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Yu Y, Xiao W, Du LY, Li Y, Xiong C, Liang FR, Mao B, Fu JJ. Acupuncture for dyspnea and breathing physiology in chronic respiratory diseases: A systematic review and meta-analysis of randomized controlled trials. Heliyon 2024; 10:e31176. [PMID: 38813170 PMCID: PMC11133705 DOI: 10.1016/j.heliyon.2024.e31176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 05/05/2024] [Accepted: 05/12/2024] [Indexed: 05/31/2024] Open
Abstract
Background Dyspnea, a common symptom of chronic respiratory diseases (CRDs), is closely linked to higher levels of functional impairment and death, leading to significant societal and financial challenges. Despite numerous clinical trials and systematic reviews suggested the potential benefits of acupuncture for chronic obstructive pulmonary disease (COPD) and lung cancer, there is currently insufficient evidence to conclusively prove its effectiveness in alleviating dyspnea in patients with CRDs. Methods To compile and evaluate the existing data on the effectiveness and safety of acupuncture for managing dyspnea in CRDs. Randomized controlled trials investigating acupuncture for the treatment of dyspnea in patients with CRDs, such as COPD, lung cancer, asthma, bronchiectasis, interstitial lung disease, chronic pulmonary heart disease and bronchitis, were searched and retrieved from five electronic databases in English or Chinese. Results A total of 23 studies meeting the inclusion criteria were found in databases, covering various CRDs such as COPD, lung cancer, and asthma. A meta-analysis that compared acupuncture to a control group (which included no acupuncture and sham acupuncture) found significant advantages for acupuncture in reducing dyspnea severity (P = 0.0003), increasing 6MWD (P < 0.00001), improving quality of life measured by St. George's Respiratory Questionnaire (P = 0.03) and karnofsky performance status score (P < 0.00001). No significance was found in breathing physiology represented by FEV1 (P = 0.34) and FVC (P = 0.15). There was a comparable incidence of negative outcomes in both groups (P = 0.07). Results were consistent when compared to sham acupuncture. In addition, subgroup analyses were also consistent when different diseases or types of acupuncture were analyzed. Conclusions Acupuncture may be an effective and safe non-pharmacological complementary intervention to relief dyspnea for patients with CRDs. Nevertheless, research with high quality and large sample sizes is needed for further investigation.
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Affiliation(s)
- Yan Yu
- Division of Pulmonary Medicine, Department of Internal Medicine, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, PR China
| | - Wei Xiao
- Division of Pulmonary Medicine, Department of Internal Medicine, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, PR China
| | - Long-Yi Du
- Division of Pulmonary Medicine, Department of Internal Medicine, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, PR China
| | - Yu Li
- Department of Pneumology, Pidu District Hospital of Traditional Chinese Medicine, The Third Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan 611730, PR China
| | - Chan Xiong
- Department of Pneumology, Pidu District Hospital of Traditional Chinese Medicine, The Third Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan 611730, PR China
| | - Fan-Rong Liang
- Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan 610036, PR China
| | - Bing Mao
- Division of Pulmonary Medicine, Department of Internal Medicine, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, PR China
| | - Juan-Juan Fu
- Division of Pulmonary Medicine, Department of Internal Medicine, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, PR China
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Ouanes S, Hashem LA, Makki I, Khan F, Mahgoub O, Wafer A, Dulaimy O, Amro R, Ghuloum S. Mortality in Qatari individuals with mental illness: a retrospective cohort study. Ann Gen Psychiatry 2024; 23:14. [PMID: 38637811 PMCID: PMC11027414 DOI: 10.1186/s12991-024-00499-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 03/25/2024] [Indexed: 04/20/2024] Open
Abstract
INTRODUCTION There is substantial evidence that people with mental illness have higher mortality rates than the general population. However, most of the studies were from Western countries, and it is not clear whether this finding also applies to Arab countries like Qatar. OBJECTIVES We aimed to explore whether mortality in patients with mental illness in Qatar, is different from those without. METHODS We conducted a retrospective cohort study, including all Qatari nationals deceased in 2017 and 2018, using the list of registered deaths from Hamad Medical Corporation (HMC) Mortuary. We divided the cohort of deceased people into two groups: with and without mental illness. For each of the groups, we collected the age at death, the reported cause of death as well as sociodemographic and clinical data. RESULTS There were 602 registered deaths in 2017 and 589 deaths in 2018. The prevalence of mental illness was 20.4%. Compared to subjects without mental illness, subjects with mental illness surprisingly had higher age at death (median ± IQR = 76.5 ± 22.1 years vs. 62.7 ± 32.9 years; p < .001). This difference persisted even after we controlled for covariates. Individuals with mental illness were more likely to die of an infection (OR = 1.98[1.44;2.71]), or of chronic respiratory disease (OR = 3.53 [1.66;7.52]) but less likely to die because of accidental (OR = 0.21[0.09;0.49]) or congenital causes (OR = 0.18[0.04;0.77]). CONCLUSION Contrary to most previous studies, we did not find that mortality was higher in Qatari individuals with mental illness. Sociocultural factors, free and easy-to-access healthcare, and an enhanced role of mental health professionals in detecting medical comorbidities may explain this finding.
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Affiliation(s)
- Sami Ouanes
- Department of Psychiatry, Hamad Medical Corporation, POBOX 3050, Doha, Qatar
| | - Lien Abou Hashem
- Department of Psychiatry, Hamad Medical Corporation, POBOX 3050, Doha, Qatar
| | - Ibrahim Makki
- Department of Psychiatry, Hamad Medical Corporation, POBOX 3050, Doha, Qatar
| | - Faisal Khan
- Department of Psychiatry, Hamad Medical Corporation, POBOX 3050, Doha, Qatar
| | - Omer Mahgoub
- Department of Psychiatry, Hamad Medical Corporation, POBOX 3050, Doha, Qatar
| | - Ahmed Wafer
- Department of Psychiatry, Hamad Medical Corporation, POBOX 3050, Doha, Qatar
| | - Omer Dulaimy
- Department of Psychiatry, Hamad Medical Corporation, POBOX 3050, Doha, Qatar
| | - Raed Amro
- Department of Psychiatry, Hamad Medical Corporation, POBOX 3050, Doha, Qatar
| | - Suhaila Ghuloum
- Department of Psychiatry, Hamad Medical Corporation, POBOX 3050, Doha, Qatar.
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Ying Y, Khunthason S, Apidechkul T, Nilvarangkul K. Influencing factors of good quality of life among chronic obstructive pulmonary disease patients living in Zhejiang Province, China. Sci Rep 2024; 14:8687. [PMID: 38622219 PMCID: PMC11018838 DOI: 10.1038/s41598-024-59289-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 04/09/2024] [Indexed: 04/17/2024] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a chronic, progressive and debilitating disease that affects quality of life (QOL), especially among patients living in poor environments. This study aimed to determine the influencing factors of good QOL among COPD patients living in Zhejiang, China. A cross-sectional study was conducted to collect data from participants in six tertiary hospitals in Zhejiang Province by a simple random sampling method. A validated questionnaire was used to collect general information, environmental factors, and COPD stage. The standardized St. George's Respiratory Questionnaire (SGRQ) was used to assess QOL. Logistic regression was used to determine influencing factors of good QOL among COPD patients at a significance level of α = 0.05. A total of 420 participants were recruited for analysis. The overall prevalence of patients with good QOL was 25.7%. Six variables were found to be associated with good QOL in the multivariable analysis. Patients who were employed had 2.35 times (95% CI 1.03-5.34) greater odds of having good QOL than those who were unemployed. Those whose family income was higher than 100,000 CNY had 2.49 times (95% CI 1.15-5.39) greater odds of having good QOL than those whose family income was lower than 100,000 CNY. Those who had treatment expenses less than 5,000 CNY had 4.57 (95% CI 1.57-13.30) times greater odds of having good QOL than those who had treatment expenses of 5,000 CNY or higher. Those who had mild or moderate airflow limitation were 5.27 times (95% CI 1.61-17.26) more likely to have good QOL than those who were in a severe or very severe stage of COPD. Those who had a duration of illness less than 60 months had 5.57 times (95% CI 1.40-22.12) greater odds of having good QOL than those who had a duration of illness of 120 months or more. Those who were not hospitalized within the past 3 months had 9.39 times (95% CI 1.62-54.43) greater odds of having good QOL than those who were hospitalized more than twice over the past 3 months. Socioeconomic status, disease stage and accessibility were associated with good QOL among COPD patients in Zhejiang Province, China. Increasing family income and implementing measures to improve the accessibility of medical care, including developing a proper system to decrease the cost of treatment for COPD patients, can improve patients' QOL.
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Affiliation(s)
- Yubing Ying
- School of Health Science, Mae Fah Luang University, 333 Moo 1, Ta Sud Subdistrict, Muang District, 57100, Chiang Rai Province, Thailand
| | - Siriyaporn Khunthason
- School of Health Science, Mae Fah Luang University, 333 Moo 1, Ta Sud Subdistrict, Muang District, 57100, Chiang Rai Province, Thailand.
| | - Tawatchai Apidechkul
- School of Health Science, Mae Fah Luang University, 333 Moo 1, Ta Sud Subdistrict, Muang District, 57100, Chiang Rai Province, Thailand
| | - Kessarawan Nilvarangkul
- Chiang Rai Rajabhat University, 80 Moo 9 Phaholyothin Road, Muang District, 57100, Chiang Rai, Thailand
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Hong CS, Shen YC, Chang ET, Hou HC, Chen YJ. Exercise training influence on cognitive capacity and mental health within chronic obstructive pulmonary disease - A pilot study. Tzu Chi Med J 2024; 36:188-194. [PMID: 38645787 PMCID: PMC11025594 DOI: 10.4103/tcmj.tcmj_128_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 06/13/2023] [Accepted: 09/23/2023] [Indexed: 04/23/2024] Open
Abstract
Objective Although pulmonary rehabilitation and regular exercise have improved negative emotions and cognitive capacity within cases of chronic obstructive pulmonary disease (COPD), influence by exercise training upon different cognitive and memory functions in COPD is still controversial. This investigation aimed to assess whether cognitive performance and mental health are affected by the benefits of exercise training within cases of COPD. Materials and Methods This pilot investigation included thirty-three patients with Global Initiative for Chronic Obstructive Lung Disease stage ≥B. Based on the subjects' rights, all included patients could choose to join either the exercise group or the control group, according to their free will. Twelve patients were assigned to receive exercise treatment over a 2-month period, while the remaining 16 patients were assigned to the control group. Cognitive capacity outcomes were measured using the Wechsler Memory Scale-III Word List Test, Stroop task, and psychomotor vigilance task (PVT). Mood states were assessed through the Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI). Results Most cases demonstrated major improvement for BDI and BAI scorings post-60-day therapy. During PVT, the omission rate decreased, while the hit rate increased, indicating an improvement in attention performance. Furthermore, this investigation found a significant increase in immediate verbal and recognition memory for word-list test. However, no major performance shifts were found on Stroop analysis. Conclusion This investigation demonstrated that a 2-month exercise training program resulted in significant improvement in negative emotions, immediate memory, recognition memory, and attention.
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Affiliation(s)
- Cheng-Siao Hong
- Department of Human Development and Psychology, Tzu Chi University, Hualien, Taiwan
| | - Yu-Chih Shen
- Department of Psychiatry, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - En-Ting Chang
- School of Medicine, Tzu Chi University, Hualien, Taiwan
- Department of Chest Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Hui-Chuan Hou
- Department of Chest Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Yi-Jen Chen
- Department of Chest Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
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Nakamura NH, Oku Y, Fukunaga M. "Brain-breath" interactions: respiration-timing-dependent impact on functional brain networks and beyond. Rev Neurosci 2024; 35:165-182. [PMID: 37651646 DOI: 10.1515/revneuro-2023-0062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 08/06/2023] [Indexed: 09/02/2023]
Abstract
Breathing is a natural daily action that one cannot do without, and it sensitively and intensely changes under various situations. What if this essential act of breathing can impact our overall well-being? Recent studies have demonstrated that breathing oscillations couple with higher brain functions, i.e., perception, motor actions, and cognition. Moreover, the timing of breathing, a phase transition from exhalation to inhalation, modulates specific cortical activity and accuracy in cognitive tasks. To determine possible respiratory roles in attentional and memory processes and functional neural networks, we discussed how breathing interacts with the brain that are measured by electrophysiology and functional neuroimaging: (i) respiration-dependent modulation of mental health and cognition; (ii) respiratory rhythm generation and respiratory pontomedullary networks in the brainstem; (iii) respiration-dependent effects on specific brainstem regions and functional neural networks (e.g., glutamatergic PreBötzinger complex neurons, GABAergic parafacial neurons, adrenergic C1 neurons, parabrachial nucleus, locus coeruleus, temporoparietal junction, default-mode network, ventral attention network, and cingulo-opercular salience network); and (iv) a potential application of breathing manipulation in mental health care. These outlines and considerations of "brain-breath" interactions lead to a better understanding of the interoceptive and cognitive mechanisms that underlie brain-body interactions in health conditions and in stress-related and neuropsychiatric disorders.
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Affiliation(s)
- Nozomu H Nakamura
- Division of Physiome, Department of Physiology, Hyogo Medical University, 1-1, Mukogawa cho, Nishinomiya, Hyogo 663-8501, Japan
| | - Yoshitaka Oku
- Division of Physiome, Department of Physiology, Hyogo Medical University, 1-1, Mukogawa cho, Nishinomiya, Hyogo 663-8501, Japan
| | - Masaki Fukunaga
- Section of Brain Function Information, National Institute of Physiological Sciences, 38 Nishigonaka Myodaiji, Okazaki, Aichi 444-8585, Japan
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Zhao X, Liu G, Liu D, Zou L, Huang Q, Chen M, Li D, Wu B, Wu H, Huang D, Wu D. Clinical and economic burden of anxiety/depression among older adult COPD patients: evidence from the COPD-AD China Registry study. Front Psychiatry 2024; 14:1221767. [PMID: 38260779 PMCID: PMC10800442 DOI: 10.3389/fpsyt.2023.1221767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 12/15/2023] [Indexed: 01/24/2024] Open
Abstract
Background Anxiety and depression are common in patients with chronic obstructive pulmonary disease (COPD), especially older adult patients. This can complicate the disease progression and lead to increased clinical and economic burden. We sought to investigate the clinical and economic burdens associated with the presence of anxious and/or depressive symptoms among older adult COPD patients. Methods We screened 579 patients aged over 60 years and diagnosed with COPD via a lung function test following the 2017 Global Initiative Chronic Obstructive Lung Disease (GOLD) guidelines. Anxiety and depression were measured using the Hospital Anxiety and Depression Scale (HADS) through face-to-face interviews at admission. Follow-up was conducted by telephone calls at 6, 12, 18, 24, and 36 months after discharge to assess clinical and economic burden. COPD-anxiety and/or depression patients were matched to patients without anxiety and depression (COPD-only) using propensity scores. Multivariate regression models were used to compare clinical and economic burden between COPD-anxiety and/or depression and COPD-only groups. Results Compared with COPD-only patients, COPD patients complicated with anxiety and/or depression had increased clinical burden, including higher COPD-related outpatient visits, COPD-related hospitalizations, and length of COPD-related hospitalizations (p < 0.001). Moreover, they also had an increased economic burden, including higher annual total healthcare costs, medical costs, and pharmacy costs (p < 0.001). Conclusion Older adult COPD patients with anxiety or depression had significantly higher clinical and economic burdens than patients without these comorbidities. These findings deserve further exploration and may be useful for the formulation of relevant healthcare policies.
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Affiliation(s)
- Xuanna Zhao
- Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Gege Liu
- Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
- First College for Clinical Medicine, Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Dewei Liu
- Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
- First College for Clinical Medicine, Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Li Zou
- Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Qiu Huang
- Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Min Chen
- Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Dongming Li
- Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Bin Wu
- Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Hua Wu
- Department of Information Technology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Dan Huang
- Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Dong Wu
- Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
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Kham-Ai P, Heaton K, Xiao C, Wheeler P. Systematic Review and Meta-Analysis of Psychological Distress and Acute Exacerbation of Chronic Obstructive Pulmonary Disease and Consequences. Nurs Res 2024; 73:62-71. [PMID: 37768970 DOI: 10.1097/nnr.0000000000000694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
BACKGROUND People with chronic obstructive pulmonary disease (COPD) occasionally develop acute exacerbation of COPD-a potentially fatal condition. Psychological distress was associated with acute exacerbation of COPD. However, the evidence on the effect of psychological distress on acute exacerbation of COPD remains unclear. OBJECTIVE The aim of this study was to explore the influence of psychological distress on acute exacerbation of COPD and its consequences. METHODS The current review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines using three databases (PubMed, CINAHL, and PsyINFO) that were searched to identify relevant articles. Pooled risk ratios and 95% confidential interval were calculated from the included studies' data with random-effect methods to estimate the effect of psychological distress on acute exacerbation of COPD and its consequences. RESULTS Nineteen articles were included in the review. Most revealed that psychological distress was significantly associated with increased risk of acute exacerbation of COPD and its consequences. The meta-analyses showed that psychological distress increased risk of acute exacerbation of COPD, COPD-related hospitalization, and death. CONCLUSION Psychological distress had negative effects on acute exacerbation of COPD and its consequences. The results of the meta-analyses show that persons with COPD and psychological distress had a greater risk of acute exacerbation of COPD, hospitalization, and death.
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Jadhav U, Bhanushali J, Sindhu A, Reddy BSK. Navigating Compassion: A Comprehensive Review of Palliative Care in Respiratory Medicine. Cureus 2023; 15:e50613. [PMID: 38226109 PMCID: PMC10788689 DOI: 10.7759/cureus.50613] [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: 11/30/2023] [Accepted: 12/15/2023] [Indexed: 01/17/2024] Open
Abstract
Palliative care has emerged as a crucial aspect of comprehensive healthcare, particularly in respiratory medicine. This review navigates the intricate landscape of palliative care in the context of respiratory diseases, including chronic obstructive pulmonary disease (COPD), idiopathic pulmonary fibrosis (IPF), and lung cancer. The exploration begins with a comprehensive examination of palliative care's definition, significance, and purpose in respiratory medicine. It progresses to understanding common respiratory diseases, their impact on patients' quality of life, and the nuances of disease progression and prognosis. Delving into the principles of palliative care, the review highlights the importance of a patient- and family-centered approach, emphasizing the multidisciplinary collaboration required for holistic care. Symptom management takes center stage, with a detailed exploration of dyspnea, cough, and pain, covering pharmacological and non-pharmacological interventions. The psychosocial and spiritual dimensions are then unveiled, recognizing the psychological impact of respiratory diseases and the significance of addressing spiritual needs with cultural sensitivity. Communication in palliative care is explored through breaking lousy news, advance care planning, and shared decision-making. The section acknowledges the complex considerations surrounding end-of-life care, including recognizing the end-of-life phase, establishing care goals, and withdrawing life-sustaining therapies. Recognizing the indispensable role of caregivers, the review underscores the importance of caregiver support. It delineates strategies for providing emotional and practical support alongside a crucial focus on self-care for caregivers who shoulder the responsibilities of providing palliative care. As the exploration concludes, the challenges in implementing palliative care in respiratory medicine are outlined, from late referrals to communication barriers. However, the review also envisions a future marked by innovation, with emerging approaches, such as telehealth and personalized medicine, offering promising avenues for improvement. Research gaps and areas for improvement are identified, emphasizing the need for a collaborative effort to enhance the quality of palliative care for individuals facing respiratory diseases. The review culminates in a call to action, urging early palliative care integration, investment in education and training, research initiatives, advocacy for accessible services, and collaboration across disciplines. By heeding this call, healthcare providers, researchers, and policymakers can collectively contribute to the evolution and enhancement of palliative care in the challenging landscape of respiratory medicine.
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Affiliation(s)
- Ulhas Jadhav
- Respiratory Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Jay Bhanushali
- Respiratory Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Arman Sindhu
- Respiratory Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Bingu Shiv Kiran Reddy
- Respiratory Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Roberts M, Smith T, Wheatley J, Cho JG. Symptom Burden of Patients with Chronic Obstructive Pulmonary Disease Attending the Westmead Breathlessness Service: Prevalence, Associations, and Sex-Related Differences. Int J Chron Obstruct Pulmon Dis 2023; 18:2825-2837. [PMID: 38053921 PMCID: PMC10695132 DOI: 10.2147/copd.s433541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 11/09/2023] [Indexed: 12/07/2023] Open
Abstract
Purpose Chronic obstructive pulmonary disease (COPD) is a progressive disease resulting in a range of symptoms including breathlessness. "Symptom burden" describes the severity and impact of multiple symptoms in an individual and is best quantified using validated symptom instruments but is not routinely measured in clinical practice. Therefore, we wanted to assess overall symptom burden in patients with moderate-to-severe COPD and find associated independent predictors. Patients and methods A single-centre cross-sectional study of patients with COPD who attended the Westmead Breathlessness Service between March 2017 and May 2022 was conducted. We obtained baseline demographic data, lung function, assessed quality of life (CAT), anxiety/depression (HADS), and measured symptom burden (CMSAS). We compared variables between men and women using unpaired t tests or Mann-Whitney tests for continuous variables, and Fisher's exact tests for categorical variables. We used multiple regression to look for independent predictors of overall symptom burden. Data were analysed using Stata/IC 15.1. Results Eighty-nine patients with COPD, mean age 72.6 years, 55% male, mean FEV1 32% predicted, reported an average of 8.9 symptoms including 6.9 physical and 1.6 psychological symptoms. The most common physical symptoms were shortness of breath (100%) and lack of energy (80%), and the most common psychological symptoms were worrying (65%) and feeling anxious (61%). Median CMSAS total score was higher in women than men (1.34 versus 1.04, respectively; p=0.03) with more women experiencing nervousness (p=0.011) and anxiety (p=0.005). Female sex (p=0.003), HADS-Anxiety (p=0.0001), and HADS-Depression (p=0.0001) were independently associated with total CMSAS score in a multiple linear regression model and explained 63% of total CMSAS variability. Conclusion Very high physical and psychological symptom burden exists among patients with severe COPD. Anxiety, depression, and female sex were independently associated with increasing symptom burden. Identifying and understanding sex differences for COPD symptoms, and interventions targeting anxiety and depression may help to reduce overall symptom burden within this population.
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Affiliation(s)
- Mary Roberts
- Department of Respiratory and Sleep Medicine, Westmead Hospital, Westmead, NSW, Australia
- University of Sydney at Westmead Hospital, Westmead, NSW, Australia
- Ludwig Engel Centre for Respiratory Research, Westmead Institute for Medical Research, Westmead, NSW, Australia
| | - Tracy Smith
- Department of Respiratory and Sleep Medicine, Westmead Hospital, Westmead, NSW, Australia
| | - John Wheatley
- Department of Respiratory and Sleep Medicine, Westmead Hospital, Westmead, NSW, Australia
- University of Sydney at Westmead Hospital, Westmead, NSW, Australia
- Ludwig Engel Centre for Respiratory Research, Westmead Institute for Medical Research, Westmead, NSW, Australia
| | - Jin-Gun Cho
- Department of Respiratory and Sleep Medicine, Westmead Hospital, Westmead, NSW, Australia
- University of Sydney at Westmead Hospital, Westmead, NSW, Australia
- Ludwig Engel Centre for Respiratory Research, Westmead Institute for Medical Research, Westmead, NSW, Australia
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van Dijk SHB, Brusse-Keizer MGJ, Effing T, van der Valk PDLPM, Ploumen EH, van der Palen J, Doggen CJM, Lenferink A. Exploring Patterns of COPD Exacerbations and Comorbid Flare-Ups. Int J Chron Obstruct Pulmon Dis 2023; 18:2633-2644. [PMID: 38022827 PMCID: PMC10657781 DOI: 10.2147/copd.s428960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 11/09/2023] [Indexed: 12/01/2023] Open
Abstract
Background Comorbidities are known to complicate disease management in patients with Chronic Obstructive Pulmonary Disease (COPD). This is partly due to lack of insight into the interplay of acute exacerbations of COPD (AECOPD) and comorbid flare-ups. This study aimed to explore patterns of AECOPDs and comorbid flare-ups. Methods Data of increased symptoms were extracted from a 12-month daily symptom follow-up database including patients with COPD and comorbidities (chronic heart failure (CHF), anxiety, depression) and transformed to visualizations of AECOPDs and comorbid flare-up patterns over time. Patterns were subsequently categorized using an inductive approach, based on both predominance (ie, which occurs most often) of AECOPDs or comorbid flare-ups, and their simultaneous (ie, simultaneous start in ≥ 50%) occurrence. Results We included 48 COPD patients (68 ± 9 years; comorbid CHF: 52%, anxiety: 40%, depression: 38%). In 25 patients with AECOPDs and CHF flare-ups, the following patterns were identified: AECOPDs predominant (n = 14), CHF flare-ups predominant (n = 5), AECOPDs nor CHF flare-ups predominant (n = 6). Of the 24 patients with AECOPDs and anxiety and/or depression flare-ups, anxiety and depression flare-ups occurred simultaneously in 15 patients. In 9 of these 24 patients, anxiety or depression flare-ups were observed independently from each other. In 31 of the included 48 patients, AECOPDs and comorbid flare-ups occurred mostly simultaneously. Conclusion Patients with COPD and common comorbidities show a variety of patterns of AECOPDs and comorbid flare-ups. Some patients, however, show repetitive patterns that could potentially be used to improve personalized disease management, if recognized.
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Affiliation(s)
- Sanne H B van Dijk
- Health Technology & Services Research, TechMed Centre, University of Twente, Enschede, the Netherlands
- Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Marjolein G J Brusse-Keizer
- Health Technology & Services Research, TechMed Centre, University of Twente, Enschede, the Netherlands
- Medical School Twente, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Tanja Effing
- College of Medicine and Public Health, School of Medicine, Flinders University, Adelaide, Australia
- School of Psychology, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
| | | | - Eline H Ploumen
- Health Technology & Services Research, TechMed Centre, University of Twente, Enschede, the Netherlands
- Department of Cardiology, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Job van der Palen
- Medical School Twente, Medisch Spectrum Twente, Enschede, the Netherlands
- Cognition, Data & Education, BMS Faculty, University of Twente, Enschede, the Netherlands
| | - Carine J M Doggen
- Health Technology & Services Research, TechMed Centre, University of Twente, Enschede, the Netherlands
- Clinical Research Centre, Rijnstate Hospital, Arnhem, the Netherlands
| | - Anke Lenferink
- Health Technology & Services Research, TechMed Centre, University of Twente, Enschede, the Netherlands
- Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, the Netherlands
- Clinical Research Centre, Rijnstate Hospital, Arnhem, the Netherlands
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11
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Shen Z, Qiu B, Chen L, Zhang Y. Common gastrointestinal diseases and chronic obstructive pulmonary disease risk: a bidirectional Mendelian randomization analysis. Front Genet 2023; 14:1256833. [PMID: 38046045 PMCID: PMC10690629 DOI: 10.3389/fgene.2023.1256833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 10/26/2023] [Indexed: 12/05/2023] Open
Abstract
Background: Observational studies suggest an association between gastrointestinal diseases and chronic obstructive pulmonary disease (COPD), but the causal relationship remains unclear. Methods: We conducted bidirectional Mendelian randomization (MR) analysis using summary data from genome-wide association study (GWAS) to explore the causal relationship between common gastrointestinal diseases and COPD. Gastrointestinal diseases included gastroesophageal reflux disease (GERD), peptic ulcer disease (PUD), irritable bowel syndrome (IBS), Crohn's disease (CD), ulcerative colitis (UC), functional dyspepsia (FD), non-infectious gastroenteritis (NGE), and constipation (CP). Significant MR analysis results were replicated in the COPD validation cohort. Results: Bidirectional MR analysis supported a bidirectional causal relationship between GERD and COPD, and COPD was also found to increase the risk of IBS and CP. Our study also provided evidence for a bidirectional causal relationship between PUD and COPD, although the strength of evidence may be insufficient. Furthermore, we provided evidence that there is no causal association between CD, UC, FD, NGE, and COPD. Conclusion: This study offers some evidence to clarify the causal relationship between common gastrointestinal diseases and COPD. Further research is needed to understand the underlying mechanisms of these associations.
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Affiliation(s)
- Zixiong Shen
- Department of Thoracic Surgery, The First Hospital of Jilin University, Changchun, China
| | - Binxu Qiu
- Department of Gastrointestinal Surgery, The First Hospital of Jilin University, Changchun, China
| | - Lanlan Chen
- Hepatobiliary and Pancreatic Surgery, The First Hospital of Jilin University, Changchun, China
| | - Yiyuan Zhang
- Department of Thoracic Surgery, The First Hospital of Jilin University, Changchun, China
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12
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Alqahtani MM, Alanazi AMM, Aljohani H, Ismaeil TT, Algarni SS, Alotaibi TF, Alotaibi MM, Kalan ME, Lein DH, Alqahtani MK, Alwadeai KS, Almutairi AB, Hendricks PS. The relationship between chronic lung disease diagnosis and the susceptibility to e-cigarette use in adults: The mediation effects of psychosocial, cognitive influences, and the moderation effect of physiological factors. Tob Induc Dis 2023; 21:116. [PMID: 37745030 PMCID: PMC10515703 DOI: 10.18332/tid/169741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 07/16/2023] [Accepted: 07/19/2023] [Indexed: 09/26/2023] Open
Abstract
INTRODUCTION There is a paucity of studies on e-cigarette use among adults with chronic lung disease. In the present study, we aimed to assess whether psychosocial or cognitive factors elucidate the relationship between chronic lung disease (CLD) and susceptibility to e-cigarette use and whether the relationship between CLD and e-cigarette use is conditional on the presence of respiratory symptoms. METHODS We recruited adults aged ≥18 years in Alabama with CLD from university medical clinics (n=140) and individuals without CLD (n=123 as a reference group). Information on sociodemographics, susceptibility to e-cigarette use, psychosocial factors, and cognitive factors were collected. Mediation analysis was used to assess whether the psychosocial factors or cognitive factors explained the association between CLD and susceptibility to using e-cigarettes, and moderation analysis was conducted to determine if respiratory factors would change the association between CLD and susceptibility to e-cigarette use. RESULTS Psychosocial factors (stress, depression, anxiety) and e-cigarette positive expectancy were notably high among individuals with CLD. Having CLD was associated with a lower likelihood of susceptibility to e-cigarette use. Higher levels of stress, being a smoker, boredom, taste/sensorimotor manipulation, and social facilitation were associated with higher odds of susceptibility to using e-cigarettes among individuals with CLD. Mediation analysis indicated a statistically significant indirect effect of CLD on the susceptibility to using e-cigarettes through stress and boredom reduction. We did not find a statistically significant interaction between CLD and respiratory symptoms affecting susceptibility to using e-cigarettes. CONCLUSIONS Individuals with CLD often exhibit stress, depression, and a positive view of e-cigarettes but are generally less inclined to use them. Stress, smoking habits, boredom, taste, and social influence can increase their susceptibility to e-cigarette use. Our findings call for further exploration to evaluate the temporal relationship between CLD status, psychosocial factors, cognitive factors, and susceptibility to using e-cigarettes. TRIAL REGISTRATION The study was registered on ClinicalTrials.gov, on 5 November 2019. Identifier: NCT04151784.
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Affiliation(s)
- Mohammed M Alqahtani
- Department of Respiratory Therapy, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Department of Respiratory Care, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Abdullah M M Alanazi
- Department of Respiratory Therapy, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Department of Respiratory Care, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Hassan Aljohani
- Department of Respiratory Therapy, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Department of Respiratory Care, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Taha T Ismaeil
- Department of Respiratory Therapy, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Department of Respiratory Care, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Saleh S Algarni
- Department of Respiratory Therapy, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Department of Respiratory Care, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Tareq F Alotaibi
- Department of Respiratory Therapy, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Department of Respiratory Care, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Mansour M Alotaibi
- Department of Physical Therapy, College of Applied Medical Sciences, Northern Border University, Arar, Saudi Arabia
| | | | - Donald H Lein
- Department of Physical Therapy, School of Health Professions, University of Alabama at Birmingham, Birmingham, United States
| | - Mobarak K Alqahtani
- Department of Respiratory Therapy, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Department of Respiratory Care, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Khalid S Alwadeai
- Department of Rehabilitation Science, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Anwar B Almutairi
- Physical Therapy Department, School of Allied Health, Kuwait University, Kuwait City, Kuwait
| | - Peter S Hendricks
- Department of Psychiatry, School of Medicine, University of Alabama at Birmingham, Birmingham, United States
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13
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Patel TA, Jain B, Eala MAB, Manlongat KD, Vapiwala N, Celi LA, Dee EC. Disparities in Receipt of Mental Health Services and Mental Distress Among Patients with Chronic Obstructive Pulmonary Disease. J Gen Intern Med 2023; 38:2849-2851. [PMID: 37349638 PMCID: PMC10506969 DOI: 10.1007/s11606-023-08273-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 06/09/2023] [Indexed: 06/24/2023]
Affiliation(s)
- Tej A Patel
- University of Pennsylvania, Philadelphia, PA, USA
| | - Bhav Jain
- Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Michelle Ann B Eala
- College of Medicine, University of the Philippines, Manila, Philippines
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA, USA
| | | | - Neha Vapiwala
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Leo Anthony Celi
- Harvard Medical School, Boston, MA, USA.
- Laboratory for Computational Physiology, Massachusetts Institute of Technology, Cambridge, MA, USA.
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Edward Christopher Dee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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14
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Mathews AM. The Functional and Psychosocial Consequences of COPD. Respir Care 2023; 68:914-926. [PMID: 37353332 PMCID: PMC10289619 DOI: 10.4187/respcare.10542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/25/2023]
Abstract
COPD is a chronic respiratory disease that commonly coexists with other chronic conditions. These comorbidities have been shown to influence overall disease burden and mortality in COPD, and these comorbidities have an important impact on functional status and other psychosocial factors. Mental health disorders, especially anxiety and depression are common comorbidities in COPD. However, the mechanisms and interactions of anxiety and depression in COPD are poorly understood and these conditions are often underdiagnosed. The interplay between anxiety and depression and COPD is likely multifactorial and complex. An obvious mechanism is the expected psychological consequences of having a chronic illness. However, there is increasing interest in other potential biological processes, such as systemic inflammation, smoking, hypoxia, and oxidative stress. Recognition and diagnosis of comorbid anxiety and depression in patients with COPD is often challenging because there is no consensus on the appropriate screening tools or rating scales to use in this patient population. Despite the challenges in accurate assessment of anxiety and depression, there is growing evidence to support that these comorbid mental health conditions in COPD result in worse outcomes, including poor health-related quality of life, increased exacerbations with associated health-care utilization and cost, increased functional disability, and increased mortality. There are limited data of variable quality on effective treatment and management strategies, both pharmacologic and non-pharmacologic, for anxiety and depression in COPD. However, cumulative evidence demonstrates that complex psychological and lifestyle interventions, which include a pulmonary rehabilitation component, may offer the greatest benefit. The high prevalence and negative impact of depression and anxiety highlights the need for comprehensive, innovative, and standardized chronic disease management programs for individuals with COPD.
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Affiliation(s)
- Anne M Mathews
- Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado.
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15
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Christiansen CF, Løkke A, Bregnballe V, Prior TS, Farver-Vestergaard I. COPD-Related Anxiety: A Systematic Review of Patient Perspectives. Int J Chron Obstruct Pulmon Dis 2023; 18:1031-1046. [PMID: 37304765 PMCID: PMC10257401 DOI: 10.2147/copd.s404701] [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] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 05/30/2023] [Indexed: 06/13/2023] Open
Abstract
Background Anxiety in patients with chronic obstructive pulmonary disease (COPD) is prevalent but often unidentified and therefore not adequately managed. Clinicians find it difficult to detect anxiety symptoms and to differentiate subclinical anxiety from anxiety disorders, because of the considerable overlap between symptoms of COPD and anxiety. Purpose We synthesized existing qualitative research on patients' experiences of COPD-related anxiety with the purpose of gaining a richer understanding and proposing a model of the construct. Methods Searches for qualitative studies of patients' experiences of COPD-related anxiety were conducted independently by two authors in the databases of PubMed (MEDLINE), CINAHL (EBSCO), and PsycInfo (APA). English-language studies including patients diagnosed with COPD were reviewed, and data were analyzed using thematic analysis. Results A total of 41 studies were included in the review. Four themes related to COPD-related anxiety were identified: initial events; internal maintaining factors; external maintaining factors; and behavioral maintaining factors. Based on the identified four themes, a conceptual model of COPD-related anxiety from the patient perspective was developed. Conclusion A conceptual model of COPD-related anxiety from the patient perspective is now available, with the potential to inform future attempts at improving identification and management of COPD-related anxiety. Future research should focus on the development of a COPD-specific anxiety questionnaire containing domains that are relevant from the patient perspective.
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Affiliation(s)
- Camilla F Christiansen
- Department of Medicine, Lillebaelt Hospital, Vejle, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Anders Løkke
- Department of Medicine, Lillebaelt Hospital, Vejle, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | | | - Thomas Skovhus Prior
- Center for Rare Lung Diseases, Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | - Ingeborg Farver-Vestergaard
- Department of Medicine, Lillebaelt Hospital, Vejle, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
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16
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Neale CD, Christensen PE, Dall C, Ulrik CS, Godtfredsen N, Hansen H. Sleep Quality and Self-Reported Symptoms of Anxiety and Depression Are Associated with Physical Activity in Patients with Severe COPD. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16804. [PMID: 36554684 PMCID: PMC9778999 DOI: 10.3390/ijerph192416804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 11/25/2022] [Accepted: 12/07/2022] [Indexed: 06/17/2023]
Abstract
Sleep quantity, quality and symptoms of depression or anxiety potentially affect the level of daily physical activity (PAL) and plausibly counteracts benefits from pulmonary rehabilitation programs. Their collective impact on PAL is sparsely investigated, particularly in patients with severely progressed chronic obstructive pulmonary disease (COPD). Aim: To investigate if sleep quantity, quality and symptoms from self-reported hospital anxiety and depression scores (HADS) are associated with PAL. Methods: In this exploratory cross-sectional study data were analysed from 148 participants with COPD; GOLD grade II-IV; GOLD group B to D (52% female, mean 69.7 ± SD of 8.4 years, FEV1% predicted 33.6 ± 10.9, 6MWD 327 ± 122 m, CAT 20 ± 7 points), eligible for conventional outpatient hospital-based pulmonary rehabilitation. Participants had sleep and PAL measured 24 h per day for five consecutive days with an activPAL monitor. Adjusted negative binomial regression was applied to investigate the associations with PAL. Results: Participants walked median (25th, 75th percentile) of 2358 (1325.75; 3822.25) steps per day and 14% walked >5000 steps per day on average. Time in bed (TIB) were a median (25th, 75th percentile) of 8.3 (7.1; 9.7) hours and numbers of nocturnal sleeping bouts (NSB) were 1.5 (0.8; 3), Anxiety (HADS-A) and depression (HADS-D) scores were median (25th, 75th percentile) of 5 (3; 8) points and 3 (2; 6) points, respectively, whereof 29% (HADS-A) and 15% (HADS-D) reported scores ≥8 points indicating significant symptoms. The fully adjusted rate ratio (RR) for steps per day for TIB (hours) [RR 0.97 (95% CI: 0.92; 1.02)], NSB (numbers) [RR 1.02 (95% CI: 0.97; 1.07)] were not significantly associated with number of steps per day, while there was a significantly association with number of steps per day for HADS-A [RR 1.04 (95% CI: 1.01; 1.07)] and HADS-D [RR 0.95 (95% CI: 0.91; 0.99)]. Conclusion: This exploratory cross-sectional study found a statistically significant association between HADS-A and HADS-D with numbers of steps per day in patients with severe COPD.
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Affiliation(s)
- Christopher D. Neale
- Department of Physical and Occupational Therapy, Copenhagen University Hospital, 2400 Copenhagen, Denmark
| | | | - Christian Dall
- Department of Physical and Occupational Therapy, Copenhagen University Hospital, 2400 Copenhagen, Denmark
- Institute for Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Charlotte Suppli Ulrik
- Institute for Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark
- Respiratory Research Unit and Department of Respiratory Medicine, Copenhagen University Hospital, 2650 Hvidovre, Denmark
| | - Nina Godtfredsen
- Institute for Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark
- Respiratory Research Unit and Department of Respiratory Medicine, Copenhagen University Hospital, 2650 Hvidovre, Denmark
| | - Henrik Hansen
- Respiratory Research Unit and Department of Respiratory Medicine, Copenhagen University Hospital, 2650 Hvidovre, Denmark
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17
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Abudiab S, Fuller-Thomson E. Flourishing despite Chronic Obstructive Pulmonary Disease (COPD): Findings from a Nationally Representative Survey of Canadians Aged 50 and Older. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16337. [PMID: 36498409 PMCID: PMC9735626 DOI: 10.3390/ijerph192316337] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/07/2022] [Accepted: 11/16/2022] [Indexed: 06/17/2023]
Abstract
Chronic Obstructive Pulmonary Disease (COPD) is a leading cause of mortality and is often associated with serious disability and depression. Little is known about the characteristics of those who are in complete mental health (CMH) despite having COPD. This study’s objectives are to: (1) estimate the prevalence and odds of absence of psychiatric disorders (APD) and CMH among older adults that reported having COPD, compared to their peers that did not; (2) identify factors associated with APD and with CMH. Bivariate and logistic regression analyses were conducted using the nationally representative Canadian Community Health Survey—Mental Health. The results indicate that there was a significantly (p < 0.001) lower prevalence of APD (86.7% vs. 95.0%) and CMH (66.7% vs. 77.0%) among older adults aged 50+ with COPD (n = 703) compared to those without COPD (n = 10,189). Half of the sample was female (50.5%) and the majority of whom were under age 70 (62.5%). Factors significantly (p < 0.05) associated with higher odds of APD and of CMH among older adults with COPD include being married, having a confidant, being physically active, and having no lifetime history of major depressive disorder or generalized anxiety disorder. For every additional adverse childhood experience, the odds of APD declined by 31%. The majority of those with COPD are mentally flourishing despite having this disabling and life-threatening disorder. These findings underline the importance of targeted interventions and outreach to those most vulnerable to poorer mental health outcomes including the socially isolated.
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Affiliation(s)
- Sally Abudiab
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON M5S 1V4, Canada
| | - Esme Fuller-Thomson
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON M5S 1V4, Canada
- Institute for Life Course and Aging, University of Toronto, Toronto, ON M5S 1V4, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON M5G 1V7, Canada
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18
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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.
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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
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19
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Connolly M, Ryder M. Consideration of Symptom Management in Advanced Heart Failure. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15160. [PMID: 36429877 PMCID: PMC9690631 DOI: 10.3390/ijerph192215160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/09/2022] [Accepted: 11/16/2022] [Indexed: 06/16/2023]
Abstract
This work provides an opinion on palliative care for people with heart disease. The work focuses on the management of key symptoms associated with both end stage heart disease, applying a palliative approach and suggesting treatment options. The work also indicates the potential for greater collaboration of specialist teams including specialist palliative care in the assessment and management of patients with complex needs as they progress through their disease trajectory. The practical application of evidence-based guidelines and recommendations is key to the successful individualised management of complex symptoms.
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Affiliation(s)
- Michael Connolly
- School of Nursing, Midwifery & Health Systems, University College Dublin, Belfield, D04 V1W8 Dublin, Ireland
- Education & Research Centre, Our Lady’s Hospice & Care Services, Harold’s Cross, D6W RY72 Dublin, Ireland
| | - Mary Ryder
- School of Nursing, Midwifery & Health Systems, University College Dublin, Belfield, D04 V1W8 Dublin, Ireland
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20
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Pelgrim CE, van Ark I, van Berkum RE, Schuitemaker-Borneman AM, Flier I, Leusink-Muis T, Janbazacyabar H, Diks MAP, Gosker HR, Kelders MCJM, Langen RCJ, Schols AMWJ, Hageman RJJ, Braber S, Garssen J, Folkerts G, van Helvoort A, Kraneveld AD. Effects of a nutritional intervention on impaired behavior and cognitive function in an emphysematous murine model of COPD with endotoxin-induced lung inflammation. Front Nutr 2022; 9:1010989. [PMID: 36466426 PMCID: PMC9714332 DOI: 10.3389/fnut.2022.1010989] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 11/02/2022] [Indexed: 08/29/2023] Open
Abstract
One cluster of the extrapulmonary manifestations in chronic obstructive pulmonary disease (COPD) is related to the brain, which includes anxiety, depression and cognitive impairment. Brain-related comorbidities are related to worsening of symptoms and increased mortality in COPD patients. In this study, a murine model of COPD was used to examine the effects of emphysema and repetitive pulmonary inflammatory events on systemic inflammatory outcomes and brain function. In addition, the effect of a dietary intervention on brain-related parameters was assessed. Adult male C57Bl/6J mice were exposed to elastase or vehicle intratracheally (i.t.) once a week on three consecutive weeks. Two weeks after the final administration, mice were i.t. exposed to lipopolysaccharide (LPS) or vehicle for three times with a 10 day interval. A dietary intervention enriched with omega-3 PUFAs, prebiotic fibers, tryptophan and vitamin D was administered from the first LPS exposure onward. Behavior and cognitive function, the degree of emphysema and both pulmonary and systemic inflammation as well as blood-brain barrier (BBB) integrity and neuroinflammation in the brain were assessed. A lower score in the cognitive test was observed in elastase-exposed mice. Mice exposed to elastase plus LPS showed less locomotion in the behavior test. The enriched diet seemed to reduce anxiety-like behavior over time and cognitive impairments associated with the presented COPD model, without affecting locomotion. In addition, the enriched diet restored the disbalance in splenic T-helper 1 (Th1) and Th2 cells. There was a trend toward recovering elastase plus LPS-induced decreased expression of occludin in brain microvessels, a measure of BBB integrity, as well as improving expression levels of kynurenine pathway markers in the brain by the enriched diet. The findings of this study demonstrate brain-associated comorbidities - including cognitive and behavioral impairments - in this murine model for COPD. Although no changes in lung parameters were observed, exposure to the specific enriched diet in this model appeared to improve systemic immune disbalance, BBB integrity and derailed kynurenine pathway which may lead to reduction of anxiety-like behavior and improved cognition.
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Affiliation(s)
- Charlotte E. Pelgrim
- Division of Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands
| | - Ingrid van Ark
- Division of Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands
| | - Ronja E. van Berkum
- Division of Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands
| | - Anne M. Schuitemaker-Borneman
- Division of Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands
| | - Inge Flier
- Division of Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands
| | - Thea Leusink-Muis
- Division of Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands
| | - Hamed Janbazacyabar
- Division of Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands
| | - Mara A. P. Diks
- Division of Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands
| | - Harry R. Gosker
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, Netherlands
| | - Marco C. J. M. Kelders
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, Netherlands
| | - Ramon C. J. Langen
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, Netherlands
| | - Annemie M. W. J. Schols
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, Netherlands
| | | | - Saskia Braber
- Division of Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands
| | - Johan Garssen
- Division of Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands
- Danone Nutricia Research, Utrecht, Netherlands
| | - Gert Folkerts
- Division of Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands
| | - Ardy van Helvoort
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, Netherlands
- Danone Nutricia Research, Utrecht, Netherlands
| | - Aletta D. Kraneveld
- Division of Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands
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21
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National Trends in Prevalence of Depression in Men and Women with Chronic Obstructive Pulmonary Disease Hospitalized in Spain, 2016–2020. J Clin Med 2022; 11:jcm11216337. [PMID: 36362570 PMCID: PMC9655616 DOI: 10.3390/jcm11216337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 10/24/2022] [Accepted: 10/25/2022] [Indexed: 11/23/2022] Open
Abstract
(1) Background: To describe trends in the prevalence of depression in men and women with COPD hospitalized in Spain (2016–2020). (2) Methods: We used a nationwide discharge database to select all patients ≥35 years with COPD. (3) Results: The prevalence of depression was 3.54-times higher in women with COPD than in men (OR 3.54; 95%CI 3.48–3.6). It decreased significantly between 2016 and 2020, although the reduction was only significant in women (12.27% in 2016 vs. 10.56% in 2020). Older age, comorbidity and the most recent years of hospital admission were associated with lower prevalence of depression in both men and women, while obesity, obstructive sleep apnea (OSA) and use of oxygen prior to admission were risk factors. In-hospital mortality (IHM) increased significantly over time. Older age, comorbidity, the use of oxygen prior to admission and having been hospitalized in 2020 increased the risk of IHM. Female sex was associated with a lower IHM in patients with depression and COPD. (4) Conclusions: The prevalence of depression has decreased over time in women with COPD while it has not changed significantly in men with this disease. IHM increased over time both in men and women with COPD and depression, with higher prevalence in the former.
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22
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Aldabayan YS, Alqahtani JS, Al Rajeh AM, Abdelhafez AI, Siraj RA, Thirunavukkarasu V, Aldhahir AM. Prevalence and Predictors of Sleep Disturbance, Anxiety and Depression among Patients with Chronic Respiratory Diseases. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191912819. [PMID: 36232114 PMCID: PMC9566771 DOI: 10.3390/ijerph191912819] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 09/28/2022] [Accepted: 09/29/2022] [Indexed: 05/13/2023]
Abstract
BACKGROUND Poor sleep quality, depression, and anxiety are common comorbidities among individuals with chronic respiratory diseases (CRDs). However, there has been no work to estimate their prevalence and assess their associations among the CRDs population in Saudi Arabia. METHODS A cross-sectional study was conducted in primary healthcare centers and included a total of 390 patients. Structured self-administered questionnaires were completed that included the Sleep Quality Pittsburgh Sleep Quality Index (PSQI) and Hospital Anxiety and Depression Score (HADS). Multiple linear regression analyses were performed to assess the associations between patients' characteristics and sleep disturbance, anxiety and depression. RESULTS Poor sleep quality, depression, and anxiety affect 75%, 49.2%, and 36.4% of the study participants, respectively. The PSQI was significantly correlated with anxiety (r = 0.30) and depression (r = 0.16). Furthermore, a significant correlation was found between anxiety and depression (r = 0.44). The predictors of poor sleep quality were age, gender, and family history of CRDs, education level and anxiety and these variables accounted for 0.19% of the variance in PSQI. Variables that independently predicted an increased level of depression were age, gender, marital status, family history of CRDs, diagnosis, previous hospital admission, the presence of comorbidities, dyspnea last month and anxiety. On the other hand, the variables that independently predicted an increased level of anxiety were age, BMI, family history of CRDs, previous hospital admission, the presence of comorbidities, dyspnea last month and depression. CONCLUSION Healthcare providers managing patients with CRDs should be alert to the high prevalence of poor sleep quality, depression, and anxiety. Appropriate interventions to reduce the prevalence should be developed and timely applied.
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Affiliation(s)
- Yousef S. Aldabayan
- Department of Respiratory Care, King Faisal University, Al Ahsa 31982, Saudi Arabia
- Correspondence:
| | - Jaber S. Alqahtani
- Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam 34313, Saudi Arabia
| | - Ahmed M. Al Rajeh
- Department of Respiratory Care, King Faisal University, Al Ahsa 31982, Saudi Arabia
| | - Amal Ismael Abdelhafez
- Department of Nursing, King Faisal University, Al Ahsa 31982, Saudi Arabia
- Department of Critical Care & Emergency Nursing, Assiut University, Asyut 71717, Egypt
| | - Rayan A. Siraj
- Department of Respiratory Care, King Faisal University, Al Ahsa 31982, Saudi Arabia
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23
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Heijmans M, Poortvliet R, Van der Gaag M, González-González AI, Beltran Puerta J, Canelo-Aybar C, Valli C, Ballester M, Rocha C, Garcia ML, Salas-Gama K, Kaloteraki C, Santero M, Niño de Guzmán E, Spoiala C, Gurung P, Moaddine S, Willemen F, Cools I, Bleeker J, Kancheva A, Ertl J, Laure T, Kancheva I, Pacheco-Barrios K, Zafra-Tanaka J, Mavridis D, Angeliki Veroniki A, Zevgiti S, Seitidis G, Alonso-Coello P, Groene O, Sunol R, Orrego C. Using a Taxonomy to Systematically Identify and Describe Self-Management Interventions Components in Randomized Trials for COPD. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191912685. [PMID: 36231985 PMCID: PMC9566761 DOI: 10.3390/ijerph191912685] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 09/26/2022] [Accepted: 09/30/2022] [Indexed: 05/19/2023]
Abstract
Self-management interventions (SMIs) may improve outcomes in Chronic Obstructive Pulmonary Disease (COPD). However, accurate comparisons of their relative effectiveness are challenging, partly due to a lack of clarity and detail regarding the intervention content being evaluated. This study systematically describes intervention components and characteristics in randomized controlled trials (RCTs) related to COPD self-management using the COMPAR-EU taxonomy as a framework, identifying components that are insufficiently incorporated into the design of the intervention or insufficiently reported. Overall, 235 RCTs published between 2010 and 2018, from a systematic review were coded using the taxonomy, which includes 132 components across four domains: intervention characteristics, expected patient (or caregiver) self-management behaviours, patient relevant outcomes, and target population characteristics. Risk of bias was also assessed. Interventions mainly focused on physical activity (67.4%), and condition-specific behaviours like breathing exercise (63.5%), self-monitoring (50.8%), and medication use (33.9%). Support techniques like education and skills-training, self-monitoring, and goal setting (over 35% of the RCTs) were mostly used for this. Emotional-based techniques, problem-solving, and shared decision-making were less frequently reported (less than 15% of the studies). Numerous SMIs components were insufficiently incorporated into the design of COPD SMIs or insufficiently reported. Characteristics like mode of delivery, intensity, location, and providers involved were often not described. Only 8% of the interventions were tailored to the target population's characteristics. Outcomes that are considered important by patients were hardly taken into account. There is still a lot to improve in both the design and description of SMIs for COPD. Using a framework such as the COMPAR-EU SMI taxonomy may contribute to better reporting and to better informing of replication efforts. In addition, prospective use of the taxonomy for developing and reporting intervention content would further aid in building a cumulative science of effective SMIs in COPD.
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Affiliation(s)
- Monique Heijmans
- Netherlands Institute for Health Services Research (NIVEL), 3513 Utrecht, The Netherlands
- Correspondence:
| | - Rune Poortvliet
- Netherlands Institute for Health Services Research (NIVEL), 3513 Utrecht, The Netherlands
| | - Marieke Van der Gaag
- Netherlands Institute for Health Services Research (NIVEL), 3513 Utrecht, The Netherlands
| | - Ana I. González-González
- Avedis Donabedian Research Institute (FAD), 08037 Barcelona, Spain
- Faculty of Medicine, Universitat Autònoma de Barcelona (UAB), 08025 Barcelona, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), 28029 Madrid, Spain
| | - Jessica Beltran Puerta
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), 08025 Barcelona, Spain
| | - Carlos Canelo-Aybar
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), 08025 Barcelona, Spain
| | - Claudia Valli
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), 08025 Barcelona, Spain
| | - Marta Ballester
- Avedis Donabedian Research Institute (FAD), 08037 Barcelona, Spain
- Faculty of Medicine, Universitat Autònoma de Barcelona (UAB), 08025 Barcelona, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), 28029 Madrid, Spain
| | - Claudio Rocha
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), 08025 Barcelona, Spain
| | - Montserrat León Garcia
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), 08025 Barcelona, Spain
| | - Karla Salas-Gama
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), 08025 Barcelona, Spain
| | - Chrysoula Kaloteraki
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), 08025 Barcelona, Spain
| | - Marilina Santero
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), 08025 Barcelona, Spain
| | - Ena Niño de Guzmán
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), 08025 Barcelona, Spain
| | - Cristina Spoiala
- Netherlands Institute for Health Services Research (NIVEL), 3513 Utrecht, The Netherlands
| | - Pema Gurung
- Netherlands Institute for Health Services Research (NIVEL), 3513 Utrecht, The Netherlands
| | - Saida Moaddine
- Netherlands Institute for Health Services Research (NIVEL), 3513 Utrecht, The Netherlands
| | - Fabienne Willemen
- Netherlands Institute for Health Services Research (NIVEL), 3513 Utrecht, The Netherlands
| | - Iza Cools
- Netherlands Institute for Health Services Research (NIVEL), 3513 Utrecht, The Netherlands
| | - Julia Bleeker
- Netherlands Institute for Health Services Research (NIVEL), 3513 Utrecht, The Netherlands
| | - Angelina Kancheva
- Netherlands Institute for Health Services Research (NIVEL), 3513 Utrecht, The Netherlands
| | - Julia Ertl
- Netherlands Institute for Health Services Research (NIVEL), 3513 Utrecht, The Netherlands
| | - Tajda Laure
- Netherlands Institute for Health Services Research (NIVEL), 3513 Utrecht, The Netherlands
| | - Ivana Kancheva
- Netherlands Institute for Health Services Research (NIVEL), 3513 Utrecht, The Netherlands
| | - Kevin Pacheco-Barrios
- Avedis Donabedian Research Institute (FAD), 08037 Barcelona, Spain
- Faculty of Medicine, Universitat Autònoma de Barcelona (UAB), 08025 Barcelona, Spain
| | - Jessica Zafra-Tanaka
- Avedis Donabedian Research Institute (FAD), 08037 Barcelona, Spain
- Faculty of Medicine, Universitat Autònoma de Barcelona (UAB), 08025 Barcelona, Spain
| | - Dimitris Mavridis
- Department of Primary Education, School of Education, University of Ioannina, 45110 Ioannina, Greece
| | - Areti Angeliki Veroniki
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON M5B 1W8, Canada
- Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON M5S 3G8, Canada
| | - Stella Zevgiti
- Department of Primary Education, School of Education, University of Ioannina, 45110 Ioannina, Greece
| | - Georgios Seitidis
- Department of Primary Education, School of Education, University of Ioannina, 45110 Ioannina, Greece
| | - Pablo Alonso-Coello
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), 08025 Barcelona, Spain
| | | | - Rosa Sunol
- Avedis Donabedian Research Institute (FAD), 08037 Barcelona, Spain
- Faculty of Medicine, Universitat Autònoma de Barcelona (UAB), 08025 Barcelona, Spain
| | - Carola Orrego
- Avedis Donabedian Research Institute (FAD), 08037 Barcelona, Spain
- Faculty of Medicine, Universitat Autònoma de Barcelona (UAB), 08025 Barcelona, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), 28029 Madrid, Spain
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Ramos-Vera C, Saintila J, O'Diana AG, Calizaya-Milla YE. Identifying latent comorbidity patterns in adults with perceived cognitive impairment: Network findings from the behavioral risk factor surveillance system. Front Public Health 2022; 10:981944. [PMID: 36203679 PMCID: PMC9530468 DOI: 10.3389/fpubh.2022.981944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 08/30/2022] [Indexed: 01/25/2023] Open
Abstract
Background People with cognitive impairment may be exposed to an increased risk of comorbidities; however, the clustering of comorbidity patterns in these patients is unclear. Objective To explore the network structure of chronic comorbidity in a U.S. national sample spanning all 50 U.S. states with more than 170,000 participants reporting perceived cognitive impairment. Methods This is a cross-sectional study conducted using Behavioral Risk Factor Surveillance System (BRFSS) secondary data collected in 2019 and covering 49 U.S. states, the District of Columbia, Guam, and the Commonwealth of Puerto Rico. A total of 15,621 non-institutionalized U.S. adult participants who reported "yes" to the subjective cognitive impairment question were considered, of whom 7,045 were men and 8,576 were women. All participants were aged 45 years or older. A statistical graphical model was used that included clustering algorithms and factorization of variables in a multivariate network relationship system [exploratory graphical analysis (EGA)]. Results The results of the EGA show associations between the comorbid conditions evaluated. These associations favored the clustering of various comorbidity patterns. In fact, three patterns of comorbidities have been identified: (1) arthritis, asthma, respiratory diseases, and depression, (2) obesity, diabetes, blood pressure high, and blood cholesterol high, and (3) heart attack, coronary heart disease, stroke, and kidney disease. Conclusion These results suggest the development of interdisciplinary treatment strategies in patients with perceived cognitive impairment, which could help to design an integrated prevention and management of the disease and other related health problems, such as Alzheimer's disease and related dementias.
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Affiliation(s)
- Cristian Ramos-Vera
- Research Area, Faculty of Health Sciences, Universidad César Vallejo, Lima, Peru
| | - Jacksaint Saintila
- Escuela de Medicina Humana, Universidad Señor de Sipán, Chiclayo, Peru,*Correspondence: Jacksaint Saintila
| | - Angel García O'Diana
- Research Area, Faculty of Health Sciences, Universidad César Vallejo, Lima, Peru
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Hao R, Zhang M, Jin H, Zuo J, Hu J. Construction of the health risk assessment index system for assessing the chronic diseases based on the general health. J Family Med Prim Care 2022; 11:5527-5534. [PMID: 36505657 PMCID: PMC9731059 DOI: 10.4103/jfmpc.jfmpc_2110_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 06/14/2022] [Accepted: 06/27/2022] [Indexed: 11/07/2022] Open
Abstract
Aims This study aimed to construct a standardized health risk assessment index system (HRAIS) under the guidance of general health and facilitate the family doctors to carry out chronic disease management. Methods Available chronic disease surveillance systems and indexes were reviewed to identify potential indexes. The Delphi method was performed to establish the HRAIS, and the analytic hierarchy process was used to calculate the index weight. Results HRAIS included four first-level indexes and 38 second-level indexes. The authority coefficient was 0.86. The Kendall's W for the two rounds of Delphi consultation were 0.202 and 0.210 (p < 0.001). The weights of the first-level indexes from high to low were physiological health (0.409), psychosocial health (0.290), health-related behaviors (0.205), and environment (0.097). Thus, HRAIS is a multi-dimension and multi-index tool, which can be used as a guideline for family doctors in early screening, early intervention, and classified management of main chronic diseases.
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Affiliation(s)
- Ran Hao
- Department of Clinical Humanistic Care and Nursing Research Center, School of Nursing, Hebei Medical University, Shijiazhuang, Hebei, China
| | - Meng Zhang
- Department of Clinical Humanistic Care and Nursing Research Center, School of Nursing, Hebei Medical University, Shijiazhuang, Hebei, China,Intensive Care Unit, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Haoyu Jin
- Department of Clinical Humanistic Care and Nursing Research Center, School of Nursing, Hebei Medical University, Shijiazhuang, Hebei, China
| | - Jinfan Zuo
- Department of Clinical Humanistic Care and Nursing Research Center, School of Nursing, Hebei Medical University, Shijiazhuang, Hebei, China
| | - Jie Hu
- Department of Clinical Humanistic Care and Nursing Research Center, School of Nursing, Hebei Medical University, Shijiazhuang, Hebei, China,Department of Science and Technology, Hebei Medical University, Shijiazhuang, Hebei, China,Address for correspondence: Prof. Jie Hu, Department of Science and Technology, Hebei Medical University, Shijiazhuang, Hebei, China. E-mail:
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Anlló H, Larue F, Herer B. Anxiety and Depression in Chronic Obstructive Pulmonary Disease: Perspectives on the Use of Hypnosis. Front Psychol 2022; 13:913406. [PMID: 35664144 PMCID: PMC9161213 DOI: 10.3389/fpsyg.2022.913406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 04/22/2022] [Indexed: 11/13/2022] Open
Abstract
Chronic Obstructive Pulmonary Disease (COPD) is a highly prevalent and debilitating respiratory condition, characterized by chronic airflow limitation, breathlessness, and other persistent respiratory symptoms. Critically, patients suffering from COPD often find themselves trapped in a vicious comorbidity cycle: while breathlessness and increased respiratory rate are known inducers of anxiety, the latter have been shown in turn to exacerbate breathlessness and chest discomfort. Hypnosis holds great potential for the simultaneous complementary management of anxiety and breathlessness in COPD. It is an inexpensive psychological intervention tailored to the patient's own experience, convenient in terms of logistics and implementation. In this short qualitative review, we present hypnosis' structural, cognitive, and neural fundamentals, and assess existing instances of hypnosis use in the treatment of anxiety, depression, and respiratory disease. We then discuss its potential as a tool for improving health-related quality of life and the self-management of COPD within (and beyond) pulmonary rehabilitation.
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Affiliation(s)
- Hernán Anlló
- Laboratory of Cognitive and Computational Neuroscience, Department of Cognitive Studies, École Normale Supérieure de Paris, PSL University, Paris, France
- Complementary Care and Behavior Research Team, Bligny Hospital Center, Briis-sous-Forges, France
| | - François Larue
- Complementary Care and Behavior Research Team, Bligny Hospital Center, Briis-sous-Forges, France
- Palliative Care Unit, Bligny Hospital Center, Briis-sous-Forges, France
| | - Bertrand Herer
- Complementary Care and Behavior Research Team, Bligny Hospital Center, Briis-sous-Forges, France
- Pneumology Unit, Bligny Hospital Center, Briis-sous-Forges, France
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27
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Lokesh KS, Rao AA, Chaya SK, Jayaraj BS, Praveena AS, Krishna M, Madhivanan P, Padukudru Anand M. Associations of Vitamin D, chronic obstructive pulmonary disease and acute exacerbations of COPD with anxiety and depression: a nested case control study. Wellcome Open Res 2022. [DOI: 10.12688/wellcomeopenres.17439.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Lower vitamin D levels have not only been associated with chronic obstructive pulmonary disease (COPD), exacerbations and lower lung functions, but also with anxiety and depression. We examined the associations of severity of anxiety and depression using HAM-A (Hamilton Anxiety Rating Scale) and HAM-D (Hamilton Depression Rating Scale) scores with COPD and vitamin D levels. Methods: Observational nested case control study was conducted in MUDHRA cohort. One hundred COPD subjects and 100 age- gender- matched non-COPD subjects (controls) underwent evaluation of socioeconomic status, respiratory symptoms, spirometry, severity of anxiety and depression, six minute walk test and estimation of serum vitamin D levels. Independent association of low vitamin D levels with severity of anxiety and depression was assessed by logistic regression. Results: COPD group had higher mean±SD anxiety and depression scores (HAM-A 8.0±3.5, HAM-D 8.72±4) compared to control group (HAM-A 4.51±2.2, HAM-D 4.3±2). The COPD group had 53 subjects with mild/moderate anxiety/depression whereas control group had 16 subjects with mild/moderate anxiety/depression. In COPD group, subjects with mild/moderate anxiety/depression had lower vitamin D levels compared to subjects with no/minimal anxiety/depression, while the difference in control group was not significant. In logistic regression, anxiety and depression levels had independent association with vitamin D levels, lung function variables, six-minute walk distance and presence of COPD. In COPD subgroup, anxiety and depression levels had independent association with breathlessness, GOLD FEV1 staging, CAT score, SGRQ-C Symptom score and exacerbation of COPD. Conclusions: Greater proportion of COPD subjects suffer from anxiety and depression as compared to subjects without COPD. Severity of anxiety and depression was greater in COPD subjects. Poorer lung functions, higher respiratory symptoms and lower vitamin D levels are associated with higher levels of anxiety and depression in COPD subjects. There is an urgent need to recognise anxiety and depression in COPD patients.
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Chiu YC, Lee SW, Liu CW, Lan TY, Wu LSH. Relationship between gut microbiota and lung function decline in patients with chronic obstructive pulmonary disease: a 1-year follow-up study. Respir Res 2022; 23:10. [PMID: 35033061 PMCID: PMC8760664 DOI: 10.1186/s12931-022-01928-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 01/05/2022] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory lung disease characterized by a persistent limitation in airflow. Gut microbiota is closely correlated with lung inflammation. However, gut microbiota has not been studied in patients with declining lung function, due to chronic lung disease progression. SUBJECTS AND METHODS Stool samples were obtained from 55 patients with COPD that were in stable condition at enrolment (stage 1) and at a 1-year follow-up (stage 2). After extracting stool DNA, we performed next generation sequencing to analyse the distribution of gut microbiota. RESULTS Patients were divided to control and declining lung function groups, based on whether the rate of forced expiratory volume in 1 s (FEV1) had declined over time. An alpha diversity analysis of initial and follow-up stool samples showed a significant difference in the community richness of microbiota in the declining function group, but not in the control group. At the phylum level, Bacteroidetes was more abundant in the control group and Firmicutes was more abundant in the declining function group. The Alloprevotella genus was more abundant in the control group than in the declining function group. At 1-year follow-up, the mean proportions of Acinetobacter and Stenotrophomonas significantly increased in the control and declining function groups, respectively. CONCLUSION Some community shifts in gut microbiota were associated with lung function decline in COPD patients under regular treatment. Future studies should investigate the mechanism underlying alterations in lung function, due to changes in gut bacterial communities, in COPD.
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Affiliation(s)
- Yu-Chi Chiu
- Department of Internal Medicine, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan.,Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Department of Nursing, Yuanpei University of Medical Technology, Hsinchu, Taiwan
| | - Shih-Wei Lee
- Department of Internal Medicine, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan
| | - Chi-Wei Liu
- Department of Internal Medicine, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan
| | - Tzuo-Yun Lan
- Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, Taipei, Taiwan.
| | - Lawrence Shih-Hsin Wu
- Graduate Institute of Biomedical Sciences, China Medical University, No. 91 Hsueh-Shih Road, Taichung, 404, Taiwan. .,Center of Allergy, Immunology, and Microbiome (A.I.M.), China Medical University Children's Hospital, Taichung, Taiwan.
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Cravo A, Attar D, Freeman D, Holmes S, Ip L, Singh SJ. The Importance of Self-Management in the Context of Personalized Care in COPD. Int J Chron Obstruct Pulmon Dis 2022; 17:231-243. [PMID: 35095272 PMCID: PMC8791295 DOI: 10.2147/copd.s343108] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 12/20/2021] [Indexed: 01/13/2023] Open
Abstract
Despite current guidelines and decades of evidence on the benefits of a self-management approach, self-management of COPD remains relatively under-utilized in clinical care compared with other chronic diseases. However, self-management interventions can play a valuable role in supporting people with COPD to respond to changing symptoms, and thereby make appropriate decisions regarding the management of their own chronic condition. In this review, we discuss the history and evolution of the concept of self-management, assess current multidisciplinary support programs and clinical interactions designed to optimize self-management, and reflect on how effective these are in terms of clinical and humanistic outcomes. We also evaluate the mechanisms for encouraging change from protocol-based care towards a more personalized care approach, and discuss the role of digital self-management interventions and the importance of addressing health inequalities in COPD treatment, which have been accelerated by the COVID-19 pandemic. Reflecting on the importance of self-management in the context of symptom monitoring and provision of educational support, including information from patient organizations and charities, we discuss the ideal components of a self-management plan for COPD and provide six key recommendations for its implementation: 1) better education for healthcare professionals on disease management and consultation skills; 2) new targets and priorities for patient-focused outcomes; 3) skills gap audits to identify barriers to self-management; 4) best practice sharing within primary care networks and ongoing professional development; 5) enhanced initial consultations to establish optimal self-management from the outset; and 6) negotiation and sharing of self-management plans at the point of diagnosis.
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Affiliation(s)
- Ana Cravo
- Medical Affairs, Boehringer Ingelheim Ltd, Bracknell, UK
| | - Darush Attar
- North Central London Clinical Commissioning Group (CCG), London, UK
| | | | - Steve Holmes
- The Park Medical Practice, Shepton Mallet, UK
- Correspondence: Steve Holmes The Park Medical Practice, Cannard’s Grave Road, Shepton Mallet, Somerset, BA4 5RT, UKTel +44 1749 334383 Email
| | - Lindsay Ip
- King’s Health Partners and Ealing Community Partners, London, UK
| | - Sally J Singh
- Faculty of Health and Life Sciences, Coventry University, Coventry, UK
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
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Watson A, Wilkinson TMA. Digital healthcare in COPD management: a narrative review on the advantages, pitfalls, and need for further research. Ther Adv Respir Dis 2022; 16:17534666221075493. [PMID: 35234090 PMCID: PMC8894614 DOI: 10.1177/17534666221075493] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) remains a leading cause of morbidity and mortality despite current treatment strategies which focus on smoking cessation, pulmonary rehabilitation, and symptomatic relief. A focus of COPD care is to encourage self-management, particularly during COVID-19, where much face-to-face care has been reduced or ceased. Digital health solutions may offer affordable and scalable solutions to support COPD patient education and self-management, such solutions could improve clinical outcomes and expand service reach for limited additional cost. However, optimal ways to deliver digital medicine are still in development, and there are a number of important considerations for clinicians, commissioners, and patients to ensure successful implementation of digitally augmented care. In this narrative review, we discuss advantages, pitfalls, and future prospects of digital healthcare, which offer a variety of tools including self-management plans, education videos, inhaler training videos, feedback to patients and healthcare professionals (HCPs), exacerbation monitoring, and pulmonary rehabilitation. We discuss the key issues with sustaining patient and HCP engagement and limiting attrition of use, interoperability with devices, integration into healthcare systems, and ensuring inclusivity and accessibility. We explore the essential areas of research beyond determining safety and efficacy to understand the acceptability of digital healthcare solutions to patients, clinicians, and healthcare systems, and hence ways to improve this and sustain engagement. Finally, we explore the regulatory challenges to ensure quality and engagement and effective integration into current healthcare systems and care pathways, while maintaining patients’ autonomy and privacy. Understanding and addressing these issues and successful incorporation of an acceptable, simple, scalable, affordable, and future-proof digital solution into healthcare systems could help remodel global chronic disease management and fractured healthcare systems to provide best patient care and optimisation of healthcare resources to meet the global burden and unmet clinical need of COPD.
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Affiliation(s)
- Alastair Watson
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UKNIHR Southampton Biomedical Research Centre, University Hospital Southampton, Southampton, UKCollege of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Tom M A Wilkinson
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK. NIHR Southampton Biomedical Research Centre, University Hospital Southampton, Southampton, UK
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Howell D. Enabling patients in effective self-management of breathlessness in lung cancer: the neglected pillar of personalized medicine. Lung Cancer Manag 2021; 10:LMT52. [PMID: 34899992 PMCID: PMC8656340 DOI: 10.2217/lmt-2020-0017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 05/20/2021] [Indexed: 11/21/2022] Open
Abstract
Globally, engagement of patients in the self management of disease and symptom problems has become a health policy priority to improve health outcomes in cancer. Unfortunately, little attention has been focused on the provision of self-management support (SMS)in cancer and specifically for complex cancer symptoms such as breathlessness. Current management of breathlessness, which includes treatment of underlying disease, pharmacological agents to address comorbidities and opiates and anxiolytics to change perception and reduce the sense of breathing effort, is inadequate. In this perspective paper, we review the rationale and evidence for a structured, multicomponent SMS program in breathlessness including four components: breathing retraining, enhancing positive coping skills, optimizing exertional capacity and reducing symptom burden and health risks. The integration of SMS in routine lung cancer care is essential to improve breathlessness, reduce psychological distress, suffering and improve quality of life.
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Affiliation(s)
- Doris Howell
- Princess Margaret Cancer Research Centre, Toronto, ON, Canada
- Faculty of Nursing, University of Toronto, Toronto, ON, Canada
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Verkleij M, Appelman I, Altenburg J, Twisk J, Quittner AL, Haarman E. Anxiety and depression in Dutch patients with primary ciliary dyskinesia and their caregivers: associations with health-related quality of life. ERJ Open Res 2021; 7:00274-2021. [PMID: 34708110 PMCID: PMC8542938 DOI: 10.1183/23120541.00274-2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 07/02/2021] [Indexed: 11/12/2022] Open
Abstract
Background Primary ciliary dyskinesia (PCD) might be a risk factor for the development of anxiety and depression. This study investigated the associations between anxiety, depression and health-related quality of life (HRQoL) in individuals with PCD and their caregivers. Methods Children, adolescents and adults with PCD and their caregivers were invited to participate in a mental health screening programme. During regular yearly outpatient visits, measures of anxiety (GAD-7), depression (PHQ-9), HRQoL (QOL-PCD), lung function (forced expiratory volume in 1 s (FEV1)) and body mass index (BMI)) were collected and associations of anxiety, depression and HRQoL were estimated. Results A total of 103 individuals participated in the mental health screening programme. Elevated levels of anxiety (scores ≥10 on GAD-7) were found in 6% of adults (n=33), 14% of children (n=7), 6% of adolescents (n=17) and 20% of caregivers (n=46, 52% of mothers). Elevated depression levels (scores ≥10 on PHQ-9) were found in 18% of adults, 14% of children, 6% of adolescents and 11% of caregivers. Anxiety and depression were associated with scales on the QOL-PCD. Mothers reported higher anxiety scores than fathers (30% versus 9%, p=0.03). A strong negative relationship was found between depression in caregivers and physical functioning (QOL-PCD) of the child. Anxiety and depression were not significantly associated with anxiety/depression in their child. Conclusion This is the first study investigating anxiety and depression in individuals with PCD and their caregivers. Our results revealed elevated levels of anxiety and depression, which were associated with worse HRQoL. These results suggest the need for psychological support in PCD. Individuals with PCD and their caregivers are at risk of developing symptoms of anxiety and depression, which are associated with worse HRQoL. There is an urgent need for psychological care in PCD, especially in adults with PCD and caregivers.https://bit.ly/3rmbgc9
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Affiliation(s)
- Marieke Verkleij
- Dept of Pediatric Psychology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Iris Appelman
- Dept of Pediatric Psychology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Josje Altenburg
- Dept of Pulmonology, Amsterdam UMC, Amsterdam, the Netherlands
| | - Jos Twisk
- Dept of Epidemiology and Data Science, Amsterdam UMC, Amsterdam, the Netherlands
| | | | - Eric Haarman
- Dept of Pediatric Pulmonology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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Sakharkar P, Mai T. Co-Occurring Depression and Associated Healthcare Utilization and Expenditure in Individuals with Respiratory Condition: A Population-Based Study. PHARMACY 2021; 9:pharmacy9040157. [PMID: 34698242 PMCID: PMC8544672 DOI: 10.3390/pharmacy9040157] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 09/13/2021] [Accepted: 09/23/2021] [Indexed: 11/16/2022] Open
Abstract
The existing literature is limited on the prevalence of depression among people with respiratory conditions and person-level factors that are associated with increased healthcare utilization and expenditures. The aim of this study was to explore the prevalence, pattern of healthcare use, and expenditures in noninstitutionalized individuals having co-occurring depression with respiratory conditions. The Medical Expenditure Panel Survey (MEPS) data from 2011 to 2017 was used in this study. Our sample included individuals having respiratory conditions (asthma, emphysema, and chronic bronchitis) with and without depression. Healthcare use and expenditure data were analyzed using a chi-square test, t-tests, and multiple linear regression analyses. There were 8848 individuals in the study. The prevalence of comorbid depression was 20%. Individuals with co-occurring depression with respiratory conditions differed significantly from individuals without co-occurring depression for age ≥ 45 years, white, and with ≤2 chronic disease conditions. Depressed individuals with respiratory conditions had higher healthcare utilization and expenditures. The presence of co-occurring depression with respiratory conditions increases the treatment complexity, healthcare utilization, and expenditure. Better treatment and management of these patients may reduce healthcare use and expenditures in the future.
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Affiliation(s)
- Prashant Sakharkar
- Department of Clinical and Administrative Sciences, College of Science, Health and Pharmacy, Roosevelt University, Schaumburg, IL 60173, USA
- Correspondence: ; Tel.: +1-847-240-4077
| | - Thanh Mai
- College of Pharmacy and Health Sciences, Western New England University, Springfield, MA 01119, USA;
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Racial Disparities in Health Risk Indicators Reported by Alabamians Diagnosed with COPD. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18189662. [PMID: 34574587 PMCID: PMC8470414 DOI: 10.3390/ijerph18189662] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/01/2021] [Accepted: 09/09/2021] [Indexed: 12/27/2022]
Abstract
Chronic Obstructive Pulmonary Disease (COPD) is a growing public health problem in the southern United States, particularly in Alabama. However, very little is known about specific health risk factors disproportionately impacting Alabamians with COPD. We conducted a latent class analysis of 2015–2019 Behavioral Risk Factor Surveillance System data from 4057 Alabamians with COPD (White = 2947, Black = 873, Other = 237). Eighteen risk indicators were examined across three health-related domains: (1) comorbidities, (2) limited healthcare access, and (3) substance use/abuse. Racial disparities between Black and white Alabamians with COPD were assessed using configural similarity analysis. Findings showed that almost one-third (31%) of Alabamians with COPD were in the high-risk class for eight comorbidities, and nearly one-half (48.88%) belonged to the high-risk class for limited healthcare access. Black Alabamians with COPD who did not have health insurance were much more likely to be at high risk for limited healthcare access (94.44%) when compared to their counterparts with insurance (5.56%), χ2(df = 2) = 1389.94, p < 0.0001. Furthermore, the proportion of high-risk, uninsured Black Alabamians with COPD (94.44%) substantially exceeded the percentage of high-risk, uninsured white Alabamians with COPD (59.70%). Most Alabamians with COPD (82.97%) were at low risk for substance use/abuse. Future research should explore new mechanisms for facilitating better healthcare access among high-risk Alabamians living with COPD and other prevalent comorbidities. Greater attention should be focused on Black Alabamians with COPD who cannot afford adequate health insurance.
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Impact of Frailty on Hippocampal Volume in Patients with Chronic Obstructive Pulmonary Disease. Biomedicines 2021; 9:biomedicines9091103. [PMID: 34572291 PMCID: PMC8468719 DOI: 10.3390/biomedicines9091103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 08/22/2021] [Accepted: 08/25/2021] [Indexed: 12/11/2022] Open
Abstract
Brain frailty may be related to the pathophysiology of poor clinical outcomes in chronic obstructive pulmonary disease (COPD). This study examines the relationship between hippocampal subfield volumes and frailty and depressive symptoms, and their combined association with quality of life (QOL) in patients with COPD. The study involved 40 patients with COPD. Frailty, depressive symptoms and QOL were assessed using Kihon Checklist (KCL), Hospital Anxiety and Depression Scale (HADS), and World Health Organization Quality of Life Assessment (WHO/QOL-26). Anatomical MRI data were acquired, and volumes of the hippocampal subfields were obtained using FreeSurfer (version 6.0). Statistically, HADS score had significant association with WHO/QOL-26 and KCL scores. KCL scores were significantly associated with volumes of left and right whole hippocampi, presubiculum and subiculum, but HADS score had no significant association with whole hippocampi or hippocampal subfield volumes. Meanwhile, WHO/QOL-26 score was significantly associated with volume of the left CA1. There was a significant association between frailty, depression, and QOL. Hippocampal pathology was related to frailty and, to some extent, with QOL in patients with COPD. Our results suggest the impact of frailty on hippocampal volume and their combined associations with poor QOL in COPD.
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Liang Z, Wang Q, Fu C, Liu R, Wang L, Pei G, Xu L, He C, Wei Q. What conservative interventions can improve the long-term quality of life, depression, and anxiety of individuals with stable COPD? A systematic review and meta-analysis. Qual Life Res 2021; 31:977-989. [PMID: 34383225 DOI: 10.1007/s11136-021-02965-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2021] [Indexed: 02/05/2023]
Abstract
PURPOSE Many conservative interventions are used in the management of stable chronic obstructive pulmonary disease (COPD). It could be helpful for the prescribers to know what the evidence suggests about the effects of these interventions on the long-term quality of life (QoL), depression, and anxiety. This study aimed to summarize the rationale for the use of conservative interventions to improve the long-term QoL, depression, and anxiety in patients with stable COPD. METHODS The MEDLINE, Embase, Cochrane Library, and Web of Science databases were searched from database inception to December 2019. Randomized clinical trials (RCTs) investigating the long-term effects of conservative interventions on three parameters, including QoL, depression, and anxiety in patients with COPD were eligible for further analysis. To improve methodological rigor, only RCTs examining these parameters as primary outcomes were included. The standardized mean differences (SMD) with 95% confidence intervals (CIs) were calculated using random effects models. Quality of evidence was rated using the updated version of Van Tulder's criteria. RESULTS Thirty-eight RCTs were identified. Regarding long-term depression, there was moderate evidence supporting cognitive behavioral therapy compared with usual care in patients with COPD; regarding the long-term QoL of patients with COPD, there was limited evidence supporting walking programs, supplementary sugarcane bagasse dietary fiber, roflumilast, and tiotropium. CONCLUSIONS Cognitive behavioral therapy is effective in alleviating the long-term depression of patients with COPD. Evidence for other interventions was insufficient, making it difficult to draw conclusions in terms of their effectiveness on the long-term QoL, depression, and anxiety.
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Affiliation(s)
- Zejun Liang
- Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China.,Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Qian Wang
- Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China.,Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Chenying Fu
- State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Rui Liu
- Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China.,Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Lu Wang
- Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China.,Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Gaiqin Pei
- Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China.,Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Lin Xu
- Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China.,Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Chengqi He
- Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China.,Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Quan Wei
- Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China. .,Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
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Kelly M, Steed L, Sohanpal R, Pinnock H, Barradell A, Dibao-Dina C, Mammoliti KM, Wileman V, Rowland V, Newton S, Moore A, Taylor S. The TANDEM trial: protocol for the process evaluation of a randomised trial of a complex intervention for anxiety and/or depression in people living with chronic obstructive pulmonary disease (COPD). Trials 2021; 22:495. [PMID: 34311766 PMCID: PMC8313120 DOI: 10.1186/s13063-021-05460-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 07/15/2021] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND TANDEM is a randomised controlled trial of a complex healthcare intervention to improve the psychological and physical health of people living with chronic obstructive pulmonary disease (COPD) and anxiety and/or depression. Based on health psychology theory set out in a logic model, respiratory health professionals were recruited and trained to deliver a cognitive behavioural approach intervention (The TANDEM intervention) under the supervision of senior cognitive behavioural practitioners. Here, we describe the protocol for the process evaluation commissioned alongside the trial. A realist approach that includes attention to describing contexts and mechanisms has been adopted. METHODS We set up a multi-disciplinary team to develop and deliver the process evaluation. The mixed-methods design incorporates quantitative process data; monitoring of intervention fidelity; qualitative interviews with patients, carers, health professionals (facilitators) and clinical supervisors about their perspectives on acceptability of the intervention; and exploration with all stakeholders (including management/policy-makers) on future implementation. Normalisation process theory (NPT) will inform data collection and interpretation with a focus on implementation. Quantitative process data will be analysed descriptively. Qualitative interview data will be analysed before the trial outcomes are known using analytic induction and constant comparison to develop themes. Findings from the different elements will be reported separately and then integrated. CONCLUSION Detailed description and analysis of study processes in a research trial such as TANDEM enables research teams to describe study contexts and mechanisms and to examine the relationship with outcomes. In this way, learning from the trial goes beyond the randomised control trial (RCT) model where effectiveness is prioritised and makes it possible to explore issues arising for post-trial study implementation. TRIAL REGISTRATION ISRCTN ISRCTN59537391 . Registered on 20 March 2017. Trial protocol version 6.0, 22 April 2018. Process evaluation protocol version 4.0, 1 November 2020.
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Affiliation(s)
- Moira Kelly
- Centre for Primary Care and Mental Health, Institute of Population Health Sciences, Barts and The London School of Medicine and Dentistry, Yvonne Carter Building, 58, Turner Street, London, E1 2AB, UK.
| | - Liz Steed
- Centre for Primary Care and Mental Health, Institute of Population Health Sciences, Barts and The London School of Medicine and Dentistry, Yvonne Carter Building, 58, Turner Street, London, E1 2AB, UK
| | - Ratna Sohanpal
- Centre for Primary Care and Mental Health, Institute of Population Health Sciences, Barts and The London School of Medicine and Dentistry, Yvonne Carter Building, 58, Turner Street, London, E1 2AB, UK
| | - Hilary Pinnock
- Allergy and Respiratory Research Group, Usher Institute of Population Health Sciences and Informatics, Doorway 3, Medical School, Teviot Place, Edinburgh, EH8 9AG, UK
| | - Amy Barradell
- Department of Respiratory Sciences, College of Life Sciences, NIHR Leicester Biomedical Research Centre- Respiratory Glenfield Hospital, University of Leicester, Groby Road, Leicester, LE3 9QP, UK
| | - Clarisse Dibao-Dina
- Université de Tours, Université de Nantes, INSERM, SPHERE U1246, 10 Boulevard Tonnellé, B.P. 3223, 37044, Tours, cedex 1, France
| | - Kristie-Marie Mammoliti
- Birmingham Clinical Trials Unit and WHO Collaborating Centre for Global Women's Health Research, University of Birmingham, Birmingham, B15 2TT, UK
| | - Vari Wileman
- Centre for Primary Care and Mental Health, Institute of Population Health Sciences, Barts and The London School of Medicine and Dentistry, Yvonne Carter Building, 58, Turner Street, London, E1 2AB, UK
| | - Vickie Rowland
- Department of Health & Social Sciences, University of the West of England, Frenchay Campus, Coldharbour Lane, Bristol, BS16 1QY, UK
| | - Sian Newton
- Centre for Primary Care and Mental Health, Institute of Population Health Sciences, Barts and The London School of Medicine and Dentistry, Yvonne Carter Building, 58, Turner Street, London, E1 2AB, UK
| | - Anna Moore
- The Education Academy, Barts Health NHS Trust, Royal London Hospital, Whitechapel Road, London, E1 1FR, UK
| | - Stephanie Taylor
- Centre for Primary Care and Mental Health, Institute of Population Health Sciences, Barts and The London School of Medicine and Dentistry, Yvonne Carter Building, 58, Turner Street, London, E1 2AB, UK
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Fairlamb HJ, Murtagh FEM. Health professionals' perceptions of palliative care for end-stage cardiac and respiratory conditions: a qualitative interview study. BMC Palliat Care 2021; 20:103. [PMID: 34233688 PMCID: PMC8265062 DOI: 10.1186/s12904-021-00805-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 06/11/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND End-stage cardiac and respiratory diseases are common in the UK. People with these end-stage conditions experience similar, or even worse, symptomatic suffering to cancer patients but are less likely to receive specialist palliative care services. The objective of this study is to explore health professional perceptions and current practices in relation to specialist palliative care for patients with end-stage cardiac and respiratory disease. METHODS Qualitative study using in-depth interviews with health professionals, audio recorded and transcribed verbatim for thematic analysis. The study was conducted with doctors and nurses from cardiology, respiratory, and palliative care specialities in the UK. The participants had to be involved clinically in providing care to people with end-stage cardiac or respiratory diseases. RESULTS A total of 16 health professionals participated (5 cardiology, 5 respiratory, and 6 palliative care). Participants reported variable disease trajectories in these diseases making deciding on timing of palliative care involvement difficult. This was complicated by lack of advance care planning discussions, attributed to poor communication, and lack of health professional time and confidence. Participants reported poor interdepartmental education and limited specialist palliative care involvement in multidisciplinary teams. CONCLUSIONS Palliative care for end-stage cardiac and respiratory diseases needs more attention in research and practice. Better integration of advance care planning discussions and early patient education/professional awareness are needed to enable timely referral to palliative care. Moreover, increased interdepartmental working for health professionals via joint educational and clinical meetings is perceived as likely to support earlier and increased referral to specialist palliative care services.
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Affiliation(s)
| | - Fliss E M Murtagh
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
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Prevalence and Determinants of Mental Health among COPD Patients in a Population-Based Sample in Spain. J Clin Med 2021; 10:jcm10132786. [PMID: 34202915 PMCID: PMC8268632 DOI: 10.3390/jcm10132786] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 05/29/2021] [Accepted: 06/23/2021] [Indexed: 11/24/2022] Open
Abstract
(1) Background: To assess the prevalence of mental disorders (depression and anxiety), psychological distress, and psychiatric medications consumption among persons suffering from COPD; to compare this prevalence with non-COPD controls and to identify which variables are associated with worse mental health. (2) Methods: This is an epidemiological case-control study. The data were obtained from the Spanish National Health Survey 2017. Subjects were classified as COPD if they reported suffering from COPD and the diagnosis of this condition had been confirmed by a physician. For each case, we selected a non-COPD control matched by sex, age, and province of residence. Conditional logistic regression was used for multivariable analysis. (3) Results: The prevalence of mental disorders (33.9% vs. 17.1%; p < 0.001), psychological distress (35.4% vs. 18.2%; p < 0.001), and psychiatric medications consumption (34.1% vs. 21.9%; p < 0.001) was higher among COPD cases compared with non-COPD controls. After controlling for possible confounding variables, such as comorbid conditions and lifestyles, using multivariable regression, the probability of reporting mental disorders (OR 1.41; 95% CI 1.10–1.82).), psychological distress (OR 1.48; 95% CI 1.12–1.91), and psychiatric medications consumption (OR 1.38 95% CI 1.11–1.71) remained associated with COPD. Among COPD cases, being a woman, poor self-perceived health, more use of health services, and active smoking increased the probability of suffering from mental disorders, psychological distress, and psychiatric medication use. Stroke and chronic pain were the comorbidities more strongly associated with these mental health variables. (4) Conclusions: COPD patients have worse mental health and higher psychological distress and consume more psychiatric medications than non-COPD matched controls. Variables associated with poorer mental health included being a woman, poor self-perceived health, use of health services, and active smoking.
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Giri PC, Stevens GJ, Merrill-Henry J, Oyoyo U, Balasubramanian VP. Participation in pulmonary hypertension support group improves patient-reported health quality outcomes: a patient and caregiver survey. Pulm Circ 2021; 11:20458940211013258. [PMID: 34035896 PMCID: PMC8132099 DOI: 10.1177/20458940211013258] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 03/12/2021] [Indexed: 11/29/2022] Open
Abstract
Support group participation has been shown to be effective in many chronic medical conditions. The evidence for integrating support group into pulmonary hypertension care and its effect on quality of life, physical and psychological well-being is limited. We sought to assess the effect of support group participation on quality of life in patients diagnosed with pulmonary hypertension and their caregivers. The emPHasis-10 questionnaire (a tool validated for quality of life assessment in pulmonary hypertension) was used to evaluate the effect of support group participation. Additional demographic and health-related quality measures were examined. Results showed that 165 subjects were enrolled in the study; 122 (74.4%) were patients with pulmonary hypertension, 41 (25.0%) were their caregivers, and 2 (0.02%) did not respond. The cohort was predominantly female (n = 128, 78%), Caucasian (n = 10, 61%), and the principal self-reported classification of pulmonary hypertension was World Health Organization Group 1 (n = 85, 51.8%) and the self-reported New York Heart Association Functional Class was II and III (n = 43, 57.3%). Most participants (n = 118, 71.5%) attended support groups and of them, a majority (n = 107, 90.6%) stated it helped them. There was no difference in quality of life as assessed by emPHasis-10 scores with support group participation (median score 30 vs 32, p = 0.387). There was self-reported improvement in understanding condition better including procedures such as right heart catheterization, medication compliance, and confidence in self-care (p < 0.05). Using multivariate logistic regression, baseline variables that were independently associated with emPHasis-10 scores for the entire cohort included knowledge of New York Heart Association Functional Class (odds ratio: 1.919, 95% CI: 1.004–3.67, p = 0.04) and greater distance traveled to visit pulmonary hypertension physician (odds ratio: 1.391, 95% CI: 0.998--1.94, p = 0.05). In conclusion, support group participation does not improve quality of life as assessed by emPHasis-10 scores but improves other meaningful health-related quality outcomes.
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Affiliation(s)
- Paresh C Giri
- Pulmonary and Critical Care Department, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Gizelle J Stevens
- Pulmonary and Critical Care Department, Loma Linda University Medical Center, Loma Linda, CA, USA
| | | | - Udochukwu Oyoyo
- Department of Dental Education Services, Loma Linda University School of Dentistry, Loma Linda, CA, USA
| | - Vijay P Balasubramanian
- Pulmonary and Critical Care Department, University of California San Francisco-Fresno, Fresno, CA, USA
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Wańkowicz P, Szylińska A, Rotter I. The Impact of the COVID-19 Pandemic on Psychological Health and Insomnia among People with Chronic Diseases. J Clin Med 2021; 10:jcm10061206. [PMID: 33799371 PMCID: PMC7998391 DOI: 10.3390/jcm10061206] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 03/11/2021] [Accepted: 03/12/2021] [Indexed: 12/24/2022] Open
Abstract
The outbreak of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic highlighted the serious problems of health care systems but also threatened the mental and physical health of patients worldwide. The goal of this study was to assess psychological health and insomnia in people with chronic diseases in the time of elevated stress associated with the pandemic. The study involved 879 people from Zachodniopomorskie province in Poland. Each participant provided basic demographic data, data on symptoms of insomnia, depression, anxiety and information on concomitant diseases such as hypertension, diabetes mellitus, coronary heart disease, heart failure, dyslipidemia, chronic obstructive pulmonary disease, Hashimoto’s disease and smoking cigarettes. Chronic diseases included in this study showed a strong correlation between Hashimoto’s disease and increase scores according to the Insomnia Severity Index (ISI, r = 0.797, p < 0.001), the Generalized Anxiety Disorder scale (GAD-7, r = 0.766, p < 0.001) and the Patient Health Questionnaire (PHQ-9, r = 0.767, p < 0.001). After the results were corrected for age, gender, diagnosed hypertension, dyslipidemia and cigarette smoking, it was confirmed that the diagnosis of Hashimoto’s disease was associated with an increased risk of anxiety (odds ratio (OR) = 2.225; p < 0.001), depression (OR = 2.518; p < 0.001) and insomnia (OR = 3.530; p < 0.001). Our study showed that during the SARS-CoV-2 pandemic patients with Hashimoto’s disease show a higher risk of insomnia, anxiety and depression.
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Martucci VL, Richmond B, Davis LK, Blackwell TS, Cox NJ, Samuels D, Velez Edwards D, Aldrich MC. Fate or coincidence: do COPD and major depression share genetic risk factors? Hum Mol Genet 2021; 30:619-628. [PMID: 33704461 DOI: 10.1093/hmg/ddab068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 02/24/2021] [Accepted: 02/27/2021] [Indexed: 01/12/2023] Open
Abstract
Major depressive disorder (MDD) is a common comorbidity in chronic obstructive pulmonary disease (COPD), affecting up to 57% of patients with COPD. Although the comorbidity of COPD and MDD is well established, the causal relationship between these two diseases is unclear. A large-scale electronic health record clinical biobank and genome-wide association study summary statistics for MDD and lung function traits were used to investigate potential shared underlying genetic susceptibility between COPD and MDD. Linkage disequilibrium score regression was used to estimate genetic correlation between phenotypes. Polygenic risk scores (PRS) for MDD and lung function traits were developed and used to perform a phenome-wide association study (PheWAS). Multi-trait-based conditional and joint analysis identified single-nucleotide polymorphisms (SNPs) influencing both lung function and MDD. We found genetic correlations between MDD and all lung function traits were small and not statistically significant. A PRS-MDD was significantly associated with an increased risk of COPD in a PheWAS [odds ratio (OR) = 1.12, 95% confidence interval (CI): 1.09-1.16] when adjusting for age, sex and genetic ancestry, but this relationship became attenuated when controlling for smoking history (OR = 1.08, 95% CI: 1.04-1.13). No significant associations were found between the lung function PRS and MDD. Multi-trait-based conditional and joint analysis identified three SNPs that may contribute to both traits, two of which were previously associated with mood disorders and COPD. Our findings suggest that the observed relationship between COPD and MDD may not be driven by a strong shared genetic architecture.
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Affiliation(s)
- Victoria L Martucci
- Vanderbilt Genetics Institute, Vanderbilt University School of Medicine, Nashville, TN 37232, USA.,Division of Genetic Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Bradley Richmond
- Department of Veterans Affairs Medical Center, Nashville, TN 37212, USA.,Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Lea K Davis
- Vanderbilt Genetics Institute, Vanderbilt University School of Medicine, Nashville, TN 37232, USA.,Division of Genetic Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37232, USA.,Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Timothy S Blackwell
- Department of Veterans Affairs Medical Center, Nashville, TN 37212, USA.,Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN 37232, USA.,Department of Cell and Developmental Biology, Vanderbilt University School of Medicine, Nashville, TN 37232, USA
| | - Nancy J Cox
- Vanderbilt Genetics Institute, Vanderbilt University School of Medicine, Nashville, TN 37232, USA.,Division of Genetic Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - David Samuels
- Vanderbilt Genetics Institute, Vanderbilt University School of Medicine, Nashville, TN 37232, USA.,Department of Molecular Physiology and Biophysics, Vanderbilt University School of Medicine, Nashville, TN 37232, USA
| | - Digna Velez Edwards
- Vanderbilt Genetics Institute, Vanderbilt University School of Medicine, Nashville, TN 37232, USA.,Division of Quantitative Sciences, Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN 37232, USA.,Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Melinda C Aldrich
- Vanderbilt Genetics Institute, Vanderbilt University School of Medicine, Nashville, TN 37232, USA.,Division of Genetic Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37232, USA.,Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN 37232, USA.,Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, TN 37232, USA.,Division of Epidemiology, Vanderbilt University Medical Center, Nashville, TN 37232, USA
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Assessment of Stress, Depressive and Anxiety Symptoms in Patients with COPD during In-Hospital Pulmonary Rehabilitation: An Observational Cohort Study. ACTA ACUST UNITED AC 2021; 57:medicina57030197. [PMID: 33669130 PMCID: PMC7996584 DOI: 10.3390/medicina57030197] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 02/18/2021] [Accepted: 02/20/2021] [Indexed: 12/21/2022]
Abstract
Background and Objectives: The relationship between physical health and mental health has been considered for years. A number of studies have shown a correlation between depressive states and the progress of somatic diseases. It seems that the proper cooperation of specialists may result in the improvement of the patient’s well-being and a positive effect on the course of the rehabilitation process. The aim of this study was to assess the symptoms of depression, anxiety, and stress in patients with chronic obstructive pulmonary disease (COPD) as well as the assessment of the relationship of psychological symptoms with sociodemographic factors and physical condition. Materials and Methods: The study enrolled 51 COPD patients who underwent a three-week pulmonary rehabilitation program. After admission to the rehabilitation department, the subjects were asked to complete the Hospital Anxiety and Depression Scale (HADS) questionnaire, the Perception of Stress Questionnaire (PSQ), and a sociodemographic questionnaire. Results: Anxiety states were diagnosed in 70% of respondents and depressive states were diagnosed in 54% of patients. Some of the respondents (14%) also showed a tendency to experience various grounded stresses. Additionally, there were correlations between the mental state and the results of fitness and respiratory tests. Conclusions: Patients with COPD are at risk for mental disorders, which may adversely affect their general health and significantly limit their physical and respiratory efficiencies. The development of widely available therapeutic solutions to reduce symptoms associated with depression, anxiety, and stress seems to be an important challenge for the management of patients with COPD.
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Zhang Y, Zhao X. Effects of the Health Belief Model-Based Intervention on Anxiety, Depression, and Quality of Life in Chronic Obstructive Pulmonary Disease. Neuroimmunomodulation 2021; 28:129-136. [PMID: 34062535 DOI: 10.1159/000512993] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 11/09/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a chronic respiratory condition. COPD causes a heavy burden on the patients through negative impacts on the quality of life and psychological health. The health belief model (HBM) is proposed and modified by several social psychologists and is confirmed to have benefits in the recovery of various diseases. This research aimed to explore the effects of the HBM-based intervention on anxiety, depression, and quality of life in COPD patients entering pulmonary rehabilitation (PR). METHODS This research was conducted at the Tianjin Rehabilitation Recuperate Center of Chinese PLA in 2019. A total of 136 COPD patients were randomized into the intervention group and the control group. In the control group, patients received the PR program. In the intervention group, patients received both PR program and the HBM-based intervention. Quality of life was measured by the COPD assessment test. The outcomes of anxiety and depression were measured by the Hospital Anxiety and Depression Scale. RESULTS The HBM-based intervention decreased both anxiety and depression scores among COPD patients. The COPD assessment test score was declined by the HBM-based intervention, which also decreased the serum levels of interleukin-6 and C-reactive protein in COPD patients entering PR. CONCLUSION The HBM-based intervention alleviates anxiety and depression, enhances quality of life, and inhibits inflammation in COPD patients entering PR.
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Affiliation(s)
- Yating Zhang
- Department of Respiratory, Tianjin Chest Hospital, Tianjin, China
| | - Xiangfang Zhao
- Department of Geriatrics Ward, Tianjin Rehabilitation Recuperate Center of Chinese PLA, Tianjin, China
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Anlló H, Herer B, Delignières A, Bocahu Y, Segundo I, Mach Alingrin V, Gilbert M, Larue F. Hypnosis for the Management of Anxiety and Dyspnea in COPD: A Randomized, Sham-Controlled Crossover Trial. Int J Chron Obstruct Pulmon Dis 2020; 15:2609-2620. [PMID: 33122899 PMCID: PMC7591014 DOI: 10.2147/copd.s267019] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 09/23/2020] [Indexed: 12/13/2022] Open
Abstract
Background Patients with chronic obstructive pulmonary disease (COPD) are prone to dyspnea, increased respiratory rate and other anxiety-inducing symptoms. Hypnosis constitutes a complementary procedure capable of improving subjective feelings of anxiety. Objective Assessing the efficacy of a 15-minute hypnosis intervention for immediate improvement of anxiety in severe COPD patients. Methods Twenty-one participants, COPD patients (mean FEV1 < 32.3%), were randomly assigned to two individual sessions in crossover (sham and hypnosis, 24-h washout period, arms: hypnosis-sham [n=11]/sham-hypnosis [n=10]). We tracked pre- and post-intervention anxiety (STAI-6 score) as primary endpoint. Results Nineteen (90.5%) participants completed the study. Anxiety diminished significantly after hypnosis (STAI-6 scores −23.8% [SD = 18.4%] hypnosis vs −3.1% [32.8%] sham; χ2=8, P<0.01, Bayes Factor 5.5). Respiratory rate also decreased after hypnosis. Improvements in SpO2 and Borg exertion scores were registered after both conditions. Conclusion A 15-minute hypnosis session improved participants’ anxiety and lowered respiratory rate (as opposed to sham). Improvements in anxiety were correlated with an alleviation in respiratory strain. Results imply that hypnosis can contribute to the improvement of anxiety levels and breathing mechanics in severe COPD patients. Registration Id ISRCTN10029862.
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Affiliation(s)
- Hernán Anlló
- Clinical Hypnosis Research Team, Bligny Hospital Center, Briis-sous-Forges, France.,Watanabe Cognitive Science Laboratory, School of Fundamental Science and Engineering. Waseda University, Tokyo, Japan
| | - Bertrand Herer
- Clinical Hypnosis Research Team, Bligny Hospital Center, Briis-sous-Forges, France.,Pneumology Unit, Bligny Hospital Center, Briis-sous-Forge, France
| | - Agathe Delignières
- Clinical Hypnosis Research Team, Bligny Hospital Center, Briis-sous-Forges, France.,Counselling and Psychological Care Unit, Bligny Hospital Center, Briis-sous-Forge, France
| | - Yolaine Bocahu
- Clinical Hypnosis Research Team, Bligny Hospital Center, Briis-sous-Forges, France.,Pneumology Unit, Bligny Hospital Center, Briis-sous-Forge, France
| | - Isabelle Segundo
- Clinical Hypnosis Research Team, Bligny Hospital Center, Briis-sous-Forges, France.,Pneumology Unit, Bligny Hospital Center, Briis-sous-Forge, France
| | - Valérie Mach Alingrin
- Clinical Hypnosis Research Team, Bligny Hospital Center, Briis-sous-Forges, France.,Palliative Care Unit, Bligny Hospital Center, Briis-sous-Forge, France
| | - Marion Gilbert
- Clinical Hypnosis Research Team, Bligny Hospital Center, Briis-sous-Forges, France.,Pneumology Unit, Bligny Hospital Center, Briis-sous-Forge, France
| | - François Larue
- Clinical Hypnosis Research Team, Bligny Hospital Center, Briis-sous-Forges, France.,Palliative Care Unit, Bligny Hospital Center, Briis-sous-Forge, France
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Veeraboina N, Doshi D, Kulkarni S, Patanapu SK, Dantala SN, Adepu S. Association of state and trait anxiety with oral health status among adult dental patients. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:e2020070. [PMID: 32921765 PMCID: PMC7716995 DOI: 10.23750/abm.v91i3.8986] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Accepted: 11/02/2019] [Indexed: 11/23/2022]
Abstract
Background: Dental caries and periodontal diseases are the most prevalent oral health problems worldwide. Behavioral and psychosocial factors along with social, economic and cultural conditions may alter the health balance, favoring the onset of dental diseases. Hence the study was conducted to assess the association of state and trait anxiety with oral health status among adult dental patients. Methods: The study was carried out among 456 adult dental patients visiting Panineeya Institute of Dental Sciences and Hospital, Hyderabad. Anxiety levels were measured by State-Trait Anxiety Inventory-short version (STAI-S) consisting subscales State Anxiety (SA) and Trait Anxiety (TA). Clinical examination was done using WHO Basic Oral Health survey assessment form, 2013. The data was analyzed using Statistical Package for Social Sciences Software 21.0. p≤0.05 was considered statistically significant. Results: A significant gender difference (p=0.001) was noted for total anxiety with higher mean score observed among males (46.13±5.98) than females (45.32±6.00).Similarly, significant higher mean score was observed among males (23.31±4.08) than females (p=0.03) for State anxiety. Females had higher mean DMFT (3.61±3.21), DT (2.04±2.05), FT (0.49±1.34) and MT (1.08±2.09) components but significant difference was noted only for overall DMFT (p=0.03) and DT (p=0.001) component than males. Conclusion: Gender, education and previous dental visits didn’t show any significant association with total anxiety, state and trait anxiety. Likewise, none of the oral parameters showed any significant association except for the Decayed Teeth (DT) component of DMFT with total anxiety levels among study subjects. (www.actabiomedica.it)
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Long J, Ouyang Y, Duan H, Xiang Z, Ma H, Ju M, Sun D. Multiple Factor Analysis of Depression and/or Anxiety in Patients with Acute Exacerbation Chronic Obstructive Pulmonary Disease. Int J Chron Obstruct Pulmon Dis 2020; 15:1449-1464. [PMID: 32606653 PMCID: PMC7310996 DOI: 10.2147/copd.s245842] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 04/30/2020] [Indexed: 01/05/2023] Open
Abstract
Objective To reveal the risk factors, the symptom distribution characteristics, the clinical values of white blood cell counts (WBC counts), red blood cell distribution width (RDW), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and monocyte-to-lymphocyte ratio (MLR) in hospitalized patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) combined with depression and/or anxiety. Methods The study included prospective cross-sectional and case-control studies, and was executed in the Affiliated Hospital of Zunyi Medical University, Guizhou, China. Previously diagnosed chronic obstructive pulmonary disease (COPD) patients who admitted to the hospital with AECOPD, patients with depression and/or anxiety, and healthy people were enrolled in the study. The Hamilton Rating Scales were used to assess all subjects, and the complete blood counts (CBC) were collected. Baseline data and clinical measurement data [spirometry, arterial blood gas analysis, and COPD evaluation test (the CAT scale)] from patients with AECOPD were collected. Results Of the 307 patients with AECOPD included, 63.5% (N=195) had depressive and/or anxiety symptoms, and 36.5% (N=112) had no symptoms. Sex, respiratory failure, number of comorbidities, number of acute exacerbations in the previous year and the CAT score were closely related to AECOPD combined with depression and/or anxiety (p<0.05). The CAT scale score were the independent risk factor (OR=6.576, 95% CI 3.812-11.342) and significant predictor of AECOPD with depression and/or anxiety (AUC=0.790,95% CI 0.740-0.834); the patients with depression and/or anxiety were more severe and characteristic than the patients with AECOPD combined with depression and/or anxiety; RDW was associated with AECOPD with depression and/or anxiety (p=0.020, OR1.212,95% CI1.03-1.426), and had certain clinical diagnostic value (AUC=0.570,95% CI 0.531-0.626). Conclusion Depression and anxiety should not be ignored in patients with AECOPD. The severity and quality of life of COPD were closely related to the occurrence of depression and/or anxiety symptoms. In most cases, perhaps depression and anxiety in AECOPD are only symptoms and not to the extents of the diseases. RDW had clinical diagnostic value in AECOPD combined with depression and/or anxiety. NLR, PLR, MLR, and RDW may become the novel indicators for evaluating the degree of inflammation of AECOPD and deserve further research.
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Affiliation(s)
- Jian Long
- Department of Respiratory Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi City, Guizhou, People’s Republic of China
- Zunyi Fifth People’s Hospital (Zunyi Mental Health Center), Zunyi City, Guizhou, People’s Republic of China
| | - Yao Ouyang
- Department of Respiratory Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi City, Guizhou, People’s Republic of China
| | - Haizhen Duan
- Department of Emergency Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi City, Guizhou, People’s Republic of China
| | - Zhongyong Xiang
- Zunyi Fifth People’s Hospital (Zunyi Mental Health Center), Zunyi City, Guizhou, People’s Republic of China
| | - Hongchang Ma
- Zunyi Fifth People’s Hospital (Zunyi Mental Health Center), Zunyi City, Guizhou, People’s Republic of China
| | - Mingliang Ju
- Shanghai Mental Health Center Affiliated to School of Medicine, Shanghai Jiao Tong University, Shanghai City, People’s Republic of China
| | - Desheng Sun
- Department of Respiratory Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi City, Guizhou, People’s Republic of China
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Meijer E, van Eeden AE, Kruis AL, Boland MRS, Assendelft WJJ, Tsiachristas A, Rutten-van Mölken MPMH, Kasteleyn MJ, Chavannes NH. Exploring characteristics of COPD patients with clinical improvement after integrated disease management or usual care: post-hoc analysis of the RECODE study. BMC Pulm Med 2020; 20:176. [PMID: 32552784 PMCID: PMC7302138 DOI: 10.1186/s12890-020-01213-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 06/10/2020] [Indexed: 11/23/2022] Open
Abstract
Background The cluster randomized controlled trial on (cost-)effectiveness of integrated chronic obstructive pulmonary disease (COPD) management in primary care (RECODE) showed that integrated disease management (IDM) in primary care had no effect on quality of life (QOL) in COPD patients compared with usual care (guideline-supported non-programmatic care). It is possible that only a subset of COPD patients in primary care benefit from IDM. We therefore examined which patients benefit from IDM, and whether patient characteristics predict clinical improvement over time. Method Post-hoc analyses of the RECODE trial among 1086 COPD patients. Logistic regression analyses were performed with baseline characteristics as predictors to examine determinants of improvement in QOL, defined as a minimal decline in Clinical COPD Questionnaire (CCQ) of 0.4 points after 12 and 24 months of IDM. We also performed moderation analyses to examine whether predictors of clinical improvement differed between IDM and usual care. Results Regardless of treatment type, more severe dyspnea (MRC) was the most important predictor of clinically improved QOL at 12 and 24 months, suggesting that these patients have most room for improvement. Clinical improvement with IDM was associated with female gender (12-months) and being younger (24-months), and improvement with usual care was associated with having a depression (24-months). Conclusions More severe dyspnea is a key predictor of improved QOL in COPD patients over time. More research is needed to replicate patient characteristics associated with clinical improvement with IDM, such that IDM programs can be offered to patients that benefit the most, and can potentially be adjusted to meet the needs of other patient groups as well. Trial registration Netherlands Trial Register, NTR2268. Registered 31 March 2010.
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Affiliation(s)
- Eline Meijer
- Department of Public Health and Primary Care, Leiden University Medical Centre, PO Box 9600, 2300 RC, Leiden, Netherlands.
| | - Annelies E van Eeden
- Department of Public Health and Primary Care, Leiden University Medical Centre, PO Box 9600, 2300 RC, Leiden, Netherlands
| | - Annemarije L Kruis
- Department of Public Health and Primary Care, Leiden University Medical Centre, PO Box 9600, 2300 RC, Leiden, Netherlands
| | - Melinde R S Boland
- Institute of Health, Policy & Management, Erasmus University Rotterdam, PO Box 1738, 3000 DR, Rotterdam, Netherlands
| | - Willem J J Assendelft
- Department of Primary and Community Care, Radboud University Medical Centre, 6500 HB, Nijmegen, Netherlands
| | - Apostolos Tsiachristas
- Institute of Health, Policy & Management, Erasmus University Rotterdam, PO Box 1738, 3000 DR, Rotterdam, Netherlands.,Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, OX3 7LF, UK
| | | | - Marise J Kasteleyn
- Department of Public Health and Primary Care, Leiden University Medical Centre, PO Box 9600, 2300 RC, Leiden, Netherlands.,Department of Pulmonology, Leiden University Medical Centre, Leiden, PO Box 9600, 2300 RC, Leiden, Netherlands
| | - Niels H Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Centre, PO Box 9600, 2300 RC, Leiden, Netherlands
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Williams MT, Johnston KN, Paquet C. Cognitive Behavioral Therapy for People with Chronic Obstructive Pulmonary Disease: Rapid Review. Int J Chron Obstruct Pulmon Dis 2020; 15:903-919. [PMID: 32425516 PMCID: PMC7186773 DOI: 10.2147/copd.s178049] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Accepted: 02/21/2020] [Indexed: 12/30/2022] Open
Abstract
Cognitive behavioral therapy (CBT) is increasingly recommended in the management of people living with chronic obstructive pulmonary disease (COPD). This rapid review presents the evidence base for CBT for people with COPD and describes 1) the nature of CBT interventions and comparators in controlled trials (high or low resource intensity); and 2) factors influencing intervention effects on health outcomes (anxiety, depression, breathlessness, quality of life and exercise capacity). Primary studies reporting CBT interventions in adults with COPD were identified with data extracted by a single reviewer (20% of studies checked for data accuracy). Studies were synthesized descriptively with meta-analyses (random effects models) of controlled trials undertaken to report mean standardized effect sizes (95% CI) for health outcomes. Random effects meta-regression models explored whether CBT target, intervention dosage, intensity, facilitator profession, delivery mode, clinically significant anxiety/depression, trial design/quality and sample size predicted effect size. The search identified 33 primary studies published between 1996 and 2019 (controlled trials n=24, single group cohort n=6, case exemplars n=2, phenomenological n=1). Controlled trials frequently compared high-intensity CBT interventions against enhanced/usual care (n=12) or high-intensity CBT interventions against high-intensity comparators (n=11). When all controlled studies were included, small, significant improvements favoring CBT were evident across all health outcomes (SMD ranged from -0.27 to 0.35, p<0.05). When intensity dyads were considered, significant improvements were evident only when high-intensity CBT interventions were compared to enhanced usual care/usual care (SMDs ranged from -0.45 to 0.54, p <0.05). No other variable consistently predicted intervention effect sizes across all health outcomes. Overall, the evidence base supports the use of CBT for a range of health outcomes in people with COPD. Consistent benefits were evident when high-resource-intensive CBT interventions were compared to usual care. Low-resource-intensity CBT warrants further investigation in settings where cost of comprehensive care is prohibitive.
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Affiliation(s)
- Marie T Williams
- Innovation, Implementation and Clinical Translation in Health (IIMPACT), School of Health Sciences, University of South Australia, Adelaide, SA 5000, Australia
| | - Kylie N Johnston
- Innovation, Implementation and Clinical Translation in Health (IIMPACT), School of Health Sciences, University of South Australia, Adelaide, SA 5000, Australia
| | - Catherine Paquet
- Australian Centre of Precision Health, School of Health Sciences, University of South Australia, Adelaide, SA 5000, Australia
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50
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O'Donnell DE, Milne KM, James MD, de Torres JP, Neder JA. Dyspnea in COPD: New Mechanistic Insights and Management Implications. Adv Ther 2020; 37:41-60. [PMID: 31673990 PMCID: PMC6979461 DOI: 10.1007/s12325-019-01128-9] [Citation(s) in RCA: 93] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Indexed: 12/29/2022]
Abstract
Dyspnea is the most common symptom experienced by patients with chronic obstructive pulmonary disease (COPD). To avoid exertional dyspnea, many patients adopt a sedentary lifestyle which predictably leads to extensive skeletal muscle deconditioning, social isolation, and its negative psychological sequalae. This "dyspnea spiral" is well documented and it is no surprise that alleviation of this distressing symptom has become a key objective highlighted across COPD guidelines. In reality, this important goal is often difficult to achieve, and successful symptom management awaits a clearer understanding of the underlying mechanisms of dyspnea and how these can be therapeutically manipulated for the patients' benefit. Current theoretical constructs of the origins of activity-related dyspnea generally endorse the classical demand-capacity imbalance theory. Thus, it is believed that disruption of the normally harmonious relationship between inspiratory neural drive (IND) to breathe and the simultaneous dynamic response of the respiratory system fundamentally shapes the expression of respiratory discomfort in COPD. Sadly, the symptom of dyspnea cannot be eliminated in patients with advanced COPD with relatively fixed pathophysiological impairment. However, there is evidence that effective symptom palliation is possible for many. Interventions that reduce IND, without compromising alveolar ventilation (VA), or that improve respiratory mechanics and muscle function, or that address the affective dimension, achieve measurable benefits. A common final pathway of dyspnea relief and improved exercise tolerance across the range of therapeutic interventions (bronchodilators, exercise training, ambulatory oxygen, inspiratory muscle training, and opiate medications) is reduced neuromechanical dissociation of the respiratory system. These interventions, singly and in combination, partially restore more harmonious matching of excessive IND to ventilatory output achieved. In this review we propose, on the basis of a thorough review of the recent literature, that effective dyspnea amelioration requires combined interventions and a structured multidisciplinary approach, carefully tailored to meet the specific needs of the individual.
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Affiliation(s)
- Denis E O'Donnell
- Respiratory Investigation Unit, Division of Respirology, Department of Medicine, Kingston Health Sciences Centre and Queen's University, Kingston, ON, Canada.
| | - Kathryn M Milne
- Respiratory Investigation Unit, Division of Respirology, Department of Medicine, Kingston Health Sciences Centre and Queen's University, Kingston, ON, Canada
- Clinician Investigator Program, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Matthew D James
- Respiratory Investigation Unit, Division of Respirology, Department of Medicine, Kingston Health Sciences Centre and Queen's University, Kingston, ON, Canada
| | - Juan Pablo de Torres
- Division of Respirology, Department of Medicine, Kingston Health Sciences Centre and Queen's University, Kingston, ON, Canada
| | - J Alberto Neder
- Division of Respirology, Department of Medicine, Kingston Health Sciences Centre and Queen's University, Kingston, ON, Canada
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