1
|
Cunha BLM, Costa LSP, Porfírio PV, de Sousa Dantas D, de Melo Marinho PE. Effects of whole-body vibration exercise on functional capacity, muscle strength, and quality of life in individuals with severe chronic obstructive pulmonary disease: a systematic review and meta-analysis. Physiother Theory Pract 2024:1-11. [PMID: 38953511 DOI: 10.1080/09593985.2024.2374053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 06/18/2024] [Indexed: 07/04/2024]
Abstract
BACKGROUND Whole body vibration (WBV) exercise is a therapy used for individuals with low tolerance to conventional exercises, such as patients with chronic obstructive pulmonary disease (COPD). This study aimed to assess the impact of WBV exercise on the functional capacity, muscle strength, and health-related quality of life (HRQoL) in severe COPD patients. METHODS Studies published until March 2024 were reviewed, encompassing randomized clinical trials (RCTs) without temporal or linguistic constraints, comparing WBV exercise with other interventions. The PubMed/MEDLINE, Scopus, Cochrane Airways Trials Register, and CINAHL databases were queried. The Revised Cochrane risk-of-bias tool for randomized trials 2.0A was employed for quality assessment. RESULTS Among 351 screened studies, 7 met the criteria, totaling 356 participants (WBV group, n = 182; control group, n = 174). Meta-analysis revealed a significant mean difference of 41.36 m [95%CI (13.28-69.44); p = .004] in the 6-minute walk test distance favoring the WBV group for functional capacity. Lower limb muscle strength improved in 57.14% of included studies. HRQoL meta-analysis demonstrated a 1.13-point difference [95%CI -1.24-3.51; p = .35] favoring WBV, although group differences were not significant. A mean difference of 2.31 points favored the control group in health condition [95%CI (-1.32-5.94); p = .021]. CONCLUSION WBV exercise is recognized as a promising therapeutic modality for severe COPD patients, notably enhancing functional capacity. Although heterogeneous study protocols weaken the evidence for clinically relevant outcomes, improvements in lower limb muscle strength and HRQoL were also observed, differences between groups were not significant.
Collapse
Affiliation(s)
- Beatriz Luiza Marinho Cunha
- Post-graduation Program in Physical Therapy, Health Sciences Center, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
| | - Layane Santana P Costa
- Post-graduation Program in Physical Therapy, Health Sciences Center, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
| | - Pedro Vinicius Porfírio
- Undergraduation Course in Physical Therapy, Health Sciences Center, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
| | - Diego de Sousa Dantas
- Post-graduation Program in Physical Therapy, Health Sciences Center, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
| | - Patrícia Erika de Melo Marinho
- Post-graduation Program in Physical Therapy, Health Sciences Center, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
| |
Collapse
|
2
|
Wu DL, Luo CL, Du X, Li PP, Jiang M, Liu T, Sun Y. Current Status and Influencing Factors of Readiness for Discharge of Elderly Patients with Chronic Obstructive Pulmonary Disease. Patient Prefer Adherence 2023; 17:1323-1333. [PMID: 37255947 PMCID: PMC10226539 DOI: 10.2147/ppa.s410725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 05/03/2023] [Indexed: 06/01/2023] Open
Abstract
Objective Readiness for hospital discharge is an important indicator of patients' transition from illness to health and can predict rehabilitation and prognosis. Identifying factors that influence readiness for discharge is crucial for developing effective nursing interventions. Therefore, this study aims to investigate the current status of discharge readiness and its influencing factors in elderly patients with chronic obstructive pulmonary disease (COPD). Methods A total of 311 elderly inpatients diagnosed with COPD were enrolled in this investigation at a tertiary hospital in Chengdu between December 2021 and June 2022. Questionnaires were designed to collect general information, disease-related information, and responses to the Readiness for Hospital Discharge Scale (RHDS) and the Quality of Discharge Teaching Scale (QDTS). Univariate and multivariate linear regression analyses were employed to further analyze factors related to discharge readiness and the correlation between discharge readiness and the quality of discharge guidance. Results The total score of discharge readiness of elderly COPD patients was 77.72 ± 11.86 with a mean score of 6.48 ± 0.19 for each item. The quality of discharge instructions was 110.54 ± 15.66, with a mean score of 6.12 ± 0.15 for each item. Discharge preparation was positively correlated with the quality of discharge guidance. Multivariate analysis showed that marital status, admission mode, length of stay in hospital, Classification of Severity of Airflow Limitation, mMRC classification, number of medications taken with discharge, presence of inhalers in medication orders, mode of home oxygen therapy, and quality of discharge guidance were independent factors of discharge readiness in elderly COPD patients (P < 0.05). Conclusion Both discharge readiness and the quality of discharge guidance for elderly COPD patients in China are currently suboptimal and need further improvement. The survey findings provide valuable insights that can guide future management practices and interventions aimed at improving discharge readiness.
Collapse
Affiliation(s)
- Dao-Lin Wu
- School of Nursing, Chengdu Medical College, Chengdu, Sichuan, People’s Republic of China
- Clinical Medical College and the First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, People’s Republic of China
| | - Chun-Li Luo
- School of Nursing, Chongqing Medical University, Chongqing, People’s Republic of China
| | - Xu Du
- School of Nursing, Chengdu Medical College, Chengdu, Sichuan, People’s Republic of China
| | - Pei-Pei Li
- School of Nursing, Chengdu Medical College, Chengdu, Sichuan, People’s Republic of China
| | - Min Jiang
- School of Nursing, Chengdu Medical College, Chengdu, Sichuan, People’s Republic of China
| | - Tao Liu
- Clinical Medical College and the First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, People’s Republic of China
- Department of Oncology, Clinical Medical College and the First Affiliated Hospital of Chengdu Medical College, Key Clinical Specialty of Sichuan, Chengdu, Sichuan, People’s Republic of China
| | - Yun Sun
- School of Nursing, Chengdu Medical College, Chengdu, Sichuan, People’s Republic of China
- Clinical Medical College and the First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, People’s Republic of China
| |
Collapse
|
3
|
Tang T, Li Z, Lu X, Du J. Development and validation of a risk prediction model for anxiety or depression among patients with chronic obstructive pulmonary disease between 2018 and 2020. Ann Med 2022; 54:2181-2190. [PMID: 35916588 PMCID: PMC9351569 DOI: 10.1080/07853890.2022.2105394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Anxiety and depression are important risk factors for chronic obstructive pulmonary disease (COPD). The aim of this study was to develop a prediction model to predict anxiety or depression in COPD patients. The retrospective study was conducted in COPD patients receiving stable treatment between 2018 and 2020 to develop prediction model. The variables, were readily available in clinical practice, were analysed. After data preprocessing, model training and performance evaluation were performed. Validity of the prediction model was verified in 3 comparative model training. Between 2018 and 2020, 375 eligible patients were analysed. Thirteen variables were included into the final model: gender, age, marital status, education level, long-term residence, per capita annual household income, payment method of medical expenses, direct economic costs of treating COPD in the past year, smoking, COPD progression, number of acute exacerbation of COPD in the last year, regular treatment with inhalants and family oxygen therapy. Risk score threshold in each sample in the training set was 1.414. The area under the curve value was respectively 0.763 and 0.702 in the training set and test set, which were higher than three comparative models. The simple prediction model to predict anxiety or depression in patients with COPD has been developed. Based on 13 available data in clinical indicators, the model may serve as an instrument for clinical decision-making for COPD patients who may have anxiety or depression.Key messagesThirteen variables were included into the prediction model.The AUC value was, respectively, 0.763 and 0.702 in the training set and test set, which were higher than three comparative models.The simple prediction model to predict anxiety or depression in patients with COPD has been developed.
Collapse
Affiliation(s)
- Tingyu Tang
- Department of Respiratory Medicine, Zhejiang Hospital, Hangzhou, China
| | - Zongju Li
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Xiaoling Lu
- Department of Respiratory Medicine, Zhejiang Hospital, Hangzhou, China
| | - Jianzong Du
- Department of Respiratory Medicine, Zhejiang Hospital, Hangzhou, China
| |
Collapse
|
4
|
Piotrkowska R, Mędrzycka-Dąbrowska W, Jarzynkowski P, Ślusarz R. Nicotine Dependence and the Level of Motivation for Ceasing Smoking in the Case of Patients Undergoing Vascular Surgeries Versus the Optimisation of Perioperative Care-Pilot Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191610393. [PMID: 36012032 PMCID: PMC9408470 DOI: 10.3390/ijerph191610393] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 08/17/2022] [Accepted: 08/19/2022] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Smoking is one of key risk factors of cardiovascular diseases, including abdominal aortic aneurysm (AAA), peripheral arterial disease (PAD), and carotid artery disease (CAD). Despite attempts being made to make the society aware of the consequences of passive and active smoking, as well as worldwide and nationwide epidemiologic research reflecting the scale of the problem, there are still a lot of smokers. AIM The purpose of the study was to assess the relationship between the degree of addiction and the level of motivation for ceasing smoking in the case of patients before vascular surgery. Furthermore, to point out factors that have a significant impact on the level of nicotine dependence and motivation for ceasing smoking. METHODS The survey included patients qualified for vascular surgeries. The patients were active smokers: 69.3% men and 30.7% women. The survey was conducted in the form of a questionnaire based on standard research tools: the Fagerström Test for Nicotine Dependence (FTND), the Test of Motivation for Ceasing Smoking by Nina Schneider, and the original questionnaire aimed at collecting social and demographic data. RESULTS Most patients showed a high or moderate degree of nicotine dependence: 46.5% and 40.6%, respectively. An average nicotine dependence ratio based on the Fagerström test was 6.23 ± 2.39. An average motivation for the ceasing smoking ratio was 4.88 ± 2.76. Only 34.7% of the patients had a high motivation for ceasing smoking. Over half of the patients (61.4%) attempted to cease smoking in the past. CONCLUSIONS Most patients undergoing vascular surgeries showed a high or moderate degree of nicotine dependence and low motivation to quit smoking. The greater the addiction to nicotine, the lower the motivation to quit smoking. Social and demographic factors do not affect the degree of nicotine addiction and the motivation to quit smoking. Years of smoking had an impact on the incidence of chronic obstructive pulmonary disease (COPD).
Collapse
Affiliation(s)
- Renata Piotrkowska
- Department of Surgical Nursing, Medical University of Gdańsk, Dębinki 7, 80-211 Gdańsk, Poland
- Clinic of Cardiac and Vascular Surgery, University Clinical Centre, Dębinki 7, 80-952 Gdańsk, Poland
| | - Wioletta Mędrzycka-Dąbrowska
- Department of Anaesthesiology Nursing and Intensive Care, Medical University of Gdańsk, Dębinki 7, 80-211 Gdańsk, Poland
| | - Piotr Jarzynkowski
- Department of Surgical Nursing, Medical University of Gdańsk, Dębinki 7, 80-211 Gdańsk, Poland
| | - Robert Ślusarz
- Neurological and Neurosurgical Nursing Department, Faculty of Health Science, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Łukasiewicza 1, 85-821 Bydgoszcz, Poland
| |
Collapse
|
5
|
Peñailillo L, Valladares-Ide D, Jannas-Velas S, Flores-Opazo M, Jalón M, Mendoza L, Nuñez I, Diaz-Patiño O. Effects of eccentric, concentric and eccentric/concentric training on muscle function and mass, functional performance, cardiometabolic health, quality of life and molecular adaptations of skeletal muscle in COPD patients: a multicentre randomised trial. BMC Pulm Med 2022; 22:278. [PMID: 35854255 PMCID: PMC9297587 DOI: 10.1186/s12890-022-02061-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 07/04/2022] [Indexed: 11/12/2022] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) is the third cause of death worldwide. COPD is characterised by dyspnoea, limited exercise tolerance, and muscle dysfunction. Muscle dysfunction has been linked to dysregulation between muscle protein synthesis, myogenesis and degradation mechanisms. Conventional concentric cycling has been shown to improve several clinical outcomes and reduce muscle wasting in COPD patients. Eccentric cycling is a less explored exercise modality that allows higher training workloads imposing lower cardio-metabolic demand during exercise, which has shown to induce greater muscle mass and strength gains after training. Interestingly, the combination of eccentric and concentric cycling training has scarcely been explored. The molecular adaptations of skeletal muscle after exercise interventions in COPD have shown equivocal results. The mechanisms of muscle wasting in COPD and whether it can be reversed by exercise training are unclear. Therefore, this study aims two-fold: (1) to compare the effects of 12 weeks of eccentric (ECC), concentric (CONC), and combined eccentric/concentric (ECC/CONC) cycling training on muscle mass and function, cardiometabolic health, physical activity levels and quality of life in severe COPD patients; and (2) to examine the molecular adaptations regulating muscle growth after training, and whether they occur similarly in specific muscle fibres (i.e., I, IIa and IIx). Methods Study 1 will compare the effects of 12 weeks of CONC, ECC, versus ECC/CONC training on muscle mass and function, cardiometabolic health, levels of physical activity and quality of life of severe COPD patients using a multicentre randomised trial. Study 2 will investigate the effects of these training modalities on the molecular adaptations regulating muscle protein synthesis, myogenesis and muscle degradation in a subgroup of patients from Study 1. Changes in muscle fibres morphology, protein content, genes, and microRNA expression involved in skeletal muscle growth will be analysed in specific fibre-type pools. Discussion We aim to demonstrate that a combination of eccentric and concentric exercise could maximise the improvements in clinical outcomes and may be ideal for COPD patients. We also expect to unravel the molecular mechanisms underpinning muscle mass regulation after training in severe COPD patients. Trial Registry: Deutshches Register Klinischer Studien; Trial registration: DRKS00027331; Date of registration: 12 January 2022. https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00027331.
Collapse
Affiliation(s)
- Luis Peñailillo
- Exercise and Rehabilitation Sciences Laboratory, School of Physical Therapy, Faculty of Rehabilitation Sciences, Universidad Andres Bello, 700 Fernández Concha, Las Condes, 7591538, Santiago, Chile.
| | - Denisse Valladares-Ide
- Long Active Life Laboratory, Instituto de Ciencias de la Salud, Universidad de O'Higgins, Rancagua, Chile
| | - Sebastián Jannas-Velas
- Long Active Life Laboratory, Instituto de Ciencias de la Salud, Universidad de O'Higgins, Rancagua, Chile
| | | | | | - Laura Mendoza
- Respiratory Unit, Departamento de Medicina, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Ingrid Nuñez
- Department of Pulmonary Diseases, Faculty of Medicine, Pontifical Catholic University of Chile, Santiago, Chile.,Department of Critical Care, Faculty of Medicine, Pontifical Catholic University of Chile, Santiago, Chile
| | - Orlando Diaz-Patiño
- Department of Pulmonary Diseases, Faculty of Medicine, Pontifical Catholic University of Chile, Santiago, Chile.,Department of Critical Care, Faculty of Medicine, Pontifical Catholic University of Chile, Santiago, Chile
| |
Collapse
|
6
|
Merino M, Martín Lorenzo T, Maravilla-Herrera P, Ancochea J, Gómez Sáenz JT, Hass N, Molina J, Peces-Barba G, Trapero-Bertran M, Trigueros Carrero JA, Hidalgo-Vega Á. A Social Return on Investment Analysis of Improving the Management of Chronic Obstructive Pulmonary Disease Within the Spanish National Healthcare System. Int J Chron Obstruct Pulmon Dis 2022; 17:1431-1442. [PMID: 35761956 PMCID: PMC9233487 DOI: 10.2147/copd.s361700] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 06/02/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose To define a set of proposals that would improve the current management of chronic obstructive pulmonary disease (COPD) within the Spanish National Healthcare System (SNHS) from a comprehensive multidisciplinary perspective and to assess the impact of its implementation from clinical, healthcare, economic, and social perspectives. Patients and Methods A group of 20 stakeholders related to COPD (healthcare professionals, patients, and informal caregivers, among others) participated in an online Delphi process to agree on a set of 15 proposals that would improve the current management of COPD within the SNHS in four areas: diagnosis, risk stratification, management of exacerbations, and management of stable COPD. A one-year forecast-type social return on investment (SROI) analysis was used to estimate the impact that implementing the set of proposals would have in relation to the investment required. A sensitivity analysis was used to test the strength of the model when varying assumption-based data-points. Results The hypothetical implementation of the complete set of 15 proposals would require a €668 million investment and would generate a €2079 million social impact concerning savings for the SNHS and quality of life improvements for patients and their informal caregivers, among others. Accordingly, for every euro invested in the set of proposals, a social return of €3.11 would be generated (€2.71 in the worst-case scenario and €3.62 in the best-case scenario) of both tangible (32.56%) and intangible nature (67.44%). Conclusion Altogether, implementing this set of 15 proposals would generate a positive social impact, threefold the required investment. The results may inform decisions relative to healthcare policy and practice regarding COPD management within the SNHS, further contributing to reduce the large burden of COPD.
Collapse
Affiliation(s)
| | | | | | - Julio Ancochea
- Pulmonology Service, La Princesa University Hospital - IIS-Princesa, Madrid, Spain
- Faculty of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
- Respiratory Diseases Networking Biomedical Research Centre - CIBERES, Carlos III Institute of Health - ISCIII, Madrid, Spain
| | | | - Nicole Hass
- Chronic Obstructive Pulmonary Disease Patient and Family Association - APEPOC, Pontevedra, Spain
| | - Jesús Molina
- Francia Health Centre, Fuenlabrada, Madrid, Spain
| | - Germán Peces-Barba
- Pulmonology Service, Fundación Jiménez Díaz University Hospital, Madrid, Spain
| | - Marta Trapero-Bertran
- Basic Sciences Department, University Institute for Patient Care, Universitat Internacional de Catalunya, Barcelona, Spain
| | | | - Álvaro Hidalgo-Vega
- Department of Economic Analysis and Finances, Universidad de Castilla-La Mancha, Toledo, Spain
| |
Collapse
|
7
|
Zhao N, Dong C. Correlation of Serum IL-18, BDNF, and IL-1 β with Depression and Prognosis after Acute Exacerbation of Chronic Obstructive Pulmonary Disease. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:3555982. [PMID: 35535228 PMCID: PMC9078809 DOI: 10.1155/2022/3555982] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 03/22/2022] [Accepted: 04/06/2022] [Indexed: 12/15/2022]
Abstract
Objective To explore the correlation of serum IL-18, BDNF, and IL-1β with depression and prognosis after acute exacerbation of chronic obstructive pulmonary disease (COPD). Methods By means of retrospective analysis, the data of 240 patients at the acute exacerbation of COPD treated in our hospital (February 2018-February 2021) were analyzed. All patients received conventional treatment 1 d after admission, patients' serological indicators were measured before treatment, and after 30 d of follow-up, the patients were divided into the survival group (SG) and death group (DG) according to their clinical outcomes, the Beck's Depression Inventory (BDI) scores of the surviving patients were investigated, the correlation of IL-18, BDNF, and IL-1β levels with depression was analyzed by R analytics, and the correlation of IL-18, BDNF, and IL-1β levels with prognosis was analyzed by ROC curve analysis. Results The results of 30 d follow-up showed that 220 patients survived (91.7%) and 20 patients died (8.3%). Among the surviving patients, 95 patients had depression and 125 patients did not have depression; the BDI scores of the depressed subjects and the nondepressed subjects were 10.35 ± 1.25 points and 2.06 ± 0.76 points, respectively; significant differences in IL-18, BDNF, and IL-1β levels between SG and DG were observed (P < 0.05); significant differences in IL-18, BDNF, and IL-1β levels between the depressed subjects and the nondepressed subjects were observed (538.43 ± 19.02 vs. 515.32 ± 9.65, 7.54 ± 0.56 vs. 12.11 ± 2.41, and 8.70 ± 0.98 vs. 8.12 ± 0.87; P < 0.001); among the depressed patients, the IL-18 and IL-1β levels were positively correlative with the BDI scores (r = 0.781, r = 0.2583, P < 0.001, P = 0.012), and the BDNF level was negatively correlative with the BDI scores (r = -0.3277, P = 0.001) before treatment; according to the ROC analysis, the AUC (95% CI) of IL-18, BDNF, and IL-1β in predicting prognosis was 0.8770 (0.8281-0.9260), 0.7723 (0.6879-0.8567), and 0.7165 (0.6080-0.8250) (P < 0.05), respectively. Conclusion In regard to the depression in COPD patients after acute exacerbation, IL18 and IL-1β show positive correlation, and BDNF presents negative correlation. All three indicators have predictive value for patient outcome.
Collapse
Affiliation(s)
- Nan Zhao
- Department of Respiration, The First Affiliated Hospital of Harbin Medical University, 150001 Harbin City, Heilongjiang Province, China
| | - Chengcheng Dong
- Department of Respiration, The First Affiliated Hospital of Harbin Medical University, 150001 Harbin City, Heilongjiang Province, China
| |
Collapse
|
8
|
Martinez FJ, Agusti A, Celli BR, Han MK, Allinson JP, Bhatt SP, Calverley P, Chotirmall SH, Chowdhury B, Darken P, Da Silva CA, Donaldson G, Dorinsky P, Dransfield M, Faner R, Halpin DM, Jones P, Krishnan JA, Locantore N, Martinez FD, Mullerova H, Price D, Rabe KF, Reisner C, Singh D, Vestbo J, Vogelmeier CF, Wise RA, Tal-Singer R, Wedzicha JA. Treatment Trials in Young Patients with Chronic Obstructive Pulmonary Disease and Pre-Chronic Obstructive Pulmonary Disease Patients: Time to Move Forward. Am J Respir Crit Care Med 2022; 205:275-287. [PMID: 34672872 PMCID: PMC8886994 DOI: 10.1164/rccm.202107-1663so] [Citation(s) in RCA: 64] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is the end result of a series of dynamic and cumulative gene-environment interactions over a lifetime. The evolving understanding of COPD biology provides novel opportunities for prevention, early diagnosis, and intervention. To advance these concepts, we propose therapeutic trials in two major groups of subjects: "young" individuals with COPD and those with pre-COPD. Given that lungs grow to about 20 years of age and begin to age at approximately 50 years, we consider "young" patients with COPD those patients in the age range of 20-50 years. Pre-COPD relates to individuals of any age who have respiratory symptoms with or without structural and/or functional abnormalities, in the absence of airflow limitation, and who may develop persistent airflow limitation over time. We exclude from the current discussion infants and adolescents because of their unique physiological context and COPD in older adults given their representation in prior randomized controlled trials (RCTs). We highlight the need of RCTs focused on COPD in young patients or pre-COPD to reduce disease progression, providing innovative approaches to identifying and engaging potential study subjects. We detail approaches to RCT design, including potential outcomes such as lung function, patient-reported outcomes, exacerbations, lung imaging, mortality, and composite endpoints. We critically review study design components such as statistical powering and analysis, duration of study treatment, and formats to trial structure, including platform, basket, and umbrella trials. We provide a call to action for treatment RCTs in 1) young adults with COPD and 2) those with pre-COPD at any age.
Collapse
Affiliation(s)
| | - Alvar Agusti
- Catedra Salut Respiratoria and,Institut Respiratorio, Hospital Clinic, Barcelona, Spain;,Institut d’investigacions biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain;,Centro de Investigacion Biomedica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Bartolome R. Celli
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - MeiLan K. Han
- University of Michigan Health System, Ann Arbor, Michigan
| | - James P. Allinson
- National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Surya P. Bhatt
- Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Peter Calverley
- Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, United Kingdom
| | | | | | | | - Carla A. Da Silva
- Clinical Development, Research and Early Development, Respiratory and Immunology, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Gavin Donaldson
- National Heart and Lung Institute, Imperial College, London, United Kingdom
| | | | - Mark Dransfield
- Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Rosa Faner
- Department of Biomedical Sciences, University of Barcelona, Barcelona, Spain
| | | | - Paul Jones
- St. George’s University of London, London, United Kingdom
| | | | | | | | | | - David Price
- Observational and Pragmatic Research Institute, Singapore;,Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
| | - Klaus F. Rabe
- LungenClinic Grosshansdorf, Member of the German Center for Lung Research, Grosshansdorf, Germany;,Department of Medicine, Christian Albrechts University Kiel, Member of the German Center for Lung Research Kiel, Germany
| | | | | | - Jørgen Vestbo
- Manchester University NHS Trust, Manchester, United Kingdom
| | - Claus F. Vogelmeier
- Department of Medicine, Pulmonary and Critical Care Medicine, University of Marburg, Member of the German Center for Lung Research, Marburg, Germany
| | | | | | | |
Collapse
|
9
|
López-Campos JL, Calle Rubio M, Izquierdo Alonso JL, Fernández-Villar A, Abascal-Bolado B, Alcázar B, García-Río F, Peces-Barba G, Serra Batlles J, Martínez Garcerán JJ, Riesco Miranda JA, Figueira-Gonçalves JM, Soler-Cataluña JJ, Temprano M, Ortega Ruiz F, Santos Pérez S, Álvarez Martínez CJ. Forum COPD working group consensus on the diagnosis, treatment and follow-up of COPD. Arch Bronconeumol 2021; 57:596-599. [PMID: 35702916 DOI: 10.1016/j.arbr.2021.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 12/29/2020] [Indexed: 06/15/2023]
Affiliation(s)
- José Luis López-Campos
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Universidad de Sevilla, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.
| | - Myriam Calle Rubio
- Departamento de Medicina, Universidad Complutense de Madrid, Hospital Clínico de San Carlos, Madrid, Spain
| | - José Luis Izquierdo Alonso
- Departamento de Medicina y Especialidades, Universidad de Alcalá, Hospital Universitario de Guadalajara, Guadalajara, Spain
| | - Alberto Fernández-Villar
- Hospital Álvaro Cunqueiro, Instituto de Investigación Sanitaria Galicia Sur (IISGS), Vigo, Spain
| | | | - Bernardino Alcázar
- Servicio de Neumología, AIG de Medicina, Hospital de Alta Resolución de Loja, Granada, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | | | - Germán Peces-Barba
- Hospital Universitario Fundación Jiménez Díaz, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | | | | | | | | | | | | | - Francisco Ortega Ruiz
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Universidad de Sevilla; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Salud Santos Pérez
- Hospital Universitario de Bellvitge-IDIBELL, Hospitalet de Llobregat, Barcelona, Spain
| | | |
Collapse
|
10
|
Fernández-García S, Represas-Represas C, Ruano-Raviña A, Fernández-García A, González-Montaos A, Priegue-Carrera A, Pérez-Ríos M, Fernández-Villar A. Sociodemographic and Clinical Variables Related to the Overburden of the Informal Caregivers of Patients Hospitalized for Chronic Obstructive Pulmonary Disease Exacerbations. Int J Chron Obstruct Pulmon Dis 2021; 16:1119-1126. [PMID: 33907398 PMCID: PMC8068495 DOI: 10.2147/copd.s301637] [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: 01/12/2021] [Accepted: 03/22/2021] [Indexed: 11/23/2022] Open
Abstract
Objective To increase our knowledge of the patient variables related to the overburden of the caregivers of patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPDs). Methodology This was a cross-sectional study of patients with severe COPD who have informal caregivers. We performed a multivariate analysis of sociodemographic (economic situation, care, dependence, social risk, and use of social services) and clinical (degree of dyspnea, previous hospitalizations, disease impact, pulmonary function, and comorbidity) factors and related these to the burden of informal caregivers, as evaluated using the Zarit scale. Results The study included 91 patients, age 72.6±8.7 years and 80 were male (89.7%); the mean modified Medical Research Council dyspnea scale (mMRC) score was 2.5±0.8; mean FEV1 was 39.5 ± 13.2%; and 70 patients (76.9%) were dependent for basic activities. Of the informal caregivers, 90 (90.9%) were women, 49 (49.4%) were partners or spouses, and 29 (29.6%) were daughters. The mean Zarit questionnaire score was 51.4±14.2, with 63 of carers (69.2%) perceiving some overburden, and 34 (37.4%) describing the overburden as mild–moderate. The variables related to informal caregiver overburden in the multivariate study were the previous use of social resources [OR = 8.1 (95% CI = 1.03–69.9); p = 0.04], degree of mMRC dyspnea 3–4 [OR =4.7 (95% CI = 1.7–13.2); p = 0.003], and two or more admissions for AEPOC in the previous year [OR = 4.5 (95% CI = 1.7–13.2); p = 0.003]. Of the informal caregivers of patients who had presented two or more of these variables, 92.3% perceived an overburden. Conclusion The variables associated with overburden are easily accessible in patient medical records, or can be obtained by interviewing patients or their relatives. This information would allow to detect and assess the overburden of informal caregivers to provide an early warning of this problem.
Collapse
Affiliation(s)
- Sara Fernández-García
- Pneumology Department, Alvaro Cunqueiro University Hospital, NeumoVigo I+i Research Group, Institute of Health Research Galicia Sur (IISGS), Vigo, Spain
| | - Cristina Represas-Represas
- Pneumology Department, Alvaro Cunqueiro University Hospital, NeumoVigo I+i Research Group, Institute of Health Research Galicia Sur (IISGS), Vigo, Spain
| | - Alberto Ruano-Raviña
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago, Spain.,Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain.,Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Alberto Fernández-García
- Pneumology Department, Alvaro Cunqueiro University Hospital, NeumoVigo I+i Research Group, Institute of Health Research Galicia Sur (IISGS), Vigo, Spain
| | - Almudena González-Montaos
- Pneumology Department, Alvaro Cunqueiro University Hospital, NeumoVigo I+i Research Group, Institute of Health Research Galicia Sur (IISGS), Vigo, Spain
| | - Ana Priegue-Carrera
- Pneumology Department, Alvaro Cunqueiro University Hospital, NeumoVigo I+i Research Group, Institute of Health Research Galicia Sur (IISGS), Vigo, Spain
| | - Mónica Pérez-Ríos
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago, Spain.,Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Alberto Fernández-Villar
- Pneumology Department, Alvaro Cunqueiro University Hospital, NeumoVigo I+i Research Group, Institute of Health Research Galicia Sur (IISGS), Vigo, Spain
| |
Collapse
|
11
|
López-Campos JL, Calle Rubio M, Izquierdo Alonso JL, Fernández-Villar A, Abascal-Bolado B, Alcázar B, García-Río F, Peces-Barba G, Serra Batlles J, Martínez Garcerán JJ, Riesco Miranda JA, Figueira-Gonçalves JM, Soler-Cataluña JJ, Temprano M, Ortega Ruiz F, Santos Pérez S, Álvarez Martínez CJ. Forum COPD Working Group Consensus on the Diagnosis, Treatment and Follow-Up of COPD. Arch Bronconeumol 2021:S0300-2896(21)00023-5. [PMID: 33674118 DOI: 10.1016/j.arbres.2020.12.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 12/26/2020] [Accepted: 12/29/2020] [Indexed: 11/30/2022]
Affiliation(s)
- José Luis López-Campos
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias. Instituto de Biomedicina de Sevilla (IBiS). Hospital Universitario Virgen del Rocío/Universidad de Sevilla. Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES). Instituto de Salud Carlos III, Madrid, España.
| | - Myriam Calle Rubio
- Departamento de Medicina. Universidad Complutense de Madrid. Hospital Clínico de San Carlos, Madrid, España
| | - José Luis Izquierdo Alonso
- Departamento de Medicina y Especialidades. Universidad de Alcalá. Hospital Universitario de Guadalajara, Guadalajara, España
| | - Alberto Fernández-Villar
- Hospital Álvaro Cunqueiro. Instituto de Investigación Sanitaria Galicia Sur (IISGS), Vigo, España
| | | | - Bernardino Alcázar
- Servicio de Neumología. AIG de Medicina. Hospital de Alta Resolución de Loja. Granada. Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES). Instituto de Salud Carlos III, Madrid, España
| | | | - Germán Peces-Barba
- Hospital Universitario Fundación Jiménez Díaz. Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES). Instituto de Salud Carlos III, Madrid, España
| | | | | | | | | | | | | | - Francisco Ortega Ruiz
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias. Instituto de Biomedicina de Sevilla (IBiS). Hospital Universitario Virgen del Rocío/Universidad de Sevilla; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES). Instituto de Salud Carlos III, Madrid, España
| | - Salud Santos Pérez
- Hospital Universitario de Bellvitge-IDIBELL. Hospitalet de Llobregat, Barcelona, España
| | | |
Collapse
|