respectively). There was a low probability of publication bias.

Conclusion: Our findings indicate a graded, concentration-dependent, significant relation between higher circulating fibrinogen and more severity of COPD.

The Investigation of Falls and Balance from the Perspective of Activities of Daily Living in Patients with COPD

The aim of this study was (1) to compare the activities of daily living (ADLs), perceived falling risk and balance in chronic obstructive pulmonary disease (COPD) patients with or without falling history and (2) to investigate the relationship between ADLs and balance. Fourteen patients with COPD with a history of falling whose mean falling frequency was 2.64 ± 0.74 times in the last 12-months (fallers) and 14 age and sex-matched patients with COPD with no history of falling (non-fallers) were included. The outcome measures were the London Chest Activity of Daily Living (LCADL) scale, Activities-Specific Balance Confidence (ABC) scale, Berg Balance Scale (BBS), 6-minute walking test, and quadriceps-femoris strength. Fallers reported increased dyspnoea perception in ADLs, decreased balance confidence, and disturbed balance compared with non-fallers (p < 0.05). A strong correlation was found between the LCADL scale item score (dressing the upper body) and the BBS total score (rho = -0.81, p = 0.001) in fallers. The LCADL scale item score (going out socially) was significantly correlated with the total score of the ABC scale (rho = -0.61, p = 0.001). Moderate correlations were found between the LCADL scale item scores (dressing the upper body, washing hair, and walking up stairs) and the BBS total score (p < 0.003). This study demonstrated that increased severity of dyspnoea perception during ADLs is associated with impaired balance and poor balance confidence, regardless of functional capacity and peripheral muscle strength in patients with COPD. The balance confidence was low in functional mobility-based activities in patients with COPD with a history of falling.

Evaluation of balance in patients with chronic obstructive pulmonary disease with practical tests

INTRODUCTION

Patients with chronic obstructive pulmonary disease (COPD) have impaired balance and hence fall more frequently. Easy application of balance evaluation tests can prevent the loss of time in the outpatient clinic for patients with COPD. In this study, we aimed to compare the efficacy of Berg Balance Scale (BBS), a time-consuming but a widely used test, with other easy-to-perform tests such as the Single Leg Stance (SLS), Five Repetition Sit to Stand (5STS), Four Step Square (FSST), and Timed Up and Go (TUG) tests.

METHODS

A total of 71 patients with COPD and 70 control subjects with matching demographic characteristics were included in the study. All patients undertook pulmonary function tests and their scores of 6-min walk-test (6MWT), modified Medical Research Council (mMRC) dyspnoea scale, COPD assessment questionnaire (CAT) and body mass index (B) were recorded. In addition, the severity of airway obstruction (O), the dyspnoea severity (D) and exercise capacity (E) (BODE) index scores were measured. All patients with COPD were classified into four groups, A to D, based on the GOLD 2017 criteria. All subjects undertook the BBS, SLS, 5STS, FSST and TUG tests.

RESULTS

Balance tests revealed increased balance impairment in patients with COPD in comparison with the control subjects (P < .05). The BBS, SLS, FSST and TUG examinations suggested that balance impairment was frequent in Groups C and D patients with COPD (P < .05). FSST and TUG had the highest correlation with BBS (r = -.812 and -.842 and P < .001 and <.001, respectively). The results of FSST and TUG were the closest to those of BBS test.

CONCLUSIONS

FSST and TUG tests can be applied for the assessment of bodily balance status among patients with COPD in outpatient clinics.

Falls prevalence and risk factors in people with chronic obstructive pulmonary disease: A systematic review

BACKGROUND

Falls are frequent in people with chronic obstructive pulmonary disease (COPD) and related to increased morbidity, mortality, and health care costs in older adults. This systematic review aims to synthesise the falls outcomes and to examine risk factors for falls in the COPD literature.

METHODS

The protocol was registered in the Prospective Register of Systematic Reviews (PROSPERO: CRD42015017257). Searches were updated and operated in five electronic databases in December 2019 for studies reporting falls outcomes and risk factors in people with COPD. Meta-analyses were conducted on the prevalence of fallers and frequent fallers. Quality assessment appraised the risk of bias of included articles.

RESULTS

Twenty-three studies met the eligibility criteria and were retained after the full-text review. In the meta-analyses, the pooled prevalence of COPD fallers was 30% (95%CI 19%-42%), and the pooled prevalence of frequent fallers (≥2 falls in the analysed period of occurrence) was 24% (95%CI 2%-56%). The falls incidence rate in stable COPD varied from 1.17 to 1.49 falls/person-year. Different study methodologies were identified. Age, female gender, falls history, the number of medications, comorbidities, coronary heart disease, use of supplemental oxygen, impaired balance performance and smoking history were risk factors for falls identified in stable COPD.

CONCLUSION

Prevalence of fallers, frequent fallers, and falls incidence rate have been reported in the COPD literature using a varying methodology. People with stable COPD present with ageing and disease-related risk factors for falls. Further research using the recommended prospective recording is needed in COPD.

Coenzyme Q10: Novel Formulations and Medical Trends

The aim of this review is to shed light over the most recent advances in Coenzyme Q10 (CoQ10) applications as well as to provide detailed information about the functions of this versatile molecule, which have proven to be of great interest in the medical field. Traditionally, CoQ10 clinical use was based on its antioxidant properties; however, a wide range of highly interesting alternative functions have recently been discovered. In this line, CoQ10 has shown pain-alleviating properties in fibromyalgia patients, a membrane-stabilizing function, immune system enhancing ability, or a fundamental role for insulin sensitivity, apart from potentially beneficial properties for familial hypercholesterolemia patients. In brief, it shows a remarkable amount of functions in addition to those yet to be discovered. Despite its multiple therapeutic applications, CoQ10 is not commonly prescribed as a drug because of its low oral bioavailability, which compromises its efficacy. Hence, several formulations have been developed to face such inconvenience. These were initially designed as lipid nanoparticles for CoQ10 encapsulation and distribution through biological membranes and eventually evolved towards chemical modifications of the molecule to decrease its hydrophobicity. Some of the most promising formulations will also be discussed in this review.

Effects of garlic supplementation on serum inflammatory markers: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND AND AIMS

Previous studies have indicated that garlic consumption may be beneficial in improving inflammation. This systematic review and meta-analysis aimed to examine the effect of garlic supplementation on inflammatory biomarkers.

METHODS

PubMed/Medline, Scopus and ISI web of science were searched up to February 2019. Random effects model was used to calculate the overall effects on C-reactive protein (CRP), Interleukin-6 (IL-6), and Tumor necrosis factor- α (TNF-α).

RESULTS

17 randomized controlled trials (RCTs) were included in the meta-analyses. Garlic supplementation significantly reduced the level of circulating CRP (P < 0.05), whereas it did not have any significant effect on IL-6 level (p > 0.05). Sub-group analysis showed that aged garlic extract (AGE) was able to reduce CRP and TNF-α significantly (P < 0.05).

CONCLUSIONS

This meta-analysis showed that supplementation with garlic could reduce the level of circulating CRP and AGE could reduce the level of TNF-α and CRP, whereas it had no significant effect on the IL-6 level.

Balance assessment in people with COPD: An evidence-based guide

Balance problems and an increased rate and risk of falls are common in people with chronic obstructive pulmonary disease (COPD). Although a balance assessment is now recommended by clinical practice guidelines for pulmonary rehabilitation, specific tests have yet to be suggested. The purpose of this review is to provide an evidence-based synthesis of balance measurement in older adults and in people with COPD, to guide practice in this area. An overview of best practices for assessing balance and fall risk in older adults is provided along with a practical synthesis of evidence to date on common balance measures used in people with COPD such as the Timed Up and Go, Single Leg Stance, Berg Balance, and Mini and Full Balance Evaluation Systems Tests. Finally, two clinical scenarios are described to illustrate the process of evidence-based clinical decision-making with respect to balance assessment in people with COPD. Ultimately, the selection of balance test and its interpretation will depend on the purpose of the assessment, available data on psychometric properties, the patient’s individual characteristics, and the resources available to the clinician.

Exercise Training in Patients With Non-Small Cell Lung Cancer During In-Hospital Chemotherapy Treatment: A RANDOMIZED CONTROLLED TRIAL

This study aimed to assess the impact of exercise training in patients with lung cancer on several outcomes compared to a control group. Results suggest that exercise programs in patients with lung cancer are a practical and beneficial intervention for enhancing mobility and physical fitness.

Purpose:

The aim of this study was to perform a randomized trial to assess the impact of exercise training in patients with non–small cell lung cancer during chemotherapy on several outcomes in comparison to a control group (CG).

Methods:

The exercise training group (ETG) consisted of 20 patients and the CG consisted of 10 patients. In the ETG, a 4-wk in-hospital exercise training program was performed in 2-wk cycles interspersed with consecutive rounds of chemotherapy with cytostatic drugs. The exercise training program was individualized and included warm-up, respiratory muscle exercise, training on a cycle ergometer or treadmill, and Nordic walking. CG participants were assessed before and after 6 wk of chemotherapy alone.

Results:

Comparing pre- and post-intervention values, the ETG demonstrated an increase in 6-min walk distance (486 ± 92 vs 531 ± 103 m, P = .01). In a battery of physical performance tests: Up and Go Test (6.3 ± 1.0 vs 6.0 ± 1.1 sec, P = .01); chair stand (13.3 ± 2.8 vs 14.3 ± 3.4 repetitions, P = .001); and arm curl (18.4 ± 3.1 vs 20.4 ± 3.5 repetitions, P = .001) all improved significantly. Spirometry values also improved: FEV₁ % predicted (76 ± 16 vs 84 ± 15, P = .01), FVC % predicted (87 ± 14 vs 95 ± 13, P = .01), and FEV₁/FVC (73 ± 13% vs 76 ± 12%, P = .04). The exercise training was well tolerated, without any adverse events due to exercise. There were no significant improvements in the CG.

Conclusions:

This study suggests that planned, individualized, and supervised exercise programs in patients with advanced lung cancer during chemotherapy are a practical and beneficial intervention for enhancing mobility and physical fitness.

Balance impairment in individuals with COPD: a systematic review with meta-analysis

BACKGROUND

People with chronic obstructive pulmonary disease (COPD) are four times more likely to fall than healthy peers, leading to increased morbidity and mortality. Poor balance is a major risk factor for falls. This review aims to quantify the extent of balance impairment in COPD, and establish contributing clinical factors, which at present are sparse.

METHODS

Five electronic databases were searched, in July 2017 and updated searches were performed in March 2019, for studies comparing balance in COPD with healthy controls. Meta-analyses were conducted on sample mean differences (MD) and reported correlations between balance and clinical factors. Meta-regression was used to quantify the association between mean difference in percentage predicted forced expiratory volume in 1 s (FEV₁) and mean balance impairment. Narrative summaries were provided where data were insufficient for meta-analysis.

RESULTS

Twenty-three studies were included (n=2751). Meta-analysis indicated COPD patients performed worse than healthy controls on timed up and go (MD=2.77 s, 95% CI 1.46 s to 4.089 s, p=<0.005), single leg stance (MD=-11.75 s, 95% CI -15.12 s to -8.38 s, p=<0.005) and berg balance scale (MD=-6.66, 95% CI -8.95 to -4.37, p=<0.005). The pooled correlation coefficient between balance and reduced quadriceps strength was weak-moderate (r=0.37, 95% CI 0.23 to 0.45, p=<0.005). The relationship between differences in percentage predicted FEV₁ and balance were negligible (r² =<0.04).

CONCLUSIONS

Compared with healthy controls, people with COPD have a clinically meaningful balance reduction, which may be related to reduced muscle strength, physical activity and exercise capacity. Our findings support a need to expand the focus of pulmonary rehabilitation to include balance assessment and training, and further exploration of balance impairment in COPD. PROSPERO registration number CRD4201769041.

Balance Impairment and Effectiveness of Exercise Intervention in Chronic Obstructive Pulmonary Disease-A Systematic Review

OBJECTIVE

To systematically review the evidence for balance impairment and effectiveness of interventions on balance in people with chronic obstructive pulmonary disease (COPD).

DATA SOURCES

Four electronic databases (Scopus, CINAHL, PubMed, Cochrane Library databases) were searched from inception until June 30, 2019.

STUDY SELECTION

Two reviewers independently searched with keywords focusing on COPD, postural control, and exercise. Cross-sectional studies related to balance and randomized controlled trials (RCTs) related to the effectiveness of exercise intervention on balance outcomes were included.

DATA EXTRACTION

Two reviewers independently extracted data of balance impairment on participants, exercise training on balance outcome measures. Methodological quality of cross-sectional studies was assessed using the National Institutes of Health (NIH) Quality Assessment Tool. Methodological quality of RCTs was assessed using the Physiotherapy Evidence Database (PEDro) scale and bias was analyzed using the Cochrane risk of bias.

DATA SYNTHESIS

A narrative review with descriptive synthesis was used. Fifteen cross-sectional studies and 4 RCTs met the final inclusion criteria. The quality of 10 cross-sectional studies were rated as moderate to high (NIH score≥7). Most studies demonstrated impaired balance in people with COPD than in people without COPD. The quality of all included RCTs was good to excellent (PEDro score=6-9). One RCT had a low risk of bias. Generally, pulmonary rehabilitation program combined with balance training, Tai Chi, and cycling exercise showed significant improvement in balance in people with COPD.

CONCLUSIONS

Impaired balance is evident in people with COPD. Available RCTs suggest that exercise interventions may improve balance performance in COPD patients. However, more research on the effect of exercise interventions on balance in COPD patients is still required.

Risk Factors for Postural and Functional Balance Impairment in Patients with Chronic Obstructive Pulmonary Disease

Reduced balance function has been observed during balance challenging conditions in the chronic obstructive pulmonary disease (COPD) population and is associated with an increased risk of falls. This study aimed to examine postural balance during quiet standing with eyes open and functional balance in a heterogeneous group of COPD and non-COPD (control) subjects, and to identify risk factors underlying balance impairment using a large panel of methods. In COPD and control subjects, who were mostly overweight and sedentary, postural and functional balance were assessed using center-of-pressure displacement in anterior-posterior (AP) and medio-lateral (ML) directions, and the Berg Balance Scale (BBS), respectively. COPD showed 23% greater AP sway velocity (p = 0.049). The presence of oxygen therapy, fat mass, reduced neurocognitive function, and the presence of (pre)diabetes explained 71% of the variation in postural balance in COPD. Transcutaneous oxygen saturation, a history of exacerbation, and gait speed explained 83% of the variation in functional balance in COPD. Neurocognitive dysfunction was the main risk factor for postural balance impairment in the control group. This suggests that specific phenotypes of COPD patients can be identified based on their type of balance impairment.

Neuromuscular electrostimulation as an adjuvant therapy to pulmonary rehabilitation programs in chronic obstructive pulmonary disease

Introduction. Chronic obstructive pulmonary disease (COPD) is commonly associated with a vicious circle of sedentary lifestyle - deconditioning - muscular dysfunction. High-frequency neuromuscular electrostimulation has demonstrated beneficial effects among subjects with muscle weakness. This study aimed to evaluate the benefits of merging pulmonary rehabilitation program (PRP) with neuromuscular electrostimulation in patients with very severe COPD. Material and methods. The study included 38 males with clinically stable COPD, who were divided in 2 groups: group A-19 patients that underwent a PRP of 5 sessions/week for 4 weeks and group B-19 patients that underwent intercostal and lower extremity muscle electrostimulation (5 sessions/week for 4 weeks, 60 min /session) in association with the same type of PRP. Saint Georges’s Respiratory Questionnaire (SGRQ), Modified Medical Research Council (mMRC) dyspnea scale, spirometry, maximal inspiratory pressure (PImax) and maximal expiratory pressure (PEmax), six minutes walking test (6MWT) and bio-electrical impedance were examined before and after the intervention. Results. Electrostimulation applied in group B increased muscle mass (50.15 ± 0.61kg vs 53.97 ± 0.87kg, p<0.001)., PEmax (5.41 ± 0.25 vs post 6.79 ± 0.22, p<0.0003) and improved mMRC score (2.68 ± 0.15 vs 2.10 ± 0.15, p<0.0109), 6MWT (369.6 ± 10.77m vs post: 445.6 ± 6.03 m) and SGRQ (61.32 ± 1.83 vs. 44.95 ± 1.94, p<0.0001). In group B only SGRQ score (55.05 ± 1.32 vs. 50.05 ± 1.51, p=0.018) was improved after PRP. Conclusion. A protocol which combines PRP with neuromuscular electrical stimulation in patients with very severe forms of COPD, has grater beneficial effect on dyspnoea, exercise tolerance, muscle mass toning and quality of life, compared with PRP alone.

Exercise Training Modalities for People with Chronic Obstructive Pulmonary Disease

Exercise training confers health benefits for people with chronic obstructive pulmonary disease (COPD). This article reviews the evidence for several exercise training modalities shown to be beneficial among individuals with COPD. These modalities include aerobic, resistance, nonlinear periodized, upper limb and balance training, as well as yoga, Tai Chi, inspiratory muscle training, whole body vibration training and neuromuscular electrical stimulation. The literature pertaining to each modality was critically reviewed, and information on the rationale, mechanism(s) of action (where known), benefits, and exercise prescription is described to facilitate easy implementation into clinical practice.

New evaluation of trunk movement and balance during walking in COPD patients by a triaxial accelerometer

Background

Individuals with COPD may experience ambulatory difficulty due to both effort intolerance arising from respiratory dysfunction and impaired balance control during walking. However, the trunk movement during walking has not been evaluated or adjusted for patients with COPD. The Lissajous index (LI) visually and numerically evaluates the left–right symmetry of the trunk movement during walking and is useful in clinical practice. In COPD patients, the LI is used as an indicator of the left–right symmetry of the trunk during walking. Here, we used the LI to evaluate the symmetry of COPD patients based on bilateral differences in mediolateral and vertical accelerations, and we investigated the correlation between the patients’ symmetry evaluation results and their physical function.

Patients and methods

Sixteen stable COPD patients (all males; age 71.3±9.2 years) and 26 healthy control subjects (15 males; age 68.2±6.9 years) participated in this study. They performed the 10-minute walk test at a comfortable gait speed wearing a triaxial accelerometer, and we measured their trunk acceleration for the evaluation of symmetry. Motor functions were also evaluated in the patients with COPD.

Results

The average mediolateral bilateral difference and LI values of the COPD patients were significantly larger than those of the healthy subjects. The COPD patients’ LI values were significantly correlated with their static balance.

Conclusion

The LI measured using a triaxial accelerometer during walking is useful in balance assessments of patients with COPD.

Aging and extrapulmonary effects of chronic obstructive pulmonary disease

INTRODUCTION

People with COPD have a decline in functional status, but little is known about the rate of decline and factors that contribute. Of particular concern is the decline in cognitive and functional performance. Decrease in cognitive and functional performance will finally lead to decreased health status, sedentary life style and premature frailty.

AIM

The aim of this study is to compare functional performance and cognitive status in patients with COPD of different ages and to examine the changes in extrapulmonary effects.

PATIENTS AND METHODS

This study included 62 patients with COPD risk class D who were divided into two groups (<70 years, N=30 and >70 years, N=32). Patients first completed the Montreal Cognitive Assessment (MoCA), which is a 30-point test that assesses different cognitive domains, while isometric knee extension (IKE) was measured using a digital handheld dynamometer, and functional exercise level was assessed using the 6-minute walking distance (6MWD) test.

RESULTS

The patients' older age (age higher than 70 years) was associated with a significantly lower body mass index (BMI, 27.50 vs 24.24 kg/m²; P=0.020), higher vital capacity parameters, forced vital capacity (FVC, 2.74 vs 2.82 L; P=0.799), FVC (%) (73.00 vs 66.50, P=132), forced expiratory volume in the first second (FEV₁, 0.93 vs 1.13 L; P=0.001) and FEV₁ (%) (28.50 vs 30.50, P=0.605). In addition, patients at older age presented a significantly reduced physical activity capacity, 6MWD (385.93 vs 320.84 m, P<0.001) and IKE (24.75 vs 22.55 kgf, P=0.005), as well as higher values for inflammatory biomarkers, C-reactive protein (8.77 vs 3.34 mg/L, P=0.022). Moreover, patients at older age presented significantly lower score at the cognitive assessment, MoCA (23.50 vs 20.00, P<0.001).

CONCLUSION

Elderly COPD patients have reduced exercise capacity and muscle strength, deteriorated cognitive function and increased inflammatory markers. Furthermore, inflammation markers were significantly correlated with muscle strength, walking distance and cognitive impairment.

Impaired calcium signaling in muscle fibers from intercostal and foot skeletal muscle in a cigarette smoke-induced mouse model of COPD

INTRODUCTION

Respiratory and locomotor skeletal muscle dysfunction are common findings in chronic obstructive pulmonary disease (COPD); however, the mechanisms that cause muscle impairment in COPD are unclear. Because Ca2+ signaling in excitation-contraction (E-C) coupling is important for muscle activity, we hypothesized that Ca2+ dysregulation could contribute to muscle dysfunction in COPD.

METHODS

Intercostal and flexor digitorum brevis muscles from control and cigarette smoke-exposed mice were investigated. We used single cell Ca2+ imaging and Western blot assays to assess Ca2+ signals and E-C coupling proteins.

RESULTS

We found impaired Ca2+ signals in muscle fibers from both muscle types, without significant changes in releasable Ca2+ or in the expression levels of E-C coupling proteins.

CONCLUSIONS

Ca2+ dysregulation may contribute or accompany respiratory and locomotor muscle dysfunction in COPD. These findings are of significance to the understanding of the pathophysiological course of COPD in respiratory and locomotor muscles. Muscle Nerve 56: 282-291, 2017.

Effects of coenzyme Q10 supplementation on inflammatory markers: A systematic review and meta-analysis of randomized controlled trials

The aims of this meta-analysis were to evaluate the effects of coenzyme Q10 (CoQ10) supplementation on inflammatory mediators including C-reactive protein (CRP), interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) by analyzing published randomized controlled trials (RCTs). A systematic search in PubMed, Cochrane Library and Clinicaltrials.gov was performed to identify eligible RCTs. Data synthesis was performed using a random- or a fixed-effects model depending on the results of heterogeneity tests, and pooled data were displayed as weighed mean difference (WMD) and 95% confidence interval (CI). Seventeen RCTs were selected for the meta-analysis. CoQ10 supplementation significantly reduced the levels of circulating CRP (WMD: -0.35mg/L, 95% CI: -0.64 to -0.05, P=0.022), IL-6 (WMD: -1.61pg/mL, 95% CI: -2.64 to -0.58, P=0.002) and TNF-α (WMD: -0.49pg/mL, 95% CI: -0.93 to -0.06, P=0.027). The results of meta-regression showed that the changes of CRP were independent of baseline CRP, treatment duration, dosage, and patients characteristics. In the meta-regression analyses, a higher baseline IL-6 level was significantly associated with greater effects of CoQ10 on IL-6 levels (P for interaction=0.006). In conclusion, this meta-analysis of RCTs suggests significant lowering effects of CoQ10 on CRP, IL-6 and TNF-α. However, results should be interpreted with caution because of the evidence of heterogeneity and limited number of studies.

Chronic obstructive pulmonary disease phenotypes and balance impairment

BACKGROUND/OBJECTIVE

Chronic obstructive pulmonary disease (COPD) is a respiratory disease that results in airflow limitation and respiratory distress, also having many nonrespiratory manifestations that affect both function and mobility. Preliminary evidence suggests that balance deficits constitute an important secondary impairment in individuals with COPD. Our objective was to investigate balance performance in two groups of COPD patients with different body compositions and to observe which of these groups are more likely to experience falls in the future.

METHODS

We included 27 stable COPD patients and 17 healthy individuals who performed a series of balance tests. The COPD patients were divided in two groups: emphysematous and bronchitic. Patients completed the activities balance confidence scale and the COPD assessment test questionnaire and afterward performed the Berg Balance Scale, timed up and go, single leg stance and 6-minute walking distance test. We analyzed the differences in the balance tests between the studied groups.

RESULTS

Bronchitic COPD was associated with a decreased value when compared to emphysematous COPD for the following variables: single leg stance (8.7 vs 15.6; P<0.001) and activities balance confidence (53.2 vs 74.2; P=0.001). Bronchitic COPD patients had a significantly higher value of timed up and go test compared to patients with emphysematous COPD (14.7 vs 12.8; P=0.001).

CONCLUSION

Patients with COPD have a higher balance impairment than their healthy peers. Moreover, we observed that the bronchitic COPD phenotype is more likely to experience falls compared to the emphysematous phenotype.