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Ghanei M, Philip KEJ, Moghadam MRS, Hosseini H, Babaie A, Roustanezhad M, Hopkinson NS. Pulmonary rehabilitation in Iranian outpatients with mustard gas lung disease: a randomised controlled trial. BMJ Open 2024; 14:e083085. [PMID: 38806414 PMCID: PMC11138312 DOI: 10.1136/bmjopen-2023-083085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 05/15/2024] [Indexed: 05/30/2024] Open
Abstract
OBJECTIVE People with mustard gas lung disease experience cough, sputum, breathlessness and exercise limitation. We hypothesised that pulmonary rehabilitation (PR) would be beneficial in this condition. DESIGN An assessor-blind, two-armed, parallel-design randomised controlled clinical trial. SETTING Secondary care clinics in Iran. PARTICIPANTS 60 men with breathlessness due to respiratory disease caused by documented mustard gas exposure, mean (SD) age 52.7 (4.36) years, MRC dyspnoea score 3.5 (0.7), St. George's Respiratory Questionnaire (SGRQ) 72.3 (15.2). INTERVENTIONS Participants were allocated either to a 6-week course of thrice-weekly PR (n=31) or to usual care (n=29), with 6-week data for 28 and 26, respectively. OUTCOME MEASURES Primary endpoint was change in cycle endurance time at 70% baseline exercise capacity at 6 weeks. Secondary endpoints included 6 min walk distance, quadriceps strength and bulk, body composition and health status. For logistical reasons, blood tests that had been originally planned were not performed and 12-month follow-up was available for only a small proportion. RESULTS At 6 weeks, cycle endurance time increased from 377 (140) s to 787 (343) s with PR vs 495 (171) s to 479 (159) s for usual care, effect size +383 (231) s (p<0.001). PR also improved 6 min walk distance+103.2 m (63.6-142.9) (p<0.001), MRC dyspnoea score -0.36 (-0.65 to -0.07) (p=0.016) and quality of life; SGRQ -8.43 (-13.38 to -3.48) p<0.001, as well as quadriceps strength+9.28 Nm (1.89 to 16.66) p=0.015. CONCLUSION These data suggest that PR can improve exercise capacity and quality of life in people with breathlessness due to mustard gas lung disease and support the wider provision of this form of care. TRIAL REGISTRATION NUMBER IRCT2016051127848N1.
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Affiliation(s)
- Mostafa Ghanei
- Chemical Injuries Research Center, Systems Biology and Poisonings Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
| | - Keir E J Philip
- National Heart and Lung Institute, Imperial College London, London, UK
| | | | - Hamed Hosseini
- Clinical Trial Center, Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
| | - Aliakbar Babaie
- Janbazan Medical and Engineering Research Center, Tehran, Iran (the Islamic Republic of)
| | - Mohammad Roustanezhad
- Janbazan Medical and Engineering Research Center, Tehran, Iran (the Islamic Republic of)
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da Silva MMC, Arcuri JF, Di Lorenzo VAP. Individualized, low-cost and accessible pulmonary rehabilitation program based on functional clinical tests for individuals with COPD-a study protocol of a randomized controlled trial. Trials 2021; 22:367. [PMID: 34039406 PMCID: PMC8152053 DOI: 10.1186/s13063-021-05267-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 04/13/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients with chronic obstructive pulmonary disease (COPD) present pulmonary and extrapulmonary impairments. The strategies used to mitigate these impairments are pulmonary rehabilitation programs (PRP). However, there is limited access to PRP in specialized centers and the study of low-cost home rehabilitation programs had non-individualized prescription, which might have led to insignificant positive effects. So, it is important to develop new low-cost protocols that involve individualized prescription, as well as physiotherapist supervision. This study describes an accessible, low-cost, and individualized pulmonary rehabilitation protocol and compare its results when performed with or without a weekly physiotherapist-supervised session on patients with COPD. METHODS This is a descriptive protocol of a clinical trial, randomized, single-blinded, and type of framework is superiority conducted at the Spirometry and Respiratory Physical Therapy Laboratory of the Federal University of São Carlos (UFSCar). The trial is registered in the Brazilian Clinical Trials Registry (ReBec) URL: http://www.ensaiosclinicos.gov.br/rg/RBR-533hht/ with Register Number UTN code U1111-1220-8245. The sample size is 50 patients and is calculated using the results of a pilot study. DISCUSSION-POTENTIAL IMPACT AND SIGNIFICANCE OF THE STUDY It is expected that the low-cost and new supervised rehabilitation program complemented with home exercises will present positive results, especially on exercise capacity, which will make available a more accessible and effective PRP for patients with COPD. TRIAL REGISTRATION ClinicalTrials.gov U1111-1220-8245 . Registered on September 20, 2018.
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Affiliation(s)
- Marcela Maria Carvalho da Silva
- Postgraduate Physiotherapy Department of Federal University of São Carlos, Rodovia Washington Luiz, São Carlos, São Paulo, 13565-905, Brazil.
| | - Juliano Ferreira Arcuri
- Postgraduate Physiotherapy Department of Federal University of São Carlos, Rodovia Washington Luiz, São Carlos, São Paulo, 13565-905, Brazil
| | - Valéria Amorim Pires Di Lorenzo
- Postgraduate Physiotherapy Department of Federal University of São Carlos, Rodovia Washington Luiz, São Carlos, São Paulo, 13565-905, Brazil
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Buttery SC, Zysman M, Vikjord SAA, Hopkinson NS, Jenkins C, Vanfleteren LEGW. Contemporary perspectives in COPD: Patient burden, the role of gender and trajectories of multimorbidity. Respirology 2021; 26:419-441. [PMID: 33751727 DOI: 10.1111/resp.14032] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 02/21/2021] [Indexed: 12/13/2022]
Abstract
An individual's experience of COPD is determined by many factors in addition to the pathological features of chronic bronchitis and emphysema and the symptoms that derive directly from them. Multimorbidity is the norm rather than the exception, so most people with COPD are living with a range of other medical problems which can decrease overall quality of life. COPD is caused by the inhalation of noxious particles or gases, in particular tobacco smoke, but also by early life disadvantage impairing lung development and by occupations where inhaled exposures are common (e.g. industrial, farming and cleaning work). Wealthy people are therefore relatively protected from developing COPD and people who do develop the condition may have reduced resources to cope. COPD is also no longer a condition that predominantly affects men. The prevalence of COPD among women has equalled that of men since 2008 in many high-income countries, due to increased exposure to tobacco, and in low-income countries due to biomass fuels. COPD is one of the leading causes of death in women in the USA, and death rates attributed to COPD in women in some countries are predicted to overtake those of men in the next decade. Many factors contribute to this phenomenon, but in addition to socioeconomic and occupational factors, there is increasing evidence of a higher susceptibility of females to smoking and pollutants. Quality of life is also more significantly impaired in women. Although most medications (bronchodilators and inhaled corticosteroids) used to treat COPD demonstrate similar trends for exacerbation prevention and lung function improvement in men and women, this is an understudied area and clinical trials frequently have a preponderance of males. A better understanding of gender-based predictors of efficacy of all therapeutic interventions is crucial for comprehensive patient care. There is an urgent need to recognize the increasing burden of COPD in women and to facilitate global improvements in disease prevention and management in this specific population. Many individuals with COPD follow a trajectory of both lung function decline and also multimorbidity. Unfavourable lung function trajectories throughout life have implications for later development of other chronic diseases. An enhanced understanding of the temporal associations underlying the development of coexisting diseases is a crucial first step in unravelling potential common disease pathways. Lessons can be learned from exploring disease trajectories of other NCD as well as multimorbidity development. Further research will be essential to explain how early life risk factors commonly influence trajectories of COPD and other diseases, how different diseases develop in relation to each other in a temporal way and how this ultimately leads to different multimorbidity patterns in COPD. This review integrates new knowledge and ideas pertaining to three broad themes (i) the overall burden of disease in COPD, (ii) an unappreciated high burden in women and (iii) the contrast of COPD trajectories and different multimorbidity patterns with trajectories of other NCD. The underlying pathology of COPD is largely irreversible, but many factors noted in the review are potentially amenable to intervention. Health and social care systems need to ensure that effective treatment is accessible to all people with the condition. Preventive strategies and treatments that alter the course of disease are crucial, particularly for patients with COPD as one of many problems.
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Affiliation(s)
- Sara C Buttery
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Maéva Zysman
- Centre de Recherche cardio-thoracique de Bordeaux, Univ-Bordeaux, Pessac, France.,Service des Maladies Respiratoires, CHU Bordeaux, Pessac, France
| | - Sigrid A A Vikjord
- Department of Medicine and Rehabilitation, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway.,HUNT Research Centre, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Levanger, Norway
| | | | - Christine Jenkins
- Respiratory Group, The George Institute for Global Health, Sydney, NSW, Australia
| | - Lowie E G W Vanfleteren
- COPD Center, Department of Respiratory Medicine and Allergology, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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4
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Croghan A, Brunette A, Holm KE, Kozora E, Moser DJ, Wamboldt FS, Meschede K, Make BJ, Crapo JD, Weinberger HD, Moreau KL, Bowler RP, Hoth KF. Reduced Attention in Former Smokers with and without COPD. Int J Behav Med 2019; 26:600-607. [PMID: 31732904 PMCID: PMC7269072 DOI: 10.1007/s12529-019-09826-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Attention difficulties are often reported by patients with chronic obstructive pulmonary disease (COPD); however, limited research exists using objective tests designed specifically to measure attention in this population. This study aimed to (1) identify specific attention deficits in COPD and (2) determine which demographic/clinical characteristics are associated with reduced attention. METHODS Eighty-four former smokers (53 COPD, 31 no COPD) completed questionnaires, pulmonary function testing, and the Conner's Continuous Performance Test II (CPT-II). Participants with and without COPD were compared on CPT-II measures of inattention, impulsivity, and vigilance. CPT-II measures that differed significantly between the two groups were further examined using hierarchical regression modeling. Demographic/clinical characteristics were entered into models with attention as the dependent variable. RESULTS Participants with COPD performed worse than those without COPD on CPT measures of inattention and impulsivity (i.e., detectability [discrimination of target from non-target stimuli], perseverations [reaction time under 100 ms], omissions [target stimuli response failures], and commissions [responses to non-target stimuli]). More severe COPD (measured by greater airflow limitation) was associated with poorer ability to detect targets vs. foils and perseverative responding after adjusting for age and other covariates in the model. CONCLUSION Former smokers with COPD experience problems with attention that go beyond slowed processing speed, including aspects of inattention and impulsivity. Clinicians should be aware that greater airflow limitation and older age are associated with attention difficulties, as this may impact functioning.
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Affiliation(s)
- Anna Croghan
- Department of Psychology, University of North Dakota, Grand Forks, ND, USA
- Department of Psychiatry, University of Iowa Carver College of Medicine, 200 Hawkins Dr., W278GH, Iowa City, IA, 52242, USA
| | - Amanda Brunette
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA, USA
| | - Kristen E Holm
- National Jewish Health, Department of Medicine, Denver, CO, USA
- Colorado School of Public Health, Department of Community and Behavioral Health, Aurora, CO, USA
| | - Elizabeth Kozora
- National Jewish Health, Department of Medicine, Denver, CO, USA
- Department of Psychiatry, University of Colorado School of Medicine at the Anschutz Medical Campus, Aurora, CO, USA
| | - David J Moser
- Department of Psychiatry, University of Iowa Carver College of Medicine, 200 Hawkins Dr., W278GH, Iowa City, IA, 52242, USA
| | - Frederick S Wamboldt
- National Jewish Health, Department of Medicine, Denver, CO, USA
- Department of Psychiatry, University of Colorado School of Medicine at the Anschutz Medical Campus, Aurora, CO, USA
| | | | - Barry J Make
- National Jewish Health, Department of Medicine, Denver, CO, USA
- University of Colorado School of Medicine at the Anschutz Medical Campus, Aurora, CO, USA
| | - James D Crapo
- National Jewish Health, Department of Medicine, Denver, CO, USA
- University of Colorado School of Medicine at the Anschutz Medical Campus, Aurora, CO, USA
| | - Howard D Weinberger
- National Jewish Health, Department of Medicine, Denver, CO, USA
- University of Colorado School of Medicine at the Anschutz Medical Campus, Aurora, CO, USA
| | - Kerrie L Moreau
- University of Colorado School of Medicine at the Anschutz Medical Campus, Aurora, CO, USA
- VA Eastern Colorado Geriatric Research, Education, and Clinical Center Aurora, Denver, CO, USA
| | - Russell P Bowler
- National Jewish Health, Department of Medicine, Denver, CO, USA
- University of Colorado School of Medicine at the Anschutz Medical Campus, Aurora, CO, USA
| | - Karin F Hoth
- Department of Psychiatry, University of Iowa Carver College of Medicine, 200 Hawkins Dr., W278GH, Iowa City, IA, 52242, USA.
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Sedighi Moghadam MR, Ghanei M, Kenn K, Hopkinson NS. Pulmonary rehabilitation in patients with mustard gas lung disease: a study protocol for a randomized controlled trial. Trials 2019; 20:132. [PMID: 30764860 PMCID: PMC6376791 DOI: 10.1186/s13063-019-3180-3] [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: 07/07/2018] [Accepted: 01/05/2019] [Indexed: 11/23/2022] Open
Abstract
Background More than 60,000 people have health problems due to chemical weapons exposure during the Iran–Iraq war. Respiratory consequences of mustard gas exposure are common and disabling; medical interventions have limited effect. Patients complain of cough, sputum, breathlessness and exercise limitation. We hypothesized that patients with this condition would benefit from pulmonary rehabilitation. Methods We outline the protocol for an assessor-blind, two-armed, parallel-design randomized controlled clinical trial (IRCT2016051127848N1). Sixty patients with respiratory disease due to documented sulfur mustard gas exposure will be randomized to either take part in a 6-week pulmonary rehabilitation programme or receive usual care. Inclusion criteria include forced expiratory volume in 1 second < 80% predicted and Medical Research Council dyspnoea score ≥ 3. The primary endpoint will be the change in cycle endurance time at 70% baseline exercise capacity at 6 weeks. Lung function, physical activity, the strength and endurance of the quadriceps muscle, and quality of life will also be compared. Outcomes will be assessed at 6 weeks and 12 months. Health care utilization will also be assessed. Discussion If the study confirms that rehabilitation is effective for patients with mustard gas lung disease this should prompt provision of the intervention to this patient group. Trial registration Iranian Registry of Clinical Trials, IRCT2016051127848N1. Registered on 24 May 2016. Electronic supplementary material The online version of this article (10.1186/s13063-019-3180-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mohamad Reza Sedighi Moghadam
- Janbazan Medical and Engineering Research Centre (JMERC), No 17, Farokh Street, Moghaddas Ardabili Street, Tehran, Iran
| | - Mostafa Ghanei
- Chemical Injuries Center, Systems Biology and Poisonings Institute, Baqiyatallah University of Medical Sciences, Molla Sadra Street, Tehran, Iran.
| | - Klaus Kenn
- Schön Klinik Berchtesgadener Land, Malterhöh 1, 83471, Schönau am Königssee, Germany
| | - Nicholas S Hopkinson
- National Heart and Lung Institute, Imperial College London Faculty of Medicine, Royal Brompton Campus, London, SW3 6NP, UK
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6
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Payne P, Fiering S, Zava D, Gould TJ, Brown A, Hage P, Gaudet C, Crane-Godreau M. Digital Delivery of Meditative Movement Training Improved Health of Cigarette-Smoke-Exposed Subjects. Front Public Health 2018; 6:282. [PMID: 30406067 PMCID: PMC6202937 DOI: 10.3389/fpubh.2018.00282] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 09/12/2018] [Indexed: 12/11/2022] Open
Abstract
Many FA who flew prior to the ban on smoking in commercial aircraft exhibit an unusual pattern of long-term pulmonary dysfunction. This randomized controlled study tested the hypothesis that digitally delivered meditative movement (MM) training improves chronic obstructive pulmonary disease (COPD)-related symptoms in flight attendants (FA) who were exposed to second-hand cigarette smoke (SHCS) while flying. Phase I of this two-phase clinical trial was a single-arm non-randomized pilot study that developed and tested methods for MM intervention; we now report on Phase II, a randomized controlled trial comparing MM to a control group of similar FA receiving health education (HE) videos. Primary outcomes were the 6-min walk test and blood levels of high sensitivity C-reactive protein (hs-CRP). Pulmonary, cardiovascular, autonomic and affective measures were also taken. There were significant improvements in the 6-min walk test, the Multidimensional Assessment of Interoceptive Awareness (MAIA) score, and the COPD Assessment Test. Non-significant trends were observed for increased dehydroepiandrosterone sulfate (DHEAS) levels, decreased anxiety scores and reduced blood hs-CRP levels, and increased peak expiratory flow (PEF). In a Survey Monkey questionnaire, 81% of participants who completed pre and post-testing expressed mild to strong positive opinions of the study contents, delivery, or impact, while 16% expressed mild negative opinions. Over the course of the year including the study, participant adoption of the MM practices showed a significant and moderately large correlation with overall health improvement; Pearson's R = 0.62, p < 0.005. These results support the hypothesized benefits of video-based MM training for this population. No adverse effects were reported. Clinical Trial Registration:www.ClinicalTrials.gov, identifier: NCT02612389
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Affiliation(s)
- Peter Payne
- Department of Microbiology and Immunology, Geisel School of Medicine at Dartmouth, Lebanon, PA, United States
| | - Steven Fiering
- Department of Microbiology and Immunology, Geisel School of Medicine at Dartmouth, Lebanon, PA, United States
| | - David Zava
- ZRT Laboratory, Beaverton, OR, United States
| | - Thomas J Gould
- Department of Biobehavioral Health, Pennsylvania State University, University Park, PA, United States
| | - Anthony Brown
- Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
| | - Paul Hage
- Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
| | - Carole Gaudet
- Department of Microbiology and Immunology, Geisel School of Medicine at Dartmouth, Lebanon, PA, United States
| | - Mardi Crane-Godreau
- Department of Microbiology and Immunology, Geisel School of Medicine at Dartmouth, Lebanon, PA, United States
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Vasileiadis IE, Goudis CA, Giannakopoulou PT, Liu T. Angiotensin Converting Enzyme Inhibitors and Angiotensin Receptor Blockers: A Promising Medication for Chronic Obstructive Pulmonary Disease? COPD 2018. [PMID: 29521545 DOI: 10.1080/15412555.2018.1432034] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is a complex disorder that primarily affects the lungs and is characterized not only by local pulmonary, but also by systemic inflammation which promotes the development of extrapulmonary and cardiovascular co-morbidities. Angiotensin converting enzyme (ACE) inhibitors and ARBs (angiotensin receptor blockers) are widely used drugs in the treatment of cardiovascular diseases, with growing evidence suggesting potential benefits in COPD patients. The purpose of this review is to describe the correlation of renin-angiotensin system (RAS) with COPD pathophysiology and to present the latest data regarding the potential role of RAS blockers in COPD.
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Affiliation(s)
- Ioannis E Vasileiadis
- a Department of Cardiology , General Hospital of Thessaloniki G. Papanikolaou , Thessaloniki , Greece
| | - Christos A Goudis
- b Department of Cardiology , General Hospital of Serres , Serres , Greece
| | - Pinelopi T Giannakopoulou
- a Department of Cardiology , General Hospital of Thessaloniki G. Papanikolaou , Thessaloniki , Greece
| | - Tong Liu
- c Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology , Second Hospital of Tianjin Medical University , Tianjin , People's Republic of China
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Curtis KJ, Meyrick VM, Mehta B, Haji GS, Li K, Montgomery H, Man WDC, Polkey MI, Hopkinson NS. Angiotensin-Converting Enzyme Inhibition as an Adjunct to Pulmonary Rehabilitation in Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med 2017; 194:1349-1357. [PMID: 27248440 DOI: 10.1164/rccm.201601-0094oc] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
RATIONALE Epidemiological studies in older individuals have found an association between the use of angiotensin-converting enzyme (ACE) inhibition (ACE-I) therapy and preserved locomotor muscle mass, strength, and walking speed. ACE-I therapy might therefore have a role in the context of pulmonary rehabilitation (PR). OBJECTIVES To investigate the hypothesis that enalapril, an ACE inhibitor, would augment the improvement in exercise capacity seen during PR. METHODS We performed a double-blind, placebo-controlled, parallel-group randomized controlled trial. Patients with chronic obstructive pulmonary disease, who had at least moderate airflow obstruction and were taking part in PR, were randomized to either 10 weeks of therapy with an ACE inhibitor (10 mg enalapril) or placebo. MEASUREMENTS AND MAIN RESULTS The primary outcome measurement was the change in peak power (assessed using cycle ergometry) from baseline. Eighty patients were enrolled, 78 were randomized (age 67 ± 8 years; FEV1 48 ± 21% predicted), and 65 completed the trial (34 on placebo, 31 on the ACE inhibitor). The ACE inhibitor-treated group demonstrated a significant reduction in systolic blood pressure (Δ, -16 mm Hg; 95% confidence interval [CI], -22 to -11) and serum ACE activity (Δ, -18 IU/L; 95% CI, -23 to -12) versus placebo (between-group differences, P < 0.0001). Peak power increased significantly more in the placebo group (placebo Δ, +9 W; 95% CI, 5 to 13 vs. ACE-I Δ, +1 W; 95% CI, -2 to 4; between-group difference, 8 W; 95% CI, 3 to 13; P = 0.001). There was no significant between-group difference in quadriceps strength or health-related quality of life. CONCLUSIONS Use of the ACE inhibitor enalapril, together with a program of PR, in patients without an established indication for ACE-I, reduced the peak work rate response to exercise training in patients with chronic obstructive pulmonary disease.
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Affiliation(s)
- Katrina J Curtis
- 1 National Institute for Health Research Respiratory Biomedical Research Unit, Royal Brompton & Harefield NHS Trust and Imperial College, London, United Kingdom
| | - Victoria M Meyrick
- 1 National Institute for Health Research Respiratory Biomedical Research Unit, Royal Brompton & Harefield NHS Trust and Imperial College, London, United Kingdom.,2 Department of Respiratory Medicine, King's College London NHS Foundation Trust, London, United Kingdom
| | - Bhavin Mehta
- 1 National Institute for Health Research Respiratory Biomedical Research Unit, Royal Brompton & Harefield NHS Trust and Imperial College, London, United Kingdom
| | - Gulam S Haji
- 1 National Institute for Health Research Respiratory Biomedical Research Unit, Royal Brompton & Harefield NHS Trust and Imperial College, London, United Kingdom
| | - Kawah Li
- 3 Institute for Sport, Exercise and Health, University College London, London, United Kingdom; and
| | - Hugh Montgomery
- 3 Institute for Sport, Exercise and Health, University College London, London, United Kingdom; and
| | - William D-C Man
- 1 National Institute for Health Research Respiratory Biomedical Research Unit, Royal Brompton & Harefield NHS Trust and Imperial College, London, United Kingdom.,4 Harefield Pulmonary Rehabilitation Unit, Harefield Hospital, London, United Kingdom
| | - Michael I Polkey
- 1 National Institute for Health Research Respiratory Biomedical Research Unit, Royal Brompton & Harefield NHS Trust and Imperial College, London, United Kingdom
| | - Nicholas S Hopkinson
- 1 National Institute for Health Research Respiratory Biomedical Research Unit, Royal Brompton & Harefield NHS Trust and Imperial College, London, United Kingdom
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Kon SSC, Jolley CJ, Shrikrishna D, Montgomery HE, Skipworth JRA, Puthucheary Z, Moxham J, Polkey MI, Man WDC, Hopkinson NS. ACE and response to pulmonary rehabilitation in COPD: two observational studies. BMJ Open Respir Res 2017; 4:e000165. [PMID: 28321311 PMCID: PMC5353252 DOI: 10.1136/bmjresp-2016-000165] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 12/13/2016] [Accepted: 01/13/2017] [Indexed: 01/17/2023] Open
Abstract
Introduction Skeletal muscle impairment is an important feature of chronic obstructive pulmonary disease (COPD). Renin–angiotensin system activity influences muscle phenotype, so we wished to investigate whether it affects the response to pulmonary rehabilitation. Methods Two studies are described; in the first, the response of 168 COPD patients (mean forced expiratory volume in one second 51.9% predicted) to pulmonary rehabilitation was compared between different ACE insertion/deletion polymorphism genotypes. In a second, independent COPD cohort (n=373), baseline characteristics and response to pulmonary rehabilitation were compared between COPD patients who were or were not taking ACE inhibitors or angiotensin receptor antagonists (ARB). Results In study 1, the incremental shuttle walk distance improved to a similar extent in all three genotypes; DD/ID/II (n=48/91/29) 69(67)m, 61 (76)m and 78 (78)m, respectively, (p>0.05). In study 2, fat free mass index was higher in those on ACE-I/ARB (n=130) than those who were not (n=243), 17.8 (16.0, 19.8) kg m−2 vs 16.5 (14.9, 18.4) kg/m2 (p<0.001). However change in fat free mass, walking distance or quality of life in response to pulmonary rehabilitation did not differ between groups. Conclusions While these data support a positive association of ACE-I/ARB treatment and body composition in COPD, neither treatment to reduce ACE activity nor ACE (I/D) genotype influence response to pulmonary rehabilitation.
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Affiliation(s)
- Samantha S C Kon
- NIHR Respiratory Biomedical Research Unit , Royal Brompton and Harefield NHS Foundation Trust and Imperial College , London , UK
| | - Caroline J Jolley
- Department of Respiratory Medicine , King's College Hospital , London , UK
| | - Dinesh Shrikrishna
- NIHR Respiratory Biomedical Research Unit , Royal Brompton and Harefield NHS Foundation Trust and Imperial College , London , UK
| | - Hugh E Montgomery
- Institute for Human Health and Performance University College , London , UK
| | | | - Zudin Puthucheary
- Department of Respiratory Medicine , King's College Hospital , London , UK
| | - John Moxham
- NIHR Respiratory Biomedical Research Unit , Royal Brompton and Harefield NHS Foundation Trust and Imperial College , London , UK
| | - Michael I Polkey
- NIHR Respiratory Biomedical Research Unit , Royal Brompton and Harefield NHS Foundation Trust and Imperial College , London , UK
| | - William D-C Man
- NIHR Respiratory Biomedical Research Unit , Royal Brompton and Harefield NHS Foundation Trust and Imperial College , London , UK
| | - Nicholas S Hopkinson
- NIHR Respiratory Biomedical Research Unit , Royal Brompton and Harefield NHS Foundation Trust and Imperial College , London , UK
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10
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Payne P, Fiering S, Leiter JC, Zava DT, Crane-Godreau MA. Effectiveness of a Novel Qigong Meditative Movement Practice for Impaired Health in Flight Attendants Exposed to Second-Hand Cigarette Smoke. Front Hum Neurosci 2017; 11:67. [PMID: 28270757 PMCID: PMC5318411 DOI: 10.3389/fnhum.2017.00067] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Accepted: 02/01/2017] [Indexed: 12/12/2022] Open
Abstract
This single-arm non-randomized pilot study explores an intervention to improve the health of flight attendants (FA) exposed to second-hand cigarette smoke prior to the smoking ban on commercial airlines. This group exhibits an unusual pattern of long-term pulmonary dysfunction. We report on Phase I of a two-phase clinical trial; the second Phase will be a randomized controlled trial testing digital delivery of the intervention. Subjects were recruited in the Northeastern US; testing and intervention were administered in 4 major cities. The intervention involved 12 h of training in Meditative Movement practices. Based on recent research on the effects of nicotine on fear learning, and the influence of the autonomic nervous system on immune function, our hypothesis was that this training would improve autonomic function and thus benefit a range of health measures. Primary outcomes were the 6-min walk test and blood levels of C-reactive protein. Pulmonary, cardiovascular, autonomic, and affective measures were also taken. Fourteen participants completed the training and post-testing. There was a 53% decrease in high sensitivity C-Reactive Protein (p ≤ 0.05), a 7% reduction in systolic blood pressure (p ≤ 0.05), a 13% increase in the 6-min walk test (p ≤ 0.005), and significant positive changes in several other outcomes. These results tend to confirm the hypothesized benefits of MM training for this population, and indicate that autonomic function may be important in the etiology and treatment of their symptoms. No adverse effects were reported. This trial is registered at ClinicalTrials.gov (https://clinicaltrials.gov/ct2/show/NCT02612389/), and is supported by a grant from the Flight Attendant Medical Research Institute (FAMRI).
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Affiliation(s)
- Peter Payne
- Department of Microbiology and Immunology, Geisel School of Medicine at Dartmouth Lebanon, NH, USA
| | - Steven Fiering
- Department of Microbiology and Immunology, Geisel School of Medicine at Dartmouth Lebanon, NH, USA
| | - James C Leiter
- Department of Molecular and System Biology, Geisel School of Medicine at Dartmouth Lebanon, NH, USA
| | | | - Mardi A Crane-Godreau
- Department of Microbiology and Immunology, Geisel School of Medicine at Dartmouth Lebanon, NH, USA
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Cleutjens FA, Franssen FM, Spruit MA, Vanfleteren LE, Gijsen C, Dijkstra JB, Ponds RW, Wouters EF, Janssen DJ. Domain-specific cognitive impairment in patients with COPD and control subjects. Int J Chron Obstruct Pulmon Dis 2016; 12:1-11. [PMID: 28031706 PMCID: PMC5182042 DOI: 10.2147/copd.s119633] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Impaired cognitive function is increasingly recognized in COPD. Yet, the prevalence of cognitive impairment in specific cognitive domains in COPD has been poorly studied. The aim of this cross-sectional observational study was to compare the prevalence of domain-specific cognitive impairment between patients with COPD and non-COPD controls. A neuropsychological assessment was administered in 90 stable COPD patients and 90 non-COPD controls with comparable smoking status, age, and level of education. Six core tests from the Maastricht Aging Study were used to assess general cognitive impairment. By using Z-scores, compound scores were constructed for the following domains: psychomotor speed, planning, working memory, verbal memory, and cognitive flexibility. General cognitive impairment and domain-specific cognitive impairment were compared between COPD patients and controls after correction for comorbidities using multivariate linear and logistic regression models. General cognitive impairment was found in 56.7% of patients with COPD and in 13.3% of controls. Deficits in the following domains were more often present in patients with COPD after correction for comorbidities: psychomotor speed (17.8% vs 3.3%; P<0.001), planning (17.8% vs 1.1%; P<0.001), and cognitive flexibility (43.3% vs 12.2%; P<0.001). General cognitive impairment and impairments in the domains psychomotor speed, planning, and cognitive flexibility affect the COPD patients more than their matched controls.
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Affiliation(s)
- Fiona Ahm Cleutjens
- Department of Research and Education, CIRO, Centre of Expertise for Chronic Organ Failure, Horn
| | - Frits Me Franssen
- Department of Research and Education, CIRO, Centre of Expertise for Chronic Organ Failure, Horn
| | - Martijn A Spruit
- Department of Research and Education, CIRO, Centre of Expertise for Chronic Organ Failure, Horn
| | - Lowie Egw Vanfleteren
- Department of Research and Education, CIRO, Centre of Expertise for Chronic Organ Failure, Horn
| | - Candy Gijsen
- Department of Research and Education, CIRO, Centre of Expertise for Chronic Organ Failure, Horn
| | - Jeanette B Dijkstra
- Department of Medical Psychology, Maastricht UMC+/School for Mental Health and Neurosciences (MHeNS)
| | - Rudolf Whm Ponds
- Department of Medical Psychology, Maastricht UMC+/School for Mental Health and Neurosciences (MHeNS)
| | - Emiel Fm Wouters
- Department of Research and Education, CIRO, Centre of Expertise for Chronic Organ Failure, Horn; Department of Respiratory Medicine, Maastricht UMC+, Maastricht, the Netherlands
| | - Daisy Ja Janssen
- Department of Research and Education, CIRO, Centre of Expertise for Chronic Organ Failure, Horn
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12
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Vasquez A, Logomarsino JV. Anemia in Chronic Obstructive Pulmonary Disease and the Potential Role of Iron Deficiency. COPD 2015; 13:100-9. [PMID: 26418826 DOI: 10.3109/15412555.2015.1043519] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The purpose of this review is to evaluate the role of anemia on patient outcomes in chronic obstructive pulmonary disease (COPD), the potential contribution that low iron stores may play in this process, and possible treatment considerations. A review of research studies found that anemia is associated with declining functional outcomes, increased health care utilization and costs, and increased mortality in COPD. Associations exist between reduced iron intake and progression of COPD and in reduction of iron status with declining lung function. Currently data are limited on the effects of either treating anemia or utilizing iron supplementation in anemic COPD patients. If iron supplementation might therefore reverse some of the declines that patients experience, then routine screening and treatment may turn out to be an effective, simple and inexpensive intervention. Iron supplementation models utilized in other inflammatory-related disease states were reviewed as a possible starting point to evaluate treatment options in COPD. Future research can be directed to establish best practice standards for the use of iron supplementation in COPD.
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Affiliation(s)
- Amber Vasquez
- a Central Michigan University , Mount Pleasant , Michigan , USA
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13
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Shrikrishna D, Tanner RJ, Lee JY, Natanek A, Lewis A, Murphy PB, Hart N, Moxham J, Montgomery HE, Kemp PR, Polkey MI, Hopkinson NS. A randomized controlled trial of angiotensin-converting enzyme inhibition for skeletal muscle dysfunction in COPD. Chest 2014; 146:932-940. [PMID: 24556825 PMCID: PMC4188149 DOI: 10.1378/chest.13-2483] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Skeletal muscle impairment is a recognized complication of COPD, predicting mortality in severe disease. Increasing evidence implicates the renin-angiotensin system in control of muscle phenotype. We hypothesized that angiotensin-converting enzyme (ACE) inhibition would improve quadriceps function and exercise performance in COPD. METHODS This double-blind, randomized placebo-controlled trial investigated the effect of the ACE inhibitor, fosinopril, on quadriceps function in patients with COPD with quadriceps weakness. Primary outcomes were change in quadriceps endurance and atrophy signaling at 3 months. Quadriceps maximum voluntary contraction (QMVC), mid-thigh CT scan of the cross-sectional area (MTCSA), and incremental shuttle walk distance (ISWD) were secondary outcomes. RESULTS Eighty patients were enrolled (mean [SD], 65 [8] years, FEV1 43% [21%] predicted, 53% men). Sixty-seven patients (31 fosinopril, 36 placebo) completed the trial. The treatment group demonstrated a significant reduction in systolic BP (Δ-10.5 mm Hg; 95% CI, -19.9 to -1.1; P = .03) and serum ACE activity (Δ-20.4 IU/L; 95% CI, -31.0 to -9.8; P < .001) compared with placebo. No significant between-group differences were observed in the primary end points of quadriceps endurance half-time (Δ0.5 s; 95% CI, -13.3-14.3; P = .94) or atrogin-1 messenger RNA expression (Δ-0.03 arbitrary units; 95% CI, -0.32-0.26; P = .84). QMVC improved in both groups (fosinopril: Δ1.1 kg; 95% CI, 0.03-2.2; P = .045 vs placebo: Δ3.6 kg; 95% CI, 2.1-5.0; P < .0001) with a greater increase in the placebo arm (between-group, P = .009). No change was shown in the MTCSA (P = .09) or ISWD (P = .51). CONCLUSIONS This randomized controlled trial found that ACE inhibition, using fosinopril for 3 months, did not improve quadriceps function or exercise performance in patients with COPD with quadriceps weakness. TRIAL REGISTRY Current Controlled Trials; No.: ISRCTN05581879; URL: www.controlled-trials.com.
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Affiliation(s)
- Dinesh Shrikrishna
- National Heart & Lung Institute (NHLI), NIHR Respiratory Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust and Imperial College London, University College London, London, England; Molecular Medicine Section, National Heart & Lung Institute (NHLI), Imperial College London, University College London, London, England
| | - Rebecca J Tanner
- National Heart & Lung Institute (NHLI), NIHR Respiratory Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust and Imperial College London, University College London, London, England
| | - Jen Y Lee
- Molecular Medicine Section, National Heart & Lung Institute (NHLI), Imperial College London, University College London, London, England
| | - Amanda Natanek
- National Heart & Lung Institute (NHLI), NIHR Respiratory Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust and Imperial College London, University College London, London, England; Molecular Medicine Section, National Heart & Lung Institute (NHLI), Imperial College London, University College London, London, England
| | - Amy Lewis
- Molecular Medicine Section, National Heart & Lung Institute (NHLI), Imperial College London, University College London, London, England
| | - Patrick B Murphy
- Guy's and St. Thomas' NHS Foundation Trust and NIHR Comprehensive Biomedical Research Centre and Department of Asthma, Allergy &, University College London, London, England
| | - Nicholas Hart
- Guy's and St. Thomas' NHS Foundation Trust and NIHR Comprehensive Biomedical Research Centre and Department of Asthma, Allergy &, University College London, London, England
| | - John Moxham
- Respiratory Science, Division of Asthma, Allergy and Lung Biology, King's College London, University College London, London, England
| | - Hugh E Montgomery
- Institute for Human Health and Performance, University College London, London, England
| | - Paul R Kemp
- Molecular Medicine Section, National Heart & Lung Institute (NHLI), Imperial College London, University College London, London, England
| | - Michael I Polkey
- National Heart & Lung Institute (NHLI), NIHR Respiratory Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust and Imperial College London, University College London, London, England
| | - Nicholas S Hopkinson
- National Heart & Lung Institute (NHLI), NIHR Respiratory Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust and Imperial College London, University College London, London, England.
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14
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Maddocks M, Shrikrishna D, Vitoriano S, Natanek SA, Tanner RJ, Hart N, Kemp PR, Moxham J, Polkey MI, Hopkinson NS. Skeletal muscle adiposity is associated with physical activity, exercise capacity and fibre shift in COPD. Eur Respir J 2014; 44:1188-98. [PMID: 24993908 PMCID: PMC4216454 DOI: 10.1183/09031936.00066414] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Quadriceps muscle phenotype varies widely between patients with chronic obstructive pulmonary disease (COPD) and cannot be determined without muscle biopsy. We hypothesised that measures of skeletal muscle adiposity could provide noninvasive biomarkers of muscle quality in this population. In 101 patients and 10 age-matched healthy controls, mid-thigh cross-sectional area, percentage intramuscular fat and skeletal muscle attenuation were calculated using computed tomography images and standard tissue attenuation ranges: fat -190- -30 HU; skeletal muscle -29-150 HU. Mean±sd percentage intramuscular fat was higher in the patient group (6.7±3.5% versus 4.3±1.2%, p = 0.03). Both percentage intramuscular fat and skeletal muscle attenuation were associated with physical activity level, exercise capacity and type I fibre proportion, independent of age, mid-thigh cross-sectional area and quadriceps strength. Combined with transfer factor of the lung for carbon monoxide, these variables could identify >80% of patients with fibre type shift with >65% specificity (area under the curve 0.83, 95% CI 0.72-0.95). Skeletal muscle adiposity assessed by computed tomography reflects multiple aspects of COPD related muscle dysfunction and may help to identify patients for trials of interventions targeted at specific muscle phenotypes.
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Affiliation(s)
- Matthew Maddocks
- Dept of Palliative Care, Policy and Rehabilitation, King's College London, London, UK Dept of Asthma, Allergy and Lung Biology, King's College London, London, UK Both authors contributed equally
| | - Dinesh Shrikrishna
- National Heart and Lung Institute, NIHR Respiratory Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust and Imperial College, London, UK Both authors contributed equally
| | - Simone Vitoriano
- Dept of Palliative Care, Policy and Rehabilitation, King's College London, London, UK Dept of Asthma, Allergy and Lung Biology, King's College London, London, UK
| | - Samantha A Natanek
- National Heart and Lung Institute, NIHR Respiratory Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust and Imperial College, London, UK
| | - Rebecca J Tanner
- National Heart and Lung Institute, NIHR Respiratory Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust and Imperial College, London, UK
| | - Nicholas Hart
- NIHR Comprehensive Biomedical Research Centre, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK
| | - Paul R Kemp
- National Heart and Lung Institute, NIHR Respiratory Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust and Imperial College, London, UK
| | - John Moxham
- Dept of Palliative Care, Policy and Rehabilitation, King's College London, London, UK Dept of Asthma, Allergy and Lung Biology, King's College London, London, UK
| | - Michael I Polkey
- National Heart and Lung Institute, NIHR Respiratory Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust and Imperial College, London, UK
| | - Nicholas S Hopkinson
- National Heart and Lung Institute, NIHR Respiratory Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust and Imperial College, London, UK
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15
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Clark SJ, Zoumot Z, Bamsey O, Polkey MI, Dusmet M, Lim E, Jordan S, Hopkinson NS. Surgical approaches for lung volume reduction in emphysema. Clin Med (Lond) 2014; 14:122-7. [PMID: 24715121 PMCID: PMC4953281 DOI: 10.7861/clinmedicine.14-2-122] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Lung volume reduction surgery (LVRS) for chronic obstructive pulmonary disease (COPD) is recommended in both British and international guidelines because trials have shown improvement in survival in selected patients with poor baseline exercise capacity and upper lobe-predominant emphysema. Despite this, few procedures are carried out, possibly because of historical concerns about high levels of morbidity and mortality associated with the operation. The authors reviewed data on lung volume reduction procedures at their institution between January 2000 and September 2012. There were no deaths within 90 days of unilateral LVRS (n = 81), bullectomy (n = 20) or intracavity drainage procedures (n = 14). These data suggest that concerns about surgical mortality should not discourage LVRS in selected patients with COPD, provided that it is undertaken within a multidisciplinary team environment involving appropriate patient selection.
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Affiliation(s)
- Samuel J Clark
- NIHR Respiratory Biomedical Research Unit at Royal Brompton and Harefield NHS Foundation Trust and Imperial College London, UK
| | - Zaid Zoumot
- NIHR Respiratory Biomedical Research Unit at Royal Brompton and Harefield NHS Foundation Trust and Imperial College London, UK
| | - Olivia Bamsey
- NIHR Respiratory Biomedical Research Unit at Royal Brompton and Harefield NHS Foundation Trust and Imperial College London, UK
| | - Michael I Polkey
- NIHR Respiratory Biomedical Research Unit at Royal Brompton and Harefield NHS Foundation Trust and Imperial College London, UK
| | - Michael Dusmet
- NIHR Respiratory Biomedical Research Unit at Royal Brompton and Harefield NHS Foundation Trust and Imperial College London, UK
| | - Eric Lim
- NIHR Respiratory Biomedical Research Unit at Royal Brompton and Harefield NHS Foundation Trust and Imperial College London, UK
| | - Simon Jordan
- NIHR Respiratory Biomedical Research Unit at Royal Brompton and Harefield NHS Foundation Trust and Imperial College London, UK
| | - Nicholas S Hopkinson
- NIHR Respiratory Biomedical Research Unit at Royal Brompton and Harefield NHS Foundation Trust and Imperial College London, UK
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16
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Choudhury G, Rabinovich R, MacNee W. Comorbidities and Systemic Effects of Chronic Obstructive Pulmonary Disease. Clin Chest Med 2014; 35:101-30. [DOI: 10.1016/j.ccm.2013.10.007] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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17
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Mendoza L, Gogali A, Shrikrishna D, Cavada G, Kemp SV, Natanek SA, Jackson AS, Polkey MI, Wells AU, Hopkinson NS. Quadriceps strength and endurance in fibrotic idiopathic interstitial pneumonia. Respirology 2013; 19:138-43. [DOI: 10.1111/resp.12181] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2012] [Revised: 07/04/2013] [Accepted: 08/03/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Laura Mendoza
- Hospital Clínico; Universidad de Chile; Santiago Chile
- National Institute for Health Research Respiratory Biomedical Research Unit; Royal Brompton and Harefield NHS Foundation Trust and Imperial College; London UK
| | - Athena Gogali
- National Institute for Health Research Respiratory Biomedical Research Unit; Royal Brompton and Harefield NHS Foundation Trust and Imperial College; London UK
| | - Dinesh Shrikrishna
- National Institute for Health Research Respiratory Biomedical Research Unit; Royal Brompton and Harefield NHS Foundation Trust and Imperial College; London UK
| | - Gabriel Cavada
- Escuela de Salud Pública; Universidad de Chile; Santiago Chile
| | - Samuel V. Kemp
- National Institute for Health Research Respiratory Biomedical Research Unit; Royal Brompton and Harefield NHS Foundation Trust and Imperial College; London UK
| | - Samantha A. Natanek
- National Institute for Health Research Respiratory Biomedical Research Unit; Royal Brompton and Harefield NHS Foundation Trust and Imperial College; London UK
| | - Abigail S. Jackson
- National Institute for Health Research Respiratory Biomedical Research Unit; Royal Brompton and Harefield NHS Foundation Trust and Imperial College; London UK
| | - Michael I. Polkey
- National Institute for Health Research Respiratory Biomedical Research Unit; Royal Brompton and Harefield NHS Foundation Trust and Imperial College; London UK
| | - Athol U. Wells
- National Institute for Health Research Respiratory Biomedical Research Unit; Royal Brompton and Harefield NHS Foundation Trust and Imperial College; London UK
| | - Nicholas S. Hopkinson
- National Institute for Health Research Respiratory Biomedical Research Unit; Royal Brompton and Harefield NHS Foundation Trust and Imperial College; London UK
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18
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Natanek SA, Gosker HR, Slot IG, Marsh GS, Hopkinson NS, Man WDC, Tal-Singer R, Moxham J, Kemp PR, Schols AM, Polkey MI. Heterogeneity of quadriceps muscle phenotype in chronic obstructive pulmonary disease (Copd); implications for stratified medicine? Muscle Nerve 2013; 48:488-97. [DOI: 10.1002/mus.23784] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2013] [Indexed: 02/01/2023]
Affiliation(s)
- Samantha A. Natanek
- NIHR Respiratory Biomedical Research Unit of the Royal Brompton; and Harefield NHS Foundation Trust and Imperial College London; London SW3 6NP United Kingdom
- Department of Respiratory Medicine; NUTRIM School for Nutrition, Toxicology & Metabolism, Maastricht University Medical Centre; AZ Maastricht Netherlands
- Molecular Medicine Section; National Heart & Lung Institute; Imperial College London, South Kensington Campus; London United Kingdom
| | - Harry R. Gosker
- Molecular Medicine Section; National Heart & Lung Institute; Imperial College London, South Kensington Campus; London United Kingdom
| | - Ilse G.M. Slot
- Molecular Medicine Section; National Heart & Lung Institute; Imperial College London, South Kensington Campus; London United Kingdom
| | - Gemma S. Marsh
- NIHR Respiratory Biomedical Research Unit of the Royal Brompton; and Harefield NHS Foundation Trust and Imperial College London; London SW3 6NP United Kingdom
| | - Nicholas S. Hopkinson
- NIHR Respiratory Biomedical Research Unit of the Royal Brompton; and Harefield NHS Foundation Trust and Imperial College London; London SW3 6NP United Kingdom
| | - William D.-C. Man
- NIHR Respiratory Biomedical Research Unit of the Royal Brompton; and Harefield NHS Foundation Trust and Imperial College London; London SW3 6NP United Kingdom
| | - Ruth Tal-Singer
- Department of Respiratory Medicine; Denmark Hill Campus, GKT School of Medicine; Bessemer Road London United Kingdom
| | - John Moxham
- GlaxoSmithKline; King of Prussia; Pennsylvania USA
| | - Paul R. Kemp
- Department of Respiratory Medicine; NUTRIM School for Nutrition, Toxicology & Metabolism, Maastricht University Medical Centre; AZ Maastricht Netherlands
| | - Annemie M.W.J. Schols
- Molecular Medicine Section; National Heart & Lung Institute; Imperial College London, South Kensington Campus; London United Kingdom
| | - Michael I. Polkey
- NIHR Respiratory Biomedical Research Unit of the Royal Brompton; and Harefield NHS Foundation Trust and Imperial College London; London SW3 6NP United Kingdom
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19
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Boutou AK, Shrikrishna D, Tanner RJ, Smith C, Kelly JL, Ward SP, Polkey MI, Hopkinson NS. Lung function indices for predicting mortality in COPD. Eur Respir J 2013; 42:616-25. [PMID: 23349449 PMCID: PMC3759303 DOI: 10.1183/09031936.00146012] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Chronic obstructive pulmonary disease (COPD) is characterised by high morbidity and mortality. It remains unknown which aspect of lung function carries the most prognostic information and if simple spirometry is sufficient. Survival was assessed in COPD outpatients whose data had been added prospectively to a clinical audit database from the point of first full lung function testing including spirometry, lung volumes, gas transfer and arterial blood gases. Variables univariately associated with survival were entered into a multivariate Cox proportional hazard model. 604 patients were included (mean±sd age 61.9±9.7 years; forced expiratory volume in 1 s 37±18.1% predicted; 62.9% males); 229 (37.9%) died during a median follow-up of 83 months. Median survival was 91.9 (95% CI 80.8–103) months with survival rates at 3 and 5 years 0.83 and 0.66, respectively. Carbon monoxide transfer factor % pred quartiles (best quartile (>51%): HR 0.33, 95% CI 0.172–0.639; and second quartile (51–37.3%): HR 0.52, 95% CI 0.322–0.825; versus lowest quartile (<27.9%)), age (HR 1.04, 95% CI 1.02–1.06) and arterial oxygen partial pressure (HR 0.85, 95% CI 0.77–0.94) were the only parameters independently associated with mortality. Measurement of gas transfer provides additional prognostic information compared to spirometry in patients under hospital follow-up and could be considered routinely. Transfer factor not GOLD stage is the most powerful predictor of survival in patients with COPDhttp://ow.ly/mGmjG
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Affiliation(s)
- Afroditi K Boutou
- NIHR Respiratory Biomedical Research Unit at Royal Brompton and Harefield NHS Foundation Trust and Imperial College, London, UK
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20
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Kelly JL, Elkin SL, Fluxman J, Polkey MI, Soljak MA, Hopkinson NS. Breathlessness and skeletal muscle weakness in patients undergoing lung health screening in primary care. COPD 2012; 10:40-54. [PMID: 23272667 DOI: 10.3109/15412555.2012.727923] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Earlier diagnosis of COPD is a major public health challenge as symptoms may be attributed to the normal consequences of aging. The optimum strategy for identifying patients with COPD remains to be determined. People aged 35 and over (n = 1896) on a GP practice register were randomised to either invitation or an opportunistic lung health check which included spirometry, quadriceps strength and MRC dyspnoea score. Then, 101 participants subsequently completed the General Practice Physical Activity Questionnaire. A total of 335 attended over a 15-week period; 156 were in the invitation group and 179 from the opportunist group. In 25 persons, spirometry was unsatisfactory or contraindicated. Spirometry was normal in 204(65.8%) and restrictive in 36(11.6%). 70(22.6%) had airflow obstruction, corresponding to Global Initiative for Chronic Lung Disease (GOLD) stages I-IV in 18(5.8%), 35(11.3%), 14(4.5%) and 3(1.0%), respectively. The opportunist group were significantly more likely to have airflow obstruction 30.1% vs 14.3% (p = 0.001). Breathlessness was reported commonly (40.5%) and quadriceps strength correlated significantly with MRC dyspnoea score independent of age, sex, pack-years smoked, fat-free mass and FEV(1) percent predicted. This relationship was also present in the subgroup of healthy participants (n = 143). 51.5% of participants screened were classified as "inactive" and this group were weaker and more breathless than those who were more active. Airflow obstruction was more common in those screened opportunistically. Breathlessness and inactivity are common in patients taking part in spirometry screening. Breathlessness is significantly associated with leg strength independent of spirometry and should be amenable to interventions to increase physical activity.
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Affiliation(s)
- Julia L Kelly
- NIHR Respiratory Biomedical Research Unit at Royal Brompton and Harefield NHS Foundation Trust and, Imperial College, London, Royal Brompton Hospital, London, United Kingdom
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21
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Renin-angiotensin system blockade: a novel therapeutic approach in chronic obstructive pulmonary disease. Clin Sci (Lond) 2012; 123:487-98. [PMID: 22757959 DOI: 10.1042/cs20120081] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
ACE (angiotensin-converting enzyme) inhibitors and ARBs (angiotensin II receptor blockers) are already widely used for the treatment and prevention of cardiovascular disease and their potential role in other disease states has become increasingly recognized. COPD (chronic obstructive pulmonary disease) is characterized by pathological inflammatory processes involving the lung parenchyma, airways and vascular bed. The aim of the present review is to outline the role of the RAS (renin-angiotensin system) in the pathogenesis of COPD, including reference to results from fibrotic lung conditions and pulmonary hypertension. The review will, in particular, address the emerging evidence that ACE inhibition could have a beneficial effect on skeletal muscle function and cardiovascular co-morbidity in COPD patients. The evidence to support the effect of RAS blockade as a novel therapeutic approach in COPD will be discussed.
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